AND ADDRESS / DR.MALASIDDAPPA METRI S/O S.M.METRI A/P: UDACHAN TQ: AFZALPUR DIST: GULBARGA-585217
PH No. 0-9591796941
2) / NAME OF THE INSTITUTION / M.S. RAMAIAH DENTAL COLLEGE
AND HOSPITAL, BANGALORE.
3) / COURSE OF STUDY AND
SUBJECT / MASTER OF DENTAL SURGERY,
CONSERVATIVE DENTISTRY AND ENDODONTICS.
4) / DATE OF ADMISSION TO THE COURSE / 19-05-2010
5) / TITLE OF THE TOPIC / COMPARATIVE EVALUATION OF TWO FINAL IRRIGATION TECHNIQUES FOR THE REMOVAL OF PRECIPITATE FORMED BY THE INTERACTION BETWEEN SODIUM HYPOCHLORITE AND CHLORHEXIDINE
Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka
Annuxere II
Proforma for registration of subjects for dissertation
6) / BRIEF RESUME OF THE INTENDED WORK6.1 / NEED FOR THE STUDY
One of the most important objective of endodontic therapy is the complete elimination of microorganisms from root canal system.
Antimicrobial effect of NaOCl and chlorhexidine used in combination was shown to be better than that of either component.
However, the presence of NaOCl in canals during irrigation with chlorhexidine produces an orange brown precipitate known as parachloroaniline. Studies have showed which is carcinogenic in nature.
There are various methods to remove precipitate, amongst some of them are using Absolute alcohol, Ultrasonics, and EDTA, etc.
Some of the studies have showed citric acid has been tried to remove the precipitate.
Recently introduced F-files (Plastic Endo, USA) also have been tried. F-file has a unique design with a diamond abrasive embedded into a nontoxic polymer. This file was designed to remove debris without further enlarging the canal.
Very few literatures have explained about the removal of precipitate, hence the aim of the study to evaluate the two final irrigation techniques to remove the precipitate.
6.2 / REVIEW OF LITERATURE
In a study¹, forty single-rooted, extracted human teeth were selected for this study. The specimens were randomly divided into four groups of each. (1) the test group, 5ml of 17% EDTA followed by 5ml of 2.5% NaOCl and a final flush with 5ml of 2% chlorhexidine; (2) in the absolute alcohol group, a similar irrigation sequence was followed but received intermediate flushes of 5ml of absolute alcohol; (3) the saline group received 5ml of saline; and (4) the distilled water group received 5ml of distilled water. By this study showed interaction between sodium hypochlorite and chlorhexidine resulted in an insoluble neutral salt as a precipitate that can be prevented using absolute alcohol and minimized using saline and distilled water as intermediate flushes.
In a study², forty-four single-rooted, extracted human teeth were used for this study. Teeth were randomly divided into 2 experimental groups (A and B) of 15 teeth. Group-A, maximum amount of precipitate formation, Group-B, minimum amount of precipitate. Because the reaction between sodium hypochlorite and chlorhexidine produces a carcinogenic product, potential leaching of parachloroaniline into the surrounding tissues is a concern. An additional interface between the sealer and the dentin can also affect the seal of the root canal.
In a study³, thirty-four recently extracted upper anterior teeth were selected. 30 specimens were randomly divided into three groups. (1) Positive control group, no irrigation regimen was performed; (2) citric acid and chlorhexidine group,; and (3) sodium hypochlorite and chlorhexidine group. Combination of 1% sodium hypochlorite and 2% chlorhexidine solutions results in the formation of a flocculate precipitate that acts as a chemical smear layer reducing the dentin permeability in the apical third.
In a study4, two-fold serial dilutions of the NaOCl were prepared. 0.5ml of 2% CHX was added to NaOCl. This study showed that even a lowest concentration of NaOCl also forms a precipitate when it will comes in contact with chlorhexidine solution. As with the color change, the precipitate occurred immediately and showed no change with time.
In another study5, sodium EDTA, chlorhexidine digluconate was used. The precipitate was formed by combining equal volumes of CHX and EDTA with vigorous stirring using a magnetic stir bar. This study was evaluated the reaction between chlorhexidine and EDTA, unlike the reaction between chlorhexidine and sodium hypochlorite, does not produce significant quantities of parachloroaniline.
6.3 / OBJECTIVE
To assess the effectiveness of two final irrigation techniques on the removal of precipitate formed by the interaction between sodium hypochlorite and chlorhexidine.
7) / MATERIALS AND METHODS
7.1 / MATERIALS USED
Ø Sixty single rooted extracted human teeth
Ø Saline
Ø Diamond discs
Ø Gates Glidden drills
Ø #15 to #60 K-file
Ø 2.5% sodium hypochlorite
Ø 17% EDTA
Ø 2% chlorhexidine
Ø Absolute alcohol
Ø F-files (Plastic Endo, LLC, Buffalo Grove, IL,USA)
Ø Ultrasonics
Ø Stereomicroscope
7.2 / METHODOLOGY
Forty five single rooted extracted human teeth will be taken for the study.
↓
External surfaces of the teeth will be cleaned of tissue remnants and stored in 0.9% saline.
Teeth will be decoronated 1mm below the cementoenamel junction.
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Coronal flaring of root canals will performed by using Gates Glidden drills #2 and #3. ↓
Working length will be determined with a #15 K file introduced into the canal until the tip of the file will visible at the apical foramen.
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The root ends of the prepared teeth will be inserted into the softened impression compound and allowed to set. This prevents extrusion of the irrigants out of the apex.
↓
Canals will be instrumented with K files to #60 at the apex in a crown-down technique.
↓
During instrumentation, the canals will be irrigated between each instrument change with 1ml of 2.5% sodium hypochlorite, 3mm from the working length, using a 26-gauge needle.
↓
5ml of 17% EDTA will be used to remove smear layer. After instrumentation
specimens will be randomly divided into three groups, containing 15 teeth on each.
Group-1. Control group, irrigated with 5ml of 2.5% NaOCl and a final flush with 2% Chlorhexidine.
Group-2. Irrigated with 5ml of 2.5% NaOCl and 5ml of 2% Chlorhexidine followed by 5ml of saline along with F-files.
Group-3. Irrigated with 5ml of 2.5% NaOCl and 5ml of 2% Chlorhexidine followed by 5ml of 15% citric acid along with passive ultrasonics.
A thin longitudinal slot was made along the buccal and lingual aspect of the root using diamond discs. Both halves of the split tooth will be examined by stereomicroscope.
Root samples of each group will be examined at the coronal, middle, and apical third levels.
STATISTICAL ANALYSIS:
The result will be analyzed by using analysis of variance and the Bonferroni method.
7.3 / Does the study requires any investigations or intervention to be conducted on
patients or other humans or animals?
No.
7.4 / Has the ethical clearance been obtained from your institution in case of
the above?
Not applicable.
8)
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5) / REFERENCES
Shashikala Krishnamurthy, and Sunu Sudhakaran. Evaluation and Prevention of the Precipitate Formed on Interaction between Sodium Hypochlorite and Chlorhexidine. J Endod 2010;36:1154-1157.
Tung B. Bui, craig Baumgartner, and John C. Mitchell. Evaluation of the Interaction between Sodium Hypochlorite and Chlorhexidine Gluconate and its effect on Root Dentin. J Endod 2008;34:181-185.
Eduardo Akisue, Viviane S. Tomita, Giulio Gavini. Effect of the Combination of Sodium Hypochlorite and Chlorhexidine on Dentinal Permeability and Scanning Electron Microscopy Precipitate Observation. J Endod 2010;36:847-850.
Bettina R. Basrani, Sheela Manek, Rana N.S. Sodhi, Edward Fillery. Interaction between Sodium Hypochlorite and Chlorhexidine. J Endod 2007;33:966-969.
Brian J. Rasimick, Michelle Nekich, Megan M. Hladek, Barry L. Musikant. Interaction between Chlorhexidine Digluconate and EDTA. J Endod 2008;34:1521-1523.
9. / SIGNATURE OF THE CANDIDATE:
10. / REMARKS OF THE GUIDE:
11. / NAME AND DESIGNATION OF:
11. (1) GUIDE:
11. (2) SIGNATURE: / DR. SWAROOP HEGDE
PROFESSOR,
DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS.
11. (3) CO-GUIDE:
11. (4) SIGNATURE:
11. (5) HEAD OF THE DEPARTMENT:
11. (6) SIGNATURE: / DR. B.V. SREENIVASA MURTHY
PROFESSOR AND HOD,
DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS.
12. / 12. (1) REMARKS OF THE CHAIRMAN AND PRINCIPAL
12. (2) SIGNATURE:
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