ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Removing The Smear Layer With MTAD During Endodontic Treatment improves The Apical Seal
Clinical Question In endodontically treated teeth, does removing the smear layer using MTAD, compared to EDTA+NaOCl, improve the apical seal?
Clinical Bottom Line Irrigation using MTAD in endodontic treatment provides superior apical seal when compared to EDTA+NaOCl. This is supported by an in vitro study in which irrigation using MTAD outperformed irrigation with EDTA+NaOCl by a statistically significant margin.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22430689Nischith/2012N=60 extracted human teethIn vitro
Key results60 freshly extracted human maxillary central incisors were randomly divided into two experimental groups (A&B) of 25 teeth each and a control group(C) of 10 teeth. The canals were irrigated as follows throughout instrumentation: Group A: 17% EDTA followed by 3% NaOCl, Group B: MTAD, Group C: Saline. The root surfaces of the teeth were then coated with nail polish and immersed in India ink dye for 1 week at 37°C. Group B demonstrated the best apical seal when compared to Groups A and C (p=0.001).
Evidence Search Smear layer removal and endodontics, apical seal
Comments on
The Evidence
Strict inclusion and exclusion criteria were employed in the selection of teeth used for this study. The authors do not report the length of time the canals were exposed to the different irrigants. The evidence suggests that use of MTAD, compared to EDTA+NaOCl as root canal irrigants, results in a more favorable apical seal. While the MTAD showed the best apical seal, it is unknown whether this has any clinical significance. Since the molecule size of the dye used in this study is significantly smaller than bacteria, it does not accurately replicate clinical situations. Further, as one of the most important aims of cleaning and shaping is to sterilize the canal space, it would be of interest to know whether MTAD is an effective antibacterial irrigant. A randomized clinical trial reporting success rates would provide the best evidence in this case.
Applicability Even though MTAD is costly, evidence indicates that its use will result in a superior apical seal. Further research is necessary to establish its effect on clinical outcomes.
Specialty/Discipline (Endodontics)
Keywords Apical Seal, EDTA, MTAD, Sodium hypochlorite, Smear layer
ID# 2966
Date of submission: 12/08/2015spacer
E-mail ahmad.al-salman@ucdenver.edu
Author Ahmad Al-Salman
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ethelyn Thomason, DMD
Faculty mentor/Co-author e-mail ETHELYN.THOMASONLARSEN@UCDENVER.EDU
Basic Science Rationale
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