Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer—A Systematic Review of In Vitro Studies
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion Criteria and Exclusion Criteria
2.2. Search Strategy
2.3. Selection of Studies
2.4. Data Extraction
2.5. Risk of Bias
3. Results
3.1. Assessment of Smear Layer Removal
- A.
- Size of apical preparation
- B.
- Irrigation protocol
- C.
- Volume and time of irrigation
- D.
- Choice of irrigation needle and irrigant activation
- E.
- Method of smear layer assessment
- F.
- Magnification level and scoring criteria
3.2. Risk of Bias
4. Discussion
4.1. Quantitative Review
4.2. Qualitative Review
4.3. Inference
4.4. Limitation and Future Inference
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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PubMed | (((extracted teeth) AND (root canal treatment [MeSH Terms])) OR (endodontic treatment [MeSH Terms])) AND (herbal irrigants [MeSH Terms])) OR (herbal root canal irrigants)) OR (EDTA [MeSH Terms])) OR (Ethylenediaminetetraaceticacid [MeSH Terms])) OR (sodium hypochlorite solution [MeSH Terms])) OR (sodium hypochlorite root canal irrigant)) AND (smear layer removal) |
Scopus | (TITLE-ABS-KEY (root canal therapy) OR TITLE-ABS-KEY (endodontic treatment) OR TITLE-ABS-KEY (root canal irrigants) AND TITLE-ABS KEY (sodium hypochlorite irrigant) OR ALL (ethylenediaminetetraaceticacid) OR ALL (edta) AND TITLE-ABS-KEY (smear layer removal)) |
Cochrane library | #1 Endodontic treatment #2 Root canal treatment #3 Root canal irrigant #4 Sodium Hypochlorite irrigant #5 EDTA #6 Herbal irrigants #7 Smear layer removal |
Author | Title of Included Article |
---|---|
Lahijani et al. 2006 [8] | The effect of German chamomile (Marticariarecutita L.) extract and tea tree (Melaleucaalternifolia L.) oil used as irrigants on removal of smear layer: a scanning electron microscopy study |
Murray et al. 2008 [9] | Evaluation of Morinda Citrifolia as an Endodontic Irrigant |
Candeiro et al. 2011 [10] | A comparative scanning electron microscopy evaluation of smear layer removal with apple cidar vinegar and sodium hypochlorite associated with EDTA |
Costa et al. 2012 [11] | In vitro evaluation of the root canal cleaning ability of plant extracts and their antimicrobial action |
Chabbra et al. 2015 [12] | Smear layer removal efficacy of combination of herbal extracts in two different ratios either alone or supplemented with sonic agitation: An in vitro scanning electron microscope study |
Evren OK et al. 2015 [13] | Antibacterial and smear layer removal capability of oregano extract solution |
Kumar A et al. 2018 [14] | Comparative Evaluation of Antibacterial and Smear Layer Removal Efficacy of Two Different Herbal Irrigants: An in vitro Study |
Susan et al. 2019 [15] | Intra radicular Smear Removal Efficacy of Triphala as a Final Rinse Solution in Curved Canals: A Scanning Electron Microscope Study |
Author and Year | Selection of Teeth | Sample Size | Herbal Irrigant | Positive Control | Negative Control | Other Irrigant |
---|---|---|---|---|---|---|
Lahijani et al. 2006 [8] | Single rooted permanent teeth | N = 40 | Group C: hydroalcoholic extract of German chamomile group D: tea tree oil | Group B: 2.5% NaoCl with 17% EDTA | Group A: sterile distilled water | Group E: 2.5% NaoCl alone |
Murray et al. 2008 [9] | Permanent Single Rooted Premolar | N = 60 | Group 1: 6% MorindaCitrifolia Juice (MCJ) with a flush of 17% EDTA, followed by a final flush of MCJ Group 2: 6% MCJ mixed equally with 2% CHX with a flush of EDTA and final flush of MCJ/2% CHX Group 3: 6% MCJ with a flush of saline, followed by a final flush of MCJ | Group 4: 6% NaoCl with a flush of 17% EDTA, followed by a final flush of 6% NaoCl | Group 6: Sterile Saline | Group 5: 2% Chlorhexidine |
Candeiro et al. 2011 [10] | Maxillary and mandibular molars | N = 40 | Group A—Apple vinegar Group B—Apple vinegar and 17% EDTA as final rinse | Group C—1% NaOCl and 17%EDTA as a final rinse | Group D: Saline | - |
Costa et al. 2012 [11] | Single rooted permanent teeth | N = 20 | Group 1: 50% Aroeira-Da-Praia Group 2: 50% Quixabeira | Group 3: 2.5% NaoCl with 17% EDTA | Not mentioned | - |
Evren OK et al. 2015 [13] | Permanent maxillary central incisors | N = 180 | Group 9: 1% OES + distilled water Group 10: 2% OES + distilled water Group 11: 5% OES + distilled water Group 12: 1% OES + 17% EDTA + distilled water Group 13: 2% OES + 17% EDTA + distilled water Group 14: 5% OES + 17% EDTA + distilled water | Group 8: 5.25% NaoCl + 17% EDTA + distilled water | Group 15: sterile saline + 17% EDTA + distilled water | - |
Chabbra et al. 2015 [12] | Single canal teeth | N = 50 | Group C—Combination of Citrus aurantifolia and Sapindusmukorossi in 1:1 ratio Group D—Combination of Citrus aurantifolia and Sapindusmukorossi in 1:1 ratio supplemented with sonic agitation Group E—Combination of Citrus aurantifolia and Sapindusmukorossi in 2:1 ratio Group F—Combination of Citrus aurantifolia and Sapindusmukorossi in 2:1 ratio supplemented with sonic agitation | Group B—17% ethylenediaminetetraacetic acid | Group A— Distilled water | |
Kumar A et al. 2018 [14] | Maxillary central incisors | N = 120 Antimicrobial efficacy (n = 60), smear layer removal efficacy (n = 60). | Group IIB: 25% Neem extract (n = 20) Group IIC: 25% Tulsi extract (n = 20) | Group IIA: 17% EDTA (n = 20) | Not mentioned | - |
Susan et al. 2019 [15] | Mandibular first molar | N = 74 | Group 3: Triphala premixed Group 4: Triphala premixed(Sonic activation) Group 5: Triphala premixed (Ultrasonic activation) Group 6: 3% Triphala in 10% DMSO Group 7: 5% Triphala in 10% DMSO Group 8: 10% Triphala in 10% DMSO Group 9: 10% citric acid Group 10:10% DMSO | Group 2: 17% EDTA | Group 1: normal saline | - |
Author and Year | Root Canal Preparation (Instruments Used and Size of Preparation) | Irrigation Protocol | Volume of Irrigant | Time of Irrigation | Needle Used for Irrigation | Irrigant Activation Devices Used |
---|---|---|---|---|---|---|
Lahijani et al. 2006 [8] | K file up to 30 apical preparation | No protocol was mentioned In group A, C, D, and E, the intra instrumentation irrigant was the same as the final flush irrigant In group B, 2.5% Naocl was followed by 17% EDTA as a final flush | Intra instrumentation— 2 mL Final flush-10 mL | Intra instrumentation 10 s Final flush— 2 min | Not mentioned in the study | Nil |
Murray et al. 2008 [9] | Protaper up to 35.06 | No protocol was mentioned Group 1: 6% Morinda Citrifolia Juice (MCJ) with a flush of 17% EDTA, followed by a final flush of MCJ Group 2: 6% MCJ mixed equally with 2% CHX with a flush of EDTA and final flush of MCJ/2% CHX Group 3: 6% MCJ with a flush of saline, followed by a final flush of MCJ Group 4: 6% NaoCl with a flush of 17% EDTA, followed by a final flush of 6% NaoCl | Not mentioned in the study | Not mentioned in the study | Not mentioned in the study | Nil |
Candeiro et al. 2011 [10] | Up to 45 K file | No protocol was mentioned | 2ml of irrigating solution at every change of file | Not mentioned | Not mentioned | Not mentioned |
Costa et al. 2012 [11] | Preparation size was not mentioned | No protocol was mentioned Group 1 and Group 2—respective irrigant was used. Group 3—2.5% sodium hypochlorite, followed by 17% EDTA, and then, 3% saline solution. | Group 1 and 2—3 mL | Not mentioned in the study | Not mentioned in the study | Nil |
Evren OK et al. 2015 [13] | Protaper up to 50 0.6 | No protocol mentioned Following the canal preparation, irrigation was performed with the respective irrigant | Group 8 3 mL 5.25% Naocl 3 mL 17% EDTA 5 mL distilled water Group 9 3 mL 1% OES 5 mL distilled water Group 10 3 mL 2% OES 5 mL distilled water Group 11 3 mL 5% OES 5 mL distilled water Group 12 3 mL 1% OES 3 mL 17% EDTA 5 mL distilled water Group 13 3 mL 2% OES 3 mL 17% EDTA 5 mL distilled water Group 14 3 mL 5% OES 3 mL 17% EDTA 5 mL distilled water Group 15 3 mL sterile saline 3 mL 17% EDTA 5 mL distilled water | 1min 1 min 1min 1 min 1 min 1 min 1 min 1 min 1 min 1 min 1 min 1 min 1 min 1 min 1 min 1 min 1 min 1 min 1 min 1 min 1 min | Not mentioned | Nil |
Chabbra et al. 2015 [12] | Apical size 35, 0.06 taper using nickel titanium files | No protocol was mentioned | During instrumentation, each root canal irrigated using 2 mL and final rinse 3 mL of solution corresponding to its group | 5 min | 30 gauge Side vented | Sonic activation performed in group D and F |
Kumar et al. 2018 [14] | K file up to 30 size apical preparation | No protocol mentioned (following the canal preparation, irrigation was performed with respective irrigant) | 6ml | 45 s | 25-gauge needle | Nil |
Susan et al. 2019 [15] | Up to apical size 25, 0.06 taper using rotary nickel–titanium files | 1 mL of the irrigant was used for canal irrigation after each instrument No protocol was mentioned | 8 mL during biomechanical preparation, and 5 mL for final rinse | 3 min | 28-gauge side vented needle | Not mentioned |
Author and Year | Smear Layer Evaluation Method | Assessment of Level of Root Canal | Magnification | Scoring Criteria | Statistical Analysis | % of Open Dentinal Tubules | Outcome |
---|---|---|---|---|---|---|---|
Lahijani et al. 2006 [8] | SEM analysis | Cervical, middle, and apical level of canal | 2000× and 5000× | Hulsmann et al. criteria | Kruskal–Wallis and Mann–Whitney U tests | 2.5% Naocl with 17%EDTA—no smear layer detected 2.5% Naocl—moderate smear layer, mainly in apical third Chamomile—moderate to heavy smear layer in apical third. Moderate to thin in middle and coronal sections | 2.5% Naocl followed by 17% EDTA showed better results in smear layer when compared to chamomile extract. The least effective was tea tree oil |
Murray et al. 2008 [9] | SEM analysis | Cervical, middle, and apical level of canal | 2000× | Modified semi-quantitative visual criterion by Madison and Hokett criteria | X2 statistical test | % of complete smear layer removal 6% Naocl with 17% EDTA final flush—80% smear removed (middle and coronal area) MCJ with 17% EDTA final flush—70% smear removed (middle and coronal area) MCJ with saline—20, 30, 20% smear removed (apical, middle, coronal, respectively) | 6% MCJ was equally effective as 6% Naocl when 17% EDTA was used as final flush. |
Candeiro et al. 2011 [10] | SEM analysis | Middle and apical third | ×1000 | Vale et al. criteria | Kruskal–Wallis and Dunn’s test Wilcoxon test | Middle third less smear layer removal than apical third | Apple cider vinegar with EDTA showed better smear layer removal, followed by apple cider vinegar and NaoCl/EDTA |
Costa et al. 2012 [11] | SEM analysis | Cervical, middle, and apical level of canal | Not mentioned | Not mentioned | Kruskal–Wallis analysis | Naocl with EDTA—more accumulation of smear layer in apical third than middle and coronal Aroeira-Da-Praia—more accumulation of smear layer in apical third and middle than coronal Quixabeira—less accumulation of smear layer than Naocl with EDTA | Quixabeira was found to be more effective in apical smear layer removal than Naocl with EDTA |
Evren OK et al. 2015 [13] | SEM analysis | Levels not mentioned | ×8000 | Not mentioned | Kruskal–Wallis and Mann–Whitney U tests | 1 or 2 or 5% oregano extract solution followed by 17% EDTA showed maximum removal of smear layer, whereas 1 or 2 or 5% oregano extract alone failed to remove the smear layer | 5.25% NaoCl followed by 17%EDTA showed similar effect on smear layer removal as that of 1 or 2 or 5% oregano extract solution |
Chabbra et al. 2015 [12] | SEM analysis | Coronal, middle, and apical third | ×1000 | Hulsmann et al. criteria | One-way analysis of variance. Tukey’s post hoc test | Mean score of smear layer 17% EDTA (Group B) Coronal = 1.4 Middle = 2.2 Apical = 1.8 Group F (Citrus aurantifolia and Sapindusmukorossi in 2:1 ratio with sonic agitation) Coronal = 1.6 Middle = 2.6 Apical = 2.1 | 17% EDTA and Combination of Citrus aurantifolia and Sapindusmukorossi in 2:1 ratio with sonic agitation showed maximum removal of smear layer |
Kumar A et al. 2018 [14] | SEM analysis | Levels not mentioned | Not mentioned | Rome et al. criteria | One-way analysis of variance. Tukey’s post hoc test | Mean of smear layer EDTA = 1.20 Neem leaf extract = 1.90 Tulsi extract = 2.70 | EDTA showed maximum removal of smear layer followed by neem extract. The least was observed with tulsi. |
Susan et al. 2019 [15] | SEM analysis | Coronal, middle, and apical third | ×2000 | Caron et al. | Not mentioned | Mean score of smear layer Group 5: Triphala premixed (Ultrasonic activation) = 1.6 ± 0.63 | Triphala showed least amounts of smear in all thirds of the root canal, with mean values of 1.6 ± 0.63, similar to that of EDTA |
Author and Year | Experimental Condition (Control Groups, Sampling Methods) | Evidence on Ethical Approval | Incomplete Data (Needle Size, Design, Time & Volume of Irrigation) | Blinding | Standardization | Reporting Data |
---|---|---|---|---|---|---|
Lahijani et al. 2006 [8] | Low | High | Unclear (type of needle and needle design not mentioned) | High (not mentioned) | Low | Unclear (percentage or mean value of remaining smear layer adherent not mentioned) |
Murray et al. 2008 [9] | Low | Low | High (volume of irrigant, time of irrigation, and type of needle used not mentioned) | High (not mentioned) | Low | Low |
Candeiro et al. 2011 [10] | Low | High | High (time and needle gauge and design not mentioned) | High | Unclear (irrigation protocol not mentioned) | Low |
Costa et al. 2012 [11] | Unclear (negative control not mentioned) | High | High (volume of irrigant, type of needle used not mentioned) | High (not mentioned) | High (range of magnification for SEM analysis not mentioned) | Unclear (percentage or mean value of remaining smear layer adherent not mentioned) |
Evren OK et al. 2015 [13] | Low | High | Low | High | Unclear (irrigation protocol not mentioned) | Low |
Chabbra et al. 2015 [12] | Low | High | Unclear (gauge and needle design not mentioned) | High (not mentioned) | High (smear layer assessment at different levels and criteria for assessment, type of needle used not mentioned) | Unclear (percentage or mean value of remaining smear layer adherent not mentioned) |
Kumar A et al. 2018 [14] | Unclear (negative control not mentioned) | High | Low | High (not mentioned) | High (irrigation protocol was not mentioned, smear layer assessment at different levels, and range of magnification not mentioned) | Unclear (percentage or mean value of remaining smear layer adherent not mentioned) |
Susan et al. 2019 [15] | Low | High | Low | High | Low | Unclear (statistical test not reported) |
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Teja, K.V.; Janani, K.; Alqahtani, A.A.; Robaian, A.; Alhalabi, F.; Merdad, K.A.; Alam, M.K.; Shrivastava, D.; Jose, J.; Srivastava, K.C. Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer—A Systematic Review of In Vitro Studies. Int. J. Environ. Res. Public Health 2022, 19, 6870. https://doi.org/10.3390/ijerph19116870
Teja KV, Janani K, Alqahtani AA, Robaian A, Alhalabi F, Merdad KA, Alam MK, Shrivastava D, Jose J, Srivastava KC. Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer—A Systematic Review of In Vitro Studies. International Journal of Environmental Research and Public Health. 2022; 19(11):6870. https://doi.org/10.3390/ijerph19116870
Chicago/Turabian StyleTeja, Kavalipurapu Venkata, Krishnamachari Janani, Abdullah Ali Alqahtani, Ali Robaian, Feras Alhalabi, Khalid A. Merdad, Mohammad Khursheed Alam, Deepti Shrivastava, Jerry Jose, and Kumar Chandan Srivastava. 2022. "Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer—A Systematic Review of In Vitro Studies" International Journal of Environmental Research and Public Health 19, no. 11: 6870. https://doi.org/10.3390/ijerph19116870