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- Reader's Forum Precipitate from a combination of sodium hypochlorite and chlorhexidine
- Jin-Woo Kim
-
Restorative Dentistry & Endodontics 2012;37(3):185-186.
DOI: https://doi.org/10.5395/rde.2012.37.3.185
Published online: August 29, 2012
Gangneung-Wonju National University, Korea.
©Copyights 2012. The Korean Academy of Conservative Dentistry.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Q.
Recently I heard that Chlorhexidine can form a precipitate when used in combination with NaOCl during intra-canal irrigation. What's the adverse effect of this precipitate and how can I reduce the chance of precipitation?
From Dr. Yoon-Woo Park (Chuncheon Ye-dental clinic)
A.
During the cleaning and shaping of the root canal, various irrigants have been used to reduce the residual debris, necrotic tissue, and bacteria, as well as to remove smear layer.1-3 Though sodium hypochlorite (NaOCl) is the most common irrigant used in root canal treatment, chlorhexidine (CHX) has been suggested as either an alternative or an adjunct root canal irrigant because of its antimicrobial qualities and substantivity.4-7
A combination of NaOCl and CHX for root canal irrigation has been advocated to enhance their antimicrobial properties.8 Zehender proposed an irrigation regimen as the following: 2.5% NaOCl during instrumentation, and a final flush of the canals is performed in the sequence of 17% EDTA, 2.5% NaOCl, and 2% CHX.
However, the presence of NaOCl in the canals during irrigation with CHX produces an orange-brown precipitate known as parachloroaniline (PCA) (Figure 1).3,10-12 The precipitate occludes the dentinal tubules and may compromise the seal of the obturated root canal.12 Leaching of PCA from the insoluble precipitate is of concern because it has been shown to be cytotoxic in rats and possibly carcinogenic in humans (International Agency for Research on Cancer group 2B).13,14
To solve this problem, we have to try to prevent or minimize precipitation by preventing or minimizing the chance for the two irrigants to come in contact with each other. Basrani et al.11 recommended washing away the remaining NaOCl with alcohol or EDTA, before using CHX. Choi et al.15 compared different canal irrigation methods to prevent precipitation. There were no significant differences in percentage of remaining debris and patent tubules among all experimental groups at all levels.
It seems prudent to make an effort to prevent precipitation when using an irrigation regimen combining CHX and NaOCl.
Jin-Woo Kim (Gangneung-Wonju National University)
- 1. Byström A, Sundqvist G. Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy. Scand J Dent Res 1981;89:321-328. ArticlePubMed
- 2. Orstavik D, Haapasalo M. Disinfection by endodontic irrigants and dressings of experimentally infected dentinal tubules. Endod Dent Traumatol 1990;6:142-149. ArticlePubMed
- 3. Basrani BR, Manek S, Mathers D, Fillery E, Sodhi RN. Determination of 4-chloroaniline and its derivatives formed in the interaction of sodium hypochlorite and chlorhexidine by using gas chromatography. J Endod 2010;36:312-314. ArticlePubMed
- 4. Estrela C, Estrela CR, Barbin EL, Spanó JC, Marchesan MA, Pécora JD. Mechanism of action of sodium hypochlorite. Braz Dent J 2002;13:113-117. ArticlePubMed
- 5. Siqueira JF Jr, Batista MM, Fraga RC, de Uzeda M. Antibacterial effects of endodontic irrigants on black-pigmented gram-negative anaerobes and facultative bacteria. J Endod 1998;24:414-416. ArticlePubMed
- 6. Leonardo MR, Tanomaru Filho M, Silva LA, Nelson Filho P, Bonifácio KC, Ito IY. In vivo antimicrobial activity of 2% chlorhexidine used as a root canal irrigating solution. J Endod 1999;25:167-171. ArticlePubMed
- 7. Dametto FR, Ferraz CC, Gomes BP, Zaia AA, Teixeira FB, de Souza-Filho FJ. In vitro assessment of the immediate and prolonged antimicrobial action of chlorhexidine gel as an endodontic irrigant against Enterococcus faecalis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:768-772. ArticlePubMed
- 8. Kuruvilla JR, Kamath MP. Antimicrobial activity of 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate separately and combined, as endodontic irrigants. J Endod 1998;24:472-476. ArticlePubMed
- 9. Zehnder M. Root canal irrigants. J Endod 2006;32:389-398. ArticlePubMed
- 10. Vivacqua-Gomes N, Ferraz CC, Gomes BP, Zaia AA, Teixeira FB, Souza-Filho FJ. Influence of irrigants on the coronal microleakage of laterally condensed gutta-percha root fillings. Int Endod J 2002;35:791-795. ArticlePubMed
- 11. Basrani BR, Manek S, Sodhi RN, Fillery E, Manzur A. Interaction between sodium hypochlorite and chlorhexidine gluconate. J Endod 2007;33:966-969. PubMed
- 12. Bui TB, Baumgartner JC, Mitchell JC. Evaluation of the interaction between sodium hypochlorite and chlorhexidine gluconate and its effect on root dentin. J Endod 2008;34:181-185. ArticlePubMed
- 13. Chhabra RS, Huff JE, Haseman JK, Elwell MR, Peters AC. Carcinogenicity of p-chloroanaline in rats and mice. Food Chem Toxicol 1991;29:119-124. PubMed
- 14. Barbin LE, Saquy PC, Guedes DF, Sousa-Neto MD, Estrela C, Pécora JD. Determination of para-chloroaniline and reactive oxygen species in chlorhexidine and chlorhexidine associated with calcium hydroxide. J Endod 2008;34:1508-1514. ArticlePubMed
- 15. Choi MS, Park SH, Cho KM, Kim JW. The comparison of different canal irrigation methods to prevent reaction precipitate between sodium hypochlorite and chlorhexidine. J Korean Acad Conserv Dent 2010;35:80-87.Article
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XML DownloadPrecipitate from a combination of sodium hypochlorite and chlorhexidine
Figure 1 A representative photograph of brown precipitate formation after consequent use of sodium hypochlorite and chlorhexidine in experimental conditions.
Figure 1
Precipitate from a combination of sodium hypochlorite and chlorhexidine
