A Scanning Electron Microscope Evaluation of Smear Layer Removal and Antimicrobial Action of Mixture of Tetracycline, Acid and Detergent, Sodium Hypochlorite, Ethylenediaminetetraacetic Acid, and Chlorhexidine Gluconate: An In vitro Study.

Objectives: The main objective is to evaluate the efficiency in removal of smear layer of mixture of tetracycline, acid and detergent (MTAD), sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA) and chlorhexidine gluconate by scanning electron microscope (SEM) evaluation and also to evaluate the antimicrobial action of the same irrigants against standard culture strains of Enterococcus faecalis .

Materials and Methods: This study included 60 extracted permanent teeth with single root canal. The sample was categorized into five groups with 12 teeth in each group. Root canals were enlarged till size 40 with K-files. One group was kept as control and irrigated only with saline. Other four groups used 5% NaOCl as irrigant during instrumentation and MTAD, 5% NaOCl, 17% EDTA, and 2% chlorhexidine gluconate as final rinse. Teeth were split and examined under SEM. To test the antibacterial action, the zone of inhibition method using agar plates was used. Obtained data were statistically analyzed by SPSS version 17 (SPSS Inc., Chicago, IL, USA).

Results: MTAD and 17% EDTA removed smear layer from all regions of the root canals. About 5% NaOCl and 2% chlorhexidine gluconate were ineffective in removing the smear layer. The mean zone of inhibition formed by the irrigants was in the following order; MTAD (40.5 mm), 2% chlorhexidine gluconate (29.375 mm), 17% EDTA (24.125 mm), 5% NaOCl (22.125 mm), and saline (zero).

Conclusion: MTAD showed high smear layer removal efficacy, but no significant difference was found to that of 17% EDTA. As the dimensions of the zones of inhibition showed, MTAD has got highest antibacterial action against E. faecalis , followed by 2% chlorhexidine gluconate, 17% EDTA, and 5% NaOCl. However, the exact correlation of in vitro study results to clinical conditions is impossible due to the variables involved.