Effects of EDTA as an irrigating solution alone or combined with NaOCl vs. other substances during treatment of the root canal system
Keywords:
ENDODONCIA; COMPUESTOS QUÍMICOS; IRRIGACIÓN TERAPÉUTICA; TRATAMIENTO DEL CONDUCTO RADICULAR., ENDODONTICS; CHEMICAL COMPOUNDS; THERAPEUTIC IRRIGATION; ROOT CANAL THERAPY., ENDODONTIA; COMPOSTOS QUÍMICOS; IRRIGAÇÃO TERAPÊUTICA; TRATAMENTO DO CANAL RADICULAR.Abstract
Introduction: effective disinfection of the root canal system depends on irrigation protocols capable of eliminating biofilms, tissue remnants, and smear layer, all of which directly influence the clinical success of endodontic treatment.
Objective: to examine differences between the use of ethylenediaminetetraacetic acid as a single irrigant or combined with sodium hypochlorite versus other irrigation solutions in root canal therapy.
Methods: a systematic documentary review was conducted following prisma guidelines, through searches in specialized databases from 2017 to 2023. High-impact and up-to-date sources were selected and analyzed to establish a pertinent approach to the topic.
Development: studies agree that ethylenediaminetetraacetic acid has strong chelating capacity, facilitates removal of the smear layer, and promotes exposure of dentinal tubules. Its effectiveness increases when combined with sodium hypochlorite, particularly for removing residual tissue and intracanal calcium hydroxide. Compared with solutions such as citric acid, maleic acid, or preparations combined with chlorhexidine and detergents, its performance varies depending on the root third evaluated. Some emerging alternatives, such as nanobubbles and new irrigation systems, show superior potential for apical cleaning without compromising dentin microhardness. The sequence, concentration, and activation of the irrigant significantly influence clinical outcomes.
Conclusions: ethylenediaminetetraacetic acid remains a key component of irrigation protocols, especially when used together with sodium hypochlorite. Currently, new technologies offer potential improvements, although further evidence is required to support their effectiveness.
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1. Boutsioukis C, Arias-Moliz MT. Present status and future directions - irrigants and irrigation methods. Int Endod J [Internet]. 2022 May [Citado 20/05/2025]; 55(Suppl 3): 588-612. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/iej.13739
2. Nogo-Živanović D, Kanjevac T, Bjelović L, Ristić V, Tanasković I. The effect of final irrigation with MTAD, QMix, and EDTA on smear layer removal and mineral content of root canal dentin. Microsc Res Tech [Internet]. 2019 Jun [Citado 20/05/2025]; 82(6): 923-930. Disponible en: https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/10.1002/jemt.23239
3. Tosco V, Monterubbianesi R, Aranguren J, Memè L, Putignano A, Orsini G. Evaluation of the Efficacy of Different Irrigation Systems on the Removal of Root Canal Smear Layer: A Scanning Electron Microscopic Study. Applied Sciences [Internet]. 2023 [Citado 20/05/2025]; 13(1):149. Disponible en: https://www.mdpi.com/2076-3417/13/1/149/review_report
4. Vega Correa M, Monar Coloma J. Estudio comparativo in vitro a través de microfotografía de la efectividad del anillo ultrasónico HBW y la punta ultrasónica IrriS en la remoción de barrillo dentinario. Odontoinvestigación [Internet]. 2021 [Citado 20/05/2025]; 7(1): 24-37. Disponible en: https://revistas.usfq.edu.ec/index.php/odontoinvestigacion/article/view/2175
5. Mohammadi Z, Shalavi S, Moeintaghavi A, Jafarzadeh H. A Review Over Benefits and Drawbacks of Combining Sodium Hypochlorite with Other Endodontic Materials. The Open Dentistry Journal [Internet]. 2017 [Citado 20/05/2025]; 11: 661–669. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC5750725/
6. Walsh LJ, George R. Activation of Alkaline Irrigation Fluids in Endodontics. Materials [Internet]. 2017 [Citado 20/05/2025]; 10(10): 1214. Available from: https://www.mdpi.com/1996-1944/10/10/1214.
7. Doumani M, Adnan H, Ahmad D, Mohammad S, Mohamad S, Salman R. A Review: The Applications of EDTA in Endodontics (Part I). IOSR-JDMS [Internet]. 2017 [Citado 20/05/2025]. 16(9): 83-85. Disponible en: https://www.iosrjournals.org/iosr-jdms/papers/Vol16-issue9/Version-5/P1609058385.pdf
8. Elbahary S, Haj-yahya S, Khawalid M, et al. Effects of different irrigation protocols on dentin surfaces as revealed through quantitative 3D surface texture analysis. Sci Rep [Internet]. 2020 [Citado 20/05/2025]; 10: 22073. Disponible en: https://doi.org/10.1038/s41598-020-79003-9.
9. Mohammadi Z, Shalavi S, Yaripour S, Kinoshita JI, Manabe A, Kobayashi M, et al. Smear Layer Removing Ability of Root Canal IrrigationSolutions: A Review. The Journal of Contemporary Dental Practice [Internet]. 2019 [Citado 20/05/2025]; 20(3):395-402. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31204334/
10. Shekhar S, Mallya PL, Ballal V, Shenoy R. To evaluate and compare the effect of 17% EDTA, 10% citric acid, 7% maleic acid on the dentinal tubule penetration depth of bio ceramic root canal sealer using confocal laser scanning microscopy: an in vitro study F1000Res [Internet]. 2022 [Citado 20/05/2025]; 11: 1561. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36875990/
11. Alshwali H, Iohara K, Taroush M, Huang GT-J, Nakashima M, Azim AA, Nanobubble-Enhanced Antimicrobial Agents: A Promising approach For Regenerative Endodontics. Journal of Endodontics [Internet]. 2020 [Citado 20/05/2025]; 46(9):1248-1255. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32553876/
12. Tonelli SQ, Nunes E, Heleno JFG, Carvalho MG. Use of EDTA improves the quality of root canal filling in artificial lateral canals. American Journal of Materials Science [Internet]. 2020 [Citado 20/05/2025]; 10(1): 9–14. Disponible en: http://article.sapub.org/10.5923.j.materials.20201001.02.html
13. Mello I, Robazza CR, Antoniazzi JH, Coil J. Influence of different volumes of EDTA for final rinse on smear layer removal. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics [Internet]. 2008 [Citado 20/05/2025]; 106(5): e40–e43. Disponible en: https://pubmed.ncbi.nlm.nih.gov/18718781/
14. Grando CP, Martinez EF, Fontana CE, Pedro Rocha DG, Pessoa Stringheta C, da Silveira Bueno CE. Effectiveness of Sodium Hypochlorite plus EDTA Compared with Peracetic Acid in Removing Smear Layer and Killing Enterococcus faecalis. Iranian endodontic journal [Internet]. 2019 [Citado 20/05/2025]; 14(1): 56–62. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36879593/
15. Álvarez-Sagües A, Herce N, Amador U, Llinares-Pinel F, Nistal-Villan E, Presa J, et al. Efficacy of EDTA and HEDP Chelators in the Removal of Mature Biofilm of Enterococcus faecalis by PUI and XPF File Activation. Dentistry journal [Internet]. 2021 [Citado 20/05/2025]; 9(4): 41. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33918842/
16. Murugesan K, Vishwanath S, Kadandale S, Thanikachalam Y, Parthasarathy R, Ilango S. Comparative Evaluation of Smear Layer Removal in Apical Third Using Four Different Irrigants With Ultrasonic Agitation: An In Vitro Scanning Electron Microscopy (SEM) Analysis. Cureus [Internet]. 2022 Mar 14 [Citado 20/05/2025]; 14(3):e23142. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35444899/
17. Wang D, Shen Y, Ma J, Hancock REW, Haapasalo M. Antibiofilm Effect of D-enantiomeric Peptide Alone and Combined with EDTA In Vitro. Journal of Endodontics [Internet]. 2017 [Citado 20/05/2025]; 43(11): 1862-1867. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28951034/
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