Antimicrobial efficacy of ozonated water, gaseous ozone, sodium hypochlorite and chlorhexidine in infected human root canals

Evaluation of postoperative pain in endodontic retreatment with apical periodontitis using ozonated 2% chlorhexidine and 0.1% octenidine application: A randomized clinical trial

Introduction

This study aimed to evaluate and compare postoperative pain (PP) in single-visit nonsurgical endodontic retreatment (SV NSER) with 2% chlorhexidine (CHX), 0.1% octenidine (OCT) with or without ozone, and 5.25% sodium hypochlorite (NaOCl).

Materials and Methods

In this randomized, parallel, prospective, double-blind, clinical trial, 132 single-rooted, root-filled teeth with symptomatic apical periodontitis (AP) requiring NSER were allocated into six groups randomly (n = 22/group): 2% CHX with NaOCl (CHXH), 2% Ozonated CHX without NaOCl (OCHX), 2% Ozonated CHX with NaOCl (OCHXH), 0.1% OCT with NaOCl (OCTH), 0.1% Ozonated OCT without NaOCl (OOCT), and 0.1% Ozonated OCT with NaOCl (OOCTH). Standard NSER protocol was followed groups were irrigated with 15 ml of ozonated or nonozonated irrigant (CHX/OCT) for 3-5 min with ultrasonic agitation. PP at baseline, after 6, 12, 24, 48 h, and 7 days was recorded using the Visual Analog Scale (VAS). Logistic regression of predictor variables was compared using the Chi-square test. For group-wise and time-wise comparisons, a two-way analysis of variance followed by the post hoc Bonferroni test was carried out.

Results

None of the patient-related variables in logistic regression obtained a statistically significant (P > 0.05) role in PP. The VAS score after 6 h was OCHX (4.72) > OOCT (4.42) > CHXH (4.23) > OCTH (3.95) > OCHXH (3.42) > OOCTH (3.21). OOCTH and OCHXH groups demonstrated statistically significant reductions in VAS scores at various time intervals (P < 0.05).

Conclusion

SV NSER with ozonated OCT, CHX irrigation, and NaOCl resulted in lesser PP at all time intervals, i.e., 6, 12, 24, 48 h, and 7 days in patients with symptomatic AP.

Assessment of Smear Layer Removal and Penetration Depth of Root Canal Irrigant Using Different Irrigation Activation Systems: A Comparative Study

AIM

The aim of the current study was to evaluate the penetration depth and smear layer removal of root canal irrigant using various irrigation activation techniques.

MATERIALS AND METHODS

In this investigation, sixty single-rooted premolars extracted for orthodontic purposes were chosen. Diamond burs were used to create an access cavity, and #10 K-file was used to determine the patency. About sixty samples were divided into the following three groups (20 samples in each group), group I: Irrigation with conventional needle, group II: Activation of EndoVac system, group III: Passive ultrasonic irrigation (PUI). The efficacy of the smear layer was assessed using a scanning electron microscopy at a ×2000 magnification. One-way ANOVA was used to record and analyze the data. All statistical analyses were performed with a significance level of p < 0.05.

RESULTS

At coronal third, the maximum smear layer was removed in group II (1.26 ± 0.02) followed by group III (1.84 ± 0.16) and group I (2.89 ± 0.21). At middle third, smear layer removal was maximum in group I (1.18 ± 0.10) followed by group III (1.72 ± 0.09) and group I (2.66 ± 0.18). At apical third, the more smear layer was removed in group II (1.02 ± 0.01) followed by group III (1.58 ± 0.08) and group I (2.38 ± 0.06). There was a highly significant difference found between the three different irrigation systems at all three levels (p < 0.001).

CONCLUSION

In conclusion, every irrigation device that was evaluated was successful in removing the smear layer from the root canal. However, the EndoVac system group removed a greater amount of smear layer compared with PUI and conventional needle group.

CLINICAL SIGNIFICANCE

With the goal of promoting cleaning that is beyond the ability of mechanical devices, irrigation is a crucial part of root canal therapy. If an efficient irrigation delivery system is used, the irrigants can reach the working length (WL). This type of distribution system needs to provide a suitable amount of irrigants up to the WL, as well as have enough flow and be effective at debriding the entire canal system. How to cite this article: Pujari MD, Das M, Das A, et al. Assessment of Smear Layer Removal and Penetration Depth of Root Canal Irrigant Using Different Irrigation Activation Systems: A Comparative Study. J Contemp Dent Pract 2024;25(4):331-334.

Comparative Evaluation of Penetration of Various Nano-sized Intra-canal Medicaments: An In Vitro Confocal Laser Scanning Microscopic Study

Background

To assess and contrast the depth of penetration of conventional calcium hydroxide, nanoparticle calcium hydroxide, silver nanoparticles, and combination of nanoparticle calcium hydroxide and silver nanoparticles into dentinal tubules using confocal laser scanning microscope.

Materials and Methods

Eighty human single-rooted teeth were decoronated and instrumented up to Protaper Universal F3. Teeth were separated into four groups at random (n = 20) following chemomechanical preparation. Group 1: Control Conventional Calcium Hydroxide; Group 2: Nanoparticle Calcium Hydroxide; group 3: Silver Nanoparticles; group 4: Combination of Nanoparticle Calcium Hydroxide and Silver Nanoparticles. With the use of lentulo spirals, medications were injected into the canals, stirred up with ultrasound, and then kept at 37°C for 24 hours. A 1 mm thick slice was obtained at 5 mm from the root apex by sectioning the root perpendicular to the long axis of the tooth and then put on a glass slide to measure the depth of penetration using a confocal laser microscope.

Statistical Analysis

To quantify the depth of penetration among the four groups, a one-way ANOVA was used and post hoc-Tukey's test was used to compare between groups.

Results

All of the groups were statistically significant, with group 4 showing the greatest depth of penetration, followed by group 2 and group 3. In contrast, all other groups in the intergroup comparison were statistically significant (P value 0.05) aside from the comparison of group 2 to group 3.

Conclusion

Silver nanoparticles and nanoparticle calcium hydroxide together demonstrated greater penetration than calcium hydroxide, silver nanoparticles, and nanoparticle calcium hydroxide alone.

Effect of 20-ppm ozone and 1% chlorhexidine gels on plaque index and Streptococcus mutans counts in the dental plaque in 6-12-year-old children: A randomized, double-blind clinical trial

Background

One of the methods to control dental caries is to use ozone. Since it is difficult for children to use mouthwashes, the present study aimed to evaluate 20-ppm zone and 1% chlorhexidine (CHX) gels' effects on the plaque index and Streptococcus mutans counts in 6-12-year-old children.

Methods

In the present double-blind clinical trial, 165 children, 6-12 years of age, referring to the Department of Pediatric Dentistry, Tabriz Faculty of Dentistry, were selected based on inclusion and exclusion criteria and randomly assigned to three groups: ozone gel, CHX gel, and control. The subjects were instructed to place an adequate amount of the gels on all the surfaces of their teeth with one clean finger. The patients and evaluators were blinded to the study groups. The plaque index and S. mutans counts in plaque samples were determined before intervention and three weeks after intervention on the buccal surface of the most posterior maxillary tooth (left or right). S. mutans counts were determined by culture. STATA software version 14 was used for statistical analyses using Wilcoxon, Kruskal-Wallis, and post hoc Dum tests. Statistical significance was defined at P<0.05.

Results

The 20-ppm ozone and 1% CHX gels significantly decreased dental plaque compared to the control group (P<0.05), and their effects were similar (P>0.05). These gels significantly decreased the colonies and bacterial counts of S. mutans (P<0.05).

Conclusion

The performance of 20-ppm ozone gel in decreasing the dental plaque and S. mutans counts was similar to 1% CHX gel.

Analysis of antimicrobial efficacy of sodium hypochlorite and ozonated water against biofilm in oval canals

This in vitro study compared the antimicrobial efficacy of 2.5% sodium hypochlorite (NaOCl) and 8 µg/mL ozonated water agitated by passive ultrasonic irrigation (PUI) or PUI combined with EndoActivator (EA) against mature multispecies biofilm. One hundred and five oval-shaped mandibular premolars were instrumented, sterilized, and inoculated with Enterococcus faecalis, Candida albicans, and Staphylococcus aureus, divided into: control group - saline; O3 group - ozonated water; O3 PUI group - ozonated water with PUI agitation; O3 PUI+EA group - ozonated water with PUI+EA agitation; NaOCl group - NaOCl; NaOCl PUI group - NaOCl with PUI agitation; and NaOCl PUI+EA group - NaOCl with PUI+EA agitation. Microbiological samples were collected before (S1) and after (S2) the disinfection procedures and the data were statistically analyzed using the Kruskal-Wallis test. In the culture method, there was significant disinfection in the O3 PUI+EA, NaOCl, NaOCl PUI, and NaOCl PUI+EA groups (p˂0.05). The combination of NaOCl with PUI+EA reduced microbial counts to zero (p˂0.05). In the qPCR method, there was a significant reduction in the total count of viable microorganisms in the O3 PUI, O3 PUI+EA, NaOCl, NaOCl PUI, and NaOCl PUI+EA groups (p˂0.05). It can be concluded that 2.5% NaOCl with and without agitation, as well as 8 µg/mL ozonated water with its action enhanced by the agitation techniques, were effective in root canal disinfection, and their antimicrobial efficacy is related to the microorganisms present in the biofilm.

Potential Clinical Applications of Ozone Therapy in Dental Specialties-A Literature Review, Supported by Own Observations

Apart from conventional treatment, dentists are increasingly relying on physical therapy modalities in their clinical practice. The aim of this literature review is to analyze the clinical relevance and potential uses of ozone in modern dentistry. The research question is geared towards detailing the multiple potential applications of ozone therapy in a range of dental specialties. Based on the available literature, accessed via the PubMed, Google Scholar, Scopus, and EBSCO databases, a detailed search of the electronic literature was performed for 2001-2022. Eligible studies were chosen according to inclusion and exclusion criteria, using keywords: ozone, ozone therapy, therapeutic applications, oxidants, dental disinfectants, oral medicine, physical therapy in dentistry. Out of 834 manuscripts, 273 studies were curated. A total of 70 publications were used in the final consideration. After assessing their quality, they were analyzed to determine the relevance and potential use of ozone in the various aspects of modern dentistry. Ozone therapy is used mainly as an adjunct to the primary clinical or pharmacological treatment. In some cases of oral mucosal disease, it has proven effective as a primary therapy. During the literature analysis, it was noted that ozone therapy in dentistry is a subject of ongoing research, and the results are not always consistent. The multitude of studies in the literature on the applications of ozone in dentistry reflects the search for its undiscovered physical therapeutic potential.

Ozonated water as an irrigant in disinfecting root canal systems - a systematic review

Aim To evaluate the efficacy of ozonated water as an irrigant in disinfection of the root canal system.Materials and methods This systematic review was conducted according to PRISMA guidelines and methodological studies were assessed through the Cochrane Risk of Bias tool. All studies on extracted human teeth using ozonated water were considered for the study, whereas ex vivo studies, studies on animal dentition and studies which were published in languages other than English were excluded from the study. The search was carried out on various databases such as PubMed, Google Scholar and ScienceDirect within the last 15 years. The assessment of quality of the studies was performed under the following: 1) size of sample; 2) control group; 3) standardisation of procedure; 4) statistical analysis performed; 5) risk of bias.Results There were a total of 154 study results, out of which duplicates and full-text analysis were excluded. A total of seven studies were included in the systematic review. The results in one study by Cardoso et al. showed ozonated water was better at reducing microbial counts, while two other studies demonstrated the difference in reducing microbial counts when comparing ozonated water against other irrigants. The remaining four studies concluded that ozonated water did not perform better as compared to the other irrigants such as sodium hypochlorite and chlorhexidine.Discussion It could be concluded that ozonated water is not a better disinfecting irrigant than sodium hypochlorite and chlorhexidine in the disinfection of the root canal system; however, it had an almost comparable level of disinfection.

Comparative Evaluation of the Remineralization Potential of Fluoride-containing Toothpaste, Honey Ginger Paste and Ozone. An In Vitro Study

Introduction

A drop in pH of the oral cavity results in demineralization, which, if continued, leads to loss of minerals from tooth structure, resulting in dental caries. A goal of modern dentistry is to manage noncavitated caries lesions noninvasively through remineralization in an attempt to prevent disease progression.

Materials and methods

A total of 40 extracted premolar teeth were selected for the study. The specimens were divided into four groups, group I, the control group; group II, remineralizing agent as fluoride toothpaste; group III, the treatment material as ginger and honey paste; and group IV, the treatment material as ozone oil. An initial reading of surface roughness and hardness was recorded for the group (control group). Repeated treatment has continued lasting 21 days. This saliva was changed each day. Following the lesion formation procedure, the surface microhardness was measured for all specimens. The parameters were 200 gm force for 15 seconds with a Vickers indenter and the roughness of the demineralized area of each specimen was obtained by using the surface roughness tester.

Results

Surface roughness was checked by using a surface roughness tester. Before starting the pH cycle, the baseline value for the control group was calculated. The baseline value for the control group was calculated. The surface roughness average value for 10 samples is 0.555 µm and the average surface microhardness is 304 HV; the average surface roughness value for fluoride is 0.244 µm and the microhardness is 256 HV, 0.241 µm, and 271 HV value for honey-ginger paste. For ozone surface roughness average value is 0.238 µm and the surface microhardness average mean value is 253 HV.

Conclusion

The future of dentistry will rely on the regeneration of tooth structure. There is no significant difference seen between each treatment group. Considering the adverse effect of fluoride, we can consider honey-ginger and ozone as good remineralizing agents for fluoride.

How to cite this article

Kade KK, Chaudhary S, Shah R, et al. Comparative Evaluation of the Remineralization Potential of Fluoride-containing Toothpaste, Honey Ginger Paste and Ozone. An In Vitro Study. Int J Clin Pediatr Dent 2022;15(5):541-548.

Antimicrobial Effect of Calcium Hydroxide Combined with Electrolyzed Superoxidized Solution at Neutral pH on Enterococcus faecalis Growth

Objective

To evaluate the effect of the combination of calcium hydroxide (Ca(OH)₂) and a novel electrolyzed superoxidized solution at neutral pH, known as OxOral® on Enterococcus faecalis growth in root canals.

Methods

Sixty human teeth were used, from which root canals were infected and randomly divided into the following treatment groups: saline solution, saline solution plus Ca(OH)₂, OxOral®, and OxOral® plus Ca(OH)₂.

Results

A permanent reduction in bacterial growth was observed at days 1, 6, 12, and 18 after OxOral® plus Ca(OH)₂ treatment from 4.4 ± 0.074 log₁₀ CFU/mL to 0.0 ± 0.001 log₁₀ CFU/mL. In addition, alkaline conditions maintenance was observed from application time (pH = 12.2 ± 0.033) to 18 d posttreatment (pH = 12.6 ± 0.083).

Conclusion

The combination of OxOral® and Ca(OH)₂ provides an alkaline pH and inhibits E. faecalis growth into the root canals. Our study opens the possibility for further research on the use of OxOral® in endodontic therapy.

Evaluation of Ozone Therapy in Endodontic Treatment of Teeth with Necrotic Pulp and Apical Periodontitis: A Randomized Clinical Trial

INTRODUCTION

The aim of this study was to compare the effect of different application techniques of ozone on the prevalence of postendodontic pain in patients undergoing single-visit root canal treatment.

METHODS

hundred eight patients with necrotic pulp in single-rooted teeth and apical periodontitis participated in the trial. A standard single-visit endodontics protocol was followed with 5.25% sodium hypochlorite and rotary nickel-titanium files. After shaping and cleaning, patients were randomly allocated into the following groups: group 1 (n = 21), ozone treatment with no activation (NA); group 2 (n = 22), ozone treatment with manual dynamic activation (MDA); group 3, (n = 21), ozone treatment with passive ultrasonic activation (PUA); group 4 (n = 23), ozone treatment with sonic activation (SA); and group 5 (n = 21), no ozone treatment (the control group). Patient levels of discomfort were recorded at 6 different time intervals using the visual analog scale (VAS). Comparison of the mean difference between the groups and time intervals was performed using 2-way analysis of variance followed by a post hoc Bonferroni test. The level of significance was set at 5%.

RESULTS

VAS scores were highest for the control > NA > MDA > SA > PUA groups. A statistically significant reduction in VAS scores was observed in the PUA and SA groups in comparison with the NA, control, and MDA groups. Timewise comparison showed a highly significant decline in VAS scores at all time intervals (P < .001).

CONCLUSIONS

Ultrasonic and sonic activation of ozone resulted in less pain in patients undergoing single-visit endodontics compared with no ozone treatment.

Effect of Cavity Disinfectants on Adhesion to Primary Teeth-A Systematic Review

Some authors have been proposing the use of cavity disinfectants in order to reduce, or even eliminate, the effect of the microorganisms present in a dental cavity before a restoration is placed. The aim of this study was to evaluate the effect of different cavity disinfectants on bond strength and clinical success of composite and glass ionomer restorations on primary teeth. The research was conducted using Cochrane Library, PubMed/MEDLINE, SCOPUS, and Web of Science for articles published up to February 2021. The search was performed according to the PICO strategy. The evaluation of the methodological quality of each in vitro study was assessed using the CONSORT checklist for reporting in vitro studies on dental materials. Sixteen in vitro studies and one in situ study fulfilled the inclusion criteria and were analyzed. Chlorhexidine was the most studied cavity disinfectant, and its use does not compromise dentin bonding. Sodium hypochlorite is a promising alternative, but more research on its use is required to clearly state that it can safely be used as a cavity disinfectant for primary teeth. Although other disinfectants were studied, there is a low-level evidence attesting their effects on adhesion, therefore their use should be avoided.

The antimicrobial effect of different ozone protocols applied in severe curved canals contaminated with Enterococcus faecalis: ex vivo study

The aim of this study was to evaluate 3 different irrigation protocols using ozone on monoculture biofilm of Enterococcus faecalis. Fifty disto-buccal roots of maxillary first molars were instrumented up to the size 25.08, sterilized and then incubated with Enterococcus faecalis for 21 days for biofilm maturation in the root canal walls. After contamination, the initial collection (S1) was performed and the 50 samples were divided in 3 experimental groups (n = 15) and 1 positive control group (n = 5) as follows: Group1: Ozonated water (40 µg/ml); Group2: gaseous ozone (40 µg/ml); Group3: Ozonated water (40 µg/ml) under continuous ultrasonic irrigation (CUI) and, Group 4: 2.5% sodium hypochlorite (positive control). The final collection (S2) was performed using hedstroem files # 25 by scraping the root canal wall and absorbed paper cone. The collected samples were analyzed by CFU/ml count and qPCR. To compare the effect of irrigation methods and to investigate E. faecalis count data, Kruskal-Wallis and Wilcoxon nonparametric tests were used at p < 05. The values of the differences between the S1 values and the S2 values revealed that the groups did not differ significantly for either E. faecalis CFU count data (p = 0.713) or q-PCR (p = 0.185), however, it is observed that for all groups, the CFU count of E. faecalis decreased over 99%. For the q-PCR assay, the reduction was on the order of 74-95%. Only the NaOCl positive control group presented total elimination of CFU/mL bacterial counting. The ozone protocols assessed were similar in regard to Enterococcus faecalis reduction.

Application of Selected Nanomaterials and Ozone in Modern Clinical Dentistry

This review is an attempt to summarize current research on ozone, titanium dioxide (TiO₂), silver (Ag), copper oxide CuO and platinum (Pt) nanoparticles (NPs). These agents can be used in various fields of dentistry such as conservative dentistry, endodontic, prosthetic or dental surgery. Nanotechnology and ozone can facilitate the dentist’s work by providing antimicrobial properties to dental materials or ensuring a decontaminated work area. However, the high potential of these agents for use in medicine should be confirmed in further research due to possible side effects, especially in long duration of observation so that the best way to apply them can be obtained.

Effect of Cavity Disinfectants on Dentin Bond Strength and Clinical Success of Composite Restorations-A Systematic Review of In Vitro, In Situ and Clinical Studies

Cavity disinfection becomes an important step before a dental restorative procedure. The disinfection can be obtained cleaning the dental cavity with antimicrobial agents before the use of adhesive systems. The aim of this study was to conduct a systematic review on the effect of different cavity disinfectants on restorations’ adhesion and clinical success. A search was carried out through the Cochrane Library, PubMed, and Web of Science. In vitro and in situ studies reporting results on dentin bond strength tests, and clinical studies published until August 2020, in English, Spanish and Portuguese were included. The methodological quality assessment of the clinical studies was carried out using the Revised Cochrane risk-of-bias tool. Chlorhexidine could preserve adhesion to dentin. EDTA and ethanol had positive results that should be further confirmed. Given the significant lack of scientific evidence, the use of lasers, fluoridated agents, sodium hypochlorite, or other products as cavity disinfectants should be avoided. Chlorhexidine is a safe option for cavity disinfection with adequate preservation of adhesion to dentin. Moreover, future researches should be focused on the efficacy of these disinfectants against cariogenic bacteria and their best application methods.

Comparative Evaluation of pH and In Vitro Cytotoxicity of Zinc Oxide-Ozonated Eugenol and Conventional Zinc Oxide Eugenol as Endodontic Sealers

Background:

Eugenol released from zinc oxide eugenol (ZOE)–based sealants may cause irritation to the periapical tissues and has cytotoxic potential. Ozone therapy has numerous clinical applications with humans because of its bactericidal action, detoxifying effect, stimulation of angiogenesis, and wound-healing capacity. Therefore ozone can be incorporated in ZOE sealer to exploit these properties.

Materials and Methods:

Eugenol was ozonated using ozonator machine and the samples were divided into two groups: Group I: zinc oxide eugenol (n = 10) and Group II: zinc oxide–ozonated eugenol (OZOE; n = 10). The pH of the fresh sealer samples and the set samples was measured using calibrated pH meter after predetermined time intervals. Cytotoxicity of the set sealer was evaluated on mouse L929 fibroblasts using cellular metabolic assay.

Results:

pH of the samples in Group II was higher when compared to Group I. Group II showed higher cell viability than the Group I.

Conclusion:

OZOE sealers can be used as an alternative to the conventional ZOE sealers.

The Combination of Diode Laser and Ozonated Water in the Treatment of Complicated Pulp Gangrene

The study aimed to investigate the effects of endodontic space decontamination using a laser combined with ozonated water in the therapy of complicated pulp gangrene. The subject of this in vivo study was a 12-year-old patient diagnosed with extensive periapical periodontitis on the mandibular right first molar. Biological samples were initially collected to identify the active pathogen—Enterococcus faecalis, then the nonsurgical endodontic treatment was performed in a single visit, according to the active disinfection guidelines of the identified pathogen. Two-month postoperative, clinical and radiological examination revealed a complete healing of the periapical lesion. The correct diagnosis of this endodontic–periodontal pathology, and the unconventional treatment of the complex system of infected root canals, allowed a favorable treatment result without any surgical intervention. This unconventional approach, which combines a laser technique with ozonated water, allows for predictable results in periapical lesion treatment.

Comparison of antimicrobial efficacy of aqueous ozone, green tea, and normal saline as irrigants in pulpectomy procedures of primary teeth

AIM

Sodium hypochlorite, though considered an ideal root canal irrigant, cannot be used at required concentrations in children, due to its undesirable effects. Hence, it is imperative to search for an ideal root canal irrigant to avoid these undesirable effects which we hope to achieve with this study. The antimicrobial efficacy of aqueous ozone, green tea, and normal saline as irrigants in pulpectomy procedures of the primary teeth has been compared.

MATERIALS AND METHODS

Sixty patients between 4 and 8 years of age with a single-rooted deciduous tooth indicated for pulpectomy were included. The infected teeth were randomly allocated to one of the three treatment groups based on the irrigating agents used, namely normal saline, green tea extract, or ozonated water. Specimens for anaerobic culture were collected three times from the teeth: before irrigation, after initial irrigation, and on the 3^rd day after final irrigation.

RESULTS AND CONCLUSION

Mean colony forming unit (CFU) count after both initial and final irrigation with ozonated water was significantly lower when compared with green tea and normal saline. Further, it was observed that the mean CFU count with green tea was significantly lower than the counts obtained with normal saline on the 3^rd day after final irrigation. Hence, both ozonated water and green tea could be considered a good alternative to conventional root canal irrigants in the primary teeth. Larger sample sizes with a larger variety of irrigants are recommended.

Cytotoxicity evaluation of a new ozonized olive oil

Objective:

The cytocompatibility of a new ozonized olive oil toward immortalized human gingival fibroblasts (HGFs) was evaluated and compared with two common antimicrobial agents based on chlorhexidine digluconate (CHX).

Materials and Methods:

The cytocompatibility of the samples was tested on immortalized HGF-1 cells by 3-(4, 5-dimethyl thiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) assay. The cells were incubated for 2 or 24 h with increasing dilution of ozonized olive oil or CHX agents. The percentage of viable cells was calculated relative to control cells set to 100%.

Results:

The ozonized olive oil is cytocompatible, and the viability values of the cells treated for 2 or 24 h with increasing concentrations of ozonized olive oil were significantly higher (P < 0.01) compared with the values obtained using CHX.

Conclusions:

The present data demonstrate that due to its cytocompatibility, the new ozonized olive oil could be considered an alternative antibacterial agent.

Antimicrobial efficacy of 2.5% sodium hypochlorite, 2% chlorhexidine, and ozonated water as irrigants in mesiobuccal root canals with severe curvature of mandibular molars

Objective

The aim of this study is to evaluate the antimicrobial efficacy of 2.5% sodium hypochlorite, 2% chlorhexidine, and ozonated water on biofilms of Enterococcus faecalis, Streptococcus mutans, and Candida albicans in mesiobuccal root canals with severe curvature of mandibular molars.

Materials and Methods

This was an experimental ex vivo study in microbiologic laboratory. Sixty mesiobuccal root canals with severe curvature of mandibular molars were contaminated with standard strains of E. faecalis, S. mutans, and C. albicans. The specimens were randomly divided into four groups (n = 15) according to irrigating solution: SH: 2.5% sodium hypochlorite; CH: 2% chlorhexidine; O₃: ozonated water; and control: double-distilled water. The mesiobuccal root canals of all groups were instrumented with the WaveOne Gold Primary reciprocating system. Three cycles of instrumentation with three short in-and-out brushing motions were performed: (1) in the coronal third, (2) in the middle third, and (3) in the apical third of the canal. A ProGlider file was used before the first cycle.

Statistical Analysis

Statistical analysis was performed using one-way analysis of variance followed by Tukey's multiple comparison test. Samples were collected for viable bacterial counts before and after instrumentation.

Results

All groups showed significant biofilm reduction after irrigation (P < 0.01). After instrumentation, sodium hypochlorite (98.07%), chlorhexidine (98.31%), and ozonated water (98.02%) produced a significantly reduction in bacterial counts compared with double-distilled water (control, 72.98%) (P < 0.01).

Conclusion

All irrigants tested in this study showed similar antimicrobial activity. Thus, ozonated water may be an option for microbial reduction in the root canal system.

Is it really penetration? Part 2. Locomotion of Enterococcus faecalis cells within dentinal tubules of bovine teeth

OBJECTIVE

The aim of the present vitro study was to examine the question whether devitalized Enterococcus faecalis (E. faecalis) cells can migrate into dentinal tubules and if that process takes place in a time-dependent manner.

DESIGN

Sixty bovine root canals were incubated with devitalized and vital streptomycin-resistant E. faecalis strains after root canal enlargement (size 80, taper .02) with 3% NaOCl solution. Incubation times 7, 14, 21, 28, 35, and 42 days. Samples were processed for analysis by scanning electron microscopy (SEM) and DAPI (4',6-diamidino-2-phenylindole) staining. The penetration depth was calculated with the measurement tool of the Axio Vision program (Zeiss, Jena, Germany). Statistical analysis was performed by Kruskal-Wallis (α = 0.05) and Mann-Whitney U test (p < 0.05).

RESULTS

Devitalized E. faecalis strains were able to migrate into dentinal tubules. The total number and penetration depth of devitalized E. faecalis cells was lower compared to the vital suspension of E. faecalis. It was noted, that bacterial penetration was not common to all of the dentinal tubules in the vital E. faecalis control and especially in the devitalized control. The migration took place in a time-dependent migration characteristic.

CONCLUSIONS

Devitalized E. faecalis cells are still able to migrate into the dentinal tubules due to possible electrokinetic and osmotic processes. Thereby, increased exposure times lead to a time-dependent penetration characteristic.

CLINICAL RELEVANCE

Since devitalized bacteria can migrate as well into dentinal tubules, the presence of bacteria within dentinal tubules cannot be interpreted as a failure of tested preparation regimens.

Evaluation of low-level diode laser irradiation and various irrigant solutions on the biological response of stem cells from exfoliated deciduous teeth

This study aimed to evaluate cytotoxic effects and the apoptosis of Gallium-Aluminum-Arsenide (GaAlAs) diode laser irradiation, sodium hypochlorite (NaOCl), ozonated water and ethylene diamine tetraacetic acid (EDTA) on stem cells from human exfoliated deciduous teeth (SHEDs). Cells were exposed to EDTA (5%, 8.5%, 17%), NaOCl (1%, 2.5%, 5%) ozonated water (5, 10, 20 μg/ml) and GaAlAs diode laser irradiation (energy densities of 0.5, 1, 1.5 j/cm²). Culture medium included D-MEM, supplemented with 15% foetal bovine serum, 1% l-glutamine, 1% penicillin-streptomycin, 1% gentamycin, amphotericin-B and served as control group. The prepared irrigants were added to the relevant wells and incubated with the cells at 37 °C for 5, 10 and 15 min. The cells in the laser group were also incubated at 37 °C for 5, 10 and 15 min after the laser application. Cell viability and proliferation were analysed with the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay. The percentage of cell viability showed a significant reduction in all concentrations of the EDTA and NaOCl groups when compared to the control group, diode laser irradiation and ozonated water groups at 5th, 10th and 15th minutes respectively but high cytotoxic effects of all EDTA and NaOCl groups with decreased over 50% of cell viability were observed at the 15th minute. Also EDTA group with 17% concentration (17%E) presented the lowest survival rate on SHEDs with mean of 21.67% ± 6.101 at this time interval. The lowest toxic effects were observed at the 5th minutes compared to other time periods at experimental groups. For detection of apoptotic cells, the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labelling (TUNEL) method was performed. According to the MTT results, doses showed the highest toxicity (cell survival decreased over 50%) in each group were selected for TUNEL assay (17% EDTA; 1% NaOCl; 10 μg/ml Ozonated water; 1.5 j/cm² diode laser irradiation). The significantly lowest percentages of TUNEL-positive cells were detected in ozonated water (10.67% ± 2.93) and diode laser irradiation (13.24% ± 7.61) compared to EDTA (39.89% ± 11.54) and NaOCl (31.15% ± 10.64) respectively. Also the difference between percentage of TUNEL-positive cells in EDTA and NaOCl groups was not significant. Synergistic combination of ozonated water and diode laser irradiation may be used in the disinfection step of necrotic root canals.

Kinetics of antifungal activity of home-generated ozonated water on Candida albicans

Background and Purpose:

Candida-associated denture stomatitis is one of the most common forms of oral candidiasis among denture wearers. Regarding this, the aim of the present study was to evaluate the antifungal effects of home-generated ozonated water on the adhesion of the C. albicans attached to the surface of the denture base acrylic resins.

Materials and Methods:

For the purpose of the study, different concentrations of C. albicans were added to the tubes containing acrylic resin blocks, and then incubated for 2 h at 35°C. The samples were assigned into three groups, each of which contained 42 samples, including normal saline (NS) solution as the negative control, nystatin (N) solution as the positive control, and ozonated water as the test group. The samples were washed and placed in an ultrasonic bath. Subsequently, the saline solution was cultured on Sabouraud dextrose agar. The concentrations of Candida were evaluated during the contact times.

Results:

The test group (i.e., ozonated water) with 114 colony-forming units (CFU) showed a significant reduction of Candida colonies, compared to the NS group with 2,172 CFU. The 120- and 1-minute incubation with ozonated water showed the highest and lowest effects on the viability of Candida adhered to the acrylic resin, respectively.

Conclusion:

Based on the findings, home-generated ozonated water can be applied to remove the Candida attached to the surface of the denture plates.

Demetallization of Enterococcus faecalis biofilm: a preliminary study

Objectives To determine the concentration of calcium, iron, manganese and zinc ions after the application of chelator to Enterococcus faecalis biofilms. Material and Methods Fifty bovine maxillary central incisors were prepared and inoculated with E. faecalis for 60 days. The following were used as irrigation solutions: 17% EDTA (pH 3, 7 and 10), 2.5% sodium hypochlorite (NaOCl) combined with 17% EDTA (pH 3, 7 and 10), distilled water (pH 3, 7 and 10), and 2.5% NaOCl. Each solution was kept in the root canal for five minutes. Fifteen uncontaminated root canals were irrigated with 17% EDTA (pH 3, 7 and 10). Six teeth were used as bacterial control. The number of calcium, iron, manganese and zinc ions was determined using flame atomic absorption spectrometry. Mean ± standard deviation (SD) values were used for descriptive statistics. Results Calcium chelation using 17% EDTA at pH 7 was higher than at pH 3 and 10, regardless of whether bacterial biofilm was present. The highest concentration of iron occurred at pH 3 in the presence of bacterial biofilm. The highest concentration of manganese found was 2.5% NaOCl and 17% EDTA at pH 7 in the presence of bacterial biofilm. Zinc levels were not detectable. Conclusions The pH of chelating agents affected the removal of calcium, iron, and manganese ions. The concentration of iron ions in root canals with bacterial biofilm was higher after the use of 17% EDTA at pH 3 than after the use of the other solutions at all pH levels.

Evaluation of Antimicrobial Efficacy of Nanosilver Solution, Sodium Hypochlorite and Normal Saline in Root Canal Irrigation of Primary Teeth

Background:

Bacteria are the main etiological factors in the development of dentinal caries and its progression to pulpal and periapical disease. Enterococcus faecalis is the bacterial species most frequently recovered from the root-filled teeth.

Aim:

This study aimed to evaluate the antimicrobial effectiveness of nanosilver (NS) solution as an endodontic irrigation solution of primary teeth against E. faecalis.

Settings and Design:

Thirty-six canals of primary teeth were selected for this ex vivo study.

Methods and Materials:

Thirty-six canals of primary teeth were prepared up to the file #35 and all of the specimens were sterilized. Then, root canals were inoculated with a suspension containing E. faecalis bacteria. The teeth were then randomly divided into three groups. Antimicrobial effectiveness was evaluated immediately after dividing into groups by counting colony-forming units on brain heart infusion broth plates.

Statistical Analysis:

Data were analyzed using Kolmogorov–Smirnov, Welch, and Dunnett's T3 tests.

Results:

Sodium hypochlorite showed the highest antimicrobial effectiveness against E. faecalis and showed significant differences compared with normal saline and NS solution (P < 0.001).

Conclusion:

Based on the results of this study, solution of NS particles can be used as an alternative to other root canal irrigating solutions.

Comparison of the Antimicrobial Efficacy of the EndoVac System and Conventional Needle Irrigation in Primary Molar Root Canals

PURPOSE

The purpose of this study was to compare the antimicrobial efficacy of the EndoVac system and conventional needle irrigation to eliminate E faecalis in primary molar root canals.

STUDY DESIGN

60 extracted human primary second molar roots were instrumented up to an apical size .04/35 and randomly divided into two groups; Group 1: conventional needle (n=30) and Group 2: EndoVac (n=30), and four subgroups (two experimental subgroups; (a) 2.5% sodium hypochlorite (NaOCl) + ethylenediaminetetraacetic acid (EDTA) (n=20), (b) ozonated water (OW) + EDTA (n=20), and control groups (c) 5.25% NaOCl (n=10) and (d) saline (n=10). All roots were sterilized and then inoculated with E.faecalis. Before and after final irrigation procedures, root canals were sampled and the grown colony forming units (CFUs) were counted. Data were analyzed by Kruskall-Wallis and Mann-Whitney U tests using a 0.05 significance level.

RESULTS

The EndoVac reduced more bacteria than the conventional needle did but it was not statistically significant (p>0.05). NaOCl alone or followed by EDTA totally eliminated bacteria. OW + EDTA showed higher reduction of bacteria but could not totally eliminate bacterias.

CONCLUSIONS

In the context of bacterial elimination, the EndoVac was not significantly better than the conventional needle. Although, there were fewer CFU/mg when using EndoVac, there was not any statistically significant superiority to conventional needle irrigation. An OW+EDTA regimen showed antibacterial effect in the primary molar root canals but it was significantly less effective than NaOCl+EDTA.

The effect of sodium hypochlorite concentration and irrigation needle extension on biofilm removal from a simulated root canal model

To investigate the effect of sodium hypochlorite concentration and needle extension on removal of Enterococcus faecalis biofilm, sixty root canal models were 3D printed. Biofilms were grown on the apical 3 mm of the canal for 10 days. Irrigation for 60s with 9 mL of either 5.25% or 2.5% NaOCl or water was performed using a needle inserted either 3 or 2 mm from the canal terminus and imaged using fluorescence microscopy and residual biofilm percentages were calculated using imaging software. The data were analysed using analysis of covariance and two-sample t-tests. A significance level of 0.05 was used throughout. Residual biofilm was less using 5.25% than with 2.5% NaOCl. Statistically significant biofilm removal was evident with the needle placed closer to the canal terminus. A greater reduction of available chlorine and pH was noted as the concentration increased. One-minute irrigation was not sufficient for complete biofilm removal.

Unusual Root Canal Irrigation Solutions

Microorganisms and their by-products play a critical role in pulp and periradicular pathosis. Therefore, one of the main purposes of root canal treatment is disinfection of the entire system of the canal. This aim may be obtained using mechanical preparation, chemical irrigation, and temporary medication of the canal. For this purpose, various irrigation solutions have been advocated. Common root canal irrigants, such as sodium hypochlorite, chlorhexidine, and a mixture of tetracycline, acid, and detergent have been extensively reviewed. The aim of this review was to address the less common newer root canal irrigation solutions, such as citric acid, maleic acid, electrochemically activated water, green tea, ozonated water, and SmearClear.

Effects of Diode Laser, Gaseous Ozone, and Medical Dressings on Enterococcus faecalis Biofilms in the Root Canal Ex Vivo

The objective was to compare the antibacterial effects of adjunctive disinfection using diode laser and gaseous ozone compared to the medical dressings calcium hydroxide (Ca(OH)₂) and chlorhexidine gel (CHX-Gel) on Enterococcus faecalis biofilms in human root canals ex vivo. Root canals of 180 human extracted teeth were infected by E. faecalis and divided into 3 main groups (G): G1, control; G2, instrumentation and irrigation using 0.9% NaCl; G3, instrumentation and irrigation using 1% NaOCl. In each main group, the following treatments were applied: gaseous ozone, diode laser, and medical dressings of Ca(OH)₂ or CHX-Gel for 7 days (n = 15). Reduction of colony forming units (CFUs) inside the root canal of planktons and frequencies of adherent bacteria after treatment were calculated. Bacterial reduction was significantly affected by the irrigation protocol (p < 0.0005) and the disinfection method (p < 0.0005), and a significant interaction between both factors could be observed (p < 0.0005; ANOVA). In G3 (instrumentation using 1% NaOCl), no significant effect of disinfection methods could be demonstrated on planktonic bacteria (p = 0.062; ANOVA) and frequencies of adherent bacteria (p > 0.05; chi-square test). Instrumentation and irrigation using NaOCl combined with ozone or laser application resulted in comparable bacterial reduction on E. faecalis to the application of medical dressings.

Ozone Gas Effect on Mineral Content of Dentin exposed to Streptococcus mutans Biofilm: An Energy-dispersive X-ray Evaluation

AIM

This study aims to assess the effect of ozone gas on dentin exposed to Streptococcus mutans biofilm by evaluation of mineral content [log calcium-to-phosphorus (Ca/P)] using energy-dispersive X-ray (EDX) spectroscopy.

MATERIALS AND METHODS

Five human third molars were sectioned into four slices of dentin and distributed in four groups: I - control (no treatment); II - ozone therapy; III - biofilm development; IV - ozone therapy followed by biofilm development. Mineral content (log Ca/P) was evaluated by EDX. Data were analyzed by analysis of variance and Tukey's test (p < 0.05).

RESULTS

Results showed that the mineral content of control group (I) was similar to ozone group (II), and was statistically higher than biofilm (III) and ozone + biofilm (IV). The lowest log Ca/P was determined in biofilm group (III).

CONCLUSION

It can be concluded that ozone gas did not grant preventive effects of demineralization by S. mutans biofilm on dentin surface.

CLINICAL SIGNIFICANCE

Ozone gas therapy may be an alternative noninvasive treatment aiming to reduce the levels of caries-associated microorganisms. This therapy may, thereby, be an alternative and/or complementary treatment strategy in preventive dentistry.

Common Operative Procedural Errors and Clinical Factors Associated with Root Canal Treatment

Abstract Operative procedural errors must be well analyzed in order to avoid influence negatively the root canal treatment (RCT) prognosis. The successful RCT prevents tooth loss and avoids pain and apical periodontitis. This review aimed to categorize common operative procedure errors and clinical factors associated with RCT. Based on this, will be approached common errors of procedures within the clinical operative sequence: endodontic treatment planning, pulp and periapical disease diagnosis, anaesthesia, access cavity preparation, isolation with rubber dam, root canal preparation, root canal filling and retreatment, restoration of endodontically treated teeth, postoperative pain, follow up of endodontically treated teeth. The professional must remind that in each phase of RCT an operative error may have adverse implication on prognosis, and these errors characterize risk factors to failure. The knowledge of probable operative procedural errors and its consequences are essentials to avoid future problems to the tooth health.

The Effect of Diode Laser on Planktonic Enterococcus faecalis in Infected Root Canals in an Ex Vivo Model

OBJECTIVE

This study examined the bactericidal effect of diode laser irradiation against intracanal Enterococcus faecalis.

METHODS AND MATERIALS

m total of 128 extracted single-rooted and single-canal teeth were treated with ProTaper instruments (Dentsply Maillefer, Ballaigues, Switzerland). A total of 120 root canals were inoculated with E. faecalis for 21 days, and the samples were randomly divided into five groups: Group 1 (n = 24) samples were irrigated with only saline solution (positive controls); Group 2 (n = 24) was treated with only 5.25% sodium hypochlorite; Group 3 (n = 24) was irrigated with saline solutions activated by diode laser; Group 4 (n = 24) was treated with 5.25% sodium hypochlorite activated by diode laser; and Group 5 (n = 24) was irrigated with saline solution with methylene blue dye activated by the diode laser Fox (Sweden & Martina, Padova, Italy); additionally, eight teeth were not contaminated and their canals were irrigated with saline solution and used as a negative control. The Uro-Quick system was used to determine the microbial residual charge. The data were analyzed using Pearson's chi-square test (p < 0.001).

RESULTS

A statistically significant reduction in bacterial count was observed in Group 2 and Group 4 (p < 0.001). There were no statistically significant differences among the other groups (p > 0.001).

CONCLUSIONS

Evidence indicates that the diode laser was not more effective than sodium hypochlorite in reducing free bacteria.

Bactericidal Efficacy of Photodynamic Therapy and Chitosan in Root Canals Experimentally Infected with Enterococcus faecalis: An In Vitro Study

OBJECTIVE

To evaluate the antibacterial efficacy of photodynamic therapy (PDT) and chitosan against Enterococcus faecalis and assess the possible enhancive effect of chitosan on the photosensitizer methylene blue in experimentally infected root canals of extracted human teeth in vitro.

BACKGROUND DATA

E. faecalis is frequently found in persistent endodontic infections. In this context, the antimicrobial PDT or newer antibacterial alternatives such as chitosan could become modern alternatives to existing antibacterial treatment approaches.

METHODS

One hundred two single-rooted extracted teeth were used. The teeth were contaminated with 0.1 mL E. faecalis (3 × 10⁸ cell/mL). These were randomized into six treatment groups (n = 17 teeth): Group 1 (2.5% NaOCl); Group 2 (PDT); Group 3 (chitosan 3 mg/mL); Group 4 (PDT+chitosan 3 mg/mL); Group 5 (positive control, no treatment); and Group 6 (negative control, no inoculation, no treatment). The canal content was sampled with sterile paper points. The samples were cultured on blood agar plates to determine the number of colony-forming units (CFU)/mL. Five teeth in each group were analyzed by scanning electron microscope (SEM) to determine the percentage of area with contamination and debris.

RESULTS

The positive control group showed the highest number of CFU/mL, with statistically significant differences in comparison with the other treatment groups (p ≤ 0.05). Group 4 (PDT+chitosan) showed the lowest CFU/mL count, followed by Group 2 (PDT alone), which obtained similar results to Group 1 (NaOCl), but there was no significance between the treated groups. SEM images showed that Group 4 (PDT+Chitosan) showed the lowest area of contamination.

CONCLUSIONS

Combination of PDT and chitosan showed antibacterial potential against endodontic infection by E. faecalis.

Antimicrobial activity of ozone and NaF-chlorhexidine on early childhood caries

An early childhood carie (ECC) is an extremely destructive form of tooth decay. The aim of this study was to investigate the action of ozone (O3), and the association of sodium fluoride (NaF) with chlorhexidine (CHX) on bacteria related to ECC. Overnight culture of the bacteria was performed. On exponential phase the suspension was adjusted (101-108 CFU/mL). A drop (10μL) of each concentration of bacteria was applied on sheep blood agar plates and treated with O3 (2, 20, 200, and 2,000 ppm); after 18 hours, recovery analysis of CFU verified the reduction of bacterial activity. For NaF-CHX, sterile 96-well plates were prepared and divided into groups: G1 (150 µL TSB); G2 (20 µL of bacteria + 25 µL CHX + 25 µL NaF); and G3 (150 µL TSB + 20 µL of bacteria + 50 µL water). The plates were verified by analysis of the optical density (0, 12, 14, 16, and 18 hours). The data from O3 test were submitted to ANOVA and Tukey's test (p < 0.05). For the data from NaF-CHX, the ANOVA 2-way and Bonferroni's test (p < 0.05) were used. The number of CFU/mL showed death > 3log10 (99.9%) for all bacteria (ozone ≥ 20ppm), while the combination of NaF-CHX was more effective (p < 0.001) compared to each substance tested alone and the control group. The antimicrobial agents tested were able to inhibit all bacteria tested; O3 seemed to be a good alternative for controlling progression of carious lesions, while the association of NaF-CHX showed to be a good antimicrobial with easy and inexpensive application.

Effect of EDTA on TGF-β1 released from the dentin matrix and its influence on dental pulp stem cell migration

Bioactive molecules stored in dentin, such as transforming growth factor beta1 (TGF-b1), may be involved in the signaling events related to dental tissue repair. The authors conducted an in vitro evaluation of the amount of TGF-b1 released from dentin slices after treatment with 10% ethylenediaminetetraacetic acid (EDTA), 2.5% sodium hypochlorite (NaOCl) or phosphate-buffered saline (PBS), and the effect of this growth factor on stem cell migration from human exfoliated deciduous teeth (SHED). Sixty 1-mm-thick tooth slices were prepared with or without the predentin layer, and treated with either 10% EDTA for 1 minute, 2.5% NaOCl for 5 days or kept in PBS. Tooth slice conditioned media were prepared and used for TGF-b1 ELISA and migration assays. Culture medium with different concentrations of recombinant human TGF-b1 (0.5, 1.0, 5.0 or 10.0 ng/mL) was also tested by migration assay. The data were evaluated by ANOVA and Tukey's test. Optical density values corresponding to media conditioned by tooth slices either containing or not containing the predentin layer and treated with 10% EDTA were statistically greater than the other groups and close to 1 ng/mL. Increased rates of migration toward media conditioned by tooth slices containing the predentin layer and treated with PBS, 10% EDTA or 2.5% NaOCl were observed. Recombinant human TGF-b1 also stimulated migration of SHED, irrespective of the concentration used. EDTA may be considered an effective extractant of TGF-b1 from the dentin matrix. However, it does not impact SHED migration, suggesting that other components may account for the cell migration.

Effects of photodynamic therapy, 2 % chlorhexidine, triantibiotic mixture, propolis and ozone on root canals experimentally infected with Enterococcus faecalis: an in vitro study

The aim of this study was to evaluate the antibacterial effect of photodynamic therapy (PDT), 2 % chlorhexidine (CHX). The teeth were contaminated with 0.1 mL Enterococcus faecalis (3 × 10⁸ cell/mL) and randomized into eight treatment groups: Group 1 (2.5 % NaOCl); Group 2 (PDT); Group 3 (2 % CHX); Group 4 (TAM); Group 5 (propolis), Group 6 (ozone), Group 7 (positive control) and Group 8 (negative control). Following treatment, the canal content was sampled. The samples were cultured in triplicate on blood agar plates to determine the number of colony forming units (CFU)/mL. The teeth were analyzed by SEM to determine the percentage of area with contamination and debris. The group with the lowest CFU/mL count was the ozone group, which obtained similar values to the PDT group. SEM images showed that 2.5 % NaOCL group showed the lowest percentage of contaminated area. Applications of PDT, 2 % CHX, TAM, propolis and ozone showed antibacterial potential similar to 2.5 % NaOCL.

Endodontic Treatment of an Autogenous Transplanted Tooth Using an Er,Cr:YSGG Laser and Radial Firing Tips: Case Report

OBJECTIVE AND BACKGROUND

Although several surgical techniques have been reported, no study has yet reported alternative strategies for endodontic treatment of autogenous transplanted teeth. Therefore, the aim of this clinical report is to present the long-term endodontic outcome of a nonvital autogenously transplanted third molar treated with an Er,Cr:YSGG laser and radial firing tips (RFTs).

CASE REPORT

Autogenous tooth transplantation can be considered an alternative to restore edentulous areas and, in donor's teeth with complete root formation, root canal treatment should be performed up to 14 days following transplantation. In the present case report, the patient returned only after 6 months, with clinical and radiological signs of apical periodontitis (AP) associated with the transplanted tooth.

METHODS

Instead of traditional endodontic chemical irrigants or medications, the protocol for smear-layer removal and root canal disinfection was based on intracanal irradiation with an Er,Cr:YSGG laser and RFTs.

RESULTS

After 3-years' follow-up, the complete reestablishment of the periodontal ligament and the arrest of the resorptive process could be noticed.

CONCLUSIONS

This protocol has shown to be effective for the endodontic treatment of a transplanted multi-rooted tooth with AP. Further randomized clinical trials should be conducted to clearly demonstrate the effectiveness of this laser-assisted endodontic protocol.

Ozone- A Biological Therapy in Dentistry- Reality or Myth?????

The usage of ozone in dentistry has been proposed because of its antimicrobial, disinfectant, biocompatibility and healing properties. In the last decade a number of therapeutic protocols with ozone have been developed to address common dental infections associated with periodontal disease, RCT and caries. Despite these advantages, therapeutic ozone's application in dentistry is limited because of its possible side effects. Hence, dental practitioners need to know the proper usage of ozone therapy that can provide better patient care and considerably cut down the time and cost of the treatment.

Characterization of successful root canal treatment

Knowing the outcome of root canal treatment (RCT) is determinant to substantiate the clinical decision making process, especially when RCT is weighed against the extraction of natural teeth or replacement by prosthetic elements. The ideal scenario in all clinical situations should combine healing/prevention of disease (apical periodontitis) and the functional retention of the tooth. Understanding the risk factors associated with endodontic failure is a key factor to increase the chances of success. The logical action is to reverse the existing disease, which requires intervention to neutralize the bacterial invasion and disrupt the bacterial biofilm within the complex anatomy. Success is more predictable when the immune host defenses are favorable. However, success has different meanings to the dentist, to the patient and to the tooth itself. The life of an endodontically treated tooth depends on the accuracy of the diagnosis and planning, excellence of disinfection, instrumentation and filling procedures (antimicrobial strategies, root canal shaping and coronal and apical seal) and finally the rehabilitation management. The interpretation of constant or intermittent pain and/or discomfort associated with apical periodontitis (AP) in endodontically treated tooth may be suggestive of endodontic failure. The success features of RCT, namely absence of pain, regression of AP, tight seal of canal and coronal spaces, and recovery of tooth function, must be reevaluated over time. In case of doubt between success and failure, cone beam computed tomography (CBCT) could be indicated for detection and precise localization of AP. The possibility of map reading on CBCT images characterizes the real multidimensional structure, providing accurate information on the presence, absence or regression of AP. The survival of an endodontically treated tooth implies understanding the biological and mechanical outcomes as multifactorial events over the individual's life span. The objective of this review of literature is to discuss relevant factors associated with patient's health, tooth and dentist that could account for a successful RCT.

Effect of ozonated oil and chlorhexidine gel on plaque induced gingivitis: A randomized control clinical trial

BACKGROUND

Several chemotherapeutic agents have been developed to prevent gingivitis and its progression into periodontitis. In this present study, the efficacy of ozonated oil and chlorhexidine gel was assessed and compared on plaque induced gingivitis.

AIM

To evaluate the effect of ozonated oil on plaque induced gingivitis and to compare its efficacy with chlorhexidine gel.

MATERIALS AND METHODS

A total of 20 subjects, aged from 18 to 65 years, with plaque-induced gingivitis were selected from the outpatient Department of Periodontology, Government Dental College and Hospital, Aurangabad, for this study. They were divided randomly into the test or ozonated oil group (Group I) and the control or chlorhexidine gel group (Group II) with 10 subjects in each group. Subjects were randomly assigned to massage their gingiva thrice a day for 3 weeks with ozonated oil (test), and chlorhexidine gel (control). Plaque index and gingival index scores were recorded for the 20 subjects at baseline and after 3 weeks.

RESULTS

Ozonated oil (Group I) and chlorhexidine gel (Group II) groups showed statistically significant differences with respect to plaque index and gingival index, from the baseline to 3 weeks (P < 0.001 in both). But the difference between Group I and Group II, at the end of the study period, was not statistically significant with respect to the plaque index and gingival index.

CONCLUSIONS

The ozonated oil and chlorhexidine gel, both can be used as an effective agent in maintaining and improving gingival health.

Antibacterial Activity of Diode Laser and Sodium Hypochlorite in Enterococcus Faecalis-Contaminated Root Canals

Introduction:

The aim of the present in vitro study was to evaluate the disinfection ability of 980-nm diode laser in comparison with sodium hypochlorite (NaOCl) as a common root canal irrigant in canals infected with Enterococcus faecalis (E. faecalis).

Methods and Materials:

The root canals of 18 extracted single-rooted premolars were prepared by rotary system. After decoronation, the roots were autoclaved. One specimen was chosen for the negative control, and the remaining teeth were incubated with E. faecalis suspension for two weeks. Subsequently, one specimen was selected as the positive control and the remaining samples were divided into two groups (n=8). The samples of the first group were irrigated with 5.25% NaOCl and the second group were treated with a 980-nm diode laser. Microbial samples were taken from the root canals and bacterial cultivation was carried out. The average value and the standard deviation of colony-forming units (CFU) of each specimen were measured using descriptive statistics. The student’s t-test was used to compare the reduction in CFU in each group. The equality of variance of CFU was measured by the Levene’s test.

Results:

NaOCl resulted in 99.87% removal of the bacteria and showed significantly more antibacterial effect compared to the 980-nm diode laser which led to 96.56% bacterial reduction (P<0.05).

Conclusion:

Although 5.25% NaOCl seems to reduce E. faecalis more effectively, the diode laser also reduced the bacterial count. Therefore a 980-nm diode laser could be considered as a complementary disinfection method in root canal treatment.

Effect of Instrumentation Techniques, Irrigant Solutions and Artificial accelerated Aging on Fiberglass Post Bond Strength to Intraradicular Dentin

OBJECTIVE

To evaluate the effect of instrumentation techniques, irrigant solutions and specimen aging on fiberglass posts bond strength to intraradicular dentine.

MATERIALS AND METHODS

A total of 120 bovine teeth were prepared and randomized into control and experimental groups resulting from three study factors (instrumentation techniques, irrigant solutions, specimen aging). Posts were cemented with RelyX U100. Samples were submitted to push-out test and failure mode was evaluated under a confocal microscope.

RESULTS

In specimens submitted to water artificial aging, nickel-titanium rotary instruments group presented higher bond strength values in apical third irrigated with NaOCl or chlorhexi-dine. Irrigation with NaOCl resulted in higher bond strength than ozonated water. Artificial aging resulted in significant bond strength increase. Adhesive cement-dentin failure was prevalent in all the groups.

CONCLUSION

Root canal preparation with NiTi instruments associated with NaOCl irrigation and ethylenediaminetetra acetic acid (EDTA) increased bond strength of fiberglass posts cemented with self-adhesive resin cement to intraradicular dentine. Water artificial aging significantly increased post-Clinical significance: The understanding of factors that may influence the optimal bond between post-cement and cement-dentin are essential to the success of endodontically treated tooth restoration.

Antibacterial Potential of 2.5% Sodium Hypochlorite in Distinct Irrigation Protocols on Enterococcus faecalis Biofilm

OBJECTIVE

The aim of this study was to evaluate the effect of irrigation methods on antibacterial potential of 2.5% NaOCl on Enterococcus faecalis biofilm.

MATERIALS AND METHODS

Enterococcus faecalis biofilms were prepared during 60 days on 48 human root canals and randomized into control and experimental groups using positive and negative pressure irrigation. Bacterial growth was analyzed using turbidity of culture medium followed by UV spectrophotometry, and scanning electron microscopy (SEM) analyses were performed. Mean and standard deviations were used for evaluate the mean optical densities associated to the number of bacteria present culture, and Scheirer-Ray-Hare (an extension of the Kruskal-Wallis test) and Tamhane test to analyze the SEM images in the groups and thirds. Significance was set at 5%.

RESULTS

Enterococcus faecalis was still present after root canal cleaning regardless of irrigation methods or bacterial identification methods.

CONCLUSION

Positive and negative pressure irrigation protocols using 2.5% NaOCl show a similar capacity to reduce E. faecalis in infected root canals.

Bactericidal effects of various irrigation solutions against staphylococcus aureus in human root canal

Purpose:

The aim of the present study was to evaluate and to compare the antibacterial effects of various irrigation solutions against Staphylococcus aureus (S. aureus) in human root canals.

Materials and Methods:

120 single-root mandibular premolar teeth were selected. The teeth were prepared and sterilized. S. aureus was incubated in the root canals and kept at 37°C for 24h. The infected root canals were divided into one positive (saline) and one negative (sodium hypochlorite) control, and four experimental groups [Ethylene-diaminetetra-aceticacid, Chlorhexidine Gluconate, Super-oxidized water(SPO), Aqueous ozone] (n=20). Flow rate of irrigation was applied with 5 mL/min flow rate for 3 min to ensure standardization among all study groups. Following the irrigation, paper points were placed in the root canals and then transferred in sterile eppendorf. Remaining bacteria were counted on blood agar plates and the data were analyzed using one-way ANOVA and Tukey’s test.

Results:

Although there were statistically significant differences among SPO and other experimental groups (p<0.05), there was no statistically significant difference between SPO and NaOCl (p>0.05).

Conclusion:

Super-oxidized water may be recommended as an alternative irrigation solution instead of NaOCl against S. aureus in root canals.

Antimicrobial effect of ozonated water, sodium hypochlorite and chlorhexidine gluconate in primary molar root canals

OBJECTIVE

The aim was to determine the antimicrobial effect of ozonated water, ozonated water with ultrasonication, sodium hypochloride and chlorhexidine (CHX) in human primary root canals contaminated by Enterococcus faecalis (E. faecalis).

MATERIALS AND METHODS

Fifty-eight extracted human primary molar teeth were used. Crowns were cut off using a diamond saw under water-cooling. One hundred roots were obtained and mechanically prepared. The roots were then sterilized by autoclaving in water for 15 min at 121°C. All samples were contaminated with E. faecalis for 24 h and the root canals were randomly divided into five groups (n = 20). Group I: 25 mg/L of Ozonated water (O3aq), Group II: 25 mg/L of O3aq with ultrasonication, Group III: 2.5% Sodium hypochloride (NaOCl), Group IV: 2% CHX and Group V: Positive control. The canal of each specimen was irrigated for 4 min and positive control was untreated. All root canals were agitated with sterile saline solution. The saline solution was collected from canals with sterile paper points. For each specimen, the paper points were transposed to eppendorf vials containing 2 ml of brain heart infusion. According to bacterial proliferation, the mean values of optical density were achieved by ELİSA (Biotek EL ×800, Absorbance Microplate Reader, ABD) and the data were analyzed.

RESULTS

NaOCI, CHX and two types of O3aq were found statistically different than positive control group. NaOCI irrigation was found significantly most effective.

CONCLUSIONS

NaOCl, CHX and O3aq applications provide antibacterial effect in vitro conditions in primary root canals.