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Use of Peracetic Acid As Irrigation Solution in Endodontics: Overview

Year 2025, Volume: 11 Issue: 2, 205 - 214, 31.08.2025

Abstract

Success in endodontic treatment is associated with removing microorganisms from the root canal system and preventing reoccurrence of infection. Irrigation of root canals is very effective in the success of endodontic treatment. Sodium hypochlorite (NaOCl) is the most commonly used irrigant during endodontic treatment due to its antimicrobial properties and organic tissue dissolving capacity. However, when used alone, it is not sufficient to remove the inorganic tissue formed. It is recommended to use NaOCl together with chelating agents as an ideal irrigation protocol to enhance antisepsis and avoid the limitations of commonly used solutions. However, this protocol requires a long clinical time. Moreover, it is known that the combined use of NaOCI and some chelation agents can cause changes in the mineral and organic content of dentin, erosion and a decrease in the microhardness of dentin. Using an irrigation agent that acts as both a chelating and antimicrobial actions can be a good alternative and save time during treatment. Peracetic acid (PAA) is a candidate to be an alternative irrigation solution thanks to its antimicrobial activity and ability to remove the smear layer. This review aims to present the properties of this irrigation solution by examining the studies investigating the effectiveness and applicability of PAA in endodontic practice.

References

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  • Peters OA, Schönenberger K, Laib A. Effects of four Ni–Ti preparation techniques on root canal geometry assessed by micro computed tomography. Int Endod J. 2001;34(3):221–30.
  • Haapasalo M, Shen Y, Wang Z, Gao Y. Irrigation in endodontics. Br Dent J. 2014;216(6):299–303.
  • Zehnder M. Root Canal Irrigants. J Endod. 2006;32(5):389–98.
  • Grawehr M, Sener B, Waltimo T, Zehnder M. Interactions of ethylenediamine tetraacetic acid with sodium hypochlorite in aqueous solutions. Int Endod J. 2003;36(6):411–5.
  • Basrani B, Haapasalo M. Update on endodontic irrigating solutions. Endod Topics. 2012;27(1):74– 102.
  • Zehnder M, Kosicki D, Luder H, Sener B, Waltimo T. Tissue-dissolving capacity and antibacterial effect of buffered and unbuffered hypochlorite solutions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(6):756–62.
  • Lester KS, Boyde A. Scanning electron microscopy of instrumented, irrigated and filled root canals. Br Dent J. 1977;143(11):359–67.
  • Pasqualini D, Cuffini AM, Scotti N et al. Comparative evaluation of the antimicrobial efficacy of a 5% sodium hypochlorite subsonic-activated solution. J Endod. 2010;36(8):1358–60.
  • Lottanti S, Gautschi H, Sener B, Zehnder M. Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer. Int Endod J. 2009;42(4):335–43.
  • Tartari T, Guimarães BM, Amoras LS, Duarte MAH, Silva e Souza PAR, Bramante CM. Etidronate causes minimal changes in the ability of sodium hypochlorite to dissolve organic matter. Int Endod J. 2015;48(4):399–404.
  • Goldman M, Goldman LB, Cavaleri R, Bogis J, Lin PS. The efficacy of several endodontic irrigating solutions: a scanning electron microscopic study: part 2. J Endod. 1982;8(11):487–92.
  • Bystrom A, Sundqvist G. The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. Int Endod J. 1985;18:35.
  • Aslantas EE, Buzoglu HD, Altundasar E, Serper A. Effect of EDTA, sodium hypochlorite, and chlorhexidine gluconate with or without surface modifiers on dentin microhardness. J Endod. 2014;40(6):876–9.
  • Patil C, Uppin V. Effect of endodontic irrigating solutions on the microhardness and roughness of root canal dentin: An in vitro study. Indian J Dent Res. 2011;22(1):22-7.
  • Ballal NV, Kandian S, Mala K, Bhat KS, Acharya S. Comparison of the efficacy of maleic acid and ethylenediaminetetraacetic acid in smear layer removal from instrumented human root canal: A scanning electron microscopic study. J Endod. 2009;35(11):1573–6.
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  • Martell AE, Motekaitis RJ. Determination and use of stability constants. In: New York: John Wiley & Sons. VCH publishers; 1992.
  • Brandão-Neto DDO, Mello JVZ, Marceliano-Alves MFV et al. Final endodontic irrigation with 2% peracetic acid: antimicrobial activity and cytotoxicity. Eur J Dent. 2021;15(3):533–8.
  • Rutala WA, Weber DJ. Disinfection of endoscopes: review of new chemical sterilants used for highlevel disinfection. Infect Control Hosp Epidemiol. 1999;20(1):69–76.
  • Kovaleva J, Degener JE, van der Mei HC. Mimicking disinfection and drying of biofilms in contaminated endoscopes. J Hosp Infect. 2010;76(4):345–50.
  • Kitis M. Disinfection of wastewater with peracetic acid: a review. Environ Int. 2004;30(1):47–55.
  • Kayaoglu G, Ørstavik D. Virulence factors of Enterococcus faecalis: Relationship to endodontic disease. Crit Rev Oral Biol Med. 2004;15(5):308–20.
  • Guerreiro-Tanomaru JM, Morgental RD, Faria-Junior NB, Berbert FL, Tanomaru-Filho M. Antibacterial Effectiveness of Peracetic Acid and Conventional Endodontic Irrigants. Braz Dent J. 2011;22(4):285–7.
  • Dornelles-Morgental R, Guerreiro-Tanomaru JM, De Faria-Jnior NB, Hungaro-Duarte MA, Kuga MC, Tanomaru-Filho M. Antibacterial efficacy of endodontic irrigating solutions and their combinations in root canals contaminated with Enterococcus faecalis. Oral Surg, Oral Med, Oral Pathol, Oral Radiol Endod. 2011;112(3):396–400.
  • Cord CB, Velasco RVC, Ribeiro Melo Lima LF, Rocha DGP, Da Silveira Bueno CE, Pinheiro SL. Effective analysis of the use of peracetic acid after instrumentation of root canals contaminated with enterococcus faecalis. J Endod. 2014;40(8):1145–8.
  • Salvia AC, Teodoro GR, Balducci I, Koga-Ito CY, Oliveira SH. Effectiveness of 2% peracetic acid for the disinfection of gutta-percha cones. Braz Oral Res. 2011;25(1):23–7.
  • Subha N, Prabhakar V, Koshy M, Abinaya K, Prabu M, Thangavelu L. Efficacy of peracetic acid in rapid disinfection of Resilon and gutta-percha cones compared with sodium hypochlorite, chlorhexidine, and povidone-iodine. J Endod. 2013;39(10):1261–4.
  • Hartmann RC, Neuvald L, Barth Jr V et al. Antimicrobial efficacy of 0.5% peracetic acid and EDTA with passive ultrasonic or manual agitation in an Enterococcus faecalis biofilm model. Aust Endod J. 2019;45(1):57–63.
  • Arias-Moliz MT, Ordinola-Zapata R, Baca P et al. Antimicrobial activity of Chlorhexidine, Peracetic acid and Sodium hypochlorite/etidronate irrigant solutions against Enterococcus faecalis biofilms. Int Endod J. 2015;48(12):1188–93.
  • La Carbona S, Sauvageot N, Giard JC et al. Comparative study of the physiological roles of three peroxidases (NADH peroxidase, Alkyl hydroperoxide reductase and Thiol peroxidase) in oxidative stress response, survival inside macrophages and virulence of Enterococcus faecalis. Mol Microbiol. 2007;66(5):1148–63.
  • Baureder M, Reimann R, Hederstedt L. Contribution of catalase to hydrogen peroxide resistance in Enterococcus faecalis. FEMS Microbiol Lett. 2012;331(2):160–4.
  • Ordinola-Zapata R, Bramante CM, Garcia RB et al. The antimicrobial effect of new and conventional endodontic irrigants on intra-orally infected dentin. Acta Odontol Scand. 2013;71(3-4):424-31.
  • Naenni N, Thoma K, Zehnder M. Soft tissue dissolution capacity of currently used and potential endodontic irrigants. J Endod. 2004;30(11):785–7.
  • Tanomaru-Filho M, Silveira BR, Martelo RB, Guerreiro-Tanomaru JM. Influence of Concentration and Agitation of Sodium Hypochlorite and Peracetic Acid Solutions on Tissue Dissolution. J Contemp Dent Pract. 2015;16(11):876–9.
  • Wang Z, Shen Y, Haapasalo M. Effect of smear layer against disinfection protocols on enterococcus faecalis-infected dentin. J Endod. 2013;39(11):1395– 400.
  • Araújo AC, Nunes E, Fonseca AA, Cortes MI, Horta MC, Silveira FF. Influence of smear layer removal and application mode of MTA on the marginal adaptation in immature teeth: a SEM analysis. Dent Traumatol. 2013;29(3):212–7.
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  • Keine KC, Kuga MC, Coaguila-Llerena H, Palma- Dibb RG, Faria G. Peracetic acid as a single endodontic irrigant: effects on microhardness, roughness and erosion of root canal dentin. Microsc Res Tech. 2020;83(4):375–80.
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Perasetik Asitin Endodontide İrrigasyon Solüsyonu Olarak Kullanımı: Genel Bakış

Year 2025, Volume: 11 Issue: 2, 205 - 214, 31.08.2025

Abstract

Endodontik tedavide başarı, kök kanal sisteminden mikroorganizmaların uzaklaştırılması ve enfeksiyonun tekrar oluşmasının önlenmesi ile ilişkilidir. Kök kanallarının irrigasyonu, endodontik tedavinin başarısında oldukça etkilidir. Sodyum hipoklorit (NaOCl), antimikrobiyal özelliği ve organik doku çözme kapasitesi nedeniyle endodontide en yaygın kullanılan irrigasyon solüsyonudur. Ancak tek başına kullanıldığında inorganik dokunun kanallardan uzaklaştırılmasında yeterli olmamaktadır. Antisepsiyi güçlendirmek ve yaygın kullanılan solüsyonların kısıtlamalarının önüne geçmek amacıyla ideal bir irrigasyon protokolü olarak NaOCl’nin şelasyon ajanlarıyla birlikte kullanılması önerilir. Ancak bu protokol uzun bir klinik zaman gerektirir. Üstelik NaOCI ile bazı şelasyon ajanlarının birlikte kullanılmasının dentinin mineral ve organik içeriğinde değişikliklere, erozyona ve dentin mikrosertliğinde azalmaya neden olabildiği de bilinmektedir. Hem şelasyon ajanı görevi gören hem de antimikrobiyal etkiye sahip bir irrigasyon solüsyonunun kullanılması endodontide iyi bir alternatif olabilir ve tedavi sırasında zaman kazandırabilir. Perasetik asit (PAA), antimikrobiyal etkinliği ve smear tabakasını uzaklaştırma özelliği sayesinde alternatif bir irrigasyon solüsyonu olmaya adaydır. Bu derleme PAA’nın endodonti pratiğindeki etkinliğini ve uygulanabilirliğini araştıran çalışmaları inceleyerek, bu irrigasyon solüsyonunun özelliklerini sunmayı amaçlamaktadır.

Ethical Statement

Yukarıda bilgileri yer alan çalışmanın, etik kurul izni gerektirmeyen çalışmalar arasında yer aldığını beyan ederim.

References

  • Haapasalo M, Shen Y, Qian W, Gao Y. Irrigation in Endodontics. Dent Clin North Am. 2010;54(2):291– 312.
  • Peters OA, Schönenberger K, Laib A. Effects of four Ni–Ti preparation techniques on root canal geometry assessed by micro computed tomography. Int Endod J. 2001;34(3):221–30.
  • Haapasalo M, Shen Y, Wang Z, Gao Y. Irrigation in endodontics. Br Dent J. 2014;216(6):299–303.
  • Zehnder M. Root Canal Irrigants. J Endod. 2006;32(5):389–98.
  • Grawehr M, Sener B, Waltimo T, Zehnder M. Interactions of ethylenediamine tetraacetic acid with sodium hypochlorite in aqueous solutions. Int Endod J. 2003;36(6):411–5.
  • Basrani B, Haapasalo M. Update on endodontic irrigating solutions. Endod Topics. 2012;27(1):74– 102.
  • Zehnder M, Kosicki D, Luder H, Sener B, Waltimo T. Tissue-dissolving capacity and antibacterial effect of buffered and unbuffered hypochlorite solutions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(6):756–62.
  • Lester KS, Boyde A. Scanning electron microscopy of instrumented, irrigated and filled root canals. Br Dent J. 1977;143(11):359–67.
  • Pasqualini D, Cuffini AM, Scotti N et al. Comparative evaluation of the antimicrobial efficacy of a 5% sodium hypochlorite subsonic-activated solution. J Endod. 2010;36(8):1358–60.
  • Lottanti S, Gautschi H, Sener B, Zehnder M. Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer. Int Endod J. 2009;42(4):335–43.
  • Tartari T, Guimarães BM, Amoras LS, Duarte MAH, Silva e Souza PAR, Bramante CM. Etidronate causes minimal changes in the ability of sodium hypochlorite to dissolve organic matter. Int Endod J. 2015;48(4):399–404.
  • Goldman M, Goldman LB, Cavaleri R, Bogis J, Lin PS. The efficacy of several endodontic irrigating solutions: a scanning electron microscopic study: part 2. J Endod. 1982;8(11):487–92.
  • Bystrom A, Sundqvist G. The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. Int Endod J. 1985;18:35.
  • Aslantas EE, Buzoglu HD, Altundasar E, Serper A. Effect of EDTA, sodium hypochlorite, and chlorhexidine gluconate with or without surface modifiers on dentin microhardness. J Endod. 2014;40(6):876–9.
  • Patil C, Uppin V. Effect of endodontic irrigating solutions on the microhardness and roughness of root canal dentin: An in vitro study. Indian J Dent Res. 2011;22(1):22-7.
  • Ballal NV, Kandian S, Mala K, Bhat KS, Acharya S. Comparison of the efficacy of maleic acid and ethylenediaminetetraacetic acid in smear layer removal from instrumented human root canal: A scanning electron microscopic study. J Endod. 2009;35(11):1573–6.
  • Kuhlfluck I, Klammt J. Suitability of peracetic acid for root canal disinfection. Stomatol DDR. 1980;30(8):558–63.
  • Lensing HH, Oei HL. Investigations on the sporicidal and fungicidal activity of disinfectants. Zentralbl Bakteriol Mikrobiol Hyg B. 1985 Dec;181(6):487–95.
  • Martell AE, Motekaitis RJ. Determination and use of stability constants. In: New York: John Wiley & Sons. VCH publishers; 1992.
  • Brandão-Neto DDO, Mello JVZ, Marceliano-Alves MFV et al. Final endodontic irrigation with 2% peracetic acid: antimicrobial activity and cytotoxicity. Eur J Dent. 2021;15(3):533–8.
  • Rutala WA, Weber DJ. Disinfection of endoscopes: review of new chemical sterilants used for highlevel disinfection. Infect Control Hosp Epidemiol. 1999;20(1):69–76.
  • Kovaleva J, Degener JE, van der Mei HC. Mimicking disinfection and drying of biofilms in contaminated endoscopes. J Hosp Infect. 2010;76(4):345–50.
  • Kitis M. Disinfection of wastewater with peracetic acid: a review. Environ Int. 2004;30(1):47–55.
  • Kayaoglu G, Ørstavik D. Virulence factors of Enterococcus faecalis: Relationship to endodontic disease. Crit Rev Oral Biol Med. 2004;15(5):308–20.
  • Guerreiro-Tanomaru JM, Morgental RD, Faria-Junior NB, Berbert FL, Tanomaru-Filho M. Antibacterial Effectiveness of Peracetic Acid and Conventional Endodontic Irrigants. Braz Dent J. 2011;22(4):285–7.
  • Dornelles-Morgental R, Guerreiro-Tanomaru JM, De Faria-Jnior NB, Hungaro-Duarte MA, Kuga MC, Tanomaru-Filho M. Antibacterial efficacy of endodontic irrigating solutions and their combinations in root canals contaminated with Enterococcus faecalis. Oral Surg, Oral Med, Oral Pathol, Oral Radiol Endod. 2011;112(3):396–400.
  • Cord CB, Velasco RVC, Ribeiro Melo Lima LF, Rocha DGP, Da Silveira Bueno CE, Pinheiro SL. Effective analysis of the use of peracetic acid after instrumentation of root canals contaminated with enterococcus faecalis. J Endod. 2014;40(8):1145–8.
  • Salvia AC, Teodoro GR, Balducci I, Koga-Ito CY, Oliveira SH. Effectiveness of 2% peracetic acid for the disinfection of gutta-percha cones. Braz Oral Res. 2011;25(1):23–7.
  • Subha N, Prabhakar V, Koshy M, Abinaya K, Prabu M, Thangavelu L. Efficacy of peracetic acid in rapid disinfection of Resilon and gutta-percha cones compared with sodium hypochlorite, chlorhexidine, and povidone-iodine. J Endod. 2013;39(10):1261–4.
  • Hartmann RC, Neuvald L, Barth Jr V et al. Antimicrobial efficacy of 0.5% peracetic acid and EDTA with passive ultrasonic or manual agitation in an Enterococcus faecalis biofilm model. Aust Endod J. 2019;45(1):57–63.
  • Arias-Moliz MT, Ordinola-Zapata R, Baca P et al. Antimicrobial activity of Chlorhexidine, Peracetic acid and Sodium hypochlorite/etidronate irrigant solutions against Enterococcus faecalis biofilms. Int Endod J. 2015;48(12):1188–93.
  • La Carbona S, Sauvageot N, Giard JC et al. Comparative study of the physiological roles of three peroxidases (NADH peroxidase, Alkyl hydroperoxide reductase and Thiol peroxidase) in oxidative stress response, survival inside macrophages and virulence of Enterococcus faecalis. Mol Microbiol. 2007;66(5):1148–63.
  • Baureder M, Reimann R, Hederstedt L. Contribution of catalase to hydrogen peroxide resistance in Enterococcus faecalis. FEMS Microbiol Lett. 2012;331(2):160–4.
  • Ordinola-Zapata R, Bramante CM, Garcia RB et al. The antimicrobial effect of new and conventional endodontic irrigants on intra-orally infected dentin. Acta Odontol Scand. 2013;71(3-4):424-31.
  • Naenni N, Thoma K, Zehnder M. Soft tissue dissolution capacity of currently used and potential endodontic irrigants. J Endod. 2004;30(11):785–7.
  • Tanomaru-Filho M, Silveira BR, Martelo RB, Guerreiro-Tanomaru JM. Influence of Concentration and Agitation of Sodium Hypochlorite and Peracetic Acid Solutions on Tissue Dissolution. J Contemp Dent Pract. 2015;16(11):876–9.
  • Wang Z, Shen Y, Haapasalo M. Effect of smear layer against disinfection protocols on enterococcus faecalis-infected dentin. J Endod. 2013;39(11):1395– 400.
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There are 81 citations in total.

Details

Primary Language Turkish
Subjects Endodontics
Journal Section Review
Authors

Özge Bekar 0000-0003-1980-8133

Publication Date August 31, 2025
Submission Date February 1, 2024
Acceptance Date July 8, 2024
Published in Issue Year 2025 Volume: 11 Issue: 2

Cite

Vancouver Bekar Ö. Perasetik Asitin Endodontide İrrigasyon Solüsyonu Olarak Kullanımı: Genel Bakış. Aydin Dental Journal. 2025;11(2):205-14.

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