A Review Over Benefits and Drawbacks of Combining Sodium Hypochlorite with Other Endodontic Materials

Is a mix - A fix? "A microscopic analysis of depth of penetration of three combinations of irrigants"

Aims

The aim of the study is to evaluate the penetration depth of irrigants mixed with NaOCl into dentinal tubules at the apical third of the root canal using a confocal laser scanning microscope (CLSM).

Materials and Methods

Thirty-six single-rooted teeth were selected, decoronated, and straight-line access established. Then, the canal was enlarged with hand Protaper till size F3. The samples were divided randomly into three groups: Group 1 was irrigated with 3% NaOCl mixed with 1% phytic acid; Group 2 was irrigated with 3% NaOCl mixed with 18% etidronic acid; and Group 3 was irrigated with 3% NaOCl mixed with chitosan. The samples were subjected to CLSM evaluation. One-way analysis of variance with Tukey's post hoc was used for statistical analysis.

Results

Group 3 (NaOCl with chitosan) showed a greater depth of penetration in comparison to Groups 1 and 2.

Conclusion

Within limitations, it can be concluded that chitosan, in combination with NaOCl can be used as an alternative to the current irrigation protocol.

The effect of nanobased irrigants on the root canal dentin microhardness: an ex-vivo study

BACKGROUND

Given the favorable antimicrobial properties of zinc oxide (ZnONPs), standard silver (AgNPs), and imidazolium-based silver (Im-AgNPs) nanoparticles, this study aimed to evaluate their influence on the microhardness of root canal dentin.

METHODS

In this experimental study, 40 mandibular premolars were decoronated at the cementoenamel junction and longitudinally sectioned into halves to create 80 specimens. They were randomly allocated to 5 groups (n = 16) and irrigated with ZnONPs, AgNPs, Im-AgNPs, NaOCl, or normal saline (as the negative control) for 15 min. The Vickers Hardness Number (VHN) was measured on each root canal third before and after being soaked in irrigants. Statistical analysis was performed using paired t-test, one-way ANOVA, and post hoc Tukey's test (α = 0.05).

RESULTS

Im-AgNPs and ZnONPs irrigants improved the microhardness of root dentin, whereas, AgNPs and NaOCl decreased it. ZnONPs yielded the highest VHN at the coronal third (P˂0.001), while the Im-AgNPs provided the highest VHN at the middle and apical thirds (P˂0.001). The AgNPs group showed the lowest VHN at the apical third.

CONCLUSIONS

The irrigants containing Im-AgNPs and ZnONPs significantly enhanced the root dentin microhardness. However, the use of AgNPs resulted in decreased microhardness.

Comparative evaluation of antimicrobial efficacy of nanosilver solution, Azadirachta indica, sodium hypochlorite, and normal saline as root canal irrigants in primary teeth

Background

Microorganisms are the main cause of pulpal and periapical diseases. Hence, the elimination of such potential microbes is achieved by endodontic treatment. Mechanical preparation is the main mechanism to reduce the bacterial load in canals which is enhanced by intracanal irrigants. Despite these procedures, some bacteria might persist within the canals. It is important to disinfect the pulp space and dentinal tubules thoroughly with an effective endodontic irrigant to prevent reinfection of a treated root canal.

Aim

This study aimed to evaluate and compare the antimicrobial efficacy of nanosilver (NS) Solution, Azadirachta indica, sodium hypochlorite, and normal saline when used as irrigants in infected root canals of primary teeth.

Settings and Design

The study was a prospective randomized control trial which was conducted as per the consort statement.

Materials and Methods

Eighty pulpally involved primary teeth requiring endodontic treatment of children aged 5-12 years were selected for this study. The subjects were randomly allocated to 4 groups (3 irrigant and control groups) consisting of 20 children each where Group I = NS solution, Group II = A. indica, Group III = Sodium hypochlorite (2.5%), and Group IV = Control group. Microbiological samples were collected at the baseline (before irrigation) and postirrigation after biomechanical preparation using the selected irrigant. The samples were subjected to an anaerobic bacterial culture test. Microbial colonies were identified and expressed as colony forming units per milliliter.

Statistical Analysis

Data were analyzed using one-way analysis of variance, Paired t-test, and Post hoc Bonferroni test.

Results

NS solution showed the highest mean of 4.384 × 10³ ± 1.019 followed by Sodium hypochlorite with a mean of 3.500 × 10³ ± 1.193 and A. indica of 2.590 × 10³ ± 0.778.

Conclusion

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

Current Trends in Irrigation Solution and Adjunct Use During Endodontic Therapy Among Dental Professionals in Jeddah, Saudi Arabia: A Cross-Sectional Study

Introduction  Chemical irrigation is a crucial component of endodontic therapy, and irrigation adjuncts increase the efficiency of non-surgical root canal system disinfection, reduce microbial loads, and enhance the penetration of irrigants throughout the root canal system. This study aimed to determine the current trends in chemical irrigation and its adjunct use during root canal therapy by general dental practitioners (GDPs) and endodontic specialists in both government and private sectors in the city of Jeddah, Saudi Arabia. Methods This cross-sectional study used a self-administered survey sent to GDPs and endodontic specialists in both government and private sectors in the city of Jeddah, Saudi Arabia. Responses were accepted from November 2019 till May 2020. The survey was randomly distributed to consenting participants. The results are presented using descriptive statistics. Results A total of 302 participants responded to the survey, with a 44% response rate. The majority of responses were from GDPs (54%), while 46% were from endodontic specialists. Regarding the workplace, 59% of respondents were public sector professionals, 25% were private sector professionals, and 16% were both public and private sector professionals. Around 30% of the respondents used sodium hypochlorite (NaOCI) as their primary irrigation solution during root canal treatment, with 52% using it at its full-strength concentration and 18% and 17% preferring to use it in combination with Ethylenediaminetetraacetic acid (EDTA) only or EDTA and saline, respectively. When asked to rank the reasons for choosing their irrigant of choice during therapy; antibacterial capability and tissue dissolution were the most crucial factors to 80% and 57% of participants, respectively. Half of the respondents irrigated the canal to 2 mm from the apex and 21% irrigated to 1 mm from the apex. Three-quarters of participants aimed to remove the smear layer during root canal treatment. Only 47% of respondents used adjuncts to irrigation, and 71% reported that their choice of irrigation solution would differ depending on whether the apex is open or closed. Conclusion Most respondents used full-strength NaOCI concentration as the main irrigation solution and routinely removed the smear layer during root canal treatment. Only 47% of respondents used irrigation adjuncts such as ultrasonics.

Use of Adjunct Antiseptic Agents in Periprosthetic Joint Infections

Periprosthetic joint infection is a leading cause for failure of contemporary total hip arthroplasty and total knee arthroplasty projected to nearly double in the next decade and reach an economic burden of $1.85 billion in the United Sates by 2030. Although multiple treatments for periprosthetic joint infection have been described, a thorough débridement and joint lavage to decrease bacterial bioburden and to remove biofilm remains a critical component of treatment. Various adjunct antiseptic agents such as chlorhexidine, povidone-iodine, hydrogen peroxide, acetic acid, and chlorine compounds are currently in off-label use in this capacity. Each antiseptic agent, however, has a distinct mechanism of action and targets different organisms, and some combinations of agents may lead to tissue toxicity. In this review, currently available adjunct antiseptic washes will be described in detail based on their mechanism of action and the evidence for their use will be reviewed. Furthermore, this review puts forward an evidence-based treatment algorithm based on the specific causative organism.

Efficacy of antimicrobial photodynamic therapy (aPDT) in reducing cariogenic bacteria in primary deciduous dentine

AIM

The aim is to systematically review the efficacy of aPDT in minimizing cariogenic bacteria in primary dentine when compared to tooth preparation and endodontic debridement.

MATERIALS AND METHODS

The focused question was: Is aPDT (intervention) effective in minimizing the cariogenic bacteria (outcome) in deciduous dentine (participants) after caries removal when compared to before aPDT or mechanical caries removal alone (controls). The keywords that were used were: 'antimicrobial photodynamic therapy', 'dentine', 'primary teeth' and 'deciduous teeth' in different combinations. Following the exclusion of the irrelevant studies, eight (seven clinical studies and one in vitro study) studies were included in the review. The data from each study was extracted and the quality of each article was assessed.

RESULTS

In four out of the eight studies, aPDT with methylene blue or toluidine blue had improved the efficacy of microbial reduction in deciduous dentine when compared to conventional root canal treatment or caries removal. In four studies, no significant improvement in microbial reduction was observed following aPDT compared to caries removal or endodontic debridement without aPDT. Four studies received an overall quality grading of 'medium', three studies were assessed as having a 'low' quality and only one study received an overall grading of 'high' quality.

CONCLUSION

Within the limitations of this review, aPDT may improve the anti-bacterial efficacy of restorative and endodontic procedures in deciduous teeth. However, due to lack of long-term clinical trials and robust study designs, the efficacy of aPDT in minimizing cariogenic bacteria in deciduous dentine is debatable.

Management of Intracanal Separated File Fragment in a Four-Rooted Mandibular Third Molar

The success of endodontic therapy is attributed to complete arbitration of the bound entities concealed within the complexity and absolute disinfection of the root canal system, thus, deeming it mandatory to effectively negotiate and overcome the challenges posed by obstruction, either iatrogenic or anatomic. To achieve this, considerable depth of knowledge and expertise with reference to variations in root canal morphology and clinical mishap management is substantially as important as developing fine observation skills in conjunction with an appropriate armamentarium and a keen sense of determination, thereby enhancing one's clinical acumen by several folds. In the present case, following rubber dam isolation, the temporary restoration was removed, and the remaining carious dentin was excavated. Endodontic access cavity was refined and explored with a DG-16 probe, following which three separate canal orifices were identified in the pulp chamber floor (mesiobuccal, mesiolingual, and distal). On further observation under a surgical operating microscope and continuous exploration with the DG-16 probe, a fourth canal was found in the mesial aspect of the tooth (middle mesial). With instrumentation, it was confirmed that a fractured object was indeed present at the apical third of the mesiolingual root of tooth 38. Bypassing of the fractured fragment was initiated with a size 10 SS K-file coupled with copious irrigation with 3% sodium hypochlorite. In the present case report, four distinct canals comprising 3 mesial and 1 distal canal were recognized, and the fractured instrument in one of the canals was bypassed successfully.

Recent update on potential cytotoxicity, biocompatibility and preventive measures of biomaterials used in dentistry

Dental treatment is provided for a wide variety of oral health problems like dental caries, periodontal diseases, periapical infections, replacement of missing teeth and orthodontic problems. Various biomaterials, like composite resins, amalgam, glass ionomer cement, acrylic resins, metal alloys, impression materials, bone grafts, membranes, local anaesthetics, etc., are used for dental applications. The physical and chemical characteristics of these materials influence the outcome of dental treatment. It also impacts on the biological, allergic and toxic potential of biomaterials. With innovations in science and their positive results, there is also a need for awareness about the biological risks of these biomaterials. The aim of dental treatment is to have effective, yet safe, and long-lasting results for the benefit of patients. For this, it is important to have a thorough understanding of biomaterials and their effects on local and systemic health. Materials used in dentistry undergo a series of analyses before their oral applications. To the best of our knowledge, this is the first and original review that discusses the reasons for and studies on the toxicity of commonly used biomaterials for applications in dentistry. It will help clinicians to formulate a methodical approach for the selection of dental biomaterials, thus providing an awareness for forecasting their risk of toxic reactions.

Influence of chelating solutions on tubular dentin sealer penetration: A systematic review with network meta-analysis

This systematic review assessed the influence of conventional final irrigation with chelating solutions (CS) on tubular dentin sealer penetration (TDSP). The literature search was conducted in eight electronic databases using MeSH, DeCS, EMTREE and free terms. The study protocol followed the PRISMA guidelines and was registered on the PROSPERO database (CRD42020203080). Twelve studies were included, and a qualitative synthesis and network meta-analysis of the data were performed. The risk of bias of the studies was assessed using an adaptation of the JBI Critical Appraisal tool. QMix was the solution with the highest probability of having the highest percentage of TDSP in the apical (34.1%), middle (86.5%) and coronal (97.7%) thirds. Eleven studies presented a moderate risk of bias, whereas one study presented a high risk of bias. In conclusion, CS improves sealer penetration into the dentinal tubules with QMix demonstrating superior results.

Combined Effect of Melittin and DNase on Enterococcus faecalis Biofilms and Its Susceptibility to Sodium Hypochlorite

Biofilm communities are tolerant to antimicrobials and difficult to eradicate. This study aimed to investigate the effect of melittin, an antimicrobial peptide, either alone or in combination with deoxyribonuclease (DNase), an inhibitor of extracellular deoxyribonucleic acid (eDNA), against Enterococcus faecalis (E. faecalis) biofilms, and biofilm susceptibility to sodium hypochlorite (NaOCl). Biofilms of E. faecalis were developed in root canals of bovine teeth. The biofilms were treated with distilled water (control), melittin, DNase, or DNase+melittin. The antibiofilm effects of the treatments were analyzed using colony forming unit (CFU) assay, crystal violet staining, confocal laser scanning microscopy (CLSM), and field emission scanning electron microscope (FE-SEM). The susceptibility of DNase+melittin-treated biofilms to NaOCl (0%, 2.5% and 5%) was investigated by the CFU assay. The data were statistically analyzed using one-way analysis of variance, followed by Tukey's test. A p-value of <0.05 was considered significant. Specimens treated with DNase+melittin showed a more significant decrease in the CFUs, eDNA level, and biofilm formation rate than those treated only with melittin or DNase (p < 0.05). CLSM analysis showed DNase+melittin treatment significantly reduced the volume of biofilms and extracellular polymeric substance compared to either treatment alone (p < 0.05). FE-SEM images showed a high degree of biofilm disruption in specimens that received DNase+melittin. 2.5% NaOCl in specimens pretreated with DNase+melittin showed higher antibacterial activity than those treated only with 5% NaOCl (p < 0.05). This study highlighted that DNase improved the antibiofilm effects of melittin. Moreover, DNase+melittin treatment increased the susceptibility of biofilms to NaOCl. Thus, the complex could be a clinical strategy for safer use of NaOCl by reducing the concentration.