OJST  Vol.4 No.8 , August 2014
In Vitro Evaluation of the Staining Effects of Two Intracanal Medicaments over a 3-Month Period
Aim: The aim of this study was to evaluate in vitro the tooth color alterations associated with two intracanal medicaments, calcium hydroxide and calcium hydroxide combined with aquatic solution of chlorexidine, for up to three months post-treatment. Materials & Methods: Thirty-one intact human anterior mature teeth were used. Black adhesive tape with a 4-mm diameter window was used to standardize the enamel surface intended for color analysis. After access cavity preparation, cleaning and shaping were completed with rotary nickel-titanium files. The teeth were randomly divided into two groups (n = 15), each according to the intracanal medicament used: (A) calcium hydroxide paste (UltraCalTM XSTM Ultradent Products, Inc., USA); (B) 2% chlorhexidine aquatic solution combined with pure calcium hydroxide powder. In one tooth, no medicament was placed (pilot). The enamel surfaces were colormetrically evaluated at the following time intervals: before placing the medicaments, immediately after placement, after 1 week as well as after 1, 2 and 3 months post-treatment. The CIE color parameters (L*, a*, b*) were recorded for each material and the corresponding color differences (ΔΕ) were calculated and statistically analyzed. Results: The most significant factor in tooth discoloration was the time intervals. The most important changes of the ΔΕ values were recorded after the 1st week and after the 3rd month. L* presented an overall increase in both groups, resulting in a higher lightness of the crown color. Only L* did show significant alterations during specific time intervals. Conclusions: There is no statistically significant relationship between the type of intracanal medicament and tooth color alteration. Time is statistically the most important factor affecting the discoloration ability of Ca(OH)2, either combined with chlorexidine or not. Consequently, the clinician should always take this into account before using such medicaments for a long-term treatment.

Cite this paper
Kontogiannis, T. , Koursoumis, A. and Kerezoudis, N. (2014) In Vitro Evaluation of the Staining Effects of Two Intracanal Medicaments over a 3-Month Period. Open Journal of Stomatology, 4, 381-388. doi: 10.4236/ojst.2014.48052.
[1]   Krastl, G., Allgayer, N., Lenherr, P., Filippi, A., Taneja, P. and Weiger, R. (2013) Tooth Discoloration Induced by Endodontic Materials: A Literature Review. Dental Traumatology, 29, 2-7.

[2]   Ahmed, H.M.A. and Abbott, P.V. (2012) Discoloration Potential of Endodontic Procedures and Materials: A Review. International Endodontic Journal, 45, 883-897.

[3]   Lenherr, P., Allgayer, N., Weiger, R., Filippi, A., Attin, T. and Krastl, G. (2012) Tooth Discoloration Induced by Endodontic Materials: A Laboratory Study. International Endodontic Journal, 45, 942-949.

[4]   Silveira, C.F.M., Cunha, R.S., Fontana, C.E., de Martin, A.S., Gomes, B.P.F.A., Lopes Motta, R.H. and Bueno, C.E.S. (2011) Assessment of the Antibacterial Activity of Ca(OH)2 Combined with Chlorexidine Paste and Other Intracanal Medications against Bacterial Pathogens. European Journal of Dentistry, 5, 1-7.

[5]   Carrotte, P. (2004) Endodontics: Part 9. Calcium Hydroxide, Root Resorption, Endo-Perio Lesions. British Dental Journal, 197, 735-743.

[6]   Mohammadi, Z. and Dummer, P.M.H. (2011) Properties and Applications of Calcium Hydroxide in Endodontics and Dental Traumatology. International Endodontic Journal, 44, 697-730.

[7]   Siren, E.K., Haapasalo, M.P.P., Waltimo, T.M.T. and Orstavik, D. (2004) In Vitro Antibacterial Effect of Calcium Hydroxide Combined with Chlorexidine or Iodine Potassium on Enterococcus Faecalis. European Journal of Oral Science, 112, 326-331.

[8]   Mohammadi, Z. and Abbott, P.V. (2009) The Properties and Applications of Chlorexidine in Endodontics. International Endodontic Journal, 42, 288-302.

[9]   Gomes, B.P., Vianna, M.E., Zaia, A.A., Almeida, J.F., Souza-Filho, F.J. and Ferraz, C.C. (2013) Chlorexidine in Endodontics. Brazilian Dental Journal, 24, 89-102.

[10]   Zanatta, F.B., Antoniazzi, R.P. and Rosing, C.K. (2010) Staining and Calculus Formation after 0.12% Chlorexidine Rinses in Plaque-Free and Plaque Covered Surfaces. Journal of Applied Oral Science, 18, 515-521.

[11]   Koursoumis, A., Kerezoudis, N.P. and Kakampoura, A. In Vitro Assessment of Tooth Color Alteration by Two Different Types of Endodontic Irrigants. Journal of Contemporary Dental Practice (under publication).

[12]   Eliades, T., Kakaboura, A., Eliades, G. and Bradley, T.G. (2001) Comparison of Enamel Colour Changes Associated with Orthodontic Bonding Using Two Different Adhesives. European Journal of Orthodontics, 23, 85-90.

[13]   Seghi, R.R., Hewlett, E.R. and Kim, J. (1989) Visual and Instrumental Colorimetric Assessment of Small Color Differences on Translucent Dental Porcelain. Journal of Dental Research, 68, 1760-1764.

[14]   Kim, S.T., Abbott, P.V. and McGinley, P. (2000) The Effects of Ledermix Paste on Discolouration of Mature Teeth. International Endodontic Journal, 33, 227-232.

[15]   Kim, S.T., Abbott, P.V. and McGinley, P. (2000) The Effects of Ledermix Paste on Discolouration of Immature Teeth. International Endodontic Journal, 33, 233-237.

[16]   Day, P.F., Duggal, M.S., High, A.S., Robertson, A., Gregg, T.A., Ashley, P.F., et al. (2011) Discoloration of Teeth after Avulsion and Replantation: Results from a Multicenter Randomized Controlled Trial. Journal of Endodontics, 37, 1052-1057.

[17]   Andreasen, J.O., Andreasen, F.M. and Andersson, L. (2007) Text-book and Colour Atlas of Traumatic Injuries to the Teeth. 4th Edition, Blackwell Munksgaard, Copenhagen.

[18]   Addy, M. and Moran, J. (1995) Mechanisms of Stain Formation on Teeth, in Particular Associated with Metal Ions and Antiseptics. Advances in Dental Research, 9, 450-456.

[19]   Addy, M. and Roberts, W.R. (1981) Comparison of the Bisbiguanide Antiseptics Alexidine and Chlorexidine. II. Clinical and in Vitro Staining Properties. Journal of Clinical Periodontology, 8, 220-230.

[20]   Wang, C.S., Arnold, R.R., Trope, M. and Teixeira, F.B. (2007) Clinical Efficiency of 2% Chlorhexidine Gel in Reducing Intracanal Bacteria. Journal of Endodontics, 33, 1283-1289.

[21]   Dametto, F.R., Ferraz, C.C., Gomes, B.P., Zaia, A.A., Teixeira, F.B. and de Souza-Filho, F.J. (2005) In Vitro Assessment of the Immediate and Prolonged Antimicrobial Action of Chlorhexidine Gel as an Endodontic Irrigant against Enterococcus faecalis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, 99, 768-772.

[22]   Rosenthal, S., Spångberg, L. and Safavi, K. (2004) Chlorhexidine Substantivity in Root Canal Dentin. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, 98, 488-492.

[23]   Athanassiadis, B., Abbott, P.V. and Walsh, L.J. (2007) The Use of Calcium Hydroxide, Antibiotics and Biocides as Antimicrobial Medicaments in Endodontics. Australian Dental Journal, 52, S64-S82.

[24]   Schafer, E. and Bössmann, K. (2005) Antimicrobial Efficacy of Chlorexidine and Two Calcium Hydroxide Formulations against Enterococcus faecalis. Journal of Endodontics, 31, 53-56.