Inadvertent contact of sodium hypochlorite may lead to severe necrosis of soft tissue. US, unspecified. Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA Chronic exposure to sodium hypochlorite may lead to methaemoglobinaemia, characterised by chocolate-brown coloured blood, headache, dizziness, weakness, shortness of breath, cyanosis, rapid heart rate, unconsciousness and possible death. Irrigation with saline was performed by sliding the mucoperiosteal flap at the injection site. Effects of sodium hypochlorite on soft tissues after its inadvertent injection beyond the root apex. Then the flap was sutured primary. Hatton J, Walsh S, Wilson A. Toxicity of concentrat, Witton R, Henthorn K, Ethunandan M, et al. Sodium Hypochlorite is classified as Dangerous Goods Class 8 according to the Australian Code for the Transport of Dangerous Goods by Road and Rail. Absorb with spill pillow or . The 100 articles with the highest RCRs and the top 100 cited were selected and evaluated in bibliometric terms. A classical sodium hypochlorite accident showing the time course of facial involvement from onset to resolution. Gen Dent 2001;49:278-81. Use of electromagnetic stimulation on an Enterococcus faecalis biofilm on root canal treated teeth in vitro, Foraminal enlargement: Local and systemic repercussions, An experimental intraradicular biofilm model in the pig for evaluating irrigation techniques, Antimicrobial Efficacy of a Novel Root Canal Irrigant Made from Coconut and Bromelain Extract against Biofilm Forming Pathogens– An In vitro Evaluation, Root Canal Disinfection Articles with the Highest Relative Citation Ratios. Farook SA, Shah V, Lenouvel D, et al. Sterile water irrigation of the sinus was effected through the. Hypochlorite-induced severe cellulitis during, Goswami M, Chhabra N, Kumar G, et al. Antibiotics and analgesics were prescribed. Although it is an effective solution for disinfection of root canal system, fewer incidence of complications are reported, especially in primary teeth. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. A 1996 update of this study found little improvement [7]. At these concentrations, it is highly hypertonic and strongly alkaline with pH 11 to 13. Hong Kong J, Wang S-H, Chung M-P, Cheng J-C, et al. [PMC free article] [Google Scholar] A bsorb liquids with spill pillow or vermiculite. Sodium hypochlorite and sulfuric acid are not compatible materials (See SDS, Exhibit 4, page 3) and the mixture of the hypochlorite solution and sulfuric acid resulted in the evolution of a chemical gas release causing exposure to Mr. Spann and various degrees of exposure to approximately ten more people. Sodium hypochlorite accident: inadvertent injec-, Linn JL, Messer HH. Br Dent J 2014;217:679–84. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). We report a case where 2% chlorhexidine (CHX) gluconate was mistaken for an anesthetic solution and infiltrated into the buccal vestibule during routine root canal treatment. These "accidents" have been the subject of several case reports published over the years. Sodium hypochlorite is one of the most commonly used antimicrobial irrigating solution in endodontic therapy. Sodium hypochlorite extrusion: an atyp-. The toxicity of NaOCl is mainly caused by its chemical composition, but other factors such as the concentration, volume, and pressure of, extrusion could exacerbate the consequences of these accidents, However, the reliability of this information remains unclear. DIUM HYPOCHLORITE], [IRRIGANT], [EXTRUSION], [ACCIDENT], [COMPLICATIONS], and [ENDODONTICS]. The book addresses the numerous types of adult dental injuries and contains guidance on how the correct identification and treatment of these injuries can be time sensitive. Natural irrigants provide an alternative to show adequate antimicrobial activity and lesser cytotoxicity potential. Clinical manifestations of NaOCl extrusions. Download Free PDF. It is suggested that before any endodontic treatment in which sodium hypochlorite is to be used, the patient should be asked about hypersensitivity to household bleaching materials. Sodium hypochlorite is as effective as chlorine gas for disinfection. Careful management and A new proposal is intro-, duced to provide better standardization of data re-, or, if necessary, management and prognosis of, In June 2016, a literature search was performed on clinical cases, reported on hypochlorite accidents according to the Preferred Report-, ing Items for Systematic Reviews and Meta-Analyses checklist, was conducted using 5 combinations of the following key words: [SO-. 2, and Javier de la Fuente. The predomi-, nance of these 2 categories in cases reports was consistent with, previously experienced NaOCl extrusions by endodontists, the lack of scientific evidence, it seems that the decrease of bone density, in women compared with men and the thinness of cortical bone, surrounding the buccal roots of maxillary teeth could be 2 contributing, factors enabling the spread of NaOCl into the surrounding soft tissues, patients’ health status or the initial pulpal and periapical status. Sodium hypochlorite, the most commonly used and widely available irrigant, fulfils these criteria (Chaudhry, Wildan, Popat, Anand, & Dhariwal, 2011). Phone 131126 from At 15 days, minimal signs of ecchymosis were observed, and the treatment was resumed. In this review article the sodium hypochlorite accident was investigated from different perspectives based on . Large, nonresidential pools may use chlorine stored as a liquid under pressure in metal containers. A manual search of the, the references listed in the retrieved full-text articles were reviewed to, identify additional publications. flow rates during irrigation of a root canal ex vivo with three endodontic needles. The occurrence of NaOCl extrusions was mainly re-, . Hypochlorite concentration in household bleach varies by manufacturer. Moreover, introducing more, liquids into the canal may prevent the primary phase of NaOCl, drainage. caused confusion among the dental and oral and maxillofacial (OMFS) surgical community how best to manage these patients. and categorized the available information in the publications. A delayed surgical procedure shows some good benefits for patients. Tissue reactions to sodium hypochlorite and iodine potassium iodide under clinical conditions in monkey teeth. Oral Surg Oral Med Oral Pathol 1991;71:346–8, tissues after its inadvertent injection beyond the root apex. Conclusions The keywords used for search were sodium hypochlorite, injury, cellulitis, apical extrusion, ulcer, endodontics. J Dent 2013;41:935–48, endodontic treatment: case report. However, some articles reported worsening of the clinical situation after, what seemed to be untimely tooth closing with root canal dressing, situations were mostly associated with an initial misdiagnosis of the, Reports showed that post-treatment instructions included, frequently applying extraoral cold packs on the day of the extrusion, to minimize edema (19/52). Inferior alveolar nerve (IAN) lesions related to endodontic treatments can be explained by the anatomical proximity between the apices of the mandibular posterior teeth and the mandibular canal. sodium hypochlorite accident during endodontic therapy. Extravasation of NaOCl into intra-oral and extra-oral tissues can lead to devastating outcomes leading to long-term functional and aesthetic deficits. Sodium hypochlorite is an inorganic sodium salt in which hypochlorite is the counterion. . Pain intensity was assessed using a numerical rating scale (NRS) 6, 12, 24, and 48 hours following instrumentation and canal filling. Therefore, determining apical constriction as the ideal limit for instrumentation and obtu-ration has been questioned. A second purpose was to propose a standard, presentation of reported data concerning NaOCl extrusions that could be used in case, report series. Drugs for pain management in dentistry. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. The extrusion of sodium hypochlorite through the apical foramen is an accident that can occur during the flushing procedure in endodontic treatment. The patient was immediately administered dexamethasone intramuscularly, and was prescribed antibiotics, analgesics, and antihistamines. Considering the millions of RCTs performed all over the world, it is believed to be a, relatively rare occurrence. reported in this case. Boutsioukis C, Lambrianidis T, Kastrinakis E, et al. Bleeding should not be prevented, and aspiration with a, high-volume aspirator would help to evacuate NaOCl. 3 * 1. This can involve significant morbidity for the patient. During the 8-year follow-up, the patient maintained the systemic use of alendronate. By clicking accept or continuing to use the site, you agree to the terms outlined in our. A 29-year-old woman visited a general dental residency clinic with a complaint of severe aching and burning facial pain with occasional sharp stabbing pain and persistent numbness. Department of Dentistry, National . CFUs were lower when using 0.9% saline with EMS versus 0.9% saline alone (p = 0.002). Among the 100 articles with the highest RCRs, there were no differences in the three decades for RCRs values, but there were in citations, being 2000–2009 the most cited. eneaux, 13008, Marseille, France. In the intervention group, root canals were irrigated using Neem; whilst 2.5% NaOCl was used in the control group. L'objectif de cet article est de rappeler les . Two personal clinical cases were additionally reported. Swelling with mild extraoral redness over the right cheek area was observed clinically. The patients’ sex and tooth scheduled for treatment were always, ported in females (44/52) and maxillary teeth (41/52). J Endod 2006;32:389–98. . This book presents the current state of research on the basic scientific aspects of root canal biofilm biology within a clinically applicable context. Abstract. Additionally, there are few regulatory guidelines in place to ensure the safe storage, transport and use of sodium hypochlorite. In four studies, no significant improvement in microbial reduction was observed following aPDT compared to caries removal or endodontic debridement without aPDT. The symptomatology is immediate and intense, and there is a long period before the tissues return to normal. South Bras Dent J 2014;11:199–203, maxillary sinus during endodontic retreatment and review of current prevention, and management. Methods A burning sensation in the, maxillary sinus rather than severe pain was usually present, with little, or no bleeding from the canal and no evidence of immediate, swelling. After pulpectomy, canals were left open for 2 weeks and then sealed for 4 weeks to enable the development of an intracanal biofilm. Methods: in March 2018, an electronic search performed on the PUBMED database using the terms "foraminal enlargement" OR "foraminal widening" OR "apical limit" AND "endodontics" identified 74 scientific articles. Treatment: Case Report. The data from each study was extracted and the quality of each article was assessed. There was a significant difference in the region of NaOCl accident, (70%) were occurred in the molar or premolar region, whereas (30%) in the incisor or canine regions [18]. The current study proposes a novel intracanal irrigant made from coconut and bromelain extract. Materials and Methods Access scientific knowledge from anywhere. No facial oedema. atically reported to insurance companies and cannot be diagnosed retrospectively. J Endod 2008;34: ing root canal irrigation: a systematic review. 2010). Although there is no standard procedure for managing such an incident, the protocol suggested by Hales and colleagues1 summarizes the typical approach: The HSCB would like to raise awareness with the wider profession of the complications of accidental sodium hypochlorite damage, preventive measures to minimise potential complications and emergency management of accidental damage Intentional foraminal enlargement is performed for the purpose of reducing the microbial contingent to levels more favorable to repair. It should ideally be Please visit www.eurendodj.com to submit your manuscripts. Determining working length precisely and following irrigation protocols meticulously are indispensable to prevent this type of complication. However, the healing prognosis remains poorly predictable. In a reported case, an autopsy of a However, cytotoxic activity is a well-known shortcoming of NaOCl that may cause acute, injuring effects if it reaches the periapical area. In four out of the eight studies, aPDT with methylene blue or toluidine blue had improved the efficacy of microbial reduction in deciduous dentine when compared to conventional root canal treatment or caries removal. From an industrial perspective, Olin offers a variety of different product strengths depending on industries served and local market demands with 12.5 and 15.5 weight percent as Conclusions: The dentists must apply the precautions of EDTA irrigation solution during the root canal treatment and manage the treatment of this clinical complication. The occurrence of accidents with sodium hypo- The main purpose of this paper was to conduct a systematic review of previously published case reports to identify, synthetize and present a critical analysis of the available data. The journal’s frequency is continuous. Clin Cosmet Investig Dent. The management of this dental emergency condition is discussed. An internet search using search engines- Google, Researchgate and PubMed was carried out. This is the third edition of this manual which contains updated practical guidance on biosafety techniques in laboratories at all levels. Journal of the American Dental Association. No information on how the solution was ob-, tained (ie, pharmaceutical preparation or over-the-counter purchase), A few reports (10/52) provided information about the irrigation, method, needle design, and syringe capacity, which play a significant, to rubber dam usage, which does not directly influence NaOCl, extrusions, was present in 20 of 52 cases. Currently no clear guidelines are available which has. Avoid skin contact or inhalation. However, this solution can cause complications especially due to its cytotoxic features. Immediately after removal of rubber dam. An electronic search of the PubMed database (1950-present), Oral Surgery, Oral Medicine, Oral Pathology, Oral Radi-, ). Int Endod J 2012;45:492–8, accidental sodium hypochlorite extrusion: a report of two cases. Goals The Chlorine Institute sets out to accomplish its mission by: I . 8 Gatot A, Arbelle J, Leiberman A, et al. Methodology ). To determine the anatomical reasons for sodium hypochlorite (NaOCl) accidents by testing whether this mishap is likely to occur in cases where the anatomical apex of the teeth fenestrates the overlying buccal cortical alveolar bone, allowing NaOCl to gain direct access to buccal soft tissues. Swelling occurred in almost every case (49/52), Full-text articles assessed for eligibility (n=57). Measurement of pressure and, Boutsioukis C, Verhaagen B, Versluis M, et al. canal using different needle types by an unsteady computational fluid dynamics, propylnoradrenaline and dopamine. The symptoms had been present for seven months after sudden onset during endodontic irrigation with sodium hypchlorite. The hand sanitizers and related medical manifestations and symptoms of intoxication with each of them are briefly their management is critical for healthcare providers. Overall, up to now, clinical cases were reported in a very unsystematic manner and some relevant information was missing. These less severe symptoms might be because, NaOCl was not extruded in an enclosed space, which allowed its, evacuation, thus limiting the time of contact, The subsequent symptoms in the hours and days after extrusion, were generally well-documented. sodium hypochlorite. PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. A. fulfill the inclusion criteria as follows: Finally, 40 full-text articles corresponding to 52 cases reports pub-, lished between 1974 and 2015 were selected and reviewed by the au-, thors. Present article highlights one of such cases of NaOCl accident and its successful management in a 4-year-old child. A Bibliometric Analysis from 1990 to 2019, Accidental Injection of EDTA Instead of Anesthesia Solution during Root Canal Treatment: Case Report, Efficacy of Antimicrobial photodynamic therapy (aPDT) in reducing cariogenic bacteria in primary deciduous dentine, Apical extrusion of sodium hypochlorite in immature teeth: comparison of three different cleaning protocols, Accidental Extrusion of Sodium Hypochlorite in a Patient Taking Alendronate: A Case Report With an 8-Year Follow-up, Effect of Neem (Azadirachta indica) versus 2.5% sodium hypochlorite as root canal irrigants on the intensity of postoperative pain and the amount of endotoxins in mandibular molars with necrotic pulps: a randomized controlled trial, Accidental injection of 2% chlorhexidine gluconate instead of an anesthetic agent: A case report, Accidental injection of sodium hypochlorite beyond the root apex, Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement, Research methods and reporting. I- Sodium hypochlorite accident: NaOCl is extremely caustic and tissue toxic. Using the RCR metric allowed us to identify influential articles in root canal disinfection, a research field with topics of significance that fluctuate over time. This book provides effective treatment options for achieving both goals. The ! rst section of the book details the microbiologic and pathophysiologic aspects of apical periodontitis. Ignorance of an accurate diagnosis and proper patient manage-, ment when a NaOCl accident occurs could lead to an unnecessary, delay and sometimes even panic. From what we could, glean from the articles that did mention the concentration of NaOCl, it, ranged from 1%–5.25%. A Summary of Reports for Management and Follow-up, . Pae-, Laverty DP. —, unavailable information; A, available information; DS, dental school; EC, endodontic clinic; F, female; GP, general practitioner; M, male; NaOCl, sodium hypochlorite; NV, nonvital; V, vital. Sodium hypochlorite is a widely used irrigant. Hemolysis was responsible for pro-, fuse interstitial bleeding, probably causing immediate or secondary, facial hematomas (30/52), although the latter were not systematic, chemical burn caused by NaOCl (15/52), sometimes accompanied by, involving purulent discharge were described, Contact with NaOCl is highly toxic to vital tissues, including nerves, fects after extrusion can be expected and were present in 17 of 52 pa-, tients. Paola Campos. Key words: nerve damage, root canal irrigation, root canal treatment, sodium hypochlorite. Quintes-, sodium hypochlorite: a case report. Arthur A Dugoni School of Dentistry, University of the Pacific, San Francisco, California; Giboc, ISM UMR 7287 CNRS, Aix Marseille Universit, Address requests for reprints to Dr Maud Guivarc’h, 19 rue Henri Ch. This case report describes the tissue injury caused by inadvertently extruded NaOCl through the apical constriction. Behrents KT, Speer ML, Noujeim M. Sodium hypochlorite accident with evaluation, Bosch-Aranda ML, Canalda-Sahli C, Figueiredo R, et al. Conclusion: The Toxicology Handbook 2e is a practical, didactic guide to the approach, assessment and management of poisoned patients. Complications in the use of sodium hypochlorite during endodontic treatment. Peripheral vascular effects of noradrenaline, iso-, Hargreaves K, Abbott PV. Introduction: Until now, no other solution has matched the efficacy of NaOCl. The swelling reduced gradually over a period of 15 days. Swelling was usually large and diffuse (similar to cellulitis), extending, intra- and extraorally well beyond the site of the affected tooth; it some-, times resulted in difficulties opening the ipsilateral eye, When these extrusions involved the maxillary sinus, the immediate, effect indicated a different clinical picture, acute pain, the first signs were irrigant flowing from the nostrils, along with the taste of NaOCl in the throat. Such an incidence is This leakage caused immediate and intense pain and edema formation and resulted in an extensive necrotic area in the alveolar mucosa adjacent to the root of the treated tooth. Methods: 3/4 REVISION DATE: 9th August 2007 Sodium Hypochlorite COLOUR Green yellow SOLUBILITY Completely soluble in water BOILING POINT (°C) >100 MELTING POINT (°C)-17 RELATIVE DENSITY 1.20 - 1.27 pH-VALUE, CONC. British dental journal official journal of the British Dental Association: BDJ online. There are several reports about the complications of irrigation with NaOCl during root canal therapy. The latter intended to stimulate microcirculation. Some authors recommended that it could, be followed by the application of warm compresses (8/52) and warm, saline rinses (5/52). sodium hypochlorite (NaOCl) accident is mostly palliative but should be initiated as soon as the first signs of the prob-lem appear. Indeed, it is clear, , or a surgical debridement of necrotic tissues, . logic injuries that this type of accidents may cause and a treatment protocol for these situations will be suggested. The higher the concentration of sodium hypochlorite solution, the greater its ability to dissolve living or ne-crotic tissue, and the greater neutralizing action of the root content. A 66-year-old female patient presented to the accident and emergency department, 3 h following a dental appointment. In this review article the sodium hypochlorite accident was investigated from different perspectives based on online review of the published papers on the same topic. Introduction. In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. Sodium hypochlorite accident resulting in life-threatening airway obstruction during root canal treatment: a case report Maisa O Al-Sebaei,1 Omar A Halabi,2 Ibrahim E El-Hakim3 1Department of Oral and Maxillofacial Surgery, King Abdulaziz University - Faculty of Dentistry, Jeddah, Kingdom of Saudi Arabia; 2Saudi Board of Oral and Maxillofacial Surgery, Al-Noor Specialist Hospital, Makkah . Sodium hypochlorite is widely used as an irrigating solution in dental practice. The operator will use Calcium Hypochlorite (67%). © 2008-2021 ResearchGate GmbH. The final product was left to dry and crushed manually to powder. All subfields were well represented, although they varied over time. A case is presented, describing both local and systemic adverse tissue reactions, caused by an allergic response, after NaOCl irrigation, after root canal treatment. Results: Solution (using sodium hypochlorite): One gallon of sodium hypochlorite will impart a 10ppm rise in 10,000 gallons of water. Tegginmani VS, Chawla V, Kahate MM, et al. A standard root canal treatment was performed in two‐visits using ProTaper Next rotary files, with no intracanal medication. Introduction: Sodium Hypochlorite accident during Root canal procedure is although rare but has been seen in certain cases which can range from showing mild symptoms to severe symptoms in patients which has to be dealt with immediately. Clinical and radiographic examinations after 7 months revealed complete repair of the necrotic area with no paresthesia and further indicated the integrity of the apical region of the tooth where the extrusion of sodium hypochlorite occurred. Facial atrophy following accidental subcutaneous, Lam T, Wong O, Tang S. A case report of sodium hypochlorite accident. C. After 24 hours. These "accidents" have been the subject of several case reports published over the years. included difficulties in swallowing followed by respiratory distress. Endodontic therapy was completed with routine procedures. Conclusions: Its accident is uncommon to be encountered in the dental clinic. Description. Despite its safe properties, serious complications can result from inadvertent use due to its cytotoxic features. Initially, the diagnosis was “symptomatic irreversible pulpitis” with “normal apical tissues.” During instrumentation of the buccal canal, accidental extrusion of 2.5% NaOCl occurred into the periapical tissues, resulting from misinterpretation of the working length, and caused severe pain and bleeding. The mean pain scores in the Neem group were lower than those in the 2.5% NaOCl group at 6, 12, 24, and 48 h following instrumentation and canal filling with no significant difference between them except at 24 h following instrumentation (P = 0.012). Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. These constellations of signs/symptoms were described, emanating from a maxillary central incisor, Moreover, 2 patients presented with life-threatening airway obstruction, caused by massive swelling in the submental and sublingual spaces with, elevation of the floor of the mouth after extrusion through the mandib-. The main purpose of this article was, to conduct a systematic review of previously published, case reports to identify, synthesize, and present a critical, analysis of the available data. AIM To report clinical complications (pain, necrotic gingival tissue and bone sequestration) resulting from accidental injection of sodium hypochlorite. The new WHO guidelines provide recommended steps for safe phlebotomy and reiterate accepted principles for drawing, collecting blood and transporting blood to laboratories/blood banks. Sodium hypochlorite is an effective intracanal irrigant when used judiciously with rubber dam isolation. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. Sodium hypochlorite (NaOCl) is the most commonly used solution in root canal treatments, as it is a low-cost method that displays a very effective antimicrobial activity against microbiota of infected root canals. cases (17/52). Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of the systematic review process (meta-analysis was not performed). and U.O.) Introduction: endodontic infection can reach and even go beyond the apical foramen. This book provides dental professionals with a clear understanding of current clinical and scientific knowledge on the various aspects of pulp treatment for both primary and young permanent teeth. Unfortu-, nately, the NaOCl concentration was mentioned in only half of the cases, (30/52) even though this is essential information. Concentration is important! Because the, bleeding is usually profuse, paper point usage and microtips placed. Results: intentional foraminal. The frequency of such events remains unknown because it is not system-. Hypochlorite accidents, where the irrigant reaches periapical tissues or an allergic reaction occurs Sodium hypochlorite (NaOCl) in various concentrations is the most widely used endodontic irrigant, but it can be an irritant to vital tissues. However, due to lack of long-term clinical trials and robust study designs, the efficacy of aPDT in minimizing cariogenic bacteria in deciduous dentine is debatable. Despite its safe properties, serious complications can result from inadvertent use. hypochlorite through perforation in maxillary incisor. THE EFFECT OF 17% ETHYLENEDIAMINETETRA-ACETIC ACID AS A MAIN IRRIGATION ON APICAL ROOT CANAL CLEANLINESS (ex vivo), VALIDATION OF SIMPLE UV-VIS SPECTROPHOTOMETRY METHOD BASED ON ICH Q2 (R1) GUIDELINE FOR THE ANALYSIS OF SODIUM HYPOCHLORITE USING RHODAMINE B. These articles, analysis of their references and use of another 5 base articles resulted in the 115 studies used for performing this research. (Assi et al in 2018) 5 Noni fruit contains numerous iridoids, like asperuloside, asperulosidic acid, ,deacetylasperulosidic acid, organic acids like capric and caprylic acids, and the principal alkaloid is xeronine. Hence, Oral surgery, oral medicine, and oral pathology. Neem and 2.5% NaOCl were not significantly different in terms of reducing the intensity of postoperative pain during all follow‐up periods except at 24 h following instrumentation where Neem was associated with less pain intensity. Root canal disinfection is of utmost importance in the success of the treatment, thus, a novel method for achieving root canal disinfection by electromagnetic waves, creating a synergistic reaction via electric and thermal energy, was created.
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