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Drews DJ, Nguyen AD, Diederich A, Gernhardt CR. The Interaction of Two Widely Used Endodontic Irrigants, Chlorhexidine and Sodium Hypochlorite, and Its Impact on the Disinfection Protocol during Root Canal Treatment. Antibiotics (Basel) 2023; 12:antibiotics12030589. [PMID: 36978457 PMCID: PMC10044599 DOI: 10.3390/antibiotics12030589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
In recent years, sodium hypochlorite and chlorhexidine digluconate have been the gold standard of irrigation solutions utilized within the disinfection protocol during root canal treatments. Nowadays, it is known that, during chemical disinfection of the root canal, consecutive application of sodium hypochlorite and chlorhexidine digluconate leads to the formation of an orange-brown precipitate. This precipitate is described as being chemically similar to para-chloroaniline, which is suspected to have cytotoxic and carcinogenic effects. Concerns also exist regarding its influence on the leakage of root canal fillings, coronal restorations, and tooth discoloration. The purpose of this article is to review the literature on the interaction of sodium hypochlorite and chlorhexidine digluconate on the tooth and its surrounding tissues, and to discuss the effect of the precipitate formed during root canal treatment. We further address options to avoid the formation of the precipitate and describe alternative irrigation solutions that should not interact with sodium hypochlorite or chlorhexidine digluconate.
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Affiliation(s)
- Dirk-Joachim Drews
- Private Dental Practice, 69469 Weinheim, Germany
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Anh Duc Nguyen
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Antje Diederich
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
| | - Christian Ralf Gernhardt
- University Outpatient Clinic for Conservative Dentistry and Periodontology, Martin-Luther-University Halle-Wittenberg, 06112 Halle, Germany
- Correspondence: ; Tel.: +49-345-557-3741
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Orhan EO, Irmak Ö, Hür D. What does not form after accidental sodium hypochlorite contact with chlorhexidine? Int Endod J 2022; 55:685-688. [PMID: 35511028 DOI: 10.1111/iej.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/23/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ekim Onur Orhan
- Translational Medicine Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey.,Department of Endodontics, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Özgür Irmak
- Department of Restorative Dentistry, Faculty of Dentistry, Near East University, Nicosia, Cyprus
| | - Deniz Hür
- Department of Chemistry, Faculty of Science, Eskişehir Technical University, Eskisehir, Turkey
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Celik D, Ozalp Koca AT, Kosar T, Tasdemir T. The effects of final irrigants on the push-out bond strength of two calcium silicate-based root canal sealers: an in vitro study. Eur Oral Res 2021; 55:146-151. [PMID: 34746786 PMCID: PMC8547750 DOI: 10.26650/eor.2021922696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/17/2021] [Accepted: 05/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose: The purpose of the present study was to investigate the effect of the different
irrigant combinations used in final irrigation on the push-out bond strength of root
canal sealers that have different compositions. Materials and methods: In total 60 dentinal slices in 1 mm thickness were collected from 15 extracted
mandibular premolar teeth; 4 slices from each tooth. 3 canal-like artificial cavities
were opened on each dentinal slice. Samples were divided into 4 experimental
groups, each of which consisted of 15 samples. In group 1, samples were immersed
in 5.25% NaOCl and 17% EDTA solutions respectively; in group 2, immersed in
5.25% NaOCl and 2% CHX solutions respectively; in group 3, immersed in 5.25%
NaOCl, 17% EDTA and 2% CHX solutions respectively; and in group 4 immersed
in distilled water. After drying with absorbent papers, each cavity in dentinal slice
sample was filled with different sealer (Endoseal MTA, Tech Biosealer Endo or AH
Plus). Two days later, the push-out bond examination was performed. Results: AH Plus showed higher push-out bond strength value in two combinations (group
2 and 3) in which final irrigants contained CHX (p<0.001). Dentinal push-out bond
strengths of root canal sealers from Endoseal MTA and Tech BioSealer Endo were
not affected by final irrigant (p=0.965). Conclusion: Using CHX after NaOCl in final irrigant increases push-out strength of epoxy resinbased
sealer but, did not create any difference in dentinal push-out bond strength
of calcium silicate-based sealers.
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Affiliation(s)
- Davut Celik
- Department of Endodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
| | - Ayse Tuba Ozalp Koca
- Department of Endodontics, Faculty of Dentistry, Bahcesehir University, IstanbulTurkey
| | - Tugba Kosar
- Department of Endodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
| | - Tamer Tasdemir
- Department of Endodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
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Khatib MS, Ameer B, Ajit Mannur N, Ramalingaiahsetty AM, Peerzade SM, Bambawale A. Decoding the Perplexing Mystery of Para-Chloroaniline Formation: A Systematic Review. J Int Soc Prev Community Dent 2020; 10:142-147. [PMID: 32670901 PMCID: PMC7340001 DOI: 10.4103/jispcd.jispcd_488_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/26/2019] [Accepted: 12/30/2019] [Indexed: 11/04/2022] Open
Abstract
Objective The objective of this article was to understand and decode the mystery of the formation of para-chloroaniline (PCA). The ingredient of the brown precipitate after mixing sodium hypochlorite (NaOCl) and chlorhexidine gluconate (CHX) is still in debate. Materials and Methods Various studies adopt a different methodology to substantiate that it may contain PCA, which is a carcinogenic agent. The purpose of this systematic review is to evaluate the relationship between PCA and brown precipitate. Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies were manually searched. There was no disagreement between the two reviewers. This review was reported and conducted in step with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Of 233 articles, only 13 articles met the inclusion criteria. Available scientific evidence was more supportive that the brown precipitate form after mixing NaOCl and CHX may form para-chloroamide moiety rather than free PCA, and PCA may be the by-product of CHX degradation. Conclusion On the basis of the current evidence and data extracted from the various databases, it can be concluded that the mixture of sodium hypochlorite and chlorhexidine does not form PCA, and PCA may be the by-product of high concentrated chlorhexidine. Further studies are required to substantiate the evidence.
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Affiliation(s)
- Mohd Sibghatullah Khatib
- Department of Conservative Dentistry and Endodontics, Dr. Syamala Reddy Dental College Hospital and Research Centre, Bangalore, India
| | - Bilal Ameer
- SJM Dental College and Hospital, Chitradurga, India
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Wu D, Ma YZ, Jia J, Xin BC, Wang DS, Sun DG, Wang LX. Removal of the root canal smear layer using Carisolv III and sodium hypochlorite. Medicine (Baltimore) 2020; 99:e20372. [PMID: 32481420 DOI: 10.1097/md.0000000000020372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present study investigated the effectiveness of a Carisolv III + 0.5% sodium hypochlorite (NaOCl)-based root canal irrigant for smear layer removal.Forty maxillary incisors were randomly divided into 4 groups (n = 10 per group). The canals in group A (experimental) were prepared with 0.5% NaOCl, and Carisolv III and 0.5% NaOCl was used for the final washing; groups B and C (positive controls) used 2% and 5.25% NaOCl, respectively; and group D (negative control) used phosphate-buffered saline (PBS). Ethylenediaminetetraacetic acid (EDTA) was used for all of the groups. A 5-point scoring scale and scanning electron microscopy were used to evaluate the effectiveness of the irrigants. The canals were consistently cleaner in the coronal and middle thirds than in the apical thirds (P < .05).For cleaning the root canals, 5.25% NaOCl was more effective than 2% NaOCl, 0.5% NaOCl + Carisolv III, and phosphate-buffered saline , respectively (P < .05). The 2% NaOCl solution showed similar results to 0.5% NaOCl + Carisolv III (P > .05). The combination of 5.25% NaOCl and 17% EDTA remains the most effective irrigant for removal of the root canal smear layer.A combination of Carisolv III + 0.5% NaOCl (with 17% EDTA) showed a cleaning ability similar to that of 2% NaOCl (with 17% EDTA).
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Affiliation(s)
- Di Wu
- Department of Cariology and Endodontology, Qingdao Stomatological Hospital, Qingdao
| | - Yong-Zhen Ma
- Department of Stomatology, Tai'an City Central Hospital, Tai'an
| | - Jing Jia
- Department of Stomatology, Tai'an City Central Hospital, Tai'an
| | - Bing-Chang Xin
- Department of Cariology and Endodontology, Qingdao Stomatological Hospital, Qingdao
| | - Da-Shan Wang
- Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - De-Gang Sun
- Department of Cariology and Endodontology, Qingdao Stomatological Hospital, Qingdao
| | - Ling-Xiang Wang
- Department of Cariology and Endodontology, Qingdao Stomatological Hospital, Qingdao
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Buyukozer Ozkan H, Terlemez A, Orhan EO. Proton Nuclear Magnetic Resonance Spectroscopy Analysis of Mixtures of Chlorhexidine with Different Oxidizing Agents Activated by Photon-Induced Photoacoustic Streaming for Root Canal Irrigation. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:374-379. [PMID: 32119810 DOI: 10.1089/photob.2019.4734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: The aim of this in vitro study was to investigate the possible interactions between photon-induced photoacoustic streaming (PIPS™)-activated oxidizing agents and 2% chlorhexidine digluconate. Background data: There is no information about the safety of laser-activated oxidizing agents in combination usage with chlorhexidine gluconate. Materials and methods: Groups were designed as follows G1: 98% para-chloroaniline (PCA); G2: 2% chlorhexidine (CHX); G3: 5.25% sodium hypochlorite (NaOCl) +2% CHX; G4: 5.25% NaOCl (30 sec PIPS activated) +2% CHX; G5: 5.25% NaOCl (60 sec PIPS activated) +2% CHX; G6: 3.5% chlorine dioxide (ClO2) + 2% CHX; G7: 3.5% (ClO2) (30 sec PIPS activated) +2% CHX; G8: 3.5% (ClO2) (60 sec PIPS activated) +2% CHX. The laser-irrigation protocol was performed with an erbium:yttrium-aluminum-garnet laser with a wavelength of 2940 nm equipped with a 140 mm long endodontic fiber tip (PIPS) using 10 mJ at 15 Hz (0.15 W), per pulse operating outputs. Groups were analyzed with proton nuclear magnetic resonance spectroscopy, using PCA as an internal standard. Results: No free PCA was formed in any groups of mixtures or after PIPS activation. Conclusions: Mixing of 3.5% ClO2 and 2% CHX does not form bulky precipitates, unlike the mixture NaOCl + CHX. PIPS activation does not cause changes in reactions of oxidizing agents.
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Affiliation(s)
- Hatice Buyukozer Ozkan
- Department of Endodontics, Faculty of Dentistry, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Arslan Terlemez
- Department of Endodontics, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
| | - Ekim Onur Orhan
- Department of Endodontics, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
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Arslan H, Karataş E, Keskin A. Response to the letter: 'Comments on misinterpretation of the proton nuclear magnetic resonance spectroscopic data of a previous study' by Orhan&Irmak. Int Endod J 2020; 53:285-286. [PMID: 31917483 DOI: 10.1111/iej.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Arslan
- Department of Endodontics, Faculty of Dentistry, Istanbul Health Sciences University, Istanbul, Turkey.,Department of Endodontics, Faculty of Dentistry, Eastern Mediterranean University, Famagusta, Turkey
| | - E Karataş
- Department of Endodontics, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - A Keskin
- Eti Krom Research&Development Center, Elazığ, Turkey
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Orhan EO, Irmak O. Comments on misinterpretation of the proton nuclear magnetic resonance spectroscopic data of a previous study. Int Endod J 2019; 52:1397-1398. [PMID: 31407361 DOI: 10.1111/iej.13167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E O Orhan
- Department of Endodontics, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - O Irmak
- Department of Restorative Dentistry, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey
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