RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

ANNEXURE -II

PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION.

1. / Name of the candidate & address / DR.MANJULA S P
POST GRADUATE STUDENT,
A.E.C.S MAARUTI COLLEGE OF DENTAL SCIENCES RESEARCH CENTRE,
NO.108,BTM 6th STAGE,1st PHASE,HULIMAVU TANK BUND ROAD,OFF BANNERGHATTA ROAD,BANGALORE-560076.
2. / Name of the Institution / A.E.C.S MAARUTI COLLEGE OF
DENTAL SCIENCES & RESEARCH CENTRE.
BANGALORE-560076.
3. / Course of the study & subject / MASTER OF DENTAL SURGERY IN
CONSERVATIVE DENTISTRY AND ENDODONTICS.
4. / Date of admission to the course / 30/05/2012
5. / TITLE OF THE TOPIC:
“A COMPARATIVE STUDY OF EFFICACY OF DIFFERENT CONCENTRATIONS OF PERACETIC ACID, SODIUM HYPOCHLORITE WITH PASSIVE IRRIGATION, CITRIC ACID AND ETHYLENE DIAMINE TETRA ACETIC ACID ON THE REMOVAL OF CALCIUM HYDROXIDE FROM ROOT CANALS – AN IN VITRO STUDY.”
6. / BRIEF RESUME OF INTENDED WORK:
6.1 Need for the study :
Microorganisms in the root canal system are considered to play a major role in the pathogenesis of apical periodontitis1.
An intracanal medicament is used to improve the disinfection of the root canals; calcium hydroxide is the most commonly used intracanal medicament4. It is used in the infected root canals because of its alkalinity, good anti-microbial potential, organic tissue dissolution capability and anti-inflammatory effects1,3.
Calcium hydroxide should be removed completely from the root canals when used as an intracanal medicament because it prevents sealers from penetrating in to the dentinal tubules resulting in potential reduction of sealer adaptation. It could also react chemically with the sealer to adversely affect its desired properties and also the dentinal bond strength. Therefore removal of calcium hydroxide dressing before the root canal filling is critical and could affect the outcome of the treatment1, 2.
The most commonly used method for removing calcium hydroxide is instrumentation along with sodium hypochlorite or citric acid irrigating solutions5 .Recently, peracetic acid in different concentrations is being recommended to remove calcium hydroxide from root canalsl.
Peracetic acid is a disinfectant widely used in the food industry and in hospitals which is sporocidal, bacteriocidal, virucidal and fungicidal1.
Peracetic acid is used for the elimination of biofilm formation. The acetic acid content is responsible for inorganic material dissolution and also bonds to the calcium to form complexes which are easily soluble in water1.
Therefore, the present study is taken up to evaluate the efficacy of different concentrations of peracetic acid solutions, sodium hypochlorite with passive irrigation, citric acid and ethylene diamine tetra acetic acid in the removal of calcium hydroxide from root canals.
6.2REVIEW OF LITERATURE:
1. This study was undertaken to compare the efficiencies of different concentrations of peracetic acid solutions, ethylene diamine tetra acetic acid, sodium hypochlorite solutions in the removal of calcium hydroxide from root canals. The peracetic acid had better removal effect in coronal and apical thirds of root canals compared to ethylene diamine tetra acetic acid1.
2. The purpose of this study is to compare the efficacy of different solutions like sodium hypochlorite, 10% citric acid, 20% ethylene diamine tetra acetic acid in the removal of calcium hydroxide from root canals. The result showed none of the irrigants nor their respective combinations were able to completely remove the calcium hydroxide from root canals. Chelating agents such as citric acid and ethylene diamine tetra acetic acid showed the best results .The combination of chelators and sodium hypochlorite did not result in significant improvement of calcium hydroxide removal2.
3. This study was undertaken to evaluate the effects of ethylene diamine tetra acetic acid , etidronic acid, peracetic acid when used in conjuction with sodium hypochlorite as root canal irrigants on calcium removal from canals. Irrigation with ethylene diamine tetra acetic acid and peracetic acid dissolved more calcium when compared to 2% sodium hypochlorite and etidronic acid3.
4.This study was undertaken to compare the efficacy of several techniques for the removal of calcium hydroxide from root canals. The result showed significantly less material obtained with canal brush, passive ultrasonic agitation of sodium hypochlorite and there was no significant difference between syringe delivery of sodium hypochlorite and sodium hypochlorite+ ethylene diamine tetra acetic acid 4.
5.The purpose of this study was to compare the efficacy of ultrasonic irrigation and RinsEndo in removing calcium hydroxide and Ledermix paste from simulated root canal irrregularities. The results showed none of the irrigation techniques was able to completely remove the intracanal medicaments from the apical part of the root canal. But significantly less Ledermix paste was detected when compared with calcium hydroxide5.
6. The purpose of this study was to compare the efficiency of removing calcium hydroxide / chlorhexidine gel, calcium hydroxide / chlorhexidine solution with the use of instrumentation and irrigation with sodium hypochlorite and ethylene diamine tetra acetic acid solutions. The results showed none of the techniques used removed the inter appointment root canal medicaments effectively. Overall, calcium hydroxide/chlorhexidine (gel) paste was associated with significantly larger amount of residue, whereas calcium hydroxide/chlorhexidine (solution) paste was associated with less residue with or without the use of patency file6.
6.3AIMS AND OBJECTIVES OF THE STUDY:
The aim of the study is to evaluate the efficacy of different concentrations of peracetic acid solutions, sodium hypochlorite with passive irrigation, citric acid and ethylene diamine tetra acetic acid in the removal of calcium hydroxide from root canals.
7.MATERIALS AND METHODS:
7.1sources of data or materials:
·  Fifty eight extracted human single rooted teeth
·  1%Peracetic acid (Leo chemicals,India)
·  0.5% Peracetic acid (Leo chemicals, India)
·  3% Sodium hypochlorite (Deor, India)
·  17%EDTA (Leo chemicals,India)
·  10%Citric acid (Leo chemicals, India)
·  Saline (Ives drugs,India)
·  ProtaperNiTi rotary system (Dentsplymaillefer, Switzerland)
·  Ultrasonic unit (EMS,Switzerland)
·  Ultrasonic endodontic Kfile size #20
·  27 guage hypodermic needle with beveled tip (Dispovan,India)
·  Calcium hydroxide powder(Prime dental products, India)
·  Distilled water (Ranbaxy,India)
·  Lentulo spiral (Dentsplymaillefer, Switzerland)
·  Coltosol F (Coltenewhaledent, Switzerland)
·  #15 Kfile(Mani, Japan)
·  Paper points(Dentsply, USA)
·  Diamond Disc (Horico,Germany)
·  Chisel (Manipal, India)
·  Stereomicroscope (Labovision, Olympus)
7.2METHODOLOGY:
Method of collection of data:
Human single rooted teeth will be collected from the department of Oral and Maxillofacial Surgery, A.E.C.S.Maaruti college of Dental sciences and Research Institute, Bangalore.
Inclusion criteria:
·  Healthy single rooted teeth with intact clinical crowns.
·  Teeth without dental caries.
·  Teeth extracted for periodontal reasons or orthodontic reasons.
Exclusion criteria:
·  Decayed teeth.
·  Teeth which are completely discolored.
·  Teeth which are restored.
·  Teeth with developmental anomalies.
·  Teeth with hard or discolored arrested caries.
·  Teeth with internal or external resorption.
·  Teeth which are badly attrited or with deep cervical abrasions.
·  Deciduous teeth.
PREPARATION OF SAMPLES
The teeth will be decoronated to standardize the root length to 12mm.Working length will be established 1mm short of the apical foramen. Biomechanical preparation will be performed using Protaper NiTi system up to F5. The canals will be irrigated with 3ml 0f 3% sodium hypochlorite between each instrument . Then the canals will be irrigated with 5ml of 3% sodium hypochlorite followed by 17% ethylene diamine tetra acetic acid to remove the smear layer. Finally, 10ml distilled water is used to remove all traces of irrigants from the canal.
The canals will be dried with paper points and filled with calcium hydroxide paste (calcium hydroxide powder+distilled water) using lentulospiral .The access cavities will be sealed with temporary filling material (Coltosol F).
The teeth will be stored in 100% relative humidity for one week .
The specimens will be randomly divided into 6 experimental groups:
GROUP I (Control)
-Negative group[n=4]
Teeth not filled with calcium hydroxide.
-Positive group [n=4]
Calcium hydroxide is removed with distilled water.
GROUP II [n=10]
3ml of 17% ethylene diamine tetra acetic acid with passive irrigation.
GROUP III [n=10]
3ml of 3%sodium hypochlorite with passive ultrasonic irrigation.
GROUP IV [n=10]
3ml of 10% citric acid with passive irrigation.
GROUP V [n=10]
3ml of 1% peracetic acid with passive irrigation.
GROUP VI [n=10]
3ml of 0.5% peracetic acid with passive irrigation.
A size #15 k file will be introduced till the working length to loosen the calcium hydroxide from root canals and to create the space for irrigation needle.
Irrigation will be performed passively at a 3ml per minute flow rate with 27 guage hypodermic needle.
Two grooves will be placed on the buccal and lingual surfaces using a diamond disc. The roots will be split longitudinally in to two halves using a chisel. Then, the samples will be viewed under stereomicroscope at a magnification of 30X.
STEREOMICROSCOPIC EVALUATION:
Cleanliness of the root canal walls will be evaluated in the apical, middle and cervical thirds of the roots at 30X magnification.
Evaluation will be performed independently by two observers and the following scoring system will be used to assess the quantity of the remnants on the canal walls:
·  Score 0: Absence of residue
·  Score 1: Small amount of residue.
·  Score2: Moderate amount of residue.
·  Score 3: Large amount of residue
STATISTICAL ANALYSIS:
The data will be statistically analyzed using one way ANOVA(Analysis of variance) and Kruskal-wallis test.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
NOT APPLICABLE
7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR
INSTITUTION?
YES
7.5 TRIALTESTS (PILOT STUDY) DONE IF ANY?
YES

8. LIST OF REFERENCES:

1. / Burak Sagsen, Yakup U, Tugrul A, Burban Can C
“The effect of peracetic acid on removing calcium hydroxide from the root canals”. Journal of Endodontics, 2012; 38:1197-1201.
2. / Rodig T, Vogel S, Zapf A, Hulsmann M
“Efficacy of different irrigants in the removal of calcium hydroxide from root canals.”
International Endodontic Journal, 2010; 43, 519-527.
3. / Lottanti S, Gautschi H, Sener B, Zehnder M.
“Effect of ethylenediamine tetra acetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer”.
International Endodontic Journal, 2009; 42, 335-343.
4. / Tasdemir T ,Celik D, Er K, Yildirim T, Ceyhanli K.T, Yesilyurt C
“Efficacy of several techniques for the removal of calcium hydroxide medicament from root canals”.
International Endodontic Journal, 2011; 44, 505-509.
5. / Tina Rodig, Manja Hirschleb, Antonia Zapf , Michael Hulsmann.
“Comparison of ultrasonic irrigation and RinsEndo for the remov al of calcium hydroxide and Ledermix paste from root canals”.
International Endodontic Journal, 2011; 44, 1155-1161.
6. / Lambrianidis T, Kosti E, Boutsioukis C, Mazinis M.
“Removal efficacy of various calcium hydroxide -chlorhexidine medicaments from the root canal”.
International Endodontic Journal, 2006; 41, 55-61.
9 / SIGNATURE OF THE CANDIDATE
10 /

REMARKS OF THE GUIDE

/ This study might help us in knowing which is the best solution in removing all the remnants of calcium hydroxide from root canal as it might interfere in achieving a good hermetic seal.
11 / NAME AND DESIGNATION OF
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 HEAD OF DEPARTMENT
11.6 SIGNATURE / DR.FARHAT NASREEN
PROFESSOR,
DEPARTMENT OF CONSERVATIVE
DENTISTRY & ENDODONTICS,
A.E.C.S MAARUTI COLLEGE OF
DENTAL SCIENCES AND RESEARCH CENTRE,
BANGALORE-76.
DR. RAGHU SRINIVASAN
PROFESSOR & HOD,
DEPARTMENT OF CONSERVATIVE
DENTISTRY & ENDODONTICS,
A.E.C.S MAARUTI COLLEGE OF
DENTAL SCIENCES AND RESEARCH CENTRE,
BANGALORE-76.
DR. RAGHU SRINIVASAN
PROFESSOR & HOD,
DEPARTMENT OF CONSERVATIVE
DENTISTRY & ENDODONTICS,
A.E.C.S MAARUTI COLLEGE OF
DENTAL SCIENCES AND RESEARCH CENTRE,
BANGALORE-76.
12. / 12.1 REMARKS OF CHAIRMAN AND PRINICIPAL
12.2  SIGNATURE

Flow chart of intended study

Consent Form

For Collection of Extracted Teeth

PATIENT DETAILS:

Name:

Age:

Sex:

CONSENT

I understand and acknowledge that:

1.  My tooth/teeth will be used for dental research and dental education purposes only.

2.  I have been informed that consent is voluntary and my decision not to consent will in no way prejudice any ongoing treatment.

3.  I understand that the tooth/teeth will be stored with other teeth and without any identifying information.

I,……………………………………….have read this form and give consent for the same.

………………………………………

Signature

9