Smear Layer
Smear Layer
CONTENTS
• Introduction
• Definition
• History
• Morphology of the smear layer
– Formation of smear layer
– Structure
– Thickness
– Composition
• Physiological considerations
– Influence on sensitivity of dentin
– Influence on permeability of dentin
• Functional implications in Restorative dentistry
• Smear layer & Bonding
• Smear layer in Endodontics
• Influence of smear layer on sealing
• Removal of smear layer
– Chemical
– Ultrasonics
– Lasers
• Conclusion
INTRODUCTION
• Whenever the tooth surface is altered by rotary or manual
instrumentation, cutting debris is smeared over the enamel &
dentin surfaces, forming what is termed the smear layer.
• According to Cohen:
Smear layer is an amorphous ,relatively smooth layer
of microcrystalline debris whose surface cannot be seen
with naked eye.
Morphology of the Smear
Layer
A John Gwinett
• Whenever dentin is cut with a hand instrument or a rotary
instrument, the mineralized matrix shatters rather than
being uniformly sheared or cleaved, producing considerable
quantities of cutting debris.
David H Pashley
• The smear layer increases the resistance to movement of
fluid across dentin discs both in vivo and vitro.
• The ease with which fluid could flow through etched dentin
(dentin free of a smear layer), termed 'hydraulic
conductance'
INFLUENCE ON SENSITIVITY OF DENTIN
• Dentin sensitivity is caused by open tubules in exposed dentin
(Brannstrom 1982, 1986, 1992).
Bowen
Nakabayashi
• Smear layer can be a detriment to effective bonding.
• Brittle in nature
• Term commonly used for bonding after acid etching but also to
the layers produced by a self-etch adhesive
Incorporating the smear layer
(Self-etch approach)
Smear Layer in Endodontics
• Endodontic smear layer is very similar to coronal smear
layer in composition
Profile
Hero 642
Stainless steel engine reamer (Mani)
Conclusion –
• Although better instrumentation scores were obtained in
canals prepared with AET, complete cleanliness was not
achieved by any of the techniques and instruments
investigated
Bacterial presence
Michelich et al 1980,
Pashley et al 1981, Safavi
et al 1990 Yang et al 2002, Holstein et al 1990,
Foster et al 1993, Lester et al 1977,
Holz et al 1987, White et al 1984
Effect of Smear layer on Sealing ability of
canal obturation : A Systematic Review &
Meta-analysis
A Shahravan et al
JOE Feb 2007
• To determine whether smear layer removal reduces leakage
of obturated teeth in vitro
• 26 studies included
• 65 comparisons
• Taylor et al 1997,
“Coronal leakage : effects of smear layer, obturation
technique & sealer” JOE 1997:23:508
• Cold vs Warm compaction ; ZOE vs resin sealer
• Evans et al 1986
Cobankara et al 2004,
“Evaluation of influence of smear layer on the apical &
coronal sealing ability of two sealers” JOE 2004
• AH 26 & RoekoSeal
• Removal of the smear layer had a positive effect in reducing
apical & coronal leakage for both.
Economides et al 2004
“Comparative study of apical sealing ability of a new resin
based sealer” JOE 2004 :30:403
Timpawat et al 2001
“ Effect of removal of smear layer on apical microleakage”
Electrochemical test studies
• Vassiliadis et al
“Effect of smear layer on coronal microleakage”
OOOOE 1996
• Cold technique with ZOE sealer
Following explanations have been drawn by several
authors to support the idea of removing the smear layer :
• Obturation type,
• sealer type,
• type of dye used,
No effect on the results
• site of leakage test,
• duration of the test &
• year of publication
Lasers
Ultrason Chemica
ics l
Chemical removal
Sodium hypochlorite
• When used alone EDTA removed the inorganic portion but left
an organic layer in the tubules.
Sodium hypochlorite + EDTA
• Final irrigation was done with 10ml of 17% EDTA for 1 & 10
min respectively in each group followed by 10ml of 5%
NaOCl in both the groups
Citric acid
• Better than many acids such as polyacrylic acid, lactic acid &
phosphoric acid (Meryon et al 1987)
• Wayman et al 1979 – showed best results with sequential use
of 10% citric acid & 2.5% NaOCl, then again followed by 10%
citric acid .
• Substantivity
Barkhordar et al (1997) –
• Doxycycline HCl (100mg/ml) is effective in removing the
smear layer
Ersev et al (2001) –
• Tetracycline as effective as 50% citric acid but tetracycline
demineralized less peritubular dentin than citric acid.
MTAD
(Mixture of tetracycline isomer, an acid & a detergent)
Torabinejad et al 2003
Conclusion
• SmearClear seems to be the best solution for removal of the
smear layer after root canal instrumentation.
Ultrasonic removal
Acoustic streaming
Cameron et al ,1983
“The use of ultrasonics in the removal of smear layer : A SEM
study”
Baumgartner et al , 1992
“Efficacy of several concentrations of NaOCl for root canal
irrigation”