Endodontic Irrigants Research Articles

Effect of microbubble as local drug delivery system in endodontic management - An In-Vitro study

Background and ObjectivesMicrobubbles (MBs) are gas or vapor-filled cavities inside liquids with sizes ranging from 2 to 3 µm. Recently, MBs have shown great promise in nanomedicine owing to their high encapsulation efficiency, targeted drug release, improved biocompatibility, and longer blood circulation. Furthermore, they are more suitable for focusing on particular body regions and are safer and non-invasive. MBs generators are used to create bubbles in fluid dynamics, chemistry, medicine, agriculture, and the environment. Drug delivery using MBs increases penetration without causing systemic toxicity.In this study, we examined whether the use of microbubbles as a local drug-delivery mechanism increases tubular penetration of endodontic medications and irrigant. Materials and MethodsAn Enterococcus faecalis culture was added to 38 dentin cylinders of single-rooted teeth. Samples were divided into the experimental and control groups that received a triple antibiotic paste with and without MB infusion (n = 19 in each group), respectively. After 14 days, the number of live bacteria in the samples was determined using confocal laser scanning microscopy. ResultsAfter 14 days of contact with the medication, the percentages of live and dead bacteria were assessed. Results show that Group 2 (Triple antibiotic infused micro bubble) showed significantly (P < 0.05) higher antibacterial efficacy than Group 1 (TAP). ConclusionIn this study, the antibacterial efficacy was significantly higher in the experimental group than in the control group. Therefore, within the limitations of the study it can be said that MB infusion is a viable technique to improve root canal disinfection. Hence, it can be considered as a novel technique for local drug delivery systems in endodontic management.

Effect of sodium hypochlorite, ethylenediaminetetraacetic acid, and dual-rinse irrigation on dentin adhesion using an etch-and-rinse or self-etch approach

The aim was to investigate the influence of endodontic irrigation solutions and protocols on the micro-tensile bond strength (μTBS) to dentin using an etch-and-rinse (ER) or self-etch (SE) adhesive approach. Eighty extracted human molars were ground to dentin. After pretreating for 27 min (21 min–3 min–3 min) with five different endodontic irrigation protocols (Group 1: NaOCl–EDTA–NaOCl; Group 2: NaOCl–NaOCl–EDTA; Group 3: NaOCl–NaCl–NaOCl; Group 4: Dual Rinse–Dual Rinse–Dual Rinse; Group 5: NaCl–NaCl–NaCl), an ER (Optibond FL, Kerr) or a SE (Clearfil SE Bond, Kuraray) adhesive system was applied. After light-curing, composite build-ups were made and cut into dentin-composite sticks. μTBS and failure modes were analyzed. Nonparametric statistical analyses (α = 0.05) were performed for comparison of the five groups within each type of adhesive as well as between the two adhesive systems used. The use of an ER instead of a SE adhesive system resulted in significantly higher μTBS for all irrigation protocols except for group 1 (NaOCl–EDTA–NaOCl) and 2 (NaOCl–NaOCl–EDTA). A statistical difference between the five different endodontic irrigation protocols was only found within the SE adhesive group, where group 1 (NaOCl–EDTA–NaOCl) achieved highest values. The use of an ER adhesive system cancels out the effect of the endodontic irrigation solution. The highest μTBS was achieved when using a NaOCl–EDTA–NaOCl-irrigation protocol in combination with Clearfil SE Bond, which shows that the selection of the endodontic irrigation should match the corresponding SE adhesive system.

Endodontic irrigation: Science or marketing?

Endodontic irrigation: Science or marketing?

Evaluation of the antimicrobial action and cleaning ability of different naturally based vinegar used as endodontic irrigants

Evaluation of the antimicrobial action and cleaning ability of different naturally based vinegar used as endodontic irrigants

Sodium hypochlorite as an endodontic irrigant and its effect on dentine: a review of literature

Successful endodontic treatment is achieved by a combination of factors which include acceptable instrumentation, optimal irrigation and disinfection of the root canal system. It is vital that a suitable antimicrobial agent be used during irrigation and sodium hypochlorite emerges as the optimal agent to be used as it complies with most of the criteria of an ideal irrigant. Sodium hypochlorite is a popular choice as an endodontic irrigant due to its solvent activity as well as its antimicrobial action. The tissue dissolving ability of sodium hypochlorite depends on its concentration, volume, contact time of solution with tissue remnants, refreshment and/or activation cycles of solution, as well as the surface area of exposed tissue

Evaluation of pH and Optical Properties of Dual Rinse HEDP Irrigating Solution

This study investigates the pH values and optical characteristics of Dual Rinse HEDP, either independently or combined with sodium hypochlorite (NaOCl), and compares them to other irrigants used in endodontics. The solutions used in this study were commercially acquired and prepared, followed by pH measurements using a pH meter and spectral analysis using UV/Vis spectrophotometry in specified wavelengths of the ultraviolet (UV) C (190–280 nm), UVB (281–315 nm), UVA (316–400 nm), visible light (VL) (401–780 nm), and near-infrared (NIR) spectra (781–1100 nm). The pH analysis revealed alkaline values for NaOCl, EDTA, Dual Rinse HEDP, and the HEDP + NaOCl combination, an acidic value for citric acid, and nearly neutral values for chlorhexidine and distilled water. Spectral analysis revealed the notable absorption characteristics of endodontic irrigants. In the UV range, all solutions exhibited higher absorption values to water (p &lt; 0.05), with Dual Rinse HEDP resembling EDTA and citric acid, and HEDP + NaOCl resembling NaOCl. The NIR region highlights absorption peaks around 975 nm for all solutions, including NaOCl and Dual Rinse HEDP + NaOCl, suggesting potential applications in laser-activated irrigation. This study provides comprehensive insights into the pH and optical features of endodontic irrigants, emphasizing their potential roles in enhancing disinfection strategies and optimizing laser-activated irrigation protocols.

Clinical significance of the main methods of root canal irrigation in endodontics: a systematic review

Clinical significance of the main methods of root canal irrigation in endodontics: a systematic review

Influence of Ozonated Water and Photodynamic Therapy on the Bond Strength of Anatomical Fiberglass Posts to Root Dentin. An In Vitro Study

ABSTRACT This study evaluates, in vitro, the effects of ozonated water as auxiliary endodontic irrigating and photodynamic therapy on the bond strength of fiberglass posts to root dentin. Sixty bovine incisors were prepared and divided into six groups (n=10):Oxidation only G1 Distilled water G2 5.25% NaOCl G3 10–15mg/L O3. Ox+PDT G4 DW+PDT G5 NaOCl+PDT G6 O3+PDT. Anatomical fiberglass posts were cemented and the roots were sectioned and submitted to the push-out test. Bond strength values were analyzed with two-way ANOVA and Tukey 5%. Failure patterns were analyzed. Sodium hypochlorite and ozonated water without photodynamic therapy showed the highest bond strength, and sodium hypochlorite with photodynamic therapy had the lowest bond strength. The O3+PDT association showed intermediate results. Considering that the main purpose of the O3 is disinfection, it was noted that ozonated water did not interfere on the bond strength of fiberglass posts to root dentin. Photodynamic therapy affected bond strength, mainly when associated with sodium hypochlorite. The ozonated water increases the PDT bond strength results.

Effect of diode laser irradiation and application of nanoparticle herbal endodontic irrigation solutions on Candida albicans and Enterococcus faecalis bacteria

Effect of diode laser irradiation and application of nanoparticle herbal endodontic irrigation solutions on Candida albicans and Enterococcus faecalis bacteria

Apical enlargement favors endodontic irrigation – an in vivo study

Objective: This study evaluated the irrigation penetration during root canal instrumentation and the clinical step in which the irrigation solution can be detected in the apical region.&#x0D; Materials and Methods:&#x0D; Twenty necrotic molars were divided according to the irrigation protocol, saline solution with manual active pressure, and 2.5% sodium hypochlorite with dripping delivery. Solution penetration assessment used a radiopaque component added to each irrigant solely before a periapical radiograph. Instrumentation sequence was: #10, and #15 K-files (step 1), cervical flaring using WaveOne Small (step 2), WaveOne Small at working length (step 3), Hero-642 #35/.02 (step 4), and Hero-642 #40/.02 (step 5). The step each contrasted-irrigant reached the 2-mm-apical region was registered. Shapiro-Wilk and Fisher's exact tests were used for comparisons.&#x0D; Results: In step 3, both contrasted-irrigants started to be detected in the apical region, and after step 5, contrasted-irrigants penetrated in 100% of the cases, without significant difference.&#x0D; Conclusion: Considering distal molar roots, the apical enlargement up to an instrument #40.02 favors the irrigation to reach the 2-mm apical region.

Effect of final irrigation protocols with chitosan nanoparticle and genipin on dentine against collagenase degradation: An ex-vivo study.

Endodontic irrigants may affect the mechanical and chemical properties of dentine. This study evaluated the effects of various final irrigation protocols including the use of chitosan nanoparticle (CSnp) and cross-linking with genipin on the (1) mechanical and (2) chemical properties of dentine against enzymatic degradation. CSnp was synthesized and characterized considering physiochemical parameters and stability. The root canals of 90 single-rooted teeth were prepared and irrigated with NaOCl. Dentine discs were obtained and divided into groups according to the following irrigation protocols: Group NaOCl+EDTA, Group NaOCl+CSnp, Group NaOCl+EDTA+CSnp, Group NaOCl+CSnp+Genipin, Group NaOCl+EDTA+CSnp+Genipin and Group distilled water. (1) Mechanical changes were determined by microhardness analysis using Vickers-tester. (2) Chemical changes were determined by evaluating molecular and elemental compositions of dentine using Fourier transform infrared spectroscopy (FTIR) analysis and scanning electron microscope (SEM)/energy dispersive X-ray spectroscopy (EDS) analysis, respectively. All analyses were repeated after the discs were kept in collagenase for 24 h. Data were analysed with repeated measures analysis of variance and Bonferroni correction for microhardness analysis, and Kruskal-Wallis and Wilcoxon tests for FTIR and SEM/EDS analyses (p = .05). (1) Collagenase application did not have a negative effect on microhardness only in Group NaOCl+EDTA+CSnp+Genipin when compared with the post-irrigation values (p > .05). Post-collagenase microhardness of Group NaOCl+EDTA+CSnp and Group NaOCl+CSnp+Genipin was similar to the initial microhardness (p > .05). (2) After collagenase, Amide III/ ratio presented no change in Group NaOCl+EDTA+CSnp, Group NaOCl+CSnp+Genipin and Group NaOCl+EDTA+CSnp+Genipin (p > .05), while decreased in other groups (p < .05). Collagenase did not affect / ratio in the groups (p > .05). There were no changes in the groups in terms of elemental level before and after collagenase application (p > .05). CSnp and genipin positively affected the microhardness and molecular composition of dentine. This effect was more pronounced when CSnp was used after EDTA.

Comparing the Biofilm Removal Capacity of NaOCl, Povidone-Iodine, Chlorhexidine, Curcumin, and Triphala as Endodontic Irrigants.

A sessile multicellular organism that is immersed in a self-produced matrix of extracellular polymeric substances and has its cells firmly attached to a surface is referred to as a microbial biofilm. When it comes to pulp and periradicular pathosis, biofilms are crucial.To reduce the number of microorganisms in the root canal and assist in treating periapical pathosis, endodontic therapy must include decontamination of the system of tooth root canals through biomechanical preparation and irrigation of the root canal.This study compares sodium hypochlorite (NaOCl), povidone-iodine, chlorhexidine, curcumin, and triphala as endodontic irrigating solutions regarding their capacity to eliminate biofilm from root canals. A total of 60 patients were included if they had pulpitis. Two specific samples (samples A and B) were chosen for analysis from a collection of samples so that their bacterial composition is most similar to that of acute pulpitis. The suspensions of bacterial cells from this polymicrobial culture have been collected from frozen stock and then regrown by inoculation on Columbia agar base (Basingstoke, UK) with the addition of vitamin K1, hemin, and 5% (v/v) calf blood. The pureness of the suspensions was assessed using colony morphology and Gram staining. Analytical profile index (API) 20A tests or automated test for bacteria (ATB) ID 32A tests were initially used to identify the isolates. These polymicrobial cultures' in vitro biofilms were developed using membrane filters made of cellulose nitrate. The tested irrigating solutions were as follows: 5.25% sodium hypochlorite, 10% triphala, 0.2% chlorhexidine gluconate, 10% povidone-iodine, and 5% curcumin (CUR). On the other hand, phosphate-buffered saline was taken as a control agent. As the standard of excellence in endodontic irrigation, NaOCl has eliminated all germs in sample A following 15 minutes of culture and in both of the specimens after 40 minutes. Iodine also eliminated all germs after 40 minutes of administration, indicating that it would be worth exploring using iodine as a potential endodontic irrigant. Iodine achieved total bacterial elimination after 40 minutes in both samples; however, it was less effective after 15 minutes. Our findings indicate that iodine solution is the most suitable alternative after the supremely effective NaOCl, although it requires longer contact times to generate the necessary and recognized broad-spectrum antibacterial properties, including in the case of biofilms. Furthermore, curcumin also showed significant results after NaOCl and iodine. The antibacterial potency of each studied irrigant was significant, supporting their usage in endodontics. It was observed that NaOCl has the maximum antibacterial activity.

Evaluation of Antimicrobial Efficacy of 3.8% Silver Diamine Fluoride as a Root Canal Irrigant against Enterococcus Faecalis in Primary Teeth: A Randomised Clinical Trial

Introduction: During a pulpectomy, the infected or inflamed pulp tissues are removed, and the root canal is thoroughly cleaned with mechanical instrumentation and copious irrigation. Various endodontic irrigants are available, such as Sodium Hypochlorite (NaOCl), Chlorhexidine (CHX) gluconate, Ethylene Diamine Tetra Acetic Acid (EDTA), Mixture of doxycycline, citric acid, and a detergent (MTAD), etc. Among these, CHX gluconate is widely used as an endodontic irrigant and medicament due to its antibacterial effect and substantivity. Enterococcus faecalis is the most common bacterial species found in necrotic teeth, with high viability and antibiotic resistance. A 3.8% Silver Diamine Fluoride (SDF) has antimicrobial properties and has been shown to eliminate E. faecalis from the root canals of permanent teeth. However, there are no studies in the literature that have evaluated its efficacy as a root canal irrigant in primary teeth. Aim: To evaluate the antimicrobial efficacy of 3.8% SDF against E. faecalis in primary teeth. Materials and Methods: This was a in-vivo double-blinded randomised clinical trial conducted at Department of Paediatric and Preventive Dentistry, GSL Dental College and Hospital, Rajahmundry, Andhra Pradesh, India in children aged 3-8 years old. The study included 60 primary teeth that required pulpectomy. The teeth were divided into two groups and irrigated: 30 teeth with 3.8% SDF (Group I) and 30 teeth with 2% CHX (Group II). In all cases, two microbiological samples were taken using sterile absorbent paper points: the first after access opening and the second after the final irrigation. All samples were assessed using the agar plate method. The results were analysed statistically using a Student's paired t-test. Results: After analysing the pre- and postirrigation samples, there was a statistically significant reduction in Colony Forming Units (CFU)mL (p&lt;0.05) in both groups. When comparing the two groups, no statistical difference was observed in the percentage reduction of bacterial colonies (p&gt;0.05). Conclusion: The reduction in CFU/mL of E. faecalis was comparable in both groups. Thus, 3.8% SDF can be used as an alternative root canal irrigant to 2% CHX.

Update on chelating agents in endodontic treatment: A systematic review.

The aim of this review was to assess the evidence regarding the most commonly used chelating agents in terms of efficacy, erosive potential, cytotoxicity, interaction, antimicrobial effect, impact on sealers adhesion, and release of growth factors. MEDLINE (PubMed) database, Cochrane Library and Scopus were searched up to January 14, 2023, including studies with one or more of the following chelating agents: 17% EDTA, 9% and 18% HEDP, 10% and 20% citric acid, 2%-2.25% peracetic acid and 7% maleic acid. In addition, the reference lists of all selected articles were also checked to identify additional relevant studies. Articles published in English and available in full-text were selected. The quality of studies was assessed using the modified CONSORT checklist guide and the Cochrane Collaboration tool. The electronic search yielded 538 citations, 56 of which were included. The articles included had moderate and low evidence values. Among 56 articles included, 55 were in vitro studies and one was a randomized clinical trial. Among the in vitro studies, 15 evaluated efficacy and dentin erosion, 12 evaluated interaction with other endodontic irrigants, 9 tested antimicrobial effect, 4 evaluated cytotoxicity in hamster and rat lung cells, 9 evaluated intervention in adhesion of filling materials and 8 focused on release of growth factors and on behavior of stem cells in regenerative endodontic. The RCT tested antimicrobial effect. 17% EDTA is the most effective in smear layer removal and in releasing growth factors on regenerative endodontics. However, the current incorporation of 9% and 18% etidronic acid has shown optimal results due to its compatibility with sodium hypochlorite and its capability on avoiding smear layer formation through a continuous chelation action. Despite these preliminary findings, methodological standardization between studies is required and in vivo studies are necessary to confirm in vitro studies. Key words:Chelating Agents, Smear Layer, Systematic Review, Endodontics, Root Canal Irrigants.

A Novel Educational Approach for Safe Endodontic Syringe Irrigation: A Randomized Controlled In Vitro Study.

Syringe irrigation, commonly used for delivering sodium hypochlorite (NaOCl) during root canal treatment, requires careful handling to prevent NaOCl extrusion into periapical tissues. This randomized controlled in vitro study aimed to quantify syringe plunger forces exerted by dental undergraduates and to assess the impact of an educational intervention on adherence to safe irrigant delivery parameters. Fifty-two undergraduates performed syringe irrigation at three intervals: baseline (T1), after two weeks (T2), and after 12 weeks (T3). At T1, irrigation was conducted without prior educational intervention, while at T2, it was preceded by an intervention. The educational intervention involved a short video highlighting safe irrigation practices, including plunger force and time recommendations for syringe irrigation. At T3, the undergraduates were randomly allocated to two groups: One received a repeated intervention, while the other did not. Syringe irrigation was performed on a 3D-printed tooth using two side-vented cannulas: one of 25 Gauge (G) and another of 30 G. A syringe equipped with a force sensor recorded the plunger forces. Based on earlier research, plunger forces exceeding 10 Newtons (N) for the 25 G cannula and 40 N for the 30 G cannula were deemed critical. The data were subjected to descriptive statistical analyses. Overall, the mean of maximum values of plunger forces remained under 10 N for the 25 G and below 20 N for the 30 G cannulas, with only few measurements exceeding 40 N. Instances of surpassing the critical plunger force threshold were more common with the 25 G side-vented cannula than with the 30 G variant. At T3, the group that received the repeated educational intervention exhibited lower average maximum plunger forces for both types of cannulas compared with the group that did not receive the intervention. Integrating plunger force measurements with targeted educational interventions presents an effective approach for instructing undergraduates in the proper techniques of syringe irrigation. The findings suggest that, generally, undergraduates do not apply excessive plunger forces that could risk apical irrigant extrusion. The implementation of repeated educational interventions has been shown to decrease the plunger forces exerted by undergraduates, underscoring its effectiveness in fostering safe endodontic irrigation.

Evaluation of cytotoxicity of 3.8 % SDF and BioAKT solutions on the viability of dental pulp stem cells

IntroductionNonsurgical endodontic therapies have evolved from classic endodontic therapies to regenerative endodontic treatments (RETs) in recent years. In context of the cytotoxic activity of the most commonly used endodontic irrigant, NaOCl, newer endodontic irrigating solutions should be tested for its effective use in RETs. The aim of this trial was to examine and assess the cytotoxic response of 3.8 % SDF and BioAKT irrigating solutions on the viability of DPSCs. MethodsThe viability of DPSCs cultivated in 5.25 % NaOCl, 3.8 % SDF & BioAKT at dilutions of 1:100,1:20 &1:10 were evaluated through MTT assay after 10 min, 60 min and 24 h incubation, detection of apoptosis and ALP activity after 7,14 & 21-days incubation. A two-way analysis of variance (ANOVA) with post hoc Turkey HSD was performed to determine significant differences between the specimens tested. ResultsWhen compared to the control at all time periods, all test specimens at varied dilutions (1:100, 1:20, and 1:10) caused no cytotoxic effects. The maximum number of live cells and ALP activity was observed with DPSCs cultivated in BioAKT followed by 3.8 % SDF and 5.25 % NaOCl at all time intervals. ConclusionDifferent doses of 3.8 % SDF and BioAKT solution revealed encouraging outcomes when compared to 5.25 % NaOCl in terms of viability, proliferation and long-term ALP functioning potential when cultivated in DPSCs.

Eradication of mature biofilm from the isthmus region using Er, Cr: YSGG Laser as an activator of 2% chlorhexidine gluconate.

Challenges in the root canal system, such as isthmus, may limit the action of endodontic equipment and irrigation solutions, so using laser agitation is recommended to upgrade the removal of microbial biofilm. The objective of this study is to assess the effectiveness of the laser in photon-induced photoacoustic streaming protocol agitation of 2% chlorohexidine gluconate in removing mature biofilm in complex root canal systems. Seventy-five mesial roots of the lower first and second molars were separated and cultivated with Enterococcus faecalis bacteria for 30 days (except for the negative control group samples). The samples were divided into four groups (n=15), one group acted as a positive control, other groups were irrigated with 2% chlorohexidine gluconate, some of them were agitated with a passive ultrasonic device, while the other samples were agitated by an Erbium, chromium-doped yttrium, scandium, gallium, and garnet laser in photon-induced photoacoustic streaming protocol. An atomic force microscope was used as a new method to get the results in the isthmus area; A scanning electron microscope was also used in the study to examine the samples before and after the treatment. Statistical Package for Social Sciences software was used to collect and analyze data, and two-way ANOVA was used to compare the means of the test groups. According to the atomic force microscope and scanning electron microscope analyses, Erbium laser and passive ultrasonic activation groups showed higher antimicrobial efficacy than the syringe irrigation group (p<0.05). According to the study's results, the agitation of chlorohexidine gluconate fluid by Erbium laser in photon-induced photoacoustic streaming at 0.75 W offers better Enterococcus faecalis biofilm removal in the difficult-to-reach areas of lower first and second molars. Key words:Atomic force microscope, 2% chlorhexidine gluconate, Enterococcus faecalis, Erbium, chromium-doped yttrium, scandium, gallium, garnet laser, passive ultrasonic.

Highly Effective DPA-SCP Sonosensitizer for Biofilm Removal in Infected Root Canals via Sonodynamic Therapy

Chemical debridement constitutes a pivotal phase in eradicating microbial entities during endodontic therapy. The antimicrobial efficacy of endodontic irrigants in clinical use is contingent upon their concentration; however, elevated concentrations...

Endodontic irrigation systems: Review article

Endodontic irrigation systems: Review article

Novel nano-cubosomal chlorhexidine for endodontic irrigation: Development, characterization, and performance evaluation against E. faecalis and streptococcal biofilms in human extracted teeth

Disinfection of the root canal system is one of the most complicated procedures and involves the use of a variety of equipment and techniques, irrigation regimens, and intracanal medications. “Cubosomes” (CUs) are among the few nanocarriers that are currently being explored for active drug delivery systems. A novel cubosomal chlorhexidine (CHX) for root canal irrigation was developed, and its release profile and antimicrobial efficacy against Enterococcus faecalis and streptococcal biofilms were evaluated. CUs were characterized for shape, particle size, polydispersity index, zeta potential, and drug entrapment. Drug release was determined using the dialysis method. Microbial analysis of live and dead bacteria was performed via confocal laser scanning microscopy (CLSM). The average particle size, polydispersity index, and zeta potential of the CHX CUs were 157 nm, 0.4, and 19 mV, respectively. The drug entrapment efficiency was approximately 47%. Drug release studies revealed that the cubosomal formulation released approximately 77% of the drug at the end of 6 hours, and complete release was detected at 24 hours. Confirmation of biofilm formation by CLSM and the percentage (%) survival of biofilm cells revealed that the Cubosomal formulation more effectively inhibited biofilm formation even after 48 hours. Both colony-forming unit and CLSM tests revealed that cubosomal CHX showed improved antimicrobial efficacy. The novel cubosomal CHX delivery system for endodontic irrigation was proven to be successful, as it improved the release of CHX, in turn improving its antimicrobial efficacy compared to that of regular CHX solution.