ISSN- O: 2458 - 868X, ISSN–P: 2458 – 8687

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International Journal of Medical Science and Innovative Research (IJMSIR)

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Volume – 4, Issue – 1, February - 2019, Page No. : 214 - 219

Chelating Agents In Endodontics :An Overview

1
Farheen Akhtar , Bonny Paul , 3Mantri Shivkumar , 2Kavita Dube , 4Charu Kapur 1Ankita, 1Niharika Singh
2

1
Post Graduate, Department of Conservative dentistry and Endodontics, Hitkarini Dental College, Jabalpur, M.P, India.
2
Professor, Department of Conservative dentistry and Endodontics, Hitkarini Dental College, Jabalpur, M.P, India.
3
Professor and Head, Department of Conservative dentistry and Endodontics, Hitkarini Dental College, Jabalpur, M.P,
India.
4
Senior Lecturer, Department of Conservative dentistry and Endodontics, Hitkarini Dental College, Jabalpur, M.P, India.
Corresponding Author: Dr Bonny Paul, Professor, Department of Conservative dentistry and Endodontics, Hitkarini
Dental College, Jabalpur, M.P, India
Type of Publication: Review Article
Conflicts of Interest: Nil
Abstract important aid for successful endodontic treatment and
Chelating agents were developed in endodontics as an it is based on the use of chelating agent, irrigating
aid for preparation of narrow and calcified root canals. solutions and proper root canal instrumentation.[2] An
Clinically chelating agents are used along with amorphous ,irregular and granular layer is produced
irrigating solutions to facilitate root canal during biomechanical preparation. This layer is termed
instrumentation and to remove the smear layer. The as “smear layer” which contains inorganic debris,
main purpose for removal of the smear layer is to organic material like pulp tissue , necrotic debris,
eliminate the micro-organisms from the root canal and odontoblastic process , coagulated proteins, blood
disinfect the open dentinal tubules. Various chelating cells, nerve fibers, collagen, tissue fluid,
agents like EDTA , chitosan, peracetic acid, maleic microorganisms and their byproducts. Presence of
acid, citric acid and etidronate have potential to smear layer causes microleakage, acts as a barrier
maximize root canal disinfection. This article presents between canal walls and filling materials and reduces
an overview of chelating agents and focusing on its dentinal permeability.[3] There are many reasons for
relevance in endodontics. use of chelating agents along with irrigating solutions
Keywords: Chelating agents, Chitosan, Citric acid during biomechanical preparation such as removal of
Ethylenediaminetetraacetic acid, Etidronate, Maleic debris and inorganic phase of smear layer , difficulty
acid, Peracetic acid , Phytic acid. of penetration of the instruments in calcified root
Introduction canal, prepared in a dentinal walls for better adhesion
Endodontic treatment depends on access opening, of filling materials etc .[1] The efficiency of chelating
Page 214

cleaning and shaping , disinfection and sealing of the agent depends on various factors such as root canal
root canal.[1] Biomechanical preparation is an

Corresponding Author: Dr Bonny Paul, Volume – 4 Issue - 1, Page No. 214 - 219
Dr Bonny Paul, et al. International Journal of Medical Sciences and Innovative Research (IJMSIR)

length ,pH , hardness of the dentin ,duration of of EDTA is self limiting , non toxic ,colorless ,
[4]
application and concentration of chelating agents. biocompatible and water soluble solid . It acts as a
Several chelating agents has been introduced such as lubricant,chelator and decalcifying agent . It helps in
ethylenediaminetetraacetic acid (EDTA), peracetic bypassing of broken instrument . EDTA binds to
acid, etidronic, citric acid, maelic acid,phytic acid, metals with four carboxylate and two amine groups
chitosan . and forms strong complexes with
History of Development Of Chelators Mn(II),Cu(II),Fe(III) and Co(III). EDTA is the most
In 1951, Hahn & Reygadas , Screebny & Nikiforuk effective chelating agent in endodontic therapy.15-
were the first who reported the demineralizing effect 17% EDTA solution is recommended for final
[11]
of EDTA on dental hard tissues. In 1957, Nygaard- irrigation of the root canal. 17% EDTA is the most
Ostby were the first who introduced in endodontics common concentration used for endodontic therapy.
and who suggested the use of 15% EDTA solution (pH EDTA causes necrosis of pulp remnants ,inflammatory
7.3) with following composition reaction of periapical tissue and erosion of peritubular
 Disodium salt of EDTA (17.00g) and intertubular dentin .[5]
 Aqua dest.(100.00 ml) Endodontic smear layer has been formed during
 5M sodium hydroxide (9.25 ml) biomechanical preparation.The smear layer plays an
After a fews years detergent was added to increase important role in adhesion of root canal sealer and
cleaning and bactericidal capability of EDTA solution gutta percha to the root canal walls and apical leakage
. In 1963 Von der Fehr & Nygaard-Ostby introduced .In 1963,Nygaard-Ostby et al reported that EDTA
EDTAC. EDTAC is developed when EDTA is mixed decalcified dentin to a depth of 20-30 micrometer in
with 0.84g of quarternary ammonium compound 5min. Gin Chen et al in 2011 recommended liquid
(Cetavlon; Goldberg Abramovich ,1977) and the aim EDTA to be used as a final flushing solution during
of this addition is to reduce surface tension of the root canal preparation because it provides better
irrigant, facilitate wetting of root canal and increase smear layer removal before obturation.[19] SemraCalt et
ability to penetrate chelators in dentine. al suggested that EGTA be used as an alternative
Initially liquid chelator were used as irrigation during chelating agent. Based on the findings 10ml of 17%
biomechanical preparation of root canal. In 1969, EDTA would completely remove the smear layer and
Stewart et al introduced paste type chelating agent i.e EGTA was somewhat effective in removing the smear
RC-Prep(premier Dental ; Philadelphia, PA, USA).[5] layer but the results indicated that EDTA action is
Ethylenediaminetetraacetic Acid (EDTA) stronger than that of EGTA. Hengameh Ashraf et al in
EDTA is a polyaminocarboxylic acid. The chemical 2014 compared effectiveness of 17% EDTA with 18%
formula of EDTA is etidronate and Er: YAG in the removal of smear layer.
(HO2CCH2)2NCH2CH2N(CH2CO2H). The properties Findings revealed that 17% EDTA was effective in
215

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Dr Bonny Paul, et al. International Journal of Medical Sciences and Innovative Research (IJMSIR)

removal of smear layer than Er: YAG laser and 18% Crustacean shells involves the removal of proteins and
[16]
etidronate. dissolution of calcium carbonate . Chitosan have
Combination of EDTA and NaOCl was recommended excellent properties such as biodegradability
for effective removal of both organic and inorganic ,biocompatible ,non-toxicity and adsorption
components of smear layer[4]. Baumgartner and Mader .Chemical modifications, graft reactions ,ionic
et al revealed EDTA and NaOCl caused progressive interactions have been made to prepare functional
dissolution of peritubular and intertubular dentin , so derivatives of chitosan . Chitosan is only soluble in
the diameter of tubular orifices were enlarged to2.5 to aqueous solutions of such some acids and selective N-
4µm.Yamada et al suggested EDTA and NaOCl alkylidinations and N –acylation.Four steps has been
[18]
should be applied in 10ml of volume. Teixeria et al needed to produce chitosan from crustacean shells:
compared the combination of EDTA and NaOCl in 1, 1. Deproteinization
3 and 5 min application times and it was concluded 2. Demineralization
that 1 min application time of EDTA and NaOCl is 3. Decolouration
[17]
sufficient. EDTA maintained its ability to chelate 4. Deacetylation
calcium in presence of NaOCl whereas tissue Chemically chitosan are linear polymine. They have
dissolution property of NaOCl was reduced. When reactive amino and hydroxyl groups and chelates many
EDTA was added to NaOCl solution the content of transitional metal ions .Biologically chitosan are
free chlorine was reduced from 0.50-0.06% ,so the biocompatible and binds to mammalian and microbial
authors concluded EDTA and NaOCl were to be used cells aggressively. They have regenerative effect on
separately during instrumentation.[5] connective gum tissue and accelerates the formation of
Chitosan osteoblast responsible for bone formation. They also
Chitosan is a natural polysaccharide. It was obtained are hemostatic, fungistatic , spermicidal, antitumor,
by acetylation of chitin, which was found in shells of anticholesteremic, immunoadjuvant and central
crabs and shrimps (Kurita 1998). Chitosan is a nervous system depressant.
derivative of chitin and produced by deacetylation of The applications for chitosan are as follows-
[15]
chitin in high alkaline conditions . It is a linear 1. Medicine and pharmaceuticals (antibacterial and
polymer of α(1→4)-linked 2-amino-2-deoxy- β -D- antitumour agent ,drug carrier ,wound healing
glucopyranose. It is derived from N-deacetylation and accelerator)
characterized by the degree of deacetylation and 2. Biotechnology (enzyme and cell carrier
copolymer of N-acetylglucosamine and glucosamine. ,chromatography resin )
Glycol chitin and a partial o-hydroxyethylated chitin 3. Environment (water treatment)
were the first derivatives of chitosan. Chitosan is 4. Agriculture (seed preparation)
produced from crustacean shells and this crustacean 5. Cosmetics and food(iron and calcium absorption
216

shells contain quantities of astaxanthin and carotenoid. accelerator ,fibre source)[6]

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Dr Bonny Paul, et al. International Journal of Medical Sciences and Innovative Research (IJMSIR)

Etidronate capacity.[3][16] HEBP can be mixed chair side with

Bisphosphonate have a calcium chelating property and NaOCl without fearing any loss of NaOCl activity.[7]
have similar structure with pyrophosphate. The Citric Acid
structure of pyrophosphate can chelate the divalent Citric acid is another chelating agents which is used to
cations (Ca⁺²).It has strong remodelling bone eliminate smear layer after root canal preparation. 10-
affinity.The bone remodeling perform at three levels . 50% concentration of citric acid is used in endodontic
1. At tissue level – It decreases bone resorption and therapy. Zehnder et al proved that 10% concentration
number of formation of bone cells .So it can leads to citric acid was less toxic and effective for removal of
decrease in bone activity.So, positive bone balance is smear layer. Citric acid is used along with NaOCl so,
maintained. it reduces the availability of free chlorine and effect on
2. At cellular level –It decreases osteoclast in bacteria and organic tissue.[10] Citric acid reacts with
recruitment , increases the osteoclast apoptosis metal to form a nonionic soluble chelate. In operative
,decreased osteoclast adhesion , decrease in depth of dentistry citric acid has been proposed as a mild
resorption site, decreased in release of cytokines by the etchant for dental hard tissue, particularly for dentinal
macrophages and increase the number of osteoblast conditioning and enhanced smear layer and smear plug
and differentiation. removal(Hennequin et al ,1994).[8] It is also used in
3. At molecular level – It inhibits the mevalonate periodontal therapy for conditioning dentin.[15] Citric
pathway which is an important cellular metabolic acid is less cytotoxic. It is biocompatible to the tissue
pathway present in all higher eukaryotes and many and helps in cemenum formation and periodontal
bacteria. tissue regeneration.[12] Citric acid is a weak organic
Systemically bisphosphonates are administered in acid .
patients who are suffering from osteoclastic bone Peracetic Acid
resorption , neoplastic disease , osteoporosis, Pagets Peracetic acid has antibacterial, sporicidal, antifungal
disease , multiple myeloma ,breast cancer and prostate and antiviral properties. The explanation for
cancer. Now a days, it can be used as a chelating agent antibacterial properties is its oxidizing action which
because of fewer adverse effects on root dentin . It is a leads to denaturation of protein, disruption of cell
weak chelating agent. Etidronate is not only used as a membrane, sulfhydryl oxidation and formation of
chelating agent ,but also can be used in household , sulfur bonds in proteins, enzymes and other
personal products such as soap and toothpaste to metabolities.It has the potential to inactivate bacteria,
control calculus formation. Zehnder et al was the first fungi, yeast at low concentration etc. Peracetic acid
investigator who used etidronate for smear layer can be clinically advantageous for bacteriocidal effect
removal. Chelation effect of HEBP depends on and the removal of smear layer. Peracetic acid remains
concentration because it has constant calcium-binding in equilibrium with hydrogen peroxide, acetic acid and
217

acetylhydroperoxide. Acetic acid is responsible for

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Dr Bonny Paul, et al. International Journal of Medical Sciences and Innovative Research (IJMSIR)

removal of smear layer.2.25% Peracetic acid is References

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