ABILITY TO REMOVE CALCIUM HYDROXIDE FROM THE ROOT CANAL
Rödig et al.[75] assessed the efficacy of 1% NaOCl, 10% citric acid and 20% EDTA in the removal of calcium hydroxide from root canals. According to their findings none of the irrigants or their respective combinations was able to completely remove the calcium hydroxide. Chelating agents such as citric acid and EDTA showed the best results. The combination of chelators and NaOCl did not result in significant improvement of calcium hydroxide removal. da Silva et al.[76] showed that irrigation with 17% EDTA-T and 37% phosphoric acid is more effective than NaOCl and citric acid in the removal of calcium hydroxide from the apical third. Salgado et al.[77] revealed that recapitulation of master apical file in combination with irrigants improved the removal of calcium hydroxide medication better than an irrigant flush alone.
Margelos et al.[78] revealed that using 15% EDTA or NaOCl alone as irrigants did not remove calcium hydroxide from the root canal, but combining these two irrigants with hand instrumentation improved the effectiveness of the removal.
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ETHYLENE GLYCOL TETRAACETIC ACID
EGTA is a polyaminocarboxylic acid, a chelating agent that is related to the better known EDTA, but with a much higher affinity for calcium than for magnesium ions. It is useful for making buffer solutions that resemble the environment inside living cells[79] where calcium ions are usually at least a thousand fold less concentrated than magnesium.
The pKa for binding of calcium ions by tetrabasic EGTA is 110, but the protonated forms do not significantly contribute to binding, so at pH 7, the apparent pKa becomes 6.91. Qin et al.[80] for an example of a pKa calculation.
Calt and Serper[81] indicated that the action of EDTA is stronger than that of EGTA for removal of smear layer. However, EGTA did not cause erosion of the intertubular and peritubular dentine. Cruz-Filho et al.[46] reported that 1% EGTA and 15% EDTAC reduced root dentine microhardness similarly. In a SEM study Viswanath et al.[82] demonstrated that both EGTA and EDTA completely removed the smear layer. De Sousa and Silva[83] reported that that EDTA and EGTA presented the same effect on dentine Ca2+ extraction. Tripod et al.[84] demonstrated that EGTA solubilized more than 60% of dentine while EDTA solubilized about 20% of it.
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EFFECT ON THE QUALITY OF OBTURATION
The dentine adhesion of root canal sealers can be improved by dentine pre-treatment with EDTAC; although, this effect is more pronounced after Er:YAG laser pre-treatment. The highest increase in adhesiveness was found for Sealer 26. For calcium hydroxide-based sealers only a slight increase was found.[85] Morris et al.[86] found that both NaOCl and EDTA significantly reduced the bond strength of resin cement to root dentine. Perdigao et al.[87] showed that this reduction can be completely reversed by application of 10% ascorbic acid or 10% sodium ascorbate. It has been revealed that dentine adhesives bound significantly better to calcified dentine than to decalcified dentine pretreated with EDTA. Michiels et al.[88] showed that the reduction in through-and-through leakage was significantly higher with the Nd:YAG laser as smear-layer modifier than when smear layer was removed with an EDTA rinsing solution.
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Footnotes
Source of Support: Nil.
Conflict of Interest: None declared
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REFERENCES
1. Holleman AF, Wiberg E. San Diego: Academic Press; 2001. Inorganic Chemistry.
2. Harris DC. New York: W.H. Freeman Company; 2007. Quantitative Chemical Analysis.
3. Carolina EC, Laura BL, Viviana GR, Valencia ME. Development and validation of a method for the determination of EDTA in non-alcoholic drinks by HPLC. J Food Compost Anal. 2007;20:248–52.
4. Yuan Z, Vanbriesen JM. The formation of intermediates in EDTA and NTA biodegradation. Environ Eng Sci. 2006;23:533–44.
5. Von der Fehr FR, Nygaard-Ostby B. Effect of EDTAC and sulfuric acid on root canal dentine. Oral Surg Oral Med Oral Pathol. 1963;16:199–205.
6. Wu L, Mu Y, Deng X, Zhang S, Zhou D. Comparison of the effect of four decalcifying agents combined with 60°C 3% sodium hypochlorite on smear layer removal. J Endod. 2012;38:381–4. [PubMed]
7. Fabiani C, Franco V, Covello F, Brambilla E, Gagliani MM. Removal of surgical smear layer. J Endod.2011;37:836–8. [PubMed]
8. Prado M, Gusman H, Gomes BP, Simão RA. Scanning electron microscopic investigation of the effectiveness of phosphoric acid in smear layer removal when compared with EDTA and citric acid. J Endod. 2011;37:255–8. [PubMed]
9. Dai L, Khechen K, Khan S, Gillen B, Loushine BA, Wimmer CE, et al. The effect of QMix, an experimental antibacterial root canal irrigant, on removal of canal wall smear layer and debris. J Endod.2011;37:80–4. [PubMed]
10. Rödig T, Döllmann S, Konietschke F, Drebenstedt S, Hülsmann M. Effectiveness of different irrigant agitation techniques on debris and smear layer removal in curved root canals: A scanning electron microscopy study. J Endod. 2010;36:1983–7. [PubMed]
11. Caron G, Nham K, Bronnec F, Machtou P. Effectiveness of different final irrigant activation protocols on smear layer removal in curved canals. J Endod. 2010;36:1361–6. [PubMed]
12. Zand V, Lotfi M, Rahimi S, Mokhtari H, Kazemi A, Sakhamanesh V. A comparative scanning electron microscopic investigation of the smear layer after the use of sodium hypochlorite gel and solution forms as root canal irrigants. J Endod. 2010;36:1234–7. [PubMed]
13. Mello I, Kammerer BA, Yoshimoto D, Macedo MC, Antoniazzi JH. Influence of final rinse technique on ability of ethylenediaminetetraacetic acid of removing smear layer. J Endod. 2010;36:512–4. [PubMed]
14. Uroz-Torres D, González-Rodríguez MP, Ferrer-Luque CM. Effectiveness of the endoactivator system in removing the smear layer after root canal instrumentation. J Endod. 2010;36:308–11. [PubMed]
15. Mancini M, Armellin E, Casaglia A, Cerroni L, Cianconi L. A comparative study of smear layer removal and erosion in apical intraradicular dentine with three irrigating solutions: A scanning electron microscopy evaluation. J Endod. 2009;35:900–3. [PubMed]
16. da Silva LA, Sanguino AC, Rocha CT, Leonardo MR, Silva RA. Scanning electron microscopic preliminary study of the efficacy of smearclear and EDTA for smear layer removal after root canal instrumentation in permanent teeth. J Endod. 2008;34:1541–4. [PubMed]
17. Spanó JC, Silva RG, Guedes DF, Sousa-Neto MD, Estrela C, Pécora JD. Atomic absorption spectrometry and scanning electron microscopy evaluation of concentration of calcium ions and smear layer removal with root canal chelators. J Endod. 2009;35:727–30. [PubMed]
18. Gu XH, Mao CY, Kern M. Effect of different irrigation on smear layer removal after post space preparation. J Endod. 2009;35:583–6. [PubMed]
19. Kuah HG, Lui JN, Tseng PS, Chen NN. The effect of EDTA with and without ultrasonics on removal of the smear layer. J Endod. 2009;35:393–6. [PubMed]
20. Saito K, Webb TD, Imamura GM, Goodell GG. Effect of shortened irrigation times with 17% ethylene diamine tetra-acetic acid on smear layer removal after rotary canal instrumentation. J Endod. 2008;34:1011–4. [PubMed]
21. Teixeira CS, Felippe MC, Felippe WT. The effect of application time of EDTA and NaOCl on intracanal smear layer removal: An SEM analysis. Int Endod J. 2005;38:285–90. [PubMed]
22. Guerisoli DM, Marchesan MA, Walmsley AD, Lumley PJ, Pecora JD. Evaluation of smear layer removal by EDTAC and sodium hypochlorite with ultrasonic agitation. Int Endod J. 2002;35:418–21.[PubMed]
23. Di Lenarda R, Cadenaro M, Sbaizero O. Effectiveness of 1 mol L-1 citric acid and 15% EDTA irrigation on smear layer removal. Int Endod J. 2000;33:46–52. [PubMed]
24. Adigğzel O, Yiğit-Özer S, Kaya S, Uysal İ, Ganidağli-Ayaz S, Akkuş Z. 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;112:803–8. [PubMed]
25. Sen BH, Ertürk O, Pişkin B. The effect of different concentrations of EDTA on instrumented root canal walls. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:622–7. [PubMed]
26. Perez F, Rouqueyrol-Pourcel N. Effect of a low-concentration EDTA solution on root canal walls: A scanning electron microscopic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99:383–7.[PubMed]
27. Scelza MF, Pierro V, Scelza P, Pereira M. Effect of three different time periods of irrigation with EDTA-T, EDTA, and citric acid on smear layer removal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2004;98:499–503. [PubMed]
28. Patterson SS. In vivo and in vitro studies of the effect of the disodium slat of ethylenediamine tetra-acetate on human dentine and its endodontic implications. Oral Surg Oral Med Oral Pathol. 1963;16:83–103.[PubMed]
29. Russell SM. The effect of electrolyzed oxidative water applied using electrostatic spraying on pathogenic and indicator bacteria on the surface of eggs. Poult Sci. 2003;82:158–62. [PubMed]
30. Kotula R, Bordácová J. The effect of ethylenediaminetetraacetic acid on the oral microflora. Dtsch Stomatol. 1969;19:575–81. [PubMed]
31. Yoshida T, Shibata T, Shinohara T, Gomyo S, Sekine I. Clinical evaluation of the efficacy of EDTA solution as an endodontic irrigant. J Endod. 1995;21:592–3. [PubMed]
32. Heling I, Chandler NP. Antimicrobial effect of irrigant combinations within dentinal tubules. Int Endod J.1998;31:8–14. [PubMed]
33. Heling I, Irani E, Karni S, Steinberg D. In vitro antimicrobial effect of RC-Prep within dentinal tubules. J Endod. 1999;25:782–5. [PubMed]
34. Steinberg D, Heling I, Daniel I, Ginsburg I. Antibacterial synergistic effect of chlorhexidine and hydrogen peroxide against Streptococcus sobrinus, Streptococcus faecalis and Staphylococcus aureus. J Oral Rehabil. 1999;26:151–6. [PubMed]
35. Orstavik D, Haapasalo M. Disinfection by endodontic irrigants and dressings of experimentally infected dentinal tubules. Endod Dent Traumatol. 1990;6:142–9. [PubMed]
36. Ordinola-Zapata R, Bramante CM, Cavenago B, Graeff MS, Gomes de Moraes I, Marciano M, et al. Antimicrobial effect of endodontic solutions used as final irrigants on a dentine biofilm model. Int Endod J.2012;45:162–8. [PubMed]
37. Ballal NV, Yegneswaran PP, Mala K, Bhat KS. In vitro antimicrobial activity of maleic acid and ethylenediaminetetraacetic acid on endodontic pathogens. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112:696–700. [PubMed]
38. Arias-Moliz MT, Ferrer-Luque CM, Espigares-Rodríguez E, Liébana-Ureña J, Espigares-García M. Bactericidal activity of phosphoric acid, citric acid, and EDTA solutions against Enterococcus faecalis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:e84–9. [PubMed]
39. Bystrom A, Sundqvist G. The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. Int Endod J. 1985;18:35–40. [PubMed]
40. Sen BH, Akdeniz BG, Denizci AA. The effect of ethylenediamine-tetraacetic acid on Candida albicans.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90:651–5. [PubMed]
41. Pawlicka H. The use of chelating agents for widening of the root canals. Determination of microhardness. Stomatol DDR. 1982;32:355–61. [PubMed]
42. Cruz-Filho AM, Sousa-Neto MD, Savioli RN, Silva RG, Vansan LP, Pécora JD. Effect of chelating solutions on the microhardness of root canal lumen dentin. J Endod. 2011;37:358–62. [PubMed]
43. Ballal NV, Mala K, Bhat KS. Evaluation of the effect of maleic acid and ethylenediaminetetraacetic acid on the microhardness and surface roughness of human root canal dentin. J Endod. 2010;36:1385–8.[PubMed]
44. Eldeniz AU, Erdemir A, Belli S. Effect of EDTA and citric acid solutions on the microhardness and the roughness of human root canal dentin. J Endod. 2005;31:107–10. [PubMed]
45. Ari H, Erdemir A, Belli S. Evaluation of the effect of endodontic irrigation solutions on the microhardness and the roughness of root canal dentin. J Endod. 2004;30:792–5. [PubMed]
46. Cruz-Filho AM, Sousa-Neto MD, Saquy PC, Pécora JD. Evaluation of the effect of EDTAC, CDTA, and EGTA on radicular dentin microhardness. J Endod. 2001;27:183–4. [PubMed]
47. De-Deus G, Paciornik S, Mauricio MH. Evaluation of the effect of EDTA, EDTAC and citric acid on the microhardness of root dentine. Int Endod J. 2006;39:401–7. [PubMed]
48. Rossi-Fedele G, Doğramaci EJ, Guastalli AR, Steier L, de Figueiredo JA. Antagonistic interactions between sodium hypochlorite, chlorhexidine, EDTA, and citric acid. J Endod. 2012;38:426–31. [PubMed]
49. Zehnder M, Schmidlin P, Sener B, Waltimo T. Chelation in root canal therapy reconsidered. J Endod.2005;31:817–20. [PubMed]
50. Irala LE, Grazziotin-Soares R, Salles AA, Munari AZ, Pereira JS. Dissolution of bovine pulp tissue in solutions consisting of varying NaOCl concentrations and combined with EDTA. Braz Oral Res.2010;24:271–6. [PubMed]
51. Baumgartner JC, Ibay AC. The chemical reactions of irrigants used for root canal debridement. J Endod.1987;13:47–51. [PubMed]
52. Clarkson RM, Podlich HM, Moule AJ. Influence of ethylenediaminetetraacetic acid on the active chlorine content of sodium hypochlorite solutions when mixed in various proportions. J Endod.2011;37:538–43. [PubMed]
53. Girard S, Paqué F, Badertscher M, Sener B, Zehnder M. Assessment of a gel-type chelating preparation containing 1-hydroxyethylidene-1, 1-bisphosphonate. Int Endod J. 2005;38:810–6. [PubMed]
54. Grawehr M, Sener B, Waltimo T, Zehnder M. Interactions of ethylenediamine tetraacetic acid with sodium hypochlorite in aqueous solutions. Int Endod J. 2003;36:411–7. [PubMed]
55. Saquy PC, Maia Campos G, Sousa Neto MD, Guimarães LF, Pécora JD. Evaluation of chelating action of EDTA in association with Dakin›s solution. Braz Dent J. 1994;5:65–70. [PubMed]
56. Akisue E, Tomita VS, Gavini G, Poli de Figueiredo JA. Effect of the combination of sodium hypochlorite and chlorhexidine on dentinal permeability and scanning electron microscopy precipitate observation. J Endod. 2010;36:847–50. [PubMed]
57. González-López S, Camejo-Aguilar D, Sanchez-Sanchez P, Bolaños-Carmona V. Effect of CHX on the decalcifying effect of 10% citric acid, 20% citric acid, or 17% EDTA. J Endod. 2006;32:781–4. [PubMed]
58. Rasimick BJ, Nekich M, Hladek MM, Musikant BL, Deutsch AS. Interaction between chlorhexidine digluconate and EDTA. J Endod. 2008;34:1521–3. [PubMed]
59. Erickson RL. Surface interactions of dentin adhesive materials. Oper Dent. 1992;17(Suppl 5):81–94.[PubMed]
60. Nakabayashi N, Pashley D. Tokyo: Quintessence Publishing Co; 2000. Hybridization of Dental Hard Tissues.
61. Anusavice KJ. Philadelphia: CV Saunders; 2003. Phillips’ Science of Dental Materials.
62. Sousa-Neto MD, Silva Coelho FI, Marchesan MA, Alfredo E, Silva-Sousa YT. Ex vivo study of the adhesion of an epoxy-based sealer to human dentine submitted to irradiation with Er: YAG and Nd: YAG lasers. Int Endod J. 2005;38:866–70. [PubMed]
63. Sousa-Neto MD, Passarinho-Neto JG, Carvalho-Júnior JR, Cruz-Filho AM, Pécora JD, Saquy PC. Evaluation of the effect of EDTA, EGTA and CDTA on dentin adhesiveness and microleakage with different root canal sealers. Braz Dent J. 2002;13:123–8. [PubMed]
64. Stratton RK, Apicella MJ, Mines P. A fluid filtration comparison of gutta-percha versus Resilon, a new soft resin endodontic obturation system. J Endod. 2006;32:642–5. [PubMed]
65. Tay FR, Loushine RJ, Weller RN, Kimbrough WF, Pashley DH, Mak YF, et al. Ultrastructural evaluation of the apical seal in roots filled with a polycaprolactone-based root canal filling material. J Endod.2005;31:514–9. [PubMed]
66. Resende LM, Rached-Junior FJ, Versiani MA, Souza-Gabriel AE, Miranda CE, Silva-Sousa YT, et al. A comparative study of physicochemical properties of AH plus, epiphany, and epiphany SE root canal sealers. Int Endod J. 2009;42:785–93. [PubMed]
67. Shipper G, Ørstavik D, Teixeira FB, Trope M. An evaluation of microbial leakage in roots filled with a thermoplastic synthetic polymer-based root canal filling material (Resilon) J Endod. 2004;30:342–7.[PubMed]
68. Shokouhinejad N, Sharifian MR, Jafari M, Sabeti MA. Push-out bond strength of Resilon/epiphany self-etch and gutta-percha/AH26 after different irrigation protocols. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110:e88–92. [PubMed]
69. Nunes VH, Silva RG, Alfredo E, Sousa-Neto MD, Silva-Sousa YT. Adhesion of Epiphany and AH Plus sealers to human root dentin treated with different solutions. Braz Dent J. 2008;19:46–50. [PubMed]
70. Nygaard-Ostby B. Chelation in root canal therapy: ethylenediaminetetraacetic acid for cleansing and widening of root canals. Odontol Tidskr. 1957;65:3–11.
71. Lindemann RA, Hume WR, Wolcott RB. Dentin permeability and pulpal response to EDTA. J Prosthet Dent. 1985;53:341–3. [PubMed]
72. Segura JJ, Calvo JR, Guerrero JM, Sampedro C, Jimenez A, Llamas R. The disodium salt of EDTA inhibits the binding of vasoactive intestinal peptide to macrophage membranes: Endodontic implications. J Endod. 1996;22:337–40. [PubMed]
73. Segura JJ, Calvo JR, Guerrero JM, Jimenez-Planas A, Sampedro C, Llamas R. EDTA inhibits in vitrosubstrate adherence capacity of macrophages: Endodontic implications. J Endod. 1997;23:205–8. [PubMed]
74. Cehreli ZC, Onur MA, Taşman F, Gümrükçüoğlu A, Artuner H. Effects of current and potential dental etchants on nerve compound action potentials. J Endod. 2002;28:149–51. [PubMed]
75. Rödig T, Vogel S, Zapf A, Hülsmann M. Efficacy of different irrigants in the removal of calcium hydroxide from root canals. Int Endod J. 2010;43:519–27. [PubMed]
76. da Silva JM, Silveira A, Santos E, Prado L, Pessoa OF. Efficacy of sodium hypochlorite, ethylenediaminetetraacetic acid, citric acid and phosphoric acid in calcium hydroxide removal from the root canal: A microscopic cleanliness evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2011;112:820–4. [PubMed]
77. Salgado RJ, Moura-Netto C, Yamazaki AK, Cardoso LN, de Moura AA, Prokopowitsch I. Comparison of different irrigants on calcium hydroxide medication removal: Microscopic cleanliness evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:580–4. [PubMed]
78. Margelos J, Eliades G, Verdelis C, Palaghias G. Interaction of calcium hydroxide with zinc oxide-eugenol type sealers: A potential clinical problem. J Endod. 1997;23:43–8. [PubMed]
79. Bett G, Glenna CL, Rasmusson A, Randall L. Computer models of ion channels. In: Candido C, Rosenbaum DS, editors. Quantitative Cardiac Electrophysiology. New York: Marcel Dekker; 2002.
80. Qin N, Olcese R, Bransby M, Lin T, Birnbaumer L. Ca2+-induced inhibition of the cardiac Ca2+channel depends on calmodulin. Proc Natl Acad Sci U S A. 1999;96:2435–8. [PMC free article][PubMed]
81. Calt S, Serper A. Smear layer removal by EGTA. J Endod. 2000;26:459–61. [PubMed]
82. Viswanath D, Hegde AM, Munshi AK. The removal of the smear layer using EGTA: A scanning electron microscopic study. J Clin Pediatr Dent. 2003;28:69–74. [PubMed]
83. Sousa SM, Silva TL. Demineralization effect of EDTA, EGTA, CDTA and citric acid on root dentin: A comparative study. Braz Oral Res. 2005;19:188–92. [PubMed]
84. Tripodi D, D’Ercole S, De Fazio P, Spoto G. Demineralizing action of EGTA in endodontics. Int J Immunopathol Pharmacol. 2007;20:93–6. [PubMed]
85. Hülsmann M, Heckendorff M, Lennon A. Chelating agents in root canal treatment: Mode of action and indications for their use. Int Endod J. 2003;36:810–30. [PubMed]
86. Morris MD, Lee KW, Agee KA, Bouillaguet S, Pashley DH. Effects of sodium hypochlorite and RC-prep on bond strengths of resin cement to endodontic surfaces. J Endod. 2001;27:753–7. [PubMed]
87. Perdigão J, Eiriksson S, Rosa BT, Lopes M, Gomes G. Effect of calcium removal on dentin bond strengths. Quintessence Int. 2001;32:142–6. [PubMed]
88. Michiels R, Vergauwen TE, Mavridou A, Meire M, De Bruyne M, De Moor RJ. Investigation of coronal leakage of root fillings after smear-layer removal with EDTA or Nd: YAG lasing through capillary-flow porometry. Photomed Laser Surg. 2010;28(Suppl 2):S43–50. [PubMed]