Effect of smear layer removal on the diffusion of calcium hydroxide through radicular dentin

Forty single-rooted teeth were sectioned transversely through the cementoenamel junction and instrumented to a size #50 K-Flex file at the working length by saline irrigation. Each root was placed in a dilution vial containing 10 ml of normal saline, and the pH and Ca2+ levels were recorded after 24 h. The roots in group 1 then received a final irrigation with 20 ml of normal saline. Group 2 received a final irrigation with 10 ml of 17% ethylenediaminetetraacetic acid followed by 10 ml of 5.25% NaOCl to remove the smear layer. Group 3 was irrigated in the same manner as group 2, but calcium hydroxide (CH) was placed into the root canal. Group 4 was irrigated with 20 ml of NaOCl, and CH was placed into the root canal. The pH and Ca2+ levels were recorded at 1, 3, 5, and 7 days. After 7 days a 3- x 3- x 1-mm external defect was created in the coronal one third of the root surface. The pH and Ca2+ levels were subsequently recorded at 1, 3, and 7 days. Groups 3 and 4 demonstrated significantly higher H+ and Ca2+ levels than did groups 1 and 2 three days after CH placement and at all subsequent intervals. Group 3 demonstrated significantly higher H+ and Ca2+ readings at some but not all intervals. The results demonstrated that CH diffuses from the root canal to the exterior surface of the root and that the removal of the smear layer may facilitate this diffusion.