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Smear Layer Removal from Root Canal Dentine and Antimicrobial Effect of Citric Acid-modified Chlorhexidine

OBJECTIVE: To study the effectiveness of various concentrations of citric acid (CA) added to 2% chlorhexidine (CHX) on smear layer removal from the root canal wall and antimicrobial efficacy against Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans). METHODS: Fifty-three single-r...

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Autores principales: Dewi, Anat, Upara, Chawin, Chaiariyakul, Danupong, Louwakul, Phumisak
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Kare Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881384/
https://www.ncbi.nlm.nih.gov/pubmed/33353912
http://dx.doi.org/10.14744/eej.2020.38258
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author Dewi, Anat
Upara, Chawin
Chaiariyakul, Danupong
Louwakul, Phumisak
author_facet Dewi, Anat
Upara, Chawin
Chaiariyakul, Danupong
Louwakul, Phumisak
author_sort Dewi, Anat
collection PubMed
description OBJECTIVE: To study the effectiveness of various concentrations of citric acid (CA) added to 2% chlorhexidine (CHX) on smear layer removal from the root canal wall and antimicrobial efficacy against Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans). METHODS: Fifty-three single-rooted mandibular premolars were decoronate and the root canals underwent mechanical instrumentation using MTwo rotary files to size 40/0.06. The samples were then randomly divided into 5 groups according to the root canal irrigants to be used: 17% ethylenediaminetetraacetic acid (EDTA), 2% CHX, 1%, 6%, and 10% citric acid-modified 2% chlorhexidine (CAmCHX). Three teeth irrigated with phosphate-buffered saline (PBS) were used as a negative control. The smear layer removal effectiveness was evaluated under scanning electron microscopy (SEM). Images were randomly taken at the apical, middle, and coronal third level. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. Disc diffusion and direct exposure tests were performed along with three additional control groups consisting of 1%, 6%, and 10% CA groups to assess and compare the antimicrobial efficacy of irrigants against E. faecalis and C. albicans. Statistical analysis was conducted using one-way ANOVA and Dunnett’s T3 tests. RESULTS: Smear layer removal effectiveness in 17% EDTA group and 6% and 10% CAmCHX groups were not significantly different in the coronal and apical third of the root canal (P>0.05), however at the middle third of the root canal, the 10% CAmCHX group had significantly less remaining smear layer than all of the other experimental groups (P<0.05). There was significantly more smear layer remnant in the CHX group (P<0.01). For antimicrobial efficacy, the largest growth inhibition zone against E. faecalis was recorded in the 10% CAmCHX group (P<0.05). For planktonic E. faecalis, 1%, 6%, and 10% CAmCHX demonstrated an insignificant difference in antimicrobial efficacy compared to CHX (P>0.05). CA demonstrated no antifungal effect against C. albicans. Whereas, 6% and 10% CAmCHX resulted in the largest growth inhibition zone. Also, adding CA to CHX resulted in an insignificant difference in antifungal effect against planktonic C. albicans compared to CHX (P>0.05). CONCLUSION: When CA was added into CHX, the mixed irrigant demonstrated smear layer removal ability. Additionally, its antimicrobial effect remained the same.
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spelling pubmed-78813842021-02-16 Smear Layer Removal from Root Canal Dentine and Antimicrobial Effect of Citric Acid-modified Chlorhexidine Dewi, Anat Upara, Chawin Chaiariyakul, Danupong Louwakul, Phumisak Eur Endod J Original Article OBJECTIVE: To study the effectiveness of various concentrations of citric acid (CA) added to 2% chlorhexidine (CHX) on smear layer removal from the root canal wall and antimicrobial efficacy against Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans). METHODS: Fifty-three single-rooted mandibular premolars were decoronate and the root canals underwent mechanical instrumentation using MTwo rotary files to size 40/0.06. The samples were then randomly divided into 5 groups according to the root canal irrigants to be used: 17% ethylenediaminetetraacetic acid (EDTA), 2% CHX, 1%, 6%, and 10% citric acid-modified 2% chlorhexidine (CAmCHX). Three teeth irrigated with phosphate-buffered saline (PBS) were used as a negative control. The smear layer removal effectiveness was evaluated under scanning electron microscopy (SEM). Images were randomly taken at the apical, middle, and coronal third level. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. Disc diffusion and direct exposure tests were performed along with three additional control groups consisting of 1%, 6%, and 10% CA groups to assess and compare the antimicrobial efficacy of irrigants against E. faecalis and C. albicans. Statistical analysis was conducted using one-way ANOVA and Dunnett’s T3 tests. RESULTS: Smear layer removal effectiveness in 17% EDTA group and 6% and 10% CAmCHX groups were not significantly different in the coronal and apical third of the root canal (P>0.05), however at the middle third of the root canal, the 10% CAmCHX group had significantly less remaining smear layer than all of the other experimental groups (P<0.05). There was significantly more smear layer remnant in the CHX group (P<0.01). For antimicrobial efficacy, the largest growth inhibition zone against E. faecalis was recorded in the 10% CAmCHX group (P<0.05). For planktonic E. faecalis, 1%, 6%, and 10% CAmCHX demonstrated an insignificant difference in antimicrobial efficacy compared to CHX (P>0.05). CA demonstrated no antifungal effect against C. albicans. Whereas, 6% and 10% CAmCHX resulted in the largest growth inhibition zone. Also, adding CA to CHX resulted in an insignificant difference in antifungal effect against planktonic C. albicans compared to CHX (P>0.05). CONCLUSION: When CA was added into CHX, the mixed irrigant demonstrated smear layer removal ability. Additionally, its antimicrobial effect remained the same. Kare Publishing 2020-12-09 /pmc/articles/PMC7881384/ /pubmed/33353912 http://dx.doi.org/10.14744/eej.2020.38258 Text en Copyright: © 2020 European Endodontic Journal http://creativecommons.org/licenses/by-nc/4.0 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
spellingShingle Original Article
Dewi, Anat
Upara, Chawin
Chaiariyakul, Danupong
Louwakul, Phumisak
Smear Layer Removal from Root Canal Dentine and Antimicrobial Effect of Citric Acid-modified Chlorhexidine
title Smear Layer Removal from Root Canal Dentine and Antimicrobial Effect of Citric Acid-modified Chlorhexidine
title_full Smear Layer Removal from Root Canal Dentine and Antimicrobial Effect of Citric Acid-modified Chlorhexidine
title_fullStr Smear Layer Removal from Root Canal Dentine and Antimicrobial Effect of Citric Acid-modified Chlorhexidine
title_full_unstemmed Smear Layer Removal from Root Canal Dentine and Antimicrobial Effect of Citric Acid-modified Chlorhexidine
title_short Smear Layer Removal from Root Canal Dentine and Antimicrobial Effect of Citric Acid-modified Chlorhexidine
title_sort smear layer removal from root canal dentine and antimicrobial effect of citric acid-modified chlorhexidine
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881384/
https://www.ncbi.nlm.nih.gov/pubmed/33353912
http://dx.doi.org/10.14744/eej.2020.38258
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