Disinfecting Oval-shaped Root Canals: Effectiveness of Different Supplementary Approaches

Introduction: This study compared the ability of different approaches to supplement the antibacterial effects of chemomechanical preparation in oval-shaped root canals. Methods: Long oval canals from extracted teeth infected with Enterococcus faecalis (ATCC 29212) were chemomechanically prepared up to a 40/04 rotary BioRaCe instrument using 2.5% NaoCl irrigation and then subjected to two supplementary protocols. In the passive ultrasonic irrigation (PUI)/chlorhexidine (CHX) group, canals were subjected to PUI for the activation of NaoCl followed by a final rinse with 0.2% CHX digluconate solution. In the Hedstrom group, canals received additional Hedstrom filing directed towards the buccal and lingual canal recesses. Bacteriological samples were taken before and after preparation, after PUI or Hedstrom instrumentation, and after CHX final rinsing. Results: Chemomechanical preparation and the supplementary steps promoted a highly significant bacterial reduction (P < .001). Quantitative (reduction in levels) and qualitative (frequency of negative cultures) analyses showed that PUI alone or Hedstrom filing did not significantly increase bacterial reduction (P > .05). Further rinsing with CHX also failed to significantly increase bacterial elimination when compared with post-PUI samples. However, the cumulative antibacterial effects of PUI and CHX final rinse were effective in significantly reducing bacterial counts to levels below those achieved after preparation (P = .03). This combined PUI/CHX approach also resulted in a significant increase in the incidence of negative cultures (P = .04). Conclusions: Findings suggest that there may be a benefit of using the PUI for the activation of NaoCl followed by a final rinse with CHX as supplementary steps in the treatment of infected oval-shaped root canals. (J Endod 2011;37:496-501)