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Effectiveness of Different Disinfection Protocols on the Reduction of Bacteria in Enterococcus faecalis Biofilm in Teeth with Large Root Canals

Published:January 29, 2016DOI:https://doi.org/10.1016/j.joen.2015.12.016

      Highlights

      • We formed biofilms in teeth with large root canals and unlimited irrigant access.
      • The effect of mechanical instrumentation (MI) and noninvasive irrigating protocols on bacteria was compared.
      • MI was the most effective and reliable method to disinfect large root canals.
      • Passive ultrasonic irrigation (PUI) enhanced the efficacy of sodium hypochlorite irrigation.
      • Noninvasive disinfection protocols, including PUI, could not substitute for MI.

      Abstract

      Introduction

      This study compared the effectiveness of different disinfection protocols in reducing bacteria in an Enterococcus faecalis biofilm in teeth with large root canals.

      Methods

      Fifty-five roots were prepared from human mandibular premolars with large single root canals, and 50 roots were infected with E. faecalis for 21 days. Four roots were observed using scanning electron microscopy to verify biofilm formation. The remaining specimens were assigned into 5 experimental groups and a sterile control group: mechanical instrumentation using files size 60–90 and 2.5% sodium hypochlorite (NaOCl) (MI-N), irrigation with 2.5% NaOCl (IR-N), irrigation with 2.5% NaOCl using intermittent passive ultrasonic irrigation (PUI-N), irrigation with normal saline, and no intervention (initial). After root canal disinfection, dentin specimens were collected for microbial analysis. Mean colony forming units were determined and compared between groups using 1-way analysis of variance.

      Results

      The lowest number of intracanal bacteria (24.5 colony-forming units/mL) was recovered from the MI-N group followed by the PUI-N and IR-N groups. The irrigation with normal saline group did not show a significant reduction compared with the initial group. However, there were significant differences between groups (P < .01). The remaining bacteria in the PUI-N group was 4.5-fold lower compared with the IR-N group; however, it was 1862-fold higher compared with the MI-N group.

      Conclusions

      MI-N was the most effective method to disinfect large root canals. Although ultrasonic activation enhanced the efficacy of root canal irrigation, it could not substitute for mechanical instrumentation even in large root canals with unlimited irrigant access to the apical portion.

      Key Words

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