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Wikström A, Romani Vestman N, Rakhimova O, Lazaro Gimeno D, Tsilingaridis G, Brundin M. Microbiological assessment of success and failure in pulp revitalization: a randomized clinical trial using calcium hydroxide and chlorhexidine gluconate in traumatized immature necrotic teeth. J Oral Microbiol 2024; 16:2343518. [PMID: 38665416 PMCID: PMC11044761 DOI: 10.1080/20002297.2024.2343518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Aim To compare differences in the disinfection efficacy of calcium hydroxide (CH) and chlorhexidine gluconate (CHD) dressings in pulp revitalization (PR) of traumatized immature necrotic teeth; to investigate the microflora in successful/failed PR and whether bacterial persistence influences the outcomes of PR. Methods Microbiological assessment of the average bacterial load (CFU/sample) and bacterial diversity (taxa/sample) was performed on 41 teeth at three timepoints (S2-before, S3-after debridement and S5- after root canal dressing). Results The primary microflora was more diverse in successful cases than in failed. Decreases in CFU/sample and taxa/sample occurred S2 - S3, though new increases occurred at S5 in the CHD subgroup (successful and failed) and CFU/sample in the CH subgroup (failed). At S5, the successful cases showed more bacterial decreases. No specific species was associated with the outcomes with no statistical differences between the disinfection efficacy. Conclusions There were no statistical differences in CH and CHD efficacy. At S5, microflora persisted in both successful and failed outcomes, but the abundance and diversity increased significantly only in the failed cases. The successful outcomes presented higher diversity and higher decreases of the primary microflora at S5 than the failed outcomes. The abundance and diversity increased significantly at S5 only in failed cases.
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Affiliation(s)
- Alina Wikström
- Division of Orthodontics and Paediatric Dentistry, Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Endodontics, Public Dental Health Services, Eastmaninstitutet, Stockholm, Sweden
- Centre of Paediatric Oral Health, Huddinge, Sweden
| | - Nelly Romani Vestman
- Department of Odontology, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | | | - David Lazaro Gimeno
- Department of Plant Physiology, Umeå Plant Science Centre, Umeå University, Umeå, Sweden
| | - Georgios Tsilingaridis
- Division of Orthodontics and Paediatric Dentistry, Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
- Centre of Paediatric Oral Health, Huddinge, Sweden
| | - Malin Brundin
- Department of Odontology, Umeå University, Umeå, Sweden
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Keles A, Askerbeyli Ors S, Purali N, Kucukkaya Eren S. Effect of different sealer activation techniques on dentinal tubule penetration. AUST ENDOD J 2023; 49:470-475. [PMID: 36723389 DOI: 10.1111/aej.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 02/02/2023]
Abstract
The aim of this study was to evaluate the influence of different activation techniques on dentin tubule penetration of root canal sealer. Seventy-five teeth with single canals were chemomechanically prepared. A calcium silicate-based sealer was stained with a fluorescent dye (rhodamine B), placed into the canals and activated according to the following groups: control (no activation), EDDY, EndoActivator, ultrasonic and XP-Endo Finisher. Then, the samples were obturated. The percentages of sealer penetration at various depth levels of root sections were measured with confocal laser scanning microscopy. XP-Endo Finisher presented the highest penetration at 50 μm (p < 0.05). XP-Endo Finisher showed similar penetration with EDDY at 100 and 200 μm (p > 0.05) while presented higher penetration than the other groups (p < 0.05). At 500 μm, XP-Endo Finisher presented higher penetration than EndoActivator (p < 0.05) while similar penetration with the other groups (p > 0.05). XP-Endo Finisher can be recommended for activation during sealer placement for better penetration into dentin tubules.
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Affiliation(s)
- Ahmet Keles
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Sevinc Askerbeyli Ors
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Nuhan Purali
- Departmant of Biophysics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selen Kucukkaya Eren
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Isil T, Ozlem K, Defne BH, Eray GM, Abdurrahim K. Toxicity evaluation of indocyanine green mediated photodynamic therapy. Photodiagnosis Photodyn Ther 2023; 44:103754. [PMID: 37595656 DOI: 10.1016/j.pdpdt.2023.103754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND The aim of the study is to determine the cytotoxic, genotoxic and inflammatory effects of indocyanine green (ICG) mediated photodynamic therapy (PDT) in direct contact with L-929 mouse fibroblast cells and over a dentin barrier. METHODS Eight groups were evaluated; control (C), group with a dentin barrier (D), ICG applied directly on the cells (ICG), ICG applied over a dentin barrier (D-ICG), only laser applied (L), laser applied over a dentin barrier (D-L), ICG and laser applied directly on the cells (ICG-L), ICG and laser applied over a dentin barrier (D-ICG-L). Cell viability was evaluated via ATP Assay, DNA damage was evaluated via Comet Assay, and inflammatory markers IL-1β and TNF-α were assessed via ELISA test. RESULTS Cell viability decreased in group ICG (p<0.001). Cell viability decrease was higher in Group ICG-L (p<0.001). Cell viability decrease was lower in group D-ICG-L (p>0.05). Group L caused an increase in cell number (p<0.001). DNA damage was observed in ICG, D-ICG, and ICG-L groups (p<0.05). None of the groups displayed an increase of inflammatory markers IL-1β and TNF-α (p>0.05). CONCLUSIONS The presence of dentin between ICG and cells acted as a barrier and protected the cells. ICG-mediated PDT did not cause any cytotoxic, genotoxic or inflammatory effect. The use of ICG-mediated PDT for cavity disinfection is acceptable, but at this concentration its use in periodontal pocket disinfection is not recommended due to its cytotoxic and genotoxic properties.
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Affiliation(s)
- Turp Isil
- BezmialemVakif University, Faculty of Dentistry, Department of Prosthodontics, Istanbul, Turkey
| | - Kara Ozlem
- BezmialemVakif University, Faculty of Dentistry, Department of Prosthodontics, Istanbul, Turkey.
| | | | - Guler Metin Eray
- University of Health Sciences Turkey, Hamidiye School of Medicine, Department of Medical Biochemistry, Istanbul, Turkey; University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Haydarpasa Numune Health Application and Research Center, Department of Medical Biochemistry, Istanbul, Turkey
| | - Kocyigit Abdurrahim
- BezmialemVakif University, Faculty of Medicine, Department of Medical Biochemistry, Istanbul, Turkey
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Wen C, Zuo W, Luo W, He F. Effectiveness of three auxiliary irrigation methods for cleaning the internal walls of root canals of curved isolated teeth. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2023; 41:554-562. [PMID: 37805679 PMCID: PMC10580228 DOI: 10.7518/hxkq.2023.2023062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/26/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES This study aimed to compare the effectiveness of ultrasound and acoustic and laser cleaning of curved root canals. METHODS A total of 92 molars with independent root canals with a curvature of 20°-40° were prepared and standardized at 04 25# and stained with gentian violet solution for 72 h. Among them, 52 were randomly divi-ded into four groups for final rinsing (n=13): NI group, PUI group, EDDY group, and PIPS group. Ten samples in each group were cut horizontally along the long axis perpendicular to the root and divided into curved upper, curved, and apical segments. Images were taken with a stereomicroscope and Image J measurements were taken to calculate the depth of rinse penetration. The remaining three samples from each group were split along the long axis of the dentin, photographed by scanning electron microscope to record the dentin tubule exposure and staining layer, and scored for staining layer by double-blind method. SPSS 26.0 software was used to perform statistical analysis and select the best flushing method. An extra 40 samples were randomly divided into four groups for detection of flushing fluid penetration depth (n=10): 10, 20, 30, and 40 s. RESULTS In the upper part, the mean depth of infiltration was not significantly different between the experimental and control groups (P>0.05). The PIPS group had a significantly lower smear layer score than the control group and the EDDY group (P<0.01). In the curved segment, the mean depth of infiltration was significantly greater in the PUI group than in the control group (P<0.05); the tarnish layer score was lower in each experimental group than in the control group. At the top, the mean depth of infiltration was greater in the PUI and PIPS groups than in the control group (P<0.05), and the smear layer score was lower in the PIPS group than in the other groups (P<0.05). After the time was changed, the depth of infiltration of PUI increased only in the apical segment as the flushing time increased. CONCLUSIONS The PUI and PIPS methods facilitate the penetration of irrigation solution into the dentin canal in curved root canals, especially in the apical segment. The PIPS technique is effective in removing the smear layer in curved root canals.
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Affiliation(s)
- Chaoying Wen
- School of Stomatology, Jinan University, Guangzhou 510632, China
- Dept. of Stomatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, China
| | - Wenxin Zuo
- Dept. of Stomatology, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
| | - Wen Luo
- School of Stomatology, Jinan University, Guangzhou 510632, China
- Dept. of Stomatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, China
| | - Fei He
- Dept. of Stomatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, China
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Hahn CL, Sherman J, Hanford K. Ageing-related effects of dye penetration in the apical 5 mm mesiobuccal and mesial roots of molars. AUST ENDOD J 2023; 49:272-278. [PMID: 35980749 DOI: 10.1111/aej.12677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 12/01/2022]
Abstract
This study examined how the tubular permeability in the apical 5 mm of mesial roots was affected by age, direction, distance from root apex, canal shape and canal number. Twenty mesiobuccal/mesial roots of maxillary/mandibular molars from three age groups (<30, 30-60, >60 years) were prepared. Maximal dye penetration in buccal, lingual, mesial and distal directions was measured at 1-mm segment depth and analysed statistically. The <30 years group, when comparing to the >60 years group, had significantly deeper dye penetration in buccal and lingual directions. The permeability in proximal directions was not affected by either age or canal number. In the >60 years group, neither direction, segment depth nor canal number significantly impacted the permeability. However, these parameters significantly impacted samples younger than 60 years. Effective removal of infected root canal dentine would depend on age and its related preferred direction, distance from root apex and canal number.
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Affiliation(s)
- Chin-Lo Hahn
- Department of Surgical Specialties, College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska, USA
| | - Jordan Sherman
- Department of Surgical Specialties, College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska, USA
| | - Kathryn Hanford
- Department of Statistics, University of Nebraska - Lincoln, Lincoln, Nebraska, USA
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de Oliveira RA, Weissheimer T, Só GB, da Rosa RA, Souza MA, Ribeiro RG, Só MVR. Dentinal tubule penetration of sodium hypochlorite in root canals with and without mechanical preparation and different irrigant activation methods. Restor Dent Endod 2023; 48:e1. [PMID: 36875814 PMCID: PMC9982243 DOI: 10.5395/rde.2023.48.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives This study evaluated the dentinal penetration depth of 2.5% sodium hypochlorite (NaOCl) in root canals with and without preparation and different irrigant activation protocols. Materials and Methods Sixty-three bovine mandibular incisors were randomly allocated to 6 groups (n = 10): G1, preparation + conventional needle irrigation (CNI); G2, preparation + passive ultrasonic irrigation (PUI); G3, preparation + Odous Clean (OC); G4, no preparation + CNI; G5, no preparation + PUI; G6, no preparation + OC; and CG (negative control; n = 3). Samples were filled with crystal violet for 72 hours. Irrigant activation was performed. Samples were sectioned perpendicularly along the long axis, 3 mm and 7 mm from the apex. Images of the root thirds of each block were captured with a stereomicroscope and analyzed with an image analysis software. One-way analysis of variance, followed by the Tukey post hoc test, and the Student's t-test were used for data analysis, with a significance level of 5%. Results The NaOCl penetration depth was similar when preparation was performed, regardless of the method of irrigation activation (p > 0.05). In the groups without preparation, G6 showed greater NaOCl penetration depth (p < 0.05). The groups without preparation had a greater NaOCl penetration depth than those with preparation (p = 0.0019). Conclusions The NaOCl penetration depth was similar in groups with root canal preparation. Without root canal preparation, OC allowed deeper NaOCl penetration. The groups without preparation had greater NaOCl penetration than those undergoing root canal preparation.
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Affiliation(s)
- Renata Aqel de Oliveira
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Theodoro Weissheimer
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Gabriel Barcelos Só
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Abreu da Rosa
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Matheus Albino Souza
- Department of Endodontics, School of Dentistry, University of Passo Fundo (UPF), Passo Fundo, RS, Brazil
| | - Rodrigo Gonçalves Ribeiro
- Department of Endodontics, School of Dentistry, State University of Western Paraná (UNIOESTE), Cascavel, PR, Brazil
| | - Marcus Vinicius Reis Só
- Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Widbiller M, Rosendahl A, Schlichting R, Schuller C, Lingl B, Hiller KA, Buchalla W, Galler KM. Impact of Endodontic Irrigant Activation on Smear Layer Removal and Surface Disintegration of Root Canal Dentine In Vitro. Healthcare (Basel) 2023; 11:healthcare11030376. [PMID: 36766951 PMCID: PMC9914448 DOI: 10.3390/healthcare11030376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
The objective of this study was to compare the ability of different endodontic irrigation activation methods to enable irrigant penetration, remove the smear layer from root canal walls after preparation, and investigate surface effects on dentine. Root canals of 90 single-rooted teeth were prepared and irrigated with EDTA (17%) and sodium hypochlorite (5%), where both irrigants or sodium hypochlorite only were activated as follows: conventional needle irrigation, ultrasonic activation, sonic activation (EDDY), or laser-based activation (photon-induced photoacoustic streaming/PIPS). For the evaluation of irrigant penetration into dentinal tubules, methylene blue was injected and activated as well. Subsequently, teeth were sectioned horizontally, and dye penetration depths were measured. Alternating sections were split in halves and randomly selected for scanning electron microscopic analysis. Root canal dentine was assessed for smear layer removal and surface disintegration according to a defined scoring system. The data were analyzed statistically with nonparametric and chi-squared tests for whole teeth and separately for coronal, middle, and apical thirds. All the tested activation methods removed a thicker smear layer than needle irrigation only. Additional activation of EDTA improved penetration depths of the irrigants, but not the smear layer removal. Surface disintegration of root canal dentine was observed with the additional activation of EDTA and particularly after laser-based techniques. Additional activation of EDTA does not seem to offer any convincing advantages in terms of irrigant penetration or smear layer removal but disrupts the dentine surface. Especially laser-based activation resulted in undesirable destruction of root canal wall dentine.
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Affiliation(s)
- Matthias Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence:
| | - Andreas Rosendahl
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | | | - Christine Schuller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Benedikt Lingl
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Karl-Anton Hiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Wolfgang Buchalla
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Kerstin M. Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nuernberg, 91054 Erlangen, Germany
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Guo X, Sun Y, Wang Z, Ren B, Xu HHK, Peng X, Li M, Wang S, Wang H, Wu Y, Weir MD, Zhou X, Lan F, Cheng L. The Preventive Effect of A Magnetic Nanoparticle-Modified Root Canal Sealer on Persistent Apical Periodontitis. Int J Mol Sci 2022; 23:13137. [PMID: 36361925 PMCID: PMC9655100 DOI: 10.3390/ijms232113137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 08/23/2023] Open
Abstract
Persistent apical periodontitis is a critical challenge for endodontists. Developing root canal filling materials with continuous antibacterial effects and tightly sealed root canals are essential strategies to avoid the failure of root canal therapy and prevent persistent apical periodontitis. We modified the EndoREZ root canal sealer with the antibacterial material dimethylaminododecyl methacrylate (DMADDM) and magnetic nanoparticles (MNPs). The mechanical properties of the modified root canal sealer were tested. The biocompatibility of this sealer was verified in vitro and in vivo. Multispecies biofilms were constructed to assess the antibacterial effects of the modified root canal sealer. We applied magnetic fields and examined the extent of root canal sealer penetration in vitro and in vivo. The results showed that EndoREZ sealer containing 2.5% DMADDM and 1% MNP had biological safety and apical sealing ability. In addition, the modified sealer could increase the sealer penetration range and exert significant antibacterial effects on multispecies biofilms under an external magnetic field. According to the in vivo study, the apices of the root canals with the sealer containing 2.5% DMADDM and 1% MNP showed no significant resorption and exhibited only a slight increase in the periodontal ligament space, with a good inhibitory effect on persistent apical periodontitis.
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Affiliation(s)
- Xiao Guo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yan Sun
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Zheng Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Biao Ren
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Hockin H. K. Xu
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA
| | - Xian Peng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Mingyun Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Suping Wang
- Stomatology Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Haohao Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yao Wu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Michael D. Weir
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Fang Lan
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Shirur KS, Padya BS, Pandey A, Hegde MM, Narayan AI, Rao BSS, Bhat VG, Mutalik S. Development of Lipidic Nanoplatform for Intra-Oral Delivery of Chlorhexidine: Characterization, Biocompatibility, and Assessment of Depth of Penetration in Extracted Human Teeth. NANOMATERIALS (BASEL, SWITZERLAND) 2022; 12:3372. [PMID: 36234500 PMCID: PMC9565570 DOI: 10.3390/nano12193372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
Microorganisms are the major cause for the failure of root canal treatment, due to the penetration ability within the root anatomy. However, irrigation regimens have at times failed due to the biofilm mode of bacterial growth. Liposomes are vesicular structures of the phospholipids which might help in better penetration efficiency into dentinal tubules and in increasing the antibacterial efficacy. Methods: In the present work, chlorhexidine liposomes were formulated. Liposomal chlorhexidine was characterized by size, zeta potential, and cryo-electron microscope (Cryo-EM). Twenty-one single-rooted premolars were extracted and irrigated with liposomal chlorhexidine and 2% chlorhexidine solution to evaluate the depth of penetration. In vitro cytotoxicity study was performed for liposomal chlorhexidine on the L929 mouse fibroblast cell line. Results: The average particle size of liposomes ranged from 48 ± 4.52 nm to 223 ± 3.63 nm with a polydispersity index value of <0.4. Cryo-EM microscopic images showed spherical vesicular structures. Depth of penetration of liposomal chlorhexidine was higher in the coronal, middle, and apical thirds of roots compared with plain chlorhexidine in human extracted teeth when observed under the confocal laser scanning microscope. The pure drug exhibited a cytotoxic concentration at which 50% of the cells are dead after a drug exposure (IC50) value of 12.32 ± 3.65 µg/mL and 29.04 ± 2.14 µg/mL (on L929 and 3T3 cells, respectively) and liposomal chlorhexidine exhibited an IC50 value of 37.9 ± 1.05 µg/mL and 85.24 ± 3.22 µg/mL (on L929 and 3T3 cells, respectively). Discussion: Antimicrobial analysis showed a decrease in colony counts of bacteria when treated with liposomal chlorhexidine compared with 2% chlorhexidine solution. Nano-liposomal novel chlorhexidine was less cytotoxic when treated on mouse fibroblast L929 cells and more effective as an antimicrobial agent along with higher penetration ability.
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Affiliation(s)
- Krishnaraj Somyaji Shirur
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka State, India
| | - Bharath Singh Padya
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka State, India
| | - Abhijeet Pandey
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka State, India
| | - Manasa Manjunath Hegde
- Department of Radiation Biology & Toxicology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka State, India
| | - Aparna I. Narayan
- Department of Prosthodontics and Crown and Bridge, Manipal College of Dental Sciences Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka State, India
| | - Bola Sadashiva Satish Rao
- Department of Radiation Biology & Toxicology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka State, India
| | - Varadaraj G. Bhat
- Department of Pharmaceutical Chemistry, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka State, India
| | - Srinivas Mutalik
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka State, India
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Fouad A, Diogenes A, Torabinejad M, Hargreaves K. Microbiome Changes During Regenerative Endodontic Treatment Using Different Methods of Disinfection. J Endod 2022; 48:1273-1284. [PMID: 36030971 DOI: 10.1016/j.joen.2022.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The purpose of this study was to characterize qualitatively and quantitatively the changes in the endodontic microbiome, in teeth with necrotic pulp, open apexes and apical periodontitis, with three antimicrobial protocols, undertaken in a multicenter clinical trial. METHODS Microbiological samples were collected from 116 RET teeth, and 97 qualified for inclusion. The teeth were randomly divided into three treatment groups: apexification (APEX), regeneration (REGEN) and revascularization (REVASC), all in two appointments. The group variables in the first appointment irrigants, and second appointment irrigants and medicaments were as follows: APEX: 5.25-6% NaOCl, 5.25-6% NaOCl + 17% EDTA and calcium hydroxide; REGEN: 1.25% NaOCl, 17% EDTA and 0.1 mg/mL triple antibiotic paste (TAP); and REVASC 5.25% NaOCl, saline and 1g/mL TAP, respectively. Sampling was done upon access (S0), after irrigation in the first appointment (S1), and after using medication and irrigation in the second appointment (S2). RESULTS Quantitative PCR analysis of the 16S rRNA gene showed significant reduction in bacterial load from S0 to S2 in all groups; however, the APEX and REVASC groups had significantly less residual DNA than the REGEN group (p=0.0045). The relative abundance of Bacteroidetes, Fusobacteria, Spirochaetes and Synergistetes were reduced with the treatment rendered. However, relative abundance of Firmicutes and Actinobacteria was not changed, and that of Proteobacteria increased. LEfSe analysis showed that reduction in bacterial taxa was more in REVASC than APEX which in turn was more than in REGEN. CONCLUSION Enhanced antimicrobial protocols lead to better reduction in quantitative and qualitative parameters of the endodontic microflora.
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Affiliation(s)
- Ashraf Fouad
- Department of Endodontics, School of Dentistry, University of Alabama at Birmingham
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health San Antonio Dentistry, University of Texas Health San Antonio
| | - Mahmoud Torabinejad
- Department of Endodontics, Loma Linda University School of Dentistry, Loma Linda University
| | - Ken Hargreaves
- Department of Endodontics, University of Texas Health San Antonio Dentistry, University of Texas Health San Antonio
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11
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Alfirdous RA, Alquiria TA, Jacinto RC, Martinho FC. A modified dentin infection model with Fluorescent Lipopolysaccharide and
LPS
sampling technique to compare
XP‐Endo
finisher and passive ultrasonic irrigation. Int Endod J 2022; 55:1081-1090. [DOI: 10.1111/iej.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- R. A. Alfirdous
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics University of Maryland School of Dentistry Baltimore Maryland USA
- Prince Abdulrahman Advanced Dental Institute Riyadh Kingdom of Saudi Arabia
| | - T. A. Alquiria
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics University of Maryland School of Dentistry Baltimore Maryland USA
- Prince Abdulrahman Advanced Dental Institute Riyadh Kingdom of Saudi Arabia
| | - R. C. Jacinto
- Division of Endodontics, Department of preventive and restorative dentistry School of Dentistry, Aracatuba São Paulo SP Brazil
| | - F. C. Martinho
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics University of Maryland School of Dentistry Baltimore Maryland USA
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12
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Boutsioukis C, Arias-Moliz MT, Chávez de Paz LE. A critical analysis of research methods and experimental models to study irrigants and irrigation systems. Int Endod J 2022; 55 Suppl 2:295-329. [PMID: 35171506 PMCID: PMC9314845 DOI: 10.1111/iej.13710] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
Irrigation plays an essential role in root canal treatment. The purpose of this narrative review was to critically appraise the experimental methods and models used to study irrigants and irrigation systems and to provide directions for future research. Studies on the antimicrobial effect of irrigants should use mature multispecies biofilms grown on dentine or inside root canals and should combine at least two complementary evaluation methods. Dissolution of pulp tissue remnants should be examined in the presence of dentine and, preferably, inside human root canals. Micro-omputed tomography is currently the method of choice for the assessment of accumulated dentine debris and their removal. A combination of experiments in transparent root canals and numerical modeling is needed to address irrigant penetration. Finally, models to evaluate irrigant extrusion through the apical foramen should simulate the periapical tissues and provide quantitative data on the amount of extruded irrigant. Mimicking the in vivo conditions as close as possible and standardization of the specimens and experimental protocols are universal requirements irrespective of the surrogate endpoint studied. Obsolete and unrealistic models must be abandoned in favour of more appropriate and valid ones that have more direct application and translation to clinical Endodontics.
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Affiliation(s)
- C Boutsioukis
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M T Arias-Moliz
- Department of Microbiology, Faculty of Dentistry, University of Granada, Granada, Spain
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13
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Hegde M, Thirunarayanan S. Value addition property of a cationic surfactant on endodontic irrigant: A confocal laser scanning microscope study. J Conserv Dent 2022; 25:380-384. [PMID: 36187855 PMCID: PMC9520653 DOI: 10.4103/jcd.jcd_135_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Chlorhexidine (CHX) is a commonly used root canal irrigant with high surface tension which prevents its penetration into the isthmus and fins of the root canal. Surfactants have known to reduce the surface tension of the liquid. Cetylpyridinium chloride (CPC) is a cationic surfactant. The aim of this study is to assess the contact angle formed and depth of penetration of the endodontic irrigant with and without the addition of surfactant. Methods: Contact angle analysis – Ninety-nine freshly extracted and cleaned single-rooted mandibular premolars were obtained. Thirty-three teeth were sectioned longitudinally and then transversely. The sections were mounted on an acrylic block, polished to obtain a flat dentin surface. Five microliter of Group 1: 2% CHX as control, Group 2: 2% CHX + 0.1% CPC, and Group 3: 2% CHX + 0.2% CPC were placed on the dentin surface and subjected to contact angle analysis. Depth of penetration – Access cavity was prepared in sixty-six teeth and instrumented to working length till Protaper Gold F2. The samples were assigned to Groups 1, 2, and 3 and irrigated accordingly, and subjected to a confocal laser scanning Microscopy. Data were analyzed using one-way ANOVA and Tukey multiple comparison test. Karl Pearson's correlation test was performed to analyze the correlation between the two. Results: Group 3 had the lowest contact angle (12.82°) and the highest depth of penetration (222.74 μm) when compared to Group 1 and Group 2. Karl Pearson's correlation showed no correlation between the contact angle and the depth of penetration. Conclusion: Higher the concentration of CPC, lower is the contact angle formed with the dentin and higher is the depth of penetration into the dentinal tubule.
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14
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Ballikaya E, Koc N, Avcu N, Cehreli ZC. The quality of root canal treatment and periapical status of permanent teeth in Turkish children and teens: a retrospective CBCT study. Oral Radiol 2021; 38:405-415. [PMID: 34714509 DOI: 10.1007/s11282-021-00570-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/16/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to assess the quality of root canal fillings and the prevalence of periapical radiolucencies in the permanent teeth of 6-18 year-old Turkish children. METHODS CBCT images of 150 patients' 235 teeth with a mean age of 16.0 ± 2.06 years were included. Root development stage, quality of root canal filling, the presence and severity of periapical radiolucencies, and their relationship with anatomical structures were recorded. Correlations between the quality of root canal filling, periapical lesion, and lesion size were assessed using regression analyses. RESULTS A total of 235 teeth (528 root canals) were evaluated. 65.5% of root canals had periapical lesions. Immature roots and mandibular teeth had the highest prevalence and the largest size of periapical radiolucencies (p < 0.05). Overfilling (n = 52), underfilling (n = 93), unfilled (n = 46), inhomogeneously filled (n = 113) root canals and poor coronal restoration (n = 85 teeth) were observed in terms of technical failures of endodontic treatment. The quality of endodontic treatment was associated with the presence of periapical lesion and lesion size (p < 0.05). Teeth with under-filled, overfilled or inhomogeneously filled root canals and poor coronal restoration had a periapical lesion larger than 5 mm (p < 0.05). Immature teeth were most associated with the presence of lesion (OR = 4.07) and the lesion size > 5 mm (OR = 3.71). CONCLUSION The prevalence of periapical radiolucencies in young permanent teeth showed an increase when the tooth was an incisor, had incomplete root development, or the root filling had technical errors.
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Affiliation(s)
- Elif Ballikaya
- Faculty of Dentistry, Department of Pediatric Dentistry, Hacettepe University, Sıhhıye, 06100, Ankara, Turkey.
| | - Nagihan Koc
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Hacettepe University, Sıhhıye, 06100, Ankara, Turkey
| | - Nihal Avcu
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Hacettepe University, Sıhhıye, 06100, Ankara, Turkey
| | - Zafer Cavit Cehreli
- Faculty of Dentistry, Department of Pediatric Dentistry, Hacettepe University, Sıhhıye, 06100, Ankara, Turkey
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15
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Kitagawa H, Kitagawa R, Tsuboi R, Hirose N, Thongthai P, Sakai H, Ueda M, Ono S, Sasaki JI, Ooya T, Imazato S. Development of endodontic sealers containing antimicrobial-loaded polymer particles with long-term antibacterial effects. Dent Mater 2021; 37:1248-1259. [PMID: 33972098 DOI: 10.1016/j.dental.2021.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/02/2021] [Accepted: 04/24/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this study is to prepare new dental resins with a long-lasting antimicrobial activity. Specifically, this study evaluates an approach for controlling infection in root canals using sealers containing polyhydroxyethyl methacrylate trimethylolpropane trimethacrylate (polyHEMA/TMPT) particles loaded with cetylpyridinium chloride (CPC). In addition, the physical properties of sealers containing CPC-loaded polyHEMA/TMPT particles (CLP) are determined. METHODS PolyHEMA/TMPT particles with 10 (10%-CLP) and 25wt.% CPC (25%-CLP) with different particle sizes were fabricated and incorporated in HEMA-based sealers. CPC-release profiles were evaluated over 14 days of immersion in water, followed by 14 days of storage and 14 days of water immersion. The antibacterial activity of these sealers against Enterococcus faecalis in dentinal tubules was assessed using a root-canal-infection model. Their sealing abilities were evaluated by fluid filtration and physical properties were tested according to the ISO 6876 standard. The long-term antibacterial activity of the cured sealer containing 25%-CLP (∼21μm particle diameter) was re-assessed after 1 year of storage. RESULTS After 28 days of immersion, 25%-CLP exhibited a higher and sustained CPC release unlike 10%-CLP. Residual bacteria in root dentinal tubules were eradicated by obturation with 25%-CLP-containing sealers. The incorporation of 25%-CLP (∼21μm) had no adverse effects on the sealing ability and physical properties of the sealer and resulted in long-term antibacterial activity. SIGNIFICANCE The incorporation of CPC-loaded particles in HEMA resins yielded endodontic sealers with long-term bactericidal activity against E. faecalis in root canals. These sealers can potentially be used to prevent recurrent apical periodontitis.
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Affiliation(s)
- Haruaki Kitagawa
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Ranna Kitagawa
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Ririko Tsuboi
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Nanako Hirose
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Pasiree Thongthai
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hirohiko Sakai
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Mayuka Ueda
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shunka Ono
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Jun-Ichi Sasaki
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Tooru Ooya
- Graduate School of Engineering, Kobe University, 1-1 Rokkoudai, Nada, Kobe, Hyogo 657-8501, Japan
| | - Satoshi Imazato
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
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16
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Characterization of Histopathology and Microbiota in Contemporary Regenerative Endodontic Procedures: Still Coming up Short. J Endod 2021; 47:1285-1293.e1. [DOI: 10.1016/j.joen.2021.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 12/25/2022]
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17
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Hahn CL, Hanford K. An In Vitro Model to Study the Colonization and Tubular Invasion of Enterococcus faecalis. J Endod 2021; 47:451-457. [PMID: 33359252 DOI: 10.1016/j.joen.2020.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The purpose of this study was to examine the colonization and tubular invasion of Enterococcus faecalis in minimally altered canal walls. We hypothesized that age, axial directions (buccolingual or mesiodistal), regions (apical, midroot, or cervical), and disinfection treatment (sodium hypochlorite or autoclave) would impact bacterial colonization and invasion patterns. METHODS Single roots of extracted teeth from 2 age groups (≤30 years old and ≥60 years old) were challenged with bacteria for 2 weeks. Colonization on the canal walls in 3 regions was evaluated with scanning electron microscopy. The prevalence of tubular invasion in the axial directions in 3 regions was examined with confocal laser scanning microscopy. The data were analyzed using the GLIMMIX procedure in SAS software (SAS Institute Inc, Cary, NC) with a Tukey adjustment for comparisons. RESULTS Bacteria successfully colonized and invaded tubules in 2 weeks. The apical region in the ≥60-year age group was the least infected. A significantly higher invasion prevalence in a buccolingual (B/L) than a mesiodistal (M/D) direction was detected in both age groups and in all 3 regions. The ≤30-year age group had a significantly higher prevalence of tubular invasion than the ≥60-year age group in the B/L and M/D direction, respectively. Sodium hypochlorite treatment significantly impacted bacterial colonization and invasion in more calcified areas. CONCLUSIONS Our data support a more conservative enlargement of the apical region of older teeth. An emphasis in a B/L direction rather than an M/D direction is recommended for debridement.
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Affiliation(s)
- Chin-Lo Hahn
- Department of Surgical Specialties, College of Dentistry, University of Nebraska Medical Center, Lincoln, Nebraska.
| | - Kathryn Hanford
- Department of Statistics, University of Nebraska-Lincoln, Lincoln, Nebraska
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18
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Küçük F, Yıldırım S, Çetiner S. Cytotoxicity assessment of different doses of ozonated water on dental pulp cells. BMC Oral Health 2021; 21:32. [PMID: 33468083 PMCID: PMC7816490 DOI: 10.1186/s12903-021-01392-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/10/2021] [Indexed: 12/25/2022] Open
Abstract
Background The purpose of this study was to assess the cytotoxicity of various concentrations of ozonated water (OW) on human primary dental pulp cells. Methods Human primary dental pulp cells were isolated from exfoliated primary canine teeth of an 11-year-old patient with good systemic and oral health. Afterwards, cells were divided into 6 experimental groups; four groups of OW in concentrations of 2 mg/L, 4 mg/L, 8 mg/L, and 16 mg/L, untreated control group, and cell culture without cells. Cytotoxicity was evaluated after exposure for 5-min exposure using Mosmann’s Tetrazolium Toxicity (MTT) assay at 0 h and 48 h time points. Data were analyzed using a repeated measures analysis of variance and Post-hoc tests were performed using Bonferroni correction for multiple comparisons. Results All experimental groups showed proliferation at 0 h time point. However, all groups also experienced a decrease in overtime at 48 h time point (p < 0.05). At both time points 2 mg/L OW showed the highest cell viability as well as proliferation. At 0 h time point, the increase in cell viability for all experimental groups was found statistically significant when compared to positive control group (p < 0.05). At 48 h time point, although 8 mg/L and 16 mg/L OW showed statistically significant reduction in compare to 0 h time point, 2 mg/L and 4 mg/L OW groups didn’t experience any statistically significant difference (p < 0.05). Conclusion Considering our findings, due to ozonated water's induced a higher proliferation rate of dental pulp cells, indicating their biocompatibility and a possible adjuvant on irrigating agent in regenerative endodontic procedures.
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Affiliation(s)
- Ferdiye Küçük
- Department of Pediatric Dentistry, Faculty of Dentistry, Near East University, Nicosia, Mersin 10, Turkey.
| | - Sibel Yıldırım
- Department of Pediatric Dentistry, Faculty of Dentistry, Selçuk University, Konya, Turkey
| | - Serap Çetiner
- Department of Pediatric Dentistry, Faculty of Dentistry, University of Kyrenia, Kyrenia, Mersin 10, Turkey
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19
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What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis? Eur Arch Paediatr Dent 2021; 22:311-340. [PMID: 33420674 PMCID: PMC8213569 DOI: 10.1007/s40368-020-00575-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/17/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate and assess the current knowledge about apexification and regenerative techniques as a meaningful treatment modality and to map the scientific evidence for the efficacy of both methods for the management of traumatised immature teeth with pulp necrosis and apical periodontitis. METHODS This systematic review searched five databases: PubMed, Web of Science, Cochrane Library, Ovid (Medline), and Embase. Published articles written in English were considered for inclusion. The following keywords were used: Regenerative endodontic treatment OR regenerat* OR revital* OR endodontic regeneration OR regenerative endodontics OR pulp revascularization OR revasculari* OR 'traumatized immature teeth'. Only peer-reviewed studies with a study size of at least 20 cases followed up for 24 months were included. Eligibility assessment was performed independently in a blinded manner by three reviewers and disagreements were resolved by consensus. Subgroup analyses were performed on three clinical outcomes: survival, success, and continued root development. RESULTS Seven full texts out of 1359 citations were included and conventional content analysis was performed. Most of the identified citations were case reports and case series. CONCLUSIONS In the present systematic review, the qualitative analysis revealed that both regenerative and apexification techniques had equal rates of success and survival and proved to be effective in the treatment of immature necrotic permanent teeth. Endodontic regenerative techniques appear to be superior to apexification techniques in terms of stimulation of root maturation, i.e. root wall thickening and root lengthening. Knowledge gaps were identified regarding the treatment and follow-up protocols for both techniques.
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20
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Zhang L, Li Y, Zhang Q, Du N, Li X, Zhang Q, Yuan L, Dong F, Jiang Y, Tang J, Wang Y. Antimicrobial Activity of an Implantable Wireless Blue Light-Emitting Diode Against Root Canal Biofilm In Vitro. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:694-702. [PMID: 33103954 DOI: 10.1089/photob.2020.4821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: We developed an implantable wireless blue micro light-emitting diode (micro-LED) device and evaluated the utility of continuous antimicrobial blue light (aBL) irradiation emitted from this micro-LED for root canal disinfection. Methods: An implantable wireless blue micro-LED device (peak wavelength: 410 nm, maximum power: 15 mW) was developed to be placed in the root canal. Optical transmission of the device in human dentin tissue was simulated using Monte Carlo ray-tracing method. The bactericidal effect of low-level aBL on planktonic root canal infection-related bacteria [Enterococcus faecalis, methicillin-resistant Streptococcus aureus (MRSA), and Prevotella intermedia] was evaluated by colony counting. The biocompatibility of continuous low-level aBL exposure was evaluated by infrared thermal imaging and cell viability tests. Thirty extracted intact human single-rooted teeth were prepared and the root canals were infected with E. faecalis for 14 days to form biofilm. The infected root canals were randomly divided into three groups (n = 10), and treated with normal saline (group NS), calcium hydroxide (group CH), and micro-LED device (group aBL) for 3 and 7 days. The bactericidal effect of each group was evaluated by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Results: Monte Carlo simulation showed that blue light irradiation of the micro-LED device decreased exponentially with the light transmission distance through human dentin tissue. Planktonic E. faecalis, MRSA, and P. intermedia were significantly eliminated after irradiation with 432, 36, and 1.35 J/cm2 aBL, respectively (p < 0.05). Infrared thermal imaging and cell viability tests showed that continuous aBL exposure is biocompatible in vitro. CLSM and SEM analyses revealed that the micro-LED device had a greater antimicrobial effect than CH on E. faecalis biofilm in the root canal. Conclusions: The wireless blue micro-LED device is a promising and user-friendly approach for root canal disinfection that will facilitate infection control in the root canal using aBL.
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Affiliation(s)
- Ludan Zhang
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, China.,Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.,NHC Key Laboratory of Digital Technology of Stomatology, Peking University, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China
| | - Yamin Li
- State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Qian Zhang
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ning Du
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xuefen Li
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qianyi Zhang
- School of Materials Science and Engineering, Tsinghua University, Beijing, China
| | - Lintian Yuan
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, China.,Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.,NHC Key Laboratory of Digital Technology of Stomatology, Peking University, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China
| | - Fan Dong
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, China.,Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.,NHC Key Laboratory of Digital Technology of Stomatology, Peking University, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China
| | - Yuxi Jiang
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, China.,Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.,NHC Key Laboratory of Digital Technology of Stomatology, Peking University, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China
| | - Jun Tang
- State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yuguang Wang
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, China.,Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.,NHC Key Laboratory of Digital Technology of Stomatology, Peking University, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Peking University, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China
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21
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Fouad AF. Contemporary Microbial and Antimicrobial Considerations in Regenerative Endodontic Therapy. J Endod 2020; 46:S105-S114. [DOI: 10.1016/j.joen.2020.06.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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22
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Abdel Raheem IA, Abdul Razek A, Elgendy AA, Labah DA, Saleh NM. Egyptian Propolis-Loaded Nanoparticles as a Root Canal Nanosealer: Sealing Ability and in vivo Biocompatibility. Int J Nanomedicine 2020; 15:5265-5277. [PMID: 32884255 PMCID: PMC7434463 DOI: 10.2147/ijn.s258888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/08/2020] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
| | - Amro Abdul Razek
- Endodontics Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | | | - Doaa Ahmed Labah
- Oral Biology and Dental Medicine Department, Faculty of Dentistry, Zagazig University, Zagazig, Egypt
| | - Noha Mohamed Saleh
- Pharmaceutics Department, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
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23
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Balhaddad AA, Garcia IM, Ibrahim MS, Rolim JPML, Gomes EAB, Martinho FC, Collares FM, Xu H, Melo MAS. Prospects on Nano-Based Platforms for Antimicrobial Photodynamic Therapy Against Oral Biofilms. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:481-496. [PMID: 32716697 DOI: 10.1089/photob.2020.4815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: This review clusters the growing field of nano-based platforms for antimicrobial photodynamic therapy (aPDT) targeting pathogenic oral biofilms and increase interactions between dental researchers and investigators in many related fields. Background data: Clinically relevant disinfection of dental tissues is difficult to achieve with aPDT alone. It has been found that limited penetrability into soft and hard dental tissues, diffusion of the photosensitizers, and the small light absorption coefficient are contributing factors. As a result, the effectiveness of aPDT is reduced in vivo applications. To overcome limitations, nanotechnology has been implied to enhance the penetration and delivery of photosensitizers to target microorganisms and increase the bactericidal effect. Materials and methods: The current literature was screened for the various platforms composed of photosensitizers functionalized with nanoparticles and their enhanced performance against oral pathogenic biofilms. Results: The evidence-based findings from the up-to-date literature were promising to control the onset and the progression of dental biofilm-triggered diseases such as dental caries, endodontic infections, and periodontal diseases. The antimicrobial effects of aPDT with nano-based platforms on oral bacterial disinfection will help to advance the design of combination strategies that increase the rate of complete and durable clinical response in oral infections. Conclusions: There is enthusiasm about the potential of nano-based platforms to treat currently out of the reach pathogenic oral biofilms. Much of the potential exists because these nano-based platforms use unique mechanisms of action that allow us to overcome the challenging of intra-oral and hard-tissue disinfection.
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Affiliation(s)
- Abdulrahman A Balhaddad
- PhD Program in Dental Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA.,Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Isadora M Garcia
- PhD Program in Dental Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA.,Dental Materials Laboratory, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Salem Ibrahim
- PhD Program in Dental Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA.,Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Juliana P M L Rolim
- Department of Dentistry, Christus University Center (Unichristus), Fortaleza, Brazil
| | - Edison A B Gomes
- Department of Dentistry, Christus University Center (Unichristus), Fortaleza, Brazil
| | - Frederico C Martinho
- Endodontic Division, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Fabricio M Collares
- Dental Materials Laboratory, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Hockin Xu
- PhD Program in Dental Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA.,Biomaterials & Tissue Engineering Division, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Mary Anne S Melo
- PhD Program in Dental Biomedical Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA.,Division of Operative Dentistry, Department of General Dentistry, University of Maryland School of Dentistry, Baltimore, Maryland, USA
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24
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Dezhurko-Korol VA, Novozhilova NE, Makeeva IM, Arkhipova AY, Moisenovich MM, Akhmadishina LV, Lukashev AN, Semenov AM, Leontieva MR, Byakova SF. The influence of centrifugation and inoculation time on the number, distribution, and viability of intratubular bacteria and surface biofilm in deciduous and permanent bovine dentin. Arch Oral Biol 2020; 114:104716. [PMID: 32325265 DOI: 10.1016/j.archoralbio.2020.104716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 11/27/2022]
Abstract
The present study aimed to assess the influence of centrifugation and inoculation time on the number, distribution, and viability of intratubular bacteria and surface monospecies E. faecalis biofilm. MATERIALS AND METHODS Forty-four semicylindrical specimens cut from primary (n = 22) and permanent (n = 22) bovine teeth were randomly assigned to the experimental groups. Teeth of each type were inoculated with E. faecalis with and without centrifugation for 1 and 14 days. The number, localization, viability of bacteria and depth of their penetration were assessed with bacterial culturing of dentin shavings, scanning electron microscopy (SEM) and confocal laser electron microscopy (CLSM). Three-way ANOVA with post-hoc Tukey test were used to assess the influence of different experimental setups on dentin infection. RESULTS Severe dentin infection was observed in permanent and deciduous teeth after centrifugation and 1-day incubation: bacteria reached the full length of dentinal tubules and colony-forming units were too numerous to count. The volume of green fluorescence didn't differ significantly in permanent teeth compared with deciduous (p = 1.0). After 1-day stationary inoculation, small number of cultivable bacteria and few viable bacteria in dentinal tubules were found in both groups. After 14-day stationary inoculation, the dentin infection according to CLSM was deeper in deciduous teeth compared with permanent (p = 0.006 and p = 0.019 for centrifugation and stationary inoculation, respectively). CONCLUSION The most even and dense dentin infection was observed in primary and permanent bovine teeth after centrifugation and 1-day inoculation, and in deciduous teeth after 14-day stationary inoculation.
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Affiliation(s)
- Viktoria A Dezhurko-Korol
- Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Mojaiskii val str., 11, 121059б, Moscow, Russia
| | - Nina E Novozhilova
- Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Mojaiskii val str., 11, 121059б, Moscow, Russia.
| | - Irina M Makeeva
- Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Mojaiskii val str., 11, 121059б, Moscow, Russia
| | - Anastasia Yu Arkhipova
- Department of Biology, Lomonosov Moscow State University, Leninskie Gory, 1-12, 119991, Moscow, Russia
| | - Mihail M Moisenovich
- Department of Biology, Lomonosov Moscow State University, Leninskie Gory, 1-12, 119991, Moscow, Russia
| | - Ludmila V Akhmadishina
- E.I. Martsinovsky Institute of Medical Parasitology and Tropical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), M. Pirogovskaya str., 20-1, 119435, Moscow, Russia
| | - Alexander N Lukashev
- E.I. Martsinovsky Institute of Medical Parasitology and Tropical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), M. Pirogovskaya str., 20-1, 119435, Moscow, Russia
| | - Alexander M Semenov
- Department of Biology, Lomonosov Moscow State University, Leninskie Gory, 1-12, 119991, Moscow, Russia
| | - Maria R Leontieva
- Department of Biology, Lomonosov Moscow State University, Leninskie Gory, 1-12, 119991, Moscow, Russia
| | - Svetlana F Byakova
- Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Mojaiskii val str., 11, 121059б, Moscow, Russia
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25
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Eggmann F, Vokac Y, Eick S, Neuhaus KW. Sonic irrigant activation for root canal disinfection: power modes matter! BMC Oral Health 2020; 20:102. [PMID: 32276625 PMCID: PMC7147034 DOI: 10.1186/s12903-020-01088-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/25/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sonic irrigant activation has gained widespread popularity among general dentists and endodontists alike in recent years. This in vitro study aimed to evaluate the impact of three power modes of a sonic activation device (EDDY) on its antimicrobial effectiveness in infected root canals. METHODS The root canals of straight, human roots (n = 120) were prepared to size 40/.06. In a short-term infection experiment, the root canals were inoculated with different microbial species for three days. The following irrigation protocols, using 4 ml of normal saline as irrigant, were performed: negative control, manual rinsing, sonic irrigant activation at power modes "low", "medium" and "high". In a second, long-term experiment, testing the same irrigation protocols, inoculation lasted 21 days and sodium hypochlorite was used as irrigant. Sequential infection control samples were assessed using culture assays. The statistical analysis included one-way analysis of variance of log10-scaled counts of colony-forming units (CFU) with post-hoc comparisons using Bonferroni corrections and Chi2 tests (α = 0.05). RESULTS In the short-term experiment, the sonic irrigation protocols decreased the number of CFUs by 1.88 log10 units compared with the negative control (p < 0.001). The power modes "medium" and "high" achieved the most effective reduction of the microbial load. In the long-term experiment, microbial regrowth occurred after 7 days unless the device was used at its highest power setting. CONCLUSIONS The power modes of the sonic irrigation device have a significant impact on the effectiveness for endodontic disinfection. The sonic irrigation device should always be used at the highest power setting in order to maximize its antimicrobial effectiveness.
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Affiliation(s)
- Florin Eggmann
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, UZB, University of Basel, Mattenstrasse 40, CH-4056, Basel, Switzerland.
| | | | - Sigrun Eick
- Laboratory of Oral Microbiology, Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Klaus W Neuhaus
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, UZB, University of Basel, Mattenstrasse 40, CH-4056, Basel, Switzerland.,Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
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26
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Virdee SS, Farnell DJJ, Silva MA, Camilleri J, Cooper PR, Tomson PL. The influence of irrigant activation, concentration and contact time on sodium hypochlorite penetration into root dentine: an
ex vivo
experiment. Int Endod J 2020; 53:986-997. [DOI: 10.1111/iej.13290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/09/2020] [Indexed: 12/29/2022]
Affiliation(s)
- S. S. Virdee
- Department of Restorative Dentistry School of Dentistry & Birmingham Dental Hospital University of Birmingham Birmingham UK
| | | | - M. A. Silva
- Histology School of Dentistry Federal University of Campina Grande Patos Brazil
| | - J. Camilleri
- Department of Restorative Dentistry School of Dentistry & Birmingham Dental Hospital University of Birmingham Birmingham UK
| | - P. R. Cooper
- Department of Oral Sciences Faculty of Dentistry University of Otago Otago New Zealand
| | - P. L. Tomson
- Department of Restorative Dentistry School of Dentistry & Birmingham Dental Hospital University of Birmingham Birmingham UK
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27
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Solomonov M, Kim HC, Hadad A, Levy DH, Ben Itzhak J, Levinson O, Azizi H. Age-dependent root canal instrumentation techniques: a comprehensive narrative review. Restor Dent Endod 2020; 45:e21. [PMID: 32483538 PMCID: PMC7239687 DOI: 10.5395/rde.2020.45.e21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 11/11/2022] Open
Abstract
The aim of this article was to review age-dependent clinical recommendations for appropriate root canal instrumentation techniques. A comprehensive narrative review of canal morphology, the structural characteristics of dentin, and endodontic outcomes at different ages was undertaken instead of a systematic review. An electronic literature search was carried out, including the Medline (Ovid), PubMed, and Web of Science databases. The searches used controlled vocabulary and free-text terms, as follows: 'age-related root canal treatment,' 'age-related instrumentation,' 'age-related chemo-mechanical preparation,' 'age-related endodontic clinical recommendations,' 'root canal instrumentation at different ages,' 'geriatric root canal treatment,' and 'pediatric root canal treatment.' Due to the lack of literature with practical age-based clinical recommendations for an appropriate root canal instrumentation technique, a narrative review was conducted to suggest a clinical algorithm for choosing the most appropriate instrumentation technique during root canal treatment. Based on the evidence found through the narrative review, an age-related clinical algorithm for choosing appropriate instrumentation during root canal treatment was proposed. Age affects the morphology of the root canal system and the structural characteristics of dentin. The clinician's awareness of root canal morphology and dentin characteristics can influence the choice of instruments for root canal treatment.
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Affiliation(s)
- Michael Solomonov
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Yangsan, Korea
| | - Avi Hadad
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Dan Henry Levy
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | - Joe Ben Itzhak
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
| | | | - Hadas Azizi
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Israel
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28
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Baras BH, Melo MAS, Thumbigere-Math V, Tay FR, Fouad AF, Oates TW, Weir MD, Cheng L, Xu HHK. Novel Bioactive and Therapeutic Root Canal Sealers with Antibacterial and Remineralization Properties. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E1096. [PMID: 32121595 PMCID: PMC7084849 DOI: 10.3390/ma13051096] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023]
Abstract
According to the American Dental Association Survey of Dental Services Rendered (published in 2007), 15 million root canal treatment procedures are performed annually. Endodontic therapy relies mainly on biomechanical preparation, chemical irrigation and intracanal medicaments which play an important role in eliminating bacteria in the root canal. Furthermore, adequate obturation is essential to confine any residual bacteria within the root canal and deprive them of nutrients. However, numerous studies have shown that complete elimination of bacteria is not achieved due to the complex anatomy of the root canal system. There are several conventional antibiotic materials available in the market for endodontic use. However, the majority of these antibiotics and antiseptics provide short-term antibacterial effects, and they impose a risk of developing antibacterial resistance. The root canal is a dynamic environment, and antibacterial and antibiofilm materials with long-term effects and nonspecific mechanisms of action are highly desirable in such environments. In addition, the application of acidic solutions to the root canal wall can alter the dentin structure, resulting in a weaker and more brittle dentin. Root canal sealers with bioactive properties come in direct contact with the dentin wall and can play a positive role in bacterial elimination and strengthening of the root structure. The new generation of nanostructured, bioactive, antibacterial and remineralizing additives into polymeric resin-based root canal sealers are discussed in this review. The effects of these novel bioactive additives on the physical and sealing properties, as well as their biocompatibility, are all important factors that are presented in this article.
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Affiliation(s)
- Bashayer H. Baras
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; (B.H.B.); (V.T.-M.); (T.W.O.)
- Department of Restorative Dental Science, College of Dentistry, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mary Anne S. Melo
- Division of Operative Dentistry, Department of General Dentistry, University of Maryland School of Dentistry, Baltimore, MD 21201, USA;
| | - Vivek Thumbigere-Math
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; (B.H.B.); (V.T.-M.); (T.W.O.)
| | - Franklin R. Tay
- Department of Endodontics, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA;
| | - Ashraf F. Fouad
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC 27599-7450, USA;
| | - Thomas W. Oates
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; (B.H.B.); (V.T.-M.); (T.W.O.)
| | - Michael D. Weir
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; (B.H.B.); (V.T.-M.); (T.W.O.)
| | - Lei Cheng
- Department of Operative Dentistry and Endodontics, West China School of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610000, China
| | - Hockin H. K. Xu
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; (B.H.B.); (V.T.-M.); (T.W.O.)
- Center for Stem Cell Biology & Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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30
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Fouad AF. Microbiological aspects of traumatic injuries. Dent Traumatol 2019; 35:324-332. [PMID: 31125490 DOI: 10.1111/edt.12494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022]
Abstract
After traumatic injuries to teeth, microorganisms may invade the compromised pulp tissue and initiate pulp infection and periapical inflammation. In addition to bone resorption that typically accompanies pulp necrosis, root resorption frequently occurs. Root resorption has several variants that may occur shortly after the trauma or at a later stage. The pathological changes seen after traumatic injuries to teeth are invariably linked to the presence of microbial irritants. The presence of bacterial biofilms in the dental pulp space can be treated with regenerative or therapeutic endodontic procedures. However, necrosis of periodontal ligament is usually terminal for the tooth involved. In this review, the sources of bacteria after traumatic injuries are discussed. The types and role of microorganisms involved in the pathogenesis of endodontic pathosis after traumatic injuries are presented, and contemporary approaches for the management of these conditions are reviewed. Contemporary antimicrobial strategies are discussed. The rationale for the use of systemic and topical antimicrobials is presented. Finally, novel approaches to the use of antimicrobial therapies, particularly in regenerative procedures, are reviewed.
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Affiliation(s)
- Ashraf F Fouad
- Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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31
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Chaniotis A, Petridis X. Cervical Level Biological Repair of the Access Opening after Regenerative Endodontic Procedures: Three Cases with the Same Repair Pattern. J Endod 2019; 45:1219-1227. [DOI: 10.1016/j.joen.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/23/2019] [Accepted: 07/01/2019] [Indexed: 12/25/2022]
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32
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Digka A, Sakka D, Lyroudia K. Histological assessment of human regenerative endodontic procedures (
REP
) of immature permanent teeth with necrotic pulp/apical periodontitis: A systematic review. AUST ENDOD J 2019; 46:140-153. [DOI: 10.1111/aej.12371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Anna Digka
- Department of Endodontology School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece
| | - Dimitra Sakka
- Department of Endodontology School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece
| | - Kleoniki Lyroudia
- Department of Endodontology School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece
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33
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El-Tayeb MM, Abu-Seida AM, El Ashry SH, El-Hady SA. Evaluation of antibacterial activity of propolis on regenerative potential of necrotic immature permanent teeth in dogs. BMC Oral Health 2019; 19:174. [PMID: 31387578 PMCID: PMC6685241 DOI: 10.1186/s12903-019-0835-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 06/27/2019] [Indexed: 02/08/2023] Open
Abstract
Background This study evaluated the antibacterial efficiency and ability of propolis to promote regeneration of immature permanent non-vital dogs’ teeth. Methods Ninety six immature permanent premolars teeth in 6 mongrel dogs were divided randomly into: experimental teeth (N = 72) and control teeth (N = 24). Periapical pathosis was induced in all experimental and positive control teeth. Experimental teeth were classified according to the used intra-canal medication into: group I (N = 36), propolis paste was used and group II (N = 36), triple antibiotic paste (TAP) was used. Bacteriologic samplings were collected before and after exposure to intra-canal medicaments. After the disinfection period (3 weeks), revascularization was induced in all experimental teeth. Each group was subdivided according to the root canal orifice plug into: subgroup A (N = 18), propolis paste was used and subgroup B (N = 18), mineral trioxide aggregates (MTA) was used. Each subgroup was further subdivided according to the evaluation period into 3 subdivisions (6 teeth each): subdivision 1; after 2 weeks, subdivision 2; after one month and subdivision 3; after 2 months. Positive control group had 12 teeth with induced untreated periapical pathosis. Negative control group had 12 untouched sound teeth. All teeth were evaluated with radiography and histology. The bacteriologic and radiographic data were analyzed using repeated measures ANOVA and post-hoc Tukey tests. The histologic data were analyzed using Kruskal-Wallis test, Mann-Whitney U test with Bonferroni’s adjustment and Chi-square test. The significance level was set at P ≤ .05. Results There was no significant difference in the antibacterial effectiveness between TAP and propolis groups (P > .05). In all subdivisions, there was no significant difference between the experimental groups in terms of increase in root length and dentin thickness, decrease in apical closure, new hard tissue formation, vital tissue formation inside the pulp canal and apical closure scores (P > .05). Conclusion Propolis can be comparable with TAP as a disinfection treatment option in regenerative endodontic. As a root canal orifice plug after revascularization of necrotic immature permanent teeth in dogs, propolis induces a progressive increase in root length and dentin thickness and a decrease in apical diameter similar to those of MTA.
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Affiliation(s)
- M M El-Tayeb
- Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - A M Abu-Seida
- Department of Surgery, Anesthesiology & Radiology, Faculty of Veterinary Medicine, Cairo University, Giza Square, Giza, PO: 12211, Egypt.
| | - S H El Ashry
- Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - S A El-Hady
- Department of Microbiology & Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Ultrasonic Irrigant Activation during Root Canal Treatment: A Systematic Review. J Endod 2019; 45:31-44.e13. [PMID: 30558797 DOI: 10.1016/j.joen.2018.09.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/05/2018] [Accepted: 09/16/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aim of this study was to systematically review the evidence on the cleaning and disinfection of root canals and the healing of apical periodontitis when ultrasonic irrigant activation is applied during primary root canal treatment of mature permanent teeth compared with syringe irrigation. METHODS An electronic search was conducted of the Cochrane Library, Embase, LILACS, PubMed, SciELO, and Scopus databases using both free-text key words and controlled vocabulary. Additional studies were sought through hand searching of endodontic journals and textbooks. The retrieved studies were screened by 2 reviewers according to predefined criteria. The included studies were critically appraised, and the extracted data were arranged in tables. RESULTS The electronic and hand search retrieved 1966 titles. Three clinical studies and 45 in vitro studies were included in this review. Ultrasonic activation did not improve the healing rate of apical periodontitis compared with syringe irrigation after primary root canal treatment of teeth with a single root canal. Conflicting results were reported by the in vitro microbiological studies. Ultrasonic activation was more effective than syringe irrigation in the removal of pulp tissue remnants and hard tissue debris based on both clinical and in vitro studies. Ultrasonic activation groups were possibly favored in 13 studies, whereas syringe irrigation groups may have been favored in 3 studies. CONCLUSIONS The level of the available evidence was low, so no strong clinical recommendations could be formulated. Future studies should focus on the antimicrobial effect and healing of apical periodontitis in teeth with multiple root canals.
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35
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Galler KM, Grubmüller V, Schlichting R, Widbiller M, Eidt A, Schuller C, Wölflick M, Hiller KA, Buchalla W. Penetration depth of irrigants into root dentine after sonic, ultrasonic and photoacoustic activation. Int Endod J 2019; 52:1210-1217. [PMID: 30828819 DOI: 10.1111/iej.13108] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/28/2019] [Indexed: 01/03/2023]
Abstract
AIM To compare penetration depths of endodontic irrigants into the dentinal tubules of extracted teeth when using several activation methods. METHODOLOGY The root canals of 90 extracted human teeth were prepared to size 40, .06 taper. The straight and round-shaped root canals were distributed randomly into six groups, and final irrigation was performed with EDTA and sodium hypochlorite as follows: (I) manual dynamic activation, (II) Ultrasonic, (III) Sonic, (IV) PIPS (photon-induced photoacoustic streaming, (V) SWEEPS (shock-wave enhanced emission photoacoustic streaming) and (0) control without final irrigation or activation. Subsequently, methylene blue was inserted into the canals and activated according to the groups (I-V). Teeth were sectioned horizontally, imaged under a light microscope, and dye penetration depths were measured in six sections per tooth and 24 points on a virtual clock-face per section. Data were analysed statistically by nonparametric tests for whole teeth and separately for coronal, middle and apical thirds. RESULTS Penetration of dye into the dentinal tubules was lowest for the controls. Median penetration depths amounted to 700-900 μm for groups I-V with differences in the apical thirds between group I and the other test groups. Minimum penetration depths were significantly greater for PIPS in the apical thirds (P ≤ 0.046). CONCLUSIONS Greater penetration depths occurred in the apical thirds for ultrasonic, sonic and laser-induced activation compared to manual dynamic activation. PIPS was associated with deeper penetration of irrigants. The novel SWEEPS mode did not increase irrigant penetration.
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Affiliation(s)
- K M Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - V Grubmüller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | | | - M Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - A Eidt
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - C Schuller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - M Wölflick
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - K-A Hiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - W Buchalla
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
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Aboud LRDL, Santos BCD, Lopes RT, Viana LAC, Scelza MFZ. Effect of Aging on Dentinal Crack Formation after Treatment and Retreatment Procedures: a Micro-CT Study. Braz Dent J 2018; 29:530-535. [DOI: 10.1590/0103-6440201802134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/30/2018] [Indexed: 11/22/2022] Open
Abstract
Abstract In order to evaluate the volume of dentinal cracks taking into account the age of the dentin and the type of file system used for endodontic procedures, forty freshly extracted single-rooted lower incisive teeth presenting similar root volume, were divided into two groups according to the age of the patient: Group Young (18 - 30 years old) and Group Old (60 years old or more). Each specimen was scanned by microcomputed tomography (micro-CT) in three stages: (i) before any treatment, (ii) after endodontic treatment with Reciproc files (REC), and (iii) after subsequent endodontic retreatment. Each group was subdivided into two subgroups, according to the retreatment technique used: retreatment with REC or with ProTaper Universal Retreatment (PUR) files. For each subgroup, the images were analyzed for differences in the volume of dentinal cracks in the middle and apical thirds of the teeth , according to the dentin age. In both stages (before and after instrumentation), the micro-CT images of the old root dentin presented with higher volume of cracks than those of the young root dentin, statistical significance notwithstanding (p>0.01). The use of REC files appeared to have no statistically significant differences in the generation of cracks in any type of root dentin when compared with PUR files (p>0.01). When retreated with PUR, the old root dentin presented with a significantly higher volume of cracks (p<0.01) when compared with the old root dentin initially.
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Kim SG, Malek M, Sigurdsson A, Lin LM, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J 2018; 51:1367-1388. [PMID: 29777616 DOI: 10.1111/iej.12954] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/14/2018] [Indexed: 12/13/2022]
Abstract
The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. There is increasing literature on this field since the initial reports of Iwaya et al. (Dental Traumatology, 17, 2001, 185) and Banchs & Trope (Journal of Endodontics, 30, 2004, 196). Endogenous stem cells from an induced periapical bleeding and scaffolds using blood clot, platelet rich plasma or platelet-rich fibrin have been utilized in regenerative endodontics. This approach has been described as a 'paradigm shift' and considered the first treatment option for immature teeth with pulp necrosis. There are three treatment outcomes of regenerative endodontics; (i) resolution of clinical signs and symptoms; (ii) further root maturation; and (iii) return of neurogenesis. It is known that results are variable for these objectives, and true regeneration of the pulp/dentine complex is not achieved. Repair derived primarily from the periodontal and osseous tissues has been shown histologically. It is hoped that with the concept of tissue engineering, namely stem cells, scaffolds and signalling molecules, that true pulp regeneration is an achievable goal. This review discusses current knowledge as well as future directions for regenerative endodontics. Patient-centred outcomes such as tooth discolouration and possibly more appointments with the potential for adverse effects needs to be discussed with patients and parents. Based on the classification of Cvek (Endodontics and Dental Traumatology, 8, 1992, 45), it is proposed that regenerative endodontics should be considered for teeth with incomplete root formation although teeth with near or complete root formation may be more suited for conventional endodontic therapy or MTA barrier techniques. However, much is still not known about clinical and biological aspects of regenerative endodontics.
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Affiliation(s)
- S G Kim
- Division of Endodontics, Columbia University College of Dental Medicine, New York, NY, USA
| | - M Malek
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
| | - A Sigurdsson
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
| | - L M Lin
- Department of Endodontics, New York University College of Dentistry, New York, NY, USA
| | - B Kahler
- The University of Queensland School of Dentistry, Brisbane, Australia
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Periodontal and endodontic infectious/inflammatory profile in primary periodontal lesions with secondary endodontic involvement after a calcium hydroxide-based intracanal medication. Clin Oral Investig 2018; 23:53-63. [DOI: 10.1007/s00784-018-2401-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/22/2018] [Indexed: 12/19/2022]
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Nagendrababu V, Jayaraman J, Suresh A, Kalyanasundaram S, Neelakantan P. Effectiveness of ultrasonically activated irrigation on root canal disinfection: a systematic review of in vitro studies. Clin Oral Investig 2018; 22:655-670. [DOI: 10.1007/s00784-018-2345-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/15/2018] [Indexed: 12/01/2022]
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de Almeida NF, Brasil SDC, Ferreira DDC, Armada L. Aging effects in the expression of macrophages in post-treatment apical periodontitis lesions. SPECIAL CARE IN DENTISTRY 2017; 37:230-235. [PMID: 28873244 DOI: 10.1111/scd.12234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the CD68 immunoexpression in post-treatment apical periodontitis lesions of older patients and compare them with lesions of younger/middle age adults. METHODS Biopsy specimens from 21 apical periodontitis lesions (12 granulomas and 9 cysts) were selected from older patients and 25 apical periodontitis lesions from younger/middle age adults (12 cysts and 13 granulomas) were selected and analyzed by immunohistochemistry using silanized slides with anti-CD68 antibody. The slides were subdivided in five high-power fields and the images were observed under an optical microscope to evaluate the epithelial and connective tissues. RESULTS The results showed that there was no statistical difference for the CD68 expression in epithelial tissue of cysts between younger/middle age adults and older patients. However, for the connective tissue of both cysts and granulomas, there was a statistical difference between the two age groups. There was a statistical difference between the epithelial and the connective tissues in cysts of younger/middle age adults, and also when the epithelial tissue of the cysts was compared with connective tissue of the granuloma. In the group of older patients, there was no statistical difference between the connective tissue of the cysts and granulomas. CONCLUSION The intensity of the macrophage staining was greater in the connective tissue of cysts and granulomas alike in the younger/middle age adult patients, suggesting that these cells participate actively in this tissue. Immune responses in older patients may be compromised, suggesting that there is a greater tendency for the endodontic treatment of these patients to fail.
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Affiliation(s)
| | | | - Dennis de Carvalho Ferreira
- Faculty of Dentistry, Department of Endodontics, Universidade Estacio de Sa, 37873, Rio de Janeiro, RJ, Brazil.,Faculty of Dentistry, Universidade Veiga de Almeida, RJ, Brazil
| | - Luciana Armada
- Faculty of Dentistry, Department of Endodontics, Universidade Estacio de Sa, 37873, Rio de Janeiro, RJ, Brazil
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Alyahya A, Alqareer A. Does the Removal of Cementum Facilitate Bacterial Penetration into Dentinal Tubules In Vitro? J Endod 2017; 43:1111-1115. [PMID: 28476468 DOI: 10.1016/j.joen.2017.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The importance of an intact layer of cementum on the root surface in preventing bacterial penetration into radicular dentin has not been sufficiently investigated. The aim of this in vitro study was to determine the effect of the absence of cementum from the root surface and the length of the infection period (2 or 4 weeks) on the maximum depth of bacterial penetration and the percentage of sectors lined with bacteria. METHODS Sound, single-rooted extracted teeth with closed apices were randomly assigned to either a control group (cementum present [CP]) or an experimental group (cementum removed [CR]). Each group was further divided randomly into 2 subgroups: 2-week infection (CP2 and CR2) and 4-week infection (CP4 and CR4). Teeth were then artificially infected with Enterococcus faecalis and prepared for histology. RESULTS A total of 107 teeth were available for histologic examination, 25 teeth in CP2, 31 teeth in CP4, 27 teeth in CR2, and 24 teeth in CR4. Pairwise comparisons revealed statistically significant differences in the maximum depth of bacterial penetration for the following combinations: CP2-CR2, CP2-CR4, CP4-CR2, and CP4-CR4 (P < .001). Pairwise comparisons also revealed a statistically significant difference in the percentage of sectors lined with bacteria for CP2-CR2, CP2-CP4, and CP2-CR4 (P < .001). CONCLUSIONS The results support the hypothesis that the absence of cementum facilitates bacterial penetration into dentinal tubules. Results also suggest that the process of radicular dentin infection is time dependent and highlight the importance of early treatment of infected teeth, especially in situations in which cementum discontinuity is suspected.
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Affiliation(s)
- Asma Alyahya
- Department of Developmental and Preventive Sciences, Faculty of Dentistry, Kuwait University, Kuwait.
| | - Athbi Alqareer
- Department of Developmental and Preventive Sciences, Faculty of Dentistry, Kuwait University, Kuwait
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Abstract
This report compares and evaluates the treatment outcomes of regenerative endodontic treatment and apical plug as two accepted treatment protocols in a pair of necrotic immature maxillary central incisors of a 12-year old female. The patient was referred complaining of a dull pain and swelling in her upper lip area. She had a history of trauma to the anterior maxilla two years earlier. Both teeth were clinically diagnosed with pulp necrosis and periapical radiographs revealed that separate periapical radiolucent lesions surrounded the immature apices of both teeth. The left and right incisors were treated with apical plug and regenerative endodontic treatment, respectively, using calcium-enriched mixture (CEM) cement. The patient was followed-up for three years. During this period, both teeth were clinically asymptomatic and showed complete radiographic healing of the periapical lesions. The right central incisor showed root development. No tooth discoloration was evident. Apexification by apical plug placement and pulp regeneration are both reliable treatments for immature non-vital teeth. In order to choose the right treatment the advantages of either technique should be weighed against its drawbacks. CEM cement can be successfully applied for both purposes. This biomaterial causes less discoloration of the tooth.
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Konstantinidi E, Psimma Z, Chávez de Paz LE, Boutsioukis C. Apical negative pressure irrigation versus syringe irrigation: a systematic review of cleaning and disinfection of the root canal system. Int Endod J 2017; 50:1034-1054. [PMID: 27898180 DOI: 10.1111/iej.12725] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/24/2016] [Indexed: 01/10/2023]
Abstract
The aim of this study was to systematically review and critically analyse the published data on the treatment outcome (primary outcome) and on the cleaning and disinfection of root canals (secondary outcomes) achieved by negative pressure irrigation as compared to syringe irrigation. An electronic search was conducted in EMBASE, LILACS, PubMed, SciELO, Scopus and Web of Knowledge using both free-text keywords and controlled vocabulary. Additional studies were sought through hand searching of endodontic journals and of the relevant chapters of endodontic textbooks. No language restriction was imposed. The retrieved studies were screened by two reviewers according to predefined criteria. Included studies were critically appraised and the extracted data were arranged in tables. The electronic search and hand search retrieved 489 titles. One clinical study and 14 in vitro studies were finally included in the review; none of these studies assessed treatment outcome, four studies assessed the antimicrobial effect, seven studies evaluated the removal of pulp tissue remnants, and four studies investigated the removal of hard tissue debris or both hard tissue debris and pulp tissue remnants. Poor standardization and description of the protocols was evident. Inconclusive results were reported about the cleaning and disinfection accomplished by the two irrigation methods. Negative pressure irrigation was more effective under certain conditions when compared to suboptimal syringe irrigation; however, the variability of the protocols hindered quantitative synthesis. There is insufficient evidence to claim general superiority of any one of these methods. The level of the available evidence is low, and the conclusions should be interpreted with caution.
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Affiliation(s)
- E Konstantinidi
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Z Psimma
- Private Practice, Rotterdam, The Netherlands
| | - L E Chávez de Paz
- Division of Endodontics, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - C Boutsioukis
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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Stauffacher S, Lussi A, Nietzsche S, Neuhaus KW, Eick S. Bacterial invasion into radicular dentine-an in vitro study. Clin Oral Investig 2016; 21:1743-1752. [PMID: 27722787 DOI: 10.1007/s00784-016-1960-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/14/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We wanted to investigate differences in invasiveness into radicular dentinal tubules by monocultured and co-cultured bacteria frequently found in infected root canals. METHODS Fifty-one human roots were incubated for 8 weeks with monocultured Streptococcus gordonii ATCC 10558, Streptococcus sanguinis ATCC 10556, and with five capnophiles/anaerobes as well as with capnophiles/anaerobes co-cultured with a streptococcal species. Thereafter, bacterial samples were cultured from the inner, middle, and outer third of the root dentine of longitudinally broken teeth (n = 5). In addition, scanning electron microscopy (SEM) images were obtained. RESULTS Single gram-positive species were able to penetrate into the middle and outer third of the root dentine. Fusobacterium nucleatum ATCC 25586 was not found in any of the dentine specimens. Prevotella intermedia ATCC 25611 and Porphyromonas gingivalis ATCC 33277 were found in the inner and middle third. The bacterial load of streptococci was higher in all thirds in co-cultures compared to single infections. In co-cultures with streptococci, Actinomyces oris ATCC 43146 was found in the outer third in 9/10 samples, whereas P. intermedia ATCC 25611 was not detectable inside dentine. Co-culture with S. sanguinis ATCC 10556 enabled F. nucleatum ATCC 25586 to invade dentine; SEM images showed that F. nucleatum ATCC 25586 had a swollen shape. CONCLUSIONS Invasiveness of bacteria into dentinal tubules is species-specific and may change depending on culturing as a single species or co-culturing with other bacteria. CLINICAL RELEVANCE Oral streptococci may promote or inhibit invasion of capnophiles/anaerobes into radicular dentine.
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Affiliation(s)
- Simone Stauffacher
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - Adrian Lussi
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland
| | - Sandor Nietzsche
- Center of Electron Microscopy, University Hospital of Jena, Jena, Germany
| | - Klaus W Neuhaus
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.
| | - Sigrun Eick
- Laboratory of Oral Microbiology, Department of Periodontology, University of Bern, Bern, Switzerland
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Verma P, Nosrat A, Kim J, Price J, Wang P, Bair E, Xu H, Fouad A. Effect of Residual Bacteria on the Outcome of Pulp Regeneration In Vivo. J Dent Res 2016; 96:100-106. [DOI: 10.1177/0022034516671499] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- P. Verma
- Department of Endodontics, Periodontics, and Prosthodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA
| | - A. Nosrat
- Department of Endodontics, Periodontics, and Prosthodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA
| | - J.R. Kim
- Department of Endodontics, Temple University, Philadelphia, PA, USA
| | - J.B. Price
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA
| | - P. Wang
- Department of Endodontics, Periodontics, and Prosthodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA
| | - E. Bair
- Department of Endodontics, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H.H. Xu
- Department of Endodontics, Periodontics, and Prosthodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA
| | - A.F. Fouad
- Department of Endodontics, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Gutknecht N, Al-Karadaghi TS, Al-Maliky MA, Conrads G, Franzen R. The Bactericidal Effect of 2780 and 940 nm Laser Irradiation on Enterococcus faecalis in Bovine Root Dentin Slices of Different Thicknesses. Photomed Laser Surg 2015; 34:11-6. [PMID: 26685038 DOI: 10.1089/pho.2015.3960] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this in vitro study was to investigate the antibacterial effect of the dual wavelength (2780 nm Er,Cr:YSGG and 940 nm diode) laser in elimination of Enterococcus faecalis in comparison with a 2780 nm Er,Cr:YSGG laser alone. BACKGROUND DATA Various laser wavelengths have been introduced as an adjunct in root canal treatment because of laser's bactericidal effect. MATERIALS AND METHODS Seventy- five slices of dentin with thicknesses of 300, 500, and 1000 μm (n = 25 each) obtained from caries-free bovine teeth were inoculated with 1 μL of E. faecalis suspension [1.67 × 10(7) colony-forming units (CFU)] and divided randomly into three groups: (A) samples indirectly irradiated with power settings of 1.06 W, 50 Hz, and 50 μs for Er,Cr:YSGG laser; (B) samples indirectly irradiated with Er,Cr:YSGG laser with the same power settings as group A and simultaneously with a 940 nm diode laser of 0.51 W in pulsed mode; and five samples from each thickness that were chosen as an unirradiated control group (Co). After irradiation, the CFU of E. faecalis were counted and the bacterial reduction was analyzed using Kruskal-Wallis nonparametric and post-hoc Dunnett tests. RESULTS There were statistical differences between groups A and B compared with the control group over all the three dentin slice thicknesses (p < 0.001). However, there was no statistical difference between groups A and B in killing of E. faecalis on 500 μm dentin slices. There were significantly more viable bacteria in group A than in group B in 300 and 1000 μm dentin slices (p < 0.01). CONCLUSIONS The results of this in vitro study showed that the dual wavelength laser system obtained a significantly higher bactericidal effect on E. faecalis than Er,Cr:YSGG laser, reaching a depth of 1000 μm of dentin.
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Affiliation(s)
- Norbert Gutknecht
- 1 Department of Conservative Dentistry, Periodontology and Preventive Dentistry, RWTH University Hospital Aachen , Aachen, Germany
| | - Tamara Sardar Al-Karadaghi
- 1 Department of Conservative Dentistry, Periodontology and Preventive Dentistry, RWTH University Hospital Aachen , Aachen, Germany .,2 Department of Biomedical Applications, Institute of Laser for Postgraduate Studies, University of Baghdad , Baghdad, Iraq
| | - Mohammed Abbood Al-Maliky
- 2 Department of Biomedical Applications, Institute of Laser for Postgraduate Studies, University of Baghdad , Baghdad, Iraq
| | - Georg Conrads
- 3 Division of Oral Microbiology and Immunology, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, RWTH University Hospital Aachen , Aachen, Germany
| | - Rene Franzen
- 1 Department of Conservative Dentistry, Periodontology and Preventive Dentistry, RWTH University Hospital Aachen , Aachen, Germany
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Nosrat A, Kolahdouzan A, Hosseini F, Mehrizi EA, Verma P, Torabinejad M. Histologic Outcomes of Uninfected Human Immature Teeth Treated with Regenerative Endodontics: 2 Case Reports. J Endod 2015; 41:1725-9. [DOI: 10.1016/j.joen.2015.05.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/05/2015] [Accepted: 05/05/2015] [Indexed: 01/09/2023]
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48
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Bezgin T, Sönmez H. Review of current concepts of revascularization/revitalization. Dent Traumatol 2015; 31:267-73. [DOI: 10.1111/edt.12177] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Tuğba Bezgin
- Faculty of Dentistry; Department of Pediatric Dentistry; Ankara University; Ankara Turkey
| | - Hayriye Sönmez
- Faculty of Dentistry; Department of Pediatric Dentistry; Ankara University; Ankara Turkey
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Chen EW, Carey AJ, Ulett GC, George R. Characterisation of the efficacy of endodontic medications using a three-dimensional fluorescent tooth model: Anex vivostudy. AUST ENDOD J 2015; 41:88-96. [DOI: 10.1111/aej.12089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Emily W. Chen
- School of Dentistry and Oral Health; Griffith University; Gold Coast Queensland Australia
| | - Alison J. Carey
- School of Medical Sciences; Griffith University; Gold Coast Queensland Australia
| | - Glen C. Ulett
- School of Medical Sciences; Griffith University; Gold Coast Queensland Australia
| | - Roy George
- School of Dentistry and Oral Health; Griffith University; Gold Coast Queensland Australia
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50
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McCabe P. Revascularization of an immature tooth with apical periodontitis using a single visit protocol: a case report. Int Endod J 2014; 48:484-97. [DOI: 10.1111/iej.12344] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/23/2014] [Indexed: 01/30/2023]
Affiliation(s)
- P. McCabe
- The Oranhill Dental Suite; Oranmore, Co.; Galway Ireland
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