1
|
Auerbach D, Alaugaily I, Davis S, Azim AA. A promising approach utilising photothermal energy to disinfect the root canal system: An in vitro investigation. AUST ENDOD J 2024. [PMID: 38995151 DOI: 10.1111/aej.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/30/2024] [Accepted: 06/20/2024] [Indexed: 07/13/2024]
Abstract
This study aimed to assess root canal disinfection through various irrigation protocols, including a novel photothermal system called 'LEAP'. Mandibular premolars were infected with Enterococcus faecalis and divided into five groups for different treatments: Group 1: standard needle irrigation; Group 2: passive ultrasonic irrigation; Group 3: GentleWave; Group 4: LEAP; and Group 5: Group 1 + Group 4. Microbial counts were measured before (S1) and after disinfection (S2) using colony-forming units (CFU) and confocal laser scanning microscopy (CLSM). Results revealed a significant reduction in bacterial counts for all groups (p < 0.05). While the percentage of dead bacteria near the canal wall (0-50 μm) did not differ significantly, at 50-150 μm, LEAP and SNI + LEAP exhibited significantly higher bacterial reduction than other groups (p < 0.05). The findings indicate that LEAP is comparable to existing irrigation devices in the main root canal and notably superior in tubular disinfection.
Collapse
Affiliation(s)
- Daniela Auerbach
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Ibrahim Alaugaily
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Scott Davis
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Adham A Azim
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| |
Collapse
|
2
|
Vieira WDA, de-Jesus-Soares A, Lopes EM, Gomes BPFA, Lima BP. Effect of supplementary sodium hypochlorite agitation techniques on an ex vivo oral multispecies biofilm during passive disinfection of simulated immature roots. Int Endod J 2024; 57:966-980. [PMID: 38387884 DOI: 10.1111/iej.14053] [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: 10/31/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024]
Abstract
AIM To compare the effect of different sodium hypochlorite (NaOCl) agitation techniques on an ex vivo oral multispecies biofilm during passive disinfection of simulated immature roots. METHODOLOGY Extracted human teeth were prepared to simulate immature roots. They were infected with a dental plaque-derived multispecies biofilm and cultured for 14 days. The roots were randomly designated into four groups: (1) negative control (PBS), (2) 1.5% NaOCl (CNI), (3) CNI + Ultrasonic activation (UA), (4) CNI + EasyClean agitation (ECA), (5) CNI + XP-endo finisher agitation (XPF), and (6) positive control (6% NaOCl). Biofilm samples were collected from the root canals and used to determine the number of viable cells (colony-forming units), scanning electron microscopy, and 16S rRNA gene sequencing. The mean colony-forming units per mL (CFU/mL) were analysed using One-way anova. 16S rRNA sequencing data were analysed for alpha (observed OTUs, Shannon index, and Chao1) and beta diversity (Bray-Curtis dissimilarities). The LEfSe analysis was used to determine the effect of treatment procedures on the abundance of root canal microbiota. The significance was set at .05. RESULTS PBS and CNI samples had significantly higher CFU/mL counts than UA, ECA, XPF, and 6% NaOCl samples (p < .05). The pre-treatment, PBS, and CNI groups had significantly greater alpha diversity than the UA, ECA, XPF, and 6% NaOCl groups (p < .05). NaOCl agitation groups and the 6% NaOCl group achieved a more pronounced reduction in bacteria from the genera Fusobacterium, Actinomyces, Porphyromonas, and Capnocytophaga. CONCLUSIONS The effectiveness of passive disinfection protocols was enhanced by NaOCl agitation techniques, suggesting that this supplementary method can improve the outcome of revitalization procedures.
Collapse
Affiliation(s)
- Walbert de Andrade Vieira
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, Universidade Estadual de Campinas - UNICAMP, Piracicaba, Brazil
| | - Adriana de-Jesus-Soares
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, Universidade Estadual de Campinas - UNICAMP, Piracicaba, Brazil
| | - Erica M Lopes
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, Universidade Estadual de Campinas - UNICAMP, Piracicaba, Brazil
| | - Brenda P F A Gomes
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, Universidade Estadual de Campinas - UNICAMP, Piracicaba, Brazil
| | - Bruno P Lima
- Division of Basic Sciences, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
3
|
Park KH, Ordinola-Zapata R, Noblett WC, Lima BP, Staley C. The effect of ultrasonic and multisonic irrigation on root canal microbial communities: An ex vivo study. Int Endod J 2024; 57:895-906. [PMID: 37983635 DOI: 10.1111/iej.13996] [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: 12/07/2022] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023]
Abstract
AIM To analyse the effect of ultrasonic irrigant activation (UIA) and the GentleWave (GW) multisonic irrigation (GW) with minimal instrumentation on the root canal microbial diversity in an ex vivo model that used extracted molars with a history of pulp necrosis. METHODOLOGY Twenty-three mandibular molars were prepared ex vivo for collection of superficial (surface control), pre-treatment and post-treatment samples 24 h after extraction. Samples were divided into two groups: UIA using 6% NaOCl (n = 11) and GW group (n = 12). All samples were processed using quantitative real-time polymerase chain reaction (qPCR) and 16S rRNA next-generation sequencing to measure microbial diversity before and after the antimicrobial treatment. For qPCR, a t-test (α = .05) was used to compare the log10 reduction. The Chao1 and Shannon indices evaluated alpha diversity. Differences in community composition (beta diversity) were evaluated by analysis of similarity (ANOSIM). Kruskal-Wallis test with Bonferroni corrections was performed to evaluate the differences in abundances genera in the samples. RESULTS Quantitative real-time polymerase chain reaction revealed an estimated 1.6 and 2.6 log10 reduction for UIA and GW groups respectively (p = .048). An average of 5 ± 4 and 3 ± 5 operational taxonomic units (OTUs) were found in surface's samples in the UIA and GW group respectively. These values were significantly lower (p < .001) compared to the number of preoperative OTUs in those groups (155 ± 79 and 187 ± 121). In assessing beta diversity, there were no significant differences found in pre-treatment samples (R = .090, p = .070 ANOSIM with Bonferroni corrections). Also, no significant differences in community composition were observed in post-treatment samples (R = -.05, p = .829). After treatment, there was a significant reduction of Eubacterium using conventional treatment with UIA and a significant reduction of Prevotella using minimal instrumentation with GW irrigation (p = .007 and p = .002 respectively). CONCLUSION Quantitative PCR analysis revealed a significant reduction in microbial load for GW group. Overall, diversity changes were similar between UIA and GW irrigation in this ex vivo model that used extracted teeth with a history of pulp necrosis. OTUs obtained from the surface sample were negligible and did not affect the statistical outcome of the study.
Collapse
Affiliation(s)
- Ki Hong Park
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ronald Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
| | - W Craig Noblett
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bruno P Lima
- Division of Basic Sciences, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christopher Staley
- Division of Basic & Translational Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
4
|
Hackbarth M, Montoya M, Noblett WC, Lima BP, Dietz M, Staley C, Ordinola-Zapata R. An In Vitro Evaluation of the Antimicrobial Efficacy of a Novel Irrigant Using Next-Generation Sequencing. J Endod 2024:S0099-2399(24)00305-4. [PMID: 38815857 DOI: 10.1016/j.joen.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION To evaluate the antimicrobial activity of Triton irrigation versus 4% sodium hypochlorite (NaOCl) utilizing a direct contact test and an extracted tooth model. METHODS In the first experiment, a direct contact test was conducted to compare bacterial DNA removal and microbial diversity changes following irrigation with 4% NaOCl or Triton. Hydroxyapatite and dentin discs were inoculated with subgingival human-derived dental plaque for 2 weeks utilizing the Center for Disease Control biofilm reactor and subsequently challenged with the root canal irrigants for 5 minutes. In the second experiment, teeth contaminated with a multispecies biofilm (n = 24) were assigned into two treatment groups, NaOCl or Triton irrigation. Samples were obtained for quantitative real-time polymerase chain reaction and next-generation sequencing analysis before and after instrumentation. The Shannon and Chao1 indices were used to measure alpha diversity. The Bray-Curtis dissimilarity and ANOSIM was used to measure beta diversity. Differences in abundances of genera were evaluated using Kruskal-Wallis test with Bonferroni corrections. RESULTS The direct contact test revealed no significant differences in the bacterial load based on 16S rRNA gene molecules/μL, reads, or differences in the Shannon index among groups. In the extracted tooth model, a bacterial load reduction of log10 3.08 ± 0.69 and 2.76 ± 0.91 were found for NaOCl and Triton, respectively (P = .348). Next-generation sequencing showed fewer reads, lower Chao1, and beta diversity values when pretreatment and post-treatment samples were assessed in both experimental groups (P < .0001). The Kruskal-Wallis analysis found that 17 genera of bacteria were over-represented in minimal values in the Triton post-treatment group, 14 of these genera represented less than 1% of the microbial community. CONCLUSIONS Both irrigants had limited antimicrobial activity in the direct contact test. When used in conjunction with mechanical instrumentation both irrigants were able to reduce the bacterial DNA load and diversity in comparison with pretreatment communities. The NaOCl irrigation, followed by ethylenediaminetetraacetic acid flush, was more effective in decreasing DNA counts from low-abundance organisms.
Collapse
Affiliation(s)
- Mallory Hackbarth
- Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - Meghan Montoya
- Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - W Craig Noblett
- Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - Bruno P Lima
- Division of Basic Sciences, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | - Matthew Dietz
- Division of Basic & Translational Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Christopher Staley
- Division of Basic & Translational Research, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Ronald Ordinola-Zapata
- Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, Minnesota.
| |
Collapse
|
5
|
Karatas E, Hadis M, Palin WM, Milward MR, Kuehne SA, Camilleri J. Minimally invasive management of vital teeth requiring root canal therapy. Sci Rep 2023; 13:20389. [PMID: 37990070 PMCID: PMC10663499 DOI: 10.1038/s41598-023-47682-9] [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: 09/18/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
The present study aimed to investigate the possible use of a non-instrumentation technique including blue light irradiation for root canal cleaning. Extracted human single rooted teeth were selected. Nine different groups included distilled water, NaOCl, intra-canal heated NaOCl, and NaOCl + EDTA irrigation after either instrumentation or non-instrumentation, and a laser application group following non-instrumentation technique. The chemical assessment of the root canal dentine was evaluated using energy dispersive spectroscopy (EDS) and Fourier transform infrared (FT-IR) spectroscopy. Surface microstructural analyses were performed by using scanning electron microscopy (SEM). The antimicrobial efficacy of different preparation techniques was evaluated using microbial tests. Light application didn't change the calcium/phosphorus, carbonate/phosphate and amide I/phosphate ratios of the root canal dentin. The root canal dentin preserved its original chemistry and microstructure after light application. The instrumentation decreased the carbonate/phosphate and amide I/phosphate ratios of the root canal dentin regardless of the irrigation solution or technique (p < 0.05). The application of light could not provide antibacterial efficacy to match the NaOCl irrigation. The NaOCl irrigation both in the non-instrumentation and instrumentation groups significantly reduced the number of bacteria (p < 0.05). The use of minimally invasive root canal preparation techniques where the root canal is not instrumented and is disinfected by light followed by obturation with a hydraulic cement sealer reduced the microbial load and preserved the dentin thus may be an attractive treatment option for management of vital teeth needing root canal therapy.
Collapse
Affiliation(s)
- E Karatas
- Ataturk University, Erzurum, Turkey
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, 5, Mill Pool Way Edgbaston, Birmingham, B5 7EG, UK
| | - M Hadis
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, 5, Mill Pool Way Edgbaston, Birmingham, B5 7EG, UK
| | - W M Palin
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, 5, Mill Pool Way Edgbaston, Birmingham, B5 7EG, UK
| | - M R Milward
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, 5, Mill Pool Way Edgbaston, Birmingham, B5 7EG, UK
| | - S A Kuehne
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, 5, Mill Pool Way Edgbaston, Birmingham, B5 7EG, UK
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - J Camilleri
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, 5, Mill Pool Way Edgbaston, Birmingham, B5 7EG, UK.
| |
Collapse
|
6
|
Alquria TA, Alfirdous RA, Gupta S, Santamaria MP, Santamaria IF, Gomes APM, Tiradentes N, Silva EG, Martinho FC. Comparison of conventional and contemporary root canal disinfection protocols against bacteria, lipoteichoic acid (LTA), and lipopolysaccharide (LPS). Sci Rep 2023; 13:1206. [PMID: 36681702 PMCID: PMC9867776 DOI: 10.1038/s41598-022-26855-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/21/2022] [Indexed: 01/22/2023] Open
Abstract
This study devised a dual-species biofilm model to investigate bacteria, lipoteichoic acid (LTA), and lipopolysaccharide (LPS) simultaneously, and compared the efficacy of conventional and contemporary disinfection protocols. Seventy single-rooted mandibular premolars were included. Fourteen teeth were negative control, and 56 teeth were infected with 3-week-old E. faecalis and E. coli GFP biofilm. Fourteen/56 teeth were positive control, with seven teeth processed for CLSM analysis and seven teeth sampled with paper points (PPs) and cryogenically ground for bacterial, LTA, and LPS analyses. Forty-two teeth were randomly divided into three groups: GWS (GentleWave system) + MIT (minimally invasive technique), PUI (passive ultrasonic irrigation) + CIT (conventional instrumentation technique), and XP-EF (XP-endo Finisher) + CIT (All, n = 14). Samples were collected before (s1) and after disinfection (s2) with PPs and after cryogenically ground (s3). CFUs were counted, and LTA and LPS were quantified with LTA-ELISA and LAL assay, respectively. XP-EF was as effective as PUI (p > 0.05). GWS + MIT was the most effective disinfection protocol against bacteria, LTA, and LPS (p < 0.05). In conclusion, PUI, XP-EF, and GWS were highly effective against bacteria, LTA, and LPS, with GWS being the most effective.
Collapse
Affiliation(s)
- Theeb A Alquria
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
- Department of Restorative Dental Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rayyan A Alfirdous
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
- Prince Abdulrahman Advanced Dental Institute, Riyadh, Kingdom of Saudi Arabia
| | - Swati Gupta
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | | | - Ingrid F Santamaria
- Department of General Dentistry, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Ana P M Gomes
- Endodontic Division, Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Naiara Tiradentes
- Endodontic Division, Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Eduardo G Silva
- Department of Social and Pediatric Dentistry, Institute of Science and Technology, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Frederico C Martinho
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.
| |
Collapse
|
7
|
Coaguila‐Llerena H, Ordinola‐Zapata R, Staley C, Dietz M, Chen R, Faria G. Multispecies biofilm removal by a multisonic irrigation system in mandibular molars. Int Endod J 2022; 55:1252-1261. [PMID: 35976101 PMCID: PMC9561058 DOI: 10.1111/iej.13813] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/12/2022] [Accepted: 08/11/2022] [Indexed: 01/09/2023]
Abstract
AIM The aim of the study was to assess biofilm removal efficacy of GentleWave System and passive ultrasonic irrigation (PUI). METHODOLOGY Twenty-two human mandibular molars with Vertucci's type II configuration in the mesial root were selected. Teeth were autoclaved, inoculated with dental plaque and incubated in a CDC biofilm reactor for two weeks. The mesial roots were instrumented up to 20.06 file (V-Taper) for the GentleWave group and up to 35.04 file (Vortex Blue) for PUI group. Irrigation was performed using GentleWave and PUI irrigation protocols (n = 11). Dentine debris on paper points samples were obtained for quantitative real-time polymerase chain reaction (qPCR) and 16S ribosomal RNA gene sequencing (next-generation aequencing-NGS). For qPCR, a non-parametric test (α = 0.05) was used. Next-generation sequencing data were analysed using mothur, with alpha diversity calculated as the Shannon and Chao1 indices and Bray-Curtis dissimilarities were used for beta diversity. Differences in alpha diversity and abundances of genera were evaluated using Kruskal-Wallis test. Differences in community composition were evaluated using analysis of similarity with Bonferroni correction for multiple comparisons. RESULTS Quantitative real-time polymerase chain reaction results showed that the reduction estimated in percentages for both groups was equivalent (p > .05). NGS analysis showed that both techniques promoted a significant reduction in reads and OTUs number (p < .05). Shannon alpha diversity and Chao1 index showed no differences between pre- or post-treatment samples for both groups (p > .05). Additionally, pre-treatment communities differed from post-treatment samples in both groups regarding bacterial taxa reduction (ANOSIM R = 0.50 and 0.55, p < .001). CONCLUSIONS Bacterial reduction in mesial roots of mandibular molars prepared to 35.04 with PUI was similar to those prepared to 20.06 with a multisonic irrigant activation system.
Collapse
Affiliation(s)
- Hernán Coaguila‐Llerena
- Department of Restorative Dentistry, Araraquara School of DentistrySão Paulo State University –UNESPSão PauloBrazil,Division of EndodonticsUniversity of Minnesota School of DentistryMinneapolisMinnesotaUSA
| | - Ronald Ordinola‐Zapata
- Division of EndodonticsUniversity of Minnesota School of DentistryMinneapolisMinnesotaUSA
| | - Christopher Staley
- Division of Basic & Translational Research, Department of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Matthew Dietz
- Division of Basic & Translational Research, Department of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Ruoqiong Chen
- Department of Diagnostic and Biological Sciences, School of DentistryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Gisele Faria
- Department of Restorative Dentistry, Araraquara School of DentistrySão Paulo State University –UNESPSão PauloBrazil
| |
Collapse
|
8
|
Metabology: Analysis of metabolomics data using community ecology tools. Anal Chim Acta 2022; 1232:340469. [DOI: 10.1016/j.aca.2022.340469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022]
|
9
|
Neelakantan P, Vishwanath V, Taschieri S, Corbella S. Present status and future directions ‐ Minimally invasive root canal preparation and periradicular surgery. Int Endod J 2022; 55 Suppl 4:845-871. [DOI: 10.1111/iej.13750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- P. Neelakantan
- Faculty of Dentistry The University of Hong Kong Hong Kong SAR
| | - V. Vishwanath
- Faculty of Dentistry The University of Hong Kong Hong Kong SAR
| | - S. Taschieri
- Department of Biomedical Surgical and Dental Sciences Università degli Studi di Milano Milan Italy
- IRCCS Istituto Ortopedico Galeazzi Milan Italy
- Department of Oral Surgery Institute of Dentistry I. M. Sechenov First Moscow State Medical University Moscow Russia
| | - S. Corbella
- Department of Biomedical Surgical and Dental Sciences Università degli Studi di Milano Milan Italy
- IRCCS Istituto Ortopedico Galeazzi Milan Italy
- Department of Oral Surgery Institute of Dentistry I. M. Sechenov First Moscow State Medical University Moscow Russia
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|