Effects of Contemporary Irrigant Activation Schemes and Subsequent Placement of an Interim Dressing on Bacterial Presence and Activity in Root Canals Associated with Asymptomatic Apical Periodontitis

New tools for activating endodontic irrigants have evolved, yet their impact on root canal disinfection, in comparison to the passive placing of an inter-visit medication, have not yet been fully elucidated. The use of DNA- and rRNA-based methods may cast some new light on this issue, as they allow a comparison to be made between microbial presence and activity. Therefore, the aim of this single-arm intervention trial is to evaluate the antibacterial effect of endodontic procedures using both molecular methods. Root canal samples were obtained from 20 patients with asymptomatic apical periodontitis after each treatment step: access cavity, chemo-mechanical preparation, adjunctive procedures (XP-endo Finisher file and passive ultrasonic irrigation), calcium hydroxide medication, and 2nd-visit root canal preparation. DNA and cDNA from the samples were subjected to quantitative polymerase chain reaction with universal primers for the bacterial 16S rRNA gene. Chemo-mechanical preparation promoted a drastic reduction in bacterial levels and activity, whereas the adjunctive procedures did not make a significant contribution to further disinfection. At the 2nd visit, bacteria were active after the use of calcium hydroxide medication; however, they were significantly reduced after a 2nd-visit preparation. Consequently, the lowest bacterial levels were found at the end of the treatment. This clinical trial, which used an rRNA and rDNA combined approach, confirmed previous studies showing that root canal preparation represents the main strategy for root canal disinfection.

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Antibacterial effect of root canal preparation and calcium hydroxide paste (Calen) intracanal dressing in primary teeth with apical periodontitis

Journal of Applied Oral Science ◽

10.1590/s1678-77572005000400007 ◽

2005 ◽

Vol 13 (4) ◽

pp. 351-355 ◽

Cited By ~ 12

Author(s):

Gisele Faria ◽

Paulo Nelson-Filho ◽

Aldevina Campos de Freitas ◽

Sada Assed ◽

Izabel Yoko Ito

Keyword(s):

Calcium Hydroxide ◽

Root Canal ◽

Primary Teeth ◽

Antibacterial Effect ◽

Apical Periodontitis ◽

Wilcoxon Test ◽

Microbial Culture ◽

Root Canal Preparation ◽

Root Canals ◽

Mechanical Preparation

The aim of this study was to evaluate the antibacterial action of root canal mechanical preparation using 2.5% sodium hypochlorite as the irrigating solution and a calcium hydroxide paste as the antibacterial intracanal dressing in human primary teeth root canals with pulp necrosis and apical periodontitis by means of microbial culture. A total of 26 root canals of human primary teeth with pulp necrosis and apical periodontitis were used. Samples were collected before, 72h after biomechanical treatment and 72h after removal of the intracanal dressing. Comparison by Wilcoxon test showed that root canal mechanical preparation effectively eliminated all microorganisms in 20% of the root canals, and the intracanal dressing in 62.5%; however, the cumulative action of biomechanical treatment and intracanal dressing eliminated the microorganisms of 70% of the root canals (p<0.001). Isolated root canal mechanical preparation presented poorer microbiological results that those obtained with root canal mechanical preparation and the use of an intracanal dressing indicating the necessity of topical application of an intracanal medication between sessions in primary teeth with pulp necrosis and apical periodontitis.

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Possibility of usage of a homeopathic remedy heparsulfuris in the therapy of endoperiodontal lesion

Stomatoloski glasnik Srbije ◽

10.2298/sgs0202053b ◽

2002 ◽

Vol 49 (1-2) ◽

pp. 53-56

Author(s):

Tatjana Brkanic ◽

Slavoljub Zivkovic

Keyword(s):

Clinical Practice ◽

Calcium Hydroxide ◽

Root Canal ◽

Apical Periodontitis ◽

Endodontic Treatment ◽

Root Canal Preparation ◽

Everyday Clinical Practice ◽

Homeopathic Remedy ◽

Periodontal Tissues

The aim of this paper was to, on the basis of everyday clinical practice analize the effect of a homeopathic remedy, as a complementary remedy in endodontic therapy of endoperiodontal lesions and chronic apical periodontitis and to radiologically check its effect on the flow and speed of reparation of damaged periodontal tissues. Endodontic therapy was done according to the usual protocol for the therapy of infectious canals with root canal preparation, medication with calcium hydroxide points and hermetic obturation with AH-26 paste. During endodontic treatment patients were taking homeophatic remedy Hepar sulfuris per os three times daily. The remedy stimulates the natural defences mechanism of the organism. Radiological follow up after three months period showed obvious reductiont of radiologic radiolucency in periapical region.

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In Vivo Study of Calcium Hydroxide Endodontic Treatment in Chronic Apical Periodontitis

ARS Medica Tomitana ◽

10.2478/arsm-2018-0034 ◽

2018 ◽

Vol 24 (4) ◽

pp. 164-167

Author(s):

Gheorghiu Irina-Maria ◽

Mitran Loredana ◽

M. Mitran ◽

Temelcea Anca-Nicoleta ◽

Scarlatesc Sanziana ◽

...

Keyword(s):

Antimicrobial Activity ◽

Calcium Hydroxide ◽

Root Canal ◽

Essential Role ◽

Apical Periodontitis ◽

Endodontic Treatment ◽

Microbial Load ◽

Root Canals

Abstract The aim of this study was to evaluate the in vivo efficiency of endodontic treatment with calcium hydroxide in chronic apical periodontitis by determining the microbial load from the endodontic space in different stages of treatment. The microbiological determinations that have been made have led to the conclusion that calcium hydroxide possesses a redoubltable antimicrobial activity, but only with the condition of long-lasting contact with the root canals. Another important result is the essential role of the rigorous biomechanical treatment of the root canals, intracanal medication with calcium hydroxide is addresses mostly to microorganisms located in root canal ramifications.

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Disinfection and outcome of root canal treatment using single-file or multifile systems and Ca(OH)2 medication

Brazilian Dental Journal ◽

10.1590/0103-6440202003245 ◽

2020 ◽

Vol 31 (5) ◽

pp. 493-498

Author(s):

Mônica A. S. Neves ◽

José C. Provenzano ◽

Simone C. L. Fonseca ◽

Renata C. V. Rodrigues ◽

Lucio S. Gonçalves ◽

...

Keyword(s):

Success Rate ◽

Calcium Hydroxide ◽

Root Canal ◽

Apical Periodontitis ◽

Antibacterial Effects ◽

Bacterial Reduction ◽

Root Canals ◽

Single File ◽

Polymerase Chain ◽

Clinical Study Reports

Abstract This clinical study reports on the antibacterial effects and outcome of endodontic treatment using either a single-file or a multifile system, associated with calcium hydroxide interappointment medication. The root canals of single-rooted teeth with apical periodontitis were treated by using either Reciproc or BioRaCe instrument systems, 2.5% NaOCl irrigation, and calcium hydroxide medication. Bacteriological samples taken before preparation and immediately before obturation were evaluated for total bacterial counts by quantitative real-time polymerase chain reaction (qPCR). Patients were followed up and the treatment outcome was assessed by clinical and radiographic criteria. Decreasing lesions were classified as success in a lenient criterion or failure in a rigid one. Bacteria were detected in all initial samples (47 cases) and were significantly reduced after treatment in both groups (p<0.001). In the Reciproc and BioRaCe groups, 7/25 (28%) and 11/22 (50%) root canals yielded negative qPCR results before obturation, respectively (p>0.05). Quantitative bacterial reduction was similar between groups (p>0.05). The success rate in the BioRaCe group was 95.5% and 77% in the loose and rigid criterion, respectively. In the Reciproc group, corresponding figures were 88% and 76%. Differences in outcome were not significant (p>0.05). No diseased case showed negative qPCR results for bacteria. A difference of >1 Log10 counts was observed between healed and diseased cases. Root canal treatments of teeth with apical periodontitis using a single-file or a multifile system for preparation, associated with NaOCl irrigation and calcium hydroxide interappointment medication, showed similar antibacterial effectiveness and success rate.

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Antimicrobial activity of calcium hydroxide pastes on Enterococcus faecalis cultivated in Root Canal Systems

Brazilian Dental Journal ◽

10.1590/s0103-64402009000100005 ◽

2009 ◽

Vol 20 (1) ◽

pp. 32-36 ◽

Cited By ~ 10

Author(s):

Patricia Elaine Panicali Lana ◽

Miriam Fatima Záccaro Scelza ◽

Licínio Esmeraldo Silva ◽

Ana Luíza de Mattos-Guaraldi ◽

Raphael Hirata Júnior

Keyword(s):

Antimicrobial Activity ◽

Calcium Hydroxide ◽

Enterococcus Faecalis ◽

Root Canal ◽

Culture Medium ◽

Root Canals ◽

Mechanical Preparation ◽

Canal Systems ◽

Adjuvant Effects

The effectiveness of calcium hydroxide pastes: Calen™ and PMCC-Calen™ associated to chemo-mechanical preparation was assessed on Enterococcus faecalis grown within root canals. Seventy incisors were inserted into TSB medium, sterilized and contaminated with E. faecalis. Culture medium was replaced each 24 h and incubated at 37oC for 72 h. After chemo-mechanical preparation, root canals were filled with Calen™ or PMCC-Calen™ (7 or 14 days). Pastes were removed and teeth were inserted into test tubes containing Enterococcosel broth. Calen™ paste (maintained for 7 and 14 days) induced 70% elimination of enterococci and PMCC-Calen™ 100% elimination only after maintenance for 14 days. These medications were significantly more effective (p<0.001) than chemo-mechanical protocol alone and PMCC-Calen™ maintained for 7 days, both incapable to eliminate the viability of enterococci. Calcium hydroxide pastes demonstrated important adjuvant effects in the elimination of enterococci during chemo-mechanical preparation of root canal systems. When associated with PMCC, calcium hydroxide pastes should be maintained for at least 14 days.

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Comparison of the removal of calcium hydroxide medicaments on the root canal treatment irrigated with manual and sonic agitation technique

Padjadjaran Journal of Dentistry ◽

10.24198/pjd.vol29no3.14479 ◽

2017 ◽

Vol 29 (3) ◽

Author(s):

Anna Muryani ◽

Ayu Trisna Hayati ◽

Rahmi Alma Farah Adang

Keyword(s):

Calcium Hydroxide ◽

Root Canal ◽

Artificial Saliva ◽

Apical Part ◽

Root Canal Treatment ◽

Root Canal Preparation ◽

Root Canals ◽

Experimental Laboratory ◽

The One ◽

Flowable Composites

Introduction: Irrigation of the root canal is an important part of the endodontic treatment. Root irrigation technique can be done with the manual and sonic system by using 2.5% NaOCI solution. Calcium hydroxide [Ca(OH)2 ] is used as a medicament for root canal sterilization. Root canal treatment will fail due to the imperfect removal of Ca(OH)2 residue. The objective of this research was to analyze the comparison of the removal of Ca(OH)2 medicaments on the root canal treatment irrigated with manual and sonic agitation technique using 2.5% NaOCI. Methods: The methods used in this study was experimental laboratory. The sample used was 30 maxillary incisors. The teeth were then divided into two groups randomly, then the root canal preparation was done by the crown down technique with irrigation using 2.5% NaOCI. The radicular part of the teeth was then split longitudinally, given a standardized groove in the one-third of the apical part, then applied with water-solved calcium hydroxide. The teeth were unified afterwards by using flowable composites, then soaked in the artificial saliva. The sample of the 1st group was irrigated by manual agitation technique, and the 2nd group by sonic agitation technique. The data results were analyzed by Kruskal-Wallis and Mann-Whitney tests. Results: The results of Ca(OH)2 removal were different between manual agitation technique compared to the sonic agitation technique. Conclusion: The irrigation using 2.5% NaOCl with the sonic agitation technique were proven to be more effective in removing Ca(OH)2 from root canals than the manual agitation technique.

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Endodontic Management of a Tooth with Severe External Root Resorption using Injected Non-setting Calcium Hydroxide Paste: A Case Report

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44299.13858 ◽

2020 ◽

Author(s):

Orlando Aguirre Guedes ◽

Tiago Luan Henrique ◽

Pollyana Sousa Lôbo El Zayek ◽

Andreza Maria Fábio Aranha ◽

Helder Fernandes De Oliveira

Keyword(s):

Calcium Hydroxide ◽

Root Canal ◽

Root Resorption ◽

Pathological Condition ◽

Cold Test ◽

Apical Periodontitis ◽

Radiographic Examination ◽

Root Canals ◽

External Root Resorption ◽

Composite Resin Restoration

External Root Resorption (ERR) is a pathological condition that can lead to tooth loss if not diagnosed and treated correctly. Calcium Hydroxide Ca(OH)2 is an intracanal medicament, which is used in cases of teeth with pulp necrosis, peri-radicular lesions and ERR. This paper describes the endodontic management of a tooth with severe ERR using injected non-setting Ca(OH)2 paste. A 28-year-old patient was referred for endodontic evaluation of tooth 47, which presented an extensive composite resin restoration and was negative to cold test. Panoramic and periapical radiographs revealed the presence of a filled pulp chamber, calcified root canals, ERR on the mesial and distal roots, and apical periodontitis in the mesial and distal roots. The diagnosis of asymptomatic apical periodontitis and severe ERR was established, and conventional root canal treatment combined with non-setting Ca(OH)2dressing was chosen. After five months, no more discharge from the root canal was observed, and a decrease in the size of the periapical lesion and arrest of ERR was detected. The root canal was filled, and the patient was referred for restoration. At the 6-months follow-up, radiographic examination evidenced periapical repair and containment of the ERR process. Chemomechanical root preparation in association with a non-setting Ca(OH)2 dressing protocol allows positive outcomes during the management of severe ERR associated with pulp necrosis and periapical inflammation.

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Comparison of the incidence of post-operative pain after low-level laser therapy between single- and multi-visit root canal treatments for chronic apical periodontitis: A prospective randomized clinical trial

International Dental Research ◽

10.5577/intdentres.2021.vol11.no1.6 ◽

2021 ◽

Vol 11 (1) ◽

pp. 30-37

Author(s):

Helin Özkan Özcan ◽

Faruk Haznedaroğlu ◽

Selçuk Gökyay

Keyword(s):

Laser Therapy ◽

Root Canal ◽

Apical Periodontitis ◽

Low Level Laser Therapy ◽

Low Level ◽

Root Canals ◽

Low Level Laser ◽

Mechanical Preparation ◽

Post Operative Pain ◽

Level Laser

Aim: The aim of this clinical study was to evaluate the effect of low-level laser therapy, used in conjunction with conventional canal disinfection techniques, on post-operative pain after single- and multi-visit root canal treatments for chronic apical periodontitis. Methodology: 100 volunteers were randomly divided into 4 groups. The main inclusion criteria were radiographic evidence of apical periodontitis (minimum size of 2.0 × 2.0 mm) and a diagnosis of pulpal necrosis confirmed by a negative response to vitality tests. All the root canals were prepared using a standard shaping technique and irrigation procedure. In Groups I and III, the root canals were obturated during the first visit following chemo-mechanical preparation. In Groups II and IV, the root canals were medicated with calcium hydroxide and obturated during a second visit, 1 week later. In Groups III and IV, after the chemo-mechanical preparation, the root canals were additionally irradiated by an 810-nm diode laser at 1.5 W output for 20 seconds. A modified visual analogue scale was used to measure pain at 4, 8, 12, 24, and 48 hours and 7 days after the treatment. Results: There was no statistically significant difference between the groups in terms of post-operative pain at any time during the observation period (p > .05). Post-operative pain occurred only at 8 and 12 hours and at 1, 2, and 3 days in all groups. There was no correlation between the results regarding age, gender, periapical index scores, or tooth type. Conclusion: The use of low-level laser therapy had no significant effect on the incidence of post-operative pain, and single-visit root canal treatment may be a strong alternative to multi-visit treatment. How to cite this article: Özkan Özcan H, Haznedaroğlu F, Gökyay S. Comparison of the incidence of post-operative pain after low-level laser therapy between single- and multi-visit root canal treatments for chronic apical periodontitis: A prospective randomized clinical trial. Int Dent Res 2021;11(1):30-7. https://doi.org/10.5577/intdentres.2021.vol11.no1.6 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

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An experimental intraradicular biofilm model in the pig for evaluating irrigation techniques

BMC Oral Health ◽

10.1186/s12903-021-01536-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Toshinori Tanaka ◽

Yoshio Yahata ◽

Keisuke Handa ◽

Suresh V. Venkataiah ◽

Mary M. Njuguna ◽

...

Keyword(s):

16S Rrna ◽

Root Canal ◽

Apical Periodontitis ◽

Exposure Model ◽

Rrna Gene ◽

16S Rrna Sequence ◽

Bacterial Phyla ◽

Biofilm Model ◽

Biofilm Removal

Abstract Background We established an in vivo intraradicular biofilm model of apical periodontitis in pigs in which we compared the efficacy of different irrigant activation techniques for biofilm removal. Methods Twenty roots from the deciduous mandibular second premolar of 5 male pigs were used. After pulpectomy, canals were left open for 2 weeks and then sealed for 4 weeks to enable the development of an intracanal biofilm. The intraradicular biofilms was evaluated using SEM and bacterial 16S rRNA gene-sequencing. To investigate the efficacy of biofilm removal, root canal irrigations were performed using conventional needle, passive ultrasonic, subsonic, or laser-activated irrigation. Real-time PCR was conducted to quantitate the remaining biofilm components. Statistical analysis was performed using ANOVA followed by a Tukey kramer post-hoc test with α = 0.05. Results The pulp exposure model was effective in inducing apical periodontitis and SEM analysis revealed a multi-layer biofilm formation inside the root canal. 16S rRNA sequence analysis identified Firmicutes, Bacteroidetes, and Fusobacteria as the predominant bacterial phyla components, which is similar to the microbiome profile seen in humans. None of the tested irrigation techniques completely eradicated the biofilm components from the root canal, but the subsonic and laser-activated irrigation methods produced the lowest bacterial counts (p < 0.05). Conclusions An experimental intraradicular biofilm model has been successfully established in pigs. Within the limitations of the study, subsonic or laser-activated irrigation demonstrated the best biofilm removal results in the pig system.

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Portland Cement Use in Dental Root Perforations: A Long Term Followup

Case Reports in Dentistry ◽

10.1155/2014/637693 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Álvaro Henrique Borges ◽

Matheus Coelho Bandeca ◽

Mateus Rodrigues Tonetto ◽

Luis Augusto Faitaroni ◽

Elibel Reginna de Siqueira Carvalho ◽

...

Keyword(s):

Portland Cement ◽

Calcium Hydroxide ◽

Root Canal ◽

Clinical Signs ◽

Signs And Symptoms ◽

Clinical Aspects ◽

Iatrogenic Perforation ◽

Root Canals ◽

First Case ◽

Clinical Signs And Symptoms

Root canal and furcal perforations are causes of endodontic therapy failure and different materials that stimulate tissue mineralization have been proposed for perforation treatment. In the first case, a patient presented tooth 46 with unsatisfactory endodontic treatment and a periapical radiographic lesion. A radiolucent area compatible with a perforating internal resorption cavity was found in the mesial root. The granulation tissue was removed, and root canals were prepared. The intracanal medication was composed of calcium hydroxide and the perforation cavity was filled with Portland cement. The 11-year followup showed radiographic repair of the tissue adjacent to the perforation and absence of clinical signs and symptoms or periapical lesion. In the second case, a patient presented with edema on the buccal surface of tooth 46. The examination showed a radiolucent area in the furcation region compatible with an iatrogenic perforation cavity. The mesial root canals were calcified, and only the distal root canal was prepared. The cavity was filled with a calcium hydroxide-based paste and the distal root canal was obturated. In sequence, the perforation cavity was filled with Portland cement. The 9-year followup showed the tooth in masticatory function with radiographic and clinical aspects compatible with normality.

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