Identification and localization of extraradicular biofilm-forming bacteria associated with refractory endodontic pathogens

Application of a chairside anaerobic culture test for endodontic treatment

Periapical lesions are caused by bacterial infections. The fundamental objective of endodontic treatment is to eliminate bacteria present in the root canal system because they play an important role in the development and maintenance of periapical lesions. Therefore, confirming the absence of bacteria before filling root canals is important. Anaerobic culture tests have been used in many endodontic cases, and they have brought about good treatment outcomes. These tests, however, require specific apparatuses and bacteriological techniques. Here, we report a chairside anaerobic culture test that does not require any specialized apparatuses or techniques. We also report two endodontic cases in which this simple test was used. Both patients were diagnosed with chronic purulent periapical lesions. After confirming the absence of bacteria in the root canals, they were filled with gutta-percha points. At followup, the radiolucencies showed recovery, although longterm observation is under way. From these results, the authors conclude that this simple chairside anaerobic culture test is effective for evaluating periapical lesion treatment procedures.

A Porphyromonas gingivalis mutant defective in a putative glycosyltransferase exhibits defective biosynthesis of the polysaccharide portions of lipopolysaccharide, decreased gingipain activities, strong autoaggregation, and increased biofilm formation

The Gram-negative anaerobic bacterium Porphyromonas gingivalis is a major pathogen in periodontal disease, one of the biofilm-caused infectious diseases. The bacterium possesses potential virulence factors, including fimbriae, proteinases, hemagglutinin, lipopolysaccharide (LPS), and outer membrane vesicles, and some of these factors are associated with biofilm formation; however, the precise mechanism of biofilm formation is still unknown. Colonial pigmentation of the bacterium on blood agar plates is related to its virulence. In this study, we isolated a nonpigmented mutant that had an insertion mutation within the new gene PGN_1251 (gtfB) by screening a transposon insertion library. The gene shares homology with genes encoding glycosyltransferase 1 of several bacteria. The gtfB mutant was defective in biosynthesis of both LPSs containing O side chain polysaccharide (O-LPS) and anionic polysaccharide (A-LPS). The defect in the gene resulted in a complete loss of surface-associated gingipain proteinases, strong autoaggregation, and a marked increase in biofilm formation, suggesting that polysaccharide portions of LPSs influence attachment of gingipain proteinases to the cell surface, autoaggregation, and biofilm formation of P. gingivalis.

Epidemiologic evaluation of the outcomes of orthograde endodontic retreatment

INTRODUCTION

Teeth undergoing initial endodontic therapy have a very high survival rate. Some teeth that continue to show signs of pathosis after the initial therapy will require nonsurgical (orthograde) retreatment. Outcome assessment of endodontic retreatment is crucial for appropriate case selection and treatment planning. However, reports on outcomes of orthograde endodontic retreatment performed by endodontists are limited in number, and the reported data vary. In this study, outcomes of orthograde endodontic retreatment performed on 4744 teeth were assessed during a period of 5 years.

METHODS

Data were obtained from retreatments that were performed by endodontists participating in the Delta Dental Insurance plan that insures approximately 15 million individuals in the USA.

RESULTS

Overall, 89% of teeth were retained in the oral cavity 5 years after the endodontic retreatment. Four percent of all teeth underwent apical surgery that occurred mostly within 2 years from completion of orthograde retreatment. Eleven percent of teeth were extracted at the end of the 5-year observation period.

CONCLUSIONS

It appears that orthograde endodontic retreatment yields high incidence of tooth retention after 5 years.

Characterization of bacterial flora in persistent apical periodontitis lesions

INTRODUCTION

Microorganisms are able to survive and induce persistent infection in periapical tissues. The aim of this study was to investigate the composition of the microflora of persistent apical periodontitis lesions.

METHODS

Twenty apical lesion samples were obtained from 20 patients with chronic apical periodontitis by root end surgery and processed using aerobic or anaerobic culture techniques. All isolated strains were identified by 16S ribosomal DNA sequence analysis.

RESULTS

Seventy-four strains were isolated, belonging to 31 bacterial species obtained from the 20 apical lesions that were isolated. The majority of the strains were facultative anaerobes (51.6%). Propionibacterium acnes, Staphylococcus epidermidis, Pseudomonas aeruginosa and Fusobacterium nucleatum were isolated from 16.2, 9.5, 6.8 and 5.4% of the samples, respectively. Fifteen samples harboured more than one species. The predominant association was P. acnes, S. epidermidis and F. nucleatum.

CONCLUSION

The microbiota of persistent apical periodontitis lesions is composed by diverse types of microorganisms with biofilm-forming capacity, including P. acnes, S. epidermidis and F. nucleatum.

A review of novel bacterial complex lipids: implications for the pathogenesis of apical periodontitis

The importance of the role played by bacteria in the pathogenesis of pulpal and apical disease has been established. One of the characteristics of apical periodontitis is apical bone resorption, which is due to apical immune response to bacterial infection. Recently, novel bacterial complex lipid called phosphorylated dihydroceramides has been discovered to be of inflammatory activators. The bacterial lipids stimulate prostaglandin E2, IL-6, and TNF-α secretion, inhibit osteoblast differentiation and function, and induce osteoclast formation. The biological activities are in Toll-like receptor 2 (TLR2)-dependent manner. These new findings imply that bacterial lipids could be important virulent factors that cause apical bone resorption. Future investigations may determine the significance of the bacterial lipids in the pathogenesis and treatment of endodontic diseases.

Bacterial diversity in persistent periapical lesions on root-filled teeth

BACKGROUND

The purpose of this study was to analyze the bacterial diversity in persistent apical lesions on root-filled teeth by using culture-independent molecular methods.

DESIGN

Twenty surgically removed apical lesions from therapy-resistant teeth were examined for the presence of bacterial DNA using PCR targeting the 16s ribosomal RNA gene, followed by cloning and sequencing.

RESULTS

Bacterial DNA was detected in 17 of the 20 samples (85%). A total of 236 clones were analyzed. Seven different bacterial phyla were represented and a total of 75 different bacterial taxa were identified; 36% of the species have not yet been cultivated. Commonly detected bacterial species included Fusobacterium spp., Prevotella spp., Tannerella forsythia, Porphyromonas endodontalis, Treponema denticola, Bacteroidetes spp., Peptostreptococcus spp., and Streptococcus spp.

CONCLUSIONS

A wide range of bacteria was identified in periapical lesions on therapy-resistant teeth. These bacteria may contribute in the etiology of periapical infection and impede healing of these lesions.

Antibacterial efficacy of intracanal medicaments on bacterial biofilm: a critical review

The purpose of this paper is to discuss critically the antibacterial efficacy of intracanal medicaments on bacterial biofilm. Longitudinal studies were evaluated by a systematic review of English-language articles retrieved from electronic biomedical journal databases (MEDLINE, EMBASE, CENTRAL) and handsearching records, using different matches of keywords for root canal biofilm, between 1966 and August 1st, 2007. The selected articles were identified from titles, abstracts and full-text articles by two independent reviewers, considering the tabulated inclusion and exclusion criteria. Disagreements were resolved by consensus. The search retrieved 91 related articles, of which 8.8% referred to in vivo studies demonstrating the lack of efficacy of endodontic therapy on bacterial biofilm. Intracanal medicaments were found to have a limited action against bacterial biofilm.

Synergistic pathogenicity of Porphyromonas gingivalis and Fusobacterium nucleatum in the mouse subcutaneous chamber model

Porphyromonas gingivalis and Fusobacterium nucleatum are often coisolated from sites of infection, such as suppurative apical periodontitis. The synergistic pathogenicity of mixed infection of P. gingivalis HG 405 with F. nucleatum PK 1594 was studied in the mouse subcutaneous chamber model in groups of seven animals. The minimal dose for P. gingivalis HG 405 that was required to infect 100% of the chambers was reduced by 1,000-fold when animals were inoculated in the same chamber with 1 x 10(9)F. nucleatum PK 1594 (p < 0.001). To benefit from the presence of the fusobacteria, P. gingivalis HG 405 had to be coinoculated; inoculation in separate chambers for the same animal had no such effect (p < 0.001). Subinfective F. nucleatum inocula also benefited from the association with P. gingivalis HG 405 and uniformly established an infection when this partner was present (p < 0.001). These results suggest that the frequent and natural coexistence of P. gingivalis and F. nucleatum in diseased sites may express such a synergism in successful establishment and survival of small inocula.

Antimicrobial activity of calcium hydroxide pastes on Enterococcus faecalis cultivated in Root Canal Systems

The effectiveness of calcium hydroxide pastes: Calen™ and PMCC-Calen™ associated to chemo-mechanical preparation was assessed on Enterococcus faecalis grown within root canals. Seventy incisors were inserted into TSB medium, sterilized and contaminated with E. faecalis. Culture medium was replaced each 24 h and incubated at 37oC for 72 h. After chemo-mechanical preparation, root canals were filled with Calen™ or PMCC-Calen™ (7 or 14 days). Pastes were removed and teeth were inserted into test tubes containing Enterococcosel broth. Calen™ paste (maintained for 7 and 14 days) induced 70% elimination of enterococci and PMCC-Calen™ 100% elimination only after maintenance for 14 days. These medications were significantly more effective (p<0.001) than chemo-mechanical protocol alone and PMCC-Calen™ maintained for 7 days, both incapable to eliminate the viability of enterococci. Calcium hydroxide pastes demonstrated important adjuvant effects in the elimination of enterococci during chemo-mechanical preparation of root canal systems. When associated with PMCC, calcium hydroxide pastes should be maintained for at least 14 days.

Stimulation of Fusobacterium nucleatum biofilm formation by Porphyromonas gingivalis

BACKGROUND/AIMS

Bacterial infection is a major cause of periapical periodontitis. Eradication of these microorganisms from apical lesions is essential to the success of endodontic treatment. The aim of this study was to clarify the molecular interaction between Fusobacterium nucleatum, Porphyromonas gingivalis and other microorganisms associated with periapical periodontitis.

METHODS

Microorganisms isolated from periapical lesions were inoculated into type-I collagen-coated polystyrene microtiter plates and maintained at 37 degrees C under anaerobic conditions for 2 days, after which, the quantity of organized biofilm on the plates was evaluated by crystal violet staining. Growth enhancement via soluble factor was evaluated by separated coculture using a 0.4-mum membrane filter.

RESULTS

F. nucleatum exhibited strong adherence to type-I collagen-coated polystyrene microplates. Biofilm formation by F. nucleatum was significantly enhanced by P. gingivalis. It was complemented by compartmentalized coculture with P. gingivalis. Enhancement of biofilm formation by P. gingivalis was only slightly reduced by inactivation of its autoinducer-2-producing gene luxS.

CONCLUSION

The results suggest that P. gingivalis enhances biofilm formation by F. nucleatum by releasing diffusible signaling molecules other than autoinducer-2.

Determination of the minimum inhibitory concentration of four medicaments used as intracanal medication

The aim of this study was to determine the minimum inhibitory concentration (MIC) of iodoform, calcium hydroxide, IKI (iodine potassium iodine) and CFC (ciprofloxacin, Flagyl (metronidazole) and calcium hydroxide) required to kill S. aureus, Pseudomonas aeruginosa, Enterococcus faecalis and B. fragilis. In the experiment, medicaments were added to bacterial species into test tubes, in 10 different concentrations. The MIC was the lowest concentration of the drug at which bacterial growth could not be observed. In this investigation, CFC was the most effective medicament against all bacteria. All drugs were able to eliminate E. faecalis and B. fragilis, while IKI was not effective against S. aureus. IKI and calcium hydroxide were not able to eliminate P. aeruginosa as well.

Er:Yag laser irradiation of the microbiological apical biofilm

One problem in cases of healing-resistant periapical lesions is to eradicate the contamination at the periapical area. This contamination is due to the microbiological biofilm formed by microorganisms and their subproducts lodged in apical third of the root, on both cementum and dentin surface. Paraendodontic surgery consists of the mechanical removal of harmful agents to promote healing and periapical health. The purpose of this study was to assess the results of Er:YAG laser irradiation on the apical root third of newly extracted teeth to eliminate microbial contamination on root apex surface. Apical irradiation was performed with an Er:YAG laser device using an experimental contact tip, at 100 mJ, 10 Hz, 1 W, 39 J/cm(2), 3 times on the target area. SEM analysis showed the elimination of part of the irradiated cementum and the formation of small roughened without exposing the subjacent dentin. Vaporization of the remaining periodontal tissue and removal of microbiological apical biofilm (MAB) were also observed on the irradiated areas. Under the tested conditions and based on the findings of this study, Er:YAG laser may be considered effective for removal of microbiological apical biofilm.