Bacteriologic investigation of the effects of sodium hypochlorite and chlorhexidine during the endodontic treatment of teeth with apical periodontitis

Abstract

Objective. This clinical study was undertaken to compare the effectiveness of 2.5% sodium hypochlorite (NaOCl) and 0.12% chlorhexidine digluconate as irrigants in reducing the cultivable bacterial populations in infected root canals of teeth with apical periodontitis. Study design. According to stringent inclusion/exclusion criteria, 32 teeth with primary intraradicular infections and chronic apical periodontitis were selected and followed in the study. Bacterial samples were taken at the baseline (S1) and after chemomechanical preparation using either NaOCl (n 16) or chlorhexidine (n 16) as irrigants (S2). Cultivable bacteria recovered from infected root canals at the 2 stages were counted. Isolates from S2 samples were identified by means of 16S rRNA gene sequencing analysis. Results. At S1, all canals were positive for bacteria, and the median number of bacteria per canal was 7.32 105 for the NaOCl group and 8.5 105 for the chlorhexidine group. At S2, the median number of bacteria in canals irrigated with NaOCl and chlorhexidine was 2.35 103 and 2 102, respectively. Six of 16 (37.5%) canals from the NaOCl group and 8 of 16 (50%) canals from the chlorhexidine group yielded negative cultures. Chemomechanical preparation using either solution substantially reduced the number of cultivable bacteria in the canals. No significant difference was observed between the NaOCl and chlorhexidine groups with regard to the number of cases yielding negative cultures (P .72) or quantitative bacterial reduction (P .609). The groups irrigated with NaOCl or chlorhexidine showed a mean number of 1.3 and 1.9 cultivable species per canal, respectively. The great majority of isolates in S2 were from gram-positive bacteria, with streptococci as the most prevalent taxa. Conclusions. The present findings revealed no significant difference when comparing the antibacterial effects of 2.5% NaOCl and 0.12% chlorhexidine used as irrigants during the treatment of infected canals