COMPARISON OF THE EFFECTIVENESS OF SODIUM HYPOCHLORITE AND CHLORHEXIDINE AS IRRIGANTS IN SINGLE VISIT ROOT CANAL THERAPY

SUMMARY

Objectives

This randomized controlled (clinical) trial was conducted to compare the effectiveness of sodium hypochlorite and chlorhexidine as irrigants in single visit root canal therapy. The study was also carried out to determine if there is any association between tooth type and the effectiveness of the irrigant used.

Method

Consenting subjects (n=110) referred to the restorative unit of the dental department, Lagos State University Teaching Hospital were randomly assigned to sodium hypochlorite and chlorhexidine groups, having met the selection criteria. The frequency of post-obturation pain was recorded over an observation period of 30 days divided into four recall visits: Post –op day 1, day 7, day 14 and day 30. Pain was defined as any unpleasant sensation, causing discomfort to the patient and was assessed by the verbal descriptor pain scale: o- no pain; 1-2-mild pain (pain can be ignored); 3-6 – moderate pain (pain interferes with task/concentration); 7-8 – pain severe (pain interferes with basic needs); 9 -10 – worst possible pain (bed rest is required). This scale is based on the quality guidelines for endodontic treatment: a consensus report of the European Society of Endodontology 2006. The canals of all teeth were prepared and filled by a single operator using the step-back and lateral condensation techniques. All patients were placed on antibiotics (amoxil,) but no analgesic was given. The data were analysed using SPSS version 20 and test of statistical significance was done using the chi-square test. P value of 0.05 or less was taken as statistically significant.

Result

Nine of the 110 patients seen were excluded from the analysis as they failed to attend post-obturation review. The number of patients that experienced postobturation pain during the first recall visit (day 1) was 4 (8.3%) out of the 48 respondents in the sodium hypochlorite group while three 3 (5.7%) out of the 53 respondents were in the chlorhexidine group. This revealed a slightly higher incidence of post obturation pain in the sodium hypochlorite group than in the chlorhexidine group but this was not statistically significant (p> 0.05). The pain experience in all cases was level 1 pain (mild pain that could be ignored). There was no record of pain from the second recall visit (day-7) to the last recall visit (day-30) in both treatment groups.

The pain experienced in the sodium hypochlorite group in the following tooth type to wit: three posterior teeth and one anterior tooth was not statistically significant (P > 0.05). Similarly, the pain experienced in the chlorhexidine group in the following tooth type to wit: one posterior tooth and two anterior teeth was not statistically significant (P > 0.05). Therefore pain experience in this study could not be attributed to tooth type.

Conclusion

There was no statistically significant difference in the effectiveness of sodium hypochlorite or chlorhexidine irrigants as assessed by incidence of postobturation pain in single visit endodontic therapy in carefully selected cases. There was also no association between the tooth type and the effectiveness of the irrigant used; sodium hypochlorite or chlorhexidine.

TABLE OF CONTENTS

 

TITLE PAGE ……………………………………………………………………………………………. i

CERTIFICATION……………………………………………………………………………………… ii

DEDICATION ………………………………………………………………………………………… iii

DECLARATION ……………………………………………………………………………………… iv

TABLE OF CONTENTS …………………………………………………………………………….. v

LIST OF TABLES…………………………………………………………………………………………..viii

LIST OF FIGURES…………………………………………………………………………………………..ix

ACKNOWLEDGEMENTS …………………………………………………………………………. xi

LIST OF ABBREVIATIONS ……………………………………………………………………….. xii

SUMMARY …………………………………………………………………………………………. xiv

 

CHAPTER ONE ………………………………………………………………………………………. 1

INTRODUCTION…………………………………………………………………………………….. 1

 

CHAPTER TWO ……………………………………………………………………………………… 3

2.0. AIM AND OBJECTIVES. ……………………………………………………………………… 3

2.1 AIM: ………………………………………………………………………………………………. 4

2.2 OBJECTIVES: ……………………………………………………………………………………. 4

 

CHAPTER THREE ……………………………………………………………………………………. 4

3.0 THE LITERATURE REVIEW ………………………………………………………………….. 4

3.1 Basis of Root Canal Irrigation …………………………………………………………….. 5

3.2 Irrigation ………………………………………………………………………………………… 5

3.3. Variables Affecting Root Canal Irrigation. ……………………………………………. 6

3.4 Ideal Requirements Of Root Canal Irrigant. ………………………………………….. 7

3.5 THE IRRIGANTS. ……………………………………………………………………………….. 8

3.5.1 SODIUM HYPOCHLORITE (NaOCl) …………………………………………………….. 8

3.5.2 CHLORHEXIDINE (CHX). ………………………………………………………………… 11

 

CHAPTER FOUR …………………………………………………………………………………… 17

4.0 MATERIALS AND METHOD ………………………………………………………………. 17

4.1 DESCRIPTION OF STUDY AREA………………………………………………………….. 17

4.2       STUDY DESIGN ……………………………………………………………………………. 18

4.3 STUDY POPULATION (DESCRIPTION OF STUDY POPULATION) ……………….. 18

4.4 SAMPLE SIZE DETERMINATION. ……………………………………………………….. 19

4.5 SAMPLE SIZE …………………………………………………………………………………. 20

4.6 SAMPLING TECHNIQUE …………………………………………………………………… 21

4.7 EXPERIMENTAL DESIGN ………………………………………………………………….. 21

4.8 DATA COLLECTION METHOD ……………………………………………………………. 22

4.9 DATA ANALYSIS ……………………………………………………………………………… 23

4.10 INCLUSION CRITERIA …………………………………………………………………….. 24

4.11 EXCLUSION CRITERIA …………………………………………………………………….. 24

4.12 INSTRUMENT OF MEASUREMENT: ………………………………………………….. 24

4.13 VALIDITY OR VALIDATION OF THE STUDY: ………………………………………… 24

4.14 ETHICAL CLEARANCE AND PERMISSION TO CONDUCT THE STUDY. ……… 25

4.15 TIME AND DURATION OF STUDY. ……………………………………………………. 25

 

CHAPTER FIVE …………………………………………………………………………………….. 25

5.0 RESULTS ……………………………………………………………………………………….. 25

5.1 DISTRIBUTION OF RESPONDENTS …………………………………………………….. 25

 

CHAPTER ONE

INTRODUCTION

Microorganisms have been incriminated in the pathogenesis of pulpal infections. Therefore, the elimination or reduction of pathogens in root canal is the mainstay of successful root canal (endodontic) treatment^1-2. The current consensus is that one-visit treatment procedures are acceptable in cases where the patient exhibits a vital pulp as is the case with acute irreversible pulpitis^3-5. The removal of the inflamed pulp tissue in an endodontic procedure with an effective antimicrobial irrigant should result in a successful outcome^3-5. Obturation at the initial visit also precludes the contamination as a result of leakage during the period between the patients’ visits in a multivisit regimen³.

Acute irreversible pulpitis is said to occur when the inflammatory process present in the dental pulp is persistent and cannot be resolved by systemic or locally applied medicaments^{6, 7}. The inflammatory process is usually initiated by microbial infection from carious lesion, extensive traumatic exposure of the pulp, fracture of the crown or root, and cracked tooth syndrome^{8, 9}.  Also, severe thermal and chemical irritation of the pulp causes tissue necrosis and subsequent bacterial infection¹⁰. Dental caries is by far, the most common source of bacterial infection of the dental pulp^{2, 6, 7}. These infections are polymicrobial^11-14 but only a few species are isolated in any given case i.e. four to seven different species¹⁵. The predominant organisms are obligate anaerobes^15-17.  The bacteria mainly found include Enterococcus spp, Lactobacillus spp, Propionibacterium spp, Streptococcus spp, Pantoea spp, Prevotella spp, and Selenomonas spp. Others are Capnocytophaga spp,

Dialister        spp,    Eubacterium            spp,    Fusobacterium       spp,    Gemella        spp, Mogibacterium spp, Peptostreptococcus spp, Solobacterium and Veillonella spp15-17. 

Yeast like Candida albicans have been isolated from some infected root canals¹⁸.

Once infection is established in root canal, it cannot be eliminated by the host defense system or systemic antibiotics because microorganisms in the dentinal tubules are inaccessible to them^19-21. Also transport of antimicrobial medications to the site of infection is hindered by pulpal necrosis^{19, 21}. Therefore, the treatment options for acute irreversible pulpitis are extraction^{20, 21}, pulpotomy in deciduous teeth²² and root canal treatment in permanent teeth23-25.

The goal of root canal treatment is to eliminate the microbial pathogens and necrosed tissues of the tooth, prepare the root canal for an hermetic seal and prevention of re-entry of microorganisms into the root canal²⁶. Once sealed, any microbe that is left in the dentinal tubules is entombed and does not have access to nutrients and so dies off²⁶.

Severe stabbing pain that is little affected by simple analgesics is the common feature of acute irreversible pulpitis^{6, 27}. Successful treatment of the condition results in rapid pain relief^{27, 28}.

Debridement of the root canal by instrumentation and irrigation is considered the most important single factor in the treatment of endodontic diseases²³. Mounting evidence from epidemiological research also indicates that the combination of high-quality coronal restoration and technically satisfactory root canal treatment is associated with the greatest long-term prognosis²³. The ongoing discussion in international endodontics about one-appointment therapy in the treatment of apical periodontitis has naturally further motivated the newly emerged research activities on root canal irrigants^{3, 23}.

The current consensus is that one-visit treatment procedures are acceptable in cases where the patient exhibits a vital pulp as is the case with acute irreversible pulpitis^{3-5, 23}, but elimination of the infective organisms by an effective chemomechanical preparation and obturation of the canals at the initial visits precludes the chances of recontamination with pathogen as in multiple visits.

JUSTIFICATION

Most of the work done in the area of root canal irrigants are mostly laboratory based and care must be taken in applying these results in clinical practice. This is because of clear differences between in-vivo and in-vitro environments. This includes the high volume and concentrations of irrigants used in in-vitro studies which cannot be used in-vivo. Likewise, the chemical environment in in-vivo studies is quite different from that of laboratory environment.

Therefore, it is appropriate that in-vivo studies be conducted to investigate the root canal irrigant that will be most effective in one visit root canal treatment.

Consequently, this study was conducted to evaluate the effectiveness of chlorhexidine and sodium hypochlorite as root canal irrigants.

COMPARISON OF THE EFFECTIVENESS OF SODIUM HYPOCHLORITE AND CHLORHEXIDINE AS IRRIGANTS IN SINGLE VISIT ROOT CANAL THERAPY

Sharing is caring!