Chemical aspect of sodium hypochlorite activation in obtaining favorable outcomes of endodontic treatment: An in-vitro study.

Background: Endodontic treatment is one of the most widely performed procedures in a dental office. New techniques for enhancing the effectiveness of irrigants are being introduced into the dental market. It is crucial to choose a proper method to obtain the highest possible long-term success of performed endodontic treatment. Sodium hypochlorite (NaOCl) appears to be one of the most common and profitable solutions for root canal irrigation. The activation of a solution may be analyzed in 2 fields, physical - turbulence of flow, and chemical - disintegration of irrigant molecules into very active radicals that improve its activity. While the physical alternations of irrigant flow with different techniques are widely studied, there are not many attempts to approach the subject in chemical terms.
Objectives: The aim of the study was to compare the chemical effectiveness of 2 methods of NaOCl activation: ultrasonics vs the Self-Adjusting File system (SAF) as an adjunct to increase the efficacy of the irrigant.
Material and Methods: The level of activation was evaluated via a reaction of the activated NaOCl samples, with 9-fluorenol as the starting organic material. The model reaction is based on the oxidation of 9-fluorenol to 9-fluorenon. The evaluation was performed using 1H nuclear magnetic resonance (NMR) spectroscopy, comparing the spectra obtained for the examined mixtures.
Results: Nuclear magnetic resonance studies show that the use of ultrasonics resulted in increased chemical degradation of NaOCl as compared to the SAF system and non-agitated samples. The prevalence of chemical activation in the ultrasonic group over the SAF group was almost 3 times higher, 3.11 to 1.20, respectively. The Kruskal-Wallis rank sum test revealed there is a statistically significant difference in distributions between the groups.
Conclusions: Both SAF and ultrasonics activate NaOCl. Ultrasonic agitation provided higher chemical activation of NaOCl solution than the SAF. The use of ultrasonic agitation of NaOCl in endodontic treatment will allow us to obtain better long-term clinical results.