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BMC Oral Health
Published in: BMC Oral Health 1/2020

Open Access 01-12-2020 | Research article

The influence of two forms of chlorhexidine on the accuracy of contemporary electronic apex locators

Authors: Ewa Marek, Ryta Łagocka, Katarzyna Kot, Krzysztof Woźniak, Mariusz Lipski

Published in: BMC Oral Health | Issue 1/2020

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Abstract

Background

Accurate determination of working length (WL) is crucial for the success of endodontic therapy. The aim of this study was to determine the influence of 2% chlorhexidine digluconate solution, 2% chlorhexidine digluconate gel and 2% hypochlorite solution on the accuracy of two devices: the Raypex 5 and the ApexDal.

Methods

Twenty-nine single-rooted human teeth were used in this study. The crowns were cut horizontally and embedded in an alginate mass. In each tooth, six endodontic measurements were made using two electronic apex locators (EALs): a Raypex 5 and an ApexDal. For each EAL, measurements were taken with the following products: 2% chlorhexidine solution (CHX-S group), 2% chlorhexidine gel (CHX-G group) and 2% NaOCl (NaOCl group). After performing an endodontic measurement, the endodontic instruments were stabilized with flow resin composite. Afterwards, the roots were removed from the alginate mass, and the apical one-third of each root was cut lengthways to recover the canal system. Last, the distance between the file tip and the apical foramen was measured under a microscope at 60 x magnification.

Results

Statistically significant differences were found between CHX-S and NaOCl and CHX-G and NaOCl, but no significant differences were detected between CHX-S and CHX-G during the testing of both devices. No statistically significant differences were observed between the Raypex 5 and ApexDal for all intracanal media tested.

Conclusion

The EALs Raypex 5 and ApexDal had higher accuracy in the anatomical foramen of the root containing chlorhexidine in the gel or in the solution form than in the canal containing sodium hypochlorite.
Literature
1.
Ziegler AA, Altenburger MJ, Wrbas KT. In vivo comparison of working length determination with electronic apex locators. Int Endod J. 2007;40:133–8.PubMedCrossRef
2.
Stein TJ, Corcoran JF. Noioniozing method of locating the apical constriction (minor foramen) in root canals. Oral Surg Oral Med Oral Pathol. 1991;71:96–9.PubMedCrossRef
3.
Basmadijan-Charles CL, Farge P, Bourgeois DM, Lebrun T. Factors influencing the long-term results of endodontic treatment: a review of the literature. Int Dent J. 2002;52:81–6.CrossRef
4.
Kang JA, Kim SK. Accuracies of seven different apex locators under various conditions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:e57–62.PubMedCrossRef
5.
Plotino G, Grande NM, Brigsnte L, Lesti B, Somma F. Ex vivo accuracy of three electronic apex locators root ZX, elements diagnostic unit, apex locator and ProPex. Int Endod J. 2006;39:408–14.PubMedCrossRef
6.
Meares WA, Steiman HR. The influence of sodium hypochlorite irrigation on the accuracy of the root ZX electronic apex locator. J Endod. 2002;28:595–8.PubMedCrossRef
7.
Kim E, Marmo M. An in vivo comparison of working length determination by only root ZX apex locator versus combining root ZX apex locator with radiographs using a new impression technique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:e79–83.PubMedCrossRef
8.
Ózsezer E, Inan U, Aydin U. In vivo evaluation of ProPex electronic apex locator. J Endod. 2007;33:974–7.PubMedCrossRef
9.
ElAyouti A, Weiger R, Löst C. Frequency of overinstrumentation with an acceptable radiographic working length. J Endod. 2001;27:49–52.PubMedCrossRef
10.
ElAyouti A, Weiger R, Löst C. The ability of root ZX apex locator to reduce the frequency of overestimated radiographic working length. J Endod. 2002;28:116–9.PubMedCrossRef
11.
Marcos-Arenal JL, Rivera EM, Caplan DJ. Evaluation the paper point technique for locating the apical foramen after canal preparation. Oral Surg. Oral Med Oral Pathol Oral Radiol Endod. 2009;108:e101–5.CrossRef
12.
Dunlap CA, Remeikis NA, BeGole EA, Rauschenberger CR. An in vivo evaluation of an electric apex locator that uses the ratio method vital and necrotic canals. J Endod. 1998;24:48–50.PubMedCrossRef
13.
Pratten DH, McDonald NJ. Comparison of radiographic and electronic working lengths. J Endod. 1996;22:173–6.PubMedCrossRef
14.
Khandewal D, Ballal NV, Sarawathi MV. Comparative evaluation of accuracy of 2 electronic apex locators with convetional radiography: an ex vivo study. J Endod. 2015;41(2):201–4.PubMedCrossRef
15.
Gurel MA, Helvacioglu Kivanc B, Ekici A. A comparative assessment of the accuracies of Raypex 5, Raypex 6, iPex and iPex II electronic apex locators: an in vitro study. J Istanb Univ Fac Dent. 2017;51:28–33.PubMedPubMedCentral
16.
Yolagiden M, Ersahan S, Suyun G, Bilgec E, Aydin C. Comparison of four electronic apex locators in detecting working length: an ex vivo study. J Contemp Dent Pract. 2018;19:1427–33.PubMedCrossRef
17.
Saraswathi V, Kedia A, Purayil TP, Ballal V, Saini A. Comparative evaluation of the accuracy of two electronic apex locators in determining the working length in teeth with simulated apical root resorption: an in vitro study. J Conserv Dent. 2016;19:402–5.PubMedPubMedCentralCrossRef
18.
Marroquín BB, Fernández CC, Schmidtmann I, Willershausen B, Goldberg F. Accuracy of electronic apex locators to detect root canal perforations with inserted me-tallic posts: an ex vivo study. Head Face Med. 2014;10:57.PubMedPubMedCentralCrossRef
19.
Ding J, Gutmann JL, Fan B, Lu Y, Chen H. Investigation of Apex Locators and Related Morphological. J Endod. 2010;36:1399–403.PubMedCrossRef
20.
Erdemir A, Eldeniz AU, Ari H, Belli S, Esener T. The influence of irrigation solutions on the accuracy of the electronic apex locator facility in the tri auto ZX handpiece. Int Endod J. 2007;40:391–7.PubMedCrossRef
21.
Kuruvilla JR, Kamath MP. Antimicrobial activity of 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate separately and combined, as endodontic irrigants. J Endod. 1998;24:472–6.PubMedCrossRef
22.
Mohammadia Z, Giardinoc L, Palazzid F, Asgarya S. Agonistic and Antagonistic Interactions between Chlorhexidine and Other Endodontic Agents: A Critical Review. Iran Endod J. 2015;10:1–5.
23.
Basrani BR, Manek S, Fillery E. Using diazotization to characterize the effect of heat orSodium hypochlorite on 2.0% Chlorhexidine. J Endod. 2009;35:1296–9.PubMedCrossRef
24.
Khadse P, Kamra A, Banga KS. Effectiveness of various intermediate irrigants for the prevention of precipitate formed by the interaction of sodium hypochlorite and chlorhexidine-an in vitro study. Edodontology. 2014;26:309–13.
25.
Wang CS, Arnold RR, Trope M, Teixeira BF. Clinical efficiency of 2% chlorhexidine gel in reducing intracanal bacteria. J Endod. 2007;33:1283–9.PubMedCrossRef
26.
Filho M, Leonardo M, Silva L, Anibal F, Faccioli L. Inflammatory responses to different endodontic irrigating solutions. Int Endod J. 2002;35:735–9.CrossRef
27.
Paquette L, Legner M, Fillery ED, Friedman S. Antibacterial efficacy of chlorhexidine gluconate intracanal medication in vivo. J Endod. 2007;33:788–95.PubMedCrossRef
28.
Siqueira JF, Rôças IN, Lopez HP, Magalhães FAC, Uzeda M. Elimination of Candida albicans infection of the radicular dentin by intracanal medications. J Endod. 2003;29:501–4.PubMedCrossRef
29.
Portenier I, Waltimo TD, Ørstavik D, Haapasalo M. Killing of enterococcus faecalis by MTAD and chlorhexidine digluconate with or without Cetrimide in the presence or absence of dentine powder or BSA. J Endod. 2006;32:138–41.PubMedCrossRef
30.
Rosenthal S, Spangberg L, Safavi K. Chlorhexidine substantivity in root canal dentin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:488–92.PubMedCrossRef
31.
Dametto FR, Ferraz CC, Gomes BP, Zaia AA, Teixeira FB, de Souza-Filho FJ. In vitro assessment of the immediate and prolonged antimicrobial action of chlorhexidine gel as an endodontic irrigant against enterococcus faecalis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99:768–72.PubMedCrossRef
32.
Shin HS, Yang WK, Kim M, Ko HJ, Cho KM, Park SH, Kim JW. Accuracy of root ZX in teeth with simulated root perforation in the presence of gel or liquid type endodontic irrigant. Restor Dent Endod. 2012;37:149–54.PubMedPubMedCentralCrossRef
33.
Tinaz AC, Sevimli LS, Görgül G, Türköz G. The effects of sodium hypochlorite concentrations on the accuracy of an apex locating device. J Endod. 2002;28:160–2.PubMedCrossRef
34.
Fouad AF, Rivera EM, Krell KV. Accuracy of the Endex with variation in canal irrigants and foramen sizes. J Endod. 1983;19:63–7.CrossRef
35.
Ebrahim AK, Yoshioka T, Kobayashi C, Suda H. The effects of size, sodium hypochlorite and blood on the accuracy of root ZX apex locator in enlarged root canals: an in vitro study. Aust Dent J. 2006;51:153–7.PubMedCrossRef
36.
Akisue E, Poli de Figueiredo JA. Influence of pulp vitality on length determination by using the elements diagnostic unit and apex locator. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:e129–32.PubMedCrossRef
37.
Jenkins JA, Walker WA, Schindler WG, Flores CM. An in vitro evaluation of the accuracy of the root ZX in the presence of various irrigants. J Endod. 2001;27:209–11.PubMedCrossRef
38.
Jain S, Kapur R. Comparative evaluation of accuracy of two electronic apex locators in the presence of various irrigants: An in vitro study. Contemp Clin Dent. 2012;3(Suppl 2):S140–5.PubMedPubMedCentralCrossRef
39.
Khursheed I, Bansal R, Bansal T, Singh HP, Yadav M, Reddy KJ. A comparative evaluation of working length with digital radiography and third generation apex locator (ProPex) in the presence of various intracanal irrigants: an in vivo/ex vivo study. Dent Res J. 2014;11:56–60.
40.
Paras M, Manjunath V, Manjunath MK. Comparison of accuracy of two electronic apex locators in the presence of various irrigants: an in vitro study. J Conserv Dent. 2012;15:178–82.CrossRef
41.
Kaufman A, Katz A. Realiability of root ZX apex locator texted by an in vitro model. J Endod. 1993;19:201.CrossRef
42.
Prasad AB, Harshit S, Aastha SA, Deepak R. An Invitro evaluation of the accuracy of two electronic apex locators to determine working length in the presence of various Irrigants. Ethiop J Health Sci. 2016;26:457–62.PubMedPubMedCentralCrossRef
43.
Gomes S, Oliver R, Macouzet C, Mercadé M, Roig M, Duran-Sindreu F. In vivo evaluation of the Raypex 5 by using different irrigants. J Endod. 2012;38:1075–7.PubMedCrossRef
44.
Joesten MD, Hogg JL, Castellion ME. The word of chemistry: essentials. 4th ed. Belmont: Brooks Cole; 2004. p. 461.
45.
Ebrahim AK, Wadachi R, Suda H. An in vitro evaluation of the accuracy of Dentaport ZX apex locator in enlarged root canals. Aust Dent J. 2007;52:193–7.PubMedCrossRef
46.
Schäfer E, Bossmann K. Antimicrobial efficacy of chloroxylenol and chlorhexidine in the treatment of infected root canals. Am J Dent. 2001;14:233–7.PubMed
47.
48.
Zamany A, Safavi K, Spångberg LS. The effect of chlorhexidine as an endodontic disinfectant. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:578–81.PubMedCrossRef
49.
Dammaschke T, Jung N, Harks I, Schafer E. The effect of different root canal medicaments on the elimination of enterococcus faecalis ex vivo. Eur J Dent. 2013;7:442–8.PubMedPubMedCentralCrossRef
50.
Dammaschke T, Schneider U, Stratmann U, Yoo JM, Schäfer E. Effect of root canal dressings on the regeneration of inflamed periapical tissue. Acta Odontol Scand. 2005;63:143–52.PubMedCrossRef
51.
Oliveira TN, Vivacqua-Gomes N, Bernardes RA, Vivan RR, MAH D, Vasconcelos BC. Determination of the accuracy of 5 electronic apex locators in the function of different employment protocols. J Endod. 2017;43:1663–7.PubMedCrossRef
52.
Saatchi M, Aminozarbian MG, Noormohammadi H, Baghaei B. Influence of blood on the accuracy of Raypex 5 and root ZX electronic foramen locators: an in vivo study. Braz Dent J. 2016;27:336–9.PubMedCrossRef
53.
Al-Hadlaq SM. Effect of chloroform, orange solvent and eucalyptol on the accuracy of four electronic apex locators. Aust Endod J. 2013;39:112–5.PubMedCrossRef
54.
55.
Steffen H, Splieth CH, Behr K. Comparison of measurements obtaining with hand files or the canal leader attached to electronic apex locators: an in vitro study. Int Endod J. 1999;32:103–7.PubMedCrossRef
56.
Luigi Cianconi L, Angott V, Felici R, Conte G, Mancin M. Accuracy of Three Electronic Apex Locators Compared with Digital Radiography: An Ex Vivo Study. J Endod. 2010;36:2003–7.PubMedCrossRef
57.
Mancini M, Palopoli P, Iorio L, Conte G, Ciancon L. Accuracy of an Electronic Apex Locator in the Retreatment of Teeth Obturated with Plastic or Cross-linked Gutta-percha Carrier-based Materials: An Ex Vivo Study. J Endod. 2014;40:2061–5.PubMedCrossRef
58.
Kaufman AY, Keila S, Yoshpe M. Accuracy of new apex locator: an in vitro study. Int Endod J. 2002;35:186–92.PubMedCrossRef
Metadata
Title
The influence of two forms of chlorhexidine on the accuracy of contemporary electronic apex locators
Authors
Ewa Marek
Ryta Łagocka
Katarzyna Kot
Krzysztof Woźniak
Mariusz Lipski
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2020
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-019-0994-z

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