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Susila AV, Sai S, Sharma N, Balasubramaniam A, Veronica AK, Nivedhitha S. Can natural irrigants replace sodium hypochlorite? A systematic review. Clin Oral Investig 2023; 27:1831-1849. [PMID: 36808559 DOI: 10.1007/s00784-023-04913-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/03/2023] [Indexed: 02/20/2023]
Abstract
CONTEXT Sodium hypochlorite, a gold standard for irrigation in endodontics, has disadvantages like toxicity and root dentin weakening. Alternatives derived from natural products are being explored. AIMS This systematic review was done to understand the clinical benefits of natural irrigants when compared with a standard irrigant, sodium hypochlorite. SETTINGS AND DESIGN REGISTRATION This systematic review was registered with PROSPERO (2018 CRD42018112837) METHODS AND MATERIAL: This review was done in conformation to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA 2020) statement. In vivo studies using at least one natural irrigant and sodium hypochlorite (NaOCl) were included. Studies using them as medicaments were excluded. PubMed, Cochrane and SCOPUS were searched. RevMan tool for Risk of Bias 2 (RoB 2) and risk-of-bias tool to assess non-randomized studies of interventions (ROBINS-I) were used. GRADEpro was used to assess certainty of evidence. RESULTS Ten articles (6 RCTs and 4 clinical studies) on approximately 442 patients were included. Seven natural irrigants were evaluated clinically. Due to the heterogeneity, meta-analysis could not be conducted. Antimicrobial efficacy was found to be similar for castor oil, neem, garlic-lemon, noni, papaine and NaOCl. Neem, papaine-chloramine, neem-NaOCl and neem-CHX were superior, while propolis, miswak and garlic were inferior to NaOCl. Post-operative pain was less for neem. There was no significant difference between papaine-chloramine, garlic extract and sodium hypochlorite in clinical/radiographic success. CONCLUSIONS The studied natural irrigants are not more efficacious than NaOCl. At the moment, they cannot replace NaOCl routinely and may only substitute in select cases.
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Affiliation(s)
- Anand Venkatraman Susila
- Department of Conservative Dentistry & Endodontics, Madha Dental College & Hospital, Somangalam, Kavanoor Road, Kundrathur, Chennai, Tamil Nadu, 600069, India.
| | - Shamini Sai
- Department of Conservative Dentistry & Endodontics, Madha Dental College & Hospital, Somangalam, Kavanoor Road, Kundrathur, Chennai, Tamil Nadu, 600069, India
| | - Nikita Sharma
- Department of Conservative Dentistry & Endodontics, Shree Bankey Bihari Dental College and Research Centre, Masuri, NH 24, Ghaziabad, Uttar Pradesh, India
| | - Arthi Balasubramaniam
- Department of Public Health Dentistry, Saveetha Dental College, Saveetha University, Chennai, Tamil Nadu, India
| | - Aruna Kumari Veronica
- Department of Conservative Dentistry & Endodontics, Madha Dental College & Hospital, Somangalam, Kavanoor Road, Kundrathur, Chennai, Tamil Nadu, 600069, India
| | - Sureshbabu Nivedhitha
- Department of Conservative Dentistry & Endodontics, Saveetha Dental College, Saveetha University, Chennai, Tamil Nadu, India
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Hachem CE, Nehme W, Kaloustian MK, Ghosn N, Daou M, Zogheib C, Karam M, Mhanna R, Macaluso V, Kharouf N, Chedid JCA. The Effectiveness of Different Irrigation Techniques on Debris and Smear Layer Removal in Primary Mandibular Second Molars: An In Vitro Study. J Contemp Dent Pract 2022; 23:1173-1179. [PMID: 37073943 DOI: 10.5005/jp-journals-10024-3440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
AIMS The aim of the present in vitro study was to compare the effectiveness of passive ultrasonic irrigation (PUI), sonic irrigation, and mechanic dynamic activation on the removal of debris and smear layer from primary mandibular second molars during pulpectomy. MATERIALS AND METHODS Mesial roots of 48 primary mandibular second molars were prepared with an R-motion 21 mm file (30/0.04) (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland), irrigated with 1% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), and divided into four groups (n = 24 canals) according to the final irrigation activation technique: control group without activation, PUI with Ultra-X (Eighteeth, Changzhou, China), mechanical activation with XP-endo Finisher (FKG), and sonic irrigation with EQ-S (Meta Biomed, Chungcheongbuk-do, Korea). The roots were split longitudinally and analyzed using scanning electron microscopy (SEM). The presence of debris and smear layer was assessed using a 5-grade scoring scale with 200× and 1000× magnification, respectively. The Kruskal-Wallis and Friedman tests were used for data analysis. RESULTS The activation of the irrigant significantly improved debris and smear layer removal (p < 0.001). There was no significant difference between Ultra-X, XP-endo Finisher, and EQ-S (p > 0.05). No activation technique was able to completely eliminate debris and smear layer from the root canals of primary mandibular second molars. CONCLUSIONS During pediatric pulpectomy, the irrigation protocol must include activation of the irrigation solutions using either ultrasonic, sonic, or mechanical activation techniques to enhance the removal of debris and smear layer for a better prognosis. CLINICAL SIGNIFICANCE During root canal treatment on primary teeth, the clinician must incorporate an activation technique in the irrigation protocol to enhance the removal of debris and smear layer and increase the success of the treatment.
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Affiliation(s)
- Claire El Hachem
- Department of Pediatric and Community Dentistry, Saint Joseph University, Beirut, Lebanon, Phone: +0096170107702, e-mail:
| | - Walid Nehme
- Department of Endodontics, Saint Joseph University, Beirut, Lebanon; Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, United States of America, Orcid: https://orcid.org/0000-0002-1589-1454
| | - Marc Krikor Kaloustian
- Department of Endodontics, Faculty of Dental Medicine, Saint Joseph University, Beirut, Lebanon, Orcid: https://orcid.org/0000-0002-0811-6935
| | - Nabil Ghosn
- Faculty of Dental Medicine, Craniofacial Research Laboratory, Saint Joseph University, Beirut, Lebanon, Orcid: https://orcid.org/0000-0003-1524-5310
| | - Maha Daou
- Faculty of Dental Medicine, Saint Joseph University, Beirut, Lebanon; McGill University, Montreal, Canada, Orcid: https://orcid.org/0000-0001-6882-9227
| | - Carla Zogheib
- Department of Endodontics, Faculty of Dental Medicine, Saint Joseph University, Beirut, Lebanon, Orcid: https://orcid.org/0000-0003-0857-6998
| | - Mia Karam
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon, Orcid: https://orcid.org/0000-0002-9783-3334
| | - Rami Mhanna
- Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon, Orcid: https://orcid.org/0000-0003-0345-625X
| | - Valentina Macaluso
- ESTA, School of Business & Technology, Belfort, France, Orcid: https://orcid.org/0000-0002-6503-9841
| | - Naji Kharouf
- Department of Biomaterials and Bioengineering, INSERM UMR_S1121, Strasbourg University, Strasbourg, France; Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, Strasbourg, France, Orcid: https://orcid.org/0000-0001-6768-138X
| | - Jean Claude Abou Chedid
- Department of Pediatric and Community Dentistry, Faculty of Dental Medicine, Saint Joseph University, Beirut, Lebanon, Orcid: https://orcid.org/0000-0001-5161-8693
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Elheeny AAH, Abdelmotelb MA. Postoperative pain after primary molar pulpectomy using rotary or reciprocating single files: A superior, parallel, randomized clinical trial. Int J Paediatr Dent 2022; 32:819-827. [PMID: 35152509 DOI: 10.1111/ipd.12959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
AIM To compare postoperative pain intensity between two single-file systems with different kinetics (the OneShape file with continuous rotation vs. the WaveOne Gold file with reciprocation movement) after primary molar pulpectomy. DESIGN This superiority, parallel, randomized clinical trial included 164 healthy children aged 6 to 8 years with asymptomatic, necrotic, maxillary primary second molars due to caries. An equal number of children were assigned to the two groups. The teeth of children in Group 1 were instrumented with the OneShape rotary system (Micro-Mega), whereas teeth of children in Group 2 were instrumented with the WaveOne Gold reciprocating system (Dentsply Maillefer). Postoperative pain intensity was assessed using a 4-point pain scale at 6, 12, 24, 48 and 72 h and 1 week after treatment. The parent of each participant received 6 flashcards that included four faces and a word describing each face. A chi-square test was used to compare postoperative pain intensity. The level of significance was set to 5%. RESULTS Over the follow-up period, no significant difference in postoperative pain intensity was found between the two groups (p > .05). Although the absolute risk reduction maximum limit of 95% CI equal or exceeded the predetermined proportional difference of 0.15, pain intensity was inconclusive at 6, 24, and 48 hours denoting that the superiority of the OneShape single-file over the WaveOne Gold single-file could not be declared. CONCLUSIONS Postoperative pain intensity associated with a rotary vs. reciprocating file system was nearly similar.
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Mahfouz Omer SM, Mohamed DA, Ali Abdel Latif RM. Comparative Evaluation of the Antibacterial Effect of Allium Sativum, Calcium hydroxide and Their Combination as Intracanal Medicaments in Infected Mature Anterior Teeth A Randomized Clinical Trial. Int Endod J 2022; 55:1010-1025. [DOI: 10.1111/iej.13801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Shaimaa Mohamed Mahfouz Omer
- Department of Pediatric Dentistry, Preventive Dentistry and Dental Public Health, Faculty of Dentistry Suez Canal University Egypt
| | | | - Reham Mohamed Ali Abdel Latif
- Department of Pediatric Dentistry, Preventive Dentistry and Dental Public Health, Faculty of Dentistry Suez Canal University Egypt
- Department of Restorative Dental Science, Vision Colleges Jeddah Saudi Arabia
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Does the use of natural products for endodontic therapy in primary teeth have sufficient evidence for clinical practice? A scoping review. Clin Oral Investig 2022; 26:6043-6060. [DOI: 10.1007/s00784-022-04633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022]
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Abd El Fatah YAM, Khattab NMA, Gomaa YF, Elheeny AAH. Cone-beam computed tomography analysis of primary root canals transportation and dentin loss after instrumentation with two-pediatric rotary files. BMC Oral Health 2022; 22:214. [PMID: 35641977 PMCID: PMC9153195 DOI: 10.1186/s12903-022-02245-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background This in vitro study aims to compare rotary files (Fanta and Zuanba) with manual K files according to the amount of dentin removed and canal transportation in primary mandibular second molars by CBCT images. Methods This experimental study was conducted on 60 extracted human second primary molars. That were divided into three groups according to root canal preparation group "I" instrumented with manual K-files, group "II" instrumented with rotary Fanta files, and group "III" instrumented with rotary Zuanba files. After root canal preparation, teeth were scanned before and after mechanical preparation with CBCT scanner. Then the amount of dentin removed was determined at three levels, including the coronal, middle and apical levels. Data were statically analysed using the Kruskal–Wallis test. Result No statistically significant difference in the amount of dentin removed were noted between the manual and the rotary groups at the coronal and apical RC levels (P = 0.420) and (P = 0.819) respectively but significant difference was noted at the middle third (P = 0.043). Regarding RC transportation, no significant difference was noted among the three groups with the exception of the apical RC level (P = 0.043). Conclusion Although no significant differences were noted between rotary and manual files, the rotary files showed better performance.
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Garlic ( Allium sativum L.) Bioactives and Its Role in Alleviating Oral Pathologies. Antioxidants (Basel) 2021; 10:antiox10111847. [PMID: 34829718 PMCID: PMC8614839 DOI: 10.3390/antiox10111847] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023] Open
Abstract
Garlic (Allium sativa L.) is a bulbous flowering plant belongs to the family of Amaryllidaceae and is a predominant horticultural crop originating from central Asia. Garlic and its products are chiefly used for culinary and therapeutic purposes in many countries. Bulbs of raw garlic have been investigated for their role in oral health, which are ascribed to a myriad of biologically active compounds such as alliin, allicin, methiin, S-allylcysteine (SAC), diallyl sulfide (DAS), S-ally-mercapto cysteine (SAMC), diallyl disulphide (DADS), diallyl trisulfide (DATS) and methyl allyl disulphide. A systematic review was conducted following the PRISMA statement. Scopus, PubMed, Clinicaltrials.gov, and Science direct databases were searched between 12 April 2021 to 4 September 2021. A total of 148 studies were included and the qualitative synthesis phytochemical profile of GE, biological activities, therapeutic applications of garlic extract (GE) in oral health care system, and its mechanism of action in curing various oral pathologies have been discussed. Furthermore, the safety of incorporation of GE as food supplements is also critically discussed. To conclude, GE could conceivably make a treatment recourse for patients suffering from diverse oral diseases.
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Abdelmotelb MA, Gomaa YF, Khattab NMA, Elheeny AAH. Premixed bioceramics versus mineral trioxide aggregate in furcal perforation repair of primary molars: in vitro and in vivo study. Clin Oral Investig 2021; 25:4915-4925. [PMID: 33483869 DOI: 10.1007/s00784-021-03800-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The current study was carried out to (1) evaluate premixed bioceramic (BC) and mineral trioxide aggregate (MTA) sealing properties in a laboratory and (2) compare the performance of these two materials in repairing an immediate iatrogenic furcal perforation of primary molars both clinically and radiographically. MATERIALS AND METHODS In vitro sections including eighty mandibular second primary molars were sorted into 4 equal groups: (1) an intact furcation area group, (2) an artificial perforation group (unrepaired), (3) an artificial perforation group repaired with MTA, and (4) an artificial perforation group repaired with premixed BC. The dye extraction method was used to assess the sealing ability of the material. Clinically, the study was designed as an equivalent parallel randomized controlled trial. Seventy-six mandibular second primary molars with immediate furcal perforation were sealed with MTA and premixed BC. Teeth were evaluated clinically and radiographically at 3, 6, and 12 months. RESULTS Although the difference was statistically insignificant (p = 0.058), the premixed BC group had better sealing ability than the MTA group [mean difference = 0.020; 95% CI (-0.001, 0.040)]. Clinically and radiographically, the two materials had an equivalent success rate in the first 3 months [ARR = 0.05; 95% CI (-0.07, 0.17)] but inequivalent success rates at 6 and 12 months with premixed BC performing better than MTA. CONCLUSIONS The present findings confirm that premixed BC is a promising material that can be used to repair a furcal perforation of primary molars. Premixed BC has better sealing properties and better performance at the clinical and radiographic levels than MTA. CLINICAL RELEVANCE (1) Accidental furcal perforation in primary molars is one of the worst problems that results in diminishing the lifetime expectancy of primary teeth if not properly treated. Though new BC repair materials have been introduced to enhance healing and tissue inductive properties, there is an obvious shortage in clinical trials covering this area. The present study is a premier study that assesses a recently introduced premixed BC material in the furcal perforation of primary teeth and compares its outcomes with those of the widely used MTA. TRIAL REGISTRATION ClinicalTrials.gov PRS reference #NCT04137861.
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Affiliation(s)
| | - Yasser Fathi Gomaa
- Dental Biomaterials, Faculty of Dentistry, Minia University, Minya, Egypt
| | | | - Ahmad Abdel Hamid Elheeny
- Paediatric and Community Dentistry, Faculty of Dentistry, Minia University, Ard Shalaby, El Minia, Minya, 61519, Egypt.
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Elheeny AAH. Articaine efficacy and safety in young children below the age of four years: An equivalent parallel randomized control trial. Int J Paediatr Dent 2020; 30:547-555. [PMID: 32223002 DOI: 10.1111/ipd.12640] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/04/2020] [Accepted: 03/18/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pain control is a mandatory aspect in pediatric dentistry office through local anesthesia. AIM To assess the safety and efficacy of 4% articaine local anesthetic in young children below four years old. DESIGN An equivalent randomized control trial with two parallel arms included 184 young children (92 per group) aged from 36 to 47 months seeking pulpotomy of mandibular primary molars which performed after buccal infiltration injection. The control group received lidocaine hydrochloride 2% with epinephrine 1:100 000. The intervention was articaine hydrochloride 4% with epinephrine 1:100 000. Children's behavior during injection and treatment have assessed using Faces, Legs, Activity, Cry, and Consolability (FLACC) and child's behavior using Frankl Behavior Rating Scale (FBRS). In addition, post-operative complications have been addressed. RESULTS Both anesthetic agents were equivalent during the injection phase. During the treatment phase, the absolute risk difference (ARR) between the two groups was 0.120 (95% CI: -0.003; 0.243). The maximum limit of 95% CI surpassed the margin of equivalence, indicating that less pain has been expressed during pulpotomy among children delivered articaine when compared to their counterparts in the lidocaine group. Concerning post-operative complications, no statistically significant difference was detected between the two anesthetic drugs. CONCLUSION The findings supported the efficient and secure use of articaine hydrochloride 4% with epinephrine 1:100 000 to treat children between the ages of 3 and below 4 years old.
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