CHX Irrigation Research Articles

The Effect of Different Final Irrigation Regimens on the Dentinal Tubule Penetration of Three Different Root Canal Sealers: A Confocal Laser Scanning Microscopy Study In Vitro.

This study evaluated the effects of different final irrigation regimens on the dentin tubule penetration of three different root canal sealers using confocal laser scanning microscopy (CLSM). A total of 160 single-rooted extracted mandibular premolar teeth were divided into five groups (n = 32 each) according to the solution used in the final rinse protocol, as follows: 17% ethylenediaminetetraacetic acid (EDTA) (group 1), 17% EDTA and 2% chlorhexidine gluconate (CHX) (group 2), 7% maleic acid (MA) (group 3), 7% MA and 2% CHX (group 4), and 5.25% NaOCl (group 5). Two roots from each group were examined under scanning electron microscopy (SEM) to visualize smear layer removal. Experimental groups were then split randomly into three subgroups (n = 10) and obturated using a cold lateral condensation technique with 0.1% rhodamine B-labelled sealers [either AH Plus (group A), EndoREZ (group E), or Tech BioSealer Endo (group T)] and gutta-percha. Specimens were sectioned and observed by CLSM to evaluate the percentage and maximum depth of sealer penetration at the apical, middle, and coronal levels. Statistical comparison was performed on grouped (apical, middle, and coronal segments) and ungrouped data using two-way ANOVA with Bonferroni post hoc test (p < 0.01). AH Plus showed the greatest tubule penetration while Tech BioSealer Endo showed the least. Resin-based sealers displayed deeper and more consistent penetration. CHX irrigation positively influenced sealer tubule penetration.

In vitro and in vivo research of atmosphere pressure nonequilibrium plasmas on root canal disinfection: implication for alternative strategy for irrigation.

To investigate an intracanal disinfection methodology of APNPs (atmosphere pressure nonequilibrium plasmas) or modified APNPs in root canal treatment and evaluate the antimicrobial efficiency against in vitro infected dentinal tubules and in vivo experimental apical periodontitis. Dentine specimens were centrifugated with Enterococcus faecalis to generate 1-day-old and 3-week-old biofilms, and were treated with 2% chlorhexidine (Chx), APNP or modified APNP for 3 and 10 min (n=4). LIVE/DEAD staining was employed to analyze the ratio of deactivated bacteria. Experimental apical periodontitis in beagles was induced. Root canal therapy with APNPs or modified APNPs was performed and the antimicrobial effect was evaluated by histological and radiographical analyses. APNP deactivated 1-day-old and 3-week-old E. feacalis in dentinal tubules as much as 2% Chx irrigating. Modified APNP significantly deactivated more E. faecalis biofilms in dentinal tubules for 3-min and 10-min treatments, without thermal damage or dentinal destruction being observed. In beagles' apical periodontitis, significantly increased BV/TV and decreased lesion volume of apical bone were found in modified APNP group than 2% Chx irrigation group according to μCT. Fewer inflammatory cells and bacterial residual in dentine were observed in modified APNP-treated apical tissue by histology staining compared with those in the 2% Chx irrigation group. The antimicrobial effect of APNP jet irradiation was comparable to that of 2% Chx irrigation. No structural damage in dentine or tissue necrosis at the periapical region was induced upon treatment. The modified APNP demonstrated an increased antimicrobial efficacy compared with 2% Chx irrigation both in vitro and in vivo. The modified APNPs can be used as an alternative intracanal disinfection strategy.

Evaluation of modified cold-atmospheric pressure plasma (MCAP) for the treatment of peri-implantitis in beagles.

To assess the effect of adjunctive use of modified cold-atmospheric pressure plasma (MCAP) to surgically mechanical debridement (MD) on peri-implantitis (PI) in beagles. Bilateral mandibles of beagles with PI, which induced by cotton ligature twined with steel in sub-marginal around the implant, were randomly divided into two groups: MD in conjunction with 2% CHX irrigation (control group) and MD with adjunctive intervention of MCAP (plasma group). Sulcus bleeding index (SBI), probing depth (PD) and bone height (BH) were examined before and after intervention using computed tomography and histological staining. Additionally, interleukin (IL)-1β, IL-6 and IL-17 levels in peri-implant sulcular fluid (PISF) were measured by ELISA. A significant improvement in SBI, PD and BH was found in the plasma group (p<.05) when compared with the control group after three months of intervention. In addition, IL-1β and IL-17, but not IL-6 levels decreased (p<.05) in the plasma group compared with the control group after intervention. The adjunctive use of MCAP to MD for PI can enhance bone formation around the implant and inhibit the inflammatory response. The application of MCAP could be considered a favourable adjunct to MD for PI.

Evaluation of Effect of Disinfection Systems on Bond Strength of Root Canal Sealers

Objective: The aim of this in vitro study is to evaluate and compare the effects of different disinfection methods (NaOCl irrigation, CHX irrigation, laser, PDT) on the bond strength of different root canal sealers (AH Plus sealer, MTA Fillapex, EndoSequence BC Sealer ).Methods: In this study, one hundred and twenty extracted human mandibular premolar teeth were used. The teeth were randomly divided into 3 experimental groups and 12 subgroups using the website (3 different sealers and 4 different disinfection methods). Two slices were obtained from apical part, middle part and coronal part of each root. The push-out test was performed on each slice with a universal test machine. The maximum load applied to the filling material before failure was recorded in Newtons (N) and converted to megapascals (MPa). Data were subject to Kruskal- Wallis test. Mann- Whitney U test was used for pairwise comparison with bonferroni correction. Significance level was set at a = 0.05Results: Kruskal Wallis test indicated that there were significant differences among the sealer groups for apical (p =0 ,000) and middle sections (P = 0,001), and coronal sections (P = 0,000). Conclusion: Under the study limitation; the bonding strength of root canal sealers is influenced by disinfection methods.

Outcome of Endodontic Retreatment Using 2 Root Canal Irrigants and Influence of Infection on Healing as Determined by a Molecular Method: A Randomized Clinical Trial

IntroductionThis study compared the clinical and radiographic outcome of endodontic retreatment of teeth with apical periodontitis using either 1% sodium hypochlorite (NaOCl) or 2% chlorhexidine digluconate (CHX) as the irrigant. The influence of residual infection detected by a molecular method on the outcome was also examined. MethodsFifty-two root-filled teeth with apical periodontitis were randomly assigned into 2 groups according to the irrigant used during retreatment. Root canal microbiological samples taken before (S1) and after (S2) preparation using either NaOCl or CHX irrigation and after calcium hydroxide medication (S3) were subjected to 16S ribosomal RNA gene-based real-time quantitative polymerase chain reaction (qPCR) to quantify total bacteria. The periapical status was scored using the periapical index and dichotomized as healed (<3) or not healed (≥3) at the 1- and 4-year follow-up. ResultsForty-five (NaOCl, n = 20; CHX, n = 25) and 33 teeth (NaOCl, n = 16; CHX, n = 17) were available at the 1- and 4-year follow-up, respectively. After 1 year, 65% in the NaOCl group and 64% in the CHX group healed, with no differences between them (P > .05). At the later follow-up, the corresponding figures were 81% and 82%, respectively (P > .05). Canals that yielded qPCR-negative results in S3 had a higher healing rate (79%) than qPCR-positive canals (45%, P < .05). The mean bacterial load increased from S2 to S3 in half of the unhealed cases (P < .05). All S3-positive canals containing <3.12 × 103 bacterial cell counts healed. Increasing the apical level of the root canal filling influenced the outcome (P < .05). ConclusionsNo significant differences in the clinical outcome between 1% NaOCl and 2% CHX were found. Bacterial persistence at the time of filling as detected by qPCR significantly affected the outcome.

Comparative evaluation of antibacterial effect of nanoparticles and lasers against Endodontic Microbiota: An in vitro study.

BackgroundPresent study was conducted with the aim of evaluating antimicrobial efficacy of silver (AgNP) and gold nanoparticles (AuNP) with and without Nd: YAG laser (L) irradiation against experimentally inoculated Enterococcus faecalis in infected human root dentin.Material and Methods120 extracted single rooted human teeth were prepared and inoculated with E. faecalis for 24 hrs. The teeth were then randomly divided into 4 experimental group: AgNPs group: irrigation for 3minutes with 50 μl of 100 ppm, the AuNPs group: irrigation with 50 μl of 100 ppm, the AgNPs & Nd: YAG lasers group: irrigation with 50 μl of 100 ppm + irradiation with 1.5W laser for 60 seconds, the AuNPs & Nd: YAG lasers group: irrigation with 50 μl of 100 ppm + irradiation with 1.5W laser for 60 seconds. One control group consisting of 2% CHX irrigation for 3 minutes was also there (n = 20). The specimens were collected from the canal before and after irrigation, and colony forming units were observed.ResultsSignificant difference was found among all the groups in comparison to the control group (p<0.05). The greatest reduction in CFU’s was observed with combination of AgNPs & Nd: YAG lasers group.Conclusions AgNPs in combination with Nd: YAG laser irradiation has the potential to be used as root canal disinfectant. Key words:Antibacterial efficacy, gold, silver, nanoparticles, lasers, solid-state.

Antibacterial Effectiveness of 2 Root Canal Irrigants in Root-filled Teeth with Infection: A Randomized Clinical Trial

IntroductionThis study compared the antibacterial effects of 1% sodium hypochlorite (NaOCl) and 2% chlorhexidine digluconate (CHX) during retreatment of teeth with apical periodontitis. MethodsRoot canal–treated teeth with apical periodontitis were randomly distributed into 2 groups. Bacteriological samples were taken from the canals before (S1) and after (S2) preparation using either NaOCl or CHX irrigation and after calcium hydroxide medication (S3); 16S ribosomal RNA gene-based real-time quantitative polymerase chain reaction was performed to quantify total bacteria, streptococci, and Enterococcus faecalis. ResultsForty-nine teeth were available for analysis (NaOCl, n = 20; CHX, n = 29). Bacterial DNA occurred in all S1 samples, streptococci in 57% and E. faecalis in 6%. The total bacterial counts decreased from S1 to S2 in both groups (P < .01) but were higher in S3 than S2 (P < .01). Thirty-five percent of the teeth in the NaOCl group were positive in S2, decreasing to 20% in S3. In the CHX group, 41% were positive in S2, decreasing to 31% in S3. The bacterial load in S1 influenced the incidence of bacteria in S2 (P < .01). Streptococci were significantly reduced in both groups, and E. faecalis was found in only 1 S2 sample and not in S3. No significant difference between NaOCl and CHX was found. ConclusionsNaOCl and CHX both reduced bacterial counts and the number of infected canals. Intracanal medication with calcium hydroxide reduced the number of canals with persistent infection but resulted in overall larger bacterial counts in the cases positive for bacteria. The effectiveness of antimicrobial treatment can be influenced by the initial bacterial load.

Effect of Antimicrobials Used in Regenerative Endodontic Procedures on 3-week-old Enterococcus faecalis Biofilm

IntroductionWe evaluated the effect of various antimicrobials used in endodontic regeneration on a 3-week-old Enterococcus faecalis biofilm. MethodsE. faecalis biofilm was grown on standardized dentin samples for 3 weeks. Infected dentin samples were randomized into 8 experimental groups (n = 8) and treated with calcium hydroxide (Ca[OH]2), 500 mg/mL of double antibiotic paste (DAP, equal portions of metronidazole and ciprofloxacin), low dilutions of DAP (1 or 0.1 mg/mL loaded into a methylcellulose vehicle system), sterile saline, or placebo paste (only methylcellulose) for 7 days. The other experimental groups were treated with 1.5% sodium hypochlorite (NaOCl) or 2% chlorhexidine gluconate (CHX) solutions for 5 minutes. After the assigned treatments, the bacterial biofilms were detached from dentin, spiral plated, and quantified using an automated counting machine. Permutation tests followed by Sidak post hoc multiple comparisons were used for statistical analyses (α = 0.05). ResultsThe infected dentin treated with 1.5% NaOCl or 500 mg/mL of DAP provided complete eradication of bacterial biofilm. Furthermore, the infected dentin treated with 2% CHX, Ca(OH)2, or 1 mg/mL of DAP had a comparable antibiofilm effect, but they were not able to completely eradicate bacterial biofilm. No significant difference in the antibiofilm effect was observed between 500 mg/mL of DAP, Ca(OH)2, 1.5% NaOCl, and 2% CHX. ConclusionsAt least 1 mg/mL of DAP in a methylcellulose vehicle system is required to eliminate a substantial amount of E. faecalis biofilm. Furthermore, the antibiofilm effects of 1.5% NaOCl and 2% CHX irrigation solutions were comparable with that of 500 mg/mL of DAP and Ca(OH)2.

Bacterial Composition at the Implant-Abutment Connection under Loading in vivo.

Platform-switched implants have been demonstrated to prevent bone loss after loading. The present study evaluated bacterial composition of sites from implant-abutment connections of immediately loaded implants, which were placed in the anterior mandible. Ten patients participated in this study. A and B implant systems with two different prosthetic connections (Morse tapered vs internal polygonal butt-joint connections, respectively) were placed and loaded for 2 years. The abutments were removed (AB sample) after careful decontamination. Bacterial sampling of the abutments, inner part of the implants (before/visit 1 and after rinsing with chlorhexidine [CHX]/visit 2), and after new abutment connection and loading for 1 additional month, a new sampling (visit 3) was taken to compare the bacteria composition in association with the two connections. Bacterial profiles of samples were determined by using the human oral microbe identification microarray. A total of 240 samples were analyzed taken at different time intervals. Nonparametric statistical analysis (Wilcoxon Rank sum) with uncorrected alpha (p < .05) and after corrections (Benjamini-Hochberg) found no statistical significance between the two connections. No significant changes in the overall microbial profiles were detected at the different time intervals. However, there were trends toward presence of periodontitis-associated species at the B implants in all samples (AB, visit 1, even after CHX irrigation) and after decontamination, abutment replacement, and 1-month loading period. CHX irrigation does not seem to have any effect on decontamination of connections. As shown previously, there is significantly more bone loss around B implants compared with A implants. Although there was no statistical difference in the microbial profiles, there was indeed a trend for the presence of typical periodontal pathogens associated with the internal polygonal butt-joint connection. A possible scenario is that this connection tends to harbor the pathogens that may be involved in subsequent bone loss.

Elimination of E. Faecalis by a New Non‐Thermal Atmospheric Pressure Plasma Handheld Device for Endodontic Treatment. A Preliminary Investigation

AbstractThe aim of this study was to investigate the feasibility of an atmospheric pressure plasma jet (PJ) for endodontic treatment and to compare the antimicrobial efficiency with conventional irrigation solutions (chlorhexidine digluconate (CHX), sodium hypochlorite (NaOCl)) against intracanal bacteria (E. faecalis) using a standardized simulated root canal model. The disinfection efficiency was determined by number of colony forming units. Scanning electron microscopy was used to investigate the effect of the treatment procedures on bacteria inside the root canal. The PJ achieved a significantly higher microbial reduction than chemical CHX irrigation and a comparable one with NaOCl. The application of PJ for endodontic treatment could provide a new possibility of controlling endodontic infection. magnified image

Adjunctive Antimicrobial Therapy of Periodontitis: Long‐Term Effects on Disease Progression and Oral Colonization

This study assessed the long-term effects of adjunctive antimicrobial therapy on periodontal disease progression and oral colonization. Patients with previously untreated chronic periodontitis and subgingival Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis were randomly assigned to subgingival scaling without (control group) or with systemic amoxicillin plus metronidazole and CHX irrigation (test group). Relative attachment levels were determined and subgingival and mucosal plaque samples were taken at baseline, at 10 days (plaque only) and at 3, 6, 9, 12, 18, and 24 months following initial therapy. During maintenance therapy, patients received supragingival debridement only. After 24 months, the 18 test group patients showed at sites with initial probing depths (PD) > or =7 mm a significantly (P <0.05) higher frequency of 2 mm or more attachment gain (37.3% +/- 4.6%) and lower frequency of attachment loss (7.2% +/- 3.1%) compared to the 17 controls (8.2% +/- 3.9% and 19.1% +/- 13.1%, respectively). Compared to controls, the intraoral prevalence of A. actinomycetemcomitans (up to 18 months) and P. gingivalis (up to 3 months) decreased and that of Eikenella corrodens (at 10 days) increased in test patients (P <0.05). In both treatment groups, the detection frequency of Tannerella forsythensis decreased transiently, while an overall increase was recorded for Treponema ssp. Over the 24-month period, a single course of the administered adjunctive antimicrobial therapy led to a relative risk reduction of 62% for attachment loss at deep sites. However, with the exception of A. actinomycetemcomitans, it failed to induce long-term changes in the prevalence profiles of oral colonization.

Multifactorial assessment of predictors for prevention of periodontal disease progression.

Univariate approaches have identified single factors influencing periodontal disease progression. The aim of this explorative approach was to assess the influence of various predictive factors responsible for the prevention of periodontal disease progression in the same patient sample. Patients with untreated chronic periodontitis underwent subgingival debridement alone or in combination with adjunctive antimicrobial therapy (systemic amoxicillin and metronidazole/7 days plus supragingival CHX irrigation). Supportive periodontal therapy was performed over a 24-month period. As predictors, clinical, microbial, immunological, and genetic parameters were assessed. The primary outcome variable was the percentage of teeth without attachment loss >/=2 mm over the study period (stability of attachment). At 24 months, multiple regression analysis identified adjunctive antimicrobial therapy for teeth with initially at least one site showing a pocket probing depth of >/=7 mm and IgG(4) reactivity against a 110-kDa protein of A. actinomycetemcomitans at teeth with initial pocket probing depths </=6 mm as main predictors of long-term attachment stability ( p<0.05). Other parameters failed to influence treatment outcome. Adjunctive antimicrobial therapy and antibody reactivity may be dominant factors influencing the prevention of attachment loss in patients receiving periodontal therapy.

Bacteremia Following Subgingival Irrigation and Scaling and Root Planing

The purpose of this study was to determine the incidence of bacteremia after a single professional subgingival irrigation with a 0.12% chlorhexidine gluconate mouthrinse (CHX) as well as after a subsequent scaling and root planing (S/RP) during the same visit. Thirty subjects each with at least 1 site that probed 4 mm or more and bled on probing were randomly assigned to the following groups: 1) irrigation with 0.12% CHX; 2) irrigation with sterile water; and 3) non-irrigated controls. To begin the study blood was drawn just before and 2 minutes after irrigation. Thirty minutes later, blood was drawn again just before and 2 minutes after S/RP at the same site. Specimens were cultured for anaerobic and aerobic microorganisms using standard cultural techniques. Eighteen blood cultures from 15 subjects yielded positive cultures resulting in 23 isolates. Gram-positive rods comprised 34.8% of the total isolates; Gram-positive cocci 34.8%, Gram-negative rods 21.7%, and Gram-negative cocci 8.7%. In the CHX group, bacteremia was detected in 5 subjects after irrigation and in 2 other subjects after S/RP. In the water group, bacteremia was detected in one subject after irrigation and in 4 subjects after S/RP. The control group had 3 bacteremias after S/RP. There was no significant difference between the incidence of bacteremia associated with irrigation by CHX or sterile water (P = 0.141). There was also no significant difference in the incidence of bacteremia after S/RP between the CHX and sterile water irrigation groups and in patients who did not receive irrigation (control group) (P = 0.88).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and Microbiological Effects of Subgingival and Gingival Marginal Irrigation With Chlorhexidine Gluconate

Recent interest in the local delivery of antimicrobial and anti-inflammatory agents has stimulated interest in the efficacy of various treatment regimens. Chlorhexidine gluconate (CHX) delivered daily by home-applied marginal irrigation as a 0.04% solution in combination with a single professional irrigation of 0.12% CHX was tested over a 3-month period. Sixty periodontal maintenance patients each having at least 2 pockets greater than or equal to 4 mm probing depth, and bleeding on probing were assigned to either Group 1: one professional subgingival 0.12% CHX (Peridex) irrigation (Perio Pik) followed by adjunctive daily home marginal 0.04% CHX irrigation (Pik Pocket); Group 2: one professional subgingival 0.12% CHX irrigation followed by adjunctive daily home marginal water irrigation; Group 3: one professional subgingival water irrigation followed by adjunctive daily home marginal water irrigation; or Group 4: control. At baseline and 3 month visits, subgingival plaque samples were taken from 2 sites per patient. Cultural microbiological analysis was performed using non-selective and selective media. Plaque Index, Gingival Index, pocket probing depths, and gingival recession were assessed. Scaling and root planing (supportive periodontal treatment) was provided for each patient followed by subgingival irrigation as outlined above. At 3 months the Gingival Index and pocket probing depths were both significantly reduced (P less than .05) in all irrigation groups compared to baseline. There were no significant changes in clinical parameters in the control group from baseline to 3 months. In Group 1 the GI was significantly reduced (P less than .05) compared to Group 4 at 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of Subgingival Irrigation on Bacteremia Following Scaling and Root Planing

The purpose of this study was to determine the effects of professional subgingival irrigation, together with subsequent patient administered home marginal irrigation, on the incidence of bacteremia after scaling and root planing (Sc/RP). A total of 60 periodontal maintenance patients were assigned to either Group 1: subgingival irrigation, with 0.12% CHX and daily marginal irrigation with 0.04% CHX; Group 2: subgingival irrigation with 0.12% CHX and daily marginal irrigation with water; Group 3: subgingival and daily marginal irrigation with water; Group 4: Non-irrigation (control). Patients entered the study after receiving a thorough periodontal maintenance appointment including a complete examination, Sc/RP, and standard oral hygiene instruction. Blood samples were taken at the 3-month visit before and after Sc/RP. Microbiological culturing was done using the Septi-Chek system, selective and non-selective media. Results from 54 patients showed that bacteremia was detected prior to Sc/RP in 2 patients and after Sc/RP in 10 patients. No significant effect by treatment regimens on post Sc/RP bacteremia could be detected. The organisms isolated included Eubacterium lentum, Propionibacterium acnes, Streptococcus species, Neisseria species, Candida albicans, Staphylococcus species, and un-identified Gram-negative rods.

Supragingival Irrigation with 0.06% Chlorhexidine in Naturally Occurring Gingivitis I. 6 Month Clinical Observations

The purpose of this study was to assess the efficacy of supragingival irrigation with 0.06% chlorhexidine gluconate (CHX) on naturally occurring gingivitis. The relative benefit of CHX irrigation in comparison with CHX rinsing, water irrigation, and normal oral hygiene was evaluated. In a blind, placebo-controlled 6-month study 222 patients were assigned to one of four groups: Group 1: Once daily irrigation with 300 ml water followed by irrigation with 200 ml 0.06% chlorhexidine gluconate (experimental); Group 2: Twice daily rinsing with 15 ml 0.12% chlorhexidine (positive control); Group 3: Once daily irrigation with 500 ml water (irrigation control) and Group 4: Sodium fluoride dentifrice for normal oral hygiene only (negative control). All groups used the same sodium fluoride dentifrice for tooth brushing. At baseline, 3 months, and 6 months patients were examined for Gingival Index (GI), Bleeding on Probing (BOP), Plaque Index (PLI), Pocket probing depth (PD), Calculus Index (CI), and stain. After the baseline visit all patients received a supra- and subgingival oral prophylaxis. At 6 months GI and BOP were significantly (P less than or equal to 0.05) reduced by adjunctive CHX irrigation (42.5% and 35.4%, respectively), CHX rinse (24.1% and 15.0%), and water irrigation (23.1% and 24.0%) compared to tooth brushing alone. Plaque was significantly (P less than or equal to 0.05) reduced only by CHX irrigation (53.2%) and CHX rinse (43.3%) while calculus and staining were significantly (P less than or equal to 0.05) increased in the two chlorhexidine groups (276.4% (irrigation) and 273.2% (rinse)). Although significant (P less than or equal to 0.05), pocket probing depth reduction was minimal after CHX irrigation (4.6%).(ABSTRACT TRUNCATED AT 250 WORDS)