Quantitative Insight into PCA Formation following Different Chlorhexidine Activation Methods in Endodontic Treatment.

The aim of the study was a quantitative analysis of p-chloroaniline (PCA) formation during 2% CHX activation with US and MDI methods in a root canal-like environment with the HPLC-DAD method and, thus, a safety assessment of US and MDI agitation of CHX in endodontic treatment. Two percent CHX was activated with the US method using ISO 30 and 35 K-file, and the MDI method using ISO 30.06 and 35.06 GP cones for 15, 30, 60, and 90 s. PCA concentration was assessed with the HPLC-DAD method. PCA concentration was also assessed for 2% CHX after 0, 3, 18, and 21 days of storage in ambient conditions. PCA was detected in all samples in all methods of activation. The concentration of PCA was dependent on time of activation in US ISO 30 and ISO 35 group (p < 0.05). In the MDI ISO 30.06 and ISO 35.06 groups, a similar trend was observed but without statistical significance (p > 0.05). PCA was detected in shelf-stored 2% CHX and the concentration was related to the time of storage. PCA is released after CHX activation with US and MDI, but mean concentrations are not higher than those observed from self-degradation of shelf-stored 2% CHX.

Single-visit nonsurgical endodontic treatment of maxillary sinusitis: A case series.

The etiopathology of maxillary sinusitis of dental origin (MSDO) is well established, and chronic apical periodontitis is the second most common cause of all dental-induced sinusitis incidents. The literature presents no common treatment protocols for MSDO and very few studies address the impact of root canal treatment (RCT) in its management. The literature presents cases of maxillary sinusitis resolution after performing a multivisit nonsurgical endodontic treatment, yet none described complete healing of MSDO as a result of single-visit nonsurgical RCT. This paper reports a case series of maxillary sinusitis of endodontic origin (MSEO) associated with upper maxillary molars that were successfully treated with single-visit nonsurgical antiseptic RCT. In all cases, the clinical symptoms subsided within a week after endodontic treatment. Control cone-beam computed tomography (CBCT) scan showed healing of periapical bone and total resolution of maxillary sinusitis symptoms. MSDO treatment protocol should start with nonsurgical antiseptic RCT. Single-visit nonsurgical endodontic treatment can be effective in MSEO management. CBCT is a method of choice in MSEO diagnostics. Endodontists are well trained and well equipped to treat MSDO, and the cooperation between ear, nose, and throat specialists, maxillofacial surgeons, and endodontists is crucial for both: good diagnostics and treatment.

Insight into the Reaction of Alexidine with Sodium Hypochlorite: A Potential Error in Endodontic Treatment.

Therapeutic success in endodontic treatment depends on successful infection control. Alexidine dihydrochloride (ALX) was recently proposed as a potential alternative to 2% chlorhexidine (CHX) as it possesses similar antimicrobial properties, expresses substantivity and does not produce p-chloroaniline (PCA) when mixed with sodium hypochlorite (NaOCl). However, the products released in this reaction have not been described to date. The aim of this study was to identify detected chemical compounds formed in the reaction of ALX and NaOCl with the ultra-high-performance liquid chromatography-mass spectrophotometry (UHPLC-MS) method and assess whether precipitates and PCA are formed in this reaction. Solutions of ALX were mixed with the equivalent volume of 2% and 5.25% (w/v) NaOCl solutions. As control, 2% (w/v) CHX was mixed with 2% and 5.25% (w/v) NaOCl. Samples were subjected to the UHPLC-MS analysis. The mixture of ALX and NaOCl resulted in a yellowish precipitate formation, the amount of which depended on NaOCl concentration. Interaction of ALX and NaOCl resulted in the production of aliphatic amines. No PCA was formed when NaOCl was mixed with ALX. However, for the first time, we identified the possible products of the interaction. The interaction between NaOCl and ALX results in the formation of aliphatic amines; therefore, these compounds should not be mixed during endodontic treatment.