Extrusion Of Sodium Hypochlorite Research Articles

Spectrophotometric Analysis of Apical Extrusion of Sodium Hypochlorite using Different Irrigation Protocols in an Ex Vivo Model of Immature Teeth.

To evaluate the effect of different agitation methods on apical extrusion of 1.5% sodium hypochlorite (NaOCl) in an ex vivo model of immature teeth. Sixty extracted human inferior incisors were prepared to simulate immature teeth and embedded in an artificial root socket made of silicone impression material. The teeth were then divided into four groups: Conventional needle irrigation (CNI) alone, CNI supplemented with Ultrasonic Irrigant Activation (UIA), EasyClean (EC), or XP-endo Finisher (XPF). Extruded NaOCl was collected, reacted with m-cresol purple, and its absorbance values were measured. The data were statistically analyzed using One-way analysis of variance with a significance level of 5%. All groups showed apically extruded irrigating solution, and the mean volumes of extruded NaOCl did not differ significantly between any of the test groups (p⟩0.05). The activation of 1.5% NaOCL by UIA, EC, or XPF as supplementary to CNI does not promote greater apical extrusion when compared to CNI alone in simulated immature teeth.

Extrusion of Sodium Hypochlorite in Oval-Shaped Canals: A Comparative Study of the Potential of Four Final Agitation Approaches Employing Agarose-Embedded Mandibular First Premolars.

Background: The aim of this investigation was to assess the apical extrusion potential of sodium hypochlorite (NaOCl) in agarose-embedded mandibular first premolars employing four final agitation procedures. Methods: Based on CBCT confirmation of single oval-shaped canals, one hundred extracted mandibular first premolars were chosen. Using 5.25% NaOCl, the teeth were prepared using the XP Endo Shaper and divided into experimental and control groups. The following were the experimental groups: Group 1 comprised the XP-Endo Finisher, Group 2 the Ultrasonic Activation, Group 3 the Gentle File Finisher Brush, and Group 4 the 27-gauge side-vented needle. To test extrusion, the teeth were placed in a 0.2% agarose gel that contained the pH-sensitive dye m-cresol purple, allowing pixel quantification via ImageJ software (version 1.54i). Results: The XP Endo Finisher featured the most pixels, depicting higher apical extrusion (p < 0.01), followed by the side-vented needle, Gentle File Finisher Brush, and PUI, while the Control Group endured no extrusion. Conclusions: The effective irrigation method for root canal therapy is critical, especially in situations of open apices, resorption, or perforation. According to in vitro experiments, the XP-Endo Finisher has the maximum sodium hypochlorite extrusion, which is determined by parameters such as apical preparation size and irrigation system.

Management of irrigation procedural errors: A case report

Sodium hypochlorite is the most widely used irrigant in endodontics because of its tissue dissolving ability and effective antimicrobial action. However, extrusion of sodium hypochlorite from the root canal system may lead to severe cytotoxic effects, regardless of the concentration used. This case report entails the management of inadvertent extrusion of sodium hypochlorite.

Management of root perforation and sodium hypochlorite extrusion injury

A patient was brought to A&amp;E by their GDP who had injected sodium hypochlorite (NaOCl) through a perforation in the patient's LR4, resulting in pain, swelling and immediate formation of a large, necrotic ulcer. Within 2 days, the patient developed paraesthesia in the distribution of the right mental nerve. Antibiotics and steroids were prescribed to alleviate the acute symptoms. The perforation was repaired with mineral trioxide aggregate (MTA) and root canal treatment was completed with the aid of a microscope. Review appointments were arranged to monitor healing of the injury.CPD/Clinical Relevance: Management of iatrogenic root perforation and associated NaOCl injury is useful knowledge.

Comparative evaluation of four different root canal irrigation techniques for apical extrusion of sodium hypochlorite - An in vitro study.

This study compared the potential for apical extrusion of sodium hypochlorite (NaOCl) when using needle irrigation (NI), passive ultrasonic irrigation (PUI), passive subsonic irrigation (PSI), and negative pressure system (NP). One hundred freshly extracted human permanent anterior teeth with complete root formation were embedded rigidly in agarose gel-containing cresol purple. Teeth were randomly allocated to six groups: G1-NI; G2-PUI; G3-PSI; G4-NP; G5-positive control; and G6-negative control. The chemomechanical preparation was completed and 12 ml of 3% NaOCl was delivered for 180 s in all groups. Dye diffusion was standardized by doing gel photography after the NaOCl final irrigation the Chi-square test and Kruskal-Wallis one-way analysis of variance test were used for the data analysis. G1 had statistically significant apical extrusion compared to G2 (P = 0.001), G3 (P = 0.001), and G4 (P = 0.001) groups. G4 showed the least amount of apical extrusion. pH-sensitive gel model is useful in evaluating NaOCl extrusion. NP produced least NaOCl extrusion as compared to the other three systems. Due consideration should be given to the potential for apical extrusion of the irrigant before the selection of an irrigation system.

Evaluation of machine-assisted irrigation on removal of intracanal biofilm and extrusion of sodium hypochlorite using a three-dimensionally printed root canal model.

This study aimed to compare the biofilm removal and apical extrusion of sodium hypochlorite (NaOCl) following machine-assisted irrigation using a three-dimensionally (3D) printed dentin-insert model. Multispecies biofilms were formed in a 3D-printed curved root canal model with dentin insert. The model was then placed in a container that was filled with 0.2% agarose gel containing 0.1% m-Cresol purple. Root canals were irrigated with 1% NaOCl using syringe irrigation, sonically agitated (EndoActivator or EDDY) or ultrasonically activated (Endosonic Blue) irrigation. Samples were photographed and the color-changed area was measured. Biofilm removal was assessed using colony-forming unit counting, confocal laser scanning microscopic analysis and scanning electron microscopic observations. The data were analyzed using one-way ANOVA, followed by Tukey test (P < 0.05). EDDY and Endosonic Blue demonstrated significantly greater reduction of biofilms compared to other groups. No significant differences were observed in the remaining biofilm volume in syringe irrigation and EndoActivator groups. Furthermore, EDDY and Endosonic Blue presented with numerous exposed dentinal tubules. EDDY showed significantly greater NaOCl extrusion compared to other groups. Ultrasonic activation with a small-sized nickel-titanium file irrigation system may be beneficial in intracanal biofilm removal avoiding extrusion of NaOCl beyond the root apex.

Comparison of apical extrusion of sodium hypochlorite in immature teeth after needle irrigation, ultrasonic irrigation, EDDY, Er:YAG, and diode lasers.

This study aimed to assess the apical extrusion of sodium hypochlorite in immature teeth caused by needle irrigation, ultrasonic irrigation, EDDY, Er:YAG, and diode lasers. Seventy-five human maxillary anterior teeth were selected. After the apical 3mm of the roots was resected, the canal lumen was enlarged with #2 to #5 Gates-Glidden burs. The teeth were fixed to the lid of a flat-sided clear plastic container, and the plastic containers were filled with 0.2% agarose gel containing 1mL of 0.1% m-cresol purple. Then, the specimens were allocated into five groups according to the irrigation activation techniques: needle irrigation, ultrasonic irrigation, EDDY, Er:YAG laser, and diode laser. The apical extrusion of sodium hypochlorite caused the color change in the gel. The containers were digitally photographed, and the percentage of pixels of irrigant extrusion (the color change) in each photograph was calculated. The diode laser group showed a significantly lower percentage of pixels than needle irrigation, EDDY, and Er:YAG laser (p < 0.05). The irrigant extrusion value of the ultrasonic irrigation group was significantly lower than that of the EDDY and Er:YAG laser groups (p < 0.05). There was no significant difference between the other groups (p > 0.05). All the groups caused irrigant extrusion in the immature teeth. The diode laser and ultrasonic irrigation caused less sodium hypochlorite extrusion than EDDY and Er:YAG laser. The needle irrigation showed more irrigant extrusion than the only diode laser group.

Apical extrusion of sodium hypochlorite in immature teeth: comparison of three different cleaning protocols.

This study compared standard needle irrigation, passive ultrasonic irrigation, XP-Endo Finisher and Easy Clean in the apical extrusion of sodium hypochlorite (NaOCl) in a model simulating immature teeth. Ten bovine teeth were maintained in suspension in a container with the apical portion in contact with 0.2% agarose gel containing 0.1% metacresol purple. The canals were irrigated with 2.5% NaOCl, according to each irrigation protocol. After 3 min, apical extrusion of NaOCl was observed by the colour gel change when in contact with NaOCl. The containers were photographed, and the NaOCl extrusion area was measured. All protocols showed NaOCl extrusion, providing similar area (P > 0.05). Considering the similarity among the studied protocols, all of them can be considered during the endodontic treatment of immature teeth. Further studies on the particularities of immature teeth should be performed to evaluate cell viability, cleaning efficiency, disinfection capacity and dentin removal promoted by the irrigation protocols.

Accidental Extrusion of Sodium Hypochlorite in a Patient Taking Alendronate: A Case Report With an 8-Year Follow-up

Extrusion of sodium hypochlorite (NaOCl) is a very rare accident with the most common complications including pain, swelling, and hematoma. It can occur even if procedural guidelines, predisposing conditions, and risk factors are taken into consideration. A 59-year-old female patient was admitted to the endodontics department to treat a left maxillary first premolar (World Dental Federation tooth 24). The medical history included osteoporosis and systemic medication with alendronate. Initially, the diagnosis was “symptomatic irreversible pulpitis” with “normal apical tissues.” During instrumentation of the buccal canal, accidental extrusion of 2.5% NaOCl occurred into the periapical tissues, resulting from misinterpretation of the working length, and caused severe pain and bleeding. The canal was immediately flushed using copious irrigation with saline solution. An analgesic and corticosteroid were prescribed. At 3 and 7 days, ecchymosis and slight hematoma were observed extraorally in the area of the affected tooth and an intraoral ulceration at the apex of the affected tooth. At 15 days, minimal signs of ecchymosis were observed, and the treatment was resumed. At 30 days after the accident, there was complete remission of the sequelae. The clinical, radiographic, and tomographic assessment after 1 month, 1 year, and 8 years showed favorable case evolution. During the 8-year follow-up, the patient maintained the systemic use of alendronate. It can be concluded that NaOCl extrusion is an accident that causes patients and clinicians to experience an unpleasant consequence. The radiographic working length should always be determined carefully. A successful outcome can be achieved in patients who take alendronate.

Sodium Hypochlorite Extrusion Accidents: Management and Medico-Legal Considerations

Sodium hypochlorite is considered the most widely used irrigant in endodontics as it exhibits effective antimicrobial activity and has potent tissue-dissolving ability. Whilst it is considered safe when used within the confines of the root canal system, it can cause serious complications when inadvertent periradicular extrusion occurs. This article outlines the complications of sodium hypochlorite extrusion and reviews the appropriate management based on the contemporary evidence. Preventive measures are suggested and the relevant medico-legal considerations are outlined.

The Frequency Of Sodium Hypochlorite Extrusion During Endodontic Treatments

The Frequency Of Sodium Hypochlorite Extrusion During Endodontic Treatments

Low-Level Laser Therapy as a Coadjuvant in Sodium Hypochlorite Extrusion Management

Aim: The extrusion of sodium hypochlorite through the apical foramen is an accident that can occur during the endodontic treatment although is relatively uncommon, Due to the severe tissue damage that is caused by the solution, the management becomes important to prevent serious sequalae. Low-level laser therapy might be useful to treat damaged soft tissues because of its bio modulatory effects, which may reduce edema and prevent infection. Methods: In this clinical case, the accidental leakage of 5% sodium hypochlorite during the preparation of the root canal of an upper left canine is reported. The accident caused immediate and intense pain and severe edema and ecchymosis. The conventional treatment protocol was applied along with low-level laser therapy. Results: Clinical examination revealed the healing of soft tissue in thirteen days, besides a significant pain reduction in three days after laser therapy was applied. Conclusion: The combination of low-level laser therapy with a conventional treatment protocol could be a useful tool to manage such an accident.

Um novo instrumento para o tratamento do canal radicular após preparo quimiomecânico: XP-Endo Finisher

Objetivo: o objetivo deste trabalho é apresentar uma revisão da literatura sobre o XP-endo Finisher, abordando os resultados de estudos que avaliaram este novo instrumento endodôntico. Material e Métodos: foi realizada uma busca nas bases de dados PubMed e Bireme entre 2015 (quando o instrumento foi lançado ao mercado) e 2017, utilizando os seguintes descritores: XP-endo Finisher. Resultados: dezoito artigos foram recuperados e divididos em categorias de acordo com o tipo de avaliação: Remoção de pasta de hidróxido de cálcio; Remoção de pasta de antibiótico triplo; Remoção de material de enchimento; Extrusão de hipoclorito de sódio durante instrumentação; Extrusão de restos de dentina durante a instrumentação; Ação antimicrobiana e antibiofilme; e remoção de esfregaço e camada de detritos. Conclusão: de acordo com os artigos revisados ??neste estudo, pode-se concluir que XP-endo Finisher pode ter um impacto positivo no tratamento endodôntico. Este instrumento mostrou resultados promissores para remoção de medicação intracanal; remoção do material de enchimento durante o retratamento endodôntico; esfregaço e remoção de detritos; realce da ação antimicrobiana de irrigantes; e melhoria da remoção do biofilme.

Apical extrusion of sodium hypochlorite irrigation during root canal treatment using monoject or hypodermic irrigation needle

Objective: Sodium hypochlorite has been routinely delivered into the pulp canal via irrigation needle. The study aimed at to determine the advantage and disadvantage of apical extrusion of sodium hypochloride using monoject or hypodermic irrigation needle in root canal treatment.Materials and Methods: Eighty single rooted teeth with closed apices were used in this in vitro study to determine apical extrusion of sodium hypochlorite using the gel diffusion technique. Extracted human anterior teeth were used as study samples. Monoject (size 27G) and hypodermic (27G× ½, 0.40×13mm, Terumo Needle) irrigation needle were used. The highest concentration of 5.25% hypochlorite solution was used for irrigation. To standardize the time diffusion of the dye, the gel was photographed at exactly 20 minutes after the initial irrigation with sodium hypochlorite.Results: A total of 36 out of 40 (90%) teeth in the hypodermic needle group showed positive apical extrusion compared to 14 of 40 teeth (35%) in the monoject group regardless of apical size. The discoloration of agar was clearly obtained after the sample tooth had been irrigated with sodium hypochlorite indicating the sign of apical extrusion. It is therefore; recommend that monoject irrigation needle should be used by students regardless of costs during root canal treatment in the polyclinic or dental clinic due to its safety in order to prevent sodium hypochlorite accident.Conclusion: Monoject needle showed significantly less sodium hypochlorite extrusion compared to hypodermic needleBangladesh Journal of Medical Science Vol.15(4) 2016 p.575-578

Apical Extrusion of Sodium Hypochlorite using Various Mechanical Activators

ABSTRACT Aim To evaluate the volume of sodium hypochlorite extruded from the apex on using various mechanical activators. Materials and methods Forty extracted single-rooted mandibular premolar teeth were taken. Standardized access opening with chemicomechanical preparation till protaper F3 was done with 2 mL of 5.25% sodium hypochlorite in between instrumentation of each file. The apical patency was checked with 10 K file. The teeth were then divided into four groups: Group I (n = 10) activation was done with #20 side-vented needle; group II (n = 10) activation was done with GP cones; group III (n = 10) activation was done with Irrisafe tips; group IV (n = 10) activation was done with endoactivator. As much as 10 mL of 5.25% sodium hypochlorite has been used with each group to activate the irrigant. The extruded sodium hypochlorite during activation with various systems was been collected in prepared apparatus. The obtained samples were analyzed for sodium ion concentration. Evaluation of the volume of sodium hypochlorite extruded from the apex was analyzed using absorption spectrometry. Then the above results were then statistically analyzed. Results Varying amount of apical extrusion was seen among the above study groups. Minimum amount of apical extrusion was seen with endoactivator. Maximum amount of apical extrusion was seen with needle irrigation followed by GP cones. How to cite this article Vangala A, Doshi SR, Aparadh A, Hegde V. Apical Extrusion of Sodium Hypochlorite using Various Mechanical Activators. World J Dent 2016;7(3):146-149.

Use of a 660-nm Laser to Aid in the Healing of Necrotic Alveolar Mucosa Caused by Extruded Sodium Hypochlorite: A Case Report

The extrusion of sodium hypochlorite through the apical foramen is an accident that can occur during the flushing procedure in endodontic treatment. The symptomatology is immediate and intense, and there is a long period before the tissues return to normal. Low-level laser therapy might be useful as an adjunctive treatment for damaged soft tissues because of its anti-inflammatory and analgesic effects, which may reduce edema and prevent infection. In this clinical case, the accidental leakage of 1% sodium hypochlorite during the preparation of the root canal of a maxillary right central incisor is reported. This leakage caused immediate and intense pain and edema formation and resulted in an extensive necrotic area in the alveolar mucosa adjacent to the root of the treated tooth. The conventional treatment protocol was combined with low-level laser therapy. Clinical and radiographic examinations after 7 months revealed complete repair of the necrotic area with no paresthesia and further indicated the integrity of the apical region of the tooth where the extrusion of sodium hypochlorite occurred. The combination of low-level laser therapy with a conventional treatment protocol in this case of the extrusion of 1% sodium hypochlorite resulted in the healing of the wounds.

Accidental Extrusion of Sodium Hypochlorite during Endodontic Treatment in a Primary Tooth

Although sodium hypochlorite is the most frequently used canal irrigant during endodontic treatment, its complications are not as well recognized as its effectiveness. This report demonstrates that sodium hypochlorite extrusion during endodontic treatment can cause severe complications. A 5-year-old boy experienced immediate pain and swelling, ecchymosis in surrounding tissues, and profuse bleeding from the root canal during endodontic treatment, because of accidental extrusion of sodium hypochlorite. The patient was hospitalized, and analgesics and antibiotics were prescribed. Accidental extrusion of the irrigating solution occurs more frequently in teeth with immature apices, root resorption, and apical perforations; therefore, caution is needed. When such complications occur, proper management and medications are needed.

Evaluation of 4 Different Irrigating Systems for Apical Extrusion of Sodium Hypochlorite

IntroductionThe aim of this study was to evaluate NaOCl apical extrusion by using negative apical pressure (EndoVac), sonic agitation (EndoActivator), side-vented needle (Max-i-Probe), and photon induced photoacoustic streaming (PIPS 10 mJ and PIPS 20 mJ) laser irrigation in an in vitro gel model. MethodsExtracted mandibular and maxillary central incisors (n = 18) were prepared to size 35/.04 and 55/.04, respectively. Teeth were mounted in transparent containers with clear acrylic and suspended in a color-changing pH-sensitive gel, creating a closed system. By using a crossover design, each tooth was sequentially irrigated by using 6% NaOCl with each device following manufacturers' recommendations. Each tooth served as its own control. Pre-irrigation and post-irrigation buccal and proximal view photographs served to measure the longest distance of extrusion and were analyzed with ImageJ software. Mean results were analyzed by using Kruskal-Wallis and Dunn post hoc test (P < .05). ResultsThere were no significant differences between EndoVac, EndoActivator, and the passive extrusion groups. The EndoVac and EndoActivator groups produced significantly less extrusion than PIPS irrigation. Max-i-Probe extrusion results were more variable than those of EndoActivator but had no significant difference. Across all irrigation systems, there were no significant differences with respect to apical preparation size. ConclusionsUnder the in vitro conditions of this study, no difference was found between the 10 mJ and 20 mJ PIPS laser groups. EndoVac demonstrated significantly less potential for apical extrusion than PIPS and Max-i-Probe, whereas apical preparation size did not significantly affect extrusion of irrigant. The potential for apical extrusion of endodontic irrigants should be a consideration when selecting a system for final irrigation.

Hypochlorite-induced severe cellulitis during endodontic treatment: case report

Sodium hypochlorite is a solution used in endodontic treatment, and if an accidental apical extrusion occurs, serious complications may affect soft tissue. Objective: The aim of this article is to present a case of apical extrusion of sodium hypochlorite (NaOCl) during root canal system instrumentation. Case report:A 28-year-old woman sought a local dental service for root canal treatment of tooth #24. Conventional endodontic treatment was adopted, which consisted of the use of 2.5% NaOCl solution as irrigation solution applied with a 10-ml syringe and 22G hypodermic needle. At that time, the patient reported extreme pain and a burning sensation in the left maxillary region, followed by the formation of intense edema. A clinical diagnosis of hypochlorite-induced cellulitis was made. The patient was treated immediately with amoxicillin (500 mg, orally) at intervals of 8 h for 7 days and dexamethasone (4 mg, intramuscularly) at intervals of 24 h for 3 days. In the subsequent endodontic treatment, 2% chlorhexidine gel applied with a 5-ml syringe and 24G needle was used as irrigation for a better control of treatment and to prevent new accidents. The root canals were instrumented using adequate crown-down technique, which provides a conical shape, and filled by lateral condensation technique. The patient was symptom free at the 8-month clinical follow-up. Conclusion: Dentists should always carefully follow all stages of dental treatment planning without neglecting any of them, paying attention to the solutions used and their storage as well as performing a specific technique with maximum accuracy. If an accident occurs, the appropriate handling of the situation will enable the satisfactory completion of treatment.

Apical extrusion of sodium hypochlorite activated with two laser systems and ultrasonics: a spectrophotometric analysis

BackgroundThe aim of the present study was to compare the effect of ultrasonically or laser (Nd:YAG or diode) activated irrigation on the irrigating solution extrusion compared to non-activated syringe irrigation.MethodsExtracted mandibular premolar teeth (n = 48) with single canals were instrumented. The teeth were secured through the lid of an Eppendorf tube filled with 1.0 mL distilled water to collect the apically extruded irrigating solution. The teeth were randomly divided into four groups: non-activated syringe irrigation, diode laser, Nd:YAG laser and passive ultrasonic irrigation (PUI) using 2 % NaOCl. The irrigating solution extruded through the apical foramen was collected in the Eppendorf tube and evaluated by a chemical reaction with using a spectrophotometer. The data was analyzed using one-way ANOVA and Tukey’s post hoc test (α = 0.05).ResultsAll the groups showed apically extruded irrigating solution. There were significant differences among the groups (p < 0.05). Nd:YAG laser activated irrigation showed greater extrusion (p < 0.05), while the non-activated syringe irrigation showed less extrusion (p < 0.05). Only the difference between diode laser and PUI was not statistically significant (p > 0.05).ConclusionWithin the limitations of this in vitro study, the researchers concluded that non-activated syringe irrigation caused less apically extruded irrigating solution than PUI and LAI using Nd:YAG or diode lasers.