The Application of Nano Silver Argitos as a Final Root Canal Irrigation for the Treatment of Pulpitis and Apical Periodontitis. In Vitro Study

Background: Endodontic treatment of various forms of pulpitis with variations of root canal system anatomy should be performed with high quality. The use of various antibacterial agents is aimed at maintaining the success of endodontic treatment. The aim of this study was to evaluate the penetration and fixation of the nano-silver solution on the dentinal surface during endodontic treatment. Materials and methods: the study was carried out on 70 extracted single-rooted teeth, randomly divided into two groups. In the teeth of the first group, the smear layer was removed after canal preparation with 17% EDTA solution; in the second group, the smear layer was not removed. In both groups, for the final treatment of the canal, a colloidal 1% solution of нанo серебра nanosilver was used. Samples were cut and prepared for analysis using micro-CT, scanning electron microscopy (SEM), X-ray microanalysis and energy dispersive spectrometry (elemental mapping). Results: in 100% of cases in groups of teeth with a preserved smear layer, the ability of a 1% colloidal solution of nanosilver with particles of 1–2 nm to be fixed on dentin with a removed and preserved smear layer and to leave a film on the dentinal surface was established. In the samples with removed smear layer, silver was found in 73.5% of cases. Conclusion: The nano-silver solution with a particle size of 1–2 nm proved its ability to penetrate the dentinal surfaces and create a final film covering the dentinal surface of the root canal before applying the sealer.

Investigation of Er:YAG laser-activated irrigation for the removal of biofilm and observations of laser-induced cavitation behavior

Background We investigated the biofilm removal effects of LAI using a pig model, focusing on the impact of the fiber tip position, and used a high-speed camera to observe the occurrence and positioning of the cavitation associated with laser irradiation. Methods A total of 16 roots of deciduous mandibular second premolars from 4 pigs were used. After a pulpectomy, the canals were left open for two weeks and sealed for 4 weeks to induce intraradicular biofilm. Then, root canal irrigation was performed with Er:YAG laser activation. The fiber tip was inserted at two different positions, i.e., into the root canal in the intracanal LAI group and into the pulp chamber in the coronal LAI group. Intracanal needle irrigation with saline or 5% NaOCl was utilized in the positive control and CNI groups. SEM and qPCR were carried out to evaluate treatment efficacy. For qPCR, ANOVA and a Tukey-Kramer post hoc test were performed with α = 0.05. A high-speed camera was used to observe the generation of cavitation bubbles and the movement of the induced bubbles after laser irradiation. Results The intracanal and coronal LAI groups showed significantly lower amounts of bacteria than either the positive control or CNI groups. There was no significant difference found between the intracanal and coronal LAI groups. SEM images revealed opened dentinal tubules with the destruction of biofilm in both LAI groups. High-speed camera images demonstrated cavitation bubble production inside the root canal after a single pulse irradiation pulse. The generated bubbles moved throughout the entire internal multi-rooted tooth space. Conclusions Coronal LAI can generate cavitation in the root canal with a simply placed fiber inside the pulp chamber, leading to effective biofilm removal. This method could thus contribute to the future development of endodontic treatments for refractory apical periodontitis caused by intraradicular biofilm.

Investigation of Er:YAG laser-activated irrigation for the removal of biofilm and observations of laser-induced cavitation behavior

BackgroundWe investigated the biofilm removal effects of LAI using a pig model, focusing on the impact of the fiber tip position, and used a high-speed camera to observe the occurrence and positioning of the cavitation associated with laser irradiation.MethodsA total of 16 roots of deciduous mandibular second premolars from 4 pigs were used. After a pulpectomy, the canals were left open for two weeks and sealed for 4 weeks to induce intraradicular biofilm. Then, root canal irrigation was performed with Er:YAG laser activation. The fiber tip was inserted at two different positions, i.e., into the root canal in the intracanal LAI group and into the pulp chamber in the coronal LAI group. Intracanal needle irrigation with saline or 5% NaOCl was utilized in the positive control and CNI groups. SEM and qPCR were carried out to evaluate treatment efficacy. For qPCR, ANOVA and a Tukey-Kramer post hoc test were performed with α=0.05. A high-speed camera was used to observe the generation of cavitation bubbles and the movement of the induced bubbles after laser irradiation.ResultsThe intracanal and coronal LAI groups showed significantly lower amounts of bacteria than either the positive control or CNI groups. There was no significant difference found between the intracanal and coronal LAI groups. SEM images revealed opened dentinal tubules with the destruction of biofilm in both LAI groups. High-speed camera images demonstrated cavitation bubble production inside the root canal after a single pulse irradiation pulse. The generated bubbles moved throughout the entire internal multi-rooted tooth space.ConclusionsCoronal LAI can generate cavitation in the root canal with a simply placed fiber inside the pulp chamber, leading to effective biofilm removal. This method could thus contribute to the future development of endodontic treatments for refractory apical periodontitis caused by intraradicular biofilm.

Effect of Sodium Hypochlorite Concentration in Continuous Chelation on Dislodgement Resistance of an Epoxy Resin and Hydraulic Calcium Silicate Sealer

The conditioning of the root canal wall during chemo-mechanical root canal treatment differentially affects the adhesion of root canal sealers. This investigation evaluated the impact of sodium hypochlorite (NaOCl) concentration as used in a root canal irrigation concept called continuous chelation, with 1-hydroxyethylidene-1,1-diphosphonic acid (HEDP) contained in the NaOCl solution that is applied. Fourier-transform infrared spectra of the dentinal wall were gathered. The consequential effects on push-out bond strength of an epoxy resin (AH Plus) versus a hydraulic CaSi sealer (BioRoot RCS) were assessed. Single-rooted extracted human teeth were used and irrigated with pure NaOCl at a concentration of 0% (physiological saline), 2.5%, or 5.25%. Dual Rinse HEDP (9%) was added to the solutions, or not added for further control. Pure NaOCl solutions caused a decrease in the amide III: phosphate ratios, which was counter-acted by the addition of HEDP. It was observed that the adhesion of the epoxy resin sealer under investigation was negatively affected by this NaOCl deproteinization of the canal wall in a dose-dependent manner, while the opposite was observed with the CaSi sealer. HEDP when used in conjunction with NaOCl was beneficial for the adhesion of both sealers.

ANTIBACTERIAL EFFECTIVENESS OF LERAK FRUIT ETHANOL EXTRACT (Sapindus rarak DC) AND 2% CHLORHEXIDINE IN Enterococcus faecalis

The failure of a root canal treatment can be caused by the facultative anaerobic bacteria Enterococcus faecalis, which should be eliminated throughout root canal irrigation. Chlorhexidine 2% is a popular antibacterial liquid used in root canal irrigation. Natural substances can also be used to make antibacterial irrigation liquids. One natural substance with antibacterial properties is lerak fruit extract (Sapindus rarak DC), containing 28 per cent of saponins, alkaloid compounds, polyphenols, antioxidant chemicals, and flavonoid groups and tannins. This study was conducted to determine the effectiveness of 25% lerak fruit extract (Sapindus rarak DC) against E. faecalis compared to 2% Chlorhexidine. This study is a pure experimental study using the agar diffusion method against three experimental groups chlorhexidine 2% as a positive control, lerak fruit extract (Sapindus rarak DC) as a treatment group, and aquadest as a negative control. Each group was repeated ten times on Muller Hinton Agar (MHA) media which was applied using a paper disc. Then the diameter of the inhibition zone was calculated using a caliper. The results in this study, 25% lerak (Sapindus rarak DC) fruit extract had an average inhibition zone diameter of 11.775 mm, and an average inhibition zone diameter of 2% chlorhexidine was 19.745 mm. The difference in the diameter of the inhibition zone was significantly different in all groups. Conclusion ethanol extract of lerak fruit (Sapindus rarak DC) 25% can inhibit the growth of E. faecalis and can be used as an alternative to other antimicrobial agents as disinfection of root canal irrigation.

Endodontic treatment regimens and their application in practice - survey and comparative study

Introduction: Endodontics is a rapidly developing field of dentistry. Dentists have an increasing selection of techniques, tools, and materials to ensure therapeutic success.Aim: The aim of the study was to analyze the endodontic treatment regimens and their application in the daily practice of dentists. Material and Methods: A dentist survey was conducted through a Google Doc. The link to the form was placed on online dental groups, sent by e-mail to the offices and the questionnaire was also delivered to the dental offices in a printed form.Results: The majority of respondents always perform endodontic treatment procedures on pregnant women, take three X-rays and use a rubber dam during the treatment. Almost all respondents have the opportunity to take an X-ray in the workplace, and the working length is usually measured by the electronic method. The most commonly used methods of root canal preparation are the traditional and crown-down methods, and the most commonly used root canal filling method - the thermal method. Most of the respondents declared the following rinsing protocol: NaOCl and CA or EDTA. Apex locator, ultrasounds, and microscopes are used in most dental offices, and more than half of the dentists responded that they perform procedures like broken tools removal or obliterated canals enlargement.Conclusions: Polish endodontics has developed over the years. Modern solutions are used more and more often. The canals are filled with the thermal method, and the popularity of performing complex endodontic procedures has increased. However, it is necessary to conduct further studies comparing the effectiveness of the canal preparation methods and the standardization of the root canal irrigation protocol.

Effectiveness of photon-initiated photoacoustic streaming in root canal models with different diameters or tapers

Background This study aimed to compare the use of photon-initiated photoacoustic streaming (PIPS) and conventional needle irrigation (CNI) in conjunction with different concentrations of sodium hypochlorite (NaOCl) to remove Enterococcus faecalis (E. faecalis) suspended bacteria and biofilms from root canal systems with different diameters or tapers. Methods Artificial root canal samples (n = 480) were randomly divided into three groups (n = 160/group). The canals were prepared to fit file sizes #10/.02, #25/.02, or #25/.06. The size #10/.02 group was incubated for seven days. The size #25/.02 or #25/.06 group was incubated for 2 days. A stable biological model of E. faecalis infection was established. The root canals were washed with distilled water or with 1%, 2%, or 5.25% NaOCl combined with CNI or PIPS. Bacterial suspensions and biofilms were assessed using an ATP assay kit and fluorescence microscopy. Image-Pro Plus was used to analyse the average fluorescence intensity to determine the most suitable root canal irrigation solution. Results In the CNI and PIPS groups, the ATP value of the 5.25% NaOCl subgroup was the lowest, followed by that of the 2% and 1% NaOCl subgroups. The ATP value of the distilled water subgroup was the highest (P < 0.05). When the root canal taper was 0.02, the ATP value of the #10/.02 + PIPS group was significantly lower than that of the #25/.02 + CNI group (P < 0.05). The average fluorescence intensity of the #10/.02 + PIPS group was lower than that of the #25/.02 + CNI group (P < 0.05). When the apical diameter was #25, the ATP value of the 0.02 taper in the PIPS group was lower than that of the 0.06 taper in the CNI group (P < 0.05), and the average fluorescence intensity of the 0.02 taper + PIPS group was lower than that of the 0.06 taper + CNI group (P < 0.05). PIPS combined with 2% and 5.25% NaOCl effectively improved the long-term antibacterial effect after irrigation and re-culture for 6 h. Conclusions Compared with CNI, PIPS has greater ability to remove bacteria in root canals with a small preparation diameter and a small taper. PIPS with 2% and 5.25% NaOCl exhibited superior antibacterial and bacteriostatic effects.

The Evaluation of Anti-Microbial-Effect to Enterococcus Faecalis by Hypochlorous Acid Water

Periapical periodontitis is a major disease, and difficult to achieve successful treatment in some cases. Therefore, root canal irrigation is one of the most important processes to successful endodontic treatment. Sodium Hypochlorite (NaOCl) solution is the most commonly used root canal irrigate. However using NaOCl solution on endodontic treatment should be considered its problems such as allergy, serious tissue damage when inadvertently injected into the maxillary sinus or oral mucosa. Therefore, another root canal irrigant that is safe and has a high antimicrobial effect is desirable. In this study, Hypochlorous Acid (HClO) water was used to evaluate the microbicidal efficacy of the Enterococcus faecalis (E. faecalis) and considered the possibility to be a future root canal irrigant candidate. Original (200ppm), 10% diluted (20ppm), 25% diluted (50ppm) and 50% diluted (100ppm) HClO water were used in this study. Each experimental solution was mixed with low concentrations (5×107 CFU/ml) or high concentration (5×109 CFU/ml) of E. faecalis at 30 seconds, 1minute, 3 minutes, 5 minutes respectively. Then they were placed onto BHI agar plates and incubated for 48 h at 37 ºC, followed by counting the number of Colony formation. The results showed that in the condition of 5×107 CFU/ml E.faecalis, no colony formation was shown within 30 seconds by 50 % diluted HClO water. Whereas only original water was attained to inhibit colony formation completely within 30 seconds under the density of 5×109 CFU/ml E, faecalis. In conclusion, 200ppm HClO water has a capacity to anti-microbiological effect against E.faecalis same as NaOCl solution. Keywords: root canal irrigant, hypochlorous acid (HClO) water, Enterococcus faecalis (E. faecalis)

The Effect of Er:YAG Lasers on the Reduction of Aerosol Formation for Dental Workers

Infection prevention in dental practice plays a major role, especially during the COVID-19 pandemic. This study aimed to measure the quantity of aerosol released during various dental procedures (caries and prosthetic treatment, debonding of orthodontic brackets, root canal irrigation) while employing the Er:YAG lasers combined with a high-volume evacuator, HVE or salivary ejector, SE. The mandibular second premolar was extracted due to standard orthodontic therapy and placed in a dental manikin, to simulate typical treatment conditions. The particle counter was used to measure the aerosol particles (0.3–10.0 μm) at three different sites: dental manikin and operator’s and assistant’s mouth area. The study results showed that caries’ treatment and dental crown removal with a high-speed handpiece and the use of the SE generated the highest aerosol quantity at each measured site. All three tested Er:YAG lasers significantly reduced the number of aerosol particles during caries’ treatment and ceramic crown debonding compared the conventional handpieces, p < 0.05. Furthermore, the Er:YAG lasers generated less aerosol during orthodontic bracket debonding and root canal irrigation in contrast to the initial aerosol quantity measured in the dental office. The use of the Er:YAG lasers during dental treatments significantly generates less aerosol in the dental office setting, which reduces the risk of transmission of viruses or bacteria.