The effect of the irrigation solutions on dentin organic components: Pilot study

INTRODUCTION. Tooth decay and its complications are prevalent dental issues among adults. Endodontic treatment is the standard of care for complicated caries, specifically pulpitis and periodontitis. Endodontic irrigants, which are placed in the root canal lumen for a specific duration, can affect the intracanal dentin structure (organic and inorganic substances) in various ways. The use of polyhexanide-based antiseptic products in endodontics is a promising idea to overcome microbial resistance and minimize microbial-related endodontic treatment failures.
AIM. The aim of this study is to investigate the qualitative impact of standard irrigation solutions and a polyhexanide-based composition on the collagen matrix of dentin.
MATERIALS AND METHODS. The study investigated the effect of nine solutions on the dentin of the tooth root. Twelve intact maxillary third molars extracted for orthodontic reasons were taken for the study. The teeth were fixed in a 10% neutral formalin solution for at least one day and were decalcinated. 5–10 μm thick sample sections were made and stained with picrosirius (Picrosirius Red, Biovitrum, Russia) before being examined under polarized light. The histological slice was analyzed using a Carl Zeiss (Germany) software and hardware complex based on ZEN v3.0 and light microscope Axioimager M.1. All microphotos were loaded into the Fiji distribution program of ImageJ for microscopy pixel classification.
RESULTS. Upon analysis of the diagrams, it appears that there is a lower amount and density of stained dentin collagen array after exposure to sodium hypochlorite solutions of 3% and 1.5%, as well as polyhexanide.
CONCLUSIONS. The data obtained from the histogram analyzer of samples stained with picrosirius suggests that polyhexanide may have a qualitative effect on the organic structure of hard tissues, particularly collagen.

1. Friedman S., Mor C. The success of endodontic therapy – healing and functionality. J Calif Dent Assoc. 2004;32(6):493–503. Available at: https://pubmed.ncbi.nlm.nih.gov/15344440/ (accessed: 03.01.2024).

2. Basmadjian-Charles C.L., Farge P., Bourgeois D.M., Lebrun T. Factors influencing the long-term results of endodontic treatment: A review of the literature. Int Dent J. 2002;52(2):81–86. https://doi.org/10.1111/j.1875-595X.2002.tb00605.x

3. Alley B.S., Kitchens G.G., Alley L.W., Eleazer P.D. A comparison of survival of teeth following endodontic treatment performed by general dentists or by specialists. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98(1):115–118. https://doi.org/10.1016/j.tripleo.2004.01.004

4. Bartols A., Bormann C., Werner L., Schienle M., Walther W., Dörfer C.E. A retrospective assessment of different endodontic treatment protocols. PeerJ. 2020;30;8:e8495. https://doi.org/10.7717/peerj.8495

5. Siqueira Jr J.F., Rôças I.N., Santos S.R., Lima K.C., Magalhães F.A.С., de Uzeda M. Efficacy of instrumentation techniques and irrigation regimens in reducing the bacterial population within root canals. J Endod. 2002;28(3):181–184. https://doi.org/10.1097/00004770-200203000-00009

6. Goldberg M., Kulkarni A.B., Young M., Boskey A. Dentin: Structure, composition and mineralization. Front Biosci (Elite Ed). 2011;3(2):711–735. https://doi.org/10.2741/E281

7. Tjäderhane L., Carrilho M.R., Breschi L., Tay F.R., Pashley D.H. Dentin basic structure and composition – an overview. Endod Topics. 2009;20(1):3–29. https://doi.org/10.1111/j.1601-1546.2012.00269.x

8. Zaslansky P. Dentin. In: Fratzl P. (ed.) Collagen: Structure and mechanics. Boston, MA: Springer US; 2008, pp. 421–446. https://doi.org/10.1007/978-0-387-73906-9_15

9. de Mattos Pimenta Vidal C., Leme-Kraus A.A., Rahman M., Farina A.P., Bedran-Russo A.K. Role of proteoglycans on the biochemical and biomechanical properties of dentin organic matrix. Arch Oral Biol. 2017;82:203–208. https://doi.org/10.1016/j.archoralbio.2017.06.020

10. Tjäderhane L. Dentin basic structure, composition, and function. In: Versiani M., Basrani B., Sousa-Neto M. (eds) The root canal anatomy in permanent dentition. Springer, Cham; 2019, pp. 17–27. https://doi.org/10.1007/978-3-319-73444-6_2

11. Haapasalo M., Shen Y., Qian W., Gao Y. Irrigation in endodontics. Dent Clin North Am. 2010;54(2):291–312. https://doi.org/10.1016/j.cden.2009.12.001

12. Akçay A., Gorduysus M., Rahman B., Gorduysus M.O. Effects of six different irrigation systems on potential apical extrusion of irrigants. J Int Dent Med Res. 2019;12(1):1–5. Available at: https://www.researchgate.net/publication/332267181_Irrigation_Systems (accessed: 03.01.2024).

13. Bukhari S., Babaeer A. Irrigation in endodontics: A review. Curr Oral Health Rep. 2019;6(4):367–376. https://doi.org/10.1007/s40496-019-00241-6

14. Aslantas E.E., Buzoglu H.D., Altundasar E., Serper A. Effect of EDTA, sodium hypochlorite, and chlorhexidine gluconate with or without surface modifiers on dentin microhardness. J Endod. 2014;40(6):876–879. https:// doi.org/10.1016/j.joen.2013.10.041

15. Gu L.-S., Huang X.-Q., Griffin B., Bergeron B.R., Pashley D.H., Niu L.-N., Tay F.R. Primum non nocere – The effects of sodium hypochlorite on dentin as used in endodontics. Acta Biomater. 2017;61:144–156. https:// doi.org/10.1016/j.actbio.2017.08.008

16. Pascon F.M., Kantovitz K.R., Sacramento P.A., Nobredos-Santos M., Puppin-Rontani R.M. Effect of sodium hypochlorite on dentine mechanical properties. A review. J Dent. 2009;37(12):903–908. https://doi.org/10.1016/j.jdent.2009.07.004

17. Oyarzún A., Cordero A.M., Whittle M. Immunohistochemical evaluation of the effects of sodium hypochlorite on dentin collagen and glycosaminoglycans. J Endod. 2002;28(3):152–156. https://doi.org/10.1097/00004770-200203000-00002

18. Kramer A., Roth B., Müller G., Rudolph P., Klöcker N. Influence of the antiseptic agents polyhexanide and octenidine on FL cells and on healing of experimental superficial aseptic wounds in piglets. A double-blind, randomised, stratified, controlled, parallel-group study. Skin Pharmacol Physiol. 2004;17(3):141–146. https://doi.org/10.1159/000077241

19. van der Sluis L.W.M/, Verhaagen B., Macedo R., Versluis M. The Role of Irrigation in Endodontics. In: Olivi G., De Moor R., DiVito E. (eds) Lasers in Endodontics. Springer, Cham; 2016, pp. 45–69. https://doi.org/10.1007/978-3-319-19327-4_3

20. Taffarel C., Bonatto F.D., do Carmo Bonfante F., Palhano H.S., Vidal C.D., Cecchin D., Souza M.A. Effect of chemical and natural irrigant solutions on microhardness of root dentin – an in vitro study. Braz J Oral Sci. 2018;17:e18409. https://doi.org/10.20396/bjos.v17i0.8654060

21. Arul B., Suresh N., Sivarajan R., Natanasabapathy V. Influence of volume of endodontic irrigants used in different irrigation techniques on root canal dentin microhardness. Indian J Dent Res. 2021;32(2):230–235. https://doi.org/10.4103/ijdr.IJDR_709_18

22. Metzger Z., Solomonov M., Kfir A. The role of mechanical instrumentation in the cleaning of root canals. Endod Topics. 2013;29(1):87–109. Available at: https:// solomonov.pro/upload/statyi/metzgertopics_2013.pdf (accessed: 03.01.2024).

23. Tartari T., Bachmann L., Maliza A.G.A., Andrade F.B., Duarte M.A.H., Bramante C.M. Tissue dissolution and modifications in dentin composition by different sodium hypochlorite concentrations. J Appl Oral Sci. 2016;24(3):291–298. https://doi.org/10.1590/1678-775720150524

24. Mai S., Kim Y.K., Arola D.D., Gu L.-S., Kim J.R., Pashley D.H., Tay F.R. Differential aggressiveness of ethylenediamine tetraacetic acid in causing canal wall erosion in the presence of sodium hypochlorite. J Dent. 2010;38(3):201–206. https://doi.org/10.1016/j.jdent.2009.10.004

25. Baldasso F.E.R., Roleto L., de Silva V.D., Morgental R.D., Kopper P.M.P. Effect of final irrigation protocols on microhardness reduction and erosion of root canal dentin. Braz Oral Res. 2017;31:e40. https://doi.org/10.1590/1807-3107BOR-2017.vol31.0040

26. Wang Z., Maezono H., Shen Y., Haapasalo M. Evaluation of root canal dentin erosion after different irrigation methods using energy-dispersive X-ray spectroscopy. J Endod. 2016;42(12):1834–1839. https://doi.org/10.1016/j.joen.2016.07.024

27. Khan A., Nikhil V., Pandey A., Chaturvedi P. Effectiveness of polyhexamethylene biguanide, chlorhexidine, and calcium hydroxide intracanal medicament against intraradicular mature polymicrobial biofilm: A microbiological study. J Conserv Dent. 2022;25(5):536–540. https://doi.org/10.4103/jcd.jcd_288_22

28. Rita C., Nikhil V., Surapaneni S.K. Determination of minimum inhibitory concentration (MIC) of a polyhexamethylene biguanide (PHMB) solution: A potential root canal irrigant. Annu Res Rev Biol. 2017;15(2):1–7. https://doi.org/10.9734/ARRB/2017/34141

29. Weerakoon A.T., Condon N., Cox T.R., Sexton C., Cooper C., Meyers I.A. et al. Dynamic dentin: A quantitative microscopic assessment of age and spatial changes to matrix architecture, peritubular dentin, and collagens types I and III. J Struct Biol. 2022;214(4):107899. https://doi.org/10.1016/j.jsb.2022.107899