Abstract
BackgroundThe success of endodontic treatment depends largely on the control of microorganisms present in infected root canals. The aim of this study was to determine the residual antimicrobial activity of several final irrigation protocols with 7% maleic acid (MA) alone and combined with chlorhexidine (CHX), cetrimide (CTR) or both, in root canals infected with Enterococcus faecalis. Biofilms of E. faecalis were grown in uniradicular roots for 4 weeks. A total of 72 specimens were divided into 5 experimental groups according to the final irrigation regime used: Group 1: 2.5% NaOCl; Group 2: 7% MA; Group 3: 7% MA + 0.2% CTR; Group 4: 7% MA + 2% CHX; Group 5: 7% MA + 0.2% CTR + 2% CHX; and Control group: 0.9% saline solution. Twelve roots (2/group) that were instrumented and not infected served as negative or sterility controls. The proportion of ungrown samples over 60 days was evaluated using non-parametric Kaplan-Meier survival analysis. Differences among groups were tested using the log-rank test (p< 0.05).ResultsThe association of MA with CHX and CHX + CTR as final irrigating solutions showed the best results, 5 and 4 samples out of 12, respectively, and without differences between them (p = 0.928), followed by 7% MA + 0.2% CTR with 7 out of 12. The 7% MA (11/12) group showed significant differences with respect to the groups in which MA was combined with CHX (p < 0.005) and CHX + CTR (p < 0.005).ConclusionFinal irrigating solutions of 7% MA combined with 2% CHX or 2% CHX + 0.2% CTR were found to effectively improve antimicrobial root canal disinfection.
Highlights
The success of endodontic treatment depends largely on the control of microorganisms present in infected root canals
A number of chemical solutions and their combinations may be used, as no single solution is capable of dissolving organic tissue, eliminating the smear layer created during instrumentation, and preventing bacterial recolonization over a long period of time
Antiseptic and/or surfactant agents such as chlorhexidine (CHX) or cetrimide (CTR), with proven substantivity [7,8], have demonstrated antimicrobial residual activity when used as final irrigating solutions in different regimens [6,9,10]
Summary
The success of endodontic treatment depends largely on the control of microorganisms present in infected root canals. The aim of this study was to determine the residual antimicrobial activity of several final irrigation protocols with 7% maleic acid (MA) alone and combined with chlorhexidine (CHX), cetrimide (CTR) or both, in root canals infected with Enterococcus faecalis. Sodium hypochlorite (NaOCl) is the main solution used during and after instrumentation, given its potent antimicrobial action and ability to dissolve organic matter and necrotic tissue [2,3,4]. Because it lacks residual antimicrobial activity, the regrowth of persistent microorganisms is not avoided [5,6]. Antiseptic and/or surfactant agents such as chlorhexidine (CHX) or cetrimide (CTR), with proven substantivity [7,8], have demonstrated antimicrobial residual activity when used as final irrigating solutions in different regimens [6,9,10]
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