Comparison of the Antimicrobial Efficacy of the EndoVac System and Conventional Needle Irrigation in Primary Molar Root Canals

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.

Antibiotic Mixtures in Noninstrumental Endodontic Treatment of Primary Teeth with Necrotic Pulps: A Systematic Review

OBJECTIVE

To compare the effectiveness of topical antibiotic mixtures used in noninstrumental endodontic treatment (NIET) of primary teeth.

METHODS

Electronic databases including MEDLINE, the Cochrane Library, and Scopus database were searched. Randomized clinical trials evaluating the clinical and radiological outcomes of topical antibiotics used in NIET were selected. The revised Cochrane risk-of-bias tool (RoB 2.0) was used to assess the quality of the methodology of the included articles.

RESULTS

Five articles comparing the outcomes of four different drugs combination were included. Three studies conducted to evaluate the success rate of two combinations of antibacterial drugs consisting of ciprofloxacin-minocycline-metronidazole (3 Mix) in one group and ciprofloxacin-minocycline-ornidazole in the other group showed no statistically significant difference between both groups (P > 0.05). The ciprofloxacin-minocycline-ornidazole group showed better results compared with the 3 Mix group. One study conducted to compare the effectiveness of 3 Mix with ciprofloxacin-tinidazole-minocycline reported no significant difference between both groups, and one study that compared 3 Mix and ciprofloxacin-metronidazole-clindamycin mixture concluded that the overall success rates of both groups were 80.96% and 76.20%, respectively, with no statistically significant difference.

CONCLUSION

Based on the overall success rates, the ciprofloxacin-minocycline-ornidazole mixture was considered more effective than the 3 Mix which was more effective than the ciprofloxacin-tinidazole-minocycline and the ciprofloxacin-metronidazole-clindamycin groups. Clinical Relevance. Different antibiotic combinations, showing good clinical and radiographic success in treating necrotic primary teeth, can be used effectively in NIET and this technique can be considered effective for teeth with advanced root resorption and when conventional endodontic treatment is contraindicated.

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.

The effects of various irrigation protocols on root canal wall adaptation and apical microleakage in primary teeth

Objective: The objective of this study is to evaluate the wall adaptation and apical microleakage values following the application of various irrigation protocols in primary teeth.Material and methods: For the two parts of the study, extracted upper incisor primary teeth were randomly included to the 1% sodium hypochlorite (NaOCl), 10% ethylenediaminetetraacetic acid (EDTA)+1% NaOCl, 6% citric acid (CA)+1% NaOCl and 0.9% physiological saline (PS) groups. Canal wall adaptation and apical microleakage were assessed by scanning electron microscopy (SEM) and stereomicroscope, respectively.Results: 6% CA + 1% NaOCl group was found to be the most successful irrigation protocol in providing strong canal wall adaptation and less apical microleakage, followed by 10% EDTA +1% NaOCl. 6% CA +1% NaOCl was significantly superior regarding apical microleakage (p < .05).Conclusions: Due to the ability to provide appropriate changes in the root canal walls to make a well-adapted and leak-proof canal filling, 6% CA + 1% NaOCl can be recommended as an irrigation protocol in primary teeth.

The effect of 17% EDTA and QMiX ultrasonic activation on smear layer removal and sealer penetration: ex vivo study

This study aimed to compare the effect of conventional irrigation (CI) and passive ultrasonic irrigation (PUI) with 17% EDTA and QMiX on the maximum depth and percentage of sealer penetration into the dentinal tubules by confocal laser scanning microscopy (CLSM) and to describe the cleaning of root canal walls by scanning electron microscopy (SEM). Eighty single-rooted human mandibular premolars were instrumented and randomly assigned to four groups (n = 20): EDTA + CI, QMiX + CI, EDTA + PUI, and QMiX + PUI. Ten samples from each group were examined by SEM (2,000×) and the remaining 40 roots were filled with a single gutta-percha cone and AH Plus sealer mixed with 0.1% rhodamine B for analysis by CLSM (10×). Images were assessed at distances of 2 mm (apical), 5 mm (middle), and 8 mm (coronal) from the apex with the Leica Application Suite V4.10 software. The EDTA + PUI and QMiX + PUI protocols presented higher rates of debris/smear layer removal in the apical and middle thirds. The PUI was superior to CI in the maximum depth of sealer penetration at the middle third. The QMiX + PUI group had a higher percentage of sealer penetration at the apical third. The PUI and QMiX protocol improved debris/smear layer removal and tubular dentin sealer penetration.