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Sodium hypochlorite irrigation and safety

Pai ARV

Br Dent J, 2023 Apr;234(7):488.
PMID: 37059753 DOI: 10.1038/s41415-023-5755-3
Fulltext Clinical research on sodium hypochlorite irrigation and extrusion: The gap and scope

Pai ARV

J Dent Sci, 2023 Jul;18(3):1417-1418.
PMID: 37404641 DOI: 10.1016/j.jds.2023.05.005
Injection of sodium hypochlorite into soft tissues of the oral cavity: A literature review with clinical preventive recommendations

Pai ARV

J Stomatol Oral Maxillofac Surg, 2023 Dec;124(6S2):101581.
PMID: 37544507 DOI: 10.1016/j.jormas.2023.101581

Injection of sodium hypochlorite (NaOCl) solution instead of local anaesthetic (LA) solution is an iatrogenic error with serious consequences including medico-legal implications. Such cases have been reported despite recommended precautionary measures. The purpose of this article is to review the literature on such cases and present clinical preventive recommendations. Electronic search was conducted in PubMed/Medline, Google Scholar, Cochrane, Scopus, Lilacs, ScienceDirect, and Crossref databases for articles reporting accidental or mistaken or inadvertent injection of NaOCl instead of LA during dental or endodontic treatment. Articles reporting NaOCl accident due to extrusion or injection of NaOCl beyond root confines were excluded. A total of 11 articles were found and reviewed. Data pertaining to the patient, injected NaOCl, cause, clinical manifestations, management, hospitalization, healing and recovery, and long-term or residual effects were extracted, compiled, and analysed for interpretation and discussion. Injection of NaOCl instead of LA into the soft tissues leads to varying clinical manifestations with unpredictable extent, outcome, and recovery period. The onus lies with the clinician to prevent it. Therefore, a clinician must take all the precautionary measures and confirm the identity of LA and NaOCl solutions before delivering them. The presented clinical recommendations assist clinicians to prevent it, including its potential medico-legal consequences. However, in case of such an unfortunate event, it is crucial to immediately identify and quickly manage it to limit the tissue damage or complications.
Analysis of Shaping Abilities of Rotary File Systems in Oval Canals with Moderate Root Curvature: A Randomized Controlled Ex Vivo Study

Thomas AR, Reddy TVK, Tan JY, Qing SEJ, Qing CS, Xuan LY, et al.

J Contemp Dent Pract, 2023 Apr 01;24(4):221-227.
PMID: 37469260 DOI: 10.5005/jp-journals-10024-3471

AIM: The purpose of this study was to evaluate and compare the canal transportation tendencies and centering ability of the TruNatomy shaper (TN) and XP-endo shaper (XPS) rotary systems in oval-shaped canals with moderate root curvature (15°-25°), using cone-beam computed tomography (CBCT) imaging.
MATERIALS AND METHODS: Sixty single-rooted permanent human teeth were chosen after considering the inclusion and exclusion criteria. The teeth were divided into two groups (n = 30). The test group was instrumented with TN files and the other with XPS according to manufacturer's instructions. CBCT images were taken before and after instrumentation to record the root canal distances from mesial, distal, buccal, and lingual borders of the root at 3, 5, and 7 mm distances from the root apex using a specific formula. Statistical analysis was done using the Statistical Package for the Social Sciences software program, version 20.0. The data were analyzed using the unpaired t test.
RESULTS: Both TN and XPS were safe for use in oval-shaped canals with moderate root curvature. However, the XPS showed higher buccolingual transportation as compared with TN at 3 mm from the apex and higher mesiodistal transportation at 3 and 5 mm levels from the apex as compared with TN.
CONCLUSION: Canal transportation has been detected in both systems; however, the values obtained were within the safe range (<0.3 mm). Overall, no significant difference was observed between TN and XPS (p > 0.05) in their canal transportation tendencies and centering ability.
CLINICAL SIGNIFICANCE: The study assesses the canal centering and transportation tendencies of the recently launched TN rotary system in extracted teeth with a combination of morphologies. The findings of the study are significant clinically as minimum transportation of the canal, minimal dentin removal, efficient disinfection, and three-dimensional obturation of the root canal are considered important factors in deciding the prognosis of endodontic therapy.
Application of a new system for classifying root canal morphology in undergraduate teaching and clinical practice: a national survey in Malaysia

Ahmed HMA, Che Ab Aziz ZA, Azami NH, Farook MS, Khan AA, Mohd Noor NS, et al.

Int Endod J, 2020 Jun;53(6):871-879.
PMID: 32003029 DOI: 10.1111/iej.13271

AIM: To evaluate and compare the feedback of final year undergraduate dental students in eight Malaysian dental schools on the application of a new system for classifying root canal morphology in teaching and clinical practice.
METHODS: One PowerPoint presentation describing two classification systems for root canal morphology (Oral Surgery Oral Medicine Oral Pathology, 1974 38, 456 and its supplemental configurations, International Endodontic Journal 2017, 50, 761) was delivered to final year undergraduate dental students in eight dental schools in Malaysia by two presenters (each presented to four schools). To examine students' feedback on the utility of each system, printed questionnaires consisting of six questions (five multiple choice questions and one open-ended question) were distributed and collected after the lecture. The questionnaire was designed to compare the classification systems in terms of accuracy, practicability, understanding of root canal morphology and recommendation for use in pre-clinical and clinical courses. The exact test was used for statistical analysis, with the level of significance set at 0.05 (P = 0.05).
RESULTS: A total of 382 (out of 447) students participated giving a response rate of 86%. More than 90% of students reported that the new system was more accurate and more practical compared with the Vertucci system (P 0.05). The students' responses for all questions were almost similar for both presenters (P > 0.05).
CONCLUSIONS: The new system of International Endodontic Journal 2017, 50, 761 for classifying root and canal morphology was favoured by final year undergraduate dental students in Malaysia. The new system has the potential to be included in the undergraduate endodontic curriculum for teaching courses related to root and canal morphology.