Effect of additives to sodium hypochlorite on pulp tissue dissolution and physico-mechanical effects on root canal dentin: A systematic review

Abstract

Background: It is widely accepted now that; additives to sodium hypochlorite helps in better pulp tissue dissolution. However, due to proprietary concerns, the available literature is unable to clarify exactly how the modified NaOCl is better than unaltered NaOCl. This review evaluates the effect of additives on sodium hypochlorite on pulp tissue dissolution and physicomechanical effects on dentin. Methods: A systematic search was conducted using Medline PubMed, Ebscohost, Scopus, Google Scholar up to and including September 31, 2018, to identify relevant studies. All cross-reference lists of the selected studies were also screened. The inclusion criteria were articles in English or those having a detailed summary in English, published between January 2009 and September 2018. Articles were providing information about sodium hypochlorite, surfactants, and etidronic acid. Articles were providing information about in vitro studies, in which effect on root dentin was evaluated. Review, case reports, abstracts, letters to editors, and editorials were excluded. In vivo studies were excluded from this systematic review. Results: A total of 195 articles were examined, of which 11 articles were selected for the final synthesis. Most of the articles concluded that additives to sodium hypochlorite led to better pulp tissue dissolution and reduced the hardness of root canal dentin. Conclusion: This systematic review was able to garner adequate information stating that additives to sodium hypochlorite performed better pulp tissue dissolution. It was also able to evaluate successfully the physicomechanical effects of these solutions on root canal dentin.