Dentin tubule numerical density variations below the CEJ

Root Canal Dentin Microhardness after Contact with Antibiotic Medications: An In Vitro Study

Background: Antibiotic pastes used as intracanal medication in cases of revascularization therapy might cause negative effects on tooth properties, such as a reduction in dentin microhardness. This in vitro study investigated dentin microhardness in three different locations distancing from the canal lumen after 20 days of treatment with a tri-antibiotic paste (ciprofloxacin, metronidazole, and minocycline), and with a double-antibiotic paste (ciprofloxacin and metronidazole), with calcium hydroxide [Ca(OH)2] UltracalTM XS-treated dentin as comparison. Material and Methods: Human mandibular premolars (n = 48) had the root canals cleaned and shaped and were used to produce dentin slices. Dentin slices remained immersed in the medications for 20 days. The Knoop microhardness (KHN) test was performed before (baseline/Day-0) and after treatment (Day-20) with the medications. Indentations were made at 25 µm, 50 µm, and 100 µm distances from the root canal lumen. The KHN was compared intra-group using Wilcoxon's test. Independent groups were compared using Mann-Whitney's and Kruskal-Wallis' tests, at α = 5%. Results: The microhardness in all the tested groups was reduced at Day-20 in comparison with Day-0 (p < 0.001) (intra-group comparison/same distances). The Day-0 values were similar, and the Day-20 values were higher for the Ca(OH)2 group (p < 0.05) (comparison between groups/same distances). Conclusions: Calcium hydroxide for 20 days would be preferred rather than antibiotic pastes to minimize the expected reduction in dentin microhardness during regenerative procedures.

Effect of continuous chelation on the dentinal tubule penetration of a calcium silicate-based root canal sealer: a confocal laser microscopy study

BACKGROUND

This study aimed to evaluate the effect of various irrigation protocols on the penetration depth of a calcium silicate-based sealer into dentinal tubules using confocal laser scanning microscopy (CLSM).

METHODS

Twenty single-rooted mandibular premolars were endodontically prepared and divided into the following two groups according to the irrigation protocol used (n = 10): Group I: NaOCl + EDTA and Group II: continuous chelation (NaOCl/Dual Rinse). Obturation was performed with the warm vertical compaction technique using TotalFill HiFlow bioceramic sealer mixed with a fluorophore dye. Samples were observed using CLSM at 10× to measure the percentage of sealer penetration and its maximum depth into the dentinal tubules. Data were analysed using one-way ANOVA followed by Tukey's post-hoc test. The significance level was set at p < 0.05 within all tests.

RESULTS

Comparing the overall results of all sections tested, no statistically significant differences existed between the groups regarding the percentage of sealer penetration (p = 0.612) and maximum depth of penetration (p > 0.05).

CONCLUSIONS

With both types of irrigation used, dentinal tubule penetration was higher in the coronal section than in the apical section. Continuous chelation using NaOCl/Dual Rinse HEDP performed better in the coronal segments, while irrigation using NaOCl + EDTA promoted a higher percentage of sealer penetration in the apical segment.

Dental Age Estimation Using Multiphoton Microscopy: A Potential Tool for Forensic Science

Normal aging affects the different structures of teeth, in particular, the dentine. These changes are useful in forensic disciplines as a tool for age estimation. Although multiphoton (MP) microscopy has been used to explore dental pieces, a relationship between age and MP response of the human dentine has not been proposed yet. The relationship between MP signals and natural dentine aging is investigated herein. An index of age (INAG) combining two-photon excitation fluorescence (TPEF) and second harmonic generation (SHG) images has been used to quantify these changes. The results show that the INAG significantly decreases with age. Moreover, peritubular dentine size and collagen internal properties are also modified with age. This information confirms the usefulness of this technique in forensic age estimation after disasters (natural or manmade) with a lack of comprehensive fingerprint database. Courts and other government authorities might also benefit from this tool when the official age of individuals under special circumstances is required for legal or medical reasons.

Mobile Nanobots for Prevention of Root Canal Treatment Failure

Millions of root canal treatments fail worldwide due to remnant bacteria deep in the dentinal tubules located within the dentine tissue of human teeth. The complex and narrow geometry of the tubules renders current techniques relying on passive diffusion of antibacterial agents ineffective. Here, the potential of actively maneuvered nanobots is investigated to disinfect dentinal tubules, which can be incorporated during a standard root canal procedure. It is demonstrated that magnetically driven nanobots can reach the depths of the tubules not possible with current clinical practices. Subtle alterations of the magnetic drive allow both deep implantations of the nanobots isotopically distributed throughout the dentine and spatially controlled recovery from selected regions, further supported by numerical simulations. Finally, the integration of bactericidal therapeutic modality with the nanobots is demonstrated, thereby validating the tremendous potential of nanobots in dentistry and nanomedicine in general.

Black Drum Fish Teeth: Built for Crushing Mollusk Shells

With an exclusive diet of hard-shelled mollusks, the black drum fish (Pogonias cromis) exhibits one of the highest bite forces among extant animals. Here we present a systematic microstructural, chemical, crystallographic, and mechanical analysis of the black drum teeth to understand the structural basis for achieving the molluscivorous requirements. At the material level, the outermost enameloid shows higher modulus (E_r = 126.9 ± 16.3 GPa, H = 5.0 ± 1.4 GPa) than other reported fish teeth, which is attributed to the stiffening effect of Zn and F doping in apatite crystals and the preferential co-alignment of crystallographic c-axes and enameloid rods along the biting direction. The high fracture toughness (K_c = 1.12 MPa⋅m^1/2) of the outer enameloid also promotes local yielding instead of fracture during crushing contact with mollusk shells. At the individual-tooth scale, the molar-like teeth, high density of dentin tubules, enlarged pulp chamber, and specialized dentin-bone connection, all contribute to the functional requirements, including confinement of contact compressive stress in the stiff enameloid, enhanced energy absorption in the compliant dentin, and controlled failure of tooth-bone composite under excessive loads. These results show that the multi-scale structures of black drum teeth are adapted to feed on hard-shelled mollusks. STATEMENT OF SIGNIFICANCE: The black drum fish feeds on hard-shelled mollusks, which requires strong, tough, and wear-resistant teeth. This study presents a comprehensive multiscale material and mechanical analysis of the black drum teeth in achieving such remarkable biological function. At microscale, the fluoride- and zinc-doped apatite crystallites in the outer enameloid region are aligned perpendicular to the chewing surface, representing one of the stiffest biomineralized materials found in nature. In the inner enameloid region, the apatite crystals are arranged into intertwisted rods with crystallographic misorientation for increased crack resistance and toughness. At the macroscale, the molariform geometry, the two-layer design based on the outer enameloid and inner dentin, enlarged pulp chamber and the underlying strong bony toothplate work synergistically to contribute to the teeth's crushing resistance.

Evaluation of the Effect of Long-term Use of Three Intracanal Medicaments on the Radicular Dentin Microhardness and Fracture Resistance: An in vitro study

Objectives

The aim of this research was to evaluate the effect of long-term use of three intracanal medicaments on the radicular dentin microhardness and fracture resistance.

Material and methods

A chemomechanical preparation was done using the Protaper rotary instruments up to F3. The teeth were stored in an incubator at 37°C at 100% humidity and were categorized in three groups by random allocation, namely: Triple Antibiotic Paste (TAP), Calcium hydroxide paste (Apexcal) and Ledermix. Following medicament application, the access openings of all teeth were sealed with 4 mm thickness of cavit. The samples were stored for periods of 1 week, 1 month and 3months. Two dentin cylinders measuring 5mm and 3mm were obtained from each sample. The cervical third was used for fracture resistance and the middle third was used for micro hardness evaluation. The microhardness testing was done using a Knoop microhardness tester, and the fracture resistance testing was done using the universal testing machine.

Results

Calcium hydroxide showed maximally negative effect on the physical properties of radicular dentin compared to TAP (p= 0.0100 at one month and Ledermix (p=0.0001 at one month). With an increase in the application time, there was an increased deterioration in the physical properties of radicular dentin.

Conclusion

Long-term placement of calcium hydroxide, Triple Antibiotic Paste, and Ledermix (p= 0.0001at 3 months) significantly affects the microhardness and fracture resistance of radicular dentin.

A software approach for identifying the effect of dental caries on dentin-enamel junction

Dental decay is the most prevalent oral disease worldwide since more than 2.4 billion people suffer from caries of permanent teeth. Therefore, any details about its progression into the hard-dental tissues could contribute to unravelling the mechanisms underlying this process. We have analyzed dental tissue sections with and without caries in order to detect structure differences corelating them with clinical aspects observable from the tooth surface. Our working hypothesis was based on finding a link between the process of tertiary dentin laying (as a response to coronal caries) and the subsequent obliteration of dentin tubules. We have selected N=10 extracted teeth with/without coronal caries, resin-embedded and sectioned them. A specific software was used to digitally quantify the density of unobliterated dentin tubules reaching the dentin-enamel junction (DEJ), considering as positive threshold criteria the presence of the odontoblast process inside the analyzed tubule. This study showed the differences between the healthy and carious-affected hard-dental coronal tissues. More odontoblast processes reached the DEJ in unaffected teeth. Using specific software, we have quantified their density decrease near a lesion. We have studied the dynamics of the carious study and measured the consequent structural modifications of the dentin. In conclusion, there is a significant difference between the number of dentin tubules containing odontoblast processes that reach the DEJ in healthy∕altered tissues. The tooth reacts not only by production of tertiary dentin to protect the pulp chamber, but also by obliteration of dentin tubules, thus reducing the number of odontoblast processes reaching the DEJ. This pilot study could serve as the starting point in developing a dedicated software that could deliver a personalized pattern for decay progression by analyzing one single tooth and extrapolate the result to all the patient's remaining ones.

Evaluating the antibacterial effect of synthesized herbal toothpastes and their efficacy for dentine tubule occlusion: Scanning electron microscopy and energy-dispersive X-ray spectroscopy analysis

The tubule occlusion of two newly developed herbal toothpastes was examined. They were prepared based on the mixture of pomegranate peel and Equisetum arvense extracts with strontium acetate. The antimicrobial activity of pomegranate peel and E. arvense were determined using minimum inhibitory concentration (MIC). Then, 30 mid-coronal dentin discs from the human third molars were etched for 30 s with the lemon juice (pH = 2.4). The specimens divided into the three groups. While the control group had 6 specimens, Groups 1 and 2 were including 12 specimens. Group 1 brushed with toothpaste containing 10% strontium acetate and 5% hydroalcoholic extracts of pomegranate peel, and Group 2 brushed with 5% strontium acetate, 5% hydroalcoholic extracts of E. arvense, and 5% hydroalcoholic extracts of pomegranate peel. Brushing was simulated for 6 months with 2 N loading. Then, 50% of discs in each group were immersed in lemon juice for 1 min. Moreover, specimens in control group were brushed with distilled water. Finally, all 30 discs were analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDXS). The occluded dentin tubules were counted and statistically evaluated. It was found that the number of open dentin tubules decreases significantly after brushing with both tested toothpastes compared with control group (p < .001). Moreover, a significant difference was observed between two toothpastes before and after acid immersion process (p < .001). The SEM micrographs confirmed the dentin tubule occlusion of both herbal dentifrices. Besides, EDXS analysis approved the strontium and silica presence on the dentin tubules for the toothpaste which was based on E. arvense.

Copper-Calcium Hydroxide and Permanent Electrophoretic Current for Treatment of Apical Periodontitis

Endodontic failure has been and continues to be a problem for endodontics-specialists. Complicated anatomy, numerous foramens, and accessory canals are an environment for microorganisms to infect the teeth. The purpose of the present work was to evaluate the regeneration of copper–calcium hydroxide (Cupral)-endodontically treated teeth diagnosed with apical periodontitis using an electrophoresis technique. In total, 132 patients, aging from 19 to 65 years old, underwent endodontic treatment mono- and multi-radicular teeth, with complicated canals from January 2019 to June 2020. The patients were divided into two groups: (i) the control group—which included 54 patients (n = 62 teeth) receiving endodontic paste (Calcipast + 1) and, as final filling, the AH-Plus^TM cement—and (ii) the Cupral group, which included 78 patients (n = 80 teeth) receiving Cupral paste plus the electrophoretic current and, as final filling, the Atacamit-alkaline cement. The clinical cases were periodically observed along an 18-month follow-up period via radiography. Data were expressed as focal size of the lesions (mean ± standard error (SEM) of all the radiographic outcomes) observed in each group at each interval point. Statistical analysis was performed using the Student’s t-test that allowed us to compare the control and Cupral groups; the statistical significance was set at p < 0.05 and p < 0.01, where the latter was highly significant. Before treatments, the focal sizes were 4.8 mm and 4.95 mm for control and Cupral-treated groups, respectively. After 6 months, the mean focal sizes were 3.9 mm and 2.14 mm for the control and Cupral groups, respectively. After 12 months, in the control group, the mean focal size was measured at 2.8 mm, while, in Cupral group, the lesion size decreased down to 0.31 mm and a highly dynamic regeneration of the destructive focal-bone occurred. After 18 months, the lesions were further significantly reduced in the control group (mean values of 2.62 mm), while they were barely detectable in the Cupral group (0.2 mm). In conclusion, we provide initial evidence that the Cupral-electrophoresis methodology is effective in treating destructive periodontitis of teeth with problematic canals up to 18 months, thus allowing teeth preservation.

Egyptian Propolis-Loaded Nanoparticles as a Root Canal Nanosealer: Sealing Ability and in vivo Biocompatibility

Background

Successful endodontic therapy is mainly governed by the satisfactory sealing ability of the applied root canal sealer. Also, tolerability of root canal structure to accommodate the presence of a sealer participates in the efficiency of the treatment. Hence, this study was aimed to extrapolate our previous one that was concerned with the preparation and evaluation of novel nature-based root canal sealers. Our current work is focused on the evaluation of sealing ability and in vivo biocompatibility.

Materials and Methods

Egyptian propolis was extracted (ProE) and encapsulated in polymeric nanoparticles (ProE-loaded NPs). Two root sealers, PE sealer and PE nanosealer, were fabricated by incorporating ProE and ProE-loaded NPs, respectively. The sealing ability of the developed sealers was tested by a dye extraction method. An in vivo biocompatibility study was conducted using a subcutaneous implantation method for two and four weeks. At the same time, a model sealer (AH Plus®) was subjected to the same procedures to enable accurate and equitable results.

Results

The teeth treated with PE sealer exhibited weak sealing ability which did not differ from that of unfilled teeth. PE nanosealer enhanced the sealing ability similarly to the model sealer with minimal apical microleakage. Studying in vivo biocompatibility indicated the capability of the three tested sealers to induce cell proliferation and tissue healing. However, PE nanosealer had superior biocompatibility, with higher potential for cell regeneration and tissue proliferation.

Conclusion

PE nanosealer can be presented as an innovative root canal sealer, with enhanced sealing ability as well as in vivo biocompatibility. It can be applied as a substitute for the currently available sealers that demonstrate hazardous effects.

[Ways of solving the problem of dentin hypersensitivity in children after professional oral hygiene]

AIM

To design an algorithm of decreasing dentin hypersensitivity in children after professional oral hygiene.

METHODS AND MATERIALS

Intact teeth extracted for orthodontic reasons in children and adults were involved in the pilot study. The enamel surface was cleaned by manual instruments and then polished with polishing pastes containing sodium bicarbonate, fluoride, calcium and phosphates. The results were studied with the help of a scanning electronic microscope. 60 14-15 years schoolchildren, the residents of Krasnogorsk, a town in the Moscow region, took part in the study. All of them were diagnosed dental plaque (K03.6) and underwent professional oral hygiene by manual instruments. Then the teeth were polished with polishing toothpastes. To reduce dentin hypersensitivity after these procedures the SENSODYNE Rapid Relief toothpaste was applied.

RESULTS

The pilot study showed a destructive effect of a manual instrument on the tooth enamel especially in children. The data of the scanning electronic microscope demonstrated that the manual method with the use of polishing pastes containing sodium bicarbonate, fluoride, calcium and phosphates led to a significantly lower negative effect of this manual method on the tooth enamel both in children and adults. The application of SENSODYNE Rapid Relief by children at home after professional oral hygiene led to a decrease of dentin hypersensitivity by 65, 37%.

CONCLUSION

The designed algorithm of the children's follow-up procedures after professional oral hygiene includes the application of polishing pastes containing sodium bicarbonate, fluoride, calcium, phosphates and the Sensodyne Rapid Relief toothpaste at home. This helps to minimize negative consequences of manual tooth plaque removal in case of professional oral hygiene.

Design, Evaluation And Antimicrobial Activity Of Egyptian Propolis-Loaded Nanoparticles: Intrinsic Role As A Novel And Naturally Based Root Canal Nanosealer

BACKGROUND

Propolis is a unique natural adhesive product collected by honeybees. It contains a diversity of bioactive compounds with reported functional properties such as antioxidants, antibacterial, antifungal, anti-inflammatory, antiviral and anticancer activity. Dental caries is a worldwide problem that caused by microbial growth usually progress from tooth enamel to the underlying pulpal tissues and root canal. This situation could be controlled by a sequence of steps to remove microorganisms and fill root canal with a suitable long-lasting root canal sealer. Unfortunately, leachable and degradation products of the currently used sealers compromised their antimicrobial activity by inflammatory modulation associated with irritation and toxicity of periapical tissues.

MATERIALS AND METHODS

Hence, propolis was selected to be designed as a natural root canal sealer due to its amazing functional properties. Moreover, its handling properties were enhanced and potentiated by its incorporation in polymeric nanoparticles (NPs). Frist, propolis was collected, extracted and analyzed for its bioactive compounds. After that, propolis-loaded NPs of PLGA (ProE-loaded NPs) were developed and fully characterized regarding physicochemical properties, in vitro release and in vitro cytotoxicity. Then, root canal sealers were fabricated and assayed for their antimicrobial activity. Both cytotoxicity and antimicrobial activity were compared to those of a model sealer; AH Plus®.

RESULTS

The results revealed that spherical nanoscopic NPs with narrow size distribution were obtained. ProE-loaded NPs exhibited accepted entrapment efficiency (>80) and prolonged release. In vitro cytotoxicity study confirmed the safety of ProE-loaded NPs. Also, the developed sealers showed antimicrobial activity versus bacterial strains of Enterococcus faecalis and Streptococcus mutans and antifungal activity against Candida albicans.

CONCLUSION

ProE-loaded NPs could be incorporated in and represented as a root canal sealer with prolonged release and enhanced cytocompatibility as well as antimicrobial activities.

Novel Chlorhexidine-Loaded Polymeric Nanoparticles for Root Canal Treatment

Persistence of microorganisms in dentinal tubules after root canal chemo-mechanical preparation has been well documented. The complex anatomy of the root canal and dentinal buffering ability make delivery of antimicrobial agents difficult. This work explores the use of a novel trilayered nanoparticle (TNP) drug delivery system that encapsulates chlorhexidine digluconate, which is aimed at improving the disinfection of the root canal system. Chlorhexidine digluconate was encapsulated inside polymeric self-assembled TNPs. These were self-assembled through water-in-oil emulsion from poly(ethylene glycol)-b-poly(lactic acid) (PEG-b-PLA), a di-block copolymer, with one hydrophilic segment and another hydrophobic. The resulting TNPs were physicochemically characterized and their antimicrobial effectiveness was evaluated against Enterococcus faecalis using a broth inhibition method. The hydrophilic interior of the TNPs successfully entrapped chlorhexidine digluconate. The resulting TNPs had particle size ranging from 140–295 nm, with adequate encapsulation efficiency, and maintained inhibition of bacteria over 21 days. The delivery of antibacterial irrigants throughout the dentinal matrix by employing the TNP system described in this work may be an effective alternative to improve root canal disinfection.

Structure, property, and function of sheepshead (Archosargus probatocephalus) teeth

OBJECTIVES

This paper studies A. probatocephalus teeth and investigates the mechanical properties and chemical composition of the enameloid and dentin.

DESIGN

Nanoindentation tests with a max load of 1000 μN and X-ray Energy Dispersive Spectroscopy (EDS) were performed along the diameter of the polished sample. Microstructural analysis of the dentin tubules was performed from SEM images.

RESULTS

From nanoindentation testing, the dentin of the sheepshead teeth has a nanoindentation hardness of 0.89 ± 0.21 (mean ± S.D.) GPa and a reduced Young's modulus of 23.29 ± 5.30 GPa. The enameloid of A. probatocephalus has a hardness of 4.36 ± 0.44 GPa and a mean reduced Young's modulus of 98.14 ± 6.91 GPa. Additionally, nanoindentation tests showed that the enameloid's hardness and modulus increased closer to the surface of the tooth. X-ray Energy Dispersive Spectroscopy (EDS) data further suggests that the gradient may be a result of the wt% fluoride within the enameloid, where an increase in fluoride results in an increase in reduced Young's modulus and hardness.

CONCLUSION

The microstructural characterization of the number density and area of the dentin tubules were used to address the porosity effect in the dentin to achieve the experimentally validated microhardness. The mechanical properties of the sheepshead teeth were also compared with previous nanoindentation tests from other aquatic species. The sheepshead teeth exhibit a greater reduced Young's modulus and hardness compared to shark and piranha teeth.

Decreased dentin tubules density and reduced thickness of peritubular dentin in hyperbilirubinemia-related green teeth

Background

It is stated anecdotally that patients with liver diseases in childhood who develop green teeth have increased risk for rampant caries, which may be secondary to changes in dental structure. The aim of this study was to test the hypothesis that hyperbilirubinemia affects the dentin morphology of green teeth.

Material and Methods

Sixteen primary teeth were prepared and divided into two groups (green teeth, n = 8 and control, n = 8), which were transversely fractured across the cervical third of the dental crowns; dentin was prepared and sputter-coated with gold, and examined under a scanning electron microscope. The mean density and mean diameter of dentin tubules, as well as the thickness of peritubular dentin, were compared.

Results

Hyperbilirubinemia was associated with a decrease in the density of the dentin tubules (p< .01) and the thickness of peritubular dentin of green teeth (p< .01).

Conclusions

There was a correlation between childhood hyperbilirubinemia and changes in the dentin morphology, including a decrease in the density of the dentin tubules and a reduction in the thickness of peritubular dentin in green teeth.

Key words:Hyperbilirubinemia, liver disease, childhood, dentin tubules, human teeth, scanning electron microscopy.