Evaluation of a mixture of zinc oxide, calcium hydroxide, and sodium fluoride as a new root canal filling material for primary teeth

Comparison of clinical performance of obturating materials in pulpectomies: A randomized clinical trial

BACKGROUND

Chemomechanical debridement is insufficient to disinfect all bacteria from the root canals of primary teeth, and obturation of canals with an appropriate material thus acquires excellent importance and remains a critical step in the ultimate success of pulpectomy.

AIM

The aim of the study was to compare and evaluate Endoflas, Metapex, and a mixture of calcium hydroxide (CH) and zinc oxide (ZnO) as obturating materials (OMs) in primary mandibular second molars.

MATERIALS AND METHODS

Seventy-five mandibular second primary molars requiring pulpectomies were identified in children aged 4-8 years. They were randomly allocated to the three treatment groups according to the type of OM received using the block randomization technique. After the completion of chemomechanical debridement, the canals were filled with Endoflas, Metapex, and CH-ZnO mixture, respectively. The intergroup clinical and radiographic comparison was made based on Coll and Sadrian criteria to decipher their clinical performance at 1, 3, and 6 months.

RESULTS

No statistically significant differences between the groups were observed at any evaluation time interval (P > 0.05). At 6 months, the clinical success rates were 95.2% in Endoflas, 96% in Metapex, and 95.8% in the CH and ZnO mixture groups, respectively. The materials, however, behaved differently in different clinical situations.

CONCLUSION

Based on the observations, all three OMs showed similar clinical success in maintaining tooth functioning, but their use can be restricted to indications. However, prospective studies with longer follow-ups with more stringent eligibility criteria are required to reach more definitive conclusions.

Biocompatibility of Ajwain Oil Combined with Eugenol and Zinc Oxide as a Deciduous Root Canal Obturating Material: An In Vivo Study

Aim and objectives

The present study was intended to assess the biocompatibility of newly formulated materials such as zinc oxide (ZO) admixed with ajwain oil (A) as well as ajwain eugenol (E) (1:1 ratio) against ZOE through an animal model as root canal obturating materials in deciduous teeth.

Materials and methods

The study involved randomly selected 24 albino rats, which were divided into three groups based on test materials. Two polyethylene tubes (PETT) (8 mm long × 1 mm internal diameter) were inserted into connective tissues of the dorsal side on either side of each rat viz empty tube (negative control) and another containing test material (test group). Animals were sacrificed at the end of the 7th and 21st days. PETT with surrounding connective tissues were excised. Histopathological evaluations of the material's biocompatibility were done by determining inflammatory tissue responses. Non-parametric tests such as Kruskal-Wallis and Mann-Whitney U were used for statistical analysis (p < 0.05).

Results

Histopathological examination on the 7th day showed increased polymorphonuclear cells for all test materials compared to the negative control (p = 0.92), suggesting acute inflammation. The inflammation subsided gradually after 21 days (p = 0.48). The lymphocytes increased after 21 days for all the materials indicating chronic inflammation (p = 0.79), as well as fibroblasts (p = 0.34) and capillaries (p = 0.35), indicating healing and repair.

Conclusion

The newly formulated obturating materials were found to be biocompatible compared to ZOE.

How to cite this article

Dahake PT, Joshi SS, Kale YJ, et al. Biocompatibility of Ajwain Oil Combined with Eugenol and Zinc Oxide as a Deciduous Root Canal Obturating Material: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(3):431-436.

Physicochemical, Pre-Clinical, and Biological Evaluation of Viscosity Optimized Sodium Iodide-Incorporated Paste

This study aimed to investigate the impact of different viscosities of silicone oil on the physicochemical, pre-clinical usability, and biological properties of a sodium iodide paste. Six different paste groups were created by mixing therapeutic molecules, sodium iodide (D30) and iodoform (I30), with calcium hydroxide and one of the three different viscosities of silicone oil (high (H), medium (M), and low (L)). The study evaluated the performance of these groups, including I30H, I30M, I30L, D30H, D30M, and D30L, using multiple parameters such as flow, film thickness, pH, viscosity, and injectability, with statistical analysis (p < 0.05). Remarkably, the D30L group demonstrated superior outcomes compared to the conventional iodoform counterpart, including a significant reduction in osteoclast formation, as examined through TRAP, c-FOS, NFATc1, and Cathepsin K (p < 0.05). Additionally, mRNA sequencing showed that the I30L group exhibited increased expression of inflammatory genes with upregulated cytokines compared to the D30L group. These findings suggest that the optimized viscosity of the sodium iodide paste (D30L) may lead to clinically favorable outcomes, such as slower root resorption, when used in primary teeth. Overall, the results of this study suggest that the D30L group shows the most satisfactory outcomes, which may be a promising root-filling material that could replace conventional iodoform-based pastes.

Effectiveness of iodoform-based filling materials in root canal treatment of deciduous teeth: a systematic review and meta-analysis

Introduction

The objective was to review the effectiveness of iodoform-based compared to noniodoform-based filling materials in the root canal treatment of deciduous teeth.

Methods

This systematic review and meta-analysis used randomized clinical trials with six months or more follow-up. The risk of bias of individual studies and the certainty of the evidence were evaluated (Cochrane risk of bias tool and GRADE, respectively).

Results

The initial search resulted in 5,127 studies after removal of duplicates. After screening by title and abstract, 34 full-text studies were eligible and 21 remained in the qualitative synthesis and 19 in the meta-analysis. Iodoform-based filling materials resulted in fewer clinical failures when compared to noniodoform-based filling materials at the 6 months (OR = 0.43, 95%CI: 0.19–0.97, p = .04) and 9–12 months (OR = 0.46, 95%CI: 0.23–0.93, p = .03), but not at the 18–30 months follow-up (OR = 1.08, 95%CI: 0.58–2.03, p = .81). When considering radiographic failures, there was no statistical difference between iodoform-based and noniodoform-based filling materials at the 6 months (OR = 0.72, 95%CI: 0.39–1.32, p = .29) and 18–30 months follow-ups (OR = 1.06, 95%CI: 0.51–2.21, p = .87), but fewer radiographic failures were detected at the 9–12 months follow-up (OR = 0.49, 95%CI: 0.29–0.80, p = .005).

Conclusion

Iodoform-based filling materials showed better clinical and radiographic performance when compared to non-iodoform-based filling materials in the short term, and similar performance in the long term. However, most of the studies exhibited unclear or high risk of bias and the overall certainty of the evidence ranged from low to very low. Therefore, new randomized clinical trials must be accomplished to corroborate this conclusion.

Comparative evaluation of zinc oxide-eugenol and zinc oxide with Neem oil in root canal treatment of primary teeth: Split-mouth study with 12 months follow-up

Background

Various root canal filling materials are used to preserve pulp tissue involved carious the primary tooth. A single material that fulfills all the requirements of an ideal root canal filling material for primary teeth is yet unavailable. Hence, this study was initiated to evaluate clinically and radiographically, the efficacy of two obturating materials - zinc oxide eugenol (ZOE) and zinc oxide mixed with Neem oil (ZON) for 12 months.

Aims

To assess the success rate of a mixture of zinc oxide and neem oil in comparison to zinc oxide-eugenol paste, as an obturating material in primary molars. To compare the efficacy of ZON as an obturating material at the various time interval of 3, 6, 9, and 12 months postoperatively.

Materials and methods

This split-mouth, double-blind study was performed on 24 children aged 5-7 years, who presented with bilaterally infected primary molars. Total 48 infected primary molars were divided into two groups for pulpectomy followed by obturation with ZOE and ZON, respectively. Randomization with the chit-pick method, for the control and experimental drug, was performed. A follow-up for 12 months was performed. The Chi-square test was used for inter-group comparison and the Z test was used for the analysis of data over a period of time.

Results

Overall clinical findings in this study revealed 91.7% results in ZOE compared with 100% results in the ZON group. The radiographical findings revealed 91.7% results in ZOE compared with 100% success in the ZON group.

Conclusion

ZON demonstrated excellent effectiveness as an obturating material in the 12-month follow-up period as compared to ZOE in primary teeth. The efficacy elicited in this study could be a basis to recommend ZON as herbal alternative obturation material.

Evaluation of the Antibacterial Activity of Triclosan-incorporated Root Canal Filling Materials for Primary Teeth against Enterococcus faecalis

Aim and objective

To compare the antibacterial activity of root canal filling materials namely zinc oxide eugenol and Endoflas FS with or without the incorporation of Triclosan.

Materials and methods

The study consisted of four groups, with 15 samples in each group: group I (zinc oxide eugenol paste), group Ia (zinc oxide eugenol paste + 2.5% Triclosan), group II (Endoflas FS), and group IIa (Endoflas FS + 2.5% Triclosan). A double layer agar well diffusion test was used to evaluate the antibacterial activity against Enterococcus faecalis. The zones of microbial inhibition were measured at the end of 24 hours, 6th day, and 29th day.

Results

On intergroup comparison, the difference in the antibacterial activity was found to be highly significant (p < 0.001). Among the various groups evaluated, group IIa showed the highest antibacterial activity against E. faecalis followed by group II, group Ia, and the least activity being shown by group I throughout the experimental periods. On intragroup comparison at different time intervals, a maximum zone of inhibition was seen at 24 hours with a p value < 0.05 in all the tested groups.

Conclusion

Incorporation of 2.5% triclosan into zinc oxide eugenol and Endoflas FS enhanced the antimicrobial activity of both the root canal filling materials with lasting antimicrobial activity even at the end of the 29th day.

Clinical significance

The antimicrobial efficacy of a root canal filling material is an ideal requirement, which will help in combating the residual microflora present in the root canal system following chemomechanical preparation. The addition of an antimicrobial agent such as triclosan to the root canal filling materials, enhances their antimicrobial efficacy significantly and thus, rendering the pulpectomy-treated tooth with a better prognosis.

How to cite this article

Deepak BM, Prabhakar AR, Karuna YM, et al. Evaluation of the Antibacterial Activity of Triclosan-incorporated Root Canal Filling Materials for Primary Teeth against Enterococcus faecalis. Int J Clin Pediatr Dent 2021;14(3):393–397.

Clinical Evaluation of Root Resorption and its Correlation with Obturation Quality in Pulpectomized Deciduous Teeth with Different Obturating Materials: An In vivo Study

Aims and Objectives:

The aim was to evaluate the root resorption in pulpectomized deciduous teeth and its correlation with obturation quality using zinc oxide and eugenol (ZOE), Metapex and Endoflas at the interval of 6 and 12 months.

Materials and Methods:

A total of 150 infected primary mandibular molars were randomly and equally divided into three subgroups (n = 50 each): Group 1 (ZoE), Group 2 (Metapex), and Group 3 (Endoflas) based on the obturation material preferred. The teeth were clinically and radiographically evaluated at 6 and 12 months' postoperatively by another investigator who was blinded to the type of filling material that was used in each tooth. Kruskal–Wallis test, Mann–Whitney Test, and Wilcoxon Signed-Rank Test was used for statistical analysis.

Results:

When the obturation quality was assessed, the optimal filling was found in 78% of the cases while the rest have underfilling (9%) and overfilling (13%). The incidence of overfilling was higher in the cases with some root resorption. After 12 months, Group 2 showed maximum variation with the highest incidence (70%) of extensive resorption both interradicular and intraradicular (Grade 3 score) followed by Group 1 (26%) and Group 3 (16%), respectively.

Conclusion:

Among all the materials, Endoflas showed the highest success rate with least incidence of resorption both outside and within the root canal (hollow tube effect) whereas least success rate was observed with Metapex having the hollow tube effect in majority of the cases (70%) after the follow-up of 12 months.

Evaluation of Dentin Adaptability of Fluoride Varnish as a Root Canal Sealer Using Scanning Electron Microscopy

Objectives:

This study aimed to assess the dentin adaptability of a certain type of fluoride varnish, as a novel root canal sealer, in comparison with AH-Plus sealer.

Materials and Methods:

Twenty-four extracted single-rooted, single-canal human permanent teeth with straight and fully formed roots and no internal calcification, resorption or cracks, were selected and decoronated such that the remaining root length was 14 mm in all teeth. Root canals were prepared using the Mtwo rotary file system according to the manufacturer’s instructions and filled with gutta-percha and either AH-Plus (n=12) or fluoride varnish (n=12) via the lateral compaction technique. Each root was then sectioned at 4 and 8 mm distances from the apex for evaluation under a scanning electron microscope (SEM). The gap size between the sealer and dentin was measured. Statistical analysis was performed using the Kolmogorov-Smirnov test and t-test with the significance level set at 0.05.

Results:

The mean gap size was 14.407±1.402 μm and 8.342±0.694 μm in the roots obturated with AH-Plus and fluoride varnish sealers, respectively. The t-test revealed a statistically significant difference (P<0.001) in this regard between the two groups.

Conclusion:

Fluoride varnish, as a root canal sealer, has a superior adaptation to dentinal canal walls compared to the AH-Plus sealer.

Investigating The Antimicrobial Activity Of Different Root Canal Filling Pastes In Deciduous Teeth

Background

The antiseptic property of root canal filling materials is very important for the removal of residual pathogens from root canals. The aim of the current study was to investigate the antimicrobial activity of mineral trioxide aggregate (MTA), calcium hydroxide (CH), Metapex, zinc oxide eugenol (ZOE), and CEM-cement.

Materials and methods

Four standard bacterial strains including Staphylococcus aureus (ATCC 6538), Enterococcus faecalis (ATCC 29212), Pseudomonas aeruginosa (ATCC 27853), and Bacillus subtilis (ATCC 6633) and Candida albicans (ATCC 10231) were used. On five plates containing Brain Heart Infusion (BHI) agar, five cavities were made. Then, the plates were cultured by 0.1 mL of bacterial suspension with a concentration of 0.5 McFarland. Afterwards, the cavities were filled with the tested materials and were incubated at 37 °C for 24, 48, and 72 hrs. Diameters of microbial inhibition zones were then measured.

Results

The highest mean diameter of growth inhibition zones was observed around ZOE and then CH and CEM-cement. According to the Kruskal-Wallis test, there was a significant difference among the tested groups (P<0.041).

Conclusion

Considering antimicrobial activity, CH was an acceptable alternative to ZOE.

Evaluation of a mixture of zinc oxide-10% sodium fluoride as novel root canal filling material: A pilot study!!

BACKGROUND

To establish mixture of zinc oxide and 10% sodium fluoride as a novel root canal obturating material for primary teeth.

AIM

This study aims to evaluate clinical and radiographic success of a mixture of zinc oxide and 10% sodium fluoride as root canal obturating material.

SETTINGS AND DESIGN

This pilot study was conducted among 30 primary molars indicated for pulpectomy.

METHODS

Thirty grossly decayed primary molars of children aged 4-9 years were selected with signs or symptoms of irreversibly inflamed or degenerative pulp tissue. Single sitting pulpectomy was carried out in all the teeth with a mixture of zinc oxide powder with 10% sodium fluoride, and they were subsequently restored with preformed crown. Teeth were assessed clinically and radiographically at 3-, 6-, 9-, and 12-month intervals.

STATISTICAL ANALYSIS

Data were analyzed using SPSS Software Version 20.0 (IBM SPSS Statistics, Chicago, IL, USA) and statistical significance was determined by Chi-square test; level of significance was set at P < 0.05.

RESULTS

Overall clinical and radiographic success rate of combination of zinc oxide and sodium fluoride was 92.9% and 85.7%, respectively, at the end of 12 months. Furthermore, resorption rate of material matched resorption of tooth root. Excess filling material was also observed to resorb at the end of 3 months.

CONCLUSION

These results suggest that combination of zinc oxide and sodium fluoride can be considered as suitable alternative root canal obturating materials for primary teeth with low cost to achieve acceptable therapeutic results.

Assessment of facultative anaerobes from the root canals of deciduous molars: An in vivo study

Background. The current research aimed to assess the prevalence of facultative anaerobes isolated from the root canals of deciduous molars.

Methods. The present research enrolled 60 children in the 6‒9-year age group based on clinical and radiographic findings. Under aseptic conditions, access cavities were prepared followed by collection of samples from infected root canals with the help of sterile paper points. The samples thus obtained were subjected for microbial assay.

Results. It was found that Enterococcus faecalis was isolated in 30% of cases, Escherichia coli in 28.4%, Staphylococcus aureus in 25%, α-hemolytic Streptococci in 15% and Proteus mirabilis in 1.6% of cases.

Conclusion. It was concluded from the results of the present study that the root canals of deciduous molars had predominance of facultative anaerobes, confirming its polymicrobial nature. This identification of microbes is crucial as it aids in understanding the pathogenesis of pulpal and periradicular diseases to provide effective antimicrobial irrigation and medicament for endodontic treatment.

Antimicrobial Efficacy of Contemporary Obturating Materials used in Primary Teeth- An In-vitro Study

INTRODUCTION

Preservation of primary tooth with non-vital pulp has been a major problem for pediatric dentist. In such cases, the preferred treatment modality is pulpectomy. The objective of pulpectomy is complete removal of necrotic and irreversibly infected pulp of an affected tooth but, in spite of chemomechanical preparation and copious irrigation of canal, there are chances of failure of pulp therapy due to the entrapped micro organisms in the canal space owing to the tortuous and complex nature of the root canal system and change in their morphology with root resorption. Thus, for optimal success of endodontic treatment, obturating material with antimicrobial properties is advocated in deciduous teeth.

AIM

The aim of the study was to assess the antimicrobial efficacy of different obturating materials used in pediatric dentistry.

MATERIALS AND METHODS

In the present study, antimicrobial efficacy of endoflas, Zinc Oxide Eugenol (ZOE), calcium hydroxide with chlorhexidine, calcium hydroxide with iodoform and distilled water, metapex and saline as control were assessed and compared with each other. The antimicrobial efficacy of obturating materials was evaluated against E. faecalis (ATCC 29212) by agar diffusion method. The statistical analysis was done using SPSS Version 15.0. The Analysis of Variance (ANOVA) and Post-Hoc Tests (Tukey-HSD) were performed to reveal the statistical significance.

RESULTS

Intergroup comparison at 24 hours (Tukey's test) revealed significant difference amongst all the groups. Endoflas had significantly higher zone of inhibition as compared to all the other groups except group treated with ZOE (p-value <0.001).

CONCLUSION

The antimicrobial activity of obturating materials according to results obtained from the present study can be summarized as follows: Endoflas > ZOE >Calcium hydroxide + Chlorhexidine > Calcium hydroxide + Iodoform +Distilled water ~ Metapex > Saline.

Correlation between oral health and Child-OIDP index in 12- and 15-year-old children from Modinagar, India

To investigate the relationship between oral health measures and oral health-related quality of life using the Child-Oral Impact on Daily Performance index among school children of Modinagar. A cross-sectional analytical study was conducted on 900 school children aged 12 and 15 years in Modinagar, India. Children were interviewed about sociodental impacts on quality of life and examined for their normative treatment need for dental caries, traumatic dental injuries, and dentofacial anomalies. Frequency distributions for bivariate analysis and logistic regression for multivariate analysis were used for statistical analysis. Prevalence of oral impacts was high (60%), with a mean score of 2.49 ± 3.92. A significant association (P ≤ .05) was observed in oral impacts on daily performances with age, presence of dental caries, traumatic injuries, and dentofacial anomalies score. A strong association between clinical dental indicators and oral impacts in children showed eating followed by cleaning of teeth and smiling as the most commonly affected daily performances.

Histological evaluation of bone response to pediatric endodontic pastes: an experimental study in guinea pig

This study aimed to evaluate by the intra-osseous implant technique the most commonly used materials for pulp therapy in pediatric dentistry: calcium hydroxide (CH), Guedes Pinto paste and CTZ paste, according to FDI (1980) and ANSI/ADA (1982) recommendations. Thirty guinea pigs, 10 for each material, divided into experimental periods of 4 and 12 weeks received one implant on each side of the lower jaw symphysis. The external lateral tube wall served as control for the technique. At the end of the observation periods, the animals were euthanized and specimens were prepared for routine histological examination. It was observed that CH and CTZ paste induced severe inflammation, a large amount of necrotic tissue, lymphocytes, foreign body cells and bone resorption, while Guedes Pinto Paste induced little or no inflammation in the 4-week observation period. After 12 weeks, the reactions to CH and Guedes Pinto paste were also absent/mild, presenting a general pattern of replacement by recently formed bone tissue while a moderate to severe inflammatory response was observed with CTZ paste. Guedes Pinto paste presented acceptable biocompatibility levels in both analyzed periods; CH only showed acceptable biocompatibility in the 12-week period while CTZ paste showed no biocompatibility in both periods. Among the tested materials, only Guedes Pinto paste presented an acceptable biocompatibility.

A systematic review of root canal filling materials for deciduous teeth: is there an alternative for zinc oxide-eugenol?

The aim of this systematic review was to determine whether there is a root canal filling for deciduous teeth equally or more effective than zinc oxide-eugenol cement (ZOE). Six clinical trials selected for inclusion were independently reviewed by two researchers. Only two showed statistically significant different success rates between the test and the control groups. One found that an iodoform paste with calcium hydroxide (IP + Ca) performed better than ZOE, and the other found that ZOE performed similarly to IP + Ca. The other four studies compared ZOE with an iodoform paste (IP), a calcium hydroxide cement (Ca(OH)₂), or IP + Ca. In these trials, the success rates in the ZOE groups were slightly lower than in the other groups. There seems to be no convincing evidence to support the superiority of any material over ZOE, and both ZOE and IP + Ca appear to be suitable as root canal fillings for deciduous teeth.

Histopathological evaluation of root canal filling materials for primary teeth

This study aimed to assess the response of apical and periapical tissues of dogs' teeth after root canal filling with different materials. Forty roots from dogs' premolars were prepared biomechanically and assigned to 4 groups filled with: Group I: commercial calcium hydroxide and polyethylene glycol-based paste (Calen®) thickened with zinc oxide; Group II: paste composed of iodoform, Rifocort® and camphorated paramonochlorophenol; Group III: zinc oxide-eugenol cement; Group IV: sterile saline. After 30 days, the samples were subjected to histological processing. The histopathological findings revealed that in Groups I and IV the apical and periapical regions exhibited normal appearance, with large number of fibers and cells and no resorption of mineralized tissues. In Group II, mild inflammatory infiltrate and mild edema were observed, with discrete fibrogenesis and bone resorption. Group III showed altered periapical region and thickened periodontal ligament with presence of inflammatory cells and edema. It may be concluded that the Calen paste thickened with zinc oxide yielded the best tissue response, being the most indicated material for root canal filling of primary teeth with pulp vitality.