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Wenzler JS, Falk W, Frankenberger R, Braun A. Temporary Root Canal Obturation with a Calcium Hydroxide-Based Dressing: A Randomized Controlled Clinical Trial. Antibiotics (Basel) 2023; 12:1663. [PMID: 38136697 PMCID: PMC10740497 DOI: 10.3390/antibiotics12121663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Successful bacterial inactivation or elimination is essential for successful outcomes in endodontics. This study investigated the efficacy of a calcium hydroxide paste (Ca(OH)2) as a temporary medical dressing for 1 week after chemomechanical root canal treatment (CMRCT). Microbiological samples from 26 patients were collected after endodontic emergency treatment as follows: (1) removal of the provisional filling material; (2) CMRCT; (3) irrigation with sodium hypochlorite I (3%); (4) medicinal insertion of Ca(OH)2; and (5) irrigation with sodium hypochlorite II (3%). A microbiological examination was carried out after the specimens had been taken from the root canals via saline and sterile paper points. CMRCT resulted in a significant reduction in total bacterial load (TBL) in the root canal (p < 0.05). Additional irrigation (3) resulted in a further significant reduction in TBL (p < 0.05). In contrast, Ca(OH)2 medication did not prevent the bacterial load from returning to the previous level immediately after CMRCT, but did not increase above that level either (p < 0.05). However, the increase in TBL was significant (p < 0.05) in comparison with the disinfection groups (I/II). Administration of Ca(OH)2 for 1 week shows that in combination with an additional disinfection procedure, an increase in TBL must be expected, but not above the level of conditions after CMRCT.
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Affiliation(s)
- Johannes-Simon Wenzler
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany;
- Department of Operative Dentistry, Endodontics and Pediatric Dentistry, Campus Marburg, University Medical Center Giessen and Marburg, Georg-Voigt-Strasse 3, 35039 Marburg, Germany
| | - Wolfgang Falk
- Center for Oro-Dental Microbiology, Hamburger Chausse 25, 24220 Flintbek, Germany
| | - Roland Frankenberger
- Department of Operative Dentistry, Endodontics and Pediatric Dentistry, Campus Marburg, University Medical Center Giessen and Marburg, Georg-Voigt-Strasse 3, 35039 Marburg, Germany
| | - Andreas Braun
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany;
- Department of Operative Dentistry, Endodontics and Pediatric Dentistry, Campus Marburg, University Medical Center Giessen and Marburg, Georg-Voigt-Strasse 3, 35039 Marburg, Germany
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Teja KV, Janani K, Srivastava KC, Shrivastava D, Natoli V, Di Blasio M, Cicciu M, Minervini G. Comparative evaluation of antimicrobial efficacy of different combinations of calcium hydroxide against Enterococcus faecalis. BMC Oral Health 2023; 23:849. [PMID: 37951871 PMCID: PMC10638705 DOI: 10.1186/s12903-023-03552-4] [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: 07/10/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The study aims to compare the synergistic antibacterial efficacy of different combinations of calcium hydroxide as an intracanal medicament against E. faecalis. MATERIAL AND METHODS The current study included four hundred extracted human permanent mandibular premolar teeth. After complete chemo-mechanical preparation, the middle third of the root was sectioned using a rotary diamond disc and a total of 400 samples were obtained. The specimens were inoculated with E. faecalis for 21 days. After that, specimens were divided into five groups (n = 80) based on materials used for the disinfection of samples: Group I, calcium hydroxide alone; Group II, calcium hydroxide + 2% chlorhexidine gel; Group III, calcium hydroxide + 2% chitosan gel; Group IV, calcium hydroxide + 0.02% silver nanoparticle gel; Group V, calcium hydroxide + Bioactive glass S53P4. Dentin shavings from the apical third were obtained from the inner third of dentin were obtained using gates glidden no.1 to the apical depth, followed by no.2, 3, 4 and 5 analyzed for E. faecalis using the culture method. One-way analysis of variance (ANOVA) was used for data analysis, followed by post-hoc Tukey's test for multiple comparisons of means to check the difference in bacterial inhibition between the groups. RESULTS ANOVA results revealed a significant reduction of bacterial counts in all the groups compared (p < 0.001). Intergroup comparison showed maximum bacterial reduction (p < 0.001) with calcium hydroxide + bioactive glass S53P4 compared with other groups. CONCLUSION Synergistic effect of calcium hydroxide showed better bacterial reduction compared to calcium hydroxide alone. Among the combinations evaluated, calcium hydroxide with bioactive glass, found to be most effective compared to other groups.
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Affiliation(s)
- Kavalipurapu Venkata Teja
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College & Hospitals, Saveetha University, Chennai, Tamilnadu, India
| | - Krishnamchari Janani
- Department of Conservative Dentistry and Endodontics, SRM Dental College, Ramapuram, Chennai, Tamilnadu, India
| | - Kumar Chandan Srivastava
- Department of Oral & Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, Jouf University, 72345, Sakaka, Saudi Arabia.
| | - Deepti Shrivastava
- Department of Preventive Dentistry, College of Dentistry, Jouf University, 72345, Sakaka, Saudi Arabia.
- Department of Periodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, 602105, India.
| | - Valentino Natoli
- Department of Dentistry, School of Biomedical and Health Sciences, European University of Madrid, 28670, Madrid, Spain
| | - Marco Di Blasio
- Department of Medicine and Surgery, University Center of Dentistry, University of Parma, 43126, Parma, Italy.
| | - Macro Cicciu
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123, Catania, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80121, Naples, Italy
- Saveetha Dental College & Hospitals Saveetha Institute of Medical & Technical Sciences Saveetha University, Saavetha Dental College, Chennai, India
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Thonai S, Kataki R, Das L, Begum F, Deka A, Borah DK. Comparative evaluation of calcium ion release, pH change, and dentinal tubule penetration of four different formulations of calcium hydroxide-based intracanal medicaments - An in vitro study. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2023; 26:657-662. [PMID: 38292750 PMCID: PMC10823981 DOI: 10.4103/jcde.jcde_39_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/10/2023] [Accepted: 09/18/2023] [Indexed: 02/01/2024]
Abstract
Aim The aim of the study was to evaluate and compare the release of calcium ion, pH change, and dentinal penetration depth of four different formulations of calcium hydroxide-based intracanal medicaments. Materials and Methods Eighty mandibular single-rooted premolar teeth were divided into four groups (n = 20): Group 1 - calcium hydroxide (CH) + distilled water (DW), Group 2 - nanocalcium hydroxide + DW, Group 3 - calcium hydroxide + chitosan, and Group 4 - calcium hydroxide + 2% chlorhexidine gluconate. Biomechanical preparation was done till the F2 rotary ProTaper system and intracanal medicaments were placed. Calcium ions and pH were assessed at 24 h, 7 days, 15 days, and 30 days using an ultraviolet spectrophotometer and pH meter, respectively. The evaluation of tubule penetration was scanned under a field emission scanning electron microscope. Results A significant difference was seen in calcium ion release and pH change among the four groups at 24 h, 7 days, 15 days, and 30 days as well as depth of dentinal penetration. Conclusion Calcium hydroxide mixed with 2% chlorhexidine gel showed alkaline pH and the highest calcium ion release as well as significant dentinal tubule penetration among all the four groups under observation. Both combinations can enhance antimicrobial effectiveness as intracanal medicaments. Further clinical study should be carried out to optimize its use as an alternative treatment modality.
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Affiliation(s)
- Salouno Thonai
- Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India
| | - Rubi Kataki
- Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India
| | - Lima Das
- Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India
| | - Firdushi Begum
- Department of Biochemistry, Guwahati Medical College and Hospital, Guwahati, Assam, India
| | - Adrija Deka
- Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India
| | - Diganta Kumar Borah
- Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati, Assam, India
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Nadar A, Muliya VS, Pai S, Pentapati KC. A comparative evaluation of calcium ion release and pH change using calcium hydroxide nanoparticles as intracanal medicament with different vehicles - An in vitro study. J Conserv Dent 2023; 26:47-51. [PMID: 36908721 PMCID: PMC10003273 DOI: 10.4103/jcd.jcd_387_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 12/12/2022] Open
Abstract
Context Nano-calcium hydroxide (NCH) has been proven to have several advantages over normal calcium hydroxide, supporting in its possible use as an intracanal medicament. Aim The aim is to evaluate and compare calcium ion release and pH change using NCH with different vehicles as intracanal medicament. Subjects and Methods Sixty freshly extracted premolars were decoronated at the cementoenamel junction level and the length was standardized. Canals were enlarged to F3 size using protaper rotary system. The samples were divided into three groups (n = 20), namely NCH + distilled water (Group 1), NCH + propylene glycol (Group 2), and NCH + chitosan (CT) (Group 3). Each sample was suspended in 6 ml of distilled water using silicone putty with only the apical third of the roots immersed. The pH and calcium ions were assessed at 24 h, 7 days, 15 days, and 30 days using a pH meter and ultraviolet spectrophotometer, respectively. Statistical Analysis Comparison of mean calcium release and pH change was made using Kruskal-Wallis ANOVA with post-hoc Dunn's test. The level of significance was set at 5%. Results A significant difference was seen in the calcium ion release and pH change among the three groups at 24 h, 7 days, 15 days, and 30 days. Conclusions NCH mixed with propylene glycol showed alkaline pH and adequate release of calcium ions till 30 days. NCH mixed with CT exhibited a high pH at the end of 30 days. Both combinations proved their efficacy as intracanal medicaments.
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Affiliation(s)
- Ashima Nadar
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vidya Saraswathi Muliya
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Swathi Pai
- Department of Conservative Dentistry and Endodontics, KVG Dental College and Hospital, Sullia, Karnataka, India
| | - Kalyana Chakravarthy Pentapati
- Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Hama Gharib DS, Salman RF. Feasibility of the crude extracts of Amorphophallus paeoniifolius and Colocasia esculenta as intracanal medicaments in endodontic therapy in comparison to the 940 nm diode laser: An in vitro antimicrobial study. J Dent Sci 2023; 18:145-156. [PMID: 36643226 PMCID: PMC9831863 DOI: 10.1016/j.jds.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/26/2022] [Indexed: 01/18/2023] Open
Abstract
Background/purpose The elimination and debridement of intracanal bacteria are credited with long-term effectiveness in endodontic therapy. This study aimed to compare the antimicrobial efficacies of Amorphophallus paeoniifolius (Suran), Colocasia esculenta (Aravi) crude extracts as intracanal medicaments with calcium hydroxide (CH), 2% chlorhexidine (CHX) gel, and 940 nm diode laser. Materials and methods Fifty-eight intact, single-root, extracted human mandibular premolar teeth were prepared. The samples were sterilized, transferred into microcentrifuge tubes, and inoculated with E. faecalis. The samples were placed in an incubator for three weeks to allow the biofilm to grow. Then the samples were randomly divided into five experimental groups (n = 10), disinfected with Suran, Aravi crude extracts, CH, 2% CHX gel, and a 940 nm diode laser. The negative control group (n = 4) and the positive control group (n = 4). Then the samples were observed under light and scanning electron microscopy to monitor the E. faecalis biofilm. The sampling method was carried out in paper point (intracanal) and Peeso bur (intradentinal). Later the number of colony-forming units was counted and analyzed. Results Colony-forming units were significantly reduced in the 2% CHX gel in both sampling methods, while Suran showed lower colony-forming units compared to Aravi and CH. The differences between experimental groups were not statistically significant (P > 0.05) in both sampling methods. Conclusion This study showed that the application of Suran and Aravi crude extracts as intracanal medicaments leads to a significant reduction in the number of bacterial colonies compared to CH, 2% CHX gel, and 940 nm diode laser.
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Affiliation(s)
- Didar Sadiq Hama Gharib
- Department of Conservative Dentistry, College of Dentistry, University of Sulaimani, As Sulaymaniyah, 46001, Iraq
- Corresponding author. Department of Conservative Dentistry, College of Dentistry, University of Sulaimani, As Sulaymaniyah, 46001, Iraq.
| | - Raid Fahim Salman
- Department of Conservative Dentistry, College of Dentistry, Hawler Medical University, Erbil, Iraq
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Estrela C, Cintra LTA, Duarte MAH, Rossi-Fedele G, Gavini G, Sousa-Neto MD. Mechanism of action of Bioactive Endodontic Materials. Braz Dent J 2023; 34:1-11. [PMID: 36888836 PMCID: PMC10027099 DOI: 10.1590/0103-6440202305278] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/06/2023] [Indexed: 03/08/2023] Open
Abstract
A continuous search for bioactive materials capable of supporting the replacement of damaged pulp tissue, with effective sealing potential and biocompatibility, has represented the attention of studies over the last decades. This study involves a narrative review of the literature developed by searching representative research in PUBMED/MEDLINE and searches in textbooks associated with the mechanism of action of bioactive materials (calcium hydroxide, mineral trioxide aggregate (MTA), and calcium silicate cements). The reflective analysis of the particularities of the chemical elements of these materials, considering the tissue and antibacterial mechanism of action, allows a better understanding of the characteristics and similarities in their tissue responses. Calcium hydroxide paste remains the antibacterial substance of choice as intracanal dressing for the treatment of root canal system infections. Calcium silicate cements, including MTA, show a favorable biological response with the stimulation of mineralized tissue deposition in sealed areas when in contact with connective tissue. This is due to the similarity between the chemical elements, especially ionic dissociation, the potential stimulation of enzymes in tissues, and the contribution towards an alkaline environment due to the pH of these materials. The behavior of bioactive materials, especially MTA and the new calcium silicate cements in the biological sealing activity, has been shown to be effective. Contemporary endodontics has access to bioactive materials with similar properties, which can stimulate a biological seal in lateral and furcation root perforations, root-end fillings and root fillings, pulp capping, pulpotomy, apexification, and regenerative endodontic procedures, in addition to other clinical conditions.
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Affiliation(s)
- Carlos Estrela
- School of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | | | | | | | - Giulio Gavini
- School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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7
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Ahmad MZ, Merdad KA, Sadaf D. An overview of systematic reviews on endotoxins in endodontic infections and the effectiveness of root canal therapy in its removal. Evid Based Dent 2022:10.1038/s41432-022-0826-x. [PMID: 36482195 DOI: 10.1038/s41432-022-0826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/16/2022] [Indexed: 06/17/2023]
Abstract
Background The objective of this overview was to synthesise the current evidence on the role of endotoxins in endodontics infections and to evaluate the effectiveness of endodontic procedures in its removal using information from published systematic reviews.Methods Electronic databases Medline, Scopus, Embase, Cochrane Library and Google Scholar were searched for reviews published up to July 2021. Systematic reviews on endotoxins based on clinical and/or observational studies were included. The quality of systematic reviews was assessed with the AMSTAR2 tool.Results A total of five systematic reviews were selected, of which two reviews were of high quality. A significantly higher level of endotoxins were found in teeth with exudation, teeth with a previous episode of pain and pain on percussion. Chemomechanical preparation of root canals significantly reduce endotoxin levels. Calcium hydroxide intracanal medication in symptomatic teeth was significantly effective in endotoxin reduction (standardised mean difference -1.051 [95% confidence interval -2.039 to -0.063]; p <0.05; I2 = 83.3%; certainty of evidence = very low). Multiple session root canal treatment in teeth with symptomatic apical periodontitis was significantly more effective in endotoxins/lipopolysaccharides removal than single-session treatment.Conclusion Limited quality of evidence showed a significant association of endotoxins in infected teeth with clinical symptoms. Conventional chemomechanical preparation of root canals and intracanal medication were unable to eliminate endotoxins from the root canal system. Future evolution of effective disinfection therapies is warranted.
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Affiliation(s)
- Muhammad Z Ahmad
- Restorative Dentistry Department, College of Dentistry in Ar Rass, Qassim University, Alrass, Saudi Arabia
| | - Khalid A Merdad
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Durre Sadaf
- Department of Microbial Diseases, University College London, Eastman Dental Institute, London, United Kingdom.
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Ordinola-Zapata R, Noblett C, Perez-Ron A, Ye Z, Vera J. Present status and future directions of intracanal medicaments. Int Endod J 2022; 55 Suppl 3:613-636. [PMID: 35322427 PMCID: PMC9321724 DOI: 10.1111/iej.13731] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
Two fundamental goals of endodontic treatment are to prevent or treat apical periodontitis. From a predictive perspective, several variables can affect the outcome of root canal treatment. Some of these variables depend on intraoperative factors, which include irrigation technique, size of the apical preparation, use of intracanal medicaments or the number of appointments necessary to complete the treatment. However, the outcome may also be affected by host and microbial factors. The intensity of periradicular bone loss or tissue damage, the presence of preoperative pain and associated conditions such as mechanical allodynia and central sensitization, the anatomical complexity of the apical portion of the canal, and the virulence and longevity of the bacterial infection can all have a profound influence on the outcome. Furthermore, numerous medical conditions have been reported to decrease the capability of the immune system to heal the periapical tissues. It is the clinician's responsibility to analyse these variables and incorporate them into the disinfection strategy to maximize the chances of healing. This narrative review will focus on the present status of intracanal medicaments, the clinical indications for their use and future directions for research.
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Affiliation(s)
- R Ordinola-Zapata
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - C Noblett
- Division of Endodontics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | | | - Z Ye
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R, China.,Minnesota Dental Research Center for Biomaterials and Biomechanics (MDRCBB), School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - J Vera
- Division of Endodontics, School of Dentistry, University of Missouri, Kansas City, MO, USA
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Ahmad MZ, Sadaf D, Merdad KA, Almohaimeed A, Onakpoya IJ. Calcium hydroxide as an intracanal medication for postoperative pain during primary root canal therapy: A systematic review and meta-analysis with trial sequential analysis of randomised controlled trials. J Evid Based Dent Pract 2021; 22:101680. [DOI: 10.1016/j.jebdp.2021.101680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/08/2021] [Accepted: 11/28/2021] [Indexed: 12/01/2022]
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Nascimento GG, Rabello DGD, Corazza BJM, Gomes APM, Silva EG, Martinho FC. Comparison of the effectiveness of single- and multiple-sessions disinfection protocols against endotoxins in root canal infections: systematic review and meta-analysis. Sci Rep 2021; 11:1226. [PMID: 33441646 PMCID: PMC7806761 DOI: 10.1038/s41598-020-79300-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022] Open
Abstract
This systematic review (SR) addressed the following common clinical question: What is more effective in reducing or eliminating endotoxin in endodontic infections—single or multiple-session treatments using calcium hydroxide medications? Literature searches of Medline/PubMed, Embase, Cochrane Library, Scielo, Science Direct, Web of Knowledge, Scopus, and Google Scholar databases. Two reviewers independently assessed the eligibility for inclusion, extracted data, and evaluated the quality of the studies using the risk of bias tools. Electronic searches resulted in 358 articles, of which 32 studies were included for full-text assessment, and nine were included in this review. Meta-analysis pooling all the nine studies revealed lower levels of endotoxin for multiple-session treatment (P < 0.001). The sub-group analysis indicated no difference between single-session and 7 days of Ca(OH)2 medication (SMD − 0.32; P = 0.22). However, 14-days (I2 = 80.5%, P < 0.001) and 30-days (I2 = 78.9%, P < 0.01) of Ca(OH)2 medication was more effective than single-session treatment (both, p < 0.001). Overall, Overall, this SR provides evidence to support that multiple-session disinfection protocols with the placement of Ca(OH)2 medications are more effective in reducing the levels of endotoxin from root canal infections compared to single-session when applied for 14 and 30 days.
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Affiliation(s)
- Gustavo G Nascimento
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Diego G D Rabello
- Endodontic Division, Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University, São José dos Campos, São Paulo, Brazil
| | - Bruna J M Corazza
- Endodontic Division, Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University, São José dos Campos, São Paulo, Brazil
| | - Ana P M Gomes
- Endodontic Division, Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University, São José dos Campos, São Paulo, Brazil
| | - Eduardo G Silva
- Department of Social and Pediatric Dentistry, Institute of Science and Technology, São Paulo State University, São José dos Campos, São Paulo, Brazil
| | - Frederico C Martinho
- Endodontic Division, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.
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Effects of different pulp-capping materials on cell death signaling pathways of lipoteichoic acid-stimulated human dental pulp stem cells. Odontology 2020; 109:547-559. [PMID: 33206337 DOI: 10.1007/s10266-020-00571-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE This study aimed to evaluate the response of dental pulp stem cells (DPSCs) cultured with and without lipoteichoic acid (LTA) to different pulp-capping materials. METHODS The cells were cultured and seeded in 6-well plates and exposed to 1% LTA solution. Dycal, ProRoot MTA and Biodentine materials were applied on cells and all groups were evaluated by cell proliferation, viability, cell cycle and cell death signaling pathways for 24 and 72 h. RESULTS LTA + Dycal treatment significantly inhibited the proliferation of DPSCs and increased the apoptosis rate of cells more than the other groups at 72 h. Compared to other groups, LTA + Dycal treatment significantly increased the levels of Caspase-3 and AKT and decreased the levels of p-AKT. CONCLUSIONS The results of this study revealed that all tested materials caused apoptosis in DPSCs via an extrinsic apoptotic pathway. The DPSCs showed an early apoptosis response to the Dycal and a late apoptosis response to the ProRoot MTA and Biodentine treatments. LTA led autophagy and inhibited the proliferation of DPSCs. ProRoot MTA and Biodentin eliminated the LTA's bioactivity with higher efficiency than Dycal.
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Photosensitizers attenuate LPS-induced inflammation: implications in dentistry and general health. Lasers Med Sci 2020; 36:913-926. [PMID: 33150475 DOI: 10.1007/s10103-020-03180-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
Antimicrobial photodynamic therapy (aPDT) is a complementary therapeutic modality for periodontal and endodontic diseases, in which Gram-negative bacteria are directly involved. Currently, there are few evidences regarding the effects of aPDT on bacterial components such as lipopolysaccharide (LPS) and it would represent a major step forward in the clinical use of this therapy. In this context, this study aimed to evaluate the efficacy of different photosensitizers (PSs) used in aPDT in LPS inhibition. Four PSs were used in this study: methylene blue (MB), toluidine blue (TBO), new methylene blue (NMB), and curcumin (CUR). Different approaches to evaluate LPS interaction with PSs were used, such as spectrophotometry, Limulus amebocyte lysate (LAL) test, functional assays using mouse macrophages, and an in vivo model of LPS injection. Spectrophotometry showed that LPS decreased the absorbance of all PSs used, indicating interactions between the two species. LAL assay revealed significant differences in LPS concentrations upon pre-incubation with the different PSs. Interestingly, the inflammatory potential of LPS decreased after previous treatment with the four PSs, resulting in decreased secretion of inflammatory cytokines by macrophages. In vivo, pre-incubating curcumin with LPS prevented animals from undergoing septic shock within the established time. Using relevant models to study the inflammatory activity of LPS, we found that all PSs used in this work decreased LPS-induced inflammation, with a more striking effect observed for NMB and curcumin. These data advance the understanding of the mechanisms of LPS inhibition by PSs.
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Verma N, Sangwan P, Tewari S, Duhan J. Effect of Different Concentrations of Sodium Hypochlorite on Outcome of Primary Root Canal Treatment: A Randomized Controlled Trial. J Endod 2019; 45:357-363. [PMID: 30827769 DOI: 10.1016/j.joen.2019.01.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/23/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the effect of 2 different concentrations of sodium hypochlorite on healing and postoperative pain after primary endodontic treatment. METHODS One hundred mandibular molars with pulp necrosis and chronic apical periodontitis were randomly assigned to 2 treatment groups: high-concentration (HC) 5% sodium hypochlorite and low-concentration (LC) 1% sodium hypochlorite. Root canal treatment was performed using a standardized protocol. Canals were prepared using equal volumes of respective irrigants after each instrument change. After chemomechanical preparation, the final flush was performed with 5 mL 17% EDTA solution followed by 5 mL 5% or 1% sodium hypochlorite depending on the group. All patients were asked to record the degree of pain on a visual analog scale every 24 hours for 1 week. At the second visit, canals were obturated, and the teeth were restored permanently. Clinical and radiographic evaluations were performed every 3 months for 12 months. The data collected were statistically analyzed. RESULTS Eighty-six teeth were available for evaluation at the 1-year follow-up. The overall healing rate observed was 76.7%. Greater healing was observed in the HC (81.4%) group compared with the LC group (72.1%), but the difference was not statistically significant (P > .05). No significant differences in pain incidence and pain scores were found between the 2 groups (P >.05), with lower values reported in the LC group. CONCLUSIONS The use of LC or HC sodium hypochlorite did not result in a significant difference in the clinical outcome.
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Affiliation(s)
- Neha Verma
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Pankaj Sangwan
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India.
| | - Sanjay Tewari
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Jigyasa Duhan
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
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de Oliveira RL, Guerisoli DMZ, Duque JA, Alcalde MP, Onoda HK, Domingues FHF, Vivan RR, Duarte MAH. Computed microtomography evaluation of calcium hydroxide-based root canal dressing removal from oval root canals by different methods of irrigation. Microsc Res Tech 2019; 82:232-237. [PMID: 30614119 DOI: 10.1002/jemt.23164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/12/2018] [Accepted: 09/26/2018] [Indexed: 11/12/2022]
Abstract
The aim of this study was to evaluate the capacity of conventional irrigation, passive ultrasonic irrigation (PUI), and Easy Clean for removing calcium hydroxide-based root canal dressing from oval root canals. Thirty mandibular uniradicular incisors with oval canals were used, and subjected to chemical-mechanical preparation with Reciproc R40 instruments. The main canal was filled with a paste based on Ca(OH)2 P.A., iodoform and propylene glycol in the ratio of 3:1:1. The teeth were stored in 100% humidity at a temperature of 37°C for 14 days. Afterwards, the teeth were divided into three groups (n = 10) according to the method of irrigation used (conventional irrigation, PUI, and Easy Clean). The specimens were analyzed by computed microtomography at three time intervals: before placing the root canal dressing, with the root canal dressing in place, and after application of the irrigation methods for removing it. The data were submitted to Kruskal-Wallis and Dunn tests for analyzing the canal as a whole, and Friedman and Dunn for analyzing the root thirds. The results showed that conventional irrigation was less efficient for removing the root canal dressing in comparison with the methods that agitated the irrigant solution (p < .05). When the root canal was analyzed as a whole, Easy Clean, and PUI were similar (p > .05). In analysis of the thirds, Easy Clean was more efficient than conventional irrigation in all the thirds, while PUI showed this behavior only in the cervical third (p < .05). The authors concluded that in oval canals, none of the irrigation methods were capable of removing all the root canal dressing, however, the methods that agitated the irrigant solution were more efficient than conventional irrigation.
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Affiliation(s)
- Renata L de Oliveira
- Faculty of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Mississippi, Brazil
| | - Danilo M Z Guerisoli
- Faculty of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Mississippi, Brazil
| | - Jussaro A Duque
- Department of Dentistry, Endodontics and Dental Materials Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Murilo P Alcalde
- Department of Dentistry, Endodontics and Dental Materials Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Hélio K Onoda
- Faculty of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Mississippi, Brazil
| | | | - Rodrigo R Vivan
- Department of Dentistry, Endodontics and Dental Materials Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Marco A H Duarte
- Department of Dentistry, Endodontics and Dental Materials Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Kamath S, Shetty R, Shetty S, Nighot N, Ramnani K, Bhujbal D. Efficacy of XP-Endo finisher in removal of calcium hydroxide from root canal system: A systematic review. JOURNAL OF THE INTERNATIONAL CLINICAL DENTAL RESEARCH ORGANIZATION 2019. [DOI: 10.4103/jicdro.jicdro_15_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Madarati AA, Zafar MS, Sammani AMN, Mandorah AO, Bani-Younes HA. Preference and usage of intracanal medications during endodontic treatment. Saudi Med J 2018; 38:755-763. [PMID: 28674723 PMCID: PMC5556285 DOI: 10.15537/smj.2017.7.18345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To investigate the preferences of general dental practitioners (GDPs) and endodontists in using endodontic intra-canal medications (ICMs). Methods: This observational and descriptive study was conducted in 2014 in the western province of Saudi Arabia. Following ethical clearance and 2 pilot studies, a web-based questionnaire was electronically sent to 375 randomly and systematically selected GDPs and all endodontists in the western province (n=49). An accompanying e-mail explained the study’s aims and confirmed that the data yielded would remain confidential. The responses were collected, and the data was analyzed using the Chi-square test at p=0.05. Results: Significantly, the highest proportion of respondents (53.7%) reported disinfection of the root canals as the main function of ICMs. Calcium hydroxide (CH) was the preferred material of the majority of those who used the same ICM in all cases (85.7%). While the vast majority of all endodontists (87.5%) used CH after pulp extirpation, 48.5% of GDPs used formocresol (p<0.001). Almost 30% of those who used ICMs after pulp extirpation did not do so after cleaning and shaping of vital cases. Most endodontists used CH (62.5%) and antibiotics (37.5%) in necrotic pulp cases without apical lesions, which were significantly greater than those of GDPs who did the same (43.8% and 17.2%). Conclusions: Participants were aware that the main function of ICMs is disinfection of the root canal system. However, it is clear that GDPs should reduce their reliance on phenol- and formaldehyde-based medications. There was a distinct trend toward the use of ICMs, especially CH, in necrotic pulp cases.
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Affiliation(s)
- Ahmad A Madarati
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Makkah, Kingdom of Saudi Arabia. E-mail.
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Shrestha A, Friedman S, Torneck CD, Kishen A. Bioactivity of Photoactivated Functionalized Nanoparticles Assessed in Lipopolysaccharide-contaminated Root Canals In Vivo. J Endod 2017; 44:104-110. [PMID: 29153731 DOI: 10.1016/j.joen.2017.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The persistence of dentin-bound lipopolysaccharides (LPS) in disinfected root canals impedes treatment outcomes of endodontic procedures. This study assessed the effects of photoactivated rose bengal-functionalized chitosan nanoparticles (CSRBnps) on LPS-contaminated root dentin in vivo using an intraosseous implantation model and neotissue formation as a marker. METHODS Fifty human, 3-mm-long root segments with a 1.2-mm canal lumen were divided into 5 groups (n = 10): group 1, canals not contaminated; group 2, canals contaminated with Pseudomonas aeruginosa LPS; group 3, canals contaminated and disinfected with sodium hypochlorite (NaOCl); group 4, canals contaminated and disinfected with NaOCl and calcium hydroxide; and group 5, canals contaminated and disinfected with NaOCl and CSRBnps (300 μg/mL) with photoactivation (λ = 540 nm, 40 J/cm2). Specimens were implanted into mandibles of guinea pigs, block dissected after 4 weeks, and the canal content evaluated histologically and immunohistochemically. The ingrown neotissue interface (50 μm) with dentin was characterized for fibroblasts, osteoclasts, inflammatory markers, dentin resorption, mineralization, and angiogenesis and dichotomized as type 1 (no inflammation and resorption, indicative of LPS inactivation) or type 2 (inflammation and resorption). The frequency of the observed parameters was analyzed using the Fisher exact test. RESULTS The outcome was categorized as type 1 in groups 1 and 5, type 2 in group 2, and mixed type 1 and 2 in groups 3 and 4. The outcomes in groups 1 and 5 (P > .05) differed significantly (P < .05) from those in groups 2, 3, and 4. CONCLUSIONS Disinfection of LPS-contaminated root canals with photoactivated CSRBnps in vivo supported ingrowth of neotissue without signs of inflammation or resorption, suggestive of effective inactivation of dentin-bound LPS.
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Affiliation(s)
- Annie Shrestha
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Shimon Friedman
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Calvin D Torneck
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Anil Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
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Hamdan R, Michetti J, Pinchon D, Diemer F, Georgelin-Gurgel M. The XP-Endo Finisher for the removal of calcium hydroxide paste from root canals and from the apical third. J Clin Exp Dent 2017; 9:e855-e860. [PMID: 28828150 PMCID: PMC5549582 DOI: 10.4317/jced.53962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background The aim was to compare the efficacy of the passive ultrasonic irrigation PUI and the Xp-endo Finisher (FKG-Dentaire, La-Chaux-de-Fonds, Switzerland) in removing the calcium hydroxide paste from root canals and from the apical third. Material and Methods Sixty-eight root canals of single-rooted teeth were shaped using the BT-Race files (FKG-Dentaire, La-Chaux-de-Fonds, Switzerland). Ca(OH)2 was placed in all samples except for the negative control group (n=4). Remaining teeth were randomly divided into three groups: G1-Xp (n=30), G2-PUI (n=30) and the positive control group (n=4). Removal procedure consisted of three repeated one-minute-cycles. Samples were split longitudinally, photos of halves were taken at X6.4 magnification and were analyzed using the ImageJ-Software (The National Institutes of Health NIH, Bethesda, Maryland, USA) to calculate the percentage of surfaces with residual Ca(OH)2; the results were compared using the Wilcoxon-Mann Whitney test. Photos of the apical thirds were taken at X16 and X40 magnifications and were scored by two examiners from (0) to (4). Scores of the apical third were compared using the Fisher test. Results The Xp-endo Finisher removed completely the Ca(OH)2 dressing from four teeth (13.33%) whereas the PUI in one tooth (3.33%). The mean values of the remaining Ca(OH)2 were (2.1%, 3.6%) respectively and the difference was not significant (p= 0.195). Both examiners found the Xp-endo Finisher more efficient in the apical third and the difference was significant; p= (0.025, 0.047) respectively. Conclusions The Xp-endo Finisher showed a superiority over the PUI in removing the Ca(OH)2 from the apical third after 3 minutes of activation. Key words:Calcium hydroxide removal, Passive ultrasonic irrigation, Xp-endo Finisher.
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Affiliation(s)
- Rami Hamdan
- DDS. Service d'Odontologie Conservatrice-Endodontie, Faculté de Chirurgie Dentaire, Toulouse and the CHU de Toulouse, 3 Chemin des Maraîchers, 31400 Toulouse, France
| | - Jérôme Michetti
- MDS. Service d'Odontologie Conservatrice-Endodontie, Faculté de Chirurgie Dentaire, Toulouse and the CHU de Toulouse, 3 Chemin des Maraîchers, 31400 Toulouse, France and IRIT - UMR CNRS 5505, Avenue de l'étudiant, 31400 Toulouse, France
| | - Déborah Pinchon
- DDS. Service d'Odontologie Conservatrice-Endodontie, Faculté de Chirurgie Dentaire, Toulouse and the CHU de Toulouse, 3 Chemin des Maraîchers, 31400 Toulouse, France
| | - Franck Diemer
- PHD. Service d'Odontologie Conservatrice-Endodontie, Faculté de Chirurgie Dentaire, Toulouse and the CHU de Toulouse, 3 Chemin des Maraîchers, 31400 Toulouse, France and Institut Clément Ader (ICA, FRE CNRS 3687), 3 Rue Caroline Aigle, 31400 Toulouse, France
| | - Marie Georgelin-Gurgel
- PHD. Service d'Odontologie Conservatrice-Endodontie, Faculté de Chirurgie Dentaire, Toulouse and the CHU de Toulouse, 3 Chemin des Maraîchers, 31400 Toulouse, France
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Reestablishing the Function and Esthetics in Traumatized Permanent Teeth with Large Apical Lesion. Case Rep Dent 2017; 2016:3830813. [PMID: 28078147 PMCID: PMC5203891 DOI: 10.1155/2016/3830813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/11/2016] [Accepted: 11/29/2016] [Indexed: 11/17/2022] Open
Abstract
Dental trauma is a challenge for dental integrity and can lead to pulp necrosis. The clinical case reports the diagnosis of a maxillary right central incisor traumatized and its multidisciplinary treatment. Calcium hydroxide material was used to perform the processing apexification. An apical surgery was carried out to remove the apical periodontitis and to return the aesthetics to the patient; internal and external tooth whitening in maxillary right central incisor was performed. We conclude that surgery associated with the root filling in the central incisor led to a successful completion. Moreover, it is of utmost importance to demonstrate the interaction between the various areas of dentistry.
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Samiei M, Shahi S, Abdollahi AA, Eskandarinezhad M, Negahdari R, Pakseresht Z. The Antibacterial Efficacy of Photo-Activated Disinfection, Chlorhexidine and Sodium Hypochlorite in Infected Root Canals: An in Vitro Study. IRANIAN ENDODONTIC JOURNAL 2016; 11:179-83. [PMID: 27471527 PMCID: PMC4947840 DOI: 10.7508/iej.2016.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/04/2016] [Accepted: 04/22/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study compared the efficacy of light-activated low-power laser, 2% chlorhexidine (CHX) and 2.5% NaOCl in eliminating Enterococcus faecalis (E. faecalis) from the root canal system. METHODS AND MATERIALS The root canals of 60 maxillary central incisors were contaminated with E. faecalis and then the bacteria were incubated for 24 h. All the root canals were instrumented in a crown-down manner with #4 and 3 Gates-Glidden drills, followed by RaCe rotary files (40/0.10, 35/0.08, and 30/0.06). The samples were randomly assigned to three experimental groups and one control group (n=15). In the control group no intervention was made. In the photo-activated disinfection (PAD) group, laser therapy was undertaken with diode laser beams (with an output power of 100 mW/cm(2)) for 120 sec. For the other two experimental groups, root canals were irrigated either with 5 mL of 2% CHX or 2.5% NaOCl solutions, respectively. The Kruskal-Wallis test was used to compare the CFU values of the bacteria and post-hoc Bonferroni test was used for pairwise comparisons. The level of significance was set at 0.05. RESULTS The inhibition of bacterial growth in all the experimental groups was significantly superior to the control group (P<0.05). There was no significant difference between the effect of PAD and 2% CHX (P=0.05). The effect of 2.5% NaOCl was significantly better than that of the PAD technique (P<0.001). In addition, 2.5% NaOCl was significantly better than 2% CHX (P=0.007). CONCLUSION Photodynamic therapy was effective in reducing the E. faecalis counts in comparison with the control group, but 2.5% NaOCl solution was the most effective protocol.
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Affiliation(s)
- Mohammad Samiei
- Department of Endodontics, Dental and Periodontal Research Center, Dental School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahriar Shahi
- Department of Endodontics, Dental and Periodontal Research Center, Dental School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Ardalan Abdollahi
- Department of Endodontics, Dental and Periodontal Research Center, Dental School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahsa Eskandarinezhad
- Department of Endodontics, Dental and Periodontal Research Center, Dental School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramin Negahdari
- Department of Prosthodontics, Dental and Periodontal Research Center, Dental School, Tabriz University of Medical Sciences, Tabriz, Iran
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Joy Sinha D, Garg P, Verma A, Malik V, Maccune ER, Vasudeva A. Dentinal Tubule Disinfection with Propolis & Two Extracts of Azadirachta indica Against Candida albicans Biofilm Formed on Tooth Substrate. Open Dent J 2015; 9:369-74. [PMID: 26962368 PMCID: PMC4763964 DOI: 10.2174/1874210601509010369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 08/26/2015] [Accepted: 09/13/2015] [Indexed: 11/22/2022] Open
Abstract
Aim: This study evaluates the disinfection of dentinal tubules using Propolis, Azadirachta indica (alcoholic and aqueous extracts), 2% chlorhexidine gel and calcium hydroxide against Candida albicans biofilm formed on tooth substrate. Materials & Method: One hundred and five human teeth were infected with Candida albicans for 2 days. Samples were divided into 7 groups. Group I- Propolis, Group II- Alcoholic extract of Azadirachta indica, Group III- Aqueous extract of Azadirachta indica, Group IV- 2% Chlorhexidine, Group V- Calcium hydroxide, Group VI- Ethanol and Group VII- Saline (negative control). At the end of 1,3 and 5 days, the antimicrobial efficacy of medicaments against Candida albicans was assessed at the depths of 200 µm and 400 µm. Results: The overall percentage inhibition of fungal growth (at 200 µm and 400 µm depth) was 99.2% with 2% chlorhexidine gel. There was no statistical difference between propolis, alcoholic extract of Azadirachta indica (neem) and 2% chlorhexidine. Conclusion: Propolis and alcoholic extract of Azadirachta indica performed equally well as that of 2% Chlorhexidine.
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Affiliation(s)
- Dakshita Joy Sinha
- Conservative Dentistry & Endodontics, Kothiwal Dental College & Research Centre, Moradabad (U.P.)- 244001, India
| | - Paridhi Garg
- Conservative Dentistry & Endodontics, Kothiwal Dental College & Research Centre, Moradabad (U.P.)- 244001, India
| | - Anurag Verma
- School of Pharmaceutical Sciences, IFTM University, Moradabad, India
| | | | | | - Agrima Vasudeva
- Conservative Dentistry & Endodontics, Kothiwal Dental College & Research Centre, Moradabad (U.P.)- 244001, India
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Ethem Yaylali I, Kececi AD, Ureyen Kaya B. Ultrasonically Activated Irrigation to Remove Calcium Hydroxide from Apical Third of Human Root Canal System: A Systematic Review of In Vitro Studies. J Endod 2015; 41:1589-99. [DOI: 10.1016/j.joen.2015.06.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/11/2015] [Accepted: 06/15/2015] [Indexed: 11/29/2022]
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Zayed M, Hassan R, Riad M. Evaluation of the antibacterial efficacy of different bioactive lining and pulp capping agents. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.tdj.2015.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Çiçek E, Bodrumlu E. Power Hydrogen Evaluation of Apexification Materials: EndoCal 10, Mineral Trioxide Aggregate and Calasept Plus. J Contemp Dent Pract 2015; 16:463-7. [PMID: 26323449 DOI: 10.5005/jp-journals-10024-1707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The present study was to evaluate pH values of apexification materials. MATERIALS AND METHODS The materials were placed in 1 cm long and 4 mm diameter tubes. After sample immersion, glass flasks were hermetically sealed with rubber caps to attenuate any effects of external environmental factors and maintained at 37°C. The power hydrogen of the pastes was measured 1 hour, 3 hours, 8 hours, 24 hours, 72 hours and 7 days after preparation. pH was calibrated with solutions of known pH (7.0). Mann-Whitney test were used to determine significant differences. RESULTS The mean pH of all medications was < 12.0 throughout the experiment. At 24 hours, EndoCal 10 had the highest pH of all the materials (p < 0.05). CONCLUSION According to the results obtained, it may be concluded that calcium oxide (EndoCal 10) presented the highest pH compared with mineral trioxide aggregate (MTA) and Calasept Plus [Ca(OH)2]. CLINICAL SIGNIFICANCE Apexification is an important treatment in immature teeth. For this reason, used materials in apexification should have some properties, such as high pH and stimulating to be hard tissue. Therefore, the material should be chosen carefully in apexification of immature teeth.
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Affiliation(s)
- Ersan Çiçek
- Department of Endodontics, Faculty of Dentistry, Bulent Ecevit University, Zonguldak, Turkey, Phone: +903722613413, e-mail:
| | - Emre Bodrumlu
- Department of Endodontics, Faculty of Dentistry, Bulent Ecevit University, Zonguldak, Turkey
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Shrestha A, Cordova M, Kishen A. Photoactivated polycationic bioactive chitosan nanoparticles inactivate bacterial endotoxins. J Endod 2015; 41:686-91. [PMID: 25637193 DOI: 10.1016/j.joen.2014.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/01/2014] [Accepted: 12/07/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The current root canal disinfection protocols fail to markedly inactivate bacterial endotoxins from infected root dentin. This study aimed to evaluate the ability of antibacterial photodynamic therapy with chitosan-conjugated rose bengal nanoparticles (CSRBnps) to selectively inactivate endotoxins/lipopolysaccharides (LPSs). METHODS Antimicrobial agents such as calcium hydroxide (Ca[OH]2), chitosan nanoparticles (CSnps), CSRBnps, and methylene blue (MB) were assessed for their ability to neutralize LPSs obtained from Pseudomonas aeruginosa in a time-dependent interaction with/without photoactivation (20 and 40 J/cm(2)). The inflammatory potential of the treated/untreated LPSs was assessed on macrophage cells (RAW 267.4) using nitric oxide- and enzyme-linked immunosorbent assay (tumor necrosis factor α and interleukin-6 expression)-based analysis. These antimicrobials were tested directly on macrophage cells for cytotoxicity using the mitochondrial activity assay and light microscopy. The data were analyzed using 1-way analysis of variance and the Tukey test. RESULTS CSnps were least effective in LPS inactivation. Interluekin-6 expression was reduced only with CSRBnp treatment. CSnps and CSRBnps were completely nontoxic, and MB showed slight toxicity to macrophage cells. Ca(OH)2 was highly cytotoxic (P < .005) even at 30 minutes of exposure. CSRBnps and MB with/without photoactivation significantly inactivated LPSs with reduced nitric oxide and tumor necrosis factor α expression (P < .05). Cell death and detachment after Ca(OH)2 treatment resulted in complete absence of all 3 inflammatory markers. CONCLUSIONS Photodynamically activated CSRBnps caused significant inactivation of endotoxins and the subsequent reduction of all tested inflammatory markers from activated macrophages. Antimicrobial CSRBnps in combination with photodynamic therapy showed the potential to effectively inactivate bacterial endotoxins.
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Affiliation(s)
- Annie Shrestha
- Discipline of Endodontics, University of Toronto, Toronto, Ontario, Canada
| | - Martha Cordova
- Dental Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Anil Kishen
- Discipline of Endodontics, University of Toronto, Toronto, Ontario, Canada.
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Batista VEDS, Olian DD, Mori GG. Diffusion of hydroxyl ions from calcium hydroxide and Aloe vera pastes. Braz Dent J 2014; 25:212-6. [PMID: 25252256 DOI: 10.1590/0103-6440201300021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/02/2014] [Indexed: 11/22/2022] Open
Abstract
This study evaluated the diffusion through the dentinal tubules of hydroxyl ions from different calcium hydroxide (CH) pastes containing Aloe vera. Sixty single-rooted bovine teeth were used. The tooth crowns were removed, the root canals were instrumented and the specimens were assigned to 4 groups (n=15) according to the intracanal medication: Group CH/S - CH powder and saline paste; Group CH/P - CH powder and propylene glycol paste; Group CH/A - calcium hydroxide powder and Aloe vera gel paste; Group CH/A/P - CH powder, Aloe vera powder and propylene glycol paste. After placement of the root canal dressings, the teeth were sealed coronally and apically with a two-step epoxy adhesive. The teeth were placed in identified flasks containing deionized water and stored in an oven with 100% humidity at 37 °C. After 3 h, 24 h, 72 h, 7 days, 15 days and 30 days, the deionized water in the flasks was collected and its pH was measured by a pH meter. The obtained data were subjected to statistical analysis at a significance level of 5%. The results demonstrated that all pastes provided diffusion of hydroxyl ions through the dentinal tubules. The combination of Aloe vera and CH (group CH/A) provided a constant release of calcium ions. Group CH/A/P showed the highest pH at 24 and 72 h. In conclusion, the experimental pastes containing Aloe vera were able to enable the diffusion of hydroxyl ions through the dentinal tubules.
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Affiliation(s)
- Victor Eduardo de Souza Batista
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, UNESP - Univ Estadual Paulista, Araçatuba, SP, Brazil
| | | | - Graziela Garrido Mori
- Department of Integrated Clinics, Adamantina School of Dentistry, FAI - Integrated Colleges of Adamantina, Adamantina, SP, Brazil
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Sousa ELR, Martinho FC, Leite FRM, Nascimento GG, Gomes BPFA. Macrophage cell activation with acute apical abscess contents determined by interleukin-1 Beta and tumor necrosis factor alpha production. J Endod 2014; 40:1752-7. [PMID: 25205261 DOI: 10.1016/j.joen.2014.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 04/22/2014] [Accepted: 06/10/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This clinical study has investigated the antigenic activity of bacterial contents from exudates of acute apical abscesses (AAAs) and their paired root canal contents regarding the stimulation capacity by levels of interleukin (IL)-1 beta and tumor necrosis factor alpha (TNF-α) throughout the root canal treatment against macrophage cells. METHODS Paired samples of infected root canals and exudates of AAAs were collected from 10 subjects. Endodontic contents were sampled before (root canal sample [RCS] 1) and after chemomechanical preparation (RCS2) and after 30 days of intracanal medication with calcium hydroxide + chlorhexidine gel (Ca[OH]2 + CHX gel) (RCS3). Polymerase chain reaction (16S rDNA) was used for detection of the target bacteria, whereas limulus amebocyte lysate was used to measure endotoxin levels. Raw 264.7 macrophages were stimulated with AAA exudates from endodontic contents sampled in different moments of root canal treatment. Enzyme-linked immunosorbent assays were used to measure the levels of TNF-α and IL-1 beta. RESULTS Parvimonas micra, Porphyromonas endodontalis, Dialister pneumosintes, and Prevotella nigrescens were the most frequently detected species. Higher levels of endotoxins were found in samples from periapical exudates at RCS1 (P < .005). In fact, samples collected from periapical exudates showed a higher stimulation capacity at RCS1 (P < .05). A positive correlation was found between endotoxins from exudates with IL-1 beta (r = 0.97) and TNF-α (r = 0.88) production (P < .01). The significant reduction of endotoxins and bacterial species achieved by chemomechanical procedures (RCS2) resulted in a lower capacity of root canal contents to stimulate the cells compared with that at RCS1 (P < .05). The use of Ca(OH)2 + CHX gel as an intracanal medication (RCS3) improved the removal of endotoxins and bacteria from infected root canals (P < .05) whose contents induced a lower stimulation capacity against macrophages cells at RCS1, RCS2, and RCS3 (P < .05). CONCLUSIONS AAA exudates showed higher levels of endotoxins and showed a greater capacity of macrophage stimulation than the paired root canal samples. Moreover, the use of intracanal medication improved the removal of bacteria and endotoxins from infected root canals, which may have resulted in the reduction of the inflammatory potential of the root canal content.
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Affiliation(s)
- Ezilmara L R Sousa
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas, UNICAMP, Piracicaba, São Paulo, Brazil; Department of Conservative Dentistry, Endodontics Division, Pelotas School of Dentistry
| | - Frederico C Martinho
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas, UNICAMP, Piracicaba, São Paulo, Brazil; Department of Restorative Dentistry, Endodontics Division, São Jose dos Campos Dental School, State University of São Paulo, UNESP, São Jose dos Campos, São Paulo, Brazil
| | | | - Gustavo G Nascimento
- Pelotas School of Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas, UNICAMP, Piracicaba, São Paulo, Brazil.
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Ganesh MR, Chaurasia VR, Masamatti VKS, Mujeeb A, Jhamb A, Agarwal JH. In vitro evaluation of antibacterial efficacy of calcium hydroxide in different vehicles. J Int Soc Prev Community Dent 2014; 4:56-60. [PMID: 24818097 PMCID: PMC4015164 DOI: 10.4103/2231-0762.131268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM This study was aimed to evaluate the antibacterial effect of calcium hydroxide (CH) in different vehicles in an in vitro model. MATERIALS AND METHODS Calcium hydroxide paste prepared with two conventionally used vehicles namely, camphorated monochlophenol, distilled water and propylene glycol. The antibacterial activity of these paste were tested against five micro-organisms that can commonly occur in the infected root canals. RESULTS The results of this study indicate that a paste of CH made with propylene glycol exerts significant antibacterial action. Hence, it can be recommended for use as an intracanal medicament in preference to a paste prepared with a tissue toxic phenolic compound like camphorated monochlorophenol.
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Affiliation(s)
- M R Ganesh
- Department of Conservative Dentistry and Endodontics, Institute of Dental Science, Bareilly, India
| | | | | | - Abdul Mujeeb
- Department of Operative Dentistry, College of Dentistry, Taibha University, Al-Madinah Al- Munawarah, Saudi Arabia
| | - Ashu Jhamb
- Yamuna Institute of Dental Sciences and Research, Gadholi, Yamunanagar, Haryana, India
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Adl A, Motamedifar M, Shams MS, Mirzaie A. Clinical investigation of the effect of calcium hydroxide intracanal dressing on bacterial lipopolysaccharide reduction from infected root canals. AUST ENDOD J 2013; 41:12-6. [PMID: 24330326 DOI: 10.1111/aej.12054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this clinical study was to determine the effect of 7 day intracanal dressing with calcium hydroxide on the amount of bacterial lipopolysaccharide (LPS; endotoxin) in human teeth with necrotic and infected pulp and apical periodontitis. Twenty-five single-rooted teeth with necrotic pulps and apical periodontitis were selected. Samples were collected before (S1), after root canal preparation (S2) and after 7 day intracanal dressing with calcium hydroxide (S3). The limulus amoebocyte lysate assay was used to quantify LPS. LPS was present in 100% of the root canals before (S1), after preparation (S2) and after 7 day intracanal dressing (S3). A significant reduction, equal to 29.54%, was found after root canal preparation (P < 0.05). A significant difference (equal to 25.26% reduction) was also detected between S2 and S3 (P < 0.05). Total endotoxin reduction (S3 compared with S1) was found to be 47.34%. Endotoxin concentration of the infected root canals was reduced after root canal preparation and also after 7 days of dressing of canals with calcium hydroxide; however, relatively high values of endotoxin remained in the root canals.
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Affiliation(s)
- Alireza Adl
- Department of Endodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Vaziri S, Kangarlou A, Shahbazi R, Nazari Nasab A, Naseri M. Comparison of the bactericidal efficacy of photodynamic therapy, 2.5% sodium hypochlorite, and 2% chlorhexidine against Enterococcous faecalis in root canals; an in vitro study. Dent Res J (Isfahan) 2013; 9:613-8. [PMID: 23559928 PMCID: PMC3612200 DOI: 10.4103/1735-3327.104882] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Enterococcus faecalis has been widely used as a valuable microbiological pathogen for in vitro studies due to its ability to successfully colonize the root canal in a biofilm-like style, invade dentinal tubules, and resist endodontic treatment procedures.The aim of this study was to compare the bactericidal efficacy of photodynamic therapy (PDT), 2% chlorhexidine, 2.5% NaOCl, and combination of PDT and 2.5% NaOCl against E. faecalis. MATERIALS AND METHODS Sixty single-rooted teeth had their canals contaminated with E. faecalis in brain heart infusion broth and were incubated for 48 hours.The canals were then subjected to 2% chlorhexidine, 2.5% NaOCl, PDT (red light emitting diode 625 nm+ Toludine Blue) and PDT + 2.5% NaOCl. Controls consisted of no treatment (positive control) and without inoculation of bacterium (negative control). Following treatment, the canal contents were sampled with sterile paper points.The samples were dispersed in transport medium, serially diluted, and cultured on blood agar to determine the number of colony forming units (CFU). Data were analyzed by Mann-Whitney U test at 5% significance level. The significance level for all analyses was set at P <.05. RESULTS Combination of PDT and 2.5% NaOCl achieved maximum reduction in recovered viable bacteria, no viable bacteria was observed after treatment of PDT + 2.5% NaOCl. CONCLUSION Combination of PDT and 2.5% NaOCl simultaneously is effective in the elimination of E. faecalis from dentinal tubules under the conditions of this study.
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Affiliation(s)
- Shahram Vaziri
- Department of Oral Biology, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gomes BP, Vianna ME, Zaia AA, Almeida JFA, Souza-Filho FJ, Ferraz CCR. Chlorhexidine in Endodontics. Braz Dent J 2013; 24:89-102. [DOI: 10.1590/0103-6440201302188] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/02/2013] [Indexed: 11/21/2022] Open
Abstract
Chemical auxiliary substances (CAS) are essential for a successful disinfection and cleanness of the root canals, being used during the instrumentation and if necessary, as antimicrobial intracanal medicaments. Different CAS have been proposed and used, among which sodium hypochlorite (NaOCl), chlorhexidine (CHX), 17% EDTA, citric acid, MTAD and 37% phosphoric acid solution. CHX has been used in Endodontics as an irrigating substance or intracanal medicament, as it possesses a wide range of antimicrobial activity, substantivity (residual antimicrobial activity), lower cytotoxicity than NaOCl whilst demonstrating efficient clinical performance, lubricating properties, rheological action (present in the gel presentation, keeping the debris in suspension); it inhibits metalloproteinase, is chemically stable, does not stain cloths, it is odorless, water soluble, among other properties. CHX has been recommended as an alternative to NaOCl, especially in cases of open apex, root resorption, foramen enlargement and root perforation, due to its biocompatibility, or in cases of allergy related to bleaching solutions. The aim of this paper is to review CHX's general use in the medical field and in dentistry; its chemical structure, presentation form and storage; mechanism of action; antimicrobial activity including substantivity, effects on biofilms and endotoxins, effects on coronal and apical microbial microleakage; tissue dissolution ability; interaction with endodontic irrigants; effects on dentin bonding, metalloproteinases and collagen fibrils; its use as intracanal medicament and diffusion into the dentinal tubules; its use as disinfectant agent of obturation cones; other uses in the endodontic therapy; and possible adverse effects, cytotoxicity and genotoxicity.
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MAEKAWA LE, VALERA MC, de OLIVEIRA LD, CARVALHO CAT, CAMARGO CHR, JORGE AOC. Effect of Zingiber officinale and propolis on microorganisms and endotoxins in root canals. J Appl Oral Sci 2013; 21:25-31. [PMID: 23559108 PMCID: PMC3881809 DOI: 10.1590/1678-7757201302129] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 01/14/2013] [Accepted: 01/14/2013] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED The purpose of this study was to evaluate the effectiveness of glycolic propolis (PRO) and ginger (GIN) extracts, calcium hydroxide (CH), chlorhexidine (CLX) gel and their combinations as ICMs (ICMs) against Candida albicans, Enterococcus faecalis, Escherichia coli and endotoxins in root canals. MATERIAL AND METHODS After 28 days of contamination with microorganisms, the canals were instrumented and then divided according to the ICM: CH+saline; CLX, CH+CLX, PRO, PRO+CH; GIN; GIN+CH; saline. The antimicrobial activity and quantification of endotoxins by the chromogenic test of Limulus amebocyte lysate were evaluated after contamination and instrumentation at 14 days of ICM application and 7 days after ICM removal. RESULTS AND CONCLUSION After analysis of results and application of the Kruskal-Wallis and Dunn statistical tests at 5% significance level, it was concluded that all ICMs were able to eliminate the microorganisms in the root canals and reduce their amount of endotoxins; however, CH was more effective in neutralizing endotoxins and less effective against C. albicans and E. faecalis, requiring the use of medication combinations to obtain higher success.
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Affiliation(s)
- Lilian Eiko MAEKAWA
- DDS, MSc, PhD, Department of Restorative Dentistry, UNESP - Univ
Estadual Paulista, São José dos Campos, SP, Brazil
| | - Marcia Carneiro VALERA
- DDS, MSc, PhD, Chair Professor, Department of Restorative Dentistry,
UNESP - Univ Estadual Paulista, São José dos Campos, SP, Brazil
| | - Luciane Dias de OLIVEIRA
- DDS, MSc, PhD, Assistant Professor, Department of Biosciences and Oral
Diagnosis, UNESP - Univ Estadual Paulista, São José dos Campos, SP, Brazil
| | - Cláudio Antonio Talge CARVALHO
- DDS, MSc, PhD, Associate Professor, Department of Restorative
Dentistry, UNESP - Univ Estadual Paulista, São José dos Campos, SP, Brazil
| | - Carlos Henrique Ribeiro CAMARGO
- DDS, MSc, PhD, Associate Professor, Department of Restorative
Dentistry, UNESP - Univ Estadual Paulista, São José dos Campos, SP, Brazil
| | - Antonio Olavo Cardoso JORGE
- DDS, MSc, PhD, Chair Professor, Department of Oral Diagnosis and
Biosciences, UNESP - Univ Estadual Paulista, São José dos Campos, SP, Brazil
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Mohammadi Z, Shalavi S, Yazdizadeh M. Antimicrobial activity of calcium hydroxide in endodontics: a review. Chonnam Med J 2012; 48:133-40. [PMID: 23323217 PMCID: PMC3539092 DOI: 10.4068/cmj.2012.48.3.133] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 09/25/2012] [Accepted: 09/26/2012] [Indexed: 11/06/2022] Open
Abstract
The purpose of endodontic therapy is to preserve the patient's natural teeth without compromising the patient's local or systemic health. Calcium hydroxide has been included in several materials and antimicrobial formulations that are used in several treatment modalities in endodontics, such as inter-appointment intracanal medicaments. The purpose of this article was to review the antimicrobial properties of calcium hydroxide in endodontics. Calcium hydroxide has a high pH (approximately 12.5-12.8) and is classified chemically as a strong base. The lethal effects of calcium hydroxide on bacterial cells are probably due to protein denaturation and damage to DNA and cytoplasmic membranes. Calcium hydroxide has a wide range of antimicrobial activity against common endodontic pathogens but is less effective against Enterococcus faecalis and Candida albicans. Calcium hydroxide is also a valuable anti-endotoxin agent. However, its effect on microbial biofilms is controversial.
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Affiliation(s)
- Z Mohammadi
- Department of Endodontics, School of Dentistry, Hamedan University of Medical Sciences, Hamedan, Iran. ; Iranian Center for Endodontic Research (ICER), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ballal NV, Kumar SR, Laxmikanth HK, Saraswathi MV. Comparative evaluation of different chelators in removal of calcium hydroxide preparations from root canals. Aust Dent J 2012; 57:344-8. [DOI: 10.1111/j.1834-7819.2012.01710.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Endo MS, Martinho FC, Zaia AA, Ferraz CCR, Almeida JFA, Gomes BPFA. Quantification of cultivable bacteria and endotoxin in post-treatment apical periodontitis before and after chemo-mechanical preparation. Eur J Clin Microbiol Infect Dis 2012; 31:2575-83. [DOI: 10.1007/s10096-012-1598-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/29/2012] [Indexed: 10/28/2022]
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Maekawa LE, Valera MC, Oliveira LDD, Carvalho CAT, Koga-Ito CY, Jorge AOC. In vitro evaluation of the action of irrigating solutions associated with intracanal medications on Escherichia coli and its endotoxin in root canals. J Appl Oral Sci 2011; 19:106-12. [PMID: 21552710 PMCID: PMC4243747 DOI: 10.1590/s1678-77572011000200005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 02/16/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of auxiliary chemical substances and intracanal medications on Escherichia coli and its endotoxin in root canals. MATERIAL AND METHODS Teeth were contaminated with a suspension of E. coli for 14 days and divided into 3 groups according to the auxiliary chemical substance used: G1) 2.5% sodium hypochlorite (NaOCl); G2) 2% chlorhexidine gel (CLX); G3) pyrogen-free solution. After, these groups were subdivided according to the intracanal medication (ICM): A) Calcium hydroxide paste (Calen®), B) polymyxin B, and C) Calcium hydroxide paste+2% CLX gel. For the control group (G4), pyrogen-free saline solution was used without application of intracanal medication. Samples of the root canal content were collected immediately after biomechanical preparation (BMP), at 7 days after BMP, after 14 days of intracanal medication activity, and 7 days after removal of intracanal medication. The following aspects were evaluated for all collections: a) antimicrobial activity; b) quantification of endotoxin by the Limulus Amebocyte Lysate test (LAL). Results were analyzed by the Kruskal-Wallis and Dunn's tests at 5% significance level. RESULTS The 2.5% NaOCl and CLX were able to eliminate E. coli from root canal lumen and reduced the amount of endotoxin compared to saline. CONCLUSIONS It was concluded that 2.5% NaOCl and CLX were effective in eliminating E. coli. Only the studied intracanal medications were to reduce the amount of endotoxin present in the root canals, regardless of the irrigant used.
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Affiliation(s)
- Lilian Eiko Maekawa
- Department of Restorative Dentistry, São Paulo State University, São José dos Campos, SP, Brazil.
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37
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Mohammadi Z, Dummer PMH. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J 2011; 44:697-730. [PMID: 21535021 DOI: 10.1111/j.1365-2591.2011.01886.x] [Citation(s) in RCA: 341] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Calcium hydroxide has been included within several materials and antimicrobial formulations that are used in a number of treatment modalities in endodontics. These include, inter-appointment intracanal medicaments, pulp-capping agents and root canal sealers. Calcium hydroxide formulations are also used during treatment of root perforations, root fractures and root resorption and have a role in dental traumatology, for example, following tooth avulsion and luxation injuries. The purpose of this paper is to review the properties and clinical applications of calcium hydroxide in endodontics and dental traumatology including its antibacterial activity, antifungal activity, effect on bacterial biofilms, the synergism between calcium hydroxide and other agents, its effects on the properties of dentine, the diffusion of hydroxyl ions through dentine and its toxicity. Pure calcium hydroxide paste has a high pH (approximately 12.5-12.8) and is classified chemically as a strong base. Its main actions are achieved through the ionic dissociation of Ca(2+) and OH(-) ions and their effect on vital tissues, the induction of hard-tissue deposition and the antibacterial properties. The lethal effects of calcium hydroxide on bacterial cells are probably due to protein denaturation and damage to DNA and cytoplasmic membranes. It has a wide range of antimicrobial activity against common endodontic pathogens but is less effective against Enterococcus faecalis and Candida albicans. Calcium hydroxide is also an effective anti-endotoxin agent. However, its effect on microbial biofilms is controversial.
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Affiliation(s)
- Z Mohammadi
- Department of Endodontics, Hamedan University of Medical Sciences, Hamedan, Iran.
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Influence of 2% chlorhexidine gel on calcium hydroxide ionic dissociation and its ability of reducing endotoxin. ACTA ACUST UNITED AC 2011; 111:653-8. [PMID: 21393032 DOI: 10.1016/j.tripleo.2010.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 10/05/2010] [Accepted: 11/14/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of 2% chlorhexidine gel (CHX) on pH, calcium release, and Ca(OH)(2) capability of reducing endotoxin. STUDY DESIGN Calcium release was verified by atomic-absorbance spectrophotometry, and pH was measured with a pHmeter. For endotoxin quantification, extracted human teeth previously contaminated with standard endotoxin were filled with: group I, Ca(OH)(2) + saline solution; group II, Ca(OH)(2) + CHX; and group III, CHX for 14 days. The remaining endotoxin was quantified by using chromogenic quantitative test. Statistical analysis was performed with analysis of variance and Tukey post hoc test (P < .05). RESULTS Group II released more calcium than group I (P < .05) after 15 days. Groups I and II showed alkaline pH in all periods, and group I showed higher pH values than group II (P < .05) after 30 days. Groups II and III showed significantly more decreased endotoxin than group I. CONCLUSIONS CHX did not interfere with the chemical properties of Ca(OH)(2), in fact even improving its properties of reducing the endotoxin content in root canals in vitro.
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Valera MC, da Rosa JA, Maekawa LE, de Oliveira LD, Carvalho CAT, Koga-Ito CY, Jorge AOC. Action of propolis and medications against Escherichia coli and endotoxin in root canals. ACTA ACUST UNITED AC 2011; 110:e70-4. [PMID: 20868987 DOI: 10.1016/j.tripleo.2010.01.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 01/25/2010] [Accepted: 01/29/2010] [Indexed: 11/18/2022]
Abstract
This study evaluated the action of propolis and intracanal medications against Escherichia coli and endotoxin. Forty-eight dental roots were contaminated with E. coli. The root canals were instrumented with propolis and divided into groups according to the type of intracanal medication: Ca(OH)(2), polymyxin B, or Ca(OH)(2) + 2% chlorhexidine gel. In the control group, saline solution was used without application of intracanal medication. Counts of colony-forming units were carried out and the endotoxin was quantified by the chromogenic Limulus amobocyte lysate assay. The results were evaluated by analysis of variance and the Dunn test (5%). Root canal irrigation with propolis was effective to completely eliminate E. coli and reduce the amount of endotoxins. All intracanal medications contributed to the significant decrease in endotoxins. Only intracanal medications may reduce the amount of endotoxins in the root canals. The greatest efficacy was observed for medications containing Ca(OH)(2).
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Affiliation(s)
- Marcia Carneiro Valera
- Department of Restorative Dentistry, School of Dentistry of São José dos Campos, São Paulo State University, São José dos Campos, Brazil.
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Rocha RASS, Silva RAB, Assed S, Medeiros AI, Faccioli LH, Pécora JD, Nelson-Filho P. Nitric oxide detection in cell culture exposed to LPS after Er:YAG laser irradiation. Int Endod J 2009; 42:992-6. [DOI: 10.1111/j.1365-2591.2009.01608.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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41
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Húngaro Duarte MA, Midena RZ, Zeferino MA, Vivan RR, Weckwerth PH, dos Santos F, Guerreiro-Tanomaru JM, Tanomaru-Filho M. Evaluation of pH and Calcium Ion Release of Calcium Hydroxide Pastes Containing Different Substances. J Endod 2009; 35:1274-7. [DOI: 10.1016/j.joen.2009.05.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 05/04/2009] [Accepted: 05/10/2009] [Indexed: 11/25/2022]
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Abstract
Apexification is a procedure for treating and preserving immature permanent teeth that have lost pulp vitality. It contrasts apexogenesis in terms of its outcome in that apical maturation and normal root thickness cannot be obtained. Apexification has been a routine practice for such teeth for many decades, and despite a literature replete with discussion, including recent artificial barrier methods with mineral trioxide aggregate, ultimately there has been no major breakthrough to improve this treatment. Recently, two new clinical concepts have emerged. One involves a revitalization approach to achieve tissue generation and regeneration. In this method, new living tissue is expected to form in the cleaned canal space, allowing continued root development in terms of both length and thickness. The other is the active pursuit of pulp/dentine regeneration via tissue engineering technology to implant or re-grow pulps. Although the technology is still at its infancy, it has the potential to benefit immature pulpless teeth by allowing continued growth and maturation. With this understanding, it may be predicted that apexification will become less needed in years to come. This study will overview the recent concept of pulp revitalization in the treatment of immature teeth with nonvital pulps and the emerging research on pulp tissue engineering and regeneration.
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Affiliation(s)
- G T-J Huang
- Department of Endodontics, Prosthodontics and Operative Dentistry, College of Dental Surgery, University of Maryland, Baltimore, MD 21201, USA.
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Mori GG, Ferreira FC, Batista FRDS, Godoy AMDS, Nunes DC. Evaluation of the diffusion capacity of calcium hydroxide pastes through the dentinal tubules. Braz Oral Res 2009; 23:113-8. [DOI: 10.1590/s1806-83242009000200004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 05/27/2008] [Indexed: 11/22/2022] Open
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da Silva LAB, da Silva RAB, Branco LGS, Navarro VP, Nelson-Filho P. Quantitative radiographic evaluation of periapical bone resorption in dog's teeth contaminated with bacterial endotoxin (LPS) associated or not with calcium hydroxide. Braz Dent J 2009; 19:296-300. [PMID: 19180317 DOI: 10.1590/s0103-64402008000400002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 11/11/2008] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to quantify radiographically the periapical bone resorption in dogs' teeth contaminated with bacterial endotoxin (LPS), associated or not with calcium hydroxide. After pulp tissue removal, 60 premolars were randomly assigned to 4 groups and were either filled with LPS (group 1), filled with LPS plus calcium hydroxide (group 2) or filled with saline (group 3) for a period of 30 days. In group 4, periapical lesion formation was induced with no canal treatment. Standardized radiographs were taken at the beginning of the treatment and after 30 days and the Image J Program was used for measurement of periapical lesion size. Periapical lesions were observed in groups 1 (average of 8.44 mm2) and 4 (average of 3.02 mm2). The lamina dura was intact and there were no areas of periapical bone resorption in groups 2 and 3. It may be concluded that calcium hydroxide was effective in inactivating LPS, as demonstrated by the absence of apical periodontitis in the roots that were filled with bacterial endotoxin plus calcium hydroxide.
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Affiliation(s)
- Léa Assed Bezerra da Silva
- Department of Pediatric, Preventive and Community Dentistry, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Singla R, Marwah N, Dutta S. Single Visit versus Multiple Visit Root Canal Therapy. Int J Clin Pediatr Dent 2008; 1:17-24. [PMID: 25206084 PMCID: PMC4086535 DOI: 10.5005/jp-journals-10005-1004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Accepted: 11/08/2008] [Indexed: 11/23/2022] Open
Abstract
Aim: The purpose of this study was to determine clinical success rate of single visit verses multiple visit root canal treatment in cariously exposed vital primary molars. Material& methods: 40 children in age group of 4 to 7 years were divided equally into two treatment groups and recall visits were carried out after one week, one month and three months and six months.
Results: Statistically no significant difference was found. Conclusion: Multiple visit and single visit root canal treatment demonstrated almost equal success but most important aspect for success in pulpectomy cases is the indication of each case and then its subsequent treatment, be it multiple or single visit root canal treatment.
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Affiliation(s)
- Rajesh Singla
- Postgraduate Student, Govt. Dental College, Rohtak, India
| | - Nikhil Marwah
- Asst. Professor, Govt. Dental College, Rohtak, India
| | - Samir Dutta
- Sr. Professor and Head, Govt. Dental College, Rohtak, India
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da Silva RAB, Leonardo MR, da Silva LAB, de Castro LMS, Rosa AL, de Oliveira PT. Effects of the association between a calcium hydroxide paste and 0.4% chlorhexidine on the development of the osteogenic phenotype in vitro. J Endod 2008; 34:1485-9. [PMID: 19026879 DOI: 10.1016/j.joen.2008.08.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 08/18/2008] [Accepted: 08/24/2008] [Indexed: 01/12/2023]
Abstract
The present study aimed to evaluate whether the association between a calcium hydroxide paste (Calen paste) and 0.4% chlorhexidine (CHX) affects the development of the osteogenic phenotype in vitro. With rat calvarial osteogenic cell cultures, the following parameters were assayed: cell morphology and viability, alkaline phosphatase activity, total protein content, bone sialoprotein immunolocalization, and mineralized nodule formation. Comparisons were carried out by using the nonparametric Kruskal-Wallis test (level of significance, 5%). The results showed that the association between Calen paste and 0.4% CHX did not affect the development of the osteogenic phenotype. No significant changes were observed in terms of cell shape, cell viability, alkaline phosphatase activity, and the total amount of bone-like nodule formation among control, Calen, or Calen + CHX groups. The strategy to combine Ca(OH)(2) and CHX to promote a desirable synergistic antibacterial effect during endodontic treatment in vivo might not significantly affect osteoblastic cell biology.
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Affiliation(s)
- Raquel Assed Bezerra da Silva
- Department of Pediatric Clinic, Preventive and Social Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Vianna ME, Horz HP, Conrads G, Feres M, Gomes BPFA. Comparative analysis of endodontic pathogens using checkerboard hybridization in relation to culture. ACTA ACUST UNITED AC 2008; 23:282-90. [DOI: 10.1111/j.1399-302x.2007.00425.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mechanism of calcium hydroxide–induced neutrophil migration into air-pouch cavity. ACTA ACUST UNITED AC 2008; 105:814-21. [DOI: 10.1016/j.tripleo.2007.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 07/23/2007] [Accepted: 12/09/2007] [Indexed: 11/15/2022]
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de Oliveira LD, Jorge AOC, Carvalho CAT, Koga-Ito CY, Valera MC. In vitro effects of endodontic irrigants on endotoxins in root canals. ACTA ACUST UNITED AC 2007; 104:135-42. [DOI: 10.1016/j.tripleo.2006.11.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 09/13/2006] [Accepted: 11/22/2006] [Indexed: 11/27/2022]
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Gomes BPFDA, Vianna ME, Sena NT, Zaia AA, Ferraz CCR, de Souza Filho FJ. In vitro evaluation of the antimicrobial activity of calcium hydroxide combined with chlorhexidine gel used as intracanal medicament. ACTA ACUST UNITED AC 2006; 102:544-50. [PMID: 16997123 DOI: 10.1016/j.tripleo.2006.04.010] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Revised: 04/06/2005] [Accepted: 04/21/2006] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the antimicrobial activity of calcium hydroxide (Ca(OH)2) combined with 2% chlorhexidine gluconate (CHX) gel against endodontic pathogens and to compare the results with the ones achieved by Ca(OH)2 mixed with sterile water and by CHX gel alone. Two methods were used: the agar diffusion test and the direct contact test. Ca(OH)2 + 2% CHX gel produced inhibitory zones ranging from 2.84 to 6.5 mm, and required from 30 seconds to 6 hours to eliminate all tested microorganisms. However, 2% CHX gel showed the largest microbial growth zones from 4.33 to 21.67 mm, and required 1 minute or less to inhibit all tested microorganisms. A paste of Ca(OH)2 plus sterile water inhibited only the microorganisms with which it was in direct contact and required from 30 seconds to 24 hours to kill all tested microorganisms. In conclusion, 2% CHX gel + Ca(OH)2 showed better antimicrobial activity than Ca(OH)2 manipulated with sterile water.
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