Reduction in Bacterial Loading Using MTAD as an Irrigant in Pulpectomized Primary Teeth

The aim of the present study was to evaluate the reduction in bacterial loading uing MTAD as an irrigating solution in pulpectomized primary teeth. Study design: A randomized, controlled clinical trial was performed that included primary teeth with pulp necrosis. Sixty necrotic canals were included, 30 irrigated with MTAD (experimental group) and 30 with 1% Na0Cl solution (control group); in all cases, 2 microbiological samples from within the canals were taken with sterile paper points, the first after the canal opening and before the first irrigation, and the second after instrumentation and final irrigation, before obturation. All samples were evaluated by Agar plate method. Results: The results were statistically analyzed by student ‘t’ test. After analyzing samples before and after irrigation in the control group (NaOCl), we found a significant decrease of bacterial load ( p = < 0.001). The same occurred in the MTAD group samples ( p = < 0.001). When both groups were compared post irrigation, a statistically significant difference was observed in favor of MTAD. Conclusion: MTAD can be suggested as an alternative irrigant for pulpectomy of necrotic teeth.

pulpectomy, MTAD, 1% Na0Cl

1. Oncag O, Hosgor M, HilmiogluS, Zekioglu O, Eronat C, Burhanoglu D. Comparison of antibacterial and toxic effects of various root canal irrigants. Int Endod J;36:423-32.. 2003.

2. Cohen S, Burns RC. “Las vias de la pulpa” 8th ed. Madrid, spain: Mosby,:254-59. 2002.

3. Regan JD, Fleury AA. Irrigants in non surgical endodontic treatment. J Am Dent Assoc 2006;52:84-92.

4. Zehnder M. Root canal irrigants.j Endod;32:389-98. 2006.

5. Holan G, Fuks AB. A comparison of pulpectomies using ZOE and KRI paste in primary molars: A retrospective study. Pediatr Dent;15:403-7. 1993.

6. Medici MC, Froner IC. A scanning electron microscopic evaluation of different root canal irrigation regimes. Braz Oral Res;20:235-40. 2006,

7. Zehnder M, Kosicki D, Luder H, Sener B, Waltimo T. Tissue dissolving capacity ans antimicrobial effect of buffered and unbuffered hypochlorite solutions. Oral Surg Oral Med Oral Radiol Endod;94:756-62. 2002.

8. Hulsmann M, Hahn W. Complications during root canal irrigation: literature review and case reports. Int Endod J;33:186-93. 2003.

9. Gernhardt CR, Eppendorf K, Kozlowski A, Brandt M. Toxicity of concentrated sodium hypochlorite used as an endodontic irrigant. Int Endod J;37:272-80. 2004.

10. Torabinejad M, Johnson WB, inventors. Irrigation solution and methods for use. US Patent 20030235804. December 25,2003.

11. Shabahang S, Mahmoud Torabinejad. Effect of MTAD on Enterococcus faecalis – Contaminated root canals of extracted human teeth. J Endod ;9:576-579. 2003.

12. Singla MG, Garg A, Gupta S. MTAD in endodontics: an update review. Oral Surg Oral Med Oral Pathol Oral Radio Endod;112(3):e70-76. 2011.

13. Torabinejad M, Shabahang S, Bahjri K. Effect of MTAD on postoperative discomfort: a randomized clinical trial. J Endod;31:171-176. 2005.

14. Zhang W, Torabinejad M, Li Y. Evaluation of cytotoxicity of MTAD using the MTT-tetrazolium method. J Endod;29:654-657. 2003.

15. Frais S, Ng Yl, Gulabivala K. Some factors affecting the concentration of available chlorine in commercial sources of sodium hypochlorite. Int Endod J;34:206-15. 2001.

16. Landis JR, Koch G. The measurement of observer agreement for categorical data. Biometrics;33:159-74. 1977.

17. Carlsson J, Sundqvist G. Evaluation of methods of transport and cultivation of bacterial specimens from infected dental root canals. Oral Surg Oral Med Oral Pathol;;49:451-54. 1980.

18. Manzur A, Gonzalez AM, Pozos A, Silva Herzog D, Friedman S. Bacteria quantification in teeth with apical periodontitis related to instrumentation and different intracanal medications: a randomized clinical trial. J Endod;33:114-18. 2007.

19. Siqueira JF Jr, Rocas IN: Catonella morbid and Granulicatella adiancodens: new species in endodontic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod;102:259-64. 2006.

20. Elizabeth Martin, Mangala A. Nadkarni, Nicholas A. Jacques Neil Hunter. Quantitative microbiological study of human carious dentin by culture and real-time PCR: Association of anaerobes with histopathological changes in chronic pulpitis. Clin. Microbiol; 40 [5]:1698-1704. 2002.

21. Bernard Rosner .Fundamentals of Biostatistics, 5th Ed, Duxbury;.p. 80-240.2002.

22. Ruiz Esparza CL, Garrocho Rangel A, Gonzalez Amaro AM, Flores REeyes H, Pozos Guillen AJ. Reduction in bacterial loading using 2% chlorhexidine gluconate as an irrigant in pulpectomized primary teeth : A preliminary report. J Clin Pediatr Dent;35[3]:265-70. 2011.

23. Gomes BP, Lilley JD, Drucker DB. Associations of endodontic symptoms and signs with particular combinations of specific bacteria. Int Endod J;29:69-75. 1996.

24. Torabinejad M, Shabahang S, Aprecio R, Kettering. The antimicrobial effect of MTAD: An in vitro investigation.; J Endod;29:400-03. 2003.

25. Shabahang S, Pouresmail M, Torabinejad M. In vitro antimicrobial effect of MTAD and NaOCl.; J Endod;29:450-52. 2003.

26. Siqueria JF, Machado AG, Silveria 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 root canals in vitro. Int Endod J;30:279-82. 1997.

27. Torabinejad M, Khademi AA, Babagoli J. A new solution for removal of the smear layer. J Endod;29:170-75. 2003.

28. Asha Nara, Dhanu, Prakash Chandra, Lata Anandakrishna, Dhananjaya. Comparative evaluation of antimicrobial efficacy of MTAD. 3% NaOCl and propolis against E. faecalis. IJCPD;3[1]:21-25. 2010.

29. Carlsson J, Sunquist G. Evaluation of methods of transport and cultivation of bacterial specimens from infected dental root canals. Oral Surg Oral Med Oral Pathol;49:451-54. 1980.

30. Manzur A, Gonzalez AM, Pozos A, Silva Herzog D, Friedman S. Bacterial quantification in teeth with apical periodontitis related to instrumentation and different inracanal medications: a randomized clinical trial. J Endod;33:114-18. 2007.

31. Ng YL, Spratt D, Sriskantharajah S, Gulabivala K. Evaluation of protocols for field contamination before bacterial sampling of root canals for contemporary microbiology techniques. J Endod;29:317-20. 2003.

32. Siqueira JF Jr, Rocas IN, Favieri A, Lima KC. Chemomechanical reduction of the bacterial population in the root canal after instrumentation and irrigation with 1%, 2.5% and 5.25% sodium hypochlorite. J Endod;26:331-4. 2000.

33. Siqueira JF Jr, Rocas IN, Santos SR, Lima KC, Magalhaes FA, de Uzeda M. Efficacy of instrumentation techniques and irrigation regimes I reducing the bacterial population within root canals. J Endod;28:181-4. 2002.

34. Estrela CR, Estrela C, Reis C, Bammann LL, Pecora JD. Control of microorganisms in vitro by endodontic irrigants. Braz Dent J;14:187-92. 2003.

35. Camara AC, de Albuquerque MM, Aguiar CM, de Barros Correia AC. In vitro antimicrobial activity of 0.5%, 1% and 2.5% sodium hypochlorite in root canals instrumented with the Protaper Universal system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod;108:e55-61. 2009.

36. D Arcangelo C, Varvara G, de Fazio P. An evaluation of the action of different root canal irrigants on facultative aerobicanareobic, obligate anaerobic and microaerophilic bacteria. J Endod;25:351-3. 1999.

37. Naenni N, Thoma K, Zehnder M. Soft tissue dissolution capacity of currently used and potential endodontic irrigants. J Endod;30:785-7. 2004.

38. Baumgartner JC, Cuenin PR. Efficacy of several concentrations of sodium hypochlorite for root canal irrigation. J Endod;18:605-12. 1992.

39. Beltz RE, Torabinejad M, Pouresmail M. Quantitative analysis of the solubilizing action of MTAD, sodium hypochlorite and EDTA on bovine pulp and dentin. J Endod;29:334-7. 2003.