The Effect of Sodium Hypochlorite and Chlorhexidine as Irrigant Solutions for Root Canal Disinfection: A Systematic Review of Clinical Trials

Abstract

Aims: This systematic review aimed to compare the effectiveness of sodium hypochlorite and chlorhexidine for root canal disinfection during root canal therapy. Methods:A literature search for clinical trials was made on the PUBMED (Medline), Web of Knowledge, SCOPUS, and Science Direct databases and in the reference lists of the identified articles up to January 2015. Quality assessment of the selected studies was carried out according to the CONSORT statement. Results:One clinical trial and four randomized clinical trials (RCTs) were selected from the 172 papers initially identified. There was heterogeneity in the laboratory methods used to assess the root canal disinfection as well as in the concentrations of the irrigants used. Therefore, meta-analysis was not performed. Two studies reported effective and similar reductions in bacterial levels for both irrigants. Sodium hypochlorite was more effective than chlorhexidine to reduce microorganisms in one study and another reported opposite findings. Both root irrigants were ineffective in eliminating endotoxins from necrotic pulp root canals in one study. Trial design and information regarding randomization procedures were not clearly described in the clinical trials. No study compared laboratory results with clinical outcomes. Conclusions:The available evidence on this topic is scarce and the findings of studies were not consistent. Additional RCTs using clinical outcomes to compare the use of sodium hypochlorite and chlorhexidine during root canal therapy are needed.

Intracanal Irrigating Solutions Prior to Calcium Hydroxide Medication and Its Effects on Root Dentin Strength

“…Regarding the irrigating solutions, it is well known that NaOCl appears to be the most employed solution due to its bactericidal activity (4,5,7,8), excellent lubrication (2), ability to dissolve organic components (1,6), bleaching capacity and low surface tension (1,2). However, adverse effects of NaOCl irrigation on dentin's mechanical properties (3,10,11,13,19) have been reported, including decrease of microhardness (10), flexural strength (11) and elastic modulus (3).…”

“…Ideally, an irrigating solution should promote debridement, lubrication, dissolve organic tissue and eradicate the microorganisms from the root canal system (4)(5)(6)(7)(8). However, sodium hypochlorite is unable to remove inorganic components, and thus, unable to remove the smear layer produced during canal instrumentation (5,6).…”

Evaluation of Post-Operative Pain After Irrigation Using End-Vented Navitip Tips Versus Side-Vented Navitip Tips in Teeth With Irreversible Pulpitis: A Randomized Clinical Trial Part Vi.

“…In this study, 2.6 % NaOCl was used as routine irrigant due to its broad antibacterial activity and organic material dissolution ability (16) . A low concentration of 2.6% NaOCl was used due to less toxicity and same antibacterial efficacy compared with higher concentration of 5.25 % NaOCl (17,18) .…”

Gelatin as a Chlorhexidine Digluconate Immobilizing Agent

“…The antimicrobial effect of chlorhexidine is due to the attraction and adsorption of the chlorhexidine cationic molecules on the surface of the microorganism's cells [2]. This interaction promotes the alteration of the cell membrane permeability, resulting in the loss of intracellular components and the osmotic imbalance of the cell [3,4]. Its sizeable microbial spectrum, persistence, and low toxicity [5,6], promoted the use of this substance in several areas related to the health.…”