Antimicrobial Efficacy of Sodium Hypochlorite,.11
Antimicrobial Efficacy of Sodium Hypochlorite,.11
Antimicrobial Efficacy of Sodium Hypochlorite,.11
Department of Pediatric and Preventive Dentistry, Maulana Azad Institute of Dental Sciences, 1Department of Microbiology, Govind
Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
70 © 2023 Journal of Indian Society of Pedodontics and Preventive Dentistry | Published by Wolters Kluwer - Medknow
Chauhan, et al.: Primary molar root canal disinfection: A comparative study
Endodontic infections being polymicrobial in nature was a randomized controlled trial carried out after
are dominated by obligate anaerobic bacteria. obtaining prior approval from the Ethical Committee
Studies indicate 69% facultative anaerobes and 70% of the Institution with approval number‑MAIDS
Gram‑positive bacteria in the infected root canals with committee/2016/3260. The sample size was estimated
the two most prevalent species being Peptostreptococcus using the following formula.
and Streptococcus spp. are reported.[2] Effective
elimination of infection from the root canal system n = σ2 (Zα + Zβ) 2/d2
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from the root canal. Irrigants are used during the deviation assumed to be equal for both groups.
endodontic treatment to flush out loose debris, dissolve
organic matter in the canal, lubricate the dentinal walls, The teeth were divided equally into the following
and be antimicrobial.[3] Several irrigation solutions have three groups of 45 primary molar teeth each by block
been recommended for use in combination with root random allocation as shown below based on inclusion
canal preparation such as Sodium Hypochlorite (NaOCl), and exclusion criteria.
Chlorhexidine, MTAD, Aqueous Ozone, Saline, Nd:
YAG laser, Er: YAG laser, Er, Cr:YSGG laser. Total sample size (n) = 45 children (age group = 4–8 years)
In the present study, root canal disinfection was The sample was divided into three groups based on the use of irrigating agents
performed using NaOCl, Saline, and Er, Cr:YSGG
laser in primary molars. One of the most commonly GROUP I GROUP II GROUP III
used irrigating agents during instrumentation in 2.5% NaOCl Er,Cr:YSGG laser irradiation Saline
(15 children) (15 children) (15 children)
primary teeth has been NaOCl. It is a proteolytic
agent which has a wide range of activity against
several endodontic microorganisms. It has Inclusion and exclusion criteria
excellent tissue‑dissolving ability and hemostatic The children aged between 4 and 8 years were included
properties.[4] Some of its disadvantages include bad in the study with positive parental informed consent.
odor and taste, cytotoxicity,[5,6] deteriorative effects on Primary molars infected with either abscess, sinus tract
the mechanical and chemical properties/composition or with signs of irreversible pulpitis were included.
of dentine.[7,8] Furthermore, due to its highly irritant Radiographically, the teeth showing interradicular or
nature for periapical tissues, researchers have periapical radiolucency and with less than two‑thirds
developed alternative irrigants. of root resorption were enrolled. Teeth with abnormal
anatomy and calcified canals, with unrestorable
Recently, new disinfection approaches have been crowns or with evidence of extensive internal/
suggested, and one of these includes the use of laser. external pathological root resorption were excluded.
Several types of lasers are being used such as Nd: Patients who presented with any systemic disorder or
YAG laser (1064 nm), Er: YAG laser (2940 nm) and Er, medically compromising conditions or had received
Cr:YSGG laser (2780 nm). The Erbium Laser having antibiotics 2 weeks before microbial sampling were
high affinity with water, shallow depth of tissue excluded from the study.
penetration, and no thermal damage makes it an ideal
laser for use in pediatric patients.[9] The aim of the Clinical procedures
present study was to compare the antimicrobial efficacy Tooth isolation was done by rubber dam after local
of NaOCl, Saline, and Er, Cr:YSGG laser‑assisted anesthesia administration and cleaned with pumice.
disinfection through microbiological analysis in root Access opening was done using a high‑speed
canal treatment of primary molars. handpiece and canals were located under dental
operating microscope. Shaping and cleaning the canals
The null hypothesis of the study was that the were done with sterile Kerr files and Hedstrom files.
antimicrobial efficacy of Er, Cr:YSGG laser‑assisted Pre‑ and postirrigation samples were collected in
disinfection is no better than that of irrigation with all three groups with paper points sterilized using a
NaOCl and saline. glass bead sterilizer and transported to Microbiology
Laboratory, Department of Microbiology, Govind
Materials and Methods Ballabh Pant Institute of Postgraduate Medical
Education and Research, New Delhi, for estimating the
A total of 45 children aged 4–8 years participated number of bacteria in suspension (as colony‑forming
in the study in the Department of Pedodontics and unit [CFU]/ml). Bacteria were cultured on blood agar
Preventive Dentistry at Maulana Azad Institute and MacConkey agar bacterial culture medium and
of Dental Sciences, New Delhi. The present study incubated under aerobic and anaerobic conditions. The
Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 41 | Issue 1 | January-March 2023 | 71
Chauhan, et al.: Primary molar root canal disinfection: A comparative study
bacterial count was done after 24–48 h of incubation The data were entered into MS Excel and statistically
using the semi‑quantitative technique (Standard loop analyzed using SPSS-PC-21.0 version (IBM, Inc.
method). Root canal treatment was completed after Virginia, United States) Chi‑square test was used
taking the sample from root canal in the same visit. for categorical variables. McNemar test was used to
compare the colony count from pre‑ to postirrigation
Group A ‑ During instrumentation, irrigation was phase. The level of statistical significance was set at
done with 2.5% NaOCl. P < 0.05.
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Group C ‑ During instrumentation, irrigation was A significant difference was seen in the aerobic colony
done with saline. count among three study groups after irrigation with
respective irrigating agents as P < 0.05 as shown in
Table 1. Postirrigation sodium hypochloride (Group A)
was found to be most effective followed by Er,
Cr:YSGG laser (Group B) and saline (Group C) was
found ineffective against aerobic colonies.
a b
Figure 2: (a) Pre-irrigation sample collection with paper points, (b)
Transport media containing Pre-irrigation sample
a b
Figure 4: (a) Post-irrigation sample collection with paper points, (b)
Figure 3: Laser‑assisted irrigation with Er, Cr:YSGG laser Transport media containing Post-irrigation sample
72 Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 41 | Issue 1 | January-March 2023 |
Chauhan, et al.: Primary molar root canal disinfection: A comparative study
Table 1: Intergroup comparison of aerobic colony necessary for complete disinfection. A large number
count (postirrigation) of substances have been used as root canal irrigants
Aerobic (CFU/mL) Total,
which include normal saline, citric and phosphoric
n (%) acids, ethylenediaminetetraacetic acid, proteolytic
>10 ,3
>10 ,
4
>10 ,
5
No growth,
n (%) n (%) n (%) n (%) enzymes, NaOCl, sodium hydroxide, urea, potassium
NaOCl 2 (13.3) 1 (6.7) 2 (13.3) 10 (66.7) 15 (100.0)
hydroxide, hydrogen peroxide, chlorhexidine
Er, Cr: 4 (26.7) 2 (13.3) 0 9 (60.0) 15 (100.0)
gluconate, and lasers.[11] Our study aimed to compare
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Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 41 | Issue 1 | January-March 2023 | 73
Chauhan, et al.: Primary molar root canal disinfection: A comparative study
In the present study, it was also seen that root canal wears were required for the operator, assistant, and
disinfection using NaOCl is more effective against patient. In addition, the Pediatric Dentist must adapt
aerobic bacteria whereas Er, Cr:YSGG laser‑assisted behavior management techniques along with the
disinfection is more effective against anaerobic bacteria. skills to use new laser technologies to provide efficient
Kouchi et al.[24] demonstrated that bacteria are capable dental care to the pediatric patients.[31]
of invading the periluminal dentin up to a depth of
1100 µm. On the other hand, chemical disinfectants Our results suggest that the Er, Cr:YSGG laser may be
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penetrate no more than 130 µm into the dentin as a valuable tool for root canal disinfection of primary
indicated by Berutti et al.[25] In addition, curved root molars. In the present study, negative culture was
canals or canal branching can act as potential obstacles obtained in 9 samples when anaerobic bacterial count
for penetration of conventional root canal irrigants. was done in preirrigation cases. This might have
occurred due to improper paper point sampling,
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 02/14/2024
The utilization of lasers helps to overcome this issue, sensitivity during transportation and bacterial culture
as already discussed by Schoop et al. (2009).[26] The techniques that provided the inability to culture
high penetration depth of the Er, Cr:YSGG laser in anaerobic bacteria in 9 samples.[26] As this was a time
the dentinal tissue seems to be the most appropriate bounded study, a minimum sample size was taken.
explanation for the effective antibacterial activity. One For more elaborate results, a larger sample size is
possible explanation for this kind of light propagation recommended.
is given by Vaarkamp et al.[27] and Kienle et al.[28] These
authors have described the ability of enamel prisms
and dentine tubules to scatter light within dental Conclusion
hard tissues. In addition, the micropulse generated by
Er, Cr:YSGG laser is responsible for the penetration The present study assessed the antimicrobial efficacy
of energy of about 3 µm into the water to achieve of NaOCl, saline, and Er, Cr:YSGG laser‑assisted
expansion of intratubular water and the collapse of disinfection in root canal treatment of primary molars.
water vapor as deep as 1000 µm or more, which is The antimicrobial efficacy in reducing the aerobic
capable of producing acoustic waves strong enough bacterial count is seen highest with NaOCl followed by
to disrupt intratubular bacteria. This penetration into Er, Cr:YSGG laser. Whereas, the antimicrobial efficacy
dentin may provide additional advantages for the use in reducing the anaerobic bacterial count is seen highest
of laser over conventional methods of disinfection, with Er, Cr:YSGG laser followed by NaOCl. Saline was
such as NaOCl irrigation, in cases where there is found to be an ineffective irrigating agent in reducing
limited access of the agent to the interstices of the the aerobic as well as anaerobic bacteria in root canal
root canal system may limit antimicrobial activity.[29] treatment of primary molars. Our study suggests that
The use of flexible fiber tips allows the irradiation the Er, Cr:YSGG laser may be used as a valuable tool
of even narrow or curved root canals. Arnabat et al. for root canal disinfection of primary molars.
showed that Er, Cr:YSGG Waterlase™ laser at 2W for
60 s operating at 20 Hz was as effective as 5% NaOCl Financial support and sponsorship
and more efficient than Er, Cr:YSGG laser at 1W Nil.
for 120 s, 60 s, 30 s, and 2W for 30 s, when applied
for measuring its bactericidal effect in root canals Conflicts of interest
experimentally colonized with Enterococcus faecalis. There are no conflicts of interest.
Furthermore, the output power of 2W results in no
carbonization or melting of the root canal walls, and
the resulting temperature increase is not high enough References
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