Outcome of Endodontic Retreatment Using 2 Root Canal Irrigants and Influence of Infection on Healing as Determined by a Molecular Method: A Randomized Clinical Trial |
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| Affiliation: | 1. Department of Endodontics, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway;2. Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway;3. Department of General Practice, University of Oslo, Oslo, Norway;4. Department of Endodontics, Estácio de Sá University, Rio de Janeiro, Brazil;1. Department of Endodontics, School of Dentistry, Grande Rio University, Rio de Janeiro, Rio de Janeiro, Brazil;2. Department of Restorative Dentistry II, Federal University of Maranhão, São Luis, Maranhao, Brazil;3. Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil;4. Department of Conservative Dentistry, School of Dentistry, Complutense University, Madrid, Spain;1. MSciD Post-Graduate Program in Dentistry, School of Dentistry, Meridional Faculty - IMED, Passo Fundo, Rio Grande do Sul, Brazil;2. MSciD and PhD Post-Graduate Program in Oral Sciences, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil;1. Department of Endodontics, The Texas A&M University Baylor College of Dentistry, Dallas, Texas;2. Endodontics, Center for Advanced Dental Education, Saint Louis University, St Louis, Missouri;1. Molecular Microbiology Laboratory, Department of Endodontics, Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil;2. Department of Endodontics, Faculty of Dentistry, Grande Rio University, Duque de Caxias, Rio de Janeiro, Brazil;1. Department of Operative Dentistry, Chulalongkorn University, Bangkok, Thailand;2. Department of Microbiology Research Unit on Oral Microbiology and Immunology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand;1. Department of Endodontics, School of Dentistry, Istanbul Medipol University, Istanbul, Turkey;2. Dental Materials Unit, Center for Dental and Oral Medicine, Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, University of Zürich, Zürich, Switzerland |
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| Abstract: | ![]()
IntroductionThis study compared the clinical and radiographic outcome of endodontic retreatment of teeth with apical periodontitis using either 1% sodium hypochlorite (NaOCl) or 2% chlorhexidine digluconate (CHX) as the irrigant. The influence of residual infection detected by a molecular method on the outcome was also examined.MethodsFifty-two root-filled teeth with apical periodontitis were randomly assigned into 2 groups according to the irrigant used during retreatment. Root canal microbiological samples taken before (S1) and after (S2) preparation using either NaOCl or CHX irrigation and after calcium hydroxide medication (S3) were subjected to 16S ribosomal RNA gene-based real-time quantitative polymerase chain reaction (qPCR) to quantify total bacteria. The periapical status was scored using the periapical index and dichotomized as healed (<3) or not healed (≥3) at the 1- and 4-year follow-up.ResultsForty-five (NaOCl, n = 20; CHX, n = 25) and 33 teeth (NaOCl, n = 16; CHX, n = 17) were available at the 1- and 4-year follow-up, respectively. After 1 year, 65% in the NaOCl group and 64% in the CHX group healed, with no differences between them (P > .05). At the later follow-up, the corresponding figures were 81% and 82%, respectively (P > .05). Canals that yielded qPCR-negative results in S3 had a higher healing rate (79%) than qPCR-positive canals (45%, P < .05). The mean bacterial load increased from S2 to S3 in half of the unhealed cases (P < .05). All S3-positive canals containing <3.12 × 103 bacterial cell counts healed. Increasing the apical level of the root canal filling influenced the outcome (P < .05).ConclusionsNo significant differences in the clinical outcome between 1% NaOCl and 2% CHX were found. Bacterial persistence at the time of filling as detected by qPCR significantly affected the outcome. |
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| Keywords: | Apical limit of obturation chlorhexidine endodontic retreatment retreatment outcome root-filled teeth with infection sodium hypochlorite |
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