Microbiological Effectiveness of Sodium Hypochlorite Gel and Aqueous Solution When Implemented for Root Canal Disinfection in Multirooted Teeth: A Randomized Clinical Study

Abstract

The aim of endodontic therapy is to use various antimicrobial medications for proper cleaning and shaping to create an environment free of microorganisms by eradicating as many as possible from the root canal space. Even although it is a gold standard irrigant, sodium hypochlorite (NaOCl) is known for its cytotoxic effects on vital periapical tissues, making its higher concentrations inappropriate for use in conditions such as wide, underdeveloped, or damaged apices and in cases of perforations. Consequently, if it is ascertained that a gel form of sodium hypochlorite has equivalent antibacterial activity to the aqueous solution form, it could be employed in such situations. The aim of this study was the microbiologic evaluation of 5.25% sodium hypochlorite gel and aqueous solution as root canal disinfectants in multirooted teeth with primary endodontic lesions. Following ethical approval and CTRI registration, 42 patients who gave their consent and had multirooted teeth with pulpal necrosis and asymptomatic apical periodontitis were considered for the study. Following the opening of the access, pre-endodontic build up in case of class-II cavities and working length determination, a pre-operative sample (S1), which was regarded as the pre-operative microbial load of that canal, was acquired from the largest canal using a sterile paper point while maintaining strict isolation and disinfection. The computer randomization approach was used to divide the teeth into two groups at random just before beginning of chemo-mechanical preparation: Group A (n = 21)—canal disinfection with 5.25% sodium hypochlorite gel; Group B (n = 21)—canal disinfection with 5.25% sodium hypochlorite aqueous solution. Following the canal disinfection, a post-operative (S2) sample which was regarded as the postoperative microbial load of that canal was collected from the same canal using a sterile paper point. The Colony-Forming Units (CFUs) for the S1 and S2 samples were determined after 48 h aerobic incubation on Brain Heart Infusion (BHI) agar plates. The patients and the microbiologist were blinded throughout the procedure. Using SPSS 20.0 software (USA), the Shapiro–Wilk test and the Lilliefors Significance Correction were used for normality, followed by the Mann–Whitney U test which was used to compare the CFU difference (×105) between the two groups. A p value of <0.05 was perceived as statistically significant. The mean colony-forming units count difference between the 5.25% sodium hypochlorite gel and aqueous solution groups did not differ in a manner that was statistically significant (p = 0.744). In multirooted teeth with primary endodontic lesions, the 5.25% sodium hypochlorite gel and the aqueous solution demonstrated comparable antimicrobial effectiveness when implemented as root canal disinfectants.

Disinfection Efficacy of Laser Activation on Different Forms and Concentrations of Sodium Hypochlorite Root Canal Irrigant against Enterococcus faecalis in Primary Teeth

“…A comparable result was reported in an in vivo study performed by Kotecha et al, where they treated multirooted primary teeth that had endodontic lesions using 5.25% sodium hypochlorite gel and solution, with both the interventions demonstrating comparable antimicrobial effectiveness when implemented as root canal disinfectants [10]. In addition, other in vitro studies have also demonstrated comparable efficacy of both sodium hypochlorite gel and solution [11][12][13].…”

“…Furthermore, it was reported that the largest number of microorganisms is present in the main root canal of primary teeth; yet, a significant portion of microorganisms is present in lateral canals, apical ramifications, as well as dentinal tubules. These place a burden on the clinician to accomplish all the aforementioned tasks in a duration that matches the attention span of our young paediatric patients [10].…”

Cleaning and disinfection of the root canal system provided by four active supplementary irrigation methods

“…It is primarily based on the associated use of endodontic instruments (mechanical cleaning) and auxiliary chemical solutions (chemical cleaning), further complemented by the physical cleaning performed by injection followed by aspiration of the irrigating solutions into the RCS 1,2 .The metallurgical revolution occurred in the last years has positively impacted endodontic science, stemming from the development and improvement of instruments with different designs, objectives, kinematics, characteristics, and properties 3 . However, the difficulties imposed by the anatomical complexity and the infection of the RCS continue to be the pillars of endodontic failure 4 , thus encouraging the study of alternatives to enhance the chemical and disinfection processes [5][6][7][8][9] .The EndoActivator system (EAS) (Dentsply-Maillefer, Ballaigues, Switzerland) is a sonically driven activation tool developed to promote a vigorous agitation of the irrigant or chelating solutions within the root canals. Using a needle and syringe, the system has raised irrigation efficiency better than conventional irrigation (CI).…”

“…The metallurgical revolution occurred in the last years has positively impacted endodontic science, stemming from the development and improvement of instruments with different designs, objectives, kinematics, characteristics, and properties 3 . However, the difficulties imposed by the anatomical complexity and the infection of the RCS continue to be the pillars of endodontic failure 4 , thus encouraging the study of alternatives to enhance the chemical and disinfection processes [5][6][7][8][9] .…”