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Prasad N, Dasson Bajaj P, Shenoy R, Dutta A, Thomas MS. Sodium Hypochlorite Concentration and Postendodontic Pain - Unveiling the Optimal Balance: A Systematic Review and Meta-Analysis. J Endod 2024; 50:1233-1244. [PMID: 38880472 DOI: 10.1016/j.joen.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION This study systematically reviewed literature regarding the effect of different concentrations of sodium hypochlorite (NaOCl) used during root canal treatment (RCT) on postendodontic pain (PEP) and rescue analgesia. METHODS Following registration with PROSPERO (CRD42023388916), a search was conducted using PubMed, Scopus, Web of Science, and Embase databases. Randomized controlled trials of patients receiving RCT which assessed PEP at different time intervals were included. Following data extraction and Cochrane risk of bias assessment 2, meta-analyses were performed to evaluate PEP during the first 48 hours along with rescue analgesic intake. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Five randomized controlled trials with 674 patients were included. One study exhibited a low risk of bias, while 4 raised some concerns. Patients treated with low concentrations of NaOCl (≤3%) were significantly less likely to report PEP at 24 hours (OR = 2.32; [95% CI, 1.63-3.31]; P < .05) and 48 hours (OR = 2.49; [95% CI, 1.73-3.59]; P < .05) as compared with high concentrations of NaOCl (≥5%). Furthermore, with low concentrations of NaOCl, significantly lesser moderate-severe PEP was reported at 24 hours (OR = 2.32; [95% CI, 1.47-3.62]; P < .05) and 48 hours (OR = 2.35; [95% CI, 1.32-4.16]; P < .05) and lesser analgesia was needed (OR = 2.43; [95% CI, 1.48-4.00]; P < .05). CONCLUSIONS While PEP can be influenced by several factors, low certainty evidence suggests that when NaOCl is used as an irrigant during RCT, PEP may be less likely with lower concentrations of NaOCl. Moderate certainty evidence indicates that lesser analgesia may be required with lower concentrations of NaOCl. These results should be cautiously interpreted.
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Affiliation(s)
- Niharika Prasad
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Parul Dasson Bajaj
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ramya Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Arindam Dutta
- Department of Restorative Dentistry, School of Dentistry, College of Biomedical and Lifesciences, Cardiff University, Cardiff, UK
| | - Manuel S Thomas
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Madi M, Alsaad SS, AlAssiry N, Attia D, AlAssiry M, Zakaria O. Multilevel Modeling Analysis of Odontogenic Risk Factors and Nasal Septum Deviation Associated with Maxillary Sinus Mucosal Thickening: A Cone-Beam Computed Tomography Study. Dent J (Basel) 2024; 12:74. [PMID: 38534298 DOI: 10.3390/dj12030074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
(1) Background: In this study, the impact of odontogenic risk factors with nasal septum deviation on maxillary sinus mucosal thickening was assessed using Cone-beam computed tomography CBCT. (2) Methods: A total of 328 maxillary sinus regions from 164 patients (85 males and 79 females) were examined. Images were interpreted by dental specialists and Otolaryngologists. Coronal and sagittal sections were examined to assess the proximity of the root tips of posterior maxillary teeth (RPMT) to the maxillary sinus. The periodontal bone loss for all maxillary posterior teeth was also assessed. Consequently, maxillary sinus mucosal thickening (MT) was further classified into three gradings. Multilevel modeling regression analysis was used due to the hierarchical structuring of the data. Four models were developed, a null model with no factors, a model with tooth-level factors (RPMT, PBL, tooth condition, and root length), a model with patient-level factors (gender and nasal septum deviation), and a model with combined patient- and tooth-level factors. Regression estimates (AOR) and 95% confidence intervals (CIs) of individual and tooth factors were calculated. (3) Results: Multilevel regression analysis showed that RPMT was significantly associated with MT of maxillary sinus (p < 0.001), where patients who had RPMT > 0 had higher odds of MT of maxillary sinus. Tooth condition was also found to be significantly associated with MT of maxillary sinus, where teeth with failed RCT (p < 0.001) and teeth with restorations (p < 0.008) had higher odds of MT of maxillary sinus (AOR = 2.87, 95%CI 1.65, 4.42, AOR = 1.64, 95%CI 1.14, 2.36, respectively). (4) Conclusions: In order to plan preoperative treatment for maxillary posterior teeth, it is important to assess the anatomical relationship between the sinus floor and the root tips of the maxillary posterior teeth. Additionally, we establish a better understanding of the clinician before surgical intervention is conducted.
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Affiliation(s)
- Marwa Madi
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Sara S Alsaad
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Nada AlAssiry
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Dina Attia
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21527, Egypt
| | - Mansour AlAssiry
- Department of Otolaryngology, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
| | - Osama Zakaria
- Department of Biomedical Dental Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
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Sabino-Silva R, Cardoso IV, Vitali FC, Alves AMH, Souza BDM, Bortoluzzi EA, da Fonseca Roberti Garcia L, da Silveira Teixeira C. Prevalence of postoperative pain after endodontic treatment using low and high concentrations of sodium hypochlorite: a systematic review and meta-analysis. Clin Oral Investig 2023; 27:4157-4171. [PMID: 37466716 DOI: 10.1007/s00784-023-05151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/11/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To determine the prevalence of postoperative pain after endodontic treatment using low (LC) and high (HC) concentrations of sodium hypochlorite (NaOCl). MATERIALS AND METHODS Six databases and the grey literature were searched to identify randomized clinical trials that evaluated postoperative pain after endodontic treatment using NaOCl. NaOCl concentrations were dichotomized into 'LC' (0.5% to 3%) and 'HC' (≥ 5%) and a proportion meta-analysis was applied to determine the postoperative pain prevalence: overall and according to pain intensity and postoperative time. The prevalence of patients using pain control medication was also determined. A significance level of 5% and a random effect model were applied for data analysis. Between-study heterogeneity was assessed by I2 index. Risk of bias (RoB) was assessed using the Cochrane Risk-of-Bias 2.0 tool. The certainty of evidence was assessed using the GRADE approach. RESULTS Ten studies were included in the review and eight in the meta-analysis. The overall prevalence of postoperative pain was 45% in LC and 39% in HC. The prevalence of pain in LC and HC after 24 h was 25% and 40%, respectively. After 48 h, the prevalence decreased to 10% in LC and 25% in HC. 'Absent pain' was the most prevalent score. The prevalence of patients who used medication was 9% in LC and 15% in HC. Three studies were classified as 'high RoB', five as 'low RoB', and two as 'some concerns'. The certainty of evidence was very low. CONCLUSIONS The overall prevalence of postoperative pain after endodontic treatment using LC and HC of NaOCl was 45% and 39%, respectively. CLINICAL RELEVANCE Postoperative pain is common after endodontic treatment using NaOCl, but tends to decrease over time.
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Affiliation(s)
- Rayssa Sabino-Silva
- Department of Dentistry, Federal University of Santa Catarina, Delfino Conti S/N, Trindade, Santa Catarina, 88040-370, Florianopolis, Brazil
| | - Ihan Vitor Cardoso
- Department of Dentistry, Federal University of Santa Catarina, Delfino Conti S/N, Trindade, Santa Catarina, 88040-370, Florianopolis, Brazil
| | - Filipe Colombo Vitali
- Department of Dentistry, Federal University of Santa Catarina, Delfino Conti S/N, Trindade, Santa Catarina, 88040-370, Florianopolis, Brazil
| | - Ana Maria Hecke Alves
- Department of Dentistry, Federal University of Santa Catarina, Delfino Conti S/N, Trindade, Santa Catarina, 88040-370, Florianopolis, Brazil
| | - Beatriz Dulcineia Mendes Souza
- Department of Dentistry, Federal University of Santa Catarina, Delfino Conti S/N, Trindade, Santa Catarina, 88040-370, Florianopolis, Brazil
| | - Eduardo Antunes Bortoluzzi
- Department of Diagnosis & Oral Health, School of Dentistry, University of Louisville, Louisville, KY, USA
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry, Federal University of Santa Catarina, Delfino Conti S/N, Trindade, Santa Catarina, 88040-370, Florianopolis, Brazil
| | - Cleonice da Silveira Teixeira
- Department of Dentistry, Federal University of Santa Catarina, Delfino Conti S/N, Trindade, Santa Catarina, 88040-370, Florianopolis, Brazil.
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Singh S, Shetty K. Letter to the editor. AUST ENDOD J 2023; 49:462. [PMID: 35861447 DOI: 10.1111/aej.12668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Surmayee Singh
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, India
- Affiliated to Manipal Academy of Higher Education, Manipal, India
| | - Karthik Shetty
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, India
- Affiliated to Manipal Academy of Higher Education, Manipal, India
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Azizi Mazreah S, Shirvani A, Azizi Mazreah H, Dianat O. Evaluation of irrigant extrusion following the use of different root canal irrigation techniques: A systematic review and meta-analysis. AUST ENDOD J 2023; 49:396-417. [PMID: 35988128 DOI: 10.1111/aej.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
This systematic review investigates whether different irrigation techniques have different effects on irrigant extrusion from mature tooth apices. Articles published between January 2000 and January 2022 were searched in six electronic databases (MEDLINE, Embase, Google Scholar, Web of Science, Scopus and Cochrane) using appropriate keywords. Overall, 2265 articles were screened by their titles and abstracts. Fifty-six full-text articles were selected based on the inclusion criteria. Of them, 17 in vitro studies were included in the systematic review and meta-analysis. The meta-analysis was conducted using the random-effects inverse variance method. The results showed that the negative pressure technique caused a lesser amount (p = 0.00) and frequency (p = 0.00) of extrusion than the open-ended needle irrigation. Sonic and ultrasonic activation caused less amount of extrusion than both open-ended (p = 0.00 or p = 0.01) and closed-ended needle (p = 0.00) irrigation.
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Affiliation(s)
| | - Armin Shirvani
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, Maryland, USA
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Pai ARV. Clinical research on sodium hypochlorite irrigation and extrusion: The gap and scope. J Dent Sci 2023; 18:1417-1418. [PMID: 37404641 PMCID: PMC10316479 DOI: 10.1016/j.jds.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/04/2023] [Indexed: 07/06/2023] Open
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Al-Jadaa A, Saidi Z, Mahmoud M, Al-Taweel R, Zehnder M. Assessment of Irrigant Agitation Devices in Simulated Closed and Open Root Canal Systems. J Endod 2023; 49:438-444.e6. [PMID: 36642215 DOI: 10.1016/j.joen.2023.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The in vitro efficacy of irrigant activation devices has not been contrasted to their safety. This was attempted in this study using apically closed versus patent simulated root canal systems in epoxy resin models, with the latter featuring a simulated periapical lesion. METHODS All 72 models had 2 joining canals connected by an isthmus, which was filled with dentin debris. The simulated periapical lesion was filled with colored gelatin in the 36 respective models. Canals were irrigated with 1.3% sodium hypochlorite. Samples were divided into 4 subgroups per system (n = 9): conventional irrigation, sonic low (EndoActivator; Dentsply Sirona, Charlotte, NC) and high frequency (EDDY; VDW, Munich, Germany), and ultrasonic agitation of the irrigant (always applying 3 cycles of 20 seconds). The total cleared surface areas (mm2) in the simulated isthmus and periapical lesion were compared between systems and devices using parametric tests (P < .05). RESULTS The cleaning of the isthmus was more effective in the apically open compared with the closed systems and was also significantly influenced by the agitation method (P < .001). In the closed systems, EDDY and ultrasonic agitation achieved the significantly (P < .05) best cleaning of the isthmus. In the open systems, ultrasonic agitation showed the single best result (P < .05). EDDY caused by far the highest and ultrasonic agitation the lowest dissolution of the gelatin in the simulated periapical lesion. CONCLUSIONS Under the conditions of this study, ultrasonic agitation of a previously administered sodium hypochlorite irrigant was more laterally targeted and thus safer and more effective than sonic agitation methods.
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Affiliation(s)
- Anas Al-Jadaa
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Zehraa Saidi
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Maise Mahmoud
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Rahaf Al-Taweel
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Matthias Zehnder
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
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Vivekananda Pai AR. Factors influencing the occurrence and progress of sodium hypochlorite accident: A narrative and update review. J Conserv Dent 2023; 26:3-11. [PMID: 36908722 PMCID: PMC10003279 DOI: 10.4103/jcd.jcd_422_22] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 12/12/2022] Open
Abstract
Sodium hypochlorite (NaOCl) is one of the most commonly used irrigant because of its several advantages. However, it is highly cytotoxic and can lead to severe tissue damage. NaOCl accident occurs when it is extruded beyond root confines into periapical or periradicular tissues. It is an irrigant mishap which can be life threatening and/or cause residual or long term or permanent consequences with malpractice and medico-legal implications. There are many factors which can influence the occurrence and progress of NaOCl accident. These factors can be broadly categorized as patient (host)-, tooth-, operator-, and NaOCl-related factors. They can be further categorized as predisposing and extent factors. It is vital for a clinician to thoroughly understand and identify various influencing factors to prevent NaOCl accident with its associated consequences including any potential medico-legal issues. The purpose of this article is to provide a narrative review on various factors which predispose to the occurrence of NaOCl accident and influence its extent and/or outcome.
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Affiliation(s)
- A. R. Vivekananda Pai
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Manipal University College Malaysia, Jalan Batu Hampar, Bukit Baru, 75150 Melaka, Malaysia
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The Potential of Phenothiazines against Endodontic Pathogens: A Focus on Enterococcus-Candida Dual-Species Biofilm. Antibiotics (Basel) 2022; 11:antibiotics11111562. [PMID: 36358217 PMCID: PMC9686549 DOI: 10.3390/antibiotics11111562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Persistent apical periodontitis occurs when the endodontic treatment fails to eradicate the intraradicular infection, and is mainly caused by Gram-positive bacteria and yeasts, such as Enterococcus faecalis and Candida albicans, respectively. Phenothiazines have been described as potential antimicrobials against bacteria and fungi. This study aimed to investigate the antimicrobial potential of promethazine (PMZ) and chlorpromazine (CPZ) against E. faecalis and C. albicans dual-species biofilms. The susceptibility of planktonic cells to phenothiazines, chlorhexidine (CHX) and sodium hypochlorite (NaOCl) was initially analyzed by broth microdilution. Interaction between phenothiazines and CHX was examined by chequerboard assay. The effect of NaOCl, PMZ, CPZ, CHX, PMZ + CHX, and CPZ + CHX on biofilms was investigated by susceptibility assays, biochemical and morphological analyses. Results were evaluated through one-way ANOVA and Tukey’s multiple comparison post-test. PMZ, alone or in combination with irrigants, was the most efficient phenothiazine, capable of reducing cell counts, biomass, biovolume, carbohydrate and protein contents of dual-species biofilms. Neither PMZ nor CPZ increased the antimicrobial activity of CHX. Further investigations of the properties of phenothiazines should be performed to encourage their use in endodontic clinical practice.
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Park R, Choi M, Seo J, Park EH, Jang SW, Shon WJ, Kim HY, Kim W. Root canal irrigation system using remotely generated high-power ultrasound. ULTRASONICS SONOCHEMISTRY 2022; 90:106168. [PMID: 36137469 PMCID: PMC9493060 DOI: 10.1016/j.ultsonch.2022.106168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/27/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Root canal treatment is performed to remove the bacteria proliferating in the root canals of a tooth. Many conventional root canal irrigation methods use an instrument inserted into the root canals. However, bacteria removal is often incomplete in the apical region of the root canal, and the treatment carries clinical risks, such as instrument fracture and extrusion of irrigation liquid through the canal apex. We here suggest a novel, remotely generated high-intensity ultrasound irrigation system that exhibits better irrigation performance and a reduced clinical risk. Our device employs powerful ultrasonic waves generated by a transducer placed outside a target tooth. The generated ultrasonic waves are guided to travel into the root canals. In the root canals of the target tooth, acoustic cavitation occurs, and vapor bubbles are created. The dynamic motions of vapor bubbles create remarkable cleaning effects. Using root canal models, we tested the cleaning performance of the proposed system and compared it with other conventional irrigation methods. The results revealed that biofilm in the apical region of the root canal models can be removed exclusively using the proposed system, thus demonstrating an improvement in cleaning performance. We also measured pressure at the apex of the root canals of an extracted tooth while operating the proposed system. Our system exhibited a smaller pressure compared to the syringe irrigation method, thus suggesting a reduced risk of apical extrusion of the irrigation liquid. Since the proposed system operates without inserting instruments into the root canal, it can clean multiple root canals in a tooth simultaneously with a single treatment. The proposed device would be a breakthrough in root canal treatment in terms of irrigation performance, clinical safety, and ease of treatment.
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Affiliation(s)
- Ryeol Park
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Minsu Choi
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Jaedeok Seo
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea
| | - Eun Hyun Park
- Department of Conservative Dentistry, Dental Research Institute and School of Dentistry, Seoul National University, Seoul 03080, Republic of Korea.
| | | | - Won-Jun Shon
- Department of Conservative Dentistry, Dental Research Institute and School of Dentistry, Seoul National University, Seoul 03080, Republic of Korea
| | - Ho-Young Kim
- Department of Mechanical Engineering, Seoul National University, Seoul 08826, Republic of Korea.
| | - Wonjung Kim
- Department of Mechanical Engineering, Sogang University, Seoul 04107, Republic of Korea; Institute of Emergent Materials, Sogang University, Seoul 04107, Republic of Korea.
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SERÇE FİKİRLİ B, ALTUNKAYNAK B, KAYAOĞLU G. Kök kanal geometrisinin ve iğne tipinin apikalden irrigan taşmasına etkisi: ex vivo çalışma. ACTA ODONTOLOGICA TURCICA 2022. [DOI: 10.17214/gaziaot.945129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: The aim was to evaluate the effect of root canal geometry on the amount of apical extrusion of irrigant, by testing different tapers and needle types.
Materials and Method: Forty-three extracted single-rooted human mandibular premolar teeth were accessed. Experimental groups were instrumented to produce increasing amounts of taper in each successive group: Group 1 (#25/.02), Group 2 (#25/.04), Group 3 (#25/.06), and Group 4 (#25/.08) (n=43, each). Irrigation was done sequentially by using a 30-G open-ended flat needle, 30-G close-ended side-vented needle, and 27-G open-ended beveled needle. Flat and side-vented needles were each placed 3 mm short of the apex, while the beveled needle was placed as far as possible in the canal without binding. Extruded irrigant was collected in preweighed foam cubes. Statistical significance was set at p<0.05.
Results: An increase in canal taper led to a decrease in the amount of extruded irrigant for the flat needle (p<0.05; Groups 1 and 2 versus 3 and 4) and side-vented needle (p<0.05; Groups 1 and 2 versus 4), but no significant effect was found for the beveled needle. The amount of extruded irrigant was greater with the flat than with the side-vented needle at all tapers and with the beveled needle at most tapers (p<0.05). The side-vented needle was generally associated with the least amount of extrusion.
Conclusion: Given a constant needle insertion depth, the amount of apically extruded irrigant decreased as canal taper increased. The greatest and least amounts of extrusion were generally observed with the flat and side-vented needle, respectively.
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Affiliation(s)
| | | | - Güven KAYAOĞLU
- Department of Endodontics, Faculty of Dentistry, Gazi University
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Cytotoxicity and Efficacy in Debris and Smear Layer Removal of HOCl-Based Irrigating Solution: An In Vitro Study. J Funct Biomater 2022; 13:jfb13030095. [PMID: 35893463 PMCID: PMC9326542 DOI: 10.3390/jfb13030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/10/2022] Open
Abstract
In the present study we evaluated the cytotoxicity of super-oxidized water on human gingival fibroblasts and its efficacy in debris and smear layer removal from root canal walls. Cultured gingival fibroblasts were exposed to super-oxidized water (Sterilox), which was diluted in Iscove’s modified Dulbecco’s medium (IMDM) at 30%, 40%, 50%, 60% and 70% concentrations. The control group was maintained in IMDM. The cell viability was evaluated by means of an MTT assay after incubation periods of 1 h, 2 h, 24 h and 48 h. Pathological cellular changes were also observed under fluorescence and phase contrast microscopes. The efficacy in debris and smear layer removal was evaluated in comparison to the conventional application of sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA). Forty maxillary premolars were randomly divided into two equal groups (n = 20) and shaped with ProTaper NEXT rotary instruments using Sterilox or NaOCl/EDTA for irrigation. Afterwards, roots were split longitudinally and examined under a scanning electron microscope. The results revealed that super-oxidized water and sterile distilled water have acceptable biological properties for endodontic applications at concentrations up to 50% (p > 0.05). Moreover, super-oxidized water is equally effective in debris and smear layer removal as compared to NaOCl/EDTA (p > 0.05).
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Özdemir O, Hazar E, Koçak S, Sağlam BC, Koçak MM. The frequency of sodium hypochlorite extrusion during root canal treatment: an observational clinical study. Aust Dent J 2022; 67 Suppl 1:S57-S64. [PMID: 35707880 DOI: 10.1111/adj.12924] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To determine the frequency of sodium hypochlorite (NaOCl) extrusion and evaluate the outcome of the injury. METHODS A total of 1123 teeth indicated root canal treatment were included. Open-ended needle was used during/after the instrumentation. Acute burning pain during irrigation was considered as NaOCl extrusion. Negative aspiration was applied for patients with extrusion, and appropriate treatment was planned due to the symptoms. The number of patients who experienced extrusion and symptoms were recorded. Analysis of variance (ANOVA), at p<0.05, was used to compare the data groups. RESULTS NaOCl extrusion rate was found at 0.89%, and the injury with swelling that differential diagnosis of NaOCl accident caused by extrusion rate was 0.18%. The most common findings besides acute pain, as a sign of extrusion (n=10), were accompanying apical bleeding (n=6), and swelling (n=2). According to the number of visits, a significant correlation was found between the symptoms (p = 0.010). No serious injury such as a neurological sign, tissue necrosis, or trismus occurred in any patient. CONCLUSIONS Demographic characteristics of the patients and preoperative condition of teeth were not related to NaOCl extrusion. The increasing number of visits may affect the probability of an accident. Negative aspiration immediately may be crucial in preventing severe injuries. © 2022 Australian Dental Association.
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Affiliation(s)
- Olcay Özdemir
- Karabük University, Faculty of Dentistry, Department of Endodontics, 78050, Karabük, Turkey
| | - Ecehan Hazar
- Zonguldak Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, 67600, Zonguldak, Turkey
| | - Sibel Koçak
- Zonguldak Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, 67600, Zonguldak, Turkey
| | - Baran Can Sağlam
- Zonguldak Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, 67600, Zonguldak, Turkey
| | - Mustafa Murat Koçak
- Zonguldak Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, 67600, Zonguldak, Turkey
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Comparative effects of erbium-doped yttrium aluminum garnet laser, the shock wave-enhanced emission photoacoustic streaming, and the conventional needle irrigation on apical extrusion of irrigants. Photodiagnosis Photodyn Ther 2022; 39:102878. [DOI: 10.1016/j.pdpdt.2022.102878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
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Boutsioukis C, Arias‐Moliz MT, Chávez de Paz LE. A critical analysis of research methods and experimental models to study irrigants and irrigation systems. Int Endod J 2022; 55 Suppl 2:295-329. [PMID: 35171506 PMCID: PMC9314845 DOI: 10.1111/iej.13710] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
Irrigation plays an essential role in root canal treatment. The purpose of this narrative review was to critically appraise the experimental methods and models used to study irrigants and irrigation systems and to provide directions for future research. Studies on the antimicrobial effect of irrigants should use mature multispecies biofilms grown on dentine or inside root canals and should combine at least two complementary evaluation methods. Dissolution of pulp tissue remnants should be examined in the presence of dentine and, preferably, inside human root canals. Micro-computed tomography is currently the method of choice for the assessment of accumulated dentine debris and their removal. A combination of experiments in transparent root canals and numerical modeling is needed to address irrigant penetration. Finally, models to evaluate irrigant extrusion through the apical foramen should simulate the periapical tissues and provide quantitative data on the amount of extruded irrigant. Mimicking the in vivo conditions as close as possible and standardization of the specimens and experimental protocols are universal requirements irrespective of the surrogate endpoint studied. Obsolete and unrealistic models must be abandoned in favour of more appropriate and valid ones that have more direct application and translation to clinical Endodontics.
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Affiliation(s)
- Christos Boutsioukis
- Department of EndodontologyAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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16
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Boutsioukis C, Arias-Moliz MT. Present status and future directions - irrigants and irrigation methods. Int Endod J 2022; 55 Suppl 3:588-612. [PMID: 35338652 PMCID: PMC9321999 DOI: 10.1111/iej.13739] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long‐term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long‐term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.
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Affiliation(s)
- C Boutsioukis
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M T Arias-Moliz
- Department of Microbiology, Faculty of Dentistry, University of Granada, Granada, Spain
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S. DPA, Solete P, Jeevanandan G, Syed AA, Almahdi S, Alzhrani M, Maganur PC, Vishwanathaiah S. Effect of Various Irrigant Activation Methods and Its Penetration in the Apical Third of Root Canal-In Vitro Study. Eur J Dent 2022; 17:57-61. [PMID: 35189642 PMCID: PMC9949917 DOI: 10.1055/s-0041-1742122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the irrigant penetration using iohexol dye with four irrigation techniques. METHODOLOGY Single-rooted premolars were recently extracted and preserved in physiological saline solution. All the samples were standardized to 16 mm. Standard endodontic access was prepared using endoaccess bur (Dentsply Maillefer, Switzerland). The initial patency was established using #10 k file (Mani, Utsunomiya, Tochigi, Japan) to the working length. The cleaning and shaping were performed using the file system ProFit S3 in the following sequence: P0 (orifice enlarger), PF1 (yellow), PF2 (red) #25, and PF3 (blue) #30. The samples were randomly allocated in concealed opaque envelopes into four groups. This was performed by a trained dentist. Fifteen samples were allocated to one group. The groups were divided as follows: Group A-conventional needle (CN), Group B-side-vented needle (SVN), Group C-manual dynamic agitation (MDA), and Group D-EndoActivator (EA). The radiopaque dye irrigant agitation/activation was performed by one operator to prevent operator bias. Following irrigation using the different techniques, digital radiographs were taken, and the measurement was taken from the apical foramen to the point where the dye had penetrated apically for each tooth and the data were entered into an Excel sheet for all the four groups. RESULTS Comparing the four groups, there was a statistically significant difference among the four groups (p < 0.05), thus, favoring the alternate hypothesis. EA had resulted in better penetration of the irrigant compared with the other three groups (p < 0.05). CONCLUSION It was evident that irrigant penetration was best achieved with the use of an EA followed by MDA, SVNs, and then the CN when the preparation was done till size 30 (PF3 #30) using ProFit S3 rotary file system.
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Affiliation(s)
- Delphine Pricilla Antony S.
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Pradeep Solete
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Ganesh Jeevanandan
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India,Ganesh Jeevanandan, BDS, MDS, PhD Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical ScienceChennai, Tamil NaduIndia
| | - Ather Ahmed Syed
- Division of Pedodontics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Samaher Almahdi
- Division of Pedodontics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | | | - Prabhadevi C. Maganur
- Division of Pedodontics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Satish Vishwanathaiah
- Division of Pedodontics, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia,Address for correspondence Satish Vishwanathaiah, BDS, MDS, FICD, FPFA Division of Pedodontics, Department of Preventive Dental Sciences, College of Dentistry, Jazan UniversityJazanKingdom of Saudi Arabia
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Tashkandi N, Alghamdi F. Effect of Chemical Debridement and Irrigant Activation on Endodontic Treatment Outcomes: An Updated Overview. Cureus 2022; 14:e21525. [PMID: 35223300 PMCID: PMC8863357 DOI: 10.7759/cureus.21525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 12/20/2022] Open
Abstract
Chemical debridement is considered one of the most important steps during root canal treatment to target unreached areas and provide thorough disinfection of the canals. The efficiency of this step efficiency can be increased using different agitation and irrigation techniques/devices. This comprehensive review aimed to summarize the effect of various irrigant activation and agitation techniques/devices on endodontic treatment outcomes. Using mechanical active irrigation, which enables the activation or agitation of the irrigating solution, is beneficial in root canal treatment by increasing the efficiency of delivering the irrigant up to working length and ensuring isthmus cleanliness. However, considerable variation was noticed between the protocols used in each technique with a lack of well-designed randomized clinical trials to focus on the long-term outcome. Moreover, a low level of evidence was noticed regarding the effectiveness of certain activation techniques over others. Therefore, each study needs to be carefully weighed before using its results and embracing its conclusion. Future studies need to focus more on the antimicrobial effect of each technique and its effect on the healing of apical periodontitis. Also, recent advances, such as multisonic and laser activation, are promising tools that need more clinical investigations to show their efficiency.
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Claudino Ribeiro JR, da Silveira Bueno CE, Bruno KF, Dos Reis S, de Martin AS, Fontana CE, Pelegrine RA. Impact of sodium hypochlorite on organic tissue dissolution in the periapical region of immature permanent teeth: an ex vivo study. J Endod 2022; 48:555-560. [PMID: 35032539 DOI: 10.1016/j.joen.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION To evaluate the impact of different sodium hypochlorite irrigation protocols on organic tissue dissolution in the periapical region of simulated immature permanent teeth. METHODS Eight single-rooted premolars and 48 samples of porcine palatal mucosa were used. Acrylic resin prototypes were constructed, placing the tissue in close contact with the dental apices. Specimens were then divided into six groups (n=8): two control groups, of saline irrigation with (NS/WA) or without (NS/NA) ultrasonic activation, and four experimental groups, of 1.5% and 2.5% sodium hypochlorite irrigation, with (NaOCl 1.5%/WA and NaOCl 2.5%/WA) or without (NaOCl 1.5%/NA and NaOCl 2.5%/NA) activation. Root canals were irrigated with 20 mL of the solution for 5 minutes, distributed over four irrigation cycles. In each cycle, after irrigation, the solution was either kept stagnant or activated for 30 seconds and then replaced. Specimens were weighed on a precision balance before and after the irrigation protocols. Tissue dissolution was measured by the difference between the initial and final weights. One-way ANOVA was applied, followed by Tukey's HSD test (α=0.05). RESULTS The NS/NA and NS/WA groups had mean weight reductions similar to the 1.5% NaOCl/NA group (p>0.05) and lower than the others (p<0.05). The 2.5% NaOCl/NA and 2.5% NaOCl/WA groups had the highest mean weight loss (p<0.05), while the 1.5% NaOCl/WA group had intermediate values (p<0.05). CONCLUSIONS Periapical tissue dissolution occurred in all groups, with greater impact observed with 2.5% NaOCl, with or without ultrasonic activation.
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Affiliation(s)
- José Ricardo Claudino Ribeiro
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil.
| | - Carlos Eduardo da Silveira Bueno
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil
| | - Kely Firmino Bruno
- Endodontics, Faculdade Sul Americana, BR-153, Km 502, Jardim da Luz, 74850370, Goiânia, GO, Brazil
| | - Samuel Dos Reis
- Endodontics, Faculdade Sul Americana, BR-153, Km 502, Jardim da Luz, 74850370, Goiânia, GO, Brazil
| | - Alexandre Sigrist de Martin
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil
| | - Carlos Eduardo Fontana
- Center for Life Sciences, Postgraduate Program in Health Sciences, Pontifícia, Universidade Católica de Campinas (PUC-CAMPINAS), Rua Professor Doutor Euryclides de Jesus Zerbini, 1516, CampusI/ Av. John Boyd Dunlop, s/n, 13087571, Campinas, SP, Brazil
| | - Rina Andréa Pelegrine
- Endodontics, Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo, Mandic, R. Dr. José Rocha Junqueira, 13, 13045755, Campinas, SP, Brazil
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Ramesh S, Teja K, Choudhari S, Janani K, Jose J, Vasundhara K. A questionnaire-based cross-sectional survey of Indian postgraduates and endodontists on awareness, attitude, and practice of using conventional syringe needle irrigation during root canal treatment. SAUDI ENDODONTIC JOURNAL 2022. [DOI: 10.4103/sej.sej_26_22] [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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Namsoy E, Serefoglu B, Hulsmann M, Caliskan MK. Influence of various application systems on the amount of extruded irrigant in simulated immature teeth with regard to gravity: An ex-vivo study. Niger J Clin Pract 2022; 25:1831-1837. [DOI: 10.4103/njcp.njcp_270_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Accidental Extrusion of Sodium Hypochlorite in a Patient Taking Alendronate: A Case Report With an 8-Year Follow-up. J Endod 2021; 47:1947-1952. [PMID: 34626612 DOI: 10.1016/j.joen.2021.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 12/22/2022]
Abstract
Extrusion of sodium hypochlorite (NaOCl) is a very rare accident with the most common complications including pain, swelling, and hematoma. It can occur even if procedural guidelines, predisposing conditions, and risk factors are taken into consideration. A 59-year-old female patient was admitted to the endodontics department to treat a left maxillary first premolar (World Dental Federation tooth 24). The medical history included osteoporosis and systemic medication with alendronate. Initially, the diagnosis was "symptomatic irreversible pulpitis" with "normal apical tissues." During instrumentation of the buccal canal, accidental extrusion of 2.5% NaOCl occurred into the periapical tissues, resulting from misinterpretation of the working length, and caused severe pain and bleeding. The canal was immediately flushed using copious irrigation with saline solution. An analgesic and corticosteroid were prescribed. At 3 and 7 days, ecchymosis and slight hematoma were observed extraorally in the area of the affected tooth and an intraoral ulceration at the apex of the affected tooth. At 15 days, minimal signs of ecchymosis were observed, and the treatment was resumed. At 30 days after the accident, there was complete remission of the sequelae. The clinical, radiographic, and tomographic assessment after 1 month, 1 year, and 8 years showed favorable case evolution. During the 8-year follow-up, the patient maintained the systemic use of alendronate. It can be concluded that NaOCl extrusion is an accident that causes patients and clinicians to experience an unpleasant consequence. The radiographic working length should always be determined carefully. A successful outcome can be achieved in patients who take alendronate.
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Hoedke D, Kaulika N, Dommisch H, Schlafer S, Shemesh H, Bitter K. Reduction of dual-species biofilm after sonic- or ultrasonic-activated irrigation protocols: A laboratory study. Int Endod J 2021; 54:2219-2228. [PMID: 34418114 DOI: 10.1111/iej.13618] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 01/11/2023]
Abstract
AIM To evaluate the antibacterial effect of sonic- and ultrasonic-activated irrigation on bacterial reduction of a dual-species biofilm in root canals compared to nonactivated irrigation in a laboratory study. METHODOLOGY Two hundred and forty extracted human single-rooted maxillary anterior teeth were divided into two main groups (G, n = 120) according to the initial preparation size of the root canal (G1: size 25, 0.06 taper, G2: size 40, 0.06 taper). Root canals were inoculated with Enterococcus faecalis and Streptococcus oralis. After 5 days, G1 received combined instrumentation (up to size 40, 0.06 taper) and irrigation/activation, whereas G2 received solely irrigation/activation protocols. In both groups, irrigation was performed with sodium hypochlorite (NaOCl 1%) or physiological saline (NaCl 0.9%), using nonactivated syringe irrigation, sonic activation (2 x 30 s) or ultrasonic activation (2 x 30 s). Logarithmic reduction factors (LRFs) of colony-forming units were analysed separately for dentine-adherent and planktonic bacteria immediately after irrigation/activation protocols (time-point 1) or after 5 days of further incubation (time-point 2) by analysis of variance (anova) and post hoc tests (Tukey's HSD, t-test). The significance level was set at 0.05. RESULTS In G1 subgroups (combined instrumentation with irrigation/activation), LRFs were significantly affected by the applied irrigation solution (p < .0001), but not by the activation method (p > .05; anova). In G2 subgroups (solely irrigation/activation), both, irrigant solution and activation, significantly affected LRFs (p < .0001, anova). Sonic activation resulted in significantly higher LRFs than ultrasonic activation (p < .0001) which had significantly greater reductions than nonactivated irrigation (p < .05; Tukey's HSD). At T2, strong bacterial regrowth was observed in all groups; however, a significant bacterial reduction was detected for factors instrumentation, irrigant solution and activation (p < .0001; anova). Similar LRFs were found for dentine-adherent and planktonic bacterial cells in all groups (r = 0.91 at T1, r = 0.8 at T2). CONCLUSIONS In this laboratory study on extracted maxillary anterior teeth high-frequency sonic activation resulted in a greater bacterial reduction compared to ultrasonic activation in groups receiving solely irrigation/activation protocols; however, irrigation using NaOCl and ultrasonic activation also contributed significantly to bacterial reduction compared to the control groups.
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Affiliation(s)
- Daniela Hoedke
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Namira Kaulika
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Henrik Dommisch
- Department of Periodontology, Oral Medicine and Oral Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Sebastian Schlafer
- Section for Oral Ecology and Caries Control, Department of Dentistry and Oral Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hagay Shemesh
- Department of Endodontology, Academic Center of Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Kerstin Bitter
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Souza MA, Bonacina LV, Trento A, Bonfante FDC, Porsch HF, Ricci R, Lago BLT, Lago CTR, Gabrielli ES, Bervian J, Farina AP, Cecchin D. Influence of the apical limit of instrumentation and photodynamic therapy on the postoperative pain of lower molars with asymptomatic apical periodontitis. Photodiagnosis Photodyn Ther 2021; 36:102489. [PMID: 34416381 DOI: 10.1016/j.pdpdt.2021.102489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of present study was to evaluate the influence of apical limit of instrumentation and PDT on the postoperative pain of lower molars with asymptomatic apical periodontitis. METHODS Forty patients were included in the present study and were divided into 4 groups (n=10), according to apical limit of instrumentation and use of PDT: instrumentation at 0.0 measurement; instrumentation at 0.0 measurement+PDT; instrumentation 1mm beyond 0.0 measurement; instrumentation 1mm beyond 0.0 measurement+PDT. In the PDT, the root canals were filled with 0.01% methylene blue, remaining for 5 min. The low-intensity laser was used with 100 mW, 660-690 nm wavelength), using intra-canal fibre. Root canals were irradiated for 90 s, delivering total dose of 9 J and energy density of 320 J/cm2. After root canal preparation and PDT protocols, root canals were filled with gutta-percha and AH Plus endodontic sealer, being sealed with composite resin.The evaluation of postoperative pain was performed by visual analog scale after 24, 48, 72 hours and 7 days. Data were analysed by specific statistical tests, at level of 5%. RESULTS No statistical significant difference was observed among experimental groups in all evaluation periods, as well as in the intragroup analysis over time, regarding postoperative pain and analgesic medication consumption (p>0.05). CONCLUSIONS Apical limit of instrumentation and PDT have no influence on the postoperative pain of lower molars with asymptomatic apical periodontitis.
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Affiliation(s)
| | | | - Alexia Trento
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | | | | | - Rafaela Ricci
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | | | | | | | - Juliane Bervian
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | - Ana Paula Farina
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
| | - Doglas Cecchin
- School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil
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Kuligowski P, Jaroń A, Preuss O, Gabrysz-Trybek E, Bladowska J, Trybek G. Association between Odontogenic and Maxillary Sinus Conditions: A Retrospective Cone-Beam Computed Tomographic Study. J Clin Med 2021; 10:jcm10132849. [PMID: 34199113 PMCID: PMC8268029 DOI: 10.3390/jcm10132849] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022] Open
Abstract
Odontogenic infections can directly trigger maxillary sinusitis. CBCT is an excellent choice for precise examination of maxillary sinuses and hard tissues within the oral cavity. The objective of this retrospective and the cross-sectional study was to analyze the influence of odontogenic conditions on the presence and intensity of maxillary sinus mucous membrane thickening using CBCT imaging. Moreover, periodontal bone loss and anatomic relationship between adjacent teeth and maxillary sinuses were assessed to evaluate its possible impact on creating maxillary thickening. The study sample consisted of 200 maxillary sinuses of 100 patients visible on CBCT examination with a field of view of 13 × 15 cm. The presented study revealed a significant influence of periapical lesions, inappropriate endodontic treatment, severe caries, and extracted teeth on the presence of increased thickening of maxillary sinus mucous membrane. In addition, an increase in the distance between root apices and maxillary sinus floor triggered a significant reduction of maxillary sinus mucous membrane thickening. The presence of periodontal bone loss significantly increases maxillary sinus mucous membrane thickening.
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Affiliation(s)
- Piotr Kuligowski
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (P.K.); (A.J.); (O.P.)
| | - Aleksandra Jaroń
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (P.K.); (A.J.); (O.P.)
| | - Olga Preuss
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (P.K.); (A.J.); (O.P.)
| | - Ewa Gabrysz-Trybek
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Unii Lubelskiej 1 St., 71-242 Szczecin, Poland;
| | - Joanna Bladowska
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska 213 St., 50-556 Wroclaw, Poland;
| | - Grzegorz Trybek
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland; (P.K.); (A.J.); (O.P.)
- Correspondence:
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26
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Magni E, Jäggi M, Eggmann F, Weiger R, Connert T. Apical pressures generated by several canal irrigation methods: A laboratory study in a maxillary central incisor with an open apex. Int Endod J 2021; 54:1937-1947. [PMID: 34022070 PMCID: PMC8518727 DOI: 10.1111/iej.13575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/19/2021] [Indexed: 01/13/2023]
Abstract
Aim A laboratory study to determine the apical pressure generated by seven canal irrigation methods in an anterior tooth with an open apex. Methodology Canal irrigation was performed on a 3D‐printed central maxillary incisor with an open apex (maximum diameter of 2.1 mm). Ultrasonically activated irrigation (UAI), sonic activation (EDDY), negative pressure irrigation (EndoVac), the self‐adjusting file (SAF) and the XP‐endo Finisher were employed at tooth length (TL), TL—1 mm, TL—2 mm and TL—3 mm. UAI was tested at three intensity levels additionally. Hydrodynamic irrigation with RinsEndo was performed in the pulp chamber, at the canal orifice, the coronal third, the middle of the canal and at TL. Er:YAG laser activation, at four frequency settings, was performed in the pulp chamber and at the orifice of the canal. The pressure of the fluid towards the canal terminus generated by activation was directly transferred to a pressure sensor with a range of 0 to 120 mmHg and a response time of ≤0.5 ms. The critical threshold for apical extrusion of the irrigant was set at 5.73 mmHg (lower limit of the central venous pressure: 5.88 ± 0.15 mmHg). Each experiment was repeated ten times. The tests were followed by descriptive analyses (maximum, mean, standard deviation, 95% confidence interval). Results EndoVac, the SAF, the XP‐endo Finisher, and UAI never exceeded the critical threshold at any insertion depth or intensity level. Er:YAG laser activation exceeded the critical threshold exclusively at frequency settings that varied from the manufacturer's recommendation. EDDY at TL and RinsEndo at any insertion depth exceeded the critical threshold in 100% of the measurements. EDDY at TL—1,—2, and—3 mm crossed the critical threshold in 30%, 10%, and 20% of the measurements, respectively. Conclusions In a simulated maxillary central incisor with an open apex, irrigation with EndoVac, Er:YAG laser activation, UAI, the SAF, and the XP‐endo Finisher generated apical pressures below the critical threshold of 5.73 mmHg. By contrast, using EDDY and RinsEndo for irrigation produced higher apical pressures that exceeded the critical threshold.
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Affiliation(s)
- Eva Magni
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
| | - Marco Jäggi
- Department of Reconstructive Dentistry, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
| | - Florin Eggmann
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
| | - Thomas Connert
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine UZB, University of Basel, Basel, Switzerland
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Souza EM, Campos MG, Rosas Aguilar R. Mapping the periapex anatomical pattern of teeth involved in sodium hypochlorite accidents: a cross-sectional quasi-experimental study. Int Endod J 2021; 54:1212-1220. [PMID: 33826773 DOI: 10.1111/iej.13528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/05/2021] [Indexed: 12/30/2022]
Abstract
AIM To determine the anatomical reasons for sodium hypochlorite (NaOCl) accidents by testing whether this mishap is likely to occur in cases where the anatomical apex of the teeth fenestrates the overlying buccal cortical alveolar bone, allowing NaOCl to gain direct access to buccal soft tissues. METHODOLOGY Following a cross-sectional, nonrandomized design, 13 patients who suffered unintentional NaOCl accidents whilst undergoing root canal treatment were included. After remission of symptoms, the root canals were fully irrigated with an innocuous radiopaque solution (saline diluted Claritrast 300) and subsequently CBCT scanned to create a 3D-map of the periapex and tracking of the irrigant pathway throughout the periapical tissues. An extra group of five control patients, who underwent root canal treatment with no NaOCl accident, was also CBCT-scanned after irrigation with the tracking radiopaque solution. The anatomical relationship of the cortical bone and the root apex, as well as the distribution of irrigation solution in the periapical tissue, was associated with patients undergoing a NaOCl accident or not, using a Fisher's exact test. RESULTS The frequency of teeth with apical cortical fenestration was significantly higher in the NaOCl accident-positive group, compared to the negative (P < 0.001). All 13 accident-positive patients had an anatomical apex in direct contact with the buccal soft tissue via fenestration of the overlying cortical bone and direct contact of the foramen with the soft tissues. The radiopaque solution was distributed in the soft tissue in these cases. In contrast, accident-negative patients had no fenestration of the buccal cortical bone and the anatomical root apex was within the cancellous bone or within a bone-confined periapical lesion. The radiopaque solution was also found in the cancellous bone or the periapical lesion, but patients had no manifestations of a NaOCl accident. CONCLUSION This quasi-experimental cross-sectional clinical study suggests that, in addition to the presence of the extruded NaOCl solution, a patent foramen that fenestrates the cortical bone merging into the mucosal tissue might constitute a risk for the clinical manifestation of a NaOCl accident. Preoperative 3D scans aid in anticipating when an accident is likely to occur.
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Affiliation(s)
- E M Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Brazil
| | - M G Campos
- Department of Endodontics, Escuela Nacional de Estudios Superiores UNAM, León, Mexico
| | - R Rosas Aguilar
- Department of Endodontics, Escuela Nacional de Estudios Superiores UNAM, León, Mexico
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Ordinola-Zapata R, Crepps JT, Arias A, Lin F. In vitro apical pressure created by 2 irrigation needles and a multisonic system in mandibular molars. Restor Dent Endod 2021; 46:e14. [PMID: 33680903 PMCID: PMC7906849 DOI: 10.5395/rde.2021.46.e14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 11/12/2022] Open
Abstract
Objectives The aim of this study was to evaluate the apical pressure generated by 2 endodontic irrigation needles and the GentleWave system in mandibular molars. Materials and Methods The mesial and distal root canals of 12 mandibular molars were irrigated with a 30-gauge close-end needle or with a 30-gauge open-end needle. Procedures were performed in the mesial and distal canals. The GentleWave procedure and irrigation at 1 mm from the apex in the distal roots using an open-end needle were used, respectively, as negative and positive controls. The apical pressure was measured using a data acquisition pressure setup. Apical pressure exerted by the different needles in the 2 different canal types was statistically compared using 2-way analysis of variance. Results Significant differences were found in the apical pressure for both needles and the canal type. The lowest values were obtained with close-end needles and in mesial canals. Negative apical pressure values were obtained using GentleWave. Conclusions The needle and the canal type influenced the apical pressure. The GentleWave procedure produced negative apical pressure.
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Affiliation(s)
- Ronald Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Joseph T Crepps
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Ana Arias
- Conservative Dentistry Department, School of Dentistry, Universidad Complutense de Madrid, Madrid, Spain
| | - Fei Lin
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China
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Ramesh S, Sujith I, Teja K. Assessment of irrigant flow and apical pressure in simulated canals of single-rooted teeth with different root canal tapers and apical preparation sizes: An ex vivo study. J Conserv Dent 2021; 24:314-322. [PMID: 35282587 PMCID: PMC8896124 DOI: 10.4103/jcd.jcd_651_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Irrigation dynamics vary in optimally shaped canals. Various factors combine to create a stress-induced environment leading to a dynamic irrigant flow. Aim: The aim of the study is to evaluate the irrigant flow and apical pressure using 30G open-ended needle in virtually created root canal model of single-rooted teeth. Materials and Methods: Sixty extracted single-rooted premolars were selected and prepared using a single rotary instrument Hyflex CM and grouped as – Group I: 30 size 0.6% taper (n = 15), Group II: 30 size 0.4% taper (n = 15), Group III: 25 size 0.6% taper (n = 15), and Group IV: 25 size 0.4% taper (n = 15). Postinstrumentation imaging was carried out using cone-beam computed tomography, and computer-aided design models were obtained. Subgrouping was done based on the nozzle position, and computational fluid dynamic analysis was carried out for the respective parameters assessed. Results: Statistical significance was elicited in all the groups at different nozzle positions analyzed (P < 0.05). A post hoc test revealed significance in the mean flow rate and flow velocity in Group I at low nozzle position (P < 0.05) as compared to others. Conclusions: 30 size 0.6% tapered preparations proved efficient irrigant flow and least apical pressures at all nozzle positions.
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Effect of Different Irrigation Solutions on the Diffusion of MTA Cement into the Root Canal Dentin. MATERIALS 2020; 13:ma13235472. [PMID: 33271754 PMCID: PMC7730380 DOI: 10.3390/ma13235472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 12/11/2022]
Abstract
(1) Aim: This study aims to analyze the in vitro infiltration of a silicate root canal sealer into dentinal tubules after using different endodontic irrigating solutions. (2) Methods: Twenty-nine teeth with single roots were separated into three groups according to the final irrigation protocol: G1 n = 10) = 17% EDTA (ethylenediaminetetraacetic acid) + 3.0% sodium hypochlorite (NaOCl), G2 (n = 10) = 17% EDTA + 2.0% chlorhexidine and G3 (Control group, n = 9) = 17% EDTA + saline solution. Root canals were filled using cold lateral compaction technique with MTA Fillapex sealer and gutta-percha. The sealer was labeled with rhodamine B. The teeth were segmented at the middle and third apical sections, which were visualized using 10× confocal laser microscopy to determine the sealer penetration percentage. (3) Results: In the apical section, no statistically significant differences were found between the groups regarding sealer penetration. In the middle section, Group 1 obtained the highest percentage, and Group 2 the lowest (p = 0.004). Group 1 also presented statistically significant differences in the Control Group (p = 0.031) and had close sealer penetration values. Meanwhile, the Control Group (p = 0.023) and Group 2 (p = 0.029) revealed a significant decrease of sealer penetration between the apical and middle sections. (4) Conclusion: The obtained results support that final irrigation with NaOCl promoted similar sealer penetration in the apical and middle sections. On the other hand, a significant decrease in the sealer penetration of the middle section was observed for the chlorhexidine and saline groups. Compared to other irrigant solutions, NaOCl promotes more uniform sealer penetration, which can correlate with better sealing and, consequently, higher endodontic treatment success.
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Cunha TC, Matos FDS, Paranhos LR, Bernardino ÍDM, Moura CCG. Influence of glide path kinematics during endodontic treatment on the occurrence and intensity of intraoperative and postoperative pain: a systematic review of randomized clinical trials. BMC Oral Health 2020; 20:175. [PMID: 32571285 PMCID: PMC7310418 DOI: 10.1186/s12903-020-01164-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/12/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Preliminary canal enlargement (glide path preparation) may play a significant role in the development of pain. The aim of this systematic review of randomized clinical trials was to assess the influence of glide path kinematics during endodontic treatment on the occurrence and intensity of intraoperative and postoperative pain. METHODS A search was performed in June 2019 in six electronic databases (PubMed, Scopus, LILACS, SciELO, Embase and Web of Science) and two grey literature databases (OpenGrey and OpenThesis). The bibliographic references of the eligible articles were also hand-searched. The included clinical studies assessed the occurrence and intensity of intraoperative and/or postoperative pain after root canal preparation without glide path preparation (WGP) or with glide path preparation using manual (M-GP), continuous rotary (CR-GP), or reciprocating (R-GP) instruments. The primary outcome was the occurrence and intensity of intraoperative and postoperative pain, while analgesic consumption was the secondary outcome. The full texts of the eligible studies were analyzed by two reviewers who performed calibration exercises to verify the risk of bias and quality of the individual studies using the Joanna Briggs Institute Critical Appraisal tool. RESULTS From 1283 identified articles, only six studies were included in the qualitative analysis of the results, with a total sample of 884 patients/teeth. Three studies presented a high risk of bias, while three studies presented a moderate risk. Two studies reported that CR-GP causes lower pain levels than M-GP and WGP, and three studies showed no differences between CR-GP and R-GP. Regarding analgesic consumption, two studies found no differences among glide path kinematics, and one study reported lower consumption for CR-GP than for M-GP. Because of the limited number of studies and methodological differences, no statistical analyses were performed for the glide path kinematics comparisons. CONCLUSIONS Compelling evidence indicating a significantly different occurrence and intensity of pain among glide path kinematics is lacking. The systematic review protocol was registered in the PROSPERO database [CRD42020139989].
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Affiliation(s)
- Thaís Christina Cunha
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Felipe de Souza Matos
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - Luiz Renato Paranhos
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Av. Pará, 1720, Bloco 2G, sala 1, Umuarama, Uberlândia, MG, CEP 38405-320, Brazil.
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Eggmann F, Vokac Y, Eick S, Neuhaus KW. Sonic irrigant activation for root canal disinfection: power modes matter! BMC Oral Health 2020; 20:102. [PMID: 32276625 PMCID: PMC7147034 DOI: 10.1186/s12903-020-01088-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/25/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sonic irrigant activation has gained widespread popularity among general dentists and endodontists alike in recent years. This in vitro study aimed to evaluate the impact of three power modes of a sonic activation device (EDDY) on its antimicrobial effectiveness in infected root canals. METHODS The root canals of straight, human roots (n = 120) were prepared to size 40/.06. In a short-term infection experiment, the root canals were inoculated with different microbial species for three days. The following irrigation protocols, using 4 ml of normal saline as irrigant, were performed: negative control, manual rinsing, sonic irrigant activation at power modes "low", "medium" and "high". In a second, long-term experiment, testing the same irrigation protocols, inoculation lasted 21 days and sodium hypochlorite was used as irrigant. Sequential infection control samples were assessed using culture assays. The statistical analysis included one-way analysis of variance of log10-scaled counts of colony-forming units (CFU) with post-hoc comparisons using Bonferroni corrections and Chi2 tests (α = 0.05). RESULTS In the short-term experiment, the sonic irrigation protocols decreased the number of CFUs by 1.88 log10 units compared with the negative control (p < 0.001). The power modes "medium" and "high" achieved the most effective reduction of the microbial load. In the long-term experiment, microbial regrowth occurred after 7 days unless the device was used at its highest power setting. CONCLUSIONS The power modes of the sonic irrigation device have a significant impact on the effectiveness for endodontic disinfection. The sonic irrigation device should always be used at the highest power setting in order to maximize its antimicrobial effectiveness.
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Affiliation(s)
- Florin Eggmann
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, UZB, University of Basel, Mattenstrasse 40, CH-4056, Basel, Switzerland.
| | | | - Sigrun Eick
- Laboratory of Oral Microbiology, Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Klaus W Neuhaus
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, UZB, University of Basel, Mattenstrasse 40, CH-4056, Basel, Switzerland.,Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
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Mostafa MEHAA, El‐Shrief YAI, Anous WIO, Hassan MW, Salamah FTA, El Boghdadi RM, El‐Bayoumi MAA, Seyam RM, Abd‐El‐Kader KG, Amin SAW. Postoperative pain following endodontic irrigation using 1.3% versus 5.25% sodium hypochlorite in mandibular molars with necrotic pulps: a randomized double‐blind clinical trial. Int Endod J 2020; 53:154-166. [DOI: 10.1111/iej.13222] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
| | - Y. A. I. El‐Shrief
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - W. I. O. Anous
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - M. W. Hassan
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - F. T. A. Salamah
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - R. M. El Boghdadi
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | | | - R. M. Seyam
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - K. G. Abd‐El‐Kader
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
| | - S. A. W. Amin
- Department of Endodontics Faculty of Dentistry Cairo University Cairo Egypt
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Fasoulas A, Boutsioukis C, Lambrianidis T. Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management. Int Endod J 2019; 52:1586-1604. [DOI: 10.1111/iej.13183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 06/30/2019] [Indexed: 12/17/2022]
Affiliation(s)
- A. Fasoulas
- Department of Hygiene and Epidemiology, Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| | - C. Boutsioukis
- Department of Endodontology Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - T. Lambrianidis
- Department of Endodontology Dental School Aristotle University of Thessaloniki Thessaloniki Greece
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Perotti S, Bin P, Cecchi R. Hypochlorite accident during wndodontic therapy with nerve damage - A case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:104-108. [PMID: 29633752 PMCID: PMC6357615 DOI: 10.23750/abm.v89i1.6067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/03/2017] [Indexed: 02/04/2023]
Abstract
Endodontic therapy is a routinely practised clinical procedure with few reported complications but, as a bleaching agent, inadvertent spillage of sodium hypochlorite beyond the root canal system may result in extensive soft tissue or nerve damage, and even airway compromise. Although very rare, complications arising from hypochlorite extrusion beyond the root apex are described. NaOCl causes oxidation of protein and lipid membrane and causes necrosis, hemolysis and dermal ulcerations (2-4). Neurological complication are very rare. Paraesthesia and anaesthesia may affect the mental, inferior dental and infra-orbital branches of the trigeminal nerve and normal sensation may take many months to completely resolve (6, 7). Nerve damage (the buccal branch) was described in 2005 by Witton et al. (8) and patients exhibited a loss of the naso-labial groove and a down turning of the angle of the mouth and the motor function was regained after several months. We present a case in which the extrusion of NaOCl solution during endodontic therapy led to important destructive effects on soft tissues and nerves. The arisen medico legal issues are discussed. (www.actabiomedica.it)
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Affiliation(s)
| | | | - Rossana Cecchi
- Legal Medicine, Faculty of Medicine, University of Parma, Italy.
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Nagendrababu V, Pulikkotil SJ, Sultan OS, Jayaraman J, Peters OA. Methodological and Reporting Quality of Systematic Reviews and Meta-analyses in Endodontics. J Endod 2018; 44:903-913. [PMID: 29602531 DOI: 10.1016/j.joen.2018.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/07/2017] [Accepted: 02/10/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The aim of this systematic review (SR) was to evaluate the quality of SRs and meta-analyses (MAs) in endodontics. METHODS A comprehensive literature search was conducted to identify relevant articles in the electronic databases from January 2000 to June 2017. Two reviewers independently assessed the articles for eligibility and data extraction. SRs and MAs on interventional studies with a minimum of 2 therapeutic strategies in endodontics were included in this SR. Methodologic and reporting quality were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), respectively. The interobserver reliability was calculated using the Cohen kappa statistic. Statistical analysis with the level of significance at P < .05 was performed using Kruskal-Wallis tests and simple linear regression analysis. RESULTS A total of 30 articles were selected for the current SR. Using AMSTAR, the item related to the scientific quality of studies used in conclusion was adhered by less than 40% of studies. Using PRISMA, 3 items were reported by less than 40% of studies, which were on objectives, protocol registration, and funding. No association was evident comparing the number of authors and country with quality. Statistical significance was observed when quality was compared among journals, with studies published as Cochrane reviews superior to those published in other journals. AMSTAR and PRISMA scores were significantly related. CONCLUSIONS SRs in endodontics showed variability in both methodologic and reporting quality.
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Affiliation(s)
- Venkateshbabu Nagendrababu
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
| | - Shaju Jacob Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Omer Sheriff Sultan
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Jayakumar Jayaraman
- Division of Community and Children Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Ove A Peters
- Department of Endodontics, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, California; The University of Queensland Dental School, UQ Oral Health Centre, Herston, Queensland, Australia
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Bersezio C, Vildósola P, Sáez M, Sánchez F, Vernal R, Oliveira OB, Jorquera G, Basualdo J, Loguercio A, Fernández E. Does the Use of a "Walking Bleaching" Technique Increase Bone Resorption Markers? Oper Dent 2018. [PMID: 29533717 DOI: 10.2341/16-334-c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This randomized clinical trial evaluated the effect of 35% hydrogen peroxide in comparison with 37% carbamide peroxide in a nonvital bleaching technique of "walking bleaching" (four sessions of treatment) on periodontal markers: nuclear factor kappa B-ligand (RANK-L-process of root resorption marker) and interleukin 1β (IL-1β-inflammatory response marker). METHODS AND MATERIALS Fifty volunteers presenting with discoloration of nonvital teeth and endodontic treatment in good condition participated. Fifty teeth were randomly divided into two study groups according to bleaching gel: HP = 35% hydrogen peroxide (n=25) and 37% carbamide peroxide (n=25). Nonvital bleaching was performed with a walking bleaching technique consisting of four sessions of bleach application. Gingival crevicular fluid samples were taken in order to quantify the RANK-L and IL-1β levels by enzyme-linked immunosorbent assay. Samples were obtained from six periodontal sites for each bleached tooth: three vestibular and three palatine (mesial, middle, and distal) at seven time periods: baseline, after each of the four sessions of nonvital bleaching, at one week, and at one month after nonvital bleaching. Tooth color variations were analyzed in each session by VITA Bleachedguide 3D-MASTER (ΔSGU). RESULTS Significant increments in the RANK-L and IL-1β levels were detected in each evaluated time compared with baseline ( p<0.05); however, no differences were detected between hydrogen peroxide and carbamide peroxide on increments of the biomarkers studied. The change of color was effective for both nonvital bleaching therapies ( p<0.05). CONCLUSIONS Nonvital bleaching induced a significant increment in the RANK-L and IL-1β levels in periodontal tissues around bleached, nonvital teeth.
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Uzunoglu-Özyürek E, Karaaslan H, Türker SA, Özçelik B. Influence of size and insertion depth of irrigation needle on debris extrusion and sealer penetration. Restor Dent Endod 2018; 43:e2. [PMID: 29487833 PMCID: PMC5816991 DOI: 10.5395/rde.2018.43.e2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 11/08/2017] [Indexed: 12/28/2022] Open
Abstract
Objectives To determine the effect of size and insertion depth of irrigation needle on the amount of apical extruded debris and the amount of penetration depth of sealer using a confocal laser scanning microscope (CLSM). Materials and Methods Twenty maxillary premolars were assigned to 2 groups (n = 10), according to the size of needle tip, 28 G or 30 G. Buccal roots of samples were irrigated with respective needle type inserted 1 mm short of the working length (WL), while palatal roots were irrigated with respective needle type inserted 3 mm short of the WL. Prepared teeth were removed from the pre-weighed Eppendorf tubes. Canals were filled with F3 gutta-percha cone and rhodamine B dye-labeled AH 26 sealer. Teeth were transversally sectioned at 1 and 3 mm levels from the apex and observed under a CLSM. Eppendorf tubes were incubated to evaporate the irrigant and were weighed again. The difference between pre- and post-weights was calculated, and statistical evaluation was performed. Results Inserting needles closer to the apex and using needles with wider diameters were associated with significantly more debris extrusion (p < 0.05). The position of needles and level of sections had statistically significant effects on sealer penetration depth (p < 0.05 for both). Conclusions Following preparation, inserting narrower needles compatible with the final apical diameter of the prepared root canal at 3 mm short of WL during final irrigation might prevent debris extrusion and improve sealer penetration in the apical third.
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Affiliation(s)
- Emel Uzunoglu-Özyürek
- Department of Endodontics, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Hakan Karaaslan
- Department of Endodontics, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Sevinç Aktemur Türker
- Department of Endodontics, Bülent Ecevit University Faculty of Dentistry, Zonguldak, Turkey
| | - Bahar Özçelik
- Department of Endodontics, Hacettepe University Faculty of Dentistry, Ankara, Turkey
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Shetty VP, Naik BD, Pachlag AK, Yeli MM. Comparative evaluation of the amount of debris extruded apically using conventional syringe, passive ultrasonic irrigation and EndoIrrigator Plus system: An in vitro study. J Conserv Dent 2018; 20:411-414. [PMID: 29430092 PMCID: PMC5799986 DOI: 10.4103/jcd.jcd_200_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: The aim of this study is to compare the effects of conventional syringe, passive ultrasonic irrigation (PUI), and EndoIrrigator Plus on the amount of apically extruded debris. Materials and Methods: Thirty extracted human mandibular premolars were selected and randomly assigned to three groups (n = 10). The root canals were irrigated with conventional syringe, PUI, and EndoIrrigator Plus. Sodium hypochlorite was used as an irrigant, and debris was collected in a previously described experimental model (Myers and Montgomery 1991). It was then stored in an incubator at 37°C for 10 days to evaporate the irrigant before weighing the dry debris. The mean weight of debris was assessed, one-way analysis of variance was used for comparison of values, and post hoc Tukey's test was used between groups (P = 0.05). Results: The EndoIrrigator Plus group extruded significantly less debris than PUI and conventional syringe groups (P < 0.05). Furthermore, PUI group extruded significantly less debris than conventional syringe irrigation group (P < 0.05). Conclusions: 1. All the three irrigation systems were associated with apical extrusion of debris, 2. EndoIrrigator Plus system extruded significantly less debris than the PUI system and the conventional syringe irrigation system, 3. PUI system extruded significantly less debris than the conventional syringe irrigation system.
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Affiliation(s)
- Vidhi Prabhakar Shetty
- Department of Conservative Dentistry and Endodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Balaram Damodar Naik
- Department of Conservative Dentistry and Endodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Amit Kashinath Pachlag
- Department of Conservative Dentistry and Endodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Mahantesh Mrityunjay Yeli
- Department of Conservative Dentistry and Endodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
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Nagendrababu V, Jayaraman J, Suresh A, Kalyanasundaram S, Neelakantan P. Effectiveness of ultrasonically activated irrigation on root canal disinfection: a systematic review of in vitro studies. Clin Oral Investig 2018; 22:655-670. [DOI: 10.1007/s00784-018-2345-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/15/2018] [Indexed: 12/01/2022]
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Uncertain Decision-Making in Primary Root Canal Treatment. J Evid Based Dent Pract 2017; 17:205-215. [PMID: 28865817 DOI: 10.1016/j.jebdp.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/15/2017] [Accepted: 01/16/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES A systematic review of literature was conducted to compare the success and survivability of primary root canal interventions. METHODS The Preferred Reporting Items for Systematic Reviews and Meta Analyses protocol was adopted in this study to systematically assess and report systematic reviews related to success or survival or failure rates of primary root canal interventions. MEDLINE and Cochrane Oral Health Library were both searched by using specific search terms to identify relevant literature, until June 2016. The search was augmented by handsearching. Then, the quality of the included systematic reviews was assessed by using the Revised Assessment of Multiple Systematic Reviews (RAMSTAR) protocol. RESULTS Only 9 systematic reviews were identified. The RAMSTAR scores of the included reviews ranged from 43/44 to 29/44. Nevertheless, the later reviews did not provide sufficient evidence or statistically significant evidence to support any of the interventions used during primary root canal treatment. In addition, a number of key steps during primary root canal treatment, such as types of dental files, root canal instrumentation techniques, orthograde obturation materials, and techniques, were not assessed by systematic reviews. CONCLUSION The current status of evidence related to the success and survivability of primary root canal interventions is lacking. This puts dentists under marked degrees of uncertainty. Consequently, patients are potentially exposed to health care risks. It is then essential to develop tailored methods and tools for decision-making under uncertainty to aid both dentists and patients engaged in primary root canal treatment.
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Jang JK, Kwak SW, Ha JH, Kim HC. Anatomical relationship of maxillary posterior teeth with the sinus floor and buccal cortex. J Oral Rehabil 2017; 44:617-625. [PMID: 28547776 DOI: 10.1111/joor.12525] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
Abstract
This study aimed to evaluate the possibility of root fenestration or oroantral communication by evaluating the distance from root apex to the sinus floor and buccal cortex in maxillary posterior teeth using cone-beam computed tomography (CBCT) images. The study included 2182 roots of the maxillary posterior teeth from 219 patients after reviewing CBCT images of 462 patients according to the location of roots by two endodontists. The distances from each root apex to the maxillary sinus floor and buccal and palatal cortices were evaluated according to sex and age, and the mean values were compared by one-way analysis of variance and Mann-Whitney U-test. The distance between root apex and maxillary sinus floor was the greatest in maxillary first premolars and shortest in the mesio-buccal roots of maxillary second molars. The distances from root apex to the buccal and palatal cortical bones were significantly greater in male patients than those in female patients (P < 0·05). The palatal roots of maxillary first molars exhibited the highest incidence as well as the greatest mean length (1·96 mm) of protrusion into the maxillary sinus. The distance from root apex to the sinus floor was found to increase with age, except in case of maxillary second premolars. Understanding the relationship of maxillary posterior teeth with the sinus floor and buccal cortex could provide clinicians valuable information to help reduce iatrogenic damage.
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Affiliation(s)
- J K Jang
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Yangsan, Korea
| | - S W Kwak
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Yangsan, Korea
| | - J H Ha
- Department of Conservative Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - H C Kim
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Yangsan, Korea
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Effect of Canal Anastomosis on Periapical Fluid Pressure Build-up during Needle Irrigation in Single Roots with Double Canals using a Polycarbonate Model. Sci Rep 2017; 7:1582. [PMID: 28484231 PMCID: PMC5431501 DOI: 10.1038/s41598-017-01697-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/31/2017] [Indexed: 12/03/2022] Open
Abstract
Sodium hypochlorite is an effective irrigant for chemical debridement of root canals. However, increasing the intracanal pressure during irrigant delivery may result in irrigant extrusion into the bone and soft tissues surrounding the tooth. Because clinicians often encounter teeth with intracanal communications, the objective of the present study was to examine the effects of canal anastomosis on the generation of periapical fluid pressure at different fluid flow rates and insertion depths. Two similar polycarbonate models were used to simulate a single root with double canals, one containing, and the other without communicating channels between the canals. For both models, periapical pressure increased with increasing irrigant flow rates and insertion depths of a 30-gauge side-venting needle. In the presence of communicating channels, the magnitude of pressure build-up decreased by almost 90% irrespective of the fluid flow rate or needle insertion depth. Pressure reduction in anastomoses-containing roots provides an explanation why pressure generation in single roots is considerably higher. Nevertheless, it is still possible in teeth with canal anastomoses for pressure exceeding the intraosseous pressure to be generated when the fluid flow rate is sufficiently high and when the needle tip is close to the apical terminus.
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Romualdo PC, de Oliveira KMH, Nemezio MA, Küchler EC, Silva RAB, Nelson-Filho P, Silva LAB. Does apical negative pressure prevent the apical extrusion of debris and irrigant compared with conventional irrigation? A systematic review and meta-analysis. AUST ENDOD J 2017; 43:129-137. [DOI: 10.1111/aej.12162] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Priscilla Coutinho Romualdo
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | | | - Mariana Alencar Nemezio
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | - Erika Calvano Küchler
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | - Raquel Assed Bezerra Silva
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
| | - Lea Assed Bezerra Silva
- Department of Pediatric Dentistry; School of Dentistry of Ribeirão Preto; University of São Paulo; Ribeirão Preto Brazil
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Konstantinidi E, Psimma Z, Chávez de Paz LE, Boutsioukis C. Apical negative pressure irrigation versus syringe irrigation: a systematic review of cleaning and disinfection of the root canal system. Int Endod J 2017; 50:1034-1054. [PMID: 27898180 DOI: 10.1111/iej.12725] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/24/2016] [Indexed: 01/10/2023]
Abstract
The aim of this study was to systematically review and critically analyse the published data on the treatment outcome (primary outcome) and on the cleaning and disinfection of root canals (secondary outcomes) achieved by negative pressure irrigation as compared to syringe irrigation. An electronic search was conducted in EMBASE, LILACS, PubMed, SciELO, Scopus and Web of Knowledge using both free-text keywords and controlled vocabulary. Additional studies were sought through hand searching of endodontic journals and of the relevant chapters of endodontic textbooks. No language restriction was imposed. The retrieved studies were screened by two reviewers according to predefined criteria. Included studies were critically appraised and the extracted data were arranged in tables. The electronic search and hand search retrieved 489 titles. One clinical study and 14 in vitro studies were finally included in the review; none of these studies assessed treatment outcome, four studies assessed the antimicrobial effect, seven studies evaluated the removal of pulp tissue remnants, and four studies investigated the removal of hard tissue debris or both hard tissue debris and pulp tissue remnants. Poor standardization and description of the protocols was evident. Inconclusive results were reported about the cleaning and disinfection accomplished by the two irrigation methods. Negative pressure irrigation was more effective under certain conditions when compared to suboptimal syringe irrigation; however, the variability of the protocols hindered quantitative synthesis. There is insufficient evidence to claim general superiority of any one of these methods. The level of the available evidence is low, and the conclusions should be interpreted with caution.
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Affiliation(s)
- E Konstantinidi
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Z Psimma
- Private Practice, Rotterdam, The Netherlands
| | - L E Chávez de Paz
- Division of Endodontics, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - C Boutsioukis
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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Guivarc'h M, Ordioni U, Ahmed HMA, Cohen S, Catherine JH, Bukiet F. Sodium Hypochlorite Accident: A Systematic Review. J Endod 2017; 43:16-24. [DOI: 10.1016/j.joen.2016.09.023] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/30/2016] [Indexed: 12/22/2022]
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Yaylali IE, Alaçam T. Critical Assessment of Search Strategies in Systematic Reviews in Endodontics. J Endod 2016; 42:854-60. [PMID: 27071976 DOI: 10.1016/j.joen.2016.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/28/2016] [Accepted: 02/29/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The aim of this study was to perform an overview of literature search strategies in systematic reviews (SRs) published in 2 endodontic journals, Journal of Endodontics and International Endodontic Journal. METHODS A search was done by using the MEDLINE (PubMed interface) database to retrieve the articles published between January 1, 2000 and December 31, 2015. The last search was on January 10, 2016. All the SRs published in the 2 journals were retrieved and screened. Eligible SRs were assessed by using 11 questions about search strategies in the SRs that were adapted from 2 guidelines (ie, AMSTAR checklist and the Cochrane Handbook). RESULTS A total of 83 SRs were retrieved by electronic search. Of these, 55 were from the Journal of Endodontics, and 28 were from the International Endodontic Journal. After screening, 2 SRs were excluded, and 81 SRs were included in the study. Some issues, such as search of grey literature and contact with study authors, were not fully reported (30% and 25%, respectively). On the other hand, some issues, such as the use of index terms and key words and search in at least 2 databases, were reported in most of the SRs (97% and 95%, respectively). The overall quality of the search strategy in both journals was 61%. No significant difference was found between the 2 journals in terms of evaluation criteria (P > .05). CONCLUSIONS There exist areas for improving the quality of reporting of search strategies in SRs; for example, grey literature should be searched for unpublished studies, no language limitation should be applied to databases, and authors should make an attempt to contact the authors of included studies to obtain further relevant information.
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Affiliation(s)
| | - Tayfun Alaçam
- Department of Endodontics, Gazi University, Ankara, Turkey
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Darcey J, Jawad S, Taylor C, Roudsari RV, Hunter M. Modern endodontic principles part 4: irrigation. ACTA ACUST UNITED AC 2016; 43:20-2, 25-6, 28-30 passim. [DOI: 10.12968/denu.2016.43.1.20] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- James Darcey
- Consultant and Honorary Lecturer in Restorative Dentistry, University Dental Hospital of Manchester
| | - Sarra Jawad
- Specialty Registrar/Honorary Clinical Lecturer in Restorative Dentistry, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH
| | - Carly Taylor
- Clinical Lecturer/Honorary Specialty Registrar in Restorative Dentistry, Dental School, University of Manchester
| | - Reza Vahid Roudsari
- Clinical Lecturer/Honorary Specialty Registrar in Restorative Dentistry, Dental School, University of Manchester
| | - Mark Hunter
- Registered Endodontic Specialist, simplyendo, Altrincham, Postgraduate Clinical Teaching Fellow, Dental School, University of Manchester, Oxford Road, Manchester M13 9PL, UK
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Yost RA, Bergeron BE, Kirkpatrick TC, Roberts MD, Roberts HW, Himel VT, Sabey KA. Evaluation of 4 Different Irrigating Systems for Apical Extrusion of Sodium Hypochlorite. J Endod 2015; 41:1530-4. [PMID: 26143609 DOI: 10.1016/j.joen.2015.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 05/16/2015] [Accepted: 05/17/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate NaOCl apical extrusion by using negative apical pressure (EndoVac), sonic agitation (EndoActivator), side-vented needle (Max-i-Probe), and photon induced photoacoustic streaming (PIPS 10 mJ and PIPS 20 mJ) laser irrigation in an in vitro gel model. METHODS Extracted mandibular and maxillary central incisors (n = 18) were prepared to size 35/.04 and 55/.04, respectively. Teeth were mounted in transparent containers with clear acrylic and suspended in a color-changing pH-sensitive gel, creating a closed system. By using a crossover design, each tooth was sequentially irrigated by using 6% NaOCl with each device following manufacturers' recommendations. Each tooth served as its own control. Pre-irrigation and post-irrigation buccal and proximal view photographs served to measure the longest distance of extrusion and were analyzed with ImageJ software. Mean results were analyzed by using Kruskal-Wallis and Dunn post hoc test (P < .05). RESULTS There were no significant differences between EndoVac, EndoActivator, and the passive extrusion groups. The EndoVac and EndoActivator groups produced significantly less extrusion than PIPS irrigation. Max-i-Probe extrusion results were more variable than those of EndoActivator but had no significant difference. Across all irrigation systems, there were no significant differences with respect to apical preparation size. CONCLUSIONS Under the in vitro conditions of this study, no difference was found between the 10 mJ and 20 mJ PIPS laser groups. EndoVac demonstrated significantly less potential for apical extrusion than PIPS and Max-i-Probe, whereas apical preparation size did not significantly affect extrusion of irrigant. The potential for apical extrusion of endodontic irrigants should be a consideration when selecting a system for final irrigation.
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Affiliation(s)
- Ross A Yost
- Keesler Medical Center, Keesler Air Force Base, Mississippi
| | | | | | - Mark D Roberts
- Keesler Medical Center, Keesler Air Force Base, Mississippi
| | | | - Van T Himel
- Louisiana State University, New Orleans, Louisiana
| | - Kent A Sabey
- Louisiana State University, New Orleans, Louisiana
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Jamleh A, Fukumoto Y, Takatomo Y, Kobayashi C, Suda H, Adorno CG. A comparison between two negative pressure irrigation techniques in simulated immature tooth: an ex vivo study. Clin Oral Investig 2015; 20:125-31. [DOI: 10.1007/s00784-015-1489-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/04/2015] [Indexed: 01/09/2023]
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