|Year : 2009 | Volume
| Issue : 2 | Page : 76-84
Evaluation and comparison of biological cleaning efficacy of two endofiles & irrigants by microbial quantification- In vivo study
Shalini Aggarwal1, Shresth Kumar Bhagat2
1 Professor, Department of Conservative Dentistry, Endodontics & Esthetic Dentistry, Dr. D. Y. Patil Dental College And Hospital, Pimpri, Pune, India
2 Postgraduate Student, Department of Conservative Dentistry, Endodontics & Esthetic Dentistry, Dr. D. Y. Patil Dental College And Hospital, Pimpri, Pune, India
|Date of Web Publication||4-Mar-2011|
Professor, Department of Conservative Dentistry, Endodontics & Esthetic Dentistry, Dr. D. Y. Patil Dental College And Hospital, Pimpri, Pune
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The endodontic triad comprises of cleaning & shaping, disinfection and obturation. Success of root canal therapy is majorly achieved by proper cleaning and shaping. However elimination of bacterial contaminants as well as necrotic debris of the canals requires the adjunctive use of irrigants.
To achieve a satisfactory biological and mechanical cleaning proper selection of endodontic instruments and irrigants is necessary.
In this study we are comparing and evaluating cleaning efficacy of endofiles (K-Flex files and Hand protapers) & root canal irrigants (3% Sodium Hypochlorite and Chlorhexidine2%) by microbial quantification. Root canal samples were collected in autoclavable bottles containing transport media (nutrient broth) and samples were cultured in tryptose soya agar at incubation temp of 37 0 c for 24-48 hrs and colonies were counted with digital colony counter.
The purpose of this study is to aid the clinician to select the proper instrument and irrigant which minimics the failure rate of root canal treatment for the benefit of patient.
|How to cite this article:|
Aggarwal S, Bhagat SK. Evaluation and comparison of biological cleaning efficacy of two endofiles & irrigants by microbial quantification- In vivo study. J Int Clin Dent Res Organ 2009;1:76-84
|How to cite this URL:|
Aggarwal S, Bhagat SK. Evaluation and comparison of biological cleaning efficacy of two endofiles & irrigants by microbial quantification- In vivo study. J Int Clin Dent Res Organ [serial online] 2009 [cited 2019 Jul 23];1:76-84. Available from: http://www.jicdro.org/text.asp?2009/1/2/76/77282
| Introduction|| |
In root canal treatment, the first objective is achieved by skillful instrumentation coupled with liberal irrigation. This double pronged attack will eliminate most of the bacterial contaminants of the canal as well as the necrotic debris and dentin. A vast array of instrumentation, both hand held and engine driven, is available for root canal preparation. Up to the last decade of the past century, endodontic instruments were manufactured from stainless steel. With the advent of nickel titanium ,instrument design began to vary in terms of nickel titanium, instrument design began to vary in terms of taper, length of cutting blades, and tip design. With new versions rapidly becoming available, the clinician find difficult to pick the file and technique most suitable for an individual case.
Although instrumentation of the root canal is the primary method of canal debridement, irrigation is a critical adjunct. Irregularities in canal system such as narrow isthmi and apical deltas prevent complete debridement by mechanical instrumentation alone. Irrigation serves as a physical flush to remove debris as well as bactericidal agents, tissue solvent, and lubricant. Furthermore, some irrigants are effective in eliminating the smear layer.
So in this study microbial quantification was used to evaluate and compare biological cleaning efficacy of two endo files and irrigants.
| Materials and Method|| |
32 cases of chronic irreversible pulpitis, out of which 16 deciduous and 16 permanent teeth have been included in the study. The cases were divided into four groups of both permanent and deciduous teeth.
In group 1 chemomechanical preparation done with rotary protaper and 3%sodium hypochlorite, group-II with rotary protaper and chlorhexidine, group III-with K-files and 2% chlorhexidine & group IV-K-files and 3% sodium hypochlorite.
After rubberdam isolation, access opening is done and canal orifice is enlarged upto 3 number gates glidden drill. After locating the orifice with DG-16 probe. Then sterile 15 numbered paper points are inserted into the canal for 30 seconds and then transferred to autoclaved bottles containing transport media (nutrient broth). These samples were sent to microbial laboratory for microbial quantification.
According to specific groups, chemomechanical preparation was done and after thorough debridement post operative samples were collected with 15 number paper points and transported to microbial laboratory for microbial quantification. Both the pre and post samples were incubated at 37 degree celcius for 24 hours.
The samples were cultured in trypticase soya agar media. The agar media was prepared with trypticase soya agar and 5% of human blood. The petri dish were inoculated by continuous streaking of the culture media. Then the plates were incubated at 37 deg celcius for 24-48 hrs. after the growth of colonies of pre and post operative samples of each group, colony count was done with DSK colony counter.
| Results|| |
Table showing differences in pre and post operative samples of colony forming units of all the four groups in deciduous as well as permanent teeth. The post operative samples of group I has shown minimal colony forming units followed by group II, III and I V.
In this study group (protaper and 2% chlorhexidine) has shown minimal microbial count after chemomechanical preparation followed by group II (Protaper and sodium hypochlorite), group III (K flex file and chlorhexidine) and group IV ( K-Flex file and sodium hypochlorite).
| Statistical Analysis of Post Operative Samples|| |
| Discussion|| |
It is well known that rotary protaper prepares root canals efficiently. The distinguishing feature of protaper system is the progressive variable tapers of each instrument that develops a progressive taper in both vertical and horizontal direction. Although instrumentation of the root canal is the primary method for the canal debridement, irrigation is a critical adjunct. Irregularities in canal system such as narrow isthmi and apical deltas prevent complete debridement by mechanical instrumentation alone. Irrigation serves as a physical flush to remove debris as well as serving as a bactericidal agent, tissue solvent, and lubricant. Further more, some irrigants are effective in eliminating smear layer.
The major benefits of protaper over K flex files are as follows:
- Progressive taper design which improves flexibility and carving efficiency, an important asset in curved and restricted canals.
- The balanced pitch and helical angles of the instrument optimize cutting action while effectively augering debris coronally, as well as preventing instrument from screwing into the canal.
- Both the shapers and finishers remove the debris and soft tissue from the canal and finish the preparation with smooth continuous taper.
- The triangular cross section of the instrument increases safety, cutting action and tactile sense while reducing the lateral contact area between the file and the dentin.
- The modified guided instrument tip can easily follow a prepared glide path without gouging side walls.
In comparison to step back, step down technique has minimized or eliminated the amount of necrotic debris that could be extruded through the apical foramen during instrumentation. This would help prevent post treatment discomfort, incomplete cleansing and difficulty in achieving a biocompatible seal at the apical constriction. The major advantage of step-down preparation is the freedom from constrains of the apical enlarging instrument. By first flaring the coronal two- thirds of the canal, the final apical instruments are unencumbered through most of their length. This increased access allows greater control and less chance of zipping near the apical constriction. It also provides a coronal escapeway that reduces the piston in a cylinder effect, responsible for debris extrusion from the apex.
Although sodium hypochlorite is one of the most widely used irrigating solutions as it is an effective microbial agent, it also serves as a lubricant during instrumentation and dissolves vital and non vital tissues but many studies have proved that chlorhexidine shows better antibacterial activity substantivity and biocompatibility than sodium hypochlorite.
| Conclusion|| |
Constant endeavors are going on to achieve complete sterilization of root canal space. This study has given the best results with chemomechanical preparation with protaper and chlorhexidine and has shown a pathway for a successful endodontic treatment. But still more research work is required to obtain a complete sterilization of root canal space.
| References|| |
|1.||Antimicrobial Efficacy Of 0.2 & 2 % Chlorhexidine And Sodium Hypochlorite As A Root Canal Irrigants : An In Vivo Study [ Lekshmy Devi S And Kamath PM] |
|2.||Ringel AM,Patterson SP,Newton CW,Miller CH, Multhern JM In vitro evaluation of chlorhexidine gluconate solution and sodium hypochlorite solution as root canal irrigants J Endod 1982, 8 ,200-204. |
|3.||The Quality of Canal Preparation Using Stainless SteelHand Files and Nickel-Titanium Rotary Instruments [Ida De Noronha De Ataide Rahul Wagle Marina Fernandes ] |
|4.||Isolation And Identification Of Root Canal Bacteria From Symptomatic Nonvital Teeth With Periapical Pathosis Anuradha Rani, Ashok Chopra |
|5.||Haapasolo M: Bacteroids in dental root canal infections. Endod. Dent. Traumatol.,1989 ; 5 : 1 10. |
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|7.||Haapasolo M: Bacteroids in dental root canal infections.Endod. Dent. Traumatol.,1989 ; 5 : 1 10. |