• Restorative Dentistry and Endodontics
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• v.45 no.3
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• pp.39.1-39.11
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• 2020

Despite the vast literature on the effects of root canal irrigants on the dentin characteristics, the precise effects of clinically relevant irrigation sequences remain unclear. In this review, we systematically dissect the role of different sequential irrigation approaches that are used in clinical endodontics. Using a systematic search strategy, we attempt to answer the question: 'Which irrigating sequence has the most deleterious effects on dentin structure and properties?' The effect of irrigants on the dentin composition and mechanical properties have been reviewed. A wide variety of concentrations, duration and techniques have been employed to characterize the effects of chemicals on dentin properties, thus making it impossible to draw guidelines or recommendations of irrigant sequences to be followed clinically. It was apparent that all the studied irrigation sequences potentially result in some deleterious effects on dentin such as decrease in the flexural strength, microhardness, modulus of elasticity and inorganic content and organic-inorganic ratio of the dentin. However, the literature still lacks comprehensive investigations to compare the deleterious effect of different irrigation sequences, using a wide variety of qualitative and quantitative methods. Such investigations are essential to make clinical recommendations and strategize efforts to minimize chemically-induced damage to dentin characteristics.

• Restorative Dentistry and Endodontics
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• v.40 no.1
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• pp.50-57
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• 2015

Objectives: The usage of medicinal plants as natural antimicrobial agents has grown in many fields including dental medicine. The aim of this in vitro study was three-fold: (i) to determine the chemical compositions of the Ferula gummosa essential oil (FGEO), (ii) to compare the antimicrobial efficacy of the oil with sodium hypochlorite (NaOCl) and chlorhexidine (CHX), (iii) to assess the toxic behavior of FGEO in different concentrations compared to 5% NaOCl and 0.2% CHX. Materials and Methods: Gas chromatography/mass spectrometry (GC/MS) was used to determine the chemical compositions of the oil. The disk diffusion method and a broth micro-dilution susceptibility assay were exploited to assess the antimicrobial efficacy against Enterococcus faecalis, Staphylococcus aureus, Streptococcus mitis, and Candida albicans. The cytocompatibility of the FGEO was assessed on L929 fibroblasts, and compared to that of NaOCl and CHX. Results: Twenty-seven constituents were recognized in FGEO. The major component of the oil was ${\beta}$-pinene (51.83%). All three irrigants significantly inhibited the growth of all examined microorganisms compared to the negative control group. FGEO at $50{\mu}g/mL$ was effective in lower concentration against Enterococcus faecalis than 5% NaOCl and 0.2% CHX, and was also more potent than 0.2% CHX against Candida albicans and Staphylococcus aureus. FGEO was a cytocompatible solution, and had significantly lower toxicity compared to 5% NaOCl and 0.2% CHX. Conclusions: FGEO showed a promising biological potency as a root canal disinfectant. More investigations are required on the effectiveness of this oil on intracanal bacterial biofilms.

• Journal of Oral Medicine and Pain
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• v.36 no.3
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• pp.199-205
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• 2011

During root canal treatment, overinstrumentation with hand or mechanically driven files can perforate the mandibular canal, allowing the extrusion of endodontic sealers, dressing agents, and irrigant solutions out of the tooth and into the canal. The patient may report symptoms such as pain, hyperesthesia, hypoesthesia, anesthesia, dysesthesia and paresthesia. Such problems must be resolved as quickly as possible to avoid irreversible sequelae caused by certain neurotoxic materials that form part of endodontic sealants. Although there have been no controlled trials of treatment protocols involving endodontically related injuries to the inferior alveolar nerve, the normal therapeutic sequence for this complication is the control of pain and inflammation and, whenever possible, the surgical elimination of the cause. However, total resolution of pain and reduction in or disappearance of paraesthesia after a non-surgical management have been reported. Antiepileptic drugs such as gabapentin or pregabalin have been used for the treatment of neuropathic pain. This article describes a case of inferior alveolar nerve(IAN) damage after endodontic treatment of a mandibular right second molar and the treatment with non-surgical approach using prednisone and gabapentin medication, monitoring the patient's condition with clinical neurosensory examination and current perception threshold test(Neurometer).

• The Journal of the Korean dental association
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• v.53 no.11
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• pp.795-803
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• 2015

A questionnaire-based survey was done to evaluate the patients' perception on the use of Rubber Dam (RD) for the tooth isolation during dental treatment. Total 106 questionnaire were gathered and the data were analyzed according to the patients' gender, age, previous experience of RD. The 96% of total patients reported no experience of RD in their previous treatment. The first advantage of RD was selected as the protection of irrigant and medication into the oral cavity and the disadvantage was selected as saliva gathering during treatment. 98% of patients want to use RD for the next treatment and 99% remarked that the RD is essential for the dental treatment. Based on the surveyed data, majority of the patients highly satisfied with the RD use and they want to use RD and may consider the use of RD for the selection of dental clinic.

• Restorative Dentistry and Endodontics
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• v.48 no.3
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• pp.28.1-28.13
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• 2023

Objectives: This study aimed to investigate the effect of the application method of 2% chlorhexidine (CHX) and its influence on the adhesion of fiberglass posts cemented with a self-adhesive resin cement. Materials and Methods: Sixty human mandibular premolars were endodontically treated and divided into 5 groups (n = 12), according to the canal irrigant and its application method: 2 groups with conventional syringe irrigation (CSI)-2.5% sodium hypochlorite (NaOCl) (control) and 2% CHX- and 3 groups with 2% CHX irrigation/activation-by passive ultrasonic irrigation (PUI), Easy Clean file, and XP-Endo Finisher file. Two roots per group were evaluated for smear layer (SL) removal by scanning electron microscopy. For other roots, fiber posts were luted using a self-adhesive resin cement. The roots were sectioned into 6 slices for push-out bond strength (BS) (7/group) and nanoleakage (NL) (3/group). Data from SL removal were submitted to Kruskal-Wallis and Student-Newman-Keuls tests (α = 0.05). Data from BS and NL were evaluated by 2-way analysis of variance and Tukey's test (α = 0.05). Results: For SL removal and BS, the CHX irrigation/activation promoted better values than CSI with CHX (p < 0.05), but it was not significantly different from CSI with NaOCl (p > 0.05). For NL, the lowest values were obtained by the chlorhexidine irrigation/activation groups (p < 0.05). Conclusions: Active 2% CHX irrigation can be used to improve the post space cleaning and adhesion before fiber post cementation with self-adhesive resin cements.

• Restorative Dentistry and Endodontics
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• v.40 no.3
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• pp.216-222
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• 2015

Objectives: To evaluate the effects of copolymer of acrylic acid and maleic acid (Poly[AA-co-MA]) and calcium hypochlorite ($Ca(OCl)_2$) on root canal dentin using scanning electron microscope (SEM). Materials and Methods: Twenty-four single-rooted teeth were instrumented and the apical and coronal thirds of each root were removed, leaving the 5 mm middle thirds, which were then separated into two pieces longitudinally. The specimens were randomly divided into six groups and subjected to each irrigant for 5 min as follows: G1, $Ca(OCl)_2$; G2, Poly(AA-co-MA); G3, $Ca(OCl)_2$ + Poly(AA-co-MA); G4, sodium hypochlorite (NaOCl); G5, ethylenediaminetetraacetic acid (EDTA); G6, NaOCl+EDTA. The specimens were prepared for SEM evaluation. Smear layer, debris and erosion scores were recorded by two blinded examiners. One image from G3 was analyzed with energy dispersive spectroscopy (EDS) on suspicion of precipitate formation. Data were analyzed using the Kruskal-Wallis and Dunn tests. Results: G1 and G4 showed the presence of debris and smear layer and they were statistically different from G2, G3, G5 and G6 where debris and smear layer were totally removed (p < 0.05). In G1 and G4, erosion evaluation could not be done because of debris and smear layer. G2, G3 and G5 showed no erosion, and there was no significant difference between them. G6 showed severe erosion and was statistically different from G2, G3 and G5 (p < 0.05). EDS microanalysis showed the presence of Na, P, and Ca elements on the surface. Conclusions: Poly(AA-co-MA) is effective in removing the smear layer and debris without causing erosion either alone or with $Ca(OCl)_2$.

• Restorative Dentistry and Endodontics
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• v.40 no.3
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• pp.195-201
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• 2015

Objectives: The use of chitosan nanoparticles (CNPs) in endodontics is of interest due to their antibiofilm properties. This study was to investigate the ability of bioactive CNPs to remove the smear layer and inhibit bacterial recolonization on dentin. Materials and Methods: One hundred bovine dentin sections were divided into five groups (n = 20 per group) according to the treatment. The irrigating solutions used were 2.5% sodium hypochlorite (NaOCl) for 20 min, 17% ethylenediaminetetraacetic acid (EDTA) for 3 min and 1.29 mg/mL CNPs for 3 min. The samples were irrigated with either distilled water (control), NaOCl, NaOCl-EDTA, NaOCl-EDTA-CNPs or NaOCl-CNPs. After the treatment, half of the samples (n = 50) were used to assess the chelating effect of the solutions using portable scanning electronic microscopy, while the other half (n = 50) were infected intra-orally to examine the post-treatment bacterial biofilm forming capacity. The biovolume and cellular viability of the biofilms were analysed under confocal laser scanning microscopy. The Kappa test was performed for examiner calibration, and the non-parametric Kruskal-Wallis and Dunn tests (p < 0.05) were used for comparisons among the groups. Results: The smear layer was significantly reduced in all of the groups except the control and NaOCl groups (p < 0.05). The CNPs-treated samples were able to resist biofilm formation significantly better than other treatment groups (p < 0.05). Conclusions: CNPs could be used as a final irrigant during root canal treatment with the dual benefit of removing the smear layer and inhibiting bacterial recolonization on root dentin.

• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.2
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• pp.129-136
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• 2011

Microorganisms are the main causative factors of pulpal and periapical diseases, therefore successful endodontic treatment is depend on the effective elimination of intracanal bacterial populations. Many studies have been reported antimicrobial effect of Allyl isothiocyanate (AIT) which the principle ingredient of Horseradish (Armoracia rusticana) root extracts. The purposes of this study are to evaluate the antimicrobial effectiveness of Horseradish root extracts against Enterococcus faecalis in root canals of extracted human teeth and compare to sodium hypochlorite (NaOCl). Extracted human mandibular premolar root canals were infected with E. faecalis for 21 days, and then irrigated with Horseradish root extracts, NaOCl solution and saline. After canal irrigation, first samples (S1) were taken. After first sampling, the canals were additionally incubated 7 days, and then second samples (S2) were taken. The samples were inoculated on EHI agar plate to determine the colony forming units (CFU). 1. Mean values of CFU in S1 were $5.815{\times}10^3$ CFU/ml at Horseradish groups, and $3.465{\times}10^3$ CFU/ml at NaOCI groups. There was no statistically significant differences (p=0.086). 2. Mean values of CFU in S2 were $3.100{\times}10^3$ CFU/ml at Horseradish groups, and $5.252{\times}10^5$ CFU/ml at NaOCI groups. There was statistically significant difference (p<.05). 3. There was no statistically significant differences (p=0.076) between S1 and S2 at Horseradish groups in the mean values of CFU. However, there was statistically significant differences (p<.05) between S1 and S2 at NaOCI groups in the mean values of CFU.

• Restorative Dentistry and Endodontics
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• v.45 no.4
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• pp.47.1-47.11
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• 2020

Objectives: The aim of this study was to assess the physicochemical properties, cytotoxicity and penetration into dentinal tubules of ChlorCid^TM Surf (3% sodium hypochlorite [NaOCl] with surfactant) in comparison to ChlorCid^TM (3% NaOCl without surfactant). Materials and Methods: The physicochemical properties evaluated were pH, surface tension, free available chlorine (FAC) and contact angle. Cytotoxicity was evaluated in L929 fibroblasts exposed to the solutions by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide and neutral red assays. Assessment of penetration into dentinal tubules was performed by staining single-rooted permanent human teeth with crystal violet (n = 9), which were irrigated with the solutions and analyzed in cervical, middle and apical segments. Data were analyzed by one-way analysis of variance (ANOVA) and Tukey's post-test, 2-way ANOVA and Bonferroni's post-test or t-test (α = 0.05). Results: ChlorCid^TM Surf and ChlorCid^TM FAC values were close to those indicated by the manufacturer. ChlorCid^TM Surf showed lower surface tension and contact angle on dentin, and higher pH than ChlorCid^TM (p < 0.05). The penetration of ChlorCid^TM Surf was higher in cervical and middle segments, compared with ChlorCid^TM (p < 0.05). There was no difference in irrigant cytotoxicity (p > 0.05). Conclusions: ChlorCid^TM Surf showed lower surface tension, lower contact angle on root canal dentin, higher penetration into dentinal tubules and more alkaline pH, compared with ChlorCid^TM. However, both solutions showed similar cytotoxicity and FAC content.

• Restorative Dentistry and Endodontics
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• v.31 no.3
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• pp.169-178
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• 2006

This study was to verify that the combined application of NaOCl and EDTA was more effective in removal of smear layer than the application of NaOCl alone. furthermore it was aimed to find out the optimal time for the application of EDTA. Thirty five single rooted teeth were cleaned and shaped. NaOCl solution was used as an irrigant during instrumentation. After instrumentation, root canals of the control group were irrigated with 5 ml of NaOCl for 2 minutes. 30 sec, 1 min, and 2 min group were irrigated with 5 ml of 17% EDTA for 30 sec, 1 min, and 2 min respectively. Then the roots were examined with scanning electron microscopy for evaluating removal of smear layer and erosion of dentinal tubule. The results were as follows; 1. The control group: The smear layer was not removed at all. 2. The other groups: 1) $Middle\frac{1}{3}$: All groups showed almost no smear layer. And the erosion occurred more frequently as increasing irrigation time. 2) $Apical\frac{1}{3}$: The cleaning effect of 2 min group was better than the others. The results suggest that 2 min application of 17% EDTA should be adequate to remove smear layer on both $apical\frac{1}{3}\;and\;middle\frac{1}{3}$.