sodium-hypochlorite and Periapical-Periodontitis

Topics: Dental Alloys; Dental Pulp Cavity; Elasticity; Equipment Design; Gutta-Percha; Hot Temperature; Humans; Nickel; Odontometry; Patient Care Planning; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Sodium Hypochlorite; Stress, Mechanical; Titanium; Tooth, Nonvital

Apical periodontitis is an inflammatory response around the root tip of a tooth to microbial infection of the root canal system. Therefore, disinfection of the root canal system is the most important aim of root canal treatment. There are various mechanical and chemical ways to clean and disinfect. Most methods, however, cannot be relied upon to fully decontaminate in all cases. There are problems, for example, with the proper concentrations of disinfectant agents, like sodium hypochlorite. But the more recent agents, like ethylenediaminetetraacetic acid, calcium hydroxide or antibiotic pastes also have disadvantages, which are mostly a result of poor access of the irrigant to the biofilm bacteria in the affected root canals. Currently, a new strategy with a modified salt solution is under investigation that offers the prospect of being used as a root canal irrigant. At this moment the preferred treatment still seems to be to remove infected tissue as much as possible and to create access for irrigation procedures. The best results are achieved with 1-2% sodium hypochlorite as a disinfectant, possibly alternating with ethylenediaminetetraacetic acid as a cleansing agent. There is no scientific evidence for the successful use of calcium hydroxide.. Parodontitis apicalis is een ontstekingsreactie rond de wortelpunt van een gebitselement en wordt vrijwel altijd veroorzaakt door een microbiële infectie van het wortelkanaalstelsel. Daarom is desinfectie van het wortelkanaalstelsel een hoofddoel van de wortel­kanaalbehandeling. Er zijn verschillende mechanische en chemische wijzen om te reinigen en te desinfecteren. Echter, de meeste methoden leiden niet altijd tot volledige decontaminatie. Zo zijn er problemen met de juiste concentratie desinfectiemiddelen, zoals hypochloriet. Maar ook de nieuwere middelen, zoals ethyleendiaminetetra-azijnzuur, calciumhydroxide en antibioticapasta hebben nadelen, die veelal worden veroorzaakt door de slechte bereikbaarheid van de biofilm in de geïnfecteerde kanalen. Op dit moment wordt er een middel onderzocht dat veel perspectief biedt om te gebruiken als wortelkanaalirrigatiemiddel. Vooralsnog lijkt de beste behandeling om het geïnfecteerde weefsel zoveel mogelijk te verwijderen en om toegang te creëren voor het te gebruiken desinfectiemiddel. De beste resultaten worden verkregen met 1-2% natriumhypochloriet als desinfectans, eventueel afgewisseld met ethyleendiaminetetra-azijnzuur als reinigingsmiddel. Voor het succesvol toepassen van calciumhydroxide is nog onvoldoende wetenschappelijk bewijs.

Topics: Calcium Hydroxide; Disinfection; Edetic Acid; Humans; Periapical Periodontitis; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite

Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation of root development. In this article we describe successful revascularization treatment of 2 necrotic immature first mandibular molars.. The clinical and radiographic examinations showed extensive coronal caries, immature roots, and periapical radiolucencies in mandibular first molars of a 9-year-old boy and an 8-year-old girl. The exam findings suggested revascularization treatment in both cases, which was started with irrigation of the canals by using NaOCl 5.25% for 20 minutes, followed by 3 weeks of triple antibiotic (metronidazole, ciprofloxacin, and minocycline) paste dressing. Next, the antibiotic paste was removed, bleeding was induced in the canals, and calcium enriched mixture (CEM) cement was placed over blood clots.. In radiographic and clinical follow-ups both cases were asymptomatic and functional, periapical radiolucencies were healed, and roots continued to develop.. Revascularization is a realistic treatment in immature necrotic molars. In addition, placing CEM cement as a new endodontic biomaterial over the blood clot formed inside the canals provided good seal and favorable outcomes.

Topics: Anti-Bacterial Agents; Apexification; Biocompatible Materials; Calcium; Child; Ciprofloxacin; Dental Cements; Dental Pulp Necrosis; Female; Follow-Up Studies; Humans; Male; Mandible; Metronidazole; Minocycline; Molar; Neovascularization, Physiologic; Odontogenesis; Periapical Abscess; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Time Factors; Tooth Root; Treatment Outcome

Traditional methods of treatment of immature root with necrotic pulp and apical periodontitis pose multiple challenges. These challenges include disinfection of the root canal with standard protocols that aggressively use endodontic files, filling the root canal with an open apex that provides no barrier for stopping the root filling material before impinging on the periodontal tissues, and the susceptibility of the teeth to fracture because of their thin roots. Disinfection using sodium hypochlorite, apical barrier formation using calcium hydroxide as well as mineral trioxide aggregate, and pulp revascularization of fractured tooth with the help of blood clot and collagen-enhanced matrix has been discussed in detail in this article.

Topics: Aluminum Compounds; Animals; Apexification; Calcium Compounds; Calcium Hydroxide; Dental Pulp; Drug Combinations; Humans; Neovascularization, Physiologic; Oxides; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Therapy; Silicates; Sodium Hypochlorite; Tooth Root; Tooth, Nonvital

Enterococcus faecalis is a microorganism commonly detected in asymptomatic, persistent endodontic infections. Its prevalence in such infections ranges from 24% to 77%. This finding can be explained by various survival and virulence factors possessed by E. faecalis, including its ability to compete with other microorganisms, invade dentinal tubules, and resist nutritional deprivation. Use of good aseptic technique, increased apical preparation sizes, and inclusion of 2% chlorhexidine in combination with sodium hypochlorite are currently the most effective methods to combat E. faecalis within the root canal systems of teeth. In the changing face of dental care, continued research on E. faecalis and its elimination from the dental apparatus may well define the future of the endodontic specialty.

Topics: Anti-Infective Agents; Chlorhexidine; Citric Acid; Dental Restoration Failure; Doxycycline; Enterococcus faecalis; Humans; Periapical Periodontitis; Polysorbates; Retreatment; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Virulence Factors

The complex internal anatomy, host defences and the virulence of micro-organisms are important factors to consider in choosing a root canal treatment. The choice of an irrigation solution for use in infected root canals requires an exact knowledge of the micro-organisms responsible for the infective process, as well as the properties of different irrigation solutions in the treatment of teeth with asymptomatic apical periodontitis. Irrigation solutions must have a targeted antimicrobial action and the ability to dissolve organic tissues. Sodium hypochlorite (NaOCl) is the most used irrigation solution in endodontics and, because of its mechanism of action, it causes a biosynthetic alteration in cellular metabolism and a phospholipid destruction, a formation of chloramines which interferes in cellular metabolism, an oxidative action with irreversible enzymatic inactivation in bacteria, and a lipid and fatty acid degradation. However, it must be said that its use is able to remove collagen fibres and thereby to prevent the hybrid layer formation, which is considered by many authors as the fundamental qualification for a correct and adequate adhesion to dentin. The aim of this paper is to examine the mechanisms of action of sodium hypochlorite based on its antimicrobial and physical-chemical properties and to see how its action could interfere in the resistance of dentin adhesion. Scientific research has shown the now attested validity of sodium hypochlorite as an antibacterial agent with a proteolytic action, while other studies made on the adhesion strength on dentin surface have given conflicting results.

Topics: Collagen; Dentin; Disinfectants; Humans; In Vitro Techniques; Microscopy, Electron, Scanning; Periapical Periodontitis; Root Canal Therapy; Sodium Hypochlorite

Calcium hydroxide has found its use in endodontic treatments. On the other hand, chlorhexidine is more and more proposedfor uses in clinical endodontics. Could chlorhexidine surpass calcium hydroxide and what are the benefits of chlorhexidine? This literature overview concludes that both medications are useful and that further studies are necessary before chosing one above the other.

Topics: Bacteria; Calcium Hydroxide; Chlorhexidine; Dentin; Drug Combinations; Humans; Pain, Postoperative; Periapical Periodontitis; Root Canal Irrigants; Smear Layer; Sodium Hypochlorite

This paper reviews current concepts of root canal infection and the consequences for endodontic treatment strategies and practices. In particular, root canal disinfection by chemical and mechanical means is discussed, as are the possibilities and limitations of proposed methods to reduce the time necessary to obtain a disinfected canal.

Topics: Bacterial Infections; Calcium Hydroxide; Dental Caries; Dental Pulp Diseases; Disinfection; Focal Infection, Dental; Humans; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Time Factors

Periradicular lesions are diseases either primarily or secondarily caused by microorganisms and therefore they must be prevented or treated accordingly. If the professional is well-versed in both preventing and eliminating the root canal infection, the success rate of endodontic therapy may exceed 90 percent. The present paper discusses theoretical and practical aspects of effective antimicrobial endodontic therapy and delineates strategies to effectively control root canal infections.

Topics: Anti-Bacterial Agents; Bacterial Infections; Calcium Hydroxide; Dental Pulp Diseases; Humans; Laser Therapy; Periapical Periodontitis; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite

This study compared in vitro the anastomosis cleaning efficacy of different irrigant activation techniques at different levels; control group non-activation (NA), passive ultrasonic irrigation (PUI) using Irrisafe, and EDDY sonic activation.. Sixty anastomosis-containing mesial roots of mandibular molars were mounted in resin, sectioned at 2, 4, and 6 mm from the apex. Then reassembled and instrumented in a copper cube. For the irrigation technique roots were randomly divided into 3 groups (n = 20): group 1: NA, group 2: Irrisafe, group 3: EDDY. Stereomicroscopic images of anastomoses were taken after instrumentation and after irrigant activation. ImageJ program was used to calculate the percentage of anastomosis cleanliness. The percentage of cleanliness was calculated before and after final irrigation within each group and were then compared using paired t-tests. Intergroup and intragroup analyses were performed to compare between different activation techniques at the same root canal level (2, 4 and 6 mm) (intergroup) and to evaluate if each technique had different cleanliness efficacy according to the root canal level (intragroup) using one-way analysis of variance and post hoc tests (p < 0.05).. All three irrigation techniques significantly improved anastomosis cleanliness (p < 0.001). Both activation techniques were significantly better than the control group at all levels. Intergroup comparison revealed that EDDY significantly achieved the best overall anastomosis cleanliness. The difference between EDDY and Irrisafe was significant in favor to EDDY at 2 mm and insignificant at 4 and 6 mm. The intragroup comparison showed that improvement in anastomosis cleanliness (i2-i1) in the needle irrigation without activation group (NA) was significantly higher in the apical 2 mm level compared to the 4 & 6 levels. While the difference in anastomosis cleanliness improvement (i2-i1) between levels in both Irrisafe and EDDY groups was insignificant.. Irrigant activation improves anastomosis cleanliness. EDDY was the most efficient in cleaning anastomoses located in the critical apical part of the root canal.. Cleaning and disinfection of the root canal system followed by apical and coronal sealing is the key for healing or prevention of apical periodontitis. Remnants of debris and microorganisms retained within the anastomoses (isthmuses), or other root canal irregularities may lead to persistent apical periodontitis. Proper irrigation and activation are essential for cleaning root canal anastomoses.

Topics: Anastomosis, Surgical; Dental Pulp Cavity; Humans; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation

To evaluate the effect of combination of auxiliary irrigation technology and root canal irrigation solution in the treatment of chronic apical periodontitis with fistula, and try to seek a more effective and minimally invasive therapeutic strategy.. One hundred and fifty patients with fistulous chronic apical periodontitis who were diagnosed in Hefei Stomatological Hospital from January 2021 to January 2022 were randomly divided into 6 groups, 25 cases in each group. The 6 groups were as follows, group A: 0.5%NaOCl +ultrasonically activated irrigation; Group B: 1.0%NaOCl+ultrasonically activated irrigation; Group C: 2.0%CHX+ultrasonically activated irrigation; Group D: 0.5%NaOCl+sonic activation; Group E: 1.0%NaOCl+sonic activation; Group F: 2.0%CHX+sonic activation. The fistula healing time, treatment effect and postoperative pain were observed in each group. The data were analyzed with SPSS 20.0 software package.. In terms of fistula healing, the 10-day fistula healing rate of group E and group F was higher than that of group A and group D，and the difference was statistically significant(P＜0.05); but there was no significant difference between group E and group F (P＞0.05). The effective rate at 1 month after operation in group A was lower, and the difference was significant (P＜0.05). In terms of postoperative pain, the VAS score of group A was lower than that of group E and group F at all time points, and the difference was statistically significant(P＜0.05).. In the treatment of chronic apical periodontitis with fistula, 1.0% NaOCl or 2.0% CHX combined with ultrasonically activated irrigation or sonic activation obtain a better short-term effect，of which the sonic activation group can also obtain early healing of the fistula, but the incidence of postoperative pain is higher when sonic activation is used.

Topics: Fistula; Humans; Pain, Postoperative; Periapical Periodontitis; Root Canal Irrigants; Sodium Hypochlorite; Therapeutic Irrigation

The aim of this study was to compare the effect of different application techniques of ozone on the prevalence of postendodontic pain in patients undergoing single-visit root canal treatment.. hundred eight patients with necrotic pulp in single-rooted teeth and apical periodontitis participated in the trial. A standard single-visit endodontics protocol was followed with 5.25% sodium hypochlorite and rotary nickel-titanium files. After shaping and cleaning, patients were randomly allocated into the following groups: group 1 (n = 21), ozone treatment with no activation (NA); group 2 (n = 22), ozone treatment with manual dynamic activation (MDA); group 3, (n = 21), ozone treatment with passive ultrasonic activation (PUA); group 4 (n = 23), ozone treatment with sonic activation (SA); and group 5 (n = 21), no ozone treatment (the control group). Patient levels of discomfort were recorded at 6 different time intervals using the visual analog scale (VAS). Comparison of the mean difference between the groups and time intervals was performed using 2-way analysis of variance followed by a post hoc Bonferroni test. The level of significance was set at 5%.. VAS scores were highest for the control > NA > MDA > SA > PUA groups. A statistically significant reduction in VAS scores was observed in the PUA and SA groups in comparison with the NA, control, and MDA groups. Timewise comparison showed a highly significant decline in VAS scores at all time intervals (P < .001).. Ultrasonic and sonic activation of ozone resulted in less pain in patients undergoing single-visit endodontics compared with no ozone treatment.

Topics: Dental Pulp Cavity; Dental Pulp Necrosis; Humans; Ozone; Pain, Postoperative; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite

This study aimed to assess the effect of a 980-nm diode laser following chemomechanical root canal preparation on the severity of post-operative pain (PP) after root canal treatment (RCT).. This study included asymptomatic, single-rooted teeth with a periapical index (PAI) score of 3 or 4. All the patients received RCT, including dressing with calcium hydroxide (Ca(OH). The average pain level in the control group 24 h after the first visit was significantly higher than that in the laser group (p < 0.05). The average pain level 24 h and 48 h after the second visit was significantly higher in the control group (p < 0.05). The levels of PP 24 h after the first visit were higher than those after the second visit only in the control group (p < 0.05). After the first visit, analgesic use in the control group was significantly higher after 8 h (40%) and 24 h (23%) as compared with that in the laser group (p < 0.05).. Root canal irradiation with a diode laser may reduce PP after RCT in single-rooted teeth with a PAI score of 3 or 4.. Effect of the Diode Laser on Post-operative Pain After Endodontic Treatment in Teeth with Apical Periodontitis: NCT04486196. Registered 24 July 2020-Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT04486196.

Topics: Dental Pulp Cavity; Humans; Lasers, Semiconductor; Pain, Postoperative; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite

This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization.. Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis.. A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%).. Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.

Topics: Adolescent; Adult; Analysis of Variance; Bacteria; Bacterial Load; Colony Count, Microbial; Cone-Beam Computed Tomography; Dental Pulp Cavity; DNA Probes; Female; Humans; Linear Models; Male; Middle Aged; Periapical Periodontitis; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Therapeutic Irrigation; Treatment Outcome; Ultrasonic Therapy; Young Adult

To evaluate the effect of NaOCl irrigant activation using passive ultrasonic activation, F-files, XP-endo Finisher files and or needle irrigation alone on the reduction of intracanal bacteria from root canals in teeth undergoing root canal treatment.. Eighty patients with asymptomatic apical periodontitis were randomly divided into four groups. Access cavities were prepared and pre-treatment samples were taken (S1). Canals were then prepared and post-instrumentation samples (S2) taken. NaOCl was then activated with the various irrigant activation systems and post-irrigation samples (S3) taken. The samples were processed and colony forming units (CFUs) of bacteria were determined. The reduction in CFUs among the experimental groups were analysed using the Kruskal Wallis test and pairwise comparisons with the Mann-Whitney test. The Friedman test was used to compare the differences in the reduction of CFUs within the groups.. Overall, for all groups there was a significant reduction in the CFUs from S1 to S2 (P < 0.05) and from S2 to S3 (P < 0.05). Both XP-endo Finisher and passive ultrasonic activation techniques were associated with the greatest reduction in CFUs with no significant difference between them (P = 0.24). However, both were associated with significantly lower CFUs when compared to F-file activation and needle irrigation (P < 0.05). F-file activation reduced the CFUs significantly more compared to needle irrigation (P = 0.04).. XP-endo Finisher file activation and passive ultrasonic activation were equivalent in terms of reduction in CFUs. F-file activation did not reduce the CFUs to the same extent as the XP-endo Finisher file and ultrasonic activation but reduced the CFUs more than needle irrigation.. The present study highlights the effect of new XP-endo Finisher file and passive ultrasonic activation in reducing the bacterial load from the root canal system which is important for the success of root canal treatment.

Topics: Bacteria; Dental Pulp Cavity; Humans; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Therapeutic Irrigation

This randomized clinical study compared the in vivo antibacterial efficacy of Reciproc Blue (RB), XP-endo Shaper (XP-S), and XP-endo Shaper associated with XP-endo Finisher (XP-F) systems in infected oval-shaped root canals with primary apical periodontitis.. In this study, 28 human teeth with a single root and a single canal were randomly assigned to 2 groups according to the instrumentation technique: group 1, RB (n = 14) and group 2, XP-endo (XP-S and XP-F, n = 14). The single-rooted teeth were prepared by reciprocating and rotary nickel-titanium instruments with 5.25% sodium hypochlorite irrigation. Samples were collected from the canal at the baseline (S1), after chemomechanical preparation (S2), and after XP-F instrumentation (S3). The DNA extracts were subjected to quantitative analysis for total bacterial counts by quantitative real-time polymerase chain reaction. The data were analyzed using the analysis of variance test, and the level of significance was set at 5%.. All samples tested positive for the presence of bacteria at baseline, and the bacterial counts substantially reduced after treatment procedures (P < .01). The results showed no statistical difference between RB and XP-S instrumentation with respect to the bacterial reduction (P > .05). A marked bacterial reduction was observed after the use of the XP-F instrument (P < .01).. The XP-S and RB systems sharply reduced the bacterial load in oval-shaped root canals with primary apical periodontitis. XP-F used as a supplementary instrument to chemomechanical preparation promoted a significantly higher bacterial reduction.

Topics: Bacterial Load; Dental Pulp Cavity; Humans; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

The objective of this work was to investigate in vivo the effects of calcium hydroxide-based intracanal medication (ICM) on the levels of bacteria, pro-inflammatory cytokines (PICs), and matrix metalloproteinases (MMPs) in root canals and periradicular tissues of teeth with failure of the root canal treatment and apical periodontitis.. Twenty infected root canals of single-rooted teeth were randomly assigned into two groups according to the irrigant used for chemomechanical preparation (CMP) (n = 10 per group): G1 - 2% chlorhexidine (CHX) gel and G2 - 6% sodium hypochlorite (NaOCl). Root canal contents were taken by using paper points before CMP (S1) and after 30 days of calcium hydroxide-based ICM (S2). Microbial reduction was calculated by means of colony-forming unit count (CFU/mL), with PICs and MMPs (pg/mL) being measured by using enzyme-linked immunosorbent assay (ELISA).. Culturable bacteria (101.2 ± 79.2), PICs (IL-1β 1.2 ± 0.4 and TNF-α 8.8 ± 4.7), MMP-2 (803.7 ± 96.4), MMP-3 (453.9 ± 229.3), MMP-8 (245.9 ± 122.4), MMP-9 (129.4 ± 29.6), and MMP-13 (70.8 ± 12.8) were present in all S1 samples. After 30 days of ICM (S2), a 99.5% microbial reduction was observed, together with a significant reduction of PICs in all groups. Overall, it was observed a decrease in the levels of MMPs (S2), except MMP-13, which was found in increased levels after ICM (P < .05), independently of the groups.. Calcium hydroxide-based intracanal medications have had a positive effect on the microbial reduction by decreasing the levels of PICs and MMPs. Both auxiliary chemical substances (i.e., 2% CHX and 6% NaOCl) presented similar effects when calcium hydroxide was used as intracanal medication.. Teeth with failure of the root canal treatment and apical periodontitis, and consequently with high levels of bacteria, PIC, and MMP, may present a better prognosis after a 30 days of a calcium hydroxide-based ICM.

Topics: Adult; Bacteria; Calcium Hydroxide; Chlorhexidine; Colony Count, Microbial; Cytokines; Dental Pulp Cavity; Humans; Matrix Metalloproteinases; Middle Aged; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

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.. 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.. 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.. The use of LC or HC sodium hypochlorite did not result in a significant difference in the clinical outcome.

Topics: Adult; Chronic Disease; Dental Pulp Necrosis; Dose-Response Relationship, Drug; Female; Humans; Male; Mandible; Molar; Pain, Postoperative; Periapical Periodontitis; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Treatment Outcome; Wound Healing; Young Adult

To assess whether Dual Rinse HEDP, an etidronate that can be combined with NaOCl to create an endodontic irrigating solution containing both hypochlorite and a chelator in the form of 1-hydroxyethane 1,1-diphosphonic acid (HEDP), alters the clinical efficacy of NaOCl or adds any untoward clinical effects.. In this randomized controlled double-blind single-centre trial, a pure NaOCl solution was compared to a HEDP-containing counterpart regarding antimicrobial efficacy, postoperative pain, and the host response by means of changes in MMP-9 levels in periapical fluid. Sixty patients presenting with asymptomatic apical periodontitis (one tooth each) were randomly divided into two groups (N = 30) based on irrigation regime. Pre- and post-treatment microbial aerobic and anaerobic cultures and MMP-9/total protein (TP) periapical fluid samples were collected. Postoperative pain levels were assessed 24 h after treatment. Categorical data were compared between groups using the Fisher's exact test, continuous data using the Wilcoxon signed-rank test, α = 0.05.. Irrigation with pure NaOCl rendered 40% canals free of culturable microorganisms, compared to 50% with the NaOCl/HEDP mixture (P = 0.60). As assessed by matrix-assisted laser desorption/ionization-time-of-flight analysis (MALDI-TOF), no apparent selection of aerobic or anaerobic taxa occurred in either group. One patient in the NaOCl group experienced moderate pain, whilst two patients in the NaOCl/HEDP group experienced mild postoperative pain. MMP-9/TP levels in periapical fluid declined significantly (P < 0.001) after 1 week with no medication in the root canal, without significant difference between treatment groups (P > 0.05).. This trial found no influence of HEDP on clinical NaOCl effects.

Topics: Dental Pulp Cavity; Double-Blind Method; Etidronic Acid; Humans; Periapical Periodontitis; Root Canal Irrigants; Sodium Hypochlorite

This study compared the clinical and radiographic outcome of endodontic retreatment of teeth with apical periodontitis using either 1% sodium hypochlorite (NaOCl) or 2% chlorhexidine digluconate (CHX) as the irrigant. The influence of residual infection detected by a molecular method on the outcome was also examined.. Fifty-two root-filled teeth with apical periodontitis were randomly assigned into 2 groups according to the irrigant used during retreatment. Root canal microbiological samples taken before (S1) and after (S2) preparation using either NaOCl or CHX irrigation and after calcium hydroxide medication (S3) were subjected to 16S ribosomal RNA gene-based real-time quantitative polymerase chain reaction (qPCR) to quantify total bacteria. The periapical status was scored using the periapical index and dichotomized as healed (<3) or not healed (≥3) at the 1- and 4-year follow-up.. Forty-five (NaOCl, n = 20; CHX, n = 25) and 33 teeth (NaOCl, n = 16; CHX, n = 17) were available at the 1- and 4-year follow-up, respectively. After 1 year, 65% in the NaOCl group and 64% in the CHX group healed, with no differences between them (P > .05). At the later follow-up, the corresponding figures were 81% and 82%, respectively (P > .05). Canals that yielded qPCR-negative results in S3 had a higher healing rate (79%) than qPCR-positive canals (45%, P < .05). The mean bacterial load increased from S2 to S3 in half of the unhealed cases (P < .05). All S3-positive canals containing <3.12 × 10. No significant differences in the clinical outcome between 1% NaOCl and 2% CHX were found. Bacterial persistence at the time of filling as detected by qPCR significantly affected the outcome.

Topics: Chlorhexidine; Dental Pulp Cavity; Humans; Periapical Periodontitis; Retreatment; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite

The aim of this blind, in vivo, randomized controlled trial was to evaluate the antibacterial effect of Nd:YAG laser irradiation in endodontic treatment of single-rooted teeth with apical periodontitis. The hypothesis was that mechanical enlargement of the root canal and Nd:YAG laser irradiation would yield more negative bacterial samples than conventional treatment.. Forty-one patients (45 teeth) were allocated to the laser (n = 22) or control (n = 23) group. The teeth in the laser group were instrumented, irrigated with saline, and irradiated with Nd:YAG laser according to a standard protocol. The teeth in the control group were similarly instrumented but irrigated with 1% unbuffered sodium hypochlorite and 15% EDTA solution. Bacterial samples were taken before and after treatment, blinded, and immediately sent for culturing and analysis.. The initial bacterial samples were positive in 20 of 22 teeth in the laser group and 18 of 23 (P = .414) in the control group. After the initial treatment, negative bacterial samples were found in 11 teeth in the laser group and 13 (P = .768) in the control group. After 2 to 4 days with no antibacterial dressing in the root canals, 5 teeth in the laser group and 9 (P = .337) in the control group yielded negative bacterial samples.. After intervention, neither the test group nor the control group yielded predictable negative bacterial samples. Thus, the results failed to verify the hypothesis that Nd:YAG laser irradiation would yield significantly more negative bacterial samples than conventional irrigation with 1% unbuffered sodium hypochlorite solution.

Topics: Aged; Bacteria; Disinfectants; Female; Humans; Lasers, Solid-State; Male; Middle Aged; Periapical Periodontitis; Sodium Hypochlorite; Therapeutic Irrigation

This clinical study evaluated the influence of the apical preparation size using nickel-titanium rotary instrumentation and the effect of a disinfectant on bacterial reduction in root canal-treated teeth with apical periodontitis.. Forty-three teeth with posttreatment apical periodontitis were selected for retreatment. Teeth were randomly divided into 2 groups according to the irrigant used (2.5% sodium hypochlorite [NaOCl], n = 22; saline, n = 21). Canals were prepared with the Twisted File Adaptive (TFA) system (SybronEndo, Orange, CA). Bacteriological samples were taken before preparation (S1), after using the first instrument (S2), and then after the third instrument of the TFA system (S3). In the saline group, an additional sample was taken after final irrigation with 1% NaOCl (S4). DNA was extracted from the clinical samples and subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria and streptococci.. S1 from all teeth were positive for bacteria. Preparation to the first and third instruments from the TFA system showed a highly significant intracanal bacterial reduction regardless of the irrigant (P < .01). Apical enlargement to the third instrument caused a significantly higher decrease in bacterial counts than the first instrument (P < .01). Intergroup comparison revealed no significant difference between NaOCl and saline after the first instrument (P > .05). NaOCl was significantly better than saline after using the largest instrument in the series (P < .01).. Irrespective of the type of irrigant, an increase in the apical preparation size significantly enhanced root canal disinfection. The disinfecting benefit of NaOCl over saline was significant at large apical preparation sizes.

Topics: Adult; Bacteria; DNA, Bacterial; Female; Humans; Male; Middle Aged; Periapical Periodontitis; Real-Time Polymerase Chain Reaction; Root Canal Irrigants; Root Canal Preparation; Sodium Chloride; Sodium Hypochlorite; Tooth, Nonvital; Young Adult

In this single-blinded, prospective, randomized, controlled clinical trial, the effectiveness of an ozone gas or NaOCl/CHX disinfection protocol was compared within the root canal treatment of apical periodontitis.. There were no significant differences between the success rates (ozone group: 96.2/95.5 % after 6/12 months; NaOCl group: 95.5/95.2 % after 6/12 months). The differences in the decreases in PAI values and apical lesion sizes were also insignificant after 6 and 12 months. The bacterial reduction showed no significant differences between groups after chemo-mechanical treatment and after inter-appointment dressing. The most commonly found bacterial genera were Streptococcus spp., Parvimonas spp. and Prevotella spp.. The here used ozone gas and NaOCl/CHX protocols showed no difference in bacterial reduction in the sampled areas of the root canals.. Within the limitations of the study, ozone gas seems to be a possible alternative disinfection agent within the root canal treatment of apical periodontitis.

Topics: Anti-Infective Agents, Local; Chlorhexidine; Disinfectants; Disinfection; Female; Humans; Male; Middle Aged; Ozone; Periapical Periodontitis; Polymerase Chain Reaction; Prospective Studies; Root Canal Therapy; Single-Blind Method; Sodium Hypochlorite; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Treatment Outcome

This randomized clinical study compared the antibacterial effects of irrigation with either 2.5% sodium hypochlorite (NaOCl) or 2% chlorhexidine (CHX) during the preparation of infected root canals with rotary nickel-titanium instruments.. The root canals of 50 single-rooted teeth with apical periodontitis were prepared by using BioRaCe rotary instruments (FKG Dentaire, La Chaux-de-Fonds, Switzerland) and irrigation with either 2.5% NaOCl (n = 25) or 2% CHX (n = 25). Samples were taken from the canal at baseline (S1) and after (S2) chemomechanical preparation. DNA was extracted from the clinical samples, and the reduction of the levels of total bacteria and streptococci was evaluated by means of a 16S ribosomal RNA gene-based quantitative polymerase chain reaction assay.. All S1 samples were positive for the presence of bacteria. After chemomechanical preparation using either 2.5% NaOCl or 2% CHX, 44% and 40% of the root canals still had detectable bacteria, respectively. As for total bacterial counts, a mean number of 3.7 × 10(5) bacterial cell equivalents was present in S1 samples from the NaOCl group, with a substantial reduction in S2 to a mean of 5.49 × 10(2) cell equivalents (P < .001). In the CHX group, a mean bacterial load of 8.77 × 10(4) cell equivalents occurred in S1, with a significant reduction in S2 to a mean of 2.81 × 10(3) cells (P < .001). The differences in both the presence/absence and quantitative data were not statistically significant (P > .05). Both irrigation protocols were highly effective in reducing the levels of Streptococcus species (P < .001).. No significant difference was observed for the clinical antibacterial effectiveness of rotary preparation using either 2.5% NaOCl or 2% CHX as the main irrigant.

Topics: Adolescent; Adult; Bacteria; Bacterial Load; Brazil; Chlorhexidine; Colony Count, Microbial; Dental Alloys; Dental Pulp Cavity; Disinfectants; Disinfection; DNA, Bacterial; Female; Humans; Male; Middle Aged; Nickel; Periapical Periodontitis; Polymerase Chain Reaction; RNA, Ribosomal, 16S; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Rotation; Sodium Hypochlorite; Streptococcus; Titanium; Young Adult

This study compared the antibacterial effects of 1% sodium hypochlorite (NaOCl) and 2% chlorhexidine digluconate (CHX) during retreatment of teeth with apical periodontitis.. Root canal-treated teeth with apical periodontitis were randomly distributed into 2 groups. Bacteriological samples were taken from the canals before (S1) and after (S2) preparation using either NaOCl or CHX irrigation and after calcium hydroxide medication (S3); 16S ribosomal RNA gene-based real-time quantitative polymerase chain reaction was performed to quantify total bacteria, streptococci, and Enterococcus faecalis.. Forty-nine teeth were available for analysis (NaOCl, n = 20; CHX, n = 29). Bacterial DNA occurred in all S1 samples, streptococci in 57% and E. faecalis in 6%. The total bacterial counts decreased from S1 to S2 in both groups (P < .01) but were higher in S3 than S2 (P < .01). Thirty-five percent of the teeth in the NaOCl group were positive in S2, decreasing to 20% in S3. In the CHX group, 41% were positive in S2, decreasing to 31% in S3. The bacterial load in S1 influenced the incidence of bacteria in S2 (P < .01). Streptococci were significantly reduced in both groups, and E. faecalis was found in only 1 S2 sample and not in S3. No significant difference between NaOCl and CHX was found.. NaOCl and CHX both reduced bacterial counts and the number of infected canals. Intracanal medication with calcium hydroxide reduced the number of canals with persistent infection but resulted in overall larger bacterial counts in the cases positive for bacteria. The effectiveness of antimicrobial treatment can be influenced by the initial bacterial load.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Load; Chlorhexidine; Dental Pulp Cavity; Enterococcus faecalis; Female; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Periapical Periodontitis; Real-Time Polymerase Chain Reaction; Root Canal Irrigants; Sodium Hypochlorite; Streptococcal Infections; Streptococcus; Young Adult

This study investigated the presence of target bacterial species and the levels of endotoxins in teeth with apical periodontitis. Levels of inflammatory mediators (interleukin [IL]-1β and tumor necrosis factor [TNF]-α) were determined after macrophage stimulation with endodontic content after different phases of endodontic therapy using different irrigants.. Thirty primarily infected root canals were randomly assigned into 3 groups according to the irrigant used for root canal preparation (n = 10 per group): GI: 2.5% sodium hypochlorite, GII: 2% chlorhexidine gel, and GIII (control group): saline solution. Root canal samples were taken by using paper points before (s1) and after root canal instrumentation (s2), subsequently to 17% EDTA (s3), after 30 days of intracanal medication (Ca[OH]2 + saline solution) (s4), and before root canal obturation (s5). Polymerase chain reaction (16S recombinant DNA) and limulus amebocyte lysate assay were used for bacterial and endotoxin detection, respectively. Macrophages were stimulated with the root canal contents for IL-1β/TNF-α measurement using enzyme-linked immunosorbent assay.. Porphyromonas gingivalis (17/30), Porphyromonas endodontalis (15/30), and Prevotella nigrescens (11/30) were the most prevalent bacterial species. At s1, endotoxins were detected in 100% of the root canals (median = 32.43 EU/mL). In parallel, substantial amounts of IL-1β and TNF-α were produced by endodontic content-stimulated macrophages. At s2, a significant reduction in endotoxin levels was observed in all groups, with GI presenting the greatest reduction (P < .05). After a root canal rinse with EDTA (s3), intracanal medication (s4), and before root canal obturation (s5), endotoxin levels reduced without differences between groups (P < .05). IL-1β and TNF-α release decreased proportionally to the levels of residual endotoxin (P < .05).. Regardless of the use of sodium hypochlorite or CHX, the greatest endotoxin reduction occurs after chemomechanical preparation. Increasing steps of root canal therapy associated with intracanal medication enhances endotoxin reduction, leading to a progressively lower activation of proinflammatory cells such as macrophages.

Topics: Chlorhexidine; Humans; Interleukin-1beta; Lipopolysaccharides; Macrophage Activation; Periapical Periodontitis; Porphyromonas endodontalis; Porphyromonas gingivalis; Prevotella nigrescens; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Tumor Necrosis Factor-alpha

This in vivo study compared the antibacterial effects of 2 instrumentation systems in root canal-treated teeth with apical periodontitis.. Forty-eight teeth with a single root and a single canal showing post-treatment apical periodontitis were selected for this study. For retreatment, teeth were randomly divided into 2 groups according to the instrumentation system used: Self-Adjusting File (SAF; ReDent-Nova, Ra'anana, Israel) and Twisted File Adaptive (TFA; SybronEndo, Orange, CA). In both groups, 2.5% sodium hypochlorite was the irrigant. Bacteriological samples were taken before (S1) and after chemomechanical preparation (S2). In the TFA group, passive ultrasonic irrigation (PUI) was performed after instrumentation, and samples were also taken after this supplementary step (S2b). DNA was extracted from the clinical samples and subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria, streptococci, and Enterococcus faecalis. Statistical analyses from quantitative real-time polymerase chain reaction data were performed within groups using the Wilcoxon matched pairs test and between groups using the Mann-Whitney U test and the Fisher exact test with the significance level set at P < .05.. Bacteria were detected in S1 samples from 43 teeth, which were then included in the antibacterial experiment. Both SAF and TFA instrumentation protocols showed a highly significant intracanal bacterial reduction (P < .001). Intergroup quantitative comparisons disclosed no significant differences between TFA with or without PUI and SAF (P > .05). PUI did not result in significant improvement in disinfection (P > .05).. Both instrumentation systems/treatment protocols were highly effective in significantly reducing the intracanal bacterial counts. No significant difference was observed between the 2 systems in disinfecting the canals of teeth with post-treatment apical periodontitis.

Topics: Adolescent; Adult; Aged; Bacterial Load; Child; Dental Pulp Cavity; Female; Humans; Male; Middle Aged; Periapical Periodontitis; Retreatment; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation; Ultrasonics; Young Adult

Post-obturation pain is frustrating to both patients and dentists. Its incidence may change with the use of contemporary endodontic techniques. This randomised clinical trial aims to compare the incidence of post-obturation pain at one and seven days after single-visit and multiple-visit non-surgical endodontic treatments.. Patients who required primary endodontic treatment in the two clinical trial centres in Hong Kong (HK) and in Beijing (PK) were recruited. Three HK dentists and three PK dentists performed endodontic treatments on 567 teeth using the same procedures and materials, either in a single visit or over multiple visits, using either core carrier or cold lateral condensation for obturation.. The attrition rate was 5.1%, and a total of 538 teeth were evaluated. Among these teeth, 232 (43%) were operated in HK, 275 (51%) were treated in a single visit, and 234 (43%) were treated using core carrier obturation. Logistic regression analysis showed that teeth with apical periodontitis (OR = 0.35, 95% CI = 0.21-0.57, p < 0.01) and less pre-operative pain (OR = 1.10, 95% CI = 1.03-1.18, p < 0.01) had lower incidences of post-obturation pain after one day. The incidences of post-obturation pain after one day for single-visit and multiple-visit treatments were 24.7% (68 of 275) and 33.5% (88 of 263), respectively (p = 0.50). The incidences of post-obturation pain after seven days for single-visit and multiple-visit treatments were 4.0% (11 of 275) and 5.3% (14 of 263), respectively (p = 0.47).. There was no significant difference in the incidences of post-obturation pain after one day and seven days with single-visit or multiple-visit endodontic treatments.. ChiCTR-IOR-15005989.

Topics: Adult; Appointments and Schedules; Calcium Hydroxide; Dental Fistula; Epoxy Resins; Female; Follow-Up Studies; Gutta-Percha; Humans; Male; Middle Aged; Pain; Pain Measurement; Periapical Abscess; Periapical Periodontitis; Periodontal Pocket; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Tooth Mobility

The aim of this randomized controlled clinical trial was to investigate the antimicrobial efficacy of traditional positive pressure (PP) irrigation compared with apical negative pressure (ANP) in tapered as well as non-tapered root canal preparation techniques.. Patients referred for treatment of mandibular permanent molars with necrotic pulps and apical periodontitis were considered for this study. A total of 32 eligible teeth were evaluated based on strict inclusion and exclusion criteria and randomly assigned as follows: Group 1: LightSpeed LSX 0.02 preparation and A NP irrigation (n = 8). Group 2: LightSpeed LSX 0.02 preparation and PP irrigation (n = 8). Group 3: ProTaper preparation and A NP irrigation (n = 8). Group 4: ProTaper preparation and PP irrigation (n = 8). A ll teeth were sampled immediately upon access (S1), after completion of the chemo- mechanical preparation (S2), and one week later after intracanal medication (S3). All samples were microbiologically processed immediately and plated in duplicates on aerobic plates, anaerobic plates, and chocolate plates and colonies statistically analyzed.. No statistically significant differences were found between groups at S1. When comparing colony-forming unit (CFU) levels at S1 and S2 within groups, the reduction was statistically significant in all groups. While no significant difference was found in the proportion of teeth that culture positive at either S2 or S3 by shaping groups, a significant difference was noted when comparing PP irrigation and A NP groups. The percentage of samples in the PP irrigation group with a negative culture at both time points was 67%, compared to 100% among the A NP group.. Within the limitations of the present study, taper and apical size failed to demonstrate a difference in microbiological reduction of cultivable bacteria. On the other hand, A NP revealed a significant difference when compared to PP irrigation.

Topics: Anti-Infective Agents; Calcium Hydroxide; Colony Count, Microbial; Dental Pulp Cavity; Dental Pulp Necrosis; Edetic Acid; Female; Humans; Male; Periapical Periodontitis; Pressure; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Single-Blind Method; Sodium Hypochlorite; Therapeutic Irrigation

Clinical reports stating the efficacy of novel root canal disinfection protocols are an important focus in endodontic research. This blind randomized clinical trial assessed the clinical efficacy of the erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser radial firing tips (RFT) versus the concomitant use of 3 % sodium hypochlorite and interim calcium hydroxide paste in necrotic teeth with chronic apical periodontitis. We hypothesized to find similar or improved bone healing in the laser-assisted endodontic treatment. Thirty-six anterior and premolar teeth were randomly assigned. In group 1, teeth were prepared with 3 % sodium hypochlorite for irrigation and calcium hydroxide as inter-appointment dressing; in group 2, teeth were prepared with saline solution and irradiated with Er,Cr:YSGG laser using RFT2 (140 μs, 37.5 mJ, 20 Hz) and RFT3 (140 μs, 62.5 mJ, 20 Hz) in the first and second appointment, respectively, four times each, moving at 2 mm s(-1) from apical to coronal. The primary outcome measure was changed in apical bone density at 6 months, using the periapical index (PAI) for blind radiographic evaluation. Twenty-nine patients were examined and subjected to statistical analysis, 12 in group 1 and 17 in group 2. There was one treatment failure in group 1. Both groups gave similar outcomes exhibiting statistically significant decreases in PAI scores.

Topics: Adolescent; Adult; Aged; Calcium Hydroxide; Child; Disinfection; Female; Humans; Lasers, Solid-State; Male; Middle Aged; Periapical Periodontitis; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Treatment Outcome; Young Adult

The aim of this randomized, controlled, prospective clinical study was to determine if foraminal enlargement instrumentation during endodontic treatment is associated with more postoperative pain compared with standard nonenlargement instrumentation.. Forty volunteers with a single root canal were diagnosed with asymptomatic necrosis with apical periodontitis and randomized into 2 experimental groups (ie, the control group and the foraminal enlargement group). Endodontic treatment was performed in a single visit, and volunteers were instructed to record pain intensity (ie, none, slight, moderate, and severe). Scores from 1 to 4 were attributed to each kind of pain after 12, 24, and 48 hours. The Kolmogorov-Smirnov and Student's t tests were used to determine significant differences at P < .05.. No statistically significant age difference was found between the groups (P > .05, Student's t test). Postoperative pain showed no statistically significant difference between the groups at any observation period (P > .05). Also, no significant difference was observed in the mean number of analgesic tablets used between the groups (P > .05).. The foraminal enlargement and nonenlargement techniques resulted in the same postoperative pain and necessity for analgesic medication. This may suggest that the use of foraminal enlargement should be performed for endodontic treatment previsibility without increasing postoperative pain.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Asymptomatic Diseases; Dental Pulp Cavity; Dental Pulp Necrosis; Dental Pulp Test; Female; Follow-Up Studies; Gutta-Percha; Humans; Ibuprofen; Male; Pain Measurement; Pain, Postoperative; Periapical Periodontitis; Prospective Studies; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Sodium Hypochlorite; Tooth Apex

This study analyzed the in vivo microbiological status of the root canal systems of mesial roots of mandibular molars with primary apical periodontitis after 1- or 2-visit endodontic treatment.. Mesial root canals were instrumented by using either a combination of K3 and LightSpeed instruments (mesiobuccal canals) or the ProTaper system (mesiolingual canals), with 5% NaOCl irrigation. Patency files were used. Smear layer was removed, and a final rinse with 5 mL of 2% chlorhexidine was performed. In the 2-visit group (7 roots, 14 canals), canals were medicated with calcium hydroxide for 1 week and then obturated by using the continuous wave of compaction technique. In the 1-visit group (6 roots, 12 canals), canals were immediately obturated after chemomechanical procedures. Teeth were extracted 1 week after root canal instrumentation and processed for histobacteriologic analysis.. In the 1-visit group, no case was completely free of bacteria; residual bacteria occurred in the main root canal (5 of 6 cases), isthmus (5 of 6), apical ramifications (4 of 6), and dentinal tubules (5 of 6). In the 2-visit group, 2 cases were rendered bacteria-free; residual bacteria were found in the main canal only in 2 cases (none of them with persistent dentinal tubule infection), in the isthmus (4 of 7 cases), and in ramifications (2 of 7). The 2 instrumentation techniques performed similarly. When filling material was observed in ramifications, it was usually intermixed with necrotic tissue, debris, and bacteria.. The 2-visit protocol by using an interappointment medication with calcium hydroxide resulted in improved microbiological status of the root canal system when compared with the 1-visit protocol. Residual bacteria were more frequent and abundant in ramifications, isthmuses, and dentinal tubules when root canals were treated without an interappointment medication. Apical ramifications and isthmuses were never completely filled. The use of an antibacterial interappointment agent is necessary to maximize bacterial reduction before filling.

Topics: Adult; Aged; Anti-Infective Agents, Local; Bacteria; Bacterial Load; Biofilms; Calcium Hydroxide; Chlorhexidine; Dental Alloys; Dental High-Speed Equipment; Dental Pulp Cavity; Dental Pulp Necrosis; Dentin; Equipment Design; Female; Gutta-Percha; Humans; Male; Methylmethacrylates; Middle Aged; Nickel; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Smear Layer; Sodium Hypochlorite; Titanium; Tooth Apex; Zinc Oxide-Eugenol Cement

The aim of this study was to evaluate the outcome of single- versus 2-visit root canal treatment of teeth with apical periodontitis after a 2-year follow-up period.. Three hundred maxillary and mandibular nonvital teeth with apical periodontitis were treated in either a single visit or 2 visits. The main inclusion criteria were radiographic evidence of apical periodontitis (minimum size ≥ 2.0 × 2.0 mm) and a diagnosis of pulpal necrosis confirmed by a negative response to hot and cold tests. Radiographically, all teeth showed small and irregular periapical radiolucencies before treatment. The canals were enlarged with LightSpeedLSX (Discus Dental, Culver City, CA) root canal instruments to a final apical preparation size #60 for anterior and premolar teeth and size #45 to #55 for molars. The EndoVac negative-pressure irrigation system (Discus Dental) was used for disinfecting irrigation, and all canals were filled by lateral compaction of gutta-percha and Sealapex sealer (SybronEndo, Orange, CA). The healing results were clinically and radiographically evaluated 2 years postoperatively.. Of the 300 teeth treated, 18 were lost to follow-up, 9 in the 2-visit group and 9 in the 1-visit group. Of the 282 teeth studied, the randomization procedure had allocated 146 teeth to 1-visit treatment and 136 teeth to 2-visit treatment. Teeth with symptoms of persisting periapical inflammation were scored as not healed. Teeth with a reduced periapical rarefaction were judged as uncertain. Teeth with complete restitution of the periodontal contours were judged as healed. In the 1-visit group, 141 of 146 teeth (96.57%) were classified as healed as compared with 121 (88.97%) of 136 teeth in the 2-visit group. Eleven cases were classified as uncertain in the 2-visit group (8.08%) compared with 4 (2.73%) in the 1-visit group. Two of 10 teeth in the 2-visit group presented with pain before the 2-year follow-up and were classified as not healed. The hypothesis tests were conducted at the 0.05 level of significance. Statistical analysis of the healing results did not show any significant difference between the groups (P = .05).. Several factors play an important role in the decision-making process of 1- versus 2-visit endodontics. Among these are objective factors like preoperative diagnosis, the ability to obtain infection control, root canal anatomy, procedural complications, and subjective factors like patients' signs and symptoms. This study provided evidence that with a treatment protocol with instrumentation to predefined larger apical instrumentation sizes and irrigation with a negative apical pressure system can lead to healing in cases of apical periodontitis, which is a significant finding compared with more dated studies that showed average healing of apical periodontitis cases. With the given sample size, there was no statistically significant difference between the 2 treatment modalities.

Topics: Adolescent; Adult; Calcium Hydroxide; Dental Pulp Necrosis; Dental Pulp Test; Edetic Acid; Female; Follow-Up Studies; Gutta-Percha; Humans; Male; Middle Aged; Office Visits; Periapical Periodontitis; Periapical Tissue; Radiography; Risk Factors; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Salicylates; Sodium Hypochlorite; Tooth, Nonvital; Treatment Outcome; Wound Healing; Young Adult

Recent in vitro studies that use an apical negative pressure irrigation system, EndoVac, have demonstrated promising results in the production of debris-free root canals, while also preventing potential extrusion of irrigants into the periapical region. We conducted a randomized, controlled, prospective clinical study to determine whether the use of EndoVac irrigation (EndoVac group) was more efficient compared with standard needle irrigation (control group) in obtaining canals from which microbes could not be cultivated.. Routine endodontic therapy was performed in 48 patients with necrotic, single-rooted, single-canal teeth. The patients were randomly assigned to either the EndoVac group (n = 25) or control group (n = 23). Irrigation with either method was carried out with 0.5% sodium hypochlorite. After surface disinfection, before instrumentation and on completion of chemomechanical preparation, intracanal microbial samples were obtained and cultured under anaerobic conditions. The frequency of microbial cultivability by using either irrigation system was analyzed.. The frequency of obtaining culture-negative root canals was 90.9% and 82.6% for the control group and EndoVac group, respectively. There was no significant difference in the antimicrobial efficacy of either control group or EndoVac group (Fisher exact test, P = .665). Furthermore, no significant association between study variables and the irrigation systems' antimicrobial efficacy was found (P > .05).. The results of this prospective in vivo study demonstrate that the antimicrobial efficacy of EndoVac irrigation is comparable to that of standard irrigation.

Topics: Bacteria; Bacteriological Techniques; Calcium Hydroxide; Dental Disinfectants; Dental Pulp Cavity; Dental Pulp Necrosis; Disinfection; Edetic Acid; Humans; Hydrogen Peroxide; Microinjections; Periapical Periodontitis; Prospective Studies; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation; Treatment Outcome

To compare 2 irrigation solutions in terms of postoperative pain after single-visit treatment of chronic apical periodontitis with pulp necrosis.. A total of 126 patients requiring treatment of apical periodontitis and pulp necrosis were randomly assigned to 2 groups according to the solution used for irrigation: 5.25% sodium hypochlorite (NaOCl) or 2% chlorhexidine gel (CLX) (63 patients in each group). To assess postoperative pain, a questionnaire and pain intensity scale were administered at 24, 48 and 72 hours and 7 days after the procedure. The χ2 test was used to compare the intensity of pain with the 2 irrigation solutions.. No patients reported severe pain at any stage. Moderate pain was reported by 3% of patients (2/63 in each group) after 24 hours and by no patients beyond 24 hours, regardless of the irrigant used. Mild pain was more frequent but diminished rapidly (reported by 19% [12/63] of patients in the NaOCl group and 16% [10/63] in the CLX group at 24 hours, by 10% [6/63] in the NaOCl group and 11% [7/63] in the CLX group at 48 hours, by 3% [2/63] in both groups at 72 hours and by 2% [1/63] in both groups at 7 days). There were no statistically significant differences in postoperative pain between the 2 groups at any time point (p > 0.05).. The incidence of postoperative pain after single-visit endodontic treatment of chronic apical periodontitis with pulp necrosis was uniformly low, regardless of the irrigant used.

Topics: Adolescent; Adult; Chlorhexidine; Composite Resins; Dental Pulp Cavity; Dental Pulp Necrosis; Dental Restoration, Permanent; Female; Follow-Up Studies; Gutta-Percha; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Periapical Periodontitis; Prospective Studies; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Tooth Apex; Young Adult

The purpose of this prospective, randomized clinical study was to compare the results of a nonactivated single-irrigation protocol (NAI) that used only 1% NaOCl with a passive ultrasonic multi-irrigation protocol (PUI) that used 1% NaOCl, 17% ethylenediaminetetraacetic acid, and 2% chlorhexidine in rendering canals bacteria free. In addition, the effect of a second-visit instrumentation after intra-appointment calcium hydroxide (CaOH(2)) was also evaluated in bacterial elimination.. Fifty patients were recruited with a posterior tooth requiring primary endodontic treatment of apical periodontitis. Standard nonsurgical endodontic therapy was performed on both groups in a 2-visit approach by using calcium hydroxide intracanal medicament. Teeth were randomly treated with the NAI or PUI protocols in the first visit after complete instrumentation. Bacterial cultures were obtained at 4 periods during treatment from the canals: (1) before instrumentation, (2) after irrigation protocol, (3) after CaOH(2) medication, and (4) before obturation. Statistical analysis was performed on data by using the Fisher exact test and multivariate analysis.. NAI and PUI rendered canals 80% and 84% bacteria free, respectively, at the end of the first visit. After CaOH(2) medication the total sample (NAI + PUI) had increased to 87% bacteria free, and the second-visit instrumentation resulted in a total of 91% bacteria free. These differences were not significant (P > .05).. There was no statistical difference between irrigation methods. Each protocol resulted in a high frequency of negative cultures. This high frequency of negative cultures obtained in 1 visit is most likely related to an increased volume and depth of irrigation compared with previously reported protocols.

Topics: Analysis of Variance; Chi-Square Distribution; Chlorhexidine; Colony Count, Microbial; Dental Pulp Cavity; Edetic Acid; Female; Humans; Linear Models; Male; Periapical Periodontitis; Prospective Studies; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Therapeutic Irrigation; Ultrasonic Therapy

The purpose of this clinical study was to compare the antimicrobial effects of 2.5% sodium hypochlorite (NaOCl) and 0.12% chlorhexidine digluconate (CHX) when used as irrigants during treatment of teeth with apical periodontitis.. Forty-seven single-rooted single-canal teeth with necrotic pulps and asymptomatic apical periodontitis were selected for this study according to stringent inclusion/exclusion criteria. Bacterial samples were taken at the baseline (S1) and after (S2) chemomechanical preparation using 2.5% NaOCl (n = 30) or 0.12% CHX (n = 17) as the irrigant. Bacterial, archaeal, and fungal presence was evaluated by broad-range polymerase chain reaction (PCR), whereas bacterial identifications were performed by a closed-ended reverse-capture checkerboard approach targeting 28 candidate endodontic pathogens.. All S1 samples were PCR positive for bacterial presence but negative for both archaea and fungi. Both NaOCl- and CHX-based protocols were significantly effective in reducing the bacterial levels and number of taxa. No significant differences were observed between them in all tested parameters including the incidence of negative PCR results in S2 (40% for NaOCl vs 47% for CHX, p = 0.8), reduction in the number of taxa per canal (p = 0.3), and reduction in the bacterial levels (p = 0.07). The most prevalent taxa in S2 samples from the NaOCl group were Propionibacterium acnes, Streptococcus species, Porphyromonas endodontalis, and Selenomonas sputigena. In the CHX group, the most prevalent taxa in S2 were Dialister invisus, Actinomyces israelii, Prevotella baroniae, Propionibacterium acidifaciens, and Streptococcus species.. Treatment protocols using irrigation with either NaOCl or CHX succeeded in significantly reducing the the number of bacterial taxa and their levels in infected root canals, with no significant difference between these substances.

Topics: Bacteria; Chlorhexidine; Dental Pulp Cavity; Disinfectants; Humans; Periapical Periodontitis; Root Canal Irrigants; Sodium Hypochlorite; Treatment Outcome

The present investigation evaluated the ability of a new passive sonic irrigation (sonic group) system (EndoActivator) to eliminate cultivable bacteria from root canals in vivo and compared it with that of standard syringe irrigation (control group).. Data were obtained by using bacteriologic sampling of root canals treated by endodontic residents. Sampling results from 1 session of treatment were then compared with results obtained after intervisit calcium hydroxide disinfection and a second session of treatment.. There was no significant difference in the ability of sonic group and control group to eliminate cultivable bacteria from root canals (P > .05). A second session and intervisit calcium hydroxide disinfection were able to eliminate cultivable bacteria from significantly more teeth than a single session of treatment (P < .05).. These in vivo results strengthen the case for a multi-visit approach to the treatment of apical periodontitis.

Topics: Bacteria; Calcium Hydroxide; Colony Count, Microbial; Dental Pulp Cavity; Dental Restoration, Temporary; Disinfection; Humans; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Sonication; Syringes; Therapeutic Irrigation; Time Factors; Ultrasonics

This clinical study was conducted to compare the efficacy of chemomechanical preparation with 2.5% sodium hypochlorite (NaOCl) and 2% chlorhexidine (CHX) gel on eliminating oral bacterial lipopolysaccharide (LPS) in teeth with pulp necrosis and apical periodontitis.. Fifty-four root canals were selected. Samples were collect before (s1) and after chemomechanical preparation (s2). Teeth were randomly divided into groups: GI, 2.5% NaOCl (n = 27) and GII, CHX gel (n = 27). Limulus amebocyte lysate assay was used to quantify endotoxins.. Endotoxin was present in 100% of the samples investigated, with a median value of 272 endotoxin units (EU)/mL (GI) and of 152.46 EU/mL (GII). As a result of chemomechanical preparation, LPS content was reduced to a median value of 86 EU/mL (GI) and 85 EU/mL (GII). Higher percentage value of endotoxin reduction was found in GI (P < .05).. The 2.5% NaOCl and 2% CHX gel were not effective in eliminating endotoxin from the primarily infected root canals.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Chlorhexidine; Chromogenic Compounds; Dental Pulp Cavity; Dental Pulp Necrosis; Endotoxins; Humans; Lipopolysaccharides; Middle Aged; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Treatment Outcome; Young Adult

Clinical assessment of the efficacy of novel root canal disinfection protocols is an important focus in endodontic research. This randomized double-blinded study assessed the antibacterial efficacy of a final rinse with BioPure MTAD (MTAD) and intracanal medication with 2% chlorhexidine gel (CHX) in teeth with apical periodontitis.. Canals in 30 teeth (single-rooted and multi-rooted) were prepared by using 1.3% NaOCl, rinsed with MTAD or saline in random sequence, medicated with CHX for 7 days, irrigated with 1.3% NaOCl, and filled. Bacteriologic root canal samples were obtained by aspiration before (1A) and after (1B) canal preparation, after the final rinse (1C), after CHX was flushed (2A), and after final irrigation (2B). Bacteria were enumerated by epifluorescence-microscopy (EFM) by using 2 staining methods and by colony-forming-unit (CFU) counts after 14 days of incubation.. Bacterial counts (EFM) in 1B were greater than 95% decreased from 1A. Low bacterial densities in 1B, 1C, 2A, and 2B did not differ significantly from each other. EFM counts were consistently higher than CFU counts.. The final rinse with MTAD and medication with CHX did not reduce bacterial counts beyond levels achieved by canal preparation with NaOCl.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteria, Aerobic; Bacteria, Anaerobic; Chlorhexidine; Citric Acid; Cohort Studies; Colony Count, Microbial; Dental Pulp Cavity; Dental Restoration, Permanent; Double-Blind Method; Doxycycline; Female; Glass Ionomer Cements; Gutta-Percha; Humans; Male; Microscopy, Fluorescence; Middle Aged; Periapical Periodontitis; Polysorbates; Resins, Synthetic; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Sodium Hypochlorite

It was the aim of the present study to evaluate root canal samples for the presence and numbers of specific species as well as for total bacterial load in teeth with chronic apical periodontitis using quantitative real-time polymerase chain reaction (PCR).. Forty adult patients with one radiographically documented periapical lesion were included. Twenty teeth presented with primary infections and 20 with secondary infections, requiring retreatment. After removal of necrotic pulp tissue or root canal filling, a first bacterial sample was obtained. Following chemo-mechanical root canal preparation a second sample was taken and a third sample was obtained after 14 days of intracanal dressing with calcium hydroxide. Analysis by real-time PCR enabled the quantification of total bacterial counts and of nine selected species.. Root canals with primary infections harbored significantly more bacteria (by total bacterial count) than teeth with secondary infections (P < 0.05). Mean total bacterial count in the retreatment group was 2.1 x 10(6) and was significantly reduced following root canal preparation (3.6 x 10(4)) and intracanal dressing (1.4 x 10(5)). Corresponding values for primary infections were: 4.6 x 10(7), 3.6 x 10(4), and 6.9 x 10(4). The numbers of the selected bacteria and their detection frequency were also significantly reduced.. Root canals with primary infections contained a higher bacterial load. Chemo-mechanical root canal preparation reduced bacterial counts by at least 95%.

Topics: Adult; Aged; Bacteroides; Calcium Hydroxide; Chlorhexidine; Colony Count, Microbial; Dental Pulp Cavity; Dental Pulp Diseases; Dental Pulp Necrosis; Female; Follow-Up Studies; Fusobacterium nucleatum; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Middle Aged; Peptostreptococcus; Periapical Periodontitis; Polymerase Chain Reaction; Porphyromonas endodontalis; Retreatment; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite

The present investigation recorded the 2-year clinical and radiographic outcome of one- and two visit endodontic treatment and studied the significance of the bacteriologic sampling results on the outcome. A randomization procedure allocated 53 teeth to one-visit treatment and 48 teeth to two-visit treatment. At the end of the study period, 32 teeth (65%) in the one-visit group and 30 teeth (75%) in the two-visit group were classified as healed. The statistical analysis of the healing results did not show any significant difference between the groups (p = 0.75). Forty-nine (80%) of the 61 teeth that were obturated after a negative micobiologic sample were classified as healed. Teeth sealed after positive samples healed in 44%. The present study gave evidence that similar healing results might be obtained through one- and two-visit antimicrobial treatment.

Topics: Calcium Hydroxide; Dental Pulp Cavity; Dental Pulp Necrosis; Female; Follow-Up Studies; Gutta-Percha; Humans; Hydrogen Peroxide; Male; Middle Aged; Oxidants; Periapical Periodontitis; Radiography; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Therapy; Smear Layer; Sodium Hypochlorite; Treatment Outcome; Wound Healing

This study was conducted to determine the bacterial reduction using Profile GT files and a strict irrigation protocol utilizing 5.25% NaOCl and EDTA. The additive antibacterial effect of Ca(OH)2 was also evaluated. In addition, the study compared the bacterial reduction with the GT protocol versus larger instrumentation. Thirty-one subjects with apical periodontitis were recruited. Bacterial samples were taken upon access (S1), after instrumentation and a strict irrigation protocol (S2), and following >1 wk of Ca(OH)2 (SC). A log10 transformation of colony forming units was done since sample bacterial counts are not normally distributed. At S1, 93.55% of canals sampled bacteria. At S2, 52.72% of the cases sampled bacteria. At SC, 14% of the cases cultured bacteria. The McNemar test showed a significant reduction (p<0.0009) in bacteria between S1 and S2. This was also true between S2 and SC (p<0.0019). It was concluded the GT protocol significantly reduced the number of bacteria in the canal but failed to render the canal bacteria free in more than half of the cases Ca(OH)2 application significantly further reduced bacteria. Lastly, large apical instrumentation removed more bacteria than small apical instrumentation.

Topics: Bacteria, Anaerobic; Calcium Hydroxide; Chelating Agents; Chi-Square Distribution; Colony Count, Microbial; Dental Instruments; Dental Pulp Cavity; Edetic Acid; Humans; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

The objective was to evaluate the clinical efficacy of chemomechanical preparation of the root canals with sodium hypochlorite and interappointment medication with calcium hydroxide in the control of root canal infection and healing of periapical lesions. Fifty teeth diagnosed with chronic apical periodontitis were randomly allocated to one of three treatments: Single visit (SV group, n = 20), calcium hydroxide for one week (CH group n = 18), or leaving the canal empty but sealed for one week (EC group, n = 12). Microbiological samples were taken to monitor the infection during treatment. Periapical healing was controlled radiographically following the change in the periapical index at 52 wk and analyzed using one-way ANOVA. All cases showed microbiological growth in the beginning of the treatment. After mechanical preparation and irrigation with sodium hypochlorite in the first appointment, 20 to 33% of the cases showed growth. At the second appointment 33% of the cases in the CH group revealed bacteria, whereas the EC group showed remarkably more culture positive cases (67%). Sodium hypochlorite was effective also at the second appointment and only two teeth remained culture positive. Only minor differences in periapical healing were observed between the treatment groups. However, bacterial growth at the second appointment had a significant negative impact on healing of the periapical lesion (p < 0.01). The present study indicates good clinical efficacy of sodium hypochlorite irrigation in the control of root canal infection. Calcium hydroxide dressing between the appointments did not show the expected effect in disinfection the root canal system and treatment outcome, indicating the need to develop more efficient inter-appointment dressings.

Topics: Calcium Hydroxide; Chronic Disease; Dental Pulp Cavity; Disinfectants; Follow-Up Studies; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Treatment Outcome; Wound Healing

The purpose of this study was to establish whether addition of a 2% chlorhexidine rinse to a conventional treatment protocol enhances the rate of the successful disinfection of the root canal system in vivo.. Twenty-four teeth with infected necrotic pulps and resorbing apical periodontitis were treated with a conventional technique in which 1% NaOCl as irrigant was used. Half of the cases received an additional rinse with 2% chlorhexidine. Prereduced thioglycollate medium was used to take cultures that were incubated for 4 weeks.. Cultivable bacteria were retrieved at the conclusion of the first visit in 1 out of 12 chlorhexidine cases whereas in the control group 7 out of 12 cases showed growth. This difference was significant (P < .05).. The findings are clinically important.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Bacteria; Calcium Hydroxide; Chi-Square Distribution; Child; Chlorhexidine; Dental Pulp Cavity; Dental Pulp Necrosis; Disinfectants; Drug Combinations; Follow-Up Studies; Humans; Middle Aged; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Single-Blind Method; Sodium Hypochlorite

This clinical study evaluated the antibacterial effects of calcium hydroxide associated with different vehicles during the treatment of infected teeth with apical periodontitis.. Bacteriologic samples were taken from 90 necrotic root canals of teeth with apical periodontitis before (S1) and after preparation with a rotary nickel-titanium instrument system and 2.5% sodium hypochlorite irrigation (S2). The teeth were distributed in 3 groups according to the intracanal medication used, which consisted of a calcium hydroxide paste in glycerin, camphorated paramonochlorophenol/glycerin (CHPG), or 2% chlorhexidine for 1 week, and then another sample was taken (S3). The frequency of bacteria-positive cases and the reduction of bacterial counts were evaluated by quantitative real-time polymerase chain reaction.. Substantial intracanal bacterial reduction was observed after preparation in the 3 groups (P < .001). After calcium hydroxide paste in glycerin medication, the number of bacteria-positive cases decreased from 20/29 (69%) to 17/29 (59%); however, the mean bacterial counts increased 8.4% from S2 to S3. Medication with CHPG reduced the number of bacteria-positive cases from 17/29 (59%) to 15/29 (52%), with a significant mean S2-S3 reduction of 71% (P < .05). In the chlorhexidine group, the number of bacteria-positive cases decreased from 21/30 (70%) to 17/30 (57%) after medication, with a mean S2-S3 reduction of 55%, which, however, was not statistically significant (P > .05). Intergroup comparisons showed no significant differences (P > .05).. Comparison between the 3 calcium hydroxide pastes showed no significant differences in antibacterial effectiveness in the main root canal. However, only the CHPG paste showed a significant reduction in bacterial counts when postpreparation and postmedication samples were compared.

Topics: Anti-Bacterial Agents; Bacteria; Calcium Hydroxide; Chlorhexidine; Dental Pulp Cavity; Glycerol; Humans; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

To investigate the efficacy of the supplementary use of a rotary agitation method [XP-endo Finisher (XPF)] and sonically-activated irrigation [EndoActivator (EA)], using droplet digital PCR (ddPCR) on reducing the bacterial load in previously root canal treated teeth with apical periodontitis. Twenty patients with post-treatment apical periodontitis were allocated into two groups according to the irrigation activation method used: XPF and EA group. Total bacterial loads, as well as the amount of Enterococcus faecalis (E. faecalis) were determined before (S1) and after (S2) chemomechanical preparation, and after final irrigation activation (S3) by means of ddPCR. The bacterial copy numbers were compared between groups using the Friedman test (Nonparametric Repeated Measures ANOVA). When the groups were examined in terms of gender, age, number of root canals, periapical index score, sterility control total bacteria (SCTB), S1- and S2-total bacteria copy number, it was found that there was no statistical difference between the XPF group and the EA group (p > 0.05). Subsequent activation (S3) resulted in a significant microbial reduction in both XPF and EA groups, both of which reduced significantly more bacteria than chemomechanical instrumentation (S2) (p < 0.0001). On the contrary, S3-total bacteria copy number of the EA group was lower than the XPF group (p < 0.0147). There was no statistical difference between the XPF group and the EA group in terms of E. faecalis copy number (p > 0.05). Although both the XPF and the EA optimised the antibacterial efficiency of chemomechanical preparation in previously root canal-treated teeth with apical periodontitis, a lower total bacterial copy number was achieved with the EA application than the XPF application.

Topics: Bacteria; Dental Pulp Cavity; Enterococcus faecalis; Humans; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

There is still a lack of knowledge regarding the permeability and configuration of infected root dentin. The aim of this ex vivo study was to compare the dentin penetrability of healthy teeth and necrotic teeth with apical periodontitis by evaluating the penetration of sodium hypochlorite (NaOCl) and to analyze the histopathological features of root dentin.. Forty-eight molars were collected and divided into two groups. The clinical diagnosis for one group was pulp necrosis with apical periodontitis and the pulp and periapex were normal in the other group. Forty-eight straight roots were divided into two groups: infected and healthy. First, all root canals were stained with 2% methylene blue to visualize penetration after standard root canal instrumentation and irrigation. Transverse sections were obtained, and the dye penetration parameters were measured. The cross sections were processed to 20-30 μm and stained with hematoxylin and eosin for observation of the histopathological changes in the root dentin.. The maximum penetration depth, median penetration depth and penetration percentage of NaOCl solutions, in infected root canals were significantly lower than those in healthy root canals. The histopathological analysis showed that the frequency of reparative dentin formation in infected root canals was significantly greater than that in healthy root canals.. The dentin penetrability of teeth with necrotic teeth and apical periodontitis was more superficial during root canal irrigation than that of healthy teeth. The histopathological changes in infected radicular dentin, namely the formation of reparative dentin, might be associated with the lower permeability of dentin tubules in human teeth with apical periodontitis.

Topics: Dental Pulp Cavity; Dentin; Humans; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

The objective of this study was to monitor the effects of chemomechanical preparation (CMP) performed with 6% sodium hypochlorite and calcium hydroxide-based intracanal medication (ICM) on the levels and diversity of bacteria, endotoxins (lipopolysaccharides [LPS]), and lipoteichoic acid (LTA) in root canals of teeth with symptomatic irreversible pulpitis.. Samples were collected from 10 teeth with symptomatic irreversible pulpitis before CMP (S1), after CMP (S2), and after ICM (S3). The levels of bacteria, LPS, and LTA were assessed by using checkerboard DNA-DNA hybridization, LAL Pyrogent 5000, and enzyme-linked immunosorbent assay, respectively. Wilcoxon test, repeated-measures analysis of variance, and Tukey post hoc test were used for statistical analysis at a significance level of 5%.. Forty species were detected at S1. Two species were eliminated after CMP and 5 after ICM. Resistant and pain-related species were detected in the root canals. Higher levels of culturable bacteria were detected at S1. However, CMP and ICM effectively reduced the microbial load in the root canals. Higher levels of LPS and LTA were detected at S1. CMP was effective in reducing both LPS and LTA (P < .05). ICM produced additional reduction in the levels of LPS (P > .05) and LTA (P < .05).. Chemomechanical preparation using 6% sodium hypochlorite and calcium hydroxide-based intracanal medication were effective in reducing the levels of bacteria, LPS, and LTA in teeth with vital pulp and irreversibly inflamed pulp.

Topics: Dental Pulp Cavity; Humans; Periapical Periodontitis; Pulpitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

Dens invaginatus is a dental anomaly that can predispose the tooth to pulp and periapical pathology.. Different endodontists treated 6 maxillary incisors with dens invaginatus associated with apical periodontitis. Cone-beam computed tomography was used to help with diagnosis and treatment planning in most patients. Four patients received diagnoses of Oehlers type II dens invaginatus and the other 2 as type III. In some patients with type II, the invagination had to be perforated to permit access to the apical part of the true root canal. Both the true canal and the invagination (pseudocanal) were treated in all cases using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation and supplementary disinfection approaches. Calcium hydroxide medication was used in all but 1 case. The root canal and invagination were often filled using thermoplasticized gutta-percha techniques, sometimes using an apical plug with a bioceramic material in teeth with large apical openings. All treated patients had favorable clinical and radiographic outcomes.. Regardless of the complex anatomic variations, common strategic therapeutic approaches were identified that might serve as recommendations for proper management of teeth with dens invaginatus and apical periodontitis. These approaches include cone-beam computed tomographic planning, aggressive disinfection using sodium hypochlorite ultrasonic or sonic activation and calcium hydroxide intracanal medication, and thermoplasticized gutta-percha obturation of both the root canal and invagination.

Topics: Calcium Hydroxide; Dens in Dente; Gutta-Percha; Humans; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite

The purpose of this study was to characterize qualitatively and quantitatively the changes in the endodontic microbiome, in teeth with necrotic pulp, open apexes, and apical periodontitis, with 3 antimicrobial protocols, undertaken in a multicenter clinical trial.. Microbiological samples were collected from 116 regenerative endodontic teeth, and 97 qualified for inclusion. The teeth were randomly divided into 3 treatment groups: apexification (APEX), regeneration (REGEN), and revascularization (REVASC), all in 2 appointments. The group variables in the first appointment irrigants, and second appointment irrigants and medicaments were as follows: APEX: 5.25%-6% NaOCl, 5.25%-6% NaOCl + 17% EDTA and calcium hydroxide; REGEN: 1.25% NaOCl, 17% EDTA, and 0.1 mg/mL triple antibiotic paste (TAP); and REVASC 5.25% NaOCl, saline, and 1 g/mL TAP, respectively. Sampling was done upon access (S0), after irrigation in the first appointment (S1), and after using medication and irrigation in the second appointment (S2).. Quantitative polymerase chain reaction analysis of the 16S ribosomal RNA gene showed significant reduction in bacterial load from S0 to S2 in all groups; however, the APEX and REVASC groups had significantly less residual DNA than the REGEN group (P = .0045). The relative abundance of Bacteroidetes, Fusobacteria, Spirochaetes, and Synergistetes were reduced with the treatment rendered. However, relative abundance of Firmicutes and Actinobacteria was not changed, and that of Proteobacteria increased. LEfSe analysis showed that reduction in bacterial taxa was more in REVASC than APEX, which in turn was more than in REGEN.. Enhanced antimicrobial protocols lead to better reduction in quantitative and qualitative parameters of the endodontic microflora.

Topics: Anti-Bacterial Agents; Calcium Hydroxide; Dental Pulp Cavity; Disinfection; Edetic Acid; Humans; Microbiota; Periapical Periodontitis; Regenerative Endodontics; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

The present study was conducted to evaluate the presence of aerobic bacteria, anaerobic bacteria, E. faecalis, F. nucleatum, Propionibacteria sp., Actinomyces sp., and their reduction at various stages of endodontic retreatment with the use of conventional protocol (5.25 % Sodium Hypochlorite (NaOCl) as the irrigant along with Calcium Hydroxide (Ca (OH)2) as intracanal medicament and advocated protocol (SmearOFF as the irrigant along with 2% Chlorhexidine (CHX) gel as intracanal medicament).. Twenty eight patients fulfilling the eligibility criteria were selected for root canal retreatment and randomly allocated into two groups. Group 1: Final irrigant as SmearOFF+Chlorhexidine 2% gelas intracanal medicament (n=14). Group 2: Final irrigant as 5.25% NaOCl+Ca(OH)2 as intracanal medicament (n=14). With aseptic environment, access opening was performed followed by Gutta Percha (GP) removal and sample S1 was collected for bacterial analysis. The biomechanical preparation was done by using Reciproc system with additional finishing with XP-Endo Finisher R. Sample S2 was then collected for bacterial analysis after the final irrigation protocol in the respective groups. Intracanal medicaments were placed for one week and sample S3 was collected. All the samples were subjected to qualitative analysis using PCR and quantification was done by Colony Forming Unit (CFU) analysis.. Aerobic [28/28], Anaerobic [28/28], Propionibacterium sp. [20/28] and F. nucleatum [24/28] were the most frequently isolated in S1 sample followed by Actinomyces sp. [16/28] and E. faecalis sp. [19/28]. Chemico-mechanical preparation followed by irrigation (S2 sample) resulted in significant reduction of all types of bacteria in both groups. Group-1 (SmearOFF as the final irrigant) had significantly superior efficacy against aerobic bacteria, E. faecalis and F. nucleatum (P<0.05) as compared to Group-2 (NaOCl). After medicament placement, significant differences between the groups were noted only for the E. Faecalis group. For the S3 samples, the mean bacterial reduction was significant in Aerobic and F. nucleatum in S3 samples for Group 1 and Group 2.. Chemico-mechanical preparation followed by irrigation resulted in significant reduction in bacterial load irrespective of the final irrigant. SmearOFF was significantly better than NaOCl in minimizing bacterial load of E. faecalis and F. nucleatum. 2% Chlorhexidine gel has superior antimicrobial efficacy against E. faecalis and may be recommended in secondary endodontic treatment.

Topics: Actinomyces; Bacteria; Calcium Hydroxide; Chlorhexidine; Dental Pulp Cavity; Disinfection; Gutta-Percha; Humans; Periapical Periodontitis; Retreatment; Root Canal Irrigants; Sodium Hypochlorite

To evaluate in a clinical trial the efficacy of reciprocating and ultrasonic activation of 6% sodium hypochlorite (NaOCl) in the microbial composition and reduction in microbial load as well as in levels of lipopolysaccharide (LPS) and lipoteichoic acid (LTA) in teeth with primary endodontic infections.. Samples were collected from 24 root canals with pulp necrosis and periapical lesions, before and after chemo-mechanical canal preparation. The teeth were randomly divided according to the activation protocol as follows: control group without activation (WA, n = 8), reciprocating activation group using Easy Clean tip (EC, n = 8) and ultrasonic activation group using Irrisonic insert (US, n = 8). Microbiological specimens were processed using a culture technique and microbiota composition was analysed using the checkerboard technique. The levels of LPS and LTA were quantified using limulus amebocyte lysate (LAL) and enzyme-linked immunosorbent assay (ELISA), respectively. The Fisher's exact test, Kruskal-Wallis, Dunn's and Wilcoxon's test with a significance level of P < 0.05 were used for statistical analysis.. All initial specimens had growth of viable bacteria in fastidious anaerobe agar (FAA), with an average of 10. Activation of 6% NaOCl reduced the levels of LPS and LTA with no differences between the groups. However, ultrasonic activation was associated with a greater reduction in microbial load within root canals.

Topics: Dental Pulp Cavity; Humans; Infections; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Ultrasonics; Virulence Factors

In the course of the present study four endodontic treatment schemes were tested and the most effective scheme was determined through the use of calcium hydroxide-based paste being applied three times at an interval of 7-14 days with the subsequent long-term temporary obturation using calcium hydroxide with iodoform, ultrasonic activation of sodium hypochlorite in the root canal, hydrodynamic irrigation and a diode laser. During the entire treatment period, the most effective scheme has revealed a reduction in defect size by 2,57±0,17 (p>0,0001) as well as a 1,84 degree (p>0,0001) decrease in PAI score. Based on optical density data, it was concluded that the application of calcium hydroxide with iodoform in the treatment scheme leads to an 2,2-4,2% improvement in bone tissue regeneration in the periapical zone. The greatest and complete inhibition of microorganisms was determined in patients of the first and third experimental groups in which a diode laser was used. The use of a diode laser in endodontic dental treatment with periapical destruction, enhances antibacterial activity and contributes to the complete inhibition of pathogenic microflora in the root canals.. В ходе настоящего исследования были апробированны четыре схемы эндодонтического лечения и определена наиболее эффективная схема лечения с применением временной лечебной пасты на основе кальция гидроксида три раза с интервалом по ٧-14 дней с последующей долгосрочной временной обтурацией кальций гидроксида с йодоформом, ультразвуковой активации гипохлорита натрия в корневом канале, гидродинамической ирригации и диодного лазера. В наиболее эффективной схеме за весь период лечения наблюдалось уменьшение размера дефекта на 2,57±0,17 мм (p>0,001) и снижение показания индекса PAI на 1,٨٤ балла (p>٠,٠٠1). На основании данных денситометрии определено, что применение гидроксида кальция с йодоформом в схеме лечения приводит к улучшению репарации костной ткани в периапикальной зоне на ٢,٢-4,2%. Наибольшее и полное ингибирование микроорганизмов определено у пациентов первой и третьей опытной группы, в которых был использован диодный лазер. Применение диодного лазера при эндодонтическом лечении зубов с периапикальной деструкцией усиливает антибактериальную активность и способствует полному ингибированию исследованной патогенной микрофлоры в корневых каналах.

Topics: Calcium Hydroxide; Humans; Periapical Periodontitis; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite

The purpose of the study was to evaluate the degree of purification of the deltoid root canal branching during endodontic treatment of teeth. Morphological assessment of dentine of 14 extracted incisors and premolars in patients aged from 24 up to 56 years with the diagnosis chronic apical periodontitis was conducted in two experimental groups: main (1 group, 7 teeth) and control (2 group, 7 teeth). In the 2 group conventional root canal treatment was carried out with processing of 3% solution of sodium hypochlorite and final sealing with gutta-percha pins by lateral condensation. In the 1 group root canals were additionally irrigated by 3% sodium hypochlorite solution by means of the RinsEndo device. Based on the study results we recommend using the hydrodynamic method of irrigation of root canals with 3% sodium hypochlorite solution in endodontic treatment of patients with chronic apical periodontitis.. Цель исследования — оценить степень очистки дельтовидных ответвлений корневого канала в процессе эндодонтического лечения зубов. Выполнена морфологическая оценка состояния твердых тканей 14 удаленных зубов — резцов и премоляров — у пациентов в возрасте от 24 до 56 лет с диагнозом «хронический апикальный периодонтит». Выделены две экспериментальные группы: основная (1-я, 7 зубов) и контрольная (2-я, 7 зубов). Во 2-й группе проводили эндодонтическое лечение зубов с созданием модели клинических условий по традиционной методике c медикаментозной обработкой 3% раствором гипохлорита натрия и окончательным пломбированием гуттаперчевыми штифтами методом латеральной конденсации. В 1-й группе дополнительно применяли гидродинамический метод ирригации корневых каналов 3% раствором гипохлорита натрия с помощью аппарата RinsEndo. На основании полученных морфологических исследований рекомендуется использование гидродинамического метода ирригации корневых каналов зубов 3% раствором гипохлорита натрия с помощью аппарата RinsEndo дополнительно к традиционному эндодонтическому лечению пациентов с хроническими формами апикального периодонтита.

Topics: Dental Pulp Cavity; Dentin; Humans; Middle Aged; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Sodium Hypochlorite

This study evaluated the bacterial levels after regenerative endodontic procedures and their correlation with the treatment outcome using molecular microbiology methods.. Root canal samples of 15 necrotic immature teeth were analyzed by quantitative polymerase chain reaction. Bacteria were counted before treatment (S1), after irrigation with 6% sodium hypochlorite (S2), and after intracanal dressing (S3) using either triple antibiotic paste (n = 7) or calcium hydroxide with chlorhexidine (n = 8). The Wilcoxon test for related samples and the Mann-Whitney test were used for statistical analysis (P < .05). After a follow-up period of 12-48 months, clinical and radiographic findings were correlated with microbiological data using a linear regression model (P < .05).. All S1 and S2 samples were positive for bacteria, but the number of positive S3 samples decreased to 53.3% (P = .001). Overall, there was a significant reduction of bacterial levels after each treatment step (S1-S2, P = .001; S2-S3, P = .02). In the triple antibiotic paste and chlorhexidine groups, 57.1% and 50% of S3 samples were positive with median numbers of 6.97 × 10. Although the bacterial levels were drastically reduced after the regenerative endodontic procedures, the residual bacteria influenced the thickness of the dentinal walls.

Topics: Calcium Hydroxide; Dental Pulp Cavity; Dental Pulp Necrosis; Periapical Periodontitis; Regenerative Endodontics; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite

We describe complete healing of an extensive cystic lesion by using a conservative approach: root canal treatment with concurrent surgical drainage. A silicone Foley catheter drain was modified into a surgical drainage stent, which was then used for 4 weeks. Disinfection of the root canal was achieved by the use of hand files and irrigation with 5.25% NaOCl for a minimum of 30 minutes. The irrigant changes were performed at 5-minute intervals, and no intracanal dressing was used. At subsequent follow-up examinations, cone-beam computed tomography and periapical radiographs confirmed that complete healing had occurred around the periapical and lateral areas of affected teeth. This case report indicates the potential for healing of large cystic lesions by nonsurgical root canal treatment.

Topics: Combined Modality Therapy; Conservative Treatment; Dental Pulp Necrosis; Disinfection; Drainage; Female; Follow-Up Studies; Humans; Middle Aged; Periapical Periodontitis; Radicular Cyst; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Time Factors; Treatment Outcome

The effect of irrigation time on the antimicrobial efficacy of an apical negative pressure irrigation system was examined in vitro, followed by validation of the antimicrobial effect in vivo using the identified optimal irrigation time.. For the in vitro experiment, 44 extracted premolars were decoronated, instrumented, autoclaved and inoculated with Enterococcus faecalis (ATCC 29212) for 21 days. Four teeth were used as positive control, without irrigation. Each of the remaining 40 teeth was irrigated with 2.5% NaOCl, delivered via the EndoVac MacroCannula for 10 s, and subsequently via the EndoVac MicroCannula for 15, 30, 45, 60 or 90 s per canal, respectively (N = 8). After irrigation, microbial samples were collected, transferred to BHI broth and incubated for counting of bacterial colony forming units (CFUs). Based on the in vitro results, 8.25% NaOCl was delivered via the EndoVac MicroCannula for 60 s, during root canal treatment of 20 human subjects presented with apical periodontitis. Microbial samples retrieved in vivo prior to canal instrumentation (S0), after chemomechanical debridement (S1) and after irrigation with EndoVac (S2) were cultured in an anaerobic chamber for 7 days for CFU evaluation.. Compared with the control, irrigation significantly reduced bacterial populations (p < .05). Irrigation delivery via the EndoVac demonstrated improved antibacterial efficacy with increased irrigation time (p < .05). Samples retrieved from canals after NaOCl delivery in vivo with the EndoVac for 60 s were all culture-negative.. Microbial elimination may be achieved with 8.25% NaOCl delivered via the EndoVac apical negative pressure irrigation device for 60 s.. With the use of the EndoVac apical negative pressure irrigant delivery system, optimal elimination of the intracanal bacterial load can only be achieved when sodium hypochlorite is delivered via the MicroCannula for at least 60 s per canal.

Topics: Alloys; Anti-Infective Agents; Bacterial Load; Bicuspid; Debridement; Dental Pulp Cavity; Disinfection; Enterococcus faecalis; Humans; Periapical Periodontitis; Pressure; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Thiosulfates; Time Factors

The aim of this study was to evaluate histologically the newly formed tissues after regenerative endodontic procedures (REPs) in dogs using either a blood clot (BC) or 2 different formulations of a chitosan hydrogel as scaffolds.. Apical periodontitis was induced by inoculating immature teeth with oral plaque in 4 beagle dogs. Teeth (n = 96) were divided into 2 control (n = 20) and 4 test groups (n = 76) according to the treatment: apexification and REPs with BC, sodium hyaluronate:chitosan (HA:CS) scaffolds, or pectin:chitosan (P:CS) scaffolds. All root canals were disinfected with 2.5% sodium hypochlorite and a triple antibiotic paste intracanal medicament before evoked bleeding, clot formation, or scaffold placement. Thirteen weeks after treatment, the animals were sacrificed and the jaw blocks harvested for histologic processing, histomorphometric analysis, and statistical analysis.. The lumens of the root canals were completely filled with mineral trioxide aggregate with evidence of a mineralized apical bridge between the root canal walls in 83% of the samples in the apexification group. Vital vascularized tissue was found in the REP groups; apical closure happened in 66.7% of these treatments, and root growth was detected more often as an increase in thickness (85.6%) than in length (45.6%). The greatest amount of mineralized tissue inside the canal was observed in the BC group, with statistical significance compared with the HA:CS and P:CS groups (P < .05). Further histologic evaluation revealed the presence of apical papilla.. The addition of chitosan scaffolds to blood in regenerative procedures in dogs did not improve the formation of new mineralized tissues along the root canal walls or the histologic evidence of the regeneration of a pulp-dentin complex.

Topics: Aluminum Compounds; Animals; Apexification; Blood Coagulation; Calcium Compounds; Chitosan; Dental Pulp Necrosis; Dogs; Drug Combinations; Hyaluronic Acid; Hydrogels; Oxides; Periapical Periodontitis; Regeneration; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Therapy; Silicates; Sodium Hypochlorite; Tissue Scaffolds

This study was to evaluate the bactericidal effect of Er:YAG laser-activated sodium hypochlorite irrigation (Er:YAG + NaOCl) on biofilms of Enterococcus faecalis clinical isolate.. It was reported that Er:YAG + NaOCl had effective bactericidal effect on laboratory-adapted E. faecalis strain, while no study has reported its effect on the clinical isolate.. Eighteen E. faecalis strains were isolated from 39 root-filled teeth with periapical lesions, and their biofilm formation abilities were evaluated using the crystal violet staining method. Extracted human root canals were prepared to a 40#/.04 K3 instrument and contaminated with the E. faecalis isolate that presented the strongest biofilm formation ability for 4 weeks. The infected canals then received treatments of syringe irrigation with normal saline (NS) or NaOCl, ultrasonic activated irrigations US + NS and US + NaOCl, and Er:YAG laser-activated irrigations Er:YAG + NS and Er:YAG + NaOCl. The root canals were examined using scanning electron microscopy (SEM). The bacterial reductions were evaluated using the cell count method.. SEM results showed that biofilm-like structures formed on the root canal walls after 4-week bacterial incubation. Er:YAG + NaOCl completely removed the E. faecalis biofilm from the root canal wall and made it the cleanest and most smooth surface among the treatment groups. Bacterial reductions in the treatment groups were presented in a descending order of Er:YAG + NaOCl (98.8%), US + NaOCl (98.6%) > NaOCl (94.0%) > Er:YAG + NS (91.9%) > US + NS (78.1%) > NS (51.1%) (p < 0.05).. The Er:YAG + NaOCl showed an effective bactericidal effect on biofilms of E. faecalis isolate, which may be considered an effective protocol for root canal treatment.

Topics: Biofilms; Dental Pulp Cavity; Enterococcus faecalis; Humans; Lasers, Solid-State; Periapical Periodontitis; Photochemotherapy; Root Canal Irrigants; Root Canal Therapy; Sampling Studies; Sensitivity and Specificity; Sodium Hypochlorite

To compare the effectiveness of large apical preparations and complementary canal preparation with the Self-Adjusting File (SAF) in removing endotoxins from the root canal of teeth with apical periodontitis.. Ten single-rooted and single-canaled teeth with post-treatment apical periodontitis were selected. Endotoxin samples were taken after removal of the root filling (S1), after chemomechanical preparation (CMP) using 2.5% NaOCl and an R25 file (S2), after CMP using 2.5% NaOCl and an R40 file (S3) and after complementary CMP using the SAF system (S4). Limulus amebocyte lysate (LAL) was used to measure endotoxin levels. The Friedman and Wilcoxon tests were used to compare endotoxin levels at each clinical intervention (P < 0.05).. After root filling removal, endotoxin was detected in 100% of the root canals (S1, 4.84 EU mL. Apical enlargement protocols were effective in significantly reducing endotoxin levels. Complementary preparation with the SAF system failed to eliminate residual endotoxin contents beyond those obtained with the R40 instrument.

Topics: Dental Instruments; Endotoxins; Humans; Periapical Periodontitis; Retreatment; Root Canal Preparation; Sodium Hypochlorite

Different types of scaffolds have been suggested for endodontic repair procedures. The aim of this study was to compare the outcome of procedures using blood clot vs plasma rich in growth factors (PRGF) scaffold in immature teeth with apical periodontitis in dogs.. In this in vivo animal study, 20 teeth (30 canals) with open apices were divided into two groups (n = 12): (1) blood clot and (2) PRGF. Two positive and negative control groups were also selected randomly. After exposing the pulp and inducing periapical inflammation by placing a sponge soaked in a suspension of dental plaque, the root canals of both groups were flushed with sodium hypochlorite and filled with triple antibiotic paste. After 28 days, the antibiotic mixture was removed, bleeding was induced through the apical foramen, and mineral trioxide aggregate was placed over the blood clot in group one and PRGF scaffold in group two. Access cavities were then filled with composite resin. The radiographic and histological findings were compared immediately after the procedure, as well as after 3 and 6 months of follow-up.. There was no statistically significant difference between the two experimental groups with regard to the radiographic or histological results (P > 0.05). The incidence of healed periapical radiolucency was 60% and 53.33% in groups one and two, respectively. Apical closure was noted in 60% of samples in both experimental groups. New cementum-like tissue formation was detected along the walls of the canals, and bone-like islands within the canals were also observed.. Plasma rich in growth factors scaffold showed no advantage over blood clots regarding healing of the periapical radiolucency, radiographic apical closure and type of the newly formed soft and hard tissues.

Topics: Aluminum Compounds; Animals; Blood Coagulation; Calcium Compounds; Dogs; Drug Combinations; Intercellular Signaling Peptides and Proteins; Oxides; Periapical Periodontitis; Platelet-Rich Plasma; Silicates; Sodium Hypochlorite; Tissue Scaffolds; Tooth Apex

Endodontic infections are characterized by their microbial polymorphism with the presence of pathogenic agents such as bacteria. The aim of this study was to investigate the presence of yeast in the root canals of teeth with pulp necrotic with or without apical periodontitis and to study the sensibility of these at disinfection at sodium hypochlorite to 2.5 %.. Root canal samples, taken with paper points before and after disinfection with sodium hypochlorite dosed at 2.5 % on 50 single rooted teeth in 38 patients, were seeded in petri dishes containing Sabouraud Chloramphenicol (SC) (Conda Laboratories, Madrid). These stains were incubated in an incubator at 37°C for 48hours. The presence of yeast was confirmed by white colonies on the entire circumference of the tip paper. The identification of species was done by macroscopic and microscopic examinations associated with Blastese test.. The yeast colonies were isolated from 7 teeth (14 %) out of 50. All positive samples were from teeth with an open necrotic pulp (P<0.001). The only species found was Candida albicans. Immediate disinfection with sodium hypochlorite at 2.5 % did not show a complete elimination of yeasts.. The results of this study show that the canal of necrotic teeth with or without apical periodontitis may shelter yeasts even after immediate disinfection with sodium hypochlorite 2.5 %.

Topics: Adolescent; Adult; Aged; Candida albicans; Child; Dental Pulp Necrosis; Disinfection; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Periapical Periodontitis; Senegal; Sodium Hypochlorite; Therapeutic Irrigation; Yeasts; Young Adult

The infectious content of root canals, including bacteria and lipoteichoic acid (LTA), cause injuries to the periapical tissues. The purpose of this clinical study was to quantify the levels of both LTA and cultivable bacteria at the different phases of endodontic retreatment (ER) of teeth with post-treatment apical periodontitis. It also aimed to investigate the presence of gram-positive microorganisms before and after chemomechanical preparation (CMP) and intracanal medication (ICM).. Twenty infected root canals of single-rooted teeth were randomly assigned into 2 groups according to the chemical substance used for CMP (n = 10 per group): chlorhexidine (CHX) group, 2% CHX gel, and the sodium hypochlorite (NaOCl) group, 6% NaOCl. Root canal samples were taken using paper points before (S1) and after CMP (S2) and after 30 days of ICM with calcium hydroxide + 2% CHX gel (S3). Microorganisms were identified by the culture technique using biochemical tests. Cultivable bacteria were determined by counting the colony-forming unit. LTA levels were measured using the enzyme-linked immunosorbent assay (pg/mL).. A total of 70 gram-positive species, out of 102 species isolated, were found in the root canals (54 in S1, 4 in S2, and 12 in S3). Enterococcus faecalis was the most frequent isolated taxon in all phases of the ER. LTA (574.0 ± 94.7) and cultivable bacteria (101.2 ± 79.2) were present in all S1 samples. CMP decreased the overall levels of cultivable bacteria by 99.4% and LTA by 24.8% (P < .05), whereas the total overall reduction level of ICM on viable bacteria was 99.5% and on LTA it was 38.6% (P < .05). CMP with 2% CHX gel (CHX group, 99.3%) was more effective (P < .05) than 6% NaOCl (NaOCl group, 92.1%) on bacterial reduction. Likewise, ICM showed a 100% reduction in the CHX group and 98.5% in the NaOCl group. Regarding the reduction of LTA, CMP with 2% CHX gel (CHX group, 26.9%) was more effective (P < .05) than 6% NaOCl (NaOCl group, 22.6%). In addition, ICM showed a 43.2% reduction in the CHX group and 36.2% in the NaOCl group (P > .05).. The reduction rates of bacteria were higher than the LTA. Moreover, gram-positive microorganisms were present in all phases of the endodontic retreatment.

Topics: Adult; Bacteria; Chlorhexidine; Dental Pulp Cavity; Enterococcus faecalis; Gram-Positive Bacteria; Humans; Lipopolysaccharides; Middle Aged; Periapical Periodontitis; Random Allocation; Retreatment; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Teichoic Acids

Varicella zoster virus (VZV) is responsible for the primary infection chickenpox. After the initial infection, it remains latent but can reactivate, resulting in shingles (herpes zoster). Previous reports have implicated VZV in the pathogenesis of apical periodontitis, but the involvement of the virus has not been investigated fully. The present case describes a patient who suffered from a severe episode of shingles and subsequently developed periapical radiolucencies of all the teeth in the affected nerve distribution. Molecular and culture techniques showed the presence of VZV DNA in the root canal system in the absence of bacteria. This confirms that VZV can cause localized pulp necrosis and apical periodontitis. The lesions healed after endodontic treatment, implying chemomechanical debridement using sodium hypochlorite irrigation and a calcium hydroxide interim dressing may be effective against the virus.

Topics: Calcium Hydroxide; Chickenpox; Dental Pulp Cavity; Dental Pulp Necrosis; DNA, Viral; Herpes Zoster; Herpesvirus 3, Human; Humans; London; Male; Middle Aged; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Resorption; Sodium Hypochlorite

This study evaluates histologically the efficacy of 4 revascularization protocols in necrotic-infected immature dog teeth with apical periodontitis (AP).. Forty double-rooted immature premolar teeth from 4 female Beagle dogs aged 5 months were used. Four teeth were left untouched as negative controls; the other 36 teeth were infected to develop pulp necrosis and AP. Four teeth were left untreated and assigned to the positive control group. The last 28 teeth were randomly assigned into four experimental groups of 8 teeth, each one treated with a different treatment protocol: A1, sodium hypochlorite (SH)+blood clot (BC); A2, SH+platelet-rich plasma (PRP); B1, SH+modified tri-antibiotic paste (mTAP)+BC; B2, SH+mTAP+PRP. The animals were sacrificed, histologic sections were prepared and three parameters were assessed: (1) presence or absence of new hard tissue on the internal root dentinal walls, (2) presence or absence of continued apical closure, and (3) presence or absence of vital tissue within the canal space.. Significant differences (p<0.05) between the four experimental groups were evident in the percentage of teeth showing histological apical closure (34.5%) and vital tissue within the canal space (68.8%). Group B2 showed the maximal improvement in the three variables assessed (p<0.05). Group A1 showed the minimum percentages in the three parameters assessed (p<0.05).. These results suggest that an intracanal dressing of mTAP, and the use of PRP as scaffold, improves the success rate of the revascularization procedure.

Topics: Aluminum Compounds; Animals; Bicuspid; Calcium Compounds; Cefixime; Ciprofloxacin; Combined Modality Therapy; Dental Pulp; Dental Pulp Necrosis; Dogs; Drug Combinations; Female; Metronidazole; Oxides; Periapical Periodontitis; Platelet-Rich Plasma; Random Allocation; Root Canal Irrigants; Root Canal Therapy; Silicates; Sodium Hypochlorite

Enterococcus faecalis is a pathogenic gram-positive bacterium closely associated with apical periodontitis. Although sodium hypochlorite (NaOCl) has been used as a common endodontic irrigant to eradicate bacteria in the root canal, it has not been elucidated whether NaOCl attenuates the inflammatory response induced by the E. faecalis virulence factor lipoteichoic acid (EfLTA).. Structurally intact EfLTA purified from E. faecalis was treated with NaOCl at various concentrations and time periods. Murine macrophage cell line RAW 264.7 was treated with interferon gamma followed by treatment with intact or NaOCl-treated EfLTA to determine the inducibility of inflammatory mediators such as nitric oxide, interferon gamma-inducible protein 10, and macrophage inflammatory protein-1α. Reporter gene assays assessed by flow cytometry were used to examine the ability of intact or NaOCl-treated EfLTA to activate Toll-like receptor 2 (TLR2), which is known to recognize EfLTA on host cells. Structural damage of EfLTA by NaOCl was examined using silver staining and thin-layer chromatography.. NaOCl-treated EfLTA showed markedly less induction of nitric oxide, interferon gamma-inducible protein 10, and macrophage inflammatory protein-1α in RAW 264.7 cells compared with intact EfLTA. In contrast to intact EfLTA that potently stimulated TLR2 activation, NaOCl-treated EfLTA did not activate TLR2. Structural analysis showed that NaOCl damaged EfLTA structure by deacylation.. NaOCl deacylates the glycolipid moiety of EfLTA, which fails to activate TLR2, leading to the reduced production of inflammatory mediators.

Topics: Animals; Chemokine CCL3; Chemokine CXCL10; CHO Cells; Cricetulus; Enterococcus faecalis; Lipopolysaccharides; Macrophages; Mice; Nitric Oxide; Periapical Periodontitis; RAW 264.7 Cells; Root Canal Irrigants; Sodium Hypochlorite; Teichoic Acids; Toll-Like Receptor 2

The purpose of this retrospective case series was to investigate the outcome of the revascularization procedure in necrotic immature teeth.. The residents and faculty members at the University of Pennsylvania endodontic department were invited to submit consecutive revascularization cases treated by them, irrespective of the outcome, during the time period of 2009 to 2012. Twenty-eight of 35 submitted necrotic immature teeth met the inclusion criteria. The treatment protocol included minimal instrumentation and irrigation with 3% sodium hypochlorite and 17% EDTA. Triple antibiotic paste was placed for a minimum of 21 days. After blood clot induction, either EndoSequence Bioceramic Putty (Brasseler, Savannah, GA) or mineral trioxide aggregate was placed below the cementoenamel junction, and composite was used as a final restoration. The follow-up period ranged from 7 to 72 months. The outcome was assessed as complete healing (the absence of clinical signs and symptoms, complete resolution of periradicular radiolucency, increase in the root dentin thickness/length, and apical closure), incomplete healing (the absence of clinical signs and symptoms, the periapical lesion completely healed without any signs of root maturation or thickening, the periapical lesion either reduced in size or unchanged with/without radiographic signs of increasing root dentin thickness/length, or apical closure), and failure (persistent clinical signs and symptoms and/or increased size of the periradicular lesion).. Twenty-one of 28 cases (75%) healed completely, 3 cases (10.7%) failed during the observation period and needed further treatment, and 4 cases (14%) presented with incomplete healing.. Within the limitation of this study, the outcome of revascularization, wherein healing of periapical periodontitis and maturation of roots occurs, is fairly high, making it a viable treatment option in comparison with apexification.

Topics: Adolescent; Adult; Aluminum Compounds; Anti-Bacterial Agents; Apexification; Calcium Compounds; Child; Dental Pulp Necrosis; Dental Restoration, Permanent; Dentin; Drug Combinations; Edetic Acid; Humans; Neovascularization, Physiologic; Oxides; Pennsylvania; Periapical Periodontitis; Periapical Tissue; Radiography, Dental; Regeneration; Retrospective Studies; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Silicates; Sodium Hypochlorite; Tooth; Tooth Apex; Treatment Failure; Treatment Outcome; Young Adult

To discuss the clinical and radiological outcome of a revascularization procedure which was completed in a single visit (using sodium hypochlorite 5% as the sole disinfectant) in an immature tooth with a necrotic pulp and apical periodontitis.. A 7-year-old girl was referred in pain following trauma to the maxillary anterior region some 6-7 weeks previously. The maxillary left central incisor tooth was diagnosed with a necrotic pulp and acute apical periodontitis. Under local anaesthesia and rubber dam isolation, an access cavity was prepared. The canal was irrigated with a 5% sodium hypochlorite solution and agitated with an ultrasonic file. A 17% EDTA solution was also used for a final rinse. Bleeding was induced into the canal space from the periapical tissues using a K-file. An MTA layer/barrier was placed directly onto the blood clot, and a further layer of GC Fuji IX cement was placed on top of the MTA to restore the access cavity. The tooth was reevaluated at 6 weeks, 3 months, 6 months, 1 year and 18 months. The tooth has remained symptom free. Radiographic examination shows progressive thickening of the root canal walls, root lengthening and apical closure.. Disinfection with 5% sodium hypochlorite followed by the induction of a blood clot into the root canal space may be sufficient to promote revascularization in certain circumstances. A single visit revascularization procedure is a potential treatment option.

Topics: Child; Dental Pulp Necrosis; Female; Glass Ionomer Cements; Humans; Neovascularization, Physiologic; Periapical Periodontitis; Periapical Tissue; Root Canal Therapy; Sodium Hypochlorite

Short-chain fatty acids (SCFAs) are bacterial metabolic end products that may function as virulence factors. This study evaluated the occurrence of SCFAs in infected root canals before and after treatment.. Samples were taken from root canals of teeth with apical periodontitis before (S1) and after (S2) chemomechanical preparation with either NaOCl or chlorhexidine as the irrigant and then after interappointment medication with calcium hydroxide (S3). High-performance liquid chromatography was used for detection of SCFAs. Selected bacterial taxa that are recognized producers of the target SCFAs were identified by real-time polymerase chain reaction.. Butyric acid was the most common fatty acid in S1, followed by propionic acid. Both molecules were also found in S2 and S3 from both NaOCl and chlorhexidine groups. Lactic acid was not present in detectable levels in S1, but it occurred in 1 postinstrumentation sample and in 9 samples taken after calcium hydroxide medication. Of the target taxa, Fusobacterium nucleatum was the most prevalent in S1 (76%), followed by members of the Actinobacteria phylum (71%), Streptococcus species (59%), and Parvimonas micra (53%). Gram-positive taxa, especially streptococci, were the most prevalent bacteria in S2 and S3. SCFA detection was matched with the respective potential producer species in most cases.. This first report of SCFAs in infected root canals suggests that these molecules may play a role in the pathogenesis of apical periodontitis. Significance of persistence of SCFAs after treatment and its effects on the long-term outcome await elucidation.

Topics: Calcium Hydroxide; Chlorhexidine; Fatty Acids, Volatile; Humans; Periapical Periodontitis; Root Canal Irrigants; Sodium Hypochlorite; Virulence Factors

The case of a lower molar with apical periodontitis, which had previous root canal treatment and a fractured instrument in the distal root beyond the foramen, is presented.. The simultaneous presence of a foreign body (endodontic instrument or material) in periapical tissues and microorganisms in the root canal, are etiological factors in the formation or maintenance of a periapical lesion, and can lead to failure in endodontic treatment.. This instrument was removed through the staging platform technique, by using ultrasound and an Instrument removal system (IRS) microtube under microscope visual amplification. All the canals were re-instrumented, irrigated with sodium hypochlorite and passive ultrasonic irrigation, removal of smear layer and intracanal medication with calcium hydroxide for 8 days, after which they were filled. The symptoms disappeared and clinical and radiograph 2-year follow-up shows healing of periapical tissues.. The combined use of visual magnification microscope, ultrasound and the IRS system by staging platform technique, allowed the removal of an endodontic instrument beyond the foramen, which made it possible to apply a conventional disinfection protocol.. Endodontic re-treatment by conservative approach of complicated cases it is an option with good clinical prognosis, before apical surgery or extraction.

Topics: Adult; Calcium Hydroxide; Equipment Failure; Female; Follow-Up Studies; Foreign Bodies; Gutta-Percha; Humans; Microsurgery; Periapical Abscess; Periapical Periodontitis; Periapical Tissue; Retreatment; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Tooth, Nonvital; Ultrasonic Therapy

This study evaluates radiographically the efficacy of 4 revascularization protocols in necrotic-infected immature dog teeth with apical periodontitis (AP).. Forty double-rooted immature premolar teeth from 4 female beagle dogs aged 5 months were used. Four teeth were left untouched as negative controls; the other 36 teeth were infected to develop pulp necrosis and AP following different treatment protocols. Four teeth were left untreated and assigned to the positive control group, and the last 28 teeth were randomly assigned into 4 experimental groups of 8 teeth: A1, sodium hypochlorite (NaOCl) + a blood clot; A2, NaOCl + platelet-rich plasma (PRP); B1, NaOCl + modified triantibiotic paste (mTAP) + a blood clot; and B2, NaOCl + mTAP + PRP. Teeth were monitored radiographically for 6 months regarding healing of periapical radiolucencies, thickening of the dentinal walls, and apical closure of roots.. Significant differences (P < .05) between the 4 groups were evident in the percentage of teeth showing improvement of periapical radiolucencies (62.5%), continued radiographic thickening of radicular walls (53.1%), radiographic apical closure (43.8%), and deposition of hard tissue on radicular dentin walls (53.1%). Group B2 showed maximal improvement in the 3 variables assessed (P < .05). Group A1 showed the minimum percentages in the 3 parameters assessed (P < .05).. These results suggest that an intracanal dressing of mTAP and the use of PRP as scaffold improves the success rate of the revascularization procedure.

Topics: Aluminum Compounds; Animals; Anti-Bacterial Agents; Bicuspid; Calcium Compounds; Dental Pulp; Disease Models, Animal; Dogs; Drug Combinations; Female; Negative-Pressure Wound Therapy; Neovascularization, Physiologic; Oxides; Periapical Periodontitis; Periodontal Dressings; Platelet-Rich Plasma; Random Allocation; Silicates; Sodium Hypochlorite; Treatment Outcome

To evaluate in vivo the antibacterial effectiveness of the self-adjusting file (SAF) using molecular methods.. Root canals from single-rooted teeth with apical periodontitis were instrumented using the SAF system under continuous irrigation with 2.5% NaOCl. DNA extracts from samples taken before and after instrumentation were subjected to quantitative analysis of total bacteria counts and levels of streptococci by quantitative real-time polymerase chain reaction (qPCR). The reverse-capture checkerboard assay was also used to identify 28 bacterial taxa before (S1) and after (S2) SAF instrumentation. SAF was also compared with a conventional hand nickel-titanium instrumentation technique for total bacterial reduction. Data from qPCR were analysed statistically within groups using the Wilcoxon matched pairs test and between groups using the Mann-Whitney U-test and the Fisher's exact test, with significance level set at P < 0.05.. Self-adjusting file significantly reduced the total bacterial counts from a mean number of 1.96 × 10(7) cells to 1.34 × 10(4) cells (P < 0.001). Quantitatively, the 99.9% reduction in total bacterial counts associated with the SAF system was significantly superior to the 95.1% reduction obtained by hand instrumentation (P < 0.001). Qualitatively, SAF resulted in significantly more cases with negative PCR results for bacteria (54.5%) than hand instrumentation (4.5%) (P < 0.001). The SAF system succeeded in significantly reducing the streptococcal levels, but four cases still harboured these bacteria in S2. Checkerboard analysis revealed that not only streptococci but also some anaerobic and even as-yet-uncultivated bacteria may resist the effects of chemomechanical procedures.. The SAF instrumentation system was highly effective in reducing bacterial populations from infected root canals and performed significantly better than hand instrumentation. However, because half of the samples still had detectable bacteria after preparation with SAF, supplementary disinfection is still required to maximize bacterial elimination.

Topics: Bacterial Load; Dental Pulp Cavity; Female; Humans; Male; Periapical Periodontitis; Real-Time Polymerase Chain Reaction; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

A significant portion of the bacteria taking part of the microbiome associated with apical periodontitis still remain to be cultivated and phenotypically characterized. This molecular study evaluated the prevalence of selected as-yet-uncultivated and difficult-to-culture bacterial taxa in infected root canals and their susceptibility to chemomechanical procedures.. Root canals of single-rooted teeth with apical periodontitis were prepared using rotary nickel-titanium instruments and 2.5% sodium hypochlorite as the irrigant. DNA extracts from samples taken before (S1) and after (S2) chemomechanical preparation were surveyed for the presence of 7 as-yet-uncultivated phylotypes and 1 difficult-to-culture species using end-point polymerase chain reaction. Samples were also subjected to quantitative analysis of total bacteria and levels of the 2 most prevalent taxa.. Bacteroidaceae sp. HOT-272 (24%) and Fretibacterium fastidiosum (20%) were the most prevalent taxa in S1. Their mean counts in S1 were 8.25 × 10(3) and 2.13 × 10(3) rRNA gene copies, corresponding to 0.18% and 0.55% of the total bacteria. Chemomechanical debridement promoted a highly statistically significant reduction in total bacterial counts (P < .001), but 64% of the canals were still positive for bacterial presence. Of the target taxa, only Bacteroidaceae sp. HOT-272 and F. fastidiosum were detected in S2 (each one in 1 sample). The reduction in counts of both taxa was also highly significant (P < .001).. Findings confirmed that several as-yet-uncultivated and difficult-to-grow bacterial taxa can participate in the microbiome associated with apical periodontitis. Two of them were found in relatively high prevalence but rarely as a dominant species. Chemomechanical procedures were highly effective in completely eliminating these taxa or at least substantially reducing their numbers.

Topics: Bacteria; Bacterial Load; Bacteriological Techniques; Bacteroidaceae; Dental Alloys; Dental Pulp Cavity; Dental Pulp Necrosis; DNA, Bacterial; Equipment Design; Gram-Negative Anaerobic Bacteria; Humans; Megasphaera; Microbiota; Nickel; Periapical Periodontitis; Phenotype; Polymerase Chain Reaction; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Titanium

Mechanical debridement plays an important role in eliminating intracanal bacteria, such as biofilm on the canal walls and bacteria in the dentinal tubules. Mechanical debridement is not recommended for root canal disinfection in revascularization/revitalization therapy. Here we report a failed revascularization/revitalization case, which could be due to inadequate root canal disinfection without mechanical removal of biofilm and bacteria in dentinal tubules.. A 6-year-old boy had a traumatic injury to tooth #9, which was avulsed and replanted within 40 minutes. The tooth subsequently developed a local swelling in the periapical area. The patient was referred to the Postgraduate Endodontic Clinic for revascularization/revitalization therapy on tooth #9. The treated tooth remained asymptomatic for 16 months and then developed pain and local periapical swelling. The oral surgeon extracted the revascularized/revitalized tooth. On request, the extracted tooth was processed for histologic and histobacteriologic examination.. The tissue in the canal was completely destroyed. Most bacteria were observed in the apical portion and not in the coronal portion of the canal and formed biofilm on the canal walls and penetrated into the dentinal tubules.. On the basis of histobacteriologic observations, the failure of revascularized/revitalized tooth could be due to inadequate root canal disinfection without mechanical debridement. It may be important to perform mechanical debridement as part of the revascularization/revitalization therapy to disrupt the biofilm on the canal walls and remove bacteria in the dentinal tubules because revascularization/revitalization therapy is able to increase thickening of the canal walls.

Topics: Aluminum Compounds; Anti-Bacterial Agents; Anti-Infective Agents, Local; Apexification; Biofilms; Calcium Compounds; Calcium Hydroxide; Child; Chlorhexidine; Dental Pulp Cavity; Dentin; Drug Combinations; Follow-Up Studies; Humans; Incisor; Male; Methylmethacrylates; Neovascularization, Physiologic; Oxides; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Silicates; Sodium Hypochlorite; Tooth Apex; Tooth Avulsion; Tooth Replantation; Treatment Failure; Zinc Oxide-Eugenol Cement

Pulp necrosis in immature teeth and the resulting periodontal apical inflammation negatively affect root formation. Resolvin E1 (RvE1) is a lipid-derived endogenous pro-resolution molecule that controls inflammation. The aim of this investigation was to evaluate the impact of RvE1 applied as an intracanal medication on root formation in nonvital immature teeth.. To arrest root development, pulpectomy was performed in the lower first molars of 4-week-old Wistar rats. After 3 weeks, irrigation with 2.5% sodium hypochlorite and 0.9% sterile saline was performed, and either a triple antibiotic paste (TAP) or RvE1 in saline was applied into the root canals. In the control group, access openings drilled into molars were left exposed to the oral environment. Root development and periapical repair were evaluated radiographically and histologically at 3 and 6 weeks after treatment.. RvE1 reduced periapical lesion size compared with the control at 3 weeks, which was similar to TAP. Inflammatory response in the RvE1-treated group was markedly reduced compared with both TAP and control specimens. At 6 weeks, root development was observed in both groups, but RvE1 treatment produced less cellularity with more regular calcified tissue deposition.. RvE1 and TAP had a positive impact on reducing inflammation and promoting root formation. RvE1 was more effective in reducing inflammation at earlier stages. RvE1 has potential to be used as root canal dressing to control inflammation in endodontically compromised teeth before complete root formation. Stability of RvE1 within the root canal and its delivery are issues to be addressed before its clinical use.

Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ciprofloxacin; Dental Pulp Cavity; Dental Pulp Necrosis; Eicosapentaenoic Acid; Male; Metronidazole; Minocycline; Odontogenesis; Periapical Periodontitis; Pulpectomy; Rats; Rats, Wistar; Root Canal Irrigants; Sodium Hypochlorite; Tooth Calcification; Tooth Root; Tooth, Nonvital

The aim of this clinical article is to describe the unusual anatomy that was detected in a maxillary first molar during routine endodontic treatment.. Variation in Root and Root canal morphology especially in multirooted teeth presents a constant challenge for a clinician in their detection and management. The literature is replete with cases that have extra canal or Root but cases with fused Root and fewer numbers of canals are sparse.. This case report describes the endodontic management of one such unusual case of maxillary first molar presenting with a single fused buccal and a palatal Root. The confirmatory diagnosis of this morphologic aberration was done with the help of spiral computerized tomography, which revealed that the contralateral tooth also had a similar morphology.. Dental practitioners should always be aware of the fact that abnormalities need not be in form of extra Roots or Root canals; anomalies can also be in form of fewer number of Roots or Root canals.. A thorough knowledge of the complexities and variations of the Root canal system would help in avoiding some of the common iatrogenic access opening errors like perforations and excessive tooth removal caused during the search for the missing or extracanal.

Topics: Adult; Calcium Hydroxide; Dental Pulp Cavity; Dental Pulp Necrosis; Epoxy Resins; Female; Follow-Up Studies; Gutta-Percha; Humans; Maxilla; Molar; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Tomography, Spiral Computed; Tooth Root

Topics: Adult; Aged; Calcium Hydroxide; Dental Pulp Cavity; Epoxy Resins; Female; Gutta-Percha; Humans; Male; Middle Aged; Periapical Periodontitis; Pulpitis; Radiography, Bitewing; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Sodium Hypochlorite

Regenerative endodontic treatment (RET) has been used in treating nonvital immature permanent tooth whose root formation ranged from approximately two-thirds of the full root length to almost completely developed root with open apex at least 1.1 mm in diameter according to the reported cases. However, this case report was to introduce RET in an affected tooth at an early stage of root development.. The premolar #29 in an 8-year-old girl had pulpal necrosis and apical periodontitis caused by the fracture of dens evaginatus. Its root was at the beginning of formation. Copious hemorrhagic drainage was observed after preparing of an access cavity. The canal was irrigated with 3% NaOCl solution, sterile normal saline, and chlorhexidine. Root dressing with triple antibiotic was then performed and left for 4 weeks. We used a K-file to create bleeding into the canal after flushing and drying the root canal. Mineral trioxide aggregate was carefully placed over the formed blood clot.. Clinical examination at 1, 3, 6, 9, and 12 months revealed an asymptomatic tooth. Radiographic examination revealed resolution of periapical radiolucency, increased thickening of the canal wall, and lengthening of the root, which demonstrated the continual development of the tooth root. Noticeably, the first-month postoperative radiograph showed radiopaque image in the root canal like an isolated island, which was gradually obvious during follow-up. Cone-beam computed tomography revealed that the calcification was attached with dentin wall in buccolingual direction, and the root canal was not completely obliterated.. RET is feasible for a tooth at an early stage of root development that has necrotic pulp and periapical lesion.

Topics: Aluminum Compounds; Anti-Bacterial Agents; Apexification; Bicuspid; Calcium Compounds; Calcium Hydroxide; Child; Chlorhexidine; Cone-Beam Computed Tomography; Dental Pulp Cavity; Dental Pulp Necrosis; Drug Combinations; Female; Follow-Up Studies; Humans; Odontogenesis; Oxides; Periapical Periodontitis; Regeneration; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Silicates; Sodium Hypochlorite; Tooth Fractures; Tooth Root

Endodontic management of teeth with aberrant root canal morphology can be challenging. This article presents a case in which multiple angulated radiographs and a dental operating microscope clearly revealed the presence of 3 root canals in a right mandibular central incisor with 2 different canal patterns. This case report emphasizes the importance of utilizing a dental operating microscope to understand unusual root canal morphology.

Topics: Anatomic Variation; Calcium Hydroxide; Dental Pulp Cavity; Dental Pulp Necrosis; Edetic Acid; Epoxy Resins; Female; Follow-Up Studies; Gutta-Percha; Humans; Incisor; Microscopy; Microsurgery; Middle Aged; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite

This article reports a case of persistent apical periodontitis lesion in a mesiobuccal root of a maxillary molar subjected to single-visit endodontic treatment.. The treatment protocol followed endodontic standards including using nickel-titanium instruments with working length ending 0.5-mm short of the apex, establishment and maintenance of apical foramen patency, irrigation with 5% NaOCl, smear layer removal, a final rinse with and ultrasonic agitation of chlorhexidine, and filling by the vertical compaction technique. Even so, the lesion in the mesiobuccal root became larger in size after follow-up examination at 1 year 6 months, and periradicular surgery was performed. Radiographic control after 11 months showed that periradicular healing was almost complete. The root apex and the lesion were analyzed histologically and histobacteriologically.. The lesion was diagnosed as a "pocket cyst," and no bacteria were noted extraradicularly. The cause of continued disease was a heavy bacterial biofilm infection located in an intricate network of apical ramifications. Bacteria were also observed on the walls of one of the mesiobuccal canals packed between the obturation material and the root canal wall.. This case report reinforces the need for treating the infected root canal as a complex system that possesses anatomic intricacies in which bacteria can spread and remain unaffected by treatment procedures.

Topics: Apicoectomy; Biofilms; Chlorhexidine; Dental Pulp Cavity; Follow-Up Studies; Humans; Male; Middle Aged; Periapical Periodontitis; Recurrence; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Sodium Hypochlorite; Tooth Apex; Tooth, Nonvital

To evaluate clinically the antibacterial effects of root canal treatment procedures using molecular microbiology analyses.. Samples were taken from 14 necrotic root canals of teeth with apical periodontitis before (S1) and after instrumentation with NaOCl irrigation (S2), a final rinse with chlorhexidine (CHX) (S3) and then one-week interappointment medication with calcium hydroxide/CHX paste (S4). The parameters examined included the following: incidence of positive broad-range PCR results for bacterial presence; impact on bacterial community structures evaluated by PCR-Denaturing Gradient Gel Electrophoresis (DGGE); quantitative bacterial reduction determined by real-time PCR; and identification of bacterial persisters by cloning and sequencing. Data from the different tests were subjected to statistical analyses and diversity indicator calculations.. All S1 samples were positive for bacteria in all tests. Treatment procedures promoted a decrease in microbial diversity and significantly reduced the incidence of positive results and the bacterial counts (P < 0.05). In general, each subsequent treatment step improved disinfection. No specific taxon or community pattern was associated with post-treatment samples.. Supplementary steps consisting of a final rinse with CHX followed by calcium hydroxide interappointment medication promoted further decrease in the bacterial bioburden to levels significantly below those achieved by the chemomechanical procedures alone. Because the long-term outcome of root canal treatment is dependent upon maximal bacterial reduction, the present results are of clinical relevance.

Topics: Anti-Infective Agents, Local; Bacterial Load; Biodiversity; Calcium Hydroxide; Chlorhexidine; Denaturing Gradient Gel Electrophoresis; Dental Alloys; Dental Pulp; Dental Pulp Cavity; Dental Pulp Necrosis; Disinfection; Edetic Acid; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Consortia; Molecular Biology; Nickel; Periapical Periodontitis; Real-Time Polymerase Chain Reaction; RNA, Bacterial; RNA, Ribosomal, 16S; Root Canal Irrigants; Root Canal Preparation; Sequence Analysis, RNA; Smear Layer; Sodium Hypochlorite; Titanium

To describe a technique for the placement of apical Mineral trioxide aggregate (MTA) plugs in canals with wide apices.. A novel technique to fill root canals with an apical diameter larger than 0.4 mm is presented. The technique includes three main stages; three Thermafil carriers of increasing size, previously de-sheathed by removing the Gutta-percha coating, are selected to engage 1, 2 and 3 mm short of the apex. Their use allows the negotiation of acute curvatures and ledged canals. Subsequently, an MTA plug matching the apical gauge is pre-formed with a pellet block, placed and condensed using the modified carriers in sequence. The presented protocol for the management of teeth with apices of a diameter greater than 0.4 mm allows a favourable apical control of the MTA. Clinical cases completed using this methodology are presented.. MTA placement in teeth with wide apices was facilitated by using de-sheathed Thermafil carriers, to create an appropriate seal and stable platform for Gutta-percha backfilling or subsequent fibre post placement. The use of de-sheathed Thermafil carriers of different sizes allows predictable placement of pre-formed MTA plugs. Gauging of Thermafil carriers enhances control of the condensation phase to limit the extrusion of MTA.

Topics: Adult; Aluminum Compounds; Calcium Compounds; Dental Pulp Cavity; Drug Combinations; Equipment Design; Female; Humans; Male; Odontometry; Oxides; Periapical Diseases; Periapical Periodontitis; Post and Core Technique; Retreatment; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Silicates; Sodium Hypochlorite; Tooth Apex; Young Adult

This in vivo study used molecular microbiology methods to evaluate the effects of passive ultrasonic irrigation (PUI) as a supplementary disinfecting step after root canal preparation.. Samples were taken from 10 necrotic root canals of teeth with apical periodontitis before (S1) and after rotary nickel-titanium instrumentation using 2.5% NaOCl as the irrigant (S2) and then after PUI for NaOCl activation (S3). The parameters examined included the incidence of positive broad-range polymerase chain reaction (PCR) results for bacterial presence, the impact on bacterial diversity evaluated by PCR-denaturing gradient gel electrophoresis (DGGE), the quantitative bacterial reduction determined by real-time PCR, and the identification of persistent species by clone library analysis.. All S1 samples were positive for bacteria in all tests. Treatment procedures were significantly effective in reducing the incidence of positive results for bacteria, the number of bacterial cells (infectious bioburden), and the bacterial diversity (number of species and abundance). However, the supplementary PUI approach did not succeed in significantly enhancing disinfection beyond that achieved by chemomechanical preparation. Several bacterial species/phylotypes were identified in post-treatment samples that were positive for bacteria.. Findings from this clinical study including a small sample size suggest that PUI can be ineffective in significantly improving disinfection of the main root canal after chemomechanical procedures.

Topics: Actinobacteria; Bacteria; Bacterial Load; Campylobacter; Dental Alloys; Dental Pulp Cavity; Dental Pulp Necrosis; Electrophoresis; Fusobacterium nucleatum; Gram-Positive Bacteria; Humans; Nickel; Periapical Periodontitis; Pseudomonas aeruginosa; Real-Time Polymerase Chain Reaction; RNA, Bacterial; RNA, Ribosomal, 16S; Root Canal Irrigants; Root Canal Preparation; Smear Layer; Sodium Hypochlorite; Sonication; Therapeutic Irrigation; Titanium; Ultrasonics

To compare the antibacterial efficacy of two instrumentation techniques, one using hand nickel-titanium (NiTi) instruments and the other using rotary NiTi instruments, in root canals of teeth with apical periodontitis.. Root canals from single-rooted teeth were instrumented using either hand NiTi instruments in the alternated rotation motion technique or rotary BioRaCe instruments. The irrigant used in both groups was 2.5% NaOCl. DNA extracts from samples taken before and after instrumentation were subjected to quantitative analysis by real-time polymerase chain reaction (qPCR). Qualitative analysis was also performed using presence/absence data from culture and qPCR assays.. Bacteria were detected in all S1 samples by both methods. In culture analysis, 45% and 35% of the canals were still positive for bacterial presence after hand and rotary NiTi instrumentation, respectively (P > 0.05). Rotary NiTi instrumentation resulted in significantly fewer qPCR-positive cases (60%) than hand NiTi instrumentation (95%) (P = 0.01). Intergroup comparison of quantitative data showed no significant difference between the two techniques.. There was no significant difference in bacterial reduction in infected canals after instrumentation using hand or rotary NiTi instruments. In terms of incidence of positive results for bacteria, culture also showed no significant differences between the groups, but the rotary NiTi instrumentation resulted in more negative results in the more sensitive qPCR analysis.

Topics: Bacteria; Bacterial Load; Bacteriological Techniques; Dental Alloys; Dental Pulp Cavity; Dental Pulp Necrosis; Dentin; Edetic Acid; Equipment Design; Humans; Nickel; Periapical Periodontitis; Real-Time Polymerase Chain Reaction; Root Canal Irrigants; Root Canal Preparation; Rotation; Smear Layer; Sodium Hypochlorite; Titanium

To report several types of response of immature permanent teeth with infected necrotic pulp tissue and either apical periodontitis or abscess to revascularization procedures.. Twenty immature permanent teeth with infected necrotic pulp tissue and either apical periodontitis or abscesses from 20 patients were included. The teeth were isolated with rubber dam, and pulp chambers was accessed through the crowns. The canals were gently irrigated with 5.25% sodium hypochlorite with minimal mechanical debridement. Calcium hydroxide was used as an inter-appointment intracanal medicament and placed into the coronal half of the canal space. After resolution of clinical signs and symptoms, bleeding was induced into the canal space from the periapical tissues using K-files. The coronal canal space was sealed with a mixture of mineral trioxide aggregate (MTA) and saline solution. The access cavity was filled with composite resin. These immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscesses were followed up from 6 to 26 months.. Five types of responses of these immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures were observed: type 1, increased thickening of the canal walls and continued root maturation; type 2, no significant continuation of root development with the root apex becoming blunt and closed; type 3, continued root development with the apical foramen remaining open; type 4, severe calcification (obliteration) of the canal space; type 5, a hard tissue barrier formed in the canal between the coronal MTA plug and the root apex.. Based on this case series, the outcome of continued root development was not as predictable as increased thickening of the canal walls in human immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess after revascularization procedures. Continued root development of revascularized immature permanent necrotic teeth depends on whether the Hertwig's epithelial root sheath survives in case of apical periodontitis/abscess. Severe pulp canal calcification (obliteration) by hard tissue formation might be a complication of internal replacement resorption or union between the intracanal hard tissue and the apical bone (ankylosis) in revascularized immature permanent necrotic teeth.

Topics: Adolescent; Aluminum Compounds; Apexification; Calcium Compounds; Calcium Hydroxide; Child; Composite Resins; Dental Materials; Dental Pulp Calcification; Dental Pulp Necrosis; Dental Restoration, Permanent; Dentin, Secondary; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Neovascularization, Physiologic; Odontogenesis; Oxides; Periapical Abscess; Periapical Periodontitis; Periapical Tissue; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Silicates; Sodium Hypochlorite; Tooth Apex; Tooth Root; Treatment Outcome

This article describes a case of recurrent post-treatment apical periodontitis and late failure after endodontic retreatment performed in a single visit.. The patient presented with a tooth exhibiting inadequate endodontic treatment and a large periradicular lesion that extended laterally to the root. Retreatment was performed in a single visit and involved chemomechanical preparation using 5.25% NaOCl as the irrigant and root canal obturation by Schilder's vertical compaction technique. A large lateral canal was radiographically revealed after obturation. After 2 years, the lesion was no longer radiographically discernible, a condition that was confirmed 9 years after retreatment procedures. Nonetheless, after 12 years, radiographs revealed recurrent disease. Apical surgery was performed, and the root apex, including the area of the large lateral canal, was resected with care to maintain the lesion attached to it. The biopsy specimen was subjected to histopathologic and histobacteriologic analyses.. Longitudinal sections of the apical root specimen revealed a heavy dentinal tubule infection surrounding the area of the lateral canal. Bacteria were not found in any other area of the specimen. No other possible reason for the inflammatory periradicular lesion, such as root fracture, coronal leakage, or foreign-body reaction, was evident.. A persistent intraradicular infection caused by bacteria located within dentinal tubules is the most reasonable explanation for resurgence of the apical periodontitis lesion. This case report stresses the importance of attaining proper disinfection of the root canal system for a predictable long-term outcome of the treatment.

Topics: Adult; Aluminum Compounds; Apicoectomy; Biopsy; Calcium Compounds; Dental Pulp Cavity; Dentin; Drug Combinations; Female; Follow-Up Studies; Gutta-Percha; Humans; Oxides; Periapical Periodontitis; Recurrence; Retreatment; Retrograde Obturation; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Silicates; Smear Layer; Sodium Hypochlorite; Tooth Apex; Treatment Failure

To evaluate the disinfection efficacy of MTAD on Enterococcus faecalis biofilm and smear layer colonization in apical isthums of the root canal system.. Fifteen extracted human maxillary first premolars with isthmus anatomic structure which confirmed by stereo-microscope were contaminated with E. faecalis in vitro and randomly divided into 5 groups: the first group was not treated serving as a baseline control, the second group was treated by normal saline (NS) serving as negative control, the third group was treated by MTAD , the forth group by 5.25% NaOCl, and the fifth group by 5.25% NaOCl + EDTA. All roots in the latter four groups were instrumented by Protaper rotary files and irrigated with respective irrigant, then the roots were split longitudinally and a scanning electron microscope was used to evaluate the antibacterial activity and smear layer cleaning ability of irrigants on isthmus.. In the first group, E. faecalis colonized on the isthmus surface and aggregated together to form biofilm-like microorganism community, some bacteria also colonized in the dentinal tubules. When treated with NS, both smear layer and bacteria remained (median of smear layer score was 5). MTAD can remove partial smear layer, and have limited antibacterial activity, some bacteria embedded in smear layer (the median was 3) and were destroyed; In 5.25% NaOCl treatmentgroup, the smear layer was not removed (median of smear layer score was also 5), but all bacteria on the surface were extinguished. The combined use of 5.25% NaOCl and EDTA produced a cleaner isthmus surface and had marked antimicrobial effect, with the median of smear layer score being only 1.. MTAD may permeate into the isthmus area of apical root canal system, but only performed a partial effect of disinfection and limited antibacterial activity. Sodium hypochlorite cooperated with EDTA can remove infection effectively in the isthmus area.

Topics: Biofilms; Citric Acid; Doxycycline; Enterococcus faecalis; Gram-Positive Bacterial Infections; Humans; In Vitro Techniques; Periapical Periodontitis; Periapical Tissue; Polysorbates; Root Canal Irrigants; Sodium Hypochlorite

This case series reports the outcomes of 8 patients (ages 9-4 years) who presented with 9 immature permanent teeth with pulpal necrosis and apical periodontitis. During treatment, 5 of the teeth were found to have at least some residual vital tissue remaining in the root canal systems. After NaOCI irrigation and medication with ciprofloxacin, metronidazole, and minocycline, these teeth were sealed with mineral trioxide aggregate and restored. The other group of 4 teeth had no evidence of any residual vital pulp tissue. This second group of teeth was treated with NaOCl irrigation and medicated with ciprofloxacin, metronidazole, and minocycline followed by a revascularization procedure adopted from the trauma literature (bleeding evoked to form an intracanal blood clot). In both groups of patients, there was evidence of satisfactory postoperative clinical outcomes (1-5 years); the patients were asymptomatic, no sinus tracts were evident, apical periodontitis was resolved, and there was radiographic evidence of continuing thickness of dentinal walls, apical closure, or increased root length.

Topics: Adolescent; Aluminum Compounds; Anti-Bacterial Agents; Apexification; Calcium Compounds; Calcium Hydroxide; Child; Ciprofloxacin; Dental Pulp; Dental Pulp Necrosis; Dentin, Secondary; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Metronidazole; Minocycline; Odontogenesis; Oxides; Periapical Periodontitis; Regeneration; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Silicates; Sodium Hypochlorite; Tooth Apex; Tooth, Nonvital; Treatment Outcome

The ability of 2 different approaches to supplement the antimicrobial effects of chemomechanical debridement in infected root canals was compared in vivo.. Samples from necrotic root canals of teeth with apical periodontitis were taken at the baseline (S1), after preparation with rotary nickel-titanium BioRaCe instruments and 2.5% NaOCl irrigation (S2), and then after either passive ultrasonic irrigation (PUI) for activation of NaOCl (n = 13) or a final rinse with 2% chlorhexidine (CHX) (n = 14) (S3). The incidence of positive culture for bacteria and fungi as well as positive broad-range polymerase chain reaction (PCR) results for bacteria, fungi, and archaea was determined.. All S1 samples were positive for bacteria in all methods. Fungi were not detected, and archaea occurred in only one S1 sample. Treatment procedures were significantly effective in reducing the incidence of positive culture and PCR results. Although both supplementary approaches reduced the incidence of positive bacteriologic results when compared with postinstrumentation samples, reduction was not statistically significant (P > .05). There was no significant difference for intergroup comparisons either (P > .05).. Although supplementary disinfection with either PUI or a final rinse with CHX can reduce the number of cases with positive culture and PCR results for bacteria, many cases still remain with detectable bacteria in the main root canal. Research on alternative or supplementary antimicrobial methods or substances should be encouraged.

Topics: Anti-Infective Agents, Local; Archaea; Bacteria; Chlorhexidine; Dental Alloys; Dental Pulp Cavity; Dental Pulp Necrosis; Equipment Design; Fungi; Humans; Iodine; Microbiological Techniques; Nickel; Periapical Periodontitis; Polymerase Chain Reaction; Root Canal Irrigants; Root Canal Preparation; Smear Layer; Sodium Hypochlorite; Therapeutic Irrigation; Titanium; Ultrasonics

Topics: Humans; Periapical Periodontitis; Radiography, Dental; Sodium Hypochlorite; Treatment Outcome; Ultrasonic Therapy

This culture-independent molecular microbiology study evaluated the antimicrobial effects of chemomechanical preparation supplemented by intracanal medication during treatment of teeth with apical periodontitis.. Samples were taken from 24 necrotic root canals at the baseline (S1), after chemomechanical preparation by using 2.5% NaOCl as the irrigant (S2), and after a 7-day interappointment medication with calcium hydroxide paste in either glycerin (CHG) or camphorated paramonochlorophenol/glycerin (CHPG) (S3). Bacterial, archaeal, and fungal presence was evaluated by polymerase chain reaction (PCR), and bacterial identifications were performed by a closed-ended reverse-capture checkerboard approach targeting 28 candidate endodontic pathogens.. All S1 samples were positive for bacteria but negative for both archaea and fungi. Treatment procedures were highly effective in reducing the bacterial levels and number of taxa. Overall, 46% of S2 samples and 62.5% of S3 samples were PCR-negative for bacteria. Specifically, S2 and S3 samples yielded negative PCR results in 50% and 58% of the canals in the CHG group and in 42% and 67% of the canals in the CHPG group, respectively. Except for comparisons with S1 samples, no other statistically significant differences were observed for intragroup and intergroup comparisons involving S2 and S3. Several taxa were still found in S2 and S3 samples, and the most prevalent were Propionibacterium acnes and Streptococcus species.. Bacterial levels and number of taxa were substantially reduced after chemomechanical preparation and intracanal medication. However, presence of detectable levels of persisting bacteria in many cases indicates that the search for more effective antimicrobial treatment strategies should be stimulated.

Topics: Anti-Infective Agents, Local; Archaea; Bacteria; Bacterial Load; Bacteroidetes; Calcium Hydroxide; Camphor; Chlorophenols; Dental Pulp Cavity; Dental Pulp Necrosis; Disinfection; Drug Combinations; Fungi; Glycerol; Humans; Microbiological Techniques; Nucleic Acid Hybridization; Periapical Periodontitis; Polymerase Chain Reaction; Porphyromonas; Propionibacterium acnes; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Solvents; Streptococcus

The objective of this article was to show an alternative clinical approach to retreating teeth having had prior combined nonsurgical and surgical endodontic treatment with retrograde amalgam fillings. Nonsurgical retreatment performed alone has historically presented numerous challenges for the clinician and an uncertain outcome for the patient. Surgical retreatment has the potential disadvantages of additional root shortening, bone loss, and scarring.. Four cases are presented with recalls up to 5.5 years.. The procedure was shown to be predictable and successful in this series. Root length was preserved, and surgery was avoided.. Nonsurgical amalgam removal from the root end may provide a desirable alternative to the more common and complicated option of combined nonsurgical and surgical endodontic retreatment.

Topics: Adult; Aged, 80 and over; Aluminum Compounds; Apicoectomy; Bicuspid; Calcium Compounds; Calcium Hydroxide; Chlorhexidine; Dental Amalgam; Dental Pulp Cavity; Drug Combinations; Female; Follow-Up Studies; Humans; Incisor; Male; Middle Aged; Oxides; Periapical Periodontitis; Retreatment; Retrograde Obturation; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Silicates; Sodium Hypochlorite; Suction; Tooth Apex; Ultrasonic Therapy

The present study aimed at developing an experimental model in rat molars for evaluating treatment strategies in necrotic immature teeth.. To define the periods to be adopted in the experimental procedures and to confirm induction of periapical lesions and interruption of root embryogenesis, the left lower first molars of 4-weeks-old Wistar rats underwent pulpectomy and were left open to the oral environment. Comparisons with the right lower first molars (vital teeth) were performed in animals with ages of 7, 10, 13, and 16 weeks. In another group of animals the teeth were left open for 3 weeks, and then interventions for disinfection including the use of an antibiotic paste were carried out. Root formation was then assessed after 3 and 6 weeks on the basis of radiographic and histologic evaluation.. Vital teeth showed increase of root length and hard tissue thickness throughout the experimental periods. On the other hand, induction of necrosis arrested root formation. Teeth subjected to disinfection with sodium hypochlorite associated with the triple antibiotic paste showed significant reduction of periapical lesions, gain in root length, and increased wall thickness compared with the control (P < .05).. The root canal disinfection protocol used was able to reduce periapical lesion size and improve root development. The experimental model presented should contribute to studies that aim at improving therapeutic strategies for necrotic immature teeth by using a rat model.

Topics: Animals; Anti-Bacterial Agents; Apexification; Cementogenesis; Ciprofloxacin; Dental Pulp Necrosis; Disease Models, Animal; Drug Combinations; Metronidazole; Minocycline; Odontogenesis; Periapical Periodontitis; Radiography; Rats; Rats, Wistar; Root Canal Irrigants; Sodium Hypochlorite; Tooth Apex; Tooth, Nonvital

The purpose of this study was to determine the effect of sodium hypochlorite (NaOCl) on human pulp cells to provide an aid in determining its optimum concentration in maintaining the viability of remaining pulp cells in the revascularization of immature permanent teeth with apical periodontitis.. Human pulp tissue cells taken from extracted third molars were plated, incubated, and subjected to various concentrations of NaOCl (0.33%, 0.16%, 0.08%, and 0.04%) for 5-, 10-, and 15-minute time intervals to simulate possible contact times in vivo. The Cell Titer-Glo Luminescent Cell Viability Assay was used to determine the number of viable cells present in culture following treatment.. The results showed an increase in cell viability with the lowering of NaOCl concentration. The use of 0.04% NaOCl was similar to the control, indicating nearly complete preservation of cell viability at all time intervals tested. As sodium hypochlorite concentration increased from 0.04% to 0.33%, cell viability decreased correspondingly.. The results indicate that the lowest concentration of NaOCl tested did not affect the viability of cells. This may prove beneficial in developing a new treatment protocol to help preserve existing vital pulp cells in revascularization cases.

Topics: Cell Count; Cells, Cultured; Dental Pulp; Disinfectants; Dose-Response Relationship, Drug; Humans; Neovascularization, Physiologic; Periapical Periodontitis; Pilot Projects; Regeneration; Root Canal Irrigants; Sodium Hypochlorite

The aim of this study was to investigate levels of matrix metalloproteinase-8 (MMP-8) and substance P (SP) in gingival crevicular fluid (GCF) during root canal treatment (RCT) of nonvital teeth.. Patients scheduled for nonsurgical RCT were prospectively selected; all patients provided informed consent. GCF samples were collected from teeth scheduled for RCT and their contralateral teeth across 3 different time periods. MMP-8 and SP levels were measured using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using a mixed model analysis and the Pearson correlation analysis.. Patients' subjective pain levels were significantly related to both MMP-8 and SP levels. MMP-8 and SP levels in GCF were decreased during RCT, and they showed a positive correlation with each other (P < .05).. This study demonstrated that periradicular inflammation of endodontic origin can elevate SP and MMP-8 levels in GCF.

Topics: Adult; Female; Follow-Up Studies; Gingival Crevicular Fluid; Humans; Inflammation Mediators; Male; Matrix Metalloproteinase 8; Neurotransmitter Agents; Pain Measurement; Periapical Periodontitis; Prospective Studies; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Substance P; Tooth, Nonvital; Toothache

This study identified the bacterial taxa enduring endodontic treatment procedures by using a combined 16S ribosomal RNA-based reverse-transcriptase polymerase chain reaction (RT-PCR) and reverse-capture checkerboard hybridization approach.. Samples were taken from infected canals of 15 teeth with apical periodontitis before treatment (S1), after chemomechanical preparation with NaOCl as the irrigant (S2), and after interappointment medication with a calcium hydroxide paste (S3). Bacterial presence was first screened by a DNA-based single PCR assay. RNA extracts were subjected to RT-PCR, and the resulting products were surveyed for the presence of 28 targeted taxa by using the checkerboard method.. Bacteria were found in all S1 samples. Detectable levels of bacterial ribosomal RNA, used as an indicator of viability, were observed in 60% of the cases after chemomechanical preparation and 53% after intracanal medication. The most prevalent taxa in S1 were Olsenella uli (67%), Pyramidobacter piscolens (60%), Streptococcus species (53%), and Bacteroidetes clone X083 (53%). Streptococcus species (47%), Fusobacterium nucleatum (40%), and O. uli (33%) prevailed in S2, whereas Streptococcus species (47%), Propionibacterium acnes (27%), and O. uli (27%) were the most frequent taxa in S3.. The present study with a combined molecular approach revealed that bacterial diversity was overall markedly reduced by treatment procedures. Although bacterial taxa more frequently identified in post-treatment samples emerge as potential risk factors for persistent disease, this remains to be determined by longitudinal studies.

Topics: Bacteria; Calcium Hydroxide; Camphor; Chlorophenols; Chronic Periodontitis; Dental Pulp Cavity; DNA, Bacterial; Drug Combinations; Drug Resistance, Bacterial; Humans; Oligonucleotide Array Sequence Analysis; Periapical Periodontitis; Reverse Transcriptase Polymerase Chain Reaction; RNA, Bacterial; RNA, Ribosomal, 16S; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

Topics: Anti-Infective Agents, Local; Bacterial Infections; Calcium Hydroxide; Candida albicans; Chlorhexidine; Dental Pulp Necrosis; Enterococcus faecalis; Humans; Periapical Periodontitis; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Sodium Hypochlorite

The objective of this study was to evaluate in vivo the revascularization and the apical and periapical repair after endodontic treatment using 2 techniques for root canal disinfection (apical negative pressure irrigation versus apical positive pressure irrigation plus triantibiotic intracanal dressing) in immature dogs' teeth with apical periodontitis.. Two test groups of canals with experimentally induced apical periodontitis were evaluated according to the disinfection technique: Group 1, apical negative pressure irrigation (EndoVac system), and Group 2, apical positive pressure irrigation (conventional irrigation) plus triantibiotic intracanal dressing. In Group 3 (positive control), periapical lesions were induced, but no endodontic treatment was done. Group 4 (negative control) was composed of sound teeth. The animals were killed after 90 days and the maxillas and mandibles were subjected to histological processing. The sections were stained with hematoxylin and eosin and Mallory Trichrome and examined under light microscopy. A description of the apical and periapical features was done and scores were attributed to the following histopathological parameters: newly formed mineralized apical tissue, periapical inflammatory infiltrate, apical periodontal ligament thickness, dentin resorption, and bone tissue resorption. Intergroup comparisons were done by the Kruskal-Wallis and Dunn's tests (alpha = 0.05).. Although statistically significant difference was found only for the inflammatory infiltrate (P < .05), Group 1 presented more exuberant mineralized formations, more structured apical and periapical connective tissue, and a more advanced repair process than Group 2.. From the histological observations, sodium hypochlorite irrigation with the EndoVac system can be considered as a promising disinfection protocol in immature teeth with apical periodontitis, suggesting that the use of intracanal antibiotics might not be necessary.

Topics: Alveolar Bone Loss; Alveolar Process; Animals; Anti-Bacterial Agents; Ciprofloxacin; Connective Tissue; Dental Pulp Cavity; Dentin; Dentin, Secondary; Dogs; Drug Combinations; Metronidazole; Minocycline; Neovascularization, Physiologic; Periapical Periodontitis; Periapical Tissue; Periodontal Ligament; Pressure; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Resorption; Sodium Hypochlorite; Therapeutic Irrigation; Tooth Apex; Wound Healing

This clinical study was conducted to investigate the ability of chemomechanical preparation with 2.5% NaOCl + 17% ethylenediaminetetraacetic acid (EDTA) and rotary nickel-titanium (NiTi) system in removing endotoxin from primary root canal infection with apical periodontitis.. Twenty-one root canals with necrotic pulps were selected. Samples were collected before (s1) and after chemomechanical preparation (s2). The limulus amebocyte lysate (LAL) assay was used to quantify endotoxins.. The LAL assay indicated that endotoxins were present in 100% of the root canals investigated (19/19) before (s1) and after chemomechanical preparation (s2). Analyses of the quantitative data revealed that the endotoxin content was significantly reduced at s2 (98.06%) compared with that at s1 (P < .05).. Our findings indicate that chemomechanical preparation with 2.5% NaOCl + 17% EDTA and rotary NiTi files was effective in reducing endotoxin load in the root canal infection from primarily infected teeth with apical periodontitis.

Topics: Adolescent; Adult; Aged; Chelating Agents; Dental Alloys; Dental Pulp Cavity; Dental Pulp Necrosis; Edetic Acid; Endotoxins; Equipment Design; Humans; Limulus Test; Lipopolysaccharides; Middle Aged; Nickel; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Titanium; Young Adult

We describe the successful use of a combination of nonsurgical root canal treatment and ultrasonic irrigation for collaborative management of a maxillary left lateral incisor with perforation of the apical third of the root. During the endodontic treatment procedure, the ultrasonically activated tip was used for intracanal irrigation. The area of perforation in the apical third of the root and the main root canal space were obturated with gutta-percha and root canal sealer, using a lateral condensation method. A follow-up clinical and radiographic examination at 5 years after treatment showed an asymptomatic tooth with excellent osseous healing.

Topics: Adult; Dental Instruments; Dental Pulp Necrosis; Humans; Incisor; Male; Maxilla; Periapical Periodontitis; Retreatment; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Therapeutic Irrigation; Tooth Injuries; Tooth Root; Ultrasonics

The purpose of this study was to compare the favorable outcome of root canal treatment determined by periapical radiographs (PRs) and cone beam computed tomography (CBCT) scans. Ninety-six roots of dogs' teeth were used to form four groups (n= 24). In group 1, root canal treatments were performed in healthy teeth. Root canals in groups 2 through 4 were infected until apical periodontitis (AP) was radiographically confirmed. Roots with AP were treated by one-visit therapy in group 2, by two-visit therapy in group 3, and left untreated in group 4. The radiolucent area in the PRs and the volume of CBCT-scanned periapical lesions were measured before and 6 months after the treatment. In groups 1, 2, and 3, a favorable outcome (lesions absent or reduced) was shown in 57 (79%) roots using PRs but only in 25 (35%) roots using CBCT scans (p = 0.0001). Unfavorable outcomes occurred more frequently after one-visit therapy than two-visit therapy when determined by CBCT scans (p = 0.023).

Topics: Animals; Bicuspid; Calcium Hydroxide; Composite Resins; Cone-Beam Computed Tomography; Dental Amalgam; Dental Pulp Cavity; Dental Restoration, Permanent; Dogs; Epoxy Resins; Glass Ionomer Cements; Gutta-Percha; Methylmethacrylates; Periapical Periodontitis; Periapical Tissue; Radiography, Dental, Digital; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Time Factors; Treatment Outcome; Zinc Oxide-Eugenol Cement

The aim of this Case Series was to evaluate the radiographic quality of root fillings performed 5 years previously using the noninstrumentation technology (NIT)-obturation method and to assess radiographically the outcome of these root canal treatments.. Seventeen patients requiring root canal treatment participated in this study and were re-evaluated after 5 years. After instrumentation with K-Flexofiles, Calcium-Hydroxide inter-appointment dressing, re-entry and copious irrigation with NaOCl, the teeth were root filled using the NIT.. Immediately after obturation the root fillings were (-0.78 +/- 0.11 mm) short when taking the radiographic apex as a reference point. After 60 months these values were -0.85 +/- 0.11 mm. No statistical difference was found (P > 0.05). In the periapical region, PAI rating 1 and 2 increased from 20.1% to 75.6% after 60 months.. * This prospective Case Series demonstrated the performance of the NIT-obturation method in vivo. * Root canals filled by the reduced-pressure method using sealer combined with gutta-percha cones showed good radiographic quality. * Periapical healing after 5 years was comparable with conventional filling techniques.

Topics: Bismuth; Calcium Hydroxide; Dental Pulp Cavity; Drug Combinations; Epoxy Resins; Follow-Up Studies; Gutta-Percha; Humans; Periapical Periodontitis; Periapical Tissue; Prospective Studies; Pulpitis; Radiography; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Silver; Sodium Hypochlorite; Technology, Dental; Titanium; Tooth Apex; Treatment Outcome; Vacuum; Vibration; Wound Healing

This case series reports the outcomes of 8 patients (ages 9-14 years) who presented with 9 immature permanent teeth with pulpal necrosis and apical periodontitis. During treatment, 5 of the teeth were found to have at least some residual vital tissue remaining in the root canal systems. After NaOCl irrigation and medication with ciprofloxacin, metronidazole, and minocycline, these teeth were sealed with mineral trioxide aggregate and restored. The other group of 4 teeth had no evidence of any residual vital pulp tissue. This second group of teeth was treated with NaOCl irrigation and medicated with ciprofloxacin, metronidazole, and minocycline followed by a revascularization procedure adopted from the trauma literature (bleeding evoked to form an intracanal blood clot). In both groups of patients, there was evidence of satisfactory postoperative clinical outcomes (1-5 years); the patients were asymptomatic, no sinus tracts were evident, apical periodontitis was resolved, and there was radiographic evidence of continuing thickness of dentinal walls, apical closure, or increased root length.

Topics: Adolescent; Anti-Infective Agents, Local; Child; Ciprofloxacin; Dens in Dente; Dental Pulp; Dental Pulp Necrosis; Dentition, Permanent; Female; Humans; Male; Metronidazole; Minocycline; Neovascularization, Physiologic; Periapical Periodontitis; Regeneration; Root Canal Irrigants; Sodium Hypochlorite; Tooth Apex

This study investigated the long-term (1-4 years) outcome of the endodontic treatment of teeth with apical periodontitis lesions performed by undergraduate students using a defined antimicrobial protocol.. Treatment protocol included a crown-down instrumentation technique, apical enlargement to predetermined sizes and apical level, irrigation with 2.5% sodium hypochlorite, and intracanal medication with calcium hydroxide/camphorated paramonochlorophenol (CPMC) paste. The first 100 teeth from patients who returned for follow-up were examined. The outcome was assessed based on radiographic and clinical criteria as healed (success), healing (uncertain), or not healed (failure).. Overall results showed that 76% of the teeth healed, 19% were healing, and 5% had not healed. Most healed cases (75%) or failed cases (80%) were already evident at 2 years. Seven cases took 4 years to heal completely.. The low failure rate observed in this study reinforces the importance of using an evidence-based antimicrobial strategy during endodontic treatment of teeth with apical periodontitis.

Topics: Anti-Infective Agents, Local; Bismuth; Calcium Hydroxide; Camphor; Chlorophenols; Clinical Protocols; Dental Plaque; Dental Pulp Necrosis; Dental Restoration Failure; Drug Combinations; Follow-Up Studies; Gutta-Percha; Humans; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Rubber Dams; Sodium Hypochlorite; Treatment Outcome

Root canal bacteria in teeth with apical periodontitis were enumerated after extraction and incubation. Canals in 36 teeth were sampled after: S1, incubation for 2 hours (group A), 2 days (group B), 4 days (group C), and 6 days (group D); S2, subsequent incubation for 1 week; S3, canal disinfection; and S4, final incubation for 1 week. Bacterial concentrations were determined by culture (colony-forming unit [CFU]) and epifluorescence-microscopy (EFM) and compared by using pairwise and exact-permutation tests (p < 0.05). CFU counts were lower than EFM counts. CFU counts in S1 were higher in Gp(A) than in Gp(C) (p < 0.004) and Gp(D) (p < 0.02). EFM counts in S1 were higher in Gp(A) than in Gp(C) (p < 0.02). Both enumeration methods showed bacterial counts decreasing from S1 to S2 (p < 0.04). EFM was superior to culture in this ex vivo model. The indigenous flora survived incubation for 6 days, but the adverse effect of initial access would preclude testing of disinfection protocols that require two sessions.

Topics: Bacteria; Colony Count, Microbial; Dental Disinfectants; Dental Pulp Cavity; Dental Pulp Exposure; Dentin; Humans; Materials Testing; Microscopy, Fluorescence; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Time Factors

This clinical study was conducted to quantify endotoxins and cultivable bacteria in teeth with pulp necrosis and apical periodontitis before and after chemomechanical preparation with 2.5% sodium hypochlorite (NaOCl) and to investigate the possible correlation of endotoxin and cultivable bacteria with the presence of clinical symptomatology. Twenty-four root canals were selected. Samples were collected before (s1) and after chemomechanical preparation (s2). Culture techniques were used to determine the colony-forming unit. A limulus amebocyte lysate (LAL) assay was used to quantify endotoxins (lipopolysaccharide, LPS). LPS and bacteria were detected in 100% of the initial samples (s1), with a median concentration of 139 endotoxin units/mL and 2.64 x 10(5) colony-forming units/mL, respectively. Higher levels of LPS were found in teeth with clinical symptomatology (p < .05). At s2, mean endotoxin reduction of 59.99% and mean bacterial load reduction of 99.78% were found. Our findings indicated that chemomechanical preparation with 2.5% NaOCl was moderately effective against bacteria but less effective against endotoxins in root canal infection. Furthermore, a statistically significant association was found between higher levels and clinical symptomatology.

Topics: Adolescent; Adult; Bacteria; Colony Count, Microbial; Dental Pulp Necrosis; Endotoxins; Humans; Limulus Test; Middle Aged; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

Bacteria that persist after endodontic disinfection procedures may lead to treatment failure. Over 50% of the bacteria found in endodontic infections are as-yet-uncultivated so investigations of bacteria that endure treatment procedures should include techniques that side-step cultivation. This culture-independent study evaluated the bacterial reduction promoted by intracanal disinfection procedures and identified the taxa persisting after treatment. Samples taken from the infected canals of teeth with apical periodontitis before treatment (S1), after instrumentation using NaOCl as irrigant (S2) and after interappointment medication with a calcium hydroxide paste (S3) were subjected to 16S rRNA gene clone library and real-time polymerase chain reaction analyses. The S2 and S3 samples from five of the 15 canals showed negative results. In the other cases, instrumentation and instrumentation/medication promoted a significant reduction (99.67% and 99.85%, respectively) in the number of bacteria when compared to S1 samples. Forty-three distinct bacterial taxa were identified, of which 24 (56%) were as-yet-uncultivated phylotypes. Nineteen of these 43 taxa (including eight as-yet-uncultivated phylotypes) were disclosed in post-treatment samples, with streptococci being the most prevalent taxa. Findings demonstrated that culture-independent methods provide a detailed insight into the effects of intracanal disinfection protocols, helping to define more effective strategies to deal with endodontic bacteria, including as-yet-uncultivated phylotypes.

Topics: Actinobacteria; Bacteria; Bacteriological Techniques; Bacteroides; Calcium Hydroxide; Colony Count, Microbial; Dental Pulp Cavity; Disinfectants; Fusobacteria; Gram-Positive Bacteria; Humans; Periapical Periodontitis; Proteobacteria; RNA, Bacterial; RNA, Ribosomal, 16S; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Streptococcus

This clinical study was undertaken to compare the effectiveness of 2.5% sodium hypochlorite (NaOCl) and 0.12% chlorhexidine digluconate as irrigants in reducing the cultivable bacterial populations in infected root canals of teeth with apical periodontitis.. According to stringent inclusion/exclusion criteria, 32 teeth with primary intraradicular infections and chronic apical periodontitis were selected and followed in the study. Bacterial samples were taken at the baseline (S1) and after chemomechanical preparation using either NaOCl (n = 16) or chlorhexidine (n = 16) as irrigants (S2). Cultivable bacteria recovered from infected root canals at the 2 stages were counted. Isolates from S2 samples were identified by means of 16S rRNA gene sequencing analysis.. At S1, all canals were positive for bacteria, and the median number of bacteria per canal was 7.32 x 10(5) for the NaOCl group and 8.5 x 10(5) for the chlorhexidine group. At S2, the median number of bacteria in canals irrigated with NaOCl and chlorhexidine was 2.35 x 10(3) and 2 x 10(2), respectively. Six of 16 (37.5%) canals from the NaOCl group and 8 of 16 (50%) canals from the chlorhexidine group yielded negative cultures. Chemomechanical preparation using either solution substantially reduced the number of cultivable bacteria in the canals. No significant difference was observed between the NaOCl and chlorhexidine groups with regard to the number of cases yielding negative cultures (P = .72) or quantitative bacterial reduction (P = .609). The groups irrigated with NaOCl or chlorhexidine showed a mean number of 1.3 and 1.9 cultivable species per canal, respectively. The great majority of isolates in S2 were from gram-positive bacteria, with streptococci as the most prevalent taxa.. The present findings revealed no significant difference when comparing the antibacterial effects of 2.5% NaOCl and 0.12% chlorhexidine used as irrigants during the treatment of infected canals.

Topics: Chlorhexidine; Colony Count, Microbial; Dental Pulp Cavity; Humans; Periapical Periodontitis; Polymerase Chain Reaction; RNA, Ribosomal, 16S; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Statistics, Nonparametric; Stem Cells; Streptococcus

This clinical study investigated the bacterial reduction after instrumentation using 2.5% sodium hypochlorite (NaOCl) as an irrigant and further interappointment dressing with a calcium hydroxide (Ca(OH)(2))/camphorated paramonochlorophenol (CPMC) paste. Eleven teeth with primary intraradicular infections and chronic apical periodontitis selected according to stringent inclusion/exclusion criteria followed in the study. Bacterial samples were taken before treatment (S1), after chemomechanical preparation using hand NiTi files and 2.5% NaOCl (S2), and following a 7-day medication with a Ca(OH)(2) paste in CPMC (S3). Cultivable bacteria recovered from infected root canals at the three stages were counted and identified by means of 16S rRNA gene sequencing analysis. At S1, all cases harbored bacteria, with a mean number of 2.8 taxa per canal (range, 1-6). At S2, 6 of 11 (54.5%) of the cases yielded positive cultures, with one to three species per canal. At S3, only one case (9.1%) was positive for the presence of bacteria, with Propionibacterium acnes as the only taxon isolated. A significantly high reduction in bacterial counts was observed between S1 and S2, and S1 and S3. Significant differences were also observed for comparisons involving S2 and S3 samples with regard to both quantitative bacterial reduction (p = 0.029) and number of culture-negative cases (p = 0.03). It was concluded that chemomechanical preparation with 2.5% NaOCl as an irrigant significantly reduced the number of bacteria in the canal but failed to render the canal free of cultivable bacteria in more than one-half of the cases. A 7-day intracanal dressing with Ca(OH)(2)/CPMC paste further significantly increased the number of culture-negative cases.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Bacteria; Calcium Hydroxide; Camphor; Chi-Square Distribution; Child; Chlorophenols; Colony Count, Microbial; Dental Pulp Cavity; Dental Pulp Necrosis; DNA, Bacterial; Drug Combinations; Female; Humans; Male; Middle Aged; Periapical Periodontitis; RNA, Ribosomal, 16S; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite

This clinical study was conducted to assess the bacterial reduction after chemomechanical preparation with 2.5% NaOCl as an irrigant and the additive antibacterial effect of intracanal dressing with calcium hydroxide. According to stringent inclusion criteria, 11 teeth with primary intraradicular infections and chronic apical periodontitis were selected and monitored in the study. Bacterial samples were taken at the baseline (before treatment) (S1), after chemomechanical preparation with 2.5% NaOCl as an irrigant (S2), and after a 7-day dressing with a calcium hydroxide paste in glycerin (S3). Cultivable bacteria recovered from infected root canals at the 3 stages were counted and identified by means of 16S rRNA gene sequencing analysis. At S1, all canals were positive for bacteria, with the mean number of 2.8 taxa per canal (range, 1-6). At S2, 5 cases (45.5%) still harbored cultivable bacteria, with 1 or 2 species per canal. At S3, bacteria were cultured from 2 cases (18.2%), with 1 species per positive case. There was no indication that any specific bacterial taxon was more resistant to treatment. A significant reduction in bacterial counts was observed between S1 and S2, and S1 and S3. However, no statistically significant difference was observed for comparisons involving S2 and S3 samples with regard to the number of cases yielding negative cultures (P = .18) or quantitative bacterial reduction (P = .19). It was concluded that the whole antibacterial protocol used in this study significantly reduced the number of bacteria in the canal and rendered most canals free of cultivable bacteria.

Topics: Adult; Calcium Hydroxide; Dental Disinfectants; Dental Pulp Cavity; Female; Humans; Male; Middle Aged; Periapical Periodontitis; RNA, Ribosomal, 16S; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Statistics, Nonparametric

This study assessed the effectiveness of different concentrations of sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) (Vista Dental Products, Racine, WI), and BioPure MTAD (Dentsply Endodontics-Tulsa Dental, Tulsa, OK). Intracanal contents were collected from 10 patients diagnosed with chronic apical periodontitis. The samples were cultured on hemisections of root apices to generate a polymicrobial biofilm. Each biofilm was separately immersed in 6% NaOCl, 3% NaOCl, 1% NaOCl, 2% CHX, 1% NaOCl followed by BioPure MTAD, and sterile phosphate buffered solution (PBS). SEM analysis showed 6% NaOCl and 3% NaOCl were capable of disrupting and removing the biofilm; 1% NaOCl and 1% NaOCl followed by MTAD were capable of disrupting the biofilm, but not eliminating bacteria; 2% CHX was not capable of disrupting the biofilm. Viable bacteria could not be cultured from specimens exposed to 6% NaOCl, 2 % CHX, or 1% NaOCl followed by BioPure MTAD. These results indicate that 6% NaOCl was the only irrigant capable of both rendering bacteria nonviable and physically removing the biofilm.

Topics: Biofilms; Chlorhexidine; Citric Acid; Dental Pulp Necrosis; Doxycycline; Humans; Microbial Viability; Microscopy, Electron, Scanning; Periapical Periodontitis; Polysorbates; Root Canal Irrigants; Sodium Hypochlorite; Tooth Apex

Four clinical cases of immature teeth that developed periradicular periodontitis or abscess underwent a conservative treatment approach, i.e. without canal instrumentation. Instead, only copious 2.5% NaOCl irrigation was performed. All cases presented herein developed mature apices after 7 months to 5 years after the initial treatment without complications, although narrowing canal space was observed. Our clinical observations support a shifting paradigm toward a conservative approach by providing a favorable environment for tissue regeneration. The mechanism of this continued development and formation of the root end is discussed.

Topics: Child; Dental Pulp; Female; Humans; Male; Periapical Abscess; Periapical Periodontitis; Regeneration; Root Canal Irrigants; Root Canal Obturation; Sodium Hypochlorite; Tooth Apex

To assess the in vivo intracanal microbial status of apical root canal system of mesial roots of human mandibular first molars with primary apical periodontitis immediately after one-visit endodontic treatment. The residual intracanal infection was confirmed by correlative light and transmission electron microscopy.. Sixteen diseased mesial roots of mandibular first molars were treated endodontically, each in one visit. Mesio-buccal canals were instrumented using stainless steel hand files and mesio-lingual canals with a nickel-titanium rotary system. The canals were irrigated with 5.25% sodium hypochlorite (NaOCl) during the instrumentation procedures, rinsed with 10 mL of 17% ethylenediamine tetraacetic acid (EDTA), and obturated with gutta-percha and zinc oxide eugenol cement. Thereafter, the apical portion of the root of each tooth was removed by flap-surgery. The specimens were fixed, decalcified, subdivided in horizontal plane, embedded in plastic, processed, and evaluated by correlative light and transmission electron microscopy.. Fourteen of the 16 endodontically treated teeth revealed residual intracanal infection after instrumentation, antimicrobial irrigation, and obturation. The microbes were located in inaccessible recesses and diverticula of instrumented main canals, the intercanal isthmus, and accessory canals, mostly as biofilms.. The results show (1) the anatomical complexity of the root canal system of mandibular first molar roots and (2) the organization of the flora as biofilms in inaccessible areas of the canal system that cannot be removed by contemporary instruments and irrigation alone in one-visit treatment. These findings demonstrate the importance of stringent application of all nonantibiotic chemo-mechanical measures to treat teeth with infected and necrotic root canals so as to disrupt the biofilms and reduce the intraradicular microbial load to the lowest possible level so as to expect a highly favorable long-term prognosis of the root canal treatment.

Topics: Adolescent; Adult; Aged; Apicoectomy; Biofilms; Dental Pulp Cavity; Edetic Acid; Female; Gutta-Percha; Humans; Male; Microscopy, Electron, Transmission; Middle Aged; Molar; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Tooth Apex; Zinc Oxide-Eugenol Cement

This study assessed the efficacy of a triple antibiotic paste in the disinfection of immature dog teeth with apical periodontitis. The canals were sampled before (S1) and after (S2) irrigation with 1.25% NaOCL and after dressing with a triple antibiotic paste (S3), consisting of metronidazole, ciprofloxacin, and minocycline. At S1, 100% of the samples cultured positive for bacteria with a mean CFU count of 1.7 x 10. At S2, 10% of the samples cultured bacteria-free with a mean CFU count of 1.4 x 10. At S3, 70% of the samples cultured bacteria-free with a mean CFU count of only 26. Reductions in mean CFU counts between S1 and S2 (p < 0.0001) as well as between S2 and S3 (p < 0.0001) were statistically significant. These results indicate the effectiveness of a triple antibiotic paste in the disinfection of immature teeth with apical periodontitis.

Topics: Animals; Bacteria, Anaerobic; Ciprofloxacin; Colony Count, Microbial; Dental Pulp; Dogs; Drug Therapy, Combination; Metronidazole; Minocycline; Neovascularization, Physiologic; Periapical Periodontitis; Root Canal Irrigants; Sodium Hypochlorite; Tooth Apex

In six monkeys, 160 root canals were inoculated with a combination of four bacterial strains belonging to species Streptococcus milleri, Peptostreptococcus anaerobius, Prevotella oralis, and Fusobacterium nucleatum. In two other monkeys, 24 root canals were inoculated with a five-strain combination consisting of these strains and a strain of Enterococcus faecalis. All strains were previously isolated from an infected monkey root canal. After 8-12 months, survival of the strains was recorded bacteriologically, and the reaction in the periapical region was radiographed. From 180 of 184 root canals, one or more of the bacterial strains were reisolated. The two facultative strains were more frequently reisolated than the anaerobic strains. Apical periodontitis was registered in the periapical region of more than 96% of root canals with reisolated bacteria but in none of those without reisolated bacteria. Endodontic treatment was carried out in two sessions with an interval of 14 d without interappointment dressings, and the effect was evaluated bacteriologically before and after each treatment. The chemo-mechanical treatment reduced significantly the number of strains and bacterial cells. The facultative bacteria were more resistant to the treatment than the anaerobic bacteria. The five-strain combination had a higher survival rate than the four-strain combination.

Topics: Animals; Bacteria, Anaerobic; Dental Pulp Cavity; Enterococcus faecalis; Female; Fusobacterium nucleatum; Hydrogen Peroxide; Macaca fascicularis; Peptostreptococcus; Periapical Periodontitis; Prevotella; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Streptococcus milleri Group

The objective of this study was to evaluate the influence of irrigants on the antimicrobial potential of calcium hydroxide paste in dogs' teeth with apical periodontitis. Forty-eight premolar teeth of adult mongrel dogs had their root canals opened to the oral environment for 6 months. The root canals were prepared and treated with different irrigating solutions and intracanal medicaments, according to the following groups: 1) 2.5% sodium hypochlorite (NaOCl) + calcium hydroxide paste (CHP); 2) 2% chlorhexidine (CHX) + CHP; 3) vinegar + CHP; 4) vinegar + vinegar. In group 4, both the irrigating solution and intracanal medicament were vinegar, which was renewed every 7 days. Each sample was collected by using two paper points maintained in position for 1 min, and individually transported and immersed in 7 mL of Letheen broth (LB), followed by incubation at 37 degrees C for 48 h. Microbial growth was analyzed by two methods: turbidity of the culture medium and subculture on a specific nutrient broth (brain heart infusion). After 21 days, all experimental groups had microbial growth, however, in different percentages: group 1 - 30%; group 2 - 30%; group 3 - 40%; group 4 - 60%. All materials tested had antimicrobial potential; however, the influence of calcium hydroxide paste on the control of microorganisms must be remembered.

Topics: Acetic Acid; Animals; Anti-Infective Agents, Local; Bacteria; Calcium Hydroxide; Chlorhexidine; Dental Pulp Cavity; Dogs; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Wound Healing

To evaluate the effect of biomechanical preparation with different irrigating solutions and calcium hydroxide dressing in dog root canals containing bacterial endotoxin (lipopolysaccharides; LPS).. One hundred and forty premolar roots from seven dogs were filled with Escherichia coli LPS for 10 days (three roots were lost during histological processing). The following irrigating solutions were used for biomechanical preparation: 1% (group I, n = 20), 2.5% (group II, n = 19) and 5% sodium hypochlorite (group III, n = 19), 2% chlorhexidine digluconate (group IV, n = 20) and physiological saline solution (group V, n = 19). In group VI (n = 20), the LPS solution was maintained in the root canal during the entire experiment and in group VII (n = 20), after biomechanical preparation with saline solution, the root canals were filled with a calcium hydroxide dressing (Calen; control). After 60 days, the animals were sacrificed and the following parameters of periapical disease were evaluated: (a) inflammatory infiltrate, (b) periodontal ligament thickness, (c) cementum resorption and (d) bone resorption. Scores were given and data were analysed statistically with the Kruskal-Wallis and Dunn tests (P < 0.05).. Histopathological evaluation showed that groups I-VI had more inflammatory infiltrate, greater periodontal ligament thickening and greater cementum and bone resorption (P < 0.05) compared to group VII, which received the calcium hydroxide intracanal dressing.. Biomechanical preparation with the irrigating solutions did not inactivate the effects of the endotoxin but the calcium hydroxide intracanal dressing did appear to inactivate the effects induced by the endotoxin in vivo.

Topics: Alveolar Bone Loss; Animals; Anti-Infective Agents, Local; Calcium Hydroxide; Chlorhexidine; Dental Cementum; Disinfectants; Dogs; Endotoxins; Escherichia coli; Lipopolysaccharides; Periapical Periodontitis; Periodontal Ligament; Root Canal Irrigants; Root Canal Preparation; Root Resorption; Sodium Chloride; Sodium Hypochlorite; Statistics, Nonparametric

The choice of an irrigating solution for use in infected root canals requires previous knowledge of the microorganisms responsible for the infectious process as well as the properties of different irrigating solutions. Complex internal anatomy, host defenses and microorganism virulence are important factors in the treatment of teeth with asymptomatic apical periodontitis. Irrigating solutions must have expressive antimicrobial action and tissue dissolution capacity. Sodium hypochlorite is the most used irrigating solution in endodontics, because its mechanism of action causes biosynthetic alterations in cellular metabolism and phospholipid destruction, formation of chloramines that interfere in cellular metabolism, oxidative action with irreversible enzymatic inactivation in bacteria, and lipid and fatty acid degradation. The aim of this work is to discuss the mechanism of action of sodium hypochlorite based on its antimicrobial and physico-chemical properties.

Topics: Bacteria; Chloramines; Dental Pulp; Dental Pulp Cavity; Disinfectants; Enzyme Inhibitors; Fatty Acids; Humans; Lipids; Oxidants; Oxidation-Reduction; Periapical Periodontitis; Phospholipids; Root Canal Irrigants; Sodium Hypochlorite; Solubility; Virulence

It has been suggested that the apical portion of a root canal is not adequately disinfected by typical instrumentation regimens. The purpose of this study was to determine whether instrumentation to sizes larger than typically used would more effectively remove culturable bacteria from the canal. Forty patients with clinical and radiographic evidence of apical periodontitis were recruited from the endodontic clinic. Mandibular cuspids (n = 2), bicuspids (n = 11), and molars (mesial roots) (n = 27) were selected for the study. Bacterial sampling was performed upon access and after each of two consecutive instrumentations. The first instrumentation utilized 1% NaOCI and 0.04 taper ProFile rotary files. The cuspid and bicuspid canals were instrumented to a #8 size and the molar canals to a #7 size. The second instrumentation utilized LightSpeed files and 1% NaOCl irrigation for further enlargement of the apical third. Typically, molars were instrumented to size 60 and cuspid/bicuspid canals to size 80. Our findings show that 100% of the cuspid/bicuspid canals and 81.5% of the molar canals were rendered bacteria-free after the first instrumentation sizes. The molar results improved to 89% after the second instrumentation. Of the (59.3%) molar mesial canals without a clinically detectable communication, 93% were rendered bacteria-free with the first instrumentation. Using a Wilcoxon rank sum test, statistically significant differences (p < 0.0001) were found between the initial sample and the samples after the first and second instrumentations. The differences between the samples that followed the two instrumentation regimens were not significant (p = 0.0617). It is concluded that simple root canal systems (without multiple canal communications) may be rendered bacteria-free when preparation of this type is utilized.

Topics: Bacteria; Bicuspid; Cuspid; Dental Alloys; Dental Pulp Cavity; Disinfectants; Disinfection; Equipment Design; Humans; Molar; Nickel; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Statistics as Topic; Statistics, Nonparametric; Titanium; Tooth Apex

The objective of this study was to evaluate the apical and periapical repair after endodontic treatment of teeth with pulp necrosis and a chronic periapical lesion in dogs. Seventy-two root canals from four mongrel dogs were submitted to biomechanical preparation, using 5.25% sodium hypochlorite or 2% chlorhexidine digluconate as the irrigating solution. The root canals were subsequently either filled immediately with Sealapex, using active lateral gutta-percha condensation, or a calcium hydroxide root canal dressing was applied for 15 days before filling with Sealapex. After 210 days, the animals were killed by anesthetic overdose, and the obtained histological sections were stained with hematoxylin and eosin for optical microscopic analysis of apical and periapical repair. There was better histological repair in the groups with the root canal dressing (p < 0.05) than the groups with immediate obturation. Comparing the immediate obturation groups, irrigation with chlorhexidine solution resulted in better repair than sodium hypochlorite.

Topics: Animals; Bone Resorption; Calcium Hydroxide; Chlorhexidine; Dental Pulp Necrosis; Disease Models, Animal; Disinfectants; Dogs; Female; Gutta-Percha; Male; Periapical Diseases; Periapical Periodontitis; Periapical Tissue; Periodontal Ligament; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Root Resorption; Salicylates; Sodium Hypochlorite; Statistics as Topic; Statistics, Nonparametric; Time Factors; Wound Healing

This report describes 2 endodontic patients who had persistent signs and symptoms after conventional root canal treatment. The aim of this study was to determine what microorganisms were present in the root canals of the teeth with failed endodontic therapy.. After removal of the root fillings, the canals were sampled by advanced microbiological techniques and the isolates were characterized by various tests.. Bacteria, which grew in pure cultures, were isolated in each case. The bacteria were similar to each other and were classified as Actinomyces on the basis of phylogenic and phenotypic evidence. The bacteria were different from others within the genus, thus warranting designation as a new species, Actinomyces radicidentis.. The 2 cases of endodontic failure were infected with A radicidentis, a new Actinomyces species. This bacterium joins a restricted group of other microorganisms that have been associated with failure of root canal treatment.

Topics: Actinomyces; Actinomycosis; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Calcium Hydroxide; Dental Pulp Cavity; Drug Resistance, Microbial; Female; Humans; Male; Microscopy, Electron; Periapical Abscess; Periapical Diseases; Periapical Granuloma; Periapical Periodontitis; Phenotype; Phylogeny; Root Canal Irrigants; Root Canal Therapy; Root Resorption; Sodium Hypochlorite; Treatment Failure

The occurrence of Enterococcus faecalis in root canals of previously root filled teeth with apical periodontitis requiring retreatment was studied in Lithuanian patients. Twenty-five asymptomatic teeth were included in the study. Avoiding contamination microbiological samples were taken from the canals before and after preparation and irrigation with sodium hypochlorite and EDTA. Microbes were isolated from 20 of 25 teeth. E. faecalis was isolated from 14 of those 20 culture positive teeth, usually in pure culture or as a major component of the flora. Second samples taken after preparation revealed growth in 7 of the 20 teeth. Five of the seven cases were E. faecalis in pure culture. Isolation of E. faecalis was not related to the use of any particular root filling material in the original root filling. The results indicate that, rather than previous chemical treatment, it is the ecological conditions present in the incompletely filled root canal that are important for the presence of E. faecalis in these teeth.

Topics: Bacteriological Techniques; Chelating Agents; Dental Pulp Cavity; Disinfectants; Edetic Acid; Enterococcus faecalis; Gram-Positive Bacterial Infections; Humans; Lithuania; Periapical Periodontitis; Retreatment; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Specimen Handling

The purpose of this study was to evaluate the extent of bacterial reduction with nickel-titanium rotary instrumentation and 1.25% NaOCl irrigation. Also, the additional antibacterial effect of calcium hydroxide for >1 wk was tested. Forty-two subjects with radiographic and clinical signs of chronic apical periodontitis were recruited. The canals were sampled before treatment, during and after instrumentation, and after treatment with calcium hydroxide and the samples incubated anaerobically for 7 days at 37 degrees C. The bacteria from each sample were quantified and the log10 values were used for calculations and comparisons. The initial sample confirmed infection of the canals. There was a significantly greater pattern of reduction of bacteria when NaOCl was used as an irrigant, compared with sterile saline (p < 0.05). After instrumentation with NaOCl irrigation, 61.9% of canals were rendered bacteria-free. The placement of calcium hydroxide for at least 1 wk rendered 92.5% of the canals bacteria free. This was a significant reduction, compared with NaOCl irrigation alone (p = 0.0001). The results of this study indicate that NaOCl irrigation with rotary instrumentation is an important step in the reduction of canal bacteria during endodontic treatment. However this method could not consistently render canals bacteria-free. The addition of calcium hydroxide intracanal medication should be used to more predictably attain this goal.

Topics: Anaerobiosis; Analysis of Variance; Bacteria; Calcium Hydroxide; Chronic Disease; Colony Count, Microbial; Dental Alloys; Dental Pulp Cavity; Disinfectants; Equipment Design; Follow-Up Studies; Humans; Linear Models; Nickel; Periapical Periodontitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Sodium Chloride; Sodium Hypochlorite; Statistics as Topic; Time Factors; Titanium

This study investigated the role of infection on the prognosis of endodontic therapy by following-up teeth that had had their canals cleaned and obturated during a single appointment. The root canals of 55 single-rooted teeth with apical periodontitis were thoroughly instrumented and irrigated with sodium hypochlorite solution. Using advanced anaerobic bacteriological techniques, post-instrumentation samples were taken and the teeth were then root-filled during the same appointment. All teeth were initially infected; after instrumentation low numbers of bacteria were detected in 22 of 55 root canals. Periapical healing was followed-up for 5 years. Complete periapical healing occurred in 94% of cases that yielded a negative culture. Where the samples were positive prior to root filling, the success rate of treatment was just 68%--a statistically significant difference. Further investigation of three failures revealed the presence of Actinomyces species in each case; no other specific bacteria were implicated in failure cases. These findings emphasize the importance of completely eliminating bacteria from the root canal system before obturation. This objective cannot be reliably achieved in a one-visit treatment because it is not possible to eradicate all infection from the root canal without the support of an inter-appointment antimicrobial dressing.

Topics: Bacteria; Bacterial Infections; Biopsy; Dental Disinfectants; Dental Pulp Cavity; Follow-Up Studies; Humans; Immunohistochemistry; Periapical Periodontitis; Periapical Tissue; Root Canal Obturation; Sodium Hypochlorite; Time Factors; Treatment Outcome

The aim of this study was to evaluate clinically and radiographically the long-term results of endodontic therapy. A total of 172 mature teeth with periapical radiolucencies with and without symptoms were treated endodontically using calcium hydroxide paste as the intracanal medicament and a calcium hydroxide containing root canal sealer. In 58 teeth, the dressing was accidentally or intentionally extruded into the lesions. All cases were followed up for a period of 2-5 years. The teeth in which the dressing was extruded did not show a different healing pattern from the ones treated conventionally. The complete healing rate for all cases was 80.8% while incomplete healing had taken place in 7.6% of the cases.

Topics: Adolescent; Adult; Calcium Hydroxide; Evaluation Studies as Topic; Extravasation of Diagnostic and Therapeutic Materials; Female; Follow-Up Studies; Humans; Male; Middle Aged; Periapical Periodontitis; Prognosis; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Treatment Outcome; Wound Healing; Zinc Oxide

Dogs' teeth with induced chronic periapical periodontitis were treated endodontically by two different methods, and the results were compared. A total of 40 root canals from the upper and lower premolars of two dogs were prepared chemomechanically. In method 1, a high-concentration (5.25%) hypochlorite solution was used during the instrumentation of the root canal, and an antibacterial dressing was applied between sessions, followed by filling of the root canal. In method 2, a low-concentration (0.5%) sodium hypochlorite solution was used as an adjunct to mechanical debridement, and the root canal was filled during the same session. The histopathological results showed that method 1 led to better periapical repair than method 2.

Topics: Animals; Anti-Infective Agents, Local; Calcium Hydroxide; Dental Cementum; Dogs; Edetic Acid; Periapical Periodontitis; Periapical Tissue; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Time Factors; Treatment Outcome; Wound Healing

The effects of different intracanal medicaments and zinc oxide-eugenol based root canal sealers on an experimentally induced apical periodontitis were studied histologically in mesial roots of lower molars of Wistar rats. After root canal instrumentation each canal was filled either with an intracanal medicament twice for 3 days each time or with a sealer for 21 days. The intracanal medicament chlorophenol caused periapical tissue damage. P-chloroxylenol-camphor lead to periapical improvement as did 5% sodium-hypochlorite. 12% sodium-hypochlorite gave tissue damage. After intracanal medication with an aqueous suspension of calcium hydroxide periapical repair was clearly visible. A combination of a corticoid and an antibiotic appeared to induce damage of the periapical tissues. The root canal sealers Endomethasone and N2 essentially impaired periapical repair. The results were acceptable for Aptal-Zink-Harz root canal fillings after 21 days as well as after 56 days.

Topics: Administration, Topical; Animals; Anti-Inflammatory Agents; Calcium Hydroxide; Camphor; Chlorophenols; Demeclocycline; Dexamethasone; Drug Combinations; Eugenol; Female; Formaldehyde; Hydrocortisone; Periapical Periodontitis; Periapical Tissue; Rats; Rats, Wistar; Root Canal Filling Materials; Root Canal Irrigants; Sodium Hypochlorite; Thymol; Triamcinolone Acetonide; Zinc Oxide; Zinc Oxide-Eugenol Cement

The objective of the present study was to evaluate radiographically and bacteriologically apical and periapical repair in dogs' teeth with induced chronic periapical lesions with the use of two different operative techniques (techniques 1 and 2). The study was conducted on 40 root canals of upper and lower premolars from two dogs aged approximately 12 months. Periapical lesions were induced by leaving the root canals exposed to the oral environment for 5 days and then sealing them with zinc oxide-eugenol for 45 days. After this period, radiographic examination revealed the occurrence of a radiolucent lesion and endodontic treatment was started. The two techniques did not differ in terms of chemomechanical preparation, final filling, or type of cement, but differed in terms of irrigating solution and the presence of an antibacterial dressing. Thus 4% to 6% hypochlorite and hydrogen peroxide (10 volumes) were used in technique 1 during chemomechanical preparation and an antibacterial dressing based on calcium hydroxide was applied between sessions, whereas Dakin's fluid (0.5% sodium hypochlorite solution) and a final filling with no antibacterial dressing were used in technique 2. After chemomechanical preparation, the root canals were filled with gutta-percha cones and Sealapex (Sealapex-Sybron, Kerr, Sao Paulo, Brazil), and the animals were killed 270 days after the final filling. Blocks were cut into 6-microns sections and stained by the Brown and Brenn method.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Calcium Hydroxide; Camphor; Chi-Square Distribution; Chlorophenols; Chronic Disease; Dental Cementum; Dental Pulp Cavity; Dentin; Dogs; Drug Combinations; Endotoxins; Gram-Positive Bacteria; Hydrogen Peroxide; Periapical Periodontitis; Radiography; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite

Dogs' teeth with apical periodontitis were treated endodontically, Dakin's solution being used in an experimental group as the irrigation solution, and camphorated paramonochlorophenol as an intracanal dressing. For a second group of teeth, the irrigation solution used was physiologic saline, dry cotton only being placed into the pulpal chamber to take the place of an intracanal dressing. In a second visit, overinstrumentation and a new application of the same kind of dressing were performed, the root canals being then filled with gutta-percha cones and zinc oxide-eugenol cement. Other specimens were treated, in one visit, where physiologic saline or Dakin's solution were the irrigation solutions. The animals were sacrificed 6 months after the obturation of the root canals. Histologic exams showed better results for the experimental group where Dakin's solution and camphorated paramonochlorophenol had been used, with signs of repair characterized by newly formed cementum and bone tissue, as well as a marked reduction in size of the periapical lesions. No differences were seen in the results with physiologic saline or Dakin's solution as irrigants.

Topics: Animals; Anti-Infective Agents, Local; Camphor; Chlorophenols; Dogs; Drug Combinations; Granulation Tissue; Periapical Periodontitis; Root Canal Irrigants; Sodium Hypochlorite; Wound Healing

Some endodontic emergencies occur as a result of attempts to relieve symptoms of pulpitis. The aim of this study was to identify any predictor of postoperative pain in a patient population treated by dental students. Patients who reported for treatment of symptomatic pulpitis were subjected to three different emergency treatment regimens. Clinical data was collected on those patients who reported in the emergency service with severe postoperative pain within 24 hours of emergency endodontic treatment. Statistical analysis of these data suggested that the type of endodontic emergency procedure carried out was a significant predictor of severe postoperative pain.

Topics: Adolescent; Adult; Age Factors; Aged; Child; Emergencies; Female; Florida; Humans; Incidence; Male; Middle Aged; Pain, Postoperative; Periapical Periodontitis; Pulpectomy; Pulpitis; Pulpotomy; Root Canal Filling Materials; Root Canal Irrigants; Sex Factors; Sodium Hypochlorite; Tooth; Zinc Oxide-Eugenol Cement

Topics: Animals; Dental Pulp Cavity; Macaca fascicularis; Male; Periapical Periodontitis; Periapical Tissue; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Ultrasonic Therapy

Topics: Animals; Iodine; Macaca mulatta; Periapical Periodontitis; Periapical Tissue; Potassium Iodide; Sodium Hypochlorite; Tooth Resorption