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Song Y, Ham H, Lee W, Kim RJY. Assessing the efficacy of jet dispenser versus direct syringe injection for calcium hydroxide paste placement in artificial root canals. Sci Rep 2023; 13:19447. [PMID: 37945801 PMCID: PMC10636178 DOI: 10.1038/s41598-023-46683-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
This study aimed to evaluate the efficacy of a novel jet dispenser (JD) for filling simulated straight and curved canals with calcium hydroxide (Ca(OH)2) paste by comparing the level of intracanal medicament with traditional direct syringe delivery. The Ca(OH)2 paste was delivered into the canals using either a direct syringe with binding tip and unbinding tip or a JD. The analysis of the ratio of the canal filled area (RCFA) in the coronal, middle, and apical thirds was conducted using the Kruskal-Wallis and Mann-Whitney U tests (α = 0.05). The JD resulted in a significantly higher RCFA of 1.00 in the middle and apical thirds in both the straight and curved canals than the direct syringe method (p < 0.001). Voids were frequently observed in the direct syringe group, whereas JD showed no voids within the filled area. In the direct syringe groups, the apical area was more readily filled in both canal types when the tip was bound (p < 0.001). The JD was found to be more effective in filling the entire canal space than the binding and unbinding conditions of the direct injection method, particularly in the apical area.
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Affiliation(s)
- Youngwook Song
- School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hwichan Ham
- Department of Aerospace Engineering, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
| | - WooCheol Lee
- Department of Conservative Dentistry, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
| | - Ryan Jin Young Kim
- Department of Dental Science, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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Harish, Kumari S, Parihar J, Akash, Kumari J, Kumar L, Debnath M, Kumar V, Mishra RK, Gwag JS, Singhal R, Mukhopadhyay AK, Kumar P. Synthesis, Characterization, and Antibacterial Activity of Calcium Hydroxide Nanoparticles Against Gram‐Positive and Gram‐Negative Bacteria. ChemistrySelect 2022. [DOI: 10.1002/slct.202203094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Harish
- Department of Physics Manipal University Jaipur Jaipur 303007 Rajasthan India
| | - Sapna Kumari
- Department of Bioscience Manipal University Jaipur Jaipur 303007 Rajasthan
| | - Jagdish Parihar
- Department of Physics Manipal University Jaipur Jaipur 303007 Rajasthan India
- Department of Bioscience & Bioengineering Indian Institute of Technology (IIT) - Jodhpur Jodhpur 342001 Rajasthan India
| | - Akash
- Department of Physics Manipal University Jaipur Jaipur 303007 Rajasthan India
| | - Jyoti Kumari
- Department of Physics Manipal University Jaipur Jaipur 303007 Rajasthan India
| | - Lalit Kumar
- Department of Physics Manipal University Jaipur Jaipur 303007 Rajasthan India
| | - Mousumi Debnath
- Department of Bioscience Manipal University Jaipur Jaipur 303007 Rajasthan
| | - Vipin Kumar
- Department of Physics Yeungnam University Gyeongsan, Gyeongbuk 38541 South Korea
| | | | - Jin Seog Gwag
- Department of Physics Yeungnam University Gyeongsan, Gyeongbuk 38541 South Korea
| | - Rahul Singhal
- Department of Physics Malaviya National Institute of Technology Jaipur 302017 India
| | - Anoop Kumar Mukhopadhyay
- Department of Physics Manipal University Jaipur Jaipur 303007 Rajasthan India
- Department of Physics Sharda School of Basic Sciences and Research Sharda University, Greater Noida 201310 Uttar Pradesh India
| | - Pushpendra Kumar
- Department of Physics Manipal University Jaipur Jaipur 303007 Rajasthan India
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Biocompatibility and Antibacterial Action of Salvadora persica Extract as Intracanal Medication (In Vitro and Ex Vivo Experiment). MATERIALS 2022; 15:ma15041373. [PMID: 35207914 PMCID: PMC8878108 DOI: 10.3390/ma15041373] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
This study aimed to test the biocompatibility and antibacterial properties of Salvadora persica (S. persica) extract, a natural product, as an intracanal medication in comparison with calcium hydroxide (Metapaste, META BIOMED, Cheongju, Korea). The pH values of both materials were tested. The biocompatibility of S. persica extract and Metapaste was determined using light microscopy and MTT assays. The antibacterial action was tested using the zone of bacterial inhibition on four common bacterial species. In addition, intracanal medication was administered using 68 extracted single-rooted teeth contaminated with Enterococcus faecalis (E. faecalis), and the percentage reduction in colony count (% RCC) at 1, 3, and 7 days was measured. The extension of activity for both materials was assessed using histological sections and scanning electron microscopy. S. persica was found to be acidic in nature. Both materials showed significantly lower cell viability than the positive control cells on days 1 and 3 but not on day 7. S. persica showed better antibacterial effects against E. faecalis and S. mutans. S. persica extract showed 97.6%, 98.9%, and 99.3% RCC values at 1, 3, and 7 days, respectively, which are comparable to those of Metapaste. S. persica herbal extract is a promising material that can be utilized as an intracanal medication, but its use requires further research.
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Bazán Aliaga RB, Reátegui Arévalo Ó, Solórzano Espinoza LV, Castro Arredondo JA, Miranda García VE, Martínez Cadillo EE, Quispe-Salcedo Á. [Inhibitory activity of the ethanolic extract of Cyperus Rotundus from the Cajamarca region (Contumazá province) in a standardize strain of S treptococcus mutans (ATCC ® 25175 TM )]. REVISTA CIENTÍFICA ODONTOLÓGICA 2022; 10:e093. [PMID: 38389917 PMCID: PMC10880713 DOI: 10.21142/2523-2754-1001-2022-093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 02/23/2022] [Indexed: 02/24/2024] Open
Abstract
Objective The purpose of this study was to determine in vitro the inhibitory activity of the ethanolic extract of Cyperus rotundus (Cajamarca - Contumazá) against a standardize strain of Streptococcus mutans (ATCC®25175™). Materials and methods This study was an experimental in vitro study, which consisted of determining the inhibitory effect of three concentrations of the ethanolic extract of Cyperus rotundus: 250 mg/ml, 500 mg/ml, and 1000 mg/ml against a strains of Streptococcus mutans (ATCC®25175™). Ten tests were performed for each concentration, having 0.12% chlorhexidine as a positive control for Streptococcus mutans plates and 10% DMSO as a negative control. To evaluate the inhibitory effect, the disk diffusion method or Kirby-Bauer test was used, reading the results at 48 hours after initial sowing. Results None of the three concentrations of the ethanolic extract of Cyperus rotundus demosntrated inhibitory effects on the Streptococcus mutans strain; however, the positive control, chlorhexidine, clearly showed inhibition halos of 14.43 mm ± 1.23 mm after 48 hours of incubation. Conclusions The ethanolic extract of Cyperus rotundus did not inhibit the growth of Streptococcus mutans. It is recommended to deepen the chemical analysis of the components of this plant and explore other extraction methods to verify its bacteriostatic action versus other oral and non-oral microorganisms.
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Affiliation(s)
- Rosita Belén Bazán Aliaga
- Carrera de Estomatología, Universidad Científica del Sur. Lima, Perú. , , , Universidad Científica del Sur Carrera de Estomatología Universidad Científica del Sur Lima Peru
| | - Óscar Reátegui Arévalo
- Dirección General de Investigación, Desarrollo e Innovación (DGIDI) de la Universidad Científica del Sur. Lima, Perú. Universidad Científica del Sur Dirección General de Investigación, Desarrollo e Innovación (DGIDI) Universidad Científica del Sur Lima Peru
| | - Luz Verónica Solórzano Espinoza
- Sede Villa. Universidad Científica del Sur. Lima, Perú. Universidad Científica del Sur Sede Villa Universidad Científica del Sur Lima Peru
| | - Juan Antonio Castro Arredondo
- Carrera de Estomatología, Universidad Científica del Sur. Lima, Perú. , , , Universidad Científica del Sur Carrera de Estomatología Universidad Científica del Sur Lima Peru
| | - Víctor Elmo Miranda García
- Laboratorio de Química y Bioquímica de Productos Naturales, Universidad Científica del Sur. Lima, Perú. Universidad Científica del Sur Laboratorio de Química y Bioquímica de Productos Naturales Universidad Científica del Sur Lima Peru
| | - Elba Estefanía Martínez Cadillo
- Carrera de Estomatología, Universidad Científica del Sur. Lima, Perú. , , , Universidad Científica del Sur Carrera de Estomatología Universidad Científica del Sur Lima Peru
| | - Ángela Quispe-Salcedo
- Carrera de Estomatología, Universidad Científica del Sur. Lima, Perú. , , , Universidad Científica del Sur Carrera de Estomatología Universidad Científica del Sur Lima Peru
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Tavsan O, Simsek N. The effects of root canal perforation repair materials on the bond strength of fiber posts. J Appl Biomater Funct Mater 2021; 19:22808000211027050. [PMID: 34615407 DOI: 10.1177/22808000211027050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study aimed to evaluate the effect of calcium hydroxide and bioceramics used in perforation repair on the bonding strength of fiber posts via a push-out test. METHODOLOGY This study used 106 extracted single-rooted human mandibular premolar teeth. Root canal preparations were performed with a rotary file system and perforations were created in the middle third of each tooth. The samples were randomized into two main experimental groups, one with calcium hydroxide and one without. Each group had four subgroups in which different bioceramic cements were applied (n = 11) and a control group (n = 9). The root canals perforations were repaired using MTA, Biodentine, Bioaggregate, and Endosequence BC root repair material. A fiber post was applied to each tooth and a push-out test was performed. The samples were examined at 40× magnification with a digital microscope in order to identify fracture type. RESULTS Bonding strength was calculated in MPa. A statistical analysis showed that the calcium hydroxide had no effect on the bonding strength of the fiber posts. A comparison of the perforation repair materials revealed that Biodentine in the calcium hydroxide group and Bioaggregate in both groups decreased the bonding strength compared to the other materials (p < 0.05). The most common failure type was adhesive failure between the dentin and resin cement (38.16%). CONCLUSIONS The use of different perforation repair materials can affect the bonding strength of fiber posts. Therefore, the choice of perforation repair material should be made on an individual basis.
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Affiliation(s)
- Oğuz Tavsan
- Department of Endodontics, Faculty of Dentistry, Usak University, Usak, Turkey
| | - Neslihan Simsek
- Department of Endodontics, Faculty of Dentistry, Inonu University, Malatya, Turkey
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Bharti R, Tikku AP, Chandra A, Gupta P. Antimicrobial Effectiveness of Photodynamic Therapy, 5% Sodium Hypochlorite and 2% Chlorhexidine Gluconate in Root Canal Treated Teeth: A Clinical Study. JOURNAL OF ADVANCED ORAL RESEARCH 2021. [DOI: 10.1177/23202068211018984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate the effectiveness of photodynamic therapy (PDT), sodium hypochlorite (NaOCl) and chlorhexidine gluconate (CHO) in the endodontic re-treatment in the removing of microorganisms from previously filled infected root canals. Materials and Methods: The study samples consist of 54 root canal treated anterior teeth with apical periodontitis were randomly divided into three groups according to the disinfection protocol. Microbiological samples from the root canals were collected after removing the gutta-percha (S1) and following the endodontic re-treatment (S2) with either 5% NaOCl, 2% CHO or PDT procedure for 1 minute. Microbiological samples were cultivated on selective plates to assess the presence or absence of microbial growth and determine the average reduction of viable microorganisms. Results: Significant reduction in the total bacterial count in all the groups at post treatment ( P < .001). PDT provided statistically higher (99.74%) elimination of Enterococcus faecalis in comparison to NaOCl (95%) and CHO (88%). Conclusions: The use of PDT in endodontic re-treatment led to the significant reduction of the remaining bacterial species. So, PDT can be used for routine endodontic disinfection in failed root canal cases.
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Affiliation(s)
- Ramesh Bharti
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, King George’s Medical University Lucknow, Lucknow, Uttar Pradesh, India
| | - Aseem Prakash Tikku
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, King George’s Medical University Lucknow, Lucknow, Uttar Pradesh, India
| | - Anil Chandra
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Prashant Gupta
- Department of Microbiology, Faculty of Medicine, King George’s Medical University Lucknow, Lucknow, Uttar Pradesh, India
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Postoperative pain in endodontic retreatment of one visit versus multiple visits: a systematic review and meta-analysis of randomized controlled trials. Clin Oral Investig 2021; 25:455-468. [PMID: 33399930 DOI: 10.1007/s00784-020-03767-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of this systematic review and meta-analysis (SRM) was to assess the postoperative pain (PP) after non-surgical endodontic retreatment (NSER) in a one visit compared to multiple visits. The PICO question used was "Does NSER in patients with unsatisfactory endodontic treatment in a one-visit visit have a similar PP to that of NSER in multiple visits?" MATERIALS AND METHODS This systematic review followed PRISMA and was registered in PROSPERO (CRD42019136700). Searches were performed in the PubMed/MEDLINE, Scopus, and the Cochrane Library databases for articles published until September 2020. The eligible criteria were randomized clinical trials (RCTs). The meta-analysis was based on the Mantel-Haenszel. The PP after the retreatment was analyzed using a dichotomous outcome, measured according to risk ratio (RR) when p < 0.05. The Cochrane scale was used to assess risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. RESULTS Four studies were included. In general analysis without considering intensity, one-visit NSER presented lower PP than the multiple visits only for 1 and 30 days [(RR = 0.67; CI: 0.48 to 0.93; p = 0.02), and (RR = 0.09; CI: 0.01 to 0.66; p = 0.02)], respectively. Regarding sub-analysis considering the intensity, one visit present lower mild PP when compared with multiple visits [(RR = 0.54; CI: 0.30, 0.96; p = 0.04); (RR = 0.33; CI: 0.12, 0.88; p = 0.03); and (RR = 0.12; CI: 0.02, 0.86; p = 0.03)], respectively. However, sub-analysis for moderate and severe PP showed no significant difference, independently of period evaluated (p > 0.05). Regarding the risk of bias analysis, a low risk was observed for most domains, except allocation that was considered unclear, while the certainty of evidence for each analysis was considered low. CONCLUSION Within the limitations of study, the one and multiple visit can be considered adequate, because both present a similar occurrence of PP, except for mild pain. However, due to the low number of studies, further well conducted and standardized RCTs are needed to reassess these results. CLINICAL RELEVANCE Both therapies of endodontic retreatment can be considered in clinical practice. Therefore, the endodontist must consider the patient's individual characteristics and experience to consider the best treatment approach.
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Mahmoud O, Al-Meeri WA, Farook MS, Al-Afifi NA. Calcium Silicate-Based Cements as Root Canal Medicament. Clin Cosmet Investig Dent 2020; 12:49-60. [PMID: 32158275 PMCID: PMC7047992 DOI: 10.2147/ccide.s241015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aims to retard the setting reaction of CSC by mixing it with 2% chlorhexidine gel (CHX) which will be used as an intracanal medicament, and to evaluate the removal of the experimental medicaments from the root canal. Materials and Methods White Portland cement, white ProRoot MTA and Biodentine were mixed with 2% CHX. The setting time, flowability and film thickness of the CSC/CHX mixture (experimental medicaments) were assessed and measured following the standards of ISO specification. Calcium ion release was measured using ICP-OES, while pH was tested using a pH meter. Moreover, twenty single-rooted teeth were filled with the experimental medicaments for seven days, then the medicaments were removed and the samples analyzed using SEM. Calcium hydroxide paste was used as a control. Results The setting time of the experimental medicaments was inhibited until 84 days. The calcium ion release of the experimental medicaments was significantly higher compared to the control over the period of 14 days (P<0.001). The mean pH value was above 11.45 for all tested materials over a period of 14 days, with no significant difference between them (P<0.05). There was no significant difference in film thickness of the experimental medicaments compared to the control (P> 0.05). However, the flowability of the experimental medicaments was significantly higher than the control (P<0.05). SEM showed no significant differences in the removal of the intracanal medicaments between all the tested groups. Conclusion The addition of 2% CHX to CSCs retarded or inhibited its setting reaction over a period of 84 days. The calcium ion release and flowability of these experimental medicaments was found to be better than calcium hydroxide. Removal of the intracanal medicaments from the root canal was successfully achieved in all groups. Therefore, these experimental medicaments have the potential to be used as an enhanced root canal medicament.
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Affiliation(s)
- Okba Mahmoud
- Department of Restorative Dentistry, College of Dentistry, Ajman University, Ajman, United Arab Emirates.,Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Walid Ali Al-Meeri
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Mohideen Salihu Farook
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Nashwan Abdullah Al-Afifi
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia
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Savitha A, SriRekha A, Vijay R, Ashwija, Champa C, Jaykumar T. An in vivo comparative evaluation of antimicrobial efficacy of chitosan, chlorhexidine gluconate gel and their combination as an intracanal medicament against Enterococcus faecalis in failed endodontic cases using real time polymerase chain reaction (qPCR). Saudi Dent J 2019; 31:360-366. [PMID: 31337941 PMCID: PMC6626259 DOI: 10.1016/j.sdentj.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/24/2019] [Accepted: 03/03/2019] [Indexed: 01/22/2023] Open
Abstract
Aim To evaluate the in vivo antibacterial efficacy of 2% chlorhexidine gel (CHX), 2% chitosan (CS) gel and their combination as an intracanal medicament against Enterococcus faecalis during endodontic retreatment procedure, with the use of qPCR. Method A total of 45 single rooted permanent teeth were selected from 28 systemically healthy patients (mean age of 43 years). After complete disinfection and access opening as well as gutta-percha (GP) removal, the first microbiological pretreatment sample (S1) was collected. After completion of instrumentation, a post-instrumentation sample (S2) was taken and the teeth were randomly divided into three experimental groups: 2% CHX gel; 2% CS gel; 2% CHX with CS; Fuji IX glass ionomer cement was used to seal the access; after 7 days, the post medication sample (S3) was collected and E. faecalis was quantified using qPCR. Results Maximum reduction in bacterial mean CFU (×106) counts was observed between S1 and S2; S2 and S3; S1 and S3 in 2% CHX with chitosan group compared to other groups. Percentage reduction in CFU (×106) counts at different time intervals (S1-S2; S2-S3; S1-S3) was maximum for the 2% CHX with the chitosan group. Comparison of the mean CFU (×106) count within the 2% CHX gel group and the 2% CHX with chitosan group at different time intervals (S1,S2,S3) was found to be highly significant (P = 0.001); whereas in group II, it was significant (P = 0.002). Conclusion 2% CHX with chitosan group showed the highest microbial reduction against E. faecalis during retreatment of failed endodontic cases.
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Affiliation(s)
- A Savitha
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
| | - A SriRekha
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
| | - R Vijay
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
| | - Ashwija
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
| | - C Champa
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
| | - T Jaykumar
- Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore 560068, India
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Jasrotia A, Farooq R, Bhagat R, Bhagat K, Sharma N, Habib S. Removal efficacy of various calcium hydroxide/chlorhexidine medicaments from the root canal with the aid of biological microscope. INDIAN JOURNAL OF DENTAL SCIENCES 2019. [DOI: 10.4103/ijds.ijds_72_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Braun A, Hagelauer FJP, Wenzler J, Heimer M, Frankenberger R, Stein S. Microcrack Analysis of Dental Hard Tissue After Root Canal Irradiation with a 970-nm Diode Laser. Photomed Laser Surg 2018; 36:621-628. [DOI: 10.1089/pho.2018.4470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andreas Braun
- Department of Operative Dentistry and Endodontology, University of Marburg, Marburg, Germany
| | | | - Johannes Wenzler
- Department of Operative Dentistry and Endodontology, University of Marburg, Marburg, Germany
| | - Matthias Heimer
- Department of Operative Dentistry and Endodontology, University of Marburg, Marburg, Germany
| | - Roland Frankenberger
- Department of Operative Dentistry and Endodontology, University of Marburg, Marburg, Germany
| | - Steffen Stein
- Department of Orthodontics, University of Marburg, Marburg, Germany
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Erdem Hepsenoglu Y, Eyuboglu TF, Özcan M. Postoperative Pain Intensity after Single- versus Two-visit Nonsurgical Endodontic Retreatment: A Randomized Clinical Trial. J Endod 2018; 44:1339-1346. [DOI: 10.1016/j.joen.2018.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/24/2018] [Accepted: 05/27/2018] [Indexed: 11/15/2022]
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Abstract
Diseases of the dental pulp often have an infectious origin, and treatments are aimed to control infections of the root canal system. Endodontic treatment principles originally evolved on the basis of trial and error, and only in recent decades have scientific methods been adopted to support clinical strategies. Yet, relevant research on the disease processes, their diagnoses, and efficient treatment are rare in the endodontic literature. Hence, the advancement of biologically based knowledge significant to clinical endodontics has been slow. Therefore, many differences of opinion still prevail in this field of dentistry. This review highlights and analyzes the background of some of the more heavily debated issues in recent years. Specifically, it deals with disagreements regarding the clinical management of pulpal exposures by caries in the adult dentition, definitions of success and failure of endodontic therapy, and causes of and measures to control infections of the root canal system. Clearly, a most apparent gap in the published endodontic literature is the lack of randomized clinical trials that address the more significant controversial matters relating to the management of pulpal wounds, medication, and the number of appointments required for the treatment of infected root canals. However, trials in endodontics require extremely long follow-up periods if valid conclusions are to be generated. Therefore, it is not to be expected that there will be rapid solutions to these issues in the foreseeable future.
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Affiliation(s)
- G. Bergenholtz
- Department of Endodontology and Oral Diagnosis, Faculty of Odontology, The Sahlgrenska Academy at Göteborg University, Box 40530, Göteborg, Sweden
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Hamza MOB, Gufran K, Baroudi K. Assessment of the Potential of CFC (Calcium hydroxide Flagyl Ciprofloxacin) for the Rapid Disinfection of Resilon and Gutta-Percha. J Clin Diagn Res 2015; 9:ZC40-3. [PMID: 26557614 DOI: 10.7860/jcdr/2015/13442.6619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Obturating materials exposed to the dental operating environment has been shown to be contaminated, making rapid chair side disinfection mandatory to ensure the sterility of the root canals. OBJECTIVE The purpose of this study was to investigate the effectiveness of CFC (combination of Calcium hydroxide, Flagyl and Ciprofloxacin) for the rapid disinfection of Gutta-percha and Resilon cones. MATERIALS AND METHODS Seventy new Gutta-percha and Resilon cones were randomly selected, contaminated with Enterococcus faecalis and divided into 4 group according to the irrigant used for disinfection {Group I: 5.25% Sodium Hypochlorite (NaOCl), Group II: MTAD, Group III: 2% Chlorhexidine (CHX), Group IV: CFC (a combination of Calcium hydroxide, Flagyl and Ciprofloxacin)}. All the samples were placed in a centrifuge tube with BHI broth after being washed with sterile water. The samples were then incubated for 7 days at 37(o)C. Samples were randomly plated on Mac Conkey agar plate and the colony count was recorded and the observations were drawn. RESULTS A 5.25% NaOCl required 1 minute exposure for effective disinfection of all the samples. MTAD could eliminate E.faecalis from gutta-percha samples in 30 seconds whereas it required 1 minute of exposure for Resilon cones. Both 2% CHX and CFC could not disinfect the samples with 1 minute exposure and a minimum of 5 minute exposure was required. CONCLUSION A 5.25% NaOCl and Biopure MTAD required less chair side time to disinfect all the samples effectively when compared with 2% CHX and CFC.
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Affiliation(s)
- Mariam Omer Bin Hamza
- Lecturer, Department of Restorative Dental Sciences, Al-Farabi Colleges , Riyadh, Saudi Arabia
| | - Khalid Gufran
- Lecturer, Department of Preventive Dental Sciences, College of Dentistry, Salman Bin Abdul Aziz University , Al-Kharj, Saudi Arabia
| | - Kusai Baroudi
- Assistant Professor, Department of Preventive Dental Sciences, Al-Farabi Colleges , Riyadh, Saudi Arabia
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Kim D, Kim E. Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part II. in vivo studies. Restor Dent Endod 2014; 40:97-103. [PMID: 25984470 PMCID: PMC4432264 DOI: 10.5395/rde.2015.40.2.97] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022] Open
Abstract
The first part of this study reviewed the characteristics of calcium hydroxide (Ca(OH)2) and summarized the results of in vitro studies related to its antimicrobial effects. The second part of this review covers in vivo studies including human clinical studies and animal studies. The use of Ca(OH)2 as an intracanal medicament represented better histological results in animal studies. However, human clinical studies showed limited antimicrobial effects that microorganisms were reduced but not eliminated through the treatment, and that some species had resistance to Ca(OH)2. Most of clinical outcome studies supported that there is no improvement in healing of periapical lesions when Ca(OH)2 was applied between appointments. Further studies are required for the antimicrobial effects of Ca(OH)2, and search for the ideal material and technique to completely clean infected root canals should be continued.
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Affiliation(s)
- Dohyun Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
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Tan JME, Parolia A, Pau AKH. Intracanal placement of calcium hydroxide: a comparison of specially designed paste carrier technique with other techniques. BMC Oral Health 2013; 13:52. [PMID: 24098931 PMCID: PMC3851299 DOI: 10.1186/1472-6831-13-52] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/21/2013] [Indexed: 11/12/2022] Open
Abstract
Background This study compared the effectiveness of a Specially Designed Paste Carrier technique with the Syringe-Spreader technique and the Syringe-Lentulo spiral technique in the intracanal placement of calcium hydroxide. Methods Three groups, each containing 15 single-rooted human anterior teeth were prepared using standardized Mtwo rotary instruments to a master apical file size 40 with 0.04 taper. Each group was filled with calcium hydroxide paste using: Syringe and #25 finger spreader (Group 1); Syringe and #4 rotary Lentulo spiral (Group 2), Specially Designed Paste Carrier (Group 3). Using pre-filling and post-filling radiographs in buccolingual and mesiodistal planes, the radiodensities at 1 mm, 3 mm, 5 mm, and 7 mm from the apical foramen were analyzed by ANOVA and Bonferroni post hoc tests. Results Overall, The Specially Designed Paste Carrier technique showed a statistically significantly higher mean radiodensity than the two other compared techniques. No significant difference was detected between the Syringe-Lentulo spiral and the Syringe-Spreader techniques. Conclusion The Specially Designed Paste Carrier technique was more effective than the Syringe-Spreader technique and the Syringe-Lentulo spiral technique in the intracanal placement of calcium hydroxide.
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Affiliation(s)
- Joseph Meng Ern Tan
- Faculty of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur, 57000, Malaysia.
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Teles AM, Manso MC, Loureiro S, Silva R, Madeira IGC, Pina C, Cabeda JM. Effectiveness of two intracanal dressings in adult Portuguese patients: a qPCR and anaerobic culture assessment. Int Endod J 2013; 47:32-40. [PMID: 23647356 DOI: 10.1111/iej.12122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 04/03/2013] [Indexed: 12/20/2022]
Abstract
AIM To quantify bacterial equivalents before and after chemomechanical preparation using 3% sodium hypochlorite (NaOCl) and intracanal dressing with calcium hydroxide paste (Ca(OH)2 ) or 2% Chlorhexidine digluconate gel (CHX) in necrotic pulps associated or not with apical periodontitis and to further compare this quantification with counts of anaerobic microorganisms. METHODOLOGY Prospective clinical trial in 69 single-rooted adult teeth (strict inclusion criteria); CHX group: 34; Ca(OH)2 group: 35. Bacteria samples were taken at baseline (S1), after chemomechanical preparation (S2) and after 14 days of intracanal dressing (S3). Bacterial equivalents were assessed by broad-range real-time polymerase chain reaction (qPCR), and live viable bacteria measured with conventional anaerobic culture (CFU/mL). Descriptive/inferential analysis was performed with spss vs. 20.0 (α = 0.05) using the Kruskal-Wallis, Mann-Whitney and chi-squared tests and Spearman's correlation coefficients. RESULTS Both groups showed a significant decrease between S1 and S2 (Mann-Whitney U-test; P < 0.001) both in qPCR and in culture. In the Ca(OH)2 -group, no variation was observed between S2 and S3 by qPCR and culture. In contrast, the CHX group showed a significant increase from S2 to S3 by both techniques. The two groups were only significantly different in S3 (Mann-Whitney U-test; P ≤ 0.001), with a worse performance in the CHX group. Again, these results were congruent by both approaches. Data from both approaches correlate reasonably (rS < 0.5). CONCLUSIONS Infected root canals contained a high bacterial load, and the chemomechanical root canal preparation reduced bacterial equivalents by 99.1% and anaerobic counts by 98.5%. Intracanal dressings were not efficient at reducing bacterial load, but the 14-day intracanal dressing with Ca(OH)2 performed significantly better than CHX, particularly in cases with apical periodontitis.
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Affiliation(s)
- A M Teles
- Health Sciences Faculty, Fernando Pessoa University, Oporto, Portugal; Abel Salazar Institute for the Biomedical Sciences, Oporto University, Oporto, Portugal
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Koçak MM, Koçak S, Oktay EA, Kiliç A, Yaman SD. In vitro evaluation of the minimum bactericidal concentrations of different root-end filling materials. J Contemp Dent Pract 2013; 14:371-4. [PMID: 24171975 DOI: 10.5005/jp-journals-10024-1330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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 evaluate the minimum bactericidal concentrations (MBC) of root-end filling materials ProRoot MTA, MTA Angelus and IRM. MATERIALS AND METHODS Macrodilution broth method was used. Microorganisms used were: Staphylococcus aureus (ATCC 29213), Enterococcus faecalis (ATCC 29212) and Streptococcus mutans. Serial two-fold dilutions of root-end filling samples were prepared in macrodilution tubes with concentrations ranging from 1/2 to 1/512. The samples dilutions were incubated for 24 hours. After incubation, 0.1 ml of diluted culture was inoculated onto the surface of supplemented sheep blood agar (Merck, Germany) and all plates were incubated at 37°C in aerobic condition for 24 hours. The MBC was defined as the lowest concentration of root-end filling samples where no growth was recorded. RESULTS MBC of both mineral trioxide aggregate (MTA) products against S. aureus were recorded as 15.62 mg/ml and for IRM 31.25 mg/ml MBC for both MTA groups against E. faecalis were recorded as 31.25 mg/ml and for IRM 62.5 mg/ml. MBC of all root-end filling samples against S. mutans were recorded as 62.5 mg/ml. CONCLUSION All tested root-end filling materials showed acceptable MBC against S. aureus and E. faecalis. CLINICAL SIGNIFICANCE All tested materials can be used safely for filling of a root-end cavity.
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Affiliation(s)
- Mustafa Murat Koçak
- Assistant Professor, Faculty of Dentistry, Department of Endodontics Bulent Ecevit University, Turkey, e-mail:
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Vaziri S, Kangarlou A, Shahbazi R, Nazari Nasab A, Naseri M. Comparison of the bactericidal efficacy of photodynamic therapy, 2.5% sodium hypochlorite, and 2% chlorhexidine against Enterococcous faecalis in root canals; an in vitro study. Dent Res J (Isfahan) 2013; 9:613-8. [PMID: 23559928 PMCID: PMC3612200 DOI: 10.4103/1735-3327.104882] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Enterococcus faecalis has been widely used as a valuable microbiological pathogen for in vitro studies due to its ability to successfully colonize the root canal in a biofilm-like style, invade dentinal tubules, and resist endodontic treatment procedures.The aim of this study was to compare the bactericidal efficacy of photodynamic therapy (PDT), 2% chlorhexidine, 2.5% NaOCl, and combination of PDT and 2.5% NaOCl against E. faecalis. MATERIALS AND METHODS Sixty single-rooted teeth had their canals contaminated with E. faecalis in brain heart infusion broth and were incubated for 48 hours.The canals were then subjected to 2% chlorhexidine, 2.5% NaOCl, PDT (red light emitting diode 625 nm+ Toludine Blue) and PDT + 2.5% NaOCl. Controls consisted of no treatment (positive control) and without inoculation of bacterium (negative control). Following treatment, the canal contents were sampled with sterile paper points.The samples were dispersed in transport medium, serially diluted, and cultured on blood agar to determine the number of colony forming units (CFU). Data were analyzed by Mann-Whitney U test at 5% significance level. The significance level for all analyses was set at P <.05. RESULTS Combination of PDT and 2.5% NaOCl achieved maximum reduction in recovered viable bacteria, no viable bacteria was observed after treatment of PDT + 2.5% NaOCl. CONCLUSION Combination of PDT and 2.5% NaOCl simultaneously is effective in the elimination of E. faecalis from dentinal tubules under the conditions of this study.
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Affiliation(s)
- Shahram Vaziri
- Department of Oral Biology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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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Sinha N, Patil S, Dodwad PK, Patil AC, Singh B. Evaluation of antimicrobial efficacy of calcium hydroxide paste, chlorhexidine gel, and a combination of both as intracanal medicament: An in vivo comparative study. J Conserv Dent 2013; 16:65-70. [PMID: 23349580 PMCID: PMC3548350 DOI: 10.4103/0972-0707.105302] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/10/2012] [Accepted: 09/27/2012] [Indexed: 12/01/2022] Open
Abstract
Aim: To compare the antimicrobial efficacy of calcium hydroxide (CH), 2% chlorhexidine gel (CHX) and a combination of both, on obligate anaerobes, facultative anaerobes and Candida spp . Materials and Methods: 90 single rooted permanent teeth were included in the study. After complete disinfection and access opening, the first microbiological pre-treatment sample (S1) was collected. After completion of instrumentation, a post-instumentation sample (S2) was taken and the teeth were divided into three groups: Group I: CH, Group II: 2% CHX, Group III: 2% CHX with CH. After 1 week, a post-medication sample (S3) was collected. Results: All three medicaments were effective in the elimination of obligate anaerobes. CHX and combination showed higher antimicrobial effect against facultative anaerobes and Candida spp. in comparison with CH. But there was no statistical significant difference between Group II and Group III. Conclusion: CHX with or without CH was more effective than CH alone against all the tested micro-organisms.
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Affiliation(s)
- Nidhi Sinha
- Department of Conservative Dentistry and Endodontics, Jodhpur Dental College, Jodhpur National University, Jodhpur, India
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Barcelos R, Tannure PN, Gleiser R, Luiz RR, Primo LG. The influence of smear layer removal on primary tooth pulpectomy outcome: a 24-month, double-blind, randomized, and controlled clinical trial evaluation. Int J Paediatr Dent 2012; 22:369-81. [PMID: 22221174 DOI: 10.1111/j.1365-263x.2011.01210.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effect of smear layer (SL) removal on primary tooth pulpectomy outcome has not been well elucidated. AIM To determine the effect of SL removal on primary tooth pulpectomy outcome. METHODS This is a double-blind, randomized, and controlled clinical trial. Forty-eight patients were randomly divided into SL removal (G1 = 40 teeth) or smear layer nonremoval (G2 = 42 teeth) groups. Following the chemomechanical preparation with K-files and 2.5% sodium hypochlorite (NaOCl), teeth were irrigated with either 6% citric acid and 0.9% physiologic solution (G1) or only 0.9% physiologic solution (G2). Camphorated paramonochlorophenol was used as intracanal medication. At the second appointment, 1 week after, root canals were filled with zinc oxide-eugenol paste. Clinical and radiographical baseline criteria were stipulated equally for both groups. RESULTS The success rate (G1 = 91.2%; G2 = 70.0%) was statistically different (P = 0.04) between the groups. In G2, the outcome was affected significantly by pulpal necrosis (P = 0.02), pre-operatory symptoms (P = 0.02), and periapical/inter-radicular radiolucency (P = 0.04). CONCLUSION The pulpectomy outcome was improved by smear layer removal. The outcome for teeth with pulpal necrosis, pre-operatory symptoms, or periapical/inter-radicular radiolucency was significantly improved by removal of the smear layer.
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Affiliation(s)
- Roberta Barcelos
- Department of Specific Formation, School of Dentistry, Federal Fluminense University (UFF), Nova Friburgo, Brazil.
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Abstract
Purpose The objective of this study was to perform an in vitro evaluation of the antibacterial properties of 6 endodontic sealers (Endomethasone C, Argoseal, Bioseal Normal, Acroseal, AH Plus, Sicura Seal). Methods The agar diffusion test (well and paper disc methods) with Enterococcus faecalis, Staphylococcus aureus and Streptococcus mutans was used. For the well method, Petri dishes were inoculated with bacterial suspensions. Each well was completely filled with freshly mixed endodontic sealer. For the paper disc method, sterile paper discs were immersed in freshly mixed sealers and put on agar plates. Diameters of halos formed around the sealers were measured after 24 h and 48 h. Statistical analysis: The effects of well method and of paper disc method were analyzed by 1-way ANOVA. Results Endomethasone C, Argoseal and Bioseal showed the largest inhibition halos for all the tested microorganisms, while Sicura Seal and AH Plus showed low antibacterial effects. Moreover, the comparison of well method and paper disc methods showed significant statistical differences (P<0,01) for all sealers and indicated a dose-dependent antimicrobial effect.
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Antimicrobial Effects of Calcium Hydroxide and Chlorhexidine on Enterococcus faecalis. J Endod 2010; 36:1389-93. [DOI: 10.1016/j.joen.2010.04.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 04/23/2010] [Accepted: 04/29/2010] [Indexed: 11/19/2022]
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In vitro antimicrobial activity of calcium hydroxide mixed with different vehicles against Enterococcus faecalis and Candida albicans. ACTA ACUST UNITED AC 2009; 108:297-301. [DOI: 10.1016/j.tripleo.2009.03.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 03/12/2009] [Accepted: 03/12/2009] [Indexed: 11/19/2022]
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Proportion of healed teeth with apical periodontitis medicated with two percent chlorhexidine gluconate liquid: a case-series study. J Endod 2009; 35:1182-5. [PMID: 19720213 DOI: 10.1016/j.joen.2009.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 05/04/2009] [Accepted: 05/10/2009] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Chlorhexidine gluconate (CHX) is a potential intracanal medicament, but data on healing after its use are lacking. Previously we reported on bacterial sampling in 22 teeth with apical periodontitis medicated with CHX. This study assessed healing in those teeth. METHODS Canals were instrumented and medicated with 2% CHX liquid for 7-15 days and subsequently irrigated and filled. Bacterial samples were taken before and after instrumentation, after medication and before root filling, and enumerated by culture and vital microscopy. After 2-4 years, subjects were examined clinically and radiographically by assigning Periapical Index scores by independent calibrated examiners. Outcome was dichotomized as healed or disease. RESULTS With 2 teeth extracted, 1 deceased subject, and 2 nonrespondents, 16 of 17 examined teeth (94%) were healed without association with bacterial sampling results. The proportion of healed teeth in this study did not differ significantly (Fisher exact test; P = .20) from that in a historical control (90%). CONCLUSIONS The results suggested a comparable outcome after medication with 2% CHX liquid and calcium hydroxide.
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Semenoff TADV, Semenoff Segundo A, de Figueiredo JAP. Biocompatibility of different intracanal medications in rat bucal submucosa tissue. J Appl Oral Sci 2009; 16:12-7. [PMID: 19089283 PMCID: PMC4327274 DOI: 10.1590/s1678-77572008000100004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 10/24/2007] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to analyze the buccal tissue responses of Wistar rats to 2% chlorhexidine solution, calcium hydroxide and the association of both products. For this purpose, 30 specimens were randomly implanted in the filtrum of the four upper and lower hemiarches with a polyethylene tube containing one of the following substances: 2% chlorhexidine solution, calcium hydroxide and 2% chlorhexidine solution (test groups); calcium hydroxide and distilled water and distilled water (control groups). Ten rats each were distributed according to time interval of evaluation at 7, 15 and 30 days. The histological sections were stained with Harris hematoxylin and eosin. Analysis was performed with an optical microscope at x100, x200 and x400 magnifications by an expert examiner blinded to the materials. The sections were classified by scores attributed to inflammatory events and by a ranking determined according to the severity of the inflammation. The results of the inflammatory events and severity ranking were submitted to the Kruskal-Wallis test at a 0.05 level of significance. No statistically significant difference occurred among the tested materials; however, all materials showed a decreased of severity with respect to longer time intervals.
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Enkel B, Dupas C, Armengol V, Akpe Adou J, Bosco J, Daculsi G, Jean A, Laboux O, LeGeros RZ, Weiss P. Bioactive materials in endodontics. Expert Rev Med Devices 2008; 5:475-94. [PMID: 18573047 DOI: 10.1586/17434440.5.4.475] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Endodontic treatment in dentistry is a delicate procedure and many treatment attempts fail. Despite constant development of new root canal filling techniques, the clinician is confronted with both a complex root canal system and the use of filling materials that are harmful for periapical tissues. This paper evaluates reported studies on biomaterials used in endodontics, including calcium hydroxide, mineral trioxide aggregate, calcium phosphate ceramics and calcium phosphate cements. Special emphasis is made on promising new biomaterials, such as injectable bone substitute and injectable calcium phosphate cements. These materials, which combine biocompatibility, bioactivity and rheological properties, could be good alternatives in endodontics as root canal fillers. They could also be used as drug-delivery vehicles (e.g., for antibiotics and growth factors) or as scaffolds in pulp tissue engineering.
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Affiliation(s)
- Bénédicte Enkel
- Nantes University Hospital, Pôle Odontologie, ERT 10-51 Equipe de Recherche Clinique en Odontologie et Chirurgie Osseuse, Faculté de Chirurgie Dentaire 1 Place Alexis Ricordeau, Nantes Cedex 01, France.
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Blanscet ML, Tordik PA, Goodell GG. An Agar Diffusion Comparison of the Antimicrobial Effect of Calcium Hydroxide at Five Different Concentrations with Three Different Vehicles. J Endod 2008; 34:1246-8. [DOI: 10.1016/j.joen.2008.07.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Revised: 07/14/2008] [Accepted: 07/16/2008] [Indexed: 11/24/2022]
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Abstract
Apical periodontitis, an inflammatory process around the apex of a tooth root, is primarily a sequel to microbial infection of the pulp space. The microbial flora is composed of a restricted group of the total oral flora, selected by environmental pressures of anaerobiosis, nutrition and competition with other species and inhabits the root canal as a biofilm of coaggregated communities in an extracellular matrix. The untreated infected canal is generally composed of a polymicrobial mix with approximately equal proportions of Gram-positive and Gram-negative species, dominated by obligate anaerobes. The type of microbial flora in the root-filled tooth with persistent apical periodontitis has very different characteristics. These infections are characterized by one or just a few species, predominantly Gram-positive micro-organisms with an equal distribution of facultative and obligate anaerobes. Enterococcus faecalis has been a conspicuous finding in most studies. Because the primary aetiological problem is infection, endodontic treatment is directed at control and elimination of the root canal flora by working in a sterile way. Based on current knowledge, the best available method for obtaining clean, microbe-free root canals is by instrumentation with antimicrobial irrigation reinforced by an intracanal dressing with calcium hydroxide.
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Affiliation(s)
- D Figdor
- Faculty of Medicine, Dentistry and Health Sciences, School of Dental Science, University of Melbourne.
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Da Silva GN, De Camargo EA, Salvadori DMF, Ribeiro DA. Genetic damage in human peripheral lymphocytes exposed to antimicrobial endodontic agents. ACTA ACUST UNITED AC 2007; 104:e58-61. [PMID: 17560139 DOI: 10.1016/j.tripleo.2007.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Formocresol, paramonochlorophenol, or calcium hydroxide have been widely used in dental practice to eradicate bacteria and consequently to produce root canal disinfection. Taking into consideration strong evidence for a relationship between DNA damage and carcinogenesis, the purpose of the present study was to evaluate the genotoxic effects of antimicrobial endodontic compounds in human peripheral lymphocytes by single-cell gel (comet) assay. This technique detects DNA strand breaks in individual cells. STUDY DESIGN A total of 10 microL of the tested substance solution (formocreso1, paramonochlorofeno1, and calcium hydroxide at 100-microg/mL concentration) was added to human peripheral lymphocytes from 10 volunteers for 1 hour at 37 degrees C. The negative control group was treated with vehicle control (PBS) for 1 hour at 37 degrees C, as well. For the positive control group, lymphocytes were exposed to hydrogen peroxide at 100 microM during 5 minutes on ice. RESULTS No DNA breakage was detected after a treatment of peripheral lymphocytes by formocresol, paramonochlorophenol, or calcium hydroxide at 100 microg/mL. CONCLUSIONS In summary, our results indicate that exposure to formocresol, paramonochlorophenol, or calcium hydroxide may not be a factor that increases the level of DNA lesions in human peripheral lymphocytes as detected by single-cell gel (comet) assay.
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Affiliation(s)
- Glenda N Da Silva
- Department of Pathology, Botucatu Medical School, Sao Paulo State University, Sao Paulo, Brazil
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Ballal V, Kundabala M, Acharya S, Ballal M. Antimicrobial action of calcium hydroxide, chlorhexidine and their combination on endodontic pathogens. Aust Dent J 2007; 52:118-21. [PMID: 17687957 DOI: 10.1111/j.1834-7819.2007.tb00475.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The common recovery of Candida albicans and Enterococcus faecalis from failed root canals of teeth in which previous treatment has failed is notable. These organisms have been shown to be resistant to antimicrobial action of calcium hydroxide but are sensitive to chlorhexidine gluconate. The aim of the present in vitro study was to investigate the antimicrobial efficacy of calcium hydroxide paste, 2% chlorhexidine gel and their combination against Candida albicans and Enterococcus faecalis. METHODS Inoculae of these organisms were used to make lawn cultures on Sabouraud's dextrose agar and blood agar plates. Wells were prepared with these lawn cultures and filled with calcium hydroxide paste, 2% chlorhexidine gel and their combination. The agar plates were kept overnight for incubation at 37 degrees C and the zone of inhibition was examined after 24 and 72 hours. RESULTS The results suggest that 2% chlorhexidine gel alone is more effective at 72 hours than calcium hydroxide paste alone or in combination with 2% chlorhexidine gel against both the organisms, even though calcium hydroxide showed better antifungal efficacy against Candida albicans at 24 hours. CONCLUSION In failed root canal treatments, 2% chlorhexidine gel may be a more effective intracanal medicament than calcium hydroxide paste or their combination against Candida albicans and Enterococcus faecalis.
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Affiliation(s)
- V Ballal
- Manipal College of Dental Sciences, Manipal, Karnataka, India.
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Sathorn C, Parashos P, Messer H. Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysis. Int Endod J 2007; 40:2-10. [PMID: 17209826 DOI: 10.1111/j.1365-2591.2006.01197.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To determine to what extent does calcium hydroxide intracanal medication eliminate bacteria from human root canals, compared with the same canals before medication, as measured by the number of positive cultures, in patients undergoing root canal treatment for apical periodontitis (teeth with an infected root canal system). METHODOLOGY CENTRAL, MEDLINE and EMBASE databases were searched. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through the Science Citation Index to identify potentially relevant subsequent primary research. REVIEW METHODS The included studies were pre-/post-test clinical trials comparing the number of positive bacterial cultures from treated canals. Data in those studies were independently extracted. Risk differences of included studies were combined using the generic inverse variance and random effect method. RESULTS Eight studies were identified and included in the review, covering 257 cases. Sample size varied from 18 to 60 cases; six studies demonstrated a statistically significant difference between pre- and post-medicated canals, whilst two did not. There was considerable heterogeneity among studies. Pooled risk difference was -21%; 95% CI: -47% to 6%. The difference between pre- and post-medication was not statistically significant (P = 0.12). CONCLUSIONS Calcium hydroxide has limited effectiveness in eliminating bacteria from human root canal when assessed by culture techniques.
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Affiliation(s)
- C Sathorn
- Endodontic Unit, School of Dental Science, The University of Melbourne, Melbourne,Vic. Australia.
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Balto KA. Calcium hydroxide has limited effectiveness in eliminating bacteria from human root canal. Evid Based Dent 2007; 8:15-6. [PMID: 17380176 DOI: 10.1038/sj.ebd.6400467] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
DATA SOURCES Searches of Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, six thesis databases (Networked Digital Library of Theses and Dissertations, Proquest Digital Dissertations, OAIster, Index to Theses, Australian Digital Thesis program and Dissertation.com) and one conference report database (BIOSIS Previews) were undertaken. There were no language restrictions. STUDY SELECTION Studies were included in which participants had a noncontributory medical history, presented with mature teeth and radiographic evidence of periapical bone loss (as an indication of pre-operative canal infection), whose selected root canals had not previously received any endodontic treatment, and who had undergone nonsurgical root canal treatment during the study in which calcium hydroxide had also been used to seal in the canals. In addition, it was required that microbiological sampling had been undertaken during the course of treatment, before canal preparation, after canal preparation and after canal medication. Aerobic and anaerobic culturing techniques were performed on all samples. The treatment outcomes were stated in terms of positive and negative canal cultures. DATA EXTRACTION AND SYNTHESIS All data were extracted in the same manner using a standardised data extraction sheet. Between-study heterogeneity was assessed using the standard chi-squared test or Q-statistic. The principal measure of treatment effect (antibacterial efficacy) was risk difference, which is normally defined as the risk in the experimental group minus risk in the control group. For the purpose of this study, it is given as the difference in the proportion of bacteria-positive cultures pre- and post-medication. RESULTS Out of the eight studies (257 cases) included, one study used a small control group (in which canals were left empty, and no intracanal medicament was used between appointments). The other seven studies simply compared the frequency of positive cultures before and after calcium hydroxide medication. Six studies demonstrated a statistically significant difference between pre- and postmedicated canals, whereas two did not. There was considerable heterogeneity among studies. The pooled risk difference was 21% (95% confidence intervals, 6-47%. The difference in the proportion of cases positive for bacteria before and after treatment was not statistically significant (P = 0.12). CONCLUSIONS Based on the current best available evidence, calcium hydroxide has limited effectiveness in eliminating bacteria from human root canals, when assessed by culture techniques. The quest for better antibacterial protocols and sampling techniques must continue to ensure that bacteria can be reliably eradicated prior to obturation.
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Miyagak DC, de Carvalho EMOF, Robazza CRC, Chavasco JK, Levorato GL. In vitro evaluation of the antimicrobial activity of endodontic sealers. Braz Oral Res 2006; 20:303-6. [PMID: 17242789 DOI: 10.1590/s1806-83242006000400004] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Accepted: 03/22/2006] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study is to evaluate the antimicrobial activity of the endodontic sealers: N-Rickert, Sealapex, AH Plus, Mineral Trioxide Aggregate (MTA) and portland cement. The Agar diffusion method was used in plates previously inoculated with the following microorganisms: C. albicans, S. aureus, E. faecalis, E. coli. The diameters of microbial inhibition zones were measured after 24 hours of incubation in kiln at 37°C. According to the methodology used, it was possible to conclude that only the sealers AH Plus and N-Rickert presented antimicrobial activity against C. albicans, S. aureus, and E. coli; no antimicrobial activity in MTA, Sealapex and portland cement was observed. N-Rickert presented the largest inhibition zones varying from 8 to 18 mm, and the microorganism E. faecalis was resistant against all sealers tested.
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Mônika CM, Fröner IC. A scanning electron microscopic evaluation of different root canal irrigation regimens. Braz Oral Res 2006; 20:235-40. [PMID: 17119706 DOI: 10.1590/s1806-83242006000300010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 06/12/2006] [Indexed: 05/12/2023] Open
Abstract
The purpose of this study was to assess the effectiveness of endodontic irrigants in removing the smear layer from instrumented root canal walls using Scanning Electron Microscopy (SEM). The endodontic irrigants used were: 1% sodium hypochlorite (NaOCl); 1% NaOCl mixed to 17% EDTAC; 2% chlorhexidine gel; and Ricinus communis gel. Photomicrographs of the middle and apical thirds were evaluated with the aid of the Fotoscore - v. 2.0 software. The results indicated that the mixture of sodium hypochlorite and EDTAC completely removed the smear layer from dentinal walls. The other endodontic irrigants were not as efficient in cleansing the root canals.
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Affiliation(s)
- Chaves Medici Mônika
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo
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Eldeniz AU, Erdemir A, Hadimli HH, Belli S, Erganis O. Assessment of antibacterial activity of EndoREZ. ACTA ACUST UNITED AC 2006; 102:119-26. [PMID: 16831684 DOI: 10.1016/j.tripleo.2005.06.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Revised: 11/08/2004] [Accepted: 06/12/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this in vitro study was to evaluate antibacterial activity of a new resin based sealer, EndoREZ in comparison with 5 other sealers: AH 26, Diaket, Sultan, Apexit, and RoekoSeal. STUDY DESIGN The effect of 6 different sealers on the growth of 3 bacteria (Enterococcus faecalis, Staphylococcus aureus, and Pseudomonas aeruginosa) was measured using the agar diffusion test (ADT) and direct contact test (DCT). For ADT, 200 microL bacterial suspensions were spread on agar plates and freshly mixed sealers were applied to uniform wells punched in the agar. The zones of inhibition of bacterial growth were measured at 24 hours, 48 hours, 7 days, and 10 days. For DCT, 2 sets of sealers were prepared: fresh and 24-hour samples. Fresh samples were used within 20 minutes of mixing time while 24-hour samples were allowed to set in a humid atmosphere at 37 degrees C for 24 hours before testing. Sealers were mixed and placed on the walls of microtiter plate wells and 10-microL bacterial suspensions were allowed to directly contact the sealers for 1 hour. Fresh media were added and 15 microL were transferred from this plate to another plate containing fresh medium (215 microL). Bacterial growth of this last plate was then measured using spectrophotometer every hour over 16 hours. RESULTS ADT results indicated that EndoREZ, Apexit, and RoekoSeal did not show any antibacterial activity. In DCT results, AH 26 and Sultan were potent bacterial growth inhibitors. CONCLUSION EndoREZ is not as potent a bacterial growth inhibitor as Sultan and AH 26.
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Affiliation(s)
- Ayce Unverdi Eldeniz
- Department of Endodontics, Faculty of Dentistry, University of Selcuk, Konya, Turkey.
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Abstract
Calcium hydroxide is a multipurpose agent, and there have been an increasing number of indications for its use. Some of its indications include direct and indirect pulp capping, apexogenesis, apexification, treatment of; root resorption, iatrogenic root perforations, root fractures, replanted teeth and interappointment intracanal dressing. The purpose of this paper is to review the properties and various indications for the use of calcium hydroxide.
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Abstract
The aim of root canal treatment is to eliminate bacteria from the infected root canal and to prevent reinfection. Biomechanical cleaning and shaping greatly reduces the number of bacteria. Nevertheless, due to anatomical complexity of the root canal system, residues and bacteria cannot be removed completely. Therefore, various substances have been used during canal preparation to remove debris, necrotic tissue, bacteria and smear layer. The most common irrigant of choice is sodium hypochlorite (NaOCI): it is an effective antimicrobial agent and tissue solvent. However, NaOCI can be toxic. Chlorhexidine gluconate (CHX) is a broad-spectrum antimicrobial agent. As a root canal irrigant and intracanal medicament, CHX has an antibacterial efficacy comparable to that of NaOCI, and is effective against resistant bacterial strains. CHX may result in residual antimicrobial activity of the dentine surface after prolonged exposure of the root canal to CHX. CHX also has a low grade of toxicity. In this review CHX will be discussed in detail.
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Affiliation(s)
- Bettina Basrani
- Faculty of Dentistry, University of Toronto, 124 Edward Street #348C, M5SG 1G6. Toronto, Ontario, Canada.
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Dammaschke T, Schneider U, Stratmann U, Yoo JM, Schäfer E. Effect of root canal dressings on the regeneration of inflamed periapical tissue. Acta Odontol Scand 2005; 63:143-52. [PMID: 16191907 DOI: 10.1080/00016350510019801] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to evaluate the effects of chlorhexidine and calcium hydroxide on apical periodontitis in rats. Experimentally induced apical periodontitis was established on the mesial roots of maxillary molars of Wistar rats by leaving the root canals exposed to the oral cavity for 14 d. In the positive control group (n=10 teeth), the root canals were not further treated, but the coronal access openings were filled with composite. In the negative control group (n=10 teeth), partial pulpotomies were performed aseptically and the coronal access openings were sealed immediately. In a third control group (n=10 teeth) the canals were instrumented, left empty, and the coronal access openings were sealed. In the experimental groups, the root canals were instrumented and filled with either 2% chlorhexidine gel or calcium hydroxide paste (n=10 teeth per group). After 7 d all rats were killed and the histological sections were stained for microscopic analysis of periapical regeneration. The data of the subjective evaluation were analyzed with the Kruskal-Wallis test. Lesion sizes were measured and statistically analyzed using the ANOVA and post-hoc Scheffé test. The two treatment groups showed significantly lower average inflammatory scores and smaller lesion sizes than the positive and third control group (p<0.05). No statistically significant differences were obtained between the two treatment groups (p>0.05). Chlorhexidine used as an intra-canal medicament showed good periapical regeneration, suggesting that this may be an alternative to calcium hydroxide root canal dressing.
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Affiliation(s)
- Till Dammaschke
- Poliklinik für Zahnerhaltung, Westfälische Wilhelms-Universität, Münster, Germany.
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Ribeiro DA, Scolastici C, De Lima PLA, Marques MEA, Salvadori DMF. Genotoxicity of antimicrobial endodontic compounds by single cell gel (comet) assay in Chinese hamster ovary (CHO) cells. ACTA ACUST UNITED AC 2005; 99:637-40. [PMID: 15829890 DOI: 10.1016/j.tripleo.2004.07.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In the current study, the potential DNA damage associated with exposure to a number of antimicrobial endodontic compounds was assessed by the single cell gel (comet) assay in vitro. STUDY DESIGN Chinese hamster ovary (CHO) cells were exposed to formocresol, paramonochlorophenol, calcium hydroxide, or chlorhexidine at final concentration ranging from 0.01% to 1%. RESULTS Formocresol, paramonochlorophenol, and calcium hydroxide, as well as chlorhexidine in all concentrations tested did not contribute to the DNA damage. CONCLUSION These findings are clinically relevant since they represent an important contribution to the correct evaluation of the potential health risk associated with exposure to dental agents.
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Affiliation(s)
- Daniel Araki Ribeiro
- Department of Pathology, Botucatu Medical School -- São Paulo State University, Botucatu, Brazil.
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de Souza CAS, Teles RP, Souto R, Chaves MAE, Colombo APV. Endodontic Therapy Associated with Calcium Hydroxide As an Intracanal Dressing: Microbiologic Evaluation by the Checkerboard DNA-DNA Hybridization Technique. J Endod 2005; 31:79-83. [PMID: 15671813 DOI: 10.1097/01.don.0000133157.60731.3f] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study evaluated the predominant microbiota of infected necrotic pulps and the effects of calcium hydroxide therapy on these microorganisms by the checkerboard DNA-DNA hybridization technique. Conventional endodontic therapy associated with calcium hydroxide as intracanal dressing was performed in 12 single-rooted teeth with pulp necrosis and periradicular bone lesion. Samples were collected from the canal at baseline and 14 days after therapy, and the presence of 44 bacterial species was determined by the checkerboard method. Significant differences in the microbiota from baseline to post-therapy were sought by the paired-samples t test. The most prevalent species included F. nucleatum ss. vincentii, C. sputigena, C. ochracea, S. constellatus, V. parvula, P. gingivalis, P. melaninogenica, and S. sanguis. Most of the microorganisms were reduced after treatment, particularly A. gerencseriae, A. israelii, A. naeslundii, C. gingivalis, C. ochracea, P. gingivalis, S. noxia, S. sanguis, and S. oralis (p < 0.05). Conversely, A. actinomycetemcomitans, C. sputigena, and E. corrodens increased in numbers after therapy. These results indicate that conventional endodontic therapy with calcium hydroxide results in the reduction of pathogenic species associated with pulp necrosis. However, its use is limited, because it did not eliminate the whole spectrum of microorganisms.
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Oliveira LD, Leão MVP, Carvalho CAT, Camargo CHR, Valera MC, Jorge AOC, Unterkircher CS. In vitro effects of calcium hydroxide and polymyxin B on endotoxins in root canals. J Dent 2005; 33:107-14. [PMID: 15683891 DOI: 10.1016/j.jdent.2004.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2004] [Revised: 08/10/2004] [Accepted: 08/13/2004] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the effects of intracanal medicaments on endotoxins in root canals. METHODS Seventy-five freshly extracted maxillary incisors were used in this study. The crowns of teeth were sectioned near the CEJ in order to standardize the root length to 14 mm. The root canals were instrumented to an apical size #50 file and irrigated with 1% sodium hypochlorite solution and sterilized with 60Co gamma irradiation. Standardized suspension containing Escherichia coli endotoxin was inoculated into the 60 root canals. The specimens were randomly assigned to 5 groups (n=15), according to the intracanal medicament used: (G1) calcium hydroxide; (G2) polymyxin B; (G3) combination neomycin-polymyxin B-hydrocortisone; (G4) positive control (no intracanal medicament); (G5) negative control (no endotoxin and no intracanal medicament). After 7 days, the detoxification of endotoxin was evaluated by Limulus lysate assay and antibody production in B-lymphocytes culture. RESULTS Groups 1, 2 and 5 presented the best results by Limulus lysate and were significantly different to groups 3 and 4 (p<0.05). Stimulation of antibodies production in cell culture by groups 1 and 6 was smaller and statistically different than groups 2, 3, 4 and 5 (p<0.05). Groups 2 and 5 induced a small increase in the antibodies production in relation to the groups 1 and 6. Groups 3 and 4 induced a significant increase of antibodies production (p<0.05). CONCLUSIONS The calcium hydroxide and polymyxin B intracanal medicaments detoxified endotoxin in root canals and altered the properties of LPS to stimulate the antibody production by B-lymphocytes. The combination neomycin-polymyxin B-hydrocortisone did not detoxified endotoxin.
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Affiliation(s)
- L D Oliveira
- Department of Oral Biosciences and Diagnosis, School of Dentistry, Paulista State University-UNESP, Av. Eng. Francisco José Longo 777, São José dos Campos 12245-000, SP Brazil.
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Schäfer E, Bössmann K. Antimicrobial Efficacy of Chlorhexidine and Two Calcium Hydroxide Formulations Against Enterococcus faecalis. J Endod 2005; 31:53-6. [PMID: 15614008 DOI: 10.1097/01.don.0000134209.28874.1c] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate the efficacy of chlorhexidine (CHX) and calcium hydroxide (Ca(OH2) against Enterococcus faecalis in vitro. Extracted single-rooted human teeth were instrumented up to size 40. After removal of the smear layer, an inoculum of E. faecalis was inserted into the root canals. After incubation, the inoculum was removed and the root canals were filled with one of three different disinfectants: Ca(OH2 paste, CHX 2%, and a mixture of CHX and Ca(OH2 paste (n = 10 in each group). Control teeth were filled with water of standardized hardness (n = 10). The teeth were then incubated for 3 days. After incubation, each root canal was instrumented, and the removed dentin was examined microbiologically. CHX was significantly more effective against E. faecalis than was Ca(OH2 paste or a mixture of CHX with Ca(OH2 paste (p < 0.05). There was no increase in the efficiency of Ca(OH2 paste when CHX was added (p > 0.05). The results suggest that CHX is effective in the elimination of E. faecalis from dentinal tubules under the conditions of this study.
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Affiliation(s)
- Edgar Schäfer
- Poliklinik für Zahnerhaltung, University School of Dentistry, Münster, Germany.
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46
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Abstract
The authors reviewed the literature evaluating the antibacterial effectiveness of intracanal medicaments used in the management of apical periodontitis. A PICO (problem, intervention, comparison, outcome) strategy was developed to identify studies dealing with calcium hydroxide, phenolic derivatives, iodine-potassium iodide, chlorhexidine, and formocresol. The final inclusion/exclusion criteria eliminated all papers except five that evaluated calcium hydroxide. The total sample size in the included studies was 164 teeth. Microbiologic sampling was performed before endodontic treatment (S1), after instrumentation and irrigation (S2), and after intracanal medication (S3). At S2, 62% of canals were positive. After medication, 27% still showed detectable growth. Of cultures that were positive at S2, 45% were still positive at S3. Most studies did not address issues of culture reversals or false positive and false negative cultures. The main component of antibacterial action appears to be associated with instrumentation and irrigation, although canals cannot be reliably rendered bacteria free. Calcium hydroxide remains the best medicament available to reduce residual microbial flora further.
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Affiliation(s)
- Amanda Law
- Postgraduate Endodontics, School of Dental Science, University of Melbourne, Melbourne, Australia.
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do Amorim CVG, Aun CE, Mayer MPA. Susceptibility of some oral microorganisms to chlorhexidine and paramonochlorophenol. Braz Oral Res 2004; 18:242-6. [PMID: 15619879 DOI: 10.1590/s1806-83242004000300012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Since the use of antimicrobial agents is required in endodontic therapies, this study aimed at determining the minimum inhibitory concentrations (MICs) of chlorhexidine digluconate and paramonochlorophenol (PMC) against microorganisms commonly found in endodontic infections. Both agents were tested by agar dilution tests against Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Candida albicans, Prevotella intermedia, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella denticola and Prevotella melaninogenica. The MIC of chlorhexidine ranged from 2.67 to 80.00 µg/ml, and the MIC of PMC from 46.67 to 213.33 µg/ml. The highest MIC value of PMC was detected for E. faecalis whereas E. coli was the most susceptible microorganism to this agent. The highest MIC values of chlorhexidine were observed for P. aeruginosa whereas E. coli and P. denticola were the most susceptible microorganisms to this agent. Since the MIC values observed are much lower than the concentrations currently used in the endodontic therapy, it is suggested that both agents are effective in reducing the microbiota in the root canal.
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Ribeiro DA, Marques MEA, Salvadori DMF. Lack of Genotoxicity of Formocresol, Paramonochlorophenol, and Calcium Hydroxide on Mammalian Cells by Comet Assay. J Endod 2004; 30:593-6. [PMID: 15273643 DOI: 10.1097/01.don.0000121614.10075.a3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Formocresol, paramonochlorophenol, and calcium hydroxide are widely used in dentistry because of their antibacterial activities in root canal disinfection. However, the results of genotoxicity studies using these materials are inconsistent in literature. The goal of this study was to examine the genotoxic potential of formocresol, paramonochlorophenol, and calcium hydroxide using mouse lymphoma cells and human fibroblasts cells in vitro by the comet assay. Data were assessed by Kruskal-Wallis nonparametric test. The results showed that all compounds tested did not cause DNA damage for the tail moment or tail intensity parameters. These findings suggest that formocresol, paramonochlorophenol, and calcium hydroxide do not promote DNA damage in mammalian cells and that the comet assay is a suitable tool to investigate genotoxicity.
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Affiliation(s)
- Daniel Araki Ribeiro
- Center for Genotoxins and Carcinogens Evaluation (TOXICAN), Department of Pathology, Botucatu School of Medicine, Botucatu, SP, Brazil.
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Hosoya N, Kurayama H, Iino F, Arai T. Effects of calcium hydroxide on physical and sealing properties of canal sealers. Int Endod J 2004; 37:178-84. [PMID: 15009407 DOI: 10.1111/j.0143-2885.2004.00781.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To investigate whether Ca(OH)2 in four different agents alters the physical properties (Exp. I) and sealing ability (Exp. II) of root canal sealers. EXPERIMENT (Exp. I) Calcipex (Nippon Sika-Yakuhin, Shimonoseki, Japan), Vitapex (Neo-Dental, Tokyo, Japan), Calkyl (Showa Yakuhin, Tokyo, Japan), and Ca(OH)2 were used as Ca(OH)2 agents. Four sealers were tested for flow, working time, setting time, and film thickness: Canals (Showa Yakuhin), Canals-N (Showa Yakuhin), Ketac -Endo (Espe, Seefeld, Germany), and Sealapex (Kerr, Romulus, MI, USA). Each Ca(OH)2 agent was added to 10 vol.% of each sealer, and the mixture and controls without a Ca(OH)2 agent were tested according to ISO specifications. Measurements were compared using Student's t-tests (P < 0.05). (Exp. II) After removing Ca(OH)2 agents applied to the root canals of 100 extracted human teeth, canals were filled with sealer. Controls were filled with each sealer without Ca(OH)2 agents. Sealing ability was evaluated using distance of dye penetration from the apices. Dye penetration data were compared using analysis of variance and post hoc Newman-Keuls test (P < 0.05). RESULTS Ca(OH)2 agents influenced the physical properties of the sealers. Flow and setting time met ISO requirements, but film thickness and working time did not. Apical sealing ability of all four sealers was influenced by Ca(OH)2 agents. The sealing ability of Sealapex improved with all Ca(OH)2 agents. The physical and sealing abilities varied among the other sealers. CONCLUSIONS Contact with Ca(OH)2 agents left on the canal wall caused considerable changes to the sealing ability of sealers.
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Affiliation(s)
- N Hosoya
- Department of Periodontics and Endodontics, Tsurumi University School of Dental Medicine, Tsurumi-ku, Yokohama, Japan.
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Basrani B, Tjäderhane L, Santos JM, Pascon E, Grad H, Lawrence HP, Friedman S. Efficacy of chlorhexidine- and calcium hydroxide-containing medicaments against Enterococcus faecalis in vitro. ACTA ACUST UNITED AC 2004; 96:618-24. [PMID: 14600699 DOI: 10.1016/s1079-2104(03)00166-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We sought to assess the efficacy of chlorhexidine (CHX) and calcium hydroxide, Ca(OH)(2), against Enterococcus faecalis in vitro. STUDY DESIGN The effect of CHX (0.2% and 2% in gel or solution) and Ca(OH)(2) (alone or with 0.2% CHX gel) was evaluated by using the agar diffusion test and an in vitro human root inoculation method, to measure zone of inhibition or bacterial growth with optical density analysis, respectively. For optical density analysis, samples from infected root canals were collected after 7 days of medication and were cultured for 24 hours in brain-heart infusion to detect viable bacteria. RESULTS In the agar diffusion test, CHX was effective against E faecalis in a concentration-dependent fashion, but Ca(OH)(2) alone had no effect. In the root canal inoculation test, CHX was significantly more effective against E faecalis than Ca(OH)(2) was (P < .05), but there were no significant differences between the modes of medication or concentrations of CHX. CONCLUSIONS CHX is effective against E faecalis in vitro. Further in vivo studies are needed to confirm the value of CHX in clinical treatment.
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Affiliation(s)
- Bettina Basrani
- Dalhousie University, Endodonic Division, Department of Dental Clinical Sciences, Halifax, Nova Scotia, Canada.
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