Restor Dent Endod.  2021 Aug;46(3):e33. 10.5395/rde.2021.46.e33.

Enhanced visualization of the root canal morphology using a chitosanbased endo-radiopaque solution

• Govind S
• Jena A
• Pattanaik S
• Anarasi M
• Mohapatra S
• Shivagange V

• KMID: 2548077
• DOI: http://doi.org/10.5395/rde.2021.46.e33

Abstract

Objectives
This study aimed to investigate the efficacy of ionic and non-ionic-based contrast media (in vitro study) and the combinatorial effect of chitosan-based endo-radiopaque solution (CERS) (in vivo study) for visualization of the root canal anatomy.
Materials and Methods
in vitro study (120 teeth): The root canal of maxillary premolars and molars (in vitro group 1 and 2 respectively, n = 60 each) were analyzed using 4 different contrast media (subgroups: Omnipaque 350, Iopamidol, Xenetix 350, and Urografin 76; n = 15 each) in combination with 5.25% sodium hypochlorite (NaOCl). Based on the results of the in vitro study, in vivo study (80 teeth) was done to compare Xenetix 350 + 5.25% NaOCl with CERS (in vivo group 1 and 2 respectively, n = 40 each) on maxillary and mandibular premolars and molars. Two endodontists used radiovisiography to assess the depth of ingress and identify the aberrant root anatomy after access cavity preparation, and after initial cleaning and shaping of canals. Kruskal-Wallis test was used for in vitro comparison (p < 0.05), and Wilcoxon signed-rank test and Mann-Whitney U test for in vivo analysis (p < 0.01).
Results
In vitro study, Xenetix 350 + 5.25% NaOCl facilitated a significant higher visualization (p < 0.05). For in vivo study, CERS had a statistically significant depth of ingress (p < 0.01), and was efficient in identifying the aberrant root canal anatomy of premolars and molars.
Conclusions
CERS facilitates better visualization of the root canal anatomy of human premolars and molars.

Keyword

Chitosan; Contrast media; Digital radiography; Root canal anatomy

Figure

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  Figure 1 In vitro radiographs illustrating Ingress of Xenetix 350 + 5.25% sodium hypochlorite into root canals. (A, E) Pre-operative radiographs (mesio-distal) of maxillary premolar and molar teeth. (B, F) Compromised ingress of contrast solution into the root canals after access opening. (C, G) Working length radiographs of premolar and molar teeth. (D, H) Complete ingress of contrast solution into the root canals after cleaning and shaping.

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  Figure 2 Flowchart representing the allocation of participants to groups and subgroups for in vivo study.NaOCl, sodium hypochlorite; CERS, chitosan-based endo-radiopaque solution.

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  Figure 3 In vivo radiographs illustrating ingress of Xenetix 350 + 5.25% sodium hypochlorite (A-F) and chitosan-based endo-radiopaque solution (G-P) into root canals after access opening (A, C, E, G, I, K, M, O); after cleaning and shaping (B, D, F, H, J, L, N, P).

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  Figure 4 Post obturation radiographs illustrating accessory canals in chitosan-based endo-radiopaque solution group.

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