Comparison of Herbal Agents with Sodium Hypochlorite as Root Canal Irrigant: A Systematic Review of In Vitro Studies

During endodontic treatment, eliminating microorganisms from the root canals should be considered with utmost importance. Before filling the canal, every effort should be made to ensure optimal shaping and adequate disinfection of the root canal system. This systematic review aimed to compare the efficacy of herbal agents with sodium hypochlorite (NaOCl) in reducing the microbial load while used as a root canal irrigant. The research question in the present study was to assess “Is there a significant difference in reducing microbial load comparing sodium hypochlorite (NaOCl) and herbal agents.” Electronic databases (PubMed, Scopus, and Web of Science) were searched from their start dates to November 2020 using strict inclusion and exclusion criteria and reviewed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Only in vitro studies comparing herbal agents with NaOCl regarding antimicrobial efficiency were included. Two reviewers independently assessed the included article. 825 articles were obtained from an electronic database. Twenty papers were included for review of the full text. Eleven papers were excluded because they did not meet the inclusion criteria. Finally, nine articles were included in the systematic review. The present systematic review was at the in vitro level; therefore, the result cannot translate the exact clinical conditions. This systematic review concludes that herbal agents cannot be used as a main irrigant for canal disinfection.

Antimicrobial Efficacy of a Novel Root Canal Irrigant Made from Coconut and Bromelain Extract against Biofilm Forming Pathogens– An In vitro Evaluation

Objective: Sodium hypochlorite is shown to be a gold standard intracanal irrigant which has shown to have adequate antimicrobial properties and tissue dissolving properties. The toxicity of these irrigants are seen to be high towards various cells. Natural irrigants provide an alternative to show adequate antimicrobial activity and lesser cytotoxicity potential. The current study proposes a novel intracanal irrigant made from coconut and bromelain extract. Material and Methods: 10grams of sodium hydroxide was dissolved in deionized water followed by which 60ml of coconut oil was added to the warm water bath (40C). The final product was left to dry and crushed manually to powder. This powder was then taken in measured quantity to make a final product containing 20% of coconut and 4% of bromelain. The obtained irrigant was then evaluated against Enterococcus faecalis using Agar well diffusion method. Results: For the natural irrigant, the maximum zone of inhibition was seen highest at 22mm against Enterococcus faecalis and 25mm against Candida Albicans. For 3% sodium hypochlorite when compared against Enterococcus faecalis and Candida Albicans showed a maximum zone of inhibition at 33mm against Enterococcus faecalis and 35mm against Candida Albicans. Conclusion: The study shows that the novel irrigant derived from coconut and bromelain extract has a good antimicrobial efficacy against Enterococcus faecalis and Candida albicans. It can be concluded that it has a potential application as a root canal irrigant for root canal disinfection.

Effect of Different Root Canal Irrigant Solutions on the Release of Dentin-Growth Factors: A Systematic Review and Meta-Analysis

Irrigant solutions are used to promote dentin-growth factors (GF) release for regenerative endodontics. This review aimed to evaluate the reports comparing the release of GFs using different root canal irrigant solutions. Eligible studies compared the in vitro GF release in human teeth after the use of at least two distinct solutions. A search was conducted on Pubmed, Scopus, Web of Science, and Lilacs on 11 August 2021. Risk of bias was assessed using SciRAP. Study characteristics and quantitative data were extracted, and meta-analyses were performed for the mean difference (95% confidence interval) of the release of transforming growth factors Beta 1 (TGF-β1) by EDTA compared to other irrigants. Of sixteen eligible studies, eight were included in quantitative analysis. ELISA assays showed higher TGF-β1 release from 10% EDTA compared to 10% citric acid (p < 0.00001). Immunogold assays showed higher levels of TGF-β1 for 17% EDTA (p < 0.00001) compared to 10% citric acid. GRADE identified a low to very low certainty of evidence. These results point to an increased release of TGF-β1 in dentin treated with EDTA. The high heterogeneity and very low certainty of the evidence demand further studies before EDTA indication as a better irrigant for regenerative endodontics. Registration: CRD42020160871 (PROSPERO).

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)