Antioxidant, Final irrigant, Microhardness alteration, Smear layer removal
Citation Information :
Idayadullah A, Thangaraj DN, Saravanan S, Mathew S, Kumaravadivel K, Thangavel B. Comparative Evaluation of Two Different Antioxidants on Smear Layer Removal and Microhardness of Root Dentin: An In Vitro Study. World J Dent 2023; 14 (10):888-893.
Aim: The aim of this study was to evaluate the smear layer removal and microhardness alteration potential of two different antioxidants as final irrigants on root dentin.
Materials and methods: The study aimed to investigate the effects of different irrigants on smear layer removal and microhardness alteration in 90 single-rooted mandibular premolars that were decoronated and instrumented till F2 using ProTaper Gold rotary files with 5.25% sodium hypochlorite (NaOCl) irrigation. The teeth were divided into two groups—the smear layer removal group and the microhardness group. In the smear layer removal group, 45 teeth were randomly assigned to three subgroups based on the final irrigation protocol: group I—ethylenediaminetetraacetic acid (EDTA) (positive control), group II—glutathione, and group III—gallic acid. After the final irrigation, the root canals were thoroughly rinsed with 10 mL of distilled water. Subsequently, the roots were split and observed under a scanning electron microscope (SEM) to assess smear layer removal effectiveness. In the microhardness group, all 45 roots were split into two halves and mounted in acrylic blocks. One-half of each root was used for baseline microhardness measurement, while the other halves were exposed to the experimental irrigants to compare pre and postvalues. The microhardness alteration was then evaluated using a Vickers microhardness tester. Appropriate statistical tests were employed to analyze the data obtained from both the smear layer removal and microhardness tests.
Results: In smear layer removal EDTA performed better than glutathione and gallic acid in the coronal third. In the middle third EDTA and glutathione performed equally followed by gallic acid. In the apical third glutathione performed better than EDTA followed by gallic acid. In microhardness alteration analysis, all the tested samples showed alteration in microhardness.
Conclusion: Glutathione showed better smear layer removal and less alteration in microhardness and it is as effective in performance as EDTA.
Clinical significance: The primary objective of this study was to explore alternative final irrigants to replace EDTA in root canal irrigation. Results obtained from glutathione to gallic acid were found to be effective in terms of smear layer removal and showed comparable results to EDTA. Interestingly, glutathione demonstrated the ability to reverse the adverse effects of NaOCl on root dentin and induced minimal microhardness alteration when compared to the other tested irrigants. These findings suggest that glutathione holds promise as a potential substitute for EDTA in root canal procedures, offering similar smear layer removal capabilities while also exhibiting the added advantage of mitigating NaOCl-induced damage to root dentin.
Al-Rahabi M, Abdulkhayum AM. Single visit root canal treatment: review. Saudi Endod J 2012;2(2):80–84. DOI: 10.4103/1658-5984.108156
Adiguzel O, Yigit-Ozer S, Kaya S, et al. Effectiveness of ethylenediaminetetraacetic acid (EDTA) and MTAD on debris and smear layer removal using a self-adjusting file. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112(6):803–808. DOI: 10.1016/j.tripleo.2011.05.038
Ballal NV, Kandian S, Mala K, et al. Comparison of the efficacy of maleic acid and ethylenediaminetetraacetic acid in smear layer removal from instrumented human root canal: a scanning electron microscopic study. J Endod 2009;35(11):1573–1576. DOI: 10.1016/j.joen.2009.07.021
Abuhaimed TS, Abou Neel EA. Sodium hypochlorite irrigation and its effect on bond strength to dentin. BioMed Res Int 2017;2017:1930360. DOI: 10.1155/2017/1930360
Slutzky-Goldberg I, Maree M, Liberman R, et al. Effect of sodium hypochlorite on dentin microhardness. J Endod 2004;30(12):880–882. DOI: 10.1097/01.don.0000128748.05148.1e
Shivana V, Gupta S. Antioxidants: stress busters in dentistry-a review. J Dent Pract Res 2013;1(2):9–19.
Hulsmann M, Rummelin C, Schafers F. Root canal cleanliness after preparation with different endodontic handpieces and hand instruments: a comparative SEM investigation. J Endodont 1997;23(5):301–306. DOI: 10.1016/S0099-2399(97)80410-4
Haapasalo M, Shen Y, Wang Z, et al. Irrigation in endodontics. Br Dent J 2014;216(6):299–303. DOI: 10.1038/sj.bdj.2014.204
Calt S, Serper A. Time-dependent effects of EDTA on dentin structures. J Endod 2002;28(1):17–19. DOI: 10.1097/00004770-200201000-00004
Christopher SR, Mathai V, Nair RS, et al. The effect of three different antioxidants on the dentinal tubular penetration of Resilon and real seal SE on sodium hypochlorite-treated root canal dentin: an in vitro study. J Conserv Dent 2016;19(2):161–165. DOI: 10.4103/0972-0707.178702
Mali SR, Shaikh S, Phase A, et al. In vitro comparison of three different antioxidants on endodontic sealer infiltration. Int J Adv Sci Tech 2020;29(8s):3184–3190.
Pizzorno J. Glutathione! Integr Med (Encinitas) 2014;13(1):8–12. PMID: 26770075.
National Center for Biotechnology Information. Pub. National Center for Biotechnology Information. PubChem Compound Summary for CID 124886, Glutathione 2023.
Rajakumaran A, Ramesh H, Ashok R, et al. Smear layer removal and microhardness alteration potential of a naturally occurring antioxidant–an in vitro study. Cureus. 2019;11(7):1–7.
National Center for Biotechnology Information. PubChem Compound Summary for CID 370, Gallic Acid 2023.
Mankeliya S, Singhal RK, Gupta A, et al. A comparative evaluation of smear layer removal by using four different irrigation solutions like root canal irrigants: an in vitro SEM study. J Contemp Dent Pract 2021;22(5):527–531.
Ballal NV, Jain H, Rao S, et al. Evaluation of SmearOFF, maleic acid and two EDTA preparations in smear layer removal from root canal dentin. Acta Odontol Scand 2019;77(1):28–32. DOI: 10.1080/00016357.2018.1495842
Saha SG, Sharma V, Bharadwaj A, et al. Effectiveness of various endodontic irrigants on the microhardness of the root canal dentin: an in vitro study. J Clin Diagn Res 2017;11(4):ZC01–ZC04. DOI: 10.7860/JCDR/2017/24018.9472
Aslantas EE, Buzoglu HD, Altundasar E, et al. Sodium hypochlorite, and chlorhexidine gluconate with or without surface modifiers on dentin microhardness. J Endodont 2014;40(6):876–879. DOI: 10.1016/j.joen.2013.10.041
Venkataraman KJ, Boominathan SK, Nagappan R, et al. Efficacy of glycolic acid on debris and smear removal as a final rinse solution in curved canals: a scanning electron microscope study. J Pharm Bioallied Sci 2021;13(2):1603–1608. DOI: 10.4103/jpbs.jpbs_310_21
Marí M, Morales A, Colell A, et al. Mitochondrial glutathione, a key survival antioxidant. Antioxid Redox Signal 2009;11(11):2685–2700. DOI: 10.1089/ARS.2009.2695