Effects of smear layer removal agents on the physical properties and microstructure of mineral trioxide aggregate cement.

OBJECTIVE: To compare the effect of QMix (Dentsply Sirona), 7% maleic acid (MA), and 17% ethylenediaminetetraacetic acid (EDTA) on the microhardness, flexural strength and microstructure of mineral trioxide aggregate (MTA; ProRoot MTA, Dentsply Sirona). METHODS: Forty MTA specimens were divided into four groups: [I] QMix [II] 7% MA [III] 17% EDTA and [IV] distilled water (control). After treatment with 5mL of the respective solution for 1min, the specimens were tested for microhardness using a Knoop hardness tester. Forty additional specimens were similarly treated and evaluated for the flexural strength using a universal testing machine. For microstructure evaluation, MTA specimens were treated in a similar manner and examined by X-ray diffractometry and scanning electron microscopy (SEM). RESULTS: For microhardness, there were no differences between distilled water, QMix and EDTA groups. However, MTA exposed to distilled water had higher microhardness than MA. When compared with QMix and EDTA, MA had lower microhardness; there was no difference between EDTA and QMix. For flexural strength, distilled water group had higher flexural strength than the other agents. There were no differences between EDTA vs MA and EDTA vs QMix. Specimens treated with QMix had higher flexural strength than MA. X-ray diffraction indicated that EDTA inhibited hydration of MTA. For SEM, all the tested agents altered the microstructure of MTA when compared to distilled water. CONCLUSION: MA had more detrimental effect on the physical properties of MTA and EDTA was more detrimental to the hydration of MTA. CLINICAL SIGNIFICANCE: The present study highlights the effect of newer chelating agents on the physical properties and microstructure of MTA. Preventing the deterioration of MTA is important for its long term success in endodontic procedures.