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Abstract Introduction The aim of this study was to evaluate the effect of 2 different concentrations of sodium hypochlorite on healing and postoperative pain after primary endodontic treatment. Methods One hundred mandibular molars with pulp necrosis and chronic apical periodontitis were randomly assigned to 2 treatment groups: high-concentration (HC) 5% sodium hypochlorite and low-concentration (LC) 1% sodium hypochlorite. Root canal treatment was performed using a standardized protocol. Canals were prepared using equal volumes of respective irrigants after each instrument change. After chemomechanical preparation, the final flush was performed with 5 mL 17% EDTA solution followed by 5 mL 5% or 1% sodium hypochlorite depending on the group. All patients were asked to record the degree of pain on a visual analog scale every 24 hours for 1 week. At the second visit, canals were obturated, and the teeth were restored permanently. Clinical and radiographic evaluations were performed every 3 months for 12 months. The data collected were statistically analyzed. Results Eighty-six teeth were available for evaluation at the 1-year follow-up. The overall healing rate observed was 76.7%. Greater healing was observed in the HC (81.4%) group compared with the LC group (72.1%), but the difference was not statistically significant (P >.05). No significant differences in pain incidence and pain scores were found between the 2 groups (P >.05), with lower values reported in the LC group. Conclusions The use of LC or HC sodium hypochlorite did not result in a significant difference in the clinical outcome. [ABSTRACT FROM AUTHOR]

Introduction Octenisept (OCT; Schülke & Mayr, Nordersdedt, Germany), an antimicrobial, antibiofilm agent and a promising root canal irrigant, can be potentially combined with sodium hypochlorite (NaOCl) during endodontic treatment. The aim of this study was first to identify the precipitate formed on the interaction between OCT and NaOCl and secondly to compare its effect on dentinal tubules with that of precipitate formed on combining chlorhexidine (CHX) and NaOCl. Methods This observational study was conducted in 3 stages. Initially, the color changes and precipitate formation were assessed when the test solution 0.1% OCT and 5.2% NaOCl were mixed. Color changes were compared with those observed when 2% CHX was mixed with 5.2% NaOCl. The residue obtained on combining OCT and NaOCl was subjected to proton nuclear magnetic resonance ( 1 H NMR) and mass spectrometric (MS) analysis. In the final stage, dentinal surfaces irrigated alternatively with OCT and NaOCl were compared using scanning electron microscopy (SEM) with the dentinal surface irrigated with CHX and NaOCl. Results The OCT-NaOCl mixture changed in color from initial milky white to transparent over time, whereas the CHX-NaOCl mixture showed an immediate peach-brown discoloration. 1 H NMR and MS analysis established that the whitish precipitate obtained on combining OCT and NaOCl solutions correlated with the structure of phenoxyethanol (PE). SEM revealed dense precipitate occluding the dentinal tubules with the CHX and NaOCl group, whereas the precipitate was sparse and partially occluded in the OCT and NaOCl group. Conclusions The whitish precipitate formed with the OCT-NaOCl mixture was identified as PE, a compound already present in OCT, and it partly occluded the dentinal tubules. [ABSTRACT FROM AUTHOR]

Introduction Mixing sodium hypochlorite (NaOCl) with chlorhexidine (CHX) forms a brown-colored precipitate. Previous studies are not in agreement whether this precipitate contains para-chloroaniline (PCA). Tests used for analysis may demonstrate different outcomes. Purpose of this study was to determine whether PCA is formed through the reaction of mixing NaOCl and CHX by using high performance liquid chromatography, proton nuclear magnetic resonance spectroscopy, gas chromatography, thin layer chromatography, infrared spectroscopy, and gas chromatography/mass spectrometry. Methods To obtain a brown precipitate, 4.99% NaOCl was mixed with 2.0% CHX. This brown precipitate was analyzed and compared with signals obtained from commercially available 4.99% NaOCl, 2% solutions, and 98% PCA in powder form. Results Chromatographic and spectroscopic analyses showed that brown precipitate does not contain free PCA. Conclusions This study will be a cutoff proof for the argument on PCA formation from reaction of CHX and NaOCl. [ABSTRACT FROM AUTHOR]

Introduction This study was conducted to investigate whether the interaction between the turbidimetric limulus amebocyte lysate (LAL) substrate for endotoxin measurement and the substances/antimicrobial agents used in endodontic therapy can lead to the inhibition/enhancement of endotoxin recovery. Methods Ten microliters of a suspension of Escherichia coli endotoxin (O55:B55) was inoculated and kept in contact for 1 hour with different substances categorized as follows: group 1: auxiliary chemical substances: 5.25% and 2.5% sodium hypochlorite solutions, 2% chlorhexidine (CHX) (gel and solution), 1% Natrosol gel (Drogal Chemicals and Pharmaceuticals Ltd, Piracicaba, SP, Brazil), 17% EDTA, 10% citric acid, 3% hydrogen peroxide, 5% sodium thiosulfate, and 0.5% Tween 80 associated with 0.07% soy lecithin (Drogal Chemicals and Pharmaceuticals Ltd) and group 2: intracanal medications: neomycin/polymyxin B/hydrocortisone (Otosporin; Glaxo Wellcome, Rio de Janeiro, RJ, Brazil); calcium hydroxide (Ca[OH] 2 ); Ca(OH) 2 + 2% CHX gel; Ca(OH) 2 + 2% CHX gel + zinc oxide eugenol; Ca(OH) 2 + camphorated paramonochlorophenol (Calen; S.S. White, Rio de Janeiro, RJ, Brazil); triple antibiotic paste; mineral trioxide aggregate (MTA); and iodoform. Positive and negative controls consisted of root canal hemorrhagic exudate and pyrogen-free sterile water, respectively. All samples were diluted up to a 10:4 dilution. Each dilution was individually examined by the turbidimetric LAL assay. Collected data were analyzed through performance characteristics of the LAL assay such as linearity, coefficient of variation percentage, and product positive control (PPC) values. Results Correlation coefficient (≥0.980) and coefficient of variation percentage (<10%) of the standard curve in triplicate showed the tests' linearity. Spike recovery of auxiliary chemical substances achieved PPC values ranging from 50%–197%, showing no interferences with LAL substrate. Conversely, 3% hydrogen peroxide achieved product inhibition in which endotoxin values were underestimated even after the 10:4 dilutions. Regarding intracanal medicaments, neomycin/polymyxin B/hydrocortisone also inhibited endotoxin detection in all dilutions investigated (PPC values <50%). In contrast, Ca(OH) 2 + 2% CHX gel + ZOE as well as triple antibiotic paste led to the enhancement of endotoxin detection in which endotoxin values could not be validated by the turbidimetric kinetic LAL assay (PPC value >200%). Conclusions The performance characteristics of the kinetic turbidimetric assay for endotoxin measurement, such as precision and reproducibility, are modulated by the interaction of the LAL substrate with the substances/antimicrobial agents used in endodontic therapy. [ABSTRACT FROM AUTHOR]

Introduction This study compared the influence of different irrigants with and without ultrasound or laser irradiation on the bond strength of glass fiber posts using a self-etching adhesive in a supplementary dentin pretreatment. Methods Ninety bovine incisor roots were divided into 3 groups according to the irrigant tested: 2% chlorhexidine (CHX) ( n = 30); 2.5% sodium hypochlorite (NaOCl) ( n = 30), and saline solution (control) ( n = 30). Each group was randomly divided into 3 subgroups according to the supplementary dentin pretreatment: ultrasound, Nd:YAG laser, and nonsupplemented (control). A self-etching adhesive system (Futurabond DC; VOCO GmbH, Cuxhaven, Germany) was used, and the glass fiber posts were cemented with dual-cure epoxy-based luting agent (Bifix QM, VOCO GmbH). All roots were sectioned transversely, and the push-out test was performed. Failure mode analysis was also evaluated. Results Bond strength decreased significantly after the use of 2.5% NaOCl in all root thirds ( P < .05). CHX showed no difference in the mean bond strength value compared with saline solution ( P > .05). The supplementary dentin pretreatment using the Nd:YAG laser or ultrasound did not improve the bond strength values for both NaOCl and CHX ( P > .05). Moreover, the apical third exhibited the lowest mean bond strength values ( P < .05). Analysis indicated that the predominant failure mode was the mixed type. Conclusions Regardless of the irrigant used, the supplementary dentin pretreatment with ultrasound or laser irradiation showed no improvement in bond strength. Also, the use of NaOCl decreased the bond strength of glass fiber posts using a self-etching adhesive system, whereas CHX preserved it. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The aim of this study was to evaluate the influence of different irrigation protocols on resin-based sealer bond strength to dentin and the associated failure pattern. Methods: One hundred eighty single-rooted premolars were used. Roots were divided into 18 groups according to the irrigation protocol used and instrumented using 5.25% NaOCl or 2% chlorhexidine (CHX) gel as chemical auxiliary substances and 17% EDTA or 37% phosphoric acid for smear layer removal. Finally, CHX solution was used as the final irrigant in some groups. Root canals were filled with either gutta-percha and AH Plus (Dentsply, Petropolis, RJ, Brazil) (GP/AH) or Resilon/Real Seal SE (SybronEndo, Orange, CA). Bond strength was measured by the push-out test. Additionally, failure patterns were classified as adhesive, cohesive, and mixed. Data were statistically analyzed by Kruskal-Wallis and Mann-Whitney U tests. Results: In the GP/AH groups, high bond strength values were obtained when NaOCl was associated with phosphoric acid with (6.9 ± 3.9) and without (7.4 ± 3.8) a final flush with CHX. However, when CHX gel was used, the association with EDTA with (7.5 ± 3.2) and without (6.0 ± 2.3) a final flush with CHX solution showed better results. The GP/AH groups mainly showed a cohesive failure pattern. Evaluation of Resilon/Real Seal SE showed that higher bond strength values were reached when CHX was associated with phosphoric acid with (5.2 ± 3.0) and without (4.2 ± 2.0) a final flush with CHX solution. The failure patterns were mainly adhesive. Conclusions: Irrigation protocols influenced the bond strength of resin sealers to dentin. [Copyright &y& Elsevier]

Abstract: Introduction: The aim of this study was to evaluate the effect of various endodontic irrigants on the push-out bond strength of Biodentine (Septodont, Saint Maur des Fossés, France) in comparison with contemporary root perforation repair materials. Methods: Midroot dentin of canine teeth was horizontally sectioned into 1-mm-thick slices. The canal space of each dentin slice was enlarged with a diamond bur to 1.4 mm in diameter. The samples were divided into 5 groups (n = 40), and the following materials were placed, respectively: Biodentine, ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK), amalgam, Dyract AP (Dentsply DeTrey, Konstanz, Germany), and intermediate restorative material (IRM, Dentsply DeTrey). The samples were wrapped in wet gauze for 10 minutes and divided into 3 subgroups (n = 10) to be immersed into 3.5% sodium hypochlorite, 2% chlorhexidine gluconate (CHX), or saline for 30 minutes. No irrigation was performed in the controls (n = 10), and a wet cotton pellet was placed over each test material. After incubation for 48 hours, the dislodgement resistance of the samples was measured using a universal testing machine. The samples were examined under a stereomicroscope to determine the nature of the bond failures. Results: Biodentine showed significantly higher push-out bond strength than MTA (P < .05). The statistical ranking of push-out bond strength values was as follows: Dyract AP > amalgam ≥ IRM ≥ Biodentine > MTA. The push-out bond strength of Dyract AP, amalgam, IRM, and Biodentine was not significantly different when immersed in NaOCl, CHX, and saline solutions, whereas MTA lost strength when exposed to CHX. Conclusions: Biodentine showed considerable performance as a perforation repair material even after being exposed to various endodontic irrigants, whereas MTA had the lowest push-out bond strength to root dentin. [Copyright &y& Elsevier]

Abstract: Introduction: The aim of this study was to investigate the effect of different concentrations of cetrimide with or without 5% EDTA solution on the microhardness of human root dentin in vitro. Methods: Twenty-five recently extracted single-rooted human teeth were selected. The roots were split longitudinally into 2 parts. The specimens were randomly divided into the following 5 groups and were treated with 5% EDTA, 5% EDTA + 0.25% cetrimide, 5% EDTA + 0.50% cetrimide, 0.25% cetrimide, and 0.50% cetrimide immediately after the initial baseline microhardness measurements. A standardized volume of 50 mL of each solution was used for 1 minute. The reference microhardness values of untreated specimens were initially measured with a Vickers indenter under a 50-g load and a 10-second dwell time at the midroot level of the root dentin. Post-treatment microhardness values were obtained in the same manner as the initial ones. The decrease in microhardness was calculated as a percentage. Data were analyzed statistically by 1-way analysis of variance (P = .05) and the post hoc Tukey test for multiple comparisons at the same level of significance. Results: All solutions significantly decreased the microhardness of root dentin (P < .05). Although there was no significant difference among the solutions (P > .05), the specimens in the EDTA + 0.50% cetrimide solution group showed the highest change in microhardness. The plain EDTA and plain 0.50% cetrimide groups had similar values. Conclusions: The use of surfactants higher than 0.25% in concentration is questionable for clinical conditions. [Copyright &y& Elsevier]

Abstract: Introduction: The greatest reduction in microhardness of the most superficial layer of dentin of the root canal lumen is desired. The use of chelating agents during biomechanical preparation of root canals removes smear layer, increasing the access of the irrigant into the dentin tubules to allow adequate disinfection, and also reduces dentin microhardness, facilitating the action of endodontic instruments. This study evaluated the effect of different chelating solutions on the microhardness of the most superficial dentin layer from the root canal lumen. Methods: Thirty-five recently extracted single-rooted maxillary central incisors were instrumented, and the roots were longitudinally sectioned in a mesiodistal direction to expose the entire canal extension. The specimens were distributed in seven groups according to the final irrigation: 15% EDTA, 10% citric acid, 5% malic acid, 5% acetic acid, apple vinegar, 10% sodium citrate, and control (no irrigation). A standardized volume of 50 μL of each chelating solution was used for 5 minutes. Dentin microhardness was measured with a Knoop indenter under a 10-g load and a 15-second dwell time. Data were analyzed statistically by one-way analysis of variance and Tukey-Kramer multiple-comparison test at 5% significance level. Results: EDTA and citric acid had the greatest overall effect, causing a sharp decrease in dentin microhardness without a significant difference (p > .05) from each other. However, both chelators differed significantly from the other solutions (p < .001). Sodium citrate and deionized water were similar to each other (p > .05) and did not affect dentin microhardness. Apple vinegar, acetic acid, and malic acid were similar to each other (p > .05) and presented intermediate results. Conclusion: Except for sodium citrate, all tested chelating solutions reduced microhardness of the most superficial root canal dentin layer. EDTA and citric acid were the most efficient. [Copyright &y& Elsevier]

Abstract: Introduction: Laser-generated pressure waves may have application for removing debris and smear layers from root canals. Past work has employed middle infrared erbium lasers. The present study examined whether near infrared 940 and 980 nm diode lasers (Biolase Ezlase and Sirona Sirolaser, respectively) could induce cavitations in aqueous media. Methods: Laser energy was delivered into a capillary tube using a 200 μm fiber, and the formation of cavitations observed with a microscope. In the first part of the study, a range of laser parameters were trialled to establish conditions which form cavitations within 5 seconds of the commencement of laser irradiation. The second part of the study compared cavitation in distilled water, aerated tap water, degassed distilled water, ozonated water, 3 and 6% hydrogen peroxide using panel setting of 2.5 W/25 Hz for the Sirolaser, and 4 W/10 Hz for the Ezlase. Results: Both diode laser systems could induce cavitation in water-base media by the formation and implosion of water vapour. Laser power played a more important role than pulse frequency or pulse interval. Optimal laser-initiated cavitation occurred when weak (3%) peroxide solutions were used as the target irrigant, rather than water. Conclusion: This phenomenon has potential for enhancing debridement in endodontics. [Copyright &y& Elsevier]

Abstract: Introduction: Enterococcus faecalis is the most commonly isolated bacteria from root canals of teeth with persistent periapical periodontitis. Its ability to grow as a biofilm impedes the elimination of E. faecalis by using irrigating solutions. The purpose of this study was to assess the efficacy of cetrimide and chlorhexidine (CHX), alone and in association, in combined and alternating form, in eradicating biofilms of E. faecalis. Methods: Biofilms grown in the MBEC–high-throughput device for 24 hours were exposed to irrigating solutions for 30 seconds and 1 and 2 minutes. Eradication was defined as 100% kill of biofilm bacteria. The Student t test was used to compare the efficacy of the associations of the 2 irrigants. Results: Cetrimide eradicated E. faecalis biofilms at concentrations of 0.5%, 0.0312%, and 0.0078% at 30 seconds and 1 and 2 minutes of contact time, respectively. CHX did not eradicate the biofilms at any of the concentrations (4% initial concentration) or times assayed. The association of 0.1% and 0.05% cetrimide with any concentration of CHX, whether in combined or alternating application, effectively eradicated E. faecalis biofilms at all the contact times tested. Eradication was also achieved with 0.02% and 0.01% cetrimide at 2 minutes. Statistical analysis revealed significantly better results with alternating rather than combined use of cetrimide and CHX (P < .05). Conclusions: The associated use of cetrimide and CHX provided better results than their applications as single agents against E. faecalis biofilms, and the alternating application was significantly more effective than the combined mode of application. [Copyright &y& Elsevier]

Abstract: Introduction: This study evaluated the effectiveness of the NaviTip FX (Ultradent Products Inc, South Jordan, UT), a 30-gauge brush-covered irrigation needle, in removing debris and smear layer in vitro. Methods: Forty mesio-buccal maxillary and mandibular first molar root canals with 20° to 30° curved roots were randomly divided into four groups (n = 10). The irrigation protocol after cleaning and shaping was as follows: NaOCl/EDTA/nonbrushing (NaED) group: passive use with 5.25% NaOCl followed by 17% EDTA and saline; EDTA/brushing (EDBr) group: passive use with 5.25% NaOCl followed by left and right manual rotary up and down brushing using 17% EDTA and a saline rinse; EDTA/FileEze (Ultradent Products Inc)/brushing (EDFEBr) group: same as EDBr, however, with FileEze; and control group (CG): a standard 30-gauge NaviTip irrigation needle used passively. The roots were split longitudinally and the canals examined in a scanning electron microscope. Debris and smear layer were recorded at 1, 5, and 10 mm from the working length (WL) using a three-step scoring scale and 300-μm square grid. Mean scores were calculated and statistically analyzed (p < 0.05) between and within groups. Results: Comparison between groups revealed that at all evaluation levels EDBr and EDFEBr groups were significantly cleaner (p < 0.05) than NaED and CG, with no significant difference between them. Comparison within groups did not show significant differences (p > 0.05). All groups showed significantly better smear layer removal (p < 0.05) at 5 and 10 mm from the WL. The EDBr group exhibited no significant differences (p > 0.05) between the three evaluation levels. Conclusion: In moderately curved root canals, a NaviTip FX used with 5.25% NaOCL and 17% EDTA solution with manual brushing as well as the same method augmented by FileEze was the most effective cleaning protocol. [Copyright &y& Elsevier]

Abstract: Aim: The aim of this study was to evaluate the concentration of calcium ions and smear layer removal by using root canal chelators according to flame atomic absorption spectrophotometry and scanning electron microscopy. Forty-two human maxillary central incisors were irrigated with 15% ethylenediaminetetraacetic acid (EDTA), 10% citric acid, 10% sodium citrate, apple vinegar, 5% acetic acid, 5% malic acid, and sodium hypochlorite. The concentration of calcium ions was measured by using flame atomic absorption spectrometry, and smear layer removal was determined by scanning electron microscopy. Mean ± standard deviation, one-way analysis of variance, Tukey-Kramer, Kruskal-Wallis, Dunn, and kappa tests were used for statistical analysis. The use of 15% EDTA resulted in the greatest concentration of calcium ions followed by 10% citric acid; 15% EDTA and 10% citric acid were the most efficient solutions for removal of smear layer. [Copyright &y& Elsevier]

Abstract: The aim of this study was to evaluate the minimal biofilm eradication concentration (MBEC) of sodium hypochlorite (NaOCl), chlorhexidine (CHX), EDTA, and citric and phosphoric acids after 1, 5, and 10 minutes of exposure to biofilms of Enterococcus faecalis. The biofilms grew in the MBEC high-throughput device for 24 hours at 37°C and were exposed to 10 serial two-fold dilutions of each irrigating solution. The viable cell counts were log10 transformed, and a concentration of an irrigant was considered to eradicate the biofilms when it produced a reduction of ≥ 5 logarithmic units. NaOCl was the most effective agent, capable of eradicating the biofilms after 1 minute at a concentration of 0.00625%. CHX eradicated biofilm after 5 minutes at 2%. EDTA and citric and phosphoric acid solutions were not effective against the biofilms at any concentration or time tested. [Copyright &y& Elsevier]

Abstract: The aim of this study was to compare the antimicrobial efficacy of 5.25% NaOCl, BioPure MTAD (Dentsply Tulsa Dental, Johnson City, TN), and Tetraclean (Ogna Laboratori Farmaceutici, Milano, Italy) against Enterococcus faecalis biofilm generated on cellulose nitrate membrane filters. After incubation, the membrane filters were transferred into tubes containing 5 mL of the selected antimicrobial solution test agent or NaCl 0.9% (positive control) and incubated for 5, 30, and 60 minutes at 20°C. After each period of time, the test agents were vortexed for 60 seconds to resuspend the microorganisms. Ten-fold serial dilutions were generated in reduced transport fluid. Each dilution was plated onto a brain heart infusion plates. The plates were then incubated for 48 hours in an aerobic atmosphere at 37°C and colony-forming units per membrane was calculated. Statistical analysis showed that only 5.25% NaOCl can disgregate and remove the biofilm at every time; however, treatment with Tetraclean caused a high degree of biofilm disgregation in every considered time intervals as compared with MTAD (T5 p < 0.05, T30 p < 0.01, and T60 p < 0.001). [Copyright &y& Elsevier]

Abstract: This study examined the effects of commonly employed endodontic irrigants on Epiphany-dentin bond strengths. Smear layers were created on dentin discs obtained from human third molars. Five groups of 10 discs each were treated with one of the following: (a) water; (b) 2% chlorhexidine; (c) 6% sodium hypochlorite (NaOCl); (d) 6% NaOCl followed by EDTA and water; or (e) 1.3% NaOCl followed by MTAD. The treated surfaces were air-dried and treated with Epiphany primer. Hollow steel tubes were placed on the dentin surfaces, and Epiphany sealer was applied to dentin inside the tubes. Samples were tested for shear bond strengths after 7 days of storage. Representative specimens were examined using scanning electron microscopy. One-way ANOVA and Tukey’s test revealed significant differences among the groups (p < 0.05). Using water or chlorhexidine as an irrigant resulted in significantly lower bond strengths when compared with NaOCl, NaOCl/EDTA, or NaOCl/MTAD. Neither EDTA nor MTAD significantly improved Epiphany-dentin bond strengths when compared with NaOCl used alone. [Copyright &y& Elsevier]

Abstract: Local wound debridement in the diseased pulp space is the main step in root canal treatment to prevent the tooth from being a source of infection. In this review article, the specifics of the pulpal microenvironment and the resulting requirements for irrigating solutions are spelled out. Sodium hypochlorite solutions are recommended as the main irrigants. This is because of their broad antimicrobial spectrum as well as their unique capacity to dissolve necrotic tissue remnants. Chemical and toxicological concerns related to their use are discussed, including different approaches to enhance local efficacy without increasing the caustic potential. In addition, chelating solutions are recommended as adjunct irrigants to prevent the formation of a smear layer and/or remove it before filling the root canal system. Based on the actions and interactions of currently available solutions, a clinical irrigating regimen is proposed. Furthermore, some technical aspects of irrigating the root canal system are discussed, and recent trends are critically inspected. [Copyright &y& Elsevier]

Abstract: This study investigated the ability of chlorine dioxide to eliminate Enterococcus faecalis from dentinal tubules of bovine incisors. Thirty-seven extracted bovine incisor roots were sectioned into seventy-four 5 mm disks. Standardized lumens were filled with either sterile Brain Heart Infusion Broth (contamination controls, n = 10) or BHI containing E. faecalis (1.0 × 108 cfu/ml). Disks were incubated in 5% CO2 at 37°C for 72 h. To simulate endodontic instrumentation the lumens were again enlarged. Sixty disks were randomly divided into four experimental groups and filled with one of the following irrigants: 10% Clidox-S (chlorine dioxide), 13.8% BioClenz (chlorine dioxide), 5.25% Clorox, or saline. The disks were incubated for 30 min and were then frozen, pulverized, serially diluted in phosphate buffered saline, and plated on BHI plates in triplicate. Total colony forming units were counted macroscopically. Statistical analysis of the data was performed with a Kruskal-Wallis one-way ANOVA on ranks (p < 0.05, n = 60). Bacterial counts, expressed in log10 cfu/disk were as follows (“>” denotes significant differences): Saline > Clidox-S = BioClenz > Clorox. All negative controls were sterile. Chlorine dioxide and NaOCL were both effective in eliminating E. faecalis from the dentinal disks within 30 min. [Copyright &y& Elsevier]

Abstract: Introduction: This in vitro study assessed the adhesion of Epiphany self-etch (SE) root canal sealer to dentin treated with different irrigation regimens. Methods: Flat dentin surfaces were obtained from human third molar teeth; smear layer was created on each sample. Five groups of 10 samples each were conditioned with one of the following regimens: (1) deionized water for 10 minutes; (2) 5% sodium hypochlorite (NaOCl) for 10 minutes; (3) 5% NaOCl for 10 minutes and then 10% sodium ascorbate (Na-Ascr) for 10 minutes; (4) 5% NaOCl for 10 minutes and then 2% chlorhexidine (CHX) for 5 minutes; or (5) 5% NaOCl for 10 minutes and then 10% Na-Ascr for 10 minutes, followed by 2% CHX for 5 minutes. The conditioned dentin surfaces were dried with absorbent paper points. The Epiphany SE sealer was placed on each dentin surface with the use of hollow stainless steel tubes with specific diameter and height. The samples were stored in 100% humidity at 37°C for 7 days and then tested for shear bond strength in a universal testing machine. Results: Shear bond strength data were analyzed by one-way analysis of variance and Tukey post hoc tests (P < .05). There were statistically significant differences among the groups. Conclusions: NaOCl decreased the bond strength of Epiphany SE sealer to dentin, whereas the use of Na-Ascr reversed this negative effect of NaOCl. CHX had neither negative nor positive influence on the bond strength. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Chelating agents, such as EDTA or citric acid, can be incorporated into irrigants in order to provide different properties in a single compound. Maleic acid has recently been proposed as an alternative irrigant to EDTA given its better smear layer removal and biocompatibility; however, its antimicrobial activity is not known. The purpose of the present study was therefore to evaluate the in vitro capacity of maleic acid in eradicating Enterococcus faecalis biofilms and to evaluate the combinations of cetrimide with maleic acid, citric acid, and EDTA. Methods: E. faecalis biofilms were grown in the MBEC high-throughput device (Innovotech; Edmonton, Alberta, Canada) for 24 hours and exposed to the irrigating solutions for 30 seconds and 1 and 2 minutes. “Eradication” was defined as 100% bacterial kill. The Student t test was used to compare the efficacy of the irrigant combinations. Results: Maleic acid eradicated E. faecalis biofilms at a concentration of 0.88% after 30 seconds and at 0.11% after 2 minutes of contact time. When combined with 0.2% cetrimide, it eradicated the biofilms at all three times of exposure. The combination of 0.2% cetrimide with either 15% EDTA or 15% citric acid gave 100% bacterial kill after one minute of contact with the biofilms. Conclusions: Maleic acid showed antimicrobial activity against E. faecalis biofilm both alone or in association with cetrimide from 30 seconds onward and the combination of EDTA and citric acid with cetrimide eradicated biofilm after 1 minute of contact. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this study was to compare the effectiveness of F-files and ultrasonics to remove the smear layer from instrumented root canals when irrigated with sodium hypochlorite and EDTA. Sixty healthy human premolar teeth were instrumented with ProTaper file series to F3, and the canals were enlarged with Profiles 35/.06, 40/.06, and 45/.06. The canals were then instrumented with either the F-file or an ultrasonically activated #20 K-file with or without EDTA. The removal of smear layer was visualized using blind scanning electron microscopic micrographs. There appeared to be little difference between the F-file and the ultrasonically activated #20 K-file in removal of the smear layer with or without EDTA. The effect of ultrasonic activation appeared to be self-limiting with high-volume flushes of irrigant. It appears the F-file was not any more beneficial in removing smear layer. Conversely, smear layer removal appears to be mostly influenced by the introduction of an EDTA rinse. [Copyright &y& Elsevier]

Abstract: The aim of this study is to compare the surface tension of four common endodontic irrigants: Moltendo EDTA 17%, Cetrexidin, Smear Clear, Sodium hypochlorite 5.25%, with the surface tension of MTAD and Tetraclean. Freshly produced MilliQ water was used as a reference. All measurements were performed following the Wilhelmy plate technique, using a Cahn DCA-322 Dynamic Contact Angle Analyzer at the temperature of 22°C. MilliQ water, sodium hypochlorite 5.25%, and EDTA 17% had the highest surface tension, whereas those of Cetrexedin and Tetraclean has shown the lowest surface tension value. Both new irrigants, MTAD and Tetraclean, are capable of removing the smear layer. Thanks to their low surface tension, increasing the intimate contact of irrigant solutions with the dentinal walls, they may permit deeper penetration. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to compare the antifungal efficacy of 6% sodium hypochlorite (NaOCl), 2% chlorhexidine gluconate (CHX), 17% ethylene-diaminetetraacetic acid (EDTA), and BioPure MTAD as a final rinse on Candida albicans in vitro. Forty-eight, single rooted teeth were randomly divided into four groups each with a positive and a negative control. After root canal preparation, experimental teeth were inoculated with Candida albicans (ATCC 60193) and incubated for 72 hours. The groups were rinsed as follows: 1 ml of 6% NaOCl, 0.2 ml of 2% CHX, 1 ml of 17% EDTA, and 5 ml of BioPure MTAD. Aliquots from the experimental teeth were plated on Sabouraud 4% dextrose agar plates and colony-forming units were counted as a measure of antifungal activity. The results showed that 6% NaOCl and 2% CHX were equally effective and statistically significantly superior to BioPure MTAD and 17% EDTA (p < 0.05) in antifungal activity. [Copyright &y& Elsevier]

Regenerative endodontic procedures for immature teeth with pulp necrosis have gained a lot of interest. Basic scientific research has documented the potential for dental pulp regeneration in preclinical studies. A number of case reports and case series have shown the control of clinical infection and increases in thickness and length of the roots. Preoperative infection is an important factor that predicts outcome in nonsurgical endodontic treatment in mature teeth and seems to also be an important determinant of outcome in treating immature teeth. However, antimicrobial strategies for the immature tooth in which pulp regeneration is contemplated are different from those used in mature cases. This is because of the interest in disinfecting the root canal to a higher level to promote tissue growth without disrupting the bioactive potential of root dentin and the viability of stem cells from which the regenerated tissue would develop. This review addresses the factors involved in making clinical decisions in this area in light of the information available on the microbiology of endodontic infections, the efficacy to antimicrobial strategies, and the outcomes of regenerative and alternative procedures. [ABSTRACT FROM AUTHOR]