IADR Abstract Archives
Calcium Hydroxide versus Chlorhexidine Effects on Endotoxins: A Systematic Review
Objectives: The aim of the study was to systematically review the effect of calcium hydroxide (CH) compared to chlorhexidine (CHX) or CH/CHX combination as intracanal medicaments on the endotoxin-levels in infected root canals of mature permanent teeth.
Methods: Two independent reviewers searched Cochrane library, PubMed, LILACS, Web of Science, Trip-database, EBSCOhost, Scopus, ongoing trials registries, OpenGrey, ProQuest and other sources (conference proceedings, major journals in dentistry, backward and forward search) from the start till September 2019 with no language restrictions. Only randomized clinical trials (RCTs) were included. Data was extracted and risk of bias (RoB) assessed using Cochrane RoB 2.0 tool. Meta-analysis was performed using RevMan 5.3 software. Mean difference (MD) and standardized mean difference (SMD) with 95% confidence intervals (CI) were used as summary effect measures.
Results: Two RCTs (N=96 teeth) were included. All included teeth were single-rooted, asymptomatic and with apical-periodontitis. One study had ‘Some Concerns’ about RoB, while the other had low RoB. CH decreased endotoxin-levels compared to CHX after 7d-application (SMDpooled -0.75, 95% CI -1.44 to -0.06, 2 studies, 40 patients, I2 88%) and 14d-application (MD -13.99, 95% CI -19.41 to -8.57, 1 study, 24 patients); a sensitivity analysis of 7d-application findings, however, showed no difference (SMDpooled -0.73, 95% CI-2.76 to 1.3). CH and CH/CHX showed similar effects on endotoxin-levels after 7d-application (SMDpooled 0.48, 95% CI -0.15 to 1.12, 2 studies, 40 patients, I2=0%) and 14d-application (MD -0.28, 95% CI -1.99 to 1.43, 1 study, 24 patients).
Conclusions: In infected root canals of mature-permanent teeth, CH-application may reduce endotoxin-levels more than CHX, yet, have a similar effect as CH/CHX combination. The available evidence is, however, very limited.
Methods: Two independent reviewers searched Cochrane library, PubMed, LILACS, Web of Science, Trip-database, EBSCOhost, Scopus, ongoing trials registries, OpenGrey, ProQuest and other sources (conference proceedings, major journals in dentistry, backward and forward search) from the start till September 2019 with no language restrictions. Only randomized clinical trials (RCTs) were included. Data was extracted and risk of bias (RoB) assessed using Cochrane RoB 2.0 tool. Meta-analysis was performed using RevMan 5.3 software. Mean difference (MD) and standardized mean difference (SMD) with 95% confidence intervals (CI) were used as summary effect measures.
Results: Two RCTs (N=96 teeth) were included. All included teeth were single-rooted, asymptomatic and with apical-periodontitis. One study had ‘Some Concerns’ about RoB, while the other had low RoB. CH decreased endotoxin-levels compared to CHX after 7d-application (SMDpooled -0.75, 95% CI -1.44 to -0.06, 2 studies, 40 patients, I2 88%) and 14d-application (MD -13.99, 95% CI -19.41 to -8.57, 1 study, 24 patients); a sensitivity analysis of 7d-application findings, however, showed no difference (SMDpooled -0.73, 95% CI-2.76 to 1.3). CH and CH/CHX showed similar effects on endotoxin-levels after 7d-application (SMDpooled 0.48, 95% CI -0.15 to 1.12, 2 studies, 40 patients, I2=0%) and 14d-application (MD -0.28, 95% CI -1.99 to 1.43, 1 study, 24 patients).
Conclusions: In infected root canals of mature-permanent teeth, CH-application may reduce endotoxin-levels more than CHX, yet, have a similar effect as CH/CHX combination. The available evidence is, however, very limited.