Endodontic Irrigants Research Articles

Analysis of chemical and morphological properties of root dentine treated with a single multifunctional endodontic irrigant solution.

The aim was to evaluate the chemical, morphological aspects and microhardness of root dentin after treatment with Triton™ solution. Twenty blocks of root dentin were distributed in two groups (n = 10): Control (C) (2.5% NaOCl+17% EDTA+2.5% NaOCl) and Triton™ solution (T). Morphological analysis was performed before and after treatments with confocal laser microscopy. Chemical composition and microhardness were analysed after the treatments using Raman spectroscopy and Knoop microhardness. Results were submitted to Student's t-test and Mann-Whitney test (p < 0.05). The C group had greater tubule number, area and perimeter (p < 0.001), besides a regular surface, while T showed an irregular surface with cracks and erosions, lower organic content intensity (p < 0.001) and higher inorganic/organic ratio (p = 0.003) than C, which had higher microhardness than T (p = 0.003). Triton™ exposed a lower number, area and perimeter of dentinal tubules, with cracks and erosions in root dentin. It also showed significant chemical alterations in the organic content, reducing it, resulting in lower microhardness.

An innovative endodontic irrigation system

An innovative endodontic irrigation system

“Comparative evaluation of cytotoxicity of three herbal endodontic irrigants at three intervals of time” – An in vitro study

Aim: The aim of the study was to evaluate and compare the cytotoxicity of 25% of neem leaf extract (Azadirachta indica), 20% of guava leaf extracts (Psidium guajava), and 20% of cinnamon extract (Cinnamomum zeylanicum) irrigants at three intervals of time. Methodology: Four groups were formed (n = 15), Group 1 (control group) – normal saline solution, Group 2 – 25% of neem extract, Group 3 – 20% of guava extract, and Group 4 – 20% of cinnamon extract. Each group was further divided into three subgroups based on intervals (n = 5). Subgroup A – at 10 min, Subgroup B – at 20 min, and Subgroup C – at 30 min. One hundred microliters of each irrigant was added to 2 mL of the diluted red blood cells suspension obtained from a human volunteer. Hemoglobin (Hb) estimation was done with an automated hematology analyzer after incubating the test samples at 10, 20, and 30 min intervals. Results: The reduction in the mean Hb values was not statistically significant in the normal saline, guava, and cinnamon groups. However, in the neem extract group, the mean Hb values reduced significantly at P &lt; 0.001. Among the subgroups, Subgroup A (10 min) showed the least cytotoxicity. Conclusion: In the present study, 20% guava extract had the lowest cytotoxicity and cytotoxicity increased with time. Hence, 20% guava extract can be used as an alternative to conventional irrigants as it has been shown to have the least cytotoxicity.

An innovative endodontic irrigation system.

An innovative endodontic irrigation system.

Antibiofilm efficacy of plant extracts as root canal irrigants in endodontics: a systematic literature review

Antibiofilm efficacy of plant extracts as root canal irrigants in endodontics: a systematic literature review

Effect of Er:YAG Laser-Activated Irrigation with Side-Firing Spiral Endo Tip on Dentin Mineral Composition of Tooth Root Canals

Background: Treating tooth root canal systems with Er:YAG laser together with irrigants has been shown to be effective in reducing biofilms formed by Enterococcus faecalis. This study investigated whether laser-activated irrigation (LAI) with side-firing Endo tip (LiteTouch™; Light Instruments, Yokneam, Israel) affects dentin mineral composition when used with common endodontic irrigants. Methods: Root canals of extracted human teeth were treated with Er:YAG laser using a side-firing Endo tip combined with 17% ethylenediaminetetraacetic acid (EDTA) and/or 2.5% NaOCl in continuous or intermittent mode for 60 s. Dentin mineral composition (Ca, P, O) in coronal, middle, and apical regions of root canals was examined by energy dispersive X-ray spectroscopy. Results: The use of LAI with continuous EDTA resulted in the largest reduction in Ca and P levels. A final NaOCl rinse mitigated the EDTA-mediated mineral loss in all root canal regions and increased the O content. Likewise, the reduced Ca/O and Ca/P ratios caused by continuous EDTA irrigation were reversed when combined with a final NaOCl rinse. Conclusions: LAI with Er:YAG Endo tip using continuous EDTA irrigation followed by NaOCl caused minimal dentin mineral loss and can therefore be considered to be a safe treatment module for cleaning root canals.

Comparative evaluation of accuracy of three different electronic apex locators in the presence of various endodonticirrigants: An in vitro study

AIM AND OBJECTIVES. To evaluate and compare the accuracy of Root ZX, Raypex6, and I Root and electronic apex locators in the presence of NaOCl (3%), Citric acid (10%), MTAD and Green tea extract as endodontic irrigants.MATERIAL AND METHOD. Sixty single rooted human permanent teeth were used for the study. Access cavities were prepared and the teeth were decoronated. Teeth were divided as follows: Group I-Root ZX apex locator (n=20), IA – NaOCl 3% endodontic irrigant (n=5), IB – Citric Acid 10% endodontic irrigant (n=5), IC – MTAD endodontic irrigant (n=5), ID- Green Tea extract endodontic irrigant (n=5). Group II: Raypex 6 apex locator (n=20). IIA – NaOCl 3% endodontic irrigant (n=5), IIB – Citric acid 10% endodontic irrigant (n=5). IIC – MTAD endodontic irrigant (n = 5), IID – Green tea extract endodontic irrigant (n=5). Group III-i-ROOT apex locator (n=20). IIIA – NaOCl 3% endodontic irrigant (n=5), IIIB – Citric Acid 10% endodontic irrigant (n=5), IIIC – MTAD endodonticirrigant (n=5), IIID – Green tea extract endodontic irrigant (n=5). The actual working length was determined using a 15 K file and the working model was prepared using Alginate in a rectangular box. The teeth were embedded into the working model and the electronic measurements were made with each electronic apex locator. The data was collected, analyzed and subjected to statistical analysis.RESULTS. No significant difference was found when Raypex 6 apex locator was used along with all the endodontic irrigants except green tea extract. Root ZXshowed statistically significant difference with green tea extract and MTAD. I-root showed statistically significant difference with all the irrigants except green tea extract.CONCLUSION. Citric acid 10% was consistently accurate when assessed with all the three apex locators, whereas Green tea extract demonstrated the least accurate readings with all apex locators.

Influence of Root Canal Size and Curvature on Insertion Depth of Three Different Endodontic Irrigation Needles

Influence of Root Canal Size and Curvature on Insertion Depth of Three Different Endodontic Irrigation Needles

The investigation of endodontic irrigants and polyhexanide-based solution action on smear layer

AIM. The effect of irrigants on the smear layer on the intracanalicular dentin surface is one of the important issues in endodontics. The objective of this article is to determine the effect of different concentrations of polyhexanide-based solutions and standard irrigants on the smear layer using scanning electron microscopy (SEM).MATERIALS AND METHODS. The present study was conducted on 42 extracted teeth (third molars, first and second premolars) with formed apices that had been extracted for orthodontic indications. The teeth were decoronated and samples were prepared. In order to create a smear layer, the lumen of the canals was instrumented with H-file #40 throughout. A simulation of root canal irrigation was conducted by immersing the specimens in a 5-ml container filled with the proper solution for 1 hour: group 1 – no treatment (n = 6); group 2 – saline (n = 6); group 3 – 2% chlorhexidine (n = 6); group 4 – 3% sodium hypochlorite (n = 6); group 5 – 17% EDTA; group 6 – polyhexanide 0.1% (n = 6); group 7 – polyhexanide 0.2% (n = 6). A ~30 nm thick platinum film was sputtered onto the surface of each sample using a magnetron deposition technique. SEM microphotos were acquired on a Vega3 TESCAN scanning electron microscope (SEM) with an SE secondary electron detector, which enables imaging with high topographic contrast. The initial detector (incamera) was employed for image acquisition, with an electron energy of 30 keV. Images were acquired at magnifications of x20 (overview image), x150, x250, x500, x1000, x2500, x7500 for each sample.RESULTS. The samples from groups 1 and 5 demonstrated the absence of a smear layer on the dentin surface and the absence of smear plugs in the dentinal tubules. Groups 2 and 3 are distinguished by the deposition of a pronounced amorphous smear layer and the obturation of all dentinal tubules. Groups 4, 6, and 7 are distinguished by the deposition of a smaller volume of smear layer on the dentin surface, as well as the presence of semi-open or completely open entrances to the dentinal tubules.CONCLUSION. The data obtained indicates that antiseptic compositions based on polyhexanide in concentrations of 0.1 and 0.2% do not have a pronounced effect on the smear layer. However, in visual evaluation of SEM micrographs, their effect is comparable to that of 3% sodium hypochlorite. In instances where enhanced dissolution of the smear layer and smear plugs from the tubules is necessary to facilitate decontamination of the wall dentin, the combination of antiseptics with chelate compounds, such as 17% EDTA, may be employed.

Sodium Hypochlorite Accidents in Endodontic Practice: Clinical Evidence and State of the Art.

Sodium hypochlorite (NaOCl) is widely utilized in endodontics for its effective antimicrobial properties and ability to dissolve necrotic tissues. However, its use is not devoid of risks, including potential severe tissue damage and chemical burns. This systematic review evaluates the documented risks of using NaOCl in endodontic treatments. It compares its safety and efficacy with other endodontic irrigants, such as EDTA and chlorhexidine. This review followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines and registered with PROSPERO. Comprehensive searches were performed in PubMed, Scopus, Web of Science, and CENTRAL databases, with additional hand searches in grey literature. Studies were selected reporting adverse effects related to NaOCl used in endodontic procedures, ranging from randomized controlled trials to case reports. Data extraction and risk of bias assessment were systematically performed using standardized tools. Seventeen studies were included, detailing instances from chemical burns to severe allergic reactions and tissue necrosis associated with NaOCl use. The risk of bias was predominantly low across the studies. Sodium hypochlorite demonstrated a higher efficacy in microbial eradication and tissue dissolution than other irrigants, though it also showed a higher incidence of severe complications when mishandled. Sodium hypochlorite remains a cornerstone in endodontic disinfection due to its potent antimicrobial and tissue dissolution properties. However, its application must be meticulously managed to prevent complications. Future research should focus on optimizing concentrations and application techniques to enhance safety and effectiveness, potentially integrating safer alternatives or complementary solutions like EDTA to mitigate risks while preserving irrigant benefits.

Effectiveness of mechanical vs. chemomechanical methods in removing intracanal calcium hydroxide medication: a randomised trial.

To compare the mechanical and chemomechanical methods for removing calcium hydroxide medication from the root canal system. The triple-blind, randomised clinical trial was conducted at the Department of Operative Dentistry and Endodontics, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan, from December 16, 2022, to June 15, 2023, and comprised patients having necrotic teeth and chronic apical pathosis. They were randomised into groups A and B. On the initial visit, after access opening and chemomechanical preparation, calcium hydroxide paste was placed as an intracanal medication in both groups. the patients were recalled after two weeks. In Group A, calcium hydroxide was removed from the canals using a rotary master apical file, while in Group B, an endoactivator was used to sonically agitate the endodontic irrigant. Verification of placement was done by using a periapical radiograph. Data was analysed using SPSS 26. Of the 98 individuals assessed initially, 60(61.22%) were included; 34(57%) females and 26(43%) males with age ranging from 19 to 57 years. There were 27(45%) incisors, 22(36.7%) premolars and 11(18.3%) canines. There were 30(50%) patients in each of the 2 groups. The intergroup difference was not statistically significant (p=0.43). Tooth arch did not significantly correlate with the removal method (p=0.79). Both methods were found to be equally effective in removing water-based calcium hydroxide medication from the endodontic system. NCT05744661.

Comparative Evaluation of the Effect of Various Irrigating Solutions on the Push-Out Bond Strength of Biodentine and Mineral Trioxide Aggregate: An In Vitro Study

Introduction: A successful endodontic treatment is ba¬sed on combination of adequate instrumentation, irrigation and obturation of canal system. The objectives of endodontic irrigants are lubrication of root canal, removal of microorganisms, pulp, dentinal remnants and dissolution of tissues. The objective of root-end filling is establishment of proper apical hermetic seal. Aim: To evaluate and compare the effect of various irrigating solutions on push-out bond strength of Biodentine and Mineral trioxide aggregate (MTA). Materials and Method: Sixty-four extracted human single rooted teeth were decoronated 1.5-2 mm coronal to cemento-enamel junction. The root canals were prepared and divided into four groups (n=16): Group I- Normal Saline (Control group), Group II- Triple antibiotic solution, Group III- 2% Chlorhexidine, Group IV- Morinda citrifolia solution. Mid root dentin was sectioned horizontally and irrigated further with respective irrigating solutions for 5 minutes and divided into 2 subgroups: Subgroup A- Biodentine and Subgroup B- MTA. The root-end filling material was incrementally placed and embedded in acrylic blocks. Samples were tested for push-out bond strength using universal testing machine. Results: The highest push-out bond strength was shown by 2% Chlorhexidine group when used with Biodentine and lowest when normal saline was used with Biodentine. Conclusion: All experimental irrigating solutions increased the push-out bond strength of MTA and Biodentine.

In Vitro Evaluation of Sodium Hypochlorite, Chlorhexidine, Propolis, and Calcium Hydroxide Effect on Lipoteichoic-Acid-Induced Proinflammatory Cytokines Production.

This study aimed to evaluate the effects of sodium hypochlorite (NaOCl), chlorhexidine (CHX), and the glycolic extract of propolis (GEP) as endodontic irrigants and of calcium hydroxide [Ca(OH)2], CHX, or Ca(OH)2 + CHX as intracanal medications on the capacity of the lipoteichoic acid (LTA) of Enterococcus faecalis in macrophages' proinflammatory cytokines production. Freshly extracted 108 human single-rooted teeth were used in this study. The LTA of E. faecalis was standardized in double-distilled pyrogen-free water (250 µg/mL) and inoculated into the specimens subdivided into nine subgroups (n = 12). Cultures of murine macrophages (RAW 264.7) were treated with 30 µL of each sample collected from root canals and incubated (37 °C, 5% CO2) for 24 h. Lastly, anti-TNF-α, anti-IL-6, anti-IP-10, anti-MIP-1α, anti-G-CSF, and anti-IL-1β DuoSet kits were used to perform an ELISA assay. Data were analyzed using one-way ANOVA and Tukey test (p ≥ 0.05). It was found that 1% NaOCl was the most effective irrigant in reducing the capacity of LTA in cytokines production, followed by 12% GEP and 2% CHX, respectively. Ca(OH)2 + CHX presented the best results when associated with NaOCl or GEP. Thus, NaOCl or GEP associated with Ca(OH)2 + CHX were effective in reducing the capacity of LTA in different macrophages pro-inflammatory cytokines production.

A Comparative Evaluation of the Effect of Different Endodontic Irrigating Solutions on Microhardness of Root Canal Dentin: An in vitro Study.

During endodontic therapy, irrigation solutions applied in the root canal may affect the physicochemical properties of the dentinal wall, thereby changing its microhardness. This may adversely affect the sealing ability and adhesion of dental materials. Therefore, many studies have focused on the search for an ideal root canal irrigant that has a minimal effect on dentinal microhardness. This in vitro study was conducted to determine the changes in dentin microhardness after root canal irrigation with different endodontic irrigants. Ninety-five freshly extracted maxillary central incisor teeth with straight single canals were selected. These teeth were sectioned transversely at the level of the cementoenamel junction. The working length of each tooth was determined, and canal space was prepared by the HyFlex CM rotary file system. During instrumentation, normal saline was used for irrigation. Then, teeth were split longitudinally into two segments. According to the irrigating solution employed, samples were divided into five groups (n=19): normal saline (Group A), 3% sodium hypochlorite (Group B), 2% chlorhexidine (Group C), 5% calcium hypochlorite (Group D), and 0.2% nanochitosan (Group E).3 mL of the corresponding irrigating solution was administered for total15 minutes in each prepared sample. The Vickers micro-hardness tester was then used to assess micro-hardness. The data was analyzed using one-way analysis of variance (ANOVA). All tested irrigating solutions decreased the dentinal microhardness. Samples irrigated with 5% calcium hypochlorite demonstrated dentinal microhardness of 42.43±1.62, which is the lowest among all the tested groups, followed by nano chitosan, sodium hypochlorite, and chlorhexidine. Samples treated with control group (saline) demonstrated the maximum microhardness of dentin in the present study. Within the limitations of this research, it can be concluded that the tested novel irrigating solutions, 5% calcium hypochlorite and 0.2% nanochitosan, were more detrimental to radicular dentin microhardness when compared with conventional endodontic irrigants.

In-vitro Antimicrobial Activity of Mtad, Photoactivated Disinfection Along with Chlorohexidine on Enterococcus faecalis, Staphylococcus aureus and Candida albicans

This study evaluated the antimicrobial activity of five root canal irrigants against MTCC of Enterococcus faecalis, Staphylococcus aureus, Candida albicans, in-vitro study of the inhibitory activity of PAD in conventional Endodontic Treatment (CET) and also combination of CET with PAD (CHX+PAD). All of these microorganisms were incubated in the presence of an Endodontic irrigant. Agar diffusion tests were performed and colony counts were tested using paper point to evaluate the inhibitory effect of the irrigants. The mean diameters of the inhibition zones for C. albican were 21mm 3% Naocl, 19mm CHX, 0.7PAD, 22mm CHX+PAD, 20mm Fluconazole, 18mm Doxycycline. The zone diameters of the inhibition zones of Enterococcus faecalis were 17mm 0.5% Naocl, 18mm CHX, 12mmPAD, 35mm MTAD, and 19mm PAD+CHX. The Zone Diameter of the inhibition zones of Staphylococcus aureus were 18mmCHX, 12mm PAD, 19mm PAD+CHX, 25mm MTAD, and 19mm 3% NaoCl. Together High inhibitory effect was detected for PAD+CHX and MTAD on all three pathogens. Candida showed more inhibition to all irrigants followed by Staphylococcus aureus and Enterococcus faecalis.

Breakthrough in the Development of Endodontic Irrigants.

The three main components of endodontic success are three-dimensional obturation, pulp space sterilization, and biomechanical preparation. Instrumentation techniques are insufficient to accomplish complete disinfection of the pulp space. It is essential to use additional tools, such as endodontic irrigants. This review article aims to provide a general overview of the different root canal irrigants and their clinical uses. Endodontic treatment focuses more on removing infectious material from the root canal system to facilitate the healing of an existing periapical lesion or to prevent the periradicular tissues from being infected. It is important to note that instrumentation alone can reach every part of the root canal wall. Therefore, the irrigation procedure is a crucial aspect of endodontic therapy. Irrigation requires the application of various irrigants, like sodium and chlorhexidine, to get rid of debris, bacteria, and tissue leftovers. The accomplishment of root canal treatments counts heavily on the thoroughness of irrigation, contributing to optimal canal shaping and disinfection. Modern root canal irrigation systems incorporate syringes, needles, and advanced delivery mechanisms, including sonic and ultrasonic devices. These inventions aim to enhance the mechanical action of irrigants, reaching intricate canal anatomy more efficiently. Understanding the dynamics of root canal irrigation and staying abreast of technological advancements are essential for clinicians to achieve improved treatment outcomes in endodontic procedures.

Genotoxicity Evaluation of a Hyperosmotic Solution Proposed as Endodontic Irrigant

Genotoxicity Evaluation of a Hyperosmotic Solution Proposed as Endodontic Irrigant

Cytotoxic Effect of Two Different Concentrations of Sodium Hypochlorite: An In-Vitro Study.

Introduction The endodontic treatment of primary teeth presents considerable complications due to their distinct anatomical properties. In order to achieve a successful endodontic treatment, certain factors must be assessed. These factors include a precise diagnosis, thorough cleaning, and a reliable disinfection protocol. Although sodium hypochlorite (NaOCl) has been effective as an irrigation agent in primary teeth, it is important to recognize that higher concentrations of NaOCl might possibly inflict toxic harm on the periapical environment if they penetrate the tooth's apical foramina. Since primary teeth are important, pediatric dentists must choose an appropriate NaOCl concentration for root canal irrigation, as higher concentrations can be toxic. Thus, the current investigation examined the cytotoxicity of two different NaOCl concentrations at various volumes. Methods To evaluate the cytotoxicity potential, a culture ofnauplii (brine shrimp) was prepared and subjected to testing. For the test, 5, 10, 20, and 40 µL of 1% and 3% NaOCl were added to the brine shrimp culture at different concentrations, and saline was used as a control. After a span of 24 hours, the total number of alive nauplii was duly noted. Results After 24 hours, nauplii showed no mortality in the control group. For 1% NaOCl, mortality ranged from 10% to 20% across volumes, with no significant differences (p = 0.193). In contrast, 3% NaOCl caused significantly higher mortality: 20% at 5 µL, 30% at 10 and 20 µL, and 60% at 40 µL (p = 0.007). Tukey's analysis revealed no significant differences for 1% NaOCl (p > 0.05) but significant differences for 3% NaOCl at 40 µL (p < 0.05). Conclusion Based on the results of the present study, it was observed that a 1% NaOCl solution exhibited a lower level of toxicity in comparison to a 3% NaOCl solution. These findings highlight the importance of using lower concentrations of NaOCl for endodontic irrigation in pediatric dentistry to reduce the risk of tissue damage and ensure safer outcomes for young patients.

Endodontic irrigants from a comprehensive perspective.

This review article explores the fundamental principles of modern endodontics with a focus on root canal cleaning and shaping. It reviews commonly used endodontic irrigant, namely sodium hypochlorite (NaOCl), herbal extracts, chlorhexidine (CHX), and chelating agents, highlighting their properties, applications, and potential drawbacks. NaOCl, a key antimicrobial agent, demonstrates effectiveness against various microorganisms but poses challenges such as high cytotoxicity. Herbal extracts, gaining recognition in endodontics, present an alternative with potential advantages in preserving dentin integrity. CHX, known for its broad-spectrum antimicrobial activity, is discussed in both liquid and gel formulations, emphasizing its role in reducing smear layer formation and preserving hybrid layer durability. Chelating agents, specifically ethylenediaminetetraacetic acid and citric acid, play a vital role in removing the smear layer, enhancing dentin permeability, and facilitating the penetration of antimicrobial agents. The review article underscores the importance of careful application and consideration of each irrigant's properties to ensure safe and effective endodontic procedures. It serves as a valuable guide for clinicians in selecting appropriate irrigants based on specific treatment requirements.

Efficacy of ultrasonic vs. Laser-activated irrigation in endodontics. Bibliographic review.

Efficacy of ultrasonic vs. Laser-activated irrigation in endodontics. Bibliographic review.