NaOCl Irrigation Research Articles

Controlling root canal infection in oncological patients with apical periodontitis

This study evaluated the effectiveness of chemomechanical preparation associated with intracanal medication in reducing the total bacterial load of infected root canals in cancer patients undergoing antineoplastic treatment. The prevalence, levels and response to treatment of Streptococcus and Actinobacteria species were also assessed. The root canals of teeth with apical periodontitis from oncological and control patients were treated using rotary instrumentation, 2.5% NaOCl irrigation and 1-week calcium hydroxide medication (n=23/group). Bacteriological root canal samples were taken before (S1) and after chemomechanical preparation (S2), and after intracanal medication (S3). DNA extracted from the samples was subjected to 16S rRNA gene-based quantitative real-time polymerase chain reaction assays for evaluation of the treatment effects on total bacteria, Streptococcus species, and members of the Actinobacteria phylum. All S1 samples were positive for bacteria. S1-to-S2 and S1-to-S3 bacterial reduction values were highly significant (p<0.01). Although bacterial counts were reduced from S2 to S3, the decrease was not statistically significant (p>0.05). Intergroup comparisons showed no significant differences in S1, S2 and S3 counts (p>0.05). In the oncological group, 77% of the cases were positive for bacteria in S2, and 68% in S3. In the control group, corresponding figures were 65% for both S2 and S3. There were no significant differences between groups as for streptococci and actinobacteria prevalence, levels and response to treatment (p>0.05). Root canal treatment using rotary instruments, NaOCl irrigation and calcium hydroxide medication was highly effective in reducing the bacterial populations in infected teeth with apical periodontitis from cancer patients, with no significant differences to controls.

Intracanal antibacterial effects of a bioceramic medication compared with calcium hydroxide pastes in different vehicles

The intracanal antibacterial effectiveness of a bioceramic medication was compared with calcium hydroxide pastes in different vehicles. Extracted mandibular incisors with a single long oval canal were selected and distributed into 5 groups based on anatomically paired micro-computed tomographic analyses. The root canals were prepared up to an instrument size 35/04 and contaminated for 30 days with a mixed bacterial culture from subgingival biofilm added with Enterococcus faecalis. The canals were medicated with Bio-C Temp (Angelus Indústria de Produtos Odontológicos, Londrina, PR, Brazil) or a calcium hydroxide paste in glycerin (CHG), camphorated paramonochlorophenol/ glycerin (CHPG), or 2% chlorhexidine (CHCX). Control specimens were filled with sterile saline. After 7 days, the medication was removed by using rotary instruments and saline irrigation. A supplementary approach was conducted, which consisted of 2.5% NaOCl irrigation and agitation with XP-endo Finisher. Bacteriological samples were taken before application (S1) and after removal (S2) of the intracanal medication, and after the supplementary approach (S3). Bacterial DNA extracted from the samples was quantified using real-time polymerase chain reaction. Bacterial counts were significantly reduced from S1 to S2 in all groups, except for the control group. As for S1-to-S3 changes, all groups (control included) showed significant bacterial reduction. S2-to-S3 changes were only significant in the CHPG and CHCX groups (p<0.05). Intergroup comparisons showed no significant differences in S2 (p>0.05), with all medications significantly better than the control (p<0.05). In S3, only the CHPG and CHCX groups showed further significant bacterial reductions. Categorical data analysis showed no intergroup differences (p>0.05). All tested medications significantly reduced the intracanal bacterial counts, with no significant differences between them. Final NaOCl irrigation and agitation using XP-endo Finisher further enhanced disinfection in the CHCX and CHPG groups.

Testing the Inhibitory Activity of Bajakah Tampala (Spatholobus littoralis Hassk) Wood Extract from South Kalimantan on the Growth of Pseudomonas aeruginosa Bacteria

Background: Dental root canal treatment aims to eliminate microorganisms that cause infection in the tooth root canal, one of which is Pseudomonas aeruginosa bacteria. Disinfection of dental root canals with 0.5% - 5.25% NaOCl irrigation solution is still constrained so it is necessary to look for alternatives. The bajakah tampala plant (Spatholubus littoralis Hassk) is known to contain antibacterial compounds, namely flavonoids, saponins, tannins, and polyphenols. Objective: To evaluate the inhibitory activity of bajakah tampala wood extract (Spatholobus littoralis Hassk) from South Kalimantan against the growth of Pseudomonas aeruginosa bacteria. Method: Post test-only with control group design. The test groups were 100%, 75%, 50% bajakah tampala wood extract solution and positive control 2.5% NaOCL solution. Extraction using maceration method. Bacterial growth inhibition was tested by well diffusion method. Inhibition zone was measured using a caliper. Results: The growth inhibition from the largest to the smallest was shown by 75%, 100% and 50% bajakah wood extracts with mean inhibition zone diameters of 5.05 mm, 3.84 mm and 2.02 mm respectively, meanwhile the positive control was 16.14 mm. One Way Anova test showed significant difference in inhibition (p&lt;0.05) in all groups. Post hoc test showed no significant difference in the inhibition of 75% bajakah tampala wood extract with 100% extract. The inhibition of 100% and 75% extracts was significantly greater than 50% extract. The inhibition of NaOCL 2.5% was significantly greater than all groups of test extracts. Conclusion: Bajakah tampala wood extract has inhibitory activity against the growth of Pseudomonas aeruginosa bacteria.

Comparison between Corrosion of Stainless Steel Hand k-file and Nickel-Titanium Rotary Instrument following Immersion in 5.25% NaOCL Irrigation Solution: An In Vitro Study

The study was aimed to compare the corrosion of stainless-steel hand K-file and Nickel-titanium rotary instrument following immersion in 5.25% NaOCL irrigation solution, in vitro. A total of 20 new Nickel-titanium (NiTi) rotary files and 20 stainless steel (K file) was selected and immersed in 5.25% NaOCL irrigation solution. All files were subjected to the corrosion test: Record the open circuit potential (OCP) for 1 h on a strip chart with high impedance. The strip chart recording for each file was classified into a stability score: (i) stable, (ii) unstable, or (iii) erratic. The percentage of OCP was measured by a potentiostat and a standard calomel electrode reference. The frequencies of visually observed corrosion were further investigated by scanning electron microscope (SEM). The results of the present study confirmed that stainless steel file showed greater corrosion rate than that of NiTi files. Additionally, both files had pitting and crevice corrosion, as seen by scanning electron microscopy (SEM) analysis. However, NiTi files demonstrated a lower rate of corrosion than stainless steel files. In conclusion, NiTi files showed greater corrosion resistance than that of stainless-steel files.

Outcome of Nonsurgical Root Canal Treatment of Teeth With Large Apical Periodontitis Lesions: A Retrospective Study

IntroductionThis study reported on the outcome of the nonsurgical root canal treatment/retreatment of teeth with large apical periodontitis lesions. The influence of some variables on the prognosis was also evaluated. MethodsThe study included 199 teeth with large apical periodontitis lesions from 184 patients, treated/retreated by a single operator. Most teeth were managed in a single visit using NaOCl irrigation. Cases were followed up periodically from >1 to 8 years. Treatment/retreatment outcome was evaluated by clinical and radiographic/tomographic criteria and categorized as healed, healing, or diseased. For statistical analysis, data were dichotomized in such a way that healing cases were considered as success in a loose criterion or failure in a rigid one. ResultsClinical/radiographic analyses revealed that 67% of the initial treatment cases were classified as healed, 22.5% as healing, and 11% as diseased. Treatment success rates were 89% (loose) and 67% (rigid). Variables that influenced the treatment outcome included previous abscess and antibiotic use, very large lesions (≥10 mm), and a sinus tract. The median follow-up time for treatment was 31.5 months. As for retreatment cases, 47% were healed, 32% were healing, and 21% were diseased. Retreatment success rates were 79% (loose) and 47% (rigid), in a median follow-up of 32 months. Cases evaluated by cone-beam computed tomography had lower healed rates. ConclusionsFindings demonstrate that high favorable outcome rates can be achieved by nonsurgical root canal treatment or retreatment of teeth with large apical periodontitis lesions.

Assessment of Vertical Force Generated with Single File Systems during Shaping of Constricted Root Canals.

This study aimed to evaluate the shaping force generated with OneShape (OS) and HyFlex EDM (HEDM) systems designed for single file shaping, in comparison with ProTaper Next (PTN). Maxillary premolar teeth received access cavity preparation and their canals were shaped with OS, HEDM, or PTN to size 25 according to manufacturer's instructions with consistent pressure on the files to give a gentle "in-and-out" movements of 2 mm amplitude. The canal shaping was completed with a total of three insertions. After each insertion, 1% NaOCl irrigation and recapitulation with K-file size 15 were performed. The vertical shaping force was measured using a force gauge (M5-20 Advanced Digital Force Gauge; Mark-10 Corporation, NY). The shaping time was analyzed by using a one-way analysis of variance (ANOVA) test and differences between the mean apical and coronal maximum force values were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. The level of significance was set as 0.05. The magnitude of the vertical forces increased with successive advancements of the instruments within the canal. During canal shaping procedures in all groups, the apical and coronal maximum force values of the OS and HEDM ranged from 2.5 to 7.2 N and 1.3 to 2.9 N, respectively. PTN generated the lowest maximum apical forces during the second and third insertions (p < 0.05). HEDM generated significantly less maximum coronal forces than both OS and PTN during the first insertion while the use of OS was associated with the highest amount of force values in the second and third insertions (p < 0.05). In terms of shaping time, no significant differences were detected among the three tested systems (p = 0.606). The tested single file systems were associated with higher shaping forces in the apical direction that were significant in the second and third insertions.

Comparative evaluation of the efficacy of 1% and 3% Sodium hypochlorite in reducing the microbial counts in primary teeth root canals using Bioluminometer – A randomized clinical trial

PurposeSodium hypochlorite (NaOCl) is commonly used to irrigate primary teeth during pulpectomy. Although high concentrations of NaOCl are effective, they pose a risk of toxic damage to periapical tissues if NaOCl penetrates through the apical foramen. Therefore, low concentrations of NaOCl are preferred to mitigate this risk. However, concerns persist regarding the antibacterial efficacy of low concentrations of NaOCl compared to high concentrations. The objective of this study was to assess and compare the efficacy of 1% and 3% NaOCl irrigation in reducing bacterial load within primary teeth root canals. Materials and methodsThis clinical study involved forty participants divided into two groups. Group 1 (n = 20) received canal irrigation with 1 % NaOCl solution, while Group 2 (n = 20) received canal irrigation with 3 % NaOCl solution. Microbial samples were collected from the root canal using a paper point before and after irrigation. The samples were aseptically transferred to ultra-snap tubes and then analyzed using a Bioluminometer. The results were recorded. ResultsBoth groups exhibited a decrease in bacterial count after irrigation. The mean colony count post irrigation for 3 % NaOCl was 258.05 ± 28.61, and for 1 % NaOCl it was 267.60 ± 30.56. However, no statistically significant difference was observed upon intergroup comparison. ConclusionThis study shows that 1% NaOCl is equally effective as 3% NaOCl in reducing bacterial count in root canals. Thus, using 1% NaOCl as an irrigant is appropriate in clinical practice.

Optical microscopy evaluation of root canal filling removal by beginner operators in posterior teeth.

This study analyzed the effectiveness of root canal filling removal in lower molars performed by beginner operators using optical microscopy. A total of 55 mandibular first and second molars with mesial roots exhibiting an average curvature of 10-20° were selected based on preoperative radiographs. Instrumentation was done with ProTaper Gold (Dentsply Sirona) up to F2 (25/.08), using 2ml of 2.5% NaOCl irrigation solution after each file. Root canal obturation was performed using gutta-percha points with cold lateral condensation and Sealapex (Kerr Dental). Coronal fillings were made with composite resin and stored in distilled water for two years. Removal of the root canal fillings was performed with AF Retreatment Rotary (AFRR) and AF Blue R3 (AFBR3) (Fanta Dental Materials) under reciprocating motion with 2.5% NaOCl irrigation. Cross-sections of the coronal, middle, and apical thirds were analyzed at 40x magnification using a STEINDORFF POL microscope with a digital camera. Image analysis was conducted using Image J software, version 1.54, to determine the efficiency of root canal filling removal by percentage. Statistical analysis via one-way ANOVA revealed significant differences between distal and mesial roots (P < 0.05). Specifically, for mesial roots, the removal efficiency was 70.65% in the coronal third, 54.66% in the middle third, and 21.32% in the apical third. Significant difficulties were noted due to fractured files, calcifications, and debris accumulation in the isthmuses. The study concluded that the protocol using Fanta files demonstrated significant differences in removal efficiency correlated with root curvature, compounded by the inexperience of beginner operators. The findings highlight the challenges faced by novice practitioners in achieving effective root canal filling removal.

An In Vitro Evaluation of the Antimicrobial Efficacy of a Novel Irrigant Using Next-Generation Sequencing

IntroductionTo evaluate the antimicrobial activity of Triton irrigation versus 4% sodium hypochlorite (NaOCl) utilizing a direct contact test and an extracted tooth model. MethodsIn the first experiment, a direct contact test was conducted to compare bacterial DNA removal and microbial diversity changes following irrigation with 4% NaOCl or Triton. Hydroxyapatite and dentin discs were inoculated with subgingival human-derived dental plaque for 2 weeks utilizing the Center for Disease Control biofilm reactor and subsequently challenged with the root canal irrigants for 5 minutes. In the second experiment, teeth contaminated with a multispecies biofilm (n = 24) were assigned into two treatment groups, NaOCl or Triton irrigation. Samples were obtained for quantitative real-time polymerase chain reaction and next-generation sequencing analysis before and after instrumentation. The Shannon and Chao1 indices were used to measure alpha diversity. The Bray–Curtis dissimilarity and ANOSIM was used to measure beta diversity. Differences in abundances of genera were evaluated using Kruskal–Wallis test with Bonferroni corrections. ResultsThe direct contact test revealed no significant differences in the bacterial load based on 16S rRNA gene molecules/μL, reads, or differences in the Shannon index among groups. In the extracted tooth model, a bacterial load reduction of log10 3.08 ± 0.69 and 2.76 ± 0.91 were found for NaOCl and Triton, respectively (P = .348). Next-generation sequencing showed fewer reads, lower Chao1, and beta diversity values when pretreatment and post-treatment samples were assessed in both experimental groups (P < .0001). The Kruskal–Wallis analysis found that 17 genera of bacteria were over-represented in minimal values in the Triton post-treatment group, 14 of these genera represented less than 1% of the microbial community. ConclusionsBoth irrigants had limited antimicrobial activity in the direct contact test. When used in conjunction with mechanical instrumentation both irrigants were able to reduce the bacterial DNA load and diversity in comparison with pretreatment communities. The NaOCl irrigation, followed by ethylenediaminetetraacetic acid flush, was more effective in decreasing DNA counts from low-abundance organisms.

Lipopeptide biosurfactant as a potential root canal irrigation agent: Antimicrobial and anti-biofilm evaluation

ObjectivesLipopeptide Biosurfactant (LB) is a bacteria derived compound able to reduce surface tension between water and hydrophobic substances and exhibit antimicrobial and anti-biofilm properties. This study aimed to investigate the antimicrobial and anti-biofilm effect of a Lipopeptide Biosurfactant (LB) on Enterococcus faecalis, and its potential use in root canal treatment, either as a standalone irrigation solution or in conjunction with sodium hypochlorite (NaOCl). MethodsLB was extracted from Bacillus clausii isolate and the dry extract was diluted in deionized water. The antimicrobial effect of LB against planktonic E. faecalis was evaluated by determining the Minimal Inhibitory Concentration (MIC50). The anti-biofilm effect was evaluated by Minimal Biofilm Inhibitory Concentration (MBIC50) and Minimal Biofilm Eradication Concentration (MBEC50) assays on biofilm grown on dentin specimen surface. To evaluate the effectiveness of LB as a single irrigation solution and as a pre-irrigation prior to NaOCl, live and dead bacterial cells were quantified using Confocal Laser Scanning Microscopy (CLSM), and cell biomass was assessed. ResultsLB exhibited an MIC50 and MBIC50 of 100 ppm, with an MBEC50 of 1000 ppm, resulting in 52.94 % biofilm inhibition and 60.95 % biofilm eradication on dentin specimens. The effectiveness was concentration-dependent, at 500 ppm, LB demonstrated comparable antimicrobial efficacy to 2.5 % NaOCl. Pre-irrigation with LB resulted in lower biofilm biomass compared to NaOCl alone. ConclusionPre-irrigation with LB enhanced the antimicrobial effect when followed by NaOCl irrigation. Consequently, LB shows promise as both a standalone root canal irrigation solution and as an adjunct to NaOCl in root canal treatment. Clinical significanceThe study highlights the potential of Lipopeptide Biosurfactant (LB) as an environmentally friendly irrigation solution for root canal treatment, demonstrating potent antimicrobial and anti-biofilm properties against Enterococcus faecalis. LB exhibits concentration-dependent efficacy comparable to 2.5 % NaOCl and can be used as a standalone irrigation solution or in conjunction with NaOCl.

Can the addition of surfactants to NaOCl irrigation impact on the percentage of voids of root canal filling?

This study evaluated the impact of canal irrigation using surfactants associated to NaOCl on the percentage of voids of root canal filling through micro-computed tomographic (micro-CT) analysis. 27 mandibular mesial roots with Vertucci type II canal configuration with isthmus were selected and scanned in a micro-CT device. The specimens were assigned to three groups (n = 9), according to the irrigation solution during instrumentation: 2.5% NaOCl without additives (control), 2.5% NaOCl with 0.1% Benzalkonium Chloride and 2.5% NaOCl with 0.1% Tween 80. After obturation, the specimens were rescanned, and the percentage of voids were calculated. Data were analysed using one-way ANOVA with a significance level of 5%. The percentage of voids were similar among the groups (p > 0.05). None of the specimens showed completely voids-free areas. The addition of surfactants to NaOCl irrigation did not improve the quality of root canal filling of mandibular mesial root canals.

Comparative Evaluation of the Microleakage of Self-etch Adhesives on the Pulp Chamber Dentin after Proanthocyanidin Application: An In vitro Study

ABSTRACT Background: The long-term success of adhesive restorations is contingent on minimizing microleakage, which can lead to postoperative sensitivity and secondary caries. Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) irrigation are commonly employed during adhesive restorative procedures, but their impact on microleakage remains a concern. Proanthocyanidin (PA), a naturally derived agent, has shown potential in enhancing bond strength. Aim: This study aimed to compare and evaluate the effect of treatment with or without 30% PA of the pulp chamber dentin after 1% NaOCl and 17% EDTA irrigation on the microleakage of adhesive restorations. Materials and Methods: Forty caries-free, freshly extracted permanent human molars were used. The pulp chamber roof was removed, and the roots were resected. Canal orifices were enlarged and sealed. Specimens were divided into four groups based on adhesives (OptiBond All-In-One and Adper Easy One) and irrigation regimens. After irrigation, pulp chambers were restored with Filtek Bulk-Fill composite resin. Microleakage was assessed using methylene blue dye penetration. Results: Microleakage was observed in all groups, irrespective of irrigation protocol and adhesives. PA application showed reduced dye penetration compared to without PA, although not statistically significant. Statistical analysis was performed using Kruskal–Wallis and Mann–Whitney tests at P &lt; 0.05. Conclusion: Irrigation protocols and the use of PA had no significant effect on the microleakage of self-etch adhesives to pulp chamber dentin. A 1-min application of 30% PA solution after NaOCl and EDTA irrigation did not improve the bonding of self-etch adhesives to pulp chamber dentin.

Antibacterial effectiveness of different final irrigation activation techniques.

Background and objective: To evaluate and compare the antibacterial effectiveness of ultrasonic, diode laser, XP endo finisher and finisher gentle file brush against Enterococcus faecalis in root canal dentin. Methods: Fifty-five single-rooted extracted mandibular premolars were decoronated to have a length of 12 mm, instrumented biomechanically with protaper Next up to size X3. After sterilization, five roots were selected as negative controls and the remaining teeth were inoculated with E. faecalis and incubated for 48 hr and at 37 ºC. The roots were then randomly divided into five groups (n=10), GI: Control group, GII: 5.25% NaOCl irrigation was activated by the ultrasonic system , GIII: By 980-nm diode laser , GIV: By Xp-endo finisher and GV : Activated by Finisher gentle file-brush. The antimicrobial efficacy was tested by collecting transfer fluid saline from the canals and counting the colony forming units (CFUs) of viable E. faecalis on agar plates. The statistical calculations were performed in JMP pro 14.3.0. using Analysis of Variance (ANOVA) followed by a Tukey test to define the differences between the tested groups. Result: The mean bacterial CFU were 10.6 X 10^7 for Finisher gentle file brush, 35.6×10^7 for Diode laser, 39.6×10^7 for ultrasonic and 42.3×10^7 for XP Endo Finisher. Finisher gentle file brush showed a significant reduction in the colony count compared to the other groups. Conclusion: None of the irrigation activation techniques removed the bacteria completely from the canal. The four tested irrigation activation techniques were shown to be effective in the disinfection of the E. faecalis-contaminated root canals. Finisher gentle file brush was the most effective against E. faecalis, while XP endo finisher was the least effective against E. faecalis. treatment against E. faecalis in the root canal. Keywords: Utrasonic, Diode laser, XP endo finisher, irrigation activation techniques

Effect of Irrigation Solution of Sodium Hypochlorite, Ethylenediamine Tetraacetic Acid, Chitosan Oligosaccharide and Agitation Techniques on Calcium Hydroxide Removal in Root Canal: In Vitro Study

Root canal treatment removes all infected pulp tissue and shapes the root canal to be appropriately filled to prevent bacteria from re-entering the root canal. Chitosan oligosaccharide is a promising irrigation solution because it has high solubility and low molecular weight, biocompatibility, good adhesion, and chelating properties.This study aims to assess the impact of various irrigation solutions, namely sodium hypochlorite, ethylenediamine tetraacetic acid, chitosan oligosaccharide, and different agitation strategies, on the efficacy of calcium hydroxide removal within the root canal. A total of 24 single-root mandibular premolars were extracted, decolonized, and root canal treated using Ca(OH)2. Examination of residual Ca(OH)2 in the channel was examined with a Scanning Electron Microscope (SEM). SEM results are assessed based on scoring with a double-blind method. Chitosan oligosaccharide irrigant with ultrasonic agitation can remove residual (Ca(OH)2) on the surface of the root canal wall, which is very good compared to the aspirator with XP Endo Finisher. The 2.5%NaOCl + 17% EDTA solution with ultrasonic agitation was better than the agitation with XP Endo Finisher. The ultrasonic agitation technique removes residue (Ca(OH)2) better than the XP endo finisher technique after being influenced by 2.5% NaOCl irrigation solution, 17% EDTA, and 2% chitosan oligosaccharides.The ultrasonic agitation technique generally removed up to 70% residue compared to the XP endo finisher agitation technique (30%) from all cervical, middle, and apical parts of the root canal:The ultrasonic agitation technique removes residue (Ca(OH)2 more than the XP Endo Finisher technique. Chitosan Oligosaccharide 2% has a better effect on removing residue (Ca(OH)2 in root canals. In comparison, 2% NaOCl irrigation solution is better than 17% EDTA in removing debris (Ca(OH)2 ).

Perawatan saluran akar periodontitis apikalis kronis pada gigi insisivus lateral maksilaris kiri

Background: Root canal treatment is one of the modalities to treat periapical lesions. The success of root canal treatment in periapical lesions can be seen with the patient's chief complaint and the healing of periapical lesions as seen by the radiograph. Objective: This case report aims to demonstrate root canal treatment on a maxillary anterior tooth with periapical lesion. Case report: A 22-year-old female patient came with complaints of a maxillary anterior tooth that had throbbing pain several months ago, after having it filled by a previous dentist, and since then, it has never hurt again. Intra-oral examination of tooth 12 showed composite resin on the mesiopalatal surface. Radiographic findings showed that there was a round radiolucency in the periapical area with a diameter of 4 mm. Root canal treatment was performed based on the diagnosis of chronic apical periodontitis et causa necrotic pulp. Root canal treatment begins with the application of a rubber dam, opens the cavity, explores the root canal, and shapes the root canal. Biomechanical preparation was carried out using Protaper Hand Use with crown down technique, combined with 2.5% NaOCl irrigation. The first visit ends with the disinfection of the root canal using calcium hydroxide. Subsequent treatment was carried out with subjective and objective examination, removal of temporary filling, cleaning of calcium hydroxide, and final irrigation with 2.5% NaOCl, 17% EDTA, and 2% CHX. Obturation was achieved using the vertical condensation technique. The restoration was accomplished at the next visit using composite resin. Conclusion: Root canal treatment on teeth with chronic apical periodontitis was successfully carried out.

Minimally invasive management of vital teeth requiring root canal therapy

The present study aimed to investigate the possible use of a non-instrumentation technique including blue light irradiation for root canal cleaning. Extracted human single rooted teeth were selected. Nine different groups included distilled water, NaOCl, intra-canal heated NaOCl, and NaOCl + EDTA irrigation after either instrumentation or non-instrumentation, and a laser application group following non-instrumentation technique. The chemical assessment of the root canal dentine was evaluated using energy dispersive spectroscopy (EDS) and Fourier transform infrared (FT-IR) spectroscopy. Surface microstructural analyses were performed by using scanning electron microscopy (SEM). The antimicrobial efficacy of different preparation techniques was evaluated using microbial tests. Light application didn’t change the calcium/phosphorus, carbonate/phosphate and amide I/phosphate ratios of the root canal dentin. The root canal dentin preserved its original chemistry and microstructure after light application. The instrumentation decreased the carbonate/phosphate and amide I/phosphate ratios of the root canal dentin regardless of the irrigation solution or technique (p < 0.05). The application of light could not provide antibacterial efficacy to match the NaOCl irrigation. The NaOCl irrigation both in the non-instrumentation and instrumentation groups significantly reduced the number of bacteria (p < 0.05). The use of minimally invasive root canal preparation techniques where the root canal is not instrumented and is disinfected by light followed by obturation with a hydraulic cement sealer reduced the microbial load and preserved the dentin thus may be an attractive treatment option for management of vital teeth needing root canal therapy.

Impact of contracted endodontic access cavity designs on root canal disinfection using diode laser: An “In-Vitro” Study

Introduction: New approaches for minimal invasive endodontic access cavity designs had been introduced for preserving the structural integrity of the offending tooth. Diode laser has been now widely used in root canal disinfection and showing highly promising results. Aim: to evaluate the impact of contracted endodontic access cavity designs on root canal disinfection using diode laser. Materials and Methods: Fifty-four intact freshly extracted human mandibular first molars were selected for the use in this study. Only the mesial roots of the selected samples were included in this study. Samples were randomly divided into three equal groups (n=18) according to the type of access cavity performed. Group (1): conventional access cavities, Group (2): Ninja access cavities, and Group (3): truss access cavities. Isolates of Enterococcus Faecalis (E.Fecacalis) were introduced in the root canals of the mesial roots of the selected samples. Samples were further sub-divided into two equal sub-groups (n=9) according to the disinfection method. Sub-group (a): Diode laser disinfection, and Sub-group (b): NaOCl 2.5% followed by EDTA 17% irrigation. Bacterial evaluation was performed using confocal laser scanning electron microscope. Results: The results showed that using Diode laser disinfection have shown higher bacterial reduction in comparison to NaOCl irrigation, but with no statistically significant difference. For access cavity designs, regardless of the type of disinfection used, conventional access cavities have shown the highest bacterial reduction, with the least bacterial reduction with Ninja access cavities. Conclusion: Contracted endodontic access cavities did not offer any advantages in comparison with the conventional endodontic access cavities regarding bacterial reduction. Diode laser can be used as an effective adjunct tool in root canal disinfection.

Performance of two different electronic apex locators during the removal of calcium silicate-based sealers

Aim: The aim of this in vitro study is to evaluate the accuracy of Root ZX and Propex Pixi during the retreatment of root canals obturated with different calcium silicate-based root canal sealers. Methodology: Root canals of ninety human premolar teeth were shaped with ProTaper universal rotary files up to size F2 under 5.25% NaOCl irrigation for the present study. Root canal filling was carried out by lateral condensation technique using with gutta-percha and sealers; MTA Fillapex, CeraSeal or AH Plus. After seven days, the obturating materials were removed using D-Race files. While actual working length was recorded by direct observation, electronic working lengths were determined by Propex Pixi or Root ZX for tolerance limits of 0.5 mm and 1.0 mm. Data were analyzed using Shapiro Wilk, Mann-Whitney U, and Kruskal-Wallis tests (p &lt; 0.05). Results: The performance of Propex Pixi and Root ZX was found to be statistically similar and did not differ on the root canals filled with different root canal sealers (p &lt; 0.05). Propex Pixi and Root ZX demonstrated more accurate measurements in the range of ±1 mm compared to ±0.5 mm in all groups, regardless of the type of root canal sealer used when filling the root canals before retreatment (p &lt; 0.05). Conclusion: Root ZX and Propex Pixi can be used confidently in the retreatment of the root canals in which CeraSeal, MTA Fillapex, and AH Plus are used as sealers. How to cite this article: Göçer PA, Durmazpınar PM, Baştürk FB. Performance of two different electronic apex locators during the removal of calcium silicate-based sealers. Int Dent Res 2023;13(S1):20-25. https://doi.org/10.5577/idr.2023.vol13.s1.3 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Cytokine expression of IL-8 before and after root canal treatment in patients with symptomatic apical periodontitis: A clinical trial.

Thirty-six patients were allocated according to their pulp status into two experimental groups (n = 18) receiving the same treatment protocol; group 1: Vital pulps with SAP, and group 2: non-vital pulps with SAP. Conventional endodontic treatment was done on two visits; isolation and disinfection of the operative field were undertaken, and two-stage access cavity preparation was implemented. The first pre-instrumentation peri-apical sample (S1) was collected prior to cleaning and shaping procedures. A 2.5% NaOCl irrigation was used to thoroughly irrigate the canal after performing root canal preparation utilising the ProTaper Next (PTN) rotary system. After 1 week, the second post-instrumentation peri-apical sample (S2) was collected. Using an ELISA kit, the quantity of IL-8 was evaluated following the collection of all samples. In all pre-instrumentation samples, IL-8 was detected (100%). The level of IL-8 expression was significantly decreased from the S1 to S2 of all samples (p < 0.001). The intra-group comparison showed a statistically significant reduction in the level of IL-8 expression between S1 and S2 in both vital and non-vital groups where p < 0.001* in both groups. The inter-group comparison of levels of IL-8 expression (vital and non-vital) revealed a significant difference between both groups regarding the pretreatment sample with the higher levels of IL-8 shown in the non-vital group (p < 0.001). While in the post-treatment sample, both groups showed a significant reduction in the level of IL-8 expression but the difference between them was not statistically significant (p = 0.226). Root canal instrumentation seems to be efficient in decreasing the levels of anti-inflammatory cytokines, namely IL-8. Further research should clarify how intra-canal medicaments affect inflammatory mediator levels.

Efficacy of Different Root Canal Irrigating Solutions in Removing Smear Layer: A Scanning Electron Microscopic Study.

Background The aim of the present investigation was to evaluate and compare the efficacy of frequently used chemical agents in terms of their capacity to eliminate the smear layer after instrumentation, as observed via scanning electron microscopy (SEM). Materials and methods Sixty extracted single-rooted mandibular premolar teeth, each with roots 15 mm in length, were used in this study. The teeth were divided into one control group and four study groups, each containing 12 teeth. In Control Group 0, teeth were irrigated with 3 ml of saline only. In Group 1, teeth were irrigated initially with 3% sodium hypochlorite (NaOCl) and then given a final rinse with 3 ml of 17% ethylenediaminetetraacetic acid (EDTA) for one minute. In Group 2, teeth were irrigated with 3% NaOCl and given a final rinse with 3 ml of a mixture of tetracycline, acid, and detergent (MTAD, BIOPURE) for one minute. In Group 3, teeth were irrigated with saline and given a final rinse with 3 ml of 17% EDTA for one minute. In Group 4, teeth were irrigated with saline and given a final rinse with 3 ml of MTAD for one minute.One-half of each tooth was chosen and prepared for scanning electron microscopic (SEM) examination at the cervical, middle, and apical thirds. These were observed at magnifications of up to 1,000 times to check for the presence or absence of a smear layer. The data were analyzed using the Kruskal-Wallis test and post-hoc Dunn's test. Results All of the root canal irrigation protocols exhibited superior efficacy compared to the control group in the elimination of the smear layer. Group 2 (3% NaOCl with MTAD) showed the lowest mean scores, compared to all the groups, followed by Group 1 (3% NaOCl with 17% EDTA). MTAD was more effective than EDTA. The smear layer was effectively removed from the apical third, followed by the middle and coronal thirds of the root. Conclusion Initial irrigation with 3% NaOCl and one-minute final irrigation with 3 ml MTADwas the most effective root irrigant, and particularly indicated in teeth with infection of the apical third.