The influence of irrigant activation, concentration and contact time on sodium hypochlorite penetration into root dentine: an ex vivo experiment.

Abstract

To establish whether irrigant activation techniques, namely manual dynamic activation (MDA), passive ultrasonic irrigation (PUI) and sonic irrigation (SI), improve the tubular penetration of sodium hypochlorite (NaOCl) into root dentine when compared with conventional needle irrigation (CNI). Secondly, investigate if increasing NaOCl concentration and/or contact time improves the performance of these techniques. A total of 83 extracted human maxillary permanent canines were decoronated to 15mm, and root canals prepared to a size 40, .10 taper. Root dentine was stained with crystal violet for 72h and embedded in silicone. Eighty specimens were randomly distributed into 16 groups (n=5) according to the irrigant activation technique, NaOCl concentration (2%; 5.25%) and irrigant contact time (10min; 20min). All activation techniques were used for 60s in the last minute of irrigation. Additionally, three teeth were not exposed to NaOCl to confirm adequate dentine staining had occurred (i.e. negative control). All specimens were subsequently dissected, observed under a light microscope and NaOCl penetration depth (µm) determined by measuring the average width of bleached dentine using ImageJ software. Statistical comparisons were made with paired and unpaired t-tests, anovas followed by post hoc Tukey's and Dunnett's tests, and a general linear model (α<0.05). Overall, NaOCl penetration ranged from 38.8 to 411.0µm with MDA, PUI and SI consistently resulting in significantly greater tubular infiltration than CNI (P<0.05). The deepest measurements in the coronal, middle and apical segments were all recorded in the MDA; 5.25%; 20min group and the least in the CNI; 2%; 10min group. Increasing either irrigant concentration or contact time resulted in significantly greater NaOCl penetration depths for all techniques and segments of the canal (P<0.05). However, when irrigant concentration and contact time were increased together, a significant interaction effect between these two independent variables was observed on overall NaOCl penetration (P<0.05). Agitating irrigants with MDA, PUI or SI, as well as using greater irrigant concentrations or contact times, potentiated NaOCl penetration into root dentine. However, longer durations of NaOCl exposure at lower concentrations resulted in similar depths of tubular penetration as those achieved at higher concentrations.