DIAGNOdent Laser Fluorescence Assessment of Endodontic Infection

Water-soluble vitamin-E for enhancing fluorescence diagnosis in infected human dentine treated with NaOCl

INTRODUCTION

Bacterial fluorescence methods are of interest in endodontics for informing endpoints for debridement. This study explored potential fluorescence quenching reversal effects of a water-soluble vitamin E conjugate (d-α-Tocopherol polyethylene glycol 1000 succinate, TPGS) when applied to polymicrobial biofilms grown on dentine that had been exposed to sodium hypochlorite (NaOCl) to cause quenching.

METHOD

Extracted human teeth were debrided, embedded in transparent acrylic resin and sectioned. After smear layer removal, tooth dentine sections were inoculated with a polymicrobial inoculum, and cultured for 7 days to create biofilms. Samples (n = 8 per group) were exposed to 1 % or 4 % NaOCl for 2 or 4 min, and then treated with TPGS. Bacterial fluorescence readings under laser excitation at 655 nm were assessed over 10 min using a calibrated DIAGNOdent device. All data were assessed for normality (Kolmogorov-Smirnov test) and analysed with ANOVA followed by Bonferroni post-hoc tests.

RESULTS

NaOCl at both concentrations quenched fluorescence readings of biofilms grown on dentine samples, with a maximal reduction of 40.4 % at 5 min after 4 % NaOCl. Treatment with TPGS gave faster recovery of fluorescence readings compared to the control at 5 and 10 min.

CONCLUSION

The water-soluble antioxidant TPGS partially reversed fluorescence quenching caused by NaOCl. This agent may have value clinically for reducing the time needed for fluorescence readings to recover when NaOCl is used as an irrigant. This will facilitate more accurate assessment of endpoints for canal debridement.

Real-time optical detection of endodontic infection using bacterial autofluorescence

OBJECTIVES

For successful root canal treatment (RCT), it is essential to objectively assess the presence and activity of bacteria in the root canal system. However, current methods rely on subjective observations of root canal exudates. This study aimed to confirm whether real-time optical detection using bacterial autofluorescence can evaluate endodontic infection status by assessing the red fluorescence (RF) detected from root canal exudates.

METHODS

During RCT, endodontic paper points were used to collect root canal exudates scored using conventional organoleptic tests to assess the severity of root canal infections. RF on the paper points was assessed using quantitative light-induced fluorescence (QLF) technology. RF intensity and area from the paper points were quantified, and their correlations with infection severity were assessed using their organoleptic scores. The oral microbiome composition of RF samples was compared with non-red fluorescent (non-RF) samples.

RESULTS

The RF detection rate was nil and >98% in the non-infectious and severe groups. The RF intensity and area significantly increased with infection severity (p<0.001) and showed strong correlations with organoleptic scores (r=0.72, 0.82, respectively). The diagnostic accuracy for detecting root canal infection using RF intensity was good to excellent (AUC = 0.81-0.95) and increased with infection severity. The microbial diversity of the RF samples was significantly lower than that of the non-RF samples. Gram-negative anaerobic bacteria such as Prevotella and Porphyromonas were more predominant in RF samples.

CONCLUSIONS

Optical detection using bacterial autofluorescence can objectively evaluate endodontic infection status in real-time by assessing the RF of endodontic root canal exudates.

CLINICAL SIGNIFICANCE

This real-time optical technology can be utilised to detect endodontic bacterial infection without conventional incubation, allowing clinicians to determine the endpoint of chemomechanical debridement and increase the positive outcomes of RCTs.

Non-invasive biomedical sensors for early detection and monitoring of bacterial biofilm growth at the point of care

Bacterial infections have long been a serious global health issue. Biofilm formation complicates matters even more. The biofilm's extracellular polymeric substances (EPSs) matrix protects bacteria from the host's immune responses, yielding strong adhesion and drug resistance as the biofilm matures. Early bacterial biofilm detection and bacterial biofilm growth monitoring are crucial to treating biofilm-associated infections. Current detection methods are highly sensitive but not portable, are time-consuming, and require expensive equipment and complex operating procedures, limiting their use at the point of care. Therefore, there is an urgent need to develop affordable, on-body, and non-invasive biomedical sensors to continuously monitor and detect early biofilm growth at the point of care through personalized telemedicine. Herein, recent advances in developing non-invasive biomedical sensors for early detection and monitoring bacterial biofilm growth are comprehensively reviewed. First, biofilm's life cycle and its impact on the human body, such as biofilm-associated disease and infected medical devices, are introduced together with the challenges of biofilm treatment. Then, the current methods used in clinical and laboratory settings for biofilm detection and their challenges are discussed. Next, the current state of non-invasive sensors for direct and indirect detection of bacterial biofilms are summarized and highlighted with the detection parameters and their design details. Finally, commercially available products, challenges of current devices, and the further trend in biofilm detection sensors are discussed.

Root canal cleaning in roots with complex canals using agitated irrigation fluids

The internal topography of the root canal is complex, especially for the mesial root of the permanent first molar. In response to such challenges, enhanced irrigation protocols have been developed, using laser pulses to agitate fluids and enhance the removal of microbial deposits. The aim of this laboratory study was to assess the effectiveness of laser agitation of sodium hypochlorite in removing multispecies biofilms grown in the mesial root of the permanent first molars. The five agitation groups (N = 12 roots for each) were: 940 nm diode laser (superpulsed mode, 50 μs/pulses at 20 Hz using 20 mJ/pulse); 1064 nm Nd: YAG laser (200 μs/pulse at 20 Hz using 20 mJ/pulse); 2940 nm Er: YAG laser (50 μs/pulse at 15 Hz using a 400/14 conical tip in the SWEEPS protocol, with 20 mJ/pulse); passive ultrasonic agitation at 28 kHz (positive control); and irrigation with a 27-gauge side vented needle for 2 min per canal (negative control). Biofilm removal was assessed by confocal microscopic imaging of root slices at 1, 4 and 7 mm from the root apex. None of the tested methods were effective in completely eradicating biofilm from the most confined regions of the root canal system. The greatest challenge was cleaning the isthmus regions. There was a positive correlation between canal cleaning and isthmus cleaning, suggesting that increased effectiveness in cleaning root canal walls is associated with more effective isthmus cleaning. Wider and narrow isthmuses were cleaned better than long and narrow isthmuses.

Laser-fluorescence assessment of sodium hypochlorite quenching reversal agents on human dentine

BACKGROUND

Laser-fluorescence diagnostic technology for real-time clinical assessment of residual bacteria could help assist in determining the endpoints for root canal debridement. Sodium hypochlorite (NaOCl) can however quench fluorescence and lead to false low reading. This study aims to evaluate various antioxidant for their ability to recover quenched fluorescence in dentine treated with NaOCl.

METHODS

Human dentine fluorescence was measured using 655 nm laser at baseline and again after a 2 min application of 4% NaOCl. The putative recovery agents were then applied, and the fluorescence measured after 5, 10, 20, 30 and 60 min. Recovery from quenching was also assessed using laser confocal scanning microscopy (CLSM) with a bound tetracycline fluorophore using 488 nm excitation.

RESULTS

A 5 min application of vitamin E oil or buffered 2% lignocaine solution (1:80,000 adrenaline) was effective in regaining quenched fluorescence within the following 5 mins. Distilled water, sodium thiosulfate, unbuffered 2% lignocaine with 1:80000 adrenaline and phosphate buffered saline were less effective, and of equal performance. Ascorbic acid and butylated hydroxyanisole were not effective and had deleterious effects on the levels of dentine fluorescence. CLSM provided confirmation of recovery from quenched fluorescence using vitamin E oil.

CONCLUSION

Based on these findings, reversal agents should be employed when assessing the fluorescence of dentine that has been exposed to NaOCl or other quenching agents.

Evaluation of the effect of various endodontic irrigants and medicaments on dentine fluorescence

This study examined the effect of various root canal irrigants and medicaments on dentin fluorescence elicited by 655 nm visible red laser light. To replicate clinical use, irrigants were applied onto dentin samples for 2 min, while medicaments were applied for 2 weeks. Fluorescence values tracked from baseline across the following to 24 h, starting 5 min after exposure. Sodium hypochlorite, hydrogen peroxide, and articaine local anaesthetic (4% articaine with 1:1000,000 adrenaline) all significantly quenched fluorescence (p < 0.0001), which then returned to baseline levels after 20 min. Conversely, elevated fluorescence readings were recorded after 3% mepivacaine (p < 0.05), 0.2% chlorhexidine (p < 0.01) and chloroform (p <0.05). A 2 week application of Ledermix™ paste containing 3% demeclocycline caused an irreversible increase in fluorescence (p < 0.0001). Other tested endodontic materials (15% EDTA, eucalyptus oil, calcium hydroxide, Odontopaste™ clindamycin paste, and distilled water) had no impact on dentine fluorescence. The influences of endodontic materials on dentin fluorescence need to considered when using fluorescence endpoints to guide the progress of root canal treatment.

Fluorescence characteristics of E. faecalis in dentine following treatment with oxidizing endodontic irrigants

INTRODUCTION

This study aimed to assess changes in the fluorescence characteristics of Enterococcus faecalis in human dentine over a period of 24 h following treatment with endodontic irrigants.

METHOD

Sterilised, non-functional extracted third molars were embedded in acrylic resin and uniformly sectioned into 2 mm thick dentine sections. After the removal of smear layer, the dentine sections were inoculated with E. faecalis and cultured for 7 days. The infected dentine sections were subsequently treated with different concentrations of sodium hypochlorite (NaOCl) and hydrogen peroxide (H₂O₂). Bacterial fluorescence readings were assessed at different time points using a calibrated laser device. All data were assessed for normality (Kolmogorov Smirnoff test) and analysed using ANOVA with Bonferroni post-hoc tests.

RESULTS

Fluorescence readings were quenched when E. faecalis infected human dentine sections were treated with oxidizing irrigants in vitro. Throughout a 24-hour period, fluorescence recovered in part but did not return to baseline level.

CONCLUSION

The fluorescence quenching effect of these oxidizing agents needs to be considered when using laser fluorescence in assessing the quality of root canal debridement or disinfection.

Novel Approaches to Detect and Treat Biofilms within the Root Canals of Teeth: A Review

Biofilms located within the root canals of teeth are a unique and pressing concern in dentistry and in medical microbiology. These multispecies biofilms, which include fungi as well as bacteria, form in a protected site with low shear stress and low oxygen tension. Systemic antibiotics are of limited value because of the lack of blood flow of the site, and issues with innate and acquired resistance. Physical disruption using hand or rotary powered instruments does not reach all locations in the root canal system where biofilms are present. Alternative strategies including agitated irrigation fluids, continuous chelation, materials with highly alkaline pH, and antimicrobial nanoparticles are being explored to meet the challenge. Detection and quantification of biofilms using fluorescence-based optical methods could provide an indication of successful biofilm removal and an endpoint for physical and chemical treatments.

BEL1-LIKE HOMEODOMAIN 11 regulates chloroplast development and chlorophyll synthesis in tomato fruit

Chloroplast development and chlorophyll(Chl)metabolism in unripe tomato contribute to the growth and quality of the fruit, however these mechanisms are poorly understood. In this study, we initially investigated seven homeobox-containing transcription factors (TFs) with specific ripening-associated expression patterns using virus-induced gene silencing (VIGS) technology and found that inhibiting the expression of one of these TFs, BEL1-LIKE HOMEODOMAIN11 (SlBEL11), significantly increased Chl levels in unripe tomato fruit. This enhanced Chl accumulation was further validated by generating stable RNA interference (RNAi) transgenic lines. RNA sequencing (RNA-seq) of RNAi-SlBEL11 fruit at the mature green (MG) stage showed that 48 genes involved in Chl biosynthesis, photosynthesis and chloroplast development were significantly upregulated compared with the wild type (WT) fruit. Genomic global scanning for Homeobox TF binding sites combined with RNA-seq differential gene expression analysis showed that 22 of these 48 genes were potential target genes of SlBEL11 protein. These genes included Chl biosynthesis-related genes encoding for protochlorophyllide reductase (POR), magnesium chelatase H subunit (CHLH) and chlorophyllide a oxygenase (CAO), and chloroplast development-related genes encoding for chlorophyll a/b binding protein (CAB), homeobox protein knotted 2 (TKN2) and ARABIDOPSIS PSEUDO RESPONSE REGULATOR 2-LIKE (APRR2-like). Electrophoretic mobility shift assay (EMSA) and chromatin immunoprecipitation quantitative polymerase chain reaction (PCR) (ChIP-qPCR) assays were employed to verify that SlBEL11 protein could bind to the promoters for TKN2, CAB and POR. Taken together, our findings demonstrated that SlBEL11 plays an important role in chloroplast development and Chl synthesis in tomato fruit.

Difference assessment of composite resins and sound tooth applicable in the resin-imbedded tooth for resin repair using fluorescence, microhardness, DIAGNOdent, and X-ray image

OBJECTIVE

Visual differentiation of resin and tooth in a tooth cavity is not simple due to their highly similar shade. The purpose of the present study was to find any noninvasive method which can effectively differentiate resin from sound tooth in a resin-imbedded tooth for resin repair.

MATERIALS AND METHODS

For the study, various resin products were imbedded into the cavity of sound tooth. By applying laser of different wavelengths, autofluorescence (AF) of sound tooth and resin products were obtained. Microhardness, X-ray radiograph, and DIAGNOdent were tested for each tooth, resin product, and resin-imbedded tooth.

RESULTS

For the AF spectra obtained using the 405-nm wavelength, sound tooth has emission peak at 440-470 nm and near 490 nm. Sound tooth has several times higher microhardness than resin products regardless of position in tooth subsurface. Due to the difference of radiopaque fillers' composition and concentration, resin products have different brightness in the X-ray radiograph. DIAGNOdent readings for tooth and resin products were inconsistently different, and the difference of obtained values was slightly not to be applicable for the differentiation.

CONCLUSION

Among the tested methods, with noninvasive treatment, AF spectrum by the 405-nm wavelength showed the apparent difference between resin and tooth.

CLINICAL SIGNIFICANCE

For the resin repair in a resin-imbedded tooth cavity, AF spectrum produced by 405-nm wavelength could be a useful method in tracing the resin-tooth boundary if combined with conventional X-ray radiography.

Activation of Alkaline Irrigation Fluids in Endodontics

In conventional endodontic treatment, alkaline solutions of sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) are used in combination to disinfect the root canal system and to eliminate debris and smear layers. An important concept that has emerged over recent years is the use of active physical methods for agitating these fluids to improve their penetration within areas that are not reached by endodontic instruments and to accelerate the chemical actions of these alkaline fluids against planktonic microorganisms, biofilms, soft tissue remnants and smear layers. Ultrasonic agitation and more recently pulsed lasers have emerged as two promising methods for activating endodontic irrigation fluids. Ultrasonic agitation with piezoelectric devices employs a moving tip, while laser agitation uses a stationary tip. Both methods cause cavitation, followed by implosions and shear forces which assist with debridement. Fluid streaming further enhances the activity of the fluids. While agitation enhances performance of irrigants, extrusion of fluids from the root canal during activation is a hazard that must be controlled.

Rapid Bacterial Detection during Endodontic Treatment

Bacteria present in the root canal (RC) space following an RC treatment (RCT) can lead to persistent infections, resulting in treatment failure and the need for reintervention or extraction. Currently, there are no standardized methods in use to clinically detect bacterial presence within RC spaces. The use of paper point sampling and fluorescence staining was shown to be a rapid method, able to detect residual bacteria following treatment. The study demonstrated that Calcein acetoxymethyl (AM) proved to be a suitable dye for detecting vital bacteria within mature endodontic biofilms, with an improved sensitivity over colony-forming unit counting in a stressed biofilm model. Furthermore, in a clinical trial with primary RCTs, 53 infected teeth were sampled in vivo, and increased detection of vital cells was found when compared with colony-forming unit counting, highlighting the sensitivity of the technique in detecting low cell numbers. By combining fluorescent staining and microspectroscopy with software-based spectral analysis, successful detection of vital cells from RCs was possible after 5 min of Calcein AM incubation. Application of this technology during RCT has the potential to reduce persistent infections through vital cell detection and additional treatment. Furthermore, this technique could be applied to antimicrobial research and disinfection control in clinical settings ( ClinicalTrials.gov NCT03055975).

Optical diagnostics in the oral cavity: an overview

As the emphasis shifts from damage mitigation to disease prevention or reversal of early disease in the oral cavity, the need for sensitive and accurate detection and diagnostic tools become more important. Many novel and emergent optical diagnostic modalities for the oral cavity are becoming available to clinicians with a variety of desirable attributes including: (i) non-invasiveness, (ii) absence of ionizing radiation, (iii) patient-friendliness, (iv) real-time information (v) repeatability, and (vi) high-resolution surface and subsurface images. In this article, the principles behind optical diagnostic approaches, their feasibility and applicability for imaging soft and hard tissues, and their potential usefulness as a tool in the diagnosis of oral mucosal lesions, dental pathologies, and other dental applications will be reviewed. The clinical applications of light-based imaging technologies in the oral cavity and of their derivative devices will be discussed to provide the reader with a comprehensive understanding of emergent diagnostic modalities.