Abstract
Background The goals of this randomized double-blind trial were to assess the antimicrobial activity in vivo of Sodium hypochlorite (NaOCl) vs. chlorhexidine gluconate (CHX) used in combination either with EndoActivator® or IRRI S® files in patients with apical periodontitis. Material and MethodsA total of 120 patients with apical periodontitis (in single or multiple root canals) were randomly assigned to the four irrigation protocols outlined below: Group A: 5.25% sodium hypochlorite (NaOCl) + EndoActivator®; Group B: 5.25% NaOCl + IRRI S® files; Group C: 2% chlorhexidine gluconate (CHX) + EndoActivator®; Group D: 2% CHX + IRRI S® files. Paper points were used to collect microbiological samples before (1A samples) and after (1B samples) irrigation. Viable colony-forming units (CFU) were quantified twice: (1) without speciation, and (2) only for Enterococcus Faecalis(EF). Statistical analysis was performed using SPSS 22.0 for Windows.ResultsNo significant differences were observed between NaOCl and CHX in the reduction of CFU; in fact, reduction was < 93% for the two irrigants. Conversely, statistically significant differences were found between the two activation techniques (sonic and ultrasonic) in the reduction of Enterococcus Faecalis(EF). Thus, the effectiveness of ultrasonic activation was significantly higher (< 93%; p=0.012) as compared to sonic activation. Following the combination of the two irrigants with the two activation techniques (groups A, B, C and D), significant differences were observed between group A and B (p=0.025) in the reduction of EF populations, reaching up to 94%.Conclusions NaClO and CHX are effective in reducing intracanal bacterial load. Ultrasonic activation is the most effective activation technique in reducing EF populations. Key words:Chlorhexidine gluconate, sodium hypochlorite, ultrasonic irrigation, sonic irrigation, apical periodontitis, Enterococcus faecalis.
Highlights
Apical periodontitis is the defense mechanism the human body has developed to keep destruction of the dental pulp and microbial infection of the root canal system from spreading beyond the apical foramen and allow periapical tissue repair [1]
No statistically significant differences were found between NaClO and chlorhexidine gluconate (CHX) regarding colony-forming units (CFU) reduction without speciation (p=0.853) or in the reduction of Enterococcus faecalis populations (p=0.777)
Several authors have demonstrated the effectiveness of NaClO and CHX in vivo [7,13] and ex vivo [14,15,16] in reducing CFU count, with no significant differences between these two irrigants
Summary
Apical periodontitis is the defense mechanism the human body has developed to keep destruction of the dental pulp and microbial infection of the root canal system from spreading beyond the apical foramen and allow periapical tissue repair [1]. The treatment of choice for periodontitis involves the chemo-mechanical preparation of root canals to remove or reduce the microbial load until it is compatible with periapical health. Rasimick et al observed that NaClO does not eradicate microbia from root canals completely [6] This fact evidences the need for the development of new irrigation techniques that overcome the limitations of NaClO and keep its properties. In 2002, Basrani et al concluded that canal dressing with 2% CHX for one week may provide residual antimicrobial activity [10] The goals of this randomized double-blind trial were to assess the antimicrobial activity in vivo of Sodium hypochlorite (NaOCl) vs chlorhexidine gluconate (CHX) used in combination either with EndoActivator® or IRRI S® files in patients with apical periodontitis. Statistically significant differences were found between the two activation techniques (sonic and ultrasonic) in the reduction of Enterococcus faecalis (EF). Ultrasonic activation is the most effective activation technique in reducing EF populations
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