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Barazy R, Alafif H, Achour H, Al-Aloul A, Alsayed Tolibah Y. Can antimicrobial photodynamic therapy serve as an effective adjunct protocol for disinfecting the necrotic root canal system? A randomized controlled study. BDJ Open 2024; 10:53. [PMID: 38902230 PMCID: PMC11190140 DOI: 10.1038/s41405-024-00239-y] [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: 03/06/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Bacterial infection plays an important role in persistent periapical lesions and inadequate disinfection of root canals is considered the biggest factor responsible for endodontic treatment failure. Antimicrobial Photodynamic Therapy (aPDT) has become the latest choice to eradicate microorganisms in root canals. OBJECTIVE This study aims to evaluate the effectiveness of Antimicrobial Photodynamic Therapy (aPDT) in bacterial count reduction compared to Passive Ultrasonic Activation (PUI) and Ca(OH)2 dressings. MATERIALS AND METHODS Forty-five anterior single canal teeth with medium-sized periapical lesions (2-5 mm) were divided into three groups according to the disinfecting technique (each group consists of 15 canals with 1:1:1 allocation ratio): Group A: Ca(OH)2 dressing. Group B: Passive Ultrasonic Activation (PUI). Group C: Antimicrobial Photodynamic Therapy (aPDT). Direct bacterial viable count method was used to count the colonies forming units (CFU) before and after the disinfecting and the bacterial count reduction was estimated, the statistical analysis was performed at a 95% confidence level using the Chi-square and Mann-Whitney U test. RESULTS aPDT showed no statistically significant difference when compared to passive ultrasonic irrigation (P > 0.05) but showed higher and more promising results when compared to Ca(OH)2 dressings (P < 0.05). CONCLUSIONS aPDT has the ability and effectiveness as a disinfecting technique in necrotic and infected root canals. CLINICAL SIGNIFICANCE OF THE STUDY The results of this clinical trial provide that aPDT can be considered an adjunct method for root canal disinfection with the same effectiveness as passive ultrasonic irrigation.
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Affiliation(s)
- Remy Barazy
- Department of Endodontics, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic
| | - Hisham Alafif
- Department of Endodontics, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic
| | - Hassan Achour
- Department of Endodontics, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic
| | - Ahmad Al-Aloul
- Department of Endodontics, Faculty of Dentistry, Al-Sham Private University, Damascus, Syrian Arab Republic
| | - Yasser Alsayed Tolibah
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic.
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Purwasena IA, Fitri DK, Putri DM, Endro H, Zakaria MN. Lipopeptide biosurfactant as a potential root canal irrigation agent: Antimicrobial and anti-biofilm evaluation. J Dent 2024; 144:104961. [PMID: 38527516 DOI: 10.1016/j.jdent.2024.104961] [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: 02/19/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVES Lipopeptide Biosurfactant (LB) is a bacteria derived compound able to reduce surface tension between water and hydrophobic substances and exhibit antimicrobial and anti-biofilm properties. This study aimed to investigate the antimicrobial and anti-biofilm effect of a Lipopeptide Biosurfactant (LB) on Enterococcus faecalis, and its potential use in root canal treatment, either as a standalone irrigation solution or in conjunction with sodium hypochlorite (NaOCl). METHODS LB was extracted from Bacillus clausii isolate and the dry extract was diluted in deionized water. The antimicrobial effect of LB against planktonic E. faecalis was evaluated by determining the Minimal Inhibitory Concentration (MIC50). The anti-biofilm effect was evaluated by Minimal Biofilm Inhibitory Concentration (MBIC50) and Minimal Biofilm Eradication Concentration (MBEC50) assays on biofilm grown on dentin specimen surface. To evaluate the effectiveness of LB as a single irrigation solution and as a pre-irrigation prior to NaOCl, live and dead bacterial cells were quantified using Confocal Laser Scanning Microscopy (CLSM), and cell biomass was assessed. RESULTS LB exhibited an MIC50 and MBIC50 of 100 ppm, with an MBEC50 of 1000 ppm, resulting in 52.94 % biofilm inhibition and 60.95 % biofilm eradication on dentin specimens. The effectiveness was concentration-dependent, at 500 ppm, LB demonstrated comparable antimicrobial efficacy to 2.5 % NaOCl. Pre-irrigation with LB resulted in lower biofilm biomass compared to NaOCl alone. CONCLUSION Pre-irrigation with LB enhanced the antimicrobial effect when followed by NaOCl irrigation. Consequently, LB shows promise as both a standalone root canal irrigation solution and as an adjunct to NaOCl in root canal treatment. CLINICAL SIGNIFICANCE The study highlights the potential of Lipopeptide Biosurfactant (LB) as an environmentally friendly irrigation solution for root canal treatment, demonstrating potent antimicrobial and anti-biofilm properties against Enterococcus faecalis. LB exhibits concentration-dependent efficacy comparable to 2.5 % NaOCl and can be used as a standalone irrigation solution or in conjunction with NaOCl.
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Affiliation(s)
- Isty Adhitya Purwasena
- School of Life Sciences and Technology, Bandung Institute of Technology. Jl. Ganesha 10, Bandung, 40132, Indonesia
| | - Dinda Kurnia Fitri
- Faculty of Dentistry, Universitas Jenderal Achmad Yani. Jl. Terusan Jenderal Sudirman PO BOX 148, Cimahi, Indonesia
| | - Destaya Mentari Putri
- School of Life Sciences and Technology, Bandung Institute of Technology. Jl. Ganesha 10, Bandung, 40132, Indonesia
| | - Hartanto Endro
- Faculty of Dentistry, Universitas Jenderal Achmad Yani. Jl. Terusan Jenderal Sudirman PO BOX 148, Cimahi, Indonesia
| | - Myrna Nurlatifah Zakaria
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Palanisamy R, Anirudhan S, Roja RJS, Koshy M. Comparison of ultrasonic versus side-vented needle irrigation for reductions in bacterial growth and postoperative pain: A randomized controlled trial. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2023; 26:616-620. [PMID: 38292745 PMCID: PMC10823969 DOI: 10.4103/jcde.jcde_61_23] [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: 06/30/2023] [Revised: 08/07/2023] [Accepted: 09/21/2023] [Indexed: 02/01/2024]
Abstract
Background Postoperative pain affects 16%-25% of root canal therapy patients. The irrigating system and irrigants used should reduce bacterial load without irrigant extrusion beyond the root canal apex, potentially reducing postoperative pain and discomfort. Aim This study aims to compare the effects of passive ultrasonic irrigation and side-vented needle irrigation on postoperative pain and bacterial load in single-rooted teeth with pulp necrosis. Materials and Methods Eighty patients with pulpal necrosis in single-rooted teeth were randomly categorized into two groups (n = 40 each): Group A (side-vented needle irrigation) and Group B (passive ultrasonic irrigation). Bacterial samples were collected using sterile paper points after initial access cavity preparation (S1) and standard endodontic instrumentation + irrigation (S2). Bacterial growth was assessed on MacConkey and blood agar. Pain was recorded 30 min preoperatively and 6, 12, 24, and 48 h postoperatively. Statistical Analysis Used Chi-square test, independent t-test and paired t-test. Results Irrigation with Irrisafe tips showed increased number of bacteria-free samples and a significant reduction in postoperative pain (at the 6 and 12 h time-points) when compared to side-vented needle. Conclusions Passive ultrasonic irrigation with Irrisafe tips may be more effective than side-vented needle irrigation in reducing postoperative pain and intracanal bacterial load in patients undergoing endodontic treatment.
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Affiliation(s)
- Revathi Palanisamy
- Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, Dr. TNMGRM University, Coimbatore, Tamil Nadu, India
| | - Subha Anirudhan
- Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, Dr. TNMGRM University, Coimbatore, Tamil Nadu, India
| | - R. Jaya Shree Roja
- Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, Dr. TNMGRM University, Coimbatore, Tamil Nadu, India
| | - Minu Koshy
- Department of Conservative Dentistry and Endodontics, Sri Ramakrishna Dental College and Hospital, Dr. TNMGRM University, Coimbatore, Tamil Nadu, India
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Elashiry MM, Bergeron BE, Tay FR. Enterococcus faecalis in secondary apical periodontitis: Mechanisms of bacterial survival and disease persistence. Microb Pathog 2023; 183:106337. [PMID: 37683835 DOI: 10.1016/j.micpath.2023.106337] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
Enterococcus faecalis is a commensal bacterium commonly found in the human gastrointestinal tract. However, in individuals with compromised immune systems, the pathogen can lead to severe illness. This opportunistic pathogen is associated with secondary apical diseases and is adept at resisting antibiotics and other forms of treatment because of its numerous virulence factors. Enterococcus faecalis is capable of disrupting the normal functions of immune cells, thereby hindering the body's ability to eradicate the infection. However, intensive research is needed in further understanding the adverse immunomodulatory effects of E. faecalis. Potential strategies specific for eradicating E. faecalis have proven beneficial in the treatment of persistent secondary apical periodontitis.
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Affiliation(s)
- Mohamed M Elashiry
- Department of Endodontics, Dental College of Georgia, Augusta University, Georgia, USA; Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
| | - Brian E Bergeron
- Department of Endodontics, Dental College of Georgia, Augusta University, Georgia, USA
| | - Franklin R Tay
- Department of Endodontics, Dental College of Georgia, Augusta University, Georgia, USA
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Loyola-Fonseca SC, Campello AF, Rodrigues RCV, Alves FRF, Brasil SC, Vilela CLS, Gonçalves LS, Provenzano JC, Siqueira JF, Rôças IN. Disinfection and Shaping of Vertucci Class II Root Canals after Preparation with Two Instrument Systems and Supplementary Ultrasonic Activation of Sodium Hypochlorite. J Endod 2023; 49:1183-1190. [PMID: 37419243 DOI: 10.1016/j.joen.2023.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION This study compared disinfection and shaping after root canal preparation with either XP-endo Shaper or TruNatomy instrument systems, supplemented by ultrasonic activation of sodium hypochlorite (NaOCl) with either stainless-steel (SS) or nickel-titanium (NiTi) inserts. METHODS Mesial roots from mandibular molars with Vertucci class II configuration were divided into 2 groups (n = 24) based on anatomically paired micro-computed tomography (micro-CT) analyses. Pre and postpreparation micro-CT scans were obtained to evaluate the shaping performance. The canals were contaminated with a mixed bacterial culture for 30 days and then subjected to preparation with either XP-endo Shaper or TruNatomy instruments using NaOCl irrigation. Supplementary ultrasonic activation of NaOCl was conducted using either an SS (TruNatomy group) or NiTi (XP-endo Shaper group) insert. Bacteriological samples were taken from the canals before preparation (S1), after preparation (S2), and after the supplementary approach (S3). Bacterial reduction was evaluated using a quantitative real-time polymerase chain reaction. RESULTS Preparation with both instrument systems significantly reduced bacterial counts (P < .01). After preparation, 36% (TruNatomy) and 35% (XP-endo Shaper) were negative for bacteria. These values increased to 59% and 65% after ultrasonic activation with the SS and NiTi inserts, respectively. The quantitative data in S2 showed that XP-endo Shaper promoted a significantly higher bacterial reduction than TruNatomy (P < .05). No significant intragroup differences were observed after ultrasonic activation (P > .05), probably because the SS insert promoted a significantly higher S2-to-S3 reduction than the NiTi insert (P < .01). Micro-CT analysis revealed no significant differences in the unprepared areas between the groups (P > .05). CONCLUSIONS The XP-endo Shaper caused a significantly higher bacterial reduction than TruNatomy in Vertucci class II canals. Better antibacterial results after ultrasonic activation were observed for the SS ultrasonic inserts than for the NiTi inserts.
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Affiliation(s)
- Simone C Loyola-Fonseca
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea F Campello
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata C V Rodrigues
- Department of Endodontics, Faculty of Dentistry, Veiga de Almeida University (UVA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávio R F Alves
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Sabrina C Brasil
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caren L S Vilela
- Laboratory of Molecular Microbial Ecology, Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucio S Gonçalves
- Postgraduate Program in Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Claudio Provenzano
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - José F Siqueira
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabela N Rôças
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
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Chalub LO, Nunes GP, Strazzi-Sahyon HB, Ferrisse TM, Dos Santos PH, Gomes-Filho JE, Cintra LTA, Sivieri-Araujo G. Antimicrobial effectiveness of ultrasonic irrigation in root canal treatment: a systematic review of randomized clinical trials and meta-analysis. Clin Oral Investig 2023; 27:1343-1361. [PMID: 36757461 DOI: 10.1007/s00784-023-04897-4] [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: 06/27/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis (SRM) was to answer the question as to whether the use of ultrasonic irrigation (UI) results in better antimicrobial activity in root canal disinfection compared to conventional irrigation (CI). METHODS A literature search was performed in the main scientific databases, carried out until October 2021. The eligibility criteria were randomized clinical trials (RCTs). Two meta-analyses were conducted using R software with the "META" package. The mean difference (MD) and odds ratio (OR) measure of effect were calculated. The fixed effect model was applied with a 95% confidence interval. The Cochrane collaboration scale was used to assess risk of bias and the GRADE tool to assess the quality of evidence. RESULTS A total of 1782 records were screened, and 12 studies meeting the criteria were included in this review. A low risk of bias was observed for most domains, except allocation concealment that was considered unclear. The certainty of evidence was classified as moderate in the OR meta-analyses and low in the MD meta-analyses. Ultrasonic irrigation resulted in a better antimicrobial effect in both meta-analyses, MD 1.42 [1.60; 1.23] p < 0.0001, I2 = 80%; and OR 3.86 [1.98; 7.53] p< 0.0001, I2 = 28.7%. CONCLUSION Within the limitations of this SRM, UI presented better antimicrobial efficacy than CI. CLINICAL RELEVANCE UI should be used by clinicians as it promotes better antimicrobial efficacy in patients undergoing endodontic treatment.
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Affiliation(s)
- Lucas Orbolato Chalub
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, 1193 José Bonifácio Street, Araçatuba, SP, 16015-050, Brazil
| | - Gabriel Pereira Nunes
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, 1193 José Bonifácio Street, Araçatuba, SP, 16015-050, Brazil
| | - Henrico Badaoui Strazzi-Sahyon
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, 1193 José Bonifácio Street, Araçatuba, SP, 16015-050, Brazil
| | - Túlio Morandin Ferrisse
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara School of Dentistry, São Paulo State University - UNESP, 1680 Humaitá Street, Araraquara, SP, 14801-385, Brazil
| | - Paulo Henrique Dos Santos
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, 1193 José Bonifácio Street, Araçatuba, SP, 16015-050, Brazil
| | - João Eduardo Gomes-Filho
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, 1193 José Bonifácio Street, Araçatuba, SP, 16015-050, Brazil
| | - Luciano Tavares Angelo Cintra
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, 1193 José Bonifácio Street, Araçatuba, SP, 16015-050, Brazil
| | - Gustavo Sivieri-Araujo
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, 1193 José Bonifácio Street, Araçatuba, SP, 16015-050, Brazil.
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Cheung AWT, Lee AHC, Cheung GSP. Clinical efficacy of activated irrigation in endodontics: a focused review. Restor Dent Endod 2021; 46:e10. [PMID: 33680899 PMCID: PMC7906851 DOI: 10.5395/rde.2021.46.e10] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 02/02/2023] Open
Abstract
Root canal debridement, which includes the removal of infected tissues and microbial biofilms, is considered the corner stone of root canal treatment. Chemical adjuncts play a multitude of functions in this regard, as tissue solvents, antimicrobial agents and for removing the smear layer. These adjuncts (irrigants) are usually delivered using a syringe and needle. With increasing knowledge of the complexity of root canal anatomy and tenacity of microbial biofilms, the need for strategies that potentiate the action of these irrigants within the root canal system cannot be overemphasized. Several such activated irrigation strategies exist. The aim of this review is to comprehensively discuss the different irrigant activation methods from the context of clinical studies.
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Affiliation(s)
- Amelia Wan Tin Cheung
- Discipline of Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - Angeline Hui Cheng Lee
- Discipline of Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
| | - Gary Shun Pan Cheung
- Discipline of Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
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Ruksakiet K, Hanák L, Farkas N, Hegyi P, Sadaeng W, Czumbel LM, Sang-ngoen T, Garami A, Mikó A, Varga G, Lohinai Z. Antimicrobial Efficacy of Chlorhexidine and Sodium Hypochlorite in Root Canal Disinfection: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Endod 2020; 46:1032-1041.e7. [PMID: 32413440 DOI: 10.1016/j.joen.2020.05.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/20/2020] [Accepted: 05/05/2020] [Indexed: 02/02/2023]
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Effects of Contemporary Irrigant Activation Schemes and Subsequent Placement of an Interim Dressing on Bacterial Presence and Activity in Root Canals Associated with Asymptomatic Apical Periodontitis. J Clin Med 2020; 9:jcm9030854. [PMID: 32245051 PMCID: PMC7141523 DOI: 10.3390/jcm9030854] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 01/09/2023] Open
Abstract
New tools for activating endodontic irrigants have evolved, yet their impact on root canal disinfection, in comparison to the passive placing of an inter-visit medication, have not yet been fully elucidated. The use of DNA- and rRNA-based methods may cast some new light on this issue, as they allow a comparison to be made between microbial presence and activity. Therefore, the aim of this single-arm intervention trial is to evaluate the antibacterial effect of endodontic procedures using both molecular methods. Root canal samples were obtained from 20 patients with asymptomatic apical periodontitis after each treatment step: access cavity, chemo-mechanical preparation, adjunctive procedures (XP-endo Finisher file and passive ultrasonic irrigation), calcium hydroxide medication, and 2nd-visit root canal preparation. DNA and cDNA from the samples were subjected to quantitative polymerase chain reaction with universal primers for the bacterial 16S rRNA gene. Chemo-mechanical preparation promoted a drastic reduction in bacterial levels and activity, whereas the adjunctive procedures did not make a significant contribution to further disinfection. At the 2nd visit, bacteria were active after the use of calcium hydroxide medication; however, they were significantly reduced after a 2nd-visit preparation. Consequently, the lowest bacterial levels were found at the end of the treatment. This clinical trial, which used an rRNA and rDNA combined approach, confirmed previous studies showing that root canal preparation represents the main strategy for root canal disinfection.
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Orozco EIF, Toia CC, Cavalli D, Khoury RD, Cardoso FGDR, Bresciani E, Valera MC. Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial. J Appl Oral Sci 2019; 28:e20190100. [PMID: 31800872 PMCID: PMC6886399 DOI: 10.1590/1678-7757-2019-0100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/16/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. METHODOLOGY Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. RESULTS A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). CONCLUSION Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.
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Affiliation(s)
- Esteban Isai Flores Orozco
- Universidade Estadual Paulista (UNESP), Instituto de Ciências e Tecnologia, Departamento de Odontologia Restauradora, São José dos Campos, São Paulo, Brasil
| | - Cassia Cestari Toia
- Universidade Estadual Paulista (UNESP), Instituto de Ciências e Tecnologia, Departamento de Odontologia Restauradora, São José dos Campos, São Paulo, Brasil
| | - Daiana Cavalli
- Universidade Estadual Paulista (UNESP), Instituto de Ciências e Tecnologia, Departamento de Odontologia Restauradora, São José dos Campos, São Paulo, Brasil
| | - Rayana Duarte Khoury
- Universidade Estadual Paulista (UNESP), Instituto de Ciências e Tecnologia, Departamento de Odontologia Restauradora, São José dos Campos, São Paulo, Brasil
| | - Flávia Goulart da Rosa Cardoso
- Universidade Estadual Paulista (UNESP), Instituto de Ciências e Tecnologia, Departamento de Odontologia Restauradora, São José dos Campos, São Paulo, Brasil
| | - Eduardo Bresciani
- Universidade Estadual Paulista (UNESP), Instituto de Ciências e Tecnologia, Departamento de Odontologia Restauradora, São José dos Campos, São Paulo, Brasil
| | - Marcia Carneiro Valera
- Universidade Estadual Paulista (UNESP), Instituto de Ciências e Tecnologia, Departamento de Odontologia Restauradora, São José dos Campos, São Paulo, Brasil
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Electrochemical Disinfection of Experimentally Infected Teeth by Boron-Doped Diamond Electrode Treatment. J Clin Med 2019; 8:jcm8122037. [PMID: 31766433 PMCID: PMC6947473 DOI: 10.3390/jcm8122037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 02/05/2023] Open
Abstract
Disinfection and prevention of re-infection are the decisive treatment steps in endodontic therapy. In this study, boron-doped diamond (BDD) electrodes have been fabricated and used for disinfecting the root canals of extracted human teeth, which had been covered with bacterial biofilms formed by Bacillus subtilis and Staphylococcus epidermidis. The growth of B. subtilis could be successfully impaired, achieving a complete disinfection after 8.5 min treatment time with the success of disinfection depending on the insertion depth of the electrode in the root canal. S. epidermidis could completely be removed after 3.5 min treatment time. A clinically applicable electrode array led to complete disinfection after treatment times of 10 min for S. epidermidis and 25 min for B. subtilis. BDD electrode application allowed for the improved disinfection of root canals and dentin tubules based on a continuous production of reactive oxygen species and their enhanced penetration of dentin tubules most likely due the formation of a continuous stream of small gas bubbles. The treatment times that are required here will be shortened in clinical application, as mechanical shaping of the canal system would precede the disinfection process.
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Effectiveness of passive ultrasonic irrigation on periapical healing and root canal disinfection: a systematic review. Br Dent J 2019; 227:228-234. [DOI: 10.1038/s41415-019-0532-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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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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Prada I, Micó-Muñoz P, Giner-Lluesma T, Micó-Martínez P, Muwaquet-Rodríguez S, Albero-Monteagudo A. Update of the therapeutic planning of irrigation and intracanal medication in root canal treatment. A literature review. J Clin Exp Dent 2019; 11:e185-e193. [PMID: 30805124 PMCID: PMC6383907 DOI: 10.4317/jced.55560] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/21/2019] [Indexed: 11/30/2022] Open
Abstract
Background The success of endodontic treatment derives from the complete elimination of microorganisms capable of causing an intraradicular or extraradicular infection. To achieve a more effective eradication of these microorganisms, endodontic instrumentation must always be implemented with abundant irrigation, which has to achieve chemical, mechanical and biological effects. The irrigators most used today are NaOCl, CHX and EDTA, released into the ducts through different techniques such as syringe, manual agitation, positive or negative apical pressure, sonic or ultrasonic activation, PIPS and PDT. The objective of this review is to update the different irrigating solutions and intracanal disinfection drugs, as well as to establish an irrigation protocol in the endodontic treatment. Material and Methods Systematic search of scientific articles in the databases PubMed, Medline and Google Scholar, with the following keywords Endodontic, Infection, Failure, Irrigation, Retreatment and Irrigation protocol. The exclusion criteria were “case report” articles and articles with a publication date prior to 2000. Results 48 articles that met the inclusion criteria were analyzed. Comparing the different articles it can be seen that the NaOCl is the “gold standard” in terms of immediate antimicrobial efficacy, followed by the CHX that has a long-term antibacterial effect. As an intra-conductive drug it is advisable to use the combination of Ca(OH)2 with CPMC. Conclusions The most adequate irrigation protocol consists of using 2.5% NaOCl activated with ultrasound followed by a final wash with 7% MA or 0.2% CTR combined with 2% CHX. Key words:Endodontic failure, endodontic infection, enterococcus faecalis, endodontic retreatment, irrigation, sodium hipoclorite, irrigation protocol.
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Affiliation(s)
- Ilaria Prada
- Licensed Dentist at Universidad Europea de Valencia, España
| | - Pedro Micó-Muñoz
- Endodontic and restorative dentistry Titular Professor, Universidad Europea de Valencia, España
| | - Teresa Giner-Lluesma
- Endodontic and restorative dentistry Associate Professor, Universidad Europea de Valencia, España
| | - Pablo Micó-Martínez
- Licensed Dentist at Universidad Europea de Valencia. Periodontology and Osteointegration Master at Universidad de Valencia, España
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Moreira RN, Pinto EB, Galo R, Falci SGM, Mesquita AT. Passive ultrasonic irrigation in root canal: systematic review and meta-analysis. Acta Odontol Scand 2019; 77:55-60. [PMID: 30264624 DOI: 10.1080/00016357.2018.1499960] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate whether there are differences between the root canal disinfection, comparing the passive ultrasonic irrigation technique with the conventional technique. MATERIALS AND METHODS The following electronic databases were searched: Pubmed; VHL; Web of Sciences and OVID with no publication date restriction. The study's quality evaluation was carried out using the Handbook by Cochrane. The online research identified 5464 studies. From the nine studies selected for a full reading of the text, five were included in the present systematic review. Meta-analysis was performed in three articles, which evaluated the root canal's cleanness through microbiological analysis. RESULTS Only one article concluded that the ultrasonic passive irrigation showed a better performance compared with the conventional irrigation. None of the articles analyzed presented a low risk of bias in all domains. According to the results of the meta-analysis, there was no statistical difference between the groups (OR = 0.34, IC 95%: 0.10-1.19). CONCLUSIONS The level of evidence comparing the two techniques is fragile since in all studies some type of bias was observed which may interfere in the results and conclusions.
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Affiliation(s)
- Rafaela Nogueira Moreira
- Department of Dentistry, Federal University of Jequitinhonha e Mucuri Vallyes, Diamantina, Brazil
| | | | - Rodrigo Galo
- Department of Dentistry, Federal University of Jequitinhonha e Mucuri Vallyes, Diamantina, Brazil
| | | | - Ana Terezinha Mesquita
- Department of Dentistry, Federal University of Jequitinhonha e Mucuri Vallyes, Diamantina, Brazil
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Sigurdsson A, Garland RW, Le KT, Rassoulian SA. Healing of Periapical Lesions after Endodontic Treatment with the GentleWave Procedure: A Prospective Multicenter Clinical Study. J Endod 2018; 44:510-517. [DOI: 10.1016/j.joen.2017.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/25/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022]
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Nakamura VC, Pinheiro ET, Prado LC, Silveira AC, Carvalho APL, Mayer MPA, Gavini G. Effect of ultrasonic activation on the reduction of bacteria and endotoxins in root canals: a randomized clinical trial. Int Endod J 2017; 51 Suppl 1:e12-e22. [PMID: 28439928 DOI: 10.1111/iej.12783] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/20/2017] [Indexed: 02/01/2023]
Abstract
AIM This randomized clinical trial aimed to compare the effectiveness of ultrasonic activation with that of nonactivated irrigation on the removal of bacteria and endotoxin from root canals. METHODOLOGY Fifty patients with necrotic pulps and asymptomatic apical periodontitis were randomly allocated into two groups according to the final irrigation protocol after root canal preparation: Group UI - ultrasonic irrigation (n = 25) and Group NI - needle irrigation (n = 25). The root canals were medicated with calcium hydroxide for 14 days. Microbiological sampling was performed before (S1) and after the root canal preparation (S2), after the irrigation protocols (S3) and after the removal of the intracanal medication (S4). Total bacteria counts were determined by qPCR and the endotoxin levels by the limulus amebocyte lysate assay. Intragroup analyses were performed using the Wilcoxon test for related samples, whereas intergroup analyses were performed using the Mann-Whitney U-test (P < 0.05). RESULTS All S1 samples were positive for bacteria, with median numbers of 1.49 × 106 and 8.55 × 105 bacterial cells for the UI and NI groups, respectively. This number significantly decreased in S2 samples (UI: 1.41 × 104 ; NI: 3.53 × 104 ; both with P < 0.001). After final irrigation protocols, there was a significant decrease in bacterial load from S2 to S3 samples in both groups (UI: 4.29 × 103 ; NI: 1.08 × 104 ; P < 0.01). Intergroup analysis revealed a significant difference between irrigation methods regarding bacterial counts in S3 samples (P < 0.05). In contrast, no significant differences were observed between groups for endotoxin levels (P > 0.05). CONCLUSIONS Ultrasonic activation was more effective than nonactivated irrigation for reducing the number of bacteria but not the endotoxin levels in root canals of teeth with apical periodontitis.
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Affiliation(s)
- V C Nakamura
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - E T Pinheiro
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - L C Prado
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - A C Silveira
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - A P L Carvalho
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - M P A Mayer
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - G Gavini
- Discipline of Endodontic, Department of Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Tatikonda A, Sudheep N, Biswas KP, Gowtham K, Pujari S, Singh P. Evaluation of Bacteriological Profile in the Apical Root Segment of the Patients with Primary Apical Periodontitis. J Contemp Dent Pract 2017; 18:44-48. [PMID: 28050984 DOI: 10.5005/jp-journals-10024-1986] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Apical periodontitis usually results from bacterial accumulation and contamination occurring in the root-canal system, and extending beyond the apical foramen to involve the periapical tissues. Literature has a paucity of the studies that stress on the division and analysis of the pulp canal segments. The reason for this disparity might be the technique used for collecting the samples from the pulp canals. Hence, we carried out the present study to evaluate the microbial flora in the apical part of the roots with necrotic pulp canals. MATERIALS AND METHODS The present study included the assessment of 40 freshly extracted teeth that had necrotized pulpal tissue along with the presence of periapical periodontal lesions. Removal of the soft tissue lesions attached to the root portion of the teeth along with apical periodontal lesions was done with the help of scalpel blade, after rinsing them with a sterile solution of saline. Thorough cleaning of the root surfaces was done with hydrogen peroxide followed by rapid disinfection with the help of sodium hypochlorite at varying concentrations. Sectioning of the root portion of all the specimens with the help of a disk was done perpendicular to the long axis of the teeth at a distance of roughly 5 to 6 mm from the teeth's apicalmost point. Cryotubes were used for transferring the specimens of apical portions containing 1 mL of buffer and were subjected to immediate frozen processing at a temperature of -20°C. A 10 K-type file was used for the initial collection of the samples followed by subsequent incubation of the files and paper pints in the incubation cabinet. Subsequent deoxyribonucleic acid (DNA) extraction from the samples was done following the procedure described by Siqueira et al. Paster et al's modification of the reverse-capture checkerboard assay was used in the present study. Semiquantitative data were used for overcoming the difficulties arising due to obtaining the counts of the polymerase chain reaction (PCR)-based analysis of specimens. RESULTS A positive result for the 16S ribosomal ribonucleic acid (rRNA) gene primer was observed only in two examined specimens of all the samples of the apical portion of the root canals in the present study. Negative result was shown by all the control group specimens, which were sterile samples. Presence of bacteria was confirmed by PCR in 38 out of 40 examined specimens. Amount of bacterial taxa, out of these 24 samples, ranged up to 6. Pseudoramibacter alactolyticus, Porphyromonas endodontalis, Dialister oral species, Bacteroidetes species, Streptococcus species, Olsenella uli, Synergistes species, Fusobacterium nucleatum, Parvimonas micra, Treponema denticola, and Filifactor alocis were the specific species detected. Bacteroidetes species was the only species that were detected at levels at or above 105. Heavy bacterial infections were noticed in more than 45% of the cases at the periradicular part of the root canals. CONCLUSION Microbial flora of the apical segment of the root with necrotized pulp tissue comprises a vast variety of pathogenic bacteria. CLINICAL SIGNIFICANCE For better prognosis of the treatment of such cases, adequate knowledge of the microbial flora of the root, especially the apical portion is necessary.
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Affiliation(s)
- Aravind Tatikonda
- Department of Periodontics, Triveni Institute of Dental Sciences Bilaspur, Chhattisgarh, India, Phone: +919501544877, e-mail:
| | - N Sudheep
- Department of Periodontics, Educare Institute of Dental Sciences, Malappuram, Kerala, India
| | - Krishna P Biswas
- Department of Conservative Dentistry and Endodontics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - K Gowtham
- Department of Conservative Dentistry and Endodontics, Malla Reddy Dental College, Hyderabad, Telangana, India
| | - Sudarshan Pujari
- Department of Conservative Dentistry and Endodontics, Pandit Deendayal Upadhyay Dental College, Solapur, Maharashtra, India
| | - Padam Singh
- Department of Periodontology and Implantology, ITS Dental College, Greater Noida, Uttar Pradesh, India
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Retsas A, Koursoumis A, Tzimpoulas N, Boutsioukis C. Uncontrolled Removal of Dentin during In Vitro Ultrasonic Irrigant Activation in Curved Root Canals. J Endod 2016; 42:1545-9. [DOI: 10.1016/j.joen.2016.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/28/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
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12-month Healing Rates after Endodontic Therapy Using the Novel GentleWave System: A Prospective Multicenter Clinical Study. J Endod 2016; 42:1040-8. [DOI: 10.1016/j.joen.2016.04.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 11/16/2022]
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21
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Sigurdsson A, Le KT, Woo SM, Rassoulian SA, McLachlan K, Abbassi F, Garland RW. Six-month healing success rates after endodontic treatment using the novel GentleWave™ System: The pure prospective multi-center clinical study. J Clin Exp Dent 2016; 8:e290-8. [PMID: 27398180 PMCID: PMC4930639 DOI: 10.4317/jced.52779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/04/2015] [Indexed: 12/02/2022] Open
Abstract
Background This prospective multi-center (PURE) clinical study evaluated healing rates for molars after root canal treatment employing the GentleWave® System (Sonendo, Inc., Laguna Hills, CA). Material and Methods Eighty-nine patients met the inclusion criteria and consented for this clinical study after referral for a root canal treatment. All enrolled patients were treated with the GentleWave System. Five endodontists performed the clinical procedures and follow-up evaluations. Pre-operative, intra-operative, and post-operative data were collected from the consented patients. Each patient was evaluated for clinical signs and symptoms. Two trained, blinded, and independent evaluators scored the subject tooth radiographs for apical periodontitis using the periapical index (PAI). The teeth classified as healing or healed were considered as a success and composed of a cumulative success rate of healing. Statistical analysis was performed by using the Fisher’s exact test, Pearson correlation, and multivariate logistic regression analyses of the pre-operative prognostic factors at 0.05 significance level. Results Seventy-seven patients were evaluated at six months with a follow-up rate of 86.5%. The cumulative success rate of healing was 97.4%. Eleven prognostic factors were identified using bivariate analyses. Using logistic analyses, the two prognostic significant variables that were directly correlated to healing were the pre-operative presence of periapical index (p value=0.016), and single treatment visits (p value=0.024). Conclusions In this six-month PURE clinical study, the cumulative success rate of healing was 97.4% when patients were treated with the GentleWave® System. Key words:Healing rate, root canal treatment, molar, GentleWave™, Sonendo®, Multisonic Ultracleaning™ .
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Affiliation(s)
- Asgeir Sigurdsson
- DDS, MS. Department of Endodontics, New York University College of Dentistry, New York
| | - Khang T Le
- DDS. Private Practices, Santa Ana, California
| | - Stacey M Woo
- DDS, PhD. Private Practices, Whittier, California
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Boutsioukis C, Tzimpoulas N. Uncontrolled Removal of Dentin during In Vitro Ultrasonic Irrigant Activation. J Endod 2016; 42:289-93. [DOI: 10.1016/j.joen.2015.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 12/21/2022]
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Plotino G, Cortese T, Grande NM, Leonardi DP, Di Giorgio G, Testarelli L, Gambarini G. New Technologies to Improve Root Canal Disinfection. Braz Dent J 2016; 27:3-8. [DOI: 10.1590/0103-6440201600726] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/22/2016] [Indexed: 11/21/2022] Open
Abstract
Abstract Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice.
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Tanomaru-FIlho M, Torres FFE, Chávez-Andrade GM, Miano LM, Guerreiro-Tanomaru JM. Intermittent or continuous ultrasonically activated irrigation: micro-computed tomographic evaluation of root canal system cleaning. Clin Oral Investig 2015; 20:1541-6. [DOI: 10.1007/s00784-015-1645-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 10/26/2015] [Indexed: 12/01/2022]
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Tanomaru-Filho M, Miano LM, Chávez-Andrade GM, Torres FFE, Leonardo RDT, Guerreiro-Tanomaru JM. Cleaning of Root Canal System by Different Irrigation Methods. J Contemp Dent Pract 2015; 16:859-63. [PMID: 26718291 DOI: 10.5005/jp-journals-10024-1771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to compare the cleaning of main and lateral canals using the irrigation methods: negative pressure irrigation (EndoVac system), passive ultrasonic irrigation (PUI) and manual irrigation (MI). MATERIALS AND METHODS Resin teeth were used. After root canal preparation, four lateral canals were made at 2 and 7 mm from the apex. Root canals were filled with contrast solution and radiographed pre- and post-irrigation using digital radiographic system [radiovisiography (RVG)]. The irrigation protocols were: MI1-manual irrigation [22 G needle at 5 mm short of working length-WL]; MI2-manual irrigation (30G needle at 2 mm short of WL); PUI; EV1-EndoVac (microcannula at 1 mm short of WL); EV2-Endovac (microcannula at 3 mm short of WL). The obtained images, initial (filled with contrast solution) and final (after irrigation) were analyzed by using image tool 3.0 software. Statistical analysis was performed by analysis of variance (ANOVA) and Tukey tests (5% significance level). RESULTS EV1 and EV2, followed by PUI showed better cleaning capacity than manual irrigation (MI1 and MI2) (p < 0.05). CONCLUSION Negative pressure irrigation and PUI promoted better cleaning of main and simulated lateral canals. CLINICAL SIGNIFICANCE Conventional manual irrigation technique may promote less root canal cleaning in the apical third. For this reason, the search for other irrigation protocols is important, and EndoVac and PUI are alternatives to contribute to irrigation effectiveness.
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Affiliation(s)
- Mário Tanomaru-Filho
- Professor, Department of Restorative Dentistry, Araraquara Dental School, UNESP-Univ Estadual Paulista, , Rua Humaita 1680 Centro CEP 14801-903, Araraquara, Sao Paulo, Brazil Phone: +55-16-3301-6390, e-mail:
| | - Lucas Martinati Miano
- Department of Restorative Dentistry, Araraquara Dental School, UNESP-Univ Estadual Paulista, Araraquara, Sao Paulo, Brazil
| | | | | | - Renato de Toledo Leonardo
- Department of Restorative Dentistry, Araraquara Dental School, UNESP-Univ Estadual Paulista, Araraquara, Sao Paulo, Brazil
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Plotino G, Grande N. Nuove tecnologie per il miglioramento della disinfezione canalare. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)30079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Revitalization of Open Apex Teeth with Apical Periodontitis Using a Collagen-Hydroxyapatite Scaffold. J Endod 2015; 41:966-73. [DOI: 10.1016/j.joen.2014.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/28/2014] [Accepted: 12/13/2014] [Indexed: 11/22/2022]
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