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ORIGINAL ARTICLE
Year : 2016  |  Volume : 6  |  Issue : 3  |  Page : 127-130

Gutta-percha disinfection: A knowledge, attitude, and practice study among endodontic postgraduate students in India


Department of Conservative Dentistry and Endodontics, Sree Siddhartha Dental College and Hospital, Tumkur, Karnataka, India

Date of Web Publication29-Aug-2016

Correspondence Address:
V J Vivek
Department of Conservative Dentistry and Endodontics, Sree Siddhartha Dental College and Hospital, Tumkur - 527 107, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-5984.189353

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  Abstract 


Aim: (1) To evaluate knowledge, attitude, and practices about methods of gutta-percha disinfection by endodontic postgraduate students in India. (2) To check the sterility of two commercially available, freshly, and previously opened gutta-percha box which was exposed to the clinical environment. Materials and Methods: Data were collected in a prescribed format from 400 endodontic postgraduate students. The questionnaire was designed to evaluate their knowledge about standard sterilization protocols of gutta-percha points, attitude toward the utility of guidelines/protocols of sterilization in the success of root canal treatment and practice of these sterilization protocols. For microbial assay, 10 cones of freshly opened gutta-percha 6% taper of size 25 from diadent (Diadent Group International, Korea) Group A and Dentsply (Dentsply Maillefer, Switzerland) Group B. Cones from the same companies which was kept in chair side working environment during obturation were selected as Group C and Group D, respectively, for aerobic and anaerobic culturing. Results: Among the respondents 75% did not practice any disinfection protocols. Only 25% followed the disinfection of gutta-percha cones. In anaerobic culture Group B turned out to be positive in all samples, all other groups were negative. Conclusions: The endodontic postgraduate students possess adequate knowledge on disinfecting gutta-percha cones, but regular practice of this is uncommon. Microbial assay showed that even freshly opened gutta-percha cones might be contaminated.

Keywords: Disinfection, gutta-percha, microbial assay, postgraduates, sterility


How to cite this article:
Panuganti V, Vivek V J, Jayashankara C M, Anilkumar S, Girish S A, Nanjundasetty JK. Gutta-percha disinfection: A knowledge, attitude, and practice study among endodontic postgraduate students in India. Saudi Endod J 2016;6:127-30

How to cite this URL:
Panuganti V, Vivek V J, Jayashankara C M, Anilkumar S, Girish S A, Nanjundasetty JK. Gutta-percha disinfection: A knowledge, attitude, and practice study among endodontic postgraduate students in India. Saudi Endod J [serial online] 2016 [cited 2019 Sep 19];6:127-30. Available from: http://www.saudiendodj.com/text.asp?2016/6/3/127/189353




  Introduction Top


The goals of endodontic treatment are the successful entrance, cleaning, and shaping of the root canal system and filling to prevent the microbial reinfection. Decreasing the number of microorganisms without damaging, the adjacent vital tissues enhance the success rate of endodontic treatment.[1] Priority in all steps is to eliminate or, at least, minimize microbial contamination. During endodontic therapy, an aseptic sequence is to be strictly followed to achieve this primary intention.[2] Presently, gutta-percha cones are the most commonly used material for the obturation of the root canal system. They are biocompatible, dimensionally stable, radiopaque, and thermoplastic. If necessary, they can also be easily removed from root canals.[3] Even though gutta-percha cones are produced under aseptic conditions and have some antimicrobial properties mainly due to their zinc oxide component,[4] they can be contaminated by handling, even if carefully removed from their packages. They can also be contaminated by aerosols and physical sources during the storage and treatment process.[5]

Making the gutta-percha cones used to fill the root canal system free from pathogenic micro-organisms would be in concurrence with the goal of endodontic therapy.[6] Moreover, it is against the basics of any standard disinfection protocol to contaminate the disinfected area with a potentially contaminated filling material. Hence, disinfection of the obturating material is mandatory. Therefore, a rapid chair side chemical disinfection is advocated. A large variety of chemical disinfectants have been used to sterilize gutta-percha cones before root canal filling including sodium hypochlorite (NaOCl), glutaraldehyde, alcohol, chlorhexidine (CHX), hydrogen peroxide, polyvinylpyrrolidone iodine, and mixture tetracycline citric acid and detergent (MTAD) (DENTSPLY Tulsa Dental, Tulsa, OK, USA) which is a mixture of doxycycline, 10% citric acid and Tween-80 detergent. It has been found by numerous studies that sterilization by immersing cones in NaOCl at 5.25% concentration is effective for a rapid high disinfection level.[7],[8],[9],[10],[11]

Various other studies have shown that the use of CHX is more beneficial as the microscopic changes in the gutta-percha cones can be avoided after disinfection, unlike in case of NaOCl.[12],[13]

Knowledge, attitudes, and practices (KAP) study was done previously on sterilization protocols followed by postgraduate students in dental colleges of India while using rotary files. The results showed though they had adequate knowledge and positive attitude on sterilization, the practice of this was less prevalent.[14] A pilot study was done on gutta-percha disinfection showed a lesser prevalence of disinfection practices. Hence, it was decided to evaluate the prevalence of this disinfection practice among postgraduate students and to check the sterility of cones from two commercially available, freshly opened gutta-percha boxes and a previously opened box exposed to the clinical environment. The purpose of this study was to evaluate KAP about methods of gutta-percha disinfection by endodontic postgraduate students in India. In addition, the sterility of freshly and previously opened gutta-percha will be evaluated.


  Materials and Methods Top


Data were collected in a prescribed format from 400 endodontic postgraduate students. Privacy was guaranteed, and the individual results were kept confidential. The questionnaires were designed to evaluate:

  • Knowledge about standard sterilization protocols of gutta-percha points
  • Attitude toward the utility of guidelines/protocols of sterilization in the success of root canal treatment and
  • Practice of these sterilization protocols.


Majority of the questions were close ended. The feasibility of the study and the clarity, quality, and length of the questionnaire items were ensured by means of a pilot survey conducted in Department of Conservative Dentistry and Endodontics (Sree Siddhartha Dental College and Hospital, Tumkur). Ethical clearance waiver form was also obtained.

Microbial assay

For microbial assay, 10 gutta-percha cones of freshly opened box 6% taper of size 25 were selected randomly from five boxes, two from each box, of the following companies:

  • Group A - Diadent (Diadent Group International, Korea), and
  • Group B - Dentsply (Dentsply Maillefer, Switzerland).


Cones from the same companies that were kept for 2 months intentionally at chair side working environment were also selected similarly as:

  • Group C - (Diadent in clinical environment) and
  • Group D - (Dentsply in a clinical environment).


Each cone was transferred to test tube containing 1 ml of thioglycollate broth. The test tubes were then vortexed and inoculated in MacConkey agar and chocolate agar for 48 h for aerobic culture. It was inoculated on to supplementary blood agar for 72 h for anaerobic culture. Colony forming units if any was counted manually.


  Results Top


Knowledge

Of 400 students, 265 (66%) knew that gutta-percha cones were neither sterile nor predisinfected while 214 (54%) believed in 1 min immersion in 5.25% NaOCl solution for disinfection [Figure 1].
Figure 1: Answer of gutta-percha disinfection protocol

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Attitude

A total of 342 (85%) of respondents thought that the disinfection of gutta-percha plays an important role in the outcome of root canal treatment, whereas 58 (15%) thought otherwise.

Practice

Solid core gutta-percha was the unanimous choice for routinely used obturating material in practice, and lateral condensation was the routine method of obturation. Only 98 (25%) respondents routinely practiced disinfection of the gutta-percha cones.

Microbial assay

In microbial culture, both Group A and Group B gave negative culture. However, in anaerobic culture Group B turned out to be positive in all samples with average colony growth of 150 colonies. This showed the cones to be nonsterile in the package itself. The purpose of microbial assay was to check the sterility of cones only, hence the Group D, which was the same as Group B exposed to clinical conditions, was omitted. Bacterial culture of Group C was carried out, and it again turned out to be negative in aerobic and anaerobic cultures.


  Discussion Top


It would be worthwhile if cones used to fill the root canal system were free from pathogenic micro-organisms because endodontic therapy is mainly a procedure of decontamination to prevent the dissemination of microorganisms throughout the root canal system and periapical tissues.[15],[16] Though none of the manufacturers claim that their gutta-percha cones were sterile in the current survey, 34% of the postgraduate students thought the cones were sterile in the package. The students overall had adequate knowledge on the methods to disinfect gutta-percha cones with 54% using NaOCl and 34% using CHX for disinfection.

There have been some controversies regarding the surface alterations of the gutta-percha cones due to salt precipitations after using NaOCl as a disinfectant, which could negatively impact the sealing ability when used along with resin based sealers especially.[9],[12],[13] There has been evidence to show that disinfection of cones by immersing into CHX was ideal without causing any deteriorating surface defects.[10],[13],[16]

This survey showed that 86% of endodontic postgraduate students thought the disinfection of gutta-percha cones played an important role in the outcome of root canal treatment. Despite this knowledge on the nonsterility of cones, and on the various chair side methods to disinfect them before obturation, 75% did not practice any disinfection protocols. Only 25% followed the disinfection of gutta-percha cones. The basic principle of minimizing of the endodontic microbial flora and preventing further contamination seems to have been violated by not pursuing any of this simple chairside disinfection protocols.

Cones from commercially available companies, Diadent (Diadent Group International, Korea) and Dentsply (Dentsply Maillefer, Switzerland) were selected in the current study. Groups A and C showed no microbial growth. The sterility of the Group A can be attributed to the antibacterial properties of the zinc oxide combined with the stearic acid in the gutta-percha.[3],[4] It is stated that stearic acid, a constituent in them, also had some inhibitory effect on some bacterial species.[17] The laser inspection of cones, as claimed by the manufacturer, could have also helped in some disinfection.

The microbiological assay of the gutta-percha cones turned to be negative in all aerobic cultures, but in Group B, where freshly opened cones were used, the anaerobic culture turned out to be positive. This clearly underlines the importance of disinfection of gutta-percha cones before using it to obturate. Other groups, including the ones that were previously opened and was under clinical use giving a negative culture, can explain the higher success rates of root canal treatments despite not following gutta-percha disinfection. The sterility of the cones in the box, that was under clinical use depends on the sterility of the chair side environment, as there were no intentional attempts made to contaminate the cones unlike in other studies that gave positive results.[16],[18] The sterility of freshly opened cones from the same company, Dentsply was checked by Gomes et al. and this had also given a similar result.[16]

The limitations of this study include the shorter incubation times used. A longer incubation time may be needed for some species of bacteria, and this cannot be overlooked. Hence, more sensitive tests such as polymerase chain reaction testing are to be carried out before confirming the sterility of gutta-percha cones. However, even with the shorter incubation times, the fact that one group turned positive for bacteria strengthen the point for disinfection.


  Conclusions Top


  • The endodontic postgraduate students possess adequate knowledge on disinfecting gutta-percha cones, but regular practise of this is uncommon
  • Microbial assay showed that even freshly opened gutta-percha cones might be contaminated.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Siqueira JF Jr., Rôças IN, Santos SR, Lima KC, Magalhães FA, de Uzeda M. Efficacy of instrumentation techniques and irrigation regimens in reducing the bacterial population within root canals. J Endod 2002;28:181-4.  Back to cited text no. 1
    
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3.
Dummer PM. Root canal filling. In: Pitt Fort TR, editor. Harty's Endodontics in Clinical Practice. 4th ed. Oxford: Wright; 1997. p. 123-53.  Back to cited text no. 3
    
4.
Moorer WR, Genet JM. Antibacterial activity of gutta-percha cones attributed to the zinc oxide component. Oral Surg Oral Med Oral Pathol 1982;53:508-17.  Back to cited text no. 4
    
5.
da Motta PG, de Figueiredo CB, Maltos SM, Nicoli JR, Ribeiro Sobrinho AP, Maltos KL, et al. Efficacy of chemical sterilization and storage conditions of gutta-percha cones. Int Endod J 2001;34:435-9.  Back to cited text no. 5
    
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Pang NS, Jung IY, Bae KS, Baek SH, Lee WC, Kum KY. Effects of short-term chemical disinfection of gutta-percha cones: Identification of affected microbes and alterations in surface texture and physical properties. J Endod 2007;33:594-8.  Back to cited text no. 7
    
8.
Valois CR, Silva LP, Azevedo RB. Effects of 2% chlorhexidine and 5.25% sodium hypochlorite on gutta-percha cones studied by atomic force microscopy. Int Endod J 2005;38:425-9.  Back to cited text no. 8
    
9.
Short RD, Dorn SO, Kuttler S. The crystallization of sodium hypochlorite on gutta-percha cones after the rapid-sterilization technique: An SEM study. J Endod 2003;29:670-3.  Back to cited text no. 9
    
10.
Siqueira JF Jr., da Silva CH, Cerqueira M das D, Lopes HP, de Uzeda M. Effectiveness of four chemical solutions in eliminating Bacillus subtilis spores on gutta-percha cones. Endod Dent Traumatol 1998;14:124-6.  Back to cited text no. 10
    
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Senia ES, Marraro RV, Mitchell JL, Lewis AG, Thomas L. Rapid sterilization of gutta-percha cones with 5.25% sodium hypochlorite. J Endod 1975;1:136-40.  Back to cited text no. 11
    
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Topuz Ö, Saglam BC, Sen F, Sen S, Gökagaç G, Görgül G. Effects of sodium hypochlorite on gutta-percha and Resilon cones: An atomic force microscopy and scanning electron microscopy study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:e21-6.  Back to cited text no. 12
    
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Tilakchand M, Naik B, Shetty AS. A comparative evaluation of the effect of 5.25% sodium hypochlorite and 2% chlorhexidine on the surface texture of Gutta-percha and resilon cones using atomic force microscope. J Conserv Dent 2014;17:18-21.  Back to cited text no. 13
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Aslam A, Panuganti V, Nanjundasetty JK, Halappa M, Krishna VH. Knowledge and attitude of endodontic postgraduate students toward sterilization of endodontic files: A cross sectional study. Saudi Endod J 2014;4:18-22.  Back to cited text no. 14
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Frank RJ, Pelleu GB Jr. Glutaraldehyde decontamination of gutta-percha cones. J Endod 1983;9:368-71.  Back to cited text no. 15
    
16.
Gomes BP, Vianna ME, Matsumoto CU, Rossi Vde 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;100:512-7.  Back to cited text no. 16
    
17.
Dantas da Silva LL, Nascimento M, Siqueira Silva DH, Furlan M, da Silva Bolzani V. Antibacterial activity of a stearic acid derivative from Stemodia foliosa. Planta Med 2002;68:1137-9.  Back to cited text no. 17
    
18.
Pradeep K, Kidiyoor KH, Pavithra J, Nageshwar R. Chair side disinfection of gutta-percha points – Anin vitro comparative study between 5 different agents at different concentrations. Int J Dent Update 2011;1:11-5.  Back to cited text no. 18
    


    Figures

  [Figure 1]


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