Main Article Content
Background:Continuous chelation can be defined as the concept of using a single mix of a weak chelator with NaOCL throughout the entire root canal preparation procedure without causing a reduction in the antimicrobial and proteolytic activity of NaOCL. Etidronic acid, also known as "1-Hydroxyethylidene-1, 1-Bisphosphonate" HEBP, or HEDP, is a soft biocompatible chelator utilized in direct combination with sodium hypochlorite to form an all-in-one deproteinizing, disinfecting, and chelating solution. It's the only chelator available as a certified commercial product, "Dual Rinse HEDP," approved for endodontic usage. This review aims to analyze and bring up-to-date data about the continuous chelation protocol using a combination of HEDP with sodium hypochlorite in endodontic irrigation. Data: only papers that were published electronically were searched within the review. Sources: “Google Scholar”,” PubMed” websites were used for searching data by using the following keywords: : Bisphosphonates, Continuous chelation, Dual rinse HEDP, Etidronate, HEBP. The most relevant papers related to the topic were chosen, specifically the original articles and clinical studies, including only English-language articles from 2005 to September 2022. Conclusion:Combining a weak chelator with NaOCL solution, a single irrigation solution mixture with soft tissue dissolving ability and antibacterial properties with chelating capability can be created, which can be considered a good alternative to the conventional irrigation protocol (sequential irrigation) with NaOCL followed by using a strong chelator such as EDTA. The obvious benefit is that only one solution is required for root canal cleansing and decontamination, also decreasing the time for irrigation and providing better conditioning of root canal walls for root-filling materials
Received date: 12-10-2022
This work is licensed under a Creative Commons Attribution 4.0 International License.
Licenses and Copyright
The following policy applies in The Journal of Baghdad College of Dentistry (JBCD):
# JBCD applies the Creative Commons Attribution (CC BY) license to articles and other works we publish. If you submit your paper for publication by JBCD, you agree to have the CC BY license applied to your work. Under this Open Access license, you as the author agree that anyone can reuse your article in whole or part for any purpose, for free, even for commercial purposes. Anyone may copy, distribute, or reuse the content as long as the author and original source are properly cited. This facilitates freedom in re-use and also ensures that JBCD content can be mined without barriers for the needs of research.
# If your manuscript contains content such as photos, images, figures, tables, audio files, videos, etc., that you or your co-authors do not own, we will require you to provide us with proof that the owner of that content (a) has given you written permission to use it, and (b) has approved of the CC BY license being applied to their content. We provide a form you can use to ask for and obtain permission from the owner. If you do not have owner permission, we will ask you to remove that content and/or replace it with other content that you own or have such permission to use.Don't assume that you can use any content you find on the Internet, or that the content is fair game just because it isn't clear who the owner is or what license applies.
# Many authors assume that if they previously published a paper through another publisher, they own the rights to that content and they can freely use that content in their paper, but thatâ€™s not necessarily the case, it depends on the license that covers the other paper. Some publishers allow free and unrestricted re-use of article content they own, such as under the CC BY license. Other publishers use licenses that allow re-use only if the same license is applied by the person or publisher re-using the content. If the paper was published under a CC BY license or another license that allows free and unrestricted use, you may use the content in your JBCD paper provided that you give proper attribution, as explained above.If the content was published under a more restrictive license, you must ascertain what rights you have under that license. At a minimum, review the license to make sure you can use the content. Contact that JBCD if you have any questions about the license. If the license does not permit you to use the content in a paper that will be covered by an unrestricted license, you must obtain written permission from the publisher to use the content in your JBCD paper. Please do not include any content in your JBCD paper which you do not have rights to use, and always give proper attribution.
# If any relevant accompanying data is submitted to repositories with stated licensing policies, the policies should not be more restrictive than CC BY.
# JBCD reserves the right to remove any photos, captures, images, figures, tables, illustrations, audio and video files, and the like, from any paper, whether before or after publication, if we have reason to believe that the content was included in your paper without permission from the owner of the content.
Mounes B, Alhashimi R. The push out bond strength of bioceramic seal-er (Total Fill) after warm and cold obturation tech-niques An in vitro comparative. J Baghdad Coll Dent. 2022; 34 :7-16.
Ordinola‐Zapata R, Bramante C, Cavenago B, Graeff M, Gomes de Moraes I, Marciano M, et al. Antimicrobial effect of endodontic solutions used as final irrigants on a dentine biofilm model. Int Endod J. 2012; 45 :162-8.
Tagelsir A, Yassen GH, Gomez GF, Gregory RL. Effect of antimicrobials used in regenerative endodontic procedures on 3-week-old Enterococcus faecalis biofilm. J Endod. 2016;42 :258-62.
Paqué F, Boessler C, Zehnder M. Accumulated hard tissue debris levels in mesial roots of mandibular molars after sequential irrigation steps. Int Endod J. 2011; 44 :148-53.
Lottanti S, Gautschi H, Sener B, Zehnder M. Effects of ethylenediaminetetraacetic, etidronic and peracetic acid irrigation on human root dentine and the smear layer. Int Endod J. 2009;42:335-43.
Wagner MH, Da Rosa RA, de Figueiredo JAP, Duarte MAH, Pereira JR, Só MVR. Final irrigation protocols may affect intraradicular dentin ultrastructure. Clin oral Investig. 2017;21:2173-82.
Cecchin D, Giaretta VS, Cadorin BG, Souza MA, Vidal CdMP, Farina AP. Effect of synthetic and natural-derived novel endodontic irrigant solutions on mechanical properties of human dentin. J Mater Sci: Mater Med. 2017;28:1-6.
Grawehr M, Sener B, Waltimo T, Zehnder M. Interactions of ethylenediamine tetraacetic acid with sodium hypochlorite in aqueous solutions. Int Endod J. 2003;36:411-5.
Zehnder M, Schmidlin P, Sener B, Waltimo T. Chelation in root canal therapy reconsidered. J Endod. 2005;31:817-20.
Neelakantan P, Varughese A, Sharma S, Subbarao C, Zehnder M, De‐Deus G. Continuous chelation irrigation improves the adhesion of epoxy resin‐based root canal sealer to root dentine. Int Endod J. 2012;45:1097-102.
Zollinger A, Mohn D, Zeltner M, Zehnder M. Short‐term storage stability of Na OC l solutions when combined with Dual Rinse HEDP. Int Endod J. 2018; 51:691-6.
Tartari T, Guimarães B, Amoras L, Duarte M, Silva e Souza P, Bramante C. Etidronate causes minimal changes in the ability of sodium hypochlorite to dissolve organic matter. Int Endod J. 2015;48:399-404.
Paqué F, Rechenberg D-K, Zehnder M. Reduction of hard-tissue debris accumulation during rotary root canal instrumentation by etidronic acid in a sodium hypochlorite irrigant. J Endod. 2012;38:692-5.
Neelakantan P, Cheng C, Mohanraj R, Sriraman P, Subbarao C, Sharma S. Antibiofilm activity of three irrigation protocols activated by ultrasonic, diode laser or Er: YAG laser in vitro. Int Endod J. 2015;48:602-10.
Biel P, Mohn D, Attin T, Zehnder M. Interactions between the tetrasodium salts of EDTA and 1-hydroxyethane 1, 1-diphosphonic acid with sodium hypochlorite irrigants.JEndod. 2017;43:657-61.
Wright PP, Kahler B, Walsh LJ. The effect of heating to intracanal temperature on the stability of sodium hypochlorite admixed with etidronate or EDTA for continuous chelation. J Endod. 2019;45:57-61.
Fukuzaki S. Mechanisms of actions of sodium hypochlorite in cleaning and disinfection processes. Biocontrol sci. 2006;11:147-57.
Wright PP, Kahler B, Walsh LJ. The effect of temperature on the stability of sodium hypochlorite in a continuous chelation mixture containing the chelator clodronate. Aust Endod J. 2020;46:244-8.
Wright PP, Cooper C, Kahler B, Walsh L. From an assessment of multiple chelators, clodronate has potential for use in continuous chelation. Int Endod J. 2020;53:122-34.
Wright PP, Cooper C, Kahler B, Walsh LJ. Multiple assessment methodologies in determining the antibiofilm actions of sodium hypochlorite mixed with clodronate or etidronate in endodontic irrigation. J Microbiol Methods. 2021;180:106107.
Wright PP, Scott S, Kahler B, Walsh LJ. Organic tissue dissolution in clodronate and etidronate mixtures with sodium hypochlorite. J Endod. 2020;46:289-94.
Ballal NV, Das S, Rao B, Zehnder M, Mohn D. Chemical, cytotoxic and genotoxic analysis of etidronate in sodium hypochlorite solution. Int Endod J. 2019;52:1228-34.
Ballal NV, Gandhi P, Shenoy PA, Shenoy Belle V, Bhat V, Rechenberg DK, et al. Safety assessment of an etidronate in a sodium hypochlorite solution: randomized double-blind trial. Int Endod J. 2019;52:1274-82.
Al-Badr RJ, Al-Huwaizi HF. Effect of Tea Tree, Thymus Vulgaris and Nigella Sativa Oils on The Elimination of Enterococcus Faecalis (In Vitro Study). J baghdad Coll Dent. 2017;29:55-62.
Al-Timan JAA, Al-Huwaizi HF, Abed HH. Evaluating the effect of adding Chitosan nanoparticles on the disinfection properties of Glyde material: An in vitro study. Res J Pharm Technol. 2020;13:255-8.
Arias-Moliz MT, Ordinola-Zapata R, Baca P, Ruiz-Linares M, Ferrer-Luque CM. Antimicrobial activity of a sodium hypochlorite/etidronic acid irrigant solution. J Endod. 2014;40:1999-2002.
Arias‐Moliz M, Ordinola‐Zapata R, Baca P, Ruiz‐Linares M, García García E, Hungaro Duarte M, et al. Antimicrobial activity of chlorhexidine, peracetic acid and sodium hypochlorite/etidronate irrigant solutions against Enterococcus faecalis biofilms. Int Endod J. 2015;48 :1188-93.
Arias-Moliz MT, Morago A, Ordinola-Zapata R, Ferrer-Luque CM, Ruiz-Linares M, Baca P. Effects of dentin debris on the antimicrobial properties of sodium hypochlorite and etidronic acid. J Endod. 2016; 42:771-5.
Morago A, Ordinola-Zapata R, Ferrer-Luque CM, Baca P, Ruiz-Linares M, Arias-Moliz MT. Influence of smear layer on the antimicrobial activity of a sodium hypochlorite/etidronic acid irrigating solution in infected dentin. J Endod. 2016;42:1647-50.
Solana C, Ruiz-Linares M, Baca P, Valderrama MJ, Arias-Moliz MT, Ferrer-Luque CM. Antibiofilm activity of sodium hypochlorite and alkaline tetrasodium EDTA solutions. J Endod. 2017;43(12):2093-6.
Tartari T, Wichnieski C, Bachmann L, Jafelicci Jr M, Silva R, Letra A, et al. Effect of the combination of several irrigants on dentine surface properties, adsorption of chlorhexidine and adhesion of microorganisms to dentine. Int Endod J. 2018;51:1420-33.
Morago A, Ruiz‐Linares M, Ferrer‐Luque CM, Baca P, Rodríguez Archilla A, Arias‐Moliz MT. Dentine tubule disinfection by different irrigation protocols. Micros Res Techniq. 2019;82:558-63.
Clarkson RM, Podlich HM, Moule AJ. Influence of ethylenediaminetetraacetic acid on the active chlorine content of sodium hypochlorite solutions when mixed in various proportions. J Endod. 2011;37(4):538-43.
Ballal N, Gandhi P, Shenoy PA, Shenoy Belle V, Bhat V, Rechenberg DK, et al. Safety assessment of an etidronate in a sodium hypochlorite solution: randomized double‐blind trial. Int Endod J. 2019;52:1274-82.
Giardino L, Savadori P, Generali L, Mohammadi Z, Del Fabbro M, De Vecchi E, et al. Antimicrobial effectiveness of etidronate powder (Dual Rinse® HEDP) and two EDTA preparations against Enterococcus faecalis: A preliminary laboratory study. Odontology. 2020;108:396-405.
Hand RE, Smith ML, Harrison JW. Analysis of the effect of dilution on the necrotic tissue dissolution property of sodium hypochlorite. J Endod. 1978;4:60-4.
Tartari T, Oda D, Zancan R, da Silva T, de Moraes I, Duarte M, et al. Mixture of alkaline tetrasodium EDTA with sodium hypochlorite promotes in vitro smear layer removal and organic matter dissolution during biomechanical preparation. Int Endod J. 2017;50:106-14.
Macedo R, Wesselink P, Zaccheo F, Fanali D, Van Der Sluis L. Reaction rate of NaOCl in contact with bovine dentine: effect of activation, exposure time, concentration and pH. Int Endod J. 2010;43:1108-15.
De-Deus G, Zehnder M, Reis C, Fidel S, Fidel RAS, Galan Jr J, et al. Longitudinal co-site optical microscopy study on the chelating ability of etidronate and EDTA using a comparative single-tooth model. J Endod. 2008;34:71-5.
Tartari T, Duarte Junior AP, Silva Junior JOC, Klautau EB, Souza Junior MHS, Souza Junior PdARS. Etidronate from medicine to endodontics: effects of different irrigation regimes on root dentin roughness. J Appl Oral Sci. 2013;21:409-15.
Ulusoy Ö, Savur I, Alaçam T, Çelik B. The effectiveness of various irrigation protocols on organic tissue removal from simulated internal resorption defects. Int Endod J. 2018;51:1030-6.
Hoffmann T, Friedel P, Harnisch C, Häußler L, Pospiech D. Investigation of thermal decomposition of phosphonic acids. J Anal Appl Pyrol . 2012;96:43-53.
Kim R, Kim YG, Kim M-Y, Song BC, Kim S-h, Kim J-h. Interaction of Hydroxyethylidene bisphosphonate (HEBP) with other endodontic irrigants on tissue dissolving capacity and antimicrobial effect. J Dent Rehabil Appl Sci . 2017;33:106-13.
De Hemptinne F, Slaus G, Vandendael M, Jacquet W, De Moor RJ, Bottenberg P. In vivo intracanal temperature evolution during endodontic treatment after the injection of room temperature or preheated sodium hypochlorite. J Endod. 2015;41:1112-5.
Rath PP, Yiu CK, Matinlinna JP, Kishen A, Neelakantan P. The effects of sequential and continuous chelation on dentin. Dent Mater . 2020;36:1655-65.
Al-Khafaji HA, Al-Huwaizi HF. Cleaning efficiency of root canals using different rotary instrumentation systems: a comparative in vitro study. IJMRHS. 2019;8:89-93.
McComb D, Smith DC. A preliminary scanning electron microscopic study of root canals after endodontic procedures. J Endod. 1975;1:238-42.
Kfir A, Goldenberg C, Metzger Z, Hülsmann M, Baxter S. Cleanliness and erosion of root canal walls after irrigation with a new HEDP-based solution vs. traditional sodium hypochlorite followed by EDTA. A scanning electron microscope study. Clin Oral Investig. 2020;24:3699-706.
Smith RM, Martell AE. Critical stability constants: second supplement: Springer; 1989.
Deari S, Mohn D, Zehnder M. Dentine decalcification and smear layer removal by different ethylenediaminetetraacetic acid and 1‐hydroxyethane‐1, 1‐diphosphonic acid species. Int Endod J. 2019;52:237-43.