Microbe infection is not only the key pathogenic factor of primary endodontic infectious diseases, but also the arch-crimina of endodontic treatment fail. Therefore, the endodontic treatment success is based on the debridement of infectious root canal, elimination of bacteria, and the prevention of endodontic reinfection. It is beset with difficulties to control the endodontic infection in clinic because of the bacterial variety, anatomic complexity of root canal, and limitation of the root canal therapeutic methods. In order to get the ideal prognosis of the root canal treatment, in the procedure of the therapy, it should be the tight isolation of tooth, reasonable choose of the root canal preparation technique, rational use of root canal preparation instrument, effective irrigation of root canal, proper root canal dressing, and the 3-dimensional obturation of root canal.
Humans ; Infection Control ; Root Canal Irrigants ; Root Canal Preparation ; Root Canal Therapy

Root canal therapy is the most efficient way to treat pulptitis and periapical inflammation, which can clear infections of root canal systems, fill the root canal firmly, and avoid reinfection. However, the variations in root canal morphology and complexity of infection confer difficulty in thoroughly eliminating microorganisms and their by-products in the root canal system, especially in the root apex area (including the top one-third of the root canal and periapical tissue), which is described as the hardest area to clean during endodontic treatment. Infection is difficult to remove entirely because the apex area is hard to approach using dental instruments and because of the existence of special morphological structures, such as apical ramification, intercanal anastomoses, and lateral branch of root canal. This review gives a brief introduction of the characteristics and difficulties of apical infection and knowledge on how to control such infections, including root apex preparation, irrigation and disinfection, and root canal filling.
Dental Pulp Cavity ; Humans ; Infection Control ; Periapical Periodontitis ; Root Canal Filling Materials ; Root Canal Irrigants ; Root Canal Obturation ; Root Canal Preparation ; Root Canal Therapy

OBJECTIVETo assess the efficacy of ultrasonic irrigation of the root canal in vivo and in vitro.

METHODSSixty anterior teeth or premolars with the diagnosis of periapical periodontitis were divided into two groups (syringe irrigation group, group S and ultrasonic irrigation group, group U) and were evaluated clinically. Sixty extracted teeth with single straight canals were selected. Forty of them were divided into two groups and were evaluated histologically. Another twenty teeth were divided into two groups and were evaluated by SEM.

RESULTSClinically, the number of lateral canals obturated in group U was more than that in group S (P < 0.01). The incidence of pain during irrigation were 13.3% in group S, and 3.3% in group U (P > 0.05). Histologically, the amount of organic debris of the root canals in group U were significantly less than that in group S (P < 0.01). By SEM study, the number of visible open dentinal tubules in group U were significantly greater than that in group S (P < 0.05).

CONCLUSIONUltrasonic irrigation of the root canal will be a useful technique in root canal therapy.

Humans ; Molar ; ultrastructure ; Periapical Diseases ; therapy ; Root Canal Irrigants ; therapeutic use ; Root Canal Therapy ; Ultrasonics

Intracanal antisepsis acts as one of the fundamental steps in root canal therapy. Intracanal medication is very common among the multitudinous root canal disinfection methods so far. However, as the most frequently-used intracanal medication, calcium hydroxide exists some problems, such as insufficient antimicrobial power and antibiogram. Thus exploring new root canal disinfectant is necessary. Herbal medicine is gaining favor for its wide varieties, broad efficacy and affordable prices. The current researches revealed that many kinds of herbs or compound herbal preparations possess good ability of antimicrobial and other properties that superior to those of traditional root canal disinfectants. However, herbal medicine itself and the studies have shortcomings. This paper will provide a review of various herbal alternatives that are being studied of late years.
Antisepsis ; Calcium Hydroxide ; Herbal Medicine ; Root Canal Irrigants ; Root Canal Therapy

The essence of pulp and periapical disease is bacterial infection. Thus, satisfactory infection control is the premise and foundation of healing, in which root canal preparation is a critical procedure. Root canal system anatomy, infection degree, physical cutting during root canal preparation, and certain cleaning measures affect the quality of infection control. Appropriate evaluation of the grades of infected root canals before treatment is necessary because different grades of root canal infection demand various disinfection schedules to facilitate tissue healing and guarantee the long-term success rate of endodontic treatment.
Dental Pulp Cavity ; Humans ; Infection Control ; Periapical Diseases ; Periapical Periodontitis ; Root Canal Irrigants ; Root Canal Preparation ; Root Canal Therapy

Root canal therapy is the common treatment for endodontic infections. Successful root canal therapy depends on favorable root canal preparation, root canal medication and three-dimensional obturation of the root canal system. The key to successful root canal therapy is to prevent re-infection of the highly complex root canal systems by removing infecious biofilms and bacterial toxins in the root canal system. The present paper reviews the pathogenic mechanism of the Enterococcus faecalis in the harsh environment of root canal system, the inflammation and immunity of refractory periapical periodontitis and the progress of infection control methods.
Dental Pulp Cavity ; Enterococcus faecalis ; Humans ; Periapical Periodontitis/therapy* ; Persistent Infection ; Root Canal Irrigants ; Root Canal Preparation ; Root Canal Therapy

OBJECTIVETo evaluate the effect of different root canal irrigants on smear layer removal and dentinal tubule opening of root canal surfaces after post space preparation.

METHODSThirty maxillary anteriors were endodontically treated. After post space preparation, the teeth were assigned to three groups with ten teeth each: group A, B, C. 3% H2O2, 15% ethylenediamine tetraacetic acid(EDTA), 15% EDTA and 3% NaClO were used as irrigant of group A, B, C. After post space irrigation, eight teeth of each group were examined under scanning electron microscope (SEM) for smear layer removal and dentinal tubule opening. The left two specimens were restored with fiber posts and prepared for evaluation of resin tag formation.

RESULTSThe cleansing effectiveness of group A, B and C was respectively 3.89 +/- 0.36, 1.77 +/- 0.30, 1.25 +/- 0.21. The dentinal tubule opening of group A, B and C was respectively (2.53 +/- 0.19), (3 11 +/- 023) (3.83 +/- 0.52) microm. The cleansing effectiveness and dentinal tubule opening of root canal surfaces were significantly affected by different root canal irrigants (P < 0.05). Excessive erosion of the dentin was observed in group C. Resin tag formation differed between the three irrigant groups, and group B showed excellent resin tag formation.

CONCLUSIONIrrigation with 15% EDTA after post space preparation can excellently remove the smear layer and improve dentinal tubule opening, permitting well penetration of resin adhesive into the dentinal tubules and collagen fibrillar structure.

Dental Pulp Cavity ; Dentin ; Edetic Acid ; Humans ; Hydrogen Peroxide ; Microscopy, Electron, Scanning ; Root Canal Irrigants ; Root Canal Preparation ; Root Canal Therapy ; Smear Layer ; Sodium Hypochlorite ; Tooth Root

OBJECTIVETo evaluate the ability of Biopure MTAD in removing smear layer in vitro.

METHODSForty extracted single-rooted human teeth were randomly divided into five groups: Distilled water in group A, 5.25% NaClO and 17% EDTA in group B, 1.3% NaClO in group C, 1.3% NaClO and Biopure MTAD in group D, 1.3% NaClO and 3% EDTA in group E. The canals were prepared and irrigated with one of the five different irrigating agent respectively. The amount of smear layer and erosion on the surface of the root canal walls were examined with scanning electron microscope.

RESULTSThe whole surfaces of root canals in group A and C were covered by smear layer. The surfaces of root canals in the coronal and middle thirds of samples in group B, D, E were free of smear layer (P>0.05) and the apical third of canals in the group D were significantly cleaner (P<0.05) than that in group B and E. The coronal and middle sections were significantly eroded in group B compared with group D and E (P<0.05). The degree of erosion in the apical section was not statistically different among group B, D and E (P>0.05).

CONCLUSIONBiopure MTAD and 1.3% NaClO are effective irrigating agents for removal of the smear layer on the surface of root canal. There is no significant change in the structure of the surface of root canal.

Citric Acid ; Doxycycline ; Edetic Acid ; Humans ; In Vitro Techniques ; Microscopy, Electron, Scanning ; Polysorbates ; Root Canal Irrigants ; Root Canal Preparation ; Root Canal Therapy ; Smear Layer ; Tooth Root

OBJECTIVES: This study investigated the cleaning ability of ultrasonically activated irrigation (UAI) and a novel activation system with reciprocating motion (EC, EasyClean, Easy Equipamentos Odontológicos) when used with a relatively new chelating agent (QMix, Dentsply). In addition, the effect of QMix solution when used for a shorter (1 minute) and a longer application time (3 minutes) was investigated. MATERIALS AND METHODS: Fifty permanent human teeth were prepared with K3 rotary system and 6% sodium hypochlorite. Samples were randomly assigned to five groups (n = 10) according to the final irrigation protocol: G1, negative control (distilled water); G2, positive control (QMix 1 minute); G3, QMix 1 minute/UAI; G4, QMix 1 minute/EC; G5, QMix 3 minutes. Subsequently the teeth were prepared and three photomicrographs were obtained in each root third of root walls, by scanning electron microscopy. Two blinded and pre-calibrated examiners evaluated the images using a four-category scoring system. Data were statistically analyzed using Kruskal-Wallis and Dunn tests (p < 0.05). RESULTS: There were differences among groups (p < 0.05). UAI showed better cleaning ability than EC (p < 0.05). There were improvements when QMix was used with auxiliary devices in comparison with conventional irrigation (p < 0.05). Conventional irrigation for 3 minutes presented significantly better results than its use for 1 minute (p < 0.05). CONCLUSIONS: QMix should be used for 1 minute when it is used with UAI, since this final irrigation protocol showed the best performance and also allowed clinical optimization of this procedure.
Endodontics ; Humans ; Microscopy, Electron, Scanning ; Root Canal Irrigants ; Root Canal Therapy ; Smear Layer ; Sodium Hypochlorite ; Tooth ; Ultrasonics

OBJECTIVETo provide experimental evidence for the exploitation of cinnamaldehyde as a kind of root canal disinfectant through studying the effect of cinnamaldehyde on endotoxin in root canals.

METHODSThis experimental model of periapical periodontitis was established with Wistar rats. The 75 rats were divided randomly into 3 groups: Group of cinnamaldehyde, group of formaldehyde cresol formocresol, group of physiological saline. The level of endotoxin was measured by quantitative chromogenic tachypleus amebocyte lysate method before and after sealing the drugs in the root canal.

RESULTSThe level of endotoxin in the group of cinnamaldehyde and formaldehyde cresol formocresol decreased obviously (P < 0.05), and the difference between them was of no significance (P > 0.05), the group of physiological saline was of no significant difference (P > 0.05).

CONCLUSIONCinnamaldehyde can decrease the level of endotoxin obviously.

Acrolein ; analogs & derivatives ; Animals ; Dental Pulp Cavity ; Endotoxins ; Formocresols ; Periapical Periodontitis ; Rats ; Rats, Wistar ; Root Canal Irrigants ; Root Canal Therapy