Penetration Depth of Sodium Hypochlorite in Dentinal Tubules after Conventional Irrigation, Passive Ultrasonic Agitation and Nd:YAG Laser Activated Irrigation
Journal of Lasers in Medical Sciences,
Vol. 7 No. 2 (2016),
15 Esfand 2016
,
Page 105-111
Abstract
Introduction: The penetration depth of irrigating solutions in dentinal tubules is limited; consequently, bacteria can remain inside dentinal tubules after the cleaning and shaping of the root canal system. Therefore, new irrigation systems are required to increase the penetration depth of irrigating solutions in dentinal tubules.
Methods: A comparative study regarding the penetration depth of sodium hypochlorite (NaOCl) solution in dentinal tubules using four methods, (1) conventional irrigation (CI), (2) smear layer removal plus conventional irrigation (gold standard), (3) passive ultrasonic agitation (PUA) and (4) Nd:YAG laser activated irrigation (LAI), took place on 144 extracted mandibular teeth with a single root canal. After decoronation with a diamond disc and working length determination, the apical foramen was sealed with wax. The canals were prepared up to #35 Mtwo rotary file and 5.25% NaOCl was used for irrigation during preparation. To study the penetration depth of NaOCl, smear layer was eliminated in all samples. Dentinal tubules were stained with crystal violet and after longitudinal sectioning of teeth, the two halves were reassembled and root canal preparation was performed up to #40 Mtwo rotary file. Then the samples were distributed into four experimental groups. Depth of the bleached zone was evaluated by stereomicroscope (20X). Data were analyzed by Kruskal-Wallis test.
Results: The highest and lowest average for NaOCl penetration depth in all three coronal, middle and apical sections belonged to CI + smear layer removal and CI. A statistically significant difference was seen when comparing the penetration depth of CI + smear layer removal group to CI and PUA groups in coronal and middle third, in which the average NaOCl penetration depth of the gold standard group was higher (P < 0.05). A statistically significant difference was seen between CI + smear layer removal group and the other three groups including CI, PUA and LAI in apical third, in which the average NaOCl penetration depth in the gold standard group was higher (P < 0.001).
Conclusion: The standard protocol for smear layer removal led to more effective smear layer elimination and deeper penetration depth of irrigation solutions. PUA and LAI groups exhibited less smear layer elimination and penetration depth of irrigation solutions. Therefore, CI+smear layer removal should still be considered as the gold standard.
- Agitation
- Irrigation
- Lasers
- Nd
- YAG
- Ultrasonic.
How to Cite
References
Clegg MS, Vertucci FJ, Walker C, Zand V. The effect of exposure to irrigant solutions on apical dentin biofilms in vitro. J Endod. 2006;32(5):434-437. doi:10.1016/j. joen.2005.07.002.
Chow TW. Mechanical effectiveness of root canal irrigation. J Endod. 1983;9(11):475-479. doi:10.1016/ s0099-2399(83)80162-9.
Baker NA, Eleazer PD, Averbach RE. Scanning electron microscopic study of the efficacy of various irrigation solutions. J Endod. 1975;1(4):127-135.
Cheung GS, Stock CJR. In vitro cleaning ability of root canal irrigants with and without Endosonics. Int Endod J. 1993;26(6):334-343. doi: 10.1111/j.1365-2591.1993. tb00766.x
Foster KH, Kulild JC, Weller RN. Effect of smear layer removal on the diffusion of calcium hydroxide through radicular dentin. J Endod. 1993;19(9):136-140.
Nielsen BA, Baumgartner JC. Comparision of the Endovac system to needle irrigation of the root canals. J Endod. 2007;33(5):611-615. doi:10.1016/j.joen.2007.01.020.
Chopra S, Murray PE, Namerow KN. A scanning electron microscopic evaluation of the effectiveness of the F-file versus ultrasonic activation of a K-file to remove smear layer. J Endod. 2008;34(12):1234-1235. doi:10.1016/j. joen.2008.07.006
Bahcall J, Oslen FK. Clinical introduction of a plastic rotary endodontic finishing file. Endo Prac. 2007;10(5):17-20.
Paragliola R, Franco V, Fabiani C, Mazzoni A, Nato F, Tay FR, et al. Final Rinse Optimization: Influence of Different Agitation protocols. J Endod. 2010;36(2):282-285. doi:10.1016/j.joen.2009.10.004
Wu Mk, Dummer PM, Wesselink PR. Consequences of and strategies to deal with residual post-treatment root canal infection. Int Endod J. 2006;39(5):343-356. doi:10.1111/ j.1365-2591.2006.01092.x.
Serper A, Ozbek M, Calt S. Accidental sodium hypochlorite-induced skin injury during endodontic treatment,. J Endod. 2004;30(3):180-181. doi:10.1097/00004770-200403000- 00013.
Bradford CE, Eleazer PD, Downs KE, Scheetz JP. Apical pressures developed by needles for canal irrigation. J Endod. 2002;28(9):333-335. doi:10.1097/00004770- 200204000-00019
Siqueira JF, Rocas IN, Lopez HP. Patterns of microbial clonization in primary root canal infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93(12):174-178.
Van der Sluis LM, Wu MK, Versluis M, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J. 2007;40(6):415-426.
Stabholz A, Sahar-Helft S, Moshonov J. lasers in endodontics. Dent clin north Am. 2004;48(4):809-832. doi:10.1016/j.cden.2004.05.012.
Wang Q, Zhang C, Yin X. Evaluation of bactericidal effect of Er;Cr:YSGG and Nd:YAG lasers in experimentally infected root canals. J Endod. 2007;33(7):830-832. doi:10.1016/j. joen.2007.03.017.
Koba K, Kimura Y, Matsumoto K, Takeuchi T, Ikarugi T, Shimizu T. A histopathologial study of the morphological changes at the apical seat in the periapical region after irradiation with a pulsed Nd:YAG laser. Int Endod J. 1998;31(6):415-420. doi:10.1046/j.1365- 2591.1998.00177.x.
Miserendino LJ, Levy GC, Rizoiu IM. Effects of the Nd:YAG laser on the permeability of root canal wall dentin. J Endod. 1995;21(2):83-87.
Minamisako MC, Kinoshita JL, Matsumoto K, Stolf DP, Marques JL. A study on root canal cleaning by Nd:YAG laser with black dye solution. J Oral Laser Applications. 2009;9(2):101-109.
De Moor RJ, Torbeyns D, Meire M. Lasers in endodontics. Part 2: root canal wall cleanliness and modification. Endod Pract Today. 2009;3:19-33.
Blanken J, De Moor RJ, Meire M, Verdaasdonk R. Laser induced explosive vapor and cavitation resulting in effective irrigation of the root canal. Part 1: a visualization study. Lasers Surg Med. 2009;41(7):514-519. doi:10.1002/ lsm.20798.
William S, Goldman M. Penetrrability of the smeared layer by a strain of Proteus vulgaris. J Endod. 1985;11(5):385- 388. doi:10.1016/s0099-2399(85)80026-1.
Goldberg F, Abramovich A. Analysis of the effect of EDTAC on the dentinal walls of the root canal. J Endod. 1977;3(5):101-105. doi:10.1016/s0099-2399(77)80203-3.
Nair BG, Reddy KA. Advances in root canal disinfection. J Pharm Biomed Sci. 2011;5(24):1-3.
Hata G, Hayami S, Weine FS, Toda T. Effectiveness of oxidative potential water as a root canal irrigant. Int Endod J. 2001;34(12):308-317. doi:10.1046/j.1365- 2591.2001.00395.x
Ciucchi B, Khettabi M, Holz J. The effectiveness of different endodontic irrigation procedures on the removal of smear layer: A scanning electron microscopic study. Int Endod J. 1989;22(9):21-28. doi:10.1111/j.1365-2591.1989.tb00501.x.
Gu LS, Kim JR, Ling j, Choi KK, Pashley DH, Tay FR. Review of contemporary irrigant agitation techniques and devices. J Endod. 2009;35(6):791-804. doi:10.1016/j. joen.2009.03.010.
Mello I, Kammerer BA, Yoshimoto D, Macedo MC, Antoniazzi JH. Influence of final rinse technique on ability of Ethylenediaminetetraacetic acid of removing smear layer. J Endod. 2010;36(3):512-514. doi:10.1016/j. joen.2009.11.004.
Kokkas AB, BoutsioukisACh, Vassiliadis LP, Stavrianos CK. The influence of the smear layer on dentinal tubule penetration depth by three different root canal sealers : an in vitro study. J Endod. 2004;30(2):100-102. doi:10.1097/00004770-200402000-00009.
Fogel HM, Pashley DH. Dentin permeability : effects of endodontic procedures on root slabs. J Endod. 1990;16(9):442-445. doi:10.1016/s0099-2399(06)81888-1.
Cunningham WT, Cole JS 3rd, Balekjian AY. Effect of alcohol on the spreading ability sodium hypochlorite endodontic irrigant. Oral surgery, Oral medicine and oral Pathology. 1982;54(12):333-335.
Hauser V, Braun A, Frentzen M. Penetration depth of a dye marker into dentin using a novel hydrodynamic system (RinsEndo). Int Endod J. 2007;40(8):644-652. doi:10.1111/ j.1365-2591.2007.01264.x
Paque F, Luder HU, Sener B, Zehnder M. Tubular sclerosis rather than smear layer impedes dye penetration into the dentine of endodontically instrumented root canals. Int Endod J. 2006;39(1):18-25.
Zou L, Shen Y, Li W, Haapasalo M. Penetration of Sodium Hypochlorite into dentin. J Endod. 2010;36(5):793-796.
Peters LB, Wesselink PR, Buijs JF, Winkelholf AJ. Viable bacteria in root dentinal tubules of teeth with apical periodontitis. J Endod. 2001;27(5):76-81. doi:10.1097/00004770-200102000-00002.
Schafer E, Bossmann K. Antimicrobial efficacy of chlorhexidine and two calcium hydroxide formulations against Entrococcus fecalis. J Endod. 2005;31(9):53-56. doi:10.1097/01.don.0000134209.28874.1c.
Haapasalo M, Qrstavik D. In vitro infection and disinfection of dentinal tubules. J Dent Res. 1987;66(5):1375-1379. doi: 10.1177/00220345870660081801.
Ando N, Hoshino E. Predominant obligate anaerobes invading the deep layers of root canal dentin. Int Endod J. 1990;23(12):20-27. doi:10.1111/j.1365-2591.1990. tb00798.x.
De Gregorio C, Steves R, Cisneros R, Heilborn C, Cohenca N. Effect of EDTA, sonic and ultrasonic activation on the penetration of sodium hypochlorite into simulated lateral canals: An in vitro study. J Endod. 2009;35(6):891-895. doi:10.1016/j.joen.2009.03.015.
Buck R, Eleazer PD, Staat RH. In vitro disinfection of dentinal tubules by various endodontic irrigants. J Endod. 1999;25(9):786-788. doi:10.1016/s0099-2399(99)80297-0.
Lloyd A, Uhles JP, Clement DJ, Garcia-Godoy F. Elimination of intracanal tissue and debris through a novel laser-activated system assessed using high-resolution micro-computed tomography: a pilot study. J Endod. 2014;40(4):584-587. doi:10.1016/j.joen.2013.10.040.
- Abstract Viewed: 1207 times
- PDF Downloaded: 481 times