Comparison of bacterial removal from dentinal tubules with different irrigant agitation techniques: An in vitro study

Effect of the Irrigation Agitation Technique on Postoperative Pain in Teeth With Symptomatic Irreversible Pulpitis

Introduction Irrigation of the root canal system is a vital step in endodontic treatment aimed at disinfecting the canal. The efficacy of irrigation can be improved by various irrigation agitation methods. One such novel method of interest is the manual dynamic agitation (MDA) technique. However, the effect of MDA on postoperative pain as compared to needle irrigation (NI) with sodium hypochlorite has been scarcely explored. This study aimed to compare the effects of NI and MDA techniques on postoperative pain in teeth with symptomatic irreversible pulpitis. Materials and methods This quasi-experimental study was conducted at the Department of Operative and Paediatric Dentistry, Fauji Foundation Dental Hospital, over four months after gaining ethical approval. One hundred and sixty-eight participants diagnosed with symptomatic irreversible pulpitis were enrolled in the study through the purposive sampling technique. The participants were divided into two groups based on the irrigation technique used: Group A (NI) and Group B (MDA). Postoperative pain was recorded after six hours, 24 hours, 48 hours, and seven days using the 0-100mm visual analog scale (VAS). The VAS scores were compared using an independent sample t-test. Results Out of 168 participants, 48.2% were in Group A and 51.2% in Group B. The study found that VAS pain scores for Group B (MDA) were significantly lower at six hours, 24 hours, 48 hours, and seven days as compared to Group A (NI), with a p-value less than 0.001. Conclusion This study shows that the MDA technique leads to decreased postoperative pain both immediately after endodontic treatment and a week later as compared to the NI technique. Hence, the use of MDA can aid in controlling postendodontic pain and, therefore, ensure smoother recovery and increased patient satisfaction.

An odontogenic cutaneous sinus tract in an unusual site with multiple misdiagnoses

Key Clinical Message

Dental clinicians and physicians should be careful in differential diagnosis of facial cutaneous nodules, since they might have an odontogenic origin.

Abstract

Odontogenic cutaneous sinus tracts are commonly misdiagnosed and mismanaged; thus, they are prone to recurrence. Herein, a 21-year-old female patient is reported with a red fluctuant nodule on her right cheek which had been misdiagnosed as an epidermoid cyst, cystic acne, and parotid gland fistula. The odontogenic origin of the lesion was first suspected when the patient presented to the Department of Endodontics, Faculty of Dentistry for a routine dental check-up. Multiple-visit non-surgical root canal retreatment of the maxillary right first molar, without any additional treatment, resulted in shrinkage of the lesion. After 1 year, the lesion was resolved completely, the respective tooth and the cheek were asymptomatic, and the patient had no complaint.

Cleaning efficacy of EDDY versus ultrasonically-activated irrigation in root canals: a systematic review and meta-analysis

BACKGROUND

Ultrasonically-activated irrigation (UAI) is effective in root canal irrigation but may damage canal walls. EDDY is a sonic activation system with flexible working tips that cause no harm to dentinal walls. This review explores the intracanal cleaning efficacy of EDDY compared with UAI in vitro.

METHODS

The systematic review was registered in the PROSPERO database (CRD42021235826). A literature search was conducted in six electronic databases. In vitro studies that compared the removal of smear layer, debris, soft tissue or microbes in root canals between EDDY and UAI were included. Data extraction and quality assessment were performed. Meta-analyses were conducted on smear layer removal and debris elimination with the standardized mean difference (SMD). Heterogeneity was measured using the I² test and the Chi² test. The random-effect model was used when I² > 50%, or p < 0.1, otherwise the fixed-effect model was applied. The level of significance was set at p < 0.05.

RESULTS

19 articles were included in this systematic review and 7 articles were included in meta-analyses. Meta-analyses on smear layer removal showed unimportant differences between EDDY and UAI at any canal third (coronal [SMD = 0.08, 95% confidence interval (95%CI): -0.29 to 0.45; p = 0.44, I² = 0%]; middle [SMD = 0.02, 95% CI: -0.44 to 0.47; p = 0.94, I² = 0%]; apical [SMD = 0.01, 95%CI: -0.35 to 0.38; p = 0.70, I² = 0%]). Meta-analyses on debris removal evaluated by scanning electron microscope (coronal [SMD = 0.03, 95% CI: -0.41 to 0.46; p = 0.27, I² = 23%]; middle [SMD = -0.24, 95% CI: -0.83 to 0.35; p = 0.80, I² = 0%]; apical [SMD = 0.24, 95%CI: -0.20 to 0.67; p = 0.36, I² = 2%]) and micro-CT (SMD = 0.36, 95% CI: -0.67 to 1.40; p = 0.03, I² = 70%) both found insignificant differences. No meta-analysis was undertaken on soft-tissue removal and disinfection due to the various study designs, but the qualitative analyses implied that EDDY achieved similar performance to UAI in both aspects.

CONCLUSIONS

Limited evidence indicated that EDDY was comparable to UAI in removing smear layer, debris, soft tissue and microbes ex vivo. Considering UAI may damage canal walls, EDDY might be a substitute for UAI in irrigation activation. But more randomized clinical trials are required to explore the clinical extrapolation of the results in this review.

Evaluation of the Antibacterial Effect of Xylene, Chloroform, Eucalyptol, and Orange Oil on Enterococcus faecalis in Nonsurgical Root Canal Retreatment: An Ex Vivo Study

Objectives

The present ex vivo study is aimed at evaluating the antibacterial efficacy of chloroform, eucalyptol, orange oil, and xylene against E. faecalis biofilm during nonsurgical root canal retreatment.

Materials and Methods

Eighty single-rooted teeth were instrumented. The samples were autoclaved, infected with E. faecalis for 4 weeks, and obturated with gutta-percha. Then the teeth were randomly assigned to 4 groups (n = 20): (1) chloroform, (2) eucalyptol, (3) orange oil, and (4) xylene. In all of the groups, gutta-percha removal was conducted according to the same protocol although the solvent used in each group was different. Bacterial samples were collected after gutta-percha removal and following additional apical enlargement. Intergroup and intragroup analyses were conducted using one-way ANOVA combined with the post hoc Tukey test and the paired-sample t-test, respectively. Statistical significance was set to 0.05.

Results

All of the groups showed more than 99% bacterial load reduction. The least bacterial load after gutta-percha removal was observed in the chloroform group (p < 0.001). The orange oil group showed a significantly lower bacterial load compared to the eucalyptol group (p = 0.001), while it was not different from the xylene group (p = 0.953). The xylene group also had a significantly lower bacterial load compared with the eucalyptol group (p = 0.017). After apical enlargement, the chloroform group had a significantly lower bacterial load compared to the other groups. The comparison of bacterial load values before and after apical enlargement in the chloroform and eucalyptol groups showed a statistically significant difference (p_choloroform = 0.011, p_eucalyptol = 0.001).

Conclusion

Chloroform was the most effective solvent in terms of antimicrobial activity against E. faecalis followed by orange oil and xylene, which were not significantly different though, and eucalyptol. All of the solvents showed more than 99% bacterial load reduction. Chloroform and xylene revealed to be associated with favorable antibiofilm activity among the examined solvents.

Reduction of dual-species biofilm after sonic- or ultrasonic-activated irrigation protocols: A laboratory study

AIM

To evaluate the antibacterial effect of sonic- and ultrasonic-activated irrigation on bacterial reduction of a dual-species biofilm in root canals compared to nonactivated irrigation in a laboratory study.

METHODOLOGY

Two hundred and forty extracted human single-rooted maxillary anterior teeth were divided into two main groups (G, n = 120) according to the initial preparation size of the root canal (G1: size 25, 0.06 taper, G2: size 40, 0.06 taper). Root canals were inoculated with Enterococcus faecalis and Streptococcus oralis. After 5 days, G1 received combined instrumentation (up to size 40, 0.06 taper) and irrigation/activation, whereas G2 received solely irrigation/activation protocols. In both groups, irrigation was performed with sodium hypochlorite (NaOCl 1%) or physiological saline (NaCl 0.9%), using nonactivated syringe irrigation, sonic activation (2 x 30 s) or ultrasonic activation (2 x 30 s). Logarithmic reduction factors (LRFs) of colony-forming units were analysed separately for dentine-adherent and planktonic bacteria immediately after irrigation/activation protocols (time-point 1) or after 5 days of further incubation (time-point 2) by analysis of variance (anova) and post hoc tests (Tukey's HSD, t-test). The significance level was set at 0.05.

RESULTS

In G1 subgroups (combined instrumentation with irrigation/activation), LRFs were significantly affected by the applied irrigation solution (p < .0001), but not by the activation method (p > .05; anova). In G2 subgroups (solely irrigation/activation), both, irrigant solution and activation, significantly affected LRFs (p < .0001, anova). Sonic activation resulted in significantly higher LRFs than ultrasonic activation (p < .0001) which had significantly greater reductions than nonactivated irrigation (p < .05; Tukey's HSD). At T2, strong bacterial regrowth was observed in all groups; however, a significant bacterial reduction was detected for factors instrumentation, irrigant solution and activation (p < .0001; anova). Similar LRFs were found for dentine-adherent and planktonic bacterial cells in all groups (r = 0.91 at T1, r = 0.8 at T2).

CONCLUSIONS

In this laboratory study on extracted maxillary anterior teeth high-frequency sonic activation resulted in a greater bacterial reduction compared to ultrasonic activation in groups receiving solely irrigation/activation protocols; however, irrigation using NaOCl and ultrasonic activation also contributed significantly to bacterial reduction compared to the control groups.

Detection, treatment and prevention of endodontic biofilm infections: what's new in 2020?

Endodontic disease, a biofilm infection of the root canal space, is a significant cause of dental morbidity worldwide. Endodontic treatment, or root canal treatment, as it is commonly known is founded on the ability to eradicate microbial biofilm infection and prevent re-infection of the highly complex root canal space. Despite many "advances" in clinical endodontics we have seen little improvement in outcomes. The aim of this critical review paper is to provide a contemporary view of endodontic microbiology and biofilm polymicrobiality, provide an understanding of the host response, and how together these impact upon clinical treatment. Ultimately, it is intended to provide insight into novel opportunities and strategies for the future diagnostics, treatment, and prevention of endodontic disease.