17 April 2019

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Does heating sodium hypochlorite improve pulp dissolution?

Massimo Gagliani

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Root canal irrigation with sodium hypochlorite is an essential standard in root canal irrigation, being able to act both against the bacterial component and with the pulp tissue. In this authoritative study conducted by Dr. Alfredo Iandolo under the guidance of Prof Massimo Amato, the intracanal heating methods of sodium hypochlorite are best highlighted. The specific objective was to verify how hypochlorite can act in the lateral channels filled with radicular pulp.

MATERIALS AND METHODS 
In an in vitro study, simulated root canals with pulp inserted into artificial lateral canals were irrigated with 6% sodium hypochlorite, taking care to activate it in the following ways: a) heating the solution (50 ° C) inside a container from which it was sucked up, b) intracanal heating by means of a heater used for compacting gutta-percha (System B - point 30 / .04) c) activation with ultrasound (EndoUltra, Vista Dental, USA) d) ultrasonic activation with intracanal heating similar to groups b) and c). 

RESULTS 
The synergistic action of ultrasound and intracanal heating (Group d) was the only one capable of dissolving, if not completely, the pulp nestled in the lateral canals.

CONCLUSIONS 
The dissolution through the use of sodium hypochlorite, although at concentrations equal to 6%, of dental pulp inside lateral channels appears to be very difficult; however, only the combined action of the ultrasonic energy and the intracanal temperature increase through the use of heated compactors allows to act significantly with the portion of the pulp present in the gorges of the endodontic space.

CLINICAL IMPLICATIONS 
The presence of pulp inside the lateral canals is an incontrovertible clinical datum; it is illusory that the hypochlorite alone can dissolve it in a short time. The synergistic action of hypochlorite heated inside the canal and of ultrasounds could guarantee this action; the need to act in these areas could however be interesting in cases where the necrotic process has also involved the most anfrattuous spaces of the endodonto, from which the great utility of the irrigation system developed in this study derives.

For additional informations: 
An in vitro evaluation of the degree of pulp tissue dissolution through different root canal irrigation protocol