Root Canal Irrigation Solutions Research Articles

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.

The effect of the enzymes trypsin and DNase I on the antimicrobial efficiency of root canal irrigation solutions.

The purpose of this study was to evaluate the antibacterial efficacy of using 2.5% NaOCl, 2% chlorhexidine (CHX), Irritrol, and chitosan-coated silver nanoparticles (AgCNPs) alone or in combination with deoxyribonuclease I (DNase I) and trypsin pre-enzyme applications in dentin samples contaminated with Enterococcus faecalis (E. faecalis) by CLSM. 144 dentin blocks with confirmed E. faecalis biofilm formation were divided randomly according to the irrigation protocol (n = 12): NaOCl, CHX, Irritrol, AgCNPs, trypsin before NaOCl, CHX, Irritrol, AgCNPs, and DNase I before NaOCl, CHX, Irritrol, AgCNPs. Dentin blocks were stained with the Live/Dead BacLight Bacterial Viability Kit and viewed with CLSM after irrigation applications. The percentage of dead and viable bacteria was calculated using ImageJ software on CLSM images. At a significance level of p < 0.05, the obtained data were analyzed using one-way Anova and post-hoc Tukey tests. In comparison with NaOCl, CHX had a higher percentage of dead bacteria, both when no pre-enzyme was applied and when DNase I was applied as a pre-enzyme (p < 0.05). There was no difference in the percentage of dead bacteria between the irrigation solutions when trypsin was applied as a pre-enzyme (p > 0.05). AgCNPs showed a higher percentage of dead bacteria when trypsin was applied as a pre-enzyme compared to other irrigation solutions (p < 0.05), while the pre-enzyme application did not affect the percentage of dead bacteria in NaOCl, CHX, and Irritrol (p > 0.05). No irrigation protocol tested was able to eliminate the E. faecalis biofilm. While the application of trypsin as a pre-enzyme improved the antimicrobial effect of AgCNPs, it did not make any difference over other irrigation solutions.

Niosomal Doxycycline and Triamcinolone: A Novel Approach to Minimize Cytotoxicity in Endodontic Medicaments.

Mechanical root canal preparations and irrigation solutions are essential for reducing microbial counts in the root canal system. However, these methods do not completely eliminate microorganisms. Intracanal medicaments are used to further decrease microbial counts. This study aims to assess the cytotoxicity of various intracanal medicaments. In this in vitro study, murine fibroblast cell lines (L929) were cultured in a controlled environment. The MTT assay was employed to evaluate the cytotoxicity of different medicament combinations, including calcium hydroxide and triamcinolone (D1), niosomal doxycycline and triamcinolone (D2), calcium hydroxide (D3), and a combination of doxycycline and triamcinolone (D4). Statistical analysis was performed using ANOVA and Dunnett's test. The results indicated that D1 and D2 had lower cytotoxicity, while D4 exhibited the highest cytotoxicity. D1 was found to be non-cytotoxic up to a concentration of 500 µg/mL over a period of 72 hours. D2 and D3 showed similar effects up to concentrations of 250 µg/mL and 100 µg/mL, respectively, for 72 hours. In contrast, D4 exhibited cytotoxicity at concentrations above 75 µg/mL at 72 hours. This study suggests that encapsulating doxycycline in niosomal structures (D2) reduces cytotoxicity in murine fibroblast cell lines (L929) for at least 24 and 48 hours. These findings offer promising implications for the development of endodontic medicaments with improved biocompatibility.

Self-perceived pain levels following irrigation with various concentrations ofsodium hypochlorite solution and gels: A systematic review of randomized clinical studies

Background:Sodium hypochlorite, a prevalent root canal irrigation solution, valued for its antibacterial properties and tissue-dissolving abilities, varies in concentration (0.5% to 8.25%). However, its efficacy across formulations awaits systematic evaluation.Aim:Toevaluate self-perceived post-operative pain levels in a 5.25% concentration of NaOCl in gel or solution form. Materials and Methods:An unrestricted search of indexed databases (PubMed, Embase, Scopus, Web of Science, and Cochrane) and a manual search were performed up to April 2023. Three randomized controlled trials (RCTs) compared a solution form of 5.25% NaOCl to other solution concentrations, whereas 2 RCTs compared a gel form of 5.25% NaOCl concentration to 5.25 % NaOCl solution form. The risk of Bias (RoB) assessment was conducted using the Cochrane tool.Results: A total of 5 RCTs met the inclusion criteria and were included in the review. Four RCTs used the visual analog scale (VAS), whereas 1 RCT used the numeric rating scale (NRS) to assess post-operative pain. Three RCTs had a moderate Risk of Bias (RoB), whereas 1 had a low and 1 had a high RoB.Conclusion:Based on the current evidence the concentration of NaOCl used during irrigation did not have any effect on the post-operative pain developed regardless of the use of a gel or solution forms. Future randomized studies with standardized protocols are needed to further investigate the efficacy of NaOCl concentration on postoperative pain in endodontic treatment

Comparison of antibacterial effect of plantaricin 149 suspension and traditional root canal irrigation solutions in root canal infections in vitro

Dental pulp and periapical diseases are common conditions in stomatology, caused by various pathogenic microorganisms. Antimicrobial peptides, as new antibiotics, offer promising applications in the irrigation and disinfection medicaments for root canals.One patient with chronic periapical periodontitis was selected to extract the clinical pathogenic bacteria. Porphyromonas gingivalis (Pg) (ATCC 33,277), Streptococcus mutans (Sm) (ATCC 25,175), and Prevotella intermedius (Pi) (ATCC 25,611) were used as test strains. The effects of plantaricin (Pln) 149 on the biofilm formation and growth in infected root canals were evaluated by RT-PCR, laser confocal scanning microscopy, and bacterial diversity analysis. In addition, the cytotoxicity of Pln 149 (100 µg/mL) to human dental pulp stem cells (hDPSCs) was assessed using an MTT assay. Pln 149 exhibited significant inhibitory effects on Pg Sm and Pi (P < 0.05), with significant differences in the biofilm images of the laser confocal scanning microscope (P < 0.05). There were no significant differences in hDPSCs viability or proliferation between the Pln 149 and control groups. Considering the excellent antimicrobial effects and low cytotoxicity, we suggest that Pln 149 might be a promising option for root canal irrigation solutions.

Can herbal products be alternative root canal irrigation solutions in primary teeth? An in vitro study

To evaluate antimicrobial properties and smear layer removal efficiency of various plant extracts and apple cider vinegar (AV). A total of 112 primary molars roots were randomly divided into two groups (n = 56) for antimicrobial test and infected with E faecalis and Candida albicans then divided again into 7 groups (n = 8) as physiological saline (PS), NaOCI, white tea (WT), Helichrysum arenarium (HA), AV, Citrus lemon (CL), and Anzer thyme (AT). Disinfecting abilities were measured with ImageJ. In the smear layer removal efficiency test, prepared 70 roots were divided into 7 groups (n = 10) as in the antimicrobial test also 2 subgroups were designed as with or without EDTA usage (n = 5). All samples were examined under SEM. Open dentin tubule percentage was evaluated with ImageJ. HA and CL showed higher antibacterial activity against E. faecalis than PS (p = 0.038, p = 0.009) Antifungal activity of AV against C. albicans was higher than saline (p < 0.001). AV in the coronal third and CL in the middle third removed more smear layer than saline and NaOCI (p < 0.05). In the coronal region, HA and AV showed similar smear layer removal efficacy to NaOCl + EDTA (p > 0.05). CL, HA, and AV presented statistically similar results to NaOCl + EDTA in smear layer removal efficacy in the middle region (p > 0.05). CL and AV have antimicrobial efficacy against E. faecalis and C. albicans respectively and smear layer removal activity.

The Effect of a Novel Silver-Citrate Root Canal Irrigation Solution (BioAkt), Ethylenediamine Tetraacetic Acid (EDTA), and Citric Acid on the Microhardness of Root Canal Dentin: A Comparative In Vitro Study.

Background and objective The use of a chelating agentas an adjunct to disinfectant irrigation is very necessary to remove the smear layer formed during root canal treatment. However, the decalcifying solutionshave a negative impact on dentin microhardness, which might affectthe result of endodontic therapy. The aim of this study is to evaluate the effect of 17% ethylenediamine tetraacetic acid (EDTA), a novel silver-citrate root canal irrigation solution (BioAkt), 10% citric acid, and 40% citric acid on the microhardness of root canal dentin. Materials and methods Forty-five single-root teeth were distributed equally into five groups A, B, C, D, and Etreated withdistilled water as a control, 17% EDTA, BioAkt, 10% citric acid, and 40% citric acid, respectively. The dentin microhardness was measured before and after the experiment, and the collected data were analyzed using paired sample T-test, One-way ANOVA test, and least significant difference (LSD) test (multiple comparisons), (P < 0.05). Result The results showed that the averages of dentin microhardness values before the experiment were 62.83 kg/mm², 65.34 kg/mm², 64.79 kg/mm², 62.95 kg/mm², and 56.47 kg/mm² for groups A, B, C, D, and E, respectively, while the averages after the experiment were 62.60 kg/mm², 54.92 kg/mm², 54.50 kg/mm², 51.31 kg/mm², and 49.37kg/mm² accordingly. Statistical analysis revealed that17% EDTA, BioAkt, 10% citric acid, and 40% citric acid decreased the dentin microhardness significantlycomparing with the negative control group, without statistical differences among them. Conclusion The chelating agents 17% EDTA, BioAkt, 10% citric acid, and 40% citric acid declined the microhardness of root canal dentin similarly, which might have possible effects on endodontic treatment and the properties of root canal filling materials as well.

Influence of chlorhexidine 2% and sodium hypochlorite 5.25% on micro-tensile bond strength of universal adhesive system (G-Premio Bond)

Aim: One of the reasons for the failure of adhesion in composite restorations and secondary caries may be the chemical irrigants used during the endodontic treatment. NaOCl is widely used for the biomechanical preparation of root canals due to its antimicrobial properties and capacity to dissolve organic material. In addition, another very effective decontamination solution is chlorhexidine 2%. There are few studies about the effect of root canal irrigation solutions on bond strength of universal adhesives therefore, in this study we have investigated the influence of CHX 2% and NaOCl 5.25% on micro-tensile bond strength of G-Premio Bond. Methods: Twenty-four human teeth were randomly allocated to the following groups: G1, immersion in saline solution 0.9% for 30 minutes (control); G2, immersion in CHX 2% for 30 minutes; G3, immersion in NaOCl 5.25% for 30 minutes. After restoration, the dentin/resin interface was tested by micro-tensile bond strength. The surfaces morphology was analyzed by Scanning Electron Microscopy. Data were analyzed by ANOVA followed by Tukey test in SPSS software Version 24. Results: There was a statistically significant difference between G3 and G1 (P &lt; 0.05). There were no statistically significant differences among G1 and G2, G2 and G3. Conclusion: Root canal irrigation with NaOCl 5.25% significantly reduced the micro-tensile bond strength in the G-Premio Bond at self-etch mode, but the use of CHX did not make a significant difference.

Antibacterial efficacy of peracetic acid in comparison with sodium hypochlorite or chlorhexidine against Enterococcus faecalis and Parvimonas micra

BackgroundThe main goal of an endodontic treatment is a complete debridement of the root canal system; however, currently mechanical shaping and chemical cleaning procedures for this purpose have deemed non-satisfactory.MethodsThe efficacy of peracetic acid (PAA; 0.5, 1.0, 2.0%), as a root canal irrigation solution, against Enterococcus faecalis (DSM 20478) and Parvimonas micra (DSM 20468) when compared with the one of sodium hypochlorite (NaOCI; 1.0, 3.0, 5.0%), chlorhexidine digluconate (CHX; 0.12, 0.2, 2.0%) and 0.9% NaCI (as a control solution) was in vitro investigated with the agar diffusion and direct contact methods. The inhibition zone diameters observed with the agar diffusion test were determined. The viable bacterial counts (CFU/ml) were calculated with the direct method.ResultsThe agar diffusion test showed that all three root canal irrigation solutions had an efficacy against E. faecalis at all concentrations. The largest inhibition zone diameters against E. faecalis were observed with 5.0% NaOCI. At all three concentrations of PAA, NaOCI, and CHX, the inhibition zone diameter increased with increase in concentration. For P. micra, PAA had a similar inhibition zone diameter despite a concentration increase. In contrast, for NaOCI and CHX, the inhibition zone diameter increased with increasing concentration. 2.0% CHX produced the largest inhibition zone diameter against P. micra. For E. faecalis, only the comparison between 2.0% PAA and 5.0% NaOCI showed statistical significance (p = 0.004). For P. micra the efficacy comparison between the lowest, middle, and highest concentrations of each solution, a statistical significance (p < 0.05) was found for all three solutions. After direct contact with PAA, NaOCI and CHX, no viable bacteria could be determined for either P. micra or E. faecalis.ConclusionsPAA had a similar antibacterial efficacy as the one of NaOCl and CHX when in direct contact with E. faecalis and P. micra. In the agar diffusion test, PAA showed a similar antibacterial efficacy as the one of CHX and a lower one as the one of NaOCl for E. faecalis.

The assessment of chlorine concentrations in sodium hypochlorite solutions used by dental practitioners in Morocco: A survey

Introduction: The purpose of this survey was to assess the concentration of chlorine in sodium hypochlorite solutions (NaOCl) used as root canal irrigation solutions by the dentists in Marrakech, Morocco.Materials and Methods: A survey was carried out among 74 practitioners registered with the Moroccan Order of Dentists, of whom 36 (48.6%) were men and 38 (51.4%) were women. A self-administered questionnaire was used. Among the questions, participants were asked about the number of treatments performed per week, the type of irrigation solution used, and the storage of the irrigation solution. After this interview, a 30 mL sample of that solution was sent to a laboratory to determine the amount of chlorine by iodometric titration. Jamovi version 1.8.1/ANOVA and the t-test were used to perform the statistical analysis (P < 0.05).Results: All the practitioners except two used the NaOCl as an irrigant. Besides, 84.7% prepared their solutions. The solutions were stored 63.8% of the time in opaque containers. The mean percent of chlorine concentration was 0.95% ± 0.68%. The concentration was also higher in the ready-to-use solutions (1.39%) than those prepared in the office (0.87%). Moreover, this difference was statistically significant (P = 0.01).Conclusion: The results confirmed that the NaOCl is the solution that practitioners use mostly. The conditions of dilution and storage are inappropriate, and the concentration is very low at 0.95%.

A Review on Root Canal Irrigation Solutions in Endodontics

Introduction: This paper aims to review the different characteristics of root canal irrigants including sodium hypochlorite (NaOCl), chlorhexidine (CHX), hydrogen peroxide (H2O2), iodine potassium iodide (IKI), antibiotic-based irrigants, photo-activated disinfection, electrochemically activated water, and QMix. The literature on root canal irrigation solutions in the context of endodontics up to June 2020 was reviewed using PubMed and MEDLINE. NaOCl was identified as the most likely effective irrigation solution that could be used for endodontics. Its antimicrobial activity is at least comparable or even greater than that of other common irrigants. Tetraclean was also proposed to be more effective than CHX against endodontic microorganisms. In addition, Hypoclean was suggested as the most potent and effective irrigant against Candida albicans. Similarly, IKI was introduced as a successful irrigant in killing Candida albicans and Enterococcus faecalis. MTAD is also known to be effective in smear layer removal as well as against the growth of Enterococcus faecalis. EDTA is also considered to have limited antimicrobial activity.

Genotoxicity Induced by Cellular Uptake of Chitosan Nanoparticles in Human Dental Pulp Cells

<i>Objective:</i> Recent <i>in vitro</i> studies have shown that chitosan nanoparticles in several root canal sealers, intracanal medicament, and irrigation solutions could enhance the antimicrobial activity. However, the nanotoxicity of chitosan has not been fully studied. The aim of this study was to evaluate cellular uptake and genotoxicity of various sizes and concentrations of chitosan nanoparticles cultured with human dental pulp cells. <i>Methods:</i> Human dental pulp cells were derived from human dental pulp tissues and cultured for 24 hours with 50 nm and 318 nm FITC-tagged chitosan nanoparticles in concentrations: 0.1 mg/mL, 0.5 mg/mL, and 2 mg/mL as study groups, and 0 mg/mL as a control. The fluorescence intensity of the FITC tagged chitosan nanoparticles was measured using a spectrophotometer to determine the cellular uptake. Genotoxicity was assessed by the Cytokinesis-block micronucleus method and by measuring the fluorescent intensity of the phosphorylated H2AX nuclear foci. Statistical analysis was performed using One-Way ANOVA, post-hoc Tukey, and Chi-square tests. <i>Results:</i> Chitosan nanoparticles were able to internalize the human dental pulp cells and significantly induced micronuclei, nuclear buds, and pH2AX foci at concentrations of 0.5 mg/mL and 2 mg/mL as compared to 0.1 mg/mL (<I>P </i>< 0.01) and control group (<i>P </i>< 0.01). At both concentrations, 0.5 mg/mL and 2 mg/mL, 50 nm chitosan significantly induced higher proportions of micronuclei (<i>P</i>=0.001), nuclear buds (<i>P</i>=0.009), and pH2AX nuclear foci (<i>P</i>=0.00004) as compared to 318 nm chitosan. <i>Conclusion:</i> 50 nm and 318 nm chitosan nanoparticles at concentrations 0.5 mg/mL and 2 mg/mL penetrated human dental pulp cells and induced genotoxicity in dose-dependent and size-associated manners.

EFFECT OF GRAPE SEED EXTRACT SOLUTION ON THE MICROHARDNESS OF THE ROOT CANAL DENTIN: AN IN VITRO STUDY

Objective: Grape seed extract (GSE) containing proanthocyanidin as a root canal irrigation solution has its antibacterial effects and ability to eliminatethe smear layer. In addition, proanthocyanidin acts as a cross-linking agent of collagen, which adds to dentin’s mechanical properties. This studyanalyzed the effect of GSE containing 2.9% proanthocyanidin on the microhardness of the dentin in the root canal.Methods: Fifty teeth were divided into three groups and immersed in GSE solution, 3% NaOCl solution, or distilled water (controls) for 30 min for 3consecutive days. The microhardness was measured using the Vickers method. Data were analyzed using the Kruskal–Wallis test.Results: The GSE group presented the highest microhardness values, whereas the lowest values in the NaOCl group. No significant difference inmicrohardness observed between the GSE and distilled water groups.Conclusion: The GSE solution maintains the microhardness of the root canal dentin.

In Vitro Evaluation of Antibacterial Properties and Smear Layer Removal/Sealer Penetration of a Novel Silver-Citrate Root Canal Irrigant.

This study aimed at evaluating the efficacy of a novel silver-citrate root canal irrigation solution (BioAKT) on smear layer removal, sealer penetration after root canal instrumentation and antibacterial activity. Single-root teeth were endodontically treated, sealed with an epoxi-amine resin sealer and irrigated using: Group I: 5.25% sodium hypochlorite (NaOCl); Group II: silver-citrate solution (BioAKT); Group III: phosphate buffer solution (PBS); Group IV: 17% ethylenediaminetetraacetic acid (EDTA). Smear layer removal and silver deposition at the coronal, middle and apical portion of each canal were analyzed using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS). Sealer penetration into dentinal tubules at coronal, middle and apical portion was assessed through dye-assisted confocal microscopy (CSM). Both SEM and CSM micrographs were evaluated by two examiners (κ = 0.86), who were blind to the irrigation regimens; scores were given according to the degree of penetration of the sealer. Data analysis included Pearson’s x2 and Sidak’s multiple comparisons. Dentin discs were polished and sterilized. Enterococcus faecalis biofilms were grown using a continuous-flow bioreactor under anaerobic conditions for 72 h. Specimens were irrigated with the tested solutions, and bacterial viability was assessed using a tetrazolium salt assay (MTT). Statistical analysis included one-way ANOVA and Student’s post-hoc t-test (p < 0.05). BioAKT and EDTA were the most efficient solutions both in removing the smear layer and allowing sealer penetration. However, at the apical portion BioAKT performed significantly better compared to EDTA both in smear layer removal and sealer penetration (p < 0.05). BioAKT and NaOCl showed comparable antibacterial effect (p = 0.53). In conclusion, BioAKT represents a suitable smear layer removal agent, which allows for reliable sealer penetration at the apical portion of the root canal system and offers significant antibacterial properties.

Postoperative Pain After the use of Sodium Hypochlorite gel and Solution Forms: A Randomized Clinical Study.

Objective:The present study aimed to compare the effect of sodium hypochlorite (NaOCl) gel and solution forms on postoperative pain level.Methods:Fifty-two patients were divided into two groups according to the root canal irrigation solution. In the NaOCl solution group, the root canals were irrigated with 2 mL of 5.25% NaOCl between each pecking motion. In the NaOCl gel group, 5.25% NaOCl gel was used according to the manufacturer’s instructions. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels on 24, 48, and 72 hours and 1 week after treatment using VAS.Results:Intergroup analyses revealed that the NaOCl gel group resulted in significantly less postoperative pain than the NaOCl solution group on day 1.Conclusion:It can be concluded that using NaOCl gel during root canal preparation results in less postoperative on day 1 when compared with the NaOCl solution.

Comparing a Combination of Saline and Chlorhexidine with Saline as Root Canal Irrigation Solutions in Pulpectomy of the Primary Molars in 6-9 Years Old Children, A Double Blind Clinical Trial

Introduction: Using irrigation solutions in pulpectomy procedures for children is the best technique to dissolve and remove the soft necrotic materials during instrumentation. Normal saline solution (NSS) has no antibacterial activity and only results in root canal cleaning during irrigation. The 2% chlorhexidine gluconate (CHX) solution significantly decreases bacterial colonies, compared to NSS. The present study was performed to evaluate the success of irrigation by NSS and CHX combined solution, in comparison to NSS. Materials and Methods: The current study was conducted on 60 children aged 6‒9 years allocated to the two groups of test and control. All the participants had one primary molar tooth with signs and symptoms of irreversible pulpitis. During pulpectomy of the 30 teeth, the standard technique, consisting of irrigation with 0.9% NSS was used for the control group. The 30 teeth of the remaining subjects in the case group were irrigated with an equal volume of 0.2% CHX and NSS combination. Clinical radiographic follow-ups were scheduled at 6 and 12 month post-operation intervals. Results: The success rates at 12 month follow-up from clinical and radiographic viewpoints in the control group were 83% and 73%, respectively. For the case group, success rates of 97% and 90% were reported clinically and radiographically, respectively. There were no significant diffferences between the case and control groups at 6- (P= 0.492) and 12- (P= 0.195) month clinical follow-ups. On the other hand, the two groups were siginificantly different regarding the 6-month radiographic follow-up (P=0.038); however, such difference was not significant at the 12-month follow-up (P=0.095). Conclusion: Theone-year follow-up showed that there is no diffference between CHX and NSS as irrigation solutions for cleaning the root canals of primary teeth with irreversible pulpitis.

Contrasting efficacy of cocoa POD HUSK extract and 8% propolis extract in maintaining of root canal wall cleanliness

Background: The existence of the smear layer, which can be produced during root canal instrumentation, may compromise the bond between filling material and the root canal walls. Therefore, the use of an effective root canal irrigation solution, a commonly employed form of which is sodium hypochloride (NaOCl), is important. Sodium hypochloride has several positive properties including effectiveness as a disinfectant agent and its ability to promote tissue-dissolution, although it is ineffective at cleaning the smear layer. There have been numerous recent studies of the application of phytomedicines in endodontics due to their advantages such as minimum toxicity and cost effectiveness. The saponin contained in both the propolis and cocoa pod husk acts as a surfactant that may lower surface tension and dissolve debris containing organic and anorganic materials. Purpose: The study aimed to provide evidence of the differences between root canal wall cleanliness when treated with 8% propolis extract and different concentrations of cocoa pod husk extract. Methods: 25 extracted teeth with single straight root canals were randomly divided into five categories (n=5). Sample preparation was performed using a rotary file and irrigated with different solutions. The first group was administered 2.5% NaOCl, the second group 8% propolis, the third group 3.12% cocoa pod husk extract, the fourth group 6.25% cocoa pod husk extract, and the fifth group 12.50% cocoa pod husk extract. The samples were then dissected into two sections at the apical third and their cleanliness scores subjected to a Mann-Whitney test with a significance level of p=0.05. Results: A significant difference was identified between all groups (p&lt;0.05) and on the median control test, the highest value of 1.6 was recorded by the 6.25% cocoa pod husk extract, compared to the other four groups Conclusion: Cocoa pod husk extract demonstrates greater efficacy at cleaning root canal walls compared to 8% propolis extract.

Investigation of different sodium hypochlorite volumes, concentrations and times of irrigation in endodontic therapy: a systematic review

Investigation of different sodium hypochlorite volumes, concentrations and times of irrigation in endodontic therapy: a systematic review

АНАЛИЗ ПРИЧИН НЕУДАЧ ЭНДОДОНТИЧЕСКОГО ЛЕЧЕНИЯ И УДАЛЕНИЯ ЗУБОВ С ДИАГНОЗОМ «ХРОНИЧЕСКИЙ АПИКАЛЬНЫЙ ПЕРИОДОНТИТ»

Object. Causes of failure of endodontic treatment and causes of tooth extraction with a diagnosis of chronic apical periodontitis. Purpose ― to analyze the causes of failure of endodontic treatment and the causes of tooth extraction with a diagnosis of chronic apical periodontitis to determine ways to improve the effectiveness of conservative treatment. Methodology. A retrospective analysis of 864 medical records of a dental patient and 532 results of x-ray examinations of patients who underwent tooth extraction was carried out. 198 dentists-therapists of the city of Tyumen and the South of the Tyumen region were interviewed to determine the shortcomings of endodontic treatment. During the survey, doctors expressed their subjective opinion about the main reasons for the failure of therapeutic treatment of teeth with apical periodontitis and the reasons for their subsequent tooth extraction. Results. According to the survey, the failure of conservative treatment is most often associated with non-compliance with treatment protocols and the complexity of the anatomical structure of the root canals, as well as the inability to adequately clean the root canal system. A retrospective analysis of the data related to tooth extraction revealed that the main cause of tooth extraction is chronic apical periodontitis, which accounts for 69 %. The main reason for the removal of teeth diagnosed with chronic apical periodontitis was a significant destruction of the crown. Summary. In the course of this work, we justified the need to improve existing methods of conservative treatment of apical periodontitis. Improvement of endodontic treatment should be aimed at the development and implementation of effective methods of root canal cleaning and irrigation solution activation. In order to improve the prognosis of endodontic treatment and reduce the proportion of tooth extractions for periodontitis, it is necessary to improve the quality of the final restoration and to monitor its tightness.

Smear Layer Removing Ability of Root Canal Irrigation Solutions: A Review

The purpose of this review is to address the smear layer removing the ability of root different canal irrigants including ethylenediaminetetraacetic acid (EDTA), a mixture of tetracycline, acid and detergent (MTAD), tetraclean, citric acid, Q-Mix, maleic acid, and smear clear. Smear layer is a layer which is produced during instrumentation. It contains both organic and inorganic materials. It may also contain bacteria and their byproduct considering the root canal situation. This layer may prevent the penetration of the healing material introduced to the canal to the interior of the dentinal tubules. In addition, it can affect the adaptation of sealing materials to the root canal walls. The smear layer removal ability of MTAD is superior and faster than EDTA. Tetraclean is similarly composed of an acid, an antibiotic, and a detergent. The presence of doxycycline is believed to help the smear layer removal ability of these irrigants. Antibiotics such as tetracycline had similar smear layer removal ability as even citric acid. EDTA is an amino acid with a chelating ability that sequestrates metal ions. Some believed EDTA smear layer removing ability is better than MTAD, tetraclean, SmearClear, and 20% citric acid which is controversial in case of comparison between MTAD and EDTA. Phosphoric acid is efficient enough to be comparable to EDTA in removing the smear layer. Maleic acid is an organic compound with acid etching smear layer removal. Its ability seems to be similar or even better than EDTA. Citric acid as another organic acid is believed to be used as smear removing agent. HEBP is another chelating agent that can be used in combination with NaOCl; however, HEBP is a weak decalcifying agent compared to EDTA and hence cannot be applied as a mere final rinse. QMiX is a combination of CHX, EDTA, and detergent and should be used at final rinse. It is believed that QMiX is as efficient as EDTA. Smear clear is a 17% EDTA solution including an anionic and cationic (cetrimide) surfactant. The ability of QMiX is similar to EDTA. There are different canal irrigation solutions with various smear layer removal ability that some should be used as a mere final rinse and some should not. The usage of canal irrigation solutions depends on the clinical situation and preference of the dentists. This study provides a good guide for clinician of the field.