ENDODONTOLOGY

Decalcifying Effect of Three Chelating Agents

ROLI BHATNAGAR *#
DHANYA KUMAR N. M. **#
VASUNDHARA SHIVANNA ***#

ABSTRACT
Background and Objectives: The objective of my study is to determine the efficacy of 17% EDTA plus 1.25 %
sodium lauryl ether sulfate (EDTA-T), 10% Citric acid and 17% EDTA with respect to calcium ion extraction from
the root canal dentin.
Method: The study sample comprises of 90 freshly extracted permanent human maxillary incisors. Access cavity
is prepared in all the teeth. A step back method of biomechanical preparation is done. The last instrument to be
used in the apical third is K-file no. 40 and in the middle and coronal third K-file no. 80 is used. At the change of
each instrument, 2 ml of sodium hypochlorite irrigating solution is used for irrigation. The final irrigation is done
by dividing the samples into nine groups. Final irrigation is done for 3 minutes, 10 minutes and 15 minutes with
20 ml of the irrigation solutions, EDTA-T, 10% Citric acid and 17% EDTA. The solution is collected in a container
after the required time periods for each group and calcium concentration in the solution used for final irrigation
is determined by using atomic absorption spectroscope. The values are recorded and the data is statistically
analyzed using one-way ANOVA for multiple group comparisons followed by Newman-Keuls range test for
pairwise comparisons, with level of significance as 5%.
Results: 10% citric acid showed maximum amount of calcium extracted. 17% EDTA also showed calcium extraction
similar to citric acid but comparatively less. EDTA-T showed least amount of calcium extraction, though it had the
best penetrability of 17% EDTA because of the presence of surfactant 1.25% sodium lauryl ether sulfate.
Interpretation and Conclusion: Overall, the maximum decalcification of the root canal with respect to calcium
ion extraction was seen with 10% citric acid.
Key words: biomechanical preparation, final irrigation, decalcification, calcium extraction, chelation.

to report the presence of smear layer on root canal

INTRODUCTION
The success of endodontic treatment is mainly

walls. The smear layer is an amorphous structure

dependant on thorough cleaning and shaping of root

composed of an organic portion, that is coagulated

canal system. A clean root canal system along with

proteins, necrotic and normal pulpal tissue, saliva,

a three dimensional seal is the clinicians road to

microorganisms, etc. and an inorganic portion that

success. In endodontics smear layer results directly

is minerals from the dentinal structure. Thus,

from instrumentation used to prepare the canal wall.

adequate removal is not possible only by sodium

Because the tooth structure is cut, instead of being

hypochlorite but a chelating agent is required for

uniformly sheared, the mineralized matrix shatters

removal of inorganic dentin. Ostby, found that

and forms smear layer, which is scattered over the

EDTA reduced the time necessary for debridement,

dentinal surface. McComb and Smith were the first

aided in enlarging narrow or obstructed canals. The

* Post-graduate Student, ** Professor, *** Professor & Head. # Dept Of Conservative Dentistry & Endodontics, College Of Dental Sciences, Davangere-577004

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ENDODONTOLOGY

DECALCIFYING EFFECT OF THREE CHELATING AGENTS

solution is neither bactericidal nor bacteriostatic,

study. All experimental teeth are cleaned and dried

but it inhibits the growth of eventually destroyed

in a desiccator for 1 hour. Access opening was done

bacteria by the process of starvation. EDTA is

for all the selected teeth. A high-speed handpiece

generally effective at pH of 7.2. In endodontics,

was used with a no.4 round bur on the lingual side,

citric acid is widely accepted as an irrigant, showing

at the middle third of the tooth. Biomechanical

its biocompatibility compared to EDTA and effective

preparation was done using step back technique of

smear layer removal. Yamaguchi et al, proposed

instrumentation in all ninety teeth. The last

citric acid as an endodontic irrigant. Goldman et

instrument to be used in the apical third is K-file

al, reported the effects of removal of smear layer

no. 40 and in the middle/coronal third is K-file no.

obtained with citric acid were similar to those by

80. At each instrument change, 2ml of NaOCl is

EDTA. Citric acid is less cytotoxically irritable to

used for irrigation. For final irrigation, the groups

tissue than EDTA. Smith and Wayman concluded

were divided as follows,

that the smaller the concentration of citric acid

Group 1 : 20 ml of EDTA-T for 3 minutes.

solution, the smaller the antimicrobial effect of citric

Group 2 : 20 ml of 17% EDTA for 3 minutes.

acid is related to its low pH, which promotes the

Group 3 : 20 ml of 10% citric acid for

3 minutes.

denaturation of proteins. Citric acid has also been

shown to be effective on anaerobic microorganisms.

Group 4 : 20 ml of EDTA-T for 10 minutes.

Pavia and Antoniazzi first recommended the

Group 5 : 20 ml of 17% EDTA for 10 minutes.

association of Tergentol (sodium lauryl ether sulfate)

Group 6 : 20 ml of 10% EDTA for 10 minutes.

with Furacin later with EDTA. It is believed that

Group 7 : 20 ml of EDTA-T for 15 minutes.

addition of a surface-active agent, Tergentol could

Group 8 : 20 ml of 17% EDTA for 15 minutes.

stimulate a reduction in its surface tension and

Group 9 : 20 ml of 10% citric acid for

15 minutes.

wettability and improve its penetration into the

uninstrumented areas of root canal system. Although

The solution was collected in a container after

1.25% sodium lauryl ether sulfate with 17% EDTA

the required time periods for each groups and the

did not allow calcium removal with same intensity

calcium concentration in the solution used for final

as EDTA, but further research is still being carried

irrigation was determined by using atomic

out in respect to EDTA-T. The purpose of my study

absorption spectroscope. Descriptive data are

is to determine the efficacy of EDTA-T, 10% Citric

presented as mean, standard deviation, standard

acid and 17% EDTA with respect to calcium ion

error and range values. One-way ANOVA is used

extraction from the root canal dentin.

for multiple group comparisons followed by

METHODOLOGY

Newman-Keuls range test for pairwise comparisons.

A P-value of 0.05 or less was considered statistically

The experimental method consisted of ninety

significant.

freshly extracted maxillary incisors collected. After

extraction, the teeth were rinsed in tap water to

RESULTS

remove the attached soft tissue and stored in

In all the solutions the calcium extraction is

deionized water (pH7), till the time of experimental

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ENDODONTOLOGY

DECALCIFYING EFFECT OF THREE CHELATING AGENTS

CALCIUM EXTRACTION OF THREE

SOLUTIONS AT THREE DIFFERENT
TIME INTERVALS

seen to be highest in the first 10 minutes. At fifteen

minutes the calcium ion extract readings are less,
showing that the maximum effect is at early time
periods, showing the time dependant effects.
Overall, citric acid has maximum efficacy in terms
of calcium extraction. EDTA-T solution has the least
efficacy in terms of calcium ion extraction at the
three different time intervals, when compared with
10% citric acid and with 17% EDTA. At 3 minutes
there is a significant statistical difference between
EDTA-T and 10% citric acid and between EDTA-T
and 17% EDTA. All recording done has a P-value
less than 0.01.

RANGE, MEAN, STANDARD DEVIATION OF Ca++ REMOVAL AFTER 3, 10 AND

15 MINUTES (ppm)
3 Minutes

Materials

10 Minutes

Range

Mean

SD

EDT
AT
EDTA

28.2 36.4

31.7

2.9 0.90

17% EDT
A
EDTA

82.8 96.8

89.8

10% Citric Acid

70.6-84.1

77.3

SE

15 Minutes

Range

Mean

SD

58.2-78.4

68.5

6.5 2.05

4.2 1.32 110.2- 128.2

117.9

4.2 1.33 162.6-174.6

168.4

DISCUSSION

SE

Range

Mean

SD

80.2-98.7

90.9

5.9 1.88

5.7 1.82 130.8- 146.2

137.8

4.6 1.45

3.6 1.15 188.6-198.5

193.5

3.2 1.01

SE

itself by my study to be the most effective in terms

10% citric acid has shown to have the highest

of calcium ion extraction out of the three solutions,

amount of calcium extraction in comparison to 17%

yet it is not preferred to be used in dental clinics

EDTA and EDTA-T at all three time intervals. Citric

because it precipitates in the canal to form crystals,

acid compared to EDTA is as good a chelating agent.

which may harbor microorganisms and hamper the

The 10% solutions with a pH of 1.8 are effective in

effective three dimensional seal. It has a disagreeable

removal of smear layer. The maximum decalcifying

odor and sour taste. EDTA-T extracted the least

effect was seen between 3 and 10 minutes. The

amount of calcium from root dentin compared to

probable reasons for this could be as it forms

10% citric acid and 17% EDTA at the three times it

complex with calcium of tooth which is greater than

has shown an increase in permeability at the apical

that of EDTA. It is biocompatible to the tissues, helps

level and association of 1.25% sodium lauryl ether

in cementum formation and periodontal tissue

sulfate with 17% EDTA did not allow the chelation

regeneration. It is also economical compared to

of calcium ions with same intensity as EDTA used

EDTA and at concentrations used in dentistry it has

alone. EDTA-T has been used for better penetration

antimicrobial effect. Though citric acid has proved

of 17% EDTA into the dentinal tubules by use of

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ENDODONTOLOGY

DECALCIFYING EFFECT OF THREE CHELATING AGENTS

the surfactant Tergentol (1.25% sodium lauryl ether

surface energy thus increasing the wettability of

sulfate) which reduces the surface tension and

EDTA and its better penetrability.

increases wettability of the uninstrumented areas

3) Calcium extraction with 10% citric acid and

and helps remove smear layer. 17% EDTA though

17% EDTA was statistically similar with respect to

an efficient chelating agent, but according to my

efficacy. Thus, both can be recommended as good

study, supported by various authors it should be

decalcifying agents.

placed second in line of use after 10% citric acid. It

showed similar effects to citric acid. At 3 minutes

4) In dental clinics because of its crystal

there was a slightly more decalcification of 17%

precipitation in the root canal that harbors

EDTA than 10% citric acid, abut at 10 and 15

microorganisms and prevents an effective three

minutes citric acid showed more decalcification

dimensional seal, sour taste and disagreeable odor,

than EDTA. This could be as EDTA causes necrosis

citric acid is not preferred as a final irrigant. EDTA

of pulp remnants, inflammatory reaction of

is generally used as it has a decalcification action,

periapical tissues, toxicity has been shown at 17%

though comparatively less than citric acid but

concentrations, its leakage to periapical tissues

efficient in final irrigation.

inhibits macrophage function, it has also shown time

BIBLIOGRAPHY

dependant effect, causing erosion of peritubular and

1. Haznedaroglu F. Efficacy of various concentrations of citric

acid at different ph values for smear layer removal. Oral Surgery
Oral Medicine Oral pathology. 2003; 96(3): 340-344.

intertubular dentin. Ostby proposed the use of EDTA

because, it has certain dentin dissolving effects,

2. Machado-Silveiro LH, Gonzalez-Lopez S, GonzalezRodriguez MP. Decalcification of root canal dentin by citric
acid, EDTA and sodium citrate. International Endodontic
Journal. 2004; 37: 365-369.

reduces time necessary for debridement, aids in

enlarging narrow or obstructed canals, helps make
possible the bypassing of broken instruments in

3. Scelza MFZ, 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 Surgery Oral Medicine
Oral pathology. 2004; 98(4): 499-503.

canals, it is self-limiting and shows no corrosive

effect on instruments. Overall, if we think in terms
of calcium extraction, 10% citric acid is an ideal

4. Calt S, Serper A. Time dependant effects of EDTA on dentin

structures. Journal of Endodontics.2002; 28(1): 17-19.

solution. But thinking in terms of an efficient smear

layer removal and patient comfort, out of the three

5. Scelza MFZ, Teixeira AM, Scelza P. Decalcifying effect of

EDTA-T, 10% Citric acid and 17% EDTA on root canal dentin.
Oral Surgery Oral Medicine Oral pathology. 2003; 95(2): 23423

solutions EDTA is the most ideal.

CONCLUSION
The following conclusions have been drawn

6. Koulaouzidou EZ, Margelos J, Beltes P, Kortsaris AH.

Cytotoxic effects of different concentrations of neutral and
alkaline EDTA solutions used as root canal irrigants. Journal of
Endodontics. 1999; 25(1): 21-23.

from my study,
1) Least amount of calcium ion extraction at
the three time intervals is seen with EDTA-T.
2) EDTA-T shows most efficient penetration
into the root canal dentin, because of the surfactant,
sodium lauryl ether sulfate present which decreases
46