Comparative evaluation of antibacterial efficacy of Allium sativum extract, aqueous ozone, diode laser, and 3% sodium hypochlorite in root canal disinfection: An in vivo study

A Comparative Evaluation of the Effect of Different Endodontic Irrigating Solutions on Microhardness of Root Canal Dentin: An in vitro Study

Statement of the Problem

During endodontic therapy, irrigation solutions applied in the root canal may affect the physicochemical properties of the dentinal wall, thereby changing its microhardness. This may adversely affect the sealing ability and adhesion of dental materials. Therefore, many studies have focused on the search for an ideal root canal irrigant that has a minimal effect on dentinal microhardness.

Purpose

This in vitro study was conducted to determine the changes in dentin microhardness after root canal irrigation with different endodontic irrigants.

Materials and Method

Ninety-five freshly extracted maxillary central incisor teeth with straight single canals were selected. These teeth were sectioned transversely at the level of the cementoenamel junction. The working length of each tooth was determined, and canal space was prepared by the HyFlex CM rotary file system. During instrumentation, normal saline was used for irrigation. Then, teeth were split longitudinally into two segments. According to the irrigating solution employed, samples were divided into five groups (n=19): normal saline (Group A), 3% sodium hypochlorite (Group B), 2% chlorhexidine (Group C), 5% calcium hypochlorite (Group D), and 0.2% nanochitosan (Group E).3 mL of the corresponding irrigating solution was administered for total15 minutes in each prepared sample. The Vickers micro-hardness tester was then used to assess micro-hardness. The data was analyzed using one-way analysis of variance (ANOVA).

Results

All tested irrigating solutions decreased the dentinal microhardness. Samples irrigated with 5% calcium hypochlorite demonstrated dentinal microhardness of 42.43±1.62, which is the lowest among all the tested groups, followed by nano chitosan, sodium hypochlorite, and chlorhexidine. Samples treated with control group (saline) demonstrated the maximum microhardness of dentin in the present study.

Conclusion

Within the limitations of this research, it can be concluded that the tested novel irrigating solutions, 5% calcium hypochlorite and 0.2% nanochitosan, were more detrimental to radicular dentin microhardness when compared with conventional endodontic irrigants.

Evaluation of postoperative pain using warm versus room temperature sodium hypochlorite as an irrigant in mandibular molars with irreversible pulpitis: A randomized controlled trial

Introduction

The study evaluates and compare the effect of 3% warm NaOCl with NaOCl at room temperature in root canal irrigation on postoperative pain.

Materials and Methods

In this randomized controlled trial, mandibular molars with symptomatic irreversible pulpitis in healthy 18-year-old patients and above were included. The sample consisted of 56 patients evaluating the postoperative pain, allocated randomly into 2 groups of 3% NaOCl at two different temperatures, i.e. at room temperature and at 60°C. Endodontic treatment was initiated for each group and instrumentation was done using MTwo rotary files. The final irrigation was performed according to the groups assigned. For each included tooth, preoperative and postoperative pain scores at 6, 12, 24, 48, and 72 h were collected through the Heft Parker Visual Analog Scale. Statistical analysis was performed using independent t-test, Chi-square test, Mann-Whitney U-test, and Friedman test followed by Wilcoxon test.

Results

The mean percentage reduction in pain scores was significantly higher among the warm NaOCl group as compared to the control group at different time intervals (P < 0.001). The mean number of analgesics taken was significantly lower among the warm NaOCl group as compared to the control group (P < 0.001).

Conclusion

The warm NaOCl group recorded less postoperative pain than the control group during the first 72 h following single-visit endodontic therapy.

Comparative evaluation of antifungal efficacy of conventional endodontic irrigants and chitosan nanoparticles

Aim

The purpose of this study was to evaluate the efficacy of 3% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and chitosan nanoparticles against Candida albicans using the agar disc-diffusion test.

Materials and Methods

Strain of C. albicans was cultivated in Sabouraud Dextrose Agar. Chitosan nanoparticles were synthesized using an ionic gelation method. Four groups were made according to the irrigants used. Group 1: 3% NaOCl, Group 2: 2% CHX, Group 3: chitosan nanoparticles, and Group 4: saline as control. Discs were added with the different irrigants and placed in a dish containing C. albicans. The plates were incubated at 37°C for 24h. The zone of inhibition was measured in millimeter.

Results

Statistical analysis was performed using the test of one-way variance (ANOVA) and post hoc Tukey. Group 1 showed significantly higher zone of inhibition compared to Groups 2 and 3 (P < 0.05). There were no significant differences between the zones of inhibition of Groups 2 and 3 (P < 0.05).

Conclusion

Chitosan nanoparticles and 2% CHX have similar efficacy against C. albicans, whereas 3% NaOCl was significantly better than both chitosan nanoparticles and CHX.

Can natural irrigants replace sodium hypochlorite? A systematic review

CONTEXT

Sodium hypochlorite, a gold standard for irrigation in endodontics, has disadvantages like toxicity and root dentin weakening. Alternatives derived from natural products are being explored.

AIMS

This systematic review was done to understand the clinical benefits of natural irrigants when compared with a standard irrigant, sodium hypochlorite.

SETTINGS AND DESIGN REGISTRATION

This systematic review was registered with PROSPERO (2018 CRD42018112837) METHODS AND MATERIAL: This review was done in conformation to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA 2020) statement. In vivo studies using at least one natural irrigant and sodium hypochlorite (NaOCl) were included. Studies using them as medicaments were excluded. PubMed, Cochrane and SCOPUS were searched. RevMan tool for Risk of Bias 2 (RoB 2) and risk-of-bias tool to assess non-randomized studies of interventions (ROBINS-I) were used. GRADEpro was used to assess certainty of evidence.

RESULTS

Ten articles (6 RCTs and 4 clinical studies) on approximately 442 patients were included. Seven natural irrigants were evaluated clinically. Due to the heterogeneity, meta-analysis could not be conducted. Antimicrobial efficacy was found to be similar for castor oil, neem, garlic-lemon, noni, papaine and NaOCl. Neem, papaine-chloramine, neem-NaOCl and neem-CHX were superior, while propolis, miswak and garlic were inferior to NaOCl. Post-operative pain was less for neem. There was no significant difference between papaine-chloramine, garlic extract and sodium hypochlorite in clinical/radiographic success.

CONCLUSIONS

The studied natural irrigants are not more efficacious than NaOCl. At the moment, they cannot replace NaOCl routinely and may only substitute in select cases.

An innovative technique to safely perform active cleaning in teeth with open apices: CAB technique

The current study aims to evaluate in vitro the extrusion of NaOCl, using an artificial root canal with an open apex, using different canal irrigation protocols. For this study, a transparent artificial root canal was used. The apex was shaped to be oversized and irregular in form. After root canal mechanical shaping, the artificial cylindrical chamber, which was made below the large apical foramen, was filled with fuchsine-stained bovine pulp tissue. Afterward, irrigation protocols were carried out and compared regarding their safety with regards to irrigant extrusion. Subsequently, the examiner created two groups, Group A: internal heating associated with ultrasonic activation and Group B: internal heating associated with ultrasonic activation, using the CAB technique. In both the groups, 5.25% sodium hypochlorite solution was used as the irrigant. Regarding assessing the presence or absence of the extrusion, photographs at ×20 were taken and analyzed. For the statistical analysis, a t-test for paired samples was used. Extrusion of irrigant beyond the apex was present only in Group A. The main objective of endodontic treatment is the removal of damaged tissues and bacteria. For this reason, active cleaning is crucial in all endodontic treatment cases. Internal heating followed with ultrasonic activation while using the CAB technique was an effective and safe technique to ensure no irrigant extrusion beyond the open apex.