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Kartit Z, Delacroix C, Clement C, Beurrier M, Mouton-Faivre C, Petitpain N. Sodium hypochlorite accident diagnosis and management: Analysis from the literature and the French pharmacovigilance database. Fundam Clin Pharmacol 2024; 38:630-639. [PMID: 38268036 DOI: 10.1111/fcp.12985] [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: 10/04/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE Sodium hypochlorite (NaOCl) is considered as the reference irrigation solution in endodontics. However, NaOCl-related accidents may occur, and non-dentist health professionals might under-recognize this rare adverse effect although it is potentially severe, with possible medical and aesthetic sequelae. We performed a literature review to provide to non-dentist healthcare professionals a large picture of symptoms, management and potential consequences of NaOCl accidents. METHODS We queried PubMed and the French Pharmacovigilance database and retrieved 76 cases for analysis (70 from 57 published articles, and six from the database). RESULTS The analysis showed that patients were mostly women (79%), aged around of 42 years, undergoing upper jawbone (74%) endodontic procedure. NaOCl concentration ranged from 1% to 10%, with 0.5 to 30 mL injected. Most cases (86%) corresponded to an accidental extrusion beyond the root apex to the periapical tissues, followed by tissular injection by error (8%) and extrusion into the maxillary sinus (3%). Local symptoms always occurred within 24 h, mostly pain (99%), edema (89%) and/or ecchymosis (61%). Complications were mainly neurological (29%), necrotic (22%) and cutaneous (9%). Most of patients (76%) fully recovered after medical management but 18 (24%) required surgical management. CONCLUSION Any healthcare professional should be aware of the classical symptomatic triad of NaOCl accident with sudden pain, haemorrhage/ecchymosis and swelling, to start or recommend adequate management. Patients should be reassured, but a close follow-up is necessary to avoid delayed complication.
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Affiliation(s)
- Zahoua Kartit
- Centre Régional de Pharmacovigilance, CHRU Nancy-Brabois, Vandoeuvre-lès-Nancy, France
| | - Céline Delacroix
- Service de Dermatologie-allergologie, CHRU Nancy-Brabois, Vandoeuvre-lès-Nancy, France
| | - Céline Clement
- Département de Prévention-Épidémiologie-Économie de la Santé-Odontologie Légale, CHRU Nancy, Faculté d'odontologie, Vandoeuvre-lès-Nancy, France
| | - Mathilde Beurrier
- Centre Régional de Pharmacovigilance, CHRU Nancy-Brabois, Vandoeuvre-lès-Nancy, France
| | - Claudie Mouton-Faivre
- Service de Dermatologie-allergologie, CHRU Nancy-Brabois, Vandoeuvre-lès-Nancy, France
| | - Nadine Petitpain
- Centre Régional de Pharmacovigilance, CHRU Nancy-Brabois, Vandoeuvre-lès-Nancy, France
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Navayath M, Ramesh SR, Kalaiselvam R, Ashok R, Rajendran MR, Balaji L. Evaluation of Nanomagnesium Oxide in Combination with Garlic Extract as an Endodontic Irrigant: An In Vitro Study. J Contemp Dent Pract 2023; 24:459-466. [PMID: 37622623 DOI: 10.5005/jp-journals-10024-3530] [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] [Indexed: 08/26/2023]
Abstract
AIM The aim of this in vitro study was to evaluate the effectiveness of the combination of garlic extract in combination with magnesium oxide (MgO) for use as an endodontic irrigant at various contact times. MATERIALS AND METHODS All 48 teeth were divided into 6 groups according to irrigation used after inoculation with Enterococcus faecalis and incubation. The control groups consisted of saline and sodium hypochlorite (NaOCl) used as irrigants and the test groups employed garlic extract combined with nano-magnesium oxide (nano-MgO) used as irrigant with two contact times, namely, 2 and 5 minutes, and garlic extract and nano-MgO used solely for 5 minutes each. Colony-forming units (CFUs) were counted after plating and incubation. RESULTS In NaOCl, and in both combination groups, there was a significant reduction in CFU counts. The saline group showed no decrease. Statistical analysis showed no difference in efficacy between NaOCl and the two combination groups. There was a statistical difference between the combination group and garlic/nano-MgO alone at both 2 and 5 minutes. CONCLUSIONS Under the conditions of this study, a novel irrigant, a combination of nanoparticles of MgO and garlic extract was as effective as NaOCl against E. faecalis in an in vitro model at two tested contact times. CLINICAL SIGNIFICANCE Combination of MgO nanoparticles and garlic extract achieves disinfection comparable to gold standard NaOCl without harmful caustic effects of hypochlorite.
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Affiliation(s)
- Malikka Navayath
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Seshan Rakkesh Ramesh
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India, Phone: +91 9952841991, e-mail:
| | - Rajeswari Kalaiselvam
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Rupa Ashok
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Mathan Rajan Rajendran
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Lakshmi Balaji
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
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He X, Li Y, Nie M, Yu Y, Chen H, Pan C, Zhao J. Transient apical peak pressure measurement of Er:YAG laser-activated irrigation in different in vitro tooth models using a high-frequency sensor system. Lasers Med Sci 2023; 38:123. [PMID: 37171630 DOI: 10.1007/s10103-023-03779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
The transient apical pressure side effect is an important safety consideration for Er:YAG laser-activated irrigation (LAI). Therefore, this study aimed to measure the transient apical peak pressure (TAPP) of LAI under different laser settings in various tooth models using a high-frequency sensor system. Tooth models with different pulp chamber structures, apical diameters, and curvatures were prepared using transparent resin and filled with deionised water. The Er:YAG laser fibre was placed 3 mm from the root canal orifice. Irrigation was performed at 10-40 mJ and 20-50 Hz using the super short pulse mode. The TAPP was measured using a 50,000-sample/second pressure sensor connected to the models' apices. The TAPP of LAI was significantly higher than that of other chemical preparation methods. Among all investigated factors, pulp chamber anatomy and apical diameters had the greatest effects and were highly related to the apical peak pressure. Root canal curvature showed no direct correlation with TAPP. The larger the final prepared working width, the greater the TAPP. Furthermore, both pulse energy and frequency had positive correlations with TAPP. In conclusion, tooth anatomy factors and laser parameter settings influenced TAPP during Er:YAG LAI. Therefore, proper settings of laser parameters are important to improve the safety of Er:YAG LAI.
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Affiliation(s)
- Xinyu He
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Yizhou Li
- Department of Stomatology, Yuquan Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 100040, People's Republic of China
| | - Mingyuan Nie
- Fluid Mechanics Key Laboratory of Education Ministry, Beihang University, Beijing, 100191, People's Republic of China
| | - Yue Yu
- Fluid Mechanics Key Laboratory of Education Ministry, Beihang University, Beijing, 100191, People's Republic of China
| | - Haotian Chen
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Chong Pan
- Fluid Mechanics Key Laboratory of Education Ministry, Beihang University, Beijing, 100191, People's Republic of China
| | - Jizhi Zhao
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
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Benjelloun L, Taleb B. Facial hematoma of endodontic origin: A case report. Ann Med Surg (Lond) 2022; 81:104484. [PMID: 36147151 PMCID: PMC9486721 DOI: 10.1016/j.amsu.2022.104484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
Endodontic treatment is a common procedure in dentistry that consists of elimination of organic tissues, infected debris, and pathogenic bacteria from the canal system by means of mechanical instrumentation associated with abundant disinfecting agents (Haapasalo et al., 2005) [1]. Despite progress with its implementation, dentists may at any time be faced with complications during or after a root canal procedure. While some of these problems can be anticipated, many can never really be predicted. A complication such as a hematoma that is usually seen as a complication of trauma or oral surgery, is rarely seen after a simple endodontic treatment. It put the dentist in a confused and uncomfortable situation. Dentists should be aware of the possible occurrence of this incident and should know what can cause it and how to manage it. We report the case of a 63-year-old patient, referred by her general dentist to our center for the sudden onset of a facial hematoma after endodontic treatment. Facial Hematoma is a well-known and recognized complication in oral and maxillofacial surgery or in facial trauma. Hematoma is a rare, unknown, and unexpected complication after routine canal therapy. It can be an accident of sodium hypochlorite by extrusion of the solution through root apices. It is responsible of important morbidity. To avoid hypochlorite accidents, particularly hematoma, some recommendations must be followed, and the basics of endodontic treatment must be respected.
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Hespanhol FG, Guimarães LS, Antunes LAA, Antunes LS. Effect of intracanal cryotherapy on postoperative pain after endodontic treatment: systematic review with meta-analysis. RESTORATIVE DENTISTRY & ENDODONTICS 2022; 47:e30. [PMID: 36090511 PMCID: PMC9436646 DOI: 10.5395/rde.2022.47.e30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/31/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022]
Abstract
Objectives This study aimed to evaluate the effectiveness of final irrigation with cold saline solution after endodontic treatment compared with saline solution at room temperature against postoperative pain following endodontic treatment. Materials and Methods A broad search was performed in the PubMed, Web of Science, Scopus, Cochrane Library, Virtual Health Library (LILACS), and Grey Literature databases. Two independent reviewers performed data extraction, risk of bias using the Cochrane methodology, and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results Eight studies were included in qualitative synthesis. Intracanal cryotherapy favored the reduction of postoperative pain in the systematic review. Four studies were included in meta-analyses. The meta-analysis showed that intracanal cryotherapy reduced postoperative pain in teeth with symptomatic apical periodontitis (SAP) at 24 hours. There was no association between intracanal cryotherapy and control (room temperature) groups in teeth with normal periapical tissue with respect to postoperative pain at 24 hours and 48 hours. Conclusions Intracanal cryotherapy was effective in reducing postoperative pain after endodontic treatment in teeth with SAP.
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Affiliation(s)
| | - Ludmila Silva Guimarães
- Postgraduate Program, School of Dentistry, Fluminense Federal University, Niterói, RJ, Brazil
| | - Lívia Azeredo Alves Antunes
- Postgraduate Program, School of Dentistry, Fluminense Federal University, Niterói, RJ, Brazil
- Specific Formation Department, School of Dentistry of Nova Friburgo, Fluminense Federal University, Niterói, RJ, Brazil
| | - Leonardo Santos Antunes
- Postgraduate Program, School of Dentistry, Fluminense Federal University, Niterói, RJ, Brazil
- Specific Formation Department, School of Dentistry of Nova Friburgo, Fluminense Federal University, Niterói, RJ, Brazil
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Accidental Extrusion of Sodium Hypochlorite in a Patient Taking Alendronate: A Case Report With an 8-Year Follow-up. J Endod 2021; 47:1947-1952. [PMID: 34626612 DOI: 10.1016/j.joen.2021.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/22/2022]
Abstract
Extrusion of sodium hypochlorite (NaOCl) is a very rare accident with the most common complications including pain, swelling, and hematoma. It can occur even if procedural guidelines, predisposing conditions, and risk factors are taken into consideration. A 59-year-old female patient was admitted to the endodontics department to treat a left maxillary first premolar (World Dental Federation tooth 24). The medical history included osteoporosis and systemic medication with alendronate. Initially, the diagnosis was "symptomatic irreversible pulpitis" with "normal apical tissues." During instrumentation of the buccal canal, accidental extrusion of 2.5% NaOCl occurred into the periapical tissues, resulting from misinterpretation of the working length, and caused severe pain and bleeding. The canal was immediately flushed using copious irrigation with saline solution. An analgesic and corticosteroid were prescribed. At 3 and 7 days, ecchymosis and slight hematoma were observed extraorally in the area of the affected tooth and an intraoral ulceration at the apex of the affected tooth. At 15 days, minimal signs of ecchymosis were observed, and the treatment was resumed. At 30 days after the accident, there was complete remission of the sequelae. The clinical, radiographic, and tomographic assessment after 1 month, 1 year, and 8 years showed favorable case evolution. During the 8-year follow-up, the patient maintained the systemic use of alendronate. It can be concluded that NaOCl extrusion is an accident that causes patients and clinicians to experience an unpleasant consequence. The radiographic working length should always be determined carefully. A successful outcome can be achieved in patients who take alendronate.
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Sesquiterpene Lactones from Cotula cinerea with Antibiotic Activity against Clinical Isolates of Enterococcus faecalis. Antibiotics (Basel) 2021; 10:antibiotics10070819. [PMID: 34356740 PMCID: PMC8300741 DOI: 10.3390/antibiotics10070819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 02/01/2023] Open
Abstract
Cotula cinerea, belonging to the tribe Anthemideae, is a plant widespread in the Southern hemisphere. It is frequently used in folk medicine in North African countries for several of its medical properties, shown by its extracts and essential oils. The dichloromethane extract obtained from its aerial parts demonstrated antibiotic activity against Enterococcus faecalis and was fractionated by bioguided purification procedures affording five main sesquiterpene lactones. They were identified by spectroscopic methods (NMR and ESIMS data) as guaiantrienolides, i.e., 6-acetoxy-1β-,6-acetoxy-1α-, and 6-acetoxy-10-β-hydroxyguaiantrienolide (1-3), and germacrenolides, i.e., haagenolide and 1,10-epoxyhaagenolide (4 and 5). The absolute configuration was assigned by applying the advanced Mosher's method to haagenolide and by X-ray diffraction analysis to 1,10-epoxyhaagenolide. The specific antibiotic and antibiofilm activities were tested toward the clinical isolates of Enterococcus faecalis. The results showed that compounds 3-5 have antibacterial activity against all the strains of E. faecalis, while compound 2 exhibited activity only toward some strains. Compound 1 did not show this activity but had only antibiofilm properties. Thus, these metabolites have potential as new antibiotics and antibiofilm against drug resistant opportunistic pathogens.
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Essential Oils as Alternatives for Root-Canal Treatment and Infection Control against Enterococcus faecalis—A Preliminary Study. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11041422] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Since natural alternatives are needed in dentistry for the treatment of root canal, where the standard irrigant is NaOCl with significant toxicity, the aim of the study was to assess the antibacterial properties of non-chemical root-canal irrigants (aqueous extracts of oregano, thyme, lemongrass, melaleuca and clove essential oils) against Enterococcus faecalis. For this, aqueous extracts of each essential oil (AqEO) were prepared. A solution of sodium hypochlorite (NaOCl) was used as a positive standard against which the antimicrobial effects of AqEO could be reported. The root canals of seven teeth were inoculated with 20 µL of Enterococcus faecalis ATCC29212 inoculum and incubated overnight at 37 °C. All the teeth canals were instrumented and were irrigated with the corresponding AqEO, NaOCl and saline solution, then rinsed with saline. Bacteriological samples for each canal post-instrumentation were collected with sterile paper points which were inoculated on culture media. A second processing followed the same methodology but involved only irrigation and no instrumentation. Using instrumentation, thyme and clove completely inhibited Enterococcus faecalis growth. Without instrumentation, clove and oregano AqEOs completely reduced the bacterial load as seen in direct inoculation, but bacterial growth was observed in all the samples after enrichment, except for NaOCl. Nevertheless, the turbidity of the enrichment media was lower for the samples irrigated with AqEOs than for control. In conclusion, AqEOs of thyme, oregano and clove showed a promising antibacterial effect, especially when teeth instrumentation was performed.
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Kanagasingam S, Blum IR. Sodium Hypochlorite Extrusion Accidents: Management and Medico-Legal Considerations. Prim Dent J 2020; 9:59-63. [PMID: 33225856 DOI: 10.1177/2050168420963308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sodium hypochlorite is considered the most widely used irrigant in endodontics as it exhibits effective antimicrobial activity and has potent tissue-dissolving ability. Whilst it is considered safe when used within the confines of the root canal system, it can cause serious complications when inadvertent periradicular extrusion occurs. This article outlines the complications of sodium hypochlorite extrusion and reviews the appropriate management based on the contemporary evidence. Preventive measures are suggested and the relevant medico-legal considerations are outlined.
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Affiliation(s)
- Shalini Kanagasingam
- Senior Clinical Lecturer, Course Lead MSc and MClinDent in Endodontology School of Dentistry, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, UK.,Consultant and Specialist in Restorative Dentistry; Reader in Primary Dental Care and Advanced General Dental Practice, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, UK
| | - Igor R Blum
- Consultant and Specialist in Restorative Dentistry; Reader in Primary Dental Care and Advanced General Dental Practice, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, UK
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Grenier D, Marcoux E, Azelmat J, Ben Lagha A, Gauthier P. Biocompatible combinations of nisin and licorice polyphenols exert synergistic bactericidal effects against Enterococcus faecalis and inhibit NF-κB activation in monocytes. AMB Express 2020; 10:120. [PMID: 32632823 PMCID: PMC7338318 DOI: 10.1186/s13568-020-01056-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
Enterococcus faecalis is one of the bacterial species most frequently isolated from persistent endodontic and apical periodontal infections. The aim of the present study was to evaluate the synergistic antibacterial effects of nisin and selected licorice polyphenols (glabridin, licoricidin, licochalcone A) against planktonic and biofilm-embedded E. faecalis cells. The biocompatibility and anti-inflammatory properties of the nisin/licorice polyphenol combinations were also investigated. The lantibiotic bacteriocin (nisin), the two isoflavonoids (glabridin, licoricidin), and the chalcone (licochalcone A) efficiently inhibited the growth of E. faecalis, with MICs ranging from 6.25 to 25 µg/mL. Combining nisin with each licorice polyphenol individually resulted in a significant synergistic antibacterial effect. Following a 30-min contact, nisin in combination with either glabridin, licoricidin, or licochalcone A caused significant biofilm killing. The nisin/licorice polyphenol combinations had no cytotoxic effects (oral epithelial cells, gingival fibroblasts, and stem cells of the apical papilla), with the exception of nisin/glabridin, when used at their MICs. Lastly, we showed that nisin/glabridin, nisin/licoricidin, and nisin/licochalcone A inhibit NF-κB activation induced by E. faecalis in a monocyte model, suggesting that these combinations possess anti-inflammatory properties. The present study provides evidence that combinations of nisin and glabridin, licoricidin, or licochalcone A show promise as root canal disinfection agents.
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Marcoux E, Lagha AB, Gauthier P, Grenier D. Antimicrobial activities of natural plant compounds against endodontic pathogens and biocompatibility with human gingival fibroblasts. Arch Oral Biol 2020; 116:104734. [PMID: 32454322 DOI: 10.1016/j.archoralbio.2020.104734] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of the present study was to investigate three licorice-derived polyphenols (glabridin, licochalcone A, licoricidin) as well as cinnamon oil for their antimicrobial activities against major endodontic pathogens: Enterococcus faecalis, Streptococcus mutans, Actinomyces israelii, Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas endodontalis, and Candida albicans. The synergistic interactions between the four compounds and chlorhexidine were assessed on E. faecalis. Lastly, the biocompatibility of the tested compounds was assessed using human gingival fibroblasts. DESIGN Minimal inhibitory concentrations (MIC) and minimal microbicidal concentrations (MMC) were determined using a microplate dilution assay. A luminescence assay monitoring adenosine triphosphate was used to assess the antimicrobial activity of the tested compounds against E. faecalis biofilm. The synergistic effects of the tested compounds in association with chlorhexidine were evaluated using the checkerboard technique. Cytotoxicity toward human gingival fibroblasts was assessed by determination of cell metabolic activity using a colorimetric assay. RESULTS Cinnamon oil showed the strongest microbicidal activity. Licochalcone A, licoricidin, and glabridin had MIC values ranging from 1.56 to 25 μg/mL against the six endodontic bacterial pathogens. The natural plant compounds were active to various extents against E. faecalis embedded in a biofilm. Synergistic antibacterial effects between chlorhexidine and the compounds, mainly glabridin, were observed against E. faecalis. Following a 2-h exposure, licochalcone A, licoricidin, and glabridin demonstrated no cytotoxicity toward gingival fibroblasts at concentrations up to 50 μg/mL, while cinnamon oil and, to a lesser extent, chlorhexidine displayed some cytotoxicity. CONCLUSIONS The present study provides evidence that the natural plant compounds tested show promise as root canal disinfection agents.
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Affiliation(s)
- Eve Marcoux
- Oral Ecology Research Group, Faculty of Dentistry, Université Laval, Quebec City, QC, Canada
| | - Amel Ben Lagha
- Oral Ecology Research Group, Faculty of Dentistry, Université Laval, Quebec City, QC, Canada
| | - Philippe Gauthier
- Oral Ecology Research Group, Faculty of Dentistry, Université Laval, Quebec City, QC, Canada
| | - Daniel Grenier
- Oral Ecology Research Group, Faculty of Dentistry, Université Laval, Quebec City, QC, Canada.
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Kouno A, Watanabe S, Hongo T, Yao K, Satake K, Okiji T. Effect of Pulse Energy, Pulse Frequency, and Tip Diameter on Intracanal Vaporized Bubble Kinetics and Apical Pressure During Laser-Activated Irrigation Using Er:YAG Laser. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:431-437. [PMID: 32364877 DOI: 10.1089/photob.2019.4739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Er:YAG laser-activated irrigation (LAI) is an effective method of root canal cleaning, but irrigant extrusion from the apical foramen has been a concern. We aimed to analyze the effects of pulse energy, pulse frequency, and laser tip diameter on intracanal vapor bubble kinetics and periapical pressure generation during LAI with Er:YAG laser. Background: Irrigant vapor bubble kinetics are one of indices of root canal cleaning efficacy. However, few studies have compared laser pulse conditions to vapor bubble kinetics, in relation to periapical pressure. Methods: A plastic root canal model (apical diameter 0.50 mm, 6% taper, 20 mm long) was filled with distilled water, and LAI with Er:YAG laser (Erwin AdvErl Unit; 30, 50, or 70 mJ; 10, or 20 pulses per second; laser tip R200T or R600T) was performed with the end of the tip fixed at 15 mm from the root apex. The number, maximum diameter, and velocity of vapor bubbles were analyzed by high-speed video imaging. Pressure generated outside the apical foramen was measured with a pressure sensor. Results: Vapor bubble count and maximum diameter increased significantly with pulse energy, pulse frequency, and tip diameter. Vapor bubble velocity increased significantly with pulse frequency, but not with pulse energy or tip diameter. Periapical pressure increased significantly with pulse energy, pulse frequency, and tip diameter. Conclusions: The pulse frequency was the single factor that significantly affected all the examined parameters (the number, diameter, and velocity) of vapor bubble kinetics together with the periapical pressure.
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Affiliation(s)
- Akira Kouno
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Satoshi Watanabe
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomoyuki Hongo
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kanako Yao
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kazuhisa Satake
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takashi Okiji
- Division of Oral Health Sciences, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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13
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Dioguardi M, Gioia GD, Illuzzi G, Laneve E, Cocco A, Troiano G. Endodontic irrigants: Different methods to improve efficacy and related problems. Eur J Dent 2019; 12:459-466. [PMID: 30147418 PMCID: PMC6089055 DOI: 10.4103/ejd.ejd_56_18] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Shaping and cleaning a root canal system along with the preservation of the surrounding periodontal tissues are the principal goals of an endodontic treatment. While most of the attention is paid to the mechanical aspects of a root canal treatment, an essential feature of it is the irrigation. All over the years, many materials have been used to clean the root canal of a tooth, and certainly, the sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid solutions are the most used and most reliable ones. Putting them inside of a canal is mostly done using a normal syringe, but many techniques have been involved in this process, including the use of sonic/ultrasonic instruments, the use of shaping files, and even laser, to increase the efficacy of irrigant solutions, especially of NaOCl one. Each one of this technique faces some disadvantages, just as the vapor lock effect and the apical extrusion, and has a different action on features such as the reaction rate and the shear stress of an endodontic irrigant solution. In this narrative review, we describe the different features of many irrigant solutions and the different ways of upgrading their efficacy in the cleaning of a root canal system, with the use of tables to summarize the entire description, and drawing the readers' attention to a photographic illustration for a better understanding of the topic.
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Affiliation(s)
- Mario Dioguardi
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Giovanni Di Gioia
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Gaetano Illuzzi
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Enrica Laneve
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Armando Cocco
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, Foggia University, Foggia, Italy
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Zandi H, Petronijevic N, Mdala I, Kristoffersen AK, Enersen M, Rôças IN, Siqueira JF, Ørstavik D. Outcome of Endodontic Retreatment Using 2 Root Canal Irrigants and Influence of Infection on Healing as Determined by a Molecular Method: A Randomized Clinical Trial. J Endod 2019; 45:1089-1098.e5. [DOI: 10.1016/j.joen.2019.05.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/15/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022]
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15
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Slaughter RJ, Watts M, Vale JA, Grieve JR, Schep LJ. The clinical toxicology of sodium hypochlorite. Clin Toxicol (Phila) 2019; 57:303-311. [PMID: 30689457 DOI: 10.1080/15563650.2018.1543889] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Martin Watts
- National Poisons Centre, University of Otago, Dunedin, New Zealand
- Emergency Department, Southland Hospital, Invercargill, New Zealand
| | - J. Allister Vale
- West Midlands Poisons Unit, City Hospital, and University of Birmingham, Birmingham, UK
| | | | - Leo J. Schep
- National Poisons Centre, University of Otago, Dunedin, New Zealand
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16
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Mallya L, Shenoy R, Mala K, Shenoy S. Evaluation of the antimicrobial efficacy of 20% Punica granatum, 0.2% chlorhexidine gluconate, and 2.5% sodium hypochlorite used alone or in combinations against Enterococcus faecalis: An in-vitro study. J Conserv Dent 2019; 22:367-370. [PMID: 31802821 PMCID: PMC6873594 DOI: 10.4103/jcd.jcd_43_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives The study was aimed at evaluating the antimicrobial efficacy of 20% Punica granatum, 0.2% chlorhexidine (CHX) gluconate, and 2.5% sodium hypochlorite used alone or in combinations against Enterococcus faecalis. Materials and Methods Aqueous extract of pomegranate peel was prepared in the Pharmacology Departmental Laboratory. A total of 240 wells were prepared (40 for each group) with 5 wells per with a diameter of 6 mm and depth of 4 mm at equidistant from each other. Using a pipette, each well was filled with 50 μl of the test irrigant solution. CHX (0.2%), 2.5% sodium hypochlorite, and aqueous extract of pomegranate peel and their combinations were tested as root canal irrigants against a standard strain of E. faecalis (ATCC 29212) on sheep blood agar plate by calculating the zones of inhibition. The mean diameter of zones was calculated and tabulated. Data were analyzed using one-way analysis of variance and Tukey's post hoc test. Descriptive statistics was obtained using SPSS software (version 11.5) with P established at < 0.05. Results Combination of Punica granatum with sodium hypochlorite and CHX showed maximum mean zones of inhibition with mean of 23.9 and 25.7 mm, respectively, and showed significantly better results than all other groups either irrigants used alone or in combinations. Conclusions Punica granatum and CHX was proved to be a very good combination among experimental groups against E. faecalis, and sodium hypochlorite was least effective against E. Faecalis.
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Affiliation(s)
- Laxmish Mallya
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Affiliated to Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Ramya Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Affiliated to Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Kundabala Mala
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Affiliated to Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Suchitra Shenoy
- Department of Microbiology, Kasturba Medical College, Affiliated to Manipal Academy of Higher Education, Mangalore, Karnataka, India
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UĞUR AYDIN ZELİHA, AKPINAR KEREMENGİN, HEPOKUR CEYLAN, ALTUNBAŞ DEMET. Human Osteoblast Hücre Hattı Üzerinde Qmix, Etilen Diamintetraasetik Asit ve Klorhheksidin’in Sitotoksisitesinin Değerlendirilmesi. CUMHURIYET DENTAL JOURNAL 2018. [DOI: 10.7126/cumudj.438506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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18
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Yao K, Satake K, Watanabe S, Ebihara A, Kobayashi C, Okiji T. Effect of Laser Energy and Tip Insertion Depth on the Pressure Generated Outside the Apical Foramen During Er:YAG Laser-Activated Root Canal Irrigation. Photomed Laser Surg 2017; 35:682-687. [DOI: 10.1089/pho.2017.4268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Kanako Yao
- Department of Pulp Biology and Endodontics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kazuhisa Satake
- Department of Pulp Biology and Endodontics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Watanabe
- Department of Pulp Biology and Endodontics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Arata Ebihara
- Department of Pulp Biology and Endodontics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Chihiro Kobayashi
- Oral Diagnosis and General Dentistry Dental Hospital, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Takashi Okiji
- Department of Pulp Biology and Endodontics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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Guivarc'h M, Ordioni U, Ahmed HMA, Cohen S, Catherine JH, Bukiet F. Sodium Hypochlorite Accident: A Systematic Review. J Endod 2017; 43:16-24. [DOI: 10.1016/j.joen.2016.09.023] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/30/2016] [Indexed: 12/22/2022]
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Gonçalves LS, Rodrigues RCV, Andrade Junior CV, Soares RG, Vettore MV. The Effect of Sodium Hypochlorite and Chlorhexidine as Irrigant Solutions for Root Canal Disinfection: A Systematic Review of Clinical Trials. J Endod 2016; 42:527-32. [PMID: 26852149 DOI: 10.1016/j.joen.2015.12.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/26/2015] [Accepted: 12/22/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This systematic review aimed to compare the effectiveness of sodium hypochlorite and chlorhexidine for root canal disinfection during root canal therapy. METHODS A literature search for clinical trials was made on the PubMed (MEDLINE), Web of Knowledge, SCOPUS, and Science Direct databases and in the reference lists of the identified articles up to January 2015. Quality assessment of the selected studies was performed according to the Consolidated Standards of Reporting Trials statement. RESULTS One clinical trial and 4 randomized clinical trials were selected from the 172 articles initially identified. There was heterogeneity in the laboratory methods used to assess the root canal disinfection as well as in the concentrations of the irrigants used. Therefore, meta-analysis was not performed. Two studies reported effective and similar reductions in bacterial levels for both irrigants. Sodium hypochlorite was more effective than chlorhexidine in reducing microorganisms in 1 study, and another reported opposite findings. Both root irrigants were ineffective in eliminating endotoxins from necrotic pulp root canals in 1 study. Trial design and information regarding randomization procedures were not clearly described in the clinical trials. No study compared laboratory results with clinical outcomes. CONCLUSIONS The available evidence on this topic is scarce, and the findings of studies were not consistent. Additional randomized clinical trials using clinical outcomes to compare the use of sodium hypochlorite and chlorhexidine during root canal therapy are needed.
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Affiliation(s)
- Lucio Souza Gonçalves
- Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Renata Costa Val Rodrigues
- Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Endodontics, Faculty of Dentistry, Veiga de Almeida University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Vieira Andrade Junior
- Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Health, Dentistry Division, Southwest State University of Bahia, Jequié, Bahia, Brazil
| | - Renata G Soares
- Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mario Vianna Vettore
- Unit of Dental Public Health, School of Clinical Dentistry, University of Sheffield, Sheffield, England
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Del Carpio-Perochena A, Monteiro Bramante C, Hungaro Duarte M, Bombarda de Andrade F, Zardin Graeff M, Marciano da Silva M, Cavalini Cavenago B, Lucas Fernandes S. Effect of Temperature, Concentration and Contact Time of Sodium Hypochlorite on the Treatment and Revitalization of Oral Biofilms. J Dent Res Dent Clin Dent Prospects 2015; 9:209-15. [PMID: 26889356 PMCID: PMC4753028 DOI: 10.15171/joddd.2015.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 09/13/2015] [Indexed: 12/24/2022] Open
Abstract
Background and aims. Increasing the temperature of sodium hypochlorite (NaOCl) enhances its dissolution
and antibacterial properties. However, the high resistance of multi-species biofilms could
restrict the effect of the solution regardless of its temperature, enabling the long-term
recovery of the surviving bacteria. The aim of this study was to investigate if the
increase of temperature of NaOCl improves its antibacterial and dissolution ability on
oral biofilms and if the post-treatment remaining bacteria were capable of growing in a
nutrient-rich medium. Materials and methods. Forty dentin blocks were infected
intra-orally for 48 hours. Then, the specimens were treated with 1% and 2.5% NaOCl at room
temperature (22ºC) and body temperature (37ºC) for 5 and 20 min. The percentage of live
cells and the biovolume were measured pre- (control) and post-treatment and after the
biofilm revitalization. Four confocal ‘stacks’ were chosen from random areas of each
sample. Statistical analysis was performed using Kruskal-Wallis and Dunn tests.
Statistical significance was defined at P <0.05. Results. All the NaOCl groups were effective in dissolving
the biofilm at any temperature, concentration and contact time without statistical
differences among them (P >0.05). The 1%-NaOCl for 5min was not able to significantly
kill the bacteria, regardless of its temperature and contact time (P >0.05). Conclusion. The temperature variation of the NaOCl was not
relevant in killing or dissolving bacterial biofilms. Twenty-four hours of reactivation
did not appear to be enough time to induce a significant bacterial growth.
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Affiliation(s)
- Aldo Del Carpio-Perochena
- Doctor of Sciences, Department of Endodontics, Bauru Dental School of Bauru, University of São Paulo, Bauru, São Paulo, Brazil
| | - Clovis Monteiro Bramante
- Associate Professor, Department of Endodontics, Bauru Dental School of Bauru, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marco Hungaro Duarte
- Associate Professor, Department of Endodontics, Bauru Dental School of Bauru, University of São Paulo, Bauru, São Paulo, Brazil
| | - Flaviana Bombarda de Andrade
- Associate Professor, Department of Endodontics, Bauru Dental School of Bauru, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marcia Zardin Graeff
- Laboratory Specialist, Integrated Research Centre (CIP), Bauru Dental School of Bauru, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marina Marciano da Silva
- Doctor of Sciences, Department of Endodontics, Bauru Dental School of Bauru, University of São Paulo, Bauru, São Paulo, Brazil
| | - Bruno Cavalini Cavenago
- Doctor of Sciences, Department of Endodontics, Bauru Dental School of Bauru, University of São Paulo, Bauru, São Paulo, Brazil
| | - Samuel Lucas Fernandes
- Master of Sciences, Department of Endodontics, Bauru Dental School of Bauru, University of São Paulo, Bauru, São Paulo, Brazil
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Bramante CM, Duque JA, Cavenago BC, Vivan RR, Bramante AS, de Andrade FB, Duarte MAH. Use of a 660-nm Laser to Aid in the Healing of Necrotic Alveolar Mucosa Caused by Extruded Sodium Hypochlorite: A Case Report. J Endod 2015; 41:1899-902. [DOI: 10.1016/j.joen.2015.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/13/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022]
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Guidelines for management of sodium hypochlorite extrusion injuries. Br Dent J 2015; 217:679-84. [PMID: 25525012 DOI: 10.1038/sj.bdj.2014.1099] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 11/09/2022]
Abstract
Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics. It is highly effective at dissolving organic debris and disinfecting the root canal system due to the high pH. Extravasation of NaOCl into intra-oral and extra-oral tissues can lead to devastating outcomes leading to long-term functional and aesthetic deficits. Currently no clear guidelines are available which has caused confusion among the dental and oral and maxillofacial (OMFS) surgical community how best to manage these patients. Following a literature review and considering our own experience we have formulated clear and precise guidelines to manage patients with NaOCl injury.
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Inadvertent apical extrusion of sodium hypochlorite with evaluation by dental volumetric tomography. Case Rep Dent 2015; 2015:247547. [PMID: 25883812 PMCID: PMC4390169 DOI: 10.1155/2015/247547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/10/2015] [Accepted: 03/15/2015] [Indexed: 11/18/2022] Open
Abstract
This case report describes the tissue injury caused by inadvertently extruded NaOCl through the apical constriction. A 56-year-old female patient with complaints of pain, swelling, and ecchymosis on the left side of her face was referred to our clinic. The symptoms had emerged following root canal treatment of the maxillary left first premolar, and a soft tissue complication due to apical extrusion of NaOCl was diagnosed. Antibiotics and analgesics were prescribed. DVT images revealed that the buccal root apex had perforated the maxillary bone. The patient was followed up every other day and became asymptomatic on the 10th day. Endodontic therapy was completed with routine procedures. Determining working length precisely and following irrigation protocols meticulously are indispensable to prevent this type of complication. 3D visualization of the affected area may reveal the cause of the incident.
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Tissue Dissolution by a Novel Multisonic Ultracleaning System and Sodium Hypochlorite. J Endod 2014; 40:1178-81. [DOI: 10.1016/j.joen.2013.12.029] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 11/23/2022]
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Alkahtani A, Alkahtany SM, Anil S. An in vitro evaluation of the cytotoxicity of varying concentrations of sodium hypochlorite on human mesenchymal stem cells. J Contemp Dent Pract 2014; 15:473-481. [PMID: 25576116 DOI: 10.5005/jp-journals-10024-1565] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To evaluate and compare the cytotoxicity of various concentrations of sodium hypochlorite on immortalized human bone marrow mesenchymal stem cells (MSCs). MATERIALS AND METHODS The 5.25 percent sodium hypochlo-rite (NaOCl) at concentrations of 0.5, 0.1, 0.025, 0.0125, and 0.005 mg/ml were used to assess the cytotoxic effect on MSCs. Immortalized human bone marrow mesenchymal stem cells (hTERT-MSCs) were exposed to NaOCl at 5 different concentrations. Cell viability was assessed by 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and alamarBlue assays. The cell morphology changes were assessed with scanning electron microscopy (SEM) after exposure to 2, 4, and 24 hour incubation. The ethidium bromide/acridine orange (EB/ AO) fuorescent stain was applied to the cells in the 8-chamber slides after they were incubated with the testing agents for 2 and 4 hours to detect live and dead cells. The observations were quantitatively and qualitatively analyzed. RESULTS The cell viability study using MTT assay and AB assay showed significant reduction with varying concentration at 2 and 4 hours incubation period. The cell viability decreased with the higher percentage of NaOCl. The exposure time also revealed an inverse relation to the cell viability. The SEM analysis showed reduction in the number of cells and morphological alterations with 0.5 mg/ml at 2 and 4 hours compared to 0.025 mg/ml NaOCl. Destruction of the cells with structural alterations and lysis was evident under fuorescence microscope when the cells were exposed to 0.5 mg/ml NaOCl. CONCLUSION Within the limitations of this in vitro study it can be concluded that NaOCl is toxic to the human bone marrow MSCs. The cell lysis was evident with higher concentration of sodium hypochlorite. From the observations, it can be concluded that a lower concentration of NaOCl may be used as endodontic irrigant due to its cytotoxic properties. Further studies are mandatory to evolve a consensus on the optimal concentration of sodium hypochlorite to be used as endodontic irrigant.
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Affiliation(s)
- Ahmed Alkahtani
- Associate Professor, Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia, e-mail:
| | - Sarah M Alkahtany
- Lecturer, Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sukumaran Anil
- Professor, Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Alkahtani A, Alkahtany SM, Mahmood A, Elsafadi MA, Aldahmash AM, Anil S. Cytotoxicity of QMix™ endodontic irrigating solution on human bone marrow mesenchymal stem cells. BMC Oral Health 2014; 14:27. [PMID: 24678861 PMCID: PMC3972967 DOI: 10.1186/1472-6831-14-27] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/25/2014] [Indexed: 11/21/2022] Open
Abstract
Background Debridement and disinfection of the root canal system is a crucial step in endodontic procedures. The effectiveness of irrigation relies on both the mechanical flushing action and the ability of irrigants to dissolve tissue and kill bacteria. The objective of the present study is to evaluate and compare the cytotoxicity of QMix™ root canal irrigating solution on immortalized human bone marrow mesenchymal stem cells (hTERT-MSC-C1) and to compare it with that of sodium hypochlorite (NaOCl). Methods Immortalized human bone marrow mesenchymal stem cells (hTERT-MSCs) were exposed to QMix™ and NaOCl. Cell viability was assessed by 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and alamarBlue assays. The cell morphology was studied after two hours of exposure to QMix™ and NaOCl. Scanning electron microscopy (SEM) analyses were performed after 2- and 4-hour incubation periods. Finally, ethidium bromide/acridine orange (EB/AO) fluorescent stain was applied to the cells in the 8-chamber slides after they were incubated with the testing agents for 2 hours to detect live and dead cells. The observations were tabulated and analyzed statistically. Results QMix™ exposure resulted in a significantly higher percentage of cell viability than NaOCl in the MTT and alamarBlue assays at three time points compared to the control. The SEM analysis demonstrated minimal morphological changes associated with cells that were exposed to the QMix™ solution, with little shrinkage and fragmentation of the cell wall. The live/dead analysis showed that the number of live cells after exposure to QMix™ was similar to that of the untreated control. No cell structure could be observed with the NaOCl group, indicating cell lysis. Conclusion Both the QMix™ and NaOCl solutions were toxic to human bone marrow MSCs. Each solution might have induced cell death in a different way as evidenced in the cell viability, SEM and fluorescent studies. The slower cell death induced by QMix™ might therefore be less aggressive and more acceptable to living tissues.
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Affiliation(s)
- Ahmad Alkahtani
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Post Box 60169, Riyadh 11545, Saudi Arabia.
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Mishra L, Patnaik S, Patro S, Debnath N, Mishra S. Iatrogenic subcutaneous emphysema of endodontic origin - case report with literature review. J Clin Diagn Res 2014; 8:279-81. [PMID: 24596796 DOI: 10.7860/jcdr/2014/6909.3876] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/28/2013] [Indexed: 11/24/2022]
Abstract
Surgical emphysema is well known and many case reports have been published on this. Many authors have reported this as a complication post dentoalveolar treatment. Diffusion of air into facial planes and periorbital area during endodontic procedures has been rarely reported. The use of three way air syringe and forceful irrigation of root canal can lead to surgical emphysema of subcutaneous tissue planes in and around the teeth which are involved. This case report highlights one such complication seen during endodontic treatment, discusses aetiology, complications and conservative management of this dental office emergency.
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Affiliation(s)
- Lora Mishra
- Assistant Professor, Department of Conservative Dentistry & Endodontics, Institute of Dental Sciences, S'O' A University , Bhubaneswar, Odisha, India
| | - Swarnav Patnaik
- Assistant Professor, Department of Oral v Maxillofacial Surgery, Hitech Dental College , Bhubaneswar, Odisha, India
| | - Sangram Patro
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Hitech Dental College , Bhubaneswar, Odisha, India
| | - Nitai Debnath
- Assistant Professor, Department of Prosthodontics, College of Dental Sciences and Hospital , Indore, India
| | - Satyaranjan Mishra
- Associate Professor, Department of Oral Medicine and Radiology, Institute of Dental Sciences, S'O' A University , Bhubaneswar, Odisha, India
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Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review. J Dent 2013; 41:935-48. [PMID: 23994710 DOI: 10.1016/j.jdent.2013.08.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/12/2013] [Accepted: 08/17/2013] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur. METHODS To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed. RESULTS By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented. CONCLUSIONS Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system.
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Khan S, Niu LN, Eid AA, Looney SW, Didato A, Roberts S, Pashley DH, Tay FR. Periapical Pressures Developed by Nonbinding Irrigation Needles at Various Irrigation Delivery Rates. J Endod 2013; 39:529-33. [DOI: 10.1016/j.joen.2013.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 12/24/2022]
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Boutsioukis C, Psimma Z, van der Sluis LWM. Factors affecting irrigant extrusion during root canal irrigation: a systematic review. Int Endod J 2013; 46:599-618. [DOI: 10.1111/iej.12038] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/08/2012] [Indexed: 11/29/2022]
Affiliation(s)
- C. Boutsioukis
- Physics of Fluids Group; Faculty of Science and Technology, and MESA+ Institute for Nanotechnology; University of Twente; Enschede; the Netherlands
| | - Z. Psimma
- Department of Endodontology; Dental School; Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - L. W. M. van der Sluis
- Department of Conservative Dentistry and Endodontics; Paul Sabatier University; Toulouse; France
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Harrel SK, Abraham CM, Rivera-Hidalgo F. Tissue resistance to soft tissue emphysema during minimally invasive periodontal surgery. J Contemp Dent Pract 2012; 13:886-91. [PMID: 23404021 DOI: 10.5005/jp-journals-10024-1247] [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
AIM The aim of this study was to determine the pressure where oral soft tissue resistance will be overcome resulting in soft tissue emphysema and to measure the safety of an antifouling device for a videoscope used during minimally invasive periodontal surgery. MATERIALS AND METHODS Resistance was measured in vitro in porcine tissue. One study arm measured palatal tissue resistance to air applied through a needle. Another arm measured resistance in a surgical access for minimally invasive periodontal surgery (MIS). India ink was placed on the tissue,pressure at 0,3,10,15,20, and 25 pounds/square inch (psi)applied, and penetration of India ink into the tissue was measured. Three trials in three sites were performed at each pressure in both arms of the study. RESULTS Pressure applied to palatal tissue through a needle showed no significant penetration of India ink until 15 psi (0.90 ± 0.24 mm, p = 0.008). Penetration considered clinically significant was noted at 20 and 25 psi (4 to 6 mm, p ≤ 0.0001). No significant penetration was noted in minimally invasive incisions. CONCLUSION Within the test system, pressures of 15 psi or less seem unlikely to cause soft tissue emphysema. No evidence of tissue emphysema was noted with the video scope antifouling device. CLINICAL SIGNIFICANCE The use of pressures greater than 15 pounds per square inch should be avoided during surgical procedures. The antifouling device for a videoscope appears safe for use during minimally invasive periodontal surgery.
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Affiliation(s)
- Stephen K Harrel
- Department of Periodontology, Baylor College of Dentistry Texas, USA.
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Behrents KT, Speer ML, Noujeim M. Sodium hypochlorite accident with evaluation by cone beam computed tomography. Int Endod J 2012; 45:492-8. [DOI: 10.1111/j.1365-2591.2011.02009.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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