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Zou X, Zheng X, Liang Y, Zhang C, Fan B, Liang J, Ling J, Bian Z, Yu Q, Hou B, Chen Z, Wei X, Qiu L, Chen W, He W, Xu X, Meng L, Zhang C, Chen L, Deng S, Lei Y, Xie X, Wang X, Yu J, Zhao J, Shen S, Zhou X, Yue L. Expert consensus on irrigation and intracanal medication in root canal therapy. Int J Oral Sci 2024; 16:23. [PMID: 38429299 PMCID: PMC10907616 DOI: 10.1038/s41368-024-00280-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 03/03/2024] Open
Abstract
Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment. However, irrigant selection or irrigation procedures are far from clear. The vapor lock effect in the apical region has yet to be solved, impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes. Additionally, ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified. Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes. Indeed, clinicians have been aware of these concerns for years. Based on the current evidence of studies, this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions. The evolution of different kinetic irrigation methods, their effects, limitations, the paradigm shift, current indications, and effective operational procedures regarding intracanal medication are also discussed. This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication, thus facilitating a better understanding of infection control, standardizing clinical practice, and ultimately improving the success of endodontic therapy.
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Affiliation(s)
- Xiaoying Zou
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
- Center of Stomatology, Peking University Hospital, Beijing, China
| | - Xin Zheng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuhong Liang
- Department of Emergency, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Chengfei Zhang
- Restorative Dental Sciences, Endodontics, Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Bing Fan
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jingping Liang
- Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Clinical Research Center for Oral Diseases; National Center for Stomatology; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Junqi Ling
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology , Guangzhou, China
| | - Zhuan Bian
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qing Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Operative Dentistry & Endodontics, School of Stomatology, The Fourth Military Medical University, Xián, China
| | - Benxiang Hou
- Center for Microscope Enhanced Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zhi Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xi Wei
- Department of Operative Dentistry and Endodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University & Guangdong Provincial Key Laboratory of Stomatology , Guangzhou, China
| | - Lihong Qiu
- Department of Endodontics, School of Stomatology, China Medical University, Shenyang, China
| | - Wenxia Chen
- College & Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Wenxi He
- Department of Stomatology, Air Force Medical Center, The Air Force Medical University, Beijing, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liuyan Meng
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Chen Zhang
- Department of Endodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing, China
| | - Liming Chen
- Department of Endodontics, Guiyang Stomatological Hospital, Guiyang, China
| | - Shuli Deng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Yayan Lei
- Department of Endodontics, the Affiliated Stomatological Hospital of Kunming Medical University, Kunming, China
| | - Xiaoli Xie
- Department of Endodontology, Hunan Xiangya Stomatological Hospital, Central South University, Changsha, China
| | - Xiaoyan Wang
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Jinhua Yu
- Institute of Stomatology, Nanjing Medical University & Department of Endodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Jin Zhao
- Department of Endodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Song Shen
- Center of Stomatology, Peking University Hospital, Beijing, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Lin Yue
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China.
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Smoczer C, Park YK, Herrington JB, Askar MA, Plecha S, Krukonis E, Paurazas SB. A Potential Intracanal Medicament, 2-Hydroxyisocaproic Acid (HICA): Cytotoxicity, Genotoxicity, and Its Effect on SCAP Differentiation. Dent J (Basel) 2023; 11:270. [PMID: 38132408 PMCID: PMC10743052 DOI: 10.3390/dj11120270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Intracanal medicaments with maximal antimicrobial efficacy and minimal damage to resident stem cells are essential for successful regenerative endodontic procedures. 2-Hydroxyisocaproic acid (HICA) could have the attributes of a potential intracanal medicament. This study evaluates its cytotoxicity, genotoxicity, and effects on the odontogenic and osteogenic differentiation of the stem cells of the apical papilla (SCAP). Cytotoxicity and cell viability assays were performed on cells treated for 24, 48, and 72 h with varying concentrations of HICA and compared to the standard intracanal medicament, calcium hydroxide. The genotoxicity was assessed via immunofluorescence for two markers of DNA double-strand breaks: phosphorylated γH2AX and 53BP1. The SCAP differentiation was evaluated based on the alkaline phosphatase activity, Alizarin Red staining, and expression of odontogenic and osteogenic genes (DSPP1, BSP1, OCN, RUNX2) in the presence of selected HICA concentrations. HICA was not cytotoxic at concentrations up to 10 mg/mL, regardless of the exposure time, although it was cytostatic at all tested concentrations. HICA was not genotoxic at concentrations below 5 mg/mL. No difference in cytotoxicity or genotoxicity was found between HICA and calcium hydroxide at 1 mg/mL. HICA retained about 70% of the osteogenic differentiation potential at 1 mg/mL. Within the limitations of this in vitro study, we show that HICA at 1 mg/mL could be a potential intracanal medicament for REPs.
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Affiliation(s)
- Cristine Smoczer
- Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (C.S.); (S.P.); (E.K.)
| | - Yun K. Park
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
| | - James B. Herrington
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
| | - Mazin A. Askar
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
| | - Sarah Plecha
- Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (C.S.); (S.P.); (E.K.)
| | - Eric Krukonis
- Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (C.S.); (S.P.); (E.K.)
| | - Susan B. Paurazas
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
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Durga Bhavani G, Rathod T, Parveen N, Tirupathi P, Dharavattu P, Sekhar V, Sharma D, Anlesteffy SG. Assessment of the Antimicrobial Effectiveness of Herbal Root Canal Irrigants (Propolis, Triphala, and Aloe Vera) and Chlorhexidine Against Enterococcus Faecalis. Cureus 2023; 15:e41628. [PMID: 37565091 PMCID: PMC10410603 DOI: 10.7759/cureus.41628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Complete microbial eradication from the root canal and 3-dimensional obturation of the canal space are necessary for an efficient root canal procedure. AIM The current research was conducted to assess the antimicrobial effectiveness of herbal root canal irrigants and Chlorhexidine against Enterococcus faecalis. MATERIALS AND METHODS The brain heart infusion (BHI) broth was used to grow the E. faecalis (ATCC) bacterial culture overnight before it was inoculated onto Mueller-Hinton agar plates. Agar-well diffusion was used to measure antibacterial inhibition. Respective propolis, Triphala, aloe vera, and chlorhexidine irrigants were added to the appropriate wells in agar plates and incubated for 24 hours at 37°C. Each well's bacterial inhibition zone was measured and recorded. Statistics were used to tabulate and analyze the results. RESULTS Chlorhexidine indicated the maximum inhibitory zone against E. faecalis, subsequently propolis and Triphala, and the lowest by A. vera extract. CONCLUSION Propolis, Triphala, and aloe vera were tested herbal remedies that demonstrated an inhibitory zone against E. faecalis. These irrigants are therefore, suitable for use as root canal irrigating solutions.
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Affiliation(s)
- Gondi Durga Bhavani
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Kadapa, IND
| | - Tejasree Rathod
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Kadapa, IND
| | - Nusrath Parveen
- Independent Practitioner, Conservative Dentistry and Endodontics, Hyderabad, IND
| | - Pudu Tirupathi
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Kadapa, IND
| | - Prabhakar Dharavattu
- Department of Conservative Dentistry and Endodontics, Gitam Dental College, Visakhapatnam, IND
| | - Vssk Sekhar
- Department of Conservative Dentistry and Endodontics, Sree Sai Dental College and Research Institute, Srikakulam, IND
| | | | - S G Anlesteffy
- Periyar University, Department of Microbiology, Salem, IND
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Shamma BM, Kurdi SA, Rajab A, Arrag EA. Evaluation of antibacterial effects of different intracanal medicaments on Enterococcus faecalis in primary teeth: An in vitro study. Clin Exp Dent Res 2023; 9:341-348. [PMID: 36752174 PMCID: PMC10098284 DOI: 10.1002/cre2.718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES Successful endodontic therapy is based on the reduction of infecting bacteria by cleaning, shaping, and disinfecting of the root canal system, thus the use of intracanal dressing is necessary for optimal success of root canal treatment. This study was designed to evaluate the effect of chitosan and propolis as intracanal medicaments against Enterococcus faecalis compared to calcium hydroxide in primary root canals. MATERIAL AND METHODS Ninety-six extracted primary second molars were collected. Teeth preparation was completed to size 30 K-file. They were randomly divided into four groups; (A): chitosan, (B): propolis, (C): calcium hydroxide, and (D): control group (saline). The tooth specimens were inoculated with E. faecalis. Then, tested materials were applied for all groups in accordance to the groups each tooth belonged to. Following this, the bacterial colonies were counted after 24 h, 72 h, and 1 week of applying dressing materials and incubation. Finally, one-way analysis of variance and Fisher's least significant difference tests were used for statistical comparisons between the groups at a significance level of .05. RESULTS No statistically significant difference was found between groups A, B, and C for both 24 h and a week (p ≥ .05). Yet, a statistical difference between groups A, B, C, and D after 72 h and 1 week were seen (p ≤ .05). CONCLUSIONS Chitosan and propolis medicaments were as effective as calcium hydroxide against E. faecalis in primary root canal treatment and might be considered as an alternative dressing material between treatment sessions.
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Affiliation(s)
- Bushra Munzer Shamma
- Department of Pediatric Dentistry, Dental CollegeDamascus UniversityDamascusSyria
| | - Saleh Al Kurdi
- Department of Pediatric Dentistry, Dental CollegeDamascus UniversityDamascusSyria
| | - Anas Rajab
- Department of Organic Chemistry, Faculty of PharmacySyrian Private UniversityDaraaSyria
| | - Ettihad Abo Arrag
- Department of Pediatric Dentistry, Dental CollegeDamascus UniversityDamascusSyria
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