Reduction of intracanal bacteria using nickel-titanium rotary instrumentation and various medications

The purpose of this study was to evaluate the extent of bacterial reduction with nickel-titanium rotary instrumentation and 1.25% NaOCl irrigation. Al so, the additional antibacterial effect of calcium hydroxide for >1 wk was tested. Forty-two subjects with radiographic and clinical signs of chronic apical periodontitis were recruited. The canals were sampled before treatme nt, during and after instrumentation, and after treatment with calcium hydr oxide and the samples incubated anaerobically for 7 days at 37 degreesC. Th e bacteria from each sample were quantified and the log,, values were used for calculations and comparisons. The initial sample confirmed infection of the canals. There was a significantly greater pattern of reduction of bact eria when NaOCl was used as an irrigant, compared with sterile saline (p < 0.05). After instrumentation with NaOCl irrigation, 61.9% of canals were re ndered bacteria-free. The placement of calcium hydroxide for at least 1 wk rendered 92.5% of the canals bacteria free. This was a significant reductio n, compared with NaOCl irrigation alone (p = 0.0001). The results of this s tudy indicate that NaOCl irrigation with rotary instrumentation is an impor tant step in the reduction of canal bacteria during endodontic treatment. H owever this method could not consistently render canals bacteria-free. The addition of calcium hydroxide intracanal medication should be used to more predictably attain this goal.