Antibacterial efficacy of MTAD final rinse and two percent chlorhexidine gel medication in teeth with apical periodontitis: a randomized double-blinded clinical trial.
BACKGROUND
Clinical assessment of the efficacy of novel root canal disinfection protocols is an important focus in endodontic research. This randomized double-blinded study assessed the antibacterial efficacy of a final rinse with BioPure MTAD (MTAD) and intracanal medication with 2% chlorhexidine gel (CHX) in teeth with apical periodontitis.


METHODS
Canals in 30 teeth (single-rooted and multi-rooted) were prepared by using 1.3% NaOCl, rinsed with MTAD or saline in random sequence, medicated with CHX for 7 days, irrigated with 1.3% NaOCl, and filled. Bacteriologic root canal samples were obtained by aspiration before (1A) and after (1B) canal preparation, after the final rinse (1C), after CHX was flushed (2A), and after final irrigation (2B). Bacteria were enumerated by epifluorescence-microscopy (EFM) by using 2 staining methods and by colony-forming-unit (CFU) counts after 14 days of incubation.


RESULTS
Bacterial counts (EFM) in 1B were greater than 95% decreased from 1A. Low bacterial densities in 1B, 1C, 2A, and 2B did not differ significantly from each other. EFM counts were consistently higher than CFU counts.


CONCLUSIONS
The final rinse with MTAD and medication with CHX did not reduce bacterial counts beyond levels achieved by canal preparation with NaOCl.
Malkhassian
Gevik
G
Department of Endodontics, Faculty of Dentistry, University of Toronto, Ontario, Canada. gevik.malkhassian@dentistry.utoronto.ca
Manzur
Aldo J
AJ
Legner
Milos
M
Fillery
Edward D
ED
Manek
Sheela
S
Basrani
Bettina R
BR
Friedman
Shimon
S
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001420:Bacteria, Aerobic / Q000302:isolation & purification; D001421:Bacteria, Anaerobic / Q000302:isolation & purification; D002710:Chlorhexidine / Q000627:therapeutic use*; D019343:Citric Acid / Q000627:therapeutic use*; D015331:Cohort Studies; D015169:Colony Count, Microbial; D003786:Dental Pulp Cavity / Q000382:microbiology; D003793:Dental Restoration, Permanent / Q000379:methods; D004311:Double-Blind Method; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D005899:Glass Ionomer Cements; D006171:Gutta-Percha / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D010485:Periapical Periodontitis / Q000382:microbiology / Q000628:therapy*; D011136:Polysorbates / Q000627:therapeutic use*; D012117:Resins, Synthetic; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D012388:Root Canal Irrigants / Q000627:therapeutic use*; D012389:Root Canal Obturation; D018915:Root Canal Preparation / Q000295:instrumentation / Q000379:methods*; D012973:Sodium Hypochlorite / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D005899:Glass Ionomer Cements; C475043:MTAD (intracanal irrigant); C081144:Photac-Fil; D011136:Polysorbates; D012117:Resins, Synthetic; D012387:Root Canal Filling Materials; D012388:Root Canal Irrigants; D019343:Citric Acid; D006171:Gutta-Percha; D012973:Sodium Hypochlorite; D004318:Doxycycline; D002710:Chlorhexidine