When we instrument on root surfaces, we leave behind a smear layer. It’s composed of residual calculus, cementum, bacteria, and bacterial-derived products that cover the root surface in the thickness of 1 and 5 µm, depending on the instrument used.
The smear layer is amorphous, granular, and irregular. An analogy of the smear layer is when someone uses a saw, shards of wood fly everywhere, causing a layer of sawdust to cover everything. Imagine trying to attach a piece of tape to a surface that is covered with sawdust; it won’t adhere as well as to a clean surface.
The same applies to the healing of the periodontium. The smear layer acts as a barrier between periodontal tissues and the root surface; it inhibits blood clot adhesion, reduces cell attachment to the root surface, prevents formation of new connective tissues insertions, and harbors bacteria for regrowth.3 If we remove the smear layer, it can facilitate periodontal tissue reattachment.
How is a smear layer removed? It’s removed through a strong chelator or with an acid. Several products have been tested, such as citric acid, tetracycline, or EDTA, but they did not show any additional clinical benefits. Another study used a scanning electron microscope to evaluate root surfaces after use with sodium hypochlorite (Perisolv), silver nanoparticles (Perioflush), and HybenX (Epien Medical). It was found that removal of the smear layer from root surfaces was more efficiently done with HybenX than the other agents, which facilitates periodontal tissue reattachment at the intervention sites.
Removal of the smear layer through root conditioning with HybenX is used as an adjunct to mechanical root surface instrumentation to create a more biocompatible surface for early cell migration, attachment, cell-matrix interaction, fiber development, and periodontal regeneration. This results in the formation of a long junctional epithelium on the root surface.
HybenX is a desiccant agent formulated as a liquid or gel containing an aqueous mixture of 60% sulfonated phenolics, 28% sulfuric acid, and 12% water. It acts not only as a root conditioner, but a product that dehydrates or desiccates the biofilm, shrinks the extracellular biofilm matrix, coagulates bacteria, and detaches the biofilm from the root and gingival surfaces while cauterizing soft tissues.
It is FDA cleared as a medical device and is a successful adjunct to periodontal therapies. One study followed the therapeutic results for one year and found that when the desiccant HybenX was combined with SRP, there was a significant decrease in pocket depths compared to periodontal therapy alone. Check it out in action in these Hygiene Edge videos to see if it is right for your practice
Hygiene Edge was created by three dental hygiene educators who love both dentistry and education. With over 40 years of experience both in the education space and in the dental field, Melia Lewis, Jessica Atkinson, and Shelley Brown love sharing their knowledge through helpful, short videos online, speaking, and working with amazing companies. You can find more information at Hygiene Edge, on YouTube, and Instagram @hygieneedge. Have a question or a tricky area? Let us know! We'd love to help.
