Efecto de los extractos fitoquímicos en la eliminación del barro dentinario en el tratamiento de conductos radiculares / Effects of phytochemical extracts on smear layer removal in root canal treatment

Introduction: Studies suggested that phytochemical products are considered potential solutions to smear layer removal due to their biological safety in cleaning root canal systems, lower toxicity, lower irritant effect and antimicrobial effect. Objective: The aim of the present study was to perform a systematic review to evaluate smear layer removal of root canal systems by different natural product solutions. Methods: systematic review. Search of the literature was performed on Pubmed, Scopus, Cochrane, Web of Science, Scielo and Google Scholar according the PRISMA protocol. Studies were included if they performed the experiments of smear layer removal on extracted permanent human teeth. Articles published in any language without restriction of year of publication were included in this review. The risk of bias assessment in the included studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies. The search strategy resulted in the retrieval of 6221 publications. After the eligibility criteria application, 8 articles were selected for analysis. Results: It was observed that some natural products solutions showed effects on smear layer removal, especially on coronal third. The phytochemical products such as Salvadora persica, chamomile alcohol extract and grape seed extract demonstrated good potential of smear layer removal, however, its effectiveness and clinical applicability are still unclear. Conclusions: Although the limitations of this study, it is possible to highlight those phytochemical products such as Salvadora persica, chamomile alcohol extract and grape seed extract that demonstrated good potential on SL removal(AU)

Introducción: Los productos fitoquímicos se consideran soluciones potenciales para la eliminación del barro dentinario debido a su seguridad biológica en la limpieza del sistema de conductos radiculares, menor toxicidad, menor efecto irritante y efecto antimicrobiano. Objetivo: Evaluar la eliminación del barro dentinario de los sistemas de conductos radiculares mediante diferentes soluciones de productos naturales. Métodos: La búsqueda de la literatura se realizó en Pubmed, Scopus, Cochrane, Web of Science, SciELO y Google Scholar, según el protocolo PRISMA. Los estudios se incluyeron si realizaron los experimentos de eliminación del barro dentinario en dientes humanos permanentes extraídos. En esta revisión se incluyeron artículos publicados en cualquier idioma, sin restricción de año de publicación. La evaluación del riesgo de sesgo en los estudios incluidos se evaluó mediante la lista de verificación de evaluación crítica del Instituto Joanna Briggs para estudios cuasiexperimentales. La estrategia de búsqueda resultó en la recuperación de 6221 publicaciones. Después de la aplicación de los criterios de elegibilidad, se seleccionaron 8 artículos para su análisis. Resultados: Se observó que algunas soluciones de productos naturales mostraron efectos sobre la eliminación del barro dentinario, especialmente en el tercio coronal. Los productos fitoquímicos como salvadora pérsica, extracto de alcohol de manzanilla y extracto de semilla de uva demostraron un buen potencial de eliminación del barro dentinario; sin embargo, su efectividad y aplicabilidad clínica aún no están claras. Conclusiones: A pesar de las limitaciones de este estudio, es posible destacar aquellos productos fitoquímicos como salvadora pérsica, extracto de alcohol de manzanilla y extracto de semilla de uva demostraron buen potencial de eliminación del barro dentinario(AU)

Direct and Indirect Effect of Chlorhexidine on Survival of Stem Cells from the Apical Papilla and Its Neutralization.

INTRODUCTION: Several irrigants have been used for disinfection in regenerative endodontic procedures including chlorhexidine (CHX). In this context, the antibacterial properties of disinfectants are mainly in focus of research even though they may have an undesirable impact on the fate of stem cells. In this study, we hypothesized that CHX has both a direct effect when applied to stem cells of the apical papilla (SCAPs) and an indirect effect when SCAPs are exposed to dentin previously conditioned with CHX. METHODS: Cell toxicity was evaluated in vitro using the CellTox green fluorescence assay (Promega, Madison, WI) and CellTiter-Glo (Promega) after SCAPs were exposed directly to a dynamic concentration range of CHX; apical papilla explant cultures were stained with ApopTag (Merck Millipore, Billerica, MA) after culture with CHX. Furthermore, standardized slabs from human dentin were treated with CHX and consecutively rinsed in EDTA, L-α-lecithin (Sigma-Aldrich, St Louis, MO), or L-α-lecithin followed by EDTA. After that, SCAPs were cultured on the slabs for 5 days, and cellular viability was determined (indirect effect). Data were treated nonparametrically and analyzed using the Krukal-Wallis test (P ≤ .05). RESULTS: Direct exposure of SCAPs to CHX highly affected cell viability at concentrations above 10-3%, whereas lower concentrations had no adverse effect. During the initial 60 minutes, concentrations of 10-2% CHX or higher resulted in early pronounced toxicity with a maximum effect within 15 minutes after exposure. Likewise, CHX-conditioned dentin slabs were detrimental to SCAP survival; however, the deleterious effects were completely reversed by neutralization with L-α-lecithin. CONCLUSIONS: Chlorhexidine is toxic to SCAPs when applied directly or indirectly via conditioned dentin. If applied for a short time and neutralized by L-α-lecithin, it can be a gentle and cell-preserving disinfectant before endodontic regeneration.

Laser therapy as an adjunct in the treatment of sodium hypochlorite extrusion through a root perforation: a case report.

Accidental sodium hypochlorite extrusion can occur during endodontic irrigation procedures. The symptoms appear immediately and include severe pain, swelling, and probable tissue necrosis adjacent to the root of the treated tooth. Treatment of sodium hypochlorite extrusion involves immediate and copious saline irrigation to neutralize the area and prescription of analgesic, anti-inflammatory, and antibiotic medications. Low-level laser therapy (LLLT) might be useful as an adjuvant treatment for damaged soft tissues to improve healing. This case report describes the treatment of accidental extrusion of 1% sodium hypochlorite through a root canal perforation in a mandibular incisor during endodontic treatment. The extrusion caused minor swelling within the mentolabial sulcus and a large area of necrosis in the gingivolabial mucosa and right edentulous premolar area. Conventional treatment was performed in association with LLLT. Clinical and radiographic examinations after 6 months showed complete healing of the necrotic area without paresthesia and the repair of apical tissues.

Sodium hypochlorite chemical burn in an endodontist's eye during canal treatment using operating microscope.

INTRODUCTION: This study describes a case of eye burn induced by sodium hypochlorite used as an irrigant during root canal preparation. METHODS: A 24-year-old female endodontist was using an operating microscope during root canal treatment, and as the root canal was irrigated, the pressure cannula burst and the irrigant (3.5% sodium hypochlorite) came into direct contact with her left eye. She immediately sought ophthalmologic emergency care for pain, redness of the cornea, burning sensation, photophobia, intraocular pressure, and blurred vision. The initial treatment consisted of washing the eye with saline solution and administering analgesic and anti-inflammatory (steroid) medications. One day after the accident, a topical demulcent and hydroxypropyl medication were applied to the eyeball (conjunctiva), the eye was bandaged for 24 hours, and rest was prescribed for 7 days. Eight days later, a corneal ulcer was diagnosed, and antibiotic and anti-inflammatory (steroid) medications were used. RESULTS: Vision was restored without any sequelae 4 weeks after the accident. The endodontist was instructed to apply control medication (Lagricel; Sophia SA, Caracas, Venezuela) for 3 months and to return for ophthalmologic follow-up every 6 months. CONCLUSIONS: Sodium hypochlorite is an effective antibacterial irrigant indicated for the treatment of root canal infections. The tissue cytotoxicity highlights the need to inform the patient of the risk factors of accidents and enhance care with individual protection equipment for the patient and the professional during clinical procedures.

A comparative study of the debridement efficacy and apical extrusion of dynamic and passive root canal irrigation systems.

BACKGROUND: Root canal irrigation carries a risk of extrusion of irrigant into the periapical tissues which can be associated with pain, swelling, and tissue damage. Studies have shown less extrusion with sonic or apical negative pressure devices compared with syringe and side-port needle or passive ultrasonic irrigation with continuous irrigant flow. This study aimed to evaluate the effectiveness of the EndoVac irrigation system, regarding 1) debris removal and 2) the control of apically extruded irrigating solution. METHODS: Fifty extracted human single-rooted teeth were used in this study. The teeth were then randomly divided into three experimental groups according to the type of irrigation used and one control group. In group 1, irrigation was performed using the EndoVac irrigation system. In group 2, irrigation was performed using a 30-gauge, tip-vented irrigation needle. In group 3, irrigation was performed using a 30-gauge, side-vented irrigation needle. The control group received instrumentation with no irrigation to serve as a control for cleaning efficiency. Root canal instrumentation was performed using the Profile NiTi rotary system with a crown-down technique. All of the experimental teeth were irrigated with the same amount of 5.25% sodium hypochlorite. The amount of extruded irrigating solution was then measured by subtracting the post-instrumentation weight from the pre-instrumentation weight using an electronic balance. The cleanliness of debris removal was evaluated using scanning electron microscopy. RESULTS: EndoVac irrigation had the least amount of extrusion followed by the side-vented and tip-vented method. The difference between the groups was statistically significant (P <0.01). As for the cleaning results, the debris collection in the EndoVac and tip-vented groups was the least in the apical third. In the control and the side-vented groups, the debris was the greatest in the apical third, but this difference was not significant among the three experimental groups. CONCLUSIONS: The EndoVac irrigation system extruded significantly less irrigant solution than either needle irrigation system. Debris collection was the least in the apical third for the EndoVac irrigation system. No significant difference was found in the cleaning efficiency among the three irrigation systems.

Effect of nitric oxide inhibitor and donor substances on the inflammatory process caused by endodontic irrigants.

UNLABELLED: Nitric oxide (NO) has been considered a key molecule in inflammation. OBJECTIVE: The aim of this study was to evaluate the effect of treatment with L-NAME and sodium nitroprussiate, substances that inhibit and release NO, respectively, on tissue tolerance to endodontic irrigants. MATERIAL AND METHODS: The vital dye exudation method was used in a rat subcutaneous tissue model. Injections of 2% Evans blue were administered intravenously into the dorsal penial vein of 14 male rats (200-300 g). The NO inhibitor and donor substances were injected into the subcutaneous tissue in the dorsal region, forming two groups of animals: G1 was inoculated with L-NAME and G2 with sodium nitroprussiate. Both groups received injections of the test endodontic irrigants: acetic acid, 15% citric acid, 17% EDTA-T and saline (control). After 30 min, analysis of the extravasated dye was performed by light absorption spectrophotometry (620 nm). RESULTS: There was statistically significant difference (p<0.05) between groups 1 and 2 for all irrigants. L-NAME produced a less intense inflammatory reaction and nitroprussiate intensified this process. CONCLUSIONS: Independently of the administration of NO inhibitors and donors, EDTA-T produced the highest irritating potential in vital tissue among the tested irrigating solutions.

Effect of nitric oxide inhibitor and donor substances on the infammatory process caused by endodontic irrigants

Nitric oxide (NO) has been considered a key molecule in infammation. OBJECTIVE: The aim of this study was to evaluate the effect of treatment with L-NAME and sodium nitroprussiate, substances that inhibit and release NO, respectively, on tissue tolerance to endodontic irrigants. MATERIAL AND METHODS: The vital dye exudation method was used in a rat subcutaneous tissue model. Injections of 2 percent Evans blue were administered intravenously into the dorsal penial vein of 14 male rats (200-300 g). The NO inhibitor and donor substances were injected into the subcutaneous tissue in the dorsal region, forming two groups of animals: G1 was inoculated with L-NAME and G2 with sodium nitroprussiate. Both groups received injections of the test endodontic irrigants: acetic acid, 15 percent citric acid, 17 percent EDTA-T and saline (control). After 30 min, analysis of the extravasated dye was performed by light absorption spectrophotometry (620 nm). RESULTS: There was statistically signifcant difference (p<0.05) between groups 1 and 2 for all irrigants. L-NAME produced a less intense infammatory reaction and nitroprussiate intensifed this process. CONCLUSIONS: Independently of the administration of NO inhibitors and donors, EDTA-T produced the highest irritating potential in vital tissue among the tested irrigating solutions.

Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report.

INTRODUCTION: A triple antibiotic mixture of ciprofloxacin, metronidazole, and minocycline was used as an intracanal medicament in an attempt to disinfect the root canal system for revascularization of a tooth with a necrotic pulp. However, discoloration developed after applying the triple antibiotic mixture. METHODS: Six weeks after a triple antibiotic paste had been applied to the root canal of tooth #8 of a 7-year-old girl, the tooth showed a dark discoloration. An in vitro experiment with human extracted teeth was performed to determine which of the 3 antibiotics caused the tooth discoloration. Another experiment was then carried out to examine whether a currently used dentin bonding agent would prevent or reduce such discoloration. The degree of discoloration was assessed by using a colorimeter. RESULTS: Among the components of the triple antibiotic paste, only minocycline caused the tooth discoloration. Moreover, the dentin bonding agent reduced the intensity of the discoloration but did not prevent it. CONCLUSIONS: The possible esthetic problems with the tooth color should be considered when using minocycline as a canal medication.

Effects of different irrigation regimens on the sealing properties of repaired furcal perforations.

OBJECTIVE: The pulp chamber is inevitably exposed to irrigants during endodontic therapy. This study aimed to investigate whether different irrigation regimens would alter the sealing ability of repaired furcal perforations. STUDY DESIGN: Pulp chambers of 90 extracted human molars were accessed, after which standardized diamond bur-cut perforations were created in the center of the pulp chamber floor. The canal orifices and the apical end of roots were sealed with acid-etch composite resin. Eighty teeth were randomly divided into 2 groups (n = 40/group) according to the material used for repairing the perforation defects: (1) Mineral trioxide aggregate (MTA), (2) Super-EBA. The remaining teeth (n = 10) served as controls. The specimens were further subgrouped according to the irrigation regimens applied over the repair site (n = 10/group): (a) 5.25% NaOCl, (b) 5.25% NaOCl + EDTA, (c) 5.25% NaOCl + MTAD, and (d) No irrigation. Coronal leakage was measured by the fluid-filtration method at 1 day and 1 week. RESULTS: Fluid conductance was not affected by the type of repair material (P = .964) or time (P = .726), but was affected significantly by the irrigation regimens in the following ranking: (P < .001): NaOCl < or = No Irrigation < NaOCl + MTAD < or = NaOCl + EDTA. CONCLUSION: The sealing ability of furcal perforations repaired with MTA or Super-EBA were differentially affected by exposure to the tested irrigation regimens.

Calcium loss from root canal dentin following EDTA, EGTA, EDTAC, and tetracycline-HCl treatment with or without subsequent NaOCl irrigation.

The aim of this study was to determine the extent of calcium removal on root canal dentin after 17% EDTA, 17% EGTA, 15% EDTAC, and 1% tetracycline-HCl treatment; with or without subsequent use of 2.5% NaOCl. Extracted single-rooted human teeth were bisected longitudinally and the root halves (n=100) were isolated with nail varnish, leaving the root canal exposed. The samples were immersed in the test solutions for 1 and 5 minutes, after which the amount of calcium ion (Ca(2+)) release into the solutions was determined by flame photometry. Regardless of treatment time, all single (treatment solution only) and combined (treatment solution with subsequent NaOCl application) irrigation regimens removed significantly more Ca(2+) than control treatment (distilled water). Compared with other groups, treatment with 17% EDTA and 17% EDTA + 2.5% NaOCl resulted in the maximum amount of Ca(2+) removal from root canal dentin (p<0.05). All combined-treatment groups except 17% EGTA + 2.5% NaOCl removed significantly more Ca(2+) than their single-treatment versions (p<0.05). Within each test group, extending the treatment time to 5 minutes resulted in significantly more Ca(2+) removal (p<0.05).

Effects of endodontic irrigation solutions on mineral content of root canal dentin using ICP-AES technique.

The aim of this in vitro study was to evaluate mineral content of root canal dentin after treatment with several endodontic irrigation solutions. Sixty mandibular anterior teeth extracted for periodontal reasons used. The crowns of the teeth were removed at the cemento-enamel junction. Pulp tissues were removed and the teeth were randomly divided into six groups including 10 teeth each. Root canals were enlarged with gates-glidden burs (# 1, 2, and 3). The groups were treated as follows: group 1, 0.2% chlorhexidine gluconate for 15 min; group 2, 3% H2O2 for 15 min; group 3, 17% EDTA for 15 min; group 4, 5.25% NaOCl for 15 min; group 5, 2.5% NaOCl for 15 min; and group 6, distilled water (control). Dentin chips were obtained using gates-glidden burs (# 4, 5, and 6). The levels of five elements calcium, phosphorus, magnesium, potassium, and sulfur in each specimens were analyzed using ICP-AES (Inductively Coupled Plasma Atomic Emission Spectrometry) technique. Changes in the levels of the chemical elements were recorded. The results were then statistically analyzed by one-way ANOVA and Tukey tests. There was a significant decrease in the calcium and phosphorus levels after treatment with all irrigation solutions except for 5.25% NaOCl when compared with the control group (p < 0.05). The K, Mg, and S level changes were not statistically significant (p > 0.05). It has been concluded that endodontic irrigation solutions have an effect on mineral contents of root dentin.

Accidental sodium hypochlorite-induced skin injury during endodontic treatment.

A case of accidental skin injury caused by leakage of sodium hypochlorite solution from the rubber dam during root canal preparation is reported. After placement of a rubber dam and initiation of root canal treatment, the patient complained of a burning sensation with sodium hypochlorite irrigation. The complaints were ignored by the practitioner, and a skin rash developed on and around the patient's chin, followed by scab formation. The patient required medical treatment with topical Hamamelis virginiana extract for 2 weeks, with full recovery.

Endodontic irrigation.

This review of current research and literature investigates trends in endodontic irrigation, focusing on the goals of irrigation and the ability of different irrigants to meet these goals.

Intracanal medicaments.

Intracanal medicaments in endodontics have been used for a number of reasons both in the past and currently. These include the elimination or reduction of microorganisms, rendering canal contents inert, prevention of post-treatment pain, and to enhance anesthesia. The chemical nature of medicaments employed are varied; they come from a number of different groups. Often, different chemicals or drugs are combined in a "cocktail" in an attempt to elicit a variety of effects with a single application. After reviewing in vivo and in vitro research, there is a decided lack of evidence of the clinical effectiveness of intracanal medicaments, with the exception of steroids for prevention of pain. What is clear from the research, is the toxicity and potential allergenicity of the commonly used intracanal medicaments, particularly those of the phenolic and aldehyde derivatives. Ready accessibility to periapical tissues and systemic circulation raises serious doubts as to whether their use is safe. It is also unlikely that most medicaments enhance clinical success. Considering the research, the findings of which are reinforced by clinical experience, intracanal medicaments are primarily useless. The one exception is intracanal or systemic steroids. They are effective in reducing the incidence of post-treatment pain.