The comparison of the effect of endodontic irrigation on cell adherence to root canal dentin.

PubMed

Ring, Karla C; Murray, Peter E; Namerow, Kenneth N; Kuttler, Sergio; Garcia-Godoy, Franklin

2008-12-01

The purpose of this study was to compare the effect of 10 different endodontic irrigation and chelating treatments on dental pulp stem cell (DPSC) attachment to root canal surfaces. Thirty-eight extracted human nondiseased single-canal teeth were cleaned and shaped using ProTaper and ProFile rotary instrumentation (Tulsa Dentsply, Tulsa, OK). The irrigation treatments investigated were 6% sodium hypochlorite, 2% chlorhexidine gluconate, Aquatine Endodontic Cleanser, and Morinda citrifolia juice. The irrigation treatments were used in conjunction with EDTA or MTAD. The instrumented teeth were immediately placed in cell culture with confluent DPSCs for 1 week. The number of attached DPSCs appeared to be correlated with the cytotoxicity of the root canal irrigating solution (analysis of variance, p < 0.0001). The presence or absence of the smear layer had little influence on DPSC activity (chi-square, p > 0.05). The results suggest that biocompatible irrigants are needed to promote DPSC attachment to root canal dentin, which is essential to accomplish some regenerative endodontic therapies.

[Evaluation of root canal isthmus debridement efficacy of Er:YAG laser in combination with sodium hypochlorite].

PubMed

Zhou, Meng-Qi; Wang, Hao-Ming; Xiao, Jia-Qi; Hong, Jin

2016-10-01

To histologically evaluate the efficacy of sodium hypochlorite (NaClO) in combination with Er:YAG (erbium-doped yttrium aluminium garnet) laser in dissolving necrotic tissue and cleaning root canals as well as canal isthmuses. After scanned by cone-beam CT (CBCT), 50 well-prepared premolars with root canal isthmuses were selected and randomly assigned into 5 groups. They were subsequently subjected to different regimens as followed: group A-irrigated with 1% NaClO for 1 minute, group B- irradiated by Er:YAG laser at 0.5 W combined with 1% NaClO irrigation for 1 minute, group C- irradiated by Er:YAG laser at 1.0 W combined with 1% NaClO irrigation for 1 minute, group D- irradiated by Er:YAG laser at 2.0 W combined with 1% NaClO irrigation for 1 minute,group E- negative control. After histological preparation and staining, the cross-sections were evaluated for percentage of tissue removal from root canals and isthmuses. The cleanliness values were calculated using SPSS 13.0 software package. The mean percentage of root canals in group A, B, C and D was 95.24%, 96.53%、97.63% and 98.22%, respectively, and the mean percentage of isthmuses was 16.50%, 51.48%, 52.56% and 53.83%, respectively. The mean percentage of root canal and isthmus cleanliness values were significantly higher in group B, C and D (P<0.05) than that in group A. There was no significant differences of root canal and isthmus cleanliness among group B, C and D. Er:YAG laser combined with 1% NaClO irrigation may be used effectively in root canal and root canal isthmus cleanliness as a new method.

Decalcifying capability of irrigating solutions on root canal dentin mineral content

PubMed Central

Poggio, Claudio; Dagna, Alberto; Vinci, Andrea; Beltrami, Riccardo; Cucca, Lucia; Giardino, Luciano

2015-01-01

Background: Chelating agents are believed to aid root canal irrigation and to be able to remove the inorganic smear layer. Aims: The purpose of the present study was to evaluate and to compare the decalcifying capability of different irrigating solutions (Tubuliclean, Largal Ultra, ethylenediaminetetraacetic acid 17%, Tetraclean, Tetraclean NA). Materials and Methods: Sixty maxillary central incisors were used. Root canals were instrumented and irrigated. From each root, four comparable slices of cervical dentin were obtained. At three successive 5-min interval immersion times, the concentration of calcium extracted from root canal dentin was assessed with an inductively coupled plasma-atomic emission spectrometer. Statistical Analysis Used: Data were analyzed by means of Kruskal Wallis and Mann–Whitney tests. Significance was predetermined at P < 0.05. Results and Conclusions: For all irrigating solutions, the maximum amount of Ca2+ extracted from root canal dentin samples was reached after 10 min contact time except for citric acid-based agents (Tetraclean and Tetraclean NA) which induced a higher and still increasing calcium release even after 10 min contact time. In order to obtain an efficient decalcifying action on dentin and to facilitate the biomechanical procedures, citric acid-based irrigants can be applied. PMID:26097355

Influence of irrigation and obturation techniques on artificial lateral root canal filling capacity.

PubMed

Silva, Emmanuel J; Herrera, Daniel R; Souza-Júnior, Eduardo J; Teixeira, João M

2013-01-01

The aim of this study was to evaluate the influence of two different irrigation protocols on artificial lateral root canal filling capacity using different obturation techniques. Sixty single-root human teeth were used. Two artificial lateral canals were created in the apical third. Root canals were instrumented up to a 45 K-file to the working length. Before each file, root canals were irrigated either with 2 mL of 2.5% NaOCl or 2% chlorhexidine gel with further irrigation with saline solution and 3 mL of 17% EDTA. Specimens were randomly divided into three groups according to the obturation technique: (1) lateral compaction technique; (2) Tagger hybrid technique; and (3) thermoplasticized technique using BeeFill 2 in 1. All groups used AH Plus as the root canal sealer. The specimens were decalcified and cleared in methyl salicylate. The total length of lateral canals was observed under X30 magnification with a stereomicroscope and measured on the buccal and lingual root surfaces using Leica IM50 software. The data were submitted to ANOVA and Tukey test (p < 0.05). Among the obturation techniques, BeeFill 2 in 1 showed deeper penetration into all lateral canals than the lateral compaction or Tagger hybrid techniques (p < 0.05). The lateral compaction group showed the worst results (p < 0.05). Irrigants did not affect the outcome; there was no difference between NaOCl and chlorhexidine when the same obturation technique was used (p > 0.05). Regardless of the irrigant used during endodontic procedures, the thermoplasticized techniques showed higher penetration behavior for filling artificial lateral canals than the lateral compaction technique.

Effect of photodynamic therapy (PDT) on Enterococcus faecalis biofilm in experimental primary and secondary endodontic infections.

PubMed

Tennert, Christian; Feldmann, Katharina; Haamann, Edwina; Al-Ahmad, Ali; Follo, Marie; Wrbas, Karl-Thomas; Hellwig, Elmar; Altenburger, Markus J

2014-11-04

To determine the antibacterial effect of photodynamic Therapy on Enterococcus faecalis (E. faecalis) biofilms in experimentally infected human root canals in primary infections and endodontic retreatments. One hundred and sixty single-rooted extracted teeth with one root canal were prepared using ProTaper instruments. Seventy specimens were left without root canal filling and autoclaved. The root canals of another 70 specimens were filled with Thermafil and AH Plus and the root canal fillings were removed after 24 hours using ProTaper D files and plasma sterilized. The specimens were infected with a clinical isolate of E. faecalis for 72 hours. Samples were taken using sterile paper points to determine the presence of E. faecalis in the root canals. The specimens were randomly divided into groups according to their treatment with 20 teeth each and a control. In the PDT group the teeth were treated using PDT, consisting of the photosensitizer toluidine blue and the PDT light source at 635 nm. In the NaOCl (sodium hypochlorite) group the root canals were rinsed with 10 mL of 3% NaOCl. In the NaOCl-PDT group the root canals were rinsed with 10 mL of 3% of sodium hypochlorite and then treated with PDT. Samples were taken after treatments using sterile paper points. Additionally, remaining root canal filling material was recovered from the root canal walls. Survival fractions of the samples were calculated by counting colony-forming units. A one-way analysis of variance (ANOVA) was applied to the data to assess the effect of different treatment techniques. Antimicrobial treatment of root canals caused a significant reduction of bacterial load in all groups. NaOCl irrigation eliminated E. faecalis most effectively. PDT alone was less effective compared to NaOCl irrigation and the combination of NaOCl irrigation and PDT. CFU levels recovered from the filling material after NaOCl irrigation of the root canals were 10fold higher compared to PDT and the combination of NaOCl irrigation and PDT. Photodynamic therapy killed E. faecalis in experimental primary endodontic infections and retreated human root canals. PDT is an effective supplement in root canal disinfection, especially in endodontic retreatments.

Irrigation of human prepared root canal – ex vivo based computational fluid dynamics analysis

PubMed Central

Šnjarić, Damir; Čarija, Zoran; Braut, Alen; Halaji, Adelaida; Kovačević, Maja; Kuiš, Davor

2012-01-01

Aim To analyze the influence of the needle type, insertion depth, and irrigant flow rate on irrigant flow pattern, flow velocity, and apical pressure by ex-vivo based endodontic irrigation computational fluid dynamics (CFD) analysis. Methods Human upper canine root canal was prepared using rotary files. Contrast fluid was introduced in the root canal and scanned by computed tomography (CT) providing a three-dimensional object that was exported to the computer-assisted design (CAD) software. Two probe points were established in the apical portion of the root canal model for flow velocity and pressure measurement. Three different CAD models of 27G irrigation needles (closed-end side-vented, notched open-end, and bevel open-end) were created and placed at 25, 50, 75, and 95% of the working length (WL). Flow rates of 0.05, 0.1, 0.2, 0.3, and 0.4 mL/s were simulated. A total of 60 irrigation simulations were performed by CFD fluid flow solver. Results Closed-end side-vented needle required insertion depth closer to WL, regarding efficient irrigant replacement, compared to open-end irrigation needle types, which besides increased velocity produced increased irrigant apical pressure. For all irrigation needle types and needle insertion depths, the increase of flow rate was followed by an increased irrigant apical pressure. Conclusions The human root canal shape obtained by CT is applicable in the CFD analysis of endodontic irrigation. All the analyzed values –irrigant flow pattern, velocity, and pressure – were influenced by irrigation needle type, as well as needle insertion depth and irrigant flow rate. PMID:23100209

Irrigation of human prepared root canal--ex vivo based computational fluid dynamics analysis.

PubMed

Snjaric, Damir; Carija, Zoran; Braut, Alen; Halaji, Adelaida; Kovacevic, Maja; Kuis, Davor

2012-10-01

To analyze the influence of the needle type, insertion depth, and irrigant flow rate on irrigant flow pattern, flow velocity, and apical pressure by ex-vivo based endodontic irrigation computational fluid dynamics (CFD) analysis. Human upper canine root canal was prepared using rotary files. Contrast fluid was introduced in the root canal and scanned by computed tomography (CT) providing a three-dimensional object that was exported to the computer-assisted design (CAD) software. Two probe points were established in the apical portion of the root canal model for flow velocity and pressure measurement. Three different CAD models of 27G irrigation needles (closed-end side-vented, notched open-end, and bevel open-end) were created and placed at 25, 50, 75, and 95% of the working length (WL). Flow rates of 0.05, 0.1, 0.2, 0.3, and 0.4 mL/s were simulated. A total of 60 irrigation simulations were performed by CFD fluid flow solver. Closed-end side-vented needle required insertion depth closer to WL, regarding efficient irrigant replacement, compared to open-end irrigation needle types, which besides increased velocity produced increased irrigant apical pressure. For all irrigation needle types and needle insertion depths, the increase of flow rate was followed by an increased irrigant apical pressure. The human root canal shape obtained by CT is applicable in the CFD analysis of endodontic irrigation. All the analyzed values -irrigant flow pattern, velocity, and pressure - were influenced by irrigation needle type, as well as needle insertion depth and irrigant flow rate.

Optodynamic Phenomena During Laser-Activated Irrigation Within Root Canals

NASA Astrophysics Data System (ADS)

Lukač, Nejc; Gregorčič, Peter; Jezeršek, Matija

2016-07-01

Laser-activated irrigation is a powerful endodontic treatment for smear layer, bacteria, and debris removal from the root canal. In this study, we use shadow photography and the laser-beam-transmission probe to examine the dynamics of laser-induced vapor bubbles inside a root canal model and compare ultrasonic needle irrigation to the laser method. Results confirm important phenomenological differences in the two endodontic methods with the laser method resulting in much deeper irrigation. Observations of simulated debris particles show liquid vorticity effects which in our opinion represents the major cleaning mechanism.

Root Canal Irrigation: Chemical Agents and Plant Extracts Against Enterococcus faecalis

PubMed Central

Borzini, Letizia; Condò, Roberta; De Dominicis, Paolo; Casaglia, Adriano; Cerroni, Loredana

2016-01-01

Background: There are various microorganisms related to intra and extra-radicular infections and many of these are involved in persistent infections. Bacterial elimination from the root canal is achieved by means of the mechanical action of instruments and irrigation as well as the antibacterial effects of the irrigating solutions. Enterococcus faecalis can frequently be isolated from root canals in cases of failed root canal treatments. Antimicrobial agents have often been developed and optimized for their activity against endodontic bacteria. An ideal root canal irrigant should be biocompatible, because of its close contact with the periodontal tissues during endodontic treatment. Sodium hypoclorite (NaOCl) is one of the most widely recommended and used endodontic irrigants but it is highly toxic to periapical tissues. Objectives: To analyze the literature on the chemotherapeutic agent and plant extracts studied as root canal irrigants. In particularly, the study is focused on their effect on Enterococcus faecalis. Method: Literature search was performed electronically in PubMed (PubMed Central, MEDLINE) for articles published in English from 1982 to April 2015. The searched keywords were “endodontic irrigants” and “Enterococcus faecalis” and “essential oil” and “plant extracts”. Results: Many of the studied chemotherapeutic agents and plant extracts have shown promising results in vitro. Conclusion: Some of the considered phytotherapic substances, could be a potential alternative to NaOCl for the biomechanical treatment of the endodontic space. PMID:28217184

Comparison of Different Irrigants in the Removal of Endotoxins and Cultivable Microorganisms from Infected Root Canals

PubMed Central

Valera, Marcia Carneiro; Cardoso, Flávia Goulart da Rosa; Chung, Adriana; Xavier, Ana Cláudia Carvalho; Figueiredo, Mariana Diehl; Martinho, Frederico Canato; Palo, Renato Miotto

2015-01-01

This study was conducted to compare the effectiveness of different irrigants used to remove endotoxins and cultivable microorganisms during endodontic therapy. Forty root canals were contaminated and divided into groups according to the irrigant: 2% NaOCl + surfactant, 2% CHX, 2.5% NaOCl, and pyrogen-free saline solution (control). Samples were collected after root canal contamination (S1), after instrumentation (S2), and 7 days after instrumentation (S3). Microorganisms and endotoxins were recovered from 100% of the contaminated root canals (S1). At S2, 2% NaOCl + surfactant, 2% CHX, and 2.5% NaOCl were able to completely eliminate cultivable microorganisms. At S3, both 2% CHX and 2.5% NaOCl were effective in preventing C. albicans and E. coli regrowth, but E. faecalis was still detected. No microorganism species was recovered from root canals instrumented with 2% NaOCl + surfactant. At S2, a higher percentage value of endotoxin reduction was found for 2% NaOCl + surfactant (99.3%) compared to 2% CHX (98.9%) and 2.5% NaOCl (97.18%) (p < 0.05). Moreover, at S3, 2% NaOCl + surfactant (100%) was the most effective irrigant against endotoxins. All irrigants tested were effective in reducing microorganisms and endotoxins from root canals. Moreover, 2% NaOCl + surfactant was the most effective irrigant against endotoxins and regrowth of microorganisms. PMID:26346574

The self-adjusting file (SAF). Part 3: removal of debris and smear layer-A scanning electron microscope study.

PubMed

Metzger, Zvi; Teperovich, Ehud; Cohen, Raphaela; Zary, Raviv; Paqué, Frank; Hülsmann, Michael

2010-04-01

The aim of this study was to evaluate the cleaning ability of the Self-Adjusting File (SAF) system in terms of removal of debris and smear layer. Root canal preparations were performed in 20 root canals using an SAF operated with a continuous irrigation device. The glide path was initially established using a size 20 K-file followed by the SAF file that was operated in the root canal via a vibrating motion for a total of 4 minutes. Sodium hypochlorite (3%) and EDTA (17%) were used as continuous irrigants and were alternated every minute during this initial 4-minute period. This was followed by a 30-second rinse using EDTA applied through a nonactivated SAF and a final flush with sodium hypochlorite. The roots were split longitudinally and subjected to scanning electron microscopy (SEM). The presence of debris and a smear layer in the coronal, middle, and apical thirds of the canal were evaluated through the analysis of the SEM images using five-score evaluation systems based on reference photographs. The SAF operation with continuous irrigation, using alternating irrigants, resulted in root canal walls that were free of debris in all thirds of the canal in all (100%) of the samples. In addition, smear layer-free surfaces were observed in 100% and 80% of the coronal and middle thirds of the canal, respectively. In the apical third of the canal, smear layer-free surfaces were found in 65% of the root canals. The operation of the SAF system with continuous irrigation coupled with alternating sodium hypochlorite and EDTA treatment resulted in a clean and mostly smear layer-free dentinal surface in all parts of the root canal. Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Ultrasonic irrigation of a maxillary lateral incisor with perforation of the apical third of the root.

PubMed

Tsurumachi, Tamotsu; Takita, Toshiya; Hashimoto, Kazuhiro; Katoh, Takeshi; Ogiso, Bunnai

2010-12-01

We describe the successful use of a combination of nonsurgical root canal treatment and ultrasonic irrigation for collaborative management of a maxillary left lateral incisor with perforation of the apical third of the root. During the endodontic treatment procedure, the ultrasonically activated tip was used for intracanal irrigation. The area of perforation in the apical third of the root and the main root canal space were obturated with gutta-percha and root canal sealer, using a lateral condensation method. A follow-up clinical and radiographic examination at 5 years after treatment showed an asymptomatic tooth with excellent osseous healing.

Comparison of the EndoVac system and conventional needle irrigation on removal of the smear layer in primary molar root canals.

PubMed

Buldur, B; Kapdan, A

2017-09-01

This study aimed to compare the EndoVac system and conventional needle irrigation in removing smear layer (SR) from primary molar root canals. Fifty extracted human primary second molar roots were instrumented up to an apical size of 0.04/35 and randomly divided into two main groups; Group 1: EndoVac system (n = 25) and Group 2: Conventional needle irrigation (n = 25) and three subgroups (a) NaOCl + ethylenediaminetetraacetic acid (EDTA) (n = 20) (b) ozonated water (OW) + EDTA (n = 20) and (c) saline (control, n = 10). After a standardized final irrigation protocol performed for all teeth, scanning electron microscope images were taken at ×1000 magnification for each thirds of each root canal. Data were analyzed by the weighted kappa, Kruskal-Wallis, and Wilcoxon signed rank tests. EndoVac was more effective than conventional needle in the removal of SR from the apical third of the root canal system (P < 0.05). The OW + EDTA regimen provided similar SR removal compared with NaOCl + EDTA. EndoVac has better performance than conventional needle irrigation in the removal of the SR in the apical thirds of the primary molar root canals. As a final irrigation regimen, the OW + EDTA regimen is as effective as the NaOCl + EDTA regimen.

Comparison of positive-pressure, passive ultrasonic, and laser-activated irrigations on smear-layer removal from the root canal surface.

PubMed

Sahar-Helft, Sharonit; Sarp, Ayşe Sena Kabaş; Stabholtz, Adam; Gutkin, Vitaly; Redenski, Idan; Steinberg, Doron

2015-03-01

The purpose of this study was to compare the efficacy of three irrigation techniques for smear-layer removal with 17% EDTA. Cleaning and shaping the root canal system during endodontic treatment produces a smear layer and hard tissue debris. Three irrigation techniques were tested for solution infiltration of this layer: positive-pressure irrigation, passive ultrasonic irrigation, and laser-activated irrigation. Sixty extracted teeth were divided into six equal groups; 17% EDTA was used for 60 sec irrigation of five of the groups. The groups were as follows: Group 1, treated only with ProTaper™ F3 Ni-Ti files; Group 2, positive-pressure irrigation, with a syringe; Group 3, passive ultrasonic irrigation, inserted 1 mm short of the working length; Group 4, passive ultrasonic irrigation, inserted in the upper coronal third of the root; Group 5, Er:YAG laser-activated irrigation, inserted 1 mm short of the working length; and Group 6, Er:YAG laser-activated irrigation, inserted in the upper coronal third of the root. Scanning electron microscopy showed that the smear layer is removed most efficiently using laser-activated irrigation at low energy with 17% EDTA, inserted either at the working length or only in the coronal upper third of the root. Amounts of Ca, P, and O were not significantly different on all treated dentin surfaces. Smear-layer removal was most effective when the root canals were irrigated using Er:YAG laser at low energy with 17% EDTA solution. Interestingly, removal of the smear layer along the entire canal was similar when the laser was inserted in the upper coronal third and at 1 mm short of the working length of the root canal. This effect was not observed with the ultrasonic and positive-pressure techniques.

Additional disinfection with a modified salt solution in a root canal model.

PubMed

van der Waal, Suzette V; Oonk, Charlotte A M; Nieman, Selma H; Wesselink, Paul R; de Soet, Johannes J; Crielaard, Wim

2015-10-01

The aim of this study is to investigate the disinfecting properties of a modified salt solution (MSS) and calcium hydroxide (Ca(OH)2) in a non-direct-contact ex-vivo model. Seventy-four single-canal roots infected with Enterococcus faecalis were treated with 1% sodium hypochlorite (NaOCl) irrigation or with NaOCl irrigation with subsequent dressing with MSS or Ca(OH)2. After removal of the dressings, the roots were filled with bacterial growth medium and incubated for seven days to enable the surviving bacteria to repopulate the root canal lumen. Growth was determined by sampling the root canals with paper points before treatment (S1), after treatment (S2) and incubation after treatment (S3). The colony forming units were counted at S1 and S2. At S3, growth was determined as no/yes regrowth. The Kruskal-Wallis, McNemar and χ(2) test were used for statistical analyses. At S2, in the NaOCl group, growth was found in 5 of 19 root canals. After the removal of MSS or Ca(OH)2 bacteria were retrieved from one root canal in both groups. At S3, repopulation of the root canals had occurred in 14 of 19 roots after sole NaOCl irrigation, 6 of 20 roots after MSS-dressing and in 14 of 20 roots after Ca(OH)2-dressing. MSS was more effective in preventing regrowth than Ca(OH)2 (P=0.009). The modified salt solution prevented regrowth in roots which indicates that it can eliminate persistent bacteria. Dressing the root canals with Ca(OH)2 did not provide additional disinfection after NaOCl irrigation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Combined effects of photodynamic therapy and irrigants in disinfection of root canals.

PubMed

Susila, Anand V; Sugumar, R; Chandana, C S; Subbarao, C V

2016-06-01

In this study, the combined effects of photodynamic therapy and irrigants in eradicating common endodontic pathogens are evaluated. Roots of 80 extracted single rooted teeth are divided into 2 groups (1) mechanical flushing; (2) antibacterial irrigation. After cleaning and shaping, they are inoculated with either (A) Streptococcus mutans or (B) Enterococcus faecalis and incubated. They are again subdivided and either only irrigated or irrigated and lased. Dentin shavings are taken from root canal walls and cultured. Statistical analysis using One-Way ANOVA and Post-hoc tests are done. The combination eradicated both bacteria. Antibacterial irrigants controlled S. mutans better than PDT (p = 0.041). The combination of PDT and antibacterial irrigation proposed in this study can be used in all primary cases for thorough and reliable disinfection of root canals but may be highly effective in resistant cases like endodontic failures, as E. faecalis is prevalent in such cases. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Evaluation of the antimicrobial effect of super-oxidized water (Sterilox®) and sodium hypochlorite against Enterococcus faecalis in a bovine root canal model

PubMed Central

ROSSI-FEDELE, Giampiero; de FIGUEIREDO, José Antonio Poli; STEIER, Liviu; CANULLO, Luigi; STEIER, Gabriela; ROBERTS, Adam P.

2010-01-01

Ideally root canal irrigants should have, amongst other properties, antimicrobial action associated with a lack of toxicity against periapical tissues. Sodium hypochlorite (NaOCl) is a widely used root canal irrigant, however it has been shown to have a cytotoxic effect on vital tissue and therefore it is prudent to investigate alternative irrigants. Sterilox's Aquatine Alpha Electrolyte® belongs to the group of the super-oxidized waters; it consists of a mixture of oxidizing substances, and has been suggested to be used as root canal irrigant. Super-oxidized waters have been shown to provide efficient cleaning of root canal walls, and have been proposed to be used for the disinfection of medical equipment. Objective To compare the antimicrobial action against Enterococcus faecalis of NaOCl, Optident Sterilox Electrolyte Solution® and Sterilox's Aquatine Alpha Electrolyte® when used as irrigating solutions in a bovine root canal model. Methodology Root sections were prepared and inoculated with E. faecalis JH2-2. After 10 days of incubation the root canals were irrigated using one of three solutions (NaOCl, Optident Sterilox Electrolyte Solution® and Sterilox's Aquatine Alpha Electrolyte®) and subsequently sampled by grinding dentin using drills. The debris was placed in BHI broth and dilutions were plated onto fresh agar plates to quantify growth. Results Sodium hypochlorite was the only irrigant to eliminate all bacteria. When the dilutions were made, although NaOCl was still statistically superior, Sterilox's Aquatine Alpha Electrolyte® solution was superior to Optident Sterilox Electrolyte Solution®. Conclusion Under the conditions of this study Sterilox's Aquatine Alpha Electrolyte® appeared to have significantly more antimicrobial action compared to the Optident Sterilox Electrolyte Solution® alone, however NaOCl was the only solution able to consistently eradicate E. faecalis in the model. PMID:21085808

A Comparative Evaluation on Antimicrobial Effect of Honey, Neem Leaf Extract and Sodium Hypochlorite as Intracanal Irrigant: An Ex-Vivo Study

PubMed Central

Narayanan, Retna Kumari; Vadakkepurayil, Kannan

2016-01-01

Introduction The major determinant of the success of root canal treatment depends on meticulous disinfection of the root canal using intracanal irrigants. The most commonly used root canal irrigant is sodium hypochlorite which has disadvantages of cytotoxicity and unpleasant taste. So there is a need to identify a more biocompatible root canal irrigant. Aim The aim of this ex-vivo study was to evaluate the efficacy of 40% honey, 100% neem leaf extract and 5.25% sodium hypochlorite as an intracanal irrigant against the isolated microorganisms from infected root canal. Materials and Methods The samples were collected from infected root canals of 60 primary molar teeth indicated for pulpectomy. Alpha hemolytic Streptococci, gram negative bacilli, Candida, Staphylococci, Lactobacilli, Enterococci, Spore bearing gram positive bacilli and Micrococci were the microorganisms isolated from the samples. The zone of inhibition against the microbial growth was measured by agar well diffusion method. Statistical analysis was done by Repeated Analysis of Variance (ANOVA) and Bonferroni method. Results Statistical analysis showed that the means of the zones of inhibition measured in this study were 18.56mm, 2.09mm and 1.62mm for sodium hypochlorite, 100% neem leaf extract and 40% honey respectively. The significance was greater between sodium hypochlorite and the other two agents as p-value was <0.001. Conclusion The results indicated that 5.25% sodium hypochlorite is more effective as root canal irrigant when compared with 100% neem leaf extract and 40% honey. It was also observed that 100% neem leaf extract has greater antimicrobial effect than 40% honey. PMID:27656571

Efficiency of Different Endodontic Irrigation and Activation Systems in Removal of the Smear Layer: A Scanning Electron Microscopy Study.

PubMed

Karade, Priyatam; Chopade, Rutuja; Patil, Suvarna; Hoshing, Upendra; Rao, Madhukar; Rane, Neha; Chopade, Aditi; Kulkarni, Anish

2017-01-01

This in vitro study was designed to evaluate and compare different endodontic irrigation and activation systems for removal of the intracanal smear layer. Forty recently extracted, non-carious human intact single rooted premolars were selected and divided into five groups ( n =10) according to the root canal irrigation systems; syringe and needle irrigation (CTR), sonic irrigation, passive ultrasonic irrigation (PUI) and EndoVac irrigation system. All groups were prepared to #40 apical size with K-files. Each sample was subjected to final irrigation by using four different irrigation/activation systems. After splitting the samples, one half of each root was selected for examination under scanning electron microscope (SEM). The irrigation systems were compared using the Fisher's exact test with the level of significance set at 0.05. The four groups did not differ from each other in the coronal and mid-root parts of the canal. In the apical part of the canal none of the methods could completely remove all the smear layer but EndoVac system showed significantly better removal of smear layer and debris than the other methods. Within the limitations of the present study, the EndoVac system cleaned the apical part of the canal more efficiently than sonic, ultrasonic and syringe and needle irrigation.

Confocal laser scanning, scanning electron, and transmission electron microscopy investigation of Enterococcus faecalis biofilm degradation using passive and active sodium hypochlorite irrigation within a simulated root canal model.

PubMed

Mohmmed, Saifalarab A; Vianna, Morgana E; Penny, Matthew R; Hilton, Stephen T; Mordan, Nicola; Knowles, Jonathan C

2017-08-01

Root canal irrigation is an important adjunct to control microbial infection. The aim of this study was to investigate the effect of 2.5% (wt/vol) sodium hypochlorite (NaOCl) agitation on the removal, killing, and degradation of Enterococcus faecalis biofilm. A total of 45 root canal models were manufactured using 3D printing with each model comprising an 18 mm length simulated root canal of apical size 30 and taper 0.06. E. faecalis biofilms were grown on the apical 3 mm of the models for 10 days. A total of 60 s of 9 ml of 2.5% NaOCl irrigation using syringe and needle was performed, the irrigant was either left stagnant in the canal or agitated using manual (Gutta-percha), sonic, and ultrasonic methods for 30 s. Following irrigation, the residual biofilms were observed using confocal laser scanning, scanning electron, and transmission electron microscopy. The data were analyzed using one-way ANOVA with Dunnett post hoc tests at a level of significance p ≤ .05. Consequence of root canal irrigation indicate that the reduction in the amount of biofilm achieved with the active irrigation groups (manual, sonic, and ultrasonic) was significantly greater when compared with the passive and untreated groups (p < .05). Collectively, finding indicate that passive irrigation exhibited more residual biofilm on the model surface than irrigant agitated by manual or automated (sonic, ultrasonic) methods. Total biofilm degradation and nonviable cells were associated with the ultrasonic group. © 2017 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.

Effect of diode laser and ultrasonics with and without ethylenediaminetetraacetic acid on smear layer removal from the root canals: A scanning electron microscope study.

PubMed

Amin, Khalid; Masoodi, Ajaz; Nabi, Shahnaz; Ahmad, Parvaiz; Farooq, Riyaz; Purra, Aamir Rashid; Ahangar, Fayaz Ahmad

2016-01-01

To evaluate the effect of diode laser and ultrasonics with and without ethylenediaminetetraacetic acid (EDTA) on the smear layer removal from root canals. A total of 120 mandibular premolars were decoronated to working the length of 12 mm and prepared with protaper rotary files up to size F3. Group A canals irrigated with 1 ml of 3% sodium hypochlorite (NaOCl) followed by 3 ml of 3% NaOCl. Group B canals irrigated with 1 ml of 17% EDTA followed by 3 ml of 3% NaOCl. Group C canals lased with a diode laser. Group D canals were initially irrigated with 0.8 ml of 17% EDTA the remaining 0.2 ml was used to fill the root canals, and diode laser application was done. Group E canals were irrigated with 1 ml distilled water with passive ultrasonic activation, followed by 3 ml of 3% NaOCl. Group F canals were irrigated with 1 ml EDTA with passive ultrasonic activation, followed by 3 ml of 3% NaOCl. Scanning electron microscope examination of canals was done for remaining smear layer at coronal middle and apical third levels. Ultrasonics with EDTA had the least smear layer scores. Diode laser alone performed significantly better than ultrasonics.

Efficacy of different irrigation and activation systems on the penetration of sodium hypochlorite into simulated lateral canals and up to working length: an in vitro study.

PubMed

de Gregorio, Cesar; Estevez, Roberto; Cisneros, Rafael; Paranjpe, Avina; Cohenca, Nestor

2010-07-01

The removal of vital and necrotic pulp tissue, microorganisms, and their toxins is essential for endodontic success. However, the complex anatomy of the root canal system has limited our ability to debride it completely. Hence the purpose of this study was to evaluate the effect of currently used irrigation and activation systems on the penetration of sodium hypochlorite into simulated lateral canals and to working length in a closed system. One hundred single-rooted teeth were used in this study. A total of 600 simulated lateral canals were created, 6 in each tooth, with 2 lateral canals at 2, 4.5, and 6 mm of working length. To resemble the clinical situation, a closed system was created by coating each root with soft modeling wax. Roots were then randomly assigned to 4 experimental groups: group 1 (n = 20), Endoactivator (sonic activation); group 2 (n = 20), passive ultrasonic (PUI) activation; group 3 (n = 20), F file; group 4 (n = 20), apical negative pressure (ANP) irrigation; and control group 5 (n = 20), positive pressure irrigation. The samples were evaluated by direct observation of the images recorded under the dental operating microscope. The results demonstrated that the ANP irrigation group was superior at reaching working length, and PUI was the most effective at lateral canal penetration. The ANP irrigation system demonstrated limited activation of the irrigant into lateral canals but reached the working length significantly more than the other groups tested. In contrast, PUI group demonstrated significantly more penetration of irrigant into lateral canals but not up to the working length. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Sodium hypochlorite in endodontics: an update review.

PubMed

Mohammadi, Zahed

2008-12-01

The major objective in root canal treatment is to disinfect the entire root canal system. This requires that the pulpal contents be eliminated as sources of infection. This goal may be accomplished using mechanical instrumentation and chemical irrigation, in conjunction with medication of the root canal between treatment sessions. Microorganisms and their by-products are considered to be the major cause of pulpal and periradicular pathosis. In order to reduce or eliminate bacteria and pulpal tissue remnants, various irrigation solutions have been suggested to be used during treatment. Sodium hypochlorite, an excellent non-specific proteolytic and antimicrobial agent, is the most common irrigation solution used during root canal therapy. The purpose of this paper was to review different aspects of sodium hypochlorite use in endodontics.

Apical pressure created during irrigation with the GentleWave™ system compared to conventional syringe irrigation.

PubMed

Haapasalo, Markus; Shen, Ya; Wang, Zhejun; Park, Ellen; Curtis, Allison; Patel, Payal; Vandrangi, Prashanthi

2016-09-01

The purpose of this study is to compare pressures at the apical foramen created by conventional syringe irrigation and the GentleWave™ System, which releases high-velocity degassed irrigants to the pulp chamber and uses broad-spectrum sound energy for cleaning. The apical pressure generated during irrigation was measured for palatal and distobuccal root canals of four extracted maxillary molars after no instrumentation, minimal instrumentation to a size #15/.04, instrumentation to a size #40/.04 taper, and after perforating the apical foramen to size #40. The root canals opened into an air-tight custom fixture coupled to a piezoresistive pressure transducer. Apical pressures were measured for the GentleWave™ System and syringe-needle irrigation at different irrigant flow rates, with the needle tip at 1 and 3 mm from the apical foramen using 30-gauge (G) open-ended or side-vented safety tip needles. The GentleWave™ System generated negative apical pressures (P < 0.001 compared with syringe irrigation); the mean pressures were between -13.07 and -17.19 mmHg. The 30 G needles could not reach the 1 and 3 mm from the working length in uninstrumented and 1 mm in minimally instrumented canals. The mean positive pressures between 6.46 and 110.34 mmHg were measured with needle irrigation depending on the flow rate, needle insertion depth, and size of the root canal. The GentleWave™ System creates negative pressure at the apical foramen during root canal cleaning irrespective of the size of canal instrumentation. Positive apical pressures were measured for syringe irrigation. Negative pressure during irrigation contributes to improved safety as compared to high-positive pressure.

Measurement and visualization of file-to-wall contact during ultrasonically activated irrigation in simulated canals.

PubMed

Boutsioukis, C; Verhaagen, B; Walmsley, A D; Versluis, M; van der Sluis, L W M

2013-11-01

(i) To quantify in a simulated root canal model the file-to-wall contact during ultrasonic activation of an irrigant and to evaluate the effect of root canal size, file insertion depth, ultrasonic power, root canal level and previous training, (ii) To investigate the effect of file-to-wall contact on file oscillation. File-to-wall contact was measured during ultrasonic activation of the irrigant performed by 15 trained and 15 untrained participants in two metal root canal models. Results were analyzed by two 5-way mixed-design anovas. The level of significance was set at P < 0.05. Additionally, high-speed visualizations, laser-vibrometer measurements and numerical simulations of the file oscillation were conducted. File-to-wall contact occurred in all cases during 20% of the activation time. Contact time was significantly shorter at high power (P < 0.001), when the file was positioned away from working length (P < 0.001), in the larger root canal (P < 0.001) and from coronal towards apical third of the root canal (P < 0.002), in most of the cases studied. Previous training did not show a consistent significant effect. File oscillation was affected by contact during 94% of the activation time. During wall contact, the file bounced back and forth against the wall at audible frequencies (ca. 5 kHz), but still performed the original 30 kHz oscillations. Travelling waves were identified on the file. The file oscillation was not dampened completely due to the contact and hydrodynamic cavitation was detected. Considerable file-to-wall contact occur-red during irrigant activation. Therefore, the term 'Passive Ultrasonic Irrigation' should be amended to 'Ultrasonically Activated Irrigation'. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Model assessing thermal changes during high temperature root canal irrigation

PubMed Central

Bartolo, Analise; Koyess, Edmond; Micallef, Christopher

2016-01-01

The main aim of root canal irrigation is to eliminate micro-organisms. Sodium hypochlorite (NaOCl) is considered to be the ideal material and raising its temperature potentiates the antimicrobial activity. NaOCl may lead to localised tissue necrosis when extruded past the root apex. This study analyses the use of high temperature root canal irrigation as an alternative process for the elimination of microorganisms from the root canal system. An experimental set-up was designed where a constant supply of heat was passed from a heat source through a copper wire inside the root canal. The data acquired together with known constants pertaining to enamel and dentine was used to numerically model the thermal changes in a tooth using a finite element method. Results obtained from the finite element thermal model of the tooth were repeatable and were validated with the experimental results. The thermo-physical properties of the tooth were varied and convergence criteria met. The temperatures reached were below what has been reported to cause irreversible damage to the bone. This was further confirmed from a series of simulations that were undertaken. The temperatures achieved were suitable for the elimination of microorganisms during root canal therapy. PMID:27733934

Irrigant flow within a prepared root canal using various flow rates: a Computational Fluid Dynamics study.

PubMed

Boutsioukis, C; Lambrianidis, T; Kastrinakis, E

2009-02-01

To study using computer simulation the effect of irrigant flow rate on the flow pattern within a prepared root canal, during final irrigation with a syringe and needle. Geometrical characteristics of a side-vented endodontic needle and clinically realistic flow rate values were obtained from previous and preliminary studies. A Computational Fluid Dynamics (CFD) model was created using FLUENT 6.2 software. Calculations were carried out for five selected flow rates (0.02-0.79 mL sec(-1)) and velocity and turbulence quantities along the domain were evaluated. Irrigant replacement was limited to 1-1.5 mm apical to the needle tip for all flow rates tested. Low-Reynolds number turbulent flow was detected near the needle outlet. Irrigant flow rate affected significantly the flow pattern within the root canal. Irrigation needles should be placed to within 1 mm from working length to ensure fluid exchange. Turbulent flow of irrigant leads to more efficient irrigant replacement. CFD represents a powerful tool for the study of irrigation.

Three rooted, four canalled mandibular first molar (Radix Entomolaris).

PubMed

Parolia, Abhishek; Kundabala, M; Thomas, M S; Mohan, M; Joshi, N

2009-01-01

A mandibular first molar with two distal roots is an interesting example of anatomic variation. This paper describes case reports of mandibular first molar with three roots (one mesial and two distal) and four canals (two in mesial and one in each distobuccal and distolingual root). The canals were shaped with protaper rotary files and irrigated with 5.25% sodium hyochlorite, 0.2 %w/v of chlorhexidine gluconate and normal saline as the fi nal irrigant. The canals were then obturated with gutta- percha and AH plus sealer. These case reports show an anatomic variation of internal morphology of the tooth and points out the importance of searching for additional canals.

Irrigation dynamics associated with positive pressure, apical negative pressure and passive ultrasonic irrigations: a computational fluid dynamics analysis.

PubMed

Chen, José Enrique; Nurbakhsh, Babak; Layton, Gillian; Bussmann, Markus; Kishen, Anil

2014-08-01

Complexities in root canal anatomy and surface adherent biofilm structures remain as challenges in endodontic disinfection. The ability of an irrigant to penetrate into the apical region of a canal, along with its interaction with the root canal walls, will aid in endodontic disinfection. The aim of this study was to qualitatively examine the irrigation dynamics of syringe irrigation with different needle tip designs (open-ended and closed-ended), apical negative pressure irrigation with the EndoVac® system, and passive ultrasonic-assisted irrigation, using a computational fluid dynamics model. Syringe-based irrigation with a side-vented needle showed a higher wall shear stress than the open-ended but was localised to a small region of the canal wall. The apical negative pressure mode of irrigation generated the lowest wall shear stress, while the passive-ultrasonic irrigation group showed the highest wall shear stress along with the greatest magnitude of velocity. © 2013 The Authors. Australian Endodontic Journal © 2013 Australian Society of Endodontology.

The antimicrobial effectiveness of 25% propolis extract in root canal irrigation of primary teeth.

PubMed

Verma, Manjesh Kumar; Pandey, Ramesh Kumar; Khanna, Richa; Agarwal, Jyotsna

2014-01-01

The choice of irrigating solution used in root canals of primary teeth is complicated by their complex morphology and paucity of associated literature. Propolis is a natural product that has gained interest in this context due to its antibacterial effectiveness against several endodontic pathogens. The present study was undertaken to assess the potential of water-soluble 25% propolis extract against microorganisms present in root canals of primary teeth during endodontic procedures. The child patients in the age group of 4-7 years with radiographic evidence of carious pulp exposure were included in the study. Definitive selection was done after gaining access into the pulp chamber and root canals of the selected teeth. The clinical and radiographic evidence of pathosis was ruled out for inclusion in the study. The selected teeth were divided into two groups randomly. In Group A 0.9% isotonic saline and in Group B 25% extract water-soluble propolis were used as irrigating solution, respectively. The bacterial samples were collected both pre- and post-irrigation and were transferred for microbial assay. STAISTISTICAL ANALYSIS: Wilcoxon matched signed rank test was used to compare the pre-and post-irrigation bacterial counts. Mann-Whitney test was used to compare the mean change (pre-post) in bacterial colony counts of groups in the study. Antimicrobial effectiveness of 25% water-soluble extract of propolis in the root canals of primary teeth was confirmed in the present study. The reduction in the mean bacterial colony counts of all the isolated bacteria was noticed higher in Group B than Group A. The results of the present study have confirmed that the antibacterial effectiveness of water-soluble extract of propolis in the root canals of primary teeth in vivo. Considering the low toxicity concerns and antibacterial effectiveness, water-soluble extract of 25% propolis can be advocated as a root canal irrigant in endodontic treatment of primary teeth.

Antibacterial efficacy of an endodontic sonic-powered irrigation system: An in vitro study.

PubMed

Zeng, Chang; Willison, Jon; Meghil, Mohamed M; Bergeron, Brian E; Cutler, Christopher W; Tay, Franklin R; Niu, Lina; Ma, Jingzhi

2018-06-13

To evaluate the efficacy of EDDY, a new sonic-powered irrigation system, in reducing intracanal bacteria load. Thirty-eight instrumented, autoclaved single-rooted human premolars were inoculated with Enterococcus faecalis (ATCC-29212) for 21 days. Two teeth were used as negative control without bacterial contamination. For the bacteria-inoculated teeth, 6 were used as positive control without irrigation. The remaining 30 teeth were randomly divided into 2 groups (N = 15), using 3% NaOCl as irrigant: (A) 30-gauge syringe needle irrigation (SNI), (B) EDDY (VDW, Munich, Germany). Twelve teeth per group and 4 teeth in the positive control were evaluated for bacterial reduction using MTT assay. The remaining teeth were split for BacLight LIVE/DEAD staining to examine the percentages of live/dead bacteria present in the dentinal tubules from different canal locations (coronal, mid-root and apical portions of the canal space) using confocal laser scanning microscopy (CLSM). MTT assay indicated that both SNI and EDDY significantly reduced overall intracanal bacterial load compared with the positive control, with no significant difference between the two techniques. CLSM indicated that EDDY had better intratubular bacterial killing efficacy than SNI in the coronal and mid-root portions of the canal space only but not in the apical portion. In all canal locations (coronal, mid-root apical), both systems failed to eliminate bacteria that proliferated deep within the dentinal tubules. With the use of 3% NaOCl, sonic-powered irrigant activation with EDDY tips did not provide additional advantage over SNI in killing Enterococcus faecalis from deep intraradicular dentin. Both the sonic-powered root canal irrigant activation system and syringe needle irrigation can reduce intracanal bacteria load but are incapable of completely killing all bacteria that resided deep within the dentinal tubules of root canals infected with Enterococcus faecalis. Published by Elsevier Ltd.

Comparison of the Antimicrobial Efficacy of Two Antibiotics Sparfloxacin and Augmentin as Experimental Root Canal Irrigating Solutions against Enterococcus faecalis - An Invitro Study

PubMed Central

Venigalla, Bhuvan Shome; Surakanti, Jayaprada Reddy; Thumu, Jayaprakash; Chennamaneni, Krishna Chaitanya; Kalluru, Rama S.

2016-01-01

Introduction One of the main goals of endodontic treatment is root canal disinfection and to prevent subsequent chances of reinfection. Adjuvant to instrumentation, root canal irrigants are required to eliminate the bacteria found on the root canal walls and lateral canals within the dentinal tubules. Aim To measure and compare the antibacterial efficacy of two antibiotics as experimental root canal irrigating solutions against Enterococcus faecalis (E. faecalis). Materials and Methods Fifteen Brain Heart Infusion agar plates were inoculated with Enterococcus faecalis-American Type Culture Collection (ATCC) 29212. 5 micrograms (mcg) Sparfloxacin discs, 30mcg Augmentin discs, and sterile paper test discs saturated with 2% Chlorhexidine (CHX), 3% Sodium Hypochlorite (NaOCl) and 5% NaOCl solutions were placed on agar plates. Sodium Chloride 0.9% (NaCl) paper discs were used as controls. Fifteen plates were incubated aerobically at 37°C. Results were expressed as per the terms of the diameter of the inhibition zone. Results Results suggested a statistically significant difference in the zones of inhibition between five irrigating solutions (p < 0.001). Conclusion Although, zones of inhibition were found in all the groups, 5mcg Sparfloxacin and 30mcg Augmentin showed maximum antimicrobial activity against E.faecalis. PMID:27135003

Investigations into in situ Enterococcus faecalis biofilm removal by passive and active sodium hypochlorite irrigation delivered into the lateral canal of a simulated root canal model.

PubMed

Mohmmed, S A; Vianna, M E; Penny, M R; Hilton, S T; Mordan, N J; Knowles, J C

2018-06-01

To investigate in situ Enterococcus faecalis biofilm removal from the lateral canal of a simulated root canal system using passive or active irrigation protocols. Root canal models (n = 43) were manufactured from transparent resin materials using 3D printing. Each canal was created with an 18 mm length, apical size 30, a .06 taper and a lateral canal of 3 mm length, with 0.3 mm diameter. Biofilms were grown in the lateral canal and apical 3 mm of the main canal for 10 days. Three models from each group were examined for residual biofilm using SEM. The other forty models were divided into four groups (n = 10). The models were observed under a fluorescence microscope. Following 60 s of 9 mL of 2.5% NaOCl irrigation using syringe and needle, the irrigant was either left stagnant in the canal or activated using gutta-percha, sonic or ultrasonic methods for 30 s. Images were then captured every second using an external camera. The residual biofilm percentages were measured using image analysis software. The data were analysed using generalized linear mixed models. A significance level of 0.05 was used throughout. The greatest level of biofilm removal was obtained with ultrasonic agitation (66.76%) followed by sonic (45.49%), manual agitation (43.97%) and passive irrigation groups (38.67%), respectively. The differences were significant between the residual biofilm in the passive irrigation and both sonic and ultrasonic groups (P = 0.001). Agitation resulted in better penetration of 2.5% NaOCl into the lateral canal of an artificial root canal model. Ultrasonic agitation of NaOCl improved the removal of biofilm. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Efficacy of irrigation systems on penetration of sodium hypochlorite to working length and to simulated uninstrumented areas in oval shaped root canals.

PubMed

de Gregorio, C; Paranjpe, A; Garcia, A; Navarrete, N; Estevez, R; Esplugues, E O; Cohenca, N

2012-05-01

To assess the ability of sodium hypochlorite (NaOCl) to penetrate simulated lateral canals and to reach working length (WL) when using the self-adjusting file (SAF). Seventy single-rooted teeth with oval-shaped canals were used. Upon access, presence of a single canal was confirmed by direct visualization under a dental-operating microscope. Canal length and patency were obtained using a size 10 K-file and root length standardized to 18 mm. Pre-enlargement was restricted to the coronal one-third. The apical size of each canal was gauged at WL and samples larger than size 30 were excluded. Canals were instrumented for 5 min using the SAF system while delivering a total of 20 mL of 5.25% NaOCl and 5 mL of 17% EDTA. Then, the apical diameters were standardized to size 35 using hand files. Four hundred and twenty simulated lateral canals were then created during the clearing process and roots coated with wax to create a closed system. All samples were then cleared and randomly assigned to four experimental groups: 1 (n = 15) positive pressure; 2 (n = 15) SAF without pecking motion; 3 (n = 15) SAF with pecking motion; 4 (n = 15) apical negative pressure (ANP) irrigation and (n = 10) control groups. Samples were scored on the basis of the ability of the contrast solution to reach WL and permeate into the simulated lateral canals to at least 50% of the total length. The Kruskal-Wallis test was used to analyse irrigant penetration and the Tukey test to determine statistical differences between groups (P < 0.05). All samples irrigated with ANP were associated with irrigant penetration to WL (Table 1). The differences between group 4 (ANP) and all other groups were significant in penetration to WL (P < 0.05). The pecking motion allowed for further penetration of the irrigant when using the SAF system but failed to irrigate at WL. None of the experimental groups demonstrated predictable irrigation of simulated lateral canals. In this laboratory model, ANP was the only delivery system capable of irrigating consistently to full WL. None of the systems tested produced complete irrigation in artificial lateral canals. © 2012 International Endodontic Journal.

Efficacy of 3D conforming nickel titanium rotary instruments in eliminating canal wall bacteria from oval-shaped root canals.

PubMed

Bortoluzzi, Eduardo A; Carlon, Daniel; Meghil, Mohamed M; El-Awady, Ahmed R; Niu, Lina; Bergeron, Brian E; Susin, Lisiane; Cutler, Christopher W; Pashley, David H; Tay, Franklin R

2015-05-01

To evaluate the effectiveness of TRUShape® 3D Conforming Files, compared with Twisted Files, in reducing bacteria load from root canal walls, in the presence or absence of irrigant agitation. Extracted human premolars with single oval-shaped canals were infected with Enterococcus faecalis. Teeth in Group I (N=10; NaOCl and QMix® 2in1 as respective initial and final irrigants) were subdivided into 4 subgroups: (A) TRUShape® instrumentation without irrigant activation; (B) TRUShape® instrumentation with sonic irrigant agitation; (C) Twisted Files without irrigant agitation; (D) Twisted Files with sonic irrigant agitation. To remove confounding factor (antimicrobial irrigants), teeth in Group II (N=10) were irrigated with sterile saline, using the same subgroup designations. Specimens before and after chemomechanical débridement were cultured for quantification of colony-forming units (CFUs). Data from each group were analyzed separately using two-factor ANOVA and Holm-Sidak multiple comparison (α=0.05). Canal wall bacteria were qualitatively examined using scanning electron microscopy (SEM) and light microscopy of Taylor-modified Brown and Brenn-stained demineralised sections. CFUs from subgroups in Group I were not significantly different (P=0.935). For Group II, both file type (P<0.001) and irrigant agitation (P<0.001) significantly affected log-reduction in CFU concentrations. The interaction of these two factors was not significant (P=0.601). Although SEM showed reduced canal wall bacteria, bacteria were present within dentinal tubules after rotary instrumentation, as revealed by light microscopy of longitudinal root sections. TRUShape® files removed significantly more canal wall bacteria than Twisted Files when used without an antibacterial irrigant; the latter is required to decontaminate dentinal tubules. Root canal disinfection should not be focused only on a mechanistic approach. Rather, the rational choice of a rotary instrumentation system should be combined with the use of well-tested antimicrobial irrigants and delivery/agitation techniques to establish a clinically realistic chemomechanical débridement protocol. Published by Elsevier Ltd.

Evaluation of triple antibiotic paste removal by different irrigation procedures.

PubMed

Berkhoff, Julie A; Chen, Paul B; Teixeira, Fabricio B; Diogenes, Anibal

2014-08-01

Regenerative endodontics aims to re-establish a functional pulp-dentin complex. First, the root canal system is disinfected primarily by irrigants and medicaments. Triple antibiotic paste (TAP), a commonly used intracanal medicament, has been shown to be directly toxic to stem cells at concentrations greater than 0.1 g/mL. Thus, its complete removal is a crucial step in regenerative endodontic procedures. We hypothesized that currently used irrigation techniques do not completely remove TAP from root canal system. TAP was radiolabeled by the incorporation of I(125), and calcium hydroxide (Ultracal; Ultradent, South Jordan, UT) was radiolabeled with Ca(45). The intracanal medicaments were placed into standardized human root segments and incubated for 28 days at 37°C. Then, canals were irrigated with EndoActivator (Dentsply, Tulsa, OK), passive ultrasonic irrigation, EndoVac (SybronEndo, Coppell, TX), or a syringe/Max-i-Probe needle (Dentsply Rinn, Elgin, IL) using a standardized irrigation protocol in a closed system. Radioactivity levels (counts per minute values) were measured for each tooth before and after the irrigation protocols. Furthermore, the canals were sequentially enlarged and dentin samples collected and evaluated for radioactivity. Data were analyzed with analysis of variance and Bonferroni post hoc testing (P < .05). Approximately 88% of the TAP was retained in the root canal system regardless of the irrigation technique used (no difference among groups). Furthermore, approximately 50% of the radiolabeled TAP was present circumferentially up to 350 μm within the dentin. Conversely, up to 98% of the radiolabeled intracanal calcium hydroxide was removed, and most residual medicament was found present in the initial 50 μm of dentin. Current irrigation techniques do not effectively remove TAP from root canal systems, possibly because of its penetration and binding into dentin. However, calcium hydroxide is effectively removed with significant less residual presence. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

An in vitro evaluation of various irrigation techniques for the removal of double antibiotic paste from root canal surfaces

PubMed Central

GOKTURK, Hakan; OZKOCAK, Ismail; BUYUKGEBİZ, Fevzi; DEMİR, Osman

2016-01-01

ABSTRACT Objective The aim of this study was to investigate the effectiveness of conventional syringe irrigations, passive ultrasonic irrigation (PUI), Vibringe, CanalBrush, XP-endo Finisher, and laser-activated irrigation (LAI) systems in removing double antibiotic paste (DAP) from root canals. Material and Methods One hundred five extracted single-rooted teeth were instrumented. The roots were split longitudinally. Three standard grooves were created and covered with DAP. The roots were distributed into seven groups: Group 1, beveled needle irrigation; Group 2, double side-vented needle irrigation; Group 3, CanalBrush; Group 4, XP-endo Finisher; Group 5, Vibringe; Group 6, PUI; Group 7, LAI. The amount of remaining DAP was scored under a stereomicroscope. Results Group 4, Group 6, and Group 7 removed significantly more DAP than the other protocols in the coronal region. Group 7 was more efficient in the middle region; however, no significant difference was found between Group 7 and Group 6. No differences were found between groups in the apical region either, except for the comparisons between groups 7 and 2, and groups 2 and 3. Conclusions None of the investigated protocols were able to completely remove the DAP from the grooves. The Vibringe and XP-endo Finisher systems showed results similar to those of conventional needle irrigation. PMID:28076461

A novel experimental approach to investigate the effect of different agitation methods using sodium hypochlorite as an irrigant on the rate of bacterial biofilm removal from the wall of a simulated root canal model.

PubMed

Mohmmed, Saif Alarab; Vianna, Morgana E; Penny, Matthew R; Hilton, Stephen T; Mordan, Nicola; Knowles, Jonathan C

2016-10-01

Root canal irrigation is an important adjunct to control microbial infection. This study aimed primarily to develop a transparent root canal model to study in situ Enterococcus faecalis biofilm removal rate and remaining attached biofilm using passive or active irrigation solution for 90s. The change in available chlorine and pH of the outflow irrigant were assessed. A total of forty root canal models (n=10 per group) were manufactured using 3D printing. Each model consisted of two longitudinal halves of an 18mm length simulated root canal with size 30 and taper 0.06. E. faecalis biofilms were grown on the apical 3mm of the models for 10days in Brain Heart Infusion broth. Biofilms were stained using crystal violet for visualization. The model halves were reassembled, attached to an apparatus and observed under a fluorescence microscope. Following 60s of 9mL of 2.5% NaOCl irrigation using syringe and needle, the irrigant was either left stagnant in the canal or activated using gutta-percha, sonic and ultrasonic methods for 30s. Images were then captured every second using an external camera. The residual biofilm percentages were measured using image analysis software. The data were analyzed using Kruskal-Wallis test and generalized linear mixed model. The highest level of biofilm removal was with ultrasonic agitation (90.13%) followed by sonic (88.72%), gutta-percha (80.59%), and passive irrigation group (control) (43.67%) respectively. All agitation groups reduced the available chlorine and pH of NaOCl more than that in the passive irrigation group. The 3D printing method provided a novel model to create a root canal simulation for studying and understanding a real-time biofilm removal under microscopy. Ultrasonic agitation of NaOCl left the least amount of residual biofilm in comparison to sonic and gutta-percha agitation methods. Copyright © 2016 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Comparison of the Antibacterial Effect and Smear Layer Removal Using Photon-Initiated Photoacoustic Streaming Aided Irrigation Versus a Conventional Irrigation in Single-Rooted Canals: An In Vitro Study

PubMed Central

Zhu, Xiaofei; Yin, Xingzhe; Chang, Jeffrey W.W.; Wang, Yu; Cheung, Gary S.P.

2013-01-01

Abstract Objective: The Er:YAG laser with photon-induced photoacoustic streaming (PIPS) technique was reported to be effective in root canal disinfection. This study attempted to further investigate the antibacterial efficacy and smear layer removal ability of PIPS in comparison with conventional syringe irrigation in vitro. Methods: For antibacterial analysis, 48 single-rooted human teeth were prepared and inoculated with Enterococcus faecalis, and then divided into six groups of eight roots each. The colony-forming units (CFUs) per milliliter were determined after infection as the baseline. Then, the teeth were subjected to either PIPS plus 3% sodium hypochlorite (PIPS+NaOCl) or conventional syringe irrigation with 0.9% saline, 3% NaOCl, 17% ethylenediaminetetraacetic acid (EDTA), 0.2% chlorhexidine gluconate (CHX), or 3% NaOCl alternating with 17% EDTA. The reduction of CFUs in the individual group was determined. Additionally, scanning electron microscopy (SEM) examination of the canal walls for E. faecalis colonization was performed. For comparing the smear removal efficacy, another 48 single-rooted teeth, assigned to different groups as mentioned, were irrigated after mechanical instrumentation. The presence of a smear layer at different levels of the root canal was scored by SEM examination. Results: No significant differences were found in CFU reduction. No bacteria could be observed by SEM in the NaOCl, NaOCl+EDTA, and PIPS+NaOCl groups. The scores of smear layer of the NaOCl+EDTA and PIPS+NaOCl groups were significantly lower than those of the other groups in the coronal and middle third of the root canal. None of the methods can effectively remove smear layer in the apical third. Conclusions: PIPS system supplied with NaOCl and conventional syringe irrigation with NaOCl+EDTA are comparable in their ability to remove E. faecalis and smear layer in single-rooted canals. PMID:23863104

From files to SAF: 3D endodontic treatment is possible at last.

PubMed

Metzger, Zvi

2011-01-01

3D cleaning, shaping and obturation of root canals has always been the desired goal of endodontic treatment which in many cases is difficult to attain. The introduction of NiTi rotary files made a major change in endodontic practice, making treatment easier, safer and faster. Nevertheless, after 16 years of intensive development, most of these instruments still share several drawbacks, the major one being the inability to three-dimensionally clean and shape oval root canals. The Self-Adjusting File (SAF) System was designed to overcome many of the current drawbacks of rotary file systems. It is based on a hollow, highly compressible file that adapts itself three-dimensionally to the shape of a given root canal, including its cross section. The file is operated with vibratory in-and-out motion, with continuous irrigation delivered by a peristaltic pump through the hollow file. A uniform layer of dentin is removed from the whole circumference of the root canal, thus achieving the main goals of root canal treatment while preserving the remaining root dentin. The 3D scrubbing effect of the file, combined with the always fresh irrigant, result in unprecedentedly clean canals which facilitate in turn better obturation. More effective disinfection of flat-oval root canals is another goal which is simultaneously attained. The safety of the root-canal treatment is also greatly enhanced by the high mechanical stability of the SAF and by using a new concept of no-pressure irrigation. The SAF System gets the operator much closer to the long-desired goal of 3D root-canal treatment.

The Effect of Sodium Hypochlorite and Chlorhexidine as Irrigant Solutions for Root Canal Disinfection: A Systematic Review of Clinical Trials.

PubMed

Gonçalves, Lucio Souza; Rodrigues, Renata Costa Val; Andrade Junior, Carlos Vieira; Soares, Renata G; Vettore, Mario Vianna

2016-04-01

This systematic review aimed to compare the effectiveness of sodium hypochlorite and chlorhexidine for root canal disinfection during root canal therapy. A literature search for clinical trials was made on the PubMed (MEDLINE), Web of Knowledge, SCOPUS, and Science Direct databases and in the reference lists of the identified articles up to January 2015. Quality assessment of the selected studies was performed according to the Consolidated Standards of Reporting Trials statement. One clinical trial and 4 randomized clinical trials were selected from the 172 articles initially identified. There was heterogeneity in the laboratory methods used to assess the root canal disinfection as well as in the concentrations of the irrigants used. Therefore, meta-analysis was not performed. Two studies reported effective and similar reductions in bacterial levels for both irrigants. Sodium hypochlorite was more effective than chlorhexidine in reducing microorganisms in 1 study, and another reported opposite findings. Both root irrigants were ineffective in eliminating endotoxins from necrotic pulp root canals in 1 study. Trial design and information regarding randomization procedures were not clearly described in the clinical trials. No study compared laboratory results with clinical outcomes. The available evidence on this topic is scarce, and the findings of studies were not consistent. Additional randomized clinical trials using clinical outcomes to compare the use of sodium hypochlorite and chlorhexidine during root canal therapy are needed. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Semiconductor laser irradiation improves root canal sealing during routine root canal therapy

PubMed Central

Hu, Xingxue; Wang, Dashan; Cui, Ting; Yao, Ruyong

2017-01-01

Objective To evaluate the effect of semiconductor laser irradiation on root canal sealing after routine root canal therapy (RCT). Methods Sixty freshly extracted single-rooted human teeth were randomly divided into six groups (n = 10). The anatomic crowns were sectioned at the cementoenamel junction and the remaining roots were prepared endodontically with conventional RCT methods. Groups A and B were irradiated with semiconductor laser at 1W for 20 seconds; Groups C and D were ultrasonically rinsed for 60 seconds as positive control groups; Groups E and F without treatment of root canal prior to RCT as negative control groups. Root canal sealing of Groups A, C and E were evaluated by measurements of apical microleakage. The teeth from Groups B, D and F were sectioned, and the micro-structures were examined with scanning electron microscopy (SEM). One way ANOVA and LSD-t test were used for statistical analysis (α = .05). Results The apical sealing of both the laser irradiated group and the ultrasonic irrigated group were significantly different from the control group (p<0.5). There was no significant difference between the laser irradiated group and the ultrasonic irrigated group (p>0.5). SEM observation showed that most of the dentinal tubules in the laser irradiation group melted, narrowed or closed, while most of the dentinal tubules in the ultrasonic irrigation group were filled with tooth paste. Conclusion The application of semiconductor laser prior to root canal obturation increases the apical sealing of the roots treated. PMID:28957407

A Review Over Benefits and Drawbacks of Combining Sodium Hypochlorite with Other Endodontic Materials.

PubMed

Mohammadi, Zahed; Shalavi, Sousan; Moeintaghavi, Amir; Jafarzadeh, Hamid

2017-01-01

As the root canal system considered to be complex and unpredictable, using root canal irrigants and medicaments are essential in order to enhance the disinfection of the canal. Sodium hypochlorite is the most common irrigant in endodontics. Despite its excellent antimicrobial activity and tissue solubility, sodium hypochlorite lacks some important properties such as substantivity and smear layer removing ability. The aim of this review was to address benefits and drawbacks of combining sodium hypochlorite with other root canal irrigants and medicaments. According to the reviewed articles, NaOCl is the most common irrigation solution in endodontics. However, it has some drawbacks such as inability to remove smear layer. One of the drawbacks of NaOCl is its inability to remove the smear layer and lack of substantivity. The adjunctive use of other materials has been suggested to improve NaOCl efficacy. Nevertheless, further studies are required in this field.

Cleaning capacity of octenidine as root canal irrigant: A scanning electron microscopy study.

PubMed

Coaguila-Llerena, Hernán; Stefanini da Silva, Virgínia; Tanomaru-Filho, Mario; Guerreiro Tanomaru, Juliane Maria; Faria, Gisele

2018-06-01

The aim of this study was to assess the cleaning capacity of the octenidine hydrochloride (OCT) used as root canal irrigant by scanning electron microscopy (SEM) analysis. Sixty human unirradicular extracted teeth were randomly distributed in 6 groups (n = 10) according to irrigant solutions which were used during root canal preparation: G1, 0.1% OCT; G2, 2% chlorhexidine (CHX); G3, 2.5% sodium hypochlorite (NaOCl); G4, OCT + 17% ethylenediaminetetraacetic acid (EDTA); G5, 2.5% NaOCl + 17% EDTA and G6, distilled water. All specimens were instrumented with ProTaper system up to F4. Teeth were sectioned and prepared for SEM. The smear layer was evaluated using a 5-score system and the data were analyzed by Kruskal-Wallis and Dunn (α = 0.05). In all root canal thirds there was no significant difference between OCT, CHX, NaOCl, and water groups (p > .05), and these groups showed higher smear layer values than NaOCl + EDTA and OCT + EDTA groups (p < .05). There was no significant difference between NaOCl + EDTA and OCT + EDTA groups (p > .05). It was concluded that OCT used as a single root canal irrigant presented poor cleaning capacity and could be used in association with a final irrigation with EDTA to obtain smear layer removal. © 2018 Wiley Periodicals, Inc.

Smear layer removal evaluation of different protocol of Bio Race file and XP- endo Finisher file in corporation with EDTA 17% and NaOCl.

PubMed

Zand, Vahid; Mokhtari, Hadi; Reyhani, Mohammad-Frough; Nahavandizadeh, Neda; Azimi, Shahram

2017-11-01

The aim of the present study was to compare the amount of the smear layer remaining in prepared root canals with different protocols of Bio RaCe files and XP-endo Finisher file (XPF) in association with 17% EDTA and sodium hypochlorite solution. A total of 68 extracted single-rooted teeth were randomly divided into 4 experimental groups (n=14) and two control groups (n=6). The root canals were prepared with Bio RaCe files (FKG Dentaire, Switzerland) using the crown-down technique based on manufacturer's instructions and irrigated according to the following irrigation techniques: Group 1: XPF with 2 mL of 2.5% NaOCl for 1 minute. Group 2:, XPF with 1 mL of 17% EDTA for one minute. Group 3: XPF was used for 1 minute in association with normal saline solution. Group 4: XP-endo Finisher file for 30 seconds in association with 2.5% NaOCl and 17% EDTA for 30 seconds. The negative control group: NaOCl (2.5%) was used during root canal preparation, followed by irrigation with 17% EDTA at the end of root canal preparation. The positive control group: Normal saline solution was used for irrigation during root canal preparation. In all the groups, during preparation of the root canals with Bio RaCe file, 20 mL of 2.5% NaOCl was used for root canal irrigation and at the end of the procedural steps 20 mL of normal saline solution was used as a final irrigant. The samples were analyzed under SEM at ×1000‒2000 magnification and evaluated using Torabinejad scoring system. Data were analyzed with non-parametric Kruskal-Wallis test and post hoc Mann-Whitney U test, using SPSS. Statistical significant was defined at P <0.05. The results of the study showed the least amount of the smear layer at coronal, middle and apical thirds of the root canals in groups 2, which was not significantly different from the negative control group ( P <0.5). Under the limitations of the present study, use of a combination of NaOCl and EDTA in association with XPF exhibited the best efficacy for the removal of the smear layer. Key words: Smear layer, XP-endo Finisher file, EDTA, Sodium hypochlorite.

Scanning Electron Microscopic Evaluation of Root Canal Irrigation with Saline, Sodium Hypochlorite, and Citric Acid,

DTIC Science & Technology

1983-12-01

with six different irrigation regimens. Sodium hypochlorite (NaOCl) was significantly more effective than citric acid in "* removing superficial...EVALUATION OF ROOT CANAL IRRIGATION WITH SALINE, SODIUM HYPOCHLORITE , AND CITRIC ACID 4 *J. Craig Baumgartner, D.D.S., M.S. • **Carolyn M. Brown, D.D.S., M.S...preparation with six different irrigation regimens. Sodium hypochlorite (NaOCl) was significantly more effective than citric acid in removing superficial

Histological study of the effect of some irrigating solutions on bacterial endotoxin in dogs.

PubMed

Silva, Léa Assed Bezerra da; Leonardo, Mario Roberto; Assed, Sada; Tanomaru Filho, Mário

2004-01-01

The aim of this study was to evaluate, histopathologically, the effectiveness of mechanical preparation of root canals using different irrigating solutions in dog teeth filled with LPS after pulpectomy. A total of 120 root canals of 6 mongrel dogs were filled with a solution of LPS after pulpectomy. The irrigating solutions used were saline, 1, 2.5, and 5% sodium hypochlorite, and 2% chlorhexidine. No irrigation was used in the control group. The animals were sacrificed after 60 days and the teeth were fixed and demineralized. Subsequently, serial 6-microm sections were stained with hematoxylin and eosin and Mallory's trichrome for histopathological analysis and Brown-Brenn for verification of bacterial contamination. Analysis showed that the inflammatory infiltrate was statistically less intense in the groups in which the root canals were irrigated with 5% sodium hypochlorite and 2% chlorhexidine. However, none of the irrigating solutions completely inactivated the harmful effects of LPS. Mechanical preparation associated with different irrigating solutions did not completely inactivate LPS.

The fluid mechanics of root canal irrigation.

PubMed

Gulabivala, K; Ng, Y-L; Gilbertson, M; Eames, I

2010-12-01

Root canal treatment is a common dental operation aimed at removing the contents of the geometrically complex canal chambers within teeth; its purpose is to remove diseased or infected tissue. The complex chamber is first enlarged and shaped by instruments to a size sufficient to deliver antibacterial fluids. These irrigants help to dissolve dying tissue, disinfect the canal walls and space and flush out debris. The effectiveness of the procedure is limited by access to the canal terminus. Endodontic research is focused on finding the instruments and clinical procedures that might improve success rates by more effectively reaching the apical anatomy. The individual factors affecting treatment outcome have not been unequivocally deciphered, partly because of the difficulty in isolating them and in making the link between simplified, general experimental models and the complex biological objects that are teeth. Explicitly considering the physical processes within the root canal can contribute to the resolution of these problems. The central problem is one of fluid motion in a confined geometry, which makes the dispersion and mixing of irrigant more difficult because of the absence of turbulence over much of the canal volume. The effects of treatments can be understood through the use of scale models, mathematical modelling and numerical computations. A particular concern in treatment is that caustic irrigant may penetrate beyond the root canal, causing chemical damage to the jawbone. In fact, a stagnation plane exists beyond the needle tip, which the irrigant cannot penetrate. The goal is therefore to shift the stagnation plane apically to be coincident with the canal terminus without extending beyond it. Needle design may solve some of the problems but the best design for irrigant penetration conflicts with that for optimal removal of the bacterial biofilm from the canal wall. Both irrigant penetration and biofilm removal may be improved through canal fluid agitation using a closely fitting instrument or by sonic or ultrasonic activation. This review highlights a way forward by understanding the physical processes involved through physical models, mathematical modelling and numerical computations.

In vitro comparison of passive and continuous ultrasonic irrigation in simulated lateral canals of extracted teeth.

PubMed

Castelo-Baz, Pablo; Martín-Biedma, Benjamín; Cantatore, Giuseppe; Ruíz-Piñón, Manuel; Bahillo, José; Rivas-Mundiña, Berta; Varela-Patiño, Purificación

2012-05-01

Complete endodontic system disinfection requires the removal of vital and necrotic pulp tissue, microorganisms, and toxins. The purpose of this study was to compare the effects of 2 ultrasonic irrigation techniques on the penetration of sodium hypochlorite into the main canal and simulated lateral canals of extracted teeth. Two simulated lateral canals each were created 2, 4, and 6 mm from the working length in 60 single-rooted teeth (6 canals/tooth, n = 360). To resemble the clinical situation, a closed system was created in each tooth. The teeth were randomly assigned to 3 experimental irrigation groups: group 1 (n = 20), positive pressure irrigation (PPI); group 2 (n = 20), passive ultrasonic irrigation (PUI); and group 3 (n = 20), continuous ultrasonic irrigation (CUI). Samples were evaluated by direct observation of still images recorded under a dental operating microscope. To examine irrigating solution penetration, 20% Chinese ink (Sanford Rotring GmbH, Hamburg, Germany) was added to a 5% sodium hypochlorite solution and delivered into the root canals. The results showed a significantly higher (P < .05) penetration of irrigant into the lateral canals in the CUI group. PUI and CUI did not differ significantly in solution penetration into the apical thirds of the main canals. The PPI group showed a significantly lower penetration of sodium hypochlorite into the main and lateral canals compared with the CUI and PUI groups. CUI as a final rinse significantly increased the penetration of irrigating solution into simulated lateral canals. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effects of different sonic activation protocols on debridement efficacy in teeth with single-rooted canals

PubMed Central

Niu, Li-na; Luo, Xiao-juan; Li, Guo-hua; Bortoluzzi, Eduardo A.; Mao, Jing; Chen, Ji-hua; Gutmann, James L.; Pashley, David H.; Tay, Franklin R.

2014-01-01

Objectives The effects of different EndoActivator® (EA) sonic activation protocols on root canal debridement efficacy were examined. Methods Root canals in 48 single-rooted teeth were instrumented, irrigated initially with NaOCl and divided into 6 groups (N=8) based on the application time of QMix (antimicrobial calcium-chelating irrigant), and the time and sequence of EA irrigant activation - Positive Control: 90 sec QMix; Negative Control: 90 sec saline; Group 1A: 15 sec QMix + 15 sec QMix with EA-activation; Group 1B: 30 sec QMix + 30 sec of QMix with EA-activation; Group 2A: 15 sec QMix with EA-activation + 15 sec QMix; Group 2B: 30 sec QMix with EA-activation + 30 sec QMix. Split roots were examined with scanning electron microscopy for assignment of smear and debris scores in locations along the coronal, middle and apical thirds of the canals. The overall cleanliness of pooled canal locations in the Positive Control and the 4 experimental groups were compared with chi-square tests. Results Significant differences were detected among the 5 groups (p<0.001). Post-hoc pairwise comparisons indicated that the overall canal cleanliness was in the order (from best to worst): 1B = 2B > 2A > 1A > Positive Control. Completely clean canals could not be achieved due to the absence of continuous irrigant flow for EA to clear intraradicular debris. Conclusions Irrespective of the sonic activation sequence, irrigant activation for 30 seconds during a 60-second period of QMix application appears to maximize the smear layer and debris removal potential of the EndoActivator® system. PMID:24878251

Antimicrobial Activity of Photodynamic Therapy Against Enterococcus faecalis Before and After Reciprocating Instrumentation in Permanent Molars.

PubMed

Pinheiro, Sérgio Luiz; Azenha, Giuliana Rodrigues; Democh, Yasmin Marialva; Nunes, Daniela Camila; Provasi, Silvia; Fontanetti, Giovana Masiero; Duarte, Danilo Antônio; Fontana, Carlos Eduardo; da Silveira Bueno, Carlos Eduardo

2016-12-01

The present study sought to evaluate the antimicrobial activity against Enterococcus faecalis of photodynamic therapy applied before and after reciprocating instrumentation of permanent molars. Apical extrusion of debris can cause flare-ups due to introduction of bacteria into the periapical tissues. Eighteen mesial roots from permanent mandibular molars were selected. The crowns were removed to obtain a standard root length of 15 mm. The included mesial roots had an angulation of 10°-40° and canals with independent foramina. The orifice of each mesiolingual canal was sealed with light-curing resin, and the working length was established visually, 1 mm short of the apical foramen. The roots were rendered impermeable and sterilized, and the mesiobuccal canals were contaminated with a standard strain of E. faecalis for 21 days. Specimens were randomly divided into three groups (n = 6): G1, photodynamic therapy performed before instrumentation and irrigation with 0.9% NaCl (saline) solution; G2, photodynamic therapy performed after instrumentation and irrigation with 0.9% NaCl; and G3 (control), instrumentation and irrigation with 2.5% NaOCl (sodium hypochlorite) solution. Canals were shaped with a WaveOne primary file (25.08) and irrigated with 0.9% NaCl. E. faecalis samples were collected before and after each procedure, and the results were analyzed using descriptive statistics and the Kruskal-Wallis and Wilcoxon tests. Significant reductions in E. faecalis were observed when photodynamic therapy was performed before and after instrumentation of the root canal system (p < 0.05). Reciprocating instrumentation significantly reduced E. faecalis colonies in experimentally contaminated root canal systems (p < 0.05). Photodynamic therapy was effective in removing E. faecalis from the root canal system, whether performed before or after reciprocating instrumentation.

Apical extrusion of debris: a literature review of an inherent occurrence during root canal treatment.

PubMed

Tanalp, J; Güngör, T

2014-03-01

Extrusion of intracanal debris as well as irrigants is a common occurrence during root canal treatment, and no instrument or technique has thoroughly solved this problem. Because flare-ups may arise with any irritation directed towards periapical tissues, a shaping or irrigation technique should minimize the risk of apical extrusion, even though it may not be prevented. There has been a rapid evolution of root canal instruments and irrigation systems through the last decade, and many have been assessed for their debris extrusion potential. The purpose of this review was to identify publications regarding the evaluation of debris, bacteria and irrigant extrusion during root canal treatment. A PubMed, Ovid and MEDLINE search was conducted using the keywords "apical extrusion", "debris extrusion" and "endodontic treatment". The literature search extended over a period of more than 30 years up to 2012. Content of the review was limited to apical extrusion of debris and irrigants, extrusion of liquid by irrigation methods and bacterial extrusion. Issues relevant to apical extrusion were obtained by further search in the reference sections of the retrieved articles. The review provides an update on the current status of apical extrusion. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Effectiveness of root canal debris removal using passive ultrasound irrigation with chlorhexidine digluconate or sodium hypochlorite individually or in combination as irrigants.

PubMed

Ferreira, Rafael Brandao; Marchesan, Melissa Andreia; Silva-Sousa, Yara Teresinha; Sousa-Neto, Manoel

2008-07-01

The aim of this in vitro study was to evaluate the cleaning capacity of different auxiliary chemical substances energized with ultrasound in radicular dentin using morphologic analysis. Twenty-eight single-canal, mandibular incisors were prepared with the Hero 642 canal preparation system following the sequence: 25/12, 30/06, 35/02, and 40/02, 1 mm from the apex. The specimens were then divided into four groups of seven teeth. During biomechanical preparation the teeth were irrigated with 2 ml of distilled water between files. Each group of specimens (n=7) received a final irrigation with 100 ml of the following irrigants that were activated with ultrasound for 3 minutes: Group 1- distilled water; Group 2- 0.2% chlorhexidine digluconate (CHX); Group 3- 2.5% sodium hypochlorite (NaOCl); and Group 4-the filtrate obtained after combining 0.2% CHX and 2.5% NaOCl. The apical portions of the root canals from each group were then submitted to histological processing and analyzed using optical microscopy. Results showed statistical differences between the groups (p<0.01). Groups 1 and 2 (distilled water and 0.2% CHX respectively) were statistically similar in terms of a greater amount of debris, whereas 2.5% NaOCl and the filtrate were more efficient in removal of debris. There is no additional benefit in terms of debris removal from root canal walls by irrigating with the filtrate obtained from the combination of NaOCl and CHX when compared to using NaOCl alone. The findings of this study suggest the time and expense of preparing and using a combination of NaOCl and CHX is not warranted compared to using NaOCl alone for root canal irrigation.

In vitro study of calcium hydroxide removal from mandibular molar root canals.

PubMed

Ma, Jingzhi; Shen, Ya; Yang, Yan; Gao, Yuan; Wan, Pan; Gan, Yan; Patel, Payal; Curtis, Allison; Khakpour, Mehrzad; Haapasalo, Markus

2015-04-01

Previous studies have shown the difficulty in removing calcium hydroxide (Ca[OH]2) paste from the root canals before root filling. Mesial and distal canals of 30 mandibular molars were prepared with the WaveOne Primary (25/.08) and Large file (40/.08) (Dentsply Tulsa Dental Specialties, Tulsa, OK), respectively. All canals were then filled with Ca(OH)2. The teeth were divided into the following 3 treatment groups (each with n = 10): (1) instrumentation with needle irrigation, (2) instrumentation with irrigation and passive ultrasonic activation (PUI), and (3) the GentleWave system (Sonendo, Inc, Laguna Hills, CA) without instrumentation. The irrigation time in each group was 7.5 minutes. To further test the efficiency of the GentleWave system, shorter times of 90 seconds were tested using water alone. Reconstructed micro-computed tomographic scans were used to measure the volume of the canals and Ca(OH)2 after instrumentation, initial filling of Ca(OH)2, and after its removal. The percentage of Ca(OH)2 remaining in the canals was calculated. None of the 10 teeth (30 canals) in the conventional irrigation and PUI groups were completely cleaned of Ca(OH)2 in 7.5 minutes. In the apical third of mesial and distal canals, respectively, conventional irrigation removed 47.82% ± 16.36% and 77.68% ± 12.82%, PUI removed 61.66% ± 25.54% and 88.85 ± 12.06%, and the GentleWave system removed significantly more Ca(OH)2 (P < .05) with 100% and 98.78% ± 3.84%. Additional experiments in 10 teeth, using only water as the irrigant, revealed that the GentleWave system removed 99.85% and 99.97% of Ca(OH)2 within 90 seconds without the use of any instruments in the mesial and distal canals, respectively. The study confirms the difficulty to remove Ca(OH)2 from root canals using conventional methods. The GentleWave system removed the paste within 90 seconds using water irrigation alone. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The effect of passive ultrasonic activation of 2% chlorhexidine or 5.25% sodium hypochlorite irrigant on residual antimicrobial activity in root canals.

PubMed

Weber, Carol Diener; McClanahan, Scott B; Miller, Glenn A; Diener-West, Marie; Johnson, James D

2003-09-01

Ninety-four single-canal roots were prepared using the step-down technique. Forty-two canals were irrigated with 2% chlorhexidine, 42 canals with 5.25% sodium hypochlorite (NaOCl), and 10 control canals with phosphate-buffered saline (PBS). The chlorhexidine and NaOCl groups were each then equally divided into a final irrigation group and a 1-min passive ultrasonic irrigation group. Canals were enlarged with a Parapost drill. The apical 3-5 mm was covered with nail polish. Canals were rinsed with PBS, dried, refilled with PBS, and stored. At 6 h, 20 microl of fluid was pipetted from each canal and placed into wells on agar plates, which were inoculated with Streptococcus sanguinis. The plates were incubated, and zones of inhibition were measured. Sampling was repeated at 24, 48, 72, 96, 120, 144, and 168 h. Residual antimicrobial activity with 2% chlorhexidine was statistically significantly superior to 5.25% NaOCl with irrigation alone and with final passive ultrasonic activation (p < 0.001). Chlorhexidine experimental groups demonstrated residual antimicrobial activity for as long as 168 h.

Effect of ultrasonic activation on the reduction of bacteria and endotoxins in root canals: a randomized clinical trial.

PubMed

Nakamura, V C; Pinheiro, E T; Prado, L C; Silveira, A C; Carvalho, A P L; Mayer, M P A; Gavini, G

2018-01-01

This randomized clinical trial aimed to compare the effectiveness of ultrasonic activation with that of nonactivated irrigation on the removal of bacteria and endotoxin from root canals. Fifty patients with necrotic pulps and asymptomatic apical periodontitis were randomly allocated into two groups according to the final irrigation protocol after root canal preparation: Group UI - ultrasonic irrigation (n = 25) and Group NI - needle irrigation (n = 25). The root canals were medicated with calcium hydroxide for 14 days. Microbiological sampling was performed before (S1) and after the root canal preparation (S2), after the irrigation protocols (S3) and after the removal of the intracanal medication (S4). Total bacteria counts were determined by qPCR and the endotoxin levels by the limulus amebocyte lysate assay. Intragroup analyses were performed using the Wilcoxon test for related samples, whereas intergroup analyses were performed using the Mann-Whitney U-test (P < 0.05). All S1 samples were positive for bacteria, with median numbers of 1.49 × 10 6 and 8.55 × 10 5 bacterial cells for the UI and NI groups, respectively. This number significantly decreased in S2 samples (UI: 1.41 × 10 4 ; NI: 3.53 × 10 4 ; both with P < 0.001). After final irrigation protocols, there was a significant decrease in bacterial load from S2 to S3 samples in both groups (UI: 4.29 × 10 3 ; NI: 1.08 × 10 4 ; P < 0.01). Intergroup analysis revealed a significant difference between irrigation methods regarding bacterial counts in S3 samples (P < 0.05). In contrast, no significant differences were observed between groups for endotoxin levels (P > 0.05). Ultrasonic activation was more effective than nonactivated irrigation for reducing the number of bacteria but not the endotoxin levels in root canals of teeth with apical periodontitis. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Evaluation of smear layer removal and marginal adaptation of root canal sealer after final irrigation using ethylenediaminetetraacetic, peracetic, and etidronic acids with different concentrations.

PubMed

Ulusoy, Özgür İlke; Zeyrek, Salev; Çelik, Bülent

2017-07-01

The purpose of this study was to investigate the effects of different irrigation solutions on the smear layer removal and marginal adaptation of a resin-based sealer to root canal dentine. A total of 152 instrumented roots were irrigated with the following irrigants: 9,18% etidronic acid (HEBP), 0.5, 1,2% peracetic acid (PAA), 17% ethylenediaminetetraacetic acid (EDTA), saline. The amount of smear layer was evaluated using scanning electron microscope (SEM) in seventy root samples. Eighty-two roots were filled with AH Plus and gutta-percha. Slices obtained from apical third of each specimen were viewed with SEM to assess marginal adaptation. Use of 9% and 18% HEBP resulted in more efficient smear layer removal in the apical third than the other chelators (p < 0.05). Higher smear layer scores in the coronal and middle thirds were obtained from 0.5%, 1% PAA groups. Regarding marginal adaptation, 18% HEBP group showed the lowest gap size values (p < 0.05), and better marginal adaptation. Etidronic acid is a promising candidate for final irrigation of root canals. © 2017 Wiley Periodicals, Inc.

Factors affecting irrigant extrusion during root canal irrigation: a systematic review.

PubMed

Boutsioukis, C; Psimma, Z; van der Sluis, L W M

2013-07-01

The aim of the present study was to conduct a systematic review and critical analysis of published data on irrigant extrusion to identify factors causing, affecting or predisposing to irrigant extrusion during root canal irrigation of human mature permanent teeth. An electronic search was conducted in Cochrane Library, LILACS, PubMed, SciELO, Scopus and Web of Knowledge using a combination of the terms 'irrigant', 'rinse', 'extrusion', 'injection', 'complication', 'accident', 'iatrogenic', 'root canal', 'tooth' and 'endodontic'. Additional studies were identified by hand-searching of six endodontic journals and the relevant chapters of four endodontic textbooks, resulting in a total of 460 titles. No language restriction was imposed. After applying screening and strict eligibility criteria by two independent reviewers, 40 case reports and 10 ex vivo studies were included in the review. A lack of clinical studies focusing on irrigant extrusion during root canal irrigation was evident. The reviewed case reports focused mainly on the clinical manifestations and management of the accidents and did not provide adequate details on the possible factors that may influence irrigant extrusion. The data from the included ex vivo studies were inconclusive due to major methodological limitations, such as not simulating the presence of periapical tissues and not assessing the validity of irrigant detection methods. The extensive variability in the protocols employed hindered quantitative synthesis. The choice of factors investigated in ex vivo studies seems not to have been driven by the available clinical evidence. These issues need to be addressed in future studies. © 2012 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Efficacy of xylene and passive ultrasonic irrigation on remaining root filling material during retreatment of anatomically complex teeth.

PubMed

Cavenago, B C; Ordinola-Zapata, R; Duarte, M A H; del Carpio-Perochena, A E; Villas-Bôas, M H; Marciano, M A; Bramante, C M; Moraes, I G

2014-11-01

To evaluate the volume of remaining filling material in the mesial root canals of mandibular molars after root canal retreatment with different procedures performed sequentially. The mesial root canals of 12 human first mandibular molars were instrumented using the BioRace system until a size 25, .06 taper instrument. The mesial roots were filled with gutta-percha and AH-Plus using a vertical compaction technique. The specimens were scanned using microcomputed tomography with a voxel size of 16.8 μm before and after the retreatment procedures. To remove the filling material, the root canals were enlarged until the size 40, .04 taper instrument. The second step was to irrigate the root canals with xylene in the attempt to clean the root canals with paper points. In the third step, the passive ultrasonic irrigation technique (PUI) was performed using 2.5% sodium hypochlorite. The initial and residual filling material volume (mm(3) ) after each step was evaluated from the 0.5 to 6.5 mm level. The obtained data were expressed in terms of percentage of residual filling material. Statistical analysis was performed using the Friedman test (P < 0.05). All specimens had residual filling materials after all retreatment procedures. Passive ultrasonic irrigation enhanced the elimination of residual filling material in comparison with the mechanical stage at the 0.5-2.5 mm and 4.5-6.5 mm levels (P < 0.05). No significant difference was found between xylene and PUI methods. Filling materials were not completely removed by any of the retreatment procedures. The use of xylene and PUI after mechanical instrumentation enhanced removal of materials during endodontic retreatment of anatomically complex teeth. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Micro-computed tomography evaluation of the removal of calcium hydroxide medicament from C-shaped root canals of mandibular second molars.

PubMed

Ma, J Z; Shen, Y; Al-Ashaw, A J; Khaleel, H Y; Yang, Y; Wang, Z J; Peng, B; Haapasalo, M

2015-04-01

To use micro-computed tomography (μ-CT) to evaluate the amount of calcium hydroxide [Ca(OH)2 ] remaining in the C-shaped root canals of mandibular second molars after attempting to remove it with passive ultrasonic and sonic irrigation. Thirty mandibular second molars, 15 in C1 and 15 in C2 configurations as first identified by μ-CT, were divided into three groups (five C1 and five C2 in each group) for the three irrigation methods. All teeth were prepared to ProTaper Universal F2 and filled with Ca(OH)2 paste. The Ca(OH)2 was removed with F2 files and irrigation without agitation or with agitation using either EndoActivator or ultrasonics. μ-CT was used to measure the initial amount of Ca(OH)2 present. After removal of Ca(OH)2, μ-CT imaging was used to assess the percentage of volume of residual Ca(OH)2 in the canal. Data were analysed using one-way anova test. There was no significant difference in the mean volume of the root canal systems after instrumentation amongst the three groups. The three irrigation techniques left 2-17% of Ca(OH)2 in the root canals after removal. The mean volume of the remaining Ca(OH)2 was higher in the group without agitation than in the groups with sonic or ultrasonic agitation (P < 0.05). In the apical third, 68% of the canal space remained occupied by Ca(OH)2 when no agitation was used, whereas 28% and 31% remained filled by Ca(OH)2 in the EndoActivator and ultrasonic groups, respectively. There was no significant difference in the amount of residual Ca(OH)2 between the EndoActivator and ultrasonic groups. The proportion of remaining Ca(OH)2 in the apical canals was higher than in the middle and coronal canals in all groups (P < 0.05). A considerable proportion of the apical canal space remained filled with Ca(OH)2 in the C-shaped root canals after instrumentation and conventional needle irrigation. Although combining rotary instrumentation and irrigation with sonic or ultrasonic agitation reduced the amount of residual Ca(OH)2 in the C-shaped root canals, the large amount of calcium hydroxide in the critical apical area remains a concern. Alternative strategies should be considered in medication of the apical canal in C-shaped teeth. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Comparative Effectiveness of New Mechanical Irrigant Agitating Devices for Debris Removal from the Canal and Isthmus of Mesial Roots of Mandibular Molars.

PubMed

Duque, Jussaro Alves; Duarte, Marco Antonio Hungaro; Canali, Lyz Cristina Furquim; Zancan, Rafaela Fernandes; Vivan, Rodrigo Ricci; Bernardes, Ricardo Affonso; Bramante, Clovis Monteiro

2017-02-01

The aim of this study was to compare the effectiveness of Easy Clean (Easy Dental Equipment, Belo Horizonte, MG, Brazil) in continuous and reciprocating motion, passive ultrasonic irrigation (PUI), Endoactivator systems (Dentsply Maillefer, Ballaigues, Switzerland), and conventional irrigation for debris removal from root canals and isthmus. Fifty mesial roots of mandibular molars were embedded in epoxy resin using a metal muffle; afterward, the blocks containing the roots were sectioned at 2, 4, and 6 mm from the apex. After instrumentation, the roots were divided into 5 groups (n = 10) for application of the final irrigation protocol using Easy Clean in continuous rotation, Easy Clean in reciprocating motion, PUI, Endoactivator, and conventional irrigation. Scanning electron microscopic images were taken after instrumentation and after the first, second, and third activation of irrigating solution to evaluate the area of remaining debris with image J software (National Institutes of Health, Bethesda, MD). The protocol of 3 irrigating solution activations for 20 seconds provided better cleaning of the canal and isthmus. On conclusion of all procedures, analysis of the canals showed a statistical difference only at 2 mm; the Easy Clean in continuous rotation was more efficient than conventional irrigation (P < .05). On conclusion of all steps, the largest difference was observed in the isthmus in which the Easy Clean in continuous rotation was more effective than conventional irrigation at the 3 levels analyzed and the Endoactivator at 4 mm (P < .05). The PUI promoted greater cleaning than conventional irrigation at 6 mm (P < .05). There was no statistical difference between Easy Clean in continuous rotation, Easy Clean in reciprocating motion, and PUI (P > .05). Irrigating solution activation methods provided better cleaning of the canal and isthmus, especially the Easy Clean used in continuous rotation. The protocol of 3 irrigating solution activations for 20 seconds favored better cleaning. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Monitoring the effectiveness of root canal procedures on endotoxin levels found in teeth with chronic apical periodontitis

PubMed Central

MARINHO, Ariane Cassia Salustiano; MARTINHO, Frederico Canato; ZAIA, Alexandre Augusto; FERRAZ, Caio Cezar Randi; GOMES, Brenda Paula Figueiredo de Almeida

2014-01-01

Objective: The aim of this study was to monitor the effectiveness of root canal procedures by using different irrigants and intracanal medication on endotoxin levels found in root canals of teeth with chronic apical periodontitis. Material and Methods: Thirty root canals of teeth with pulpal necrosis associated with periapical lesions were selected and randomly divided into groups according to the irrigants used: GI - 2.5% NaOCl, GII - 2% chlorhexidine (CHX) gel, and GIII - saline solution (SS) (all, n=10). Samples were collected with sterile/apyrogenic paper points before (S1) and after root canal instrumentation (S2), after use of 17% ethylenediaminetetraacetic acid (EDTA) (S3), and after 30 days of intracanal medication (Ca(OH)2+SS) (S4). A turbidimetric kinetic Limulus Amebocyte Lysate assay was used for endotoxin measurement. Results: Endotoxins were detected in 100% of the root canals investigated (30/30), with a median value of 18.70 EU/mL. After S2, significant median percentage reduction was observed in all groups, irrespective of the irrigant tested: 2.5% NaOCl (99.65%) (GI), 2% CHX (94.27%) (GII), and SS (96.79%) (GIII) (all p<0.05). Root canal rinse with 17% EDTA (S3) for a 3-minute period failed to decrease endotoxin levels in GI and a slight decrease was observed in GII (59%) and GIII (61.1%) (all p>0.05). Intracanal medication for 30 days was able to significantly reduce residual endotoxins: 2.5% NaOCl (90%) (GI), 2% CHX (88.8%) (GII), and SS (85.7%) (GIII, p<0.05). No differences were found in the endotoxin reduction when comparing s2 and s4 treatment groups. Conclusion: Our findings demonstrated the effectiveness of the mechanical action of the instruments along with the flow and backflow of irrigant enduring root canal instrumentation for the endotoxin removal from root canals of teeth with chronic apical periodontitis. Moreover, the use of intracanal medication for 30 days contributed for an improvement of endotoxin reduction. PMID:25075670

A Review Over Benefits and Drawbacks of Combining Sodium Hypochlorite with Other Endodontic Materials

PubMed Central

Mohammadi, Zahed; Shalavi, Sousan; Moeintaghavi, Amir

2017-01-01

Introduction: As the root canal system considered to be complex and unpredictable, using root canal irrigants and medicaments are essential in order to enhance the disinfection of the canal. Sodium hypochlorite is the most common irrigant in endodontics. Despite its excellent antimicrobial activity and tissue solubility, sodium hypochlorite lacks some important properties such as substantivity and smear layer removing ability. Objective: The aim of this review was to address benefits and drawbacks of combining sodium hypochlorite with other root canal irrigants and medicaments. Discussion: According to the reviewed articles, NaOCl is the most common irrigation solution in endodontics. However, it has some drawbacks such as inability to remove smear layer. One of the drawbacks of NaOCl is its inability to remove the smear layer and lack of substantivity. Conclusion: The adjunctive use of other materials has been suggested to improve NaOCl efficacy. Nevertheless, further studies are required in this field. PMID:29387282

Comparison of the EndoVac system to needle irrigation of root canals.

PubMed

Nielsen, Benjamin A; Craig Baumgartner, J

2007-05-01

Past studies have shown that current irrigation methods are effective at cleaning root canals coronally but less effective apically. To be effective, endodontic irrigants should ideally be delivered near working length. The purpose of this study was to compare the efficacy of the EndoVac irrigation system and needle irrigation to debride root canals at 1 and 3 mm from working length. One tooth of each matched pair was instrumented and irrigated by using the EndoVac, which uses negative pressure to deliver irrigating solutions to working length. The other tooth of the matched pair was instrumented and irrigated with a 30-gauge ProRinse irrigating needle. All teeth were irrigated with sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) for a predetermined amount of time, and total volume of irrigant used was recorded. After instrumentation and irrigation, the teeth were fixed, decalcified, and sectioned at 1 mm and 3 mm from working length. Serial sections were made and digitally photographed. The amount of remaining debris was determined as a percentage of the area of the canal lumen. Remaining debris and total irrigant were analyzed by using the Wilcoxon signed rank test at the 5% confidence level. At the 1-mm level, significantly less debris was found in the EndoVac group (p=0.0347). At the 3-mm level, there was no significant difference between groups. Significantly more irrigant was delivered with the EndoVac (p<0001). This study showed significantly better debridement at 1 mm from working length by using the EndoVac compared with needle irrigation.

Debris remaining in the apical third of root canals after chemomechanical preparation by using sodium hypochlorite and glyde: an in vivo study.

PubMed

Cruz, Alvaro; Vera, Jorge; Gascón, Gerardo; Palafox-Sánchez, Claudia A; Amezcua, Octavio; Mercado, Gabriela

2014-09-01

During chemomechanical instrumentation, several liquid or paste substances are used to ease the action of the files and to eliminate debris and the smear layer. The aim of this study was to evaluate whether the use of a paste containing EDTA during cleaning and shaping of the root canal helps to eliminate debris. Twenty root canals in dog teeth were instrumented by a crown-down technique by using nickel-titanium rotary files. In 10 root canals (group A), sodium hypochlorite was used during instrumentation, followed by a final irrigation with 17% liquid EDTA. In another 10 canals (group B), sodium hypochlorite was again used as the irrigating solution, but Glyde File Prep paste was used with every instrument, and a final irrigation with EDTA was also carried out. Two additional teeth were used as positive and 2 as negative controls. The jaws were prepared for histologic evaluation. In group A where Glyde was not used during cleaning and shaping, little or no debris was found in the apical third of the instrumented root canals; however; in group B in which Glyde File Prep paste was used during chemomechanical instrumentation, moderate to high accumulation of debris was observed in the apical third. The use of Glyde File Prep paste during rotary mechanical instrumentation favors the accumulation of debris in the apical third of the root canals. Irrigation with NaOCl and a final flush with EDTA by means of a small-gauge needle with simultaneous aspiration led to less accumulation of debris than in the Glyde File Prep group (P < .05). Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effect of 95% Ethanol as a Final Irrigant before Root Canal Obturation in Primary Teeth: An in vitro Study.

PubMed

Thiruvenkadam, G; Asokan, Sharath; John, Baby; Priya, Pr Geetha

2016-01-01

Successful obturation in the primary teeth demands complete dryness of the root canal system. The purpose of this study was to determine the effect of 95% ethanol as the final irrigant before root canal obturation in primary teeth. A total of 20 extracted primary mandibular canines were biomechanically prepared and pre-obturated volume of each tooth was assessed using spiral computed tomography (CT). The specimens were divided into two groups (n = 10): group 1, Metapex group; group 2, zinc oxide eugenol group. Each group was further divided randomly into two subgroups (n = 5): subgroup 1, canals were dried with 95% ethanol; subgroup 2, canals were blot dried with paper points with the last one appearing dry. All canals were obturated and the postobturated volume of each tooth was measured. The percentage of obturated volume (POV) was calculated using the formula: (postobturated volume/preobturated volume) × 100. The POV between the groups was statistically analyzed using Mann-Whitney test and Wilcoxon Signed rank test appropriately. Root canals that were dried with ethanol showed better obturation than using paper points alone and the difference was statistically significant in both group 1 (p < 0.001) and group 2 (p < 0.002). Drying of the root canal system with 95% ethanol can result in better obturation in the primary teeth. How to cite this article: Thiruvenkadam G, Asokan S, John B, Geetha Priya PR. Effect of 95% Ethanol as a Final Irrigant before Root Canal Obturation in Primary Teeth: An in vitro Study. Int J Clin Pediatr Dent 2016;9(1):21-24.

[Analysis of different endodontic sealers and strategies of root canal irrigation on the bond strength of fiber posts].

PubMed

Zhu, Shujin; Liu, Cuiling; Zheng, Zheng; Yang, Liyuan; Gao, Xu

2015-06-01

To evaluate the influence of eugenol-containing and resin-containing endodontic sealers on the bond strength of fiber posts using different strategies of root canal irrigation. Forty-eight mandibular premolars were endodontically treated. The specimens were randomly assigned into two groups according to different endodontic sealers. Group A used Endofil (eugenol-containing endodontic sealer), and group B used AH-plus (resin-containing endodontic sealer). After post space preparation, each group was randomly assigned into three subgroups according to the strategies of root canal irrigation (eight premolars in each subgroup). Group Al and B1: 0.9%NaCl irrigation; Group A2 and B2: 17% ethylene diamine tetraacetic acid (EDTA)+5.25%NaClO+0.9%NaCl irrigation; Group A3 and B3: ultrasonic agitation associated with 1 7%EDTA+5.25%NaClO+0.9%NaCl. One week after the cementation of fiber posts using RelyX™ Unicem, a push-out test was performed to measure the bond strength of the posts. The microstructure of the root canal surface was examined under scanning electron microscope (SEM). The bond strengths of the six groups were as follows: Al (7.96±2.23) MPa, A2 (9.95±2.89) MPa, A3 (18.88±3.69) MPa, B1 (11.41±3.71) MPa, B2 (14.00±4.04) MPa, and B3 (19.14±3.27) MPa. Statistical analysis revealed a significant interaction between the different endodontic sealers and the strategies of root canal irrigation (P<0.05). Lower bond strength was found in group Al but not in group BI (P<0.05), and the same result was revealed when comparing group A2 and B2. No significant difference was observed between group A3 and B3 (P>0.05). SEM showed that the root canal in group A3 and B3 achieved the cleanest surface with nearly all dentine tubules opened. The eugenol-containing endodontic sealer can impair the bond strength of fiber posts compared with the resin-containing sealer when the root canal is irrigated by 0.9% NaCl or 17%EDTA+5.25%NaClO+0.9%NaC. No difference was observed between the two sealers when using 17%EDTA+5.25% NaCIO+0.9%NaCl combined with ultrasonic irrigation.

Influence of a passive sonic irrigation system on the elimination of bacteria from root canal systems: a clinical study.

PubMed

Huffaker, S Kirk; Safavi, Kamran; Spangberg, Larz S W; Kaufman, Blythe

2010-08-01

The present investigation evaluated the ability of a new passive sonic irrigation (sonic group) system (EndoActivator) to eliminate cultivable bacteria from root canals in vivo and compared it with that of standard syringe irrigation (control group). Data were obtained by using bacteriologic sampling of root canals treated by endodontic residents. Sampling results from 1 session of treatment were then compared with results obtained after intervisit calcium hydroxide disinfection and a second session of treatment. There was no significant difference in the ability of sonic group and control group to eliminate cultivable bacteria from root canals (P > .05). A second session and intervisit calcium hydroxide disinfection were able to eliminate cultivable bacteria from significantly more teeth than a single session of treatment (P < .05). These in vivo results strengthen the case for a multi-visit approach to the treatment of apical periodontitis. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Sodium Hypochlorite Irrigation and Its Effect on Bond Strength to Dentin

PubMed Central

Abuhaimed, Tariq S.

2017-01-01

Effective shaping and cleaning of root canals are essential for the success of endodontic treatment. Due to the complex anatomy of root canal spaces, the use of various instrumentation techniques alone is not effective in producing bacteria-free root canal spaces. Irrigation, disinfectants, rinses, and intervisit medications are used in conjunction with the mechanical instrumentation to ensure the success of endodontic treatment. Sodium hypochlorite (NaOCl), a halogenated compound, is routinely used to irrigate the root canal during endodontic treatments. NaOCl has been known for its antibacterial action, proteolytic and dissolution capacity, and debridement properties. NaOCl, however, can alter the composition of dentin and hence its interaction with the adhesive resins used to bond the restorative materials to treated dentin. This review therefore covers in depth the action of NaOCl on dentin-adhesive resin bond strength including both enhancement and reduction, then mechanisms proposed for such action, and finally how the adverse action of NaOCl on dentin can be reversed. PMID:28904947

Sodium Hypochlorite Irrigation and Its Effect on Bond Strength to Dentin.

PubMed

Abuhaimed, Tariq S; Abou Neel, Ensanya A

2017-01-01

Effective shaping and cleaning of root canals are essential for the success of endodontic treatment. Due to the complex anatomy of root canal spaces, the use of various instrumentation techniques alone is not effective in producing bacteria-free root canal spaces. Irrigation, disinfectants, rinses, and intervisit medications are used in conjunction with the mechanical instrumentation to ensure the success of endodontic treatment. Sodium hypochlorite (NaOCl), a halogenated compound, is routinely used to irrigate the root canal during endodontic treatments. NaOCl has been known for its antibacterial action, proteolytic and dissolution capacity, and debridement properties. NaOCl, however, can alter the composition of dentin and hence its interaction with the adhesive resins used to bond the restorative materials to treated dentin. This review therefore covers in depth the action of NaOCl on dentin-adhesive resin bond strength including both enhancement and reduction, then mechanisms proposed for such action, and finally how the adverse action of NaOCl on dentin can be reversed.

Comparison of efficacy of pulverization and sterile paper point techniques for sampling root canals.

PubMed

Tran, Kenny T; Torabinejad, Mahmoud; Shabahang, Shahrokh; Retamozo, Bonnie; Aprecio, Raydolfo M; Chen, Jung-Wei

2013-08-01

The purpose of this study was to compare the efficacy of the pulverization and sterile paper point techniques for sampling root canals using 5.25% NaOCl/17% EDTA and 1.3% NaOCl/MTAD (Dentsply, Tulsa, OK) as irrigation regimens. Single-canal extracted human teeth were decoronated and infected with Enterococcus faecalis. Roots were randomly assigned to 2 irrigation regimens: group A with 5.25% NaOCl/17% EDTA (n = 30) and group B with 1.3% NaOCl/MTAD (n = 30). After chemomechanical debridement, bacterial samplings were taken using sterile paper points and pulverized powder of the apical 5 mm root ends. The sterile paper point technique did not show growth in any samples. The pulverization technique showed growth in 24 of the 60 samples. The Fisher exact test showed significant differences between sampling techniques (P < .001). The sterile paper point technique showed no difference between irrigation regimens. However, 17 of the 30 roots in group A and 7 of the 30 roots in group B resulted in growth as detected by pulverization technique. Data showed a significant difference between irrigation regimens (P = .03) in pulverization technique. The pulverization technique was more efficacious in detecting viable bacteria. Furthermore, this technique showed that 1.3% NaOCl/MTAD regimen was more effective in disinfecting root canals. Published by Elsevier Inc.

Release of Growth Factors into Root Canal by Irrigations in Regenerative Endodontics.

PubMed

Zeng, Qian; Nguyen, Sean; Zhang, Hongming; Chebrolu, Hari Priya; Alzebdeh, Dalia; Badi, Mustafa A; Kim, Jong Ryul; Ling, Junqi; Yang, Maobin

2016-12-01

The aim of this study was to investigate the release of growth factors into root canal space after the irrigation procedure of regenerative endodontic procedure. Sixty standardized root segments were prepared from extracted single-root teeth. Nail varnish was applied to all surfaces except the root canal surface. Root segments were irrigated with 1.5% NaOCl + 17% EDTA, 2.5% NaOCl + 17% EDTA, 17% EDTA, or deionized water. The profile of growth factors that were released after irrigation was studied by growth factor array. Enzyme-linked immunosorbent assay was used to validate the release of transforming growth factor (TGF)-β1 and basic fibroblast growth factor (bFGF) at 4 hours, 1 day, and 3 days after irrigation. The final concentrations were calculated on the basis of the root canal volume measured by cone-beam computed tomography. Dental pulp stem cell migration on growth factors released from root segments was measured by using Transwell assay. Total of 11 of 41 growth factors were detected by growth factors array. Enzyme-linked immunosorbent assay showed that TGF-β1 was released in all irrigation groups. Compared with the group with 17% EDTA (6.92 ± 4.49 ng/mL), the groups with 1.5% NaOCl + 17% EDTA and 2.5% NaOCl + 17% EDTA had significantly higher release of TGF-β1 (69.04 ± 30.41 ng/mL and 59.26 ± 3.37 ng/mL, respectively), with a peak release at day 1. The release of bFGF was detected at a low level in all groups (0 ng/mL to 0.43 ± 0.22 ng/mL). Migration assay showed the growth factors released from root segments induced dental pulp stem cell migration. The root segment model in present study simulated clinical scenario and indicated that the current irrigation protocol released a significant amount of TGF-β1 but not bFGF. The growth factors released into root canal space induced dental pulp stem cell migration. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Antimicrobial activity of root canal irrigants against biofilm forming pathogens- An in vitro study

PubMed Central

Ghivari, Sheetal Basavraj; Bhattacharya, Haimanti; Bhat, Kishore G.; Pujar, Madhu A.

2017-01-01

Aims: The aim of the study was to check the antimicrobial activity of the 5% Sodium hypochlorite, 2% Chlorhexidine, 0.10% Octenidine (OCT), and 2% Silver Zeolite (SZ) at different time intervals against a single species biofilm of Enterococcus faecalis, Staphylococcus aureus, and Candida albicans model prepared on a nitrocellulose membrane. Settings and Design: In vitro nitrocellulose biofilm model was used to check antibacterial efficacy of root canal irrigants. Materials and Methods: The in vitro nitrocellulose biofilm model was used to check the antibacterial activity of root canal irrigants. Single species biofilms were suspended into 96-well microtiter plate and treated with root canal irrigants for 1, 5, 10, 15, 30, and 60 s, respectively. The remaining microbial load in the form of colony-forming unit/ml after antimicrobial treatment was tabulated and data were statistically analyzed. Statistical Analysis: SPSS version 17, Kruskal–Wallis ANOVA, Mann–Whitney U-test, and Wilcoxon matched pair test (P < 0.05) were used. Results: All tested microorganisms were eliminated within 30 s by all the antimicrobial substances tested except normal saline. 2% chlorhexidine and 0.10% OCT were equally effective against C. albicans at 30 s. Conclusion: The newly tested irrigants have shown considerable antibacterial activity against selected single species biofilm. OCT (0.10%) can be used as an alternative endodontic irrigant. PMID:29279615

An evaluation of microbial leakage after using MTAD as a final irrigation.

PubMed

Ghoddusi, Jamileh; Rohani, Armita; Rashed, Tahereh; Ghaziani, Pari; Akbari, Majid

2007-02-01

Cleaning the root canal is not possible without using proper irrigation. The aim of this in vitro study was to evaluate the effect of MTAD as a final irrigant on bacterial leakage of the root canal, and its interaction with two conventional root canal sealers. We used 132 extracted human maxillary anterior teeth. The teeth were randomly divided into three experimental groups (n=40) and two groups (n=6) of positive and negative control. In group 1, the smear layer was not removed and irrigation was performed using 5.25% NaOCl. In group 2, the smear layer was removed using EDTA, and in group 3, the smear layer was removed using MTAD according to the clinical protocol of use. The teeth in each group were obturated with gutta-percha and AH-Plus or Rickert sealer. The coronal portion of each root was placed in contact with inoculum of Streptococcus mutans in Brain Heart Infusion (BHI) culture media. Each root tip was placed in one bottle containing sterile BHI. Mean duration of bacterial penetration in groups 2 and 3 was significantly greater than in group 1, but there was no significant difference between groups 2 and 3. According to our findings, it takes longer for bacteria to penetrate when either EDTA or MTAD is used for smear layer removal. The root canals obturated with AH Plus showed significantly longer duration of resistance to bacterial penetration than canals obturated with Rickert.

In vivo efficacy of three different endodontic irrigation systems for irrigant delivery to working length of mesial canals of mandibular molars.

PubMed

Munoz, Hugo Roberto; Camacho-Cuadra, Karla

2012-04-01

Many in vitro studies have debated over the ability of different irrigant delivery and/or agitation systems to reach the apical third of curved root canals; however, little is known about irrigant penetration in vivo. Therefore, the purpose of this study was to compare the efficacy of the conventional endodontic irrigation needle, passive ultrasonic irrigation (PUI), and a negative pressure system for irrigant delivery to working length (WL) of mesial canals of mandibular molars. Thirty mesial canals of 30 vital mandibular first or second molars were randomly assigned into 3 groups (n = 10): (1) Monoject syringe with 27-gauge needle; (2) PUI with IrriSafe tip; and (3) EndoVac system. All canals were treated following the same preparation protocol to size 35/0.04 by using 5.25% NaOCl as irrigant during preparation procedure. Before obturation, canals were irrigated with 1 mL of a radiopaque solution by using the assigned irrigation system, and a digital radiograph was taken by using a parallel technique. With the aid of image editing software the distance between WL and maximum irrigant penetration was measured. Mean distances for Monoject, PUI, and EndoVac groups were 1.51 mm, 0.21 mm, and 0.42 mm, respectively. Analysis of variance test showed statistically significant differences between groups (P < .001). Tukey honestly significant difference test showed statistically significant differences between the Monoject group and the other 2 groups (P < .001) but no significant differences between PUI and EndoVac groups (P = .06). PUI and EndoVac are more effective than the conventional endodontic needle in delivering irrigant to WL of root canals. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

A comparative scanning electron microscopic investigation of the smear layer after the use of sodium hypochlorite gel and solution forms as root canal irrigants.

PubMed

Zand, Vahid; Lotfi, Mehrdad; Rahimi, Saeed; Mokhtari, Hadi; Kazemi, Ali; Sakhamanesh, Vahideh

2010-07-01

The effect of sodium hypochlorite (NaOCl) gel along with EDTA on the removal of the smear layer has not been studied; therefore, the aim of the present study was to compare the efficacy of gel and solution forms of NaOCl in removal of the smear layer from root canal walls. A total of 40 single-rooted teeth with minimum curvature (<5 degrees) were selected and divided into two experimental groups, each containing 15 teeth and one positive control group containing 10 teeth. The canals of all the teeth were prepared with rotary RaCe instruments up to #35. In the NaOCl solution group, the root canals were flushed with 2.5% NaOCl solution during instrumentation and in NaOCl gel group, the instruments were coated with gel form of NaOCl and used inside the root canals; then saline was used for root canal irrigation. Finally, 1 mL of 17% EDTA was used to rinse inside the root canals and remained in the root canals for 2 minutes in the both experimental groups; in the saline group, only saline was used for irrigation. The amount of the smear layer was quantified according to the Torabinejad method using a scanning electron microscope. Data were analyzed by the Kruskal-Wallis and Mann-Whitney tests. All the statistical analyses were set with a significance level of alpha = 0.05. There were no significant differences between NaOCl gel and solution forms in the coronal, middle, and apical thirds of root canals. There were significant differences between NaOCl solution and saline groups in the three parts of root canal walls and between NaOCl gel and saline in the coronal, middle, and apical thirds. The use of NaOCl gel can be as effective as NaOCl solution along with EDTA in smear layer removal in the three parts of root canal walls. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Antibacterial Potential of 2.5% Sodium Hypochlorite in Distinct Irrigation Protocols on Enterococcus faecalis Biofilm.

PubMed

Alves, Denise Ramos Silveira; Cunha, Rodrigo Sanches; da Silveira Bueno, Carlos Eduardo; de Alencar, Ana Helena Gonçalves; de Araújo Estrela, Cyntia Rodrigues; dos Santos, Tatiane Oliveira; Estrela, Carlos

2015-05-01

The aim of this study was to evaluate the effect of irrigation methods on antibacterial potential of 2.5% NaOCl on Enterococcus faecalis biofilm. Enterococcus faecalis biofilms were prepared during 60 days on 48 human root canals and randomized into control and experimental groups using positive and negative pressure irrigation. Bacterial growth was analyzed using turbidity of culture medium followed by UV spectrophotometry, and scanning electron microscopy (SEM) analyses were performed. Mean and standard deviations were used for evaluate the mean optical densities associated to the number of bacteria present culture, and Scheirer-Ray-Hare (an extension of the Kruskal-Wallis test) and Tamhane test to analyze the SEM images in the groups and thirds. Significance was set at 5%. Enterococcus faecalis was still present after root canal cleaning regardless of irrigation methods or bacterial identification methods. Positive and negative pressure irrigation protocols using 2.5% NaOCl show a similar capacity to reduce E. faecalis in infected root canals.

Effectiveness of different final irrigation protocols in removing debris in flattened root canals.

PubMed

Nadalin, Michele Regina; Perez, Danyel Elias da Cruz; Vansan, Luiz Pascoal; Paschoala, Cristina; Souza-Neto, Manoel Damião; Saquy, Paulo César

2009-01-01

This study evaluated in vitro the capacity of debris removal from the apical third of flattened root canals, using different final irrigation protocols. Thirty human mandibular central incisors with a mesiodistal flattened root were prepared using rotary instrumentation by Endo-Flare 25.12 and Hero 642 30.06, 35.02, 40.02 files, irrigated with 2 mL of 1% NaOCl after each file. The specimens were randomly distributed into 5 groups according to the final irrigation of root canals: Group I: 10 mL of distilled water (control), Group II: 10 mL of 1% NaOCl for 8 min, Group III: 2 mL of 1% NaOCl for 2 min (repeated 4 times), Group IV: 10 mL of 2.5% NaOCl for 8 min, and Group V: 10 mL of 2.5% NaOCl for 2 min (repeated 4 times). The apical thirds of the specimens were subjected to histological processing and 6-microm cross-sections were obtained and stained with hematoxylin-eosin. The specimens were examined under optical microscopy at x40 magnification and the images were subjected to morphometric analysis using the Scion image-analysis software. The total area of root canal and the area with debris were measured in square millimeters. Analysis of variance showed no statistically significant difference (p>0.05) among the groups GI (2.39 +/- 3.59), GII (2.91 +/- 2.21), GIII (0.73 +/- 1.36), GIV (0.95 +/- 0.84) and GV (0.51 +/- 0.22). In conclusion, the final irrigation protocols evaluated in this study using the Luer syringe presented similar performance in the removal of debris from the apical third of flattened root canals.

Endoscopic root canal treatment.

PubMed

Moshonov, Joshua; Michaeli, Eli; Nahlieli, Oded

2009-10-01

To describe an innovative endoscopic technique for root canal treatment. Root canal treatment was performed on 12 patients (15 teeth), using a newly developed endoscope (Sialotechnology), which combines an endoscope, irrigation, and a surgical microinstrument channel. Endoscopic root canal treatment of all 15 teeth was successful with complete resolution of all symptoms (6-month follow-up). The novel endoscope used in this study accurately identified all microstructures and simplified root canal treatment. The endoscope may be considered for use not only for preoperative observation and diagnosis but also for active endodontic treatment.

Efficacy of laser-driven irrigation versus ultrasonic in removing an airlock from the apical third of a narrow root canal.

PubMed

Peeters, Harry Huiz; Gutknecht, Norbert

2014-08-01

The purpose of the study was to test the hypothesis that air entrapment occurs in the apical third of a root canal during irrigation. A second objective was to test the null hypothesis that there is no difference between laser-driven irrigation (an erbium, chromium:yttrium-scandium-gallium-garnet laser) and passive ultrasonic irrigation in removing an airlock from the apical third. One hundred twenty extracted human teeth with single narrow root canals were randomised into two experimental groups (n = 40) and two control groups (n = 20). The specimens were shaped using hand instruments up to a size 30/0.02 file. The teeth were irrigated with a mixture of saline, radiopaque contrast and ink in solution. In the passive ultrasonic irrigation group, the irrigant was activated with an ultrasonic device for 60 s. In the laser group, the irrigant was activated with a laser for 60 s. It was concluded that if the insertion of irrigation needle is shorter than the working length, air entrapment may develop in the apical third, but the use of laser-driven irrigation is completely effective in removing it. © 2013 The Authors. Australian Endodontic Journal © 2013 Australian Society of Endodontology.

Determination of Root Canal Cleanliness by Different Irrigation Methods and Morphometric Analysis of Apical Third.

PubMed

Seixas, Fábio Heredia; Estrela, Carlos; Bueno, Mike Reis; Sousa-Neto, Manoel Damião; Pécora, Jesus Djalma

2015-06-01

The aim of this study was to determine the root canal area before and after the instrumentation 1 mm short of the apical foramen by clinical and cone beam computed tomography (CBCT) methods, and to evaluate the cleanliness of the apical region in mesiodistal flattened teeth by using optical microscopy. Forty-two human single-canal mandibular incisors were instrumented using the Free Tip Preparation technique up to three, four or five instruments from the initial. Cone beam computed tomography scans were acquired of the samples before and after root canal preparation (RCP). Irrigation was performed by conventional or hydrodynamic means, using 2.5% sodium hypochlorite. The samples were prepared for observation under an optical microscope. Images were digitally obtained, analyzed and the results were submitted to statistical analysis (two-way ANOVA complemented by Bonferroni's post-test). There was no significant difference between the studied anatomical areas with both CBCT and clinical methods. There were no differences between irrigation methods. It was verified differences between instrumentation techniques. Instrumentation with four instruments from the initial instrument determined a significant increase in the contact area when compared to preparation with three instruments, but RCP with 5 instruments did not result in a better cleanliness. The analysis with CBCT was not capable to determine the precise shape of surgical apical area comparing to the clinical method. Both the conventional and hydrodynamic irrigation techniques were not able to promote root canals debris-free. The instruments action in root canal walls was proportional to the number of instruments used from the initial apical instrument.

Canal and isthmus debridement efficacies of two irrigant agitation techniques in a closed system

PubMed Central

Susin, L.; Yoon, J. C.; Liu, Y.; Parente, J. M.; Loushine, R. J.; Ricucci, D.; Bryan, T.; Weller, R. N.; Pashley, D. H.; Tay, F. R.

2010-01-01

Aim To compare canal and isthmus debris debridement efficacies of the manual dynamic irrigation (MDI) and apical negative pressure (ANP) techniques in the mesial root of mandibular first molars with narrow isthmi, using a closed canal design. Methodology Micro-computed tomography was employed to select 20 teeth, each containing a narrow isthmus. Each root was sealed at the apex with hot glue and embedded in polyvinylsiloxane to simulate a closed canal system. The teeth were submitted to a standardised instrumentation protocol. Final irrigation was performed with either the MDI or the ANP technique using the EndoVac system (N=10). Masson trichrome-stained sections were prepared from completely demineralised roots at ten canal levels between 1–2.8 mm of the anatomical apices. Areas occupied by canals and isthmus of each root and debris in the corresponding regions were digitised by the NIH Image J software and statistically analysed using two-way repeated measures ANOVA. Results For the instrumented canals, there were no differences between the two groups (p=0.131) in the area occupied by debris at all canal levels (p=0.343). Conversely, for the isthmus, less debris was found in the ANP group (p<0.001) but no differences were seen in each group with respect to the ten canal levels (p=0.352). Conclusion Neither technique produce completely removed debris from the isthmus regions. However the EndoVac system, which encompasses the ANP concept, removed considerably more debris from narrow isthmi of the mandibular mesial roots. PMID:20726910

Effectiveness of supplementary irrigant agitation with the Finisher GF Brush on the debridement of oval root canals instrumented with the Gentlefile or nickel titanium rotary instruments.

PubMed

Neelakantan, P; Khan, K; Li, K Y; Shetty, H; Xi, W

2018-07-01

To examine the efficacy of a novel supplementary irrigant agitating brush (Finisher GF Brush, MedicNRG, Kibbutz Afikim, Israel) on the debridement of root canals prepared with a novel stainless steel rotary instrumentation system (Gentlefile; MedicNRG), or nickel titanium rotary instruments in oval root canals. Mandibular premolars (n = 72) were selected and divided randomly into three experimental groups (n = 24) after microCT scanning: group 1, canal preparation to rotary NiTi size 20, .04 taper (R20); group 2, rotary NiTi to size 25, .04 taper (R25) and group 3, Gentlefile size 23, .04 taper (GF). Specimens were subdivided into two subgroups: subgroup A, syringe-and-needle irrigation (SNI); subgroup B, Finisher GF Brush (GB). Ten untreated canals served as controls. Specimens were processed for histological evaluation, and the remaining pulp tissue (RPT) was measured. Data were analysed using Mann-Whitney and Kruskal-Wallis tests (P = 0.05). All experimental groups had significantly less RPT than the control (P < 0.05). Group 3B (GF-GB) had significantly less RPT than groups 1B (R20-GB) and 2B (R25-GF; P < 0.05). When irrigated with SNI, there was no significant difference in the RPT between the three groups (P > 0.05). When instrumented with R20, there was no significant difference between SNI and GF (P < 0.05) whilst GB had significantly less RPT than SNI for R25 (P < 0.05). Supplementary irrigant agitation with the Finisher GF Brush improved the debridement of canals prepared with Gentlefile and size 25, .04 taper rotary NiTi. Root canal debridement did not significantly differ between the instruments when syringe irrigation was used. © 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.

An in vitro evaluation of the degree of pulp tissue dissolution through different root canal irrigation protocols.

PubMed

Amato, Massimo; Pantaleo, Giuseppe; Abtellatif, Dina; Blasi, Andrea; Gagliani, Massimo; Iandolo, Alfredo

2018-01-01

The aim of this study is to evaluate in vitro , using artificial lateral canals, the rate of dissolution of the pulp tissue through different protocols of canal irrigation. One hundred artificial canals provided with lateral canals have been used. Each lateral canal was filled with pulp tissue and calibrated to 0.002 mg. All canals were irrigated using five different protocols. Five groups have been used for the experiment: Group A, distilled water (control); Group B, preheated NaOCl; Group C, NaOCl heated inside the canal; Group D, NaOCl ultrasonically activated; and Group E, NaOCl heated inside the canal with ultrasonic activation. All samples were weighed through professional microbalance in three different phases: before insertion of the pulp tissue into the lateral canal, after insertion of the pulp tissue and, finally, after different protocols of irrigation. A statistical analysis with Kruskal-Wallis test and Mann-Whitney test was performed. The partial dissolution of the pulp tissue inside the artificial lateral canal occurs only using the protocol with NaOCl heated inside the canal with ultrasonic activation. Other irrigation protocols are not able to dissolve the pulp tissue. The main objective of endodontic therapy is the removal of damaged tissues and bacteria. Modern literature highlights that it is impossible to remove all the pulp tissues and bacteria from the whole endodontic space. Hence, to achieve excellence and get positive results in the short and long term, it is necessary to use techniques and technologies that may increase the degree of root canal detersion.

[The use of self-adapting system files (SAF) for controlling microbial biofilms of root canals in the treatment of apical periodontitis].

PubMed

Tsarev, V N; Mamedova, L A; Siukaeva, T N; Podporin, M S

The aim of this study was to conduct a clinical and laboratory study and evaluate the effectiveness of endodontic root canal treatment using a self-adapting files system (SAF) in the complex treatment of patients with chronic apical periodontitis. 3% sodium hypochlorite solution was used as irrigation agent in all groups which included 20 patients treated with conventional manual tools, 21 patients receiving treatment with ultrasonic activation of irrigant and 26 patients treated with SAF system. Root canal biofilm structure was studied by scanning electron microscopy (SEM) using a Quantum 3D microscope (USA). Clinical efficiency of the root canal treatment was assessed by complications frequency a year after treatment. SEM revealed the presence of high levels of microbial contamination of dentine tubules in the apical portion of the tooth. In standard method group the percentage of re-treatment and surgery was higher than in the studied groups. Use of SAF irrigation system was associated with a decrease in the number of identified pathogens. However, the study revealed high resistance of Enterococcus spp., Porphyromonas gingivalis, Candida albicans to all types of endodontic treatment, so the improvement of methods of root canal microbial biofilms removing need to be continued.

Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer.

PubMed

Lottanti, S; Gautschi, H; Sener, B; Zehnder, M

2009-04-01

To evaluate the effects of ethylenediaminetetraacetic (EDTA), etidronic (EA) and peracetic acid (PA) when used in conjunction with sodium hypochlorite (NaOCl) as root canal irrigants on calcium eluted from canals, smear layer, and root dentine demineralization after instrumentation/irrigation. Single-rooted human premolars were irrigated as follows (n = 12 per group): (1) 1% NaOCl during instrumentation, deionized water after instrumentation, (2) 1% NaOCl during, 17% EDTA after instrumentation, (3) a 1 : 1-mixture of 2% NaOCl and 18% EA during and after instrumentation, and (4) 1% NaOCl during, 2.25% PA after instrumentation. Irrigant volumes and contact times were 10 mL/15 min during and 5 mL/3 min after instrumentation. The evaluated outcomes were eluted calcium by atomic absorption spectroscopy, smear-covered areas by scanning electron microscopy in secondary electron mode and apparent canal wall decalcifications on root transsections in backscatter mode. For the smear layer analysis, sclerotic dentine was taken into consideration. Results were compared using appropriate parametric and nonparametric tests, alpha = 0.05. The statistical comparison of the protocols regarding calcium elution revealed that protocol (1) yielded less calcium than (3), which yielded less than protocols (2) and (4). Most of the instrumented canal walls treated with one of the decalcifying agents were free of smear layer. Protocols (1) and (3) caused no decalcification of root dentine, whilst (2) and (4) showed substance typical demineralization patterns. The decalcifying agents under investigation were all able to remove or prevent a smear layer. However, they eroded the dentine wall differently.

Chemomechanical preparation by hand instrumentation and by Mtwo engine-driven rotary files, an ex vivo study.

PubMed

Krajczár, Károly; Tigyi, Zoltán; Papp, Viktória; Marada, Gyula; Sára, Jeges; Tóth, Vilmos

2012-07-01

To compare the disinfecting efficacy of the sodium hypochlorite irrigation by root canal preparation with stainless steel hand files, taper 0.02 and nickel-titanium Mtwo files with taper 0.04-0.06. 40 extracted human teeth were sterilized, and then inoculated with Enterococcus faecalis (ATCC 29212). After 6 day incubation time the root canals were prepared by hand with K-files (n=20) and by engine-driven Mtwo files (VDW, Munich, Germany) (n=20). Irrigation was carried out with 2.5% NaOCl in both cases. Samples were taken and determined in colony forming units (CFU) from the root canals before and after the preparation with instruments #25 and #35. Significant reduction in bacterial count was determined after filing at both groups. The number of bacteria kept on decreasing with the extension of apical preparation diameter. There was no significant difference between the preparation sizes in the bacterial counts after hand or engine-driven instrumentation at the same apical size. Statistical analysis was carried out with Mann-Whitney test, paired t-test and independent sample t-test. Significant reduction in CFU was achieved after the root canal preparation completed with 2.5% NaOCl irrigation, both with stainless steel hand or nickel-titanium rotary files. The root canal remained slightly infected after chemo mechanical preparation in both groups. Key words:Chemomechanical preparation, root canal disinfection, nickel-titanium, conicity, greater taper, apical size.

Chemomechanical preparation by hand instrumentation and by Mtwo engine-driven rotary files, an ex vivo study

PubMed Central

Krajczár, Károly; Tigyi, Zoltán; Papp, Viktória; Sára, Jeges; Tóth, Vilmos

2012-01-01

Objective: To compare the disinfecting efficacy of the sodium hypochlorite irrigation by root canal preparation with stainless steel hand files, taper 0.02 and nickel-titanium Mtwo files with taper 0.04-0.06. Study Design: 40 extracted human teeth were sterilized, and then inoculated with Enterococcus faecalis (ATCC 29212). After 6 day incubation time the root canals were prepared by hand with K-files (n=20) and by engine-driven Mtwo files (VDW, Munich, Germany) (n=20). Irrigation was carried out with 2.5% NaOCl in both cases. Samples were taken and determined in colony forming units (CFU) from the root canals before and after the preparation with instruments #25 and #35. Results: Significant reduction in bacterial count was determined after filing at both groups. The number of bacteria kept on decreasing with the extension of apical preparation diameter. There was no significant difference between the preparation sizes in the bacterial counts after hand or engine-driven instrumentation at the same apical size. Statistical analysis was carried out with Mann-Whitney test, paired t-test and independent sample t-test. Conclusions: Significant reduction in CFU was achieved after the root canal preparation completed with 2.5% NaOCl irrigation, both with stainless steel hand or nickel-titanium rotary files. The root canal remained slightly infected after chemo mechanical preparation in both groups. Key words:Chemomechanical preparation, root canal disinfection, nickel-titanium, conicity, greater taper, apical size. PMID:24558545

Influence of an apical negative pressure irrigation system on bacterial elimination during endodontic therapy: a prospective randomized clinical study.

PubMed

Pawar, Rekha; Alqaied, Abdullah; Safavi, Kamran; Boyko, Jennifer; Kaufman, Blythe

2012-09-01

Recent in vitro studies that use an apical negative pressure irrigation system, EndoVac, have demonstrated promising results in the production of debris-free root canals, while also preventing potential extrusion of irrigants into the periapical region. We conducted a randomized, controlled, prospective clinical study to determine whether the use of EndoVac irrigation (EndoVac group) was more efficient compared with standard needle irrigation (control group) in obtaining canals from which microbes could not be cultivated. Routine endodontic therapy was performed in 48 patients with necrotic, single-rooted, single-canal teeth. The patients were randomly assigned to either the EndoVac group (n = 25) or control group (n = 23). Irrigation with either method was carried out with 0.5% sodium hypochlorite. After surface disinfection, before instrumentation and on completion of chemomechanical preparation, intracanal microbial samples were obtained and cultured under anaerobic conditions. The frequency of microbial cultivability by using either irrigation system was analyzed. The frequency of obtaining culture-negative root canals was 90.9% and 82.6% for the control group and EndoVac group, respectively. There was no significant difference in the antimicrobial efficacy of either control group or EndoVac group (Fisher exact test, P = .665). Furthermore, no significant association between study variables and the irrigation systems' antimicrobial efficacy was found (P > .05). The results of this prospective in vivo study demonstrate that the antimicrobial efficacy of EndoVac irrigation is comparable to that of standard irrigation. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Smear Layer Evaluation on Root Canal Preparation with Manual and Rotary Techniques using EDTA as an Irrigant: A Scanning Electron Microscopy Study

PubMed Central

Manjunatha, M; Annapurna, Kini; Sudhakar, V; Sunil Kumar, VC; Hiremath, Vinay Kumar; Shah, Ankur

2013-01-01

Introduction: The aim of any root canal treatment is to achieve a canal free of micro organisms, residual pulp remnants, debris and smear layer for the long term success of the procedure. Manual and automated instrumentation techniques along with proper irrigation regime is used to arrive at the aforementioned goal. Many authors focused on the preparation capabilities of various manual and rotary instruments but very few investigators stressed on the actual cleaning abilities of these instruments. Aims and objectives: This study was undertaken to evaluate the cleaning efficiency of manual K flex files and rotary Pro File systems in the root canals using a scanning electron microscope. Material and Methods:Thirty single rooted mandibular first premolars were divided into two groups and randomized (the manual group-M and the ProFile group-P) with respect to the preparation technique. The Manual group was hand instrumented with stainless steel K- Flexofiles by means of a conventional filing technique. The Pro File group was instrumented according to the manufacturer's instructions using a rotary handpiece. All canals were shaped and cleaned under frequent irrigation with EDTA. Final irrigation was carried out with 3 mL of normal saline solution to neutralize the action of the irrigant. The roots were split, one half of each tooth was selected for further SEM technique analysis and examined under the scanning electron microscope. The canal walls were quantitatively evaluated for the amount of debris and smear layer. The apical, middle and coronal regions of the canal surface, were graded (1-5) for debris and smear layer. A statistical analysis was performed using a Mann-Whitney Rank Sum test. ProFile performed least effective cleaning. Manual K-Flexofiles led to a grooved pattern. Results and Conclusion: A statistically significant difference was observed (p<0.05) between the two instrumentation techniques concerning the amount of debris and smear layer at the apical level. The manually filed canals had less debris and smear layer than those using a rotary technique. It was concluded from this study that none of the instrumentation techniques employed, produced the canal walls which were free of surface debris and smear layer. The manual instrumentation technique was better in cleaning the canals compared to the ProFile rotary Ni-Ti instruments despite the step-back technique used for manual instrumentation. How to cite this article: Manjunatha M, Kini A, Sudhakar V, Sunil K V C, Hiremath V K, Shah A. Smear Layer Evaluation on Root Canal Preparation with Manual and Rotary Techniques using EDTA as an Irrigant: A Scanning Electron Microscopy Study. J Int Oral Health 2013; 5(1):66-78. PMID:24155580

[Root canal treatment of mandibular first premolar with 4 root canals: a case report].

PubMed

Liu, Xin-yang; Zhan, Fu-Liang

2015-10-01

The mandibular first premolar can be considered one of the most challenging teeth to treat, due to the complexity of its root canal morphology and increased incidence of multiple canals. A case of endodontic treatment of a mandibular first premolar exhibiting a total of 4 distinct root canals and 4 apical foramina was described. Anatomic variation of root canal morphology should be considered in endodontic treatment to ensure a favorable healing outcome, and its identification could be enhanced by careful examination using a dental operating microscope. Obturation of root canals using a warm vertical compaction technique with a highly-radiopaque root canal sealer, such as AH Plus, after careful ultrasonic activated irrigation might allow the flow of sealer into the narrowed but unprepared part of the canal, thereby facilitating optimum chemo-mechanical debridement of the root canal system.

The failures of root canal preparation with hand ProTaper.

PubMed

Bătăiosu, Marilena; Diaconu, Oana; Moraru, Iren; Dăguci, C; Tuculină, Mihaela; Dăguci, Luminiţa; Gheorghiţă, Lelia

2012-07-01

The failures of root canal preparation are due to some anatomical deviation (canal in "C" or "S") and some technique errors. The technique errors are usually present in canal root cleansing and shaping stage and are the result of endodontic treatment objectives deviation. Our study was made on technique errors while preparing the canal roots with hand ProTaper. Our study was made "in vitro" on 84 extracted teeth (molars, premolars, incisors and canines). The canal root of these teeth were cleansed and shaped with hand ProTaper by crown-down technique and canal irrigation with NaOCl(2,5%). The dental preparation control was made by X-ray. During canal root preparation some failures were observed like: canal root overinstrumentation, zipping and stripping phenomenon, discarded and/or fractured instruments. Hand ProTaper represents a revolutionary progress of endodontic treatment, but a deviation from accepted rules of canal root instrumentation can lead to failures of endodontic treatment.

Visualization of irrigant flow and cavitation induced by Er:YAG laser within a root canal model.

PubMed

Matsumoto, Himeka; Yoshimine, Yoshito; Akamine, Akifumi

2011-06-01

Laser-activated irrigation (LAI) has recently been introduced as an innovative method for root canal irrigation. However, there is limited information about the cleaning mechanism of an Er:YAG laser. In this study, we visualized the action of laser-induced bubbles and fluid flow in vitro to better understand the physical mechanisms underlying LAI. An Er:YAG laser was equipped with a novel cone-shaped tip with a lateral emission rate of approximately 80%. Laser light was emitted at a pulse energy of 30, 50, or 70 mJ (output energy: 11, 18, or 26 mJ) and a repetition rate of 1 or 20 pulses per second, without air or water spray. Fluid flow dynamics in a root canal model were observed by using glass-bead tracers under a high-speed camera. Moreover, laser-induced bubble patterns were visualized in both free water and the root canal model. Tracers revealed high-speed motion of the fluid. A full cycle of expansion and implosion of vapor and secondary cavitation bubbles were clearly observed. In free water, the vapor bubble expanded for 220 microseconds, and its shape resembled that of an apple. In the root canal model, the vapor bubble expanded in a vertical direction along the canal wall, and bubble expansion continued for ≥700 microseconds. Furthermore, cavitation bubbles were created much more frequently in the canal model than in free water. These results suggest that the cleaning mechanism of an Er:YAG laser within the root canal might depend on rapid fluid motion caused by expansion and implosion of laser-induced bubbles. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The effect of different final irrigant activation techniques on the bond strength of an epoxy resin-based endodontic sealer: a preliminary study.

PubMed

Topçuoğlu, Hüseyin Sinan; Tuncay, Öznur; Demirbuga, Sezer; Dinçer, Asiye Nur; Arslan, Hakan

2014-06-01

The aim of this study was to evaluate whether or not different final irrigation activation techniques affect the bond strength of an epoxy resin-based endodontic sealer (AH Plus; Dentsply DeTrey, Konstanz, Germany) to the root canal walls of different root thirds. Eighty single-rooted human mandibular premolars were prepared by using the ProTaper system (Dentsply Maillefer, Ballaigues, Switzerland) to size F4, and a final irrigation regimen using 3% sodium hypochlorite and 17% EDTA was performed. The specimens were randomly divided into 4 groups (n = 20) according to the final irrigation activation technique used as follows: no activation (control), manual dynamic activation (MDA), CanalBrush (Coltene Whaledent, Altststten, Switzerland) activation, and ultrasonic activation. Five specimens from each group were prepared for scanning electron microscopic observation to assess the smear layer removal after the final irrigation procedures. All remaining roots were then obturated with gutta-percha and AH Plus sealer. A push-out test was used to measure the bond strength between the root canal dentin and AH Plus sealer. The data obtained from the push-out test were analyzed using 2-way analysis of variance and Tukey post hoc tests. The bond strength values mostly decreased in the coronoapical direction (P < .001). In the coronal and middle thirds, ultrasonic activiation showed a higher bond strength than other groups (P < .05). In the apical third, MDA displayed the highest bond strength to root dentin (P < .05). The majority of specimens exhibited cohesive failures. The bond strength of AH Plus sealer to root canal dentin may improve with ultrasonic activation in the coronal and middle thirds and MDA in the apical third. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Anatomy of Sodium Hypochlorite Accidents Involving Facial Ecchymosis – A Review

PubMed Central

Zhu, Wan-chun; Gyamfi, Jacqueline; Niu, Li-na; Schoeffel, G. John; Liu, Si-ying; Santarcangelo, Filippo; Khan, Sara; Tay, Kelvin C-Y.; Pashley, David H.; Tay, Franklin R.

2013-01-01

Objectives Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur. Methods To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavor to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed. Results By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented. Conclusions Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system. PMID:23994710

Anatomy of sodium hypochlorite accidents involving facial ecchymosis - a review.

PubMed

Zhu, Wan-chun; Gyamfi, Jacqueline; Niu, Li-na; Schoeffel, G John; Liu, Si-ying; Santarcangelo, Filippo; Khan, Sara; Tay, Kelvin C-Y; Pashley, David H; Tay, Franklin R

2013-11-01

Root canal treatment forms an essential part of general dental practice. Sodium hypochlorite (NaOCl) is the most commonly used irrigant in endodontics due to its ability to dissolve organic soft tissues in the root canal system and its action as a potent antimicrobial agent. Although NaOCl accidents created by extrusion of the irrigant through root apices are relatively rare and are seldom life-threatening, they do create substantial morbidity when they occur. To date, NaOCl accidents have only been published as isolated case reports. Although previous studies have attempted to summarise the symptoms involved in these case reports, there was no endeavour to analyse the distribution of soft tissue distribution in those reports. In this review, the anatomy of a classical NaOCl accident that involves facial swelling and ecchymosis is discussed. By summarising the facial manifestations presented in previous case reports, a novel hypothesis that involves intravenous infusion of extruded NaOCl into the facial vein via non-collapsible venous sinusoids within the cancellous bone is presented. Understanding the mechanism involved in precipitating a classic NaOCl accident will enable the profession to make the best decision regarding the choice of irrigant delivery techniques in root canal débridement, and for manufacturers to design and improve their irrigation systems to achieve maximum safety and efficient cleanliness of the root canal system. Copyright © 2013 Elsevier Ltd. All rights reserved.

Antimicrobial efficacy of 2.5% sodium hypochlorite, 2% chlorhexidine, and ozonated water as irrigants in mesiobuccal root canals with severe curvature of mandibular molars

PubMed Central

Pinheiro, Sergio Luiz; da Silva, Caio Cesar; da Silva, Lucas Augusto; Cicotti, Marina P.; Bueno, Carlos Eduardo da Silveira; Fontana, Carlos Eduardo; Pagrion, Letícia R.; Dalmora, Natália P.; Daque, Thaís T.; de Campos, Francisco UF

2018-01-01

Objective: The aim of this study is to evaluate the antimicrobial efficacy of 2.5% sodium hypochlorite, 2% chlorhexidine, and ozonated water on biofilms of Enterococcus faecalis, Streptococcus mutans, and Candida albicans in mesiobuccal root canals with severe curvature of mandibular molars. Materials and Methods: This was an experimental ex vivo study in microbiologic laboratory. Sixty mesiobuccal root canals with severe curvature of mandibular molars were contaminated with standard strains of E. faecalis, S. mutans, and C. albicans. The specimens were randomly divided into four groups (n = 15) according to irrigating solution: SH: 2.5% sodium hypochlorite; CH: 2% chlorhexidine; O3: ozonated water; and control: double-distilled water. The mesiobuccal root canals of all groups were instrumented with the WaveOne Gold Primary reciprocating system. Three cycles of instrumentation with three short in-and-out brushing motions were performed: (1) in the coronal third, (2) in the middle third, and (3) in the apical third of the canal. A ProGlider file was used before the first cycle. Statistical Analysis: Statistical analysis was performed using one-way analysis of variance followed by Tukey's multiple comparison test. Samples were collected for viable bacterial counts before and after instrumentation. Results: All groups showed significant biofilm reduction after irrigation (P < 0.01). After instrumentation, sodium hypochlorite (98.07%), chlorhexidine (98.31%), and ozonated water (98.02%) produced a significantly reduction in bacterial counts compared with double-distilled water (control, 72.98%) (P < 0.01). Conclusion: All irrigants tested in this study showed similar antimicrobial activity. Thus, ozonated water may be an option for microbial reduction in the root canal system. PMID:29657531

Relevance of the clustered regularly interspaced short palindromic repeats of Enterococcus faecalis strains isolated from retreatment root canals on periapical lesions, resistance to irrigants and biofilms

PubMed Central

Tong, Zhongchun; Du, Yu; Ling, Junqi; Huang, Lijia; Ma, Jinglei

2017-01-01

A high prevalence of Enterococcus faecalis (E. faecalis) is observed in teeth with root canal treatment failures. Clustered regularly interspaced short palindromic repeats (CRISPR) are widely distributed in prokaryotes that have adaptive immune systems against mobile elements, including pathogenic genes. The present study investigated the relevance of the CRISPR in E. faecalis strains isolated from retreated root canals on biofilms, periapical lesions and drug resistance. A total of 20 E. faecalis strains were extracted from the root canals of teeth referred for root canal retreatment. CRISPR-Cas loci were identified by two pairs of relevant primers and polymerase chain reaction. The susceptibility of the 20 isolated strains to intracanal irrigants was evaluated by 1- and 5-minute challenges with a mixture of a tetracycline isomer, an acid and a detergent (MTAD), 2% chlorhexidine (CHX) and 5.25% sodium hypochlorite (NaOCl). The microtiter plate assay and crystal violet staining were used to compare the biofilm formation of the E. faecalis isolate strains. Out of the 20 E. faecalis isolate strains, 5 strains that lacked CRISPR-cas determinants exhibited significant periapical lesions. Among the 15 strains containing CRISPR-cas determinants, 8 were isolated from root canals with inadequate fillings and 7 were isolated from root canals without any fillings. The five strains lacking CRISPR-cas loci were observed to be more resistant to MTAD and 2% CHX than the 15 strains that had CRISPR-cas loci. All of the strains exhibited the same susceptibility to 5.25% NaOCl. Furthermore, the 5 strains lacking CRISPR-cas determinants generated more biofilm than the other 15 strains. Thus, the results of the present study suggested that E. faecalis root canal isolates lacking CRISPR-cas exhibit higher resistance to intracanal irrigants, stronger biofilm formation and generate significant periapical lesions. PMID:29285081

Relevance of the clustered regularly interspaced short palindromic repeats of Enterococcus faecalis strains isolated from retreatment root canals on periapical lesions, resistance to irrigants and biofilms.

PubMed

Tong, Zhongchun; Du, Yu; Ling, Junqi; Huang, Lijia; Ma, Jinglei

2017-12-01

A high prevalence of Enterococcus faecalis ( E. faecalis ) is observed in teeth with root canal treatment failures. Clustered regularly interspaced short palindromic repeats (CRISPR) are widely distributed in prokaryotes that have adaptive immune systems against mobile elements, including pathogenic genes. The present study investigated the relevance of the CRISPR in E. faecalis strains isolated from retreated root canals on biofilms, periapical lesions and drug resistance. A total of 20 E. faecalis strains were extracted from the root canals of teeth referred for root canal retreatment. CRISPR-Cas loci were identified by two pairs of relevant primers and polymerase chain reaction. The susceptibility of the 20 isolated strains to intracanal irrigants was evaluated by 1- and 5-minute challenges with a mixture of a tetracycline isomer, an acid and a detergent (MTAD), 2% chlorhexidine (CHX) and 5.25% sodium hypochlorite (NaOCl). The microtiter plate assay and crystal violet staining were used to compare the biofilm formation of the E. faecalis isolate strains. Out of the 20 E. faecalis isolate strains, 5 strains that lacked CRISPR-cas determinants exhibited significant periapical lesions. Among the 15 strains containing CRISPR-cas determinants, 8 were isolated from root canals with inadequate fillings and 7 were isolated from root canals without any fillings. The five strains lacking CRISPR-cas loci were observed to be more resistant to MTAD and 2% CHX than the 15 strains that had CRISPR-cas loci. All of the strains exhibited the same susceptibility to 5.25% NaOCl. Furthermore, the 5 strains lacking CRISPR-cas determinants generated more biofilm than the other 15 strains. Thus, the results of the present study suggested that E. faecalis root canal isolates lacking CRISPR-cas exhibit higher resistance to intracanal irrigants, stronger biofilm formation and generate significant periapical lesions.

The self-adjusting file (SAF) system: An evidence-based update.

PubMed

Metzger, Zvi

2014-09-01

Current rotary file systems are effective tools. Nevertheless, they have two main shortcomings: They are unable to effectively clean and shape oval canals and depend too much on the irrigant to do the cleaning, which is an unrealistic illusionThey may jeopardize the long-term survival of the tooth via unnecessary, excessive removal of sound dentin and creation of micro-cracks in the remaining root dentin. The new Self-adjusting File (SAF) technology uses a hollow, compressible NiTi file, with no central metal core, through which a continuous flow of irrigant is provided throughout the procedure. The SAF technology allows for effective cleaning of all root canals including oval canals, thus allowing for the effective disinfection and obturation of all canal morphologies. This technology uses a new concept of cleaning and shaping in which a uniform layer of dentin is removed from around the entire perimeter of the root canal, thus avoiding unnecessary excessive removal of sound dentin. Furthermore, the mode of action used by this file system does not apply the machining of all root canals to a circular bore, as do all other rotary file systems, and does not cause micro-cracks in the remaining root dentin. The new SAF technology allows for a new concept in cleaning and shaping root canals: Minimally Invasive 3D Endodontics.

Effectiveness of various irrigation protocols for the removal of calcium hydroxide from artificial standardized grooves

PubMed Central

GOKTURK, Hakan; OZKOCAK, Ismail; BUYUKGEBIZ, Feyzi; DEMIR, Osman

2017-01-01

Abstract Objective The aim of this study was to investigate the ability of laser-activated irrigation (LAI), XP-endo Finisher, CanalBrush, Vibringe, passive ultrasonic irrigation (PUI), and conventional syringe irrigation systems on the removal of calcium hydroxide (CH) from simulated root canal irregularities. Material and Methods The root canals of one hundred and five extracted single-rooted teeth were instrumented using Reciproc rotary files up to size R40. The teeth were split longitudinally. Two of the three standard grooves were created in the coronal and apical section of one segment, and another in the middle part of the second segment. The standardized grooves were filled with CH and the root halves were reassembled. After 14 days, the specimens were randomly divided into 7 experimental groups (n=15/group). CH was removed as follows: Group 1: beveled needle irrigation; Group 2: double side-vented needle irrigation; Group 3: CanalBrush; Group 4: XP-endo Finisher; Group 5: Vibringe; Group 6: PUI; Group 7: LAI. The amount of remaining CH in the grooves was scored under a stereomicroscope at 20× magnification. Statistical evaluation was performed using Kruskal–Wallis and Bonferroni-Correction Mann–Whitney U tests. Results Groups 1 and 2 were the least efficient in eliminating CH from the grooves. Groups 6 and 7 eliminated more CH than the other protocols; however, no significant differences were found between these two groups (P>.05). Conclusions Nevertheless, none of the investigated protocols were able to completely remove all CH from all three root regions. LAI and PUI showed less residual CH than the other protocols from artificial grooves. PMID:28678948

Antibacterial properties of root canal lubricants: a comparison with commonly used irrigants.

PubMed

Wong, Samantha; Mundy, Lance; Chandler, Nicholas; Upritchard, Jenine; Purton, David; Tompkins, Geoffrey

2014-12-01

The aim was to assess in vitro the antibacterial activity of 10 root canal lubricants. K-Y Jelly personal lubricant, RC-Prep, File-Eze, File-Rite, EndoPrep Gel, Endosure Prep Crème 15%, Prep-Rite, Glyde, SlickGel ES and Alpha Glide were selected and compared in their antimicrobial properties to seven irrigants. Serial dilutions of each agent in tryptic soy broth were inoculated with either Enterococcus faecalis or Pseudomonas aeruginosa and incubated at 37C for 24 h. During incubation bacterial growth was measured by optical density (A(600)), and samples removed for cultivation on tryptic soy broth agar. Against both test bacteria after 1 h incubation, six lubricants recorded minimum bactericidal concentrations ranging from 1/10 to 1/80, whereas the inhibitory activity of the irrigants ranged from 1/20 to 1/640. Under these conditions, several lubricants exhibited antimicrobial activity comparable with some irrigants. Three irrigants, Consepsis (containing chlorhexidine), Endosure EDTA/C (containing cetrimide) and EndoPrep Solution (containing cetrimide), showed superior antibacterial action to lubricants against both species. The irrigants containing ethylenediamine tetraacetic acid and cetrimide were the most effective against both bacterial species at all time intervals. Antimicrobial activity of the lubricants did not correlate to pH values, which ranged from 2.9 to 10.3. Root canal lubricants have antibacterial properties that may help to disinfect canals. © 2014 Australian Society of Endodontology.

Comparative evaluation of postoperative pain after using endodontic needle and EndoActivator during root canal irrigation: A randomised controlled trial.

PubMed

Ramamoorthi, Surendar; Nivedhitha, Malli Sureshbabu; Divyanand, Madras Jeyaprakash

2015-08-01

The purpose of this study was to evaluate and compare the postoperative level of pain after activation of irrigants using EndoActivator with conventional needle irrigation during root canal therapy. In this prospective randomised clinical trial, 72 symptomatic irreversible pulpitis patients were selected. Based on block randomisation after routine root canal preparation, patients were assigned to two groups. In group EN, procedures were performed with endodontic irrigating needle (n = 36) while group EA received activation using EndoActivator (n = 36) in the final irrigation protocol. All the participants were called through phone at 8, 24 and 48 h to analyse pain score using visual analogue scale. Those patients who developed pain were prescribed ibuprofen 200 mg. Pain score and frequency of tablet intake were recorded and statistically analysed. Results showed that group EA resulted in significantly less postoperative pain and analgesics intake than group EN. In conclusion, within the limitations of this study, the activation of irrigants using EndoActivator can be considered an effective method for reducing postoperative pain. © 2014 Australian Society of Endodontology.

Wall shear stress effects of different endodontic irrigation techniques and systems.

PubMed

Goode, Narisa; Khan, Sara; Eid, Ashraf A; Niu, Li-na; Gosier, Johnny; Susin, Lisiane F; Pashley, David H; Tay, Franklin R

2013-07-01

This study examined débridement efficacy as a result of wall shear stresses created by different irrigant delivery/agitation techniques in an inaccessible recess of a curved root canal model. A reusable, curved canal cavity containing a simulated canal fin was milled into mirrored titanium blocks. Calcium hydroxide (Ca(OH)2) paste was used as debris and loaded into the canal fin. The titanium blocks were bolted together to provide a fluid-tight seal. Sodium hypochlorite was delivered at a previously-determined flow rate of 1 mL/min that produced either negligible or no irrigant extrusion pressure into the periapex for all the techniques examined. Nine irrigation delivery/agitation techniques were examined: NaviTip passive irrigation control, Max-i-Probe(®) side-vented needle passive irrigation, manual dynamic agitation (MDA) using non-fitting and well-fitting gutta-percha points, EndoActivator™ sonic agitation with medium and large points, VPro™ EndoSafe™ irrigation system, VPro™ StreamClean™ continuous ultrasonic irrigation and EndoVac apical negative pressure irrigation. Débridement efficacies were analysed with Kruskal-Wallis ANOVA and Dunn's multiple comparisons tests (α=0.05). EndoVac was the only technique that removed more than 99% calcium hydroxide debris from the canal fin at the predefined flow rate. This group was significantly different (p<0.05) from the other groups that exhibited incomplete Ca(OH)2 removal. The ability of the EndoVac system to significantly clean more debris from a mechanically inaccessible recess of the model curved root canal may be caused by robust bubble formation during irrigant delivery, creating higher wall shear stresses by a two-phase air-liquid flow phenomenon that is well known in other industrial débridement systems. Copyright © 2013 Elsevier Ltd. All rights reserved.

Assessing accumulated hard-tissue debris using micro-computed tomography and free software for image processing and analysis.

PubMed

De-Deus, Gustavo; Marins, Juliana; Neves, Aline de Almeida; Reis, Claudia; Fidel, Sandra; Versiani, Marco A; Alves, Haimon; Lopes, Ricardo Tadeu; Paciornik, Sidnei

2014-02-01

The accumulation of debris occurs after root canal preparation procedures specifically in fins, isthmus, irregularities, and ramifications. The aim of this study was to present a step-by-step description of a new method used to longitudinally identify, measure, and 3-dimensionally map the accumulation of hard-tissue debris inside the root canal after biomechanical preparation using free software for image processing and analysis. Three mandibular molars presenting the mesial root with a large isthmus width and a type II Vertucci's canal configuration were selected and scanned. The specimens were assigned to 1 of 3 experimental approaches: (1) 5.25% sodium hypochlorite + 17% EDTA, (2) bidistilled water, and (3) no irrigation. After root canal preparation, high-resolution scans of the teeth were accomplished, and free software packages were used to register and quantify the amount of accumulated hard-tissue debris in either canal space or isthmus areas. Canal preparation without irrigation resulted in 34.6% of its volume filled with hard-tissue debris, whereas the use of bidistilled water or NaOCl followed by EDTA showed a reduction in the percentage volume of debris to 16% and 11.3%, respectively. The closer the distance to the isthmus area was the larger the amount of accumulated debris regardless of the irrigating protocol used. Through the present method, it was possible to calculate the volume of hard-tissue debris in the isthmuses and in the root canal space. Free-software packages used for image reconstruction, registering, and analysis have shown to be promising for end-user application. Copyright © 2014. Published by Elsevier Inc.

The antimicrobial effectiveness of photodynamic therapy used as an addition to the conventional endodontic re-treatment: a clinical study.

PubMed

Jurič, Ivona Bago; Plečko, Vanda; Pandurić, Dragana Gabrić; Anić, Ivica

2014-12-01

The purpose of the study was to evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) used as an adjunct to the endodontic re-treatment in the eradication of microorganisms from previously filled root canals. The study sample consisted of 21 randomly selected patients with root filled and infected root canal system with chronic apical periodontitis on incisors or canines, who have had previously endodontic treatment. Microbiological samples from the root canals were collected after accessing the canal, following the endodontic re-treatment and after the aPDT procedure. During instrumentation, the root canals were irrigated with 2.5% sodium hypochlorite (NaOCl), and the final irrigation protocol included 17% ethylenediaminetetraacetic acid followed by NaOCl. Root canals were filled with a phenothiazinium chloride and irradiated with a diode laser (λ=660 nm, 100 mW) for 1 min. Microbiological samples from the root canals were cultivated on selective plates, and the identification was done by micromorphology, macromorphology and different API strips as well as bacterial counts (colony forming units). Fourteen bacteria species were isolated from the root canals initially, with a mean value of 4.57 species per canal. Although endodontic re-treatment alone produced a significant reduction in the number of bacteria species (p<0.001), the combination of endodontic treatment and aPDT was statistically more effective (p<0.001). No bacteria were cultivated from the main root canals of 11 teeth. The results indicated that the aPDT used as an adjunct to the conventional endodontic therapy achieved a significant further reduction of intracanal microbial load. Copyright © 2014 Elsevier B.V. All rights reserved.

Measurement of pressure changes during laser-activated irrigant by an erbium, chromium: yttrium, scandium, gallium, garnet laser.

PubMed

Peeters, Harry Huiz; De Moor, Roeland J G

2015-07-01

The use of Er,Cr:YSGG laser to activate irrigants results in the creation of vapour bubbles and shockwaves. The present study evaluated the magnitude of pressure changes in the root canal during laser-activated irrigation. The root canal of a single extracted maxillary canine was enlarged to a size 40/0.06 file. A pressure sensor was inserted apically into the root canal. The tooth was processed as follows. In the EDTA condition, the tooth was irrigated with 17 % EDTA; in the NaOCl condition, the tooth was irrigated with 3 % NaOCl. In all conditions, the irrigants were activated at 0.75 and 1.75 W for 60 s using RFT2 and MZ2 tips; to analyse the effect of tip placement, the tip was activated at the orifice and after inserting the tip 5 mm deeper than the orifice. Data showed no significant difference between irrigation regimens (p > 0.05). There were no significant differences of the pressure between RFT2 and MZ2 tips (p > 0.05). The placement of tips closer to the apex resulted in significantly higher pressure than at the orifice (p < 0.001). The use of 1.75 W power resulted in a significantly higher increase of pressure compared to 0.75 W (p < 0.001), regardless either the type of solutions or tips used. The magnitude of the pressure changes in the root canal at 0.75 W was significantly lower than 1.75 W regardless of either type of tips or solutions used. The closer the insertion of the tip to the apex, the higher the pressure.

Sodium hypochlorite chemical burn in an endodontist's eye during canal treatment using operating microscope.

PubMed

Regalado Farreras, Desirée C; Puente, Carlos García; Estrela, Carlos

2014-08-01

This study describes a case of eye burn induced by sodium hypochlorite used as an irrigant during root canal preparation. A 24-year-old female endodontist was using an operating microscope during root canal treatment, and as the root canal was irrigated, the pressure cannula burst and the irrigant (3.5% sodium hypochlorite) came into direct contact with her left eye. She immediately sought ophthalmologic emergency care for pain, redness of the cornea, burning sensation, photophobia, intraocular pressure, and blurred vision. The initial treatment consisted of washing the eye with saline solution and administering analgesic and anti-inflammatory (steroid) medications. One day after the accident, a topical demulcent and hydroxypropyl medication were applied to the eyeball (conjunctiva), the eye was bandaged for 24 hours, and rest was prescribed for 7 days. Eight days later, a corneal ulcer was diagnosed, and antibiotic and anti-inflammatory (steroid) medications were used. Vision was restored without any sequelae 4 weeks after the accident. The endodontist was instructed to apply control medication (Lagricel; Sophia SA, Caracas, Venezuela) for 3 months and to return for ophthalmologic follow-up every 6 months. Sodium hypochlorite is an effective antibacterial irrigant indicated for the treatment of root canal infections. The tissue cytotoxicity highlights the need to inform the patient of the risk factors of accidents and enhance care with individual protection equipment for the patient and the professional during clinical procedures. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Continuous chelation irrigation improves the adhesion of epoxy resin-based root canal sealer to root dentine.

PubMed

Neelakantan, P; Varughese, A A; Sharma, S; Subbarao, C V; Zehnder, M; De-Deus, G

2012-12-01

To test the impact of continuous chelation by NaOCl+ etidronic acid (HEBP) during instrumentation, and a final rinse of EDTA or NaOCl + HEBP on the dentine bond strength of an epoxy resin sealer (AH Plus). Single-rooted teeth (n = 100) were divided into five groups (n = 20) based on the irrigation protocol and their root canals instrumented using a rotary Ni-Ti system: 2.5% NaOCl during instrumentation followed by bi-distilled water (G1) or 17% EDTA (G2) as final rinse; 1 : 1 mixture of 5% NaOCl and 18% HEBP during instrumentation, and the same mixture (G3), 17% EDTA (G4) or bi-distilled water (G5) as final rinse. Canals were filled with AH Plus. Roots were sectioned, and push-out tests were performed in coronal, middle and apical root thirds. Results were analysed using analysis of variance (anova) and Bonferroni test for multiple comparisons. The alpha-type error was set at 0.05 for all the analyses. Push-out bond strength was highest in coronal and lowest in apical root thirds (P < 0.05). Groups that used NaOCl + HEBP irrigation during instrumentation had significantly higher bond strengths than groups following the NaOCl-EDTA irrigation in all root thirds (P < 0.05). The use of a strong chelator as final flush further increased bond strengths (G4, P < 0.05). The continuous chelation irrigation protocol optimizes the bond strength of an epoxy resin sealer to dentine. © 2012 International Endodontic Journal.

Antibacterial Efficacy of Super-Oxidized Water on Enterococcus faecalis Biofilms in Root Canal

PubMed Central

Zan, Recai; Alacam, Tayfun; Hubbezoglu, Ihsan; Tunc, Tutku; Sumer, Zeynep; Alici, Oguzhan

2016-01-01

Background The success of endodontic treatment depends on a few crucial factors. One of these factors is the complete chemomechanic preparation of root canal against various bacteria. In particular, the effect of resistant bacteria may cause intense pain with flare-up and formation of periapical lesions. Therefore, the strong effect of irrigants plays an important role in terms of the complete elimination of these bacteria to achieve long-term successful treatment. Objectives The aim of this study was to investigate the antibacterial effects of super-oxidized water (SPO) in root canals infected with Enterococcus faecalis biofilms. Methods One hundred twenty single-root, premolar teeth were selected. Initially, the teeth were prepared and then disinfected. E. faecalis were inoculated and kept at 37°C for 24 hours in the root canals. The re-inoculation procedure was repeated on the first, fourth, seventh, and tenth days. The infected root canals were divided into one negative (saline) and one positive (sodium hypochlorite) control group and four experimental groups (super-oxidized water: 1, 2, 3, or 5 minutes) (n = 20). Paper points were placed in the root canals to control and evaluate the biofilm formation. Biofilms were counted on blood agar plates, and data was evaluated and statistically analyzed using one-way ANOVA and Tukey’s test. Results Although sodium hypochlorite (NaOCl) showed no statistically significant difference when compared with three and five minutes of SPO irrigation (P > 0.05), NaOCl showed statistically significant differences among all other groups (P < 0.05). Conclusions Super-oxidized water indicated a remarkable and similar bactericidal effect to that of traditional NaOCl against E. faecalis biofilms. In terms of successful endodontic treatment approaches, super-oxidized water may be used as an effective irrigation solution in clinics. PMID:27800142

The failures of root canal preparation with hand ProTaper

PubMed Central

Bătăiosu, Marilena; Diaconu, Oana; Moraru, Iren; Dăguci, C.; Ţuculină, Mihaela; Dăguci, Luminiţa; Gheorghiţă, Lelia

2012-01-01

The failures of root canal preparation are due to some anatomical deviation (canal in “C” or “S”) and some technique errors. The technique errors are usually present in canal root cleansing and shaping stage and are the result of endodontic treatment objectives deviation. Objectives: Our study was made on technique errors while preparing the canal roots with hand ProTaper. Methodology: Our study was made “in vitro” on 84 extracted teeth (molars, premolars, incisors and canines). The canal root of these teeth were cleansed and shaped with hand ProTaper by crown-down technique and canal irrigation with NaOCl(2,5%). The dental preparation control was made by X-ray. Results: During canal root preparation some failures were observed like: canal root overinstrumentation, zipping and stripping phenomenon, discarded and/or fractured instruments. Conclusions: Hand ProTaper represents a revolutionary progress of endodontic treatment, but a deviation from accepted rules of canal root instrumentation can lead to failures of endodontic treatment. PMID:24778848

Effect of endodontic irrigating solutions on the microhardness and roughness of root canal dentin: an in vitro study.

PubMed

Patil, Chetan R; Uppin, Veerendra

2011-01-01

To evaluate the effect of widely used endodontic irrigating solutions on root dentin microhardness and surface roughness. One hundred twenty, non-carious extracted human permanent incisor teeth were selected. The crowns of the teeth were sectioned and the roots were separated longitudinally to get 240 specimens. These specimens were then divided into six groups according to the irrigating solutions used. The solutions used were 5% and 2.5% NaOCl solutions, 3% H2 O2 , 17% EDTA solution, 0.2% chlorhexidine gluconate, and distilled water. Then, the specimens were subjected to microhardness and roughness testing. The data were analyzed using ANOVA and Tukey's multiple comparison tests. The results of this study indicated that all irrigation solutions, except 0.2% chlorhexidine gluconate, decreased the microhardness of root dentin, and 3% H2 O2 and 0.2% chlorhexidine gluconate had no effect on surface roughness. Within the limitation of this study, it is concluded that 0.2% chlorhexidine gluconate seems to be an appropriate irrigation solution, because of its harmless effect on the microhardness and surface roughness of root canal dentin.

Cavitation measurement during sonic and ultrasonic activated irrigation.

PubMed

Macedo, Ricardo; Verhaagen, Bram; Rivas, David Fernandez; Versluis, Michel; Wesselink, Paul; van der Sluis, Luc

2014-04-01

The aims of this study were to quantify and to visualize the possible occurrence of transient cavitation (bubble formation and implosion) during sonic and ultrasonic (UAI) activated irrigation. The amount of cavitation generated around several endodontic instruments was measured by sonochemiluminescence dosimetry inside 4 root canal models of human dimensions and varying complexity. Furthermore, the spatial distribution of the sonochemiluminescence in the root canal was visualized with long-exposure photography. Instrument oscillation frequency, ultrasonic power, and file taper influenced the occurrence and amount of cavitation. In UAI, cavitation was distributed between the file and the wall extending beyond the file and inside lateral canals/isthmuses. In sonic activated irrigation, no cavitation was detected. Cavitation was shown to occur in UAI at clinically relevant ultrasonic power settings in both straight and curved canals but not around sonically oscillating instruments, driven at their highest frequency. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Antibacterial Efficacy of Calcium Hypochlorite with Vibringe Sonic Irrigation System on Enterococcus faecalis: An In Vitro Study

PubMed Central

Dumani, Aysin; Guvenmez, Hatice Korkmaz; Yilmaz, Sehnaz; Yoldas, Oguz; Kurklu, Zeliha Gonca Bek

2016-01-01

Aim. The purpose of this study was to compare the in vitro efficacy of calcium hypochlorite (Ca[OCl]2) and sodium hypochlorite (NaOCl) associated with sonic (Vibringe) irrigation system in root canals which were contaminated with Enterococcus faecalis. Material and Methods. The root canals of 84 single-rooted premolars were enlarged up to a file 40, autoclaved, inoculated with Enterococcus faecalis, and incubated for 21 days. The samples were divided into 7 groups according to the irrigation protocol: G0: no treatment; G1: distilled water; G2: 2.5% NaOCl; G3: 2.5% Ca(OCl)2; G4: distilled water with sonic activation; G5: 2.5% NaOCl with sonic activation; and G6: 2.5% Ca(OCl)2 with sonic activation. Before and after decontamination procedures microbiological samples were collected and the colony-forming units were counted and the percentages of reduction were calculated. Results. Distilled water with syringe irrigation and sonic activation groups demonstrated poor antibacterial effect on Enterococcus faecalis compared to other experimental groups (p < 0.05). There was no statistically significant difference between syringe and sonic irrigation systems with Ca(OCl)2 and NaOCl. Conclusion. The antimicrobial property of Ca(OCl)2 has been investigated and compared with that of NaOCl. Both conventional syringe irrigation and sonic irrigation were found effective at removing E. faecalis from the root canal of extracted human teeth. PMID:27218106

Efficacy of Needle, Ultrasonic, and Endoactivator Irrigation and Photon-Induced Photoacoustic Streaming in Removing Calcium Hydroxide from the Main Canal and Isthmus: An In Vitro Micro-Computed Tomography and Scanning Electron Microscopy Study.

PubMed

Li, Dongxia; Jiang, Shan; Yin, Xingzhe; Chang, Jeffrey Wen Wei; Ke, Jie; Zhang, Chengfei

2015-06-01

The aim of this in vitro study was to use high-resolution micro-computed tomography (micro-CT) and scanning electron microscopy (SEM) to compare the efficacy of four irrigation techniques [needle, ultrasonic, EndoActivator, and photon-induced photoacoustic streaming (PIPS)] in removing calcium hydroxide (Ca[OH]2) from the root canal and isthmus of maxillary premolars. Twenty-four maxillary first premolars were selected based on the presence of isthmus regions on micro-CT scans. Root canals were instrumented with an F2 file using ProTaper rotary instruments and filled with Ca(OH)2 paste. Samples were stored at 37°C and 100% humidity for 1 week and randomly divided into four groups (n=6 each), according to irrigation technique. Samples were scanned with micro-CT before instrumentation, after Ca(OH)2 filling, and after irrigation. Ca(OH)2 reduction in the coronal, middle, and apical thirds and in the isthmus were assessed with three-dimensional image analysis. Next, specimens were split longitudinally, and canal walls were examined with SEM for Ca(OH)2 residues. Data were statistically evaluated with the Kruskal-Wallis and Mann-Whitney tests (p=0.05). The PIPS and ultrasonic groups showed greater Ca(OH)2 reduction in the apical third and higher cleanliness of the isthmus than the EndoActivator and needle irrigation groups (p<0.05). Ca(OH)2 residue scores in the PIPS and ultrasonic groups were significantly lower than those in the EndoActivator and needle groups in all regions of the root canals (p<0.05). There was no significant difference between PIPS and ultrasonic groups (p>0.05), or between EndoActivator and needle groups (p>0.05). PIPS and ultrasonic irrigation more effectively removed Ca(OH)2 from the main canal and isthmus in maxillary premolars than did EndoActivator or needle irrigation.

Effects of Diode Laser, Gaseous Ozone, and Medical Dressings on Enterococcus faecalis Biofilms in the Root Canal Ex Vivo

PubMed Central

Vlassakidis, Alexander; Niepel, Mediha; Hoedke, Daniela; Schulze, Julia; Neumann, Konrad; Moter, Annette; Noetzel, Jörn

2017-01-01

The objective was to compare the antibacterial effects of adjunctive disinfection using diode laser and gaseous ozone compared to the medical dressings calcium hydroxide (Ca(OH)2) and chlorhexidine gel (CHX-Gel) on Enterococcus faecalis biofilms in human root canals ex vivo. Root canals of 180 human extracted teeth were infected by E. faecalis and divided into 3 main groups (G): G1, control; G2, instrumentation and irrigation using 0.9% NaCl; G3, instrumentation and irrigation using 1% NaOCl. In each main group, the following treatments were applied: gaseous ozone, diode laser, and medical dressings of Ca(OH)2 or CHX-Gel for 7 days (n = 15). Reduction of colony forming units (CFUs) inside the root canal of planktons and frequencies of adherent bacteria after treatment were calculated. Bacterial reduction was significantly affected by the irrigation protocol (p < 0.0005) and the disinfection method (p < 0.0005), and a significant interaction between both factors could be observed (p < 0.0005; ANOVA). In G3 (instrumentation using 1% NaOCl), no significant effect of disinfection methods could be demonstrated on planktonic bacteria (p = 0.062; ANOVA) and frequencies of adherent bacteria (p > 0.05; chi-square test). Instrumentation and irrigation using NaOCl combined with ozone or laser application resulted in comparable bacterial reduction on E. faecalis to the application of medical dressings. PMID:28567421

Efficacy of new irrigating solution on smear layer removal in apical third of root canal: A scanning electron microscope study.

PubMed

Patil, Priyanka Himmatrao; Gulve, Meenal Nitin; Kolhe, Swapnil Janardan; Samuel, Roshan Mathew; Aher, Gayatri Balasaheb

2018-01-01

The aim of this in vitro study is to evaluate and compare the smear layer removal efficacy of etidronic acid-based irrigating solution with others in the apical third of the root canal. Forty human single-rooted mandibular premolar teeth were taken and decoronated to standardize the canal length. After biomechanical preparation, teeth were randomly divided into four groups ( n = 10) and the final irrigation was carried out with tested irrigants. Group I: normal saline (negative control); Group II: 5.25% sodium hypochlorite (NaOCl) with surfactant and 17% ethylenediaminetetraacetic acid (EDTA) with surfactant; Group III: freshly mixed BioPure MTAD; and Group IV: freshly mixed Chloroquick solution. The teeth were split into two halves and observed under a scanning electron microscope to analyze the amount of smear layer present. Data were analyzed using the Kruskal-Wallis test and Mann-Whitney test. Group II (5.25% NaOCl with surfactant followed by 17% EDTA with surfactant) showed least smear layer scores (1.1 ± 0.3162). This was followed by Group III (MTAD) (2.2 ± 0.4216) and then Group IV (Chloroquick) (2.4 ± 0.5164). Sequential use of 5.25% NaOCl with surfactant and 17% EDTA with surfactant was found to be the most efficient than MTAD and Chloroquick in the removal of smear layer in the apical third of root canal.

Comparison of the Antimicrobial Efficacy of the EndoVac System and Conventional Needle Irrigation in Primary Molar Root Canals.

PubMed

Buldur, Burak; Kapdan, Arife

The purpose of this study was to compare the antimicrobial efficacy of the EndoVac system and conventional needle irrigation to eliminate E faecalis in primary molar root canals. 60 extracted human primary second molar roots were instrumented up to an apical size .04/35 and randomly divided into two groups; Group 1: conventional needle (n=30) and Group 2: EndoVac (n=30), and four subgroups (two experimental subgroups; (a) 2.5% sodium hypochlorite (NaOCl) + ethylenediaminetetraacetic acid (EDTA) (n=20), (b) ozonated water (OW) + EDTA (n=20), and control groups (c) 5.25% NaOCl (n=10) and (d) saline (n=10). All roots were sterilized and then inoculated with E.faecalis. Before and after final irrigation procedures, root canals were sampled and the grown colony forming units (CFUs) were counted. Data were analyzed by Kruskall-Wallis and Mann-Whitney U tests using a 0.05 significance level. The EndoVac reduced more bacteria than the conventional needle did but it was not statistically significant (p>0.05). NaOCl alone or followed by EDTA totally eliminated bacteria. OW + EDTA showed higher reduction of bacteria but could not totally eliminate bacterias. In the context of bacterial elimination, the EndoVac was not significantly better than the conventional needle. Although, there were fewer CFU/mg when using EndoVac, there was not any statistically significant superiority to conventional needle irrigation. An OW+EDTA regimen showed antibacterial effect in the primary molar root canals but it was significantly less effective than NaOCl+EDTA.

Effect of endodontic irrigation with 1% sodium hypochlorite and 17% EDTA on primary teeth: a scanning electron microscope analysis.

PubMed

Ximenes, Marcos; Triches, Thaisa C; Beltrame, Ana Paula C A; Hilgert, Leandro A; Cardoso, Mariane

2013-01-01

This study evaluated the efficacy of 2 final irrigation solutions for removal of the smear layer (SL) from root canals of primary teeth, using scanning electron microscope (SEM) analysis. Thirty primary molars were selected and a single operator instrumented the canals. The initial irrigation was done with a 1% sodium hypochlorite (NaOCl) solution. After the preparation, the roots were randomly divided into 3 groups for final irrigation: Group 1, 1% NaOCl (n = 10); Group 2, 17% EDTA + 1% NaOCl (n = 10); and Group 3, 17% EDTA + saline solution (n = 10). The roots were prepared for SEM analysis (magnification 1000X). The photomicrographs were independently analyzed by 2 investigators with SEM experience, attributing scores to each root third in terms of SL removal. Kruskal-Wallis and Mann-Whitney tests revealed that there was no statistical difference between the groups (P = 0.489). However, a statistical difference was found (P < 0.05) in a comparison of root thirds, with the apical third having the worst results. Comparing the thirds within the same group, all canals showed statistical differences between the cervical and apical thirds (P < 0.05). The authors determined that no substance or association of substances were able to completely remove SL.

The self-adjusting file (SAF) system: An evidence-based update

PubMed Central

Metzger, Zvi

2014-01-01

Current rotary file systems are effective tools. Nevertheless, they have two main shortcomings: They are unable to effectively clean and shape oval canals and depend too much on the irrigant to do the cleaning, which is an unrealistic illusionThey may jeopardize the long-term survival of the tooth via unnecessary, excessive removal of sound dentin and creation of micro-cracks in the remaining root dentin. The new Self-adjusting File (SAF) technology uses a hollow, compressible NiTi file, with no central metal core, through which a continuous flow of irrigant is provided throughout the procedure. The SAF technology allows for effective cleaning of all root canals including oval canals, thus allowing for the effective disinfection and obturation of all canal morphologies. This technology uses a new concept of cleaning and shaping in which a uniform layer of dentin is removed from around the entire perimeter of the root canal, thus avoiding unnecessary excessive removal of sound dentin. Furthermore, the mode of action used by this file system does not apply the machining of all root canals to a circular bore, as do all other rotary file systems, and does not cause micro-cracks in the remaining root dentin. The new SAF technology allows for a new concept in cleaning and shaping root canals: Minimally Invasive 3D Endodontics. PMID:25298639

Efficacy of 4 Irrigation Protocols in Killing Bacteria Colonized in Dentinal Tubules Examined by a Novel Confocal Laser Scanning Microscope Analysis

PubMed Central

Azim, Adham A.; Aksel, Hacer; Zhuang, Tingting; Mashtare, Terry; Babu, Jegdish P.; Huang, George T.-J.

2016-01-01

Introduction The aim of this study was to determine the efficiency of 4 irrigation systems in eliminating bacteria in root canals, particularly in dentinal tubules. Methods Roots of human teeth were prepared to 25/04, autoclaved, and inoculated with Enterococcus faecalis for 3 weeks. Canals were then disinfected by (1) standard needle irrigation, (2) sonically agitating with EndoActivator, (3) XP Endo finisher, or (4) erbium:yttrium aluminum garnet laser (PIPS) (15 roots/group). The bacterial reduction in the canal was determined by MTT assays. For measuring live versus dead bacteria in the dentinal tubules (4 teeth/group), teeth were split open and stained with LIVE/DEAD BackLight. Coronal, middle, and apical thirds of the canal dentin were scanned by using a confocal laser scanning microscope (CLSM) to determine the ratio of dead/total bacteria in the dentinal tubules at various depths. Results All 4 irrigation protocols significantly eliminated bacteria in the canal, ranging from 89.6% to 98.2% reduction (P < .001). XP Endo had the greatest bacterial reduction compared with other 3 techniques (P < .05). CLSM analysis showed that XP Endo had the highest level of dead bacteria in the coronal, middle, and apical segments at 50-μm depth. On the other hand, PIPS had the greatest bacterial killing efficiency at the 150-μm depth in all 3 root segments. Conclusions XP Endo appears to be more efficient than other 3 techniques in disinfecting the main canal space and up to 50 μm deep into the dentinal tubules. PIPS appears to be most effective in killing the bacteria deep in the dentinal tubules. PMID:27130334

Efficacy of 4 Irrigation Protocols in Killing Bacteria Colonized in Dentinal Tubules Examined by a Novel Confocal Laser Scanning Microscope Analysis.

PubMed

Azim, Adham A; Aksel, Hacer; Zhuang, Tingting; Mashtare, Terry; Babu, Jegdish P; Huang, George T-J

2016-06-01

The aim of this study was to determine the efficiency of 4 irrigation systems in eliminating bacteria in root canals, particularly in dentinal tubules. Roots of human teeth were prepared to 25/04, autoclaved, and inoculated with Enterococcus faecalis for 3 weeks. Canals were then disinfected by (1) standard needle irrigation, (2) sonically agitating with EndoActivator, (3) XP Endo finisher, or (4) erbium:yttrium aluminum garnet laser (PIPS) (15 roots/group). The bacterial reduction in the canal was determined by MTT assays. For measuring live versus dead bacteria in the dentinal tubules (4 teeth/group), teeth were split open and stained with LIVE/DEAD BackLight. Coronal, middle, and apical thirds of the canal dentin were scanned by using a confocal laser scanning microscope (CLSM) to determine the ratio of dead/total bacteria in the dentinal tubules at various depths. All 4 irrigation protocols significantly eliminated bacteria in the canal, ranging from 89.6% to 98.2% reduction (P < .001). XP Endo had the greatest bacterial reduction compared with other 3 techniques (P < .05). CLSM analysis showed that XP Endo had the highest level of dead bacteria in the coronal, middle, and apical segments at 50-μm depth. On the other hand, PIPS had the greatest bacterial killing efficiency at the 150-μm depth in all 3 root segments. XP Endo appears to be more efficient than other 3 techniques in disinfecting the main canal space and up to 50 μm deep into the dentinal tubules. PIPS appears to be most effective in killing the bacteria deep in the dentinal tubules. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

A comparative assessment of the accuracy of electronic apex locator (Root ZX) in the presence of commonly used irrigating solutions

PubMed Central

Raidullah, Ebadullah; Francis, Maria L.

2014-01-01

Objectives: This study aimed to evaluate the accuracy of Root ZX in determining working length in presence of normal saline, 0.2% chlorhexidine and 2.5% of sodium hypochlorite. Material and Methods: Sixty extracted, single rooted, single canal human teeth were used. Teeth were decoronated at CEJ and actual canal length determined. Then working length measurements were obtained with Root ZX in presence of normal saline 0.9%, 0.2% chlorhexidine and 2.5% NaOCl. The working length obtained with Root ZX were compared with actual canal length and subjected to statistical analysis. Results: No statistical significant difference was found between actual canal length and Root ZX measurements in presence of normal saline and 0.2% chlorhexidine. Highly statistical difference was found between actual canal length and Root ZX measurements in presence of 2.5% of NaOCl, however all the measurements were within the clinically acceptable range of ±0.5mm. Conclusion: The accuracy of EL measurement of Root ZX within±0.5 mm of AL was consistently high in the presence of 0.2% chlorhexidine, normal saline and 2.5% sodium hypochlorite. Clinical significance: This study signifies the efficacy of ROOT ZX (Third generation apex locator) as a dependable aid in endodontic working length. Key words:Electronic apex locator, working length, root ZX accuracy, intracanal irrigating solutions. PMID:24596634

Comparative antibacterial efficacies of hydrodynamic and ultrasonic irrigation systems in vitro.

PubMed

Cachovan, Georg; Schiffner, Ulrich; Altenhof, Saskia; Guentsch, Arndt; Pfister, Wolfgang; Eick, Sigrun

2013-09-01

To ensure root canal treatment success, endodontic microbiota should be efficiently reduced. The in vitro bactericidal effects of a hydrodynamic system and a passive ultrasonic irrigation system were compared. Single-rooted extracted teeth (n = 250) were contaminated with suspensions of Enterococcus faecalis ATCC 29212, mixed aerobic cultures, or mixed anaerobic cultures. First, the antibacterial effects of the hydrodynamic system (RinsEndo), a passive ultrasonic irrigation system (Piezo smart), and manual rinsing with 0.9% NaCl (the control) were compared. Colony-forming units were counted. Second, the 2 systems were used with 1.5% sodium hypochlorite (NaOCl) alone or NaOCl + 0.2% chlorhexidine (CHX). The colony-forming units in the treated and untreated roots were determined during a period of 5 days. Both irrigation systems reduced bacterial numbers more effectively than manual rinsing (P < .001). With NaCl, ultrasonic activated irrigation reduced bacterial counts significantly better than hydrodynamic irrigation (P = .042). The NaOCl + CHX combination was more effective than NaOCl alone for both systems (P < .001), but hydrodynamic irrigation was more effective with NaOCl + CHX than the passive ultrasonic irrigation system. Both irrigation systems, when combined with NaOCl + CHX, removed bacteria from root canals. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Mandibular first premolar with four canals.

PubMed

Du, Yi; Lee, Angeline H C; Zhang, Chengfei

2013-02-01

A case of endodontic treatment of a mandibular first premolar exhibiting a total of four distinct root canals and four apical foramina is described. This occurrence in mandibular first premolar has rarely been reported in the endodontic literature. Endodontic treatment that considers the anatomic variation of root canal morphology is important to ensure a favorable healing outcome, and its identification could be enhanced by careful examination using a dental operating microscope. Obturation of root canals using a warm vertical compaction technique with a highly-radiopaque root canal sealer, such as AH Plus, after careful ultrasonic activated irrigation with ethylenediaminetetraacetic acid might allow the flow of sealer into the narrowed but unprepared part of the canal. This offers valuable adjuncts for the successful negotiation of calcified main canals, thereby facilitating optimum chemo-mechanical debridement of the root canal system. © 2013 Blackwell Publishing Asia Pty Ltd.

Laser induced explosive vapor and cavitation resulting in effective irrigation of the root canal. Part 1: a visualization study.

PubMed

Blanken, Jan; De Moor, Roeland Jozef Gentil; Meire, Maarten; Verdaasdonk, Rudolf

2009-09-01

Limited information exists regarding the induction of explosive vapor and cavitation bubbles in an endodontic rinsing solution. It is also not clear whether a fiber has to be moved in the irrigation solution or can be kept stationary. No information is available on safe power settings for the use of cavitation in the root canal. This study investigates the fluid movements and the mechanism of action caused by an Er,Cr:YSGG laser in a transparent root model. Glass models with an artificial root canal (15 mm long, with a 0.06 taper and apical diameter of 400 microm) were used for visualization and registration with a high-speed imaging technique (resolution in the microsecond range) of the creation of explosive vapor bubbles with an Er,Cr:YSGG laser at pulse energies of 75, 125, and 250 mJ at 20 Hz using a 200 microm fiber (Z2 Endolase). Fluid movement was investigated by means of dyes and visualization of the explosive vapor bubbles, and as a function of pulse energy and distance of the fiber tip to the apex. The recordings in the glass model show the creation of expanding and imploding vapor bubbles with secondary cavitation effects. Dye is flushed out of the canal and replaced by surrounding fluid. It seems not necessary to move the fiber close to the apex. Imaging suggests that the working mechanism of an Er,Cr:YSGG laser in root canal treatment in an irrigation solution can be attributed to cavitation effects inducing high-speed fluid motion into and out the canal.

Ultrasonic activation and chemical modification of photosensitizers enhances the effects of photodynamic therapy against Enterococcus faecalis root-canal isolates.

PubMed

Tennert, C; Drews, A M; Walther, V; Altenburger, M J; Karygianni, L; Wrbas, K T; Hellwig, E; Al-Ahmad, A

2015-06-01

The aim of this study was to evaluate the effect of photodynamic therapy (PDT) on Enterococcus faecalis biofilms in artificially infected root canals using modified photosensitizers and passive ultrasonic activation. Two hundred and seventy extracted human teeth with one root canal were instrumented utilizing ProTaper files, autoclaved, infected with E. faecalis T9 for 72 h and divided into different groups: irrigation with 3% sodium hypochlorite (NaOCl), 20% ethylenediaminetetraacetic acid (EDTA), or 20% citric acid, PDT without irrigation, PDT accompanied by irrigation with NaOCl, EDTA, or citric acid, PDT using an EDTA-based photosensitizer or a citric-acid-based photosensitizer and PDT with ultrasonic activation of the photosensitizer. A 15 mg/ml toluidine blue served as the photosensitizer, activated by a 100 mW LED light source. Sterile paper points were used for sampling the root canals and dentin chips were collected to assess the remaining contamination after treatment. Samples were cultured on blood agar plates and colony forming units were quantified. PDT alone achieved a reduction in E. faecalis counts by 92.7%, NaOCl irrigation alone and combined with PDT by 99.9%. The antibacterial effects increased by the combination of irrigation using EDTA or citric acid and PDT compared to irrigation alone. More than 99% of E. faecalis were killed using PDT with the modified photosensitizers and ultrasonic activation. NaOCl based disinfection achieved the highest antimicrobial effect. Using PDT with an EDTA-based or citric-acid-based phozosensitizer or activating the photosensitizer with ultrasound resulted in a significantly higher reduction in E. faecalis counts compared to conventional PDT. Copyright © 2015 Elsevier B.V. All rights reserved.

Antibacterial Efficacy of a New Sonic Irrigation Device for Root Canal Disinfection.

PubMed

Neuhaus, Klaus W; Liebi, Melanie; Stauffacher, Simone; Eick, Sigrun; Lussi, Adrian

2016-12-01

Passive ultrasonic irrigation (PUI) is the most widespread method used to activate irrigation solutions. Concerns have been raised that PUI is less effective in curved root canals and is not passive at all. Our aim was to compare a novel passive sonic irrigation (PSI) device (6000 Hz) with PUI and manual irrigation (MI) with respect to their efficiency in removing different endodontic microorganisms from curved and straight root canals. We performed 2 experiments as follows. In a 3-day infection model, we included 8 groups of single or dual microbial species that were rinsed with 0.9% sodium chloride using PSI, PUI, or MI. Colony-forming units (CFUs) were counted after incubation, and log 10 transformations were performed for statistical comparisons. In a 21-d infection model, we tested the same irrigation protocols on 4 groups of microorganisms and used 1.5% sodium hypochlorite as an irrigant. Infection control samples were taken at day 0, 3, 5, and 7 after treatment and were subsequently reincubated. Using sodium chloride as an irrigant, the amount of reduction in CFUs compared with the negative control was approximately 3 log 10 units for PSI at 6000 Hz, 2 log 10 units for PUI, and 1 log 10 unit for MI. PSI reduced the microorganism CFUs significantly better than PUI. Using sodium hypochlorite led to a significant reduction in microorganism CFUs even with MI. After 3 days, compared with MI, microorganism regrowth significantly reduced after PSI and PUI treatment, but in these groups, in at least half of the samples, microorganisms were detectable after 7 days. PSI at 6000 Hz might be at least equal to PUI with respect to reduction of the microbial load in curved and straight root canals. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Assessing the efficacy of citrus aurantifolia extract on smear layer removal with scanning electron microscope.

PubMed

Bolhari, Behnam; Sharifian, Mohammad Reza; Aminsobhani, Mohsen; Monsef Esfehani, Hamid Reza; Tavakolian, Pardis

2012-01-01

The purpose of this study was to determine the effects of citrus aurantifolia (CA) extract on smear layer removal in different parts of root canals. Thirty-nine single-rooted human teeth were randomly divided into three experimental (n=12) and one control (n=3) groups. Teeth were instrumented using MTwo rotary instruments. Root canals were irrigated with NaOCl during instrumentation. The canals in each group were irrigated with one of the following: completed mixture of citrus aurantifolia extracts, 17% EDTA, and alcoholic extract of CA. Distilled water was used for the control group. The irrigants were left within the canal for 20 minutes, and then rinsed with normal saline solution. Teeth were subsequently split longitudinally into 2 halves, and the canals were examined by a scanning electron-microscope. Cleanliness was evaluated using a five point scoring system. Statistical significant difference was found between groups (P<0.05). The smear layer was more effectively removed with 17% EDTA compared to alcoholic CA extract. However, they were both able to remove the smear layer in the coronal segment. Completed CA extract removed more smear layer in coronal and middle parts compared with the alcoholic extract (P=0.001); however, there was no significant difference in the apical part. Both of the alcoholic and completed mixtures of citrus aurantifolia extracts were not able to effectively remove smear layer compared with 17% EDTA during root canal therapy.

Visualization of removal of trapped air from the apical region in simulated root canals by laser-activated irrigation using an Er,Cr:YSGG laser.

PubMed

Peeters, Harry Huiz; De Moor, Roeland J G; Suharto, Djoko

2015-08-01

The aim of this visualization study was to obtain a better understanding of the mechanism by which trapped air is removed from the apical region of simulated root canals by activation of an irrigant using an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser during endodontic procedures. A high-speed imaging system with high temporal and spatial resolution was used to visualize laser-induced shock waves in a resin block model with a curved root canal (inner diameter at the apex 0.08 mm, taper 4 %, crown height 10 mm, overall length 40 mm) and a glass cylinder model with a straight root canal (inner diameter 1 mm, crown height 10 mm, overall length 40 mm). The study utilized MZ3 and RFT3 tips in each model, without water or air spray, and with an average power of 1 W at 35 Hz. Laser-activated irrigation overcame the airlock effect by releasing air trapped in the air column. The mechanism underlying the removal of trapped air from the apical region using an Er,Cr:YSGG laser in a dry root canal is via the disruption of the surface tension at the solution-air interface. This disruption, caused by bubble implosion (cavitation), displaces air in the form of bubbles from the apical region toward the solution, which allows the solution to travel apically.

Influence of different final irrigation regimens and various endodontic filling materials on vertical root fracture resistance.

PubMed

Sungur, D D; Altundasar, E; Uzunoglu, E; Yilmaz, Z

2016-01-01

The aim of this study was to evaluate the influence of different endodontic materials and final irrigation regimens on vertical root fracture (VRF) resistance. Eighty human teeth were prepared then assigned into two groups (n = 40) according to the final irrigations. G1: 5 mL, 5.25% sodium hypochlorite (NaOCl), G2: 5 mL, 2% chlorhexidine gluconate (CHX). Each group was assigned into four subgroups according to the obturation system used (n = 10): A: iRoot SP/single gutta-percha cone (SGP), B: Only iRoot SP, C: Mineral trioxide aggregate (MTA)-Fillapex/SGP, D: AH26/SGP. The specimens were embedded in acrylic molds and subjected to compressive loading at a rate of 1 mm min until VRF occurred. Data were analyzed via three-way ANOVA tests. The statistically significant difference was found among groups (P < 0.05). The G1A and G1B and G1D revealed significantly higher-VRF values than G1C (P = 0.023). The roots filled with MTA-Fillapex revealed lower-VRF values than the other subgroups (P < 0.05). Groups irrigated with NaOCl had significantly lower-VRF values than the groups irrigated with CHX (P < 0.05). Final irrigation regimens could alter VRF resistance of root canals filled with different obturation technique and root canal sealers.

Comparative analysis of endodontic smear layer removal efficacy of 17% ethylenediaminetetraacetic acid, 7% maleic acid, and 2% chlorhexidine using scanning electron microscope: An in vitro study.

PubMed

Attur, Kailash; Joy, Mathew T; Karim, Riyas; Anil Kumar, V J; Deepika, C; Ahmed, Haseena

2016-08-01

The aim of the present study was to evaluate the efficiency of different endodontic irrigants in the removal of smear layer through scanning electron microscopic image analysis. The present in vitro study was carried out on 45 single-rooted extracted human mandibular premolar teeth with single canal and complete root formation. Teeth were randomly assigned to three groups with 15 teeth in each group. Group I samples were irrigated with 17% ethylenediaminetetraacetic (EDTA) irrigation, Group II with 7% maleic acid irrigation, and Group III with 2% chlorhexidine irrigation. Scanning electron microscope evaluation was done for the assessment of smear layer removal in the coronal, middle, and apical thirds. Comparison of the smear layer removal between the three different groups was done by Kruskal-Wallis test, followed by Mann-Whitney U test for comparing individual groups. A P value less than 0.05 was considered to be statistically significant. Statistically significant difference was seen between the two test groups (17% EDTA vs. 7% maleic acid and 17% EDTA vs. 2% chlorhexidine) in smear layer removal at coronal, middle, and apical thirds of the root canal. The most efficient smear layer removal was seen in Group I with 17% EDTA irrigation compared with other groups (P < 0.05) and the least by 2% chlorhexidine. The present study shows that 17% EDTA efficiently removes the smear layer from root canal walls.

Antimicrobial activity of sodium hypochlorite in endodontics.

PubMed

Mohammadi, Zahed; Shalavi, Sousan

2013-01-01

One of the major objectives in endodontic therapy is to disinfect the entire root canal system. This goal may be achieved using mechanical instrumenation and chemical irrigation in conjunrction with medication of the root canal between treatment sessions. Microorganisms and their by-products are considered to be the major cause of pulpal and periradicular patholic. In order to reduce or eliminate bacteria and popular tissue remnants, the use of various irrigation solution during treatment have been suggested. Sodium hypochlorite (NaOCI), the most common irrigant, is an excellent nonspecific proteolytic and antimicrobial agent. The purpose of this paper is to review the antimicrobial activity of sodium hypochlorite.

Measurement of pressure and flow rates during irrigation of a root canal ex vivo with three endodontic needles.

PubMed

Boutsioukis, C; Lambrianidis, T; Kastrinakis, E; Bekiaroglou, P

2007-07-01

To monitor ex vivo intra-canal irrigation with three endodontic needles (25, 27 and 30 gauge) and compare them in terms of irrigant flow rate, intra-barrel pressure, duration of irrigation and volume of irrigant delivered. A testing system was constructed to allow measurement of selected variables with pressure and displacement transducers during ex vivo intra-canal irrigation with a syringe and three different needles (groups A, B, C) into a prepared root canal. Ten specialist endodontists performed the irrigation procedure. Each operator performed ten procedures with each needle. Data recorded by the transducers were analysed using Friedman's test, Wilcoxon Signed Rank test, Mann-Whitney U-test and Kendall's T(b) test. The level of significance was set to 95%. Significant differences were detected among the three needles for most variables. Duration of delivery and flow rates significantly decreased as the needle diameter increased, whilst pressure increased up to 400-550 kPa. Gender of the operator had a significant impact on the results. Experience of the operators (years) were negatively correlated to volume of irrigant (all groups), to the duration of delivery (groups A, B) and to the average flow rate (group A). Finer diameter needles require increased effort to deliver the irrigant and result in higher intra-barrel pressure. The syringe and needles used tolerated the pressure developed. Irrigant flow rate should be considered as a factor directly influencing flow beyond the needle. Wide variations of flow rate were observed among operators. Syringe irrigation appears difficult to standardize and control.

Effect of Aquatine Endodontic Cleanser on smear layer removal in the root canals of ex vivo human teeth.

PubMed

Garcia, Faustino; Murray, Peter E; Garcia-Godoy, Franklin; Namerow, Kenneth N

2010-01-01

The purpose of this study was to measure and compare the root canal cleanliness and smear layer removal effectiveness of Aquatine Endodontic Cleanser (Aquatine EC) when used as an endodontic irrigating solution in comparison with 6% sodium hypochlorite (NaOCl). Forty-five human teeth were randomly allocated to five treatment groups; the pulp chamber was accessed, cleaned, and shaped by using ProTaper and ProFile rotary instrumentation to an ISO size #40. The teeth were then processed for scanning electron microscopy, and the root canal cleanliness and removal of smear layer were examined. The most effective removal of smear layer occurred with Aquatine EC and NaOCl, both with a rinse of EDTA. Aquatine EC appears to be the first hypochlorous acid approved by the FDA to be a possible alternative to the use of NaOCl as an intracanal irrigant. Further research is needed to identify safer and more effective alternatives to the use of NaOCl irrigation in endodontics.

Oscillation characteristics of endodontic files: numerical model and its validation.

PubMed

Verhaagen, Bram; Lea, Simon C; de Bruin, Gerrit J; van der Sluis, Luc W M; Walmsley, A Damien; Versluis, Michel

2012-11-01

During a root canal treatment, an antimicrobial fluid is injected into the root canal to eradicate all bacteria from the root canal system. Agitation of the fluid using an ultrasonically vibrating miniature file results in a significant improvement in the cleaning efficacy over conventional syringe irrigation. Numerical analysis of the oscillation characteristics of the file, modeled as a tapered, driven rod, shows a sinusoidal wave pattern with an increase in amplitude and decrease in wavelength toward the free end of the file. Measurements of the file oscillation with a scanning laser vibrometer show good agreement with the numerical simulation. The numerical model of endodontic file oscillation has the potential for predicting the oscillation pattern and fracture likeliness of various file types and the acoustic streaming they induce during passive ultrasonic irrigation.

Chlorhexidine gluconate, its properties and applications in endodontics

PubMed Central

Mohammadi, Zahed

2008-01-01

The major objective in endodontic therapy is to disinfect the entire root canal system. This requires that the pulpal content be eliminated as sources of infection. This goal may be accomplished by mechanical instrumentation and chemical irrigation, in conjunction with medication of the root canal between treatment sessions. Microorganisms and their by-products are considered to be the major cause of pulpal and periradicular pathosis. In order to reduce or eliminate bacteria from the root canal system, various irrigants have been used during treatment. Chlorhexidine is a cationic solution which can be used during treatment. It has a wide range of antimicrobial activity. Furthermore, because of its cationic structure, chlorhexidine has a unique property named substantivity. The purpose of this paper is to review different aspects of chlorhexidine in endodontics. PMID:24265633

Proinflammatory Activity of Primarily Infected Endodontic Content against Macrophages after Different Phases of the Root Canal Therapy.

PubMed

Marinho, Ariane C S; Martinho, Frederico C; Leite, Fábio R M; Nascimento, Gustavo G; Gomes, Brenda P F A

2015-06-01

This study investigated the presence of target bacterial species and the levels of endotoxins in teeth with apical periodontitis. Levels of inflammatory mediators (interleukin [IL]-1β and tumor necrosis factor [TNF]-α) were determined after macrophage stimulation with endodontic content after different phases of endodontic therapy using different irrigants. Thirty primarily infected root canals were randomly assigned into 3 groups according to the irrigant used for root canal preparation (n = 10 per group): GI: 2.5% sodium hypochlorite, GII: 2% chlorhexidine gel, and GIII (control group): saline solution. Root canal samples were taken by using paper points before (s1) and after root canal instrumentation (s2), subsequently to 17% EDTA (s3), after 30 days of intracanal medication (Ca[OH]2 + saline solution) (s4), and before root canal obturation (s5). Polymerase chain reaction (16S recombinant DNA) and limulus amebocyte lysate assay were used for bacterial and endotoxin detection, respectively. Macrophages were stimulated with the root canal contents for IL-1β/TNF-α measurement using enzyme-linked immunosorbent assay. Porphyromonas gingivalis (17/30), Porphyromonas endodontalis (15/30), and Prevotella nigrescens (11/30) were the most prevalent bacterial species. At s1, endotoxins were detected in 100% of the root canals (median = 32.43 EU/mL). In parallel, substantial amounts of IL-1β and TNF-α were produced by endodontic content-stimulated macrophages. At s2, a significant reduction in endotoxin levels was observed in all groups, with GI presenting the greatest reduction (P < .05). After a root canal rinse with EDTA (s3), intracanal medication (s4), and before root canal obturation (s5), endotoxin levels reduced without differences between groups (P < .05). IL-1β and TNF-α release decreased proportionally to the levels of residual endotoxin (P < .05). Regardless of the use of sodium hypochlorite or CHX, the greatest endotoxin reduction occurs after chemomechanical preparation. Increasing steps of root canal therapy associated with intracanal medication enhances endotoxin reduction, leading to a progressively lower activation of proinflammatory cells such as macrophages. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Eight months of clinical experience with the Self-Adjusting File system.

PubMed

Solomonov, Michael

2011-06-01

The Self-Adjusting File (SAF) system (ReDent-Nova, Ra'anana, Israel) has been recently introduced for the simultaneous instrumentation and irrigation of root canals. The SAF is claimed to adapt itself three dimensionally to the root canal, including its cross-section. It is operated with a continuous flow of sodium hypochlorite that is delivered into the root canal through the hollow file and claimed to be activated by sonic agitation of the irrigant. Our aim was to present for the first time clinical cases prepared with the SAF system and to describe a clinical classification of canals, according to their difficulty, with recommendations for endodontic treatment sequences for each category. This report is based on the experience of a single endodontist, who used the system to treat more than 50 consecutive primary endodontic cases over the prior 8 months. A clinical classification was developed which enabled the operator to select a treatment protocol for easy and optimal glide path preparation to be effectively used with the SAF file in the various root canals encountered in the clinical environment. Clinical classification of canal difficulty makes root canal treatment sequences with the SAF simple and predictable. Many types of cases can be treated with the SAF system although a novice user is advised to advance slowly along the learning curve from simpler to more complicated canals. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Assessment of the Incidence of Posttreatment Endodontic Flare-ups in Patients undergoing Single-sitting Root Canal Therapies: A Clinical Study.

PubMed

Priyank, Harsh; Devi, T M Chaitra; Goel, Pallavi; Sahu, Nivedita; Nihalani, Shweta; Shandilya, Ashutosh

2016-10-01

Endodontic therapy is one of the commonly used procedures for treating the teeth affected by various pathologies. One of the major problems for endodontists despite the advancements in the root canal procedures is the posttreatment endodontic flare-ups. Much debate exists regarding the completion of endodontic therapy in a single sitting or multiple sittings. Hence, we assessed the incidence of endodontic flare-ups in patients undergoing single-sitting root canal therapies. The present study included 200 patients who underwent single-sitting endodontic therapy. Clinical details and conditions of each and every tooth of every patient were recorded before and after the completion of endodontic therapy. Irrigation during the root canal procedures was done by 2.5% NaOCl solution in most of the cases while others were irrigated with various combinations of ethylenediaminetetraacetic acid (EDTA) and cycloheximide (CHX) solutions. Follow-up records and readings of the patents were noted and were subjected to statistical analysis. Four groups were formed which divided the patients equally on the basis of their age. Out of 50 patients in the age group of 21 to 30 years, only 4 showed posttreatment endodontic flare-ups, while no endodontic flare-up was recorded in patients with age group of 31 to 50 years. Only two male and four females showed flare-ups postoperatively. A nonsignificant correlation was obtained when flare-up cases were compared on the basis of type of irrigation solution used during canal preparation. Single-sitting endodontic therapy appears to be a successful procedure with good prognosis and minimal posttreatment flare-up results, even in patients with periapical pathologies. Single-sitting root canal procedures can be successfully carried in patients with vital or nonvital pulp tissues and also in patients with periapical lesions.

Wettability of root canal sealers on intraradicular dentine treated with different irrigating solutions.

PubMed

Ballal, Nidambur Vasudev; Tweeny, Adlyn; Khechen, Khaled; Prabhu, K Narayan; Satyanarayan; Tay, Franklin R

2013-06-01

The aim of this in vitro study was to evaluate the wettability of AH Plus and ThermaSeal Plus sealers on intraradicular dentine treated with different irrigating solutions. Fifty anterior teeth were decoronated and split longitudinally. Each root half was divided into 5 groups (n=10). Group I: 5mL of 2.5% NaOCl+QMix. Group II: 5mL of 2.5% NaOCl+17% EDTA. Group III: 5mL of 2.5% NaOCl+7% maleic acid. Group IV: 5mL of 2.5% NaOCl. Group V: 5mL of distilled water. Irrigation regimens were performed for 1min. Each specimen was placed inside a Dynamic Contact Angle Analyser. A controlled-volume droplet of sealer was placed on each specimen and the static contact angle was analysed. The contact angle made by both sealers with EDTA-irrigated dentine was significantly larger when compared to the other irrigants (P<0.05). For ThermaSeal Plus, contact angles produced on maleic acid-, NaOCl- and distilled water-irrigated dentine were not significantly different, but were all significantly larger than the contact angle produced on QMix-irrigated dentine (P<0.05). For AH Plus, contact angles produced on NaOCl- and distilled water-irrigated dentine were not significantly different, but were significantly larger than those made by maleic acid and QMix. When used as a final irrigant, QMix favours the wetting of root canal dentine by both AH Plus and ThermaSeal Plus sealers. Maleic acid shows a promising result when compared to EDTA and NaOCl. Wettability of both sealers is the worst on EDTA-irrigated dentine. The present study highlights the effect of newer endodontic irrigating solutions on the wettability of sealers on to the root canal dentine, which is required for obtaining good obturation seal. Copyright © 2013 Elsevier Ltd. All rights reserved.

Comparison of the antibacterial effect of sodium hypochlorite and aloe vera solutions as root canal irrigants in human extracted teeth contaminated with enterococcus faecalis.

PubMed

Sahebi, S; Khosravifar, N; Sedighshamsi, M; Motamedifar, M

2014-03-01

The main purpose of a root canal treatment is to eliminate the bacteria and their products from the pulp space. Sodium hypochlorite has excellent antibacterial properties, but also some negative features. The aim of the present study is to compare the antimicrobial effect of Aloe Vera solution with sodium hypochlorite on E.faecalis in the root canals of human extracted teeth. Sixty human extracted single rooted teeth were selected for this in vitro study. The teeth recruited in this study had no cracks, internal resorption, external resorption and calcification. Enterococcus faecalis was injected in the root canals of all teeth. The teeth were then divided into three groups randomly. Each group consisted of 20 teeth that were all rinsed with one of the following solutions: sodium hypochlorite 2.5%, Aloe vera and normal saline. Subsequent to rinsing, root canals of all teeth were sampled. The samples were cultured and growth of the bacteria was assessed after 48 hours. The number of colonies of the bacteria was then counted. The difference between the inhibitory effect of Aloe vera and normal saline on E.faecalis was not significant according to independent t-test (p= 0.966). The inhibitory effect of sodium hypochlorite on E.faecalis was much greater than that of Aloe vera and normal saline (p< 0.001). Aloe vera solution is not recommended as a root canal irrigator, but future studies are suggested to investigate the antibacterial effect of Aloe vera with longer duration of exposure and as an intra canal medicament.

Apical extrusion of debris and irrigants using hand and three rotary instrumentation systems − An in vitro study.

PubMed

Madhusudhana, Koppolu; Mathew, Vinod Babu; Reddy, Nelaturi Madhusudhan

2010-10-01

Sterilization of the root canal is a prime aim of successful endodontics. The cleaning and shaping of the canal is directed as achieving this goal. The extrusion of apical debris has a deleterious effect on the prognosis of root canal treatment. Several instrument designs and instrumentation techniques have been developed to prevent this. Forty caries free single rooted human mandibular premolar teeth were divided in four groups of ten teeth each. Teeth in each group were instrumented until the working length with rotary ProTaper, K3, Mtwo systems, and hand K-type stainless steel files. Debris and irrigant extruded from the apical foramen were collected into vials and the amounts were quantitatively determined. The data obtained were analyzed using Kruskal-Wallis one-way analysis of variance and Mann-Whitney U tests. The results show that all instrumentation techniques produced significant amount of extruded debris and irrigant. The engine-driven nickel-titanium systems showed less apical extrusion of debris and irrigant than manual technique. No statistically significant difference was found between the groups at [P > 0.05]. Maximum apical debris and irrigant extrusion was seen with K-file group and least in the Mtwo group. The use of rotary files and techniques to perform instrumentation does show less extrusion of the debris and irrigant from the apex. This can contribute to more successful endodontic therapy.

Oral tissue complications during endodontic irrigation: literature review.

PubMed

Kishor, Nanda

2013-04-01

The literature concerning the etiology, symptomatology and management of complications during root canal irrigation is reviewed. Clinical symptoms are discussed, as well as preventive and therapeutic considerations.

Cleanliness in the Root Canal System: An Scanning Electron Microscopic Evaluation of Manual and Automated Instrumentation using 4% Sodium Hypochlorite and EDTA (Glyde File Prep)―An in vitro Study

PubMed Central

Meshram, GK

2010-01-01

ABSTRACT Aim : To assess the cleaning efficacy of manual and automated instrumentation using 4% sodium hypochlorite singly and in combination with Glyde file Prep as root canal irrigant. Methodology : The study utilized 40 extracted human permanent premolars with single, straight and fully formed root. The teeth were then divided into four groups of ten each, Group I and II were prepared by manual instruments with 4% sodium hypochlorite used as irrigant singly [Group I] or in combination with Glyde file prep. Group III and IV were prepared by automated instruments at 250 rpm with 4% sodium hypochlorite as irrigant singly [Group III] and in combination with glyde file prep [Group IV] automated instrumentation. After completion of the root canal preparation the canal, teeth were prepared for SEM examination. These photomicrographs were qualitatively evaluated using criteria. Overall cleanliness, presence or absence of the smear layer, presence or absence of the debris, patency of the opening of dentinal tubules. Results : When comparing the cleansing efficacy of manual and automated instrumentation using 4% sodium hypochlorite better cleansing was there with manual instrumentation. When comparing the cleansing efficacy of manual and automated instrumentation using combination regime cleansing is better with automated instrumentation. When comparing the cleansing efficacy of manual instrumentation using 4% sodium hypochlorite singly and in combination with EDTA, the combination regime led to better cleansing. When comparing the cleansing efficacy of automated instrumentation using 4% sodium hypochlorite singly and in combination regime lead to better cleansing. Conclusion : Neither of instrumentation technique, nor irrigating regimes were capable of providing a completely clean canal. Automated instrumentation with a combination of sodium hypochlorite & EDTA resulted the best cleansing efficacy. PMID:27616839

Cutaneous Sinus Tract from Mandibular Second Molar with C-shaped Canal System and Improper Former Root Canal Treatment: A Case Report.

PubMed

Gharechahi, Maryam; Dastmalchi, Parisa

2016-01-01

Here, we report the diagnosis and treatment of an extraoral cutaneous sinus tract originating in a mandibular second molar with a C-shaped root canal system. The patient was referred to our department by a dermatologist after a series of unsuccessful treatments, including antibiotics. Diffuse radiolucency on a preoperative radiograph revealed that earlier root canal treatment had been only partially successful. Consequently, we performed retreatment of the root canal comprising removal of the former restoration and gutta-percha, cleaning and shaping, and passive irrigation with sodium hypochlorite. The patient responded well, and the cutaneous lesion completely resolved uneventfully within 1 month postoperatively. Preoperative recognition and thorough knowledge of the root canal anatomy and conventional methods of obturation are necessary in performing successful endodontic treatment.

Second-generation Platelet Concentrate (Platelet-rich Fibrin) as a Scaffold in Regenerative Endodontics: A Case Series.

PubMed

Bakhtiar, Hengameh; Esmaeili, Shahram; Fakhr Tabatabayi, Setareh; Ellini, Mohammad Reza; Nekoofar, Mohammad Hossein; Dummer, Paul M H

2017-03-01

The purpose of this case series was to report the clinical and radiographic results of a pulp regenerative procedure using platelet-rich fibrin (PRF), a second-generation platelet concentrate, in immature teeth with necrotic pulps. Root canal revascularization using PRF was performed on 4 immature teeth with necrotic pulps. After access cavity preparation, the root canals were irrigated with low concentration sodium hypochlorite solution (1.5% sodium hypochlorite [20 mL/canal, 5 minutes]) and then irrigated with saline (20 mL/canal, 5 minutes). Equal proportions (167 mg) of ciprofloxacin, metronidazole, and cefaclor were mixed and diluted to a final concentration of 1 g/mL. Finally, the canal was sealed with 3-4 mm of a temporary restorative material, and patients were dismissed for 2 to 3 weeks. At the second appointment, 9 mL of the patient's whole blood was obtained and centrifuged to prepare a PRF clot. Canals were irrigated with 17% EDTA, and a sharp spreader was inserted beyond the apex. Then, the PRF clot was placed inside the root canals, and Biodentine (Septodont, Saint-Maur, France) was placed directly over the PRF. The teeth were restored permanently with glass ionomer cement and composite resin. Clinical examinations revealed that all cases were asymptomatic at the recall appointments at 1, 3, 6, 12, and 18 months. Radiographs revealed resolution of the periapical lesions, further root development, and apical closure in all cases. On the basis of the short-term results up to 12 months, PRF clots acted as successful scaffolds for the regeneration of pulpal contents in immature teeth with necrotic pulps. Copyright © 2016 American Association of Endodontists. All rights reserved.

Root canal obturation: experimental study on the thermafil system related to different irrigation protocols

PubMed Central

Migliau, Guido; Sofan, Afrah Ali Abdullah; Sofan, Eshrak Ali Abdullah; Cosma, Salvatore; Eramo, Stefano; Gallottini, Livio

2014-01-01

Summary Aim The aim of this study was to stress the ability of a specific obturation technique (thermafil technique) to seal root canal system in presence or absence of smear layer. Methodology Sixteen monoradicular teeth, extracted for periodontal reasons, were collected for this study. All specimens were prepared with nickel-titanium rotary files, and then divided into two groups: for each group was applied a different kind of irrigation method, verifying the effectiveness in removing the smear layer, thus rendering the dentinal tubules more permeable for penetration of softened gutta-percha. Thermafil system was used to fill the root canals, and then all the specimens were observed under scanning electron microscope (SEM). Results The results showed that the Group which followed irrigation only with sodium hypochlorite exhibited significantly less gutta-percha tags when compared to the second Group, which was irrigated with sodium hypochlorite and EDTA. Conclusion The thermafil systems have a very good quality of compression and fluency that permit to gain a good seal of endodontic space; furthermore it allows the penetration of gutta-percha with the formation of numerous of gutta-percha tags inside the dentinal tubules above all when smear layer is reduced or eliminated. PMID:25506413

Comparison of the Antimicrobial Efficacy of Octenidine Dihydrochloride and Chlorhexidine with and Without Passive Ultrasonic Irrigation - An Invitro Study.

PubMed

Cherian, Bastin; Gehlot, Paras Mull; Manjunath, Mysore Krishnaswamy

2016-06-01

Elimination of microorganisms from infected root canals is a complicated task. Numerous measures have been described to reduce the microbial load in the root canal system, including the use of various instrumentation techniques, irrigation regimens and intracanal medicaments. The drawbacks of few commonly used irrigants include toxic and harmful side effects, microbial resistance to antimicrobial agents and staining. Hence there is a need for alternative agents which are nontoxic, effective and safe. To compare and evaluate antimicrobial effects of 2% Chlorhexidine (CHX) versus 0.1% Octenidine Dihydrochloride (OCT) as root canal irrigant with and without passive ultrasonic irrigation against Enterococcus faecalis (E. faecalis) in vitro and to evaluate the depth of penetration of irrigant solution into the dentinal tubules at the junction of middle and apical third. Forty eight freshly extracted, single rooted human mandibular premolars were decoronated and root specimen standardized to 14mm. Biofilm of E. faecalis (strain ATCC 29212) was grown for seven days and the specimens were divided into four groups (n=12) based on irrigation protocol : Group I- Conventional Syringe Irrigation (CSI) with 2% CHX, Group II- CSI + 0.1% OCT, Group III-Passive Ultrasonic Irrigation (PUI) + 2% CHX and Group IV- PUI+ 0.1% OCT. Dentin shavings were collected at two depths (200μm and 400μm) and total number of colony forming units were determined. The data were statistically analyzed using ANOVA, Scheffes multiple comparison of means and paired t-test (p<0.05). Group III and IV (PUI) showed significant difference compared to Group I and II (CSI) both at 200μm and 400μm (p=0.000). For Group III and Group IV no significant differences were found at 200μm and 400μm (p=1.000 and 0.363 respectively), however significant difference was found between data at 200μm and 400μm for all the four groups (p=0.000). Octenidine (0.1%) was more effective than 2% Chlorhexidine against E. faecalis both at 200μm and 400μm. Passive ultrasonic irrigation proved to enhance the antimicrobial action of the irrigants.

A comparative study of the debridement efficacy and apical extrusion of dynamic and passive root canal irrigation systems

PubMed Central

2014-01-01

Background Root canal irrigation carries a risk of extrusion of irrigant into the periapical tissues which can be associated with pain, swelling, and tissue damage. Studies have shown less extrusion with sonic or apical negative pressure devices compared with syringe and side-port needle or passive ultrasonic irrigation with continuous irrigant flow. This study aimed to evaluate the effectiveness of the EndoVac irrigation system, regarding 1) debris removal and 2) the control of apically extruded irrigating solution. Methods Fifty extracted human single-rooted teeth were used in this study. The teeth were then randomly divided into three experimental groups according to the type of irrigation used and one control group. In group 1, irrigation was performed using the EndoVac irrigation system. In group 2, irrigation was performed using a 30-gauge, tip-vented irrigation needle. In group 3, irrigation was performed using a 30-gauge, side-vented irrigation needle. The control group received instrumentation with no irrigation to serve as a control for cleaning efficiency. Root canal instrumentation was performed using the Profile NiTi rotary system with a crown-down technique. All of the experimental teeth were irrigated with the same amount of 5.25% sodium hypochlorite. The amount of extruded irrigating solution was then measured by subtracting the post-instrumentation weight from the pre-instrumentation weight using an electronic balance. The cleanliness of debris removal was evaluated using scanning electron microscopy. Results EndoVac irrigation had the least amount of extrusion followed by the side-vented and tip-vented method. The difference between the groups was statistically significant (P <0.01). As for the cleaning results, the debris collection in the EndoVac and tip-vented groups was the least in the apical third. In the control and the side-vented groups, the debris was the greatest in the apical third, but this difference was not significant among the three experimental groups. Conclusions The EndoVac irrigation system extruded significantly less irrigant solution than either needle irrigation system. Debris collection was the least in the apical third for the EndoVac irrigation system. No significant difference was found in the cleaning efficiency among the three irrigation systems. PMID:24512441

[Effects of different techniques on removal of vapor lock in the apical region of curved canals: a cone-beam computed tomography study].

PubMed

Su, Z; Bai, Y H; Hou, X M

2017-02-18

To compare the effect of four different techniques on removal of vapor lock in the apical region of curved root canals. Forty simulated resin root canals with 45° curvature were prepared using WaveOne Primary, then the apical foramen were sealed with soft wax. The teeth were divided randomly into 4 groups thereafter (n=10). Contract solution was injected into the canals using a 30 G side-vented needle and scanned with cone-beam CT (CBCT) to identify the volume of the vapor lock. Four different techniques including photon-induced photoacoustic streaming (PIPS) laser-activated irrigation, gutta-percha cone technique, ultrasonic irrigation, and sonic irrigation were used to remove the vapor locks in the root canals. The residual volume of the vapor lock was identified again using CBCT scanning data. Accordingly, the reduction rates of the vapor lock were calculated. Furthermore, the initial and residual vapor lock length was calculated. The data were analyzed by using the One-way ANOVA analysis and Kruskal-Wallis H test at a significance level of P<0.05. There was no significant difference in the initial vapor lock volume (P>0.05). Residual volume of the vapor lock for PIPS laser-activated irrigation was 0 mm(3), and that for gutta-percha cone technique was (0.02±0.07) mm3, significantly lower than those of ultrasonic and sonic irrigation, the values being (0.20±0.09) mm(3) and (0.23±0.06) mm(3) (P<0.001), respectively. The reduction rates of the vapor lock of PIPS laser-activated irrigation and gutta-percha cone technique were 100.00% (100.00%, 100.00%) and 100.00% (77.66%, 100.00%), respectively, significantly higher than those of ultrasonic irrigation [70.37% (56.41%, 91.43%)] and sonic irrigation [63.54% (51.47%, 74.00%), P<0.001]. The length of the residual vapor lock for PIPS laser-activated irrigation was 0 mm, and that for gutta-percha cone technique was (0.15±0.47) mm, significantly lower than those of ultrasonic and sonic irrigation, values being (2.21±0.09) mm and (2.34±0.08) mm (P<0.001), respectively. The length of the residual vapor locks in the ultrasonic and sonic group remained approximately the same as the distance between the working tip and the apical foramen. PIPS laser activated irrigation and gutta-percha cone technique could remove the vapor lock from the apical region of curved canals effectively.

Effects of sodium hypochlorite associated with EDTA and etidronate on apical root transportation.

PubMed

Silva e Souza, P A R; das Dores, R S E; Tartari, T; Pinheiro, T P S; Tuji, F M; Silva e Souza, M H

2014-01-01

To evaluate the influence of sodium hypochlorite associated with EDTA and etidronate on apical root transportation. Forty-five roots of human mandibular molars with curvatures of 15-25° were embedded in acrylic resin to allow standardized angulation of the initial and final radiographs. The pre-instrumentation radiographs of the mesiobuccal canal of each root were taken using a radiograph digital sensor with a size 15 K-file in the canal. The canals were prepared with the ProTaper Universal system (Dentsply Maillefer, Ballaigues, Switzerland), using one of the following irrigation regimens during the instrumentation (n = 15): G1 - irrigation with 20 mL of saline solution (control); G2 - alternating irrigation with 2.5% hypochlorite solution (NaOCl) (15 mL); and 17% ethylenediaminetetraacetic acid (EDTA) (5 mL). During instrumentation, the canal was filled with NaOCl and then between each exchange of instrument filled with EDTA for 1 min, and G3 - irrigation with 20 mL of 5% NaOCl and 18% etidronate solution (HEBP) mixed in equal parts. The postinstrumentation radiographs were made with a F3 instrument in the canal. The images were magnified and superposed with Adobe Photoshop software (Adobe Systems, Mountain View, CA, USA). Apical transportation was determined with AutoCAD 2012 software (Autodesk Inc., San Rafael, CA, USA) by measuring the distance in millimetres between the tips of the instruments. The results were subjected to the nonparametric statistical Kruskal-Wallis test (α < 0.05). The median transportation and interquartile range values were 0.00 ± 0.05 for G1, 0.08 ± 0.23 for G2 and 0.13 ± 0.14 for G3. Comparison between groups showed that apical transportation in G3 was significantly greater than in G1 (P < 0.05). The use of NaOCl associated with etidronate increased apical transportation in the canals of extracted teeth. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Effect of super-oxidized water, sodium hypochlorite and EDTA on dentin microhardness.

PubMed

Ghisi, Alexandre Corrêa; Kopper, Patrícia Maria Poli; Baldasso, Flávia E R; Stürmer, Caroline P; Rossi-Fedele, Giampiero; Steier, Liviu; Figueiredo, José Antonio Poli de; Morgental, Renata Dornelles; Vier-Pelisser, Fabiana Vieira

2014-01-01

The present study aimed to evaluate the influence of the following irrigating solutions on the microhardness of root canal dentin: 2% sodium hypochlorite (2NaOCl), 5% sodium hypochlorite (5NaOCl), super-oxidized water (400 ppm Sterilox - Sx) and 17% EDTA (E). Eighty roots from bovine incisors were randomly divided into 8 groups (n=10): 2NaOCl, 5NaOCl, Sx, and 2NaOCl + E, 5NaOCl + E, Sx + E (associated with E as final irrigant for 5 min), E solely and distilled water (dH2O) as the negative control. Root canal preparation was performed by hand instruments, using one of the irrigation protocols for 30 min. Then, 5 mm of the cervical root third were cut out from each sample and subjected to the Vickers microhardness test, at two points, one at approximately 500-1000 µm from the root canal lumen (distance 1), and the other at approximately 500-1000 µm from the external root surface (distance 2). Data were analyzed by Wilcoxon and Kruskal-Wallis tests at 5% significance level. Microhardness values at distance 1 were significantly lower than those at distance 2 for all groups, except 5NaOCl and 5NaOCl + E groups (p>0.05). EDTA showed the lowest microhardness values. However, no statistically significant difference was detected among groups at distance 1 and EDTA was significantly different only from Sx at distance 2. In conclusion, all tested solutions showed lower microhardness at the most superficial root canal dentin layer compared to the one found near the external root surface, except 5NaOCl and 5NaOCl + E; EDTA promoted lower microhardness values in comparison to Sterilox at this site.

Effect of rotary instrumentation and of the association of calcium hydroxide and chlorhexidine on the antisepsis of the root canal system in dogs.

PubMed

Soares, Janir Alves; Leonardo, Mario Roberto; da Silva, Léa Assed Bezerra; Tanomaru Filho, Mario; Ito, Izabel Yoko

2006-01-01

This study aimed at evaluating the antisepsis of the root canal system (RCS) and periapical region (PR) provided by rotary instrumentation associated with chlorhexidine + calcium hydroxide as intracanal medicament. Chronic periapical lesions were induced in 26 pre-molar roots in two dogs. After microbiological sampling, automatic instrumentation using the Profile system and irrigation with 5.25% sodium hypochlorite solution, with a final rinse of 14.3% EDTA followed by profuse irrigation with physiological saline were carried out in 18 root canals. After drying the canals, a paste based on calcium hydroxide associated with a 2% chlorhexidine digluconate solution was placed inside them. After 21 days, the medication was removed, leaving the root canals empty and coronally sealed. After 96 hours, a final microbiological sample was obtained, followed by histomicrobiological processing by the Brown & Brenn method. Eight untreated root canals represented the control group (C-G). Based on the Mann-Whitney test at a confidence level of 5% (p < 0.05), the procedures of antisepsis used offered significant efficacy (p < 0.05) resulting in 100.0% of the canals free of microorganisms. In the C-G, an elevated incidence of various microbial morphotypes was confirmed in all sites of the RCS, with the presence of microbial colonies in the periapical region. In contrast, the experimental group showed a similar pattern of infection in the RCS, although less intense and a reduced level of periapical infection (p < 0.05). It was concluded that adequate instrumentation followed by the application of calcium hydroxide + chlorhexidine offered significant elimination of microorganisms.

The efficacy of the self-adjusting file and ProTaper for removal of calcium hydroxide from root canals

PubMed Central

FARIA, Gisele; KUGA, Milton Carlos; RUY, Alessandra Camila; ARANDA-GARCIA, Arturo Javier; BONETTI-FILHO, Idomeo; GUERREIRO-TANOMARU, Juliane Maria; LEONARDO, Renato Toledo

2013-01-01

Objective The goal of this study was to evaluate the efficacy of the Self-Adjusting File (SAF) and ProTaper for removing calcium hydroxide [Ca(OH)2] from root canals. Material and Methods Thirty-six human mandibular incisors were instrumented with the ProTaper system up to instrument F2 and filled with a Ca(OH)2-based dressing. After 7 days, specimens were distributed in two groups (n=15) according to the method of Ca(OH)2 removal. Group I (SAF) was irrigated with 5 mL of NaOCl and SAF was used for 30 seconds under constant irrigation with 5 mL of NaOCl using the Vatea irrigation device, followed by irrigation with 3 mL of EDTA and 5 mL of NaOCl. Group II (ProTaper) was irrigated with 5 mL of NaOCl, the F2 instrument was used for 30 seconds, followed by irrigation with 5 mL of NaOCl, 3 mL of EDTA, and 5 mL of NaOCl. In 3 teeth Ca(OH)2 was not removed (positive control) and in 3 teeth canals were not filled with Ca(OH)2 (negative control). Teeth were sectioned and prepared for the scanning electron microscopy. The amounts of residual Ca(OH)2 were evaluated in the middle and apical thirds using a 5-score system. Results None of the techniques completely removed the Ca(OH)2 dressing. No difference was observed between SAF and ProTaper in removing Ca(OH)2 in the middle (P=0.11) and the apical (P=0.23) thirds. Conclusion The SAF system showed similar efficacy to rotary instrument for removal of Ca(OH)2 from mandibular incisor root canals. PMID:24037074

Visualization of removal of trapped air from the apical region of the straight root canal models generating 2-phase intermittent counter flow during ultrasonically activated irrigation.

PubMed

Peeters, Harry Huiz; Iskandar, Bernard; Suardita, Ketut; Suharto, Djoko

2014-06-01

The purpose of this in vitro study was to obtain a better understanding of the mechanism of irrigant traveling apically and generating 2-phase intermittent counter flow in straight root canal models during activation of the irrigant by ultrasonic means in an endodontic procedure. A high-speed imaging system, with high temporal and spatial resolution (FastCam SA5; Photron, Tokyo, Japan) at a frame rate of 100,000 frames per second using a macro lens (60 mm, f/2.8; Nikon, Tokyo, Japan), was used to visualize, in glass models of root canals, an ultrasonically induced acoustic pressure wave in an EDTA solution environment. A 25-mm stainless steel noncutting file #20 driven by an ultrasonic device (P5 Newtron; Satelec Acteon, Mérignac, France) at power settings of 5 and 7 produced disturbances at the solution-air interface. We found that apically directed travel of the irrigant was caused by disruption of the surface tension at the solution-air interface. This disruption caused by ultrasonic activation energy displaced air in the form of bubbles from the apical region toward the solution. The apical movement of the solution may be attributed to ultrasonically induced wave generation at the solution-air interface, resulting in the removal of trapped air from the root canal and allowing the solution to travel apically in the opposite directions (via a 2-phase intermittent counter flow). Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effective analysis of the use of peracetic acid after instrumentation of root canals contaminated with Enterococcus faecalis.

PubMed

Cord, Caroline Berwanger; Velasco, Rafael Vidal Cortez; Ribeiro Melo Lima, Laíla Fernanda; Rocha, Daniel Guimarães Pedro; da Silveira Bueno, Carlos Eduardo; Pinheiro, Sérgio Luiz

2014-08-01

The aim of this study was to evaluate the effectiveness of peracetic acid (PAA) in cleaning root canals contaminated with Enterococcus faecalis. Sixty first and second mandibular molars were used. Their mesiobuccal canals were prepared with the Reciproc System (VDW, Munich, Germany). The canals were irrigated with 10 mL saline during instrumentation. The teeth were randomly divided into 3 groups (n = 20), according to the irrigation solution to be used after instrumentation: group PAA (5 mL 1% PAA), group EDTA/sodium hypochlorite (NaOCl) (5 mL 17% EDTA followed by 5 mL 2.5% sodium hypochlorite), and group S (5 mL saline). Microbiological samples were collected before instrumentation and after final irrigation. Bacterial quantification was performed by counting the number of colony-forming units (CFUs/mL). The results were analyzed by the nonparametric Wilcoxon and Kruskal-Wallis tests. The 3 groups showed a significant reduction (P < .05) in CFUs/mL after final irrigation. PAA and NaOCl associated with EDTA produced a significantly higher reduction in CFUs/mL (P < .05) compared with saline. There was no statistically significant difference between PAA and EDTA + 2.5% NaOCl (P > .05). According to the results of the present study, the effectiveness of 1% PAA was similar to that of 17% EDTA + 2.5% NaOCl in cleaning curved root canals contaminated with E. faecalis. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effect of Intermediate Flush Using Different Devices to Prevent Chemical Smear Layer Formation.

PubMed

Silva, Camilla Corrêa; Ferreira, Vivian Maria Durange; De-Deus, Gustavo; Herrera, Daniel Rodrigo; Prado, Maíra do; Silva, Emmanuel João Nogueira Leal da

2017-01-01

This study compared the effect of intermediate flush with distilled water delivered by conventional irrigation, EndoVac microcannula or Self-Adjusting File (SAF) system in the prevention of chemical smear layer (CSL) formation. Thirty human premolars were used. Canals were prepared with Reciproc system and 5.25% NaOCl. After chemomechanical preparation, samples were divided in 3 groups (n=10) according to the intermediate irrigation protocol with distilled water using: conventional irrigation, EndoVac microcannula or SAF. A final flush with 2% chlorhexidine solution was used and scanning electron microscopy was performed to assess protocol effectiveness. Two calibrated evaluators attributed scores according the presence or absence of CSL on the surface of the root canal walls at the coronal, middle and apical thirds, as follows: (1) no CSL; (2) small amounts of CSL; (3) moderate CSL; and (4) heavy CSL. Differences between protocols were analyzed with Kruskal-Wallis and Mann-Whitney U tests. Friedman and Wilcoxon signed rank tests were used for comparison between each root canal third. SAF resulted in less formation of CSL when compared with the conventional irrigation and EndoVac microcannula (p<0.05). When root canal thirds were analyzed, conventional irrigation and EndoVac groups showed less CSL formation at coronal and middle thirds in comparison to the apical third (p<0.05). In SAF group, there was no difference among the thirds (p>0.05). It may be concluded that an intermediate flush of distilled water, delivered by the SAF system resulted in a better reduction of CSL formation during chemomechanical preparation.

Effect of aquatine endodontic cleanser on smear layer removal in the root canals of ex vivo human teeth

PubMed Central

GARCIA, Faustino; MURRAY, Peter E.; GARCIA-GODOY, Franklin; NAMEROW, Kenneth N.

2010-01-01

Objectives The purpose of this study was to measure and compare the root canal cleanliness and smear layer removal effectiveness of Aquatine Endodontic Cleanser (Aquatine EC) when used as an endodontic irrigating solution in comparison with 6% sodium hypochlorite (NaOCl). Material and Methods Forty-five human teeth were randomly allocated to five treatment groups; the pulp chamber was accessed, cleaned, and shaped by using ProTaper and ProFile rotary instrumentation to an ISO size #40. The teeth were then processed for scanning electron microscopy, and the root canal cleanliness and removal of smear layer were examined. Results The most effective removal of smear layer occurred with Aquatine EC and NaOCl, both with a rinse of EDTA. Conclusions Aquatine EC appears to be the first hypochlorous acid approved by the FDA to be a possible alternative to the use of NaOCl as an intracanal irrigant. Further research is needed to identify safer and more effective alternatives to the use of NaOCl irrigation in endodontics. PMID:20835577

Influence of antimicrobial solutions in the decontamination and adhesion of glass-fiber posts to root canals

PubMed Central

HARAGUSHIKU, Gisele Aihara; BACK, Eduardo Donato Eing Engelke; TOMAZINHO, Paulo Henrique; BARATTO, Flares; FURUSE, Adilson Yoshio

2015-01-01

Objective This study evaluated the effect of root canal disinfectants on the elimination of bacteria from the root canals, as well as their effect on glass-fiber posts bond strength. Material and Methods Fifty-three endodontically treated root canals had post spaces of 11 mm in length prepared and contaminated with E. faecalis. For CFU/ml analysis, eight teeth were contaminated for 1 h or 30 days (n=4). Teeth were decontaminated with 5% NaOCl, 2% CHX, or distilled water. As control, no decontamination was conducted. After decontamination, sterile paper points were used to collect samples, and CFU/ml were counted. For push-out, three groups were evaluated (n=15): irrigation with 2.5% NaOCl, 2% CHX, or sterile distilled water. A bonding agent was applied to root canal dentin, and a glass-fiber post was cemented with a dual-cured cement. After 24 h, 1-mm-thick slices of the middle portion of root canals were obtained and submitted to the push-out evaluation. Three specimens of each group were evaluated in scanning electron microscopy (SEM). Data were analyzed with one-way ANOVA and Dunnett’s T3 test (α=0.05). Results The number of CFU/ml increased from 1 h to 30 days of contamination in control and sterile distilled water groups. Decontamination with NaOCl was effective only when teeth were contaminated for 1 h. CHX was effective at both contamination times. NaOCl did not influence the bond strength (p>0.05). Higher values were observed with CHX (p<0.05). SEM showed formation of resin tags in all groups. Conclusion CHX showed better results for the irrigation of contaminated root canals both in reducing the bacterial contamination and in improving the glass-fiber post bonding. PMID:26398518

Antibacterial Activity of Diode Laser and Sodium Hypochlorite in Enterococcus Faecalis-Contaminated Root Canals.

PubMed

Sohrabi, Khosrow; Sooratgar, Aidin; Zolfagharnasab, Kaveh; Kharazifard, Mohammad Javad; Afkhami, Farzaneh

2016-01-01

The aim of the present in vitro study was to evaluate the disinfection ability of 980-nm diode laser in comparison with sodium hypochlorite (NaOCl) as a common root canal irrigant in canals infected with Enterococcus faecalis (E. faecalis). The root canals of 18 extracted single-rooted premolars were prepared by rotary system. After decoronation, the roots were autoclaved. One specimen was chosen for the negative control, and the remaining teeth were incubated with E. faecalis suspension for two weeks. Subsequently, one specimen was selected as the positive control and the remaining samples were divided into two groups (n=8). The samples of the first group were irrigated with 5.25% NaOCl and the second group were treated with a 980-nm diode laser. Microbial samples were taken from the root canals and bacterial cultivation was carried out. The average value and the standard deviation of colony-forming units (CFU) of each specimen were measured using descriptive statistics. The student's t-test was used to compare the reduction in CFU in each group. The equality of variance of CFU was measured by the Levene's test. NaOCl resulted in 99.87% removal of the bacteria and showed significantly more antibacterial effect compared to the 980-nm diode laser which led to 96.56% bacterial reduction (P<0.05). Although 5.25% NaOCl seems to reduce E. faecalis more effectively, the diode laser also reduced the bacterial count. Therefore a 980-nm diode laser could be considered as a complementary disinfection method in root canal treatment.

Apical extrusion of debris and irrigants using hand and three rotary instrumentation systems– An in vitro study

PubMed Central

Madhusudhana, Koppolu; Mathew, Vinod Babu; Reddy, Nelaturi Madhusudhan

2010-01-01

Introduction: Sterilization of the root canal is a prime aim of successful endodontics. The cleaning and shaping of the canal is directed as achieving this goal. The extrusion of apical debris has a deleterious effect on the prognosis of root canal treatment. Several instrument designs and instrumentation techniques have been developed to prevent this. Materials and Methods: Forty caries free single rooted human mandibular premolar teeth were divided in four groups of ten teeth each. Teeth in each group were instrumented until the working length with rotary ProTaper, K3, Mtwo systems, and hand K-type stainless steel files. Debris and irrigant extruded from the apical foramen were collected into vials and the amounts were quantitatively determined. The data obtained were analyzed using Kruskal-Wallis one-way analysis of variance and Mann-Whitney U tests. Results: The results show that all instrumentation techniques produced significant amount of extruded debris and irrigant. The engine-driven nickel-titanium systems showed less apical extrusion of debris and irrigant than manual technique. No statistically significant difference was found between the groups at [P > 0.05]. Maximum apical debris and irrigant extrusion was seen with K-file group and least in the Mtwo group. Conclusions: The use of rotary files and techniques to perform instrumentation does show less extrusion of the debris and irrigant from the apex. This can contribute to more successful endodontic therapy. PMID:22114427

Microtensile bond strength of etch-and-rinse and self-etching adhesives to intrapulpal dentin after endodontic irrigation and setting of root canal sealer.

PubMed

Wattanawongpitak, Nipaporn; Nakajima, Masatoshi; Ikeda, Masaomi; Foxton, Richard M; Tagami, Junji

2009-02-01

To evaluate the effect of endodontic irrigation regimens and calcium hydroxide root canal sealer (Sealapex) on the microtensile bond strengths (muTBS) of dual-curing resin composite (Clearfil DC Core Automix) to the intrapulpal dentin. Forty standardized coronal-half root canal dentin specimens obtained from human premolars were divided into 4 groups: group A, no treatment (control); group B, Sealapex; group C, NaOCl/Sealapex; group D, EDTA/NaOCl/Sealapex. After 7 days of storage in 100% relative humidity, Sealapex was removed. Dentin surfaces were bonded with adhesives, either etch-and-rinse (Single Bond) or self-etching (Clearfil SE Bond), and built up with resin composite. The bonded specimens were trimmed into an hourglass shape with a 1-mm2 cross-sectional area for microtensile testing (n = 20). The muTBS to intrapulpal dentin was analyzed using two-way ANOVA and Dunnett's TC test. Two teeth of each group were prepared for micromorphological analysis of dentin surface. The root canal sealer with or without endodontic irrigation significantly affected the bond strengths of resin composite to intrapulpal dentin compared with the control group (p < 0.05). There were no significant differences in muTBS of each experimental group between etch-and-rinse and self-etching adhesives (p > 0.05). The dentin surface was covered with a mud-like material after sealer application for 7 days. The root canal sealer reduced the muTBS of dual-curing resin composite with etch-and-rinse and self-etching adhesive systems to intrapulpal dentin. Treatment with EDTA followed by NaOCI prior to obturation caused an additional reduction in muTBS of both adhesive systems to intrapulpal dentin.

Alkaline Sodium Hypochlorite Irrigant and Its Chemical Interactions

PubMed Central

Kahler, Bill; Walsh, Laurence J.

2017-01-01

Endodontic irrigating solutions may interact chemically with one another. This is important, because even when solutions are not admixed, they will come into contact with one another during an alternating irrigation technique, forming unwanted by-products, which may be toxic or irritant. Mixing or alternating irrigants can also reduce their ability to clean and disinfect the root canal system of teeth by changing their chemical structure with subsequent loss of the active agent, or by inducing precipitate formation in the root canal system. Precipitates occlude dental tubules, resulting in less penetration of antimicrobials and a loss of disinfection efficacy. Sodium hypochlorite is not only a very reactive oxidizing agent, but is also the most commonly used endodontic irrigant. As such, many interactions occurring between it and other irrigants, chelators and other antimicrobials, may occur. Of particular interest is the interaction between sodium hypochlorite and the chelators EDTA, citric acid and etidronate and between sodium hypochlorite and the antimicrobials chlorhexidine, alexidine, MTAD and octenisept. PMID:28961175

The Use of Lasers in Disinfection and Cleanliness of Root Canals: a Review

PubMed Central

Anić, Ivica

2014-01-01

The outcome of root canal treatment is based on efficient disinfection of the root canal system and prevention of reinfection. Current chemomechanical cleaning methods do not always achieve these goals, and insufficient root canal disinfection is the main reason for endodontic failure. Due to high energy content and specific characteristics of laser light, laser treatment has been proposed for cleaning and disinfecting the root canal system. This paper reviews the literature covering the effect of Er:YAG, Er,Cr:YSGG, Nd:YAG and diode laser on the root canal wall in the removal of smear layer and against intracanal bacteria. Recently, the use of laser energy to induce cavitation and acoustic streaming of intracanal irrigants has been investigated. Based on recent literature, it can be concluded that lasers have bactericidal effects. However, they still cannot replace sodium hypochlorite and should be considered as an adjunct to the current chemical root canal disinfection protocols. Certain lasers can help in removing the smear layer and debris and can modify the morphology of the root canal wall. Unfortunately, there have not been enough randomized clinical studies evaluating endodontic treatment outcome following the use of laser. PMID:27688346

Comparison of apical extrusion of sodium hypochlorite using 4 different root canal irrigation techniques.

PubMed

İriboz, Emre; Bayraktar, Koral; Türkaydın, Dilek; Tarçın, Bilge

2015-03-01

We compared the apical extrusion of sodium hypochlorite delivered with a 27-G needle, self-adjusting file (SAF), passive ultrasonic irrigation, or the EndoVac system (SybronEndo, Orange, CA) during the instrumentation and final irrigation of root canals. Matched paired single-canal teeth were divided into 8 groups. The experimental groups were needle irrigation size #30 (NI30) and #50 (NI50), SAF size #30 (SAF30) and #50 (SAF50), passive ultrasonic irrigation size #30 (PUI30) and #50 (PUI50), and EndoVac size #30 (EV30) and #50 (EV50). Teeth were embedded in 0.2% agarose gel (pH = 7.4) containing 1 mL 0.1% m-Cresol purple (Sigma-Aldrich, St Louis, MO), which changes color at a pH level of 9.0. Root canals were irrigated with sodium hypochlorite and EDTA using 4 different techniques, and the amount of irrigant was controlled. Standardized digital photographs were taken 20 minutes after the first irrigant was used and were analyzed to determine the amount of extrusion (expressed as a percentage of total pixels). The amounts of apical extrusion obtained in the NI30, NI50, SAF30, SAF50, PUI30, PUI50, EV30, and EV50 groups were 30% (3/10), 50% (5/10), 20% (2/10), 70% (7/10), 40% (4/10), 40% (4/10), 10% (1/10), and 10% (1/10), respectively. The overall extrusion frequency, regardless of the apical preparation size, was 40% (8/20) for needle, 45% (9/20) for SAF, 40% (8/20) for ultrasonic irrigation, and 10% (2/20) for EndoVac. Although the SAF group showed more extrusion, the percentage of pixels was significantly higher in the needle irrigation group (P < .01). The EndoVac group showed significantly lower extrusion values than the other techniques in terms of the number of teeth and pixels (P < .05 and P < .01, respectively). The risk of apical extrusion is significantly lower with the EndoVac in comparison with the 3 other techniques. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Concentration and time-dependent effect of initial sodium hypochlorite on the ability of QMix and ethylenediaminetetraacetic acid to remove smear layer.

PubMed

Aksel, Hacer; Serper, Ahmet

2017-01-01

The aim of this study was to compare the ability of 17% ethylenediaminetetraacetic acid (EDTA) and QMix with different concentrations and time exposures of initial sodium hypochlorite (NaOCl) to remove the smear layer from the root canals. Eighty maxillary central incisors were used. After instrumentation, the teeth were divided into eight experimental groups according to the initial and final rinse. About 2.5% and 5% NaOCl were used during instrumentation and for 1 or 3 min was used as postinstrumentation initial irrigants, and 17% EDTA and QMix used as final irrigants. The apical and middle parts of the specimens were observed by scanning electron microscope. Data were analyzed using the Kruskal-Wallis, Mann-Whitney, and Friedman's test. Regardless of the type of final irrigant, QMix allowed more smear layer removal than EDTA after using 5% initial NaOCl for 3 min. In the apical part of the root canal walls, the smear layer was not completely removed. QMix and EDTA were similarly effective in smear layer removal at the middle parts of the root canal regardless of the concentration and time exposure of initial NaOCl, while none of the irrigation protocols was able to remove smear layer at the apical parts.

The Effect of Diode Laser on Planktonic Enterococcus faecalis in Infected Root Canals in an Ex Vivo Model.

PubMed

Cretella, Gilda; Lajolo, Carlo; Castagnola, Raffaella; Somma, Francesco; Inchingolo, MariaTeresa; Marigo, Luca

2017-04-01

This study examined the bactericidal effect of diode laser irradiation against intracanal Enterococcus faecalis. m total of 128 extracted single-rooted and single-canal teeth were treated with ProTaper instruments (Dentsply Maillefer, Ballaigues, Switzerland). A total of 120 root canals were inoculated with E. faecalis for 21 days, and the samples were randomly divided into five groups: Group 1 (n = 24) samples were irrigated with only saline solution (positive controls); Group 2 (n = 24) was treated with only 5.25% sodium hypochlorite; Group 3 (n = 24) was irrigated with saline solutions activated by diode laser; Group 4 (n = 24) was treated with 5.25% sodium hypochlorite activated by diode laser; and Group 5 (n = 24) was irrigated with saline solution with methylene blue dye activated by the diode laser Fox (Sweden & Martina, Padova, Italy); additionally, eight teeth were not contaminated and their canals were irrigated with saline solution and used as a negative control. The Uro-Quick system was used to determine the microbial residual charge. The data were analyzed using Pearson's chi-square test (p < 0.001). A statistically significant reduction in bacterial count was observed in Group 2 and Group 4 (p < 0.001). There were no statistically significant differences among the other groups (p > 0.001). Evidence indicates that the diode laser was not more effective than sodium hypochlorite in reducing free bacteria.

Application of 17% EDTA Enhances Diffusion of (45)Ca-labeled OH(-) and Ca(2+) in Primary Tooth Root Canal.

PubMed

Ximenes, Marcos; Cavalcanti Taguchi, Carolina Mayumi; Triches, Thaisa Cezaria; Sartori, Neimar; Pereira Dias, Luis Alberto; de Araujo, Elaine Bortoleti; Cardoso, Mariane

2016-01-01

Proper cleaning of the root canal is key to the success of endodontic treatment as it allows more effective diffusion of medication throughout the dentinal tubules. The aim of this in vitro study was to investigate the efficacy of 17% ethylenediaminetetraacetic acid (EDTA) in enhancing diffusion of hydroxyl (OH(-)) and calcium ions (Ca(2+)) throughout the root canal in primary teeth. The canals of 25 primary tooth roots were cleaned with endodontic files and 1% sodium hypochlorite. Three groups (G) were then established: GI, in which final irrigation was performed with 1% sodium hypochlorite; GII, in which 17% EDTA was used; and GIII, in which no irrigation was performed. The roots canals in GI and GII were filled with a calcium hydroxide-based paste labeled with the radioisotope calcium-45. Diffusion of OH(-) was detected with pH strips and Ca(2+) analyzed by measuring radioactivity in counts per min. Group II differed statistically from the other groups in diffusion of OH(-) at 24 hr (p<0.05), but no significant difference among groups was found at the day 7 evaluation; GII also differed statistically from the other groups in diffusion of Ca(2+) at 24 hr (p<0.05). These results suggest that application of 17% EDTA in primary tooth enhances diffusion of OH(-) and Ca(2+).

Comparative evaluation of canal isthmus debridement efficacy of modified EndoVac technique with different irrigation systems.

PubMed

Thomas, Anchu Rachel; Velmurugan, Natanasabapathy; Smita, Surendran; Jothilatha, Sundaramurthy

2014-10-01

The purpose of this study was to evaluate the canal isthmus debridement efficacy of a new modified EndoVac (Discus Dental, Culver City, CA) irrigation protocol in comparison with EndoVac, passive ultrasonic irrigation (PUI), and conventional needle irrigation in mesial roots of mandibular molars. The mesial roots of 64 extracted mandibular molars mounted in resin using Kuttler's endodontic cube, sectioned at 2 and 4 mm from the working length, were randomly divided into 4 groups (n = 16): group 1: Max-I-Probe (Dentsply Tulsa Dental, York, PA), group 2: EndoVac (EVI), group 3: modified EndoVac, and group 4: PUI. The specimens were reassembled and instrumented. A standard irrigation protocol was used during cleaning and shaping and final irrigation with the 4 irrigation/agitation techniques. Images of the isthmus region were taken before and after cleaning and shaping and after final irrigation. The percentage reduction of debris in the isthmus region was calculated by using the software program Image J (v1.43; National Institutes of Health, Bethesda, MD). Intergroup analysis was performed using the Kruskal Wallis and Mann-Whitney U tests. Intragroup analysis was performed using Friedman and Wilcoxon signed rank tests. The level of significance was set at P < .05. Intragroup analysis revealed a statistically significant difference in the percentage reduction of debris after cleaning and shaping and after final irrigation protocol in all the groups (P < .001). The final irrigation protocol produced significantly cleaner canal isthmuses in all the groups (P < .001). On intergroup analysis, the modified EVI group performed significantly better than the other groups. The EVI and PUI groups performed better than the Max-I-Probe group. There was no statistical significance between the EVI and PUI groups. Canal isthmuses were significantly cleaner with the modified EndoVac irrigation technique when compared with the cleanliness seen with the other irrigation systems. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Apical and periapical repair of dogs' teeth with periapical lesions after endodontic treatment with different root canal sealers.

PubMed

Leonardo, Mário Roberto; Salgado, Antônio Alberto; da Silva, Léa Assed; Tanomaru Filho, Mário

2003-01-01

The aim of this study was to evaluate the apical and periapical repair after root canal treatment of dogs' teeth with pulp necrosis and chronic periapical lesion using different root canal sealers. After periapical lesion induction, forty-four root canals of 3 dogs were submitted to biomechanical preparation using 5.25% sodium hypochlorite as an irrigating solution. A calcium hydroxide dressing (Calen PMCC) was applied for 15 days and the root canals were filled using the lateral condensation technique with gutta-percha points and Sealapex, AH Plus or Sealer Plus for sealing. After 180 days, the animals were sacrificed by anesthetic overdose and the obtained histological sections were stained with hematoxylin-eosin for optical microscopic analysis of the apical and periapical repair. The groups filled with Sealapex and AH Plus had better histological repair (p < 0.05) than the group filled with Sealer Plus, that had unsatisfactory results.

Subcutaneous emphysema during root canal therapy: endodontic accident by sodium hypoclorite.

PubMed

Tenore, Gianluca; Palaia, Gaspare; Ciolfi, Chiara; Mohsen, Mohamed; Battisti, Andrea; Romeo, Umberto

2017-01-01

Cervicofacial subcutaneous emphysema is defined as the abnormal introduction of air in the subcutaneous tissues of the head and neck. It is mainly caused by trauma, head and neck surgery, general anesthesia, and coughing or habitual performance of Valsalva manoeuvre. The occurrence of subcutaneous emphysema after dental treatment is rare, and diffusion of gas into the mediastinum is much rarer, especially when the procedure is a nonsurgical treatment. Presented here is a case of subcutaneous emphysema that occurred after sodium hypochlorite irrigation during endodontic treatment, and the description of its etiologies and prevention during nonsurgical endodontic treatment. Endodontic success can be essentially achieved via good debridement of a root canal, and an ideal endodontic irrigant is effective in removing the smear layer, opening the dentinal tubules, and producing a clean surface for closer obturation. A 60-years-old woman had an abnormal swelling and pain during an endodontic treatment accompanied by her dentist to the emergency room and was referred to our observation for complaining of severe pain, ecchymosis and severe swelling on the left side of her face. The aforementioned symptoms appeared after sodium hypochlorite irrigation and aggressive use of air spray for drying the root canal during the endodontic treatment of the upper left lateral incisor. An extrusion during an inappropriate endodontic treatment may occasionally be reported and can cause tissue damage. NaOCl is one of the best and most commonly used irrigating solutions because of its efficacy, but it can also negatively affect the periapical tissues. Determining the correct working length, even when performing an intraoperative periapical radiograph and confirming the root canal integrity, could help avoid these kinds of accidents.

Comparison of the Antimicrobial Efficacy of Octenidine Dihydrochloride and Chlorhexidine with and Without Passive Ultrasonic Irrigation - An Invitro Study

PubMed Central

Cherian, Bastin; Manjunath, Mysore Krishnaswamy

2016-01-01

Introduction Elimination of microorganisms from infected root canals is a complicated task. Numerous measures have been described to reduce the microbial load in the root canal system, including the use of various instrumentation techniques, irrigation regimens and intracanal medicaments. The drawbacks of few commonly used irrigants include toxic and harmful side effects, microbial resistance to antimicrobial agents and staining. Hence there is a need for alternative agents which are nontoxic, effective and safe. Aim To compare and evaluate antimicrobial effects of 2% Chlorhexidine (CHX) versus 0.1% Octenidine Dihydrochloride (OCT) as root canal irrigant with and without passive ultrasonic irrigation against Enterococcus faecalis (E. faecalis) in vitro and to evaluate the depth of penetration of irrigant solution into the dentinal tubules at the junction of middle and apical third. Materials and Methods Forty eight freshly extracted, single rooted human mandibular premolars were decoronated and root specimen standardized to 14mm. Biofilm of E. faecalis (strain ATCC 29212) was grown for seven days and the specimens were divided into four groups (n=12) based on irrigation protocol : Group I- Conventional Syringe Irrigation (CSI) with 2% CHX, Group II- CSI + 0.1% OCT, Group III-Passive Ultrasonic Irrigation (PUI) + 2% CHX and Group IV- PUI+ 0.1% OCT. Dentin shavings were collected at two depths (200μm and 400μm) and total number of colony forming units were determined. The data were statistically analyzed using ANOVA, Scheffes multiple comparison of means and paired t-test (p<0.05). Results Group III and IV (PUI) showed significant difference compared to Group I and II (CSI) both at 200μm and 400μm (p=0.000). For Group III and Group IV no significant differences were found at 200μm and 400μm (p=1.000 and 0.363 respectively), however significant difference was found between data at 200μm and 400μm for all the four groups (p=0.000). Conclusion Octenidine (0.1%) was more effective than 2% Chlorhexidine against E. faecalis both at 200μm and 400μm. Passive ultrasonic irrigation proved to enhance the antimicrobial action of the irrigants. PMID:27504415

A preliminary study of a new endodontic irrigation system: Clean Jet Endo.

PubMed

Nouioua, F; Slimani, A; Levallois, B; Camps, J; Tassery, H; Cuisinier, F; Bukiet, F

2015-03-01

The purpose of the present study was to assess the irrigant penetration and cleaning ability of a new irrigation system, the Clean Jet Endo (Produits Dentaires SA, Switzerland) in comparison to conventional irrigation followed or not by sonic activation. Irrigant penetration was evaluated on resin blocks simulators by measuring the methylene blue absorbance thanks to a UV/visible spectrophotometer and cleaning ability was assessed in an ex vivo experiment according to the debris score in an artificial canal extension before and after the final irrigation protocol. A statistical analysis was carried out in order to highlight the significant differences between the irrigation techniques. Clean Jet Endo permitted to better eliminate the methylene blue into the simulated canals. A significant difference between the 2 techniques was observed in the middle third (p = 0.005) as well as in the apical third (p < 0.2). An additional microscope observation (16X) confirmed that Clean Jet Endo@ usage led to a better penetration of irrigant within the lateral canals of the simulators. Likewise, this irrigating system permitted to better eliminate the debris in the lateral groove than the other techniques. In conclusion, our findings implied the potential of this new irrigation system to enhance root canal debridement and disinfection.

Disinfection of Contaminated Canals by Different Laser Wavelengths, while Performing Root Canal Therapy

PubMed Central

Asnaashari, Mohammad; Safavi, Nassimeh

2013-01-01

Removal of smear layer and disinfection of canals are important objectives of teeth root canal cleaning. In order to achieve this purpose, rinsing substances, intra canal drugs as well as ultrasound are used. Today, use of laser to remove smear layer and to disinfect root canals has increasingly attracted the attentions. Till now different lasers such as CO2, Nd:YAG, Er:YAG, Er,Cr:YSGG have been used for debris and smear removal from the canals. Numerous studies have shown that Er:YAG is the most appropriate laser for intra canal debris and smear removal. In addition different laser wavelengths have been used directly or as an adjunctive to disinfect canals. Laser light can penetrate areas of canals where irrigating and disinfecting solutions cannot reach, like secondary canals and deep dentinal tubules and also can eliminate microorganisms. Different studies have confirmed the penetration of Nd:YAG laser in deep dentin and reduction of microorganisms penetration. But studies on comparison of antibacterial effects of Nd:YAG laser with sodium hypochlorite showed effectiveness of both, with a better effect for sodium hypochlorite. Studies performed in relation with anti-microbial effects of Diode laser with various parameters show that this laser can be effective in reducing intra canal bacterial count and penetration in the depth of 500 microns in dentin. In studies performed on Diode laser in combination with canal irrigating solutions such as sodium hypochlorite and oxygenated water better results were obtained. Although studies on disinfection by the Erbium laser family show that use of this laser alone can be effective in disinfecting canals, studies evaluating the disinfecting effects of this laser and different concentrations of sodium hypochlorite show that the latter alone is more effective in disinfecting canals. And better results were obtained when Erbium laser was used in combination with sodium hypochlorite irrigating solution in canals. Results of the aforementioned articles indicate that this laser is effective in combination with a rinsing solution such as sodium hypochlorite. Results from studies including several types of the different Er:YAG, Ho:YAG, Nd:YAG, Er,Cr:YSGG lasers in disinfecting canals showed that all wavelengths used in disinfection for different thicknesses of dentin were efficacious without damaging thermal effect. Considering that use of different lasers in canals can be accompanied with temperature increase which can sometimes lead to damages to teeth and surrounding tissues, thus the use of photochemical phenomenon for elimination of microorganisms have attracted attention of many researchers. Studies in this field imply the efficacy of this method in reducing canal bacterial count and recommend its use as an adjunctive after biomechanical preparation of canals. Results from performed studies show removal of intra canal debris and smear layer by different lasers and particularly the Erbium laser family. Furthermore various laser wavelengths, particularly of Diode and Nd:YAG lasers can be effective in reducing intra canal microbial count. Maximum effect is obtained when laser light is used in canals in combination with sodium hypochlorite irrigating substance in appropriate concentration. Therefore use of laser energy can improve success rate of root canal treatments. PMID:25606301

The effects of different irrigation protocols on removing calcium hydroxide from the root canals.

PubMed

Üstün, Y; Aslan, T; Sagsen, B; Dincer, A N

2016-01-01

The aim of this study was to evaluate the efficiencies of different irrigation protocols and solutions in the removal of calcium hydroxide (Ca[OH]2). Sixty-eight maxillary incisors were used. Root canals were prepared and filled with Ca(OH)2. Two control (n = 4) and six experimental groups (n = 10) were adjusted: Group 1:1% peracetic acid (PAA) + master apical file (MAF); Group 2: 17% ethylenediaminetetraacetic acid (EDTA) + MAF; Group 3: 9% 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) + MAF; Group 4: 1% PAA + ultrasonic activation (UA); Group 5: 17% EDTA + UA; Group 6: 9% HEBP + UA. The cleanliness of root canal thirds were evaluated with scanning electron microscopy. Statistical analysis were performed (α = 0.05). At coronal thirds; PAA + UA was superior to EDTA + MAF, HEBP + MAF; and PAA + MAF was superior to EDTA + MAF, HEBP + MAF (P < 0.05). At middle thirds; PAA + MAF and PAA + UA were superior to EDTA + MAF and EDTA + UA; and, PAA + UA was superior to HEBP + MAF (P < 0.05). There were no significant differences among the rest of the experimental groups (P > 0.05). Complete removal of Ca(OH)2could not be achieved by none of the irrigants at all root thirds.

Evaluation of instrumentation systems in reducing E. faecalis from root canals: TF adaptive and ProTaper next versus single file systems.

PubMed

Karataş, Ertuğrul; Gültekin, Esra; Arslan, Hakan; Kirici, Damla Özsu; Alsancak, Meltem; Topçu, Meltem Çolak

2015-03-01

To compare the effect of the TF Adaptive, ProTaper Next, OneShape, WaveOne, Reciproc, (SAF) on the reduction of E. faecalis in experimentally infected root canals. 70 human mandibular incisor teeth with straight roots and single root canals were selected for this experiment and the root canals of the selected teeth were infected with E. faecalis. After contamination, all the root canals were randomly divided into 7 groups: control, ProTaper Next, TF Adaptive, SAF, WaveOne, Reciproc, and OneShape. After the irrigation procedures, samples were taken from root canals with paper points and incubated in blood agar plates. The colonies grown on the blood agar were counted and interpreted as colony forming units per milliliter. Analysis of results showed that all instrumentation systems were more effective in reducing the number of bacteria than the control (P<.001). The ProTaper Next, TF Adaptive, WaveOne, Reciproc, and OneShape systems were significantly more effective than the SAF system in reducing E. faecalis within the root canals (P<.001). All instrumentation systems used in this study provided a significant reduction in bacterial populations.

In Vivo Intracanal Temperature Evolution during Endodontic Treatment after the Injection of Room Temperature or Preheated Sodium Hypochlorite.

PubMed

de Hemptinne, Ferdinand; Slaus, Gunter; Vandendael, Mathieu; Jacquet, Wolfgang; De Moor, Roeland J; Bottenberg, Peter

2015-07-01

Heating a sodium hypochlorite solution improves its effectiveness. The aim of this study was to measure the in vivo temperature changes of sodium hypochlorite solutions that were initially preheated to 66°C or at room temperature inside root canals during routine irrigation. Thirty-five root canals were prepared to ISO size 40 with 4% taper. A type K (nickel-chromium-nickel) thermocouple microprobe (Testo NV, Ternat, Belgium) was positioned within 3 mm of the working length to measure the temperature at 1-second intervals. In each canal, 2 test protocols were evaluated in a randomized order with 3% sodium hypochlorite solutions: (1) preheated to 66°C and (2) at room temperature. The temperature measurements began 5 seconds before the 25 seconds of irrigant injections and continued for 240 seconds. This resulted in 270 data points for each protocol. The temperature of the irrigant at room temperature increased from the initial intracanal temperature after injection of 20.7°C (±1.2°C) to 30.9°C (±1.3°C) in 10 seconds and to 35°C (±0.9°C) after 240 seconds. The temperature of the preheated to 66°C solution decreased from 56.4°C (±2.7°C) to 45.4°C (±3.0°C) after 5 seconds, reached 37°C (±0.9°C) after 60 seconds, and reached 35.7°C (±0.8°C) after 240 seconds. The original temperatures of the sodium hypochlorite solutions were buffered inside the root canal and tended to rapidly evolve to equilibrium. The findings of this study contribute to an improved understanding of the thermodynamic behaviors of irrigant solutions inside root canals in vivo. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Review of ultrasonic irrigation in endodontics: increasing action of irrigating solutions

PubMed Central

Mozo, Sandra; Llena, Carmen

2012-01-01

Introduction: Effective irrigant delivery and agitation are prerequisites for successful endodontic treatment. Ultrasonic irrigation can be performed with or without simultaneous ultrasonic instrumentation. Existing literature reveals that ultrasonic irrigation may have a very positive effect on chemical, biological and physical debridement of the root canal system as investigated in many in vitro studies. Objective: The purpose of this review article was to summarize and discuss the available information concerning ultrasonic irrigation in endodontics. Methods: This article presents an overview of ultrasonic irrigation methods and their debridement efficacy. In this paper the relevant literature on passive ultrasonic irrigation is reviewed. Information from original scientific papers or reviews listed in MEDLINE and Cochrane were included in the review. Results: The use of ultrasound in the irrigation procedure results in improved canal cleanliness, better irrigant transfer to the canal system, soft tissue debridement, and removal of smear layer and bacteria. There are many in vitro studies, but there is a need to standardize protocols, and correlate the clinical efficacy of ultrasonic devices with improved treatment outcomes. Understanding the basis of ultrasonic irrigation is fundamental for clinicians and researchers to improve the design and use of ultrasonic irrigation. Key words:Ultrasonic irrigation, ultrasound, smear layer, endodontics. PMID:22143738

ANTIMICROBIAL ACTIVITY OF SODIUM HYPOCHLORITE ASSOCIATED WITH INTRACANAL MEDICATION FOR Candida albicans AND Enterococcus faecalis INOCULATED IN ROOT CANALS

PubMed Central

Valera, Marcia Carneiro; da Silva, Katy Costa Godinho; Maekawa, Lilian Eiko; Carvalho, Cláudio Antonio Talge; Koga-Ito, Cristiane Yumi; Camargo, Carlos Henrique Ribeiro; Silva e Lima, Raphael

2009-01-01

Objective: The purpose of this study was to evaluate the action of sodium hypochlorite (NaOCl) associated with an intracanal medication against Candida albicans and Enterococcus faecalis inoculated in root canals. Material and Methods: Thirty-six human single-rooted teeth with single root canals were used. The canals were contaminated with C. albicans and E. faecalis for 21 days and were then instrumented with 1% NaOCl. The roots were divided into 3 groups (n=12) according to the intracanal medication applied: calcium hydroxide paste, 2% chlorhexidine (CHX) gel, and 2% CHX gel associated with calcium hydroxide. The following collections were made from the root canals: a) initial sample (IS): 21 days after contamination (control), b) S1: after instrumentation, c) S2: 14 days after intracanal medication placement; S3: 7 days after intracanal medication removal. The results were analyzed statistically by the Kruskal-Wallis test at 5% significance level. Results and Conclusions: Both 1% NaOCl irrigation and the intracanal medications were effective in eliminating E. faecalis and C. albicans inoculated in root canals. PMID:20027425

Antimicrobial activity of sodium hypochlorite associated with intracanal medication for Candida albicans and Enterococcus faecalis inoculated in root canals.

PubMed

Valera, Marcia Carneiro; Silva, Katy Costa Godinho da; Maekawa, Lilian Eiko; Carvalho, Cláudio Antonio Talge; Koga-Ito, Cristiane Yumi; Camargo, Carlos Henrique Ribeiro; Lima, Raphael Silva e

2009-01-01

The purpose of this study was to evaluate the action of sodium hypochlorite (NaOCl) associated with an intracanal medication against Candida albicans and Enterococcus faecalis inoculated in root canals. Thirty-six human single-rooted teeth with single root canals were used. The canals were contaminated with C. albicans and E. faecalis for 21 days and were then instrumented with 1% NaOCl. The roots were divided into 3 groups (n=12) according to the intracanal medication applied: calcium hydroxide paste, 2% chlorhexidine (CHX) gel, and 2% CHX gel associated with calcium hydroxide. The following collections were made from the root canals: a) initial sample (IS): 21 days after contamination (control), b) S1: after instrumentation, c) S2: 14 days after intracanal medication placement; S3: 7 days after intracanal medication removal. The results were analyzed statistically by the Kruskal-Wallis test at 5% significance level. Both 1% NaOCl irrigation and the intracanal medications were effective in eliminating E. faecalis and C. albicans inoculated in root canals.

Effect of root canal sealers and irrigation agents on retention of preformed posts luted with a resin cement.

PubMed

Mayhew, J T; Windchy, A M; Goldsmith, L J; Gettleman, L

2000-06-01

This study examined the effect of three sealers and four irrigants on retention of Dentatus preformed posts luted with Panavia 21 resin cement. Gutta-percha with one of the following sealers--EWT, AH26, Nogenol, or no sealer (control)--was used to fill the root canals of 160 autoclaved incisor and premolar tooth roots. After 72 hr 8 mm post spaces were created with Dentatus Probos Pathfinders and Dentatus reamers. After irrigating the post spaces with saline, 5.25% NaOCl, 50% citric acid followed by NaOCl, or 40% H3PO4, followed by NaOCl, Panavia 21 TC cement was introduced into the canal on the Dentatus #4 stainless steel post's threads. An up-and-down and counterclockwise motion and then a forward twist seated the posts without engaging dentin. Mesiodistal and faciolingual radiographs visualized the chambers. After 72 hr posts were removed axially with an Instron at 5 mm/min. Surprisingly, using Nogenol sealer reduced post retention whereas EWT and AH26 increased retention compared with no sealer. Post retention improved after acid etchants, especially for AH26.

Laser assisted irrigation and hand irrigation for root canal decontamination: a comparison

NASA Astrophysics Data System (ADS)

Olivi, M.; Stefanucci, M.; Todea, C.

2014-01-01

Aim: to compare the bactericidal efficiency of conventional method and LAI for root canal decontamination. Material and method: 22 human single root teeth, extracted for periodontal problems, mechanically prepared up to ISO 25 at the working lenght were divided in 2 groups: after sterilization, the teeth were infected with enterococcus faecalis and incubated for 4 weeks. Group A: 10 teeth were irrigated with conventional hand technique (CI): 3ml of 5% NaClO were used for two times of 30s each and after washing with sterile bi-distilled water for 20s, a final irrigation was performed with 3ml of 17% EDTA. Group B: 10 teeth were irrigated with 3ml of NaClO and activated by erbium laser, two cycles of 30s; also the final irrigation with 3ml of 17% EDTA was activated by erbium laser. In both the groups a resting time of 30s was used between the two sessions to allow the reaction rate of NaClO. The Erbium laser 2940 nm (LightWalker AT, Fotona; Lublijana, Slovenia) was used with 50microsecond pulse duration, at 15Hz, 20mJ, with a 600micron PIPS tip. Two samples were used as positive and negative control.

The Effect of Four Commonly used Root Canal Irrigants on the Removal of Smear Layer: An In-vitro Scanning Electron Microscope Study.

PubMed

Kumar, Pawan; Prasad, Narayana; Darawade, Ashish; Bhagat, Shresht Kumar; Narayana, Narayana; Darawade, Pradyma

2015-09-01

The objective of this study was to compare the efficiency of four commonly used chemicals in their ability to remove smear layer after instrumentation using scanning electron microscope (SEM). Seventy-five extracted single canaled teeth of roots ranging 10-12 mm in length were used for the study. Teeth were divided into 4 study groups and 1 control group of 15 teeth each. Standard access to the pulp chambers were performed with diamond burs. The lengths of the teeth were determined by the introduction of a size 15 K-file into the root canal until the tip reached the apical foramen. The working length for preparation of the canal is set 0.5 mm shorter than the measurement. Irrigation was performed using 2 ml of irrigant for every instrument change and finally rinsed using 5 ml of the respective solutions. The roots were then split with a chisel and hammer. One-half of each tooth was selected and prepared for SEM examination. After assembly on coded stubs, the specimens were placed in a vacuum chamber and sputter-coated with a 300 Å gold layer. The specimens were then analyzed using a Philips SEM XL 30. The dentinal wall of the cervical, middle and apical thirds was observed at magnifications of up to ×1000 for the presence/absence of smear layer and visualization of the entrance to dentinal tubules. Photomicrographs (×1000) of these areas on each of the coronal, middle and apical thirds were made Data were analyzed using Kruskal-Wallis test and Mann-Whitney U test. SEM study done on these prepared teeth with the popularly used four chemicals, namely, 3% NaOCl (Group A), 3% NaOCl followed by 17% ethylene diamine-tetra-acetic acid (Group B), 0.2% chlorhexidine (Group C) and 3% NaOCl followed by MTAD (Group D), with distilled water (Group E) which is used as control, revealed that NaOCl showed statistically significant, better cleansing effect than distilled water. Chlorhexidine and NaOCl showed equal kind of efficacy but were statistically significant, with lower efficacy than MTAD. It may be concluded that MTAD appears to be the most effective solution compared to the rest. The study demonstrated that MTAD as a final rinse after the entire instrumentation with 3% NaOCl as irrigant provided the best cleansing in all parts of the root canal system. The smear layer has been shown to hinder the penetration of intracanal disinfectants and sealers into dentinal tubules and has the potential of compromising the seal of the root filling. Degradation of the smear layer after treatment may contribute to leakage and reinfection of the root canal space. Removal of the smear layer reduced the penetration of bacteria through the root canal system after root filling.

Investigation of the Efficacy of Passive Ultrasonic Irrigation Versus Irrigation with Reciprocating Activation: An Environmental Scanning Electron Microscopic Study.

PubMed

Kato, Augusto Shoji; Cunha, Rodrigo Sanches; da Silveira Bueno, Carlos Eduardo; Pelegrine, Rina Andrea; Fontana, Carlos Eduardo; de Martin, Alexandre Sigrist

2016-04-01

The objective of this ex vivo study was to compare the efficacy of passive ultrasonic irrigation (PUI) versus a new activation system using reciprocating motion (EasyClean [EC]; Easy Equipamentos Odontológicos, Belo Horizonte, Brazil) to remove debris from the root canal walls at 6 predetermined apical levels using environmental scanning electron microscopy. Mesiobuccal root canals of 10 mandibular molars were prepared with a 30/.05 final instrument. The specimens were embedded in flasks containing heavy body silicone, cleaved longitudinally, and 6 round indentations were made into the apical region of the buccal half at 1-mm intervals. The same specimens were used to prepare a blank control group (no debris), a negative control group (completely covered by debris), and 2 experimental groups: PUI and irrigation with reciprocating activation. Standardized images of the indentations were obtained under environmental scanning electron microscopy and assessed by 2 examiners. The amount of debris was then classified using a 4-category scoring system. The kappa test was applied to determine interexaminer agreement, whereas the Kruskal-Wallis, Dunn, and Friedman tests were used to compare scores. The EC group had results statistically similar to those of the blank control group for all 6 root levels examined. The PUI group had results statistically similar to those of the negative control group for the 3 most apical levels and similar to those of the blank control group for the 3 most cervical levels. Activating the irrigant with a reciprocating system (EC) promoted more effective debris removal from the more apical regions of the root canal when compared with PUI. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

The Effect of Gaseous Ozone in Infected Root Canal

PubMed Central

Ajeti, Nova Nexhmije; Pustina-Krasniqi, Teuta; Apostolska, Sonja

2018-01-01

OBJECTIVES: During the treatment of chronic apical periodontitis and pulp necrosis the main role is to irrigate the root canal. AIM: The aim of this in vivo study was to irrigate with 0.9% NaCl (Natrium Chloride), 2.5 % NaOCl (Sodium Hypochlorite Solution, Sigma Aldrich - Germany) and 2% CHX (Chlorhexidine Digluconate Solution, Sigma Aldrich - Spain) combined with Gaseous Ozone (Prozone WH, Austria). MATERIAL AND METHODS: This study was realised in the University Dentistry Clinical Centre of Kosovo (UDCCK), respectively in the Department of Endodontic and Dental Pathology, Dental Branch, Faculty of Medicine, Prishtina, Kosovo. The 40 subjects involved in this study belonged to both genders, in age between 15 -65 years. The sample selection was randomised. The retroalveolar radiography for each patient was taken in the suspected tooth. As a therapeutic plan the authors decided to disinfect the root canal with the irrigants, as follows: 2.5 % NaOCl, 2 % CHX and gaseous ozone. RESULTS: The statistical analyses were based on Kruskal - Vallis test, X - test, DF = 3, r < 0.01. In the isolated average number of the aerobe and anaerobe bacteria colonies, when gaseous ozone was used, there was the significant statistical difference. CONCLUSIONS: When gaseous ozone was combined with irrigants 0.9%, 2.5 % NaOCl and 2% CHX, it was concluded that the number of colonies of aerobic and anaerobic bacteria was reduced. PMID:29531611

2016 ASE undergraduate essay competition candidate information.

PubMed

Chen, Alice

2018-04-01

The aim of this review is to discuss the role of medicaments and materials used in teeth undergoing root canal treatment and how they affect the overall prognosis of root canal treated teeth. Irrigants, medicaments and materials play a vital role in RCT. They reduce the overall microbial load within the root canal system, help reduce inter-appointment pain, and induce apexification during RCT of permanent teeth with immature apices. In addition, they also help create a hermetic coronal and periradicular seal to entomb any residual microorganisms within the canals and prevent future ingress of contaminants into the root canal system and subsequent reinfection. Whilst the role of various materials in RCT has been thoroughly investigated, the available literature and longitudinal clinical studies evaluating the affect of such materials on the prognosis of RCT is scarce, and requires further investigation. © 2017 Australian Society of Endodontology Inc.

Clinical features and endodontic treatment of two-rooted mandibular canines: report of four cases.

PubMed

Stojanac, Igor; Premović, Milica; Drobac, Milan; Ramić, Bojana; Petrović, Ljubomir

2014-01-01

Predictable endodontic treatment depends on the dentist's knowledge about root canal morphology and its possible anatomic variations. The majority of mandibular canines have one root and root canal, but 15% may have two canals and a smaller number may have two distinct roots. The following clinical reports describe endodontic treatment of mandibular canines with two roots and two root canals. OUTLINE OF CASES Four clinical case reports are presented to exemplify anatomical variation in the human mandibular canine. Detailed analysis of the preoperative radiographs and careful examination of the pulp chamber floor detected the presence of two root canal orifices in all canines. Working length was determined with an electronic apex locator and biomechanical preparation was carried out by using engine driven BioRaCe Ni-Ti rotary instruments in a crown-down manner, followed by copious irrigation with 1% sodium hypochlorite. Definitive obturation was performed using cold lateral condensation with gutta-percha cones and Top Seal paste. The treatment outcome was evaluated using postoperative radiographs. Endodontists should be aware of anatomical variations of the treated teeth, and should never presume that canal systems are simple.

Effect of EDTA preparations on rotary root canal instrumentation.

PubMed

Whitbeck, Evan R; Swenson, Kelli; Tordik, Patricia A; Kondor, Shayne A; Webb, Terry D; Sun, Jirun

2015-01-01

The aim of this study was to evaluate whether rotary instrumentation using saline, EDTA 17% solution, or RC-Prep (Premier Dental, Philadelphia, PA) resulted in differences in root canal transportation. The secondary objective was to assess if instrumentation using these agents caused changes in the working length and canal volume. Moderately curved mesiobuccal roots of 24 maxillary molars were standardized in length and randomized into 1 control and 2 experimental groups. The canals were instrumented with 0.04 taper rotary files to size #30. All groups were irrigated with saline. Group 1 was also irrigated using EDTA 17% solution (Pulpdent Corp, Watertown, MA), and in group 2, RC-Prep was used. X-ray micro-computed tomographic scans and working length measurements were made before and after instrumentation. Three-dimensional models were created from the pre- and postinstrumentation scan data and compared for volume changes. Centroid points were calculated in cross-sectional slices of the canals, and transportation was determined by measuring the distance between the pre- and postinstrumentation points. The data were analyzed with 1-way analysis of variance (α = 0.05) and the Tukey post hoc test. Less transportation was observed in group 2 than in group 1 (P = .001) and the control group (P = .014). Transportation in group 1 and the control group was not significantly different. Canal volume in group 1 was increased relative to group 2 (P = .004) and the control group (P = .022). No significant differences in the working length were observed. The use of chelating agents during root canal instrumentation did not significantly increase apical transportation. Published by Elsevier Inc.

Comparative evaluation of calcium hypochlorite and sodium hypochlorite associated with passive ultrasonic irrigation on antimicrobial activity of a root canal system infected with Enterococcus faecalis: an in vitro study.

PubMed

de Almeida, Ana Paula; Souza, Matheus Albino; Miyagaki, Daniela Cristina; Dal Bello, Yuri; Cecchin, Doglas; Farina, Ana Paula

2014-12-01

The purpose of this study was to compare in vitro the effectiveness of calcium hypochlorite (Ca[OCl]2) and sodium hypochlorite (NaOCl) associated with passive ultrasonic irrigation in root canals of bovine teeth infected with Enterococcus faecalis. The root canals of 60 single-rooted bovine extracted teeth were enlarged up to a file 45, autoclaved, inoculated with Enterococcus faecalis, and incubated for 30 days. The samples were divided into 6 groups (n = 10) according to the protocol for decontamination: G1: no treatment; G2: distilled water; G3: 2.5% NaOCl; G4: 2.5% Ca(OCl)2; G5: 2.5% NaOCl with ultrasonic activation; and G6: 2.5% Ca(OCl)2 with ultrasonic activation (US). Microbiological testing (colony-forming unit [CFU] counting) was performed to evaluate and show, respectively, the effectiveness of the proposed treatments. Data were subjected to 1-way analysis of variance followed by the post hoc Tukey test (α = 0.05). Groups 1 and 2 showed the highest mean contamination (3.26 log10 CFU/mL and 2.69 log10 CFU/mL, respectively), which was statistically different from all other groups (P < .05). Group 6 (Ca[OCl]2 + US) showed the lowest mean contamination (1.00 log10 CFU/mL), with no statistically significant difference found in groups 3 (NaOCl), 4 (Ca[OCl]2), and 5 (NaOCl + US) (P < .05). Ca(OCl)2 as well as passive ultrasonic irrigation can aid in chemomechanical preparation, contributing in a significant way to the reduction of microbial content during root canal treatment. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Evaluation of the influence of time and concentration of sodium hypochlorite on the bond strength of glass fibre post.

PubMed

Knight, Beau; Love, Robert M; George, Roy

2017-10-24

This study evaluated the effect of time and concentrations of sodium hypochlorite on the bond strength of a glass fibre post cemented in a root canal with resin cement. A total of 45 single-rooted extracted human teeth were prepared with Protaper ® universal files, randomly allocated into nine groups and then subjected to 1% or 4% NaOCl for a period of 1 min or 2 min. Fibre posts were then bonded into the root canal, sectioned and the bond strength tested using a push-out test. A longer irrigation time resulted in a significant reduction (P < 0.05) in bond strength, while a final additional irrigation with distilled water significantly reduced bond strength. The concentration of NaOCl did not significantly affect bond strength. Within the limitations of this study, it was observed that regardless of the concentration of NaOCl used, shorter irrigation times favoured better fibre post bonding. © 2017 Australian Society of Endodontology Inc.

Antibacterial effect of chlorhexidine-cetrimide combination, Salvia officinalis plant extract and octenidine in comparison with conventional endodontic irrigants.

PubMed

Guneser, Mehmet Burak; Akbulut, Makbule Bilge; Eldeniz, Ayce Unverdi

2016-01-01

The aim of the present study was to compare the antimicrobial effect of sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), a CHX/cetrimide solution (CHX+CTR), octenidine hydrochloride (OCT) and Salvia officinalis plant extract against Enterococcus faecalis. Seventy decoronated single-rooted human teeth were infected and divided into 6 test (n=10) and 2 control groups (n=5) (negative, sterile samples and positive, infected samples). Following irrigants were then applied to test groups: 2.5% NaOCl, 5.25% NaOCl, CHX, CHX+CTR, S. officinalis extract and OCT. The dentin chips were obtained from inner root canal walls and analyzed by counting the number of colony forming units (CFU). The 2.5% NaOCl, 5.25% NaOCl, CHX and OCT groups presented no bacterial growth (CFU=0). S. officinalis and CHX+CTR groups reduced the number of E. faecalis cells but could not eliminate all. OCT may have potential as an endodontic irrigant in treatment of infected root canals.

Effect of apical size and taper on volume of irrigant delivered at working length with apical negative pressure at different root curvatures.

PubMed

de Gregorio, Cesar; Arias, Ana; Navarrete, Natalia; Del Rio, Veronica; Oltra, Enrique; Cohenca, Nestor

2013-01-01

The purpose of this investigation was to determine the effect that apical preparation size and preparation taper have on the volume of irrigant delivered at the working length for different canal curvatures using apical negative pressure irrigation. One hundred fifty-five human teeth (55 maxillary canines and 100 mandibular molars) were used in this study. Root canals were prepared with rotary instruments to a size 35.04 and separated into 3 experimental groups according to their degree of curvature: group A (n = 50) included canal curvatures ranging from 0° to 10°, group B (n = 50) from 11° to 30°, and group C (n = 50) from 31° to 65°. Samples of each curvature group were further randomized to experimental subgroups according to the apical size and taper as follow: 35.06, 40.04, 40.06, 45.04, and 45.06. The apical third was irrigated using a microcannula and the volume of NaOCl suctioned at the working length under negative pressure was measured over a period of 30 seconds using a fluid recovery trap. Positive controls consisted of measuring the maximum volume of 5.25% NaOCl capable of being suctioned by the microcannula from an open glass vial over 30 seconds. Negative control was the volume of irrigant aspirated by the microcannula with a preparation size of 25.04 over 30 seconds. The volume of irrigant was significantly greater when the apical preparation size increased from 35.06 to 40.04. As the apical preparation taper increased further from 40.04 to 40.06, the volume of irrigant significantly improved in group B, but it was not significant in group A. Apical preparation sizes greater than 40.06 did not show an increase of the volume of irrigant aspirated. The degree of root canal curvature decreased the volume of irrigant at the working length for a given apical size and taper. An apical preparation of 40.06 significantly increased the volume and exchange of irrigant at the working length regardless of curvature. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

A microleakage study of gutta-percha/AH Plus and Resilon/Real self-etch systems after different irrigation protocols.

PubMed

Prado, Maíra; Simão, Renata Antoun; Gomes, Brenda Paula Figueiredo de Almeida

2014-06-01

The development and maintenance of the sealing of the root canal system is the key to the success of root canal treatment. The resin-based adhesive material has the potential to reduce the microleakage of the root canal because of its adhesive properties and penetration into dentinal walls. Moreover, the irrigation protocols may have an influence on the adhesiveness of resin-based sealers to root dentin. The objective of the present study was to evaluate the effect of different irrigant protocols on coronal bacterial microleakage of gutta-percha/AH Plus and Resilon/Real Seal Self-etch systems. One hundred ninety pre-molars were used. The teeth were divided into 18 experimental groups according to the irrigation protocols and filling materials used. The protocols used were: distilled water; sodium hypochlorite (NaOCl)+eDTA; NaOCl+H3PO4; NaOCl+eDTA+chlorhexidine (CHX); NaOCl+H3PO4+CHX; CHX+eDTA; CHX+ H3PO4; CHX+eDTA+CHX and CHX+H3PO4+CHX. Gutta-percha/AH Plus or Resilon/Real Seal Se were used as root-filling materials. The coronal microleakage was evaluated for 90 days against Enterococcus faecalis. Data were statistically analyzed using Kaplan-Meier survival test, Kruskal-Wallis and Mann-Whitney tests. No significant difference was verified in the groups using chlorhexidine or sodium hypochlorite during the chemo-mechanical preparation followed by eDTA or phosphoric acid for smear layer removal. The same results were found for filling materials. However, the statistical analyses revealed that a final flush with 2% chlorhexidine reduced significantly the coronal microleakage. A final flush with 2% chlorhexidine after smear layer removal reduces coronal microleakage of teeth filled with gutta-percha/AH Plus or Resilon/Real Seal SE.

Influence of Laser Activated Irrigation with two Erbium Lasers on Bond Strength of Inidividually Formed Fiber Reinforced Composite Posts to Root Canal Dentin.

PubMed

Parčina, Ivana; Amižić; Miletić, Ivana; Ionescu, Andrei C; Brambilla, Eugenio; Gabrić, Dragana; Baraba, Anja

2016-12-01

The aim of this in vitro study was to investigate the effect of laser activated irrigation (LAI) using two erbium lasers on bond strength of individually formed fiber-reinforced composite (FRC) posts to root canal dentin. Twenty-seven single-rooted human teeth were endodontically treated and after post space preparation divided into three groups (n=9 per group), according to the pre-treatment of post space preparation: 1) Conventional syringe irrigation (CSI) and saline; 2) Er.YAG photon-induced photoacoustic streaming (PIPS) technique and saline; 3) Er,Cr:YSGG activated irrigation with RFT2 tip. Two specimens from each group were used for SEM analysis. The remaining specimens (n=7 per group) received individually formed FRC post, everStick POST, luted with self-adhesive cement, G-CEM LinkAce. After cementation, the roots were perpendicularly sectioned into 1 mm thin sections and a push-out test was carried out (0.5 mm/min). The data were calculated as megapascals and were log transformed and statistically analysed using one-way ANOVA at the level of significance set at 5%. In the control group, the smear layer was still present. In the Er:YAG group, the smear layer was removed. In the Er,Cr:YSGG group, the smear layer was partially removed. The Er,Cr:YSGG group achieved the highest bond strength values, followed by the control group and then the Er:YAG group, but no statistically significant difference was found in bond strength values in the tested group of post space pretreatment (p=0.564). LAI using two erbium lasers, with PIPS or RFT2 tip, did not affect the bond strength of individually formed FRC posts to root canal dentin.

Evaluation of the smear layer removal and erosive capacity of EDTA, boric acid, citric acid and desy clean solutions: an in vitro study.

PubMed

Turk, Tugba; Kaval, Mehmet Emin; Şen, Bilge Hakan

2015-09-03

The purpose of this study was to investigate the smear layer removal and erosive capacity of various irrigation solutions with sequential use of NaOCl on instrumented root canal walls. The root canals of single-rooted teeth were instrumented with ProTaper rotary instrument. Then, the teeth were randomly divided into five experimental groups. The root canals were irrigated with one of the following solutions (5 mL/1 min): 5% EDTA, 5% boric acid (BA), a mixture of BA and CA, 2.5% citric acid (CA) and 5% Desy Clean. After irrigating with 2.5% NaOCl and distilled water, the roots were split into two halves and each half was prepared for SEM examination. Representative photographs were taken from each third at x500 and x1000 magnifications. Double blind scoring was performed by two calibrated observers for smear layer and erosion. The scores were statistically analyzed using Kruskal-Wallis, Dunn's post hoc and Spearman's correlation tests (p = 0.05). There were statistically significant differences among the solutions by means of smear layer and erosion (p < 0.05). While 2.5% CA solution was the most effective solution in removal of smear layer, it was also the most erosive solution (p < 0.05). 5% Desy Clean removed smear layer effectively and caused less erosion. There was a negative, but statistically significant correlation between presence of smear layer and erosion (r = -0.684; p < 0.0001). Desy Clean can be a promising agent as an irrigation solution with optimal smear layer removal capacity and less erosive effects.

A 25% tannic acid solution as a root canal irrigant cleanser: a scanning electron microscope study.

PubMed

Bitter, N C

1989-03-01

A scanning electron microscope was used to evaluate the cleansing properties of a 25% tannic acid solution on the dentinal surface in the pulp chamber of endodontically prepared teeth. This was compared with the amorphous smear layer of the canal with the use of hydrogen peroxide and sodium hypochlorite solution as an irrigant. The tannic acid solution removed the smear layer more effectively than the regular cleansing agent.

Synergistic effect of microbubble emulsion and sonic or ultrasonic agitation on endodontic biofilm in vitro.

PubMed

Halford, Andrew; Ohl, Claus-Dieter; Azarpazhooh, Amir; Basrani, Bettina; Friedman, Shimon; Kishen, Anil

2012-11-01

Irrigation dynamics and antibacterial activity determine the efficacy of root canal disinfection. Sonic or ultrasonic agitation of irrigants is expected to improve irrigation dynamics. This study examined the effects of microbubble emulsion (ME) combined with sonic or ultrasonic agitation on irrigation dynamics and reduction of biofilm bacteria within root canal models. Two experiments were conducted. First, high-speed imaging was used to characterize the bubble dynamics generated in ME by sonic or ultrasonic agitation within canals of polymer tooth models. Second, 5.25% NaOCl irrigation or ME was sonically or ultrasonically agitated in canals of extracted teeth with 7-day-grown Enterococcus faecalis biofilms. Dentinal shavings from canal walls were sampled at 1 mm and 3 mm from the apical terminus, and colony-forming units (CFUs) were enumerated. Mean log CFU/mL values were analyzed with analysis of variance and post hoc tests. High-speed imaging demonstrated strongly oscillating and vaporizing bubbles generated within ME during ultrasonic but not sonic agitation. Compared with CFU counts in controls, NaOCl-sonic and NaOCl-ultrasonic yielded significantly lower counts (P < .05) at both measurement levels. ME-sonic yielded significantly lower counts (P = .002) at 3 mm, whereas ME-ultrasonic yielded highly significantly lower counts (P = .000) at both measurement levels. At 3 mm, ME-ultrasonic yielded significantly lower CFU counts (P = .000) than ME-sonic, NaOCl-sonic, and NaOCl-ultrasonic. Enhanced bubble dynamics and reduced E. faecalis biofilm bacteria beyond the level achieved by sonic or ultrasonic agitation of NaOCl suggested a synergistic effect of ME combined with ultrasonic agitation. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effect of post-space treatment on retention of fiber posts in different root regions using two self-etching systems.

PubMed

Zhang, Ling; Huang, Li; Xiong, Yu; Fang, Ming; Chen, Ji-Hua; Ferrari, Marco

2008-06-01

The effect of post-space treatment on the retention of fiber posts in different root regions was evaluated using two self-etching systems. Post spaces were prepared in extracted premolars and then the root canals were subjected to one of the following post-space treatments: (i) water irrigation (control); (ii) etching with 35% phosphoric acid for 30 s; (iii) irrigation with 17% EDTA followed by 5.25% sodium hypochlorite (NaOCl); and (iv) ultrasonic agitation associated with 17% EDTA and 5.25% NaOCl irrigating solutions. The dentin surfaces were examined under scanning electron microscopy (SEM) after different post-space treatments. Fiber posts were then luted in the treated roots using resin cement with either Clearfil SE Bond or Clearfil DC Bond, and the thin-slice push-out test was performed. Scanning electron microscopy showed that all the post-space treatments tested were effective in removal of the smear layer of debris, or sealer/gutta-percha remnants, on the root canal. The apical push-out strength was affected by post-space treatment. Both 35% phosphoric acid etching and ultrasonic agitation in combination with EDTA/NaOCl irrigation improved the apical push-out strength of the fiber post, regardless of the type of self-etching system. A solo irrigation with an EDTA/NaOCl solution resulted in a lower apical push-out strength compared with the other two experimental groups.

A novel approach to determine the effect of irrigation on temperature and failure of Ni-Ti endodontic rotary files

PubMed Central

Mousavi, Sayed Ali; Kargar-Dehnavi, Vida; Mousavi, Sayed Amir

2012-01-01

Background: Nickel-titanium (Ni-Ti) rotary instrument files are important devices in Endodontics in root canal preparation. Ni-Ti file breakage is a critical and problematic issue and irrigation techniques were applied to decrease risk of file failure root. The aim of the present study was to compare the temperature gradient change of different irrigation solutions with Ni-Ti rotary instrument system during root canal preparation and also to define their effects on the file failure. Materials and Methods: A novel computerized instrumentation was utilized and thirty standard (ProFile #25/.04) files were divided into three groups and subjected to a filing in the root canal test. Changes in temperature on teeth under constant instrumental conditions with custom-designed computerized experimental apparatus were measured by using a temperature sensor bonded to the apical hole. A rotary instrument for canal preparation in three series of solution was used and the changes in temperature after each solution were compared. Finally, the file failure results were mentored according to each step of test. Comparisons were performed between group status clinically by using ANOVA (t) test, once the sample showed up normal and differences of P<0.01 were considered significant. All data collected were computerized and analyzed for frequency, distribution, and statistical description. Results: There was a decrease in the temperature of the instruments, which were immersed in 5% NaOCl, when compared with the water group (P<0.01). There was also a decrease in the temperature of the instruments immersed in water, when compared with the no solution group (P<0.01). Test results showed that sodium hypochlorite, water, or air of root canals does alter the properties of gradual temperature change and contributes to the failure of the instruments. Conclusion: By immersing the file in 5% NaOCl, the temperature gradient decreased and instrument failure was reduced. PMID:23087732

The Effect of File Size and Type and Irrigation Solutions on the Accuracy of Electronic Apex Locators: An In Vitro Study on Canine Teeth.

PubMed

Janeczek, Maciej; Kosior, Piotr; Piesiak-Pańczyszyn, Dagmara; Dudek, Krzysztof; Chrószcz, Aleksander; Czajczyńska-Waszkiewicz, Agnieszka; Kowalczyk-Zając, Małgorzata; Gabren-Syller, Aleksandra; Kirstein, Karol; Skalec, Aleksandra; Bryła, Ewelina; Dobrzyński, Maciej

2016-01-01

Measurements of the root canal during endodontic treatment have a significant influence on the course of the therapeutic process as well as on its final result in both human and veterinary medicine. The apical constriction should be the termination point for the preparation and filling of the root canal. This research was conducted with the use of a Septodont kit consisting of a small chamber filled with the examined solution in which a healthy second incisor was placed. The step back method was applied for the root canal preparation and master apical file of 30 was used. The working length was 22 mm. The examination was conducted with the use of steel as well as nickel titanium hand instruments. Different irrigation solutions and two types of apex locators were used. Measurements of the working length of the root canal showed dependence on the size of the instrument. Examinations carried out in various environments showed that analogical measurements were obtained only for sodium hypochlorite solutions. In other environments the measured sections were shortened. Comparative examinations with the use of steel instruments demonstrated insignificant measurement differences. Compared to these results, the measurements in nickel titanium group were characterized by more considerable deviations.

The Effect of File Size and Type and Irrigation Solutions on the Accuracy of Electronic Apex Locators: An In Vitro Study on Canine Teeth

PubMed Central

Kosior, Piotr; Piesiak-Pańczyszyn, Dagmara; Dudek, Krzysztof; Chrószcz, Aleksander; Czajczyńska-Waszkiewicz, Agnieszka; Kowalczyk-Zając, Małgorzata; Gabren-Syller, Aleksandra; Bryła, Ewelina

2016-01-01

Measurements of the root canal during endodontic treatment have a significant influence on the course of the therapeutic process as well as on its final result in both human and veterinary medicine. The apical constriction should be the termination point for the preparation and filling of the root canal. This research was conducted with the use of a Septodont kit consisting of a small chamber filled with the examined solution in which a healthy second incisor was placed. The step back method was applied for the root canal preparation and master apical file of 30 was used. The working length was 22 mm. The examination was conducted with the use of steel as well as nickel titanium hand instruments. Different irrigation solutions and two types of apex locators were used. Measurements of the working length of the root canal showed dependence on the size of the instrument. Examinations carried out in various environments showed that analogical measurements were obtained only for sodium hypochlorite solutions. In other environments the measured sections were shortened. Comparative examinations with the use of steel instruments demonstrated insignificant measurement differences. Compared to these results, the measurements in nickel titanium group were characterized by more considerable deviations. PMID:27747242

Antimicrobial activity of different disinfection methods against biofilms in root canals.

PubMed

Gergova, Raina T; Gueorgieva, Tzvetelina; Dencheva-Garova, Mariya S; Krasteva-Panova, Assya Z; Kalchinov, Vasil; Mitov, Ivan; Kamenoff, Julia

2016-08-01

The aim of the present study was to evaluate the bactericidal effects of different disinfection methods against microbial biofilms grown in root canals. A total of 300 freshly-extracted human teeth were infected with microbial pathogens. The biofilm formation and the effects of laser therapy, photodynamic therapy (PDT), iontophoresis, and disinfection with irrigating solutions were evaluated by counting the generations of microbial cells in the samples of root canals and by scanning electron microscopy. Enterococcus faecalis and other Gram-positive cocci demonstrated highest sensitivity to the methods of antibacterial action compared here. In most of the cases observed, the antibacterial treatment was less effective against Gram-negative bacteria in dental biofilms. The biofilms that were most difficult to eliminate were those formed by Pseudomonas aeruginosa. Iontophoresis treatment with iodine and chemical disinfection with hypochlorite and chlorhexidine demonstrated the most powerful bactericidal effect. When PDT was applied with Fotosan as a photosensitizer, better disinfection was achieved in comparison to the other lasers alone. The comparison of these different strategies for endodontic treatment showed that hypochlorite, followed by the chlorhexidine irrigant in our experimental conditions, gave the most satisfactory results against the formation of bacterial biofilms in the root canals. © 2015 Wiley Publishing Asia Pty Ltd.

Factors affecting the periapical healing process of endodontically treated teeth.

PubMed

Holland, Roberto; Gomes, João Eduardo; Cintra, Luciano Tavares Angelo; Queiroz, Índia Olinta de Azevedo; Estrela, Carlos

2017-01-01

Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. This review aims to discuss the important therapeutic factors associated with the clinical protocol used during root canal treatment and to highlight the systemic conditions associated with the periapical healing process of endodontically treated teeth. The antibacterial strategies indicated in the conventional treatment of an inflamed and infected pulp and the modulation of the host's immune response may assist in tissue repair, if wound healing has been hindered by infection. Systemic conditions, such as diabetes mellitus and hypertension, can also inhibit wound healing. The success of root canal treatment is affected by the correct choice of clinical protocol. These factors are dependent on the sanitization process (instrumentation, irrigant solution, irrigating strategies, and intracanal dressing), the apical limit of the root canal preparation and obturation, and the quality of the sealer. The challenges affecting the healing process of endodontically treated teeth include control of the inflammation of pulp or infectious processes and simultaneous neutralization of unpredictable provocations to the periapical tissue. Along with these factors, one must understand the local and general clinical conditions (systemic health of the patient) that affect the outcome of root canal treatment prediction.

Factors affecting the periapical healing process of endodontically treated teeth

PubMed Central

Holland, Roberto; Gomes, João Eduardo; Cintra, Luciano Tavares Angelo; Queiroz, Índia Olinta de Azevedo; Estrela, Carlos

2017-01-01

Abstract Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. This review aims to discuss the important therapeutic factors associated with the clinical protocol used during root canal treatment and to highlight the systemic conditions associated with the periapical healing process of endodontically treated teeth. The antibacterial strategies indicated in the conventional treatment of an inflamed and infected pulp and the modulation of the host's immune response may assist in tissue repair, if wound healing has been hindered by infection. Systemic conditions, such as diabetes mellitus and hypertension, can also inhibit wound healing. The success of root canal treatment is affected by the correct choice of clinical protocol. These factors are dependent on the sanitization process (instrumentation, irrigant solution, irrigating strategies, and intracanal dressing), the apical limit of the root canal preparation and obturation, and the quality of the sealer. The challenges affecting the healing process of endodontically treated teeth include control of the inflammation of pulp or infectious processes and simultaneous neutralization of unpredictable provocations to the periapical tissue. Along with these factors, one must understand the local and general clinical conditions (systemic health of the patient) that affect the outcome of root canal treatment prediction. PMID:29069143

Biofilms in Endodontics-Current Status and Future Directions.

PubMed

Neelakantan, Prasanna; Romero, Monica; Vera, Jorge; Daood, Umer; Khan, Asad U; Yan, Aixin; Cheung, Gary Shun Pan

2017-08-11

Microbiota are found in highly organized and complex entities, known as biofilms, the characteristics of which are fundamentally different from microbes in planktonic suspensions. Root canal infections are biofilm mediated. The complexity and variability of the root canal system, together with the multi-species nature of biofilms, make disinfection of this system extremely challenging. Microbial persistence appears to be the most important factor for failure of root canal treatment and this could further have an impact on pain and quality of life. Biofilm removal is accomplished by a chemo-mechanical process, using specific instruments and disinfecting chemicals in the form of irrigants and/or intracanal medicaments. Endodontic research has focused on the characterization of root canal biofilms and the clinical methods to disrupt the biofilms in addition to achieving microbial killing. In this narrative review, we discuss the role of microbial biofilms in endodontics and review the literature on the role of root canal disinfectants and disinfectant-activating methods on biofilm removal.

Biofilms in Endodontics—Current Status and Future Directions

PubMed Central

Neelakantan, Prasanna; Romero, Monica; Vera, Jorge; Daood, Umer; Khan, Asad U.; Yan, Aixin; Cheung, Gary Shun Pan

2017-01-01

Microbiota are found in highly organized and complex entities, known as biofilms, the characteristics of which are fundamentally different from microbes in planktonic suspensions. Root canal infections are biofilm mediated. The complexity and variability of the root canal system, together with the multi-species nature of biofilms, make disinfection of this system extremely challenging. Microbial persistence appears to be the most important factor for failure of root canal treatment and this could further have an impact on pain and quality of life. Biofilm removal is accomplished by a chemo-mechanical process, using specific instruments and disinfecting chemicals in the form of irrigants and/or intracanal medicaments. Endodontic research has focused on the characterization of root canal biofilms and the clinical methods to disrupt the biofilms in addition to achieving microbial killing. In this narrative review, we discuss the role of microbial biofilms in endodontics and review the literature on the role of root canal disinfectants and disinfectant-activating methods on biofilm removal. PMID:28800075

Impact of Various Irrigating Agents on Root Fracture: An in vitro Study.

PubMed

Tiwari, Sukriti; Nikhade, Pradnya; Chandak, Manoj; Sudarshan, C; Shetty, Priyadarshini; Gupta, Naveen K

2016-08-01

Irrigating solutions are used for cleaning and removing dentinal debris, and the other remains from pulpal space during biomechanical preparation. Therefore, we evaluated the impact of various irrigating agents on root fracture at 5-minute time exposure. We sectioned 60 permanent maxillary premolars with fully formed root structures transversely maintaining the root length of approximately 14 mm. Five study groups were made comprising ethylenediaminetetraacetic acid (EDTA), cetrimide, citric acid, and so on as various irrigating agents. A universal force test machine was used to calculate the force which was enough to fracture each root. Analysis of variance (ANOVA) test was used to access the level of significance. About 10% citric acid solution as an irrigating agent showed minimal fracture opposing results, whereas 10% EDTA solution showed the maximum fracture resistance of root portion. Selection of suitable EDTA concentration that has minimal adverse effect on the mechanical properties of the tooth is very important for the successful management of tooth fracture. About 10% EDTA provided the highest fracture resistance, necessitating the use of irrigating solution in root canal therapy (RCT). Further research with higher and different study groups is required to search for more efficient irrigating solution to improve the outcome of RCT.

A comparative evaluation of cleaning efficacy (debris and smear layer removal) of hand and two NiTi rotary instrumentation systems (K3 and ProTaper): a SEM study.

PubMed

Reddy, K Balakoti; Dash, Shreemoy; Kallepalli, Sowmya; Vallikanthan, Sangeetha; Chakrapani, N; Kalepu, Vamsi

2013-11-01

The present study was conducted to compare the cleaning efficacy (debris and smear layer removal) of hand and two NiTi rotary instrumentation systems (K3 and ProTaper). Sixty single rooted human maxillary anterior teeth decoronated at the cementoenamel junction were used. All the specimens were divided into four groups of 15 teeth each, group I--ProTaper rotary instrumentation done, group II--K3 rotary instrumentation done, group III--Stainless steel K-file instrumentation done, group IV--root canal irrigation without instrumentation. Root canal preparation was done in a crown down manner and 3% sodium hypochlorite was used as irrigant after each file followed by final rinse with 5 ml of 17% EDTA solution, then specimens were scanning electron microscopic (SEM) examination. Statistical analysis was done using one-way ANOVA followed by post hoc Tukey's HSD test. Group I showed highly statistical significant difference compared to other groups. There was no statistically significant difference considering smear layer at any levels among the groups with no smear layer formation in group IV. ProTaper rotary instrumentation showed the maximum cleaning efficacy followed by K3 rotary instrumentation in the coronal, middle and apical thirds of the root canal. ProTaper rotary instruments are more efficient than hand and K3 rotary instruments during root canal treatment.

Influence of lasing parameters on the cleaning efficacy of laser-activated irrigation with pulsed erbium lasers.

PubMed

Meire, Maarten A; Havelaerts, Sophie; De Moor, Roeland J

2016-05-01

Laser-activated irrigation (LAI) using erbium lasers is an irrigant agitation technique with great potential for improved cleaning of the root canal system, as shown in many in vitro studies. However, lasing parameters for LAI vary considerably and their influence remains unclear. Therefore, this study sought to investigate the influence of pulse energy, pulse frequency, pulse length, irradiation time and fibre tip shape, position and diameter on the cleaning efficacy of LAI. Transparent resin blocks containing standardized root canals (apical diameter of 0.4 mm, 6% taper, 15 mm long, with a coronal reservoir) were used as the test model. A standardized groove in the apical part of each canal wall was packed with stained dentin debris. The canals were filled with irrigant, which was activated by an erbium: yttrium aluminium garnet (Er:YAG) laser (2940 nm, AT Fidelis, Fotona, Ljubljana, Slovenia). In each experiment, one laser parameter was varied, while the others remained constant. In this way, the influence of pulse energy (10-40 mJ), pulse length (50-1000 μs), frequency (5-30 Hz), irradiation time (5-40 s) and fibre tip shape (flat or conical), position (pulp chamber, canal entrance, next to groove) and diameter (300-600 μm) was determined by treating 20 canals per parameter. The amount of debris remaining in the groove after each LAI procedure was scored and compared among the different treatments. The parameters significantly (P < 0.05, Kruskal-Wallis) affecting debris removal from the groove were fibre tip position, pulse length, pulse energy, irradiation time and frequency. Fibre tip shape and diameter had no significant influence on the cleaning efficacy.

Value added cleaning and disinfection of the root canal: laser-activated irrigation and laser-induced photoporation

NASA Astrophysics Data System (ADS)

De Moor, Roeland J. G.; Meire, Maarten A.

2016-03-01

Among present-day marketed systems ultrasonic activation appears to be the best way to activate and potentiate endodontic irrigants. An alternative for ultrasonic activation of irrigants is laser activated irrigation (LAI) or photoninitiated acoustic streaming. Based on present-day research it appears that LAI (especially with Erbium lasers) can be more efficient for debris removal out of root canals and interaction with the endodontic biofilms thanks to the induction of specific cavitation phenomena and acoustic streaming. Other wavelengths are now explored to be used for LAI. Another way to interact with biofilms is to rely on laser-induced photoporation in combination with gold nanoparticles ( AuNPs). The latter is an alternative physical method for delivering macromolecules in cells. Nanosized membrane pores can be created upon pulsed laser illumination. Depending on the laser energy, pores are created through either direct heating of the AuNPs or by vapour nanobubbles that can emerge around the AuNPs.

Effect of different irrigation on smear layer removal after post space preparation.

PubMed

Gu, Xin-Hua; Mao, Cai-Yun; Kern, Matthias

2009-04-01

The purpose of this study was to evaluate the effect of different irrigating solutions on smear layer removal and dentinal tubule opening on root canal surfaces after post space preparation and to study whether additional ultrasonic irrigation has any effect on smear layer removal. Forty-eight anterior teeth were treated endodontically. After post space preparation, they were assigned to six groups: group 1, EDTA; group 2, EDTA with ultrasonic activation; group 3, sodium hypochlorite (NaOCl); group 4, NaOCl with ultrasonic activation; group 5, sodium chloride (NaCl); and group 6, NaCl with ultrasonic activation. Specimens were examined under a field-emission scanning electron microscope and scored for debris removal and dentinal tubule opening at the coronal, middle, and apical thirds of the root canal. The results showed that EDTA performed significantly better than NaCl and NaOCl in smear layer removal and dentinal tubule opening. Additional ultrasonic irrigation did not improve smear layer removal significantly.

A scanning electron microscopic study to evaluate the efficacy of NaviTip FX in removing the canal debris during root canal preparation: an in vitro study.

PubMed

Chandra, Vinay; Gandi, Padma; Shivanna, Anil Kumar; Srinivas, Siva; Himgiri, S; Nischith, K G

2013-07-01

To evaluate the efficacy of NaviTip FX in removing the canal debris during root canal preparation using scanning electron microscopic study. Thirty single rooted teeth with completely formed apices were used in this study. Standard endodontic access cavity preparations were performed. Then the teeth were randomly divided into two groups: groups 1 and 2 of 15 teeth each group. For group 1, NaviTip FX (brush covered needle) was used to irrigate the canal with 5.25% sodium hypochlorite after each instrument use. For group 2, NaviTip (brushless needle) was used for irrigation following each instrument use. ProTaper rotary files were used for the canal preparation. The teeth were then cleaned and dried before splitting them into two halves. The half with most visible part of the apex was used for scanning electron microscopic evaluation. The results were statistically analyzed using the Mann-Whitney U-test at significance level p < 0.005. The mean values for coronal and middle third of group 1 showed lower debris scores than group 2 and this difference was statistically significant at a p-value 0.01 and 0.05 respectively, but no significance difference between them at the apical third at a p-value of < 0.05. The NaviTip FX (brush covered needle) showed effectively better canal wall debris removal than the NaviTip (brushless needle).

Root canal debridement: an online study guide.

PubMed

2008-05-01

The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. This section will present root canal debridement including subdivisions on canal access, canal debridement, orifice enlargement and preflaring, crown-down technique, balanced force, nickel titanium and other shape memory alloys, rotary engine-driven techniques, endodontic instruments, irrigation, electronic apex locators, sonics/ultrasonics, smear layer, and intracanal medicaments.

Antibacterial Effect of Azadirachta indica (Neem) or Curcuma longa (Turmeric) against Enterococcus faecalis Compared with That of 5% Sodium Hypochlorite or 2% Chlorhexidine in vitro.

PubMed

Joy Sinha, Dakshita; D S Nandha, Kanwar; Jaiswal, Natasha; Vasudeva, Agrima; Prabha Tyagi, Shashi; Pratap Singh, Udai

2017-01-01

The purpose of this study was to compare the antibacterial properties of Azadirachta indica (neem) or Curcuma longa (turmeric) against Enterococcus faecalis with those of 5% sodium hypochlorite or 2% chlorhexidine as root canal irrigants in vitro. The activity of neem, chlorhexidine, sodium hypochlorite, or turmeric against E. faecalis was measured on agar plates using the agar diffusion method. The tube dilution method was used to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the irrigants used. Chlorhexidine or neem exhibited the greatest antibacterial activity when used as endodontic irrigants against E. faecalis, followed by sodium hypochlorite. No statistically significant difference was observed between neem, sodium hypochlorite, or chlorhexidine. The MIC of neem was 1: 128, which was similar to that of chlorhexidine. The MBC for each of these irrigants was 1: 16. Neem yielded antibacterial activity equivalent to 2% chlorhexidine or sodium hypochlorite against E. faecalis, suggesting that it offers a promising alternative to the other root canal irrigants tested.

Antibacterial efficacy of Mangifera indica L. kernel and Ocimum sanctum L. leaves against Enterococcus faecalis dentinal biofilm

PubMed Central

Subbiya, Arunajatesan; Mahalakshmi, Krishnan; Pushpangadan, Sivan; Padmavathy, Kesavaram; Vivekanandan, Paramasivam; Sukumaran, Vridhachalam Ganapathy

2013-01-01

Introduction: The Enterococcus faecalis biofilm in the root canal makes it difficult to be eradicated by the conventional irrigants with no toxicity to the tissues. Hence, plant products with least side effects are explored for their use as irrigants in the root canal therapy. Aim: To evaluate and compare the antibacterial efficacy of Mangifera indica L. kernel (mango kernel) and Ocimum sanctum L. leaves (tulsi) extracts with conventional irrigants (5% sodium hypochlorite (NaOCl) and 2% chlorhexidine) against E. faecalis dentinal biofilm. Materials and Methods: Agar diffusion and broth microdilution assay was performed with the herbal extracts and conventional irrigants (2% chlorhexidine and 5% NaOCl) against E. faecalis planktonic cells. The assay was extended onto 3 week E. faecalis dentinal biofilm. Results: Significant reduction of colony forming units (CFU)/mL was observed for the herbal groups and the antibacterial activity of the herbal groups was at par with 5% NaOCl. Conclusions: The antibacterial activity of these herbal extracts is found to be comparable with that of conventional irrigants both on the biofilm and planktonic counterparts. PMID:24082577

Evaluation of Antimicrobial and Antifungal efficacy of Chitosan as endodontic irrigant against Enterococcus Faecalis and Candida Albicans Biofilm formed on tooth substrate.

PubMed

Yadav, Pankaj; Chaudhary, Sarika; Saxena, Rajendra K; Talwar, Sangeeta; Yadav, Sudha

2017-03-01

Bacterial biofilms formed on the root canal wall are often difficult to remove. This study aimed to evaluate the cytotoxic effect and antibacterial efficacy of chitosan when used as root canal irrigant against E. Faecalis and Candida albicans biofilm formed on tooth substrate. The present study evaluated antibacterial effect of 0.25% Chitosan, 0.5% Chitosan, 2% chlorhexidine and 3% sodium hypochlorite against Enterococcus faecalis and Candida Albicans . Agar-well diffusion methods, minimal inhibitory concentration tests and biofilm susceptibility assays were used to determine antibacterial activity. Teeth specimens were sectioned to obtain a standardized tooth length of 12mm. Specimens were inoculated with 10 mL of the freshly prepared E. Faecalis suspension and Candida albicans for 4 weeks. The specimens were then instrumented with ProTaper rotary files F3 size. After irrigation with test solution, three sterile paper points were placed into one canal, left for 60 s and transferred to a test tube containing 1 mL of reduced transport fluid. The number of CFU in 1 mL was determined. 3-week biofilm qualitative assay showed complete inhibition of bacterial growth with 3% Sodium hypochlorite, 2% Chlorhexidine and Chitosan except saline, which showed presence of bacterial growth. Significant reduction of colony forming units (CFU)/mL was observed for the chitosan groups and the antibacterial activity of the chitosan groups was at par with 3% NaOCl and 2% Chlorhexidine. It was observed that the chitosan showed no cytotoxicity at 3mg/ml and 10% cytotoxicity at 6mg/ml. The use of chitosan as a root canal irrigant might be an alternative considering the various undesirable properties of NaOCl and chlorhexidine. Key words: Biofilm, Candida albicans, Chitosan, Cytotoxicity, Enterococcus faecalis.

Comparison of the antimicrobial efficacy of irrigation using the EndoVac to endodontic needle delivery.

PubMed

Miller, Todd A; Baumgartner, J Craig

2010-03-01

The purpose of this investigation was to compare the antimicrobial efficacy of root canal irrigation with the EndoVac (Discus Dental, Culver City, CA) to endodontic needle irrigation in the apical 5 mm of root canals infected with Enterococcus faecalis. Bilaterally matched, extracted human teeth were sterilized and inoculated with E. faecalis. Specimens in the EndoVac group were irrigated using the EndoVac system, whereas those in the needle group were irrigated with a 30-G side-vented needle. After chemomechanical preparation, the apical 5 mm of the roots were removed, frozen in liquid nitrogen, and pulverized to expose E. faecalis in dentinal tubules or other morphologic irregularities. The number of colony forming units (cfus) of E. faecalis per mg dentin was determined. The EndoVac Group had a mean of 31.6 cfu/mg, whereas the needle group had a mean of 157 cfu/mg. This represents a bacterial reduction of 99.7% in group A and 98.8% in group B when compared with positive controls. Although there were fewer cfu/mg when using the EndoVac, there was not a statistically significant difference between the EndoVac and needle groups. Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

An in vivo comparison of antimicrobial efficacy of sodium hypochlorite and Biopure MTAD™ against enterococcus faecalis in primary teeth: A qPCR study.

PubMed

Tulsani, S G; Chikkanarasaiah, N; Bethur, S

2014-01-01

Biopure MTAD™, a new root canal irrigant has shown promising results against the most common resistant microorganism, E. faecalis, in permanent teeth. However, there is lack of studies comparing its antimicrobial effectiveness with NaOCl in primary teeth. The purpose of this study was to compare the in vivo antimicrobial efficacy of NaOCl 2.5% and Biopure MTAD™ against E. faecalis in primary teeth. Forty non vital single rooted primary maxillary anterior teeth of children aged 4-8 years, were irrigated either with NaOCl 2.5% (n=15), Biopure MTAD™ (n=15) and 0.9% Saline (n=10, control group). Paper point samples were collected at baseline (S1) and after chemomechanical preparation (S2) during the pulpectomy procedure. The presence of E. faecalis in S1 & S2 was evaluated using Real time Polymerase Chain Reaction. Statistical significant difference was found in the antimicrobial efficacy of NaOCl 2.5 % and BioPure MTAD™ when compared to saline (p>0.05). However, no statistical significant difference was found between the efficacies of both the irrigants. NaOCl 2.5% and BioPure MTAD™, both irrigants are equally efficient against E. faecalis in necrotic primary anterior teeth. MTAD is a promising irrigant, however clinical studies are required to establish it as ideal root canal irrigant in clinical practice.

Biofilm removal by 6% sodium hypochlorite activated by different irrigation techniques.

PubMed

Ordinola-Zapata, R; Bramante, C M; Aprecio, R M; Handysides, R; Jaramillo, D E

2014-07-01

To compare the removal of biofilm utilizing four irrigation techniques on a bovine root canal model. Fifty dentine specimens (2 × 2 mm) were infected with biofilm. The samples were then adapted to previously created cavities in the bovine model. The root canals were irrigated twice with 2 mL of 6% sodium hypochlorite for 2 min (4 min total). Following initial irrigation, the different treatment modalities were introduced for 60 s (3 × 20 s intervals). The evaluated techniques were needle irrigation, Endoactivator (Dentsply Tulsa Dental, Tulsa, OK, USA), passive ultrasonic irrigation and laser-activated irrigation (photon-induced photoacoustic streaming). The controls were irrigated with distilled water and conventional needle irrigation. Subsequently, the dentine samples were separated from the model and analysed using a scanning electron microscope (SEM). Fifteen operative fields were scanned per block, and SEM pictures were captured. Two calibrated evaluators examined the images and collected data using a four-degree scale. Nonparametric tests were used to evaluate for statistical significance amongst the groups. The group undergoing laser-activated irrigation using photon-induced photoacoustic streaming exhibited the most favourable results in the removal of biofilm. Passive ultrasonic irrigation scores were significantly lower than both the Endoactivator and needle irrigation scores. Sonic and needle irrigation were not significantly different. The least favourable results were found in the control group. Laser activation of 6% sodium hypochlorite significantly improved the cleaning of biofilm-infected dentine followed by passive ultrasonic irrigation. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Endodontic 'solutions' part 1: a literature review on the use of endodontic lubricants, irrigants and medicaments.

PubMed

Good, Melissa; El, Karim Ikhlas A; Hussey, David L

2012-05-01

Endodontic lubricants, irrigants and medicaments help prepare and disinfect root canal systems (RCS) but primary and secondary cases involve different microbes and therefore it is unlikely that one protocol will be effective for both case types. Each individual 'solution' or sequence of'solutions' could play a significant role in each case type, but there are no detailed published guidelines in existence. To help inform clinical practice it was decided to undertake a literature review followed by a UK and Republic of Ireland wide audit on current endodontic'solution' usage within dental schools. The literature review was undertaken under the following headings: pre-op oral rinse; file lubricants; root canal irrigants and intracanal medicaments and provides an evidence base for protocol development for both primary and retreatment cases.The audit project and the protocols developed from the findings of both the literature review and audit will be presented in Part 2.

Spectrophotometric determination of irrigant extrusion using passive ultrasonic irrigation, EndoActivator, or syringe irrigation.

PubMed

Rodríguez-Figueroa, Carolina; McClanahan, Scott B; Bowles, Walter R

2014-10-01

Sodium hypochlorite (NaOCl) irrigation is critical to endodontic success, and several new methods have been developed to improve irrigation efficacy (eg, passive ultrasonic irrigation [PUI] and EndoActivator [EA]). Using a novel spectrophotometric method, this study evaluated NaOCl irrigant extrusion during canal irrigation. One hundred fourteen single-rooted extracted teeth were decoronated to leave 15 mm of the root length for each tooth. Cleaning and shaping of the teeth were completed using standardized hand and rotary instrumentation to an apical file size #40/0.04 taper. Roots were sealed (not apex), and 54 straight roots (n = 18/group) and 60 curved roots (>20° curvature, n = 20/group) were included. Teeth were irrigated with 5.25% NaOCl by 1 of 3 methods: passive irrigation with needle, PUI, or EA irrigation. Extrusion of NaOCl was evaluated using a pH indicator and a spectrophotometer. Standard curves were prepared with known amounts of irrigant to quantify amounts in unknown samples. Irrigant extrusion was minimal with all methods, with most teeth showing no NaOCl extrusion in straight or curved roots. Minor NaOCl extrusion (1-3 μL) in straight roots or curved roots occurred in 10%-11% of teeth in all 3 irrigant methods. Two teeth in both the syringe irrigation and the EA group extruded 3-10 μL of NaOCl. The spectrophotometric method used in this study proved to be very sensitive while providing quantification of the irrigant levels extruded. Using the PUI or EA tip to within 1 mm of the working length appears to be fairly safe, but apical anatomy can vary in teeth to allow extrusion of irrigant. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Disinfecting Effects of Rotary Instrumentation with Either 2.5% Sodium Hypochlorite or 2% Chlorhexidine as the Main Irrigant: A Randomized Clinical Study.

PubMed

Rôças, Isabela N; Provenzano, José Claudio; Neves, Mônica A S; Siqueira, José F

2016-06-01

This randomized clinical study compared the antibacterial effects of irrigation with either 2.5% sodium hypochlorite (NaOCl) or 2% chlorhexidine (CHX) during the preparation of infected root canals with rotary nickel-titanium instruments. The root canals of 50 single-rooted teeth with apical periodontitis were prepared by using BioRaCe rotary instruments (FKG Dentaire, La Chaux-de-Fonds, Switzerland) and irrigation with either 2.5% NaOCl (n = 25) or 2% CHX (n = 25). Samples were taken from the canal at baseline (S1) and after (S2) chemomechanical preparation. DNA was extracted from the clinical samples, and the reduction of the levels of total bacteria and streptococci was evaluated by means of a 16S ribosomal RNA gene-based quantitative polymerase chain reaction assay. All S1 samples were positive for the presence of bacteria. After chemomechanical preparation using either 2.5% NaOCl or 2% CHX, 44% and 40% of the root canals still had detectable bacteria, respectively. As for total bacterial counts, a mean number of 3.7 × 10(5) bacterial cell equivalents was present in S1 samples from the NaOCl group, with a substantial reduction in S2 to a mean of 5.49 × 10(2) cell equivalents (P < .001). In the CHX group, a mean bacterial load of 8.77 × 10(4) cell equivalents occurred in S1, with a significant reduction in S2 to a mean of 2.81 × 10(3) cells (P < .001). The differences in both the presence/absence and quantitative data were not statistically significant (P > .05). Both irrigation protocols were highly effective in reducing the levels of Streptococcus species (P < .001). No significant difference was observed for the clinical antibacterial effectiveness of rotary preparation using either 2.5% NaOCl or 2% CHX as the main irrigant. Copyright © 2016. Published by Elsevier Inc.

Influence of the Apical Preparation Size and the Irrigant Type on Bacterial Reduction in Root Canal-treated Teeth with Apical Periodontitis.

PubMed

Rodrigues, Renata Costa Val; Zandi, Homan; Kristoffersen, Anne Karin; Enersen, Morten; Mdala, Ibrahimu; Ørstavik, Dag; Rôças, Isabela N; Siqueira, José F

2017-07-01

This clinical study evaluated the influence of the apical preparation size using nickel-titanium rotary instrumentation and the effect of a disinfectant on bacterial reduction in root canal-treated teeth with apical periodontitis. Forty-three teeth with posttreatment apical periodontitis were selected for retreatment. Teeth were randomly divided into 2 groups according to the irrigant used (2.5% sodium hypochlorite [NaOCl], n = 22; saline, n = 21). Canals were prepared with the Twisted File Adaptive (TFA) system (SybronEndo, Orange, CA). Bacteriological samples were taken before preparation (S1), after using the first instrument (S2), and then after the third instrument of the TFA system (S3). In the saline group, an additional sample was taken after final irrigation with 1% NaOCl (S4). DNA was extracted from the clinical samples and subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria and streptococci. S1 from all teeth were positive for bacteria. Preparation to the first and third instruments from the TFA system showed a highly significant intracanal bacterial reduction regardless of the irrigant (P < .01). Apical enlargement to the third instrument caused a significantly higher decrease in bacterial counts than the first instrument (P < .01). Intergroup comparison revealed no significant difference between NaOCl and saline after the first instrument (P > .05). NaOCl was significantly better than saline after using the largest instrument in the series (P < .01). Irrespective of the type of irrigant, an increase in the apical preparation size significantly enhanced root canal disinfection. The disinfecting benefit of NaOCl over saline was significant at large apical preparation sizes. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

[Endodontic microbiology: antimicrobial canal medications].

PubMed

Seltzer, S; Farber, P A

1989-06-01

Medicaments used for reducing or eliminating microorganisms from infected root canals include: irrigating solutions, such as sodium hypochlorite, urea peroxide and hydrogen peroxide, chloramine, iodine-potassium-iodide solution, and chlorhexidine solution. In addition, various intracanal drugs, such as calcium hydroxide and antibiotics, are in use. The characteristics of these drugs are discussed.

An analytical Micro CT methodology for quantifying inorganic dentine debris following internal tooth preparation.

PubMed

Robinson, Jonathan P; Lumley, Philip J; Claridge, Ela; Cooper, Paul R; Grover, Liam M; Williams, Richard L; Walmsley, A Damien

2012-11-01

MicroCT allows the complex canal network of teeth to be mapped but does not readily distinguish between structural tissue (dentine) and the debris generated during cleaning. The aim was to introduce a validated approach for identifying debris following routine instrumentation and disinfection. The mesial canals of 12 mandibular molars were instrumented, and irrigated with EDTA and NaOCl. MicroCT images before and after instrumentation and images were assessed qualitatively and quantitatively. Debris in the canal space was identified through morphological image analysis and superimposition of the images before and after instrumentation. This revealed that the removal of debris is prohibited by protrusions and micro-canals within the tooth creating areas which are inaccessible to the irrigant. Although the results arising from the analytical methodology did provide measurements of debris produced, biological differences in the canals resulted in variances. Both irrigants reduced debris compared to the control which decreased with EDTA and further with NaOCl. However, anatomical variation did not allow definitive conclusions on which irrigant was best to use although both reduced debris build up. This work presents a new approach for distinguishing between debris and structural inorganic tissue in root canals of teeth. The application may prove useful in other calcified tissue shape determination. Remaining debris may contain bacteria and obstruct the flow of irrigating solutions into lateral canal anatomy. This new approach for detecting the amount of remaining debris in canal systems following instrumentation provides a clearer methodology of the identification of such debris. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effect of a surfactant on the antimicrobial activity of sodium hypochlorite solutions.

PubMed

Bolfoni, Marcos Rodolfo; Ferla, Marcelo dos Santos; Sposito, Otávio da Silva; Giardino, Luciano; Jacinto, Rogério de Castilho; Pappen, Fernanda Geraldes

2014-01-01

The objective of the present study was to evaluate the antimicrobial activity of sodium hypochlorite (NaOCl) associated with a surfactant. Seventy single-rooted extracted human teeth were inoculated with Enterococcus faecalis, and incubated for 21 days (37 °C). The groups were distributed according to the irrigation solution used during root canal preparation: 5%, 2.5% and 1% NaOCl; 5%, 2.5% and 1% Hypoclean®, a solution containing a surfactant (cetrimide) associated with NaOCl. Three microbiological samples were collected from each tooth: S1 - before instrumentation; S2 - immediately after instrumentation; and S3 - after a seven-day period. Data were submitted to ANOVA and Tukey test with 5% significance level. The results showed that immediately after root canal preparation (S2), E. faecalis was eliminated in all the experimental groups. However, after 7 days (S3), only the groups in which Hypoclean was used, remained contamination-free, including Hypoclean associated with 1% NaOCl, while the root canals irrigated with 1% NaOCl only, presented the highest percentage of bacterial growth. In conclusion, the addition of surfactant increased the antimicrobial activity of 1% NaOCl to levels similar to 5% NaOCl.

Evaluation of Apical Vapor Lock Formation and comparative Evaluation of its Elimination using Three different Techniques: An in vitro Study.

PubMed

Agarwal, Anand; Deore, Rahul B; Rudagi, Kavitarani; Nanda, Zinnie; Baig, Mirza Osman; Fareez, Md Adil

2017-09-01

The aim of this study was (i) to evaluate the formation of air bubbles in the apical region of root canal (apical vapor lock) during syringe irrigation, using cone beam computed tomography (CBCT) and (ii) comparative evaluation of the elimination of an established vapor lock by EndoActivator, ultrasonics, and manual dynamic agitation (MDA), using CBCT. A total of 60 extracted human single-rooted teeth were equally divided into three groups of 20 teeth each. The samples were decoronated 17 mm from the apex, cleaned, and shaped to size F4 Protaper using 3% sodium hypochlorite. Samples were irrigated with 3% sodium hypochlorite + cesium chloride radiopaque dye, and preoperative CBCT images were obtained. After formation of apical vapor lock in the scanned teeth, EndoActivator (group I), passive ultrasonic irrigation (group II), and MDA with K-file (group III) were performed and the teeth were again placed in CBCT scanner and results analyzed using the chi-square test. The apical vapor lock was formed in all the samples. Out of the 20 teeth in each group, the apical vapor lock was eliminated in 18 samples of EndoActivator group (90%), 16 samples of ultrasonic group (80%), while it was eliminated in 10 samples by MDA (50%). It is concluded that (1) apical vapor lock is consistently formed during endodontic irrigation in closed canal systems and (2) sonic activation performs better than the ultrasonics and MDA in eliminating the apical vapor lock, with statistically significant difference between all the three groups (p < 0.05). The results suggest that the apical vapor lock (dead water zone) is consistently formed during routine endodontic irrigation which impedes irrigant penetration till the working length, thereby leading to inefficient debridement. Hence, to eliminate this vapor lock, techniques, such as sonics or ultrasonics should be used along with the irrigant after shaping and cleaning of the root canal.

Effect of EDTA, sodium hypochlorite, and chlorhexidine gluconate with or without surface modifiers on dentin microhardness.

PubMed

Aslantas, Eda E; Buzoglu, Hatice Dogan; Altundasar, Emre; Serper, Ahmet

2014-06-01

This study aimed to evaluate the effects of root canal irrigants on the microhardness of root canal dentin in the presence and absence of surface-modifying agents. Forty-eight root halves were prepared by longitudinal splitting of the distal roots of 24 freshly extracted mandibular human third molars and embedded in autopolymerizing acrylic resin, leaving the dentin surface exposed. After polishing, the microhardness values of the untreated dentin surfaces were recorded by using Vickers tester at the mid-root level. The root halves were randomly assigned to 6 groups composed of 8 samples each and treated for 5 minutes with one of the following irrigants: 17% EDTA, REDTA, 2% chlorhexidine gluconate (CHX), 2% CHX with surface modifiers (CHX-Plus), 6% NaOCl, or 6% NaOCl with surface modifiers (Chlor-XTRA). After surface treatment, dentin microhardness values were recorded at close proximity to the initial indentation areas. Experimental data were statistically analyzed by using the t test and one-way analysis of variance, followed by Tukey honestly significant difference test at α = 0.05. EDTA, REDTA, NaOCl, and Chlor-XTRA significantly decreased the microhardness of root dentin compared with intact controls (P < .05). The addition of surface modifiers to the irrigants did not affect the microhardness of the samples. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Antibacterial and residual antimicrobial activities against Enterococcus faecalis biofilm: A comparison between EDTA, chlorhexidine, cetrimide, MTAD and QMix.

PubMed

Zhang, Rui; Chen, Min; Lu, Yan; Guo, Xiangjun; Qiao, Feng; Wu, Ligeng

2015-08-06

We compared the antibacterial and residual antimicrobial activities of five root canal irrigants (17% EDTA,2% chlorhexidine,0.2% cetrimide, MTAD, and QMix) in a model of Enterococcus faecalis biofilm formation. Sixty dentin blocks with 3-week E. faecalis biofilm were divided into six equal groups and flushed with irrigant for 2 min or left untreated. A blank control group was also established. Antibacterial activities of the irrigants were evaluated by counting colony forming units. To test residual antimicrobial activities, 280 dentin blocks were divided into seven equal groups and flushed with irrigant for 2 min or left untreated and then incubated with E. faecalis suspension for 48 h, or used as a blank. No bacteria were observed in the blank control group. The number of viable E. faecalis was significantly fewer in the irrigant-treated groups compared with the untreated control (P < 0.05). Among the five irrigants, QMix had the strongest antibacterial activity. Residual antimicrobial activities of CHX were significantly higher at 12 h, 24 h and 36 h compared to untreated control (P < 0.05). All five root canal irrigants were effective to some extent against E. faecalis, but QMix and CHX had the strongest, and CHX the longest (up to 36 h), antimicrobial activity.

Vitality of Enterococcus faecalis inside dentinal tubules after five root canal disinfection methods

PubMed Central

Vatkar, Niranjan Ashok; Hegde, Vivek; Sathe, Sucheta

2016-01-01

Aim: To compare the vitality of Enterococcus faecalis within dentinal tubules after subjected to five root canal disinfection methods. Materials and Methods: Dentin blocks (n = 60) were colonized with E. faecalis. After 4 weeks of incubation, the dentin blocks were divided into one control and five test groups (n = 10 each). The root canals of test groups were subjected to one of the disinfection methods, namely, normal saline (NS), sodium hypochlorite (NaOCl), chlorhexidine digluconate (CHX), neodymium-doped yttrium aluminum garnet (Nd: YAG) laser, and diode laser. The effect of disinfection methods was assessed by LIVE/DEAD BacLight stain under the confocal laser scanning microscopy to determine the “zone of dead bacteria” (ZDB). Mean values were calculated for ZDB and the difference between groups was established. Results: Penetration of E. faecalis was seen to a depth of >1000 μm. Viable bacteria were detected with NS irrigation. NaOCl and CHX showed partial ZDB. When the root canals were disinfected with Nd: YAG and diode lasers, no viable bacteria were found. Conclusion: E. faecalis has the ability to colonize inside dentinal tubules to a depth of >1000 μm. In contrast to conventional irrigants, both Nd: YAG and diode lasers were effective in eliminating the vitality of E. faecalis. NS, NaOCl, and CHX showed viable bacteria remaining in dentinal tubules. PMID:27656064

The effect of ultrasonic post instrumentation on root surface temperature.

PubMed

Huttula, Andrew S; Tordik, Patricia A; Imamura, Glen; Eichmiller, Frederick C; McClanahan, Scott B

2006-11-01

This study measured root surface temperature changes when ultrasonic vibration, with and without irrigation, was applied to cemented endodontic posts. Twenty-six, extracted, single-rooted premolars were randomly divided into two groups. Root lengths were standardized, canals instrumented, obturated, and posts cemented into prepared spaces. Thermocouples were positioned at two locations on the proximal root surfaces. Samples were embedded in plaster and brought to 37 degrees C in a water bath. Posts were ultrasonically vibrated for 4 minutes while continuously measuring temperature. Two-way ANOVA compared effects of water coolant and thermocouple location on temperature change. Root surface temperatures were significantly higher (p < 0.001) when posts were instrumented dry. A trend for higher temperatures was observed at coronal thermocouples of nonirrigated teeth and at apical thermocouples of irrigated teeth (p = 0.057). Irrigation during post removal with ultrasonics had a significant impact on the temperature measured at the external root surface.

A comparison of residual smear layer and erosion following different endodontic irrigation protocols tested under clinical and laboratory conditions.

PubMed

Cehreli, Zafer C; Uyanik, M Ozgur; Nagas, Emre; Tuncel, Behram; Er, Nuray; Comert, Fugen Dagli

2013-09-01

To compare the smear layer removal efficacy and erosive effects of different irrigation protocols under clinical and laboratory conditions. Mandibular third molars (n = 32) of 30-45 year-old patients were instrumented with rotary files and were randomly assigned to one of the following groups for final irrigation: (1) 5.25% NaOCl; (2) 17% EDTA; and (3) BioPure MTAD. Thereafter, the teeth were immediately extracted and processed for micromorphological investigation. In vitro specimen pairs were prepared by repeating the clinical experiments on freshly-extracted mandibular third molars. To compare open and closed systems, laboratory experiments were repeated on 32 additional teeth with enlarged apical foramen. The cleanliness of the root canals and the extent of erosion were assessed by environmental scanning electron microscopy. Specimens prepared under clinical and laboratory conditions had similar cleanliness and erosion scores (p > 0.05). Under both conditions, the tested solutions were more effective in removing the smear layer in the coronal and middle regions than in the apical one. Comparison of closed and open systems showed similar levels of cleanliness and erosion in all regions (p > 0.05), with the exception of 17% EDTA showing significantly higher levels of cleanliness and erosion in the apical third of open-end specimens. Based on clinical correlates of in vitro root canal cleanliness and erosion, laboratory testing of root canal irrigants on extracted teeth with closed apices can serve as a reliable method to simulate the clinical condition. EDTA was the most effective final irrigation solution in removing the smear layer at the expense of yielding the greatest erosive effect.

Efficacy of sonic and ultrasonic activation for removal of calcium hydroxide from mesial canals of mandibular molars: a microtomographic study.

PubMed

Wiseman, Anne; Cox, Timothy C; Paranjpe, Avina; Flake, Natasha M; Cohenca, Nestor; Johnson, James D

2011-02-01

The purpose of this study was to use micro-computed tomography (micro-CT) scanning to evaluate the efficacy of sonic and passive ultrasonic irrigation (PUI) on calcium hydroxide (Ca[OH](2)) removal and to measure the volume and percentage of Ca(OH)(2) remaining in the root canal system. The root canals of 46 extracted human mandibular molar teeth were prepared with rotary instruments and randomly assigned to two experimental groups (n = 40) as well as positive and negative controls (n = 6). In each experimental group, 20 teeth were assigned to each irrigation protocol, sonic or passive ultrasonic irrigation. All experimental teeth and the positive controls were filled with Ca(OH)(2), whereas the negative control teeth did not receive Ca(OH)(2). All teeth were scanned using micro-CT scanning to determine the dressing volume. After 7 days, the Ca(OH)(2) was removed in the experimental groups using rotary instrumentation only, and the teeth were again scanned using micro-CT scanning to calculate volume and percentage of Ca(OH)(2) removed. Positive control teeth were not subjected to rotary instrumentation. Experimental samples were then irrigated using either sonic or passive ultrasonic and the volume of remaining Ca(OH)(2) was calculated using micro-CT. Remnants of Ca(OH)(2) were found in all experimental groups. No Ca(OH)(2) was found in the negative controls, whereas a mean of 8.7 mm(3) of Ca(OH)(2) was recorded in the positive controls. Rotary plus passive ultrasonic irrigation removed significantly more Ca(OH)(2) (85.7%) than rotary plus sonic irrigation (71.5%) (p < 0.001). The combination of rotary instrumentation and passive ultrasonic activation for 3 periods of 20 seconds results in significantly lower amounts of Ca(OH)(2) remnants in the canal compared with sonic irrigation. Copyright © 2011. Published by Elsevier Inc.

Microbiological assessment of root canals following use of rotary and manual instruments in primary molars.

PubMed

Subramaniam, Priya; Tabrez, T A; Babu, K L Girish

2013-01-01

To assess the microflora of root canals in primary molars following use of rotary NiTi files and conventional hand NiTi and stainless steel files. This randomized clinical trial consisted of a total of 60 first and second primary molars requiring root canal treatment, who were selected from children aged 5-9 years. Based on type of root canal instrumentation, the teeth were randomly assigned to three groups of twenty teeth each; Group A: Rotary NiTi files, Group B: Hand NiTi files and Group C: Hand stainless steel files. Following administration of local anesthesia, isolation with rubber dam was carried out. For the purpose of instrumentation and sampling, the palatal canal of maxillary molars and the distal canal of mandibular molars were selected. Prior to sampling, the orifices of other canals in these teeth were sealed, so as to prevent any contamination. Instrumentation was carried out in each group using respective instruments along with intermittent saline irrigation. Root canal samples were obtained both before and after instrumentation, using sterile absorbent paper points and transferred to a sterile vial with transport fluid. Serial dilutions were prepared and cultured on suitable agar media. Both aerobic and anaerobic microbial counts were made. Data obtained was subjected to statistical analysis using Wilcoxon signed rank test and one-way Analysis of variance. In all three groups, there was a significant reduction in both aerobic and anaerobic mean microbial count following root canal instrumentation. (p < 0.001). Rotary NiTi files were as efficient as conventional hand instruments in significantly reducing the root canal microflora.

Effectiveness of Three Different Irrigants - 17% Ethylenediaminetetraacetic Acid, Q-MIX, and Phytic Acid in Smear Layer Removal: A Comparative Scanning Electron Microscope Study.

PubMed

Jagzap, Janhavi Balasaheb; Patil, Sanjay S; Gade, Vandana Jaykumar; Chandhok, Deepika J; Upagade, Madhura A; Thakur, Deepa A

2017-01-01

Removal of smear layer from the root canal walls is important for long-standing endodontic success. The aim of this study is to evaluate and compare smear layer removing ability among 17% ethylenediaminetetraacetic acid (EDTA), Q-MIX, and phytic acid by scanning electron microscopy (SEM). This in-vitro experimental study assessed smear layer removal using three different irrigants. Thirty single-rooted freshly extracted human permanent premolars were collected, disinfected, and decoronated to a standardized root length of 13 mm. Root canals were cleaned and shaped till F2 universal rotary protaper at working length 1 mm short of the apex. They were randomly divided into three groups, and final irrigation was done accordingly. Group 1 ( n = 10): with 1 ml of 17% EDTA, Group 2 ( n = 10): with 1 ml of Q-MIX, Group 3 ( n = 10): with 1 ml of phytic acid. Samples were then longitudinally sectioned and evaluated under SEM at coronal, middle, and apical levels. Two-way analysis of variance and Tukey's post hoc test were performed. The level of significance was set at 0.05. Smear layer removing ability among irrigants and sections in descending order: 17 EDTA > Q-MIX > phytic acid; coronal > middle > apical. 17% EDTA showed better and promising results followed by Q-MIX and then phytic acid.

Irrigant flow during photon-induced photoacoustic streaming (PIPS) using Particle Image Velocimetry (PIV).

PubMed

Koch, Jon D; Jaramillo, David E; DiVito, Enrico; Peters, Ove A

2016-03-01

This study aimed to compare fluid movements generated from photon-induced photoacoustic streaming (PIPS) and passive ultrasonic irrigation (PUI). Particle Image Velocimetry (PIV) was performed using 6-μm melamine spheres in water. Measurement areas were 3-mm-long sections of the canal in the coronal, midroot and apical regions for PIPS (erbium/yttrium-aluminium garnet (Er:YAG) laser set at 15 Hz with 20 mJ), or passive ultrasonic irrigation (PUI, non-cutting insert at 30% unit power) was performed in simulated root canals prepared to an apical size #30/0.04 taper. Fluid movement was analysed directly subjacent to the apical ends of ultrasonic insert or fiber optic tips as well as at midroot and apically. During PUI, measured average velocities were around 0.03 m/s in the immediate vicinity of the sides and tip of the ultrasonic file. Speeds decayed to non-measureable values at a distance of about 2 mm from the sides and tip. During PIPS, typical average speeds were about ten times higher than those measured for PUI, and they were measured throughout the length of the canal, at distances up to 20 mm away. PIPS caused higher average fluid speeds when compared to PUI, both close and distant from the instrument. The findings of this study could be relevant to the debriding and disinfecting stage of endodontic therapy. Irrigation enhancement beyond needle irrigation is relevant to more effectively eradicate microorganisms from root canal systems. PIPS may be an alternative approach due to its ability to create high streaming velocities further away from the activation source compared to ultrasonic activation.

The power of the bubble: comparing ultrasonic and laser activated irrigation

NASA Astrophysics Data System (ADS)

De Moor, Roeland J. G.; Meire, Maarten A.; Verdaasdonk, Rudolf M.

2014-01-01

The major problem of irrigation is the fluid motion within the confined geometry of the root canal : efficient dispersion of the liquid is difficult, conventional irrigation is limited due to the absence of turbulence over much of the canal volume, vapour lock may limit apical cleaning and disinfection, there is also a stagnation plane beyond the needle tip. The best way to improve irrigant penetration and biofilm removal is achieved by means of the agitation of the fluid. Today ultrasonic activation appears to be the best way to activate and potentiate irrigants among the present-day used means and marketed systems. Another way to activate irrigation solutions is the use of lasers: laser activated irrigation or photon-initiated acoustic streaming have been investigated. Based on present-day research it appears that the efficacy of laser activation (especially with Erbium lasers) can be more efficient thanks to the induction of specific cavitation phenomena and acoustic streaming. Other wavelengths are now explored to be used for laser activated irrigation.

Novel use of platelet-rich fibrin matrix and MTA as an apical barrier in the management of a failed revascularization case.

PubMed

Yadav, Pankaj; Pruthi, Preeti Jain; Naval, Ruchika Roongta; Talwar, Sangeeta; Verma, Mahesh

2015-08-01

We report management of a failed revascularization/revitalization case, which could be due to inadequate removal of biofilm and bacteria in dentinal tubules. The use of an apical matrix barrier in form of a platelet-rich fibrin (PRF) membrane for stabilization of MTA in root end apexification procedure is described. The canal was cleansed of old MTA present in the cervical third using H files, irrigated using saline and finally irrigated with 2.5% NaOCl and saline. To obtain canal disinfection, calcium hydroxide paste was temporized in the canal. In subsequent appointments, PRF was placed at the root tip followed by 5-mm apical plug with mineral trioxide aggregate. One week later, the root canal was obturated with thermoplasticized gutta-percha. A 6-month and a 2-year follow ups showed reduction of periapical radiolucency and adequately functional tooth. One-visit apexification techniques provide an alternative treatment for failed revascularization cases. Follow up confirmed complete healing periradicularly. Apexification in one step using an apical barrier of PRF and a plug of MTA can be considered a predictable treatment and may be an alternative to long-term revascularization failures. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The effect of peracetic acid on removing calcium hydroxide from the root canals.

PubMed

Sağsen, Burak; Ustün, Yakup; Aslan, Tuğrul; Canakçi, Burhan Can

2012-09-01

The goal of this study was to evaluate the efficiencies of different irrigation solutions in the removal of calcium hydroxide (CH). Forty-eight maxillary central incisor teeth were used. Root canals were prepared with the ProTaper system (Dentsply Maillefer, Baillagues, Switzerland). Five milliliters 2% NaOCl, 5 mL 17% EDTA, and 10 mL saline were used for final irrigation. The canals were filled with CH paste. Specimens were randomly divided into 4 experimental groups (n = 10) according to irrigation protocols. Positive and negative control groups (n = 4) were used. Group 1 used 2.5 mL 17% EDTA, group 2 used 2.5 mL 2.5% NaOCl + 2.5 mL 17% EDTA, group 3 used 2.5 mL 1% peracetic acid (PAA), and group 4 used 2.5 mL 0.5% PAA. The specimens were evaluated with scanning electron microscope analysis and scored. Kruskal-Wallis and Student Newman-Keuls post hoc tests were used for statistical analysis. In the apical thirds, 1% PAA was superior to the other groups (P < .05); however, there were no significant differences among the other groups (P > .05). In the middle thirds, no significant differences were found among the groups (P > .05). In the coronal thirds, 1% PAA was superior to the other groups. There were significant differences among all the other groups (P < .05). According to the findings of the present study, 1% PAA could be recommended for the removal of CH from the root canals. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

Evaluation of final irrigation regimens with maleic acid for smear layer removal and wettability of root canal sealer.

PubMed

Ballal, Nidambur Vasudev; Ferrer-Luque, Carmen Maria; Sona, Mrunali; Prabhu, K Narayan; Arias-Moliz, Teresa; Baca, Pilar

2018-04-01

To evaluate the smear layer removal and wettability of AH Plus sealer on root canal dentin treated with MA (maleic acid), MA + CTR (cetrimide) and MA + CTR + CHX (chlorhexidine) as final irrigating regimens. For smear layer removal, 40 teeth were instrumented to size F4 and divided into four groups: (1) 7% MA, (2) 7% MA + 0.2% CTR, (3) 7% MA + 0.2% CTR + 2% CHX, (4) distilled water (control). After irrigation, teeth were subjected to SEM analysis. For contact angle analysis, 20 teeth were split longitudinally and divided into four groups similar to smear layer analysis. AH plus sealer was placed on each specimen and contact angle was analysed. In both smear layer (p = .393) and contact angle analysis (p = .961), there was no significant difference between the groups MA and MA + CTR. However, MA + CTR + CHX removed smear layer less effectively (p = .023) and increased the contact angle of the sealer (p = .005). In smear layer analysis, specimens in negative control group were heavily smeared. In case of contact angle analysis, samples in the control group had least contact angle. MA alone or in combination with CTR removed smear layer effectively and increased the wettability of AH plus sealer to root canal dentin.

Adjunctive Steps for Disinfection of the Mandibular Molar Root Canal System: A Correlative Bacteriologic, Micro-Computed Tomography, and Cryopulverization Approach.

PubMed

Alves, Flávio R F; Andrade-Junior, Carlos V; Marceliano-Alves, Marília F; Pérez, Alejandro R; Rôças, Isabela N; Versiani, Marco A; Sousa-Neto, Manoel D; Provenzano, José C; Siqueira, José F

2016-11-01

This study evaluated the disinfecting ability of chemomechanical preparation with rotary nickel-titanium instruments, followed by 2 distinct adjunctive procedures in the root canals of extracted mandibular molars by means of a correlative analytical approach. Twenty-two extracted mandibular molars were selected and anatomically matched between groups on the basis of micro-computed tomographic analysis. In the first phase of the experiment, root canals were contaminated with Enterococcus faecalis and subjected to chemomechanical preparation with BT RaCe instruments and 2.5% NaOCl irrigation. Then either XP-Endo Finisher instrument or passive ultrasonic irrigation was used to supplement disinfection. Micro-computed tomography was used to show whether the percentage of unprepared areas correlated to bacterial counts. In the second phase, the same teeth were contaminated once again, and the adjunctive procedures were used. Samples from the isthmus area of mesial roots and the apical 5-mm fragment of distal roots were obtained by cryopulverization. Samples taken before and after treatment steps in both phases were evaluated by quantitative polymerase chain reaction and statistically analyzed. In phase 1, preparation in both groups resulted in substantial decrease of bacterial counts (P < .001). The adjunctive approaches led to a further small bacterial reduction, which was significant for XP-Endo Finisher (P < .05). No significant differences were observed between groups for persisting bacterial counts. Correlative analysis revealed no statistically significant relationship between bacterial reduction and the percentage of unprepared areas (P > .05). In phase 2, both methods had significant antibacterial effects in the main canal, but none of them could predictably disinfect the isthmus/recess areas. Both XP-Endo Finisher and passive ultrasonic irrigation exhibited antibacterial effectiveness, but only the former caused a significant reduction in the bacterial counts after chemomechanical preparation. None of them were effective in predictably disinfecting the isthmus/recess areas. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effectiveness of several solutions to prevent the formation of precipitate due to the interaction between sodium hypochlorite and chlorhexidine and its effect on bond strength of an epoxy-based sealer.

PubMed

Magro, M G; Kuga, M C; Aranda-Garcia, A J; Victorino, K R; Chávez-Andrade, G M; Faria, G; Keine, K C; Só, M V R

2015-05-01

To evaluate the effectiveness of isopropyl alcohol, saline or distilled water to prevent the precipitate formed between sodium hypochlorite (NaOCl) and chlorhexidine (CHX) and its effect on the bond strength of an epoxy-based sealer in radicular dentine. The root canals of 50 extracted human canines (n = 10) were instrumented. In G1, root canals were irrigated with 17% EDTA and 2.5% NaOCl; G2, as G1, except that 2% CHX was used as the final irrigant. In the other groups, intermediate flushes with isopropyl alcohol (G3), saline (G4) or distilled water (G5) were used between NaOCl and CHX. The specimens were submitted to SEM analysis to evaluate the presence of debris and smear layer, in the apical and cervical segments. In sequence, fifty extracted human canines were distributed into five groups (n = 10), similar to the SEM study. After root filling, the roots were sectioned transversally to obtain dentine slices, in the cervical, middle and apical thirds. The root filling was submitted to a push-out bond strength test using an electromechanical testing machine. Statistical analysis was performed using Kruskal-Wallis and Dunn's tests (α = 5%). All groups had similar amounts of residue precipitated on the canal walls (P > 0.05). The push-out bond strength values were similar for all groups, independently of the root third evaluated (P > 0.05). Isopropyl alcohol, saline and distilled water failed to prevent the precipitation of residues on canal walls following the use of NaOCl and CHX. The residues did not interfere with the push-out bond strength of the root filling. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Influence of irrigation regimens on the adherence of Enterococcus faecalis to root canal dentin.

PubMed

Kishen, Anil; Sum, Chee-Peng; Mathew, Shibi; Lim, Chwee-Teck

2008-07-01

Enterococcus faecalis is frequently associated with post-treatment endodontic infections. Because adherence of bacteria to a substrate is the earliest stage in biofilm formation, eliciting the factors that links adherence of this bacterium to dentin would help in understanding its association with treatment-failed root canals. This investigation aimed to study the effects of endodontic irrigants on the adherence of E. faecalis to dentin. The bacteria adherence assay was conducted by using fluorescence microscopy, and the adhesion force was measured by using atomic force microscopy. There were significant increases in adherence and adhesion force after irrigation of dentin with ethylenediaminetetraacetic acid (EDTA), whereas sodium hypochlorite (NaOCl) reduced it. With the use of chlorhexidine (CHX), the force of adhesion increased, but the adherence assay showed a reduction in the number of adhering bacteria. The irrigation regimen of EDTA, NaOCl, and CHX resulted in the least number of adhering E. faecalis cells. This study highlighted that chemicals that alter the physicochemical properties of dentin will influence the nature of adherence, adhesion force, and subsequent biofilm formation of E. faecalis to dentin.

Complication of improper management of sodium hypochlorite accident during root canal treatment

PubMed Central

Faras, Fatemah; Abo-Alhassan, Fawaz; Sadeq, Abdullah; Burezq, Hisham

2016-01-01

Sodium Hypochlorite (NaOCl) is a common irrigation solution used in root canal treatment. It has strong antibacterial and tissue dissolving properties. Nevertheless, it has some serious complications, some of which are life-threatening. A young male presented with severe chemical burn of the right infraorbital area and partial necrosis of the hard palate resulting from extrusion of NaOCl during root canal treatment of the upper right 2nd molar tooth. The patient had a facial scar, and mucosal damage healed nearly completely. Several precautions must be taken during NaOCl use to prevent the spread of the solution into surrounding tissues. Early recognition of NaOCl accident and proper immediate management are important to achieve the best possible outcome. PMID:27891318

Efficacy of low concentrations of sodium hypochlorite and low-powered Er,Cr:YSGG laser activated irrigation against an Enterococcus faecalis biofilm.

PubMed

Christo, J E; Zilm, P S; Sullivan, T; Cathro, P R

2016-03-01

To establish the antibacterial efficacy of low concentrations of sodium hypochlorite with and without Er,Cr:YSGG laser activation on Enterococcus faecalis biofilms in extracted teeth. The root canals of 96 decoronated single-rooted extracted human teeth were prepared to a size 40, 0.06 taper 1 mm beyond the apex. They were mounted within a flow cell, which was sterilized before pumping a nutrient media through the root canals. The flow cell was inoculated with E. faecalis (ATCC 700802) and cultivated for 4 weeks. The root-ends were sealed, and the roots were then subjected to one of six treatment groups: group 1: syringe irrigation (SI) with saline (control) using a 27 -gauge Monoject needle 1 mm from the apex for 2 min; group 2: as for group 1 but with 1% NaOCl; group 3: as for group 1 but with 4% NaOCl; group 4: 0.5% NaOCl irrigation for 15 s followed by laser-activated irrigation (LAI) with four 15-s cycles replenishing the irrigant between cycles; group 5: as for group 4 but with 1% NaOCl as the irrigant; group 6: as for group 4 but with 4% NaOCl as the irrigant. Following treatment, teeth were crushed and viable bacteria were quantitated by serial dilution and plating. The colony-forming unit values were compared between groups using one-way anova and Tukey-adjusted post hoc tests. A two-tailed P value of <0.05 was considered statistically significant. The mean number of cells recovered from the 1% NaOCl SI group was significantly higher than that from the 4% NaOCl LAI group (P = 0.02). Within the limitations of this laboratory study, low-powered (0.5 W) Er,Cr:YSGG laser activation did not improve the antibacterial effect of low concentrations of sodium hypochlorite. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Modern Endodontic Principles Part 3: Preparation.

PubMed

Darcey, James; Taylor, Carly; Roudsari, Reza Vahid; Jawad, Sarra; Hunter, Mark

2015-11-01

The purpose of instrumentation is to facilitate irrigation and allow controlled obturation. This article will revisit methods of instrumentation of the root canal system with consideration given to length determination, apical preparation and the concept of patency filing. It will discuss hand instrumentation and rotary preparation looking at emerging technology such as reciprocating systems and the self-adjusting file. CPD/CLINICAL RELEVANCE: Mechanical preparation of the root canal system is of fundamental importance in achieving success, creating a more easily managed environment from a biological perspective.

Accidental sodium hypochlorite-induced skin injury during endodontic treatment.

PubMed

Serper, Ahmet; Ozbek, Murat; Calt, Semra

2004-03-01

A case of accidental skin injury caused by leakage of sodium hypochlorite solution from the rubber dam during root canal preparation is reported. After placement of a rubber dam and initiation of root canal treatment, the patient complained of a burning sensation with sodium hypochlorite irrigation. The complaints were ignored by the practitioner, and a skin rash developed on and around the patient's chin, followed by scab formation. The patient required medical treatment with topical Hamamelis virginiana extract for 2 weeks, with full recovery.

Comparison of the root canal debridement ability of two single file systems with a conventional multiple rotary system in long oval-shaped root canals: In vitro study.

PubMed

Khoshbin, Elham; Shokri, Abbas; Donyavi, Zakieh; Shahriari, Shahriar; Salehimehr, Golsa; Farhadian, Maryam; Kavandi, Zeinab

2017-08-01

This study sought to compare the root canal debridement ability of Neolix, Reciproc and ProTaper rotary systems in long oval-shaped root canals. Eighty five extracted single-rooted human teeth with long oval-shaped single root canals were selected and divided into three experimental groups(n=25) and one control group (n= 10). Root canals were filled with Vitapex radiopaque contrast medium and prepared with Neolix, Reciproc or ProTaper systems. The control group only received irrigation. Digital radiographs were obtained at baseline and postoperatively and subjected to digital subtraction. The percentage of reduction in contrast medium was quantified at 0-5 mm and 5-10 mm distances from the apex. The data were analyzed using one-way ANOVA and t-test. The mean percentage of the contrast medium removed was not significantly different in the 0-5mm segment among the three groups ( P =0.6). In the 5-10mm segment a significant difference was found in this regard among the ProTaper and Reciproc groups ( P =0.02) and the highest mean percentage of contrast medium was removed by ProTaper. But, difference between ProTaper and Neolix as well as Neolix and Reciproc was not significant. In Neolix ( P =0.024) and Reciproc ( P =0.002) systems, the mean percentage of the contrast medium removed from the 0-5mm segment was significantly greater than that in 5-10mm segment; however, this difference was not significant in ProTaper group ( P =0.069). Neolix single-file system may be a suitable alternative to ProTaper multiple-file system in debridement of long oval shaped canals. Key words: Root Canal Preparation, Debridement, Root Canal Therapy.

Apically-extruded debris using the ProTaper system.

PubMed

Azar, Nasim Gheshlaghi; Ebrahimi, Gholamreza

2005-04-01

The purpose of this in vitro study was to determine the quantity of debris and irrigant extruded apically using the ProTaper system compared to ProFiles and K-Flexofiles. Thirty-six mesio-buccal root canals of human mandibular molars were selected and divided into three groups of twelve canals. Two groups were instrumented with ProFiles and ProTapers according to the manufacturer's instructions. The other group was instrumented with K-Flexofiles using the step-back technique. A standard amount of irrigant was used for each canal. Apically-extruded debris and irrigant was collected in pre-weighed vials. The mean weight of extruded debris and irrigant for each group was statistically analysed using Student's t-test and one-way ANOVA. All instrumentation techniques produced extruded debris and irrigant. Although the mean amount of extrusion with the step-back technique was higher than the two rotary systems, there was no significant difference between the three groups (p > 0.05). NiTi rotary systems were associated with less apical extrusion, but were not significantly better than hand file instrumentation. All techniques extruded debris.

A microleakage study of gutta-percha/AH Plus and Resilon/Real self-etch systems after different irrigation protocols

PubMed Central

PRADO, Maíra; SIMÃO, Renata Antoun; GOMES, Brenda Paula Figueiredo de Almeida

2014-01-01

The development and maintenance of the sealing of the root canal system is the key to the success of root canal treatment. The resin-based adhesive material has the potential to reduce the microleakage of the root canal because of its adhesive properties and penetration into dentinal walls. Moreover, the irrigation protocols may have an influence on the adhesiveness of resin-based sealers to root dentin. Objective The objective of the present study was to evaluate the effect of different irrigant protocols on coronal bacterial microleakage of gutta-percha/AH Plus and Resilon/Real Seal Self-etch systems. Material and Methods One hundred ninety pre-molars were used. The teeth were divided into 18 experimental groups according to the irrigation protocols and filling materials used. The protocols used were: distilled water; sodium hypochlorite (NaOCl)+eDTA; NaOCl+H3PO4; NaOCl+eDTA+chlorhexidine (CHX); NaOCl+H3PO4+CHX; CHX+eDTA; CHX+ H3PO4; CHX+eDTA+CHX and CHX+H3PO4+CHX. Gutta-percha/AH Plus or Resilon/Real Seal Se were used as root-filling materials. The coronal microleakage was evaluated for 90 days against Enterococcus faecalis. Data were statistically analyzed using Kaplan-Meier survival test, Kruskal-Wallis and Mann-Whitney tests. Results No significant difference was verified in the groups using chlorhexidine or sodium hypochlorite during the chemo-mechanical preparation followed by eDTA or phosphoric acid for smear layer removal. The same results were found for filling materials. However, the statistical analyses revealed that a final flush with 2% chlorhexidine reduced significantly the coronal microleakage. Conclusion A final flush with 2% chlorhexidine after smear layer removal reduces coronal microleakage of teeth filled with gutta-percha/AH Plus or Resilon/Real Seal SE. PMID:25025557

In vitro particle image velocity measurements in a model root canal: flow around a polymer rotary finishing file.

PubMed

Koch, Jon D; Smith, Nicholas A; Garces, Daniel; Gao, Luyang; Olsen, F Kris

2014-03-01

Root canal irrigation is vital to thorough debridement and disinfection, but the mechanisms that contribute to its effectiveness are complex and uncertain. Traditionally, studies in this area have relied on before-and-after static comparisons to assess effectiveness, but new in situ tools are being developed to provide real-time assessments of irrigation. The aim in this work was to measure a cross section of the velocity field in the fluid flow around a polymer rotary finishing file in a model root canal. Fluorescent microparticles were seeded into an optically accessible acrylic root canal model. A polymer rotary finishing file was activated in a static position. After laser excitation, fluorescence from the microparticles was imaged onto a frame-transfer camera. Two consecutive images were cross-correlated to provide a measurement of a projected, 2-dimensional velocity field. The method reveals that fluid velocities can be much higher than the velocity of the file because of the shape of the file. Furthermore, these high velocities are in the axial direction of the canal rather than only in the direct of motion of the file. Particle image velocimetry indicates that fluid velocities induced by the rotating file can be much larger than the speed of the file. Particle image velocimetry can provide qualitative insight and quantitative measurements that may be useful for validating computational fluid dynamic models and connecting clinical observations to physical explanations in dental research. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Comparison of Vibringe, EndoActivator, and needle irrigation on sealer penetration in extracted human teeth.

PubMed

Bolles, Jordan A; He, Jianing; Svoboda, Kathy K H; Schneiderman, Emet; Glickman, Gerald N

2013-05-01

Vibringe is a new device that allows continuous sonic irrigation of the canal system during endodontic treatment. The aim of this study was to compare the effect of different irrigation systems on sealer penetration into dentinal tubules of extracted single-rooted teeth. Fifty single-rooted human teeth were instrumented and randomly divided into 4 groups: group 1 (control), saline; group 2 (conventional irrigation), 17% EDTA followed by 6% NaOCl; group 3 (EndoActivator), same irrigants as group 2; group 4 (Vibringe), same irrigants as group 2. Obturation of all teeth was done with gutta-percha and SimpliSeal labeled with fluorescent dye. Transverse sections at 1 mm and 5 mm from the root apex were examined by using confocal laser scanning microscopy. Percentage and maximum depth of sealer penetration were measured by using NIS-Elements Br 3.0 imaging software. Groups 3 and 4 had a significantly greater percentage of the canal wall penetrated by sealer at the 5-mm level than group 1 (P < .0125), but not group 2. No other differences were found between the groups at either section level for both the percentage of sealer penetration and maximum depth. The 5-mm sections in each experimental group had a significantly higher percentage and maximum depth of sealer penetration than did the 1-mm sections (P < .0125). The use of sonic activation with either the EndoActivator or Vibringe did not significantly improve the sealer penetration when compared with conventional irrigation. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Bond strength of epoxy resin-based root canal sealer to human root dentin irradiated with Er,Cr:YSGG laser.

PubMed

Franceschini, Keila de Almeida; Silva-Sousa, Yara Teresinha Corrêa; Lopes, Fabiane Carneiro; Pereira, Rodrigo Dantas; Palma-Dibb, Regina Guenka; de Sousa-Neto, Manoel Damião

2016-12-01

The aim was to evaluate the influence of Er,Cr:YSGG laser irradiation associated with different final irrigation protocols on the bond strength of epoxy resin-based root canal sealer to root dentin, on the dentin/filling material interface and in the temperature variation during irradiation. Ninety-six maxillary canines were prepared with K3 rotary system up to #45/0.02 instrument, irrigating with distilled water between files. The specimens were randomly assigned to three groups-final irrigation (distilled water, 1% NaOCl, and 17% EDTAC) and four subgroups (n = 8)-laser parameters (non-irradiated, 2 W/20 Hz, 3 W/20 Hz, and 4 W/20 Hz). During irradiation, the temperatures were measured on the outer root dentin wall in the three thirds, and root apex. Canals were filled with lateral condensation of AHPlus sealer and gutta-percha cones. Two slices from each third were submitted to a push-out test in Instron machine and the failure mode was analyzed. One slice from each third was analyzed by confocal laser microscopy to evaluate the percentage of the perimeter of the root canal cross-section with sealer tags and depth of tags. Data were analyzed by ANOVA, Kruskal-Wallis, and Tukey's tests (P < 0.05). Er,Cr:YSGG laser irradiation increased sealer bond strength to dentin, regardless of the final irrigation. The highest values were obtained for 3 W (4.02 ± 1.32) and 4 W (4.18 ± 0.98) powers and different from the non-irradiated group (2.64 ± 0.58) (P < 0.05). The 2 W irradiation produced similar results to 3 W and 4 W when associated with 17% EDTA. Final irrigation with 17% EDTAC provided higher bond strength (4.01 ± 1.02) compared with distilled water (3.11 ± 1.09) and 1% NaOCl (3.47 ± 1.18) (P < 0.05). The cervical third (4.01 ± 1.21) presented significantly higher bond strength than the apical third (3.04 ± 0.89). There was a greater percentage of adhesive and mixed failure. In the groups irradiated with 3 W [21.1 (14.1-27.7)] and 4 W [17.8 (11.9-23.7)], a greater depth of filling material tags was observed compared with the non-irradiated group [12.9 (9.0-20.0)]. The greatest percentage of canal perimeter with sealer tags was observed in the irradiated groups, with no difference among them (P > 0.05). The temperature rise was proportional to the increase of laser power. Er,Cr:YSGG laser irradiation increased the bond strength of an epoxy resin-based sealer to root dentin, with greater formation of sealer tags for all tested powers, especially when combined with 17% EDTAC final irrigation; temperature rise during irradiation remained below the critical threshold biologically accepted. Lasers Surg. Med. 48:985-994, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Effect of Alcohol on the Spreading Ability of Sodium Hypochlorite Endodontic Irrigant

DTIC Science & Technology

1982-09-01

Research Progress Sodium Hypochlorite Endodontic Irrigant Report (Interim) 6. PERFORMING ORG. REPORT NUMBER 7. AU THOR(s) 8. CONTRACT OR GRANT NUMBER(s...neceewary and Identify by block nam.ber) Alcohol Sodium hypochlorite Endodontics Root canal 20, ABSTRACT (Continue on reveree side If neceeseay and...depressant significantly increased the ability of the sodium hypochlorite endodontic irrigant to penetrate in vitro. A freshly mixed solution containing 30

The Use of Different Irrigation Techniques to Decrease Bacterial Loads in Healthy and Diabetic Patients with Asymptomatic Apical Periodontitis.

PubMed

Ghoneim, Mai; Saber, Shehab ElDin; El-Badry, Tarek; Obeid, Maram; Hassib, Nehal

2016-12-15

Diabetes mellitus is a multisystem disease which weakens the human's immunity. Subsequently, it worsens the sequelae of apical periodontitis by raising a fierce bacterial trait due to the impaired host response. This study aimed to estimate bacterial reduction after using different irrigation techniques in systemically healthy and diabetic patients with asymptomatic apical periodontitis. Enterococcus faecalis , Peptostreptococcus micros , and Fusobacterium necleatum bacteria were chosen, as they are the most common and prevailing strains found in periodontitis. Bacterial samples were retrieved from necrotic root canals of systemically healthy and diabetic patients, before and after endodontic cleaning and shaping by using two different irrigation techniques; the conventional one and the EndoVac system. Quantitive polymerase chain reaction (qPCR) was utilised to detect the reduction in the bacterial count. The EndoVac irrigation system was effective in reducing bacteria, especially Peptostreptococcus micros in the diabetic group when compared to conventional irrigation technique with a statistically significant difference. The EndoVac can be considered as a promising tool in combination with irrigant solution to defeat the bacterial colonies living in the root canal system. Additional studies ought to be done to improve the means of bacterial clearance mainly in immune-compromised individuals.

The Use of Different Irrigation Techniques to Decrease Bacterial Loads in Healthy and Diabetic Patients with Asymptomatic Apical Periodontitis

PubMed Central

Ghoneim, Mai; Saber, Shehab ElDin; El-Badry, Tarek; Obeid, Maram; Hassib, Nehal

2016-01-01

BACKGROUND: Diabetes mellitus is a multisystem disease which weakens the human’s immunity. Subsequently, it worsens the sequelae of apical periodontitis by raising a fierce bacterial trait due to the impaired host response. AIM: This study aimed to estimate bacterial reduction after using different irrigation techniques in systemically healthy and diabetic patients with asymptomatic apical periodontitis. MATERIAL AND METHODS: Enterococcus faecalis, Peptostreptococcus micros, and Fusobacterium necleatum bacteria were chosen, as they are the most common and prevailing strains found in periodontitis. Bacterial samples were retrieved from necrotic root canals of systemically healthy and diabetic patients, before and after endodontic cleaning and shaping by using two different irrigation techniques; the conventional one and the EndoVac system. Quantitive polymerase chain reaction (qPCR) was utilised to detect the reduction in the bacterial count. RESULTS: The EndoVac irrigation system was effective in reducing bacteria, especially Peptostreptococcus micros in the diabetic group when compared to conventional irrigation technique with a statistically significant difference. CONCLUSION: The EndoVac can be considered as a promising tool in combination with irrigant solution to defeat the bacterial colonies living in the root canal system. Additional studies ought to be done to improve the means of bacterial clearance mainly in immune-compromised individuals. PMID:28028421

Efficacy of passive ultrasonic irrigation with natural irrigants (Morinda citrifolia juice, Aloe Vera and Propolis) in comparison with 1% sodium hypochlorite for removal of E. faecalis biofilm: an in vitro study.

PubMed

Bhardwaj, Anuj; Velmurugan, Natanasabapathy; Ballal, Suma

2013-01-01

Present study evaluated the efficacy of natural derivative irrigants, Morinda citrifolia juice (MCJ), Aloe Vera and Propolis in comparison to 1% sodium hypochlorite with passive ultrasonic irrigation for removal of the intraradicular E. faecalis biofilms in extracted single rooted human permanent teeth. Biofilms of E. faecalis were grown on the prepared root canal walls of 60 standardized root halves which were longitudinally sectioned. These root halves were re-approximated and the samples were divided into five groups of twelve each. The groups were, Group A (1% NaOCl), Group B (MCJ), Group C (Aloe vera), Group D (Propolis) and Group E (Saline). These groups were treated with passive ultrasonic irrigation (PUI) along with the respective irrigants. The root halves were processed for scanning electron microscopy. Three images (X2.5), coronal, middle and apical, were taken for the twelve root halves in each of the five groups. The images were randomized and biofilm coverage assessed independently by three calibrated examiners, using a four-point scoring system. 1% NaOCl with passive ultrasonic irrigation (PUI) was effective in completely removing E. faecalis biofilm and was superior to the natural irrigants like MCJ, Aloe vera and Propolis tested in this study. 1% NaOCl used along with passive ultrasonic irrigation was effective in completely removing E. faecalis biofilm when compared to natural irrigants (MCJ, Aloe Vera and Propolis).

Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure.

PubMed

Lovelace, Tyler W; Henry, Michael A; Hargreaves, Kenneth M; Diogenes, Anibal

2011-02-01

Immature teeth with open apices treated with conventional nonsurgical root canal treatment often have a poor prognosis as a result of the increased risk of fracture and susceptibility to recontamination. Regenerative endodontics represents a new treatment modality that focuses on reestablishment of pulp vitality and continued root development. This clinical procedure relies on the intracanal delivery of a blood clot (scaffold), growth factors (possibly from platelets and dentin), and stem cells. However, to date, the clinical presence of stem cells in the canal space after this procedure has not been demonstrated. The purpose of this clinical study was to evaluate whether regenerative endodontic procedures are able to deliver stem cells into the canal space of immature teeth in young patients and to identify the possible tissue origin for these cells. After informed consent, the first appointment consisted of NaOCl irrigation and treatment with a triple antibiotic paste. One month later, the root canal space was irrigated with sterile saline, and bleeding was evoked with collection of samples on paper points. Real-time reverse-transcription polymerase chain reaction and immunocytochemistry were conducted to compare the gene transcripts and proteins found in the root canal sample with levels found in the systemic circulation. Molecular analyses of blood collected from the canal system indicated the significant accumulation of transcripts for the stem cell markers CD73 and CD105 (up to 600-fold), compared with levels found in the systemic blood. Furthermore, this effect was selective because there was no change in expression of the differentiation markers ALK-P, DSPP, ZBTB16, and CD14. Histologic analyses demonstrated that the delivered cells expressed both CD105 and STRO-1, markers for a subpopulation of mesenchymal stem cells. Collectively, these findings demonstrate that the evoked-bleeding step in regenerative procedures triggers the significant accumulation of undifferentiated stem cells into the canal space where these cells might contribute to the regeneration of pulpal tissues seen after antibiotic paste therapy of the immature tooth with pulpal necrosis. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

[The use of ultrasonic files in canal preparation].

PubMed

Calas, P; Terrie, B

1990-01-01

The continuous high volume of irrigating solution delivered by the ultrasonic system facilitates the root canal debridement. An excellent cleaning of dentin wall is obtained even on surfaces unreached by the mechanical instrumentation. In order to obtain an efficacious preparation, the use of ultrasonic files were combined with instrumentation. This new technique is described in this article.

Temperature changes accompanying near infrared diode laser endodontic treatment of wet canals.

PubMed

Hmud, Raghad; Kahler, William A; Walsh, Laurence J

2010-05-01

Diode laser endodontic treatments such as disinfection or the generation of cavitations should not cause deleterious thermal changes in radicular dentin. This study assessed thermal changes in the root canal and on the root surface when using 940 and 980 nm lasers at settings of 4 W/10 Hz and 2.5 W/25 Hz, respectively, delivered into 2000-mum fibers to generate cavitations in water. The root surface temperature in the apical third was recorded, as was the water temperature in coronal, middle, and apical third regions, by using thermocouples placed inside the canal. Lasing was undertaken with either rest periods or rinsing between 5-second laser exposures. Both diode lasers induced only modest temperature changes on the external root surface at the settings used. Even though the temperature of the water within the canal increased during lasing by as much as 30 degrees C, the external root surface temperature increased by only a maximum of 4 degrees C. Irrigation between laser exposures was highly effective in minimizing thermal changes within the root canal and on the root surface. Diode laser parameters that induce cavitation do not result in adverse thermal changes in radicular dentin. Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Antibacterial and residual antimicrobial activities against Enterococcus faecalis biofilm: A comparison between EDTA, chlorhexidine, cetrimide, MTAD and QMix

NASA Astrophysics Data System (ADS)

Zhang, Rui; Chen, Min; Lu, Yan; Guo, Xiangjun; Qiao, Feng; Wu, Ligeng

2015-08-01

We compared the antibacterial and residual antimicrobial activities of five root canal irrigants (17% EDTA,2% chlorhexidine,0.2% cetrimide, MTAD, and QMix) in a model of Enterococcus faecalis biofilm formation. Sixty dentin blocks with 3-week E. faecalis biofilm were divided into six equal groups and flushed with irrigant for 2 min or left untreated. A blank control group was also established. Antibacterial activities of the irrigants were evaluated by counting colony forming units. To test residual antimicrobial activities, 280 dentin blocks were divided into seven equal groups and flushed with irrigant for 2 min or left untreated and then incubated with E. faecalis suspension for 48 h, or used as a blank. No bacteria were observed in the blank control group. The number of viable E. faecalis was significantly fewer in the irrigant-treated groups compared with the untreated control (P < 0.05). Among the five irrigants, QMix had the strongest antibacterial activity. Residual antimicrobial activities of CHX were significantly higher at 12 h, 24 h and 36 h compared to untreated control (P < 0.05). All five root canal irrigants were effective to some extent against E. faecalis, but QMix and CHX had the strongest, and CHX the longest (up to 36 h), antimicrobial activity.

Enhanced removal of Enterococcus faecalis biofilms in the root canal using sodium hypochlorite plus photon-induced photoacoustic streaming: an in vitro study.

PubMed

Al Shahrani, Mohammed; DiVito, Enrico; Hughes, Christopher V; Nathanson, Dan; Huang, George T-J

2014-05-01

The purpose of this study was to determine the effectiveness of laser-activated irrigation by photon-induced photoacoustic streaming (PIPS) using Er:YAG laser energy in decontaminating heavily colonized root canal systems in vitro. Extracted single-rooted human teeth (n=60) were mechanically and chemically prepared, sterilized, inoculated with Enterococcus faecalis for 3 weeks, and randomly assigned to four groups (n=15): Group I (control, no decontamination), Group II (PIPS+6% NaOCl), Group III (PIPS+saline), and Group IV (6% NaOCl). PIPS settings were all preset to 50 μsec pulse, 20 mJ, 15 Hz, for an average power of 0.3 W. After decontamination, the remaining live microbes from all specimens were collected and recovered via plate counting of the colony-forming units (CFUs). Randomized root canal surfaces were examined with scanning electron microscopy and confocal laser microscopy. Mean variance and Dunnett's t test (post-hoc test) comparisons were used to compare mean scores for the three groups with the control group. The CFU analysis showed the following measurements (mean±SE): Group I (control), 336.8±1.8; Group II (PIPS+NaOCl), 0.27±0.21; Group III (PIPS+saline), 225.0±21; and Group IV (NaOCl), 46.9±20.29. Group II had significantly lower CFUs than any other groups (p<0.05). Both imaging analyses confirmed levels of remaining bacteria on examined root surfaces. The use of the PIPS system along with NaOCl showed the most efficient eradication of the bacterial biofilm. It appears that laser-activated irrigation (LAI) utilizing PIPS may enhance the disinfection of the root canal system.

Enhanced Removal of Enterococcus faecalis Biofilms in the Root Canal Using Sodium Hypochlorite Plus Photon-Induced Photoacoustic Streaming: An In Vitro Study

PubMed Central

Al Shahrani, Mohammed; DiVito, Enrico; Hughes, Christopher V.; Nathanson, Dan

2014-01-01

Abstract Objective: The purpose of this study was to determine the effectiveness of laser-activated irrigation by photon-induced photoacoustic streaming (PIPS) using Er:YAG laser energy in decontaminating heavily colonized root canal systems in vitro. Materials and methods: Extracted single-rooted human teeth (n=60) were mechanically and chemically prepared, sterilized, inoculated with Enterococcus faecalis for 3 weeks, and randomly assigned to four groups (n=15): Group I (control, no decontamination), Group II (PIPS+6% NaOCl), Group III (PIPS+saline), and Group IV (6% NaOCl). PIPS settings were all preset to 50 μsec pulse, 20 mJ, 15 Hz, for an average power of 0.3 W. After decontamination, the remaining live microbes from all specimens were collected and recovered via plate counting of the colony-forming units (CFUs). Randomized root canal surfaces were examined with scanning electron microscopy and confocal laser microscopy. Mean variance and Dunnett's t test (post-hoc test) comparisons were used to compare mean scores for the three groups with the control group. Results: The CFU analysis showed the following measurements (mean±SE): Group I (control), 336.8±1.8; Group II (PIPS+NaOCl), 0.27±0.21; Group III (PIPS+saline), 225.0±21; and Group IV (NaOCl), 46.9±20.29. Group II had significantly lower CFUs than any other groups (p<0.05). Both imaging analyses confirmed levels of remaining bacteria on examined root surfaces. Conclusions: The use of the PIPS system along with NaOCl showed the most efficient eradication of the bacterial biofilm. It appears that laser-activated irrigation (LAI) utilizing PIPS may enhance the disinfection of the root canal system. PMID:24717113

Comparison of the in vivo antimicrobial effectiveness of sodium hypochlorite and chlorhexidine used as root canal irrigants: a molecular microbiology study.

PubMed

Rôças, Isabela N; Siqueira, José F

2011-02-01

The purpose of this clinical study was to compare the antimicrobial effects of 2.5% sodium hypochlorite (NaOCl) and 0.12% chlorhexidine digluconate (CHX) when used as irrigants during treatment of teeth with apical periodontitis. Forty-seven single-rooted single-canal teeth with necrotic pulps and asymptomatic apical periodontitis were selected for this study according to stringent inclusion/exclusion criteria. Bacterial samples were taken at the baseline (S1) and after (S2) chemomechanical preparation using 2.5% NaOCl (n = 30) or 0.12% CHX (n = 17) as the irrigant. Bacterial, archaeal, and fungal presence was evaluated by broad-range polymerase chain reaction (PCR), whereas bacterial identifications were performed by a closed-ended reverse-capture checkerboard approach targeting 28 candidate endodontic pathogens. All S1 samples were PCR positive for bacterial presence but negative for both archaea and fungi. Both NaOCl- and CHX-based protocols were significantly effective in reducing the bacterial levels and number of taxa. No significant differences were observed between them in all tested parameters including the incidence of negative PCR results in S2 (40% for NaOCl vs 47% for CHX, p = 0.8), reduction in the number of taxa per canal (p = 0.3), and reduction in the bacterial levels (p = 0.07). The most prevalent taxa in S2 samples from the NaOCl group were Propionibacterium acnes, Streptococcus species, Porphyromonas endodontalis, and Selenomonas sputigena. In the CHX group, the most prevalent taxa in S2 were Dialister invisus, Actinomyces israelii, Prevotella baroniae, Propionibacterium acidifaciens, and Streptococcus species. Treatment protocols using irrigation with either NaOCl or CHX succeeded in significantly reducing the the number of bacterial taxa and their levels in infected root canals, with no significant difference between these substances. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Regenerative Endodontic Treatment of an Immature Necrotic Molar with Arrested Root Development by Using Recombinant Human Platelet-derived Growth Factor: A Case Report.

PubMed

Zhujiang, Annie; Kim, Sahng G

2016-01-01

Regenerative endodontic treatment has provided a treatment option that aims to allow root maturation. The present report describes the regenerative endodontic treatment of a necrotic, immature molar by using recombinant human platelet-derived growth factor (rhPDGF-BB) and shows the continued root maturation in the tooth with arrested root development. A regenerative endodontic procedure that used a growth factor was performed for a necrotic molar with arrested root formation in a 20-year-old patient. Thorough disinfection by using mechanical instrumentation and copious irrigation of antimicrobial agents as well as intracanal medication with calcium hydroxide was performed throughout the first 2 appointments. At the third appointment, the root canals were irrigated with an antimicrobial solution and 17% EDTA, and bleeding was evoked by passing sterile paper points beyond the apex in each canal. Small pieces of a collagen membrane saturated with rhPDGF-BB solution from GEM 21S were packed into each canal. Mineral trioxide aggregate was placed, and Cavit and composite resin were used to restore the tooth. Complete root maturation and resolution of a periapical radiolucency were observed at the 15-month follow-up. The present report presents a regenerative endodontic procedure that uses rhPDGF-BB for a necrotic molar with arrested root development. The finding of continued root development in the present case suggests that regenerative endodontic treatment may be able to resume the root maturation process in teeth with arrested root formation. Further clinical studies are required to investigate the efficacy of rhPDGF-BB in regenerative endodontic treatment. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Sonochemical and high-speed optical characterization of cavitation generated by an ultrasonically oscillating dental file in root canal models.

PubMed

Macedo, R G; Verhaagen, B; Fernandez Rivas, D; Gardeniers, J G E; van der Sluis, L W M; Wesselink, P R; Versluis, M

2014-01-01

Ultrasonically Activated Irrigation makes use of an ultrasonically oscillating file in order to improve the cleaning of the root canal during a root canal treatment. Cavitation has been associated with these oscillating files, but the nature and characteristics of the cavitating bubbles were not yet fully elucidated. Using sensitive equipment, the sonoluminescence (SL) and sonochemiluminescence (SCL) around these files have been measured in this study, showing that cavitation occurs even at very low power settings. Luminol photography and high-speed visualizations provided information on the spatial and temporal distribution of the cavitation bubbles. A large bubble cloud was observed at the tip of the files, but this was found not to contribute to SCL. Rather, smaller, individual bubbles observed at antinodes of the oscillating file with a smaller amplitude were leading to SCL. Confinements of the size of bovine and human root canals increased the amount of SL and SCL. The root canal models also showed the occurrence of air entrainment, resulting in the generation of stable bubbles, and of droplets, near the air-liquid interface and leading eventually to a loss of the liquid. Copyright © 2013 Elsevier B.V. All rights reserved.

Antimicrobial photodynamic therapy combined with conventional endodontic treatment to eliminate root canal biofilm infection.

PubMed

Garcez, Aguinaldo S; Ribeiro, Martha S; Tegos, George P; Núñez, Silvia C; Jorge, Antonio O C; Hamblin, Michael R

2007-01-01

To compare the effectiveness of antimicrobial photodynamic therapy (PDT), standard endodontic treatment and the combined treatment to eliminate bacterial biofilms present in infected root canals. Ten single-rooted freshly extracted human teeth were inoculated with stable bioluminescent Gram-negative bacteria, Proteus mirabilis and Pseudomonas aeruginosa to form 3-day biofilms in prepared root canals. Bioluminescence imaging was used to serially quantify bacterial burdens. PDT employed a conjugate between polyethylenimine and chlorin(e6) as the photosensitizer (PS) and 660-nm diode laser light delivered into the root canal via a 200-micro fiber, and this was compared and combined with standard endodontic treatment using mechanical debridement and antiseptic irrigation. Endodontic therapy alone reduced bacterial bioluminescence by 90% while PDT alone reduced bioluminescence by 95%. The combination reduced bioluminescence by >98%, and importantly the bacterial regrowth observed 24 hours after treatment was much less for the combination (P<0.0005) than for either single treatment. Bioluminescence imaging is an efficient way to monitor endodontic therapy. Antimicrobial PDT may have a role to play in optimized endodontic therapy. (c) 2006 Wiley-Liss, Inc.

Comparative antifungal efficacy of light-activated disinfection and octenidine hydrochloride with contemporary endodontic irrigants.

PubMed

Eldeniz, Ayce Unverdi; Guneser, Mehmet Burak; Akbulut, Makbule Bilge

2015-02-01

The aim of this study was to evaluate the antifungal effects of light-activated disinfection (LAD) in comparison with contemporary root canal irrigation solutions: sodium hypochlorite and 2% chlorhexidine gluconate and a new wound antiseptic, octenidine hydrochloride. Seventy extracted teeth having single root canals were contaminated with Candida albicans for 14 days. The samples were divided into five experimental (n = 10) and two control (positive and negative) groups (n = 10): (1) LAD with toluidine blue O, (2) octenidine hydrochloride (OCT), (3) 2.5% sodium hypochlorite (2.5% NaOCl), (4) 5.25% sodium hypochlorite (5.25% NaOCl) and (5) 2% chlorhexidine. Five millilitres of each test solution was applied for 3 min, and irradiation time used for LAD was 30 s. After treatment, the dentin chips were collected from inner canal walls into vials containing phosphate buffered saline, vortexed, serially diluted, seeded on Tryptic Soy Agar plates and incubated (37 °C, 48 h). The number of colony-forming units was then counted. Differences between LAD group and positive control group were statistically significant (P < 0.05). All Candida cells were totally eliminated in root canals irrigated with OCT, 2.5% NaOCl, 5.25% NaOCl and 2% chlorhexidine groups (CFU = 0). Within the limitations of this ex vivo study, LAD had minimal antimicrobial effect on C. albicans when used 30 s, and further modifications in LAD protocol are required to improve its antifungal capability. A new wound antiseptic, octenidine hydrochloride, demonstrated better potential than LAD in elimination of Candida albicans cells and may be a promising alternative to NaOCl and chlorhexidine solutions in future.

Photodynamic therapy with two different photosensitizers as a supplement to instrumentation/irrigation procedures in promoting intracanal reduction of Enterococcus faecalis.

PubMed

Souza, Letícia C; Brito, Patrícia R R; de Oliveira, Julio C Machado; Alves, Flávio R F; Moreira, Edson J L; Sampaio-Filho, Hélio R; Rôças, Isabela N; Siqueira, José F

2010-02-01

This in vitro study aimed to investigate the antibacterial effects of photodynamic therapy (PDT) with methylene blue (MB) or toluidine blue (TB) (both at 15 microg/mL) as a supplement to instrumentation/irrigation of root canals experimentally contaminated with Enterococcus faecalis. Seventy extracted teeth had their root canals contaminated with an endodontic strain of E. faecalis for 7 days, instrumented with nickel-titanium instruments and irrigated either with 2.5% NaOCl or with 0.85% NaCl, and then randomly distributed into four experimental groups: MB/NaOCl (PDT with MB and NaOCl as the irrigant), TB/NaOCl (PDT with TB and NaOCl as the irrigant), MB/NaCl (PDT with MB and NaCl as the irrigant), and TB/NaCl (PDT with TB and NaCl as the irrigant). For PDT, the photosensitizer remained in the canal for 2 minutes before exposed to red light emitted from a diode laser for 4 minutes. Samples were taken before and after instrumentation/irrigation and following the specific PDT procedure for each group, plated onto Mitis-salivarius agar and the colony forming units counted. Regardless of the irrigant used (NaOCl or NaCl), instrumentation significantly reduced bacterial counts in comparison to the baseline (p < 0.001). NaOCl as the irrigant was significantly more effective than NaCl, and this difference persisted after PDT, irrespective of the photosensitizer used (p < 0.05). PDT with either MB or TB did not significantly enhance disinfection after chemomechanical preparation using NaOCl as irrigant (p > 0.05). No significant differences were observed between the two photosensitizers (p > 0.05). These in vitro results suggest that PDT with either MB or TB may not exert a significant supplemental effect to instrumentation/irrigation procedures with regard to intracanal disinfection. Further adjustments in the PDT protocol may be required to enhance predictability in bacterial elimination before clinical use is recommended. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Impact of needle insertion depth on the removal of hard-tissue debris.

PubMed

Perez, R; Neves, A A; Belladonna, F G; Silva, E J N L; Souza, E M; Fidel, S; Versiani, M A; Lima, I; Carvalho, C; De-Deus, G

2017-06-01

To evaluate the effect of depth of insertion of an irrigation needle tip on the removal of hard-tissue debris using micro-computed tomographic (micro-CT) imaging. Twenty isthmus-containing mesial roots of mandibular molars were anatomically matched based on similar morphological dimensions using micro-CT evaluation and assigned to two groups (n = 10), according to the depth of the irrigation needle tip during biomechanical preparation: 1 or 5 mm short of the working length (WL). The preparation was performed with Reciproc R25 file (tip size 25, .08 taper) and 5.25% NaOCl as irrigant. The final rinse was 17% EDTA followed by bidistilled water. Then, specimens were scanned again, and the matched images of the canals, before and after preparation, were examined to quantify the amount of hard-tissue debris, expressed as the percentage volume of the initial root canal volume. Data were compared statistically using the Mann-Whitney U-test. None of the tested needle insertion depths yielded root canals completely free from hard-tissue debris. The insertion depth exerted a significant influence on debris removal, with a significant reduction in the percentage volume of hard-tissue debris when the needle was inserted 1 mm short of the WL (P < 0.05). The insertion depth of irrigation needles significantly influenced the removal of hard-tissue debris. A needle tip positioned 1 mm short of the WL resulted in percentage levels of hard-tissue debris removal almost three times higher than when positioned 5 mm from the WL. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

One- versus two-visit endodontic treatment of teeth with apical periodontitis: a histobacteriologic study.

PubMed

Vera, Jorge; Siqueira, José F; Ricucci, Domenico; Loghin, Simona; Fernández, Nancy; Flores, Belina; Cruz, Alvaro G

2012-08-01

This study analyzed the in vivo microbiological status of the root canal systems of mesial roots of mandibular molars with primary apical periodontitis after 1- or 2-visit endodontic treatment. Mesial root canals were instrumented by using either a combination of K3 and LightSpeed instruments (mesiobuccal canals) or the ProTaper system (mesiolingual canals), with 5% NaOCl irrigation. Patency files were used. Smear layer was removed, and a final rinse with 5 mL of 2% chlorhexidine was performed. In the 2-visit group (7 roots, 14 canals), canals were medicated with calcium hydroxide for 1 week and then obturated by using the continuous wave of compaction technique. In the 1-visit group (6 roots, 12 canals), canals were immediately obturated after chemomechanical procedures. Teeth were extracted 1 week after root canal instrumentation and processed for histobacteriologic analysis. In the 1-visit group, no case was completely free of bacteria; residual bacteria occurred in the main root canal (5 of 6 cases), isthmus (5 of 6), apical ramifications (4 of 6), and dentinal tubules (5 of 6). In the 2-visit group, 2 cases were rendered bacteria-free; residual bacteria were found in the main canal only in 2 cases (none of them with persistent dentinal tubule infection), in the isthmus (4 of 7 cases), and in ramifications (2 of 7). The 2 instrumentation techniques performed similarly. When filling material was observed in ramifications, it was usually intermixed with necrotic tissue, debris, and bacteria. The 2-visit protocol by using an interappointment medication with calcium hydroxide resulted in improved microbiological status of the root canal system when compared with the 1-visit protocol. Residual bacteria were more frequent and abundant in ramifications, isthmuses, and dentinal tubules when root canals were treated without an interappointment medication. Apical ramifications and isthmuses were never completely filled. The use of an antibacterial interappointment agent is necessary to maximize bacterial reduction before filling. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Assessment of Coronal Leakage of Temporary Restorations in Root Canal-treated Teeth: An in vitro Study.

PubMed

Srivastava, Pankaj K; Nagpal, Ajay; Setya, Gaurav; Kumar, Sunil; Chaudhary, Alankrita; Dhanker, Kuldeep

2017-02-01

Coronal leakage is one of the constant concerns in routine dental practice. It is one of the factors responsible for the failure of root canal therapy. Permanent restorations should be given as soon as possible after the completion of root canal therapy. If unavoidable, provisional restoration should be given in such a way that it maximally reduced the leakage of microorganisms and fluids from the external environment into the canal space. Hence, we evaluated the effect of saliva on the coronal leakage of temporary restorations. Biomechanical preparation of the root canals of 204 fresh mandibular first premolar teeth was done using endodontic files with intermittent irrigation of sodium hypochlorite solution and ethylenediaminetetraacetic acid. Alternate irrigation with normal saline was done periodically. After preparation, drying of the canals was done using paper points followed by sealing of the apical foramen. For the assessment of the microleakage, Siqueira et al apparatus and method was used. All the specimens were divided into four groups based on the provisional restorative material used. All the groups were further divided into three subgroups based on the presence and absence of intracanal medicaments. Verissimo et al's criteria were used to check the turbidity at 1-, 2-, 3-, and 4-week interval respectively. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software. Chi-square test was used to measure the level of significance, and p < 0.05 was considered to be significant. In group I, all the subgroups' specimens showed significant difference at 1 week's time. Only the subgroup with no intracanal medicaments in Cavit-containing provisional restoration showed nonsignificant alterations. Statistically significant alterations were seen at 1, 2, and 3 weeks' interval in all the subgroups except for one with intracanal medicaments. All the temporary restorative materials were not able to prevent microleakage after 1 week's time, with worst bacterial resistance shown by Ketac Molar and ionomer restorative material. Future studies are advocated for better prognosis of root canal therapy.

Smear Layer Removal in the Apical Third of Root Canals by Two Chelating Agents and Laser: A Comparative in vitro Study

PubMed Central

Ashraf, Hengameh; Asnaashari, Mohammad; Darmiani, Soheila; Birang, Reza

2014-01-01

Introduction: Smear layer (SL) is produced as a result of mechanical instrumentation of the canal(s). Despite the controversies regarding its removal, the evidence-based trend has shifted towards removing and eliminating the SL. Different methods have been used to remove the SL and the aim of this in vitro study was to evaluate the ability of 17% ethylenediaminetetraacetic acid (EDTA), 18% etidronate and Er: YAG on effective removal of the SL. Methods and Materials: Fifty straight single-rooted teeth were divided into three experimental groups (n=15) and one control group of five. The canals were instrumented with HERO 642 rotary files up to 30/0.06. In group 1, canals were irradiated with Er: YAG laser; in groups 2 and 3, canals were irrigated with 17% EDTA and 18% etidronate, respectively. In group 4 (control) distilled water was used for canal irrigation. The amount of remaining SL was quantified according to Hulsmann’s method with scanning electron microscopy (SEM). Data was analyzed by the Kruskal-Wallis and Mann-Whitney U tests (P<0.05). Results: The results showed statistically significant differences in terms of SL removal among the groups (P<0.05). The amount of removed SL by EDTA was significantly greater followed by Er: YAG laser and 18% etidronate. Conclusion: Within the limitations of this study, EDTA was more effective in removing SL compared to Er: YAG and etidronate. PMID:25031596

Evaluation of effectiveness of various irrigating solutions on removal of calcium hydroxide mixed with 2% chlorhexidine gel and detection of orange-brown precipitate after removal.

PubMed

Arslan, Hakan; Gok, Tuba; Saygili, Gokhan; Altintop, Hülya; Akçay, Merve; Çapar, Ismail Davut

2014-11-01

The aims of the present study were to evaluate the effect of various irrigating solutions on the removal of calcium hydroxide mixed with 2% chlorhexidine gel from an artificial groove created in a root canal and the generation of orange-brown precipitate in the remaining calcium hydroxide mixed with 2% chlorhexidine gel after irrigation with the various irrigating solutions. The root canals of 48 mandibular premolars were prepared using ProTaper Universal Rotary instruments (Dentsply Maillefer, Ballaigues, Switzerland) up to size F4. The roots were split longitudinally, and a standardized groove was prepared in the apical part of 1 segment. The root halves were reassembled, and calcium hydroxide mixed with 2% chlorhexidine gel medicament was placed into the grooves. The roots were randomly divided into 4 experimental groups specified by the irrigation solution used: 1% NaOCl, 17% EDTA, 7% maleic acid, and 10% citric acid (n = 12). The amount of remaining medicament was evaluated under a stereomicroscope using a 4-grade scoring system. After irrigation, the specimens were also evaluated for the presence/absence of orange-brown precipitate. The effects of the different irrigation solutions on medicament removal were statistically evaluated using the Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction at a 95% confidence level (P = .0083). Solutions of 7% maleic acid and 10% citric acid were superior to solutions of 1% NaOCl and 17% EDTA in removing calcium hydroxide mixed with 2% chlorhexidine gel (P < .0083). There were no significant differences among the other groups (P > .0083). Orange-brown precipitate was observed in all specimens of the NaOCl group but in no specimens in the other groups. Irrigation solutions of 7% maleic acid and 10% citric acid were more effective in the removal of calcium hydroxide mixed with 2% chlorhexidine gel than those of 1% NaOCl and 17% EDTA. Orange-brown precipitate was found in all specimens of the NaOCl-irrigated groups. However, the precipitate was not observed in specimens in the groups irrigated with 17% EDTA, 7% maleic acid, and 10% citric acid. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Effect of sonic and ultrasonic activation on organic tissue dissolution from simulated grooves in root canals using sodium hypochlorite and EDTA.

PubMed

Conde, A J; Estevez, R; Loroño, G; Valencia de Pablo, Ó; Rossi-Fedele, G; Cisneros, R

2017-10-01

To compare soft-tissue dissolution by sodium hypochlorite, with an EDTA intermediate rinse, with or without activation with passive ultrasonic activation (PUI) or sonic activation using the Endoactivator (EA) or Eddy tips (ED). The root canals of eighty-three human maxillary central incisors were chemo-mechanically prepared and the teeth split. A standardized longitudinal intracanal groove was created in one of the root halves. Eighty-three porcine palatal mucosa samples were collected, adapted to fit into the grooves and weighed. The re-assembled specimens were randomly divided into four experimental groups (n = 20), based on the final rinse: no activation; EA; PUI; ED, using 2.5% sodium hypochlorite, with an EDTA intermediate rinse. A control group (n = 3) was irrigated with distilled water without activation. The solutions were delivered using a syringe and needle 2 mm from working length. Total irrigation time was 150 s, including 60 s of activation in the specific groups. The study was carried out at 36 ± 2 °C. The porcine palatal mucosa samples were weighed after completion of the assays. Student paired t-test and anova were used to assess the intra- and intergroup weight changes. The multiple comparisons were evaluated using Bonferroni correction (α = 0.05). Weight loss occurred in all experimental groups. Irrigant activation resulted in greater weight loss when compared to the nonactivated group [vs. EA (P = 0.001); vs. PUI (P < 0.001); vs. ED (P < 0.001)]. No significant differences were found amongst the different activation systems. Activation increased the tissue-dissolving activity of irrigants from artificial grooves in root canals of maxillary central incisors. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

A study on FlexMaster : a Ni-Ti rotary engine driven system for root canal preparation.

PubMed

Alam, M S; Bashar, A K; Begumr, J A; Kinoshita, J I

2006-07-01

In the present study, the effectiveness of recently introduced rotary Nickel Titanium FlexMaster engine driven system was evaluated for cleaning and shaping of root canals in extracted human teeth and compared with that done by the Nickel Titanium Flexofile hand instruments. A total of 40 root canals from 36 extracted mandibular and maxillary teeth with curvature ranging between 20 and 30 degree were divided into two groups, consisting 20 canals in each. FlexMaster instrumentation was done in 20 canals, using crown-down technique and manual filing with Flexofile was done in other 20 canals, using conventional and step-back techniques. 5.25% sodium hypochlorite (NaOCl) solution and 17% ethelene di-amine tetra-acetic acid (EDTA) were used alternatively for irrigation after canal preparation by each instrument size. Time needed for canal preparation of individual canal was recorded. A procedural error such as instrument breakage was also noted. After preparation, all the roots were cut longitudinally by using diamond burs in turbine handpiece and examined under scanning electron microscope. Apical region was quantified for debris and smear layer based on a 5-score numerical evaluation scale. The data established for scoring the debris and smear layer and preparation time of individual canal were analyzed statistically using the Mann-Whitney U test. Completely cleaned root canals were not found with any of the two instruments and none of the instruments maintained the original canal uniformity and regular dentine surface. Because significantly less debris was found in the apical region using the manual filing technique (p< 0.05). Thus the flexmaster system was found to produce less cleaner root canal walls than manual technique. Only one FlexMaster finishing file sized 30 was separated in the apical region during preparation of 30 degree curved canal. The time taken by FlexMaster was significantly better (p< 0.01) than that of hand instruments.

Smear layer production by 3 rotary reamers with different cutting blade designs in straight root canals: a scanning electron microscopic study.

PubMed

Jeon, In-Soo; Spångberg, Larz S W; Yoon, Tai-Cheol; Kazemi, Reza B; Kum, Kee-Yeon

2003-11-01

The design of the cutting blade of rotary instruments may affect the outcome of root canal instrumentation in terms of cleanliness. The aim of this scanning electron microscopic study was to compare the quality and amount of smear layer generated in the apical third of straight root canals by 2 rotary nickel-titanium reamers and 1 rotary steel reamer with different cutting blade designs. Seventy intact, single-rooted human mandibular premolars with straight, fully developed roots were selected for this study. Before instrumentation, the cervical portion of all teeth was removed by using a microtome (Isomet), leaving 13-mm-long roots. Automated preparation was performed with ProFile (n = 20) and Hero 642 (n = 20) reamers by using the crown-down technique and with a stainless steel engine reamer (Mani; n = 20) by using a reaming motion. All root canals were instrumented to No. 40. A control group (pulp extirpation with barbed broaches; n = 10) was also included. Irrigation with 3 mL of a 1% sodium hypochlorite (NaOCl) solution was performed after each instrumentation. After the instrumentation, each root was split longitudinally, and a scanning electron microscope was used to examine the selected areas of the canal walls at the apical third from 2 different perspectives. A 4-category scoring system for smear layer was used, and the resulting scores were statistically analyzed. The least smear layer remained in the Hero 642 group at the selected apical third of straight root canals (P < .05). However, all instruments left a smear layer. The surface texture of the smear layer, in addition to the depth and the frequency of packed materials into the dentinal tubules, varied with instrument type. These data revealed that the design of the cutting blade of rotary instruments can affect root canal cleanliness in straight root canals. This information may be useful in the selection of nickel-titanium rotary reamers.

Evaluation of apical extrusion of debris and irrigant using two new reciprocating and one continuous rotation single file systems.

PubMed

Nayak, Gurudutt; Singh, Inderpreet; Shetty, Shashit; Dahiya, Surya

2014-05-01

Apical extrusion of debris and irrigants during cleaning and shaping of the root canal is one of the main causes of periapical inflammation and postoperative flare-ups. The purpose of this study was to quantitatively measure the amount of debris and irrigants extruded apically in single rooted canals using two reciprocating and one rotary single file nickel-titanium instrumentation systems. Sixty human mandibular premolars, randomly assigned to three groups (n = 20) were instrumented using two reciprocating (Reciproc and Wave One) and one rotary (One Shape) single-file nickel-titanium systems. Bidistilled water was used as irrigant with traditional needle irrigation delivery system. Eppendorf tubes were used as test apparatus for collection of debris and irrigant. The volume of extruded irrigant was collected and quantified via 0.1-mL increment measure supplied on the disposable plastic insulin syringe. The liquid inside the tubes was dried and the mean weight of debris was assessed using an electronic microbalance. The data were statistically analysed using Kruskal-Wallis nonparametric test and Mann Whitney U test with Bonferroni adjustment. P-values less than 0.05 were considered significant. The Reciproc file system produced significantly more debris compared with OneShape file system (P<0.05), but no statistically significant difference was obtained between the two reciprocating instruments (P>0.05). Extrusion of irrigant was statistically insignificant irrespective of the instrument or instrumentation technique used (P >0.05). Although all systems caused apical extrusion of debris and irrigant, continuous rotary instrumentation was associated with less extrusion as compared with the use of reciprocating file systems.

Bacterial leakage in root canals filled with AH Plus and dentine bonding agents.

PubMed

Navarro-Escobar, Esther; Baca, Pilar; Ruiz-Linares, Matilde; Arias-Moliz, Maria Teresa; Perez-Heredia, Mercedes; Ferrer-Luque, Carmen Maria

2014-11-01

The aim of this study was to compare the efficacy of different dentine adhesives in delaying the coronal bacterial leakage of Enterococcus faecalis in filled root canals. Materials and methods. Ninety-five lower incisors of patients >65 years of age were instrumented using the ProTaper system and were irrigated with 1 mL of 2.5% sodium hypochlorite (NaOCl) alternated with 1 mL 17% EDTA between each file change. Final irrigation was performed with 5 mL of 17% EDTA and then flushed with 5 mL of distilled water. The teeth were randomly divided into five experimental groups (n = 15/group) and one of the following dentine adhesives was applied: (1) AdheSE; (2) Excite DSC; (3) Clearfil Protect Bond; (4) One Coat 7.0; or (5) Control group without adhesive. After filling the root canals, the samples were mounted on a double chamber device to evaluate the bacterial filtration of E. faecalis during a period of 240 days. The results underwent non-parametric Kaplan-Meier survival analysis and comparisons among groups were done using the Log-Rank test. At 240 days, E. faecalis was detected in samples of all groups in the lower chamber. The highest survival value was obtained by One Coat 7.0, giving statistically significant differences from the other groups, whereas Clearfil Protect Bond, AdheSE and Excite DSC showed similar behaviours, likewise similar to the Control group. One Coat 7.0 adhesive system provides the longest survival value to delay E. faecalis coronal leakage in filled root canals.

Regenerative endodontics--biologically-based treatment for immature permanent teeth: a case report and review of the literature.

PubMed

Thomson, A; Kahler, B

2010-12-01

A paradigm shift in the treatment of immature, necrotic teeth has occurred with biologically-based principles and regenerative endodontic protocols replacing traditional 'apexification' procedures. Preliminary research suggests that stem and progenitor cells from the pulp and/or periodontium contribute to continued root development when regenerative procedures are followed. A mandibular premolar tooth with a chronic periapical abscess was irrigated with sodium hypochlorite with minimal instrumentation and then dressed with tri-antibiotic paste consisting of ciprofloxacin, metronidazole and amoxicillin. At a subsequent visit a blood clot was evoked in the canal by irritating periapical tissues and the canal sealed with mineral trioxide aggregate, glass ionomer cement and composite resin. Resolution of apical periodontitis and the draining sinus, continued root maturation and apical closure occurred over an 18-month period. The tooth became responsive to pulp sensibility testing. It is important that dentists recognize the potential of regenerative endodontics in the treatment of necrotic, immature teeth. Initial management should involve irrigation with sodium hypochlorite only. Intra-canal medicaments, such as calcium hydroxide, are contraindicated as they inhibit further root growth. This report uses a variation of the tri-antibiotic paste currently recommended for regenerative procedures that avoided the discolouration of the crown associated with current protocols. Regenerative endodontics with continued root growth may reduce the risk of fracture and premature tooth loss associated with traditional 'apexification' procedures where the root remains thin and weak. © 2010 Australian Dental Association.

1064-nm Nd:YAG and 980-nm Diode Laser EDTA Agitation on the Retention of an Epoxy-Based Sealer to Root Dentin.

PubMed

Macedo, Helena Suleiman de; Messias, Danielle Cristine Furtado; Rached-Júnior, Fuad Jacob; Oliveira, Ligia Teixeira de; Silva-Sousa, Yara Teresinha Correa; Raucci-Neto, Walter

2016-01-01

Root canal irrigants are used to minimize the negative effects of smear layer on endodontic sealer retention. The aim of this study was to evaluate the efficacy of agitation of 17% ethylenediaminetetraacetic acid (EDTA) with ultrasonic, 1064-nm Nd:YAG and 980-nm diode laser on the retention of an epoxy-based sealer to the root canal walls. Forty single-rooted bovine teeth were instrumented with ProTaper rotary system and divided into four groups according to the final irrigation protocol (n = 10): (1) 17% EDTA (control); (2) 17% EDTA with 50-s ultrasonic agitation; (3) 17% EDTA with 50-s diode laser (2-W) agitation; and (4) 17% EDTA with 50-s Nd:YAG (1.5-W) laser agitation. After endodontic filling with gutta-percha F5 master cone and Sealer 26, the roots were sectioned at the cervical, middle, and apical root thirds to obtain 1.5-mm slices. Push-out tests were performed using a universal testing machine at a 1 mm/min crosshead speed. Data were analyzed using two-way ANOVA and Tukey's tests (α=0.05). Apical root thirds had significant higher retention values than cervical and middle thirds (p < 0.05). EDTA with 1064-nm Nd:YAG or 980-nm diode laser presented the highest retention values and was significantly different from EDTA with ultrasonic agitation and EDTA only (p < 0.05). Adhesive failures were predominant to EDTA only group. Mixed failures were predominant to all agitation groups. 1064-nm Nd:YAG and 980-nm diode laser EDTA agitation enhanced the retention of the epoxy-based sealer to the root canal walls compared with that due to EDTA only or EDTA with ultrasonic agitation.

[Influence of the root canal instrumentation size on the disinfection of intracanal microbe by Er:YAG laser].

PubMed

Xu, Xue-song; Zhu, Ya-qin

2015-12-01

To evaluate the influence of different root canal instrumentation size on disinfection of intracanal microbe of dental root canal. 368 extracted human anterior teeth with single straight root were randomly divided into 8 groups of 46 roots in each. They were instrumented with K3 Ni-Ti files as follows: group A1 and group B1(#25/0.06), group A2 and group B2(#30/0.06), group A3 and group B3(#35/0.06), group A4 and group B4(#40/0.06). After being prepared and sterilized by autoclaving, group A was inoculated with Enterococcus faecalis, and group B was inoculated with Candida albicans. All groups were irrigated with Er:YAG laser combination of 3% NaOCl, 17% EDTA and 0.9% saline, and then the numbers of microbe on the surface of root canal walls were counted after the treatment, the absolute reduction of counting colony forming units(CFUs) and the relative residual rate of CFUs in the individual group was determined. The Date was analyzed with GraphPad Prism 5.02 software package by one-way analysis of variance. Levels of disinfection on E.faecalis and C.albicans increased when root canals were enlarged; #40/0.06 showed the best disinfection, #35/0.06 showed a significantly better disinfection than #30/0.06 and #25/0.06. Substantial reduction of microbe was obtained in #35/0.06 and #40/0.06 compared with #25/0.06 and #30/0.06(P<0.05). Within the root canal size of #25/0.06-#40/0.06, under the conditions of Er:YAG laser combination of 3% NaOCl, 17% EDTA and 0.9% saline, it was concluded that the reduction of E.faecalis and C.albicans of the anterior straight root canals could be predicted by increasing the root canal instrumentation size large than #30/0.06.

Antibacterial properties of silver nanoparticles as a root canal irrigant against Enterococcus faecalis biofilm and infected dentinal tubules.

PubMed

Rodrigues, C T; de Andrade, F B; de Vasconcelos, L R S M; Midena, R Z; Pereira, T C; Kuga, M C; Duarte, M A H; Bernardineli, N

2018-02-03

To evaluate the antimicrobial action of an irrigant containing silver nanoparticles in an aqueous vehicle (AgNp), sodium hypochlorite and chlorhexidine against Enterococcus faecalis biofilm and infected dentinal tubules. Bovine dentine blocks were used for E. faecalis biofilm development for 21 days and irrigated with 94 ppm AgNp solution, 2.5% NaOCl and 2% chlorhexidine for 5, 15 and 30 min. For infection of dentinal tubules with E. faecalis, dentine specimens from bovine incisors were submitted to a contamination protocol over 5 days, with eight centrifugation cycles on every alternate day, and irrigated with the same solutions and time intervals used for the biofilm. The specimens were stained with the Live/Dead technique and evaluated using a confocal laser scanning microscope (CLSM). The bioImage_L software was used for measurement of the total biovolume of biofilm in μm 3 and percentage of viable bacteria (green cells) in biofilm and in dentinal tubules found after the irrigation. Statistical analyses were performed using Kruskal-Wallis and Dunn's tests for quantification of viable cells in biofilm, the Friedman test for comparisons of viable bacteria in dentinal tubules in different areas of the root canal and the Mann-Whitney U-test to compare the action of the irrigants between the two methods (P < 0.05). The AgNp solution eliminated fewer bacteria, but was able to dissolve more biofilm compared with chlorhexidine (P < 0.05). NaOCl had the greatest antimicrobial activity and biofilm dissolution capacity. AgNp solution had less antimicrobial action in infected dentinal tubules compared with NaOCl (P < 0.05). The AgNp solution after 5 min was more effective in eliminating planktonic bacteria in dentinal tubules than in biofilm, but at 30 min fewer viable bacteria were observed in the biofilm compared with intratubular dentine (P < 0.05). AgNp irrigant was not as effective against E. faecalis compared to solutions commonly used in root canal treatment. NaOCl is appropriate as an irrigant because it was effective in disrupting biofilm and in eliminating bacteria in biofilms and in dentinal tubules. © 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Continued root maturation despite persistent apical periodontitis of immature permanent teeth after failed regenerative endodontic therapy.

PubMed

Lin, Louis M; Kim, Sahng G; Martin, Gabriela; Kahler, Bill

2018-01-16

Three immature permanent teeth with pulp necrosis and apical periodontitis were treated with regenerative endodontic therapy (RET), which included root canal disinfection with sodium hypochlorite irrigation, intra-canal medication with calcium hydroxide paste, 17% EDTA rinse, induction of periapical bleeding into the canal, collagen matrix and MTA coronal seal, and composite resin restoration of access cavities. After different periods of follow-up, it was observed that continued root maturation, especially apical closure occurred despite persistent apical periodontitis of immature permanent teeth after failed RET. This finding is of interest as the secondary goal of further root maturation occurred despite failure of the primary goal of elimination of clinical symptom/sign and periapical inflammation. The possible biological mechanisms that could allow for further root maturation to occur in spite of persistent root canal infection of immature permanent teeth are discussed. Based on these observations, the biology of wound healing of immature permanent teeth after injury is not fully understood and should be further investigated. This case report demonstrates that whilst further root maturation is considered a successful outcome for teeth treated with RET, the primary objective must be the resolution of the signs and symptoms of apical periodontitis. © 2018 Australian Society of Endodontology Inc.

Smear layer removal and canal cleanliness using different irrigation systems (EndoActivator, EndoVac, and passive ultrasonic irrigation): field emission scanning electron microscopic evaluation in an in vitro study.

PubMed

Mancini, Manuele; Cerroni, Loredana; Iorio, Lorenzo; Armellin, Emiliano; Conte, Gabriele; Cianconi, Luigi

2013-11-01

The purpose of this study was to evaluate the effectiveness of different irrigating methods in removing the smear layer at 1, 3, 5, and 8 mm from the apex of endodontic canals. Sixty-five extracted single-rooted human mandibular premolars were decoronated to a standardized length of 16 mm. Specimens were shaped to ProTaper F4 (Dentsply Maillefer, Ballaigues, Switzerland) and irrigated with 5.25% NaOCl at 37°C. Teeth were divided into 5 groups (2 control groups [n = 10] and 3 test groups [n = 15]) according to the final irrigant activation/delivering technique (ie, sonic irrigation, passive ultrasonic irrigation [PUI], or apical negative pressure). Root canals were then split longitudinally and observed by field emission scanning electron microscopy. The presence of debris and a smear layer at 1, 3, 5, and 8 mm from the apex was evaluated. Scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests. The EndoActivator System (Dentsply Tulsa Dental Specialties, Tulsa, OK) was significantly more efficient than PUI and the control groups in removing the smear layer at 3, 5, and 8 mm from the apex. The EndoVac System (Discus Dental, Culver City, CA) removed statistically significantly more smear layer than all groups at 1, 3, 5, and 8 mm from the apex. At 5 and 8 mm from the apex, PUI and the EndoVac did not differ statistically significantly, but both performed statistically better than the control groups. In our study, none of the activation/delivery systems completely removed the smear layer from the endodontic dentine walls; nevertheless, the EndoActivator and EndoVac showed the best results at 3, 5, and 8 mm (EndoActivator) and 1, 3, 5, and 8 mm (EndoVac) from the apex. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

One-appointment endodontic therapy: biological considerations.

PubMed

Lin, Louis M; Lin, Jarshen; Rosenberg, Paul A

2007-11-01

The authors conducted a literature review to present the best available biological evidence concerning one-appointment endodontic therapy for asymptomatic teeth with apical periodontitis. Because of recent advances in technology, such as rotary engines and nickel-titanium instruments, some practitioners are performing one-appointment endodontic therapy for asymptomatic teeth with apical periodontitis. The authors reviewed the literature, which revealed only a small number of randomized, controlled clinical trials that have been conducted on one-appointment versus multiple-appointment endodontic therapy. As the apical canal preparation is enlarged, a greater percentage of bacteria is eradicated from infected root canals. In addition, sufficiently large apical root canal enlargement facilitates the delivery of antimicrobial irrigant to the apical portion of the canal. However, an association between positive or negative preobturation root canal culture results and the outcome of endodontic treatment has not been well-established. The best available evidence, based on a systematic literature review, indicates that one-appointment endodontic therapy may be feasible in selected cases of apical periodontitis in asymptomatic teeth. However, additional randomized, controlled clinical trials are required.

Effects of NaOCl, EDTA and MTAD when applied to dentine on stress distribution in post-restored roots with flared canals.

PubMed

Belli, S; Eraslan, O; Eraslan, O; Eskitascioglu, M; Eskitascioglu, G

2014-12-01

To evaluate the effect of NaOCl, EDTA and MTAD on the stress distribution and levels in roots with flared canals and three different aesthetic post systems using finite element stress analysis (FEA). Three-dimensional (3D) FEA models simulating a maxillary incisor with excessive structural loss and flared root canals were created. The dentine of the first models of each post group was assumed as homogenous, whereas the others were deemed as having their elastic modulus affected up to 100 μm deep as a result of irrigation protocol (5.25 NaOCl, 17% EDTA and MTAD for 2 h). A sound incisor tooth model was used as the control. Restorations were created according to the post system used (pre-fabricated fibre post (PFP)), polyethylene fibre (Ribbond) post and core build-up (RBP), and one-piece milled zirconia post and core (ZP). Ceramic crowns were added to the models. A 300-N static load was applied at the centre of the palatal surface of the models to calculate the stress distributions. The SolidWorks/Cosmosworks structural analysis programmes were used for FEA analysis. Results were presented by considering von Mises criteria. The analysis of the von Mises stresses revealed that RBP created less stress in the remaining root dentine when compared to PFP and ZP. ZP maintained the stresses inside its body and reduced stress on the palatal surface of the root; however, it forwarded more stress towards the apical area. NaOCl-, EDTA- and MTAD-treated dentine increased the stresses within the root structure regardless of the effect of the post system used (11-15.4 MPa for PFP, 9.5-13.02 MPa for RBP and 14.2 MPa for ZP). Amongst the irrigation solutions used, EDTA and MTAD increased the stresses more than NaOCl in all models. All the irrigation solutions showed the same stress levels and distributions in the ZP model. NaOCl-, EDTA- and MTAD- treated dentine and a rigid post with high elastic modulus may increase fracture risk in roots with flared canals by increasing the stresses within root dentine. Therefore, solutions that alter the elastic modulus of dentine less (such as NaOCl) or an individually shaped post-core system constructed with a material that has an elastic modulus close to dentine (polyethylene fibre) should be used in weak roots. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Antimicrobial Photodynamic Therapy Combined With Conventional Endodontic Treatment to Eliminate Root Canal Biofilm Infection

PubMed Central

Garcez, Aguinaldo S.; Ribeiro, Martha S.; Tegos, George P.; Núñez, Silvia C.; Jorge, Antonio O.C.; Hamblin, Michael R.

2011-01-01

Background and Objective To compare the effectiveness of antimicrobial photodynamic therapy (PDT), standard endodontic treatment and the combined treatment to eliminate bacterial biofilms present in infected root canals. Study Design/Materials and Methods Ten single-rooted freshly extracted human teeth were inoculated with stable bioluminescent Gram-negative bacteria, Proteus mirabilis and Pseudomonas aeruginosa to form 3-day biofilms in prepared root canals. Bioluminescence imaging was used to serially quantify bacterial burdens. PDT employed a conjugate between polyethylenimine and chlorin(e6) as the photosensitizer (PS) and 660-nm diode laser light delivered into the root canal via a 200-µ fiber, and this was compared and combined with standard endodontic treatment using mechanical debridement and antiseptic irrigation. Results Endodontic therapy alone reduced bacterial bioluminescence by 90% while PDT alone reduced bioluminescence by 95%. The combination reduced bioluminescence by >98%, and importantly the bacterial regrowth observed 24 hours after treatment was much less for the combination (P<0.0005) than for either single treatment. Conclusions Bioluminescence imaging is an efficient way to monitor endodontic therapy. Antimicrobial PDT may have a role to play in optimized endodontic therapy. PMID:17066481

Root canal penetration of a sodium hypochlorite mixture using sonic or ultrasonic activation.

PubMed

Sáinz-Pardo, Marta; Estevez, Roberto; Pablo, Óliver Valencia de; Rossi-Fedele, Giampiero; Cisneros, Rafael

2014-01-01

The purpose of this ex vivo study was to determine, in "open" and "closed" systems, whether the design has an influence on the penetration length of sodium hypochlorite mixed with a radiopaque contrast medium, measured in millimeters, when delivered using positive pressure (PP) and using sonic (SI) or passive ultrasonic (PUI) activation. Sixty single-rooted teeth were divided into two groups: open and closed systems (n=30). Root canal shaping was performed to a working length of 17 mm. The samples were divided into three sub-groups (n=10) according to irrigant delivery and activation: PP, and SI or PUI activation. By using radiographs, penetration length was measured, and vapor lock was assessed. For the closed group, the penetration distance means were: PP 15.715 (±0.898) mm, SI 16.299 (±0.738) mm and PUI 16.813 (±0.465) mm, with vapor lock occurring in 53.3% of the specimens. In the open group, penetration to 17 mm occurred in 97.6% of the samples, and no vapor lock occurred. Irrigant penetration and distribution evaluation using open and closed systems provide significantly different results. For closed systems, PUI is the most effective in delivering the irrigant to working length, followed by SI.

In vitro evaluation of the accuracy of five different electronic apex locators for determining the working length of endodontically retreated teeth.

PubMed

Ebrahim, Aqeel Khalil; Wadachi, Reiko; Suda, Hideaki

2007-04-01

The aim of this study was to evaluate the accuracy of five electronic apex locators (EALs) in determining the working length (WL) of teeth after removal of the root canal obturation materials. A total of 32 extracted straight, single-rooted teeth were used. The actual canal length (AL) was determined and the WL was established by subtracting 0.5 mm from the AL. The root canals were instrumented and divided into two groups. One group (n = 6) served as control, while the other group (n = 26) was the experimental group. In the experimental group, the root canals were obturated using vertically compacted gutta-percha with AH 26 sealer. In both groups, the access cavities were restored with a provisional restoration and stored for 15 days at 37 degrees C and 100% humidity. The root canal obturation material was removed, and the teeth were then mounted in an experimental apparatus. Five EALs were used: Dentaport ZX, ProPex, Foramatron D10, Apex NRG and Apit 7. For the electronic measurement of canal length, a size 25 K-file was used. During measurement, the canal was irrigated with 2.5% sodium hypochlorite. The difference (D) between the AL and the electronically determined length (EDL), AL-EDL, was calculated and recorded for each measurement. Data were analysed by two-way anova and Fisher's PLSD test. In both groups, statistically significant differences were found among the EALs (P < 0.01). In conclusion, the Dentaport ZX, ProPex and Foramatron D10 were more accurate than the other two EALs in determining the WL in teeth after removal of the root canal obturation materials. However, the Apex NRG and Apit 7 were also reliable for determination of the WL in the majority of the cases.

Cleaning lateral morphological features of the root canal: the role of streaming and cavitation.

PubMed

Robinson, J P; Macedo, R G; Verhaagen, B; Versluis, M; Cooper, P R; van der Sluis, L W M; Walmsley, A D

2018-01-01

To investigate the effects of ultrasonic activation file type, lateral canal location and irrigant on the removal of a biofilm-mimicking hydrogel from a fabricated lateral canal. Additionally, the amount of cavitation and streaming was quantified for these parameters. An intracanal sonochemical dosimetry method was used to quantify the cavitation generated by an IrriSafe 25 mm length, size 25 file inside a root canal model filled with filtered degassed/saturated water or three different concentrations of NaOCl. Removal of a hydrogel, demonstrated previously to be an appropriate biofilm mimic, was recorded to measure the lateral canal cleaning rate from two different instruments (IrriSafe 25 mm length, size 25 and K 21 mm length, size 15) activated with a P5 Suprasson (Satelec) at power P8.5 in degassed/saturated water or NaOCl. Removal rates were compared for significant differences using nonparametric Kruskal-Wallis and/or Mann-Whitney U-tests. Streaming was measured using high-speed particle imaging velocimetry at 250 kfps, analysing both the oscillatory and steady flow inside the lateral canals. There was no significant difference in amount of cavitation between tap water and oversaturated water (P = 0.538), although more cavitation was observed than in degassed water. The highest cavitation signal was generated with NaOCl solutions (1.0%, 4.5%, 9.0%) (P < 0.007) and increased with concentration (P < 0.014). The IrriSafe file outperformed significantly the K-file in removing hydrogel (P < 0.05). Up to 64% of the total hydrogel volume was removed after 20 s. The IrriSafe file typically outperformed the K-file in generating streaming. The oscillatory velocities were higher inside the lateral canal 3 mm compared to 6 mm from WL and were higher for NaOCl than for saturated water, which in turn was higher than for degassed water. Measurements of cavitation and acoustic streaming have provided insight into their contribution to cleaning. Significant differences in cleaning, cavitation and streaming were found depending on the file type and size, lateral canal location and irrigant used. In general, the IrriSafe file outperformed the K-file, and NaOCl performed better than the other irrigants tested. The cavitation and streaming measurements revealed that both contributed to hydrogel removal and both play a significant role in root canal cleaning. © 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.

A Review of Antibacterial Agents in Endodontic Treatment

PubMed Central

Rahimi, Saeed; Janani, Maryam; Lotfi, Mehrdad; Shahi, Shahriar; Aghbali, Amirala; Vahid Pakdel, Mahdi; Salem Milani, Amin; Ghasemi, Negin

2014-01-01

Microorganisms play a major role in initiation and perpetuation of pulpal and periapical diseases. Therefore, elimination of the microorganisms present in the root canal system is the fundamental objective of endodontic treatment. The use of mechanical debridement, chemical irrigation or other antimicrobial protocols and intra-canal medicaments are critical to attain this goal. The aim of this article was to review the antimicrobial agents and their properties in endodontics. PMID:25031587

Evaluation of Apical Extrusion of Debris and Irrigant Using Two New Reciprocating and One Continuous Rotation Single File Systems

PubMed Central

Nayak, Gurudutt; Singh, Inderpreet; Shetty, Shashit; Dahiya, Surya

2014-01-01

Objective: Apical extrusion of debris and irrigants during cleaning and shaping of the root canal is one of the main causes of periapical inflammation and postoperative flare-ups. The purpose of this study was to quantitatively measure the amount of debris and irrigants extruded apically in single rooted canals using two reciprocating and one rotary single file nickel-titanium instrumentation systems. Materials and Methods: Sixty human mandibular premolars, randomly assigned to three groups (n = 20) were instrumented using two reciprocating (Reciproc and Wave One) and one rotary (One Shape) single-file nickel-titanium systems. Bidistilled water was used as irrigant with traditional needle irrigation delivery system. Eppendorf tubes were used as test apparatus for collection of debris and irrigant. The volume of extruded irrigant was collected and quantified via 0.1-mL increment measure supplied on the disposable plastic insulin syringe. The liquid inside the tubes was dried and the mean weight of debris was assessed using an electronic microbalance. The data were statistically analysed using Kruskal-Wallis nonparametric test and Mann Whitney U test with Bonferroni adjustment. P-values less than 0.05 were considered significant. Results: The Reciproc file system produced significantly more debris compared with OneShape file system (P<0.05), but no statistically significant difference was obtained between the two reciprocating instruments (P>0.05). Extrusion of irrigant was statistically insignificant irrespective of the instrument or instrumentation technique used (P >0.05). Conclusions: Although all systems caused apical extrusion of debris and irrigant, continuous rotary instrumentation was associated with less extrusion as compared with the use of reciprocating file systems. PMID:25628665

Effect of sodium hypochlorite irrigation with or without surfactants on the bond strength of an epoxy-based sealer to dentin.

PubMed

Guneser, Mehmet Burak; Arslan, Dilara; Dincer, Asiye Nur; Er, Gamze

2017-05-01

This study evaluated the effect of sodium hypochlorite (NaOCl) irrigation with or without surfactants on the bond strength of an epoxy-based sealer to the root canal dentin. Eighty decoronated single-rooted human mandibular premolars were instrumented using the rotary system. The roots were subsequently rinsed with 5 ml 17 % EDTA for 1 min and then randomly divided into 3 test groups (n = 20) and 1 control group (n = 20) according to the type of irrigation with experimental 5 % NaOCl (Wizard, RehberKimya, Istanbul, Turkey) solutions: Group 1: NaOCl-0.1 % benzalkonium chloride; Group 2: NaOCl-0.1 % Tween 80; Group 3: NaOCl-0.1 % Triton X-100; control group: NaOCl without any surfactants. Five samples from each group were prepared for scanning electron microscopy to examine the surface of root canal dentin. The 15 samples remaining in each group were obturated with gutta-percha and AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany) using the cold lateral compaction technique. A push-out test was used to measure the bond strength between the sealer and root canal dentin. Data were analyzed using two-way analysis of variance and Tukey's post hoc tests (P = 0.05). The NaOCl-0.1 % Triton X-100 group demonstrated the highest mean bond-strength values in all root thirds among the groups (P < 0.05). However, the bond strength of the sealer in the NaOCl-0.1 % benzalkonium chloride and NaOCl-0.1 % Tween 80 groups did not differ from that in the control group (P > 0.05). Additionally, the bond-strength values decreased in the corono-apical direction for all groups (P < 0.05). NaOCl solution with Triton X-100 can provide higher bond strength of the epoxy resin-based sealer to root dentin compared to NaOCl solution wiithout any surfactant. The bond strength of sealer to dentin can be improved by the addition of the surfactants to NaOCl solution.

A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health.

PubMed

Ng, Y-L; Mann, V; Gulabivala, K

2011-07-01

To investigate the probability of and factors influencing periapical status of teeth following primary (1°RCTx) or secondary (2°RCTx) root canal treatment. This prospective study involved annual clinical and radiographic follow-up of 1°RCTx (1170 roots, 702 teeth and 534 patients) or 2°RCTx (1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2-4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error. proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P ≤ 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2°RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of root-filling extrusion (P ≤ 0.001); and presence of a satisfactory coronal restoration (P ≤ 0.001). Success based on periapical health associated with roots following 1°RCTx (83%) or 2°RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor 'EDTA as an additional irrigant' had different effects on the two treatments. © 2011 International Endodontic Journal.

Comparison of sealer penetration using the EndoVac irrigation system and conventional needle root canal irrigation.

PubMed

Kara Tuncer, Aysun; Unal, Bayram

2014-05-01

The aim of this study was to compare the effect of the EndoVac irrigation system (SybronEndo, Orange, CA) and conventional endodontic needle irrigation on sealer penetration into dentinal tubules. Forty single-rooted, recently extracted human maxillary central incisors were randomly divided into 2 groups according to the irrigation technique used: conventional endodontic needle irrigation and EndoVac irrigation. All teeth were instrumented using the ProFile rotary system (Dentsply Maillefer, Ballaigues, Switzerland) and obturated with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) labeled with fluorescent dye. Transverse sections at 1, 3, and 5 mm from the root apex were examined using confocal laser scanning microscopy. The total percentage and maximum depth of sealer penetration were then measured. Mann-Whitney test results showed that EndoVac irrigation resulted in a significantly higher percentage of sealer penetration than conventional irrigation at both the 1- and 3-mm levels (P < .05). However, no difference was found at the 5-mm level. The 5-mm sections in each group showed a significantly higher percentage and maximum depth of sealer penetration than did the 1- and 3-mm sections (P < .05). The EndoVac irrigation system significantly improved the sealer penetration at the 1- to 3-mm level over that of conventional endodontic needle irrigation. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Entrococcus faecalis Elimination in Root Canals Using Silver Nanoparticles, Photodynamic Therapy, Diode Laser, or Laser-activated Nanoparticles: An In Vitro Study.

PubMed

Afkhami, Farzaneh; Akbari, Saba; Chiniforush, Nasim

2017-02-01

The aim of this study was to compare the efficacy of silver nanoparticles (AgNPs), an 810-nm diode laser (DL), conventional photodynamic therapy (PDT) with the use of indocyanine green (ICG) photosensitizer, and modified PDT with the use of AgNPs for the disinfection of root canals inoculated with Enterococcus faecalis. The root canals of 65 extracted human single-rooted teeth were prepared, and E. faecalis was incubated in the root canals for 4 weeks. The teeth were then randomly divided into the following 4 experimental groups: the DL group: 810-nm DL irradiation (1 W, 4 times for 10 seconds), the AN group: 5 minutes of irrigation with 5 mL AgNPs (100 ppm), the ICG/DL group: conventional PDT with ICG (1 mg/mL)/810-nm DL (200 mW, 30 seconds), and the AN/ICG/DL group: modified PDT with AgNPs/ICG/810-nm DL (200 mW, 30 seconds). There was also a control group, which consisted of 5 minutes of irrigation with 5 mL 2.5% sodium hypochlorite (n = 9). Samples were obtained from dentin chips before and after the interventions. A reduction in colony count was assessed by counting the colony-forming units. Significant reductions were noted in E. faecalis colony counts in all groups (P < .05). The greatest reduction in colony count (99.12%) was noted in the AN/ICG/DL group (AgNPs/ICG/810-nm diode laser); however, the differences in this respect between the AN/ICG/DL group and the DL (97.41%), AN (94.42%), and control groups (94.61%) were not significant (P > .05). PDT with ICG, an 810-nm diode laser, and AgNPs has the potential to be used as an adjunct for disinfection of the root canal system. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

A Comparative SEM Investigation of Smear Layer Remaining on Dentinal Walls by Three Rotary NiTi Files with Different Cross Sectional Designs in Moderately Curved Canals

PubMed Central

Kakkar, Pooja; Vats, Asit

2015-01-01

Objective: The objective of this study was to compare the smear layer formed on root canal walls during canal preparation of extracted human teeth by Twisted, Mtwo, and ProTaper rotary nickel titanium instruments. Materials and Methods: Sixty single rooted human premolar teeth with root curvature <250 were selected and randomly divided into three Groups (n= 20 teeth per Group). Three types of rotary nickel titanium instruments were used, Twisted (SybronEndo, Orange, CA, USA), Mtwo (VDW, Munich, Germany) and ProTaper (Dentsply Maillefer, Ballaigues, Switzerland) according to manufacturer’s instructions to instrument the root canals. Irrigation for all groups was performed after each instrument change with 3ml of 3% sodium hypochlorite followed by Glyde (File Prep, Dentsply, Maillefer, Ballaigues, Switzerland) as chelator paste and lubricant. Three different areas (coronal, middle and apical thirds) of the root canal were evaluated using scanning electron microscopy (SEM). The canal wall of each sample was assessed and compared using a predefined scale for the presence or absence of smear layer. Data were analysed statistically using ANOVA and Tukey HSD test Results: All three groups showed statistically significant more smear layer in the apical thirds of the canal as compared to the coronal and middle thirds (p<0.001). Mtwo rotary file system produced significantly less smear layer (p<0.001) compared to Twisted and ProTaper rotary instruments in the apical portion. Twisted Files resulted in less smear layer formation in the apical thirds of the canal compared to ProTaper rotary instruments but were statistically insignificant. Conclusion: Completely clean root canals were not found after instrumentation with any of the three instruments. Under the confines of this study Mtwo instruments produced significantly cleaner dentin wall surfaces throughout the canal length in comparison to Twisted and ProTaper rotary files. Twisted Files proved to be comparable to ProTaper rotary instruments with respect to canal cleanliness in the apical thirds of the root canal. PMID:25954704

Effect of dentin powder on the antimicrobial properties of hyperpure chlorine-dioxide and its comparison to conventional endodontic disinfecting agents.

PubMed

Herczegh, Anna; Gyurkovics, Milán; Ghidan, Ágoston; Megyesi, Marianna; Lohinai, Zsolt

2014-06-01

Previously we found that the high purity chlorine-dioxide(ClO2) has a very potent disinfectant efficacy on oral pathogenic microorganisms and as a root canal irrigant it is able to eliminate the experimental Enterococcus faecalis(E. faecalis) infection from the root canal system. This study examines whether the presence of dentin powder influences the antibacterial efficacy of ClO 2. In an in vitro dentin powder model the following irrigants were tested against planktonic E. faecalis: 2% chlorhexidine (CHX), 2.5% sodium hypochlorite (NaOCl), 0.12%ClO2 (Solumium) and one local root canal medicament: saturated Ca(OH)2. Survival of bacteria exposed to agents without and with human dentin powder or preincubated with dentin powder was investigated. The effect of the dentin powder on ClO2 concentration was investigated by titrations. Without dentin powder ClO 2 killed all E. faecalis and delivered the best result already after 1 minute; however, after longer contact time with dentin the difference between the disinfectants disappeared. The presence of dentin powder decreased the concentration of ClO 2 and attenuated the antibacterial efficiency of ClO2 and Ca(OH)2, but did not decrease of CHX and NaOCl.Preincubation with dentin powder caused significant loss of antibacterial activity of all investigated agents, ClO2 and Ca(OH)2 having the highest reduction. As the presence of dentin powder had a negative effect on the efficacy of disinfectants, the importance of elimination of dentin scrapings and smear layer from the root canal system during endodontic treatments is highly recommended. ClO 2 can be effective for a final rinse.

Mineral content analysis of root canal dentin using laser-induced breakdown spectroscopy

PubMed Central

2018-01-01

Objectives This study aimed to introduce the use of laser-induced breakdown spectroscopy (LIBS) for evaluation of the mineral content of root canal dentin, and to assess whether a correlation exists between LIBS and scanning electron microscopy/energy dispersive spectroscopy (SEM/EDS) methods by comparing the effects of irrigation solutions on the mineral content change of root canal dentin. Materials and Methods Forty teeth with a single root canal were decoronated and longitudinally sectioned to expose the canals. The root halves were divided into 4 groups (n = 10) according to the solution applied: group NaOCl, 5.25% sodium hypochlorite (NaOCl) for 1 hour; group EDTA, 17% ethylenediaminetetraacetic acid (EDTA) for 2 minutes; group NaOCl+EDTA, 5.25% NaOCl for 1 hour and 17% EDTA for 2 minutes; a control group. Each root half belonging to the same root was evaluated for mineral content with either LIBS or SEM/EDS methods. The data were analyzed statistically. Results In groups NaOCl and NaOCl+EDTA, the calcium (Ca)/phosphorus (P) ratio decreased while the sodium (Na) level increased compared with the other groups (p < 0.05). The magnesium (Mg) level changes were not significant among the groups. A significant positive correlation was found between the results of LIBS and SEM/EDS analyses (r = 0.84, p < 0.001). Conclusions Treatment with NaOCl for 1 hour altered the mineral content of dentin, while EDTA application for 2 minutes had no effect on the elemental composition. The LIBS method proved to be reliable while providing data for the elemental composition of root canal dentin. PMID:29487841

Ultrastructural analysis of root canal dentine irradiated with 980-nm diode laser energy at different parameters.

PubMed

Marchesan, Melissa Andréia; Brugnera-Junior, Aldo; Souza-Gabriel, Aline Evangelista; Correa-Silva, Silvio Rocha; Sousa-Neto, Manoel D

2008-06-01

The purpose of this in vitro study was to investigate using the scanning electron microscope (SEM) the ultrastructural morphological changes of the radicular dentine surface after irradiation with 980-nm diode laser energy at different parameters and angles of incidence. There have been limited reports on the effects of diode laser irradiation at 980 nm on radicular dentin morphology. Seventy-two maxillary canines were sectioned and roots were biomechanically prepared using K3 rotary instruments. The teeth were irrigated with 2 mL of distilled water between files and final irrigation was performed with 10 mL of distilled water. The teeth were then randomly divided into five groups (n = 8 each) according to their diode laser parameters: Group 1: no irradiation (control); group 2: 1.5 W/continuous wave (CW) emission (the manufacturer's parameters); group 3: 1.5 W/100 Hz; group 4: 3 W/CW; and group 5: 3 W/100 Hz. Laser energy was applied with helicoid movements (parallel to the canal walls) for 20 sec. Eight additional teeth for each group were endodontically prepared and split longitudinally and irradiation was applied perpendicularly to the root surface. Statistical analysis showed no difference between the root canal thirds irradiated with the 980-nm diode laser, and similar results between the parameters 1.5 W/CW and 3 W/100 Hz (p > 0.05). When considering different output powers and delivery modes our results showed that changes varied from smear layer removal to dentine fusion.

Endodontic treatment of a maxillary lateral incisor with a perforating internal resorption by using cone beam computed tomography as a diagnostic aid: a case report.

PubMed

Takita, Toshiya; Tsurumachi, Tamotsu; Ogiso, Bunnai

2011-10-01

This case report presents the endodontic treatment of a maxillary right lateral incisor with a perforating internal resorption in a 50-year-old woman. Radiographically, internal resorption appears as a fairly uniform, radiolucent enlargement of the pulp canal and distortion of the original root canal outline. The use of cone beam computed tomography can help the clinician in making a confirmatory diagnosis and determining the treatment plan before undertaking the actual treatment. After cleaning the root canal space and the resorptive defect by mechanic instrumentation, irrigation, and interim calcium hydroxide dressing, the apical third canal was filled with a gutta-percha point by lateral condensation. The resorptive defect was filled with mineral trioxide aggregate. Follow-up radiographs at 3 years showed adequate repair of the resorption, and the tooth remained asymptomatic.

The Effect of Final Rinse Agitation with Ultrasonic or 808 nm Diode Laser on Coronal Microleakage of Root-canal Treated Teeth.

PubMed

Ramazani, Mohsen; Asnaashari, Mohammad; Ahmadi, Roghayyeh; Zarenejad, Nafiseh; Rafie, Alireza; Yazadani Charati, Jamshid

2018-01-01

This in vitro study aimed at comparing the effect of agitating the final irrigant solutions of root canal by ultrasonic or using 808 nm Diode laser on the apical seal of canal. A total of 90 extracted human maxillary central incisors were prepared up to size #45 and were randomly assigned to 4 experimental groups ( n =20) and two control groups ( n =5) respectively, as follows: I ): 3 mL of 5.25% NaOCl was agitated as final irrigant solution with ultrasonic for 30 sec. The ultrasonic tip was 1 mm shorter than the working length, II ): 3 mL of 5.25% NaOCl was agitated as final irrigant with 808 nm Diode laser for 30 sec. Fiber tip, placed in 1 mm shorter from working length was spirally moved coronally, III ): 3 mL of 17% EDTA was agitated as final irrigant with 808 nm Diode laser for 30 sec and was applied similar to group II, IV ): 3 mL of 17% EDTA was stimulated as final irrigant with ultrasonic for 30 sec and was applied similar to I. Apical seal was assessed by Dual Chamber technique using Bovine Serum Albumin protein. Kruskal-Wallis and Mann Whitney tests were used with significance level lower than 0.05% for statistical analysis. The average leakage in the negative control, positive control, and groups I, II, III, IV were: 0.00, 13.5±5.1, 1.72±2.9, 5.12±5.6, 3.36±3.7, 2.4±4.2, respectively. Statistical analysis showed significant difference between groups ( P <0.05). There was a significant difference between groups 1 and 2 in terms of protein leakage . Agitating 5.25% sodium hypochlorite solution as the final irrigant with ultrasonic is more effective in apical leakage reduction compared to other groups.

MTA apical plugs in the treatment of traumatized immature teeth with large periapical lesions.

PubMed

Cehreli, Zafer C; Sara, Sezgi; Uysal, Serdar; Turgut, Melek D

2011-02-01

This case report describes the management of a late-referral case of periapically involved, traumatized immature permanent incisors by endodontic treatment and the use of mineral trioxide aggregate (MTA) apical plugs. A 10-year-old boy was referred to the clinic with a chief complaint of pain in his maxillary central incisors, which had experienced subluxation trauma 2 years earlier. Periapical radiograph of the teeth showed incomplete root development with wide-open apices and large periradicular lesions. The canals were gently debrided using K-files in conjunction with 2.5% NaOCl irrigation and 2% chlorhexidine for final flush. The root canals became asymptomatic after employing the same endodontic regimen for three visits. MTA plugs were placed in the apical area of the root canals, and the rest of the canal space was obturated by warm compaction of gutta-percha and AH Plus sealer. Resolution of the large periapical lesions was observed 2 months after treatment. At 18 months, the periapical areas revealed radiographic evidence of bone healing. Following successful removal of the toxic content of the root canal, placement of MTA plugs resulted in both healing of the periradicular radiolucency and regeneration of the periapical tissue. © 2010 John Wiley & Sons A/S.

Efficacy of Two Irrigants Used with Self-Adjusting File System on Smear Layer: A Scanning Electron Microscopy Study.

PubMed

Genç Şen, Özgür; Kaya, Sadullah; Er, Özgür; Alaçam, Tayfun

2014-01-01

Mechanical instrumentation of root canals produces a smear layer that adversely affects the root canal seal. The aim of this study was to evaluate efficacy of MTAD and citric acid solutions used with self-adjusting file (SAF) system on smear layer. Twenty-three single-rooted human teeth were used for the study. Canals were instrumented manually up to a number 20 K file size. SAF was used to prepare the root canals. The following groups were studied: Group 1: MTAD + 5.25% NaOCl, Group 2: 20% citric acid + 5.25% NaOCl, and Group 3: Control (5.25% NaOCl). All roots were split longitudinally and subjected to scanning electron microscopy. The presence of smear layer in the coronal, middle, and apical thirds was evaluated using a five-score evaluation system. Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis. In the coronal third, Group 2 exhibited the best results and was statistically different froms the other groups (P < 0.05). There was not a significant difference among the three thirds of groups according to in-group comparisons (P > 0.05). The solutions used in Group 1 and 2 could effectively remove smear layer in most of the specimens. However, citric acid was more effective than MTAD in the three thirds of the canal.

Apices of maxillary premolars observed by swept source optical coherence tomography

NASA Astrophysics Data System (ADS)

Ebihara, Arata; Iino, Yoshiko; Yoshioka, Toshihiko; Hanada, Takahiro; Sunakawa, Mitsuhiro; Sumi, Yasunori; Suda, Hideaki

2015-02-01

Apicoectomy is performed for the management of apical periodontitis when orthograde root canal treatment is not possible or is ineffective. Prior to the surgery, cone beam computed tomography (CBCT) examination is often performed to evaluate the lesion and the adjacent tissues. During the surgical procedure, the root apex is resected and the resected surface is usually observed under dental operating microscope (DOM). However, it is difficult to evaluate the details and the subsurface structure of the root using CBCT and DOM. A new diagnostic system, swept source optical coherence tomography (SS-OCT), has been developed to observe the subsurface anatomical structure. The aim of this study was to observe resected apical root canals of human maxillary premolars using SS-OCT and compare the findings with those observed using CBCT and DOM. Six extracted human maxillary premolars were used. After microfocus computed tomography (Micro CT; for gold standard) and CBCT scanning of the root, 1 mm of the apex was cut perpendicular to the long axis of the tooth. Each resected surface was treated with EDTA, irrigated with saline solution, and stained with methylene blue dye. The resected surface was observed with DOM and SS-OCT. This sequence was repeated three times. The number of root canals was counted and statistically evaluated. There was no significant difference in the accuracy of detecting root canals among CBCT, DOM and SS-OCT (p > 0.05, Wilcoxon test). Because SS-OCT can be used in real time during surgery, it would be a useful tool for observing resected apical root canals.

A Scanning Electron Microscope Evaluation of Smear Layer Removal and Antimicrobial Action of Mixture of Tetracycline, Acid and Detergent, Sodium Hypochlorite, Ethylenediaminetetraacetic Acid, and Chlorhexidine Gluconate: An In vitro Study.

PubMed

Charlie, K M; Kuttappa, M A; George, Liza; Manoj, K V; Joseph, Bobby; John, Nishin K

2018-01-01

The main objective is to evaluate the efficiency in removal of smear layer of mixture of tetracycline, acid and detergent (MTAD), sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA) and chlorhexidine gluconate by scanning electron microscope (SEM) evaluation and also to evaluate the antimicrobial action of the same irrigants against standard culture strains of Enterococcus faecalis . This study included 60 extracted permanent teeth with single root canal. The sample was categorized into five groups with 12 teeth in each group. Root canals were enlarged till size 40 with K-files. One group was kept as control and irrigated only with saline. Other four groups used 5% NaOCl as irrigant during instrumentation and MTAD, 5% NaOCl, 17% EDTA, and 2% chlorhexidine gluconate as final rinse. Teeth were split and examined under SEM. To test the antibacterial action, the zone of inhibition method using agar plates was used. Obtained data were statistically analyzed by SPSS version 17 (SPSS Inc., Chicago, IL, USA). MTAD and 17% EDTA removed smear layer from all regions of the root canals. About 5% NaOCl and 2% chlorhexidine gluconate were ineffective in removing the smear layer. The mean zone of inhibition formed by the irrigants was in the following order; MTAD (40.5 mm), 2% chlorhexidine gluconate (29.375 mm), 17% EDTA (24.125 mm), 5% NaOCl (22.125 mm), and saline (zero). MTAD showed high smear layer removal efficacy, but no significant difference was found to that of 17% EDTA. As the dimensions of the zones of inhibition showed, MTAD has got highest antibacterial action against E. faecalis , followed by 2% chlorhexidine gluconate, 17% EDTA, and 5% NaOCl. However, the exact correlation of in vitro study results to clinical conditions is impossible due to the variables involved.

On the local applications of antibiotics and antibiotic-based agents in endodontics and dental traumatology.

PubMed

Mohammadi, Z; Abbott, P V

2009-07-01

Antibiotics are a valuable adjunctive to the armamentarium available to health professionals for the management of bacterial infections. During endodontic treatment and when managing trauma to the teeth, antibiotics may be applied systemically (orally and/or parenterally) or locally (i.e. intra-dentally via irrigants and medicaments). Due to the potential risk of adverse effects following systemic application, and the ineffectiveness of systemic antibiotics in necrotic pulpless teeth and the periradicular tissues, the local application of antibiotics may be a more effective mode for delivery in endodontics. The aim of this article was to review the history, rationale and applications of antibiotic-containing irrigants and medicaments in endodontics and dental traumatology. The search was performed from 1981 to 2008 and was limited to English-language papers. The keywords searched on Medline were 'Antibiotics AND endodontics', 'Antibiotics AND root canal irrigation', 'Antibiotics AND intra-canal medicament', 'Antibiotics AND Dental trauma' and 'Antibiotics AND root resorption'. The reference section of each article was manually searched to find other suitable sources of information. It seems that local routes of antibiotic administration are a more effective mode than systemic applications. Various antibiotics have been tested in numerous studies and each has some advantages. Tetracyclines are a group of bacteriostatic antibiotics with antibacterial substantivity for up to 12 weeks. They are typically used in conjunction with corticosteroids and these combinations have anti-inflammatory, anti-bacterial and anti-resorptive properties, all of which help to reduce the periapical inflammatory reaction including clastic-cell mediated resorption. Tetracyclines have also been used as part of irrigating solutions but the substantivity is only for 4 weeks. Clindamycin and a combination of three antibiotics (metronidazole, ciprofloxacin and minocycline) have also been reported to be effective at reducing bacterial numbers in the root canal systems of infected teeth.

Differences in disinfection protocols for root canal treatments between general dentists and endodontists: A Web-based survey.

PubMed

de Gregorio, Cesar; Arias, Ana; Navarrete, Natalia; Cisneros, Rafael; Cohenca, Nestor

2015-07-01

The purpose of this study was to determine whether differences exist in disinfection protocols between endodontists and general dentists. The authors sent an invitation to participate in a Web-based survey to 950 dentists affiliated with the Spanish Board of Dentistry. Participants responded to 9 questions about irrigation protocols and other factors related to disinfection during root canal therapy. A total of 238 (25.05%) study participants successfully completed and returned the surveys. Among these participants, 50% were general dentists and 50% were endodontists. The authors found no statistically significant differences in respondents' first choice of an irrigant solution (that is, sodium hypochlorite), but they noted statistically significant differences in the protocols used by general dentists and by endodontists in relation to the concentration of sodium hypochlorite (P = .0003), the use and type of irrigant used to remove the smear layer (P = 5.39 × 10(-10)), the use of adjuncts to irrigation (P = 5.98 × 10(-8)), the enlargement of the apical preparation when shaping a necrotic tooth (P = .001), and the maintenance of apical patency throughout the debridement and shaping procedure (P = .04). General dentists and endodontists embrace different disinfection protocols. The results of the survey demonstrated that endodontists keep up to date with protocols published in the literature, whereas general dentists use protocols learned during their dental training. Both groups of clinicians should be aware of the importance of disinfection techniques and their relationship to treatment outcomes. Controlling microorganisms during a root canal treatment, especially in cases with necrotic pulp, is essential to improve treatment outcomes. Clinicians should update their protocols and also consider referring patients to a specialist when their protocols are based on traditional techniques, especially in those cases with necrotic pulp. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

Management of Teeth with Persistent Apical Periodontitis after Root Canal Treatment Using Regenerative Endodontic Therapy.

PubMed

Saoud, Tarek Mohamed A; Huang, George T-J; Gibbs, Jennifer L; Sigurdsson, Asgeir; Lin, Louis M

2015-10-01

Regenerative endodontic therapy (RET) is currently used to treat immature teeth with necrotic pulp and/or apical periodontitis. However, recently RET has been used to treat mature teeth with necrotic pulp and/or apical periodontitis and resulted in regression of clinical signs and/or symptoms and resolution of apical periodontitis. The purpose of this case report was to describe the potential of using RET to treat 2 mature teeth with persistent apical periodontitis after root canal therapy using RET. Two male patients, one 26-year old and another 12-year old, presented for retreatment of persistent apical periodontitis after root canal treatment of 2 mature teeth (#9 and #19). The gutta-percha fillings in the canals of teeth #9 and #19 were removed with Carvene gutta-percha solvent (Prevest DenPro, Jammu, India) and ProTaper Universal rotary retreatment files (Dentsply Maillefer, Ballaigues, Switzerland). The canals of both teeth were further chemomechanically debrided with rotary retreatment files and copious amounts of sodium hypochlorite irrigation and dressed with Metapaste (Meta Biomed, Chungbuk, Korea). RET was performed on teeth #9 and #19. Periapical bleeding was provoked into the disinfected root canals. The blood clots were covered with mineral trioxide aggregate plugs, and the access cavities were restored with intermediate restorative material. Teeth #9 and #19 showed regression of clinical signs and/or symptoms and healing of apical periodontitis after 13-month and 14-month follow-ups, respectively. Tooth #9 revealed narrowing of the canal space and apical closure by deposition of hard tissue. RET has the potential to be used to retreat teeth with persistent apical periodontitis after root canal therapy. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Bond strength of fiber-reinforced posts to deproteinized root canal dentin.

PubMed

Furuse, Adilson Yoshio; Cunha, Leonardo Fernandes; Baratto, Samantha Pugsley; Leonardi, Denise Piotto; Haragushiku, Gisele Aihara; Gonzaga, Carla Castiglia

2014-09-01

This study evaluated the push-out bond strength of cemented fiber posts after deproteinization of root canal dentin walls with NaOCl. The effect of the application of an antioxidant solution (sodium ascorbate) was also evaluated. A three-step etch-and-rinse (Scotch-bond - 3M Espe) and a one-step self-etching adhesive (Xeno III - Dentsply Caulk) were evaluated. Thirty bovine incisor roots were divided into 3 groups: a. Irrigation with physiologic solution (control). b. Deproteinization with 10 minutes irrigation of 5% NaOCl. c. Deproteinization with NaOCl followed by 10 minutes irrigation with 10% ascorbic acid. Fiber posts were cemented with a dual-cured cement (Rely X ARC - 3M ESPE). The push-out bond strength was evaluated after 24 hours of storage in distilled water. The data were analyzed with three-way ANOVA, one-way ANOVA and Tukey's test (α = 0.05). There were significant differences between groups (p < 0.05). The bond strength of Scotchbond was not influenced by the deproteinization. Xeno III showed a decrease in bond strength when deproteinized with 5% NaOCl (p < 0.05). For Xeno III, the subsequent irrigation with ascorbic acid was able to reverse the effect of the deproteinization. Considering the radicular thirds, the bond strength varied in the sequence-apical < middle < coronal. Only the all-in-one adhesive was influenced by the deproteinization. Considering the respective control groups, both systems showed similar bond strength results. The decreased bond strength of the self-etching adhesive following deproteinization seams to be related to the oxidant effect of the NaOCl solution and the subsequent irrigation with ascorbic acid was able to reverse the effect of the deproteinization.

Laboratory investigation of the efficacy of holmium:YAG laser irradiation in removing intracanal debris

NASA Astrophysics Data System (ADS)

Nuebler-Moritz, Michael; Gutknecht, Norbert; Sailer, Hermann F.; Hering, Peter; Prettl, Wilhelm

1997-05-01

Current endodontic therapy involves debridement and disinfection of the root canal by means of mechanical instrumentation and chemical irrigation. However, several studies have shown that these techniques fail to achieve complete cleansing. Recently, lasers have been suggested for use within root canals. This study was conducted to determine the efficacy of Holmium:YAG laser irradiation in removing intracanal debris and smear layer. Root canal surfaces of freshly-extracted human teeth were exposed to pulsed Ho:YAG laser radiation. Subsequently, laser induced structural changes were investigated using scanning electron microscopy. Temperature measurements during irradiation were performed by means of thermocouples. The result of this survey give a preliminary indication of the ability of the Ho:YAG laser to improve current endodontic treatment survey give a preliminary indication of the ability of the Ho:YAG laser to improve current endodontic treatment modalities. However, limitations exist with regard to circumscribed and well-quantified irradiation of root canal surfaces, due to the lack of perpendicular delivery of the laser beam. Additional studies will be required to develop suitable optical transmission systems, in order to achieve complete cleansing and to avoid damage to the periradicular tissues, respectively.

[Effect of revascularization treatment of immature permanent teeth with endodontic infection].

PubMed

Huang, Yibin; Chen, Ke; Zhang, Ying; Xiong, Huacui; Liu, Caiqi

2013-05-01

To observe the effect of revascularization for treatment of immature teeth with endodontic infection mediated by calcium hydroxide. Seventeen pediatric patients with endodontic infections of the permanent teeth were treated with routine root canal and pulp cavity irrigation and disinfection followed by application of calcium hydroxide paste to the root canal orifice to induce revascularization. Another 17 patients received conventional apexification procedures to serve as the control group. The patients were followed up to observe the therapeutic effect of the treatments. In the revascularization treatment group, 4 cases showed healed periapical lesions 6 to 18 months after the surgery with thickened root canal walls and closure of the apical foramen; in 10 cases, the periapical lesions healed 12 to 18 months postoperatively with lengthened root, thickened root canal wall, and narrowed apical foramen. One patient reported pain and swelling at 2 months, and 2 patients showed the formation of gum fistula and ceased development of the roots at 7 and 8 months. In the control group, the periapical lesions healed in 1 cases at 12 months postoperatively with apical foramen closure; in 11 cases, hard tissues formed in the root apex without obviously lengthened roots 6 to 8 months after the surgery; in 5 cases, no apical barrier formed even 12 to 18 months after the surgery. The overall effective rates were similar between the two groups (P>0.05). Revascularization by calcium hydroxide sealing can promote root development of immature permanent teeth with pulpitis or periradicular periodontitis.

The evaluation of endodontic flare-ups and their relationship to various risk factors.

PubMed

Onay, Emel Olga; Ungor, Mete; Yazici, A Canan

2015-11-14

To evaluate the incidence of flare-ups and identify the risk factors including age, gender, tooth type, number of root canals, initial diagnosis, the type of irrigation regimen, treatment modality and the number of visits, in patients who received root canal treatment from January 2002 to January 2008. Records of 1819 teeth belonging to 1410 patients treated by 1 endodontics specialist during 6-year period were kept. Patient, tooth, and treatment characteristics were evaluated and the relationships between these characteristics and flare-ups were studied. Statistical analysis was carried out by using Pearson Chi-square test, Fisher's Exact test, and Binary Logistic regression analyses. The incidence of flare-ups was 59 (3.2 %) out of 1819 teeth that received endodontic therapy. Pulpal necrosis without periapical pathosis was the most common indication for flare-up (6 %) (p < 0.01). Teeth undergoing multiple visits had a higher risk of developing flare-ups compared to those with single appointments (OR: 3.14, CI: 1.414-7.009, p < 0.01). There were also no statistically significant differences in the incidence of flare-ups regarding to age, gender, tooth type, number of root canals, treatment modality, and the irrigation solutions that used during the treatment. The incidence of flare-up is minimal when teeth are treated in one visit. Absence of a periapical lesion in necrotic teeth is a significant risk factor for flare-ups.

Techniques and Materials Used by General Dentists during Root Canal Treatment Procedures: Findings from the National Dental Practice-Based Research Network

PubMed Central

Eleazer, Paul D.; Gilbert, Gregg H.; Funkhouser, Ellen; Reams, G.J.; Law, A.S.; Benjamin, Paul L.

2015-01-01

Background Little is known about which materials and techniques general dentists (GDs) use during root canal procedures. The objectives were to: (1) quantify GD’s use of specific endodontic armamentarium; (2) quantify inappropriate use; and (3) ascertain if inappropriate use is associated with dentists’ practice characteristics. Methods GDs in the National Dental Practice-Based Research Network reported in a questionnaire materials and techniques they use during root canal procedures. Results 1,490 (87%) of eligible GDs participated. Most (93%; n=1,383) used sodium hypochlorite to irrigate. The most commonly used sealers were zinc oxide-eugenol (43%) and resin (40%), followed by calcium hydroxide (26%). A majority (62%; n=920) used a compaction obturation technique; 36% (n=534) used a carrier-based method. Most (96%; n=1,423) used gutta percha as a filler; 5% used paste fillers. Few used irrigants (n=46), sealers (n=4), techniques (n=49) or fillers (n=10) that investigators classified as ‘inappropriate’. Conclusions GDs use a broad range of endodontic techniques and materials, often adapting to newer technologies as they become available. Few GDs use armamentarium that the investigators classified as inappropriate. Practical Implications GDs use many types of endodontic techniques and materials, but only a very small percentage is not appropriate. PMID:26562726

Antimicrobial effect of Er:YAG laser irradiation in infected root canals: an in vitro study

NASA Astrophysics Data System (ADS)

Sampaio Moura, Marcelo; Zanin, Fatima A. A.; Brugnera, Aldo, Jr.; Rodrigues de Araujo Estrela, Cyntia; Estrela, Carlos; Djalma Pecora, Jesus

2003-06-01

This study evaluated in vitro the antimicrobial action of Er:YAG laser in infected root canals. A total of 36 human anterior teeth were prepared, sterilized and inoculated with suspensions of S. aureus, E. faecalis, P aeruginosa, B. subtilis and C. albicans. After the contamination period (28 days), the teeth were irrigated with sterile distilled water or 1% sodium hypochlorite and, then, irradiated with an Er:YAG laser (wavelength 2094 nm) with two different evaluation parameters: 52 mJ and 110 mJ laser output at the fiber tip. After the irradiation, the teeth were irrigated with sterile distilled water and the solutions were collected with sterile paper points and incubated in Letheen Broth for 48 hours. After this period 0,1 ml of this solution was transferred to 10 ml of Brain Heart Infusion and incubated for 48 hours. After 72 hours a new collect ion was done and incubated again. Based on the data, it was concluded that the distilled water or 1% sodium hypochlorite irradiated or not with an Er:YAG laser with two different parameters: 10 Hz, 110 mJ input and 52 mJ output, and 10 Hz, 250 mJ input and 110 mJ output had no antimicrobial activity in the root canals contaminated with the following microorganisms: Enterococcus faecalis, Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus subtilis and Candida albicans.

Microbial contamination of the environment after the irradiation of Er:YAG laser in infected root canals

NASA Astrophysics Data System (ADS)

Brugnera, Aldo, Jr.; Zanin, Fatima A. A.; Sampaio Moura, Marcelo; Heredia Seixas, Fabio; Rodrigues de Araujo Estrela, Cyntia; Estrela, Carlos; Djalma Pecora, Jesus

2003-06-01

The purpose of this study was to analyze the environment microbial contamination produced by Er:YAG laser irradiation in infected root canals. A total of 20 human anterior teeth were prepared, sterilized and, then, inoculated with a mixture of the following microorganisms: S. Aureus, E. Faecalis, P. Aeruginosa, B. Subtilis and C. Albicans. After the contamination period (28 days), the teeth were irrigated with sterile distilled water or 1% sodium hypochlorite and, then, irradiated with an Er:YAG laser with two different laser parameters: 52 mJ or 110 mJ output at the fiber tip. Eighteen Petri dishes with 20 ml of BHI Agar were used in the study. For each group, 3 plates with BHIA were used for the analysis of the microbial contamination of the environment during the activation of the laser in infected root canals. The plates were positioned in differing distances away from the irradiated tooth (plate 1 - distance of 15 cm, plate 2 - distance of 50 cm and plate 3 - distance of 3 meters). After the analysis of the results, it was observed that the larger microbial contamination occurred in Group 1 (teeth irrigated with sterile distilled water and irradiated with Er:YAG laser with 52 mJ output at the fiber tip), plate 1 (positioned 15 cm away from the irradiated tooth), with values greater than 30 Colony-Forming Units (CFU).

In vitro antimicrobial efficacy of MTAD and sodium hypochlorite.

PubMed

Shabahang, Shahrokh; Pouresmail, Manouchehr; Torabinejad, Mahmoud

2003-07-01

The purpose of this study was to compare the ability of a mixture of a tetracycline isomer, an acid, and a detergent (MTAD) with that of sodium hypochlorite (NaOCI) to disinfect human root canals that had been contaminated with whole saliva. One hundred and thirty-two root canals of extracted human teeth were cleaned and shaped using the passive step-back technique and rotary NiTi files. The smear layer was removed, and the teeth were autoclaved. Six autoclaved samples were transferred to sterile broth without contamination with saliva to serve as negative controls. Whole saliva was used to contaminate the root canals of the rest of the samples for 48 h. Six of these contaminated samples were irrigated with Brain Heart Infusion (BHI) broth and served as positive controls. The rest of the contaminated specimens were then divided into two experimental groups of 60 teeth each. In one group, the canals were irrigated with 1 ml MTAD, and the samples were immersed in 2 ml of the same solution for 5 min. In the second group, the specimens were similarly treated with 5.25% NaOCl. All samples were washed in BHI broth and then placed in another tube containing BHI broth and incubated for 96 h. Disinfection of the samples was determined based on presence or absence of turbidity in the broth 96 h later. Twenty-three of 60 teeth treated with NaOCl remained infected. Only one of 60 teeth treated with MTAD remained infected. Statistical analysis of the data using the Chi-square test showed a significant difference between the two groups (p < 0.0001).

Comparison of the effect of two endodontic irrigation protocols on the elimination of bacteria from root canal system: a prospective, randomized clinical trial.

PubMed

Beus, Christopher; Safavi, Kamran; Stratton, Jeffrey; Kaufman, Blythe

2012-11-01

The purpose of this prospective, randomized clinical study was to compare the results of a nonactivated single-irrigation protocol (NAI) that used only 1% NaOCl with a passive ultrasonic multi-irrigation protocol (PUI) that used 1% NaOCl, 17% ethylenediaminetetraacetic acid, and 2% chlorhexidine in rendering canals bacteria free. In addition, the effect of a second-visit instrumentation after intra-appointment calcium hydroxide (CaOH(2)) was also evaluated in bacterial elimination. Fifty patients were recruited with a posterior tooth requiring primary endodontic treatment of apical periodontitis. Standard nonsurgical endodontic therapy was performed on both groups in a 2-visit approach by using calcium hydroxide intracanal medicament. Teeth were randomly treated with the NAI or PUI protocols in the first visit after complete instrumentation. Bacterial cultures were obtained at 4 periods during treatment from the canals: (1) before instrumentation, (2) after irrigation protocol, (3) after CaOH(2) medication, and (4) before obturation. Statistical analysis was performed on data by using the Fisher exact test and multivariate analysis. NAI and PUI rendered canals 80% and 84% bacteria free, respectively, at the end of the first visit. After CaOH(2) medication the total sample (NAI + PUI) had increased to 87% bacteria free, and the second-visit instrumentation resulted in a total of 91% bacteria free. These differences were not significant (P > .05). There was no statistical difference between irrigation methods. Each protocol resulted in a high frequency of negative cultures. This high frequency of negative cultures obtained in 1 visit is most likely related to an increased volume and depth of irrigation compared with previously reported protocols. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Comparative evaluation of antimicrobial activity of hydroalcoholic extract of Aloe vera, garlic, and 5% sodium hypochlorite as root canal irrigants against Enterococcus faecalis: An in vitro study.

PubMed

Karkare, Swati Ramesh; Ahire, Nivedita Pramod; Khedkar, Smita Uday

2015-01-01

Enterococcus faecalis are the most resistant and predominant microorganisms recovered from root canals of teeth where previous treatment has failed. Over the past decade, interest in drugs derived from medicinal plants has markedly increased. In dentistry, phytomedicines has been used as an anti-inflammatory, antibiotic, analgesic, sedative, and also as an endodontic irrigant. In endodontics, because of the cytotoxic reactions of most of the commercial intracanal medicaments and their inability to eliminate bacteria completely from dentinal tubules, the trend is shifting toward use of biologic medication extracted from natural plants. To compare the antimicrobial efficacy of newer irrigating agents which would probably be as effective or more and at the same time less irritating to the tissues than sodium hypochlorite (NaOCl). The objective of this study was to compare the antimicrobial activity of saturated and diluted (1:1) hydroalcoholic extract of Aloe vera, garlic, and 5% NaOCl against E. faecalis using the commonly used agar diffusion method. Saturated hydroalcoholic extract of A. vera showed the highest zone of inhibition against E. faecalis. NaOCl, which is considered as gold standard, also showed higher zones of inhibition.

Comparative evaluation of apically extruded debris during root canal instrumentation using two Ni-Ti single file rotary systems: An in vitro study

PubMed Central

Singbal, Kiran; Jain, Disha; Raja, Kranthi; Hoe, Tan Ming

2017-01-01

Background: Apical extrusion of debris during instrumentation is detrimental to the patient. Aim: The aim of this study was to evaluate the apical extrusion of debris during root canal instrumentation using two single file rotary Ni-Ti systems. Materials and Methods: Thirty freshly extracted mandibular premolars with straight roots were sterilized and divided into two groups instrumented using: One Shape rotary Ni-Ti system with Endoflare orifice shaper (Group 1) and Neo-Niti rotary Ni-Ti system with C1 orifice shaper (Group 2). Preweighed Eppendorf tubes fitted for each tooth before instrumentation. During instrumentation, 1 mL of distilled water with a 30-gauge needle was used to irrigate after every instrument. Tips of the tooth were irrigated with 2 ml distilled water after removal from Eppendorf tubes. The total volume of irrigant in each group was the same 8 ml. All tubes were incubated at 68°C for 15 days and subsequently weighed. The difference between pre- and post-debris weights was calculated, and statistical analysis was performed using independent t-test and level of significance was set at 0.05. Results: The difference between pre- and post-weights was significantly greater for the One Shape system. Conclusions: The Neolix Niti single file was associated with less extrusion compared to One Shape single file system. PMID:28855748

Comparative evaluation of apically extruded debris during root canal instrumentation using two Ni-Ti single file rotary systems: An in vitro study.

PubMed

Singbal, Kiran; Jain, Disha; Raja, Kranthi; Hoe, Tan Ming

2017-01-01

Apical extrusion of debris during instrumentation is detrimental to the patient. The aim of this study was to evaluate the apical extrusion of debris during root canal instrumentation using two single file rotary Ni-Ti systems. Thirty freshly extracted mandibular premolars with straight roots were sterilized and divided into two groups instrumented using: One Shape rotary Ni-Ti system with Endoflare orifice shaper (Group 1) and Neo-Niti rotary Ni-Ti system with C1 orifice shaper (Group 2). Preweighed Eppendorf tubes fitted for each tooth before instrumentation. During instrumentation, 1 mL of distilled water with a 30-gauge needle was used to irrigate after every instrument. Tips of the tooth were irrigated with 2 ml distilled water after removal from Eppendorf tubes. The total volume of irrigant in each group was the same 8 ml. All tubes were incubated at 68°C for 15 days and subsequently weighed. The difference between pre- and post-debris weights was calculated, and statistical analysis was performed using independent t -test and level of significance was set at 0.05. The difference between pre- and post-weights was significantly greater for the One Shape system. The Neolix Niti single file was associated with less extrusion compared to One Shape single file system.

Ex vivo evaluation of various instrumentation techniques and irrigants in reducing E. faecalis within root canals.

PubMed

Basmaci, F; Oztan, M D; Kiyan, M

2013-09-01

To evaluate ex vivo the effectiveness of single-file instrumentation techniques compared with serial Ni-Ti rotary instrumentation with several irrigation regimens in reducing E. faecalis within root canals. A total of 81 extracted human mandibular premolar teeth with a single root canal were infected with E. faecalis before and after canal preparation. Samples were divided randomly into 9 groups, as follows: group 1-A: sterile phosphate-buffered saline + Self-adjusting file, group 1-B: 5% sodium hypochlorite + 15% EDTA + Self-adjusting file, group 1-C: 5% sodium hypochlorite + 7% maleic acid + Self-adjusting file, group 2-A: sterile phosphate-buffered saline + Reciproc (R25), group 2-B: 5% sodium hypochlorite + 15% EDTA + Reciproc (R25), group 2-C: 5% sodium hypochlorite + 7% maleic acid + Reciproc (R25), group 3-A: sterile phosphate-buffered saline + ProTaper, group 3-B: 5% sodium hypochlorite + 15% EDTA + ProTaper, group 3-C: 5% sodium hypochlorite + 7% maleic acid + ProTaper. anova was used to analyse statistically the differences in terms of reduction in colony counts between the groups, and Dunn's post hoc test was used for multiple comparisons. All techniques and irrigation regimens significantly reduced the number of bacterial cells in the root canal (P < 0.001). Comparisons amongst the groups revealed significant differences between group 1A (sterile phosphate-buffered saline + Self-adjusting file)/group 1B (5% sodium hypochlorite + 15% EDTA + Self-adjusting file) (P = 0.031), group 1A (sterile phosphate-buffered saline + Self-adjusting file)/group 2C (5% sodium hypochlorite + 7% maleic acid + Reciproc) (P = 0.003), group 2A (sterile phosphate-buffered saline + Reciproc)/group 3B (5% sodium hypochlorite + 15% EDTA + ProTaper) (P = 0.036), group 3B (5% sodium hypochlorite + 15% EDTA + ProTaper)/group 1A (sterile phosphate-buffered saline + Self-adjusting file) (P < 0.001), and group 3C (5% sodium hypochlorite + 7% maleic acid + ProTaper)/group 1A (sterile phosphate-buffered saline + Self-adjusting file) (P = 0.033). No significant differences in terms of reduction in microbial counts were observed between single-file techniques (SAF and Reciproc) and serial Ni-Ti instrumentation technique (ProTaper) in combination with irrigants. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Effectiveness of Morinda citrifolia juice as an intracanal irrigant in deciduous molars: An in vivo study

PubMed Central

Chandwani, Manisha; Mittal, Rakesh; Chandak, Shweta; Pimpale, Jitesh

2017-01-01

Background: The purpose of this study was to evaluate the microbial reduction in deciduous molars using Morinda citrifolia juice (MCJ) as irrigating solution. Materials and Methods: This was a randomized comparative study including 60 deciduous molars chosen among the patients belonging to the age group of 6–9 years based on the inclusion or exclusion criteria. The selected teeth were divided randomly into two groups based on irrigation solution used, that was, Group I (1% NaOCl) and Group II (MCJ). The microbial samples were collected both pre- and post-irrigation and were transferred for microbial assay. Paired t-test was used for intragroup analysis of pre- and post-operative mean reduction of bacterial colony forming unit (CFU)/ml, whereas Independent t-test was used to assess the intergroup, pre- and post-operative mean reduction of bacterial CFU/ml. Results: In the intragroup comparison, both of the groups showed statistically significant (P < 0.001) reduction in the mean CFU/ml; however, it did not show statistically significant reduction when intergroup comparison was carried out between the two groups. Both the study materials had clinically revealed decrease in the microbial count postirrigation. Conclusion: Both the irrigants, 1% NaOCl and MCJ, were significantly effective in the reduction of mean CFUs/ml postoperatively. The results of this study have confirmed the antibacterial effectiveness of MCJ in the root canals of deciduous teeth. Considering the low toxicity and antibacterial effectiveness of MCJ, it can be advocated as a root canal irrigant in endodontic treatment of primary teeth. PMID:28928778

A comparative evaluation of Morinda citrifolia, green tea polyphenols, and Triphala with 5% sodium hypochlorite as an endodontic irrigant against Enterococcus faecalis: An in vitro study.

PubMed

Divia, A R; Nair, Mali G; Varughese, Jolly Mary; Kurien, Shobha

2018-01-01

Endodontic infections require effective removal of microorganisms from the root canal system for long-term prognosis. Sodium hypochlorite (NaOCl) is the most effective irrigant currently, but potential complications due to its toxicity warrant search for newer alternatives. In this study, the antimicrobial efficacy of Morinda citrifolia (MC), green tea polyphenols and Triphala was compared with 5% NaOCl against Enterococcus faecalis . In this in vitro study sixty extracted human premolar teeth were infected with E. faecalis , a Group D Streptococci for 48 h. At the end of 48 h, the vital bacterial population was assessed by counting the number of colony-forming units (CFUs) on blood agar plate. Samples were divided into five groups; Group I (distilled water), Group II (NaOCl), Group III (MC), Group IV (Triphala), and Group V (green tea polyphenols). The samples were irrigated with individual test agents and CFUs were recorded. Kruskal-Wallis test was performed as the parametric test to compare different groups. Student's t -test was used to compare mean values between groups before and after treatment with test agents ( P < 0.001). NaOCl was the most effective irrigant the elimination of E. faecalis reinforcing its role as the best irrigant available currently and a gold standard for comparison of the experimental groups. Its antibacterial effect was comparable to Triphala. Among the experimental groups, MC showed the minimum antibacterial effect. The use of herbal alternatives as a root canal irrigant might prove to be advantageous considering the several undesirable characteristics of NaOCl.

Evaluation of conventional, protaper hand and protaper rotary instrumentation system for apical extrusion of debris, irrigants and bacteria- An in vitro randomized trial.

PubMed

Kalra, Pinky; Rao, Arathi; Suman, Ethel; Shenoy, Ramya; Suprabha, Baranya-Shrikrishna

2017-02-01

Endodontic instrumentation carries the risk of over extrusion of debris and bacteria. The technique used and the type of instrumentation influences this risk. The purpose of this study was to evaluate and compare the K-file, ProTaper hand and ProTaper rotary instrumentation systems for the amount of apically extruded debris, irrigant solution and intracanal bacteria. Experimental single blinded randomized type of in vitro study with sample of 30 single rooted teeth. Endodontic access cavities were prepared and the root canals were filled with the suspension of E. faecalis . Myers and Montogomery Model was used to collect apically extruded debris and irrigant. Canals were prepared using K files, Hand protapers and Protaper rotary files. Non Parametric test like Kruskal-Wallis and Mann-Whitney U test were applied to determine the significant differences among the group. Tests revealed statistically significant difference between the amount of debris and number of bacteria extruded by the ProTaper hand and the K-files. No statistically significant difference was observed between the amounts of irrigant extruded by the ProTaper hand and the K-file system. Statistically significant differences were observed between the amounts of bacteria and irrigant extruded by the ProTaper rotary and the Protaper hand. No statistically significant difference was observed between the amounts of debris extruded by the ProTaper hand and the K-file system. Amount of apical extrusion of irrigant solution, bacteria and debris are significantly greater with K File instruments and least with Protaper rotary instruments. Key words: Protaper, rotary, periapical extrusion.

Comparative Analysis of Protaper and Waveone Systems to Reduce Enterococcus Faecalis from Root Canal System in Primary Molars--An in Vitro Study.

PubMed

Pinheiro, Sérgio Luiz; Pessoa, Carolina; da Silva, Josianne Neres; Gonçalves, Rafael Orro; Duarte, Danilo Antonio; da Silveira Bueno, Carlos Eduardo

2016-01-01

To assess, in vitro, the ability of the ProTaper(™) and WaveOne(™) systems to reduce Enterococcus faecalis contamination in primary molars. Sixty roots of primary molars were contaminated with E. faecalis. Roots were randomly allocated to one of four groups (n=20): ProTaper(™), WaveOne(™), control A, or control B. The files used were S1 and S2/F1 and F2 (ProTaper(™) system) and 25.08 (WaveOne(™) system). In control group A, the root canal was left uninstrumented, whereas in control group B, the root canal was irrigated with NaCl 0.9%. E. faecalis was sampled from the root canal system before and after instrumentation and the Wilcoxon test and Mann-Whitney U were used. There were no differences in E. faecalis counts between pre-instrumentation counts in the ProTaper™ and WaveOne(™) (p>0.05). The ProTaper(™) system led to an 89.36% reduction in E. faecalis burden, versus 78.10% with the WaveOne(™) system (p>0.05). Instrumentation time was shorter with WaveOne(™) (p<0.0001). The ProTaper(™) and WaveOne™ systems were equally effective in reducing Enterococcus faecalis in primary molars. The WaveOne(™) system was associated with shorter instrumentation time.

Apical negative pressure irrigation versus syringe irrigation: a systematic review of cleaning and disinfection of the root canal system.

PubMed

Konstantinidi, E; Psimma, Z; Chávez de Paz, L E; Boutsioukis, C

2017-11-01

The aim of this study was to systematically review and critically analyse the published data on the treatment outcome (primary outcome) and on the cleaning and disinfection of root canals (secondary outcomes) achieved by negative pressure irrigation as compared to syringe irrigation. An electronic search was conducted in EMBASE, LILACS, PubMed, SciELO, Scopus and Web of Knowledge using both free-text keywords and controlled vocabulary. Additional studies were sought through hand searching of endodontic journals and of the relevant chapters of endodontic textbooks. No language restriction was imposed. The retrieved studies were screened by two reviewers according to predefined criteria. Included studies were critically appraised and the extracted data were arranged in tables. The electronic search and hand search retrieved 489 titles. One clinical study and 14 in vitro studies were finally included in the review; none of these studies assessed treatment outcome, four studies assessed the antimicrobial effect, seven studies evaluated the removal of pulp tissue remnants, and four studies investigated the removal of hard tissue debris or both hard tissue debris and pulp tissue remnants. Poor standardization and description of the protocols was evident. Inconclusive results were reported about the cleaning and disinfection accomplished by the two irrigation methods. Negative pressure irrigation was more effective under certain conditions when compared to suboptimal syringe irrigation; however, the variability of the protocols hindered quantitative synthesis. There is insufficient evidence to claim general superiority of any one of these methods. The level of the available evidence is low, and the conclusions should be interpreted with caution. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Comparative in vivo analysis of the sealing ability of three endodontic sealers in post-prepared root canals.

PubMed

Kopper, P M P; Figueiredo, J A P; Della Bona, A; Vanni, J R; Bier, C A; Bopp, S

2003-12-01

To compare the sealing ability of the endodontic sealers AH Plus, Sealer 26 and Endofill in premolar teeth of dogs exposed to the oral cavity after post-preparation. Forty teeth with two canals each underwent root canal cleaning and shaping. Before filling, the canals were randomly distributed into three groups according to the sealer to be used: Group 1 - AH Plus; Group 2 - Sealer 26; and Group 3 - Endofill (Dentsply, Indústria e Comércio Ltda.). Immediately after filling, the gutta percha and sealer were partially removed from the canals, leaving material only in the apical third of the root. The teeth were temporarily sealed with glass ionomer sealer for 72 h to ensure setting. The coronal seal was then removed and the canals were exposed to the oral cavity for 45 days. The animals were euthanased and their mandibles and maxillae were removed. After abundant irrigation with distilled water, the canals were dried and filled with India ink. The teeth were sealed again for 96 h before extraction. The roots of the extracted premolars were separated and stored in labelled test tubes. The roots were cleared and the extent of dye penetration was measured with a 20x stereoscopic magnifying lens. Statistical analysis revealed that there were significant differences between the sealers studied (P < 0.001). Means for the extent of dye penetration for AH Plus, Endofill and Sealer 26 were, respectively, 0.13, 2.27 and 3.08 mm. After 45 days exposure to the oral cavity, none of the sealers was capable of preventing leakage and coronal dye penetration. There were significant differences between the sealers studied, in terms of mean dye penetration.

Chelation and flotation in endodontic practice: an update.

PubMed

Stewart, G G

1986-10-01

The removal of broken instruments and silver points, as well as pulp tissue, may be accomplished by careful instrumentation, irrigation, and flotation. Flotation and recapitulation with smaller instruments and irrigation with copious amounts of sodium hypochlorite can clean out microorganisms and the organic matter from the tubular structure which provides a more ideal surface for sealing the root canal system. A sterile environment was obtained by removing the substrate and creating a more ideal environment for better healing.

Mineral trioxide aggregate repair of a perforating internal resorption in a mandibular molar.

PubMed

Meire, Maarten; De Moor, Roeland

2008-02-01

Internal resorption is a rare condition in permanent teeth that poses difficulties for treatment. The challenge is complicated further if the resorption extends beyond the confines of the root. This article describes treatment of a perforating internal resorption in the mesial root of a second lower molar, with adjacent destruction of the alveolar bone. After cleaning the root canal space and the resorption lacuna by mechanical instrumentation, irrigation, and interim calcium hydroxide dressing, the defect was filled with mineral trioxide aggregate, and the canals were obturated conventionally with gutta percha and epoxy resin sealer. At a 2-year follow-up examination, no clinical abnormalities were found, and complete resolution of the alveolar bone lesion and establishment of a new periodontal ligament were observed.

A laboratory comparison of apical leakage between immediate versus delayed post space preparation in root canals filled with Resilon.

PubMed

Attam, K; Talwar, S

2010-09-01

To analyse ex vivo the integrity of the apical seal of Resilon root fillings following immediate post space preparation or after 1 week when leaving either 5 mm or 3 mm of remaining filling material. One hundred and fifty freshly extracted mandibular premolar teeth with single, straight root canals were used. Teeth were autoclaved and cleaned of debris and soft tissue. After decoronation at 16 mm length, the root canals were instrumented using the K3 rotary system to apical file size 45, 0.04 taper with intermittent irrigation using 1% sodium hypochlorite. The teeth were randomly divided into five groups with 30 teeth in each group. Group 1: control group in which the root canals were not filled. Group 2: the canals were filled with Resilon and a post space prepared immediately leaving 5 mm of apical filling. Group 3: the canals were filled and post space preparation delayed for 1 week leaving 5 mm of material apically. Group 4: post space preparation in the canals was initiated immediately after filling leaving 3 mm of material apically. Group 5: the root canals were filled and post space preparation was delayed for 1 week leaving 3 mm of material apically. Microleakage was evaluated using a fluid transport device. The results were analysed statistically using one-way anova followed by Bonferroni's post hoc test. P < 0.05 was considered as statistically significant. There was a highly significant difference amongst the groups (P < 0.001). The maximum mean leakage was observed in group 5 (141.63 x 10(-6) microL min(-1) cm(-1)) and the least microleakage in group 2 (99.87 x 10(-6) microL min(-1) cm(-1)). Immediate post space preparation was associated with less microleakage than delayed preparation when both 5 mm and 3 mm of apical filling remained. Leaving 5 mm of Resilon provided a significantly better seal compared to leaving 3 mm of material.

Clinical comparison of the effectiveness of single-file reciprocating systems and rotary systems for removal of endotoxins and cultivable bacteria from primarily infected root canals.

PubMed

Martinho, Frederico C; Gomes, Ana P M; Fernandes, Aletéia M M; Ferreira, Nádia S; Endo, Marcos S; Freitas, Lilian F; Camões, Izabel C G

2014-05-01

This clinical study was conducted to compare the effectiveness of single-file reciprocating systems and rotary systems in removing endotoxins and cultivable bacteria from primarily infected root canals. Forty-eight primarily infected root canals were selected and randomly divided into 4 groups: WaveOne (Dentsply Maillefer, Ballaigues, Switzerland) (n = 12); Reciproc (VDW, Munich, Germany) (n = 12), ProTaper (Dentsply Maillefer) (n = 12), and Mtwo (VDW) (n = 12). Samples were collected before and after chemomechanical preparation. The irrigation was performed by using 2.5% sodium hypochlorite. A chromogenic limulus amebocyte lysate assay test was used to quantify endotoxins. Culture techniques were used to determine bacterial colony-forming unit counts. In the baseline samples (ie, samples collected before chemomechanical preparation), endotoxins and cultivable bacteria were recovered from 100% of the root canal samples. No differences were found in the median percentage values of endotoxin reduction achieved with reciprocating systems (ie, WaveOne [95.15%] and Reciproc [96.21%]) and with rotary systems (ie, ProTaper [97.98%] and Mtwo [96.34%]) (P < .05). Both single-file reciprocating systems (ie, WaveOne [99.45%] and Reciproc [99.93%]) and rotary systems (ProTaper [99.85%] and Mtwo [99.41%]) were effective in reducing the cultivable bacteria (all P < .05). Moreover, the culture analysis revealed no differences in bacterial load reduction (P > .05). Both single-file reciprocating systems (ie, WaveOne and Reciproc instruments) and rotary systems (ie, ProTaper and Mtwo instruments) showed similar effectiveness in reducing endotoxins and cultivable bacteria from primarily infected root canals, but they were not able to eliminate them from all root canals analyzed. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Comparative Evaluation of Smear Layer and Debris on the Canal Walls prepared with a Combination of Hand and Rotary ProTaper Technique using Scanning Electron Microscope.

PubMed

Kiran, S; Prakash, Sandeep; Siddharth, Pujari R; Saha, Supradip; Geojan, Naiza E; Ramachandran, Mookambika

2016-07-01

The effect of smear layer and debris on the success rate of endodontic treatment has not yet been definitely determined. So the present study was aimed to evaluate the amount of smear layer and debris on the canal walls prepared with a combination of hand and rotary ProTaper technique using NaOCl and ethylenediaminetetraacetic acid (EDTA) alternately as root canal irrigants using scanning electron microscope (SEM). Eighty intact freshly extracted human permanent mandibular premolar teeth were collected and randomly divided equally into four groups. In group I canals were prepared with hand K-Flexofiles; group II with rotary ProTaper instruments; group III with rotary ProTaper instruments and final instrumentation was done with hand K-Flexofile; group IV with rotary ProTaper instruments and final instrumentation was done with RC-Prep and irrigated with 1 mL of normal saline. In all groups canals were irrigated using NaOCl and EDTA alternately. After instrumentation, the teeth were prepared for SEM examination using five-score indices for debris and smear layer at coronal, middle, and apical third levels. Statistical analysis was performed using chi-square test (p < 0.05) and Kruskal-Wallis test (p < 0.05). Statistically significant difference was observed between the groups in cleaning the apical third. Groups I and III showed better canal cleanliness compared to group II. The use of EDTA and NaOCl in group III was more effective in removing debris and smear layer compared to EDTA and normal saline in group IV. Regardless of the instrumentation technique employed and the irrigant used, the cleaning ability decreased in the apical third, resulting in higher debris and smear layer scores compared to coronal and middle third levels. None of the instrumentation techniques in the present study could completely eliminate the smear layer and debris from the canal walls. Instrumentation of the canals with hand files after automated rotary preparation could result in cleaner canal walls. Alternate irrigation with NaOCl and EDTA is effective in the removal of debris and smear layer in the coronal and middle level, but the effectiveness in the apical third is less.

Antibacterial Effect of Diode Laser in Pulpectomy of Primary Teeth.

PubMed

Bahrololoomi, Zahra; Fekrazad, Reza; Zamaninejad, Shiva

2017-01-01

Introduction: Laser irradiation has been suggested as an adjunct to traditional methods of canal preparation but few studies are available on the antibacterial effect of diode laser in pulpectomy of primary teeth. The purpose of the present study is to investigate the antibacterial effect of diode laser in pulpectomy of primary teeth, in addition to define the optimal and harmless diode lasing conditions in the root canal. Methods: A total of 125 single rooted primary teeth were selected. After traditional canal cleaning, they were divided in 2 groups. Sixty-five specimens after culturing of Enterococcus faecalis into the canals, were divided in 3 groups: (1) traditional canal cleaning with 0.5% NaOCl irrigation, (2) method of group 1+ 1.5 W diode laser (980 nm, pulse), (3) without treatment (5 specimens). Then the specimens were cultured and after colony counting under light microscope, were statistically analyzed by Kruskal-Wallis and Mann-Whitney tests. For 60 specimens, temperature rise of apical and cervical parts of the external root surface were measured using 2 thermocouple type K, when radiating a 1.5 W diode laser into the canal. Results: In the first experiment, the diode laser group showed tmost reduction in bacterial count. And in the second experiment, the mean temperature rise of external root surface was less than the threshold of periodontal ligament (PDL) damage. Conclusion: Diode laser with a power output of 1.5 W, is effective in reduction of E. faecalis bacterial count without damaging periodontal structures.

Histologic evaluation of the effect of mineral trioxide aggregate-Fillapex as a root canal sealer in rat teeth submitted to late replantation

PubMed Central

Ferreira, Manuel Marques; Botelho, Maria Filomena; Abrantes, Margarida; Carvalho, Lina; Carrilho, Eunice

2017-01-01

Objective: This study aims to analyze the effect of new root canal based silicate cement, in rat teeth after late replantation, comparing with calcium hydroxide (CH) in preventing tooth root resorption. Materials and Methods: The study group included 16 Wistar rats in which the upper right central incisors were extracted and were left on a worktable for 60 min, simulating a case of tooth avulsion, after had been anesthetized. One group, (Group I), the canals were filled with CH past, before replantation. The second groups of teeth, (Group II), the canals were filled with mineral trioxide aggregate-Fillapex (MTAF). After removal, the blood clot of the socket, with saline solution irrigation, the teeth were replanted into their original socket, and splinted with silk 3/0. The rats were sacrificed 8 weeks after replantation and the specimens were prepared for histologic and histomorphometric analyses. The areas of inflammatory and replacement resorptions were selected and quantified. These data for each group of teeth were evaluated and analyzed using the Mann–Whitney test (P = 0.05). Result and Conclusion: All the replanted teeth in both groups survived. Although root canal filled with MTAF provide better results than with CH past concerning inflammatory and replacement resorption, there was no statistical difference (P = 0.527). PMID:28435372

Natural Therapeutic Options in Endodontics - A Review

PubMed Central

Venkateshbabu, Nagendrababu; Anand, Suresh; Abarajithan, Mohan; Sheriff, Sultan O.; Jacob, Pulikkotil S.; Sonia, Nath

2016-01-01

Complete eradication of microbial biofilms and elimination of the smear layer are the key factors during endodontic treatment. Various chemical irrigants have been proposed in the literature for the same. The major setback with these chemical irrigants is that they are not bio-friendly to the dental and peri-radicular tissues. In the recent years, research to use natural products for root canal disinfection has gained importance. The aim of this article is to compile various herbal products that have been used as an irrigants and intracanal medicaments in the field of Endodontics to eradicate the biofilm and remove smear layer. PMID:27386007

A comparative evaluation of antibacterial effectiveness of sodium hypochlorite, Curcuma longa, and Camellia sinensis as irrigating solutions on isolated anaerobic bacteria from infected primary teeth.

PubMed

Dhariwal, Neha Shashikant; Hugar, Shivayogi M; Harakuni, Sheetal; Sogi, Suma; Assudani, Harsha G; Mistry, Laresh Naresh

2016-01-01

In endodontics, most of the commercial intra-canal medicaments have cytotoxic reactions and because of their inability to eliminate bacteria from dentinal tubules, recent medicine has turned its attention to the usage of biologic medication prepared from natural plants. The literature to testify the efficacy of natural alternatives in primary teeth is meagre and its effects as irrigating solutions need to be evaluated. To evaluate the antibacterial effectiveness of sodium hypochlorite, ethanolic extracts of Curcuma longa (turmeric) and Camellia sinensis (green tea) as irrigating solutions against the anaerobic bacteria isolated from the root canals of infected primary teeth. Thirty patients were selected based on the selected inclusion and exclusion criteria. Preoperative radiographs were taken. Rubber dam isolation and working length estimation were done, following which thirty samples were taken from the root canals of infected primary teeth using sterile absorbent paper points and transferred to tubes containing thioglycolate transport medium. The bacteria were then isolated using standard microbiological protocols and were subjected to antibiotic sensitivity testing using the three test irrigants. SPSS 18 software using Chi-square test was used for statistical analysis. The most commonly isolated bacteria included Porphyromonas sp., Bacteroides fragilis, Peptostreptococcus, and Staphylococcus aureus. Sodium hypochlorite and C. longa (turmeric) showed good antibacterial effect and were effective against most of the isolated bacteria. There was statistically significant difference in the antibacterial effect among the three tested groups (P < 0.001). The least effective was C. sinensis (green tea). The infected primary teeth almost always present with a polymicrobial structure with a wide variety of anaerobic bacteria. The chemo-mechanical preparation plays an important role in eradicating the population of predominant micro-organisms in treating these teeth with promising effects with the use of newer test irrigants while avoiding the side effects of sodium hypochlorite.

Removal efficiency of calcium hydroxide dressing from the root canal without chemically active adjuvant.

PubMed

Maalouf, Lara; Zogheib, Carla; Naaman, Alfred

2013-03-01

Compare the efficiency in removing two calcium hydroxide [Ca(OH)2] preparations from root canal and apical third using single use syringe, ultrasonics and RinsEndo((®)) with saline solution. One hundred and eighty human singlerooted teeth were instrumented using ProTaper((®)) rotary system, divided into two groups according to Ca(OH)2 filling. A: Powder mixed with water, B: Pulpdent((®)). Each group was divided into three subgroups for the irrigation: A1, B1: Single use syringe; A2, B2: Ultrasonics; A3, B3: RinsEndo((®)). Teeth were split longitudinally, photographed and imported into Adobe Photoshop. The percentage ratios of Ca(OH)2 remaining in the canal and in the apical third were calculated. Data were statistically analyzed using 'ANOVA two-way' and 'univariate tests'. (a) Remnants of medicament were found in all teeth, (b) no statistically significant difference in the elimination of both Ca(OH)2 from the entire canal (p = 0.436), however, mixed powder was better eliminated from the apical third (p = 0.005), (c) no statistically significant difference among the irrigation techniques in the whole canal (p = 0.608), though, RinsEndo((®)) and ultrasonics were the most effective in cleaning the apical third (p = 0.032) when mixed powder was used. None of the techniques removed completely Ca(OH)2 from the canal. In the apical third, RinsEndo((®)) and ultrasonics were the most effective when mixed powder was used. Ca(OH)2, the most commonly used intracanal dressing, should be completely eliminated before the obturation to assure a good endodontic sealing. Based on the results of this study, RinsEndo((®)) and ultrasonics were the most effective in removal of Ca(OH)2 especially the powder mixed with water presentation.

Analyzing endosonic root canal file oscillations: an in vitro evaluation.

PubMed

Lea, Simon C; Walmsley, A Damien; Lumley, Philip J

2010-05-01

Passive ultrasonic irrigation may be used to improve bacterial reduction within the root canal. The technique relies on a small file being driven to oscillate freely within the canal and activating an irrigant solution through biophysical forces such as microstreaming. There is limited information regarding a file's oscillation patterns when operated while surrounded by fluid as is the case within a canal root. Files of different sizes (#10 and #30, 27 mm and 31 mm) were connected to an ultrasound generator via a 120 degrees file holder. Files were immersed in a water bath, and a laser vibrometer set up with measurement lines superimposed over the files. The laser vibrometer was scanned over the oscillating files. Measurements were repeated 10 times for each file/power setting used. File mode shapes are comprised of a series of nodes/antinodes, with thinner, longer files producing more antinodes. The maximum vibration occurred at the free end of the file. Increasing generator power had no significant effect on this maximum amplitude (p > 0.20). Maximum displacement amplitudes were 17 to 22 microm (#10 file, 27 mm), 15 to 21 microm (#10 file, 31 mm), 6 to 9 microm (#30 file, 27 mm), and 5 to 7 microm (#30, 31 mm) for all power settings. Antinodes occurring along the remaining file length were significantly larger at generator power 1 than at powers 2 through 5 (p < 0.03). At higher generator powers, energy delivered to the file is dissipated in unwanted vibration resulting in reduced vibration displacement amplitudes. This may reduce the occurrence of the biophysical forces necessary to maximize the technique's effectiveness. Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Efficacy of four different irrigation techniques combined with 60 °C 3% sodium hypochlorite and 17% EDTA in smear layer removal.

PubMed

Guo, Xiangjun; Miao, Hui; Li, Lei; Zhang, Shasha; Zhou, Dongyan; Lu, Yan; Wu, Ligeng

2014-09-08

Efforts to improve the efficacy of smear layer removal by applying irrigant activation at the final irrigation or by elevating the temperature of the irrigant have been reported. However, the combination of such activation protocols with 60 °C 3% sodium hypochlorite (NaOCl) has seldom been mentioned. The aim of this study was to compare the efficacy in smear layer removal of four different irrigation techniques combined with 60 °C 3% NaOCl and 17% EDTA. Fifty single-rooted teeth were randomly divided into five groups (n = 10) according to the irrigant agitation protocols used during chemomechanical preparation(Dentsply Maillefer, Ballaigues, Switzerland): a side-vented needle group, a ultrasonic irrigation (UI) group, a NaviTip FX group, an EndoActivator group, and a control group (no agitation). After each instrumentation, the root canals were irrigated with 1 mL of 3% NaOCl at 60 °C for 1 minute, and after the whole instrumentation, the root canals were rinsed with 1 mL of 17% EDTA for 1 minute. Both NaOCl and EDTA were activated with one of the five irrigation protocols. The efficacy of smear layer removal was scored at the apical, middle and coronal thirds. The Data were statistically analyzed using SAS version 9.2 for Windows (rank sum test for a randomised block design and ANOVA). No significant differences among the NaviTip FX group, EndoActivator group and control groups, and each of these groups showed a lower score than that of UI group (P < 0.05). Within each group, all three thirds were ranked in the following order: coronal > middle > apical (P < 0.05). In the coronal third, the NaviTip FX group was better than UI group. In the middle and apical third, the differences were not significant among any of the groups. Even without any activation, the combination of 60 °C 3% NaOCl and 17% EDTA could remove the smear layer effectively, similar to NaviTip FX or EndoActivator, and these three protocols were more effective than UI. However, regardless of different types of irrigation technique applied, complete removal of the smear layer was not achieved, particularly in the apical third.

The Effect of Canal Preparation with Four Different Rotary Systems on Formation of Dentinal Cracks: An In Vitro Evaluation.

PubMed

Khoshbin, Elham; Donyavi, Zakiyeh; Abbasi Atibeh, Erfan; Roshanaei, Ghodratollah; Amani, Faranak

2018-01-01

Endodontic rotary systems may result in dentinal cracks. They may propagate to vertical root fracture that compromises the outcome of endodontic treatment. This study aimed to compare Neolix and Reciproc (single-file systems), Mtwo and ProTaper (conventional rotary systems) in terms of dentinal crack formation in root canal walls. This in vitro study was conducted on 110 extracted human single-rooted teeth. The teeth were randomly divided into four experimental groups ( n =25) for root canal preparation with Neolix, Reciproc, Mtwo and ProTaper systems and two control groups ( n =5). The first control group underwent root canal instrumentation with hand files while the second control group received no preparation and was only irrigated. After instrumentation, root canals were horizontally sectioned at 3, 6 and 9 mm from the apex and inspected under a stereomicroscope under 12× magnification for detection of cracks. The data were analyzed using Chi-square, GEE test and Bonferroni tests ( P <0.05). No crack was found in the control groups. All rotary systems caused dentinal cracks. ProTaper, Reciproc, Mtwo and Neolix caused cracks in 92%, 80%, 68% and 48% of samples. ProTaper caused significantly more cracks than Neolix and Mtwo ( P <0.05). No significant differences were noted between other groups ( P >0.05). All rotary systems cause dentinal cracks and it is significantly different in apical, middle and coronal third of the root. Neolix appears to be a suitable alternative to other rotary systems since use of this single-file system saves time and cost and minimizes trauma to dentinal walls.

The Effect of Canal Preparation with Four Different Rotary Systems on Formation of Dentinal Cracks: An In Vitro Evaluation

PubMed Central

Khoshbin, Elham; Donyavi, Zakiyeh; Abbasi Atibeh, Erfan; Roshanaei, Ghodratollah; Amani, Faranak

2018-01-01

Introduction: Endodontic rotary systems may result in dentinal cracks. They may propagate to vertical root fracture that compromises the outcome of endodontic treatment. This study aimed to compare Neolix and Reciproc (single-file systems), Mtwo and ProTaper (conventional rotary systems) in terms of dentinal crack formation in root canal walls. Methods and Materials: This in vitro study was conducted on 110 extracted human single-rooted teeth. The teeth were randomly divided into four experimental groups (n=25) for root canal preparation with Neolix, Reciproc, Mtwo and ProTaper systems and two control groups (n=5). The first control group underwent root canal instrumentation with hand files while the second control group received no preparation and was only irrigated. After instrumentation, root canals were horizontally sectioned at 3, 6 and 9 mm from the apex and inspected under a stereomicroscope under 12× magnification for detection of cracks. The data were analyzed using Chi-square, GEE test and Bonferroni tests (P<0.05). Results: No crack was found in the control groups. All rotary systems caused dentinal cracks. ProTaper, Reciproc, Mtwo and Neolix caused cracks in 92%, 80%, 68% and 48% of samples. ProTaper caused significantly more cracks than Neolix and Mtwo (P<0.05). No significant differences were noted between other groups (P>0.05). Conclusion: All rotary systems cause dentinal cracks and it is significantly different in apical, middle and coronal third of the root. Neolix appears to be a suitable alternative to other rotary systems since use of this single-file system saves time and cost and minimizes trauma to dentinal walls. PMID:29707009

Effectiveness of Sonic, Ultrasonic, and Photon-Induced Photoacoustic Streaming Activation of NaOCl on Filling Material Removal Following Retreatment in Oval Canal Anatomy.

PubMed

Jiang, Shan; Zou, Ting; Li, Dongxia; Chang, Jeffery W W; Huang, Xiaojing; Zhang, Chengfei

2016-01-01

This study aimed to assess the effectiveness of sonic, ultrasonic and laser [photon-induced photoacoustic streaming (PIPS)] irrigation activation in removing filling remnants from oval root canals after standard canal retreatment procedures with the ProTaper universal rotary retreatment system. Twenty-eight maxillary first premolars were instrumented with ProTaper NiTi rotary instruments and obturated with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. After storage at 37°C and 100% humidity for 1 week, the specimens were retreated with the ProTaper universal retreatment system for the removal of filling material. Teeth were then randomly assigned into four groups (n = 7): group 1, positive control; group 2, retreated with sonic irrigation; group 3, retreated with ultrasonic irrigation; and group 4, retreated with laser irradiation. The specimens were scanned using micro-CT before instrumentation, after obturation and mechanical retreatment, and after additional activation procedures. The percentage volume of the filling remnants was measured. Specimens were split longitudinally after micro-CT scan, canal walls were examined using scanning electron microscopy (SEM), and the amount of residual filling material was scored. The filling materials' removal efficacy in the three experimental groups was higher than that of the control group (p < 0.05), whereas filling materials ranging from 1.46 ± 0.30 to 2.21 ± 0.46 mm(3) remained in the canal in all three experimental groups. Additionally, there was a significantly greater reduction in the amount of filling remnants in the PIPS group than in the sonic and ultrasonic groups (both p < 0.05), and significantly greater reduction in the ultrasonic group than the sonic group (p < 0.05). Activation of NaOCl with PIPS showed significantly better performance than sonic and ultrasonic techniques in removing the filling remnants following mechanical retreatment of oval root canals. The ultrasonic technique also performed better than the sonic technique. However, none of the additional activation procedures was able to completely eliminate the filling remnants.

The effects of sodium hypochlorite and chlorhexidine irrigants on the antibacterial activities of alkaline media against Enterococcus faecalis.

PubMed

Ma, Jinglei; Tong, Zhongchun; Ling, Junqi; Liu, Hongyan; Wei, Xi

2015-07-01

Sodium hypochlorite (NaOCl), chlorhexidine (CHX) and calcium hydroxide are common intracanal medicaments. The present study aimed to evaluate the effects of NaOCl and CHX on the antibacterial activities of alkaline media against Enterococcus faecalis. The survival rates of planktonic and biofilm E. faecalis were evaluated by plate counts after 1 min of pretreatment with NaOCl and CHX, and time-kill assays were then used to assess subsequent pH alkaline challenges. Dead and living cells in the E. faecalis biofilm were assessed with SYTO 9 and PI staining in combination with confocal laser scanning microscopy following exposure to NaOCl or CHX and subsequent alkaline challenges by common root canal irrigation and dressing procedures. One minute of pretreatment with 2% CHX, 0.2% CHX, or 5.25% NaOCl in combination with a subsequent alkaline challenge significantly decreased planktonic E. faecalis survival rates, but pretreatment with 1% NaOCl did not. The E. faecalis biofilm survival rates were reduced in the subsequent alkaline challenge following CHX pretreatment but gradually increased following NaOCl pretreatment. Similarly, CLSM analysis revealed that the greatest proportions of dead E. faecalis cells in the biofilms were presented in the CHX and alkaline treatment group. CHX might be more effective in improving the antibacterial activities of alkaline root canal medicaments against E. faecalis than NaOCl during routine root canal therapy procedures. Copyright © 2015 Elsevier Ltd. All rights reserved.

A comparison of the sealing ability of various temporary restorative materials to seal the access cavity: An in vitro study.

PubMed

Markose, Aji; Krishnan, Ramesh; Ramesh, Maya; Singh, Shishir

2016-10-01

In multiple-appointment root canal treatment, a temporary filling material is used to seal the access cavity between visits. The primary function of this material is to prevent the contamination of the root canal system by fluids, organic debris, and bacteria from the oral cavity. A total of fifty extracted noncarious unrestored human maxillaryanterior teeth with intact crowns and roots were selected The canals were instrumented using stepback technique and sodium hypochlorite (3%) and hydrogen peroxide (3%) were used as irrigants for each specimen alternatively. The coronal two-thirds of each canal were flared using Gates-Glidden drills up to no. 3 size and obturated with Gutta-percha using zinc oxide-eugenol (ZnOE) as sealer. The teeth were then randomly selected and divided into six groups out of which four were experimental groups and two control groups. The teeth were then immersed in 2% methylene blue dye solution for 3 days. All sealing materials and Gutta-percha were gently removed from the walls of the canal, and the entire circumference of the canal wall examined for dye penetration. The lowest mean leakage was in the Fermit-N group followed by Cavit-W, ZnOE, intermediate restorative materials (IRM), and positive control. Fermit-N showed better sealing ability compared to cavit, ZnOE and IRM.

A comparative evaluation of Morinda citrifolia, green tea polyphenols, and Triphala with 5% sodium hypochlorite as an endodontic irrigant against Enterococcus faecalis: An in vitro study

PubMed Central

Divia, A. R.; Nair, Mali G.; Varughese, Jolly Mary; Kurien, Shobha

2018-01-01

Background: Endodontic infections require effective removal of microorganisms from the root canal system for long-term prognosis. Sodium hypochlorite (NaOCl) is the most effective irrigant currently, but potential complications due to its toxicity warrant search for newer alternatives. In this study, the antimicrobial efficacy of Morinda citrifolia (MC), green tea polyphenols and Triphala was compared with 5% NaOCl against Enterococcus faecalis. Materials and Methods: In this in vitro study sixty extracted human premolar teeth were infected with E. faecalis, a Group D Streptococci for 48 h. At the end of 48 h, the vital bacterial population was assessed by counting the number of colony-forming units (CFUs) on blood agar plate. Samples were divided into five groups; Group I (distilled water), Group II (NaOCl), Group III (MC), Group IV (Triphala), and Group V (green tea polyphenols). The samples were irrigated with individual test agents and CFUs were recorded. Kruskal–Wallis test was performed as the parametric test to compare different groups. Student's t-test was used to compare mean values between groups before and after treatment with test agents (P < 0.001). Results: NaOCl was the most effective irrigant the elimination of E. faecalis reinforcing its role as the best irrigant available currently and a gold standard for comparison of the experimental groups. Its antibacterial effect was comparable to Triphala. Among the experimental groups, MC showed the minimum antibacterial effect. Conclusion: The use of herbal alternatives as a root canal irrigant might prove to be advantageous considering the several undesirable characteristics of NaOCl. PMID:29576775

Evaluation of conventional, protaper hand and protaper rotary instrumentation system for apical extrusion of debris, irrigants and bacteria- An in vitro randomized trial

PubMed Central

Kalra, Pinky; Suman, Ethel; Shenoy, Ramya; Suprabha, Baranya-Shrikrishna

2017-01-01

Background Endodontic instrumentation carries the risk of over extrusion of debris and bacteria. The technique used and the type of instrumentation influences this risk. Aim The purpose of this study was to evaluate and compare the K-file, ProTaper hand and ProTaper rotary instrumentation systems for the amount of apically extruded debris, irrigant solution and intracanal bacteria. Design Experimental single blinded randomized type of in vitro study with sample of 30 single rooted teeth. Endodontic access cavities were prepared and the root canals were filled with the suspension of E. faecalis. Myers and Montogomery Model was used to collect apically extruded debris and irrigant. Canals were prepared using K files, Hand protapers and Protaper rotary files. Statistical analysis Non Parametric test like Kruskal-Wallis and Mann-Whitney U test were applied to determine the significant differences among the group. Results Tests revealed statistically significant difference between the amount of debris and number of bacteria extruded by the ProTaper hand and the K-files. No statistically significant difference was observed between the amounts of irrigant extruded by the ProTaper hand and the K-file system. Statistically significant differences were observed between the amounts of bacteria and irrigant extruded by the ProTaper rotary and the Protaper hand. No statistically significant difference was observed between the amounts of debris extruded by the ProTaper hand and the K-file system. Conclusions Amount of apical extrusion of irrigant solution, bacteria and debris are significantly greater with K File instruments and least with Protaper rotary instruments. Key words:Protaper, rotary, periapical extrusion. PMID:28210445

Comparative anti-microbial efficacy of Azadirachta indica irrigant with standard endodontic irrigants: A preliminary study

PubMed Central

Dutta, Arindam; Kundabala, Mala

2014-01-01

Objective: The anti-microbial efficacy of 2.5% sodium hypochlorite (SHC) and 0.2% chlorhexidine gluconate were compared with an experimental irrigant formulated from the Neem tree, Azadirachta indica A. Juss. Materials and Methods: A sample of 36 single rooted anterior teeth with periapical radiolucency and absence of response to vitality tests that required root canal treatment were selected for this study. The test irrigants and their combinations were assigned to five different groups and saline served as the control. Access cavities were prepared using an aseptic technique and samples collected for both anaerobic culture and Gram stained smears, followed by irrigation and sample collection again. The number of organisms were expressed in colony forming units/ml after 72 h of incubation; the smears were analyzed for their microbial loads and tissue clearance and assessed as per defined criteria. Results: Our results found the maximum reduction in microbial loads, when analyzed by culture method, with a combination of SHC and the experimental neem irrigant. Maximum tissue clearance on the Gram Stained smears was also found with the same combination. Conclusion: Neem irrigant has anti-microbial efficacy and can be considered for endodontic use. PMID:24778508

A comparative scanning electron microscopy evaluation of smear layer removal with apple vinegar and sodium hypochlorite associated with EDTA

PubMed Central

CANDEIRO, George Táccio de Miranda; de MATOS, Isabela Barbosa; da COSTA, Clarice Fernandes Eloy; FONTELES, Cristiane Sá Roriz; do VALE, Mônica Sampaio

2011-01-01

Objective The purpose of this study was to evaluate by scanning electron microscopy (SEM) the removal of smear layer from the middle and apical root thirds after use of different irrigating solutions. Material and Methods Forty roots of permanent human teeth had their canals instrumented and were randomly assigned to 4 groups (n=10), according to the irrigating solution: apple vinegar (group A), apple vinegar finished with 17% ethylenediaminetetraacetic acid (EDTA) (group B), 1% sodium hypochlorite (NaOCl) finished with 17% EDTA (group C) and saline (group D - control). After chemomechanical preparation, the roots were cleaved longitudinally and their middle and apical thirds were examined by SEM at ×1,000 magnification. Two calibrated examiners (kappa=0.92) analyzed the SEM micrographs qualitatively attributing scores that indicated the efficacy of the solutions in removing the smear layer from the surface of the dentin tubules (1 - poor, 2 - good and 3 - excellent). Data from the control and experimental groups were analyzed by the Kruskal-Wallis and Dunn's test, while the Wilcoxon test was used to compare the middle and apical thirds of the canals within the same group (α=0.05). Results The middle third presented less amount of smear layer than the apical third, regardless of the irrigant. There was statistically significant difference (p=0.0402) among the groups in the middle third. In the apical third, the apple vinegar/EDTA group showed the greatest removal of smear layer (p=0.0373). Conclusion Apple vinegar associated or not with EDTA was effective in removing smear layer when used as an endodontic irrigant. PMID:22231000

Effectiveness of chamomile (Matricaria recutita L.), MTAD and sodium hypochlorite irrigants on smear layer.

PubMed

Venkataram, V; Gokhale, S T; Kenchappa, M; Nagarajappa, R

2013-08-01

Endodontic success depends heavily on effective chemo-mechanical debridement of root canals through the use of instruments and irrigating solutions. To compare the effectiveness of chamomile hydroalcoholic extract, Biopure™ mixture of tetracycline isomer, acid and detergent (MTAD) and 2.5 % sodium hypochlorite (NaOCl) on removal of the smear layer. Randomised controlled trial. Thirty extracted single-rooted, primary human teeth were allocated at random into three experimental groups of 10 teeth each. For each tooth, the canal was prepared using the step-back technique. During instrumentation, 2 ml of the irrigant was used for at least 10 s after each file and 10 ml as a final flush for 2 min for chamomile and NaOCL irrigants. Whereas for MTAD, an initial rinse with 1.3 % NaOCl for a cumulated period of 20 min, and use of MTAD as the final rinse for a period of 5 min was followed. Longitudinal grooves were made on root segments, then split into two halves with a chisel, stored in 2.5 % glutaraldehyde solution and fixed in ethanol series. Specimens were examined for the smear layer according to Hulsmann et al. (Int Endod J 35:668-679, 2002) criteria using a scanning electron microscope. Kruskal-Wallis and Mann-Whitney U tests were used. The most effective result in removal of smear layer occurred with the use of MTAD, followed by chamomile extract. The chamomile extract was found to be significantly more effective than 2.5 % NaOCl solution which had only minor effects. The efficacy of chamomile to remove the smear layer was superior to 2.5 % NaOCl alone, but less effective than MTAD mixture.

Antimicrobial potential of medicaments used in healing process in dogs' teeth with apical periodontitis.

PubMed

Estrela, Carlos; Holland, Roberto; Bernabé, Pedro Felício Estrada; de Souza, Valdir; Estrela, Cyntia R A

2004-01-01

The objective of this study was to evaluate the influence of irrigants on the antimicrobial potential of calcium hydroxide paste in dogs' teeth with apical periodontitis. Forty-eight premolar teeth of adult mongrel dogs had their root canals opened to the oral environment for 6 months. The root canals were prepared and treated with different irrigating solutions and intracanal medicaments, according to the following groups: 1) 2.5% sodium hypochlorite (NaOCl) + calcium hydroxide paste (CHP); 2) 2% chlorhexidine (CHX) + CHP; 3) vinegar + CHP; 4) vinegar + vinegar. In group 4, both the irrigating solution and intracanal medicament were vinegar, which was renewed every 7 days. Each sample was collected by using two paper points maintained in position for 1 min, and individually transported and immersed in 7 mL of Letheen broth (LB), followed by incubation at 37 degrees C for 48 h. Microbial growth was analyzed by two methods: turbidity of the culture medium and subculture on a specific nutrient broth (brain heart infusion). After 21 days, all experimental groups had microbial growth, however, in different percentages: group 1 - 30%; group 2 - 30%; group 3 - 40%; group 4 - 60%. All materials tested had antimicrobial potential; however, the influence of calcium hydroxide paste on the control of microorganisms must be remembered.

Determination of the Apical Sealing Abilities of Mineral Trioxide Aggregate, Portland Cement, and Bioaggregate After Irrigation with Different Solutions.

PubMed

Bayram, H Melike; Saklar, Feridun; Bayram, Emre; Orucoglu, Hasan; Bozkurt, Alperen

2015-06-01

The purpose of this study was to investigate the sealing ability of root-end filling materials such as mineral trioxide aggregate (MTA), Portland cement, and bioaggregate (BA) after irrigation with different solutions. We examined 130 human maxillar central teeth. After cutting the teeth at the cementoenamel junction, the root canals were expanded using nickel-titanium rotary instruments. Root canals were filled with AH-plus and gutta-percha. Then, the roots were cut apically, and 3 mm deep retrograde cavities were prepared. The roots were divided 12 experimental groups, consisting 10 teeth each; the positive and negative control groups contained five teeth each. The retrograde cavities were rinsed using ethylenediaminetetraacetic acid (EDTA), chlorhexidine (CHX), BioPure(™) mixture of a tetracycline isomer, an acid, and a detergent (MTAD), or distilled water. Next, groups 1, 2, 3, and 4 were sealed with MTA; groups 5, 6, 7, and 8 were sealed with Portland cement; and groups 9, 10, 11, and 12 were sealed with BA. Then, apical microleakage was evaluated by using a computerized fluid filtration method. The results of the leakage test were statistically evaluated by the post-hoc Tukey's test. MTA, Portland cement, and BA root-end filling materials showed the least leakage in the CHX and distilled water groups. The highest leakage was observed in the EDTA and MTAD groups. The sealing ability of BA was as good as that of MTA. EDTA and MTAD increased the apical leakage and CHX and distilled water decreased the leakage of the root-end filling materials examined in this study.

Effect of ultrasound streaming on the disinfection of flattened root canals prepared by rotary and reciprocating systems

PubMed Central

de Vasconcelos, Layla Reginna Silva Munhoz; Midena, Raquel Zanin; Minotti, Paloma Gagliardi; Pereira, Thais Cristina; Duarte, Marco Antonio Hungaro; de Andrade, Flaviana Bombarda

2017-01-01

Abstract New technical and scientific developments have been advocated to promote the success of the endodontic treatment. In addition to rotary and reciprocating systems, irrigating solution agitation has been suggested and passive ultrasonic irrigation (PUI) is the most used. Objective: To evaluate, in vitro, the effect of ultrasound streaming (US) in the disinfection of flattened root canal systems prepared by the ProTaper, BioRaCe and Reciproc systems, utilizing the microbiological culture. Methodology: Extracted human mandibular incisors (n=84) were used. Suspensions of Enterococcus faecalis (ATCC 29212) were standardized and inserted along with the teeth immersed in brain-heart infusion (BHI) broth. The contamination was made following a protocol during 5 days. The teeth were randomly divided into six groups: G1, ProTaper Universal; G2, ProTaper Universal with US; G3, BioRaCe; G4, BioRaCe with US; G5, Reciproc; and G6, Reciproc with US. Irrigation was performed with saline solution. After biomechanical preparation, microbiological samples were performed with sterilized paper points, which were diluted and spread on BHI agar; after 48 h, the colony forming units (CFU/mL) were counted for each sample. Results: Groups using ultrasonic agitation presented a greater antibacterial effect than the other ones, even using saline solution as irrigant. The ProTaper Universal system showed the best antibacterial activity of the tested systems (median of 0 CFU/mL with and without surfactant or ultrasonic activation [PUI]). Even with PUI, Reciproc (median of 2.5 CFU/mL with PUI and 5 without it) could not reduce as many colonies as ProTaper Universal without US. The BioRaCe system had greater bacterial reduction when using US (median of 0 CFU/mL with PUI and 30 without it). Conclusions: US promoted greater reduction in the number of bacteria in the flattened root canals prepared with nickel-titanium mechanized systems. Regarding the instruments used, the ProTaper Universal system was the most effective in reducing the bacterial number. PMID:29069144

Effect of ultrasound streaming on the disinfection of flattened root canals prepared by rotary and reciprocating systems.

PubMed

Vasconcelos, Layla Reginna Silva Munhoz de; Midena, Raquel Zanin; Minotti, Paloma Gagliardi; Pereira, Thais Cristina; Duarte, Marco Antonio Hungaro; Andrade, Flaviana Bombarda de

2017-01-01

New technical and scientific developments have been advocated to promote the success of the endodontic treatment. In addition to rotary and reciprocating systems, irrigating solution agitation has been suggested and passive ultrasonic irrigation (PUI) is the most used. To evaluate, in vitro, the effect of ultrasound streaming (US) in the disinfection of flattened root canal systems prepared by the ProTaper, BioRaCe and Reciproc systems, utilizing the microbiological culture. Extracted human mandibular incisors (n=84) were used. Suspensions of Enterococcus faecalis (ATCC 29212) were standardized and inserted along with the teeth immersed in brain-heart infusion (BHI) broth. The contamination was made following a protocol during 5 days. The teeth were randomly divided into six groups: G1, ProTaper Universal; G2, ProTaper Universal with US; G3, BioRaCe; G4, BioRaCe with US; G5, Reciproc; and G6, Reciproc with US. Irrigation was performed with saline solution. After biomechanical preparation, microbiological samples were performed with sterilized paper points, which were diluted and spread on BHI agar; after 48 h, the colony forming units (CFU/mL) were counted for each sample. Groups using ultrasonic agitation presented a greater antibacterial effect than the other ones, even using saline solution as irrigant. The ProTaper Universal system showed the best antibacterial activity of the tested systems (median of 0 CFU/mL with and without surfactant or ultrasonic activation [PUI]). Even with PUI, Reciproc (median of 2.5 CFU/mL with PUI and 5 without it) could not reduce as many colonies as ProTaper Universal without US. The BioRaCe system had greater bacterial reduction when using US (median of 0 CFU/mL with PUI and 30 without it). US promoted greater reduction in the number of bacteria in the flattened root canals prepared with nickel-titanium mechanized systems. Regarding the instruments used, the ProTaper Universal system was the most effective in reducing the bacterial number.

The effectiveness of increased apical enlargement in reducing intracanal bacteria.

PubMed

Card, Steven J; Sigurdsson, Asgeir; Orstavik, Dag; Trope, Martin

2002-11-01

It has been suggested that the apical portion of a root canal is not adequately disinfected by typical instrumentation regimens. The purpose of this study was to determine whether instrumentation to sizes larger than typically used would more effectively remove culturable bacteria from the canal. Forty patients with clinical and radiographic evidence of apical periodontitis were recruited from the endodontic clinic. Mandibular cuspids (n = 2), bicuspids (n = 11), and molars (mesial roots) (n = 27) were selected for the study. Bacterial sampling was performed upon access and after each of two consecutive instrumentations. The first instrumentation utilized 1% NaOCI and 0.04 taper ProFile rotary files. The cuspid and bicuspid canals were instrumented to a #8 size and the molar canals to a #7 size. The second instrumentation utilized LightSpeed files and 1% NaOCl irrigation for further enlargement of the apical third. Typically, molars were instrumented to size 60 and cuspid/bicuspid canals to size 80. Our findings show that 100% of the cuspid/bicuspid canals and 81.5% of the molar canals were rendered bacteria-free after the first instrumentation sizes. The molar results improved to 89% after the second instrumentation. Of the (59.3%) molar mesial canals without a clinically detectable communication, 93% were rendered bacteria-free with the first instrumentation. Using a Wilcoxon rank sum test, statistically significant differences (p < 0.0001) were found between the initial sample and the samples after the first and second instrumentations. The differences between the samples that followed the two instrumentation regimens were not significant (p = 0.0617). It is concluded that simple root canal systems (without multiple canal communications) may be rendered bacteria-free when preparation of this type is utilized.

Effect of endodontic chelating solutions on the bond strength of endodontic sealers.

PubMed

Tuncel, Behram; Nagas, Emre; Cehreli, Zafer; Uyanik, Ozgur; Vallittu, Pekka; Lassila, Lippo

2015-01-01

The purpose of this in vitro study was to evaluate the effect of various chelating solutions on the radicular push-out bond strength of calcium silicate-based and resin-based root canal sealers. Root canals of freshly-extracted single-rooted teeth (n = 80) were instrumented by using rotary instruments. The specimens were randomly divided into 4 groups according to the chelating solutions being tested: (1) 17% ethylenediaminetetraacetic acid (EDTA); (2) 9% etidronic acid; (3) 1% peracetic acid (PAA); and (4) distilled water (control). In each group, the roots were further assigned into 2 subgroups according to the sealer used: (1) an epoxy resin-based sealer (AH Plus) and (2) a calcium silicate-based sealer (iRoot SP). Four 1 mm-thick sections were obtained from the coronal aspect of each root (n = 40 slices/group). Push-out bond strength test was performed at a crosshead speed of 1 mm/min., and the bond strength data were analyzed statistically with two-way analysis of variance (ANOVA) with Bonferroni's post hoc test (p < 0.05). Failure modes were assessed quantitatively under a stereomicroscope. Irrespective of the irrigation regimens, iRoot SP exhibited significantly higher push-out bond strength values than AH Plus (p < 0.05). For both the sealers, the use of chelating solutions increased the bond strength, but to levels that were not significantly greater than their respective controls (p > 0.05). iRoot SP showed higher resistance to dislocation than AH Plus. Final irrigation with 17% EDTA, 9% Etidronic acid, and 1% PAA did not improve the bond strength of AH Plus and iRoot SP to radicular dentin.

Root canals decontamination by coherent photons initiated photoacustic streaming (PIPS) of irrigants: an ex-vivo study

NASA Astrophysics Data System (ADS)

Pedullà, E.; Genovese, C.; Scolaro, C.; Cutroneo, M.; Tempera, G.; Rapisarda, E.; Torrisi, L.

2014-04-01

The aim of this ex vivo study was to assess the antibacterial effectiveness of coherent photon initiated photoacoustic streaming (PIPS) of irrigants using an Er:YAG laser equipped with a newly designed, stripped and tapered, tip in extracted teeth with infected root canals. One hundred-forty-eight single-rooted extracted teeth were prepared using a rotary abrasive instrument providing a root channel with a suitable size. The samples were sterilized and all teeth except ten (negative control group) were inoculated with Enterococcus faecalis and incubated in a CO2 chamber at 37°C for 15 days in Eppendorff tubes filled with trypticase soy broth medium changed every 2 days. Infected teeth were then randomly divided into 4 test groups (n=32 for each): pulsed erbium:YAG laser at non-ablative settings for 30 seconds with sterile bi-distilled water (Group A) or 5% sodium hypochlorite (NaOCl) (Group B); without laser activated sterile bi-distilled water irrigation for 30 seconds (Group C) or 5% NaOCl irrigation for 30 seconds (Group D); the positive control group received no treatment in infected teeth (n=10). Colony-forming units (CFUs) were counted from bacteriologic samples taken before (S1) and after treatment (S2). Data were analyzed by Kruskal-Wallis and post hoc Dunn's multiple comparison tests. CFU counts were significantly lower in groups B and D than in group C (P<0.001). Moreover, there was a significant difference between Group A and C (P<0.001). Group B showed the highest CFU reduction, which was significantly greater than that evident in groups A or C (P<0.001). There were no statistically significant differences between group B and D (P>0.05). None of the four groups predictably generated negative samples. Under the conditions of this ex vivo study, statistically significant difference wasn't found in planktonic bacteria reduction between the laser and NaOCl or NaOCl alone groups.

A comparative evaluation of smear layer removal by using edta, etidronic acid, and maleic acid as root canal irrigants: An in vitro scanning electron microscopic study

PubMed Central

Kuruvilla, Aby; Jaganath, Bharath Makonahalli; Krishnegowda, Sahadev Chickmagaravalli; Ramachandra, Praveen Kumar Makonahalli; Johns, Dexton Antony; Abraham, Aby

2015-01-01

Aim: The purpose of this study is to evaluate and compare the efficacy of 17% EDTA, 18% etidronic acid, and 7% maleic acid in smear layer removal using scanning electron microscopic image analysis. Materials and Methods: Thirty, freshly extracted mandibular premolars were used. The teeth were decoronated to obtain working length of 17mm and instrumentation up to 40 size (K file) with 2.5% NaOCl irrigation between each file. The samples were divided into Groups I (17% ethylenediaminetetraacetic acid (EDTA)), II (18% etidronic acid), and III (7% maleic acid) containing 10 samples each. Longitudinal sectioning of the samples was done. Then the samples were observed under scanning electron microscope (SEM) at apical, middle, and coronal levels. The images were scored according to the criteria: 1. No smear layer, 2. moderate smear layer, and 3 heavy smear layer. Statistical Analysis: Data was analyzed statistically using Kruskal–Wallis analysis of variance (ANOVA) followed by Mann-Whitney U test for individual comparisons. The level for significance was set at 0.05. Results: The present study showed that all the three experimental irrigants removed the smear layer from different tooth levels (coronal, middle, and apical). Final irrigation with 7% maleic acid is more efficient than 17% EDTA and 18% etidronic acid in the removal of smear layer from the apical third of root canal. PMID:26069414

In Vitro Comparison of Apically Extruded Debris during Root Canal Preparation of Mandibular Premolars with Manual and Rotary Instruments.

PubMed

Soi, Sonal; Yadav, Suman; Sharma, Sumeet; Sharma, Mohit

2015-01-01

Background and aims. During root canal preparation, debris extruded beyond the apical foramen may result in periapical inflammation and postoperative pain. To date no root canal preparation method has been developed that extrudes no periapical debris. The purpose of this study was to identify a system leading to minimal extrusion of debris from the apical foramen. The study was conducted to comparatively evaluate the amount of apical extrusion of debris during root canal preparation using hand ProTaper and GT rotary and RaCe rotary instruments using crown-down technique. Materials and methods. Ninety freshly extracted human single-rooted mandibular premolars were equally assigned to three groups (n=30). The root canals were instrumented using hand ProTaper, GT rotary and RaCe rotary systems. Debris and irrigant extruded from the apical foramen were collected into vials. The mean weight of the remaining debris was calculated for each group and subjected to statistical analysis. Results. ANOVA was used to compare the mean dry weights of the debris extruded in the three groups, followedby post hoc Tukey tests for multiple comparisons the between groups. Highly significant differences were found in the amount of debris extruded among all the groups (P<0.001). The ProTaper group exhibited the highest mean debris weight (0.8293±0.05433 mg) and the RaCe system exhibited the lowest mean debris weight (0.1280±0.01606 mg). Conclusion. All the systems tested resulted in apical extrusion of debris. However, the hand ProTaper files extruded a significantly higher amount of debris than GT and RaCe systems.

In Vitro Comparison of Apically Extruded Debris during Root Canal Preparation of Mandibular Premolars with Manual and Rotary Instruments

PubMed Central

Soi, Sonal; Yadav, Suman; Sharma, Sumeet; Sharma, Mohit

2015-01-01

Background and aims. During root canal preparation, debris extruded beyond the apical foramen may result in periapical inflammation and postoperative pain. To date no root canal preparation method has been developed that extrudes no periapical debris. The purpose of this study was to identify a system leading to minimal extrusion of debris from the apical foramen. The study was conducted to comparatively evaluate the amount of apical extrusion of debris during root canal preparation using hand ProTaper and GT rotary and RaCe rotary instruments using crown-down technique. Materials and methods. Ninety freshly extracted human single-rooted mandibular premolars were equally assigned to three groups (n=30). The root canals were instrumented using hand ProTaper, GT rotary and RaCe rotary systems. Debris and irrigant extruded from the apical foramen were collected into vials. The mean weight of the remaining debris was calculated for each group and subjected to statistical analysis. Results. ANOVA was used to compare the mean dry weights of the debris extruded in the three groups, followedby post hoc Tukey tests for multiple comparisons the between groups. Highly significant differences were found in the amount of debris extruded among all the groups (P<0.001). The ProTaper group exhibited the highest mean debris weight (0.8293±0.05433 mg) and the RaCe system exhibited the lowest mean debris weight (0.1280±0.01606 mg). Conclusion. All the systems tested resulted in apical extrusion of debris. However, the hand ProTaper files extruded a significantly higher amount of debris than GT and RaCe systems. PMID:26697144

In vitro effects of calcium hydroxide and polymyxin B on endotoxins in root canals.

PubMed

Oliveira, L D; Leão, M V P; Carvalho, C A T; Camargo, C H R; Valera, M C; Jorge, A O C; Unterkircher, C S

2005-02-01

To evaluate the effects of intracanal medicaments on endotoxins in root canals. Seventy-five freshly extracted maxillary incisors were used in this study. The crowns of teeth were sectioned near the CEJ in order to standardize the root length to 14 mm. The root canals were instrumented to an apical size #50 file and irrigated with 1% sodium hypochlorite solution and sterilized with 60Co gamma irradiation. Standardized suspension containing Escherichia coli endotoxin was inoculated into the 60 root canals. The specimens were randomly assigned to 5 groups (n=15), according to the intracanal medicament used: (G1) calcium hydroxide; (G2) polymyxin B; (G3) combination neomycin-polymyxin B-hydrocortisone; (G4) positive control (no intracanal medicament); (G5) negative control (no endotoxin and no intracanal medicament). After 7 days, the detoxification of endotoxin was evaluated by Limulus lysate assay and antibody production in B-lymphocytes culture. Groups 1, 2 and 5 presented the best results by Limulus lysate and were significantly different to groups 3 and 4 (p<0.05). Stimulation of antibodies production in cell culture by groups 1 and 6 was smaller and statistically different than groups 2, 3, 4 and 5 (p<0.05). Groups 2 and 5 induced a small increase in the antibodies production in relation to the groups 1 and 6. Groups 3 and 4 induced a significant increase of antibodies production (p<0.05). The calcium hydroxide and polymyxin B intracanal medicaments detoxified endotoxin in root canals and altered the properties of LPS to stimulate the antibody production by B-lymphocytes. The combination neomycin-polymyxin B-hydrocortisone did not detoxified endotoxin.

A titration model for evaluating calcium hydroxide removal techniques.

PubMed

Phillips, Mark; McClanahan, Scott; Bowles, Walter

2015-01-01

Calcium hydroxide (Ca(OH)2) has been used in endodontics as an intracanal medicament due to its antimicrobial effects and its ability to inactivate bacterial endotoxin. The inability to totally remove this intracanal medicament from the root canal system, however, may interfere with the setting of eugenol-based sealers or inhibit bonding of resin to dentin, thus presenting clinical challenges with endodontic treatment. This study used a chemical titration method to measure residual Ca(OH)2 left after different endodontic irrigation methods. Eighty-six human canine roots were prepared for obturation. Thirty teeth were filled with known but different amounts of Ca(OH)2 for 7 days, which were dissolved out and titrated to quantitate the residual Ca(OH)2 recovered from each root to produce a standard curve. Forty-eight of the remaining teeth were filled with equal amounts of Ca(OH)2 followed by gross Ca(OH)2 removal using hand files and randomized treatment of either: 1) Syringe irrigation; 2) Syringe irrigation with use of an apical file; 3) Syringe irrigation with added 30 s of passive ultrasonic irrigation (PUI), or 4) Syringe irrigation with apical file and PUI (n=12/group). Residual Ca(OH)2 was dissolved with glycerin and titrated to measure residual Ca(OH)2 left in the root. No method completely removed all residual Ca(OH)2. The addition of 30 s PUI with or without apical file use removed Ca(OH)2 significantly better than irrigation alone. This technique allowed quantification of residual Ca(OH)2. The use of PUI (with or without apical file) resulted in significantly lower Ca(OH)2 residue compared to irrigation alone.

Removal of calcium hydroxide from Weine Type II systems using photon-induced photoacoustic streaming, passive ultrasonic, and needle irrigation: a microcomputed tomography study

PubMed Central

LLOYD, Adam; NAVARRETE, Geraldine; MARCHESAN, Melissa Andreia; CLEMENT, David

2016-01-01

ABSTRACT Objective This study compared the effectiveness of Er:YAG laser-activated irrigation (PIPS), passive ultrasonic irrigation (PUI) with EndoUltra and standard needle irrigation (SNI) in the removal of calcium hydroxide [Ca(OH)2] from the mesial roots of Weine Type II mandibular molars. Material and Methods Thirty mandibular molars were screened by µCT for the presence of mesial roots with complex intra-canal anatomy and a common apical foramen. The teeth were enlarged to a standardized 25/.06 preparation and filled with Ca(OH)2 paste. Specimens were divided into three groups (n=10) according to the technique used for Ca(OH)2 removal: PIPS, at 15 Hz and 20 mJ using a 9 mm long, 600 µm diameter tip; PUI using a 15/.02 tip; and SNI (30 Ga. side-vented needle). Equal volumes of 8.25% NaOCl and 17% EDTA were used in all groups. µCT was used to measure the initial amount of Ca(OH)2 present and to assess the residual volume of Ca(OH)2 following each irrigation protocol. Data were analyzed using Tukey HSD and Kruskal-Wallis tests (α=5%). Results The mean volume of Ca(OH)2 before removal was significantly higher in the coronal third than in the middle and apical third (p<0.001). Ca(OH)2 was similarly removed from the coronal and middle thirds with the three methods used (p>0.05). PIPS (median 0%; IQR: 0-0) showed significant higher Ca(OH)2 removal in the apical third than PUI (median 100%, IQR: 85-100) and SNI (median 47%; IQR: 16-72) (p<0.001). Conclusions PIPS laser-activation was more effective for the removal of Ca(OH)2 from mesial roots of mandibular molars with Weine Type II canal configurations than PUI with EndoUltra and SNI. PMID:28076457

Primum non nocere - The effects of sodium hypochlorite on dentin as used in endodontics.

PubMed

Gu, Li-Sha; Huang, Xue-Qing; Griffin, Brandon; Bergeron, Brian R; Pashley, David H; Niu, Li-Na; Tay, Franklin R

2017-10-01

The medical literature is replete with the maxim 'primum non nocere', cautioning health care providers to avoid doing any harm to human subjects in their delivery of medical care. Sodium hypochlorite (NaOCl) is a well-established irrigant for root canal treatment because of its antimicrobial and organic tissue remnant dissolution capability. However, little is known about the deleterious effect of this strong oxidizing agent on the integrity of human mineralized dentin. Iatrogenically-induced loss of dentin integrity may precipitate post-treatment root fracture and has potential medico-legal complications. In the present work, transmission electron microscopy provided evidence for collagen destruction in the surface/subsurface of dentin treated with high NaOCl concentrations and long contact times. Size exclusion chromatography showed that the hypochlorite anion, because of its small size, penetrated the water compartments of apatite-encapsulated collagen fibrils, degraded the collagen molecules and produced a 25-35µm thick, non-uniform "ghost mineral layer" with enlarged, coalesced dentinal tubules and their lateral branches. Fourier transform-infrared spectroscopy identified increases in apatite/collagen ratio in NaOCl-treated dentin. The apatite-rich, collagen-sparse dentin matrix that remained after NaOCl treatment is more brittle, as shown by the reductions in flexural strength. Understanding the deleterious effects of NaOCl on mineralized dentin enables one to balance the risks and benefits in using high NaOCl concentrations for lengthy periods in root canal debridement. Delineating the mechanism responsible for such a phenomenon enables high molecular weight, polymeric antimicrobial and tissue dissolution irrigants to be designed that abides by the maxim of 'primum non nocere' in contemporary medical practices. The antimicrobial and tissue-dissolution capacities of NaOCl render it a well-accepted agent for root canal debridement. These highly desirable properties, however, appear to be intertwined with the untoward effect of collagen matrix degradation within mineralized dentin. Because of its small size, the hypochlorite anion is capable of infiltrating mineralized collagen and destroying the collagen fibrils, producing a mineral-rich, collagen sparse ghost mineral matrix with reduced flexural strength. Findings from the present work challenge the biosafety of NaOCl when it is used in high concentrations and for lengthy time periods during root canal treatment, and laid the background work for future biomaterials design in debridement of the canal space. Published by Elsevier Ltd.

The effect of EDTA, EGTA, EDTAC, and tetracycline-HCl with and without subsequent NaOCl treatment on the microhardness of root canal dentin.

PubMed

Sayin, Taner Cem; Serper, Ahmet; Cehreli, Zafer C; Otlu, Harika G

2007-09-01

The purpose of this study was to evaluate the effect of single and combined use of ethylenediamine tetra acetic acid (EDTA), ethylene glycol bis [b-aminoethylether] N,N,N',N'-tetraacetic acid (EGTA), EDTA plus Cetavlon (EDTAC), tetracycline-HCl, and NaOCl on the microhardness of root canal dentin. The crowns of 30 single-rooted human teeth were discarded at the cementoenamel junction and the roots were bisected longitudinally to obtain root halves (N = 60). The specimens were embedded in autopolymerizing acrylic resin, leaving the root canal dentin exposed. Dentin surfaces were prepared for microhardness test by grinding and polishing. The reference microhardness values of untreated specimens were recorded using a Vicker's microhardness tester at the apical, midroot, and cervical levels of the root canal. Thereafter, the specimens treated with single (test solution only) or combined (test solution, followed by 2.5% NaOCl) versions of the irrigants for 5 minutes. Posttreatment microhardness values were obtained as with initial ones. Statistical comparisons between the test groups and among single and combined treatments were carried out using 2-way ANOVA with repeated measures (P =.05). Comparisons within each group with respect to application regions were made with Friedman's nonparametric 2-way analysis of variance at the same level of significance. All treatment regimens except distilled water significantly decreased the microhardness of the root canal dentin (P < . 05). The single and combined use of EDTA decreased the microhardness of the root canal dentin significantly more than all other treatment regimens (P < .05). Compared with their single-treatment versions, all combined treatment regimens decreased the mean microhardness values significantly (P < .05). A comparison of single and combined treatment regimens revealed significant decreases only for EDTA and EDTA + NaOCl in the coronal region and for EDTAC and EDTAC + NaOCl in the apical and middle regions of the root canal (P < .05). The use of EDTA alone or prior to NaOCl resulted in the maximum decrease in dentin microhardness. The softening effect of subsequent NaOCl treatment was both material and region dependent. However, for combined treatment regimens, subsequent use of NaOCl levels the statistical differences between the regional microhardness values obtained after treatment with EGTA, EDTAC, and tetracycline-HCl.

The self-adjusting file (SAF). Part 1: respecting the root canal anatomy--a new concept of endodontic files and its implementation.

PubMed

Metzger, Zvi; Teperovich, Ehud; Zary, Raviv; Cohen, Raphaela; Hof, Rafael

2010-04-01

To introduce a new concept, the self-adjusting file (SAF), and discuss its unique features compared with current rotary nickel-titanium file systems. The SAF file is hollow and designed as a thin cylindrical nickel-titanium lattice that adapts to the cross-section of the root canal. A single file is used throughout the procedure. It is inserted into a path initially prepared by a # 20 K-file and operated with a transline- (in-and-out) vibration. The resulting circumferential pressure allows the file's abrasive surface to gradually remove a thin uniform hard-tissue layer from the entire root canal surface, resulting in a canal with a similar cross-section but of larger dimensions. This holds also for canals with an oval or flat cross-section, which will be enlarged to a flat or oval cross-section of larger dimensions. The straightening of curved canals is also reduced because of the high pliability of the file and the absence of a rigid metal core. Thus, the original shape of the root canal is respected both longitudinally and in cross-section. The hollow SAF file is operated with a constant flow of irrigant that enters the full length of the canal and that is activated by the vibration and is replaced continuously throughout the procedure. This results in effective cleaning even at the cul de sac apical part of the canal. The SAF has high mechanical endurance; file separation does not occur; and mechanical failure, if it occurs, is limited to small tears in the latticework. The SAF represents a new step forward in endodontic file development that may overcome many of the shortcomings of current rotary nickel-titanium file systems. Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Histological analysis of cleaning efficacy of hand and rotary instruments in the apical third of the root canal: A comparative study.

PubMed

Arya, Ashtha; Bali, Dildeep; Grewal, Mandeep S

2011-07-01

To compare the cleaning efficiency of manual and rotary instrumentation in the apical third of the root canal system. In group 1 (n=10), instrumentation was performed with stainless steel K-file; in group 2 (n=10), it was done with hand ProTaper files; and in group 3 (n=10), instrumentation was done with ProTaper rotary. Distilled water was used for irrigation. The apical third was sectioned transversally and histologically processed. The cross sections were examined under optic microscope and debris was measured using Motic software. Instrumentation with stainless steel K-files showed minimum amount of debris, followed by ProTaper hand files, and rotary ProTaper files were least effective with maximum amount of debris; however, there were no significant differences between the three experimental groups. Both the manual and rotary instrumentation are relatively efficient in cleaning the apical third of the root canal system and the choice between manual and rotary instrumentation should depend on case to case basis.

Antibacterial Nanoparticles in Endodontics: A Review.

PubMed

Shrestha, Annie; Kishen, Anil

2016-10-01

A major challenge in root canal treatment is the inability of the current cleaning and shaping procedures to eliminate bacterial biofilms surviving within the anatomic complexities and uninstrumented portions of the root canal system. Nanoparticles with their enhanced and unique physicochemical properties, such as ultrasmall sizes, large surface area/mass ratio, and increased chemical reactivity, have led research toward new prospects of treating and preventing dental infections. This article presents a comprehensive review on the scientific knowledge that is available on the application of antibacterial nanoparticles in endodontics. The application of nanoparticles in the form of solutions for irrigation, medication, and as an additive within sealers/restorative materials has been evaluated to primarily improve the antibiofilm efficacy in root canal and restorative treatments. In addition, antibiotic or photosensitizer functionalized nanoparticles have been proposed recently to provide more potent antibacterial efficacy. The increasing interest in this field warrants sound research based on scientific and clinical collaborations to emphasize the near future potential of nanoparticles in clinical endodontics. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Reducing surface tension in endodontic chelator solutions has no effect on their ability to remove calcium from instrumented root canals.

PubMed

Zehnder, Matthias; Schicht, Olivier; Sener, Beatrice; Schmidlin, Patrick

2005-08-01

The aim of this study was to evaluate the effect of reducing surface tension in endodontic chelator solutions on their ability to remove calcium from instrumented root canals. Aqueous solutions containing 15.5% EDTA, 10% citric acid, or 18% 1- hydroxyethylidene-1, 1-bisphosphonate (HEBP) were prepared with and without 1% (wt/wt) polysorbate (Tween) 80 and 9% propylene glycol. Surface tension in these solutions was measured using the Wilhelmy method. Sixty-four extracted, single-rooted human teeth of similar length were instrumented and irrigated with a 1% sodium hypochlorite solution and then randomly assigned (n = 8 per group) to receive a final one-minute rinse with 5 ml of test solutions, water, or the pure aqueous Tween/propylene glycol solution. Calcium concentration in eluates was measured using atomic absorption spectrometry. Incorporation of wetting agents resulted in a reduction of surface tension values by approximately 50% in all tested solutions. However, none of the solutions with reduced surface tension chelated more calcium from canals than their pure counterparts (p > 0.05).

Evaluation of the bactericidal effect of Nd:YAG, Er:YAG, Er,Cr:YSGG laser radiation, and antimicrobial photodynamic therapy (aPDT) in experimentally infected root canals.

PubMed

Cheng, Xiaogang; Guan, Sumin; Lu, Hong; Zhao, Chunmiao; Chen, Xingxing; Li, Na; Bai, Qian; Tian, Yu; Yu, Qing

2012-12-01

In recent years, various laser systems have been introduced into the field of laser-assisted endodontic therapy. The aim of this study was to evaluate the bactericidal effect of Nd:YAG, Er:YAG, Er,Cr:YSGG laser radiation, and antimicrobial photodynamic therapy (aPDT) in experimentally infected root canals compared with standard endodontic treatment of 5.25% sodium hypochlorite (NaClO) irrigation. Two hundred and twenty infected root canals from extracted human teeth (contaminated with Enterococcus faecalis ATCC 4083 for 4 weeks) were randomly divided into five experimental groups (Nd:YAG, Er:YAG + 5.25% NaClO + 0.9% normal saline + distilled water (Er:YAG/NaClO/NS/DW), Er:YAG + 0.9% normal saline + distilled water (Er:YAG/NS/DW), Er,Cr:YSGG, and aPDT) and two control groups (5.25% NaClO as positive control and 0.9% normal saline (NS) as negative control). The numbers of bacteria on the surface of root canal walls and at different depths inside dentinal tubules before and after treatment were analyzed by means of one-way analysis of variance (one-way ANOVA). The morphology of bacterial cells before and after treatment was examined by scanning electron microscopy (SEM). After treatment, the bacterial reductions in the experimental groups and the positive control group were significantly greater than that of the negative control group (P < 0.001). However, only Er:YAG/NaClO/NS/DW group showed no bacterial growth (the bacterial reduction reached up to 100%) on the surface of root canal walls or at 100/200 µm inside the dentinal tubules. All the laser radiation protocols tested, especially Er:YAG/NaClO/NS/DW, have effective bactericidal effect in experimentally infected root canals. Er:YAG/NaClO/NS/DW seems to be an ideal protocol for root canal disinfection during endodontic therapy. Copyright © 2012 Wiley Periodicals, Inc.

Temperature increases on the external root surface during endodontic treatment using single file systems.

PubMed

Özkocak, I; Taşkan, M M; Gökt Rk, H; Aytac, F; Karaarslan, E Şirin

2015-01-01

The aim of this study is to evaluate increases in temperature on the external root surface during endodontic treatment with different rotary systems. Fifty human mandibular incisors with a single root canal were selected. All root canals were instrumented using a size 20 Hedstrom file, and the canals were irrigated with 5% sodium hypochlorite solution. The samples were randomly divided into the following three groups of 15 teeth: Group 1: The OneShape Endodontic File no.: 25; Group 2: The Reciproc Endodontic File no.: 25; Group 3: The WaveOne Endodontic File no.: 25. During the preparation, the temperature changes were measured in the middle third of the roots using a noncontact infrared thermometer. The temperature data were transferred from the thermometer to the computer and were observed graphically. Statistical analysis was performed using the Kruskal-Wallis analysis of variance at a significance level of 0.05. The increases in temperature caused by the OneShape file system were lower than those of the other files (P < 0.05). The WaveOne file showed the highest temperature increases. However, there were no significant differences between the Reciproc and WaveOne files. The single file rotary systems used in this study may be recommended for clinical use.

Increased malaria transmission around irrigation schemes in Ethiopia and the potential of canal water management for malaria vector control.

PubMed

Kibret, Solomon; Wilson, G Glenn; Tekie, Habte; Petros, Beyene

2014-09-13

Irrigation schemes have been blamed for the increase in malaria in many parts of sub-Saharan Africa. However, proper water management could help mitigate malaria around irrigation schemes in this region. This study investigates the link between irrigation and malaria in Central Ethiopia. Larval and adult mosquitoes were collected fortnightly between November 2009 and October 2010 from two irrigated and two non-irrigated (control) villages in the Ziway area, Central Ethiopia. Daily canal water releases were recorded during the study period and bi-weekly correlation analysis was done to determine relationships between canal water releases and larval/adult vector densities. Blood meal sources (bovine vs human) and malaria sporozoite infection were tested using enzyme-linked immunosorbent assay (ELISA). Monthly malaria data were also collected from central health centre of the study villages. Monthly malaria incidence was over six-fold higher in the irrigated villages than the non-irrigated villages. The number of anopheline breeding habitats was 3.6 times higher in the irrigated villages than the non-irrigated villages and the most common Anopheles mosquito breeding habitats were waterlogged field puddles, leakage pools from irrigation canals and poorly functioning irrigation canals. Larval and adult anopheline densities were seven- and nine-fold higher in the irrigated villages than in the non-irrigated villages, respectively, during the study period. Anopheles arabiensis was the predominant species in the study area. Plasmodium falciparum sporozoite rates of An. arabiensis and Anopheles pharoensis were significantly higher in the irrigated villages than the non-irrigated villages. The annual entomological inoculation rate (EIR) calculated for the irrigated and non-irrigated villages were 34.8 and 0.25 P. falciparum infective bites per person per year, respectively. A strong positive correlation was found between bi-weekly anopheline larval density and canal water releases. Similarly, there was a strong positive correlation between bi-weekly vector density and canal water releases lagged by two weeks. Furthermore, monthly malaria incidence was strongly correlated with monthly vector density lagged by a month in the irrigated villages. The present study revealed that the irrigation schemes resulted in intensified malaria transmission due to poor canal water management. Proper canal water management could reduce vector abundance and malaria transmission in the irrigated villages.

Demetallization of Enterococcus faecalis biofilm: a preliminary study

PubMed Central

ESTRELA, Carlos; COSTA E SILVA, Rodrigo; URBAN, Roberta Cerasi; GONÇALVES, Pablo José; SILVA, Júlio A.; ESTRELA, Cyntia R.A.; PECORA, Jesus Djalma; PETERS, Ove A.

2018-01-01

Abstract Objectives To determine the concentration of calcium, iron, manganese and zinc ions after the application of chelator to Enterococcus faecalis biofilms. Material and Methods Fifty bovine maxillary central incisors were prepared and inoculated with E. faecalis for 60 days. The following were used as irrigation solutions: 17% EDTA (pH 3, 7 and 10), 2.5% sodium hypochlorite (NaOCl) combined with 17% EDTA (pH 3, 7 and 10), distilled water (pH 3, 7 and 10), and 2.5% NaOCl. Each solution was kept in the root canal for five minutes. Fifteen uncontaminated root canals were irrigated with 17% EDTA (pH 3, 7 and 10). Six teeth were used as bacterial control. The number of calcium, iron, manganese and zinc ions was determined using flame atomic absorption spectrometry. Mean ± standard deviation (SD) values were used for descriptive statistics. Results Calcium chelation using 17% EDTA at pH 7 was higher than at pH 3 and 10, regardless of whether bacterial biofilm was present. The highest concentration of iron occurred at pH 3 in the presence of bacterial biofilm. The highest concentration of manganese found was 2.5% NaOCl and 17% EDTA at pH 7 in the presence of bacterial biofilm. Zinc levels were not detectable. Conclusions The pH of chelating agents affected the removal of calcium, iron, and manganese ions. The concentration of iron ions in root canals with bacterial biofilm was higher after the use of 17% EDTA at pH 3 than after the use of the other solutions at all pH levels. PMID:29451651

Limewater and Polymyxin B Associated with NaOCl for Endotoxin Detoxification in Root Canal with Necrotic Pulp.

PubMed

Carvalho, Alessandra Sverberi; Oliveira, Luciane Dias de; Cardoso, Flávia Goulart da Rosa; Oliveira, Felipe Eduardo de; Valera, Marcia Carneiro; Carvalho, Cláudio Antônio Talge

2016-01-01

This clinical study investigated the effects of endodontic treatment by using different irrigants (limewater + NaOCl and polymyxin B + NaOCl) and intracanal medication on endotoxins in teeth with primary endodontic infection and radiographically visible apical periodontitis. Thirty-three teeth with necrotic pulp and periapical lesions from different patients were selected for this study. Samples were collected after the coronal opening (S1) and after instrumentation (S2). Root canals were divided in 3 groups (n = 11) according to the irrigant combination used: NaOCl + LW: 2.5% NaOCl + calcium hydroxide solution (0.14%, limewater); NaOCl + PmB: 2.5% NaOCl + 10.000 UI/mL polymyxin B; 2.5% NaOCl (control). The third sampling (S3) was performed after ethylenediaminetetraacetic acid and the fourth (S4) after samples got 14 days with intracanal medication with 2% chlorhexidine gel + calcium hydroxide. Endotoxins (lipopolysaccharide) were quantified by chromogenic Limulus amebocyte lysate (LAL). Endotoxins were detected in all root canals after the coronal opening (S1). NaOCl + PmB group presented the greatest endotoxin reduction after instrumentation (76.17%), similar to NaOCl + LW group (67.64%, p<0.05) and different from NaOCl group (42.17%, p<0.05). After intracanal medication period (S4), there was significant increase of endotoxins neutralization. It was concluded that NaOCl + PmB promoted the greatest reduction of endotoxin levels, followed by NaOCl + LW. Intracanal medications had no significant complementary role in the reduction of endotoxins at the end of the treatment.

Roles of the combined irrigation, drainage, and storage of the canal network in improving water reuse in the irrigation districts along the lower Yellow River, China

NASA Astrophysics Data System (ADS)

Liu, Lei; Luo, Yi; He, Chansheng; Lai, Jianbin; Li, Xiubin

2010-09-01

SummaryThe commonly used irrigation system in the irrigation districts (with a combined irrigation area of 3.334 × 10 6 ha) along the lower Yellow River of China is canal network. It delivers water from the Yellow River to the fields, collects surface runoff and drainage from cropland, and stores both of them for subsequent irrigation uses. This paper developed a new combined irrigation, drainage, and storage (CIDS) module for the SWAT2000 model, simulated the multiple roles of the CIDS canal system, and estimated its performance in improving water reuse in the irrigation districts under different irrigation and water diversion scenarios. The simulation results show that the annual evapotranspiration (ET) of the double-cropping winter wheat and summer maize was the highest under the full irrigation scenario (automatic irrigation), and the lowest under the no irrigation scenario. It varied between these two values when different irrigation schedules were adopted. Precipitation could only meet the water requirement of the double-cropping system by 62-96% on an annual basis; that of the winter wheat by 32-36%, summer maize by 92-123%, and cotton by 87-98% on a seasonal basis. Hence, effective irrigation management for winter wheat is critical to ensure high wheat yield in the study area. Runoff generation was closely related to precipitation and influenced by irrigation. The highest and lowest annual runoff accounted for 19% and 11% of the annual precipitation under the full irrigation and no irrigation scenarios, respectively. Nearly 70% of the annual runoff occurred during months of July and August due to the concentrated precipitation in these 2 months. The CIDS canals play an important role in delivering the diversion water from the Yellow River, intercepting the surface runoff and drainage from cropland (inflow of the CIDS canal) and recharging the shallow aquifer for later use. Roughly 14-26% of the simulated total flow in the CIDS canal system recharged shallow aquifer through canal seepage. The water flowing out of the canal system accounted for approximately 32% of the water in the CIDS canals. The storage capacity of the CIDS canals is negatively correlated to the precipitation. In years with abundant precipitation, the volume of the surface runoff and drainage from the cropland may surpass the storage capacities of the CIDS canals, while in years with less precipitation, partial storage capacity of the CIDS canal may be occupied by the diversion water from the Yellow River. Proper maintenance of the storage capacity of the CIDS has the potential in improving the efficiency of reusing the surface runoff and field drainage for irrigation practices to mitigate the increasing water shortage along the lower Yellow River.

Effect of photodynamic therapy and non-thermal plasma on root canal filling: analysis of adhesion and sealer penetration.

PubMed

Menezes, Marilia; Prado, Maíra; Gomes, Brenda; Gusman, Heloisa; Simão, Renata

2017-01-01

The aim of this study was to evaluate the effect of photodynamic therapy (PDT) and non-thermal plasma (NTP) on adhesion and sealer penetration in root canals. Sixty single-rooted premolars were used. The teeth were prepared using a crown-down technique. NaOCl and EDTA were used for irrigation and smear layer removal, respectively. The root canals were divided into three groups: control, PDT, and NTP. After treatments, the roots were filled using gutta-percha and either AH Plus (AHP) or MTA Fillapex (MTAF) sealers. Samples were sectioned at 4, 8, and 12 mm from the apex (1-mm slices)and analyzed by the push-out bond strength test (adhesion) and confocal laser scanning microscopy (sealer penetration). Data were statistically evaluated using Kruskal-Wallis, Dunn's, and Spearman's tests. Regarding AHP, bond strength was similar in the NTP group and in the control group, but significantly lower in the PDT group. As to MTAF, both therapies showed lower values than the control group. In the confocal analysis of AHP, maximum and mean penetration, and penetrated area were statistically higher in the control group than in the PDT and NTP groups. Penetrated perimeter was similar among groups. Regarding MTAF, all parameters yielded better results in the NTP than in the control group. The PDT and control groups showed similar results except for penetrated area. PDT and plasma therapy affected the adhesion and sealer penetration of root canals filled with AH Plus and MTA Fillapex and there is no positive correlation between adhesion and sealer penetration.

28. MAIN CANAL Photographic copy of historic photo, July ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

28. MAIN CANAL - Photographic copy of historic photo, July 18, 1906 (original print located at the Carlsbad Irrigation District offices, Carlsbad, New Mexico) J.J. Lubken, photographer 'LOOKING SOUTH FROM STATION 413, ON THE MAIN CANAL, SHOWING THE REMODLING SIC OF THE OLD PECOS VALLEY IRRIGATING CANAL' - Carlsbad Irrigation District, Main Canal, 4 miles North to 12 miles Southeast of Carlsbad, Carlsbad, Eddy County, NM

Comparison of Antimicrobial Efficacy of Diode Laser, Triphala, and Sodium Hypochlorite in Primary Root Canals: A Randomized Controlled Trial

PubMed Central

Asokan, Sharath; John, Baby; Priya, Geetha; Kumar, S

2017-01-01

Aim To evaluate the antimicrobial efficacy of diode laser, triphala, and sodium hypochlorite (NaOCl) against Enterococc-cus faecalis contaminated primary root canals. Materials and methods Forty-nine single-rooted human primary teeth were reduced up to cemento-enamel junction and biomechanically prepared. After sterilization, five teeth were selected as negative controls and remaining teeth were inoculated with E. faecalis. The teeth were then randomly divided into four groups. The first group was irradiated with diode laser, the second group was irrigated with sodium hypochlorite, and the third group with triphala solution. The fourth group served as the positive control. The antimicrobial efficacy was tested by collecting transfer fluid saline from the canals and counting the colony forming units (CFUs) of viable E. faecalis on agar plates. The Mann-Whitney test was used to analyze the results, using Statistical Package for the Social Sciences software version 19. Results The results showed that mean bacterial CFU were 8.00 ± 7.87 for laser, 58.60 ± 16.63 for triphala, and 69.80 ± 19.57 for NaOCl. Laser group showed significant reduction in the colony count compared to the other groups. Triphala group showed better antibacterial activity than NaOCl, but the difference was not statistically significant. Conclusion Laser was most effective against E. faecalis and triphala can be used as an alternative disinfectant to NaOCl in primary root canals. How to cite this article Thomas S, Asokan S, John B, Priya G, Kumar S. Comparison of Antimicrobial Efficacy of Diode Laser, Triphala, and Sodium Hypochlorite in Primary Root Canals: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2017;10(1):14-17. PMID:28377648

Root canal preparation of mandibular molars with 3 nickel-titanium rotary instruments: a micro-computed tomographic study.

PubMed

Zhao, Dan; Shen, Ya; Peng, Bin; Haapasalo, Markus

2014-11-01

The aim of this study was to describe the canal shaping properties of ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Universal (PTU; Dentsply Tulsa Dental Specialties, Johnson City, TN), and WaveOne (Dentsply Maillefer) nickel-titanium instruments in mandibular first molars by using micro-computed tomographic (micro-CT) scanning. A total of 36 maxillary first molars with 2 separate mesial canals and 1 distal canal were selected and scanned preoperatively and postoperatively by using micro-CT scanning with a voxel size of 30 μm. Canals were prepared with PTU, PTN, and WaveOne systems under hypochlorite irrigation. The volume of the untreated canal; the volume of dentin removed after preparation; the amount of the uninstrumented area; and the transportation to the coronal, middle, and apical thirds of canals were measured. The preparation time and instrument failure were also recorded. Instrumentation of canals increased their volume and surface area. The distal canals had a significantly higher proportion of unprepared surfaces than mesial canals (P < .05). The PTN system produced less transportation than the WaveOne and PTU systems in the apical third of the mesial canals (P < .05). There was no significant difference on apical transportation in distal canals among the 3 instrument systems. Instrumentation with WaveOne was significantly faster than with the other 2 instruments (P < .05). The PTN, PTU, and WaveOne instruments shaped root canals in mandibular first molars in vitro without significant shaping errors. The curved canals prepared using PTN had less apical transportation than the canals prepared using WaveOne and PTU. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Reduction in bacterial counts in infected root canals after rotary or hand nickel-titanium instrumentation--a clinical study.

PubMed

Rôças, I N; Lima, K C; Siqueira, J F

2013-07-01

To compare the antibacterial efficacy of two instrumentation techniques, one using hand nickel-titanium (NiTi) instruments and the other using rotary NiTi instruments, in root canals of teeth with apical periodontitis. Root canals from single-rooted teeth were instrumented using either hand NiTi instruments in the alternated rotation motion technique or rotary BioRaCe instruments. The irrigant used in both groups was 2.5% NaOCl. DNA extracts from samples taken before and after instrumentation were subjected to quantitative analysis by real-time polymerase chain reaction (qPCR). Qualitative analysis was also performed using presence/absence data from culture and qPCR assays. Bacteria were detected in all S1 samples by both methods. In culture analysis, 45% and 35% of the canals were still positive for bacterial presence after hand and rotary NiTi instrumentation, respectively (P > 0.05). Rotary NiTi instrumentation resulted in significantly fewer qPCR-positive cases (60%) than hand NiTi instrumentation (95%) (P = 0.01). Intergroup comparison of quantitative data showed no significant difference between the two techniques. There was no significant difference in bacterial reduction in infected canals after instrumentation using hand or rotary NiTi instruments. In terms of incidence of positive results for bacteria, culture also showed no significant differences between the groups, but the rotary NiTi instrumentation resulted in more negative results in the more sensitive qPCR analysis. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Debris Evaluation after Root Canal Shaping with Rotating and Reciprocating Single-File Systems

PubMed Central

Dagna, Alberto; Gastaldo, Giulia; Beltrami, Riccardo; Poggio, Claudio

2016-01-01

This study evaluated the root canal dentine surface by scanning electron microscope (SEM) after shaping with two reciprocating single-file NiTi systems and two rotating single-file NiTi systems, in order to verify the presence/absence of the smear layer and the presence/absence of open tubules along the walls of each sample; Forty-eight single-rooted teeth were divided into four groups and shaped with OneShape (OS), F6 SkyTaper (F6), WaveOne (WO) and Reciproc and irrigated using 5.25% NaOCl and 17% EDTA. Root canal walls were analyzed by SEM at a standard magnification of 2500×. The presence/absence of the smear layer and the presence/absence of open tubules at the coronal, middle, and apical third of each canal were estimated using a five-step scale for scores. Numeric data were analyzed using Kruskal-Wallis and Mann-Whitney U statistical tests and significance was predetermined at P < 0.05; The Kruskal-Wallis ANOVA for debris score showed significant differences among the NiTi systems (P < 0.05). The Mann-Whitney test confirmed that reciprocating systems presented significantly higher score values than rotating files. The same results were assessed considering the smear layer scores. ANOVA confirmed that the apical third of the canal maintained a higher quantity of debris and smear layer after preparation of all the samples; Single-use NiTi systems used in continuous rotation appeared to be more effective than reciprocating instruments in leaving clean walls. The reciprocating systems produced more debris and smear layer than rotating instruments. PMID:27763503

Fibrin gel improves tissue ingrowth and cell differentiation in human immature premolars implanted in rats.

PubMed

Ruangsawasdi, Nisarat; Zehnder, Matthias; Weber, Franz E

2014-02-01

In pulpless immature human premolars implanted in rodents, this study investigated whether fibrin gel offered advantages over leaving the root canal empty regarding soft tissue ingrowth and cell differentiation. Root canals of extracted human immature premolars (n = 12) were accessed and then irrigated with 5% sodium hypochlorite followed by 17% ethylenediaminetetraacetic acid. Root canals were then either left empty or filled with a fibrin gel (n = 6 each) before being placed subcutaneously on top of the calvarial bone of rats (1 tooth per rat) for 12 weeks. After sacrifice, teeth were histologically assessed. Tissue ingrowth was quantified and compared between groups using the Mann-Whitney U test (P < .05). Cells adhering to the pulp canal wall were immunohistochemically screened for the presence of bone sialoprotein (BSP) and dentin sialoprotein (DSP). More tissue grew into the pulp space when teeth were filled with fibrin gel (P < .05). The presence of fibrin gel affected not only the extent of tissue ingrowth but also tissue morphology and differentiation of cells contacting the dentinal wall. In the fibrin gel group, newly formed tissue was similar to normal pulp, constituted of inner pulp, cell-rich zone, cell-free zone, and an apparent odontoblast layer, which stained positive for BSP and DSP. Newly formed blood vessels were also more abundant compared with the initially empty root canals. Under the conditions of this study, fibrin gel improved cell infiltration and cell-dentin interaction. Both are necessary for pulp tissue regeneration. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Comparative evaluation of apical extrusion of debris and irrigant with three rotary instruments using crown down technique - An in vitro study.

PubMed

Jindal, Rahul; Singh, Smita; Gupta, Siddharth; Jindal, Punita

2012-01-01

The purpose of this study was to evaluate and compare the apical extrusion of debris and irrigant using various rotary instruments with crown down technique in the instrumentation of root canals. Thirty freshly extracted human permanent straight rooted mandibular premolars with minimum root curvature of 0-10 ° were divided in three groups with 10 teeth in each group. Each group was instrumented using one of the three rotary instrumentation systems: Rotary Hero shapers, Rotary ProTaper and Rotary Mtwo. One ml of sterile water was used as an irrigant after using each instrument. Debris extruded was collected in pre weighed glass vials and the extruded irrigant was measured quantitatively by Myers and Montgomery method and was later evaporated. The weight of the dry extruded debris was calculated by comparing the pre and post instrumentation weight of glass vials for each group. Statistical analysis was done by using by a Kruskal-Wallis One-way ANOVA test. Statistical analysis showed that all the rotary instruments used in this study caused apical extrusion of debris and irrigant. A Statistically significant difference was observed with Rotary ProTaper and Rotary Mtwo groups when compared with Rotary Hero shapers. But no significant difference was observed between Rotary ProTaper and Rotary Mtwo groups. After instrumentation with different rotary instruments, Hero shapers showed a less apical extrusion of debris and irrigant.

Smear layer and debris removal using manual Ni-Ti files compared with rotary Protaper Ni- Ti files - An In-Vitro SEM study.

PubMed

Reddy, J M V Raghavendra; Latha, Prasanna; Gowda, Basavana; Manvikar, Varadendra; Vijayalaxmi, D Benal; Ponangi, Kalyana Chakravarthi

2014-02-01

Predictable successful endodontic therapy depends on correct diagnosis, effective cleaning, shaping and disinfection of the root canals and adequate obturation. Irrigation serves as a flush to remove debris, tissue solvent and lubricant from the canal irregularities; however these irregularities can restrict the complete debridement of root canal by mechanical instrumentation.Various types of hand and rotary instruments are used for the preparation of the root canal system to obtain debris free canals. The purpose of this study was to evaluate the amount of smear layer and debris removal on canal walls following the using of manual Nickel-Titanium (NiTi) files compared with rotary ProTaperNiTi files using a Scanning Electron Microscope in two individual groups. A comparative study consisting of 50 subjects randomized into two groups - 25 subjects in Group A (manual) and 25 subjects in Group B (rotary) was undertaken to investigate and compare the effects of smear layer and debris between manual and rotary NiTi instruments. Chi square test was used to find the significance of smear layer and debris removal in the coronal, middle and apical between Group A and Group B. Both systems of Rotary ProTaperNiTi and manual NiTi files used in the present study, did not create completely clean root canals. Manual NiTi files produced significantly less smear layer and debris compared to Rotary ProTaperNiTi instruments. Rotary instruments were less time consuming when compared to manual instruments. Instrument separation was not found to be significant with both the groups. Both systems of Rotary ProTaperNiTi and manual NiTi files used did not produce completely clean root canals. Manual NiTi files produced significantly less smear layer and debris compared to Rotary protaper instruments. How to cite the article: Reddy JM, Latha P, Gowda B, Manvikar V, Vijayalaxmi DB, Ponangi KC. Smear layer and debris removal using manual Ni-Ti files compared with rotary Protaper Ni-Ti files - An In-Vitro SEM study. J Int Oral Health 2014;6(1):89-94.

Smear layer and debris removal using manual Ni-Ti files compared with rotary Protaper Ni- Ti files - An In-Vitro SEM study

PubMed Central

Reddy, J M V Raghavendra; Latha, Prasanna; Gowda, Basavana; Manvikar, Varadendra; Vijayalaxmi, D Benal; Ponangi, Kalyana Chakravarthi

2014-01-01

Background: Predictable successful endodontic therapy depends on correct diagnosis, effective cleaning, shaping and disinfection of the root canals and adequate obturation. Irrigation serves as a flush to remove debris, tissue solvent and lubricant from the canal irregularities; however these irregularities can restrict the complete debridement of root canal by mechanical instrumentation.Various types of hand and rotary instruments are used for the preparation of the root canal system to obtain debris free canals. The purpose of this study was to evaluate the amount of smear layer and debris removal on canal walls following the using of manual Nickel-Titanium (NiTi) files compared with rotary ProTaperNiTi files using a Scanning Electron Microscope in two individual groups. Materials & Methods: A comparative study consisting of 50 subjects randomized into two groups – 25 subjects in Group A (manual) and 25 subjects in Group B (rotary) was undertaken to investigate and compare the effects of smear layer and debris between manual and rotary NiTi instruments. Chi square test was used to find the significance of smear layer and debris removal in the coronal, middle and apical between Group A and Group B. Results: Both systems of Rotary ProTaperNiTi and manual NiTi files used in the present study, did not create completely clean root canals. Manual NiTi files produced significantly less smear layer and debris compared to Rotary ProTaperNiTi instruments. Rotary instruments were less time consuming when compared to manual instruments. Instrument separation was not found to be significant with both the groups. Conclusions: Both systems of Rotary ProTaperNiTi and manual NiTi files used did not produce completely clean root canals. Manual NiTi files produced significantly less smear layer and debris compared to Rotary protaper instruments. How to cite the article: Reddy JM, Latha P, Gowda B, Manvikar V, Vijayalaxmi DB, Ponangi KC. Smear layer and debris removal using manual Ni-Ti files compared with rotary Protaper Ni-Ti files - An In-Vitro SEM study. J Int Oral Health 2014;6(1):89-94. PMID:24653610

Antibacterial efficacy and drug-induced tooth discolouration of antibiotic combinations for endodontic regenerative procedures.

PubMed

Mandras, N; Roana, J; Allizond, V; Pasqualini, D; Crosasso, P; Burlando, M; Banche, G; Denisova, T; Berutti, E; Cuffini, A M

2013-01-01

Elimination of microbial contamination from the root canal system is a precondition for successful root canal treatment. Teeth with immature root development, necrotic pulps and apical periodontitis present multiple challenges for successful treatment. Disinfection is achieved by irrigation followed by the placement of an intracanal medicament. A mixture of ciprofloxacin, metronidazole and minocycline (3-MIX S) has been shown to be very effective in eliminating endodontic pathogens in vitro and in vivo. Among the components of the mixture, minocycline can induce tooth discolouration after long-term oral use. Therefore, the elimination of minocycline from the above-mentioned combination has been suggested to prevent the occasion of this undesirable effect. The aim of this study was to investigate the potential antimicrobial efficacy of alternative antibiotic combinations [3-MIX C (clarithromycin); 3-MIX F (fosfomycin)] against bacteria from infected root canals. An additional objective was to evaluate their discolouration potential as possible alternatives to minocycline-based intracanal medicaments. Our in vitro results clearly demonstrated that 3-MIX C and 3-MIX F had a greater antimicrobial activity than 3-MIX S, underlying that clarithromycin still had a higher capacity to kill endodontic pathogens in vitro compared to fosfomycin. Both 3-MIX C and 3-MIX F were able to avoid the permanent staining effect of the crown.

Efficacy of chlorhexidine as a final irrigant in one-visit root canal treatment: a prospective comparative study.

PubMed

Miçooğullar Kurt, S; Çalışkan, M K

2018-03-30

To evaluate postoperative pain and radiographic evidence of periapical healing in teeth with apical periodontitis treated in one visit with an additional final irrigation using 2% chlorhexidine (CHX) and to compare the results with conventional two-visit root canal treatment (RCT) with an intracanal calcium hydroxide (CH) dressing as a control group. Ninety asymptomatic maxillary anterior teeth with periapical lesions were treated by a single operator. Root canals were prepared using the step-back technique with manual instrumentation with 2.5% NaOCl and 5% EDTA as irrigants. Half of the teeth were randomly assigned to the one-visit (OV) group and received an additional final rinse with 2% CHX before canal filling. The other teeth were treated in two visits (TV) with a CH paste made by mixing CH powder and distilled water as an interappointment dressing. All patients were recalled and investigated clinically and radiographically for 24 months. Postoperative pain at 24-48 h and changes in apical bone density indicating radiographic healing were evaluated statistically using the Mann-Whitney U-test followed by the Friedman and the Wilcoxon tests (α = 0.05). There were no significant differences between two groups regarding the incidence of postoperative pain at 24 h (OV group 50% no pain, 47.6% mild, 2.4% moderate pain/TV group 55% no pain, 42.5% mild, 2.5% moderate pain) and at 48 h (OV group 95% no pain, 5% mild pain/TV group 98% no pain, 2% mild pain). None of the patients reported severe postoperative pain, swelling and/or flare-ups during the follow-up period. There was no significant difference in the radiographic healing rates (OV group 97.6% PAI 1 and/or PAI 2 and 2.4% PAI 3/TV group 95% PAI 1 and/or PAI 2 and 5% PAI 3; P > 0.05). Both groups provided favourable and similar postoperative pain and periapical healing rates at 24 months. Thus, one-visit RCT with a final rinse with 2% CHX is an acceptable alternative to two-visit RCT with CH as temporary dressing in maxillary anterior teeth. © 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Scanning Electron Microscopic Evaluation of Residual Smear Layer Following Preparation of Curved Root Canals Using Hand Instrumentation or Two Engine-Driven Systems.

PubMed

Khademi, Abbasali; Saatchi, Masoud; Shokouhi, Mohammad Mehdi; Baghaei, Badri

2015-01-01

In this experimental study, the amount of smear layer (SL) remnants in curved root canals after chemomechanical instrumentation with two engine-driven systems or hand instrumentation was evaluated. Forty-eight mesiobuccal roots of mandibular first molars with curvatures ranging between 25 and 35 degrees (according to Schneider's method) were divided into three groups (n=16) which were prepared by either the ProTaper Universal file series, Reciproc single file system or hand instrumentation. The canals were intermittently irrigated with 5.25% NaOCl and 17% (ethylenediaminetetraacetic acid) EDTA, followed by distilled water as the final rinse. The roots were split longitudinally and the apical third of the specimens were evaluated under 2500× magnification with a scanning electron microscope (SEM). The mean scores of the SL were calculated and analyzed using the non-parametric Kruskal-Wallis and Mann-Whitney U tests. The mean scores of the SL were 2.00±0.73, 1.94±0.68 and 1.44±0.63 µm for the ProTaper Universal, Reciproc and hand instrumentation, respectively. Mean score of SL was significantly less in the hand instrumentation group than the ProTaper (P=0.027) and Reciproc (P=0.035) groups. The difference between the two engine-driven systems, however, was not significant (P=0.803). The amount of smear layer in the apical third of curved root canals prepared with both engine-driven systems was similar and greater than the hand instrumentation technique. Complete cleanliness was not attained.

Yard flooding by irrigation canals increased the risk of West Nile disease in El Paso, Texas

PubMed Central

Cardenas, Victor M.; Jaime, Javier; Ford, Paula B.; Gonzalez, Fernando J.; Carrillo, Irma; Gallegos, Jorge E.; Watts, Douglas M.

2011-01-01

Purpose To investigate the effects of use of water from irrigation canals to flood residential yards on the risk of West Nile disease in El Paso, Texas. Methods West Nile disease confirmed cases in 2009–2010 were compared with a random sample of 50 residents of the county according to access to and use of water from irrigation canals by subjects or their neighbors, as well as geo-referenced closest distance between their home address and the nearest irrigation canal. A windshield survey of 600 meters around the study subjects’ home address recorded the presence of irrigation canals. The distance from the residence of 182 confirmed cases of West Nile disease reported in 2003–2010 to canals was compared to that of the centroids of 182 blocks selected at random. Results Cases were more likely than controls to report their neighbors flooded their yards with water from canals. Irrigation canals were more often observed in neighborhoods of cases than of controls. Using the set of addresses of 182 confirmed cases and 182 hypothetic controls the authors found a statistically significant inverse relation with risk of West Nile disease. Conclusions Flooding of yards with water from canals increased the risk of West Nile disease. PMID:21943648

Yard flooding by irrigation canals increased the risk of West Nile disease in El Paso, Texas.

PubMed

Cardenas, Victor M; Jaime, Javier; Ford, Paula B; Gonzalez, Fernando J; Carrillo, Irma; Gallegos, Jorge E; Watts, Douglas M

2011-12-01

To investigate the effects of use of water from irrigation canals to flood residential yards on the risk of West Nile disease in El Paso, Texas. West Nile disease confirmed cases in 2009 through 2010 were compared with a random sample of 50 residents of the county according to access to and use of water from irrigation canals by subjects or their neighbors, as well as geo-referenced closest distance between their home address and the nearest irrigation canal. A windshield survey of 600 m around the study subjects' home address recorded the presence of irrigation canals. The distance from the residence of 182 confirmed cases of West Nile disease reported in 2003 through 2010 to canals was compared with that of the centroids of 182 blocks selected at random. Cases were more likely than controls to report their neighbors flooded their yards with water from canals. Irrigation canals were more often observed in neighborhoods of cases than of controls. Using the set of addresses of 182 confirmed cases and 182 hypothetical controls the authors found a significant, inverse relation with risk of West Nile disease. Flooding of yards with water from canals increased the risk of West Nile disease. Copyright © 2011 Elsevier Inc. All rights reserved.

Regenerative endodontic treatment (revascularization) of immature necrotic molars medicated with calcium hydroxide: a case series.

PubMed

Cehreli, Zafer C; Isbitiren, Beste; Sara, Sezgi; Erbas, Gizem

2011-09-01

Revascularization is an emerging regenerative treatment protocol with little published data available in immature molar teeth. The present case series demonstrates the outcome of revascularization treatment with intracanal medicament of calcium hydroxide in immature necrotic molars. Immature necrotic permanent first molars (n = 6) of patients 8-11 years old were treated by a revascularization protocol that used 2.5% NaOCl irrigation, medication with calcium hydroxide placed in the coronal third of the root canals, induction of apical bleeding, and coronal sealing with white mineral trioxide aggregate. Among the treated teeth, 4 molars had undergone prior root canal instrumentation by the referring dentists. National Institutes of Health Image-J program with TurboReg plug-in was used for standardization of the radiographs and to determine the increase in root length and root width. After a follow-up period of 10 months, all teeth demonstrated radiographic evidence of complete periapical healing, progressive thickening of dentinal walls, and continued apical development in the absence of clinical symptoms. Two uninstrumented molars showed a positive response to cold testing at 9 months. On the basis of a follow-up period of 10 months, the present cases demonstrate a favorable outcome of the revascularization procedure in immature necrotic molars by using calcium hydroxide medication in the coronal third of the root canals. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Modeling and assessing field irrigation water use in a canal system of Hetao, upper Yellow River basin: Application to maize, sunflower and watermelon

NASA Astrophysics Data System (ADS)

Ren, Dongyang; Xu, Xu; Hao, Yuanyuan; Huang, Guanhua

2016-01-01

Water saving in irrigation is a key issue in the upper Yellow River basin. Excessive irrigation leads to water waste, water table rising and increased salinity. Land fragmentation associated with a large dispersion of crops adds to the agro-hydrological complexity of the irrigation system. The model HYDRUS-1D, coupled with the FAO-56 dual crop coefficient approach (dualKc), was applied to simulate the water and salt movement processes. Field experiments were conducted for maize, sunflower and watermelon crops in the command area of a typical irrigation canal system in Hetao Irrigation District during 2012 and 2013. The model was calibrated and validated in three crop fields using two-year experimental data. Simulations of soil moisture, salinity concentration and crop yield fitted well with the observations. The irrigation water use was then evaluated and results showed that large amounts of irrigation water percolated due to over-irrigation but their reuse through capillary rise was also quite large. That reuse was facilitated by the dispersion of crops throughout largely fragmented field, thus with fields reusing water percolated from nearby areas due to the rapid lateral migration of groundwater. Beneficial water use could be improved when taking this aspect into account, which was not considered in previous researches. The non-beneficial evaporation and salt accumulation into the root zone were found to significantly increase during non-growth periods due to the shallow water tables. It could be concluded that when applying water saving measures, close attention should be paid to cropping pattern distribution and groundwater control in association with irrigation scheduling and technique improvement.

Apical sealing ability of Resilon/Epiphany versus gutta-percha/AH Plus: immediate and 16-months leakage.

PubMed

Paqué, F; Sirtes, G

2007-09-01

To compare the long-term apical sealing ability of gutta-percha/AH Plus and Resilon/Epiphany. The root canals of 90 single-rooted human mandibular premolars with single narrow root canals were prepared with ProFile 0.4 taper instruments to apical size 40. After each instrument, the canals were irrigated with 1% sodium hypochlorite. Subsequently, the teeth were randomly divided into four groups containing 20 teeth each. Additionally, 10 prepared premolars served as positive and 10 counterparts with intact crowns as negative controls. The root canals were filled with gutta-percha/AH Plus or Resilon/Epiphany using lateral or vertical compaction. Specimens were allowed to set for 7 days at 37 degrees C and 100% humidity. Subsequently, the root fillings were removed down to the apical 4 mm. Fluid movement was then assessed using a fluid transportation model and re-evaluated after 16 months of water storage. Leakage within and between groups was compared using nonparametric tests. Negative controls revealed no fluid movement and positive controls displayed gross fluid movement at both times of observation. At the immediate measurement, there were no significant differences between the experimental groups (Kruskal-Wallis, P > 0.05). Gutta-percha/AH Plus fillings retained their seal after 16-months storage (Wilcoxon, P > 0.05), whilst the Resilon/Epiphany groups lost their sealing capacity (Wilcoxon, P < 0.001). In these groups, 29 of the 40 specimens exhibited gross leakage similar to positive controls. Initially, Resilon/Epiphany root fillings prevented fluid movement to the same degree as gutta-percha/AH Plus counterparts, but showed more fluid movement when tested at 16 months.

Effect of photodynamic therapy and non-thermal plasma on root canal filling: analysis of adhesion and sealer penetration

PubMed Central

MENEZES, Marilia; PRADO, Maíra; GOMES, Brenda; GUSMAN, Heloisa; SIMÃO, Renata

2017-01-01

Abstract Objective The aim of this study was to evaluate the effect of photodynamic therapy (PDT) and non-thermal plasma (NTP) on adhesion and sealer penetration in root canals. Material and Methods Sixty single-rooted premolars were used. The teeth were prepared using a crown-down technique. NaOCl and EDTA were used for irrigation and smear layer removal, respectively. The root canals were divided into three groups: control, PDT, and NTP. After treatments, the roots were filled using gutta-percha and either AH Plus (AHP) or MTA Fillapex (MTAF) sealers. Samples were sectioned at 4, 8, and 12 mm from the apex (1-mm slices)and analyzed by the push-out bond strength test (adhesion) and confocal laser scanning microscopy (sealer penetration). Data were statistically evaluated using Kruskal-Wallis, Dunn’s, and Spearman’s tests. Results Regarding AHP, bond strength was similar in the NTP group and in the control group, but significantly lower in the PDT group. As to MTAF, both therapies showed lower values than the control group. In the confocal analysis of AHP, maximum and mean penetration, and penetrated area were statistically higher in the control group than in the PDT and NTP groups. Penetrated perimeter was similar among groups. Regarding MTAF, all parameters yielded better results in the NTP than in the control group. The PDT and control groups showed similar results except for penetrated area. Conclusion PDT and plasma therapy affected the adhesion and sealer penetration of root canals filled with AH Plus and MTA Fillapex and there is no positive correlation between adhesion and sealer penetration. PMID:28877278

Effect of different surface treatments on the push-out bond strength of fiber post to root canal dentin.

PubMed

Demiryürek, Ebru Ozsezer; Külünk, Safak; Saraç, Duygu; Yüksel, Gözde; Bulucu, Bilinç

2009-08-01

The purpose of this study was to evaluate the effects of different surface treatments on the bond strength of a fiber post to dentin. Sixty extracted human maxillary incisor teeth were manually shaped with K-files using the step-back technique. ISO size 45 files were used as master apical files. Post spaces were prepared and then the root canals were subjected to one of the following 5 surface treatments: irrigation with 5% sodium hypochlorite (NaOCl); treatment with ethanol, ethyl acetate, and acetone-based cleansing agent (Sikko Tim); irrigation with 17% EDTA; etching with 37% orthophosphoric acid for 15 seconds; and etching with 10% citric acid for 15 seconds. Fiber posts were luted using self-etching/self-priming dual polymerized resin cement. From the coronal part of each root, 3 slides of 0.6-mm thickness were obtained. A push-out bond strength test was performed by a universal testing machine at a crosshead speed of 0.5 mm/min. Dentin surfaces were examined under scanning electron microscopy (SEM) after different surface treatments. Data were analyzed with a one-way analysis of variance (ANOVA) and Tukey HSD test. ANOVA revealed that canal surface treatment affected the bond strength (P < .001). The highest bond strength was obtained in the Sikko Tim group. The results also showed that surface treatment methods increased the bond strength to dentin when compared with the control group. Sikko Tim group was the more effective surface treatment agent compared with EDTA, orthophosphoric acid, citric acid, and control groups; however, it could not remove the smear layer and sealer remnants effectively on radicular dentin surfaces. Removal of the smear layer and opening of dentinal tubules are not recommended when a self-etching/self-priming adhesive system is used.

Qualitative comparison of sonic or laser energisation of 4% sodium hypochlorite on an Enterococcus faecalis biofilm grown in vitro.

PubMed

Seet, Aaron N; Zilm, Peter S; Gully, Neville J; Cathro, Peter R

2012-12-01

The effectiveness of sonic activation, laser activation and syringe irrigation of 4% sodium hypochlorite in removing an Enterococcus faecalis biofilm was compared. Biofilms were grown in extracted human single rooted teeth using a flow cell apparatus. After 4 weeks' growth, teeth were subjected to each treatment using 4% sodium hypochlorite and radicular dentinal surfaces of the root canals were analysed by scanning electron microscopy. Results showed that sonic activation and syringe irrigation with sodium hypochlorite showed reduced numbers of bacterial cells on the radicular dentine but were not effective in eliminating E. faecalis in the dentinal tubules. Laser activation of sodium hypochlorite resulted in clean dentine walls and undetectable levels of bacteria within dentinal tubules. Qualitatively, sonic or laser activation of 4% NaOCl resulted in greater bacterial reduction compared with syringe irrigation, with laser activation producing the greatest overall reduction. © 2012 The Authors. Australian Endodontic Journal © 2012 Australian Society of Endodontology.

Enterococcus faecalis and Candida albicans in the dental root canal and periapical infections.

PubMed

Kovac, J; Kovac, D; Slobodnikova, L; Kotulova, D

2013-01-01

The aim of the present study was to examine the prevalence of Enterococcus faecalis and Candida albicans in endodontic infections. Samples for microbiological examination were collected from 32 patients with deep dental caries, infected dental root canal, or periapical infection. Cultivation of the dental samples yielded four strains of Enterococcus faecalis (12.5 %), and three strains of Candida albicans (9.4 %). All Enterococcus faecalis isolates were susceptible to ampicillin, one isolate was resistant to tetracycline, two to erythromycin and azithromycin (additional 2 had intermediate susceptibility), and one strain had intermediate susceptibility to ciprofloxacin and moxifloxacin. We conclude that Enterococcus faecalis and Candida albicans can participate in the dental root canal and periapical infections, and the use of effective irrigant solutions and intracanal medicaments active against these microbes is important in order to prevent endodontic therapy failures. Unexpected was the isolation of C. albicans from a nine-year-old child with periodontitis apicalis. This finding must draw attention to the possibility that even at such a young age, this microorganism could be a potential etiological agent in endodontic infections (Tab. 2, Ref. 34). Text in PDF www.elis.sk.

Efficacy of various combinations of irrigants and medicaments on Candida albican: An in vitro study.

PubMed

Singh, Mukund; Kasat, Vikrant O

2015-01-01

To evaluate the efficacy of 3% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), calcium hydroxide [Ca (OH)2], and 2% chlorhexidine in various combinations on Candida albicans in root canals for 48 h and 10 days. In this in vitro study, 95 extracted teeth were instrumented. MTCC 183 strain of C. albicans was introduced into the root canals and after 7 days, the average value of colony forming units (CFUs)/ml was determined in all the roots. Then the teeth were randomly divided into three groups: Group I (n = 15) was the control group and only saline was added to it. In group II (n = 40), 3% NaOCl was used as the irrigant and in group III (n = 40), 3% NaOCl and 17% EDTA were used as irrigants. Groups II and III were further divided into two subgroups (A and B) having 20 teeth each. After irrigation, Ca (OH)2 was placed in subgroup A and 2% chlorhexidine digluconate (CHX) solution in subgroup B of both groups as intracanal medicament. After 48 h, the CFUs/ml was determined in 45 teeth (5 from the control group and 10 from each subgroup). After 10 days, the CFUs/ml was determined in the remaining 50 teeth (10 from the control group and 10 from each subgroup). For statistical analysis, Statistical Package for Social Sciences (SPSS version 15, Chicago IL, USA) was used. A decrease in CFUs/ml of C. albicans was noted in all subgroups at 48 h, but the combination of NaOCl, EDTA, and CHX (group IIIB) was the most effective showing value of 0.095 × 10(5) CFUs/ml. On the 10(th) day, the CFUs/ml of C. albicans was further decreased in all subgroups; but again, subgroup IIIB was the most effective showing a value of 0.025 × 10(5) CFUs/ml. There was statistically significant difference in CFUs/ml of C. albicans at 48 h and on 10(th) day in all study groups. The antimicrobial activity of irrigant and intracanal medicament has a positive role in controlling the growth of C. albicans.

Efficacy of various combinations of irrigants and medicaments on Candida albican: An in vitro study

PubMed Central

Singh, Mukund; Kasat, Vikrant O.

2015-01-01

Objective: To evaluate the efficacy of 3% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), calcium hydroxide [Ca (OH)2], and 2% chlorhexidine in various combinations on Candida albicans in root canals for 48 h and 10 days. Materials and Methods: In this in vitro study, 95 extracted teeth were instrumented. MTCC 183 strain of C. albicans was introduced into the root canals and after 7 days, the average value of colony forming units (CFUs)/ml was determined in all the roots. Then the teeth were randomly divided into three groups: Group I (n = 15) was the control group and only saline was added to it. In group II (n = 40), 3% NaOCl was used as the irrigant and in group III (n = 40), 3% NaOCl and 17% EDTA were used as irrigants. Groups II and III were further divided into two subgroups (A and B) having 20 teeth each. After irrigation, Ca (OH)2 was placed in subgroup A and 2% chlorhexidine digluconate (CHX) solution in subgroup B of both groups as intracanal medicament. After 48 h, the CFUs/ml was determined in 45 teeth (5 from the control group and 10 from each subgroup). After 10 days, the CFUs/ml was determined in the remaining 50 teeth (10 from the control group and 10 from each subgroup). For statistical analysis, Statistical Package for Social Sciences (SPSS version 15, Chicago IL, USA) was used. Results: A decrease in CFUs/ml of C. albicans was noted in all subgroups at 48 h, but the combination of NaOCl, EDTA, and CHX (group IIIB) was the most effective showing value of 0.095 × 105 CFUs/ml. On the 10th day, the CFUs/ml of C. albicans was further decreased in all subgroups; but again, subgroup IIIB was the most effective showing a value of 0.025 × 105 CFUs/ml. There was statistically significant difference in CFUs/ml of C. albicans at 48 h and on 10th day in all study groups. Conclusion: The antimicrobial activity of irrigant and intracanal medicament has a positive role in controlling the growth of C. albicans. PMID:26236673

Chelation in root canal therapy reconsidered.

PubMed

Zehnder, Matthias; Schmidlin, Patrick; Sener, Beatrice; Waltimo, Tuomas

2005-11-01

The aim of this study was to assess interactions of EDTA and citric acid (CA) with sodium hypochlorite (NaOCl), the indispensable endodontic irrigant. Other chelators were simultaneously evaluated as possible alternatives: sodium triphosphate (STP), amino tris methylenephosphonic acid (ATMA), and 1- hydroxyethylidene-1, 1-bisphosphonate (HEBP). Available chlorine was titrated in chelator-NaOCl solutions. All chelators other than HEBP and STP caused an almost complete, immediate loss of available chlorine in solution. Atomic absorbtion spectrometry and SEM evaluation of root canal walls of instrumented teeth indicated that NaOCl had no negative effect on calcium-complexing ability of chelators. STP was too weak a complexing agent to warrant further studies. Finally, CA-, EDTA-, and HEBP-NaOCl mixtures were evaluated for their antimicrobial capacity. Again, EDTA and CA negatively interfered with NaOCl, while HEBP did not.

Can Canals Effectively Replace Groundwater Irrigation in Over-exploited Regions in India?

NASA Astrophysics Data System (ADS)

Jain, M.; Fishman, R.; Mondal, P.; Galford, G. L.; Bhattarai, N.; Naeem, S.; DeFries, R. S.

2017-12-01

We use high-resolution data on irrigation and cropping intensity across India to empirically estimate the impacts of losing access to groundwater irrigation in regions with critically exploited aquifers. India is the largest consumer of groundwater globally and is facing severe groundwater depletion. Canals are being promoted as an alternate irrigation source, yet few studies have quantified the effects that this transition may have on agricultural production. Our results suggest that farmers will be 50% less likely to plant a winter crop, have 20% less cropped area, and have cropped areas that are increasingly sensitive to rainfall variability when switching to canal irrigation. We estimate that national winter cropped area will decrease by approximately 13% if farmers lose access to groundwater irrigation in critically over-exploited regions, and 6% if farmers in these regions switch to canal irrigation. These results suggest that groundwater and canal irrigation are not substitutable, and farmers may have to switch to less water intensive crops or improve water use efficiency to maintain current levels of production in the future.

Surface debris of canal walls after post space preparation in endodontically treated teeth: a scanning electron microscopic study.

PubMed

Serafino, Cinzia; Gallina, Giuseppe; Cumbo, Enzo; Ferrari, Marco

2004-03-01

To evaluate surface cleanliness of root canal walls along post space after endodontic treatment using 2 different irrigant regimens, obturation techniques, and post space preparation for adhesive bonding. Forty teeth, divided into 4 groups, were instrumented, using Ni-Ti rotary files, irrigated with NaOCl or NaOCl+EDTA and obturated with cold lateral condensation (CLC) or warm vertical condensation (WVC) of gutta-percha. After post space preparation, etching, and washing procedure, canal walls were observed using a scanning electron microscope (SEM). Amount of debris, smear layer, sealer/gutta-percha remnants, and visibility of open tubules were rated. Higher amounts of rough debris, large sealer/gutta-percha remnants, thick smear layer, and no visibility of tubule orifices were recorded in all the groups at apical level of post space. At middle and coronal levels areas of clean dentin, alternating with areas covered by thin smear layer, smaller debris, gutta-percha remnants, and orifices of tubules partially or totally occluded by plugs were frequently observed. After endodontic treatment, obturation, and post space preparation SEM analysis of canal walls along post space shows large areas (covered by smear layer, debris, and sealer/gutta-percha remnants) not available for adhesive bonding and resin cementation of fiber posts.

Sealer penetration into dentinal tubules in the presence or absence of smear layer: a confocal laser scanning microscopic study.

PubMed

Kuçi, Astrit; Alaçam, Tayfun; Yavaş, Ozer; Ergul-Ulger, Zeynep; Kayaoglu, Guven

2014-10-01

The aim of this study was to test the dentinal tubule penetration of AH26 (Dentsply DeTrey, Konstanz, Germany) and MTA Fillapex (Angelus, Londrina, PR, Brazil) in instrumented root canals obturated by using cold lateral compaction or warm vertical compaction techniques in either the presence or absence of the smear layer. Forty-five extracted single-rooted human mandibular premolar teeth were used. The crowns were removed, and the root canals were instrumented by using the Self-Adjusting File (ReDent-Nova, Ra'anana, Israel) with continuous sodium hypochlorite (2.6%) irrigation. Final irrigation was either with 5% EDTA or with sodium hypochlorite. The canals were dried and obturated by using rhodamine B-labeled AH26 or MTA Fillapex in combination with the cold lateral compaction or the warm vertical compaction technique. After setting, the roots were sectioned horizontally at 4-, 8-, and 12-mm distances from the apical tip. On each section, sealer penetration in the dentinal tubules was measured by using confocal laser scanning microscopy. Regardless of the usage of EDTA, MTA Fillapex, compared with AH26, was associated with greater sealer penetration when used with the cold lateral compaction technique, and, conversely, AH26, compared with MTA Fillapex, was associated with greater sealer penetration when used with the warm vertical compaction technique (P < .05). Removal of the smear layer increased the penetration depth of MTA Fillapex used with the cold lateral compaction technique (P < .05); however, it had no significant effect on the penetration depth of AH26. Greater sealer penetration could be achieved with either the MTA Fillapex-cold lateral compaction combination or with the AH26-warm vertical compaction combination. Smear layer removal was critical for the penetration of MTA Fillapex; however, the same did not hold for AH26. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Root canal preparation with a novel nickel-titanium instrument evaluated with micro-computed tomography: canal surface preparation over time.

PubMed

Peters, Ove A; Boessler, Claudia; Paqué, Frank

2010-06-01

The aim of this part of an ongoing study was to describe the dentin removal ability of a novel nickel-titanium instrument, the self-adjusting file (SAF), by using micro-computed tomography. Twenty maxillary incisors were scanned preoperatively at 20-microm resolution and postoperatively after up to 6 minutes of preparation with an SAF with 1.5-mm or 2-mm diameter. SAFs were operated with continuous irrigation in a handpiece that provided an oscillating, in-and-out movement. Changes in canal volume compared with preoperative values as well as unprepared canal surface area were determined. Data were normally distributed and compared by analysis of variance and regression analyses. Preoperatively canal volumes were statistically similar in both groups (9.86 +/- 3.97 mm3 and 9.80 +/- 2.67 mm3). Volumes increased during preparation to 13.58 +/- 3.85 mm3 (after 6 minutes with SAF 1.5 mm) and 16.43 +/- 3.64 mm3 (after 5 minutes with SAF 2.0 mm), and overall canal shapes were adequate. Unprepared canal surface area decreased from 63.0% +/- 15.1% (2 minutes with SAF 1.5 mm) to 8.6% +/- 4.1% (5 minutes with SAF 2.0 mm). Preparation of straight root canals in maxillary anterior teeth left little canal surface uninstrumented after shaping with the SAF. The timeframe of clinical application will depend on the amount of desired dentin removal and done with an SAF selected on the basis of apical gauging. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Establishing Apical Patency: To be or not to be?

PubMed

Mohammadi, Zahed; Jafarzadeh, Hamid; Shalavi, Sousan; Kinoshita, Jun-Ichiro

2017-04-01

The apical portion of the root canal is very complex and challenging during endodontic treatment. Root canal preparation and obturation to the apical constriction may provide the best prognosis. Incomplete debridement, foramen transportation, and inadequate seal in the apical portion are considered to be responsible for treatment failure. The technique "apical patency" is considered as a way for maintaining the apical part the free of the debris by recapitulation, using a small K-file through the area of the apical foramen. This term was firstly proposed by Buchanan. In this technique, the smallest diameter file is set 1 mm longer than working length and recapitulated after each instrument to prevent packing of debris in the apical part. Apical patency has been found to be effective in achieving an apical seal with gutta-percha. Teeth prepared with a step back method and with maintained apical patency may show less leakage when obturated with cold lateral condensation technique. Data regarding the effect of apical patency on the healing of periapical tissue are very scarce, and it has been shown that the patency file has detrimental effect on the healing of periapical tissues in animal studies. However, using patency file in endodontic treatment is controversial and further studies are needed. The purpose of this article is to review the effect of using a patency file on the extrusion of root canal contents, the apical seal, postoperative pain, and healing of periapical tissues. Furthermore, the effect of establishing patency on reaching irrigation solutions to the apical portion of the canal and prognosis of root canal treatment are discussed. Keywords: Apical patency, Apical seal, Apical transportation, Postoperative pain, Prognosis.

Comparative evaluation of apically extruded debris during root canal preparation using ProTaper™, Hyflex™ and Waveone™ rotary systems

PubMed Central

Surakanti, Jayaprada Reddy; Venkata, Ravi Chandra Polavarapu; Vemisetty, Hari Kumar; Dandolu, Ram Kiran; Jaya, Nagendra Krishna Muppalla; Thota, Shirisha

2014-01-01

Background and Aims: Extrusion of any debris during endodontic treatment may potentially cause post-operative complications such as flare-ups. The purpose of this in vitro study was to assess the amount of apically extruded debris during the root canal preparation using rotary and reciprocating nickel-titanium instrumentation systems. Materials and Methods: In this study, 60 human mandibular first premolars were randomly assigned to 3 groups (n = 20 teeth/group). The root canals were instrumented according to the manufacturers’ instructions using the Reciprocating single-file system WaveOne™ (Dentsply Maillefer, Ballaigues, Switzerland) and full-sequence rotary Hyflex CM™ (Coltene Whaledent, Allstetten, Switzerland) and ProTaper™ (Dentsply Maillefer, Ballaigues, Switzerland) instruments. The canals were then irrigated using bidistilled water. The debris that was extruded apically was collected in preweighed eppendorf tubes and assessed with an electronic balance and compared. Statistical Analysis Used: The debris extrusion was compared and statistically analyzed using analysis of variance and the post hoc Student-Newman-Keuls test. Results: The WaveOne™ and ProTaper™ rotary instruments produced significantly more debris compared with Hyflex CM™ rotary instruments (P < 0.05). Conclusions: Under the conditions of this study, all systems that were used resulted in extrusion of apical debris. Full-sequence rotary instrumentation was associated with less debris extrusion compared with the use of reciprocating single-file systems. PMID:24778507

Mechanical reduction of the intracanal Enterococcus faecalis population by Hyflex CM, K3XF, ProTaper Next, and two manual instrument systems: an in vitro comparative study.

PubMed

Tewari, Rajendra K; Ali, Sajid; Mishra, Surendra K; Kumar, Ashok; Andrabi, Syed Mukhtar-Un-Nisar; Zoya, Asma; Alam, Sharique

2016-05-01

In the present study, the effectiveness of three rotary and two manual nickel titanium instrument systems on mechanical reduction of the intracanal Enterococcus faecalis population was evaluated. Mandibular premolars with straight roots were selected. Teeth were decoronated and instrumented until 20 K file and irrigated with physiological saline. After sterilization by ethylene oxide gas, root canals were inoculated with Enterococcus faecalis. The specimens were randomly divided into five groups for canal instrumentation: Manual Nitiflex and Hero Shaper nickel titanium files, and rotary Hyflex CM, ProTaper Next, and K3XF nickel titanium files. Intracanal bacterial sampling was done before and after instrumentation. After serial dilution, samples were plated onto the Mitis Salivarius agar. The c.f.u. grown were counted, and log10 transformation was calculated. All instrumentation systems significantly reduced the intracanal bacterial population after root canal preparation. ProTaper Next was found to be significantly more effective than Hyflex CM and manual Nitiflex and Hero Shaper. However, ProTaper Next showed no significant difference with K3XF. Canal instrumentation by all the file systems significantly reduced the intracanal Enterococcus faecalis counts. ProTaper Next was found to be most effective in reducing the number of bacteria than other rotary or hand instruments. © 2014 Wiley Publishing Asia Pty Ltd.

Preliminary Evaluation of Platelet Rich Fibrin-Mediated Tissue Repair in Immature Canine Pulpless Teeth.

PubMed

Wang, Qi Lin; Yang, Pan Pan; Ge, Li Hong; Liu, He

2016-03-01

To evaluate the use of platelet-rich fibrin (PRF) in the regenerative therapy of immature canine permanent teeth. Eight immature premolars of beagle dogs were pulp extracted and cleaned with irrigation, then divided into two groups of empty root canals and those filled with a PRF clot. All of the eight premolars were sealed with mineral trioxide aggregate and glass ionomer cement. Two premolars were left naturally grown as a positive control. The root development was assessed radiographically and histologically after 12 weeks. The radiological findings showed greater increases in the thickness of lateral dentinal wall in the PRF group than in the vacant group. Histologically, dental-associated mineral tissue, connective tissue, and bone-like mineral tissue grew into the root canals independent of PRF clot use. The PRF was able to increase the thickness of dental-associated mineral tissue. However, the vital tissue differed from the pulp dentin complex. Our study demonstrated the feasibility of using PRF-mediated regenerative therapy in pulpless immature teeth for improving tissue repair.

Natural medicaments in dentistry

PubMed Central

Sinha, Dakshita J.; Sinha, Ashish A.

2014-01-01

The major objective in root canal treatment is to disinfect the entire root canal system. Cleaning, shaping, and use of antimicrobial medicaments are effective in reducing the bacterial load to some extent, but some bacteria do remain behind and multiply, causing reinfection. Taking into consideration the ineffectiveness, potential side-effects and safety concerns of synthetic drugs, the herbal alternatives for endodontic usage might prove to be advantageous. Over the past decade, interest in drugs derived from medicinal plants has markedly increased. Phytomedicine has been used in dentistry as anti-inflammatory, antibiotic, analgesic, sedative and also as endodontic irrigant. Herbal preparations can be derived from the root, leaves, seeds, stem, and flowers. The PubMed database search revealed that the reference list for natural medicaments featured 1480 articles and in dentistry 173 articles. A forward search was undertaken on the selected articles and author names. This review focuses on various natural drugs and products as well as their therapeutic applications when used as phytomedicine in dentistry. PMID:25558153

Efficacy of Sodium Hypochlorite Activated With Laser in Intracanal Smear Layer Removal: An SEM Study

PubMed Central

Shahriari, Shahriar; Kasraei, Shahin; Roshanaei, Ghodratollah; Karkeabadi, Hamed; Davanloo, Hossein

2017-01-01

Introduction: The purpose of the present study was to evaluate the different concentrations of sodium hypochlorite activated with laser in removing of the smear layer in the apical, middle, and coronal segments of root canal walls by scanning electron microscopy analysis. Methods: Sixty single-rooted human mandibular teeth were decoronated to a standardized length. The samples were prepared by using Race rotary system to size 40, 0.04 taper and divided into 4 equal groups (n = 15). Group 1, irrigated with EDTA 17% and 5.25% NaOCl, groups 2, 3 and 4, 1%, 2.5%, and 5% NaOCl activated with Nd:YAG laser, respectively. Teeth were split longitudinally and subjected to scanning electron microscope (SEM). Data were analyzed by Kruskal-Wallis, Mann-Whitney tests. P value of <0.05 was considered statistically significant. Results: Five percent NaOCl LAI (laser-activated irrigation) showed best smear layer removal in test groups and the difference was statistically significant (P < 0.001). Control group (EDTA 17% and 5.25% NaOCl irrigation) showed significantly better outcomes in comparative with test groups (P < 0.001). In the apical third, compared to coronal and middle third, the canal walls were often contaminated by inorganic debris and smear layer. Conclusion: All different concentrations of sodium hypochlorite activated with laser have a positive effect on removing of smear layer. Sodium hypochlorite activated with laser removed smear layer more effectively at the coronal and middle third compared to the apical third. PMID:28912942

9. Photographic copy of photograph. (Source: National Archives Photo Collection, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

9. Photographic copy of photograph. (Source: National Archives Photo Collection, Denver, NN-366-114, Box 12, Photo 4464) Rebuilt Rock Creek Diversion Dam. Intake structure for canal is at left with suliceway and overflow section to right. April 24, 1950. - Bitter Root Irrigation Project, Rock Creek Diversion Dam, One mile east of Como Dam, west of U.S. Highway 93, Darby, Ravalli County, MT

Efficacy of ultrasonic activation of NaOCl and orange oil in removing filling material from mesial canals of mandibular molars with and without isthmus

PubMed Central

Barreto, Mirela Sangoi; da Rosa, Ricardo Abreu; Santini, Manuela Favarin; Cavenago, Bruno Cavalini; Duarte, Marco Antônio Húngaro; Bier, Carlos Alexandre Souza; Só, Marcos Vinícius Reis

2016-01-01

ABSTRACT Objectives The aim of this study was to evaluate the volume of remaining filling material after passive ultrasonic irrigation (PUI) of sodium hypochlorite (NaOCl) and orange oil in mesial canals of mandibular molars, with and without isthmus. Material and Methods Thirty mesial roots of mandibular molars were divided according to the presence or absence of isthmus. Canals were prepared and filled (Micro-CT #1). Filling was removed using rotary instruments, and specimens were sub-divided into three groups according to the irrigation procedures: Conventional – conventional irrigation with NaOCl, PUI/NaOCl – PUI of NaOCl (three activations, 20 seconds each), and PUI/orange oil – PUI of orange oil (Micro-CT#2). Specimens were enlarged using the X2 and X3 ProTaper Next instruments and submitted to the same irrigation protocols (Micro-CT #3). Results No differences were found between the experimental groups in each stage of assessment (P>0.05). The volume of residual filling material was similar to those in Micro-CT #2 and Micro-CT #3, but lower than those observed in Micro-CT #1 (P<0.05). When groups were pooled according to the presence or absence of an isthmus, volume of residual filling material was higher in specimens presenting isthmus (P<0.05). Conclusions PUI of NaOCl or orange oil did not improve filling removal. Isthmus consists in an anatomical obstacle that impairs the removal of filling material. PMID:26200525

Comparison of Antibacterial Efficacy of Turmeric Extract, Morinda Citrifolia and 3% Sodium Hypochlorite on Enterococcus faecalis: An In-vitro Study.

PubMed

Chaitanya, Bathula Vimala; Somisetty, Kusum Valli; Diwan, Abhinav; Pasha, Shiraz; Shetty, Nandaprasad; Reddy, Yashwanth; Nadigar, Shankar

2016-10-01

Sodium hypochlorite (NaOCl), the most commonly used irrigant, has many potential properties like its unique ability to dissolve pulp tissue, excellent antimicrobial activity, but has a cytotoxic effect when injected into periapical tissues. It is also known to produce allergic reactions, foul smell and taste, and potential for corrosion. Facultative organisms such as Enterococcus faecalis and aerobes like Staphylococcus aureus are considered to be the most resistant species and one of the possible causes of root canal treatment failure. So there is a need to find an alternative to sodium hypochlorite to act against these resistant microorganisms. To evaluate and compare the antibacterial efficacy of morinda citrifolia and turmeric extract with 3% NaOCl as a root canal irrigant, against E. faecalis and S.aureus . The antimicrobial efficacy was assessed in vitro using agar well diffusion method. Agar plates were prepared using Brain-Heart Infusion (BHI) agar. Cultures of E.faecalis and S.aureus were grown in nutrient broth at 37°C. Plates were incubated for 24 hours at 37°C and microbial zones of inhibition were recorded. Statistical analysis was performed using ANOVA. NaOCl (3%) showed larger zones of inhibition than herbal irrigants against both the microorganisms. Among the herbal irrigants, morinda citrifolia showed larger zones of inhibition than turmeric hydro-alcoholic extract and turmeric water extract which was statistically significant (p<0.05). NaOCl (3%) showed maximum antibacterial activity against E. faecalis , followed by morinda citrifolia and turmeric extracts. Considering the potential for undesirable properties of NaOCl, use of herbal alternatives in endodontics might prove to be advantageous.

Comparison of Antibacterial Efficacy of Turmeric Extract, Morinda Citrifolia and 3% Sodium Hypochlorite on Enterococcus faecalis: An In-vitro Study

PubMed Central

Somisetty, Kusum Valli; Diwan, Abhinav; Pasha, Shiraz; Shetty, Nandaprasad; Reddy, Yashwanth; Nadigar, Shankar

2016-01-01

Introduction Sodium hypochlorite (NaOCl), the most commonly used irrigant, has many potential properties like its unique ability to dissolve pulp tissue, excellent antimicrobial activity, but has a cytotoxic effect when injected into periapical tissues. It is also known to produce allergic reactions, foul smell and taste, and potential for corrosion. Facultative organisms such as Enterococcus faecalis and aerobes like Staphylococcus aureus are considered to be the most resistant species and one of the possible causes of root canal treatment failure. So there is a need to find an alternative to sodium hypochlorite to act against these resistant microorganisms. Aim To evaluate and compare the antibacterial efficacy of morinda citrifolia and turmeric extract with 3% NaOCl as a root canal irrigant, against E. faecalis and S.aureus. Materials and Methods The antimicrobial efficacy was assessed in vitro using agar well diffusion method. Agar plates were prepared using Brain-Heart Infusion (BHI) agar. Cultures of E.faecalis and S.aureus were grown in nutrient broth at 37°C. Plates were incubated for 24 hours at 37°C and microbial zones of inhibition were recorded. Statistical analysis was performed using ANOVA. Results NaOCl (3%) showed larger zones of inhibition than herbal irrigants against both the microorganisms. Among the herbal irrigants, morinda citrifolia showed larger zones of inhibition than turmeric hydro-alcoholic extract and turmeric water extract which was statistically significant (p<0.05). Conclusion NaOCl (3%) showed maximum antibacterial activity against E. faecalis, followed by morinda citrifolia and turmeric extracts. Considering the potential for undesirable properties of NaOCl, use of herbal alternatives in endodontics might prove to be advantageous. PMID:27891459

Influence of the dentinal wall on the pH of sodium hypochlorite during root canal irrigation.

PubMed

Macedo, Ricardo Gomes; Herrero, Noemi Pascual; Wesselink, Paul; Versluis, Michel; van der Sluis, Luc

2014-07-01

The purpose of this study was to evaluate the influence of dentin on the pH levels of different concentrations of sodium hypochlorite (NaOCl) solutions over time and to evaluate if preconditioning of dentin with 17% EDTA or agitation of the NaOCl solution influences these pH levels. A novel clinically representative model that scales with the ratio of the irrigant volume to the dentin surface area of a human root canal was used. Three standardized bovine dentin bars (2 × 2 × 10 mm) were placed in a plastic test tube. A total of 150 tubes were distributed in 29 groups. In the first experiment, the pH of various NaOCl solutions, with different concentrations (3%, 6%, and 9%) and starting pH levels (5 and 12), was monitored during exposure to dentin between 10 and 300 seconds. In a second experiment, the effect of agitation (45 Hz) and pretreatment of dentin with 17% EDTA on the pH levels of various NaOCl solutions was studied after 30 seconds of exposure to dentin. The short-term chemical stability of the tested solutions was assessed for both the concentration and the pH. The exposure time (P < .001) and concentration of the NaOCl solution (P < .011) significantly influence the pH level after exposure to dentin. However, the change in pH is too small to induce a change in the irrigant antimicrobial/tissue dissolution capacity. Agitation of the irrigant and preconditioning of the dentin did not alter the pH (P > .05). Both the pH 5 and pH 12 solutions were chemically stable for 1 hour. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Comparison of Cleaning Efficacy and Instrumentation Time in Primary Molars: Mtwo Rotary Instruments vs. Hand K-Files.

PubMed

Ramezanali, Fatemeh; Afkhami, Farzaneh; Soleimani, Ali; Kharrazifard, Mohammad Javad; Rafiee, Farshid

2015-01-01

Pulpectomy is the preferred treatment for restorable primary teeth with symptomatic irreversible pulpitis or periradicular lesion. Considering the rather new application of rotary files for pulpectomy of primary teeth, the aim of this study was to compare the cleaning efficacy and instrumentation time of hand K-files and Mtwo rotary system for preparation of human primary molars. This experimental study was conducted on 100 extracted primary maxillary and mandibular intact molars with no resorption. Access cavities were prepared and India ink was injected into the root canal on a vibrator using an insulin syringe. Canals were then divided into 5 groups (n=20): in group I, canals were instrumented using K-files up to #25 for mesial and buccal canals and #30 for palatal and distal canals. In group II, canals were prepared using Mtwo rotary files (15/0.05, 20/0.06 and 25/0.06 for mesial and buccal canals and 15/0.05, 20/0.06, 25/0.06 and finally 30/0.05 for distal and palatal canals). In group III, root canals were only irrigated with saline. Groups IV and V were the positive and negative control groups, respectively. The time required for cleaning and preparation of the canals for each of the specimens in groups I, II and III was recorded. The mean score of cleanliness of Mtwo was not significantly different from K-file group (P>0.05). However the mean instrumentation time in Mtwo group was significantly shorter (P<0.001). Although there were no differences regarding the cleaning efficacy of either system, Mtwo rotary files were far more time efficient.

Real-time implementation of model predictive control on Maricopa-Stanfield irrigation and drainage district's WM canal

USDA-ARS?s Scientific Manuscript database

Water resources are limited in many agricultural areas. One method to improve the effective use of water is to improve delivery service from irrigation canals. This can be done by applying automatic control methods that control the gates in an irrigation canal. The model predictive control MPC is ...

Effect of Instrument Design and Access Outlines on the Removal of Root Canal Obturation Materials in Oval-shaped Canals.

PubMed

Niemi, Tuomas K; Marchesan, Melissa A; Lloyd, Adam; Seltzer, Robert J

2016-10-01

The aim of this study was to compare the effectiveness of TRUShape (TS) instruments with ProFile Vortex Blue (VB) instruments for the removal of obturation materials during retreatment of single-canal mandibular premolars performed through 2 access outlines. Initial root canal treatment was completed through a contracted endodontic cavity (CEC) design. Canals were instrumented to an F2 ProTaper instrument, obturated with warm lateral condensation of gutta-percha with AH Plus sealer, and allowed to set for 30 days at 37°C and 100% humidity. For retreatment, specimens were divided into 2 groups (n = 24) on the basis of access outline, CEC or traditional endodontic cavity (TEC). Retreatment was initiated by using ProTaper Retreatment instruments (D1-D3). Specimens were then stratified, further divided (n = 12), and reinstrumented up to TS 40 .06v or 40 .06 VB. Irrigation was performed by using 8.25% NaOCl and QMix 2in1. Retreatment time was recorded. Teeth were sectioned and photographed, and the percentage of remaining obturation materials was measured. Data were analyzed with Kruskal-Wallis analysis of variance for two-factor tests (α < 0.05). The interaction between access design and instrument type showed that the combination of CEC-VB presented significantly higher amounts of remaining obturation materials on the canal surface when compared with TEC-VB, CEC-TS, and TEC-TS (P ≤ .05). None of these other combinations were different from each other (P > .05). Significantly more time was required for retreatment with CEC-TS (27.68 ± 1.4 minutes) than the other groups (P < .05). Neither retreatment protocol was able to completely eliminate all obturation materials from the root canal surface of mandibular premolars. However, in the presence of a CEC access design, using TS instruments removed more obturating material in single-rooted, oval-shaped canals. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Revascularization and periapical repair after endodontic treatment using apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing in dogs' teeth with apical periodontitis.

PubMed

da Silva, Lea Assed Bezerra; Nelson-Filho, Paulo; da Silva, Raquel Assed Bezerra; Flores, Daniel Silva Herzog; Heilborn, Carlos; Johnson, James D; Cohenca, Nestor

2010-05-01

The objective of this study was to evaluate in vivo the revascularization and the apical and periapical repair after endodontic treatment using 2 techniques for root canal disinfection (apical negative pressure irrigation versus apical positive pressure irrigation plus triantibiotic intracanal dressing) in immature dogs' teeth with apical periodontitis. Two test groups of canals with experimentally induced apical periodontitis were evaluated according to the disinfection technique: Group 1, apical negative pressure irrigation (EndoVac system), and Group 2, apical positive pressure irrigation (conventional irrigation) plus triantibiotic intracanal dressing. In Group 3 (positive control), periapical lesions were induced, but no endodontic treatment was done. Group 4 (negative control) was composed of sound teeth. The animals were killed after 90 days and the maxillas and mandibles were subjected to histological processing. The sections were stained with hematoxylin and eosin and Mallory Trichrome and examined under light microscopy. A description of the apical and periapical features was done and scores were attributed to the following histopathological parameters: newly formed mineralized apical tissue, periapical inflammatory infiltrate, apical periodontal ligament thickness, dentin resorption, and bone tissue resorption. Intergroup comparisons were done by the Kruskal-Wallis and Dunn's tests (alpha = 0.05). Although statistically significant difference was found only for the inflammatory infiltrate (P < .05), Group 1 presented more exuberant mineralized formations, more structured apical and periapical connective tissue, and a more advanced repair process than Group 2. From the histological observations, sodium hypochlorite irrigation with the EndoVac system can be considered as a promising disinfection protocol in immature teeth with apical periodontitis, suggesting that the use of intracanal antibiotics might not be necessary. Copyright (c) 2010 Mosby, Inc. All rights reserved.

Effect of different irrigation protocols on the radicular dentin interface and bond strength with a metacrylate-based endodontic sealer.

PubMed

Gonçalves, Lisandro; Silva-Sousa, Yara Teresinha Correa; Raucci Neto, Walter; Teixeira, Cleonice Silveira; Sousa-Neto, Manoel Damião; Alfredo, Edson

2014-06-01

This study assessed the influence of different endodontic chemical substances on the adhesion of the Epiphany SE/Resilon system (with and without resinous solvent) to radicular dentin walls, using the push-out test and scanning electron microscopy (SEM). Forty-eight root canals of human canines were prepared biomechanically with ProTaper rotary files (crown-down technique) and the radicular dentin was treated with either 17% EDTA, 2% chlorhexidine gel (CHX) or 2.5% NaOCl (control). The root canals were filled with Resilon cones and Epiphany SE sealer with and without resinous solvent. Six groups of eight canals each had their roots sectioned transversally to obtain 1-mm thick slices. Data were subjected to statistical analysis by ANOVA and Tukey's tests. The specimens treated with 17% EDTA (1.59 ± 0.91) presented higher bond strength (P < 0.05) than those treated with 2.5% NaOCl (0.93 ± 0.27) and 2% CHX (0.92 ± 0.22). Significantly higher bond strength (P < 0.05) was observed when the Epiphany SE was prepared with (1.37 ± 0.78) than without (0.92 ± 0.33) solvent. Adhesive failures were predominant in all groups. SEM analysis showed greater homogeneity of the filling mass when the solvent was added to the sealer. Treatment of root canal walls with 17% EDTA, and addition of a resinous solvent to Epiphany SE produced the highest adhesion to radicular dentin. © 2014 Wiley Periodicals, Inc.

Use of photoactivated disinfection and platelet-rich fibrin in regenerative Endodontics

PubMed Central

Johns, Dexton Antony; Shivashankar, Vasundara Yayathi; Krishnamma, Shoba; Johns, Manu

2014-01-01

Aim: Photoactivated disinfection has been used as an adjunct to conventional endodontic treatment. Its use in regenerative endodontics is not reported in literature. The aim of this case report was to describe a new proposal for pulp revascularization with disinfection of pulp canal space using a unique combination of a photosensitizer solution and low-power laser light. Materials and Methods: A 9-year-old boy came with the chief complaint of discolored upper central incisors (#8, #9). A diagnosis of pulp necrosis was made on the basis of clinical and radiographic findings. The canal was irrigated with 5.25% sodium hypochlorite solution and dried with paper points. Photodynamic therapy was used to disinfect the root canal and platelet-rich fibrin was used to revitalize the pulp. Three millimeters of gray mineral trioxide aggregate was placed directly over the platelet-rich plasma clot. Three days later, the tooth was double-sealed with permanent filling materials. Results: Clinical examination revealed no sensitivity to percussion or palpation tests. Radiograph revealed continued thickening of the dentinal walls, root lengthening, regression of the peri-apical lesion and apical closure. Both the roots showed complete apical closure at the 10-month follow-up. However, the teeth were not responsive to electric pulp test. Conclusion: This report of pulp revascularization shows that disinfection with photodynamic therapy combined with platelet-rich fibrin leads to satisfactory root development in necrotic immature teeth. PMID:25298655

Postoperative quality of life following single-visit root canal treatment performed by rotary or reciprocating instrumentation: a randomized clinical trial.

PubMed

Pasqualini, D; Corbella, S; Alovisi, M; Taschieri, S; Del Fabbro, M; Migliaretti, G; Carpegna, G C; Scotti, N; Berutti, E

2016-11-01

To compare the impact of rotary and reciprocating instrumentation on postoperative quality of life (POQoL) after single-visit primary root canal treatment. A randomized controlled clinical trial was designed and carried out in a University endodontic practice in northern Italy. Healthy subjects with asymptomatic irreversible pulpitis, symptomatic irreversible pulpitis or pulp necrosis with or without apical periodontitis (symptomatic or asymptomatic) scheduled for primary root canal treatment were enrolled. Single-visit root canal treatment was performed with ProTaper ™ S1-S2-F1-F2 (rotary group, n = 23) and WaveOne ™ Primary (reciprocating group, n = 24). Irrigation was performed with 5% NaOCl and 10% EDTA. Root canal filling was performed with the continuous-wave technique and ZOE sealer. POQoL indicators were evaluated for 7 days post-treatment. The variation of each indicator over time was compared using anova for repeated measures (P < 0.05). The impact of each variable on POQoL was analysed with a multivariate logistic regression model (P < 0.05). Pain curves demonstrated a more favourable time-trend in the rotary group (mean, P = 0.077; maximum, P = 0.015). Difficulty in eating (P = 0.017), in performing daily activities (P = 0.023), in sleeping (P = 0.021) and in social relations (P = 0.077), was more evident in the reciprocating group. Patients' perception of the impact of treatment on POQoL was more favourable in the rotary group (P = 0.006). Multirooted tooth type and pre-existing periradicular inflammation were associated with a decrease in POQoL. Reciprocating instrumentation affected POQoL to a greater extent than rotary instrumentation. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Histomicrobiologic aspects of the root canal system and periapical lesions in dogs' teeth after rotary instrumentation and intracanal dressing with Ca(OH)2 pastes.

PubMed

Soares, Janir Alves; Leonardo, Mário Roberto; da Silva, Léa Assed Bezerra; Tanomaru Filho, Mário; Ito, Izabel Yoko

2006-10-01

The purpose of this study was to evaluate the distribution of microorganisms in the root canal system (RCS) and periapical lesions of dogs' teeth after rotary instrumentation and placement of different calcium hydroxide [Ca(OH)2]-based intracanal dressings. Chronic periapical lesions were experimentally induced in 80 premolar roots of four dogs. Instrumentation was undertaken using the ProFile rotary system and irrigation with 5.25% sodium hypochlorite. The following Ca(OH)2-based pastes were applied for 21 days: group 1 - Calen (n=18); group 2 - Calen+CPMC (n=20); group 3 - Ca(OH)2 p.a. + anaesthetic solution (n=16) and group 4 - Ca(OH)2 p.a.+ 2% chlorhexidine digluconate (n=18). Eight root canals without endodontic treatment constituted the control group. Histological sections were obtained and stained with Brown & Brenn staining technique to evaluate the presence of microorganisms in the main root canal, ramifications of the apical delta and secondary canals, apical cementoplasts, dentinal tubules, areas of cemental resorption and periapical lesions. The results were analyzed statistically by the Mann-Whitney U test (p<0.05). The control group showed the highest prevalence of microorganisms in all sites evaluated. Gram-positive cocci, bacilli and filaments were the most frequent morphotypes. Similar microbial distribution patterns in the RCS and areas of cementum resorption were observed in all groups (p>0.05). The percentage of RCS sites containing microorganisms in groups 1, 2, 3, 4 and control were: 67.6%, 62.5%, 78.2%, 62.0% and 87.6%, respectively. In conclusion, the histomicrobiological analysis showed that the rotary instrumentation and the different calcium hydroxide pastes employed did not effectively eliminate the infection from the RCS and periapical lesions. However, several bacteria seen in the histological sections were probably dead or were inactivated by the biomechanical preparation and calcium hydroxide-based intracanal dressing.

Post-Obturation pain following one-visit and two-visit root canal treatment in necrotic anterior teeth.

PubMed

Rao, K Nandan; Kandaswamy, Raghavendra; Umashetty, Girish; Rathore, Vishnu Pratap Singh; Hotkar, Chetan; Patil, Basanagouda S

2014-04-01

To investigate and compare the post-obturation pain after one-visit and two-visit root canal treatment in non-vital anterior teeth. One hundred forty eight patients requiring root canal therapy on permanent anterior non-vital teeth with single root were included in this study. Patients were randomly assigned to either the one-appointment or the twoappointment group. The standardized protocol for all the teeth involved local anesthesia, isolation and access, engine-driven rotary nickel-titanium canal instrumentation with 2.5% NaOCl irrigation and obturation. Teeth in group 1 (n = 74) were obturated during the first appointment by using laterally condensed gutta-percha and resin sealer. Teeth in group 2 (n = 74) were given closed dressing and were obturated during the second appointment, 7 to 14 days later. A modified Visual Analogue Scale was used to measure pain after 6 hours, 24 hours, 48 hours and 7 days after the treatment. Statistical analysis was done to compare groups at each interval by using an independent-samples t test. The incidence and intensity of post-obturation pain in both Group 'A' and Group 'B' gradually reduced over the study period. When the incidence of pain was compared in the single and two visit group, it was found that the single-visit group experienced slightly less pain than the two-visit group during all study intervals, but the difference found was not statistically significant. There was no difference in postoperative pain between patients treated in only one appointment and patients treated in two appointments. The majority of patients in both groups reported no pain or only minimal pain after 7 days of treatment. How to cite the article: Rao KN, Kandaswamy R, Umashetty G, Rathore VP, Hotkar C, Patil BS. Post-Obturation pain following one-visit and two-visit root canal treatment in necrotic anterior teeth. J Int Oral Health 2014;6(2):28-32.

Nonsurgical Management of a Periapical Cyst: A Case Report

PubMed Central

Dandotikar, Deepakraj; Peddi, Ravigna; Lakhani, Bharvi; Lata, Kamini; Mathur, Aditi; Chowdary, Uday Kumar

2013-01-01

Large periapical lesions, regardless of whether they are granulomas, abscesses or cysts, are primarily caused by root canal infection. Thus the treatment protocol should be elimination of etiological factors in the root canal system rather than their product, apical true cyst. A 10 year old female patient reported to the Department of Pedodontics and Preventive Dentistry, Dr R Ahmed Dental College & Hospital, Kolkata, with the chief complaint of pain and swelling in relation to upper front fractured teeth. Clinical and radiological findings were suggestive of periapical radicular cyst. Non-surgical endodontic therapy was performed using 1% sodium hypochlorite solution irrigant and Calcium hydroxide intra canal medicament. A 12 months follow-up radiographic examination revealed progressive involution of periapical radiolucency without any clinical symptoms. Periapical cysts respond favorably to non-surgical endodontic treatment and should be considered as primary treatment modality. How to cite this article: Dandotikar D, Peddi R, Lakhani B, Lata K, Mathur A, Chowdary U K. Nonsurgical Management of a Periapical Cyst: A Case Report. J Int Oral Health 2013; 5(3):79-84. PMID:24155607

Nonsurgical management of a periapical cyst: a case report.

PubMed

Dandotikar, Deepakraj; Peddi, Ravigna; Lakhani, Bharvi; Lata, Kamini; Mathur, Aditi; Chowdary, Uday Kumar

2013-06-01

Large periapical lesions, regardless of whether they are granulomas, abscesses or cysts, are primarily caused by root canal infection. Thus the treatment protocol should be elimination of etiological factors in the root canal system rather than their product, apical true cyst. A 10 year old female patient reported to the Department of Pedodontics and Preventive Dentistry, Dr R Ahmed Dental College & Hospital, Kolkata, with the chief complaint of pain and swelling in relation to upper front fractured teeth. Clinical and radiological findings were suggestive of periapical radicular cyst. Non-surgical endodontic therapy was performed using 1% sodium hypochlorite solution irrigant and Calcium hydroxide intra canal medicament. A 12 months follow-up radiographic examination revealed progressive involution of periapical radiolucency without any clinical symptoms. Periapical cysts respond favorably to non-surgical endodontic treatment and should be considered as primary treatment modality. How to cite this article: Dandotikar D, Peddi R, Lakhani B, Lata K, Mathur A, Chowdary U K. Nonsurgical Management of a Periapical Cyst: A Case Report. J Int Oral Health 2013; 5(3):79-84.

Impact of lubricant parameters on rotary instrument torque and force.

PubMed

Boessler, Claudia; Peters, Ove A; Zehnder, Matthias

2007-03-01

In the current study, the impact of lubricant parameters on simulated root canal instrumentation was investigated. Using size 30 ProFile .06 instruments in milled artificial root canals in human dentin, the effects of sodium hypochlorite (1% NaOCl) and a chelator (18% etidronic acid) in aqueous irrigants on maximum torque, full torsional load, and maximum force values were gauged using a torque testing platform. Furthermore, the impact of the time a chelating lubricant was exposed to dentin as well as its galenic form (aqueous vs. gel-type) on the above outcome variables was evaluated. Aqueous lubricants significantly (p < 0.05, ANOVA, Newman-Keuls) reduced all outcome variables compared to dry conditions. The incorporation of a chelator further reduced these values (p < 0.05), whereas hypochlorite behaved similar to water. The chelator effect was immediate and did not increase with time. An aqueous lubricant was more beneficial than a gel-type counterpart.

A novel methodology providing insights into removal of biofilm-mimicking hydrogel from lateral morphological features of the root canal during irrigation procedures.

PubMed

Macedo, R G; Robinson, J P; Verhaagen, B; Walmsley, A D; Versluis, M; Cooper, P R; van der Sluis, L W M

2014-11-01

To introduce and characterize a reproducible hydrogel as a suitable biofilm mimic in endodontic research. To monitor and visualize the removal of hydrogel from a simulated lateral canal and isthmus for the following: I) Ultrasonic-Activated Irrigation (UAI) with water, ii) UAI with NaOCl and iii) NaOCl without UAI. A rheometer was used to characterize the viscoelastic properties and cohesive strength of the hydrogel for suitability as a biofilm mimic. The removal rate of the hydrogel from a simulated lateral canal or isthmus was measured by high-speed imaging operating at frame rates from 50 to 30,000 fps. The hydrogel demonstrated viscoelastic behaviour with mechanical properties comparable to real biofilms. UAI enhanced the cleaning effect of NaOCl in isthmi (P < 0.001) and both NaOCl and water in lateral canals (P < 0.001). A greater depth of cleaning was achieved from an isthmus (P = 0.009) than from a lateral canal with UAI and also at a faster rate for the first 20 s. NaOCl without UAI resulted in a greater depth of hydrogel removal from a lateral canal than an isthmus (P < 0.001). The effect of UAI was reduced when stable bubbles were formed and trapped in the lateral canal. Different removal characteristics were observed in the isthmus and the lateral canal, with initial highly unstable behaviour followed by slower viscous removal inside the isthmus. The biofilm-mimicking hydrogel is reproducible, homogenous and can be easily applied and modified. Visualization of its removal from lateral canal anatomy provides insights into the cleaning mechanisms of UAI for a biofilm-like material. Initial results showed that UAI improves hydrogel removal from the accessory canal anatomy, but the creation of stable bubbles on the hydrogel-liquid interface may reduce the cleaning rate. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

An Investigation of Current Endodontic Practice in Turkey

PubMed Central

Kaptan, R. F.; Haznedaroglu, F.; Kayahan, M. B.; Basturk, F. B.

2012-01-01

Objectives. The aim of this study was to gather information about the quality and quantity of root canal treatments carried out by general dental practitioners in Turkey. Methods. Questionnaires were given to 1400 dentists who attended the 16th National Congress organized by the Turkish Dental Association. The participants were asked to answer 34 multiple-choice questions. The questions were subdivided into 3 main topics; general information; general approach to endodontic treatment; and cleaning, shaping, and obturation of root canals. The statistical analysis was carried out by an χ 2-test to compare the means at a significance level of P < 0.05. Results. The response rate for this study was 43%. There was a wide variation in the number of root canal treatments completed per month. Nearly 92% of practitioners stated that they never used rubber dam. The most commonly used working length determination technique was radiographic evaluation (P < 0.05). Sodium hypochlorite was the irrigant of choice with varying concentrations and AH Plus was the sealer of choice (P < 0.05). Resin composite was the most frequently used material for final restorations. Conclusions. Endodontic procedures in general practice in Turkey have differences from widely acknowledged quality guidelines. Despite the introduction of new instruments and techniques, most of the general practitioners chose conventional methods. PMID:23251103

WelltonMohawk Irrigation System, Wasteway No. 1, WelltonMohawk Canal, North side ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Wellton-Mohawk Irrigation System, Wasteway No. 1, Wellton-Mohawk Canal, North side of Wellton-Mohawk Canal, bounded by Gila River to North & the Union Pacific Railroad & Gila Mountains to south, Wellton, Yuma County, AZ

The influence of irrigating solutions on the accuracy of the electronic apex locator facility in the Tri Auto ZX handpiece.

PubMed

Erdemir, A; Eldeniz, A U; Ari, H; Belli, S; Esener, T

2007-05-01

To determine the influence of various irrigating solutions on the accuracy of the electronic apex locator facility in the Tri Auto ZX handpiece. One hundred and forty teeth with single canals and mature apices, scheduled for extraction for either periodontal or prosthetic reasons in 76 patients were used. Following informed written consent local anaesthesia was administered, access cavities were prepared and pulp tissue removed. The teeth were then randomly divided into seven groups according to the irrigating solutions used. The root canal length measurements were completed using the Tri Auto ZX handpiece with automatic reverse function in the presence of one or other of the following solutions: 0.9% saline, 2.5% NaOCl, 3% H(2)O(2), 0.2% chlorhexidine, 17% EDTA, Ultracaine D-S or in the absence of an irrigating solution (control). Files were immobilized in the access cavity with composite resin. After extraction, the apical regions of the teeth were exposed and the file tips examined under a stereomicroscope. Distances between the file tips and the apical constriction were measured (mm) and analysed using a one-way anova and post hoc Tukey test. Mean distances from the apical constriction to the file tip were longer in the 0.9% saline group (P<0.05). There was no statistically significant difference on file tip position between the other solutions. Tri Auto ZX gave reliable results with all irrigating solutions apart from in the presence of 0.9% saline.

Infrastructure performance of irrigation canal to irrigation efficiency of irrigation area of Candi Limo in Mojokerto District

NASA Astrophysics Data System (ADS)

Kisnanto, S.; Hadiani, R. R. R.; Ikhsan, C.

2018-03-01

Performance is a measure of infrastructure success in delivering the benefits corresponding it’s design implementation. Debit efficiency is a comparison between outflow debit and inflow debit. Irrigation canal performance is part of the overall performance aspects of an irrigation area. The greater of the canal performance will be concluded that the canal is increasingly able to meet the planned benefits, need to be seen its comparison between the performance and debit efficiency of the canal. The existing problems in the field that the value of the performance of irrigation canals are not always comparable to the debit efficiency. This study was conducted to describe the relationship between the performance of the canal to the canal debit efficiency. The study was conducted at Candi Limo Irrigation Area in Mojokerto Disctrict under the authority of Pemerintahan Provinsi Jawa Timur. The primary canal and secondary canal are surveyed to obtain data. The physical condition of the primary and secondary canals into the material of this study also. Primary and secondary canal performance based on the physical condition in the field. Measurement inflow and outflow debit into the data for the calculation of the debit efficiency. The instrument used in this study such as the current meter for debit measurements in the field as a solution when there is a building measure in the field were damaged, also using the meter and the camera. Permen PU No.32 is used to determine the value of the performance of the canal, while the efficiency analysis to calculate a comparison value between outflow and inflow debit. The process of data running processing by performing the measurement and calculation of the performance of the canal, the canal debit efficiency value calculation, and display a graph of the relationship between the value of the performance with the debit efficiency in each canal. The expected results of this study that the performance value on the primary canal in the range of 0 to 100 % with debit efficiency value in the range of 0 to 100 %, while for the secondary canal 1 has a performance range between 0 to 100% with efficiency ranges between 0 to 100%, the performance of the secondary canals 2 ranges between 0 to 100% with efficiencies ranging from 0 to 100%, the secondary canal 3 performance ranges between 0 to 100% efficiency ranges between 0 to 100%, the secondary canal 4 performance ranges between 0 to 100% efficiency ranges between 0 to 100% and secondary canals 5 performance ranges between 0 to 100% efficiency ranges between 0 to 100%. For the tendency to expect from the performance and efficiency of the debit canal can have a proportional clockwise or counterclockwise, which amount can be random. The tendency to be graphed the relationship between performance and efficiency of the debit of each segment studied canal.

Micro-CT evaluation of several glide path techniques and ProTaper Next shaping outcomes in maxillary first molar curved canals.

PubMed

Alovisi, M; Cemenasco, A; Mancini, L; Paolino, D; Scotti, N; Bianchi, C C; Pasqualini, D

2017-04-01

To evaluate the ability of ProGlider instruments, PathFiles and K-files to maintain canal anatomy during glide path preparation using X-ray computed micro-tomography (micro-CT). Forty-five extracted maxillary first permanent molars were selected. Mesio-buccal canals were randomly assigned (n = 15) to manual K-file, PathFile or ProGlider groups for glide path preparation. Irrigation was achieved with 5% NaOCl and 10% EDTA. After glide path preparation, each canal was shaped with ProTaper Next X1 and X2 to working length. Specimens were scanned (isotropic voxel size 9.1 μm) for matching volumes and surface areas and post-treatment analyses. Canal volume, surface area, centroid shift, canal geometry variation through ratio of diameter ratios and ratio of cross-sectional areas were assessed in the apical and coronal levels and at the point of maximum canal curvature. One-way factorial anovas were used to evaluate the significance of instrument in the various canal regions. Post-glide path analysis revealed that instrument factor was significant at the apical level for both the ratio of diameter ratios and the ratio of cross-sectional areas (P < 0.001), with an improved maintenance of root canal geometry by ProGlider and PathFile. At the coronal level and point of maximum canal curvature, ProGlider demonstrated a tendency to pre-flare the root canal compared with K-file and PathFile. PathFile and ProGlider demonstrated a significantly lower centroid shift compared with K-file at the apical level (P = 0.023). Post-shaping analysis demonstrated a more centred preparation of ProGlider, compared with PathFile and K-files, with no significant differences for other parameters. Use of ProGlider instruments led to less canal transportation than PathFiles and K-files. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

31. MAIN CANAL Photographic copy of historic photo, December ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

31. MAIN CANAL - Photographic copy of historic photo, December 13, 1939 (original print in '1939 Annual Report of the Carlsbad Project,' located at the Carlsbad Irrigation District offices, Carlsbad, New Mexico) photographer unknown 'LINING MAIN CANAL AROUND GYP BEND' - Carlsbad Irrigation District, Main Canal, 4 miles North to 12 miles Southeast of Carlsbad, Carlsbad, Eddy County, NM

Irrigation water use for the Fort Lyon Canal, southeastern Colorado, 1989-90

USGS Publications Warehouse

Dash, R.G.

1995-01-01

The U.S. Geological Survey, in cooperation with the Bent County Board of County Commissioners, began a study to evaluate irrigation water use quanti- tatively for about 91,630 acres of farmland irrigated from the 103.7-mile-long Fort Lyon Main Canal in the Arkansas River Valley of southeastern Colorado. This report provides information from 1980 and 1990 for four hydrologic components of irrigation water use: Surface-water withdrawals, conveyance losses, ground-water withdrawals, and estimates of threretical crop consumptive use. Surface-water withdrawals for the Fort Lyon Canal were 211,150 acre-feet (about 2.3 acre-feet per acre) during 1989 and 202,000 acre-feet (about 2.2 acre-feet per acre) during 1990. Conveyance losses occurred during the transport of water in the unlined Fort Lyon Canal. Conveyance losses were as much as 72 (acre-feet per day) per mile in the first division of the canal and generally decreased in the downstream canal divisions. Ground-water withdrawals for the Fort Lyon Canal were estimated to be 38,890 acre-feet (about 0.8 acre-foot per acre irrigated ground water) during 1989 and 33,970 acre-feet (about 0.7 acre-foot per acre irrigated by ground water) during 1990. Theoretical crop consumptive use was estimated to be 227,530 acre-feet (about 2.7 acre-feet per acre of cropland) during 1989 and 251, 130 acre-feet (about 2.9 acre-feet per acre of cropland) during 1990. The total crop irrigation requirement needed from irrigation withdrawals was 172,100 acre-feet (about 2.0 acre-feet per acre of cropland) during ` 1989 and 190,050 acre-feet (about 2.2 acre-feet per acre of cropland) during 1990. Crops cultivted in the five divisions of the canal were alfalfa, sorghum, corn, wheat, pasture, and spring grains.

Root Canal Morphology and Configuration of 118 Mandibular First Molars by Means of Micro-Computed Tomography: An Ex Vivo Study.

PubMed

Wolf, Thomas Gerhard; Paqué, Frank; Zeller, Maximilian; Willershausen, Brita; Briseño-Marroquín, Benjamín

2016-04-01

The aim of this study was to investigate the root canal system morphology of the mandibular first molar by means of micro-computed tomography. The root canal configuration, foramina, and accessory canals frequency of 118 mandibular first molars were investigated by means of micro-computed tomography and 3-dimensional software imaging. A 4-digit system describes the root canal configuration from the coronal to apical thirds and the main foramina number. The most frequent root canal configurations in mesial root were 2-2-2/2 (31.4%), 2-2-1/1 (15.3%), and 2-2-2/3 (11.9%); another 24 different root canal configurations were observed in this root. A 1-1-1/1 (58.5%), 1-1-1/2 (10.2%), and 16 other root canal configurations were observed in the distal root. The mesiobuccal root canal showed 1-4 foramina in 24.6%, and the mesiolingual showed 1-3 foramina in 28.0%. One connecting canal between the mesial root canals was observed in 30.5% and 2 in 3.4%. The distolingual root canal showed 1-4 foramina in 23.7%, whereas a foramen in the distobuccal root canal was rarely detected (3.4%). The mesiobuccal, mesiolingual, and distolingual root canals showed at least 1 accessory canal (14.3, 10.2, and 4.2%, respectively), but the distobuccal had none. The root canal configuration of mandibular first molars varies strongly. According to our expectations, both the mesial and distal roots showed a high number of morphologic diversifications. The root canal system of the mesial root showed more root canal configuration variations, connecting and accessory canals than the distal root. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Efficacy of sodium hypochlorite, ethylenediaminetetraacetic acid, citric acid and phosphoric acid in calcium hydroxide removal from the root canal: a microscopic cleanliness evaluation.

PubMed

da Silva, Juliana Melo; Silveira, Amanda; Santos, Elizandra; Prado, Laiìs; Pessoa, Oscar F

2011-12-01

Rooted molars were subjected to standardized canal instrumentation to a master apical file (MAF). The samples were dressed with Ca(OH)(2), and after 7 days, teeth were reopened and Ca(OH)(2) medication was removed by 1 of 4 different experimental procedures: 2.5% sodium hypochlorite (NaOCl) (n = 10); 17% EDTA-T (n = 10); 10% citric acid (n = 10); or 37% phosphoric acid (n = 10). This was followed by reinstrumentation with MAF plus 15 mL saline solution. The roots were prepared for scanning electron microscopic analysis of the cervical, middle, and apical thirds. Statistical analysis was performed with the Kruskal-Wallis test. EDTA-T and phosphoric acid gave the best results in the apical third, with significant statistical differences compared with other groups. NaOCl gave the worst results. Irrigation with 17% EDTA-T and 37% phosphoric acid is more effective than sodium hypochlorite and citric acid in the removal of calcium hydroxide from the apical third. Copyright © 2011 Mosby, Inc. All rights reserved.

An in vitro assessment of type, position and incidence of isthmus in human permanent molars

PubMed Central

de LIMA, Fernando José Camello; MONTAGNER, Francisco; JACINTO, Rogério Castilho; AMBROSANO, Glaucia Maria Bovi; GOMES, Brenda Paula Figueiredo de Almeida

2014-01-01

Root canal anatomical complexities, such as isthmus, may limit the action of the endodontic instruments, irrigant solutions and intracanal medications, leading to endodontic treatment failure. Objectives This in vitro study assessed the type, position and incidence of isthmus in human permanent molars. Material and Methods One hundred and twenty eight upper and lower first and second permanent molars were analyzed. The roots were embedded in transparent resin, and then split at different distances from the apex (1.0-2.5-4.0-5.5-7.0 mm). Following the sample examination in stereomicroscope, the data were submitted to chi-square statistical test at a 5% significance level. Results The highest isthmus incidence was at 7.0 mm from the root apex in all samples, except the distal root of lower molars (at 5.5 mm). In upper and lower molars, type V (complete isthmus with a continuous opening between the two main root canals) was the most common classification of isthmus (28.8%). In the mesial root of first and second mandibular molars, type IV had the highest incidence (36% and 23.9%, respectively). Conclusion It was concluded that isthmus was widely found in flat roots, with a low percentage in areas close to the apex. In upper and lower molars, these structures were most frequently found at 7 mm from the apex. PMID:25141198

Detection of antibiotic resistance genes in samples from acute and chronic endodontic infections and after treatment.

PubMed

Rôças, Isabela N; Siqueira, José F

2013-09-01

The purpose of this study was twofold: survey samples from acute and chronic endodontic infections for the presence of genes encoding resistance to beta-lactams, tetracycline and erythromycin, and evaluate the ability of treatment to eliminate these genes from root canals. DNA extracts from samples of abscess aspirates (n=25) and root canals of teeth with asymptomatic apical periodontitis (n=24) were used as template for direct detection of the genes blaTEM, cfxA, tetM, tetQ, tetW, and ermC using real-time polymerase chain reaction (PCR). Bacterial presence was determined using PCR with universal bacterial primers. Root canals of the asymptomatic cases were also sampled and evaluated after chemomechanical procedures using NiTi instruments with 2.5% NaOCl irrigation. All abscess and initial root canal samples were positive for bacteria. At least one of the target resistance genes was found in 36% of the abscess samples and 67% of the asymptomatic cases. The most prevalent genes in abscesses were blaTEM (24%) and ermC (24%), while tetM (42%) and tetW (29%) prevailed in asymptomatic cases. The blaTEM gene was significantly associated with acute cases (p=0.02). Conversely, tetM was significantly more prevalent in asymptomatic cases (p=0.008). Treatment eliminated resistance genes from most cases. Acute and chronic endodontic infections harboured resistance genes for 3 classes of widely used antibiotics. In most cases, treatment was effective in eliminating these genes, but there were a few cases in which they persisted. The implications of persistence are unknown. Direct detection of resistance genes in abscesses may be a potential method for rapid diagnosis and establishment of proactive antimicrobial therapy. Copyright © 2013 Elsevier Ltd. All rights reserved.

Similar influence of stabilized alkaline and neutral sodium hypochlorite solutions on the fracture resistance of root canal-treated bovine teeth.

PubMed

Souza, Erick Miranda; Calixto, Amanda Martins; Lima, Camila Nara E; Pappen, Fernanda Geraldo; De-Deus, Gustavo

2014-10-01

Stabilizing sodium hypochlorite (NaOCl) at an alkaline pH is proposed to increase solution stability and tissue dissolution ability; however, a reduction on the flexural strength of dentin discs has been found to be a side effect. This study sought to determine whether a stabilized alkaline NaOCl reduces the fracture resistance of root canal-treated bovine teeth after root canal preparation compared with a neutral solution counterpart. The 4 anterior incisors were removed from 20 mandibular bovine jaws, and each 1 was randomly assigned to 1 of 4 groups (20 teeth each). Teeth were prepared with a sequence of 6 K-type files. The following experimental groups received a different irrigation regimen: G1: distilled water (negative control), G2: 5% NaOCl at a pH of 7.2, and G3: 5% NaOCl at a pH of 12.8; in the positive control group (G4), teeth remained untreated. The time of contact and volume of solution were carefully standardized. After bone and periodontal ligament simulation, teeth were subjected to a fracture resistance test. A significant difference was observed among the 4 groups tested (analysis of variance, P < .05). The 5% NaOCl groups (G2 and G3) presented significantly lower resistance to fracture than the control (G1 and G4) (Tukey test, P < .05). Both NaOCl solutions similarly reduced the fracture resistance at approximately 30% (Tukey test, P > .05). No differences were observed between positive and negative control groups (Tukey test, P > .05). Stabilized alkaline and neutral NaOCl solutions similarly reduced the fracture resistance of root canal-treated bovine teeth by about 30%. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Quantitative assessment of apical debris extrusion and intracanal debris in the apical third, using hand instrumentation and three rotary instrumentation systems.

PubMed

H K, Sowmya; T S, Subhash; Goel, Beena Rani; T N, Nandini; Bhandi, Shilpa H

2014-02-01

Decreased apical extrusion of debris and apical one third debris have strong implications for decreased incidence of postoperative inflammation and pain. Thus, the aim of this study was to assess quantitatively the apical extrusion of debris and intracanal debris in the apical third during root canal instrumentation using hand and three different types of rotary instruments. Sixty freshly extracted single rooted human teeth were randomly divided into four groups. Canal preparation was done using step-back with hand instrumentation, crown-down technique with respect to ProTaper and K3, and hybrid technique with LightSpeed LSX. Irrigation was done with NaOCl, EDTA, and normal saline and for final irrigation, EndoVac system was used. The apically extruded debris was collected on the pre-weighed Millipore plastic filter disk and weighed using microbalance. The teeth were submitted to the histological processing. Sections from the apical third were analyzed by a trinocular research microscope that was coupled to a computer where the images were captured and analyzed using image proplus V4.1.0.0 software. The mean weight of extruded debris for each group and intracanal debris in the root canal was statistically analyzed by a Kruskal-Wallis one-way analysis of variance and Mann-Whitney U test. The result showed that, hand instrumentation using K files showed the highest amount of debris extrusion apically when compared to ProTaper, K3 and LightSpeed LSX. The result also showed that there was no statistically significant difference between the groups in relation to presence of intracanal debris in the apical one third. Based on the results, all instrumentation techniques produced debris extrusion. The engine driven Ni-Ti systems extruded significantly less apical debris than hand instrumentation. There was no statistically significant difference between the groups in relation to presence of intracanal debris in the apical one third.

Quantitative Assessment of Apical Debris Extrusion and Intracanal Debris in the Apical Third, Using Hand Instrumentation and Three Rotary Instrumentation Systems

PubMed Central

H.K., Sowmya; T.S., Subhash; Goel, Beena Rani; T.N., Nandini; Bhandi, Shilpa H.

2014-01-01

Introduction: Decreased apical extrusion of debris and apical one third debris have strong implications for decreased incidence of postoperative inflammation and pain. Thus, the aim of this study was to assess quantitatively the apical extrusion of debris and intracanal debris in the apical third during root canal instrumentation using hand and three different types of rotary instruments. Methodology: Sixty freshly extracted single rooted human teeth were randomly divided into four groups. Canal preparation was done using step-back with hand instrumentation, crown-down technique with respect to ProTaper and K3, and hybrid technique with LightSpeed LSX. Irrigation was done with NaOCl, EDTA, and normal saline and for final irrigation, EndoVac system was used. The apically extruded debris was collected on the pre-weighed Millipore plastic filter disk and weighed using microbalance. The teeth were submitted to the histological processing. Sections from the apical third were analyzed by a trinocular research microscope that was coupled to a computer where the images were captured and analyzed using image proplus V4.1.0.0 software. The mean weight of extruded debris for each group and intracanal debris in the root canal was statistically analyzed by a Kruskal-Wallis one-way analysis of variance and Mann-Whitney U test. Results: The result showed that, hand instrumentation using K files showed the highest amount of debris extrusion apically when compared to ProTaper, K3 and LightSpeed LSX. The result also showed that there was no statistically significant difference between the groups in relation to presence of intracanal debris in the apical one third. Conclusion: Based on the results, all instrumentation techniques produced debris extrusion. The engine driven Ni-Ti systems extruded significantly less apical debris than hand instrumentation. There was no statistically significant difference between the groups in relation to presence of intracanal debris in the apical one third. PMID:24701536

Effects of NiTi rotary and reciprocating instruments on debris and smear layer scores: an SEM evaluation.

PubMed

Poggio, Claudio; Dagna, Alberto; Chiesa, Marco; Scribante, Andrea; Beltrami, Riccardo; Colombo, Marco

2014-12-30

The purpose of the present study was to investigate the cleaning efficacy of 2 different nickel-titanium (NiTi) rotary systems: a new single system Reciproc compared with the rotary full sequence Mtwo. The amount of debris and the morphology of smear layer were the parameters for the evaluation of the cleanliness of root canals. The null hypothesis of the study was that there would be no significant difference in debris scores and smear layer scores between the 2 systems. 
 Forty single-rooted freshly extracted teeth were selected and divided into 2 groups. For each group, all root canals were shaped with 2 different NiTi instruments (Mtwo and Reciproc) and irrigated with 5.25% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA) solutions by 3 trained operators. Specimens were fractured longitudinally and prepared for scanning electron microscopy (SEM) analysis at a standard magnification of ×5,000. The presence/absence of smear layer and the presence/absence of debris at the coronal, middle and apical third of each canal were evaluated using two 5-step scales for scores. Numeric data were analyzed using the Kruskal-Wallis and Mann-Whitney U statistical tests, and significance was set at a P value <0.05. 
 This study revealed significant differences among the various groups. The Mtwo group presented significantly lower smear layer scores than the Reciproc group (P<0.01) in the middle and apical third of the canal. 
 Conventional continuous rotary NiTi instruments associated with 5.25% NaOCl and 17% EDTA solutions seem to be better for obtaining clean dentinal canal walls. Reciprocating instruments leave a higher quantity of smear layer which covers dentinal walls and dentinal tubules.

Comparative evaluation of the amount of debris extruded apically using conventional syringe, passive ultrasonic irrigation and EndoIrrigator Plus system: An in vitro study

PubMed Central

Shetty, Vidhi Prabhakar; Naik, Balaram Damodar; Pachlag, Amit Kashinath; Yeli, Mahantesh Mrityunjay

2017-01-01

Aim: The aim of this study is to compare the effects of conventional syringe, passive ultrasonic irrigation (PUI), and EndoIrrigator Plus on the amount of apically extruded debris. Materials and Methods: Thirty extracted human mandibular premolars were selected and randomly assigned to three groups (n = 10). The root canals were irrigated with conventional syringe, PUI, and EndoIrrigator Plus. Sodium hypochlorite was used as an irrigant, and debris was collected in a previously described experimental model (Myers and Montgomery 1991). It was then stored in an incubator at 37°C for 10 days to evaporate the irrigant before weighing the dry debris. The mean weight of debris was assessed, one-way analysis of variance was used for comparison of values, and post hoc Tukey's test was used between groups (P = 0.05). Results: The EndoIrrigator Plus group extruded significantly less debris than PUI and conventional syringe groups (P < 0.05). Furthermore, PUI group extruded significantly less debris than conventional syringe irrigation group (P < 0.05). Conclusions: 1. All the three irrigation systems were associated with apical extrusion of debris, 2. EndoIrrigator Plus system extruded significantly less debris than the PUI system and the conventional syringe irrigation system, 3. PUI system extruded significantly less debris than the conventional syringe irrigation system. PMID:29430092

Microbiological water quality in a large irrigation system: El Valle del Yaqui, Sonora México.

PubMed

Gortáres-Moroyoqui, Pablo; Castro-Espinoza, L; Naranjo, Jaime E; Karpiscak, Martin M; Freitas, Robert J; Gerba, Charles P

2011-01-01

The primary objective of this study was to determine the microbial water quality of a large irrigation system and how this quality varies with respect to canal size, impact of near-by communities, and the travel distance from the source in the El Valle del Yaqui, Sonora, México. In this arid region, 220,000 hectares are irrigated with 80% of the irrigation water being supplied from an extensive irrigation system including three dams on the Yaqui River watershed. The stored water flows to the irrigated fields through two main canal systems (severing the upper and lower Yaqui Valley) and then through smaller lateral canals that deliver the water to the fields. A total of 146 irrigation water samples were collected from 52 sample sites during three sampling events. Not all sites could be accessed on each occasion. All of the samples contained coliform bacteria ranging from 1,140 to 68,670 MPN/100 mL with an arithmetic mean of 11,416. Ninety-eight percent of the samples contained less than 1,000 MPN/100 mL Escherichia coli, with an arithmetic mean of 291 MPN/100 mL. Coliphage were detected in less than 30% of the samples with an arithmetic average equal to 141 PFU/100 mL. Enteroviruses, Cryptosporidium oocysts, and Giardia cysts were also detected in the canal systems. No significant difference was found in the water quality due to canal system (upper or lower Yaqui Valley), canal-size (main vs. lateral), distance from source, and the vicinity of human habitation (presence of various villages and towns along the length of the canals). There was a significant decrease in coliforms (p < 0.011) and E. coli (< 0.022) concentrations as travel distance increased from the City of Obregón.

Correlative bacteriologic and micro-computed tomographic analysis of mandibular molar mesial canals prepared by self-adjusting file, reciproc, and twisted file systems.

PubMed

Siqueira, José F; Alves, Flávio R F; Versiani, Marco A; Rôças, Isabela N; Almeida, Bernardo M; Neves, Mônica A S; Sousa-Neto, Manoel D

2013-08-01

This ex vivo study evaluated the disinfecting and shaping ability of 3 protocols used in the preparation of mesial root canals of mandibular molars by means of correlative bacteriologic and micro-computed tomographic (μμCT) analysis. The mesial canals of extracted mandibular molars were contaminated with Enterococcus faecalis for 30 days and assigned to 3 groups based on their anatomic configuration as determined by μCT analysis according to the preparation technique (Self-Adjusting File [ReDent-Nova, Ra'anana, Israel], Reciproc [VDW, Munich, Germany], and Twisted File [SybronEndo, Orange, CA]). In all groups, 2.5% NaOCl was the irrigant. Canal samples were taken before (S1) and after instrumentation (S2), and bacterial quantification was performed using culture. Next, mesial roots were subjected to additional μCT analysis in order to evaluate shaping of the canals. All instrumentation protocols promoted a highly significant intracanal bacterial reduction (P < .001). Intergroup quantitative and qualitative comparisons disclosed no significant differences between groups (P > .05). As for shaping, no statistical difference was observed between the techniques regarding the mean percentage of volume increase, the surface area increase, the unprepared surface area, and the relative unprepared surface area (P > .05). Correlative analysis showed no statistically significant relationship between bacterial reduction and the mean percentage increase of the analyzed parameters (P > .05). The 3 instrumentation systems have similar disinfecting and shaping performance in the preparation of mesial canals of mandibular molars. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

[Accidental injection of sodium hypochlorite in inferior alveolar nerve block anesthesia].

PubMed

Hongyan, Li; Jian, Xu; Baorong, Zhang; Yue, Jia; Minhua, Liu; Yilang, Luo; Jing, Zhao

2016-12-01

Sodium hypochlorite (NaClO) has been widely used in clinical practice as one of the most efficient root canal irrigants. Its properties include broad-spectrum antimicrobial activity and ability to dissolve necrotic tissues. However, when used improperly, NaClO can cause a series of adverse reactions, such as mucosal inflammation, irritation, or injury. This paper presents a case of accidental injection of NaClO in inferior alveolar nerve block anesthesia.

An In vitro Comparison of Apically Extruded Debris Using Reciproc, ProTaper Universal, Neolix and Hyflex in Curved Canals.

PubMed

Labbaf, Hossein; Nazari Moghadam, Kiumars; Shahab, Shahriar; Mohammadi Bassir, Mahshid; Fahimi, Mohammad Amin

2017-01-01

As a consequence of root canal preparation, dentinal chips, irrigants and pulp remnants are extruded into preradicular space. This phenomenon may lead to post endodontic flare-ups. The purpose of this study was to compare the amount of extruded debris with four endodontic NiTi engine-driven systems. Sixty mesiobuccal roots of maxillary molars with 15-30˚ curvature were divided randomly into four groups ( n =15). Each group was instrumented up to apical size of 25 using Reciproc, ProTaper Universal, Neolix and Hyflex. Bidistilled water was used as irrigant and extruded debris was collected in pre-weighted Eppendorf tubes. Tubes were stored in incubator for drying the debris. Extruded debris were weighted in electronic microbalance with accuracy of 0.0001 g. The raw data was analyzed with one way analysis of variance (ANOVA) and Tukey's HSD post hoc test. Level of significance was set at 0.05. The debris extrusion with Reciproc files was significantly higher than the other groups ( P <0.05). Hyflex significantly extruded less debris than other files ( P <0.05). There was no significant difference between ProTaper Universal and Neolix regarding the amount of extruded debris ( P =0.98). All systems extruded debris during the instrumentation. Reciproc system significantly extruded more debris. Caution should be taken when interpreting the results of this study and applying it to the real clinical situation.

Clinical Approach of High Technology Techniques for Control and Elimination of Endodontic Microbiota

PubMed Central

Chiniforush, Nasim; Pourhajibagher, Maryam; Shahabi, Sima; Bahador, Abbas

2015-01-01

The main goal in endodontic treatment is to eradicate or at least reduce intraradicular microbial population to levels that are more compatible with periapical lesions healing process. Since endodontic infections are polymicrobial in nature, intraradicular survival of endodontic microbiota and their pathogenic properties are influenced by a combination of their virulence factors. The purpose of this article is to review the endodontic microbiota and their respective virulence attributes, as well as perform a literature review of the effects of disinfection procedures in the treatment of endodontic infections to gain best practices. Conventional technique for root canal preparation includes mechanical debridement and application of antimicrobial irrigants. Recently, laser irradiation has been used to enhance the results of root canal treatment through its thermal effect. To reduce thermal side effects, laser activated irrigation (LAI) and photon induced photoacoustic streaming (PIPS) were introduced. Antimicrobial photodynamic therapy (aPDT) by photochemical reaction uses light at a specific wavelength to activate a nontoxic photosensitizer (PS) in the presence of oxygen to produce cytotoxic products. Different PSs are used in dentistry including methylene blue (MB), toluidine blue O (TBO), indocyanine green (ICG) and curcumin. Among different options, ICG could be the best choice due to its peak absorption at wavelength of 808 nm, which coincides with the commercial diode laser devices. Also, this wavelength has more penetration depth compared to other wavelengths used in aPDT. PMID:26705458

Metaproteome analysis of endodontic infections in association with different clinical conditions.

PubMed

Provenzano, José Claudio; Siqueira, José F; Rôças, Isabela N; Domingues, Romênia R; Paes Leme, Adriana F; Silva, Márcia R S

2013-01-01

Analysis of the metaproteome of microbial communities is important to provide an insight of community physiology and pathogenicity. This study evaluated the metaproteome of endodontic infections associated with acute apical abscesses and asymptomatic apical periodontitis lesions. Proteins persisting or expressed after root canal treatment were also evaluated. Finally, human proteins associated with these infections were identified. Samples were taken from root canals of teeth with asymptomatic apical periodontitis before and after chemomechanical treatment using either NaOCl or chlorhexidine as the irrigant. Samples from abscesses were taken by aspiration of the purulent exudate. Clinical samples were processed for analysis of the exoproteome by using two complementary mass spectrometry platforms: nanoflow liquid chromatography coupled with linear ion trap quadrupole Velos Orbitrap and liquid chromatography-quadrupole time-of-flight. A total of 308 proteins of microbial origin were identified. The number of proteins in abscesses was higher than in asymptomatic cases. In canals irrigated with chlorhexidine, the number of identified proteins decreased substantially, while in the NaOCl group the number of proteins increased. The large majority of microbial proteins found in endodontic samples were related to metabolic and housekeeping processes, including protein synthesis, energy metabolism and DNA processes. Moreover, several other proteins related to pathogenicity and resistance/survival were found, including proteins involved with adhesion, biofilm formation and antibiotic resistance, stress proteins, exotoxins, invasins, proteases and endopeptidases (mostly in abscesses), and an archaeal protein linked to methane production. The majority of human proteins detected were related to cellular processes and metabolism, as well as immune defense. Interrogation of the metaproteome of endodontic microbial communities provides information on the physiology and pathogenicity of the community at the time of sampling. There is a growing need for expanded and more curated protein databases that permit more accurate identifications of proteins in metaproteomic studies.

Effect of photon-initiated photoacoustic streaming, passive ultrasonic, and sonic irrigation techniques on dentinal tubule penetration of irrigation solution: a confocal microscopic study.

PubMed

Akcay, Merve; Arslan, Hakan; Mese, Merve; Durmus, Nazlı; Capar, Ismail Davut

2017-09-01

The aim of this in vitro study was to evaluate the efficacy of different irrigation techniques including laser-activated irrigation using an erbium:yttrium-aluminum-garnet (Er:YAG) laser with a novel tip design (photon-induced photoacoustic streaming (PIPS)), Er:YAG laser with Preciso tip, sonic activation, and passive ultrasonic activation on the final irrigation solution penetration into dentinal tubules by using a laser scanning confocal microscope. In this study, 65 extracted single-rooted human mandibular premolars were instrumented up to size 40 and randomly divided into 5 groups (n = 13) based on the activation technique of the final irrigation solution as follows: conventional irrigation (control group), sonic activation, passive ultrasonic activation, Er:YAG-PIPS tip activation, and Er:YAG-Preciso tip activation. In each group, 5 mL of 5% NaOCl labeled with fluorescent dye was used during the activation as the final irrigation solution. Specimens were sectioned at 2.5 and 8 mm from the apex and then examined under a confocal microscope to calculate the dentinal tubule penetration area. Data were analyzed using two-way analysis of variance (ANOVA) and Tukey's post hoc tests (P = 0.05). Both Er:YAG laser (Preciso/PIPS) activations exhibited a significantly higher penetration area than the other groups (P < 0.05). Additionally, passive ultrasonic activation had significantly higher penetration than the sonic activation group and the control group. Statistically significant differences were also found between each root canal third (coronal > middle > apical) (P < 0.001). The results from the present study support the use of Er:YAG laser activation (Preciso/PIPS) to improve the effectiveness of the final irrigation procedure by increasing the irrigant penetration area into the dentinal tubules. The activation of the irrigant and the creation of the streaming with the Er:YAG laser have a positive effect on the irrigant penetration.

Dissolution of root canal sealers in EDTA and NaOCl solutions.

PubMed

Keleş, Ali; Köseoğlu, Mustafa

2009-01-01

Solutions of ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) have been used as canal irrigants in endodontic treatment. The authors conducted a study to compare the ability of these solutions to dissolve sealers. The authors assessed the solubility of six sealers-calcium hydroxide, polyketone, zinc oxide-eugenol, silicone and two epoxy resins-in EDTA and two concentrations of NaOCl (2.5 percent and 5.0 percent). They immersed standardized samples (n = 5) of each sealer for two minutes and 10 minutes. They obtained the mean values of sealer dissolution in solutions by calculating the difference between the original preimmersion and postimmersion weights to determine the amount of sealer removed. They compared the values via factorial analysis of variance. They analyzed differences between the six sealers with respect to their solubility in EDTA or NaOCl solutions at two minutes and 10 minutes by using a one-way analysis of variance (P < .05). In comparison with NaOCl solutions, EDTA was markedly superior in dissolving root canal sealers (P < .05). There were no significant differences between the two concentrations of NaOCl. The two epoxy resins and the silicone-based sealer were of low solubility. The zinc oxide-eugenol-based sealer was significantly more soluble than were the epoxy resins and the silicone-based sealers. Polyketone and calcium hydroxide-based sealers were the most soluble sealers (P < .05). The results of this study indicate that during nonsurgical endodontic re-treatment, EDTA and NaOCl solutions used for removing smear layer aided in the retreatment by dissolving some root canal sealers.

Comparison of post-obturation pain experience following one-visit and two-visit root canal treatment on teeth with vital pulps: a randomized controlled trial.

PubMed

Wang, C; Xu, P; Ren, L; Dong, G; Ye, L

2010-08-01

To compare the incidence and intensity of post-obturation pain after one- or two-visit root canal treatment (RCT) on anterior teeth with vital pulps and a single root and canal in a randomized controlled trial. One hundred patients requiring RCT on permanent anterior teeth with vital pulps preoperatively were included. The patients were assigned randomly into two groups of 50 patients each. After local anaesthesia, isolation, access and pulp extirpation, the canals of all teeth were prepared using engine-driven rotary ProTaper nickel-titanium instruments in a crown-down technique and irrigated with 2.5% NaOCl. The teeth in group 1 (n = 50) were filled with AH Plus sealer and gutta-percha using a lateral compaction technique at the first visit, whilst those in group 2 (n = 50) were medicated with a calcium hydroxide paste, a sterile dry cotton pellet and Caviton and scheduled for a second visit 7 days later. A modified verbal descriptor scale was used to measure preoperative pain and post-obturation pain at 6, 24, 48 h and 1 week after operation. Chi-square tests and independent-sample T-tests were used to compare the incidence and intensity of post-obturation pain of two groups at each interval. Eleven patients were excluded from the study as they failed to follow the scheduled revisit or their selected teeth had more than one root canal. Data were obtained from the remaining 89 patients. Forty-three patients were undergoing one-visit treatment (group 1) and 46 undergoing two-visit treatment (group 2). Most patients in both groups reported no pain or only slight pain within each post-obturation interval, only one in group 1 and one in group 2 had flare-ups and slight swelling. There was no statistically significant difference in the incidence and intensity of post-obturation pain experienced by two groups. The incidence and intensity of post-obturation pain experience following one- or two-visit RCT on teeth with vital pulps and a single canal were not significantly different.

10. EAST SIDE CANAL Photographic copy of historic photo, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

10. EAST SIDE CANAL - Photographic copy of historic photo, December 3, 1940 (original print in '1940 Annual Report of the Carlsbad Project,' located at the Carlsbad Irrigation District offices, Carlsbad, New Mexico) photographer unknown 'LOOKING DOWN FROM STA. #22 LATERAL #8, EAST CANAL. AFTER CCC ENROLLEES FINISHED ROCK LINING' - Carlsbad Irrigation District, East Side Canal, 1 mile North to 2 miles East of Carlsbad, Carlsbad, Eddy County, NM

9. EAST SIDE CANAL Photographic copy of historic photo, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

9. EAST SIDE CANAL - Photographic copy of historic photo, September 17, 1940 (original print in '1940 Annual Report of the Carlsbad Project,' located at the Carlsbad Irrigation District offices, Carlsbad, New Mexico) photographer unknown 'CCC ENROLLEES STARTING EXCAVATION FOR ROCK LINING DOWNSTREAM FROM STA. 22. EAST CANAL, LAT. #8' - Carlsbad Irrigation District, East Side Canal, 1 mile North to 2 miles East of Carlsbad, Carlsbad, Eddy County, NM

Survey of attitudes, materials and methods employed in endodontic treatment by general dental practitioners in North Jordan.

PubMed

Al-Omari, Wael M

2004-09-10

BACKGROUND: General dental practitioners provide the majority of endodontic treatment in Jordan. The aim of this study was to gather information on the methods, materials and attitudes employed in root canal treatment by dentists in North Jordan, in order to evaluate and improve the quality of current practice. METHODS: A questionnaire was posted to all registered general dental practitioners working in private practice in Irbid Governate in North Jordan (n = 181). The questionnaire included information on methods, materials and techniques used in endodontic treatment. RESULTS: Reply rate was 72% (n = 131). The results demonstrated that only five dentists used rubber dam occasionally and not routinely. The majority used cotton rolls for isolation solely or in combination with a high volume saliva ejector (n = 116). The most widely used irrigants were sodium hypochlorite and hydrogen peroxide, which were used by 32.9% (n = 43) and 33.6% (n = 44) of the respondents, respectively. Forty eight percent of the respondents (n = 61) used the cold lateral condensation technique for canal obturation, 31.3% (n = 41) used single cone, 9.9% (n = 13) used vertical condensation and 12.2% (n = 16) used paste or cement only for the obturation. The majority used zinc oxide eugenol as a sealer (72.5%). All, but one, respondents used hand instruments for canal preparation and the technique of choice was step back (52.7%). More than 50% (n = 70) of the dentists took one radiograph for determining the working length, whilst 22.9% (n = 30) did not take any radiograph at all. Most practitioners performed treatment in three visits for teeth with two or more root canals, and in two visits for teeth with a single root canal. CONCLUSIONS: This study indicates that dentists practicing in North Jordan do not comply with international quality standards and do not use recently introduced techniques. Many clinicians never take a radiograph for determining the working length and never used rubber dam or intra-canal medicaments.

Interaction between lidocaine hydrochloride (with and without adrenaline) and various irrigants: A nuclear magnetic resonance analysis

PubMed Central

Vidhya, Nirmal; Karthikeyan, Balasubramanian Saravana; Velmurugan, Natanasabapathy; Abarajithan, Mohan; Nithyanandan, Sivasankaran

2014-01-01

Background: Interaction between local anesthetic solution, lidocaine hydrochloride (with and without adrenaline), and root canal irrigants such as sodium hypochlorite (NaOCl), ethylene diamine tetra-acetic acid (EDTA), and chlorhexidine (CHX) has not been studied earlier. Hence, the purpose of this in vitro study was to evaluate the chemical interaction between 2% lidocaine hydrochloride (with and without adrenaline) and commonly used root canal irrigants, NaOCl, EDTA, and CHX. Materials and Methods: Samples were divided into eight experimental groups: Group I-Lidocaine hydrochloride (with adrenaline)/3% NaOCl, Group II-Lidocaine hydrochloride (with adrenaline)/17% EDTA, Group III- Lidocaine hydrochloride (with adrenaline)/2% CHX, Group IV-Lidocaine hydrochloride (without adrenaline)/3% NaOCl, Group V-Lidocaine hydrochloride (without adrenaline)/17% EDTA, Group VI-Lidocaine hydrochloride (without adrenaline)/2% CHX, and two control groups: Group VII-Lidocaine hydrochloride (with adrenaline)/deionized water and Group VIII-Lidocaine hydrochloride (without adrenaline)/deionized water. The respective solutions of various groups were mixed in equal proportions (1 ml each) and observed for precipitate formation. Chemical composition of the formed precipitate was then analysed by nuclear magnetic resonance spectroscopy (NMR) and confirmed with diazotation test. Results: In groups I and IV, a white precipitate was observed in all the samples on mixing the respective solutions, which showed a color change to reddish brown after 15 minutes. This precipitate was then analysed by NMR spectroscopy and was observed to be 2,6-xylidine, a reported toxic compound. The experimental groups II, III, V, and VI and control groups VII and VIII showed no precipitate formation in any of the respective samples, until 2 hours. Conclusion: Interaction between lidocaine hydrochloride (with and without adrenaline) and NaOCl showed precipitate formation containing 2,6-xylidine, a toxic compound. PMID:25097652

C-shaped root canal in a maxillary first molar: a case report.

PubMed

Yilmaz, Z; Tuncel, B; Serper, A; Calt, S

2006-02-01

This case report presents an unusual C-shaped root canal system in a maxillary first molar tooth. Although C-shaped root canals are most frequently seen in the mandibular second molar, they may also appear in maxillary molars. A literature search revealed only a few case reports of C-shaped root canal systems in maxillary molars. The present case describes a C-shaped canal in the buccal root of a maxillary first molar. The endodontic access cavity displayed two canal orifices, one leading to the canal system in the buccal root, the other into the palatal root canal system. In the buccal root, what appeared to be the mesial and distal canals joined to form a single C-shaped canal. --Careful examination of radiographs and the internal anatomy of teeth is essential.-- The location and morphology of root canals should be identified at high magnification under the microscope.

Biologically based treatment of immature permanent teeth with pulpal necrosis: a case series.

PubMed

Jung, Il-Young; Lee, Seung-Jong; Hargreaves, Kenneth M

2012-06-01

This case series reports the outcomes of 8 patients (ages 9-4 years) who presented with 9 immature permanent teeth with pulpal necrosis and apical periodontitis. During treatment, 5 of the teeth were found to have at least some residual vital tissue remaining in the root canal systems. After NaOCI irrigation and medication with ciprofloxacin, metronidazole, and minocycline, these teeth were sealed with mineral trioxide aggregate and restored. The other group of 4 teeth had no evidence of any residual vital pulp tissue. This second group of teeth was treated with NaOCl irrigation and medicated with ciprofloxacin, metronidazole, and minocycline followed by a revascularization procedure adopted from the trauma literature (bleeding evoked to form an intracanal blood clot). In both groups of patients, there was evidence of satisfactory postoperative clinical outcomes (1-5 years); the patients were asymptomatic, no sinus tracts were evident, apical periodontitis was resolved, and there was radiographic evidence of continuing thickness of dentinal walls, apical closure, or increased root length.

Micro-CT analyses of apical enlargement and molar root canal complexity.

PubMed

Markvart, M; Darvann, T A; Larsen, P; Dalstra, M; Kreiborg, S; Bjørndal, L

2012-03-01

To compare the effectiveness of two rotary hybrid instrumentation techniques with focus on apical enlargement in molar teeth and to quantify and visualize spatial details of instrumentation efficacy in root canals of different complexity. Maxillary and mandibular molar teeth were scanned using X-ray microcomputed tomography. Root canals were prepared using either a GT/Profile protocol or a RaCe/NiTi protocol. Variables used for evaluation were the following: distance between root canal surfaces before and after preparation (distance after preparation, DAP), percentage of root canal area remaining unprepared and increase in canal volume after preparation. Root canals were classified according to size and complexity, and consequences of unprepared portions of narrow root canals and intraradicular connections/isthmuses were included in the analyses. One- and two-way anova were used in the statistical analyses. No difference was found between the two techniques: DAP(apical-third) (P = 0.590), area unprepared(apical-third) (P = 0.126) and volume increase(apical-third) (P = 0.821). Unprepared root canal area became larger in relation to root canal size and complexity, irrespective of the technique used. Percentage of root canal area remaining unprepared was significantly lower in small root canals and complex systems compared to large root canals. The isthmus area per se contributed with a mean of 17.6%, and with a mean of 25.7%, when a narrow root canal remained unprepared. The addition of isthmuses did not significantly alter the ratio of instrumented to unprepared areas at total root canal level. Distal and palatal root canals had the highest level of unprepared area irrespective of the two instrumentation techniques examined. © 2011 International Endodontic Journal.

Apical Negative Pressure irrigation presents tissue compatibility in immature teeth

PubMed Central

Pucinelli, Carolina Maschietto; da Silva, Léa Assed Bezerra; Cohenca, Nestor; Romualdo, Priscilla Coutinho; da Silva, Raquel Assed Bezerra; Consolaro, Alberto; de Queiroz, Alexandra Mussolino; Nelson, Paulo

2017-01-01

Abstract Aim: To compare the apical negative pressure irrigation (ANP) with conventional irrigation in the teeth of immature dogs with apical periodontitis. Methods: Fifty-two immature pre-molar root canals were randomly assigned into 4 groups: ANP (n=15); conventional irrigation (n=17); healthy teeth (control) (n = 10); and teeth with untreated apical periodontitis (control) (n=10). After induction of apical periodontitis, teeth were instrumented using EndoVac® (apical negative pressure irrigation) or conventional irrigation. The animals were euthanized after 90 days. The sections were stained by HE and analyzed under conventional and fluorescence microscopy. TRAP histoenzymology was also performed. Statistical analyses were performed with the significance level set at 5%. Results: There was difference in the histopathological parameters between ANP and conventional groups (p<0.05). The ANP group showed a predominance of low magnitude inflammatory infiltrate, a smaller periodontal ligament, and lower mineralized tissue resorption. There were no differences in the periapical lesion extensions between the ANP and conventional groups (p>0.05). However, a lower number of osteoclasts was observed in the ANP group (p<0.05). Conclusion: The EndoVac® irrigation system presented better biological results and more advanced repair process in immature teeth with apical periodontitis than the conventional irrigation system, confirming the hypothesis. PMID:29211282

Endodontic Treatment of an Autogenous Transplanted Tooth Using an Er,Cr:YSGG Laser and Radial Firing Tips: Case Report.

PubMed

Martins, Miguel Rodrigues; Lima, Rita C; Pina-Vaz, Irene; Carvalho, Manuel Fontes; Gutknecht, Norbert

2016-10-01

Although several surgical techniques have been reported, no study has yet reported alternative strategies for endodontic treatment of autogenous transplanted teeth. Therefore, the aim of this clinical report is to present the long-term endodontic outcome of a nonvital autogenously transplanted third molar treated with an Er,Cr:YSGG laser and radial firing tips (RFTs). Autogenous tooth transplantation can be considered an alternative to restore edentulous areas and, in donor's teeth with complete root formation, root canal treatment should be performed up to 14 days following transplantation. In the present case report, the patient returned only after 6 months, with clinical and radiological signs of apical periodontitis (AP) associated with the transplanted tooth. Instead of traditional endodontic chemical irrigants or medications, the protocol for smear-layer removal and root canal disinfection was based on intracanal irradiation with an Er,Cr:YSGG laser and RFTs. After 3-years' follow-up, the complete reestablishment of the periodontal ligament and the arrest of the resorptive process could be noticed. This protocol has shown to be effective for the endodontic treatment of a transplanted multi-rooted tooth with AP. Further randomized clinical trials should be conducted to clearly demonstrate the effectiveness of this laser-assisted endodontic protocol.

Can intra-radicular cleaning protocols increase the retention of fiberglass posts? A systematic review.

PubMed

Oliveira, Lilian Vieira; Maia, Thais Souza; Zancopé, Karla; Menezes, Murilo de Souza; Soares, Carlos José; Moura, Camilla Christian Gomes

2018-03-15

The presence of residues within the root canal after post-space preparation can influence the bond strength between resin cement and root dentin when using fiberglass posts (FGPs). Currently, there is no consensus in the literature regarding what is the best solution for the removal of debris after post-space preparation. This systematic review involved "in vitro" studies to investigate if cleaning methods of the root canal after post-space preparation can increase the retention of FGPs evaluated by the push-out test. Searches were carried out in PubMed (MEDLINE) and Scopus databases up to July2017. English language studies published from 2007 to July 2017 were selected. 475 studies were found, and 9 were included in this review. Information from the 9 studies were collected regarding the number of samples, storage method after extraction, root canal preparation, method of post-space preparation, endodontic sealer, resin cement, cleaning methods after post-space and presence of irrigant activation. Five studies presented the best results for the association of sodium hypochlorite (NaOCl) and ethylenediamine tetra-acetic acid (EDTA), while in the other 4 studies, the solutions that showed improved retention of FGPs were photon-induced photoacoustic streaming (PIPS), Qmix, Sikko and EDTA. The results showed heterogeneity in all comparisons due to a high variety of information about cleaning methods, different concentrations, application time, type of adhesive system and resin cements used. In conclusion, this review suggests that the use of NaOCl/EDTA results in the retention of FGPs and may thus be recommended as a post-space cleaning method influencing the luting procedure.

17. Photographic copy of photograph. Location unknown but assumed to ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

17. Photographic copy of photograph. Location unknown but assumed to be uper end of canal. Features no longer extant. (Source: U.S. Department of Interior. Office of Indian Affairs. Indian Irrigation service. Annual Report, Fiscal Year 1925. Vol. I, Narrative and Photographs, Irrigation District #4, California and Southern Arizona, RG 75, Entry 655, Box 28, National Archives, Washington, DC.) Photographer unknown. MAIN (TITLED FLORENCE) CANAL, WASTEWAY, SLUICEWAY, & BRIDGE, 1/26/25. - San Carlos Irrigation Project, Marin Canal, Amhurst-Hayden Dam to Picacho Reservoir, Coolidge, Pinal County, AZ

Endodontic treatment of mandibular molars with atypical root canal anatomy: reports of 4 cases.

PubMed

Chauhan, Raju; Singh, Shweta

2015-01-01

The variations in root canal anatomy of multirooted teeth represent a continuous challenge to endodontic diagnosis and treatment. Although the most common configuration of mandibular molars is one containing 2 roots and 3 root canals, there are many different combinations. Very rarely, an additional third (supernumerary) root is seen. When it is located distolingually to the main distal root, this third root is called radix entomolaris (RE), and when it is located mesiobuccally to the mesial root, it is called radix paramolaris (RP). Variations of root canal systems need not always be in the form of extra roots or extra canals. Single roots with single canals can also occur. A general dentist should be aware of these unusual root canal morphologies in mandibular molars for the success of endodontic treatment. These case reports describe the root canal treatment of a case of RE in the mandibular first molar, 2 rare cases of RP (1 each in the mandibular first and second molars), and a mandibular second molar with a single root and root canal.

Effect of Instrumentation Techniques, Irrigant Solutions and Artificial accelerated Aging on Fiberglass Post Bond Strength to Intraradicular Dentin.

PubMed

Santana, Fernanda Ribeiro; Soares, Carlos José; Silva, Júlio Almeida; Alencar, Ana Helena Gonçalves; Renovato, Sara Rodrigues; Lopes, Lawrence Gonzaga; Estrela, Carlos

2015-07-01

To evaluate the effect of instrumentation techniques, irrigant solutions and specimen aging on fiberglass posts bond strength to intraradicular dentine. A total of 120 bovine teeth were prepared and randomized into control and experimental groups resulting from three study factors (instrumentation techniques, irrigant solutions, specimen aging). Posts were cemented with RelyX U100. Samples were submitted to push-out test and failure mode was evaluated under a confocal microscope. In specimens submitted to water artificial aging, nickel-titanium rotary instruments group presented higher bond strength values in apical third irrigated with NaOCl or chlorhexi-dine. Irrigation with NaOCl resulted in higher bond strength than ozonated water. Artificial aging resulted in significant bond strength increase. Adhesive cement-dentin failure was prevalent in all the groups. Root canal preparation with NiTi instruments associated with NaOCl irrigation and ethylenediaminetetra acetic acid (EDTA) increased bond strength of fiberglass posts cemented with self-adhesive resin cement to intraradicular dentine. Water artificial aging significantly increased post-Clinical significance: The understanding of factors that may influence the optimal bond between post-cement and cement-dentin are essential to the success of endodontically treated tooth restoration.

Root anatomy and canal configuration of the permanent mandibular first molar: a systematic review.

PubMed

de Pablo, Oliver Valencia; Estevez, Roberto; Péix Sánchez, Manuel; Heilborn, Carlos; Cohenca, Nestor

2010-12-01

The main goal of endodontic therapy is to prevent or heal apical periodontitis. However, root canal anatomy might present a clinical challenge directly related to the treatment outcome. The purpose of this study was to review published literature related to root anatomy and root canal configuration of the permanent mandibular first molar. An exhaustive search was undertaken to identify published literature related to the root anatomy and root canal morphology of the permanent mandibular first molar by using key words. The search of the MEDLINE database included all publications from 1966-May 2010. Selected articles were then obtained and reviewed. Data evaluated and summarized in the data sheet included methodology, population, number of teeth per study (power), number of root canals, type of root canal configuration, and identification of number of apical foramina. Forty-one studies were identified including a total of 18,781 teeth. The incidence of a third root was 13% and was strongly correlated with the ethnicity of the studied population. Three canals were present in 61.3%, 4 canals in 35.7%, and 5 canals in approximately 1%. Root canal configuration of the mesial root revealed 2 canals in 94.4% and 3 canals in 2.3%. The most common canal system configuration was Vertucci type IV (52.3%), followed by type II (35%). Root canal configuration of the distal root revealed type I configuration in 62.7%, followed by types II (14.5%) and IV (12.4%). The presence of isthmus communications averaged 54.8% on the mesial and 20.2% on the distal root. The number of roots on the mandibular first molar is directly related to ethnicity. Root canal morphology and configuration might present the clinician with a complex anatomy requiring more diagnostic approaches, access modifications, and clinical skills to successfully localize, negotiate, disinfect, and seal the root canal system. Crown Copyright © 2010. Published by Elsevier Inc. All rights reserved.

Retrospective Study of Root Canal Configurations of Mandibular Third Molars Using CBCT- Part-II.

PubMed

Somasundaram, Pavithra; Rawtiya, Manjusha; Wadhwani, Shefali; Uthappa, Roshan; Shivagange, Vinay; Khan, Sheeba

2017-06-01

Abnormal root canal morphologies of third molars can be diagnostically and technically challenging during root canal treatment. The aim of this retrospective study was to investigate the root and canal morphology of mandibular third molars in Central India population by using Cone Beam Computed Tomography (CBCT) analysis. CBCT images of 171 mandibular third molars were observed and data regarding number of roots, number of canals, Vertucci's classification in each root, prevalence of C shaped canal, gender and topographical relation of morphology in mandibular third molar was statistically evaluated. Majority of mandibular third molars had two roots (84.2%) and three canals (64.3%). Most mesial root had Vertucci Type II (55.6%) and Vertucci Type IV (22.2%), distal root had Type I canals (87.5%). Over all prevalence of C shaped canals in mandibular third molars was 9.4%. There was a high prevalence of two rooted mandibular third molars with three canals.

Retrospective Study of Root Canal Configurations of Mandibular Third Molars Using CBCT- Part-II

PubMed Central

Somasundaram, Pavithra; Wadhwani, Shefali; Uthappa, Roshan; Shivagange, Vinay; Khan, Sheeba

2017-01-01

Introduction Abnormal root canal morphologies of third molars can be diagnostically and technically challenging during root canal treatment. Aim The aim of this retrospective study was to investigate the root and canal morphology of mandibular third molars in Central India population by using Cone Beam Computed Tomography (CBCT) analysis. Materials and Methods CBCT images of 171 mandibular third molars were observed and data regarding number of roots, number of canals, Vertucci’s classification in each root, prevalence of C shaped canal, gender and topographical relation of morphology in mandibular third molar was statistically evaluated. Results Majority of mandibular third molars had two roots (84.2%) and three canals (64.3%). Most mesial root had Vertucci Type II (55.6%) and Vertucci Type IV (22.2%), distal root had Type I canals (87.5%). Over all prevalence of C shaped canals in mandibular third molars was 9.4%. Conclusion There was a high prevalence of two rooted mandibular third molars with three canals. PMID:28764294

Single-rooted maxillary first molar with a single canal: endodontic retreatment.

PubMed

de la Torre, Francisco; Cisneros-Cabello, Rafael; Aranguren, José Luis; Estévez, Roberto; Velasco-Ortega, Eugenio; Segura-Egea, Juan José

2008-12-01

This case report presents an unusual root canal system in a maxillary first molar tooth: a single canal in a single root. The endodontic access cavity displayed only 1 canal orifice. This case demonstrated that: 1) clinicians must have adequate knowledge about root canal morphology and its variations; 2) the location and morphology of root canals should be identified radiologically before the root canal treatment; and 3) careful examination of radiographs and the internal anatomy of teeth is essential.

Bactericidal effect of the 908 nm diode laser on Enterococcus faecalis in infected root canals

PubMed Central

Preethee, Thomas; Kandaswamy, Deivanayagam; Arathi, Ganesh; Hannah, Rosaline

2012-01-01

Aim: The aim of this study is to evaluate the bactericidal effect of 908 nm diode laser in conjunction with various irrigation regimes in disinfection of apical third of root dentin. Materials and Methods: Sixty prepared teeth with single canals were contaminated with Enterococcus faecalis. The specimens were divided into 6 groups (n = 10): Group 1 and 3 and 5 were subjected to chemo-mechanical preparation using 5.25% sodium hypochlorite (NaOCl), 17% Ethylenediaminetetraacetic acid (EDTA); 1.3% NaOCl, MTAD (mixture of doxycycline, citric acid and a detergent (Tween 80); and, 8.5% saline, respectively followed by 908 nm diode laser irradiation; Group 2 and 4, followed the same procedure as Group1 and 3, however without laser irradiation; and, Group 6, rinsed with saline solution (control). Dentin shavings from apical third were analyzed for the presence of E. faecalis using culture method and Polymerase Chain reaction (PCR). Results: One-way Analysis of variance showed statistically significant differences between the laser irradiated groups, non irradiated groups and the control group. Conclusion: 908 nm diode used in conjunction with conventional chemomechanical techniques demonstrated a significant elimination of E. faecalis in the apical third of root dentin. PMID:22368335

Effect of 5% Chlorine Dioxide Irrigant on Micro Push Out Bond Strength of Resin Sealer to Radicular Dentin: An In Vitro Study

PubMed Central

Devarasanahalli, Swapna V; Aswathanarayana, Ranjini M; Rashmi, K; Gowda, Yashwanth; Nadig, Roopa R

2017-01-01

Introduction Chlorine dioxide (ClO2) has been recently investigated as a possible root canal irrigant due to its broad spectrum of antimicrobial action, tissue dissolution and smear layer removal properties. Literature is scarce on the effect of chlorine dioxide irrigation on the resin sealer dentin bond strength. Aim To compare 5% chlorine dioxide (ClO2) with or without Ethylene Diamine Tetra Acetic acid (EDTA) with 3% Sodium hypochlorite (NaOCl) and EDTA combination as endodontic irrigants on the adhesion of AH Plus sealer to radicular dentin using micro- Push out Bond Strength (µPBS) test. Materials and Methods Forty freshly extracted central incisors were decoronated and randomly divided into four groups based on the different irrigation regimes followed during irrigation: Group I - 3% NaOCl + 17% EDTA, Group II - 5% ClO2 + 17% EDTA, Group III - 5% ClO2 and Group IV – Saline, and canal enlarged till Protaper F3. All the samples were obturated with F3 gutta-percha cones using AH Plus sealer and sectioned perpendicular to long axis to obtain 1mm thick slices from the middle and coronal portions for µPBS measurement in universal testing machine followed by assessment of failure pattern under stereomicroscope. Data was analysed using One-way analysis of variance (ANOVA), Bonferroni and t-test. Results Bond strength values were in the following order: Group I>Group II>Group III>Group IV, with no statistically significant difference amongst experimental groups on intergroup comparison, except with saline. The µPBS values were more in coronal third than middle third in all specimens, with no statistical significant difference. Mode of failure showed mixed patterns in all experimental groups except saline. Conclusion In the present study, the bond strength values of ClO2 were comparable with conventional NaOCl and EDTA combination and hence, ClO2 can be considered as an effective alternative endodontic irrigant. PMID:28658907

Efficacy of Er,Cr:YSGG Laser in Removing Smear Layer and Debris with Two Different Output Powers

PubMed Central

Bolhari, Behnam; Ehsani, Sara; Etemadi, Ardavan; Shafaq, Mohammad

2014-01-01

Abstract Objective: The purpose of this study was to evaluate the effectiveness of the erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser in removing debris and the smear layer using two different output powers on the apical, middle, and coronal segments of root canal walls. Background data: Previous literature has failed to evaluate the exclusive effect of Er,Cr:YSGG laser on the quality of smear layer and debris removal in all three segments of the root canal space. Methods: Sixty extracted teeth were included in the study. After instrumentation, samples were divided into three experimental groups and one positive control group with no further treatment. In group 1, a final irrigation was performed using ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl), sequentially. In group 2, the samples were treated with a 2.78 μm Er,Cr:YSGG laser with an output power of 1.5 W. The same laser was used in group 3, but with an output power of 2.5 W. Scanning electron microscope (SEM) images from the coronal, middle, and apical thirds of the roots were prepared and evaluated for both smear layer and debris removal by three blinded observers. Results: The results showed no differences between groups 1 and 2 regarding the quality of smear layer removal in all areas. However, the 2.5 W laser failed to remove the smear layer effectively. Regarding debris removal, the EDTA and NaOCl irrigation showed significantly better outcomes (adjusted p<0.05) in all areas. Conclusions: This study raises questions about the overall cleaning abilities of Er,Cr:YSGG lasers. PMID:25198390

Efficacy of Er,Cr:YSGG laser in removing smear layer and debris with two different output powers.

PubMed

Bolhari, Behnam; Ehsani, Sara; Etemadi, Ardavan; Shafaq, Mohammad; Nosrat, Ali

2014-10-01

The purpose of this study was to evaluate the effectiveness of the erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser in removing debris and the smear layer using two different output powers on the apical, middle, and coronal segments of root canal walls. Previous literature has failed to evaluate the exclusive effect of Er,Cr:YSGG laser on the quality of smear layer and debris removal in all three segments of the root canal space. Sixty extracted teeth were included in the study. After instrumentation, samples were divided into three experimental groups and one positive control group with no further treatment. In group 1, a final irrigation was performed using ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl), sequentially. In group 2, the samples were treated with a 2.78 μm Er,Cr:YSGG laser with an output power of 1.5 W. The same laser was used in group 3, but with an output power of 2.5 W. Scanning electron microscope (SEM) images from the coronal, middle, and apical thirds of the roots were prepared and evaluated for both smear layer and debris removal by three blinded observers. The results showed no differences between groups 1 and 2 regarding the quality of smear layer removal in all areas. However, the 2.5 W laser failed to remove the smear layer effectively. Regarding debris removal, the EDTA and NaOCl irrigation showed significantly better outcomes (adjusted p<0.05) in all areas. This study raises questions about the overall cleaning abilities of Er,Cr:YSGG lasers.

Endodontic management of mesiobuccal-2 canal in four-rooted and five-canalled mandibular third molar.

PubMed

Garg, Amit Kumar; Bhardwaj, Anuj; Mantri, Vijay R; Agrawal, Neha

2014-05-01

A case of unusual Root morphology is presented to demonstrate anatomic variations in mandibular third molar. The most common configuration of mandibular third molar is two Roots and three canals; however they may have many different combinations. Endodontic treatment was performed in mandibular third molar having aberrant anatomy. Four Root canal orifices were located with the aid of dental operating microscope (DOM) and three separate Roots were diagnosed with radiographs. Spiral computed tomography (SCT) showed the presence of an extra canal and extra Root, indicating a rare anatomic configuration. Looking for additional canals and Roots are important part of successful endodontics, as the knowledge of their existence enable clinicians to treat a case successfully that otherwise might end in failure. The use of DOM and SCT in this case greatly contributed toward making a confirmatory diagnosis and successful endodontic treatment of four-rooted and five-canalled mandibular third molar. Variation in Root canal anatomy is very common. Knowledge of these variations is very essential for successful Root canal outcome, inability to do so can lead to missed canals and failures. Hence, thorough knowledge of Root canal anatomy and advances in diagnostic aids are essential.

Endodontic management of maxillary first molar with seven root canals diagnosed using Cone Beam Computed Tomography scanning

PubMed Central

Raghavendra, Srinidhi Surya; Hindlekar, Ajit Narayan; Desai, Niranjan Nanasaheb; Vyavahare, Nishant Kishor; Napte, Bandu Devrao

2014-01-01

The main objective of root canal treatment is thorough cleaning and shaping of the entire pulp space and its complete filling with an inert filling material. A major cause of post-treatment disease is the inability to locate, debride or adequately fill all canals of the root canal system. The form, configuration, and number of root canals in the maxillary first molars have been discussed for more than half a century. Maxillary first molars commonly present with three roots and three canals, with a second mesiobuccal canal (MB2) also present. With the advent of improved magnification there are reports of multiple root canals in the maxillary first molars. Nonsurgical endodontic therapy of a left maxillary first molar with three roots and seven root canals was successfully performed under a dental operating microscope. The diagnosis of multiple root canals was confirmed with the help of Cone Beam Computed Tomography (CBCT) images. PMID:25565745

14. MAIN CANAL CANAL CHECKGATES, JUST BELOW DARK CANYON ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

14. MAIN CANAL - CANAL CHECKGATES, JUST BELOW DARK CANYON SIPHON, VIEW TO NORTHEAST - Carlsbad Irrigation District, Main Canal, 4 miles North to 12 miles Southeast of Carlsbad, Carlsbad, Eddy County, NM

Root Canal Anatomy and Morphology of Mandibular First Molars in a Selected Iranian Population: An In Vitro Study

PubMed Central

Mohammadzadeh Akhlaghi, Nahid; Khalilak, Zohreh; Vatanpour, Mehdi; Mohammadi, Saman; Pirmoradi, Sakineh; Fazlyab, Mahta; Safavi, Kamran

2017-01-01

Introduction: The aim of this study was to evaluate root canal anatomy of mandibular first molars (MFM) in a selected Iranian Population using clearing technique. Methods and Materials: A total of 150 extracted MFMs were cleared. The root canal morphology (including the root numbers and root length) and the anatomy of the root canal system (including is the number and type of canals based on Vertucci’s classification, canal curvature according to Schneider's method and the presence of isthmus) was evaluated using the buccolingual and mesiodistal parallel x-rays and stereomicroscope. The data were analyzed using the chi-square test. Results: Two and three roots were present in 96.7% and 33% of the teeth, respectively (P=0.0001). All the teeth (100%) had two canals in the mesial root, while 61.3% of the samples had one distal root canal (P=0.006). The root canal configuration in the mesial canal included type IV (55.3%) and type II (41.3%) (P=0.0001). In doubled-canalled distal roots, 68.8% and 24.3% were type II and type IV, respectively (P=0.0001). Isthmii were observed in 44.6% of mesial and 27.3% of distal roots (P=0.0001). Conclusion: The notable prevalence of type IV configuration in both roots of mandibular first molars, presence of isthmus and root curvature, necessitates the careful negotiation and cleaning of all accessible canal spaces. PMID:28179932