Orange-Brown Precipitate: A Threat to the Success of Endodontic Treatment – An In Vitro Study
DOI:
https://doi.org/10.3889/oamjms.2020.4284Keywords:
Chlorhexidine, Maleic acid, Orange brown precipitate, Parachloraniline, Sodium thiosulphateAbstract
AIM: The aim of the present study was to evaluate the effect of various intermediate irrigating solutions in the removal of orange-brown precipitate formed due to alternative use of sodium hypochlorite (NaOCl) and chlorhexidine (CHX) root canal irrigants.
METHODS: The root canals of 50 mandibular premolars were prepared using ProTaper Universal Rotary instruments (Dentsply Maillefer, Ballaigues, Switzerland) up to size F3. The roots were randomly divided into five experimental groups specified by the intermediate irrigant used; Group 1: No intermediate irrigant used (control), Group 2: Saline, Group 3: 7% maleic acid (MA), Group 4: 4% sodium thiosulfate, and Group 5: 70% isopropyl alcohol (n = 10). After final irrigation with CHX, the specimens were evaluated for the presence/absence of orange-brown precipitate under stereomicroscope.
RESULTS: Mean precipitate for all experimental groups was calculated using ANOVA F test which showed orange-brown precipitate (parachloroanaline) in all groups except Group 4 and Group 5 which were highly significant (p < 0.001) at all the levels of root canal. Intergroup pairwise comparison was done using Tukey’s post hoc test.
CONCLUSION: About 7% MA is effective in minimizing the formation of orange-brown precipitate when used as intermediate irrigant between NaOCl and CHX. However, the precipitate was not observed with 4% sodium thiosulfate and 70% isopropyl alcohol.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Byström A, Sundqvist G. Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scand J Dent Res. 1981;89(4):321-8. https://doi. org/10.1111/j.1600-0722.1981.tb01689.x PMid:6947391
Estrela C, Estrela CR, Barbin EL, Spanó JC, Marchesan MA, Pécora JD. Mechanism of action of sodium hypochlorite. Braz Dent J. 2002;13(2):113-7. https://doi.org/10.1590/ s0103-64402002000200007 PMid:12238801
Leonardo MR, Tanomaru Filho M, Silva LA, Nelson Filho P, Bonifácio KC, Ito IY. In vivo antimicrobial activity of 2% chlorhexidine used as a root canal irrigating solution. J Endod. 1999;25(3):167-71. https://doi.org/10.1016/ s0099-2399(99)80135-6 PMid:10321180
Okino LA, Siqueira EL, Santos M, Bombana AC, Figueiredo JA. Dissolution of pulp tissue by aqueous solution of chlorhexidine digluconate and chlorhexidine digluconate gel. Int Endod J. 2004;37(1):38-41. https://doi. org/10.1111/j.1365-2591.2004.00749.x PMid:14718055
Zehnder M. Root canal irrigants. J Endod. 2006;32(5):389-98. PMid:16631834
Basrani BR, Manek S, Sodhi RN, Fillery E, Manzur A. Interaction between sodium hypochlorite and chlorhexidine gluconate. J Endod. 2007;33(8):966-9. https://doi.org/10.1016/j. joen.2007.04.001 PMid:17878084
Bui TB, Baumgartner JC, Mitchell JC. Evaluation of the interaction between sodium hypochlorite and chlorhexidine gluconate and its effect on root dentin. J Endod. 2008;34(2):181-5. https://doi. org/10.1016/j.joen.2007.11.006 PMid:18215677
Krishnamurthy S, Sudhakaran S. Evaluation and prevention of the precipitate formed on interaction between sodium hypochlorite and chlorhexidine. J Endod. 2010;36(7):1154-7. https://doi.org/10.1016/j.joen.2010.01.012 PMid:20630289
Arslan H, Uygun AD, Keskin A, Karatas E, Seçkin F, Yıldırım A. Evaluation of orange-brown precipitate formed in root canals after irrigation with chlorhexidine and QMix and spectroscopic analysis of precipitates produced by a mixture of chlorhexidine/ NaOCl and QMix/NaOCl. Int Endod J. 2015;48(12):1199-203. https://doi.org/10.1111/iej.12427 PMid:25557836
Baskin SI, Horowitz AM, Nealley EW. The antidotal action of sodium nitrite and sodium thiosulfate against cyanide poisoning. J Clin Pharmacol. 1992;32(4):368-75. https://doi. org/10.1002/j.1552-4604.1992.tb03849.x PMid:1569239
Auriemma M, Carbone A, Di Liberato L, Cupaiolo A, Caponio C, De Simone C, et al. Treatment of cutaneous calciphylaxis with sodium thiosulfate: Two case reports and a review of the literature. Am J Clin Dermatol. 2011;12(5):339-46. https://doi. org/10.2165/11587060-000000000-00000 PMid:21834598
Radcliffe CE, Potouridou L, Qureshi R, Habahbeh N, Qualtrough A, Worthington H, et al. Antimicrobial activity of varying concentrations of sodium hypochlorite on the endodontic microorganisms Actinomyces israelii, A. naeslundii, Candida albicans and Enterococcus faecalis. Int Endod J. 2004;37(7):438- 46. https://doi.org/10.1111/j.1365-2591.2004.00752.x PMid:15189432
Khadse P, Kamra A, Banga KS. Effectiveness of various intermediate irrigants for the prevention of precipitate formed by the interaction of sodium hypochlorite and chlorhexidine an in vitro study. Endodontology. 2014;26(2):309-13.
Arslan H, Gok T, Saygili G, Altintop H, Akçay M, Çapar ID. Evaluation of effectiveness of various irrigating solutions on removal of calcium hydroxide mixed with 2% chlorhexidine gel and detection of orange-brown precipitate after removal. J Endod. 2014;40(11):1820-3. https://doi.org/10.1016/j. joen.2014.06.003 PMid:25201644
Kuruvilla JR, Kamath MP. Antimicrobial activity of 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate separately and combined, as endodontic irrigants. J Endod. 1998;24(7):472-6. https://doi.org/10.1016/s0099-2399(98)80049-6 PMid:9693573
Gupta H, Kandaswamy D, Manchanda SK, Shourie S. Evaluation of the sealing ability of two sealers after using chlorhexidine as a final irrigant: An in vitro study J Conserv Dent. 2013;16(1):75-78. https://doi.org/10.4103/0972-0707.105304
Kim HS, Zhu Q, Baek SH, Jung IY, Son WJ, Chang SW, et al. Chemical interaction of alexidine and sodium hypochlorite. J Endod. 2012;38(1):112-6. PMid:22152633
Mortenson D, Sadilek M, Flake NM, Paranjpe A, Heling I, Johnson JD, et al. The effect of using an alternative irrigant between sodium hypochlorite and chlorhexidine to prevent the formation of para-chloroaniline within the root canal system. Int Endod J. 2012;45(9):878-82. https://doi. org/10.1111/j.1365-2591.2012.02048.x PMid:22486894
James MN, Williams GJ. A refinement of the crystal structure of maleic acid. Acta Crystallogr. 1974;B30:1249-75.
Mohammadi Z, Shalavi S, Jafarzadeh H. Ethylenediaminetetraacetic acid in endodontics. Eur J Dent. 2013;7(Suppl 1):S135-42. https:// doi.org/10.4103/1305-7456.119091 PMid:24966721
Prabhu SG, Rahim N, Bhat KS, Mathew J. Comparison of removal of endodontic smear layer using sodium hypochlorite, EDTA and different concentrations of maleic acid: A SEM study. Endodontology. 2003;15:20-5.
Ballal NV, Kundabala M, Bhat S, Rao N, Rao BS. A comparative in vitro evaluation of cytotoxic effects of EDTA and maleic acid: Root canal irrigants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(4):633-8. https://doi.org/10.1016/j. tripleo.2009.05.039 PMid:19716720
Ballal NV, Moorkoth SM, Kundabala M, Bhat S, Hussen SS, Pathak S. Evaluation of chemical interactions of maleic acid with sodium hypochlorite and chlorhexidine gluconate. J Endod. 2011;37(10):1402-5. https://doi.org/10.1016/j.joen.2011.06.027
Rossi-Fedele G, DoÄŸramaci EJ, Guastalli AR, Steier L, de Figueiredo JA. Antagonistic interactions between sodium hypochlorite, chlorhexidine, EDTA, and citric acid. J Endod. 2012;38(4):426-31. https://doi.org/10.1016/j.joen.2012.01.006 PMid:22414823
Jain K, Agarwal P, Jain S, Seal M, Adlakha T. Alexidine versus chlorhexidine for endodontic irrigation with sodium hypochlorite. Eur J Dent. 2018;12(3):398-402. https://doi.org/10.4103/ejd. ejd_180_17 PMid:30147406
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2020 Shashidhar Chandrashekhar, Dinesh Rao, Jyothi Shashidhar, Smitha Naik (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0