CarisolvTM: an alternative to NaOCl in immature root canals?

AIM: To test the null hypothesis that Carisolv is no more effective than 1% sodium hypochlorite in cleaning uninstrumented, immature root canals. METHODOLOGY: A total of 240 uniform, immature ovine incisors were decoronated at the CEJ level and randomly divided into four groups of 60. After gross pulp extirpation, canals were flooded with normal saline (negative control), 1% NaOCl, Carisolv or 5% NaOCl (positive control) and incubated for 10 min (group 1), 20 min (group 2), 30 min (group 3) or 30 min, refreshing irrigant at 10 and 20 min (group 4). SEM photomicrographs of canal wall debris in the apical, middle and coronal thirds were scored against a 5-point scale. Internal consistency was assessed by kappa statistics. Debris scores for different irrigant regimes at different canal levels were analysed by non-parametric tests (P < 0.05). RESULTS: Canals were consistently cleaner in the coronal and middle than apical thirds. NaOCl (5%) was consistently most effective. Carisolv and NaOCl (1%) were no more effective than normal saline in group 1 (P > 0.05), but significantly more effective than normal saline in groups 2 (middle and apical 1/3), 3 and 4 (P < 0.05). Carisolv and NaOCl (1%) had comparable activity in groups 1, 2 (middle and apical thirds) and 3, but NaOCl (1%) was significantly more effective than Carisolv in group 4 (coronal and middle thirds). CONCLUSIONS: 1.The ovine incisor model presents opportunities to investigate irrigation regimes under controlled ex-vivo conditions. 2.NaOCl (5%) remains the most effective irrigant for rapid debris removal in immature root canals. 3.Carisolv cleans pulp debris from the walls of immature root canals as effectively as NaOCl (1%) during static, unrefreshed wall contact for between 20 and 30 min. 4. Refreshment of NaOCl (1%) enhances its cleaning ability above that of Carisolv.     

不同冲洗液对根尖溢出碎屑的影响

目的： 比较根管预备后不同冲洗液对根尖溢出碎屑的影响。方法：58颗正畸拔除的单根牙随机分为4组,常规根管预备后,采用不同冲洗液冲洗,对照组(A组)：7颗、蒸馏水冲洗;实验组每组17颗,B组：1% NaOCl冲洗;C组：2.5% NaOCl冲洗;D组：17% EDTA冲洗。收集冲洗后的冲洗液,通过紫外可见分光光度计检测吸光度（OD）值,比较其根尖溢出碎屑的含量。采用SPSS 13.0软件包对结果进行统计学分析。结果：冲洗前、后的OD差值分别为对照组A组0.012、B组0.122、C组0.393、D组0.021,B、C、D 3组冲洗前、后的差值与对照组相比,均有显著差异（P<0.05）。其中,C组最高,与B、D 2组相比,均差异显著（P<0.05）。结论：冲洗液能增加根尖溢出碎屑的含量,2.5%NaClO冲洗液产生较多的根尖溢出碎屑,1% NaOCl、17%EDTA溶液是临床上较理想的冲洗液。     

The choice of irrigant during hand instrumentation and ultrasonic irrigation of the root canal: a scanning electron microscope study

The purpose of this study was to investigate the use of 4 per cent sodium hypochlorite and 15 per cent EDTAC, either alone or in conjunction, as irrigants during hand instrumentation and ultrasonic irrigation of the root canal. Thirty-six extracted human teeth, each with a single, straight root 21–25 mm long were hand-instrumented through a clinical access cavity to file size 40. One millilitre of the test irrigant was used after each instrument size. Canal debridement was completed with an intermittent flush irrigation technique with one or both of the test irrigants activated by ultrasound at a medium effective power output. The specimens were sectioned longitudinally, viewed in a scanning electron microscope and scored for the presence or absence of debris and smear layer at levels less than 1 mm, 5 mm, and 10 mm from the apical seat. Under the conditions of this experiment the most effective regime was irrigation with 1 mL EDTAC after each instrument size, followed by two 30 second exposures to ultrasound + EDTAC then four 30 second exposures to ultrasound + 4 per cent sodium hypochlorite. The specimens in this group were free from retained pulp tissue and superficial smear layer, had the lowest debris scores at the < 1 mm and 5 mm levels, and the lowest total debris score. All of the techniques tested produced smear-free canals at the 10 mm level.     

ProTaper手动镍钛锉与ISO标准锉根管预备技术的对比实验研究

目的:比较ProTaper手动镍钛锉与ISO标准手用不锈钢K型锉根管预备技术的效果。方法:将40个含弯曲管的透明塑料模块随机分为两组, 每组20个,A组为ProTaper手动镍钛锉预备组(PT组);B组为手用不锈钢K型锉预备组(SS组)。记录每组根管预备所需的时间,预备后根管形态的变化,以及推出根尖液体和碎屑的量。结果:PT组根管预备所用时间明显小于SS组(P<0. 05);预备后弯曲根管被直化的程度PT组明显小于SS组(P< 0. 05 );预备过程中PT组推出根尖液体和碎屑的量显著少于SS组(P<0. 05)。结论:与传统手用不锈钢锉相比,ProTaper手动镍钛锉在根管预备方面有明显的优越性。     

Effectiveness of three endodontic irrigants at various tubular depths in human dentin

Bacteria from infected root canals can invade dentinal tubules, thus dentin disinfection is an important aspect of endodontic therapy. This study compares three endodontic irrigants for efficiency in killing bacteria established within human dentinal tubules. Root canals in extracted teeth were prepared and sterilized. Broth cultures of Enterococcus faecalis were allowed to grow within the canals to penetrate dentinal tubules. The infected canals were exposed individually to each of the irrigants for 1 min. Irrigants were 0.525% sodium hypochlorite, Tubulicid (0.2% EDTA), and 0.12% chlorhexidine (Peridex). Sterile water was the control. Viable bacteria were analyzed by drilling incrementally into dentin from the cementum toward the canal. Smaller diameter drills were used for each depth. Shavings were cultured at three depths, for each of three root levels: coronal, midroot, and apical. Although considerable variation occurred between roots, sodium hypochlorite seemed to be superior. Tubulicid and Peridex were better than water. More bacteria remained viable at greater distances from the pulp. These observations apparently apply to all levels in the canal.     

不同超声冲洗液和不同时间对根管预备后清洁效果的扫描电镜观察

目的　比较不同超声冲洗液及不同超声冲洗时间对根管预备后清洁的效果。方法　80颗离体单根管上颌前牙应用机用镍钛Protaper根管预备至F3后随机分为8组,分别用不同冲洗液超声冲洗1 min和3 min,A、B组用复方氯己定含漱液,C、D组用3%H2O2溶液,E、F组用蒸馏水,G、H组用17%EDTA溶液。最后将牙体沿颊舌向纵劈,扫描电镜观察各组样本在根颈、中、尖1/3牙本质碎屑与玷污层的清除情况,根据评分统计分析比较各组根管清洁效果。结果　不同冲洗液超声冲洗1 min时,在根颈部和根中部,G组与其它各组之间比较有显著性差异（P＜0.05）。在根尖部,G组与C组差异有统计学意义（P＜0.05）,C组与A、E组比较差异有统计学意义（P＜0.05）。不同冲洗液超声冲洗3 min时,在根颈部和根中部,H组与其它各组之间比较有显著性差异（P＜0.05）。在根尖部,H组与D组比较无显著性差异（P＞0.05）,但与B、F组比较差异有统计学意义（P＜0.05）。相同冲洗液不同冲洗时间时, A、B组在根中及根尖部差异有统计学意义（P＜0.05）,C、D组在根尖部差异有统计学意义（P＜0.05）,E、F组之间和G、H组之间比较无显著性差异（P＞0.05）。结论　17%EDTA溶液超声冲洗1 min就可去除根管玷污层和碎屑。3%H2O2和复方氯己定含漱液超声冲洗1 min效果虽不及17%EDTA,但适当延长冲洗时间可增强根尖部清洁效果。     

Histological evaluation of ultrasonic debridement comparing sodium hypochlorite and water

Twenty extracted human mandibular first and second molars with mesial canal curvatures of 18 to 35 degrees were randomly divided into two groups. Following routine endodontic access and canal length determination one of the mesial root canals was ultrasonically instrumented, using tap water in the first group or 2.6% sodium hypochlorite irrigation in the other. In both groups the other mesial canal was used as a control. The mesial roots were decalcified, serially sectioned, and stained with hematoxylin and eosin. Wall planing and soft tissue debridement were blindly evaluated using the light microscope. Mean canal wall planing and soft tissue debridement scores were compared by multiple t tests. Sodium hypochlorite, in conjunction with ultrasonic instrumentation, was more effective than tap water in wall planing when the entire root length was considered. Sodium hypochlorite, in conjunction with ultrasonic instrumentation, was more effective than tap water in soft tissue debridement in the middle third of the canal. Both irrigants were ineffective in conjunction with ultrasonic instrumentation in removing soft tissue from the main canal, the isthmus between canals, the canal fins, and the multiple branches or deltas often encountered in the apical one-third of the canal.     

四种浓度次氯酸钠根管消毒效果的评价

目的 探讨4种浓度次氯酸钠对感染根管的消毒作用.方法 将100例慢性根尖周炎患者随机分为5组,分别使用0.25%、0.50%、1.00%、2.00%的次氯酸钠和生理盐水作为根管冲洗剂,根管预备前后,分离、培养根管内厌氧菌,观察并记录细菌形态及菌落数.结果 4种浓度次氯酸钠对感染根管均有消毒作用,生理盐水的根管消毒作用差.结论 在橡皮障未能普及的情况下,作为根管冲洗剂的次氯酸钠合适浓度为1.00%.     

The use of 4 per cent sodium hypochlorite, with or without ultrasound, in cleansing of uninstrumented immature root canals; SEM study

Barbed broaches were used to remove the intact pulp from freshly extracted, single rooted, human first bicuspid teeth with an immature apex. The efficiency of 4 per cent sodium hypochlorite in the removal of soft tissue and predentine from the root canal wall was assessed using the scanning electron microscope. Four per cent sodium hypochlorite was found to be an efficient protein solvent in these wide canals, and this efficiency was increased by using ultrasound to activate the sodium hypochlorite solution. After 3 minutes exposure to the 4 per cent sodium hypochlorite/ultrasound combination, the root canal surface was free from pulpal debris and predentine. The presence of calcospherites on the root canal wall indicated that the debridement had been achieved without the loss of any of the calcified root canal wall thickness.     

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根管冲洗对根管的消毒和清理起着重要作用,冲洗液可以通过冲洗碎屑、溶解组织和消毒根管系统而提高机械预备的效力。次氯酸钠（NaClO）是目前世界范围内临床上使用最广泛的根管冲洗液之一。本文就NaClO的作用及相应机制、提高使用效率的方法、不良反应、与其他冲洗液联合应用等方面做一综述。     

Comparison of antimicrobial substantivity of root canal irrigants in instrumented root canals up to 72 h: an in vitro study

Disinfection of the root canal system is one of the primary aims of root canal treatment. This can be achieved through the use of various antimicrobial agents in the form of irrigants and medicaments. The antimicrobial substantivity of 2% chlorhexidine gluconate, 1% povidone iodine, 2.5% hydrogen peroxide followed by 2% sodium hypochlorite, and 2% sodium hypochlorite alone as irrigants was assessed in instrumented root canals. 2% chlorhexidine showed antimicrobial substantivity lasting up to 72 h, followed by 1% povidone iodine, and 2% sodium hypochlorite. Thus 2% chlorhexidine should be used as a final rinse irrigant in endodontic treatment protocols.     

Cleaning efficacy of a new root canal irrigation solution: a preliminary evaluation

AIM: A new product, electro-chemically activated water, was compared to NaOCl for its cleaning effect on root canal walls. METHODOLOGY: Root canal treatment was carried out on two groups of extracted teeth with one of the irrigants being used in each group. The control group received no treatment. All teeth were split and the canal walls viewed in a scanning electron microscope. RESULTS: The canal walls of the control group were covered by debris and bacteria. Sodium hypochlorite produced clean surfaces with the dentinal tubules open in some areas and occluded by the smear layer in other areas; in some areas bacteria were visible inside or under the smear layer. Electro-chemically activated water produced markedly cleaner surfaces, removing the smear layer in large areas. CONCLUSIONS: The cleaning efficacy of electro-chemically activated water in root canals was considered to be superior to NaOCl.     

A scanning electron microscopic evaluation of different root canal irrigation regimens

The purpose of this study was to assess the effectiveness of endodontic irrigants in removing the smear layer from instrumented root canal walls using Scanning Electron Microscopy (SEM). The endodontic irrigants used were: 1% sodium hypochlorite (NaOCl); 1% NaOCl mixed to 17% EDTAC; 2% chlorhexidine gel; and Ricinus communis gel. Photomicrographs of the middle and apical thirds were evaluated with the aid of the Fotoscore - v. 2.0 software. The results indicated that the mixture of sodium hypochlorite and EDTAC completely removed the smear layer from dentinal walls. The other endodontic irrigants were not as efficient in cleansing the root canals.     

三种冲洗液用于超声根管预备抗菌效果的对比研究

目的 探讨生理盐水、次氯酸钠、口泰与超声波联合应用杀灭感染根管内厌氧菌的效果。方法 将60例慢性根尖周炎患者共60颗患牙随机分为3组，每组各20颗患牙，三组均用超声法进行根管预备并分别以生理盐水、次氯酸钠、口泰作为超声冲洗液，根管预备前后分别取样进行厌氧培养。结果 次氯酸钠组和口泰组其厌氧菌减少程度均明显大于生理盐水组（P〈0．01）；次氯酸钠组和口泰组之间其厌氧菌减少程度无显著性差异（P〉0．05）。结论 口泰与超声波联合应用可有效杀灭感染根管内厌氧菌，其抗菌效果与次氯酸纳相近似，是一种较理想的根管超声冲洗液。     

Cleaning effectiveness of root canal irrigation with electrochemically activated anolyte and catholyte solutions: a pilot study

AIM: The aim of this study was to evaluate the potential of electrochemically activated (ECA) anolyte and catholyte solutions to clean root canals during conventional root canal preparation. METHODOLOGY: Twenty extracted single-rooted human mature permanent teeth were allocated randomly into four groups of five teeth. The pulp chambers were accessed and the canals prepared by hand with conventional stainless steel endodontic instruments using a double-flared technique. One or other of the following irrigants was used during preparation: distilled water, 3% NaOCl, anolyte neutral cathodic (ANC) (300 mg L-1 of active chlorine), and a combination of anolyte neutral cathodic (ANC) (300 mg L-1 of active chlorine) and catholyte. The teeth were split longitudinally and the canal walls examined for debris and smear layer by scanning electron microscopy. SEM photomicrographs were taken separately in the coronal, middle and apical parts of canal at magnification of x800 to evaluate the debridement of extracellular matrix and at a magnification of x2500 to evaluate the presence of smear layer. RESULTS: Irrigation with distilled water did not remove debris in the apical part of canals and left a continuous and firm smear layer overlying compressed low-mineralized predentine. All chemically active irrigants demonstrated improved cleaning potential compared to distilled water. The quality of loose debris elimination was similar for NaOCl and the anolyte ANC solution. The combination of anolyte ANC and catholyte resulted in improved cleaning, particularly in the apical third of canals. The evaluation of smear layer demonstrated that none of the irrigants were effective in its total removal; however, chemically active irrigants affected its surface and thickness. Compared to NaOCl, the ECA solutions left a thinner smear layer with a smoother and more even surface. NaOCl enhanced the opening of tubules predominantly in the coronal and middle thirds of canals, whereas combination of ANC and catholyte resulted in more numerous open dentine tubules throughout the whole length of canals. CONCLUSIONS: Irrigation with electrochemically activated solutions cleaned root canal walls and may be an alternative to NaOCl in conventional root canal treatment. Further investigation of ECA solutions for root canal irrigation is warranted.     

Effectiveness in cleaning oval-shaped root canals using Anatomic Endodontic Technology, ProFile and manual instrumentation: a scanning electron microscopic study

AIM: To compare in vitro the cleanliness of root canal walls in oval-shaped root canals following automated or manual instrumentation. METHODOLOGY: Forty-five oval-shaped single-rooted maxillary and mandibular premolars with straight canals were divided into three groups of 15. Automated canal preparation was performed using Anatomic Endodontic Technology (AET, group 1) and the ProFile system (group 2). Manual instrumentation (group 3) was performed with K-Flexofiles. Irrigation was performed using alternately 5.25% NaOCl and 17% EDTA, followed by rinsing with saline. The roots were split longitudinally into halves and the canals examined at x200 and x400 in a scanning electron microscope. The presence of debris and smear layer was recorded at distances of 1, 5 and 10 mm from the working length using a three-step scoring scale and a 300 mum square grid. Mean scores for debris and smear layer were calculated and statistically analysed for significance (P < 0.05) between and within groups, using the Kruskal-Wallis nonparametric anova and Dunn's tests. RESULTS: At 1, 5 and 10-mm levels the root canals prepared with AET had significantly less surface debris and smear layer on the canal walls compared with canals prepared with ProFile or manual instrumentation. For all three groups significantly lower mean smear layer scores (P < 0.05) were recorded at 5 and 10-mm levels compared with the 1 mm level. Significantly lower mean debris scores (P < 0.05) were also recorded at 5 and 10-mm levels for the AET group whereas no significant differences were found between the three levels for the ProFile and manual instrumentation groups. CONCLUSIONS: Although better instrumentation scores were obtained in canals prepared with AET, complete cleanliness was not achieved by any of the techniques and instruments investigated.     

The use of ultrasound and an EDTA-urea peroxide compound in the cleansing of root canals. An SEM study

Abstract — Thirty-two human teeth with constricted root canals were prepared using an EDTA-urea peroxide compound as an aid to root canal instrumentation. A final irrigation of 3 per cent sodium hypochlorite with up to five minutes of indirect ultrasound was not sufficient to remove the debris and smear layer from the canal wall when viewed under the scanning electron microscope. It was suggested that the wax-like smear layer could have clinical benefits and required further investigation.     

Determination of the minimum instrumentation size for penetration of irrigants to the apical third of root canal systems

The purpose of this study was to determine the minimum instrumentation size required for the effective penetration of irrigants and elimination of debris and smear layer from the apical third of the root canals. The mesiobuccal canals of 40 freshly extracted human mandibular first molar teeth were instrumented using the crown-down technique. The teeth were divided into four test groups according to the size of their Master Apical File (#20, #25, #30, #35), and two control groups. After final irrigation, the removal of debris and smear layer from the apical third of root canals was determined under a scanning electron microscope. The data was analyzed using Kruskal-Wallis and Mann-Whitney tests. Based on the results, it appears that the minimum instrumentation size needed for penetration of irrigants to the apical third of the root canal is a #30 file.     

Cleaning efficacy of two apical preparation regimens following shaping with hand files of greater taper

AIM: The aim of this investigation was to assess canal cleaning following shaping with hand files of greater taper. METHODOLOGY: Thirty mesial canals and 30 distal canals in mandibular molars were prepared with .08 and .10 hand files of greater taper, respectively. Following initial preparation, 0.02 instruments were used incrementally shorter in a stepback manner. In half the canals instrumentation was performed to size 35 1 mm short of the canal terminus. In the other half the series was continued through to size 60 using stepback increments of half to one millimetre as appropriate (foramen size was maintained at size 20 in all groups). Sodium hypochlorite (4.5%) and REDTA (17%) were used as irrigants for all groups. Cleaning efficacy was evaluated by scoring the amount of remaining debris using a light microscope (x50) and calibrated eyepiece micrometer (range 0-3). RESULTS: Canals stepped back through to a size 60 were significantly cleaner than those instrumented to a size 35 only (Mann-Whitney P < 0.05). CONCLUSION: Refining the apical region of canal preparation by stepping back through to a size 60 reduced remaining debris following shaping with files of greater taper.     

Carisolv对根管微渗漏的影响

目的:建立以亚硝酸钠为示踪物的流体输送模型,探讨Carisolv对根管微渗漏的影响。方法:将70颗离体牙随机分为5组,分别采用Carisolv、2%氯亚明+3%H2O2、2.5%NaclO、5%NaclO(阴性对照)、蒸馏水(阳性对照)预备根管,对根管侧方加压充填后进行桩腔预备,置于模型上,分别于第1、2、4、7、10、15、20、25、30、35、40、45、50、55、60天利用重氮反应检测由冠方向根尖方渗出的亚硝酸钠浓度。采用SPSS11.5软件包对数据进行多因素方差分析。结果:阴性对照组从第1天到第60天均未检测到亚硝酸钠。阳性对照组从第1天就检测到较高浓度的亚硝酸钠,从第1天到第60天亚硝酸钠渗出量显著高于其余4组(P<0.01)。Carisolv组亚硝酸钠渗出量显著低于2%氯亚明+3%H2O2组(P<0.01),与2.5%NaclO组相比,除第25、30、35、40天外,其渗出量均较低(P<0.05)。结论:Carisolv可有效去除玷污层,减少根管微渗漏的发生,达到良好的根管封闭目的。以亚硝酸钠作为示踪物的流体输送模型,可客观、灵敏、准确地评价根管微渗漏。