Document Type : Original Article

Authors

1 Dept. of Endodontics, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.

2 Dentist, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.

3 Dept. of Oral Medicine, Dental School, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.

4 Dept. of Basic Medical Sciences, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.

5 Postgraduate Student, Dept. of Operative Dentistry, Faculty of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.

6 Postgraduate Student, Dept. of Endodontics, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.

Abstract

Background: The elimination of pathogenic microorganisms is crucial in endodontic treatments, as Enterococcus faecalis is involved in the majority of endodontic failures. This bacterium is known for its resilience and ability to persist within the root canal system, often leading to treatment complications.
Purpose: The aim of this study was to compare the antibacterial efficiency of three different irrigation methods including passive ultrasonic, XP Endofinisher file, and Laser Diode 810 nm in infected roots with Enterococcus faecalis (E.faecalis) biofilm.
Materials and Method: In this experimental study, 48 anterior single-canal teeth were enrolled. After cutting their crowns, the teeth were cultured with E. faecalis and then randomly divided into four groups. Following preparation through the rotary system up to F4 at the working length, passive ultrasonic irrigation (Ultra X) was used inside the root canal in the first group. In the second group of the study, the XP Endofinisher file was applied to activate the irrigation solution, while in the third group, the Laser Diode 810 nm was used. The fourth group served as the control group and did not utilize any irrigation. The irrigation solution employed across all groups consisted of 1ml of 5.25% sodium hypochlorite (NaOCl), followed by a final irrigation with 5ml of 17% ethylenediaminetetraacetic acid (EDTA), 5ml of 5.25% NaOCl, and 5ml of sterile saline. After canal irrigation and sampling, bacterial colony counting was conducted, and the data were recorded. If the data were normally distributed, a variance test analysis was used; otherwise, the non-parametric Kruskal-Wallis test was applied. The tests were performed at a 5% significance level using SPSS software version 24.
Results: The reduction in the number of bacterial colonies was significantly greater in all three methods compared to the control group. The obtained data revealed that the antibacterial effect of Laser 810 nm was considerably (p< 0.05) higher than the other two groups and reduction in the number of colonies in Ultra X group was remarkably (p< 0.05) greater than the XP Endofinisher file group.
Conclusion: All three mentioned methods were effective in reducing the number of bacteria in endodontic treatments. Notably, the antibacterial efficiency of the Laser Diode 810 nm was significantly greater than that of the other two methods.

Highlights

Maryam Zare Jahromi (Google Scholar)

Amirreza Mokabberi (Google Scholar)

Keywords

  • Esmati F, Darmiani S, Nikoomanesh F, Allahyari E. Comparison of the effect of XP-endo finisher file and endoactivator in debridement of the root canals infected with Candida albicans: an in vitro J Mashhad Dent School. 2020; 20; 44: 73-80.
  • Espinoza I, Villar AJ, Loroño G, Estevez R, Plotino G, Cisneros R. Effectiveness of XP-Endo Finisher and Passive Ultrasonic Irrigation in the Removal of the Smear Layer Using Two Different Chelating Agents. J Dent. 2022; 22: 243.
  • Mousavizahed S, Amini K, Ansari G, Irrigation efficacy of Calcipex II during cleaning and shaping on Enterococcus faecalis. Iranian J Ped Dent. 2014; 9: 47-54.
  • Yaghooti*Khorasani M, Dehnavi E. A antimicrobial effects of Matrica® and chlorehexidine mouthwashes compared with sodium hypochlorite on Enterococcus faecalis and Candida albicans: an in vitro J Mashhad Dent School. 2016; 40: 177-186.
  • Farhad AR, Barekatain B, Sadeghi SA. Comparison of the effect of three root canal irrigant protocols for removing smear layer on the apical microleakage of tubliseal sealer. J Dent. 2010; 11: 21-27.
  • Yang SE, Kim YM. Comparison of Anti-Bacterial Efficacy between Passive Ultrasonic Irrigation and 980 nm-GaAlAs Laser Application in Two Root Types. Medicina. 2021; 57: 537.
  • Mozo S, Llena C, Forner L. Review of ultrasonic irrigation in endodontics: increasing action of irrigating solutions. Med Oral Patol Oral Cir Bucal. 2012; 17: e512.
  • Sahebi S, Moazami F, Sahraei S. Comparison of three Intra-canal Irrigants Effect on Flare-up Following Treatment of Necrotic Teeth. J Dent. 2010; 11: 49-56.
  • Koulogiannis A, Walmsley AD, Angeli P, Balabani S. Ultrasonic irrigation flows in root canals: effects of ultrasound power and file insertion depth. Sci Rep. 2024; 14: 5368.
  • Alves LS, Ormiga F, de Lima CO, Lopes RT, Gusman H. Root canal dentin wear during final irrigation in endodontic retreatment with passive ultrasonic irrigation and easy clean instruments. J Conserv Dent Endod. 2024; 27: 246-251.
  • Di-Nardo D, Gambarini G, Miccoli G, Di Carlo S, Iannarilli G, Lauria G, et al. Sonic vs Ultrasonic activation of sodium hypoclorite for root canal treatments. In vitro assessment of debris removal from main and lateral canals. Giornale Italiano Di Endodonzia. 2020; 34: 90-96.
  • Zhou J, T Liu, Guo L. Effectiveness of XP-Endo Finisher, and passive ultrasonic irrigation on intracanal medicament removal from root canals: a systematic review and meta-analysis. BMC Oral Health. 2021; 21: 1-15.
  • Lauritano D, Moreo G, Carinci F, Della Vella F, Di Spirito F, Sbordone L, et al. Cleaning efficacy of the XP-Endo® Finisher instrument compared to other irrigation activation procedures: a systematic review. Applied Sci. 2019; 9: 5001.
  • Bao P, Shen Y, Lin J, Haapasalo M. In Vitro Efficacy of XP-endo Finisher with 2 Different Protocols on Biofilm Removal from Apical Root Canals. J Endod. 2017; 43: 321-325.
  • Jiang AP, Ipe DS, Love RM, George R. Evaluation of bacterial kill in human roots infected with Enterococcus faecalis biofilm following 980 nm laser activation of chlorhexidine. Transl Biophotonics. 2020; 2: e202000008.
  • Schoop U, Kluger W, Moritz A, Nedjelik N, Georgopoulos A, Sperr W. Bactericidal effect of different laser systems in the deep layers of dentin. Lasers Surg Med. 2004; 35: 111-116.
  • Elsaka S, Hussein W, Hashem A, Soliman A. The Effect of Passive Ultrasonic Irrigation or XPEndo Finisher on Post-Operative Pain in Patients with Necrotic Teeth with Apical Periodontitis (Randomized Controlled Clinical Trial). Open Access Maced J Med Sci. 2022; 21: 197-204.
  • Toljan I, Bago I, Anić I. Eradication of intracanal Enterococcus faecalis biofilm by passive ultrasonic irrigation and RinsEndo system. Acta Stomatol Croat. 2016; 50: 14.
  • Dumani A, Guvenmez HK, Yilmaz S, Yoldas O, Kurklu ZG. Antibacterial efficacy of calcium hypochlorite with vibringe sonic irrigation system on enterococcus faecalis: An in vitro Biomed Res Int. 2016; 2016: 8076131.
  • Brito PR, Souza LC, de-Oliveira JC, Alves FR, De-Deus G, Lopes HP, et al. Comparison of the effectiveness of three irrigation techniques in reducing intracanal Enterococcus faecalis populations: an in vitro J. Endod. 2009; 35: 1422-1427.
  • Becking AG. Complications in the use of sodium hypochlorite during endodontic treatment: report of three cases. Oral Surg Oral Med Oral Patho. 1991; 71: 346-348.
  • Kumar KN, Kms LK. Comparison of the incidence of postoperative pain after using two continuous rotary file system with conventional needle and ultrasonic irrigation in single visit endodontics: An in vivo Int J Med Sci Diagnosis Res. 2021; 5: 78-84.
  • Carvalho MC, Zuolo ML, Arruda-Vasconcelos R, Marinho ACS, Louzada LM, Francisco PA, et al. Effectiveness of XP-Endo Finisher in the reduction of bacterial load in oval-shaped root canals. Braz Oral Res. 2019; 33: e021.
  • Ghahari P, Ghahhary A, Behrad S, Sadat*Afraz E. The Efficiency of Erbium Lasers in the Removal of Root Canal System and Surface Biofilms: A Systematic Review and Meta-Analysis. Photobiomodul Photomed Laser Surg. 2024; 42: 267-274.
  • Diaci J, Gaspirc B. Comparison of Er: YAG and Er, Cr: YSGG lasers used in dentistry. J laser health Acad. 2012; 1: 1-3.
  • Arslan H, Ayrancı LB, Karatas E, Topçuoǧlu HS, Yavuz M S, Kesim B. Effect of agitation of EDTA with 808-nanometer diode laser on removal of smear layer. J Endod. 2013; 39: 1589-1592.
  • Dhawan S, Jasuja P, Khurana H, Gakhar E, Singh H. A comparative evaluation of the efficacy of erbium: yttrium– aluminum–garnet and diode lasers in smear layer removal and dentin permeability of root canal after biomechanical preparation–A scanning electron microscopy study. J Indian Soc Pedod Prev Dent. 2020; 38: 64-70.
  • Alkhudhairy F. Canal disinfection using Nd: YAG Laser, synchronized microbubble-photodynamic activation, and carbon quantum dots on microhardness, smear layer removal, and extrusion bond strength of zirconia post to canal dentin. An invitro scanning electron microscopic analysis. Microsc Res Tech. 2024; 87: 2043-2052.
  • Luk K, Zhao IS, Gutknecht N, Chu CH. Use of carbon dioxide lasers in dentistry. Lasers Dent Sci. 2019; 3: 1-9.
  • Schoop U, Kluger W, Moritz A, Nedjelik N, Georgopoulos A, Sperr W. Bactericidal effect of different laser systems in the deep layers of dentin. Lasers Surg Med. 2004; 35: 111-116. 
  • Moeintaghavi A, Ahrari F, Fallahrastegar A, Salehnia A. Comparison of the effectiveness of CO2 and diode lasers for gingival melanin depigmentation: a randomized clinical trial. J Lasers Med Sci. 2022; 13:e8. doi:10.34172/ jlms.2022.8.
  • Ashofteh K, Sohrabi K, Iranparvar K, Chiniforush N. In vitro comparison of the antibacterial effect of three intracanal irrigants and diode laser on root canals infected with Enterococcus faecalis. Iran J Microbiol. 2014; 6: 26.
  • Gutknecht N, Franzen R, Schippers M, Lampert F. Bactericidal effect of a 980-nm diode laser in the root canal wall dentin of bovine teeth. J Clin Laser Med Surg. 2004; 22: 9-13.
  • Krikun EV, Blashkova SL. Diode laser in dental practice. Kazan Med J. 2017; 98: 1023-1028.
  • Wong J, Manoil D, Näsman P, Belibasakis GN, Neelakantan P. Microbiological aspects of root canal infections and disinfection strategies: an update review on the current knowledge and challenges. Front Oral Health. 2021; 25: 672887.
  • Asnaashari M, Ebad LT, Shojaeian S. Comparison of Antibacterial Effects of 810 and 980- nanometer Diode Lasers on Enterococcus Faecalis in the Root Canal System: An in vitro Laser Ther. 2016; 25: 209-214.
  • Beer F, Buchmair A, Wernisch J, Georgopoulos A, Moritz A. Comparison of two diode lasers on bactericidity in root canals- an in vitro study. Lasers Med Sci. 2012; 27: 361-364.
  • Alakshar A, Saleh ARM, Gorduysus MO. Debris and Smear Layer Removal from Oval Root Canals Comparing XP-Endo Finisher, EndoActivator, and Manual Irrigation: A SEM Evaluation. Eur J Dent. 2020; 14: 626-633.
  • Espinoza I, Conde Villar AJ, Loroño G, Estevez R, Plotino G, Cisneros R. Effectiveness of XPEndo Finisher and Passive Ultrasonic Irrigation in the Removal of the Smear Layer Using Two Different Chelating Agents. J Dent (Shiraz). 2021; 22: 243-251.
  • Bisen P, Malur M, Sahu Y, Singh A, Mishra P, Pal A, et al. To evaluate the efficacy of XP endo finisher and passive ultrasonic irrigation for smear layer removal using scanning electron microscopy: An in vitro Int J Appl Dent Sci. 2021; 7: 257-261.