Hipoclorito de Sodio como Agente Desproteinizante para Mejorar la Adhesión en Esmalte Hipomineralizado en Ortodoncia. Una Revisión Narrativa

Obtener una buena adhesión entre esmalte y bracket es un aspecto fundamental para el éxito del tratamiento en Ortodoncia. Algunos casos presentan desafíos en esta adhesión, especialmente cuando nos enfrentamos ante un esmalte con alteraciones como hipomineralizaciones, hipoplasias o fluorosis dental. Para sobreponer esta dificultad en la unión adhesiva se han propuesto diversas estrategias terapéuticas como es el uso de agentes desproteinizantes. El objetivo de esta revisión narrativa es describir el uso de hipoclorito de sodio como agente desproteinizante en dientes con alteraciones de esmalte para mejorar la adhesión en Ortodoncia. Se realizó una búsqueda bibliográfica en PubMed de los últimos 5 años. Se encontraron 116 artículos, de los cuales 23 cumplieron con los criterios requeridos y fueron seleccionados para la revisión. La desproteinización del esmalte con hipoclorito de sodio como paso previo al grabado ácido, es una estrategia útil en el proceso de cementación de aparatología de ortodoncia fija en dientes con alteraciones del esmalte. El uso de hipoclorito de sodio al 5,25 % es una alternativa de bajo co sto, no invasiva y eficiente para mejorar la fuerza de adhesión en pacientes con alteraciones del esmalte.

Obtaining good adhesion between enamel and bracket is a fundamental aspect for success in Orthodontics. Some cases present challenges in this adhesion, especially when we are faced with enamel with alterations such as hypomineralization, hypoplasia or dental fluorosis. To overcome this difficulty in adhesive bonding, various therapeutic strategies have been proposed, such as the use of deproteinizing agents. The objective of this study is to describe the use of sodium hypochlorite as a deproteinizing agent in teeth with enamel alterations to improve adhesion in Orthodontics. A bibliographic search was carried out in PubMed for articles within the last 5 years. In this study 116 articles were found, of which 23 met the required criteria and were selected for the review. Deproteinization of the enamel with sodium hypochlorite as a prior step to acid etching is an important stage in the cementation process of fixed appliances in orthodontics. The use of 5.25% sodium hypochlorite is a low-cost, non-invasive and efficient alternative to improve adhesion strength in patients with anomalies of tooth enamel.

Effect of Morinda citrifolia juice on the bonding strength and nanoleakage of crowns dentin / 口腔疾病防治

Objective@#To explore the effect of Morinda citrifolia juice (MCJ) combined with ethylene diamine tetraacetic acid (EDTA) on premolar bonding strength and nanoleakage and compare the results with those of the most commonly used root canal irrigation solution, sodium hypochlorite (NaClO), to provide a reference for clinical application.@*Methods@#This study was approved by the ethics review committee. Sixty-three human premolars extracted for orthodontic treatment were randomly divided into a control group (distilled water group) and 6 experimental groups according to the different rinsing solutions used after the surface enamel was removed. The experimental groups included Group A (2.5% NaClO), Group B (5.25% NaClO), Group C (6% MCJ), Group D (2.5% NaClO-17% EDTA), Group E (5.25% NaClO-17% EDTA), and Group F (6% MCJ-17% EDTA) (n = 9). After soaking in the corresponding rinsing solution for 20 minutes, they were layered and stacked on their surfaces to form 4 mm × 4 mm × 3 mm Z350 resin blocks. Six samples from each group were cut into 1 mm × 1 mm × 8 mm specimen strips for microtensile bonding strength testing. The fracture type was determined under a stereomicroscope, and the remaining 3 samples from each group were aged and cut into 1 mm thick slices for interface nanoleakage testing and scanning electron microscopy observation of the resin dentin bonding interface.@*Results@#There were significant differences in the microtensile bonding strength among the groups (P<0.05), and the control group had the highest bonding strength. Among experimental groups, Group B had the lowest bonding strength, mainly bonding interface fracture, and Group F had the highest bonding strength, mainly mixed fracture. There were significant differences in nanoleakage among all groups (P<0.05), and the control group had the lowest nanoleakage value. Among experimental groups, Group B had the highest nanoleakage, with resin protrusions being unaltered, and Group F had the lowest nanoleakage value, with resin protrusions being thick and dense.@*Conclusion@#The higher the concentration of NaClO was, the worse the bonding strength and edge sealing of the crown dentin were. The effects of root canal irrigation with MCJ and EDTA on the adhesive strength and edge sealing of crown dentin were less pronounced than those of root canal irrigation with NaClO and EDTA.

Comparative Analysis of Antimicrobial Efficacy of Electrolyzed Water with Sodium Hypochlorite Solution against Root Canal Pathogen: A Scoping Review

@#Electrolyzed water (EW) has been introduced as a surface disinfectant due to its antimicrobial properties without cytotoxic effects to oral tissues contrary to sodium hypochlorite (NaOCl), which is cytotoxic and can be detrimental if extruded beyond the root canal. This scoping review aimed to compare antimicrobial efficacy of EW with NaOCl on root canal pathogens and to assess effect of concentration and exposure time on antimicrobial efficacy. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews protocol guidelines. Electronic databases were searched for eligible articles published between 2011-2021 in PubMed, PLOS, Science Direct, and Google Scholar. Joanna Briggs Institute Critical Appraisal Tool was used for quality assessment. Of the 784 articles recovered, only 8 were eligible based on inclusion criteria. The included studies assessed several types of EW, which showed antimicrobial potential against E. faecalis in vitro in suspension and biofilm forms. EW demonstrated antimicrobial efficacy comparable with NaOCl in 5 of 8 studies. Only one study found that higher concentration and exposure time increased antimicrobial efficacy of EW; other studies showed otherwise. It can be concluded that EW can be a potential alternative solution for NaOCl as an endodontic irrigant.

Toxic effects of sodium hypochlorite as disinfectants on human bronchial epithelial cells / 环境与职业医学

Background There are a variety of microorganisms in ambient air, and susceptible people can be infected once contact with pathogenic microorganisms in the environment. In order to avoid the spread of pathogenic bacteria, disinfection is the simplest and most effective way of killing pathogenic bacteria in the environment to block the contact between pathogenic bacteria and humans. Sodium hypochlorite (NaClO) is the most widely used disinfectant, but its safety in ambient air disinfection is not clear yet. Objective To establish a model of bronchial epithelial cell (BEAS-2B) injury induced by NaClO, and to explore the mechanism of the toxic effect of NaClO disinfectants on BEAS-2B. Methods Cells were treated with concentration gradients of 0, 25, 50,100, 200, and 400 μmol·L−1 of the diluted NaClO (100 mmol·L−1) standard solution, respectively, and cell activity was measured by cell counting kit-8 (CCK-8) assay after 15 and 30 min. Cells treated with 0, 25, and 50 μmol·L−1 NaClO were selected to observe the cell morphology under an inverted microscope, apoptosis was determined by flow cytometry Annexin V FITC / PI double staining to determine the final experimental concentration. The morphology of organelles such as mitochondria was observed under a transmission electron microscope. Mitochondrial membrane potential of the cells was detected by JC-1 staining. Intracellular Ca2+ concentration was measured with a Fluo-4 AM fluorescent probe. Total cellular reactive oxygen species (ROS) was detected with a 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) fluorescent probe, cell mitochondrial ROS with a dihydroethidium (DHE) fluorescent probe, and lipid peroxidation intermediate malondialdehyde (MDA) with a commercial kit. Results Compared with 0 μmol·L−1, NaClO treatment group, cell morphology did not change a lot after 25 μmol·L−1 NaClO treatment for 30 min, and the cells began to wrinkle and become round after 30 min treatment with 50 μmol·L−1 NaClO, showing about 70% of normal cell viability (P<0.01). So 30 min 50 μmol·L−1 NaClO treatment was selected for the subsequent experiment. The experimental results found that compared with the 0 μmol·L−1 NaClO treatment group, the number of apoptotic cells increased (P<0.05), the mitochondrial membrane potential decreased (P<0.01), the intracellular Ca2+ concentration increased (P<0.05), the cellular ROS level increased (P<0.05), the mitochondrial ROS level increased (P<0.01), and the MDA content increased (P<0.01) in the NaClO treatment group.. Conclusion The study has successfully established a model of BEAS-2B injury induced by NaClO, and found that NaClO can lead to cell damage by inducing apoptosis and oxidative stress in BEAS-2B cells. According to the results, there are two possible reasons. First, NaClO solves in water to form hypochlorous acid (HClO) which is oxidative and increases the intracellular ROS level after entering cells, leading to cellular oxidative stress. Second, HClO enters cells to directly attack the mitochondrial membrane, resulting in the imbalance of potential inside and outside the mitochondrial membrane, and apoptosis caused by Ca2+ efflux.

Antimicrobial Efficacy and Dentin Collagen Damage Caused by Calcium Hypochlorite and Sodium Hypochlorite

Abstract This study aimed to evaluate the antimicrobial activity of calcium hypochlorite (Ca (OCl)2) and sodium hypochlorite (NaOCl) using confocal laser scanning microscopy (CLSM) and dentin organic matrix alteration by picrosirius staining and light microscopy (LM). Samples of human extracted teeth were infected with Enterococcus faecalis by centrifugation of the bacterial suspension and were treated with Ca(OCl)2 or NaOCl at 0.5%, 2.5%, and 6% for 15, 30, and 60 seconds. CLSM and viability staining were used to quantitatively analyze the proportions of dead/live bacteria in the canal lumen and border of the root canal. The data were analyzed by ANOVA and Fisher test. For LM analysis, one hundred bovine teeth were randomly divided into 10 test groups (n=10): G1- Without treatment; G2- 17% EDTA; G3- 6% NaOCl; G4- 6% NaOCl + EDTA; G5- 0.5% Ca(OCl)2; G6- 0.5% Ca(OCl)2 + EDTA; G7- 2.5% Ca(OCl)2; G8- 2.5% Ca(OCl)2 + EDTA; G9- 6% Ca(OCl)2; G10- 6% Ca(OCl)2 + EDTA. The samples were fragmented and stained with Picrosirius. Data were analyzed by Kruskal-Wallis and Dunn (P<0.05). There was a strong correlation between the results of the canal lumen and the border of the root canal (r=0.962). Both hypochlorites at a concentration of 0.5% showed less microbial reduction compared to 2.5% and 6% (P<0.05). There was less antimicrobial activity at 15 seconds compared to 30 and 60 seconds (P<0.05). Ca(OCl)2 and NaOCl showed similar results at the same concentrations (P>0.05). In conclusion, Ca(OCl)2 caused fewer alterations to the dentin organic matrix at concentrations of 0.5% and 2.5%. Ca(OCl)2 presents antimicrobial activity similar to NaOCl, and collagen damage is concentration-dependent.

Resumo Este estudo teve como objetivo avaliar a atividade antimicrobiana do hipoclorito de cálcio (Ca(OCl)2) e do hipoclorito de sódio (NaOCl) usando a microscopia confocal a laser (MCVL) e a alteração da matriz orgânica da dentina por meio da coloração com picrosirius e microscopia óptica (MO). Amostras de dentes humanos extraídos foram infectados com Enterococcus faecalis por centrifugação da suspensão bacteriana. As amostras foram tratadas com Ca(OCl)2 ou NaOCl a 0,5%, 2,5% e 6% durante 15, 30 e 60 segundos. A MCVLe a coloração de viabilidade foram utilizadas para analisar quantitativamente as proporções de bactérias vivas/mortas no lúmen do canal e no bordo do canal radicular. Os dados foram analisados por ANOVA e teste de Fisher LSD. Para análise de MO, cem dentes bovinos foram divididos aleatoriamente em 10 grupos teste (n=10): G1- Sem tratamento; G2- 17% de EDTA; G3- 6% de NaOCl; G4- 6% de NaOCl + EDTA; G5- 0,5% de Ca(OCl)2; G6- 0,5% de Ca(OCl)2 + EDTA; G7- 2,5% de Ca(OCl)2; G8- 2,5% de Ca(OCl)2 + EDTA; G9- 6% de Ca(OCl)2; G10- 6% de Ca(OCl)2 + EDTA. As amostras foram fragmentadas e coradas com Picrosirius. Os dados foram analisados por Kruskal-Wallis e teste de Dunn (P<0,05). Houve uma forte correlação nos resultados do lúmen do canal e na borda do canal radicular (r=0,962). Ambos os hipocloritos, a uma concentração de 0,5%, mostraram menor redução microbiana em comparação com 2,5% e 6% (P<0,05). Houve menor atividade antimicrobiana aos 15 segundos em comparação com 30 e 60 segundos (P<0,05). Em conclusão, o Ca(OCl)2 e o NaOCl apresentaram resultados semelhantes nas mesmas concentrações (P>0,05). O Ca(OCl)2 causou menos alterações na matriz orgânica da dentina em concentrações de 0,5% e 2,5%. O Ca(OCl)2 apresenta atividade antimicrobiana semelhante ao NaOCl, e os danos ao colágeno dependem da concentraçã

Effect of sodium hypochlorite and calcium hypochlorite on the apical sealing ability of endodontic sealers

Aim: This study aimed to compare the influence of sodium hypochlorite (NaOCl) and calcium hypochlorite [Ca(OCl)2 ] on the apical sealing capacity of AH Plus (Dentsply Maillefer) and Bio-C Sealer (Angelus) endodontic sealers. Methods: Sixty permanent human lower incisors were randomly allocated (http://www.randomized.org), according to the irrigant used, into three groups (n=20): 0.9% sodium chloride (NaCl/Control); 2.5% NaOCl; and 2.5% Ca(OCl)2 . The root canal was prepared with rotary files under 10 mL of the solution corresponding to the experimental group. Each group was subdivided into two (n=10) according to the sealer used for filling: AH Plus (Dentsply Maillefer) or Bio-C Sealer (Angelus). Then, all samples were immersed in black India ink for one week. After the storage period, the roots were then grooved longitudinally and split, and the ink penetration was measured from the apical part to the coronal part of the root canal into which the ink penetrated using a stereomicroscope. Data were analyzed by one-way ANOVA and Tukey's post-hoc tests. Results: There was no statistical difference in ink penetration between the different endodontic sealers tested for the same irrigating solution (p > 0.05). However, when the Bio-C Sealer (Angelus) was used, the group treated with 2.5% Ca(OCl)2 was associated with lower values of apical leakage, compared to 2.5% NaOCl (p < 0.05). For the AH Plus sealer (Dentsply Maillefer), there was no difference between the irrigants (p > 0.05). Conclusions: Associating Ca(OCl)2 irrigant with Bio-C Sealer (Angelus) seems to be a good option to reduce apical leakage

Can 0.5% Sodium Hypochlorite Treat Candida-Associated Denture Stomatitis?

ABSTRACT Objective: To evaluate a 0.5% sodium hypochlorite (SH) protocol in reducing Candida spp. levels in complete dentures (CD) and palate and denture stomatitis (DS) remission. Material and Methods: Twelve CD wearers diagnosed with Candida-associated denture stomatitis (CADS) had their initial situation (Candida spp. levels and DS score) recorded (baseline). Then, participants were instructed to soak dentures once a day (10 minutes) in 0.5% SH. Candida spp. levels and DS scores were reassessed after 15, 30, and 60 days of SH denture cleanness. Biofilms from the denture base and palate were seeded in CHROMagar Candida. After incubation, colony-forming units were calculated. The palate was photographed at each time point, and DS was assessed according to Newton's classification. Data of Candida spp. levels were analyzed by 2-way repeated measures ANOVA followed by the Holm-Sidak test, and DS scores data were accessed by Friedman's 2-way ANOVA by ranks (α=0.05). Results: 0.5% SH significantly reduced Candida spp. levels after treatment compared to baseline (p<0.001) for both sites. Although at baseline, Candida spp. counts were higher on the denture base (p<0.001), no significant differences were observed between the collected areas within the other time points (p<0.05). Also, 0.5% SH effectively reduced clinical signs of DS after treatment (p<0.05). Conclusion: The protocol tested effectively decreased Candida spp. levels on the denture base and palatal mucosa and effectively reduced the signs of DS.

Accuracy of the integrated electronic apex locator in locating simulated perforation under various irrigating solutions in an in vitro study

Aim: This study's objective was to assess the accuracy of the integrated apex locator in identifying artificial root canal perforations in the presence of saline, chlorhexidine, sodium hypochlorite, QMix, and MTAD. Methods: The root canals of 60 single-rooted extracted human teeth were perforated artificially at a point 10 mm away from the root apex. After measuring the actual lengths up to the perforation point, the teeth were then put within an alginate mould for measurements using an integrated apex locator. Using a #20 K-file in the presence of NaCl, CHX, MTAD, NaOCl, and QMix, an electronic apex locator was used to measure the perforations electronically in accordance with the manufacturer's instructions. Between the measurements, each canal was dried with paper points after being irrigated with distilled water. The accuracy of all the readings was calculated at ± 0.5 mm. Statistical analyses were performed using the Z-test. Results: In comparison to the MTAD, NaOCl, and Qmix, saline and chlorhexidine scored more readings in the ± 0.5 mm range of the perforation site, and the difference was statistically significant. Conclusion: The most precise electronic measurements of artificial perforation were obtained in the presence of chlorhexidine or saline

Acidente de hipoclorito de sódio durante retratamento endodôntico / Sodium hypochlorite accident during endodontic retreatment / Accidente con hipoclorito de sodio durante retratamiento

O retratamento endodôntico é uma intervenção executada em um dente que já apresenta um tratamento realizado anteriormente que foi mal sucedido clínica e/ou radiograficamente. O objetivo deste trabalho foi o de relatar um caso de retratamento endodôntico na clínica de Atenção Básica III da Faculdade de Odontologia de Pernambuco devido ao desconforto estético do incisivo lateral superior que estava fraturado e necessitando de prótese fixa. Após anamnese, exames extra e intra-oral e exames radiográficos, constatou-se o canal do dente 12 havia sido tratado endodonticamente há aproximadamente quatro anos. A remoção da gutta percha contaminada foi realizada com as limas rotatórias EasyLogic RT® 25mm sequência 30.10 torque 4N e 900 RPM, 25.08 torque 4Ne 900 RPM. Após remoção da guta-percha, realizou-se o protocolo de irrigação com solução de hipoclorito de sódio a 2,5% (Biodinâmic). A odontometria foi realizada com localizador apical e confirmada por radiografia periapical e o repreparo do canal radicular confeccionado com a Lima EasyLogic 2® de número 35.06 e posterior irrigação com a solução de Labarraque. Nesse momento, o paciente relatou dor e após aspiração com sugador endodôntico, notou-se sangramento abundante, correspondendo ao extravasamento do hipoclorito de sódio (Enfizema por hipoclorito de sódio. O paciente foi medicado com Amoxacilina 875mg de 12 em 12 horas durante sete dias, Predisin 20mg ­ Corticóide - um comprimido pela manhã por 4 dias e Nimesulida 100mg de 12 em 12 horas durante 5 dias. Após 24 horas o paciente não relatou dor nem edema. Na segunda sessão, 10 dias após o acidente, a obturação foi realizada com cone único de guta-percha 35.06 HBassi (Easy, associado ao cimento Bio C Sealer Fillapex (Angelus®). Concluiu-se que a conduta terapêutica imediata instituída para este caso, foi efetiva para o controle da dor e prevenção de complicações adicionais após injeção acidental de hipoclorito de sódio.

Endodontic retreatment is an intervention performed on a tooth that already has a previously performed treatment that was clinically and/ or radiographically unsuccessful. The objective of this study was to report a case of endodontic retreatment at the Primary Care Clinic III of the Faculty of Dentistry of Pernambuco due to the aesthetic discomfort of the maxillary lateral incisor that was fractured and required a fixed prosthesis. After anamnesis, extra and intraoral exams and radiographic exams, it was found that the root canal of tooth 12 had been endodontically treated for approximately four years. Removal of contaminated gutta percha with those performed with EasyLogic RT® 25mm rotary files sequence 30.10 torque 4N and 900 RPM, 25.08 torque 4N and 900 RPM. After removing the gutta-percha, the irrigation protocol was performed with a 2.5% sodium hypochlorite solution (Biodynamic). Odontometry was performed with an apex locator and confirmed by periapical radiography and root canal re-preparation made with EasyLogic 2® File number 35.06 and subsequent irrigation with Labarraque's solution. At that moment, the patient reported pain and after aspiration with an endodontic sucker, there was profuse bleeding, corresponding to sodium hypochlorite extravasation (Sodium hypochlorite emphysema. The patient was medicated with Amoxicillin 875mg every 12 hours for seven days, Predisin 20mg - Corticosteroid - one tablet in the morning for 4 days and Nimesulide 100mg every 12 hours for 5 days. After 24 hours the patient did not report pain or swelling. In the second session, 10 days after the accident, the filling was performed with a single cone of gutta-percha 35.06 HBassi (Easy, associated with Bio C Sealer Fillapex cement (Angelus®). It was concluded that the immediate therapeutic approach instituted for this case was effective for pain control and prevention of complications. additional doses after accidental injection of sodium hypochlorite.

El retratamiento endodóntico es una intervención que se realiza sobre un diente que ya tiene un tratamiento realizado previamente que resultó clínica y/o radiográficamente fallido. El objetivo de este estudio fue relatar un caso de retratamiento endodóntico en la Clínica de Atención Básica III de la Facultad de Odontología de Pernambuco debido a la incomodidad estética del incisivo lateral maxilar que estaba fracturado y requirió prótesis fija. Después de anamnesis, exámenes extraorales, intraorales y exámenes radiográficos, se encontró que el conducto radicular del diente 12 había sido tratado endodónticamente durante aproximadamente cuatro años. Eliminación de gutapercha contaminada con las realizadas con limas rotatorias EasyLogic RT® 25mm secuencia 30.10 torque 4N y 900 RPM, 25.08 torque 4N y 900 RPM. Tras retirar la gutapercha, se realizó el protocolo de irrigación con una solución de hipoclorito de sodio al 2,5% (Biodynamic). Se realizó odontometría con localizador de ápices y se confirmó mediante radiografía periapical y repreparación del conducto radicular realizada con EasyLogic 2® File número 35.06 y posterior irrigación con solución de Labarraque. En ese momento el paciente refirió dolor y luego de aspiración con ventosa endodóntica presentó sangrado profuso, correspondiente a extravasación de hipoclorito de sodio (Enfisema por hipoclorito de sodio. El paciente fue medicado con Amoxicilina 875mg cada 12 horas por siete días. Predisin 20mg - Corticosteroide - una tableta por la mañana por 4 días y Nimesulida 100mg cada 12 horas por 5 días, luego de 24 horas el paciente no refirió dolor ni hinchazón, en la segunda sesión, 10 días después del accidente, se realizó el relleno con un solo cono de gutapercha 35.06 HBassi (Easy, asociado al cemento Bio C Sealer Fillapex (Angelus®). Se concluyó que el abordaje terapéutico inmediato instituido para este caso fue eficaz para el control del dolor y la prevención de complicaciones. dosis adicionales después de accidente inyección de hipoclorito de sodio.

Impacts of Sodium Hypochlorite on Humans and Environment

Sodium hypochlorite (NaOCl) usage is increased extraordinarily after COVID-19. After lockdown, NaOCl is used as a disinfectant at every possible public and private place. Hospitals and Institutions were using it for the same purpose. In this study, NaOCl chemistry is investigated. Its impact on humans and the environment is also analyzed from the available literature. Although, some immediately recent research papers are also considered and mentioned in this paper. This paper also encapsulates information about NaOCl usage, advantage, comparison with other disinfectants, importance, precautions, etc. This study concludes the standardized use of NaOCland also recommends the policy required for its use.

Conduta terapêutica após extravasamento de hipoclorito durante o tratamento endodôntico / Therapeutic management after hypochlorite extravasation during endodontic treatment / Manejo terapéutico después de la extravasación de hipoclorito durante el tratamiento de endodoncia

O hipoclorito de sódio (NaOCl), bastante difundido nos tratamentos endodônticos como uma solução de irrigação eficaz, pode causar complicações graves através da extrusão do mesmo nos tecidos periapicais. O objetivo desse estudo é relatar um caso clínico de extravasamento de hipoclorito durante o tratamento endodôntico, evidenciando a conduta terapêutica. Paciente do sexo feminino, 52 anos, comparece ao setor de urgências e emergência do Hospital da Restauração Governador Paulo Guerra, Recife-PE, cursando com aumento de volume em hemiface direita de aspecto eritematoso, difuso, com sintomatologia dolorosa e sensação de ardência, e necrose tecidual sugestiva de extrusão do NaOCl através dos tecidos periapicais. Foi realizada a limpeza copiosa, desbridamento, drenagem cirúrgica e antibioticoprofilaxia. Observou-se redução do edema e boa cicatrização tecidual intraoral, evidenciando-se que, embora seja rara, é essencial o manejo rápido e preciso diante dessa condição, além da terapêutica medicamentosa a fim de se prevenir infecções secundárias... (AU)

Sodium hypochlorite (NaOCl), widely used in endodontic treatments as an effective irrigation solution, may cause serious complications through extrusion into the periapical tissues. The aim of this study is to report a clinical case of hypochlorite extravasation during endodontic treatment, highlighting the therapeutic approach. A 52-year-old female patient presented at the emergency department of Hospital da Restauração Governador Paulo Guerra, Recife-PE, complaining of a diffuse, erythematous swelling of the right hemiface, with painful symptoms and burning sensation, and tissue necrosis suggestive of extrusion of NaOCl through the periapical tissues. Copious cleaning, surgical debridement and drainage, and antibiotic prophylaxis were performed. A reduction in edema and good intraoral tissue healing were observed. Although rare, rapid and precise management of this condition is essential, as well as drug therapy to prevent secondary infections... (AU)

El hipoclorito de sodio (NaOCl), muy extendido en los tratamientos endodónticos como solución de irrigación eficaz, puede causar graves complicaciones por su extrusión en los tejidos periapicales. El objetivo de este estudio es reportar un caso clínico de extravasación de hipoclorito durante el tratamiento endodóntico, destacando el enfoque terapéutico. Paciente de sexo femenino, 52 años, comparece en el servicio de urgencias y emergencias del Hospital de Restauración Gobernador Paulo Guerra, Recife-PE, cursando con aumento de volumen en hemiface direita de aspecto eritematoso, difuso, con sintomatología dolorosa y sensación de ardor, y necrose tecidual sugestiva de extrusión del NaOCl a través de los tejidos periapicales. Se realizó una abundante limpieza, desbridamiento, drenaje quirúrgico y antibioprofilaxis. Se observó una reducción del edema y una buena cicatrización de los tejidos intraorales, lo que demuestra que, aunque sea poco frecuente, es esencial un tratamiento rápido y preciso de esta afección, además de la terapia farmacológica para prevenir las infecciones secundarias... (AU)

Irrigants and irrigation activation systems in Endodontics

Abstract Root canal infections are typically polymicrobial and involve strong bacterial interactions. The goal of endodontic treatment is to remove infected content from the root canal system to allow the healing of a pre-existing periapical lesion or to prevent infection of the periradicular tissues. Instrumentation alone is not capable of touching all of the root canal walls. Therefore, the irrigation process is an essential step in the endodontic treatment. However, due to the complex anatomy of the root canal system, this cleaning is very challenging. Although syringe and needle irrigation associated with the use of chemical substances is still the most used method, it does not guarantee optimal cleaning of the root canals. As a result, not only alternative irrigating substances but also numerous activation systems - which are technologies that aim to optimize the action of irrigating substances, both chemically and physically - have been developed. This work aimed to review the characteristics of both classic and current alternatives of irrigating substances and irrigation activation systems.

Resumo As infecções dos canais radiculares são tipicamente polimicrobianas e envolvem fortes interações bacterianas. O objetivo do tratamento endodôntico é remover o conteúdo infeccioso do sistema de canais radiculares, a fim de permitir a cicatrização de uma lesão periapical pré-existente ou prevenir a infecção dos tecidos perirradiculares. A instrumentação por si só não é capaz de tocar todas as paredes dos canais radiculares, desta forma a irrigação é uma etapa essencial no tratamento endodôntico. No entanto, devido à complexa anatomia do sistema de canais radiculares, essa limpeza é muito desafiadora. Embora a irrigação convencional com seringa e agulha, fazendo o uso de substâncias auxiliares seja o método mais utilizado, ela não garante a limpeza ideal dos canais radiculares. Como resultado, foram desenvolvidos inúmeros sistemas de ativação que visam otimizar a ação das substâncias irrigadoras, tanto química quanto fisicamente. O objetivo deste artigo foi revisar as características das substâncias irrigadoras (clássicas e alternativas) e dos sistemas de ativação destas substâncias.

Recent Advances in Root Canal Disinfection - A review

Chemical and mechanical root canal debridement are the primary methods used in conjuction with conventional endodontic therapy to remove all dead tissue, bacteria, and microbial byproducts from the root canal. Commonly used root canal disinfection with sodium hypochlorite, a powerful organic tissue dissolver with a broad spectrum of antibacterial properties is an excellent choice opted for dentists for disinfecting root canals. On the other hand, chelating agents such as EDTA is routinely used to remove the inorganic tissue components of the smear layer. The use of chelating agents in endodontic therapy is less effective in the apical third. While performing endodontic therapy, the dentist must ensure the direct contacts of irrigants with the whole root canal wall surfaces, especially in the narrower apical portions of the root canals. In the current article, the authors has presented a detailed review in context to the various irrigating solutions used during the biomechanical preparation, their actions and advantages and disadvantages.

Effect of sodium/calcium hypochlorite on adhesion and adaptation of fiber posts luted with a dual resin cement

Abstract This study aimed to evaluate the effect of different concentrations of sodium hypochlorite (NaOCl) and calcium hypochlorite [Ca(OCl)2] on the bond strength and adaptation of glass fiber posts luted with a dual-curing resin cement. Fifty decoronated premolars were sectioned 14 mm from the apex and endodontically treated. The root canal filling was partially removed. The specimens were divided into 5 groups (n=10) according to the irrigant for post space irrigation: 0.9% sodium chloride (NaCl), (control); 2.5% NaOCl; 5.25% NaOCl; 2.5% Ca(OCl)2; and 5.25% Ca(OCl)2. For each group, irrigation was performed with 5 ml of solution. Afterward, the posts were luted with a dual-curing resin cement. One slice from each third was obtained and submitted to the push-out test and failure modes analysis. An additional slice from the middle third was submitted to confocal images for analysis of adaptation failures (gaps). Two-way ANOVA, Tukey's post-hoc, Kruskal-Wallis with Bonferroni adjusted, and chi-square tests, analyzed data. The group treated with 5.25% NaOCl showed lower bond strength values and generated more cohesive failures compared to the control (p < 0.05). Bond strength decreased from coronal to apical in the post space (p < 0.001). The groups treated with NaOCl had the highest percentages of gaps compared to the control (p < 0.05). Regardless of concentration, Ca(OCl)2 did not influence the bond strength and the occurrence of gaps (P > 0.05). Ca(OCl)2 is a good option for irrigating the post space before luting a fiber post with a dual-curing resin cement.

Resumo Este estudo teve como objetivo avaliar o efeito de diferentes concentrações de hipoclorito de sódio (NaOCl) e hipoclorito de cálcio [Ca(OCl)2] na resistência de união e adaptação de pinos de fibra de vidro cimentados com um cimento resinoso dual. Cinquenta pré-molares tiveram suas coroas removidas, foram seccionados a 14 mm do ápice e tratados endodonticamente. A obturação do canal radicular foi parcialmente removida. Os espécimes foram divididos em 5 grupos (n=10) de acordo com o irrigante para irrigação do espaço do pino: cloreto de sódio 0.9% (NaCl), (controle); NaOCl 2.5%; NaOCl 5.25%; Ca(OCl)2 2.5%; e Ca(OCl)2 5.25%. Para cada grupo, a irrigação foi realizada com 5 ml da solução. Posteriormente, os pinos foram cimentados com um cimento resinoso dual. Uma fatia de cada terço foi obtida e submetida ao teste push-out e análise dos modos de falha. Um corte adicional do terço médio foi submetido a imagens confocais para análise de falhas de adaptação (gaps). Os dados foram analisados pelos testes ANOVA de duas vias, post-hoc de Tukey, Kruskal-Wallis com ajuste de Bonferroni e qui-quadrado. O grupo tratado com NaOCl 5.25% apresentou menores valores de resistência de união e gerou mais falhas coesivas em relação ao controle (p < 0.05). A resistência de união diminuiu de coronal para apical no espaço do pino (p < 0.001). Os grupos tratados com NaOCl apresentaram os maiores percentuais de gaps em relação ao controle (p < 0.05). Independentemente da concentração, o Ca(OCl)2 não influenciou a resistência de união e a ocorrência de gaps (P > 0.05). O Ca(OCl)2 é uma boa opção para irrigar o espaço do pino antes de cimentar um pino de fibra com um cimento resinoso dual.

Analysis of antimicrobial efficacy of sodium hypochlorite and ozonated water against biofilm in oval canals

Abstract This in vitro study compared the antimicrobial efficacy of 2.5% sodium hypochlorite (NaOCl) and 8 µg/mL ozonated water agitated by passive ultrasonic irrigation (PUI) or PUI combined with EndoActivator (EA) against mature multispecies biofilm. One hundred and five oval-shaped mandibular premolars were instrumented, sterilized, and inoculated with Enterococcus faecalis, Candida albicans, and Staphylococcus aureus, divided into: control group - saline; O3 group - ozonated water; O3 PUI group - ozonated water with PUI agitation; O3 PUI+EA group - ozonated water with PUI+EA agitation; NaOCl group - NaOCl; NaOCl PUI group - NaOCl with PUI agitation; and NaOCl PUI+EA group - NaOCl with PUI+EA agitation. Microbiological samples were collected before (S1) and after (S2) the disinfection procedures and the data were statistically analyzed using the Kruskal-Wallis test. In the culture method, there was significant disinfection in the O3 PUI+EA, NaOCl, NaOCl PUI, and NaOCl PUI+EA groups (p˂0.05). The combination of NaOCl with PUI+EA reduced microbial counts to zero (p˂0.05). In the qPCR method, there was a significant reduction in the total count of viable microorganisms in the O3 PUI, O3 PUI+EA, NaOCl, NaOCl PUI, and NaOCl PUI+EA groups (p˂0.05). It can be concluded that 2.5% NaOCl with and without agitation, as well as 8 µg/mL ozonated water with its action enhanced by the agitation techniques, were effective in root canal disinfection, and their antimicrobial efficacy is related to the microorganisms present in the biofilm.

Resumo Este estudo in vitro comparou a desinfecção do hipoclorito de sódio 2,5% (NaOCl) e da água ozonizada 8 µg/mL agitados pela irrigação ultrassônica passiva (PUI) e por associação da PUI com EndoActivator (EA) na redução de biofilme misto maduro. Cento e cinco pré-molares inferiores ovalados foram instrumentados, esterilizados e inoculados com Enterococcus faecalis, Candida albicans e Staphylococcus aureus, divididos em: Grupo controle: soro; Grupo O3: água ozonizada; Grupo O3 PUI: água ozonizada agitada por PUI; Grupo O3 PUI + EA: água ozonizada agitada por PUI e EA: Grupo NaOCl: hipoclorito de sódio; Grupo NaOCl PUI: hipoclorito de sódio agitado por PUI; Grupo NaOCl PUI + EA: hipoclorito de sódio agitado por PUI e EA. Amostras microbiológicas foram coletadas antes (S1) e após (S2) os procedimentos de desinfecção e os dados foram analisados estatisticamente pelo teste de Kruskal-Wallis. No método de cultura, houve desinfecção significativa nos grupos O3 PUI + EA, NaOCl, NaOCl PUI e NaOCl PUI + EA (p˂0.05), sendo que no grupo NaOCl PUI + EA não houve crescimento de microrganismo (p˂0.05). No método de qPCR, nas contagens dos microrganismos antes e após os protocolos de desinfecção, houve redução microbiana nos grupos O3 PUI, O3 PUI + EA, NaOCl, NaOCl PUI, NaOCl PUI + EA (p˂0.05). Concluiu-se que o NaOCl 2,5% com e sem agitação foi eficiente, assim como a água ozonizada 8 µg/mL potencializada pelos métodos de agitação na desinfecção e que a mesma está relacionada com os microrganismos presentes no biofilme.

Irrigation protocols effects on radicular dentin: Cleaning, disinfection and remaining ultrastructure / Efecto del protocolo de irrigación en la dentina radicular: limpieza, desinfección y ultraestructura remanente

A successful endodontic treatment requires a combination of satisfactory mechanical instrumentation, adequate irrigation protocols, and three-dimensional obturation of the canal system. Irrigation is considered the most critical procedure to ensure cleaning and disinfection. To date, a large variety of irrigants has been proposed. However, sodium hypochlorite (NaOCl) remains the gold standard. In order to achieve complete cleaning and disinfection, final irrigation with EDTA and ultrasonic devices has been used as an ideal protocol. Most endodontic research focuses on the cleaning and antibacterial properties of the irrigant solutions. Recent evidence demonstrated that the irrigation protocols cause erosion, affecting the radicular dentin ultrastructure. This article aims to describe the clinical features of the present knowledge concerning the effect of irrigation protocols on radicular dentin.

Un tratamiento de endodoncia exitoso requiere de una satisfactoria instrumentación mecánica, protocolos de irrigación adecuados y obturación tridimensional del sistema de conductos radiculares. La irrigación se considera el procedimiento más crítico para garantizar la limpieza y desinfección. Hasta la fecha, se ha propuesto una gran variedad de irrigantes. Sin embargo, el hipoclorito de sodio (NaOCl) sigue siendo el estándar de oro. Para lograr una limpieza y desinfección completa, se ha utilizado como protocolo ideal la irrigación final con EDTA y dispositivos ultrasónicos. La mayor parte de la investigación en endodoncia se enfoca en las propiedades antibacterianas y de limpieza de las soluciones de irrigación. Reciente evidencia demostró que los protocolos de irrigación provocan erosión, afectando la ultraestructura de la dentina radicular. Este artículo tiene como objetivo describir algunas consideraciones clínicas del conocimiento actual sobre el efecto de los protocolos de irrigación en la dentina radicular.

Efficacy of Chlorine Dioxide as an Endodontic Irrigant for Pulp Dissolution in vitro

Determine the efficacy of 5 % chlorine dioxide as an endodontic irrigant for pulp dissolution. Thirty five samples of human dental pulp were obtained, previously weighed and immersed in three solutions= 5 % ClO 2, 5.25 % NaOCl and saline (control group), for 10 minutes at 32 ºC; they were dried and reweighed. Then the weight loss was compared to the original weight and analyzed statistically. 5.25 % NaOCl and 5 % ClO 2 dissolved the dental pulp samples more effectively than saline (p> 0.001). No statistically significant difference was found between the tissue dissolving proper ties of 5.25 % NaOCl and 5 % ClO2 (p=0.893). 5 % ClO2 is effective in dissolving human dental pulp tissue.

El objetivo de este estudio fue determinar la eficacia del dióxido de cloro al 5 % como irrigante endodóntico para la disolución pulpar. Se obtuvieron 35 muestras de pulpa dental humana, se pesaron previamente y se sumergieron en tres soluciones= 5 % ClO2, 5.25 % NaOCl y suero fisiológico (grupo control), durante 10 minutos a 32ºC; se secaron y se pesaron de nuevo. Luego se comparó la pérdida de peso del peso original y se analizó estadísticamente. NaOCl al 5.25 % y ClO2 al 5 % disolvieron las muestras de pulpa dental con más eficacia que el suero fisiológico (p> 0.001). No se encontró diferencias estadísticamente significativas entre las propiedades de disolución de tejido de NaOCl al 5.25 % y ClO2 al 5 % (p=0.893) ClO2 al 5 % es eficaz para disolver tejido de pulpa dental humana.

Research progress on root canal irrigation disinfection drugs / 口腔疾病防治

@#Endodontic infection control is crucial to successful root canal treatment. Irrigation is the key step in endodontic procedures, and the application of root canal irrigation and disinfection medications play an important role. How to enhance antibacterial effects and functions in removing tissues while maintaining biocompatibility is a hot topic in endodontics. Currently, insights to address this issue can be split into two categories: one, the modification or combination of conventional endodontic irrigation solutions, and two, the development of novel endodontic irrigation solutions with new technologies and materials, for instance, nanomaterials and natural exacts. However, conventional endodontic irrigation solutions, such as sodium hypochlorite and chlorhexidine, are still the first choice in clinical practice. Most novel endodontic irrigation solutions remain at the pre-clinical laboratory stage. Clinical research and relevant data are required to determine whether various methods can improve endodontic irrigation. From basic research to clinical application is the direction for advancing to the next stage. The present article focuses on research progress on endodontic irrigation, especially concerning its antibacterial mechanism, characteristics and efficacy, to provide a reference for future clinical translation.

Calcium hydroxide diffusion after agitation of endodontic irrigants: an ex vivo study

Aim: To compare the influence of two methods of agitation of endodontics irrigants, by diffusion of calcium hydroxide [Ca(OH)2] through the dentinal tubules, measuring the pH of the medium where they were kept. Methods: Twenty mandibular incisors were prepared using a WaveOne Gold Large file, in a reciprocating movement, and then divided into (n = 10): gutta-percha cone (GPC) or Easy Clean system (ECS) agitation of 1% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. The specimens were filled with Ca(OH)2 paste, placed in flasks with 4 mL of deionized water, and stored in an incubator. The pH was read using a digital pH meter immediately after storage (T0), after 7 (T1), 14 (T2), 21 (T3), and 35 (T4) days. Results: Statistical difference between groups was observed regardless of the day pH was measured (p < 0.01). From T2 on, ECS presented higher pH values in comparison with GPC, with significant difference (p < 0.01). Conclusion: Agitation of endodontic irrigants with ECS enhances the Ca(OH)2 diffusion, providing higher pH values, from the 14th day on, when compared with GPC

Effect of two methods of irrigant agitation on the temperature and cleanliness of sodium hypochlorite associated or not with a chelator: irrigant agitation and influence in temperature

Aim: This study investigated the influence in vitro of different sodium hypochlorite (NaOCl) agitation protocols associated or not with DualRinse (HEDP) on the temperature of the solution. Methods: Forty-eight premolars were instrumented and their apical third sealed to allow a closed irrigation system. The teeth remained immersed in a basin of warm water (37°C). The teeth were divided into the groups: G1 (NaOCl+Passive Ultrasonic Irrigation (PUI)), G2 (NaOCl/HEDP + PUI), G3 (NaOCl + EasyClean (EC)) and G4 (NaOCl/HEDP + EC). The canals were filled with the respective solutions and after 180 seconds the first temperature measurement was taken (T0). Then, the solutions were agitated, following the different protocols, for 60 seconds and a new measurement was performed (T60). The temperature was measured using a digital thermometer for type "K" sensors that was inserted into the middle third of the teeth. At the end of the measurements, the teeth were sectioned and prepared for scanning electron microscopy. The dentinal wall of middle third was graded according to the amount of debris and smear layer remaining on the walls. The results were analyzed using ANOVA test and Tukey's multiple comparisons (p<0.05). Results: G1 and G2 had an average increase in temperature of 1.1°C and 1.65°C, respectively (p>0.05). EasyClean caused a decrease in the temperature of the solutions in both groups, without a significant statistical difference with T0 (p>0.05). Regarding cleaning, it was only possible to observe clean dentinal tubules in the groups with the chelator. PUI discretely increased the temperature of the solution, regardless of the solution. The opposite effect was observed after activation with EasyClean. Conclusion: The association of NaOCl with a chelating agent promoted the cleaning of the dentinal tubules