case report

Sodium Hypochlorite Solution Enhances Healing of Periapical

Lesion by Nonsurgical Method
Subrata Sarkar *, Soumyabrata Sarkar**, Badruddin Ahmed Bazmi†, Sarbani Ghosh‡

Abstract
Sodium hypochlorite (NaOC1) is a broad-spectrum antimicrobial agent effective against bacteria, spores, yeast and viruses.
It provides 100% bacterial reduction as it contains 50 ppm available chlorine at 6.7-10.7 pH at 200 C in one minute. 5.25%
NaOCl solution has a pH 11-12 and it provides immediate antibacterial action during root canal irrigation. 2.5-3% solution
has a pH of 11-12, which also gives good results. Grossman (1978) and others observed healing of large periapical lesions
by nonsurgical methods using NaOC1 solution, though the exact mechanism of healing is not clear but it is proved that
NaOC1 has good action against bacteria.

Key words: Sodium hypochlorite, root canal irrigation, nonsurgical method

P
eriapical infection of tooth/teeth is one of the
common problems in young children. Various
factors are responsible for this, of which caries and
trauma are the prime causes. Neglected trauma causes
apical swelling, pain and swallowing problem, which
are the common signs.1-5 Radiologic examination shows
large radiolucent areas in relation to affected tooth,
which may be an apical abscess, granuloma or cyst.
Gram-positive anaerobic bacteria are cultured and gram-
negetive anaerobic bacteria cause pathological change
in the apical region. This lesion has a connection with
root canals of the tooth. Various types of treatments
have been advocated to overcome this problem such as
root canal treatment along with surgical curettage in
the apical region.6
Recently, various investigators7-13 suggested a
nonsurgical treatment procedure, which will control
apical infection and promote healing of large periapical
lesions. Present paper reflects the management of
a periapical lesion of a young boy by a nonsurgical
method.
*Professor and Head, Dept. of Pedo-Preventive Dentistry
**Senior Lecturer, Dept. of Oral Diagnosis
Oral Medicine and Oral Radiology
†
Senior Lecturer, Dept. of Pedo-Preventive Dentistry
‡
Clinical Tutor, Dept. of Community Dentistry
Guru Nanak Institute of Dental Sciences and Research, Panihati���������
, Kolkata
Address for correspondence
Dr Subrata Sarkar
7, PC Ghosh Road Kolkata - 700 048
E-mail: drssarkar44@yahoo.com
Case Report
A 12-year-young boy came with complaints of pain
and swelling in 41, 42 region for last seven days.
He gave history of trauma in 41, 42 region one year
back. Recently, he developed sudden apical swelling
along with pain, fever, lymphadenitis. After proper
antibiotics, anti-inflammatory and mouth rinse history
of pain and fever subsided.
Investigation: Intraoral periapical X-ray in 41, 42
region was advised. Which showed large radiolucent
area in the region (Fig. 1).
Provisional diagnosis: Chronic periapical abscess in
41, 42 region.
Treatment plan: Nonsurgical endodontic treatment
approach.
Treatment procedure: Thermal and electrical pulp
testing was done in 41, 42 region, which failed to
respond indicating nonvital teeth. The access cavity
was prepared with the help of Round-end Fissure
Bur. Canal was kept open for 24 hours to drain out
pus from the canal. After 24 hours, 5.25% sodium
hypochlorite (�����������������������������������
NaOC1) irrigation
����������������������������
was done drop by
drop slowly (Fig. 2).
After 48 hours, with the help of protaper, enlargement
and removal of root canal debris was done. Then again
irrigation was done with 5.25% NaOCl����������������
���������������������
. Access cavity
was sealed with Cavit cement (3M). Same procedure

Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 3, May-July 2012 529

 Case Report
Figure 1. Intraoral periapical X-ray of 41, 42 region showing
large radiolucency in periapical region.
Figure 2. Sodium hypochlorite irrigation with side vented
needle drop by drop slowly.
Figure 3. Healing of the periapical region in relation to
41, 42 with radio-opaque gutta-percha in root canals.
was repeated after 48 hours intervals for five times.
Canals were debrided and dried and obturated with
gutta-percha and zinc oxide eugenol.
530
Patient was recalled after one month and intraoral
periapical X-ray was taken, which showed absence of
radiolucent zone in apical region of 41, 42. Healing
had taken place. Radio-opaque root canal fillings were
seen in 41, 42 (Fig. 3).
Discussion
Treatment of effected pulp restore normal physiological
function of tooth. Dental caries, trauma, attrition,
abrasion, erosion, etc., all cause change of pulpal status
and ultimately cause loss of vitality and house various
bacterial growth. Long-standing pathological change of
pulpal status leads to pathologic changes in periapical
region of tooth like granuloma, apical abscess and
radicular cyst.
First evidence of endodontic treatment was reported in
Israel in 2nd and 3rd century (BC). After that throughout
the world endodontic treatment was performed by
various investigators in deciduous and permanent
teeth. Various endodontists believe proper and adequate
biochemical preparation can control pulpal infection
and restore normal physiological functions of tooth.
In the year 1978, Grossman stated only biochemical
instrumentation and cleaning of root canal would
not lead to healing of apical region of nonvital tooth.
Root canal irrigation during endodontic treatment
was first introduced in the year 1859.14 Various
irrigating solutions like normal saline, hydrogen
peroxide (20%vol), povidone-iodine, calcium
hydroxide, mixture of tetracycline, acid detergent,
[MTAD],�����������������������������������������
ethylenediaminetetraacetic acid (EDTA),
soluble terramycin tablet, neem leaves and other
herbal solution) were used by endodontists for proper
debridement of canals by dissolving organic matter.
Ingle and Beveridge 1976,7 Nicholls 1977,8 Grossman
1978 were of this opinions that ��������������
NaOCl���������
was the
best irrigating solutions because ���������������
NaOC1����������
has good
antimicrobial property, property of dissolving pulpal
remnants and debris material and heals large periapical
lesions. Shih et al 1970,9 Ayhan et al (1999),10
Ercan et al (2004),11 Abdullah et al (2005),12 Berber
(2006),13 and others are of same opinion that NaOC1�
������
is a broad-spectrum antimicrobial irrigating solution
effective against bacteria, spores, yeast and virus. Ingle
and Beveridge (1976),7 Nicholls (1997)8 and others
suggested that �����������������������������������������
NaOC1������������������������������������
helps in healing of apical lesions
and debridement of root canal.
Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 3, May-July 2012

Various endodontists observed NaOC1����������
���������������
has good
bacterial killing efficiency. Thus large apical healing
can be obtained by a nonsurgical method. Present
study supports the above views.
Conclusion
Dental pulpal infection can cause periapical lesion.
Initially endodontists advocated proper root canal
treatment with apical surgical curettage. Other group
of investigators suggested that NaOC1����������
���������������
is broad-
spectrum antimicrobial irrigating solution, which can
kill various microorganisms. Proper healing of apical
region by �����������������������������������������
NaOC1 is a nonsurgical
������������������������������
method, which can
control pulpal pathology.
References
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Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 3, May-July 2012
Case Report
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