Stabilizing Sodium Hypochlorite at High pH: Effects on Soft Tissue and Dentin

Compatibility of Dual Rinse 1-Hydroxyethane-1,1-Diphosphonic Acid with Sodium Hypochlorite Solutions Containing Proprietary Additives

INTRODUCTION

A salt of 1-hydroxyethylidene-1,1-diphosphonic acid (HEDP) was commercialized some years ago. This so-called Dual Rinse (DR) HEDP has been tested for its combined actions and interactions with pure sodium hypochlorite (NaOCl) solutions. The aim of this study was to assess DR interactions with NaOCl solutions containing proprietary additives.

METHODS

Designated endodontic NaOCl solutions that come at 2 different strengths (2% and 5.25%), and without or with additives (Chloraxid and Chloraxid Extra, respectively) were tested. Some of their key chemical and physical properties were determined in the presence or absence of HEDP (9%) in the solution. In addition, soft tissue dissolution efficacy of test and control solutions was assessed in extracted teeth (n = 10 per group, 90 teeth in total).

RESULTS

The NaOCl content in the 2% Chloraxid solutions was slightly above, that in the 5.25% solutions below the labeled concentration. The additives in the Chloraxid Extra solutions neither altered their surface tension nor their viscosity. The addition of HEDP to any of the tested NaOCl solutions reduced their pH, and increased their surface tension and viscosity. HEDP-induced available chlorine loss over the first hour was similar between all NaOCl solutions. Soft tissue dissolution in the root canals was affected by NaOCl concentration, but neither by any proprietary NaOCl additive in the Chloraxid solutions, nor the addition of DR HEDP.

CONCLUSIONS

Proprietary additives had no influence on any of the tested parameters, including surface tension of the "Extra" solutions. The increased viscosity of combined NaOCl/HEDP solutions deserves further attention.

Effects of endodontic root canal irrigants on tooth dentin revealed by infrared spectroscopy: a systematic literature review

BACKGROUND

Root canal irrigation endodontic solutions have effects on the chemistry of dentin. Infrared spectroscopy is a non-destructive chemical characterization method where the strength of absorption often correlates with mineral or organic composition.

OBJECTIVES

To survey effects of commonly used irrigation solutions on the composition of root dentin as detected by widely-available Fourier transform infrared spectroscopy (FTIR) methods.

METHODS

Electronic databases were searched for articles published between 1983 to 2023. After risk of bias assessments (OHAT), studies were grouped according to effects per irrigation solution. Inclusion criteria comprised in vitro studies that used extracted human or bovine teeth, treated by irrigation solutions characterized using FTIR spectroscopy and presenting spectral data. Publications that did not present spectra were excluded.

RESULTS

A wide range of concentrations, durations, and treatment protocols have been tested but only 30 out of 3452 studies met our inclusion criteria. Different FTIR methods were used with Attenuated Total Reflection (ATR) variant being the most common (21 studies). Investigated solutions included sodium hypochlorite (NaOCl), ethylenediaminetetraacetic-acid (EDTA), 1-hydroxyethylidene-1-1-diphosphonic-acid (HEDP), peracetic-acid (PAA), glycolic-acid (GA), and citric-acid (CA) though most focused on NaOCl and EDTA. All solutions had detectable effects in the FTIR signature of dentin. NaOCl mainly affects the organics, revealing reduced amide/phosphate ratios with increasing concentrations. EDTA mainly effects the inorganic component, with the effects increasing with time and concentration, yet glycolic acid has stronger effects than EDTA on dentin. Beyond the type of irrigant and dentin exposure durations, concentration and protocol of application had strong effects. There is a lack of studies comparing similar irrigants under conditions that mimic clinical scenarios analyzing bulk sample because FTIR of powder dentin differs from FTIR of bulk dentin.

SIGNIFICANCE

The ideal root-canal irrigant should combine local disinfection properties with minimal compositional effects on healthy dentin. FTIR methods appear reliable to identify important changes in root dentin chemical composition. Such information can help understand when endodontic irrigation might lead to root degradation or possibly contribute to long term failures such as vertical fractures. Awareness of chemical damage from irrigation procedures may help clinicians select procedures that reduce deleterious effects on the root canal structures.

Effect of the use of bromelain associated with bioactive glass-ceramic on dentin/adhesive interface

OBJECTIVES

To evaluate the effect of bromelain associated with Biosilicate on the bond strength (BS) of a universal adhesive system to sound (SD) and caries-affected dentin (CAD), and on the proteolytic activity.

MATERIALS AND METHODS

Cavities were prepared in 360 molars, half submitted to cariogenic challenge. Teeth were separated into groups (n=20): Control-No treatment; CHX-0.12% chlorhexidine; NaOCl-5% sodium hypochlorite; Br5%-5% bromelain; Br10%-10% bromelain; Bio-10% Biosilicate; NaOClBio-NaOCl+Bio; Br5%Bio-Br5%+Bio; Br10%Bio-Br10%+Bio. Following treatments, the adhesive system was applied, and cavities were restored. Samples were sectioned into sticks and stored at 37 °C for 24 h, 6 months, and 1 year. Microtensile BS (2-way ANOVA, Bonferroni's test, α=0.05), fracture patterns (SEM), and adhesive interfaces (TEM) were evaluated. Bacterial collagenase assay and in situ zymography were performed.

RESULTS

In CAD, Br10% presented higher BS (p=0.0208) than Br5%Bio. Br5% presented higher BS (p=0.0033) after 6 months than after 24 h; and association of treatments, higher BS (p<0.05) after aging than after 24 h. Mixed fractures were the most prevalent. Association of treatments promoted a more uniform hybrid layer with embedded Bio particles. Experimental groups presented lower (p<0.0001) relative fluorescence units than Control. Bromelain, associated or not with Bio, showed collagenolytic degradation.

CONCLUSIONS

Bromelain associated with Biosilicate did not affect the BS to SD. In CAD, Br5%Bio decreased immediate BS but had no long-term influence. This association decreased the proteolytic activity.

CLINICAL RELEVANCE

Bromelain and Biosilicate may enhance the longevity of adhesive restorations by inhibiting endogenous proteases.

Dual effectiveness of a novel all-in-one endodontic irrigating solution in antibiofilm activity and smear layer removal

The continuous destruction of dental hard tissues increases the risk of bacterial invasion, which leads to pulp infections. Irrigation is critical for successful root canal treatment in terms of infection control. However, no single irrigant covers all of the functions demanded, including antibiofilm and tissue-dissolving activities. The aim of this study was to investigate the antimicrobial properties of Triton, an all-in-one irrigant, on Enterococcus faecalis and multispecies oral biofilms in dentin canals, as well as its ability to remove the smear layer. Dentin blocks (192 specimens) were prepared from single-root human teeth and then assigned to 48 groups (24 groups for each biofilm type). Serial centrifugation was used for bacterial introduction into dentinal tubules. After 3 weeks, half of the specimens were created a uniform smear layer. The following treatments were applied: short time (separate): Triton, 6% NaOCl, 2% NaOCl, and water (all for 3 min); short time (combined): Triton (3 + 1 min), 6% NaOCl +17% EDTA (3 + 1 or 2 + 1 min), and 2% NaOCl +17% EDTA (3 + 1 min); and long time: Triton (3 + 3 min), 6% NaOCl (5 min), 6% NaOCl +17% EDTA (5 + 1 min), and water (3 + 3 min). Confocal laser scanning microscopy and scanning electron microscopy were employed to examine the antimicrobial activity and smear layer removal, respectively. The results revealed that despite the absence or presence of the smear layer, Triton (3 + 3 min) showed the highest killing for both tested biofilms (61.53%-72.22%) among all groups (p < 0.05). Furthermore, the smear layer was removed by Triton after 3 + 3 min, exposing open dentin canals. These findings demonstrated that Triton can provide dual benefits of antibiofilm and smear layer removal capabilities simultaneously, indicating a simplified and effective strategy for application in root canal treatment.

Advances in the Role of Sodium Hypochlorite Irrigant in Chemical Preparation of Root Canal Treatment

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.

Introducing a new approach to debridement and wound bed preparation

Debridement of devitalised tissue and wound biofilm is vital to promote healing. This article introduces an innovative debridement product, ChloraSolv Wound Debridement Gel, which is as effective as a blade but also selective, atraumatic and fast-acting and does not require specialist training. Its ease of use makes it suitable for all settings and staff.

Cytotoxicity and Efficacy in Debris and Smear Layer Removal of HOCl-Based Irrigating Solution: An In Vitro Study

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).

Present status and future directions - irrigants and irrigation methods

Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long‐term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long‐term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.

Antibacterial and antibiofilm efficacy of k21-E in root canal disinfection

OBJECTIVES

The aim of the current project was to study the antimicrobial efficacy of a newly developed irrigant, k21/E against E. faecalis biofilm.

METHODS

Root canals were instrumented and randomly divided into the following groups: irrigation with saline, 6% NaOCl (sodium hypochlorite), 6% NaOCl+2% CHX (Chlorhexidine), 2% CHX, 0.5% k21/E (k21 - quaternary ammonium silane) and 1% k21/E. E. faecalis were grown (3-days) (1×10⁷CFU mL^-1), treated, and further cultured for 11-days. Specimens were subjected to SEM, confocal and Raman analysis and macrophage vesicles characterized along with effect of lipopolysaccharide treatment. 3T3 mouse-fibroblasts were cultured for alizarin-red with Sortase-A active sites and Schrödinger docking was performed. TEM analysis of root dentin substrate with matrix metalloproteinases profilometry was also included. A cytotoxic test analysis for cell viability was measured by absorbance of human dental pulp cells after exposure to different irrigant solutions for 24h. The test percentages have been highlighted in Table 1.

RESULTS

Among experimental groups, irrigation with 0.5% k21/E showed phase separation revealing significant bacterial reduction and lower phenylalanine 1003cm^-1 and Amide III 1245cm^-1 intensities. Damage was observed on bacterial cell membrane after use of k21/E. No difference in exosomes distribution between control and 0.5%k21/E was observed with less TNFα (*p<0.05) and preferential binding of SrtA. TEM images demonstrated integrated collagen fibers in control and 0.5%k21/E specimens and inner bacterial membrane damage after k21/E treatment. The k21 groups appeared to be biocompatible to the dental pulpal cells grown for 24h.

SIGNIFICANCE

Current investigations highlight potential advantages of 0.5% k21/E as irrigation solution for root canal disinfection.

Debriding effect of amino acid-buffered hypochlorite on hard-to-heal wounds covered by devitalised tissue: pilot study

OBJECTIVE

Wounds such as lower extremity ulcers are serious, costly and frequently hard to heal. Guidelines conclude that new dressings and treatments generally fail to show superiority compared with standard of care. Several mechanisms are probably responsible for impaired healing of hard-to-heal wounds, including inflammation and infection. Amino acid-buffered hypochlorite has presumed antiseptic and antibacterial properties and has been shown to be useful in the treatment of diabetic foot ulcers (DFUs). We evaluated the debriding effect of amino acid-buffered hypochlorite (ChloraSolv) on full skin hard-to-heal lower extremity ulcers covered with devitalised tissue (≥50%), with six applications over 5 weeks and follow-up at 12 weeks.

METHOD

This was an open-label, single-arm, multicentre, pre-market pilot investigation. We recruited subjects with a lower extremity ulcer, covered with devitalised tissue (≥50%), who were candidates for cleansing and debridement/desloughing. There was a weekly application of the investigational device for five weeks. Follow-up for wound status evaluation was performed at 12 weeks from baseline.

RESULTS

We evaluated 57 subjects (33 males, 24 females, median age 73 years, range 51-90 years) (intention-to-treat). Of these, 61.4% had a leg ulcer and 38.6% a foot ulcer. The median wound size at baseline was 7.7cm² (range 2.1-52cm²) with devitalised tissue coverage of 76.5%. After 5 weeks, a decrease of 72.7% in devitalised tissue was seen, and 71.4% of the subjects showed a decrease in devitalised tissue of ≥50% (evaluated independently using PictZar). At 12 weeks' follow-up the decrease in devitalised tissue was 84.4%. Wound-related pain was reported by ten subjects, resulting in 17 adverse events (AEs). Among these, 12 AEs from eight subjects were recorded as possibly or probably related to the investigational device and one AE was reported to have a causal relationship with the investigational device.

CONCLUSION

This clinical study suggests that amino acid-buffered hypochlorite can be effective and well tolerated in the treatment of hard-to-heal lower extremity ulcers to dissolve and remove devitalised tissue.

Hydrogen Peroxide Versus Sodium Hypochlorite: All a Matter of pH?

INTRODUCTION

Hydrogen peroxide (H₂O₂) and sodium hypochlorite (NaOCl) solutions are similar in that they contain oxidizing agents with a bleaching effect. NaOCl solutions are stable at a high pH, at which they also exert increased cleansing/proteolysis. On the other hand, H₂O₂ solutions are natively acidic, yet gain bleaching power on organic stains when alkalized. It was investigated whether alkalizing a H₂O₂ solution would also let it dissolve soft tissue or increase its bleaching power on blood-stained dentin.

METHODS

The stability of alkalized H₂O₂ solutions was assessed by iodometric titration. Soft tissue dissolution was investigated on porcine palatal mucosa. The bleaching effect (ΔL∗) after 60 minutes of exposure was monitored in blood-stained human dentin using a calibrated spectrophotometer. To compare similar molarities, 2.5% H₂O₂ solutions were used here, and 5.0% NaOCl was used as the positive control, whereas nonbuffered saline solution served as the negative control.

RESULTS

Adding alkali (NaOH) to the H₂O₂ solutions rendered them unstable in a dose-dependent manner. A H₂O₂ solution of pH 11.1 was chosen for the main experiments (tissue dissolution and bleaching effect) and compared with a native counterpart (pH = 4.7). Alkalizing the H₂O₂ solution had no discernible effect on its soft tissue dissolution or bleaching power (P = .75 compared with the native H₂O₂ solution). The NaOCl solution of similar molar concentration had a considerably (P < .001) higher tissue dissolving and bleaching effect under current conditions.

CONCLUSIONS

The proteolytic/bleaching effects of NaOCl solutions are unique and cannot be achieved by altering the pH of peroxide solutions.

Properties of a modified quaternary ammonium silane formulation as a potential root canal irrigant in endodontics

OBJECTIVES

Evaluate a new modified quaternary ammonium silane irrigant solution for its antimicrobial, cytotoxic and mechanical properties of dentine substrate.

METHODS

Root canal preparation was performed using stainless steel K-files™ and F4 size protaper with irrigation protocols of 6% NaOCl + 2% CHX; 3.5% QIS; 2% QIS and sterile saline. Biofilms were prepared using E. faecalis adjusted and allowed to grow for 3 days, treated with irrigants, and allowed to grow for 7 days. AFM was performed and surface free energy calculated. MC3T3 cells were infected with endo irrigant treated E. faecalis biofilms. Raman spectroscopy of biofilms were performed after bacterial re-growth on root dentine and exposed to different irrigation protocols and collagen fibers analysed collagen fibers using TEM. Antimicrobial potency against E. faecalis biofilms and cytoxicity against 3T3 NIH cells were also. Resin penetration and MitoTracker green were also evaluated for sealer penetration and mitochondrial viability. Data were analysed using One-way ANOVA, principal component analysis and post-hoc Fisher's least-significant difference.

RESULTS

Elastic moduli were maintained amongst control (5.5 ± 0.9) and 3.5% QIS (4.4 ± 1.1) specimens with surface free energy higher in QIS specimens. MC3T3 cells showed reduced viability in 6%NaOCl+2%CHX specimens compared to QIS specimens. DNA/purine were expressed in increased intensities in control and 6% NaOCl + 2% CHX specimens with bands around 480-490 cm^-1 reduced in QIS specimens. 3.5% QIS specimens showed intact collagen fibrillar network and predominantly dead bacterial cells in confocal microscopy. 3.5% QIS irrigant formed a thin crust-type surface layer with cytoplasmic extensions of 3T3NIH spread over root dentine. Experiments confirmed MitoTracker accumulation in 3.5% treated cells.

SIGNIFICANCE

Novel QIS root canal irrigant achieved optimum antimicrobial protection inside the root canals facilitating a toxic effect against the Enterococcus faecalis biofilm. Root dentine substrates exhibited optimum mechanical properties and there was viability of fibroblastic mitochondria.

Factors affecting the chemical efficacy of 2% sodium hypochlorite against oral steady-state dual-species biofilms: Exposure time and volume application

AIM

To study the influence of time and volume of 2% sodium hypochlorite (NaOCl) on biofilm removal and to investigate the changes induced on the biofilm architecture. Steady-state, dual-species biofilms of standardized thickness and a realistic contact surface area between biofilms and NaOCl were used.

METHODOLOGY

Streptococcus oralis J22 and Actinomyces naeslundii T14V-J1 biofilms were grown on saliva-coated hydroxyapatite discs within sample holders in the Constant Depth Film Fermenter (CDFF) for 96 h. Two per cent NaOCl was statically applied for three different time intervals (60, 120 and 300 s) and in two different volumes (20 and 40 μL) over the biofilm samples. The diffusion-driven effects of time and volume on biofilm disruption and dissolution were assessed with Optical Coherence Tomography (OCT). Structural changes of the biofilms treated with 2% NaOCl were studied with Confocal Laser Scanning Microscopy (CLSM) and Low Load Compression Testing (LLCT). A two-way analysis of variance (2-way anova) was performed, enabling the effect of each independent variable as well as their interaction on the outcome measures.

RESULTS

Optical coherence tomography revealed that by increasing the exposure time and volume of 2% NaOCl, both biofilm disruption and dissolution significantly increased. Analysis of the interaction between the two independent variables revealed that by increasing the volume of 2% NaOCl, significant biofilm dissolution could be achieved in less time. Examination of the architecture of the remaining biofilms corroborated the EPS-lytic action of 2% NaOCl, especially when greater volumes were applied. The viscoelastic analysis of the 2% NaOCl-treated biofilms revealed that the preceding application of higher volumes could impact their subsequent removal.

CONCLUSIONS

Time and volume of 2% NaOCl application should be taken into account for maximizing the anti-biofilm efficiency of the irrigant and devising targeted disinfecting regimes against remaining biofilms.

Volume and/or Time of NaOCl Influences the Fracture Strength of Endodontically Treated Bovine Teeth

Abstract The aim of this study was to evaluate whether amplifying the volume and/or time of contact of NaOCl affects the fracture strength of endodontically treated bovine teeth. Four bovine incisors from 10 animals were allocated into 4 groups using a split-mouth design. Root canals were instrumented using a sequence of 4 manual stainless steel files and irrigated with a 5.25% alkalized NaOCl solution. The total volume and time of irrigation, per sample, varied among the groups as following: standard volume and time of contact - 15 mL/11.5 min; volume raise - 30 mL/11.5 min; time of contact raise - 15 mL/19 min; and volume and time of contact raise - 30 mL/19 min. Samples were subjected to a fracture resistance assay. At p=0.05, two-way ANOVA statistically scrutinized the results. Effect size of NaOCl time of contact and volume were also calculated (η2). The variation in time (p=0.000), volume of irrigation (p=0.000) and the combination of both (p=0.038) negatively influenced the fracture resistance. Standard volume and time of irrigation showed the highest fracture strength while isolated increase in volume or time reduced in 25% and 37%, respectively, the fracture resistance; the simultaneous increase in volume and time of irrigation promoted a reduction of 47%. Effect size of NaOCl time of contact was superior (0.746) than the volume (0.564). Raising the volume and/or time of a 5.25% alkalized NaOCl solution reduces the fracture resistance of endodontically treated bovine teeth.

Primum non nocere - The effects of sodium hypochlorite on dentin as used in endodontics

The medical literature is replete with the maxim 'primum non nocere', cautioning health care providers to avoid doing any harm to human subjects in their delivery of medical care. Sodium hypochlorite (NaOCl) is a well-established irrigant for root canal treatment because of its antimicrobial and organic tissue remnant dissolution capability. However, little is known about the deleterious effect of this strong oxidizing agent on the integrity of human mineralized dentin. Iatrogenically-induced loss of dentin integrity may precipitate post-treatment root fracture and has potential medico-legal complications. In the present work, transmission electron microscopy provided evidence for collagen destruction in the surface/subsurface of dentin treated with high NaOCl concentrations and long contact times. Size exclusion chromatography showed that the hypochlorite anion, because of its small size, penetrated the water compartments of apatite-encapsulated collagen fibrils, degraded the collagen molecules and produced a 25-35µm thick, non-uniform "ghost mineral layer" with enlarged, coalesced dentinal tubules and their lateral branches. Fourier transform-infrared spectroscopy identified increases in apatite/collagen ratio in NaOCl-treated dentin. The apatite-rich, collagen-sparse dentin matrix that remained after NaOCl treatment is more brittle, as shown by the reductions in flexural strength. Understanding the deleterious effects of NaOCl on mineralized dentin enables one to balance the risks and benefits in using high NaOCl concentrations for lengthy periods in root canal debridement. Delineating the mechanism responsible for such a phenomenon enables high molecular weight, polymeric antimicrobial and tissue dissolution irrigants to be designed that abides by the maxim of 'primum non nocere' in contemporary medical practices.

STATEMENT OF SIGNIFICANCE

The antimicrobial and tissue-dissolution capacities of NaOCl render it a well-accepted agent for root canal debridement. These highly desirable properties, however, appear to be intertwined with the untoward effect of collagen matrix degradation within mineralized dentin. Because of its small size, the hypochlorite anion is capable of infiltrating mineralized collagen and destroying the collagen fibrils, producing a mineral-rich, collagen sparse ghost mineral matrix with reduced flexural strength. Findings from the present work challenge the biosafety of NaOCl when it is used in high concentrations and for lengthy time periods during root canal treatment, and laid the background work for future biomaterials design in debridement of the canal space.

Biofilms in Endodontics-Current Status and Future Directions

Microbiota are found in highly organized and complex entities, known as biofilms, the characteristics of which are fundamentally different from microbes in planktonic suspensions. Root canal infections are biofilm mediated. The complexity and variability of the root canal system, together with the multi-species nature of biofilms, make disinfection of this system extremely challenging. Microbial persistence appears to be the most important factor for failure of root canal treatment and this could further have an impact on pain and quality of life. Biofilm removal is accomplished by a chemo-mechanical process, using specific instruments and disinfecting chemicals in the form of irrigants and/or intracanal medicaments. Endodontic research has focused on the characterization of root canal biofilms and the clinical methods to disrupt the biofilms in addition to achieving microbial killing. In this narrative review, we discuss the role of microbial biofilms in endodontics and review the literature on the role of root canal disinfectants and disinfectant-activating methods on biofilm removal.

Influence of Concentration and Agitation of Sodium Hypochlorite and Peracetic Acid Solutions on Tissue Dissolution

AIM AND OBJECTIVE

To evaluated the tissue dissolution of sodium hypochlorite (NaOCl) and peracetic acid (PA) solutions at different concentrations, with or without ultrasonic agitation.

MATERIALS AND METHODS

The following solutions were analyzed: 2.5% NaOCl, 0.5, 1 and 2% PA, 1% PA associated with 6.5% hydrogen peroxide (HP) and saline. Fragments of bovine pulp tissue with 25 ± 2g mg were immersed into test tubes containing 4 mL of the solutions for 10 minutes. In the groups with agitation, pulp tissues were submitted to 2 cycles of 1 minute of ultrasonic agitation. The specimens were weighed after the removal from the solutions. The percentage of mass loss was calculated according to the difference of mass before and after exposure to solutions. Data were submitted to ANOVA and Tukey tests (p < 0.05).

RESULTS

A total of 2.5% NaOCl with or without agitation showed the higher tissue dissolution (between 64.5 and 67% of mass reduction) (p < 0.005). By comparing the PA solutions, the concentrations of 1 and 2% with or without agitation and the concentration of 0.5% with agitation showed similar dissolution activity (between 35.4 and 44% of mass reduction). The use of the ultrasonic agitation promoted an increase of the dissolution ability only for 0.5% PA.

CONCLUSION

Peracetic acid solution has pulp tissue dissolution. However, this ability is lower than 2.5% NaOCl solution.

CLINICAL SIGNIFICANCE

The sodium hypochlorite solution shows higher ability to dissolve tissue than PA.

Low-visibility patterning of transparent conductive silver-nanowire films

A partial etching mechanism is proposed to meet the requirement for low-visibility patterning of silver nanowire (AgNW)-based transparent conductive electrodes (TCEs) by reducing the difference in optical properties between conductive and nonconductive regions of the pattern. Using the finite difference time domain (FDTD) method, etched geometries that provide the smallest difference in transmittance after etching are theoretically determined. A sodium hypochlorite-based etchant capable that allows the etched geometry to be varied by controlling the pH is used to create a low-visibility pattern with a transmittance and haze difference of 0.07 and 0.04%, respectively. To the best of our knowledge, this is the first time that a partial etching mechanism such as this has been studied in relation to AgNW-based TCEs.

Rapid tissue dissolution efficiency of electrically-activated sodium hypochlorite on bovine muscle

Objective:

Sodium hypochlorite (NaOCl) is a common antimicrobial and tissue-dissolving irrigant. The aim of this in vitro study is to evaluate and compare dissolution capacities of sodium hypochlorite solutions after electrically activation (E-NaOCl) on bovine muscle specimens at various time periods and concentrations.

Materials and Methods:

Three sodium hypochlorite solutions of 1.25%, 2.5%, and 5% were tested at 3-min. and 5-min. with and without activation by electrically. Distilled water and NaOCl solutions without electrically activation were used as controls. Pieces of bovine muscle tissue (34 ± 2 mg) were placed in 10 mL of each solution at room temperature. In the group of E-NaOCl, electrically activation was performed through the potentiostat. The tissue specimens were weighed before and after treatment, and the percentage of weight loss was calculated.

Results:

Weight loss of the tissue increased with the concentration of E-NaOCl and NaOCl. Higher concentration and electrically activation considerably enhanced the efficacy of sodium hypochlorite. The effect of electrically activation on tissue dissolution was much greater than that of same concentrations in the groups of NaOCl (P < 0.001). Tissue weight loss was significantly higher in 2.5% and 5% E-NaOCl at 3 min. than in 2.5% and 5% NaOCl at 5 min. (P < 0.05). There were not any significant differences between the 2.5% E-NaOCl and 5% NaOCl at 5 min. (P > 0.05).

Conclusion:

Electrically activation can improve the tissue-dissolving effectiveness of sodium hypochlorite.

Efeito de diferentes soluções utilizadas como irrigante final na superfície dentinária: análise de rugosidade

INTRODUÇÃO: O uso de irrigantes pode gerar alterações microestruturais na superfície dentinária, entre as quais alterações na rugosidade. Essas alterações podem influenciar o processo de união dos materiais obturadores à dentina. OBJETIVO: O objetivo do presente trabalho foi avaliar o efeito das soluções de EDTA, hipoclorito de sódio (NaOCl) e clorexidina, como irrigante final, na rugosidade da superfície dentinária. MATERIAL E MÉTODO: Foram utilizadas raízes distais de seis terceiros molares inferiores, que foram planificadas com o auxílio de disco de lixa e cortadas em segmentos, totalizando 18 amostras. A análise inicial foi realizada utilizando-se o perfilômetro Dektak. Foram realizadas cinco varreduras por amostra. Em seguida, as amostras foram irrigadas com NaOCl para simular o preparo químico-mecânico e lavadas com água destilada. Foram então divididas em seis grupos de acordo com o protocolo de irrigação final: Água destilada; NaOCl 5,25%; clorexidina 2%; EDTA17%; EDTA 17% + NaOCl 5,25%, e EDTA 17% + clorexidina 2%. Novamente, em cada amostra, foram realizadas cinco varreduras, totalizando 15 varreduras por grupo. Os dados foram analisados estatisticamente pelos testes de Kruskal-Wallis e Mann-Whitney (p<0,05). RESULTADO: Foi encontrada alteração significativa da rugosidade somente no grupo em que houve a combinação do agente quelante com o NaOCl. CONCLUSÃO: Os protocolos de irrigação final apresentam diferentes efeitos na rugosidade da superfície dentinária.

Influence of dentin from the root canal walls and the pulp chamber floor on the pH of intracanal medicaments

INTRODUCTION

The objective of this study was to evaluate the alterations in the pH of calcium hydroxide (Ca[OH]2), 2% chlorhexidine (CHX) gel, and their combination after adding dentin powder from the root canal walls and the pulp chamber floor.

METHODS

Ca(OH)2 paste, 2% CHX gel, and their combination were examined. Dentin powder was obtained from the root canal walls and the pulp chamber floor of bovine teeth and added as 1.8% to the volume of the medications. The pH values of the mixtures were assessed immediately after preparation, after 24 hours, and on days 7 and 14. Data were analyzed statistically by analysis of variance and the Student's t test (P = .05).

RESULTS

pH values of Ca(OH)2 were always above 12 in the presence or absence of dentin powder during the 14 days of the study. A significant decrease in pH values of Ca(OH)2 was observed after 14 days when dentin from the root canal wall was added (P < .001). The pH values of CHX gel were significantly increased by the presence of dentin (P = .001). The t test showed a significant difference in the increase of the pH values when the different dentin types were added (P = .002). The pH of the Ca(OH)2 and CHX gel combination was not influenced by dentin powder from the root canal walls, and a reduction was observed after 14 days, exactly like in the control group. The pH values of the combination did not alter after 14 days when pulp chamber floor dentin was added.

CONCLUSIONS

The different dentin types variably affect the pH of Ca(OH)2 paste, 2% CHX gel, and their combination in the studied periods.