Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 3;19(11):6870.
doi: 10.3390/ijerph19116870.

Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer-A Systematic Review of In Vitro Studies

Kavalipurapu Venkata Teja  1 , Krishnamachari Janani  2 , Abdullah Ali Alqahtani  3 , Ali Robaian  3 , Feras Alhalabi  3 , Khalid A Merdad  4 , Mohammad Khursheed Alam  5   6   7 , Deepti Shrivastava  5 , Jerry Jose  8 , Kumar Chandan Srivastava  9
Affiliations

Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer-A Systematic Review of In Vitro Studies

Kavalipurapu Venkata Teja et al. Int J Environ Res Public Health. .

Abstract

This systematic review aimed to compare the efficacy of herbal agents with ethylene diamine tetraacetic acid (EDTA) in removing the smear layer during root canal instrumentation. The research question in the present study was to assess: "Is there a significant difference in reducing smear layer comparing EDTA and herbal agents?" Electronic databases (PubMed, Scopus, and Web of Science) were searched from their start dates to April 2022 using strict inclusion and exclusion criteria, and reviewed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Only in vitro studies comparing herbal agents with EDTA were included in the current systematic review. Two reviewers independently assessed the included articles. A total of 625 articles were obtained from an electronic database. Eighteen papers were included for review of the full text, out of which, ten papers were excluded because they did not meet the inclusion criteria. Finally, eight articles were included in the systematic review. The present systematic review considered only in vitro studies; hence, the result cannot be completely translated to strict clinical conditions. The results of the present systematic review have shown that quixabeira, morindacitrifolia, oregano extract, and neem show better smear layer removal compared to other herbal agents, whereas they showed reduced smear layer removal when compared with EDTA. Although, it was seen that most of the included studies did not report a high quality of evidence. Hence, the present systematic review concludes that herbal agents have reported to show inferior smear layer removal when compared to EDTA. Thus, as far as herbal based alternatives are concerned, there is no highest level of evidence to state its real benefit when used as a chelating root canal irrigant.

Keywords: EDTA; disinfection; endodontics; herbal agents irrigants; natural components; root canal treatment; smear layer.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only. * Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). ** If automation tools were used, indicate how many records were excluded by a human, and how many were excluded by automation tools.
Figure 2
Figure 2
Risk of bias.
See this image and copyright information in PMC

References

    1. Alamoudi R.A. The smear layer in endodontic: To keep or remove—An updated overview. Saudi Endod. J. 2019;9:71.
    1. Mader C.L., Baumgartner J.C., Peters D.D. Scanning electron microscopic investigation of the smeared layer on root canal walls. J. Endod. 1984;10:477–483. doi: 10.1016/S0099-2399(84)80204-6. - DOI - PubMed
    1. Goldman L.B., Goldman M., Kronman J.H., Lin P.S. The efficacy of several irrigating solutions for endodontics: A scanning electron microscopic study. Oral Surg. Oral Med. Oral Pathol. 1981;52:197–204. doi: 10.1016/0030-4220(81)90319-4. - DOI - PubMed
    1. Brännström M., Johnson G. Effects of various conditioners and cleaning agents on prepared dentin surfaces: A scanning electron microscopic investigation. J. Prosthet. Dent. 1974;31:422–430. doi: 10.1016/0022-3913(74)90152-8. - DOI - PubMed
    1. Machado R., Garcia L.D., da Silva Neto U.X., Cruz Filho A.D., Silva R.G., Vansan L.P. Evaluation of 17% EDTA and 10% citric acid in smear layer removal and tubular dentin sealer penetration. Microsc. Res. Tech. 2018;81:275–282. doi: 10.1002/jemt.22976. - DOI - PubMed

Publication types

LinkOut - more resources