Proton Nuclear Magnetic Resonance Spectroscopy Analysis of Mixtures of Chlorhexidine with Different Oxidizing Agents Activated by Photon-Induced Photoacoustic Streaming for Root Canal Irrigation

Abstract

Objective: The aim of this in vitro study was to investigate the possible interactions between photon-induced photoacoustic streaming (PIPSÔ)-activated oxidizing agents and 2% chlorhexidine digluconate. Background data: There is no information about the safety of laser-activated oxidizing agents in combination usage with chlorhexidine gluconate. Materials and methods: Groups were designed as follows G1: 98% para-chloroaniline (PCA); G2: 2% chlorhexidine (CHX); G3: 5.25% sodium hypochlorite (NaOCl) +2% CHX; G4: 5.25% NaOCl (30 sec PIPS activated) +2% CHX; G5: 5.25% NaOCl (60 sec PIPS activated) +2% CHX; G6: 3.5% chlorine dioxide (ClO 2 ) + 2% CHX; G7: 3.5% (ClO 2 ) (30 sec PIPS activated) +2% CHX; G8: 3.5% (ClO 2 ) (60 sec PIPS activated) +2% CHX. The laser-irrigation protocol was performed with an erbium:yttrium-aluminum-garnet laser with a wavelength of 2940 nm equipped with a 140 mm long endodontic fiber tip (PIPS) using 10 mJ at 15 Hz (0.15 W), per pulse operating outputs. Groups were analyzed with proton nuclear magnetic resonance spectroscopy, using PCA as an internal standard. Results: No free PCA was formed in any groups of mixtures or after PIPS activation. Conclusions: Mixing of 3.5% ClO 2 and 2% CHX does not form bulky precipitates, unlike the mixture NaOCl + CHX. PIPS activation does not cause changes in reactions of oxidizing agents.

Molecular interactions between the most commonly used endodontic lavage agents in clinical practice

“…As mentioned before, the rate of oxidizing reaction of NaOCl rapidly increases when activated with photo-activated systems, lasers, sonic and ultrasonic energy transfer. 17,18 Regarding the IR and UV-Vis spectral data, the molecular structure of EDTA changed as a consequence to first interaction with NaOCl.…”

“…Also, the highly oxidizing capacity of NaOCl can be increased by non-specific physical or physicochemical stimulations using mechanical agitations, ultrasonics, or laser irradiation in clinical practice. 17,18 Therefore, the second goal of this study was to analyze the interaction between NaOCl and EDTA after experimental cold plasma energy transferring mimicking physicochemical activation of solutions.…”

The Interaction of Two Widely Used Endodontic Irrigants, Chlorhexidine and Sodium Hypochlorite, and Its Impact on the Disinfection Protocol during Root Canal Treatment

“…The possibility of exchanging NaOCl in the combination of NaOCl and CHX was only considered possible by Buyukozer et al [ 38 ]. Chlorine dioxide (ClO 2 ) can be utilized as an alternative means of root canal irrigation instead of NaOCl, due to its antimicrobial activity, biocompatibility, and ability to dissolve organic tissue [ 87 , 88 , 89 ].…”

Evaluation of the Antibacterial Effects of Single and Combined use of Different Irrigation Solutions Against Intracanal Enterococcus Faecalis

“…According to the results of the present study, ClO 2 + CHX is effective in the elimination of E. faecalis . These two agents do not form any reactions nor do they negatively influence each other ( 26 , 27 ) and they maintain their antibacterial activity at all times when used in combinations ( Figure 4,6 ).…”