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Hanafy MS, Abdella Ahmed AK, Salem RG. Impact of using XP-endo finisher and nanobubble water during EDTA dentin conditioning on TGF-β1 release in regenerative endodontic procedures. BMC Oral Health 2024; 24:595. [PMID: 38778321 PMCID: PMC11112901 DOI: 10.1186/s12903-024-04355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Transforming Growth Factor-Beta 1 (TGF-β1) plays a crucial role in the success of Regenerative Endodontic Procedures (REPs) as they directly impact the proliferation and differentiation of stem cells. TGF-β1 is released by conditioning of the dentin matrix using 17% EDTA. EDTA was found to have deleterious effects on dentin especially in immature teeth with fragile dentin walls. Decreasing the irrigation time was reported to decrease these effects. Accordingly, enhancement and activation of the EDTA solution to maintain its efficiency in TGF-β1 release from dentin and thus compensating the reduction in irrigation time was employed. EDTA solution was enhanced by adding Nanobubble (NB) water which contains oxygen filled cavities less than 200 nm in diameter. Additionally, EDTA was activated with XP-endo Finisher rotary file. The aim of this study was to assess the impact of NB enhancement and/or XP-endo Finisher activation of the EDTA solution on the TGF-β1 release from dentin. METHODS Fifty standardized root segments with open apex were allocated to two main groups according to whether EDTA was enhanced with NB water or not, and within each group whether XP-endo Finisher activation was used or not in addition to a Negative Control group. The concentration of the released TGF-β1 in the root canal was measured using enzyme-linked immunosorbent assay (ELISA). The statistical analysis was done using the Shapiro- Wilk, Kolmogorov Smirnov, ANOVA and Post-hoc Tukey tests. RESULTS All groups released a considerable amount of TGF-β1 with the highest values in the EDTA/NB/XP group, followed by EDTA/NB, EDTA/DW/XP, EDTA/DW and Negative Control groups respectively. CONCLUSIONS The results of this study suggest that NBs can promote the success of REPs since it revealed a significant increase in the TGF-β1 release following its use in the enhancement of the EDTA solution. A comparable effect was obtained by XP-endo finisher activation of the EDTA solution. The combined use of NBs and XP-endo Finisher can be a promising addition in REPs. Accordingly, Enhancement and activation of the EDTA solution may compensate decreasing the EDTA irrigation time attempted to avoid the deleterious effect of EDTA on dentin.
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Affiliation(s)
- Mai Sayed Hanafy
- Endodontic Department, Faculty of Dentistry, Suez University, Suez, Egypt
| | | | - Rana Gehad Salem
- Pediatric Dentistry Department, Faculty of Oral and Dental Medicine, Badr University in Cairo, Cairo, Egypt.
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Zarean P, Göllner M, Zarean P, Neuhaus KW. 2D and 3D Erosion Landscape Analysis of Endodontic-Treated Teeth Using EDTA and HEDP as Chelating Agents: A High-Resolution Micro-Computed Tomographic Study. Dent J (Basel) 2023; 11:286. [PMID: 38132424 PMCID: PMC10742433 DOI: 10.3390/dj11120286] [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: 10/30/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
This study aimed to assess the amount of erosion during activated endodontic irrigation with either HEDP or EDTA via high-resolution micro-computed tomography. Two root canals of twenty premolars were prepared with ProTaper Next and irrigated with sodium hypochlorite. Palatal canals, which served as control groups, were sealed, while buccal canals were further irrigated with either EDTA (n = 10) or HEDP (n = 10), which served as test groups. Micro-CT was performed to measure erosion depth. For 2D and 3D measurements, non-parametric repeated ANOVA measurements and post hoc tests were performed. 2D analysis showed highly significant differences between the case groups at each position of the root (p ≤ 0.01). The cervical and apical positions showed significant differences in the EDTA group (p = 0.03). The 3D analysis also showed significant differences between both chelating agents (p < 0.01) and the case and control groups (p = 0.01). The mean erosion depths in the cervical, middle, and apical thirds of the EDTA group were 45.75, 41.79, and 32.25 µm, and for the HEDP group were 20.25, 16.40, and 15.96 µm, respectively. HEDP seems to have a significantly less erosive effect. Different irrigation protocols with harsher conditions, as might be the case during endodontic retreatment, could be assessed with micro-CT.
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Affiliation(s)
- Parichehr Zarean
- Department of General Pediatric and Adolescent Dentistry, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland; (P.Z.); (P.Z.)
| | - Michael Göllner
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland;
| | - Paridokht Zarean
- Department of General Pediatric and Adolescent Dentistry, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland; (P.Z.); (P.Z.)
| | - Klaus W. Neuhaus
- Department of General Pediatric and Adolescent Dentistry, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, 4058 Basel, Switzerland; (P.Z.); (P.Z.)
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
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El-Banna A, Elmesellawy MY, Elsayed MA. Flexural strength and microhardness of human radicular dentin sticks after conditioning with different endodontic chelating agents. J Conserv Dent 2023; 26:344-348. [PMID: 37398867 PMCID: PMC10309119 DOI: 10.4103/jcd.jcd_173_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The objective of this in vitro study was to examine the impact of different endodontic chelating agents on the flexural strength and microhardness of root dentin. Materials and Methods Fourty dentin sticks of (1 mm × 1 mm × 12 mm) were obtained from 10 single-rooted premolars and divided into four groups (n = 10). One stick from each tooth was assigned to one of the experimental groups and was soaked in one of the experimental chelating solutions for 5 min 17% ethylenediaminetetraacetic acid (EDTA), 2.5% phytic acid (PA), 18% etidronic acid, or saline (control group). Following the 5-min soak, the sticks' flexural strength was evaluated using a 3-point loading test using the universal testing machine, and the surface microhardness was tested using a Vickers's microhardness tester. Results PA (2.5%) and etidronic acid (18%) showed no significant detrimental effect on either the flexural strength or the surface microhardness of radicular dentin compared to the control. EDTA (17%) exhibited a significant drop in the flexural strength and microhardness of radicular dentin compared to the other groups. Conclusions PA and etidronic acid chelators do not compromise the surface and bulk mechanical properties of radicular dentin.
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Affiliation(s)
- Ahmed El-Banna
- Department of Biomaterials, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Maii Y. Elmesellawy
- Department of Endodontic, Faculty of Dentistry, Beni-Suef University, Beni Suef, Egypt
| | - Mohamed Ahmed Elsayed
- Department of Endodontics, RAK College of Dental Sciences, RAK Medical and Health Sciences University, Ras Al-Khaimah, United Arab Emirates
- Department of Endodontics, Faculty of Dentistry, Assiut University, Assiut, Egypt
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Effect of Endodontic Irrigating Solutions on Radicular Dentine Structure and Matrix Metalloproteinases-A Comprehensive Review. Dent J (Basel) 2022; 10:dj10120219. [PMID: 36547035 PMCID: PMC9776432 DOI: 10.3390/dj10120219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Irrigating solutions play an important role in the eradication of intracanal microbes and debris dissolution during endodontic treatment. Different combinations of solutions and protocols have been advocated, with sodium hypochlorite (NaOCl), ethylenediamine tetra acetic acid (EDTA), and chlorhexidine (CHX) remaining the most widely used ones by many clinicians. Although these solutions provide efficient inorganic dissolution and antimicrobial capacity, their use has also been reported to cause undesired effects on root dentin composition and mechanical and biomechanical properties, such as microhardness, surface roughness, bond strength, and matrix metalloproteinase (MMP) activity. Several corroborating studies attribute these changes in mechanical properties of dentine to the use of irrigating solutions, and there are limited reports on how the solutions affect the expression of MMPs, which may be a correlating link to understanding the role of these enzymes in dentin collagen and changes in the mechanical properties of dentin. Hence, using the basis of several studies from the literature, the objective is to comprehensively review the influence of individual and combined irrigating solutions on root dentine structure and the activity of the MMPs.
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Effect of Different Root Canal Irrigant Solutions on the Release of Dentin-Growth Factors: A Systematic Review and Meta-Analysis. MATERIALS 2021; 14:ma14195829. [PMID: 34640224 PMCID: PMC8510123 DOI: 10.3390/ma14195829] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 01/07/2023]
Abstract
Irrigant solutions are used to promote dentin-growth factors (GF) release for regenerative endodontics. This review aimed to evaluate the reports comparing the release of GFs using different root canal irrigant solutions. Eligible studies compared the in vitro GF release in human teeth after the use of at least two distinct solutions. A search was conducted on Pubmed, Scopus, Web of Science, and Lilacs on 11 August 2021. Risk of bias was assessed using SciRAP. Study characteristics and quantitative data were extracted, and meta-analyses were performed for the mean difference (95% confidence interval) of the release of transforming growth factors Beta 1 (TGF-β1) by EDTA compared to other irrigants. Of sixteen eligible studies, eight were included in quantitative analysis. ELISA assays showed higher TGF-β1 release from 10% EDTA compared to 10% citric acid (p < 0.00001). Immunogold assays showed higher levels of TGF-β1 for 17% EDTA (p < 0.00001) compared to 10% citric acid. GRADE identified a low to very low certainty of evidence. These results point to an increased release of TGF-β1 in dentin treated with EDTA. The high heterogeneity and very low certainty of the evidence demand further studies before EDTA indication as a better irrigant for regenerative endodontics. Registration: CRD42020160871 (PROSPERO).
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Gonzalez CS, Estevez R, Loroño G, García VDF, Caballero Montes JA, Rossi-Fedele G, Cisneros R. Etidronic acid and ethylenediaminetetraacetic acid associated with sodium hypochlorite have limited effect on the compressive fracture resistance of roots ex vivo. J Conserv Dent 2021; 23:484-488. [PMID: 33911358 PMCID: PMC8066680 DOI: 10.4103/jcd.jcd_527_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/20/2020] [Accepted: 12/06/2020] [Indexed: 12/04/2022] Open
Abstract
Aims: To assess the effect of etidronic acid (EA) mixed with sodium hypochlorite (NaOCl) and two ethylenediaminetetraacetic acid-containing preparations (EDTA and SmearClear) alternated with NaOCl, as a final rinse, on root fracture resistance to a compressive force. Materials and Methods: Seventy-two premolar roots were randomly allocated to the following groups according to the irrigant solutions. For the EA group, 9% EA + 2.5% NaOCl were used throughout the assays (n = 21). The remaining groups received 2.5% NaOCl during and immediately after chemo-mechanical instrumentation. Intermediately, the roots received 17% EDTA (n = 19), or SmearClear (n = 16), or no irrigation (control) (n = 16) plus a final rinse with 2.5% NaOCl. The specimens were subjected to a vertical compressive force loaded at a crosshead speed of 0.02 mm/s parallel to the long axis of the root until fracture occurred. The results were compared statistically using the one-way analysis of variance for intergroup comparisons. Results: The negative control presented with the highest values, whereas the SmearClear presented with the lowest values, though no significant differences were found when comparing the different groups (P = 0.82). Conclusions: The use of EA + NaOCl or two EDTA formulations in association with NaOCl does not affect the fracture resistance of previously chemo-mechanically prepared roots.
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Affiliation(s)
| | - Roberto Estevez
- Endodontic Unit, Engineering and Design, European University of Madrid, Madrid, Spain
| | - Gaizka Loroño
- Endodontic Unit, Engineering and Design, European University of Madrid, Madrid, Spain
| | | | | | - Giampiero Rossi-Fedele
- Endodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Rafael Cisneros
- Endodontic Unit, Engineering and Design, European University of Madrid, Madrid, Spain
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Bosaid F, Aksel H, Makowka S, Azim AA. Surface and structural changes in root dentine by various chelating solutions used in regenerative endodontics. Int Endod J 2020; 53:1438-1445. [PMID: 32619296 DOI: 10.1111/iej.13354] [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: 02/01/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 01/16/2023]
Abstract
AIM To evaluate the effects of the prolonged use of various irrigant solutions used during regenerative endodontic procedures on the physical and chemical structure of root canal dentine in extracted human teeth. METHODOLOGY Sixtyroot dentine samples from extracted, single-rooted, human teeth were assigned to 10 groups. Eight groups were irrigated with 1.5% NaOCl for 5 min, followed by 3%, 10%, 17% EDTA or 10% citric acid (CA) for 5 or 10 min. One group received only NaOCl irrigation, and samples with only distilled water irrigation were used as a control group. The changes in microhardness and flexural strength were determined using Vickers and 3-point flexural tester, respectively. Molecular and elemental compositions were recorded using FTIR and EDS spectroscopy. Data were analysed using one-way anova, Kruskal-Wallis and Mann-Whitney U tests. RESULTS The application of 1.5% NaOCl for 5 min did not affect the mineral content or microhardness of dentine (P > 0.05). However, it significantly decreased the dentine collagen peak values (P < 0.05), which was similar to the control group after the use of chelating agents (EDTA and 10% of CA) (P > 0.05). The effect of EDTA on the inorganic content was not concentration and time dependent (P > 0.05). CA resulted in a significantly greater reduction in the inorganic contents compared with the control and EDTA groups (P < 0.05). Regardless of the time, EDTA and CA significantly decreased dentine microhardness compared to the control (P < 0.05) with the greatest reduction in the CA groups (P < 0.05). NaOCl alone was associated with the lowest flexural strength, while none of the other irrigation regimens significantly decreased the flexural strength compared to the control group (P> 0.05). CONCLUSIONS Use of 1.5% NaOCl for 5 min decreased the collagen content of samples of human dentine from extracted teeth while EDTA and 10% citric acid mostly affected the inorganic content and microhardness of dentine surfaces. None of the irrigant solutions significantly decreased the mechanical properties of the entire dentine specimen.
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Affiliation(s)
- F Bosaid
- Division of Endodontics, University at Buffalo, School of Dental Medicine, Buffalo, NY, USA
| | - H Aksel
- Division of Endodontics, University at Buffalo, School of Dental Medicine, Buffalo, NY, USA
| | - S Makowka
- Dental Materials Research Laboratory, University at Buffalo, School of Dental Medicine, Buffalo, NY, USA
| | - A A Azim
- Division of Endodontics, University at Buffalo, School of Dental Medicine, Buffalo, NY, USA
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Dotto L, Sarkis Onofre R, Bacchi A, Rocha Pereira GK. Effect of Root Canal Irrigants on the Mechanical Properties of Endodontically Treated Teeth: A Scoping Review. J Endod 2020; 46:596-604.e3. [DOI: 10.1016/j.joen.2020.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 11/27/2022]
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