Canal debridement: effectiveness of sodium hypochlorite and calcium hydroxide as medicaments

In Vitro Comparative Evaluation of Cleaning Efficacy and Volumetric Filling in Primary Molars: Cone Beam Computed Tomography Evaluation

Introduction:

Pulpectomy of primary teeth is mostly carried out with hand files and broaches which is tricky and time consuming procedure. The development of new design features like varying tapers, non-cutting safety tips and varying length of cutting blades have resulted in new generation of rotary instruments.

Aim:

To compare and evaluate cleaning efficacy, canal preparation and volumetric filling using conventional files and rotary V Taper files through cone beam computed tomography.

Materials and Method:

Thirty extracted primary molars were selected. The teeth were randomly divided into three groups each containing 10 teeth i.e. 30 canals in each group. Group A was instrumented with K files; Group B rotary V Taper files and Group C was Hybrid group. Sodium hypochlorite (1%) was used for irrigation. Root canal filling was done with Zinc Oxide Eugenol cement in all groups. The volumetric analysis i.e. Percentage of Volume (POV) of the root canal filling in primary molars was done through CBCT Software.

Result:

In present study, p- value was found to be significant (<0.05). Almost 100% of canals of hybrid group were fully filled and 63.3% of canals of hand filing group were partially filled. The filling was found to be dense and no. of voids was least in hybrid group.

Conclusion:

Clinical time required in primary molar endodontics, especially with unpredictability and difficulty of canal morphology, is inevitable. The study confirms superior ability of rotary-file systems to shape severely curved canals with less time and significant decrease in procedural errors like partial filling, voids and inappropriate canal preparation.

Eficácia das manobras de desbridamento no preparo químico-mecânico quanto à desinfecção no terço apical em molares humanos

Resumo Objetivo Avaliar a eficácia das manobras de desbridamento no preparo químico-mecânico (PQM) quanto a limpeza e desinfecção no terço apical em molares humanos. Material e método Cinquenta raízes mesiais de molares inferiores humanos com dois canais radiculares foram inoculadas com E. faecalis e distribuídas aleatoriamente em cinco grupos (n=10). O PQM foi realizado com o sistema Protaper associado ao desbridamento com as limas Kerr #10 (G1 e G3) e as limas Kerr #15 (G2 e G4). O G5 representou o controle positivo, o qual foi submetido apenas ao PQM, sem receber o desbridamento. Outra variável foi o uso da medicação intracanal (MIC) à base de hidróxido de cálcio (Calen), que foi aplicada aos grupos G3 e G4. A irrigação foi feita com hipoclorito de sódio 2,5% e EDTA 17%. A análise da ação antimicrobiana se deu através da contagem das unidades formadoras de colônias (UFC). Resultado Foram aplicados o Teste Kruskal-Wallis (nas análises imediatas) e o Teste Mann-Whitney (nas análises mediatas), ambos com p=0,01. A análise imediata ao PQM apresentou-se sem diferença estatística entre os grupos (p=0,11). No G4 (#15 + MIC), os resultados das coletas mediatas foram estatisticamente significantes (p=0,01). Conclusão O desbridamento com as limas Kerr #10 e #15 não apresentou diferença significativa quanto à redução das colônias de E. faecalis quando comparado ao grupo em que não se realizou o desbridamento. Nos espécimes em que se aplicou a MIC, o desbridamento com a lima Kerr #15 (G4) foi mais eficiente do que a lima Kerr #10 (G3) em reduzir as UFC.

Rotary endodontics in primary teeth - A review

Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the "gold-standard" over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel-titanium (Ni-Ti) rotary files have been developed for use in pediatric endodontics. Using rotary instruments for primary tooth pulpectomies is cost effective and results in fills that are consistently uniform and predictable. This article reviews the use of nickel-titanium rotary files as root canal instrumentation in primary teeth. The pulpectomy technique is described here according to different authors and the advantages and disadvantages of using rotary files are discussed.

Hydroxyl and calcium ions diffusion from endodontic materials through roots of primary teeth - in vitro study

The purpose of this research was to evaluate the diffusion of calcium (Ca+2) and hydroxyl (OH-) ions from materials with a calcium hydroxide base - Ca(OH)2 through the intact roots of deciduous teeth. This diffusion of ions is important for periapical healing. Forty-six deciduous teeth were selected and instrumented to their working length with #40 files. The teeth were washed during cleaning and shaping with a 1% sodium hypochlorite (NaOCl) solution. The canals were dried with paper points. The teeth were divided into 4 groups based on the sealer type, with 10 specimens in each group. A fifth group of 6 teeth without sealer constituted the control group. The materials used as sealers were: Ca(OH)2 paste associated to propylene glycol (CaPE) thickened at the proportion of 2:1 w/v; UFSC (Federal University of Santa Catarina) paste - a mixture of 0.3g of zinc oxide with 0.3g of Ca(OH)2 with 0.2ml of olive oil 1:1 w/w; Vitapex® and Sealapex®. The coronal access was sealed with a glass ionomer after the root had been filled with each sealer. A one-third apical surface and foramen was hard-pressed with Araldite®. The teeth were stored individually in flasks containing saline solution at 37ºC and 100% humidity. The OH- and Ca+2 ions diffusion levels were determined using a pH meter and an atomic absorption spectrometer. Data were collected at 48 hours and at intervals of 7, 30, 45 and 60 days. Statistical analysis was performed using ANOVA to compare groups. In the pH evaluation, the CaPE group presented the largest OH- ions diffusion, which peaked at sixty days (p=0.0309), when compared to the other groups (p<0.0001). In relation to amount of Ca+2 ions released, the CaPE paste showed the best results, followed by the UFSC's paste. These results suggest that the CaPE paste was the material that allowed the highest diffusion of OH- and Ca+2 ions.

Endodontic re-treatment associated with the elimination of amalgam root-end filling through sinus tracts: a report of two cases

Two patients presented with complaints of recurrent drainage of purulent exudate from sinus tracts, inflammation and pain after endodontic re-treatment of the maxillary left (Case 1) and right (Case 2) lateral incisors. The periapical lesions persisted after apical curettage, apicectomy and root-end filling with silver amalgam. Radiographic examination exposed the poor quality of the endodontic treatments and the silver amalgam root-end fillings, which were associated with periapical radiolucent areas in both teeth. The sinus tract persisted after root canal cleaning and shaping, followed by a calcium hydroxide root canal dressing. The root-end fillings were periapically dislodged with endodontic K-files, and showed progressive displacement by sinus tracts up to elimination in the oral cavity. Follow ups of 42 and 65 months post procedure revealed clinical disappearance of the symptoms, sinus tracts and exudates, and radiographs revealed that the repair process of the periapical radiolucent areas was quite advanced.

Surface Tension Comparison of Four Common Root Canal Irrigants and Two New Irrigants Containing Antibiotic

The aim of this study is to compare the surface tension of four common endodontic irrigants: Moltendo EDTA 17%, Cetrexidin, Smear Clear, Sodium hypochlorite 5.25%, with the surface tension of MTAD and Tetraclean. Freshly produced MilliQ water was used as a reference. All measurements were performed following the Wilhelmy plate technique, using a Cahn DCA-322 Dynamic Contact Angle Analyzer at the temperature of 22 degrees C. MilliQ water, sodium hypochlorite 5.25%, and EDTA 17% had the highest surface tension, whereas those of Cetrexedin and Tetraclean has shown the lowest surface tension value. Both new irrigants, MTAD and Tetraclean, are capable of removing the smear layer. Thanks to their low surface tension, increasing the intimate contact of irrigant solutions with the dentinal walls, they may permit deeper penetration.

Calcium hydroxide as an intracanal medication: effect on posttreatment pain

Calcium hydroxide is advocated as an intracanal medication for various purposes, including prevention of posttreatment symptoms. This study assessed whether calcium hydroxide had a pain-controlling effect at different times when compared with no intracanal medication. One hundred forty patients participated. Conditions diagnosed were pulp/periapical pathosis with or without symptoms. At least partial cleaning and shaping was completed. At random, either Ca(OH)2 plus H2O paste or a dry cotton pellet was placed in the canals of half the teeth, respectively. All teeth were temporized with Intermediate Restorative Material. Patients assessed posttreatment pain up to 48 h as none, mild, moderate, or severe. The pain levels in each test group [Ca(OH)2 versus cotton pellet] at each time period were compared statistically with a multiple-regression analysis. There was no significant difference in posttreatment pain between the two groups at any time period or with any diagnosis or symptom. The use of calcium hydroxide as an intracanal medication was unrelated to the incidence and/or severity of posttreatment pain.

A scanning electron microscopic study of debris and smear layer remaining following use of GT rotary instruments

AIM

The aim of the present study was to assess debris and smear layer remaining following canal preparation with GT rotary instruments.

METHODOLOGY

Sixteen freshly extracted single-rooted premolar teeth were instrumented with GT rotary instruments using a crown-down preparation technique. All specimens were flushed with 2 mL of 5% NaOCl between each rotary instrument. At the end of instrumentation the following final irrigation sequence was repeated two times: 2 mL of EDTA + Cetrimide for 1 min (Largal Ultra, Septodont, France) and 2 mL of 5% NaOCl for 5 min. A final flush with saline solution was made to halt any chemical activity. Two other uninstrumented teeth that were not irrigated served as controls. All teeth were split longitudinally and prepared for SEM evaluation. The presence of debris and smear layer was evaluated from photomicrographs at x200 and x1000 magnification taken in the apical, middle and coronal thirds of the canals. Blind evaluation was performed by two trained observers and scores were compiled separately. A five category scoring system for debris and smear layer was used. Values obtained were tabulated and statistical analysis was carried out using a parametric chi-squared test.

RESULTS

Statistical analysis showed that there was no significant difference between the three regions of the root canals (P > 0.05) for debris. Comparison of the removal of the smear layer between the three regions showed that there was a statistically significant difference between all parts, especially between the coronal and apical thirds (P < 0.001). Overall, the coronal sections were cleaner than the middle and apical sections. The uninstrumented canals showed walls completely covered with tissue, confirming that specimen preparation alone did not remove tissue.

CONCLUSIONS

Under the conditions of the present study GT rotary instruments removed debris effectively, but left root canal walls covered with smear layer, particularly in the apical third.

Shaping and cleaning the root canal system: a scanning electron microscopic evaluation of a new instrumentation and irrigation technique

The purpose of the present scanning electron microscopic study was to investigate the efficacy of a combination of EDTA, NaOCl, and surface-active irrigating solutions during and after root canal preparation with ProFile nickel-titanium rotary instruments. Thirty canals were divided into three groups, instrumented and irrigated as follows: 5% NaOCl and a final flush with 17% EDTA were used for group A; group B specimens were irrigated using 17% EDTA, followed 15 s later by 1% TRITON X-100 (tensioactive agent) and then by 5% NaOCl; and group C specimens were irrigated with the same combination, but once shaping procedures were completed the irrigating sequence was repeated three times. After scanning electron microscopic evaluation, group C specimens exhibited the most effective debridement of the root canals. Results showed that tensioactive agent contributed to enhanced debridement. Cleaning was significantly improved once shaping procedures were completed.