The Effect of Smear Layer Removal on Endodontic Outcomes
Abstract
Introdnction: During mechanical instrnthentation of root canals, a thin layer of organic and inorganic debris is created along the canal referred to as the smear layer. Ethylenediaminetetraacetic acid (EDTA), in conjunction with sodium hypochlorite (NaOCl), has proven to be effective in removing the smear layer. There are differing views as to whether the smear layer should be removed, however there are no adult endodontic outcome studies supporting the need for smear layer removal. This randomized clinical trial compared the outcomes of teeth where the smear layer was removed with teeth where the smear layer remained, evaluated the influence of covariate factors on endodontic outcomes and assessed the difference between radiographic analysis of conventional film versus digitized images. Materials and Methods: Once subjects were enrolled, a standardized endodontic treatment protocol was followed with the exception of the final inigation regimen. One group received lml/canal of 17% EDTA while the other group received lml/canal of0.9% saline. At a minimum of 12 months post treatment, a follow-up clinical and radiographic exam was performed. Radiographic analysis was performed using a modified periapical index (PAI) score (1-5) on both conventional films and digitized images of the same films. Data were analyzed using Fisher's Exact test and Cohen's Kappa (p<0.05). Results: An interim analysis of 132 subjects revealed no significant difference between the inigation protocol groups (p=0.13 9). The presence of a pre-operative apical lesion negatively impacted the outcome (OR =4.88, 95% CI: 2.13-11.60, p<0.001). Radiographic analysis revealed a conversion of 25 unsure conventional films to healed of the same digitized images (Kappa=.61, 95% CI: .52-.70, p<.001). Smear layer removal did not affect the outcome, however the presence of a periapical lesion negatively influenced the outcome.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jun 30, 2018
- Accession Number
- AD1128236
Entities
People
- Kim T. Do
Organizations
- Uniformed Services University of the Health Sciences