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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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Ballal NV, Narkedamalli R, Gandhi P, Arias-Moliz MT, Baca P, Das S, Varghese J, Gaonkar SL, Rao BSS, Frazier J, Bergeron BE, Tay FR. Biological and Chemical Properties of 2-in-1 Calcium-chelating and Antibacterial Root Canal Irrigants. J Dent 2023; 134:104526. [PMID: 37100165 DOI: 10.1016/j.jdent.2023.104526] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 04/28/2023] Open
Abstract
OBJECTIVES To evaluate the capacity of canal wall smear layer removal, precipitation caused by irrigant interaction, antibacterial activity and cytotoxicity of three 2-in-1 root canal irrigating solutions METHODS: Forty single-rooted teeth were mechanically instrumented and irrigated with QMix, SmearOFF, Irritrol or 0.9% saline. Each tooth was evaluated for smear layer removal using scanning electron microscopy. Precipitation after interaction of the irrigating solutions with sodium hypochlorite (NaOCl) was evaluated with 1H nuclear magnetic resonance and mass spectroscopy. Confocal laser scanning microscopy was used to evaluate the antimicrobial activity of the irrigants against Enterococcus faecalis biofilms. Neutral red and clonogenic assays were performed on Chinese hamster V79 cells to evaluate the short-term and long-term cytotoxicity of the irrigants RESULTS: There was no significant difference between QMix and SmearOFF in eliminating smear layers from the coronal-third and middle-third of the canal spaces. In the apical-third, SmearOFF removed smear layers effectively. Irritrol incompletely removed smear layers from all the canal-thirds. When mixed with NaOCl, precipitation was evident only with Irritrol. QMix demonstrated a higher E. faecalis cell death percentage and a smaller biovolume. SmearOFF exhibited a larger decrease in biovolume compared with Irritrol, although Irritrol had a higher death percentage. Irritrol was more cytotoxic than the other irrigants on a short-term interval. In terms of long-term cytotoxicity, both Irritrol and QMix were cytotoxic CONCLUSION: QMix and SmearOFF performed better in smear layer removal and antimicrobial activity. QMix and Irritrol were cytotoxic when compared to SmearOFF. Irritrol was associated with precipitation after interacting with NaOCl.
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Affiliation(s)
- Nidambur Vasudev Ballal
- Department of Conservative Dentistry & Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajkumar Narkedamalli
- Department of Conservative Dentistry & Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Poornika Gandhi
- Department of Conservative Dentistry & Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Maria Teresa Arias-Moliz
- Department of Microbiology, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pilar Baca
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Department of Stomatology, University of Granada, Granada, Spain
| | - Shubhankar Das
- Department of Radiation Biology and Toxicology, School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jothi Varghese
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Santosh Laxman Gaonkar
- Department of Chemistry, Manipal Institute of Technology, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bola Sadashiva Satish Rao
- Department of Radiation Biology and Toxicology, School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Joshua Frazier
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian E Bergeron
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, GA, USA.
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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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Gelio MB, Ramos ATPR, Zaniboni JF, Escalante-Otárola WG, Besegato JF, Kuga MC. Effect of irrigation protocols on chemical smear layer formation over the post-space dentin. Microsc Res Tech 2022; 85:3005-3013. [PMID: 35535716 DOI: 10.1002/jemt.24149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/10/2022] [Accepted: 05/01/2022] [Indexed: 11/12/2022]
Abstract
This study evaluated the effect of irrigation protocols using 95% ethanol (ET) or 1% peracetic acid (PA) prior the use of 2% chlorhexidine (CHX) compared to distilled water (DW) on the chemical smear layer (CSL) formation and incidence of open dentin tubules at the apical, medium, and cervical third of the post-space dentin. Scanning electron microscopy (SEM) and electron dispersive spectroscopy (EDS) images were used. Forty bovine roots were endodontically treated. After, post-space preparation was performed and the roots were randomized in four groups (n = 10) according to the irrigation protocol: DW, CHX, CHX-ET and CHX-PA. The chemical composition of CSL and the incidence of open dentin tubules at the post-space thirds were evaluated by EDS (500× magnification) and SEM (2000× magnification) images, respectively. Data from chemical composition of CSL were descriptively analyzed, while the incidence of open dentin tubules was evaluated by scores and submitted to Kruskal-Wallis and Dunn test (p = .05). Cl, Bi, and Si were the chemical elements most found over the dentin after the irrigation with CHX and CHX-ET. Moreover, CHX and CHX-ET showed the highest incidence of CSL (p < .05), but without difference between them (p > .05), regardless of the post-space third. DW and CHX-PA showed similar incidence of CSL (p > .05). No difference on the incidence of open dentin tubules was found for any irrigation protocol and post-space third (p > .05). The use of 1% PA prior the post-space irrigation with CHX decrease the incidence of CSL. RESEARCH HIGHLIGHTS: The post-space irrigation with chlorhexidine results in the formation of chemical smear layer. Ethanol is not capable to remove the chemical smear layer. Peracetic acid is more effective to remove the chemical smear layer.
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Affiliation(s)
- Mariana Bena Gelio
- Department of Restorative Dentistry, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | | | - Joissi Ferrari Zaniboni
- Department of Restorative Dentistry, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | | | - João Felipe Besegato
- Department of Restorative Dentistry, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Milton Carlos Kuga
- Department of Restorative Dentistry, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
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ToF-SIMS Analysis of Demineralized Dentin Biomodified with Calcium Phosphate and Collagen Crosslinking: Effect on Marginal Adaptation of Class V Adhesive Restorations. MATERIALS 2021; 14:ma14164535. [PMID: 34443059 PMCID: PMC8398264 DOI: 10.3390/ma14164535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/05/2022]
Abstract
This study aimed to assess the effect of biomodification before adhesive procedures on the tooth-restoration interface of class V restorations located in caries-simulated vs. sound dentin, and the quality of dentin surface by time-of-flight secondary ion mass spectrometry (ToF-SIMS). Class V cavities located on cervical dentin were prepared on the buccal surfaces of extracted human molars under the simulation of intratubular fluid flow. Two dentin types, i.e., sound and demineralized by formic-acid, were biomodified with 1% riboflavin and calcium phosphate (CaP) prior to the application of a universal adhesive (Clearfil Universal Bond) in etch and rinse or self-etch mode, and a conventional micro hybrid composite (Clearfil APX). Restorations were subjected to thermo mechanical fatigue test and percentages of continuous margins (% CM) before/after fatigue were compared. Bio modification of dentin surfaces at the molecular level was analyzed by Time-of-Flight Secondary Mass Spectometry (ToF-SIMS). % CM were still significantly higher in tooth-restoration interfaces on sound dentin. Meanwhile, biomodification with riboflavin and CaP had no detrimental effect on adhesion and in carious dentin, it improved the % CM both before and after loading. Etching carious dentin with phosphoric acid provided with the lowest results, leading even to restoration loss. The presence of molecule fragments of riboflavin and CaP were detected by ToF-SIMS, evidencing dentin biomodification. The adhesive interface involving carious dentin could be improved by the use of a collagen crosslinker and CaP prior to adhesive procedures.
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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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Wu D, Ma YZ, Jia J, Xin BC, Wang DS, Sun DG, Wang LX. Removal of the root canal smear layer using Carisolv III and sodium hypochlorite. Medicine (Baltimore) 2020; 99:e20372. [PMID: 32481420 DOI: 10.1097/md.0000000000020372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present study investigated the effectiveness of a Carisolv III + 0.5% sodium hypochlorite (NaOCl)-based root canal irrigant for smear layer removal.Forty maxillary incisors were randomly divided into 4 groups (n = 10 per group). The canals in group A (experimental) were prepared with 0.5% NaOCl, and Carisolv III and 0.5% NaOCl was used for the final washing; groups B and C (positive controls) used 2% and 5.25% NaOCl, respectively; and group D (negative control) used phosphate-buffered saline (PBS). Ethylenediaminetetraacetic acid (EDTA) was used for all of the groups. A 5-point scoring scale and scanning electron microscopy were used to evaluate the effectiveness of the irrigants. The canals were consistently cleaner in the coronal and middle thirds than in the apical thirds (P < .05).For cleaning the root canals, 5.25% NaOCl was more effective than 2% NaOCl, 0.5% NaOCl + Carisolv III, and phosphate-buffered saline , respectively (P < .05). The 2% NaOCl solution showed similar results to 0.5% NaOCl + Carisolv III (P > .05). The combination of 5.25% NaOCl and 17% EDTA remains the most effective irrigant for removal of the root canal smear layer.A combination of Carisolv III + 0.5% NaOCl (with 17% EDTA) showed a cleaning ability similar to that of 2% NaOCl (with 17% EDTA).
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Affiliation(s)
- Di Wu
- Department of Cariology and Endodontology, Qingdao Stomatological Hospital, Qingdao
| | - Yong-Zhen Ma
- Department of Stomatology, Tai'an City Central Hospital, Tai'an
| | - Jing Jia
- Department of Stomatology, Tai'an City Central Hospital, Tai'an
| | - Bing-Chang Xin
- Department of Cariology and Endodontology, Qingdao Stomatological Hospital, Qingdao
| | - Da-Shan Wang
- Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - De-Gang Sun
- Department of Cariology and Endodontology, Qingdao Stomatological Hospital, Qingdao
| | - Ling-Xiang Wang
- Department of Cariology and Endodontology, Qingdao Stomatological Hospital, Qingdao
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Kukreti H, Li FC, Singh K, Sodhi R, Kishen A. Efficacy of bioactive nanoparticles on tissue-endotoxin induced suppression of stem cell viability, migration and differentiation. Int Endod J 2020; 53:859-870. [PMID: 32068891 DOI: 10.1111/iej.13283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 12/22/2022]
Abstract
AIM To characterize a lipopolysaccharide (LPS)-treated dentine tissue model (LPS dentine) to analyse the efficacy of polycationic chitosan nanoparticles (CSnp) and/or dexamethasone conjugate chitosan nanoparticles (Dex-CSnp) on the viability/differentiation potential of stem cells from apical papilla (SCAP) when exposed to LPS dentine. A further aim was to understand the effect of macrophage-dependent inflammation on SCAP migration in the presence of LPS dentine. METHODOLOGY A total of 88 dentine slabs were used. TOF-SIMS analysis was performed amongst the LPS-treated and untreated dentine groups (n = 2/group). The study was conducted using four dentine groups: no treatment (control); LPS treatment only; LPS treatment followed by CSnp conditioning; and LPS treatment followed by Dex-CSnp conditioning groups. SCAP adherence, viability, differentiation and biomineralization potential on dentine from different groups were studied using fluorescent and scanning electron microscopy. Inflammation by macrophages in response to LPS dentine was quantified, and effect on SCAP migration was analysed. Statistical analysis was performed using Student's t-test with a significance level of P < 0.05. RESULT TOF-SIMS analysis confirmed LPS contamination. LPS dentine affected SCAP viability but not adherence to dentine (P < 0.001). Conditioning of LPS dentine with either nanoparticles improved SCAP viability (P < 0.01) and rescued other LPS related adverse effects on SCAPs, such as F-actin disruption, decrease in differentiation/biomineralization potential. IL-6 produced by macrophages in response to LPS-treated dentine impeded SCAP migration (P < 0.001), diminished on CSnp and Dex-CSnp conditioning groups (P < 0.01). CONCLUSION This study developed an LPS-dentine model and highlighted the ability of CSnp and Dex-CSnp to promote stem cell viability, migration, differentiation potential and reduce inflammation, providing an environment conducive for tissue regeneration/repair.
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Affiliation(s)
- H Kukreti
- Faculty of Dentistry, Dental Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - F-C Li
- Faculty of Dentistry, Dental Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - K Singh
- Faculty of Dentistry, Dental Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - R Sodhi
- Ontario Centre for the Characterization of Advanced Materials (OCCAM), Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - A Kishen
- Faculty of Dentistry, Dental Research Institute, University of Toronto, Toronto, Ontario, Canada
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Arslan H, Karataş E, Keskin A. Response to the letter: 'Comments on misinterpretation of the proton nuclear magnetic resonance spectroscopic data of a previous study' by Orhan&Irmak. Int Endod J 2020; 53:285-286. [PMID: 31917483 DOI: 10.1111/iej.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Arslan
- Department of Endodontics, Faculty of Dentistry, Istanbul Health Sciences University, Istanbul, Turkey.,Department of Endodontics, Faculty of Dentistry, Eastern Mediterranean University, Famagusta, Turkey
| | - E Karataş
- Department of Endodontics, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - A Keskin
- Eti Krom Research&Development Center, Elazığ, Turkey
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Hashmi A, Sodhi RN, Kishen A. Interfacial Characterization of Dentin Conditioned with Chitosan Hydroxyapatite Precursor Nanocomplexes Using Time-of-flight Secondary Ion Mass Spectrometry. J Endod 2019; 45:1513-1521. [DOI: 10.1016/j.joen.2019.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 08/13/2019] [Accepted: 08/24/2019] [Indexed: 10/25/2022]
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Eachempati P, Kumbargere Nagraj S, Kiran Kumar Krishanappa S, Gupta P, Yaylali IE. Home-based chemically-induced whitening (bleaching) of teeth in adults. Cochrane Database Syst Rev 2018; 12:CD006202. [PMID: 30562408 PMCID: PMC6517292 DOI: 10.1002/14651858.cd006202.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND With the increased demand for whiter teeth, home-based bleaching products, either dentist-prescribed or over-the-counter products have been exponentially increasing in the past few decades. This is an update of a Cochrane Review first published in 2006. OBJECTIVES To evaluate the effects of home-based tooth whitening products with chemical bleaching action, dispensed by a dentist or over-the-counter. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 12 June 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library (searched 12 June 2018), MEDLINE Ovid (1946 to 12 June 2018), and Embase Ovid (1980 to 12 June 2018). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (12 June 2018) and the World Health Organization International Clinical Trials Registry Platform (12 June 2018) were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included in our review randomised controlled trials (RCTs) which involved adults who were 18 years and above, and compared dentist-dispensed or over-the-counter tooth whitening (bleaching) products with placebo or other comparable products.Quasi-randomised trials, combination of in-office and home-based treatments, and home-based products having physical removal of stains were excluded. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials. Two pairs of review authors independently extracted data and assessed risk of bias. We estimated risk ratios (RRs) for dichotomous data, and mean differences (MDs) or standardised mean difference (SMD) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 71 trials in the review with 26 studies (1398 participants) comparing a bleaching agent to placebo and 51 studies (2382 participants) comparing a bleaching agent to another bleaching agent. Two studies were at low overall risk of bias; two at high overall risk of bias; and the remaining 67 at unclear overall risk of bias.The bleaching agents (carbamide peroxide (CP) gel in tray, hydrogen peroxide (HP) gel in tray, HP strips, CP paint-on gel, HP paint-on gel, sodium hexametaphosphate (SHMP) chewing gum, sodium tripolyphosphate (STPP) chewing gum, and HP mouthwash) at different concentrations with varying application times whitened teeth compared to placebo over a short time period (from 2 weeks to 6 months), however the certainty of the evidence is low to very low.In trials comparing one bleaching agent to another, concentrations, application method and application times, and duration of use varied widely. Most of the comparisons were reported in single trials with small sample sizes and event rates and certainty of the evidence was assessed as low to very low. Therefore the evidence currently available is insufficient to draw reliable conclusions regarding the superiority of home-based bleaching compositions or any particular method of application or concentration or application time or duration of use.Tooth sensitivity and oral irritation were the most common side effects which were more prevalent with higher concentrations of active agents though the effects were mild and transient. Tooth whitening did not have any effect on oral health-related quality of life. AUTHORS' CONCLUSIONS We found low to very low-certainty evidence over short time periods to support the effectiveness of home-based chemically-induced bleaching methods compared to placebo for all the outcomes tested.We were unable to draw any conclusions regarding the superiority of home-based bleaching compositions or any particular method of application or concentration or application time or duration of use, as the overall evidence generated was of very low certainty. Well-planned RCTs need to be conducted by standardising methods of application, concentrations, application times, and duration of treatment.
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Affiliation(s)
- Prashanti Eachempati
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE)Department of ProsthodonticsJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Sumanth Kumbargere Nagraj
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE), ManipalDepartment of Oral Medicine and Oral RadiologyJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Salian Kiran Kumar Krishanappa
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE)Department of ProsthodonticsJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Puneet Gupta
- Government College of Dentistry, IndorePublic Health Dentistry1 Sardar Patel Marg.Opp M Y HospitalIndoreMadhya PradeshIndia452001
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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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Jiayi W, Ruijie H. [Research progress on QMix properties in root canal irrigation]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2017; 35:543-548. [PMID: 29188654 DOI: 10.7518/hxkq.2017.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mechanical instrumentation preparation alone is insufficient to completely remove root canal infection, and chemical irrigation is essential to eliminate infected remnants. An ideal root canal irrigant should completely remove the smear layer, lubricate the root canal, efficiently kill bacteria, induce mild or no inflammatory response in the tissues, and avoid damaging the dentin structure. However, a commercial irrigant that meets all these requirements is currently lacking. QMix is a root canal irrigation mixture of ethylenediamine tetraacetic acid (EDTA), chlorhexidine (CHX) and surfactant. This mixture can remove the smear layer efficiently, and it possesses strong antibacterial effect and good biocompatibility with minimal cytotoxicity. Furthermore, the influence of QMix on the color and micro-hardness of dentin is low, and it can improve the wettability of root canal sealant without affecting its adhesive properties. This review compares the efficiencies of QMix with other irrigants (sodium hypochlorite, CHX, EDTA, SmearClear, and MTAD) in term of smear layer removal, dentine and root canal sealing, cell cytotoxicity, and bacterial growth inhibition.
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Affiliation(s)
- Wu Jiayi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Huang Ruijie
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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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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Mirseifinejad R, Tabrizizade M, Davari A, Mehravar F. Efficacy of Different Root Canal Irrigants on Smear Layer Removal after Post Space Preparation: A Scanning Electron Microscopy Evaluation. IRANIAN ENDODONTIC JOURNAL 2017; 12:185-190. [PMID: 28512483 PMCID: PMC5431723 DOI: 10.22037/iej.2017.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction: Effective durable adhesion between post material and dentine using resin cements is essential for longevity of restoration. The aim of this in vitro study was to compare the effect of different irrigants on smear layer removal after post space preparation. Methods and Materials: A total of 75 extracted anterior human teeth were selected. The canals were instrumented by rotary system and then were filled. After preparing the post space, teeth were divided into 5 groups according to irrigants: 17% EDTA; 17% EDTA+2% CHX; 5.25% NaOCl; 17% EDTA+5.25% NaOCl; and saline. The canals were irrigated with 5 cc of each irrigants for 1 min. Specimens were examined with scanning electron microscopy (SEM). Hulsmann’s score was used for marking of smear layer removal at coronal, middle and apical thirds of post space. The data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. Results: The results revealed that subsequent use of 17% EDTA+5.25% NaOCl was more effective than the other groups in smear layer removal. No statistical difference was found among different levels of root canal within each group. Conclusion: It can be concluded that 17% EDTA+5.25% NaOCl could be an effective irrigant for smear layer removal after post space preparation.
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Affiliation(s)
- Rahele Mirseifinejad
- Operative Dentistry Department, Dental School, University of Shahid Sadughi, Yazd, Iran
| | - Mehdi Tabrizizade
- Department of Endodontics, Dental School, University of Shahid Sadughi, Yazd, Iran
| | - Abdolrahim Davari
- Operative Dentistry Department, Dental School, University of Shahid Sadughi, Yazd, Iran
| | - Fateme Mehravar
- Student, Dental School, University of Shahid Sadughi Yazd, Yazd, Iran
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Almhöjd US, Lingström P, Nilsson Å, Norén JG, Siljeström S, Östlund Å, Bernin D. Molecular Insights into Covalently Stained Carious Dentine Using Solid-State NMR and ToF-SIMS. Caries Res 2017; 51:255-263. [PMID: 28501859 DOI: 10.1159/000460828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 02/06/2017] [Indexed: 11/19/2022] Open
Abstract
Dyes currently used to stain carious dentine have a limited capacity to discriminate normal dentine from carious dentine, which may result in overexcavation. Consequently, finding a selective dye is still a challenge. However, there is evidence that hydrazine-based dyes, via covalent bonds to functional groups, bind specifically to carious dentine. The aim of this study was to investigate the possible formation of covalent bonds between carious dentine and 15N2-hydrazine and the hydrazine-based dye, 15N2-labelled Lucifer Yellow, respectively. Powdered dentine from extracted carious and normal teeth was exposed to the dyes, and the staining reactions were analysed using time-of-flight secondary ion mass spectrometry (ToF-SIMS), solid-state 13C-labelled nuclear magnetic resonance (NMR) and 15N-NMR spectroscopy. The results showed that 15N2-hydrazine and 15N2-labelled Lucifer Yellow both bind to carious dentine but not to normal dentine. It can thus be concluded that hydrazine-based dyes can be used to stain carious dentine and leave normal dentine unstained.
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Affiliation(s)
- Ulrica S Almhöjd
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Guneser MB, Dincer AN, Arslan D. Comparison of Conventional Syringe, CanalBrush, EndoActivator, Photon-Induced Photoacoustic Streaming, and Manual Instrumentation in Removing Orange-Brown Precipitate: An In Vitro Study. Photomed Laser Surg 2017; 35:311-316. [PMID: 28186862 DOI: 10.1089/pho.2016.4248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this in vitro study was to compare the various techniques for removing precipitate formed after irrigation with sodium hypochlorite (NaOCl) and chlorhexidine (CHX). BACKGROUND DATA It is still unclear whether different irrigant activation systems can effectively remove precipitate that is firmly attached to the root canal walls. METHODS Eighty-two extracted single-rooted human teeth were instrumented by using the ProTaper rotary system. The roots were irrigated with 5% NaOCl and then 2% CHX to form orange-brown precipitate on the root canal walls. The teeth were sectioned longitudinally, and the amount of precipitate on the canal walls was measured under a stereomicroscope at 15 × magnification before the root halves were reassembled. Then, conventional syringe irrigation (CSI), CanalBrush (CB), EndoActivator (EA) system, photon-induced photoacoustic streaming (PIPS), and manual instrumentation (MI) techniques were used to remove the precipitate, during which 5 mL of distilled water was used for 1 min. The amount of precipitate remaining on the canal walls was measured, and the percentage of precipitate removed was calculated. Data were analyzed by using the Kruskal-Wallis and Mann-Whitney U tests (p = 0.05). RESULTS All experimental groups contained residual precipitate. The precipitate was more effectively removed in the MI group than in the other groups (p < 0.05). The CB and EA groups showed better removal than the CSI and PIPS groups (p < 0.05), and there were no significant differences in removal between these latter two groups (p > 0.05). CONCLUSIONS None of the techniques used was able to completely remove the orange-brown precipitate from the root canal surfaces.
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Affiliation(s)
- Mehmet Burak Guneser
- Department of Endodontics, Faculty of Dentistry, Bezmialem Vakif University , Istanbul, Turkey
| | - Asiye Nur Dincer
- Department of Endodontics, Faculty of Dentistry, Bezmialem Vakif University , Istanbul, Turkey
| | - Dilara Arslan
- Department of Endodontics, Faculty of Dentistry, Bezmialem Vakif University , Istanbul, Turkey
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Thaha KA, Varma RL, Nair MG, Sam Joseph V, Krishnan U. Interaction between Octenidine-based Solution and Sodium Hypochlorite: A Mass Spectroscopy, Proton Nuclear Magnetic Resonance, and Scanning Electron Microscopy–based Observational Study. J Endod 2017; 43:135-140. [DOI: 10.1016/j.joen.2016.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
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Vemuri S, Kolanu SK, Varri S, Pabbati RK, Penumaka R, Bolla N. Effect of different final irrigating solutions on smear layer removal in apical third of root canal: A scanning electron microscope study. J Conserv Dent 2016; 19:87-90. [PMID: 26957801 PMCID: PMC4760023 DOI: 10.4103/0972-0707.173207] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The aim of this in vitro study is to compare the smear layer removal efficacy of different irrigating solutions at the apical third of the root canal. MATERIALS AND METHODS Forty human single-rooted mandibular premolar teeth were taken and decoronated to standardize the canal length to 14 mm. They were prepared by ProTaper rotary system to an apical preparation of file size F3. Prepared teeth were randomly divided into four groups (n = 10); saline (Group 1; negative control), ethylenediaminetetraacetic acid (Group 2), BioPure MTAD (Group 3), and QMix 2 in 1 (Group 4). After final irrigation with tested irrigants, the teeth were split into two halves longitudinally and observed under a scanning electron microscope (SEM) for the removal of smear layer. The SEM images were then analyzed for the amount of smear layer present using a three score system. STATISTICAL ANALYSIS Data are analyzed using the Kruskal-Wallis test and Mann-Whitney U-test. RESULTS Intergroup comparison of groups showed statistically significant difference in the smear layer removal efficacy of irrigants tested. QMix 2 in 1 is most effective in removal of smear layer when compared to other tested irrigants. CONCLUSION QMix 2 in 1 is the most effective final irrigating solution for smear layer removal.
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Affiliation(s)
- Sayesh Vemuri
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Sreeha Kaluva Kolanu
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Sujana Varri
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Ravi Kumar Pabbati
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Ramesh Penumaka
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - Nagesh Bolla
- Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
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Does Para-chloroaniline Really Form after Mixing Sodium Hypochlorite and Chlorhexidine? J Endod 2016; 42:455-9. [DOI: 10.1016/j.joen.2015.12.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/06/2015] [Accepted: 12/27/2015] [Indexed: 11/21/2022]
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Kolosowski KP, Sodhi RN, Kishen A, Basrani BR. Qualitative Time-of-Flight Secondary Ion Mass Spectrometry Analysis of Root Dentin Irrigated with Sodium Hypochlorite, EDTA, or Chlorhexidine. J Endod 2015; 41:1672-7. [DOI: 10.1016/j.joen.2015.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/17/2015] [Accepted: 06/22/2015] [Indexed: 11/29/2022]
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Vouzara T, Koulaouzidou E, Ziouti F, Economides N. Combined and independent cytotoxicity of sodium hypochlorite, ethylenediaminetetraacetic acid and chlorhexidine. Int Endod J 2015; 49:764-73. [DOI: 10.1111/iej.12517] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/29/2015] [Indexed: 11/29/2022]
Affiliation(s)
- T. Vouzara
- Department of Endodontology and Department of Operative Dentistry; School of Dentistry; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - E. Koulaouzidou
- Department of Endodontology and Department of Operative Dentistry; School of Dentistry; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - F. Ziouti
- Department of Endodontology and Department of Operative Dentistry; School of Dentistry; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - N. Economides
- Department of Endodontology and Department of Operative Dentistry; School of Dentistry; Aristotle University of Thessaloniki; Thessaloniki Greece
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