Quantitative Assessment of Dentinal Tubule Disinfection in Absence of Biofilm on Root Canal Walls: An in vitro Study
Iranian Endodontic Journal,
Vol. 15 No. 3 (2020),
1 July 2020
Introduction: This study aimed at assessing the quantitative effect of calcium hydroxide, 2% chlorhexidine gel, and 1.5% chlorhexidine linked to xanthan gel specifically against intratubular bacteria. Methods and Materials: Fifty-two semi-cylindrical bovine dentin specimens were infected with Enterococcus (E.) faecalis by centrifugation with subsequent 7-days incubation. The surface of specimens was disinfected with 3% H2O2. Scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM) and the count of bacterial colony-forming units (CFU/mg) were used to assess dentin infection. A total of 40 specimens were incubated for 2 weeks with one of the intracanal medication applied (10 samples for each group): 1) calcium hydroxide, 2) 2% chlorhexidine gel, 3) 1.5% chlorhexidine linked to xanthan gel and 4) sterile saline. Final passive ultrasonic irrigation with 3% sodium hypochlorite was performed in half of the total specimens. The effect of intracanal medications and irrigation against intratubular bacteria was assessed by bacterial culturing of dentin shavings. Two-Way ANOVA model was applied followed by post-hoc Tukey's test for multiple pair-wise comparisons of mean CFU/mg values. Results: SEM, CLSM, and bacterial culturing confirmed the absence of the surface biofilm on the root canal wall and showed vital intratubular bacteria at the depth up to 700 mm. Two-week application of 1.5% chlorhexidine with xanthan gel and 2% chlorhexidine gel significantly decreased intratubular bacterial counts compared with saline (P=0.0003 and P=0.0005, respectively). Subsequent passive ultrasonic irrigation with 3% sodium hypochlorite significantly reduced the number of intratubular bacteria in all groups except for the group with 1.5% chlorhexidine-xanthan gel (P=0.0054). Conclusion: This modified ex vivo model study showed ultrasonically activated irrigation with sodium hypochlorite had greater effect on intratubular bacteria counts compared with 2-week application of intracanal medications.
- Confocal Laser Scanning Microscopy; Electron Scanning Microscopy; Enterococcus faecalis; Root Canal Irrigants
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Hargreaves KM, Cohen S, Berman LH. Cohen's pathways of the pulp. St. Louis, Mo.: Mosby Elsevier; 2011.
Almeida DO, Chaves SC, Souza RA, Soares FF. Outcome of Single- vs Multiple-visit Endodontic Therapy of Nonvital Teeth: A Meta-analysis. J Contemp Dent Pract. 2017;18(4):330-6.
De-Deus G, Canabarro A. Strength of recommendation for single-visit root canal treatment: grading the body of the evidence using a patient-centred approach. Int Endod J. 2017;50(3):251-9.
Manfredi M, Figini L, Gagliani M, Lodi G. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst Rev. 2016;12:CD005296.
Delgado RJ, Gasparoto TH, Sipert CR, Pinheiro CR, Moraes IG, Garcia RB, et al. Antimicrobial effects of calcium hydroxide and chlorhexidine on Enterococcus faecalis. J Endod. 2010;36(8):1389-93.
Kandaswamy D, Venkateshbabu N, Gogulnath D, Kindo AJ. Dentinal tubule disinfection with 2% chlorhexidine gel, propolis, morinda citrifolia juice, 2% povidone iodine, and calcium hydroxide. Int Endod J. 2010;43(5):419-23.
Lima RK, Guerreiro-Tanomaru JM, Faria-Júnior NB, Tanomaru-Filho M. Effectiveness of calcium hydroxide-based intracanal medicaments against Enterococcus faecalis. Int Endod J. 2012;45(4):311-6.
Atila-Pektaş B, Yurdakul P, Gülmez D, Görduysus O. Antimicrobial effects of root canal medicaments against Enterococcus faecalis and Streptococcus mutans. Int Endod J. 2013;46(5):413-8.
Vasudeva A, Sinha DJ, Tyagi SP, Singh NN, Garg P, Upadhyay D. Disinfection of dentinal tubules with 2% Chlorhexidine gel, Calcium hydroxide and herbal intracanal medicaments against Enterococcus faecalis: An in-vitro study. Singapore Dent J. 2017;38:39-44.
Lakhani AA, Sekhar KS, Gupta P, Tejolatha B, Gupta A, Kashyap S, et al. Efficacy of Triple Antibiotic Paste, Moxifloxacin, Calcium Hydroxide And 2% Chlorhexidine Gel In Elimination of. J Clin Diagn Res. 2017;11(1):ZC06-ZC9.
Shakya VK, Luqman S, Tikku AP, Chandra A, Singh DK. A relative assessment of essential oil of. J Conserv Dent. 2019;22(1):34-9.
Fiorillo L. Chlorhexidine Gel Use in the Oral District: A Systematic Review. Gels. 2019;5(2).
Needleman IG, Smales FC, Martin GP. An investigation of bioadhesion for periodontal and oral mucosal drug delivery. J Clin Periodontol. 1997;24(6):394-400.
Paolantonio M, D'Ercole S, Pilloni A, D'Archivio D, Lisanti L, Graziani F, et al. Clinical, microbiologic, and biochemical effects of subgingival administration of a Xanthan-based chlorhexidine gel in the treatment of periodontitis: a randomized multicenter trial. J Periodontol. 2009;80(9):1479-92.
Gupta R, Pandit N, Aggarwal S, Verma A. Comparative evaluation of subgingivally delivered 10% doxycycline hyclate and xanthan-based chlorhexidine gels in the treatment of chronic periodontitis. J Contemp Dent Pract. 2008;9(7):25-32.
Perinetti G, Paolantonio M, Cordella C, D'Ercole S, Serra E, Piccolomini R. Clinical and microbiological effects of subgingival administration of two active gels on persistent pockets of chronic periodontitis patients. J Clin Periodontol. 2004;31(4):273-81.
Haapasalo M, Orstavik D. In vitro infection and disinfection of dentinal tubules. J Dent Res. 1987;66(8):1375-9.
Ma J, Wang Z, Shen Y, Haapasalo M. A new noninvasive model to study the effectiveness of dentin disinfection by using confocal laser scanning microscopy. J Endod. 2011;37(10):1380-5.
Carbajal Mejía JB. Antimicrobial effects of calcium hydroxide, chlorhexidine, and propolis on Enterococcus faecalis and Candida albicans. J Investig Clin Dent. 2014;5(3):194-200.
Leonardo MR, Tanomaru Filho M, Silva LA, Nelson Filho P, Bonifácio KC, Ito IY. In vivo antimicrobial activity of 2% chlorhexidine used as a root canal irrigating solution. J Endod. 1999;25(3):167-71.
Valverde ME, Baca P, Ceballos L, Fuentes MV, Ruiz-Linares M, Ferrer-Luque CM. Antibacterial efficacy of several intracanal medicaments for endodontic therapy. Dent Mater J. 2017;36(3):319-24.
Love RM. Enterococcus faecalis--a mechanism for its role in endodontic failure. Int Endod J. 2001;34(5):399-405.
Silva AR, Santos EB, Pinto SC, Gomes JC, Vaz IP, Carvalho MF. Antimicrobial effect and transdentinal diffusion of new intracanal formulations containing nitrofurantoin or doxycycline. Braz Dent J. 2014;25(5):425-9.
Herczegh A, Ghidan A, Friedreich D, Gyurkovics M, Bendő Z, Lohinai Z. Effectiveness of a high purity chlorine dioxide solution in eliminating intracanal Enterococcus faecalis biofilm. Acta Microbiol Immunol Hung. 2013;60(1):63-75.
Makeeva IM, Franko A, Semenov AM, Byakova SF, Novozhilova NE, Dezhurko-Korol VA. [The in vitro examination of the effectiveness of antiseptic substances for a surface disinfection of teeth inoculated with Escherichia coli]. Stomatologiia (Mosk). 2018;97(4):8-10.
Zou L, Shen Y, Li W, Haapasalo M. Penetration of sodium hypochlorite into dentin. J Endod. 2010;36(5):793-6.
Palazzi F, Sadile G, Mohammadi Z, Del Fabbro M, Riccitiello F. Penetration of hypochlorites with lowered surface tension into dentine tubules. Minerva Stomatol. 2016;65(6):368-77.
Palazzi F, Blasi A, Mohammadi Z, Del Fabbro M, Estrela C. Penetration of Sodium Hypochlorite Modified with Surfactants into Root Canal Dentin. Braz Dent J. 2016;27(2):208-16.
Faria G, Viola KS, Coaguila-Llerena H, Oliveira LRA, Leonardo RT, Aranda-García AJ, et al. Penetration of sodium hypochlorite into root canal dentine: effect of surfactants, gel form and passive ultrasonic irrigation. Int Endod J. 2019;52(3):385-92.
Ghorbanzadeh A, Aminsobhani M, Sohrabi K, Chiniforush N, Ghafari S, Shamshiri AR, et al. Penetration Depth of Sodium Hypochlorite in Dentinal Tubules after Conventional Irrigation, Passive Ultrasonic Agitation and Nd:YAG Laser Activated Irrigation. J Lasers Med Sci. 2016;7(2):105-11.
Akcay M, Arslan H, Mese M, Durmus N, Capar ID. Effect of photon-initiated photoacoustic streaming, passive ultrasonic, and sonic irrigation techniques on dentinal tubule penetration of irrigation solution: a confocal microscopic study. Clin Oral Investig. 2017;21(7):2205-12.
Souza CC, Bueno CE, Kato AS, Limoeiro AG, Fontana CE, Pelegrine RA. Efficacy of passive ultrasonic irrigation, continuous ultrasonic irrigation versus irrigation with reciprocating activation device in penetration into main and simulated lateral canals. J Conserv Dent. 2019;22(2):155-9.
van der Sluis LW, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J. 2007;40(6):415-26.
Küçük M, Kermeoğlu F. Efficacy of different irrigation methods on dentinal tubule penetration of Chlorhexidine, QMix and Irritrol: A confocal laser scanning microscopy study. Aust Endod J. 2019;45(2):202-8.
Peeters E, Nelis HJ, Coenye T. Comparison of multiple methods for quantification of microbial biofilms grown in microtiter plates. J Microbiol Methods. 2008;72(2):157-65.
Neelakantan P, Romero M, Vera J, Daood U, Khan AU, Yan A, et al. Biofilms in Endodontics-Current Status and Future Directions. Int J Mol Sci. 2017;18(8).
Nagendrababu V, Murray PE, Ordinola-Zapata R, Peters OA, Rôças IN, Siqueira JF, et al. A protocol for developing reporting guidelines for laboratory studies in Endodontology. Int Endod J. 2019;52(8):1090-5.
Costa BM, Iwamoto AS, Puppin-Rontani RM, Pascon FM. Comparative Analysis of Root Dentin Morphology and Structure of Human Versus Bovine Primary Teeth. Microsc Microanal. 2015;21(3):689-94.
Schilke R, Lisson JA, Bauss O, Geurtsen W. Comparison of the number and diameter of dentinal tubules in human and bovine dentine by scanning electron microscopic investigation. Arch Oral Biol. 2000;45(5):355-61.
Camargo CH, Siviero M, Camargo SE, de Oliveira SH, Carvalho CA, Valera MC. Topographical, diametral, and quantitative analysis of dentin tubules in the root canals of human and bovine teeth. J Endod. 2007;33(4):422-6.
Chávez de Paz LE, Davies JR, Bergenholtz G, Svensäter G. Strains of Enterococcus faecalis differ in their ability to coexist in biofilms with other root canal bacteria. Int Endod J. 2015;48(10):916-25.
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