SMEAR LAYER

Contents
SMEAR LAYER IN ENDODONTICS

SMEAR LAYER IN CONSERVATIVE DENTISTRY • Removal of smear layer

• Retaining of smear layer
• Smear phenomenon in cavity preparation • Smear phenomenon in Endodontics
• Topography of cut dentin • Effect on instrumentation
– History
• Sono abrasion • Effect on medicament
– Definition • • Effect on sealer and bonding
Air abrasion
– • Laser cavity preparation • Effect on microleakage
Parts of smear layer
• Effect of smear layer in dental materials • Effect on post Endo restoration
– Components of smear layer • Treatment of smear layer
• Role in microleakage
– Composition of smear layer • Bacteria under restorations • NaOCl
• Dentin permeability and sensitivity • EDTA + NaOCl
– Smear phenomenon • Chelating agents
• Pulpal reaction
– D/B smear layer in • Treatment of smear layer • MTAD
conservative dentistry and • Total etch • Organic acids
endodontics • Self etch • Newer irrigants
• GIC based • Ultrasonic
• Laser smear layer removal
HISTORY
The smear layer was an unknown and unrecognized entity for years
1952 Lammie and Draycott The earliest studies on the effects of various instruments on dental
tissues
1953 Stret their attempts were limited principally to light microscope and it
has consistently failed to identify smear layer

Charbeneou, Peyton and the first to quantify and rank the differences between burs and abrasives
Anthony by using a profilometer to record the surface topography of cut and
abraded dental tissues.

1961 Scott and O’Neel used transmission electron microscopy to study the nature of the cut
tooth surface
1963 Boyde, Switsur and Stewart Advent of SEM - grinding debris was first referred to as the smear layer .

1963 Boyde et al first to describe and demonstrate the presence of a “smear layer”
1970 Eick et al. Identification of the smear layer was made possible using the electron
microprobe with scanning electron microscope (SEM) attachment first
reported

THE SMEAR LAYER REVISITED Sumita Bhagwat*, Anacleta Heredia, Lalitagauri Mandke Indian Journal of Medical Research and Pharmaceutical Sciences January 2016; 3(1)
Smear Layer of Dentin - Operative Dentistry, Supplement 3,1984.
1970 Eick and others attempted to quantify and identify cutting debris on tooth surfaces. They
confirmed that:
• Surfaces abraded with diamonds were rougher than those cut with tungsten
carbide burs.
• Surfaces cut dry were rougher and more smeared than those in which water
was used as coolant.
• The smear layer is composed of an organic film less than 0.5 microns thick.
• Included with in it were particles of opacity ranging from 0.5 – 15 microns.
• Such layers were present on all surfaces though they were not necessarily
continuous.

1972 Jones, Lozdan and Boyde smear layers were common on enamel and dentin following the use of
instruments.

1975 McComb and Smith The presence of smear layer on instrumented root canals was first
reported

1976 Erich and co-workers discussed the role of friction and abrasion in the drilling of teeth. They
accounted for the formation of smear layers, especially in dentin by a
brittle and ductile transition and alternating rupture and transfer of
apatite and collagen matrix into the surface.

1977 Lester & Boyde smear layer as ‘organic matter trapped within translocated inorganic
dentine’.
THE SMEAR LAYER REVISITED Sumita Bhagwat*, Anacleta Heredia, Lalitagauri Mandke Indian Journal of Medical Research and Pharmaceutical Sciences January 2016; 3(1)
Smear Layer of Dentin - Operative Dentistry, Supplement 3,1984.
 DEFINITION
According to Shwartz
• “Any debris, calcific in nature, produced by reduction or instrumentation of dentin, enamel or cementum or as a
contaminant that precludes interaction with the underlying pure tooth tissue”.

According to Cohen
• “An amorphous, relatively smooth layer of microcrystalline debris whose featureless surface cannot be seen with the
naked eye.”

The American Association of Endodontists

• defined smear layer as a “surface film of debris retained on dentin or other tooth surfaces like enamel, cementum after
instrumentation with either rotary instruments or endodontic files”.

According to DCNA (1990)

• “when tooth structure is cut, instead of being uniformly sheared, the mineralised matrix shatters. Existing on the
strategic interface of restorative materials and the dentin matrix most of the debris is scattered over the enamel and
dentin surface to form what is known as smear layer”.

According to Operative Dentistry Journal (1984)

• the term smear layer applies to “any debris produced iatrogenically by the cutting, not only of dentin, but also of enamel,
cementum and even the dentin of the root canal”.
 PARTS

Cameron (1983) and • The smear layer is a bilaminar structure present on all
Mader et al. (1984) restoratively or endodontically treated dentinal surfaces
• 1) The superficial layer
The smear layer • superficial smear layer
consists of two parts: • 2) The deep layer
• a smear plug that occludes the dentinal tubules.
 The deep layer (inner layer/ smear
The outer layer (superficial layer)
plugs/loosely attached layer):
• a superficial layer that covers the dentin • the dentin tubules are obstructed by debris
surface is thin, amorphous, easy to remove tags, called smear plugs,
and about 1-5 μm thin. • These smear plugs are contiguous with the
• mainly granular substructure that entirely smear layer
covers the dentin. It lies on the actual tooth • This layer consists of materials which have
surface, covering or overlying the tubules and been forced into the dentinal tubules, forming
intertubular dentin. a smear plug which occludes the tubules and
• Various factors will determine the depth of strongly adheres to the canal walls.
this layer • which may extend into the tubule to a depth
• Mader et al. (1984) - superficial layer consists of 1–10um
of a thin layer of mineralized tissue and is • The orifices of Packing of smear debris was
about 1–2 μm in thickness. present in the tubules to a depth of 40 um
• Goldman et al. (1981) estimated the smear and can reach up to 110 μm.
thickness at 1 um and it was largely inorganic
in composition.
• Brännström and Johnson - thickness of smear
layer could range between 2 and 5 μm
COMPONENTS OF THE SMEAR LAYER
• The smear layer is not always firmly attached and neither is it continuous over the substrate.
• The composition of the smear layer has not yet been well defined,but it presumably reflects
the composition of the underlying dentin from which it is produced (Ruse and Smith)
• smear layer contains organic and inorganic substances that include fragments of odontoblastic
processes, microorganisms and necrotic materials (Pashley 1992)
• In clinical conditions a smear layer may also be contaminated by bacteria and saliva
• While cutting dentin, the heat and shear forces produced by the rotary movement of the bur
cause dentin debris to compact and aggregate.
• The smear layer is believed to consist of shattered and crushed hydroxyapatite, as well as
fragmented and denatured collagen.

THE SMEAR LAYER REVISITED Sumita Bhagwat*, Anacleta Heredia, Lalitagauri Mandke Indian Journal of Medical Research and Pharmaceutical Sciences January 2016; 3(1)
 COMPOSITION OF SMEAR LAYER
Organic portion:

• (1) Heated coagulated proteins (gelatin formed by the deterioration of collagen heated by cutting temperatures)
• (2) Necrotic and non-necrotic pulp tissues
• (3) Odontoblastic process
• (4) Saliva
• (5) Blood cells
• (6) Micro organisms

Inorganic portion:

• tooth structure and some non-specific inorganic components

• (1) Hydroxyapatite crystals
• (2) Minerals from dentinal tubules
In the early stages of instrumentation, the smear layer on the walls of canals can have a relatively high organic content because of
necrotic and/or viable pulp tissue in the root canal (Cameron 1988).

In 1975, McComb and Smith – smear layer is made of remnants of dentin, odontoblastic processes, necrotic or viable pulp tissues, and
bacteria.

Eick et al. first identified the smear layer using scanning electron microscope (SEM) and found that smear layer is made from different
size of particles ranging from <0.5 to 15 μm.
 COMPOSITION OF SMEAR LAYER

In restorative dentistry
• the smear layer is composed of denatured collagen,shattered and
crushed hydroxyapatite and other cutting debris
• It is seen that the superficial layer of dentin is more important
because the bond strength of all adhesive system is always 50% more
in this layer.
• Smear layers found on deep dentin contain more organic material
than those found on the superficial dentin.
• The inorganic content of the layer is higher.
 COMPOSITION OF SMEAR LAYER
In the early stages of instrumentation, the smear layer on the walls of canals can have a relatively high organic
content because of necrotic and/or viable pulp tissue in the root canal (Cameron 1988).

When viewed under the SEM, the smear layer often has an amorphous irregular and granular appearance
(Brannstrom et al. 1980, Yamada et al. 1983, Pashley et al. 1988)

The appearance is thought to be formed by translocating and burnishing the superficial components of the
dentine walls during treatment (Baumgartner & Mader 1987).

Additional work has shown that the smear layer contains organic and inorganic substances that include
fragments of odontoblastic processes, microorganisms and necrotic materials (Pashley 1992).

Increased centrifugal forces resulting from the movement and the proximity of the instrument to the dentine
wall formed a thicker layer which was more resistant to removal with chelating agents (Jodaikin & Austin 1981).

Variation in the thickness of smear layer - instrumentation in wet or dry field and the type and sharpness of the
cutting instruments.

whether the dentin is wet or dry during instrumentation and the cutting efficiency of the instruments determine
the thickness of smear layer.
phenomenon of tubular packing Smear phenomena
Brannstrom & Johnson (1974) and Mader et al. (1984)
• tubular packing phenomenon was due to the action of burs and instruments.
• smear plug occurred due to the rotational movement of the burs and rotary instruments
leading to scattering of the smear debris and subsequently plugged inside the tubules.

Components of the smear layer can be forced into the dentinal tubules to varying
distances (Moodnik et al. 1976, Brannstrom et al. 1980, Cengiz et al. 1990) to
form smear plugs.

hypothesis of capillary action may explain the packing phenomenon observed by

Aktener et al. (1989)

penetration of smear material into dentinal tubules caused by capillary action as

a result of adhesive forces between the dentinal tubules and the material. (Cengiz
et al. (1990)

The thickness may also depend on the type and sharpness of the cutting
instruments and whether the dentine is dry or wet when cut (Barnes 1974, Gilboe
et al. 1980, Cameron 1988).
Alamoudi RA. The smear layer in endodontics: To keep or remove – an updated overview. Saudi Endod J 2019;9:71-81.
 D/B smear layer in cavity preparation & Endodontics
The smear layer in a cavity and in the root canal may not be directly comparable.

Not only are the tools for dentine preparation different in coronal cavities, but in the
root canal the dentinal tubule numbers show greater variation and there are likely to be
more soft tissue remnants present.

Endodontic smear layer consisted not only of dentine as in the coronal smear layer, but also
the remnants of odontoblastic processes, pulp tissue and bacteria
SMEAR LAYER IN CONSERVATIVE
DENTISTRY
 Smear phenomenon in cavity preparation
– smear layers were common on enamel and dentin following the use of instruments (Jones, Lozdan
and Boyde In 1972)
– removing debris from enamel and dentin after the use of steel burs, diamond stones and hand
instruments.They reported variations in the degree to which debris was removed. Provenza and
Sardana (1996)
– Eirich (1976) stated that smearing occurs when “hydroxy apatite within the tissue is either plucked
out or broken or swept along and resets in the smeared out matrix”.

Smearing is a physico-
chemical phenomenon Plastic flow of hydroxy Temperature rises upto
rather than a thermal apatite is believed to 600’C in dentin when it
transformation of occur at lower is cut without a coolant.
apatite involving temperature than its This value is
mechanical shearing melting point and may significantly lower than
and thermal also be a contributing the melting point of
dehydration of the factor to smearing. apatite (1500-1800’C)
protein.
 •Eick and others in 1970 attempted to quantify and identify cutting debris on tooth surfaces. They
confirmed that:
• Surfaces abraded with diamonds were rougher than those cut with tungsten carbide burs.
• Surfaces cut dry were rougher and more smeared than those in which water was used as coolant.
• The smear layer is composed of an organic film less than 0.5 microns thick.
• Included with in it were particles of opacity ranging from 0.5 – 15 microns.
• Such layers were present on all surfaces though they were not necessarily continuous.

Erich and co-workers in 1976 - role of friction and abrasion in the drilling of teeth.

In restorative dentistry, when tooth structure is cut, the matrix shatters and produces considerable amount of
debris.
When a tooth is cut or abraded with an instrument, a large amount of energy is generated.

This frictional heat causes plastic and elastic deformation which can alter and deteriorate the surface of the tooth
structure.
Eirich (1976) smearing occurs when hydroxyapatite crystals within the tissue are plucked out or broken or swept
along.
This hydroxyapatite will rest within the smeared matrix and lower the surface energy.

formation of smear layers in dentin by a brittle and ductile transition and alternating rupture and transfer of
apatite and collagen matrix into the surface
 Smear phenomenon in cavity preparation
Cengiz et.al. (1990) - penetration Several factors may cause the
of smear layer into dentinal depth of the smear layer to vary
from tooth to tooth: Filing a canal without irrigation
tubules could be caused by
or cutting without a water spray
Capillary action as a result of • Dry or wet cutting of the dentin.
will produce a thicker layer of
adhesive forces between the • The type of instrument used and
• The amount and chemical make of the dentin debris
dentinal tubules and the smear
material. irrigation solution.

• produces a thicker layer as compared to when dentin was cut with a water
dry cutting of dentin
coolant
• produces a thicker layer than carbide burs, which produces a thicker smear
coarse diamond burs
layer than finishing burs.
• also produce severe smearing of the dentin due to application of high
Hand instruments
forces during mechanical excavation.
• smear layer produced with high speed is more difficult to remove than that
speed
produced with low speed
Smear Layer of Dentin - Operative Dentistry,
 TOPOGRAPHICAL DETAIL OF CUT DENTIN
• When tooth structure is cut using hand or rotary instruments, the mineralized matrix does not shred.
• Instead, it shatters and considerable amount of debris made up of mineralized collagen matrix is produced.
This exists at the junction of the restorative material and the dentin matrix to form the smear layer

Steel and tungsten carbide burs obliterate normal structural detail of the tissue.

steel and tungsten carbide burs shows a rapid deterioration of the cutting edges - brittle fracture.

Brittle significantly diminishes the cutting efficiencies of the bur - increases frictional heat - causes
smearing.
Debris, irregular in shape and non-uniform in size and distribution, remains on the surface even after
thorough lavage with H2O.

The mechanism of dental tissue removal for burs and diamond is different significantly.

As burs rotate, the flute undermines the tissue, the amount being determined by such factors as the
angle of attack of the flute.
The Smear Layer Revisited Sumita Bhagwat*, Anacleta Heredia, Lalitagauri Mandke Indian Journal Of Medical Research And Pharmaceutical
 “galling”
• Steel and tungsten carbide burs - “galling”
• produce an undulating pattern, the trough of which run perpendicular with the direction of
movement of the hand piece.
• Fine grooves can be seen running perpendicular to the undulations and parallel with the
direction of rotation of the bur.
• the frictional humps represent a rebound effect of the bur against the tissue
• The galling phenomenon appears more masked with tungsten carbide burs run at high speed.

Scanning micrograph of the cutting Scanning electron micrograph

anomalies on dentin following the showing the galling pattern on a
use of a cross-cut steel bur. dentin surface cut with a water-
cooled, tungsten carbide bur. x150
The Smear Layer Revisited Sumita Bhagwat*, Anacleta Heredia, Lalitagauri Mandke Indian Journal Of Medical Research And Pharmaceutical
 abrasive particles
• The use of coarse diamond burs produces a thicker smear layer than the use of carbide burs
• abrasive particles, passing across the tissue, ploughs through in which substrate is ejected
ahead of the abrading particle and elevated into ridges parallel with the direction of travel of
particle.
• size of the grooves including particle size, pressure and hardness of the abrasive related to the
substrate.
• A significant difference exists between diamond burs used with and without coolant or water
spray.
• absence of coolant smeared debris does not form a continuous layer but exists rather as
localised islands with discontinuities exposing the underlying dentin.
• Coolant of the water spray does not prevent smearing but appear to significantly reduce the
amount and distribution of it.

Scanning electron micrograph showing grooves

traversing a dentin surface abraded
with diamond X300.
The Smear Layer Revisited Sumita Bhagwat*, Anacleta Heredia, Lalitagauri Mandke Indian Journal Of Medical Research And Pharmaceutical
Sono-Abrasion

sono-abrasion - alternative for preparing minimally

invasive cavities.
• Advantages
• less damage to adjacent teeth and minimally invasive cavities.
• This technique is based on the removal of tooth material by an
air-driven hand piece equipped with a diamond-coated working
tip that removes tooth material by ultrasonic kinetic energy.
• Different sizes and shapes of diamond tips
• easy access to occlusal and approximal tooth lesions.
• tips are coated only on one side
• additional damage and trauma of the approximal side of
adjacent teeth is prevented.
• A sono-abraded dentin surface is also covered by a thin smear
layer.

Bonding to Dentin: Smear Layer and the Process of Hybridization K.Van Landuyt, J.De Munck, E. Coutinho, M. Peumans, P.
 semi-rotary movement of the tip, the very high frequency of
oscillations of the tip and the subsequently produced heat, dentin
exposed by sono-abrasion can also be assumed to be covered by a
smear layer.
Van Meerbeek et al. - sono-abrasion resulted in enamel and dentin
surfaces equally receptive towards bonding as compared with bur-
cut surfaces

three-step etch-and-rinse adhesive (Optibond FL; Kerr) with

omission of the acid-conditioning phase obtains higher bond
strengths when bonded to sono-abraded dentin than to bur-cut
dentin.
sono-abrasion presumably produces rather thin smear layers.

Pioch et al. - no difference between bur-prepared or sono-abraded

dentin of primary teeth.

Bonding to Dentin: Smear Layer and the Process of Hybridization K.Van Landuyt, J.De Munck, E. Coutinho, M. Peumans, P.
 Disadvantages
Air
Advantages
• increases patient comfort • problems involving
as commonly experienced removal of the dust
abrasion during mechanical particles.
preparation of teeth when • When applied on dentin,
air abrasion creates a very
rotating burs are used.
• Reduced heat irregular surface
• Reduced vibration • a discrete smear layer with
• Reduced noise smear plugs.
• Intertubular dentin seems
to be impact folded and
Air abrasion technique compressed over the
dentin tubules.
• small version of sandblasting
• which has many applications for purposes such as increasing surface roughness and enhancing
adhesion.
• Air abrasion is specifically designed for abrading tooth material.
• kinetic energy generated by a high-velocity stream of aluminum oxide particles can be utilized to
prepare hard tooth tissues while having little effect on soft materials such as gingival tissues.
• air-abraded tooth surface is more receptive to bonding because of the microretentive surface created
by air abrasion
Bonding to Dentin: Smear Layer and the Process of Hybridization K.Van Landuyt, J.De Munck, E. Coutinho, M. Peumans, P.
 Laser cavity preparation
uses • applications in caries removal and cavity preparation.
• Like air abrasion, the trembling experience caused by bur cutting is omitted,
advantage
rendering this technique more tolerable for patients.

• Laser technology can remove tooth substrate effectively and precisely by mean of a
thermo-mechanical ablation process involving microexplosions.
• Water cooling is required to prevent cracking and melting of enamel and dentin, and
Laser in to prevent thermal damage to the pulp
cavity • Laser preparation of tooth substrate does not yield a smear layer.
preparation • Erbium:YAG laser - with an ultra short square pulse technology - wavelength
2.94mm is used for cavity preparation, but also Nd:YAG laser can be applied
• Erbium:YAG laser reveals a typical scaly, coarse and irregular surface due to
microexplosions and volatilization of tooth material.

Bonding to Dentin: Smear Layer and the Process of Hybridization K.Van Landuyt, J.De Munck, E. Coutinho, M. Peumans, P.
 advantages of laser cavity preparation
• acquired rough surface, not demineralized but exhibiting
patent dentin tubules, might enhance micromechanical
retention.
• Comparing laser-prepared dentin with bur-cut dentin,
similar or better results were found for laser-prepared
dentin, regarding bond strength testing and microleakage.
• Mechanical removal of this laser-modified superficial layer
or removal by acid etching restores bond strengths but
only partially as damage and weakening may go beyond
the superficial dentin layer.
• the ablation of sound enamel and dentin by Er:YAG laser
promotes cavities with rough enamel margins and dentin
surface, with irregular and rugged walls, which are free of
smear layer

Bonding to Dentin: Smear Layer and the Process of Hybridization K.Van Landuyt, J.De Munck, E. Coutinho, M. Peumans, P.
 DISADVANTAGE OF LASER CAVITY PREPARATIONS
• current lasers do not yet offer any advantage over conventional rotary
instruments for cavity preparation, as they may even affect the
bonding substrate adversely.
• substructural cracks in dentin after the use of erbium:YAG laser.
Kataumi et al.
• irradiated dentin showed a dense but fissured layer devoid of collagen
fibrils. Ceballos et al
• this structural weakening is not only confined to the uppermost layer
of dentin, but laser irradiation also modifies and weakens dentin over a
thickness of 3–5mm, which affects adhesion of composite material.
• basal part of this layer were remnants of melted, fused and denatured
collagen fibrils found, which were poorly attached to the underlying
intact dentin.
• As interfibrillar spaces were lacking in this zone, resin infiltration must
have been impeded, thereby having hindered good adhesion

Bonding to Dentin: Smear Layer and the Process of Hybridization K.Van Landuyt, J.De Munck, E. Coutinho, M. Peumans, P.
 EFFECT OF THE
SMEAR LAYER
• When cements are applied to dentin covered with a
smear layer
• the failure can be adhesive (b/w cement and
smear layer)
• or cohesive (b/w constituents of smear layer).

Dental materials:

• The presence of smear layer has advantage in vital teeth that it will restrict the
dentinal fluid from flushing the dentin surface.
• It also hinders the process of chemical adhesion that produces the marginal seal.
• Glass ionomer cements, polycarboxylate cements and composite resins bond to the
tooth structure by chemical means. However this chemical bonding may be affected
in the presence of the smear layer .
• Masking of the underlying dentin matrix – interference with the bonding of adhesive
dental cements
polycarboxylates and GIC
• Masking of the underlying dentin matrix – interference
with the bonding of adhesive dental cements -
polycarboxylates and GIC
• cements react chemically with smear layer rather than
with matrix of sound tubular dentin
• produces a weaker bond due to the fact that the smear
layer can be torn away from the underlying matrix.

AMALGAM
• The initial sealing process under amalgam restorations
compromised because of instability of the smear layer
and its nature for leaching under amalgam.
• Thus widening of the amalgam tooth micro-crevice
and weakening of sealing mechanism occurs.
• Improper bonding of material to the dentin.
• to reduce the microleakage, a layer of liner should be
applied before condensing amalgam
 ROLE PLAYED IN MICROLEAKAGE
There • 1) Within or via the smear
are 3 layer
Microleakage is defined as the movement or flow possible • 2) Between the smear layer
of oral fluids and bacteria into the microscopic routes and cavity varnish/ cement
for • 3) Between the cavity
gap between a prepared tooth surface and a micro varnish/cement and the
restorative material. leakage: restorative material
This can cause secondary caries and sensitivity.

– Unfortunately, most restorative materials cause some amount of leakage due to solubility of cements,
differences in coefficient of thermal expansion and inability of materials to adapt 100% to the walls of the
tooth.
– Williams and Goldman - smear layer delayed the penetration .
– If the smear layer is removed by acid etching, then bacterial invasion into the dentinal tubules will take place
a lot more easily.
 There are 3
possible routes
for micro leakage:

1) Within or via the

smear layer

2) Between the
smear layer and
cavity varnish/
cement

3) Between the cavity

varnish/cement and
the restorative
material
Pashley et al. (1989) –
extensive network of microchannels around restorations that had been placed in cavities with smear layer.
The thickness of these channels was 1–10 um.

Smear layer may thus present a passage for substances to leak around or through its particles at the interface
between the filling material and the tooth structure.

Pashley & Depew (1986) reported that, when experimenting with class 1 cavities, microleakage decreased
after the removal of smear layer, but dentinal permeability increased.

Saunders & Saunders (1992) concluded that coronal leakage of root canal fillings was less in smear-free
groups than those with a smear layer.
BACTERIA UNDER SMEAR LAYER UNDER RESTORATIONS
• Water cleaned cavities with the smear layer remaining underneath the composite
restoration showed the presence of numerous bacteria, whereas in the
antiseptically cleaned cavities, bacteria were absent.
• Micro organisms get sufficient nourishment from the smear layer and dentinal
fluid.
• Bacteria - not present in freshly prepared smear layers.
• most of the smear layer should be removed and any smear layer remaining for
instance at the tubule should be antiseptically treated before the application of
lining or a luting cement
• permanent restorative materials are not sufficiently antibacterial to kill bacteria
entrapped within the smear layer, especially when a fluid filled contraction gap,
5-20 microns wide separates the restoration from the smear layer.
• under temporary fillings, Ca(OH)2 may reinforce the remaining smear plugs in the
outer apertures of dentinal tubules.
Dentin permeability:
• Dentinal tubules act as a pathway for irritants towards the pulp.
• The diameter of the tubules at the pulpal end is greater than that at the
dentinoenamel junction. This factor combined with the convergence of tubules
towards the pulp increases the dentin permeability in the deeper layers.
• The smear plugs lower dentin permeability by forming a physiologic barrier to
hydrodynamic fluid shifts and to bacterial toxins.
• The fluid flow is directly proportional to the tubule radius
• Substances diffuse across dentin at a rate that is proportional to their concentration
gradient and the surface available for diffusion.
• The removal of smear layer increases the dentin permeability by 5-6 times in vitro by
diffusion but increases it by 25-36 times by filtration.
• These problems must be considered whenever dentin is etched to facilitate retention
of a restorative material. If such restorations undergo microleakage or fracture, the
etched dentin will be more permeable than the dentin with an intact smear layer.
 Dentin sensitivity
• Rapid movement of the dentinal fluid within the tubules will stimulate
the A delta nerve fibers to produce a brief, sharp, well localized pain
called dentinal hypersensitivity.
• Smear layer offers a major resistance to fluid movement across dentin
which is an important mechanism of dentin sensitivity.

Dentin Conditioning with acids will remove the smear layer plugs exposing patent dentinal tubules to the oral
sensitivity
cavity. This can lead to sensitivity of the dentin to the point where it interferes with the oral hygiene

15 seconds of acid etching will increase the fluid movement by 20 times Etching dentin greatly increases
the ease with which fluid can move across dentin

Restorative materials or techniques which do not require the removal of smear layer tend to create less
post - operative sensitivity.

And increased dentinal sensitivity if the dentin is not sealed with a restorative material.

This is because the smear layer and plug complex account for 86% of the resistance to fluid movement
across dentin

clinically by increased sensitivity of dentin to osmotic, thermal and tactile stimuli

PULPAL IRRITATION DUE TO
REMOVAL OF SMEAR LAYER
• 37% phosphoric acid or 50% citric acid
applied for 15 seconds or 1 minute does
not result in any appreciable pulpal
reaction, inflammation or necrosis.
• Acid etchants, detergents, a thin mix of
phosphate cements, GIC and resin do not
produce any appreciable damage and
inflammation to the pulp not even when
applied to exposed pulp.
• the cut dentin should not be treated with
acid or EDTA in such a way that the tubules
opened are widened
 THE PROTECTIVE EFFECT OF SMEAR PLUGS
IN APERTURES & THE CONSEQUENCE OF
REMOVING THE PLUGS
Pashley - Natural Cavity Liner
• Etching the cavity prior to the placement of the composite resin resulted in a massive invasion
of bacteria in dentinal tubules.
• From opened tubules, bacteria may easily reach the pulp and multiply therefore removal of
smear plugs should be avoided.
• difficult to get the dentin dry because fluid continues to be supplied from below through the
tubules. This affects adhesive or mechanical bonding to dentin.
• consequence of etching and removal of smear plugs and peritubular dentin at the surface is
that the area of wet tubules may increase from about 10-25% of the total.
• smear plugs in the apertures of the tubules had prevented bacterial invasion.
• Inflammation was present under all infected cavities, increased in the etched cavities, but the
difference was not great.
• Thus smear plugs did not prevent bacterial toxins from diffusing into the pulp.
Van Meerbeek et al. Classification of modern dentin bonding
agents based on their interaction with smear layer
• Smear layer modifying dentin bonding agents
• Smear layer removing dentin bonding agents
• Smear layer dissolving dentin bonding agents
• Glass ionomer based approach

Smear layer modifying bonding agents

• Modify smear layer and incorporate into bonding process
• Concept of smear layer is natural barrier to pulp, and reducing outflow of fluid that affect bonding
• Selective etching of enamel using 37% phosphoric acid
• Dentin is treated with primer/adhesive containing weak acids that superficially react with dentin and
doesnot remove smear plugs
• On polymerisation form micromechanical bond between modified smear layer and underlying dentin
• Eg- proBond, prime and bond2.1 ,compoglass and primers used with composites
Smear layer removing bonding agents
Etch-and-rinse adhesives/ “total-etch” adhesives
initial etching step / conditioning step, followed by compulsory rinsing phase

This etching step demineralizes dentin in order to remove the smear layer and
smear plugs, and to achieve a microporous surface with enhanced bonding
capacity.
To demineralize dentin, both chelating acids and mineral acids can be used.

Many different conditioners with varying concentrations - citric, maleic, nitric,

oxalic and phosphoric acid.

In the conditioning step, phosphoric acid removes the smear layer while
demineralizing dentin over a depth of 3–5 mm, thereby exposing a scaffold of
collagen fibrils that is nearly totally depleted of hydroxyapatite
Smear layer completely removed using total etch adhesive by etch
showing removal of smear layer after acid
and rinse method
etching and formation of resin tags
Enamel and dentin simultaneously etched using 37%phosphoric
acid
Tooth surface kept mosit by gentle drying , and primer-adhesive
applied as one step/two step procedure
3 step eg- scotch bond multipurpose, all bond 2, amalgambond
plus
2step eg- single bond, gluma, optibond solo
• All three categories of adhesives exhibit a common adhesion
mechanism of hybridization.
• A hybrid layer is the resulting resin-infiltrated surface layer of
dentin (and enamel).
• process of micromechanical interlocking ensuring a
demineralization, infiltration and polymer setting process,
Nakabayashi et al.

The first approach, “dry-bonding” technique, involves air drying

of dentin after acid etching, and applying a water-based primer,
capable of re-expanding the collapsed collagen meshwork

An alternative approach is to leave dentin moist, thereby

preventing any collapse and using an acetone-based primer,
known for its water-chasing capacity.

This technique is commonly referred to as “wet bonding”

introduced by Kanca, and by Gwinnett et al., in the 1990s
 three categories of self-etch adhesives can be made according
Smear layer dissolving dentin bonding agents their acidity:
• mild (pH≥2);
• intermediate (pH = 1.5);
• strong self-etch adhesives (pH≤1

Self etch adhesives

• Self-etch adhesives do not require a separate “etch-and-rinse” phase, as they contain acidic
monomers that simultaneously condition and prime enamel and dentin.
• Contains acidified resin, basically one or more carboxylic or phosphoric acid esters grafted
to adhesive resin
• the dissolved smear layer and demineralization products are not rinsed away but
incorporated in the adhesive resin
• They dissolve smear layer and also etch underlying enamel and dentin and form hybrid
layer
• Current self-etch adhesives have been proven acidic enough to penetrate beyond the
smear layer, even without agitation and within a clinically relevant time
• Two step self etch self etch adhesive –clearfil SE bond
• One step self etch adhesive/ all in one adhesive- I bond , Gbond
 “intermediary strong” self-etch
“mild” self-etch adhesives “strong”self-etch adhesives
adhesives
• ph around 2 • ph around 1.5 • ph 1 or less
• do not completely remove the • remove the smear layer along with • micromorphological aspect is very
smear layer, a shallow demineralization of similar to that of etch-and rinse
• a relatively thin sub-micron hybrid dentin. adhesives
layer is formed without resin tags. • Short resin tags are formed, and a • characterized by a 3- to 5-mm-thick
• demineralize dentin only very limited lateral-wall hybridization hybrid layer
shallowly upto 1um, takes place. • dentinal tubules funneling,
• leaving hydroxyapatite crystals • In the bottom third of the hybrid extensive resin tags, as well as
around the collagen fibrils available layer,not all hydroxyapatite crystals tubule-wall and lateral tubule-wall
for possible chemical interaction have been dissolved. hybridization
Glass-Ionomer Approach

– technology of glass ionomers based on their auto-adhesive capacity.

– Glass ionomers are the only true self-adhesive materials as they can adhere to both enamel and dentin
by a specific glass-ionomer interaction.
– Diverse formulas of glass ionomers are on the market varying in use:
– glass ionomer restorative materials, cements and adhesives.
– glass-ionomer cements provide adhesion for indirect restorations,
– glass-ionomer adhesives can be used to bond direct composite restorations.
– Glass ionomers have a specific composition, containing polyacrylic acid, alkenoic copolymers, glass-filler
particles and water.
– resin-modified glass ionomers - When resin components are added to glass ionomers
Bonding of GIC
• The adhesion reaction to tooth tissue is based mainly on the glass-ionomer components and involves
both a micromechanical hybridization and a chemical reaction.
• Regarding bonding mechanism, special group of selfetch adhesives based on glass-ionomer
technology.
• Like self-etch adhesives, their adhesive capacity is twofold
• limited demineralization of enamel and dentin with subsequent infiltration and mechanical
interlocking
• chemical adhesion between calcium in hydroxyapatite and polyalkenoic acid

• A conditioning step with a weak polyalkenoic acid

(PAA) significantly improves the bond strength.
• Its beneficial effect on bond strength lies in a
threefold mechanism:
• (a) the removal of the smear layer by PAA;
• (b) a shallow demineralization of the tooth tissue
• (c) a chemical interaction of PAA with residual
hydroxyapatite
The demineralization reaction is set off by the high molecular weight polyalkenoic acid.

This acidic molecule exposes a microporous collagen network by selectively dissolving hydroxyapatite
crystals.
an ionic bonding takes place between the carboxyl groups of the polyalkenoic acid and the calcium of
remaining hydroxyapatite crystals.
Micromorphologically, a shallow hybrid layer of 0.5–1um in thickness is formed.

Because of a mild and partial demineralization,hydroxyapatite crystals can be distinguished on the

collagen fibrils within the hybrid layer.
SMEAR LAYER IN
ENDODONTICS
 In support of its removal
are
Bacteria may survive and
contains bacteria, their by- multiply (Brannstrom & Nyborg
products and necrotic tissue 1973) and
unpredictable thickness and (McComb & Smith 1975, Goldberg & can proliferate into the
volume because a great Abramovic 1977, Wayman et al.
dentinal tubules (Olgar et al.
portion of it consists of water 1979, Cunningham Martin 1982,
1974, Akpata & Blechman 1982,
(Cergneu et al. 1987). Yamada et al. 1983).
Williams &Goldman 1985, Meryon et
al. 1986, Meryon & Brook 1990)

limit the optimum

substrate for bacteria, penetration of disinfecting
which may serve as a allowing their deeper
reservoir of microbial irritants agents (McComb & Smith 1975,
(Pashley 1984).
penetration in the dentinal Outhwaite et al. 1976 Goldberg &
tubules (George et al. 2005) Abramovich 1977, Wayman et al.
smear layer was not a complete 1979 Yamada et al. 1983)
barrier and could only delay bacterial penetration of the
tubules (Pashley 1984, Williams & Hamper adaptation of root canal
bacterial penetration Williams & materials (White et al. 1987,
Goldman (1985) Goldman 1985 Meryon & Brook
1990) Genc¸og˘lu et al 1993a, Gutmann
1993).
Violich DR, Chandler NP. The smear layer in endodontics – a review. International Endodontic Journal, 43, 2–15, 2010.
 In support of its removal
are
Bacteria may be found deep
within dentinal tubules (Bystrom & Brannstrom (1984) had previously
Sundqvist 1981 1983, 1985) and that the smear layer delayed but stated that following the
smear layer may block the did not abolish the action of the removal of the smear layer,
effects of disinfectants in them disinfectant (Ørstavik & Haapasalo bacteria in the dentinal tubules
(Goldberg & Abramovich 1977,Wayman 1990).
et al. 1979, Yamada et al. 1983,
can easily be destroyed.
Baumgartne & Mader 1987).

It can act as a barrier between It is a loosely adherent structure and

filling materials and the canal a potential avenue for leakage and the smear layer, being a loosely
wall and therefore compromise bacterial contaminant passage adherent structure, should be
between the root canal filling and completely removed from the
the formation of a satisfactory surface of the root canal wall
seal (Lester & Boyde 1977, White et al. the dentinal walls (Mader et al. 1984,
Cameron 1987b, Meryon & Brook 1990). because it can harbour bacteria
1984, Cergneux et al. 1987,
Czonstkowsky et al. 1990, Foster et al. Its removal would facilitate canal and provide an avenue for leakage
(Mader et al. 1984, Cameron 1987a, Meryon
1993, Oks¸ an et al.1993, Yang & Bae filling (McComb & Smith 1975, Goldman et & Brook 1990).
2002). al. 1981, Cameron 1983).

Violich DR, Chandler NP. The smear layer in endodontics – a review. International Endodontic Journal, 43, 2–15, 2010.
 In support of Retaining smear layer

retaining the smear layer during canal preparation, because it can block the dentinal tubules,
preventing the exchange of bacteria and other irritants by altering permeability (Michelich et al. 1980,
Pashley et al. 1981, Safavi et al. 1990, Drake et al. 1994, Galvan et al. 1994).

The smear layer serves as a barrier to prevent bacterial migration into the dentinal tubules (Drake et
al. 1994, Galvan et al. 1994, Love et al. 1996, Perez et al. 1996).

Pashley (1985) suggested that if the canals were inadequately disinfected, or if bacterial contamination occurred
after canal preparation, the presence of a smear layer might stop bacterial invasion of the dentinal tubules.

Bacteria remaining after canal preparation are sealed into the tubules by the smear layer and
subsequent filling materials.

Some studies provide evidence to support the hypothesis that the smear layer inhibits bacterial
penetration (Pashley et al. 1981, Safavi et al. 1989).

maintaining the smear layer may block the dentinal tubules and limit bacterial or toxin penetration
by altering dentinal permeability (Michelich et al. 1980, Pashley et al. 1981, Safavi et al. 1990).
Violich DR, Chandler NP. The smear layer in endodontics – a review. International Endodontic Journal, 43, 2–15, 2010.
 Smear phenomena in Endodontics
Smear phenomena in
Tubule packing Smear layer prevention
Endodontics
• When a canal is instrumented, the • Tubule packing is seen when less • Whilst a noninstrumentation
smear layer produced will remain than half the circumference of the technique has been described for
within the canal and pulp tubule has been fractured away. canal preparation without smear
chamber. • This packing phenomenon is not formation
• Once the root canal has been seen if more than half the • efforts rather focus on methods
instrumented, the normal canal circumference of the tubule has for its removal, such as chemical
anatomy has been lost and that a been fractured means and methods such as
thick smear layer has been • Increased centrifugal forces ultrasound and hydrodynamic
formed. resulting from the movement and disinfection for its disruption.
• The dentin surface of the canal the proximity of the instrument to • This can hamper the gutta percha
appears granular, amorphous and the dentine wall formed a thicker obturated over the smear layer.
irregular. The packing material layer which was more resistant to Therefore removing it will aid in
shows a segmented appearance, removal with chelating agents better adaptation of sealers and
packed in increments. (Jodaikin & Austin 1981) obturating materials in the dentin
• The bacteria and its products in by increasing the permeability of
the smear layer can provide a dentin
reservoir of potential irritants.

Alamoudi RA. The smear layer in endodontic: To keep or remove – an updated overview. Saudi Endod J 2019;9:71-81.
THE EFFECT OF INSTRUMENTATION TECHNIQUE ON THE AMOUNT OF SMEAR LAYER
• The generation of a smear layer is almost inevitable during root canal instrumentation.
• it is well known that mechanical preparation produces considerable amount of smear layer.
• Endodontic hand files such as K‑reamers and K‑files created similar surfaces compared to rotary
files.
• instrumentation with K-reamers, K-files and Giromatic reciprocating files created similar
surfaces. McComb & Smith (1975)
• no significant difference in the amount of smear layer between canals with different tapers:
30/0.02 files and 30/0.4 files.
• The amount produced during motorized preparation, as with Gates- Glidden or post drills, is
greater in volume than that produced by hand filing instruments. (Czonstkowsky et al. 1990).
• A noninstrumental hydrodynamic technique may have future potential(Lussi et al. 1993), and
• sonically driven polymer instruments with tips of variable diameter
are reported to disrupt the smear layer in a technique called
hydrodynamic disinfection (Ruddle 2007).

Violich DR, Chandler NP. The smear layer in endodontics – a review. International Endodontic Journal, 43, 2–15, 2010.
Alamoudi RA. The smear layer in endodontic: To keep or remove – an updated overview. Saudi Endod J 2019;9:71-81.
Effects of Ørstavik and Haapasalo - the importance of removal of the smear layer and the presence of
smear layer patent dental tubules for decreasing the time necessary to achieve the disinfecting effect of
on intracanal medications.
penetration
of root canal Bystrom and Sundqvist - the presence of a smear layer can inhibit or significantly delay the
medicaments penetration of antimicrobial agents such as intracanal irrigants and medications into the
and sealers dentinal tubules.
into the Brännström - these microorganisms inside the dentinal tubules can easily be destructed
dentinal once the smear layer is removed.
tubules

Sisodia et al. - removal of smear layer helps in better resistance to bacterial penetration and
less leakage , contradicted the effect of smear layer on bond strength.

Meryon and Brook - negligible effect of smear layer on the penetration ability of three
microorganisms.

Pashley - the presence of a smear layer may limit bacteria present in the infected canal to
enter the dentinal tubules in case of inadequate canal disinfection or recontamination of the
canal between treatment sessions
Alamoudi RA. The smear layer in endodontic: To keep or remove – an updated overview. Saudi Endod J
 THE EFFECT OF SMEAR LAYER ON THE BONDING EFFICACY OF
DIFFERENT ENDODONTIC OBTURATION MATERIALS
• effect of the smear layer on the apical and coronal seal (Madison & Krell
1984, Goldberg et al. 1985, 1995, Evans & Simon 1986, Kennedy et al. 1986, Cergneux et al.
1987, Saunders & Saunders 1992, 1994, Gencoglu et al. 1993a, Karagoz-Kucukay & Bayirli
1994, Tidswell et al. 1994, Lloyd et al. 1995, Behrend et al. 1996, Chailertvanitkul et al. 1996,
Vassiliadis et al. 1996, Taylor et al. 1997, Timpawat & Sripanaratanakul 1998, Economides et
al. 1999, 2004, von Fraunhofer et al. 2000, Froe´s et al. 2000, Goya et al. 2000, Timpawat et
al. 2001, Clark-Holke et al. 2003, Cobankara et al. 2004, Park et al. 2004).
• importance of smear layer removal and its effect on
material‑to‑dentin bond strength, which promotes fluid‑tight seal
and minimized leakage.
• effective penetration of different endodontic sealers and root filling
materials into dentinal tubules after removal of the smear layer (White
et al, Sonu et al)
smear layer decreases the ability of sealer to penetrate the
• Okşan et al. -
dentinal tubules and adhere properly.
• Penetration of the sealer in the smear free groups ranged from 4-60
micro meters (Oksan et al in 1993)
Alamoudi RA. The smear layer in endodontic: To keep or remove – an updated overview. Saudi Endod J
 • Gençoğlu et al - smear layer minimizes the ability of gutta‑percha to adapt well to
canal wall regardless of the condensation techniques used; cold laterally or
thermoplastic vertically.
• Gutmann - thermoplastic gutta‑percha adapted well to canal wall after smear layer
removal regardless of the presence of sealer. Smear layer acts as a sealing barrier
between the canal wall and root filling materials and may compromise the ability to
form a satisfactory seal.

MICROLEAKAGE OF ROOT CANAL FILLINGS WITH AND WITHOUT A SMEAR LAYER

• The presence or absence of a smear layer may play an important role in the adhesiveness of
some sealers to the root canal walls.
• Studies have shown better adhesion of obturation materials to the canal walls after removal of
the smear layer.
• Other investigators said removal of the smear layer did not have any significant effect on the
microleakage of root canals when various sealers and obturation techniques were used.
• Smear layer on root canal walls acts as a physical barrier and may reduce adhesion and
penetration of the sealer into the tubules. .
Alamoudi RA. The smear layer in endodontic: To keep or remove – an updated overview. Saudi Endod J
MICROLEAKAGE OF ROOT CANAL FILLINGS WITH AND WITHOUT A SMEAR LAYER
• The presence or absence of a smear layer may play an important role in the adhesiveness
of some sealers to the root canal walls.
• Smear layer on root canal walls acts as a physical barrier and may reduce adhesion and
penetration of the sealer into the tubules. .
• If the smear layer is not removed, Since this layer is non-homogenous and weakly
adherent it may get dislodged from the underlying tubules, slowly disintegrate, dissolve
around a leaking filling material and create a void between the canal and the sealer
• Several investigators have shown less dye leakage after removal of the smear layer with
various obturation techniques and root canal sealers.
• Studies have shown a significant increase in adhesive strength and resistance to
microleakage of AH26 sealer when the smear layer was removed
• Timpawat et al - removal of the smear layer has adverse effects on the microleakage of
filled root canals.
• Sisodia et al. - removal of smear layer helps in better resistance to bacterial penetration
and less leakage , contradicted the effect of smear layer on bond strength.

Alamoudi RA. The smear layer in endodontic: To keep or remove – an updated overview. Saudi Endod J
Post cementation:
• Removal of the smear layer increases the bond and tensile
strength of the cementing medium.
• Glass ionomer cements are effective in post cementations after
smear layer removal- better chemical union with the tooth
structure.
• the BISGMA resin flowed into the exposed dentinal tubules and
into the serrations on the post thereby improving the retention.
• The use of a dentin bonding agent for cementing a post with a
composite or a glass ionomer cement - removal of the smear
layer depending upon type of bonding agent used or whether a
glass ionomer cement is used

Alamoudi RA. The smear layer in endodontic: To keep or remove – an updated overview. Saudi Endod J
REMOVAL OF SMEAR LAYER
• The following three main methods are used to remove smear layer: chemically, mechanically, laser, or combination.

Chemical removal:
• The quantity of smear layer removed by a material is related to its pH and the time of exposure

Chlorhexidine
• substantive antibacterial agent but did not show any dissolving capability to organic material or removing effect to smear
layer.

Sodium hypochlorite
• dissolve organic tissues and kill microorganisms but lacks the ability to remove smear layer.
• The ability of NaOCl to dissolve organic tissues is wellknown (Rubin et al. 1979, Wayman et al. 1979, Goldman et al. 1982)
• increases with rising temperature (Moorer & Wesselink 1982).
• capacity to remove smear layer from the instrumented canal walls has been found to be lacking.
• use of NaOCl during or after instrumentation produces superficially clean canal walls with the smear layer present (Baker
et al. 1975, Goldman et al. 1981, Berg et al. 1986, Baumgartner & Mader 1987).
• Even the combination of NaOcl and H2O2 proved to be ineffective. NaOCl cannot destroy bacteria within the tubules
closed by a smear layer covering.

Alamoudi RA. The smear layer in endodontic: To keep or remove – an updated overview. Saudi Endod J 2019;9:71-81.
Mechanical removal
• Microbrush (canal brush)
• Three sizes – small, medium, large corresponding to apical diameter of 25, 30 and 40
• Used along with irrigating solutions, rotating at slow speed
• Smear layer removal due to action of irrigant mainly rather than brush
• Acta s a irrigant activation method
• XP-endo finisher
• Rotary NiTi file come into contact with only 40-50% of canal wall.
• Changing the shape during rotation in root canal, that removes dentin debris and smear layer

Hydrodynamic disinfection
• Non instrumentation technique can prepare the canal without producing smear layer
• Hydrodynamic technique with Sonically driven polymer instruments can disrupt smear layer
When irrigating a root canal the purpose is there is no single solution which has the
twofold: ability to dissolve organic tissues and to
• to remove the organic component, the debris demineralize the smear layer, the
originating from pulp tissue and microorganisms,
• the mostly inorganic component, the smear layer. sequential use of organic and inorganic
solvents has been recommended
(Koskinen et al. 1980, Yamada et al.
1983, Baumgartner et al. 1984).

• removal of smear layer as well as soft tissue and debris can be

achieved by the alternate use of EDTA and NaOCl (Yamada et al.
1983, White et al. 1984, Baumgartner & Mader 1987, Cengiz et al.
Sodium 1990).
hypochl • NaOcl removes organic material including the collagenous matrix of
orite dentin and EDTA removes the mineralized dentin, thereby exposing
and more collagen.
EDTA

Alamoudi RA. The smear layer in endodontic: To keep or remove – an updated overview. Saudi Endod J 2019;9:71-81.
Sodium hypochlorite and EDTA

• Used in combination with EDTA, NaOCl is inactivated with

the EDTA remaining functional for several minutes.
• Goldman et.al. in 1982 - most effective working solution -
5.25% NaOcl and the most effective final flush -10 ml of
17% EDTA followed by 10 ml of 5.25% NaOcl as a final
rinse.
• the sequential application of NaOCl and EDTA during
chemomechanical preparation to help eliminating
microorganism and remove soft‑ tissue debris and smear
layer.
• this mixture has the ability to remove most of the smear
debris without extensive opening to the dentinal tubules
or erosion to peritubular dentin. (Brännström et al)
Chelating agents:
• Smear layer components include very small particles with a large surface : mass ratio, which makes them
soluble in acids (Pashley 1992).
• EDTA acids are considered one of the most common chelating irrigants in endodontics.
• These agents interact with calcium ions which are present in the dentin wall and form soluble calcium
chelates.
• Fraser (1974) stated that chelating effect was almost negligible in the apical third of the root canals.
• EDTA decalcified dentine to a depth of 20–30 um in 5 min (von der Fehr & Nygaard-O¨ stby 1963)
• McComb et al. - application of EDTA resulted in effective opening to the dentinal tubules with very little
superficial smear debris
• paste-type chelating agents, whilst having a lubricating effect, do not remove the smear layer effectively
when compared to liquid EDTA.
•addition of surfactants to liquid EDTA
•addition of two surfactants to liquid EDTA did not result in better smear layer removal (Lui et al. 2007).
•Quaternary ammonium bromide (cetrimide or Cetavlon)
•combination of 0.2% EDTA and a surface-active antibacterial solution, removed most of the smear layer
without opening many dentinal tubules.

– Calcinase - 17% sodium edetate, sodium hydroxide and

purified water
REDTA – 17% EDTA + 0.84 gm
– DPTAC – diethyl triamine penta acetic acid + Cetavalon cetrimide + soidum hydroxide
– EDTA-T – 17% EDTA + tergentol (sodium lauryl ether sulphate) EDTAC – 15% EDTA + 0.75 gm
cetavalon
– CDTA – 1% cyclohexane-1,2-diaminetetra acetic acid

Quaternary ammonium bromide (cetrimide or Cetavlon)

• EDTAC commercial name (von der Fehr & Nygaard-Ostby 1963)
• Cetrimide reduces the surface tension and increases the penetrating capacity of the solution
• Fehr and Nygaard - the addition of 0.84 g of a quaternary ammonium bromide in EDTAC
Brannstrom et al. (1980) - combination of 0.2% EDTA and a surface-active antibacterial solution removed
most of the smear layer without opening many dentinal tubules or removing peritubular dentine

ideal working time of EDTAC is recommended to be <15 min and no further chelating action could be
expected after this (Goldberg & Spielberg 1982).

Goldberg & Abramovich (1977) - the circumpulpal surface had a smooth structure and that the dentinal
tubules had a regular circular appearance with the use of EDTAC (EDTA and cetavlon).

REDTA was the most efficient irrigating solution for removing smear layer.

REDTA was used during instrumentation, there was no smear layer remaining except in the
apical part of the canal McComb & Smith (1975)
REDTA in vivo, shown that the root canal surfaces were uniformly occupied by patent
dentinal tubules with very little superficial debris (McComb et al. 1976)
Different materials were added to EDTA to enhance its effect.

RC‑Prep – 15% EDTA with 10% urea peroxide in a carbo wax base
• Stewart et al in 1969
• urea peroxide - encourage debris to float out of the root canal (Stewart et al.
1969).
• product contains a wax that remains on canal walls and decreases the hermetic
seal between canal wall and filling material Biesterfeld & Taintor 1980.
• use of 24% EDTA gel was believed to prevent the extrusion of the material to
periapical tissues compared to liquid form, increase the permeability of dentin, and
enhance the cleaning ability.

Smear Clear

• 17% EDTA solution, cetrimide, and two additional surfactants (polyoxyethylene

and isobutyl cyclohexyl phthalate ether).
• more effective when compared with 17% EDTA solution in the apical third.
• Low surface tension and improved dentin wettability to flow into narrow
canals and better removal in apical regions.
• Ankur Dua et al (2015) at duration of 1min, 3min and 5mins, smear clear
followed ny NaOCl is effective in removing smear layer.
Another chelator- EGTA (Ethylene glycol + tetra acetic acid)

ethylene glycol-bis (ß-aminoethyl ether)-N,N,N¢, N¢-tetraacetic acid (EGTA).

• bind more specifically to calcium ions. (Schmid & Reilley 1957).

• Calt & Serper (2000) compared the effects of EGTA to EDTA
• smear layer was completely eliminated using EDTA solution although it caused more
destruction and erosion to the peritubular and intertubular dentin,
• EGTA was not as efficient as EDTA in the apical third

Qmix
• an endodontic irrigant recently introduced to remove smear layer and kill
microorganisms.
• Composition: Polyaminocarboxylic acid chelating agent EDTA, a
bisbiguanide antimicrobial agent chlorhexidine (CHX), a surfactant and
deionized water
• Ability to remove smear layer by QMiX was comparable to EDTA. (Stojicic et
al 2012)
 MTAD

• Torabinejad et al. (2003)

• new irrigating solution MTAD which
demineralized dentin faster than 17% EDTA.
• containing a mixture of a tetracycline
isomer, an acid, and a detergent (MTAD).
• effective solution for the removal of the
smear layer as final rinse before obturation.
• produce an irrigant capable of both Biopure (MTAD®) - mixture of
removing the smear layer and disinfecting • Doxicycline 3% ,
the root canal system • citric acid 4.25% and
• a detergent (Tween 80)

Doxycycline – low pH act as calcium chelator, root surface demineralisation. Citric acid also has demineralising potential

does not significantly change the structure of the dentinal tubules when the canals are irrigated with sodium hypochlorite and followed with
a final rinse of MTAD.
This irrigant demineralizes dentine faster than 17% EDTA (De-Deus et al. 2007)

The effectiveness of MTAD to completely remove the smear layer is enhanced when a low concentration of NaOCl (1.3%) is used as an
intracanal irrigant before placing 1 ml of MTAD in a canal for 5 minutes and rinsing it with an additional 4 ml of MTAD as the final rinse
BioPure MTAD was the most effective agent for the purpose of smear layer removal in the apical third of the root canals.
 Modified form of MTAD
Tetraclean
Differ from MTAD in concentration of antibiotics (doxycycline 150mg/5.0ml for MTAD,
50mg/5ml for tetraclean)
Detergent tween 80 for MTAD, polupropylene glycol for tetraclean

Lower surface tension compared to MTAD and NaOCl

Tubulicid plus Super oxidised water (OXUM)

• Disodium EDTA dehydrate, benzalkonium • Powerful antimicrobial agent against bacteria fungi
chloride, citric acid, phosphate buffer, distilled and viruses.
water. • Rich in reactive oxygen species and has neutral pH.
• The use of Tubulicid plus as a final irrigant • Commercially available as OXUM, stable, long shelf
provided better smear layer removal than life.
Biopure • Effectively removes smear layer when used as
• Composition of Tubulicid plus:
rootcanal irrigant.
Cocoamphodiacetate, benzalkonium chloride, • Smear layer removal efficacy equal to 17% EDTA
disodium edetate dihydrate, phosphate buffer
solution, and aqua dest with significantly less erosion of dentinal surface
Bis‑dequalinium‑acetate (BDA)
• consists of a dequalinium compound and an oxine derivative.
• Commercial forms of BDA, Solvidont and Salvizol were introduced in the 1980s.
• ability to remove smear debris throughout the entire length of root canal.
(Kaufman et al. 1978, Kaufman 1981)(Kaufman 1983a,b, Chandler & Lilley 1987,
Lilley et al. 1988, Mohd Sulong 1989).
• have both inorganic and organic debridement actions.
• agent has a low surface tension, less toxic, and well tolerated by periodontal
tissues.
Salvizol
• commercial brand of 0.5% BDA and possesses the
combined actions of chelation of calcium and organic
debridement.
• Neutral pH, low surface tension, and good antimicrobial
action with good biocompatibility.
• Salvizol was less effective at opening dentinal tubules
than REDTA. Berg et al. (1986)
• ability to remove organic debris, but only Salvizol opened
dentinal tubules (Kaufman & Greenberg 1986)
• Solvidont – similar to salvizol - BDA
 • tetracycline hydrochloride, minocycline and doxycycline are
antibiotics effective against a wide range of microorganisms.
• Tetracyclines have broad‑spectrum antibiotic action.
Tetracylines • low pH in concentrated solution, act as a calcium chelator
and cause enamel and root surface demineralization
(Bjorvatn 1982).

Barkhordar et al. (1997) - doxycycline hydrochloride (100 mg/mL) was effective in removing
the smear layer from the surface of instrumented canals and root-end cavity preparations.

reservoir of active antibacterial agents might remain, because doxycycline readily attaches
to dentine and can be subsequently released (Baker et al. 1983, Wikesjo et al. 1986).

Haznedaroglu & Ersev (2001) 1% tetracycline hydrochloride demineralized less peritubular

dentine that of citric acid.
 Chitosan

• Chitosan is a biopolymer derived by the partial deacetylation of chitin obtained from crustacean
shells.
• Excellent biocompatibility, biodegradability, absorption capacity, low toxicity, antimicrobial
property and chelating action.
• Chitosan nitrate and chitosan acetate in combination with chlorhexidine effectively removed
smear layer
• 0.2 - 0.6% chitosan – dentin conditioning agent
• chitosan/chitosan nanoparticles to eliminate smear layer and inhibit bacterial recolonization
when used as a final irrigant during root canal treated on dentin
• Geethapriya et al. chitosan‑EDTA (1:1) exhibits excellent smear layer removal with less erosion
to the coronal and middle thirds of compared to 17% EDTA alone.
• Silva et al.- 0.2% chitosan for 3 min to remove the smear layer without causing dentinal erosion

10% urea peroxide (carbamide peroxide) in vehicle of anhydrous

Glyoxide - glycerol base.
• In 1961 Steward proposed glyoxide to be an effective adjunct to instrumentation for cleaning of the root canal.
• Glyoxide - greater solvent action and germicidal than 3% H2O2
• It enhances root canal lubrication in narrow/curved canals without softening dentin.
• When mixed with NaOCl releases (O) – effective disinfection
 Citric acid, polyacrylic acid, lactic acid, and phosphoric acid, tannic acid

Organic acids
• 10% Citric acid is an organic acid effective in removing smear layer.
• effectiveness of citric acid as a root canal irrigant (Loel 1975, Tidmarsh 1978)
• pH and time of exposure are the main factors to determine the amount of removal .
• Machado et al. - smear layer removal with 17% EDTA or 10% citric acid was equal in
efficiency
• Yamada et.al. 1983 - the 25% citric acid – NaOcl combination was not effective as 17% EDTA-
NaOcl combination
• citric acid left precipitate crystals in the root canal which might be disadvantageous to the
root canal filling. Yamada et al. 1980
• Citric acid removed smear layer better than many acids such a polyacrylic acid, lactic acid
and phosphoric acid and phosphoric acid except EDTA
• Wayman et al. (1979) - 10%, 25% and 50% citric acid solution best results in removing
smear layer with sequential use of 10% citric acid solution and 2.5% NaOCl solution, then
again followed by a 10% solution of citric acid.
50% lactic acid
• the canal walls were generally clean but the openings of the dentinal tubules did not appear completely patent.

Maleic acid
• Concentration of 5-7% removes smear layer effectively better than EDTA and QMix

Polyacrylic acid

• Polyacrylic acid is another type of organic acid that can be used as a

chelating solution. McComb and Smith compared the effect of commercial
liquid EDTA preparation (REDTA) to 5%, 10%, and 20% polyacrylic acid and
reported that there is no difference between all solutions in eliminating or
even preventing the formation of smear layer
• McComb et al. (1976) also used 5% and 10% polyacrylic acid as an irrigant
• 40% polyacrylic acid (Durelon & Fuji II liquid) - effective potent solution, not
be applied for more than 30 s (Berry et al. 1987).
• 20% polyacrylic acid was less effective than REDTA according to a study
conducted by Mc Cough and Smith.
 25% tannic acid
• introduced by Bitter in 1989 was better than NaOcl – H2O2 combination.
• tannic acid irrigant as a root canal‑chelating ,clean smooth canal wall Bitter (1989)
• tannic acid increases the organic cohesion because of the presence of collagen
cross‑linking between smear layer and dentin. Sabbak and Hassanin

To try to fix the smear layer by gluteraldehyde or tanning agents such as tannic acid or ferric
chloride.

increase the cross linking of exposed collagen fibres within the smear layer and b/w it and the matrix of
the underlying dentin to improve its cohesion.

Recent approach to the problem

• remove the smear layer by etching with acid and replace it with an artificial smear layer composed by a crystalline
precipitate .

Bowen - treating dentin with 5% ferric oxalate

• which replaced the original smear layers with a new complex permitting extremely high bond strength to be produced between
restoration and dentin.
 Ultrasonics Two types of ultrasonic irrigation :
A. Active ultrasonic irrigation (AUI)
B. Passive ultrasonic irrigation (PUI)
• Irrigant Application Methods During PUI:
• Continuous Ultrasonic Irrigation
• Intermittent Flush Ultrasonic Irrigation
• Active ultrasonic irrigation (AUI)
 IT is the simultaneous combination of ultrasonic irrigation and instrumentation. it has
been almost discarded in the clinical
• Passive ultrasonic irrigation (PUI)
 During PUI, the energy is transmitted from an oscillating file or a smooth wire to the
irrigant in the root canal by means of ultrasonic waves.
 The latter induces acoustic streaming and cavitation of the irrigant.

Acoustic Cavitation is During PUI, energy

stream defined defined as creation is transmitted from
as a rapid of steam bubbles a file or smooth
movement of the or the expansion, oscillating wire to
fluid in a circular or contraction and/or the irrigant by
vortex shape distortion of pre- means of ultrasonic
around the existing bubbles in waves
vibrating file a liquid
 handpiece and an instrument file that were both energized by ultrasound. highly intense
Ultrasonics: magnitude and velocity applied on endodontic file.
• Ultrasonically activated files have the potential to prepare and debride root canals mechanically.
• Files are driven to oscillate at ultrasonic frequencies of 25–30 kHz in a transverse vibration
• The files used for this purpose must be loose in the canal eg. size 15 files should be used to maximize microstreaming.

• Smear-free canal surfaces were observed using ultrasonics (Cameron

1983, 1987, Griffiths & Stock 1986, Alacam 1987
• only size 15 files be used to maximize microstreaming for the removal of
debris Lumley et al. (1992)
• found ultrasonic preparation unable to remove smear layer (Cymerman
et al. 1983, Baker et al. 1988, Goldberg et al. 1988).
PASSIVE ULTRASONIC IRRIGATION (PUI)
• Used in conjunction with a solution of NaOcl can Removal of smear layer:
eliminate the smear layer.
• PUI is more effective than syringe needle irrigation in removing
• The apical region of the canal showed less debris and
pulpal tissue remnants and dentin debris.
smear layer than the coronal aspects depending on the • smear layers were effectively removed from the apical, middle, and
acoustic streaming which was more intense in cervical thirds of the canal walls by EDTA plus Cetavlon (EDTAC)
magnitude and velocity at the apical region of the file and NaOCl by using a size 15 file energized by ultrasonic agitation.
Ultrasonic smear removal
• best smear layer removal was achieved with the use of ultrasonic activation Prati et al.
• the free movement of ultrasonic tip inside the root canal (PUI) produced an intense
acoustic streaming effect that enhances the cleaning efficacy and the direct physical
contact of the instrument to the canal walls (AUI) may reduce the effect. Ahmad et al.
• small‑sized instrument to maximize microstreaming effect, leading to cleaner wall.
Lumley et al.
• EndoVac system could enhance smear layer removal at the apical portion of curved
canals - Kowsky and Naganath
• Virdee et al. - irrigant activation techniques – passive ultrasonic irrigation, sonic
irrigation, apical negative pressure, and manual dynamic activation – improve intracanal
cleanliness and smear layer removal compared to conventional needle irrigation.
• Ahmetoglu et al. removal of smear layer depends primarily on the solution used and not
on the irrigation system.
Several studies showed the significant effect of ultrasonic delivery system with different
irrigation solutions in cleaning canal wall.
Cameron – varying concentrations like 2%–4% NaOCl as irrigant with ultrasonic energy can
eliminate smear debris, compared to other irrigations.
Ahmad et al. claimed that modified ultrasonic instrumentation with low concentration of 1%
NaOCl removed smear layer debris more efficiently and produced clean apical region.
Walker and del Rio - no significant difference between the different types of irrigation solutions.
Tap water gives the same result compared to NaOCl when used with ultrasonic irrigation.
Yeung et al. 5 mL of 17% EDTA with the endo activator eliminated smear layer from a curved
apical third of root canals more efficiently.
Baumgartner and Cuenin, Guerisoli et al. - irrigation with NaOCl and ultrasonic did not enhance
smear layer removal from root canal walls.
Naocl even at higher concentrations with ultrasonic agitation is not effective, advised to use
EDTA/ EDTAC with NaOCl to remove smear layer
 Laser removal

– Lasers can be used to vaporize tissues in the main canal, remove the smear layer and eliminate residual tissue
in the apical portion of root canals (Takeda et al. 1999).
– Although application of laser during endodontic treatment is safe
– limitations - it cannot access small curved canal spaces with the large straight probes that are available for
delivery of the laser beam
– Laser probe with flexible conductor tip of 300 um for inaccessible areas.
Effectiveness of lasers depends on – (Dederich et
al. 1984, O¨ nal et al. 1993, Tewfi et al. 1993, dentine disruption
Moshonov et al. 1995). • carbon dioxide laser (O¨ nal et al. 1993)
• power level of the laser machine, • the argon fluoride excimer laser (Stabholz et al.
• Wavelength of laser 1993)
• the duration of exposure,
• the argon laser (Moshonov et al. 1995,
• the absorption ability of dental tissues, Harashima et al. 1998).
• the geometry of the root canal,
• the tip-to-target distance
Commonly used laser in endodontics – Nd:YAG having wavelength of 1064 nm. Flexible conductor effectively
used in narrow and curved canals, with superior disinfection and smear layer removal.

variants of the neodymium–yttrium-aluminium-garnet (Ne:YAG) laser and reported a range of findings from
no change or disruption of the smear layer to actual melting and recrystallization of the dentine. Dederich et
al. (1984) and Tewfik et al. (1993)
Erbium yttrium- aluminium-garnet (Er:YAG) laser - optimal removal of the smear layer without melting,
charring or recrystallization associated wit other laser types. Takeda et al. (1999)

Er: YAG - 2940 nm wavelength - (erbium yttrium aluminium garnet) laser was the most effective in removing
the smear layer. The temperature rise is within acceptable limits.

Removal of smear layer with Er:YAG is superior compared with Nd:YAG in which laser is poorly absorbed by
water and is absorbed by proteins

CO2(carbon dioxide) : 10.6 μm laser removed and melted the smear layer on the instrumented canal walls,

Kimura et al. (2002) - positive effect of using Er:YAG laser on the smear layer removal, destruction of
peritubular dentine.

940 nm diode laser - irradiation of root dentin along with NaOCl and EDTA irrigation resulted in better removal
of smear layer without significant additional loss of mineral content. Saraswathi et al.
 REFERENCE

– Clinical operative dentistry principles and practice , Ramya Raghu. 2nd edition
– Alamoudi RA. The smear layer in endodontic: To keep or remove – an updated overview.
Saudi Endod J 2019;9:71-81.
– Violich DR, Chandler NP. The smear layer in endodontics – a review. International Endodontic Journal, 43, 2–
15, 2010.
– Smear Layer of Dentin - Operative Dentistry, Supplement 3,1984.

– The Smear Layer Revisited Sumita Bhagwat*, Anacleta Heredia, Lalitagauri Mandke Indian
Journal Of Medical Research And Pharmaceutical Sciences January 2016; 3(1)
– Bonding to Dentin: Smear Layer and the Process of Hybridization K.Van
Landuyt, J.De Munck, E. Coutinho, M. Peumans, P. Lambrechts, B.Van Meerbeek
Thank you