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Lopes ABS, R Lima A, D Bronzato J, Herrera DR, Francisco PA, Carvalho MCC, Abuna G, Sinhoreti M, Gomes BPFA. Influence of different presentation forms of chlorhexidine on contaminated root canals during agitation. AUST ENDOD J 2024. [PMID: 38803063 DOI: 10.1111/aej.12862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/11/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
This in vitro study aimed to verify the influence of chlorhexidine (CHX) (gel and solution) in association with different activation protocols on disinfection of root canals contaminated with Enterococcus faecalis. In total, 120 lower premolar roots were selected, contaminated and divided into 12 groups according to irrigation technique and substance. Samples were collected before and after each irrigation technique and analysed for colony-forming units (CFU). Three dentin discs were obtained for quantification of viable intratubular cells by using confocal laser scanning microscopy (CLSM). CFU results showed that sonic and ultrasonic were more effective than conventional irrigation. Ultrasonic activation was more effective than sonic for CHX gel (p < 0.05). CLSM showed that either activation was better than conventional in all groups and root canal thirds (p < 0.05). It was concluded that ultrasonic/sonic activation was more effective than conventional techniques and CHX enhanced intratubular dentin decontamination across all irrigation methods.
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Affiliation(s)
- Ana B S Lopes
- Department of Restorative Dentistry -Endodontics Division, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Augusto R Lima
- Department of Restorative Dentistry -Endodontics Division, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Juliana D Bronzato
- Department of Restorative Dentistry -Endodontics Division, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Daniel R Herrera
- Department of Restorative Dentistry -Endodontics Division, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
- Department of Endodontics, Federal Fuminense University, Rio de Janeiro, Brazil
| | - Priscila A Francisco
- Department of Restorative Dentistry -Endodontics Division, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Maria C C Carvalho
- Department of Restorative Dentistry -Endodontics Division, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Gabriel Abuna
- Department of Restorative Dentistry - Dental Materials Division, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Mario Sinhoreti
- Department of Restorative Dentistry - Dental Materials Division, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry -Endodontics Division, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
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Par M, Steffen T, Dogan S, Walser N, Tauböck TT. Effect of sodium hypochlorite, ethylenediaminetetraacetic acid, and dual-rinse irrigation on dentin adhesion using an etch-and-rinse or self-etch approach. Sci Rep 2024; 14:6315. [PMID: 38491076 PMCID: PMC10943220 DOI: 10.1038/s41598-024-57009-x] [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: 01/05/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
The aim was to investigate the influence of endodontic irrigation solutions and protocols on the micro-tensile bond strength (μTBS) to dentin using an etch-and-rinse (ER) or self-etch (SE) adhesive approach. Eighty extracted human molars were ground to dentin. After pretreating for 27 min (21 min-3 min-3 min) with five different endodontic irrigation protocols (Group 1: NaOCl-EDTA-NaOCl; Group 2: NaOCl-NaOCl-EDTA; Group 3: NaOCl-NaCl-NaOCl; Group 4: Dual Rinse-Dual Rinse-Dual Rinse; Group 5: NaCl-NaCl-NaCl), an ER (Optibond FL, Kerr) or a SE (Clearfil SE Bond, Kuraray) adhesive system was applied. After light-curing, composite build-ups were made and cut into dentin-composite sticks. μTBS and failure modes were analyzed. Nonparametric statistical analyses (α = 0.05) were performed for comparison of the five groups within each type of adhesive as well as between the two adhesive systems used. The use of an ER instead of a SE adhesive system resulted in significantly higher μTBS for all irrigation protocols except for group 1 (NaOCl-EDTA-NaOCl) and 2 (NaOCl-NaOCl-EDTA). A statistical difference between the five different endodontic irrigation protocols was only found within the SE adhesive group, where group 1 (NaOCl-EDTA-NaOCl) achieved highest values. The use of an ER adhesive system cancels out the effect of the endodontic irrigation solution. The highest μTBS was achieved when using a NaOCl-EDTA-NaOCl-irrigation protocol in combination with Clearfil SE Bond, which shows that the selection of the endodontic irrigation should match the corresponding SE adhesive system.
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Affiliation(s)
- Matej Par
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Gunduliceva 5, 10000, Zagreb, Croatia.
| | | | - Selinay Dogan
- Department of Conservative and Preventive Dentistry, Center for Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
| | - Noah Walser
- Department of Conservative and Preventive Dentistry, Center for Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
| | - Tobias T Tauböck
- Department of Conservative and Preventive Dentistry, Center for Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
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Maiola EC, Boppré LM, Savaris JM, Dias Junior LCDL, Garcia LDFR, Teixeira CDS, Bortoluzzi EA. Did in-between rinsing and agitating with distilled water prevents precipitate formation by the interaction between sodium hypochlorite and chlorhexidine canal irrigants? Microsc Res Tech 2024; 87:315-325. [PMID: 37811954 DOI: 10.1002/jemt.24435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/16/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
The interaction of sodium hypochlorite (NaOCl) and chlorhexidine gluconate (CHX) produces an orange-brown precipitate. The present study evaluated the influence of distilled water (H2 O) in different irrigation protocols designed to prevent the formation of precipitate with NaOCl and CHX. Fifty canine teeth were instrumented and split longitudinally. The canal was examined with a stereomicroscope and photographed by canal-thirds. The tooth halves were repositioned and distributed randomly into five groups, according to the final irrigation protocol (n = 10): G1 (control)-Ethylenediaminetetraacetic acid (EDTA) + NaOCl + CHX, conventional irrigation (CI); G2-EDTA + NaOCl + CHX, activated with passive ultrasonic irrigation (PUI); G3-EDTA (PUI) + NaOCl (PUI) + H2 O (CI) + CHX (PUI); G4-EDTA + NaOCl + H2 O + CHX (PUI); G5-EDTA (PUI) + NaOCl (PUI) + H2 O (continuous ultrasonic irrigation [CUI]) + CHX (PUI). The specimens were evaluated with a stereomicroscope and scanning electron microscope (SEM). Energy dispersive x-ray spectroscopy analysis was performed to identify the elemental profile of the irrigated canal walls. The images were scored according to the extensiveness of precipitate. Data were analyzed (Kruskal-Wallis test, α = 5%). Under the stereomicroscope, G1 had significantly higher scores than all the other groups in all canal-thirds (p < .05). All four experimental groups showed similar scores (p > .05). There were no significant differences in precipitate formation among root-thirds in intragroup analysis (p > .05). Upon SEM examination, overall, only G5 had lower scores than G1 (p < .05). Analysis by canal-thirds showed no significant difference among groups and among canal-thirds in the intragroup analysis (p > .05). G1 showed high Cl peaks. In-between irrigation with H2 O activated by CUI is effective in preventing precipitate formation during canal debridement with NaOCl and CHX. RESEARCH HIGHLIGHTS: Continuous ultrasonic irrigation with distilled water was capable to prevent the precipitate formation. The precipitate can be classified as a chemical smear layer.
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Affiliation(s)
- Emanuelle Catherine Maiola
- Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Letícia Mendes Boppré
- Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Julia Menezes Savaris
- Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | | | | | | | - Eduardo Antunes Bortoluzzi
- Department of Diagnosis & Oral Health, Division of Endodontics, University of Louisville, Louisville, Kentucky, USA
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Gomes BPFA, Aveiro E, Kishen A. Irrigants and irrigation activation systems in Endodontics. Braz Dent J 2023; 34:1-33. [PMID: 37909632 PMCID: PMC10642269 DOI: 10.1590/0103-6440202305577] [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: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 11/03/2023] Open
Abstract
Root canal infections are typically polymicrobial and involve strong bacterial interactions. The goal of endodontic treatment is to remove infected content from the root canal system to allow the healing of a pre-existing periapical lesion or to prevent infection of the periradicular tissues. Instrumentation alone is not capable of touching all of the root canal walls. Therefore, the irrigation process is an essential step in the endodontic treatment. However, due to the complex anatomy of the root canal system, this cleaning is very challenging. Although syringe and needle irrigation associated with the use of chemical substances is still the most used method, it does not guarantee optimal cleaning of the root canals. As a result, not only alternative irrigating substances but also numerous activation systems - which are technologies that aim to optimize the action of irrigating substances, both chemically and physically - have been developed. This work aimed to review the characteristics of both classic and current alternatives of irrigating substances and irrigation activation systems.
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Affiliation(s)
- Brenda P. F. A. Gomes
- Department of Restorative Dentistry, Division of Endodontics,
Piracicaba Dental School - State University of Campinas, UNICAMP, Brazil
| | - Emelly Aveiro
- Department of Restorative Dentistry, Division of Endodontics,
Piracicaba Dental School - State University of Campinas, UNICAMP, Brazil
| | - Anil Kishen
- Department of Dentistry, University of Toronto, Canada
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de Pellegrin SF, Pauletto G, Carlotto IB, Garcia Mendes AL, de Azevedo Mello P, Souza Bier CA. Interactions between calcium hypochlorite and irrigants commonly used in endodontic practice: a chemical analysis. J Endod 2023:S0099-2399(23)00245-5. [PMID: 37178758 DOI: 10.1016/j.joen.2023.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION This study aimed to identify possible products resulting from chemical interactions between calcium hypochlorite [Ca(OCl)2] and other irrigants for endodontic use using electrospray ionization quadrupole time-of-flight mass spectrometry (ESI-QTOF-MS). METHODS The 5.25% Ca(OCl)2 was associated with either 70% ethanol solution, distilled water, saline solution (0.9% sodium chloride), 5% sodium thiosulfate, 10% citric acid, 17% EDTA, or 2% chlorhexidine (CHX). The reaction ratio was 1:1 and the products obtained were analyzed by ESI-QTOF-MS. RESULTS The interactions between Ca(OCl)2 and CHX generated an orange-brown precipitate, without identification of para-chloroaniline (PCA), and between Ca(OCl)2 and sodium thiosulfate a milky-white precipitate. Furthermore, when the oxidizing agent was associated with EDTA and citric acid, chlorine gas was released. As for the other associations, 70% ethanol, distilled water, and saline solution, no precipitation or gas release occurred. CONCLUSION The orange-brown precipitate occurs due to the chlorination of guanidine nitrogens, and the milky-white precipitate is due to the partial neutralization of the oxidizing agent. The release of chlorine gas occurs due to the low pH of the mixture, which results in the rapid formation and decomposition of chlorine. In this context, an intermediate rinsed with distilled water, saline solution and ethanol between Ca(OCl)2 and CHX, citric acid and EDTA seems to be appropriate to prevent the formation of by-products when these irrigants need to be used in the canal. Furthermore, if it is necessary to use sodium thiosulfate, a larger volume of the solution must be used than that used for the oxidizing solution.
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Affiliation(s)
- Sidnei Flores de Pellegrin
- Graduate Program in Dentistry, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil
| | - Guilherme Pauletto
- MSciD and PhD Post-Graduate Program in Oral Science, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil
| | - Israel Bangel Carlotto
- MSciD and PhD Post-Graduate Program in Oral Science, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil
| | - Ana Luiza Garcia Mendes
- MSciD and PhD Post-Graduate Program in Chemistry, Faculty of Chemistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil
| | - Paola de Azevedo Mello
- MSciD and PhD Post-Graduate Program in Chemistry, Faculty of Chemistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil
| | - Carlos Alexandre Souza Bier
- MSciD and PhD Post-Graduate Program in Oral Science, Faculty of Dentistry, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul State, Brazil
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Drews DJ, Nguyen AD, Diederich A, Gernhardt CR. The Interaction of Two Widely Used Endodontic Irrigants, Chlorhexidine and Sodium Hypochlorite, and Its Impact on the Disinfection Protocol during Root Canal Treatment. Antibiotics (Basel) 2023; 12:antibiotics12030589. [PMID: 36978457 PMCID: PMC10044599 DOI: 10.3390/antibiotics12030589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
In recent years, sodium hypochlorite and chlorhexidine digluconate have been the gold standard of irrigation solutions utilized within the disinfection protocol during root canal treatments. Nowadays, it is known that, during chemical disinfection of the root canal, consecutive application of sodium hypochlorite and chlorhexidine digluconate leads to the formation of an orange-brown precipitate. This precipitate is described as being chemically similar to para-chloroaniline, which is suspected to have cytotoxic and carcinogenic effects. Concerns also exist regarding its influence on the leakage of root canal fillings, coronal restorations, and tooth discoloration. The purpose of this article is to review the literature on the interaction of sodium hypochlorite and chlorhexidine digluconate on the tooth and its surrounding tissues, and to discuss the effect of the precipitate formed during root canal treatment. We further address options to avoid the formation of the precipitate and describe alternative irrigation solutions that should not interact with sodium hypochlorite or chlorhexidine digluconate.
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Affiliation(s)
- Dirk-Joachim Drews
- Private Dental Practice, 69469 Weinheim, Germany
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Anh Duc Nguyen
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Antje Diederich
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Christian Ralf Gernhardt
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
- Correspondence: ; Tel.: +49-345-557-3741
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Goutham PAJ, Kalaiselvam R, Ganesh A, C BP. Antibacterial Efficacy of Irrigants with Varying Osmolarity on E. faecalis Biofilm: An In Vitro Study. J Contemp Dent Pract 2023; 23:998-1003. [PMID: 37073912 DOI: 10.5005/jp-journals-10024-3417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
AIM To evaluate the role of the addition of different concentrations of sodium chloride salt to conventional intracanal irrigants to vary their osmotic values and thereby compare their antibacterial efficacy. MATERIALS AND METHODS In an active attachment biofilm model, Enterococcus faecalis (ATCC 29212) biofilms were grown. Sodium chloride salts were added to 100 mL of distilled water to make 6M (hyperosmotic), 0.5M, and 0.25M (hypoosmotic) sodium chloride solutions, respectively. The experimental groups were divided into three groups: Group I: 5.25% sodium hypochlorite, group II: 2% chlorhexidine, and group III: 2% povidone iodine, and four subgroups within these three groups, such as subgroup A (without salt solution), subgroup B (with 6M of hyperosmotic salt solution), subgroup C (with 0.5M of hypoosmotic salt solution), and subgroup D (with 0.25M of hypoosmotic salt solution), respectively. Biofilms were treated with all the subgroups for a contact time of 15 min. A crystal violet assay was done to estimate the bacterial cell biomass. RESULTS The results revealed that subgroups IIIB, IB, and IID, ID had a statistical reduction in bacterial biomass at p < 0.05. There were no significant differences between subgroups IC, IIC, and IIIC and subgroups IA, IIA, and IIIA. CONCLUSION The antibacterial efficacy of all three irrigants was significantly affected by varying the osmolarities. CLINICAL SIGNIFICANCE The results prove that the hyperosmotic and hypoosmotic salt solutions, along with irrigants, have enhanced antibacterial efficacy on E. faecalis biofilm due to its ability to vary the turgor pressure of cell wall, as well as the inherent properties of the irrigants such as hypochlorous acid formation, ionic interaction, and free radical interactions.
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Affiliation(s)
- Pradeeba Anandi Jeya Goutham
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra College and Hospital, Sri Ramachandra Institute of Higher Education & Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Rajeswari Kalaiselvam
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra College and Hospital, Sri Ramachandra Institute of Higher Education & Research (Deemed to be University), Chennai, Tamil Nadu, India, Phone: +91 9791109099, e-mail:
| | - Arathi Ganesh
- Department of Conservative Dentistry & Endodontics, Sri Ramachandra College and Hospital, Sri Ramachandra Institute of Higher Education & Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Benedict Paul C
- Department of Biotechnology, Sri Ramachandra College and Hospital, Sri Ramachandra Institute of Higher Education & Research (Deemed to be University), Chennai, Tamil Nadu, India
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Navarrete N, Almansa JM, de la Macorra JC, Arias-Moliz MT, Arias A. Effect of the Controlled Delivery of Chelating Agents on the Pulp Tissue Dissolution Ability of Fresh Sodium Hypochlorite Solutions. J Endod 2023; 49:307-312. [PMID: 36574829 DOI: 10.1016/j.joen.2022.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate pulp tissue dissolution ability of sodium hypochlorite (NaOCl) when mixed with tetrasodic etidronate (Na4HEBP) and disodic ethylenediaminetetraacetate (Na2EDTA) under controlled flow. METHODS Bovine pulp tissue was extracted from the lower incisors of 10 bovine jaws. Pulp specimens were standardized in size (1 × 3 × 10 mm), blotted dry, and weighed (initial weight [T0]: mean (SD) = 31.98 (1.18) mg). Specimens from the same jaw were randomly assigned to 2 control (n = 3 each) and 4 experimental groups (n = 10 each): NC (negative control/distilled water), PC (positive control/6%NaOCl), G1 (3%NaOCl), G2 (3%NaOCl-17% Na2EDTA), G3 (3%NaOCl-18% Na4HEBP), and G4 (3%NaOCl-9% Na4HEBP). Distilled water and NaOCl were provided using a delivery pump under a continuous controlled rate (1 mL/min). A second pump alternately delivered either Na2EDTA or Na4HEBP at the same rate with a 30-second programmed interval. Percentage of tissue weight loss was calculated at 2, 5, and 10 minutes (T2, T5, and T10) and compared among groups with analysis of variance. Free available chlorine and pH were controlled at T0 and T10. RESULTS No tissue remained in PC at T5. No dissolution occurred in NC. There were no significant differences in the percentage of weight loss among experimental groups at any point of time. Some remnant tissue was found in G3 (1.4% ± 2.4) and G4 (1.6% ± 2.3) at T10, whereas nothing was left in G1 and G2. CONCLUSIONS The controlled delivery of Na2EDTA and Na4HEBP did not alter tissue dissolution ability of NaOCl when fresh solutions were mixed in the root canal.
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Affiliation(s)
- Natalia Navarrete
- Department of Clinical Dentistry, Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences
| | - Juan M Almansa
- Department of Conservative and Prosthetic Dentistry, School of Dentistry, Complutense University, Madrid, Spain
| | - José C de la Macorra
- Department of Conservative and Prosthetic Dentistry, School of Dentistry, Complutense University, Madrid, Spain
| | | | - Ana Arias
- Department of Conservative and Prosthetic Dentistry, School of Dentistry, Complutense University, Madrid, Spain.
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Khabadze Z, Generalova Y, Kulikova A, Podoprigora I, Abdulkerimova S, Bakaev Y, Makeeva M, Dashtieva M, Balashova M, Gadzhiev F, Mordanov O, Umarov A, Tarik H, Zoryan A, Karnaeva A, Rakhmanov Y. Irrigation in Endodontics: Polyhexanide Is a Promising Antibacterial Polymer in Root Canal Treatment. Dent J (Basel) 2023; 11:dj11030065. [PMID: 36975562 PMCID: PMC10047796 DOI: 10.3390/dj11030065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
Background:chronic apical periodontitis is a common pathology in dentistry, especially in endodontics. It is necessary to systematize data concerning commonly used irrigation solutions. The development of new protocols for endodontic treatment is a very promising direction. The use of a polyhexanide-based antiseptic can positively affect the results of endodontic treatment. Methods: the review was carried out involving the search for English language research and meta-analyses in the Google Scholar and PubMed databases. Results: the number of literary sources that were identified during the literature review is 180. After excluding publications that did not match the search criteria, the total number of articles included in the systematic review was determined to be 68. Conclusions: polyhexanide is a promising solution for infected root canal irrigation. The antibacterial activity of this substance is suitable for the elimination of pathogens responsible for the appearance of apical periodontitis.
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10
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Enhancing the intracanal antibacterial effects of sodium hypochlorite with etidronic acid or citric acid. J Endod 2022; 48:1161-1168. [PMID: 35750221 DOI: 10.1016/j.joen.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This study evaluated the bacterial reduction promoted by root canal preparation using irrigation with sodium hypochlorite (NaOCl) alone, associated with etidronic acid (HEDP) or alternated with citric acid, and after a supplementary agitation step. METHODS Extracted mandibular premolars were selected and distributed into 3 groups based on anatomically paired micro-computed tomographic analyses. The canals were contaminated with Enterococcus faecalis for 30 days and then subjected to chemomechanical preparation with a reciprocating instrument under irrigation with NaOCl alone, mixed with HEDP (NaOCl/HEDP), or alternated with citric acid (NaOCl/CA). A supplementary agitation step with the XP-endo Finisher was performed in all groups. Intracanal bacteriological samples were taken before (S1) and after preparation (S2), and after the supplementary approach (S3). DNA was extracted from the samples and subjected to quantitative real-time polymerase chain reaction. RESULTS Intragroup analyses revealed a substantial bacterial reduction from S1 to S2 or S3 in all groups (p<0.01). The supplementary agitation resulted in S2-to-S3 bacterial reduction of 6%, 68%, and 80% in the NaOCl, NaOCl/HEDP, and NaOCl/CA groups, respectively. Irrigation with NaOCl alone resulted in 53% and 47% of samples negative for bacteria in S2 and S3, respectively. Corresponding figures for NaOCl/HEDP were 75% and 85%, and 44% and 72% for NaOCl/CA. Intergroup analyses of S2 samples showed that NaOCl/HEDP was significantly more effective than the other two in reducing the bacterial levels (p<0.05). After the supplementary approach, both NaOCl/HEDP and NaOCl/CA were significantly more effective than NaOCl alone (p<0.05), with no significant differences between them (p>0.05). CONCLUSION Both the freshly combined NaOCl/HEDP solution and the alternate use of NaOCl and citric acid followed by XP-endo Finisher agitation resulted in significantly higher intracanal bacterial reduction than NaOCl alone.
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11
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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: 66] [Impact Index Per Article: 33.0] [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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Tietz L, Furlan RD, da Rosa RA, Duarte MAH, Alcalde MP, Vivan RR, Weissheimer T, Só MVR. Efficacy of reciprocating instruments and final irrigant activation protocols on retreatment of mesiobuccal roots of maxillary molars: a micro-CT analysis. Restor Dent Endod 2022; 47:e13. [PMID: 35284326 PMCID: PMC8891472 DOI: 10.5395/rde.2022.47.e13] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/22/2021] [Accepted: 09/07/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives This study evaluated the efficacy of 3 reciprocating systems and the effects of 2 instruments for irrigant activation on filling material removal. Materials and Methods Forty mesiobuccal roots of maxillary molars were prepared up to size 25.06 and obturated. Micro-computed tomography (micro-CT) examination #1 was performed. Teeth were then divided into 4 groups (n = 10), according to the retreatment protocol: (1) manual, (2) Reciproc Blue, (3) WaveOne Gold, and (4) X1 Blue. Micro-CT examinations #2 and #3 were performed after filling removal and repreparation, respectively. Next, all teeth were divided into 2 new groups (n = 20) according to the irrigant activation protocol: XP Clean (XP Clean size 25.02) and Flatsonic (Flatsonic ultrasonic tip). Micro-CT examination #4 was performed after irrigant activation. Statistical analysis was performed with a significance level set at 5%. Results WaveOne Gold removed a significantly greater amount of filling material than the manual group (p < 0.05). The time to reach the WL was similar for all reciprocating systems (p > 0.05). X1 Blue was faster than the manual group (p < 0.05). Only manual group improved the filling material removal after the repreparation stage (p < 0.05). Both activation protocols significantly improved the filling material removal (p < 0.05), without differences between them (p > 0.05). Conclusions None of the tested instruments completely removed the filling material. X1 Blue size 25.06 reached the working length in the shortest time. XP Clean and Flatsonic improved the filling material removal.
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Affiliation(s)
- Lilian Tietz
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Renan Diego Furlan
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry/University of São Paulo - FOB/USP, Bauru, Brazil
| | - Ricardo Abreu da Rosa
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry/University of São Paulo - FOB/USP, Bauru, Brazil
| | | | - Rodrigo Ricci Vivan
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry/University of São Paulo - FOB/USP, Bauru, Brazil
| | - Theodoro Weissheimer
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Marcus Vinicius Reis Só
- Department of Conservative Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
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Alves-Silva EG, Arruda-Vasconcelos R, Louzada LM, de-Jesus-Soares A, Ferraz CCR, de Almeida JFA, Marciano MA, Steiner-Oliveira C, Bello-Silva MS, Shemesh H, Paula Figueiredo de Almeida Gomes B. The effect of photodynamic therapy on postoperative pain in teeth with primary endodontic infection. Photodiagnosis Photodyn Ther 2021; 37:102700. [PMID: 34954090 DOI: 10.1016/j.pdpdt.2021.102700] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The objective of this study was to investigate the action of photodynamic therapy on pain control after endodontic treatment in asymptomatic teeth with a primary infection, within a single visit. METHODS Sixty (60) single-rooted teeth with pulp necrosis and periapical lesions were selected and randomly divided into two (2) groups (n=30), according to the protocol; a control group (CG) and a group using photodynamic therapy (aPDT). The canals were instrumented with Reciproc files # 25 up to 40 along the entire length of the canal, using 2% chlorhexidine gel as the auxiliary chemical substance, followed by irrigation with sterile saline. The canals were filled with Endomethasone N cement, 0.005% methylene blue, using AsGaAl diode laser, 660 nm wavelength, 100 mW of power and 9 J of energy, using optical fibers with 365 µm in diameter. RESULTS Pain intensity was assessed at 8, 12, 24, 48, 72 hours and 1 week after endodontic treatment using a visual analogue scale. The level of pain was classified as none (0), mild (1-3), moderate (4-7) or severe (8-10). The data were at a significance level of 5%. There was a statistically significant difference (p<0.05) in the periods of 8, 12, 24, 48 and 72 hours between the control group and the aPDT group. After 1 week, there was no statistically significant difference. CONCLUSIONS It is concluded that photodynamic therapy had a significant effect on decreasing post-endodontic treatment pain in teeth with necrotic pulp and asymptomatic periapical lesions.
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Affiliation(s)
- Esdras Gabriel Alves-Silva
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Rodrigo Arruda-Vasconcelos
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Lidiane Mendes Louzada
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Adriana de-Jesus-Soares
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Caio Cezar Randi Ferraz
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - José Flávio Affonso de Almeida
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Marina Angélica Marciano
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Carolina Steiner-Oliveira
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Marina Stella Bello-Silva
- Special Laboratory of Lasers in Dentistry (LELO), Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | - Hagay Shemesh
- Department of Endodontology, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands..
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Silva CBB, Bronzato JD, Herrera DR, Montagner F, Nunes EL, Gomes BPFA. Efficiency of a digital electrofulguration system in contaminated root canals in vitro. Braz Dent J 2021; 32:1-9. [PMID: 34755783 DOI: 10.1590/0103-6440202104067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
Decontamination of the root canal (RC) system is essential for successful endodontic therapy. In this in vitro study, it was evaluated the disinfection potential of an electrofulguration device, the Endox® Endodontic System (EES), in RC infected with Enterococcus faecalis. Sixty-five human lower premolars were instrumented with MTwo® system. The specimens were distributed into six experimental groups (n = 10), according to the irrigation protocol: 2% chlorhexidine gel (CHX); CHX + EES; 5.25% sodium hypochlorite (NaOCl); NaOCl + EES; saline solution (SS); and SS + EES. Five specimens were untreated (control). RC samples were collected before (C1) and after EES treatment (C2), after chemo-mechanical preparation (CMP) (C3), and after final EES treatment (C4). All samples were plated for colony forming units (CFU/mL) onto solid media. The data were analyzed by Wilcoxon and Friedman tests for intragroup comparisons and by Kruskal Wallis test followed by Dunn's test for intergroup comparisons (α = 0.05). Treatment with the EES did not significantly reduce the number of CFU/mL as compared to baseline levels (C1 vs. C2, p> 0.05). After CMP (C3), all groups showed a significantly reduced amount of CFU/mL (p <0.05), with no difference between CHX- and NaOCl-treated samples (p >0.05). Lastly, treatment with the EES following CMP (C4) did not significantly reduce the amount of CFU/mL (C3 vs. C4, p> 0.05). To conclude, the use of the Endox® Endodontic System did not result in considerable bacterial reduction at all operative times, while treatment with NaOCl and CHX was equally efficient for this purpose.
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Affiliation(s)
- Cimara B B Silva
- - Department of Endodontics, State University of Amazonas, Manaus, MA, Brazil
| | - Juliana D Bronzato
- - Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, SP, Brazil
| | - Daniel R Herrera
- - Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, SP, Brazil.,- Department of Endodontics, Federal Fluminense University, Niteroi, RJ, Brazil
| | - Francisco Montagner
- - Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, SP, Brazil.,- Department of Conservative Dentistry, Division of Endodontics, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Elifas L Nunes
- - Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, SP, Brazil.,- Dental Surgeon, Piracicaba, SP, Brazil
| | - Brenda P F A Gomes
- - Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, SP, Brazil
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Cerqueira-Neto ACCL, Prado MC, Pereira AC, Oliveira ML, Vargas-Neto J, Gomes BPFA, Ferraz CCR, Almeida JFA, de-Jesus-Soares A. Clinical and Radiographic Outcomes of Regenerative Endodontic Procedures in Traumatized Immature Permanent Teeth: Interappointment Dressing or Single-Visit? J Endod 2021; 47:1598-1608. [PMID: 34310980 DOI: 10.1016/j.joen.2021.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/20/2021] [Accepted: 07/16/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION More data are needed before affirming that single-visit approaches are effective and safe for regenerative endodontic procedures (REPs). This study compared clinical and radiographic outcomes of REPs between interappointment dressing or single-visit protocols. METHODS Twenty young patients presenting traumatized immature teeth with pulp necrosis were divided into 2 groups. Teeth were submitted to 6% sodium hypochlorite and 2% chlorhexidine irrigation and to 17% EDTA use before blood clot induction. In the interappointment dressing group (n = 11), calcium hydroxide was used with 2% chlorhexidine gel for 21 days before scaffold induction. In the single-visit group (n = 9), the scaffold was induced during the only appointment. Patients were followed up for 24 months. Primary, secondary, and tertiary outcomes were assessed by 3 independent evaluators. Preoperative and follow-up radiographs were assessed for quantitative measurements of the apical diameter, root width, root length, and cervical barrier placement and compared between groups using the t test or Mann-Whitney U test. Categoric variables were assessed with the G test and the Fisher exact test and continuous variables with the Mann-Whitney U test. Statistical significance was set at 5%. RESULTS One tooth showed persistence of infection. No difference was observed in cervical barrier placement (P > .05); between groups regarding primary, secondary, and tertiary outcomes (P > .05); and in parameters of quantitative radiographic outcomes (P > .05). CONCLUSIONS Completing REPs with an interappointment dressing or a single-visit protocol presented similar clinical and radiographic outcomes. A single-visit protocol of REPs using 6% sodium hypochlorite, 2% chlorhexidine, and 17% EDTA permitted satisfactory outcomes in necrotic immature permanent teeth.
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Affiliation(s)
- Ana Carolina C L Cerqueira-Neto
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Marina C Prado
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Andréa C Pereira
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Matheus L Oliveira
- Department of Oral Diagnosis, Oral Radiology Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Júlio Vargas-Neto
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Caio C R Ferraz
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - José Flávio A Almeida
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil
| | - Adriana de-Jesus-Soares
- Department of Restorative Dentistry, Endodontic Division, Piracicaba Dental School - State University of Campinas (FOP-UNICAMP), Piracicaba, São Paulo, Brazil.
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Ioannidis K, Batty C, Turner C, Smith D, Mannocci F, Deb S. A laboratory study to assess the formation of effluent volatile compounds and disinfection by-products during chemomechanical preparation of infected root canals and application of activated carbon for their removal. Int Endod J 2020; 54:601-615. [PMID: 33237607 DOI: 10.1111/iej.13454] [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: 07/08/2020] [Accepted: 11/20/2020] [Indexed: 12/01/2022]
Abstract
AIM To assess in a laboratory setting using extracted teeth the formation of volatile compounds (VOCs) and disinfection by-products (DBPs) in effluent aliquots, during chemomechanical preparation of artificially infected root canal specimens, and determine the role of silver-impregnated activated carbon (Ag-AC) in their removal. METHODOLOGY Single-rooted human teeth were decoronated to obtain 15 mm-long root specimens and a nutrient-stressed multispecies biofilm was grown in the root canals. Specimens were randomly assigned into three groups [Group 1; instrumentation with rotary files and irrigation with sterile saline, Groups 2 and 3; instrumentation with rotary files and irrigation with 2.5% NaOCl and 17% EDTA]. A portable medical suction device was used to collect the effluent aliquots during root canal irrigation. In Groups 1 and 2, the reaction products of the collected effluents were analysed by selected ion flow tube mass spectrometry (SIFT-MS). The effluents from Group 3 were treated with Ag-AC prior to SIFT-MS analysis, to assess the removal capacity of Ag-AC against the reaction products. The synthesis of Ag-AC was characterized with scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDS). Two-way analysis of variance (anova) with post hoc Tukey tests was used for data analysis and determination of a significant difference (P < 0.05). RESULTS In Group 1, effluent VOCs and DBPs were detectable at very low levels. In Group 2, the collected effluent aliquots released high concentrations of methanol, propanol, ammonia, chloroform and formaldehyde, which were significantly greater compared to Group 1 (P < 0.001). SEM/EDS analysis confirmed impregnation of Ag within the AC matrix. The treatment of effluent aliquots with Ag-AC (Group 3) resulted in a significant reduction in concentrations of acetone, acetic acid, propanol, acetaldehyde, acetonitrile and chloroform, compared to Group 2 (P < 0.001). The concentration levels of ethanol, methanol, ammonia and formaldehyde remained unaffected (P > 0.05). CONCLUSIONS In this laboratory setting using extracted human teeth, the chemomechanical preparation of artificially infected root canals resulted in the formation of toxic VOCs and DBPs as effluent suspensions. Their release during aspiration with dental suction indicates that potential environmental hazards should be investigated. The use of silver-impregnated activated carbon had potential for the point-of-use treatment of post-irrigation effluent aliquots.
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Affiliation(s)
- K Ioannidis
- Faculty of Dentistry, Oral and Craniofacial Sciences, Centre for Oral Clinical and Translational Science, Guy's Hospital, King's College London, London, UK
| | - C Batty
- School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, UK
| | - C Turner
- College of Health and Life Sciences, Brunel University, Uxbridge, London, UK
| | - D Smith
- Transspectra Limited, Newcastle Under Lyme, UK
| | - F Mannocci
- Department of Endodontology, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - S Deb
- Faculty of Dentistry, Oral and Craniofacial Sciences, Centre for Oral Clinical and Translational Science, Guy's Hospital, King's College London, London, UK
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Nassar M, Hiraishi N, Islam MS, Romero MJ, Otsuki M, Tagami J. Effect of phytic acid as an endodontic chelator on resin adhesion to sodium hypochlorite-treated dentin. Restor Dent Endod 2020; 45:e44. [PMID: 33294409 PMCID: PMC7691263 DOI: 10.5395/rde.2020.45.e44] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 12/05/2022] Open
Abstract
Objectives Phytic acid (IP6), a naturally occurring agent, has been previously reported as a potential alternative to ethylenediaminetetraacetic acid (EDTA). However, its effect on adhesion to sodium hypochlorite (NaOCl)-treated dentin and its interactions with NaOCl have not been previously reported. Thus, in this study, the effects of IP6 on resin adhesion to NaOCl-treated dentin and the failure mode were investigated and the interactions between the used agents were analyzed. Materials and Methods Micro-tensile bond strength (µTBS) testing was performed until failure on dentin treated with either distilled water (control), 5% NaOCl, or 5% NaOCl followed with chelators: 17% EDTA for 1 minute or 1% IP6 for 30 seconds or 1 minute. The failed specimens were assessed under a scanning electron microscope. The reaction of NaOCl with EDTA or IP6 was analyzed in terms of temperature, pH, effervescence, and chlorine odor, and the effects of the resulting mixtures on the color of a stained paper were recorded. Results The µTBS values of the control and NaOCl with chelator groups were not significantly different, but were all significantly higher than that of the group treated with NaOCl only. In the failure analysis, a distinctive feature was the presence of resin tags in samples conditioned with IP6 after treatment with NaOCl. The reaction of 1% IP6 with 5% NaOCl was less aggressive than the reaction of the latter with 17% EDTA. Conclusions IP6 reversed the adverse effects of NaOCl on resin-dentin adhesion without the chlorine-depleting effect of EDTA.
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Affiliation(s)
- Mohannad Nassar
- Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Noriko Hiraishi
- Cariology and Operative Dentistry, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Md Sofiqul Islam
- RAK College of Dental Sciences (RAKCODS), RAK Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah, UAE
| | - Maria Jrh Romero
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Masayuki Otsuki
- Cariology and Operative Dentistry, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junji Tagami
- Cariology and Operative Dentistry, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Ozkan HB, Cobankara FK, Sayin Z, Ozer F. Evaluation of the Antibacterial Effects of Single and Combined use of Different Irrigation Solutions Against Intracanal Enterococcus Faecalis. Acta Stomatol Croat 2020; 54:250-262. [PMID: 33132388 PMCID: PMC7586900 DOI: 10.15644/asc54/3/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objectives This study assessed the antibacterial activity of both separate and combined uses of 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), 17% ethylenediaminetetraacetic acid (EDTA), 3% hydrogen peroxide (H2O2), MTAD, SmearClear (SC) and 13.8% chlorine dioxide (ClO2) irrigation solutions against Enterococcus faecalis. Materials and Methods Two hundred eighty single rooted human premolars were randomly grouped into 26 test and 2 control (negative and positive) groups and were incubated for 24 h with E. faecalis, except for the negative control group. The tested solutions were as follow: NaOCl; CHX; ClO2; MTAD; SC; EDTA; H2O2; NaOCl + CHX; NaOCl + MTAD; SC + NaOCl; EDTA + NaOCl; H2O2 + NaOCl; ClO2 + CHX; CHX + MTAD; SC + CHX; EDTA + CHX; CHX + H2O2; ClO2 + MTAD; SC + ClO2; EDTA + ClO2; ClO2 + H2O2; SC+MTAD; EDTA+MTAD; MTAD + H2O2; SC + H2O2; and EDTA + H2O2. Optic density values were recorded at 0, 6, 12, 18, 24, 30, 36, 42 and 48 h and bacterial growth curve created for each solution. Results The CHX, MTAD and ClO2 showed a high potential for the elimination of E. faecalis, both alone and in all combinations. The EDTA, H2O2, H2O2+ EDTA, H2O2 + NaOCl and SC + NaOCl groups showed less antibacterial activity than the other groups. The SC + CHX group showed the best antibacterial effect against E. faecalis. Conclusion The SC + CHX combination can be recommended as the most effective irrigation regimen against E. faecalis in persistent endodontic infections.
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Affiliation(s)
- Hatice Buyukozer Ozkan
- Department of Endodontics, Faculty of Dentistry, Alanya Alaaddin Keykubat University, Alanya, Antalya, Turkey
| | - Funda Kont Cobankara
- Department of Endodontics, Faculty of Dentistry, Selcuk University, Konya, Turkey
| | - Zafer Sayin
- Department of Microbiology, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey
| | - Fusun Ozer
- Department of Preventive and Restorative Sciences, School of Dental Medicine University of Pennsylvania, Philadelphia, Pennsylvania
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Khatib MS, Ameer B, Ajit Mannur N, Ramalingaiahsetty AM, Peerzade SM, Bambawale A. Decoding the Perplexing Mystery of Para-Chloroaniline Formation: A Systematic Review. J Int Soc Prev Community Dent 2020; 10:142-147. [PMID: 32670901 PMCID: PMC7340001 DOI: 10.4103/jispcd.jispcd_488_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/26/2019] [Accepted: 12/30/2019] [Indexed: 11/04/2022] Open
Abstract
Objective The objective of this article was to understand and decode the mystery of the formation of para-chloroaniline (PCA). The ingredient of the brown precipitate after mixing sodium hypochlorite (NaOCl) and chlorhexidine gluconate (CHX) is still in debate. Materials and Methods Various studies adopt a different methodology to substantiate that it may contain PCA, which is a carcinogenic agent. The purpose of this systematic review is to evaluate the relationship between PCA and brown precipitate. Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies were manually searched. There was no disagreement between the two reviewers. This review was reported and conducted in step with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Of 233 articles, only 13 articles met the inclusion criteria. Available scientific evidence was more supportive that the brown precipitate form after mixing NaOCl and CHX may form para-chloroamide moiety rather than free PCA, and PCA may be the by-product of CHX degradation. Conclusion On the basis of the current evidence and data extracted from the various databases, it can be concluded that the mixture of sodium hypochlorite and chlorhexidine does not form PCA, and PCA may be the by-product of high concentrated chlorhexidine. Further studies are required to substantiate the evidence.
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Affiliation(s)
- Mohd Sibghatullah Khatib
- Department of Conservative Dentistry and Endodontics, Dr. Syamala Reddy Dental College Hospital and Research Centre, Bangalore, India
| | - Bilal Ameer
- SJM Dental College and Hospital, Chitradurga, India
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Buurma HA, Buurma BJ. The effect of smear layer on bacterial penetration through roots obturated using zinc oxide eugenol-based sealer. BMC Oral Health 2020; 20:88. [PMID: 32216774 PMCID: PMC7098078 DOI: 10.1186/s12903-020-01069-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smear layer removal has been shown to reduce bacterial penetration through root canal obturations when resin-based endodontic sealer is used. The purpose of this in vitro study was to test this effect when a non-resin-based sealer is used. MATERIAL AND METHODS Thirty root segments were assigned to the following groups: Smear layer removed (n = 8); smear layer retained (n = 8); negative controls (n = 10; 5 with smear layer, 5 without); and positive controls (n = 4; 2 with smear layer, 2 without). After rotary instrumentation, smear layers were removed in the treatment group and half of controls using 17% ethylenediamenetetraacetic acid (EDTA) prior to obturation. Each obturated root was affixed into a dual-chamber leakage model employing Streptococcus mutans. Roots were incubated at 37 °C for 120 d. Days until lower chamber turbidity occurred was recorded for each sample, and data were analyzed using Kaplan-Meier survival curve analysis (p = 0.05). RESULTS No negative controls leaked, while all positive controls were turbid within 1 day. Mean days to leakage for roots with smear layer intact was 82.75 (+/- 33.29, 95% CI), although three never leaked. Mean days to leakage through roots with smear layer removed was 46.25 (+/- 26.67, 95% CI), and all leaked. Treatment survival curves were significantly different (p = 0.048). CONCLUSIONS Under the conditions and limitations of this study, retaining the smear layer reduced the rate of bacterial penetration through canals which had been obturated using zinc oxide eugenol (ZOE) -based sealer.
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Affiliation(s)
- Hilbrand A Buurma
- Mathematics & Sciences Department, St. Leo University, 33701 State Road 52, Saint Leo, FL, 33574, USA
| | - Brian J Buurma
- Private Practice Limited to Endodontics, 3290 N Wellness Dr, Ste 270, Holland, MI, USA.
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Ioannidis K, Batty C, Turner C, Smith D, Deb S, Mannocci F. Ex vivo detection and quantification of apically extruded volatile compounds and disinfection by-products by SIFT-MS, during chemomechanical preparation of infected root canals. Dent Mater 2020; 36:257-269. [DOI: 10.1016/j.dental.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/09/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
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Vintimilla DR, Chambers L, Mauffrey C, Parry JA. Just add water? Chlorhexidine's antimicrobial properties are minimally affected by dilution in saline compared to water. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:613-615. [PMID: 31863271 DOI: 10.1007/s00590-019-02609-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/13/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dilute chlorhexidine gluconate (CHG) in sterile water is an antiseptic solution approved for intraoperative wound irrigation by the United States Food and Drug Administration. In practice, however, CHG is commonly diluted with normal saline, which can result in its precipitation potentially reducing the antimicrobial effect. The purpose of this study was to determine if the antimicrobial properties of CHG are reduced after dilution with normal saline compared to sterile water. MATERIALS AND METHODS Sterile paper disks were placed into undiluted 4% CHG (positive control), 0.05% CHG in sterile water, 0.05% CHG in normal saline, or normal saline alone (negative control) and then placed in triplicate onto the agar plates inoculated with Staphylococcus aureus. After incubating at 37 °C for 24 h, the diameter of the zone of inhibition around each disk was measured. RESULTS The mean zone of inhibition for 4% CHG, 0.05% CHG in sterile water, 0.05% CHG in normal saline, and normal saline alone was 24 ± 0.6 mm, 16 ± 0.9 mm, 14 ± 0.5 mm, and 0 ± 0 mm, respectively (p < 0.01). The zone of inhibition for dilute CHG in normal saline was on average 2.5 mm less (95% CI 1.7-3.2 mm) than that of CHG in sterile water. CONCLUSIONS Dilute CHG in normal saline, versus sterile water, retained its antimicrobial activity with a small reduction in the zone of inhibition. Surgeons and scientists should be aware of the interaction between normal saline and CHG. Future scientific studies need to control for what solution is used for dilution.
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Affiliation(s)
- David Rojas Vintimilla
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St MC 0188, Denver, CO, 80204, USA
| | - Lori Chambers
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St MC 0188, Denver, CO, 80204, USA
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St MC 0188, Denver, CO, 80204, USA
| | - Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St MC 0188, Denver, CO, 80204, USA.
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Piperidou M, Sodhi RNS, Kolosowski KP, Basrani BR. Effects of Final Irrigation with SmearOFF on the Surface of Dentin Using Surface Analytical Methods. J Endod 2018; 44:1714-1719. [PMID: 30266468 DOI: 10.1016/j.joen.2018.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/14/2018] [Accepted: 07/26/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION SmearOFF (Vista Dental Products, Racine, WI) is an irrigation solution containing chlorhexidine (CHX), EDTA, and a surfactant. This study examined the chemical interaction of SmearOFF with sodium hypochlorite (NaOCl) on the dentin surface, specifically the formation of precipitate and/or parachloroanaline (PCA). METHODS Dentin blocks prepared from human maxillary molars were mounted in resin. Dentinal tubules were exposed in a perpendicular orientation using an ultracryomicrotome. The blocks were divided into 2 groups: the CHX group, irrigation with 6% NaOCl, 17% EDTA, 6% NaOCl, and 2% CHX, and the SmearOFF group, irrigation with 6% NaOCl and SmearOFF. The dentin surface was analyzed with time-of-flight secondary ion mass spectrometry and X-ray photoelectron spectroscopy to determine the formation of precipitate or/and PCA on the surface of dentin. RESULTS Precipitation with PCA and occlusion of the dentinal tubules were noted on the dentin surface in the CHX group. No precipitate and no PCA were detected on the surface of dentin in the SmearOFF group. CONCLUSIONS Interaction of SmearOFF with NaOCl on the dentin surface did not result in the formation of precipitate or PCA.
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Affiliation(s)
- Myrto Piperidou
- MSc Endodontic Program, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Rana N S Sodhi
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Kamil P Kolosowski
- MSc Endodontic Program, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Bettina R Basrani
- MSc Endodontic Program, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
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Nuclear magnetic resonance spectroscopy and infrared spectroscopy analysis of precipitate formed after mixing sodium hypochlorite and QMix 2in1. PLoS One 2018; 13:e0202081. [PMID: 30110396 PMCID: PMC6093659 DOI: 10.1371/journal.pone.0202081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 07/28/2018] [Indexed: 11/20/2022] Open
Abstract
Background Mixing sodium hypochlorite (NaOCl) with chlorhexidine (CHX) forms a brown precipitate. QMix-2in1 (QMix) was introduced as a final irrigant. Manufacturer recommends interim flushing with saline between the application of NaOCl and QMix to prevent formation of precipitation. This study assessed whether para-chloroaniline (PCA) is formed after mixing NaOCl with QMix. Methods Commercially available, 5.25% NaOCl solution, 2% CHX, QMix, 15% ethylenediaminetetraacetic acid (EDTA) and 98% PCA in powder form were used. Groups were prepared at room temperature. Group 1, 98% PCA in powder form; Group 2, 2% chlorhexidine (CHX); Group 3, QMix; Group 4, 5.25% sodium hypochlorite (NaOCl) mixed with QMix; Group 5, 5.25% NaOCl mixed with CHX; Group 6, 15% EDTA mixed with CHX. The precipitates were extracted and analysed with Proton Nuclear Magnetic Resonance (1H-NMR) and Infrared (IR) Spectroscopy, using PCA as an internal standard. Results No PCA was found in any of the irrigant-mixture groups tested. Conclusions This study used the interpretation of spectral results for the amino signals of precipitate formed after mixing QMix with 5.25% NaOCl using different nondestructive analysis methods, with PCA as an internal standard (control). We conclude that mixing QMix or 2%CHX with 5.25% NaOCl does not yield free PCA.
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Nogo-Zivanovic D, Bjelovic L, Ivanovic V, Kanjevac T, Tanaskovic I. Consideration of the Therapeutic Potential of Irrigants in Endodontic Therapy. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2018. [DOI: 10.1515/sjecr-2016-0095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
The main objective of endodontic treatment is to remove vital and necrotic remnants of pulp tissue and microorganisms and their toxic products from the root canal. During chemo-mechanical endodontic preparation, a smear layer is formed on the wall of the canals. Due to an inability to remove all tissue remnants and the smear layer from the root canal by mechanical instrumentation, it is necessary to use irrigation to ensure sufficient cleaning and disinfection of the largest part of the root canalicular system. The most commonly used irrigants are sodium hypochlorite (Na-OCl), ethylenediaminetetraacetic acid (EDTA), citric acid and chlorhexidine (CHX). Recently, the irrigants QMix and MTAD have been introduced to the market. They are a mixture of different components having antimicrobial, organolytic and mineralytic effects on canal detritus and the smear layer. This review article investigates irrigants in terms of the nature of their effect, their efficiency, optimal concentration, and method of use, and the interactions between the irrigants most commonly used in endodontic therapy are discussed, with special emphasis on QMix and MTAD.
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Affiliation(s)
- Dajana Nogo-Zivanovic
- Department for Restorative Dentistry and Endodontics, Faculty of Medicine , University of East Sarajevo , Foca , Bosnia and Herzegovina
| | - Ljiljana Bjelovic
- Department for Restorative Dentistry and Endodontics, Faculty of Medicine , University of East Sarajevo , Foca , Bosnia and Herzegovina
| | - Vladimir Ivanovic
- Department of Restorative Odontology and Endodontics, School of Dental Medicine , University of Belgrade , Belgrade , Serbia
| | - Tatjana Kanjevac
- Department of Preventive and Pediatric Dentistry, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Irena Tanaskovic
- Department of Histology and Embryology, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
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Orhan EO, Irmak Ö. Comments of the Mismatched/Missing References in Published Article. Braz Dent J 2018; 29:222. [DOI: 10.1590/0103-6440201801751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/12/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Özgür Irmak
- Eskisehir Osmangazi University Eskisehir, Turkey
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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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Solana C, Ruiz-Linares M, Baca P, Valderrama MJ, Arias-Moliz MT, Ferrer-Luque CM. Antibiofilm Activity of Sodium Hypochlorite and Alkaline Tetrasodium EDTA Solutions. J Endod 2017; 43:2093-2096. [DOI: 10.1016/j.joen.2017.06.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 12/17/2022]
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Alkaline Sodium Hypochlorite Irrigant and Its Chemical Interactions. MATERIALS 2017; 10:ma10101147. [PMID: 28961175 PMCID: PMC5666953 DOI: 10.3390/ma10101147] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/23/2017] [Accepted: 09/24/2017] [Indexed: 11/18/2022]
Abstract
Endodontic irrigating solutions may interact chemically with one another. This is important, because even when solutions are not admixed, they will come into contact with one another during an alternating irrigation technique, forming unwanted by-products, which may be toxic or irritant. Mixing or alternating irrigants can also reduce their ability to clean and disinfect the root canal system of teeth by changing their chemical structure with subsequent loss of the active agent, or by inducing precipitate formation in the root canal system. Precipitates occlude dental tubules, resulting in less penetration of antimicrobials and a loss of disinfection efficacy. Sodium hypochlorite is not only a very reactive oxidizing agent, but is also the most commonly used endodontic irrigant. As such, many interactions occurring between it and other irrigants, chelators and other antimicrobials, may occur. Of particular interest is the interaction between sodium hypochlorite and the chelators EDTA, citric acid and etidronate and between sodium hypochlorite and the antimicrobials chlorhexidine, alexidine, MTAD and octenisept.
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Chromographic Analysis and Cytotoxic Effects of Chlorhexidine and Sodium Hypochlorite Reaction Mixtures. J Endod 2017; 43:1545-1552. [DOI: 10.1016/j.joen.2017.04.025] [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: 02/28/2017] [Accepted: 04/17/2017] [Indexed: 11/21/2022]
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Silva CC, Ferreira VMD, De-Deus G, Herrera DR, Prado MD, Silva EJNLD. Effect of Intermediate Flush Using Different Devices to Prevent Chemical Smear Layer Formation. Braz Dent J 2017; 28:447-452. [PMID: 29160396 DOI: 10.1590/0103-6440201701438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/02/2017] [Indexed: 11/21/2022] Open
Abstract
This study compared the effect of intermediate flush with distilled water delivered by conventional irrigation, EndoVac microcannula or Self-Adjusting File (SAF) system in the prevention of chemical smear layer (CSL) formation. Thirty human premolars were used. Canals were prepared with Reciproc system and 5.25% NaOCl. After chemomechanical preparation, samples were divided in 3 groups (n=10) according to the intermediate irrigation protocol with distilled water using: conventional irrigation, EndoVac microcannula or SAF. A final flush with 2% chlorhexidine solution was used and scanning electron microscopy was performed to assess protocol effectiveness. Two calibrated evaluators attributed scores according the presence or absence of CSL on the surface of the root canal walls at the coronal, middle and apical thirds, as follows: (1) no CSL; (2) small amounts of CSL; (3) moderate CSL; and (4) heavy CSL. Differences between protocols were analyzed with Kruskal-Wallis and Mann-Whitney U tests. Friedman and Wilcoxon signed rank tests were used for comparison between each root canal third. SAF resulted in less formation of CSL when compared with the conventional irrigation and EndoVac microcannula (p<0.05). When root canal thirds were analyzed, conventional irrigation and EndoVac groups showed less CSL formation at coronal and middle thirds in comparison to the apical third (p<0.05). In SAF group, there was no difference among the thirds (p>0.05). It may be concluded that an intermediate flush of distilled water, delivered by the SAF system resulted in a better reduction of CSL formation during chemomechanical preparation.
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Affiliation(s)
- Camilla Corrêa Silva
- Department of Endodontics, School of Dentistry, UNIGRANRIO - Universidade do Grande Rio, Duque de Caxias, RJ, Brazil
| | - Vivian Maria Durange Ferreira
- Department of Endodontics, School of Dentistry, UNIGRANRIO - Universidade do Grande Rio, Duque de Caxias, RJ, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, RJ, Brazil
| | - Daniel Rodrigo Herrera
- Department of Endodontics, Piracicaba School of Dentistry, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Maíra do Prado
- Department of Endodontics, Piracicaba School of Dentistry, UNICAMP - Universidade Estadual de Campinas, Piracicaba, SP, Brazil
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Prado MC, Leal F, Simão RA, Gusman H, do Prado M. The use of auxiliary devices during irrigation to increase the cleaning ability of a chelating agent. Restor Dent Endod 2017; 42:105-110. [PMID: 28503475 PMCID: PMC5426214 DOI: 10.5395/rde.2017.42.2.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/13/2016] [Indexed: 11/20/2022] Open
Abstract
Objectives This study investigated the cleaning ability of ultrasonically activated irrigation (UAI) and a novel activation system with reciprocating motion (EC, EasyClean, Easy Equipamentos Odontológicos) when used with a relatively new chelating agent (QMix, Dentsply). In addition, the effect of QMix solution when used for a shorter (1 minute) and a longer application time (3 minutes) was investigated. Materials and Methods Fifty permanent human teeth were prepared with K3 rotary system and 6% sodium hypochlorite. Samples were randomly assigned to five groups (n = 10) according to the final irrigation protocol: G1, negative control (distilled water); G2, positive control (QMix 1 minute); G3, QMix 1 minute/UAI; G4, QMix 1 minute/EC; G5, QMix 3 minutes. Subsequently the teeth were prepared and three photomicrographs were obtained in each root third of root walls, by scanning electron microscopy. Two blinded and pre-calibrated examiners evaluated the images using a four-category scoring system. Data were statistically analyzed using Kruskal-Wallis and Dunn tests (p < 0.05). Results There were differences among groups (p < 0.05). UAI showed better cleaning ability than EC (p < 0.05). There were improvements when QMix was used with auxiliary devices in comparison with conventional irrigation (p < 0.05). Conventional irrigation for 3 minutes presented significantly better results than its use for 1 minute (p < 0.05). Conclusions QMix should be used for 1 minute when it is used with UAI, since this final irrigation protocol showed the best performance and also allowed clinical optimization of this procedure.
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Affiliation(s)
- Marina Carvalho Prado
- PROCLIN Department, School of Dentistry, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernanda Leal
- PROCLIN Department, School of Dentistry, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Renata Antoun Simão
- Metallurgical and Materials Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Heloisa Gusman
- Department of Dental Clinic, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Maíra do Prado
- Metallurgical and Materials Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Department of Dental Clinic, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Quantification of Lipoteichoic Acid Contents and Cultivable Bacteria at the Different Phases of the Endodontic Retreatment. J Endod 2016; 42:552-6. [DOI: 10.1016/j.joen.2016.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/15/2015] [Accepted: 01/10/2016] [Indexed: 12/20/2022]
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Onay EO, Ungor M, Yazici AC. The evaluation of endodontic flare-ups and their relationship to various risk factors. BMC Oral Health 2015; 15:142. [PMID: 26577095 PMCID: PMC4647657 DOI: 10.1186/s12903-015-0135-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the incidence of flare-ups and identify the risk factors including age, gender, tooth type, number of root canals, initial diagnosis, the type of irrigation regimen, treatment modality and the number of visits, in patients who received root canal treatment from January 2002 to January 2008. METHODS Records of 1819 teeth belonging to 1410 patients treated by 1 endodontics specialist during 6-year period were kept. Patient, tooth, and treatment characteristics were evaluated and the relationships between these characteristics and flare-ups were studied. Statistical analysis was carried out by using Pearson Chi-square test, Fisher's Exact test, and Binary Logistic regression analyses. RESULTS The incidence of flare-ups was 59 (3.2 %) out of 1819 teeth that received endodontic therapy. Pulpal necrosis without periapical pathosis was the most common indication for flare-up (6 %) (p < 0.01). Teeth undergoing multiple visits had a higher risk of developing flare-ups compared to those with single appointments (OR: 3.14, CI: 1.414-7.009, p < 0.01). There were also no statistically significant differences in the incidence of flare-ups regarding to age, gender, tooth type, number of root canals, treatment modality, and the irrigation solutions that used during the treatment. CONCLUSIONS The incidence of flare-up is minimal when teeth are treated in one visit. Absence of a periapical lesion in necrotic teeth is a significant risk factor for flare-ups.
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Affiliation(s)
- Emel Olga Onay
- Department of Endodontics, Baskent University, School of Dentistry, 82 sok No 26, 06490, Bahcelievler, Ankara, Turkey.
| | - Mete Ungor
- Department of Endodontics, Baskent University, School of Dentistry, 82 sok No 26, 06490, Bahcelievler, Ankara, Turkey.
| | - A Canan Yazici
- Department of Biostatistics, Baskent University, School of Medicine, Ankara, Turkey.
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Toxicity of irrigating solutions and pharmacological associations used in pulpectomy of primary teeth. Int Endod J 2015; 49:746-54. [DOI: 10.1111/iej.12509] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 07/09/2015] [Indexed: 11/26/2022]
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Fahmy SH, El Gendy AAH, El Ashry SH. Dentin wettability enhancement for three irrigating solutions and their effect on push out bond strength of gutta percha / AH Plus. J Clin Exp Dent 2015; 7:e237-42. [PMID: 26155339 PMCID: PMC4483330 DOI: 10.4317/jced.51865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 01/25/2015] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study was to investigate the effect of wettability enhancement for 17% EDTA, 2.5% sodium hypochlorite and 7% maleic acid solutions on push out bond strength of gutta percha /AH Plus to root dentin. Material and Methods One hundred and eight extracted single rooted human lower premolars were instrumented up to Protaper Universal F5 then irrigated with 3ml of 2.5% NaOCl after each file. Irrigants were prepared and a pilot study for determination of Tween 80 concentration yielding the lowest surface tension value in every solution was conducted. Samples were randomly divided into a control group and two experimental groups (17% EDTA and 7% Maleate), further split into eight subgroups (n=12), according to Tween 80 implementation sequence. Roots were obturated using gutta percha and AH plus by lateral condensation. Bond strength was measured by push out test. Mode of failure was then evaluated quantitatively by stereomicroscopy. Data were statistically analyzed using one way ANOVA followed by Tukey-Kramer for multiple comparisons. Results Control group showed the lowest values. Maleic acid subgroups showed significantly higher overall values than EDTA subgroups (P<0.05). Protocols implementing surfactant containing NaOCl showed significantly lower values than plain counterparts. Failure pattern was predominantly cohesive for plain regimens and the ones implementing Tween 80 in maleic acid solutions with plain NaOCl. Conclusions Tween 80 addition to demineralizing irrigants increased the bond strength values. Surfactant containing NaOCl solutions yielded lower bond strength than plain ones. Key words:Wettability enhancement for three irrigants vs. corresponding gutta percha/AH Plus bonding.
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Affiliation(s)
- Sarah-Hossam Fahmy
- Assistant Lecturer at the Endodontic Department, Faculty of Dentistry, Ain Shams University
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Suman JM, Kuga MC, Da Rosa RA, Santini MF, Grazziotin-Soares R, Montagner F, Só MVR. Antibacterial activity of chlorhexidine after final irrigation with ethanol: CLSM and culture-based method analysis. Microsc Res Tech 2015; 78:682-7. [PMID: 26138134 DOI: 10.1002/jemt.22525] [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] [Received: 01/07/2015] [Revised: 04/30/2015] [Accepted: 05/01/2015] [Indexed: 11/07/2022]
Abstract
This study investigated the effect of 95% ethanol on the antibacterial properties of 2% chlorexidine (CHX) over monospecies biofilm (Enterococcus faecalis) through a culture-based method, and over multispecies biofilm using confocal laser scanning microscopy (CLSM). For monospecies model, E. faecalis biofilm was induced in 40 root canals. The irrigation procedures were: S-saline solution; S/CHX-saline solution + CHX; E-ethanol; and E/CHX-ethanol + CHX. Microbial sampling was performed at three periods: before (S1), immediately after (S2), and 72 h after the final flush (S3). For multispecies biofilm model, 28 sterilized bovine dentin blocks were fixed on a removable orthodontic device to allow intraoral biofilm development. Seven samples were used in each group. Statistical analysis was carried out by using the Kruskal-Wallis test and Dunn's test for multiple comparisons. There was a significant reduction in CFUs count immediately after the final flush (S2) in all experimental groups (P < 0.05). However, only S/CHX, E and E/CHX groups had CFU counts close to zero, without differences among them (P > 0.05). After 72h (S3), the S/CHX and E/CHX groups had CFU counts near zero (P > 0.05). The CFU count increased in S3 for S and E groups (P < 0.05). CLSM showed that the percentages of remaining live cells were similar in S/CHX, E, and E/CHX groups (P > 0.05). The S group had the highest percentage of live cells (P < 0.05). The 95% ethanol did not interfere in the antibacterial properties of 2% CHX over mono- and multispecies biofilms.
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Affiliation(s)
- Juliana Martins Suman
- Department of Conservative Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Milton Carlos Kuga
- Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Ricardo Abreu Da Rosa
- Department of Conservative Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Manuela Favarin Santini
- Department of Conservative Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Renata Grazziotin-Soares
- Department of Conservative Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Francisco Montagner
- Department of Conservative Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcus ViníCius Reis Só
- Department of Conservative Dentistry, Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Bharath MJ, Sahadev CK, Ramachandra PKM, Rudranaik S, George J, Thomas A. Comparative evaluation of four transport media for maintaining cell viability in transportation of an avulsed tooth - An in vitro study. J Int Soc Prev Community Dent 2015; 5:69-73. [PMID: 25767771 PMCID: PMC4355854 DOI: 10.4103/2231-0762.151981] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The study was performed to compare and evaluate the efficacy of four experimental storage media (Hank's balanced salt solution, Ringer's lactate solution, tender coconut water, and green tea extract) for maintaining cell viability of human periodontal cells at different time intervals of 15 min 30 min, 60 min, and 90 min. MATERIALS AND METHODS Human periodontal cells were cultured and stored in the four media. After 15 min 30 min, 60 min, and 90 min, the different media were examined under optical microscope and viabilities analyzed using an optical calorimeter. Mean and standard deviation were estimated from the results that were statistically analyzed using one-way analysis of variance (ANOVA) to identify the significant groups. RESULTS The results indicated that there was no difference in cell viability between the four media up to a period of 60 min, whereas green tea extract showed a lower cell viability after 90 min. CONCLUSION Within the limitations of the present study, it appears that due to superior osmolality, cost effectiveness, and easier availability, Ringer's lactate, tender coconut water, and green tea extract can be used as alternate storage media for avulsed tooth.
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Affiliation(s)
- Makonahalli Jaganath Bharath
- Department of Conservative Dentistry and Endodontics, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India
| | | | | | - Sandeep Rudranaik
- Department of Conservative Dentistry and Endodontics, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India
| | - Jijo George
- Department of Conservative Dentistry and Endodontics, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India
| | - Ashna Thomas
- Orthodontist, Private Practitioner, Jijos Dental Clinic, 15/F, T.D.K. Road, Coonoor, Niligiris, Tamil Nadu, India
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Patil P, Aminoshariae A, Harding J, Montagnese TA, Mickel A. Determination of mutagenicity of the precipitate formed by sodium hypochlorite and chlorhexidine using the Ames test. AUST ENDOD J 2015; 42:16-21. [DOI: 10.1111/aej.12100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Pranali Patil
- Department of Endodontics; Case School of Dental Medicine; Cleveland Ohio USA
| | - Anita Aminoshariae
- Department of Endodontics; Case School of Dental Medicine; Cleveland Ohio USA
| | - Jarrod Harding
- Department of Biostatistics; Case Western Reserve University; Cleveland Ohio USA
| | - Thomas A Montagnese
- Department of Endodontics; Case School of Dental Medicine; Cleveland Ohio USA
| | - Andre Mickel
- Department of Endodontics; Case School of Dental Medicine; Cleveland Ohio USA
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Evaluation of Effectiveness of Various Irrigating Solutions on Removal of Calcium Hydroxide Mixed with 2% Chlorhexidine Gel and Detection of Orange-brown Precipitate after Removal. J Endod 2014; 40:1820-3. [DOI: 10.1016/j.joen.2014.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 05/29/2014] [Accepted: 06/02/2014] [Indexed: 11/23/2022]
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Kolosowski KP, Sodhi RNS, Kishen A, Basrani BR. Qualitative analysis of precipitate formation on the surface and in the tubules of dentin irrigated with sodium hypochlorite and a final rinse of chlorhexidine or QMiX. J Endod 2014; 40:2036-40. [PMID: 25305239 DOI: 10.1016/j.joen.2014.08.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Interaction of sodium hypochlorite (NaOCl) mixed with chlorhexidine (CHX) produces a brown precipitate containing para-chloroaniline (PCA). When QMiX is mixed with NaOCl, no precipitate forms, but color change occurs. The aim of this study was to qualitatively assess the formation of precipitate and PCA on the surface and in the tubules of dentin irrigated with NaOCl, followed either by EDTA, NaOCl, and CHX or by saline and QMiX by using time-of-flight secondary ion mass spectrometry (TOF-SIMS). METHODS Dentin blocks were obtained from human maxillary molars, embedded in resin, and cross-sectioned to expose dentin. Specimens in group 1 were immersed in 2.5% NaOCl, followed by 17% EDTA, 2.5% NaOCl, and 2% CHX. Specimens in group 2 were immersed in 2.5% NaOCl, followed by saline and QMiX. The dentin surfaces were subjected to TOF-SIMS spectra analysis. Longitudinal sections of dentin blocks were then exposed and subjected to TOF-SIMS analysis. All samples and analysis were performed in triplicate for confirmation. RESULTS TOF-SIMS analysis of group 1 revealed an irregular precipitate, containing PCA and CHX breakdown products, on the dentin surfaces, occluding and extending into the tubules. In TOF-SIMS analysis of group 2, no precipitates, including PCA, were detected on the dentin surface or in the tubules. CONCLUSIONS Within the limitations of this study, precipitate containing PCA was formed in the tubules of dentin irrigated with NaOCl followed by CHX. No precipitates or PCA were detected in the tubules of dentin irrigated with NaOCl followed by saline and QMiX.
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Affiliation(s)
- Kamil P Kolosowski
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Rana N S Sodhi
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada
| | - Anil Kishen
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Bettina R Basrani
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada.
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Oliveira JS, Raucci Neto W, Faria NSD, Fernandes FS, Miranda CES, Rached-Junior FJA. Quantitative Assessment of Root Canal Roughness with Calcium-Based Hypochlorite Irrigants by 3D CLSM. Braz Dent J 2014; 25:409-15. [DOI: 10.1590/0103-6440201302433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 09/19/2014] [Indexed: 11/22/2022] Open
Abstract
Chemical solutions play important roles in endodontic treatment and promote ultrastructural changes in dentin surface. The aim of this study was to quantify root canal roughness at different concentrations of calcium hypochlorite (Ca(OCl)2) and sodium hypochlorite (NaOCl) by confocal laser scanning microscopy (CLSM). Fifty-two human mandibular premolars were sectioned and randomly organized into thirteen groups (n=8): saline (control); 1%, 2.5% and 5% NaOCl; 1%, 2.5% and 5% Ca(OCl)2; the hypochlorite groups were further divided into with or without EDTA. The chlorine concentrations of the different solutions were measured by iodine titration (%). The superficial roughness (Sa) was quantified by CLSM. Ca(OCl)2 presented substantial decrease in chlorine concentration that differed from the package indication, but without compromising the dentin ultrastructure changes. There were no significant differences in dentin roughness between Ca(OCl)2 or NaOCl at all studied concentrations. The combination with EDTA provided similar roughness values among the solutions (p>0.05). The 5% Ca(OCl)2 and NaOCl solutions significantly increased dentin roughness and did not differ from the EDTA association (p>0.05). Ca(OCl)2 promoted similar dentin roughness as the NaOCl at the same concentrations and combined with EDTA. It may be concluded that Ca(OCl)2 modified the root canal dentin roughness similarly to NaOCl, at the same concentrations and EDTA combinations used in this study. Ca(OCl)2 and NaOCl, both at 5%, significantly altered dentin roughness, overcoming EDTA association, thus Ca(OCl)2 concentrations ranging from 1% to 2.5% may be suitable solutions for root canal irrigation protocols.
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Magro MG, Kuga MC, Aranda-Garcia AJ, Victorino KR, Chávez-Andrade GM, Faria G, Keine KC, Só MVR. Effectiveness of several solutions to prevent the formation of precipitate due to the interaction between sodium hypochlorite and chlorhexidine and its effect on bond strength of an epoxy-based sealer. Int Endod J 2014; 48:478-83. [DOI: 10.1111/iej.12337] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M. G. Magro
- Department of Restorative Dentistry; Araraquara Dental School; UNESP - Univ Estadual Paulista; Araraquara PS Brazil
| | - M. C. Kuga
- Department of Restorative Dentistry; Araraquara Dental School; UNESP - Univ Estadual Paulista; Araraquara PS Brazil
| | - A. J. Aranda-Garcia
- Department of Restorative Dentistry; Araraquara Dental School; UNESP - Univ Estadual Paulista; Araraquara PS Brazil
| | - K. R. Victorino
- Department of Restorative Dentistry; Araraquara Dental School; UNESP - Univ Estadual Paulista; Araraquara PS Brazil
| | - G. M. Chávez-Andrade
- Department of Restorative Dentistry; Araraquara Dental School; UNESP - Univ Estadual Paulista; Araraquara PS Brazil
| | - G. Faria
- Department of Restorative Dentistry; Araraquara Dental School; UNESP - Univ Estadual Paulista; Araraquara PS Brazil
| | - K. C. Keine
- Department of Restorative Dentistry; Araraquara Dental School; UNESP - Univ Estadual Paulista; Araraquara PS Brazil
| | - M. V. R. Só
- Department of Restorative Dentistry; Rio Grande do Sul Federal University; Porto Alegre RS Brazil
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Tartari T, Guimarães BM, Amoras LS, Duarte MAH, Silva e Souza PAR, Bramante CM. Etidronate causes minimal changes in the ability of sodium hypochlorite to dissolve organic matter. Int Endod J 2014; 48:399-404. [DOI: 10.1111/iej.12329] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/31/2014] [Indexed: 11/29/2022]
Affiliation(s)
- T. Tartari
- Department of Endodontics; Dental School of Bauru; University of São Paulo; Bauru SP Brazil
| | - B. M. Guimarães
- Department of Endodontics; Dental School of Bauru; University of São Paulo; Bauru SP Brazil
| | - L. S. Amoras
- Department of Endodontics; Dental School; Federal University of Pará; Belém PA Brazil
| | - M. A. H. Duarte
- Department of Endodontics; Dental School of Bauru; University of São Paulo; Bauru SP Brazil
| | | | - C. M. Bramante
- Department of Endodontics; Dental School of Bauru; University of São Paulo; Bauru SP Brazil
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Abi-Rached GPC, Herrera DR, Zaia AA, Ferraz CCR, Almeida JFA, Gomes BPFA. Efficacy of ethylene-diamine-tetra-acetic acid associated with chlorhexidine on intracanal medication removal: a scanning electron microscopy study. Microsc Res Tech 2014; 77:735-9. [PMID: 24941937 DOI: 10.1002/jemt.22395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/29/2014] [Accepted: 06/06/2014] [Indexed: 11/07/2022]
Abstract
The aim of this study was to evaluate the effectiveness of 17% ethylene-diamine-tetra-acetic acid (EDTA) used alone or associated with 2% chlorhexidine gel (CHX) on intracanal medications (ICM) removal. Sixty single-rooted human teeth with fully formed apex were selected. The cervical and middle thirds of each canal were prepared with Gates Glidden drills and rotary files. The apical third was shaped with hand files. The specimens were randomly divided into two groups depending on the ICM used after instrumentation: calcium hydroxide Ca(OH)(2) +CHX or Ca(OH)(2) +sterile saline (SS). After seven days, each group was divided into subgroups according to the protocol used for ICM removal: instrumentation and irrigation either with EDTA, CHX+EDTA, or SS (control groups). All specimens were sectioned and processed for observation of the apical thirds by using scanning electron microscopy. Two calibrated evaluators attributed scores to each specimen. The differences between the protocols for ICM removal were analyzed with Kruskal-Wallis and Mann-Whitney U tests. Friedman and Wilcoxon signed rank tests were used for comparison between the score of debris obtained in each root canal third. Remains of Ca(OH)(2) were found in all specimens independently of the protocol and ICM used (P > 0.05). Seventeen percent EDTA showed the best results in removing ICM when used alone (P < 0.05), particularly in those associated with CHX. It was concluded that the chelating agent 17% EDTA significantly improved the removal of ICM when used alone. Furthermore, the type of the vehicle associated with Ca(OH)(2) also plays a role in the ICM removal.
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Affiliation(s)
- Giselle P C Abi-Rached
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, SP, Brazil
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Barrios R, Ferrer-Luque CM, Arias-Moliz MT, Ruiz-Linares M, Bravo M, Baca P. Antimicrobial substantivity of alexidine and chlorhexidine in dentin. J Endod 2013; 39:1413-5. [PMID: 24139264 DOI: 10.1016/j.joen.2013.07.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The use of irrigating solutions with long-lived activity helps to avoid failure of endodontic therapy. The aim of the present study was to evaluate and compare the antimicrobial substantivity against Enterococcus faecalis by using as carrier a dentin-volumetric unit exposed to chlorhexidine (CHX) and alexidine (ALX). METHODS Standardized dentin blocks of human molars were treated for 1 minute with 0.5% CHX, 2% CHX, 1% ALX, and 2% ALX. They were exposed to E. faecalis in suspension to determine antimicrobial substantivity during a period of 80 days. Results were analyzed by means of Kaplan-Meier survival analysis (P < .05). RESULTS ALX obtained the best results, with differences that were significantly different from CHX regardless of the concentration. Although all the samples treated with CHX were contaminated at the end of the study period, a direct relationship was seen between concentration and survival time. There was no statistically significant difference between 2% and 1% ALX. CONCLUSIONS The present study shows that 2% and 1% ALX used for 1 minute provide longer antimicrobial substantivity against E. faecalis than CHX when applied to 2% and 0.5%.
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Affiliation(s)
- Rocío Barrios
- Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain.
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