Surface tension evaluation for different root canal irrigants: an in-vitro study



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Received : 12 02 14

Review completed : 28 03 14

Accepted : 09 04 14









Original Article

SURFACE TENSION EVALUATION FOR DIFFERENT ROOT CANAL IRRIGANTS: AN IN-VITRO STUDY
Ankur V Desai, * Sonali Taneja, ** Nile A Desai, *** Pragya Kumari
* Senior Lecturer, Department of Conservative and Endodontic Dentistry, Vaidik Dental College and Research Centre, Daman, Daman & Diu, India

** Professor & Head, Department of Conservative & Endodontic Dentistry, I.T.S. Dental College and Research Centre, Ghaziabad, Uttar Pradesh, India

*** Lecturer, Department of Conservative & Endodontic Dentistry, Vaidik Dental College and Research Centre, Daman, Daman & Diu, India

† Associate Professor, Department of Conservative and Endodontic Dentistry, I.T.S. Dental College and Research Centre, Ghaziabad, Uttar Pradesh, India

________________________________________________________________________


ABSTRACT

Background: Irrigation during endodontic therapy facilitates a debris-free and aseptic root canal. An efficient irrigant not only has flushing action, lubrication, tissue-dissolving ability, wide antimicrobial effect, and low toxicity; but also requires optimum physic-chemical pre-requisites like lower surface tension and higher wettability. Aim: The study evaluated and compared surface tension of conventional root canal irrigants with some newer irrigants. Material and Method: Surface tension of eight test solutions: MilliQ water (control group), 6% Morinda citrifolia, 15% Salvadora persica, MTAD, 1:120 Propolis, Smear clear and Sodium hypochlorite 3% were evaluated and compared. Test solutions from each group (100 ml each) were divided into 10 samples of 10 ml each. Surface tension of each group was measured using the Wilhelmy plate technique with the help of Kruss Tensiometer K100. LabDesk 2.0 software was used for surface tension determination. Results were tabulated and statistical analysis of the data was performed using one way ANOVA and Unpaired t test. Results: While MilliQ water had highest recorded mean surface tension, lowest surface tension was recorded with 15% Salvadora persica. Further, the results displayed surface tension in the following descending order: MilliQ water > 3% Sodium hypochlorite > 6% Morinda citrifolia > 1:120 Propolis > Smear Clear > MTAD > 15% Salvadora persica. All the results were statistically significant (p<0.01). Conclusion: The present study suggests that 15% Salvadora persica has the lowest surface tension amongst all the tested irrigating solutions and should be able to penetrate dentinal tubules the most and induce its antimicrobial effect.

KEYWORDS: Root canal irrigants; salvadora persica; propolis; morinda citrifolia; MTAD; smear clear; sodium hypochlorite
INTRODUCTION

Success of root canal therapy (RCT) depends on various factors like: accurate diagnosis, method and quality of instrumentation, irrigation, disinfection, and three dimensional obturation of the root canal. Of these, irrigation is evidenced to play a vital role in the success of RCT. Irrigation facilitates removal of residual tissues left after instrumentation, in the complicated and irregular structures of canal anatomy like fins, lateral canals and apical deltas, which are not negotiated by instrumentation.[1,2] Efficiency of irrigation can be attributed to mechanical and chemical effects of the irrigants that are crucial during irrigation. The ideal requisites of the irrigant solutions include; flushing action, lubrication, tissue-dissolving ability, wide antimicrobial effect and low toxicity. Literature evidences that the number of infected tubules and depth of penetration of bacteria are highly variable and may range from 150µm to 50 percent of the distance between the main root canal and the cement-dentinal junction. Hence, an ideal irrigant should also have the ability to penetrate the confined areas to such an extent. Furthermore, it has been documented that the efficiency of an endodontic irrigant could be improved by reducing its surface tension or by increasing fluid flow over the debris on the roo



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Suraface Tension Evaluation for Root Canal Irrigants Desai AV, Taneja S, Desai NA, Kumari P





Table 1: List of irrigants used in the experiment

Irrigant

Manufacturer

MilliQ water

Freshly prepared

6% Morinda citrifolia juice5

Indian Herbs, New Delhi

15% Alcoholic Extract of Salvadora persica6

Indian Herbs, New Delhi

MTAD

Biopure, Dentsply Tulsa Dental,

Johnson City, TN, USA



1:120 solution of Propolis7

C C Pollen Co., Phoenix, AZ, USA

Smear Clear

SybronEndo, Orange, CA

Sodium hypochlorite 3%

Novo Dental Products, Mumbai




Table 2: Mean surface tension values for all control and test solutions.

Groups

Mean (dyne/cm)

MilliQ water

70.19

6% Morinda citrifolia

41.646

15% Salvadora persica

26.457

MTAD

30.773

1:120 Propolis

40.604

Smear Clear

32.268

3% Sodium hypochlorite

51.965




canal wall.[3,4] Hence, an irrigant should have very low surface tension that enhance its wettability. In current dental practice, sodium hypochlorite and EDTA are the most commonly used irrigants. More recently, MTAD has been established as an efficacious irrigant. Efficacy of potential irrigants like Salvadora persica, Morinda citrifolia, and Propolis has been investigated rigorously in recent era. Many studies have demonstrated that the commonly used irrigating solutions are ineffective in completely removing hard and soft tissue debris. However, little information exists with respect to the surface tension of these solutions as a potential factor that may contribute to such inefficiency. Therefore, this study was designed to compare the surface tension of regularly used root canal irrigants with that of some of the newer root canal irrigants; and the object of this study was to evaluate and compare surface tension of conventional root canal irrigants with newer root canal irrigants.

MATERIALS AND METHODS

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Test Material

The irrigants compared by this study were: MilliQ water (control group), 6% Morinda citrifolia, 15% Salvadora persica, MTAD, 1:120 Propolis, Smear clear, and Sodium hypochlorite 3% (Table 1). Test solutions from each group (100 ml each) were divided into 10 samples of 10 ml each.



Surface Tension Determination

Each sample (from all eight groups) was tested to evaluate the surface tension; i.e. 10 samples from each group were tested. Surface tension of each group was measured using the plate method, also known as Wilhelmy plate technique. Kruss Tensiometer K100 (Kruss, Hamburg, Germany) was used for performing the technique. LabDesk 2.0 software was used for surface tension determination.



Laboratory Specifications

Temperature of 350C for all the groups was maintained during the study. Platinum plate was cleaned using acetone and distilled water after each reading. The plates were then dried over a Bunsen burner flame before the next use.



Statistical Analysis

Ten reading were taken for each test Groups. The mean of the ten readings obtained from each group was taken as the surface tension value of that group. Results were tabulated and statistical analysis of the data was performed using one way ANOVA and Unpaired t test.



RESULTS

As shown in Table 2, the mean surface tension of


Suraface Tension Evaluation for Root Canal Irrigants Desai AV, Taneja S, Desai NA, Kumari P






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15% Salvadora persica solution was the lowest (26.46 dyne/cm) when compared with all the other test irrigants and control. Moreover, the control group displayed the highest surface tension readings (mean 70.19 dyne/cm) when compared with the test irrigants. As per the results of this study the test solutions and control can be sequenced in the following order as per their mean surface tension readings: MilliQ water > 3% Sodium hypochlorite > 6% Morinda citrifolia > 1:120 Propolis > Smear Clear > MTAD > 15% Salvadora persica (Figure 1). Moreover, results of ANOVA revealed significant differences among the different test solutions’ surface tensions when compared with the control group (p<0.01).

DISCUSSION

The aim of endodontic treatment is elimination of microorganisms from the root canal system and to produce an impermeable seal between oral environment and periradicular space. Instrumentation of root canal leads to the formation of smear layer which contains remnants of tissues and bacteria. Several studies have reported that with currently available instrumentation systems and protocols, large areas of the root canal remain untouched by the instruments due to complex canal anatomy.[1] The presence of root canal debris left after instrumentation prevents the penetration of irrigants and medicaments into the dentinal tubules and prevents close adaptation of obturating material to the canal wall. The mechanical debridement of the root canal system fails to completely remove the debris from the root canal walls. This emphasizes the importance of irrigation for the removal of debris, bacteria, toxic products and substrates necessary for bacterial growth from the inaccessible, uninstrumented surfaces.[8] The search for an irrigating solution with antimicrobial properties, tissue dissolving ability and concomitant biocompatibility with the periapical tissues continues to be subject of many studies.[9] Sodium hypochlorite is most commonly used irrigant for last many years. It has excellent tissue dissolution and antimicrobial properties which makes it the solution of choice for treatment of teeth with pulp necrosis. Abou – Rass et al.,[10] and Cameron[4] demonstrated that addition of a surfactant would enhance the flow and penetration of the sodium hypochlorite into the canals in vitro. However, Sodium hypochlorite has few drawbacks like tissue toxicity, safety concerns, inefficiency in removing the smear layer completely and high surface tension. The quest of finding newer and better irrigants led to the development of new generation irrigants like Smear clear, MTAD, and herbal alternatives like 6% Morinda citrifolia, 15% Salvadora persica, and Propolis (honey be



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extract). Smear Clear is a mixture of EDTA and a surfactant. While EDTA is effective in removing the smear layer; it does not demonstrate required antibacterial action.[11] MTAD, is a mixture of antibiotic, acid and detergent. MTAD is an effective solution for the removal of smear layer[12] and it also eliminates Enterococcus faecalis effectively. However, MTAD has shown lower effect in removing bacteria.[13] The new herbal Morinda citrifolia juice (6%) has a broad range of therapeutic effects, and is effective against Enterococcus faecalis as well. Its efficacy is similar to sodium hypochlorite in conjuction with EDTA as an intra canal irrigant. Salvadora persica, another herbal extract, possesses various antiplaque, anticaries, anti-inflammatory and antimycotic effects, and contains important phyto-constituents. 15% alcoholic extract of Salvadora persica is effective against both aerobic and anaerobic bacteria recovered from teeth with necrotic pulp. Its antimicrobial efficacy is not significantly different from sodium hypochlorite and chlorhexidine, but significantly different from normal saline.[6] Propolis has been used in dentistry for various purposes because of its antibacterial, antiviral, antifungal, anti-inflammatory, and anaesthetic action. 1:120. Propolis has an antimicrobial activity equal to that of sodium hypochlorite.[7] Wettability is one of the most important physicochemical properties of irrigants. The intimacy of irrigant and root dentin contact depends on the wettability of irrigant on



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dentin which plays a primary role in the capability of its penetration both into main and lateral canals and into the dentinal tubules. Wettability is directly related to the surface tension of the liquid. The efficiency of an endodontic irrigant can be improved by reducing its surface tension. By reducing its surface tension, it is possible that an irrigant could extend its protein solvent capability, bactericidal function by penetrating into the uninstrumented areas of the root canal system.The present study was designed to evaluate the surface tension of the conventional with the newly developed irrigants. To precisely assess the surface tension, accuracy of the applied technique is of great importance. In this study, Kruss Tensiometer using Wilhelmy plate technique was used which have been used in the previous studies.[11] The measuring procedure was static, which means that the plate could hold on zero level at any time. So, continuous measurement of surface tension was recorded. The advantage of the plate method is that the measured value does not need a hydrostatic correction. Platinum plate with roughened surface used in this study helps to improve its wettability. The Wilhelmy plate method was used in the present study while comparable studies used the du Nuoy Ring method. The two methods are based on a similar concept. Both are all suitable measurement techniques, provided that calibration is accomplished precisely. The beaker containing the test solution was raised till the beep sound was heard so that the same distance is maintained between the test solution and the platinum plate for each experimental group. Following this the reading were taken. Freshly produced MilliQ water was used as reference. This is because even the purest form of water undergoes contamination on storage, because of interfacial adsorption of ubiquitous hydrocarbons from the atmosphere.[11] The results showed the surface tension in the following descending order: MilliQ water > 3% Sodium hypochlorite > 6% Morinda citrifolia > 1:120 Propolis > Smear Clear > MTAD > 15% Salvadora persica. A significantly high surface tension of MilliQ water was recorded when compared with the test groups. This can be explained by the fact that MilliQ water is nothing but the purest form of water which does not contain any added chemicals that will have an effect on its surface tension. These results were in accordance with work done by Giardino et al.,[11] and Rass et al.[7] Mean surface tension of 6% Morinda citrifolia was significantly higher when compared with 15% Salvadora persica, MTAD, and Smear clear. This might be because of the presence of alcohol, saponins, tannins and chlorides salts in alcoholic extract of Salvadora persica,[14- 17] and presence of surfactant Tween 80 in MTAD and Smear clear.[11] Lower surface tension with Propolis 1:120 may be because of the presence of phenolic group like flavanoids and cinnamic acid in Propolis.[18,19] Further, the surface tension of 3% sodium hypochlorite was significantly higher when compared with 6% Morinda citrifolia and this result is in accordance with the previous studies done.[4,11]

CONCLUSION

The present study suggests that 15% Salvadora persica had the lowest surface tension amongst all tested irrigating solutions (1:120 Propolis, 6% Morinda Citrifolia, MTAD, Smear clear, 3% Sodium hypochlorite and MilliQ water) and should be able to penetrate dentinal tubules the most and induce its antimicrobial effect. Further research is required to determine the effect on the surface tension of different irrigating solution when used in combination, to take the advantage of maximum antibacterial and tissue dissolving capacity with minimum instrumentation.



CONFLICT OF INTEREST & SOURCE OF FUNDING

The author declares that there is no source of funding and there is no conflict of interest among all authors.



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  8. Torabinejad M, Khademi AA, Babagoli J, Cho Y, Johnson WB, Bozhilov K, et al. A new solution for the removal of the smear layer. J Endod. 2003;29:170-5.

  9. Giardino L, Ambu E, Savoldi E, Rimondini R, Cassanelli C, Debbia EA. Comparative evaluation of antimicrobial efficacy of sodium hypochlorite, MTAD and Tetraclean against Enterococcus faecalis biofilm. J Endod. 2007;33:852-5.

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  11. Hum TY, Pratt R. The hottentot fig as a possible commercial source of tannin. Uni of Cal.

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  13. Aghel N, Moghimipour E, Dana AE. Formulation of a herbal shampoo using total saponins of acanthophyllum squarrosum. Ira J Pharm Resear. 2007;6(3):167-72.

  14. Kandaswamy D, Venkateshbabu N, Gogulnath D, Kindo AJ. Dentinal tubule disinfection with 2% chlorhexidine gel, propolis, Morinda citrifolia juice, 2% povidine iodine and calcium hydroxide. Int Endod J. 2010;43:419-23.

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