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Alghofaily M, Alfraih J, Alsaud A, Almazrua N, Sumague TS, Auda SH, Alsalleeh F. The Effectiveness of Silver Nanoparticles Mixed with Calcium Hydroxide against Candida albicans: An Ex Vivo Analysis. Microorganisms 2024; 12:289. [PMID: 38399693 PMCID: PMC10891542 DOI: 10.3390/microorganisms12020289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION The purpose of this study was to assess the antifungal activity of silver nanoparticles (AgNPs) in combination with calcium hydroxide (Ca(OH)2) against Candida albicans (C. albicans). METHODS AgNPs was mixed with pure Ca(OH)2 powder in an aqueous base. A standard suspension (1 × 108 bacterial cells/mL) of C. albicans was prepared in a 96-well plate and incubated on shaker at 37 °C in 100% humidity to allow fungal biofilm formation in infected dentin slices (n = 98). The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of AgNPs alone or with Ca(OH)2 were determined. The samples were separately placed in 24-well tissue culture plates and divided into three experimental groups (0.03, 0.04, and 0.06) and three control groups; negative (saline) and positive chlorhexidine gel and Ca(OH)2. Quantitative measurements of fungal activity by XTT colorimetric assay and qualitative measurements using confocal laser microscopy and scanning electron microscopy were performed. RESULTS The cell viability of C. albicans in the experimental groups was significantly reduced compared to the negative control group. The combination of (AgNPs (0.04%) and Ca(OH)2) was the most potent against C. albicans. CONCLUSIONS The findings demonstrated that combining silver nanoparticles with Ca(OH)2 was more effective against C. albicans biofilm compared to Ca(OH)2 alone, suggesting a combing effect.
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Affiliation(s)
- Maha Alghofaily
- Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia;
| | - Jood Alfraih
- College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia; (J.A.); (N.A.)
| | - Aljohara Alsaud
- College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia; (J.A.); (N.A.)
| | - Norah Almazrua
- College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia; (J.A.); (N.A.)
| | - Terrence S. Sumague
- Molecular and Cell Biology Laboratory, Prince Naif Bin AbdulAziz Health Research Center, College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia;
| | - Sayed H. Auda
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11461, Saudi Arabia;
| | - Fahd Alsalleeh
- Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh 11461, Saudi Arabia;
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Gill S, Tabiyar K, Balachandran R, Priya H, Agarwal D, Sharma S, Kumar V, Chawla A, Logani A. Influence of intracanal medicaments on the periodontal and periapical healing in concurrent endodontic-periodontal lesions with/without communication: a systematic review and meta-analysis. Clin Oral Investig 2023; 27:6371-6382. [PMID: 37837467 DOI: 10.1007/s00784-023-05286-7] [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: 06/12/2023] [Accepted: 09/26/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES The purpose of this review is to determine the effectiveness of intracanal medicament (ICM) on periodontal and periapical healing (PH) of concurrent endodontic-periodontal lesions with/without communication in permanent teeth. MATERIALS AND METHODS The pre-defined protocol was registered in PROSPERO, and a literature search using keywords was conducted on PubMed, Scopus, Cochrane, Embase electronic databases, and Gray literature and was hand-searched until August 2023. Two reviewers independently screened the title and abstracts using the inclusion criteria. Randomized or non-randomized clinical trials, cohort studies, and case-control studies were included in the review. The same reviewers extracted the study-level data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 and the Newcastle-Ottawa Scale (NOS) independently. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence. Random effects meta-analysis was performed on eligible studies using Revman software. RESULTS A total of 598 records were identified from the database search; seven studies met the inclusion criteria and were included in the review. Four randomized clinical trials, two prospective cohorts, and one retrospective case-control study with 362 patients were included. Calcium hydroxide (CH) was the most commonly used ICM, followed by using chlorhexidine gel in four studies. Periodontal therapy was performed as initial scaling and root planning (SRP) in all studies, along with open flap debridement (OFD) in three randomized clinical trials. The time lapse between two treatment protocols was variable (ranging from 1 week to 3 months). All studies exhibited a decrease in probing depth (PD) and an increase in clinical attachment level (CAL) after the treatment. Meta-analysis showed insignificant differences between different ICM materials, and the certainty of evidence was low. CONCLUSION In patients with/without concurrent endodontic-periodontal lesions, intracanal medication improved clinical periodontal parameters following endodontic therapy. In terms of influence on periapical healing, the results were inconclusive. CLINICAL RELEVANCE Two-visit RCT may be considered since it allows for the placement of an ICM in endodontic-periodontal lesions with/without communication. Sufficient time should be allowed after endodontic therapy for any potential periodontal regeneration to occur.
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Affiliation(s)
- Sarita Gill
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Krunal Tabiyar
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rajiv Balachandran
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Harsh Priya
- Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Deepali Agarwal
- Division of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sidhartha Sharma
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vijay Kumar
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Amrita Chawla
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Ajay Logani
- Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India
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Rôças IN, Provenzano JC, Neves MS, Alves FR, Gonçalves LS, Siqueira JF. Effects of calcium hydroxide paste in different vehicles on bacterial reduction during treatment of teeth with apical periodontitis. J Endod 2022; 49:55-61. [DOI: 10.1016/j.joen.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/29/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
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Bang JY, Youn KE, Kim RH, Song M. Effect of the amnion-chorion or collagen membrane as a matrix on the microenvironment during a regenerative endodontic procedure. J Endod 2022; 48:1285-1293.e2. [PMID: 35850299 DOI: 10.1016/j.joen.2022.07.005] [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: 03/11/2022] [Revised: 06/13/2022] [Accepted: 07/06/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION During regenerative endodontic procedures, the microenvironment of the canal is formed by the degree of disinfection and release of ions from the applied materials onto the top surface. This study aimed to characterize the effects of amnion-chorion membrane (ACM) and collagen membrane (CM) on pulp-dentin regeneration compared to calcium silicate cements (CSCs), focusing on cell migration, mineralization potential, anti-inflammation, and angiogenesis. METHODS Two CSCs and two membranes were used: ProRoot® MTA (PM; Dentsply, Tulsa, OK, USA), RetroMTA® (RM; BioMTA, Seoul, Korea), Collagen Membrane® (CM; Genoss, Suwon, Korea), and BioXclude® (ACM; Snoasis Medical, Colorado, USA). Transwell and scratch assays were used to evaluate cell migration and wound healing. Mineralization potential was evaluated using alkaline phosphatase (ALP) activity, alizarin red S staining, and quantitative real-time-polymerase chain reaction (qRT-PCR) for the expression of marker genes. qRT-PCR was used to measure the levels of angiogenic genes and inflammatory mediators. An endothelial tube formation assay was used to assess angiogenesis. RESULTS The membranes showed superior migration and wound healing compared with CSCs. Except for RM, PM and the two membranes showed high ALP activity and mineralization nodule formation and upregulated mRNA expression of markers for mineralization. Membranes upregulated the mRNA of angiogenesis genes and increased the capillary tube formation of endothelial cells compared to CSCs. Furthermore, the membrane matrix decreased the expression of inflammatory genes. CONCLUSIONS CM and ACM showed prominent cell migration, angiogenesis, and healing effects against inflammation, as well as comparable mineralization potential compared to CSCs, recommending the use of membrane as a matrix.
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Affiliation(s)
- Ji Young Bang
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
| | - Kyeong Eun Youn
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
| | - Reuben H Kim
- The Shapiro Family Laboratory of Viral Oncology and Aging Research, UCLA School of Dentistry, Los Angeles, CA, USA; Section of Restorative Dentistry, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Minju Song
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea; Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, Korea.
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Ordinola-Zapata R, Noblett C, Perez-Ron A, Ye Z, Vera J. Present status and future directions of intracanal medicaments. Int Endod J 2022; 55 Suppl 3:613-636. [PMID: 35322427 PMCID: PMC9321724 DOI: 10.1111/iej.13731] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
Two fundamental goals of endodontic treatment are to prevent or treat apical periodontitis. From a predictive perspective, several variables can affect the outcome of root canal treatment. Some of these variables depend on intraoperative factors, which include irrigation technique, size of the apical preparation, use of intracanal medicaments or the number of appointments necessary to complete the treatment. However, the outcome may also be affected by host and microbial factors. The intensity of periradicular bone loss or tissue damage, the presence of preoperative pain and associated conditions such as mechanical allodynia and central sensitization, the anatomical complexity of the apical portion of the canal, and the virulence and longevity of the bacterial infection can all have a profound influence on the outcome. Furthermore, numerous medical conditions have been reported to decrease the capability of the immune system to heal the periapical tissues. It is the clinician's responsibility to analyse these variables and incorporate them into the disinfection strategy to maximize the chances of healing. This narrative review will focus on the present status of intracanal medicaments, the clinical indications for their use and future directions for research.
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Affiliation(s)
- R Ordinola-Zapata
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - C Noblett
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | | | - Z Ye
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R, China.,Minnesota Dental Research Center for Biomaterials and Biomechanics (MDRCBB), School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - J Vera
- Division of Endodontics, School of Dentistry, University of Missouri, Kansas City, MO, USA
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Djorić D, Minton NE, Kristich CJ. The enterococcal PASTA kinase: A sentinel for cell envelope stress. Mol Oral Microbiol 2020; 36:132-144. [PMID: 32945615 DOI: 10.1111/omi.12313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
Enterococci are Gram-positive, opportunistic pathogens that reside throughout the gastrointestinal tracts of most terrestrial organisms. Enterococci are resistant to many antibiotics, which makes enterococcal infections difficult to treat. Enterococci are also particularly hardy bacteria that can tolerate a variety of environmental stressors. Understanding how enterococci sense and respond to the extracellular environment to enact adaptive biological responses may identify new targets that can be exploited for development of treatments for enterococcal infections. Bacterial eukaryotic-like serine/threonine kinases (eSTKs) and cognate phosphatases (STPs) are important signaling systems that mediate biological responses to extracellular stimuli. Some bacterial eSTKs are transmembrane proteins that contain a series of extracellular repeats of the penicillin-binding and Ser/Thr kinase-associated (PASTA) domain, leading to their designation as "PASTA kinases." Enterococcal genomes encode a single PASTA kinase and its cognate phosphatase. Investigations of the enterococcal PASTA kinase revealed its importance in resistance to antibiotics and other cell wall stresses, in enterococcal colonization of the mammalian gut, clues about its mechanism of signal transduction, and its integration with other enterococcal signal transduction systems. In this review, we describe the current state of knowledge of PASTA kinase signaling in enterococci and describe important gaps that still need to be addressed to provide a better understanding of this important signaling system.
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Affiliation(s)
- Dušanka Djorić
- Department of Microbiology and Immunology, Center for Infectious Disease Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nicole E Minton
- Department of Microbiology and Immunology, Center for Infectious Disease Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher J Kristich
- Department of Microbiology and Immunology, Center for Infectious Disease Research, Medical College of Wisconsin, Milwaukee, WI, USA
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Raoof M, Khaleghi M, Siasar N, Mohannadalizadeh S, Haghani J, Amanpour S. Antimicrobial Activity of Methanolic Extracts of Myrtus Communis L. and Eucalyptus Galbie and their Combination with Calcium Hydroxide Powder against Enterococcus Faecalis. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2019; 20:195-202. [PMID: 31579695 PMCID: PMC6732178 DOI: 10.30476/dentjods.2019.44898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Statement of the Problem: The goal of endodontic therapy is the reduction or elimination of microorganisms from the root canal system. The use of intracanal medicament between treatment appointments is recommended in order to eliminate any remainang microorganisms in the pulp space.
Purpose: The aim of the present study was to investigate the antimicrobial activity of methanolic extracts of Myrtus communis L.
and Eucalyptus galbie, their combination with calcium hydroxide powder; combination of calcium hydroxide powder with water,
and ready-to-use calcium hydroxide paste with iodoform; against Enterococcus faecalis.
Materials and Method: In this experimental study, after gathering the plants, their methanolic extracts were obtained by masceration method. The diameters of inhibition zone of all mentioned materials were determined by agar diffusion test. Minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC); and anti biofilm effect of the materials that showed antibacterial effect in agar diffusion test, were then evaluated by tube dilution test, and microtiter plate assay followed by colorimetric crystal violet methods, respectively.
Results: After 48 hours, both herbal extracts showed antimicrobial effect. However, combination of calcium hydroxide with extracts produced no zone of inhibition.
The mean inhibition zone of Eucalyptus extract was more than that of Myrtus. However, the results of ANOVA test, showed that there was no significant difference
between the antibacterial effect of Eucalyptus galbie, Myrtus communis L. and positive control (Cefoxitin) (p Value= 0.987). The MIC for both extracts were 12.5 mg/ml.
MBC evaluation of the two methanolic extracts showed no bactericidal effect on Enterococcus faecalis. Based on ELISA analysis, biofilm formation in response to different
sub-MIC concentrations of both extracts was scored as weak to moderate.
Conclusion: The methanolic extracts of Eucalyptus galbie and Myrtus communis L. in combination with calcium hydroxide powder were not able to eliminate Enterococcus faecalis within 48 hours.
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Affiliation(s)
- Maryam Raoof
- Dept. of Endodontology, Endodontology Research Center, Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Moj Khaleghi
- Dept. of Biology, Faculty of Sciences, Shahid Bahonar University, Kerman, Iran
| | - Najmeh Siasar
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Sakineh Mohannadalizadeh
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Jahangir Haghani
- Dept. of Maxillofacial Radiology, Kerman School of Dentistry, Kerman, Iran
| | - Sara Amanpour
- Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Savitha A, SriRekha A, Vijay R, Ashwija, Champa C, Jaykumar T. An in vivo comparative evaluation of antimicrobial efficacy of chitosan, chlorhexidine gluconate gel and their combination as an intracanal medicament against Enterococcus faecalis in failed endodontic cases using real time polymerase chain reaction (qPCR). Saudi Dent J 2019; 31:360-366. [PMID: 31337941 PMCID: PMC6626259 DOI: 10.1016/j.sdentj.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/24/2019] [Accepted: 03/03/2019] [Indexed: 01/22/2023] Open
Abstract
Aim To evaluate the in vivo antibacterial efficacy of 2% chlorhexidine gel (CHX), 2% chitosan (CS) gel and their combination as an intracanal medicament against Enterococcus faecalis during endodontic retreatment procedure, with the use of qPCR. Method A total of 45 single rooted permanent teeth were selected from 28 systemically healthy patients (mean age of 43 years). After complete disinfection and access opening as well as gutta-percha (GP) removal, the first microbiological pretreatment sample (S1) was collected. After completion of instrumentation, a post-instrumentation sample (S2) was taken and the teeth were randomly divided into three experimental groups: 2% CHX gel; 2% CS gel; 2% CHX with CS; Fuji IX glass ionomer cement was used to seal the access; after 7 days, the post medication sample (S3) was collected and E. faecalis was quantified using qPCR. Results Maximum reduction in bacterial mean CFU (×106) counts was observed between S1 and S2; S2 and S3; S1 and S3 in 2% CHX with chitosan group compared to other groups. Percentage reduction in CFU (×106) counts at different time intervals (S1-S2; S2-S3; S1-S3) was maximum for the 2% CHX with the chitosan group. Comparison of the mean CFU (×106) count within the 2% CHX gel group and the 2% CHX with chitosan group at different time intervals (S1,S2,S3) was found to be highly significant (P = 0.001); whereas in group II, it was significant (P = 0.002). Conclusion 2% CHX with chitosan group showed the highest microbial reduction against E. faecalis during retreatment of failed endodontic cases.
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Affiliation(s)
- A Savitha
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
| | - A SriRekha
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
| | - R Vijay
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
| | - Ashwija
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
| | - C Champa
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
| | - T Jaykumar
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
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In Vivo Study of Calcium Hydroxide Endodontic Treatment in Chronic Apical Periodontitis. ARS MEDICA TOMITANA 2019. [DOI: 10.2478/arsm-2018-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study was to evaluate the in vivo efficiency of endodontic treatment with calcium hydroxide in chronic apical periodontitis by determining the microbial load from the endodontic space in different stages of treatment. The microbiological determinations that have been made have led to the conclusion that calcium hydroxide possesses a redoubltable antimicrobial activity, but only with the condition of long-lasting contact with the root canals. Another important result is the essential role of the rigorous biomechanical treatment of the root canals, intracanal medication with calcium hydroxide is addresses mostly to microorganisms located in root canal ramifications.
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Lima TFR, Ascendino JF, Cavalcante IDO, D Assunção FLC, Salazar-Silva JR, Silva EJNLD, Lemos SG, Soares ADJ. Influence of chlorhexidine and zinc oxide in calcium hydroxide pastes on pH changes in external root surface. Braz Oral Res 2019; 33:e005. [PMID: 30758405 DOI: 10.1590/1807-3107bor-2019.vol33.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/08/2018] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to assess the influence of chlorhexidine (liquid and gel) and zinc oxide in calcium hydroxide (CH) pastes on root pH in simulated external resorption. One hundred human anterior teeth with a single root canal were selected. After decoronation and root canal instrumentation, the specimens were divided into 4 experimental groups and 1 control group (without intracanal paste): CH + saline (CH+S), CH + 2% chlorhexidine liquid (CH+ CHX), CH + 2% chlorhexidine gel (CH+ CHXg), and CH + 2% chlorhexidine gel + zinc oxide (CH+ CHXg+ZnO). pH was measured using a microelectrode at 3 and 24 h, and 1, 2, 3, and 4 weeks after inserting intracanal pastes. Data were analyzed statistically using an ANOVA and Tukey's test (p < 0.05). The CH+CHXg+ZnO group had the highest pH values throughout (p<0.05). The CH+S and CH+ CHX groups had the highest pH values after 1 week and the CH+ CHXg group after 2 weeks. CH+ CHXg maintained the highest pH until the fourth week compared with CH+ CHX (p < 0.05). The control group remained at a neutral pH at all evaluated times. It can be concluded that chlorhexidine solution or gel maintained the alkaline pH of CH, and chlorhexidine gel allowed a slower decrease in pH over time. CH+ CHXg+ZnO showed the highest pH values and was an effective intracanal medication for maintaining alkaline root pH in the area of resorption.
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Affiliation(s)
- Thiago Farias Rocha Lima
- Universidade Federal da Paraiba - UFPB, Endodontics Area, Department of Restorative Dentistry, João Pessoa, PB, Brazil
| | | | | | - Fabio Luiz Cunha D Assunção
- Universidade Federal da Paraiba - UFPB, Endodontics Area, Department of Restorative Dentistry, João Pessoa, PB, Brazil
| | - Juan Ramon Salazar-Silva
- Universidade Federal da Paraiba - UFPB, Endodontics Area, Department of Restorative Dentistry, João Pessoa, PB, Brazil
| | | | | | - Adriana de Jesus Soares
- Universidade Estadual de Campinas - Unicamp, School of Dentistry of Piracicaba, Department of Restorative Dentistry, Piracicaba, SP, Brazil
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Madarati AA, Zafar MS, Sammani AMN, Mandorah AO, Bani-Younes HA. Preference and usage of intracanal medications during endodontic treatment. Saudi Med J 2018; 38:755-763. [PMID: 28674723 PMCID: PMC5556285 DOI: 10.15537/smj.2017.7.18345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To investigate the preferences of general dental practitioners (GDPs) and endodontists in using endodontic intra-canal medications (ICMs). Methods: This observational and descriptive study was conducted in 2014 in the western province of Saudi Arabia. Following ethical clearance and 2 pilot studies, a web-based questionnaire was electronically sent to 375 randomly and systematically selected GDPs and all endodontists in the western province (n=49). An accompanying e-mail explained the study’s aims and confirmed that the data yielded would remain confidential. The responses were collected, and the data was analyzed using the Chi-square test at p=0.05. Results: Significantly, the highest proportion of respondents (53.7%) reported disinfection of the root canals as the main function of ICMs. Calcium hydroxide (CH) was the preferred material of the majority of those who used the same ICM in all cases (85.7%). While the vast majority of all endodontists (87.5%) used CH after pulp extirpation, 48.5% of GDPs used formocresol (p<0.001). Almost 30% of those who used ICMs after pulp extirpation did not do so after cleaning and shaping of vital cases. Most endodontists used CH (62.5%) and antibiotics (37.5%) in necrotic pulp cases without apical lesions, which were significantly greater than those of GDPs who did the same (43.8% and 17.2%). Conclusions: Participants were aware that the main function of ICMs is disinfection of the root canal system. However, it is clear that GDPs should reduce their reliance on phenol- and formaldehyde-based medications. There was a distinct trend toward the use of ICMs, especially CH, in necrotic pulp cases.
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Affiliation(s)
- Ahmad A Madarati
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Makkah, Kingdom of Saudi Arabia. E-mail.
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12
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Mohammadi Z, Jafarzadeh H, Shalavi S. Antimicrobial efficacy of chlorhexidine as a root canal irrigant: a literature review. J Oral Sci 2016; 56:99-103. [PMID: 24930745 DOI: 10.2334/josnusd.56.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Use of an appropriate root canal irrigant is essential during endodontic treatment, due to the complex and unpredictable anatomy of the root canal system and limitations in the mechanical instrumentation techniques used to obtain a clean, bacteria-free canal. Several irrigants, such as sodium hypochlorite, chlorhexidine, hydrogen peroxide, and normal saline, have been proposed as canal system irrigants in endodontic treatment. The widely used endodontic irrigant chlorhexidine is a positively charged lipophilic/hydrophobic molecule that interacts with phospholipids and lipopolysaccharides on the bacterial cell membrane. In endodontics, its mode of antibacterial activity is determined by its concentration (0.2% or 2%). This article reviews findings from available endodontic studies on the antibacterial, antifungal, and antibiofilm activities of chlorhexidine.
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Affiliation(s)
- Zahed Mohammadi
- Iranian Center for Endodontic Research, Shahid Beheshti University of Medical Sciences
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Ghatole K, Gowdra RHG, Azher S, Sabharwal S, Singh VT, Sundararajan BV. Enhancing the antibacterial activity of the gold standard intracanal medicament with incorporation of silver zeolite: An in vitro study. J Int Soc Prev Community Dent 2016; 6:75-9. [PMID: 27011937 PMCID: PMC4784069 DOI: 10.4103/2231-0762.175418] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Enterococcus faecalis is a persistent organism that plays a major role in the etiology of persistent periradicular lesions after root canal treatment has been associated with different forms of periradicular disease including primary endodontic infections and persistent infections. The present study compares the antibacterial activities of calcium hydroxide, calcium hydroxide mixed with silver zeolite, and calcium hydroxide mixed with 2% chlorhexidine against E. faecalis using direct contact test. Materials and Methods: The test materials of the in vitro experimental study were grouped as group 1—calcium hydroxide mixed with sterile water, group 2—2% silver zeolite added in calcium hydroxide mixed with sterile water, and group 3—calcium hydroxide mixed with 2% chlorhexidine. The bottom of microtiter plate were coated with freshly mixed tested material and a 10 μL of bacterial suspension was placed. After 1 h of incubation at 37°C, brain–heart infusion (BHI) broth (245 μL) was added and mixed for 2 min. These were designated as “subgroup 1” wells. A volume of 15 μL of broth then transferred from subgroup 1 wells to an adjacent set of four wells containing fresh BHI medium (215 μL); these wells were designated as “subgroup 2”’ wells. The optical density was measured by a spectrophotometer after the first day, third day, and seventh day. One-way analysis of variance (ANOVA) and Tukey tests were performed for the analysis. Results: Calcium hydroxide mixed with silver zeolite showed maximum antibacterial activity. Conclusion: Silver zeolite can be added in calcium hydroxide to enhance the latter's antibacterial activity against E. faecalis.
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Affiliation(s)
- Kiran Ghatole
- Department of Conservative Dentistry and Endodontics, Sri Sai College of Dental Surgery, Telangana, India
| | | | - Samer Azher
- Department of Conservative Dentistry and Endodontics, Sri Sai College of Dental Surgery, Telangana, India
| | - Sumit Sabharwal
- Department of Conservative Dentistry and Endodontics, Saraswati Dental College and Hospital, Uttar Pradesh, India
| | - Veerandar T Singh
- Department of Conservative Dentistry and Endodontics, Sri Sai College of Dental Surgery, Telangana, India
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Menakaya IN, Oderinu OH, Adegbulugbe IC, Shaba OP. Incidence of postoperative pain after use of calcium hydroxide mixed with normal saline or 0.2% chlorhexidine digluconate as intracanal medicament in the treatment of apical periodontitis. Saudi Dent J 2015; 27:187-93. [PMID: 26644753 PMCID: PMC4642190 DOI: 10.1016/j.sdentj.2015.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 11/23/2014] [Accepted: 01/26/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To compare the incidence of postoperative pain after the use of calcium hydroxide powder mixed with normal saline or 0.2% chlorhexidine digluconate as intracanal medicament. PARTICIPANTS Fifty-five subjects aged 17-60 years with teeth diagnosed to have apical periodontitis. INTERVENTION Two-visit conventional root canal treatment of seventy teeth. The teeth were divided by randomization (balloting) into two groups: control group and experimental group, each with thirty-five teeth treated with calcium hydroxide mixed with normal saline or with 0.2% chlorhexidine digluconate as intracanal medicament respectively. Incidence of postoperative pain was assessed using the universal pain assessment tool and whether or not analgesic was taken. MAIN OUTCOME MEASURED Incidence of post-operative pain. RESULT Postoperative pain occurred only at 1-day and 1-week reviews. In the control group, the overall incidence of pain was the same at both review periods (5.7%), while the experimental group showed a slight decrease in incidence between 1-day (17.2%) and 1-week (11.4%) reviews. Incidence of flare-ups was more in the experimental group (11.4%) than in the control group (5.7%). No significant statistical differences between the two groups were observed (p > 0.05). CONCLUSION The incidence of postoperative pain was lower in the normal saline treatment group, but the difference was not statistically significant.
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Affiliation(s)
| | - Olabisi Hajarat Oderinu
- Department of Restorative Dentistry, Faculty of Dental Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Nigeria
| | - Ilemobade Cyril Adegbulugbe
- Department of Restorative Dentistry, Faculty of Dental Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Nigeria
| | - Olufemi Peter Shaba
- Department of Restorative Dentistry, Faculty of Dental Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Nigeria
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15
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Saatchi M, Shokraneh A, Navaei H, Maracy MR, Shojaei H. Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis. J Appl Oral Sci 2015; 22:356-65. [PMID: 25466470 PMCID: PMC4245746 DOI: 10.1590/1678-775720140032] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/15/2014] [Indexed: 11/22/2022] Open
Abstract
Objective Enterococcus faecalis (E. faecalis) is the most
frequently isolated strain in failed endodontic therapy cases since it is
resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine
(CHX) is more effective than CH alone against E. faecalis is a matter of
controversy. Thus, the aim of this study was to conduct a systematic review and
meta-analysis of the literature. Material and Methods A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO,
and BBO databases, Clinical trials registers, Open Grey, and conference
proceedings from the earliest available date to February 1, 2013 was carried out
and the relevant articles were identified by two independent reviewers. Backward
and forward search was performed and then inclusion and exclusion criteria were
applied. The included studies were divided into "comparisons" according to the
depth of sampling and dressing period of each medicament. Meta-analysis was
performed using Stata software 10.0. The level of significance was set at
0.05. Results Eighty-five studies were retrieved from databases and backward/forward searches.
Fortyfive studies were considered as relevant (5 in vivo, 18
in vitro, 18 ex vivo, and 4 review articles).
Nine studies were included for meta-analysis. Inter-observer agreement (Cohen
kappa) was 0.93. The included studies were divided into 21 comparisons for
meta-analysis. Chi-square test showed the comparisons were heterogeneous
(p<0.001). Random effect model demonstrated no significant difference between
CH/CHX mixture and CH alone in their effect on E. faecalis
(p=0.115). Conclusions According to the evidence available now, mixing CH with CHX does not significantly
increase the antimicrobial activity of CH against E. faecalis. It
appears that mixing CH with CHX does not improve its ex vivo
antibacterial property as an intracanal medicament against E.
faecalis. Further in vivo studies are necessary to
confirm and correlate the findings of this study with the clinical outcomes.
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Affiliation(s)
- Masoud Saatchi
- Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Shokraneh
- Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hooman Navaei
- Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hasan Shojaei
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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Menakaya IN, Adegbulugbe IC, Oderinu OH, Shaba OP. The Efficacy of Calcium Hydroxide Powder mixed with 0.2% Chlorhexidine Digluconate or mixed with Normal Saline as Intracanal Medicament in the Treatment of Apical Periodontitis. J Contemp Dent Pract 2015; 16:657-664. [PMID: 26423502 DOI: 10.5005/jp-journals-10024-1737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To compare the efficacy of calcium hydroxide powder mixed with 0.2% chlorhexidine digluconate or mixed with normal saline as intracanal medicament in the treatment of apical periodontitis. MATERIALS AND METHODS Subjects were 55 in number aged 17 to 60 years. Two-visit conventional root canal treatment was performed on 70 teeth. The teeth were divided by randomization (balloting) into two groups: control group and experimental group, each with 35 teeth treated with calcium hydroxide mixed with normal saline or with 0.2% chlorhexidine digluconate as intracanal medicament respectively. All treated teeth were evaluated clinically and radiographically for signs and symptom of periapical infection at specified periods postoperatively. Overall efficacy of medicament was rated based on quality guidelines for endodontic treatment by the European Society of Endodontology 2006. RESULTS A postoperative favorable outcome of 97.1% in the control group and 94.3% in the experimental group was observed at 6-month review. This difference was not statistically significant (p > 0.05). CONCLUSION The use of normal saline or 0.2% chlorhexidine digluconate to mix calcium hydroxide used as intracanal medicament during endodontic treatment resulted in high postoperative favorable outcomes. CLINICAL SIGNIFICANCE Efficacy of 0.2% chlorhexidine digluconate as a vehicle for mixing calcium hydroxide as an intracanal medicament in the treatment of apical periodontitis is comparable to the efficacy of calcium hydroxide mixed with normal saline.
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Affiliation(s)
- Ifeoma N Menakaya
- Department of Restorative Dentistry, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ilemobade C Adegbulugbe
- Department of Restorative Dentistry, Faculty of Dental Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olabisi H Oderinu
- Senior Lecturer, Department of Restorative Dentistry, Faculty of Dental Sciences, College of Medicine University of Lagos, PM B12003, Lagos, Nigeria, e-mail:
| | - Olufemi P Shaba
- Department of Restorative Dentistry, Faculty of Dental Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
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Rodrigues RCV, Antunes HS, Neves MAS, Siqueira JF, Rôças IN. Infection Control in Retreatment Cases: In Vivo Antibacterial Effects of 2 Instrumentation Systems. J Endod 2015; 41:1600-5. [PMID: 26234543 DOI: 10.1016/j.joen.2015.06.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This in vivo study compared the antibacterial effects of 2 instrumentation systems in root canal-treated teeth with apical periodontitis. METHODS Forty-eight teeth with a single root and a single canal showing post-treatment apical periodontitis were selected for this study. For retreatment, teeth were randomly divided into 2 groups according to the instrumentation system used: Self-Adjusting File (SAF; ReDent-Nova, Ra'anana, Israel) and Twisted File Adaptive (TFA; SybronEndo, Orange, CA). In both groups, 2.5% sodium hypochlorite was the irrigant. Bacteriological samples were taken before (S1) and after chemomechanical preparation (S2). In the TFA group, passive ultrasonic irrigation (PUI) was performed after instrumentation, and samples were also taken after this supplementary step (S2b). DNA was extracted from the clinical samples and subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria, streptococci, and Enterococcus faecalis. Statistical analyses from quantitative real-time polymerase chain reaction data were performed within groups using the Wilcoxon matched pairs test and between groups using the Mann-Whitney U test and the Fisher exact test with the significance level set at P < .05. RESULTS Bacteria were detected in S1 samples from 43 teeth, which were then included in the antibacterial experiment. Both SAF and TFA instrumentation protocols showed a highly significant intracanal bacterial reduction (P < .001). Intergroup quantitative comparisons disclosed no significant differences between TFA with or without PUI and SAF (P > .05). PUI did not result in significant improvement in disinfection (P > .05). CONCLUSIONS Both instrumentation systems/treatment protocols were highly effective in significantly reducing the intracanal bacterial counts. No significant difference was observed between the 2 systems in disinfecting the canals of teeth with post-treatment apical periodontitis.
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Affiliation(s)
- Renata C V Rodrigues
- Molecular Microbiology Laboratory, Department of Endodontics, Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Henrique S Antunes
- Molecular Microbiology Laboratory, Department of Endodontics, Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Endodontics, Faculty of Dentistry, Grande Rio University, Duque de Caxias, Rio de Janeiro, Brazil
| | - Mônica A S Neves
- Molecular Microbiology Laboratory, Department of Endodontics, Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - José F Siqueira
- Molecular Microbiology Laboratory, Department of Endodontics, Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabela N Rôças
- Molecular Microbiology Laboratory, Department of Endodontics, Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil
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18
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Microbiological Profile Resistant to Different Intracanal Medications in Primary Endodontic Infections. J Endod 2015; 41:824-30. [DOI: 10.1016/j.joen.2015.01.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 11/17/2022]
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Kim D, Kim E. Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part II. in vivo studies. Restor Dent Endod 2014; 40:97-103. [PMID: 25984470 PMCID: PMC4432264 DOI: 10.5395/rde.2015.40.2.97] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022] Open
Abstract
The first part of this study reviewed the characteristics of calcium hydroxide (Ca(OH)2) and summarized the results of in vitro studies related to its antimicrobial effects. The second part of this review covers in vivo studies including human clinical studies and animal studies. The use of Ca(OH)2 as an intracanal medicament represented better histological results in animal studies. However, human clinical studies showed limited antimicrobial effects that microorganisms were reduced but not eliminated through the treatment, and that some species had resistance to Ca(OH)2. Most of clinical outcome studies supported that there is no improvement in healing of periapical lesions when Ca(OH)2 was applied between appointments. Further studies are required for the antimicrobial effects of Ca(OH)2, and search for the ideal material and technique to completely clean infected root canals should be continued.
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Affiliation(s)
- Dohyun Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
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20
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Endo MS, Ferraz CCR, Zaia AA, Almeida JFA, Gomes BPFA. Quantitative and qualitative analysis of microorganisms in root-filled teeth with persistent infection: Monitoring of the endodontic retreatment. Eur J Dent 2014; 7:302-309. [PMID: 24926210 PMCID: PMC4053619 DOI: 10.4103/1305-7456.115414] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: The aim of this study was to investigate in vivo microorganisms detected in root-filled teeth with post-treatment apical periodontitis and quantify colony-forming units (CFU) during endodontic retreatment. Materials and Methods: Fifteen root-filled teeth had their previous gutta-percha removed and were randomly instrumented before being divided into three groups and medicated with either [Ca(OH)2 + 2% CHX gel], [Ca(OH)2 + 0.9% NaCl] or 2% CHX gel. Samples were taken after removal of gutta-percha (S1), after chemomechanical preparation using 2% CHX gel (S2), and after inter-appointment dressing (S3) for 7 or 14 days later. Cultivable bacteria recovered from infected root canals at the three stages were counted and identified by means of culture and PCR assay (16S rDNA). Quantitative data were statistically analyzed by using Mann-Whitney test in which pairs of groups were compared (P < 0.05). Results: CFU counts decreased significantly from S1 to S2 (P < 0.05). No significant difference was found between S2 and S3 (P = 0.3093) for all three experimental groups. Chemomechanical preparation and intra-canal dressing promoted significant median reductions of 99.61% and 99.57%, respectively, in the number of bacteria compared to S1 samples. A total of 110 cultivable isolates were recovered by culture technique from 32 different species and 7 different genera. Out of the 13 target species-specific primer of bacteria analyzed, 11 were detected during endodontic retreatment. Conclusion: The great majority of taxa found in post-treatment samples were Gram-positive bacteria, although Gram-negative bacteria were found by molecular methods. Moreover, our results showed that gutta-percha removal and chemomechanical preparation are effective for root canal disinfection, whereas additional intra-canal dressing did not improve disinfection.
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Affiliation(s)
- Marcos S Endo
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School - State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Caio C R Ferraz
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School - State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Alexandre A Zaia
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School - State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Jose F A Almeida
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School - State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School - State University of Campinas - UNICAMP, Piracicaba, SP, Brazil
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21
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Early dentine remineralisation: Morpho-mechanical assessment. J Dent 2014; 42:384-94. [DOI: 10.1016/j.jdent.2014.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/14/2014] [Accepted: 01/26/2014] [Indexed: 11/18/2022] Open
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Toledano M, Cabello I, Vílchez MAC, Fernández MA, Osorio R. Surface microanalysis and chemical imaging of early dentin remineralization. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2014; 20:245-256. [PMID: 24160361 DOI: 10.1017/s1431927613013639] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study reports physical and chemical changes that occur at early dentin remineralization stages. Extracted human third molars were sectioned to obtain dentin discs. After polishing the dentin surfaces, three groups were established: (1) untreated dentin (UD), (2) 37% phosphoric acid application for 15 s (partially demineralized dentin-PDD), and (3) 10% phosphoric acid for 12 h at 25° C (totally demineralized dentin-TDD). Five different remineralizing solutions were used: chlorhexidine (CHX), artificial saliva (AS), phosphate solution (PS), ZnCl2, and ZnO. Wettability (contact angle), ζ potential and Raman spectroscopy analysis were determined on dentin surfaces. Demineralization of dentin resulted in a higher contact angle. Wettability decreased after immersion in all solutions. ζ potential analysis showed dissimilar performance ranging from -6.21 mV (TDD + AS) up to 3.02 mV (PDD + PS). Raman analysis showed an increase in mineral components after immersing the dentin specimens, in terms of crystallinity, mineral content, and concentration. This confirmed the optimal incorporation and deposition of mineral on dentin collagen. Organic content reflected scarce changes, except in TDD that appeared partially denatured. Pyridinium, as an expression of cross-linking, appeared in all spectra except in specimens immersed in PS.
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Affiliation(s)
- Manuel Toledano
- Faculty of Dentistry, University of Granada, Dental Materials Section, Colegio Máximo de Cartuja s/n, 18071 Granada, Spain
| | - Inmaculada Cabello
- Faculty of Dentistry, University of Granada, Dental Materials Section, Colegio Máximo de Cartuja s/n, 18071 Granada, Spain
| | | | - Miguel Angel Fernández
- Faculty of Sciences, University of Granada, Applied Physics Section, Campus de Fuentenueva s/n, 18071 Granada, Spain
| | - Raquel Osorio
- Faculty of Dentistry, University of Granada, Dental Materials Section, Colegio Máximo de Cartuja s/n, 18071 Granada, Spain
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Tirali RE, Gulsahi K, Cehreli SB, Karahan ZC, Uzunoğlu E, Elhan A. Antimicrobial efficacy of octenidine hydrochloride, MTAD and chlorhexidine gluconate mixed with calcium hydroxide. J Contemp Dent Pract 2013; 14:456-60. [PMID: 24171989 DOI: 10.5005/jp-journals-10024-1344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this in vitro study was to investigate whether mixing with calcium hydroxide [Ca(OH)2] affects the antimicrobial action of Octenidine hydrochloride (Octenisept), MTAD and chlorhexidine against Enterococcus faecalis and Candida albicans. MATERIALS AND METHODS Freshly grown cultures of Enterococcus faecalis, Candida albicans and a mixture of both strains were incubated in agar plates containing brain-heart infusion broth (BHIB). Zones of inhibition were measured at 24 and 48 hours. Statistical analysis was performed using Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance (ANOVA, both p=0.05). RESULTS Mixing with Ca(OH)2 significantly increased the antibacterial effect of Octenisept (p<0.05), but did not alter its antifungal activity. Only chlorhexidine showed more antibacterial and antifungal efficiency compared to its Ca(OH)2-mixed version (both p<0.05). Mixing with Ca(OH)2 decreased the antibacterial efficacy of MTAD, but increased its antifungal effect (both p<0.05). CONCLUSION These results demonstrate the differential effects of Ca(OH)2 addition on the antimicrobial action of the tested endodontic medicaments in vitro. Ca(OH)2 was as effective as its combination with all of the tested medicaments.
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Affiliation(s)
- Resmiye Ebru Tirali
- Assistant Professor, Department of Pediatric Dentistry, Baskent University, Ankara, Turkey, e-mail:
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24
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Gomes BP, Vianna ME, Zaia AA, Almeida JFA, Souza-Filho FJ, Ferraz CCR. Chlorhexidine in Endodontics. Braz Dent J 2013; 24:89-102. [DOI: 10.1590/0103-6440201302188] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/02/2013] [Indexed: 11/21/2022] Open
Abstract
Chemical auxiliary substances (CAS) are essential for a successful disinfection and cleanness of the root canals, being used during the instrumentation and if necessary, as antimicrobial intracanal medicaments. Different CAS have been proposed and used, among which sodium hypochlorite (NaOCl), chlorhexidine (CHX), 17% EDTA, citric acid, MTAD and 37% phosphoric acid solution. CHX has been used in Endodontics as an irrigating substance or intracanal medicament, as it possesses a wide range of antimicrobial activity, substantivity (residual antimicrobial activity), lower cytotoxicity than NaOCl whilst demonstrating efficient clinical performance, lubricating properties, rheological action (present in the gel presentation, keeping the debris in suspension); it inhibits metalloproteinase, is chemically stable, does not stain cloths, it is odorless, water soluble, among other properties. CHX has been recommended as an alternative to NaOCl, especially in cases of open apex, root resorption, foramen enlargement and root perforation, due to its biocompatibility, or in cases of allergy related to bleaching solutions. The aim of this paper is to review CHX's general use in the medical field and in dentistry; its chemical structure, presentation form and storage; mechanism of action; antimicrobial activity including substantivity, effects on biofilms and endotoxins, effects on coronal and apical microbial microleakage; tissue dissolution ability; interaction with endodontic irrigants; effects on dentin bonding, metalloproteinases and collagen fibrils; its use as intracanal medicament and diffusion into the dentinal tubules; its use as disinfectant agent of obturation cones; other uses in the endodontic therapy; and possible adverse effects, cytotoxicity and genotoxicity.
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Delgado RJR, Gasparoto TH, Sipert CR, Pinheiro CR, de Moraes IG, Garcia RB, Duarte MAH, Bramante CM, Torres SA, Garlet GP, Campanelli AP, Bernardineli N. Antimicrobial activity of calcium hydroxide and chlorhexidine on intratubular Candida albicans. Int J Oral Sci 2013; 5:32-6. [PMID: 23538639 PMCID: PMC3632761 DOI: 10.1038/ijos.2013.12] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study investigated the efficacy of calcium hydroxide and chlorhexidine gel for the elimination of intratubular Candida albicans (C. albicans). Human single-rooted teeth contaminated with C. albicans were treated with calcium hydroxide, 2% chlorhexidine gel, calcium hydroxide plus 2% chlorhexidine gel, or saline (0.9% sodium chloride) as a positive control. The samples obtained at depths of 0–100 and 100–200 µm from the root canal system were analyzed for C. albicans load by counting the number of colony forming units and for the percentage of viable C. albicans using fluorescence microscopy. First, the antimicrobial activity of calcium hydroxide and the 2% chlorhexidine gel was evaluated by counting the number of colony forming units. After 14 days of intracanal medication, there was a significant decrease in the number of C. albicans colony forming units at a depth of 0–100 µm with chlorhexidine treatment either with or without calcium hydroxide compared with the calcium hydroxide only treatment. However, there were no differences in the number of colony forming units at the 100–200 µm depth for any of the medications investigated. C. albicans viability was also evaluated by vital staining techniques and fluorescence microscopy analysis. Antifungal activity against C. albicans significantly increased at both depths in the chlorhexidine groups with and without calcium hydroxide compared with the groups treated with calcium hydroxide only. Treatments with only chlorhexidine or chlorhexidine in combination with calcium hydroxide were effective for elimination of C. albicans.
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Influence of dentin from the root canal walls and the pulp chamber floor on the pH of intracanal medicaments. J Endod 2013; 39:701-3. [PMID: 23611395 DOI: 10.1016/j.joen.2012.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 12/26/2012] [Accepted: 12/30/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the alterations in the pH of calcium hydroxide (Ca[OH]2), 2% chlorhexidine (CHX) gel, and their combination after adding dentin powder from the root canal walls and the pulp chamber floor. METHODS Ca(OH)2 paste, 2% CHX gel, and their combination were examined. Dentin powder was obtained from the root canal walls and the pulp chamber floor of bovine teeth and added as 1.8% to the volume of the medications. The pH values of the mixtures were assessed immediately after preparation, after 24 hours, and on days 7 and 14. Data were analyzed statistically by analysis of variance and the Student's t test (P = .05). RESULTS pH values of Ca(OH)2 were always above 12 in the presence or absence of dentin powder during the 14 days of the study. A significant decrease in pH values of Ca(OH)2 was observed after 14 days when dentin from the root canal wall was added (P < .001). The pH values of CHX gel were significantly increased by the presence of dentin (P = .001). The t test showed a significant difference in the increase of the pH values when the different dentin types were added (P = .002). The pH of the Ca(OH)2 and CHX gel combination was not influenced by dentin powder from the root canal walls, and a reduction was observed after 14 days, exactly like in the control group. The pH values of the combination did not alter after 14 days when pulp chamber floor dentin was added. CONCLUSIONS The different dentin types variably affect the pH of Ca(OH)2 paste, 2% CHX gel, and their combination in the studied periods.
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Sinha N, Patil S, Dodwad PK, Patil AC, Singh B. Evaluation of antimicrobial efficacy of calcium hydroxide paste, chlorhexidine gel, and a combination of both as intracanal medicament: An in vivo comparative study. J Conserv Dent 2013; 16:65-70. [PMID: 23349580 PMCID: PMC3548350 DOI: 10.4103/0972-0707.105302] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/10/2012] [Accepted: 09/27/2012] [Indexed: 12/01/2022] Open
Abstract
Aim: To compare the antimicrobial efficacy of calcium hydroxide (CH), 2% chlorhexidine gel (CHX) and a combination of both, on obligate anaerobes, facultative anaerobes and Candida spp . Materials and Methods: 90 single rooted permanent teeth were included in the study. After complete disinfection and access opening, the first microbiological pre-treatment sample (S1) was collected. After completion of instrumentation, a post-instumentation sample (S2) was taken and the teeth were divided into three groups: Group I: CH, Group II: 2% CHX, Group III: 2% CHX with CH. After 1 week, a post-medication sample (S3) was collected. Results: All three medicaments were effective in the elimination of obligate anaerobes. CHX and combination showed higher antimicrobial effect against facultative anaerobes and Candida spp. in comparison with CH. But there was no statistical significant difference between Group II and Group III. Conclusion: CHX with or without CH was more effective than CH alone against all the tested micro-organisms.
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Affiliation(s)
- Nidhi Sinha
- Department of Conservative Dentistry and Endodontics, Jodhpur Dental College, Jodhpur National University, Jodhpur, India
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Farhad AR, Barekatain B, Allameh M, Narimani T. Evaluation of the antibacterial effect of calcium hydroxide in combination with three different vehicles: An in vitro study. Dent Res J (Isfahan) 2012; 9:167-72. [PMID: 22623933 PMCID: PMC3353693 DOI: 10.4103/1735-3327.95231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Antimicrobial activity of interappointment intracanal medications is an important consideration in endodontics. Considering the fact that calcium hydroxide (CH) cannot sterilize the root canal system, completing its antimicrobial spectrum seems necessary. The aim of this study was to compare the antibacterial activity of CH combined with three different vehicles in root canal system. Materials and Methods: In this in vitro experimental study, 61 freshly extracted human single rooted teeth were used. After chemo-mechanical preparation, the teeth were dressed with CH in combination with: G1: Distilled water (DW); G2: 5.25% sodium hypochlorite; G3: 0.2% chlorhexidine solution. All teeth were mounted in a 2-chamber apparatus. After sterilization, the coronal chamber was exposed to bacteria and the apical chamber was filled with broth for 90 days. Leakage was recorded when turbidity was observed in broth. Mean times of leakage and turbidity percentage were recorded for each group. Data were analyzed by One Way ANOVA test (α=0.005). Results: The highest mean time of contamination was for chorhexidine/CH combination (M=66.76 days), and the lowest was for DW/CH combination (M=40.29 days). Statistically significant difference was observed between G3 and G1 (P=0.042), but the difference between G2 and G3 (P=0.76) or G1 and G2 (P=0.18) were not significant. 88.23% of the samples of G1, 70.58% of G2, and 64.70% of G3 were contaminated after 3 months. Conclusion: As an intracanal medication, the chlorhexidine/CH combination had significantly more antibacterial activity than DW/CH combination.
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Affiliation(s)
- Ali Reza Farhad
- Torabinejad Dental Research Center and Department of Endodontics, Isfahan University of Medical Science, Isfahan, Iran
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Paiva SSM, Siqueira JF, Rôças IN, Carmo FL, Leite DCA, Ferreira DC, Rachid CTC, Rosado AS. Clinical antimicrobial efficacy of NiTi rotary instrumentation with NaOCl irrigation, final rinse with chlorhexidine and interappointment medication: a molecular study. Int Endod J 2012; 46:225-33. [DOI: 10.1111/j.1365-2591.2012.02111.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 07/05/2012] [Indexed: 12/01/2022]
Affiliation(s)
- S. S. M. Paiva
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - J. F. Siqueira
- Department of Endodontics and Molecular Microbiology Laboratory; Estácio de Sá University Rio de Janeiro; Brazil
| | - I. N. Rôças
- Department of Endodontics and Molecular Microbiology Laboratory; Estácio de Sá University Rio de Janeiro; Brazil
| | - F. L. Carmo
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - D. C. A. Leite
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - D. C. Ferreira
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - C. T. C. Rachid
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
| | - A. S. Rosado
- Institute of Microbiology Prof. Paulo de Góes; Federal University of Rio de Janeiro; Brazil
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Pereira MSS, Faria G, Bezerra da Silva LA, Tanomaru-Filho M, Kuga MC, Rossi MA. Response of mice connective tissue to intracanal dressings containing chlorhexidine. Microsc Res Tech 2012; 75:1653-8. [PMID: 22887775 DOI: 10.1002/jemt.22112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/13/2012] [Indexed: 11/08/2022]
Abstract
Substances containing chlorhexidine (CHX) have been studied as intracanal medicaments. The aim of the present study was to characterize the response of mouse subcutaneous connective tissue to CHX-containing medications by conventional optical microscopy. The tissue response was evaluated by implanting polyethylene tubes containing one of the substances evaluated: Calen paste + 0.5% CHX, Calen + 2% CHX, 2% CHX gel, and Calen paste (control). After experimental periods of 7, 21, and 63 days, the implants (n = 10) were removed along with the subcutaneous connective tissue. Tissue samples were subjected to histological processing, and sections were stained with hematoxylin and eosin. Qualitative and quantitative analyses of the number of inflammatory cells, blood vessels, and vascularized areas were performed. Results were analyzed by ANOVA and Tukey tests with the significance level set at 5%. We concluded that Calen + 0.5% CHX led to reparative tissue response in contrast with Calen + 2% CHX and 2% CHX gel, which induced persistent inflammatory response, pointing to the aggressive nature of this mixture. When Calen + 2% CHX and 2% CHX gel were compared, the latter induced more intense inflammatory response.
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Affiliation(s)
- Maristela Soares Swerts Pereira
- Department of Paediatric Dentistry, Preventive and Community Dentistry, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Good M, El KIA, Hussey DL. Endodontic 'solutions' part 1: a literature review on the use of endodontic lubricants, irrigants and medicaments. ACTA ACUST UNITED AC 2012; 39:239-40, 242-4, 246. [PMID: 22774686 DOI: 10.12968/denu.2012.39.4.239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endodontic lubricants, irrigants and medicaments help prepare and disinfect root canal systems (RCS) but primary and secondary cases involve different microbes and therefore it is unlikely that one protocol will be effective for both case types. Each individual 'solution' or sequence of'solutions' could play a significant role in each case type, but there are no detailed published guidelines in existence. To help inform clinical practice it was decided to undertake a literature review followed by a UK and Republic of Ireland wide audit on current endodontic'solution' usage within dental schools. The literature review was undertaken under the following headings: pre-op oral rinse; file lubricants; root canal irrigants and intracanal medicaments and provides an evidence base for protocol development for both primary and retreatment cases.The audit project and the protocols developed from the findings of both the literature review and audit will be presented in Part 2.
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Affiliation(s)
- Melissa Good
- Department of Restorative Dentistry, The Royal Hospitals, Belfast Health and Social Care Trust, Belfast, BT12 6BP, Northern Ireland, UK
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Toledano M, Yamauti M, Osorio E, Osorio R. Zinc-Inhibited MMP-Mediated Collagen Degradation after Different Dentine Demineralization Procedures. Caries Res 2012; 46:201-7. [DOI: 10.1159/000337315] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 02/01/2012] [Indexed: 12/25/2022] Open
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Ito IY, Junior FM, Paula-Silva FWG, Da Silva LAB, Leonardo MR, Nelson-Filho P. Microbial culture and checkerboard DNA-DNA hybridization assessment of bacteria in root canals of primary teeth pre- and post-endodontic therapy with a calcium hydroxide/chlorhexidine paste. Int J Paediatr Dent 2011; 21:353-60. [PMID: 21481034 DOI: 10.1111/j.1365-263x.2011.01131.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the root canal microbiota of primary teeth with apical periodontitis and the in vivo antimicrobial effects of a calcium hydroxide/chlorhexidine paste used as root canal dressing. DESIGN Baseline samples were collected from 30 root canals of primary teeth with apical periodontitis. Then, the root canals were filled with a calcium hydroxide paste containing 1% chlorhexidine for 14 days and the second bacteriologic samples were taken prior to root canal filling. Samples were submitted to microbiologic culture procedure to detect root canal bacteria and processed for checkerboard DNA-DNA hybridization. RESULTS Baseline microbial culture revealed high prevalence and cfu number of anaerobic, black-pigmented bacteroides, Streptococcus, and aerobic microorganisms. Following root canal dressing, the overall number of cfu was dramatically diminished compared to initial contamination (P <0.05), although prevalence did not change (P > 0.05). Of 35 probes used for checkerboard DNA-DNA hybridization, 31 (88.57%) were present at baseline, and following root canal dressing, the number of positive probes reduced to 13 (37.14%). Similarly, the number of bacterial cells diminished folowing application of calcium hydroxide/chlorhexidine root canal dressing (P = 0.006). CONCLUSION Apical periodontitis is caused by a polymicrobial infection, and a calcium hydroxide/chlorhexidine paste is effective in reducing the number of bacteria inside root canals when applied as a root canal dressing.
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Affiliation(s)
- Izabel Yoko Ito
- Department of Clinical Analysis, Toxicology and Bromatology, School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, SP, Brazil
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ZEHNDER MATTHIAS, PAQUÉ FRANK. Disinfection of the root canal system during root canal re-treatment. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1601-1546.2011.00254.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Osorio R, Yamauti M, Osorio E, Ruiz-Requena ME, Pashley D, Tay F, Toledano M. Effect of dentin etching and chlorhexidine application on metalloproteinase-mediated collagen degradation. Eur J Oral Sci 2011; 119:79-85. [PMID: 21244516 DOI: 10.1111/j.1600-0722.2010.00789.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dentin matrix metalloproteinases (MMPs) are involved in the degradation of collagen in resin-dentin interfaces. This study evaluated whether collagen degradation can be prevented by chlorhexidine digluconate (CHX) after different dentin demineralization procedures. The demineralization of human dentin was performed with phosphoric acid (PA), EDTA or acidic monomers (Clearfil SE Bond and Xeno V). Specimens were stored (for 24 h, or for 1 or 3 wk) in the presence or absence of CHX. In half of the groups, active MMP-2 was incorporated into the storage solution. At the end of each storage period, the C-terminal telopeptide (ICTP) concentration (which indicates the amount of collagen degradation) was measured in the storage solution. Collagen degradation was higher in PA- and EDTA-demineralized dentin. Chlorhexidine digluconate reduced collagen degradation in these groups only for 24 h. When dentin was demineralized with Clearfil SE Bond or Xeno V, collagen degradation was reduced by up to 30%, but the addition of exogenous MMP-2 significantly increased collagen degradation. In self-etchant-treated dentin, the inhibitory effect of CHX on MMPs lasted for up to 3 wk. Treating dentin with EDTA, PA or self-etching agents produces enough demineralization to permit cleavage of the exposed collagen. Monomer infiltration may exert protection on demineralized collagen, probably through immobilization of MMPs. The partial inhibitory action of CHX on MMP activity produced by self-etching adhesives was prolonged compared with the short-acting PA- or EDTA-treated dentin.
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Affiliation(s)
- Raquel Osorio
- Department of Dental Materials, School of Dentistry, University of Granada, Granada, Spain.
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Influence of 2% chlorhexidine gel on calcium hydroxide ionic dissociation and its ability of reducing endotoxin. ACTA ACUST UNITED AC 2011; 111:653-8. [PMID: 21393032 DOI: 10.1016/j.tripleo.2010.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 10/05/2010] [Accepted: 11/14/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of 2% chlorhexidine gel (CHX) on pH, calcium release, and Ca(OH)(2) capability of reducing endotoxin. STUDY DESIGN Calcium release was verified by atomic-absorbance spectrophotometry, and pH was measured with a pHmeter. For endotoxin quantification, extracted human teeth previously contaminated with standard endotoxin were filled with: group I, Ca(OH)(2) + saline solution; group II, Ca(OH)(2) + CHX; and group III, CHX for 14 days. The remaining endotoxin was quantified by using chromogenic quantitative test. Statistical analysis was performed with analysis of variance and Tukey post hoc test (P < .05). RESULTS Group II released more calcium than group I (P < .05) after 15 days. Groups I and II showed alkaline pH in all periods, and group I showed higher pH values than group II (P < .05) after 30 days. Groups II and III showed significantly more decreased endotoxin than group I. CONCLUSIONS CHX did not interfere with the chemical properties of Ca(OH)(2), in fact even improving its properties of reducing the endotoxin content in root canals in vitro.
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Rôças IN, Siqueira JF. In Vivo Antimicrobial Effects of Endodontic Treatment Procedures as Assessed by Molecular Microbiologic Techniques. J Endod 2011; 37:304-10. [DOI: 10.1016/j.joen.2010.11.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 11/06/2010] [Accepted: 11/06/2010] [Indexed: 01/28/2023]
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Osorio R, Yamauti M, Osorio E, Ruiz-Requena ME, Pashley DH, Tay FR, Toledano M. Zinc reduces collagen degradation in demineralized human dentin explants. J Dent 2010; 39:148-53. [PMID: 21108986 DOI: 10.1016/j.jdent.2010.11.005] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 10/22/2010] [Accepted: 11/16/2010] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Dentin matrix metalloproteinases are implicated in the pathogenesis of caries and contribute to collagen degradation in resin-dentin interfaces. The objective was to determine if collagen degradation may be modulated by an excess of zinc or zinc chelators. METHODS Mineralized and phosphoric acid demineralized human dentin specimens were tested. Chlorhexidine digluconate, doxycycline or ZnCl₂ were added to the media. In half of the groups, active exogenous metalloproteinase-2 was incorporated into the solution. C-terminal telopeptide determinations (radioimmunoassay) were performed after 24 h, 1 and 3 weeks. RESULTS Collagen degradation was prominent in demineralized dentin. Doxycycline fully blocked dentin proteolysis. Chlorhexidine digluconate reduced the degradation at the 24-h period. Zinc in excess strongly inhibits hydrolysis of collagen and its effect was maintained for 3 weeks. CONCLUSIONS Zinc in excess reduces MMP-mediated collagen degradation. The hypothesis that binding of zinc to collagen results in protection of sensitive cleavage sites of metalloproteinases requires further validation.
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Affiliation(s)
- R Osorio
- Department of Dental Materials, School of Dentistry, Campus de Cartuja s/n, University of Granada, E-18071 Granada, Spain.
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Antimicrobial Effects of Calcium Hydroxide and Chlorhexidine on Enterococcus faecalis. J Endod 2010; 36:1389-93. [DOI: 10.1016/j.joen.2010.04.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 04/23/2010] [Accepted: 04/29/2010] [Indexed: 11/19/2022]
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Freire LG, Carvalho CN, Ferrari PHP, Siqueira EL, Gavini G. Influence of dentin on pH of 2% chlorhexidine gel and calcium hydroxide alone or in combination. Dent Traumatol 2010; 26:276-80. [DOI: 10.1111/j.1600-9657.2010.00874.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Flanagan D. Calcium hydroxide paste as a surface detoxifying agent for infected dental implants: two case reports. J ORAL IMPLANTOL 2009; 35:204-9. [PMID: 19813427 DOI: 10.1563/1548-1336-35.4.204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dental implant treatment is successful; however, an implant can become infected during or after osseointegration. The two case reports presented here demonstrate, anecdotally, the effectiveness of endodontic calcium hydroxide paste for the surface treatment of infected, healing, or osseointegrated dental implants. Calcium hydroxide may be an appropriate surface detoxifying agent for local dental implant infections. A sequence of calcium hydroxide and 0.2% chlorhexidine gluconate surface treatment may provide a broad range of antimicrobial action for detoxifying recalcitrant infections. Calcium hydroxide should not be left in the surgical site.
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Estrela C, Silva JA, Alencar AHG, Leles CR, Decurcio DA. Response to letter to the editor: Efficacy of sodium hypochlorite and chlorhexidine against Enterococcus faecalis. J Appl Oral Sci 2009; 17:S1678-77572009000500002. [PMID: 19936507 PMCID: PMC4327656 DOI: 10.1590/s1678-77572009000500002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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In vitro antimicrobial activity of calcium hydroxide mixed with different vehicles against Enterococcus faecalis and Candida albicans. ACTA ACUST UNITED AC 2009; 108:297-301. [DOI: 10.1016/j.tripleo.2009.03.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 03/12/2009] [Accepted: 03/12/2009] [Indexed: 11/19/2022]
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Sathorn C, Parashos P, Messer H. Australian endodontists' perceptions of single and multiple visit root canal treatment. Int Endod J 2009; 42:811-8. [PMID: 19619228 DOI: 10.1111/j.1365-2591.2009.01587.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To ascertain endodontist's point of view (treatment philosophy, rationale and preference) regarding single- and multiple-visit root canal treatment. To identify the basis on which the choice is made and how the information necessary for the choice is acquired. METHODOLOGY Endodontists registered with the dental practice board of every state in Australia were contacted, and if they agreed to participate, they were interviewed either face to face or by telephone. The following topics were addressed in an interview lasting 15 to 20 min: demographics, current clinical procedures, treatment rationales and preference. A hypothetical scenario was posed to investigate which treatment regimen they would prefer to deliver if biological concerns were eliminated from consideration. RESULTS Fifty-two endodontists (71% of all Australian endodontists) agreed to participate in the study. Almost all (51/52) participants had performed single-visit root canal treatment, but very few routinely performed it. A majority of participants were willing to provide single-visit treatment where patients had time constraints, and in vital cases (including elective endodontics). The most powerful factor of influencing practice change was interpersonal contact with colleagues. Publications in academic journals have a weak influence in practice change. CONCLUSIONS Australian endodontists strongly prefer multiple-visit over single-visit root canal treatment even in cases where biological concerns are not an issue. Operator preference rather than biological or patient considerations appear to be the primary determinant of treatment choice.
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Affiliation(s)
- C Sathorn
- Endodontic Unit, School of Dental Science, The University of Melbourne, Melbourne, Australia.
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Affiliation(s)
- Z Mohammadi
- Department of Endodontics, School of Dentistry, Hamedan University of Medical Sciences, Hamedan, Iran.
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Estrela C, Silva JA, de Alencar AHG, Leles CR, Decurcio DA. Efficacy of sodium hypochlorite and chlorhexidine against Enterococcus faecalis--a systematic review. J Appl Oral Sci 2009; 16:364-8. [PMID: 19082392 PMCID: PMC4327704 DOI: 10.1590/s1678-77572008000600002] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 07/17/2008] [Indexed: 11/22/2022] Open
Abstract
The efficacy of the sodium hypochlorite (NaOCl) and chlorhexidine (CHX) on Enterococcus faecalis was evaluated by systematic review and meta-analysis. The search strategies included search in electronic biomedical journal databases (MEDLINE, EMBASE, CENTRAL) and handsearching records, using different matches of keywords for NaOCl, CHX and Enterococcus faecalis. From 41 in vivo studies, 5 studies met the inclusion criteria. In a sample containing 159 teeth, E. faecalis was detected initially in 16 (10%) teeth by polymerase chain reaction (PCR) and 42 (26.4%) teeth by microbial culture techniques. After root canal disinfection, this species was observed in 11 (6.9%) teeth by PCR and 12 (7.5%) teeth by culture. Risk differences of included studies were combined as generic inverse variance data type (Review Manager Version 5.0 _ Cochrane Collaboration, http://www.cc-ims.net, accessed 15 May 2008), taking into account the separate tracking of positive and negative cultures/PCR. The level of statistical significance was set at p<0.05. In conclusion, NaOCl or CHX showed low ability to eliminate E. faecalis when evaluated by either PCR or culture techniques.
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Silva RABD, Assed S, Nelson-Filho P, Silva LABD, Consolaro A. Subcutaneous tissue response of isogenic mice to calcium hydroxide-based pastes with chlorhexidine. Braz Dent J 2009; 20:99-106. [DOI: 10.1590/s0103-64402009000200002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 05/25/2009] [Indexed: 11/22/2022] Open
Abstract
This study was evaluated the response of subcutaneous connective tissue of isogenic mice to calcium hydroxide-based pastes with chlorhexidine digluconate (CHX). Seventy isogenic male BALB/c mice aged 6-8 weeks and weighing 15-20 g were randomly assigned to 8 groups. The animals received polyethylene tube implants as follows: Groups I, II, and III (n=10) - Calen® paste mixed with 0.4% CHX (experimental paste; Calen/CHX) for 7, 21, and 63 days, respectively; Groups IV, V, and VI (n=10) - UltraCal™ paste mixed with 2% CHX (experimental paste supplied by Ultradent Products Inc.; Ultracal/CHX) for 7, 21, and 63 days, respectively; and Groups VII and VIII (n=5): empty tube for 7 and 21 days, respectively. At the end of the experimental periods, the implants were removed together with the surrounding tissues (skin and subcutaneous connective tissue). The biopsied tissues were subjected to routine processing for histological analysis. Using a descriptive analysis and a four-point (0-3) scoring system, the following criteria were considered for qualitative and quantitative analysis of the tissue around the implanted materials: collagen fiber formation, tissue thickness and inflammatory infiltrate. A quantitative analysis was performed by measuring the thickness (µm), area (µm²) and perimeter (µm) of the reactionary granulomatous tissue formed at the tube ends. Data were analyzed statistically by the Kruskal-Wallis test and Dunn's post-test (α=0.05). Calen/CHX showed biocompatibility with the subcutaneous and reactionary tissues, with areas of discrete fibrosis and normal conjunctive fibrous tissue, though without statistically significant difference (p>0.05) from the control groups. In Groups I to III, there was a predominance of score 1, while in Groups IV to VI scores 2 and 3 predominated for all analyzed parameters. UltraCal/CHX, on the other hand, induced the formation of an inflammatory infiltrate and abundant exudate, suggesting a persistent residual aggression from the material, even 63 days after implant placement. In conclusion, the Calen paste mixed with 0.4% CHX allowed an adequate tissue response, whereas the UltraCal paste mixed with 2% CHX showed unsatisfactory results.
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Abstract
The major objective in root canal therapy is to disinfect the entire root canal system. This requires that the pulpal contents be eliminated as sources of infection. This goal may be accomplished using mechanical instrumentation and chemical irrigation, in conjunction with medication of the root canal between treatment sessions. Microorganisms and their by-products are considered to be the major cause of pulpal and periradicular pathosis. In order to reduce or eliminate bacteria, various irrigation solutions have been used during treatment. Chlorhexidine is a cationic molecule which can be used during treatment. It has a wide range antimicrobial activity. Furthermore, because of its cationic structure, chlorhexidine has a unique property named substantivity. The purpose of this paper is to review different aspects of the use of chlorhexidine gluconate in endodontics.
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Al-Nazhan S, Al-Obaida M. Effectiveness of a 2% chlorhexidine solution mixed with calcium hydroxide againstCandida albicans. AUST ENDOD J 2008; 34:133-5. [DOI: 10.1111/j.1747-4477.2007.00091.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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da Silva RAB, Leonardo MR, da Silva LAB, Faccioli LH, Medeiros AID. Effect of a calcium hydroxide–based paste associated to chlorhexidine on RAW 264.7 macrophage cell line culture. ACTA ACUST UNITED AC 2008; 106:e44-51. [DOI: 10.1016/j.tripleo.2008.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 05/09/2008] [Accepted: 06/17/2008] [Indexed: 10/21/2022]
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