Outcomes of Endodontic Therapy Comparing Conventional Sodium Hypochlorite Irrigation with Passive Ultrasonic Irrigation Using Sodium Hypochlorite and Ethylenediaminetetraacetate. A Retrospective Analysis

Intraosseous anesthesia in symptomatic irreversible pulpitis: Impact of bone thickness on perception and duration of pain

Background

Intraosseous anesthesia (IO) allows the anesthetic solution to be injected directly into the cancellous bone. The anesthetic solution immediately reaches the periapical region, and thus the axonal area of the nerve, where it can temporarily disable the sodium pump. The effect is felt almost without any time delay, and only a small amount of anesthetic solution is required.

Methods

This study aims to investigate the efficacy of IO using the Anesto® device after infiltration anesthesia (IA) and/or inferior alveolar nerve block anesthesia (IANB) failed to work in symptomatic irreversible pulpitis (hot tooth). The 33 patients included in the study were treated additionally with 1.7 ml articaine hydrochloride with 1:100,000 epinephrine hydrochloride (Ultracain® D-S, Sanofi-Aventis, Frankfurt, Germany) IO.

Results

The electrical pulp test showed that 95.76% of the volunteers reacted positively to the combination of IANB or IA with the IO. In women, the additive IO was effective at 97.22%. In men, the IO led to pain elimination in 94.00% of cases. The duration of the IO was less than a quarter of an hour (13.03 min). The IO worked longer in women than in men (13.61 min vs. 12.33 min). Overall, more than every third tooth that needed trepanation was located in the posterior area of the mandible (36.4%). Treatment of hot teeth in this area was associated with an increased pulse rate and increased residual pain. There was a moderate correlation (Spearman-Rho [IRI] = 0.280) between the Visual Analog Scale (VAS) score and bone density, and a significant correlation (IRI = 0.612) between subjective residual pain and bone width. The IO resulted in a moderate, transient increase in the pulse rate by approximately 20 bpm. This is similar to the temporary increase in heart rate after conventional anesthesia techniques in non-preloaded patients and can be considered clinically irrelevant.

Conclusion

IO with the Anesto® device as an extension and deepening of local pain elimination is recommended for the treatment of hot teeth.

Efficacy and potential use of novel sustained release fillers as intracanal medicaments against Enterococcus faecalis biofilm in vitro

Background

Enterococcus faecalis is a bacterium frequently isolated after failed root canal therapy. This study analyzed the antibacterial and antibiofilm effects in vitro of sustained-release fillers (SRF) containing cetylpyridinium chloride (CPC) against vancomycin resistant E. faecalis.

Methods

First, the solidification capability was tested by introducing liquid SRF into phosphate buffered saline, followed by 30 s of vortexing. The antimicrobial effects of SRF-CPC against static monospecies biofilms were analyzed with a metabolic assay. Inhibition of biofilm formation was tested by exposing daily refreshed E. faecalis suspensions to SRF-CPC for 9 weeks. To evaluate the effects of SRF-CPC against preformed biofilms, biofilms were grown for 1, 3 and 7 days, and then treated with SRF-CPC for 24 h. Biofilm kill time was tested by applying SRF-CPC to a 3-day-old biofilm and measuring its viability at different time points. All experiments were compared to Placebo SRFs and to untreated control biofilms. Data were analyzed with two-way ANOVA followed by Tukey’s test. Results were considered significant at P < 0.05.

Results

The liquid SRF solidified within seconds and no structural changes were observed after 30 s of vortexing at maximum speed. SRF-CPC inhibited E. faecalis biofilm formation for 7 weeks and significantly reduced its viability in weeks 8 and 9. Mature biofilms grown for 1, 3 and 7 days were destructed by SRF-CPC in less than 24 h. Fifty percent of a 3-day-old biofilm was destructed in 2 h and complete destruction occurred in less than 12 h. (P < 0.05 in all cases, compared to SRII-Placebo).

Conclusions

SRF-CPC’s physical properties and long-lasting anti-biofilm effects make it a promising coadjuvant medication for endodontic therapy.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0879-1) contains supplementary material, which is available to authorized users.

Update of the therapeutic planning of irrigation and intracanal medication in root canal treatment. A literature review

Background

The success of endodontic treatment derives from the complete elimination of microorganisms capable of causing an intraradicular or extraradicular infection. To achieve a more effective eradication of these microorganisms, endodontic instrumentation must always be implemented with abundant irrigation, which has to achieve chemical, mechanical and biological effects. The irrigators most used today are NaOCl, CHX and EDTA, released into the ducts through different techniques such as syringe, manual agitation, positive or negative apical pressure, sonic or ultrasonic activation, PIPS and PDT. The objective of this review is to update the different irrigating solutions and intracanal disinfection drugs, as well as to establish an irrigation protocol in the endodontic treatment.

Material and Methods

Systematic search of scientific articles in the databases PubMed, Medline and Google Scholar, with the following keywords Endodontic, Infection, Failure, Irrigation, Retreatment and Irrigation protocol. The exclusion criteria were “case report” articles and articles with a publication date prior to 2000.

Results

48 articles that met the inclusion criteria were analyzed. Comparing the different articles it can be seen that the NaOCl is the “gold standard” in terms of immediate antimicrobial efficacy, followed by the CHX that has a long-term antibacterial effect. As an intra-conductive drug it is advisable to use the combination of Ca(OH)2 with CPMC.

Conclusions

The most adequate irrigation protocol consists of using 2.5% NaOCl activated with ultrasound followed by a final wash with 7% MA or 0.2% CTR combined with 2% CHX.

Key words:Endodontic failure, endodontic infection, enterococcus faecalis, endodontic retreatment, irrigation, sodium hipoclorite, irrigation protocol.

Effects of plasma jet, dielectric barrier discharge, photodynamic therapy and sodium hypochlorite on infected curved root canals

The aim of this investigation was to evaluate the effects of 2 different cold atmospheric plasma (CAP) sources, photodynamic therapy and sodium hypochlorite (NaOCl), on infected root canals. Therefore, 50 standardized curved human root canals were infected with Enterococcus faecalis and assigned to 5 groups-negative control (NC), plasma jet (CAP I), dielectric barrier discharge (CAP II), photodynamic therapy (PDT) and NaOCl + passive ultrasonic irrigation-for 30 s. Colony forming units (CFUs) were determined. NaOCl was significantly more effective at reducing CFUs than all test groups (P < .0001 [Mann-Whitney U test]) in both parts of the root canal. CFUs in PDT were significantly lower than those in CAP II (P = .015), and those in CAP I were lower than those in CAP II (P = .05). Among all other groups and in the apical parts, no significant differences were found (P > .05).