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Open Access 01-12-2023 | Laser | Research

Antimicrobial efficacy of sodium hypochlorite and hyper-pure chlorine dioxide in the depth of dentin tubules in vitro

Authors: Enikő Vasziné Szabó, Brigitta Huszta, Melinda Polyák, Kasidid Ruksakiet, Róbert Bernáth, Ágoston Ghidán, Ágnes Csáki, Milia Kostadinova, Elek Dinya, János Vág, Zsolt M. Lohinai

Published in: BMC Oral Health | Issue 1/2023

Abstract

Objectives

The study aimed to compare the antibacterial effect of a novel disinfectant, hyper-pure chlorine dioxide (hClO₂) to sodium hypochlorite (NaOCl) in various depths of dentin tubules.

Materials and methods

The distal root of the extracted lower molars was infected artificially with Enterococcus faecalis. The control group was rinsed with saline, and the test groups were irrigated with either 5% NaOCl or 0.12% hClO₂. The longitudinally split teeth were stained by viability stain. The coronal third of the root was scanned with a confocal laser scanning microscope. The fluorescent intensities were measured, and the percentage of dead bacteria was calculated at depths up to 950 μm along the dentin tubules. The effect of penetration depth, irrigants, and their interaction on antimicrobial efficacy was determined by the linear mixed model.

Results

The percentage of dead bacteria was higher both in the NaOCl (45.1 ± 2.3%, p < 0.01) and in the hClO₂ (44.6 ± 3.8%, p < 0.01) irrigant groups compared to saline (23 ± 4.5%); however, there was no difference between them. The percentage of killed bacteria was not correlated with the depths in any group (p = 0.633).

Conclusions

Our results suggest that the functional penetration depth of NaOCl is at least 2–3 times more than published to date. There is no difference in disinfection effectiveness along the dentin tubules between NaOCl and hClO₂ until at least the measured 950 μm. However, both were only able to eradicate the intratubular bacteria partially.

Clinical relevance

Hyper-pure ClO₂ could be used as an alternative or final adjuvant irrigant in endodontic treatment.

Available only for authorised users

Peters LB, Wesselink PR, Moorer WR. The fate and the role of bacteria left in root dentinal tubules. Int Endod J. 1995;28(2):95–9. https://doi.org/10.1111/j.1365-2591.1995.tb00166.x.CrossRefPubMed

Zandi H, Kristoffersen AK, Orstavik D, Rocas IN, Siqueira JF Jr, Enersen M. Microbial analysis of endodontic Infections in root-filled teeth with apical periodontitis before and after irrigation using pyrosequencing. J Endod. 2018;44(3):372–8. https://doi.org/10.1016/j.joen.2017.11.019.CrossRefPubMed

Peters LB, Lindeboom JA, Elst ME, et al. Prevalence of apical periodontitis relative to endodontic treatment in an adult Dutch population: a repeated crosssectional study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;4:523–8. https://doi.org/10.1016/j.tripleo.2010.10.035.CrossRef

Ricucci D, Loghin S, Siqueira J Jr. Correlation between clinical and histologic pulp diagnoses. J Endod. 2014;40:1932–9. https://doi.org/10.1177/154411130201300207.CrossRefPubMed

Love RM, Jenkinson HF. Invasion of dentinal tubules by oral bacteria. Crit Rev Oral Biol Med. 2002;13(2):171–83. https://doi.org/10.1177/154411130201300207.CrossRefPubMed

Zehnder M, Guggenheim B. The mysterious appearance of enterococci in filled root canals. Int Endod J. 2009;42(4):277–87. https://doi.org/10.1111/j.1365-2591.2008.01537.x.CrossRefPubMed

George S, Kishen A, Song KP. The role of environmental changes on monospecies biofilm formation on root canal wall by Enterococcus faecalis. J Endod. 2005;31(12):867–72. 10.1097/01. don.0000164855.98346.fc.CrossRefPubMed

Sundqvist G, Figdor D, Persson S, Sjogren U. Microbiologic analysis of teeth with failed endodontic treatment and the outcome of Conservative re-treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(1):86–93. https://doi.org/10.1016/s1079-2104(98)90404-8.CrossRefPubMed

Stuart CH, Schwartz SA, Beeson TJ, Owatz CB. Enterococcus faecalis: its role in root canal treatment failure and current concepts in retreatment. J Endod. 2006;32(2):93–8. https://doi.org/10.1016/j.joen.2005.10.049.CrossRefPubMed

10.

Fukuzaki S. (2006) Mechanisms of actions of sodium hypochlorite in cleaning and disinfection processes. Biocontrol Sci. 2006;11(4):147 – 57. https://doi.org/10.4265/bio.11.147.

11.

Haapasalo M, Endal U, Zandi H, Coll JM. Eradication of endodontic Infection by istrumentation and irrigation solutions. Endod Top. 2005;10:77–102.CrossRef

12.

Zehnder M. Root canal irrigants. J Endod. 2006;32(5):389–98. https://doi.org/10.1016/j.joen.2005.09.014.CrossRefPubMed

13.

Sabala CL, Powell SE. Sodium hypochlorite injection into periapical tissues. J Endod. 1989;15:490–2. https://doi.org/10.1016/S0099-2399(89)80031-7.CrossRefPubMed

14.

Becking AG. Complications in the use of sodium hypochlorite during endodontic treatment. Oral Surg Oral Med Oral Pathol. 1991;72:346–8. https://doi.org/10.1016/0030-4220(91)90313-2.CrossRef

15.

Estrela C, Estrela CRA, Barbin EL, Spano JCE, Marchesan MA, Pecora J. Mechanism of action of sodium hypochlorite. Braz Dent J. 2002;13(2):113–7. https://doi.org/10.1590/s0103-64402002000200007.CrossRefPubMed

16.

Zou L, Shen Y, Li W, Haapasalo M. Penetration of sodium hypochlorite into dentin. J Endod. 2010;36(5):793–6. https://doi.org/10.1016/j.joen.2010.02.005.CrossRefPubMed

17.

Dunavant TR, Regan JD, Glickman GN, Solomon ES, Honeyman AL. Comparative evaluation of endodontic irrigants against Enterococcus faecalis biofilms. J Endod. 2006;32(6):527–31. https://doi.org/10.1016/j.joen.2005.09.001.CrossRefPubMed

18.

FDA. (2008). Code of Federal regulations 21 CFR 173.300: secondary direct food additives permitted in food for human consumption: chlorine dioxide. [Revised as of April 1, 2003].

19.

Artès F, Gómez P, Aguayo E, Escalona V, Artés-Hernández F. Sustainable sanitation techniques or keeping quality and safety of fresh-cut plant commodities. Postharvest Biol Technol. 2009;51(3):287–96.CrossRef

20.

Wu VCH, Rioux A. A simple instrument-free gaseous chlorine dioxide method for microbial decontamination of potatoes during storage. Food Microbiol. 2010;27(1):179–84. https://doi.org/10.1016/j.fm.2009.08.007.CrossRefPubMed

21.

Cobankara FK, Ozkan HB, Terlemez A. Comparison of organic tissue dissolution capacities of sodium hypochlorite and chlorine dioxide. J Endod. 2010;36(2):272–4. https://doi.org/10.1016/j.joen.2009.10.027.CrossRefPubMed

22.

Noszticzius Z, Balogh S, Gyokerne Wittman M, Kaly-Kullai K, Megyesi M, Volford A. (2008) Permeation method and apparatus for preparing fluids containing high purity chlorine dioxide. Patent Number: US 8,512,671 B2. Hungary.

23.

Aresti M, Ghidan A, Szabo E, Csak B, Stuber I, Herczegh A, Lohinai Z. (2019) Bubble formations by sodium-hypochlorite limit its penetration but not for chlorine-dioxide during endodontic irrigation. J Dent Res 98:B Paper: 0209.

24.

Noszticzius Z, Wittman M, Kaly-Kullai K, Beregvari Z, Kiss I, Rosivall L, Szegedi J. Chlorine dioxide is a size-selective antimicrobial agent. PLoS One doi. 201310.1371/journal.pone. 0079157.CrossRef

25.

Herczegh A, Gyurkovics M, Agababyan H, Ghidan A, Lohinai Z. Comparing the efficacy of hyper-pure chlorine-dioxide with other oral antiseptics on oral pathogen microorganisms and biofilm in vitro. Acta Microbiol Immunol Hung. 2013;60(3):359–73. https://doi.org/10.1556/AMicr.60.2013.3.10.CrossRefPubMed

26.

Herczegh A, Ghidan A, Friedriech D, Gyurkovics M, Bendo Z, Lohinai Z. Effectiveness of a high purity chlorine dioxide solution in eliminating intracanal Enterococcus faecalis biofilm. Acta Microbiol Immunol Hung. 2013;60(1):63–75. https://doi.org/10.1556/AMicr.60.2013.1.7.CrossRefPubMed

27.

Láng O, Nagy KS, Lang J, Perczel-Kovách K, Herczegh A, Lohinai Z, Varga G, Kohidai L. Comparative study of hyperpure chlorine dioxide with two other irrigants regarding the viability of periodontal ligament stem cells. Clin Oral Investig. 2021;25(5):2981–92. https://doi.org/10.1007/s00784-020-03618-5.CrossRefPubMed

28.

Polyák M, Péter K, Vasziné Szabó E, Lohinai Zs M, Vág J. Application of hyperpure chlorine dioxide for regenerative endodontic treatment of a root-canal-treated immature tooth with external cervical resorption and periapical lesion: a case report. Appl Sci. 2023;13(18):10400.CrossRef

29.

Andrade FB, Arias MPC, Maliza AGA, Duarte MAH, Graeff MSZ, Amoroso-Silva PA, Midena RZ, Moraes IG. A new improved protocol for in vitro intratubular dentinal bacterial contamination for antimicrobial endodontic tests: standardization and validation by confocal laser scanning microscopy. J Appl Oral Sci. 2015;23(6):591–8. https://doi.org/10.1590/1678-775720140261.CrossRefPubMedPubMedCentral

30.

Schindelin J, Arganda-Carreras I, Frise E, Kaynig V, Longair M, et al. Fiji: an open-source platform for biological-image analysis. Nat Methods. 2012;9(7):676–82. https://doi.org/10.1038/nmeth.2019.CrossRefPubMed

31.

Schneider C, Rasband W, Eliceiri K. NIH Image to ImageJ: 25 years of image analysis. Nat Methods. 2012;9:671–5. https://doi.org/10.1038/nmeth.2089.CrossRefPubMedPubMedCentral

32.

Azim AA, Aksel H, Zhuang T, Mashtare T, Babu JP, Huang GT-J. Efficacy of 4 irrigation protocols in killing bacteria colonized in dentinal tubules examined by a novel confocal laser scanning microscope analysis. J Endod. 2016;42(6):928–34. https://doi.org/10.1016/j.joen.2016.03.009.CrossRefPubMedPubMedCentral

33.

Giardino LM, Del Fabbro MM, Pereira T, Bombarda de Andrade F, Savadori P, Generali L. Dual rinse((R)) HEDP increases the surface tension of NaOCl but may increase its dentin disinfection efficacy. Odontology. 2019;107(4):521–9.CrossRefPubMed

34.

Peters LB, Wesselink PR, Moorer WR. Penetration of bacteria in bovine root dentine in vitro. Int Endod J. 2000;33(1):28–36. https://doi.org/10.1046/j.1365-2591.2000.00268.x.CrossRefPubMed

35.

Herczegh A, Barnabás P, Lohinai Z, Romana Z. Tracking of the degradation process of chlorhexidine digluconate and ethylenediaminetetraacetic acid in the presence of hyper-pure chlorine dioxide in endodontic disinfection. J Pharm Biomed Anal. 2019;164:360–4. https://doi.org/10.1016/j.jpba.2018.11.005.CrossRef

36.

Herczegh A, Gyurkovics M, Ghidan A, Megyesi M, Lohinai Z. Effect of dentin powder on the antimicrobial properties of hyperpure chlorine-dioxide and its comparison to conventional endodontic disinfecting agents. Acta Microbiol Immunol Hung. 2014;61(2):209–20. https://doi.org/10.1556/AMicr.61.2014.2.10.CrossRefPubMed

37.

Ma J, Wang Z, Shen Y, Haapasalo M. A new noninvasive model to study the effectiveness of dentin disinfection by using confocal laser scanning microscopy. J Endod. 2011;37(10):1380–5. https://doi.org/10.1016/j.joen.2011.06.018.CrossRefPubMed

38.

Paque F, Luder HU, Sener B, Zehnder M. Tubular sclerosis rather than the smear layer impedes dye penetration into the dentine of endodontically instrumented root canals. Int Endod J. 2006;39(1):18–25. https://doi.org/10.1111/j.1365-2591.2005.01042.x.CrossRefPubMed

39.

Stanley HR, White CL, McCray L. The rate of tertiary (reparative) dentine formation in the human tooth. Oral Surg Oral Med Oral Pathol. 1966;21(2):180–9. https://doi.org/10.1016/0030-4220(66)90240-4.CrossRefPubMed

40.

Sener SFK, Cobankara FK, Akgünlü F. Calcifications of the pulp chamber: prevalence and implicated factors. Clin Oral Investig. 2009;13(2):209–15. https://doi.org/10.1007/s00784-008-0212-x.CrossRefPubMed

41.

Sayegh FS, Reed AJ. Calcification in the dental pulp. Oral Surg Oral Med Oral Pathol. 1968;25(6):873–82. https://doi.org/10.1016/0030-4220(68)90165-5.CrossRefPubMed

42.

Gold SI. Root canal calcification associated with prednisone therapy: a case report. J Am Dent Assoc. 1989;119(4):523–5. https://doi.org/10.1016/s0002-8177(89)94009-9.CrossRefPubMed

43.

Edds AC, Walden JE, Scheetz JP, Goldsmith LJ, Drisko CL, Eleazer PD. Pilot study of correlation of pulp stones with Cardiovascular Disease. J Endod. 2005;31(7):504–6. https://doi.org/10.1097/01.don.0000168890.42903.2b.CrossRefPubMed

44.

Vasiliadis L, Darling AI, Levers BG. The amount and distribution of sclerotic human root dentine. Arch Oral Biol. 1983;28(7):645–9. https://doi.org/10.1016/0003-9969(83)90013-4.CrossRefPubMed

45.

Bansode PV, Pathak SD, Wavdhane MB, Khedgikar S, Rai S. Butterfly effect in endodontics: a systemic review. J Med Dent Sci Res. 2017;4(2):21–3.

46.

Cavenago BC, Carpio-Perochena AE, Ordinola-Zapata R, Estrela C, Garlet GP, et al. Effect of using different vehicles on the physicochemical, antimicrobial, and biological properties of white mineral trioxide aggregate. J Endod. 2017;43(5):779–86.CrossRefPubMed

Title: Antimicrobial efficacy of sodium hypochlorite and hyper-pure chlorine dioxide in the depth of dentin tubules in vitro
Authors: Enikő Vasziné Szabó
Brigitta Huszta
Melinda Polyák
Kasidid Ruksakiet
Róbert Bernáth
Ágoston Ghidán
Ágnes Csáki
Milia Kostadinova
Elek Dinya
János Vág
Zsolt M. Lohinai
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Laser
Published in: BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI: https://doi.org/10.1186/s12903-023-03685-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Antimicrobial efficacy of sodium hypochlorite and hyper-pure chlorine dioxide in the depth of dentin tubules in vitro

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

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