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References

Ballal NV, Kandian S, Mala K, Bhat KS, Acharya S Comparison of the efficacy of maleic acid and ethylenediaminetetraacetic acid in smear layer removal from instrumented human root canal: a scanning electron microscopic study. J Endod. 2009; 35:1573-1576
Ulusoy I, Gorgul G Effects of different irrigation solutions on root dentine microhardness, smear layer removal and erosion. Aust Endod J. 2013; 39:66-72
Kuruvilla A, Jaganath BM, Krishnegowda SC, Ramachandra PK, Johns DA, Abraham A A comparative evaluation of smear layer removal by using EDTA, etidronic acid, and maleic acid as root canal irrigants: an in vitro scanning electron microscopic study. J Cons Dent. 2015; 18:247-251
Ballal NV, Kundabala M, Bhat S, Rao N, Rao BS A comparative in vitro evaluation of cytotoxic effects of EDTA and maleic acid: root canal irrigants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108:633-638
Ferrer-Luque CM, Conde-Ortiz A, Arias-Moliz MT, Valderrama MJ, Baca P Residual activity of chelating agents and their combinations with cetrimide on root canals infected with Enterococcus faecalis. J Endod. 2012; 38:826-828
Shivanna V The effect of different irrigating solutions on the push out bond strength of endodontic sealer to dentin and assessing the fracture modes: an in-vitro study. J Int Clin Dent Res Org. 2014; 6:86-91
Ballal NV, Tweeny A, Baumgartner JC, Ginjupalli K, Saraswathi V Effect of maleic acid and ethylenediaminetetraacetic acid on the shear bond strength of RealSeal SE sealer to root canal dentin. Eur J Pros Res Dent. 2013; 21:52-156
Neelakantan P, Subbarao C, Subbarao CV, De-Deus G, Zehnder M The impact of root dentine conditioning on sealing ability and push-out bond strength of an epoxy resin root canal sealer. Int Endod J. 2011; 44:491-498
Ballal NV, Mala K, Bhat KS Evaluation of the effect of maleic acid and ethylenediaminetetraacetic acid on the microhardness and surface roughness of human root canal dentin. J Endod. 2010; 36:1385-1388

EDTA – factual disputes

From Volume 43, Issue 6, July 2016 | Pages 590-591

Authors

Vasudev Ballal

Manipal College of Dental Sciences Manipal, Karnataka, India

Articles by Vasudev Ballal

Article

Sir, I read with great interest the article entitled ‘Modern Endodontic Principles Part 4: Irrigation’ by Darcey J et al, which has been published in your esteemed journal (Dent Update 2016; 43: 20–33). It was a good review article on the basic irrigating agents and devices used in endodontics. I want to share a few of my thoughts regarding this article. The use of ethylenediaminetetraacetic acid (EDTA) mentioned in that article as a root canal irrigant needs to be reconsidered. Even though EDTA is the most frequently used chelator in endodontics, it does not remove the smear layer effectively, especially in the apical third of the root canal system which is the vital area for disinfection.1,2 In this regard, I would like to mention a novel chelating agent ‘maleic acid’, which has been studied extensively in endodontic literature. Maleic acid (7%) has been shown to remove the smear layer effectively when compared to 17% EDTA and various other chelators, especially in the apical third of the root canal system.1,2,3 It is also less cytotoxic when compared to 17% EDTA4 and has good antimicrobial properties when combined with auxiliary chemicals.5 It has been shown to improve the bond strength of resin sealers when compared to 17% EDTA.6,7,8 It has also been shown to produce increased surface roughness of the root canal walls when compared to EDTA, which might help in effective bonding of the resin-based materials to root canal dentine.9 Hence, considering these drawbacks of EDTA, a clinician should rethink its use as a chelator in endodontic therapy.