At present, the most effective method for the treatment of pulpitis and periapical inflammation is root canal therapy, in which the most critical link is root canal flushing. The ideal root canal flushing solution can dissolve necrotic tissue, and has disinfection and bactericidal effect with low toxicity. Since 1920, because sodium hypochlorite was found to be more soluble to muscle necrotic tissue than normal tissue, Crane introduced it into the field of oral root canal therapy for the first time as a root canal flushing solution, and continued to receive attention and widespread clinical application. Sodium hypochlorite is currently widely used in clinical treatment of the flushing solution, BLUEWAV sodium hypochlorite generator can prepare the solution on site, timely for research, will not reduce the concentration due to too long transport.
Tissue lysis of sodium hypochlorite
Sodium hypochlorite, as an organic solvent, can effectively dissolve organic components in pulp tissue and taint layer after contact with organic matter in root canal, soften dentine debris, and further avoid blocking apical pore. Naenni N et al. conducted an experimental study on the tissue solubility of 1%NaCIO, 10% chlorhexidine, 3% hydrogen peroxide solution and other common clinical rinsing fluids, and the experiment showed that only 1%NaCIO could dissolve tissues. After sodium hypochlorite is dissolved in water, NaOH and HCIO can be formed, and NaOH can saponification with fatty acids in the cell membrane of organic tissue in the root canal, degrade into fatty acid salts and glycerol, and lysis the cell membrane and have the function of dissolving tissue. Related research reports pointed out that NaOH can react with amino acids in tissue cells, appear neutralized, promote the formation of H2O and salt, and have the effect of hydrolyzing amino acids. During root canal treatment, the interaction of sodium hydrochlorite and chloric acid in sodium hypochlorite solution can exert the tissue-lysis effect.
Factors influencing the washing effect of NaClO
Concentration: The concentration of sodium hypochlorite solution used in clinical practice is 3% to 5%, which can destroy spores, viruses and bacteria, and has the ability to dissolve active substances in the root canal system and necrotic substances in pulp tissue. Some scholars have done experiments to study the ability of different concentrations of sodium hypochlorite to inhibit Enterococcus faecalis, and the results show that the higher the concentration, the stronger the ability to inhibit Enterococcus faecalis. High concentration NaCl0 solution has high bactericidal and tissue solubility, but it is also cytotoxic. In the study of 0ncag et al., it was found that 5.25% NaCl0 solution was used for subcutaneous injection in mice, and the inflammatory response was observed by histology two weeks later. JULIEL et al. reported that 0.5% and 1% NaCl0 soaked the skin of Dutch pigs for 8h every day, and there was no toxic reaction after 14 days. Studies have confirmed that 0.5% and 1% are acceptable non-toxic levels. Mark D. Essner used 0.33%,0.16%, 0.08%, and 0.04% sodium hypochlorite to soak dental cells, and found that only 0.04% was non-destructive to the cells, and it was very necessary to select the appropriate concentration without damaging the periodontal tissues and periapical tissues.
Time: Experiments by Vianna ME and others have proved that different concentrations of sodium hypochlorite can inhibit enterococcus faecalis, but the time required to achieve a consistent bacteriostatic effect is different. Under the condition of constant concentration and temperature, the comparison of the removal effect of soiling layer between the 60S group and the 30S group showed that the 60S group could better remove the soiling layer, which proved that the removal effect of soiling layer in the root canal was related to the root canal washing time.
Temperature: Temperature is one of the factors that affect the bactericidal effect of sodium hypochlorite. When sodium hypochlorite is heated to 60 ° C, its effective chlorine concentration increases, which can improve its ability to remove the stain layer! . Some scholars have studied the bactericidal effect and tissue dissolution effect of sodium hypochlorite by changing the temperature, and proposed that it can still maintain a stable state after 1 hour of sodium hypochlorite heating. At the same time, studies have shown that there is little difference in tissue dissolution between 1% sodium hypochlorite at 45℃ and 5.25% sodium hypochlorite at 20℃. However, the bactericidal effect of sodium hypochlorite at 45℃ is nearly 100 times higher than that at 20℃. Therefore, in order to facilitate clinical use, the concentration can be appropriately reduced and the temperature can be increased.
PH: Sodium hypochlorite solution can be acidic or alkaline, the PH value is different, its antibacterial effect and dissolution ability is also different. Mercade et al. compared the inhibitory effect of sodium hypochlorite solution with different pH values and the same concentration on Enterococcus faecalis, and verified that sodium hypochlorite can play a better bactericidal and bacteriostatic effect in acidic solution.
Clinical application of sodium hypo
Combined with EDTA
Sodium hypochlorite as a root canal flushing agent is often used in combination with the integrated flushing agent EDTA. 15%EDTA gel is widely used clinically. Some studies have found that treating root canals with 15%EDTA gel for 1min can completely remove the dentin taint layer and cause dentin demineralization. In addition, Ji Xudong et al. confirmed through experiments that the combined application of 15%EDTA and 1% sodium hypochlorite can significantly enhance the solubility of dental pulp tissue, effectively remove organic matter and inorganic matter in the root canal system, and remove the taint layer, which is widely used in clinical practice.
Equipped with ultrasonic root canal washing device
Ultrasonic treatment of sodium hypochlorite in the root canal system can accelerate its chemical reaction, and the hole effect of ultrasonic can effectively remove bacteria, debris, and stain layer to achieve a good cleaning effect. In addition, the energy released by ultrasound can heat sodium hypochlorite and promote its bactericidal ability and tissue solubility. Studies have confirmed that both ultrasonic washing and sodium hypochlorite have good cleaning effects on root canals. The organic matter on the dentin surface will liquify after contact with sodium hypochlorite. Continuous agitation of the washing solution can increase the contact area between sodium hypochlorite and root canal wall, and can effectively improve the cleaning effect of sodium hypochlorite to a certain extent.
In summary, sodium hypochlorite solution can be combined with EDTA and ultrasonic swaddling device to better clean the root canal system. However, no matter what measures and equipment are used, there is no feasible root canal irrigation method that can completely remove the root canal taint layer in the apical one-third area. In addition, the toxicity of the drug itself has greatly limited its scope of use. In view of this situation, in the actual clinical use, it is necessary to comprehensively consider all aspects of the influencing factors and possible adverse reactions of the drug, and determine a more appropriate flushing concentration and dose, so as to obtain a more significant and good effect.
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