Maleic acid as a root canal irrigant- a scoping review

Area of Science:

• Endodontics
• Dental Materials Science
• Biomaterials

Background:

• Root canal treatment (RCT) necessitates effective smear layer removal for optimal sealing and reduced microbial contamination.
• Ethylenediaminetetraacetic acid (EDTA) is a common chelator but has limitations, particularly in the apical root canal regions.
• Maleic acid (MA) is emerging as a promising alternative due to its demineralizing and adhesion-promoting properties.

Purpose of the Study:

• To evaluate maleic acid's efficacy in root canal therapy.
• Emphasis on smear layer removal, antimicrobial activity, dentin interactions, and dental material compatibility.

Main Methods:

• Systematic review adhering to PRISMA-ScR guidelines.
• Searched major databases (PubMed, Scopus, Embase, Web of Science) up to October 2024.
• Included 71 studies comparing MA with other irrigants (EDTA, citric acid) based on PICO criteria.

Main Results:

• 7% MA demonstrated superior smear layer removal in the apical third compared to 17% EDTA.
• MA enhanced dentin wettability, sealer penetration, bond strength, and removal of intracanal medicaments.
• MA showed moderate antimicrobial activity alone but improved with combinations; it negatively affected dentin microhardness and calcium silicate-based materials.

Conclusions:

• Maleic acid (MA) offers superior apical smear layer removal and advantages in adhesion and regeneration.
• Controlled application (1-3 min) is recommended to balance benefits and risks.
• MA is a promising, less cytotoxic alternative to EDTA, requiring standardized protocols and in vivo validation for clinical integration.