Nanobubble-Enhanced Antimicrobial Agents: A Promising Approach for Regenerative Endodontics

IntroductionIn this study, we investigated the properties of nanobubble (NB) water and its effect on smear layer removal and strengthening the efficiency of disinfecting agents used in regenerative endodontic treatment.MethodsNB water was generated in a NB Generator. The NB size, concentration, and pH were measured. Porcine teeth were enlarged to size 60 by using hand-files and irrigated with either NB water or 17% EDTA or received no further irrigation. The ability of irrigants to remove the smear layer was evaluated by using a scanning electron microscope (9 roots/group). Other samples (6 roots/group) were subjected to Vickers hardness test to determine the dentin microhardness. Autofluorescent tetracycline mixed with distilled water or NB water was placed inside the root canal space of porcine teeth, and the depth of medicament penetration into the dentinal tubules was visualized by using fluorescent stereomicroscope (5 roots/group). For the disinfection experiment, human roots were prepared, autoclaved, and inoculated with Enterococcus faecalis for 3 weeks. Canals were then disinfected by (1) standard needle irrigation (SNI) with 5.25% NaOCl, (2) 5.25% NaOCl with ultrasonication (US), (3) 5.25% NaOCl + XP finisher (XP), (4) SNI with 1.5% NaOCl, or (5) SNI with 1.5% NaOCl in NB water (5 roots/group). Teeth were split open and stained with LIVE/DEAD BackLight and visualized by using confocal laser scanning microscope (CLSM) at the coronal, middle, and apical thirds of the canal. The ratio of dead/total bacteria in the dentinal tubules at various depth levels (50, 100, and 150 μm) was calculated.ResultsNB water was more effective in removing smear layer than 17% EDTA and could allow infiltration of tetracycline into the dentinal tubule more than 1 mm. NB water did not alter the dentin microhardness compared with 17% EDTA (P < .05). At 50-μm depth, CLSM analysis showed no statistically significant difference between 1.5% NaOCl in NB water and 5.25% NaOCl with or without irrigation activation at the coronal, middle, and apical root segments (P > .05), ie, these groups had stronger bacterial killing than 1.5% NaOCl (P < .05). At deeper levels (100 and 150 μm), higher concentrations of NaOCl were more effective than 1.5% NaOCl with or without NB water. No statistically significant difference was noted between 5.25% NaOCl with and without irrigation activation at most depth levels (P > .05).ConclusionsNB water can allow smear layer removal and enhance tubular penetration of medicaments without changing dentin microhardness. In large canal models, NB water appears to improve the tubular disinfection capacity of lower concentration of NaOCl up to 50 μm. On the other hand, the use of irrigation activation (US or XP) did not provide any added disinfection into the dentinal tubules compared with SNI. These results suggest that NB water may be a promising adjunct to endodontic irrigants and medicaments.     

Sodium hypochlorite penetration into dentinal tubules after manual dynamic agitation and ultrasonic activation: a histochemical evaluation

The aim of this study was to compare the effects of Manual Dynamic Agitation and Passive Ultrasonic Irrigation on sodium hypochlorite (NaOCl) penetration into dentinal tubules using its bleaching ability. Thirty-four single-rooted teeth with round-shaped root canals were distributed in two homogeneous groups and one control group, characterized by different NaOCl activation systems: Manual Dynamic Agitation and Passive Ultrasonic Irrigation. After instrumentation, all root canals were stained with 10% copper sulphate solution followed by 1% rubeanic acid alcohol solution under vacuum. Final irrigation was performed with 5 mL of 5.25% NaOCl solution for 1 min and activated with Manual Dynamic Agitation or Passive Ultrasonic Irrigation for another 1 min depending on the treatment group. The teeth were transversely sectioned at the middle portion of the apical, middle, and coronal thirds and observed under light microscope. NaOCl solution penetration was evaluated by measuring the percentage of bleached circumference of the root canal relative to the stained circumference, bleached areas, mean, and maximum penetration depth. No differences in the evaluated parameters were observed between groups (p?>?0.05). Within groups, an increase of values was recorded from apical to coronal direction as for percentage of staining, percentage of bleaching and bleached area. NaOCl penetration into dentinal tubules did not significantly vary among the three levels. No significant differences in penetration of sodium hypochlorite into dentinal tubules when activated by means of Manual Dynamic Agitation or Passive Ultrasonic Irrigation were observed in the apical, middle, and coronal thirds of teeth with single straight round root canals.     

Effect of Smear Layer against Disinfection Protocols on Enterococcus faecalis–infected Dentin

IntroductionThis study examined the effect of the smear layer on the antibacterial effect of different disinfecting solutions in infected dentinal tubules.MethodsCells of Enterococcus faecalis were forced into dentinal tubules according to a previously established protocol. After a 3-week incubation period of infected dentin blocks, a uniform smear layer was produced. Forty infected dentin specimens were prepared and subjected to 3 and 10 minutes of exposure to disinfecting solutions including sterile water, 2% and 6% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), 17% EDTA, and QMiX (Dentsply Tulsa Dental, Tulsa, OK). The following combinations were also included: 2% NaOCl + 2% CHX, 2% NaOCl + QMiX, 6% NaOCl + QMiX, and 6% NaOCl + 17% EDTA + 2% CHX. Four other dentin specimens similarly infected but with no smear layer were subjected to 3 minutes of exposure to 2% CHX and 6% NaOCl for comparison. Confocal laser scanning microscopy and viability staining were used to analyze the proportions of dead and live bacteria inside the dentin.ResultsIn the presence of a smear layer, 10 minutes of exposure to QMiX, 2% NaOCl + QMiX, 6% NaOCl + QMiX, and 6% NaOCl + 17% EDTA + 2% CHX resulted in significantly more dead bacteria than 3 minutes of exposure to these same disinfecting solutions (P < .05). No statistically significant difference between 3 and 10 minutes was found in other groups (P > .05); 6% NaOCl + QMiX and 6% NaOCl + 17% EDTA + 2% CHX showed the strongest antibacterial effect. In the absence of a smear layer, 2% CHX and 6% NaOCl killed significantly more bacteria than they did in the presence of a smear layer (P < .05).ConclusionsThe smear layer reduces the effectiveness of disinfecting agents against E. faecalis in infected dentin. Solutions containing 6% NaOCl and/or QMiX showed the highest antibacterial activity.     

Effect of dentinal tubules and resin-based endodontic sealers on fracture properties of root dentin

ObjectiveTo investigate the role of dentinal tubules in the fracture properties of human root dentin and whether resin-filled dentinal tubules can enhance fracture resistance.Materials and methodsCrack propagation in human root dentin was investigated in 200 μm thick longitudinal samples and examined by light and scanning electron microscopy. 30 maxillary premolar teeth were prepared for work of fracture (Wf) test at different tubule orientations, one perpendicular and two parallel to dentinal tubules. Another 40 single canal premolars were randomly divided into four groups of 10 each: intact dentin, prepared but unobturated canal, canal obturated with epoxy rein (AH Plus?/gutta percha), or with UDMA resin sealer (Resilon^®/RealSeal^®). The samples were prepared for Wf test parallel to dentinal tubules. Wf was compared under ANOVA with statistical significance set at p < 0.05.ResultsDentinal tubules influenced the path of cracks through dentin, with micro-cracks initiated in peritubular dentin of individual tubules ahead of the main crack tip. A significant difference (p < 0.001) was found between Wf perpendicular to tubule direction (254.9 J/m²) vs. parallel to tubule direction from inner to outer dentin (479.4 J/m²). Neither canal preparation nor obturation using epoxy- or UDMA-based resins as sealer cements substantially influenced fracture properties of root dentin, despite extensive infiltration of dentinal tubules by both sealer cements.     

The effects of a sodium hypochlorite treatment on demineralized root dentin

The effects of a 10% NaOCl treatment for 2 min on demineralized human root dentin were investigated by means of: microradiography (MR), scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM) and secondary ion mass spectroscopy (SIMS). MR measurements revealed that NaOCl caused a tissue contraction not related to water loss but to removal of organic sub-stance(s), resulting in reductions of the lesion depth and mineral loss values by 15% and 42%, respectively. CLSM observations on wet dentin showed that the dentinal tubules underneath the surface are clearly observable and not deformed substantially by the NaOCl, except near the outermost surface. This indicates the importance of wet as well as of dried (high vacuum) observations. SEM micrographs (high vacuum) showed definite changes in the outer dentin surface structure, 85% of the originally open dentinal tubules were closed after NaOCl treatment. No marked changes were observed in the dentin ultrastructure inside lesions, as shown by SEM on fractured surfaces. SIMS data, pertaining to samples in high vacuum, showed a remarkable increase of chlorine (Cl) content in the entire lesion due to the NaOCl, indicating deep penetration of the original OC1 ions. The results suggest that the 2-min treatment of demineralized dentin by NaOCl solutions removes and/or changes part of the dentin matrix in nearly the whole lesion. As a consequence the mineral is somewhat redistributed, the outermost surface of a few μm is changed, but the main dentin structure and element composition are still intact. These findings indicate that NaOCl treatments are of interest in remineralization and hyperremineralization studies of dentin.     

A new noninvasive model to study the effectiveness of dentin disinfection by using confocal laser scanning microscopy

Introduction

The present study was designed to develop a standardized model for quantification of the effectiveness of dentin disinfection by different antibacterial solutions including a new root canal irrigant, Qmix.

Methods

Dentinal tubules from the root canal side in semicylindrical dentin specimens were infected with Enterococcus faecalis by centrifugation of the bacterial suspension into the tubules. Scanning electron microscopy (SEM) was used to verify the presence of bacteria in dentin. The outer side of dentin pieces was closed, and the specimens were subjected to 1-minute and 3-minute exposure to sterile water, 1%, 2%, 6% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and Qmix. Confocal laser scanning microscopy (CLSM) and viability staining were used to quantitatively analyze the proportions of dead and live bacteria inside dentin.

Results

A heavy invasion by E. faecalis was detected by both SEM and CLSM throughout the dentinal tubules. The amount of dead cells in dentin increased with increasing NaOCl concentration and time of exposure (P < .05). Qmix was equally effective in killing bacteria in dentin as 6% NaOCl; more than 40% and 60% of the bacteria were killed by both at 1 minute and 3 minutes, respectively. One percent and 2% NaOCl and 2% CHX killed 20%–30% and 30%–40% bacteria after 1 and 3 minutes of exposure, respectively, with no statistically significant differences among the 3 agents (P > .05). In the control group, which was treated with sterile water, only 4%–6% of the bacteria were dead.

Conclusions

Centrifugation helped to create a heavy, evenly distributed infection deep into the dentinal tubules. The new model made it possible to compare the effectiveness of several disinfecting solutions in killing bacteria inside dentin by a noninvasive CLSM method.     

Effect of endodontic irrigation on bonding of resin cement to radicular dentin

The influence of endodontic irrigation on shear bond strengths of resin cement to radicular dentin was investigated. Human radicular dentin blocks were divided into four groups and subjected to one of four endodontic irrigations: ethylenediaminetetraacetic acid (EDTA) group, 17% EDTA for 60 s; EDTA/sodium hypochlorite (NaOCl) group, 17% EDTA for 60 s followed by 10 ml of 5% NaOCl for 15 s; NaOCl group, 10 ml of 5% NaOCl for 15 s; and control group, no treatment. Morphological changes of dentin surface after endodontic irrigation were observed by scanning electron microscopy (SEM). A resin block was bonded to the radicular dentin after irrigation using resin cement with either wet-bonding (Uni-Etch/One-Step; Bisco) or self-etching (Tyrian SPE/One-Step Plus; Bisco) adhesives. Shear bond strengths were measured and the penetration of resin tags into dentinal tubules at resin-dentin interface was observed by SEM. With the wet-bonding system, the shear bond strengths for the EDTA/NaOCl group, in which dentinal tubules openings and uniform resin tag penetration into dentinal tubules were observed, were significantly higher than the EDTA and control groups. With the self-etching system, the shear bond strengths were significantly lower in the EDTA group compared with the NaOCl and control groups. The effects of endodontic irrigation on the bonding of resin cement to radicular dentin depended on the dentin bonding system used.     

Viability of Intratubular Bacteria after Chemomechanical Caries Removal

Introduction

The aim of this study was to assess the effect on bacterial viability within dentinal tubules after the application of sodium hypochlorite (NaOCl)– or enzyme-based chemomechanical caries removal agents.

Methods

Twenty-five caries-free dentin discs prepared from 25 sound maxillary premolars were used. The discs were then infected with Streptococcus mutans suspension and randomly divided into the following 6 groups according to the dentin treatments: the negative control group: noninfected sound dentin discs, the positive control group: infected discs were left untreated; the NaOCl group: treated with 5% NaOCl solution, the chlorhexidine (CHX) group: 2% CHX solution, the Carisolv group: Carisolv gel (Medi Team Dentalutveckling AB, Savedalen, Sweden), and the Papacarie group: Papacarie gel (Formula & Acao, São Paulo, Brazil). All the agents were applied for 5 minutes. The dentin discs were fractured into 2 halves and stained with fluorescent LIVE/DEAD Stain (Molecular Probes, Eugene, OR). Each specimen was observed using confocal laser scanning microscopy at 5 different randomly selected sites.

Results

The results of 1-way analysis of variance revealed that 5% NaOCl solution achieved the highest intratubular antibacterial effect, whereas Carisolv gel had the lowest antibacterial effect (P < .05). No significant difference in antibacterial effect was observed between the Papacarie gel and 2% CHX solution (P > .05).

Conclusions

The enzyme-based chemomechanical caries removal (Papacarie) was effective in the reduction of residual cariogenic bacteria in the dentinal tubules of coronal dentin.     

Antimicrobial Activity of a Sodium Hypochlorite/Etidronic Acid Irrigant Solution

Introduction

The aim of this study was to evaluate the antimicrobial activity of a 2.5% sodium hypochlorite (NaOCl)/9% etidronic acid (HEBP) irrigant solution on Enterococcus faecalis growing in biofilms and a dentinal tubule infection model.

Methods

The antimicrobial activity of the solutions 2.5% NaOCl and 9% HEBP alone and associated was evaluated on E. faecalis biofilms grown in the Calgary biofilm model (minimum biofilm eradication concentration high-throughput device). For the dentinal tubule infection test, the percentage of dead cells in E. faecalis–infected dentinal tubules treated with the solutions for 10 minutes was measured using confocal laser scanning microscopy and the live/dead technique. Available chlorine and pH of the solutions were also measured. Distilled water was used as the control. Nonparametric tests were used to determine statistical differences.

Results

The highest viability was found in the distilled water group and the lowest in the NaOCl-treated dentin (P < .05). Both NaOCl solutions killed 100% of the E. faecalis biofilms and showed the highest antimicrobial activity inside dentinal tubules, without statistical differences between the 2 (P < .05). The HEBP isolated solution killed bacteria inside dentinal tubules but did not present any significant effect against E. faecalis biofilms. The incorporation of HEBP to NaOCl did not cause any loss of available chlorine within 60 minutes.

Conclusions

HEBP did not interfere with the ability of NaOCl to kill E. faecalis grown in biofilms and inside dentinal tubules.     

Chelating agents: their effect on the permeability of root canal dentin.

An in vitro assessment was made of the ability of three chelating agents used in endodontics to alter the dye penetration of dentinal tubules from the root canal surface. The experiment and control for this study were within the same root. It was found that all three agents significantly reduced the dye penetration into dentin, but there was no difference among the agents in the degree of reduction of dye penetration.     

In vitro infection and disinfection of dentinal tubules

An in vitro model for dentinal tubule infection of root canals was developed. Cylindrical dentin specimens, 4 mm high with a diameter of 6 mm and a canal 2.3 mm wide, were prepared from freshly extracted bovine incisors. The cementum was removed from all dentin blocks. The tubules were opened by four-minute treatments with 17% EDTA and 5.25% NaOCl before being infected with Enterococcus faecalis ATCC 29212 in yeast extract-glucose broth. Bacteria rapidly invaded the tubules. After three weeks of incubation, a heavy infection was found 400 micron from the canal lumen, and the front of the infection reached 1000 micron in some blocks. Camphorated paramonochlorophenol (CMCP) and a calcium hydroxide compound, Calasept, were tested for their disinfecting efficacy toward E. faecalis-infected dentin. Liquid CMCP rapidly and completely disinfected the dentinal tubules, whereas CMCP in gaseous form disinfected tubules less rapidly. Calasept failed to eliminate, even superficially, E. faecalis in the tubules. The method used in bacteriological sampling allowed for sequential removal of 100-micron-thick zones of dentin from the central canal toward the periphery. Control specimens were uniformly infected and yielded growth in bur samples up to some 500 microns from the surface. The model proved quite sensitive and seems suitable for in vitro testing of root canal medicaments.     

Delivery of Antibacterial Nanoparticles into Dentinal Tubules Using High-intensity Focused Ultrasound

IntroductionHigh-intensity focused ultrasound (HIFU) produces collapsing cavitation bubbles. This study aims to investigate the efficacy of collapsing cavitation bubbles to deliver antibacterial nanoparticles into dentinal tubules to improve root canal disinfection.MethodsIn stage 1, experiments were performed to characterize the efficacy of collapsing cavitation bubbles to deliver the miniature plaster beads into a tubular channel model. In stage 2, experiments were conducted on root-dentin blocks to test the efficacy of HIFU applied at 27 kHz for 2 minutes to deliver antibacterial nanoparticles into dentinal tubules. After the stage 2 experiment, the samples were sectioned and analyzed using field-emission scanning electron microscopy and energy dispersive X-ray analysis.ResultsThe stage 1 experiment showed that collapsing cavitation bubbles using HIFU delivered plaster beads along the entire length of the tubular channel. It was observed from the stage 2 experiments that the diffusion of fluids alone was not able to deliver antibacterial nanoparticles into dentinal tubules. The collapsing cavitation bubbles treatment using HIFU resulted in significant penetration up to 1,000 μm of antibacterial nanoparticles into the dentinal tubules. The statistical analysis showed a highly significant difference in the depth of penetration of antibacterial nanoparticles between the two groups (<0.005).ConclusionThe cavitation bubbles produced using HIFU can be used as a potential method to deliver antibacterial nanoparticles into the dentinal tubules to enhance root canal disinfection.     

The effect of 25% tannic acid on prepared dentin: a scanning electron microscope-methylene blue dye study

The effect on the permeability of prepared dentin treated with 25% tannic acid and 6% citric acid was compared with the untreated dentinal surface. Methylene blue was applied to the dentin surface after treatment to evaluate penetration into dentinal tubules. The tannic acid solution reduced or prevented dye penetration of the dentinal tubules. Citric acid treatment permitted severe penetration. The 25% tannic acid solution removed the smear layer while inhibiting penetration of the dye.     

In vitro evaluation of the antibacterial effect of four root canal sealers on dental biofilms

Objectives

To dynamically evaluate the effect of four root canal sealers on the killing of biofilms within dentinal tubules.

Materials and methods

Dentin blocks were prepared for infection of the dentinal tubules. Enterococcus faecalis VP3-181 and multi-species bacteria from two donors were cultured. After 3 days of incubation, the infected dentin specimens were rinsed with sterile water for 1 min and subjected to treatment. Additionally, multi-species bacteria from donor 1 were incubated for 3 weeks to allow biofilm maturation and then the specimens were subjected to treatment. Gutta-percha-treated dentin specimens comprised the control group. A root canal sealer (bioceramic sealers: EndoSequence BC Sealer, ProRoot Endo Sealer, or GuttaFlow Bioseal; and a traditional silicone-based sealer: Guttaflow 2) was spread onto the canal walls of the dentin. The specimens were examined with confocal laser scanning microscopy at 7, 30, or 60 days.

Results

In the 3-day-old biofilm group, the proportion of killed bacteria decreased significantly from the first 7 days of treatment to 60 days of treatment for all sealers (p?<?0.05). In the 3-week-old biofilm group, 60 days of exposure to bioceramic sealers resulted in more significant dead bacteria than 7-day exposures of the biofilms (p?<?0.05). Bioceramic sealers were more effective in killing bacteria than the GuttaFlow 2 sealer (p?<?0.05).

Conclusions

Calcium silicate–based sealers showed good antimicrobial effects against biofilms within dentinal tubules, especially in the first week in young biofilms. There is no substantive antibacterial activity observed for the examined root canal sealers against young dentinal tubule biofilms.

Clinical relevance

The bioceramic root canal sealers examined demonstrate minimal additional antibacterial effects after long-term exposure to young biofilms.

     

Extension of Bactericidal Effect of Sodium Hypochlorite into Dentinal Tubules

Introduction

The aim of this study was to determine the extent of disinfection mediated by 2 concentrations of sodium hypochlorite for bacteria-laden dentin wall of a root canal.

Methods

A dual-species film, Enterococcus faecalis and Porphyromonas gingivalis, was cultivated on root canal dentin for 7 days. The canal wall was irrigated with 0.5% or 3% sodium hypochlorite (n = 8 each), with a control group (n = 2) irrigated with sterile saline. The roots were then split horizontally at 5-, 7-, and 9-mm levels from root apex and examined under confocal laser scanning microscope and then scanning electron microscope. The proportions of viable cells situated on different depths into root canal dentin were compared at a significance level of P = .05.

Results

Both concentrations of sodium hypochlorite significantly reduced the amount of live bacteria in the most superficial layer (first 0.1 mm) of root canal dentin, compared with the control; however, the difference was not significant between the 2 concentrations. For the next 2 layers (0.1–0.3 mm into dentinal tubules), irrigation with 3% hypochlorite resulted in significantly lower amounts of viable bacteria than 0.5% hypochlorite or saline. No significant difference between 0.5% or 3% sodium hypochlorite and the positive control was observed in deeper (>0.3 mm) regions into the root canal wall.

Conclusions

Increasing the concentration of sodium hypochlorite improves the penetration depth of its antibacterial action into dentinal tubules, but that seemed unable to completely eradicate bacteria residing there. Total elimination of bacteria from dentinal tubules cannot be achieved by irrigation with sodium hypochlorite alone.     

Effect of Heated Sodium Hypochlorite on the Viscoelastic Properties of Dentin Evaluated Using Dynamic Mechanical Analysis

IntroductionThis study aimed to investigate the effect of the immersion of standardized dentin bars in 5% sodium hypochlorite (NaOCl) solutions at 60°C and 80°C on their viscoelastic properties using dynamic mechanical analysis.MethodsEighteen intact teeth were used to produce 99 dentin bars of standard dimensions (12 × 1 × 2 mm) and randomly allocated to 6 groups (n = 15 each) for immersion in(1) saline at 26°C,(2) saline at 60°C,(3) saline at 80°C,(4) NaOCl at 26°C,(5) NaOCl at 60°C, and(6) NaOCl at 80°C. The bars were individually tested using dynamic mechanical analysis at baseline and after every 10 minutes of immersion in the test medium, up to 40 minutes. The effects of media, temperature, duration of exposure, and aspect ratio of bars on the storage modulus and tan delta were investigated using generalized estimating equations.ResultsThere was a significant interaction between the test medium and the duration of immersion (P < .05). The storage modulus of specimens immersed in NaOCl at 60°C or 80°C decreased significantly (P < .0001) over time of exposure, but the changes in other groups were minimal and insignificant. The tan delta of specimens immersed in saline 80°C (P < .05), NaOCl at 60°C (P < .05), or 80°C (P < .0001) increased significantly over the time of exposure, but the change in NaOCl at 26°C was minimal. Other groups displayed negligible changes.ConclusionsNaOCl at 60°C or 80°C significantly reduced the elastic behavior but increased the hysteresis of dentin under cyclic loading.     

Influence of smear layer on depth of penetration of three endodontic sealers: an SEM study

Abstract— The purpose of this study was to examine the effect of the smear layer on the penetration depth of Sealapex, Roth 811, and CRCS root canal sealers into the dentinal tubules. Forty recently extracted, human single-rooted teeth were used. The crowns were cut and removed at the cemento-enamel junction level and the root canals were prepared to a #60 K-file. The teeth were then randomly divided into two groups of 20, group A and group B. The smear layer was removed from all teeth in group A with EDTA and NaOCl. The smear layer remained in all teeth in group B. Two roots in each group were used as controls. Six roots from each group were obturated with Roth 811 sealer and gutta-percha through lateral condensation. The same process was repeated using sealers CRCS and Sealapex. Each root was then divided in two and prepared for scanning electron microscope observation. The removal of the smear layer allowed penetration of all three sealers into the dentinal tubules to a depth of between 35 μm and 80 μm. Although the CRCS sealer penetrated only up to the 35 mm point, it offered better or complete obturation of the dentinal tubules. The presence of smear layer at the root canal walls obstructed the penetration of all sealers into the dentinal tubules.     

Evaluation of the interaction between sodium hypochlorite and chlorhexidine gluconate and its effect on root dentin

The combination of sodium hypochlorite (NaOCl) and chlorhexidine (CHX) forms a precipitate. The aim of this study was to evaluate the effect of irrigating root canals with a combination of NaOCl and CHX on root dentin and dentinal tubules by using the environmental scanning electron microscope (ESEM) and a computer program (Photoshop CS2). Forty-four extracted single-rooted human teeth were instrumented and irrigated with both NaOCl and CHX to produce a precipitate. Root canal surfaces were analyzed with the ESEM. The amount of remaining debris and number of patent tubules were determined. There were no significant differences in remaining debris between the negative control group and the experimental groups. There were significantly fewer patent tubules in the experimental groups when compared with the negative control group. The NaOCl/CHX precipitate tends to occlude the dentinal tubules. Until this precipitate is studied further, caution should be exercised when irrigating with NaOCl and CHX.     

Dentinal tubule penetration of root canal sealers after root canal dressing with calcium hydroxide.

The purpose of this study was to evaluate the dentinal tubule penetration of root canal sealers after root canal dressing with calcium hydroxide (Ca(OH)2). Forty-two single-rooted teeth were instrumented to size 60. Six teeth served as the control group, and the remaining teeth were assigned to two groups. Root canals of the first group were filled with the Ca(OH)2 paste; the second group was filled with TempCanal, and all were incubated for 7 days. The samples were either irrigated with only NaOCl or with EDTA, followed by NaOCl to remove Ca(OH)2. All of the teeth were obturated with CRCS, AH26, and Ketac Endo by a lateral condensation technique. The specimens were then kept at the same conditions for another 7 days, and then all of the roots were prepared for scanning electron microscopic evaluation. Scanning electron microscopic examination revealed that Ca(OH)2 was not completely removed from the root canal surfaces, and root canal sealers did not penetrate into the dentinal tubules when only NaOCl was used. EDTA followed by NaOCl irrigation resulted in complete removal of Ca(OH)2 and root canal sealers penetrated into the dentinal tubules.     

Effect of Vehicle and Agitation Methods on the Penetration of Calcium Hydroxide Paste in the Dentinal Tubules

IntroductionThe aim of this ex vivo study was to analyze the effect of different vehicles combined with agitation methods on the penetration of calcium hydroxide (CH) paste in the dentinal tubules.MethodsSixty freshly extracted, single-rooted human premolars were prepared using WaveOne Gold (Dentsply Sirona, York, PA) and randomized into 6 experimental groups (n = 10) according to the vehicle and method of paste agitation as follows: propylene glycol (PG) + Lentulo, PG + Lentulo + ultrasound, PG + Lentulo + sonic, distilled water (DW) + Lentulo, DW + Lentulo + ultrasonic, and DW + Lentulo + sonic. The CH paste was manipulated with sodium fluorescein dye and was inserted to completely fill the root canal. Two 1-mm thick sections at 2 mm and 5 mm from the apex of each root were obtained. The sections were scanned using confocal laser scanning microscopy, and the images were analyzed using ImageJ software (Bethesda, MD) to calculate the percentage penetration and maximum penetration depth of CH paste. Statistical analysis was performed using 1-way analysis of variance and Tukey honestly significant difference post hoc tests.ResultsNo statistically significant differences between study factors at a distance of 2 mm from the apex were observed (P > .05). However, at 5 mm, a significant difference between the vehicles (P < .05) in percentage penetration was demonstrated with higher means for PG.ConclusionsVehicles interfered with the penetration of CH in the dentinal tubules at 5 mm from the apex with better results for PG.