KALSİYUM HİDROKSİT VE KLORHEKSİDİN JEL/KALSİYUM HİDROKSİT KANAL İÇİ MEDİKAMANLARININ FARKLI İRRİGASYON AKTİVASYON YÖNTEMLERİ İLE KÖK KANALINDAN UZAKLAŞTIRMA ETKİNLİĞİNİN DEĞERLENDİRİLMESİ

Year 2018, Volume: 28 Issue: 4, 524 - 533, 14.10.2018

İsmail Uzun Özgür Soysal Özdemir

https://doi.org/10.17567/ataunidfd.473909

Abstract

Amaç: Bu çalışmanın amacı; farklı irrigasyon solüs- yonlarının,
aktivasyon yöntemleri ile aktive edildikten sonra, kök kanal tedavisi sırasında
kullanılan kanal içi medikamanlarını, kök kanallarından uzaklaştırma
etkinliklerinin değerlendirilmesidir.

Gereç
ve Yöntem: Dişlere uygulanan kanal içi
medi- kamanlardan kalsiyum hidroksit ve klorheksidin jel/kal- siyum hidroksit,
3 farklı irrigasyon solüsyonu (NaOCl, Qmix ve Maleik asit), 4 farklı aktivasyon
tekniği (iğne/ şırınga irrigasyonu, Endoaktivatör, Endovac ve pasif ultrasonik
irrigasyon) ile aktive edilerek kök kanalla- rından uzaklaştırılmaya çalışıldı.
Kök kanallarında kalan medikaman miktarı steromikroskop ile incelendi. Elde
edilen veriler Kruskal Wallis ve Bonferoni düzeltmeli Mann-Whitney U testleri
ile istatistiksel olarak analiz edildi (p = 0.05).

Bulgular: İrrigasyon solüsyonlarından maleik asit ve irrigasyon
aktivasyon yöntemlerinden pasif ultrasonik irrigasyon aktivasyon yöntemi, hem
kalsiyum hidroksiti hem de klorheksidin jel/kalsiyum hidroksit kombinas- yonunu
uzaklaştırmada diğer yöntemlere göre istatik- sel olarak anlamlı derecede daha
etkili bulundu (p < 0.05).  Ayrıca
kanal içi medikamanlardan klorheksidin jel/kalsiyum hidroksit kombinasyonunun,
kalsiyum hidroksite göre kök kanallarından daha zor uzaklaş- tırıldığı
bulunmuştur (p < 0.05).     

Sonuçlar:
Kök kanallarından kanal içi
medikamanların etkili bir şekilde uzaklaştırabilmek için irrigasyon akti- vasyon
yöntemlerinin kullanılması gereklidir. En etkili yöntem ise; maleik asit ile
pasif ultrasonik irrigasyon aktivasyonunun kombine kullanılması yöntemidir
ancak hiçbir yöntem kök kanallarından kanal içi medika- manları tamamen uzaklaştıramamıştır.

*Ondokuz Mayıs Üniversitesi Diş Hekimliği Fakültesi Endodonti AD, Samsun. ** Marka Özel Diş Sağlığı Merkezi, İZMİT ≠Bu çalışma daha önce Ondokuz Mayıs Üniversitesi Diş Hekimliği Fakültesi Endodonti Anabilim Dalında Uzmanlık tezi olarak  sunulmuştur.

Anahtar
Kelimeler: Endodonti, Qmix, irrigasyon aktivasyonu, maleik
asit
AN EFFICACY EVALUATION OF DIFFERENT IRRIGATION ACTIVATION SOLUTIONS FOR
REMOVAL OF CALCIUM HYDROXIDE AND CHLORHEXIDINE GEL/CALCIUM HYDROXIDE
COMBINATION PASTE FROM ROOT CANAL SYSTEMS            

Aim:
This study aims to evaluate the
efficacy of different irrigation solutions and irrigation techniques for
removal of root-canal filling paste from root canal systems.

Materials
and Methods: Removal of calcium
hydroxide, chlorhexidine gel/ calcium hydroxide intracanal medicaments from
root canals attempted with using 3 different irrigation solutions ( NaOCl, qmix
and maleic acide) activated by 4 activation techniques ( needle/syringe
irrigation, Endoactivator, Endovac ve passive ultrasonic irrigation). Remaining
medicaments within root canals explorated under stereomicroscope.  The data were analyzed by using Kruskal-Wallis
and Bonferronni corrected Mann-Whitney U tests (p= 0.05).

Results:
Its found that maleic acid of
irrigation solutions  and passive
ultrasonic irrigation of activation techniques was significantly superior to
other tested methods in removing both calcium hydroxide and chlorhexidine
gel/calcium hydroxide combined root canal medicaments from root canals
(P<0.005). It was also found that chlorhexidine gel/calcium hydroxide
combined medicament was more resistant than calcium hydroxide to remove from
root canal system(p>0.05).

Conclusions:
Irrigation activation methods are
required for efficient removal of intracanal medicaments from root canal
system. Maleic acid irrigation and passive ultrasonic irrigation activation was
found as the most efficient method, however none of the tested methods was able
to render canal systems free of medicaments.

Keywords:
Endodontics; QMix; irrigation
activation; maleic acid

Keywords

Endodonti, Qmix, irrigasyon aktivasyonu

References

• 1. A, Claesson R, Sundqvist G. The antibac- terial effect of camphorated paramonochlo- rophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endod Dent Traumatol 1985;1:170-5.
• 2. Siqueira JF, Machado AG, Silveira RM, Lopes HP, de Uzeda M. Evaluation of the effectiveness of sodium hypochlorite used with three irrigation methods in the elimination of Enterococcus faecalis from the root canal, in vitro. Int Endod J 1997;30:279-82.
• 3. Siqueira JF, Lopes HP. Mechanisms of antimicrobial activity of calcium hydroxide: a critical review. Int Endod J 1999; 32, 361-9.
• 4. Ricucci D, Langeland K. Incomplete calcium hydroxide removal from the root canal: a case report. Int Endod J 1997;30:418-21.
• 5. Margelos J, Eliades G, Verdelis C, Palaghias G. Interaction of calcium hydroxide with zinc oxide-eugenol type sealers: a potential clinical problem. J Endod 1997; 23, 43–8.
• 6. Tatsuta CT, Morgan LA, Baumgartner JC, Adey JD. Effect of calcium hydroxide and four irrigation regimens on instrumented and uninstrumented canal wall topography. J Endod 1999;25:93-8. 7. Calt S, Serper A. Dentinal tubule penetration of root canal sealers after root canal dressing with calcium hydroxide. J Endod 1999;25:431-3
• 8. Capar ID, Ozcan E, Arslan H, et al. Effect of different final irrigation methods on the removal of calcium hydroxide from an artificial standardized groove in the apical third of root canals. J Endod 2014;40:451–4.
• 9. Kenee DM, Allemang JD, Johnson JD, et al. A quantitative assessment of efficacy of various calcium hydroxide removal techniques. J Endod. 2006; 32:563-5.
• 10. Townsend C, Maki J. An in vitro comparison of new irrigation and agitation techniques to ultrasonik agitation in removing bacteria from a simulated root canal. J Endod 2009; 35: 1040-3.
• 11. Desai P, Himel V. Comparative safety of various intracanal irrigation systems. J Endod 2009; 35(4): 545-9.
• 12. Rodig T, Hirschleb M, Zapf A, et al. Comparison of ultrasonic irrigation and RinsEndo for the removal of calcium hydroxide and Ledermix paste from root canals. Int Endod J 2011;44:1155–61.
• 13. Lambrianidis T, Margelos J, Beltes P. Removal efficiency of calcium hydroxide dressing from the root canal. J Endod 1999;25:85-8.
• 14. Akyüz Ekim ŞF, Erdemir A. Endodontide İrrigasyon Aktivasyon Yöntemleri. Atatürk Üniv Diş Hek Fak Derg 2015; 25(Supp10): 98-104.
• 15. Gu LS, Kim JR, Ling J, Choi KK, Pashley DH, Tay FR. Review of contemporary irrigant agitation techniques and devices. J Endod 2009;35: 791-804.
• 16. Rodig T, Vogel S, Zapf A, et al. Efficacy of different irrigants in the removal of calcium hydroxide from root canals. Int Endod J 2010;43:519–27.
• 17. Kenee DM, Allemang JD, Johnson JD, et al. A quantitative assessment of efficacy of various calcium hydroxide removal techniques. J Endod. 2006; 32:563-5.
• 18. Wiseman A, Cox TC, Paranjpe A, Flake NM, Cohenca N, Johnson JD. 2011. Efficacy of sonic and ultrasonic activation for removal of calcium hydroxide from mesial canals of mandibular molars: A microtomographic study. J Endod 37:235-8.
• 19. Lambrianidis T, Kosti E, Boutsioukis C, Mazinis M. Removal efficacy of various calcium hydroxide/chlorhexidine medicaments from the root canal. Int Endod J 2006;39:55-61.
• 20. Lambrianidis T, Margelos J, Beltes P. Removal efficiency of calcium hydroxide dressing from the root canal. J Endod 1999;25:85-8
• 21. Usman N, Baumgartner JC, Marshall JG (2004). Influence of instrument size on root canal debridement. J Endod 30: 110-2.
• 22. Khademi A, Yazdizadeh M, Feizianfard M. Determination of the minimum instrumentation size for penetration of irrigants to the apical third of root canal systems. J Endod 2006; 32:417-20.
• 23. Zehnder M. Root canal irrigants. J Endod 2006; 32: 389–98.
• 24. Stojicic S, Shen Y, Qian W, Johnson B,Haapasalo M. Antibacterial and smear layer removal ability of a novel irrigant, QMiX. Int Endod J 2012; 45: 363-71.
• 25. Salgado RJ, Moura-Netto C, Yamazaki AK, et al. Comparison of different irrigants on calcium hydroxide medication removal: microscopic cleanliness evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:580–4.
• 26. Rodig T, Vogel S, Zapf A, et al. Efficacy of different irrigants in the removal of calcium hydroxide from root canals. Int Endod J 2010; 43:519–27.
• 27. Hariharan VS, Nandlal B, Srilatha KT. Efficacy of various root canal irrigants on removal of smear layer in the primary root canals after hand instrumentation: a scanning electron microscopy study. J Indian Soc Pedod Prev Dent 2010; 28:271-7.
• 28. Desai P, Himel V. Comparative safety of various intracanal irrigation systems. J Endod 2009; 35: 545-9.
• 29. Balvedi RP, Versiani MA, Manna FF, Biffi JC. A comparison of two techniques for the removal of calcium hydroxide from root canals. Int Endod J 2010; 43:763-8.
• 30. Takahashi CM, Cunha RS, de Martin AS, et al. In vitro evaluation of the effectiveness of ProTaper universal rotary retreatment system for guttapercha removal with or without a solvent. J Endod 2009; 35:1580-83.
• 31. Kim SK, Kim YO. Influence of calcium hydroxide intracanal medication on apical seal. Int Endod J 2002;35: 623–8.
• 32. Michelon C, Carlo Bello de M, Mastella Lang P, Pillar R, Silveira Bech AG, Souza Bier C. A, Effectiveness of passive ultrasonic irrigation on calcium hydroxide removal with different solutions. RFO, Passo Fundo 2014;19:277-82.
• 33. Kenee DM, Allemang JD, Johnson JD, et al. A quantitative assessment of efficacy of various calcium hydroxide removal techniques. J Endod 2006; 32:563-5.
• 34. L. W. M. van der Sluis, M. Versluis, M. K. Wu, P. R. Wesselink. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J 2007; 40:415-26.
• 35. Topçuoğlu HS, Düzgün S, Ceyhanlı KT, Aktı A, Pala K, Kesim B. Efficacy of different irrigation techniques in the removal of calcium hydroxide from a simulated internal root resorption cavity. Int Endod J 2015; 48:309-16.
• 36. Arslan H, Gok T, Saygili G, Altintop H, Akçay M, Çapar İD. 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; 40:1820-3.