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Nogales CG, Cazares RXR, Nardello LCL, Mayer MPA, Gavini G, Zehnder M, Pinheiro ET. Evaluating the Impact of Ultrasonic Irrigation on Bacterial Levels and Activity Following Chemomechanical Procedures. J Endod 2024:S0099-2399(24)00481-3. [PMID: 39276864 DOI: 10.1016/j.joen.2024.09.001] [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: 03/21/2024] [Revised: 05/30/2024] [Accepted: 09/03/2024] [Indexed: 09/17/2024]
Abstract
AIM This single-arm interventional trial aimed to investigate the efficacy of ultrasonic irrigation as a supplementary disinfection approach after chemomechanical procedures using molecular techniques based on ribosomal RNA (rRNA) and rRNA genes (referred to as DNA). METHODOLOGY Samples were collected from 35 single-rooted teeth with radiographic evidence of apical periodontitis. Samples were taken after gaining root canal access (S1), chemomechanical procedures (CMP, S2), and ultrasonic irrigation (S3). DNA-targeted qPCR using universal primers was used to estimate total bacterial levels, while rRNA-targeted qPCR was used to assess bacterial activity. Ratios between rRNA and DNA levels were calculated to search for active bacteria in the samples (rRNA/ DNA ≥ 1). Wilcoxon matched-pairs signed-rank test was used to compare the differences in DNA levels between samples and DNA and rRNA levels within samples (P <.05). RESULTS DNA-based methods revealed a significant decrease in bacterial levels from S1 to S2 and S2 to S3 (both P <.05). Notably, 11 out of 35 (31.4%) root canals did not harbor bacterial DNA after CMP, whereas ultrasonic activation increased DNA-negative samples to 17 (48.6%). However, all DNA-positive samples were also positive for rRNA, with significantly higher rRNA than DNA levels (P <.05), indicating bacterial activity at the sampling time. CONCLUSIONS Ultrasonic irrigation improved the disinfection of root canals after chemomechanical procedures by reducing bacterial levels. However, persisting bacteria remained active in the root canals after CMP and ultrasonic irrigation.
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Affiliation(s)
- C G Nogales
- Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - R X R Cazares
- Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil; Discipline of Endodontics, School of Dentistry, Central University of Ecuador, Quito, Ecuador
| | - L C L Nardello
- Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - M P A Mayer
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - G Gavini
- Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - M Zehnder
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland
| | - E T Pinheiro
- Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
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Vitali FC, Santos PS, Garcia LDFR, Teixeira CDS. Postoperative pain after endodontic treatment using 8.25% vs 2.5% sodium hypochlorite in necrotic mandibular molars with apical periodontitis: A randomized double-blind clinical trial. J Am Dent Assoc 2024; 155:657-666.e2. [PMID: 38819357 DOI: 10.1016/j.adaj.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/12/2024] [Accepted: 04/26/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND This study aimed to evaluate whether the use of 8.25% sodium hypochlorite (NaOCl), compared with the use of 2.5% NaOCl, leads to higher postoperative pain after endodontic treatment. METHODS A total of 154 patients were randomly assigned into 2 groups: 8.25% and 2.5% NaOCl. A single-visit endodontic treatment was performed using a standard protocol, varying only the NaOCl concentration. Postoperative pain was assessed using the numeric rating scale at multiple times over 30 days. Overall pain scores over time were explored via multilevel mixed-effects negative binomial regression. The need for pain medication was recorded and compared between groups via the Mann-Whitney U test. RESULTS The use of 8.25% NaOCl increased postoperative pain scores over time by 3.48 times compared with the use of 2.5% NaOCl (incident rate ratio [IRR], 3.48; 95% CI, 1.57 to 7.67). Furthermore, the 8.25% NaOCl group exhibited higher pain incidence than the 2.5% NaOCl group during the 12-hour through 3-day period, with scores at these times ranging from 2.21 (IRR, 2.21; 95% CI, 1.35 to 3.62) through 10.74 (IRR, 10.74; 95% CI, 3.74 to 30.87) higher. No difference was detected in the number of analgesic capsules administered between groups. CONCLUSIONS The use of 8.25% NaOCl resulted in higher postoperative pain than the use of 2.5% NaOCl, with pain scores increasing by 3.48 times when this solution was used. Furthermore, the 8.25% NaOCl group exhibited higher pain incidence than the 2.5% NaOCl group during the 12-hour through 3-day period. PRACTICAL IMPLICATIONS The use of 8.25% NaOCl during endodontic treatment can increase postoperative pain significantly. This clinical trial was registered at the Brazilian Registry of Clinical Trials database (RBR-6vq3hc4).
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Govindaraju L, Shruthi ST, Gopal R, Jenarthanan S, Rajendran MR. Does increase in temperature of sodium hypochlorite have enhanced antimicrobial efficacy and tissue dissolution property? - A systematic review and meta-regression. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:675-684. [PMID: 39262604 PMCID: PMC11385910 DOI: 10.4103/jcde.jcde_110_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 09/13/2024]
Abstract
Objectives The objective of this study was to analyze the available evidence on the performance of increase in temperature of sodium hypochlorite on its antimicrobial efficacy and tissue dissolution property. Materials and Methods The study was conducted according to PRISMA guidelines, and a modified Joanna Briggs Institute (JBI) tool was used for quality assessment of the included studies. Two reviewers independently performed an electronic search in four databases along with the reference lists of the included articles. Results This systematic review included a total of 12 studies: antimicrobial efficacy (n = 6) and tissue dissolution property (n = 6). For the studies that were chosen, the overall risk of bias was moderate. Quantitative assessment through meta-regression was performed for tissue dissolution property. Low-concentration sodium hypochlorite irrigant (≤3%) shows a 0.13-unit times increase in tissue dissolution ability with a degree rise in temperature although not statistically significant. Conclusion Due to inconsistency in the study parameters, results pertaining to the exclusive effect of increase in the temperature of sodium hypochlorite remain inconclusive.
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Affiliation(s)
- Lokhasudhan Govindaraju
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - S T Shruthi
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Rajeswari Gopal
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Sowjanyaa Jenarthanan
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Mathan Rajan Rajendran
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
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Gobbo LB, de Araújo LP, Vieira WDA, de-Jesus-Soares A, de Almeida JFA, Ferraz CCR. Impact of passive ultrasonic irrigation on the outcome of non-surgical root canal treatment: a systematic review and meta-analysis of randomized clinical trials. Evid Based Dent 2024:10.1038/s41432-024-01033-3. [PMID: 38951661 DOI: 10.1038/s41432-024-01033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE This systematic review aimed to assess the impact of Passive Ultrasonic Irrigation on the periapical healing rate of primary root canal treatment compared to conventional syringe irrigation. METHODS Registered a priori in the PROSPERO database, this review was conducted by two independent reviewers who performed an electronic search up to December 2023. The search included databases such as MEDLINE (PubMed), Scopus, Web of Science, Embase, LILACS, and the Cochrane Library, as well as grey literature. We included randomized clinical trials (RCTs) that focused on patients undergoing primary root canal treatments. The study compared intervention groups using PUI with control groups that did not use activation techniques. Periapical healing was assessed over follow-up periods of at least six months, utilizing either periapical radiographs or cone-beam computed tomography. To synthesize the findings, a meta-analysis and trial sequence analysis were conducted, employing the Relative Risk as the measure of effect, with a 95% confidence interval. The GRADE approach was utilized to assess the certainty of the evidence. RESULTS The meta-analysis incorporated three RCTs, involving 474 patients (501 teeth). The analysis revealed that PUI led to a higher rate of periapical healing compared to CSI (Relative Risk: 1.10; 95% Confidence Interval: 1.01-1.21, I² = 0%), with moderate certainty of evidence. CONCLUSIONS Despite the limited number of high-quality RCTs, the findings showed a positive impact of PUI on periapical healing rates in primary root canal treatments, in comparison to CSI. REGISTER CRD42021290894.
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Affiliation(s)
- Leandro Bueno Gobbo
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | | | - Walbert de Andrade Vieira
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Adriana de-Jesus-Soares
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - José Flávio Affonso de Almeida
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Caio Cezar Randi Ferraz
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, SP, Brazil
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Wigler R, Srour Y, Wilchfort Y, Metzger Z, Kfir A. Debris and Smear Layer Removal in Curved Root Canals: A Comparative Study of Ultrasonic and Sonic Irrigant Activation Techniques. Dent J (Basel) 2024; 12:51. [PMID: 38534274 DOI: 10.3390/dj12030051] [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: 10/23/2023] [Revised: 01/30/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
The aim of this study was to compare the cleaning efficacy of three irrigant activation devices with a control of non-activated syringe and needle irrigation in curved root canals. Sixty human curved roots were endodontically prepared and divided into four groups (n = 15) with similar root curvature distributions. Final irrigation using 4% NaOCl was performed with a syringe and needle (30-G) alone, or with Eddy sonic powered irrigation system (polymeric tip #0.25/0.06), Endosonic ultrasonic activation (polymeric tip #0.25/0.03), or Irrisafe ultrasonic activation (stainless-steel tip, #0.25/0.00). SEM was used to evaluate cleaning efficacy, employing five-score systems for debris and smear layer. While no significant difference in debris removal was observed between Endosonic or Irrisafe activation and non-activated irrigation, Eddy sonic powered irrigation system significantly improved debris removal in the apical third of curved root canals. Smear layer removal was effective in coronal and mid-root sections for all groups but less so in the apical third. Thus, Eddy sonic powered irrigation system demonstrated higher efficacy in removing debris from the apical third of curved root canals compared with non-activated syringe and needle irrigation. However, all three irrigant activation systems exhibited no difference from the non-activated control in smear layer removal.
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Affiliation(s)
- Ronald Wigler
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | | | - Yuval Wilchfort
- The Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Zvi Metzger
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Anda Kfir
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
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Bürklein S, Abdi I, Schäfer E, Appel C, Donnermeyer D. Influence of pulse energy, tip design and insertion depth during Er:YAG-activated irrigation on cleaning efficacy in simulated severely curved complex root canal systems in vitro. Int Endod J 2024; 57:87-99. [PMID: 37947444 DOI: 10.1111/iej.13992] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
AIM To investigate the influence of pulse energy, tip geometry and tip position in simulated 3D-printed root canals with multiple side canals at different levels in all directions on the cleaning performance of laser-activated irrigation (LAI) compared to sonic activation (EDDY) and conventional needle irrigation (NI). METHODOLOGY 3D-printed root canal models (25/.06, length 20 mm, curvature 60°, radius 5 mm) with side canals (diameter 0.2 mm) at 2, 5 and 8 mm from the apex were filled with coloured biofilm-mimicking hydrogel. LAI (Morita AdvErL Evo, Kyoto, Japan) was performed with six settings (n = 20; pulse-energy, pulses per second [PPS], tip position): LAI1 (50 mJ, 25 PPS, P400FL, canal entrance [CE]), LAI2 (same as LAI1, but insertion depth 9 mm before the apical endpoint [AE] [corresponding to 1 mm above the first lateral canals]), LAI3 (80 mJ, 25 PPS, P400FL, 9 mm before AE), LAI4 (same as LAI 3, but at CE) for 3 × 20 s each, LAI5 (50 mJ, 25 PPS, P400FL 2 × 20 s, CE & R200T (30 mJ, 25 PPS, 1 × 20 s, 9 mm before AE), LAI6 (30 mJ, 25 PPS, R200T, 9 mm before AE, 3 × 20 s). A continuous irrigation (3 mL/20 s) using distilled water accompanied the irrigation cycles. NI and EDDY (3 × 20 s each; 3 mL/20 s irrigation, insertion AE minus 1 mm, amplitude 4 mm) served as control groups. Biofilm-mimicking hydrogel removal (ImageJ, NIH) was assessed for the entire system, the central canal and the lateral canals using standardized photographs with a microscope (Expert DN, Müller-Optronic) and statistically analysed was performed using Kruskal-Wallis and Dunn tests (p = .05). Irrigant extrusion beyond the foramina was also recorded. RESULTS LAI2 (99.08%; interquartile range [IQR]: 96.85-100.00) and LAI3 (97.50%; 96.24-100.00) achieved the significantly best and LAI6 (80.08%; 73.41-84.69) the significantly worst removal of hydrogel from the entire root canal system amongst all LAI configurations (p < .05). There were no significant differences between LAI6, EDDY (72.89%; 67.49-76.22) and manual irrigation (54.39%; 51.01-56.94) (p > .05). R200T laser tip caused significantly more often irrigant extrusion than all other techniques (p < .05). CONCLUSION Tip design, energy settings, and the positioning of the laser tip below the canal entrance caused an improvement in cleaning performance of the LAI. However, the small R200T tip created significantly more procedural errors (irrigant extrusion) due to higher concentrated energy.
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Affiliation(s)
- Sebastian Bürklein
- Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Münster, Germany
| | - Izzeddin Abdi
- Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Münster, Germany
| | - Edgar Schäfer
- Central Interdisciplinary Ambulance in the School of Dentistry, University of Münster, Münster, Germany
| | - Carsten Appel
- Private Practice, Endodontie am Venusberg, Bonn, Germany
| | - David Donnermeyer
- Department of Periodontology and Operative Dentistry, University of Münster, Münster, Germany
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Zogheib C, Roumi R, Baldi A, Palopoli P, Pasqualini D, Berutti E, Alovisi M. The effect of ultrasonic access cavity preparation on dentinal inner walls: a micro-CT study on cadaveric samples. Oral Radiol 2023; 39:639-645. [PMID: 37000330 DOI: 10.1007/s11282-023-00680-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/02/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE The objective of this study is to evaluate the occurrence of coronal dentinal micro-cracks after access cavity refinement using high-speed burs and ultrasonic tips by means of micro-computed tomography (micro-CT) analysis. METHODS In this study, 18 mandibular cadaveric incisors were divided into two groups according to the protocol of the preparation of the conventional access cavity. The diamond bur 802 # 12 was used until the perforation of the pulp roof. Then, the Endo-Z bur was used for the group #1 and the ultrasonic tip Start-X # 1 for the group #2 to finish and refine the access cavity. The preparation time of each access cavity has been recorded. The teeth underwent a micro-CT scan before and after the preparation of the access cavity. Fisher's exact test, the Chi-square test, the Kolmogorov-Smirnov test, the Mann-Whitney test, and the Student's test were used for statistical evaluation. RESULTS The percentage of teeth with new micro-cracks is not significantly different between the two groups (-p-value < 0.5). The number of newly formed micro-cracks and extension size were not significantly different between the two groups. The direction of extension of the micro- cracks was occluso-apical. The average duration of the access cavity is significantly smaller with the Endo-Z system (-p- value < 0.001). The roughness of walls surfaces has no statistically difference between the two groups. CONCLUSION The use of ultrasound, although slower, is considered safe in the creation of dentinal micro-cracks, in the preparation of the access cavity.
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Affiliation(s)
- C Zogheib
- Department of Endodontics, Saint Joseph University of Beirut, Beirut, Lebanon
| | - R Roumi
- Department of Endodontics, Saint Joseph University of Beirut, Beirut, Lebanon
| | - A Baldi
- Department of Surgical Sciences, Dental School, Endodontics, University of Turin, Turin, Italy
| | | | - D Pasqualini
- Department of Surgical Sciences, Dental School, Endodontics, University of Turin, Turin, Italy
| | - E Berutti
- Department of Surgical Sciences, Dental School, Endodontics, University of Turin, Turin, Italy
| | - M Alovisi
- Department of Surgical Sciences, Dental School, Endodontics, University of Turin, Turin, Italy
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Meire MA, Bronzato JD, Bomfim RA, Gomes BPFA. Effectiveness of adjunct therapy for the treatment of apical periodontitis: A systematic review and meta-analysis. Int Endod J 2023; 56 Suppl 3:455-474. [PMID: 36156804 DOI: 10.1111/iej.13838] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Adjunct therapy refers to any intracanal procedure going beyond chemomechanical preparation with instruments and traditionally delivered irrigants (excluding interim dressings). It is not clear whether and which of these adjunct therapies have a significant impact on the outcome of root canal treatment [healing of apical periodontitis (AP) and other patient-related outcomes]. OBJECTIVES This systematic review aimed to analyse available evidence on the effectiveness of adjunct therapy for the treatment of AP in permanent teeth, according to a population, intervention, comparison, outcome, time and study design framework formulated a priori by the European Society of Endodontology. METHODS Five electronic databases (PubMed, Embase, Scopus, Cochrane and Web of Science) were searched up to October 2021 to identify clinical studies comparing adjunct therapy to no adjunct therapy in adult patients with AP. Animal studies, reviews, studies with less than 10 patients per arm and studies with a follow-up time of less than 1 year, or less than 7 days for postoperative pain, were excluded. The quality of the included studies was appraised by the appropriate tools [Risk of Bias 2 (RoB2) for randomized clinical trials (RCTs) and Newcastle-Ottawa Scale for observational studies]. Meta-analysis was performed using a random-effects model. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Fourteen studies (13 RCTs and one retrospective cohort) fulfilled the inclusion criteria for this review. They evaluated different types of adjunct therapy: antimicrobial photodynamic therapy (aPDT; three studies), diode laser canal irradiation (3), Nd:YAG laser canal irradiation (2), Er;Cr:YSGG laser canal irradiation (1), ozone therapy (2) and ultrasonically activated irrigation (UAI) (4). Radiographical healing was reported in seven studies, but meta-analysis was only possible for UAI (two studies), showing no statistically significant difference in healing after 12 months. Pain after 7 days was reported in seven studies. Meta-analysis on three studies that used aPDT and on two studies using diode laser irradiation showed no significant difference in the prevalence of pain after 7 days between the control and adjunct therapy. According to RoB2 tool, six studies had a high risk of bias, five studies had some concerns, and two studies low risk of bias. The GRADE assessment revealed a very low strength of evidence for diode laser, and low strength of evidence for PDT, ozone and UAI studies. DISCUSSION The included studies displayed significant heterogeneity in terms of type of adjunct therapy, technical details per adjunct therapy, outcome reporting and several combinations of these, limiting the potential for meta-analysis. CONCLUSIONS There is insufficient evidence to recommend any adjunctive therapy for the treatment of apical periodontitis. REGISTRATION Prospero CRD42021261869.
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Affiliation(s)
- Maarten A Meire
- Section of Endodontology, Department of Oral Health Sciences, Ghent University, Ghent, Belgium
| | - Juliana D Bronzato
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, Brazil
| | - Rafael A Bomfim
- Department of Community Health, School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Brenda P F A Gomes
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, Brazil
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Wigler R, Herteanu M, Wilchfort Y, Kfir A. Efficacy of Different Irrigant Activation Systems on Debris and Smear Layer Removal: A Scanning Electron Microscopy Evaluation. Int J Dent 2023; 2023:9933524. [PMID: 37771362 PMCID: PMC10533223 DOI: 10.1155/2023/9933524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 08/19/2023] [Accepted: 09/02/2023] [Indexed: 09/30/2023] Open
Abstract
Background Irrigation is an essential component of root canal treatment to enable cleaning beyond the reach of mechanical instruments. The study aimed to assess and compare the efficacy of different final irrigation protocols, including sonic- and ultrasonic-powered irrigant-activation systems, on debris and smear layer removal in the coronal, middle, and apical thirds of straight oval root canals. Materials and Methods Straight oval root canals of 60 human mandibular incisors were prepared to size 40.04 and divided into four groups (n = 15) according to the final irrigation protocols: (a) Eddy sonic activation (b) endosonic passive ultrasonic irrigation (PUI), (c) irrisafe PUI, and (d) manual syringe and needle irrigation with no additional activation, which served as control. After the treatment procedures, the roots were split and observed using scanning electron microscopy. The presence of remaining debris and smear layer at the coronal, mid-root, and apical thirds of the canals were evaluated using a score system and statistically analyzed using multinominal models with significance level set at p < 0.05. Results None of the final irrigation protocols completely removed all debris and smear layer from all root canals. When the syringe and needle were used without activation, more debris and smear layer were found in the apical third of the canals. Activation of the final irrigant with each of the three devices significantly reduced the presence of debris in the apical third, compared to the syringe and needle final irrigation, with no difference among the three activation devices. Eddy and irrisafe activation also significantly reduced the residual smear layer in the apical third, compared to syringe and needle alone, while the reduction in the remaining smear layer by endosonic activation did not reach the significance level. Conclusions Removal of debris and smear layer from the apical part of the root canal by syringe and needle irrigation alone may be significantly improved by using sonic or ultrasonic activation of the final irrigant. Endosonic activation was less effective in removal of smear layer from the apical part of the canals compared to the other two activation systems.
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Affiliation(s)
- Ronald Wigler
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Herteanu
- The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Wilchfort
- The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anda Kfir
- Department of Endodontology, The Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Iandolo A, Pisano M, Buonavoglia A, Giordano F, Amato A, Abdellatif D. Traditional and Recent Root Canal Irrigation Methods and Their Effectiveness: A Review. Clin Pract 2023; 13:1059-1072. [PMID: 37736930 PMCID: PMC10514886 DOI: 10.3390/clinpract13050094] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023] Open
Abstract
According to contemporary dental standards, the primary goal of endodontic therapy is the chemo-mechanical cleaning of the complex root canal system. Watering root canals with approved solutions and activating them are essential parts of this operation. This review outlines various irrigant activation methods for root canal therapy. Specifically, a comparison among the methods of manual dynamic activation, sonics (subsonic, sonic, and ultrasonic), internal heating, and lasers, was conducted. The results in this work were gathered using Scopus, Web of Science, Google Scholar, and PubMed databases by searching the following keywords: sodium hypochlorite, cleaning, activation, and irrigation methods. The present work concluded that the use of irrigant activation has a greater benefit than its absence. Regardless, it is impossible to point to a single effective activation method.
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Affiliation(s)
- Alfredo Iandolo
- Department of Medicine and Surgery, School of Dentistry, University of Salerno, 84081 Salerno, Italy; (M.P.); (F.G.); (A.A.)
| | - Massimo Pisano
- Department of Medicine and Surgery, School of Dentistry, University of Salerno, 84081 Salerno, Italy; (M.P.); (F.G.); (A.A.)
| | - Alessio Buonavoglia
- Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, 40125 Bologna, Italy;
| | - Francesco Giordano
- Department of Medicine and Surgery, School of Dentistry, University of Salerno, 84081 Salerno, Italy; (M.P.); (F.G.); (A.A.)
| | - Alessandra Amato
- Department of Medicine and Surgery, School of Dentistry, University of Salerno, 84081 Salerno, Italy; (M.P.); (F.G.); (A.A.)
| | - Dina Abdellatif
- Department of Endodontics, Faculty of Dentistry, University of Alexandria, Alexandria 21531, Egypt;
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Dede M, Basche S, Neunzehn J, Dannemann M, Hannig C, Kühne MT. Efficacy of Endodontic Disinfection Protocols in an E. faecalis Biofilm Model-Using DAPI Staining and SEM. J Funct Biomater 2023; 14:jfb14040176. [PMID: 37103266 PMCID: PMC10145082 DOI: 10.3390/jfb14040176] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/28/2023] Open
Abstract
The aim of this study was to investigate the antimicrobial efficacy of different disinfection protocols in a novel Enterococcus faecalis biofilm model based on a visualization method and to evaluate the potential alteration of dentinal surface. A total of 120 extracted human premolars were allocated to 6 groups with different irrigation protocols. The assessment of the effectiveness of each protocol and the alteration of dentinal surface were visualized by using SEM and fluorescence microscopy (DAPI). A dense E. faecalis biofilm with a penetration depth of 289 μm (medial part of the root canal) and 93 μm (apical part) validated that the biofilm model had been successfully implemented. A significant difference between the 3% NaOCl groups and all the other groups in both observed parts of the root canal (p < 0.05) was detected. However, the SEM analysis revealed that the dentinal surface in the 3% NaOCl groups was severely altered. The established biofilm model and the visualization method based on DAPI are appropriate for bacterial quantification and evaluation of the depth effect of different disinfection protocols in the root canal system. The combination of 3% NaOCl with 20% EDTA or MTAD with PUI allows the decontamination of deeper dentine zones within the root canal but simultaneously alters the dentinal surface.
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Affiliation(s)
- Maria Dede
- Policlinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sabine Basche
- Policlinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Jörg Neunzehn
- Vertriebsgesellschaft GmbH, Geistlich Biomaterials, Schneidweg 5, 76534 Baden-Baden, Germany
| | - Martin Dannemann
- Faculty of Automotive Engineering, Institute of Energy and Transport Engineering, Westsächsische Hochschule Zwickau, 08056 Zwickau, Germany
| | - Christian Hannig
- Policlinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Marie-Theres Kühne
- Policlinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
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Widbiller M, Rosendahl A, Schlichting R, Schuller C, Lingl B, Hiller KA, Buchalla W, Galler KM. Impact of Endodontic Irrigant Activation on Smear Layer Removal and Surface Disintegration of Root Canal Dentine In Vitro. Healthcare (Basel) 2023; 11:healthcare11030376. [PMID: 36766951 PMCID: PMC9914448 DOI: 10.3390/healthcare11030376] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
The objective of this study was to compare the ability of different endodontic irrigation activation methods to enable irrigant penetration, remove the smear layer from root canal walls after preparation, and investigate surface effects on dentine. Root canals of 90 single-rooted teeth were prepared and irrigated with EDTA (17%) and sodium hypochlorite (5%), where both irrigants or sodium hypochlorite only were activated as follows: conventional needle irrigation, ultrasonic activation, sonic activation (EDDY), or laser-based activation (photon-induced photoacoustic streaming/PIPS). For the evaluation of irrigant penetration into dentinal tubules, methylene blue was injected and activated as well. Subsequently, teeth were sectioned horizontally, and dye penetration depths were measured. Alternating sections were split in halves and randomly selected for scanning electron microscopic analysis. Root canal dentine was assessed for smear layer removal and surface disintegration according to a defined scoring system. The data were analyzed statistically with nonparametric and chi-squared tests for whole teeth and separately for coronal, middle, and apical thirds. All the tested activation methods removed a thicker smear layer than needle irrigation only. Additional activation of EDTA improved penetration depths of the irrigants, but not the smear layer removal. Surface disintegration of root canal dentine was observed with the additional activation of EDTA and particularly after laser-based techniques. Additional activation of EDTA does not seem to offer any convincing advantages in terms of irrigant penetration or smear layer removal but disrupts the dentine surface. Especially laser-based activation resulted in undesirable destruction of root canal wall dentine.
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Affiliation(s)
- Matthias Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence:
| | - Andreas Rosendahl
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | | | - Christine Schuller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Benedikt Lingl
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Karl-Anton Hiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Wolfgang Buchalla
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Kerstin M. Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nuernberg, 91054 Erlangen, Germany
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Advances in the Role of Sodium Hypochlorite Irrigant in Chemical Preparation of Root Canal Treatment. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8858283. [PMID: 36685672 PMCID: PMC9859704 DOI: 10.1155/2023/8858283] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
Irrigation of root canal system is of great significance to the success of endodontic treatment, where sodium hypochlorite (NaOCl) is the most widely used irrigant in chemical preparation. NaOCl functions by eliminating bacterial biofilms and dissolving organic tissue, which may vary according to several factors such as the microbiology of root canal infection and the concentration of the irrigant. It has been proposed that the effectiveness of NaOCl could be enhanced via several methods, including heating the irrigant, applying in conjunction with certain reagents, or activating by agitation techniques. Despite its antibacterial and tissue-dissolving capacities, NaOCl should be used with caution to avoid detrimental effect due to its cytotoxicity and negative effect on dentin properties. In this narrative review, we discussed the factors that affect the properties of NaOCl, the methods to improve its efficacy, and the side effects that might occur in clinical practice.
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14
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Cytotoxicity and Efficacy in Debris and Smear Layer Removal of HOCl-Based Irrigating Solution: An In Vitro Study. J Funct Biomater 2022; 13:jfb13030095. [PMID: 35893463 PMCID: PMC9326542 DOI: 10.3390/jfb13030095] [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: 06/18/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/10/2022] Open
Abstract
In the present study we evaluated the cytotoxicity of super-oxidized water on human gingival fibroblasts and its efficacy in debris and smear layer removal from root canal walls. Cultured gingival fibroblasts were exposed to super-oxidized water (Sterilox), which was diluted in Iscove’s modified Dulbecco’s medium (IMDM) at 30%, 40%, 50%, 60% and 70% concentrations. The control group was maintained in IMDM. The cell viability was evaluated by means of an MTT assay after incubation periods of 1 h, 2 h, 24 h and 48 h. Pathological cellular changes were also observed under fluorescence and phase contrast microscopes. The efficacy in debris and smear layer removal was evaluated in comparison to the conventional application of sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA). Forty maxillary premolars were randomly divided into two equal groups (n = 20) and shaped with ProTaper NEXT rotary instruments using Sterilox or NaOCl/EDTA for irrigation. Afterwards, roots were split longitudinally and examined under a scanning electron microscope. The results revealed that super-oxidized water and sterile distilled water have acceptable biological properties for endodontic applications at concentrations up to 50% (p > 0.05). Moreover, super-oxidized water is equally effective in debris and smear layer removal as compared to NaOCl/EDTA (p > 0.05).
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15
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Tang S, Zhang H, Mei L, Dou K, Jiang Y, Sun Z, Wang S, Hasanin MS, Deng J, Zhou Q. Fucoidan-derived carbon dots against Enterococcus faecalis biofilm and infected dentinal tubules for the treatment of persistent endodontic infections. J Nanobiotechnology 2022; 20:321. [PMID: 35836267 PMCID: PMC9281061 DOI: 10.1186/s12951-022-01501-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/09/2022] [Indexed: 12/24/2023] Open
Abstract
Enterococcus faecalis (E. faecalis) biofilm-associated persistent endodontic infections (PEIs) are one of the most common tooth lesions, causing chronic periapical periodontitis, root resorption, and even tooth loss. Clinical root canal disinfectants have the risk of damaging soft tissues (e.g., mucosa and tongue) and teeth in the oral cavity, unsatisfactory to the therapy of PEIs. Nanomaterials with remarkable antibacterial properties and good biocompatibility have been developed as a promising strategy for removing pathogenic bacteria and related biofilm. Herein, carbon dots (CDs) derived from fucoidan (FD) are prepared through a one-pot hydrothermal method for the treatment of PEIs. The prepared FDCDs (7.15 nm) with sulfate groups and fluorescence property are well dispersed and stable in water. Further, it is found that in vitro FDCDs display excellent inhibiting effects on E. faecalis and its biofilm by inducing the formation of intracellular and extracellular reactive oxygen species and altering bacterial permeability. Importantly, the FDCDs penetrated the root canals and dentinal tubules, removing located E. faecalis biofilm. Moreover, the cellular assays show that the developed FDCDs have satisfactory cytocompatibility and promote macrophage recruitment. Thus, the developed FDCDs hold great potential for the management of PEIs.
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Affiliation(s)
- Shang Tang
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.,School of Stomatology, Qingdao University, Qingdao, 266003, China.,Dental Digital Medicine & 3D Printing Engineering Laboratory of Qingdao, Qingdao, 266003, China
| | - Hui Zhang
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.,School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Li Mei
- School of Stomatology, Qingdao University, Qingdao, 266003, China.,Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266021, China
| | - Keke Dou
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.,School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Yuying Jiang
- School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Zhanyi Sun
- State Key Laboratory of Bioactive Seaweed Substances, Qingdao Bright Moon Seaweed Group Co., Ltd., Qingdao, 266400, China
| | - Shuai Wang
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.,School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Mohamed Sayed Hasanin
- Cellulose and Paper Department, National Research Centre, Dokki, 12622, Cairo, Egypt
| | - Jing Deng
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China. .,School of Stomatology, Qingdao University, Qingdao, 266003, China. .,Dental Digital Medicine & 3D Printing Engineering Laboratory of Qingdao, Qingdao, 266003, China.
| | - Qihui Zhou
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China. .,School of Stomatology, Qingdao University, Qingdao, 266003, China. .,Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266021, China. .,University of Health and Rehabilitation Sciences, Qingdao, 266071, China.
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16
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Impact of agitation/activation strategies on the antibiofilm potential of sodium hypochlorite/etidronate mixture in vitro. BMC Oral Health 2022; 22:201. [PMID: 35606751 PMCID: PMC9125931 DOI: 10.1186/s12903-022-02222-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background To investigate the effect of a rotary agitation method or ultrasonically activated irrigation on the antibiofilm effect of a mixture of sodium hypochlorite (NaOCl) and etidronate (1-hydroxyethylidene-1,1-bisphosphonate, HEBP) using a dual-species biofilm model in root canal system. Methods Mature dual-species biofilms of Enterococcus faecalis and Streptococcus gordonii were formed in root canals of mandibular premolars. Teeth were randomly allotted (n = 12) to group 1, XP-endo Finisher (XPF); group 2, ultrasonically activated irrigation (UAI); group 3, syringe-and-needle irrigation (SNI). In all groups, canals were instrumented with a rotary instrument (XP-endo Shaper) prior to irrigant agitation/activation. A mixture containing 2.5% NaOCl and 9% HEBP was used throughout the experiment. Bacterial counts from the canal were determined using qPCR before preparation (S1), after preparation (S2), and after final irrigation agitation/activation (S3). Bacterial viability within the dentinal tubules in the coronal, middle and apical root-thirds was quantified using confocal microscopy after Live/Dead staining. The bacterial counts and viability were compared between groups using one-way ANOVA and post-hoc Tukey’s tests. Paired t-test was used to compare the bacterial counts within groups. Results Instrumentation alone could significantly reduce the microbial counts in all the groups (P < 0.0001). Subsequent agitation/activation resulted in significant microbial reduction only in XPF and UAI (P < 0.05), both of which reduced significantly more microbial counts than SNI (P < 0.05). Live/Dead staining revealed that XPF and UAI showed significantly greater percentage of dead bacteria within the dentinal tubules than SNI in the coronal third (P < 0.05); UAI resulted in the significantly highest percentage of dead bacteria in the middle third (P < 0.05); while there was no significant difference between the groups in the apical third (P > 0.05). Conclusions When using the sodium hypochlorite/etidronate mixture for irrigation, final irrigant agitation/activation with XP-endo Finisher or ultrasonic can improve disinfection of the main root canal space and the dentinal tubules in the coronal third, while ultrasonically activated irrigation appears to exhibit better disinfection within dentinal tubules in the middle third. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02222-1.
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17
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Lobo NS, Jacobs R, Vasconcelos KDF, Wanderley VA, Santos BCD, Marciano MA, Zaia AA. Influence of working length and anatomical complexities on the apical root canal filling: a nano-CT study. Braz Dent J 2022; 33:1-7. [PMID: 35766712 PMCID: PMC9645203 DOI: 10.1590/0103-6440202204576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/08/2021] [Indexed: 12/02/2022] Open
Abstract
The present study aimed to compare the filled volume by gutta-percha and sealer
in the apical region of the main canal and ramifications, after instrumentation
at two different working lengths using nano-computed tomography (nano-CT).
Twenty-two premolars with apical ramifications were selected after
micro-computed tomography evaluation and were randomly divided into groups for
further endodontic instrumentation at two different working lengths: G1 - Root
canals shaped 1 mm short of the apical foramen (n=11), and G2 - Root canals
shaped at the apical foramen (n=11). After completing root treatment, nano-CT
images were acquired, and the filled volume by gutta-percha and sealer in the
main canal apical 0-4 mm and 0-1 mm ranges, and apical ramifications were
objectively measured by an operator specialized in both radiology and
endodontics, blinded for both groups. The Mann-Whitney test was applied to
compare both groups regarding the filling of the main canal apical ranges and
apical ramifications with a significance level of 5% (α ≤ 0.05). It was observed
that root canals shaped at the apical foramen had a larger volume of the main
canal filled than root canals shaped 1 mm short of the apical foramen, at both
apical ranges (0-4 and 0-1 mm) (p<0.05). Regarding the filling of the apical
ramifications, there was no significant difference between groups (p>0.05).
In conclusion, the root canals shaped at apical foramen exhibited increased
filling volume of the main canal in the apical region. However, neither of both
working lengths influenced filling of the apical ramifications.
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Affiliation(s)
- Natalia Siqueira Lobo
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Reinhilde Jacobs
- OMFS IMPATH research group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karla de Faria Vasconcelos
- OMFS IMPATH research group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, Leuven, Belgium
| | - Victor Aquino Wanderley
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | | | - Marina Angélica Marciano
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Alexandre Augusto Zaia
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
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de Oliveira HF, da Silva Júnior IF, Teixeira LCG, Camilo NG, de Almeida Decurcio D, Guedes OA, de Araújo Estrela CR. Influence of different agitation techniques on bacterial reduction in curved root canals. AUST ENDOD J 2022; 49:104-110. [PMID: 35488771 DOI: 10.1111/aej.12623] [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: 09/22/2021] [Revised: 02/18/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the influence of agitation techniques on bacterial reduction in curved root canals. Eighty human mandibular molars were prepared, inoculated with Enterococcus faecalis and incubated at 37°C for 60 days. Then, specimens were randomly separated into two test groups (n = 36) and two control groups (n = 04) according to agitation technique: Passive ultrasonic irrigation (PUI, Irrisonic) and XP-endo Finisher (XPF). Microbial samples were collected before and after instrumentation and after final agitation using sterile paper points. Bacterial growth was analysed by turbidity of culture medium and UV spectrophotometry. The Wilcoxon rank test was used for the paired analysis, while the Mann-Whitney U-test was used for the non-paired analysis. The samples collected after final agitation were significantly different between test groups (p < 0.05). Bacterial reduction was greater in the PUI than in the XPF (p < 0.05) group. The irrigant agitation provided significant bacterial reduction. The use of the PUI showed better results.
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Affiliation(s)
| | | | | | - Naira Geovana Camilo
- Department of Endodontics, School of Dentistry, Evangelical University of Goiás, Goiás, Brazil
| | | | - Orlando Aguirre Guedes
- Department of Endodontics, School of Dentistry, Evangelical University of Goiás, Goiás, Brazil
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Paixão S, Rodrigues C, Grenho L, Fernandes MH. Efficacy of sonic and ultrasonic activation during endodontic treatment: a Meta-analysis of in vitro studies. Acta Odontol Scand 2022; 80:588-595. [PMID: 35430959 DOI: 10.1080/00016357.2022.2061591] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To ensure a successful endodontic treatment, it is important to have a proper disinfection of the root canal. The current study compares the root canal cleanliness and smear layer score between sonic and ultrasonic activation. METHOD Systematic literature review was implemented, using 12 databases. All in vitro studies comparing the efficacy of sonic and ultrasonic activation and reporting at least one outcome of interest were included. RESULTS At the apical level, pooling the data in the random-effects model (I2=64%, p = .1) revealed a statistically significant lower smear layer score within the sonic activation group (MD-0.48; 95% CI-0.92, -0.04; p = .03). Furthermore, there was a statistically significant lower push-out bond strength value among the sonic group, in contrast to the ultrasonic group at the middle (MD-0.69; 95% CI-1.13, -0.25; p = .002) and at the apical levels (MD-0.78; 95% CI-1.09, -0.46; p < .0001) of the root canal. CONCLUSIONS Sonic activation accomplished advancement relative to ultrasonic agitation in removing the smear layer, while ultrasonic activation resulted in significant cohesion between the sealers and the dentine tubules, decreasing the vulnerability of apical leakage and tooth fracture.
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Affiliation(s)
- Sara Paixão
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
| | - Cláudia Rodrigues
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
| | - Liliana Grenho
- Faculdade de Medicina Dentária, Laboratory for Bone Metabolism and Regeneration, U. Porto, Porto, Portugal
- LAQV/REQUIMTE, U. Porto, Porto, Portugal
| | - Maria Helena Fernandes
- Faculdade de Medicina Dentária, Laboratory for Bone Metabolism and Regeneration, U. Porto, Porto, Portugal
- LAQV/REQUIMTE, U. Porto, Porto, Portugal
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Dias Corpa Tardelli J, Cândido dos Reis A. Influence of surface electric charge of Ti implants on osteoblastic interaction: A systematic review. Saudi Dent J 2022; 34:335-345. [PMID: 35814840 PMCID: PMC9263760 DOI: 10.1016/j.sdentj.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022] Open
Abstract
Objective A critical analysis of the existing literature to answer “What is the influence of electrical charge of titanium alloys in the electrical interaction with osteoblastic cells for osseointegration?”. Design This systematic review followed PRISMA. The personalized search strategy was applied in PubMed, Science Direct, Embase, and Scopus databases, furthermore, in the grey literature in the Google Scholar and ProQuest. The selection process was carried out in two stages independently by two reviewers according to the eligibility criteria. The risk of bias was also analyzed. Results When applying the search strategy, 306 articles were found, after removing duplicates 277 were analyzed by title and abstract, of which 33 were selected for full reading, of which 10 met the eligibility criteria. And one was included from the additional literature search. Of these, all had a low risk of bias. Conclusions 1. The phenomenon of osseointegration is complex and, independent of the superficial electrical charge of the implant, it may occur. To understand osseointegration, attention must be paid to the synergistic action of the electrical potential; chemical composition, intrinsic to the alloy and from surface treatment; and topography, which will determine the speed of adhesion, proliferation, and osteoblast differentiation. 2. The presence of Ca2+ deposited on the surface acts as a driving force for biomineralization that induces osteoblastic attraction and differentiation; 3. For a better understanding of the current literature, more studies are needed to describe the osteogenic regulation process through protein mediation; 4. Topography and chemical composition act as decisive parameters for cell viability independent of the attractive electrical charge.
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21
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Weber MT, Alkhafaji Y, Pioch A, Trips E, Basche S, Dannemann M, Kilistoff A, Hannig C, Sterzenbach T. Quantification of Bacterial DNA from Infected Human Root Canals Using qPCR and DAPI after Disinfection with Established and Novel Irrigation Protocols. MATERIALS 2022; 15:ma15051911. [PMID: 35269141 PMCID: PMC8912041 DOI: 10.3390/ma15051911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023]
Abstract
The removal of bacterial infections within the root canal system is still a challenge. Therefore, the cleansing effect of established and new irrigation-protocols (IP) containing silver diamine fluoride (SDF) 3.8% on the whole root canal system was analyzed using quantitative PCR (qPCR) and 4′,6-diamidino-phenylindole-(DAPI)-staining. Extracted human premolars were instrumented up to F2 (ProTaper Gold) under NaCl 0.9% irrigation and incubated with Enterococcus faecalis for 42 days. Subsequently, different ultrasonically agitated IP were applied to the roots: control (no irrigation), 1. NaOCl 3%, EDTA 20%, CHX 2%, 2. NaOCl 3%, EDTA 20%, 3. NaOCl 3%, EDTA 20%, SDF 3.8%, 4. SDF 3.8%, and 5. NaCl 0.9%. One half of the root was investigated fluorescent-microscopically with DAPI. The other half was grinded in a cryogenic mill and the bacterial DNA was quantified with qPCR. The qPCR results showed a statistically significant reduction of bacteria after the application of IP 1, 2, and 3 compared to the control group. While IP 4 lead to a bacterial reduction which was not significant, IP 5 showed no reduction. These data corresponded with DAPI staining. With qPCR a new molecular-biological method for the investigation of the complete root canal system was implemented. The novel IP 3 had an equally good cleansing effect as the already established IP.
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Affiliation(s)
- Marie-Theres Weber
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
- Correspondence: ; Tel.: +49-351-458-7456
| | - Yousef Alkhafaji
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
| | - Anne Pioch
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
| | - Evelyn Trips
- Coordination Center for Clinical Studies Dresden, Medical Faculty Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01309 Dresden, Germany;
| | - Sabine Basche
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
| | - Martin Dannemann
- Faculty of Automotive Engineering, Institute of Energy and Transport Engineering, Westsächsische Hochschule Zwickau, Scheffelstraße 39, 08012 Zwickau, Germany;
| | - Alan Kilistoff
- Faculty of Medicine & Dentistry, University of Alberta, 11405 87th Ave NW, Edmonton, AB T6G 1C9, Canada;
| | - Christian Hannig
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
| | - Torsten Sterzenbach
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
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Tonini R, Salvadori M, Audino E, Sauro S, Garo ML, Salgarello S. Irrigating Solutions and Activation Methods Used in Clinical Endodontics: A Systematic Review. FRONTIERS IN ORAL HEALTH 2022; 3:838043. [PMID: 35174355 PMCID: PMC8841673 DOI: 10.3389/froh.2022.838043] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Ex vivo and in vitro studies have demonstrated the effectiveness of some irrigation protocols in reducing the bacterial load in the root canal system. However, standardized protocols have not yet been defined for the real clinical context due to many irrigation procedures available. Objective To evaluate the clinical endodontic protocols and limitations of irrigating solutions in the disinfection of the root canal system in patients with apical periodontitis. Methods PubMed, Scopus, Embase, Web of Science, and Cochrane databases were searched for randomized controlled trials (RCT) published until January 2021. Hand searching was also performed. Studies focused on evaluating the effectiveness of irrigating solutions and/or irrigation activation methods in reducing the bacterial load in the root canal system were considered. The Cochrane risk-of-bias tool for randomized trials (RoB2) was used to assess the quality of the studies. Results Four hundred and twenty eight published articles were identified. After removing the duplicate studies and analyzing full texts, seven RCTs were selected. Two studies compared pure NaOCl with some combination of NaOCl with HEDP and MTAD. Two studies analyzed the antibacterial efficacy of NaOCl and chlorhexidine (CHX). Three studies compared conventional needle irrigation with different irrigation activation methods (PUI, XP-endo finisher, F-file activator, EndoVac activator). The review attained a satisfactory methodology. The main results of each included study were described. Discussion Activation methods provide significantly higher biofilm reduction than conventional needle irrigation methods. Combinations of NaOCl with different chelating agents were ineffective in terms of antimicrobial, but it could potentially increase the risk of irrigant extrusion. However, the irrigating protocols were not carefully detailed, especially those regarding the irrigants application time or total volume. The existing literature lacks high-quality studies. The level of evidence is moderate. Conclusions The available data is too heterogeneous to compare and identify the superiority of specific valuable irrigation protocols in each clinical context. Application time, volume, and activation methods should be standardized to determine the optimal irrigating procedures to reduce the bacterial load and ensure higher predictability of the endodontic treatment. Systematic Review Registration (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218555), PROSPERO registration: CRD42020218555.
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Affiliation(s)
- Riccardo Tonini
- Department of Medical and Surgery Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy
| | - Matteo Salvadori
- Department of Medical and Surgery Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy
| | - Elisabetta Audino
- Department of Medical and Surgery Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy
| | - Salvatore Sauro
- Department of Dentistry, Dental Biomaterials and Minimally Invasive Dentistry, Cardenal Herrera-CEU University, Alfara del Patriarca, Spain
- Department of Therapeutic Dentistry, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Maria Luisa Garo
- Department of Medical and Surgery Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy
- *Correspondence: Maria Luisa Garo
| | - Stefano Salgarello
- Department of Medical and Surgery Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy
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Di Spirito F, Pisano M, Caggiano M, Bhasin P, Lo Giudice R, Abdellatif D. Root Canal Cleaning after Different Irrigation Techniques: An Ex Vivo Analysis. Medicina (B Aires) 2022; 58:medicina58020193. [PMID: 35208517 PMCID: PMC8874436 DOI: 10.3390/medicina58020193] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 01/17/2023] Open
Abstract
Background and Objectives: The endodontic space is a complex area on both micro and macro levels; therefore, traditional irrigation techniques may not guarantee a complete cleaning of such a complicated tridimensional system. The presented ex vivo study aimed to evaluate root canal cleanliness, obtained through an equal volume of traditionally applied sodium hypochlorite (NaOCl), compared to ultrasonically activated NaOCl and ultrasonically activated NaOCl that had undergone intracanal heating NaOCl. Materials and Methods: A total of 60 freshly extracted human mandibular premolars underwent root sample length standardization (18 mm), root canal preparation and, based on the irrigation method employed, were randomly and equally assigned to three study groups, composed of root samples treated with ultrasonically activated NaOCl, ultrasonically activated NaOCl that had undergone intracanal heating and traditionally applied NaOCl. The root specimens were subsequently fixated with 4% buffered formalin solution and decalcified in Morse liquid. A total often 6-micron-thick serial cross-sections were obtained, dyed using hematoxylin and eosin and examined through an optical microscope at 40×, 100×, and 200×. Results: Ultrasonically activated NaOCl that had undergone intracanal heating showed a significantly smaller amount of debris compared to ultrasonically activated and traditionally applied NaOCl groups (p value < 0.05). Conclusions: Root canal cleanliness saw significant enhancements by ultrasonically activated NaOCl that had undergone intracanal heating.
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Affiliation(s)
- Federica Di Spirito
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; (M.P.); (M.C.)
- Correspondence:
| | - Massimo Pisano
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; (M.P.); (M.C.)
| | - Mario Caggiano
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; (M.P.); (M.C.)
| | - Prashant Bhasin
- Department of Conservative Dentistry & Endodontics, Sudha Rustagi College of Dental Sciences and Research Faridabad, Faridabad 121002, India;
| | - Roberto Lo Giudice
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, ME, Italy;
| | - Dina Abdellatif
- Department of Endodontics, Faculty of Dentistry, University of Alexandria, Alexandria 21545, Egypt;
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Wong J, Manoil D, Näsman P, Belibasakis GN, Neelakantan P. Microbiological Aspects of Root Canal Infections and Disinfection Strategies: An Update Review on the Current Knowledge and Challenges. FRONTIERS IN ORAL HEALTH 2022; 2:672887. [PMID: 35048015 PMCID: PMC8757850 DOI: 10.3389/froh.2021.672887] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
The oral cavity is the habitat of several hundreds of microbial taxa that have evolved to coexist in multispecies communities in this unique ecosystem. By contrast, the internal tissue of the tooth, i.e., the dental pulp, is a physiologically sterile connective tissue in which any microbial invasion is a pathological sign. It results in inflammation of the pulp tissue and eventually to pulp death and spread of inflammation/infection to the periradicular tissues. Over the past few decades, substantial emphasis has been placed on understanding the pathobiology of root canal infections, including the microbial composition, biofilm biology and host responses to infections. To develop clinically effective treatment regimens as well as preventive therapies, such extensive understanding is necessary. Rather surprisingly, despite the definitive realization that root canal infections are biofilm mediated, clinical strategies have been focused more on preparing canals to radiographically impeccable levels, while much is left desired on the debridement of these complex root canal systems. Hence, solely focusing on "canal shaping" largely misses the point of endodontic treatment as the current understanding of the microbial aetiopathogenesis of apical periodontitis calls for the emphasis to be placed on "canal cleaning" and chemo-mechanical disinfection. In this review, we dissect in great detail, the current knowledge on the root canal microbiome, both in terms of its composition and functional characteristics. We also describe the challenges in root canal disinfection and the novel strategies that attempt to address this challenge. Finally, we provide some critical pointers for areas of future research, which will serve as an important area for consideration in Frontiers in Oral Health.
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Affiliation(s)
- Jasmine Wong
- Discipline of Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Daniel Manoil
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Peggy Näsman
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Georgios N Belibasakis
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Prasanna Neelakantan
- Discipline of Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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Claudino Ribeiro JR, da Silveira Bueno CE, Bruno KF, Dos Reis S, de Martin AS, Fontana CE, Pelegrine RA. Impact of sodium hypochlorite on organic tissue dissolution in the periapical region of immature permanent teeth: an ex vivo study. J Endod 2022; 48:555-560. [PMID: 35032539 DOI: 10.1016/j.joen.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION To evaluate the impact of different sodium hypochlorite irrigation protocols on organic tissue dissolution in the periapical region of simulated immature permanent teeth. METHODS Eight single-rooted premolars and 48 samples of porcine palatal mucosa were used. Acrylic resin prototypes were constructed, placing the tissue in close contact with the dental apices. Specimens were then divided into six groups (n=8): two control groups, of saline irrigation with (NS/WA) or without (NS/NA) ultrasonic activation, and four experimental groups, of 1.5% and 2.5% sodium hypochlorite irrigation, with (NaOCl 1.5%/WA and NaOCl 2.5%/WA) or without (NaOCl 1.5%/NA and NaOCl 2.5%/NA) activation. Root canals were irrigated with 20 mL of the solution for 5 minutes, distributed over four irrigation cycles. In each cycle, after irrigation, the solution was either kept stagnant or activated for 30 seconds and then replaced. Specimens were weighed on a precision balance before and after the irrigation protocols. Tissue dissolution was measured by the difference between the initial and final weights. One-way ANOVA was applied, followed by Tukey's HSD test (α=0.05). RESULTS The NS/NA and NS/WA groups had mean weight reductions similar to the 1.5% NaOCl/NA group (p>0.05) and lower than the others (p<0.05). The 2.5% NaOCl/NA and 2.5% NaOCl/WA groups had the highest mean weight loss (p<0.05), while the 1.5% NaOCl/WA group had intermediate values (p<0.05). CONCLUSIONS Periapical tissue dissolution occurred in all groups, with greater impact observed with 2.5% NaOCl, with or without ultrasonic activation.
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Affiliation(s)
- José Ricardo Claudino Ribeiro
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil.
| | - Carlos Eduardo da Silveira Bueno
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil
| | - Kely Firmino Bruno
- Endodontics, Faculdade Sul Americana, BR-153, Km 502, Jardim da Luz, 74850370, Goiânia, GO, Brazil
| | - Samuel Dos Reis
- Endodontics, Faculdade Sul Americana, BR-153, Km 502, Jardim da Luz, 74850370, Goiânia, GO, Brazil
| | - Alexandre Sigrist de Martin
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil
| | - Carlos Eduardo Fontana
- Center for Life Sciences, Postgraduate Program in Health Sciences, Pontifícia, Universidade Católica de Campinas (PUC-CAMPINAS), Rua Professor Doutor Euryclides de Jesus Zerbini, 1516, CampusI/ Av. John Boyd Dunlop, s/n, 13087571, Campinas, SP, Brazil
| | - Rina Andréa Pelegrine
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil
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Janani K, Teja K, Jose J, Liin GS. An evidence-based discussion on herbal-based root canal disinfection: A letter to editor unrevealing the current scope and future perspective. SAUDI ENDODONTIC JOURNAL 2022. [DOI: 10.4103/sej.sej_45_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ahangari Z, Asnaashari M, Akbarian Rad N, Shokri M, Azari-Marhabi S, Asnaashari N. Investigating the Antibacterial Effect of Passive Ultrasonic Irrigation, Photodynamic Therapy and Their Combination on Root Canal Disinfection. J Lasers Med Sci 2021; 12:e81. [PMID: 35155166 PMCID: PMC8837837 DOI: 10.34172/jlms.2021.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/06/2021] [Indexed: 12/27/2022]
Abstract
Introduction: Enterococcus faecalis is a gram-positive, facultative anaerobic bacterium associated with persistent endodontic infections. Conventional disinfection methods may not completely eradicate the bacteria within the root canal system. Therefore, novel modalities have been suggested to optimize root canal disinfection. The aim of this study was to evaluate and compare the antibacterial effect of photodynamic therapy (PDT), passive ultrasonic irrigation (PUI) and their combination in addition to conventional endodontic irrigation against E. faecalis biofilms in root canals. Methods: Root canals of 50 single-rooted extracted human teeth were prepared and incubated with E. faecalis for 21 days. They were then divided into 4 treatment groups and a control group as follows: (1) NaOCl-Syringe irrigation with 2.5% NaOCl, (2) PUI-Passive ultrasonic irrigation with NaOCl, (3) NaOCl+PDT-Photodynamic therapy following syringe irrigation with NaOCl, (4) PUI+PDT, (5) Control-Syringe irrigation with saline. Colony-forming units were counted and bacterial reduction was calculated for each treatment group. Results: All treatments led to significant reductions in the bacterial load compared to the control group. PUI and PUI+PDT led to the complete elimination of the bacteria from the root canals. NaOCl and NaOCl+PDT treatments reduced the bacteria by 99.9% and 99.5% respectively. NaOCl+PDT was significantly less effective in reducing the bacteria compared to other treatment groups. There were no significant differences between the NaOCl, PUI, and PUI+PDT groups. Conclusion: Passive ultrasonic irrigation with or without the combination of Photodynamic therapy completely eradicated the bacteria. The use of PDT as an adjunction to NaOCl syringe irrigation and PUI did not enhance their antibacterial effect.
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Affiliation(s)
- Zohreh Ahangari
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Asnaashari
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazila Akbarian Rad
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Shokri
- Department of Dental Biomaterials, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saranaz Azari-Marhabi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negin Asnaashari
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Natanasabapathy V, Arul B, Srinivasan V, Santosh SS, Vasudevan A, Arockiam S, Namasivayam A, Deivanayagam K, Srinivasan MR. Removal of accumulated hard tissue debris from mesial root of mandibular molars evaluated using micro-CT - a systematic review and network meta-analysis. Evid Based Dent 2021:10.1038/s41432-021-0207-x. [PMID: 34795397 DOI: 10.1038/s41432-021-0207-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/21/2021] [Indexed: 11/09/2022]
Abstract
Aim The aim of this systematic review and network meta-analysis was to identify the best irrigant activation technique (IAT) for the removal of accumulated hard tissue debris (AHTD) from the mesial root of mandibular molars evaluated using micro-CT studies.Methods The research question was based on the PICO format. Four electronic databases - PubMed, Scopus, Embase and Web of Science - were searched for articles up to June 2020. Selected articles were assessed for bias using the Joanna Briggs Institute Critical appraisal tool. The network meta-analysis using a fixed-effects model and SUCRA ranking were performed. The quality of the evidence was assessed using the CINeMA framework.Results Eleven studies were included for qualitative synthesis while seven were included for quantitative synthesis. The risk of bias of all included articles was low. The results based on SUCRA values revealed the IAT shock wave-enhanced emission photoacoustic streaming (100%) resulted in the greatest reduction of the volume of AHTD from mesial roots of mandibular molars. Ranking of the other IATs was as follows: photon-induced photoacoustic streaming (87%), laser-activated irrigation (79.3%), XP EndoFinisher (71.2%), ultrasonically activated irrigation (59.6%), apical negative pressure (42.3%), EasyClean (37.4%), EDDY (26.2%), EndoActivator (24.2%), self-adjusting file (11.6%) and needle irrigation (11.3%).Conclusion None of the IATs rendered the root canals completely free of AHTD. The laser-activated irrigation groups fared better than all other interventions in reducing AHTD from the mesial roots of mandibular molars. The confidence rating ranged from low to high for indirect evidence and moderate to high for mixed evidence. Results must be interpreted with caution due to the laboratory nature of the included studies.
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Affiliation(s)
- Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India.
| | - Buvaneshwari Arul
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Vignesh Srinivasan
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Sneha Susan Santosh
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Aishwarya Vasudevan
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Selva Arockiam
- Department of Orthodontics, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Ambalavanan Namasivayam
- Department of Periodontology and Oral implantology, Faculty of Dentistry, Meenakshi Ammal Dental College & Hospital, Meenakshi Academy of Higher Education and Research (MAHER), No.1, Alapakkam Main Road, Maduravoyal, Chennai, 600095, Tamil Nadu, India
| | - Kandaswamy Deivanayagam
- Department of Conservative Dentistry & Endodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, Tamil Nadu, India
| | - M R Srinivasan
- Department of Conservative Dentistry and Endodontics, Sri Venkateswara Dental College and Hospital, Chennai, 600130, Tamil Nadu, India
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Ali NT, El-Boghdadi RM, Ibrahim AM, Amin SAW. Clinical and microbiological effects of ultrasonically activated irrigation versus syringe irrigation during endodontic treatment: a systematic review and meta-analysis of randomized clinical trials. Odontology 2021; 110:419-433. [PMID: 34729673 DOI: 10.1007/s10266-021-00671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
This study aimed to systematically review clinical and microbiology-related effects of ultrasonically activated irrigation (UAI) compared to syringe irrigation (SI) during endodontic treatment. Electronic databases searching and manual searching were conducted. Only randomized clinical trials (RCTs) were included comparing UAI to SI. The RoB 2.0 Cochrane tool was used for risk-of-bias (RoB) assessment. The main outcomes were postoperative pain, treatment failure, and microbiology-related outcomes. Qualitative and quantitative analyses, wherever applicable, were performed. Risk ratios (RR) and [standardized] mean differences {[S]MD} were calculated for dichotomous and continuous outcomes, respectively. Certainty of evidence (CoE) was assessed using GRADE tool. Ten RCTs were included. UAI reduced pain incidence within the first 24 h (RR 0.50, 95% CI 0.35-0.71, 308 teeth) and microbial counts (SMDpooled - 0.40, 95% CI [- 0.78, - 0.02], I2 = 0%, 126 teeth) than SI in non-vital teeth with apical periodontitis (AP). Both groups, however, had similar effects regarding pain intensity, lipopolysaccharide amounts, and the incidence of rescue-analgesic intake, treatment failure, and microbial presence (p > 0.05). CoE ranged from low to very low. Very limited evidence suggests that UAI could reduce postoperative-pain risk within the first 24 h and microbial counts for non-vital teeth with AP compared to SI. Most meta-analyses, however, are based on very few studies, mostly low-powered, with an overall very-low-to-low CoE. Further well-designed, larger RCTs are, thus, required.
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Affiliation(s)
- Noha Tawfik Ali
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Street, ElManyal, Cairo, 11553, Egypt
| | - Randa Mohamed El-Boghdadi
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Street, ElManyal, Cairo, 11553, Egypt
| | - Ahmed Mohamed Ibrahim
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Street, ElManyal, Cairo, 11553, Egypt
| | - Suzan Abdul Wanees Amin
- Department of Endodontics, Faculty of Dentistry, Cairo University, 11 ElSaraya Street, ElManyal, Cairo, 11553, Egypt.
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The Effect of Ultrasonic Agitation on the Porosity Distribution in Apically Perforated Root Canals Filled with Different Bioceramic Materials and Techniques: A Micro-CT Assessment. J Clin Med 2021; 10:jcm10214977. [PMID: 34768498 PMCID: PMC8584978 DOI: 10.3390/jcm10214977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 01/09/2023] Open
Abstract
The present study evaluated the effect of ultrasonic agitation on the porosity distribution of BioRoot RCS/single gutta-percha cone (BR/SC) and MTA Flow (MF) root canals fillings used as apical plugs in moderately curved and apically perforated roots. Eighty mesial root canals of mandibular first molars were enlarged up to ProTaper NEXT X5 rotary instrument 2 mm beyond the apical foramen, simulating apical perforations. Specimens were randomly divided into four experimental groups (20 canals per group) according to the material and technique used for root canal obturation: BR/SC, BR/SC with ultrasonic agitation (BR/SC-UA), MF and MF with ultrasonic agitation (MF-UA). The ultrasonic tip was passively inserted into the root canal after the injection of flowable cement and activated for 10 s. The specimens were scanned before and after obturation with a high-resolution micro-computed tomography scanner, and the porosity of the apical plugs was assessed. The differences between groups were analyzed using the Kruskal-Wallis and Mann-Whitney tests, with the significance level set at 5%. None of the obturation materials and techniques used in this study was able to provide a pore-free root canal filling in the apical 5 mm. Considerably higher percentages of open and closed pores were observed in the MF and MF-UA groups, with the highest porosity being in the MF-UA group (p < 0.05). No significant differences were observed between the BR/SC and BR/SC-UA groups, where the quantity of open and closed pores remained similar (p > 0.05).
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Plasma Rich in Growth Factors in the Treatment of Endodontic Periapical Lesions in Adult Patients: A Narrative Review. Pharmaceuticals (Basel) 2021; 14:ph14101041. [PMID: 34681265 PMCID: PMC8539488 DOI: 10.3390/ph14101041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/12/2021] [Indexed: 02/07/2023] Open
Abstract
Platelet concentrates have been widely used in regenerative medicine, including endodontics. The aim of this manuscript was to assess critically the efficacy of PRF in the treatment of endodontic periapical lesions in adult patients on the basis of the literature. The PICO approach was used to properly develop literature search strategies. The PubMed database was analyzed with the keywords: "((PRP) OR (PRF) OR (PRGF) OR (CGF)) AND (endodontic) AND ((treatment) OR (therapy))". After screening of 155 results, 14 articles were included in this review. Different types of platelet concentrates are able to stimulate the processes of proliferation and differentiation of mesenchymal stem cells. Platelet rich fibrin (PRF) releases growth factors for at least 7 days at the application site. Growth factors and released cytokines stimulate the activity of osteoblasts. Moreover, the release of growth factors accelerates tissue regeneration by increasing the migration of fibroblasts. It was not possible to assess the efficacy of PRF supplementation in the treatment of endodontic periapical lesions in permanent, mature teeth with closed apexes, due to the lack of well-designed scientific research. Further studies are needed to analyze the effect of PRF on the healing processes in the periapical region.
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Plasma Rich in Growth Factors in the Treatment of Endodontic Periapical Lesions in Adult Patients: Case Reports. Int J Mol Sci 2021; 22:ijms22179458. [PMID: 34502364 PMCID: PMC8431603 DOI: 10.3390/ijms22179458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
Platelet-rich fibrin (PRF) is an autologous blood concentrate obtained without anticoagulants by centrifugation of patients’ peripheral venous blood. PRF is considered to enhance the formation of new bone. The aim of this manuscript was to present two case reports of permanent teeth with closed apexes with periapical lesions, treated endodontically with the use of PRF. The root canals were mechanically cleaned and shaped with NiTi files and irrigated with 5.25% sodium hypochlorite (NaOCl), 40% citric acid (CA), and triple distillated water. Before the canal systems were obturated, A-PRF was used as a scaffold and was placed below the cementodentinal junction with hand pluggers. Cone beam computerized tomography (CBCT) was used to assess the resolutions of periapical radiolucencies. After 6 months, the measurements of both periapical lesions were significantly reduced. Although the performed root canal treatments (RCTs) can definitely be recognized as successful, it must be emphasized that mechanical shaping and cleaning of the root canals with special disinfecting solutions significantly affect the clinical efficacy of RCT. It seems impossible to state that PRF played a leading role in the healing process of the presented periapical lesions. Further studies must be performed to assess whether RCT of mature teeth with an additional PRF application is superior to RCT performed alone.
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Ng WNI, Marruganti C, Grandini S, Neelakantan P. Root canal debridement by negative pressure irrigation, ultrasonically activated irrigation and their combination. J Oral Sci 2021; 63:286-288. [PMID: 34108301 DOI: 10.2334/josnusd.21-0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Despite scientific evidence that root canal debridement is the cornerstone for successful treatment, the effectiveness of a combination of delivery and activation systems in cleaning root canals remains unknown. This study is the first to demonstrate the remaining pulp tissue in root canals after irrigation with various techniques such as positive pressure syringe-and-needle irrigation, ultrasonic activation, negative pressure irrigation and ultrasonic activation after negative pressure irrigation. The results showed that negative pressure irrigation alone and its combination with ultrasonic activation resulted in significantly superior effectiveness than positive pressure irrigation and ultrasonic activation alone in the apical-third of root canals.
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Affiliation(s)
- Wing Nok Isaac Ng
- Discipline of Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong
| | | | | | - Prasanna Neelakantan
- Discipline of Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong
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Ballal NV, Ivica A, Meneses P, Narkedamalli RK, Attin T, Zehnder M. Influence of 1-Hydroxyethylidene-1,1-Diphosphonic Acid on the Soft Tissue-Dissolving and Gelatinolytic Effect of Ultrasonically Activated Sodium Hypochlorite in Simulated Endodontic Environments. MATERIALS (BASEL, SWITZERLAND) 2021; 14:2531. [PMID: 34068094 PMCID: PMC8152752 DOI: 10.3390/ma14102531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/24/2022]
Abstract
The addition of Dual Rinse HEDP, an etidronate powder, to a sodium hypochlorite (NaOCl) solution can create a combined single endodontic irrigant with a soft tissue-dissolving and a decalcifying effect, which can replace traditional alternating irrigation with chemically non-compatible solutions. While the short-term compatibility between NaOCl and 1-hydroxyethylidene-1,1-diphosphonic acid (HEDP) has been shown, it remains unclear whether ultrasonic activation of a combined NaOCl & HEDP solution immediately reduces the available chlorine and/or renders the NaOCl ineffective in dissolving organic tissue remnants. This was tested in three experiments: (1) direct activation in test tubes in an ultrasonic bath and then the activation by an ultrasonically oscillating tip (IrriSafe) in (2) an epoxy resin model containing a simulated isthmus filled with gelatin, and (3) extracted teeth with simulated resorption cavities filled with soft tissue. The control solutions were physiological saline and 2.5% NaOCl without HEDP. In (1), available chlorine after 30 s of ultrasonic activation (37 kHz) of test and control solution was assessed, as well as shrimp tissue weight loss in direct exposure. In (2) and (3), the ultrasonic tip was driven at 1/3 of full power using the respective unit, and areas of removed gelatin from the isthmus and tissue weight loss were used as the outcomes, respectively. Experiment (1) revealed no negative impact by HEDP on available chlorine (1), while all three experiments showed a highly significant (p > 0.001) synergistic effect, which was not hampered by HEDP, between NaOCl and ultrasonic activation regarding tissue weight loss (1, 3) and dissolution of gelatin (2).
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Affiliation(s)
- Nidambur Vasudev Ballal
- Department of Conservative Dentistry and Endodontics, Manipal Academy of Higher Education, Manipal College of Dental Sciences, Manipal, Karnataka 576104, India; (N.V.B.); (R.K.N.)
| | - Anja Ivica
- Clinic of Conservative and Preventive Dentistry, University of Zurich, 8032 Zurich, Switzerland; (A.I.); (P.M.); (T.A.)
| | - Pamela Meneses
- Clinic of Conservative and Preventive Dentistry, University of Zurich, 8032 Zurich, Switzerland; (A.I.); (P.M.); (T.A.)
| | - Raj Kumar Narkedamalli
- Department of Conservative Dentistry and Endodontics, Manipal Academy of Higher Education, Manipal College of Dental Sciences, Manipal, Karnataka 576104, India; (N.V.B.); (R.K.N.)
| | - Thomas Attin
- Clinic of Conservative and Preventive Dentistry, University of Zurich, 8032 Zurich, Switzerland; (A.I.); (P.M.); (T.A.)
| | - Matthias Zehnder
- Clinic of Conservative and Preventive Dentistry, University of Zurich, 8032 Zurich, Switzerland; (A.I.); (P.M.); (T.A.)
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Moraes MM, Coelho MS, Nascimento WM, Nogales CG, de Campos FUF, de Jesus Soares A, Frozoni M. The antimicrobial effect of different ozone protocols applied in severe curved canals contaminated with Enterococcus faecalis: ex vivo study. Odontology 2021; 109:696-700. [PMID: 33507433 DOI: 10.1007/s10266-021-00592-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate 3 different irrigation protocols using ozone on monoculture biofilm of Enterococcus faecalis. Fifty disto-buccal roots of maxillary first molars were instrumented up to the size 25.08, sterilized and then incubated with Enterococcus faecalis for 21 days for biofilm maturation in the root canal walls. After contamination, the initial collection (S1) was performed and the 50 samples were divided in 3 experimental groups (n = 15) and 1 positive control group (n = 5) as follows: Group1: Ozonated water (40 µg/ml); Group2: gaseous ozone (40 µg/ml); Group3: Ozonated water (40 µg/ml) under continuous ultrasonic irrigation (CUI) and, Group 4: 2.5% sodium hypochlorite (positive control). The final collection (S2) was performed using hedstroem files # 25 by scraping the root canal wall and absorbed paper cone. The collected samples were analyzed by CFU/ml count and qPCR. To compare the effect of irrigation methods and to investigate E. faecalis count data, Kruskal-Wallis and Wilcoxon nonparametric tests were used at p < 05. The values of the differences between the S1 values and the S2 values revealed that the groups did not differ significantly for either E. faecalis CFU count data (p = 0.713) or q-PCR (p = 0.185), however, it is observed that for all groups, the CFU count of E. faecalis decreased over 99%. For the q-PCR assay, the reduction was on the order of 74-95%. Only the NaOCl positive control group presented total elimination of CFU/mL bacterial counting. The ozone protocols assessed were similar in regard to Enterococcus faecalis reduction.
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Affiliation(s)
- Mariana Montagner Moraes
- Endodontic Department São Leopoldo Mandic School of Dentistry, Rua José Rocha Junqueira 13, Campinas, SP, Brazil
| | - Marcelo Santos Coelho
- Endodontic Department São Leopoldo Mandic School of Dentistry, Rua José Rocha Junqueira 13, Campinas, SP, Brazil.
| | - Wayne Martins Nascimento
- Endodontic Department São Leopoldo Mandic School of Dentistry, Rua José Rocha Junqueira 13, Campinas, SP, Brazil
| | | | | | | | - Marcos Frozoni
- Endodontic Department São Leopoldo Mandic School of Dentistry, Rua José Rocha Junqueira 13, Campinas, SP, Brazil
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Orlowski NB, Schimdt TF, Teixeira CDS, Garcia LDFR, Savaris JM, Tay FR, Bortoluzzi EA. Smear Layer Removal Using Passive Ultrasonic Irrigation and Different Concentrations of Sodium Hypochlorite. J Endod 2020; 46:1738-1744. [PMID: 32721483 DOI: 10.1016/j.joen.2020.07.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/22/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The present study evaluated the effect of passive ultrasonic activation (PUI) of EDTA solution followed by conventional irrigation with 2 concentrations of sodium hypochlorite (NaOCl) on smear layer removal. METHODS Fifty single-root mandibular premolars were chemomechanically prepared with ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland) nickel-titanium rotary instruments and 1% NaOCl. The roots were cleaved, and the dentin surfaces were analyzed with scanning electron microscopy operated at a low vacuum. Images were obtained from previously demarcated areas in each root canal third. The teeth were reassembled and distributed into 5 groups according to the final irrigation protocols (n = 10): group 1, EDTA/PUI + 1% NaOCl; group 2, EDTA/PUI + 5% NaOCl; group 3, EDTA/CI + 1% NaOCl; group 4, EDTA/CI + 5% NaOCl; and group 5 (negative control), saline solution/PUI. After irrigation, the teeth were reseparated and prepared for conventional high-vacuum scanning electron microscopy of the same dentin surface that was previously analyzed. The amount of debris was classified using a 4-point scoring system. Data were analyzed with Kruskal-Wallis and Dunn tests at α = 0.05. RESULTS Groups 1 and 2, which used PUI and different concentrations of NaOCl, were not significantly different; however, they differed significantly from group 3 (P < .05). With respect to canal cleanliness at different root thirds, all groups showed the worst cleaning at the apical third. CONCLUSIONS PUI activation of the EDTA irrigant is required when canal debridement is performed with EDTA and a lower concentration of NaOCl.
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Affiliation(s)
- Nayra Bittencourt Orlowski
- Department of Dentistry, Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Tamer Ferreira Schimdt
- Department of Dentistry, Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Cleonice da Silveira Teixeira
- Department of Dentistry, Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry, Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Julia Menezes Savaris
- Department of Dentistry, Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta, Georgia
| | - Eduardo Antunes Bortoluzzi
- Department of Dentistry, Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
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Asnaashari M, Kooshki N, Salehi MM, Azari-Marhabi S, Amin Moghadassi H. Comparison of Antibacterial Effects of Photodynamic Therapy and an Irrigation Activation System on Root Canals Infected With Enterococcus faecalis: An In Vitro Study. J Lasers Med Sci 2020; 11:243-248. [PMID: 32802282 DOI: 10.34172/jlms.2020.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Introduction: Enterococcus faecalis is a resistant bacterium which is the most abundant species in infected root canals. Photodynamic therapy (PDT) is a method for killing the bacteria with active Oxygen radicals generated in a photosensitizer when exposed to centralized light. Furthermore, as a new method of canal disinfection, a variety of irrigation activation systems have been introduced, one of which is GentleFile (GF) with rotary movements and spiral effects for antibacterial action. This study aimed to compare the effectiveness of the two mentioned methods when used with and without Sodium Hypochlorite in eliminating E. faecalis from infected root canals. Methods: Fifty-eight uniradicular teeth were randomly divided into 4 experimental groups of 14. Two specimens were selected for later scanning electron microscopy in order to screen the procedure steps. In each experimental group, 10 samples were selected to be treated with GF or PDT; 3 of them were selected as positive controls and the other one sample was chosen as a negative control. Experimental groups were as follows: (1) Irrigation activation system, (2) Irrigation activation system + sodium hypochlorite, (3) PDT, and (4) PDT+ sodium hypochlorite. The specimens were then cultured for a bacterial colony count. Results: The decrease in the bacterial count after the treatment with the irrigation activation system was 99.8% (P =0.011) and when the system was used with sodium hypochlorite, it was 100% (P =0.001). The antibacterial effect of PDT was 90.08% (P =0.011) and it was 99.7% when PDT was combined with sodium hypochlorite (P =0.011). Conclusion: All four methods can be administered as complementary methods in root canal disinfection. According to the results of disinfection in the experimental groups of current study it is concluded that integration of new technologies such as activation irrigation system or PDT in Combination with NaOCl ameliorates disinfection of root canal and can provide several advantages in the endodontic outcome.
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Affiliation(s)
- Mohammad Asnaashari
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Kooshki
- DDS, Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Salehi
- Dental students' research committee, faculty of dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saranaz Azari-Marhabi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hedieh Amin Moghadassi
- Research Assistant, Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences,Tehran, Iran
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Current Trends in the Use of Irrigant Activation Techniques Among Endodontists & Post-Graduate Dental Students in India -A Knowledge, Attitude and Practice Based Survey. Eur Endod J 2020; 5:73-80. [PMID: 32766515 PMCID: PMC7398998 DOI: 10.14744/eej.2020.98698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/09/2020] [Indexed: 01/10/2023] Open
Abstract
Objective: The aim of this survey was to examine the practice/use of Irrigant Activation Techniques (IAT) among Endodontists and post-graduate dental students in India. Methods: An invitation to participate in this survey was sent by electronic mail to 902 members of Indian Endodontic society. A total of 32 questions were finalized for the survey after validation by five endodontic experts. Survey contained 2 demographic questions, 7 knowledge based questions, 11 questions on attitude and 12 questions on practice of IAT. The reliability was checked by randomly asking 10 participants to fill the survey forms again after 15 days. The data was analyzed using chi-square test (P<0.05). Results: The overall response rate for the survey was 30.5%. The content validity ratio for the questionnaire was 0.972 & the reliability calculated using Kappa scores was 0.978. Most of the respondents (87.3%) use IAT, while 4.7% do not use IAT. Most commonly used IAT was Manual dynamic agitation (MDA) used by 28.7%, followed by Ultrasonics in 17.2%. Sonic & negative pressure (EndoVac) was used by less than 10% of respondents. Combination of IAT was used by 39%. In 23 (5 on knowledge, 9 on attitude & 9 on practice) out of the 32 questions in this survey, there was a statistically significant difference (P<0.05) in the answers between the groups, with post-graduate dental students opting the correct choices. Sodium hypochlorite (NaOCl) is the preferred choice of irrigant for IAT according to 48.6%, Chlorhexidine (CHX) is used by 4.2% & Ethylene diamine tetra acetic acid (EDTA) by 2.4%. Combination of two irrigants is used by 28.7% and 6% use all the three irrigants. Conclusion: Vast majority of the Endodontist in India use some form of IAT to improve the efficacy of irrigation. MDA is the most commonly used IAT.
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Evaluation of Photodynamic Therapy Using a Diode Laser 635 nm as an Adjunct to Conventional Chemo-Mechanical Endodontic Procedures against Enterococcus faecalis Biofilm: Ex-Vivo Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10082925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The study aimed to evaluate the antimicrobial effect of photodynamic therapy (PDT) with the use of Toluidine Blue (TB) on extracted teeth infected with biofilms of Enterococcus faecalis. Fifty-four extracted teeth with single-roots and single canals were mechanically shaped, autoclaved, and contaminated with E. faecalis. They were randomly divided into six groups: two groups were negative and positive control groups, two groups were subjected to mechanical instrumentation and PDT with different pre-irradiation times and irradiation times, and two groups were subjected to chemo-mechanical endodontic treatment and PDT with different pre-irradiation times and irradiation times. In PDT groups, after the application of TB, the canals were irradiated with a diode laser of wavelength 635 nm, with a fiber diameter of 200 μm and 100 mW of power in continuous mode. The bacterial load was evaluated using a BioTimer Assay protocol. The greatest reduction of bacterial load was observed in groups of combined PDT with chemo-mechanical treatment. The reductions of bacterial load in groups of combined PDT with chemo-mechanical treatment, and in the positive control group, were significant (p < 0.01) when compared to that of the negative control group. Photodynamic therapy as an adjunctive modality may improve the disinfection capacity of conventional endodontic treatment against E. faecalis.
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Eggmann F, Vokac Y, Eick S, Neuhaus KW. Sonic irrigant activation for root canal disinfection: power modes matter! BMC Oral Health 2020; 20:102. [PMID: 32276625 PMCID: PMC7147034 DOI: 10.1186/s12903-020-01088-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/25/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sonic irrigant activation has gained widespread popularity among general dentists and endodontists alike in recent years. This in vitro study aimed to evaluate the impact of three power modes of a sonic activation device (EDDY) on its antimicrobial effectiveness in infected root canals. METHODS The root canals of straight, human roots (n = 120) were prepared to size 40/.06. In a short-term infection experiment, the root canals were inoculated with different microbial species for three days. The following irrigation protocols, using 4 ml of normal saline as irrigant, were performed: negative control, manual rinsing, sonic irrigant activation at power modes "low", "medium" and "high". In a second, long-term experiment, testing the same irrigation protocols, inoculation lasted 21 days and sodium hypochlorite was used as irrigant. Sequential infection control samples were assessed using culture assays. The statistical analysis included one-way analysis of variance of log10-scaled counts of colony-forming units (CFU) with post-hoc comparisons using Bonferroni corrections and Chi2 tests (α = 0.05). RESULTS In the short-term experiment, the sonic irrigation protocols decreased the number of CFUs by 1.88 log10 units compared with the negative control (p < 0.001). The power modes "medium" and "high" achieved the most effective reduction of the microbial load. In the long-term experiment, microbial regrowth occurred after 7 days unless the device was used at its highest power setting. CONCLUSIONS The power modes of the sonic irrigation device have a significant impact on the effectiveness for endodontic disinfection. The sonic irrigation device should always be used at the highest power setting in order to maximize its antimicrobial effectiveness.
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Affiliation(s)
- Florin Eggmann
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, UZB, University of Basel, Mattenstrasse 40, CH-4056, Basel, Switzerland.
| | | | - Sigrun Eick
- Laboratory of Oral Microbiology, Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Klaus W Neuhaus
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, UZB, University of Basel, Mattenstrasse 40, CH-4056, Basel, Switzerland.,Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
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Abusrewil S, Alshanta OA, Albashaireh K, Alqahtani S, Nile CJ, Scott JA, McLean W. Detection, treatment and prevention of endodontic biofilm infections: what's new in 2020? Crit Rev Microbiol 2020; 46:194-212. [PMID: 32233822 DOI: 10.1080/1040841x.2020.1739622] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endodontic disease, a biofilm infection of the root canal space, is a significant cause of dental morbidity worldwide. Endodontic treatment, or root canal treatment, as it is commonly known is founded on the ability to eradicate microbial biofilm infection and prevent re-infection of the highly complex root canal space. Despite many "advances" in clinical endodontics we have seen little improvement in outcomes. The aim of this critical review paper is to provide a contemporary view of endodontic microbiology and biofilm polymicrobiality, provide an understanding of the host response, and how together these impact upon clinical treatment. Ultimately, it is intended to provide insight into novel opportunities and strategies for the future diagnostics, treatment, and prevention of endodontic disease.
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Affiliation(s)
- Sumaya Abusrewil
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Om Alkhir Alshanta
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Khawlah Albashaireh
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Saeed Alqahtani
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Christopher J Nile
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - James Alun Scott
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - William McLean
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Gama LT, Duque TM, Özcan M, Philippi AG, Mezzomo LAM, Gonçalves TMSV. Adhesion to high-performance polymers applied in dentistry: A systematic review. Dent Mater 2020; 36:e93-e108. [PMID: 32035670 DOI: 10.1016/j.dental.2020.01.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/26/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this systemic review, conducted in accordance with the PRISMA statement, was to investigate the impact of surface pretreatments on the bonding strength of high performance polymers (HPPs). METHODS Eight databases were searched through March 2019. Risk of bias was assessed and random effects meta-analyses were applied to analyze mean differences in shear bond strength (SBS) and tensile bond strength (TBS), considering surface pretreatments and bonding agents after 24h and thermocycling. RESULTS A total of 235 relevant titles and abstracts were found, yielding 11 final selections. Low risk of bias was observed in most studies. For polyetheretherketone (PEEK) specimens, random-effect models showed that, compared to non-treated controls, pretreatments associated with Visio.link® (Bredent, Senden, GE) increased TBS by 26.72MPa (95% confidence interval (CI), 19.69-33.76; p<0.00001) and increased SBS by 4.86MPa (95% CI, 2.61-7.10; p<0.00001). Air abrasion improved SBS by 4.90MPa (95% CI, 3.90-5.90; p<0.00001) (50μm alumina) and 4.51MPa (95% CI, 1.85-7.18; p=0.0009) (silica-coated CoJet). In comparison to non-treated controls, Visio.link® and Signum PEEK Bond® (Heraeus Kulzer, Hanau, GE) increased SBS by 33.76MPa (95% CI, 18.72-48.81; p<0.00001) and 33.28MPa (95% CI, 17.48-49.07; p<0.00001), respectively. No differences were found between Visio.link® and Signum PEEK Bond® or Monobond Plus/Heliobond® (Ivoclar Vivadent, Schaan, LH) (p>0.05). Similar results were observed for polyetherketoneketone (PEKK) specimens. SIGNIFICANCE This review shows improved HPP bonding following the application of various surface pretreatments, including air abrasion and bonding agents.
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Affiliation(s)
- Lorena Tavares Gama
- Department Prosthodontics and Periodontology, University of Campinas (UNICAMP), Limeira Avenue, 901, CEP: 13414-903, Areião, Piracicaba, Brazil.
| | - Thais Mageste Duque
- Dentistry Department, Federal University of Santa Catarina (UFSC), R. Eng. Agronômico Andrei Cristian Ferreira, s/n, CEP: 88040-900, Trindade, Florianópolis, Brazil.
| | - Mutlu Özcan
- Center for Dental and Oral Medicine, Dental Materials Unit, Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland.
| | - Analucia Gebler Philippi
- Dentistry Department, Federal University of Santa Catarina (UFSC), R. Eng. Agronômico Andrei Cristian Ferreira, s/n, CEP: 88040-900, Trindade, Florianópolis, Brazil.
| | - Luis André Mendonça Mezzomo
- Dentistry Department, Federal University of Santa Catarina (UFSC), R. Eng. Agronômico Andrei Cristian Ferreira, s/n, CEP: 88040-900, Trindade, Florianópolis, Brazil.
| | - Thais Marques Simek Vega Gonçalves
- Dentistry Department, Federal University of Santa Catarina (UFSC), R. Eng. Agronômico Andrei Cristian Ferreira, s/n, CEP: 88040-900, Trindade, Florianópolis, Brazil.
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Iandolo A, Abdellatif D, Amato M, Pantaleo G, Blasi A, Franco V, Neelakantan P. Dentinal tubule penetration and root canal cleanliness following ultrasonic activation of intracanal‐heated sodium hypochlorite. AUST ENDOD J 2019; 46:204-209. [DOI: 10.1111/aej.12393] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Alfredo Iandolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences University of Naples Federico II Naples Italy
| | - Dina Abdellatif
- Department of Endodontics Faculty of Dentistry University of Alexandria Alexandria Egypt
| | - Massimo Amato
- Department of Medicine and Surgery University of Salerno Salerno Italy
| | - Giuseppe Pantaleo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences University of Naples Federico II Naples Italy
| | - Andrea Blasi
- Department of Neurosciences, Reproductive and Odontostomatological Sciences University of Naples Federico II Naples Italy
| | - Vittorio Franco
- Dentistry Faculty of Medicine and Surgery University of Siena Siena Italy
| | - Prasanna Neelakantan
- Discipline of Endodontology Faculty of Dentistry The University of Hong Kong Hong Kong Hong Kong
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Rossi-Fedele G, Kahler B, Venkateshbabu N. Limited Evidence Suggests Benefits of Single Visit Revascularization Endodontic Procedures - A Systematic Review. Braz Dent J 2019; 30:527-535. [DOI: 10.1590/0103-6440201902670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/03/2019] [Indexed: 12/18/2022] Open
Abstract
Abstract Revascularization endodontic procedures commonly require multiple treatment sessions. However, single visit procedures may be advantageous from the clinical and patient management standpoints. The purpose of this review was to evaluate the outcomes of single-visit revascularization endodontic procedures for the management of immature permanent teeth with non-vital pulp. Two electronic databases (Scopus and PubMed) were searched, from their inception to July 2018, for studies that assessed clinical and/or radiographic and/or histologic outcomes of single-visit revascularization endodontic procedures performed in immature permanent teeth with non-vital pulp. Case reports, animal studies and clinical trials were included. The quality of case reports was appraised by Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. The quality of randomized clinical trials was assessed by the revised Cochrane risk of bias tool for randomized trials. The risk of bias for animal studies was assessed using SYRCLE’s risk of bias tool. Tabulation followed by narrative synthesis was used to draw conclusions. Seven studies satisfied the selection criteria. Five were classified as case reports, one as a randomized clinical trial and one as animal study. The latter presented with a high risk of bias, whilst the remaining showed a low risk. The evidence supporting the potential use of single-visit revascularization endodontic procedures is scarce. Successful single-visit revascularization endodontic procedures commonly include the use of high concentrations of sodium hypochlorite and EDTA combined with the use of agitation systems. Further clinical trials with long term follow up are needed to confirm the results of the current review.
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George R. Evaluation of the evidence of effectiveness of ultrasonic activated irrigation for root canal treatment. Evid Based Dent 2019; 20:83-84. [PMID: 31562409 DOI: 10.1038/s41432-019-0037-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Data sources Cochrane Library, Embase, LILACS, PubMed, SciELO, Scopus databases, endodontic journals and textbooks. Study selection Two independent reviewers screened the titles, abstracts and/or full-text of the both clinical or in vitro studies that used ultrasonic irrigant activation for management of teeth needing root canal therapy. Results The study included three clinical studies and 45 in vitro studies. The study reported no evidence of any benefit of ultrasonic activation over needle irrigation in improving the healing rate of apical periodontitis. While the study reported that the evidence for disinfection of the root canal was inconclusive it did show evidence of the efficacy of ultrasonic irrigation over needle irrigation when removal of pulp tissue remnants and hard tissue debris was assessed. Conclusion The study reported that it was essential that there should be more research into the antimicrobial effect on healing in periapical periodontitis when teeth are treated using ultrasonic activation.
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Affiliation(s)
- Roy George
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia.
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Ultrasonic Irrigant Activation during Root Canal Treatment: A Systematic Review. J Endod 2019; 45:31-44.e13. [PMID: 30558797 DOI: 10.1016/j.joen.2018.09.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/05/2018] [Accepted: 09/16/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aim of this study was to systematically review the evidence on the cleaning and disinfection of root canals and the healing of apical periodontitis when ultrasonic irrigant activation is applied during primary root canal treatment of mature permanent teeth compared with syringe irrigation. METHODS An electronic search was conducted of the Cochrane Library, Embase, LILACS, PubMed, SciELO, and Scopus databases using both free-text key words and controlled vocabulary. Additional studies were sought through hand searching of endodontic journals and textbooks. The retrieved studies were screened by 2 reviewers according to predefined criteria. The included studies were critically appraised, and the extracted data were arranged in tables. RESULTS The electronic and hand search retrieved 1966 titles. Three clinical studies and 45 in vitro studies were included in this review. Ultrasonic activation did not improve the healing rate of apical periodontitis compared with syringe irrigation after primary root canal treatment of teeth with a single root canal. Conflicting results were reported by the in vitro microbiological studies. Ultrasonic activation was more effective than syringe irrigation in the removal of pulp tissue remnants and hard tissue debris based on both clinical and in vitro studies. Ultrasonic activation groups were possibly favored in 13 studies, whereas syringe irrigation groups may have been favored in 3 studies. CONCLUSIONS The level of the available evidence was low, so no strong clinical recommendations could be formulated. Future studies should focus on the antimicrobial effect and healing of apical periodontitis in teeth with multiple root canals.
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Passive Ultrasonic Irrigation Efficacy in the Vapor Lock Removal: Systematic Review and Meta-Analysis. ScientificWorldJournal 2019; 2019:6765349. [PMID: 30992694 PMCID: PMC6434262 DOI: 10.1155/2019/6765349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/24/2019] [Indexed: 12/16/2022] Open
Abstract
Passive Ultrasonic Irrigation (PUI) represents one of the most used systems to improve the endodontic irrigants activity. PUI acts increasing the reaction rate of NaOCl, with an increase of dentinal debris and smear layer removal. There is a stronger shear stress and a vapor lock reduction. Aim of this systematic review was to figure out the effects of the PUI on the vapor lock removal, during irrigation. Literature research has been carried out by two reviewers, consulting online databases such as PubMed, EBSCO, and Google Scholar, using keywords like Vapor Lock, Vapour Lock, and Vapor Lock Endodontic. The articles list has been screened based on titles and abstracts, applying eligibility and inclusion criteria. The three articles were eligible for quantitative and statistical analysis, by using RevManager Software Version 5.3. Results show statistical heterogeneity (P=0.08; I2 index=61%) in the vapor lock elimination between the use of PUI and PPI, with an overall Odds Ratio=0.08, CI=95% [0.03;0.25]. PUI resulted to be a useful technique to improve NaOCl activity for vapor lock removal, despite PPI alone using a needle.
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Decurcio DA, Rossi-Fedele G, Estrela C, Pulikkotil SJ, Nagendrababu V. Machine-assisted Agitation Reduces Postoperative Pain during Root Canal Treatment: A Systematic Review and Meta-analysis from Randomized Clinical Trials. J Endod 2019; 45:387-393.e2. [DOI: 10.1016/j.joen.2019.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/07/2019] [Accepted: 01/15/2019] [Indexed: 11/30/2022]
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Bueno CRE, Cury MTS, Vasques AMV, Sarmiento JL, Trizzi JQ, Jacinto RC, Sivieri-Araujo G, Dezan Júnior E. Cleaning effectiveness of a nickel-titanium ultrasonic tip in ultrasonically activated irrigation: a SEM study. Braz Oral Res 2019; 33:e017. [PMID: 30892412 DOI: 10.1590/1807-3107bor-2019.vol33.0017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/28/2019] [Indexed: 02/03/2023] Open
Abstract
In endodontic treatment, regardless of the instrumentation technique, the presence of a smear layer covering contaminated dentin walls is always a concern. Thus, irrigation plays an essential role in reducing bacterial load. To enhance irrigation effectiveness, different ultrasonic activation methods and the use of different tips have been studied. This study assessed the cleaning capacity of the novel NiTi ultrasonic tip for smear layer removal using ultrasonically activated irrigation (UAI) with passive or continuous ultrasonic irrigation (PUI or CUI, respectively), compared with conventional irrigation. Forty-five single-rooted human mandibular premolars were decoronated to a standardized length of 16 mm. Instrumentation was performed using the Genius system up to size 50.04 and irrigated with 3% NaOCl. The specimens were divided into three groups (n = 15) according to the final irrigation activation technique: conventional irrigation (CI), as control group; PUI; and CUI, following the manufacturer's protocol. The samples were longitudinally cleaved and analyzed under a scanning electron microscope for smear layer removal according to a cleanliness score for the cervical, middle, and apical thirds. Data were evaluated by means of the Kruskal-Wallis and Tukey's tests, with a 5% level of significance. UAI enhanced cleaning compared to conventional irrigation, mainly at the apical third. CUI showed the best results, with statistically significant lower scores than PUI and CI (p < 0.05). Final irrigant activation with the NiTi tip showed better cleaning capacity than conventional irrigation. In addition, CUI resulted in better smear layer removal than PUI.
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Affiliation(s)
| | - Marina Tolomei Sandoval Cury
- Universidade Estadual Paulista- UNESP, Araçatuba School of Dentistry, Department of Endodontics, Araçatuba, SP, Brazil
| | - Ana Maria Veiga Vasques
- Universidade Estadual Paulista- UNESP, Araçatuba School of Dentistry, Department of Endodontics, Araçatuba, SP, Brazil
| | - Jimena Lama Sarmiento
- Universidade Estadual Paulista- UNESP, Araçatuba School of Dentistry, Department of Endodontics, Araçatuba, SP, Brazil
| | - Juliana Quintino Trizzi
- Universidade Estadual Paulista- UNESP, Araçatuba School of Dentistry, Department of Endodontics, Araçatuba, SP, Brazil
| | - Rogério Castilho Jacinto
- Universidade Estadual Paulista- UNESP, Araçatuba School of Dentistry, Department of Endodontics, Araçatuba, SP, Brazil
| | - Gustavo Sivieri-Araujo
- Universidade Estadual Paulista- UNESP, Araçatuba School of Dentistry, Department of Endodontics, Araçatuba, SP, Brazil
| | - Eloi Dezan Júnior
- Universidade Estadual Paulista- UNESP, Araçatuba School of Dentistry, Department of Endodontics, Araçatuba, SP, Brazil
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