Comparative evaluation of effect of nisin-incorporated ethylenediamine tetraacetic acid and MTAD on endodontic biofilm eradication, smear layer removal, and depth of sealer penetration

OBJECTIVES

To comparatively evaluate the nisin-incorporated ethylenediamine tetraacetic acid (N-EDTA) and MTAD on cytotoxicity, endodontic biofilm eradication potential, smear layer removal ability, and sealer penetration depth.

MATERIALS AND METHODS

N-EDTA was prepared and characterized using high-performance liquid chromatography (HPLC). Minimum inhibitory, minimum bactericidal, and minimum biofilm inhibitory concentration (MBC, MIC, and MBIC) were determined on Enterococcus faecalis (E. faecalis) strain. The cytocompatibility of N-EDTA and MTAD was evaluated using 3,(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)-based colorimetric assay. Dentin specimens (n = 88 for antibacterial analysis, n = 170 for sealer penetration depth) were prepared and subjected to the classical irrigating strategy and obturation, respectively. The scanning electron microscopic evaluation (SEM) was done for the evaluation of biofilm disruption and smear layer removal. Confocal laser scanning microscopy (CLSM) evaluation was done for determining percentage of bacterial viability and sealer penetration depth. Statistical analysis of one-way ANOVA and Tukey's HSD post hoc tests for bacterial viability and Kruskal-Wallis test and Mann-Whitney test for smear layer removal and depth of penetration were done with the significance level set at p < 0.05.

RESULTS

MTAD and N-EDTA showed cytocompatibility without any statistical differences from each other. For N-EDTA, the MIC and MBC values were 12.5 μg/ml (1:8), and MBIC values were 36 μg/ml. Biofilm disruption and killed bacterial percentage of N-EDTA was statistically higher than MTAD, whereas both the materials showed similar efficacy in the removal of the smear layer and sealer penetration depth.

CONCLUSION

N-EDTA had negligible cytotoxicity with similar smear layer removal ability, sealer penetration, and better antibiofilm potential than MTAD.

CLINICAL RELEVANCE

N-EDTA can serve as a viable alternative endodontic irrigant.

Use of final irrigants MTAD, Salvedora Perscia, Malachite green, and Ti-sapphire laser on push-out bond strength of Zirconia post

AIM

Evaluation of the push-out bond strength (PBS) of zirconia post-bonded to radicular dentin after using different final irrigants (MTAD, Malachite green (MG), Ti-sapphire laser and Salvadora persica (S.persica).

MATERIAL AND METHOD

Forty human permanent single-rooted were decoronated above the cement-enamel junction. An experienced endodontist performed all the root canal instrumentation using ProTaper universal rotary files. Canals were irrigated using 5.25% NaOCl solution followed by EDTA as a final sterilant. Obturation with gutta-percha using AH Plus sealer was performed. Post-space preparation was completed using Gates Glidden and specimens were randomly assigned to four groups based on the final disinfectant received (n=10). Group 1: 5.25% NaOCl + MTAD, group 2: 5.25% NaOCl + MG, group 3: 5.25% NaOCl +Ti-sapphire laser, and group 4: 5.25% NaOCl + S. persica. The chemically polymerized resin was used to lute zirconia posts. PBS and failure mode analysis were performed using a universal testing machine and stereomicroscope at 40X magnification. Data were compared between the two groups with 95% CI using one-way analysis of variance (ANOVA) with the Tukey post hoc test. p=0.05.

RESULTS

Group4(5.25% NaOCl+ S.persica) specimens demonstrated the maximum (8.94±0.14 MPa) bond strength. Conversely, the apical third of Group 2 (5.25% NaOCl+ MG) (2.87±0.15 MPa) samples revealed the minimum bond strength scores. Intergroup comparison exposed that Group 1 (1.3% NaOCl+ MTAD), Group 3 (5.25% NaOCl+Ti-sapphire laser), and Group 4 (5.25% NaOCl+ S. persica) at all three-thirds unveiled no significant difference in PBS (p<0.05).

CONCLUSION

Ti-sapphire laser and Salvedora Persica possess the potential to be used as a final root canal irrigant to improve the push-out bond strength of zirconia post-to-root dentin.

The influence of MTAD and QMix on the accuracy of electronic apex locator in locating simulated perforations

Aims and Background

The aim of this study was to evaluate the accuracy of the electronic actual length in detecting artificial perforations of the root canal in the presence of saline solution (NaCl, (Eczacibasi, Istanbul, Turkey), chlorhexidine [CHX (Werax, Tunadent, Izmir, Turkey)], QMix (Dentsply Tulsa, Maillefer, Ballaigues, Switzerland), and MTAD (Dentsply, Tulsa Dental, Tulsa, OK, USA).

Materials and Methods

The root canals of 25 single-rooted extracted human teeth were perforated artificially in the middle section of the root. The actual lengths up to the perforation site were measured and then, the teeth were embedded in an alginate mold. Electronic measurements of the perforations were obtained by an electronic apex locator according to the manufacturers' recommendations under dry conditions and in the presence of NaCl, CHX, MTAD, and QMix using a #20 K-file. Each canal was irrigated with distilled water and then dried with paper points between the measurements. Statistical analyses were performed using the Friedman test and Spearman Rank correlation coefficient to assess the correlations between the measurement methods.

Results

Highest correlation between the actual length and the electronic measurement was observed under dry conditions and NaCl solution (r: 0.932, r: 0.940 respectively), and the least correlation was observed with MTAD solution (r: 0.697) using statistical analysis. Moreover, the accuracy of the electronic apex locator with different irrigation solutions was statistically different from each other (P = 0.001).

Conclusion

The most accurate electronic measurements of artificial perforation were obtained under dry conditions or with NaCl.

Push out bond strength of glass fiber post to radicular dentin irrigated with Nisin and MTAD compared to methylene blue photodynamic therapy

AIM

Present lab-based study intended to appraise the effect of nisin, Mixture of Tetracycline, Acid and Detergent (MTAD), and photodynamic therapy (PDT) when used as a canal disinfectant on push-out bond strength (PBS) of fiber post to radicular dentin MATERIALS AND METHODS: Forty uni-radicular premolar teeth were extracted and disinfected in 0.5 % thymol solution. All specimens were decoronated to achieve standardize root length of 14 mm. Cleaning and shaping of the canal were done using protaper NiTi system. The canal space was dried and obturated. Post space was prepared using peso reamers up to 10 mm length and samples were randomly divided into 4 groups (n = 10). Group 1 irrigated with 10 % Nisin with MTAD, group 2: 1.3 % NaOCl and MTAD, Group 3 irrigated with 2.5 % NaOCl and 17 % EDTA and post space of samples in group 4 with PDT with MTAD. Fiber-reinforced composite post (FRCP) was fitted in canal space using self-etch resin cement. Each sample was cut into 1 mm from coronal, middle, and apical and subjected to PBS via a universal testing machine. For comparison of means, Analysis of variance (ANOVA) and Tukey multiple comparison test was used maintaining the level of significance at p < 0.05.

RESULT

Samples in group 3 post space irrigated with 2.5 % NaOCl and 17 % EDTA demonstrated the highest PBS at all root levels (cervical: 8.83 ± 0.14 MPa, middle: 7.63 ± 0.82 MPa and apical: 5.82 ± 0.32 MPa) in comparison to other tested groups. Whereas, group 1 in which Nisin 10 % with MTAD was used as a canal disinfectant displayed the lowest PBS at all levels (cervical: 6.91 ± 0.54 MPa, middle: 6.15 ± 0.31 MPa, and apical: 3.62 ± 0.68 MPa).

CONCLUSION

Post space irrigated with 1.3 % NaOCl and MTAD shows PBS similar to control group 2.5 % NaOCl and 17 % EDTA. Both types of irrigation methods have potential and can be recommended in clinical scenarios. Whereas, 10 % Nisin and PDT with MTAD as chelator needs further inquiry.

Development of a Scalable and Sublimation-Free Route to MTAD

The cyclic azodicarbonyl 4-methyl-1,2,4-triazoline-3,5-dione (MTAD) is a versatile and powerful reagent used mainly in cycloaddition chemistry. Though known for more than 50 years, its unsafe preparation, as well as purification by sublimation, hampered its widespread applicability on a larger scale. Herein we report a scalable and safe route to MTAD, which avoids the generation of methyl isocyanate. Moreover, we demonstrate that sublimation can be circumvented by the application of judicious oxidation conditions, followed by simple filtration. Overall, up to 25 g of MTAD was prepared in a single batch from commercial starting materials in three steps, with recrystallization serving as the only purification in the sequence. When employed in dearomative methodologies, the MTAD obtained by this protocol displayed synthetic efficiency equivalent to that of MTAD purified by sublimation.

The effect of a root-dentin pretreatment technique combining PIPS with MTAD aiming to improve the bond strength of glass fiber post

The aim of this study was to evaluate the combined effect of MTAD and photon-induced photoacoustic streaming (PIPS) technique on the smear layer removal and the bond strength of glass fiber post. Fifty-five human mandibular premolars were chosen. After root canal therapy and post space preparation, the teeth were equally divided to five groups according to the methods of root-dentin pretreatment: G1: distilled water (control); G2: 2.5% NaOCl+17% EDTA; G3: MTAD; G4: PIPS; G5: MTAD+PIPS. One sample was randomly selected from each group, and scanning electron microscope (SEM) was used to observe the microscopic morphology of the coronal, middle and apical level of the root-dentin. The remaining ten samples from each group were glued to glass fiber posts, and the bond strength was assessed by push-out test. SEM evaluation showed that the most complete smear layer removal was found in MTAD + PIPS group, especially in coronal third. Push-out test results exhibited that there was a statistically significant interaction between the experimental groups and root canal third (p < .0005). Significant differences could be found among five groups (p < .05): G5 > G4 > G3 > G2 > G1. G5 had the highest bond strength. In conclusion, post space pretreatments with MTAD or PIPS technique can significantly remove smear layer and improve the bond strength of glass fiber post, and combination of them works best.

A Comparative ex-vivo Study of Effects of Different Irrigation Protocols with/without Laser Activation on the Root Dentine's Micro-Hardness

Objective

To compare the effects of different irrigation protocols, with/without laser activation, on the radicular dentine's micro-hardness.

Methods

Eighty-two human extracted premolars were decoronated and divided into 7 groups. Roots were longitudinally split into two halves. The micro-hardness was measured for one half before and after irrigation protocols. The groups were; G1: MTAD without laser-activation, G2: MTAD with laser-activation, G3: sodium-hypochlorite (SH) with laser-activation, G4: SH then EDTA with laser-activation, G5: SH then MTAD with laser-activation, G6: SH without laser-activation. G7: distilled water (control). In the two-irrigants groups G4 and G5), samples were irrigated first with SH then with MTAD or EDTA irrigants, which were activated by the laser. The difference between the before- and after-irrigation micro-hardness was calculated to obtain the micro-hardness difference. Data were analyzed using the Paired Sample-t and Two-ways ANOVA tests at P=0.05.

Results

Overall, the mean dentine's micro-hardness after-irrigation (103.1) was lower than before-irrigation (116.1) (P<0.001); except for the distilled-water group, (116.6 and 112.9, respectively) (P=0.075). The micro-hardness reduction of SH without laser-activation group (32.5) was the greatest (P<0.001). The single-irrigant or laser-activation irrigation protocols caused significantly less micro-hardness reduction compared to the two-irrigants or no laser-activation protocols. The mean micro-hardness reduction of SH and MTAD groups (both with laser-activation) (5.8 and 9.3, respectively) were significantly lower than other groups, but not from that of the control group (3.7).

Conclusion

Using irrigants significantly reduced the root-dentine's micro-hardness. Although irrigants agitation by an Er: Yag laser significantly minimized micro-hardness reduction, it did not suppress the adverse effects on dentine micro-hardness when two-irrigants were used.

The Comparative Evaluation of the Post-Antimicrobial Effect of MTAD ® and 2% Chlorhexidine against Enterococcus faecalis of Permanent Teeth with Necrotic Pulp

AIM:

Enterococcus faecalis is one of the most resistant bacteria in necrotic teeth. That’s why the goal of this study was to determine the post-antibiotic effect of MTAD®& 2% Chlorhexidine® as root canal irrigating solution on clinical isolates of E. faecalis from infected root canals of permanent teeth, using the spectrophotometric technique.

MATERIAL AND METHODS:

The antibacterial efficacy of Chloramphenicol 30 mcg, Nitrofurantoin 300 mcg, Vancomycin 5 mcg, Amoxicillin/clavulanic acid 30 mcg and Ofloxacin 5 mcg against E. faecalis was compared using the Disc diffusion method. Patients were selected for this study with permanent necrotic teeth. The sterile paper point was inserted inside the infected root canal and left for 60 seconds; to obtain the microbiological sample. Postantibiotic effect of MTAD® and 2% Chlorohexidine® on E. faecalis was compared. The absorbance of bacterial growth was examined for both irrigating solutions during the first 10 hours with an hour interval, and then tested at 48, 72, 96 up to 240 hours.

RESULTS:

The results showed that during the first 10 hours, MTAD® showed immediate antibacterial effect and maintained its higher antibacterial activity than 2% chlorohexidine®. After 48, 72, 96 and 240 hours, both MTAD® and 2% chlorohexidine® showed the same prolonged action of post-antibiotic effect against E. faecalis with a non-significant difference. According to Antibiotic sensitivity, the results revealed MTAD® is the most effective antimicrobial drug, showing the highest zone of inhibition, followed by 2% Chlorhexidine and Nitrofurantoin 300 mcg which showed the same inhibitory activity

CONCLUSION:

From the current study, it can be concluded that MTAD® has a strong bactericidal effect against E. faecalis and showed the highest zone of inhibition.

Evaluation of the Effect of MTAD on Expression of Enterococcus faecalis Virulence Factors Considering the Role of Different Obturating Materials

OBJECTIVES

The aim of this study was to determine the effect of MTAD on the expression of virulence factors of Enterococcus faecalis (E.faecalis) considering the role of Guttapercha/AH26 or Resilon/RealSeal SE as root canal obturating materials.

MATERIALS AND METHODS

One-hundred and forty-four single-rooted human teeth were instrumented to a standardized apical size. Root canals were infected by E.faecalis (ATCC 29212). Ninety teeth were irrigated with MTAD and randomly divided into three groups. In two groups, root canals were obturated by either Gutta-percha/AH26 or Resilon/RealSeal SE. Root canals were kept unobturated in the third group. The remaining 54 teeth received no final irrigation. All groups were then subdivided into three timepoint subgroups in which dentin powder was obtained from each sample to determine the expression of specific virulence factors of E.faecalis (efa, esp, gel, fsr) using real-time reverse transcription polymerase chain reaction (RT-PCR). Statistical analysis was performed by one-way analysis of variance (ANOVA) and Tukey's post-hoc test. The statistical power was set at P-value ≤0.05.

RESULTS

MTAD was effective against the expression of most of the tested virulence factors, and Gutta-percha/AH26 increased the antibacterial efficacy of MTAD.

CONCLUSIONS

MTAD could inhibit the expression of some known virulence factors of E.faecalis at the majority of tested timepoints. This may partly explain some of the mechanisms of antimicrobial efficacy of MTAD against this resistant microorganism which is known as one of the main causes of failure of root canal treatment.

Efficacy of new irrigating solution on smear layer removal in apical third of root canal: A scanning electron microscope study

Aims

The aim of this in vitro study is to evaluate and compare the smear layer removal efficacy of etidronic acid-based irrigating solution with others in the apical third of the root canal.

Materials and Methods

Forty human single-rooted mandibular premolar teeth were taken and decoronated to standardize the canal length. After biomechanical preparation, teeth were randomly divided into four groups (n = 10) and the final irrigation was carried out with tested irrigants. Group I: normal saline (negative control); Group II: 5.25% sodium hypochlorite (NaOCl) with surfactant and 17% ethylenediaminetetraacetic acid (EDTA) with surfactant; Group III: freshly mixed BioPure MTAD; and Group IV: freshly mixed Chloroquick solution. The teeth were split into two halves and observed under a scanning electron microscope to analyze the amount of smear layer present.

Statistical Analysis

Data were analyzed using the Kruskal-Wallis test and Mann-Whitney test.

Results

Group II (5.25% NaOCl with surfactant followed by 17% EDTA with surfactant) showed least smear layer scores (1.1 ± 0.3162). This was followed by Group III (MTAD) (2.2 ± 0.4216) and then Group IV (Chloroquick) (2.4 ± 0.5164).

Conclusion

Sequential use of 5.25% NaOCl with surfactant and 17% EDTA with surfactant was found to be the most efficient than MTAD and Chloroquick in the removal of smear layer in the apical third of root canal.

Comparison of Antimicrobial Substantivity of Six Root Canal Irrigants against Enterococcus faecalis

Introduction

The antimicrobial substantivity of Mixture of Doxycycline, Citric acid, and Tween 80 (MTAD), Tetraclean, Tetraclean NA, Q-Mix, 2% Chlorhexidine (CHX) and Octenisept was assessed in human root dentine blocks infected with Enterococcus (E.) faecalis.

Methods and Materials

A total of 170 dentine tubes were prepared from human maxillary incisors. After crown and apical third removal, cementum was abraded. The remaining center-holed pieces were cut into 4-mm blocks, infected with E. faecalis in Brain Heart Infusion (BHI) broth for 28 days, then randomly divided into 6 experimental groups (n=25) and 2 controls (n=10). At 0, 7, 14, 21 and 28 days, dentine chips were removed from the canals, with sequential round burs with increasing diameters, and collected into freshly prepared BHI broth. After culturing, growing colonies were counted as colony forming units (CFU). Conventional non-parametric tests (Kruskal-Wallis and Mann-Whitney tests) were used to assess intra-group (at different time frames) and inter-group (at each experimental time) differences (P=0.05).

Results

Tetraclean yielded the lowest CFU counts (P<0.001) at each observation time. Tetraclean NA and Q-Mix showed better (P<0.001) substantivity than 2% CHX and MTAD (except for Q-Mix versus MTAD at 14 days, P=0.21). Conclusions: In this in vitro study, Tetraclean NA and Q-Mix displayed the best antimicrobial substantivity against E. faecalis after Tetraclean in infected human root dentine. Considering the findings of our study and potential drawbacks of antibiotic-based irrigants, free-antibiotic irrigants may represent viable alternative for final rinse in root canal treatment.

Alkaline Sodium Hypochlorite Irrigant and Its Chemical Interactions

Endodontic irrigating solutions may interact chemically with one another. This is important, because even when solutions are not admixed, they will come into contact with one another during an alternating irrigation technique, forming unwanted by-products, which may be toxic or irritant. Mixing or alternating irrigants can also reduce their ability to clean and disinfect the root canal system of teeth by changing their chemical structure with subsequent loss of the active agent, or by inducing precipitate formation in the root canal system. Precipitates occlude dental tubules, resulting in less penetration of antimicrobials and a loss of disinfection efficacy. Sodium hypochlorite is not only a very reactive oxidizing agent, but is also the most commonly used endodontic irrigant. As such, many interactions occurring between it and other irrigants, chelators and other antimicrobials, may occur. Of particular interest is the interaction between sodium hypochlorite and the chelators EDTA, citric acid and etidronate and between sodium hypochlorite and the antimicrobials chlorhexidine, alexidine, MTAD and octenisept.

Comparative evaluation of demineralization of radicular dentin with 17% ethylenediaminetetraacetic acid, 10% citric acid, and MTAD at different time intervals: An in vitro study

Background:

The smear layer has the capability to protect the bacteria within the dentinal tubules from intracanal medicament. After removal of the smear layer from infected root canals, it allows disinfection of the entire root canal. The smear layer compromising the seal between the root canal sealer and root canal wall also decreases the penetration of irrigants into dentinal tubules.

Aims:

This study compares the amount of phosphorous liberated and demineralization of the radicular dentin with 17% ethylenediaminetetraacetic acid, 10% citric acid and mixture of doxycycline, citric acid, and a detergent at different time intervals.

Materials and Methods:

Extracted maxillary single-rooted teeth were prepared by using a combination of passive step-back and rotary 0.04 taper nickel-titanium files. Sodium hypochlorite 5.25% and sterile distilled water were used as an intracanal irrigant. The canals were then treated with 5 mL of one of the following solutions such as final rinse sterile distilled water, 5.25% sodium hypochlorite, 17% ethylenediaminetetraacetic acid (EDTA) or mixture of doxycycline, citric acid, and a detergent. The presence or absence of smear layer and the amount of erosion on the surface of the root canal walls at the coronal, middle, and apical portions of each canal were examined under a scanning electron microscope.

Statistical Analysis:

Data were analyzed by one-way analysis of variance (ANOVA) to determine whether there were significant differences between the groups.

Results:

The results show that mixture of doxycycline, citric acid, and a detergent is an effective solution for the removal of the smear layer and does not significantly change the structure of the dentinal tubules.

Conclusions:

In this study, 10% citric acid shows the maximum amount of dimeneralization of radicular dentine followed by mixture of doxycycline, citric acid, and a detergent, and 17% ethylenediaminetetraacetic acid. When all the subgroups were compared, it was seen that the maximum amount of phosphorus liberation was performed by 10% citric acid >mixture of doxycycline, citric acid, and a detergent >17% EDTA at a different time interval.

Effect of different final irrigating solutions on smear layer removal in apical third of root canal: A scanning electron microscope study

AIM

The aim of this in vitro study is to compare the smear layer removal efficacy of different irrigating solutions at the apical third of the root canal.

MATERIALS AND METHODS

Forty human single-rooted mandibular premolar teeth were taken and decoronated to standardize the canal length to 14 mm. They were prepared by ProTaper rotary system to an apical preparation of file size F3. Prepared teeth were randomly divided into four groups (n = 10); saline (Group 1; negative control), ethylenediaminetetraacetic acid (Group 2), BioPure MTAD (Group 3), and QMix 2 in 1 (Group 4). After final irrigation with tested irrigants, the teeth were split into two halves longitudinally and observed under a scanning electron microscope (SEM) for the removal of smear layer. The SEM images were then analyzed for the amount of smear layer present using a three score system.

STATISTICAL ANALYSIS

Data are analyzed using the Kruskal-Wallis test and Mann-Whitney U-test.

RESULTS

Intergroup comparison of groups showed statistically significant difference in the smear layer removal efficacy of irrigants tested. QMix 2 in 1 is most effective in removal of smear layer when compared to other tested irrigants.

CONCLUSION

QMix 2 in 1 is the most effective final irrigating solution for smear layer removal.

Comparison of the effect of MTAD and conventional irrigation agents on apical leakage and push-out bond strength of root canal filling

The aim of this study was to evaluate the effect of MTAD (a mixture of tetracycline isomer, an acid, and a detergent) and conventional irrigation agents on the apical leakage and push-out bond strength of root canal filling and to correlate the apical leakage and push-out bond strength. Root canals of 120 maxillary central incisors were prepared with a ProTaper file up to F3 and distributed to six groups. Saline, 1% NaOCl, 17% EDTA, 17% EDTA/1% NaOCl, and 2% chlorhexidine (CHX) solutions were used between each file change, and 5 mL of the same irrigating solution was used for the final flush. In the MTAD group, the root canals were irrigated with 1.3% NaOCl between each file and 5 mL of MTAD for the final flush. All the root canals were filled with AH Plus sealer and gutta-percha cones. Apical leakage was evaluated using a fluid transport system. After the apical leakage test, each tooth was prepared for the push-out assessment. The statistical analysis revealed that the irrigation solutions had no effect on the apical leakage of the root canal fillings (p = 0.258). The root fillings of the groups irrigated with MTAD showed significantly lower push-out bond strength values than the other groups (p < 0.001). These commonly used irrigating solutions did not affect the apical leakage of the root canal sealer. MTAD reduced the bond strength of the root canal sealer to the root canal dentin.

Reduction in Bacterial Loading Using MTAD as an Irrigant in Pulpectomized Primary Teeth

OBJECTIVE

The aim of the present study was to evaluate the reduction in bacterial loading uing MTAD as an irrigating solution in pulpectomized primary teeth.

STUDY DESIGN

A randomized, controlled clinical trial was performed that included primary teeth with pulp necrosis. Sixty necrotic canals were included, 30 irrigated with MTAD (experimental group) and 30 with 1% Na0Cl solution (control group); in all cases, 2 microbiological samples from within the canals were taken with sterile paper points, the first after the canal opening and before the first irrigation, and the second after instrumentation and final irrigation, before obturation. All samples were evaluated by Agar plate method.

RESULTS

The results were statistically analyzed by student 't' test. After analyzing samples before and after irrigation in the control group (NaOCl), we found a significant decrease of bacterial load ( p = < 0.001). The same occurred in the MTAD group samples ( p = < 0.001). When both groups were compared post irrigation, a statistically significant difference was observed in favor of MTAD.

CONCLUSION

MTAD can be suggested as an alternative irrigant for pulpectomy of necrotic teeth.

The effect of the temperature changes of EDTA and MTAD on the removal of the smear layer: a scanning electron microscopy study

The purpose of this study was to determine the effectiveness of EDTA and MTAD at different temperatures as a final irrigant to remove the smear layer after the use of 5.25% NaOCl. Seventy-eight human mandibular premolars with single straight canal were prepared by a crown-down technique using rotary 0.06 taper nickel-titanium files. Final irrigation was performed with EDTA and MTAD at different temperatures. The removal of the smear layer in the coronal, middle and apical level of each canal was examined under scanning electron microscope. No difference was found between the EDTA and MTAD at 4°C, 25°C, and 37°C temperatures regardless of the canal level (coronal, middle and apical) (P = 0.286). In EDTA-25, EDTA-37, MTAD-25, and MTAD-37 groups, the difference among the coronal, middle, and apical levels were statistically no significant (P > 0.05). Our findings showed that EDTA and MTAD at 25°C and 37°C are more effective than EDTA and MTAD at 4°C even in the apical level.

Assessment of apical seal obtained after irrigation of root end cavity with MTAD followed by subsequent retrofilling with MTA and Biodentine: An in vitro study

Introduction:

The present study is designed to assess the apical seal obtained after root end cavity irrigation with MTAD and retrograde filling with mineral trioxide aggregate (MTA) and Biodentine.

Materials and Methods:

Sixty extracted maxillary central incisors were instrumented and obturated. Apical 3 mm of all the roots were resected and retrograde preparations of 3 mm were made in all the teeth using ultrasonic tips. Thirty root end preparations were irrigated with MTAD for 5 min (Group 1), while 30 were irrigated with saline for 5 min (Group 2). Each main group was subdivided into two subgroups containing 15 samples each. Samples under each subgroup were then filled either with MTA (1A and 2A) or Biodentine (1B and 2B). The amount of microleakage was assessed using a UV spectrophotometer.

Results:

Statistical analysis suggest a significant difference (P < 0.005) between group 1A and 2A and between the groups 1B and 2B (P < 0.1). There was a significant difference (P < 0.005) between group 1A and 1B and also between group 2A and 2B.

Conclusion:

Irrigation with MTAD significantly improved the apical seal of Biodentine, but it increased the microleakage in MTA-filled root end cavities. Also the apical seal obtained with Biodentine was superior to that obtained with MTA.

Comparative evaluation of a new endodontic irrigant - mixture of a tetracycline isomer, an Acid, and a detergent to remove the intracanal smear layer: a scanning electron microscopic study

BACKGROUND

The most important and demanding aspect of endodontic therapy is considered to be cleaning and shaping. Irrigation is considered a vital adjunct to instrumentation of the root canal for canal debridement. Until date, there is no single solution that simultaneously removes the smear layer and disinfects the entire root canal system. Thus, this in vitro study was designed to evaluate the efficiency of a new irrigation solution mixture of a tetracycline isomer, an acid, and a detergent (MTAD) (BioPure, Dentsply) containing a mixture of tetracycline (doxycycline hydrochloride), an acid (citric acid) and a detergent (Tween 80) in comparison with normal saline, 5% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA) to remove intracanal smear layer.

MATERIALS AND METHODS

A total of 60 single rooted teeth were irrigated with Saline (Group A), 5% NaOCl (Group B), 17% EDTA (Group C) and MTDA (Group D). The extent of removal of smear layer and erosion was assessed using scanning electron microscope.

RESULTS

Irrigation with 5% NaOCl and MTAD as a final flush produced the cleanest surface with all the dentinal tubules open. No conjugation or erosion of dentinal tubules was noted (P > 0.05).

CONCLUSION

MTAD flush was the most effective debridement regimen in all the three thirds of the canal showing its ability to reach the apex with no conjugation and erosion of dentinal tubules.

A comparative study of antifungal activity of endodontic irrigants

INTRODUCTION

The purpose of this in vitro study was to assess the antifungal activity of final canal rinse with either three concentrations of sodium hypochlorite (NaOCl) (0.5, 2.6 and 6%), two concentrations of chlorhexidine (CHX) (2% and 0.2%), MTAD, Tetraclean, Hypoclean and Chlor-Xtra on Candida albicans (C. albicans) in a human tooth model.

METHODS AND MATERIALS

Two hundred and thirty five extracted human maxillary central and lateral incisors were used in this study. Teeth were randomly divided into nine test groups (n=25) and positive and a negative control groups (n=5). After cleaning and shaping, teeth were contaminated with C. albicans and incubated for 72 h. The irrigation solution in nine experimental groups included: 6% NaOCl, 2.6% NaOCl, 0.5% NaOCl, 2% CHX, 0.2% CHX, MTAD, Tetraclean, Hypoclean and Chlor-Xtra. After culturing on Sabouraud 4% dextrose agar, colony-forming units (CFU) were counted.

RESULTS

6% NaOCl, 2% CHX and Chlor-Xtra were equally effective (P>0.05) and significantly superior to MTAD and Tetraclean (P<0.05). In addition, the effectiveness of Tetraclean and MTAD was significantly less than Hypoclean, NaOCl at all concentrations (6% 2.6% and 0.5%), MTAD and 0.2% CHX (P<0.05). Furthermore, Tetraclean was significantly more effective than MTAD (P<0.05).

CONCLUSION

Antifungal activity of 6% NaOCl, Chlor-Xtra and 2% CHX was significantly greater than 2.6% NaOCl, 0.5% NaOCl, MTAD, 0.2% CHX and Tetraclean.

Endodontic irrigant as a root conditioning agent: An in vitro scanning electron microscopic study evaluating the ability of MTAD to remove smear layer from periodontally affected root surfaces

BACKGROUND

Instrumentation of the root surface, results in formation of a smear layer of organic and mineralized debris which serves as a physical barrier, inhibiting new connective tissue attachment to the root surface. The present study advocates the use of an endodontic irrigant MTAD (mixture of tetracycline, citric acid and detergent) as a root conditioning agent. The main aim of the study was to compare the root conditioning ability of an endodontic irrigant MTAD (mixture of tetracycline, acid and detergent) with 17% EDTA (ethylenediaminetetraacetic acid).

MATERIALS AND METHODS

Sixty freshly extracted human single rooted teeth with confirmed periodontal involvement were selected for this study and decoronated. The apical third of each root was removed and the remaining root was sectioned longitudinally to produce a 6mm to 8mm long tooth section. The root surface was then instrumented by hand using a sharp Gracey 1-2 periodontal curette with 6-8 strokes per area to achieve a smooth glass-like surface. A total of 60 specimens were prepared which were randomly divided into three groups (n=20). Each group received the root conditioning treatments as follows: All specimens were prepared for SEM and scored according to the presence of smear layer.

RESULTS AND CONCLUSIONS

MTAD removed the smear layer successfully from the root surfaces. The mean smear score for samples treated with Biopure MTAD was lower than those treated with EDTA, (p=0.04). MTAD can be used as a root conditioning agent with efficient smear layer removal ability and known antimicrobial and anticollagenase activity.

Antibacterial peptide nisin: a potential role in the inhibition of oral pathogenic bacteria

Although the antimicrobial peptide nisin has been extensively studied in the food industry for decades, its application in the oral cavity remains to develop and evaluate its feasibility in treating oral common diseases. Nisin is an odorless, colorless, tasteless substance with low toxicity and with antibacterial activities against Gram-positive bacteria. These biologic properties may establish its use in promising products for oral diseases. This article summarizes the antibacterial efficiency of nisin against pathogenic bacteria related to dental caries and root canal infection and discusses the combination of nisin and common oral drugs.

The effect of four different irrigating solutions on the shear bond strength of endodontic sealer to dentin - An In-vitro study

BACKGROUND

To evaluate the effect of EDTA, Maleic acid, Citric acid and MTAD Irrigating Solutions on the shear bond Strength of A-H plus sealer.

MATERIALS & METHODS

Forty mandibular single rooted premolar teeth with straight roots were taken, decoronated and instrumented using Protaper rotary instruments to size #F3, 0.09 taper, at the working length, with 3 mL of 2.6% sodium hypochlorite in between irrigation. The teeth were divided into 4 groups and final irrigation was done using NaOCl/EDTA:Group 1(Positive Control group); NaOCl/Maleic acid: Group2; NaOCl/Citric acid: Group 3; NaOCl/MTAD: Group 4. Obturation was done using Obtura II thermoplasticized technique with AH Plus sealer. Each root section was then subjected to a compressive load via a universal testing machine, to measure the push out bond strength.

RESULTS

The data was collected and submitted to statistical analysis by One way ANOVA test, and Group 2: NaOCl/Maleic acid showed greater bond strength (6.542+/_ 1.12 MPa) than other groups.

CONCLUSION

Removal of smear layer with Maleic acid as a final rinse enhanced the adhesive ability of A-H plus sealer, followed by EDTA, Citric acid and MTAD. A final rinse with MTAD might have a negative effect on the bonding ability of resin-based A-H plus sealer. How to cite the article: Ravikumar J, Bhavana V, Thatimatla C, Gajjarapu S, Reddy SG, Reddy BR. The effect of four different irrigating solutions on the shear bond strength of endodontic sealer to dentin - An In-vitro study. J Int Oral Health 2014;6(1):85-8.

Residual Antimicrobial Activity of MTAD(®) in Human Dentin After Obturation with Gutta-Percha/AH26 and Resilon/RealSeal SE at Different Time Intervals; An Ex Vivo Study

OBJECTIVES

To eliminate microorganisms that are responsible for pulpal and periapical infections and to prevent reinfection of the root canal system an effective chemomechanical preparation by irrigants with sustained antimicrobial activity is beneficial. Hereby, we evaluated the residual antibacterial activity of MTAD after canal obturation at different time intervals.

MATERIALS AND METHODS

A total of 120 human single-canalled anterior teeth were selected. The root canals were instrumented to a standardized apical size. Among all, 90 teeth received final irrigation with MTAD and were divided into three groups according to their obturation materials; i.e. gutta-percha/AH26, Resilon/RealSeal SE and positive controls. All these groups were divided into three 1-, 3- and 6-week time interval subgroups. Thirty teeth as negative control had no final irrigation with MTAD, but were obturated with gutta-percha/AH26 or Resilon/RealSealSE. Dentin powder was prepared after 1, 3 and 6 weeks. Dentin powder was exposed to Enterococcus faecalis for 24h and then cultured. Colony Forming Unit (CFU) was counted.

RESULTS

Residual antimicrobial activity of MTAD in the teeth obturated with guttapercha/AH26 was significantly higher than the teeth obturated with Resilon/RealSeal SE (p<0.001). It also showed a time dependent decrease in MTAD antimicrobial activity for all groups. The highest antimicrobial activity of MTAD was found in the 1-week positive control and 1-week gutta-percha/AH26 specimens. The lowest antimicrobial activity of MTAD was found in 6-week Resilon/RealSeal SE samples and then the negative controls.

CONCLUSION

MTAD had antimicrobial activity even at the sixth week, although it had a time-dependent decrease. Resilon/Epiphany SE significantly decreased antimicrobial activity of MTAD at all time points.

An update on the management of endodontic biofilms using root canal irrigants and medicaments

Microbial biofilm is defined as a sessile multicellular microbial community characterized by cells that are firmly attached to a surface and enmeshed in a self-produced matrix of extracellular polymeric substances. Biofilms play a very important role in pulp and periradicular pathosis. The aim of this article was to review the role of endodontic biofilms and the effects of root canal irrigants, medicaments as well as lasers on biofilms A Medline search was performed on the English articles published from 1982 to 2013 and was limited to papers published in English. The searched keywords were "Biofilms AND endodontics", "Biofilms AND sodium hypochlorite", "Biofilms AND chlorhexidine", "Biofilms AND MTAD", "Biofilms AND calcium hydroxide", "Biofilms AND ozone", "Biofilms AND lasers" and "Biofilms AND nanoparticles". The reference list of each article was manually searched to find other suitable sources of information.

A review of antibacterial agents in endodontic treatment

Microorganisms play a major role in initiation and perpetuation of pulpal and periapical diseases. Therefore, elimination of the microorganisms present in the root canal system is the fundamental objective of endodontic treatment. The use of mechanical debridement, chemical irrigation or other antimicrobial protocols and intra-canal medicaments are critical to attain this goal. The aim of this article was to review the antimicrobial agents and their properties in endodontics.

Comparative evaluation of the efficacy of different irrigants including MTAD under SEM

Context:

During biomechanical preparation, a smear layer is formed which occludes the openings of dentinal tubules and disfavors the penetration of irrigants. Hence, such layers should be removed. It becomes more challenging when we approach the apical third of the root canal.

Aim:

The aim was to compare the efficacy of different irrigants including ethylenediaminetetraacetic acid (EDTA), EDTA along with ultrasonication, citric acid, and mixture of tetracycline isomer, an acid, and a detergent (MTAD) as final irrigants where sodium hypochlorite (NaOCl) was used in each experimental group during root canal preparation with special emphasis on the apical third.

Settings and Design:

Forty-five human upper anterior teeth were selected and divided into one control group (group 1) and four experimental groups (group 2 to group 5), each containing nine teeth. All the four experimental groups were irrigated with 5.25% NaOCl solution during preparation, whereas test irrigants (5 mL) as the final solution used in each experimental group were 17% EDTA, 17% EDTA along with ultrasonication, 25% citric acid, and MTAD, respectively. The samples were prepared and observed under a scanning electron microscope (SEM). The photomicrographs were recorded and evaluated with a scoring system.

Statistical Analysis Used:

Data were analyzed using Kruskal-Wallis test and Dunn's test (P = 0.05).

Results:

None of the combined irrigants was found completely effective. All the test irrigants including MTAD worked well in the middle and cervical third, whereas MTAD showed excellent results in the apical third as compared to the other groups.

Stability of Doxycycline Absorbed on Root Canal Dentin After Obturation with Gutta-Percha/AH26 and Resilon/RealSeal at Different Time Intervals

OBJECTIVE

Eradication of microorganisms present in the root canal system is paramount for the successful outcome of root canal therapy. The purpose of this study was to compare the of doxycycline absorbed from MTAD into root canal dentin after obturation with gutta-percha/AH26 and Resilon/RealSeal at different time intervals.

MATERIALS AND METHODS

Fifty-one extracted human teeth were instrumented. Thirty samples were obturated with either gutta-percha/AH26 or Resilon/self-etch RealSeal after final irrigation with MTAD. Fifteen samples were kept unobturated (positive control); six samples were obturated with either gutta-percha/AH26 or Resilon/self-etch RealSeal without MTAD irrigation (negative control). After aging for 1, 3 or 6 weeks, dentin debri were collected, the Doxycycline compound was extracted and its amount was quantified using high performance liquid chromatography. The statistical significance of the change in Doxycycline concentrations was tested with two-way ANOVA.

RESULTS

The mean concentration of Doxycycline in dentin for one, three and six-week guttapercha/AH26 samples was 1.8±0.36, 1.22±0.22 and 0.67±0.11 respectively, whereas these concentrations in Resilon/RealSeal samples were 1.60±0.26, 0.80±0.14 and 0.59±0.01 respectively. Regarding the positive control group, these concentrations were 2.09±0.11, 1.54±0.12 and 0.72±0.07 respectively for 1, 3 and 6-week intervals. No Doxycycline was detected in negative control groups. The Doxycycline concentrations showed a significant difference forobturating materials (p=0.008). These concentrations were higher in the gutta-percha/AH26 samples than Resilon/RealSeal samples in each time interval.

CONCLUSION

The remaining amount of Doxycycline bonded to dentin was higher when root canals were obturated with gutta-percha/AH26 compared to Resilon/RealSeal. The stability of Doxycycline showed a time dependent decrease.

Evaluation of push-out bond strength of AH26 sealer using MTAD and combination of NaOCl and EDTA as final irrigation

BACKGROUND

During endodontic procedures, the smear layer is formed as a result of mechanical instrumentation of the canal. Combination of ethylenediamine tetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) is widely used for removal of the smear layer. Application of Mixture of tetracycline, acid, and detergent (MTAD) as final irrigant subsequent to initial irrigation of 1.35% NaOCl has been proposed to increase clinical efficiency, biocompatibility and prolonged intra-canal antibacterial activity. Considering the importance of adhesion of endodontic sealers to the dentin walls of a prepared root canal, the present study evaluated push-out bond strength of AH26 sealer using final irrigation of MTAD and EDTA + NaOCl.

MATERIALS AND METHODS

Sixty five single-rooted teeth were prepared endodontically with the same chemomechanical technique and were randomly divided into three groups based on their final irrigation regimen: 17% EDTA + 5.25% NaOCl group (n =30), MTAD group (n =30) and control group (n =5). Obturation of the canals was performed with gutta-percha and AH26 sealer. All teeth were sectioned in order that two specimens of 1 mm thickness were obtained from the coronal and the middle one third of each root resulting in 60 specimens for each experimental group and 10 specimens for control group. For push-out test, universal-testing machine was used to exert a constant compressive apico-coronal load at a speed of 0.5 mm/min. Minimum amount of compressive load caused dislodgement was measured and converted into megapascal (MPa) scale. One-way analysis of variance and the post hoc Tukey test were used for statistical analysis of the data (α = 0.05).

RESULTS

In MTAD group, mean micro-push-out bond strength of AH26 sealer to dentin walls was obtained 2.23 MPa compared to 2.0 MPa for EDTA + NaOCl group. The mean bond strength of AH26 sealer to dentin walls was significantly greater using MTAD compared with combination of EDTA and NaOCl or saline.

CONCLUSION

MTAD final rinse significantly increased micro-push-out bond strength of AH26 sealer to canal dentin walls compared with EDTA + NaOCl.

Mixture tetracycline citric acid and detergent - A root canal irrigant. A review

BACKGROUND

Root canal irrigants play an indispensable role for the complete disinfection of the root canal system, in particular those areas of the root canal that are not accessible for instrumentation. Sodium hypochlorite, ethylene diamine tetra acetic acid, hydrogen peroxide and chlorhexidine are the most commonly used root canal irrigants in endodontic practice, but they do not satisfy all the properties of an ideal root canal irrigant. Mixture tetracycline, citric acid and detergent, a root canal irrigant, is commercially available as BioPure MTAD (Dentsply, Tulsa Dental, Tulsa, OK).

METHODOLOGY

The literature was searched for root canal irrigants used in the last 3 decades in PubMed. Data showed 83 relevant articles, of which 24 were found most suitable on the basis of description of properties, advantages and disadvantages of MTAD, hence were included. The aim of this study was to evaluate the properties of MTAD for its antibacterial efficiency, biocompatibility, chelating action with removal of endodontic smear layer and compare it with other commonly used root canal irrigants like sodium hypochlorite, ethylene diamine tetra acetic acid, hydrogen peroxide, chlorhexidine.

RESULTS

MTAD was found to be highly effective intracanal irrigant compared to other commonly used root canal irrigants with excellent disinfection of the entire root canal system.

CONCLUSION

MTAD is biocompatible with superior antimicrobial efficiency compared to other commonly used root canal irrigants.

Effect of MTAD on the shear bond strength of self-etch adhesives to dentin

Background:

As the use of different irrigants to eliminate residual debris and smear layer in the field of endodontic is unavoidable, by considering the effect of irrigants on the bond strength of resin composite restorations, this study was designed to evaluate the effect of a mixture of a tetracycline isomer, an acid, and a detergent (MTAD) on the shear bond strength of two self-etch adhesives, Clearfil SE Bond and Adper Prompt L- Pop to dentin.

Materials and Methods:

The crowns of 80 extracted premolars were transversally sectioned to expose dentin. Flat dentin surfaces were wet abraded with 320-grit abrasive paper and randomly assigned to eight groups according to two self-etch adhesive and four dentin surface treatments: direct application over smear layer (no treatment), etching with 35% phosphoric acid for 15s, 1 min 5.25% NaOCl/1 min MTAD and 20min 1.3% NaOCl/5min MTAD. Shear bond strength was tested 24 h after storage in distilled water at 37°C in incubator. Data were analyzed using one-way ANOVA followed by duncan post-hoc (α=0.05).

Results:

Phosphoric acid etching prior to SE Bond application significantly decreased the shear bond strength to dentin (P<0.05). Application of MTAD clinical protocol (20min 1.3% NaOCl/5min MTAD) did not significantly decrease the shear bond strength of self-etch adhesives to dentin (P=0.745)

Conclusions:

Based on the results of present investigation, it seems that the use of clinical protocol of 1.3% NaOCl as a root canal irrigant and a 5-min application of MTAD as a final rinse to remove the smear layer has no adverse effect on the shear bond strength of self-etch adhesives to dentin.

An In Vitro SEM Study on the Effectiveness of Smear Layer Removal of Four Different Irrigations

INTRODUCTION

The aim of this study was to compare the smear layer removal efficacies of 3% sodium hypochlorite (NaOCl), 17% Ethylenediaminetetraacetic acid (EDTA), SmearClear and BioPure MTAD using a common irrigation protocol.

MATERIALS AND METHODS

Fifty freshly extracted human single rooted maxillary and mandibular teeth were prepared by a ProTaper rotary system up to an apical preparation file size F3. Prepared teeth were randomly divided into five groups (n=10); distilled water (Group A; negative control), EDTA (Group B), SmearClear (Group C), BioPure MTAD (Group D) and NaOCl (Group E). After final irrigation with tested irrigants the teeth were decoronated, split into two halves longitudinally and observed under a scanning electron microscope (SEM) for removal of the smear layer. The SEM images were then analyzed for the amount of smear layer present using a three score system. Data were analyzed using the Kruskal-Wallis test and Mann-Whitney U test.

RESULTS

Intergroup comparison of groups B, C, and D showed no statistical significant differences in the coronal and middle thirds, however, in the apical third the canal surfaces were cleaner in samples from group D (P<0.05).

CONCLUSION

BioPure MTAD was the most effective agent for the purpose of smear layer removal in the apical third of the root canals.

Subcutaneous tissue responses to three endodontic irrigants: a comparative study

INTRODUCTION

This study aimed to compare the subcutaneous tissue responses to MTAD (mixture of a tetracycline isomer, an acid, and a detergent), 17% EDTA, and 2.6% NaOCl.

MATERIALS AND METHODS

Thirty-six Wistar albino rats were used for this study. Test solutions were injected subcutaneously into predetermined areas on the animal dorsum. The rats were then randomly divided into three groups of twelve each and sacrificed at 2 hours, 2 days, and 2 weeks. The severity of inflammation induced by each irrigant at different time intervals was assessed histologically. The data were analyzed using Kruskal-Wallis and Friedman tests.

RESULTS

The difference in severity of inflammatory reactions induced by tested irrigants at the different time intervals was statically significant (P<0.05). There was no significant difference between the severity of inflammation induced by MTAD and 2.6% NaOCl at the various time intervals (P>0.05). Subcutaneous tissue responses to MTAD were not different from those observed in 17% EDTA specimens at 2-hour and 2-day intervals (P>0.05).

CONCLUSION

Under the conditions of this study, MTAD has the same toxicity as 2.6% NaOCl.

Root canal irrigants

Successful root canal therapy relies on the combination of proper instrumentation, irrigation, and obturation of the root canal. Of these three essential steps of root canal therapy, irrigation of the root canal is the most important determinant in the healing of the periapical tissues. The primary endodontic treatment goal must thus be to optimize root canal disinfection and to prevent reinfection. In this review of the literature, various irrigants and the interactions between irrigants are discussed. We performed a Medline search for English-language papers published untill July 2010. The keywords used were ‘root canal irrigants’ and ‘endodontic irrigants.’ The reference lists of each article were manually checked for additional articles of relevance.

The impact of pH on cytotoxic effects of three root canal irrigants

AIM

Cytotoxicity of root canal irrigants is important due to their close contact with host tissues. This study was to assess the possible impact of pH on cytotoxic effects of MTAD, 17% EDTA, and 2.6% NaOCl on the human gingival fibroblasts using MTT assay.

MATERIALS AND METHODS

Human gingival fibroblasts were exposed to the irrigants and their viability was assessed after 1, 6, and 12 h. The pH of the medium was measured in each interval. Light absorption values were measured for each culture medium using Elisa Reader device.

RESULTS

NaOCl had significantly less cytotoxicity than EDTA and MTAD. Also irrigants cytotoxicity decreased in 12, 1, and 6 h, respectively.

CONCLUSION

It seems that variation of the pH resulted in variation in the cytotoxicity of solutions; i.e., it follows the pattern of the pH variation.

Comparative Evaluation of Antimicrobial Efficacy of MTAD, 3% NaOCI and Propolis Against E Faecalis

Aim

The present study sought to compare the antimicrobial efficacy of 3% NaOCl, Biopure MTAD (Tulsa Dentsply, Tulsa, OK) and Brazilian ethanolic extract of propolis (EEP) against Enterococcus faecalis (E. faecalis).

Methodology

The study utilized 55 extracted human permanent teeth with single root canal. The samples were decoronated, instrumented and sterilized. The teeth were infected with E faecalis for 48 hours. The teeth were divided randomly into 3 groups according to the irrigants used and kept in contact with the respective irrigant for 5 minutes. All the samples were incubated in brain heart infusion (BHI) broth for 96 hours. Disinfection of the samples was determined based on presence or absence of turbidity in the BHI broth 96 hours later. Statistical analysis was done using Chi-square test.

Results

All the samples treated with MTAD showed complete absence of turbidity, while all the 15 teeth treated with propolis showed presence of turbidity, 8 out of 15 teeth treated with NaOCl showed presence of turbidity. Statistical analysis of the data using chi-square test showed significant difference between the groups (P < 0.05).

Conclusion

The study concluded that MTAD was more effective than 3% NaOCl and propolis against E. faecalis.

The effect of three irrigants on the coronal leakage of the root canals system irrigants

INTRODUCTION

The production of smear layer during canal instrumentation is thought to increase coronal microleakage even after canal obturation. Previous studies have shown that the type of irrigant does not necessarily affect the seal of the obturation. Our study aimed to evaluate the effect of three irrigation solutions (MTAD, citric acid and EDTA/NaOCl) on the coronal microleakage of root canals.

MATERIALS AND METHODS

Fifty five intact single rooted teeth were instrumented and randomly divided into three experimental groups (15 teeth each) and two control groups (5 teeth each). Final irrigation was carried out with MTAD in group I, citric acid in group II, and EDTA/NaOCl in group III. EDTA/NaOCl was used for the negative control group and saline irrigation was carried out in the positive control group. After lateral compaction with gutta-percha, the access cavities of the experimental specimens were restored with temporary restorative material. Temporary cement was not used in the positive control group. In the negative control group, access cavities and foramen apices were sealed with glass ionomer. Microleakage of samples was measured using the dye penetration technique. Data were analyzed with ANOVA and Tukey test to determine statistical differences between groups.

RESULTS

MTAD, citric acid and EDTA/NaOCl all had less microleakage compared to normal saline. However, no difference was detected between the experimental groups.

CONCLUSION

In this study, all three groups demonstrated effective seal with gutta-percha obturation. This is likely to be due to various factors including their ability to remove smear layer.

The effect of Carvacrol on Enterococcus faecalis as a final irrigant

INTRODUCTION

Sodium hypochlorite (NaOCl) is an effective antimicrobial irrigant, however its toxic effects and deterrent odor are not ideal. Carvacrol is an edible plant extract with anti-inflammatory and anti-bacterial properties that is effective against Enterococcus (E) faecalis. The aim of this study was to evaluate Carvacrol's antibacterial efficacy against E. faecalis bacteria as a final irrigant.

MATERIALS AND METHODS

Forty extracted single-rooted human teeth were utilized. After mechanical preparations, samples were randomly divided into three experimental (A, B and C) and two control groups. E. faecalis was cultured in both experimental and positive control groups. After bacterial counting in all canals, 5.25% NaOCl, 0.6% Carvacrol emulsion and MTAD were used as final irrigants in groups A, B and C respectively. Data were analyzed using Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

There was no meaningful difference in bacterial reduction between groups A and B; however, group C showed significantly lower efficacy compared to other groups (P<0.05).

CONCLUSION

The 0.6% Carvacrol disinfects root canals effectively. It also has anti-inflammatory qualities and therefore may be an acceptable alternative for NaOCl.

Efficacy of MTAD, Glyde and EDTA in debridement of curved root canals

INTRODUCTION

This study aimed to compare the efficacy of MTAD, Glyde and EDTA in removing the post-preparation smear layer and debris produced in apical third of curved molar root canals.

MATERIALS AND METHODS

Forty extracted human maxillary first molars with curved mesiobuccal canals (30˚-35˚), similar root lengths and morphologies were divided into 3 experimental groups (n=12) and one control group (n=4). Canals were prepared by RaCe rotary files and were treated with the following materials between each two files: Group A (control group); 5 mL of distilled water, Group B; 1 mL of 17% ethylenediamine tetra-acetic acid (EDTA) for 1 min, Group C; BioPure(TM) MTAD (according to the manufacturer's instruction; 5mL for 5 min), and Group D; Glyde File Prep alternated with sodium hypochlorite (NaOCl) between each two files. Debridement of the apical third was evaluated using scanning electron microscope (SEM) (×5000). The data were statistically analyzed using the Kruskal-Wallis and Mann-Whitney U tests (P<0.05).

RESULTS

Statistical analysis of the data showed that MTAD and 17% EDTA were effective in removing smear layer and debris from the apical thirds. MTAD was more effective than EDTA in smear layer removal. Glyde did not adequately debride curved root canals of molar teeth.

CONCLUSION

MTAD and 17% EDTA were effective in debriding the apical third of curved molar root canals during endodontic treatment, whereas Glyde File Prep does not provide adequate debridement.

Evaluation of the antimicrobial effects of MTAD, NaOCl against selected endodontic pathogens

INTRODUCTION

The aim of this study was to compare the antimicrobial effects of MTAD, sodium hypochlorite (NaOCl) and their combination on endodontic micro-organisms.

MATERIALS AND METHODS

Zone of Inhibition (ZI) and Minimum Inhibitory Concentration (MIC) were the techniques used. In ZI technique blood agar plates were inoculated with organisms, paper discs were soaked with irrigants and maximum zones of bacterial inhibition were recorded. In the MIC technique the irrigants were serially diluted in TSB tubes and 0.1 mL of the tested microbe solutions were added. Results were obtained on the basis of turbidity and growth on agar plates. Statistical analyses were carried out using ANOVA and Tukey tests.

RESULTS

In ZI technique, we investigated 120 specimens including 5 microbial species, 3 irrigants and their control groups, each with 6 repetitions. The results demonstrated MTAD greater antimicrobial efficacy compared to NaOCl, and their mixture (M+N) against Staphylococcus (S) aureus, Enteric (E) bacteria and Enterococcus (E) faecalis (P<0.001). NaOCl was more effective in eradicating Candida (C) albicans than the others (P<0.01). MIC method (155 tubes) showed MTAD to be more effective against E. bacteria and S. aureus. MTAD and NaOCl were equally effective against E. faecalis; however, NaOCl was more effective against C. albicans.

CONCLUSION

Bacterial species were more susceptible to MTAD than NaOCl, C. albicans, however, was more susceptible to NaOCl. The advantage of NaOCl is that it has broad spectrum antimicrobial activity. The joint solution (M+N) did not prove to be more effective than their individual use.

Tissue dissolving ability of several endodontic irrigants on bovine pulp tissue

INTRODUCTION

A desirable characteristic of root canal irrigants is the ability of dissolving soft tissues. Sodium hypochlorite, an antibacterial and tissue solvent irrigant used in endodontic treatment is known to be toxic for periapical tissues. Chlorhexidine gluconate, an effective antimicrobial agent, is another irrigant with limited tissue dissolving ability. A mixture of a tetracycline isomer, an acid, and a detergent (MTAD), has recently been introduced as an alternative irrigant in root canal therapy. The purpose of this study was to evaluate the tissue dissolving effect of these root canal irrigants on bovine pulp tissue.

MATERIALS AND METHODS

Fifty pieces of bovine pulp tissue 80 mg each were treated with either normal saline, MTAD, 2% chlorhexidine gluconate, 2.6% NaOCl or 5.25% NaOCl for 10 min at 37°C. Desiccated pre-treatment and post-treatment weights of samples were compared. Using Kruskal-Wallis and Mann-Whitney U tests, data was analyzed.

RESULTS

Tissue dissolution effect of 5.25% NaOCl (85.98%) was statistically greater than that of all other solutions (P<0.05). Chlorhexidine gluconate had the weakest dissolution effect, and dissolved only 9.36% of the sample tissue. No significant differences were observed between the dissolution effects of normal saline or MTAD.

CONCLUSION

Based on the results of this study, the use of NaOCl as intracanal irrigation during instrumentation is recommended, because of its greater tissue dissolution effect.