Clinical assessment of polyhexanide as an endodontic irrigant in the management of chronic apical periodontitis
https://doi.org/10.36377/ET-0086
Abstract
INTRODUCTION. Chronic forms of apical periodontitis remain a relevant challenge in endodontic practice. The effectiveness of treatment largely depends on the quality of root canal irrigation. Polyhexamethylene guanidine (polyhexanide) is considered a promising alternative to sodium hypochlorite, offering antimicrobial activity with low cytotoxicity.
MATERIALS AND METHODS. The study included 49 patients with chronic apical periodontitis, divided into two groups. In the first group, a 0.2% polyhexanide solution was used as the primary irrigant, while the second group received a standard protocol with 3% sodium hypochlorite (NaOCl) and 17% EDTA. Treatment efficacy was evaluated based on clinical symptoms and radiographic changes at 6 and 12 months. The Mann–Whitney U test and Pearson’s chi-squared (χ²) test were used for statistical analysis.
RESULTS. The treatment success rate was 98% in the polyhexanide group and 93.6% in the control group. After 12 months, patients in the experimental group showed a lower incidence of persistent periapical lesions. Although the differences did not reach statistical significance (p > 0.05), there was a trend toward a more favorable healing process with polyhexanide use.
CONCLUSIONS. The use of a 0.2% polyhexanide solution as an irrigant demonstrated clinical efficacy comparable to the traditional protocol, with a potential reduction in the risk of adverse effects on hard tissues and surrounding structures. Further studies with larger sample sizes and longer follow-up periods are needed to definitively assess the advantages of this approach.
About the Authors
Yu. A. GeneralovaRussian Federation
Yulia A. Generalova – Assistant, Department of Therapeutic Dentistry
6 Miklukho-Maklaya Str., Moscow 117198
Competing Interests:
The authors report no conflict of interest.
A. Yu. Umarov
Russian Federation
Adam Yu. Umarov – Resident, Dentist
6 Miklukho-Maklaya Str., Moscow 117198
Competing Interests:
The authors report no conflict of interest.
A. Wehbe
Russian Federation
Ahmad Wehbe – Assistant, Department of Dentistry
6 Miklukho-Maklaya Str., Moscow 117198
Competing Interests:
The authors report no conflict of interest.
M. Yu. Dashtieva
Russian Federation
Marina Yu. Dashtieva – Assistant Department of Dentistry
6 Miklukho-Maklaya Str., Moscow 117198
Competing Interests:
The authors report no conflict of interest.
I. V. Bagdasarova
Russian Federation
Inna V. Bagdasarova – Associate Professor
6 Miklukho-Maklaya Str., Moscow 117198
Competing Interests:
The authors report no conflict of interest.
References
1. Haapasalo M., Shen Y., Wang Z., Gao Y. Irrigation in endodontics. Br Dent J. 2014;216(6):299–303. https://doi.org/10.1038/sj.bdj.2014.204
2. Mohammadi Z. Sodium hypochlorite in endodontics: an update review. Int Dent J. 2008;58(6):329–341. https://doi.org/10.1111/j.1875-595x.2008.tb00354.x
3. El Ouarti I., Chala S., Sakout M., Abdallaoui F. Prevalence and risk factors of Apical periodontitis in endodontically treated teeth: cross-sectional study in an Adult Moroccan subpopulation. BMC Oral Health. 2021;21(1):124. https://doi.org/10.1186/s12903-021-01491-6
4. Kaplan M.H., Erdoğan H. Evaluation of the interaction between alternative endodontic irrigation solutions. Acta Stomatologica Cappadocia. 2023;3(1):39–50. https://doi.org/10.54995/ASC.3.1.4
5. Niu W., Yoshioka T., Kobayashi C., Suda H. A scanning electron microscopic study of dentinal erosion by final irrigation with EDTA and NaOCl solutions. Int Endod J. 2002;35(11):934–939. https://doi.org/10.1046/j.1365-2591.2002.00594.x
6. Khabadze Z., Generalova Y., Kulikova A., Podoprigora I., Abdulkerimova S., Bakaev Y. et al. Irrigation in endodontics: Polyhexanide is a promising antibacterial polymer in root canal treatment. Dent J. 2023;11(3):65. https://doi.org/10.3390/dj11030065
7. Teixeira C.S., Felippe M.C., Felippe W.T. The effect of application time of EDTA and NaOCl on intracanal smear layer removal: an SEM analysis. Int Endod J. 2005;38(5):285–290. https://doi.org/10.1111/j.1365-2591.2005.00930.x
8. Baruwa A.O., Martins J.N.R., Meirinhos J., Pereira B., Gouveia J., Quaresma S.A. et al. The influence of missed canals on the prevalence of periapical lesions in endodontically treated teeth: A cross-sectional study. J Endod. 2020;46(1):34–39.e1. https://doi.org/10.1016/j.joen.2019.10.007 (Erratum in: J Endod. 2020;46(6):881. https://doi.org/10.1016/j.joen.2020.03.009)
9. Kulikova A.A., Khabadze Z.S., Bakaev Y.A., Fedotova N.N., Karnaeva A.S., Litvinenko A.A. Application of antiseptic composition based on polyaminopropyl biguanide in the chronic catarrhal gingivitis treatment. Endodontics Today. 2022;20(2):197–200. (In Russ.) https://doi.org/10.36377/1726-7242-2022-20-2-197-200
10. Hashim N.T., Babiker R., Priya S.P., Mohammed R., Chaitanya N.C., Padmanabhan V. et al. Microbial dynamics in periodontal regeneration: Understanding microbiome shifts and the role of antifouling and bactericidal materials: A narrative review. Curr Issues Mol Biol. 2024;46(11):12196–12213. https://doi.org/10.3390/cimb46110724
11. Teughels W., Dhondt R., Dekeyser C., Quirynen M. Biofilm and periodontal microbiology. In: Newman and Carranza’s Clinical Periodontology. 4th South Asia Edition. 2024. Chapter 8, pp. 98–110. Available at: https://pocketdentistry.com/8-biofilm-and-periodontalmicrobiology/ (accessed: 27.02.2025).
12. Kalhan A.C., Wong M.L., Allen F., Gao X. Periodontal disease and systemic health: An update for medical practitioners. Ann Acad Med Singap. 2022;51(9):567–574. https://doi.org/10.47102/annals-acadmedsg.2021503
13. Nannan M., Xiaoping L., Ying J. Periodontal disease in pregnancy and adverse pregnancy outcomes: Progress in related mechanisms and management strategies. Front Med. 2022;9:963956. https://doi.org/10.3389/fmed.2022.963956
14. Fiorellini J.P., Ishikawa S.O., Chai S. Clinical features of gingivitis. In: Newman and Carranza’s Clinical Periodontology. 4th South Asia Edition. 2024. Chapter 15, pp. 158–166. Available at: https://pocketdentistry.com/15-clinical-features-of-gingivitis/ (accessed: 27.02.2025).
Review
For citations:
Generalova Yu.A., Umarov A.Yu., Wehbe A., Dashtieva M.Yu., Bagdasarova I.V. Clinical assessment of polyhexanide as an endodontic irrigant in the management of chronic apical periodontitis. Endodontics Today. 2025;23(2):216-224. https://doi.org/10.36377/ET-0086