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Lalfakawmi S, Gupta A, Duraisamy AK, Abraham D, Mrinalini, Mane AP. Impact of Cryotreated and Warm Sodium Hypochlorite on Post-Operative Pain in Teeth with Symptomatic Irreversible Pulpitis: A Randomized Controlled Trial. J Endod 2024:S0099-2399(24)00397-2. [PMID: 38987018 DOI: 10.1016/j.joen.2024.07.002] [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: 05/22/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION The purpose of this study was to evaluate effect of cryotreated and warm sodium hypochlorite (NaOCl) on post-operative pain in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis. METHODS Sixty-six individuals with pre-operative pain scores of ≥ 54mm on the Heft Parker Visual Analogue Pain Scale (HP-VAS) diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis as per the AAE guidelines in mandibular molars were included. The preparation of the access, and the root canals were instrumented and irrigated in accordance with a standard protocol. Based on the temperature of the final irrigant, the root canals were then randomly assigned to three groups and 3% NaOCl was irrigated: Control (at 25°C), cold NaOCl (2°C) and warm NaOCl (60°C) (n = 22/group). Root canal treatment was completed at the same visit. Pre- and post-operative pain assessment at 6, 24, 48, and 72 hours was conducted using HP-VAS, and analgesic consumption was noted. Suitable statistical tests were used to analyze the data. RESULTS In comparison to the other two groups, cold NaOCl group had a lower HP-VAS score at all follow-up intervals. Between groups, there was a statistically significant difference in post-operative pain scores at 6 and 72 hours (p < 0.05). None of the subjects experienced any postoperative discomfort at 72 hours in the control and cold NaOCl group. CONCLUSION Patients treated with cold NaOCl as the final irrigant experienced significantly lesser post-operative pain at 6 hours when compared to room temperature and warm NaOCl.
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Affiliation(s)
- Serena Lalfakawmi
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies Faridabad, Haryana, India
| | - Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies Faridabad, Haryana, India.
| | - Arun Kumar Duraisamy
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies Faridabad, Haryana, India
| | - Dax Abraham
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies Faridabad, Haryana, India
| | - Mrinalini
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies Faridabad, Haryana, India
| | - Arjun Prakash Mane
- Biostatisticians, Manav Rachna Dental College, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India
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Babeer A, Bukhari S, Alrehaili R, Karabucak B, Koo H. Microrobotics in endodontics: A perspective. Int Endod J 2024; 57:861-871. [PMID: 38761098 DOI: 10.1111/iej.14082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/20/2024]
Abstract
Microorganisms are the primary aetiological factor of apical periodontitis. The goal of endodontic treatment is to prevent and eliminate the infection by removing the microorganisms. However, microbial biofilms and the complex root canal anatomy impair the disinfection process. Effective and precise endodontic therapy could potentially be achieved using advanced multifunctional technologies that have the ability to access hard-to-reach surfaces and perform simultaneous biofilm killing, removal, and detection of microorganisms. Advances in microrobotics are providing novel therapeutic and diagnostic opportunities with high precision and efficacy to address current biofilm-related challenges in biomedicine. Concurrently, multifunctional magnetic microrobots have been developed to overcome the disinfection challenges of current approaches to disrupt, kill, and retrieve biofilms with the goal of enhancing the efficacy and precision of endodontic therapy. This article reviews the recent advances of microrobotics in healthcare and particularly advances to overcome disinfection challenges in endodontics, and provides perspectives for future research in the field.
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Affiliation(s)
- Alaa Babeer
- Department of Oral Biology, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah Bukhari
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Endodontics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Rayan Alrehaili
- Department of Endodontics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Bekir Karabucak
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hyun Koo
- Biofilm Research Labs, Department of Orthodontics, Divisions of Pediatric Dentistry and Community of Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Innovation and Precision Dentistry, School of Dental Medicine, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Afkhami F, Chen Y, Walsh LJ, Peters OA, Xu C. Application of Nanomaterials in Endodontics. BME FRONTIERS 2024; 5:0043. [PMID: 38711803 PMCID: PMC11070857 DOI: 10.34133/bmef.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/20/2024] [Indexed: 05/08/2024] Open
Abstract
Recent advancements in nanotechnology have introduced a myriad of potential applications in dentistry, with nanomaterials playing an increasing role in endodontics. These nanomaterials exhibit distinctive mechanical and chemical properties, rendering them suitable for various dental applications in endodontics, including obturating materials, sealers, retro-filling agents, and root-repair materials. Certain nanomaterials demonstrate versatile functionalities in endodontics, such as antimicrobial properties that bolster the eradication of bacteria within root canals during endodontic procedures. Moreover, they offer promise in drug delivery, facilitating targeted and controlled release of therapeutic agents to enhance tissue regeneration and repair, which can be used for endodontic tissue repair or regeneration. This review outlines the diverse applications of nanomaterials in endodontics, encompassing endodontic medicaments, irrigants, obturating materials, sealers, retro-filling agents, root-repair materials, as well as pulpal repair and regeneration. The integration of nanomaterials into endodontics stands poised to revolutionize treatment methodologies, presenting substantial potential advancements in the field. Our review aims to provide guidance for the effective translation of nanotechnologies into endodontic practice, serving as an invaluable resource for researchers, clinicians, and professionals in the fields of materials science and dentistry.
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Affiliation(s)
- Farzaneh Afkhami
- School of Dentistry,
The University of Queensland, Brisbane,QLD4006, Australia
| | - Yuan Chen
- Sydney Dental School, Faculty of Medicine and Health,
The University of Sydney, Camperdown, NSW 2006, Australia
- School & Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Laurence J. Walsh
- School of Dentistry,
The University of Queensland, Brisbane,QLD4006, Australia
| | - Ove A. Peters
- School of Dentistry,
The University of Queensland, Brisbane,QLD4006, Australia
| | - Chun Xu
- School of Dentistry,
The University of Queensland, Brisbane,QLD4006, Australia
- Sydney Dental School, Faculty of Medicine and Health,
The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre,
The University of Sydney, Camperdown, NSW 2006, Australia
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Otero CIAY, Marger L, di Bella E, Feilzer A, Krejci I, Abdelaziz M. An in-vitro study on effects of laser activation on dye penetration in human root dentin. Biomater Investig Dent 2024; 11:40311. [PMID: 38645926 PMCID: PMC11022650 DOI: 10.2340/biid.v11.40311] [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] [Received: 11/20/2023] [Accepted: 02/17/2024] [Indexed: 04/23/2024] Open
Abstract
Objective To evaluate the penetration of a dye in root dentin after activation with different laser wavelengths. Materials Palatal roots of 38 human molars were enlarged and disinfected. Irrigation activation was performed with an Er:YAG laser: @50 mJ, 15 Hz (Er:YAG); a 9.3 µm CO2 laser: @40% power (CO2); diode lasers 455 nm/970 nm: @0.8 W, 15 Hz (D455, D970) and 808/980 nm: @1 W (D808, D980) and compared to positive control: etching with 35% H3PO4 (POS); negative control: water (NEG) and conventional needle irrigation: NaOCl and ethylenediaminetetraacetic acid (EDTA) (CONV). Methylene blue solution was introduced in the canal and laser-activated or left untouched for 100 s before the roots were dried and cut into horizontal slices. Dye penetration was automatically calculated by color recognition of two samples per root third (n = 8 per group in each coronal, middle and apical root thirds). The presence and absence of a smear layer was checked in two additional samples of the negative and positive control under scanning electron microscopy (SEM). Results Full-depth infiltration was not achieved in any group. Dye penetration in CONV was significantly less than in Er:YAG, CO2, POS, D455, D970, D808 and similar to NEG and D980 when results of different root thirds were pooled. Conclusion Laser activation using certain parameters enhanced dye penetration compared to conventional needle irrigation with NaOCl and EDTA (CONV).
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Affiliation(s)
- Clara Isabel Anton y Otero
- Division of Cariology and Endodontology, CUMD – University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurine Marger
- Division of Cariology and Endodontology, CUMD – University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Enrico di Bella
- Division of Cariology and Endodontology, CUMD – University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Albert Feilzer
- Department of Dental Material Sciences, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Ivo Krejci
- Division of Cariology and Endodontology, CUMD – University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marwa Abdelaziz
- Division of Cariology and Endodontology, CUMD – University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Gasparelli CHC, Marceliano-Alves MFV, Bastos LF, Lopes RT, Limoeiro AGDS, Nascimento WM, Dos Santos LMH, Boukpessi T, Soares ADJ, Frozoni M. Analysis of the penetration of NaOCl 5.25% into dentinal tubules using different irrigation protocols: An ex vivo study. AUST ENDOD J 2024; 50:140-147. [PMID: 38152976 DOI: 10.1111/aej.12824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
The objective of the study was to investigate the 5.25% sodium hypochlorite (NaOCl) penetration into the dentinal tubules after different irrigation methods. Seventy canines were stained with 1% crystal violet and divided into groups (n = 20): GEC-EasyClean; GPUI-E1 Irrisonic ultrasonic insert; GXP-XP-Endo finisher; GPC-conventional irrigation and GNC-stained tooth without irrigation. Axial sections (16×) were assessed and irrigant penetration was quantified as a bleaching halo on the surface of the apical, middle and coronal third. In the apical third, GPUI promoted greater NaOCl penetration (p < 0.05). GXP was better than GEC (p < 0.05), as was GPC (p > 0.05). The GPUI and GXP groups were similar in the middle and coronal third (p > 0.05). GPUI and GXP showed better results than GEC (p < 0.05). GPUI was more effective in the apical third and like GXP in the cervical and middle third.
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Affiliation(s)
| | - Marília Fagury Videira Marceliano-Alves
- Department of Dental Research and Endodontics, Iguaçu University, Nova Iguaçu, Brazil
- Laboratory of Orofacial Pathologies, Imaging and Biotherapies, School of Dentistry, Laboratoire d'Excellence INFLAMEX, Université Paris Cité, URP 2496, Montrouge, France
- Department of Oral Health Sciences, BIOMAT - Biomaterials Research group & UZ Leuven (University Hospitals Leuven), KU Leuven (University of Leuven), Leuven, Belgium
| | - Luan Ferreira Bastos
- Nuclear Instrumentation Department, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Ricardo Tadeu Lopes
- Nuclear Instrumentation Department, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | - Wayne Martins Nascimento
- Department of Endodontics, São Leopoldo Mandic Dental Research Center, Campinas, São Paulo, Brazil
| | | | - Tchilalo Boukpessi
- Laboratory of Orofacial Pathologies, Imaging and Biotherapies, School of Dentistry, Laboratoire d'Excellence INFLAMEX, Université Paris Cité, URP 2496, Montrouge, France
- Pitié Salpétrière Hospital Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Adriana de Jesus Soares
- Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, São Paulo, Brazil
| | - Marcos Frozoni
- Department of Endodontics, São Leopoldo Mandic Dental Research Center, Campinas, São Paulo, Brazil
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Liu H, Nio S, Shen Y. Sodium hypochlorite against Enterococcus faecalis biofilm in dentinal tubules: effect of concentration, temperature, and exposure time. Odontology 2024; 112:390-398. [PMID: 37646916 DOI: 10.1007/s10266-023-00850-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
This study aimed to evaluate the effectiveness of two sodium hypochlorite concentrations at different exposure times and temperatures against Enterococcus faecalis biofilms of varying ages in human dentinal tubules. Dentin blocks were infected with E. faecalis for either 3 days or 3 weeks of incubation. Subsequently, the samples were exposed to sterile water, 2%, and 5.25% sodium hypochlorite for 3 and 10 min at 20 °C and 60 °C . Viability staining and confocal laser scanning microscopy were used to assess the proportion of killed bacteria in the dentinal tubules after exposure. There are no significant differences in the efficacy of E. faecalis killing between 2% sodium hypochlorite at 60 °C for various exposure times and 5.25% sodium hypochlorite at different temperatures or exposure times (P > 0.05). When both solutions were compared at the same temperatures with a 10-min exposure time, no significant differences in the effectiveness of E. faecalis killing between 2% and 5.25% sodium hypochlorite were observed (P > 0.05). To optimize the effectiveness of sodium hypochlorite in killing E. faecalis while minimizing potential damage to root dentin and soft tissue, clinicians should prioritize increasing the temperature or exposure time of sodium hypochlorite, rather than raising its concentration.
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Affiliation(s)
- He Liu
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Stefanie Nio
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Zeng C, Hu P, Egan CP, Bergeron BE, Tay F, Ma J. Bacteria debridement efficacy of two sonic root canal irrigant activation systems. J Dent 2024; 140:104770. [PMID: 37923053 DOI: 10.1016/j.jdent.2023.104770] [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: 09/29/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE To evaluate the bacteria debridement efficacy of two generations of sonic root canal irrigant activation systems: EndoActivator (Dentsply Sirona), the first generation, and SmartLite Pro EndoActivator, the second generation. METHODS Instrumented, autoclaved, single-rooted human premolars were inoculated with Enterococcus faecalis (ATCC-29212) for 21 days. The bacteria biofilm-containing teeth were randomly divided into 5 groups (N=8): Group 1: Syringe-side-vented needle (S-N) delivery of saline for 1 min; Group 2: S-N delivery of 2% NaOCl for 1 min; Group 3: S-N delivery of 2% NaOCl for 5 min; Group 4: EndoActivator activation of 2% NaOCl for 1 min; Group 5: SmartLite Pro EndoActivator activation of 2% NaOCl for 1 min. The teeth were evaluated for bacterial reduction using CFU counts, and the percentages of dead bacteria within the dentinal tubules using confocal laser scanning microscopy. RESULTS Activation of NaOCl with EndoActivator or SmartLite Pro EndoActivator significantly reduced the overall intracanal bacterial load, compared with S-N irrigant delivery (P<0.05), with no significant difference between the two agitation devices (P>0.05). Nevertheless, S-N delivery of 2% NaOCl for 5 min produced better bacteria debridement than either sonic agitation system. Different degrees of bacteria kill were identified in the coronal-middle portions and apical portion of the canal space. CONCLUSION Delivery time of NaOCl affects the efficacy of bacteria disinfection. Activation for 1 min with the EndoActivator or SmartLite Pro EndoActivator demonstrated comparable canal wall biofilm and intracanal bacteria reduction efficacy when 2% NaOCl was used as irrigant for disinfecting E. faecalis in single-rooted teeth. CLINICAL SIGNIFICANCE Although the sonic root canal irrigant activation devices investigated do not completely eliminate live bacteria biofilms from the canal space, they help reduce bacteria load during irrigant activation.
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Affiliation(s)
- Chang Zeng
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Pei Hu
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Colin P Egan
- The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian E Bergeron
- The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Franklin Tay
- The Dental College of Georgia, Augusta University, Augusta, GA, USA.
| | - Jingzhi Ma
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Tsai CF, Chung JJ, Ding SJ, Chen CC. In vitro cytotoxicity and antibacterial activity of hypochlorous acid antimicrobial agent. J Dent Sci 2024; 19:345-356. [PMID: 38303880 PMCID: PMC10829635 DOI: 10.1016/j.jds.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/03/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose Bacteria-associated oral diseases such as dental caries and periodontitis are widespread epidemics that cause oral pain and loss of function. The purpose of this study was to evaluate the in vitro cytotoxicity and antibacterial activity of different concentrations of hypochlorous acid (HOCl). Materials and methods Five different concentrations (100, 200, 300, 400, and 500 ppm) of HOCl were evaluated for their antimicrobial efficacy against Gram-negative (A. actinomycetcmcomitans and P. gingivalis) and Gram-positive bacteria (S. mutans and S. sanguinis) after treatment for 1 and 10 min. Sodium hypochlorite (NaOCl) and chlorhexidine (CHX) were used as positive controls. In addition, HOCl was examined for L929 cytotoxicity and RAW 264.7 growth. Results The bacteriostatic ratio of NaOCl was comparable to that of CHX and significantly (P < 0.05) higher than that of all HOCl solutions. Higher HOCl concentration had significantly (P < 0.05) higher antibacterial effect, and the bacteriostatic ratio of 10 min treatment was slightly higher than that of 1 min treatment. CHX and NaOCl seeded into L929 cells resulted in low cell viability with only 30-39%, much significantly (P < 0.05) lower than all HOCl groups (greater than 80%). All HOCl solutions met the recommendations of ISO 10993-5 and showed no cytotoxicity, although there was a concentration-dependent decrease in cell viability. All antimicrobial agents showed the same trend of response to RAW 264.7 as L929. Conclusion Within the limit of this study, 400 ppm HOCl disinfectant may be a potential antimicrobial candidate for mouthwash, endodontic irrigants, and periodontitis treatment.
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Affiliation(s)
- Cheng-Feng Tsai
- Institute of Oral Science, Chung Shan Medical University, Taichung, Taiwan
| | - Jia-Jia Chung
- Institute of Oral Science, Chung Shan Medical University, Taichung, Taiwan
| | - Shinn-Jyh Ding
- Institute of Oral Science, Chung Shan Medical University, Taichung, Taiwan
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Cheng Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
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Özlek E, Acikgoz E, Gökkaya NZ, Taşan A, Altındağ F. Histological evaluation of the debris removal efficiency of activation of sodium hypochlorite solution at different concentrations. BMC Oral Health 2023; 23:528. [PMID: 37507750 PMCID: PMC10386604 DOI: 10.1186/s12903-023-03244-z] [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: 12/22/2022] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND This study aims to histologically evaluate the efficiency of debris removal through activation of 2.5% and 5.25% NaOCI using laser, ultrasonic, and intracanal heating methods. METHODS Sixty-four maxillary central incisor teeth were randomly divided into two groups according to the irrigation solution (n = 32); 2.5% NaOCI and 5.25% NaOCI. Subsequently, the samples were further divided into four subgroups according to the final irrigation activation technique (n = 8); SubgroupA: Er,Cs:YSGG laser, SubgroupB: Ultrasonic, Subgroup C: Intracanal heating, Subgroup D: no activation. Generalized Linear Models and Bonferroni tests were used for statistical analysis (p < 0.05). RESULTS The effect of NaOCI concentration was statistically significant (p < 0.001). Furthermore, the activation of NaOCI by laser exhibited a statistically significant difference compared to the ultrasonic and intracanal heating methods (p < 0.001). CONCLUSION The efficiency of root canal cleaning increases with higher NaOCI concentration. Activation of NaOCI also significantly enhances its effectiveness.
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Affiliation(s)
- Esin Özlek
- Department of Endodontics, Faculty of Dentistry, The University of Van Yuzuncu Yil, Van, Turkey.
| | - Eda Acikgoz
- Department of Histology and Embryology, Faculty of Medicine, The University of Van Yuzuncu Yil, Van, Turkey
| | - Nesibe Zeyneb Gökkaya
- Department of Endodontics, Faculty of Dentistry, The University of Van Yuzuncu Yil, Van, Turkey
| | - Ahmet Taşan
- Department of Endodontics, Faculty of Dentistry, The University of Van Yuzuncu Yil, Van, Turkey
| | - Fikret Altındağ
- Department of Histology and Embryology, Faculty of Medicine, The University of Van Yuzuncu Yil, Van, Turkey
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Gomes BPFA, Aveiro E, Kishen A. Irrigants and irrigation activation systems in Endodontics. Braz Dent J 2023; 34:1-33. [PMID: 37909632 PMCID: PMC10642269 DOI: 10.1590/0103-6440202305577] [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: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 11/03/2023] Open
Abstract
Root canal infections are typically polymicrobial and involve strong bacterial interactions. The goal of endodontic treatment is to remove infected content from the root canal system to allow the healing of a pre-existing periapical lesion or to prevent infection of the periradicular tissues. Instrumentation alone is not capable of touching all of the root canal walls. Therefore, the irrigation process is an essential step in the endodontic treatment. However, due to the complex anatomy of the root canal system, this cleaning is very challenging. Although syringe and needle irrigation associated with the use of chemical substances is still the most used method, it does not guarantee optimal cleaning of the root canals. As a result, not only alternative irrigating substances but also numerous activation systems - which are technologies that aim to optimize the action of irrigating substances, both chemically and physically - have been developed. This work aimed to review the characteristics of both classic and current alternatives of irrigating substances and irrigation activation systems.
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Affiliation(s)
- Brenda P. F. A. Gomes
- Department of Restorative Dentistry, Division of Endodontics,
Piracicaba Dental School - State University of Campinas, UNICAMP, Brazil
| | - Emelly Aveiro
- Department of Restorative Dentistry, Division of Endodontics,
Piracicaba Dental School - State University of Campinas, UNICAMP, Brazil
| | - Anil Kishen
- Department of Dentistry, University of Toronto, Canada
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Ren Y, Zhang J, Meng T, Li W, Li S. Reparative dentin formation as a possible factor influencing the penetrability of dentin in human teeth with apical periodontitis: an ex vivo study. BMC Oral Health 2023; 23:412. [PMID: 37344877 DOI: 10.1186/s12903-023-03105-9] [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: 04/05/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND There is still a lack of knowledge regarding the permeability and configuration of infected root dentin. The aim of this ex vivo study was to compare the dentin penetrability of healthy teeth and necrotic teeth with apical periodontitis by evaluating the penetration of sodium hypochlorite (NaOCl) and to analyze the histopathological features of root dentin. METHODS Forty-eight molars were collected and divided into two groups. The clinical diagnosis for one group was pulp necrosis with apical periodontitis and the pulp and periapex were normal in the other group. Forty-eight straight roots were divided into two groups: infected and healthy. First, all root canals were stained with 2% methylene blue to visualize penetration after standard root canal instrumentation and irrigation. Transverse sections were obtained, and the dye penetration parameters were measured. The cross sections were processed to 20-30 μm and stained with hematoxylin and eosin for observation of the histopathological changes in the root dentin. RESULTS The maximum penetration depth, median penetration depth and penetration percentage of NaOCl solutions, in infected root canals were significantly lower than those in healthy root canals. The histopathological analysis showed that the frequency of reparative dentin formation in infected root canals was significantly greater than that in healthy root canals. CONCLUSIONS The dentin penetrability of teeth with necrotic teeth and apical periodontitis was more superficial during root canal irrigation than that of healthy teeth. The histopathological changes in infected radicular dentin, namely the formation of reparative dentin, might be associated with the lower permeability of dentin tubules in human teeth with apical periodontitis.
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Affiliation(s)
- Yueyue Ren
- College and Hospital of Stomatology, Key Lab of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei, 230032, China
| | - Junsheng Zhang
- The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
- Anhui Public Health Clinical Center, Hefei, 230032, China
| | - Tiantian Meng
- College and Hospital of Stomatology, Key Lab of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei, 230032, China
| | - Wuli Li
- College and Hospital of Stomatology, Key Lab of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei, 230032, China.
| | - Song Li
- College and Hospital of Stomatology, Key Lab of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei, 230032, China.
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12
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de Oliveira RA, Weissheimer T, Só GB, da Rosa RA, Souza MA, Ribeiro RG, Só MVR. Dentinal tubule penetration of sodium hypochlorite in root canals with and without mechanical preparation and different irrigant activation methods. Restor Dent Endod 2023; 48:e1. [PMID: 36875814 PMCID: PMC9982243 DOI: 10.5395/rde.2023.48.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives This study evaluated the dentinal penetration depth of 2.5% sodium hypochlorite (NaOCl) in root canals with and without preparation and different irrigant activation protocols. Materials and Methods Sixty-three bovine mandibular incisors were randomly allocated to 6 groups (n = 10): G1, preparation + conventional needle irrigation (CNI); G2, preparation + passive ultrasonic irrigation (PUI); G3, preparation + Odous Clean (OC); G4, no preparation + CNI; G5, no preparation + PUI; G6, no preparation + OC; and CG (negative control; n = 3). Samples were filled with crystal violet for 72 hours. Irrigant activation was performed. Samples were sectioned perpendicularly along the long axis, 3 mm and 7 mm from the apex. Images of the root thirds of each block were captured with a stereomicroscope and analyzed with an image analysis software. One-way analysis of variance, followed by the Tukey post hoc test, and the Student's t-test were used for data analysis, with a significance level of 5%. Results The NaOCl penetration depth was similar when preparation was performed, regardless of the method of irrigation activation (p > 0.05). In the groups without preparation, G6 showed greater NaOCl penetration depth (p < 0.05). The groups without preparation had a greater NaOCl penetration depth than those with preparation (p = 0.0019). Conclusions The NaOCl penetration depth was similar in groups with root canal preparation. Without root canal preparation, OC allowed deeper NaOCl penetration. The groups without preparation had greater NaOCl penetration than those undergoing root canal preparation.
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Affiliation(s)
- Renata Aqel de Oliveira
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Theodoro Weissheimer
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Gabriel Barcelos Só
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Abreu da Rosa
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Matheus Albino Souza
- Department of Endodontics, School of Dentistry, University of Passo Fundo (UPF), Passo Fundo, RS, Brazil
| | - Rodrigo Gonçalves Ribeiro
- Department of Endodontics, School of Dentistry, State University of Western Paraná (UNIOESTE), Cascavel, PR, Brazil
| | - Marcus Vinicius Reis Só
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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13
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Widbiller M, Rosendahl A, Schlichting R, Schuller C, Lingl B, Hiller KA, Buchalla W, Galler KM. Impact of Endodontic Irrigant Activation on Smear Layer Removal and Surface Disintegration of Root Canal Dentine In Vitro. Healthcare (Basel) 2023; 11:healthcare11030376. [PMID: 36766951 PMCID: PMC9914448 DOI: 10.3390/healthcare11030376] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
The objective of this study was to compare the ability of different endodontic irrigation activation methods to enable irrigant penetration, remove the smear layer from root canal walls after preparation, and investigate surface effects on dentine. Root canals of 90 single-rooted teeth were prepared and irrigated with EDTA (17%) and sodium hypochlorite (5%), where both irrigants or sodium hypochlorite only were activated as follows: conventional needle irrigation, ultrasonic activation, sonic activation (EDDY), or laser-based activation (photon-induced photoacoustic streaming/PIPS). For the evaluation of irrigant penetration into dentinal tubules, methylene blue was injected and activated as well. Subsequently, teeth were sectioned horizontally, and dye penetration depths were measured. Alternating sections were split in halves and randomly selected for scanning electron microscopic analysis. Root canal dentine was assessed for smear layer removal and surface disintegration according to a defined scoring system. The data were analyzed statistically with nonparametric and chi-squared tests for whole teeth and separately for coronal, middle, and apical thirds. All the tested activation methods removed a thicker smear layer than needle irrigation only. Additional activation of EDTA improved penetration depths of the irrigants, but not the smear layer removal. Surface disintegration of root canal dentine was observed with the additional activation of EDTA and particularly after laser-based techniques. Additional activation of EDTA does not seem to offer any convincing advantages in terms of irrigant penetration or smear layer removal but disrupts the dentine surface. Especially laser-based activation resulted in undesirable destruction of root canal wall dentine.
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Affiliation(s)
- Matthias Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence:
| | - Andreas Rosendahl
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | | | - Christine Schuller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Benedikt Lingl
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Karl-Anton Hiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Wolfgang Buchalla
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Kerstin M. Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nuernberg, 91054 Erlangen, Germany
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14
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Ada KS, Shetty S, Jayalakshmi KB, Nadig PL, Manje Gowda PG, Selvan AK. Influence of different irrigant activation methods on apical debris extrusion and bacterial elimination from infected root canals. J Conserv Dent 2023; 26:31-35. [PMID: 36908725 PMCID: PMC10003277 DOI: 10.4103/jcd.jcd_378_22] [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: 06/28/2022] [Revised: 07/28/2022] [Accepted: 08/19/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The study aimed to determine the apical debris extrusion and microbial elimination from infected root canals after using different irrigant activation methods. Materials and Methods Forty freshly extracted human mandibular premolars were selected and randomly assigned to four groups (n = 10). The teeth were mechanically prepared, sterilized, and inoculated with Enterococcus faecalis for 1 week. Irrigation was done with 3% sodium hypochlorite following conventional syringe irrigation-Group 1, manual dynamic agitation (MDA)-Group 2, passive ultrasonic irrigation (PUI)-UltraX -Group 3, and sonic irrigation (SI)-EndoActivator -Group 4, and the extruded debris were collected using Myers and Montgomery model. The microbial samples were taken from the canals using sterile paper points, cultured and recorded as colonies. The amount of extruded debris was measured by subtracting the final weight of the Eppendorf tube with debris from the initial weight of the tube. Results I. Group 3 showed the least apical debris extrusion (P < 0.05), followed by Groups 2 and 1 and the highest with Group 4. II. Group 3 showed the least colony-forming units (CFUs)/ml, followed by Group 4, and finally, Group 2 showed lesser mean CFUs/ml compared to Group 1 (P < 0.05). Conclusion All the irrigation activation methods were associated with apical debris extrusion, with the PUI system extruding the least amount of debris compared to the other groups. Irrigation activation techniques were beneficial in reducing the microbial load from the infected canals with the PUI system showing a complete elimination of the microbes, followed by SI and MDA.
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Affiliation(s)
- K. Sadia Ada
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - Shibani Shetty
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - K. B. Jayalakshmi
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - Prasanna Latha Nadig
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - P. G Manje Gowda
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - Arul K. Selvan
- Department of Conservative Dentistry and Endodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
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15
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Tan L, Liu Q, Chen Y, Zhao YQ, Zhao J, Dusenge MA, Feng Y, Ye Q, Hu J, Ou-Yang ZY, Zhou YH, Guo Y, Feng YZ. Comparison of sealer penetration of sonic activation versus conventional needle irrigation: a systematic review and meta-analysis of randomized controlled trials. BMC Oral Health 2022; 22:566. [PMID: 36463149 PMCID: PMC9719620 DOI: 10.1186/s12903-022-02608-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/21/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Most existing studies comparing the efficiency of sonic irrigation (SI) and conventional needle irrigation (CNI) in increasing the penetration of sealers into dentine tubules are controversial; and this study aimed to determine whether the use of SI can lead to greater sealing ability than CNI, during the root canal treatment. METHODS The EMBASE, PubMed, and Cochrane Library databases were used to find confocal laser scanning microscopy studies evaluating percentage and maximum depth of sealer penetration following the use of SI or CNI in mature permanent teeth until October 2022. The critical estimative checklist of randomized controlled trials of the standardized Joanna Briggs Institute was adopted to independently score the quality of each study. The random-effect model for meta-analysis was used to analyse for each canal segment (apical, middle, coronal). The results are shown in the forest plots as weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). RESULTS Ninety-seven articles were included in the preliminary screening, and nine of them were included in this study. Eight studies were included in the meta-analysis.The meta-analysis exhibited great increases in the coronal (WMD: 8.09, 95% CI 2.78-13.40/WMD: 165.32, 95% CI 128.85-201.80), and middle segments (WMD: 8.81, 95% CI 5.76-11.87/WMD: 132.98, 95% CI 68.71-197.25) for the percentage and maximum depth of sealer penetration, respectively. The percentage of sealer penetration in the apical thirds region was nonsignificant (WMD: 4.73, 95% CI - 2.34-11.80). However, the maximum depth of sealer penetration in the apical thirds region was significant (WMD: 121.46, 95% CI 86.55-156.38). Chi-squared analysis revealed heterogeneity scores of 0.0-70.0% and 44.0-90.0% for the percentage and maximum depth of sealer penetration, respectively. DISCUSSION This review verified that SI significantly improves tubular dentin sealer penetration in most areas of the root canal; thus, SI may lead to better filling efficiency and anti-reinfection effects than CNI during and after the root canal therapy. Nevertheless, a large heterogeneity in the current data comparing the irrigation efficiency of SI versus CNI in the apical third of the root canal was found, implying the necessity to standardize root canal irrigation procedures and obtain more accurate results in this area. TRIAL REGISTRATION INPLASY database (INPLASY202270116).
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Affiliation(s)
- Li Tan
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Qiong Liu
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Yun Chen
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Ya-Qiong Zhao
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Jie Zhao
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Marie Aimee Dusenge
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Yao Feng
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Qin Ye
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Jing Hu
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Ze-Yue Ou-Yang
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Ying-Hui Zhou
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China ,grid.452708.c0000 0004 1803 0208National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Yue Guo
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Yun-Zhi Feng
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
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Dasgupta D, Peddi S, Saini DK, Ghosh A. Mobile Nanobots for Prevention of Root Canal Treatment Failure. Adv Healthc Mater 2022; 11:e2200232. [PMID: 35481942 DOI: 10.1002/adhm.202200232] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/12/2022] [Indexed: 12/19/2022]
Abstract
Millions of root canal treatments fail worldwide due to remnant bacteria deep in the dentinal tubules located within the dentine tissue of human teeth. The complex and narrow geometry of the tubules renders current techniques relying on passive diffusion of antibacterial agents ineffective. Here, the potential of actively maneuvered nanobots is investigated to disinfect dentinal tubules, which can be incorporated during a standard root canal procedure. It is demonstrated that magnetically driven nanobots can reach the depths of the tubules not possible with current clinical practices. Subtle alterations of the magnetic drive allow both deep implantations of the nanobots isotopically distributed throughout the dentine and spatially controlled recovery from selected regions, further supported by numerical simulations. Finally, the integration of bactericidal therapeutic modality with the nanobots is demonstrated, thereby validating the tremendous potential of nanobots in dentistry and nanomedicine in general.
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Affiliation(s)
- Debayan Dasgupta
- Centre for Nano Science and Engineering Indian Institute of Science Bangalore 560012 India
- Theranautilus Pvt. Ltd. Bangalore 560012 India
| | - Shanmukh Peddi
- Centre for Nano Science and Engineering Indian Institute of Science Bangalore 560012 India
- Theranautilus Pvt. Ltd. Bangalore 560012 India
| | - Deepak Kumar Saini
- Department of Molecular Reproduction Development and Genetics Indian Institute of Science Bangalore 560012 India
- Centre for Biosystems Science and Engineering IISc Bangalore 560012 India
| | - Ambarish Ghosh
- Centre for Nano Science and Engineering Indian Institute of Science Bangalore 560012 India
- Theranautilus Pvt. Ltd. Bangalore 560012 India
- Department of Physics Indian Institute of Science Bangalore 560012 India
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17
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Coaguila-Llerena H, Toledo JDS, Ramos AP, Faria G. Physicochemical properties and penetration into dentinal tubules of calcium hypochlorite with surfactants. Braz Dent J 2022; 33:1-11. [DOI: 10.1590/0103-6440202204567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract The aim was to assess the physicochemical properties and the penetration into dentinal tubules of calcium hypochlorite solution [Ca(OCl)2], with or without surfactants. The surfactants benzalkonium chloride, cetrimide, Tween 80 and Triton X-100 were mixed at different concentrations with sodium hypochlorite solution (NaOCl), Ca(OCl)2 and distilled water (control). Once the critical micellar concentration (CMC) of the surfactants in Ca(OCl)2 and NaOCl was determined, pH, free chlorine, surface tension and free calcium ions were evaluated. The penetration into dentinal tubules of NaOCl and Ca(OCl)2, with or without benzalkonium chloride and Triton X-100 [surfactants that promoted the lowest surface tension of Ca(OCl)2], was assessed using human premolars stained with crystal violet. The statistical tests were one-way ANOVA and Tukey’s post-test, Kruskal-Wallis and Dunn’s post-test, two-way ANOVA and Bonferroni’s post-test, and t-test; depending on the assay. The addition of surfactants reduced the surface tension of NaOCl and Ca(OCl)2, and did not alter the pH or the free available chlorine of either solution. The addition of all surfactants increased the availability of free calcium ions in Ca(OCl)2, especially benzalkonium chloride. Ca(OCl)2 exhibited lower penetration into dentinal tubules than NaOCl, and the addition of surfactants did not improve the penetration of Ca(OCl)2, but did increase the penetration of NaOCl. It can be concluded that the addition of surfactants to Ca(OCl)2 did not increase the penetration into dentinal tubules, but it did promote lower surface tension, without changing the pH or free available chlorine values, and higher availability of free calcium ions in Ca(OCl)2.
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18
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Erkan E, Gündoğar M, Uslu G, Özyürek T. Postoperative pain after SWEEPS, PIPS, sonic and ultrasonic-assisted irrigation activation techniques: a randomized clinical trial. Odontology 2022; 110:786-794. [PMID: 35267110 DOI: 10.1007/s10266-022-00700-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/24/2022] [Indexed: 12/24/2022]
Abstract
To investigate the efficacy of a new laser irrigation activation system [shock wave-enhanced emission photo-acoustic streaming (SWEEPS)] in terms of postoperative pain after primary root canal treatment compared with other techniques, namely photon-induced photo-acoustic streaming (PIPS), sonic system with EDDY, passive ultrasonic system (PUI), and manual dynamic activation (MDA). Two hundred patients with symptomatic irreversible pulpitis in mandibular premolar teeth were enrolled and randomly allocated to five different irrigation activation groups (n = 40) after chemo-mechanical root canal preparation. For irrigation activation, the SWEEPS and PIPS tips were attached to the Er-YAG laser system in the respective groups, while the Irrisafe tip was used in the PUI group and the EDDY tip in the sonic group. In the MDA group, irrigation was agitated with the master gutta-percha cone. At postoperative hours 8, 24, and 48 and on day 7, pain intensity was evaluated using the 10-mm Visual Analog Scale (VAS) and analgesic intake was recorded. The Kruskal-Wallis test was used to analyze the VAS scores, and pain prevalence and analgesic intake were examined with the Pearson's chi-square test at the 5% significance level. The PIPS and SWEEPS groups had the lowest level and prevalence of pain when compared to the remaining groups (P < 0.001). The PUI, sonic and MDA groups did not differ in terms of pain scores at hours 8 and 48 (P > 0.05). On day 7, the highest score and pain prevalence were recorded in the MDA group (P < 0.001). There was no difference between the groups in terms of analgesic intake (P > 0.05). Laser-activated irrigation systems provided lower postoperative pain scores and levels compared to the other activation systems. The MDA group had the highest pain scores and incidence at the end of the seventh day.
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Affiliation(s)
- Erhan Erkan
- Department of Endodontics, Faculty of Dentistry, Medipol University, Istanbul, Turkey
| | - Mustafa Gündoğar
- Department of Endodontics, Faculty of Dentistry, Medipol University, Istanbul, Turkey
| | - Gülşah Uslu
- Department of Endodontics, Faculty of Dentistry, Çanakkale Onsekiz Mart University, Cumhuriyet Mahallesi Sahilyolu Cad. No: 5 Kepez, Çanakkale, Turkey.
| | - Taha Özyürek
- Department of Endodontics, Faculty of Dentistry, Bahçeşehir University, Istanbul, Turkey
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SANON K, HATAYAMA T, TICHY A, THANATVARAKORN O, PRASANSUTTIPORN T, WADA T, IKEDA M, HOSAKA K, NAKAJIMA M. Smear layer deproteinization with NaOCl and HOCl: Do application/wash-out times affect dentin bonding of one-step self-etch adhesives? Dent Mater J 2022; 41:353-362. [DOI: 10.4012/dmj.2021-208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kittisak SANON
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Takashi HATAYAMA
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Antonin TICHY
- Institute of Dental Medicine, First Faculty of Medicine of the Charles University and General University Hospital in Prague
| | | | - Taweesak PRASANSUTTIPORN
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiangmai University
| | - Takahiro WADA
- Department of Advanced Biomaterials, Graduate School of Medical and Dental Sciences, Medical and Dental Science and Technology, Tokyo Medical and Dental University
| | - Masaomi IKEDA
- Department of Oral Prosthetic Engineering, Graduate School of Medical and Dental Sciences, Medical and Dental Science and Technology, Tokyo Medical and Dental University
| | - Keiichi HOSAKA
- Department of Regenerative Dental Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Masatoshi NAKAJIMA
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
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20
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Virdee SS, Bashir N, Camilleri J, Cooper PR, Tomson P. Exploiting dentine matrix proteins in cell-free approaches for periradicular tissue engineering. TISSUE ENGINEERING PART B-REVIEWS 2021; 28:707-732. [PMID: 34309453 PMCID: PMC9419954 DOI: 10.1089/ten.teb.2021.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The recent discovery of mesenchymal stem cells within periapical lesions (PL-MSC) has presented novel opportunities for managing periradicular diseases in adult teeth by way of enhancing tissue regeneration. This discovery coincides with the current paradigm shift toward biologically driven treatment strategies in endodontics, which have typically been reserved for non-vital immature permanent teeth. One such approach that shows promise is utilizing local endogenous non-collagenous dentine extracellular matrix components (dECM) to recruit and upregulate the intrinsic regenerative capacity of PL-MSCs in situ. At picogram levels, these morphogens have demonstrated tremendous ability to enhance the cellular activities in in vitro and in vivo animal studies that would otherwise be necessary for periradicular regeneration. Briefly, these include proliferation, viability, migration, differentiation, and mineralization. Therefore, topical application of dECMs during ortho- or retrograde root canal treatment could potentially enhance and sustain the regenerative mechanisms within diseased periapical tissues that are responsible for attaining favorable clinical and radiographic outcomes. This would provide many advantages when compared with conventional antimicrobial-only therapies for apical periodontitis (AP), which do not directly stimulate healing and have had stagnant success rates over the past five decades despite significant advances in operative techniques. The aim of this narrative review was to present the novel concept of exploiting endogenous dECMs as clinical tools for treating AP in mature permanent teeth. A large scope of literature was summarized to discuss the issues associated with conventional treatment modalities; current knowledge surrounding PL-MSCs; composition of the dECM; inductive potentials of dECM morphogens in other odontogenic stem cell niches; how treatment protocols can be adapted to take advantage of dECMs and PL-MSCs; and finally, the challenges currently impeding successful clinical translation alongside directions for future research.
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Affiliation(s)
- Satnam Singh Virdee
- University of Birmingham, 1724, School of Dentistry, Birmingham, West Midlands, United Kingdom of Great Britain and Northern Ireland;
| | - Nasir Bashir
- University of Birmingham, 1724, School of Dentistry, Birmingham Dental Hospital and School of Dentistry, 5 Mill Pool Way, Edgbaston, Birmingham, United Kingdom of Great Britain and Northern Ireland, B5 7SA;
| | - Josette Camilleri
- University of Birmingham, 1724, School of Dentistry, Birmingham, West Midlands, United Kingdom of Great Britain and Northern Ireland;
| | - Paul R Cooper
- University of Otago, 2495, Faculty of Dentistry, Dunedin, New Zealand;
| | - Phillip Tomson
- University of Birmingham College of Medical and Dental Sciences, 150183, School of Dentistry, Institute of Clinical Sciences, 5 Mill Pool Way, Edgbaston, Birmingham, Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland, B5 7EG.,University of Birmingham;
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21
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Zancan RF, Di Maio A, Tomson PL, Duarte MAH, Camilleri J. The presence of smear layer affects the antimicrobial action of root canal sealers. Int Endod J 2021; 54:1369-1382. [PMID: 33763882 DOI: 10.1111/iej.13522] [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: 09/08/2020] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
AIM To assess the chemical and microstructural characteristics of dentine after the use of two irrigation protocols and correlate this with the antimicrobial properties of hydraulic calcium silicate cement (HCSC) sealers and changes to the dentine structure/chemistry after sealer placement. METHODOLOGY Two irrigation protocols - Protocol A using 2% NaOCl used 5 mL/5 min and Protocol B with 2% NaOCl (5 mL/5 min) followed by 17% EDTA (5 mL/3 min) - were used to prepare dentine. The chemical and microstructural changes following irrigation were assessed by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and Fourier transform infrared (FT-IR) spectroscopy (n = 5) on dentine obtained from the mid-root and coronal parts of extracted human teeth. Four sealers (AH Plus, BioRoot, MTA Fillapex, TotalFill) were characterized by SEM/EDS (n = 3). The ability of the sealers to eradicate intratubular Enterococcus faecalis biofilms was assessed by live/dead dye and confocal laser scanning microscopy to measure the percentage of living cells. The effect of combined irrigation and root filling on dentine was assessed by SEM and EDS analysis (n = 5). Statistical analysis was undertaken using one-way anova and a number of post hoc tests to detect intergroup differences. The F-test was used for comparison of variances in the microbiology testing. RESULTS The use of NaOCl alone left the smear layer intact, with traces of chlorine remaining on dentine. The use of BioRoot sealer restored the calcium levels of dentine which had been depleted by the irrigation with EDTA. BioRoot exhibited antimicrobial properties against intratubular bacteria even in the presence of smear layer (Protocol A). Smear layer removal improved the bactericidal effect of all sealers and Ca2+ leaching. The use of a chelating agent was important for the intratubular sealer penetration for AH Plus but not the other sealers. CONCLUSION The removal of smear layer was necessary for penetration of AH Plus into the dentinal tubules. BioRoot was a more effective sealer in reducing the bacterial load in the dentinal tubules than the other materials tested and the presence of smear layer did not affect its activity.
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Affiliation(s)
- R F Zancan
- Department of Restorative Dentistry, Dental Materials and Endodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - A Di Maio
- School of Biosciences, University of Birmingham, Birmingham, UK
| | - P L Tomson
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M A H Duarte
- Department of Restorative Dentistry, Dental Materials and Endodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - J Camilleri
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Virdee SS, Ravaghi V, Camilleri J, Cooper P, Tomson P. Current trends in endodontic irrigation amongst general dental practitioners and dental schools within the United Kingdom and Ireland: a cross-sectional survey. Br Dent J 2020:10.1038/s41415-020-1984-x. [PMID: 32855518 DOI: 10.1038/s41415-020-1984-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aims To investigate current trends in endodontic irrigation amongst general dental practitioners (GDPs) and dental schools within UK and Ireland. Secondly, to evaluate if significant differences exist between the irrigant practices of National Health Service (NHS) and private GDPs.Methodology In 2019, an online questionnaire was distributed to the 18 dental schools within the UK and Ireland and 8,568 GDPs. These surveys explored current trends in teaching and usage of endodontic irrigants. Chi-squared tests were performed to make comparisons between NHS and private GDPs (α <0.01).Results All 18 dental schools (100%) and 495 GDPs (6%) returned valid questionnaires. Three hundred and thirty (66.7%) practitioners were NHS and 165 (33.3%) were private. There was strong consensus on irrigation teaching amongst dental schools. These results aligned with GDP responses in terms of irrigant selection (sodium hypochlorite [NaOCl]); NaOCl concentration (≤3%); ethylenediaminetetraacetic acid (EDTA) contact time (>0-5 minutes); final rinse protocols (penultimate EDTA rinse); irrigant temperature (room); and agitation techniques (manual dynamic activation; >0-60 seconds). There was, however, considerable variation in NaOCl contact time and GDPs infrequently used chelating agents or agitation techniques. Compared with private practitioners, NHS GDPs used significantly lower NaOCl contact times and concentrations, less EDTA and activation techniques, and more chlorhexidine (P <0.01).Conclusions Overall, irrigation teaching within the UK and Ireland is consistent and evidence-based. Furthermore, trends in irrigant usage amongst UK GDPs are now more aligned with these teaching practices. Significant differences were, however, observed between NHS and private practitioners.
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Affiliation(s)
- Satnam Singh Virdee
- Clinical Lecturer & Speciality Registrar in Restorative Dentistry, PhD Student, University of Birmingham School of Dentistry, Mill Pool Way, Birmingham, UK; Part-Time General Dental Practitioner, Abbey House Dental Practice, 9 Abbey Street, Stone, ST15 8PA, UK.
| | - Vahid Ravaghi
- Lecturer in Dental Public Health, University of Birmingham School of Dentistry, Mill Pool Way, Birmingham, UK
| | - Josette Camilleri
- Reader in Restorative Dentistry, University of Birmingham School of Dentistry, Mill Pool Way, Birmingham, UK
| | - Paul Cooper
- Professor of Oral Biology, Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Phillip Tomson
- Senior Clinical Lecturer & Consultant in Restorative Dentistry, University of Birmingham, Mill Pool Way, Birmingham, B5 7EG, UK
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