International Journal of Dental Sciences and Research, 2018, Vol. 6, No.

5, 134-137
Available online at http://pubs.sciepub.com/ijdsr/6/5/5
©Science and Education Publishing
DOI:10.12691/ijdsr-6-5-5

Efficacy of Root Canal Irrigants against Self-inducted

Streptococci – An Exvivo Study
Asaad Javaid Mirza*, Maaz Asad Javaid, Mohsin Nazi, Shaheen AbuBaker, Mohammad Khalid Shafiq

College of Dentistry, Baqai Medical University, Karachi

*Corresponding author: [email protected]
Received August 03, 2018; Revised September 10, 2018; Accepted September 18, 2018
Abstract Objective: To compare antibacterial efficacy of various root canal irrigants against self-inducted
streptococci in purposely sterilized root canals. Material and Method: Sixty (60) extracted mandibular & maxillary
molars were collected and stored in saline at ambient temperature. The teeth were deroofed & their wider canals
(distal canal in mandibular & palatal canal in maxillary molars) were selected for preparation. Working lengths of
specimens was recorded by inserting K file# 20into the canals. All teeth were washed thoroughly with normal
saline& autoclaved. Apical widening of canals was done using K-file # 30 with a step back technique. Streptococci
were inducted in the sterile canals and their colonies were counted. Result: There was apparent difference in the
antibacterial efficiency between 1% NaOCl, 0.12% chlorhexidine, 1% Povidone Iodine, NaCl, NaOCl with NaCl as
final rinse NaOCl with 0.12% chlorhexidine as final rinse. The best results were achieved with 1 % NaOCl with
Chlorhexidine as final irrigant. Conclusion: 1% NaOCl can be safely used by undergraduate dental students as main
root canal irrigant with 0.12 % chlorhexidine as a final rinse.
Keywords: irrigating solution for RCT, intracanal medication, NaOCl in endodontics, root canal irrigants
Cite This Article: Asaad Javaid Mirza, Maaz Asad Javaid, Mohsin Nazi, Shaheen AbuBaker,
and Mohammad Khalid Shafiq, “Efficacy of Root Canal Irrigants against Self-inducted Streptococci – An
Exvivo Study.” International Journal of Dental Sciences and Research, vol. 6, no. 5 (2018): 134-137.
doi: 10.12691/ijdsr-6-5-5.

periodontics to chemically control the biofilm [6]. Its use

in endodontics has been proposed both as an irrigant and
1. Introduction as an intracanal medication. It inhibits the gram-positive
and gram-negative microorganisms commonly found
Success of endodontic treatment is directly influenced in endodontic infections. Its efficacy is based on the
by the elimination of microorganisms from infected root interaction between the positive charge of the molecule
canals [1]. Majority of microbes from the canals are and the negatively charged phosphate groups on the
eliminated using hand & rotary files. Mechanical action of bacterial cell wall, which allows the CHX molecule to
instruments alone is unable toacceptably clean a root penetrate pathogenic bacteria [7].
canaldue to the intricacy of the internal tooth morphology Iodine (I2) is a strong oxidizing agent. It reacts with
marked by the presence ofapical deltas, lateral canals, free sulfhydryl groups of bacterial enzymes. Its use is
accessory canals, etc. and because direct contact between advocated as it has been shown to be an antiseptic against
the instruments and all the walls of the root canal system a broad range of micro-organisms, hypoallergenic, with
is not possible [2]. low toxicity and has a lesserpropensity for dentin staining
Irrigating solutions are therefore,essential during root [8].
canal preparation because they perform multiple functions Saline (NaCl) provides gross debridement & lubrication.
to help clean the root canal; lubricate the files, flush out A few investigators have supported isotonic saline solution as
debris, kill bacteria, and dissolve infected dentine without an irrigation solution to minimize tissue irritation &
damaging the periapical tissues. The selection of the ideal inflammation. In isotonic concentration, saline produces
irrigant depends on its antibacterial action and lack of no documented tissue damage & has been confirmed to
toxicity to periapical tissues. flush debris from the canal. It has no bactericidal action
Sodium hypochlorite (NaOCl) is an oxidizing and and therefore doesn’t effectively reduce bacterial load.
hydrolyzing agent [3]. It is bactericidal and has been used Irrigation with saline alone declines chemical destruction
as an endodontic irrigant since early twentieth century [4]. of microbiologic matter & dissolution of mechanically
As an endodontic irrigant, NaOCl solution is relatively inaccessible tissue [9].
cheap, tissue dissolving and virucidal [5]. Major primary root infections are multimicrobial,
For two decades, chlorhexidine gluconate (CHX) owing dominated by obligate anaerobic bacteria. The most
to its potent antibacterial activity has been widely used in frequently isolated microorganisms before root canal
135 International Journal of Dental Sciences and Research

treatment include Gram-negative anaerobic rods, Gram-positive solution was used for irrigation.Removal of excessive
anaerobic cocci, Gram-positive anaerobic and facultative moisture from the canals was carried out by absorbent
rods, Lactobacillus species and various Gram-positive paper points and a sterile point of 30# was retained in the
facultative Streptococci [10]. The obligate anaerobes can irrigated canal up to the determined working length for 15
be effortlessly eliminated during root canal preparation seconds. These points were transferred into sterile test
but facultative microbes like Streptococci, Enterococci, tubes, used to inoculate the bacteria in plates of 5% Blood
and Lactobacilli, once established, are more expected to Agar and incubated for 48 hours at 37°C. Colony counter
persist after chemomechanical canal preparation and root was used finally for results.
canal medication [11].
Many studies have been done in this regard with varying 2.2. Preparation of Group B, C, D, E Samples
results which cause confusion in users’ minds, especially
undergraduate dental students. To remove this ambiguity Irrigant used for group B was 0.12 % CHX, for group C
and to give a standard protocol to be followed by all the 1 % povidone Iodine, for group D NaCl, for group E
students in endodontic OPD, this exvivo study was performed NaOCl with final rinsing of CHX andfor group F NaOCl
to comparethe efficacy of various irrigants which are cheap with final rinsing of NaCl.
and commonly available for use in endodontic practices. Rest of the procedure was same as performed for
The irrigant with the best cleansing ability would be group A.
recommended for students’ to use while performing a
procedure in the endodontic clinics of the institution.
3. Results
2. Material and Method A one way analysis of variance was conducted to evaluate
the efficacy of root canal irrigants against self-inducted
1.0 % NaOCl, 0.12% Chlorhexidine, 1% Iodine, NaCl, streptococci (N=60). The independent variables included
and colonies of streptococci were used in this experimental six groups where Group A (M=2.88±0.21, n=10) was 1%
study. NaOCl, Group B (M=8.9±0.16, n=10) was 0.12%
Sixty freshly extracted human mandibular and maxillary Chlorhexidine, Group C (M=17.92±0.17, n=10) was
molars stored in saline at room temperature were taken. 1% Iodine, Group D (M=32.33±0.67, n=10) was
Teeth were deroofed by using straight fissure diamond bur NaCl, Group E (M=0.27±0.42, n=10) was 1% NaOCl +
# 21. Distal canal in the mandibular molars and the palatal 0.12 Chlorhexidine, and Group F (M=1.14±0.21, n=10)
canals in the maxillary molars were selected as they was 1% NaOCl + NaCl. Table 1 shows the mean number
are wider, straighter and easily accessible canals. Working of bacterial colonies present after irrigation had been
lengths of the specimens were recorded by using performed.
radiographs taken with # 20 K file inserted in the canals.
Apically, canals were enlarged up to size 30 K file with Table 1. Mean number of colonies found with each irrigant used
step-back technique. Rest of the radicular flaring was done Group Mean No. of Colonies
using size 50 K file.
Rating of the commonly found root canal bacteria was Group A (1%NaOCl) 2.88±0.21
carried out first, by incubating the paper points taken from Group B (0.12%CHx) 8.90 ±0.16
the unprepared infected canals as sample; in the Blood
Group C (1%Iodine) 17.92±0.17
Agar Culture Medium for 24 hours at 37°C. Microscopic
reading revealed the presence of Streptococci colonies in Group D (NaCl) 32.33±0.67
abundance.
Group E (1% NaOCl+0.12%CHx) 0.27±0.42
All teeth were washed using normal saline and autoclaved
at 121°C under 15 lbs pressure for 15mins. Group F (1%NaOCl+NaCl) 1.14±0.21
Inclusion Criteria: Distalcanals of extracted mandibular
molars and palatal canals of maxillary molars were
selected for experiment. The assumption of normality was evaluated using
Exclusion Criteria: Root treated teeth, wisdom molars, histograms and found tenable for all groups. The ANOVA
teeth with dilacerations or morphological anomalies, teeth was significant, F (5, 54) = 12346.22, p = 0.0005,
with open apices. ɳ2 = 0.13. Post Hoc comparisons to evaluate pairwise
Considering Streptococci as potential pathogen, colonies differences among group means were conducted using the
were cultured in Blood Agar and the suspension was inducted Tukey HSD test since equal variances were tenable. The
in each sterile specimen by employing the pipette of 10 µl. tests revealed significant pairwise differences between the
All sixty teeth were allowed for incubation for 48 hours mean scores of all the irrigants used, p = 0.0005.
at 37°C and divided equally into six groups of 10 each(5 Out of the 6 solutions used to irrigate the root canal,
mandibular,5 maxillary molars) designated as Group 1% NaOCl along with a final flushing of the canal with
‘A’,‘B’,‘C’,‘D’,‘E’ & ‘F’. 3 ml 0.12% CHx possessed greatest antibacterial
efficacy against microbes, followed by 1%NaOCl with
2.1. Preparation of Group A Samples a final flushing of 3 ml NaCl. Contrarily, NaCl,
when used alone, was the least effective irrigant. Figure 1
In this group 1.0 % NaOCl was used as a root canal shows a descriptive graphical representation of the
irrigant. Throughout the instrumentation, 5 ml of NaOCl results.
 International Journal of Dental Sciences and Research 136

Figure 1. Graphical representation of the results with 1%NaOCl + 0.12%CHx

4. Discussion bound to a surface, gives prolonged antimicrobial activity.

This might have been the logical reason that after NaOCl
The root canal preparation is performed with a goal to irrigation final wash with CHX rendered the canals
attain precise scrubbing and overall decontamination of bacteria free.
the canals systems but anatomical variation in canal system Although I2 is less cytotoxic and irritating to living
obstructs the canal instrumentation which consequently tissues than NaOCl and CHX [21] but its efficacy
leads to failure [12]. To avoid the procedural failure six according to findings of this study was not better than
type of irrigating solutions were used to reach and NaOCl and CHX mixture. Moreover, I2 has a much
disinfect the intracanal areas which were inaccessible to greater potential to cause an allergic reaction [22] as
mechanical debridement. Many other solutions are also compare to NaOCl and CHX [23].
marketed for this purpose. As during clinical sessions they It is therefore safe for undergraduate dental students to
are plenteously used by the learning students, only those use 1 % NaOCl for copious irrigation during the root canal
solutions were used which were easily, cheaply and procedure as of all the solutions used in this study;
uninterruptedly available in bulk quantity from the market. itseemsto be the best lonely used solution. It fulfils more
Irrigation of root canals with NaOCl in concentrations requirements of an ideal endodontic irrigant than any other
ranging from 1 % to 5.25 % is acommonly followed identified substance and used in combination with CHX as
practice. In this study the lowest percentage of NaOCl final flush serves the purpose better than using it alone
solution was used keeping in mind two reasons. Firstly, [24].
dilute solutions cause fewer complications in case any More studies with different combinations and leaving
accident occurs by an operator, especially when an irrigants inside the canal for variable time and with or
operator is a beginner as higher concentrations increase without warming NaOCl should be performed.
chances of occurring any emergency. Secondly, reports of
at least two studies show that there is no difference in
cleansing ability of 0.5 % NaOCl or 5.0 % NaOCl [13,14]. 5. Conclusion
Moreover 1 % NaOCl solutions is good enough to
dissolve canal debris [15]. Minimal number of bacterial The undergraduate dental students can safelyuse 1 %
colonies were found when 1 % NaOCl was used for canal NaOCl as main irrigating solution during a root canal
irrigation but still the canal was not free from the treatment and at end of the procedure 3 ml of CHX wash
microbial growth. This finding is in agreement with as final irrigation solution. Normal saline may also be
results of another study where canals were rendered totally used in place of CHX.
sterile with 1-5 % NaOCl [16]. The reason behind this
difference may be the time factor for which the solution is
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