Enhanced bactericidal efficacy of NaOCl at pH12 followed by acidi fied NaOCl at pH6.5 on Enterococcus faecalis biofilm

This study aimed to determine the bactericidal efficacy of sequential use of NaOCl pH 12 followed by acidified NaOCl pH 6.5, and compare it to that of either of these NaOCl solutions alone. E. faecalis biofilm was grown on standardized dentine specimens for four weeks. The specimens were randomly divided into four groups: (A) 4 min exposure to 0.9% saline solution (control); (B) 4 min exposure to 4% NaOCl pH 12; (C) 4 min exposure to 4% NaOCl pH 6.5; and (D) 2 min exposure to 4% NaOCl pH 12 followed by 2 min exposure to 4% NaOCl pH 6.5. The bactericidal activity was evaluated after the 4 min of contact time using confocal laser scanning microscopy. The volume ratio of red fluorescence to green and red fluorescence indicated the proportion of dead cells in the biofilm. The percent of dead cells in the saline solution group was significantly lower than those in the other groups. There was no significant difference between NaOCl pH 12 compared to NaOCl pH 6.5. The sequential use of NaOCl pH 12 followed by pH 6.5 significantly increased the percent of dead cells compared to both the samples exposed to either NaOCl pH 12 or pH 6.5. These results show that sequential irrigation protocol had a stronger bactericidal effect than the commonly used NaOCl pH 12.