Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-02-22, 10:39:24 | version 1.38.0
18 GENERAL DENTISTRY Dental Tribune Middle East & Africa Edition | 2/2017 Irrigation protocols comparison, an in vitro study By Dr. Salmerón P, Dr. Camacho F, & Dr. Martínez-Beneyto Y Introduction The removal of remaining pulp tis- sue, microorganisms and bacterial toxins from the root canal system is essential to the success of endodon- tic therapy. It is generally accepted that the best way to carry out remov- al is by cleaning and shaping the root canal complex; microorganisms that remain in the root canal after treat- ment (or for some reason return to colonize the root canal after fi lling) are the main causes of endodontic failure. For this reason, disinfection must be optimized (Zehnder, 2006). The use of root canal irrigants boosts bacterial elimination and facilitates the removal of necrotic tissue and dentin particles from the canal. Ir- rigants also prevent the packing of infected hard and soft tissues in the apical part of the root, and even the periapical area (Haapasalo et al., 2005). But in spite of the use of these agents, intracanal bacteria may remain after biomechanical instrumentation (Nair et al., 2005). Endodontic infections are based on multiple species of microorgan- isms and treatment must take into account the increasing resistance of the polymicrobial fl ora involved. Furthermore, the presence of debris not only reduces the effi cacy of irri- gant substances and root canal med- ication used for disinfection, but also favors the persistence of these bacte- ria in the canal system (Pagonis et al., 2010). All these factors can impede the main endodontic treatment objectives: the elimination of these etiologic agents from root canals and the disinfection of root canals and its three-dimensional network of den- tinal tubules (Cheng et al., 2012). Fail- ure to do so effectively may provoke endodontic failure. Enterococcus faecalis (E. faecalis) is a gram-positive facultative anaerobic bacteria and the cause of second- ary apical periodontitis. The resist- ance to treatment of E. faecalis is explained by its potential penetra- tion into dentinal tubules (Molander et al., 1998; Sunde et al., 2002), its prolonged survival capacity in root- fi lled teeth (Sedgley et al., 2005), its adhesion ability to the collagen ma- trix existing in dentin (Love, 2001; Kayaoglu et al., 2009) and its inade- quate response to antimicrobial irri- gation solutions (Estrela C., 2007). In this context, the prevalence of E. fae- calis is higher in persistent infections than in primary infections (Stuart et al., 2006). Different irrigating solutions have been considered to decrease endo- dontic infection and contribute to canal sanitization, including: halo- genated compounds (sodium hy- pochlorite - NaOCL), chlorhexidine (CHX), detergents (anionic, cationic), chelating agents (ethylenediamine- tetraacetic acid [EDTA], citric acid), MTAD (mixture of tetracycline cit- ric acid and detergent), triantibiotic mixture (TAM), apple vinegar (Es- trela et al., 2012), propolis (Flaviana et al., 2007) and hydrogen peroxide (Kobayashi et al., 2014). CHX digluconate, which has been proposed as root canal irrigant, is a cationic biguanide made up of two chlorophenoxy rings and two biguanide groups connected by a central hexamethylene bridge with positive charges at each end of the bridge (Jaju & Jaju, 2011). Among its main properties relevant to endo- dontic application is its broad spec- trum of antimicrobial activity, its specifi c bactericidal and bacteriostat- ic effects, and the long-term nature of its antimicrobial activity. At low concentrations, it has a bacteriostatic effect. At higher concentrations, it has a bactericidal effect due to the precipitation and coagulation of intracellular constituents (Wang et al., 2007; Xu et al., 2009), exercising its optimal effect on gram-positive bacteria at a concentration of 2%, the concentration recommended in the literature for root canal irrigation (Spangberg et al., 1973). In root canal therapy, antibiotics can be used as adjunctive medicine. Hoshino and Takushige (Hoshino & Takushige, 1998) introduced the concept of “Lesion Sterilization and Tissue Repair” or LSTR therapy based on the use of a mixture of antibiot- ics for disinfecting pulpar and peri- apical lesions. A combination of 3 MIX-MP in paste form, also known as triantibiotic mixture (TAM), is made by combining a powder composed of ciprofl oxacin, metronidazole and minocycline and a liquid composed of polyethylene glycol and propyl- ene glycol. It penetrates the dentinal tubules, and has a potent disinfect- ant effect through ciprofl oxacin’s wide-spectrum bactericidal action against gram-positive and gram negative bacteria, metronidazole’s ÿPage 19