Effects of chelating agents and sodium hypochlorite on mineral content of root dentin

Comparison of different irrigants on calcium hydroxide medication removal: microscopic cleanliness evaluation

Calcium hydroxide dressing residuals can compromise endodontic sealing. This study evaluated the cleaning efficacy of different endodontic irrigants in removing calcium hydroxide by SEM image analysis. Fifty-four single-rooted mandibular premolars were instrumented to a master apical file #60 and dressed with calcium hydroxide. After 36 hours, the teeth were reopened and Ca(OH)(2) medication was removed by 5 different experimental groups: 0.5% NaOCl (G1), EDTA-C (G2), citric acid (G3), EDTA-T (G4), and re-instrumentation with MAF using NaOCl and lubrificant, followed by EDTA-T (G5). The roots were split in the buccal-lingual direction and prepared for SEM analysis in cervical, middle, and apical thirds (9, 6, and 3mm from the apex). Five blinded examiners evaluated the wall cleanliness using a scale from 1 to 5. Statistical analysis was performed using Kruskal-Wallis at 5% level of significance. Group G5 had the best results in all thirds, with significant statistical differences compared to all other groups in the middle and coronal third, and to G1 in the apical third. On the other hand, G1, only flushed with NaOCl, had the worst results, with statistical differences in all thirds compared to the other groups. The best cleanliness was achieved by G4 and G5 groups. The recapitulation of MAF in combination with irrigants improved the removal of calcium hydroxide medication better than an irrigant flush alone.

Influence of different volumes of EDTA for final rinse on smear layer removal

OBJECTIVE

The aim of this study was to analyze the influence of different volumes of 17% EDTA for final rinse on smear layer removal on the different areas of the root canal.

STUDY DESIGN

Forty single-rooted teeth were instrumented using rotary instruments. The teeth were divided into 3 test groups according to the EDTA volume for final rinse (5 mL, 10 mL, 15 mL) and 1 control group (10 mL of 1% sodium hypochlorite). The roots were axially split into halves, and the smear layer removal from the canals was determined under scanning electron microscope. The data were analyzed using Kruskal Wallis and Dunn tests.

RESULTS

The 3 experimental groups showed no statistical difference (P > .05); however, when the test groups were compared to the control group statistically significant differences were found (P < .01). The root canal wall surfaces of teeth in the control group showed the presence of heavy smear layer through the entire length of the root canals. The other groups showed mainly smear layer-free surfaces or a small amount of debris. When coronal, middle and apical thirds were compared, there was no statistically significant difference (P > .05).

CONCLUSIONS

Based on the results, it appears that a final rinse with 5 mL of EDTA per canal provides good smear layer removal, with root canal walls free of debris and mostly open dentinal tubules in all areas.

Analysis of the interface zone between the glass ionomer and enamel and dentin of primary molars

Restoring carious teeth is one of the major dental treatment needs of young children. Conventional glassionomer materials are frequently used as filling materials in contemporary pediatric dentistry. The objective of this study was to evaluate the restorative and prophylactic efficacy of the newly marketed glass ionomer, Fuji Triage (GC, Tokyo, Japan), through morphological analysis of the interface zone between the material and the enamel and the dentin of primary molars and to determine the extent of the ion exchange at the interface zone. The sample consisted of 5 extracted intact first primary molars in which glassionomer had been used as filling material after standard class I cavity preparation. The material was placed according to the manufacturer's instructions and teeth were placed into dionised water prior to experiment. Six sections of each tooth had been examined using scanning electron microscopic and electron dispersive spectroscopic techniques (SEM/EDS). The parameters for evaluation included: morphological characteristics of the interface zone and the extent of the ion exchange between the material and the tooth structures Results were statistically analyzed using descriptive statistical methods. SEM/EDS analysis revealed the presence of the chemical bonding between the glass ionomer and the enamel and dentin, 5 and 15 ?m in width, respectively. Ion exchange has not been detected in the enamel at the EDS sensitivity level. Strontium and fluor penetration has been detected in dentin. The ion exchange and chemical bonding formation justify the usage of the conventional glass ionomer materials for restorative procedures in primary molars.

Effects of chlorhexidine and sodium hypochlorite on the microhardness of root canal dentin

OBJECTIVE

The purpose of this study was to evaluate the effects of endodontic irrigants on the microhardness of root canal dentin.

STUDY DESIGN

Thirty extracted single-rooted human teeth were used. The crowns were sectioned at the cementoenamel junction. Each root was transversely sectioned into cervical, middle, and apical segments, resulting in 90 specimens. The 3 sections of each root were separately mounted in an individual silicon device with acrylic resin. The specimens were randomly divided into the following 3 groups (n = 30), according to the irrigant solution used: (1) group 1, control (saline solution); (2) group 2, 2% chlorhexidine gluconate solution; and (3) group 3, 1% sodium hypochlorite (NaOCl). After 15 minutes of irrigation, dentin microhardness was measured on each section at 500 microm and 1000 microm from the pulp-dentin interface with a Vickers diamond microhardness tester in Vickers hardness number (VHN).

RESULTS

Data obtained were analyzed using analysis of variance and the Tukey test (5%). Specimens irrigated with 2% chlorhexidine (group 2) or 1% NaOCl (group 3) presented lower values of dentin microhardness, with significant difference in relation to the control group (P < .05).

CONCLUSION

It could be concluded that chlorhexidine and NaOCl solutions significantly reduced the microhardness of root canal dentin at 500 microm and 1000 microm from the pulp-dentin interface.

Effect of sodium hypochlorite on human root dentine – mechanical, chemical and structural evaluation

AIM

To investigate the mechanical, chemical and structural alterations of human root dentine following exposure to ascending sodium hypochlorite concentrations.

METHODOLOGY

Three-point bending tests were carried out on standardized root dentine bars (n = 8 per group, sectioned from sound extracted human third molar teeth) to evaluate their flexural strength and modulus of elasticity after immersion in 5 mL of water (control), 1% NaOCl, 5% NaOCl or 9% NaOCl at 37 degrees C for 1 h. Additional dentine specimens were studied using microelemental analysis, light microscopy following bulk staining with basic fuchsin, and scanning electron microscopy (SEM). Numerical data were compared using one-way ANOVA. Bonferroni's correction was applied for multiple testing.

RESULTS

Immersion in 1% NaOCl did not cause a significant drop in elastic modulus or flexural strength values in comparison to water, whilst immersion in 5% and 9% hypochlorite reduced these values by half (P < 0.05). Both, carbon and nitrogen contents of the specimens were significantly (P < 0.05) reduced by 5% and 9% NaOCl, whilst 1% NaOCl had no such effect. Exposure to 5% NaOCl rendered the superficial 80-100 mum of the intertubular dentine permeable to basic fuchsin. Three-dimensional SEM reconstructions of partly demineralized specimens showed NaOCl concentration-dependent matrix deterioration. Backscattered electron micrographs revealed that hypochlorite at any of the tested concentrations left the inorganic dentine components intact.

CONCLUSIONS

The current data link the concentration-dependent hypochlorite effect on the mechanical dentine properties with the dissolution of organic dentine components.

The effect of EDTA, EGTA, EDTAC, and tetracycline-HCl with and without subsequent NaOCl treatment on the microhardness of root canal dentin

OBJECTIVE

The purpose of this study was to evaluate the effect of single and combined use of ethylenediamine tetra acetic acid (EDTA), ethylene glycol bis [b-aminoethylether] N,N,N',N'-tetraacetic acid (EGTA), EDTA plus Cetavlon (EDTAC), tetracycline-HCl, and NaOCl on the microhardness of root canal dentin.

STUDY DESIGN

The crowns of 30 single-rooted human teeth were discarded at the cementoenamel junction and the roots were bisected longitudinally to obtain root halves (N = 60). The specimens were embedded in autopolymerizing acrylic resin, leaving the root canal dentin exposed. Dentin surfaces were prepared for microhardness test by grinding and polishing. The reference microhardness values of untreated specimens were recorded using a Vicker's microhardness tester at the apical, midroot, and cervical levels of the root canal. Thereafter, the specimens treated with single (test solution only) or combined (test solution, followed by 2.5% NaOCl) versions of the irrigants for 5 minutes. Posttreatment microhardness values were obtained as with initial ones. Statistical comparisons between the test groups and among single and combined treatments were carried out using 2-way ANOVA with repeated measures (P =.05). Comparisons within each group with respect to application regions were made with Friedman's nonparametric 2-way analysis of variance at the same level of significance.

RESULTS

All treatment regimens except distilled water significantly decreased the microhardness of the root canal dentin (P < . 05). The single and combined use of EDTA decreased the microhardness of the root canal dentin significantly more than all other treatment regimens (P < .05). Compared with their single-treatment versions, all combined treatment regimens decreased the mean microhardness values significantly (P < .05). A comparison of single and combined treatment regimens revealed significant decreases only for EDTA and EDTA + NaOCl in the coronal region and for EDTAC and EDTAC + NaOCl in the apical and middle regions of the root canal (P < .05).

CONCLUSIONS

The use of EDTA alone or prior to NaOCl resulted in the maximum decrease in dentin microhardness. The softening effect of subsequent NaOCl treatment was both material and region dependent. However, for combined treatment regimens, subsequent use of NaOCl levels the statistical differences between the regional microhardness values obtained after treatment with EGTA, EDTAC, and tetracycline-HCl.

Calcium Loss From Root Canal Dentin Following EDTA, EGTA, EDTAC, and Tetracycline-HCl Treatment With or Without Subsequent NaOCl Irrigation

The aim of this study was to determine the extent of calcium removal on root canal dentin after 17% EDTA, 17% EGTA, 15% EDTAC, and 1% tetracycline-HCl treatment; with or without subsequent use of 2.5% NaOCl. Extracted single-rooted human teeth were bisected longitudinally and the root halves (n=100) were isolated with nail varnish, leaving the root canal exposed. The samples were immersed in the test solutions for 1 and 5 minutes, after which the amount of calcium ion (Ca(2+)) release into the solutions was determined by flame photometry. Regardless of treatment time, all single (treatment solution only) and combined (treatment solution with subsequent NaOCl application) irrigation regimens removed significantly more Ca(2+) than control treatment (distilled water). Compared with other groups, treatment with 17% EDTA and 17% EDTA + 2.5% NaOCl resulted in the maximum amount of Ca(2+) removal from root canal dentin (p<0.05). All combined-treatment groups except 17% EGTA + 2.5% NaOCl removed significantly more Ca(2+) than their single-treatment versions (p<0.05). Within each test group, extending the treatment time to 5 minutes resulted in significantly more Ca(2+) removal (p<0.05).

Evaluation of the surface free energy on root canal dentine walls treated with chelating agents and NaOCl

AIM

To evaluate ex vivo the effects of combined and single use of EDTA, RC-Prep and NaOCl on the surface free energy of canal wall dentine using the captive bubble technique.

METHODOLOGY

Eighteen extracted human pre-molar teeth were sectioned at the crown and the apical third, the remaining mid-root portion were bisected longitudinally. Thereafter, the root halves were embedded in resin blocks that exposed the dentine surface of the canal wall. The specimens were randomly assigned to six experimental groups (n = 6) after polishing. The root dentine surfaces of the first two groups were treated with 17% EDTA or RC-Prep followed by 2.5% NaOCl irrigation. Groups 3, 4 and 5 were treated with either 17% EDTA, RC-Prep or 2.5% NaOCl alone. Control specimens were irrigated with saline solution. The surface free energies of experimental groups were calculated by measuring air and octane contact angles on the canal wall dentine. Statistical analysis was performed using the Mann-Whitney U and Bonferroni post-tests at P = 0.05.

RESULTS

Compared with the control group; combined and single use of EDTA, RC-Prep and NaOCl irrigation significantly decreased the surface free energy of canal wall dentine surfaces (P < 0.05). Among all groups tested, the use of NaOCl as a final flush following RC-Prep treatment yielded increased wettability. Nevertheless, this value remained lower than that of the control group.

CONCLUSION

Use of chelating agents alone or in combination with NaOCl decreased the wettability of root canal wall dentine.

Prophylactic efficiency of glass-ionomer fissure sealant

One of the most efficient prophylactic measures in caries prevention is sealing pits and fissures. After improvements of physical and mechanical properties, glass-ionomers are frequently used as sealing materials. The aim of this study was to evaluate the prophylactic efficiency of Fuji VII, a glass-ionomer fissure sealant, through adaptation ability and fluoride reeasing potential assessment using scanning electron microscopic and energy dispersive spectroscopic techniques. The sample consisted of 20 extracted intact human teeth, 10 premolars and 10 molars. Six sections of each tooth were analyzed using SEM. EDS analysis was conducted one week and three months after material placement. The parameters used for the evaluation included: adaptation ability, penetration depth, material structure, integrity of the interfacial zone and ion exchange extent. The sealant penetration depth was observed at 30 X magnification, and the interfacial zone between the material and the enamel at 500-10000 X. EDS was used for quantitative analysis of the material structure, interfacial zone and the enamel surface. The results were statistically analyzed the using chisquare test and descriptive statistical methods. SEM analysis revealed the zone of interaction between the enamel surface and the glass-ionomer with predominant cohesive failures within the sealant material, and satisfactory adaptation ability of the sealing material. The mean value of the penetration was 83% of the total fissure depth, without a statistically significant difference between the tested teeth groups. A lower penetration ability was observed in deep pits and fissures with a larger diameter of unfilled space (p<0.05). EDS analysis revealed the potential of the glass-ionomer for ion exchange with dental tissues. The presence of fluoride ions was detected in 2 sections 3 months after material placement. Glass-ionomers, chemically cured, biocompatible materials demonstrate satisfactory prophylactic characteristics.

Effect of Root Canal Treatments on Quartz Fiber Posts Bonding to Root Dentin

The aim of this study was to evaluate the effect of irrigants and endodontic sealers on fiber post push-out strength in both fatigue cycling and no-cycling conditions. Fifty single-rooted human teeth received five endodontic treatments. The posts were cemented using a flowable composite and a three-steps adhesive. Five specimens from each group were subjected to 2 x 10(6) cycles of 37.5 N. There were 200 sections obtained for the push-out test. Fatigue cycled groups treated with an eugenol-containing sealer showed the lowest push-out strength (p < 0.001). No significant differences were found among no-cycled groups (p = 0.665). The post-cement interface was found to be weaker than the cement-dentin one. However, fatigue cycles increased the occurrence of cement-dentin failures (p = 0.001). The eugenol-containing sealer reduced the bonding of fiber posts when mechanically cycled, thus the use of a resin-based sealer is advisable.

Effects of Endodontic Irrigation Solutions on Mineral Content of Root Canal Dentin Using ICP-AES Technique

The aim of this in vitro study was to evaluate mineral content of root canal dentin after treatment with several endodontic irrigation solutions. Sixty mandibular anterior teeth extracted for periodontal reasons used. The crowns of the teeth were removed at the cemento-enamel junction. Pulp tissues were removed and the teeth were randomly divided into six groups including 10 teeth each. Root canals were enlarged with gates-glidden burs (# 1, 2, and 3). The groups were treated as follows: group 1, 0.2% chlorhexidine gluconate for 15 min; group 2, 3% H2O2 for 15 min; group 3, 17% EDTA for 15 min; group 4, 5.25% NaOCl for 15 min; group 5, 2.5% NaOCl for 15 min; and group 6, distilled water (control). Dentin chips were obtained using gates-glidden burs (# 4, 5, and 6). The levels of five elements calcium, phosphorus, magnesium, potassium, and sulfur in each specimens were analyzed using ICP-AES (Inductively Coupled Plasma Atomic Emission Spectrometry) technique. Changes in the levels of the chemical elements were recorded. The results were then statistically analyzed by one-way ANOVA and Tukey tests. There was a significant decrease in the calcium and phosphorus levels after treatment with all irrigation solutions except for 5.25% NaOCl when compared with the control group (p < 0.05). The K, Mg, and S level changes were not statistically significant (p > 0.05). It has been concluded that endodontic irrigation solutions have an effect on mineral contents of root dentin.

Effect of a low-concentration EDTA solution on root canal walls: a scanning electron microscopic study

OBJECTIVES

The aim of this study was to evaluate, in vitro, the ability of an 8% EDTA solution to remove debris and smear produced during root canal preparation.

STUDY DESIGN

Single-rooted human teeth were used for this experiment. All root canals were instrumented in a similar fashion and irrigated with a 3.5% NaOCl solution. The teeth were divided into 6 groups. According to the groups, various final flushes were performed with a 15% or 8% EDTA solution for 1 or 3 min and with or without saline rinsing. After preparation, roots were separated into 3 thirds and each third was observed by SEM. Debris (D) and root canal smear (S) was evaluated twice.

RESULTS

The results were subjected to ANOVA. The D and S scores for all test groups were statistically different from the control group without EDTA flush (P = .0001). The lowest D and S scores were obtained by a 3 min rinse with 8% EDTA solution and a statistical difference was observed in the apical third (P < .05).

CONCLUSION

Under these in vitro conditions, 3 min 8% EDTA irrigation is as effective as 1 min 15% EDTA irrigation.

Effect of Sodium Hypochlorite on Dentin Microhardness

This study was designed to evaluate the effect on root dentin microhardness of 2.5% and 6% sodium hypochlorite solutions for various irrigation periods. Forty-two bovine roots were divided into seven groups. The control group was irrigated with saline. The experimental samples were continuously irrigated with 2.5% or 6% NaOCl for 5, 10, or 20 min. Microhardness was measured at depths of 500 mum, 1000 mum, and 1500 mum from the lumen. A decrease in microhardness was found at 500 mum between the control and samples irrigated with 6% NaOCl and 2.5% NaOCl (p = 0.352, p = 0.084 respectively) at all irrigation periods. There also was a significant difference in groups irrigated for 10 or 20 min (p = 0.001, p < 0.001 respectively). At all distances, the decrease in microhardness was more marked after irrigation with 6% NaOCl than 2.5% NaOCl.

Evaluation of the Effect of Endodontic Irrigation Solutions on the Microhardness and the Roughness of Root Canal Dentin

The purpose of this study was to evaluate the effect of 0.2% chlorhexidine gluconate on the microhardness and roughness of root canal dentin compared with widely used irrigation solutions. Ninety, mandibular, anterior teeth extracted for periodontal reasons were used. The crowns of the teeth were removed at the CEJ. The roots were separated longitudinally into two segments, embedded in acrylic resin, and polished. A total of 180 specimens were divided into 6 groups of 30 teeth at random according to the irrigation solution used: group 1: 5.25% NaOCl for 15 min; group 2: 2.5% NaOCl for 15 min; group 3: 3% H2O2 for 15 min; group 4: 17% EDTA for 15 min; group 5: 0.2% chlorhexidine gluconate for 15 min; and group 6: distilled water (control). Each group was then divided into 2 subgroups of 15 specimens: groups 1a, 2a, 3a, 4a, 5a, and 6a were submitted to Vickers microhardness indentation tests; groups 1b, 2b, 3b, 4b, 5b, and 6b were used for determination of the roughness of root dentin. The data were recorded as Vickers numbers and Ra, microm for roughness test. The results were analyzed statistically by using one-way ANOVA and Tukey tests. The results indicated that all the irrigation solutions except chlorhexidine significantly decreased microhardness of root canal dentin (p < 0.05); 3% H2O2 and 0.2% chlorhexidine gluconate had no effect on roughness of the root canal dentin (p > 0.05). Although there are many other factors for irrigation solution preference, according to the results of this study, 0.2% chlorhexidine gluconate seems to be an appropriate endodontic irrigation solutions because of its harmless effect on the microhardness and roughness of root canal dentin.

Surface debris of canal walls after post space preparation in endodontically treated teeth: a scanning electron microscopic study

PURPOSE

To evaluate surface cleanliness of root canal walls along post space after endodontic treatment using 2 different irrigant regimens, obturation techniques, and post space preparation for adhesive bonding.

STUDY DESIGN

Forty teeth, divided into 4 groups, were instrumented, using Ni-Ti rotary files, irrigated with NaOCl or NaOCl+EDTA and obturated with cold lateral condensation (CLC) or warm vertical condensation (WVC) of gutta-percha. After post space preparation, etching, and washing procedure, canal walls were observed using a scanning electron microscope (SEM). Amount of debris, smear layer, sealer/gutta-percha remnants, and visibility of open tubules were rated.

RESULTS

Higher amounts of rough debris, large sealer/gutta-percha remnants, thick smear layer, and no visibility of tubule orifices were recorded in all the groups at apical level of post space. At middle and coronal levels areas of clean dentin, alternating with areas covered by thin smear layer, smaller debris, gutta-percha remnants, and orifices of tubules partially or totally occluded by plugs were frequently observed.

CONCLUSIONS

After endodontic treatment, obturation, and post space preparation SEM analysis of canal walls along post space shows large areas (covered by smear layer, debris, and sealer/gutta-percha remnants) not available for adhesive bonding and resin cementation of fiber posts.

Chelating agents in root canal treatment: mode of action and indications for their use

Chelating agents were introduced into endodontics as an aid for the preparation of narrow and calcified root canals in 1957 by Nygaard-Østby. A liquid solution of ethylenediaminetetraacetic acid (EDTA) was thought to chemically soften the root canal dentine and dissolve the smear layer, as well as to increase dentine permeability. Although the efficacy of EDTA preparations in softening root dentine has been debated, chelator preparations have regained popularity recently. Almost all manufacturers of nickel-titanium instruments recommend their use as a lubricant during rotary root canal preparation. Additionally, a final irrigation of the root canal with 15-17% EDTA solutions to dissolve the smear layer is recommended in many textbooks. This paper reviews the relevant literature on chelating agents, presents an overview of the chemical and pharmacological properties of EDTA preparations and makes recommendations for their clinical use.

Decalcifying effect of EDTA-T, 10% citric acid, and 17% EDTA on root canal dentin

OBJECTIVE

An in vitro study was conducted to determine the efficacy of 17% EDTA plus 1.25% sodium lauryl ether sulfate (EDTA-T), 10% citric acid, and 17% EDTA with respect to Ca(++) extraction.

STUDY DESIGN

The root canals of 90 extracted human canines were instrumented by using the step-back technique. The teeth were randomly divided into 9 groups of 10 teeth each according to the solution and time intervals involved (ie, 3, 10, and 15 minutes). The Ca(++) concentration of the solution was determined by using atomic absorption spectroscopy.

RESULTS

At 3 minutes, there was no significant difference between Ca(++) extraction by 10% citric acid and 17% EDTA (P >.05). EDTA-T had the least efficacy for Ca(++) extraction (P <.05). At 10 minutes and 15 minutes, there were no significant differences between 10% citric acid and 17% EDTA or between EDTA-T and 17% EDTA (P >.05). However, 10% citric acid was significantly better than EDTA-T in terms of Ca(++) extraction (P <.05).

CONCLUSION

Both 10% citric acid and 17% EDTA are good decalcifying agents when the step-back technique is used.