Effect of final irrigation with sodium hypochlorite at different temperatures on postoperative pain level and antibacterial activity: a randomized controlled clinical study

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Abstract

Objective

To evaluate the effect of final irrigation of root canals with NaOCl solution at different temperatures on postoperative pain level and antimicrobial activity.

Methodology

45 patients were randomly divided into three groups using a web program according to the irrigation selected: NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC. First root canal samples were collected before treatment (S1). After chemo-mechanical preparation, final irrigation was performed with the selected irrigant (NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC) and second samples were collected (S2). Samples were subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels at 24, 48 and 72 hours, 5 days and 1 week after treatment using a visual analog scale (VAS).

Results

The reduction in the number of total bacterial cell equivalents from S1 to S2 was statistically significant in all groups (p<0.001). The NaOCl 2˚C group reported significantly less postoperative pain than the NaOCl 45˚C group (p<0.05). Postoperative analgesic intake was significantly higher in the NaOCl 45˚C group than in the NaOCl 2˚C group (p<0.05).

Conclusion

We conclude that final irrigation with NaOCl at different temperatures results in similar antibacterial effectiveness. Final irrigation with cold NaOCl (2˚C) is better than NaOCl 45˚C when comparing postoperative pain levels.

Related collections

Most cited references 32

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Matthias Zehnder (2006)

Local wound debridement in the diseased pulp space is the main step in root canal treatment to prevent the tooth from being a source of infection. In this review article, the specifics of the pulpal microenvironment and the resulting requirements for irrigating solutions are spelled out. Sodium hypochlorite solutions are recommended as the main irrigants. This is because of their broad antimicrobial spectrum as well as their unique capacity to dissolve necrotic tissue remnants. Chemical and toxicological concerns related to their use are discussed, including different approaches to enhance local efficacy without increasing the caustic potential. In addition, chelating solutions are recommended as adjunct irrigants to prevent the formation of a smear layer and/or remove it before filling the root canal system. Based on the actions and interactions of currently available solutions, a clinical irrigating regimen is proposed. Furthermore, some technical aspects of irrigating the root canal system are discussed, and recent trends are critically inspected.

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This study investigated the role of infection on the prognosis of endodontic therapy by following-up teeth that had had their canals cleaned and obturated during a single appointment. The root canals of 55 single-rooted teeth with apical periodontitis were thoroughly instrumented and irrigated with sodium hypochlorite solution. Using advanced anaerobic bacteriological techniques, post-instrumentation samples were taken and the teeth were then root-filled during the same appointment. All teeth were initially infected; after instrumentation low numbers of bacteria were detected in 22 of 55 root canals. Periapical healing was followed-up for 5 years. Complete periapical healing occurred in 94% of cases that yielded a negative culture. Where the samples were positive prior to root filling, the success rate of treatment was just 68%--a statistically significant difference. Further investigation of three failures revealed the presence of Actinomyces species in each case; no other specific bacteria were implicated in failure cases. These findings emphasize the importance of completely eliminating bacteria from the root canal system before obturation. This objective cannot be reliably achieved in a one-visit treatment because it is not possible to eradicate all infection from the root canal without the support of an inter-appointment antimicrobial dressing.

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Author and article information

Journal

Journal ID (nlm-ta): J Appl Oral Sci

Journal ID (iso-abbrev): J Appl Oral Sci

Journal ID (publisher-id): jaos

Title: Journal of Applied Oral Science

Publisher: Faculdade De Odontologia De Bauru - USP

ISSN (Print): 1678-7757

ISSN (Electronic): 1678-7765

Publication date (Electronic, pub): 10 February 2021

Publication date (Electronic, collection): 2021

Volume: 29

Electronic Location Identifier: e20200502

Affiliations

[1 ] orgnameAtaturk University orgdiv1Faculty of Dentistry orgdiv2Department of Endodontics Erzurum Turkey originalAtaturk University, Faculty of Dentistry, Department of Endodontics, Erzurum, Turkey.

[2 ] orgnameAtaturk University orgdiv1Faculty of Science, Molecular Biology and Genetics Microbiology Erzurum Turkey originalAtaturk University, Faculty of Science, Molecular Biology and Genetics Microbiology, Erzurum, Turkey.

Author notes

Corresponding address: Ertuğrul Karataş Ataturk University - Faculty of Dentistry - Department of Endodontics – Erzurum – 25240 - Turkey. Phone: +90.442.231 3804 - Fax: +90.442.231 2270. e-mail: dtertu@ 123456windowslive.com

Conflict of interest

The authors declare no conflict of interest.

Authors' contributions

Karataş, Ertugrul: Data curation (Equal); Formal analysis (Equal); Funding acquisition (Equal); Investigation (Equal); Methodology (Equal); Supervision (Equal). Writing-original draft (Equal); Writing-review & editing (Equal). Ayaz, Nilay: Data curation (Equal); Investigation (Equal); Methodology (Equal); Resources (Equal). Uluköylü, Esra: Investigation (Equal); Methodology (Equal). Baltacı, Mustafa Özkan: Methodology (Equal). Adıgüzel, Ahmet: Supervision (Equal)

Author information

Ertuğrul KARATAŞ https://orcid.org/0000-0002-8145-8763

Article

Other ID: 00406

DOI: 10.1590/1678-7757-2020-0502

PMC ID: 7875544

PubMed ID: 33624688

SO-VID: 5df36340-4322-46bd-819f-9930a62de61e

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 19 June 2020

Date revision received : 1 September 2020

Date accepted : 8 October 2020

Page count

Figures: 0, Tables: 5, Equations: 0, References: 28

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