sodium-hypochlorite and Root-Resorption

Calcium hydroxide has been included within several materials and antimicrobial formulations that are used in a number of treatment modalities in endodontics. These include, inter-appointment intracanal medicaments, pulp-capping agents and root canal sealers. Calcium hydroxide formulations are also used during treatment of root perforations, root fractures and root resorption and have a role in dental traumatology, for example, following tooth avulsion and luxation injuries. The purpose of this paper is to review the properties and clinical applications of calcium hydroxide in endodontics and dental traumatology including its antibacterial activity, antifungal activity, effect on bacterial biofilms, the synergism between calcium hydroxide and other agents, its effects on the properties of dentine, the diffusion of hydroxyl ions through dentine and its toxicity. Pure calcium hydroxide paste has a high pH (approximately 12.5-12.8) and is classified chemically as a strong base. Its main actions are achieved through the ionic dissociation of Ca(2+) and OH(-) ions and their effect on vital tissues, the induction of hard-tissue deposition and the antibacterial properties. The lethal effects of calcium hydroxide on bacterial cells are probably due to protein denaturation and damage to DNA and cytoplasmic membranes. It has a wide range of antimicrobial activity against common endodontic pathogens but is less effective against Enterococcus faecalis and Candida albicans. Calcium hydroxide is also an effective anti-endotoxin agent. However, its effect on microbial biofilms is controversial.

Topics: Animals; Anti-Infective Agents, Local; Antifungal Agents; Apexification; Biofilms; Calcium Hydroxide; Chlorhexidine; Dental Leakage; Dentin; Drug Synergism; Endotoxins; Humans; Hydrogen-Ion Concentration; Hydroxyl Radical; Pharmaceutical Vehicles; Pulp Capping and Pulpectomy Agents; Reactive Oxygen Species; Root Canal Filling Materials; Root Canal Irrigants; Root Resorption; Sodium Hypochlorite; Tooth Injuries

This study aimed to compare the antibacterial efficacy of standard needle irrigation (SNI), EDDY, passive ultrasonic irrigation (PUI), photon-induced photoacoustic streaming (PIPS), and shock wave enhanced emission photoacoustic streaming (SWEEPS) activation on the teeth with simulated internal root resorption (IRR) and contaminated with Enterococcus faecalis (E. faecalis) using confocal laser scanning microscopy (CLSM) analyses. A total of 79 human maxillary central incisors with a single canal were selected. The canals were accessed, and then, the roots were split in the bucco-lingual direction. Artificial IRR cavities (depth of 0.8 mm and a diameter of 1.6 mm) were prepared using round burs and 20% nitric acid in the middle region of the root halves. The root halves were reconstructed with cyanoacrylate glue, and the canals were contaminated with a culture of E. faecalis for 30 days. Root canal preparation was performed using the ProTaper Next rotary files up to X5 and 2.5% NaOCl irrigation. Teeth were randomly assigned to five groups according to the irrigation activation method (n = 15): SNI, EDDY, PUI, PIPS, and SWEEPS. The final irrigation procedures were performed using a total of 6 mL of 2.5% NaOCl for each tooth with an activation time of 3 × 30 s. The canals were stained with LIVE/DEAD BacLight dye and analyzed with CLSM to determine the percentages of dead bacteria in the biofilm. Two-way ANOVA and post hoc Tukey tests were used for statistical analysis (P < .05). None of the irrigation activation methods tested provided 100% bacterial elimination. There was no significant difference between the irrigation activation methods tested in terms of the percentage of dead bacteria (P > 0.05). In irrigation activation methods other than PIPS, there was no significant difference in the percentage of dead bacteria between the coronal, middle, and apical regions of the roots (P > 0.05). A higher percentage of dead bacteria was found in the middle region compared to the apical region in the PIPS (P < 0.05). Within the limitations of this study, SII, EDDY, PUI, PIPS, and SWEEPS have a similar antimicrobial effect on the teeth with IRR and contaminated with E. faecalis.

Topics: Anti-Bacterial Agents; Dental Pulp Cavity; Enterococcus faecalis; Humans; Lasers, Solid-State; Root Canal Irrigants; Root Canal Preparation; Root Resorption; Sodium Hypochlorite; Therapeutic Irrigation

To evaluate the clinical and radiographical success of primary molar pulpotomies which used 15.5% ferric sulfate (FS) or 1.25% sodium hypochlorite (NaOCl) for hemostasis and zinc oxide-eugenol (ZOE) and calcium hydroxide (CH) pastes as base materials.. In 29 healthy children, 80 primary molars were randomly allocated to one of the study groups: Group 1: FS-ZOE, Group 2: FS-CH, Group 3: NaOCl-ZOE, and Group 4: NaOCl-CH. After hemostasis with the respective solutions, pulp stumps and floor of the pulp chambers were covered with either ZOE or CH pastes. All teeth were restored with stainless steel crowns. Follow-up examinations were carried out at 1, 3, 6, and 12 months.. One tooth in Group 1 and two teeth in Group 4 were extracted because of pain and periapial pathosis at sixth month. After 12 months, clinical success rates of pulpotomies in Groups 1-4 were 95%, 100%, 100%, and 89.5%, respectively. The differences were not significant (P = 0.548). Radiographic success rates for Groups 1-4 were 80%, 88.9%, 78.9%, and 84.2%, respectively. No statistically significant difference was found (P = 0.968). Pain on percussion was the most observed clinical finding. However, internal root resorption was the most common radiological finding and it was observed significantly more in mandibular primary molars (P < 0.05).. Both ZOE and CH can be preferred as base materials after hemostasis achieved by the use of 15.5% FS or 1.25% NaOCl in primary tooth pulpotomy.

Topics: Bone Cements; Calcium Hydroxide; Child; Child, Preschool; Dental Caries; Dental Pulp; Female; Ferric Compounds; Follow-Up Studies; Hemostatics; Humans; Male; Pulpotomy; Radiography, Dental; Root Canal Irrigants; Root Resorption; Sodium Hypochlorite; Tooth Resorption; Tooth, Deciduous; Treatment Outcome; Zinc Oxide-Eugenol Cement

This was to evaluate the clinical and radiographic outcomes of direct pulp capping (DPC) therapy in primary molar teeth following haemostasis with various antiseptics for 12 months.. A total of 70 vital primary molar teeth with deep dentin caries were randomly allocated to different antiseptic groups. After observing the pinpoint exposure, 0.9% saline solution (SS, control), 0.5% sodium hypochlorite (SH), 2% chlorhexidine digluconate (CHX), or 0.1% octenidine dihydrochloride (OCT) was applied with sterile cotton pellets for 3 min before calcium hydroxide (CH) DPC therapy. Statistical evaluation: The intergroup radiographic success criteria were analysed using a Kruskal-Wallis test in each follow-up period at a confidence interval of 95%.. After 12 months, all groups showed a clinical success rate of 100% (no clinical failures were observed at the time of pulpectomy or extraction), and the overall radiographic success rates were OCT (100%) > SH (94.74%) > CHX (93.3%) > SS (84.21%), respectively (p > 0.05). OCT did not exhibit any failures. The undesirable radiographic failure types (pulpectomy or extraction) were mostly observed in the SS group.. Compared with SS, the success of conventional CH usage in DPC therapy of primary molar teeth could be enhanced by providing acceptable disinfection features with antiseptic solutions. OCT seems to have relative beneficial effects compared to SH and CHX.

Topics: Anti-Infective Agents, Local; Calcium Hydroxide; Child; Chlorhexidine; Crowns; Dental Amalgam; Dental Caries; Dental Cavity Lining; Dental Pulp Capping; Dental Restoration, Permanent; Female; Follow-Up Studies; Hemostatic Techniques; Humans; Imines; Male; Methylmethacrylates; Molar; Periapical Diseases; Pulp Capping and Pulpectomy Agents; Pyridines; Radiography; Root Resorption; Single-Blind Method; Sodium Hypochlorite; Stainless Steel; Time Factors; Tooth, Deciduous; Treatment Outcome; Zinc Oxide-Eugenol Cement

Intracanal mineral trioxide aggregate (MTA) may provide an alternative to calcium hydroxide in the treatment of external inflammatory root resorption. This in vitro study using human matched pairs of teeth compared white ProRoot MTA (WMTA; (Dentsply Tulsa Dental Specialties, Tulsa, OK) and an alternative material with purportedly improved handling properties, EndoSequence Root Repair Material (ES; Brasseler USA, Savannah, GA), by measuring pH in simulated root surface resorptive defects after intracanal placement. The null hypothesis tested was that there is no difference between WMTA and ES.. Bilaterally matched pairs (n = 24) of extracted, human, single-rooted teeth were instrumented to apical size 50/.06, and root surface cavities were prepared at 5 mm and 2 mm from the apex. Root canals of experimental matched pairs (n = 20) were filled with WMTA or ES; control pairs (n = 4) were filled with calcium hydroxide (positive control [POS]) or saline (negative control [NEG]). Teeth were sealed coronally and apically and immersed in saline. The pH in root surface cavities was measured at 20 minutes, 3 hours, 24 hours, 1 week, 2 weeks, 3 weeks, and 4 weeks.. The pH at 5 mm when compared with the 2-mm level was significantly higher for the WMTA, ES, and POS groups (P < .05, paired t tests); therefore, each level was analyzed separately. At both the 2-mm and 5-mm levels, significant pH changes occurred over time in the WMTA, ES (both P < .0001, repeated-measures analysis of variance), and POS (P < .0001, Friedman test) groups and not in the NEG group (mean pH = 7.32 ± 0.04, P > .05). There were no differences between WMTA and ES at 20 minutes and 3 hours at both levels or at 24 hours at 5mm. The pH of WMTA was higher than ES by 24 hours at the 2-mm level (8.79 vs 8.56, P < .05, paired t test) and after 1 week at the 5-mm level (8.91 vs 8.05, P < .0001) and was thereafter always significantly higher in WMTA compared with ES (P < .0001). The null hypothesis was rejected.. In matched pairs of teeth, intracanal placement of WMTA compared with ES resulted in a higher pH in simulated root resorption defects that was time and root level dependent.

Topics: Aluminum Compounds; Calcium Compounds; Calcium Hydroxide; Calcium Phosphates; Case-Control Studies; Dental Pulp Cavity; Dentin; Diffusion; Drug Combinations; Humans; Hydrogen-Ion Concentration; Hydroxides; Materials Testing; Oxides; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Resorption; Silicates; Sodium Chloride; Sodium Hypochlorite; Tantalum; Time Factors; Zirconium

To evaluate the effectiveness of NaOCl, NaOCl-EDTA and NaOCl + HEBP activated by ultrasonics and XP-endo Finisher on organic tissue removal from simulated internal root resorption cavities.. The root canals of 144 single-rooted teeth were instrumented. The teeth were split longitudinally, and semicircular cavities were prepared in the canal walls on each half of the roots. Samples obtained from ground bovine muscle tissue were weighed and adapted into the semicircular cavities. The root fragments were reassembled and cemented to create a circular simulated resorption cavity within the canal. Teeth were divided into twelve groups (n = 12) according to the irrigation protocols: group 1: NaOCl, no activation; group 2: NaOCl, passive ultrasonic irrigation (PUI); group 3: NaOCl, XP-endo Finisher; group 4: NaOCl-EDTA, no activation; group 5: NaOCl-EDTA, PUI; group 6: NaOCl-EDTA, XP-endo Finisher; group 7: NaOCl + HEBP, no activation; group 8: NaOCl + HEBP, PUI; group 9: NaOCl + HEBP, XP-endo Finisher; group 10: distilled water, no activation; group 11: distilled water, PUI; and group 12: distilled water, XP-endo Finisher. The teeth were disassembled, and the tissue remaining inside the resorption cavities were weighed. The data were analysed statistically using two-way anova and Fisher's LSD tests with a significance level of 0.05.. The use of XP-endo Finisher with the experimental solutions resulted in the greatest tissue weight loss compared to the other activation protocols (P < 0.001). There was no significant difference between NaOCl and NaOCl + HEBP in terms of tissue removal.. The use of a NaOCl + HEBP mixture activated with XP-endo Finisher was an effective irrigation regimen for removing simulated organic tissues from artificial internal root resorption cavities in the straight root canals of single-rooted teeth.

Topics: Edetic Acid; Etidronic Acid; Humans; Root Canal Irrigants; Root Canal Obturation; Root Resorption; Sodium Hypochlorite; Therapeutic Irrigation; Ultrasonics

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

Studies to evaluate the diagnostic power of imaging examinations to detect root resorption have been based on simulations produced by burs. Standardized, round, and well-outlined access cavities do not reproduce the characteristics of physiological lesions and may facilitate diagnosis, masking the true accuracy of imaging techniques. A methodology to simulate internal root resorption by using acid demineralization was developed.. Eleven extracted single-rooted teeth were mesiodistally sectioned into homologous halves. Root canals were labeled to ensure restricted and controlled action of fluids. The protocol was composed of 24-hour cycles (5% nitric acid for 12 hours, rinsing with deionized water, and 8% sodium hypochlorite for 10 minutes). At the end of each cycle 1 tooth was removed from treatment, defining an exposure time that cumulated to the last tooth. Electron microscopy imaging was assessed to determine lesion area and depth.. Minimum and maximum and areas and depths were 3.14 mm² and 10.34 mm² and 0.22 mm and 1.59 mm, respectively. Resorption simulated by the protocol proposed reproduced lesions of different sizes.. The irregular shape and larger diameter:depth ratio suggest that these lesions are more similar to in vivo internal root resorption, compared with bur-induced lesions.

Topics: Cone-Beam Computed Tomography; Cuspid; Dentin; Humans; Image Processing, Computer-Assisted; In Vitro Techniques; Incisor; Microscopy, Electron, Scanning; Nitric Acid; Odontometry; Root Resorption; Sodium Hypochlorite; Time Factors; Tomography, X-Ray Computed

When late replantation is performed, the root surface and root canal should be treated. Notwithstanding failures still occur, because of the high rates of root resorption, evidencing the need to search for substances that may inhibit root resorption. The acetazolamide is a known anti-resorptive agent, and its use as root canal dressing may increase the success rates in the treatment of root resorption. Therefore, this study evaluated the effect of an acetazolamide paste used as root canal dressing in late replanted teeth. The study was conducted on 24 maxillary right incisors of rats, which were avulsed and divided in two groups. In group I, the teeth were kept dry for 30 min, had their root surfaces rubbed with a blade, and were treated with 2% sodium fluoride at pH 5.5 for 20 min; the root canals were instrumented and filled with acetazolamide paste; and then the teeth were replanted. In group II, the treatment was similar to group I, except for the root canal dressing, with utilization of calcium hydroxide in group II. At 15 and 60 days after replantation, the animals were killed and the specimens were processed in a histotechnical laboratory for microscopic and morphometric analysis. The results demonstrated the ability of both intracanal substances to limit root resorption, yet they were unable to completely inhibit the root resorption. Replacement resorption lacunae were present in greater proportion in group II, at 60 days. It was concluded that the acetazolamide paste was effective to limit the root resorption, being more effective in limiting the replacement resorption compared with calcium hydroxide.

Topics: Acetazolamide; Animals; Bone Density Conservation Agents; Calcium Hydroxide; Collagen; Connective Tissue; Dental Cementum; Desiccation; Hydrogen-Ion Concentration; Incisor; Male; Periodontal Ligament; Rats; Rats, Wistar; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Resorption; Sodium Hypochlorite; Time Factors; Tooth Ankylosis; Tooth Avulsion; Tooth Replantation; Tooth Root

Inflammatory external root resorption is one of the major complications after replantation of avulsed teeth. Here we report a case of inflammatory external root resorption in a maxillary left central incisor in an 11-year old male patient that was managed and treated by using calcium enriched mixture (CEM) cement.. The patient's chief complaint was mobility of avulsed and replanted maxillary left central incisor and pain in chewing on left central and lateral incisors. Radiographic examination showed progressive inflammatory external root resorption of the left central incisor with an inadequately obturated root canal treatment. Both teeth were immature and had periapical radiolucencies. Both teeth were irrigated copiously with 2.5% NaOCl and obturated with CEM cement. However, the central incisor was treated with calcium hydroxide 6 weeks before CEM cement obturation.. The clinical and radiographic examinations at 3-, 6-, 12-, 24-, and 40-month follow-up showed that treated teeth were functional with normal mobility, the progression of the inflammatory external root resorption ceased, the resorptive lacunae were filled with newly formed bone, and periapical radiolucencies healed.. Considering the biological properties of CEM cement, especially its alkalinity and sustained calcium hydroxide release, using this novel cement for treatment of inflammatory external root resorption and obturation of immature necrotic teeth might be an applicable choice.

Topics: Apexification; Calcium Compounds; Calcium Hydroxide; Child; Dental Cements; Dental Pulp Necrosis; Follow-Up Studies; Humans; Incisor; Male; Osteogenesis; Oxides; Periapical Diseases; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Therapy; Root Resorption; Sodium Hypochlorite; Tooth Avulsion; Tooth Replantation

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

Inflammatory root resorption is a serious complication of dental trauma, which leads to progressive loss of the root structure. This report describes the treatment a previously traumatized young maxillary lateral incisor, severely affected by inflammatory root resorption. An 11-year-old boy presented with pain and mobility in his maxillary incisors which experienced fall trauma 2 years earlier. Radiographic examination revealed incomplete root development of the right central incisor, associated with advanced inflammatory root resorption and a periapical lesion. Following removal of a prior long-term calcium hydroxide dressing, the root canal was submitted to a 2-week irrigation regimen involving 1.25% sodium hypochlorite and 2% chlorhexidine gluconate. Thereafter, the entire root was filled with mineral trioxide aggregate. The radiographic follow up at 6 months showed arrest of root resorption and initiation of periapical healing in the absence of clinical symptoms and mobility. This was followed by advanced osseous regeneration and re-establishment of the periodontal space at 12 and 24 months. From the present case, it can be concluded that mineral trioxide aggregate obturation can be a viable option that can improve the healing outcomes in cases of severe inflammatory root resorption in young permanent teeth.

Topics: Aluminum Compounds; Bone Regeneration; Calcium Compounds; Child; Chlorhexidine; Dental Fistula; Dental Pulp Necrosis; Drug Combinations; Follow-Up Studies; Humans; Incisor; Male; Oxides; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Resorption; Silicates; Sodium Hypochlorite; Tooth Crown; Tooth Fractures; Tooth Mobility; Treatment Outcome

A radicular perforation caused by an inflammatory internal root resorption was present in a maxillary lateral incisor.. The root canal preparation was completed with hand files and thorough irrigation. Calcium hydroxide was placed as a temporary dressing for 10 days. At the second visit, the root canal with resorption lacuna was filled with warm vertical compaction of gutta-percha. The coronal access was restored with composite resin. A surgical flap was elevated to repair the resorption defect with gray mineral trioxide aggregate. The bony defect adjacent to the perforated lesion was filled with Unigraft (Unicare Biomedical, Laguna Hills, CA).. The tooth was in function with satisfactory clinical and radiographic results after 48 months.. According to the long term results of this case, successful sealing of a perforating defect is possible with mineral trioxide aggregate.

Topics: Adult; Aluminum Compounds; Calcium Compounds; Calcium Hydroxide; Composite Resins; Dental Materials; Dental Restoration, Permanent; Drug Combinations; Follow-Up Studies; Gutta-Percha; Humans; Incisor; Male; Maxilla; Oxides; Retrograde Obturation; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Resorption; Silicates; Sodium Hypochlorite; Surgical Flaps

The prognosis of replanted teeth depends on several factors, the most important being the length of extra-oral dry time. Studies show that after 60 min dry time, root resorption is predicted. Immediate intracanal placement of Ledermix, a paste containing triamcinolone (corticosteroid) and demeclocycline (tetracycline) has been shown to inhibit root resorption after extended dry time. However, discoloration is possible from the tetracycline in Ledermix. To evaluate the individual influence of corticosteroid and tetracycline on external root resorption after extended extra-oral dry time. Sixty-nine premolar roots of four beagle dogs were extracted and instrumented with NiTi files. Group 1 (negative control) was immediately replanted after root filling with GP and sealer; Group 2 (positive control) was root filled with GP and sealer and replanted after 60 min dry time; In groups 3-5, the canals were filled with Ledermix, Triamcinolone, and Demeclocycline, respectively, and replanted after 60 min dry time. After 4 months, the dogs were sacrificed and the roots were examined histologically for type of healing (favorable or unfavorable) and remaining root diameter. The groups treated with Ledermix, Triamcinolone and Demeclocycline had statistically significantly more favorable healing (75.8%; 69.8%; 52.4%) and more remaining root structure (5.59; 5.48; 5.09) than the group filled with GP and sealer (positive control) (0; 1.15). Corticosteroids were as effective as Ledermix at inhibiting external root resorption.

Topics: Animals; Anti-Inflammatory Agents; Demeclocycline; Dental Alloys; Desiccation; Disease Models, Animal; Dogs; Drug Combinations; Edetic Acid; Epoxy Resins; Glucocorticoids; Gutta-Percha; Nickel; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Resorption; Sodium Hypochlorite; Time Factors; Titanium; Tooth Avulsion; Tooth Replantation; Triamcinolone Acetonide; Wound Healing

The purpose of this study was to investigate the diffusion of calcium ions (Ca+2) through exposed dentinal tubules following intracanal application of mineral trioxide aggregate (MTA). Fifty-two single-rooted teeth were instrumented using 2.5% sodium hypochlorite for irrigation between each file size. Thereafter, standardized defects were created on the root surfaces so as to mimic external root resorption. The root canals and external defects received a final irrigation of 17% ethylenediaminetetraacetic acid and distilled water. MTA powder was then mixed with saline and placed into the canals. All root surfaces except the cavities were sealed with two coats of varnish. Teeth with unfilled canals (n = 26) served as controls. The teeth were immersed in saline after which the release of Ca+2 from the defects into the saline was measured at 1, 3, 7, 14, and 28 days. The results showed diffusion of Ca+2 through the defects in the dentin in MTA-filled roots with a significant increase in concentration within time.

Topics: Aluminum Compounds; Calcium; Calcium Compounds; Chelating Agents; Dental Pulp Cavity; Dentin; Diffusion; Drug Combinations; Edetic Acid; Humans; Hydrogen-Ion Concentration; Ion-Selective Electrodes; Oxides; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Resorption; Silicates; Sodium Hypochlorite; Time Factors; Water

This study evaluated microscopically the effects of root surface treatment with three different solutions in delayed rat teeth replantation. Central incisors from 30 rats (Rattus norvegicus, albinus Wistar) were extracted and left on a bench for 6 h. The pulps were extirpated and root canals were irrigated with 1% sodium hypochlorite. After endodontic treatment, the root surfaces of all teeth were submitted to a 10-min treatment with 1% sodium hypochlorite, changed every 5 min. The teeth were then rinsed with saline for 10 min and assigned to 3 groups with ten specimens each. Groups I, II and III were treated, respectively, with 2% acidulated-phosphate sodium fluoride, vitamin C solution and effervescent vitamin C (2 g, Redoxon. After root surface treatment, the teeth were filled with calcium hydroxide and replanted. The animals were sacrificed after 10 and 60 days. Group I (fluoride) presented the largest areas of replacement resorption and ankylosis. Comparing both vitamin C groups, Group III (effervescent vitamin C) yielded better results, showing more areas of ankylosis and replacement resorption than areas of inflammatory resorption.

Topics: Acidulated Phosphate Fluoride; Analysis of Variance; Animals; Antioxidants; Ascorbic Acid; Fluorides, Topical; Male; Rats; Rats, Wistar; Root Canal Irrigants; Root Resorption; Sodium Fluoride; Sodium Hypochlorite; Tooth Ankylosis; Tooth Replantation; Tooth Root; Tooth, Nonvital

To present a clinical case that illustrates the toxicity of concentrated sodium hypochlorite (NaOCl) on vital tissues.. The severe clinical consequences of extruding concentrated NaOCl into the periradicular tissues during root canal irrigation are described. After diagnosis of external resorption in tooth 34, endodontic treatment was initiated. Following irrigation with a concentrated NaOCl solution, a rapidly developing swelling and haematoma were visible. During the next few days, an extensive bruise and local necrosis of the oral mucosa developed. After healing of the involved tissues, the canal was prepared and obturated. At this time, no clinical symptoms remained.. * The use of concentrated NaOCl as a root canal irrigant might cause severe clinical problems when extruded into vital tissues. * The present report confirms the known toxicity of NaOCl to soft tissues following inadvertent extrusion. * To avoid extrusion, it is always prudent to confirm the length and integrity of the root canal system before irrigating with concentrated solutions.

Topics: Dental Pulp Cavity; Extravasation of Diagnostic and Therapeutic Materials; Female; Hematoma; Humans; Lip; Middle Aged; Mouth Mucosa; Necrosis; Odontometry; Root Canal Irrigants; Root Resorption; Sodium Hypochlorite

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 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 purpose of this study was to investigate the in vitro effect of sodium perborate, which is used as a bleaching agent in the treatment of discolored pulpless teeth, on substrate adherence capacity of macrophages. Inflammatory macrophages were obtained from Wistar rats and resuspended in RPMI-1640 medium. As a test of macrophage adhesion, the adherence capacity of macrophages to a plastic surface was determined. Assays were conducted in Eppendorf tubes for 15 min of incubation at 37 degrees C in a humidified atmosphere of 5% CO2. The adherence index was calculated. Results showed that sodium perborate decreased in a dose-dependent manner and decreased significantly (p < 0.05) the adherence index of rat peritoneal macrophages. Sodium perborate was less potent than sodium hypochlorite and eugenol in inhibiting macrophage adhesion. The inhibitory effect of sodium perborate on macrophage adhesion further supports the concept that this agent is not implicated in external cervical root resorption associated with intracoronal bleaching.

Topics: Animals; Borates; Cell Adhesion; Eugenol; Macrophages, Peritoneal; Microscopy, Electron, Scanning; Phagocytosis; Rats; Rats, Wistar; Root Resorption; Sodium Hypochlorite; Tooth Bleaching; Tooth Cervix

The effect of 5% sodium hypochlorite and 35% hydrogen peroxide on dentine samples in vitro was investigated. It was demonstrated that both 5% NaOCl and 35% H2O2 depletes the dentine, which can be recorded as weight loss. Sodium hypochlorite removes approximately 14% of dry weight from dentine samples in 24 h; hydrogen peroxide is half as destructive. The hydraulic conductance (Lp) of dentine after treatment with NaOCl is increased over 100%. It is suggested that the use of high concentrations of sodium hypochlorite during root canal treatment may negatively affect the integrity of the root canal wall thereby allowing increased access of caustic bleaching fluids to cervical vital tissues.

Topics: Dentin; Dentin Permeability; Humans; Hydrogen Peroxide; Hydrostatic Pressure; Nitric Acid; Root Resorption; Sodium Hypochlorite