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Coaguila-Llerena H, Raphael da Silva L, Faria G. Research methods assessing sodium hypochlorite cytotoxicity: A scoping review. Heliyon 2024; 10:e23060. [PMID: 38192787 PMCID: PMC10772573 DOI: 10.1016/j.heliyon.2023.e23060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 01/10/2024] Open
Abstract
Sodium hypochlorite (NaOCl) cytotoxicity has been assessed using different methodologies, which has led to arbitrary interpretations. This scoping review aimed to discuss the different methodological protocols for assessing NaOCl cytotoxicity. A literature review performed in the PubMed and Embase databases up to July 2023 identified manuscripts reporting NaOCl cytotoxicity. The dataset identified 546 publications, further screened by 2 reviewers. Ninety studies were identified and mined methodologically to collect information on cell type, cytotoxicity assay, NaOCl dilution solutions, presence of fetal bovine serum (FBS), and NaOCl exposure time. The culture medium used in cytotoxicity assays contains buffering substances that neutralize the pH of NaOCl, thus reducing its cytotoxicity, an approach that may lead to bias when solutions with different pH are compared. For short exposure periods, as in simulations to evaluate the contact between irrigant and periapical tissue cells during chemo-mechanical preparation, NaOCl dilution should be performed with saline, which does not buffer the irrigant. For long exposure periods, as in simulations of irrigant extrusions, NaOCl should be diluted in the culture medium, to reproduce the expected buffering effect occurring in extrusions. The presence of FBS in culture medium can decrease NaOCl toxicity. There is no standardization of NaOCl cytotoxicity methodologies. This poses the risk of arriving at incorrect results and, therefore, pertinent tests must be refined.
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Affiliation(s)
- Hernán Coaguila-Llerena
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University -UNESP, Araraquara, São Paulo, Brazil
| | - Luana Raphael da Silva
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University -UNESP, Araraquara, São Paulo, Brazil
| | - Gisele Faria
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University -UNESP, Araraquara, São Paulo, Brazil
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Czopik B, Woźniakiewicz A, Świętoniowska N, Zarzecka J, Woźniakiewicz M. Quantitative Insight into PCA Formation following Different Chlorhexidine Activation Methods in Endodontic Treatment. Molecules 2023; 28:6159. [PMID: 37630411 PMCID: PMC10457975 DOI: 10.3390/molecules28166159] [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: 06/14/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
The aim of the study was a quantitative analysis of p-chloroaniline (PCA) formation during 2% CHX activation with US and MDI methods in a root canal-like environment with the HPLC-DAD method and, thus, a safety assessment of US and MDI agitation of CHX in endodontic treatment. Two percent CHX was activated with the US method using ISO 30 and 35 K-file, and the MDI method using ISO 30.06 and 35.06 GP cones for 15, 30, 60, and 90 s. PCA concentration was assessed with the HPLC-DAD method. PCA concentration was also assessed for 2% CHX after 0, 3, 18, and 21 days of storage in ambient conditions. PCA was detected in all samples in all methods of activation. The concentration of PCA was dependent on time of activation in US ISO 30 and ISO 35 group (p < 0.05). In the MDI ISO 30.06 and ISO 35.06 groups, a similar trend was observed but without statistical significance (p > 0.05). PCA was detected in shelf-stored 2% CHX and the concentration was related to the time of storage. PCA is released after CHX activation with US and MDI, but mean concentrations are not higher than those observed from self-degradation of shelf-stored 2% CHX.
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Affiliation(s)
- Barbara Czopik
- Department of Conservative Dentistry with Endodontics, Faculty of Medicine, Institute of Stomatology, Jagiellonian University Medical College, Montelupich 4 St., 31-155 Kraków, Poland;
| | - Aneta Woźniakiewicz
- Department of Analytical Chemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Kraków, Poland; (A.W.); (M.W.)
| | - Natalia Świętoniowska
- Department of Analytical Chemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Kraków, Poland; (A.W.); (M.W.)
| | - Joanna Zarzecka
- Department of Conservative Dentistry with Endodontics, Faculty of Medicine, Institute of Stomatology, Jagiellonian University Medical College, Montelupich 4 St., 31-155 Kraków, Poland;
| | - Michał Woźniakiewicz
- Department of Analytical Chemistry, Faculty of Chemistry, Jagiellonian University, Gronostajowa 2, 30-387 Kraków, Poland; (A.W.); (M.W.)
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Drews DJ, Nguyen AD, Diederich A, Gernhardt CR. The Interaction of Two Widely Used Endodontic Irrigants, Chlorhexidine and Sodium Hypochlorite, and Its Impact on the Disinfection Protocol during Root Canal Treatment. Antibiotics (Basel) 2023; 12:antibiotics12030589. [PMID: 36978457 PMCID: PMC10044599 DOI: 10.3390/antibiotics12030589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
In recent years, sodium hypochlorite and chlorhexidine digluconate have been the gold standard of irrigation solutions utilized within the disinfection protocol during root canal treatments. Nowadays, it is known that, during chemical disinfection of the root canal, consecutive application of sodium hypochlorite and chlorhexidine digluconate leads to the formation of an orange-brown precipitate. This precipitate is described as being chemically similar to para-chloroaniline, which is suspected to have cytotoxic and carcinogenic effects. Concerns also exist regarding its influence on the leakage of root canal fillings, coronal restorations, and tooth discoloration. The purpose of this article is to review the literature on the interaction of sodium hypochlorite and chlorhexidine digluconate on the tooth and its surrounding tissues, and to discuss the effect of the precipitate formed during root canal treatment. We further address options to avoid the formation of the precipitate and describe alternative irrigation solutions that should not interact with sodium hypochlorite or chlorhexidine digluconate.
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Affiliation(s)
- Dirk-Joachim Drews
- Private Dental Practice, 69469 Weinheim, Germany
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Anh Duc Nguyen
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Antje Diederich
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Christian Ralf Gernhardt
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
- Correspondence: ; Tel.: +49-345-557-3741
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Bueso V, Parikh N, Terlier T, Holland JN, Sarmast ND, Jeong JW. Comparative evaluation of intermediate solutions in prevention of brown precipitate formed from sodium hypochlorite and chlorhexidine gluconate. Clin Exp Dent Res 2022; 8:1591-1597. [PMID: 36102230 PMCID: PMC9760148 DOI: 10.1002/cre2.654] [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: 06/27/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To evaluate intermediate treatments between sodium hypochlorite and chlorhexidine gluconate irrigations for the prevention of a toxic brown precipitate in root canal therapy. MATERIALS AND METHODS Thirty-nine premolars were irrigated with 6% sodium hypochlorite and divided into either: No intermediate treatment; Dry paper points; three different irrigations with 17% ethylenediaminetetraacetic acid, deionized water, or 5% sodium thiosulfate. 2% chlorhexidine gluconate was the final irrigant in all groups. Sectioned teeth were analyzed for brown precipitate intensity and area using stereomicroscopy and components related to para-chloroaniline using Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS). RESULTS Stereomicroscopy showed that 5% STS significantly reduced brown precipitate intensity and area as compared with no intermediate irrigation (p < .05, Chi-square, generalized linear model, and Tukey's multiple comparison tests). Utilizing ToF-SIMS, 5% sodium thiosulfate was most effective in reducing the components representing para-chloroaniline and chlorhexidine gluconate. CONCLUSION The 5% sodium thiosulfate was most effective among other intermediate treatments, assessed by stereomicroscopy and ToF-SIMS.
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Affiliation(s)
- Vashti Bueso
- School of DentistryThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Neha Parikh
- Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at HoustonSchool of DentistryHoustonTexasUSA
| | - Tanguy Terlier
- SIMS Laboratory, Shared Equipment AuthorityRice UniversityHoustonTexasUSA
| | - Julian N. Holland
- Office of Research, The University of Texas Health Science Center at HoustonSchool of DentistryHoustonTexasUSA
| | - Nima D. Sarmast
- Department of Endodontics, The University of Texas Health Science Center at HoustonSchool of DentistryHoustonTexasUSA
| | - Ji Wook Jeong
- Department of Endodontics, The University of Texas Health Science Center at HoustonSchool of DentistryHoustonTexasUSA
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Orhan EO, Irmak Ö, Hür D. What does not form after accidental sodium hypochlorite contact with chlorhexidine? Int Endod J 2022; 55:685-688. [PMID: 35511028 DOI: 10.1111/iej.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/23/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ekim Onur Orhan
- Translational Medicine Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey.,Department of Endodontics, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Özgür Irmak
- Department of Restorative Dentistry, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Deniz Hür
- Department of Chemistry, Faculty of Science, Eskişehir Technical University, Eskisehir, Turkey
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Terlier T, Jeong JW, Sarmast ND, Parikh N. Response to letter by Orhan et al. 2021, regarding Jeong et al. (2021) 'Assessment of the cytotoxic effects and chemical composition of the insoluble precipitate formed from sodium hypochlorite and chlorhexidine gluconate'. Int Endod J 2022; 55:689-691. [PMID: 35511029 DOI: 10.1111/iej.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tanguy Terlier
- SIMS Laboratory, Shared Equipment Authority, Rice University, Houston, Texas, USA
| | - Ji Wook Jeong
- Department of Endodontics, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nima D Sarmast
- Department of Endodontics, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Neha Parikh
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Briseño-Marroquín B, Callaway A, Shalamzari NG, Wolf TG. Antibacterial efficacy of peracetic acid in comparison with sodium hypochlorite or chlorhexidine against Enterococcus faecalis and Parvimonas micra. BMC Oral Health 2022; 22:119. [PMID: 35397605 PMCID: PMC8994351 DOI: 10.1186/s12903-022-02148-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background The main goal of an endodontic treatment is a complete debridement of the root canal system; however, currently mechanical shaping and chemical cleaning procedures for this purpose have deemed non-satisfactory.
Methods The efficacy of peracetic acid (PAA; 0.5, 1.0, 2.0%), as a root canal irrigation solution, against Enterococcus faecalis (DSM 20478) and Parvimonas micra (DSM 20468) when compared with the one of sodium hypochlorite (NaOCI; 1.0, 3.0, 5.0%), chlorhexidine digluconate (CHX; 0.12, 0.2, 2.0%) and 0.9% NaCI (as a control solution) was in vitro investigated with the agar diffusion and direct contact methods. The inhibition zone diameters observed with the agar diffusion test were determined. The viable bacterial counts (CFU/ml) were calculated with the direct method. Results The agar diffusion test showed that all three root canal irrigation solutions had an efficacy against E. faecalis at all concentrations. The largest inhibition zone diameters against E. faecalis were observed with 5.0% NaOCI. At all three concentrations of PAA, NaOCI, and CHX, the inhibition zone diameter increased with increase in concentration. For P. micra, PAA had a similar inhibition zone diameter despite a concentration increase. In contrast, for NaOCI and CHX, the inhibition zone diameter increased with increasing concentration. 2.0% CHX produced the largest inhibition zone diameter against P. micra. For E. faecalis, only the comparison between 2.0% PAA and 5.0% NaOCI showed statistical significance (p = 0.004). For P. micra the efficacy comparison between the lowest, middle, and highest concentrations of each solution, a statistical significance (p < 0.05) was found for all three solutions. After direct contact with PAA, NaOCI and CHX, no viable bacteria could be determined for either P. micra or E. faecalis. Conclusions PAA had a similar antibacterial efficacy as the one of NaOCl and CHX when in direct contact with E. faecalis and P. micra. In the agar diffusion test, PAA showed a similar antibacterial efficacy as the one of CHX and a lower one as the one of NaOCl for E. faecalis.
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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: 66] [Impact Index Per Article: 33.0] [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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