International Journal of Virology Studies & Research

Predictors of Root Canal Endodontical Treatment

Defective apical seals were identified as the main cause of failures in endodontic treatment, and several studies have emphasized the importance of adequate coronal sealing between sessions for successful endodontic therapy. Sodium hypochlorite is an irrigant solution widely used in chemotherapeutic treatment for a long time with great effectiveness. Gluconate chlorhexidine is a newer product but with excellent properties but there is still considerable controversy over which is the best product for the treatment of the root canal.
Dr. Idiberto José Zotarelli Filho, Professor from Brazil done a  systematic review on the importance of the clinical use and outcomes of Chlorhexidine gluconate, Sodium hypochlorite and Coltosol® in the endodontic treatment of canals.
The words were included Treatment dental root. Chlorhexidine gluconate, Sodium hypochlorite, and Coltosol®. For further specification, the root canal irrigation description for refinement was added during searches. The literature search was conducted through online databases: Pubmed, Periodicos.com, and Google Scholar. It was stipulated deadline, and the related search covering all available literature on virtual libraries. A total of 55 articles were found involving temporomandibular dysfunction. Initially, it was held the exclusion existing title and duplications in accordance with the interest described this work. After this process, the summaries were evaluated and a new exclusion was held. A total of 41 articles were evaluated in full, and 30 were included and discussed in this study.

The success of endodontic treatment is directly related to the observance of all principles recommended for the treatment of root canals such as complete cleaning, disinfection, and elimination of all and any residual channel system and modeling prior to restoration.
The preparation of the canal is highly influenced by the complexity and anatomical variability of the root canals that have recesses, side channels, accessories, secondary, isthmuses, oval channels, multiple foramina and apical deltas, making it difficult to clean and disinfect the endodontic system.
Residual remains, bacteria, remains of necrotic pulp tissue and dentin fragments are common and may be a nutrient medium for resilient bacteria. The biomechanical preparation of the root canals occurs by three means: mechanical, chemical and physical. In this way, the cleaning and disinfection of the channels do not only depend on the instrumentation but also on the chemical action of irrigating solutions with chemical properties such as solvency, antimicrobial activity and physical action of irrigation and aspiration.

The instruments have a limited action, reaching only the main channel light, do not reach the complex channel system, and approximately 50.0 % of the channel walls remain uninsulated during the mechanical preparation, resulting in insufficient cleaning.

Due to the limited action of the instruments, it is necessary to associate chemical substances with the instrumentation process in order to facilitate the action of the instruments, reaching the entire channel system, sanitizing the endodontic complex.



Other authors recommend the addition of chemical substances to the mechanical preparation in order to intensify the disinfection, obtaining a greater emptying and widening of the canal through the combination of chemical substance and endodontic instrument. The irrigating liquid through physical action promotes hydraulic circulation through the interior of the canal, eliminating organic matter as well as fragments of dentin. This results in the decomposition of organic and inorganic tissues and the sanification of the canal.
Sodium hypochlorite (NaOCl) has been widely used worldwide since 1792 in medicine. In endodontia, sodium hypochlorite, then known as the Dakin solution, was introduced by Barret in 1917 as a root canal irrigation solution with proven efficacy and antiseptic efficacy. Coolidge also used sodium hypochlorite as a method of cleaning and disinfecting root canals in order to improve the results. Walker in 1936, began to use root canal treatment with necrotic pulps solution irrigator with 5.0% sodium hypochlorite.
However, Grossman in 1943 was the major disseminator of the sodium hypochlorite solution irrigator with the use of channel irrigation technique alternating sodium hypochlorite at 5.0% hydrogen peroxide 3.0%, the reaction of the two substances culminated in effervescence with the release of oxygen, favoring the extinction of microorganisms and channel residues. Sodium hypochlorite belongs to the group of halogen compounds available in concentrations of 0.5 to 5.3% and up to 10.0% for clinical use.
Several studies aimed at evaluating the effects of sodium hypochlorite solutions on the decomposition of pulp tissue, on dentin permeability, on the cleaning of the canal and its bactericidal action, in its different concentrations emphasizing the superiority of sodium hypochlorite solutions compared to other auxiliary solutions of the channel preparation. Since sodium hypochlorite has been used for a long time, its results are already widely proven, based and consolidated in the international literature.
On the other hand, chlorhexidine appeared through studies with the aim of finding a new antimalarial agent, being developed poly biguanide compounds that had a significant antimicrobial potential called cationic detergent and later gluconate chlorhexidine. This compound was the basis for the production of a salt that reached the consumer market under the name of chlorhexidine gluconate in 1954.
As chlorhexidine gluconate exhibits an excellent degree of skin affinity, it is the first international antiseptic indicated for skin asepsis due to its good antibacterial activity and low levels of toxicity. Chlorhexidine gluconate was introduced in dentistry around 1959 for the control of bacterial plaques and its use, in general, occurred around 1970.
Among the main advantages of chlorhexidine gluconate are enlargement and modeling of the canal system, elimination of microorganisms and their by-products, live or necrotic pulp tissue. There are still many disagreements as to which chemical agent would have its most suitable qualities for the irrigation of the canal system provoking numerous discussions and controversies between the defenders of sodium hypochlorite and chlorhexidine gluconate, which justifies if we analyze in more detail the literature produced in the last 10 years on the employment advantages and disadvantages of each product.
Further, the ideal temporary crown sealer should promote good marginal sealing, minimum porosity, dimensional stability, abrasion and compression resistance, be easy to insert and remove, biocompatible, esthetic, low cost, low solubility, and antimicrobial activity. Defective apical seals were identified as the main cause of failures in endodontic treatment, and several studies have emphasized the importance of adequate coronal sealing between sessions for successful endodontic therapy.
The persistence of microorganisms and reinfection of the root canal or both are the main factors that contribute to the failure of endodontic treatment. For this reason, avoiding marginal infiltration, keeping the delay dressing intact becomes a prerequisite, and this is possible by placing a good temporary coronary sealing. Solubility, thermal expansion, porosity, and contraction are significant variables in the clinical performance of these materials.
The use of temporary restorative materials in endodontics is of extreme importance because it prevents contamination of the root canal, preventing infections and allowing the action of the medication used as a dressing for delay when the treatment is done in sessions. The temporary restorer Coltosol® is composed of a mixture of zinc oxide, monohydrate zinc sulfate, calcium sulfate hemihydrate, diatomaceous earth, ethylene-vinyl acetate copolymer and mint flavor.The hygroscopic expansion of Coltosol® corresponds to 17.0 - 20.0% of its volume and its prey is directly linked to fluid absorption, thus hygroscopic expansion together with masticatory forces are directly related to crown fracture endodontically treated teeth.

The temporary restorative Coltosol® (Coltène) is composed of a mixture of zinc oxide, monohydrate zinc sulfate, calcium sulfate hemihydrate, diatomaceous earth, ethylene-vinyl acetate copolymer and peppermint flavor. The hygroscopic expansion of Coltosol® corresponds to 17.0 - 20.0% of its volume, and its prey is directly linked to fluid absorption, thus hygroscopic expansion together with masticatory forces are directly related to dental fracture of crowns of endodontically treated teeth.
Thus, the sealing material, however, can, in turn, provide antimicrobial activity, allowing the reduction or elimination of microorganisms that remain in the cavity or that penetrates through microfiltrations in the coronary sealant.

The objective of the present study was to perform a systematic review of the importance of the clinical use and outcomes of Chlorhexidine gluconate, Sodium hypochlorite and Coltosol® in root canal endodontic treatment.

Continue reading .....This review article Published in IJDOS Journal.


Location: Brazil