Surface Tension of Root Canal Irrigants
I. Etikan2000, Journal of Endodontics
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FIG 1. Average surface tension values (dyne/cm).
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JOURNAL OF ENDODONTICS
Copyright © 2000 by The American Association of Endodontists
Printed in U.S.A.
VOL. 26, NO. 10, OCTOBER 2000
Surface Tension of Root Canal Irrigants
Fügen Taşman, DDS, PhD, Zafer C. Çehreli, DDS, PhD, Canan Oǧan, PhD, and İlker Etikan, PhD
The aim of this study was to evaluate the surface
tension values of established and potential endodontic irrigants to which a surface active agent
had not been added. Additionally, Cetredixine, a
surfactant-containing 0.2% chlorhexidine gluconate solution, was included in the measurements. Surface tension measurements were performed using the ring method on a DuNouy
tensiometer at a standard room temperature. Ringer’s solution, saline solution, and distilled water
had the highest surface tension values, whereas
those of NaOCl (2.5% and 5%) and 17% EDTA were
relatively low. Two anesthetic solutions, Ultracaine
and Citanest, demonstrated values similar to
NaOCl and EDTA, although a statistically significant difference was found between all solutions
tested. Cetredixin displayed the lowest surface
tension. A low surface tension agent should penetrate tubules better.
tension of these solutions as a potential factor that may contribute
to such inefficiency.
This study was, therefore, designed to compare the surface tension
of different root canal irrigants, commonly used in endodontics.
MATERIALS AND METHODS
The irrigating solutions studied were:
1. Distilled water
2. Ringer’s solution (Sigma Chemical Co., St. Louis, MO)
3. Sterile physiological saline solution (Baxter, Deerfield, IL)
4. 2.5% NaOCl (Sultan Chemists, Inc., Englewood, NJ)
5. 5% NaOCl (Sultan Chemists, Inc., Englewood, NJ)
6. 17% EDTA [prepared in the laboratory (10)]
7. 3% Hydrogen peroxide (Merck, Darmstadt, Germany)
8. Citanest–Octapressin 3% (Astra, Sweden)
9. Ultracaine DS (Hoechst-Marion Roussel, Frankfurt, Germany)
10. Cetredixine (Vebas Milanese, Italy).
The surface tension of the irrigants was measured using the
“Ring Method.” The DuNouy tensiometer (Cambridge Industrial
Instruments, London, UK) (11, 12) at a constant room temperature
of 25°C was used. The principle of the instrument depends on the
fact that the force necessary to detach a platinum-iridium ring
immersed at the surface or interface is proportional to the surface
or interfacial tension.
Before measurements, distilled water was used for zero calibrations. All glass equipment was cleaned by immersion into a cleansing solution, and the platinum ring was cleaned using a Bunsen
burner flame. For each test solution, an amount of liquid was
poured into the glass dish (of 3 cm diameter), and the dish was
elevated by a precision screw until contact with the platinum ring
was maintained. Torsion was then applied to the screw until the
platinum ring became detached and readings on the scale were
recorded in dyne/cm. Seven readings were taken for each solution,
and the average was recorded.
Statistical analysis of the data was performed using the
Kruskall-Wallis one-way ANOVA and Mann-Whitney U tests,
with significance set at p , 0.05.
The primary function of an endodontic irrigant is to remove any debris
loosened, but not removed, by instrumentation (1). Therefore, the
irrigating solution must be brought into contact with the dentin wall
and the debris (2). The intimacy of this contact depends on the
wettability of the solutions on solid dentin (3). In general, the wettability of a solution depends on its surface tension (2), which is defined
as the force between molecules that produces a tendency for the
surface area of a liquid to decrease (1). This force tends to inhibit the
spread of a liquid over a surface or to limit its ability to penetrate a
capillary tube. The efficiency of an endodontic irrigant could, therefore, be improved by reducing its surface tension because wettability
of such solutions is of primary importance in their penetration of the
main and lateral canals and predentin dentinal tubules (1–3). By the
improvement of wettability, it is also possible that an irrigant could
extend its protein solvent capability or perform the bactericidal function through penetration into the uninstrumented areas of the root
canal system (1).
Numerous studies have demonstrated that many of the commonly used irrigating solutions are ineffective in completely removing hard and soft tissue debris (4 –7). The inadequacy of
irrigating solutions has often been attributed to either the lack of
mechanical flushing (i.e. flushing volume of irrigant) (4) or their
inability to remove organic and inorganic material simultaneously
(8, 9). However, little information exists with respect to the surface
RESULTS
The results of the surface tension measurements are presented in
Fig. 1. Cetredixin showed the lowest surface tension (32 dyne/cm),
whereas that of the distilled water was found to be the highest (70
dyne/cm). Differences between the surface tension of the tested
solutions were found to be statistically significant among all samples (p , 0.05).
586
Vol. 26, No. 10, October 2000
Surface Tension of Endodontic Irrigants
587
present in the solution. Chlorhexidine gluconate (0.2%) alone possesses a broad spectrum of antimicrobial action and a relative absence
of toxicity that are desirable properties of an ideal root canal irrigant
(18). However, it is not known to possess a tissue-dissolving property
that has led to its recommended use as an endodontic irrigant in
combination with NaOCl (19, 20).
The limitation of this study was the inability to compare the surface
tension of the tested irrigants by addition of surfactants because of the
lack of a standardized surface active agent for such purposes. Further
research into the surface tension of different irrigating solutions used
in combinations and/or with the incorporation of surfactants would be
needed to take the advantage of maximum antibacterial and tissuesolvent capacity with minimum instrumentation.
FIG 1. Average surface tension values (dyne/cm).
DISCUSSION
Various factors have been reported that contribute to the failure
of root canal treatment, notably the presence of persistent intraradicular infection (13, 14). However, it is difficult to eliminate all
microorganisms and organic debris from the root canal system,
regardless of the irrigant and instrumentation (15, 16). The search
for an irrigating solution with antimicrobial properties, tissuedissolving ability, and concomitant biocompatibility with the periapical tissues continues to be the subject of many studies. However, very few studies have addressed the potential effect of surface
tension of irrigating solutions in the overall success of endodontic
treatment (1, 2).
Abou-Rass and Patonai (2) found that the chemical Polysorbate 80
reduced the surface tension of distilled water, alcohol, NaOCl, and
EDTA by 15 to 20%, thereby enhancing the flow and penetration of
the test solutions into the canals in vitro. Cameron (1) has shown the
surface tension of 4% NaOCl to be reduced from 70 mN/m to 27
mM/m by addition of 0.1% fluorochemical surfactant, Fluorad FC99.
In his study, 10 ml of surfactant-containing NaOCl was reported to be
capable of dissolving the complete contents of root canals within a
clinically acceptable duration of time, indicating that small tags of
pulpal tissue would dissolve quickly and easily if the tested solution
could be brought into contact with these tissue tags. The latter two
studies tend to indicate that endodontic irrigants with lowered surface
tension could reduce the need to remove large quantities of root
dentine to achieve a debris-free root canal. However, a search of the
literature fails to show any of these valuable laboratory data to have
been extrapolated to clinical studies. Moreover, little knowledge exists
on the surface tension of established and potential endodontic irrigants. It was, therefore the aim of this study to obtain comparative data
for surface tension values of irrigating solutions to which surfactant
materials had not been incorporated. Additionally, a new commercially available irrigant, Cetredixine, which contains 0.2% chlorhexidine gluconate and a surface-active agent (0.2% cetrimide), was
included in the study.
In observing the average surface tension values of the test solutions,
it was noted that Ringer’s solution, saline solution, and distilled
water—which are known to lack any chemical effect— had the highest values, questioning once again the efficacy of these solutions in
endodontic therapy. On the other hand, the relatively lower surface
tension values of NaOCl and EDTA may contribute to the high
success rates achieved with the combined use of these irrigants as
reported in previous reports (8, 17). Cetredixine displayed the lowest
average surface tension value, most probably because of the surfactant
Dr. Taşman is affiliated with the Department of Endodontics, Faculty of
Dentistry; Dr. Çehreli is affiliated with the Department of Pedodontics, Faculty
of Dentistry; Dr. Etikan is affiliated with the Department of Biostatistics,
Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Dr. Oğan is affiliated with the Department of Pharmaceutical Technology,
Faculty of Pharmacy, Ankara University, Ankara, Turkey. Address requests for
reprints to Dr. Fügen Taşman, Department of Endodontics, Faculty of Dentistry, Hacettepe University, 06100 Sihhiye, Ankara, Turkey.
References
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