journal article·2025Open access

Effect of precipitate formation in the root canal on the accuracy of electronic apex locators

Kürşat Er, Simay Koç, Damla Erkal, Dide Tekinarslan, Ömer Kesmez, Feride Demir, Eszther Borbely

Journal of Oral Science· Volume 67· Issue 4

Abstract

PURPOSE: This study evaluated how the formation of various types of precipitates affects the accuracy of electronic apex locators in determining the working length. METHODS: Two hundred and forty extracted human maxillary incisors were selected. A total of eight groups were used: four groups (n = 30) for the application of different irrigants; saline, sodium hypochlorite (5.25% NaOCl), chlorhexidine (2% CHX) and ethylenediaminetetraacetic acid (EDTA) (17% EDTA), and four groups (n = 30) for the formation of precipitates; orange-brown (2% CHX + 5.25% NaOCl), orange-white (2% CHX + 0.16% NaOCl), white milky (2% CHX + 17% EDTA), salt (2% CHX + saline). Electronic working length was determined by two different electronic apex locators. RESULTS: The success rate of the 5.25% NaOCl group was significantly higher than that of the white milky precipitate group. The electronic apex locators were highly effective in identifying working length, but the success rate of both devices declined due to the production of a white milky precipitate. CONCLUSION: The study emphasizes the importance of selecting appropriate irrigation protocols for optimal treatment outcomes, as the chemical interactions between solutions and precipitates significantly influence electronic apex locator measurements, highlighting the need for careful consideration of irrigant compatibility.
Source: openalex_inverted_index · Quality: baseline

Research context

OpenAlex topics: Endodontics and Root Canal Treatments · Dental materials and restorations · Dental Trauma and Treatments

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Endodontics, Faculty of Dentistry, Akdeniz University

Department of Medical Biotechnology, Health Sciences Institute, Akdeniz University

Department of Chemistry, Faculty of Science, Akdeniz University

Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Semmelweis University

References (31)

Show source-provided references
1. 1. Haapasalo M, Shen Y, Wang Z, Gao Y (2014) Irrigation in endodontics. Br Dent J 216, 299-303. doi: 10.1038/sj.bdj.2014.20410.1038/sj.bdj.2014.204 ↗
2. 2. Prado M, Júnior HMS, Rezende CM, Pinto AC, Faria RB, Simão RA et al. (2013) Interactions between irrigants commonly used in endodontic practice: a chemical analysis. J Endod 39, 505-510. doi: 10.1016/j.joen.2012.11.05010.1016/j.joen.2012.11.050 ↗
3. 3. Cullen JK, Wealleans JA, Kirkpatrick TC, Yaccino JM (2015) The effect of 8.25% sodium hypochlorite on dental pulp dissolution and dentin flexural strength and modulus. J Endod 41, 920-924. doi: 10.1016/j.joen.2015.01.02810.1016/j.joen.2015.01.028 ↗
4. 4. Gernhardt CR, Eppendorf K, Kozlowski A, Brandt M (2004) Toxicity of concentrated sodium hypochlorite used as an endodontic irrigant. Int Endod J 37, 272-280. doi: 10.1111/j.0143-2885.2004.00804.x10.1111/j.0143-2885.2004.00804.x ↗
5. 5. Çalt S, Serper A (2002) Time-dependent effects of EDTA on dentin structures. J Endod 28, 17-19. doi: 10.1097/00004770-200201000-0000410.1097/00004770-200201000-00004 ↗
6. 6. Agrawal VS, Rajesh M, Sonali K, Mukesh P (2014) A contemporary overview of endodontic irrigants - a review. J Dent App 1, 105-115.
7. 7. Rôças IN, Siqueira JF Jr (2011) Comparison of the in vivo antimicrobial effectiveness of sodium hypochlorite and chlorhexidine used as root canal irrigants: a molecular microbiology study. J Endod 37, 143-150. doi: 10.1016/j.joen.2010.11.00610.1016/j.joen.2010.11.006 ↗
8. 8. Klein U, Kleier DJ (2013) Sodium hypochlorite accident in a pediatric patient. Pediatr Dent 35, 534-538.
9. 9. Wright PP, Kahler B, Walsh LJ (2017) Alkaline sodium hypochlorite irrigant and its chemical interactions. Materials (Basel) 10, 1147. doi: 10.3390/ma1010114710.3390/ma10101147 ↗
10. 10. Gasic J, Popovic J, Živković S, Petrovic A, Barac R, Nikolic M (2012) Ultrastructural analysis of the root canal walls after simultaneous irrigation of different sodium hypochlorite concentration and 0.2% chlorhexidine gluconate. Microsc Res Tech 75, 1099-1103. doi: 10.1002/jemt.2203610.1002/jemt.22036 ↗
11. 11. Krishnamurthy S, Sudhakaran S (2010) Evaluation and prevention of the precipitate formed on interaction between sodium hypochlorite and chlorhexidine. J Endod 36, 1154-1157. doi: 10.1016/j.joen.2010.01.01210.1016/j.joen.2010.01.012 ↗
12. 12. Thomas JE, Sem DS (2010) An in vitro spectroscopic analysis to determine whether para-chloroaniline is produced from mixing sodium hypochlorite and chlorhexidine. J Endod 36, 315-317. doi: 10.1016/j.joen.2009.10.02810.1016/j.joen.2009.10.028 ↗
13. 13. Nowicki JB, Sem DS (2011) An in vitro spectroscopic analysis to determine the chemical composition of the precipitate formed by mixing sodium hypochlorite and chlorhexidine. J Endod 37, 983-988. doi: 10.1016/j.joen.2011.03.03310.1016/j.joen.2011.03.033 ↗
14. 14. Nagendrababu V, Murray PE, Ordinola-Zapata R, Peters OA, Rôças IN, Siqueira JF Jr et al. (2021) PRILE 2021 guidelines for reporting laboratory studies in Endodontics: a consensus-based development. Int Endod J 54, 1482-1490. doi: 10.1111/iej.1347710.1111/iej.13477 ↗
15. 15. ElAyouti A, Connert T, Dummer P, Löst C (2022) A critical analysis of research methods and experimental models to study working length determination and the performance of apex locators - a narrative review with recommendations for the future. Int Endod J 55, 281-294. doi: 10.1111/iej.1373810.1111/iej.13738 ↗
16. 16. Pathan JA, Nitalikar MM (2014) Formulation and evaluation of medicated chewing gum containing antibacterial agent. J Curr Pharm Res 4, 1291-1296. doi: 10.33786/JCPR.2014.v04i04.00510.33786/JCPR.2014.v04i04.005 ↗
17. 17. Orhan EO, Irmak Ö, Tasal E (2020) Vibrational spectroscopy analysis of the precipitate form after mixing sodium hypochlorite and chlorhexidine: a potential clinical problem. Int Arch Dent Sci 41, 71-76. doi: 10.5505/eudfd.2020.5683310.5505/eudfd.2020.56833 ↗
18. 18. Daood U, Bapat RA, Sidhu P, Ilyas MS, Khan AS, Mak KK et al. (2021) Antibacterial and antibiofilm efficacy of k21-E in root canal disinfection. Dent Mater 37, 1511-1528. doi: 10.1016/j.dental.2021.08.00110.1016/j.dental.2021.08.001 ↗
19. 19. Rasimick BJ, Nekich M, Hladek MM, Musikant BL, Deutsch AS (2008) Interaction between chlorhexidine digluconate and EDTA. J Endod 34, 1521-1523. doi: 10.1016/j.joen.2008.08.03910.1016/j.joen.2008.08.039 ↗
20. 20. Umamathi T, Arockia Selvi J, Agnesia Kanimozhi S, Rajendran S, Amalraj AJ (2008) Effect of Na3PO4 on the corrosion inhibition efficiency of EDTA-Zn2+ system for carbon steel in aqueous solution. Ind J Chem Technol 15, 560-565.
21. 21. Bjelović LZ, Glišić BĐ, Živković MD, Kanjevac TV (2019) Investigation of p-chloroaniline formation in the reactions between different endodontic irrigants. Kragujevac J Sci 41, 43-52. doi: 10.5937/KgJSci1941043B10.5937/KgJSci1941043B ↗
22. 22. Doğanay Yıldız E, Arslan H, Taş G, Gündoğdu EC, Keskın A, Yıldırım A (2020) Sodium thiosulphate and Tween 80 prevent the formation of para-chloroaniline in the irrigating solutions. J Dent Fac Atatürk Univ 30, 61-65. doi: 10.17567/ataunidfd.63701010.17567/ataunidfd.637010 ↗
23. 23. Jeong JW, Sarmast ND, Terlier T, van der Hoeven R, Holland JN, Parikh N (2021) Assessment of the cytotoxic effects and chemical composition of the insoluble precipitate formed from sodium hypochlorite and chlorhexidine gluconate. Int Endod J 54, 1892-1901. doi: 10.1111/iej.1358310.1111/iej.13583 ↗
24. 24. Basrani BR, Manek S, Sodhi RN, Fillery E, Manzur A (2007) Interaction between sodium hypochlorite and chlorhexidine gluconate. J Endod 33, 966-969. doi: 10.1016/j.joen.2007.04.00110.1016/j.joen.2007.04.001 ↗
25. 25. Albright PS (1937) Experimental tests of recent theories descriptive of the salting-out effect. J Am Chem Soc 59, 2098-2104. doi: 10.1021/ja01290a00510.1021/ja01290a005 ↗
26. 26. Shin HS, Yang WK, Kim MR, Ko HJ, Cho KM, Park SH et al. (2012) Accuracy of Root ZX in teeth with simulated root perforation in the presence of gel or liquid type endodontic irrigant. Restor Dent Endod 37, 149-154. doi: 10.5395/rde.2012.37.3.14910.5395/rde.2012.37.3.149 ↗
27. 27. Altunbaş D, Kuştarcı A, Toyoğlu M (2017) The influence of various irrigants on the accuracy of 2 electronic apex locators in locating simulated root perforations. J Endod 43, 439-442. doi: 10.1016/j.joen.2016.10.03110.1016/j.joen.2016.10.031 ↗
28. 28. Khatri MP, Ghivari SB, Pujar M, Faras R, Gopeshetti P, Vanti A (2019) Accuracy of two electronic apex locators in locating root perforations in curved canals in dry and wet conditions: a comparative in vitro study. Dent Res J (Isfahan) 16, 407-412. doi: 10.4103/1735-3327.27077910.4103/1735-3327.270779 ↗
29. 29. Tekinarslan D, Erkal D, Pehlivan B, Ünal E, Kayar G, Koc S et al. (2023) Effects of different irrigation solutions on the accuracy of electronic apex locators in curved and straight root canals. G Ital Endod 37, 54-61. doi: 10.32067/GIE.2023.37.01.11
30. 30. Oliveira TN, Vivacqua-Gomes N, Bernardes RA, Vivan RR, Duarte MAH, Vasconcelos BC (2017) Determination of the accuracy of 5 electronic apex locators in the function of different employment protocols. J Endod 43, 1663-1667. doi: 10.1016/j.joen.2017.03.03910.1016/j.joen.2017.03.039 ↗
31. 31. Harorlı H, Koç S, Kuştarcı A (2023) In vitro comparison of the accuracy of cone-beam computed tomography scanning and electronic apex locators in detection of simulated root perforations in different localizations. J Endod 49, 1676-1681. doi: 10.1016/j.joen.2023.09.00610.1016/j.joen.2023.09.006 ↗