RESUMEN
OBJECTIVE: To evaluate the effect of the photon-initiated photoacoustic streaming (PIPS) technique on irrigation performance with different instrumentation tapers in root canals regarding smear layer removal and subsequent sealer penetration. MATERIALS AND METHODS: One hundred twenty human mandibular molars were divided into three equal groups according to the apical preparation taper (25/4%, 25/6%, and 25/8%). Each group was divided into two equal subgroups, one received passive irrigation (PI) while the other received PIPS activation of 2.5% sodium hypochlorite and 17% EDTA. Half the samples were evaluated using electron microscope images to assess smear layer removal. The other half was obturated using gutta-percha and rhodamine B-labeled AH Plus sealer before being sectioned horizontally at different root levels (coronal, middle, and apical) to evaluate the percentage of sealer penetration using CLSM. Mann-Whitney U and Friedman tests were used to analyze smear layer scores, while sealer penetration data were analyzed using the three-way analysis of variance (ANOVA) and Tukey's post hoc test. RESULTS: Statistical analysis showed significantly better smear layer removal and better sealer penetration after PIPS activation when corresponding root thirds were compared (P<0.001). Only exception was sealer penetration in the apical third with root canal preparation of 25/4% where the difference between the irrigation methods was statistically insignificant (P>0.05). CONCLUSIONS: The use of PIPS activation in the final irrigation protocol enhanced smear layer removal and sealer penetration into dentinal tubules if the taper of the prepared canal was at least 6%. CLINICAL RELEVANCE: Increasing apical preparation taper significantly enhances PIPS performance in terms of irrigation activation thus enhancing smear layer removal and subsequent sealer penetration in dentinal tubules.
Asunto(s)
Materiales de Obturación del Conducto Radicular , Capa de Barro Dentinario , Ácido Edético , Humanos , Irrigantes del Conducto Radicular , Preparación del Conducto Radicular , Hipoclorito de SodioRESUMEN
Introduction and aim: Chlorhexidine Hydrochloride [Chx.HCl] has a broad-spectrum antibacterial effect, sustained action and low toxicity so it has been recommended as a potential root canal irrigant. The aim of this study was to improve the penetration ability, cleansing and antibacterial effect of Chx.HCl using a newly formulated Chx.HCl nanoemulsion and use it as root canal irrigant. Methods: Chx.HCl nanoemulsions were prepared using two different oils; Oleic acid and Labrafil M1944CS, two surfactants; Tween 20 and Tween 80 and co-surfactant; Propylene Glycol. Pseudoternary phase diagrams were constructed to designate the optimum systems. The prepared nanoemulsion formulae were evaluated for their drug content, emulsification time, dispersibility, droplet size, in-vitro drug release, thermodynamic stability, In-vitro antibacterial activity and ex-vivo study for the selected formula. Comparisons were made of Chx.HCl nanoemulsion with two different concentrations 0.75% and 1.6% vs Chx.HCl normal particle size as root canal irrigant for their penetration ability, cleansing effect and antibacterial effect. Results: The selected formula was F6 with composition of 2% Labrafil, 12% Tween 80 and 6% Propylene glycol. It has small particle size (12.18 nm), short emulsification time (1.67 seconds), and fast dissolution rate after 2 minutes. It was found to be a thermodynamically/physically stable system. The higher concentration of Chx.HClnanoemulsion1.6% shows the best penetration ability compared to Chx.HCl normal particle size due to the smaller particle size. Chx.HCl nanoemulsion 1.6% has the lowest mean value of the remaining debris surface area (2001.47 µm2) when compared to normal particle size material (2609.56 µm2). Conclusion: Chx.HCl nanoemulsion preparation has better cleansing ability and antibacterial effect with high efficacy on Enterococcus faecalis, where high reduction rate or complete eradication of bacterial cells has been achieved.