Comparative effects of final canal irrigation with chitosan and EDTA

Evaluation of the Effects of Retro-Cavity Preconditioning with or Without Ethylenediaminetetraacetic Acid on Root Surface pH and Dislodgement Resistance of NeoMTA2 and Mineral Trioxide Aggregate Flow Retro-Fills: An Ex Vivo Investigation

Background: The aim of this study was to investigate the effects of retro-cavity preconditioning with or without 17% ethylenediaminetetraacetic acid (EDTA) solution on root surface pH as well as dislodgement resistance of NeoMTA2 and MTA Flow retro-fills. Methods: Forty-eight single-rooted human incisors were selected. After completion of endodontic treatment, root-end resections were performed, and retro-cavities were prepared. The samples were randomly divided into two groups of A and B (n = 24 each). In group A, retro-cavities were preconditioned with 2.5% NaOCl, followed by 17% EDTA solution, whereas in group B, preconditioning was performed using 2.5% NaOCl before final irrigation with normal saline. Samples in each group were randomly subdivided into two subgroups of 1 and 2. Retro-fillings in the A1 and B1 subgroups were performed with MTA Flow, and in the A2 and B2 subgroups, they were performed with NeoMTA2. Root surface pH was measured in each sample at three different stages: before preparation of retro-cavities (pH0), after retro-cavity preconditioning (pH1), and three days after retro-filling (pH2). Subsequently, the push-out bond strength (PBS) of the retro-filling materials was measured by a universal testing machine, and their failure modes were visualized under 64× magnification. Results: Preconditioning with EDTA caused a significant increase in PBS for both NeoMTA2 and MTA Flow (p < 0.001). There was no significant difference between the average bond strength of MTA Flow and Neo MTA2 (p = 0.271). There was a significant increase in the average pH2 compared to pH1 and pH0 across all groups (p < 0.001). Specifically, the use of EDTA led to a notable increase in the average pH2 in the MTA Flow group compared to the Neo MTA2 group (p = 0.027). Groups preconditioned with EDTA more frequently indicated a cohesive failure mode. Conclusions: The use of EDTA significantly increased the push-out bond strength of retro-fill materials to dentin. However, it did not prevent the ultimate alkalinity of retro-filled cavities.

Pre-Sealing of Endodontic Access Cavities for the Preservation of Anterior Teeth Fracture Resistance

OBJECTIVE

Sodium hypochlorite solution (NaOCl) is an effective canal irrigant but interferes with the mechanical features of dentin and the bonding capability of adhesives when restoring endodontically treated teeth. This study evaluated whether access cavity resin sealing before using canal irrigant would augment the resistance of endodontically treated anterior teeth against fracture.

METHODS

Sixty maxillary incisors underwent endodontic treatment in five groups (n = 12). Irrigation with 5.25% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA) was performed in all groups except for Group 5. After root canal obturation, in Group 1, the access cavity was kept unrestored. In Group 2, immediate restoration after obturation was achieved. For Group 3, delayed restoration after 1 week was provided. In Group 4 (pre-sealed), before canal irrigation, the dentin surface of access cavities was sealed using self-adhesive composite resin (Vertise Flow) and then restored after obturation. In Group 5, which was saline irrigated, immediate restoration was performed. After storage and thermal cycling for 5000 cycles at 5°C-55°C with a dwell time of 15 s and a transfer time of 5 s, teeth were statically loaded by a universal testing machine until a fracture occurred. Data were collected as the fracture resistance (FR) and analyzed using the one-way analysis of variance and Tukey's tests.

RESULTS

FR significantly differed between all groups (p < 0.001). The lowest FR was recorded in the unrestored group (284 ± 86 N), which was not statistically different from the immediately restored group (p = 0.065). The pre-sealed group exhibited the highest FR value (810 ± 127 N, p ≤ 0.02 vs. other groups). The FR of the saline-irrigated and delayed restored groups was almost similar (p = 0.13).

CONCLUSIONS

NaOCl/EDTA irrigation resulted in an adverse effect on FR. Delayed restoration could reduce this adverse effect. Access cavity pre-sealing with flowable composites led to a higher FR than conventional methods and may be considered an effective step during treatment procedures.

Effect of final irrigation protocols with chitosan nanoparticle and genipin on dentine against collagenase degradation: An ex-vivo study

AIM

Endodontic irrigants may affect the mechanical and chemical properties of dentine. This study evaluated the effects of various final irrigation protocols including the use of chitosan nanoparticle (CSnp) and cross-linking with genipin on the (1) mechanical and (2) chemical properties of dentine against enzymatic degradation.

METHODOLOGY

CSnp was synthesized and characterized considering physiochemical parameters and stability. The root canals of 90 single-rooted teeth were prepared and irrigated with NaOCl. Dentine discs were obtained and divided into groups according to the following irrigation protocols: Group NaOCl+EDTA, Group NaOCl+CSnp, Group NaOCl+EDTA+CSnp, Group NaOCl+CSnp+Genipin, Group NaOCl+EDTA+CSnp+Genipin and Group distilled water. (1) Mechanical changes were determined by microhardness analysis using Vickers-tester. (2) Chemical changes were determined by evaluating molecular and elemental compositions of dentine using Fourier transform infrared spectroscopy (FTIR) analysis and scanning electron microscope (SEM)/energy dispersive X-ray spectroscopy (EDS) analysis, respectively. All analyses were repeated after the discs were kept in collagenase for 24 h. Data were analysed with repeated measures analysis of variance and Bonferroni correction for microhardness analysis, and Kruskal-Wallis and Wilcoxon tests for FTIR and SEM/EDS analyses (p = .05).

RESULTS

(1) Collagenase application did not have a negative effect on microhardness only in Group NaOCl+EDTA+CSnp+Genipin when compared with the post-irrigation values (p > .05). Post-collagenase microhardness of Group NaOCl+EDTA+CSnp and Group NaOCl+CSnp+Genipin was similar to the initial microhardness (p > .05). (2) After collagenase, Amide III/PO 4 3 - ratio presented no change in Group NaOCl+EDTA+CSnp, Group NaOCl+CSnp+Genipin and Group NaOCl+EDTA+CSnp+Genipin (p > .05), while decreased in other groups (p < .05). Collagenase did not affectCO 3 2 - /PO 4 3 - ratio in the groups (p > .05). There were no changes in the groups in terms of elemental level before and after collagenase application (p > .05).

CONCLUSIONS

CSnp and genipin positively affected the microhardness and molecular composition of dentine. This effect was more pronounced when CSnp was used after EDTA.

The comparative of chitosan and chitosan nanoparticle versus ethylenediaminetetraacetic acid on the smear layer removal: A systematic review and meta-analysis of in vitro study

The purpose of this systematic review of meta-analysis was to compare the effectiveness of removing the smearing layer using EDTA versus Chitosan (Ch) and Chitosan nanoparticles (Ch-NPs). A search was performed in four electronic databases (Web of Science, PubMed, Scopus, and Cochrane). The included studies were assessed by two reviewers using Joanna Briggs Institute's critical appraisal checklist for the quasi-experimental studies. Outcomes obtained by scanning electron microscopy (SEM) and conventional methods were presented as standardized mean differences alongside 95% confidence intervals. Seven investigations employed 212 single-root teeth. In the apical section (p = .317, 95% CI = -0.820 to 0.266, Tau2  = 0.387), middle segment (p = .914, 95% CI = -1.019 to 0.912, Tau2  = 1.027), and coronal segment (p = .277, 95% CI = -1.008 to 0.289, Tau2  = 0.378). This meta-analysis found no difference between Ch, Ch-NPs, and EDTA in removing the smear layer in the three segments. This systematic review is designed to show evidence related to the PICO question, in which our outcome is smear layer removal and not the clinical success of such a treatment. RESEARCH HIGHLIGHTS: The study aimed to compare the effectiveness of chitosan and chitosan nanoparticles with ethylenediaminetetraacetic acid (EDTA) in removing the smear layer, a layer of debris and organic material on the tooth surface, through a systematic review and meta-analysis. The removal of the smear layer is crucial for successful dental treatments, as it enhances the adhesion of restorative materials and improves the penetration of antimicrobial agents into dentinal tubules. The researchers conducted a systematic review and meta-analysis, searching various databases of electron microscopy results for relevant in vitro studies comparing the effects of chitosan or chitosan nanoparticles with EDTA on smear layer removal. The results encourage further exploration of chitosan and chitosan nanoparticles for clinical use in dentistry, while considering their specific applications and long-term effects.

Comparative Evaluation of the Effect of Different Chelating Agents on Mineral Content and Erosion of Radicular Dentine: A FESEM-EDS Analysis

OBJECTIVE

Irrigating solutions play an important role in the debridement and disinfection of the root canal space, and thus, it is crucial to comprehend their effects on the composition and surface structure of radicular dentine. This study evaluated and compared the effects of 17% ethylenediaminetetraacetic acid (EDTA), 9% 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) and 0.2% chitosan on the mineral content and erosion of radicular dentine when used as a final rinse.

METHODS

Sixty extracted human mandibular premolar teeth were decoronated and instrumented to ProTaper size F2. After final instrumentation, the samples were randomly divided into 4 groups (n=15) according to the type of final irrigant used: Normal saline (control), 17% EDTA, 9% HEBP and 0.2% chitosan. Field emission scanning electron microscopy was used to assess the erosion of radicular dentine, and energy dispersive X- ray spectroscopy was used to quantify the radicular dentine mineral composition at the coronal, middle and apical levels of all the prepared samples after final irrigation. The one-way analysis of variance was used for intra-group and inter-group comparisons of means, the Kruskal Wallis test for intra-group and inter-group comparisons of medians and Tukey's post hoc test for pairwise comparisons.

RESULTS

There was no significant difference in the levels of calcium (Ca), phosphorus (P) and Ca/P ratio after final rinse with 17% EDTA, 9% HEBP and 0.2% chitosan at all three root levels (p>0.05); except at the coronal level, where 0.2% chitosan caused significantly less alteration in Ca levels and Ca/P ratio than 17% EDTA and 9% HEBP respectively (p<0.05). 17% EDTA, 9% HEBP and 0.2% chitosan caused no erosion at the middle and apical levels. Meanwhile, 17% EDTA and 9% HEBP caused moderate erosion at the coronal level.

CONCLUSION

Alternatives to 17% EDTA during final irrigation can be 9% HEBP and 0.2% chitosan. (EEJ-2023-06-078).

Antimicrobial efficacy of composite irrigation solution against dominant pathogens in seawater immersion wound and in vivo wound healing assessment

Seawater immersion wound is inevitably accompanied by bacterial infection. Effective irrigation is critical for bacterial infection prevention and wound healing. In this study, the antimicrobial efficacy of a designed composite irrigation solution against several dominant pathogens in seawater immersion wounds was evaluated, and in vivo wound healing assessment was conducted in a rat model. According to the time-kill result, the composite irrigation solution exhibits excellent and rapid bactericidal effect against Vibrio alginolyticus and Vibrio parahaemolyticus within 30 s of treatment while eliminating Candida albicans, Pseudomonas aeruginosa, Escherichia coli, and the mixed microbes after 1 h, 2 h, 6 h, and 12 h of treatment, respectively. Significant bacterial count reduction of Staphylococcus aureus was observed after 5 h treatment. In addition to its skin non-irritating attribute, the in vivo wound healing results further demonstrated that the irrigation solution showed high repair efficiency in the skin defect model inoculated with the mixed microbes. The wound healing rate was significantly higher than that of the control and normal saline groups. It could also effectively reduce the number of viable bacteria on the wound surface. The histological staining indicated that the irrigation solution could reduce inflammatory cells and promote collagen fibers and angiogenesis, thereby promoting wound healing. We believed that the designed composite irrigation solution has great potential for application in the treatment of seawater immersion wounds.

Effect of Carbodiimide (EDC) on the Bond Strength Longevity of Epoxy Resin-based Endodontic Sealer to Root Dentin: An In-Vitro Study

PURPOSE

EDC (1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride) can increase dentin bonding longevity. This study aimed to evaluate the effect of final irrigation of the root canal with EDC on the bond strength (BS) longevity of an epoxy resin-based root-canal sealer.

MATERIALS AND METHODS

Twenty maxillary canines were sectioned and standardized for root length at 17 mm. Roots were instrumented and distributed into 2 groups according to the final irrigation protocol: EDTA 17%+NaOCl 2.5% (C) and EDTA 17%+NaOCl 2.5%+EDC 0.5M (EDC). The canals were dried and filled with AH Plus (Dentsply Sirona). Three slices were obtained per third, and the first slice from each third was used for the immediate push-out test (i) followed by analysis of the failure pattern (n = 10); the second slice from each third was used for the push-out test after 6-month aging (A) followed by analysis of the failure pattern (n = 10); the third slice from each third was used to examine the adhesive interface under confocal laser scanning microscopy (CLSM) (n = 10). Data were analyzed with ANOVA, Fisher's exact and Kruskal-Wallis tests.

RESULTS

Higher BSs were found for EDC-A (5.6 ± 1.9) than for EDC-I (3.3 ± 0.7), C-i (2.5 ± 1.0) and C-i (2.6 ± 1.0) (p = 0.0001), while C-A values were in some cases similar to C-i and in others similar to EDC-i. No statistically significant difference was observed between the thirds (p > 0.05), except for EDC-i, which showed lower BS for the cervical (2.79 ± 0.46) compared to the apical third (3.8 ± 0.5), while the middle third in some cases had values similar to those of the apical and in others to the cervical third (3.2 ± 0.7) (p = 0.032). More mixed adhesive failures were found in the cervical third, and more adhesive failures to the sealer occurred in the middle and apical thirds (p = 0.014). A significant difference was observed between treatments in terms of adaptation of the adhesive interface, with a higher percentage of good adaptation using EDC (66.7%) than using C (40%), and a lower percentage of poor adaptation with EDC (10%) compared to C (20%) (p < 0.05).

CONCLUSION

Root canal irrigation with EDC increased the longevity of the adhesive interface of an epoxy resin-based root-canal sealer.

The effects of different root canal irrigation protocols and artificial aging procedures on the bond strength between dentin and hybrid ceramic posts

The purpose of this study is to investigate the effects of different root canal irrigation protocols applied to the dentin and artificial aging procedures on the micro pushout bond strength (mPBS) between dentin and hybrid ceramic posts. Seventy-five single-rooted mandibular premolar teeth were divided into 5 groups (Gr1-5). 50 of the teeth were used for the mPBS tests (n = 10), whereas 25 were used for the smear layer examinations (n = 5). Post space were prepared and irrigated with different irrigation-protocols in each group. (Gr1:[SS], Gr2:[NaOCl] + SS, Gr3:[EDTA] + NaOCl + SS, Gr4:[MA] + NaOCl + SS, Gr5:[Ch] + NaOCl + SS). Post and core pattern were fabricated with pattern resin and a fiber post, after scanning, the posts were milled with Vita Enamic resin ceramic block, and cemented. After 7 days the roots were sliced at thicknesses of 1 mm; half of them were subjected to mPBS test, while the other half were tested after undergoing mechanical cycling for artificial aging. For data analysis, the Shapiro-Wilk test was utilized to test normal distributions, 3-way analysis of variance was used to compare mPBS, and Tukey's HSD test was conducted for multiple comparisons. SEM analysis was performed for examination of failure modes and smear layer removal. Different root canal irrigation protocols affected mPBS significantly. While Gr4 had the highest mPBS, Gr1 had the lowest. Regarding to different zones, the highest mPBS was in coronal zone, and the lowest one was in the apical zone. The aging procedure also led to a statistically-significant decrease in mPBS. Most frequent failure modes were cohesive failure in dentin and mixed failure. Irrigation with 7%MA (Gr4) showed better performance than 17% EDTA (Gr3) in smear layer removal, especially at the apical zone of the tooth. This is critical for the success of root canal treatment and increased the mPBS to a higher extent in all zones of the tooth.

EDTA-chitosan is a feasible conditioning agent for dentin bonding

OBJECTIVES

The bonding effects of EDTA-chitosan, phosphoric acid, and SE-Bond were compared.

MATERIALS AND METHODS

Material synthesis, Fourier transform infrared spectroscopy, transmission electron microscopy, scanning electron microscopy, laser confocal microscopy, microtensile bond strength, stereomicroscope observation section, CCK8 cytotoxicity assay, and microfluidic experiments were applied.

RESULTS

EDTA-chitosan was synthesized, and it was found by transmission electron microscopy that the application of EDTA-chitosan to dentin can extrafibrillarly demineralize collagen fibers. Scanning electron microscopy provided evidence for the retention of smear plugs in dentin conditioned with 1 wt% EDTA-chitosan. Mixed layer and long resin protrusions can be formed after bonding under a laser confocal microscope. The microtensile strength test found that the bonding strength and the durability obtained by applying the chelating agent EDTA-chitosan to dentin were equivalent to SE-Bond and better than the phosphoric acid wet bonding commonly used clinically (P < 0.05). The cytotoxicity of EDTA-chitosan was lower than that of phosphoric acid and SE-Bond in the CCK-8 assay and lower than that of phosphoric acid in the microfluidics experiment.

CONCLUSIONS

Taken together, the EDTA-chitosan extrafibrillar demineralization strategy retains intrafibrillar minerals and provides better bonding strength and durability with lower cytotoxicity.

CLINICAL RELEVANCE

EDTA-chitosan has the potential to be applied to dentin resin for direct bonding restoration and has good clinical application prospects.

Comparative evaluation of push-out bond strength of bioceramic and epoxy sealers after using various final irrigants: An in vitro study

Aim:

The aim of the study is to compare the push-out bond strength of bioceramic and epoxy sealers after using various final irrigants.

Materials and Methods:

Hundred single-rooted teeth were divided into two groups (n = 50) according to the sealer used: Group A: Bio C (bioceramic sealer), Group B: Dia-Proseal (epoxy sealer). Each group was subdivided into five subgroups (n = 10) according to the final irrigation protocol: Group A1 and B1 – 5% glycolic acid (GA), Group A2 and B2 – 17% GA, Group A3 and B3 – 0.2% chitosan, Group A4 and B4 – 17% ethylenediaminetetraacetic acid, and Group A5 and B5 – 0.9% saline. Samples were obturated in combination with one of the mentioned sealers and were allowed to set for 1 week. Two horizontal slices were obtained from each sample and subjected to push-out test.

Statistical Analysis:

The data were statistically analyzed using two-way ANOVA and independent Student's t-test.

Results:

Both the sealers exhibited higher push-out bond strength after treatment with GA with no significant difference between 5% and 17% GA. Bio C sealer with GA as final irrigant showed higher bond strength than Dia-Proseal (P < 0.05).

Conclusion:

The push-out bond strength of the sealer was significantly affected by the final irrigation solution used. The highest push-out bond strength was seen with Bio C sealer after treatment with GA with no significant difference between 5% and 17% GA.

Effects of chitosan-containing silver nanoparticles or chlorhexidine as the final irrigant on the bond strength of resin-based root canal sealers

Background. This study evaluated the combined effects of silver nanoparticles (AgNPs) and chitosan on the dentin bond strength of resin-based root canal sealers using the push-out test and scanning electron microscopy (SEM). Methods. This in vitro study was conducted on 72 extracted mandibular premolar teeth. All the teeth were decoronated perpendicular to the long axis to leave a 13-mm root length. The root canals were prepared, and the samples were randomly divided into seven experimental groups and one control group based on final irrigation solutions. All the final irrigation procedures were performed for one minute. The root canals were dried using paper points and filled with a resin-based sealer and gutta-percha points using a lateral condensation technique. Sections measuring 2 mm in thickness were taken from the apical, middle, and coronal thirds of each root using a cutting machine. The push-out test was performed using a universal testing machine. Results. The solution of AgNPs combined with 0.4% chitosan showed higher bond strength in the coronal region than a combination with 0.2% chitosan. Samples treated with 0.4% chitosan solution exhibited a higher bond strength than the 0.2% chitosan group. There were no significant differences between chlorhexidine (CHX) solution alone and in combination with 0.2% or 0.4% chitosan solution. Conclusion. The combination of chitosan and AgNPs was as effective as CHX in improving the bond strength of resin-based sealers.

Influence of the use of chelating agents as final irrigant on the push-out bond strength of epoxy resin-based root canal sealers: A systematic review

This systematic review (PROSPERO - CRD42020150722) was performed to answer the following question: Does the use of chelating agents affect the dislodgment resistance of epoxy resin-based root canal sealers? A search was conducted in PubMed, EMBASE, Scopus, LILACS and Web of Science, hand searching of two endodontic journals and grey literature until September 2020. Extracted data included: teeth used, sample size, root canal preparation, irrigant, chelating solution, neutralisation solution, type of resin-based sealer and obturation approach, storage method and duration, root third and slice thickness, plunger dimension and loading direction and the push-out testing parameters and values. The search retrieved a total of 2.389 studies. After analysis, 12 studies fulfilled the eligibility criteria and were included. Most of the final irrigation protocols with chelating agents had a positive impact and promoted an improvement in the dislodgment resistance of epoxy resin-based sealers to the root dentin.

Nanoparticles in Dentistry: A Comprehensive Review

In recent years, nanoparticles (NPs) have been receiving more attention in dentistry. Their advantageous physicochemical and biological properties can improve the diagnosis, prevention, and treatment of numerous oral diseases, including dental caries, periodontal diseases, pulp and periapical lesions, oral candidiasis, denture stomatitis, hyposalivation, and head, neck, and oral cancer. NPs can also enhance the mechanical and microbiological properties of dental prostheses and implants and can be used to improve drug delivery through the oral mucosa. This paper reviewed studies from 2015 to 2020 and summarized the potential applications of different types of NPs in the many fields of dentistry.

Influence of chelating solutions on tubular dentin sealer penetration: A systematic review with network meta-analysis

This systematic review assessed the influence of conventional final irrigation with chelating solutions (CS) on tubular dentin sealer penetration (TDSP). The literature search was conducted in eight electronic databases using MeSH, DeCS, EMTREE and free terms. The study protocol followed the PRISMA guidelines and was registered on the PROSPERO database (CRD42020203080). Twelve studies were included, and a qualitative synthesis and network meta-analysis of the data were performed. The risk of bias of the studies was assessed using an adaptation of the JBI Critical Appraisal tool. QMix was the solution with the highest probability of having the highest percentage of TDSP in the apical (34.1%), middle (86.5%) and coronal (97.7%) thirds. Eleven studies presented a moderate risk of bias, whereas one study presented a high risk of bias. In conclusion, CS improves sealer penetration into the dentinal tubules with QMix demonstrating superior results.

Time-Dependent Effect of Chitosan Nanoparticles as Final Irrigation on the Apical Sealing Ability and Push-Out Bond Strength of Root Canal Obturation

Materials and Methods

Fifty-six premolars were used in this study and divided by two evaluations: 28 teeth for apical sealing ability and 28 others for bond strength. Each study was assigned randomly into two groups of fourteen teeth: Group-1, final irrigation with 17% EDTA; Group-2, with 0.5% chitosan nanoparticles. Each group was further divided into two groups of 7 each: Group-A, final irrigation was applied for 1 minute; Group-B, for 3 minutes. All teeth were obturated with epoxy resin-based sealer and gutta-percha. In the apical sealing ability study, the obturated teeth were immersed in 2% methylene blue and observed under a stereomicroscope (8x magnification). In the bond strength study, the teeth were tested using the push-out technique and observed under a stereomicroscope (40x magnification) to determine the failure type. Data from each evaluation were analysed with two-way ANOVA followed by the LSD test.

Results

Final irrigation using 0.5% chitosan nanoparticles produced the same apical sealing ability and bond strength as 17% EDTA (p > 0.05). A significant difference occurred between application times (p < 0.05). The failure type was observed predominantly as cohesive, and the least was adhesive.

Conclusion

Regardless of the final irrigation solution used, 3-minute application time produced greater apical sealing ability and push-out bond strength than 1-minute application time.