An Ex-vivo Comparative Study to Evaluate the Efficacy of Three Root Canal Irrigation Systems in Reduction of Enterococcus Faecalis

ABSTRACT

Aim:

The purpose of this ex-vivo study is to evaluate the efficacy of three irrigation techniques in the reduction of E. faecalis in root canal.

Materials and Methods:

Eighty healthy maxillary anteriors were employed in this investigation. The bacteria E. faecalis was left on teeth for 7 days while they were kept. Once teeth were contaminated, they were randomly divided into three groups of 20 for experimentation and a control group of 20 for comparison. NaviTip FX was used to irrigate Group I, the Max-I-probe was used to water Group II, and the Endovac system was used to water Group III. The number of colony forming units (CFUs) was determined by growing bacteria from root canal samples for 2 days in Brain heart infusion agar after chemo-mechanical operations.

Results:

There was a substantial decrease in bacterial numbers across all experimental groups compared to group IV (control). Group III (Endovac) had the fewest bacterial colonies among the test groups. There were no discernible changes between Group I (the Navitip FX) and Group II (the Max I probe).

Conclusion:

Endovac was the most effective of the three irrigation methods for reducing CFUs. This study’s findings lend credence to the idea that the apical negative pressure approach has more potential than the conventional irrigation delivery system for achieving an enhanced antibacterial impact.

INTRODUCTION

Root canal therapy is performed on both healthy and diseased teeth with the intention of stopping or curing an infection in the tooth’s pulp chamber and root canals. The “endodontic triad” refers to the three components of care that all play a role in ensuring a patient’s long-term satisfaction with their endodontic treatment. This consists of the three stages of instrumentation, sterilization, and obturation. The triad’s three parts are inextricably linked to one another.[1] To complement the procedure and achieve optimal obturation, disinfection is essential after instrumentation has been used to clean the canal system.

Pulpal and periradicular illnesses have been linked to the presence of bacteria and the byproducts they produce.[2] Although obligate anaerobic bacteria predominate in the root canal flora, root canal treatment success may be affected by the presence of facultative bacteria such as Enterococcus faecalis.[3] Only E. faecalis is able to thrive in the extreme ecological circumstances of a plugged root canal. Dentinal tubules may be penetrated by it, sometimes to a great depth, allowing the tubules to evade the effects of tools and chemicals.[4] Hence Root canals contaminated with E. faecalis are notoriously difficult to clean, even with the help of chemo-mechanical preparation, disinfecting irrigants, and antibacterial dressing.[5]

Since Walker’s 1936 introduction of sodium hypochlorite (NaOCl) to endodontics, it has seen widespread use as an irrigant. To counteract the drawbacks of using a single irrigant, modern endodontists typically employ double water systems, first and final rinsing with an antiseptic such chlorhexidine (CHX) or sodium hypochlorite (NaOCl) with ethylenediaminetetraacetic acid (EDTA).[6,7]

Three different water system frameworks (the Max I probe, the Navitip FX, and the Endovac system) were used for this in vitro study to compare their efficacy in reducing the population of E. faecalis.

MATERIALS AND METHODS

Eighty human permanent maxillary anteriors were used in this investigation, ultrasonic scaler tips were used to debride their exteriors. No. 2 round burs are the industry standard for creating access holes. To achieve uniformity in apical constriction size, root canals were instrumented under saline irrigation up to a K-type file #25 using a reaming operation at the apical foramen. The usual working length is now 20 mm, achieved by gradual shortening. The foramen apicalis was closed using a GIC of type II. The teeth were then attached to self-curing resin blocks and positioned vertically up to the head and neck. The tooth blocks were autoclaved for 20 minutes at 1210° C to kill any bacteria.

“E. faecalis (ATCC 29212) was incubated in trypticase soy broth (TSB) for 24 hours, and then 5 mL of fresh TSB was added to 1 mL of the pure culture to create a suspension. A suspension of E. faecalis, measuring 0.01 milliliters was injected into each root canal using a sterile 1-milliliter syringe. Clean K-type records #15 were used to transport the bacterial suspension all the way down the root canal. The blocks were then placed on a rectangular surgical tray and placed in an incubator at 37° C and 100% humidity for 7 days.”

Group 1 instruments were employed, and then 2 mL of NaOCl was irrigated via a 30-gauge NaviTipFX into the canal. Group II instruments were followed by the injection of 2 mL of NaOCl using a 30-gauge Max I probe. Needles were inserted up to 2 mm from the WL in both groups. To prevent the solution from escaping and to allow for the backflow of the irrigating solution, the needle was moved up and down during irrigation. Irrigation with 3% NaOCl was performed for 30 seconds using the F4 instrument. The following final irrigation technique was carried out after the solution had been in the canal for 60 seconds: Three ten-second rinsing cycles of 3% NaOCl, 17% EDTA, and 3% NaOCl were performed on the canal.

The mash chamber and watercourse of Gathering 3 were constantly irrigated. The canal was irrigated with NaOCl using the master delivery tip in between instrument changes. Microirrigation was performed in three separate cycles. The first cycle utilized an irrigant concentration of 3% NaOCl, the second cycle used an irrigant concentration of 17% EDTA, and the third cycle again used an irrigant concentration of 3% NaOCl. To get rid of any leftover irrigant, the microcannula was left at WL after the third cycle was finished.

In this group, like in Group 1, instruments were utilized for positive control. Saline was utilized as the irrigant, and a 27-gauge needle and a 20-milliliter syringe were used. To examine the overall variation across groups, a one-way analysis of variance (ANOVA) may be used. A specialized statistical test was used to make comparisons within each group. Therefore, we use the post-hoc Tukey test to determine which categories are distinguishable from one another.

RESULTS

Tables 1 and 2 demonstrate that there was a statistically significant difference in the amount of E. faecalis reduced between the experimental and control groups.

Table 1.

Comparison of E. Feacalis count among four groups

Group	n	Mean	SD	P
Endovac	20	25.10	13.098	<0.001*
Maxi I Probe	20	191.00	50.14
NaviTip FX	20	220.90	52.916
Control	20	412.85	41.055

One-way ANOVA test; *Indicates significant difference at P≤0.05

Table 2.

Pairwise comparison of E. Feacalis count among four groups

Group	Mean difference in CFU	P
Endovac vs Maxi I Probe	−165.90	<0.001*
Endovac vs NaviTip FX	−195.80	<0.001*
Endovac vs Control	−387.75	<0.001*
Maxi I Probe vs NaviTip FX	−29.90	0.124
Maxi I Probe vs Control	−221.85	<0.001*
NaviTip FX vs Control	−191.95	<0.001*

Tukey’s post-hoc test, where a P=0.05 difference is considered significant

When comparing the four groups, the control group had the highest colony forming unit score (CFU) and the Endovac group had the lowest.

In a series of pairwise comparisons, the CFU in the Endovac group was considerably lower than those in the other three groups, while the CFU in the control group was significantly higher. There was no discernible difference between Maxi I Probe and NaviTip FX.

DISCUSSION

The success of an endodontic operation is significantly diminished if bacteria are present in the root canals at the time of filling. Chemo-mechanical debridement and obturation dramatically decrease bacterial burden in the root canal system and improve periapical healing in roughly 80% of patients,[8,9,10] despite the fact that the apical bacterial biofilm persists in 88% of instances.

Only contact time was able to be standardized within the framework of this investigation. Volume cannot be normalized when comparing delivery methods with distinct modes of action and, therefore, different amounts displaced in a given time frame. This result agrees with the results of Heilborn et al.,[11] who discovered that volume differences occur independently of administration route. Manual instrumentation groups were randomly assigned to receive 2 mL of irrigation solution containing sodium hypochlorite between file changes.

After evaluating the risks associated with various irrigation methods, Desai and Himel[12] determined that Endovac poses no danger to workers during normal working length. Therefore, in the present investigation, a microcannula was inserted at a usable length. When irrigating, most medical professionals would not get an ordinary needle any closer than two millimeters to the working length.[13] This distance is the ideal circumstance when comparing needle irrigation to the Endovac method.

In comparison to the control group, all of the tested irrigation methods significantly decreased the number of E. faecalis bacteria. These findings corroborate those of Brito et al.,[14] who found that using NaOCl and EDTA as an irrigant in three experimental groups (Endovac, Endoactivator, and Navitip needle) was significantly more effective than using saline. When compared to the other groups, Endovac had the fewest bacterial colonies in this study. This agrees with the results of a study by Hockett et al.[15] in which they compared the success rates of the Endovac system with needle irrigation in preventing microbial development in root canals and found that the Endovac system had the ability to achieve superior microbial control.

During the tissue dissolving process, this free chlorine is depleted and must be frequently replenished with sodium hypochlorite. According to research by Nielsen and Craig,[13] the Endovac system is able to irrigate at a substantially greater rate and volume than traditional syringe needle irrigation. Sodium hypochlorite, as shown by Sedgley et al.,[16] is substantially more successful in removing bacteria from root canals when used at a concentration of 6 ml compared to 3 mL.

Group I (NavitipFx) demonstrated a decrease in bacterial load due to mechanical activation of the brush coated needle in an aggressive scrubbing action during irrigation. Research by Al-Hadlaq et al.[17] and Zmener et al.[18] shows that brush-covered irrigation needles are more successful in clearing the root canal of detritus.

In contrast to the control group, the bacterial burden decreased in Group II (Max -i-probe). The irrigant is more likely to be delivered laterally due to the closed-ended, side-vented nature of the channel’s architecture. The root canals are cleaned more thoroughly because of the unusual design, which creates upward turbulence. When compared to the use of a needle, this method may have resulted in a much higher rate of bacterial removal. The conclusion reached by Vinothkumar et al.,[19] who used safety needles with a single side port, is supported by these findings.

In order to determine which method most effectively disinfects the root canals of teeth with apical periodontitis, clinical trials are required to analyze the effects of several regimens on a heterogeneous bacterial population. The primary constraint of this study is the lack of in vivo research into the effectiveness of these irrigation systems for enhanced cleaning of the canal wall prior to chemo-mechanical preparation.

CONCLUSION

It is concluded from this study that E. faecalis decrease has been shown with all three of the more recent irrigation delivery systems (Navitip FX, Maxi-I-probe, and Endovac). This study’s findings lend credence to the idea that the apical negative pressure approach has more potential than the conventional irrigation delivery system for achieving an enhanced antibacterial impact.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.