Research Article
ISSN: 2574 -1241
DOI: 10.26717.BJSTR.2019.14.002512
Formation of Precipitates on the Surface of Root
Dentin After Various Final Irrigation Protocols
Tatjana Kanjevac1*, Ljiljana Bjelović2, Dajana Nogo Živanović2, Bojan Kostić3 and
Irena Tanasković4
1
Department of Dentistry, Serbia
2
Department of Restorative Dentistry and Endodontics, Serbia
3
Associate at SEM Laboratory, Serbia
4
Department of Histology and embryology, Serbia
*Corresponding author: Tatjana Kanjevac, Department of Dentistry, Svetozara Markovica 69, 34000 Kragujevac, Serbia
ARTICLE INFO
Received:
January 24, 2019
Published:
February 07, 2019
abstract
Background: The aim of this study was to investigate the amount of precipitates formed
on the surface of root dentin after irrigation with sodium hypochlorite (NaOCl) and final
chlorhexidine irrigation (CHX), ethylenediaminetetraacetic acid (EDTA) + CHX, and new
combined solutions: QMiX or MTAD.
Citation: Tatjana K*, Ljiljana B, Dajana Nogo Ž, Bojan K, Irena T. Formation
of Precipitates on the Surface of Root
Dentin After Various Final Irrigation
Protocols. Biomed J Sci & Tech Res
14(2)-2019. BJSTR. MS.ID.002512.
Methods: By using the method of random sampling the roots of 90 front maxillary human
teeth were divided into five groups on the basis of the final irrigation protocol. The amount of
precipitates is determined in the coronal, middle and apical thirds by using the by scanning
electron microscopy (SEM).
Abbreviations: NaOCl: Sodium Hypochlorite; EDTA: Ethylene Diamine
Tetra Acetic Acid; CHX: Chlorhexidine;
PCA: Parachloroaniline
Conclusion: Obtained results show that after irrigation with NaOCl and final irrigation
with CHX more precipitate is formed than after the irrigation with NaOCl and final irrigation
with MTAD and QMIX.
Key words: Chlorhexidine; MTAD;
Precipitate; Sodium Hypochlorite;
QMiX
Results: SEM analysis demonstrated a significantly higher amount of precipitate was
formed in the CHX group compared to the MTAD group in the coronary (p <0.05) that is
QMiX group in the middle third (p <0.05). In the apical third, a significantly higher amount of
precipitates was found in the CHX group compared to the MTAD group and the QMiX group
(p <0.05).
Introduction
Canal irrigation represents one of the most important procedures
in the debridement of the canal space along with the mechanical
instrumentation. During and after canal instrumentation, irrigants
facilitate the removal of microorganisms, smear layer, as well as
organic residues [1]. However, none of the irrigants meets all these
requirements completely, so that during endodontic therapy, the
use of multiple solutions is necessary [2]. Therefore, irrigation of
the canal root with sodium hypochlorite (NaOCl) is recommended
in order to dissolve the organic component as well as final
irrigation with 17% ethylenediaminetetraacetic acid (EDTA) in
order to remove the inorganic component of the smear layer [3,4].
After smear layer removal, root canals can be finally rinsed with
antiseptics, such as NaOCl or chlorhexidine (CHX) to attack the
any remaining bacteria [4,5]. Recently, two new antiseptics have
been introduced into the clinical practice: MTAD, which presents
a mixture of isomers of doxycycline, citric acid and detergent, and
QMiX, CHX solution with EDTA. They are used as final irrigants
for removing the smear layer, that is as a substitute for EDTA1,
but their advantage over EDTA is to exhibit less erosive effect on
dentine [1-3]. Due to the existence of an antiseptic component in
their composition (tetracycline or CHX), MTAD and QMiX express
antimicrobial effect [5-8]. The solutions used for irrigation during
endodontic therapy come into contact with each other within the
root canal.
As a result of interactions, solid products known as precipitates
may be formed 9. By mixing NaOCl and CHX, an orange-brown
precipitate is formed which can cause a change in the color of the
teeth, the occlusion of dentinal tubules and the reduction in the
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dentine permeability [9-11]. Furthermore, according to some
findings, the precipitate contains a toxic [12] and a carcinogenic
substance [13] known as parachloroaniline (PCA). If CHX is
combined with EDTA, it leads to interaction and formation of
white precipitate [14,15] which reduces the efficiency of EDTA
solution, while mixing NaOCl and MTAD results in the formation of
a yellow precipitate [16]. Recent studies have demonstrated that,
after combining EDTA with CHX and NaOCl with MTAD, precipitate
in dentine tubules is formed which disturbs the permeability
of dentine in the apical third of the root [11]. The presence of
the precipitate in larger amounts on the surface of dentine can
significantly affect the adhesion of root dentin sealers, especially
resin based sealers [17]. However, there is still a lack of data on
the amount of precipitate, which is formed in these interactions on
the surface of the root canal dentine. Interaction between NaOCl
and QMiX has so far been examined in several studies that have
demonstrated contradictory results.
While some studies have demonstrated that the precipitate is
formed on the surface of dentine [18] and in dentine tubules 11,
others have not demonstrated the presence of the precipitate either
on the surface of dentine or in dentine tubules after NaOCl and QMiX
canal flushing [19]. Its amount in the interaction between NaOCl
and QMiX has not yet been determined.Therefore, the aim of this
study was to determine the amount of the precipitate formed on the
root dentine surface after NaOCl irrigation and final irrigation with
CHX, EDTA + CHX, QMiX or MTAD. The investigated null hypothesis
was that there was no difference between various final irrigants in
the amount of precipitate formed on the surface of the root dentine.
Material and Methods
Preparation of Samples
The protocol of this study was approved by the Ethical Committee
of Faculty of Medicine (No: 01-3-88 / 2015). Ninety extracted
frontal maxillary human teeth extracted for prosthodontics reasons
were collected. Criteria for the inclusion in the study were: an intact
tooth, previously not treated endodontically and without coronary
restoration. Radiographic evaluations were employed to verify the
presence of one central root canal, normal pulp chamber, and fully
formed apex. The crowns of the tooth were cut off so as to provide a
standardized root length of 14 mm. After that, by using the method
of random sampling, the roots were divided into five groups (n =
18) depending on the type of the irrigant used for the final iriigation:
CHX (2% CHX solution, Consepsis, Dentsply Tulsa Dental, Tulsa, OK,
USA), EDTA + CHX (17% EDTA, ENDO-SOLution, Cerkamed, PPH
Cerkamed, Stalowa Wola, Poland / 2% CHX Solution, Consepsis,
Dentsply Tulsa Dental, Tulsa, OK, USA), QMiX (Dentsply Tulsa
Dental, Tulsa , OK, USA), MTAD (Dentsply Tulsa Dental, Tulsa, OK,
USA), and a control group (distilled water). An ISO size #15 K-type
file (Dentsply Maillefer, Ballaigues, Switzerland) was inserted into
the canal until the tip of the file was observed at the apical foramen
and working length was determined subtracting 1 mm from the
recorder distance. All apices of the root are sealed with wax to
simulate clinical conditions.
Canals were prepared by machine tools Protaper Universal
(Dentsply, Maillefer, Ballaigues, Switzerland) up to F4 size (40 /
0.06). After each instrument, canals were irrigated with 1 ml of
5.25% NaOCl, except for the roots in the MTAD group, where 1.3%
NaOCl was used (manufacturer’s recommendation). Before the
final irrigation, a smear layer was removed with 5 ml of 17% EDTA
for 5 minutes from the surface of the dentinal wall of the canal,
and then with distilled water, so that only the precipitate could
remain on the dentine surface.The final irrigation protocol was
implemented as follows: CHX group: 5 ml 5.25% NaOCl (2 minutes)
+ 10 ml distilled water (2 minutes) + 5 ml CHX (2 minutes); CHX +
EDTA group: 5 ml 5.25% NaOCl (2 minutes) + 10 ml distilled water
(2 minutes) + 5 ml 17% EDTA (2 minutes) + 10 ml distilled water
(2 minutes) + 5 ml 2 % CHX (2 minutes); QMIX group: 5 ml 5.25%
NaOCl (2 minutes) + 10 ml distilled water (2 minutes) + 5 ml QMIX
(2 minutes); MTAD group: 5 ml 1.3% NaOCl (2 minutes) + 10 ml
distilled water (2 minutes) + 5 ml MTAD (2 minutes); Control group:
5 ml 5.25% NaOCl (2 minutes) + 10 ml distilled water (2 minutes)
+ 5 ml distilled water (2 minutes). All irrigating solutions were
introduced with a 27-G syringe needle (Endo Easy Tip, Ultradent
products Inc.) inserted to 1 mm of the working length. After the
final irrigation was completed, canals were dried by paper points.
Scanning Electron Microscopic (SEM) Analysis
Eighteen roots from each group were prepared for SEM
analysis. On the buccal and oral surfaces of the root, longitudinal
grooves are made by using a diamond disc and the by using a
chisel canals are divided into two halves. One randomly chosen
half of each specimen was coded and subjected to increasing
concentrations of ethanol (25%, 50%, 75% and 100%), mounted
on aluminum holder, sputter coated with gold and analyzed by SEM
(SEM, JEOL-JSM-6610LV, Tokyo, Japan) in order to determine the
presence of the precipitate on the root dentine surface. The coronal
(12 mm from apex), the middle (7 mm from apex) and the apical
(2 mm from apex) third were analyzed at an increase of 500 x,
2,000 x and 4,500 x. The 2.000 x magnification micrographics were
preserved in TIFF format and the representative areas of each root
third are analyzed using Adobe Photoshop CS5, Adobe Systems. All
images were standardized at the size of 47 μm x 63 μm and the
number of pixels of the entire image was determined. After that, the
surface of the image with the resulting precipitate was indicated by
a magnetic pointer and the number of pixels was determined. By
dividing these two values, the percentage of the precipitate for each
image was calculated.
Statistical Analysis
Statistical data processing was done in the statistic program
SPSS 20.0 (IBM Corp., Armonk, NY, USA). Since percentages of
precipitates did not follow normal distribution (KolmogorovSmirnov test p <0.05), the differences between and within groups
were determined by using the Kruskal-Wallis test and the post hoc
Dunn test. The significance levels were set at 5 %.
Results
SEM analysis demonstrated that after various irrigation
protocols on the surface of dentin, precipitate was formed in all
investigated groups. Precipitate was not observed on the samples of
the control group (Figures 1a-1c). In the CHX group, the precipitate
covers a larger area of dentine in all root thirds (Figures 2a-2c). In
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the EDTA + CHX group, precipitation is observed in all root thirds
to a lesser extent than in the CHX group (Figures 3a-3c), while the
lowest amount of the precipitate was formed using MTAD (Figures
4a-4c) and QMiX group (Figures 5a-5c). The highest amount of the
precipitate was recorded in the CHX group. Data analysis showed
that the amount of the precipitate in this group was significantly
higher in relation to the MTAD group (p <0.05) in the coronal third
and compared to the QMiX group in the middle third (p <0.05).
In the apical third, the amount of the precipitate formed in the
CHX group was significantly higher than that in the QMiX and the
MTAD group (p <0.05). A significant difference in the amount of
the precipitate was recorded in the apical third and between EDTA
+ CHX and MTAD group (p <0.05). Observed by root thirds, the
highest amount of the precipitate was found in the coronal and the
lowest in the apical third in all groups, but this difference did not
reach any statistical significance (p> 0.05) (Table 1).
Figure 1a: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after CHX irrigation in appical third.
Figure 1b: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after CHX irrigation in middle third.
Figure 1c: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after CHX irrigation in coronary
third.
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Figure 2a: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after EDTA+ CHX irrigation in
appical third.
Figure 2b: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after EDTA+ CHX irrigation in
middle third.
Figure 2c: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after EDTA+ CHX irrigation in
coronary third.
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Figure 3a: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after MTAD irrigation in appical
third.
Figure 3b: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after MTAD irrigation in middle
third.
Figure 3c: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after MTAD irrigation in coronary
third.
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Figure 4a: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after QMiX irrigation in appical third.
Figure 4b: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after QMiX irrigation in middle
third.third.
Figure 4c: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after QMiX irrigation in coronary
third.
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Figure 5a: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after distilled water irrigation in
apical third.
Figure 5b: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after distilled water irrigation in
middle third.
Figure 5c: SEM micrographs (2000 x) of the precipitate on the surface of dentin root canal after distilled water irrigation in
coronary third.
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Table 1: The amount of the precipitate (%) formed on the surface of the root canal dentine after various irrigation protocols.
Third
CHX group Mean (SD)
EDTA + CHX groupa Mean
(SD)
QMiX group Mean (SD)
MTAD group Mean (SD)
Coronal
13,13 ± 13,47Aa
7,30 ± 4,92ABa
4,34 ± 3,04ABa
4,69 ± 5,02Ba
Middle
11,81 ± 14,23Aa
6,79 ± 6,54ABa
3,85 ± 4,12Ba
4,30 ± 4,67ABa
Apical
Aa
10,07 ± 5,96
ABa
6,70 ± 4,49
Discussion
SEM analysis demonstrated that the precipitate was created
after NaOCl irrigation and final irrigation with CHX, EDTA +
CHX, MTAD or QMiX. Taking into account that the amount of
the precipitate produced in CHX group was significantly higher
compared to MTAD (coronary and apical third) and QMiX group
(middle and apical third) the null hypothesis was discarded.The
SEM analysis demonstrated that the precipitate was not formed on
the surface of dentine in the samples treated with 5.25% NaOCl and
distilled water (control group). On the other hand, in the root canals,
which were flushed with various final irrigants, the precipitate was
found on the surface of dentine. Irrigation of the root canal with
5.25% NaOCl and 2% CHX was followed by the formation of the
precipitate, which was not prevented even by the use of distilled
water as an intermediate irrigant, which is in line with the results
of other studies [20, 21,22]. In the interaction between NaOCl and
CHX, the formation of a neutral and insoluble brown precipitate
was due to the acid-base reaction [9]. In addition to NaOCl, CHX can
react with EDTA as well. This reaction results in the formation of an
insoluble pink 22 or whitish precipitate [14, 15]. This precipitate
is probably salt formed by the neutralization of CHX by EDTA. Our
results show that final flushing with solutions of 17% EDTA + 2%
CHX results in the formation of the precipitate on the surface of
dentine.
Also, in our study, the application of distilled water between the
application of 17% EDTA and 2% CHX did not prevent precipitation.
Prado et al. [15] showed that the flushing of the canal with distilled
water after 2% CHX and before the use of 17% EDTA prevented the
formation of a chemical smear layer that is precipitate. However,
if the canals are flushed with 5.25% NaOCl, then with 17% EDTA
and finally with 2% CHX the precipitate is formed on the surface
of dentine, despite the fact that between each irrigant the root
canal is flushed with distilled water [23], which is consistent with
the results of our research. It is assumed that the newly formed
precipitate is the result of the presence of NaOCl and its interaction
with CHX rather than the result of the interaction of CHX and
EDTA [23]. It is possible that CHX from QMiX reacts with NaOCl.
In the QMiX solution, the interaction between CHX and EDTA is
prevented by the chemical design of the solution [7]. According
to some findings, combining NaOCl and QMiX may cause a color
change of the solution, but without the formation of the precipitate
[24], so it is recommended by the manufacturer to flush the canal
of the root with saline solution between these two irrigants [24].
Kolosowski at al. also speak on behalf of this [19] with their studies
which did not find the precipitate on the surface of the dentine of
dentine blocks that were immersed in 2.5% NaOCl, and after that
in saline and QMiX, using secondary mass spectroscopic analysis
(TOF-SIMS).
Ca
3,57 ± 4,47B
3,66 ± 4,92Ca
On the other hand, the spectroscopic analysis of the surface of
the dentin of root canal Arslan et al. [18] showed that the flushing
of the canal with 2.5% NaOCl and QMiX, without intermediate
flushing, resulted in the formation of orange-brown precipitate on
the surface of dentine. Similar results occurred in our SEM study
where the application of QMiX after 5.25% NaOCl was followed
by the formation of the precipitate on the surface of the root canal
although the canal was flushed with distilled water between the
two irrigants. Differences in the results between our and the above
studies can be attributed to the differences in the concentration of the
applied NaOCl. It has also been shown that the type of intermediate
irrigant used to remove NaOCl prior to final CHX irrigation can have
an effect on the formation of the precipitate [15, 20, 25]. Different
results between studies can be attributed to differences in methods
used to visualize the precipitate, as well as to the characteristics of
samples and irrigation protocols. Namely, in the study conducted
by Kolosowski at al. 19 dentine blocks were opened at both ends,
which allowed the same exposure and an adequate replacement of
irrigants in all samples, probably preventing interaction between
them, as opposed to the study conducted by Arslan et al. [18] and
our research as well in which the sample were root canals flushed
by using a syringe and a needle, where it is not possible to deliver
the same amount of irrigants into all parts of the canal. In the study
by Tay et al. 16, it was observed that by mixing NaOCl and MTAD,
a yellow precipitate was formed which, after remaining in the
bottle for a longer time, changed the color to orange-yellow. Also,
these authors noted the formation of yellow precipitate along the
walls of the root canal after using 1.53% -6.15% NaOCl with final
MTAD flushing in clinical conditions [16]. This interaction is a redox
reaction in which oxidation of doxycycline in the presence of NaOCl
occurs [16].
The findings from our study are also in accordance with the
results of the mentioned research. Specifically, the precipitate was
observed on the surface of the root dentin after the irrigation of
the root canal with 1.3% NaOCl and final flushing with MTAD. It
is interesting to note that the application of distilled water after
1.3% NaOCl did not prevent formation of the precipitation [16].
The amount of precipitate formed after flushing with 5.25% NaOCl
and final flushing with 2% CHX was two to three times higher than
the amount of the precipitate formed in other groups. A statistically
significant difference in the amount of precipitation between the
CHX group and other groups was recorded only in the coronal and
apical third relative to the MTAD group and the middle and apical
third in relation to the QMiX group, which is probably a consequence
of high standard deviations in each of the examined groups. The
precipitate formed in the interaction of NaOCl and CHX reduces
the permeability of dentine, which was confirmed in our previous
research [11] and the works of other authors [26, 27]. The amount
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of the precipitate in the EDTA + CHX group and the QMiX group did
not differ significantly, but the precipitate in the EDTA + CHX group
was almost twice as high. This can be explained by a lower amount
of CHX in the QMiX solution available for interaction with NaOCl
compared to 2% CHX, which was used in the EDTA + CHX group.
Namely, the interaction between NaOCl and CHX and the formation
of the precipitate depends on the concentration of NaOCl on one
hand [9] and the concentration of CHX on the other [28].
Flushing of the canal with a lower concentration of NaOCl
(1.3%) before the final flushing with MTAD resulted in the
formation of a lower amount of the precipitate in this group.
Although there are data on the effect of the precipitate formed in
the interaction between NaOCl and CHX on the surface of dentine,
the influence of the precipitate formed in the interactions of NaOCl
and EDTA + CHX, NaOCl and MTAD, as well as NaOCl and QMiX are
insufficiently tested. Observed by root thirds, the highest amount of
the precipitation in our study was observed in the coronal and the
lowest in the apical third of the canal in all examined groups. By using
the stereomicroscope for examining the interaction between 2.5%
NaOCl and 2% CHX, Krishnamurthy & Sudhakaran [20] measured
the greatest thickness of the precipitate in the coronal and the
smallest one in apical third, with a significant difference between
the apical and the other two thirds. The observed differences in
the amount of the precipitate per root thirds in our study can be
attributed to canal anatomy and limitations of irrigation by the
application of a syringe and a needle, which prevent the delivery of
the same amounts of irrigants to all parts of the canal.
Conclusion
The results of our study show that higher amounts of the
precipitate are produced after the final CHX irrigation, than
in the case of MTAD and QMiX combination. Determining the
chemical composition of the formed precipitate and its effect on
the disinfection of the canal system and the adhesion of sealers to
root dentin, would be interesting both from scientific and clinical
aspects.
Acknowledgement
The study was supported by the Junior Project (No: 2016/06) of
the Faculty of Medical Sciences at the University of Kragujevac and
the Project of the Ministry of Education, Science and Technological
Development of the Republic Serbia (Br: 175071).
References
1. Basrani B, Haapasalo M (2012) Update on endodontic irrigating
solutions. Endod Topics 27(1): 74-102.
2. Nogo Zivanovic D, Bjelovic LJ, Ivanovic V, Kanjevac T, Tanacković I (2018)
Consideration of therapeutic possibilities of irrigants in endodontic
therapy. Ser J Exp Clin Res 19(2): 103-112.
3. Zehnder M (2006) Root canal irrigants. J Endod 32(5): 389-398.
4. Rôças IN, Siqueira JF (2011) Comparison of the in vivo antimicrobial
effectiveness of sodium hypochlorite and chlorhexidine used as root
canal irrigants: a molecular microbiology study. J Endod 37(2): 143-150.
5. Souza MA, Montagner A, Lana DL, Vidal CM, Farina AP, et al. (2017)
Comparative evaluation of the retaining of QMix and chlorhexidine
formulations on human dentin: a chemical analysis. Clin Oral Investig
21(3): 873-878.
6. Rasimick BJ, Wan J, Musikant BL, Deutsch AS (2010) Stability of
doxycycline and chlorhexidine absorbed on root canal dentin. J Endod
36(3): 489-492.
7. Stojicic S, Shen Y, Qian W, Johnson B, Haapasalo M (2012) Antibacterial
and smear layer removal ability of a novel irrigant, QMiX. Int Endod J
45(4): 363-371.
8. Jardine AP, Rosa RA, Santini MF, Wagner M, Só MV, et al. (2016) The effect
of final irrigation on the penetrability of an epoxy resin-based sealer into
dentinal tubules: a confocal microscopy study. Clin Oral Investig 20(1):
117- 123.
9. Basrani BR, Manek S, Sodhi RN, Fillery E, Manzur A (2007) Interaction
between sodium hypochlorite and chlorhexidine gluconate. J Endod
33(8): 966-969.
10. Bui TB, Baumgartner JC, Mitchell JC (2008) Evaluation of the interaction
between sodium hypochlorite and chlorhexidine gluconate and its
effect on root dentin. J Endodod 34(2): 181-185.
11. Bjelović Lj, Krunić J, Stojanović N, Erić J, Kanjevac T (2018) Evaluation
of permeability of root dentin after different irrigation protocols. Serb
Arch Med.
12. Boehncke A, Kielhorn J, Koennecker G, Pohlenz Michel C, Mangelsdorf
I (2003) Concise International Chemical Assessment Document,
4-Chloroaniline. World Health Organization, Switzerland, p. 48.
13. Chhabra RS, Huff JE, Haseman JK, Elwell MR, Peters AC (1991)
Carcinogenicity of p-chloroaniline in rats and mice. Food Chem Toxicol
29(2): 119-124.
14. Rasimick BJ, Nekich M, Hladek MM, Musikant BL, Deutsch AS (2008)
Interaction between chlorhexidine digluconate and EDTA. J Endod
34(12): 1521-1523.
15. Prado M, Santos Júnior HM, Rezende CM, Pinto AC, Faria RB, et al. (2013)
Interactions between irrigants commonly used in endodontic practice: a
chemical analysis. J Endod 39(4): 505-510.
16. Tay FR, Mazzoni A, Pashley DH, Weller RN, King NM, et al. (2006)
Ultrastructure of smear layer-covered intraradicular dentin after
irrigation with BioPure MTAD. J Endod 32(3): 218-221.
17. Vivacqua Gomes N, Ferraz CC, Gomes BP, Zaia AA, Teixeira FB, et al.
(2002) Influence of irrigants on the coronal microleakage of laterally
condensed gutta-percha root fillings. Int Endod J 35(9): 791-795.
18. Arslan H, Uygun AD, Keskin A, Karatas E, Seçkin F, et al. (2015) 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 48(12): 1199-1203.
19. Kolosowski KP, Sodhi RN, Kishen A, Basrani BR (2014) Qualitative
analysis of precipitate formation on the surface and in the tubules
of dentin irrigated with sodium hypochlorite and a final rinse of
chlorhexidine or QMiX. J Endod 40(12): 2036-2040.
20. Krishnamurthy S, Sudhakaran S (2010) Evaluation and prevention of
the precipitate formed on interaction between sodium hypochlorite and
chlorhexidine. J Endod 36(7): 1154-1157.
21. Magro MG, Kuga MC, Aranda Garcia AJ, Victorino KR, Chávez Andrade GM,
et al. (2015) Effectiveness of several solutions to prevent the formation
of precipitate due to the interaction between sodium hypochlorite and
chlorhexidine and its effect on bond strength of an epoxy-based sealer.
Int Endod J 48(5): 478-483.
22. González López S, Camejo Aguilar D, Sanchez P, Bolaños Carmona V
(2006) Effect of CHX on the decalcifying effect of 10% citric acid, 20%
citric acid, or 17% EDTA. J Endod 32(8): 781-784.
23. Do Prado M, Simão RA, Gomes BP (2013) Evaluation of different
irrigation protocols concerning the formation of chemical smear layer.
Microsc Res Tech 76(2): 196-200.
24. (2012) Dentsply Tulsa Dental Specialities. QMiX® 2 in 1 Irrigating
Solution, Directions for Use.
Copyright@ Tatjana Kanjevac| Biomed J Sci & Tech Res| BJSTR. MS.ID.002512.
10500
DOI: 10.26717.BJSTR.2019.14.002512
Volume 14- Issue 2
25. Mortenson D, Sadilek M, Flake NM Paranjpe A, Heling I, et al. (2012) 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 45(9): 878-882.
26. Paqué F, Luder HU, Sener B, Zehnder M (2006) Tubular sclerosis rather
than the smear layer impedes dye penetration into the dentine of
endodontically instrumented root canals. Int Endod J 39(1): 18-25.
27. Akisue E, Tomita VS, Gavini G, Poli de Figueiredo JA (2010) Effect of
the combination of sodium hypochlorite and chlorhexidine on dentinal
permeability and scanning electron microscopy precipitate observation.
J Endod 36(5): 847-850.
28. Gasic J, Popovic J, Zivković S, Petrovic A, Barac R, et al. (2012)
Ultrastructural analysis of the root canal walls after simultaneous
irrigation of different sodium hypochlorite concentration and 0.2%
chlorhexidine gluconate. Microsc Res Tech 75(8): 1099-1103.
ISSN: 2574-1241
DOI: 10.26717.BJSTR.2019.14.002512
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