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Kottathil H, Zehnder M, Gubler A, Attin T, Narkedamalli R, Ballal NV. Compatibility of Dual Rinse 1-Hydroxyethane-1,1-Diphosphonic Acid with Sodium Hypochlorite Solutions Containing Proprietary Additives. J Endod 2024; 50:1472-1477. [PMID: 39033801 DOI: 10.1016/j.joen.2024.07.007] [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: 04/05/2024] [Revised: 06/18/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
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.
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Affiliation(s)
- Honey Kottathil
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
| | - Matthias Zehnder
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland.
| | - Andrea Gubler
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
| | - Thomas Attin
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
| | - Rajkumar Narkedamalli
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nidambur Vasudev Ballal
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Boutsioukis C, Arias-Moliz MT. Present status and future directions - irrigants and irrigation methods. Int Endod J 2022; 55 Suppl 3:588-612. [PMID: 35338652 PMCID: PMC9321999 DOI: 10.1111/iej.13739] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- C Boutsioukis
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M T Arias-Moliz
- Department of Microbiology, Faculty of Dentistry, University of Granada, Granada, Spain
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Effects of Osmotic Stress and Sodium Hypochlorite on Endodontic Microbiota: An In-Vitro Study. Eur Endod J 2020; 5:242-247. [PMID: 33353919 PMCID: PMC7881376 DOI: 10.14744/eej.2020.70883] [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] [Indexed: 11/20/2022] Open
Abstract
Objective: To assess the effect of osmotic stress on various bacteria in a planktonic milieu and the effect of exposure to sodium hypochlorite (NaOCl) on the microbial cells previously subjected to osmotic stress. Methods: Enterococcus faecalis, Streptococcus sanguinis, Fusobacterium nucleatum, Porphyromonas gingivalis and Prevotella intermedia were suspended as follows: Iso-osmotic group 0.9% NaCl; Hypo-osmotic group “ultrapure water”; Hyper-osmotic group 9% NaCl solution for 120 hours before exposure to 0.0001% NaOCl for 10 minutes. Quantitative analyses of viable cells were performed at 0 and 120 hours and after exposure to NaOCl to obtain colony forming units (CFU/mL). A linear mixed-effects model was used to find the association between mean CFU/mL (logarithmic transformation) and the interaction of solution Group and Time (P<0.001). Results: F. nucleatum, P. gingivalis and P. intermedia did not survive after 24 hours in any of the solutions and were excluded from further testing. For S. sanguinis there were significant differences at each time interval, when holding solution group constant. After 120 hours, the Hyper-osmotic group presented with the highest CFU/mL and was significantly different to the Iso-osmotic group (P<0.001). For E. Faecalis, there was a significant difference for each pairwise comparison of time (P<0.001) in mean CFU/mL between 0 hours and 120 hours for the Iso-osmotic and Hyper-osmotic groups. At 120 hours, no significant differences were found between the three groups. Significant differences were also found between 0 hours and Post-NaOCl administration, and between 120 hours and Post-NaOCl administration for all three groups (P<0.001). Exposure to NaOCl after hypo-osmotic stress was associated with significantly less CFU/mL for S. sanguinis compared to hyperosmosis and iso-osmosis (P<0.001) and for E. Faecalis only compared to hyperosmosis (P<0.001). Conclusion: S. sanguinis and E. faecalis were able to withstand osmotic stress for 120 hours. Hypo-osmotic stress before contact with NaOCl was associated with lower viable bacterial numbers, when compared to the other media for the above species. Hyper-osmotic stress was associated with higher viable bacterial numbers after NaOCl exposure for E. faecalis.
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Trautmann E, Attin T, Mohn D, Zehnder M. Hydrogen Peroxide Versus Sodium Hypochlorite: All a Matter of pH? J Endod 2020; 47:297-302. [PMID: 33129899 DOI: 10.1016/j.joen.2020.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Erik Trautmann
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Thomas Attin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Dirk Mohn
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland; Department of Chemistry and Applied Biosciences, Institute for Chemical and Bioengineering, ETH Zurich, Zurich, Switzerland
| | - Matthias Zehnder
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
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Güçlüer Ö, Akarsu E, Yavuz E, Er K, Kuştarcı A. Human pulp tissue dissolution ability of different extracts of Sapindus mukorossi: An in vitro study. CHINESE HERBAL MEDICINES 2020; 12:178-182. [PMID: 36119798 PMCID: PMC9476676 DOI: 10.1016/j.chmed.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/20/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Due to the many negative properties of sodium hypochlorite used in current root canal treatment, interest in biocompatible natural agents is increasing day by day. The aim of this study was to evaluate whether various extract solutions of Sapindus mukorossi have dissolution effects on human pulp tissues. Methods Primarily powder extracts were obtained by extracting fruit shells of S. mukorossi in different solvents (ethanol, methanol, buthanol and distilled water). The test solutions were prepared and randomly separated into six groups with 10 samples in each group: ethanol extract, methanol extract, butanol extract, distilled water extract of S. mukorossi, sodium hypochlorite (NaOCl) and the control group. Among these, S. mukorossi extracts were separated into two subgroups, depending on their concentration level (50 µg/mL and 100 µg/mL). The pulp tissues of freshly extracted human molars were used for dissolution test. The weights of the pulpal tissues were measured and recorded for two times after the samples were placed in the solutions. Statistical analysis for all descriptive statistics was performed using SPSS 22 (P < 0.05). Results Our results showed that maximum percent yield of preparation was obtained in methanol extract of S. mukorossi. Among all of the groups, the best dissolution capacity was seen in the NaOCl group (positive control group). Among S. mukorossi groups, the best tissue solvent solution was found in SMM group at 50 µg/mL and SMB group at 100 µg/mL. Conclusion The different extracts of S. mukorossi had a capacity to dissolve pulp tissue but this capacity was less than NaOCl. Therefore, further studies will enable the creation of a commercial solution for clinical use by increasing the effectiveness of S. mukorossi while combining it with other endodontic irrigation solutions.
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Affiliation(s)
- Öznur Güçlüer
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya 07070, Turkey
- Corresponding author.
| | - Esin Akarsu
- Department of Chemistry, Faculty of Science, Akdeniz University, Antalya 07070, Turkey
| | - Emre Yavuz
- Department of Chemistry, Faculty of Science, Akdeniz University, Antalya 07070, Turkey
| | - Kürşat Er
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya 07070, Turkey
| | - Alper Kuştarcı
- Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya 07070, Turkey
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Conde AJ, Peña A, Estevez R, Loroño G, Rossi-Fedele G, Cisneros R. The effect of a preparation containing glycocholic acid and/or agitation on the tissue dissolution ability of sodium hypochlorite. AUST ENDOD J 2020; 46:338-342. [PMID: 32212289 DOI: 10.1111/aej.12406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
This study assessed the porcine palatal mucosa dissolution, from artificial grooves, by a final rinse of sodium hypochlorite (NaOCl) solely or mixed with Keratobacter ((KB); or agitation) passive ultrasonic irrigation (PUI) or sonic activation (SA). Soft-tissue samples (n = 123) were weighed and placed inside root canal grooves in central maxillary incisors. The specimens were randomly divided into six test groups (n = 20): NaOCl 3% with or without KB and the irrigation dynamics: positive pressure (PP), SA or PUI. An EDTA intermediate rinse was included. Soft-tissue weights were measured subsequently. The NaOCl + KB_PUI group showed the highest mean weight reduction, whilst the NaOCl_PP group recorded the lowest. NaOCl + KB subgroups were associated with hastened reduction compared with NaOCl subgroups. NaOCl_PP presented with significantly lower weight reduction when compared with the remaining experimental groups. The addition of KB to NaOCl or its agitation enhances tissue dissolution ex vivo. The agitation of KB-containing mixtures offers no further benefits.
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Affiliation(s)
- Antonio J Conde
- Postgraduate Program in Endodontics, European University of Madrid, Madrid, Spain
| | - Alejandro Peña
- Postgraduate Program in Endodontics, European University of Madrid, Madrid, Spain
| | - Roberto Estevez
- Postgraduate Program in Endodontics, European University of Madrid, Madrid, Spain
| | - Gaizka Loroño
- Postgraduate Program in Endodontics, European University of Madrid, Madrid, Spain
| | - Giampiero Rossi-Fedele
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rafael Cisneros
- Postgraduate Program in Endodontics, European University of Madrid, Madrid, Spain
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Wright PP, Kahler B, Walsh LJ. The effect of temperature on the stability of sodium hypochlorite in a continuous chelation mixture containing the chelator clodronate. AUST ENDOD J 2020; 46:244-248. [DOI: 10.1111/aej.12399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Patricia P. Wright
- School of Dentistry University of Queensland Herston Queensland Australia
| | - Bill Kahler
- School of Dentistry University of Queensland Herston Queensland Australia
| | - Laurence J. Walsh
- School of Dentistry University of Queensland Herston Queensland Australia
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Iglesias JE, Pinheiro LS, Weibel DE, Montagner F, Grecca FS. Influence of surfactants addition on the properties of calcium hypochlorite solutions. J Appl Oral Sci 2019; 27:e20180157. [PMID: 30624467 PMCID: PMC6322640 DOI: 10.1590/1678-7757-2018-0157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022] Open
Abstract
Objectives The aim of this study was to evaluate the influence of surfactants 0.2% or 0.1% cetrimide (Cet) or 0.008% benzalkonium chloride (BAK) on 2.5% calcium hypochlorite (Ca(OCl)2), and compare to sodium hypochlorite (NaOCl), regarding the properties of pH, free chlorine content, surface tension, contact angle, pulp dissolution and antimicrobial activity. Material and Methods The pH and free chlorine content were evaluated by digital pHmeter and by titration, respectively. Surface tension was measured by the platinum ring technique with a Du Noüy tensiometer. The solution's contact angle in human dentin surfaces was checked by Drop Shape Analyzer software. Bovine pulps were used for pulp dissolution analysis and the dissolving capacity was expressed by percent weight loss. Antimicrobial activity over Enterococcus faecalis was evaluated by the agar diffusion method. Results Surfactants addition to Ca(OCl)2 and NaOCl did not alter the pH, free chlorine content and pulp dissolution properties. Ca(OCl)2 had the highest surface tension among all tested solutions. When surfactants were added to Ca(OCl)2 and NaOCl, there was a significant reduction of surface tension and contact angle values. The addition of 0.2% or 0.1% Cet enhanced antimicrobial activity of both Ca(OCl)2 and NaOCl. Conclusion Surfactant addition to 2.5% Ca(OCl)2 has shown acceptable outcomes for pH, free chlorine content, surface tension, contact angle, pulp dissolution and antimicrobial activity. Furthermore, the addition of 0.2% Cet showed better results for all tested properties.
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Affiliation(s)
- Júlia Eick Iglesias
- Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Departamento de Odontologia Conservadora, Porto Alegre, Rio Grande do Sul, Brasil
| | - Lucas Siqueira Pinheiro
- Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Departamento de Odontologia Conservadora, Porto Alegre, Rio Grande do Sul, Brasil
| | - Daniel Eduardo Weibel
- Universidade Federal do Rio Grande do Sul, Instituto de Química, Departamento de Físico-Química, Porto Alegre, Rio Grande do Sul, Brasil
| | - Francisco Montagner
- Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Departamento de Odontologia Conservadora, Porto Alegre, Rio Grande do Sul, Brasil
| | - Fabiana Soares Grecca
- Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Departamento de Odontologia Conservadora, Porto Alegre, Rio Grande do Sul, Brasil
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Peña López A, Conde AJ, Estevez R, Valencia de Pablo O, Rossi-Fedele G, Cisneros R. Sodium Hypochlorite and a Preparation Containing Glycocholic Acid and Surfactants Have a Synergistic Action on Organic Tissue Dissolution In Vitro. J Endod 2018; 44:813-815. [PMID: 29550010 DOI: 10.1016/j.joen.2018.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate porcine palatal mucosa dissolution by sodium hypochlorite (NaOCl) with or without an auxiliary dissolving agent containing glycocholic acid and a mixture of surfactants (Keratobacter [KB]; Saint Joseph DID, Valencia, Spain). METHODS One hundred forty samples were obtained from porcine palatal mucosa and weighed using a high-precision balance. The samples were randomly divided into 4 experimental groups (n = 35) based on the test solution used: distilled water (the negative control), CanalPro NaOCl 6% (Coltene Whaledent, Altstätten, Switzerland), KB, and a 9:1 vol/vol mixture of NaOCl with KB (NaOCl + KB). After 5, 10, 15, and 20 minutes of immersion in the solutions at 27°C ± 1°C, the samples were weighted by a blinded assessor. The intergroup weight at the different time points was statistically analyzed using the analysis of variance test with the Bonferroni posttest. RESULTS All test groups presented with tissue dissolution although complete dissolution did not occur in any sample. The largest percent in weight reduction occurred between time points (t) = 0 minutes and t = 5 minutes for the NaOCl + KB group (22.5%) followed by KB (18.5%) for the same time period. NaOCl presented with similar tissue dissolution activity during the different time points, ranging from 7.8% (t = 10 minutes-t = 15 minutes) to 6.8% (t = 15 minutes-t = 20 minutes). Significant weight differences were found among the different experimental groups after 5, 10, and 15 minutes of incubation, with the only exception being KB versus NaOCl + KB. No significant differences were found when comparing the test groups at t = 20 minutes. CONCLUSIONS The addition of KB to NaOCl increased porcine palatal mucosa dissolution in vitro.
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Affiliation(s)
- Alejandro Peña López
- Postgraduate Program in Endodontics, European University of Madrid, Madrid, Spain
| | - Antonio J Conde
- Postgraduate Program in Endodontics, European University of Madrid, Madrid, Spain
| | - Roberto Estevez
- Postgraduate Program in Endodontics, European University of Madrid, Madrid, Spain
| | | | | | - Rafael Cisneros
- Postgraduate Program in Endodontics, European University of Madrid, Madrid, Spain
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Ravinanthanan M, Hegde MN, Shetty V, Kumari S. Cytotoxicity Evaluation of Combination Irrigant Regimens with MTAD on Two Different Cell Lines. Contemp Clin Dent 2018; 9:255-259. [PMID: 29875570 PMCID: PMC5968692 DOI: 10.4103/ccd.ccd_854_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Effective management of smear layer ensures adequate clinical success. Use of sodium hypochlorite (NaOCl)/ethylenediaminetetraacetic acid regimen has been the gold standard with limitations. Commercial irrigants incorporate surface modifiers to address these drawbacks. The aim of this study was to evaluate the cytotoxicity of combination regimens on target and nontarget cell lines by trypan blue assay. Materials and Methods: Nonsurfactant combination regimen of chlorhexidine (CHX) and NaOCl (2% CHX + 2.5% NaOCl) and surfactant regimens of CHX with cetrimide (CTR) (2% CHX + 0.5% CTR) and CHX with sodium dodecyl sulfate (2% CHX + 1% SDS) were prepared. 0.9% normal saline (NS) and Biopure MTAD (100%) served as control. Cytotoxicity was evaluated on human gingival fibroblast (HGF) and Henrietta Lacks (HeLa) cell lines by trypan blue assay. Thirty microliter of the cell suspension was treated with 20 μl of irrigants. The cell suspension was loaded into Neubauer chamber after 5 min and cell count was performed under inverted microscope and expressed as viability percentage. Results: Nonsurfactant combination comprising of 2% CHX + 2.5% NaOCl formed a brownish precipitate while surfactant combination regimes were stable without any precipitate formation. NS and 2% CHX + 0.5% CTR had greater viability scores on both cell lines. Two percent CHX + 1% SDS had better viability on HeLa but were severely cytotoxic on HGF. Two percent CHX + 2.5% NaOCl and MTAD were found to be severely cytotoxic on HeLa with limited viability on HGF. Conclusion: The variation in data obtained could be possibly attributed to the difference in the cellular membrane composition and mechanism of action of combination regimens. Experimental surfactant regimen 2% CHX + 0.5% CTR shows lower cytotoxicity than MTAD.
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Affiliation(s)
- Manikandan Ravinanthanan
- Department of Conservative Dentistry and Endodontics, PMS College of Dental Science and Research, Trivandrum, Kerala, India
| | - Mithra N Hegde
- Department of Conservative Dentistry and Endodontics, A. B. Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka, India
| | - Veena Shetty
- Department of Microbiology, A. B. Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka, India
| | - Suchetha Kumari
- Department of Biochemistry, A. B. Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka, India
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Mohammadi Z, Shalavi S, Moeintaghavi A, Jafarzadeh H. A Review Over Benefits and Drawbacks of Combining Sodium Hypochlorite with Other Endodontic Materials. Open Dent J 2017; 11:661-669. [PMID: 29387282 PMCID: PMC5750725 DOI: 10.2174/1874210601711010661] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/03/2017] [Accepted: 11/11/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION As the root canal system considered to be complex and unpredictable, using root canal irrigants and medicaments are essential in order to enhance the disinfection of the canal. Sodium hypochlorite is the most common irrigant in endodontics. Despite its excellent antimicrobial activity and tissue solubility, sodium hypochlorite lacks some important properties such as substantivity and smear layer removing ability. OBJECTIVE The aim of this review was to address benefits and drawbacks of combining sodium hypochlorite with other root canal irrigants and medicaments. DISCUSSION According to the reviewed articles, NaOCl is the most common irrigation solution in endodontics. However, it has some drawbacks such as inability to remove smear layer. One of the drawbacks of NaOCl is its inability to remove the smear layer and lack of substantivity. CONCLUSION The adjunctive use of other materials has been suggested to improve NaOCl efficacy. Nevertheless, further studies are required in this field.
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Affiliation(s)
- Zahed Mohammadi
- Iranian Center for Endodontic Research (ICER), Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amir Moeintaghavi
- Department of Periodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Jafarzadeh
- Department of Endodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Association between Extracellular Material and Biofilm Formation in Response to Sodium Hypochlorite by Clinical Isolates of Enterococcus faecalis. J Endod 2017; 44:269-273. [PMID: 29208399 DOI: 10.1016/j.joen.2017.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/10/2017] [Accepted: 08/17/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Extracellular material (ECM) surrounding Enterococcus faecalis may play a role in increasing resistance to environmental stresses. Our aim was to determine ECM levels in response to subminimal inhibitory concentrations of sodium hypochlorite (sub-MIC/NaOCl) or anaerobic growth and determine the impact on biofilm development. METHODS From 37 E. faecalis clinical strains, 19 were selected according to their biofilm-producing ability by using a crystal violet biofilm assay: 10 strong, 4 intermediate, and 5 non-biofilm producers. Biofilm assays were subsequently performed on all strains when subjected to sub-MIC/NaOCl. All strains were evaluated for ECM production under aerobic and anaerobic conditions and with sub-MIC/NaOCl. ECM production was assessed by using scanning electron microscopy. Double-blinded independent assessors were used to score levels of ECM production. The esp gene was detected by using polymerase chain reaction. Gelatinase activity was determined by using Todd-Hewitt and gelatin agar. RESULTS In aerobic conditions, ECM was expressed in all strains. In the presence of sub-MIC/NaOCl, of the 10 strong biofilm producers, 5 increased their ECM production, and 4 showed increased biofilm growth. Two strains had less ECM production and showed decreased biofilm growth. One isolate demonstrated no observable changes. Most non-biofilm producers demonstrated no observable differences in ECM production, although 1 strain increased biofilm growth. ECM production in anaerobic conditions was highly variable. The esp gene (n = 15) and gelatinase activity (n = 7) were evident among the isolates. CONCLUSIONS Clonal diversity among strains of E. faecalis suggests that some strong biofilm producers can upregulate ECM production and increase biofilm growth in response to sub-MIC/NaOCl.
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Zollinger A, Mohn D, Zeltner M, Zehnder M. Short-term storage stability of NaOCl solutions when combined with Dual Rinse HEDP. Int Endod J 2017; 51:691-696. [DOI: 10.1111/iej.12875] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Zollinger
- Clinic for Preventive Dentistry, Periodontology and Cariology; University of Zurich; Center for Dental Medicine; Zurich Switzerland
| | - D. Mohn
- Clinic for Preventive Dentistry, Periodontology and Cariology; University of Zurich; Center for Dental Medicine; Zurich Switzerland
- Department of Chemistry and Applied Biosciences; Institute for Chemical and Bioengineering; ETH Zurich; Zurich Switzerland
| | - M. Zeltner
- Department of Chemistry and Applied Biosciences; Institute for Chemical and Bioengineering; ETH Zurich; Zurich Switzerland
| | - M. Zehnder
- Clinic for Preventive Dentistry, Periodontology and Cariology; University of Zurich; Center for Dental Medicine; Zurich Switzerland
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Gu LS, Huang XQ, Griffin B, Bergeron BR, Pashley DH, Niu LN, Tay FR. Primum non nocere - The effects of sodium hypochlorite on dentin as used in endodontics. Acta Biomater 2017; 61:144-156. [PMID: 28801267 DOI: 10.1016/j.actbio.2017.08.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/28/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
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.
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Estevez R, Conde AJ, Valencia de Pablo O, de la Torre F, Rossi-Fedele G, Cisneros R. Effect of Passive Ultrasonic Activation on Organic Tissue Dissolution from Simulated Grooves in Root Canals Using Sodium Hypochlorite with or without Surfactants and EDTA. J Endod 2017; 43:1161-1165. [DOI: 10.1016/j.joen.2017.01.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 12/29/2022]
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Guneser MB, Arslan D, Dincer AN, Er G. Effect of sodium hypochlorite irrigation with or without surfactants on the bond strength of an epoxy-based sealer to dentin. Clin Oral Investig 2016; 21:1259-1265. [DOI: 10.1007/s00784-016-1885-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 06/13/2016] [Indexed: 12/01/2022]
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Tanomaru-Filho M, Silveira BRF, Martelo RB, Guerreiro-Tanomaru JM. Influence of Concentration and Agitation of Sodium Hypochlorite and Peracetic Acid Solutions on Tissue Dissolution. J Contemp Dent Pract 2015; 16:876-879. [PMID: 26718295 DOI: 10.5005/jp-journals-10024-1775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
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.
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Affiliation(s)
- Mário Tanomaru-Filho
- Professor, Department of Restorative Dentistry, Araraquara Dental School, Sao Paulo State University, Rua Humaita, 1680 CEP: 14801903, Araraquara, Sao Paulo, Brazil, Phone: +55-16-3301-6390 e-mail:
| | - Bruna Ramos Franco Silveira
- Department of Restorative Dentistry, Araraquara Dental School, Sao Paulo State University, Araraquara, Sao Paulo, Brazil
| | - Roberta Bosso Martelo
- Department of Restorative Dentistry, Araraquara Dental School, Sao Paulo State University, Araraquara, Sao Paulo, Brazil
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The Effect of Surfactants on the Stability of Sodium Hypochlorite Preparations. J Endod 2015; 41:1344-8. [DOI: 10.1016/j.joen.2015.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 11/20/2022]
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Rethinking root canal treatment: understanding the difference between preventing and treating endodontic infection. Br Dent J 2015; 219:13-6. [PMID: 26159976 DOI: 10.1038/sj.bdj.2015.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 11/08/2022]
Abstract
Root canal treatment is a frequently performed procedure aimed to address pulpal and peri-radicular disease. It comprises a number of clinical steps regardless of the initial diagnosis. The emphasis of each step varies according to whether there is a vital pulp (non-infected) or if the pulp system contains necrotic, infected tissue and there is peri-apical pathology. This article aims to discuss the differences in performing root canal treatments on teeth with vital and non-vital pulps. The reader should understand the differences between performing a root canal treatment in teeth with vital pulps and those with infected root canal spaces and peri-radicular pathology.
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Cullen JK, Wealleans JA, Kirkpatrick TC, Yaccino JM. The Effect of 8.25% Sodium Hypochlorite on Dental Pulp Dissolution and Dentin Flexural Strength and Modulus. J Endod 2015; 41:920-4. [DOI: 10.1016/j.joen.2015.01.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/26/2015] [Accepted: 01/26/2015] [Indexed: 10/23/2022]
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Rossi-Fedele G, Guastalli AR. Effect of an alcohol-based caries detector on the surface tension of sodium hypochlorite preparations. Braz Dent J 2015; 26:66-8. [PMID: 25672387 DOI: 10.1590/0103-6440201300172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/11/2014] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to evaluate the effect of an alcohol-based caries detector (Kurakay) on the surface tension of a conventional sodium hypochlorite (NaOCl) preparation, and a product containing a surface-active agent (Chlor-XTRA). The surface tensions of the following solutions were tested: NaOCl, a mixture of NaOCl and Kurakay 9:1 w/w, Chlor-XTRA, a mixture of Chlor-XTRA and Kurakay 9:1 w/w. Ten measurements per test solution were made at 20°C, using an optical method called the "Pendant drop method", with a commercially available apparatus. The addition of Kurakay reduced the surface tension for NaOCl (p<0.05) whilst no significant difference was detected for Chlor-XTRA (p>0.05). Statistically significant differences between the NaOCl and Chlor-XTRA groups were found (p<0.05). The addition of an alcohol-based caries detector resulted in a reduction of the original surface tension values for NaOCl only. Taking into account the fact that mixtures of NaOCl and Kurakay have been used to assess the penetration of root canal irrigants in vitro, the related changes in surface tension are a possible source of bias.
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Affiliation(s)
| | - Andrea R Guastalli
- Chemical Engineering Department, University of Barcelona, Barcelona, Spain
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22
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van der Sluis L, Boutsioukis C, Jiang LM, Macedo R, Verhaagen B, Versluis M. Root Canal Irrigation. SPRINGER SERIES ON BIOFILMS 2015. [DOI: 10.1007/978-3-662-47415-0_9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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De-Deus G, de Berredo Pinho MA, Reis C, Fidel S, Souza E, Zehnder M. Sodium Hypochlorite with Reduced Surface Tension Does Not Improve In Situ Pulp Tissue Dissolution. J Endod 2013; 39:1039-43. [DOI: 10.1016/j.joen.2013.04.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/09/2013] [Accepted: 04/23/2013] [Indexed: 11/25/2022]
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Slutzky-Goldberg I, Hanut A, Matalon S, Baev V, Slutzky H. The Effect of Dentin on the Pulp Tissue Dissolution Capacity of Sodium Hypochlorite and Calcium Hydroxide. J Endod 2013; 39:980-3. [DOI: 10.1016/j.joen.2013.04.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 04/06/2013] [Accepted: 04/23/2013] [Indexed: 11/26/2022]
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Rossi-Fedele G, Guastalli AR. Osmolarity and root canal antiseptics. Int Endod J 2013; 47:314-20. [PMID: 23889531 DOI: 10.1111/iej.12153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- G. Rossi-Fedele
- Warwick Dentistry; The University of Warwick; Coventry UK
- Pontifical Catholic University of Rio Grande do Sul; Porto Alegre RS Brazil
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Shen Y, Gao Y, Lin J, Ma J, Wang Z, Haapasalo M. Methods and models to study irrigation. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/etp.12029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Rossi-Fedele G, Prichard JW, Steier L, de Figueiredo JAP. The effect of surface tension reduction on the clinical performance of sodium hypochlorite in endodontics. Int Endod J 2012. [DOI: 10.1111/iej.12022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - J. W. Prichard
- Warwick Dentistry; The University of Warwick; Coventry; UK
| | - L. Steier
- Warwick Dentistry; The University of Warwick; Coventry; UK
| | - J. A. P. de Figueiredo
- Post-Graduate Program in Dentistry; Pontifical Catholic University of Rio Grande do Sul; Porto Alegre; RS; Brazil
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29
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Dutta A, Saunders WP. Comparative Evaluation of Calcium Hypochlorite and Sodium Hypochlorite on Soft-tissue Dissolution. J Endod 2012; 38:1395-8. [DOI: 10.1016/j.joen.2012.06.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 06/18/2012] [Accepted: 06/20/2012] [Indexed: 10/28/2022]
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30
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Clarkson RM, Kidd B, Evans GE, Moule AJ. The Effect of Surfactant on the Dissolution of Porcine Pulpal Tissue by Sodium Hypochlorite Solutions. J Endod 2012; 38:1257-60. [DOI: 10.1016/j.joen.2012.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/12/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
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