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ORIGINAL ARTICLE
Year : 2015  |  Volume : 9  |  Issue : 1  |  Page : 2-10

An in vivo study on comparison of disinfection of root canal with chemical disinfectants and disinfectant-diode laser-photodynamic treatment combined system


1 Faculty, College of Dentistry, Ajman University of Science and Technology, Al Fujairah, United Arab Emirates
2 Intern, Ajman University of Science and Technology, Al Fujairah, United Arab Emirates
3 Al Balsam Dental Centre, Ajman University of Science and Technology, al Fujairah, United Arab Emirates
4 Faculty, College of Pharmacy, Ajman University of Science and Technology, al Fujairah, United Arab Emirates
5 Faculty, College of Requirement, Ajman University of Science and Technology, Al Fujairah, United Arab Emirates

Date of Web Publication22-May-2015

Correspondence Address:
Dr. Asok Mathew
Ajman University of Science and Technology, Al Fujairah
United Arab Emirates
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-2868.157586

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  Abstract 

Background: Use of laser in dentistry is an approved modality of treatment in various specialties including endodontics. We aim to compare the disinfecting potential of the chemical method with laser alone and combination of laser photodynamic therapy with chemical method after rotary method of bio mechanical preparation. Materials and Methods: 38 patients were selected from the university clinics of Ajman University of science and technology Al Fujairah campus and divided them in to 3 groups who were clinically or /and radio graphically diagnosed cases of peri-apical disease. Percentage of bacterial growth reduction was assessed in both nonselective media like blood agar and in a selective media like mitis salivarius. In both media, percentage of bacterial reduction was analyzed with the ANOVA table. Results: The P-value (0.000) for Samples indicates that there is sufficient evidence that not all the means of samples are equal when a = 0.05 and in order to explore the differences among the means of the samples, it was found that the multiple comparison results were having similar means with regard to group A and group B. Moreover, it was noted that the mean of group C differs from the means of group A and B. Conclusions: In both of the microbiological study by Blood Agar and Mitis Salivarius media, it showed that application of either Diode laser or NaOCl alone will not bring considerable reduction in the bacterial colony. It was observed that the synergic effect of Diode laser combined with NaOCl was found to be very effective.

Keywords: Blood agar, diode laser, Mitis Salivarius, root canal treatment, Streptococcus sp


How to cite this article:
Mathew A, Lajevardi M, Abdullah Al Juboori HA, Abu Mukhaimer NH, Al-Radaideh AA, Thomas S. An in vivo study on comparison of disinfection of root canal with chemical disinfectants and disinfectant-diode laser-photodynamic treatment combined system. J Dent Lasers 2015;9:2-10

How to cite this URL:
Mathew A, Lajevardi M, Abdullah Al Juboori HA, Abu Mukhaimer NH, Al-Radaideh AA, Thomas S. An in vivo study on comparison of disinfection of root canal with chemical disinfectants and disinfectant-diode laser-photodynamic treatment combined system. J Dent Lasers [serial online] 2015 [cited 2020 Oct 29];9:2-10. Available from: https://www.jdentlasers.org/text.asp?2015/9/1/2/157586


  Introduction Top


Currently, root canal therapy mainly comprise of disinfecting the canal space by utilizing a combination of mechanical removal of tissue and chemical decontamination. The use of lasers in aiding root canal disinfection is more promising than in root canal biomechanical preparation.

For disinfection, laser energy can be used directly or can be combined with a photosensitive chemical that, when bound to microorganisms, may be activated by low-energy laser light to essentially kill the microorganism (photodynamic therapy [PDT]). Another line of experiments suggests that the propagation of acoustic waves emanating from a pulsed-low energy laser may aid in distributing disinfecting solutions more effectively across the root canal system (photon induced photo-acoustic streaming). [1],[2]

The advantages of using the laser, however, are balanced by several significant disadvantages. Root canal spaces are rarely straight and more often are curved in at least two dimensions. Root canal instruments used to clean the space throughout its length can be curved to follow the curvatures in a tooth root. In contrast, laser light will travel on a straight path; laser probes should be fabricated in a way that the laser light emerges laterally, uniformly interacting with the root canal wall. [2],[3]

The interactions involved between laser energy and the tissue can cause a rise in temperature. The increased temperature can char the canal space, damaging it to the point that the tooth may be lost. The increased temperatures also may extend to the outer surfaces of the tooth, damaging the soft tissue that connects the tooth to the surrounding bone. If the temperature is high enough, the bone surrounding the tooth may also be irreversibly injured, adversely affecting the entire area, which can result in ankylosis. [3] Moreover, cycles of melting and re-solidification of the radicular wall dentin apparently have no positive effect on clinical outcomes. [4],[5]

The use of lasers as an aid in disinfection has been researched extensively in the last few years. Currently, there exists, a body of evidence for in vitro in vivo studies on the antibacterial efficacy of high-power laser and PDT. [3],[6] However, their effects on the clinical outcomes of root canal therapy are not known at this point. While the FDA has approved diode laser as an adjunct for removal of pulp tissue in a pulpotomy procedure and apicoectomy, more research is required to develop laser energy for use in nonsurgical endodontics so that it is equal, if not superior, to present treatment modalities. Until that research is complete, patients should ask about the use of lasers in root canal treatment, especially in light of the high success rate of nonlaser procedures carried out by those trained to perform them. [7],[8],[9]


  Subjects and Methods Top


Totally, 38 patients with clinically and radiographically diagnosed periapical disease were selected randomly from Ajman University's Dental Clinic, Fujairah Campus. The study was approved by the ethical committee of Ajman University of Science and Technology. The patients were grouped into three groups. In Group A, saline along with diode laser combination was used on 10 patients and in Group B, 0.5%NaOCl was applied alone on 18 patients. Group C comprises of 10 patients with application of 0.5%NaOCl + diode laser with photosensitive dye, periogreen.

Patients were selected based on the following criteria

Inclusion criteria

  • Patients who are not having any history of tobacco usage
  • Patients with no systemic disease and with no history of any antibiotics at the time of intervention
  • Patients who are clinically or/and radiographically diagnosed as cases of periapical disease.


Exclusion criteria

  • Patients who are having any sort of periodontal disease with clinically and radiographic changes suggestive of periodontal/combined lesions.
In all the cases, preoperative IOPA was taken, and working length was estimated by k-file No-15/20. Samples were taken from patients, before getting mechanically prepared by I Race endodontic system by (FKG Switzerland) using sterile k-file size 15. All the samples were transferred directly in nutrient broth for 2 h in room temperature and cultured in both blood agar and Mitis Salivarius agar media. Diode laser SIRO laser advance (SIRONA USA) with wavelength 970 nm was used with 1.5 w power frequency: 15 Hz, energy: 21.2 J, average power: 0.7 w for groups A and C after application of indocyanine dye, (periogreen ® elixxion AG Radolfzell, Germany), for 3-5 min. The optic fiber flexible tips of size 200 mm were used for <1 mm from the working length of individual tooth. The fiber was moved in upward and downward manner for 60 s [Figure 1] and [Figure 2].
Figure 1: SIRO laser advance (Sirona USA)

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Figure 2: Periogreen photosensitive dye

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Postoperative samples were collected after I race rotary preparation and application of either laser alone in group A, sodium hypochlorite in group B and combination of laser and sodium hypochlorite in group C. Canal was dried with sterile paper points, and samples were taken with sterile file size of 30 and transferred directly to nutrient broth for 2 h in room temperature and cultured in both Blood Agar and Mitis Salivarius agar media and keep all the samples in Incubator at 37°C for 24 h [Figure 3] [Figure 4] [Figure 5] [Figure 6] [Figure 7] [Figure 8].
Figure 3: Blood Agar growth (Group A) before intervention

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Figure 4: Mitis Salivarius growth (Group A) before intervention

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Figure 5: Mitis Salivarius growth (Group B) before intervention

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Figure 6: Blood agar growth in group B before intervention

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Figure 7: Mitis Salivarius growth before intervention (Group C)

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Figure 8: Blood agar growth before intervention (Group C)

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A volume of 0.1 ml sample was diluted with the dilution factor DF = 100. 0.1 ml of solution was taken and spread it all over the media (Blood Agar and Mitis Salivarius Agar) media were kept in an incubator at 37°C for 24 h. Colonies were counted with colony counter manual method [Figure 9] [Figure 10] [Figure 11] [Figure 12] [Figure 13] [Figure 14].
Figure 9: Blood Agar growth after intervention (Group A)

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Figure 10: Mitis Salivarius growth (Growth A) after intervention

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Figure 11: Mitis Salivarius growth (Group B) after intervention

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Figure 12: Blood Agar growth after intervention (Group B)

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Figure 13: Mitis Salivarius growth after intervention (Group C)

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Figure 14: Blood agar growth after intervention (Group C)

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Samples were again taken from the grown colonies and stained with Gram-staining to find out the reduction of the Gram-positive aerobic strains [Figure 15] [Figure 16] [Figure 17] [Figure 18] [Figure 19].
Figure 15: Gram-stained bacterial colonies in blood agar (group C) before intervention

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Figure 16: Reduced Gram-stained bacterial colonies after intervention in blood agar (Group C)

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Figure 17: Gram-staining before intervention Mitis Salivarius medium

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Figure 18: Gram-staining after NaOCl application

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Figure 19: Gram-staining after diode laser application plus periogreen along with sodium hypochlorite

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  Results Top


The mean age of the 38 patients studied was 26.84 years with a standard deviation of 10.39 and a range of 9-58 years. According to the gender, 23% of the patients were females and 77% of them were male patients [Figure 20].
Figure 20: Sex distribution of patients

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The selected patients had the following results with 13.2% of patients do not have periodontal widening but in the other hand, 86.8% of the sample do have periodontal widening. Among the patients, 68.4% had periapical radiolucency and while 31.6% of patients had no periapical radiolucency. 55.3% of patients in this study had spontaneous pain as chief complaint and 44.7%, did not have pain as complaint. 57.9% of patients had pain on percussion but in the other hand, 42.1% of samples had pain on percussion.

The percentage of bacterial reduction was calculated in blood agar and Mitis Salivarius media separately for group A, B and C [Table 1] [Table 2] [Table 3].

In the blood agar media, it can be seen in the above figures, that the mean of the two samples (group A and group B) are close together but the mean of sample C is far away from both group A, and group B [Figure 21] and [Figure 22].
Figure 21: Box plot showing comparison of groups in blood agar medium

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Figure 22: Line diagram showing comparison of groups in blood agar medium

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Table 1: Reduction of number of bacterial colonies and percentage of reduction in group A


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Table 2: Reduction of number of bacterial colonies and percentage of reduction in group B


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Table 3: Reduction of number of bacterial colonies and percentage of reduction in group C


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In the ANOVA table, the P value (0.000) for Samples indicates that there is sufficient evidence that not the means of all samples are equal when a = 0.05 and in order to explore the differences among the means of the samples a multiple comparisons was made, we found that the results had similar means with regard to group A, and group B. Moreover, it was found that the mean of group C differs from the means of group A, and B [Table 4].
Table 4: Mean of percentage of bacterial reduction in B.A media


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In Mitis Salivarius media, it can be seen the above figures, the mean of the two samples (group A, and group B) are close together but the mean of sample C is far away from both group A, and group B [Figure 23] and [Figure 24].
Figure 23: Box plot showing the comparison of groups in Mitis Salivarius

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Figure 24: Line diagram showing the comparison of groups in Mitis Salivarius

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In the ANOVA table, the P value (0.000) for Samples indicates that there is sufficient evidence that not the means of all samples are equal when a = 0.05 and in order to explore the differences among the means of the samples. A multiple comparison was carried out, and the results showed that group A and group B were having similar means. Moreover, it was found that the mean of group C differs from the means of group A, and B (In Mitis Salivarius media) [Table 5].
Table 5 : Mean of percentage of bacterial reduction in M.S media


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  Discussion Top


There is a direct relation between disinfection of root canal system and success of endodontic treatments. Laser therapy has shown great promise in removal of the smear layer, bacteria and infection in endodontics. Studies have shown that conventional instrumentation together with irrigant solution can only remove partially. [10] Diode laser wavelengths balance between absorption and penetration to bring energy below dentinal surface without tending to damage it. Diode laser energy is able to activate chemical irrigants to increase their bactericidal effects. [11] In the present study combination of NaOCl and Diode Laser was more effective than either NaOCl or Laser alone, but there is a need to continue the study with higher number of samples and compare with other kinds of laser with different wavelength, power, frequency and treatment time. [10],[12]

Clinical studies clearly show advantages of laser treatments over currently-used conventional methods and techniques. The most important advantages are improved disinfection efficacy, more effective root canal cleaning, reduction of permeability, reduction of micro-leakage, and elimination of the need to use toxic solvents. According to this study, it was concluded that the reduction of Gram-positive bacteria [12],[13] (Streptococcus sp.) after usage of diode laser and NaOCl is found to be significant. The application of diode laser might be an adjunct to conventional endodontic treatment when used in combination with a NaOCl solution. [13] Synergic effect of diode laser combined with NaOCl is found to be very effective in eradicating Gram-positive, aerobic bacteria (Streptococcus group). Reduction of total number of bacteria and specially Streptococcus group (Streptococcus mutans, Streptococcus salivaris, Streptococcus mitis and Enterococcus) after NaOCl and laser is completely obvious. [14],[15],[16] The use of PDT in endodontics is not much studied. [10] The use of periogreen ® mainly for periodontal diseases has shown excellent results. From our study, it was concluded that use of periogreen ® can be an excellent adjunct in eradicating microbes and disinfecting root canals.


  Conclusions Top


In the microbiological study by blood agar and Mitis Salivarius media, it shows that application of either diode laser or NaOCl alone will not bring considerable reduction in the bacterial colony. It is also observed that the synergic effect of diode laser PDT combined with NaOCl found to be very effective in eradicating Gram-positive, aerobic bacteria (Streptococcus group). There was a similar reduction in the mixed flora as cultivated by blood agar (non-selective medium).


  Acknowledgment Top


We acknowledge the ethical committee AUST Ajman, College of dentistry, College of pharmacy, Ajman University of science and technology, Fujairah for their valuable support in carrying out this project.

 
  References Top

1.
Ashofteh K, Sohrabi K, Iranparvar K , Chiniforush N, In vitro comparison of the antibacterial effect of three intracranial irrigants and diode laser on root canals infected with Enterococcus faecalis. Indian J Microbiol 2014;6:26-30.  Back to cited text no. 1
    
2.
Olivi M, Stefanucci M, Todea C. Laser assisted irrigation and hand irrigation for root canal decontamination: A comparison Daily Medicine. Proc SPIE 2014;8925:26-30. Fifth International Conference on Lasers in Medicine: Biotechnologies Integrated in Daily Medicine, 89250G (January 14, 2014); doi: 10.1117/12.2045494.  Back to cited text no. 2
    
3.
AAE Position Statement on Use Lasers in Dentistry, American Association of Endodontists; 2012. Available from: http://www.aae.org. [Last accessed on April 2014 ??]  Back to cited text no. 3
    
4.
Larick R. Helios Laser Diode Lasers and Root Canal Decontamination, Laser Dentistry for Todays; 2011. Available from: http://www.helioslaser.com/wp/training/diode-lasers-and-root-canal-decontamination/. Accessed in April 2014.  Back to cited text no. 4
    
5.
Benedicenti S, Cassanelli C, Signore A, Ravera G, AngieroF, Decontamination of root canals with the gallium-aluminum-arsenide laser: An in vitro study. Photomed Laser Surg 2008;26:367-70.  Back to cited text no. 5
    
6.
Gordon W, Atabakhsh VA, Meza F, Doms A, Nissan R, Rizoiu I, et al. The antimicrobial efficacy of the erbium, chromium: yttrium-scandium-gallium-garnet laser with radial emitting tips on root canal dentin walls infected with Enterococcus faecalis. J Am Dent Assoc 2007;138:992-1000.  Back to cited text no. 6
    
7.
Mohammadi Z. Sodium hypochlorite in endodontics: An update review. Int Dent J 2008;58:329-41.  Back to cited text no. 7
    
8.
Gutknecht N, Lasers in endodontics Journal of the Laser and Health Academy Vol. 2008;1-4. Available from: http://www.laserandhealth.com. [Last accessed on 2014 April 20].  Back to cited text no. 8
    
9.
Meire M, De Moor R. Laser disinfection, an added value? Endod Pract Today 2007;1:159-72.  Back to cited text no. 9
    
10.
Garcez AS, Efficiency of NaOCl and laser-assisted photosensitization on the reduction of Enterococcus faecalis in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:93-8.  Back to cited text no. 10
    
11.
Wang X, Sun Y, Kimura Y, Kinoshita J, Ishizaki NT, Matsumoto K. Effects of diode laser irradiation on smear layer removal from root canal walls and apical leakage after obturation. Photomed Laser Surg 2005;23:575-81.  Back to cited text no. 11
    
12.
Ng YL, Spratt D, Sriskantharajah S, Gulabivala K. J Endod. 2003;29:317-20.  Back to cited text no. 12
    
13.
Kreisler M, Ashofteh K, Sohrabi K, Iranparvar K, Chiniforush N. Efficacy of NaOCl/H2O2 irrigation and GaAlAs laser in decontamination of root canals in vitro. J Conserv Dent 2003;32:189-96.  Back to cited text no. 13
    
14.
Facklam R, and Pigott. N. Description of phenotypic characteristics to aid in the identification of Streptococcus pneumoniae. In A. Totollian 6 th ed. Pathogenic streptococci: Present and future. Lancer Publications, St. Petersburg, Russia. 1994. p. 415-7.  Back to cited text no. 14
    
15.
Facklam RR, JA Washington II. Streptococcus and related catalase-negative gram-positive cocci. In A. Balows, WJ. Hausler, Jr., K. L. Herrmann, H. D. Isenberg, and H. J. Shadomy (ed.), Manual of clinical microbiology, 5 th ed. American Society for Microbiology, Washington, DC. 1991. p. 238-57.  Back to cited text no. 15
    
16.
Emilson CG, Bratthall D. Growth of Streptococcus mutans on various selective media. J Clin Microbiol 1976;4:95-8.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19], [Figure 20], [Figure 21], [Figure 22], [Figure 23], [Figure 24]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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