Introduction: Bacterial populations in the root canal must be eliminated or at least significantly reduced to levels compatible with the healing process of periapical tissues in order to achieve optimal results of the performed endodontic treatment. Irrigation solutions play an important role in the removal of infected tissue, bacteria and their breakdown products, and also affect the decomposition of organic and inorganic matter in the root canal system. Medications currently used in root canal cleaning and preparation are NaOCl, CHX, EDTA and MTAD. None of these solutions has all the characteristics of an ideal irrigator.
Aim:The aim of this study is to present chlorhexidine (CHX) as a drug used in endodontics, as well as describe its advantages and disadvantages. We will consider its structure and mechanisms of action as well as the target group of microorganisms it affects.
Materials and Methods: We have reviewed studies and articles published by foreign and Bulgarian authors in order to present CHX as a medicine, used in endodontics. The main topic of the review is to emphasize the benefits of using it.
Conclusion: CHX has a broad spectrum of antimicrobial activity against gram positive and gram-negative bacteria, but it does not have the ability to dissolve organic tissue. Therefore, it will not be effective when used alone. CHX can be very beneficial in reducing the amount of pathogenic bacteria inside the root canal system, which makes it an ideal irrigator for the final rinse of the root canal. Mixing CHX with Ca(OH)2 may increase its antimicrobial activity.
. Almyroudi A, Mackenzie D, McHugh S, Saunders WP. The effectiveness of various disinfectants used as endodontic intracanal medications: an in vitro study. J Endod. 2002;28:163–7. [PubMed] [Google Scholar]
. Athanassiadis B, Abbott PV, Walsh LJ (2007) The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J 52, S64-82
. Baik JE, Ryu YH, Han JY, et al. Lipoteichoic acid partially contributes to the inflammatory responses to Enterococcus faecalis. J Endod 2008;34:975– 82.
. Basrani B, Lemonie C. Chlorhexidine gluconate. Aust Endod J 2005;31:48-52. [ Links ]
. Borisova-Papancheva T. Endodontic Management of an Uncommon Anatomic Variation of Mandibular Second Premolars: A Case Report. Journal of IMAB - Annual Proceeding (Scientific Papers). 2015; 21 (4): 945-7.
. Borisova-Papancheva T, Papanchev G, Peev S, Georgiev T. Posterior Endodontic Surgery – A Case Report. Medinform. 2016; 1: 389-393.
. Borisova-Papancheva Ts., Svetlozarova Sl. Conservative management of periapical lesions of endodontic origin - a review of the different techniques. Scripta Scientifica Medicinae Dentalis. 2018. 4/2: 7-14.
. Borisova-Papancheva Ts., Svetlozarova Sl. Removal of Calcium Hydroxide Medicament from Root Canal Walls – a Review of the Different Technique. Scripta Scientifica Medicinae Dentalis. 2018. 4/2: 15-21.
. Brenda P.F.A. Gomes, Morgana E. Vianna, Alexandre A. Zaia, José Flávio A. Almeida, Francisco J. Souza-Filho, Caio C. R. Ferraz;Chlorhexidine in Endodontics. Braz. Dent. J. vol.24 no.2 Ribeirão Preto Mar./Apr. 2013
. Ciardi JE, Rolla G, Bowen WH, Reilly JA. Adsorption of Streptococcus mutans lipoteichoic acid to hydroxyapatite. Scand J Dent Res 1977;85:387–91
. Denton G.W. 1991. Chlorhexidine. In: Disinfection, Sterilization and preservation. Block SS (Editor). 4th ed. Philadelphia: Lea & Febiger, 1991; p.274-289. [ Links ]
. DENTON GW. Chlorhexidine. In: Block SS, ed. Disinfection, Sterilization, and Preservation. 2001; pp. 321-336. 8) MOHAMMADI Z, ABBOTT PV. The properties and applications of chlorhexidine in endodontics. Int Endod J 2009; 42: 288-302).
. de Souza-Filho FJ, Soares A de J, Vianna ME, Zaia AA, Ferraz CC, Gomes BP. Antimicrobial effect and pH of chlorhexidine gel and calcium hydroxide alone and associated with other materials. Braz Dent J 2008;19:28-33. [ Links ]
. Do Prado M, Simao RA, Gomes BP. Evaluation of different irrigation protocols concerning the formation of chemical smear layer. Microsc Res Tech 2013;76:196-200. [ Links ]
. Ercan E, Ozekinci T, Atakul F, Gül K. Antibacterial activity of 2% chlorhexidine gluconate and 5.25% sodium hypochlorite in infected root canal: in vivo study. J Endod 2004;30:84-87
. Gomes BP, Souza SF, Ferraz CC, et al. Effectiveness of 2% chlorhexidine gel and calcium hydroxide against Enterococcus faecalis in bovine root dentine in vitro. Int Endod J 2003;36:267–75.
. Gomes BP, Vianna ME, Matsumoto CU, Rossi V de P, Zaia AA, Ferraz CC, et al. Disinfection of gutta-percha cones with chlorhexidine and sodium hypochlorite. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:512-517. [ Links ]
. Gomes BP, Vianna ME, Sena NT, Zaia AA, Ferraz CC, de Souza Filho FJ. In vitro evaluation of the antimicrobial activity of calcium hydroxide combined with chlorhexidine gel used as intracanal medicament. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:544–50. [PubMed] [Google Scholar]
. Gomes BP, Montagner F, Berber VB, Zaia AA, Ferraz CC, de Almeida JF, et al. Antimicrobial action of intracanal medicaments on the external root surface. J Dent 2009;37:76-81. [ Links ]
. Greenstein G, Berman C, Jaffin R. Chlorhexidine. An adjunct to periodontal therapy. J Periodontol 1986;57:370-377. [ Links ]
. Heling I, Chandler NP. Antimicrobial effect of irrigant combinations within dentinal tubules. Int Endod J 1998;31:8-14. [ Links ]
. Holt DM, Watts JD, Beeson TJ, Kirkpatrick TC, Rutledge RE. The anti-microbial effect against enterococcus faecalis and the compressive strength of two types of mineral trioxide aggregate mixed with sterile water or 2% chlorhexidine liquid. J Endod. 2007;33:844–7. [PubMed] [Google Scholar]
. Jenkins S, Addy M, Wade W. The mechanism of action of chlorhexidine)( Outcome of endodontic treatment with chlorhexidine gluconate as main irrigant: A case series Hair Salas, DDS, MSc, PhD
. Jin-Kyung Lee DDS, MSD, Jung Eun Baik BS, Cheol-Heui Yun PhD, Kangseok Lee PhD, Chlorhexidine Gluconate Attenuates the Ability of Lipoteichoic Acid from Enterococcus faecalis to Stimulate Toll-like Receptor 2
. Krithikadatta J, Indira R, Dorothykalyani AL. Disinfection of dentinal tubules with 2% chlorhexidine, 2% metronidazole, bioactive glass when compared with calcium hydroxide as intracanal medicaments. J Endod 2007;33:1473– 6.
. Kuruvilla JR, Kamath MP. Antimicrobial activity of 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate separately and combined, as endodontic irrigants. J Endod 1998;24:472-476.
. Lee LW, Lan WH, Wang GY. An evaluation of chlorhexidine as an endodontic irrigant. J Formos Med Assoc 1990;89:491-7.
. EUROPEAN PHARMACOPOEIA. 5th Ed. 2005. pp. 1258- 1259. MCDONNELL G, RUSSELL AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999; 12: 147-79
. Prado M, Simão RA, Gomes BP. Impact of different irrigation protocols on resin sealer bond strength to dentin. J Endod 2013 - in press. [ Links ]
. Rosenthal S, Spangberg L, Safavi KE. Chlorhexidine substantivity in root canal dentine. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:488–92. [PubMed] [Google Scholar]
. Sena NT, Gomes BP, Vianna ME, Berber VB, Zaia AA, Ferraz CC, et al. In vitro antimicrobial activity of sodium hypochlorite and chlorhexidine against selected single-species biofilms. Int Endod J 2006;39:878-885. [ Links ]
. Signoretti FGC, Gomes BP, Montagner F, Tosello FB, Jacinto RC. Influence of 2% chlorhexidine gel on calcium hydroxide ionic dissociation and its ability of reducing endotoxin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:653-658. [ Links ]
. Siqueira JF Jr, Rocas IN, Paiva SS, Guimaraes-Pinto T, Magalhaes KM, Lima KC. Bacteriologic investigation of the effects of sodium hypochlorite and chlorhexidine during the endodontic treatment of teeth with apical periodontitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:122-130. [ Links ]
. Siqueira JF Jr, Pavia SSM, Rôças IN. Reduction in the cultivable bacterial populations in infected root canals by a chlorhexidine-based antimicrobial protocol. J Endod 2007;33:541–7.
. Slavena Svetlozarova, Tsvetelina Borisova-Papancheva. Cone Beam Computed Tomography as a Diagnostic Tool in Endodontics A Review of the Literature. Adv Dent & Oral Health. 2019; 11(1): 555810. DOI: 10.19080/ADOH.2019.11.555810
. Southard SR, Drisko CL, Killoy WJ, Cobb CM, Tira DE. The effect of 2.0% chlorhexidine digluconate irrigation on clinical parameters and the level of Bacteroides gingivalis in periodontal pockets. J Periodontol 1989;60:302-9.
. Stowe TJ, Sedgley CM, Stowe B, Fenno JC. The effects of chlorhexidine gluconate (0.12%) on the antimicrobial properties of tooth-colored ProRoot mineral trioxide aggregate. J Endod. 2004;30:429–31. [PubMed] [Google Scholar]
Stuart CH, Schwartz SA, Beeson TJ, Owatz CB. Enterococcus faecalis: its role in root canal treatment failure and current concepts in retreatment. J Endod 2006;32:93– 8.).
. Tsvetelina Borisova-Papancheva, Slavena Svetlozarova. Reasons for Extraction of Endodontically Treated Teeth – a Review of Literature. Medinform. 2020 (1):1171-7.
. Vianna ME, Gomes BPFA. Efficacy of sodium hypochlorite combined with chlorhexidine against Enterococcus faecalis in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:585-589. [ Links ]
. Wang C, Arnold R, Trope M, Teixeira F. Clinical efficiency of2% chlorhexidine gel in reducing intracanal bacteria. J Endod 2007;33:1283-1289
. Zehnder M. Root canal irrigants. J Endod 2006;32:389-398. [ Links ]
