COMPARISON OF TWO INTRACANAL MEDICAMENTS IN RESOLUTION OF APICAL RADIOLUCENCY

Amna Riaz, Anser Maxood, Saeeda Abdullah, Kiran Saba, Shahab Ud Din, Shahreen Zahid

Abstract


ABSTRACT:

Introduction: Calcium hydroxide has been used as an intracanal medicament as gold standard against root canal pathogens but its combination with chlorhexidine is not being employed in routine despite its documented efficacy and results.

Objective: The objective of this randomized controlled clinical trial was to compare radiographic evidence of periapical healing after root canal treatment with an interim calcium hydroxide and calcium hydroxide with 2% chlorhexidine dressing.

Materials & Methods: A total of 60 patients of either gender were included in the study.The age range was 15-60 years with the radiographic evidence of radiolucency of 2-4 mm in size. Both maxillary and mandibular teeth till 1st molars were selected. Teeth with previous endodontic treatment, mentally handicapped and terminally ill patients were excluded. Selected patients were placed randomly into Group I (calcium hydroxide alone) and in Group II (calcium hydroxide in combination with 2% chlorhexidine gel). Obturation and permanent filling was done at 14th day. The patient was recalled after 90 days of obturation and a radiograph was taken. Final outcome was measured at the end of 90thday of obturation.

Results: The mean healing time in terms of percentage change in size of apical radiolucency at 3 months was   91.03% for group I and 97.26% for group II with p value 0.13 (not significant).The results suggested comparable outcome after medication with 2%chlorhexidine with calcium hydroxide but 2% chlorhexidine still showed better results than the group without CHX in terms of percentage healing time.

Conclusion: This study concluded that calcium hydroxide in combination with 2% chlorhexidene as intracanal medicament results in better resolution of periapical radiolucency in terms of percentage change.

Background: As a gold standard, calcium hydroxide has always been used as a root canal medicament against root canal pathogens but its combination with chlorhexidine is not being employed in routine despite its documented efficacy and results. The objective of the study is to compare calcium hydroxide and combination of calcium hydroxide with 2% CHX on the basis of radiographic evidence of resolution of periapical radiolucency when they are used as an interappointment dressing /intracanal medicament for 14 days. Method: A total of 60 patients of either gender was included in the study. The age range was 15–60 years with the radiographic evidence of radiolucency of 2–4 mm in size. Both maxillary and mandibular teeth till first molar were selected. Teeth with previous endodontic treatment mentally handicapped and terminally ill patients were excluded. Selected patients were placed randomly into Group 1 (calcium hydroxide alone) and in Group 2 (calcium hydroxide in combination with 2% chlorhexidine gel). Obturation and permanent filling was done at 14th day. The patient was recalled after 90 days of obturation and a radiograph was taken. Final outcome was measured at the end of 90thday of obturation. Results: The mean of percentage reduction in size of apical radiolucency at 3 months was   91.03% for group 1 and 97.26% for group 2 with p-value 0.13 (not significant). The results suggested equivalent results after medication with 2%chlorhexidine with calcium hydroxide but 2% chlorhexidine still showed better results than the group without CHX in terms of healing. Conclusion: This study concluded that calcium hydroxide in combination with 2% chlorhexidene as intracanal medicament results in better resolution of periapical radiolucency in terms of percentage resolution of periapical radiolucency.

Keywords: Root canal treatment; calcium hydroxide; chlorhexidine


Full Text:

PDF

References


Ahmed I, Howlader M. Non-surgical Management of Endodontic Periradicular Pathosis - A Clinical Research Bangabandhu Sheikh Mujib Med Univ J 2006;1(1):22–8.

Penesis VA, Fitzgerald PI, Fayyad 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. J Endod 2008;34(3):251–7.

Vaghela DJ, Kandaswamy D, Venkateshbabu N, Jamini N, Ganesh A. Disinfection of dentinal tubules with two different formulations of calcium hydroxide as compared to 2% chlorhexidine: as intracanal medicaments against Enterococcus faecalis and Candida albicans: an in vitro study. J Conserv Dent 2011;14(2):182–6.

Dall AQ, Jouhar R, Ahmed NA. Comparison of Inter-appointment Pain between Ledermix and no intracanal medicament in acute apical periodontitis. J Liaquat Univ Med Health Sci 2011;10:106–11.

Fulzele P, Baliga S, Thosar N, Pradhan D. Evaluation of calcium ion, hydroxyl ion release and pH levels in various calciumhydroxide based intracanal medicaments: an in vitro study. Contemp Clin Dent 2011;2(4):291–5.

Abbott PV. Endodontics - Current and future. J Conserv Dent 2012;15(3):202–5.

Mohammadi Z, Shalavi S. Is chlorhexidine ideal vehicle for calcium hydroxide: a microbiologic view. Iran Endod J 2012;7(3):115–22.

Tervit C, Paquette L, Basrani B, Friedman S. Proportion of healed teeth with apical periodontitis medicated with two percent chlorhexidine gluconate liquid: a case-series study. J Endod 2009;35(9):1182–5.

Ng Y, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Int J Endod 2011;44(7):583–9.

De Souza-Filho FJ, Soares Ade J, Vianna ME, Zaia AA, Ferraz CC, Gomes BP. Antimicrobial effect and pH of chlorhexidine gel and calcium hydroxide alone and associated with other materials. Braz Dental J 2008;19(1):28–33.

Signoretti FGC, Gomes BP, Montagner F, Barrichello Tosello F, Jacinto RC. Influence of 2% chlorhexidine gel on calcium hydroxide ionicdissociation and its ability of reducing endotoxin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111(5):653–8.

Ferraz CCR, Gomes BP, Zaia AA, Teixeira FB, Souza-Filho FJ. In vitro assessment of the antimicrobial action and mechanical ability or chlorhexidine gel as an endodontic irrigant. J Endod 2001;27(7):452–5.

Gomes BP, Vianna ME, Senna NT, Zaia AA, Ferraz CC, de Souza-Filho FJ. In vitro evaluation of the antimicrobial activity of calcium hydroxide combined with chlorhexidine gel used as intracanal medicament. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102(4):544–50.

Gomes BP, Souza SF, Ferraz CC, Teixeira FB, Zaia AA, Valdrighi L, et al. Effectiveness of 2% chlorhexidine gel and calcium hydroxide against Enterococcus faecalis in bovine root dentine in vitro. Int Endod J 2003;36(4):267–75.

Yeung SY, Huang CS, Chan CP, Lin CP, Lin HN, Lee PH, et al. Antioxidant and pro-oxidant properties of chlorhexidine and interaction with calcium hydroxide solutions. Int Endod J 2007;40(11):837–44.

Vianna ME, Horz HP, Conrads G, Zaia AA, Souza-Filho FJ, Gomez BPFA. Effect of root canal procedures on endotoxins andendodontic pathogens. Oral Microbiol Immunol 2007;22(6):411–8.

Sirén EK, Haapasalo MP, Waltimo TM, Orstavik D. In vitro antibacterial effect of calcium hydroxide combined with chlorhexidine or iodine potassium iodine on Enterococcus faecalis. Eur J Oral Sci 2004;112(4):326–31.

Ercan E, Dalli M, Dulgergil CT. In vitro assessment of the effectiveness of chlorhexidine gel and calcium hydroxide paste with chlorhexidine against Enterococcus faecalis and Candida albicans. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102(2):27–31.

Zerella JA, Fouad AF, Spangberg LS. Effectiveness of a calcium hydroxide and chlorhexidine digluconate mixture as disinfectant during retreatment of failed endodontic cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100(6):756–61.

Almyroudi A, Mackenzie D, McHugh S, Saunders WP. The effectiveness of various disinfectants used as endodontic intracanal medications: an in vitro study. J Endod 2002;28(3):163–7.

Southard SR, Drisko CL, Killoy WJ, Cobb CM, Tira DE. The effect of 2% chlorhexidine digluconate irrigation on clinical parameters and the level of Bacteroides gingivalis in periodontal pockets. J Periodontol 1989;60(6):302–9.

Wuerch RMW, Apicella MJ, Mines P, Yancich PJ, Pashley DH. Effect of 2% chlorhexidine gel as an intracanal medication on the apical seal of the root-canal system. J Endod 2004;30(11):788–91.

Kontakiotis EG, Tsatsoulis IN, Papanakou SI, Tzanetakis GN. Effect of 2% chlorhexidine gel mixed with calcium hydroxide as an intracanal medication on sealing ability of permanent root canal filling: a 6-month follow-up. J Endod 2008;34(7):866–70.

Estrela C, Bueno MR, Leles CR, Azevedo B, Azevedo J. Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis. J Endod 2008;34(3):273–9.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]