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Artaza L, Campello AF, Soimu G, Alves FRF, Rôças IN, Siqueira JF. Outcome of Nonsurgical Root Canal Treatment of Teeth With Large Apical Periodontitis Lesions: A Retrospective Study. J Endod 2024; 50:1403-1411. [PMID: 39151889 DOI: 10.1016/j.joen.2024.08.003] [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: 07/10/2024] [Revised: 08/07/2024] [Accepted: 08/07/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION This study reported on the outcome of the nonsurgical root canal treatment/retreatment of teeth with large apical periodontitis lesions. The influence of some variables on the prognosis was also evaluated. METHODS The study included 199 teeth with large apical periodontitis lesions from 184 patients, treated/retreated by a single operator. Most teeth were managed in a single visit using NaOCl irrigation. Cases were followed up periodically from >1 to 8 years. Treatment/retreatment outcome was evaluated by clinical and radiographic/tomographic criteria and categorized as healed, healing, or diseased. For statistical analysis, data were dichotomized in such a way that healing cases were considered as success in a loose criterion or failure in a rigid one. RESULTS Clinical/radiographic analyses revealed that 67% of the initial treatment cases were classified as healed, 22.5% as healing, and 11% as diseased. Treatment success rates were 89% (loose) and 67% (rigid). Variables that influenced the treatment outcome included previous abscess and antibiotic use, very large lesions (≥10 mm), and a sinus tract. The median follow-up time for treatment was 31.5 months. As for retreatment cases, 47% were healed, 32% were healing, and 21% were diseased. Retreatment success rates were 79% (loose) and 47% (rigid), in a median follow-up of 32 months. Cases evaluated by cone-beam computed tomography had lower healed rates. CONCLUSIONS Findings demonstrate that high favorable outcome rates can be achieved by nonsurgical root canal treatment or retreatment of teeth with large apical periodontitis lesions.
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Affiliation(s)
- Liliana Artaza
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil; Department of Endodontics, Maimonides University (UMAI), Buenos Aires, Argentina
| | - Andrea F Campello
- Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil
| | - Giuliana Soimu
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávio R F Alves
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil; Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil.
| | - Isabela N Rôças
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil; Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil
| | - José F Siqueira
- Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil; Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil
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da Silva Goulart R, Oliveira-Silva M, Faria-Junior M, Silva-Sousa YTC, Miranda CES, Pitondo-Silva A. Optimized protocol for collecting root canal biofilms for in vitro studies. J Microbiol Methods 2024; 226:107048. [PMID: 39332642 DOI: 10.1016/j.mimet.2024.107048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 09/22/2024] [Accepted: 09/23/2024] [Indexed: 09/29/2024]
Abstract
Endodontic retreatment is often necessitated by several factors, including the persistence of microorganisms in the root canal system (RCS). Their complex organization in biofilms increases their pathogenic potential, necessitating new disinfection strategies. This study aimed to standardize a new in vitro protocol for collecting biofilm from the RCS. Thirty-four bovine incisors were used in the study, divided into two experimental groups with two collection steps each: (a) biofilm collection protocol and (b) absorbent paper points protocol. Twelve specimens from each group were selected for counting colony-forming units (CFUs), while eight specimens were prepared for scanning electron microscopy (SEM). Two additional specimens served as sterilization controls to ensure that experiments were free of contamination. The coronal region was removed and standardized at 15 mm. After preparation with ProTaper up to F5, the apical foramen was sealed with composite resin, and the roots were stabilized with acrylic resin in 1.5-mL Eppendorf tubes. The specimens were sterilized and inoculated with Enterococcus faecalis NTCT 775 every 24 h for 21 days. After this period, each group underwent biofilm collection protocols, and CFU and scanning electron microscopy (SEM) data were analyzed. The Shapiro-Wilk test was performed to assess the normality of log-transformed data, and the results indicated a normal distribution for all groups, allowing parametric testing. The Levene test was used to evaluate the equality of variances. The proposed biofilm collection method yielded significantly higher CFU counts compared with the absorbent paper points method, particularly when analyzed on a log₁₀ scale. An independent samples t-test confirmed a statistically significant difference between the two methods (p < 0.0001). The proposed protocol achieved an efficiency rate of 95.85 % ± 1.15 %, whereas the absorbent paper points protocol yielded a lower efficiency of 5.46 % ± 1.37 %. Therefore, the biofilm collection protocol proposed in this study proved to be more effective for biofilm removal from the RCS.
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Affiliation(s)
- Rafael da Silva Goulart
- Programa de Pós-Graduação em Odontologia, Universidade de Ribeirão Preto. Universidade de Ribeirão Preto. Av. Costábile Romano, 2201 - Ribeirânia, Ribeirão Preto, SP, Brazil CEP: 14096-900.
| | - Mariana Oliveira-Silva
- Programa de Pós-Graduação em Tecnologia Ambiental, Universidade de Ribeirão Preto. Av. Costábile Romano, 2201 - Ribeirânia, Ribeirão Preto, SP, Brazil CEP: 14096-900.
| | - Milton Faria-Junior
- Departamento de Exatas, Universidade de Ribeirão Preto. Av. Costábile Romano, 2201 - Ribeirânia, Ribeirão Preto, SP, Brazil CEP: 14096-900.
| | - Yara Teresinha Correa Silva-Sousa
- Programa de Pós-Graduação em Odontologia, Universidade de Ribeirão Preto. Universidade de Ribeirão Preto. Av. Costábile Romano, 2201 - Ribeirânia, Ribeirão Preto, SP, Brazil CEP: 14096-900.
| | - Carlos Eduardo Saraiva Miranda
- Programa de Pós-Graduação em Odontologia, Universidade de Ribeirão Preto. Universidade de Ribeirão Preto. Av. Costábile Romano, 2201 - Ribeirânia, Ribeirão Preto, SP, Brazil CEP: 14096-900; Curso de Ciências Farmacêuticas, Universidade de Ribeirão Preto. Av. Costábile Romano, 2201 - Ribeirânia, Ribeirão Preto, SP, Brazil CEP: 14096-900.
| | - André Pitondo-Silva
- Programa de Pós-Graduação em Odontologia, Universidade de Ribeirão Preto. Universidade de Ribeirão Preto. Av. Costábile Romano, 2201 - Ribeirânia, Ribeirão Preto, SP, Brazil CEP: 14096-900; Programa de Pós-Graduação em Tecnologia Ambiental, Universidade de Ribeirão Preto. Av. Costábile Romano, 2201 - Ribeirânia, Ribeirão Preto, SP, Brazil CEP: 14096-900.
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Brisson-Suárez K, Siqueira JF, Alves FRF, Campello AF, Rodrigues RCV, Voigt DD, Romeiro K, Loyola-Fonseca SC, Heggendorn FL, Mdala I, Rôças IN. Effectiveness of supplementary antimicrobial procedures in disinfecting lateral canals as evaluated by a novel ex vivo analytical approach. Sci Rep 2024; 14:21840. [PMID: 39294174 PMCID: PMC11410991 DOI: 10.1038/s41598-024-72041-7] [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: 07/29/2024] [Accepted: 09/03/2024] [Indexed: 09/20/2024] Open
Abstract
This ex vivo study devised an analytical ex vivo method for infection/disinfection of simulated lateral canals located in the middle and apical segments of the root. The antibacterial effects of supplementary approaches were tested in this model. Extracted mandibular premolars had their main root canals enlarged and then two lateral canals (100 μm in diameter) were created in the root, one in the apical and the other in the middle portion. Micro-computed tomography was used for specimen selection and to confirm the quality of the simulated ramifications. The specimens were contaminated with a mixed bacterial culture from subgingival bacterial biofilm added to pure Enterococcus faecalis strain ATCC 29212 grown overnight, using special strategies to facilitate culture medium penetration within the lateral canals. The following procedures were tested for disinfection: NaOCl/passive ultrasonic irrigation (PUI), NaOCl/XP-endo Finisher, ozonated water/continuous ultrasonic irrigation (CUI), and NaOCl/conventional irrigation with 30-G needles (control). Bacteriological samples were taken from the main canal before (S1) and after (S2) each supplementary protocol, and also from each lateral canal after treatment (S3). DNA extracted from the samples was subjected to quantitative real-time polymerase chain reaction. All S1 main canal samples were positive for bacterial presence. Bacterial counts in the main root canal substantially decreased by 99.2% after PUI, 99.1% after ozone/CUI, 99% after XP-endo Finisher, and 96% in the control group (P < 0.01 for all groups). There were no significant differences between groups (P > 0.05). The same was observed when comparing the effects of the supplementary approaches in the apical and middle lateral canals (P > 0.05). Only a few lateral canals showed no detectable bacteria. The method proposed here proved effective for ex vivo infection/disinfection studies. All supplementary approaches induced a substantial bacterial reduction in the main canal, with no significant differences between them. However, in terms of lateral canal disinfection, none of the tested approaches showed significant effects when compared to the control group.
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Affiliation(s)
- Karen Brisson-Suárez
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
- Department of Endodontics, Santa María University, Caracas, Venezuela
| | - José F Siqueira
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - Flávio R F Alves
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil.
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil.
| | - Andrea F Campello
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - Renata C V Rodrigues
- Department of Endodontics, Faculty of Dentistry, Veiga de Almeida University (UVA), Rio de Janeiro, RJ, Brazil
| | - Danielle D Voigt
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Kaline Romeiro
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Simone C Loyola-Fonseca
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - Fabiano L Heggendorn
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Ibrahimu Mdala
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Isabela N Rôças
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
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Ballal NV, Ray AB, Narkedamalli R, Urala AS, Patel V, Harris M, Bergeron BE, Tay FR. Effect of continuous vs sequential chelation on the mechanical properties of root dentin: An ex vivo study. J Dent 2024; 148:105214. [PMID: 38950767 DOI: 10.1016/j.jdent.2024.105214] [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: 05/13/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVES To evaluate the mechanical properties of root canal dentin treated with sodium hypochlorite (NaOCl) in combination with hydroxyethylidene diphosphonic acid (HEDP) or ethylenediaminetetraacetic acid (EDTA). METHODS For testing fracture resistance, 45 single-rooted teeth were instrumented and irrigated with NaOCl/HEDP, NaOCl/EDTA, or distilled water. Fifteen untreated teeth served as control. After obturation, specimens from the experimental groups were thermocycled, dynamically-loaded, and then statically-loaded in a universal testing machine until failure. For flexural strength analysis, 15 teeth were instrumented and irrigated with NaOCl/HEDP or NaOCl/EDTA. Root segments were sectioned into dentin bars and tested for flexural strength using a universal testing machine. For microhardness evaluation, 20 teeth were instrumented and irrigated with NaOCl/HEDP or NaOCl/EDTA. Dentin disks from the coronal-third of each root segment were prepared, one before and one after irrigation, for microhardness testing with a Knoop hardness tester. RESULTS The highest fracture resistance was recorded in the untreated group, and the lowest in the EDTA group. Although the HEDP group had higher fracture resistance than the EDTA group, the distilled water group demonstrated even greater fracture resistance than the HEDP group. Specimens treated with HEDP had significantly higher flexural strength and microhardness values when compared with those treated with EDTA. CONCLUSION The fracture resistance, flexural strength, and microhardness of root canal dentin were higher when root canals were irrigated with NaOCl/HEDP, when compared with NaOCl/EDTA. CLINICAL SIGNIFICANCE Irrigating root canals with NaOCl combined with HEDP significantly improves the mechanical integrity of root canal dentin compared to the use of NaOCl with EDTA.
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Affiliation(s)
- Nidambur Vasudev Ballal
- Department of Conservative Dentistry & Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Ayan Bhadra Ray
- Department of Conservative Dentistry & Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajkumar Narkedamalli
- Department of Conservative Dentistry & Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Arun S Urala
- Department of Orthodontics and Dentofacial Orthopaedics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vineet Patel
- Department of Endodontics, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Mark Harris
- Department of Endodontics, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian E Bergeron
- Department of Endodontics, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Franklin R Tay
- Department of Endodontics, Dental College of Georgia, Augusta University, Augusta, GA, USA.
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Kendell-Wall R, Nguyen JT, Salleras F, Kamboj AS, Diwen Tan SA, Manish Trivedi V, de Mello-Neto JM, Rodrigues Amaral R. Antimicrobial efficacy of Odontopaste in endodontics: a systematic review. Evid Based Dent 2024; 25:166. [PMID: 38538855 PMCID: PMC11436364 DOI: 10.1038/s41432-024-01000-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 09/29/2024]
Abstract
AIM To evaluate the efficacy of Odontopaste in reducing the microbial load in endodontics compared to other intracanal medicaments. MATERIALS AND METHODS The literature was electronically searched on PubMed, Google Scholar, Scopus, Ovid Medline and Web of Science. In-vitro, ex-vivo and in-vivo studies that evaluated the antimicrobial efficacy of Odontopaste were included. The risk of bias was assessed using the Quality Assessment Tool for In Vitro Studies. RESULTS A total of four in-vitro studies were included in the systematic review. One study showed that Odontopaste had significantly more microbial cell growth on roots in all dentine depths compared to other medicaments or test agents. Another study found that Odontopaste significantly decreased colony-forming units compared to propolis and chlorhexidine. Further results showed that Odontopaste did not significantly decrease microbial numbers when used in isolation. Additionally, combining Odontopaste and calcium hydroxide did not enhance the effectiveness of calcium hydroxide. The studies had a medium to high risk of bias. CONCLUSION There is insufficient high-quality evidence to assess the antimicrobial efficacy of Odontopaste compared to other intracanal medicaments. Further research is required to determine Odontopaste's efficacy as an antimicrobial medicament in endodontics.
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Affiliation(s)
- Rachael Kendell-Wall
- College of Medicine and Dentistry, James Cook University, Campus Smithfield, Cairns, QLD, Australia
| | - Jennifer-Thuy Nguyen
- College of Medicine and Dentistry, James Cook University, Campus Smithfield, Cairns, QLD, Australia
| | - Fauve Salleras
- College of Medicine and Dentistry, James Cook University, Campus Smithfield, Cairns, QLD, Australia
| | - Amandeep Singh Kamboj
- College of Medicine and Dentistry, James Cook University, Campus Smithfield, Cairns, QLD, Australia
| | - Serene Aimee Diwen Tan
- College of Medicine and Dentistry, James Cook University, Campus Smithfield, Cairns, QLD, Australia
| | - Vaidehi Manish Trivedi
- College of Medicine and Dentistry, James Cook University, Campus Smithfield, Cairns, QLD, Australia
| | | | - Rodrigo Rodrigues Amaral
- College of Medicine and Dentistry, James Cook University, Campus Smithfield, Cairns, QLD, Australia.
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Liu H, Lu L, Xu K, Shen Y. Treatment outcomes and prognostic factors of the apical barrier technique with premixed calcium silicate-based putty in necrotic permanent teeth with open apices: a retrospective cohort study with up to six years follow-up. Clin Oral Investig 2024; 28:425. [PMID: 38990402 DOI: 10.1007/s00784-024-05813-0] [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: 04/15/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To evaluate treatment outcomes of the apical barrier technique with premixed calcium silicate-based putty for treating necrotic permanent teeth with open apices and to identify prognostic factors. MATERIALS AND METHODS Permanent teeth with necrotic pulps and open apices treated by the apical barrier technique with premixed calcium silicate-based putty, with a minimum follow-up of 12 months, were included. Treatment outcomes were based on clinical signs, symptoms, and radiographic evaluation. The treatment outcome was dichotomized into success or failure according to strict and loose criteria. The chi-square test (or Fisher's exact test) and multiple logistic regression analysis were used to evaluate possible prognostic factors associated with treatment outcomes. RESULTS Seventy-four teeth with a follow-up time of 12-72 months (mean, 25.74 ± 14.36 months) were included in the final evaluation. The success rate was 97.30% using the loose criteria and 66.22% using the strict criteria. Multiple logistic regression analysis indicated that the size of pre-operative periapical lesion (≥ 5 mm) (odds ratio [OR]: 18.96; P = 0.0153) and root canal underfilling (OR: 8.341; P = 0.0448) were significant predictors for treatment failure under the strict criteria. CONCLUSION The apical barrier technique with premixed calcium silicate-based putty is a highly successful procedure for treating necrotic permanent teeth with open apices after an observation period of up to 6 years. Treatment success under the strict criteria is primarily affected by the size of the pre-operative periapical lesion and the apical extent of root-filling. CLINICAL RELEVANCE Careful case selection and ensuring adequate root filling quality are essential to the successful outcome of the apical barrier technique with premixed calcium silicate-based putty.
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Affiliation(s)
- He Liu
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, V6T 1Z3, Canada
| | - Le Lu
- Department of Endodontics, Suzhou Stomatological Hospital, No. 1366 Suzhan street, Suzhou, 215005, China.
| | - Ke Xu
- Department of Endodontics, Suzhou Stomatological Hospital, No. 1366 Suzhan street, Suzhou, 215005, China
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, V6T 1Z3, Canada.
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Kim KH, Lévesque C, Malkhassian G, Basrani B. Efficacy of the GentleWave System in the removal of biofilm from the mesial roots of mandibular molars before and after minimal instrumentation: An ex vivo study. Int Endod J 2024; 57:922-932. [PMID: 38374488 DOI: 10.1111/iej.14044] [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: 08/29/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024]
Abstract
AIM To compare the efficacy of Enterococcus faecalis biofilm removal using the GentleWave System (GWS) (Sonendo Inc, CA) on non-instrumented versus minimally instrumented root canal systems. METHODOLOGY Thirty-four mandibular molars were autoclaved and allocated to four groups: Negative control (n = 5); positive control (n = 5); Group 1: non-instrumentation + GWS (NI + GWS) (n = 12); and Group 2: minimal instrumentation + GWS (MI + GWS) (n = 12). Of 34 samples, 24 samples with Vertucci type 2 configuration within the mesial root of each sample were allocated to Groups 1 and 2 and then matched based on the working length and root canal configuration. After inoculation of samples with E. faecalis for 3 weeks, the GWS was used on Group 1 without any instrumentation and Group 2 after instrumentation of mesial canals until size 20/06v. CFU and SEM analysis were used. RESULTS Log10 (CFU/mL) from the positive control, and Group 1 and 2 were 7.41 ± 0.53, 3.41 ± 1.54, and 3.21 ± 1.54, respectively. Both groups showed a statistically significant difference in the reduction of viable E. faecalis cells compared to the positive control (Group 1 [p = .0001] and Group 2 [p < .0001]), whilst showing no significant difference between the two tested groups (p < .05). CONCLUSION The use of GWS on the non-instrumented root canal system could be an effective disinfection protocol in removing the biofilm without dentin debris formation.
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Affiliation(s)
- Kwang Ho Kim
- Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Céline Lévesque
- Microbiology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Gevik Malkhassian
- Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Bettina Basrani
- Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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Souza MA, Zanella ML, Vanin GN, Dallepiane FG, Pizzi CYM, Ferreira ER, Fuhr MCS, Piccolo NM, Palhano HS, da Silva Koch J, Souza KR, da Costa UM, Dos Santos VV, Steier L, Bertol CD, Figueiredo JAPD. Antimicrobial action and cytotoxicity of hypochlorous acid obtained from an innovative electrolytic device - An in vitro study. Arch Oral Biol 2024; 163:105966. [PMID: 38657440 DOI: 10.1016/j.archoralbio.2024.105966] [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: 02/12/2024] [Revised: 04/01/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE This study evaluated the antimicrobial effect and cytotoxicity of hypochlorous acid(HClO) obtained from an innovative electrolytic device. DESIGN The root canals of fifty extracted human teeth were inoculated with Enterococcus faecalis and divided into 5 groups (n = 10): DW (control); 2% chlorhexidine gel(CHX); 2.5% sodium hypochlorite(NaOCl); 250 ppm HClO and 500 ppm HClO. The counting of colony forming units evaluated the decontamination potential of each group. Cytotoxicity was evaluated after inoculation of tested protocols in fibroblastic cells for 3 min, calculating the cell viability. Specific statistical analysis was performed (α = 5%). RESULTS The highest bacterial reduction was observed in experimental groups, with no statistical differences from each other (p > 0.05). The highest number of viable cells was observed in control group, followed by 250 ppm HClO and 500 ppm HClO groups, with statistical differences from each other (p < 0.05). CONCLUSIONS It could be concluded that HClO presented high antimicrobial activity and low cytotoxicity at both tested concentrations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jordana da Silva Koch
- School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Kellyn Rocca Souza
- School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - Liviu Steier
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA; Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India
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Seron MA, Nunes GP, Ferrisse TM, Strazzi-Sahyon HB, Dos Santos PH, Gomes-Filho JE, Cintra LTA, Sivieri-Araujo G. Influence of bioceramic sealers on dentinal tubule penetration and antimicrobial effectiveness: a systematic review and meta-analysis of in vitro studies. Odontology 2024; 112:672-699. [PMID: 38374511 DOI: 10.1007/s10266-024-00904-6] [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: 10/12/2023] [Accepted: 01/08/2024] [Indexed: 02/21/2024]
Abstract
The aim of this systematic review and meta-analysis (SRM) was to evaluate whether bioceramic sealers have better penetration capacity in dentinal tubules and antimicrobial activity when compared to AH Plus® sealer. This SRM was recorded in the Open Science Framework database and followed the guidelines of the PRISMA 2020. Five databases were searched by two independent reviewers. Only in vitro studies that evaluated the effects of bioceramic sealers on dentinal tubule penetration and antimicrobial activity outcomes compared to AH Plus® sealer were included. Meta-analysis was conducted using R software, using the effect measure of the standardized mean difference (SMD) and inverse variance method. A modified Joanna Briggs Institute's Checklist was used for the risk of bias assessment. A total of 1486 studies were identified, and only 54 studies that fulfilled our eligibility criteria were included in this review. There was no statistical difference between the sealers evaluated for dentinal tubule penetration, in the thirds evaluated: coronal SMD 0.58 [0.14; 1.31], p = 0.12; middle SMD 0.07 [0.54; 0.39], p = 0.75; and apical SMD 0.08 [0.73; 0.56], p = 0.80. Both sealers demonstrated similar antimicrobial action (SMD [3.42; 5.32], p = 0.67 and SMD 0.67 [1.89; 0.55], p = 0.28). The studies presented a low risk of bias. Based on the in vitro studies included and according to the limitations of the present review, the data suggest that bioceramic and AH Plus® sealers present similar penetration capacity in dentinal tubules and antimicrobial effect, making them suitable materials to be considered in clinical practice.
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Affiliation(s)
- Marcelo Augusto Seron
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, Rua José Bonifácio 1193, Araçatuba, SP, 16015-050, Brazil
| | - Gabriel Pereira Nunes
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, Rua José Bonifácio 1193, Araçatuba, SP, 16015-050, Brazil.
| | - Tulio Morandin Ferrisse
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara School of Dentistry, São Paulo State University - UNESP, Araraquara, SP, Brazil
| | - Henrico Badaoui Strazzi-Sahyon
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil
| | - Paulo Henrique Dos Santos
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil
| | - João Eduardo Gomes-Filho
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, Rua José Bonifácio 1193, Araçatuba, SP, 16015-050, Brazil
| | - Luciano Tavares Angelo Cintra
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, Rua José Bonifácio 1193, Araçatuba, SP, 16015-050, Brazil
| | - Gustavo Sivieri-Araujo
- Department of Preventive and Restorative Dentistry, Araçatuba School of Dentistry, São Paulo State University - UNESP, Rua José Bonifácio 1193, Araçatuba, SP, 16015-050, Brazil
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10
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Akçay A, Gorduysus M, Gorduysus MO, Annamma LM, Müftüoglu S. A Comparative Evaluation of the Cleaning Efficacy of Five Different Root Canal Irrigation Devices: A Histological Study. Eur J Dent 2024; 18:827-833. [PMID: 37995725 PMCID: PMC11290919 DOI: 10.1055/s-0043-1774325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES This study is aimed to evaluate the cleaning efficacy of five different irrigation systems as SonicMax, RinsEndo, EndoVac, passive ultrasonic irrigation (PUI), and manual needle irrigation (MNI) to histologically evaluate the presence of organic structures and the penetration of irrigation solution. MATERIALS AND METHODS Forty-two single-rooted, extracted human mandibular premolars were used in the study. Each tooth was decoronated at the cementoenamel junction and the root canals were instrumented using ProTaper rotary instruments in a crown-down manner. The specimens were randomly divided into five experimental groups (n = 7) Group (1) SonicMax, group (2) RinsEndo,group (3) EndoVac, group (4) PUI, group (5) MNI, and the control groups (n = 7). Each system used 2.5% sodium hypochlorite (NaOCl), 17% ethylenediamine tetraacetic acid (EDTA), and 2.5% NaOCl, respectively, in the experimental groups. The control group did not receive any final irrigation.The measurements were analyzed by employing two-way analysis of variance multivariate results to show significant differences between the length of the dentin tubules in the apical, middle, and coronal of the six groups. The post-hoc test was used when groups were compared by pairs. RESULTS The results of this study indicate that among the five groups, the RinsEndo and EndoVac were found to be most effective in the cleaning of root canals. The RinsEndo shows highly significant results in the cleaning efficiency of the coronal and middle parts compared with the other groups. The cleaning efficiency in the apical area was the same for RinsEndo and EndoVac. CONCLUSION The result of our study indicates that RinsEndo and EndoVac may be more effective in clinical practice.
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Affiliation(s)
- Alper Akçay
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkiye
| | | | - Mehmet Omer Gorduysus
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Lovely M. Annamma
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Sevda Müftüoglu
- Department of Histology and Embryology, Faculty of Medicine, Hacettepe University, Ankara, Turkiye
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11
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Carney KA, Colloc TNE, Kilgariff JK. Management of rarely seen internal tunnelling root resorption associated with a maxillary permanent incisor. Br Dent J 2024; 236:955-961. [PMID: 38942857 PMCID: PMC11213701 DOI: 10.1038/s41415-024-7504-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 06/30/2024]
Abstract
This case presents clinical techniques and materials that may be applied in the management of internal tunnelling root resorption, a rare condition which has little published literature.A 25-year-old woman was referred to a specialist centre by her general dental practitioner following an incidental finding of a radiographic radiolucency, suggestive of root resorption associated with tooth 21. A provisional diagnosis of external cervical resorption was made, and following cone beam computed tomography (CBCT), a definitive diagnosis of internal tunnelling root resorption given. Non-surgical endodontic treatment was completed using continuous wave compaction with a calcium-silicate based sealer. No further intervention has been required.A summary of the histology, aetiology, prevalence, diagnosis, management and prognosis of internal tunnelling root resorption is provided. The benefits of CBCT for diagnosing and managing internal tunnelling resorption defects and using continuous wave compaction with a calcium-silicate based sealer, compared to cold obturation techniques, are discussed.
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Affiliation(s)
- Kirsty A Carney
- Post Dental Core Training Fellow, Dundee Dental Hospital and Research School, Dundee, Scotland, UK.
| | - Thibault N E Colloc
- Clinical Lecturer and Honorary Specialty Registrar in Endodontics, Dundee Dental Hospital and Research School, Dundee, Scotland, UK
| | - Julie K Kilgariff
- Consultant in Endodontics, Dundee Dental Hospital and Research School, Dundee, Scotland, UK
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Eltantawi AR, Abdel-Razik GM, Elhawary YM, Badr AE. Efficacy of Glycyrrhizin as an Intracanal Medicament on Bacterial Load Reduction in Primary Infected Root Canals: A Randomized Clinical Trial. J Contemp Dent Pract 2024; 25:540-546. [PMID: 39364820 DOI: 10.5005/jp-journals-10024-3705] [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] [Indexed: 10/05/2024]
Abstract
AIM This study was done to clinically investigate the efficacy of glycyrrhizin-based intracanal medication (ICM) compared to calcium hydroxide Ca(OH)2 and Ledermix on the bacterial counts inside the root canals of necrotic teeth with chronic periapical periodontitis. METHODOLOGY Thirty-six patients having single-rooted and single-canaled necrotic teeth with chronic periapical periodontitis were enrolled in this research. Aseptic control measures were taken before clinical steps. Access cavity preparation was done. First bacteriological samples (S1) were collected immediately after access cavity preparation and before cleaning and shaping inside the root canals. Cleaning and shaping were performed on the root canals. Patients were randomly allocated into 3 groups according to the type of intracanal medicament used [Ca(OH)2, Ledermix, Glycyrrhizin]. Second bacteriological samples (S2) were collected after 1 week from placing the ICMs. S1 and S2 were transferred to the lab of microbiology for culturing on blood agar dishes in anaerobic conditions, and the bacteria on the plates were enumerated as colony-forming units (CFUs) by the manual counting method. The anti-bacterial efficacy of the ICM was estimated by the percentage reduction in the bacterial colonies from S1 to S2. RESULTS All tested ICM documented a significant reduction in the CFUs from S1 to S2 (p < 0.05). Regarding S1, there was no significant difference between the three tested materials (p > 0.05). Regarding S2, Glycyrrhizin and Ledermix showed significantly lower CFUs than Ca(OH)2. There was no significant difference between Glycyrrhizin and Ledermix. CONCLUSION Under the conditions of the present study, Glycyrrhizin and Ledermix showed comparable antimicrobial effects that were better than the commonly used Ca(OH)2 ICM. Glycyrrhizin may be a promising ICM. CLINICAL SIGNIFICANCE Herbal medicine can be considered as an alternative antimicrobial material for root canal disinfection because it has many benefits, like low toxicity, absence of microbial resistance, and favorable antimicrobial efficacy. This study highlights the clinical efficacy of Glycyrrhizin as a promising ICM. How to cite this article: Eltantawi AR, Abdel-Razik GM, Elhawary YM, et al. Efficacy of Glycyrrhizin as an Intracanal Medicament on Bacterial Load Reduction in Primary Infected Root Canals: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(6):540-546.
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Affiliation(s)
- Alaa Reda Eltantawi
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt, Phone: +201062885600, e-mail: , Orcid: https://orcid.org/0000-0002-4270-6226
| | - Ghada Moustafa Abdel-Razik
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt, Orcid: https://orcid.org/0000-0001-6845-7822
| | - Yousry Mahmoud Elhawary
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt, Orcid: https://orcid.org/0000-0001-7182-9551
| | - Amany Elsaid Badr
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt, Orcid: https://orcid.org/0000-0002-3811-149X
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Nabeshima CK, Caballero-Flores H, Vicente EJ, Gavini G, Machado MEDL. Antibacterial ability of different activated irrigation after root canal preparation: intratubular analyses. Braz Dent J 2024; 35:e245883. [PMID: 38775594 PMCID: PMC11086613 DOI: 10.1590/0103-6440202405883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/15/2024] [Indexed: 05/25/2024] Open
Abstract
This study assessed the intratubular antibacterial ability of different activated irrigations after chemical mechanical preparation. Seventy-two palatal root canals of upper molars were infected with Enterococcus faecalis for 4 weeks, and then initial bacterial collection from the main root canal was performed. The root canals were prepared by using a WaveOne Gold large (45/.05) and distributed into 6 groups according to the activation of the final irrigation: ultrasonic activation (UA), XP-Endo Finisher (25/.00), XP Clean (25/.02), EasyClean (25/.04) in reciprocating motion and continuous rotary motion (ECRot), and conventional irrigation. After final irrigation, another bacterial collection from the main root canal was performed, and the root was sectioned transversely in three-thirds and stained for analysis by confocal laser microscopy. Intratubular bacteria were collected through dentin powder and plated for bacterial viability analysis. Intergroup and intragroup comparisons were performed by using analysis of variance and repeated measures analysis of variance, respectively, both at 5% significance. ECRot had higher antibacterial ability than UA (p<0.05), and both were superior to the other groups (p<0.05) in both methodologies. It can be concluded that activation of final irrigation enhances the disinfection of the root canal system, and activators have different efficacies.
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Affiliation(s)
- Cleber Keiti Nabeshima
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Hector Caballero-Flores
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Elisabete José Vicente
- Department of Microbiology, Institute of Biological Science, University of São Paulo, São Paulo, SP, Brazil
| | - Giulio Gavini
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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de Oliveira Neto RS, Souza TDM, Rosa SJ, Vivan RR, Alcalde MP, Honório HM, Duarte MAH. Biological response to endodontic treatment in one versus two-visit: a systematic review and meta-analysis of animal studies. Clin Oral Investig 2024; 28:173. [PMID: 38407663 DOI: 10.1007/s00784-024-05571-z] [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: 12/22/2023] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES To perform a systematic review of animal studies that compared the histopathological characteristics between teeth with apical periodontitis after endodontic treatment in one or two visits. MATERIALS AND METHODS This systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) - CRD42022340849. Studies were collected from PubMed/MEDLINE, LILACS, EMBASE, Livivo, SciELO, Web of Science, Scopus, and Cochrane Library and manual and gray literature searches. Animal studies that evaluated histological characteristics after endodontic treatment of teeth with apical periodontitis in one or two visits were included. Risk of bias analysis of the included studies was performed using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool. Data synthesis of the included studies with quantitative data was performed, and meta-analysis was conducted with the Comprehensive Meta-Analysis software, using the random effects model and odds ratio (OR). RESULTS Eighteen studies met the inclusion criteria (Kappa = 0.891). Meta-analyses indicated values in inflammatory infiltrate intensity with effect size of 5.5% (95% CI: 0.020-0.148; p < 0.001), periodontal ligament thickness: 25.6% (95% CI: 0.134-0.487; p < 0.001), dentin resorption: 13% (95% CI: 0.015-1.141; p = 0.066), cementum resorption: 7.1% (95% CI: 0.015-0.325; p = 0.001), bone resorption: 1.4% (95% CI: 0.002-0.130; p < 0.001), mineralized tissue resorption: 42.8% (95% CI: 0.110-1.671; p = 0.222), biological apical sealing: 13.1% (95% CI: 0.055-0.314; p < 0.001), and presence of microorganisms: 10.3% (95% CI: 0.014-0.747; p = 0.025). CONCLUSIONS When considering animal studies, the two-visit endodontic treatment, using calcium hydroxide-based intracanal medication, resulted in better biological repair characteristics. CLINICAL RELEVANCE A two-visit endodontic treatment with calcium hydroxide-based intracanal medication yields superior histopathological outcomes.
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Affiliation(s)
- Raimundo Sales de Oliveira Neto
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Vila Universitária, Al. Octávio Pinheiro Brizolla 9-75, SP, Bauru, CEP: 17012-901, Brazil.
| | - Thais de Moraes Souza
- Department of Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo - USP, Bauru, Brazil
| | - Stefani Jovedi Rosa
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Vila Universitária, Al. Octávio Pinheiro Brizolla 9-75, SP, Bauru, CEP: 17012-901, Brazil
| | - Rodrigo Ricci Vivan
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Vila Universitária, Al. Octávio Pinheiro Brizolla 9-75, SP, Bauru, CEP: 17012-901, Brazil
| | - Murilo Priori Alcalde
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Vila Universitária, Al. Octávio Pinheiro Brizolla 9-75, SP, Bauru, CEP: 17012-901, Brazil
| | - Heitor Marques Honório
- Department of Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo - USP, Bauru, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Vila Universitária, Al. Octávio Pinheiro Brizolla 9-75, SP, Bauru, CEP: 17012-901, Brazil
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15
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Amaral RR, Love RM, Braga T, Souza Côrtes MI, Rachid CTCC, Rôças IN, Siqueira JF. Impact of root canal preparation using two single-file systems on the intra-radicular microbiome of teeth with primary apical periodontitis. Clin Oral Investig 2024; 28:139. [PMID: 38332365 PMCID: PMC10853323 DOI: 10.1007/s00784-024-05544-2] [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: 05/22/2023] [Accepted: 02/05/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES This study aimed to describe the effects of two single-file systems on the diversity of the endodontic microbiome of teeth with primary asymptomatic apical periodontitis. MATERIALS AND METHODS The root canals from single-rooted teeth with apical periodontitis were prepared using either the Reciproc Blue (RB) or the XP-endo Shaper (XPS) instrument system. The latter was followed by a supplementary step with the XP-endo Finisher (XPF) instrument. For irrigation, 5.25% sodium hypochlorite was used. Root canal samples were taken at the baseline (S1), after preparation (S2), and after the supplementary step (S3). DNA was extracted and subjected to high-throughput sequencing using the MiSeq Illumina platform. RESULTS Samples from 10 teeth from the RB and 7 from the XPS group were subjected to DNA sequencing. Initial samples differed significantly from post-preparation samples in bacterial diversity, with no significant difference when comparing the two instrument systems. The most dominant phyla in S2 were Bacteroidetes, Proteobacteria, Firmicutes, Fusobacteria, and Actinobacteria. The same phyla were found to dominate baseline samples and samples taken after using XPF, but with differences in the ranking of the most dominant ones. At the genus level, the most dominant genera identified after RB instrumentation were Bacteroidaceae [G-1], Fusobacterium, and Staphylococcus, while the most dominant genera after XPS instrumentation were Fusobacterium and Porphyromonas. These genera were also dominant in the initial samples. CONCLUSIONS Both treatment protocols had measurable effects on the root canal microbial diversity, with no significant differences between them. Most of the dominant taxa involved in the primary infection and probably in the aetiology of apical periodontitis were eliminated or substantially reduced. CLINICAL RELEVANCE The most dominant taxa that persisted after instrumentation were Fusobacterium, Porphyromonas, Staphylococcus, and Bacteroidaceae [G-1].
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Affiliation(s)
- Rodrigo Rodrigues Amaral
- College of Medicine and Dentistry, James Cook University, 1/14-88 McGregor Rd, Building D1, 2nd Floor, Campus Smithfield, Smithfield, Cairns, QLD, 4878, Australia.
| | - Robert M Love
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Tiago Braga
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Maria I Souza Côrtes
- Department of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Caio T C C Rachid
- Laboratory of Biotechnology and Microbial Ecology, Institute of Microbiology Prof. Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Isabela N Rôças
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
| | - José F Siqueira
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
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16
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Kameri A, Dragidella A, Haziri A, Hashani Z, Kurteshi K, Kurti A. Antifungal and genotoxic effects of Thymus serpyllum as a root canal irrigant. Clin Exp Dent Res 2024; 10:e837. [PMID: 38345516 PMCID: PMC10847709 DOI: 10.1002/cre2.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/13/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES The aim of this study was the assessment of the efficiency of the ethyl acetate (EthOAc) extract of Thymus serpyllum against Candida albicans and to compare it with sodium hypochlorite (NaOCl) and chlorhexidine (CHX), as well as their genotoxic effect. MATERIAL AND METHODS The antifungal effectiveness of the EthOAc extract of Thymus serpyllum was determined using the agar disk diffusion method. The inhibition zones induced by the EthOAc extract were compared after 5 min, 60 min, and 24 h to those induced by standard solutions (2% CHX and 2% NaOCl). An in vitro genotoxicity assay was performed in cultured lymphocytes from the blood of human volunteers to observe micronuclei formation. Statistical analysis of the results was performed using the Kruskal-Wallis test and one-way analysis of variance. RESULTS The inhibition zone of combination of CHX with EthOAc extract of Thymus serpyllum against C. albicans was 29.7 mm after 5 min, 28.3 mm after 60 min, and 29 mm after 24 h. The inhibition zone of NaOCl in combination with EthOAc extract of Thymus serpyllum against C. albicans was 0 mm. The EthOAc extract of Thymus serpyllum did not show a genotoxic effect on lymphocyte cells. CONCLUSIONS The EthOAc extract of Thymus serpyllum in combination with CHX may be a useful root canal disinfection in endodontic therapy.
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Affiliation(s)
- Ariana Kameri
- Department of Dental Pathology and Endodontics, Faculty of MedicineUniversity of Prishtina “Hasan Prishtina”PrishtinaKosova
| | - Agime Dragidella
- Department of Dental Pathology and Endodontics, Faculty of MedicineUniversity of Prishtina “Hasan Prishtina”PrishtinaKosova
| | - Arben Haziri
- Department of Chemistry, Natural Science FacultyUniversity of Prishtina “Hasan Prishtina”PrishtinaKosova
| | - Zeqir Hashani
- Faculty of EducationUniversity “Fehmi Agani”GjakoveKosova
| | - Kemajl Kurteshi
- Department of Biology, Natural Science FacultyUniversity of Prishtina “Hasan Prishtina”PrishtinaKosova
| | - Arsim Kurti
- Department of Microbiology, Medical FacultyUniversity of Prishtina “Hasan Prishtina”PrishtinaKosova
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Hernández SR, Siqueira JF, Voigt DD, Soimu G, Brasil SC, Provenzano JC, Mdala I, Alves FRF, Rôças IN. Bacteriologic Conditions of the Apical Root Canal System of Teeth with and without Posttreatment Apical Periodontitis: A Correlative Multianalytical Approach. J Endod 2024; 50:154-163. [PMID: 37977217 DOI: 10.1016/j.joen.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION This study used a correlative multianalytical approach to investigate the bacteriologic conditions in the apical root canal system of treated teeth with or without apical periodontitis and their correlation with the technical quality of the previous root canal obturation and the presence and volume of apical periodontitis lesions. METHODS Root apexes were obtained from recently extracted root canal-treated teeth with (n = 23) and without (n = 22) apical periodontitis lesions as demonstrated by cone-beam computed tomographic examination. The root apexes were sectioned and subjected to micro-computed tomographic (micro-CT) scanning. The specimens were cryopulverized, and DNA extracted from the powder was used as a template in real-time polymerase chain reaction assays to quantify total bacteria and members of the Streptococcus genus and Actinobacteria phylum. The bacteriologic findings were compared between the 2 groups and also evaluated for associations with cone-beam computed tomographic and micro-computed tomographic data. RESULTS Bacteria were detected in all apical canal samples except 1. The mean counts of total bacteria, streptococci, and actinobacteria did not differ significantly between teeth with or without apical periodontitis (P > .05). Streptococcus levels were significantly lower by 80% in the apical canals of teeth with small lesions compared with those without lesions (P < .05). The limit of filling >2 mm short was significantly associated with more total bacterial counts compared with canals filled 0-2 mm short (P < .05). An adequate coronal restoration was significantly associated with lesser counts of Streptococcus (P < .05). CONCLUSIONS Comparable bacterial loads were observed in the apical canal system of treated teeth with and without apical periodontitis, suggesting that factors other than only the total bacterial levels may also influence the development and progression of apical periodontitis. Bacteria were found in the apical canal in virtually all cases with a high prevalence of streptococci and actinobacteria. Streptococci counts were significantly higher in the apical canal of teeth with inadequate restorations and teeth with no lesions. Underfilled canals showed higher bacterial counts.
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Affiliation(s)
- Sandra R Hernández
- Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Endodontics, Faculty of Dentistry, Francisco Marroquín University, Guatemala City, Guatemala
| | - José F Siqueira
- Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil
| | - Danielle D Voigt
- Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giuliana Soimu
- Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sabrina C Brasil
- Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil
| | - José C Provenzano
- Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil
| | - Ibrahimu Mdala
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Flávio R F Alves
- Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil.
| | - Isabela N Rôças
- Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Dental Research, Faculty of Dentistry, Iguaçu University, Nova Iguaçu, Rio de Janeiro, Brazil
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Elmsmari F, Delgado LM, Duran-Sindreu F, Pérez RA, García ML, Teulé Trull M, Afrashtehfar KI, González JA, Sánchez-López E. Novel strategies enhancing endodontic disinfection: Antibacterial biodegradable calcium hydroxide nanoparticles in an ex vivo model. Int J Pharm 2023; 648:123627. [PMID: 37984620 DOI: 10.1016/j.ijpharm.2023.123627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023]
Abstract
Due to the high failure rates associated to endodontic disinfection, this study aimed to investigate the antibacterial properties of poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) loaded with Ca(OH)2 for endodontic disinfection procedures. Ca(OH)2 NPs production and physicochemical characterization were carried out as well as multiple antibacterial tests using three bacterial strains and an ex vivo model of endodontic infection with extracted human teeth. Agar diffusion test and broth dilution determined the inhibition growth zones (n = 5) and the minimal inhibitory concentration (MIC, n = 5), respectively. Cell viability was assessed using Live/Dead staining with confocal microscopy (n = 5). Data was analysed using ANOVA followed by post-hoc analysis. After 24 h of incubation, Ca(OH)₂ NPs demonstrated a MIC of 10 µg/mL for Porphyromonas gingivalis (p < 0.001) and Enterococcus faecalis and 5 µg/mL for Fusobacterium nucleatum (p < 0.001). Although the agar diffusion test did not exhibit any inhibition area for Ca(OH)2 nor for Ca(OH)₂ NPs, this was probably due to the buffering effect of the agar medium. However, the antibacterial capacity was confirmed in an ex vivo model, where instrumentalized teeth were infected with Enterococcus Faecalis and treated after 28 days of culture. A significant reduction in bacterial metabolic activity was confirmed for Ca(OH)2 NPs (40 % reduction with a single dose) and confirmed by Live/Dead staining. In conclusion, Ca(OH)₂-loaded PLGA NPs present promising antibacterial efficacy for endodontic disinfection procedures.
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Affiliation(s)
- Firas Elmsmari
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, PO Box 346, United Arab Emirates; Department of Endodontics, Faculty of Dentistry, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain; Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, PO Box 346, United Arab Emirates
| | - Luis María Delgado
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08028 Barcelona, Spain
| | - Fernando Duran-Sindreu
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08028 Barcelona, Spain
| | - Román A Pérez
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya (UIC), 08028 Barcelona, Spain
| | - Maria Luisa García
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN(2)UB), University of Barcelona, 08028 Barcelona, Spain; Networking Research Centre of Neurodegenerative Disease (CIBERNED), Instituto de Salud Juan Carlos III, 28029 Madrid, Spain
| | - Míriam Teulé Trull
- Department of Endodontics, Faculty of Dentistry, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain
| | - Kelvin I Afrashtehfar
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, PO Box 346, United Arab Emirates; Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland; Artificial Intelligence Research Center (AIRC), Ajman University, Ajman PO Box 346, United Arab Emirates.
| | - José Antonio González
- Department of Endodontics, Faculty of Dentistry, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain.
| | - Elena Sánchez-López
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN(2)UB), University of Barcelona, 08028 Barcelona, Spain; Networking Research Centre of Neurodegenerative Disease (CIBERNED), Instituto de Salud Juan Carlos III, 28029 Madrid, Spain; Unit of Synthesis and Biomedical Applications of Peptides, IQAC-CSIC, 08034 Barcelona, Spain.
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Marceliano-Alves MF, Amoroso-Silva P, Alves FRF, Soimu G, Provenzano JC, Campello AF, Duarte ML, Moreno JO, Sierra-Cristancho A, Calle JT, Rôças IN, Siqueira JF. Multipopulation evaluation of the internal morphology of mandibular first premolars from different South American countries. A micro-computed tomography study. Arch Oral Biol 2023; 156:105809. [PMID: 37832245 DOI: 10.1016/j.archoralbio.2023.105809] [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: 08/20/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To evaluate and compare several anatomical parameters of mandibular first premolars from individuals from different Latin American countries using micro-computed tomography. DESIGN Five hundred extracted mandibular first premolars from Brazilian, Argentinian, Chilean, Colombian, and Ecuadorian individuals were scanned using micro-computed tomography (n = 100 teeth/country). Root canal configurations were classified according to established parameters. Analyses also included: canal volume and surface area, structure model index, distances from the apical foramen to the root apex or the cementoenamel junction, major/minor apical canal diameters, canal orifice shape, and prevalence of ramifications. RESULTS A single root was the most common anatomy in all countries (range, 97%-100%). Vertucci's type-I canal was the most frequent configuration (range, 36%-66%), followed by C-shaped and type-V canals. The oval-shaped canal orifice was the most predominant in all countries (range, 34%-58%), followed by the circular shape (range, 16%-47%). C-shaped canals occurred in all subpopulations (range, 14%-26%), always associated with radicular grooves. Ranges for canal ramifications were as follows: accessory canals, 36%-73%; lateral canals, 4%-12%; and apical delta, 4%-14% of the teeth. Many anatomic parameters differed significantly between countries (P < .05). CONCLUSIONS Vertucci's types-I and -V, and C-shaped canals were the most prevalent configurations in the subpopulations investigated. Accessory canals and several complex anatomies were found, with some significantly different frequencies between countries.
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Affiliation(s)
| | - Pablo Amoroso-Silva
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Flávio R F Alves
- Department of Endodontics, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil.
| | - Giuliana Soimu
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - José C Provenzano
- Department of Endodontics, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - Andrea F Campello
- Department of Endodontics, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | | | - Jaime O Moreno
- Dental School, Santo Tomás University, Bucaramanga, Colombia
| | | | | | - Isabela N Rôças
- Department of Endodontics, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
| | - José F Siqueira
- Department of Endodontics, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
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20
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de Rabello DGD, Valera MC, Corazza BJM, Dos Santos LM, Carvalho CAT. Clinical efficacy of endodontic protocols on reducing cultivable bacteria and endotoxin in infected root canal in patients submitted to head and neck radiotherapy: a randomised clinical trial. Clin Oral Investig 2023; 27:7199-7207. [PMID: 38038750 DOI: 10.1007/s00784-023-05283-w] [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: 11/04/2021] [Accepted: 11/10/2022] [Indexed: 12/02/2023]
Abstract
OBJECTIVES Assess the efficacy of biomechanical preparation using a reciprocating system followed by final irrigation protocols, then intracanal medication, on reducing endotoxins and cultivable bacteria of infected teeth in irradiated patients. MATERIALS AND METHODS Twenty-two infected single-rooted canals in patients submitted to head and neck radiotherapy were prepared by reciprocating motion and 2.5% NaOCl. Patients were randomly divided into two groups of 11 patients before the final irrigation protocol: apical positive pressure (APP) or passive ultrasonic activation (PUA). Both groups were treated in two sessions, using Ca(OH)2 as intracanal medication for 14 days. Root canal content sampling was performed after canal access (S1), after biomechanical preparation plus the irrigation protocol (S2), and after intracanal medication (S3). Chromogenic limulus amoebocyte lysate assay measured endotoxin levels (EU/mL), and bacterial load was determined by culture techniques (CFU/mL). RESULTS Treatment protocols reduced bacterial counts after S2 in both groups (p = 0.01). S3 differed from S1 (p = 0.01), but not from S2 (p = 0.4). Endotoxin levels were reduced in both groups after S2 (P = 0.03) and were lower in S3 than in S2, with significant differences in the APP group (p = 0.03). CONCLUSIONS Biomechanical preparation using a reciprocating system and 2.5% NaOCl in irradiated teeth, followed by the irrigation protocol (APP or PUA), demonstrated efficacy in reducing endodontic contaminants. Ca(OH)2 as intracanal medication should be performed in irradiated patients with infected root canals. CLINICAL RELEVANCE This clinical study demonstrated that endodontic treatment in irradiated patients is efficacious at reducing bacterial load and endotoxin levels.
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Affiliation(s)
- Diego Guilherme Dias de Rabello
- Department of Restorative Dentistry, Endodontic Division, Institute of Science and Technology, São Paulo State University - UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, São Paulo, Brazil
| | - Marcia Carneiro Valera
- Department of Restorative Dentistry, Endodontic Division, Institute of Science and Technology, São Paulo State University - UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, São Paulo, Brazil.
| | - Bruna Jordão Motta Corazza
- Department of Restorative Dentistry, Endodontic Division, Institute of Science and Technology, São Paulo State University - UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, São Paulo, Brazil
| | - Lúcio Murilo Dos Santos
- Department of Diagnosis and Surgery, Maxillofacial Surgery Division, Institute of Science and Technology, São Paulo State University - UNESP, São José dos Campos, São Paulo, 12245-000, Brazil
| | - Claudio Antônio Talge Carvalho
- Department of Restorative Dentistry, Endodontic Division, Institute of Science and Technology, São Paulo State University - UNESP, Av. Eng. Francisco José Longo, 777, São José dos Campos, São Paulo, Brazil
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21
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Wenzler JS, Falk W, Frankenberger R, Braun A. Temporary Root Canal Obturation with a Calcium Hydroxide-Based Dressing: A Randomized Controlled Clinical Trial. Antibiotics (Basel) 2023; 12:1663. [PMID: 38136697 PMCID: PMC10740497 DOI: 10.3390/antibiotics12121663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Successful bacterial inactivation or elimination is essential for successful outcomes in endodontics. This study investigated the efficacy of a calcium hydroxide paste (Ca(OH)2) as a temporary medical dressing for 1 week after chemomechanical root canal treatment (CMRCT). Microbiological samples from 26 patients were collected after endodontic emergency treatment as follows: (1) removal of the provisional filling material; (2) CMRCT; (3) irrigation with sodium hypochlorite I (3%); (4) medicinal insertion of Ca(OH)2; and (5) irrigation with sodium hypochlorite II (3%). A microbiological examination was carried out after the specimens had been taken from the root canals via saline and sterile paper points. CMRCT resulted in a significant reduction in total bacterial load (TBL) in the root canal (p < 0.05). Additional irrigation (3) resulted in a further significant reduction in TBL (p < 0.05). In contrast, Ca(OH)2 medication did not prevent the bacterial load from returning to the previous level immediately after CMRCT, but did not increase above that level either (p < 0.05). However, the increase in TBL was significant (p < 0.05) in comparison with the disinfection groups (I/II). Administration of Ca(OH)2 for 1 week shows that in combination with an additional disinfection procedure, an increase in TBL must be expected, but not above the level of conditions after CMRCT.
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Affiliation(s)
- Johannes-Simon Wenzler
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany;
- Department of Operative Dentistry, Endodontics and Pediatric Dentistry, Campus Marburg, University Medical Center Giessen and Marburg, Georg-Voigt-Strasse 3, 35039 Marburg, Germany
| | - Wolfgang Falk
- Center for Oro-Dental Microbiology, Hamburger Chausse 25, 24220 Flintbek, Germany
| | - Roland Frankenberger
- Department of Operative Dentistry, Endodontics and Pediatric Dentistry, Campus Marburg, University Medical Center Giessen and Marburg, Georg-Voigt-Strasse 3, 35039 Marburg, Germany
| | - Andreas Braun
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany;
- Department of Operative Dentistry, Endodontics and Pediatric Dentistry, Campus Marburg, University Medical Center Giessen and Marburg, Georg-Voigt-Strasse 3, 35039 Marburg, Germany
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22
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Rossi-Fedele G, Rödig T. Effectiveness of root canal irrigation and dressing for the treatment of apical periodontitis: A systematic review and meta-analysis of clinical trials. Int Endod J 2023; 56 Suppl 3:422-435. [PMID: 35579074 DOI: 10.1111/iej.13777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) and/or calcium hydroxide (Ca(OH)2 ) are commonly used during root canal treatment. Evaluation of their effectiveness regarding clinical and patient-related outcomes requires further understanding. OBJECTIVES To assess the effectiveness of root canal irrigation and dressing for the treatment of teeth with apical periodontitis (AP). METHODS A search was conducted in the PubMed-MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until July 2021. Eligibility criteria followed the a priori formulated Population, Intervention, Comparator, Outcomes, Timing, and Study design (PICOTS) framework. Clinical studies restricted to English language were included. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess the quality of included studies. Meta-analyses were performed using the fixed-effect model to obtain Risk Ratio (RR) and 95% Confidence Interval (CI), with sensitivity analysis. Overall quality of evidence of meta-analyses was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool. RESULTS The search identified 1357 records of which six fulfilled the inclusion criteria, providing data for 'irrigation' from 212 teeth and for 'dressings' from 438 teeth. Two studies reported no significant difference regarding the outcome 'pain at 7 days' using 2% chlorhexidine vs. 5.25% NaOCl and EDTA or after using different concentrations of NaOCl (1% vs. 5%). No significant difference was detected between different NaOCl concentrations regarding the reduction of AP. A meta-analysis was possible for the comparison of single-visit (SV) versus multiple-visits including the use of Ca(OH)2 demonstrating a significant effect in favour of SV (RR: 1.10; 95% CI: 1.03-1.19; p = .007; I2 = 0). RoB of included studies was moderate to low. DISCUSSION The use of Ca(OH)2 for the treatment of AP may not be beneficial. There is scarce or no evidence fulfilling the proposed PICOTS regarding irrigants and dressings. CONCLUSIONS There is moderate certainty that SV treatment is associated with better radiographic evidence of normal periodontal ligament space (strict criteria) compared with the use of Ca(OH)2. Reduction of AP is comparable after irrigation with 1% and 5% NaOCl, whereas postoperative pain at 7 days for the irrigants assessed is similar. REGISTRATION PROSPERO database CRD42021260271.
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Affiliation(s)
| | - Tina Rödig
- Department for Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
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23
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Martins JFB, Scheeren B, van der Waal SV. The Effect of Unintentional AH-Plus Sealer Extrusion on Resolution of Apical Periodontitis After Root Canal Treatment and Retreatment-A Retrospective Case-control Study. J Endod 2023; 49:1262-1268. [PMID: 37516239 DOI: 10.1016/j.joen.2023.07.021] [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: 05/23/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION This study aimed to investigate the effect of unintentional AH Plus sealer extrusion on the outcome of nonsurgical root canal treatment and retreatment in teeth with apical periodontitis (AP) compared to teeth with AP and no sealer extrusion at the 1-year follow-up. METHODS In a retrospective case-control study conducted from September 2016 to September 2021, teeth presenting clinical and radiographic signs of AP prior to treatment were included. The study comprised 2 groups: AH Plus sealer extrusion group (n = 60): initial root canal treatment or nonsurgical retreatment with unintentional apical extrusion of AH Plus sealer; and no AH Plus sealer extrusion group (n = 60): underwent the same treatment types without sealer extrusion. Additional factors, including sex, age, tooth type, tooth location, and treatment type, were recorded as potential outcome predictors. At 1-year follow-up, teeth were evaluated clinically and radiographically, and outcomes were classified as favorable (healed/healing) or unfavorable (uncertain/non-healing). Statistical analyses, such as the χ2 test, logistic regression, and Mann-Whitney U test, were employed for data analysis. RESULTS A favorable outcome was observed in 88.4% and 85% of the cases of the AH Plus sealer extrusion and no AH Plus sealer extrusion groups, respectively. There was no statistically significant difference between the groups in terms of outcomes (P > .05) when analyzed categorically or ordinally. Of independent variables, nonsurgical retreatment showed lower healing of AP in both groups. CONCLUSIONS Unintentional AH Plus sealer extrusion did not affect the healing of AP. However, initial root canal treatment showed better healing of AP than nonsurgical retreatment in the presence of AH Plus sealer extrusion. The analyzed outcome predictors had no effect on treatment outcome.
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Affiliation(s)
- J F Brochado Martins
- Departments of Preventive Dentistry and Endodontology, Academic Centre for Dentistry, Amsterdam, the Netherlands.
| | - B Scheeren
- Departments of Preventive Dentistry and Endodontology, Academic Centre for Dentistry, Amsterdam, the Netherlands
| | - S V van der Waal
- Departments of Preventive Dentistry and Endodontology, Academic Centre for Dentistry, Amsterdam, the Netherlands
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24
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Porwal P, Shah N, Singh Rao A, Jain I, Maniangat Luke A, Shetty KP, Reda R, Testarelli L, Pawar AM. Comparative Evaluation of Efficacy of Ketoprofen and Diclofenac Transdermal Patches with Oral Diclofenac Tablet on Postoperative Endodontic Pain- A Randomized Clinical Trial. Patient Prefer Adherence 2023; 17:2385-2393. [PMID: 37790865 PMCID: PMC10544139 DOI: 10.2147/ppa.s421371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Evaluate the efficacy of transdermal patches containing ketoprofen and diclofenac sodium compared to oral diclofenac tablets in reducing post-endodontic pain after single-visit root canal therapy for teeth with symptomatic irreversible pulpitis. Methods A total of 78 eligible participants with symptomatic irreversible pulpitis and preoperative VAS scores of 4 or above were enrolled after obtaining ethical approval (SVIEC/ON/DENT/SRP/22064) and CTRI registration (CTRI/2022/07/044231). Exclusion criteria included pregnancy, lactation, fractured/cracked teeth, developmental anomalies, tooth pathology, or ongoing analgesic/NSAID use. After root canal treatment, participants were randomized into three groups using computer randomization. Groups A and B received transdermal patches with Ketoprofen and diclofenac sodium, respectively, applied to the right forearm for 24 hours, with an additional patch on the left forearm for the next day. Group C received four diclofenac sodium oral tablets, twice daily for two days. VAS scales were used to assess pain at 4, 8, 24, and 48 hours post-treatment. The VAS scores collected were tabulated and statistically analyzed using SPSS version 21 with (P < 0.05). Shapiro Wilk test and the Related Samples Friedman's Two-Way Analysis of Variance by Ranks were used for statistical evaluation. Results Statistically significant reductions in mean postoperative pain scores were observed across all groups at all time points compared to preoperative scores. Notably, the Ketoprofen patch group exhibited superior performance compared to the diclofenac transdermal patch and oral diclofenac tablet groups at 48 hours, with statistical significance (p=0.047). Conclusion The present evidence substantiates the efficacy of transdermal patches containing diclofenac and ketoprofen in managing postoperative pain arising from symptomatic irreversible pulpitis in single-rooted teeth. By avoiding the use of oral NSAIDs, these patches provide effective pain relief while minimizing the risk of adverse effects, presenting a favorable option for patients.
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Affiliation(s)
- Priya Porwal
- Department of Conservative Dentistry and Endodontics, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Nimisha Shah
- Department of Conservative Dentistry and Endodontics, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Ajay Singh Rao
- Department of Conservative Dentistry and Endodontics, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Ihit Jain
- Department of Dental Sciences, GBH American Hospital, Udaipur, Rajasthan, India
| | - Alexander Maniangat Luke
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
- Centre of Medical and Bio-Allied Health Sciences Research (CMBAHSR), Ajman University, Ajman, United Arab Emirates
| | - Krishna Prasad Shetty
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates
- Centre of Medical and Bio-Allied Health Sciences Research (CMBAHSR), Ajman University, Ajman, United Arab Emirates
| | - Rodolfo Reda
- Section of Endodontics, Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Testarelli
- Section of Endodontics, Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Ajinkya M Pawar
- Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, Maharashtra, India
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25
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Sümbüllü M, Ali A, Büker M, Arslan H. The efficiency of different irrigation activation techniques in the removal of calcium silicate-based endodontic sealer from artificially created groove. AUST ENDOD J 2023; 49 Suppl 1:238-244. [PMID: 36441606 DOI: 10.1111/aej.12722] [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: 02/28/2022] [Revised: 10/07/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
This study evaluated the removal of a calcium silicate-based sealer (EndoSeal MTA) with needle irrigation (NI), passive ultrasonic irrigation (PUI), XP-endo Finisher (XPF) and EDDY. A total of 56 human mandibular premolars were instrumented up to size 40.04 taper. The roots were separated longitudinally, and grooves were prepared with an ultrasonic tip at one-half of each root canal. The grooves were covered with EndoSeal MTA and re-attached roots were investigated based on the activation techniques applied. The results showed that significantly more material (p < 0.05) was removed in the EDDY group compared to the NI, PUI and XPF groups in the apical region. In the coronal region, no significant difference was observed between EDDY, XPF and PUI (p > 0.05), whereas all the latter were significantly more effective than NI (p < 0.05). These findings show that the removal of EndoSeal MTA can be more effective with EDDY compared to XPF, PUI and NI in the apical region.
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Affiliation(s)
- Meltem Sümbüllü
- Department of Endodontics, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Afzal Ali
- Department of Conservative Dentistry and Endodontics, Pacific Dental College and Hospital, Udaipur, India
| | - Mine Büker
- Department of Endodontics, Faculty of Dentistry, Mersin University, Mersin, Turkey
| | - Hakan Arslan
- Department of Endodontics, Faculty of Dentistry, Istanbul Medeniyet University, Istanbul, Turkey
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26
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Loyola-Fonseca SC, Campello AF, Rodrigues RCV, Alves FRF, Brasil SC, Vilela CLS, Gonçalves LS, Provenzano JC, Siqueira JF, Rôças IN. Disinfection and Shaping of Vertucci Class II Root Canals after Preparation with Two Instrument Systems and Supplementary Ultrasonic Activation of Sodium Hypochlorite. J Endod 2023; 49:1183-1190. [PMID: 37419243 DOI: 10.1016/j.joen.2023.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION This study compared disinfection and shaping after root canal preparation with either XP-endo Shaper or TruNatomy instrument systems, supplemented by ultrasonic activation of sodium hypochlorite (NaOCl) with either stainless-steel (SS) or nickel-titanium (NiTi) inserts. METHODS Mesial roots from mandibular molars with Vertucci class II configuration were divided into 2 groups (n = 24) based on anatomically paired micro-computed tomography (micro-CT) analyses. Pre and postpreparation micro-CT scans were obtained to evaluate the shaping performance. The canals were contaminated with a mixed bacterial culture for 30 days and then subjected to preparation with either XP-endo Shaper or TruNatomy instruments using NaOCl irrigation. Supplementary ultrasonic activation of NaOCl was conducted using either an SS (TruNatomy group) or NiTi (XP-endo Shaper group) insert. Bacteriological samples were taken from the canals before preparation (S1), after preparation (S2), and after the supplementary approach (S3). Bacterial reduction was evaluated using a quantitative real-time polymerase chain reaction. RESULTS Preparation with both instrument systems significantly reduced bacterial counts (P < .01). After preparation, 36% (TruNatomy) and 35% (XP-endo Shaper) were negative for bacteria. These values increased to 59% and 65% after ultrasonic activation with the SS and NiTi inserts, respectively. The quantitative data in S2 showed that XP-endo Shaper promoted a significantly higher bacterial reduction than TruNatomy (P < .05). No significant intragroup differences were observed after ultrasonic activation (P > .05), probably because the SS insert promoted a significantly higher S2-to-S3 reduction than the NiTi insert (P < .01). Micro-CT analysis revealed no significant differences in the unprepared areas between the groups (P > .05). CONCLUSIONS The XP-endo Shaper caused a significantly higher bacterial reduction than TruNatomy in Vertucci class II canals. Better antibacterial results after ultrasonic activation were observed for the SS ultrasonic inserts than for the NiTi inserts.
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Affiliation(s)
- Simone C Loyola-Fonseca
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea F Campello
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata C V Rodrigues
- Department of Endodontics, Faculty of Dentistry, Veiga de Almeida University (UVA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávio R F Alves
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Sabrina C Brasil
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caren L S Vilela
- Laboratory of Molecular Microbial Ecology, Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucio S Gonçalves
- Postgraduate Program in Dentistry, Estácio de Sá University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Claudio Provenzano
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - José F Siqueira
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabela N Rôças
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Rio de Janeiro, Brazil; Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
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27
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Bago I, Đurin A, Kanižaj D, Vuletić LB, Zdrilić IV, Anić I. The efficacy of a novel SWEEPS laser-activated irrigation compared to ultrasonic activation in the removal of pulp tissue from an isthmus area in the apical third of the root canal. Lasers Med Sci 2023; 38:189. [PMID: 37599293 DOI: 10.1007/s10103-023-03857-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023]
Abstract
This study aimed to evaluate the efficacy of Shock Wave Enhanced Emission Photoacoustic Streaming (SWEEPS) in the removal of remaining pulp tissue from the root canal isthmus area in lower molars and compare it with ultrasonically activated irrigation (UAI) and conventional needle irrigation (NI). Forty-one lower molars with isthmuses between mesial canals were included in the study. The teeth were randomly distributed into experimental groups (n = 12/each) based on the final irrigation protocol (SWEEPS, UAI, or NI) and a control group (C) (n = 5). The traditional access cavity of the mesial part of each tooth was made in all samples. The mesial root canals in the experimental groups were instrumented with a Wave One Gold Primary (25/.07) file using 3% sodium hypochlorite (NaOCl) while the distal canal served as a control for the presence of pulp tissue. No treatment was performed in the C group. Sections from the isthmus region were processed for histopathology to measure the remaining pulp tissue (RPT). The results were analyzed using analysis of variance and the Kruskal-Wallis test (α = 0.05). There were no significant differences in the relative surface area of root canals and isthmus among the groups (p > 0.05). Samples in the SWEEPS group had significantly less RPT than UAI, NI, and C (p = 0.003, 0.014, 0.003, respectively). There were no significant differences between the UAI and NI (p = 0.583). SWEEPS was the most efficient in debridement of the root canal isthmus area. UAI and NI showed similar but lower efficiency.
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Affiliation(s)
- Ivona Bago
- Department of Endodontics and Restorative Dentistry, University of Zagreb School of Dental Medicine, Gundulićeva 5, Zagreb, Croatia.
| | - Adriana Đurin
- Department of Endodontics and Restorative Dentistry, University of Zagreb School of Dental Medicine, Gundulićeva 5, Zagreb, Croatia
| | - Debora Kanižaj
- Department of Endodontics and Restorative Dentistry, University of Zagreb School of Dental Medicine, Gundulićeva 5, Zagreb, Croatia
| | | | - Ivana Vidović Zdrilić
- Department of Endodontics and Restorative Dentistry, Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia
| | - Ivica Anić
- Department of Endodontics and Restorative Dentistry, University of Zagreb School of Dental Medicine, Gundulićeva 5, Zagreb, Croatia
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Pessotti VP, Jiménez-Rojas LF, Alves FRF, Rôças IN, Siqueira JF. Post-treatment apical periodontitis associated with a missed root canal in a maxillary lateral incisor with two roots: A case report. AUST ENDOD J 2023; 49:380-385. [PMID: 35801358 DOI: 10.1111/aej.12657] [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: 04/27/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Abstract
Missed canals can be a common cause of persistent intraradicular infection and post-treatment apical periodontitis. This article reports on a rare case of a maxillary lateral incisor with two roots exhibiting symptomatic post-treatment apical periodontitis regardless of a radiographically adequate root canal treatment. The second root, which was only revealed by cone-beam computed tomography, had passed unnoticed during the first treatment, and its missed canal was the most likely cause of symptoms and treatment failure. Reintervention including the proper management of the extra root canal and retreatment of the main canal resulted in the resolution of symptoms and periradicular tissue healing. This case report reinforces the need for three-dimensional radiographic diagnosis to search for the cause of post-treatment disease and guide the decision-making process for proper management.
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Affiliation(s)
- Vanessa P Pessotti
- EndoChat Research Group, Rio de Janeiro, Brazil
- Private Practice, Vila Velha, Brazil
| | - Luis F Jiménez-Rojas
- EndoChat Research Group, Rio de Janeiro, Brazil
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Flávio R F Alves
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Brazil
| | - Isabela N Rôças
- EndoChat Research Group, Rio de Janeiro, Brazil
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Brazil
| | - José F Siqueira
- EndoChat Research Group, Rio de Janeiro, Brazil
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
- Department of Dental Research, Faculty of Dentistry, Iguaçu University (UNIG), Nova Iguaçu, Brazil
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Baaij A, Visscher CM, Jansen M, Özok AR. Incidence of interappointment emergencies in multiple-visit root canal treatments performed with or without intracanal medicament by undergraduate students. Restor Dent Endod 2023; 48:e31. [PMID: 37675442 PMCID: PMC10477423 DOI: 10.5395/rde.2023.48.e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/27/2023] [Accepted: 05/07/2023] [Indexed: 09/08/2023] Open
Abstract
Objectives This retrospective cohort study examined the incidence of interappointment emergencies during multiple-visit molar root canal treatments conducted by undergraduate students. Treatments performed without the use of intracanal medicament were compared to treatments that incorporated calcium hydroxide as an intracanal medicament. Materials and Methods Interappointment emergencies, defined as instances of pain or swelling that required the patient to make an unscheduled follow-up visit, were recorded for up to 2 months after the intervention. To avoid the influence of obturation on the observed incidence of emergency visits, only unscheduled visits occurring between the start and end of the root canal treatment were included. Results Of the 719 patients included in this study, 77 (10.7%) were recorded as experiencing interappointment emergencies. Of these emergencies, 62% occurred within 2 weeks following the most recent intervention. In the group of patients who did not receive intracanal medicament, the incidence of interappointment emergencies was 11.9% (46 of 385 patients). In comparison, this rate was 9.3% (31 of 334 patients) among those who received calcium hydroxide as an intracanal medicament (odds ratio, 1.33; 95% confidence interval, 0.82-2.15; p = 0.249). Conclusions Interappointment emergencies may arise at any point during root canal treatment, but they most commonly occur within the first 2 weeks following intervention. The omission of intracanal medicament in multiple-visit molar root canal treatments, performed by undergraduate students, did not significantly increase the incidence of these emergencies.
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Affiliation(s)
- Annemarie Baaij
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Corine Mirjam Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Manon Jansen
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ahmet Rifat Özok
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Capitanio BL, Hashizume LN, Kuga MC, de Oliveira ECG, da Rosa RA, Só GB, Só MVR. Analysis of pH, calcium ion release, and energy dispersive spectroscopy of a bioceramic root canal dressing. Braz Dent J 2023; 34:54-61. [PMID: 37909642 PMCID: PMC10642275 DOI: 10.1590/0103-6440202305506] [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: 03/31/2023] [Accepted: 08/15/2023] [Indexed: 11/03/2023] Open
Abstract
This study compared the pH and calcium ion release of calcium silicate- (Bio-C Temp) and calcium hydroxide-based (Ultracal XS) medications. Intracanal remnants of both medications were also evaluated using SEM-EDS after the removal protocol. Thirty-five bovine teeth were prepared. Fifteen were filled with Bio-C Temp and 15 with Ultracal XS. Five remained without intracanal medication (control group). Five samples from each experimental time (i.e.. 24, 72, and 168 hours) were used to measure pH and calcium ions release using a digital pH meter and microplate reader, respectively. Afterward, the peaks of the chemical elements composing both medications were analyzed in SEM-EDS. One-way ANOVA and Tukey's post hoc test analyzed the pH and calcium ion release data. Student's t-test compared the medications in each experimental time. SEM-EDS described the percentage of chemical elements in the samples. Bio-C Temp and Ultracal XS showed a significant pH increase from 24 to 168 hours (p<0.05). Ultracal XS showed a higher pH value at 24 hours than Bio-C Temp (p<0.05) but were similar at 72 and 168h (p > 0.05). Calcium ion release did not depend on the experimental period (p > 0.05). Bio-C Temp showed lower calcium ions release than Ultracal XS at 24 hours (p<0.05). SEM-EDS analyses showed the remains of both medications, but the concentration of Si, Al, and W ions was present only in the calcium silicate-based medication. Bio-C Temp presented alkaline pH and a satisfactory calcium ion release over the time. The remaining of both medications were present after the protocols for paste removal.
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Affiliation(s)
- Bárbara Luzia Capitanio
- School of Dentistry, Department of Conservative Dentistry, Federal
University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Lina Naomi Hashizume
- School of Dentistry, Department of Conservative Dentistry, Federal
University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Milton Carlos Kuga
- School of Dentistry, Department of Restorative Dentistry - UNESP,
São Paulo State University, Araraquara, Brazil
| | | | - Ricardo Abreu da Rosa
- School of Dentistry, Department of Conservative Dentistry, Federal
University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Gabriel Barcelos Só
- School of Dentistry, Department of Conservative Dentistry, Federal
University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | - Marcus Vinicius Reis Só
- School of Dentistry, Department of Conservative Dentistry, Federal
University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
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Barros MC, Pedrinha VF, Graeff MSZ, Bramante CM, Duarte MAH, de Andrade FB. A new model of in vitro dentin intratubular contamination for Fusobacterium nucleatum: Validation by confocal laser scanning microscopy. Heliyon 2023; 9:e18042. [PMID: 37539102 PMCID: PMC10395344 DOI: 10.1016/j.heliyon.2023.e18042] [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: 02/01/2023] [Revised: 06/20/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023] Open
Abstract
Objectives To test and validate a new protocol for in vitro contamination of dentinal tubules using Fusobacterium nucleatum (F. nucleatum) by confocal laser scanning microscopy (CLSM), in addition to evaluating the effectiveness of conventional endodontic irrigants such as sodium hypochlorite (NaOCl) and chlorhexidine (CLX) on this biofilm. Material and methods Thirty lower premolars were contaminated with F. nucleatum (ATCC 51190) for 7 days under anaerobic conditions using the proposed new model. The specimens were divided into a control group and experimental groups, according to the irrigants: NaOCl 2.5% and CLX 2%. Then, the samples were submitted for analysis by CLSM and the LIVE/DEAD technique to quantify bacterial viability. Data normality was verified by the Shapiro-Wilk test. Intragroup and intergroup comparisons were performed using the Kruskal-Wallis test, followed by Dunn's post-test. Results The CLSM images obtained demonstrated the effectiveness of the proposed new contamination protocol, with a high percentage of viable bacteria in relation to the treated groups (p < 0.05). Lower viability values were observed for the 2.5% NaOCl group. Conclusion The new contamination protocol resulted in a high and homogeneous percentage of viable bacteria in the dentinal tubules in all specimens evaluated. Both irrigating solutions proved to be effective in reducing the intratubular microbiota, especially 2.5% NaOCl.
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Affiliation(s)
- Mirela Cesar Barros
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Victor Feliz Pedrinha
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | | | - Clovis Monteiro Bramante
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Flaviana Bombarda de Andrade
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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Giardino L, Generali L, Del Fabbro M, Tartaglia GM, Bidossi A, Savadori P. Detection of bacteria in dental samples using the Periodic acid-Schiff (PAS) histological stain. Micron 2023; 172:103498. [PMID: 37295188 DOI: 10.1016/j.micron.2023.103498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
The bacterial cell wall mainly consists of glycoproteins and polysaccharides, which could be detected in dental tissue with specific stain protocols. The present study aimed to investigate bacteria stainability in dental histological samples of human teeth by a histochemical method. Eight extracted teeth, because severely decayed, were decalcified, dehydrated, paraffin-embedded, and serially sectioned at 4 µm thickness each. The serial sections were then stained with Periodic acid-Schiff (PAS). Furthermore, SEM analysis was performed on the same slide of one previously histologically investigated tooth to acquire more details on the structures stained by the PAS method obtained from the histological procedures. Afterward, some American Type Culture Collection (ATCC) strains, smeared on glass slides, were stained following the staining method used in histological samples. Stained rod and cocci forms by PAS stain, observed under light microscopy, were predominantly detected inside dentinal tubules and root canal space of histologically examined specimens, suggesting their bacterial origin. Additional SEM analysis on the identical histological stained slide showed the precise nature of these forms (bacteria) and supplemental information regarding their vitality status. In addition, ATCC smeared strain samples showed variable PAS stainability of microorganisms investigated. Due to its properties, the PAS histochemical stain could be a valid and helpful aid for non- or weakly stainable microorganisms in infected tissues to be associated with other methods of investigation.
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Affiliation(s)
| | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Massimo Del Fabbro
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università Degli Studi di Milano, 20122 Milan, Italy; IRCCS Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, 20133, Milano, Italy
| | - Gianluca Martino Tartaglia
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università Degli Studi di Milano, 20122 Milan, Italy; IRCCS Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, 20133, Milano, Italy
| | | | - Paolo Savadori
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università Degli Studi di Milano, 20122 Milan, Italy; IRCCS Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, 20133, Milano, Italy.
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Versiani MA, Martins J, Ordinola-Zapata R. Anatomical complexities affecting root canal preparation: a narrative review. Aust Dent J 2023; 68 Suppl 1:S5-S23. [PMID: 37984802 DOI: 10.1111/adj.12992] [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] [Accepted: 10/15/2023] [Indexed: 11/22/2023]
Abstract
A fundamental aspect of the Endodontic field is the knowledge of root canal anatomy. Using a variety of techniques, the internal and external anatomy of teeth have been extensively investigated throughout the past century. Recent improvements in three-dimensional computed tomography have enabled more detailed evaluations of root canal morphology in both clinical and laboratory settings. Essentially, researches have unveiled that the root canal constitutes a complex system, comprising not only the main root canal but also lateral components, including isthmuses, fins, accessory canals and apical ramifications. Undoubtedly, this intricate morphology poses a significant challenge when it comes to the process of shaping, cleaning and disinfecting the root canal system. This article aims to explore the anatomical aspects of the root canal system that impact the chemomechanical procedures.
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Affiliation(s)
- M A Versiani
- Dental Specialty Center, Brazilian Military Police, Belo Horizonte, Brazil
| | - Jnr Martins
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Grupo de Investigação em Bioquímica e Biologia Oral, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
- Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE) - Cochrane Portugal, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisboa, Portugal
| | - R Ordinola-Zapata
- Endodontic Division, Department of Restorative Sciences, University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
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Candeiro GTDM, de Menezes AST, de Oliveira ACS, Alves FRF. Successful nonsurgical treatment of type II dens invaginatus with 5 root canals using a self-adjusting file: a case report. Restor Dent Endod 2023; 48:e17. [PMID: 37284340 PMCID: PMC10240087 DOI: 10.5395/rde.2023.48.e17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/26/2023] [Accepted: 02/22/2023] [Indexed: 06/08/2023] Open
Abstract
The present report describes the endodontic treatment of an Oehlers type II dens invaginatus in a maxillary lateral incisor with 5 root canals, an extremely rare condition. Apical periodontitis and related symptoms were noted. Cone-beam computed tomography was used to aid the diagnosis, reveal tooth morphology, and assist in canal location. The pulp chamber was carefully accessed, and the root canals were explored under magnification. All root canals were prepared with an R25 Reciproc Blue system and sodium hypochlorite (NaOCl) irrigation. After initial preparation, a self-adjusting file (SAF) with NaOCl and ethylenediaminetetraacetic acid was used to complement the disinfection. Additionally, calcium hydroxide medication was applied. Vertical compaction was used to fill the canals with a calcium silicate-based endodontic sealer and gutta-percha. After 12 months, the patient exhibited healing of the periapical region, absence of symptoms, and normal dental function. In conclusion, this nonsurgical treatment protocol was successful in promoting the cure of apical periodontitis. Both complementary disinfection with an SAF and use of calcium hydroxide medication should be considered when choosing the best treatment approach for dens invaginatus with very complex anatomy.
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Affiliation(s)
| | | | | | - Flávio Rodrigues Ferreira Alves
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Duque de Caxias, RJ, Brazil
- Department of Endodontics and Dental Research Group, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
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Jain S, Patni P, Jain P, Raghuwanshi S, Pandey SH, Tripathi S, Soni A. Comparison of dentinal tubular penetration of Intra-canal heated and Pre-heated sodium hypochlorite through different agitation techniques. J Endod 2023:S0099-2399(23)00235-2. [PMID: 37105500 DOI: 10.1016/j.joen.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION The efficacy of sodium hypochlorite (NaOCl) as an intracanal irrigant is widely debated in endodontic therapy. This study aimed to analyze and compare the penetration abilities of different modes of NaOCl application and assess the impact of various agitation strategies on promoting root canal cleanliness. MATERIALS AND METHODS This study included 168 single-rooted mandibular premolars that were randomly divided into eight groups. The two modes of application of 5% NaOCl evaluated were intracanal heating and preheating, and the agitation strategies included ultrasonic, sonic, and manual dynamic agitations (MDAs). The samples were sectioned and observed at a magnification of 1000× under a scanning electron microscope. RESULTS The analysis of variance test showed a statistically significant difference among the various groups of agitation (P < 0.05). The post hoc Tukey test confirmed that preheated NaOCl with ultrasonic agitation, intracanal-heated NaOCl with sonic agitation, and MDA had significantly higher debris scores of 1, 4, and 5, respectively, in the apical third of the canal. CONCLUSION The results indicated that the combination of intracanal-heated NaOCl and ultrasonic agitation is an effective method for reducing debris in the root canal system. These findings highlight the importance of considering both the mode of application and the agitation strategies when optimizing the use of NaOCl as an intracanal irrigant in endodontic therapy.
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Affiliation(s)
- Swati Jain
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
| | - Pallav Patni
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India.
| | - Pradeep Jain
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
| | - Swadhin Raghuwanshi
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
| | - Sanket Hans Pandey
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
| | - Shubham Tripathi
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
| | - Ankita Soni
- Sri Aurobindo College of Dentistry, Sri Aurobindo University, Indore, MP, India
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Gulabivala K, Ng YL. Factors that affect the outcomes of root canal treatment and retreatment-A reframing of the principles. Int Endod J 2023; 56 Suppl 2:82-115. [PMID: 36710532 DOI: 10.1111/iej.13897] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence-based era (1980-present) is contextualized with the earlier evidence drive in endodontics (1911-1940) triggered by the focal infection era. The current evidence-based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline-driven, or expertise-development-driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre-operative, intra-operative and postoperative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter-intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross-discipline-synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre-operative patient factors) and how the direction of this dynamic is influenced by two factors: (1) the active efficacy of the operators' root canal treatment protocol to sustain a microbial ecological shift (intra-operative treatment factors) and dampen periapical inflammation; and (2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (postoperative restorative factors).
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Affiliation(s)
- Kishor Gulabivala
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK
| | - Yuan Ling Ng
- Unit of Endodontology, Department of Restorative Dentistry, UCL Eastman Dental Institute, University College London, London, UK
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Ribeiro AV, Velásquez-Espedilla EG, de Barros MC, de Melo Simas LL, de Andrade FB. Influence of Gutta-Percha Surface on Enterococcus faecalis Initial Adhesion In Vitro: An Atomic Force Microscopy Study. Life (Basel) 2023; 13:life13020456. [PMID: 36836813 PMCID: PMC9958639 DOI: 10.3390/life13020456] [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: 12/12/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
The aim of this study was to evaluate the influence of surface topography of gutta-percha (GP) cones and plasticized disks of GP on the initial adhesion of Enterococcus faecalis (E. faecalis). The GP cones (Tanari and Dentsply brands) were cut 3 mm from the apical portion and fixed on a glass slide. To make the disks, the cones were thermoplasticized in standardized molds. The specimens were divided into groups according to the shape of the GP and the presence or absence of the bacteria. For contamination, the strain of E. faecalis (ATCC 29212) was used. The surface topography was analyzed using an atomic force microscope (AFM). The surface, roughness, and waviness parameters were evaluated by the Kruskal-Wallis and Dunn test. The comparison between disks and cones showed significant differences, where the cones were rougher, with a higher value attributed to the Dentsply cone (DC group). The same was observed for the waviness. After contamination, there was greater bacterial accumulation in cones, especially in their valleys, but both the surface and the topography became more homogeneous and smoother, with no differences between disks and cones of both brands. The topographic surface of the GP, at the micro and nanoscale, influences the initial adhesion of E. faecalis, with a greater tendency for contamination in regions associated with the presence of roughness and waviness. In this context, plasticization of GP is indicated, as it reduces surface irregularities compared to cones, contributing to less retention of bacteria.
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Affiliation(s)
- Allan Victor Ribeiro
- Department of Physics, Federal Institute of São Paulo, Birigui CEP 16201-407, SP, Brazil
| | - Evelyn Giuliana Velásquez-Espedilla
- Department of Dentistry, Endodontic and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru CEP 17012-901, SP, Brazil
| | - Mirela Cesar de Barros
- Department of Dentistry, Endodontic and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru CEP 17012-901, SP, Brazil
| | - Letícia Lobo de Melo Simas
- Department of Dentistry, Endodontic and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru CEP 17012-901, SP, Brazil
| | - Flaviana Bombarda de Andrade
- Department of Dentistry, Endodontic and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru CEP 17012-901, SP, Brazil
- Correspondence: ; Tel.: +55-143235-8344
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Savadori P, Dalfino S, Piazzoni M, Parrini M, Del Fabbro M, Tartaglia GM, Giardino L. A simplified method for detecting Gram-positive and Gram-negative bacteria in dental histological samples: A preliminary and comparative study. Acta Histochem 2023; 125:151992. [PMID: 36566583 DOI: 10.1016/j.acthis.2022.151992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Bacteria identification inside the dental tissue is a complex procedure requiring specific protocols. This study aimed to compare two classical Gram staining methods with a new staining method proposed by the authors to detect Gram-positive and Gram-negative bacteria in dental histological samples of human dentin. METHODS Ten human teeth, extracted because of various pathologies, were decalcified, dehydrated, and paraffin-embedded. Then, approximately 100 serial sections of 4 µm thickness were made per sample. The serial sections were placed on glass slides and were stained according to Brown-Brenn, Brown-Hopps, and a proposed modification of Brown-Brenn staining. Both ATCC strains, smeared on glass slides, were stained following each method's instructions used in histological samples. RESULTS From a qualitative evaluation, the Brown-Brenn method resulted in better staining of Gram-positive bacteria, while the authors' proposed staining technique was more oriented towards Gram-negative bacteria. On the other hand, the Brown-Hopps showed quite a balance in detecting Gram-positive and Gram-negative bacteria. Unlike the Brown-Brenn stain, the other two protocols showed better stainability of Gram-negative microorganisms in bacterial-smeared samples. CONCLUSION All staining techniques evaluated in this article can identify bacteria, but the outcome can change according to the staining procedure used.
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Affiliation(s)
- Paolo Savadori
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, IRCCS Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Sophia Dalfino
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, IRCCS Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milano, Italy; Complex Tissue Regeneration Department, MERLN Institute for Technology Inspired Regenerative Medicine, Maastricht, The Netherlands.
| | - Marco Piazzoni
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, IRCCS Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Matteo Parrini
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, IRCCS Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, IRCCS Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, IRCCS Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
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Jiang J, Sun J, Huang Z, Bi Z, Yu G, Yang J, Wang Y. The state of the art and future trends of root canal files from the perspective of patent analysis: a study design. Biomed Eng Online 2022; 21:90. [PMID: 36566212 PMCID: PMC9789667 DOI: 10.1186/s12938-022-01060-0] [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: 09/09/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
The goal of this review is to present a detailed and comprehensive description of the published work from the past decade regarding methods of improved material, geometric design, and additional functions in root canal files. The main improved methods of files and the most common technologies were further addressed, underlining their advantages and main limitations. Online databases (the Derwent Innovations Index) were consulted on this topic. Published work from 2010 to 2022 was collected and analyzed the relevant papers were chosen for inclusion in this review. The patent map classified the latest phase of the root canal files based on the analysis of the number of patents. The performance of the root canal files, such as materials. Directly affects the quality of the root canal therapy. We provided a thorough review of advances in the field of root canal files. In particular, three categories of improved methods were examined and compared, including material-based methods, geometry-based methods, and those based on additional functions. To understand this state of the art of different improved methods of root canal files, we conducted a literature analysis and a series of comparisons between different methods. The features and limitations of each method of root canal files were further discussed. Finally, we identified promising research directions in advancing the methods for the improved performance of root canal files. There is no perfect technology for all material/geometric design/additional functions, capable alone of fulfilling all the specificity and necessities of every patient. Although it is very promising, the material of the files remains understudied, and further work is required to make material science a pervasive technology in root canal therapy, and contribute to endodontic and periapical diseases by assisting in the subsequent development of root canal files.
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Affiliation(s)
- Jingang Jiang
- grid.411994.00000 0000 8621 1394Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080 Heilongjiang People’s Republic of China ,grid.19373.3f0000 0001 0193 3564State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, 150001 Heilongjiang People’s Republic of China
| | - Jianpeng Sun
- grid.411994.00000 0000 8621 1394Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080 Heilongjiang People’s Republic of China
| | - Zhiyuan Huang
- grid.19373.3f0000 0001 0193 3564State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, 150001 Heilongjiang People’s Republic of China
| | - Zhuming Bi
- grid.503846.c0000 0000 8951 1659Department of Civil and Mechanical Engineering, Purdue University Fort Wayne, West Lafayette, 46805 USA
| | - Guang Yu
- grid.12527.330000 0001 0662 3178Department of Mechanical Engineering, Tsinghua University, Beijing, 100084 People’s Republic of China
| | - Jingwen Yang
- grid.11135.370000 0001 2256 9319National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School of Stomatology, Beijing, 100081 People’s Republic of China ,grid.11135.370000 0001 2256 9319Peking University School of Stomatology, Beijing, 100081 People’s Republic of China
| | - Yong Wang
- grid.11135.370000 0001 2256 9319National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School of Stomatology, Beijing, 100081 People’s Republic of China ,grid.11135.370000 0001 2256 9319Peking University School of Stomatology, Beijing, 100081 People’s Republic of China
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Mergoni G, Ganim M, Lodi G, Figini L, Gagliani M, Manfredi M. Single versus multiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst Rev 2022; 12:CD005296. [PMID: 36512807 PMCID: PMC9747194 DOI: 10.1002/14651858.cd005296.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, coronal crack or fracture, or dental trauma. Successful RoCT is characterised by an absence of symptoms (i.e. pain) and clinical signs (i.e. swelling and sinus tract) in teeth without radiographic evidence of periodontal involvement (i.e. normal periodontal ligament). The success of RoCT depends on a number of variables related to the preoperative condition of the tooth, as well as the endodontic procedures. RoCT can be carried out with a single-visit approach, which involves root canal system obturation (filling and sealing) directly after instrumentation and irrigation, or with a multiple-visits approach, in which the treatment is completed in two or more sessions and obturation is performed in the last session. This review updates the previous versions published in 2007 and 2016. OBJECTIVES To evaluate the benefits and harms of completion of root canal treatment (RoCT) in a single visit compared to RoCT over two or more visits, with or without medication, in people aged over 10 years. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 25 April 2022. SELECTION CRITERIA We included randomised controlled trials and quasi-randomised controlled trials in people needing RoCT comparing completion of RoCT in a single visit compared to RoCT over two or more visits. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. tooth extraction and 2. radiological failure after at least one year (i.e. periapical radiolucency). Our secondary outcomes were 3. postoperative and postobturation pain; 4. swelling or flare-up; 5. analgesic use and 6. presence of sinus track or fistula after at least one month. We used GRADE to assess certainty of evidence for each outcome. We excluded five studies that were included in the previous version of the review because they did not meet the current standard of care (i.e. rubber dam isolation and irrigation with sodium hypochlorite). MAIN RESULTS We included 47 studies with 5805 participants and 5693 teeth analysed. We judged 10 studies at low risk of bias, 17 at high risk of bias and 20 at unclear risk of bias. Only two studies reported data on tooth extraction. We found no evidence of a difference between treatment in one visit or treatment over multiple visits, but we had very low certainty about the findings (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.09 to 2.50; I2 = 0%; 2 studies, 402 teeth). We found no evidence of a difference between single-visit and multiple-visit treatment in terms of radiological failure (RR 0.93, 95% CI 0.81 to 1.07; I2 = 0%; 13 studies, 1505 teeth; moderate-certainty evidence). We found evidence of a higher proportion of participants reporting pain within one week in single-visit groups compared to multiple visit groups (RR 1.55, 95% CI 1.14 to 2.09; I2 = 18%; 5 studies, 638 teeth; moderate-certainty evidence). We found no evidence of a difference in the proportion of participants reporting pain until 72 hours postobturation (RR 0.97, 95% CI 0.81 to 1.16; I2 = 70%; 12 studies, 1329 teeth; low-certainty evidence), pain intensity until 72 hours postobturation (mean difference (MD) 0.26, 95% CI -4.76 to 5.29; I2 = 98%; 12 studies, 1258 teeth; low-certainty evidence) or pain at one week postobturation (RR 1.05, 95% CI 0.67 to 1.67; I2 = 61%; 9 studies, 1139 teeth; very low-certainty evidence). We found no evidence of a difference in swelling or flare-up incidence (RR 0.56 95% CI 0.16 to 1.92; I2 = 0%; 6 studies; 605 teeth; very low-certainty evidence), analgesic use (RR 1.25 95% CI 0.75 to 2.09; I2 = 36%; 6 studies, 540 teeth; very low-certainty evidence) or sinus tract or fistula presence (RR 1.00, 95% CI 0.24 to 4.28; I2 = 0%; 5 studies, 650 teeth; very low-certainty evidence). Subgroup analysis found no differences between single-visit and multiple-visit RoCT for considered outcomes other than proportion of participants reporting post-treatment pain within one week, which was higher in the single-visit groups for vital teeth (RR 2.16, 95% CI 1.39 to 3.36; I2 = 0%; 2 studies, 316 teeth), and when instrumentation was mechanical (RR 1.80, 95% CI 1.10 to 2.92; I2 = 56%; 2 studies, 278 teeth). AUTHORS' CONCLUSIONS As in the previous two versions of the review, there is currently no evidence to suggest that one treatment regimen (single-visit or multiple-visit RoCT) is more effective than the other. Neither regimen can prevent pain and other complications in the 12-month postoperative period. There was moderate-certainty evidence of higher proportion of participants reporting pain within one week in single-visit groups compared to multiple-visit groups. In contrast to the results of the last version of the review, there was no difference in analgesic use.
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Affiliation(s)
- Giovanni Mergoni
- Centro Universitario di Odontoiatria, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Martina Ganim
- Centro Universitario di Odontoiatria, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Giovanni Lodi
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | | | - Maddalena Manfredi
- Centro Universitario di Odontoiatria, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
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Magar SS, Alfayyadh AY, Alruwaili KK, Almunahi HFF, Alsharari AHL, Magar SP. The Determination of Flare-Up Incidence and Associated Risk Factors During Endodontic Treatment: An Observational Retrospective Study. Cureus 2022; 14:e31424. [PMID: 36523703 PMCID: PMC9747067 DOI: 10.7759/cureus.31424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Endodontic flare-up signifies pain and/or swelling seen within a few days after an endodontic appointment by patients requiring an emergency. These are undesirable and unwanted as they cause great discomfort to the subjects and stress to the operator due to swelling and pain. AIMS This study aims to determine the flare-up incidence and associated risk factors during endodontic treatment. METHODS The present retrospective study assessed 1000 patients of both genders for endodontic flare-ups. Flare-up cases were patients having swelling or pain within 1-3 days after a root canal appointment and needing an emergency visit for relieving the symptoms. After data recording, it was subjected to statistical analysis to assess related factors, flare-up cause, and incidence rate using Fisher's exact test and chi-square test. RESULTS In the present study, the incidence rate of flare-ups is 9.4%. The majority of flare-ups were in the molar teeth followed by the anterior teeth and 6.7% (n=30) of the premolar teeth. For the number of canals, it was seen in 13.6% (n=24) of cases with multiple canals, 5.5% (n=12) of cases with two canals, and 9.6% (n=58) of cases with a single canal. In patients with no medical history, flare-ups were significantly less compared to patients with medical history (p<0.001). A significantly higher number of flare-ups were in the teeth having pulp necrosis with periapical lesions with 45.9% (n=34) (p<0.001). CONCLUSION Flare-ups are commonly seen in multiple canal teeth having pulp necrosis with periapical lesions with an associated medical history, with females being more prone to endodontic flare-up cases.
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Affiliation(s)
- Shilpa S Magar
- Department of Conservative Dentistry and Endodontics, College of Dentistry, Jouf University, Sakaka, SAU
| | - Afrah Yousef Alfayyadh
- Department of Conservative Dentistry and Endodontics, College of Dentistry, Jouf University, Sakaka, SAU
| | - Khluod Khalifah Alruwaili
- Department of Conservative Dentistry and Endodontics, College of Dentistry, Jouf University, Sakaka, SAU
| | - Hessah Fahad F Almunahi
- Department of Conservative Dentistry and Endodontics, College of Dentistry, Jouf University, Sakaka, SAU
| | | | - Shaliputra P Magar
- Department of Oral Medicine and Radiology, College of Dentistry, Jouf University, Sakaka, SAU
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Rôças IN, Provenzano JC, Neves MS, Alves FR, Gonçalves LS, Siqueira JF. Effects of calcium hydroxide paste in different vehicles on bacterial reduction during treatment of teeth with apical periodontitis. J Endod 2022; 49:55-61. [DOI: 10.1016/j.joen.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/29/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
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Alajmi B, Karobari MI, Aldowah O. Treatment of a large through and through periapical lesion using guided tissue regeneration: A case report of 2 years follow-up. Clin Case Rep 2022; 10:e6405. [PMID: 36237942 PMCID: PMC9536501 DOI: 10.1002/ccr3.6405] [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: 07/26/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
Proper removal of the diseased tissue, debriding the canal system, and sealing the defect or cavity, the surgeon prevents or reduces the spread of microorganisms within the periradicular tissues. Treatment modalities following the failure of root canal treatment (RCT) are root canal retreatment (ReRCT). Regeneration of periapical defects may have a significant problem in periradicular surgery. In such circumstances, the gingival connective tissue can proliferate, or the oral epithelium can migrate into the defect, preventing the development of normal trabecular bone. Hard tissue can be restored using guided tissue regeneration (GTR) in conjunction with endodontic treatment for endodontic-periodontal lesions. Treatment of large periapical defects using GTR increases overall treatment success.
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Affiliation(s)
- Buraikan Alajmi
- Endodontic Department at Adan Dental CenterMinistry of HealthKuwaitKuwait
| | - Mohmed Isaqali Karobari
- Conservative Dentistry Unit, School of Dental SciencesUniversiti Sains Malaysia, Health CampusKubang KerianKota bharuMalaysia
- Department of Conservative Dentistry & Endodontics, Saveetha Dental College & HospitalsSaveetha Institute of Medical and Technical Sciences UniversityChennaiIndia
| | - Omir Aldowah
- Prosthetic Dental Science Department, Faculty of DentistryNajran UniversityNajranSaudi Arabia
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Pietrzycka K, Radwanski M, Hardan L, Bourgi R, Mancino D, Haikel Y, Lukomska-Szymanska M. The Assessment of Quality of the Root Canal Filling and the Number of Visits Needed for Completing Primary Root Canal Treatment by Operators with Different Experience. Bioengineering (Basel) 2022; 9:468. [PMID: 36135014 PMCID: PMC9495316 DOI: 10.3390/bioengineering9090468] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/12/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Abstract
The main goal of root canal treatment (RCT) is to eradicate or essentially diminish the microbial population within the root canal system and to prevent reinfection by a proper chemo-mechanical preparation and hermetic final obturation of the root canal space. The aim of this study was to assess the quality of the root canal filling and the number of visits needed for completing RCT by operators with different experience, including dentistry students (4th and 5th year), general dental practitioners (GDPs), and endodontists. Data from medical records of 798 patients were analyzed, obtaining 900 teeth and 1773 obturated canals according to the inclusion and exclusion criteria. A similar number of teeth was assessed in each group in terms of density and length of root canal filling and number of visits. The larger number of visits and the lower quality of treatment was observed for 4th year students than for other groups (p < 0.05); in contrast, the endodontists needed the lowest number of visits to complete RCT and more often overfilled teeth than other operator groups (p < 0.05). Interestingly, no statistical difference in quality of root canal filling was noted between 5th year students, GPDs and endodontists. The treatment of lower teeth demanded statistically more visits than that of upper teeth (p < 0.05). The results of the study emphasize that most of the root canal filling performed by operators was considered adequate, regardless of tooth type, files used and number of visits.
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Affiliation(s)
- Krystyna Pietrzycka
- Department of Endodontics, Medical University of Lodz, 251 Pomorska Str., 92-213 Lodz, Poland
| | - Mateusz Radwanski
- Department of Endodontics, Medical University of Lodz, 251 Pomorska Str., 92-213 Lodz, Poland
| | - Louis Hardan
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon
| | - Rim Bourgi
- Department of Restorative Dentistry, School of Dentistry, Saint-Joseph University, Beirut 1107 2180, Lebanon
| | - Davide Mancino
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Biomaterials and Bioengineering, 67000 Strasbourg, France
- Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Youssef Haikel
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Biomaterials and Bioengineering, 67000 Strasbourg, France
- Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
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Vatankhah M, Khosravi K, Zargar N, Shirvani A, Nekoofar MH, Dianat O. Antibacterial efficacy of antibiotic pastes versus calcium hydroxide intracanal dressing: A systematic review and meta-analysis of ex vivo studies. J Conserv Dent 2022; 25:463-480. [PMID: 36506621 PMCID: PMC9733540 DOI: 10.4103/jcd.jcd_183_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Conflicting findings on the potency of antibiotic pastes versus calcium hydroxide (CH) have been evident in the literature. Aims To compare the antibacterial efficacy of single antibiotic paste (SAP), double antibiotic paste (DAP), triple antibiotic paste (TAP), and modified TAP (mTAP) with CH on bacterial biofilms. Methods PubMed, Scopus, and Embase were comprehensively searched until August 23, 2021. The study protocol was registered in the PROSPERO. Ex vivo studies performed on Enterococcus faecalis or polymicrobial biofilms incubated on human/bovine dentin were selected. The quality of the studies was assessed using a customized quality assessment tool. Standardized mean difference (SMD) with a 95% confidence interval (CI) was calculated for the meta-analysis. Meta-regression models were used to identify the sources of heterogeneity and to compare the efficacy of pastes. Results The qualitative and quantitative synthesis included 40 and 23 papers, respectively, out of 1421 search results. TAP (SMD = -3.82; CI, -5.44 to -2.21; P < 0.001) and SAPs (SMD = -2.38; CI, -2.81 to - 1.94; P < 0.001) had significantly higher antibacterial efficacy compared to the CH on E. faecalis biofilm. However, no significant difference was found between the efficacy of DAP (SMD = -2.74; CI, -5.56-0.07; P = 0.06) or mTAP (SMD = -0.28; CI, -0.82-0.26; P = 0.31) and CH. Meta-regression model on E. faecalis showed that SAPs have similar efficacy compared to TAP and significantly better efficacy than DAP. On dual-species (SMD = 0.15; CI, -1.00-1.29; P = 0.80) or multi-species (SMD = 0.23; CI, -0.08-0.55; P = 0.15) biofilms, DAP and CH had similar efficacy. Conclusions Ex vivo evidence showed that antibiotic pastes were either superior or equal to CH. The studied SAPs had considerably higher or similar antibacterial effectiveness compared to DAP, CH, and TAP. Hence, combined antibiotic therapy was not necessarily required for root canal disinfection ex vivo.
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Affiliation(s)
- Mohammadreza Vatankhah
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Khosravi
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Zargar
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Omid Dianat
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
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Enhancing the intracanal antibacterial effects of sodium hypochlorite with etidronic acid or citric acid. J Endod 2022; 48:1161-1168. [PMID: 35750221 DOI: 10.1016/j.joen.2022.06.006] [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: 05/02/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This study evaluated the bacterial reduction promoted by root canal preparation using irrigation with sodium hypochlorite (NaOCl) alone, associated with etidronic acid (HEDP) or alternated with citric acid, and after a supplementary agitation step. METHODS Extracted mandibular premolars were selected and distributed into 3 groups based on anatomically paired micro-computed tomographic analyses. The canals were contaminated with Enterococcus faecalis for 30 days and then subjected to chemomechanical preparation with a reciprocating instrument under irrigation with NaOCl alone, mixed with HEDP (NaOCl/HEDP), or alternated with citric acid (NaOCl/CA). A supplementary agitation step with the XP-endo Finisher was performed in all groups. Intracanal bacteriological samples were taken before (S1) and after preparation (S2), and after the supplementary approach (S3). DNA was extracted from the samples and subjected to quantitative real-time polymerase chain reaction. RESULTS Intragroup analyses revealed a substantial bacterial reduction from S1 to S2 or S3 in all groups (p<0.01). The supplementary agitation resulted in S2-to-S3 bacterial reduction of 6%, 68%, and 80% in the NaOCl, NaOCl/HEDP, and NaOCl/CA groups, respectively. Irrigation with NaOCl alone resulted in 53% and 47% of samples negative for bacteria in S2 and S3, respectively. Corresponding figures for NaOCl/HEDP were 75% and 85%, and 44% and 72% for NaOCl/CA. Intergroup analyses of S2 samples showed that NaOCl/HEDP was significantly more effective than the other two in reducing the bacterial levels (p<0.05). After the supplementary approach, both NaOCl/HEDP and NaOCl/CA were significantly more effective than NaOCl alone (p<0.05), with no significant differences between them (p>0.05). CONCLUSION Both the freshly combined NaOCl/HEDP solution and the alternate use of NaOCl and citric acid followed by XP-endo Finisher agitation resulted in significantly higher intracanal bacterial reduction than NaOCl alone.
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Ricucci D, Milovidova I, Rôças IN, Siqueira JF. Surgical management of a lateral lesion refractory to root canal retreatment caused by an extraradicular calculus. A case report. AUST ENDOD J 2022; 49:183-191. [PMID: 35644940 DOI: 10.1111/aej.12632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/29/2022]
Abstract
This article describes the management of a root canal-treated maxillary central incisor displaying a radiographic lateral radiolucency and a sinus tract that persisted irrespective of root canal retreatment following high standards. Endodontic microsurgery was indicated and curettage of the pathologic tissue revealed a calculus-like material attached to the outer root surface around the exit of a large lateral canal. A non-conventional approach was chosen: No root-end resection was conducted. Instead, the calculus was removed and the apical surface was scaled and smoothed, conserving the apical structure. Retrocavities were prepared in both lateral and apical foramens and filled with a bioceramic material. Follow-up examination showed optimal soft tissue healing. One-year follow-up of radiographs revealed healing of the lateral lesion. The lesion was diagnosed as a cyst, with an infected lumen. An exuberant calculus-like material attached to the external root surface was the most likely cause of the recalcitrant lateral periradicular lesion.
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Affiliation(s)
| | | | - Isabela N Rôças
- Department of Endodontics, Faculty of Dentistry, Grande Rio University, Rio de Janeiro, Brazil.,Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Brazil
| | - José F Siqueira
- Department of Endodontics, Faculty of Dentistry, Grande Rio University, Rio de Janeiro, Brazil.,Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Brazil
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Jarkhi A, Lee AHC, Sun Z, Hu M, Neelakantan P, Li X, Zhang C. Antimicrobial Effects of L-Chg10-Teixobactin against Enterococcus faecalis In Vitro. Microorganisms 2022; 10:microorganisms10061099. [PMID: 35744616 PMCID: PMC9228388 DOI: 10.3390/microorganisms10061099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/22/2022] [Accepted: 05/22/2022] [Indexed: 11/18/2022] Open
Abstract
Objective: Teixobactin and its analogues are a new class of antibiotics that have no detectable bacterial resistance. This study was designed to determine the antibacterial and antibiofilm activities of a novel teixobactin analogue, L-Chg10-teixobactin, against two strains of Enterococcus faecalis (E. faecalis). Materials and Methods: The efficacy of L-Chg10-teixobactin against two strains of E. faecalis (ATCC 29212 and 47077) was determined using Clinical and Laboratory Standards Institute methods. L-Chg10-teixobactin was prepared at a stock concentration of 1 mg/mL in 5% DMSO. The minimum inhibitory concentration (MIC) was calculated using a two-fold serial broth dilution method, utilizing a 96-well plate. The minimum bactericidal concentration (MBC) was determined by plating the bacteria onto agar to define the concentration that resulted in 99.9% of bacterial death. Ampicillin was used as the control. The effect of L-Chg10-teixobactin on the inhibition of ATCC 47077 strain biofilm formation was determined by measuring the minimum biofilm inhibitory concentration (MBIC) using the safranin assay, while the eradication of the preformed biofilm was determined by measuring the minimum biofilm eradication concentration (MBEC) using the XTT assay. For nonlinear data, the log dose–response curve was plotted to calculate the optimum concentration using Excel (version 16.51, Microsoft® excel. 2021, Microsoft Corporation, Reymond, WA, USA). The data are presented as mean ± standard deviation (SD). Results: The MIC and MBC values of L-Chg10-teixobactin against both strains of E. faecalis were 0.8 μg/mL. The MIC of ampicillin was 1.25 μg/mL for ATCC 29212 and ranged from 1.25 to 5 μg/mL for ATCC 47077. The MBC of ampicillin for ATCC 29212 and ATCC 47077 was 10 and 20 μg/mL, respectively. The MIC and MBC of ampicillin were much higher compared with those of L-Chg10-teixobactin. The MBEC80 of L-Chg10-teixobactin was 4.60 μg/mL for ATCC 47077, which was much lower than that of ampicillin (20 μg/mL). Conclusions:L-Chg10-teixobactin demonstrated potent antibacterial and antibiofilm effects against E. faecalis, suggesting its potential role an effective antibacterial and antibiofilm agent in endodontic treatment.
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Babeer A, Oh MJ, Ren Z, Liu Y, Marques F, Poly A, Karabucak B, Steager E, Koo H. Microrobotics for Precision Biofilm Diagnostics and Treatment. J Dent Res 2022; 101:1009-1014. [PMID: 35450484 PMCID: PMC9305841 DOI: 10.1177/00220345221087149] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Advances in small-scale robotics and nanotechnology are providing previously unimagined opportunities for new diagnostic and therapeutic approaches with high precision, control, and efficiency. We designed microrobots for tetherless biofilm treatment and retrieval using iron oxide nanoparticles (NPs) with dual catalytic-magnetic functionality as building blocks. We show 2 distinct microrobotic platforms. The first system is formed from NPs that assemble into aggregated microswarms under magnetic fields that can be controlled to disrupt and retrieve biofilm samples for microbial analysis. The second platform is composed of 3-dimensional (3D) micromolded opacifier-infused soft helicoids with embedded catalytic-magnetic NPs that can be visualized via existing radiographic imaging techniques and controlled magnetically inside the root canal, uninterrupted by the soft and hard tissues surrounding the teeth in an ex vivo model. These microrobots placed inside the root canal can remove biofilms and be efficiently guided with microscale precision. The proof-of-concept paradigm described here can be adapted to target difficult-to-reach anatomical spaces in other natural and implanted surfaces in an automated and tether-free manner.
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Affiliation(s)
- A Babeer
- Biofilm Research Laboratories, Center for Innovation & Precision Dentistry, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Oral Biology, King Abdulaziz University, Jeddah, KSA
| | - M J Oh
- Biofilm Research Laboratories, Center for Innovation & Precision Dentistry, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Z Ren
- Biofilm Research Laboratories, Center for Innovation & Precision Dentistry, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Y Liu
- Biofilm Research Laboratories, Center for Innovation & Precision Dentistry, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Preventive & Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - F Marques
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - A Poly
- Proclin Department, School of Dentistry, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - B Karabucak
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E Steager
- Biofilm Research Laboratories, Center for Innovation & Precision Dentistry, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,GRASP Laboratory, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - H Koo
- Biofilm Research Laboratories, Center for Innovation & Precision Dentistry, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
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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: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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-computed 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)
- Christos Boutsioukis
- Department of EndodontologyAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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