A PROPOSED METHODOLOGY FOR MEASURING THE BLEACHING EFFECT OF DIFFERENT ENDODONTIC IRRIGANTS UPON UNIFORM FABRICS

Abstract

Unfortunately, drawbacks exist and unwanted events could happen with the use of sodium hypochlorite, such as: critical cytotoxicity upon accidental extrusion beyond root canal apex, resulting in local tissue destruction, called sodium hypochlorite accident; moreover, it does not remove the smear layer [5] and has an unpleasant odor and taste [6]. [...]it involves a more complicated process of clothing engineering. Table 1 presents the mean degree of lightness and the standard deviation of each solution at all time intervals. 4.DISCUSSION The novelty of this study is that it is the first to address the bleaching effect of endodontic irrigation solutions on fabrics, at least to our knowledge, so that it was intractable to compare its results with those of other investigations. 5.CONCLUSIONS Despite its limitations, the proposed methodology has been shown to have the ability to measure the bleaching effect of endodontic irrigants on fabrics, as a sodium hypochlorite solution caused a significant bleaching effect on them, unlike ionized water solutions.

Abstract

Objective: The present methodological study tests and compares the bleaching effect of endodontic irrigation solutions upon uniform fabrics. Materials and Methods: precise pieces were cut from a ciel sky blue medical uniform (model 220087, JOCKEY, International. Inc, USA) and placed within a 10-millimeter customized port plate to be tested under a LabScan XE spectrophotometer with illuminant D65 (HunterLab, VA, USA). The L· value was compared for four endodontic solutions at baseline, 5 min, 24 h and 1 week later. These solutions belonged to two major types, sodium hypochlorite and ionized water. Results and discussion. Sodium hypochlorite solutions caused a statistically significant bleaching effect after 5 minutes (P < 0.05), while the ionized water groups produced no bleaching effect at any time (P > 0.05). Conclusions: the proposed methodology has the ability to measure the bleaching effect of some endodontic irrigants on fabrics, yet further investigations are needed to validate it.

Keywords: bleaching effect, uniform fabric, spectrophotometry.

1.INTRODUCTION

A successful endodontic treatment relies on two major components; mechanical instrumentation and chemical irrigation. Advancements in irrigation have been continuous in endodontic research, in the attempt of achieving the ideal irrigant, [1] capable of assuring optimized biocompatibility, mechanical flushing, smear layer removal, tissue dissolution, lubrication effect, microbial eradication, and the ability to deactivate endotoxins [2]. Hypothetically, fabric safety will add popularity to such irrigant and ensure wide acceptance of professionals wearing uniforms, especially endodontists who encountered that effect at least once.

Sodium hypochlorite was used extensively as an endodontic irrigant, due to its effective antimicrobial and tissue dissolving proprieties, as well as affordability [3]. It demonstrated strong antimicrobial action due to the hypochlorous acid that causes expeditious death within microbial cells (4). Sodium hypochlorite was the only irrigant capable of dissolving organic substances within the root canal system, a favorable property especially in necrotic cases [4]. Unfortunately, drawbacks exist and unwanted events could happen with the use of sodium hypochlorite, such as: critical cytotoxicity upon accidental extrusion beyond root canal apex, resulting in local tissue destruction, called sodium hypochlorite accident; moreover, it does not remove the smear layer [5] and has an unpleasant odor and taste [6]. Also, one of the drawbacks of sodium hypochlorite is the ability to ruin the color of patient' or dentist' clothes, if it accidentally comes into contact with them during dental treatments. Electro-chemically activated (ECA) water was proposed and used as an endodontic irrigant, as it is comparable to sodium hypochlorite in terms of antimicrobial efficiency, but has better biocompatibility, no toxicity, thus being a cheap and easily available agent [7].

The process of detecting color loss on fabrics seems simple, as it can be observed visually. In fact, it involves a more complicated process of clothing engineering. The color in fabrics is formed by a conjugated double bonded organic molecule attached to the fibers, called chromophore [8]. A bleaching solution, such as sodium hypochlorite, targets the chromophore, causing a chemical reaction that breaks one or both bonds, making the fabric appears lighter in color [9]. This process may be intentional in clothing industry [10], but it is usually undesirable when it comes to professional uniforms. Immoderate cost is inevitable when bleaching ruins these uniforms.

To our knowledge, this field was not investigated earlier and there was no proper testing method to measure such an effect. The aim of the present study was to propose a methodology for testing the bleaching effect on uniform fabrics and to apply it to different endodontic irrigants.

2.MATERIALS AND METHODS

The fabric selected for the study meets the recommendations of an ideal medical uniform fabric composition [11]. The medical uniform, ciel sky blue in color (model 220087, JOCKEY, International. Inc, USA), was composed of 72% Tri-Blend, 21% Polyester, 7% Rayon Spandex on a multi-directional stretch. It was obtained by cutting a precise piece from the abdomen region of the top uniform and from the thigh region of the pant, using a regular scissor (Fig.1). The reading machine was a LabScan XE spectrophotometer with illuminant D65 (HunterLab, VA, USA) with a 10-millimeter opening port plate.

A customized plasticport plate with a 10 mm opening in the center, corresponding to the original port plate and an inner indentation notch, was made (Fig.2). This customization provided several advantages, such as: better orientation during multiple readings with the help of the notch, better internal adaptation of the fabric and allowance of a safer direct application of the irrigation drops from the top side of the customized port.

Ten pieces of fabric were allocated for each solution and three readings from three different directions were made. Baseline line measurements of color were taken before application of the irrigant, then the drop was applied, followed by other readings after 5 min, 24 hours and one week. A total of 120 readings from each irrigant was taken using their lightness value (L·), according to the International Commission of Illumination model (CIE). Two main irrigation types with 4 different solutions have been evaluated: 5.25% Medical Use Sodium Hypochlorite (National Medical Solutions EST for Medical Devices & Cosmetics, KSA), 5.25% Household Sodium Hypochlorite (Clorox company, KSA), and 100% of two ionized water solutions, Neutrosteralyth and Anosteralyth (Eckhardt + Hedderich GmbH, Marburg, Germany). All solutions were loaded in 5 ml disposable syringes (Sofjec, Nahdi Medical Co., Jeddah, KS A). The irrigation solutions were applied on the customized port plate and left to dry at room temperature prior to their insertion inside the spectrophotometer.

Statistical analysis

Data was presented descriptively, and the One-way ANOVA test to find the statistical significance for each solution was used. The p-values <0.05 were considered as significant.

3.RESULTS

Sodium hypochlorite solutions caused a statistically significant bleaching effect after five minutes of application, with no differences between the medical use or the household one (p< 0.05). Extending time added no further significance to bleaching. On the other hand, ionized water groups caused no bleaching effect at any time (p> 0.05). Table 1 presents the mean degree of lightness and the standard deviation of each solution at all time intervals.

4.DISCUSSION

The novelty of this study is that it is the first to address the bleaching effect of endodontic irrigation solutions on fabrics, at least to our knowledge, so that it was intractable to compare its results with those of other investigations. The proposed method was of confirming what visual observation noticed using human eyes, while adding a quantitative measuring aid for better future precision and comparisons.

In endodontics, sodium hypochlorite is the most commonly utilized irrigants [12]. Idealizing such irrigants has been attempted at in research [13,14]. Their bleaching effect is well-known in textile industry, as it evidences a broad range of fabric bleaching [15], while ionized water was not commonly investigated. However, a recent study evaluated the bleaching effect of ionized water (ANOLYTE) for stained cotton fabrics [16]. The results indicated that Anolyte was less effective than sodium hypochlorite, which agrees with the findings of the current study. Nevertheless, the bleaching effect on fabrics was not investigated in the dental field, most dental color investigations approaching the restorative field [17].

The process of measuring color loss or discrepancy in small fields can be detected by two major methods - human eye inspection and machined color inspection. Human eye inspection generally relies on the sensible degree of optic nerve to the color, but it was not commonly used, due to possible subjectivity and absence of quantitative evaluation [18]. On the other hand, machined color inspection can be achieved accurately by using Colorimeters, to measure the reflectance ratio of fabric's surface to visible light on tristimulus values X, Y, Z. Furthermore, spectrophotometry uses the same concept with improved accuracy and control, compared to other colorimeters [19]. Color measurement done in the current study used a spectrophotometry with the International Commission of Illumination model (CIE) L·a·b·. The lightness value represented L·, while a· and b· represented the chroma of red-green and yellow-blue, respectively [20]. The bleaching effect causes increased lightness, which explains limitation of color measurement, in the current study, to the L· value, which rendered it simpler and more practical [9]. In large fields, color measurement can be detected by measuring the RGB values of a processed image taken by digital camera, then converting it to CIE L·a·b· values [16,21].

5.CONCLUSIONS

Despite its limitations, the proposed methodology has been shown to have the ability to measure the bleaching effect of endodontic irrigants on fabrics, as a sodium hypochlorite solution caused a significant bleaching effect on them, unlike ionized water solutions. Further testing of the current methodology is recommended for subsequent validation and optimization of endodontic irrigants.

References

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