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Weissheimer T, Pinto KP, da Silva EJNL, Hashizume LN, da Rosa RA, Só MVR. Disinfectant effectiveness of chlorhexidine gel compared to sodium hypochlorite: a systematic review with meta-analysis. Restor Dent Endod 2023; 48:e37. [PMID: 38053784 PMCID: PMC10695732 DOI: 10.5395/rde.2023.48.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/25/2023] [Accepted: 09/07/2023] [Indexed: 12/07/2023] Open
Abstract
This study aimed to compare the disinfectant ability of chlorhexidine (CHX) gel and sodium hypochlorite (NaOCl). Systematic searches were conducted from inception until December 8th, 2022 (MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, Embase, and Grey Literature databases). Only randomized clinical trials were included. The revised Cochrane risk of bias tools for randomized trials were used to assess the quality of studies. Meta-analyses were performed. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool. Six studies were included. Five had a low risk of bias and 1 had some concerns. Three studies assessed bacterial reduction. Two were included in the meta-analysis for bacterial reduction (mean difference, 75.03 [confidence interval, CI, -271.15, 421.22], p = 0.67; I2 = 74%); and 3 in the meta-analysis for cultivable bacteria after chemomechanical preparation (odds ratio, 1.03 [CI, 0.20, 5.31], P = 0.98; I2 = 49%). Five studies assessed endotoxin reduction. Three were included in a meta-analysis (mean difference, 20.59 [CI, -36.41, 77.59], p = 0.48; I2 = 74%). There seems to be no difference in the disinfectant ability of CHX gel and NaOCl, but further research is necessary.
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Affiliation(s)
- Theodoro Weissheimer
- Department of Endodontics, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Karem Paula Pinto
- Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Emmanuel João Nogueira Leal da Silva
- Department of Endodontics, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
- Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Lina Naomi Hashizume
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Abreu da Rosa
- Department of Endodontics, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Marcus Vinicius Reis Só
- Department of Endodontics, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Sy K, Chevalier C, Maton M, Mokbel I, Mahieux S, Houcke I, Neut C, Grosgogeat B, Deveaux E, Gritsch K, Agossa K. Therapeutic Potential of Chlorhexidine-Loaded Calcium Hydroxide-Based Intracanal Medications in Endo-Periodontal Lesions: An Ex Vivo and In Vitro Study. Antibiotics (Basel) 2023; 12:1416. [PMID: 37760713 PMCID: PMC10525524 DOI: 10.3390/antibiotics12091416] [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: 07/03/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Endo-periodontal lesions are challenging clinical situations where both the supporting tissues and the root canal of the same tooth are infected. In the present study, chlorhexidine (CHX)-loaded calcium hydroxide (CH) pastes were used as intracanal medications (ICMs). They were prepared and tested on pathogens found in both the root canal and the periodontal pocket. Exposure to 0.5% and 1% CHX-loaded ICMs decreased the growth of Porphyromonas gingivalis and was effective in eradicating or inhibiting an Enterococcus faecalis biofilm. CH was injected into the root canal of extracted human teeth immersed in deionized water. CHX-loaded ICMs resulted in the transradicular diffusion of active components outside the tooth through the apex and the lateral dentinal tubules, as shown by the release of CHX (from 3.99 µg/mL to 51.28 µg/mL) and changes in pH (from 6.63 to 8.18) and calcium concentrations (from 2.42 ppm to 14.67 ppm) after 7 days. The 0.5% CHX-loaded ICM was non-toxic and reduced the release of IL-6 by periodontal cells stimulated by P. gingivalis lipopolysaccharides. Results indicate that the root canal may serve as a reservoir for periodontal drug delivery and that CHX-based ICMs can be an adjuvant for the control of infections and inflammation in endo-periodontal lesions.
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Affiliation(s)
- Kadiatou Sy
- U1008, Controlled Drug Delivery Systems and Biomaterials, Inserm, CHU Lille, Université de Lille, 59000 Lille, France; (M.M.); (E.D.); (K.A.)
- Faculté d’Odontologie, Hospices Civils de Lyon, Pôle d′Odontologie, Université Lyon 1, Université de Lyon, 69372 Lyon Cedex 08, France; (B.G.); (K.G.)
| | - Charlène Chevalier
- UMR CNRS 5615 Laboratoire des Multimatériaux et Interfaces, Université Lyon 1, 69100 Villeurbanne, France; (C.C.); (I.M.)
| | - Mickaël Maton
- U1008, Controlled Drug Delivery Systems and Biomaterials, Inserm, CHU Lille, Université de Lille, 59000 Lille, France; (M.M.); (E.D.); (K.A.)
| | - Ilham Mokbel
- UMR CNRS 5615 Laboratoire des Multimatériaux et Interfaces, Université Lyon 1, 69100 Villeurbanne, France; (C.C.); (I.M.)
| | - Séverine Mahieux
- U1286 Infinite, Institute for Translational Research in Inflammation, Inserm, CHU Lille, Université de Lille, 59000 Lille, France; (S.M.); (I.H.); (C.N.)
| | - Isabelle Houcke
- U1286 Infinite, Institute for Translational Research in Inflammation, Inserm, CHU Lille, Université de Lille, 59000 Lille, France; (S.M.); (I.H.); (C.N.)
| | - Christel Neut
- U1286 Infinite, Institute for Translational Research in Inflammation, Inserm, CHU Lille, Université de Lille, 59000 Lille, France; (S.M.); (I.H.); (C.N.)
| | - Brigitte Grosgogeat
- Faculté d’Odontologie, Hospices Civils de Lyon, Pôle d′Odontologie, Université Lyon 1, Université de Lyon, 69372 Lyon Cedex 08, France; (B.G.); (K.G.)
| | - Etienne Deveaux
- U1008, Controlled Drug Delivery Systems and Biomaterials, Inserm, CHU Lille, Université de Lille, 59000 Lille, France; (M.M.); (E.D.); (K.A.)
| | - Kerstin Gritsch
- Faculté d’Odontologie, Hospices Civils de Lyon, Pôle d′Odontologie, Université Lyon 1, Université de Lyon, 69372 Lyon Cedex 08, France; (B.G.); (K.G.)
| | - Kevimy Agossa
- U1008, Controlled Drug Delivery Systems and Biomaterials, Inserm, CHU Lille, Université de Lille, 59000 Lille, France; (M.M.); (E.D.); (K.A.)
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Pereira AC, Oliveira MLD, Cerqueira-Neto ACCL, Gomes BPFA, Ferraz CCR, Almeida JFAD, Marciano MA, DE-Jesus-Soares A. Treatment outcomes of pulp revascularization in traumatized immature teeth using calcium hydroxide and 2% chlorhexidine gel as intracanal medication. J Appl Oral Sci 2020; 28:e20200217. [PMID: 32997087 PMCID: PMC7518246 DOI: 10.1590/1678-7757-2020-0217] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Pulp revascularization is an effective treatment for immature necrotic teeth. Calcium hydroxide has been used in pulp revascularization as an intracanal medication due to its antimicrobial action and the non-exhibition of crown discoloration and cytotoxicity for stem cells from the apical papilla. Our study aimed to investigate the clinical success and quantitative radiographic changes of root development in immature traumatized teeth using calcium hydroxide plus 2% chlorhexidine gel as intracanal medication. METHODOLOGY In this retrospective study, 16 patients were treated with a standardized pulp revascularization protocol. Calcium hydroxide and 2% chlorhexidine gel were manipulated in a 1:1 (v/v) ratio and inserted into root canals with Lentulo spirals (Dentsply Maillefer, Baillaigues, Switzerland). Patients were followed up for a period from 9 to 36 months for the evaluation of clinical and radiological data. Radiographic measurements of root length, root width, apical diameter, and MTA placement from the apex were quantified using software ImageJ. Wilcoxon test and t-test were used, according to nonparametric or parametric data, respectively, for changes over time in root length, root width, and apical diameter. RESULTS Fifteen teeth survived during the follow-up period (93.75%) and met the criteria for clinical success. Although the changes seem to be very small in many cases, significant increases in the average root length (14.28%, p<0.0001), root width (8.12%, p=0.0196), and decrease in apical diameter (48.37%, p=0.0007) were observed. MTA placement from the apex and age at the time of treatment was not significantly associated with the quantitative radiographic outcomes. CONCLUSIONS Pulp revascularization in traumatized immature teeth treated with calcium hydroxide plus 2% chlorhexidine gel as intracanal medication had high success and survival rates, showing periodontal healing and resolution of signs and symptoms. However, concerning the continued root development, the outcomes can still be considered unpredictable.
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Affiliation(s)
- Andrea Cardoso Pereira
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Matheus Lima de Oliveira
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Diagnóstico Oral, área de Radiologia Oral, Piracicaba, SP, Brasil
| | - Ana Carolina C L Cerqueira-Neto
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Brenda P F A Gomes
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Caio Cezar Randi Ferraz
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - José Flávio Affonso de Almeida
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Marina Angélica Marciano
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
| | - Adriana DE-Jesus-Soares
- Universidade Estadual Campinas - UNICAMP. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Restauradora, área de Endodontia. Piracicaba, SP, Brasil
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Characterization of Chlorhexidine-Loaded Calcium-Hydroxide Microparticles as a Potential Dental Pulp-Capping Material. Bioengineering (Basel) 2017; 4:bioengineering4030059. [PMID: 28952538 PMCID: PMC5615305 DOI: 10.3390/bioengineering4030059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 12/02/2022] Open
Abstract
This study explores the delivery of novel calcium hydroxide [Ca(OH)2] microparticles loaded with chlorhexidine (CHX) for potential dental therapeutic and preventive applications. Herein, we introduce a new approach for drug-delivery to deep dentin-surfaces in the form of drug-loaded microparticles. Unloaded Ca(OH)2 [Ca(OH)2/Blank] and CHX-loaded/Ca(OH)2 microparticles were fabricated by aqueous chemical-precipitation technique. The synthesized-microparticles were characterized in vitro for determination of surface-morphology, crystalline-features and thermal-properties examined by energy-dispersive X-ray scanning and transmission electron-microscopy (EDX-SEM/TEM), Fourier-transform infrared-spectroscopy (FTIR), X-ray diffraction (XRD), thermogravimetric analysis (TGA) and differential scanning-calorimetry (DSC). Time-related pH changes, initial antibacterial/biofilm-abilities and cytotoxicity of CHX-loaded/Ca(OH)2 microparticles were evaluated. Microparticles were delivered to dentin-surfaces with subsequent SEM examination of treated dentin-substrates. The in vitro and ex vivo CHX-release profiles were characterized. Ca(OH)2/Blank were hexagonal-shaped with highest z-average diameter whereas CHX-inclusion evidenced micro-metric spheres with distinguishable surface “rounded deposits” and a negative-shift in diameter. CHX:Ca(OH)2/50 mg exhibited maximum encapsulation-efficiency with good antibacterial and cytocompatible properties. SEM examination revealed an intact layer of microparticles on exposed dentin-surfaces with retention of spherical shape and smooth texture. Microparticles loaded on dentin-surfaces showed prolonged release of CHX indicating substantial retention on dentin-substrates. This study validated the inherent-applicability of this novel drug-delivery approach to dentin-surfaces using micro-metric CHX-loaded/Ca(OH)2 microparticles.
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Melo TAFD, Gründling GSL, Montagner F, Scur AL, Steier L, Scarparo RK, Figueiredo JAPD, Vier-Pelisser FV. LPS levels in root canals after the use of ozone gas and high frequency electrical pulses. Braz Oral Res 2016; 30:S1806-83242016000100231. [PMID: 26981752 DOI: 10.1590/1807-3107bor-2016.vol30.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/09/2015] [Indexed: 11/22/2022] Open
Abstract
The present study aims to verify the effect of ozone gas (OZY® System) and high frequency electric pulse (Endox® System) systems on human root canals previously contaminated with Escherichia colilipopolysaccharide (LPS). Fifty single-rooted teeth had their dental crowns removed and root lengths standardized to 16 mm. The root canals were prepared up to #60 hand K-files and sterilized using gamma radiation with cobalt 60. The specimens were divided into the following five groups (n = 10) based on the disinfection protocol used: OZY® System, one 120-second-pulse (OZY 1p); OZY® System, four 24-second-pulses (OZY 4p); and Endox® System (ENDOX). Contaminated and non-contaminated canals were exposed only to apyrogenic water and used as positive (C+) and negative (C-) controls, respectively. LPS (O55:B55) was administered in all root canals except those belonging to group C-. After performing disinfection, LPS samples were collected from the canals using apyrogenic paper tips. Limulus Amoebocyte Lysate (LAL) was used to quantify the LPS levels, and the data obtained was analyzed using one-way ANOVA. The disinfection protocols used were unable to reduce the LPS levels significantly (p = 0.019). The use of ozone gas and high frequency electric pulses was not effective in eliminating LPS from the root canals.
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Affiliation(s)
- Tiago André Fontoura de Melo
- Clinical Department, School of Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Francisco Montagner
- School of Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Liviu Steier
- Institute of Clinical Education, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Roberta Kochenborger Scarparo
- Clinical Department, School of Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Fabiana Vieira Vier-Pelisser
- Clinical Department, School of Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Gründling GL, Melo TAFD, Montagner F, Scarparo RK, Vier-Pelisser FV. QMix® irrigant reduces lipopolysacharide (LPS) levels in an in vitro model. J Appl Oral Sci 2016; 23:431-5. [PMID: 26398517 PMCID: PMC4560505 DOI: 10.1590/1678-775720140488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The presence of endotoxin inside the root canal has been associated with periapical inflammation, bone resorption and symptomatic conditions.Objectives To determine, in vitro, the effect of QMix® and other three root canal irrigants in reducing the endotoxin content in root canals.Material and Methods Root canals of single-rooted teeth were prepared. Samples were detoxified with Co-60 irradiation and inoculated with E. coli LPS (24 h, at 37°C). After that period, samples were divided into 4 groups, according to the irrigation solution tested: QMix®, 17% EDTA, 2% chlorhexidine solution (CHX), and 3% sodium hypochlorite (NaOCl). LPS quantification was determined by Limulus Amebocyte Lysate (LAL) assay. The initial counting of endotoxins for all samples, and the determination of LPS levels in non-contaminated teeth and in contaminated teeth exposed only to non-pyrogenic water, were used as controls.Results QMix® reduced LPS levels, with a median value of 1.11 endotoxins units (EU)/mL (p<0.001). NaOCl (25.50 EU/mL), chlorhexidine (44.10 EU/mL) and positive control group (26.80 EU/mL) samples had similar results. Higher levels were found with EDTA (176.00 EU/mL) when compared to positive control (p<0.001). There was no significant difference among EDTA, NaOCl and CHX groups. Negative control group (0.005 EU/mL) had statistically significant lower levels of endotoxins when compared to all test groups (p<0.001).Conclusion QMix® decreased LPS levels when compared to the other groups (p<0.001). 3% NaOCl, 2% CHX and 17% EDTA were not able to significantly reduce the root canal endotoxins load.
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Affiliation(s)
| | | | - Francisco Montagner
- Department of Conservative Dentistry, Dental School, Federal University of Rio Grande do Sul, BR
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Melo TAFD, Gründling GSL, Montagner F, Scarparo RK, Figueiredo JAPD, Vier-Pelisser FV. Are bovine teeth a suitable substitute for human teeth in in vitro studies to assess endotoxin load in root canals? Braz Oral Res 2015; 29:S1806-83242015000100282. [PMID: 26154374 DOI: 10.1590/1807-3107bor-2015.vol29.0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/27/2015] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to determine the feasibility of using bovine teeth as a suitable alternative for human teeth, in experiments involving in vitro endotoxin contamination. Twenty bovine central incisors and 20 human single-root premolars had their dental crowns removed and root lengths set at 16 mm. Root canals were prepared up to #60 K-file size and sterilized with cobalt-60 gamma irradiation (20 kGy, 6 h). The teeth were randomly divided into four groups: G1-bovine teeth (bovine negative control, n = 10), G2-human teeth (human negative control, n = 10), G3-bovine teeth, inoculated with Escherichia coli (055:B55) LPS, and G4-human teeth inoculated with E. coli LPS. The G1 and G2 groups were exposed to apyrogenic water. After the teeth had been incubated at 37 °C and atmospheric humidity for 24 h, the samples of solutions in the main canals were collected with apyrogenic absorbent paper tips. LPS levels were quantified using Limulus Amebocyte Lysate assay. The data obtained were statistically analyzed using one-way ANOVA, with a significance level of 5%. A high amount of endotoxin was detected in the inoculated human teeth (G4) when compared to the sterilized teeth (G2), as well as in the inoculated bovine teeth (G3) when compared to the inoculated human teeth (G4). However, there was no statistical difference between bovine teeth before and after the E. coli endotoxin inoculation. Therefore, under the mentioned experimental conditions, the use of bovine teeth should not be a choice for laboratory research on endotoxin contamination.
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Affiliation(s)
- Tiago André Fontoura de Melo
- Clinical Department, Dental School, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Francisco Montagner
- Endodontics Division, Dental School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - Fabiana Vieira Vier-Pelisser
- Clinical Department, Dental School, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Jacinto RC, Linhares-Farina G, Sposito ODS, Zanchi CH, Cenci MS. Influence of 2% chlorhexidine on pH, calcium release and setting time of a resinous MTA-based root-end filling material. Braz Oral Res 2015; 29:S1806-83242015000100237. [PMID: 25715035 DOI: 10.1590/1807-3107bor-2015.vol29.0036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 11/02/2014] [Indexed: 11/22/2022] Open
Abstract
The addition of chlorhexidine (CHX) to a resinous experimental Mineral Trioxide Aggregate (E-MTA) based root-end filling material is an alternative to boost its antimicrobial activity. However, the influence of chlorhexidine on the properties of this material is unclear. The aim of this study was to evaluate the influence of 2% chlorhexidine on the pH, calcium ion release and setting time of a Bisphenol A Ethoxylate Dimethacrylate/Mineral Trioxide Aggregate (Bis-EMA/MTA) based dual-cure experimental root-end filling material (E-MTA), in comparison with E-MTA without the addition of CHX and with conventional white MTA (W-MTA). The materials were placed in polyethylene tubes, and immersed in deionized water to determine pH (digital pH meter) and calcium ion release (atomic absorption spectrometry technique). The setting time of each material was analyzed using Gilmore needles. The data were statistically analyzed at a significance level of 5%. E-MTA + CHX showed an alkaline pH in the 3 h period of evaluation, the alkalinity of which decreased but remained as such for 15 days. The pH of E-MTA + CHX was higher than the other two materials after 7 days, and lower after 30 days (p < 0.05). All of the materials were found to release calcium ions throughout the 30 days of the study. The addition of CHX increased the calcium ion release of E-MTA to levels statistically similar to W-MTA. E-MTA showed shorter initial and final setting time, compared with W-MTA (p < 0.05). The addition of 2% CHX to MTA prevented setting of the material. The addition of CHX to E-MTA increased its pH and calcium ion release. However, it also prevented setting of the material.
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Affiliation(s)
| | - Giane Linhares-Farina
- Department of Semiology and Clinics, Dental School, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Otávio da Silva Sposito
- Department of Semiology and Clinics, Dental School, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - César Henrique Zanchi
- Department of Restorative Dentistry, Dental School, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Maximiliano Sérgio Cenci
- Department of Restorative Dentistry, Dental School, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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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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Soares ADJ, Lins FF, Nagata JY, Gomes BPFDA, Zaia AA, Ferraz CCR, Almeida JFAD, Souza-Filho FJD. Pulp Revascularization after Root Canal Decontamination with Calcium Hydroxide and 2% Chlorhexidine Gel. J Endod 2013; 39:417-20. [DOI: 10.1016/j.joen.2012.10.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/25/2012] [Accepted: 10/02/2012] [Indexed: 11/17/2022]
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Tüzüner T, Ulusoy AT, Baygin O, Yahyaoglu G, Yalcin I, Buruk K, Nicholson J. Direct and transdentinal (indirect) antibacterial activity of commercially available dental gel formulations against Streptococcus mutans. Med Princ Pract 2013; 22:397-401. [PMID: 23485568 PMCID: PMC5586762 DOI: 10.1159/000347234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 01/20/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the direct and transdentinal (indirect) agar diffusion antibacterial activity of different commercially available antibacterial dental gel formulations against Streptococcus mutans. MATERIALS AND METHODS The commercially available dental gel formulations were Corsodyl® (COG, 1% chlorhexidine), Cervitec® (CEG, 0.2% chlorhexidine + 0.2% sodium fluoride), Forever Bright® (FOB, aloe vera), Gengigel® (GEG, 0.2% hyaluronic acid), 35% phosphoric acid gel and distilled water (control). Direct agar diffusion was performed by isolating three wells from brain-heart infusion agar plates using sterile glass pipettes attached to a vacuum pump and adding 0.1 ml of the gels to each well. Transdentinal (indirect) agar diffusion was performed by applying gel to 0.2- and 0.5-mm-thick human dentin discs previously etched with phosphoric acid and rinsed with distilled water. Zones formed around the wells and the dentin discs were measured and analyzed using Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction (p < 0.01). RESULTS Direct agar diffusion tests showed significant differences among all gel formulations (p < 0.01) except for COG and CEG (p > 0.01). COG and CEG exhibited higher antibacterial effects compared to FOB and GEG (p < 0.01) in both direct and transdentinal (indirect) testing procedures. GEG did not show any antimicrobial activity in transdentinal (indirect) testing. CONCLUSION Commercially available dental gels inhibited S. mutans, which may indicate their potential as cavity disinfectants.
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Affiliation(s)
- Tamer Tüzüner
- Department of Pediatric Dentistry, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey.
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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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Souza M, Cecchin D, Farina AP, Leite CE, Cruz FF, Pereira CDC, Ferraz CCR, Figueiredo JAP. Evaluation of chlorhexidine substantivity on human dentin: a chemical analysis. J Endod 2012; 38:1249-52. [PMID: 22892744 DOI: 10.1016/j.joen.2012.06.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 06/01/2012] [Accepted: 06/04/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the substantivity of chlorhexidine (CHX) solution and gel within a root canal system for 24 hours, 30 days, and 90 days. METHODS Forty-five extracted human anterior teeth were used for this study. The samples were divided into 3 groups according to the chemical auxiliary substance used to perform the root canal preparation: group 1, 2% liquid CHX; group 2, 2% gel CHX; and group 3, distilled water (the control group). The working length was determined by inserting a #10 K-file into the canal up to the moment its tip was seen in the apex foramen and then withdrawing it 1 mm. The roots were prepared up to the instrument #45. Longitudinal grooves were carved on the free surfaces of the roots, providing 2 halves of each root and resulting in 30 samples per group. Each group was randomly divided into 3 subgroups (n = 10), and substantivity was evaluated after 24 hours, 30 days, and 90 days of incubation. The amount of CHX (in micrometers) was measured through reverse-phase high-performance liquid chromatography. Statistical analysis was performed by analysis of variance and the Tukey test for post hoc comparisons (α = 0.05). RESULTS The control group showed no substantivity. Significant amounts of CHX solution and gel remained retained in dentin substrates independent of the time of incubation (P < .05). CHX solution showed a higher substantivity than CHX gel, with the exception of groups incubated for 90 days. The decreasing amounts of retained CHX inside the canal were for 24 hours >30 days >90 days for CHX solution and 24 hours >30 days ≥ 90 days for CHX gel. CONCLUSIONS The results of this study indicate that CHX solution and gel are retained in root canal dentin for up to 90 days.
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Affiliation(s)
- Matheus Souza
- Department of Restorative Dentistry, UPF, Passo Fundo, Rio Grande do Sul, Brazil
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Wheater MA, Falvo J, Ruiz F, Byars M. Chlorhexidine, ethanol, lipopolysaccharide and nicotine do not enhance the cytotoxicity of a calcium hydroxide pulp capping material. Int Endod J 2012; 45:989-95. [DOI: 10.1111/j.1365-2591.2012.02057.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lima RKP, Guerreiro-Tanomaru JM, Faria-Júnior NB, Tanomaru-Filho M. Effectiveness of calcium hydroxide-based intracanal medicaments against Enterococcus faecalis. Int Endod J 2011; 45:311-6. [DOI: 10.1111/j.1365-2591.2011.01976.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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