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International Endodontic Journal May 2022Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles... (Review)
Review
Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long-term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long-term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.
Topics: Dental Pulp Cavity; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation
PubMed: 35338652
DOI: 10.1111/iej.13739 -
BioMed Research International 2017Effective 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... (Review)
Review
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.
Topics: Dental Bonding; Dental Materials; Dental Pulp Cavity; Dentin; Humans; Resin Cements; Root Canal Preparation; Sodium Hypochlorite
PubMed: 28904947
DOI: 10.1155/2017/1930360 -
Journal of Endodontics Aug 2020We aimed to compare the antimicrobial efficacy of chlorhexidine (CHX) and sodium hypochlorite (NaOCl), 2 irrigants routinely used in root canal therapy of permanent... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
We aimed to compare the antimicrobial efficacy of chlorhexidine (CHX) and sodium hypochlorite (NaOCl), 2 irrigants routinely used in root canal therapy of permanent teeth.
METHODS
Electronic databases, including PubMed, EMBASE, Web of Science, and Cochrane Library, were searched for randomized controlled trials published until March 2020. The meta-analysis of relative risk (RR) and standardized mean difference (SMD) was performed using a random effects model with a 95% confidence interval (CI). Subgroup analysis was performed for culture and molecular methods of bacterial detection.
RESULTS
The literature search yielded 2110 records without duplicates. Eight studies were eligible for a systematic review. No significant differences in the incidence of samples with positive bacterial growth after irrigation (RR = 1.003; 95% CI, 0.729-1.380; P = .987) and mean bacterial number changes (SMD = 0.311; 95% CI, -0.368 to 0.991; P = .369) were observed between CHX and NaOCl in the culture and molecular subgroups. Heterogeneity in RR (I = 0%, P = .673) was low among studies, whereas considerable heterogeneity was observed in the analysis of SMD (I = 76.336%, P = .005).
CONCLUSIONS
Our findings suggest that both CHX and NaOCl can reduce bacterial infections after irrigation without any significant difference in antimicrobial efficacy between them. Although CHX and NaOCl showed similar efficacy, their molecular mechanisms were different. Therefore, they can be used as the main antibacterial root canal irrigants. However, our results were limited by inconsistencies among retrieved articles and a lack of clinically relevant outcomes. Further well-designed clinical studies are warranted to supplement our results.
Topics: Anti-Bacterial Agents; Chlorhexidine; Dental Pulp Cavity; Enterococcus faecalis; Randomized Controlled Trials as Topic; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite
PubMed: 32413440
DOI: 10.1016/j.joen.2020.05.002 -
Journal of Endodontics Apr 2016This systematic review aimed to compare the effectiveness of sodium hypochlorite and chlorhexidine for root canal disinfection during root canal therapy. (Review)
Review
INTRODUCTION
This systematic review aimed to compare the effectiveness of sodium hypochlorite and chlorhexidine for root canal disinfection during root canal therapy.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
Topics: Anti-Infective Agents; Bacteria; Chlorhexidine; Humans; Microbial Sensitivity Tests; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite
PubMed: 26852149
DOI: 10.1016/j.joen.2015.12.021 -
Stomatologija 2020The aim of this paper was to analyze the literature published in the research related to sodium hypochlorite induced injury. An internet search using search engines...
The aim of this paper was to analyze the literature published in the research related to sodium hypochlorite induced injury. An internet search using search engines (Google, Researchgate and PubMed) was carried out. The keywords used for search were sodium hypochlorite, injury, cellulitis, apical extrusion, ulcer, endodontics. Full text articles of the articles were collected from the year 2007 to 2017. The data available from the clinical trials the journal articles were analyzed and presented in both tabular and descriptive patterns.
Topics: Accidents; Endodontics; Sodium Hypochlorite
PubMed: 32706342
DOI: No ID Found -
BioMed Research International 2023Irrigation of root canal system is of great significance to the success of endodontic treatment, where sodium hypochlorite (NaOCl) is the most widely used irrigant in... (Review)
Review
Irrigation of root canal system is of great significance to the success of endodontic treatment, where sodium hypochlorite (NaOCl) is the most widely used irrigant in chemical preparation. NaOCl functions by eliminating bacterial biofilms and dissolving organic tissue, which may vary according to several factors such as the microbiology of root canal infection and the concentration of the irrigant. It has been proposed that the effectiveness of NaOCl could be enhanced via several methods, including heating the irrigant, applying in conjunction with certain reagents, or activating by agitation techniques. Despite its antibacterial and tissue-dissolving capacities, NaOCl should be used with caution to avoid detrimental effect due to its cytotoxicity and negative effect on dentin properties. In this narrative review, we discussed the factors that affect the properties of NaOCl, the methods to improve its efficacy, and the side effects that might occur in clinical practice.
Topics: Sodium Hypochlorite; Root Canal Preparation; Dental Pulp Cavity; Root Canal Irrigants; Root Canal Therapy; Dentin
PubMed: 36685672
DOI: 10.1155/2023/8858283 -
Medical Principles and Practice :... 2021Matrix metalloproteinases (MMPs) are present in radicular dentin and can convert structural matrix proteins into signaling molecules; thus, these enzymes play an...
OBJECTIVE
Matrix metalloproteinases (MMPs) are present in radicular dentin and can convert structural matrix proteins into signaling molecules; thus, these enzymes play an essential role in dentin biomineralization and tissue regeneration therapies. Their expression on radicular dentin may be affected by the irrigation solutions used during root canal treatments. This study aimed to evaluate the effects of the most common irrigants on radicular dentin MMP expression.
MATERIALS AND METHODS
The experimental solutions were distilled water (control), 5% sodium hypochlorite (NaOCl), 18% ethylenediaminetetraacetic acid (EDTA), and 2% chlorhexidine (CHX). Samples were prepared from extracted human teeth. For zymography analysis, root sections were powderized, and dentin proteins were extracted to observe gelatinolytic activity. Root dentin slices were treated with the experimental solutions for immunohistochemical analysis using anti-MMP-2 and anti-MMP-9 antibodies. ANOVA and the Tukey test were performed.
RESULTS
Zymograms revealed the presence of MMP-2, MMP-8, and MMP-20 in the control group and the EDTA-treated group. Immunohistochemistry confirmed the presence of MMP-2 and MMP-9 mainly associated with the dentinal tubule lumens and occasionally with intertubular dentin. NaOCl- and CHX-treated groups showed lower expression of MMPs than the control group. Immuno-staining for both proteinases in the EDTA-treated group showed higher expression compared to the other experimental groups.
CONCLUSION
Our results showed that most common irrigants affect MMP expression on radicular dentin. Treatment with NaOCl and chlorhexidine resulted in lower expression of MMPs, while EDTA increased their expression in root canal dentin.
Topics: Chlorhexidine; Dentin; Edetic Acid; Humans; Matrix Metalloproteinase 2; Sodium Hypochlorite
PubMed: 34153965
DOI: 10.1159/000517887 -
International Journal of Food... Jan 2023Vibrio parahaemolyticus is a marine oriented pathogen; and biofilm formation enables its survival and persistence on seafood processing plant, complicating the hygienic...
Vibrio parahaemolyticus is a marine oriented pathogen; and biofilm formation enables its survival and persistence on seafood processing plant, complicating the hygienic practice. The objectives of this study are to assess the ability of V. parahaemolyticus isolated from seafood related environments to form biofilms, to determine the effective sodium hypochlorite concentrations required to inactivate planktonic and biofilm cells, and to evaluate the genetic diversity required for strong biofilm formation. Among nine isolates, PFR30J09 and PFR34B02 isolates were identified as strong biofilm forming strains, with biofilm cell counts of 7.20, 7.08 log CFU/cm, respectively, on stainless steel coupons after incubation at 25 °C. Free available chlorine of 1176 mg/L and 4704 mg/L was required to eliminate biofilm cells of 1.74-2.28 log CFU/cm and > 7 log CFU/cm, respectively, whereas 63 mg/L for planktonic cells, indicating the ineffectiveness of sodium hypochlorite in eliminating V. parahaemolyticus biofilm cells at recommended concentration in the food industry. These strong biofilm-forming isolates produced more polysaccharides and were less susceptible to sodium hypochlorite, implying a possible correlation between polysaccharide production and sodium hypochlorite susceptibility. Genetic diversity in mshA, mshC and mshD contributed to the observed variation in biofilm formation between isolates. This study identified strong biofilm-forming V. parahaemolyticus strains of new multilocus sequence typing (MLST) types, showed a relationship between polysaccharide production and sodium hypochlorite resistance.
Topics: Vibrio parahaemolyticus; Sodium Hypochlorite; Multilocus Sequence Typing; Biofilms; Genetic Variation
PubMed: 36370527
DOI: 10.1016/j.ijfoodmicro.2022.110011 -
Applied and Environmental Microbiology Jul 2023SARS-CoV-2 is primarily a respiratory virus that can potentially be transmitted through fomites. Sodium hypochlorite (NaOCl) and peracetic acid (PAA) are widely used...
SARS-CoV-2 is primarily a respiratory virus that can potentially be transmitted through fomites. Sodium hypochlorite (NaOCl) and peracetic acid (PAA) are widely used disinfectants on surfaces in diverse settings such as hospitals and food production facilities. The objectives of this study were to investigate the virucidal efficacy of NaOCl and PAA against SARS-CoV-2 using the ASTM standard methods. In the suspension assay, NaOCl and PAA (5, 50, and 200 ppm) were tested against SARS-CoV-2 in the presence/absence of soil load after 1 min of contact time. In the carrier assay, NaOCl and PAA were tested at 200, 400, 600, and 1,000 ppm for 1 min and 200 and 1,000 ppm for 5 and 10 min. Stainless steel (SS) and high-density polyethylene (HDPE) disks were used as carriers. The virus was suspended in soil load and the disinfectants were prepared in 300 ppm of hard water. Virus quantification was done by TCID50 assay using Vero-E6 cell line. NaOCl and PAA were effective (> 3 log reduction in infectious virus) at 50 ppm in the absence of soil load. However, in the presence of soil load, 200 ppm was required for > 3 log reduction in virus infectivity. In contrast, NaOCl and PAA at 200 ppm and with a 1-min contact time were not effective against SARS-CoV-2 on either SS or HDPE surfaces. PAA at 200 ppm for 10 min was effective against SARS-CoV-2 on SS and HDPE surfaces, whereas NaOCl required 1,000 ppm for 10 min to be effective against SARS-CoV-2 on both surfaces. In the context of the COVID-19 pandemic, the World Health Organization (WHO) recommended the use of chlorine-based products such as sodium hypochlorite (NaOCl) at 1,000 ppm for a minimum of 1 min to disinfect environmental surfaces. However, this recommendation was not based on validated studies on the actual SARS-CoV-2 itself. In fact, over half of the chemical disinfectants, including many peracetic acid products, listed in EPA List N were approved based on "kills a harder-to-kill pathogen" without further validation on SARS-CoV-2. Research on SARS-CoV-2 is restricted to BSL3 laboratories and the urgency of tackling the pandemic might explain the lack of studies on the actual virus. Our results show that the WHO recommendation of 1 min contact time with 1,000 ppm NaOCl is not effective against SARS-CoV-2 on surfaces. Also, our results indicate that PAA is effective against SARS-CoV-2 on surfaces and can be used as safer and more environmentally friendly alternative to NaOCl at a lower concentration.
Topics: Humans; Sodium Hypochlorite; Peracetic Acid; SARS-CoV-2; Pandemics; Polyethylene; COVID-19; Disinfectants
PubMed: 37347194
DOI: 10.1128/aem.00622-23 -
Clinical Oral Investigations Nov 2023To compare the clinical outcomes obtained with either mechanical subgingival debridement in conjunction with a sodium hypochlorite and amino acids containing gel... (Randomized Controlled Trial)
Randomized Controlled Trial
Clinical evaluation of sodium hypochlorite/amino acids and cross-linked hyaluronic acid adjunctive to non-surgical periodontal treatment: a randomized controlled clinical trial.
OBJECTIVES
To compare the clinical outcomes obtained with either mechanical subgingival debridement in conjunction with a sodium hypochlorite and amino acids containing gel followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with mechanical debridement alone.
MATERIALS AND METHODS
Fourty-eight patients diagnosed with stages II-III (Grades A/B) generalised periodontitis were randomly treated with either scaling and root planing (SRP) (control) or SRP plus adjunctive sodium hypochlorite/amino acid and xHyA gels (test). The primary outcome variable was reduction of probing depth (PD), while changes in clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PI) were secondary outcomes. The outcomes were assessed at baseline, at 3 and 6 months following therapy.
RESULTS
All patients completed the 6 months evaluation. At 6 months, the test group showed statistically significantly better results in terms of mean PD reduction (2.9 ± 0.4 vs 1.8 ± 0.6 mm, p < 0.001). Similarly, mean CAL gain was statistically higher in the test group compared to the control one (test: 2.6 ± 0.5 vs control: 1.6 ± 0.6 mm, p < 0.001). Mean BOP decreased from 81.8 ± 16.2% to 48.9 ± 14.5% in control (p < 0.001) and from 83.2 ± 15.5% to 17.6 ± 11.5% in test (p < 0.001) groups with a statistically significant difference favouring the test group (p < 0.001). Mean PI scores were reduced statistically significantly in both groups (from 38.8 ± 26% to 26.5 ± 20.5% in control (p = 0.039) and from 60.6 ± 10.9% to 12.7 ± 8.9% in test group (p < 0.001)), with a statistically significant difference between the groups (p < 0.001). The number of moderate pockets (4-6 mm) were reduced from 1518 (41.2%) to 803 (22.6%) in the control and from 1803 (48.6%) to 234 (7.7%) in the test group with a statistically significant difference between the groups (p < 0.001), while the number of deep pockets (≥ 7 mm) changed from 277 (7.6%) to 35 (1.0%) in the control and from 298 (8.7%) to 4 (0.1%) in test group (p = 0.003).
CONCLUSION
Within their limits the present data indicate that: a) both treatments resulted in statistically significant improvements in all evaluated clinical parameters, and b) the adjunctive subgingival application of sodium hypochlorite/amino acid and xHyA to SRP yielded statistically significantly higher improvements compared to SRP alone.
CLINICAL RELEVANCE
The combination of sodium hypochlorite/amino acid and xHyA gels to subgingival mechanical debridement appears to represent a valuable approach to additionally improve the outcomes of non-surgical periodontal treatment. Clinical Trial Registration Number NCT04662216 (ClinicalTrials.gov).
Topics: Humans; Sodium Hypochlorite; Chronic Periodontitis; Hyaluronic Acid; Amino Acids; Dental Scaling; Root Planing; Gels; Treatment Outcome
PubMed: 37740107
DOI: 10.1007/s00784-023-05271-0