Mechanisms involved in the resistance of Enterococcus faecalis to calcium hydroxide

Cytotoxicity of intracanal dressings on apical papilla cells differ upon activation with E. faecalis LTA

Objective

The aim of this study was to investigate the cytotoxic effects of modified triple antibiotic paste and an experimental composition using calcium hydroxide on lipoteichoic acid (LTA)-primed apical papilla cells (APC).

Material and Methods

Human APC were tested for in vitro cytotoxicity of modified Triple Antibiotic Paste (mTAP – Ciprofloxacin, Metronidazole and Cefaclor at 1:1:1) and of a paste of Ciprofloxacin, Metronidazole and Calcium hydroxide (CMC – 1:1:2) and modified CMC (mCMC – 2:2:1) by using MTT assay. The substances were reconstituted in DMEM at 1,000 µg/mL and ¼ serially diluted before being kept in contact with cells for 1, 3, 5 and 7 days. Further, cells were primed with 1 µg/mL of Enterococcus faecalis LTA for 7 days prior to the viability test with 1,000 µg/mL of each substance. Statistical analysis was performed using one-way analysis of variance (ANOVA) and two-way ANOVA respectively followed by Tukey’s post-test. Significance levels were set at p<0.05.

Results

In the first assay, the higher cytotoxic rates were reached by mTAP for all experimental periods. CMC was found toxic for APC at 5 and 7 days, whereas mCMC did not affect the cell viability. Only CMC and mCMC were able to induce some cellular proliferation. In the second assay, when considering the condition with medium only, LTA-primed cells significantly proliferated in comparison to LTA-untreated ones. At this context, mTAP and CMC showed similar cytotoxicity than the observed for LTA-untreated cells, while mCMC was shown cytotoxic at 7 days only for LTA-primed APC. Comparing the medications, mTAP was more cytotoxic than CMC and mCMC.

Conclusion

mTAP showed higher cytotoxicity than CMC and mCMC and the effect of topic antimicrobials might differ when tested against apical papilla cells under physiological or activated conditions.

Update of the therapeutic planning of irrigation and intracanal medication in root canal treatment. A literature review

Background

The success of endodontic treatment derives from the complete elimination of microorganisms capable of causing an intraradicular or extraradicular infection. To achieve a more effective eradication of these microorganisms, endodontic instrumentation must always be implemented with abundant irrigation, which has to achieve chemical, mechanical and biological effects. The irrigators most used today are NaOCl, CHX and EDTA, released into the ducts through different techniques such as syringe, manual agitation, positive or negative apical pressure, sonic or ultrasonic activation, PIPS and PDT. The objective of this review is to update the different irrigating solutions and intracanal disinfection drugs, as well as to establish an irrigation protocol in the endodontic treatment.

Material and Methods

Systematic search of scientific articles in the databases PubMed, Medline and Google Scholar, with the following keywords Endodontic, Infection, Failure, Irrigation, Retreatment and Irrigation protocol. The exclusion criteria were “case report” articles and articles with a publication date prior to 2000.

Results

48 articles that met the inclusion criteria were analyzed. Comparing the different articles it can be seen that the NaOCl is the “gold standard” in terms of immediate antimicrobial efficacy, followed by the CHX that has a long-term antibacterial effect. As an intra-conductive drug it is advisable to use the combination of Ca(OH)2 with CPMC.

Conclusions

The most adequate irrigation protocol consists of using 2.5% NaOCl activated with ultrasound followed by a final wash with 7% MA or 0.2% CTR combined with 2% CHX.

Key words:Endodontic failure, endodontic infection, enterococcus faecalis, endodontic retreatment, irrigation, sodium hipoclorite, irrigation protocol.

Antimicrobial and anti-inflammatory drug-delivery systems at endodontic reparative material: Synthesis and characterization

OBJECTIVE

The aim of this study was to synthesize and characterize an experimental endodontic paste.

METHODS

An experimental endodontic paste (EX) was characterized by its particle size, zeta potential, drug content and morphology. The powder of EX is composed of amoxicillin microspheres, calcium tungstate and α-tricalcium phosphate, mixed with an indomethacin nanocapsules suspension. Ultracal^® (Ultradent), an iodoform-based paste (GP) and the EX were evaluated by its physical properties (flow, film thickness and radiopacity). The cytocompatibility was performed by MTT and SRB-colorimetric assays; the cell-migration was tested with scratch assay and cell-ability to remineralization with ALP and Alizarin Red S, with fibroblastic cell line. The antibacterial activity was assessed by the formation of inhibition zones and against planktonic bacteria.

RESULTS

The EX and UL flow achieved ISO6876 standard, and GP was lower than 17mm. All pastes achieved the film thickness required. Radiopacity was equivalent to 1.81±0.25mmAl for EX, which did not differ from GP group 1.39±0.33mmAl (p>0.05). The UL presented 3.04±0.33mmAl. The values for SRB showed better citocompatibility in comparison with MTT for all materials. The ALP activity and formation of mineralized nodules demonstrated the remineralization potential for UL and EX. Cell migration showed continuous wound closure until complete cell healing, however, the EX accelerated the process (p<0.05). The EX showed the greatest inhibition zone (p<0.05) and was the only group with antibacterial activity against planktonic bacteria.

SIGNIFICANCE

The synthesized endodontic paste demonstrated reliable physical and biological properties and could be a promising material for periapical tissue repair.

Cysteamine improves the bactericidal efficacy of intra-canal medicaments against Enterococcus faecalis

Aim

The aim of this study was to compare the antimicrobial efficacy of cysteamine, calcium hydroxide[Ca(OH)2], triple antibiotic paste (TAP), chlorhexidine (CHX) and their combinations against Enterococcus faecalis (E. Faecalis).

Methods

The E. Faecalis eradication capacity of cysteamine, Calcium hydroxide (Ca[OH]2), TAP, CHX, and their combinations was tested on E. Faecalis by Kirby Brauer disc diffusion method.

Results

Cysteamine in combination with TAP was able to completely eradicate E. Faecalis within 24 hours. Ca(OH)2 was unable to show its effect on E. Faecalis in the given time.

Conclusion

Cysteamine increased the E. Faecalis eradicating capacity of TAP and also showed positive results when used in combination with Ca(OH)2, which if used alone was unable to show any action in 24 hours.

A comparative evaluation of antimicrobial efficacy and flow characteristics of two epoxy resin-based sealers-AH plus and Perma Evolution: An in vitro study

Aim of the Study

Bacteria that persist at the time of obturation increase the possibility of persistent apical periodontitis. An ideal sealer should be able to kill these remaining bacteria that are present on the dentinal walls as well as inside the dentinal tubules. This could be possible if a sealer has antimicrobial properties with optimum flow characteristics. Hence, the aim of this in vitro study was to assess the antimicrobial efficacy of epoxy resin-based sealer: AH Plus and Perma Evolution against Enterococcus faecalis on the 1^st, 3^rd, 5^th, and 7^th day and also to compare the flow characteristics of both epoxy resin-based sealers.

Materials and Methods

E. faecalis ATCC 35550 strain was used to assess the antibacterial efficacy of sealers by agar-diffusion test (ADT) and direct-contact test (DCT). Flow characteristics of sealers were measured according to the ADA specification no. 57.

Results

In ADT, Perma Evolution sealer showed larger zone of inhibition than AH plus on the 1^st, 3^rd, 5^th, and 7^th day, and in DCT, both sealers were equally effective in inhibiting E. faecalis growth on the 1^st, 3^rd, 5^th, and 7^th day. Flow test showed no significant difference between Perma Evolution and AH Plus sealer.

Conclusion

Both the tested sealers were equally effective against E. faecalis up to 7 days of incubation period. Considering flow properties, both the tested sealers showed optimum flow as per the ADA specification no. 57.

Root Microbiota in Primary and Secondary Apical Periodontitis

Apical periodontitis is an inflammatory disease of the dental periradicular tissues triggered by bacteria colonizing necrotic root canals. Primary apical periodontitis results from the microbial colonization of necrotic pulp tissues. Secondary apical periodontitis results from a persistent infection of incorrectly treated root canals. The aim of this study was to characterize the microbiota present in primary and secondary intraradicular infections associated with apical periodontitis using 16S rRNA gene amplicon sequencing. Teeth exhibiting apical periodontitis with or without root canal treatment were extracted after informed consent. From each tooth, the intraradicular content as well as a dentin sample (control) were collected and subjected to DNA extraction. PCR amplicons of the V3-V4 region of the bacterial 16S rRNA gene were pooled and sequenced (2 × 300) on an Illumina MiSeq instrument. The bioinformatics analysis pipeline included quality filtering, merging of forward and reverse reads, clustering of reads into operational taxonomic units (OTUs), removal of putative contaminant OTUs and assigning taxonomy. The most prevalent and abundant OTU in both dentin and root canal samples was assigned to anaerobic bacterium Fusobacterium nucleatum. Multivariate analysis showed clustering of microbiota by sample type (dentin vs. intraradicular content) and, in root canals, by pathology (primary vs. secondary infection). The proportions of Enterococcus faecalis and F. nucleatum were, respectively, higher and lower when comparing secondary to primary infected root canals. Co-occurrence network analysis provided evidence of microbial interactions specific to the infection type. The identification of bacterial taxa differentially abundant in primary and secondary intraradicular infections may provide the basis for targeted therapeutic approaches aimed at reducing the incidence of apical periodontitis.

Evaluation of the antibacterial efficacy of various root canal disinfection methods against Enterococcus faecalis biofilm. An ex-vivo study

BACKGROUND

Complete elimination of bacteria and their by-products from the root canal system is very difficult with current techniques. The purpose of this study was to compare the antibacterial efficacy of different disinfection protocols against Enterococcus faecalis (E. faecalis) biofilms.

METHODS

Seventy-six extracted single-rooted human teeth were selected. Root canal preparation was done by proTaper rotary instruments. The smear layer was removed by 17% EDTA, followed by 5.25% sodium hypochlorite. After sterilization using gamma irradiation, sterilized specimens were inoculated with an E. faecalis suspension, incubated for 4 days and 4 weeks and then randomly divided into two experimental groups (4 days, 4 weeks old biofilms). After the confirmation of biofilm formation with SEM, the specimens in the experimental groups were randomly divided into five experimental subgroups according to the method of disinfection applied, which included: Diode laser irradiation (810 nm, 2 W), Light activated disinfection (LAD) with Indocyanine Green, 0.2% Chlorhexidine gluconate (0.2% CHX), 0.2% CHX + LAD and 0.2% CHX + Diode groups.

RESULTS

Complete biofilm bacterial elimination was not observed in either of the experimental groups. CHX + LAD (0.2%) method exhibited the highest reduction value in biofilm and only Diode alone revealed the lowest in all the root canal portions. Disinfection protocols also showed significantly lower antibacterial efficacy against 4-week old than the 4-day old matured biofilms (P < 0.05).

CONCLUSION

All the evaluated methods in this study were effective in the relative elimination of the E. faecalis biofilms except diode laser alone. Nevertheless, 0.2% CHX + LAD exhibited significantly higher efficacy in reducing both 4-day and 4-week old biofilms.

Inhibition of Enterococcus faecalis Growth and Biofilm Formation by Molecule Targeting Cyclic di-AMP Synthetase Activity

INTRODUCTION

Enterococcus faecalis is correlated with oral diseases including recurrent root canal treatment failure because of its biofilm formation ability and various virulence factors. Cyclic di-AMP (c-di-AMP) is an omnipresent second messenger involved in many crucial cellular physiological processes, including biofilm formation. ST056083 is a small molecule working as an inhibitor of the c-di-AMP synthetase DNA integrity scanning protein (DisA) in vitro. In this study, the impact of ST056083 on E. faecalis DisA activity, bacterial growth, and biofilm formation was tested.

METHODS

The binding affinity between the protein and ligand was evaluated using the Amber score, and the binding mode was analyzed and visualized using UCSF Chimera (Resource for Biocomputing, Visualization, and Informatics, University of California, San Francisco, San Francisco, CA). The effect of ST056083 on E. faecalis DisA was evaluated using the coralyne assay. The effect of ST056083 on E. faecalis biofilm formation was determined by the biofilm quantification assay, scanning electron microscopic examination, and 3-dimensional confocal laser scanning microscopic assay. The effect of ST056083 on E. faecalis exopolysaccharide synthesis was measured by the anthrone-sulfuric method.

RESULTS

We expressed and purified E. faecalis DisA in vitro and confirmed the inhibitory effect of ST056083 on its biological activity. In addition, we showed the inhibitory effect of ST056083 on E. faecalis growth, biofilm formation, and exopolysaccharide synthesis.

CONCLUSIONS

Our findings enhance the understanding of the physiological role of c-di-AMP in E. faecalis and represent a preliminary study on the ST056083 inhibitory effect and mechanism.

Total Eradication of Bacterial Infection in Root Canal Treatment: An Electrochemical Approach

According to the American Association of Endodontists, currently 22.3 million endodontic procedures are being performed annually with the success rate of 70-95% and the average survival rate of the root canal procedure is approximately 67% after 5 years and 56% after 8 years. One of the major reason for the failure is relapse of infection. Hence, it is imperative to develop an assistive or alternative method to eradicate the bacterial infection effectively without affecting patient compliance. The application of electrochemistry has been used previously to disinfect catheters and implant disinfection. Hence, the aim of this study is to utilize the principles of electrochemistry to develop a microelectronic device to eradicate bacterial infection for root canal treatment. The electrochemical protocol includes open circuit potential (60 s) and potentiostatic scan at varying voltage (-9 to +2 V) at a different time duration (1-5 min). Enterococcus faecalis in the form of planktonic and biofilm was used in this study. After electrochemical treatment, the bacterial viability was evaluated using alamarBlue assay, colony forming units, confocal microscopy, and scanning electron microscopy. Cytotoxicity evoked by electrochemical voltage in comparison to NaOCl solution was performed using osteoblasts in 2D and 3D cell culture systems. The results of the study show that the application of -2 to +2 V at 1-5 min did not show any significant reduction in bacterial growth. However, the cathodic voltage of -9 V for 5 min showed a significant reduction (p < 0.001) in the bacterial count (80-95%). Similar results were obtained from biofilm study, which is more realistic to the in vivo condition. In contrast, the method did not induce cytotoxicity to the cells in 3D culture system (65% viability) in comparison to the highly toxic nature (0% viability) of NaOCl, indicating better patient compliance. Hence, the study provides supporting evidence to develop an electrochemically driven microelectronic device that can be a potential assistive dental instrument for endodontic procedures.

Antibacterial Effect of Azadirachta indica (Neem) or Curcuma longa (Turmeric) against Enterococcus faecalis Compared with That of 5% Sodium Hypochlorite or 2% Chlorhexidine in vitro

The purpose of this study was to compare the antibacterial properties of Azadirachta indica (neem) or Curcuma longa (turmeric) against Enterococcus faecalis with those of 5% sodium hypochlorite or 2% chlorhexidine as root canal irrigants in vitro. The activity of neem, chlorhexidine, sodium hypochlorite, or turmeric against E. faecalis was measured on agar plates using the agar diffusion method. The tube dilution method was used to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the irrigants used. Chlorhexidine or neem exhibited the greatest antibacterial activity when used as endodontic irrigants against E. faecalis, followed by sodium hypochlorite. No statistically significant difference was observed between neem, sodium hypochlorite, or chlorhexidine. The MIC of neem was 1: 128, which was similar to that of chlorhexidine. The MBC for each of these irrigants was 1: 16. Neem yielded antibacterial activity equivalent to 2% chlorhexidine or sodium hypochlorite against E. faecalis, suggesting that it offers a promising alternative to the other root canal irrigants tested.

Effects of a Chimeric Lysin against Planktonic and Sessile Enterococcus faecalis Hint at Potential Application in Endodontic Therapy

Enterococcus faecalis is a commensal opportunistic pathogen found in the intestine, mouth, and vaginal tract of humans. As an invasive pathogen in the oral cavity, E. faecalis is one of the leading causes of periapical endodontic lesions. However, due to the strong biofilm-forming capacity and tolerance of E. faecalis to conventional antibiotics and treatments, limited therapeutic options are available. In the present study, we investigated the activity of ClyR, a chimeric lysin with extended streptococcal lytic spectrum, against planktonic and sessile E. faecalis cells in vitro and in an ex vivo dental model. Our results showed that ClyR has robust and rapid lytic activity against multiple E. faecalis strains, killing >90% planktonic cells within 1 min at a concentration of 50 μg/mL. The biochemical experiments combined with microscopy analysis revealed that ClyR degrades E. faecalis biofilm with high efficacy in a dose-dependent manner, reducing the survival rate to <40% within biofilms after treatment with 50 μg/mL ClyR for 1 h. In the ex vivo dental model, ClyR showed a significant biofilm removal efficacy, killing >90% viable bacteria within biofilms at a low dose of 50 μg/mL, which is much better than ampicillin and similar to calcium hydroxide, the extensively used routine intracanal medicament in the treatment of endodontics and dental traumatology. The robust activity of ClyR against both planktonic and sessile E. faecalis suggests the potential of ClyR in treating endodontic infections caused by E. faecalis.

Do different strains of E. faecalis have the same behavior towards intracanal medications in in vitro research?

The aim of this study was to evaluate the antimicrobial action of different endodontic pastes against Enterococcus faecalis ATCC 29212, isolated from the urinary tract, and compare the action with E. faecalis ATCC 4083, isolated from the root canal. For this purpose, dentin blocks were infected for 21 days with both bacteria at different time-intervals to ensure there would be no cross contamination. After this period, blocks were immersed in the test medications for 7 days, according to the following groups: CH/S, CH/P, CH/CMCP, CH/CHX, CH/DAP and TAP. Images of the samples were captured with a confocal microscope and the percentage of live cells was computed by means of the Bioimage program. The ATCC 29212 strain was shown to be more resistant to CH/SS, Calen, CH/DAP, and TAP than the ATCC 4083 strain. The antimicrobial action of the medications against each strain were divergent concerning the order of susceptibility. The authors concluded that the strains behaved in a different manner: in general, those extracted from the urinary tract were more resistant to the tested medications. Therefore, when E. faecalis must be used for in vitro research in endodontics, we suggest the use of ATCC 4083 strain to obtain results that are closer to the clinical reality.

BAG-S53P4 as bone graft extender and antimicrobial activity against gentamicin- and vancomycin-resistant bacteria

AIM

To evaluate the suitability of bioactive glass (BAG)-S53P4 as a bone-graft extender for large bony defect filling in bone and joint infection.

MATERIALS & METHODS

Antimicrobial activity of BAG-S53P4 against clinically relevant strains isolated from bone and joint infections was evaluated by means of time-kill curves in presence of bone graft. Furthermore, the susceptibility to BAG of strains resistant to vancomycin and gentamicin was assessed.

RESULTS

Though attenuated, BAG maintains a good in vitro antimicrobial activity in presence of human body fluids and tissues contained in bone graft, with the exception of Enterococcus faecalis.

CONCLUSION

BAG-S53P4 is a suitable bone substitute that can be used as an extender with autologous bone graft to promote better fusion and healing.

Comparison of Commercial Calcium Hydroxide Pastes for Prolonged Antibacterial Effect using a Colourimetric Assessment

The anti-microbial activity of calcium hydroxide pastes used in endodontics is dependent on establishing high levels of hydroxyl ions in dentine. This study investigated hydroxyl ion diffusion from different commercial calcium hydroxide pastes using a novel colourimetric method. In this method, human tooth roots were stained with anthocyanin dye, which changed their colour according to the local pH conditions. Prepared root canals were filled with pastes formulated with the vehicle of water (Pulpdent™, Calasept Plus™), polyethylene glycol (PEG) (Calmix™) or a mixture of water, PEG and ibuprofen (Odontocide™). The changes in dye colour at fixed distances from the canal wall were monitored using standardised digital photography over a period of 3 weeks. A repeated measures analysis tracked changes in each root from baseline. Release of hydroxyl ions varied between the different commercial compositions containing water or PEG as solvents. The colour changes in the dentine, due to released hydroxyl ions, were greatest and more prolonged for completely non-aqueous compositions, when using PEG 400 as the vehicle. When water was present in the product, the duration of the pH changes was shorter. This was attributed to the presence of hydroxyl ions in the water (the common-ion effect) and a more vigorous buffering of hydroxyl ions by dentine proteins.

Synergistic mechanism of Ag+-Zn2+ in anti-bacterial activity against Enterococcus faecalis and its application against dentin infection

Background

Ag⁺ and Zn²⁺ have already been used in combinations to obtain both enhanced antibacterial effect and low cytotoxicity. Despite this, it is still unclear how the Zn²⁺ co-works with Ag⁺ in the synergistic antibacterial activity. The main purposes of this study were to investigate the co-work pattern and optimum ratio between Ag⁺ and Zn²⁺ in their synergistic antibacterial activity against E. faecalis, the possible mechanisms behind this synergy and the primary application of optimum Ag⁺–Zn²⁺ co-work pattern against the E. faecalis biofilm on dentin. A serial of Ag⁺–Zn²⁺ atomic combination ratios were tested on both planktonic and biofilm-resident E. faecalis on dentin, their antibacterial efficiency was calculated and optimum ratio determined. And the cytotoxicity of various Ag⁺–Zn²⁺ atomic ratios was tested on MC3T3-E1 Cells. The role of Zn²⁺ in Ag⁺–Zn²⁺co-work was evaluated using a Zn²⁺ pretreatment study and membrane potential—permeability measurement.

Results

The results showed that the synergistically promoted antibacterial effect of Ag⁺–Zn²⁺ combinations was Zn²⁺ amount-dependent with the 1:9 and 1:12 Ag⁺–Zn²⁺ atomic ratios showing the most powerful ability against both planktonic and biofilm-resident E. faecalis. This co-work could likely be attributed to the depolarization of E. faecalis cell membrane by the addition of Zn²⁺. The cytotoxicity of the Ag⁺–Zn²⁺ atomic ratios of 1:9 and 1:12 was much lower than 2% chlorhexidine.

Conclusions

The Ag⁺–Zn²⁺ atomic ratios of 1:9 and 1:12 demonstrated similar strong ability against E. faecalis biofilm on dentin but much lower cytotoxicity than 2% chlorhexidine. New medications containing optimum Ag⁺–Zn²⁺ atomic ratios higher than 1:6, such as 1:9 or 1:12, could be developed against E. faecalis infection in root canals of teeth or any other parts of human body.

Investigation of the effect of rapid and slow external pH increases on Enterococcus faecalis biofilm grown on dentine

BACKGROUND

Calcium hydroxide is a common endodontic medicament and has an antimicrobial effect by increasing the localized pH within the root canal. However, Enterococcus faecalis has shown some resistance to calcium hydroxide.

METHODS

A flow cell apparatus was used to grow an E. faecalis biofilm on dentine discs. Following 4 weeks growth in Todd Hewitt Broth, flow cells were exposed to either a rapid or slow increase to pH 11.5 or 12.5. Cellular viability was determined using serial plating and the number of colony-forming units was normalized against the cellular protein content. Scanning electron microscopy was carried out to qualitatively observe the effects of the different rates of pH increase.

RESULTS

A significant difference in viability between the pH rapid and slow groups was not shown in this study. Compared with pH 11.5 solutions, pH 12.5 solutions were more effective at killing bacteria although some E. faecalis still survived.

CONCLUSIONS

Enterococcus faecalis did not adapt and develop a greater resistance to high pH following a slow rise in pH compared with a rapid rise in pH. As expected, pH 12.5 was more effective in reducing bacterial numbers compared with pH 11.5 although E. faecalis was not completely eliminated.

Antimicrobial activity of Psidium cattleianum associated with calcium hydroxide against Enterococcus faecalis and Candida albicans: an in vitro study

OBJECTIVE

Evaluate, in vitro, the antimicrobial activity of Psidium cattleianum leaf extracts combined with calcium hydroxide against Enterococcus faecalis and Candida albicans biofilm.

MATERIALS AND METHODS

Dentin specimens obtained from extracted bovine incisors were infected during 14 days with E. faecalis ATCC 29212 and C. albicans ATCC 10231. The specimens were filled with calcium hydroxide pastes prepared with the following vehicles: Psidium cattleianum ethanolic, Psidium cattleianum propylene glycolic, distilled water, and saline as control. After 24 h, 3, 7, and 14 days, the canals were irrigated with sterile saline and dried. Dentin samples were collected from the canals with burs of increasing diameters. To determine the number of colony-forming units (CFU), samples were inoculated onto BHI agar supplemented with yeast extract (0.5%), at 37 °C, for 48 h, in CO₂ enriched atmosphere. Comparisons among the groups for the variation factors were performed by ANOVA and Tukey's test.

RESULTS

Ethanolic and propylene glycolic extracts showed significantly higher antimicrobial activity against E. faecalis (p < 0.01) when compared with distilled water. The ethanolic extract exhibited in 24 h the same antibacterial activity that propylene glycolic extract and distilled water after 7 and 14 days. For C. albicans, all were effective in reducing the number of CFU at all periods.

CONCLUSION

The P. cattleianum ethanolic extract presented the fastest and highest antimicrobial activity against E. faecalis, significantly reducing the microbial load in 24 h. All medications were effective against C. albicans.

CLINICAL RELEVANCE

The antibacterial potential of P. cattleianum and its biological compatibility associated with calcium hydroxide indicate promising applications in the field of dentistry.

Antibacterial Efficacy of Biosynthesized Silver Nanoparticles against Enterococcus faecalis Biofilm: An in vitro Study

Aim

This study aims to evaluate the antibacterial efficacy of biosynthesized silver nanoparticles (AgNPs) produced using the fungi against Enterococcus faecalis biofilm model on root dentin.

Materials and Methods

AgNPs were biosynthesized using the fungi Fusarium semitectum isolated from healthy leaves of Withania somnifera. Minimum inhibitory concentration (MIC) of AgNPs was determined by microbroth dilution method using series of dilutions. MIC dose was standardized to evaluate the antibacterial efficacy. For biofilm model, thirty root dentin blocks prepared using human extracted single-rooted teeth were inoculated with E. faecalis in Trypticase soy agar broth for 2 weeks with alternate day replenishment and randomly divided into three groups (n = 10 each) and treated as: Group I: Sterile distilled water, Group II: AgNPs, and Group III: 2% chlorhexidine gluconate (CHX) and incubated at 37°C for 24 h. Each dentin block was rinsed in saline, vortex shaken for 60 s, and serial decimal dilutions were prepared and plated on trypticase soy agar plates and incubated for 24 h followed by CFU colony counting and statistically analyzed using one-way ANOVA followed by post hoc Tukey honestly significant difference test.

Results

MIC of AgNPs for E. faecalis was determined as 30 mg/ml. No significant difference was seen between AgNPs and 2% CHX when compared to the control group with mean colony counts being 2.4, 2.5, and 6.77 CFU/ml (10⁷), respectively (P < 0.0001), against E. faecalis biofilm.

Conclusion

Biosynthesized AgNPs exhibit effective antimicrobial activity against E. faecalis biofilm on root dentin. Therefore, it can be employed as antimicrobial agent for root canal disinfection.

Effects of prolonged exposure to moderate static magnetic field and its synergistic effects with alkaline pH on Enterococcus faecalis

Static magnetic field (SMF) has been shown to biologically affect various microorganisms, but its effects on Enterococcus faecalis, which is associated with multiple dental infections, have not been reported yet. Besides, Enterococcus faecalis was found to be resistant to the alkaline environment provided by a major dental antimicrobial, calcium hydroxide. Therefore, the antibacterial activity of prolonged exposure to moderate SMF (170 mT) and its possible synergistic activity with alkaline pH (pH = 9) were evaluated in the study. The ability to form a biofilm under these conditions was examined by crystal violet assay. Real-time quantitative PCR was performed to evaluate the relative expression of stress (dnaK and groEL) and virulence (efaA, ace, gelE and fsrC) related genes. As the results indicated, cell proliferation was inhibited after 120 h of SMF exposure. What's more, the combined treatment of SMF and alkaline pH showed significantly improved antimicrobial action when compared to single SMF and alkaline pH treatment for more than 24 h and 72 h respectively. However, the ability to form a biofilm was also enhanced under SMF and alkaline pH treatments. SMF can induce stress response by up-regulating the expression of dnaK and elevate virulence gene expression (efaA and ace). These responses were more significant and more genes were up-regulated including groEL, gelE and fsrC when exposed to SMF and alkaline pH simultaneously. Hence, combination of SMF and alkaline pH could be a promising disinfection strategy in dental area and other areas associated with Enterococcus faecalis infections.

Microbiology of Root Canal Infections

Inflammatory reaction in the periapical tissues is induced by microbial infection in the root canal system. The aim of root canal treatment is to preserve healthy periapical tissues or to provide healing of them in restorable teeth, which have sufficient periodontal support. The amount of microbial cells in the root canal system and their virulence as well as host responses influence on the degree of periapical inflammation and symptoms. Microbial biofilm formation is typically seen on root canal walls but some microbial species are able to invade the dentine tubules to varying depth. In prolonged and complicated infections, or in case of risk of systemic spread of infection, root canal sampling for microbiological diagnostics is recommended. Anaerobic gram-negative rods are commonly isolated organisms in primary infections. In post-treatment disease, the microflora is dominated by facultatively anaerobic gram-positive cocci and rods such as Streptococcus, Enterococcus, Peptostreptococcus and Actinomyces species. Instrumentation, disinfection and interappointment medication in strict aseptic conditions are essential steps for eradication of microbial species from the infected root canal system. During past decades, Enterococcus faecalis and Candida albicans have been commonly associated organisms in treatment-resistant infections. Novel microbial detection methods are giving increasing knowledge about microbial species associated with endodontic infections and their roles in them.

Aspects of Solvent Chemistry for Calcium Hydroxide Medicaments

Calcium hydroxide pastes have been used in endodontics since 1947. Most current calcium hydroxide endodontic pastes use water as the vehicle, which limits the dissolution of calcium hydroxide that can be achieved and, thereby, the maximum pH that can be achieved within the root canal system. Using polyethylene glycol as a solvent, rather than water, can achieve an increase in hydroxyl ions release compared to water or saline. By adopting non-aqueous solvents such as the polyethylene glycols (PEG), greater dissolution and faster hydroxyl ion release can be achieved, leading to enhanced antimicrobial actions, and other improvements in performance and biocompatibility.

Removal and killing of multispecies endodontic biofilms by N-acetylcysteine

Removal of bacterial biofilm from the root canal system is essential for the management of endodontic disease. Here we evaluated the antibacterial effect of N-acetylcysteine (NAC), a potent antioxidant and mucolytic agent, against mature multispecies endodontic biofilms consisting of Actinomyces naeslundii, Lactobacillus salivarius, Streptococcus mutans and Enterococcus faecalis on sterile human dentin blocks. The biofilms were exposed to NAC (25, 50 and 100 mg/mL), saturated calcium hydroxide or 2% chlorhexidine solution for 7 days, then examined by scanning electron microscopy. The biofilm viability was measured by viable cell counts and ATP-bioluminescence assay. NAC showed greater efficacy in biofilm cell removal and killing than the other root canal medicaments. Furthermore, 100 mg/mL NAC disrupted the mature multispecies endodontic biofilms completely. These results demonstrate the potential use of NAC in root canal treatment.

Insight into Oral Biofilm: Primary, Secondary and Residual Caries and Phyto-Challenged Solutions

INTRODUCTION

Dental caries is known to be one of the most widespread, chronic infections affecting all ages and populations worldwide. The plethora of oral microbial population paves way for various endogenous infections and plays a crucial role in polymicrobial interactions contributing to biofilm-mediated diseases like caries and periodontal diseases.

METHODS

Extensive literature survey was conducted using the scientific databases like PubMed, Google scholar, Science Direct, etc. using the key words like dental caries, orodental infections, dental microbes, dental biofilm, secondary caries, phytotherapy, etc. The literature was analyzed thoroughly and critical review was performed.

RESULTS

The risk of development of secondary caries and residual caries further results in treatment failure. Drug resistance developed by oral microbes and further side effects pose serious hurdles in the current therapeutic strategies. The hyperactivities of various MMPs and the resulting massive ECM degradation are the challenging part in the design of effective therapeutic approaches. Anticariogenic phytotherapy is well appreciated owing to lesser side effects and versatility of their action. But appreciable outcomes regarding the phytochemical bioavailability and bioretention are still challenging. Site-specific delivery of phytoagents at the infected site may enhance the efficiency of these drugs. Accordingly emerging phytodentistry can be promising for the management of secondary and residual caries.

CONCLUSION

This article presents major cariogens and their mechanisms in initiating and aggravating dental caries. Effectiveness of phytotherapy and different mode of action of phytochemicals against cariogens are outlined. The article also raises major concerns and possibilities of phytochemical based therapeutics to be applied in the clinical arena of caries management.

Bactericidal Effect of Er:YAG Laser-Activated Sodium Hypochlorite Irrigation Against Biofilms of Enterococcus faecalis Isolate from Canal of Root-Filled Teeth with Periapical Lesions

OBJECTIVE

This study was to evaluate the bactericidal effect of Er:YAG laser-activated sodium hypochlorite irrigation (Er:YAG + NaOCl) on biofilms of Enterococcus faecalis clinical isolate.

BACKGROUND DATA

It was reported that Er:YAG + NaOCl had effective bactericidal effect on laboratory-adapted E. faecalis strain, while no study has reported its effect on the clinical isolate.

METHODS

Eighteen E. faecalis strains were isolated from 39 root-filled teeth with periapical lesions, and their biofilm formation abilities were evaluated using the crystal violet staining method. Extracted human root canals were prepared to a 40#/.04 K3 instrument and contaminated with the E. faecalis isolate that presented the strongest biofilm formation ability for 4 weeks. The infected canals then received treatments of syringe irrigation with normal saline (NS) or NaOCl, ultrasonic activated irrigations US + NS and US + NaOCl, and Er:YAG laser-activated irrigations Er:YAG + NS and Er:YAG + NaOCl. The root canals were examined using scanning electron microscopy (SEM). The bacterial reductions were evaluated using the cell count method.

RESULTS

SEM results showed that biofilm-like structures formed on the root canal walls after 4-week bacterial incubation. Er:YAG + NaOCl completely removed the E. faecalis biofilm from the root canal wall and made it the cleanest and most smooth surface among the treatment groups. Bacterial reductions in the treatment groups were presented in a descending order of Er:YAG + NaOCl (98.8%), US + NaOCl (98.6%) > NaOCl (94.0%) > Er:YAG + NS (91.9%) > US + NS (78.1%) > NS (51.1%) (p < 0.05).

CONCLUSIONS

The Er:YAG + NaOCl showed an effective bactericidal effect on biofilms of E. faecalis isolate, which may be considered an effective protocol for root canal treatment.

Fabrication and Appraisal of Poly (Lactic-Co-Glycolic Acid) - Moxifloxacin Nanoparticles using Vitamin E-TPGS: A Potential Intracanal Drug Delivery Agent

INTRODUCTION

Nanotechnology is gaining momentum in the search for ideal biomaterials by dental researchers. The expansible nature of Endodontology deems exploration, learning and scrutinizing newer avenues which have the potential to be applied and investigated. The popularity of polymers as drug delivery vehicles has opened avenues for their application in the root canal system. This study utilized application of biodegradable polymers as potential drug delivery vehicles against Enterococcus faecalis, one of the main reasons for post treatment disease.

AIM

This study aimed at fabricating Poly (Lactic-co-Glycolic Acid) (PLGA)-moxifloxacin nanoparticles and assessing its sustained antimicrobial efficacy with calcium hydroxide and chitosan-moxifloxacin hydrogel against Enterococcus faecalis.

MATERIALS AND METHODS

PLGA (50:50) in a quantity of 100 mg was dissolved in 1 ml ethyl acetate and 45 ml of 0.3% w/v Vitamin-E Polyethylene Glycol 1000 Succinate (vitamin E-TPGS) was kept for magnetic stirring in separate beaker. Moxifloxacin (50 μl) was added to polymer PLGA following which vitamin E-TPGS was added to the polymer. Nanoparticles were fabricated using ultrasonication and collected by centrifugation. Surface characterization was assessed using scanning electron microscope. Results were obtained in the form of zone of inhibition by the nanoparticles against Enterococcus faecalis and comparisons were made with chitosan-moxifloxacin hydrogel and calcium hydroxide using Analysis of Variance (ANOVA) followed by Student t-test.

RESULTS

Upon statistical analysis, the zone of inhibition against E. faecalis remained constant with PLGA-moxifloxacin nanoparticles for 14 days while it decreased with chitosan-moxifloxacin hydrogel and remained nil for calcium hydroxide (p<0.01).

CONCLUSION

The study posits that PLGA encapsulated moxifloxacin nanoparticles showcased sustained antibacterial effect in low doses against the test pathogen. Its sustained and programmed release makes them unique contenders for further evaluation in Endodontics as potential intracanal medicaments.

Formulation and Evaluation of Sol-Gel Drug Delivery System for Intracanal pH Sensitive Controlled Delivery of Chlorhexidine

INTRODUCTION

Persistence of viable micro-organisms even after thorough chemomechanical debridement has been cited as a major cause for endodontic failure. Chlorhexidine is a drug, which has shown marked efficacy against Enterococcus faecalis and Candida spp., which are mostly accounted for endodontic failure and it has demonstrated high degree of substantivity to dentin by adsorption. Another issue with chlorhexidine and other intracanal medicaments is the excessive or premature peaking of the drug leading to possible side effects.

AIM

The objective of this experimental work undertaken was to formulate a pH sensitive sol-gel sustained drug delivery system containing chlorhexidine.

MATERIALS AND METHODS

The formulations were prepared using different concentrations of GELRITE^® (0.1% and 0.2%) and Chlorhexidine (0.1% and 0.2%). The prepared solutions were evaluated for pharmacological properties like sterility test, viscosity, drug content, drug release characteristics, drug excipient compatible study.

RESULTS

The drug excipient compatibility studies showed no interaction between the excipient and the active constituent. The microbial analysis showed good efficacy against the test micro-organisms and Minimum Inhibitory Concentration (MIC) values against Candida albicans (ATCC^® 14053™) was observed as 4 μl/ml for both formulation containing 0.1% and 0.2% of GELRITE^® Gellan (polymer). Whereas, MIC values against Enterococcus faecalis was observed to be 3.2 μl/ml and 6 μl/ml for formulation containing 0.1% and 0.2% of GELRITE^® Gellan (polymer) respectively.

CONCLUSION

From the present study, it could be successfully demonstrated that sol-gel formulations can be simple, easy to administer mode of intracanal drug delivery system. Localized pH changes present within the canal can trigger sol-gel conversion thereby releasing the drug in sustained manner with less toxicity and side effects.

Comparison of the Antimicrobial Efficacy of Calcium Hydroxide and Photodynamic Therapy Against Enterococcus faecalis and Candida albicans in Teeth With Periapical Lesions; An In Vivo Study

Introduction: Elimination of pathological microflora of root canal systems is a major goal in endodontic treatment. This study aimed to compare the antimicrobial efficacy of calcium hydroxide as an intracanal medication and antibacterial photodynamic therapy (aPDT) against Enterococcus faecalis and Candida albicans in teeth with periapical (PA) lesions. Methods: This in vivo study was conducted on 20 patients with single-rooted mandibular premolar with previously failed endodontic treatment. This study was performed as a clinical trial (IRCTID: IRCT2016090429686N1). After conventional chemo-mechanical root canal preparation (hand and rotary instruments and 2.5% NaOCl), microbiological samples were obtained using sterile paper points, then stored in thioglycolate solution and transferred to a microbiology laboratory. Group 1 (n = 10) specimens underwent aPDT (diode laser 808 nm + 50 mg/mL methylene blue), while creamy calcium hydroxide paste was used in group 2 for a duration of 1 week. A control sample was taken with sterile paper points and F3 Protaper rotary file. The samples were dispersed in transport medium, serially diluted, and cultured on selective mediums to determine the number of colony forming units (CFUs). Data were analyzed by Mann-Whitney U test at 5% significance level. The significance level for all analyses was set at P < 0.05. Results: Number of CFU significantly decreased in both groups after the interventions (P < 0.001); however, there was no significant difference in the colony count between the 2 groups. Conclusion: aPDT and calcium hydroxide therapy showed the same antimicrobial efficacy on E. faecalis and C. albicans.

Effect of ultrasonic streaming on intra-dentinal disinfection and penetration of calcium hydroxide paste in endodontic treatment

Objective

The antimicrobial effect of ultrasonic agitation of calcium hydroxide (CH) pastes in infected bovine dentin and their penetrability were evaluated using confocal laser scanning microscopy (CLSM) and microbiological culture.

Material and Methods

Fifty-two bovine teeth were infected with Enterococcus faecalis using a new contamination protocol; then they received CH paste and were divided into groups with or without ultrasound. Ultrasonic agitation was conducted for 1 min with a plain point insert. After 15 d, the CLSM analyzed the viable and dead bacteria with Live and Dead assay. The dentinal wall debris was collected by burs, and the colony forming units (CFU/mL) were counted. The penetrability of the paste inside dentinal tubules was tested using the B-rodamine dye.

Results

The calcium hydroxide paste showed better results with the use of ultrasonic agitation (p<0.05).

Conclusion

The ultrasonic agitation of CH paste increased its antimicrobial action and was responsible for intradentinal penetration with the fulfilment of the tubules.

Evaluation of the Role of Probiotics in Endodontic Treatment: A Preliminary Study

Aims and Objectives:

The principal goal of endodontics is the prevention of periapical infection. Acute and chronic apical periodontitis occur due to the persistence of pathogenic microorganisms such as Enterococcus faecalis and Candida albicans harboring the root canal systems of the teeth. The concept of the use of probiotics in addressing endodontic disease is new and has not been studied adequately. On the basis of the success of probiotics in periodontal treatment, this preliminary work was performed (a) to evaluate the antibacterial efficacy of probiotics against common endodontic pathogens, i.e. E. faecalis and C. albicans, and (b) to evaluate the potential use of probiotic therapy as an additive in endodontic treatment procedures.

Materials and Methods:

Two commercial probiotics were selected and evaluated based upon the numbers and concentration of organisms. Pathogenic test organisms were C. albicans (ATCC 10231) and E. faecalis (ATCC 29212). Phase 1 of the study was conducted by agar cup method test to evaluate the antibacterial activity of the selected probiotics against E. faecalis and C. albicans by measuring zones of inhibition (ZOI) in mm. Microorganisms from probiotic samples were isolated following manufacturer's instructions. Pathogenic organisms were set to a 0.1 McFarland standard challenge. Circular wells of 8 mm diameter were punched in each of the poured plates. Appropriately diluted test samples were added to the above-punched wells. The volume of the solution added to each well was 100 μl. The plates were incubated in an upright position at 37°C for 24 hours under aerobic conditions. Post incubation, ZOI was measured (mm). Phase 2 was conducted by mixing 9 ml of 30% poloxamer 407 and de Man, Rogosa and Sharpe (MRS) broth in a test tube with 500 μl of either E. faecalis or C. albicans set at an optical density (OD) of 0.252, together with 500 μl of test probiotic strain, set at a respective OD. Samples were then incubated at 37°C for 48 hours, followed by serial dilutions by 1 ml till 10⁸. This was done to calculate colony forming units (CFU)/ml counts. Controls used were endodontic pathogens in 30% poloxamer with MRS broth without any probiotic group.

Results:

Probiotic groups showed inhibitory activity against E. faecalis by the agar cup method, whereas there was no effect on C. albicans. In the biofilm stage, both the test groups had an antibacterial effect on pathogenic organisms.

Conclusion:

This study suggests that probiotic organisms of the species Lactobacillus and Bifidobacterium are effective for preventing the growth of E. faecalis and C. albicansin vitro. Because probiotics are available in varied compositions and concentrations, further evaluation for their role in treating endodontic infection is suggested and warranted. In addition, the study suggested that poloxamer 407 could be utilized as an ideal delivery vehicle for probiotics for use as a potential endodontic intracanal medicament.

Differences in the chemical composition of Enterococcus faecalis biofilm under conditions of starvation and alkalinity

ABSTACT This study aimed to investigate the dynamic changes that occur in the chemical composition of an Enterococcus faecalis (E. faecalis) biofilm under conditions of starvation and in an alkaline environment and to explore the function of chemical composition changes in the resistance of the E. faecalis biofilm to an extreme environment. This study established an in vitro E. faecalis biofilm model under starvation and in an alkaline environment. During the formation of the biofilm, the pH value and nutritional condition of the culture medium were changed, and the changes in chemical composition were observed using biochemical measures. The results showed that, when the pH value of the culture medium was 11, the percentage of water-insoluble polysaccharides in the biofilm was significantly lower than under other conditions. In addition, the percentage of water-soluble polysaccharides in culture medium with pH values of 9 and 11 gradually decreased. The level of the water-soluble polysaccharides in each milligram of dry weight of biofilm at pH 11 increased compared to that under other conditions. The results from this study indicate that the chemical composition of E. faecalis biofilm changed in extreme environments. These changes served as a defensive mechanism for E. faecalis against environmental pressures.

Bactericidal effect of plasma jet with helium flowing through 3% hydrogen peroxide against Enterococcus faecalis

The aim of the present study was to assess the antimicrobial activity of plasma jet with helium (He) flowing through 3% hydrogen peroxide in root canals infected with Enterococcus faecalis. A total of 42 single-rooted anterior teeth were prepared, sterilized, inoculated with an E. faecalis suspension and incubated for 7 days. Next, the teeth were randomly divided into six experimental groups (including groups treated by plasma jet with or without He for different time durations) and one control group treated without plasma. The number of surviving bacteria in each canal was determined by counting the colony forming units (CFU)/ml on nutrient agar plates. The results indicated that statistically significant reduction in CFU/ml (P<0.005) existed for all treatment groups relative to the control group. The greatest reductions in CFU/ml were observed for Group 3 (7.027 log unit reduction) and Group 2 (6.237 log unit reduction), which were treated by plasma jet sterilization with He flowing through 3% hydrogen peroxide for 4 min or for 2 min, respectively. In addition, the reduction in Group 3 was significantly greater compared with that in Group 2 or in the groups treated by plasma jet sterilization without He flowing through 3% hydrogen peroxide for 1, 2 or 4 min. In conclusion, plasma jet with or without He flowing through 3% hydrogen peroxide can effectively sterilized root canals infected with E. faecalis and should be considered as an alternative method for root canal disinfection in endodontic treatments.

Antimicrobial Activity and Physicochemical Properties of Calcium Hydroxide Pastes Used as Intracanal Medication

INTRODUCTION

The aim of the present study was to evaluate the pH, calcium release, solubility, and antimicrobial action against biofilms of calcium hydroxide + saline solution, Calen (SS White Artigos Dentários Ltd, Rio de Janeiro, Brazil) (CH/P), Calen camphorated paramonochlorophenol (CMCP) (CH/CMPC), and calcium hydroxide + chlorhexidine (CH/CHX) pastes.

METHODS

The pH of the pastes was determined with a calibrated pH meter placed in direct contact with each paste. The root canals of acrylic teeth (N = 10) were filled with the previously mentioned intracanal dressings and immersed in ultrapure water to measure hydroxyl (pH meter) and calcium ion release (atomic absorption spectrophotometer) at time intervals of 3, 7, 15, and 30 days. To assess solubility, the root canals of acrylic teeth (N = 10) were filled with the previously mentioned pastes and scanned by micro-computed tomographic imaging before (initial) and after 7, 15, and 30 days of immersion in ultrapure water. The solubility of each specimen was the difference between the initial and final volume scanning. For antimicrobial analysis, monospecies and dual-species biofilms were in vitro induced on dentin blocks (N = 20). Afterward, they were treated with the pastes for 7 days. Live/dead dye and a confocal microscope were used to measure the percentage of living cells. Data were statistically compared (P < .05).

RESULTS

The highest OH^- ion release values were found in 3 and 30 days. Ca²⁺ releases were greater in CH/CMCP. CH/P and CH/CMCP showed a higher percentage of volume loss values. CH/CHX presented the greatest antimicrobial action.

CONCLUSIONS

CH/P and CH/CMPC showed higher solubility values in the period analyzed. Seven days of contact may be insufficient for calcium hydroxide + saline solution, CH/P, and CH/CMCP pastes to kill bacterial cells in the biofilms studied. Chlorhexidine added to CH favored greater effectiveness against the previously mentioned bacterial biofilms.

Effect of fiber insertion depth on antibacterial efficacy of photodynamic therapy against Enterococcus faecalis in rootcanals

OBJECTIVES

This in vitro study evaluated the effect of fiber insertion depth on antimicrobial efficacy of antimicrobial photodynamic therapy (aPDT) using a photosensitizer (PS; toluidine blue) and a red light-emitting diode (LED) in root canals infected with Enterococcus faecalis.

MATERIALS AND METHODS

Single-rooted extracted teeth were prepared with nickel-titanium-instruments, sterilized, contaminated with E. faecalis, and incubated for 72 h. Roots were randomly divided into four experimental groups: PS only, LED only, aPDT with LED in the apical third, aPDT with LED in the coronal third, as well as into infection and sterile controls (each n = 10). Samples were taken by collecting standardized dentine shavings from the root canal walls. After serial dilution and culturing on blood agar, colony-forming units (CFU) were counted.

RESULTS

Both aPDT groups showed a CFU reduction of 1-2 log₁₀ steps compared with the infection control, whereas the effect of fiber insertion depth was negligible (<0.5 log₁₀ steps). CFU reduction of approximately 0.5 log₁₀ steps for PS alone was detected compared with the infection control, but PS alone was less effective than both aPDT groups. No antibacterial effect was detected for LED alone.

CONCLUSIONS

aPDT reduced E. faecalis within the root canal, whereas fiber insertion depth had a negligible influence on antimicrobial effectiveness of aPDT.

CLINICAL RELEVANCE

The insertion depth of the light-emitting diode may not influence the antibacterial efficacy of photodynamic therapy against E. faecalis in straight root canals.

Development of intracanal formulation containing silver nanoparticles

This study aimed to synthetize, characterize and evaluate the antimicrobial properties of silver nanoparticles to be used in the development of a root intracanal formulation. Silver nanoparticles (AgNPs) were obtained by reduction of silver nitrate with sodium borohydride and characterized by UV-Visible spectrophotometry, scanning electron microscopy (SEM) and dynamic light scattering (DLS). The antimicrobial activity of nanoparticle formulation was evaluated by determinations of the minimum inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) against different bacterial species by the microdilution method, according to recommendations of the Clinical and Laboratory Standards Institute (CLSI). Three potential vehicles, hydroxyethylcellulose, Carbomer and polyethylene glycol were tested as carriers for formulations containing AgNPs. The efficiency of the synthesis method chosen to produce AgNPs was demonstrated by four characterization techniques. The nanoparticles showed antibacterial activity against all species tested. Incorporation of AgNPs into all experimental vehicles produced stable formulations but the one in hydroxyethylcellulose presented better physical proprieties. The results indicate that silver nanoparticles are potential antiseptic agents to be used in root canals and incorporation in adequate vehicles may favor a broader application.

An Invitro Evaluation of Antimicrobial Efficacy and Flow Characteristics for AH Plus, MTA Fillapex, CRCS and Gutta Flow 2 Root Canal Sealer

INTRODUCTION

Cleaning and shaping of root canal does not guarantee complete disinfection of the canal, regardless of the systems and techniques used for this purpose. Therefore, it becomes mandatory for the endodontic filling materials to have a good antimicrobial potential especially against E. faecalis. This research was aimed therefore to evaluate the antibacterial efficacy and flow properties of different root canal sealers.

AIM

To study invitro antimicrobial activity and flow characteristics for Resin based (AH Plus), Mineral Trioxide Aggregate based (MTA Fillapex), Calcium hydroxide based (CRCS) and Flowable Gutta-Percha (Gutta Flow 2) endodontic sealers on Enterococcus faecalis.

MATERIALS AND METHODS

Enterococcus faecalis ATCC 29212 was used to test antibacterial potential of sealers by Agar diffusion test (ADT) and Direct Contact Test (DCT). ADT was performed by punching the sealers on a well of 4×6mm diameter on Muller Hinton agar plates. These plates were inoculated with standard suspension of E. faecalis and the zone of inhibition was measured at 24 hours and after 7 days. All the sealers were prepared in accordance with the manufacturer's recommendations. Flow of sealers was measured according to ADA specification no. 57.

RESULTS

All sealers showed antibacterial activity against E. faecalis except Gutta Flow 2. At 24 hours, zone of inhibition was highest in Calcibiotic Root Canal Sealer (CRCS) and lowest in AH Plus. After 7 days the zone of inhibition decreased in AH plus, CRCS and MTA Fillapex. DCT showed a significant lower number of organisms in AH Plus, CRCS and MTA than controls at both the time intervals. Gutta Flow 2 did not show any significant antimicrobial action. Maximum and minimum flow was shown by AH Plus and CRCS respectively.

CONCLUSION

Highest microbial inhibition was shown by (CRCS), followed by MTA Fillapex and AH Plus. Gutta Flow 2 did not show any inhibition of E. faecalis by ADT. Maximum reduction in antibacterial property with time against E. faecalis was seen with AH Plus. Maximum flow was shown by AH Plus and minimum by CRCS.

In vitro comparison of antibacterial properties of bioceramic-based sealer, resin-based sealer and zinc oxide eugenol based sealer and two mineral trioxide aggregates

Objective:

Our goal of the study was to evaluate the antibacterial properties of endodontic sealers against the E. faecalis.

Materials and Methods:

Six millimeters wells were made for each material in all the preinoculated petri plates. Then, the petri plates were incubated for 24 h. The zones of inhibition appeared were measured, and the measurements were put to statistical analysis.

Results:

EndoSequence BC Sealer, MM-mineral trioxide aggregate (MTA), and ProRoot MTA showed maximum means of diameter of zones of inhibition, whereas MM-seal and Endoseal did not show any zones of inhibition.

Conclusion:

EndoSequence BC Sealer was found to be a better endodontic sealer as compared to resin-based and zinc oxide-eugenol-based sealer.

Photodynamic Inactivation of Root Canal Bacteria by Light Activation through Human Dental Hard and Simulated Surrounding Tissue

Introduction: Photodynamic inactivation of bacteria (PIB) may be a supportive antimicrobial approach for use in endodontics, but sufficient activation of photosensitizers (PS) in root canals is a critical point. Therefore, aim of this study was to evaluate the ability of PS absorbing blue (TMPyP) or red light (Methylene Blue; MB) for light activation through human dental hard and simulated surrounding tissue to inactivate root canal bacteria.

Methods: A tooth model was fabricated with a human premolar and two molars in an acrylic resin bloc simulating the optical properties of a porcine jaw. The distal root canal of the first molar was enlarged to insert a glass tube (external diameter 2 mm) containing PS and stationary-phase Enterococcus faecalis. Both PS (10 μM) were irradiated for 120 s with BlueV (20 mW/cm²; λ_em = 400–460 nm) or PDT 1200L (37.8 mW/cm²; λ_em = 570–680 nm; both: Waldmann Medizintechnik), respectively. Irradiation parameters ensured identical numbers of photons absorbed by each PS. Three setups were chosen: irradiating the glass pipette only (G), the glass pipette inside the single tooth without (GT) and with (GTM) simulated surrounding tissues. Colony forming units (CFU) were evaluated. Transmission measurements of the buccal halves of hemisected mandibular first molars were performed by means of a photospectrometer.

Results: PIB with both PS led to reduction by ≥ 5 log₁₀ of E. faecalis CFU for each setup. From transmission measurements, a threshold wavelength λ_th for allowing an amount of light transmission for sufficient activation of PS was determined to be 430 nm.

Conclusion: This study can be seen as proof of principle that light activation of given intra-canal PS from outside a tooth may be possible at wavelengths ≥ 430 nm, facilitating clinical application of PIB in endodontics.

Comparison of the Antimicrobial Efficacy of Octenidine Dihydrochloride and Chlorhexidine with and Without Passive Ultrasonic Irrigation - An Invitro Study

INTRODUCTION

Elimination of microorganisms from infected root canals is a complicated task. Numerous measures have been described to reduce the microbial load in the root canal system, including the use of various instrumentation techniques, irrigation regimens and intracanal medicaments. The drawbacks of few commonly used irrigants include toxic and harmful side effects, microbial resistance to antimicrobial agents and staining. Hence there is a need for alternative agents which are nontoxic, effective and safe.

AIM

To compare and evaluate antimicrobial effects of 2% Chlorhexidine (CHX) versus 0.1% Octenidine Dihydrochloride (OCT) as root canal irrigant with and without passive ultrasonic irrigation against Enterococcus faecalis (E. faecalis) in vitro and to evaluate the depth of penetration of irrigant solution into the dentinal tubules at the junction of middle and apical third.

MATERIALS AND METHODS

Forty eight freshly extracted, single rooted human mandibular premolars were decoronated and root specimen standardized to 14mm. Biofilm of E. faecalis (strain ATCC 29212) was grown for seven days and the specimens were divided into four groups (n=12) based on irrigation protocol : Group I- Conventional Syringe Irrigation (CSI) with 2% CHX, Group II- CSI + 0.1% OCT, Group III-Passive Ultrasonic Irrigation (PUI) + 2% CHX and Group IV- PUI+ 0.1% OCT. Dentin shavings were collected at two depths (200μm and 400μm) and total number of colony forming units were determined. The data were statistically analyzed using ANOVA, Scheffes multiple comparison of means and paired t-test (p<0.05).

RESULTS

Group III and IV (PUI) showed significant difference compared to Group I and II (CSI) both at 200μm and 400μm (p=0.000). For Group III and Group IV no significant differences were found at 200μm and 400μm (p=1.000 and 0.363 respectively), however significant difference was found between data at 200μm and 400μm for all the four groups (p=0.000).

CONCLUSION

Octenidine (0.1%) was more effective than 2% Chlorhexidine against E. faecalis both at 200μm and 400μm. Passive ultrasonic irrigation proved to enhance the antimicrobial action of the irrigants.

Efficacy of 4 Irrigation Protocols in Killing Bacteria Colonized in Dentinal Tubules Examined by a Novel Confocal Laser Scanning Microscope Analysis

INTRODUCTION

The aim of this study was to determine the efficiency of 4 irrigation systems in eliminating bacteria in root canals, particularly in dentinal tubules.

METHODS

Roots of human teeth were prepared to 25/04, autoclaved, and inoculated with Enterococcus faecalis for 3 weeks. Canals were then disinfected by (1) standard needle irrigation, (2) sonically agitating with EndoActivator, (3) XP Endo finisher, or (4) erbium:yttrium aluminum garnet laser (PIPS) (15 roots/group). The bacterial reduction in the canal was determined by MTT assays. For measuring live versus dead bacteria in the dentinal tubules (4 teeth/group), teeth were split open and stained with LIVE/DEAD BackLight. Coronal, middle, and apical thirds of the canal dentin were scanned by using a confocal laser scanning microscope (CLSM) to determine the ratio of dead/total bacteria in the dentinal tubules at various depths.

RESULTS

All 4 irrigation protocols significantly eliminated bacteria in the canal, ranging from 89.6% to 98.2% reduction (P < .001). XP Endo had the greatest bacterial reduction compared with other 3 techniques (P < .05). CLSM analysis showed that XP Endo had the highest level of dead bacteria in the coronal, middle, and apical segments at 50-μm depth. On the other hand, PIPS had the greatest bacterial killing efficiency at the 150-μm depth in all 3 root segments.

CONCLUSIONS

XP Endo appears to be more efficient than other 3 techniques in disinfecting the main canal space and up to 50 μm deep into the dentinal tubules. PIPS appears to be most effective in killing the bacteria deep in the dentinal tubules.

Antibiofilm efficacy of photoactivated curcumin, triple and double antibiotic paste, 2% chlorhexidine and calcium hydroxide against Enterococcus fecalis in vitro

Root canal disinfection is one of the most important factors governing success of root canal treatment, especially when regenerative strategies are used. This study evaluated the efficacy of 5 intracanal medicaments against mature biofilms of Enterococcus fecalis in vitro: Light activated curcumin, triple antibiotic paste (TAP), double antibiotic paste (DAP), chlorhexidine, calcium hydroxide. Untreated teeth with biofilms served as controls. Confocal microscopy was used to analyse the biofilm mass and percentage of live/dead bacteria within the root canal as well as dentinal tubules. Dentinal shavings obtained from the root canal walls (at 200 and 400 microns depth) were used to quantify the colony forming units/mL. The results showed that light activated curcumin and triple antibiotic paste brought about complete disruption of the biofilm structure (P < 0.05) while chlorhexidine and calcium hydroxide were not significantly different from the control (P > 0.05). Light activated curcumin brought about the highest percentage of dead cells at both depths, but this was not significantly different from triple antibiotic paste (P > 0.05). Curcumin, TAP and DAP brought about a significant reduction of CFU/mL at both depths compared to the control and other groups (P < 0.05). Light activated curcumin brought about a 7 log reduction of bacteria at both depths.

Antibacterial effects of N-acetylcysteine against endodontic pathogens

The success of endodontic treatment depends on the eradication of microorganisms from the root canal system and the prevention of reinfection. The purpose of this investigation was to evaluate the antibacterial and antibiofilm efficacy of N-acetylcysteine (NAC), an antioxidant mucolytic agent, as an intracanal medicament against selected endodontic pathogens. Minimum inhibitory concentrations (MICs) of NAC for Actinomyces naeslundii, Lactobacillus salivarius, Streptococcus mutans, and Enterococcus faecalis were determined using the broth microdilution method. NAC showed antibacterial activity, with MIC values of 0.78-1.56 mg/ml. The effect of NAC on biofilm formation of each bacterium and a multispecies culture consisting of the four bacterial species was assessed by crystal violet staining. NAC significantly inhibited biofilm formation by all the monospecies and multispecies bacteria at minimum concentrations of 0.78-3.13 mg/ml. The efficacy of NAC for biofilm disruption was evaluated by scanning electron microscopy and ATP-bioluminescence quantification using mature multispecies biofilms. Preformed mature multispecies biofilms on saliva-coated hydroxyapatite disks were disrupted within 10 min by treatment with NAC at concentrations of 25 mg/ml or higher. After 24 h of treatment, the viability of mature biofilms was reduced by > 99% compared with the control. Moreover, the biofilm disrupting activity of NAC was significantly higher than that of saturated calcium hydroxide or 2% chlorhexidine solution. Within the limitations of this in vitro study, we conclude that NAC has excellent antibacterial and antibiofilm efficacy against endodontic pathogens and may be used as an alternative intracanal medicament in root canal therapies.

Effectiveness of N-acetyl cysteine, 2% chlorhexidine, and their combination as intracanal medicaments on Enterococcus faecalis biofilm

Aim:

The purpose of this study was to evaluate the antibacterial efficacies of 2% chlorhexidine (CHX), N-acetyl cysteine (NAC) and assess their synergistic or antagonist action as intracanal medicament.

Materials and Methods:

Agar diffusion test was performed with 2% CHX, NAC, and their combination against E. faecalis planktonic cells. The diameters of the zones of bacterial inhibition were measured and recorded for each solution. The assay was further extended to 2 weeks old E. faecalis dentinal biofilm. Sixteen freshly extracted teeth were vertically sectioned into two halves resulting in a total of 32 samples. The samples were inoculated with bacterial suspension and incubated at 37°C for 2 weeks for biofilm formation. The samples were then divided into four experimental groups with 8 samples in each group. The samples were gently washed in saline and placed in culture wells containing the test solutions, i.e., 2% CHX, NAC, a combination of 2% CHX and NAC in 1:1 ratio, and a control group containing saline. The biofilm formed on the root canal surface were removed with a sterile scalpel and inoculated on blood agar plates to check for the formation of E. faecalis colonies.

Statistical Analysis:

For agar diffusion test, data were analyzed statistically using one-way analysis of variance and then by post-hoc Scheffe's test to compare the antimicrobial efficacy between the groups. Statistical analysis was not done for the cultures obtained from the biofilm as there was no growth in all the three test groups except the control group, i.e., saline.

Results:

In agar diffusion test, among the three groups tested, 2% CHX and NAC showed almost equal zones of inhibition whereas maximum inhibition was shown by a combination of NAC and 2% CHX suggesting a synergistic action. The results obtained were highly significant (P < 0.001) for the combination of medicament when compared to individual test group. In culture analysis, which was done for the biofilm, no growth was observed in all the three test groups. The results obtained were biologically significant but statistically insignificant.

Conclusion:

NAC has almost equal antimicrobial property as 2% CHX whereas their combination showed a synergistic action.

Cysteamine Enhances Biofilm Eradication Efficacy of Calcium Hydroxide

INTRODUCTION

Calcium hydroxide (Ca[OH]2) is a widely used interappointment dressing, but its antibacterial property is compromised by dentin. Hence, the addition of chlorhexidine (CHX) with Ca(OH)2 has been proposed. However, the antimicrobial efficacy of this mixture compared with Ca(OH)2 alone is currently still debatable. Cysteamine is a mucolytic agent used to reduce the viscosity of mucus through the disruption of proteins, which are also important components of the extracellular matrix of biofilms. The aims of this study were to determine the efficacy of cysteamine alone and in combination with Ca(OH)2 to eradicate Enterococcus faecalis biofilm compared with CHX with Ca(OH)2, and to determine if this effect is affected by dentin.

METHODS

The biofilm eradication efficacies of Ca(OH)2 alone and with cysteamine were determined using 7-day E. faecalis biofilm cultured on dentin discs and compared with Ca(OH)2 with 2% CHX. The effects of dentin on the efficacies of Ca(OH)2 alone and with either cysteamine or CHX were examined.

RESULTS

Cysteamine alone completely abolished E. faecalis biofilm at 200 mg/mL. The combination of Ca(OH)2 with either cysteamine at 10 mg/mL or 2% CHX completely obliterated E. faecalis biofilm. Cysteamine with Ca(OH)2 completely eradicated E. faecalis biofilm despite preincubation with dentin, whereas CHX with Ca(OH)2 was less effective.

CONCLUSIONS

Cysteamine effectively eliminated E. faecalis biofilm and showed synergistic effects in combination with Ca(OH)2, which were unaffected by dentin. Hence, our findings support the use of cysteamine as a potential adjunct to Ca(OH)2 as an interappointment dressing.