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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) 22430689 | Nischith/2012 | N=60 extracted human teeth | In vitro | Key results | 60 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: |
12/08/2015 |
E-mail |
ahmad.al-salman@ucdenver.edu |
Author |
Ahmad Al-Salman |
Co-author(s) |
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Co-author(s) e-mail |
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Faculty mentor/Co-author |
Ethelyn Thomason, DMD |
Faculty mentor/Co-author e-mail |
ETHELYN.THOMASONLARSEN@UCDENVER.EDU |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
None available | |
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