Effect Of Different Irrigation Solutions Research Articles

Histopathological and histomorphometric investigation of the effects of different irrigation solutions on Achilles tendon healing in rats.

This study aimed to examine the effect of irrigation fluids containing povidone-iodine (PVP-I), rifampicin (RF), and chlorhexidine gluconate (CHG) used during surgery on healing on a rat Achilles tendon model. Twenty-eight male Sprague-Dawley rats (range, 300 to 400 g) were used in the experiment carried out between November 2022 and December 2022. The rats were divided into PVP-I, RF, CHG, and control groups, with seven rats in each group. Following the tenotomy and repair of the right Achilles tendon, the surgical site was irrigated using PVP-I, RF, CHG, or normal saline (the control group) for 2 min. All rats were sacrificed on the 21st postoperative day. The samples were evaluated histomorphometrically using the scoring system modified by Svensson, Soslowsky, and Cook and histopathologically using the Bonar and Movin classifications. The RF group gave better results in all three scoring systems compared to the control, PVP-I, and CHG groups (p=0.008, p=0.002, and p=0.006, respectively). Cellularity, rounding, and tenocyte morphology showed a significant difference in favor of the RF group (p=0.004). While the distribution of ground substance glycosaminoglycans showed a significant difference in favor of the RF group, there was no significant difference among the other groups (p=0.22). Irrigation solutions containing PVP-I, RF, or CHG show no negative effect on Achilles tendon healing. Moreover, the findings suggest that RF irrigation can accelerate the healing process.

Antibiofilm Effect of Different Irrigation Solutions Activated with KTP Laser

Objectives: The aim of this study was to evaluate the antimicrobial efficacy of Potassium Titanium Phosphate (KTP) laser-activated irrigation solutions on intraradicular Enterococcus faecalis biofilms in invitro conditions by using a scanning electron microscope. Materials and Methods: 120 single-root, single canal permanent mandibular premolar human teeth were used. Sterilization and disinfection of the teeth were performed. E. faecalis biofilms were obtained after 4 weeks by re-inoculation procedures. Each group was divided into 6 groups consisting of 20 roots and root canal disinfection protocols were applied using irrigation solutions with 5.25% NaOCl, saline, super-oxidized water solution, 8ppm ozonated water, 2% CHX, 17% EDTA, all activated by KTP laser. It was smear-planted to a solid medium which split as before and after the disinfection applications for the aim of Counting Microorganism colonies from root canals and data were evaluated statistically. In this statistical evaluation one way ANOVA and Tukey tests were used. Before and after the irrigation procedures for presence and elimination of biofilm the root canals were processed for scanning electron microscopy and biofilm was examined on the standard images. Results: As a result of the statistical comparison performed among all groups, while NaOCl ensures the highest amount of elimination as a positive control group, the lowest amount of bacterial elimination was detected in the SF group that applied as the negative control group (P0,05), EDTA showed the lowest antibiofilm effect (P

The effect of irrigation solutions and sterilization process on the surface properties of ProTaper Next and TruNatomy rotary files: An atomic force microscopy study

Aim: This study sought to evaluate the effects of different irrigation solutions and sterilization processes on the surface properties of ProTaper Next (PTN; Dentsply-Maillefer, Ballaigues, Switzerland) and TruNatomy (TN; Dentsply Sirona, Ballaigues, Switzerland) nickel-titanium rotary files. Methodology: 30 ProTaper Next and 30 TruNatomy files were used. Both types of files were divided into five groups. The files in three groups were dipped into 5.25% NaOCI (CanalPro, Coltene/Whaledent, Altstätten, Switzerland), BioAKT (New Tech Solutions s.r.l., Brescia, Italy), and 18% etidronic acid (Dual Rinse HEDP, Medcem, Weinfelden, Switzerland), respectively, for 5 minutes, while the files in the fourth group were exposed to five autoclave cycles. The files in the fifth (control) group did not receive any treatment. Scans were performed from five different points using an atomic force microscope (AFM). The assumption of the conformity of the quantitative variables to a normal distribution was evaluated using the Kolmogorov-Smirnov test. A one-way analysis of variance was used to compare the quantitative measures between more than two independent groups, while the post-hoc least significant difference test was used for the pairwise comparisons (p˂0.05). Results: AFM images of the PTN and TN files in all the groups revealed surface irregularities. The root mean square (RMS) and depth values of the files dipped in NaOCI, BioAKT, and Etidronic acid were statistically higher than those of the control group (p<0.05). Moreover, the RMS and depth values were statistically higher in the files that had been subjected to five autoclave cycles when compared with the control group (p<0.05). The RMS values and depth values among the groups were found to be compatible. Conclusion: All the applications increased the surface roughness of the PTN and TN files. The Etidronic acid and sterilization applications were found to increase the RMS and depth values ​​the most when compared with the control group. How to cite this article: Öztekin F, Elmalı E. The effect of irrigation solutions and sterilization process on the surface properties of ProTaper Next and TruNatomy rotary files: An atomic force microscopy study. Int Dent Res 2022;12(2):39-46. https://doi.org/10.5577/intdentres.2022.vol12.no2.1 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Evolution of the combined effect of different irrigation solutions and activation techniques on the removal of smear layer and dentin microhardness in oval-shaped root canal: An in-vitro study.

The aim of this in vitro study was to evaluate the effect of three final irrigants, namely QMix, MTAD and EDTA, combined with three irrigation techniques, namely conventional needle irrigation (CNI), passive ultrasonic irrigation (PUI) and photon-induced photoacoustic streaming (PIPS), on smear layer removal, dentin mineral content and microhardness in oval-shaped canals. 130 decoronated premolars with single, oval root canals were equally divided into1 blank control group and 12 treatment groups (n=10) according to the final irrigation protocols. Roots in treatment groups were instrumented with ProTaper Gold to size F4 and subjected to final irrigation. Smear layer removal was assessed by using a four-level scoring system under an environmental scanning electron microscope. Energy dispersive X-ray spectroscopy was performed to measure the dentin mineral content. Dentin microhardness was measured by Knoop microhardness testing. Statistical analysis of the data was performed by using Kruskal-Wallis test, followed by Dunn's post hoc test with Bonferroni correction. PUI- and PIPS-activated QMix and EDTA removed smear layer more effectively than MTAD groups (p<0.05). Regarding the dentin mineral content and microhardness, QMix groups yielded the least calcium (Ca), phosphorus (P) and Ca/P ratio, followed by EDTA groups and MTAD groups (p<0.05). QMix groups produced significantly lower dentin microhardness values and higher hardness reduction percentages than MTAD groups (p<0.05). Within the limitations of the present study, it was concluded that QMix and EDTA were superior to MTAD in smear layer removal, especially when activated by PUI and PIPS, but these agents produced more pronounced effect on dentin mineral content and microhardness than MTAD.

Effects of Different Irrigation Solutions on the Chemical Composition of Multi-Root Canals of Radicular Dentine in Upper Premolar Teeth

The objective of this research was to assess the effects of several irrigation solutions (ISOLs) on two major (P and Ca) and some minor (Fe, Zn, and Sr) elements of multi-root canals of radicular dentin in upper premolar teeth using X-ray fluorescence analysis (XRF). Powder of fifty radicular dentin specimens were prepared and divided into five groups based on treatments with different single and combined ISOLs. These groups were: G1-distilled water (control); G2- sodium hypochlorite (NaOCl, 5.25%); G3- sodium hypochlorite (NaOCl, 5.25%) and ethylendiaminetetraacetic acid (EDTA, 17%); G4- distilled water and a mixture of tetracycline, an acid, and a detergent (MTAD); and G5- sodium hypochlorite (NaOCl, 1.3%) and MTAD. The XRF results confirmed that the ISOL G5 (Ca/P=1.6254) was the most effective one. The ratio-to-ratio correlations revealed the common origins of Fe, Zn, and Sr in root canals of radicular dentin, which was highly interacted with the major elements of P and Ca each. These interactions were insignificantly affected by the used ISOLs. Finally, XRF is highly recommended as a safe, fast, nondestructive, and relatively not expensive technique to analyze the endodontic therapy of teeth.

Effect of different irrigation porotocols on root dentine micro-hardness-An invitro study

IIrrigation solutions used and time of use has a definite effect on the micro hardness &amp; other physical properties of dentin which in turn have direct consequence on the longevity functional performance of root canal treated teeth. To evaluate the effect of different irrigation solutions on micro hardness of root dentin.Forty extracted single rooted lower premolars were used. After instrumentation all the root halves were randomly assigned into 4groups (n=10) and brought in contact with one of the following irrigants for 5 minutes. Group I: 10 ml of 5% Sodium Hypochlorite (NaOCl).Group II: 10 ml of 17% ethylene diamine tetra-acetic acid (EDTA) followed by 10 ml of 5% NaOCl.Group III: 10 ml of 5% NaOCl followed by 10 ml of 2% chlorhexidine digluconate (CHX).Group IV: 10 ml of 5% NaOCL followed by flush of 10 ml distilled water then by 10ml of 2% CHX. Dentin micro hardness was measured at baseline and after treatment to determine the change in micro hardness, using Vickers tester.Data was analyzed using following parametric tests t-test, ANOVA test and Post Hoc test. Group II ie final irrigation with EDTA showed the highest percentage decrease in micro hardness values, followed by group III, then group IV and the lowest was group I. All groups showed a significant difference between each other (P &amp;#60; 0.05), except group III and IV. The coronal third showed the highest percentage decrease with significant difference between apical and middle thirds (P &amp;#60; 0.05).EDTA with NaOCl causes greatest changes in dentine micro hardness, an intermediate flush with normal saline should be given for prevention of precipitation with NaOCl &amp; CHX.

Evaluate The Effect Of Different Irrigation Solutions During Surgical Extraction Of Impacted Lower Third Molars On Postoperative Trismus And Alveolitis

Evaluate The Effect Of Different Irrigation Solutions During Surgical Extraction Of Impacted Lower Third Molars On Postoperative Trismus And Alveolitis

The effect of different irrigation solutions and activation techniques on the expression of growth factors from dentine of extracted premolar teeth.

To evaluate in a laboratory study, the effect of different canal irrigant solutions and activation techniques on transforming growth factor (TGF-β1), insulin growth factor-1 (IGF-1), bone morphogenetic protein-7 (BMP-7) and vascular endothelial growth factor-A (VEGF-A) release levels from the dentine of extracted premolar teeth. Seventy premolar teeth with single root and canal were used. The lengths of the root segments were standardized to 12mm, and the root canals were prepared up to size 100 with hand files. All surfaces of the teeth were covered with nail polish except the inner root canal surface. The root canals were irrigated with 1.5% NaOCl. Ten teeth were allocated to the control group. The remaining sixty teeth were divided into 2main groups according to the chelating agent used (17% EDTA, 10% Citric acid; CA) and 3subgroups (n=10) according to irrigation activation technique (conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI) and Er:YAG laser activation). After the activation procedure, the root segments were placed into eppendorf tubes containing 1mL of phosphate-buffered saline solution and kept at 37℃. TGF-β1, IGF-1, BMP-7 and VEGF-A release levels from dentine were measured using the enzyme-linked immunosorbent assay (ELISA) method at 24 h and at day 7. The volume of root canals was calculated using cone-beam computed tomography. The growth factor levels were calculated in ng/mL except VEGF-A (pg/ml). Normality analysis of the data was evaluated with the Kolmogorov-Smirnov test. Statistical analysis was performed using the Mann-Whitney-U and Wilcoxon tests. Regardless of the activation type and sampling time, EDTA caused significantly more IGF release than did CA, whereas EDTA and CA were equally effective for the release of the other growth factors. For either EDTA or CA, the lowest and highest growth factor release levels were observed in the CSI and Er:YAG laser groups, respectively (p<.05). All of the growth factors were released significantly more at 24 h than on day 7 (p<.05). Irrigation activation techniques with EDTA or CA increased the release levels of all growth factors from the dentine of canal walls in extracted premolar teeth.

The Effect of Different Irrigation Solutions on the Cytotoxicity and Recovery Potential of Human Osteoblast Cells InVitro.

BackgroundSurgeons use various irrigation solutions to minimize the risk of prosthetic joint infection after total joint arthroplasty. The toxicity of these solutions is an important consideration in their use. This study investigates the effect of irrigation solutions Bacitracin, Clorpactin (sodium oxychlorosene), and Irrisept (chlorhexidine) on osteoblast cytotoxicity and proliferation.MethodsFour replicates of 6 conditions at 3 time points (1, 2, and 4 min) were tested: control (normal saline), Bacitracin (33 IU/ml), Clorpactin (0.05%, 0.1%, 0.2%), and Irrisept (0.05% chlorhexidine gluconate). Human osteoblasts were cultured at 37°C and 5% CO2 until confluent monolayers were obtained. The treatment solution was applied, and cells were washed 3x with warm phosphate-buffered saline and then supplemented with a fresh medium. Phase-contrast images were taken before and after treatment. The cytotoxicity and proliferation of the treated cells was measured for all conditions on day 3 and day 5 after treatment using the alamarBlue assay.ResultsAll test conditions showed morphological changes to cells after treatment; controls did not. Cells demonstrated curling and detachment. This effect was the worst and permanent with Irrisept, whereas other treatments showed a return to normal morphology after 1 week. All treatments showed increased %alamarBlue reduction after 5 days except Irrisept, which showed decreased reduction. There was no statistically significant time or dose dependence with Clorpactin treatment.ConclusionsClorpactin and Bacitracin are damaging to human osteoblast cells in vitro as compared with normal saline. This damage is at least partially reversible as shown by morphology and cell viability assay. Irrisept caused more damage than either Clorpactin or Bacitracin, and the damage was not reversible.

The effect of different irrigation solutions on fracture healing in a rat femur fracture model.

Objectives This study aims to evaluate and compare radiological, biomechanical, histopathological, histomorphometric and immunohistochemical effects of povidone iodine (PVP-I), hydrogen peroxide (HPO) and chlorhexidine gluconate (CHG) on fracture healing in their minimum cytotoxic and most efficient concentrations.Materials and methods This experimental animal study, conducted between April 2018 and January 2019, included 48 male Sprague Dawley® rats (weighing 356 g; aging 9 weeks) which were randomly divided into four groups: control (saline), HPO, PVP-I and CHG. Rat model of femoral fracture was established and intramedullary fixation was applied. Solutions were applied to fracture region in determined concentration and time, and all subjects were sacrificed on Day 28. Extracted femurs were investigated radiologically by micro-computed tomography. Then, all groups were divided into two random groups to be evaluated biomechanically, histopathologically, histomorphometrically and immunohistochemically.Results In histopathological evaluation, inflammation score of CHG group was significantly lower than other groups, and inflammation score of PVP-I group was significantly lower than control and HPO groups (p<0.05). Biomechanically, flexural strength (σbend) (megapascal) values of CHG and control groups showed similar results, but there was no significant difference between all groups (p>0.05). In immunohistochemical localization of bone morphogenic protein (BMP)-4, osteoblast and chondroblast histoscores (H-scores) of HPO group were significantly lower than other groups, and chondroblast H-score in CHG group was lower than control and PVP-I groups (p<0.05). In immunohistochemical localization of BMP-7, osteoblast H-score was significantly higher in CHG group than other groups (p<0.05).Conclusion We determined that CHG 0.05% solution had no negative effect on the fourth week of fracture healing histopathologically, immunohistochemically and biomechanically, and is an alternative irrigative to normal saline.

Effect of Different Irrigation Solutions on the Diffusion of MTA Cement into the Root Canal Dentin.

(1) Aim: This study aims to analyze the in vitro infiltration of a silicate root canal sealer into dentinal tubules after using different endodontic irrigating solutions. (2) Methods: Twenty-nine teeth with single roots were separated into three groups according to the final irrigation protocol: G1 n = 10) = 17% EDTA (ethylenediaminetetraacetic acid) + 3.0% sodium hypochlorite (NaOCl), G2 (n = 10) = 17% EDTA + 2.0% chlorhexidine and G3 (Control group, n = 9) = 17% EDTA + saline solution. Root canals were filled using cold lateral compaction technique with MTA Fillapex sealer and gutta-percha. The sealer was labeled with rhodamine B. The teeth were segmented at the middle and third apical sections, which were visualized using 10× confocal laser microscopy to determine the sealer penetration percentage. (3) Results: In the apical section, no statistically significant differences were found between the groups regarding sealer penetration. In the middle section, Group 1 obtained the highest percentage, and Group 2 the lowest (p = 0.004). Group 1 also presented statistically significant differences in the Control Group (p = 0.031) and had close sealer penetration values. Meanwhile, the Control Group (p = 0.023) and Group 2 (p = 0.029) revealed a significant decrease of sealer penetration between the apical and middle sections. (4) Conclusion: The obtained results support that final irrigation with NaOCl promoted similar sealer penetration in the apical and middle sections. On the other hand, a significant decrease in the sealer penetration of the middle section was observed for the chlorhexidine and saline groups. Compared to other irrigant solutions, NaOCl promotes more uniform sealer penetration, which can correlate with better sealing and, consequently, higher endodontic treatment success.

The Effect of Different Irrigation Solutions on the Accuracy of Two Electronic Apex Locators in Locating Artificial Root Perforations

The Effect of Different Irrigation Solutions on the Accuracy of Two Electronic Apex Locators in Locating Artificial Root Perforations

Effect of Different Irrigation Solutions on Coronal Microleakage in Endodontically Treated Teeth (An in vitro Study)

Background: The coronal microleakage in the endodontically treated teeth causes recurrent caries and can be associated with the restoration and the root canal treatment failures. Intra orifice barrier is an efficient alternative method to decrease coronal leakage in endodotically treated teeth and one of the best barriers is glass ionomer. The current study propose that using different irrigation solutions in root canals effect on coronal microleakage.&#x0D; Purpose: This study aimed to compare the coronal microleakage in glass ionomer obturated root canals in endodontically treated teeth using different irrigation solutions.&#x0D; Methods: Sixty extracted human single-rooted teeth with single canals were collected and disinfected with 0.5 choloro amin. After root canal therapy and evacuation of 2 mm coronal gutta percha, the teeth were divided into 3 groups of each 20, based on irrigation solutions. Glass ionomer was used as the coronal barrier and the teeth were stored in distilled water. The irrigation solutions used were: 17% EDTA, Alcohol and normal saline. Then all the specimen were submerged in 2% methylene blue dye for 24 hours at room temperature and sectioned sagittally and the dye penetration was assessed by stereomicroscope.&#x0D; Results: There were not penetration of dye only in 3.3% of teeth and all of the teeth that irrigated with saline showed dye penetration. The dye penetration was seen in 95%, 95% and 100% of the EDTA, alcohol and saline groups, respectively. Dye penetration was higher in Saline group than other two groups but coronal microleakage has not shown statistically significant differences in different groups.&#x0D; Conclusion: The results of current study indicated that using different irrigation solutions may be associated with decrease in coronal microleakage. Although, based on our findings there are not any significant differences among different irrigation solutions but more studies may be needed to confirm this results.

The effects of QMix and EndoActivator on postoperative pain in mandibular molars with nonvital pulps: a randomized clinical trial.

The purpose of this study was to compare the effects of different irrigation solutions when used EndoActivator on postoperative pain. A total of 104 subjects with nonvital pulps were selected and randomly assigned to four experimental groups; (G) 1 (n= 26) 2.5% NaOCl + conventional endodontic syringe, (G) 2 (n= 26) 2.5% NaOCl + EndoActivator, (G) 3 (n= 26) 2.5% NaOCl + QMix + conventional endodontic syringe, (G) 4 (n= 26) 2.5% NaOCl + QMix + EndoActivator. All the patients were prescribed ibuprofen 400mg to be taken every 8h in case of pain. The patients were asked to rate the severity of the postoperative pain on a visual analog scale (VAS) for 8th, 24th, 48th, and 72nd hours after the visit. The data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Chi-Square tests. G4 resulted in lesser postoperative pain levels on 8th, 24th, 48th, and 72nd hours than the G2, G3, and G1 did. There was no significant difference between G4 and G2 and between G3 and G1 in terms of the postoperative pain levels at any time interval (P> 0.05). It was determined that the postoperative values of the groups, in which EA was used, were statistically significantly lower than in the other groups. The combined use of QMix and EA provided the most significant decrease in the postoperative pain values. Successful management of postoperative pain is an important issue for the clinician. The combined use of Qmix and EA can be recommended to the clinicians.

Effect of Root Canal Irrigants on Fiber Post Bonding Using Self-adhesive Composite Cements.

To evaluate the effect of different irrigation solutions on the bonding of self-adhesive composite cements to the root canal during fiber-post cementation. One hundred twenty single-rooted human teeth were endodontically treated. The post spaces were prepared and specimens were randomly divided into ten groups, according to the combination of the factors: post space irrigation (distilled water, 2.5% NaOCl, 17% EDTA, 26% polyacrylic acid, and 17% EDTA + 2.5% NaOCl) and self-adhesive composite cement (RelyX U200 [3M Oral Care] and Multilink Speed [Ivoclar Vivadent]). The proportion of open dentinal tubules was evaluated by SEM. After fiber post cementation, six slices were obtained from each root (coronal, middle, and apical thirds) for evaluation of push-out bond strength (BS), nanoleakage (NL), and Vickers microhardness (VHN) of the composite cement. Data from open dentinal tubules were submitted to Kruskal-Wallis and Student-Newman-Keuls tests (α = 0.05). Data from BS, NL, and VHN were evaluated by two-way ANOVA and Tukey's test (α = 0.05). Irrigation with EDTA, polyacrylic acid, and EDTA + NaOCl increased the proportion of open dentinal tubules. For RelyX U200, NaOCl, distilled water and EDTA resulted in the highest BS and VHN values, while for Multi- link Speed, these values were higher only for distilled water. Both composite cements presented lower BS and VHN with polyacrylic acid. NL did not differ between experimental groups (p > 0.05). For both composite cements tested, distilled water showed better results in push-out and microhardness tests.

IN VITRO EVALUATION OF THE Effect of different irrigation solutions on the apical sealing ability of three root canal sealers when the continuous wave obturation technique was used

Aim: The aim of this study was to compare the effect of three irrigating solutions on the apical sealing ability of three endodontic sealers when the continuous wave obturation technique was used.Materials and Methods: 100 maxillary central incisors were decoronated and roots were divided into three experimental groups (n=30 each) according to the type of irrigating solution, and two control groups (n=5 each). Each experimental group was divided equally into three subgroups according to the type of obturation system. All canals were instrumented using ProTaper Universal rotary system and irrigated with 3% sodium hypochlorite (Group 1), 2% chlorohexidine (Group 2), and 3% hydrogen peroxide (Group 3), followed by 17% EDTA and distilled water. Continuous wave technique was used to obturate root canals with the following combinations: MTA Fillapex/Gutta-percha (Subgroup A), AH Plus/Gutta-percha (Subgroup B) and Realseal SE/Realseal (Subgroup C). The apical microleakage was assessed using linear dye penetration method and the data were statistically analyzed. Results: Significant differences were found between all groups (P<0.05). All root canal sealers after irrigation with 3% hydrogen peroxide showed the lowest amounts of apical leakage. Samples irrigated with 3% sodium hypochlorite or 2% chlorohexidine showed the highest amounts of apical leakage. Conclusions: The type of irrigating solution could affect the apical sealing ability of experimental sealers when used with the continuous wave obturation technique. Root canal irrigation with 3% hydrogen peroxide + 17% EDTA increased the sealing ability of all root canal sealers. Root canal irrigation with 3% sodium hypochlorite 2% chlorohexidine + 17% EDTA decreased the sealing ability of all root canal sealers.

The effects of different irrigation solutions on the bond strength of cemented fiber posts.

ObjectiveTo study effect of root canal irrigant solutions on the bond strength of cemented fiber posts, and resin cement-tags in root canal dentin.Materials and methodsFifty-two human single-rooted anterior teeth were selected and stored in 1% sodium azide. Crowns were sectioned 2 mm incisal to the cemento enamel junction with diamond bur at high speed under water-cooling. After standard root canal treatment to tested teeth, they were randomly assigned into four groups (n=13) corresponding to the endodontic irrigant solution that was used during post space preparation. The treatment groups were: Group 1: 6.15% sodium hypochlorite; Group 2: 17% EDTA; Group 3: 6.15% NaOCl +17% EDTA; Group 4: 6.15% NaOCl +0.12% chlorhexidine solution. Parallel-sided fiber posts were used for all specimens. Samples were embedded in a cylindrical PVC mounting jig to facilitate perpendicular sectioning. With low speed diamond saw, cervical and apical specimens from each tooth were obtained and subjected to push-out test using universal testing machine. SEM was used to examine the root-canal dentin surface.ResultsStatistical analysis revealed significant difference among the groups at P<0.05. Group 2 treated with EDTA, had the highest bond strength; 18.63±2.85 MPa in cervical specimens and 13.49±3.67 MPa in apical specimens. The cervical specimens of Groups 2 and 3 were significantly different than the apical specimens in the same group. Adhesive failure between cement and dentin was the main failure mode observed in all groups. Groups irrigated with EDTA showed cleaner dentin surface and better resin tag formation, while groups treated with NaOCl showed less resin tag formation and insufficient smear layer removal.ConclusionNaOCl had adverse effect on bond strength of self-adhesive resin cement to radicular dentin. EDTA irrigant solution produced higher bond strength and was more effective in removing smear layer than NaOCl.

Use of wet-to-moist cleansing with different irrigation solutions to reduce bacterial bioburden in chronic wounds.

The influence of different irrigation solutions, in conjunction with wet-to-moist cleansing, on the reduction of sessile, non-planktonic bacteria which colonise wounds, has not been investigated. In this study, the antibacterial effect of different irrigation solutions, during a 20-minute wet-to-moist cleansing, has been evaluated in chronic wounds. This study was designed as a prospective cohort study with 12 study arms and was conducted between June 2011 and April 2016. Patients with chronic wounds present for more than three months, irrespective of previous treatments, were recruited into this study. Quantitative wound swabs were obtained before and after a 20-minute, wet-to-moist cleansing, using different wound irrigation solutions. Sterile 0.9% saline served as a control. We recruited 308 patients, of which 260 patients with 299 chronic wounds were eligible for analysis. Staphylococcus aureus was the most common recovered (25.5%) microorganism, of which 8% were meticillin-resistant Staphylococcus aureus (MRSA) strains. Although 0.9% saline supported cleansing of the wound bed, it did not significantly reduce the bacterial burden. The highest reduction of bacterial burden was achieved with an aqueous solution containing betaine, zinc and polyhexamethylene biguanide (polihexanide; ln RF=3.72), followed by a 3% saline solution containing 0.2% sodium hypochlorite (ln RF=3.40). The most statistically significant reduction of bacterial burden, although not the highest, was achieved with povidone-iodine (ln RF=2.98; p=0.001) and an irrigation solution containing sea salt 1.2% and NaOCl 0.4% (ln RF=2.51; p=0.002). If a reduction of bacterial burden is warranted, wound irrigation solutions containing a combination of hypochlorite/hypochlorous acid, or antiseptics such as polihexanide, octenidine or povidone-iodine, ought to be considered.

Are large clinical trials in orthopaedic trauma justified?

BackgroundThe objective of this analysis is to evaluate the necessity of large clinical trials using FLOW trial data.MethodsThe FLOW pilot study and definitive trial were factorial trials evaluating the effect of different irrigation solutions and pressures on re-operation. To explore treatment effects over time, we analyzed data from the pilot and definitive trial in increments of 250 patients until the final sample size of 2447 patients was reached. At each increment we calculated the relative risk (RR) and associated 95% confidence interval (CI) for the treatment effect, and compared the results that would have been reported at the smaller enrolments with those seen in the final, adequately powered study.ResultsThe pilot study analysis of 89 patients and initial incremental enrolments in the FLOW definitive trial favored low pressure compared to high pressure (RR: 1.50, 95% CI: 0.75–3.04; RR: 1.39, 95% CI: 0.60–3.23, respectively), which is in contradiction to the final enrolment, which found no difference between high and low pressure (RR: 1.04, 95% CI: 0.81–1.33). In the soap versus saline comparison, the FLOW pilot study suggested that re-operation rate was similar in both the soap and saline groups (RR: 0.98, 95% CI: 0.50–1.92), whereas the FLOW definitive trial found that the re-operation rate was higher in the soap treatment arm (RR: 1.28, 95% CI: 1.04–1.57).ConclusionsOur findings suggest that studies with smaller sample sizes would have led to erroneous conclusions in the management of open fracture wounds.Trial registrationNCT01069315 (FLOW Pilot Study) Date of Registration: February 17, 2010, NCT00788398 (FLOW Definitive Trial) Date of Registration: November 10, 2008.

Effects of Different Irrigation Solutions and Protocols on Mineral Content and Ultrastructure of Root Canal Dentine.

Introduction:The aim of this study was to evaluate the effect of different irrigating solutions and irrigation protocols on the chemical and physical structure of root dentin. Materials and Methods:Thirty extracted single-rooted human teeth were selected and then distributed into the following treatment groups (n=10): G1, saline solution (0.9% NaCl); G2, 2.5% NaOCl + 17% EDTA + 2.5% NaOCl; G3, 2.5% NaOCl + 9% Etidronate (HEBP) + 2.5% NaOCl; G4, mixture of 5% NaOCl + 18% HEBP; G5, 2.5% NaOCl + 17% EDTA + 0.9% NaCl, and G6, 2.5% NaOCl + 9% HEBP + 0.9% NaCl. The ultrastructure of dentin was characterized through scanning electron microscopy (SEM) and energy dispersive x-ray spectrometry (EDS) determined the chemical composition in terms of the calcium (Ca), phosphorus (P), magnesium (Mg) and potassium (K) content and the Ca/P ratio; and the crystalline phase was analyzed by x-ray diffraction (XRD). A descriptive analysis was performed on the ultrastructure and the crystallography data of dentin. Data analysis included a chemical composition analysis of variance (one-way ANOVA) and a subsequent multiple comparison test (Tukey’s test). Results:Except for the control group, all groups showed morphological changes upon visualization with SEM. For EDS, G2 and G5 showed significant mineral loss and changes in the Ca/P ratio (P<0.05); the highest values of Ca and P were observed in G3, G4 and G6. Conclusion:All the irrigating solutions and irrigation protocols tested promoted changes in the morphology and physical and chemical composition of the dentin. However, no significant differences were observed crystallographically.