Effect of ultrasonic activation on the reduction of bacteria and endotoxins in root canals: a randomized clinical trial.

AIM: This randomized clinical trial aimed to compare the effectiveness of ultrasonic activation with that of nonactivated irrigation on the removal of bacteria and endotoxin from root canals. METHODOLOGY: Fifty patients with necrotic pulps and asymptomatic apical periodontitis were randomly allocated into two groups according to the final irrigation protocol after root canal preparation: Group UI - ultrasonic irrigation (n = 25) and Group NI - needle irrigation (n = 25). The root canals were medicated with calcium hydroxide for 14 days. Microbiological sampling was performed before (S1) and after the root canal preparation (S2), after the irrigation protocols (S3) and after the removal of the intracanal medication (S4). Total bacteria counts were determined by qPCR and the endotoxin levels by the limulus amebocyte lysate assay. Intragroup analyses were performed using the Wilcoxon test for related samples, whereas intergroup analyses were performed using the Mann-Whitney U-test (P < 0.05). RESULTS: All S1 samples were positive for bacteria, with median numbers of 1.49 × 106 and 8.55 × 105 bacterial cells for the UI and NI groups, respectively. This number significantly decreased in S2 samples (UI: 1.41 × 104 ; NI: 3.53 × 104 ; both with P < 0.001). After final irrigation protocols, there was a significant decrease in bacterial load from S2 to S3 samples in both groups (UI: 4.29 × 103 ; NI: 1.08 × 104 ; P < 0.01). Intergroup analysis revealed a significant difference between irrigation methods regarding bacterial counts in S3 samples (P < 0.05). In contrast, no significant differences were observed between groups for endotoxin levels (P > 0.05). CONCLUSIONS: Ultrasonic activation was more effective than nonactivated irrigation for reducing the number of bacteria but not the endotoxin levels in root canals of teeth with apical periodontitis.

Ex vivo evaluation of the effects of several root canal preparation techniques and irrigation regimens on a mixed microbial infection.

AIM: To assess the ex vivo effectiveness of the alternated use of 1% NaOCl and 15% citric acid in association with two instrumentation techniques for the disinfection of root canals infected with Enterococcus faecalis and Candida albicans. METHODOLOGY: Eighty human mandibular premolars with straight, oval root canals standardized to 15 mm in length were infected with a mixed culture of E. faecalis and C. albicans for 28 days. Five other teeth were used as controls and were neither contaminated nor instrumented. Specimens were divided into two groups (n = 40), according to whether the canal preparation technique used manual (K-type) or rotary (Protaper Universal) instruments. These groups were further divided into four subgroups (n = 10) according to the irrigation solution used: saline, 1% NaOCl, 1% NaOCl with alternated use of 15% citric acid and 5.25% NaOCl. Root canals were prepared with a crown-down technique until a size 50 K-file or with rotary preparation until an F5 instrument. Microbiological sampling was performed before (S1) and after (S2) the chemomechanical preparation, using sterile paper points. The specimens were split, and 0.02 g of dentine chips was collected from the root thirds to verify the presence of microorganisms in root canal walls. RESULTS: Saline and 1% NaOCl were less effective in reducing microorganisms compared with 1% NaOCl with alternated use of 15% citric acid or 5.25% NaOCl alone (P < 0.05). Both manual and rotary preparations significantly reduced microorganisms regardless of the irrigation solution used (P < 0.05). However, there was no significant difference between the canal preparation techniques (P > 0.05). CONCLUSIONS: Irrigation with 5.25% NaOCl and 1% NaOCl alternated with 15% citric acid reduced microorganisms in infected root canals significantly more than saline and 1% NaOCl.