The effect of using an alternative irrigant between sodium hypochlorite and chlorhexidine to prevent the formation of para-chloroaniline within the root canal system

Int Endod J. 2012 Sep;45(9):878-82. doi: 10.1111/j.1365-2591.2012.02048.x. Epub 2012 Apr 6.


Aim: To determine if the formation of para-chloroaniline (PCA) can be avoided by using an alternative irrigant following sodium hypochlorite but before chlorhexidine.

Methodology: Fifty-five single-rooted teeth were decoronated, instrumented to size 40, .06 taper whilst being irrigated with 14% ethylene-diamine-tetra-acetic acid (EDTA) and 6% NaOCl. Samples were then randomly divided into three experimental and two control groups. Group 1 was irrigated with saline followed by 2% chlorhexidine gluconate (CHX). Group 2 was irrigated with 50% citric acid (CA) followed by 2% CHX. Group 3 was irrigated with 14% EDTA followed by 2% CHX. The chemical identity and quantification of the PCA in the formed precipitate was determined using gas chromatography/mass spectrometry (GC/MS).

Results: All experimental groups contained PCA. The mean level of PCA for group 1 (sterile saline) was 229 ng mL(-1), group 2 (citric acid) 72 ng mL(-1) and group 3 (EDTA) 400 ng mL(-1), respectively. A significant difference was found between the saline and EDTA groups and the negative control (P < 0.05). Although no statistical significance was found between the negative control and citric acid group, PCA was still present in this experimental group.

Conclusions: Citric acid used as the intermittent irrigant had the least amount of PCA formation in the canal system. Until the threshold required to cause biological damage in humans is determined, the combination of NaOCl and CHX in root canal treatment should be avoided.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aniline Compounds / analysis*
  • Aniline Compounds / chemistry
  • Anti-Infective Agents, Local / therapeutic use*
  • Chemical Precipitation
  • Chlorhexidine / therapeutic use*
  • Citric Acid / therapeutic use
  • Dental Pulp Cavity / anatomy & histology
  • Dental Pulp Cavity / metabolism*
  • Edetic Acid / therapeutic use
  • Gas Chromatography-Mass Spectrometry / methods
  • Humans
  • Materials Testing
  • Root Canal Irrigants / therapeutic use*
  • Root Canal Preparation / methods
  • Sodium Chloride
  • Sodium Hypochlorite / therapeutic use*
  • Tryptophan Hydroxylase / antagonists & inhibitors*


  • Aniline Compounds
  • Anti-Infective Agents, Local
  • Root Canal Irrigants
  • Citric Acid
  • Sodium Chloride
  • Edetic Acid
  • Sodium Hypochlorite
  • Tryptophan Hydroxylase
  • Chlorhexidine
  • 4-chloroaniline