The influence of smear layer removal on primary tooth pulpectomy outcome: a 24-month, double-blind, randomized, and controlled clinical trial evaluation.
BACKGROUND
The effect of smear layer (SL) removal on primary tooth pulpectomy outcome has not been well elucidated.


OBJECTIVE
To determine the effect of SL removal on primary tooth pulpectomy outcome.


METHODS
This is a double-blind, randomized, and controlled clinical trial. Forty-eight patients were randomly divided into SL removal (G1 = 40 teeth) or smear layer nonremoval (G2 = 42 teeth) groups. Following the chemomechanical preparation with K-files and 2.5% sodium hypochlorite (NaOCl), teeth were irrigated with either 6% citric acid and 0.9% physiologic solution (G1) or only 0.9% physiologic solution (G2). Camphorated paramonochlorophenol was used as intracanal medication. At the second appointment, 1 week after, root canals were filled with zinc oxide-eugenol paste. Clinical and radiographical baseline criteria were stipulated equally for both groups.


RESULTS
The success rate (G1 = 91.2%; G2 = 70.0%) was statistically different (P = 0.04) between the groups. In G2, the outcome was affected significantly by pulpal necrosis (P = 0.02), pre-operatory symptoms (P = 0.02), and periapical/inter-radicular radiolucency (P = 0.04).


CONCLUSIONS
The pulpectomy outcome was improved by smear layer removal. The outcome for teeth with pulpal necrosis, pre-operatory symptoms, or periapical/inter-radicular radiolucency was significantly improved by removal of the smear layer.
Department of Specific Formation, School of Dentistry, Federal Fluminense University (UFF), Nova Friburgo, Brazil. rbarcelos@vm.uff.br
Roberta
R
Barcelos
Patricia Nivoloni
PN
Tannure
Rogerio
R
Gleiser
Ronir Raggio
RR
Luiz
Laura Guimarães
LG
Primo
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D019343:Citric Acid / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D011670:Pulpectomy / Q000379:methods*; D011859:Radiography; D012388:Root Canal Irrigants / Q000627:therapeutic use*; D018915:Root Canal Preparation / Q000379:methods*; D016369:Smear Layer; D012965:Sodium Chloride / Q000627:therapeutic use; D012973:Sodium Hypochlorite / Q000627:therapeutic use; D014094:Tooth, Deciduous / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
D004338:Drug Combinations; D012388:Root Canal Irrigants; D019343:Citric Acid; D012965:Sodium Chloride; D012973:Sodium Hypochlorite