1
|
Lockwood TD. Coordination chemistry suggests that independently observed benefits of metformin and Zn 2+ against COVID-19 are not independent. Biometals 2024; 37:983-1022. [PMID: 38578560 PMCID: PMC11255062 DOI: 10.1007/s10534-024-00590-5] [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: 11/24/2023] [Accepted: 02/12/2024] [Indexed: 04/06/2024]
Abstract
Independent trials indicate that either oral Zn2+ or metformin can separately improve COVID-19 outcomes by approximately 40%. Coordination chemistry predicts a mechanistic relationship and therapeutic synergy. Zn2+ deficit is a known risk factor for both COVID-19 and non-infectious inflammation. Most dietary Zn2+ is not absorbed. Metformin is a naked ligand that presumably increases intestinal Zn2+ bioavailability and active absorption by cation transporters known to transport metformin. Intracellular Zn2+ provides a natural buffer of many protease reactions; the variable "set point" is determined by Zn2+ regulation or availability. A Zn2+-interactive protease network is suggested here. The two viral cysteine proteases are therapeutic targets against COVID-19. Viral and many host proteases are submaximally inhibited by exchangeable cell Zn2+. Inhibition of cysteine proteases can improve COVID-19 outcomes and non-infectious inflammation. Metformin reportedly enhances the natural moderating effect of Zn2+ on bioassayed proteome degradation. Firstly, the dissociable metformin-Zn2+ complex could be actively transported by intestinal cation transporters; thereby creating artificial pathways of absorption and increased body Zn2+ content. Secondly, metformin Zn2+ coordination can create a non-natural protease inhibitor independent of cell Zn2+ content. Moderation of peptidolytic reactions by either or both mechanisms could slow (a) viral multiplication (b) viral invasion and (c) the pathogenic host inflammatory response. These combined actions could allow development of acquired immunity to clear the infection before life-threatening inflammation. Nirmatrelvir (Paxlovid®) opposes COVID-19 by selective inhibition the viral main protease by a Zn2+-independent mechanism. Pending safety evaluation, predictable synergistic benefits of metformin and Zn2+, and perhaps metformin/Zn2+/Paxlovid® co-administration should be investigated.
Collapse
Affiliation(s)
- Thomas D Lockwood
- Department Pharmacology and Toxicology, School of Medicine, Wright State University, Dayton, OH, 45435, USA.
| |
Collapse
|
2
|
Aslan T, Dadi Ş, Kafdag O, Temur N, Ildiz N, Ocsoy I, Ustun Y. Rational design of EDTA-incorporated nanoflowers as novel and effective endodontic disinfection against biofilms. Odontology 2024; 112:444-452. [PMID: 37787827 DOI: 10.1007/s10266-023-00857-2] [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: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023]
Abstract
The ethylenediaminetetradiacetic acid (EDTA) is one of the most commonly used irrigation solutions. Although EDTA has a very low antimicrobial property, it is used to remove inorganic part of smear layer in areas of root canal system. Herein, we developed EDTA-incorporated nanoflowers (EDTA NFs), for the first time, as novel and effective irrigation solution with quite high antimicrobial property to provide complete disinfection in root canal system. We both systematically elucidated the formation of the EDTA NFs with various techniques, and their catalytic and antimicrobial activities in the presence of hydrogen peroxide (H2O2) were documented through intrinsic EDTA property and peroxidase-like activities.
Collapse
Affiliation(s)
- Tugrul Aslan
- Department of Endodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Şeyma Dadi
- Department of Nanotechnology Engineering, Abdullah Gül University, 38080, Kayseri, Turkey
| | - Ozgur Kafdag
- Department of Endodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Nimet Temur
- Department of Analytical Chemistry, Faculty of Pharmacy, Erciyes University, Kayseri, 38039, Turkey
| | - Nilay Ildiz
- Medical Imaging Department, Bandırma Onyedi Eylul University, Vocational School of Health Services, 12 10200, Bandirma, Turkey
| | - Ismail Ocsoy
- Department of Analytical Chemistry, Faculty of Pharmacy, Erciyes University, Kayseri, 38039, Turkey
| | - Yakup Ustun
- Department of Endodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey.
| |
Collapse
|
3
|
Uçar AY, Kölüş T, Bozkurt DA, Neelakantan P, Ali IAA, Belli S. A laboratory investigation on the effect of biguanide- and pyridine-derived antiseptics on the adhesion of resin composites to dentin. AUST ENDOD J 2023; 49:599-605. [PMID: 37602727 DOI: 10.1111/aej.12791] [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: 02/25/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023]
Abstract
Optimal bonding of adhesive restorations to dentin is crucial to prevent microleakage and enhance the survival of root-filled teeth. The aim of this study was to investigate the effect of chlorhexidine (CHX), alexidine (ALX) and octenidine dihydrochloride (OCT) on the bond strength of resin composites to coronal dentin. Human coronal dentin specimens were treated with 2% CHX, 0.1% ALX, 0.1% OCT or saline then restored with traditional or bulk-fill resin composites. The adhesion strength between the resin and dentin was measured using the microtensile bond strength and failure mode was determined using a stereomicroscope. Treatment with ALX and OCT resulted in significantly greater μTBS compared with CHX and saline, irrespective of the resin composite used. Alexidine treatment predominantly resulted in mixed failure, while adhesive failures were frequently observed in CHX and saline-treated dentin. In conclusion, final irrigation with ALX or OCT improved the bonding of resin composites to dentin.
Collapse
Affiliation(s)
- Arzu Yağmur Uçar
- Department of Endodontics, Faculty of Dentistry, Selçuk University, Konya, Turkey
| | - Türkay Kölüş
- Department of Restorative Dentistry, Faculty of Dentistry, Karamanoğlu Mehmetbey University Ahmet Keleşoğlu, Karaman, Turkey
| | - D Alperen Bozkurt
- Department of Endodontics, Faculty of Dentistry, Necmettin Erbakan University, Konya, Turkey
| | - Prasanna Neelakantan
- Divison of Restorative Dental Sciences, Discipline of Endodontology, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Islam A A Ali
- School of Dentistry, Oregon Health & Science University, Portland, Oregon, USA
| | - Sema Belli
- Department of Endodontics, Faculty of Dentistry, Selçuk University, Konya, Turkey
| |
Collapse
|
4
|
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.
Collapse
Affiliation(s)
- Christos Boutsioukis
- Department of EndodontologyAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | | |
Collapse
|
5
|
Boutsioukis C, Arias-Moliz MT. Present status and future directions - irrigants and irrigation methods. Int Endod J 2022; 55 Suppl 3:588-612. [PMID: 35338652 PMCID: PMC9321999 DOI: 10.1111/iej.13739] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Irrigation is considered the primary means of cleaning and disinfection of the root canal system. The purpose of this review was to set the framework for the obstacles that irrigation needs to overcome, to critically appraise currently used irrigants and irrigation methods, to highlight knowledge gaps and methodological limitations in the available studies and to provide directions for future developments. Organization of bacteria in biofilms located in anatomic intricacies of the root canal system and the difficulty to eliminate them is the main challenge for irrigants. Sodium hypochlorite remains the primary irrigant of choice, but it needs to be supplemented by a chelator. Delivery of the irrigants using a syringe and needle and activation by an ultrasonic file are the most popular irrigation methods. There is no evidence that any adjunct irrigation method, including ultrasonic activation, can improve the long‐term outcome of root canal treatment beyond what can be achieved by instrumentation and syringe irrigation. It is necessary to redefine the research priorities in this field and investigate in greater depth the penetration of the irrigants, their effect on the biofilm and the long‐term treatment outcome. New studies must also focus on clinically relevant comparisons, avoid methodological flaws and have sufficiently large sample sizes to reach reliable conclusions. Future multidisciplinary efforts combining the knowledge from basic sciences such as Chemistry, Microbiology and Fluid Dynamics may lead to more effective antimicrobials and improved activation methods to bring them closer to the residual biofilm in the root canal system.
Collapse
Affiliation(s)
- C Boutsioukis
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M T Arias-Moliz
- Department of Microbiology, Faculty of Dentistry, University of Granada, Granada, Spain
| |
Collapse
|
6
|
OUP accepted manuscript. Med Mycol 2022; 60:6526320. [PMID: 35142862 PMCID: PMC8929677 DOI: 10.1093/mmy/myac008] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/13/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
Candida auris is an emerging, multi drug resistant fungal pathogen that has caused infectious outbreaks in over 45 countries since its first isolation over a decade ago, leading to in-hospital crude mortality rates as high as 72%. The fungus is also acclimated to disinfection procedures and persists for weeks in nosocomial ecosystems. Alarmingly, the outbreaks of C. auris infections in Coronavirus Disease-2019 (COVID-19) patients have also been reported. The pathogenicity, drug resistance and global spread of C. auris have led to an urgent exploration of novel, candidate antifungal agents for C. auris therapeutics. This narrative review codifies the emerging data on the following new/emerging antifungal compounds and strategies: antimicrobial peptides, combinational therapy, immunotherapy, metals and nano particles, natural compounds, and repurposed drugs. Encouragingly, a vast majority of these exhibit excellent anti- C. auris properties, with promising drugs now in the pipeline in various stages of development. Nevertheless, further research on the modes of action, toxicity, and the dosage of the new formulations are warranted. Studies are needed with representation from all five C. auris clades, so as to produce data of grater relevance, and broader significance and validity.
Collapse
|
7
|
Insight into the Reaction of Alexidine with Sodium Hypochlorite: A Potential Error in Endodontic Treatment. Molecules 2021; 26:molecules26061623. [PMID: 33804019 PMCID: PMC7999803 DOI: 10.3390/molecules26061623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 11/17/2022] Open
Abstract
Therapeutic success in endodontic treatment depends on successful infection control. Alexidine dihydrochloride (ALX) was recently proposed as a potential alternative to 2% chlorhexidine (CHX) as it possesses similar antimicrobial properties, expresses substantivity and does not produce p-chloroaniline (PCA) when mixed with sodium hypochlorite (NaOCl). However, the products released in this reaction have not been described to date. The aim of this study was to identify detected chemical compounds formed in the reaction of ALX and NaOCl with the ultra-high-performance liquid chromatography–mass spectrophotometry (UHPLC-MS) method and assess whether precipitates and PCA are formed in this reaction. Solutions of ALX were mixed with the equivalent volume of 2% and 5.25% (w/v) NaOCl solutions. As control, 2% (w/v) CHX was mixed with 2% and 5.25% (w/v) NaOCl. Samples were subjected to the UHPLC-MS analysis. The mixture of ALX and NaOCl resulted in a yellowish precipitate formation, the amount of which depended on NaOCl concentration. Interaction of ALX and NaOCl resulted in the production of aliphatic amines. No PCA was formed when NaOCl was mixed with ALX. However, for the first time, we identified the possible products of the interaction. The interaction between NaOCl and ALX results in the formation of aliphatic amines; therefore, these compounds should not be mixed during endodontic treatment.
Collapse
|
8
|
Chandki R, Nikhil V, Kalyan SS. Comparative evaluation of substantivity of two biguanides - 0.2% polyhexanide and 2% chlorhexidine on human dentin. J Conserv Dent 2020; 23:46-50. [PMID: 33223641 PMCID: PMC7657421 DOI: 10.4103/jcd.jcd_256_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/07/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Substantivity is one of the desirable characteristics of root canal irrigants. Among conventional endodontic irrigants, only chlorhexidine (CHX) is known to exert significant substantivity on root canal dentin. This study explored the substantivity activity of a polymeric biguanide-poly hexamethylene biguanide (PHMB). Aim: The aim of this study was to determine the substantivity of a polymeric biguanide - 0.2% PHMB and compare it with that of 2% CHX. Materials and Methods: To evaluate and compare the substantivity of 0.2% PHMB and 2% CHX on root canal dentin, dentin disks were prepared and substantivity after 1 h, 24 h, 7 days and 21 days was measured using spectrophotometry. Statistical Analysis Used: The data so obtained were analyzed, and the intergroup comparison was made using unpaired t-test. Results: The results of this study indicated that 0.2%. PHMB exerts significantly greater substantivity than 2% CHX on human dentin. Conclusion: Within the limitations, this study supports the use of 0.2% polyhexanide as an endodontic irrigant based on its property of substantivity.
Collapse
Affiliation(s)
- Rita Chandki
- Swami Vivekanand Subharti University, Meerut, Uttarpradesh, India
| | - Vineeta Nikhil
- Department of Conservative Dentistry and Endodontics, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
| | - S Sai Kalyan
- Department of Conservative Dentistry and Endodontics, Rural Dental College, Loni, Maharashtra, India
| |
Collapse
|
9
|
Candida albicans Virulence Factors and Pathogenicity for Endodontic Infections. Microorganisms 2020; 8:microorganisms8091300. [PMID: 32858856 PMCID: PMC7563224 DOI: 10.3390/microorganisms8091300] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023] Open
Abstract
Candida albicans (C. albicans) is the fungus most frequently isolated from endodontic root canal infections. Although recognized by dental pulp and periradicular tissue cells that elicit immune responses, it eludes host defenses and elicits cell death. Then, C. albicans binds tooth dentin, forms biofilms, and invades dentinal tubules to resist intracanal disinfectants and endodontic treatments. Insensitive to most common medicaments, it survives sequestered within biofilms and intratubular dentin. Thus, C. albicans has been associated with cases of persistent or refractory root canal infections. Its treatment strategies may require alternative intracanal irrigants, intracanal medicaments such as chlorhexidine gel or human beta defensin-3 (HBD3), Ca-Si-based obturating materials, and microsurgical procedures.
Collapse
|
10
|
Jain K, Agarwal P, Jain S, Seal M, Adlakha T. Alexidine versus chlorhexidine for endodontic irrigation with sodium hypochlorite. Eur J Dent 2019; 12:398-402. [PMID: 30147406 PMCID: PMC6089054 DOI: 10.4103/ejd.ejd_180_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: The objective of this study was to chemically evaluate precipitate formation on irrigation by different concentrations of chlorhexidine (CHX) and alexidine (ALX) with sodium hypochlorite (NaOCl). Materials and Methods: Six test tubes were prepared with 1 ml of 4% NaOCl. One milliliter of 2%, 1%, 0.5%, and 0.25% ALX was added to the first four, and in the last two, 1 ml of 2% CHX and 0.2% CHX was added, respectively. Samples were observed for color changes or precipitates at multiple time intervals. All solutions were then centrifuged at 1000 rpm for 10 min and re-examined for precipitates. This process was repeated twice. Fifty freshly extracted premolars were biomechanically prepared, dried, divided into two groups, and irrigated with 10 ml of 4% NaOCl and 10 ml of 2% ALX (Group 1) and 10 ml of 4% NaOCl and 10 ml of 2% CHX (Group 2). These samples were sectioned and observed for precipitates on the dentinal surfaces by scanning electron microscopy (SEM). Results: The color of the solution of ALX and NaOCl stayed transparent and no precipitate was observed. A color change was noted immediately on mixing CHX and NaOCl which did not change with time. Precipitates were only observed in the solutions of CHX with NaOCl and after centrifuging them. SEM views also showed dense precipitates covering the dentinal surface and occluding the dentinal tubules in Group 2. Conclusion: The interaction of ALX and NaOCl does not produce precipitates which together with its better antimicrobial action make ALX a more effective and safer replacement for CHX as an adjunctive endodontic irrigant.
Collapse
Affiliation(s)
- Kanav Jain
- Department of Dentistry, AIIMS, Rishikesh, Uttarakhand, India
| | | | - Supriya Jain
- Department of Conservative and Endodontics, ESIC Dental College and Hospital, New Delhi, India
| | - Mukut Seal
- Department of Conservative and Endodontics, Government Dental College, Guwahati, Assam, India
| | - Twisha Adlakha
- Department of Conservative and Endodontics, Terna Dental College, Mumbai, Maharashtra, India
| |
Collapse
|
11
|
Abstract
The prevalence of fungal infections has seen a rise in the past decades due to advances in modern medicine leading to an expanding population of device-associated and immunocompromised patients. Furthermore, the spectrum of pathogenic fungi has changed, with the emergence of multidrug-resistant strains such as C. auris. High mortality related to fungal infections points to major limitations of current antifungal therapy and an unmet need for new antifungal drugs. We screened a library of repurposed FDA-approved inhibitors to identify compounds with activities against a diverse range of fungi in varied phases of growth. The assays identified alexidine dihydrochloride (AXD) to have pronounced antifungal activity, including against preformed biofilms, at concentrations lower than mammalian cell toxicity. AXD potentiated the activity of fluconazole and amphotericin B against Candida biofilms in vitro and prevented biofilm growth in vivo. Thus, AXD has the potential to be developed as a pan-antifungal, antibiofilm drug. Invasive fungal infections due to Candida albicans, Aspergillus fumigatus, and Cryptococcus neoformans constitute a substantial threat to hospitalized immunocompromised patients. Further, the presence of drug-recalcitrant biofilms on medical devices and emergence of drug-resistant fungi, such as Candida auris, introduce treatment challenges with current antifungal drugs. Worse, currently there is no approved drug capable of obviating preformed biofilms, which increase the chance of infection relapses. Here, we screened a small-molecule New Prestwick Chemical Library, consisting of 1,200 FDA-approved off-patent drugs against C. albicans, C. auris, and A. fumigatus, to identify those that inhibit growth of all three pathogens. Inhibitors were further prioritized for their potency against other fungal pathogens and their ability to kill preformed biofilms. Our studies identified the bis-biguanide alexidine dihydrochloride (AXD) as a drug with the highest antifungal and antibiofilm activity against a diverse range of fungal pathogens. Finally, AXD significantly potentiated the efficacy of fluconazole against biofilms, displayed low mammalian cell toxicity, and eradicated biofilms growing in mouse central venous catheters in vivo, highlighting its potential as a pan-antifungal drug. IMPORTANCE The prevalence of fungal infections has seen a rise in the past decades due to advances in modern medicine leading to an expanding population of device-associated and immunocompromised patients. Furthermore, the spectrum of pathogenic fungi has changed, with the emergence of multidrug-resistant strains such as C. auris. High mortality related to fungal infections points to major limitations of current antifungal therapy and an unmet need for new antifungal drugs. We screened a library of repurposed FDA-approved inhibitors to identify compounds with activities against a diverse range of fungi in varied phases of growth. The assays identified alexidine dihydrochloride (AXD) to have pronounced antifungal activity, including against preformed biofilms, at concentrations lower than mammalian cell toxicity. AXD potentiated the activity of fluconazole and amphotericin B against Candida biofilms in vitro and prevented biofilm growth in vivo. Thus, AXD has the potential to be developed as a pan-antifungal, antibiofilm drug.
Collapse
|
12
|
Comparison of antibacterial activity of alexidine alone or as a final irrigant with sodium hypochlorite and chlorhexidine. BDJ Open 2018; 4:18003. [PMID: 29868242 PMCID: PMC5985655 DOI: 10.1038/bdjopen.2018.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 01/12/2023] Open
Abstract
Aims: To compare the antibacterial activity of alexidine (ALX) alone or as a final irrigant in combination with sodium hypochlorite (NaOCl), with the most common canal irrigants, NaOCl and chlorhexidine (CHX). Materials and methods: Ninety-four root fragments from extracted human teeth were infected with Enterococcus faecalis for 24 h and then distributed into 4 groups of 20 fragments each. The NaOCl, CHX and ALX groups were immersed in 1 ml of 2.5% NaOCl, 2% CHX, and 1% ALX for 10 min, respectively. The samples of the NaOCl+ALX group were immersed in 1 ml of 2.5% NaOCl for 10 min followed by 1% ALX for 10 min. Bacteriological samples were taken, cultured, and the colony-forming units were counted. Results: There was no significant differences among the experimental groups (P>0.05) except for the comparisons CHX versus ALX and NaOCl+ALX versus ALX (P=0.004). ALX alone was the worst irrigant. CHX and NaOCl+ALX eradicated all bacteria. All experimental groups were significantly more effective than the control group immersed in saline (P<0.05). Conclusions: The antibacterial effect of ALX alone was inferior to 2% CHX and 2.5% NaOCl. However, the combination of NaOCl with ALX as a final irrigant eradicated the biofilms.
Collapse
|
13
|
Kermeoglu F, Aksoy U, Kalender A, Oztan MD, Oguz EI, Kıyan M. Determination of the Minimum Inhibitory Concentrations of Alexidine and Chlorhexidine Against Enterococcus faecalis and Candida albicans: An In Vitro Study. Cureus 2018; 10:e2221. [PMID: 29692959 PMCID: PMC5912704 DOI: 10.7759/cureus.2221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction: The root canal system must be mechanically instrumented and chemically cleaned using various antimicrobial irrigants in a sequential manner or in combination for the elimination of necrotic pulp tissue and reducing the number of root canal bacteria. For this reason, new methods and materials are continuously being developed to achieve the objectives of endodontic treatment. Materials and Methods: E. faecalis (ATCC 29212) and C. albicans (ATCC 90028) standard strains were used for this study. Colonies of E. faecalis and C. albicans were harvested from the agar plates and suspended in 4 mL of phosphate buffered saline (PBS). Microorganisms were diluted to obtain a suspension of approximately 108 colony-forming units/mL (CFU/mL) in sterile PBS using McFarland standard tubes no. 0.5. Results: After a two-minute contact time, all alexidine (ALX) concentrations used in this study eradicated all E. faecalis strains, while chlorhexidine (CHX) didn’t kill 100% of E. faecalis at 0.25% and lower concentrations even after a five-minute contact time. ALX also eradicated C. albicans at all concentrations even after a one-minute contact time. CHX showed antifungal activity against C. albicans at all concentrations higher than 0.031% after a one-minute contact time. Conclusion: A 0.0156% concentration of ALX can be a good alternative to CHX as an irrigation solution in endodontic treatment when used for one minute against E. faecalis and C. albicans.
Collapse
|
14
|
Mohammadi Z, Shalavi S, Moeintaghavi A, Jafarzadeh H. A Review Over Benefits and Drawbacks of Combining Sodium Hypochlorite with Other Endodontic Materials. Open Dent J 2017; 11:661-669. [PMID: 29387282 PMCID: PMC5750725 DOI: 10.2174/1874210601711010661] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/03/2017] [Accepted: 11/11/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION As the root canal system considered to be complex and unpredictable, using root canal irrigants and medicaments are essential in order to enhance the disinfection of the canal. Sodium hypochlorite is the most common irrigant in endodontics. Despite its excellent antimicrobial activity and tissue solubility, sodium hypochlorite lacks some important properties such as substantivity and smear layer removing ability. OBJECTIVE The aim of this review was to address benefits and drawbacks of combining sodium hypochlorite with other root canal irrigants and medicaments. DISCUSSION According to the reviewed articles, NaOCl is the most common irrigation solution in endodontics. However, it has some drawbacks such as inability to remove smear layer. One of the drawbacks of NaOCl is its inability to remove the smear layer and lack of substantivity. CONCLUSION The adjunctive use of other materials has been suggested to improve NaOCl efficacy. Nevertheless, further studies are required in this field.
Collapse
Affiliation(s)
- Zahed Mohammadi
- Iranian Center for Endodontic Research (ICER), Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amir Moeintaghavi
- Department of Periodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Jafarzadeh
- Department of Endodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
15
|
Solana C, Ruiz-Linares M, Baca P, Valderrama MJ, Arias-Moliz MT, Ferrer-Luque CM. Antibiofilm Activity of Sodium Hypochlorite and Alkaline Tetrasodium EDTA Solutions. J Endod 2017; 43:2093-2096. [DOI: 10.1016/j.joen.2017.06.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 12/17/2022]
|
16
|
Varadan P, Ganesh A, Konindala R, Nagendrababu V, Ashok R, Deivanayagam K. Comparison of the Antibacterial Efficacy of Alexidine and Chlorhexidine Against Enterococcus Faecalis: An in Vitro Study. Cureus 2017; 9:e1805. [PMID: 29308333 PMCID: PMC5749941 DOI: 10.7759/cureus.1805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Introduction Root canal irrigants play an important role in reducing intracanal microorganisms, which in turn helps in achieving a successful outcome for the root canal treatment. Objective To compare the antibacterial efficacy of alexidine and chlorhexidine against Enterococcus faecalis. Methods A total of 50 extracted single-rooted teeth were randomly divided into five groups after being infected with Enterococcus faecalis. The groups were based on irrigants used: Group I - 0.4% alexidine; Group II - 1% alexidine; Group III - 1.5% percent alexidine; Group IV - 2% alexidine; Group V - 2% chlorhexidine. Following irrigation, colony-forming units were determined from the dentinal shavings collected at 400 µm depth. Results Use of 2% alexidine reduced the bacteria effectively when compared to 0.4%, 1%, and 1.5% alexidine. A statistically significant difference was not observed between 2% alexidine and 2% chlorhexidine. Discussion Alexidine, due to its higher virulence factors for bacteria and better bacterial penetrability at 400 µm depth of dentin showed better eradication of Enterococcus faecalis in comparison to chlorhexidine. Conclusion The use of 2% alexidine against Enterococcus faecalis at 400 µm depth of dentin has efficacy comparable to chlorhexidine. Hence, alexidine can be used as an alternative irrigant for chlorhexidine during endodontic procedures.
Collapse
Affiliation(s)
- Preethi Varadan
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, India
| | - Arathi Ganesh
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, India
| | - Rudra Konindala
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, India
| | - Venkateshbabu Nagendrababu
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Rupa Ashok
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, India
| | - Kandaswamy Deivanayagam
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, India
| |
Collapse
|
17
|
Surender LR, Shikha A, Swathi A, Manaswini C, Habeeb A, Prabha SS. Alexidine: a Safer and an Effective Root Canal Irrigant than Chlorhexidine. J Clin Diagn Res 2017; 11:ZC18-ZC21. [PMID: 28893035 DOI: 10.7860/jcdr/2017/27429.10160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/17/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Chlorhexidine (CHX) is generally used as the final irrigating solution in root canal therapy. Recent studies have reported that, toxic precipitates containing parachloroaniline (PCA) are formed when CHX reacts with sodium hypochlorite (NaOCl). Whereas, Alexidine (ALX), a bisbiguanide disinfectant similar to CHX, has proven to form no precipitates with NaOCl. AIM To compare antimicrobial activity of different concentrations of ALX with CHX individually and when combined with NaOCl against E. faecalis strains. MATERIALS AND METHODS Different concentrations of ALX and CHX (0.5%, 1%, and 2%) were tested individually and when mixed with 2.5% NaOCl (1:1 ratio) using disc diffusion method against E. faecalis. After 24 hours incubation at 37°C, zones of inhibition were measured for each solution. The results obtained were statistically analysed using one way ANOVA and Scheffe's post-hoc tests. The p-value <0.001 was considered as highly significant. RESULTS Regardless of the concentrations, ALX obtained the best results in comparison to CHX. There was no statistically significant difference between ALX + NaOCl and CHX + NaOCl mixtures. CONCLUSION The present study showed that, the antimicrobial property of ALX against E. faecalis was found to be superior to CHX at same concentrations.
Collapse
Affiliation(s)
- L R Surender
- Professor and Head, Department of Conservative Dentistry and Endodontics, SVS Institute of Dental Sciences, Mahabub Nagar, Telangana, India
| | - A Shikha
- Postgraduate Student, Department of Conservative Dentistry and Endodontics, SVS Institute of Dental Sciences, Mahabub Nagar, Telangana, India
| | - A Swathi
- Senior lecturer, Department of Conservative Dentistry and Endodontics, SVS Institute of Dental Sciences, Mahabub Nagar, Telangana, India
| | - C Manaswini
- Postgraduate Student, Department of Conservative Dentistry and Endodontics, SVS Institute of Dental Sciences, Mahabub Nagar, Telangana, India
| | - Aisha Habeeb
- Postgraduate Student, Department of Conservative Dentistry and Endodontics, SVS Institute of Dental Sciences, Mahabub Nagar, Telangana, India
| | - S Shashi Prabha
- Postgraduate Student, Department of Conservative Dentistry and Endodontics, SVS Institute of Dental Sciences, Mahabub Nagar, Telangana, India
| |
Collapse
|
18
|
Ruiz-Linares M, Aguado-Pérez B, Baca P, Arias-Moliz MT, Ferrer-Luque CM. Efficacy of antimicrobial solutions against polymicrobial root canal biofilm. Int Endod J 2016; 50:77-83. [DOI: 10.1111/iej.12598] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M. Ruiz-Linares
- Department of Paediatric Dentistry; University of Granada; Granada Spain
| | | | - P. Baca
- Department of Preventive Dentistry; University of Granada; Granada Spain
| | | | - C. M. Ferrer-Luque
- Department of Dental Pathology and Therapeutics; School of Dentistry; University of Granada; Granada Spain
| |
Collapse
|
19
|
Arias-Moliz MT, Ordinola-Zapata R, Baca P, Ruiz-Linares M, García García E, Hungaro Duarte MA, Monteiro Bramante C, Ferrer-Luque CM. Antimicrobial activity of Chlorhexidine, Peracetic acid and Sodium hypochlorite/etidronate irrigant solutions againstEnterococcus faecalisbiofilms. Int Endod J 2015; 48:1188-93. [DOI: 10.1111/iej.12424] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/11/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. T. Arias-Moliz
- Department of Microbiology; School of Dentistry; University of Granada; Granada Spain
| | - R. Ordinola-Zapata
- Department of Endodontics; Bauru Dental School; University of São Paulo; Bauru Brazil
| | - P. Baca
- Department of Stomatology; School of Dentistry; University of Granada; Granada Spain
| | - M. Ruiz-Linares
- Department of Stomatology; School of Dentistry; University of Granada; Granada Spain
| | - E. García García
- Department of Stomatology; School of Dentistry; University of Granada; Granada Spain
| | - M. A. Hungaro Duarte
- Department of Endodontics; Bauru Dental School; University of São Paulo; Bauru Brazil
| | - C. Monteiro Bramante
- Department of Endodontics; Bauru Dental School; University of São Paulo; Bauru Brazil
| | - C. M. Ferrer-Luque
- Department of Stomatology; School of Dentistry; University of Granada; Granada Spain
| |
Collapse
|
20
|
Hamama HH, Yiu CK, Burrow MF. Viability of Intratubular Bacteria after Chemomechanical Caries Removal. J Endod 2014; 40:1972-6. [DOI: 10.1016/j.joen.2014.07.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/06/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
|
21
|
Ruiz-Linares M, Ferrer-Luque CM, Arias-Moliz T, de Castro P, Aguado B, Baca P. Antimicrobial activity of alexidine, chlorhexidine and cetrimide against Streptococcus mutans biofilm. Ann Clin Microbiol Antimicrob 2014; 13:41. [PMID: 25139679 PMCID: PMC4236523 DOI: 10.1186/s12941-014-0041-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/03/2014] [Indexed: 11/17/2022] Open
Abstract
Background The use of antimicrobial solutions has been recommended to disinfect demineralized dentin prior to placing the filling material. The aim of this study was to evaluate the ability of several antimicrobials in controlling Streptococcus mutans (SM) biofilm formed in dentin. Methods Antimicrobial activity of 0.2% and 2% chlorhexidine (CHX), 0.2% cetrimide (CTR) and 0.2%, 0.5%, 1% and 2% alexidine (ALX) was assayed on 1-week SM biofilm formed on standardized coronal dentin blocks. Results of SM biofilm antimicrobial activity by different protocols were expressed as the kill percentage of biofilm and the term “eradication” was used to denote the kill of 100% of the bacterial population. To compare the efficacies of the different protocols the Student t test was used, previously subjecting data to the Anscombe transformation. Results All ALX concentrations tested and 0.2% CTR achieved a kill percentage higher than 99%, followed by 2% CHX with percentages above 96% (no statistically significant difference among them). Whereas 2% ALX and 0.2% CTR respectively showed eradication in 10 and 9 of the twelve specimens, 0.2% CHX did not produce eradication in any case. Conclusions The present study shows that, when used for one minute, 2% and 1% alexidine, and 0.2% cetrimide, achieve eradication of Streptococcus mutans biofilm in most specimens when applied to a dentin-volumetric model.
Collapse
Affiliation(s)
- Matilde Ruiz-Linares
- Department of Paediatric Dentistry, School of Dentistry, University of Granada, Campus de Cartuja, Colegio Máximo s/n, Granada, Spain.
| | | | | | | | | | | |
Collapse
|