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Iandolo A, Pisano M, Buonavoglia A, Giordano F, Amato A, Abdellatif D. Traditional and Recent Root Canal Irrigation Methods and Their Effectiveness: A Review. Clin Pract 2023; 13:1059-1072. [PMID: 37736930 PMCID: PMC10514886 DOI: 10.3390/clinpract13050094] [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: 08/15/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023] Open
Abstract
According to contemporary dental standards, the primary goal of endodontic therapy is the chemo-mechanical cleaning of the complex root canal system. Watering root canals with approved solutions and activating them are essential parts of this operation. This review outlines various irrigant activation methods for root canal therapy. Specifically, a comparison among the methods of manual dynamic activation, sonics (subsonic, sonic, and ultrasonic), internal heating, and lasers, was conducted. The results in this work were gathered using Scopus, Web of Science, Google Scholar, and PubMed databases by searching the following keywords: sodium hypochlorite, cleaning, activation, and irrigation methods. The present work concluded that the use of irrigant activation has a greater benefit than its absence. Regardless, it is impossible to point to a single effective activation method.
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Affiliation(s)
- Alfredo Iandolo
- Department of Medicine and Surgery, School of Dentistry, University of Salerno, 84081 Salerno, Italy; (M.P.); (F.G.); (A.A.)
| | - Massimo Pisano
- Department of Medicine and Surgery, School of Dentistry, University of Salerno, 84081 Salerno, Italy; (M.P.); (F.G.); (A.A.)
| | - Alessio Buonavoglia
- Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, 40125 Bologna, Italy;
| | - Francesco Giordano
- Department of Medicine and Surgery, School of Dentistry, University of Salerno, 84081 Salerno, Italy; (M.P.); (F.G.); (A.A.)
| | - Alessandra Amato
- Department of Medicine and Surgery, School of Dentistry, University of Salerno, 84081 Salerno, Italy; (M.P.); (F.G.); (A.A.)
| | - Dina Abdellatif
- Department of Endodontics, Faculty of Dentistry, University of Alexandria, Alexandria 21531, Egypt;
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Dede M, Basche S, Neunzehn J, Dannemann M, Hannig C, Kühne MT. Efficacy of Endodontic Disinfection Protocols in an E. faecalis Biofilm Model-Using DAPI Staining and SEM. J Funct Biomater 2023; 14:jfb14040176. [PMID: 37103266 PMCID: PMC10145082 DOI: 10.3390/jfb14040176] [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: 02/26/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/28/2023] Open
Abstract
The aim of this study was to investigate the antimicrobial efficacy of different disinfection protocols in a novel Enterococcus faecalis biofilm model based on a visualization method and to evaluate the potential alteration of dentinal surface. A total of 120 extracted human premolars were allocated to 6 groups with different irrigation protocols. The assessment of the effectiveness of each protocol and the alteration of dentinal surface were visualized by using SEM and fluorescence microscopy (DAPI). A dense E. faecalis biofilm with a penetration depth of 289 μm (medial part of the root canal) and 93 μm (apical part) validated that the biofilm model had been successfully implemented. A significant difference between the 3% NaOCl groups and all the other groups in both observed parts of the root canal (p < 0.05) was detected. However, the SEM analysis revealed that the dentinal surface in the 3% NaOCl groups was severely altered. The established biofilm model and the visualization method based on DAPI are appropriate for bacterial quantification and evaluation of the depth effect of different disinfection protocols in the root canal system. The combination of 3% NaOCl with 20% EDTA or MTAD with PUI allows the decontamination of deeper dentine zones within the root canal but simultaneously alters the dentinal surface.
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Affiliation(s)
- Maria Dede
- Policlinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sabine Basche
- Policlinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Jörg Neunzehn
- Vertriebsgesellschaft GmbH, Geistlich Biomaterials, Schneidweg 5, 76534 Baden-Baden, Germany
| | - Martin Dannemann
- Faculty of Automotive Engineering, Institute of Energy and Transport Engineering, Westsächsische Hochschule Zwickau, 08056 Zwickau, Germany
| | - Christian Hannig
- Policlinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Marie-Theres Kühne
- Policlinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
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Karasu AE, Goker Kamalı S, Turkaydın D. Comparison of apical extrusion of sodium hypochlorite in immature teeth after needle irrigation, ultrasonic irrigation, EDDY, Er:YAG, and diode lasers. Lasers Med Sci 2022; 38:8. [PMID: 36539627 DOI: 10.1007/s10103-022-03683-0] [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: 05/19/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Abstract
This study aimed to assess the apical extrusion of sodium hypochlorite in immature teeth caused by needle irrigation, ultrasonic irrigation, EDDY, Er:YAG, and diode lasers. Seventy-five human maxillary anterior teeth were selected. After the apical 3 mm of the roots was resected, the canal lumen was enlarged with #2 to #5 Gates-Glidden burs. The teeth were fixed to the lid of a flat-sided clear plastic container, and the plastic containers were filled with 0.2% agarose gel containing 1 mL of 0.1% m-cresol purple. Then, the specimens were allocated into five groups according to the irrigation activation techniques: needle irrigation, ultrasonic irrigation, EDDY, Er:YAG laser, and diode laser. The apical extrusion of sodium hypochlorite caused the color change in the gel. The containers were digitally photographed, and the percentage of pixels of irrigant extrusion (the color change) in each photograph was calculated. The diode laser group showed a significantly lower percentage of pixels than needle irrigation, EDDY, and Er:YAG laser (p < 0.05). The irrigant extrusion value of the ultrasonic irrigation group was significantly lower than that of the EDDY and Er:YAG laser groups (p < 0.05). There was no significant difference between the other groups (p > 0.05). All the groups caused irrigant extrusion in the immature teeth. The diode laser and ultrasonic irrigation caused less sodium hypochlorite extrusion than EDDY and Er:YAG laser. The needle irrigation showed more irrigant extrusion than the only diode laser group.
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Affiliation(s)
- Alparslan Eren Karasu
- Department of Endodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Selin Goker Kamalı
- Department of Endodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey.
| | - Dilek Turkaydın
- Department of Endodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Impact of agitation/activation strategies on the antibiofilm potential of sodium hypochlorite/etidronate mixture in vitro. BMC Oral Health 2022; 22:201. [PMID: 35606751 PMCID: PMC9125931 DOI: 10.1186/s12903-022-02222-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background To investigate the effect of a rotary agitation method or ultrasonically activated irrigation on the antibiofilm effect of a mixture of sodium hypochlorite (NaOCl) and etidronate (1-hydroxyethylidene-1,1-bisphosphonate, HEBP) using a dual-species biofilm model in root canal system. Methods Mature dual-species biofilms of Enterococcus faecalis and Streptococcus gordonii were formed in root canals of mandibular premolars. Teeth were randomly allotted (n = 12) to group 1, XP-endo Finisher (XPF); group 2, ultrasonically activated irrigation (UAI); group 3, syringe-and-needle irrigation (SNI). In all groups, canals were instrumented with a rotary instrument (XP-endo Shaper) prior to irrigant agitation/activation. A mixture containing 2.5% NaOCl and 9% HEBP was used throughout the experiment. Bacterial counts from the canal were determined using qPCR before preparation (S1), after preparation (S2), and after final irrigation agitation/activation (S3). Bacterial viability within the dentinal tubules in the coronal, middle and apical root-thirds was quantified using confocal microscopy after Live/Dead staining. The bacterial counts and viability were compared between groups using one-way ANOVA and post-hoc Tukey’s tests. Paired t-test was used to compare the bacterial counts within groups. Results Instrumentation alone could significantly reduce the microbial counts in all the groups (P < 0.0001). Subsequent agitation/activation resulted in significant microbial reduction only in XPF and UAI (P < 0.05), both of which reduced significantly more microbial counts than SNI (P < 0.05). Live/Dead staining revealed that XPF and UAI showed significantly greater percentage of dead bacteria within the dentinal tubules than SNI in the coronal third (P < 0.05); UAI resulted in the significantly highest percentage of dead bacteria in the middle third (P < 0.05); while there was no significant difference between the groups in the apical third (P > 0.05). Conclusions When using the sodium hypochlorite/etidronate mixture for irrigation, final irrigant agitation/activation with XP-endo Finisher or ultrasonic can improve disinfection of the main root canal space and the dentinal tubules in the coronal third, while ultrasonically activated irrigation appears to exhibit better disinfection within dentinal tubules in the middle third. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02222-1.
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Josic U, Mazzitelli C, Maravic T, Fidler A, Breschi L, Mazzoni A. Biofilm in Endodontics: In Vitro Cultivation Possibilities, Sonic-, Ultrasonic- and Laser-Assisted Removal Techniques and Evaluation of the Cleaning Efficacy. Polymers (Basel) 2022; 14:polym14071334. [PMID: 35406207 PMCID: PMC9003475 DOI: 10.3390/polym14071334] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
Incomplete and inadequate removal of endodontic biofilm during root canal treatment often leads to the clinical failure. Over the past decade, biofilm eradication techniques, such as sonication of irrigant solutions, ultrasonic and laser devices have been investigated in laboratory settings. This review aimed to give an overview of endodontic biofilm cultivation methods described in papers which investigated sonic-, ultrasonic- and Er:Yag laser-assisted biofilm removal techniques. Furthermore, the effectiveness of these removal techniques was discussed, as well as methods used for the evaluation of the cleaning efficacy. In general, laser assisted agitation, as well as ultrasonic and sonic activation of the irrigants provide a more efficient biofilm removal compared to conventional irrigation conducted by syringe/needle. The choice of irrigant is an important factor for reducing the bacterial contamination inside the root canal, with water and saline being the least effective. Due to heterogeneity in methods among the reviewed studies, it is difficult to compare sonic-, ultrasonic- and Er:Yag laser-assisted techniques among each other and give recommendations for the most efficient method in biofilm removal. Future studies should standardize the methodology regarding biofilm cultivation and cleaning methods, root canals with complex morphology should be introduced in research, with the aim of simulating the clinical scenario more closely.
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Affiliation(s)
- Uros Josic
- Department for Biomedical and Neuromotor Sciences, University of Bologna-Alma Mater Studiorum, 40139 Bologna, Italy; (U.J.); (C.M.); (T.M.); (A.M.)
| | - Claudia Mazzitelli
- Department for Biomedical and Neuromotor Sciences, University of Bologna-Alma Mater Studiorum, 40139 Bologna, Italy; (U.J.); (C.M.); (T.M.); (A.M.)
| | - Tatjana Maravic
- Department for Biomedical and Neuromotor Sciences, University of Bologna-Alma Mater Studiorum, 40139 Bologna, Italy; (U.J.); (C.M.); (T.M.); (A.M.)
| | - Ales Fidler
- Dental Clinic, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Lorenzo Breschi
- Department for Biomedical and Neuromotor Sciences, University of Bologna-Alma Mater Studiorum, 40139 Bologna, Italy; (U.J.); (C.M.); (T.M.); (A.M.)
- Correspondence:
| | - Annalisa Mazzoni
- Department for Biomedical and Neuromotor Sciences, University of Bologna-Alma Mater Studiorum, 40139 Bologna, Italy; (U.J.); (C.M.); (T.M.); (A.M.)
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Antibacterial Effect of Red Laser Therapy on Enterococcus faecalis Using Different Photosensitizers: An In Vitro Study. Int J Dent 2022; 2022:7408554. [PMID: 35186086 PMCID: PMC8853808 DOI: 10.1155/2022/7408554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/23/2021] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To assess the antibacterial effect of red laser using different photosensitizers such as methylene blue and malachite green on monoradicular premolars contaminated with E. faecalis ATCC 29212. Methods This was an in vitro experimental study. Monoradicular premolars (44, 45, 34, and 35) were used, which were treated with ProTaper Next. After instrument change, irrigation, disinfection, and aspiration were performed with 2 ml of 4% NaOCl with a NaviTip 30°G needle (Ultradent, South Jordan, UT, USA). Group 1: RL + MB (red laser associated with methylene blue photosensitizer), group 2: RL + MG (red laser associated with malachite green photosensitizer), and group 3: control (no treatment). The E. faecalis strain was cultured on trypticase soy agar (TSB) (Difco, Detroit, MI, USA) and incubated at 37°C for 24 h. After the incubation period, colony-forming units (CFU/ml) of each group were counted using the plate count method. The ANOVA test was used with a significance level of p < 0.05. Results Group 1 had the lowest antibacterial contamination as it averaged only 530 ± 581.3 CFU/ml, while group 2 had the highest contamination with an average of 1990 ± 542.5 CFU/ml. Comparison revealed that there were statistically significant differences between the RL + MB and RL + MG groups (p < 0.001). Conclusions Group 1 had the best antimicrobial potential because it presented the lowest contamination in CFU/ml of E. faecalis compared to group 2 and group 3.
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Claudino Ribeiro JR, da Silveira Bueno CE, Bruno KF, Dos Reis S, de Martin AS, Fontana CE, Pelegrine RA. Impact of sodium hypochlorite on organic tissue dissolution in the periapical region of immature permanent teeth: an ex vivo study. J Endod 2022; 48:555-560. [PMID: 35032539 DOI: 10.1016/j.joen.2022.01.004] [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: 10/08/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION To evaluate the impact of different sodium hypochlorite irrigation protocols on organic tissue dissolution in the periapical region of simulated immature permanent teeth. METHODS Eight single-rooted premolars and 48 samples of porcine palatal mucosa were used. Acrylic resin prototypes were constructed, placing the tissue in close contact with the dental apices. Specimens were then divided into six groups (n=8): two control groups, of saline irrigation with (NS/WA) or without (NS/NA) ultrasonic activation, and four experimental groups, of 1.5% and 2.5% sodium hypochlorite irrigation, with (NaOCl 1.5%/WA and NaOCl 2.5%/WA) or without (NaOCl 1.5%/NA and NaOCl 2.5%/NA) activation. Root canals were irrigated with 20 mL of the solution for 5 minutes, distributed over four irrigation cycles. In each cycle, after irrigation, the solution was either kept stagnant or activated for 30 seconds and then replaced. Specimens were weighed on a precision balance before and after the irrigation protocols. Tissue dissolution was measured by the difference between the initial and final weights. One-way ANOVA was applied, followed by Tukey's HSD test (α=0.05). RESULTS The NS/NA and NS/WA groups had mean weight reductions similar to the 1.5% NaOCl/NA group (p>0.05) and lower than the others (p<0.05). The 2.5% NaOCl/NA and 2.5% NaOCl/WA groups had the highest mean weight loss (p<0.05), while the 1.5% NaOCl/WA group had intermediate values (p<0.05). CONCLUSIONS Periapical tissue dissolution occurred in all groups, with greater impact observed with 2.5% NaOCl, with or without ultrasonic activation.
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Affiliation(s)
- José Ricardo Claudino Ribeiro
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil.
| | - Carlos Eduardo da Silveira Bueno
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil
| | - Kely Firmino Bruno
- Endodontics, Faculdade Sul Americana, BR-153, Km 502, Jardim da Luz, 74850370, Goiânia, GO, Brazil
| | - Samuel Dos Reis
- Endodontics, Faculdade Sul Americana, BR-153, Km 502, Jardim da Luz, 74850370, Goiânia, GO, Brazil
| | - Alexandre Sigrist de Martin
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil
| | - Carlos Eduardo Fontana
- Center for Life Sciences, Postgraduate Program in Health Sciences, Pontifícia, Universidade Católica de Campinas (PUC-CAMPINAS), Rua Professor Doutor Euryclides de Jesus Zerbini, 1516, CampusI/ Av. John Boyd Dunlop, s/n, 13087571, Campinas, SP, Brazil
| | - Rina Andréa Pelegrine
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil
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Sinsareekul C, Hiran-Us S. Comparison of the efficacy of three different supplementary cleaning protocols in root-filled teeth with a bioceramic sealer after retreatment-a micro-computed tomographic study. Clin Oral Investig 2021; 26:3515-3521. [PMID: 34854988 DOI: 10.1007/s00784-021-04320-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The present study evaluated the efficacy of three different supplementary cleaning protocols on the removal of bioceramic-based root canal filling materials from oval-shaped canals. MATERIALS AND METHODS A total of 36 human mandibular premolars were instrumented and obturated with gutta-percha and iRoot SP using the single-cone technique. Retreatment was performed with ProTaper Universal retreatment files. The samples were randomly divided into the following supplementary cleaning protocols: conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI), and XP-endo Finisher R (XPR). The samples underwent micro-CT scanning to quantify the amount of residual filling materials after retreatment and after performing the cleaning protocols. The volume of filling material removal was analyzed by one-way analysis of variance and post hoc Bonferroni and Games-Howell tests (P < 0.05). RESULTS There were significant differences in the amount of root canal filling material removal in every comparison group (P < 0.05). The XPR removed significantly more residual filling materials (P < 0.01) followed by PUI and CSI (P < 0.05). Similar efficacy was found in the total root canal and all root thirds. CONCLUSIONS The additional use of XP-endo Finisher R and passive ultrasonic irrigation effectively removed the bioceramic-obturated root filling materials from the oval-shaped canals. However, none of the techniques completely removed the filling materials. CLINICAL RELEVANCE The XP-endo Finisher R and passive ultrasonic irrigation exhibited greater efficacy compared with syringe irrigation in the reduction of residual filling materials after retreatment in root-filled teeth with a bioceramic sealer.
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Affiliation(s)
- Chanakarn Sinsareekul
- Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand
| | - Sirawut Hiran-Us
- Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Wangmai, Patumwan, Bangkok, 10330, Thailand.
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Küden C, Karakaş SN. Photodynamic therapy and gaseous ozone versus conventional post space treatment methods on the push-out bond strength of fiber posts luting with different resin cements. Photodiagnosis Photodyn Ther 2021; 36:102586. [PMID: 34670156 DOI: 10.1016/j.pdpdt.2021.102586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this study was to compare the push-out bond strength of fiber posts by using two different resin cement after the treatments of post space with photodynamic therapy, gaseous ozone and conventional disinfection solution. METHODS The root canal treatments of one hundred maxillary incisors were performed. The roots were randomly distributed into 5 groups (n = 20). NaOCl of 2.5% + EDTA of 17% in group 1, CHX of 2% in group 2, toluidine blue + diode laser as the photodynamic therapy (PDT) in group 3 and ozone in group 4 were applied to the post spaces. Group 5 was washed with distilled water as control group. Each group was divided into two subgroups according to the adhesive types and the posts were bonded by using RelyX and LinkForce. The bond strength was calculated using the push-out test method. Resin tag formations were photographed with SEM. The push-out bond strength was analyzed by ANOVA and Tukey tests (p = .05). RESULTS The PDT group, which showed the highest PBS among the groups bonded with LinkForce at all levels, was significantly higher than Ozone and DW groups (p<.05). NaOCl and ozone treatments provided the highest PBS among the groups bonded with RelyX for all levels and this difference was significant according to the DW group (p < .05). CONCLUSION Post space treatments improved the bond strength of the fiber post in both types of resin cement.
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Affiliation(s)
- Cihan Küden
- Department of Endodontics, Faculty of Dentistry, Cukurova University, Adana, 01380, Turkey.
| | - Seda Nur Karakaş
- Department of Restorative Dentistry, Faculty of Dentistry, Cukurova University, Adana, 01380, Turkey.
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Tanaka T, Yahata Y, Handa K, Venkataiah SV, Njuguna MM, Kanehira M, Hasegawa T, Noiri Y, Saito M. An experimental intraradicular biofilm model in the pig for evaluating irrigation techniques. BMC Oral Health 2021; 21:177. [PMID: 33827540 PMCID: PMC8028066 DOI: 10.1186/s12903-021-01536-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We established an in vivo intraradicular biofilm model of apical periodontitis in pigs in which we compared the efficacy of different irrigant activation techniques for biofilm removal. METHODS Twenty roots from the deciduous mandibular second premolar of 5 male pigs were used. After pulpectomy, canals were left open for 2 weeks and then sealed for 4 weeks to enable the development of an intracanal biofilm. The intraradicular biofilms was evaluated using SEM and bacterial 16S rRNA gene-sequencing. To investigate the efficacy of biofilm removal, root canal irrigations were performed using conventional needle, passive ultrasonic, subsonic, or laser-activated irrigation. Real-time PCR was conducted to quantitate the remaining biofilm components. Statistical analysis was performed using ANOVA followed by a Tukey kramer post-hoc test with α = 0.05. RESULTS The pulp exposure model was effective in inducing apical periodontitis and SEM analysis revealed a multi-layer biofilm formation inside the root canal. 16S rRNA sequence analysis identified Firmicutes, Bacteroidetes, and Fusobacteria as the predominant bacterial phyla components, which is similar to the microbiome profile seen in humans. None of the tested irrigation techniques completely eradicated the biofilm components from the root canal, but the subsonic and laser-activated irrigation methods produced the lowest bacterial counts (p < 0.05). CONCLUSIONS An experimental intraradicular biofilm model has been successfully established in pigs. Within the limitations of the study, subsonic or laser-activated irrigation demonstrated the best biofilm removal results in the pig system.
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Affiliation(s)
- Toshinori Tanaka
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Yoshio Yahata
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan.
| | - Keisuke Handa
- Division of Molecular Biology and Oral Biochemistry, Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa, 238-8580, Japan
| | - Suresh V Venkataiah
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Mary M Njuguna
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Masafumi Kanehira
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuya Hasegawa
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Yuichiro Noiri
- Division of Cariology, Operative Dentistry and Endodontics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakko-cho-dori, Chuo-ku, Niigata, Niigata, 951-8514, Japan
| | - Masahiro Saito
- Division of Operative Dentistry, Department of Ecological Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8575, Japan
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Liapis D, De Bruyne MAA, De Moor RJG, Meire MA. Postoperative pain after ultrasonically and laser-activated irrigation during root canal treatment: a randomized clinical trial. Int Endod J 2021; 54:1037-1050. [PMID: 33595920 DOI: 10.1111/iej.13500] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022]
Abstract
AIM To compare the intensity of postoperative pain after primary root canal treatment of asymptomatic teeth when using ultrasonically (UAI) or laser-activated irrigation (LAI). METHODOLOGY In this superiority randomized clinical trial (ClinicalTrials.gov ID: NCT03981237) with parallel design, fifty-six patients with an asymptomatic tooth in need of primary root canal treatment were enrolled. After chemo-mechanical canal preparation using rotary instruments and NaOCl irrigation, teeth were randomly assigned to two groups and patients were blinded to the final irrigation protocol. In the UAI group (n = 28), 60s activation with an Irrisafe tip was done per canal. In the LAI group (n = 28), NaOCl was activated with a pulsed Er:YAG (2940 nm) laser, equipped with a conical tip, with settings of 50 µs, 20 mJ at 15 Hz for 60 s. Patients recorded their pain intensity 6, 24, 48 and 72 h after treatment on a 100 mm visual analogue scale (VAS), as well as their analgesic consumption. Pain levels and incidence were compared across groups using the Mann-Whitney U-test and chi-square test. RESULTS Overall, mean postoperative pain intensity was low, with the majority of patients having no or minimal pain 24 h postoperatively. At 6 h postoperatively, pain intensity and incidence were significantly higher in the UAI group compared to the LAI group (P < 0.05). For the other time intervals, no significant differences in postoperative pain incidence or intensity were found. The frequency of analgesic intake did not differ significantly between the two groups. Neither of the activation methods resulted in any adverse effects. CONCLUSIONS Ultrasonically and laser-activated irrigation resulted in low and comparable levels of postoperative pain in asymptomatic patients receiving primary root canal treatment.
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Affiliation(s)
- D Liapis
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A A De Bruyne
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - R J G De Moor
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - M A Meire
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
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12
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Villalta-Briones N, Baca P, Bravo M, Solana C, Aguado-Pérez B, Ruiz-Linares M, Arias-Moliz MT. A laboratory study of root canal and isthmus disinfection in extracted teeth using various activation methods with a mixture of sodium hypochlorite and etidronic acid. Int Endod J 2020; 54:268-278. [PMID: 32970865 DOI: 10.1111/iej.13417] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 12/29/2022]
Abstract
AIM To evaluate in a laboratory setting the antibiofilm activity of several irrigating protocols including conventional irrigation, ultrasonic activation and XP-endo Finisher, with a mixture of sodium hypochlorite and etidronic acid in infected isthmuses and root canals of extracted human mandibular molar teeth. METHODOLOGY Fifty-six mesial roots of mandibular molars, half of them with a continuous isthmus from the cervical to the apical third between the two root canals (type 1), and the other half with a continuous isthmus from the cervical to the middle third and one canal in the apical third (type 2), were included. The root canals were contaminated for 7 days with an Enterococcus faecalis suspension. There were three experimental groups plus a control group (n = 7 per type of root canal anatomy). All the root canals, except for the control group that was not treated, were chemomechanically prepared and then assigned to one of the experimental groups according to the final adjunctive procedure: conventional irrigation, ultrasonic activation or XP-endo Finisher activation. The irrigating solution used was a combination of 2.5% sodium hypochlorite and 9% etidronic acid, and the final protocols were applied for three cycles of 30 s with a 3 mL volume. The antibiofilm activity was evaluated at each location (root canal and isthmus) and third (cervical, middle and apical) using confocal laser scanning microscopy and the live/dead technique. Statistical analysis was performed using SPSS (descriptive statistics) and SUDAAN (P-value calculations). RESULTS Root canals had significantly lower biovolume values than the isthmuses (P < 0.05). The biovolume in the root canals was significantly reduced in all the experimental groups in all the thirds except for conventional irrigation in the apical third (P > 0.05). In the cervical and middle thirds, ultrasonic activation was associated with the lowest biovolumes (P < 0.05), followed by XP-endo Finisher. In the isthmus, disinfection was similar in all the thirds for all the protocols. Conventional irrigation was associated with intermediate values with no significant differences from the control group or from the activated protocols (P > 0.05), although the latter were significantly different from the control group (P < 0.05). No differences were found between ultrasonic activation and XP-endo Finisher in the middle and apical thirds (P > 0.05) in the isthmuses. CONCLUSIONS In this laboratory study on extracted teeth, the isthmus was more difficult to disinfect than root canals. In the root canals, ultrasonic activation and XP-endo Finisher had a greater effectiveness than conventional irrigation. In the isthmuses, no differences were observed between the two activation techniques and conventional irrigation.
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Affiliation(s)
- N Villalta-Briones
- Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
| | - P Baca
- Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
| | - M Bravo
- Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
| | - C Solana
- Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
| | - B Aguado-Pérez
- Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
| | - M Ruiz-Linares
- Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
| | - M T Arias-Moliz
- Department of Microbiology, School of Dentistry, University of Granada, Granada, Spain
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13
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Yared G, Al Asmar Ramli G. Antibacterial Ability of Sodium Hypochlorite Heated in the Canals of Infected Teeth: An Ex Vivo Study. Cureus 2020; 12:e6975. [PMID: 32201655 PMCID: PMC7075510 DOI: 10.7759/cureus.6975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Apical periodontitis is caused by bacteria present in the root canal space. The removal of the infection is crucial to obtain healing. Canal irrigation is among one of the most important steps in eliminating bacteria. Sodium hypochlorite (NaOCl) is still the preferred irrigant due to its disinfecting and pulpal dissolution abilities. Heating NaOCl improves those abilities. However, the ability of intracanal heated NaOCl to kill bacteria has not yet been evaluated. Objectives This study compared the disinfecting ability of different irrigation regimens using NaOCl with and without sonic and ultrasonic agitation, and with and without intracanal heating of NaOCl. Methods The canals of extracted mandibular premolars were prepared, sterilized and infected with E. faecalis for 28 days. The canals were then assigned to eight groups of 10 teeth depending on the NaOCl irrigation protocol. Group CONV: conventional irrigation with syringe and needle; Group END: NaOCl sonic agitation with EndoActivator; Group EDD: NaOCl sonic agitation with EDDY; Group PUI: NaOCl passive ultrasonic agitation; Group H: intracanal heating of NaOCl; Groups END-H, EDD-H and PUI-H: NaOCl agitation with EndoActivator, EDDY and passive ultrasound, respectively, followed by intracanal heating of NaOCl. The canals were sampled before (S1) and after (S2) the different irrigation protocols were performed, the colony-forming units were counted and the percentage of bacteria reduction was calculated for each group. Results The number of bacteria decreased significantly for the different protocols (p < 0.001). The groups with NaOCl intracanal heating reduced bacteria significantly more than the other groups (p < 0.001). Five S2 samples in group H were free of bacteria. All of the S2 samples in the groups with NaOCl sonic and ultrasonic agitation followed by NaOCl heating were free of bacteria. Intracanal heating of NaOCl was more effective in killing bacteria than conventional irrigation, and sonic or passive ultrasonic agitation of NaOCl. Conclusions Intracanal heating of NaOCl has the potential to be used as an adjunct to root canal irrigation in order to increase bacterial reduction in comparison to the conventional irrigation techniques involving sonic or ultrasonic agitation. Agitation of NaOCl followed by intracanal warming of the solution seems to be very promising in eliminating bacteria from infected root canals.
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Dashtimoghadam E, Johnson A, Fahimipour F, Malakoutian M, Vargas J, Gonzalez J, Ibrahim M, Baeten J, Tayebi L. Vibrational and sonochemical characterization of ultrasonic endodontic activating devices for translation to clinical efficacy. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 109:110646. [PMID: 32228956 DOI: 10.1016/j.msec.2020.110646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/13/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Abstract
Passive activation of endodontic irrigants provides improved canal disinfection, smear layer removal, and better subsequent sealing. Although evidence suggests that passive activating endodontic devices increase the effectiveness of irrigation, no study exists to quantitatively compare and validate vibrational characteristics and cavitation produced by different ultrasonic endodontic devices. The current study aims to compare the efficiency of various commercially available ultrasonic endodontic activating devices (i.e., EndoUltra™, EndoChuck, Irrisafe™, and PiezoFlow®). The passive endodontic activating devices were characterized in terms of tip displacement and cavitation performance using scanning laser vibrometry (SLV) and sonochemical analysis, respectively. The obtained results showed that activator tip displacements and speed correlate to established cavitation thresholds. The EndoUltra™ tip speed was measured to be 14.5 and 28.1 m/s at 45 and 91 kHz, respectively, which is greater than the threshold. The EndoUltra™ was found to be the only device that exceeds the cavitation thresholds (i.e. tip speed and displacement), as evident from laser vibrometry analysis, and subsequently yielded measurable cavitation quantified via sonochemical analysis. All other passive endodontic activation devices, despite ultrasonic oscillation, were unable to produce cavitation.
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Affiliation(s)
| | | | | | - Mohamadali Malakoutian
- Electrical and Computer Engineering Department, Marquette University, Milwaukee, WI, USA
| | - Jessica Vargas
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA
| | - Jose Gonzalez
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA
| | - Mohamed Ibrahim
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA; Endodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - John Baeten
- Inter Med-Vista Dental, Racine, WI 53404, USA
| | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA.
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15
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Donmez Ozkan H, Cimen H, Ulug D, Wenski S, Yigit Ozer S, Telli M, Aydin N, Bode HB, Hazir S. Nematode-Associated Bacteria: Production of Antimicrobial Agent as a Presumptive Nominee for Curing Endodontic Infections Caused by Enterococcus faecalis. Front Microbiol 2019; 10:2672. [PMID: 31824457 PMCID: PMC6882856 DOI: 10.3389/fmicb.2019.02672] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022] Open
Abstract
Xenorhabdus and/or Photorhabdus bacteria produce antibacterial metabolites to protect insect cadavers against food competitors allowing them to survive in nature with their nematode host. The effects of culture supernatant produced by Xenorhabdus and Photorhabdus spp. were investigated against the multidrug-resistant dental root canal pathogen Enterococcus faecalis. The efficacy of seven different cell-free supernatants of Xenorhabdus and Photorhabdus species against E. faecalis was assessed with overlay bioassay and serial dilution techniques. Additionally, time-dependent inactivation of supernatant was evaluated. Among the seven different bacterial species, X. cabanillasii produced the strongest antibacterial effects. Loss of bioactivity in a phosphopantetheinyl transferase-deficient mutant of X. cabanillasii indicated that this activity is likely based on non-ribosomal peptide synthetases (NRPSs) or polyketide synthases (PKSs). Subsequent in silico analysis revealed multiple possible biosynthetic gene clusters (BGCs) in the genome of X. cabanillasii including a BGC homologous to that of zeamine/fabclavine biosynthesis. Fabclavines are NRPS-derived hexapeptides, which are connected by PKS-derived malonate units to an unusual polyamine, also PKS-derived. Due to the known broad-spectrum bioactivity of the fabclavines, we generated a promoter exchange mutant in front of the fabclavine-like BGC. This leads to over-expression by induction or a knock-out by non-induction which resulted in a bioactive and non-bioactive mutant. Furthermore, MS and MS2 experiments confirmed that X. cabanillasii produces the same derivatives as X. budapestensis. The medicament potential of 10-fold concentrated supernatant of induced fcl promoter exchanged X. cabanillasii was also assessed in dental root canals. Calcium hydroxide paste, or chlorhexidine gel, or fabclavine-rich supernatant was applied to root canals. Fabclavine-rich supernatant exhibited the highest inactivation efficacy of ≥3 log10 steps CFU reduction, followed by calcium hydroxide paste (≤2 log10 step). The mean percentage of E. faecalis-free dental root canals after treatment was 63.6, 45.5, and 18.2% for fabclavine, calcium hydroxide, and chlorhexidine, respectively. Fabclavine in liquid form or preferably as a paste or gel formulation is a promising alternative intracanal medicament.
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Affiliation(s)
- Hicran Donmez Ozkan
- Department of Endodontics, Faculty of Dentistry, Adnan Menderes University, Aydin, Turkey
| | - Harun Cimen
- Department of Biology, Faculty of Arts and Sciences, Adnan Menderes University, Aydin, Turkey
| | - Derya Ulug
- Department of Biology, Faculty of Arts and Sciences, Adnan Menderes University, Aydin, Turkey
| | - Sebastian Wenski
- Molekulare Biotechnologie, Fachbereich Biowissenschaften, Buchmann Institute for Molecular Life Sciences (BMLS), Goethe Universität Frankfurt Biozentrum, Frankfurt am Main, Germany
| | - Senem Yigit Ozer
- Department of Endodontics, Faculty of Dentistry, Adnan Menderes University, Aydin, Turkey
| | - Murat Telli
- Department of Microbiology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Neriman Aydin
- Department of Microbiology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Helge B Bode
- Molekulare Biotechnologie, Fachbereich Biowissenschaften, Buchmann Institute for Molecular Life Sciences (BMLS), Goethe Universität Frankfurt Biozentrum, Frankfurt am Main, Germany
| | - Selcuk Hazir
- Department of Biology, Faculty of Arts and Sciences, Adnan Menderes University, Aydin, Turkey
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Pedullà E, Genovese C, Messina R, La Rosa GRM, Corsentino G, Rapisarda S, Arias-Moliz MT, Tempera G, Grandini S. Antimicrobial efficacy of cordless sonic or ultrasonic devices on Enterococcus faecalis-infected root canals. ACTA ACUST UNITED AC 2019; 10:e12434. [PMID: 31294531 DOI: 10.1111/jicd.12434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/04/2019] [Accepted: 05/25/2019] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to evaluate the immediate and residual antimicrobial activity of cordless sonic or ultrasonic devices on Enterococcus faecalis (E faecalis)-infected teeth. METHODS A total of 140 single-rooted extracted teeth with E faecalis were grouped as follows (N = 15): conventional syringe irrigation with 3% sodium hypochlorite activated by ultrasonic device (group 1) or cordless ultrasonic device (group 2), EndoActivator (group 3) or without activation (group 4), conventional syringe irrigation with sterile bi-distilled water and ultrasonic device (group 5), EndoUltra (group 6), EndoActivator (group 7), or without activation (group 8). The remaining 20 teeth were used for positive and negative controls. Colony-forming units (CFU) and turbidity were recorded from bacteriological samples taken before and after irrigation and after 24 hours of re-incubation. Data were statistically analyzed using Student's t test, Mann-Whitney test, Kruskal-Wallis test, and Dunn's multiple comparison tests (P < .05). RESULTS Groups 1 and 2 showed higher antimicrobial efficacy than groups 3 and 4 (P < .05). No bacteria reduction was found in groups 5-8 (P > .05). After 24 hours, regrowth of bacteria was not significantly different for all groups (P > .05). CONCLUSIONS Ultrasound produced lower CFU and turbidity after treatment and after re-incubation of 24 hours than sonic or no activation.
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Affiliation(s)
- Eugenio Pedullà
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Italy
| | - Carlo Genovese
- Department of Biomedical Sciences, University of Catania, Italy
| | - Riccardo Messina
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Italy
| | - Giusy R M La Rosa
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Italy
| | - Giacomo Corsentino
- Department of Endodontics and Restorative Dentistry, University of Siena, Siena, Italy
| | - Silvia Rapisarda
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Italy
| | - Maria T Arias-Moliz
- Departamento de Microbiología de la Universidad de Granada, Universidad de Granada, Granada, Spain
| | - Gianna Tempera
- Department of Biomedical Sciences, University of Catania, Italy
| | - Simone Grandini
- Department of Endodontics and Restorative Dentistry, University of Siena, Siena, Italy
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17
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Sasanakul P, Ampornaramveth RS, Chivatxaranukul P. Influence of Adjuncts to Irrigation in the Disinfection of Large Root Canals. J Endod 2019; 45:332-337. [PMID: 30803542 DOI: 10.1016/j.joen.2018.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The aims of this study were to evaluate the effectiveness of disinfection methods and determine the most promising irrigation protocol for regenerative endodontics in teeth with large root canals. METHODS Sterilized root samples with 0.8-mm wide apical foramen (n = 94) were prepared from human mandibular premolars. Ninety-two samples were infected with Enterococcus faecalis for 21 days and biofilm formation was verified using scanning electron microscopy (n = 2). The 90 infected samples were randomly assigned into 9 groups: no intervention (initial), 1.5% NaOCl irrigation (1.5 N), 2.5% NaOCl irrigation (2.5 N), 1.5 N + intermittent passive ultrasonic irrigation (PUI), 1.5 N + intermittent canal brushing with Navitip FX (NFX), 1.5 N + intermittent XP-endo Finisher (XPF), 1.5 N + circumferential filing (CF), 1.5 N + 1-min Self-adjusting File (SAF), and 1.5 N + mechanical instrumentation using #90‒110 files (MI). Subsequently, the root canal walls were shaved for microbial analysis. The mean colony-forming units (CFUs) were determined and analyzed using 1-way analysis of variance. RESULTS The mean CFU count was lowest in the MI group (63.5 CFU/mL), followed by the NFX, XPF, SAF, 2.5 N, CF, PUI, 1.5 N, and initial groups. The remaining bacteria in the 1.5 N group was 3.6-fold higher than that of the PUI group; 4- to 5-fold higher than that of the 2.5 N, CF, and SAF groups; and 22-fold and 36-fold higher than that of the XPF and NFX groups, respectively. The 2.5 N and 1.5 N groups with adjunctive treatments, excluding the PUI group, had significantly fewer remaining bacteria compared with the 1.5 N group (P < .05). CONCLUSIONS Performing various procedures supplemental to 1.5 N improved large root canal disinfection. Adjunctive NFX most effectively reduced the number of bacteria without dentin removal.
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Affiliation(s)
- Parnwad Sasanakul
- Department of Operative Dentistry, Chulalongkorn University, Bangkok, Thailand
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18
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Ultrasonic Irrigant Activation during Root Canal Treatment: A Systematic Review. J Endod 2019; 45:31-44.e13. [PMID: 30558797 DOI: 10.1016/j.joen.2018.09.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/05/2018] [Accepted: 09/16/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aim of this study was to systematically review the evidence on the cleaning and disinfection of root canals and the healing of apical periodontitis when ultrasonic irrigant activation is applied during primary root canal treatment of mature permanent teeth compared with syringe irrigation. METHODS An electronic search was conducted of the Cochrane Library, Embase, LILACS, PubMed, SciELO, and Scopus databases using both free-text key words and controlled vocabulary. Additional studies were sought through hand searching of endodontic journals and textbooks. The retrieved studies were screened by 2 reviewers according to predefined criteria. The included studies were critically appraised, and the extracted data were arranged in tables. RESULTS The electronic and hand search retrieved 1966 titles. Three clinical studies and 45 in vitro studies were included in this review. Ultrasonic activation did not improve the healing rate of apical periodontitis compared with syringe irrigation after primary root canal treatment of teeth with a single root canal. Conflicting results were reported by the in vitro microbiological studies. Ultrasonic activation was more effective than syringe irrigation in the removal of pulp tissue remnants and hard tissue debris based on both clinical and in vitro studies. Ultrasonic activation groups were possibly favored in 13 studies, whereas syringe irrigation groups may have been favored in 3 studies. CONCLUSIONS The level of the available evidence was low, so no strong clinical recommendations could be formulated. Future studies should focus on the antimicrobial effect and healing of apical periodontitis in teeth with multiple root canals.
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Nagendrababu V, Jayaraman J, Suresh A, Kalyanasundaram S, Neelakantan P. Effectiveness of ultrasonically activated irrigation on root canal disinfection: a systematic review of in vitro studies. Clin Oral Investig 2018; 22:655-670. [DOI: 10.1007/s00784-018-2345-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/15/2018] [Indexed: 12/01/2022]
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Effect of different diode laser wavelengths on root dentin decontamination infected with Enterococcus faecalis. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 176:1-8. [DOI: 10.1016/j.jphotobiol.2017.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/25/2017] [Accepted: 09/11/2017] [Indexed: 01/15/2023]
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21
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Maden M, Ertuğrul İF, Orhan EO, Erik CE, Yetiş CÇ, Tuncer Y, Kahriman M. Enhancing antibacterial effect of sodium hypochlorite by low electric current-assisted sonic agitation. PLoS One 2017; 12:e0183895. [PMID: 28854274 PMCID: PMC5576683 DOI: 10.1371/journal.pone.0183895] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 08/13/2017] [Indexed: 11/18/2022] Open
Abstract
Background This research focused on the effects of low electric current (μE)-assisted sonic agitation of sodium hypochlorite on Enterococcus faecalis infected human root dentin. Methods Extracted human canine roots were instrumented, sterilized, and experimentally contaminated with E. faecalis. After incubation for 21 days, the presence of the biofilm was confirmed by scanning electron microscopy (n = 3). Roots were randomly divided into seven groups according to decontamination procedures: G1: no treatment; G2: sterile saline; G3: 5.25% sodium hypochlorite; G4: passive ultrasonic irrigation; G5: EndoActivator (Dentsply Tulsa Dental Specialties, Tulsa, OK) agitation (EA); G6: μE agitation; and G7: μE-assisted sonic agitation. Fixed μE amperage and intensities were applied in G6 and G7. Following microbial sampling, bacterial colonies were counted using the direct plating method. Results Biofilm was not eradicated in any sample. The μE-assisted sonic agitation of sodium hypochlorite revealed the lowest cfu values (p<0.05), whereas there were no significant differences among the passive ultrasonic irrigation, EndoActivator and μE agitation alone (p>0.05). Conclusions Based on available evidence, the following conclusions were drawn: The μE-assisted sonic agitation increased the antibiofilm efficiency of sodium hypochlorite than passive ultrasonic irrigation and EndoActivator. The μE-assisted sonic agitation on 5.25% sodium hypochlorite is not capable to eradicate biofilms at 10mA energy level in 60s.
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Affiliation(s)
- Murat Maden
- Department of Endodontics, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - İhsan Furkan Ertuğrul
- Department of Endodontics Dentistry, Faculty of Dentistry, Pamukkale University, Denizli, Turkey
| | - Ekim Onur Orhan
- Department of Endodontics, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
- * E-mail:
| | - Cevat Emre Erik
- Department of Endodontics, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - Ceylan Çağıl Yetiş
- Department of Pediatric Dentistry, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - Yasin Tuncer
- Department of Food Engineering, Faculty of Engineering and Architect, Süleyman Demirel University, Isparta, Turkey
| | - Mesud Kahriman
- Department of Electronics and Communication, Faculty of Engineering & Architect, Süleyman Demirel University, Isparta, Turkey
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22
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Fan W, Li Y, Sun Q, Ma T, Fan B. Calcium-silicate mesoporous nanoparticles loaded with chlorhexidine for both anti- Enterococcus faecalis and mineralization properties. J Nanobiotechnology 2016; 14:72. [PMID: 27769275 PMCID: PMC5073856 DOI: 10.1186/s12951-016-0224-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 10/12/2016] [Indexed: 11/21/2022] Open
Abstract
Background In infected periapical tissues, Enterococcus faecalis is one of the most common dominant bacteria. Chlorhexidine has been proved to show strong antibacterial ability against E. faecalis but is ineffective in promoting mineralization for tissues around root apex. Mesoporous calcium-silicate nanoparticles are newly synthesized biomaterials with excellent ability to promote mineralization and carry-release bioactive molecules in a controlled manner. In this study, mesoporous calcium-silicate nanoparticles were functionalized with chlorhexidine and their releasing profile, antibacterial ability, effect on cell proliferation and in vitro mineralization property were evaluated. Results The chlorhexidine was successfully incorporated into mesoporous calcium-silicate nanoparticles by a mixing-coupling method. The new material could release chlorhexidine as well as Ca2+ and SiO32− in a sustained manner with an alkaline pH value under different conditions. The antimicrobial ability against planktonic E. faecalis was dramatically improved after chlorhexidine incorporation. The nanoparticles with chlorhexidine showed no negative effect on cell proliferation with low concentrations. On dentin slices, the new synthesized material demonstrated a similar inhibitory effect on E. faecalis as the chlorhexidine. After being immersed in SBF for 9 days, numerous apatite crystals could be observed on surfaces of the material tablets. Conclusions Mesoporous calcium-silicate nanoparticles loaded with chlorhexidine exhibited release of ions and chlorhexidine, low cytotoxicity, excellent antibacterial ability and in vitro mineralization. This material could be developed into a new effective intra-canal medication in dentistry or a new bone defect filling material for infected bone defects.
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Affiliation(s)
- Wei Fan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, People's Republic of China
| | - Yanyun Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, People's Republic of China
| | - Qing Sun
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, People's Republic of China
| | - Tengjiao Ma
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, People's Republic of China
| | - Bing Fan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, People's Republic of China.
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