Qualitative Time-of-Flight Secondary Ion Mass Spectrometry Analysis of Root Dentin Irrigated with Sodium Hypochlorite, EDTA, or Chlorhexidine

Can Heated Distilled Water Effectively Prevent Precipitate Formation between NaOCl and CHX?

Introduction

The present study aimed to investigate the capacity of different irrigation protocols using heated distilled water at 65°C (HDW), in preventing the formation of the brown-orange precipitate observed after the interaction between sodium hypochlorite (NaOCl) and chlorhexidine (CHX).

Methods

Forty human canines were selected, prepared, and cleaved in two halves. Images of delimited areas in each root canal thirds were obtained through a stereomicroscope (16x and 40x). After reassembly, the teeth were distributed into four groups (n = 10) according to the final irrigation protocol: G1 (no HDW): EDTA + NaOCl + CHX with conventional irrigation (CI); G2 (HDW + CI): EDTA with passive ultrasonic irrigation (PUI) + NaOCl (PUI) + HDW (CI) + CHX (PUI); G3 (HDW + PUI): EDTA + NaOCl + HDW + CHX with PUI; G4 (HDW + CUI): EDTA (PUI) + NaOCl (PUI) + HDW with continuous ultrasonic irrigation (CUI) + CHX (PUI). After irrigation, the teeth were re-separated and images of the same delimited areas were obtained again. Scores were assigned according to the amount of precipitate observed, comparing the initial and final images. The data were submitted to Kruskal-Wallis, Dunn and Friedman statistical tests (α = 5%).

Results

G1(no HDW) showed the highest scores in the analysis between groups (p < 0.001), with a greater amount of precipitate in the cervical and medium thirds (p < 0.001). The thirds of the other experimental groups did not differ from each other (p > 0.05).

Conclusion

The intermediate irrigation with heated distilled water at 65°C prevented the formation of brown-orange precipitate, regardless of the use of ultrasonic activation (PUI or CUI).

A Comparative ex-vivo Study of Effects of Different Irrigation Protocols with/without Laser Activation on the Root Dentine's Micro-Hardness

Objective

To compare the effects of different irrigation protocols, with/without laser activation, on the radicular dentine's micro-hardness.

Methods

Eighty-two human extracted premolars were decoronated and divided into 7 groups. Roots were longitudinally split into two halves. The micro-hardness was measured for one half before and after irrigation protocols. The groups were; G1: MTAD without laser-activation, G2: MTAD with laser-activation, G3: sodium-hypochlorite (SH) with laser-activation, G4: SH then EDTA with laser-activation, G5: SH then MTAD with laser-activation, G6: SH without laser-activation. G7: distilled water (control). In the two-irrigants groups G4 and G5), samples were irrigated first with SH then with MTAD or EDTA irrigants, which were activated by the laser. The difference between the before- and after-irrigation micro-hardness was calculated to obtain the micro-hardness difference. Data were analyzed using the Paired Sample-t and Two-ways ANOVA tests at P=0.05.

Results

Overall, the mean dentine's micro-hardness after-irrigation (103.1) was lower than before-irrigation (116.1) (P<0.001); except for the distilled-water group, (116.6 and 112.9, respectively) (P=0.075). The micro-hardness reduction of SH without laser-activation group (32.5) was the greatest (P<0.001). The single-irrigant or laser-activation irrigation protocols caused significantly less micro-hardness reduction compared to the two-irrigants or no laser-activation protocols. The mean micro-hardness reduction of SH and MTAD groups (both with laser-activation) (5.8 and 9.3, respectively) were significantly lower than other groups, but not from that of the control group (3.7).

Conclusion

Using irrigants significantly reduced the root-dentine's micro-hardness. Although irrigants agitation by an Er: Yag laser significantly minimized micro-hardness reduction, it did not suppress the adverse effects on dentine micro-hardness when two-irrigants were used.

Effects of Different Irrigation Solutions and Protocols on Mineral Content and Ultrastructure of Root Canal Dentine

Introduction

The aim of this study was to evaluate the effect of different irrigating solutions and irrigation protocols on the chemical and physical structure of root dentin.

Materials and Methods

Thirty extracted single-rooted human teeth were selected and then distributed into the following treatment groups (n=10): G1, saline solution (0.9% NaCl); G2, 2.5% NaOCl + 17% EDTA + 2.5% NaOCl; G3, 2.5% NaOCl + 9% Etidronate (HEBP) + 2.5% NaOCl; G4, mixture of 5% NaOCl + 18% HEBP; G5, 2.5% NaOCl + 17% EDTA + 0.9% NaCl, and G6, 2.5% NaOCl + 9% HEBP + 0.9% NaCl. The ultrastructure of dentin was characterized through scanning electron microscopy (SEM) and energy dispersive x-ray spectrometry (EDS) determined the chemical composition in terms of the calcium (Ca), phosphorus (P), magnesium (Mg) and potassium (K) content and the Ca/P ratio; and the crystalline phase was analyzed by x-ray diffraction (XRD). A descriptive analysis was performed on the ultrastructure and the crystallography data of dentin. Data analysis included a chemical composition analysis of variance (one-way ANOVA) and a subsequent multiple comparison test (Tukey's test).

Results

Except for the control group, all groups showed morphological changes upon visualization with SEM. For EDS, G2 and G5 showed significant mineral loss and changes in the Ca/P ratio (P<0.05); the highest values of Ca and P were observed in G3, G4 and G6.

Conclusion

All the irrigating solutions and irrigation protocols tested promoted changes in the morphology and physical and chemical composition of the dentin. However, no significant differences were observed crystallographically.

Root canal irrigants influence the hydrophobicity and adherence of Staphylococcus epidermidis to root canal dentin: an in vitro study

Objectives

To determine the effect of root canal irrigants on the hydrophobicity and adherence of Staphylococcus epidermidis (S. epidermidis) to root canal dentin in vitro.

Materials and Methods

Root dentin blocks (n = 60) were randomly divided into 4 groups based on the irrigation regimen: group 1, saline; group 2, 5.25% sodium hypochlorite (NaOCl); group 3, 5.25% NaOCl followed by 17% ethylenediaminetetraacetic acid (EDTA); group 4, same as group 3 followed by 2% chlorhexidine (CHX). The hydrophobicity of S. epidermidis to root dentin was calculated by cell surface hydrophobicity while the adherence was observed by fluorescence microscopy, and bacteria were quantified using ImageJ software (National Institutes of Health). Statistical analysis of the data was done using Kruskal-Wallis test and Mann-Whitney U test (p = 0.05).

Results

The hydrophobicity and adherence of S. epidermidis to dentin were significantly increased after irrigating with group 3 (NaOCl-EDTA) (p < 0.05), whereas in group 4 (NaOCl-EDTA-CHX) both hydrophobicity and adherence were significantly reduced (p < 0.05).

Conclusions

The adherence of S. epidermidis to dentin was influenced differently by root canal irrigants. Final irrigation with CHX reduces the bacterial adherence and may impact biofilm formation.

Effect of application time of maleic acid on smear layer removal and mechanical properties of root canal dentin

OBJECTIVES

To evaluate the effect of maleic acid (MA) on the cleaning efficacy and mechanical properties of root canal dentine with respect to different time exposure.

MATERIALS AND METHODS

One hundred and eighty single-canal premolars were instrumented with rotary-files and then randomly assigned to test groups receiving 7% MA for 30 s, 45 s, 1 min, or 3 min or to control groups treated with 0.9% saline or 17% ethylenediaminetetraacetic acid for 45 s. The micro-hardness, nano-hardness and elastic modules were measured before and after treatment, while the amount of smear and erosion in the coronal, middle and apical thirds in root canal were evaluated by scanning electron microscopy, finally, the fracture strength was assessed by vertical root fracture testing.

RESULTS

The efficacy of smear layer removal increased with increasing MA application time. The largest effect was observed at 45 s, even in the apical third, whereas the treatment for 1 min resulted in irreversible erosion of the dentine surface. The micro-hardness and nano-indentation testing confirmed that the micro- and nano-scale mechanical properties were significantly decreased after MA application for 1 min. Furthermore, the specimens treated with MA for 3 min presented the lowest fracture resistance among all groups. In contrast, the 45 s treatment appeared to increase the fracture resistance of the tooth.

CONCLUSIONS

The cleaning efficacy and mechanical properties of root canal dentine varied with MA exposure time. The application of MA for 45 s was found to be the most promising for clinical use.