An innovative technique to safely perform active cleaning in teeth with open apices: CAB technique

Cytotoxicity and Efficacy in Debris and Smear Layer Removal of HOCl-Based Irrigating Solution: An In Vitro Study

In the present study we evaluated the cytotoxicity of super-oxidized water on human gingival fibroblasts and its efficacy in debris and smear layer removal from root canal walls. Cultured gingival fibroblasts were exposed to super-oxidized water (Sterilox), which was diluted in Iscove’s modified Dulbecco’s medium (IMDM) at 30%, 40%, 50%, 60% and 70% concentrations. The control group was maintained in IMDM. The cell viability was evaluated by means of an MTT assay after incubation periods of 1 h, 2 h, 24 h and 48 h. Pathological cellular changes were also observed under fluorescence and phase contrast microscopes. The efficacy in debris and smear layer removal was evaluated in comparison to the conventional application of sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA). Forty maxillary premolars were randomly divided into two equal groups (n = 20) and shaped with ProTaper NEXT rotary instruments using Sterilox or NaOCl/EDTA for irrigation. Afterwards, roots were split longitudinally and examined under a scanning electron microscope. The results revealed that super-oxidized water and sterile distilled water have acceptable biological properties for endodontic applications at concentrations up to 50% (p > 0.05). Moreover, super-oxidized water is equally effective in debris and smear layer removal as compared to NaOCl/EDTA (p > 0.05).

Revascularization of an Immature Permanent Tooth with Periapical Periodontitis Using Concentrated Growth Factor Assisted by Erbium Laser (2940 nm) Irrigation: A Case Report

Revascularization has been incorporated into endodontic practice and become a viable treatment alternative for immature teeth with pulp necrosis. Thorough disinfection of the root canal is a key factor for successful revascularization. An erbium: yttrium–aluminium–garnet (Er: YAG) laser has been proved advantageous for efficient root canal disinfection. This article reports one case of periapical periodontitis caused by a fractured occlusal tubercle. Revascularization assisted by Er: YAG laser irrigation was carried out with long-term follow up. During the process of treatment, we opened drainage to relieve the acute symptoms first. The necrotic pulp was removed, and then the root canal was rinsed with 0.5% sodium hypochlorite (NaOCl) solution assisted by Er: YAG laser irrigation, dried, and filled with a triple-antibiotic paste. After two weeks, the intracanal medication was removed, and 9 mL of whole vein blood was taken from the patient to prepare concentrated growth factor (CGF) after failing to induce enough blood into the canal system by over-instrumenting. The newly prepared CGF was transferred into the root canal. A 3 mm mineral trioxide aggregate (MTA) was placed directly on the thrombus of the CGF and then restored with glass-ionomer cement (GIC). The case was followed up for more than four years to record the clinical symptoms and imaging manifestations. Er: YAG irrigation is an efficient root canal disinfection protocol with the advantages of easy operation and minimal risk, which might be applicable to the revascularization of necrotic immature permanent teeth.