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      Impact of Ultrasonic Activation on the Effectiveness of Sodium Hypochlorite: A Review

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          Abstract

          Using ultrasonic devices in endodontics can enhance the antibacterial and tissue dissolving ability of different root canal irrigants such as sodium hypochlorite (NaOCl) which is the most common irrigant with excellent antibacterial and tissue dissolving abilities. However, due to its high surface tension, its penetration into the irregularities of the root canal system is a challenge. The purpose of this paper was to review the different ultrasonic devices, different types of ultrasonic irrigation, the effect(s) of ultrasonic activation on the antibacterial and biofilm-removal abilities of NaOCl as well as the effect of ultrasonic activation on the smear layer removal ability of NaOCl.

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          Most cited references55

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          Passive ultrasonic irrigation of the root canal: a review of the literature.

          Ultrasonic irrigation of the root canal can be performed with or without simultaneous ultrasonic instrumentation. When canal shaping is not undertaken the term passive ultrasonic irrigation (PUI) can be used to describe the technique. In this paper the relevant literature on PUI is reviewed from a MEDLINE database search. Passive ultrasonic irrigation can be performed with a small file or smooth wire (size 10-20) oscillating freely in the root canal to induce powerful acoustic microstreaming. PUI can be an important supplement for cleaning the root canal system and, compared with traditional syringe irrigation, it removes more organic tissue, planktonic bacteria and dentine debris from the root canal. PUI is more efficient in cleaning canals than ultrasonic irrigation with simultaneous ultrasonic instrumentation. PUI can be effective in curved canals and a smooth wire can be as effective as a cutting K-file. The taper and the diameter of the root canal were found to be important parameters in determining the efficacies of dentine debris removal. Irrigation with sodium hypochlorite is more effective than with water and ultrasonic irrigation is more effective than sonic irrigation in the removal of dentine debris from the root canal. The role of cavitation during PUI remains inconclusive. No detailed information is available on the influence of the irrigation time, the volume of the irrigant, the penetration depth of the instrument and the shape and material properties of the instrument. The influence of irrigation frequency and intensity on the streaming pattern as well as the complicated interaction of acoustic streaming with the adherent biofilm needs to be clarified to reveal the underlying physical mechanisms of PUI.
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            In vitro infection and disinfection of dentinal tubules.

            An in vitro model for dentinal tubule infection of root canals was developed. Cylindrical dentin specimens, 4 mm high with a diameter of 6 mm and a canal 2.3 mm wide, were prepared from freshly extracted bovine incisors. The cementum was removed from all dentin blocks. The tubules were opened by four-minute treatments with 17% EDTA and 5.25% NaOCl before being infected with Enterococcus faecalis ATCC 29212 in yeast extract-glucose broth. Bacteria rapidly invaded the tubules. After three weeks of incubation, a heavy infection was found 400 micron from the canal lumen, and the front of the infection reached 1000 micron in some blocks. Camphorated paramonochlorophenol (CMCP) and a calcium hydroxide compound, Calasept, were tested for their disinfecting efficacy toward E. faecalis-infected dentin. Liquid CMCP rapidly and completely disinfected the dentinal tubules, whereas CMCP in gaseous form disinfected tubules less rapidly. Calasept failed to eliminate, even superficially, E. faecalis in the tubules. The method used in bacteriological sampling allowed for sequential removal of 100-micron-thick zones of dentin from the central canal toward the periphery. Control specimens were uniformly infected and yielded growth in bur samples up to some 500 microns from the surface. The model proved quite sensitive and seems suitable for in vitro testing of root canal medicaments.
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              Sodium hypochlorite in endodontics: an update review.

              The major objective in root canal treatment is to disinfect the entire root canal system. This requires that the pulpal contents be eliminated as sources of infection. This goal may be accomplished using mechanical instrumentation and chemical irrigation, in conjunction with medication of the root canal between treatment sessions. Microorganisms and their by-products are considered to be the major cause of pulpal and periradicular pathosis. In order to reduce or eliminate bacteria and pulpal tissue remnants, various irrigation solutions have been suggested to be used during treatment. Sodium hypochlorite, an excellent non-specific proteolytic and antimicrobial agent, is the most common irrigation solution used during root canal therapy. The purpose of this paper was to review different aspects of sodium hypochlorite use in endodontics.
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                Author and article information

                Journal
                Iran Endod J
                Iran Endod J
                IEJ
                Iranian Endodontic Journal
                Iranian Center for Endodontic Research (Tehran, Iran )
                1735-7497
                2008-2746
                Fall 2015
                : 10
                : 4
                : 216-220
                Affiliations
                [a ] Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
                [b ] Iranian National Elites Foundation, Tehran, Iran;
                [c ] Private Practitioner, Hamedan, Iran ;
                [d ] Department of Periodontology, Endodontology, Pharmacology and Microbiology, Dental School, University of Brescia, Italy ;
                [e ] Department of Odontostomatological and Maxillofacial Sciences, Federico II University of Naples, Italy
                Author notes
                [* ]Corresponding author: Saeed Asgary, Iranian Center for Endodontic Research, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-21 22413897, E-mail: saasgary@yahoo.com
                Article
                10.7508/iej.2015.04.001
                4609656
                26525646
                ba4344ca-04ff-43ca-9c6a-18a35574a586
                © 2015, Iranian Center for Endodontic Research

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 April 2015
                : 1 August 2015
                : 15 August 2015
                Categories
                Review Article

                Dentistry
                antibacterial activity,biofilm,root canal irrigants,smear layer,sodium hypochlorite,ultrasonic activation

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