Prevalence of postoperative pain after endodontic treatment using low and high concentrations of sodium hypochlorite: a systematic review and meta-analysis

OBJECTIVES

To determine the prevalence of postoperative pain after endodontic treatment using low (LC) and high (HC) concentrations of sodium hypochlorite (NaOCl).

MATERIALS AND METHODS

Six databases and the grey literature were searched to identify randomized clinical trials that evaluated postoperative pain after endodontic treatment using NaOCl. NaOCl concentrations were dichotomized into 'LC' (0.5% to 3%) and 'HC' (≥ 5%) and a proportion meta-analysis was applied to determine the postoperative pain prevalence: overall and according to pain intensity and postoperative time. The prevalence of patients using pain control medication was also determined. A significance level of 5% and a random effect model were applied for data analysis. Between-study heterogeneity was assessed by I2 index. Risk of bias (RoB) was assessed using the Cochrane Risk-of-Bias 2.0 tool. The certainty of evidence was assessed using the GRADE approach.

RESULTS

Ten studies were included in the review and eight in the meta-analysis. The overall prevalence of postoperative pain was 45% in LC and 39% in HC. The prevalence of pain in LC and HC after 24 h was 25% and 40%, respectively. After 48 h, the prevalence decreased to 10% in LC and 25% in HC. 'Absent pain' was the most prevalent score. The prevalence of patients who used medication was 9% in LC and 15% in HC. Three studies were classified as 'high RoB', five as 'low RoB', and two as 'some concerns'. The certainty of evidence was very low.

CONCLUSIONS

The overall prevalence of postoperative pain after endodontic treatment using LC and HC of NaOCl was 45% and 39%, respectively.

CLINICAL RELEVANCE

Postoperative pain is common after endodontic treatment using NaOCl, but tends to decrease over time.

An In Vitro Evaluation of Antimicrobial Effects of Three Different Root Canal Irrigating Solutions against Enterococcus faecalis and Streptococcus mutans

AIM

The present study was conducted to evaluate and compare antimicrobial effect of 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) and N-Acetylcysteine (NAC) irrigating solutions against Enterococcus faecalis (E. faecalis) and Streptococcus mutans (S.mutans).

MATERIALS AND METHODS

The present study was conducted on 40 freshly extracted noncarious permanent mandibular incisors teeth of both genders (males-12, females-14). In all teeth, root canal preparation was done up to size 40 K-file. Roots were sterilized and microbial suspension of mixed culture of the tested microorganisms was inoculated into canals and incubated for 48 h. Teeth were divided into four groups, group I (5.25% sodium hypochlorite), group II (2% chlorhexidine), group III (200 mg/mL N-Acetylcysteine NAC) and group IV (sterile distilled water). The antimicrobial effect in each group was compared.

RESULTS

Statistical evaluation was completed using statistical software Statistical Package for the Social Sciences (SPSS). Planktonic S. mutans bacterial count was lowest in group III followed by group I, group II and group IV.E. faecalis count was 6.14 ± 0.12 in group I, 5.76 ± 0.44 in group II, 3.88 ± 0.08 in group III and 11.98 ± 1.04 in group IV. The difference was significant (p < 0.05). The proportion of dead cell found to be 0.04± 0.01, 0.72 ± 0.06, 0.01 ± 0.06 and 1.02 ± 0.11 in groups I, II, III and IV respectively. The difference was significant (p < 0.05).

CONCLUSION

NAC proved to be effective against E. faecalis and S. mutans. This solution can be considered alternative in root canal infections in addition with CHX and NaOCl.

CLINICAL SIGNIFICANCE

Effectiveness of three different irrigating solutions was compared and NAC found to be more efficient in decreasing bacterial count. Hence, NAC can be precisely used in irrigating root canals to achieve optimal clinical outcomes particularly regarding reoccurrences of infections. Furthermore, NAC could be proved as a promising innovation in future endodontic methodologies.

The Effect of Gentamycin in the Irrigating Solution to Prevent Joint Infection after Anterior Cruciate Ligament (ACL) Reconstruction

BACKGROUND

Arthroscopic reconstruction of ACL is an effective method to restore knee stability after ACL rupture. Postoperative septic arthritis (SA) is very uncommon while the incidence of serious complications range between 0.14% and 1.8%. Some of the devastating consequences of septic arthritis can encompass hyaline cartilage damage, arthrofibrosis, and in rare cases amputation. The purpose of this study was to evaluate the effect of gentamicin irrigation solutions as a process to restrain septic arthritis following arthroscopic ACL reconstruction.

METHODS

In this retrospective cohort study, 1464 patients who underwent ACL reconstruction with hamstring tendon autograft in our institution over 7 years (February 2008 to January 2015) were included. The patients were divided into two groups based on the type of intra-articular irrigation solution used during the surgery. Patients in Group 1 (Saline) received intra-articular irrigation with normal saline (0.9 % sodium chloride) solution, while those in Group 2 (Gentamycin) received intra-articular irrigation with gentamicin (80 mg/L) added to the normal saline solution. Data about postoperative infection, its course, management, and outcome were obtained from patients' records.

RESULTS

Seven patients developed SA, four of whom were from SALINE group (2.2%) and three from Gentamycin group (0.23%). The incidence rate of SA after arthroscopic ACL reconstruction was significantly lower (P <0.05) when irrigated with gentamicin solution than merely with saline solution.

CONCLUSION

Gentamicin irrigation solution has a preservative and protective effect against SA development following arthroscopic ACL reconstruction. We recommend evaluating this technique as a way in order to depreciate the prevalence of SA after ACL reconstruction.

Influence of Concentration and Agitation of Sodium Hypochlorite and Peracetic Acid Solutions on Tissue Dissolution

AIM AND OBJECTIVE

To evaluated the tissue dissolution of sodium hypochlorite (NaOCl) and peracetic acid (PA) solutions at different concentrations, with or without ultrasonic agitation.

MATERIALS AND METHODS

The following solutions were analyzed: 2.5% NaOCl, 0.5, 1 and 2% PA, 1% PA associated with 6.5% hydrogen peroxide (HP) and saline. Fragments of bovine pulp tissue with 25 ± 2g mg were immersed into test tubes containing 4 mL of the solutions for 10 minutes. In the groups with agitation, pulp tissues were submitted to 2 cycles of 1 minute of ultrasonic agitation. The specimens were weighed after the removal from the solutions. The percentage of mass loss was calculated according to the difference of mass before and after exposure to solutions. Data were submitted to ANOVA and Tukey tests (p < 0.05).

RESULTS

A total of 2.5% NaOCl with or without agitation showed the higher tissue dissolution (between 64.5 and 67% of mass reduction) (p < 0.005). By comparing the PA solutions, the concentrations of 1 and 2% with or without agitation and the concentration of 0.5% with agitation showed similar dissolution activity (between 35.4 and 44% of mass reduction). The use of the ultrasonic agitation promoted an increase of the dissolution ability only for 0.5% PA.

CONCLUSION

Peracetic acid solution has pulp tissue dissolution. However, this ability is lower than 2.5% NaOCl solution.

CLINICAL SIGNIFICANCE

The sodium hypochlorite solution shows higher ability to dissolve tissue than PA.

Antibacterial Potential of 2.5% Sodium Hypochlorite in Distinct Irrigation Protocols on Enterococcus faecalis Biofilm

OBJECTIVE

The aim of this study was to evaluate the effect of irrigation methods on antibacterial potential of 2.5% NaOCl on Enterococcus faecalis biofilm.

MATERIALS AND METHODS

Enterococcus faecalis biofilms were prepared during 60 days on 48 human root canals and randomized into control and experimental groups using positive and negative pressure irrigation. Bacterial growth was analyzed using turbidity of culture medium followed by UV spectrophotometry, and scanning electron microscopy (SEM) analyses were performed. Mean and standard deviations were used for evaluate the mean optical densities associated to the number of bacteria present culture, and Scheirer-Ray-Hare (an extension of the Kruskal-Wallis test) and Tamhane test to analyze the SEM images in the groups and thirds. Significance was set at 5%.

RESULTS

Enterococcus faecalis was still present after root canal cleaning regardless of irrigation methods or bacterial identification methods.

CONCLUSION

Positive and negative pressure irrigation protocols using 2.5% NaOCl show a similar capacity to reduce E. faecalis in infected root canals.