Antimicrobial activity of maleic acid and combinations of cetrimide with chelating agents against Enterococcus faecalis biofilm

Coordinative Compounds Based on Unsaturated Carboxylate with Versatile Biological Applications

This review presents an overview of the biological applications of coordinative compounds based on unsaturated carboxylates accompanied by other ligands, usually N-based heterocyclic species. The interest in these compounds arises from the valuable antimicrobial and antitumor activities evidenced by some species, as well as from their ability to generate metal-containing polymers suitable for various medical purposes. Therefore, we describe the recently discovered aspects related to the synthesis, structure, and biological activity of a wide range of unsaturated carboxylate-containing species and metal ions, originating mostly from 3d series. The unsaturated carboxylates encountered in coordinative compounds are acrylate, methacrylate, fumarate, maleate, cinnamate, ferulate, coumarate, and itaconate. Regarding the properties of the investigated compounds, it is worth mentioning the good ability of some to inhibit the development of resistant strains or microbial biofilms on inert surfaces or, even more, exert antitumor activity against resistant cells. The ability of some species to intercalate into DNA strands as well as to scavenge ROS species is also addressed.

New Perspectives for Antihypertensive Sartans as Components of Co-crystals and Co-amorphous Solids with Improved Properties and Multipurpose Activity

Sartans (angiotensin II receptor blockers, ARBs), drugs used in the treatment of hypertension, play a principal role in addressing the global health challenge of hypertension. In the past three years, their potential use has expanded to include the possibility of their application in the treatment of COVID-19 and neurodegenerative diseases (80 clinical studies worldwide). However, their therapeutic efficacy is limited by their poor solubility and bioavailability, prompting the need for innovative approaches to improve their pharmaceutical properties. This review discusses methods of co-crystallization and co-amorphization of sartans with nonpolymeric, low molecular, and stabilizing co-formers, as a promising strategy to synthesize new multipurpose drugs with enhanced pharmaceutical properties. The solid-state forms have demonstrated the potential to address the poor solubility limitations of conventional sartan formulations and offer new opportunities to develop dual-active drugs with broader therapeutic applications. The review includes an in-depth analysis of the co-crystal and co-amorphous forms of sartans, including their properties, possible applications, and the impact of synthetic methods on their pharmacokinetic properties. By shedding light on the solid forms of sartans, this article provides valuable insights into their potential as improved drug formulations. Moreover, this review may serve as a valuable resource for designing similar solid forms of sartans and other drugs, fostering further advances in pharmaceutical research and drug development.

Willow Bark-Derived Material with Antibacterial and Antibiofilm Properties for Potential Wound Dressing Applications

Tree stems contain wood in addition to 10-20% bark, which remains one of the largest underutilized biomasses on earth. Unique macromolecules (like lignin, suberin, pectin, and tannin), extractives, and sclerenchyma fibers form the main part of the bark. Here, we perform detailed investigation of antibacterial and antibiofilm properties of bark-derived fiber bundles and discuss their potential application as wound dressing for treatment of infected chronic wounds. We show that the yarns containing at least 50% of willow bark fiber bundles significantly inhibit biofilm formation by wound-isolated Staphylococcus aureus strains. We then correlate antibacterial effects of the material to its chemical composition. Lignin plays the major role in antibacterial activity against planktonic bacteria [i.e., minimum inhibitory concentration (MIC) 1.25 mg/mL]. Acetone extract (unsaturated fatty acid-enriched) and tannin-like (dicarboxylic acid-enriched) substances inhibit both bacterial planktonic growth [MIC 1 and 3 mg/mL, respectively] and biofilm formation. The yarn lost its antibacterial activity once its surface lignin reached 20.1%, based on X-ray photoelectron spectroscopy. The proportion of fiber bundles at the fabricated yarn correlates positively with its surface lignin. Overall, this study paves the way to the use of bark-derived fiber bundles as a natural-based material for active (antibacterial and antibiofilm) wound dressings, upgrading this underappreciated bark residue from an energy source into high-value pharmaceutical use.

Knowledge, Attitude, and Practice towards Chelating Agents in Endodontic Treatment among Dental Practitioners

The use of chelating agents (CAs) in the endodontic irrigation protocol is required to dissolve the inorganic components of the smear layer. We aimed to assess the knowledge, attitude, and practice of dental professionals regarding the use of CAs during root canal treatment. A cross-sectional anonymous online survey was conducted among specialized endodontists and general dentists who routinely perform endodontic treatment and work in government-funded or private clinics in Moscow. The 8 min survey consisted of four parts: basic demographic data, knowledge (five items), attitude (four items), and practice (five items). We collected 376 completed questionnaires; a majority of the respondents were general dentists (87.5%) and worked in private clinics (77.4%). Most respondents (83.5%) showed a fair knowledge of the CAs used in endodontics, while 16.5% showed a poor knowledge of the topic. Small yet significant differences were found between endodontists and general practitioners and between dentists employed by private and government-funded clinics. A majority of dental practitioners (83%) demonstrated a positive attitude towards the use of CAs in endodontic treatment, and there were no differences among the study subgroups. Almost a third of the respondents always used chelating solutions during endodontic treatment, while 17% of the respondents did not use them at all. There were significant differences in this parameter between dentists working in private and government-funded clinics. Practice significantly correlated with attitude towards chelating agents and with knowledge of the topic. In conclusion, dental practitioners demonstrated a fair knowledge of CAs. Despite a positive attitude, 71% of the respondents did not use CAs for all endodontic patients.

Gas Chromatography-Mass Spectrometry (GC-MS) Metabolite Profiling of Citrus limon (L.) Osbeck Juice Extract Evaluated for its Antimicrobial Activity Against Streptococcus mutans

Purpose The present study aimed to determine the antimicrobial nature of Citrus limon juice extract against Streptococcus mutans and to identify its metabolic profile by gas chromatography-mass spectrometry (GC-MS) technique. Materials and methods The cariogenic bacteria S. mutans were procured from Microbial Type Culture Collection and Gene Bank (MTCC), Chandigarh, India, and revived on brain heart infusion (BHI) agar. The C. limon (L.) Osbeck fruits were authenticated from the University of Trans-Disciplinary Health Sciences and Technology (TDU), Bengaluru, India. The antibacterial property of lyophilized lemon juice extract (LJE) dissolved in methanol was evaluated against S. mutans (MTCC 497) by the agar well diffusion assay. GC-MS technique was employed to identify the volatile metabolite profile of the methanolic LJE sample. The metabolite masses of the respective compounds were identified using the National Institute of Standards and Technology (NIST) library. Results The methanolic LJE sample concentration from 5 to 25 mg/ml did not demonstrate antimicrobial activity, while 30 to 100 mg/ml displayed antibacterial activity against S. mutans. Chlorohexidine (100 µg/ml) was used as the positive control, while methanol was used as the negative control. Significant antimicrobial metabolites were detected in the methanolic LJE sample by GC-MS analysis. Maleic anhydride, succinic anhydride, 6-Oxa-bicyclo[3.1.0] hexan-3-one, and 3-methyl-2,5-Furandione were the key metabolites identified in the methanolic LJE sample.  Conclusion The present study reports that C. limon is a potential candidate for the pharmaceutical industry as it possesses bioactive compounds demonstrating therapeutic properties. Further investigations are warranted to determine the individual and synergetic effects of identified metabolites in the methanolic LJE sample for its antimicrobial property. Special attention needs to be focussed on translational research for the development of anti-caries products from C. limon.

Present status and future directions - irrigants and irrigation methods

Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long‐term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long‐term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.

A critical analysis of research methods and experimental models to study irrigants and irrigation systems

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.

Microbiological Aspects of Root Canal Infections and Disinfection Strategies: An Update Review on the Current Knowledge and Challenges

The oral cavity is the habitat of several hundreds of microbial taxa that have evolved to coexist in multispecies communities in this unique ecosystem. By contrast, the internal tissue of the tooth, i.e., the dental pulp, is a physiologically sterile connective tissue in which any microbial invasion is a pathological sign. It results in inflammation of the pulp tissue and eventually to pulp death and spread of inflammation/infection to the periradicular tissues. Over the past few decades, substantial emphasis has been placed on understanding the pathobiology of root canal infections, including the microbial composition, biofilm biology and host responses to infections. To develop clinically effective treatment regimens as well as preventive therapies, such extensive understanding is necessary. Rather surprisingly, despite the definitive realization that root canal infections are biofilm mediated, clinical strategies have been focused more on preparing canals to radiographically impeccable levels, while much is left desired on the debridement of these complex root canal systems. Hence, solely focusing on "canal shaping" largely misses the point of endodontic treatment as the current understanding of the microbial aetiopathogenesis of apical periodontitis calls for the emphasis to be placed on "canal cleaning" and chemo-mechanical disinfection. In this review, we dissect in great detail, the current knowledge on the root canal microbiome, both in terms of its composition and functional characteristics. We also describe the challenges in root canal disinfection and the novel strategies that attempt to address this challenge. Finally, we provide some critical pointers for areas of future research, which will serve as an important area for consideration in Frontiers in Oral Health.

Synthesis and characterization of a novel pH-responsive drug-releasing nanocomposite hydrogel for skin cancer therapy and wound healing

Local skin cancer recurrence occurs in ∼12% of the patients post-surgery due to persistent growth of residual cancer cells. Wound infection is another significant complication following surgery. We report a novel in situ-forming nanocomposite hydrogel (NCH) containing PLGA-carboxymethyl chitosan nanoparticles (186 nm) for localized pH-responsive skin cancer therapy and wound healing. This injectable hydrogel, comprising of a citric acid-derived polymer backbone, gelled within 5 minutes, and demonstrated excellent swelling (283% of dry weight) and compressive strengths (∼5.34 MPa). Nanoparticle incorporation did not significantly affect hydrogel properties. The NCH effluents were cytocompatible with human dermal fibroblasts at 500 μg ml-1 concentration and demonstrated pH-dependent drug release and promising therapeutic efficacy against A431 and G361 skin cancer cells in vitro. Significant zones of inhibition were observed in S. aureus and E. coli cultures on NCH treatment, confirming its antibacterial properties. Our studies show that the pH-responsive NCH can be potentially used for adjuvant skin cancer treatment and wound healing.

Comparative Evaluation of the Penetration Depth into Dentinal Tubules of Three Endodontic Irrigants

This study aimed to examine the penetration depth into dentinal tubules of some chelating agents. The 17% EDTA and two preparations containing surfactants (Smear Clear, Bioakt Endo) were tested. Surface tension and liquid viscosity were measured using a Dynamic Contact Angle Analyzer and a Haake rotational rheometer. To measure the penetration depth inside dentinal tubules, thirty maxillary central incisors were selected from a pool of extracted human permanent teeth and allocated to three experimental groups (10 samples each), as well as were mechanically shaped and cleansed with 5.25% NaOCl, followed by each of the chelators being labeled with 0.1 wt % Rhodamine B according to final irrigation protocol established. The samples were embedded in an epoxy resin, after which 200 μm thick transverse sections were obtained at 2, 5, and 8 mm from the apex with a saw microtome. The specimens were then observed using a confocal laser microscope (CLSM) and the penetration of the labeled solution was measured in every third of each sample. Statistical analysis was performed using ANOVA or Kruskal-Wallis tests according to the distribution of data, evaluated with the Shapiro-Wilk normality test. Viscosity and surface tension tests have shown that BioAKT Endo has the lowest values compared to EDTA and Smear Clear. The medium penetration depth did not significantly differ among the three irrigants, while it increased considerably from the apical to the coronal level in all groups. Additionally, the maximum penetration depth increased significantly from the apical to coronal level, while among groups, BioAKT Endo showed the highest values at the apical and middle level compared to the other irrigants. No significant differences were observed among the three groups in medium and maximum penetration depths when the entire root was considered. New irrigants containing surfactants show reduced surface tension and, in one case (BioAKT Endo), viscosity. The lowering of the surface tension allows for better penetration of liquids into dentinal tubules than EDTA alone, thus improving the cleaning of the root canal system.

Recent update on potential cytotoxicity, biocompatibility and preventive measures of biomaterials used in dentistry

Dental treatment is provided for a wide variety of oral health problems like dental caries, periodontal diseases, periapical infections, replacement of missing teeth and orthodontic problems. Various biomaterials, like composite resins, amalgam, glass ionomer cement, acrylic resins, metal alloys, impression materials, bone grafts, membranes, local anaesthetics, etc., are used for dental applications. The physical and chemical characteristics of these materials influence the outcome of dental treatment. It also impacts on the biological, allergic and toxic potential of biomaterials. With innovations in science and their positive results, there is also a need for awareness about the biological risks of these biomaterials. The aim of dental treatment is to have effective, yet safe, and long-lasting results for the benefit of patients. For this, it is important to have a thorough understanding of biomaterials and their effects on local and systemic health. Materials used in dentistry undergo a series of analyses before their oral applications. To the best of our knowledge, this is the first and original review that discusses the reasons for and studies on the toxicity of commonly used biomaterials for applications in dentistry. It will help clinicians to formulate a methodical approach for the selection of dental biomaterials, thus providing an awareness for forecasting their risk of toxic reactions.

Assessment of the safety and anti-inflammatory effects of three Bacillus strains in the respiratory tract

Chronic respiratory diseases are part of accumulating health problems partly due to worldwide increase in air pollution. By their antimicrobial and immunomodulatory properties, some probiotics constitute promising alternatives for the prevention and treatment of chronic respiratory diseases. We have isolated Bacillus strains from Korean fermented foods and selected three potentially probiotic strains (two Bacillus subtilis and one Bacillus amyloliquefaciens) based on safety, antimicrobial efficacy, activity against airborne pathogens and their immunomodulatory properties in vivo. Safety evaluation included in silico analysis for confirming absence of virulence genes. Safety for the respiratory tract was confirmed by an in vivo pathogenicity test using a murine model. Antimicrobial activity was displayed against several airborne pathogens. Potential antimicrobial metabolites such as 2,3-butanediol and propylene glycol were identified as possible antagonistic agents. Immunomodulatory properties in vitro were confirmed by upregulation of IL-10 expression in a macrophage cell line. Intranasal instillation and inhalation in an ovalbumin (OVA)-induced lung inflammation murine model reduced T helper type 2 (Th2) cytokines at transcriptional and protein levels in the lungs. The safety and potentially beneficial role of these Bacillus strains could be demonstrated for the respiratory tract of a murine model.

Antimicrobial effectiveness of etidronate powder (Dual Rinse® HEDP) and two EDTA preparations against Enterococcus faecalis: a preliminary laboratory study

This study aimed to evaluate the antimicrobial and antibiofilm activity of two chelating agents: ethylenediaminetetraacetic acid (EDTA) combined or not with detergents, and etidronic acid combined with sterile saline. The bacterial inhibitory and bactericidal concentrations (MIC and MBC, respectively) were determined on Enterococcus faecalis ATCC 4083 strain. Antimicrobial tests were performed on a biofilm model after treatment with the chelating agents at different times (1, 3, and 5 min) using a biofilm eradication concentration (MBEC) and confocal laser scanning microscope (CLSM) assays. Quantification of cell biomass and percentage of live and dead cells in the biomass was assessed for each group. The normality of the distributions for each variable was assessed using the D'Agostino and Pearson's omnibus normality test. The comparison of bacterial viability among groups and between any two groups was performed using the non-parametric Kruskal-Wallis one-way analysis of variance and the Dunn's test, respectively. No significant between-group difference was observed regarding biomass reduction. On the other hand, EDTA combined with detergents displayed a substantial increase of the dead bacteria ranging between 35 and 43%; whereas, the number of cells killed in the control group and in the other treated groups always ranged between 1 and 6%, at all experimental times. The addition of detergents to EDTA can improve its anti-biofilm activity by reducing EPS production and enhancing the killing of sessile bacterial cells. Clinical relevance EDTA presents a relevant antimicrobial activity when combined with surface-active agents.

Disruption and bactericidal indices depicted in polygonal graphs to show multiple outcome effects of root canal irrigant supplements on single- and dual-species biofilms

OBJECTIVES

The aims of this study were to (1) investigate the relative time-dependent disruption and bactericidal effects of detergent-type surfactants on single- or dual-species biofilms of root canal isolates and (2) to examine the utility of polygonal graphs for depiction of biofilm disruption and cell killing.

MATERIALS AND METHODS

Single-species biofilms of Streptococcus sanguinis, Enterococcus faecalis, Fusobacterium nucleatum and Porphyromonas gingivalis were grown on nitro-cellulose membranes for 72 h and immersed in Tween®80, cetyltrimethylammoniumbromide (CTAB), and sodium dodecyl sulphate (SDS) for 1-, 5- or 10-min (n = 3 per test). The number of viable and non-viable bacteria "disrupted" from the biofilm and those "remaining-attached" was determined using a viability stain in conjunction with fluorescence microscopy. The data were analysed using non-parametric Kruskal-Wallis test with 5% significance level.

RESULTS

Gram-negative obligate anaerobes were more susceptible to cell removal than gram-positive facultative anaerobes. The majority of cells were disrupted after 1-min of exposure; however, the extent varied according to the agent and species. CTAB and SDS were more effective than Tween 80™ at disrupting biofilms and killing cells but all agents failed to achieve 100% disruption/kill.

CONCLUSIONS

Biofilm disruption and cell viability were influenced by the species, the test agent and the duration of exposure. CTAB and SDS were more effective in biofilm disruption than Tween 80™. Graphical depiction of biofilm disruption- and viability-outcomes provides an alternative means of simultaneously visualising and analysing relative efficacy in different domains.

CLINICAL RELEVANCE

Surfactants were not as effective at biofilm disruption as NaOCl but may be added to other non-disruptive antibacterial agents to enhance this property.

Natamycin and Voriconazole Exhibit Synergistic Interactions with Nonantifungal Ophthalmic Agents against Fusarium Species Ocular Isolates

The in vitro activities of two antifungal drugs in combination with four nonantifungal ophthalmic agents were evaluated using a broth microdilution method and a collection of eight Fusarium ocular isolates that exhibited resistance to both natamycin (MICs, 14 to 32 μg/ml) and voriconazole (MICs, 4 to >128 μg/ml). Synergistic and indifferent interactions were observed for natamycin and 5-fluorouracil and natamycin with timolol dependent on the Fusarium isolate tested. Isolate-dependent synergistic and indifferent interactions were also observed for natamycin with EDTA and natamycin with dorzolamide. Synergistic or indifferent interactions were observed for voriconazole with timolol and voriconazole with 5-fluorouracil depending on Fusarium isolate. Taken together, these data suggest that commonly used ophthalmic agents enhance the in vitro activity of antifungal drugs against drug-recalcitrant ocular fungal pathogens.

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

Background

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

Material and Methods

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

Results

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

Conclusions

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

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

Comparative analysis of smear layer removal by conventional endodontic irrigants with a newly experimented irrigant-fumaric acid: A scanning electron microscopic study

Introduction:

This study was aimed to evaluate the efficacy of 17% ethylenediaminetetraacetate (EDTA), 7% maleic acid and 0.7% fumaric acid in smear layer removal from the root canal walls.

Materials and Methods:

Forty single-rooted mandibular premolars were collected and prepared till F3 rotary ProTaper file with 1 ml of 3% of sodium hypochlorite after each instrument change. Samples were randomly divided into 4 groups according to the final irrigating solution: 17% EDTA, 7% maleic acid, 0.7% fumaric acid, and 0.9% saline. The samples were prepared for scanning electron microscope analysis to observe smear layer removal at coronal, middle, and apical third level of root canal system.

Results:

At coronal third level, fumaric acid was equally efficient in smear layer removal when compared to maleic acid and EDTA without any significant difference between them. At the middle third, fumaric acid showed significantly better results than maleic acid followed by EDTA. At the apical third, both fumaric acid and maleic acid were equally effective without any significant difference between them but both showed significantly better results than EDTA.

Conclusion:

Fumaric acid can be tried as a new irrigating agent for smear layer removal in root canal system.

Biofilms in Endodontics-Current Status and Future Directions

Microbiota are found in highly organized and complex entities, known as biofilms, the characteristics of which are fundamentally different from microbes in planktonic suspensions. Root canal infections are biofilm mediated. The complexity and variability of the root canal system, together with the multi-species nature of biofilms, make disinfection of this system extremely challenging. Microbial persistence appears to be the most important factor for failure of root canal treatment and this could further have an impact on pain and quality of life. Biofilm removal is accomplished by a chemo-mechanical process, using specific instruments and disinfecting chemicals in the form of irrigants and/or intracanal medicaments. Endodontic research has focused on the characterization of root canal biofilms and the clinical methods to disrupt the biofilms in addition to achieving microbial killing. In this narrative review, we discuss the role of microbial biofilms in endodontics and review the literature on the role of root canal disinfectants and disinfectant-activating methods on biofilm removal.

Unusual Root Canal Irrigation Solutions

Microorganisms and their by-products play a critical role in pulp and periradicular pathosis. Therefore, one of the main purposes of root canal treatment is disinfection of the entire system of the canal. This aim may be obtained using mechanical preparation, chemical irrigation, and temporary medication of the canal. For this purpose, various irrigation solutions have been advocated. Common root canal irrigants, such as sodium hypochlorite, chlorhexidine, and a mixture of tetracycline, acid, and detergent have been extensively reviewed. The aim of this review was to address the less common newer root canal irrigation solutions, such as citric acid, maleic acid, electrochemically activated water, green tea, ozonated water, and SmearClear.

Seasonal Variations in Surface Metabolite Composition of Fucus vesiculosus and Fucus serratus from the Baltic Sea

Perennial macroalgae within the genus Fucus are known to exude metabolites through their outer thallus surface. Some of these metabolites have pro- and/or antifouling properties. Seasonal fluctuations of natural fouling pressure and chemical fouling control strength against micro- and macrofoulers have previously been observed in Fucus, suggesting that control strength varies with threat. To date, a study on the seasonal composition of surface associated metabolites, responsible for much of the fouling control, has not been done. We sampled individuals of the two co-occurring species F. vesiculosus and F. serratus at monthly intervals (six per species and month) during a one-year field study. We analysed the chemical composition of surface associated metabolites of both Fucus species by means of gas chromatography-mass spectrometry (GC-MS) to describe temporal patterns in chemical surface composition. Additionally, we correlated abiotic and biotic parameters recorded monthly within the sampled habitat with the variation in the chemical surface landscape of Fucus. Our study revealed that the chemical surface composition of both Fucus species exhibits substantial seasonal differences between spring/summer and autumn/winter months. Light and temperature explained most of the seasonal variability in surface metabolite composition of both Fucus species. A strong summerly up-regulation of eighteen saccharides and two hydroxy acids in F. vesiculosus as well as of four fatty acids and two saccharides in F. serratus was observed. We discuss how these up-regulated molecules may have a complex effect on associated microfoulers, both promoting or decreasing fouling depending on metabolite and bacterial identity. These seasonal shifts in the surface metabolome seem to exert a compound control of density and composition of the Fucus associated biofilm.

In vitro comparison of antimicrobial effectiveness of QMix and other final irrigants in human root canals

Final root canal irrigation stands as an effective strategy for eliminating the dentin infection. This study aimed to investigate and compare the antibacterial efficacy of QMix and other four final irrigation regimens in reducing Enterococcus faecalis within human root canals. Single-canal human teeth contaminated with E. faecalis for 4 weeks were prepared chemomechanically with sodium hypochlorite (NaOCl). Then, the teeth were randomly assigned into six groups according to the final irrigation protocols: (1) EDTA/NaOCl, 17% EDTA followed by 5.25% NaOCl; (2) EDTA/chlorhexidine (CHX), 17% EDTA followed by 2% CHX; (3) EDTA/cetrimide (CTR), 17% EDTA followed by 2% CTR; (4) MTAD; (5) QMix; and (6) control, 0.9% saline. Bacterial samples collected before instrumentation and after final irrigation were cultured and the colony-forming units (CFUs) were counted. The CFUs in the QMix, EDTA/CHX, and EDTA/CTR groups were significantly lower than those in the EDTA/NaOCl group. No significant differences were observed between the QMix, EDTA/CHX, and EDTA/CTR groups. MTAD showed weaker ability than QMix and EDTA/CHX to eliminate E. faecalis, but it caused a greater reduction in CFU than EDTA/NaOCl. Hence, the antimicrobial activity of QMix was comparable to that of EDTA/CHX and EDTA/CTR and more effective than that of EDTA/NaOCl against intracanal E. faecalis.

Antibacterial and residual antimicrobial activities against Enterococcus faecalis biofilm: A comparison between EDTA, chlorhexidine, cetrimide, MTAD and QMix

We compared the antibacterial and residual antimicrobial activities of five root canal irrigants (17% EDTA,2% chlorhexidine,0.2% cetrimide, MTAD, and QMix) in a model of Enterococcus faecalis biofilm formation. Sixty dentin blocks with 3-week E. faecalis biofilm were divided into six equal groups and flushed with irrigant for 2 min or left untreated. A blank control group was also established. Antibacterial activities of the irrigants were evaluated by counting colony forming units. To test residual antimicrobial activities, 280 dentin blocks were divided into seven equal groups and flushed with irrigant for 2 min or left untreated and then incubated with E. faecalis suspension for 48 h, or used as a blank. No bacteria were observed in the blank control group. The number of viable E. faecalis was significantly fewer in the irrigant-treated groups compared with the untreated control (P < 0.05). Among the five irrigants, QMix had the strongest antibacterial activity. Residual antimicrobial activities of CHX were significantly higher at 12 h, 24 h and 36 h compared to untreated control (P < 0.05). All five root canal irrigants were effective to some extent against E. faecalis, but QMix and CHX had the strongest, and CHX the longest (up to 36 h), antimicrobial activity.

Biofilm in endodontics: A review

Endodontic disease is a biofilm-mediated infection, and primary aim in the management of endodontic disease is the elimination of bacterial biofilm from the root canal system. The most common endodontic infection is caused by the surface-associated growth of microorganisms. It is important to apply the biofilm concept to endodontic microbiology to understand the pathogenic potential of the root canal microbiota as well as to form the basis for new approaches for disinfection. It is foremost to understand how the biofilm formed by root canal bacteria resists endodontic treatment measures. Bacterial etiology has been confirmed for common oral diseases such as caries and periodontal and endodontic infections. Bacteria causing these diseases are organized in biofilm structures, which are complex microbial communities composed of a great variety of bacteria with different ecological requirements and pathogenic potential. The biofilm community not only gives bacteria effective protection against the host's defense system but also makes them more resistant to a variety of disinfecting agents used as oral hygiene products or in the treatment of infections. Successful treatment of these diseases depends on biofilm removal as well as effective killing of biofilm bacteria. So, the fundamental to maintain oral health and prevent dental caries, gingivitis, and periodontitis is to control the oral biofilms. From these aspects, the formation of biofilms carries particular clinical significance because not only host defense mechanisms but also therapeutic efforts including chemical and mechanical antimicrobial treatment measures have the most difficult task of dealing with organisms that are gathered in a biofilm. The aim of this article was to review the mechanisms of biofilms’ formation, their roles in pulpal and periapical pathosis, the different types of biofilms, the factors influencing biofilm formation, the mechanisms of their antimicrobial resistance, techniques to identify biofilms.

Antimicrobial residual effects of irrigation regimens with maleic acid in infected root canals

Background

The success of endodontic treatment depends largely on the control of microorganisms present in infected root canals. The aim of this study was to determine the residual antimicrobial activity of several final irrigation protocols with 7% maleic acid (MA) alone and combined with chlorhexidine (CHX), cetrimide (CTR) or both, in root canals infected with Enterococcus faecalis. Biofilms of E. faecalis were grown in uniradicular roots for 4 weeks. A total of 72 specimens were divided into 5 experimental groups according to the final irrigation regime used: Group 1: 2.5% NaOCl; Group 2: 7% MA; Group 3: 7% MA + 0.2% CTR; Group 4: 7% MA + 2% CHX; Group 5: 7% MA + 0.2% CTR + 2% CHX; and Control group: 0.9% saline solution. Twelve roots (2/group) that were instrumented and not infected served as negative or sterility controls. The proportion of ungrown samples over 60 days was evaluated using non-parametric Kaplan-Meier survival analysis. Differences among groups were tested using the log-rank test (p< 0.05).

Results

The association of MA with CHX and CHX + CTR as final irrigating solutions showed the best results, 5 and 4 samples out of 12, respectively, and without differences between them (p = 0.928), followed by 7% MA + 0.2% CTR with 7 out of 12. The 7% MA (11/12) group showed significant differences with respect to the groups in which MA was combined with CHX (p < 0.005) and CHX + CTR (p < 0.005).

Conclusion

Final irrigating solutions of 7% MA combined with 2% CHX or 2% CHX + 0.2% CTR were found to effectively improve antimicrobial root canal disinfection.

Antimicrobial activity of root canal irrigants associated with cetrimide against biofilm and planktonic Enterococcus faecalis

AIM

To evaluate the antibacterial activity of sodium hypochlorite (NaOCl) and chlorhexidine (CHX) alone or associated with cetrimide (CTR), and QMiX against biofilm and planktonic Enterococcus faecalis (E. faecalis) [American type culture collection (ATCC) 29212].

MATERIALS AND METHODS

The solutions 2.5% NaOCl, 2.5% NaOCl + 0.2% CTR, 2% CHX, 2% CHX + 0.2% CTR, 0.2% CTR, and QMiX were evaluated. E. faecalis biofilms were induced for 14 days on bovine dentin blocks. The irrigants were evaluated after contact with E. faecalis suspension and biofilm for 1 and 3 minutes. After that, serial decimal dilutions were made and plated on tryptic soy agar (TSA) medium. Plates were incubated for 24 hours at 37°C and the colony-forming unit (CFU) 1 ml was determined. Data were subjected to ANOVA and Tukey's tests at 5% significance.

RESULTS

All microorganisms were eliminated by direct contact of the irrigants with planktonic cells. Only NaOCl and NaOCl + CTR were able to completely eliminate the microorganisms by direct contact with E. faecalis biofilm. CHX presented effectiveness similar to CHX + CTR CTR, and QMiX after 1 minute of contact and similar to NaOCl and NaOCl + CTR after 3 minutes (p > 0.05), but was unable to completely eliminate the microorganisms. CTR and QMiX did not differ from each other.

CONCLUSION

CTR addition to CHX and NaOCl solutions did not improve the antimicrobial activity against biofilm. All evaluated irrigants and associations presented activity against planktonic E. faecalis. Only NaOCl and NaOCl + CTR eliminated biofilm after 1 and 3 minutes of direct contact.

Antibiofilm activity of irrigating solutions associated with cetrimide. Confocal laser scanning microscopy

AIM

To evaluate the antibiofilm activity of sodium hypochlorite (NaOCl) and chlorhexidine (CHX) solutions associated with cetrimide (CTR), and QMiX using confocal laser scanning microscopy.

METHODOLOGY

Enterococcus faecalis (ATCC- 29212) biofilms were induced on bovine dentine blocks for 14 days. The dentine blocks containing biofilm were immersed for 1 min in the following solutions: 2.5% NaOCl; 2.5% NaOCl + 0.2% CTR; 2% CHX; 2% CHX + 0.2% CTR; 0.2% CTR; QMiX. After contact with the solutions, the dentine blocks were stained with Live/Dead(®) BacLight for analysis of the remaining biofilm using confocal laser scanning microscope. Images were evaluated using the BioImage_L software to determine the total biovolume (μm(3) ), the green biovolume (live cells) (μm(3) ) and the percentage of substrate coverage (%). The data were subjected to nonparametric statistical test using Kruskal-Wallis and Dunn's tests at 5% significance level.

RESULTS

After exposure to irrigants, the total biovolume observed for CHX, CHX+CTR, CTR, QMiX was similar to distilled water (P > 0.05). NaOCl and NaOCl+CTR had the lowest total and green biovolume. The CTR and QMiX had intermediate green biovolume, with greater antibacterial activity than CHX and CHX+CTR (P < 0.05). The NaOCl and NaOCl+CTR solutions were associated with microorganism removal and substrate cleaning ability.

CONCLUSIONS

NaOCl and NaOCl+CTR solutions were effective on microorganism viability and were able to eliminate biofilm. The addition of cetrimide did not influence antibacterial activity.

The antimicrobial effect of new and conventional endodontic irrigants on intra-orally infected dentin

OBJECTIVES

To evaluate if the incorporation of antimicrobial compounds to chelating agents or the use of chelating agents with antimicrobial activity as 7% maleic acid and peracetic acid show similar disinfection ability in comparison to conventional irrigants as sodium hypochlorite or iodine potassium iodide against biofilms developed on dentin.

MATERIALS AND METHODS

The total bio-volume of live cells, the ratio of live cells and the substratum coverage of dentin infected intra-orally and treated with the irrigant solutions: MTAD, Qmix, Smear Clear, 7% maleic acid, 2% iodine potassium iodide, 4% peracetic acid, 2.5% and 5.25% sodium hypochlorite was measured by using confocal microscopy and the live/dead technique. Five samples were used for each irrigant solution.

RESULTS

Several endodontic irrigants containing antimicrobials as clorhexidine (Qmix), cetrimide (Smear Clear), maleic acid, iodine compounds or antibiotics (MTAD) lacked an effective antibiofilm activity when the dentin was infected intra-orally. The irrigant solutions 4% peracetic acid and 2.5-5.25% sodium hypochlorite decrease significantly the number of live bacteria in biofilms, providing also cleaner dentin surfaces (p < 0.05).

CONCLUSIONS

Several chelating agents containing antimicrobials could not remove nor kill significantly biofilms developed on intra-orally infected dentin, with the exception of sodium hypochlorite and 4% peracetic acid. Dissolution ability is mandatory for an appropriate eradication of biofilms attached to dentin.

Antimicrobial activity of essential oils and chloroform alone and combinated with cetrimide against Enterococcus faecalis biofilm

The Enterococcus faecalis bacteria have been identified as the most commonly recovered species from teeth with persistent endodontic infections. The antimicrobial activity of essential oils and chloroform (CHL), alone and in association with various concentrations of cetrimide (CTR), against biofilm of Enterococcus faecalis was investigated. Solutions of CHL, eucalyptus oil (EO) and orange oil (OO) associated with CTR at 0.3%, 0.2%, 0.1%, and 0.05% were used to determine antimicrobial activity by exposing treated bovine dentine blocks to E. faecalis. Biofilms grown in the dentine blocks for 7 days were exposed to solutions for 2 and 5 min. Biofilm reduction between OO and EO at 2 min did not show any significant differences; however, OO had a higher kill percentage of biofilms than did the eucalyptus oil at 5 min (p < 0.01). Combinations with CTR at all concentrations achieved a 100% kill rate at 2 and 5 min. The association of CTR with solvent agents achieved the maximum antimicrobial activity against E. faecalis biofilms in dentine.

Comparison of the efficacy of ethylene diamine tetraacetic acid and maleic acid in the removal of three calcium hydroxide intra-canal dressings: A spiral computerized tomography volumetric analysis

Aim:

To assess the efficacy of 17% ethylene diamine tetra acetic acid and 7% maleic acid in the removal of 3 calcium hydroxide preparations placed as intracanal medicaments.

Materials and Methods:

The root canals of 60 single rooted premolars were prepared with a step back technique and randomly assigned into 3 experimental groups (n= 20). Group A was filled with plain calcium hydroxide mixed with distilled water in which barium sulfate was added for radio opacity, Group B was filled with Apexcal and Group C was filled with Metapex. After 7 days each group was divided into 2 sub groups (n= 10). The medicaments were retrieved with 17% EDTA (first sub group) and 7% maleic acid (second sub group). Along with the above irrigants manual and ultrasonic agitation was used. The pre and post removal volume of medicaments in root canals were measured using spiral computerized tomography. The percentage difference was calculated and statistically analyzed using Kruskal Wallis and Mann Whitney U test.

Results:

17% EDTA and 7% maleic acid efficiently removed calcium hydroxide, distilled water mixture (P= 0.218) and Apexcal (P= 0.684), whereas 7% maleic acid showed better retrieval capability of Metapex than 17% EDTA (P= 0.002).

Conclusion:

Calcium hydroxide, distilled water mixture and polyethylene glycol based calcium hydroxide were efficiently removed by 17% EDTA and 7% maleic acid. 7% maleic acid removed silicone oil based calcium hydroxide preparation better than 17% EDTA.

Decalcifying effects of antimicrobial irrigating solutions on root canal dentin

Objective: The aim of this study was to determine the decalcifying efficacy of 7% maleic acid (MA), 2% chlorhexidine (CHX), and combinations of 7% MA + 0.2% cetrimide (CTR) and 2% CHX + 0.2% CTR, in four time periods. Study Design: Four specimens per tooth were obtained from a 2-mm thick slice of the cervical third of the root of ten human incisors. At 1, 2, 3 and 5 minutes of immersion, the concentrations of Ca2+ were measured by atomic absorption spectrophotometry. The results were analyzed using the Mann-Whitney U-test. Results: Statistically significant differences were seen for the extracted calcium in all time periods. The amount of calcium extracted by 7% MA was the highest at all four immersion times, followed by 7% MA + 0.2% CTR. Two percent CHX and its combination with 0.2% CTR extracted virtually no calcium. Conclusions: The decalcifying capacity of 7% MA and 2% CHX diminished when combined with 0.2% CTR.

Key words:Cetrimide; chlorhexidine; decalcification; maleic acid; spectrometry.

Eradication of enterococci biofilms by lactic acid alone and combined with chlorhexidine and cetrimide

Objective: The antimicrobial activity of lactic acid (LA) alone or in combination with chlorhexidine (CHX) and cetrimide (CTR) against three Enterococcus faecalis strains, E. faecalis ATCC 29212, E. faecalis EF-D1 and E. faecalis U-1765, one Enterococcus durans strain and one dual-species biofilm was investigated. Study Design: The irrigating solutions tested were 20%, 15%, 10%, 5% and 2.5% LA, alone and in combination with 2% CHX and with 0.2% CTR. The biofilms were grown in the MBECTM high-throughput device for 24 hours and exposed to the solutions for 30 seconds and 1 minute. “Eradication” was defined as 100% bacterial kill. Results: Twenty percent LA eradicated all enterococci biofilms after 30 seconds contact time. The association of LA + 0.2% CTR achieved better results than LA alone, in contrast with the results obtained using LA + 2% CHX. E. durans was eradicated by all the tested solutions at 1 minute. The dual-species biofilm, E. faecalis ATCC 29212 + E. durans, gave intermediate values of the pure cultures. Conclusions: LA is capable of eradicating enterococci biofilm at a concentration of 20%. The combination of lower concentrations with 0.2% CTR achieved eradication after 1 minute.

Key words:Biofilm, cetrimide, chlorhexidine, enterococcus durans, enterococcus faecalis.

MECHANICAL PROPERTIES AND CURE TEST OF A NATURAL RUBBER/POLY(VINYL ALCOHOL) BLEND

Properties and antibacterial activity of polymer blend films prepared from polyvinyl alcohol (PVA) and natural rubber (NR) blends, in the presence of maleic acid as a cross-linking agent were studied. The effect of the maleic acid content, curing temperature, and curing time on the properties of the polymer blend was investigated. Cross-linking between PVA and maleic acid was observed by attenuated total reflection mode–Fourier transform infrared spectroscopy at 1152 cm−1. The swelling ratio of the polymer blend decreased as a function of the increase of the maleic acid content. The tensile strength of the polymer blend increased with an increase of both the maleic acid and the curing time. The highest tensile strength of the samples was observed with 40% w/w maleic acid after a 24 h curing time at 120 °C. The elongation at the break of 60/40 NR/PVA was ∼500% at 120 °C for 1 h. In addition, the polymer blend showed good antibacterial activity with Staphylococcus aureus ATCC25923, Escherichia coli ATCC25922, and Acinetobacter baumannii JVC 1053 and could find many applications.

Residual effectiveness of final irrigation regimens on Enteroccus faecalis-infected root canals

INTRODUCTION

The application of a final irrigating solution that remains active over a fairly long period of time stands as one strategy for preventing bacterial recolonization or eliminating the bacteria that persist after root canal treatment. The aim of this study was to evaluate the residual antimicrobial activity of four final irrigation regimens in root canals contaminated with Enterococcus faecalis.

METHODS

Biofilms of E. faecalis were grown in uniradicular roots for 4 weeks. After preparing the roots chemomechanically, four final irrigation regimens were applied: (1) group EDTA-NaOCl, 17% EDTA followed by 5.25% sodium hypochlorite (NaOCl); (2) group MA-NaOCl, 7% maleic acid (MA) followed by 5.25% NaOCl; (3) group EDTA-CHX + CTR, 17% EDTA followed by 2% chlorhexidine (CHX) + 0.2% cetrimide (CTR); and (4) group MA-CHX + CTR, 7% MA followed by 2% CHX + 0.2% CTR. Samples were collected for 60 days to denote the presence of bacterial growth. The Fisher exact test was used to compare the percentages of specimens without E. faecalis regrowth.

RESULTS

All root canals in which the final irrigant was 5.25% NaOCl yielded positive cultures on the fifth day. Groups EDTA-CHX + CTR and MA-CHX + CTR with a final irrigation of 2% CHX + 0.2% CTR showed respective percentages of samples without regrowth of 72.1% and 66.8% at 60 days. There were no statistically significant differences between these groups.

CONCLUSIONS

The combination of 2% CHX + 0.2% CTR would be an effective alternative final irrigation regimen given its antimicrobial action over time.

In vitro antimicrobial activity of maleic acid and ethylenediaminetetraacetic acid on endodontic pathogens

OBJECTIVE

The aim of this study was to evaluate the antimicrobial efficacy of 7% maleic acid (MA) and 17% ethylenediaminetetraacetic acid (EDTA) in elimination of Enterococcus faecalis, Candida albicans, and Staphylococcus aureus at different time intervals.

STUDY DESIGN

Transfer culture of microbial strains were used for inoculum preparation and determination of time-kill assay. The viability counts of 7% MA and 17% EDTA suspensions were performed at 0, 2, 4, 6, 12, and 24 hours. Assay results were analyzed by determining number of strains that yielded log(10) CFU/mL of -1 compared with counts at 0 hours, for test medicaments at time intervals. Medicaments were considered to be microbicidal at a minimum inhibitory concentration that reduced original inoculum by >3 log(10) CFU/mL (99.9%) and microbiostatic if inoculum was reduced by <3 log(10) CFU/mL. Statistical analysis was performed using chi-square and Fisher exact tests as well as Friedman test for comparison of the time interval within the MA and EDTA groups.

RESULTS

At all time intervals, there was no significant difference between MA and EDTA for all of the organisms (P > .05). However, within the MA and EDTA groups at various time intervals, there were significant differences (P < .001).

CONCLUSIONS

Equivalent antimicrobial activity was observed by MA and EDTA against all of the organisms tested at various periods.

Residual and antimicrobial activity of final irrigation protocols on Enterococcus faecalis biofilm in dentin

INTRODUCTION

The use of root canal irrigating solutions exerting antimicrobial activity and prolonged residual activity is desirable in order to control dentin infection and delay reinfection of the root canal. The aim of this study was to evaluate the residual antimicrobial activity and the capacity to eradicate Enterococcus faecalis biofilm of different irrigating solutions, alone and in combination, in a dentin-volumetric test.

METHODS

Solutions of 2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), 0.2% cetrimide (CTR), 17% ethylendiaminetetraacetic (EDTA), 7% maleic acid (MA), and regimens of 2.5% NaOCl followed by 17% EDTA or 7% MA and 0.2% CTR or 2% CHX were used to determine their residual activity by exposing treated dentin blocks to E. faecalis for 24 hours. Antimicrobial activity was assayed on 3-week biofilm formed on dentin blocks. Results of residual activity and antimicrobial activity were respectively expressed as the inhibition percentage of biofilm formation and the kill percentage of biofilm.

RESULTS

A 2% CHX and 0.2% CTR solution showed 100% biofilm inhibition; 2.5% NaOCl showed the lowest residual activity (18.10%). The kill percentage of 2.5% NaOCl and 0.2% CTR was 100% followed by 7% MA and 2% CHX, whereas 17% EDTA was the least effective (44%). Solutions of 7% MA or 17% EDTA followed by 0.2% CTR or 2% CHX showed 100% residual and antimicrobial activity.

CONCLUSIONS

A 0.2% CTR solution alone and the combinations in which 2% CHX or 0.2% CTR was the final irrigating solution achieved the maximum residual and antimicrobial activity.