Effect of Cetrimide with Bioceramic or Calcium Hydroxide Intracanal Medication
DOI:
https://doi.org/10.15517/w37rx029Keywords:
Calcium hydroxide; Dental materials; Endodontics; Enterococcus faecalis; Root canal therapy; Silicates.Abstract
This study evaluated the pH, solubility, and intratubular decontamination of bioceramic intracanal medications Bio-C® Temp (BCT), a calcium hydroxide-based paste Calen® (CAL), and their associations with 1% Cetrimide (CTR): BCT, CAL, BCT/CTR, CAL/CTR. Polyethylene tubes filled with the medications were used for pH measurement at intervals of 1, 3, 7, 14, and 21 days. Solubility was evaluated after 14 days of immersion in distilled water at 37°C. Bovine dentin tubules contaminated with Enterococcus faecalis were used to assess intratubular decontamination using confocal laser scanning microscopy and Live/Dead BacLight Bacterial dye three days after exposure to the medications and a Control Group using Polyethylene glycol 400. Statistical analysis was performed using ANOVA and Tukey tests (p<0.05). CAL/CTR exhibited the highest pH after 1 day (p<0.05). CAL had the highest pH values at 14 and 21 days (p<0.05). BCT showed the lowest pH values at 3 days, and BCT/CTR at 7 and 21 days (p<0.05). The association of CTR did not affect the solubility of the medications (p > 0.05). CAL demonstrated superior intratubular decontamination (p<0.05), while CAL/CTR, BCT, and BCT/CTR showed similar results (p>0.05). The association of 1% cetrimide did not increase the intratubular decontamination of Bio-C® Temp and decreased the antibacterial activity of Calen®. The calcium hydroxide medication in a viscous vehicle exhibited higher alkaline potential, solubility, and intratubular decontamination.
References
Siqueira J.F. Jr, Rôças I.N. Clinical implications and microbiology of bacterial persistence after treatment procedures. J Endod. 2008 Nov; 34 (11): 1291-1301.
Haapasalo M., Orstavik D. In vitro infection and disinfection of dentinal tubules. J Dent Res. 1987 Aug; 66 (8): 1375-9.
Villa N., Santos V.V.D., Costa U.M.D., Mendes A.T., Duarte P.H.M., Rosa R.A.D., Pereira J.R., Só M.V.R. A New Calcium Silicate-Based Root Canal Dressing: Physical and Chemical Properties, Cytotoxicity and Dentinal Tubule Penetration. Braz Dent J. 2020 Nov-Dec; 31 (6): 598-604.
Oliveira L.V., de Souza G.L., da Silva G.R., Magalhães T.E.A., Freitas G.A.N., Turrioni A.P., de Rezende Barbosa G.L., Moura C.C.G. Biological parameters, discolouration and radiopacity of calcium silicate-based materials in a simulated model of partial pulpotomy. Int Endod J. 2021 Nov; 54 (11): 2133-2144.
Capitanio B.L., Hashizume L.N., Kuga M.C., Oliveira E.C.G., Rosa R.A.D., Só G.B., Só M.V.R. Analysis of pH, calcium ion release, and energy dispersive spectroscopy of a bioceramic root canal dressing. Braz Dent J. 2023 Jul-Aug; 34 (4): 54-61.
Lopes C.S., Ferrari Esteves Torres F., Faria G., Sasso-Cerri E., Guerreiro-Tanomaru J.M., Tanomaru-Filho M., Cerri P.S. Calcium silicate-based intracanal medication: Physicochemical properties and effectiveness of techniques for removing medication from the human root canal. Eur Endod J. 2024 Dec 20; 9 (4): 374-382.
Oliveira L.V., da Silva G.R., Souza G.L., Magalhães T.E.A., Barbosa G.L.R., Turrioni A.P., Moura C.C.G. A laboratory evaluation of cell viability, radiopacity and tooth discoloration induced by regenerative endodontic materials. Int Endod J. 2020 Aug; 53 (8): 1140-1152.
Lopes C.S., Delfino M.M., Tanomaru-Filho M., Sasso-Cerri E., Guerreiro-Tanomaru J.M., Cerri P.S. Hepatic enzymes and immunoinflammatory response to Bio-C Temp bioceramic intracanal medication implanted into the subcutaneous tissue of rats. Sci Rep. 2022 Feb 18; 12 (1): 2788.
Lopes C.S., Delfino M.M., Tanomaru-Filho M., Sasso-Cerri E., Guerreiro-Tanomaru J.M., Cerri P.S. Bioactive potential of Bio-C Temp demonstrated by systemic mineralization markers and immunoexpression of bone proteins in the rat connective tissue. J Mater Sci Mater Med. 2024 Feb 14; 35 (1): 13.
Escobar P.M., Silva-Sousa A.C., Camargo R.V., Simões-Carvalho M., Silva-Sousa Y.T., Mazzi-Chaves J.F., DE-Deus G., Sousa-Neto M.D. Influence of bioceramic intracanal medication on the bond strength of bioceramic root canal sealer. Braz Oral Res. 2023 May 29; 37: e056.
de Campos I.V.B., Vieira W.A., de Almeida R.F., Gabriel P.H., Marciano M.A., Gomes B.P.F.A., de-Jesus-Soares A. In Vitro Dental Discoloration Provoked by Intracanal Calcium Silicate-based Dressing Used for Regenerative Endodontic Procedures: An One-year Spectrometric Analysis. J Endod. 2023 Jul; 49 (7): 846-851.
Patri G., Bansal S., Lath H., Chatterjee I., Majee N., Sinha Y. Comparative evaluation of the antibacterial efficacy of two experimental calcium silicate-based intracanal medicaments: An in-vitro study. J Conserv Dent Endod. 2024 Apr; 27 (4): 419-423.
Guerreiro J.C.M., Ochoa-Rodrígez V.M., Rodrigues E.M., Chavez-Andrade G.M., Tanomaru-Filho M., Guerreiro-Tanomaru J.M., Faria G. Antibacterial activity, cytocompatibility and effect of Bio-C Temp bioceramic intracanal medicament on osteoblast biology. Int Endod J. 2021 Jul; 54 (7): 1155-1165.
Siqueira P.C., Soares L.D.C.C., Wanderley K.R.D.M., Deus L.B., Melo H.V., Ávila M.P.A., Estrela L.R.A., Estrela C.R.A. The impact of intracanal medicaments on crown color, pH, and antimicrobial activity: a comparative study. Braz Oral Res. 2025 Mar 10; 39: e029.
Mohammadi Z., Dummer P.M. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J. 2011 Aug; 44 (8): 697-730.
Lima R.K., Guerreiro-Tanomaru J.M., Faria-Júnior N.B., Tanomaru-Filho M. Effectiveness of calcium hydroxide-based intracanal medicaments against Enterococcus faecalis. Int Endod J. 2012 Apr; 45 (4): 311-6.
Pimenta H.C., Violante I.M., Musis C.R., Borges Á.H., Aranha A.M. In vitro effectiveness of Brazilian brown propolis against Enterococcus faecalis. Braz Oral Res. 2015; 29: S1806-83242015000100255.
McDonnell G., Russell A.D. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev. 1999 Jan;12 (1): 147-79. doi: 10.1128/CMR.12.1.147. Erratum in: Clin Microbiol Rev 2001 Jan; 4 (1): 227.
Ruiz-Linares M., Ferrer-Luque C.M., Arias-Moliz T., de Castro P., Aguado B., Baca P. Antimicrobial activity of alexidine, chlorhexidine and cetrimide against Streptococcus mutans biofilm. Ann Clin Microbiol Antimicrob. 2014 Aug 20;13: 41.
Arias-Moliz M.T., Ferrer-Luque C.M., González-Rodríguez M.P., Valderrama M.J., Baca P. Eradication of Enterococcus faecalis biofilms by cetrimide and chlorhexidine. J Endod. 2010 Jan; 36 (1): 87-90.
Baca P., Junco P., Arias-Moliz M.T., González-Rodríguez M.P., Ferrer-Luque C.M. Residual and antimicrobial activity of final irrigation protocols on Enterococcus faecalis biofilm in dentin. J Endod. 2011 Mar; 37 (3): 363-6.
Wang Z., Shen Y., Ma J., Haapasalo M. The effect of detergents on the antibacterial activity of disinfecting solutions in dentin. J Endod. 2012 Jul; 38 (7): 948-53.
Giardino L., Ambu E., Becce C., Rimondini L., Morra M. Surface tension comparison of four common root canal irrigants and two new irrigants containing antibiotic. J Endod. 2006 Nov; 32 (11): 1091-3.
Bailón-Sánchez M.E., Baca P., Ruiz-Linares M., Ferrer-Luque C.M. Antibacterial and anti-biofilm activity of AH plus with chlorhexidine and cetrimide. J Endod. 2014 Jul; 40 (7): 977-81.
Andrade F.B., Arias M.P., Maliza A.G., Duarte M.A., Graeff M.S., Amoroso-Silva P.A., Midena R.Z., Moraes I.G. A new improved protocol for in vitro intratubular dentinal bacterial contamination for antimicrobial endodontic tests: standardization and validation by confocal laser scanning microscopy. J Appl Oral Sci. 2015 Nov-Dec; 23 (6): 591-8.
Valverde M.E., Baca P., Ceballos L., Fuentes M.V., Ruiz-Linares M., Ferrer-Luque C.M. Antibacterial efficacy of several intracanal medicaments for endodontic therapy. Dent Mater J. 2017 May 31; 36 (3): 319-324.
Deveci C., Tuzuner T., Cinar C., Odabas M.E., Buruk C.K. Short-term antibacterial activity and compressive strength of biodentine containing chlorhexidine/cetirimide mixtures. Niger J Clin Pract. 2019 Feb; 22 (2): 227-231.
Carbajal Mejía J.B., Aguilar Arrieta A. Reduction of viable Enterococcus faecalis in human radicular dentin treated with 1% cetrimide and conventional intracanal medicaments. Dent Traumatol. 2016 Aug; 32 (4): 321-7.
Fava L.R., Saunders W.P. Calcium hydroxide pastes: classification and clinical indications. Int Endod J. 1999 Aug; 32 (4): 257-82.
Mohan R.P., Pai A.R. The comparison between two irrigation regimens on the dentine wettability for an epoxy resin based sealer by measuring its contact angle formed to the irrigated dentine. J Conserv Dent. 2015 Jul-Aug; 18 (4): 275-8.
Rodrigues G.B., Tanomaru-Filho M., Chavez-Andrade G.M., Esteves F.F., Guerreiro-Tanomaru J.M. Physicochemical properties and antibiofilm activity of tricalcium silicate cement and its association with cetrimide. Odovtos-Int J Dental SC. 2022 Jan-Apr; 24: 113-121.
Alamri H.M., Liu H., Zhang D., Shen Y., Haapasalo M. An In Vitro Study: Does Adding Iodine Potassium Iodide and Cetrimide to Calcium Hydroxide Paste Enhance Its Antimicrobial Effect Against Oral Biofilms? Cureus. 2023 Dec 27; 15 (12): e51203.
Ruiz-Linares M., Bailón-Sánchez M.E., Baca P., Valderrama M., Ferrer-Luque C.M. Physical properties of AH Plus with chlorhexidine and cetrimide. J Endod. 2013 Dec; 39 (12): 1611-4.
D'Costa V.F., Rodrigues A.L., Bangera M.K., Bhat P.A., Rai R.U. A Confocal Microscopic Study on Percentage Penetration of Different Sealers into Dentin. J Pharm Bioallied Sci. 2021 Jun;13 (Suppl 1): S725-S730.
Peña-Bengoa F., Magasich M.C., Bustamante D., Wastavino C., Niklander S.E., Cáceres C. Effect of Ultrasonic Activation on Dentinal Tubule Penetration of Bio-C Temp and Ultracal XS: A Comparative CLSM Assessment. Eur Endod J. 2023 Aug; 8 (4): 268-273.
Turk B.T., Sen B.H., Ozturk T. In vitro antimicrobial activity of calcium hydroxide mixed with different vehicles against Enterococcus faecalis and Candida albicans. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Aug; 108 (2): 297-301.
Ferrer-Luque C.M., Conde-Ortiz A., Arias-Moliz M.T., Valderrama M.J., Baca P. Residual activity of chelating agents and their combinations with cetrimide on root canals infected with Enterococcus faecalis. J Endod. 2012 Jun; 38 (6): 826-8.
Pereira T.C., da Silva Munhoz Vasconcelos L.R., Graeff M.S.Z., Ribeiro M.C.M., Duarte M.A.H., de Andrade F.B. Intratubular decontamination ability and physicochemical properties of calcium hydroxide pastes. Clin Oral Investig. 2019 Mar; 23 (3): 1253-1262.
Pereira T.C., Vasconcelos L.R., Graeff M.S., Duarte M.A., Bramante C.M., Andrade F.B. Intratubular disinfection with tri-antibiotic and calcium hydroxide pastes. Acta Odontol Scand. 2017 Mar; 75( 2): 87-93.
Arias M.P., Maliza A.G., Midena R.Z., Graeff M.S., Duarte M.A., Andrade F.B. Effect of ultrasonic streaming on intra-dentinal disinfection and penetration of calcium hydroxide paste in endodontic treatment. J Appl Oral Sci. 2016 Nov-Dec; 24 (6): 575-581.
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