Comparação da propriedade antimicrobiana da clorexidina e do hipoclorito de sódio como irrigantes endodônticos: revisão integrativa / Comparison between the antimicrobial properties of chlorhexidine and sodium hypochlorite as endodontic irrigants: an integrative review / Comparación de la propiedad antimicrobiana de la clorhexidina y el hipoclorito de sodio como irrigantes endodónticos: revisión integradora

Introdução:Durante o tratamento endodôntico, devido às complexidades anatômicas dos canais radiculares, a ação mecânica dos instrumentos não é suficiente para a completa desinfecção dos condutos. Dessa forma, se faz necessário o uso de soluções irrigadoras que possampotencializar a desinfecção do sistema de canais radiculares. Objetivo:Realizar uma revisão integrativa da literatura para comparar as propriedades antimicrobianas da clorexidina com o hipoclorito de sódio.Metodologia:A busca na literatura foi realizada no período de setembro de 2019 a agosto de 2021, nas seguintes bases de dados: PUBMED/MEDLINE, LILACS e SCIELO. Utilizando os descritores: clorexidina, hipoclorito de sódio, irrigante do canal radicular e limpeza. Utilizou-se como critérios de busca, trabalhos experimentais laboratoriais in vitro, publicados entre os anos de 2017 e 2021.Resultados:Foram encontrados 165 artigos, dos quais 15 foram selecionados ao final do processo. 8 trabalhos não encontraram diferença estatisticamente significativa entre a clorexidina e o hipoclorito,5 artigos apresentaram resultados superiores dohipoclorito de sódioem 2 a clorexidina foi superior. Conclusões:Após análise da literatura, observamos semelhança entre a ação antimicrobiana do hipoclorito de sódioe da clorexidina, e podemos concluir que ambas apresentam boa ação antimicrobiana, justificando seu uso clinicamente (AU).

Introduction:During endodontic treatment, due to the anatomical complexities of the root canals, the mechanical action of the instruments is not sufficient for the complete disinfection of the canals. Thus, it is necessary to use irrigating solutions that can makethe disinfection of the root canal system.Objective:Conduct an integrative literature review to compare the antimicrobial properties of chlorhexidine with sodium hypochlorite.Methodology:The literature search was carried out from September 2019 to August 2021, in the following databases: PUBMED/MEDLINE, LILACS and SCIELO. Using the descriptors: chlorhexidine, sodium hypochlorite, root canal irrigant and cleaning. As search criteria, in vitro laboratory experimental works published between 2017 and 2021 were used.Results:A total of 165 articles were found, of which 15 were selected at the end of the process. 8 studies did not find a statistically significant difference between chlorhexidine and hypochlorite, 5 articles showed superior results for NaOCl and in 2 chlorhexidine was superior.Conclusions:After analyzing the literature, we observed a similarity between the antimicrobial action of sodium hypochlorite and chlorhexidine, and we can conclude that both have good antimicrobial action, justifying their clinical use (AU).

Introducción:Durante el tratamiento endodóntico, debido a las complexidades anatómicas de los conductos radiculares, la acción mecánica de los instrumentos no es suficiente para la desinfección completa de los conductos. Por lo tanto, es necesario utilizar soluciones de irrigación que puedan mejorar la desinfección del sistema de conductos radiculares.Objetivo: Realice una revisión integradora de la literatura para comparar las propiedades antimicrobianas de la clorhexidina con el hipoclorito de sodio.Metodología: La búsqueda bibliográfica se realizó desde septiembre de 2019 hasta agosto de 2021, en las siguientes bases de datos: PUBMED/MEDLINE, LILACS y SCIELO. Usando los descriptores: chlorhexidine, sodium hypochlorite, root canal irrigant and cleaning. Como criterio de búsqueda se utilizaron trabajos experimentales de laboratorio in vitro publicados entre 2017 y 2021.Resultados: Se encontraron un total de 165 artículos, de los cuales 15 fueron seleccionados al final del proceso. 8 estudios no encontraron diferencia estadísticamente significativa entre clorhexidinae hipoclorito, 5 artículos mostraron resultados superiores para NaOCl y en 2 la clorhexidina fue superior.Conclusiones: Después de analizar la literatura, observamos una similitud entre la acción antimicrobiana del hipoclorito de sodio y la clorhexidina,y podemos concluir que ambos tienen una buena acción antimicrobiana, lo que justifica su uso clínico (AU).

Computational fluid dynamics analysis of the flow of ultrasonic irrigations in root canal / 口腔疾病防治

Objective@#To study the computational fluid dynamics (CFD) characteristics of ultrasonic root canal irrigation when the file was placed at a certain depth in the root canal, to provide a reference for clinical application.@*Methods @#First, scanning laser vibrometry (SLV) was utilized to analyze the characteristics of vibrational ultrasonic files under specific power. Then ICEM CFD 18.0 software was used to establish the root canal ultrasonic irrigation model. The insertion position of the ultrasonic working tip was set 1 mm away from the physiological apical foramen, and cloud images of the results were obtained by FLUENT 18.0 software. Volume fraction, flow velocity and pressure in the root canal were evaluated after setting the computing conditions.@*Results@#The vibration of the ultrasonic working tip was mainly transverse vibration with slight longitudinal vibration. The amplitude of transverse vibration of each part of the working tip was different. Maximum values were observed at the apical end area of the file, and the closer to the base of the file, the smaller the amplitude. The area where the cavitation volume fraction of the rinsing fluid was greater than 0 was concentrated around the working point. The flow rate of the irrigating fluid was up to 2 m/s, within the area 0.2 mm in front of the working tip, the velocity of the irrigating fluid was greater than 0.1 m/s, while within the area 0.8 mm from the root tip, the velocity of the irrigating fluid was small or even zero. The apical pressure value was non-positive when the tip of the file was 1 mm away from the apical foramen in this model.@*Conclusion@# Based on the experimental results, it appears that when the ultrasonic working tip was placed 1 mm short of the working length, the ultrasonic irrigating flow did not overflow the root apical foramen and the irrigation process was relatively safe; the irrigation fluid had a strong irrigation effect within approximately 0.2 mm in front of the working tip.

Effect of edta and qmix ultrasonic activation on the reduction of microorganisms and endotoxins in ex vivo human root canals

Abstract The present study aimed to compare the effectiveness of QMiX and 17% EDTA associated to passive ultrasonic irrigation (PUI) or manual agitation (MA) on the reduction of E. faecalis, E. coli and LPS from root canals. Forty single rooted human teeth were randomly divided into four groups (n=10), according to the final irrigation protocol: EDTA+MA, QMiX+MA, EDTA+PUI, QMiX+PUI. Sample collections were obtained from the root canal content immediately before preparation (baseline-S1), after instrumentation (S2), after final irrigation protocol (S3) and 7 days after instrumentation and final irrigation (S4). The antimicrobial effectivity and on endotoxin content were analyzed by culture procedure (CFU/mL) and LAL assay (EU/mL), respectively. The results were statistically analyzed by Kruskal-Wallis and Friedman test (α=5%). QMiX+MA and QMiX+PUI reduced 100% of E. coli and E. faecalis bacteria and also prevented E. faecalisregrowth at S4. EDTA significantly reduced E. coli, but it was not effective in reducing E. faecalis. All protocols reduced EU/mL when compared to S1, however at S4 there was a significant reduction of EU/mL only in the QMiX+MA and QMiX+PUI groups in relation to S3 and S2, respectively. Final irrigation with QMiX associated with MA or PUI had superior antibacterial efficacy compared to EDTA, eliminating 100% of E. coli and E. faecalis strains. In addition, QMiX+PUI reduced 97.61% of the initial content of LPS.

Resumo O presente estudo objetivou comparar a eficácia do QMiX e do EDTA 17% associado à irrigação ultrassônica passiva (PUI) ou agitação manual (MA) na redução de E. faecalis, E. coli e LPS de canais radiculares. Quarenta dentes humanos unirradiculares foram divididos aleatoriamente em quatro grupos (n = 10), de acordo com o protocolo final de irrigação: EDTA+MA, QMiX+MA, EDTA+PUI, QMiX+PUI. Coletas das amostras foram obtidas a partir do conteúdo do canal radicular imediatamente antes do preparo (inicial-S1), após a instrumentação (S2), após o protocolo final de irrigação (S3) e 7 dias após a instrumentação e irrigação final (S4). A eficácia antimicrobiana e o conteúdo de endotoxina foram analisados ​​por procedimento de cultura (UFC/mL) e ensaio LAL (EU/mL), respectivamente. Os resultados foram analisados estatisticamente pelo teste de Kruskal-Wallis e Friedman (α = 5%). QMiX+MA e QMiX+PUI reduziram 100% das bactérias E. coli e E. faecalis e também preveniram a recolonização de E. faecalis em S4. O EDTA reduziu significativamente E. coli, mas não foi eficaz na redução de E. faecalis. Todos os protocolos reduziram EU/mL quando comparados com S1, no entanto, no S4 houve uma redução significativa de EU/mL apenas nos grupos QMiX+MA e QMiX+PUI em relação a S3 e S2, respectivamente. A irrigação final com QMiX associada a MA ou PUI apresentou eficácia antibacteriana superior em relação ao EDTA, eliminando 100% das cepas de E. coli e E. faecalis. Além disso, QMiX+PUI reduziu 97,61% do conteúdo inicial de LPS.

Diffusion of hydroxyl ion on external root surface using different irrigating solutions: An In vitro study

Aims: The aim of this study was to evaluate the diffusion of hydroxyl ion to the external root surface using different irrigating solutions and intracanal medication with calcium hydroxide. Materials and Methods: Sixty bovine tooth roots were randomly divided into six experimental groups (n = 10), according to the irrigating substance used during biomechanical preparation: 12% glycolic propolis extract (PROP); 20% glycolic ginger extract (GENG); 2% sodium hypochlorite with surfactant (NaOClS); 2% chlorhexidine gel (CLX); 2.5% sodium hypochlorite (NaOCl); and physiological saline solution. After filling the root canals with calcium hydroxide paste, pH measurements were taken directly at the external cavities over time intervals of up to 30 days. Statistical Analysis Used: Data were submitted to two-way ANOVA and Tukey's test (P < 0.05). Results: The pH of the external root surface was increased when the surfactant associated with NaOCl was used. However, the pH values were very close for the different groups. Hydroxyl ion diffusion up to the external root surface did not exceed the pH value of 8.5, and in the hollow passage of the canal, the pH was higher than 12. Conclusions: Hydroxyl ion diffusion of calcium hydroxide paste through the dentinal tubules up to the external root surface allows minimal alkalinization of this surface, and it is greater when using NaOCl with surfactant during biomechanical preparation.

Antimicrobial efficacy of novel ethanolic extract of morinda citrifolia against enterococcus faecalis by agar well diffusion and broth dilution methods - an invitro study / Eficácia de um novo antimicrobiano etanólico de extrato de Moringa citrifolia contra Enterococcus Faecalis por meio dos métodos de difusão em ágar e de diluição em caldo ­ um estudo in vitro

Objective: The long-term success of root canal treatment is ultimately related to the effective debridement and disinfection of the root canal system. Hence, the irrigants play an important role in achieving the good penetrability and bactericidal activity. The present study was mainly aimed at evaluating the invitro antimicrobial efficacy of Novel Ethanolic Extract of Morinda Citrifolia by agar well diffusion and broth dilution methods. Material and methods: The antibacterial effect of Ethanolic Extract of Morinda Citrifolia was investigated against Enterococcus Faecalis (E. Faecalis). Agar well diffusion and broth dilution methods were used to determine the Minimal Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) Results: The MIC of Ethanolic Extract of Morinda Citrifolia extract was found to be 12.5 mg/ml and the MBC was found to be 25 mg/ml Conclusion: Novel Ethanolic Extract of Morinda Citrifolia possess antimicrobial activity against E.Faecalis. But still, future studies are needed. (AU)

Objetivo: O sucesso a longo prazo do tratamento de canais radiculares está intimamente relacionada com a efi cácia do debridamento e desinfecção do Sistema do canal radicular. Consequentemente, os irrigantes têm um importante papel na capacidade de penetração e atividade bactericida. O presente estudo teve como objetivo principal a avaliação in vitro da efi cácia antimicrobiana do novo extrato etanólico de Morinda Citrifolia por meio dos métodos de difusão em ágar ou de diluição em caldo. Material e métodos: O efeito antibacteriano do extrato etanólico de Morinda Citrifolia foi investigado contra Enterococcus Faecalis (E. Faecalis). Os métodos de diluição em ágar e de diluição em caldo foram usados para determinar a concentração inibitória minima (MIC) e concentração bactericida minima (MBC). Resultados: O MIC do extrato etanólico de Morinda Citrifolia foi obtido na concentração de 12.5mg/ml e a MBC foi de 25mg/ml Conclusão: O novo extrato etanólico de Morinda Citrifolia apresenta atividade antimicrobiana contra E.Faecalis. Porém, futuros estudos são necessários. (AU)

Effect of root canal irrigants on the bond strength between resin sealants and dentin / 口腔疾病防治

@#When the root canal is filled, the use of the adhesive resin-based sealant to form a strong bond with the dentin reduces microleakage of the apex, enhances the bending resistance of the tooth, and resists the mechanical damage of the pile preparation, thus improving the success rate of root canal treatment. However, during root canal treatment, the use of a rinsing agent may change the tissue structure of the dentin and the wettability of the dentin, thereby affecting the bonding strength between the resin sealing agent and the dentin. In this paper, the effects of a traditional root canal irrigant and several new rinsing agents on the bonding strength of resin sealant and dentin are reviewed. The results show that the traditional root canal rinsing agent NaClO is reduced as the final rinsing agent. The bonding strength of resin sealant to dentin; EDTA affects the biomechanical properties of root dentin, and the removal efficiency is low, which will affect the bond strength between the resin sealant and dentin. EDTA combined with NaClO as a final rinsing agent can improve the bonding strength. Chlorhexidine can also increase the bonding strength between the blocking agent and dentin and can be used as the final rinsing agent. The new rinsing agent MTAD has a negative impact on the resin sealing agent and dentin bond strength. QMix and maleic acid remove smear efficiency with dentin bond strengths greater than or equal to EDTA and can replace EDTA as the final rinse.

Effect of apical constriction diameter, irrigant flow rate, and needle tip design on apical pressure / 대한치과재료학회지

The purpose of this study was to evaluate the effects of apical constriction (AC) diameter, irrigant flow rate, and needle tip design on apical pressure (AP) during the root canal irrigation. Five extracted human mandibular premolars were instrumented up to #35 (0.06 taper) using nickel-titanium rotary instruments. AC was determined at 1 mm from the apical foramen. Three needles with different tip designs (notched, side-vented, and flat) were placed 3 mm from AC. APs were measured with varying flow rates of 0.05, 0.1, 0.2, and 0.3 mL/s. The AC diameter of the teeth was enlarged to #40 and #45 (0.06 taper) successively, and the aforementioned measurement procedure was repeated (n=5). When the other conditions were controlled, AP increased with decreasing AC diameter or increasing irrigant flow rate, and the AP of flat needle was the highest, followed by notched, and side-vented needle (p0.35 mm, open-end (notched or flat) needles can be used to improve irrigant replacement in the apical portion using a flow rate of 0.05 mL/s.

Effect of needle tip design and position, and irrigant flow rate on apical pressure / 대한치과재료학회지

The purpose of this study was to evaluate the effect of needle tip design and position, and irrigant flow rate on apical pressure (AP) during root canal irrigation. Five human mandibular premolars were instrumented up to #35 (0.06 taper) using nickel-titanium rotary instruments. Three different needles according to change of needle tip design (notched, side-vented, and flat) were positioned at the point of 1, 3, and 5 mm from the apical constriction (needle tip position). For each needle tip design and position, APs were measured with varying flow rates of 0.05, 0.1, 0.2, and 0.3 ml/s. When the other conditions were controlled, AP increased with decreasing needle tip position or increasing irrigant flow rate (p < 0.05). The AP of flat needle was the highest, followed by notched, side-vented needle for the same needle tip position and irrigant flow rate. The APs at needle tip position of 1 mm or with more than 0.1 ml/s flow rate were higher than central venous pressure (5.88 mmHg) for all conditions. Flat needle was not recommended for clinical use due to sharp increase of AP with changing needle tip position and irrigant flow rate. For safe and effective root canal irrigation, irrigant should be applied with the needle tip position of 3 mm and flow rate of less than 0.05 ml/s.

Comparison of different final irrigant agitation techniques for the removal of Enterococcus faecalis biofilms from root canals: an in vitro study / Comparação de diferentes técnicas finais de agitação de irrigantes para a remoção de biofilmes de Enterococcus faecalis de canais radiculares: estudo in vitro

Objective: The aim of this in vitro study was to compare the effectiveness of different final irrigant agitation techniques in the removal of Enterococcus faecalis biofilms from root canals. Material and Methods: In total, the root canals of 85 extracted single-rooted human maxillary incisors teeth were prepared using the Revo-S system to a 40/06 size. The apical foramen of each tooth was sealed by light-cured resin composite material to obstruct bacterial leakage. The specimens were sterilized in an autoclave at 121°C for 15 min and stored until further use. All teeth except five (negative control group) were inoculated with Enterococcus faecalis and incubated in a CO2 chamber at 37°C for 7 days; the trypticase soy broth was changed every 2 days. For the determination of possible biofilm formation, five of the 80 teeth were randomly selected as a positive control group; one tooth of positive control group was analysed for biofilm development by scanning electron microscope (SEM) and these teeth received no final irrigant agitation procedure. Then, the remaining 75 teeth were randomly divided into five test groups (n=15 each) and were sequentially irrigated with 5% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid and 5% NaOCl. Following each irrigant application, different final irrigant agitation techniques were introduced for 60 s (3×20-s sessions). Group 1 received manual­ dynamic agitation, group 2 received passive ultrasonic agitation (PUI), group 3 received EndoActivator agitation, group 4 received photoninitiated photoacoustic streaming (PIPS) with the Er:YAG laser and group 5 received conventional syringe irrigation. Colony-forming units (CFUs) were counted in samples from the positive control and test groups. Data were analysed using Kruskal­ Wallis and post-hoc Mann­Whitney U multiple comparison tests. Results: E. faecalis elimination was significantly better in the experimental groups than in the positive control groups (p < 0.001). Manual­dynamic agitation and conventional syringe irrigation, with no significant differences between the two groups. Conclusion: Essentially, CFU reduction was significantly greater in the PUI, EndoActivator and PIPS groups than in the manual­dynamic agitation and conventional syringe irrigation groups (p <0.001) , with no significant differences among the former three groups. (AU)

Objetivo: O objetivo deste estudo in vitro foi comparar a eficácia de diferentes técnicas finais de agitação de irrigantes na remoção de biofilmes de Enterococcus faecalis de canais radiculares. Material e Métodos: No total, os canais radiculares de 85 dentes incisivos superiores unirradiculares humanos extraídos foram preparados usando o sistema Revo-S para um tamanho 40/06. O forame apical de cada dente foi selado por material compósito de resina fotopolimerizável para obstruir o vazamento bacteriano. Os espécimes foram esterilizados em autoclave a 121 ° C por 15 min e armazenados até uso posterior. Todos os dentes, exceto cinco (grupo controle negativo), foram inoculados com Enterococcus faecalis e incubados em câmara de CO2 a 37 ° C por 7 dias; o caldo de soja tripticase foi trocado a cada 2 dias. Para a determinação da possível formação de biofilme, cinco dos 80 dentes foram selecionados aleatoriamente como grupo controle positivo; um dos dentes do grupo controle positivo foi analisado para o desenvolvimento do biofilme por microscopia eletrônica de varredura (MEV) e estes dentes não receberam nenhum procedimento final de agitação irrigante. Em seguida, os 75 dentes restantes foram aleatoriamente divididos em cinco gruposteste (n = 15 cada) e irrigados sequencialmente com hipoclorito de sódio a 5% (NaOCl), ácido etilenodiaminotetracético a 17% e NaOCl a 5%. Após cada aplicação de irrigantes, diferentes técnicas finais de agitação foram introduzidas por 60 s (3 x 20 s sessões). Grupo 1 recebeu agitação manual-dinâmica, grupo 2 recebeu agitação ultra-sônica passiva (PUI), grupo 3 recebeu agitação EndoActivator, grupo 4 recebeu fotoacústica iniciada por fóton (PIPS) com o laser Er: YAG e grupo 5 recebeu irrigação convencional com seringa. As unidades formadoras de colônia (CFUs) foram contadas em amostras dos grupos controle positivo e teste. Os dados foram analisados utilizando testes de comparação múltipla Kruskal-Wallis e post-hoc Mann-Whitney U. Resultados: A eliminação de E. faecalis foi significativamente melhor nos grupos experimentais do que nos grupos de controle positivo (p < 0,001). Agitação manual-dinâmica e irrigação com seringa convencional, sem diferenças significativas entre os dois grupos. Conclusão: Essencialmente, a redução de UFC foi significativamente maior nos grupos PUI, EndoActivator e PIPS do que nos grupos de agitação manual-dinâmica e de seringa convencional (p < 0,001), sem diferenças significativas entre os três grupos anteriores (AU)

Efetividade de soluções endodônticas na redução da viabilidade de Enterococcus faecalis cultivados em forma séssil e planctônica / Effectiveness of endodontic solutions to reduce the viability of sessile and planktonic Enterococcus faecalis

Este estudo teve como objetivo avaliar a sensibilidade dos biofilmes de E. faecalis a NaOCl, CHX e PAA após uma exposição de ácido cítrico 2,5%. O biofilme de E. faecalis foi formado em lamínulas de vidro circular de 13 mm Ø em placas de cultura de 24 poços. Os biofilmes foram tratados ou não durante 5 minutos com ácido cítrico, posteriormente, exposto a diferentes concentrações de NaOCl, CHX e PAA. A atividade antimicrobiana foi avaliada por meio da contagem de unidade formadora de colônias (UFCs). Ao analisar o percentual de redução bacteriana na forma planctônica em função do tempo e da solução/concentração, o teste de Anova demonstrou não haver diferença estatística entre CHX e NaOCl (p>0,05). Contudo a CHX, quando utilizada sozinha, apresentou menor efetividade que NaOCl (p<0,05) sobre o biofilme. O pré-tratamento do biofilme com ácido cítrico tornou as bactérias na forma séssil mais sensível ao NaOCl e ao PAA. Baseado nos resultados obtidos foi possível concluir que o tratamento com ácido cítrico aumentou a sensibilidade do biofilme de E. faecalis a irrigante utilizado em procedimento endodôntico e orienta o início do tratamento com irrigação prévia com o ácido cítrico.

The present study aimed to evaluate the sensitivity of E. faecalis biofilms to NaOCl, CHX and PAA after exposure to 2.5% citric acid. The E. faecalis biofilm was formed in 13-mm diameter circular glass microslides in 24-well culture plates. The biofilms were treated or not for 5 minutes with citric acid, and subsequently exposed to different concentrations of NaOCl, CHX and PAA. The antimicrobial activity was assessed by colony-forming unit (CFU) count. When analyzing the bacterial reduction percentage in planktonic form according to the time and solution/concentration, the Anova test demonstrated no statistical difference between CHX and NaOCl (p>0.05). However, CHX, when utilized alone, presented less effectiveness than NaOCl (p<0.05) on the biofilm. The citric acid pretreatment of the biofilm made the bacteria in the sessile form more sensitive to NaOCl and PAA. Based on the obtained results, it was possible to conclude that citric acid treatment increased the sensitivity of the E. faecalis biofilm to irrigants employed in endodontic procedures, guiding the beginning of treatment with prior citric acid irrigation.

Antibacterial effect of urushiol on E. faecalis as a root canal irrigant

OBJECTIVES: The purpose of this study was to compare the antibacterial activity of urushiol against Enterococcus faecalis (E. faecalis) to that of NaOCl. MATERIALS AND METHODS: The canals of thirty two single rooted human teeth were instrumented with Ni-Ti files (ProTaper Next X1, X2, X3, Dentsply). A pure culture of E. faecalis ATCC 19433 was prepared in sterile brain heart infusion (BHI) broth. The teeth were submerged in the suspension of E. faecalis and were incubated at 37℃ for 7 days to allow biofilm formation. The teeth were randomly divided into three experimental groups according to the irrigant used, and a negative control group where no irrigant was used (n = 8). Group 1 used physiologic normal saline, group 2 used 6% NaOCl, and group 3 used 10 wt% urushiol solution. After canal irrigation, each sample was collected by the sequential placement of 2 sterile paper points (ProTaper NEXT paper points, size X3, Dentsply). Ten-fold serial dilutions on each vials, and 100 µL were cultured on a BHI agar plate for 8 hours, and colony forming unit (CFU) analysis was done. The data were statistically analyzed using Kruskal-Wallis and Mann-whitney U tests. RESULTS: Saline group exhibited no difference in the CFU counts with control group, while NaOCl and urushiol groups showed significantly less CFU counts than saline and control groups (p < 0.05). CONCLUSIONS: The result of this study suggests 10% urushiol and 6% NaOCl solution had powerful antibacterial activity against E. faecalis when they were used as root canal irrigants.

Research progress on QMix properties in root canal irrigation / 华西口腔医学杂志

Mechanical instrumentation preparation alone is insufficient to completely remove root canal infection, and chemical irrigation is essential to eliminate infected remnants. An ideal root canal irrigant should completely remove the smear layer, lubricate the root canal, efficiently kill bacteria, induce mild or no inflammatory response in the tissues, and avoid damaging the dentin structure. However, a commercial irrigant that meets all these requirements is currently lacking. QMix is a root canal irrigation mixture of ethylenediamine tetraacetic acid (EDTA), chlorhexidine (CHX) and surfactant. This mixture can remove the smear layer efficiently, and it possesses strong antibacterial effect and good biocompatibility with minimal cytotoxicity. Furthermore, the influence of QMix on the color and micro-hardness of dentin is low, and it can improve the wettability of root canal sealant without affecting its adhesive properties. This review compares the efficiencies of QMix with other irrigants (sodium hypochlorite, CHX, EDTA, SmearClear, and MTAD) in term of smear layer removal, dentine and root canal sealing, cell cytotoxicity, and bacterial growth inhibition.

Effectiveness of NaviTip FX on intracanal calcium hydroxide removal / Efectividad de NaviTip FX para la remoción intracanal de hidróxido de cálcio

Remnants of calcium hydroxide (Ca(OH)2) post-irrigation can compromise cleansing and permeability of dentinal walls in endodontic therapy. The aim of this study was to evaluate effectiveness of irrigation needle NaviTip FX on intracanal Calcium Hydroxide removal. Twenty-two single-rooted human teeth were randomly assigned according to irrigation needle used after calcium hydroxide removal: G1- NaviTip; G2- NaviTip FX, both with n= 9; as well as negative and positive control groups, with n= 2. The samples were analyzed in scanning electron microscopy, with 500x magnification. The difference between groups were analysed by Student t test, for p 0.01. In apical third, G2 group presents better cleaning in comparison with G1 (p= 0.0007). In middle third, no differences between groups were observed. NaviTip FX irrigation needle shows greater effectiveness in removing calcium hydroxide medication than NaviTip needle in the apical third of the canal.

La presencia de hidróxido de calcio post-irrigación compromete la limpieza y la permeabilidad de la pared de la dentina durante el tratamiento endodóntico. El objetivo deste estudio fue evaluar la eficacia de la cánula de irrigación Navitip Fx en la eliminación de hidróxido de cálcio intracanalicular. Veintidós dientes unirradiculares humanos fueron divididos aleatoriamente de acuerdo con la cánula de irrigación, después de la eliminación del hidróxido de calcio, en grupos: G1- Navitip; G2- Navitip FX, ambos con n= 9; así como los grupos de control positivos y negativos, con n= 2. Las muestras fueron analizadas bajo microscopía electrónica de barrido, con magnificación de 500x. La diferencia entre los grupos fue analizada con la prueba t de Student (p 0,01). En el tercio apical, el grupo G2 presentó mejor limpieza en comparación con el grupo G1 (p= 0,0007). En el tercio medio, no se observaron diferencias entre los grupos. La cánula de irrigación Navitip FX muestra una mayor eficiencia en la eliminación de la medicación hidróxido de calcio en comparación con Navitip cánula en el tercio apical del canal.

Comparative Evaluation Of Anti – Bacterial Efficacy Of Sodium Hypochlorite And Carbolic Acid Against Enterococcus Faecalis As Root Canal Irrigant.

Background: Elimination of microorganisms from infected root canal is a complicated & difficult task. Elimination or sufficient reduction of irritants, microorganisms and prevention of recontamination of the root canal after the treatment is the essential factor for successes of the treatment. Methods: Following materials required for this study i.e. 36 teeth prepared for root canal inoculation, Enterococcus faecalis strain, 5 % and 10 % carbolic acid solution, 5.25 % sodium hypochlorite solution, phosphate buffer saline and normal saline solution. An overnight subculture plate of E.faecalis was taken for inoculum preparation and uniform suspension made in normal saline (02 ml) by taking up isolated colonies and adjusted to 0.5 McFarland standard which gives 1.5 X 108 cfu / ml. Result and Conclusion: From this study, we can conclude that 5.25 % NaOCl is one of the superior and successful endodontic irrigant against 5 % and 10% carbolic acid.In our study, result shows that sodium hypochlorite solution is superior to carbolic acid solution. However, as this study is in vitro study, not simulate the oral environment; further few clinical studies are required in evaluation of antimicrobial efficacy of these solutions for predictable and successful endodontic outcome.

Comparative Evaluation of Smear Layer Removal Efficacy Using QMix 2in1, Chitosan, Smear Clear and Glyde.

Aim and Objective: The effects of four endodontic irrigants and on a smear layer created by hand and rotary instrumentation were evaluated in vitro in the middle and apical thirds of root canals. Materials and Methods: Forty eight mature extracted mandibular premolar teeth with a single root canal and a closed apex were distributed randomly into four groups of 12 teeth each. Whilst cleaning and shaping up to size F5 using Protaper Universal System, the root canals were irrigated with 3 mL of 5.25% NaOCl, between each file size. Group 1 (G1) were irrigated with a final flush of QMix 2in1. The teeth in group 2 (G2) were irrigated with a final flush of 0.2%Chitosan, group 3 (G3) with Smear Clear and group 4 (G4) with Glyde. The teeth were split longitudinally and prepared for examination by scanning electron microscopy. Results: Specimens irrigated with a final flush of Glyde (G4) or 0.2%Chitosan (G2) were cleaner than with QMix and Smear Clear, showing very clean root canal surfaces in the middle one-third but in the apical one-third the smear layer was not completely removed, especially at the openings of the dentinal tubules. Statistical analysis showed no significant difference in the cleanliness of root canal wall between G1, G2, G3 and G4. Conclusion: Irrigation with QMix 2in1, Smear Clear, 0.2%Chitosan, and Glyde and 6% did not remove all the smear layer from the root canal system. All these irrigants showed less effectiveness in removal of smear layer from apical 3rd. Glyde showed maximum efficacy in removal of removal of smear layer followed by 0.2%Chitosan, Smear Clear and then QMix 2in1.

In vitro Antibacterial Effect of 2% Chlorhexidine Against Enterococcus faecalis in Dentin Previously Irrigated with 5% Sodium Hypochlorite / Efecto Antibacterial in vitro de Clorhexidina 2% contra Enterococcus faecalis en Dentina Irrigada Previamente con Hipoclorito de Sodio 5%

The aim of this study was to observe whether the antibacterial effect of 2% chlorhexidine against Enterococcus faecalis in dentine is altered by previous irrigation with 5% sodium hypochlorite. Dentin discs were prepared with different irrigation protocols: group 1, immersed in 2% CHX for 25 min; group 2 immersed in 5% NaOCl for 25 minutes; group 3, immersed in 5% NaOCl, dried and irrigated with 3 ml of 2% CHX; group 4 and 5 immersed in 5% NaOCl, rinsed with 5 and 25 ml of distilled water respectively, dried and irrigated with 2% CHX. Group 6, immersed in 0.9% sodium chloride. Discs were then placed in agar plates in which E. faecalis was grown and the inhibition zone around each disc was measured after 24 hours of incubation at 37 C. All experimental groups showed E. faecalis growth inhibition. The most effective irrigant was 2% CHX (P<0.05). Groups in which both NaOCl and CHX were used displayed significantly smaller inhibition halos as compared with 2% CHX. Different volumes of water for rinsing did not cause significant improvement in growth inhibition. The antimicrobial effect of 2% chlorhexidine against E. faecalis was significantly reduced when dentin was previously irrigated with 5% sodium hypochlorite despite of rinsing with different volumes of water.

El objetivo de este estudio fue observar si el efecto antibacterial de clorhexidina 2% contra Enterococcus faecalis en dentina puede verse afectado por la irrigación previa con hipoclorito de sodio al 5%.Se cortaron discos de dentina y fueron preparados de acuerdo a diferentes protocolos de irrigación: grupo 1, sumergidos en CHX 2% por 25 min; grupo 2, sumergidos en NaOCl 5% por 25 min; grupo 3 inmersos en NaOCl 5%, secados y posteriormente irrigados con 3 ml de CHX 2%; grupos 4 y 5 inmersos en NaOCl 5% por 25 minutos, lavados con 5 y 25 ml de agua destilada respectivamente, secados e irrigados con 3ml de CHX 2%. Grupo 6 inmersión en solución salina 25 min. Posteriormente, los discos fueron colocados en platos agar en los cuales creció E. faecalis y se midió el diámetro del halo de inhibición en torno a cada disco tras 24 h de incubación aeróbica a 37 C. Todos los grupos experimentales mostraron inhibición de crecimiento de E. faecalis. El irrigante más efectivo fue CHX 2% (P<0.05). Los grupos en los que se utilizó CHX y NaOCl mostraron inhibición significativamente inferior a la observada con CHX sola. El uso de diferentes volúmenes de agua para lavado de la dentina no causó una mejoría significativa en el efecto antimicrobiano observado. El efecto antimicrobiano de la clorhexidina al 2% contra E. faecalis fue reducido significativamente cuando la dentina se irrigó inicialmente con hipoclorito de sodio 5% a pesar del lavado con diferentes volúmenes de agua.

Antimicrobial and cytotoxic activity of Ferula gummosa plant essential oil compared to NaOCl and CHX: a preliminary in vitro study

OBJECTIVES: The usage of medicinal plants as natural antimicrobial agents has grown in many fields including dental medicine. The aim of this in vitro study was three-fold: (i) to determine the chemical compositions of the Ferula gummosa essential oil (FGEO), (ii) to compare the antimicrobial efficacy of the oil with sodium hypochlorite (NaOCl) and chlorhexidine (CHX), (iii) to assess the toxic behavior of FGEO in different concentrations compared to 5% NaOCl and 0.2% CHX. MATERIALS AND METHODS: Gas chromatography/mass spectrometry (GC/MS) was used to determine the chemical compositions of the oil. The disk diffusion method and a broth micro-dilution susceptibility assay were exploited to assess the antimicrobial efficacy against Enterococcus faecalis, Staphylococcus aureus, Streptococcus mitis, and Candida albicans. The cytocompatibility of the FGEO was assessed on L929 fibroblasts, and compared to that of NaOCl and CHX. RESULTS: Twenty-seven constituents were recognized in FGEO. The major component of the oil was beta-pinene (51.83%). All three irrigants significantly inhibited the growth of all examined microorganisms compared to the negative control group. FGEO at 50 microg/mL was effective in lower concentration against Enterococcus faecalis than 5% NaOCl and 0.2% CHX, and was also more potent than 0.2% CHX against Candida albicans and Staphylococcus aureus. FGEO was a cytocompatible solution, and had significantly lower toxicity compared to 5% NaOCl and 0.2% CHX. CONCLUSIONS: FGEO showed a promising biological potency as a root canal disinfectant. More investigations are required on the effectiveness of this oil on intracanal bacterial biofilms.

Activación sónica versus ultrasónica de EDTA al 10% para remoción de barrillo dentinario en el tercio apical del canal radicular / Sonic versus ultrasonic activation of 10% EDTA for smear layer removal in the root canal apical third

El objetivo de este estudio fue evaluar la efectividad de la activación sónica y ultrasónica del ácido etilendiaminotetraacético (EDTA) al 10% para remover barrillo dentinario en el tercio apical y el grado de erosión producido sobre las paredes del canal radicular. Se realizó un estudio cuantitativo experimental in vitro. Se instrumentaron 40 dientes manualmente con la técnica step-back hasta lima maestra número 55 y fueron asignados a 4 grupos según protocolo de irrigación final: I: agua destilada estéril sin activación, II: EDTA 10% sin activación por 30 segundos, III: EDTA 10% activado sónicamente por 30 segundos y IV: EDTA 10% activado ultrasónicamente por 30 segundos. Las muestras fueron observadas en MEB a una magnificación de 5000X. Se evaluó la presencia de barrillo dentinario remanente y grado de erosión según criterios de Torabinejad et al. Para el análisis estadístico se utilizó la prueba de Kruskal-Wallis y Post Hoc de Tukey con un nivel de significancia 5% (p=0,05). El grupo I (agua sin activación) presentó mayor cantidad de barrillo que el resto de los grupos (p<0,01). En cuanto a la presencia de barrillo, entre los grupos II (EDTA sin activación), III (EDTA con sonido) y IV (EDTA con ultrasonido) no hubo diferencias estadísticamente significativas. En cuanto a la erosión, el grupo II presentó una mayor erosión que el resto siendo significativa con los grupos I y III (p=0,006). Entre los grupos I, III y IV no hubo diferencias estadísticamente significativas. La activación sónica y ultrasónica del EDTA 10% no produjo una remoción de barrillo significativamente superior al compararlo con la irrigación convencional, pero sí hubo diferencias en cuanto a erosión, siendo menor con la activación sónica

The purpose of this study was to observe the effect of passive sonic and ultrasonic irrigation with 10% Ethilenediaminotetracethic acid (EDTA) on smear layer of the apical third of instrumented root canals as well as the level of erosion produced on the canal walls. For this quantitative experimental in vitro study 40 teeth were hand instrumented with step back technique until master file num 55 and divided in four groups according to the final irrigation protocol: I: distilled water without activation, II: 10% EDTA for 30 seconds without activation, III: 10% EDTA sonic activated for 30 seconds, IV: 10% EDTA ultrasonic activated for 30 seconds. Samples were prepared for MEB observation at 5000X. The presence of smear layer and erosion on dentine walls was quantified according to Torabinejad et al. criteria. Data were submitted at Kruskal-Wallis test and Tukey Post Hoc with a significance level of 5% (P=0.05). When evaluating the smear layer presence, there were no statistically significant differences between the groups II, III and IV. Group I had a highest amount of smear layer (p<0.01). As for erosion, group II showed higher erosion than the others, being significant with groups I and III (p=0.006). Among groups I, III and IV there were not statistically significant differences. Sonic and ultrasonic activation of EDTA 10% did not produce a significantly superior removal of smear layer when compared with conventional irrigation. Erosion of root canal walls was significantly lower after sonic activation

Antibacterial Power of Sodium Hypochlorite Combined with Surfactants and Acetic Acid

The aim of this ex vivo study was to compare the antibacterial power of 1% NaOCl with 1% acetic acid, 5.25% NaOCl and two commercially available NaOCl modified with surfactants in bovine root dentin. A total of 120 dentin tubes prepared from intact bovine incisors were infected for 21 days with Enterococcus faecalis and randomly divided into six groups as follows: 5.25%NaOCl; Hypoclean; Chlor-Xtra; 1% NaOCl with 1% acetic acid; infected dentin tubes (positive control); and sterile dentin tubes (negative control). At experimental times of 0, 7, 14, 21 and 28 days, dentin chips were collected using sequential round burs with increasing diameters in separate test tubes containing 3 mL of freshly prepared BHI. Statistical analysis were performed using parametric methods (one-way ANOVA, and Bonferroni's multiple comparisons test, α=0.01). After culturing, the number of colony-forming units (CFU) was counted. All the NaOCl solutions showed small number of CFU over 28 days. ChlorXtra and Hypoclean had the smallest number of CFU at all times with greater antimicrobial efficacy than 5.25% NaOCl and 1% NaOCl solution with 1% acetic acid.

O objetivo deste estudo foi verificar o poder antibacteriano do hipoclorito de sódio a 1% acrescido do ácido acético 1%, do NaOCl 5,25%, e de duas soluções irrigadoras modificadas com surfactantes, Hypoclean e Chlor-Xtra, em tubos de dentina bovina. Um total de 120 tubos de dentina preparados a partir de incisivos bovinos foram infectados durante 28 dias com o Enterococcus faecalis, e aleatoriamente divididos em seis grupos: NaOCl 5,25%; Hypoclean; Chlor-Xtra; NaOCl 1% com ácido acético 1%; tubos de dentina infectados (controle positivo); e tubos de dentina esterilizados (controle negativo). Em períodos de tempo de 0, 7, 14, 21 e 28 dias, raspas de dentina foram coletadas usando brocas esféricas com diâmetros crescentes, e mantidas em tubos de ensaio contendo 3 mL de infusão cérebro coração (brain heart infusion). A análise dos dados foi feita com testes paramétricos (ANOVA a um fator e teste de comparações múltiplas de Bonferroni, α=1%). Após a cultura, o número de unidades formadoras de colônias (UFC) foi contado. Todas as soluções de hipoclorito de sódio mostraram pequena quantidade de UFC nos períodos por até 28 dias. Chlor Xtra e Hypoclean tiveram menor número de UFC em todos os períodos observados, com maior efetividade antimicrobiana do que o NaOCl 5,25% e do que o NaOCl a 1% com ácido acético a 1%.

Carisolv as an endodontic irrigant in deciduous teeth: An SEM study.

Aim: Root canal irrigation plays an important role in the debridement and disinfection of the root canal system. "The purpose of this study was to evaluate the efficacy of Carisolv TM , 1% sodium hypochlorite (NaOCl) gel, and 1% NaOCl solution as root canal irrigants in deciduous anterior teeth." Materials and Methods: Thirty-six extracted deciduous anterior teeth were used. Root canals were flooded with NaOCl solution in Group A, NaOCl gel in Group B and Carisolv TM in Group C and incubated for 30 min. Scanning electron microscope photomicrographs of canal wall debris in the apical, middle and coronal thirds were scored. Results: The results showed that regardless of irrigation regime, canals were consistently cleaner in the coronal and middle thirds than in the apical thirds. NaOCl solution, NaOCl gel, and Carisolv TM had comparable activity at coronal third and middle third of root canals. At the apical third, NaOCl solution cleaned canals better than NaOCl gel and Carisolv TM . Carisolv TM cleaned debris better than NaOCl gel at the apical third. Conclusion: Carisolv TM can be used as an adjunct to root canal preparation.