Comparison of Endodontic Treatment Results Yielded from Using Normal Saline with IKI Final Rinse or NaOCl Irrigation: A 30-Month Follow-up Study

Abbas Abbaszadegan, Mohammadreza Nabavizadeh, Ameneh Hoseini Yekani, Akbar Khayat, Abbas Abbaszadegan, Mohammadreza Nabavizadeh, Ameneh Hoseini Yekani, Akbar Khayat

Abstract

Introduction: The aim of this clinical trial was to evaluate and compare the endodontic treatment results of teeth with apical periodontitis after thirty-month recall with two different irrigation regimen: normal saline followed by Iodine Potassium Iodide (IKI) or sodium hypochlorite (NaOCl) irrigation alone.

Materials and methods: Twenty seven patients (30 teeth) who had been included in the first part of our antimicrobial survey were recalled. In previous stage, root canal treatments were performed using either normal saline with IKI final rinse (n = 15) or NaOCl (n = 15) as irrigating solutions. Bacterial samples were taken before and after instrumentation. In this stage, three patients (6 teeth) were excluded from the follow-up schedule since they did not respond to the recall requests. The remaining 24 subjects (12 teeth in each NaOCl and IKI group) were examined clinically and radiologically. Post-operative and follow-up images were coded, blindly evaluated and given a periapical score according to PAI scoring system. The outcome was assessed in two ways; first, the changes in PAI score from base line to the follow-up evaluation in each group were assessed by wilcoxon signed rank test. In addition, Mann-Whitney U test was used to compare the differences between the post-operative and follow-up images of treatment groups. Second, the dichotomous variables as "healed" or "not healed" were compared.

Results: The Median (Min, Max) PAI scores for NaOCl group and IKI group were both 5 (3, 5) for immediate post-operative radiographs and declined to 1 (1, 2) and 2 (1, 2), respectively. A statistically significant decrease in PAI score from the base line to the follow-up evaluation was seen in both groups (P = 0.002). The decrease in NaOCl group was higher significantly in comparison to IKI group (P = 0.036). One hundred percent of the teeth were healed in both groups (PAI ≤ 2) and no teeth showed any abnormal clinical findings.

Conclusion: Root canal irrigation with NaOCl resulted in a significant higher decrease in PAI scores in comparison to irrigation with normal saline followed by IKI final rinse. Although, according to results of 30-months recall, complete bone formation was observed in all samples in both groups and no teeth showed any abnormal clinical findings. These findings depict the weight of all important clinical and biological factors which together impact the results of a successful endodontic treatment.

Keywords: Apical Periodontitis; Healing; Iodine Potassium Iodide; Sodium Hypochlorite.

Conflict of interest statement

Conflict of Interest:

‘None declared’.

References

    1. Pitt Ford TR. The effects on the periapical tissues of bacterial contamination of the filled root canal. International endodontic journal. 1982;15(1):16–22.
    1. Sjögren U, Figdor D, Persson S, Sundqvist G. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. International endodontic journal. 1997;30(5):297–306.
    1. Hauman CHJ, Love RM. Biocompatibility of dental materials used in contemporary endodontic therapy: a review. Part 1. Intracanal drugs and substances. International endodontic journal. 2003;36(2):75–85.
    1. Barnhart BD, Chuang A, Lucca JJD, Roberts S, Liewehr FR, Joyce AP. An in vitro evaluation of the cytotoxicity of various endodontic irrigants on human gingival fibroblasts. J Endod. 2005;31(8):613–615.
    1. Busslinger A, Sener B, Barbakow F. Effects of sodium hypochlorite on nickel-titanium Lightspeed instruments. International endodontic journal. 1998;31(4):290–4.
    1. Mountouris G, Silikas N, Eliades G. Effect of sodium hypochlorite treatment on the molecular composition and morphology of human coronal dentin. J Adhes Dent. 2004;6(3):175–82.
    1. Marending M, Luder HU, Brunner TJ, Knecht S, Stark WJ, Zehnder M. Effect of sodium hypochlorite on human root dentine–mechanical, chemical and structural evaluation. International endodontic journal. 2007;40(10):786–793.
    1. Tello-Barbaran J, Nakata HM, Salcedo-Moncada D, Bramante CM, Ordinola-Zapata R. The antimicrobial effect of iodine-potassium iodide after cleaning and shaping procedures in mesial root canals of mandibular molars. Acta Odontol Latinoam. 2010;23(3):244–7.
    1. Peciuliene V, Reynaud AH, Balciuniene I, Haapasalo M. Isolation of yeasts and enteric bacteria in root-filled teeth with chronic apical periodontitis. International endodontic journal. 2001;34(6):429–34.
    1. Kvist T, Molander A, Dahlen G, Reit C. Microbiological evaluation of one- and two-visit endodontic treatment of teeth with apical periodontitis: a randomized, clinical trial. Journal of Endodontic. 2004;30(8):572–6.
    1. Molander A, Reit C, Dahlen G. The antimicrobial effect of calcium hydroxide in root canals pretreated with 5% iodine potassium iodide. Endodontics & dental traumatology. 1999;15(5):205–9.
    1. Abbaszadegan A, Khayat A, Motamedifar M. Comparison of Antimicrobial Efficacy of IKI and NaOCl Irrigants in Infected Root Canals: An In Vivo Study. Iran Endod J. 2010;5(3):101–6.
    1. Grung B, Molven O, Halse A. Periapical surgery in a Norwegian county hospital: follow-up findings of 477 teeth. Journal of Endodontic. 1990;16(9):411–7. doi: 10.1016/S0099-2399(06)81882-0.
    1. Molven O, Halse A, Grung B. Surgical management of endodontic failures: indications and treatment results. International dental journal. 1991;41(1):33–42.
    1. Halse A, Molven O, Grung B. Follow-up after periapical surgery: the value of the one-year control. Endodontics & dental traumatology. 1991;7(6):246–50.
    1. Orstavik D. Time-course and risk analyses of the development and healing of chronic apical periodontitis in man. International endodontic journal. 1996;29(3):150–5.
    1. Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique. J Endod. 1979;5(3):83–90. doi: 10.1016/S0099-2399(79)80154-5.
    1. Fristad I, Molven O, Halse A. Nonsurgically retreated root filled teeth–radiographic findings after 20–27 years. International endodontic journal. 2004;37(1):12–18.
    1. Peters LB, Wesselink PR. Periapical healing of endodontically treated teeth in one and two visits obturated in the presence or absence of detectable microorganisms. International endodontic journal. 2002;35(8):660–7.
    1. Marending M, Peters OA, Zehnder M. Factors affecting the outcome of orthograde root canal therapy in a general dentistry hospital practice. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(1):119–24. doi: 10.1016/j.tripleo.2004.06.065.
    1. Orstavik D, Kerekes K, Eriksen HM. Clinical performance of three endodontic sealers. Endodontics & dental traumatology. 1987;3(4):178–86.
    1. Reit C. The influence of observer calibration on radiographic periapical diagnosis. International endodontic journal. 1987;20(2):75–81.
    1. Farzaneh M, Abitbol S, Friedman S. Treatment outcome in endodontics: the Toronto study. Phases I and II: Orthograde retreatment. Journal of Endodontic. 2004;30(9):627–33.
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174.
    1. Walters SJ. Sample size and power estimation for studies with health related quality of life outcomes: a comparison of four methods using the SF-36. Health Qual Life Outcomes. 2004;2(1):26.
    1. Strindberg LZ. An analytical study based on radiographic and clinical follow-up examinations. In: Dependence of the results of pulp therapy on certain factors. Acta Odontologica Scandinavica; 1956.
    1. Molven O, Halse A, Fristad I, MacDonald-Jankowski D. Periapical changes following root-canal treatment observed 20-27 years postoperatively. International endodontic journal. 2002;35(9):784–90.
    1. Byström A, Happonen RP, Sjögren U, Sundqvist G. Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis. Dental traumatology. 1987;3(2):58–63.
    1. Eriksen HM. Epidemiology Of Apical Periodontitis. In: Orstavik D PFT, editors., editor. Essential Endodontology: Prevention and Treatment of Apical Periodontitis. Oxford: Blackwell Science; 1998.
    1. Huumonen S, Lenander-Lumikari M, Sigurdsson A, Ørstavik D. Healing of apical periodontitis after endodontic treatment: a comparison between a silicone-based and a zinc oxide–eugenol-based sealer. International endodontic journal. 2003;36(4):296–301.
    1. Waltimo T, Trope M, Haapasalo M, Orstavik D. Clinical efficacy of treatment procedures in endodontic infection control and one year follow-up of periapical healing. Journal of Endodontic. 2005;31(12):863–6.
    1. Tervit C, Paquette L, Torneck CD, Basrani B, Friedman S. Proportion of healed teeth with apical periodontitis medicated with two percent chlorhexidine gluconate liquid: a case-series study. Journal of Endodontic. 2009;35(9):1182–5. doi: 10.1016/j.joen.2009.05.010.
    1. Sutherland SE. Critical Appraisal of the Dental Literature: Papers About Diagnosis, Etiology and Prognosis. Journal - Canadian Dental Association. 2001;67(10):582–5.
    1. Penesis VA, Fitzgerald PI, Fayad MI, Wenckus CS, BeGole EA, Johnson BR. Outcome of one-visit and two-visit endodontic treatment of necrotic teeth with apical periodontitis: a randomized controlled trial with one-year evaluation. Journal of Endodontic. 2008;34(3):251–7. doi: 10.1016/j.joen.2007.12.015.
    1. Paredes-Vieyra J, Enriquez FJ. Success rate of single- versus two-visit root canal treatment of teeth with apical periodontitis: a randomized controlled trial. Journal of Endodontic. 2012;38(9):1164–9. doi: 10.1016/j.joen.2012.05.021.
    1. Weiger R, Rosendahl R, Lost C. Influence of calcium hydroxide intracanal dressings on the prognosis of teeth with endodontically induced periapical lesions. International endodontic journal. 2000;33(3):219–26.
    1. Molander A, Warfvinge J, Reit C, Kvist T. Clinical and radiographic evaluation of one- and two-visit endodontic treatment of asymptomatic necrotic teeth with apical periodontitis: a randomized clinical trial. Journal of Endodontic. 2007;33(10):1145–8. doi: 10.1016/j.joen.2007.07.005.
    1. Marton IJ, Kiss C. Protective and destructive immune reactions in apical periodontitis. Oral Microbiol Immunol. 2000;15(3):139–50.
    1. Moorer WR, Genet JM. Evidence for antibacterial activity of endodontic gutta-percha cones. Oral Surg Oral Med Oral Pathol. 1982;53(5):503–7.
    1. Gopikrishna V, Kandaswamy D, Jeyavel RK. Comparative evaluation of the antimicrobial efficacy of five endodontic root canal sealers against Enterococcus faecalis and Candida albicans. Journal of Conservative Dentistry. 2006;9(1):2–12.
    1. Aal-Saraj AB, Ariffin Z, Masudi SM. An agar diffusion study comparing the antimicrobial activity of Nanoseal with some other endodontic sealers. Australian endodontic journal. 2012;38(2):60–3. doi: 10.1111/j.1747-4477.2010.00241.x.
    1. Haapasalo M, Udnaes T, Endal U. Persistent, recurrent, and acquired infection of the root canal system post‐treatment. Endodontic Topics. 2003;6(1):29–56.
    1. de Chevigny C, Dao TT, Basrani BR, Marquis V, Farzaneh M, Abitbol S, et al. Treatment outcome in endodontics: the Toronto study--phase 4: initial treatment. Journal of Endodontic. 2008;34(3):258–63. doi: 10.1016/j.joen.2007.10.017.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel