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

Kavalipurapu Venkata Teja, Krishnamachari Janani, Abdullah Ali Alqahtani, Ali Robaian, Feras Alhalabi, Khalid A. Merdad, Mohammad Khursheed Alam, Deepti Shrivastava, Jerry Jose and Kumar Chandan Srivastava
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Kavalipurapu Venkata Teja: Department of Conservative Dentistry and Endodontics, Mamata Institute of Dental Sciences, Bachupally, Hyderabad 500090, Telangana, India
Krishnamachari Janani: Department of Conservative Dentistry and Endodontics, SRM Institute of Science and Technology, SRM Dental College, Chennai 600089, Tamil Nadu, India
Abdullah Ali Alqahtani: Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
Ali Robaian: Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
Feras Alhalabi: Department of Conservative Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
Khalid A. Merdad: Endodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah 80200, Saudi Arabia
Mohammad Khursheed Alam: Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka 72345, Saudi Arabia
Deepti Shrivastava: Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka 72345, Saudi Arabia
Jerry Jose: Private Practice, Ernakulam District, Aluva 683106, Kerala, India
Kumar Chandan Srivastava: Oral Medicine and Radiology, Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka 72345, Saudi Arabia

IJERPH, 2022, vol. 19, issue 11, 1-15

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: endodontics; disinfection; EDTA; herbal agents irrigants; smear layer; root canal treatment; natural components (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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