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Talaat S, Hashem AA, Abu-Seida A, Abdel Wahed A, Abdel Aziz TM. Regenerative potential of mesoporous silica nanoparticles scaffold on dental pulp and root maturation in immature dog's teeth: a histologic and radiographic study. BMC Oral Health 2024; 24:817. [PMID: 39026199 PMCID: PMC11264670 DOI: 10.1186/s12903-024-04368-6] [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: 11/23/2023] [Accepted: 05/13/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE To evaluate histologically and radiographically the potential of dog's immature roots with apical periodontitis to regenerate after regenerative endodontic treatment using mesoporous silica nanoparticles (MSNs) with/without bone morphogenic protein (BMP-2) as scaffolds. METHODS In 4 mongrel dogs, 56 immature teeth with 96 roots were infected, resulting in necrotic pulps and periapical pathosis. According to the evaluation time (Group I = 30 days and Group II = 90 days), 90 roots were divided into two equal groups (45 roots each) and 6 roots used to replace any lost root during the procedure. The two main groups were further divided according to treatment protocol into 5 subgroups (9 roots each): blood clot (BC subgroup), mesoporous silica nanoparticles scaffold only (MSNs subgroup), mesoporous silica nanoparticles impregnated with BMP2 (MSNs + BMP2 subgroup), infected teeth without treatment (+ ve control subgroup) and normal untouched teeth (-ve control subgroup). All teeth surfaces were coated with Tincture iodine and calcium hydroxide was applied prior to treatment protocols. Then, teeth were restored with glass ionomer filling to seal the remaining part of the access cavity. Radiography evaluation of the increase in root length, root thickness and occurrence of apical closure were performed. Following the sacrifice of the two dogs at each time of evaluation, histopathological analysis was performed and included the inflammatory cells count, bone resorption, tissue ingrowth, deposition of hard tissue, and closure of the apical part. All data were statistically analyzed. RESULTS Compared to BC subgroup, MSNs and MSNs + BMP-2 subgroups exhibited significant higher increase in root length and thickness as well as higher vital tissue in-growth and new hard tissue formation in group II (P < 0.05). MSNs + BMP-2 subgroup had significant higher increase in root length and thickness as well as significant lower inflammatory cell count than MSNs subgroup in both groups (P < 0.05). There were no significant differences between MSNs and MSNs + BMP-2 subgroups regarding new hard tissue formation in both groups and apical closure in group I (P > 0.05). CONCLUSION MSNs with/without BMP-2 scaffolds enabled the continuing growth of roots in immature teeth with necrotic pulps and periapical pathosis. Addition of BMP-2 to MSNs scaffold improved its outcome in regenerative endodontics. CLINICAL RELEVANCE MSNs with/without BMP-2 scaffolds may alternate blood clot for regenerative endodontic treatment of immature teeth with necrotic pulps.
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Affiliation(s)
- Samar Talaat
- Endodontic Department, Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, Egypt.
| | - Ahmed A Hashem
- Department of Endodontic, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
| | - Ashraf Abu-Seida
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
- Faculty of Dentistry, Galala University, New Galala City, Suez, Egypt
| | - Adel Abdel Wahed
- Endodontic Department, Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, Egypt
| | - Tarek M Abdel Aziz
- Department of Endodontic, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Martins DCM, da Costa Sousa MG, Silva PAO, Aguiar LR, de Andrade RV, Silva-Carvalho AÉ, Saldanha-Araújo F, Franco OL, Rezende TMB. Association between host defence peptide IDR-1002 and ciprofloxacin: Effects on human dental pulp cells. AUST ENDOD J 2024. [PMID: 38963178 DOI: 10.1111/aej.12866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/15/2024] [Accepted: 06/08/2024] [Indexed: 07/05/2024]
Abstract
To evaluate the effects of the association of host defence peptide IDR-1002 and ciprofloxacin on human dental pulp cells (hDPSCs). hDPSCs were stimulated with ciprofloxacin and IDR-1002. Cell viability (by MTT assay), migration capacity (by scratch assay), production of inflammatory and anti-inflammatory mediators by hDPSCs (RT-PCR) and osteogenic differentiation (alizarin red staining) were evaluated. Phenotypic profile of hDPSCs demonstrated 97% for positive marked mesenchymal stem cell. Increased pulp cell migration and proliferation were observed after 24 and 48 h of exposure to IDR-1002 with ciprofloxacin. Mineral matrix formation by hDPSCs was observed of the association while its reduction was observed in the presence of peptide. After 24 h, the association between ciprofloxacin and IDR-1002 significantly downregulated TNFRSF-1, IL-1β, IL-8, IL-6 and IL-10 gene expression (p ≤ 0.0001). The association between the IDR-1002 and ciprofloxacin showed favourable immunomodulatory potential, emerging as a promising option for pulp revascularisation processes.
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Affiliation(s)
- Danilo César Mota Martins
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Brasília, Brasília, Distrito Federal, Brazil
- Curso de Odontologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
| | - Maurício Gonçalves da Costa Sousa
- Programa de Pós-graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, OHSU School of Dentistry, Portland, Oregon, USA
| | | | - Lana Ribeiro Aguiar
- Programa de Pós-graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
| | - Rosângela Vieira de Andrade
- Programa de Pós-graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
| | | | - Felipe Saldanha-Araújo
- Programa de Pós-graduação em Patologia Molecular, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - Octávio Luiz Franco
- Programa de Pós-graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
- S-Inova Biotech, Pós-graduação em Biotecnologia, Universidade Católica Dom Bosco, Mato Grosso, Brazil
| | - Taia Maria Berto Rezende
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Brasília, Brasília, Distrito Federal, Brazil
- Programa de Pós-graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
- Departamento de Odontologia, Universidade de Brasília, Brasília, Distrito Federal, Brazil
- Programa de Pós-graduação em Odontologia, Universidade de Brasília, Brasília, Distrito Federal, Brazil
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Leveque M, Guittat M, Thivichon-Prince B, Reuzeau A, Eveillard M, Faure M, Farges JC, Richert R, Bekhouche M, Ducret M. Next generation antibacterial strategies for regenerative endodontic procedures: A scoping review. Int Endod J 2024; 57:804-814. [PMID: 37485747 DOI: 10.1111/iej.13958] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The clinical results following regenerative endodontic procedures (REPs) vary according to numerous parameters, including the presence of bacteria. This limitation reduces the indications for REPs and calls for the development of next generation antibacterial strategies (NGAS) providing alternatives to current antibacterial strategies (CAS) such as double or triple antibiotic paste (DAP/TAP) and (Ca(OH)2). OBJECTIVES The present scoping review aims to describe the current trends regarding the use of such strategies and highlight future perspectives. METHODS Four databases (PUBMed, Cochrane, ClinicalTrials and Science Direct) were searched until 1st May 2023. RESULTS A total of 918 records were identified, 133 were screened and assessed for eligibility, and 87 articles were included. The findings show that (1) clinical studies are only available for CAS, (2) although next generation strategies are the most studied approach since 2017, they are all at the pre-clinical stage, (3) most of the next generation strategies use galenic forms which offer cell support and colonization and which simultaneously contain antibacterial molecules as alternatives to CAS and to antibiotics in general, (4) standardization is required for future research, specifically regarding the bacterial strains studied, the use of biofilm studies and the cellular behaviour assessments. CONCLUSION Although NGAS are promising strategies to improve REPs in the context of infection, the current evidence is mostly limited to pre-clinical studies. Further methodological improvement is required to allow relevant comparisons between studies and to reduce the time from bench to bedside.
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Affiliation(s)
- Marianne Leveque
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Guittat
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Béatrice Thivichon-Prince
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Alicia Reuzeau
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
| | - Matthieu Eveillard
- Département de Biologie des Agents Infectieux, CHU Angers, Angers, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, INCIT, Angers, France
| | - Marjorie Faure
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Farges
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Raphaël Richert
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Mécanique Des Contacts et Structures, CNRS/INSA, Villeurbanne, France
| | - Mourad Bekhouche
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
| | - Maxime Ducret
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305 CNRS/Université Claude Bernard Lyon 1, Lyon, France
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
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de Souza Araújo IJ, Patel T, Bukhari A, Sanz CK, Fenno JC, Ribeiro JS, Bottino MC. Natural monoterpenes-laden electrospun fibrous scaffolds for endodontic infection eradication. Odontology 2023; 111:78-84. [PMID: 35731305 DOI: 10.1007/s10266-022-00722-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/30/2022] [Indexed: 01/06/2023]
Abstract
This investigation aimed to synthesize poly(D,L-lactide) (PLA)-based fibrous scaffolds containing natural essential oils (i.e., linalool and citral) and determine their antimicrobial properties and cytocompatibility as a clinically viable cell-friendly disinfection strategy for regenerative endodontics. PLA-based fibrous scaffolds were fabricated via electrospinning with different concentrations of linalool and citral. The micromorphology and average diameter of the fibers was investigated through scanning electron microscopy (SEM). The chemical composition of the scaffolds was inferred by Fourier-transform infrared spectroscopy (FTIR). Antimicrobial efficacy against Enterococcus faecalis and Actinomyces naeslundii was also evaluated by agar diffusion and colony-forming units (CFU) assays. The scaffolds' cytocompatibility was determined using dental pulp stem cells (DPSCs). Statistical analyses were performed and the significance level was set at α = 5%. Linalool and citral's incorporation in the PLA fibrous scaffolds was confirmed in the FTIR spectra. SEM images indicate no morphological changes upon inclusion of the essential oils, except the reduced diameter of 40% linalool-laden fibers (p < 0.05). Importantly, significant antimicrobial properties were reported for citral-containing scaffolds for CFU/mL counts (p < 0.05), while only 20% and 40% linalool-laden scaffolds reduced CFU/mL (p < 0.05). Meanwhile, the inhibition halos were verified in a concentration-dependent manner for all monoterpenes-laden scaffolds. Citral- and linalool-laden PLA-based fibrous scaffolds showed acceptable cytocompatibility. The incorporation of natural monoterpenes did not alter the scaffolds' fibrous morphology, promoted antimicrobial action against endodontic pathogens, and preserved DPSCs viability. Linalool- and citral-laden electrospun scaffolds hold promise as naturally derived antimicrobial therapeutics for applications in regenerative endodontics.
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Affiliation(s)
- Isaac J de Souza Araújo
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, 1011 N. University (Room 5223), Ann Arbor, MI, 48109, USA
| | - Tamannaben Patel
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, 1011 N. University (Room 5223), Ann Arbor, MI, 48109, USA
| | - Amal Bukhari
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, 1011 N. University (Room 5223), Ann Arbor, MI, 48109, USA
| | - Carolina K Sanz
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, 1011 N. University (Room 5223), Ann Arbor, MI, 48109, USA.,Metallurgical and Materials Engineering Program-COPPE, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - J Christopher Fenno
- Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Juliana S Ribeiro
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, 1011 N. University (Room 5223), Ann Arbor, MI, 48109, USA.,Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, 1011 N. University (Room 5223), Ann Arbor, MI, 48109, USA. .,Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA.
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Local immunomodulatory effects of intracanal medications in apical periodontitis. J Endod 2022; 48:430-456. [PMID: 35032538 DOI: 10.1016/j.joen.2022.01.003] [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] [Received: 06/23/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022]
Abstract
The immune system is an extremely complex biological network that plays a crucial role in the hemostasis of periapical tissue, pathogenesis of apical periodontitis (AP) as well as periapical tissue healing. The successful elimination of microbial infections remains a significant challenge, mostly due to the ever-growing development of antimicrobial-resistant pathogens. The bacterial endurance in the root canal system contributes to features ranging from altered post-treatment healing to exacerbation of chronic periradicular immune response, that compromise the outcome of endodontic treatment. A highly effective strategy for combating infectious diseases and the associated inflammation-mediated tissue damage is to modulate the host immune response in conjunction with antimicrobial therapy. There are several medications currently used in endodontic treatment, however, they suffer various levels of microbial resistance and do not deliver all the required characteristics to simultaneously address both intracanal bacteria and periapical inflammation. Interaction of antimicrobial agents with the immune system can impact its function, leading to immune-suppressive or immune-stimulatory effects. The group of non-conventional antimicrobial medications, such as antimicrobial peptides, propolis, and nanomaterials, are agents that provide strong antimicrobial effectiveness and concomitant immunomodulatory and/or reparative effect, without any host tissue damages. Herein, we provide an overview of local immune modulation in AP and a comprehensive review of the immunomodulatory effect of antimicrobials intracanal medications applied in endodontics with specific emphasis on the antimicrobial nanomaterial-based approaches that provide immunomodulatory potential for successful clinical deployment in endodontics.
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6
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Binanzan N, Alsalleeh F. Cytokine expression and anti-microbial effectiveness of different calcium hydroxide dilutions: An In Vitro study. Indian J Dent Res 2022; 33:69-74. [PMID: 35946248 DOI: 10.4103/ijdr.ijdr_41_20] [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: 11/04/2022] Open
Abstract
Aims To determine the cytokine expression by human gingival fibroblasts in response to different calcium hydroxide (Ca(OH)2) dilutions and test the effectiveness of these dilutions in root canal dentin infected with Enterococcus faecalis (E. faecalis). Methods UltraCal XS Ca(OH)2 dilutions were prepared (60, 10, and 1 mg\mL) and co-cultured with gingival fibroblasts for 24 and 48 hours. Untreated cells were used as controls. Expressions of interleukin (IL-1β), tumour necrosis factor alpha (TNF-α), transforming growth factor beta (TGF-β), and IL-10 were analysed with real-time polymerase chain reaction (PCR). Root canals of extracted human teeth were inoculated with E. faecalis. After 21 days, canals were medicated with Ca(OH)2 dilutions for 7 days. Samples were taken to determine bacterial reduction using quantitative PCR. Analysis of variance, Tukey post-test, and Wilcoxon matched pair test were used for statistics. Results IL-1β and TNF-α expressions of all Ca(OH)2 dilutions were higher at 24 and 48 hours compared to the control. Similarly, all Ca(OH)2 dilutions induced TGF-β expression at 24 hours compared to the control and continued to be higher in 60 mg/mL groups at 48 hours. In contrast, IL-10 was constitutively expressed by untreated cells in the control group and was down-regulated significantly by all Ca(OH)2 dilutions at 24 and 48 hours. All dilutions demonstrated a significant E. faecalis reduction (P < 0.001) with no significant difference between dilution groups (P > 0.05). Conclusions All Ca(OH)2 dilutions had a differential inflammatory effect on fibroblasts and had a down-regulation effect to IL-10. All dilutions tested were effective against E. faecalis, with 60 mg/mL having the highest bacterial reduction.
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Affiliation(s)
- Najla Binanzan
- Department of Restorative Dental Sciences, Division of Endodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Fahd Alsalleeh
- Department of Restorative Dental Sciences, Division of Endodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Sousa MGDC, Xavier PD, Cantuária APDC, Amorim IA, Almeida JA, Franco OL, Rezende TMB. Antimicrobial and immunomodulatory in vitro profile of double antibiotic paste. Int Endod J 2021; 54:1850-1860. [PMID: 34033685 DOI: 10.1111/iej.13576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/20/2022]
Abstract
AIM To evaluate the antimicrobial and immunomodulatory activity of double antibiotic paste (DAP) in an in vitro infection model. METHODOLOGY The minimum inhibitory and bactericidal concentrations (MIC and MBC) and the antibiofilm activities (TTC assay) of DAP and its components (ciprofloxacin and metronidazole) were evaluated against Staphylococcus aureus and Enterococcus faecalis compared with triple antibiotic paste (TAP). The cellular viability of RAW 264.7 macrophages (24 and 72 h) and L929 fibroblasts (48 and 72 h) was evaluated by MTT. Furthermore, the production of TNF-α, IL-12, IL-6, IL-1α, IL-10 and NO (on RAW 264.7), besides IL-6, TGF-β and NO (on L929), stimulated with DAP in baseline and associated with heat-killed microbial-antigen conditions was measured by ELISA and Griess reaction. Data were analysed using the one-way ANOVA test with Bonferroni's corrections. RESULTS The MBC of pharmacopoeia DAP was similar to TAP for E. faecalis (0.25 μg. mL-1 ) and lower for S. aureus (DAP 1 μg. mL-1 and TAP 2 μg. mL-1 ; p < .001). Ciprofloxacin was the most effective antibiofilm drug from the pastes (35% of reduction for E. faecalis and S. aureus; p < .0001), and both pastes had a similar antibiofilm eradication against both biofilm species (29% and 35% for S. aureus and 76% and 85% for E. faecalis; p < .0001). DAP was cytotoxic against the tested cells. DAP significantly upregulated IL-1α (p < .001), IL-6 (p < .0001), TNF-α (p < .01) and IL-12 (p < .05; in the absence of antigens) and significantly reduced IL-6 (p < .0001; in the presence of HK-S. aureus) and IL-10 (p < .05; in the presence of both antigens) on macrophages. Furthermore, DAP upregulated IL-6 (p < .001) and NO (p < .05; in the absence of antigens), IL-6 (p < .001; in the presence of HK-S. aureus) and reduced NO (p < .001; in the presence of HK-S. aureus). CONCLUSIONS Double antibiotic paste and TAP had similar antimicrobial activity against S. aureus and E. faecalis. DAP upregulated pro-inflammatory cytokines mainly in the absence of antigens and had pro- and anti-inflammatory activity in RAW 264.7 macrophages and L929 fibroblasts in the presence of antigens involved in pulp infections.
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Affiliation(s)
- Maurício Gonçalves da Costa Sousa
- Pós-Graduação em Ciências Genômicas e Biotecnologia, Centro de Análises Proteômicas e Bioquímicas, Universidade Católica de Brasília, Brasília, Brazil
| | | | | | - Ingrid Aquino Amorim
- Pós-Graduação em Ciências Genômicas e Biotecnologia, Centro de Análises Proteômicas e Bioquímicas, Universidade Católica de Brasília, Brasília, Brazil.,Curso de Odontologia, Centro Universitário Unieuro, Brasília, Brazil
| | - Jeeser Alves Almeida
- Pós-Graduação em Saúde e Desenvolvimento na Região Centro Oeste, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
| | - Octavio Luiz Franco
- Pós-Graduação em Ciências Genômicas e Biotecnologia, Centro de Análises Proteômicas e Bioquímicas, Universidade Católica de Brasília, Brasília, Brazil.,Pós-Graduação em Patologia Molecular, Universidade de Brasília, Brasília, Brazil.,S-Inova Biotech, Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Brazil
| | - Taia Maria Berto Rezende
- Pós-Graduação em Ciências Genômicas e Biotecnologia, Centro de Análises Proteômicas e Bioquímicas, Universidade Católica de Brasília, Brasília, Brazil.,Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brazil.,Curso de Odontologia, Universidade Católica de Brasília, Brasília, Brazil
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8
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Sousa MGC, Xavier PD, Cantuária APDC, Porcino RA, Almeida JA, Franco OL, Rezende TMB. Host defense peptide IDR-1002 associated with ciprofloxacin as a new antimicrobial and immunomodulatory strategy for dental pulp revascularization therapy. Microb Pathog 2020; 152:104634. [PMID: 33242643 DOI: 10.1016/j.micpath.2020.104634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/08/2020] [Accepted: 11/17/2020] [Indexed: 12/18/2022]
Abstract
Regenerative therapies such as dental pulpal revascularization appear as an option for traumatized immature permanent teeth. However, the triple antibiotic paste - TAP (metronidazole, minocycline, and ciprofloxacin), used for these therapies, can generate cytotoxicity and dentin discoloration. In contrast, host defense peptides (HDPs) are promising antimicrobial and immunomodulatory biomolecules for dentistry. This study aimed to evaluate in vitro the antimicrobial activity (against Staphylococcus aureus and Enterococcus faecalis) and the immunomodulatory potential (by the evaluation of IL-1α, IL-6, IL-12, IL-10, TNF-α and NO, in RAW 264.7 macrophages and IL-6, TGF-β and NO, in L929 fibroblast) of synthetic peptides (DJK-6, IDR-1018, and IDR-1002), compared to TAP in an in vitro infection model containing heat-killed antigens from E. faecalis and S. aureus. Furthermore, the synergistic potential of ciprofloxacin and IDR-1002 was evaluated by checkerboard. Ciprofloxacin was the best antimicrobial of TAP, besides acting in synergism with IDR-1002. TAP was pro-inflammatory (p < 0.05), while the association of ciprofloxacin and IDR-1002 presented an anti-inflammatory profile mainly in the presence of both heat-killed antigens (p < 0.05). Based on these results, ciprofloxacin associated with IDR-1002 may demonstrate an efficient antimicrobial and immunomodulatory action in this in vitro model. Further in vivo studies may determine the real potential of this combination.
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Affiliation(s)
- Maurício Gonçalves C Sousa
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação Em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
| | - Patrícia D Xavier
- Curso de Farmácia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
| | - Ana Paula de C Cantuária
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - Rayssa A Porcino
- Programa de Pós-Graduação Em Patologia Molecular, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - Jeeser A Almeida
- Programa de Pós-Graduação Em Saúde e Desenvolvimento na Região Centro Oeste, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Octávio L Franco
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação Em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil; Programa de Pós-Graduação Em Patologia Molecular, Universidade de Brasília, Brasília, Distrito Federal, Brazil; S-Inova Biotech, Pós-Graduação Em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Mato Grosso do Sul, Brazil
| | - Taia Maria B Rezende
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação Em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil; Programa de Pós-Graduação Em Ciências da Saúde, Universidade de Brasília, Brasília, Distrito Federal, Brazil; Curso de Odontologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil.
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9
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Alshawwa H, Wang JF, Liu M, Sun SF. Successful management of a tooth with endodontic-periodontal lesion: A case report. World J Clin Cases 2020; 8:5049-5056. [PMID: 33195681 PMCID: PMC7642532 DOI: 10.12998/wjcc.v8.i20.5049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/01/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endodontic-periodontal lesion is a commonly encountered dental condition. However, the prognosis of the condition varies from good to poor. Some cases are associated with a poor prognosis that requires tooth extraction. This report presents a case of an endodontic-periodontal lesion in a tooth that was successfully treated by root canal treatment.
CASE SUMMARY A 51-year-old female patient with no medical history complained about persistent pain and discomfort in her left mandibular first molar. Clinical examination showed the left mandibular first molar with poor restoration. It was also associated with underlying necrotic pulp and periodontal involvement. Radiographic examination revealed visible bone defects in the apical and periodontal areas. Based on the findings, the patient was diagnosed with a primary endodontic lesion. A root canal treatment for the endodontic lesion was performed. The patient received a coronal all-ceramic endocrown restoration. A follow-up was arranged to check the prognosis. At the 3 mo follow-up, the clinical and radiography evaluations showed complete disappearance of signs and symptoms and an increase in the radiopacity of the root area.
CONCLUSION Despite the poor prognosis associated with many endodontic lesions, this case report highlights that a good prognosis is still possible for an endodontic lesion with apical and periodontal bone loss. In this case, it was achieved via successful root canal treatment without the need for periodontal or surgical intervention.
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Affiliation(s)
- Hamed Alshawwa
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Jia-Feng Wang
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Min Liu
- Department of Periodontics, Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Shu-Fen Sun
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
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10
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Uluköylü E, Karataş E, Albayrak M, Bayır Y. Effect of Calcium Hydroxide Alone or in Combination with Ibuprofen and Ciprofloxacin on Nuclear Factor Kappa B Ligand and Osteoprotegerin Level in Periapical Lesions: A Randomized Controlled Clinical Study. J Endod 2019; 45:1489-1495. [DOI: 10.1016/j.joen.2019.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 08/02/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
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Rahhal JG, Rovai EDS, Holzhausen M, Caldeira CL, Santos CFD, Sipert CR. Root canal dressings for revascularization influence in vitro mineralization of apical papilla cells. J Appl Oral Sci 2019; 27:e20180396. [PMID: 30994774 PMCID: PMC6459230 DOI: 10.1590/1678-7757-2018-0396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/25/2018] [Indexed: 12/12/2022] Open
Abstract
Endodontic revascularization is based on cell recruitment into the necrotic root canal of immature teeth after chemical disinfection. The clinical outcome depends on the ability of surviving cells from the apical tissue to differentiate and promote hard tissue deposition inside the dentinal walls.
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Affiliation(s)
- Juliana Garuba Rahhal
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Dentística, São Paulo, São Paulo, Brasil
| | - Emanuel da Silva Rovai
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Estomatologia, São Paulo, São Paulo, Brasil
| | - Marinella Holzhausen
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Estomatologia, São Paulo, São Paulo, Brasil
| | - Celso Luiz Caldeira
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Dentística, São Paulo, São Paulo, Brasil
| | - Carlos Ferreira Dos Santos
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Ciências Biológicas, Bauru, São Paulo, Brasil
| | - Carla Renata Sipert
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Dentística, São Paulo, São Paulo, Brasil
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Faria G, Rodrigues EM, Coaguila-Llerena H, Gomes-Cornélio AL, Neto Angéloco RR, Swerts Pereira MS, Tanomaru Filho M. Influence of the Vehicle and Antibiotic Formulation on Cytotoxicity of Triple Antibiotic Paste. J Endod 2019; 44:1812-1816. [PMID: 30477667 DOI: 10.1016/j.joen.2018.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/05/2018] [Accepted: 09/10/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The aim of this study was to assess the influence of antibiotic formulations (tablet/capsule [TC] or United States Pharmacopeia [USP]-grade antibiotics) and vehicles (water [H2O] or macrogol + propylene glycol [MP]) on the cytotoxicity and pH of triple antibiotic pastes (TAPs). METHODS L929 fibroblasts were exposed to TAPs prepared with TC or USP-grade antibiotics mixed with H2O or MP for 72 hours. Each isolated antibiotic with each vehicle, each isolated vehicle, and the culture medium were used as controls. Cytotoxicity was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and neutral red assays. The pH was measured after 3 and 8 hours of immersion of the pastes in water. Data were analyzed using analysis of variance, the Bonferroni or Tukey posttests (α = 0.05), and the Pearson correlation test (α = 0.05). RESULTS The pastes prepared with TC were less cytotoxic than pastes prepared with USP-grade antibiotics (P < .05), and pastes with the MP vehicle were less cytotoxic than pastes with H2O (P < .05). TC TAP + MP showed the lowest cytotoxicity, whereas USP-grade TAP + H2O showed the highest cytotoxicity (P < .05). All TAPs showed a pH ranging from 4.64-5.20. Irrespective of the vehicle, USP-grade TAP showed a lower pH than TC TAP (P < .05). TAPs with H2O had a lower pH than TAPs with MP (P < .05). CONCLUSIONS The vehicle and the antibiotic formulations influenced the cytotoxicity and pH of TAP. The pastes prepared with TC and MP were less acidic and less cytotoxic than the type prepared with USP-grade antibiotics and H2O.
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Affiliation(s)
- Gisele Faria
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University-UNESP, Araraquara, São Paulo, Brazil.
| | - Elisandra Márcia Rodrigues
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University-UNESP, Araraquara, São Paulo, Brazil
| | - Hernán Coaguila-Llerena
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University-UNESP, Araraquara, São Paulo, Brazil
| | - Ana Lívia Gomes-Cornélio
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University-UNESP, Araraquara, São Paulo, Brazil
| | - Renan Rodrigues Neto Angéloco
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University-UNESP, Araraquara, São Paulo, Brazil
| | - Maristela Soares Swerts Pereira
- Department of Pediatric Dentistry, Alfenas School of Dentistry, Jose Rosario Vellano University-Unifenas, Alfenas, Minas Gerais, Brazil
| | - Mario Tanomaru Filho
- Department of Restorative Dentistry, Araraquara School of Dentistry, São Paulo State University-UNESP, Araraquara, São Paulo, Brazil
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An in vitro study on the efficacy of removing calcium hydroxide from curved root canal systems in root canal therapy. Int J Oral Sci 2017. [PMID: 28644431 PMCID: PMC5518972 DOI: 10.1038/ijos.2017.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To compare the efficacy of various irrigants (citric acid, ethylenediaminetetraacetic acid (EDTA) and NaOCl) and techniques in removing Ca(OH)2 in two types of curved root canal systems, simulated root canals with specific curvatures were used to investigate the effects of different irrigants and instruments on Ca(OH)2 removal. The optimal methods were verified on extracted human teeth. Simulated root canals were assigned to one of two groups based on the irrigation solution: 10% citric acid or 2.5% NaOCl. Each group was divided into four subgroups according to the technique used to remove Ca(OH)2. The percentage of Ca(OH)2 removal in different sections of root canals was calculated. On the basis of the results obtained for the simulated canals, 10% citric acid and 17% EDTA were applied to remove Ca(OH)2 from the extracted human teeth with curved root canal systems. The teeth were scanned by micro computed tomography to calculate the percentage of Ca(OH)2 removal in the canals. In simulated root canals, we found that 10% citric acid removed more Ca(OH)2 than 2.5% NaOCl in the 0–1 mm group from the apex level (P<0.05). Ultrasonic and EndoActivator activation significantly removed more Ca(OH)2 than a size 30 K file in the apical third (P<0.05). However, there were no significant differences in any sections of the canals for 10% citric acid or 17% EDTA in removing Ca(OH)2 in extracted human teeth. We concluded that it was effective to remove residual Ca(OH)2 using the decalcifying solution with EndoActivator or Passive Ultrasonic Irrigation in a curved root canal system. A protocol for Ca(OH)2 removal was provided based on the conclusions of this study and the methods recommended in previous studies.
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Pagliarin CML, Londero CDLD, Felippe MCS, Felippe WT, Danesi CC, Barletta FB. Tissue characterization following revascularization of immature dog teeth using different disinfection pastes. Braz Oral Res 2016; 30:S1806-83242016000100273. [PMID: 27556552 DOI: 10.1590/1807-3107bor-2016.vol30.0074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/28/2016] [Indexed: 12/19/2022] Open
Abstract
Revascularization of immature teeth with necrotic pulps traditionally involves the use of triple antibiotic paste, which may sometimes lead to undesirable complications. The objective of this study was to assess tissue repair in immature dog teeth with apical periodontitis subjected to revascularization, comparing two different pastes used for root canal disinfection. Apical periodontitis was induced in 30 dog premolars. Teeth were randomly divided into three experimental groups: root canals filled with triple antibiotic paste (n = 10); root canals filled with 1% propolis paste (n = 10); and no medication (n = 10). An additional group (n = 10, no intervention) was used as control. After 7 months, the jaws were histologically evaluated for the following variables: newly formed mineralized tissue (present/absent); vital tissue in the canal space (absent/periodontal ligament-like/pulp-like); apical extension of root (present/absent); and severity of inflammatory process (absent/mild/moderate/severe). There were no statistically significant differences among the experimental groups in new mineralized tissue formation and apical root development. The formation of vital tissue in the canal space, in turn, was statistically different between the triple paste and propolis groups: vital tissues were present in all revascularized teeth disinfected with propolis paste (100%), compared to 71% of those disinfected with the triple paste. Severity of inflammatory process was different between the triple paste and no medication groups. The new tissues formed onto canal walls and in the root canal space showed characteristics of cementum and periodontal ligament, respectively. Propolis may have some advantages over the triple paste for the revascularization of immature teeth.
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Affiliation(s)
| | | | - Mara Cristina Santos Felippe
- Universidade Federal de Santa Catarina - UFSC, School of Dentistry, Department of Dentistry, Florianópolis, SC, Brazil
| | - Wilson Tadeu Felippe
- Universidade Federal de Santa Catarina - UFSC, School of Dentistry, Department of Dentistry, Florianópolis, SC, Brazil
| | - Cristiane Cademartori Danesi
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Pathology, Santa Maria, RS, Brazil
| | - Fernando Branco Barletta
- Universidade Luterana do Brazil - ULBRA, School of Dentistry, Department of Endodontics, Canoas, RS, Brazil
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15
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Carbajal Mejía JB, Aguilar Arrieta A. Reduction of viableEnterococcus faecalisin human radicular dentin treated with 1% cetrimide and conventional intracanal medicaments. Dent Traumatol 2015; 32:321-7. [DOI: 10.1111/edt.12250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Jeison B. Carbajal Mejía
- Department of Endodontics; Faculty of Dentistry; Daniel Alcides Carrión National University; UNDAC; Pasco Peru
- Department of Fixed Prosthodontics; Osaka University Graduate School of Dentistry; Suita Japan
| | - Angela Aguilar Arrieta
- Department of Endodontics; Faculty of Dentistry; Daniel Alcides Carrión National University; UNDAC; Pasco Peru
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Midena RZ, Garcia RB, Cavenago BC, Marciano MA, Minotti PG, Ordinola-Zapata R, Weckwerth PH, Andrade FBD, Duarte MAH. Analysis of the reaction of subcutaneous tissues in rats and the antimicrobial activity of calcium hydroxide paste used in association with different substances. J Appl Oral Sci 2015. [PMID: 26200527 PMCID: PMC4621947 DOI: 10.1590/1678-775720140049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to evaluate the subcutaneous tissue response in rats and the antimicrobial activity of intracanal calcium hydroxide dressings mixed with different substances against E. faecalis. Fifty four rats were divided into three experimental groups according to the vehicle in the calcium hydroxide treatment: 0.4% chlorohexidine in propylene glycol (PG), Casearia sylvestris Sw in PG and calcium hydroxide+PG (control group). The pastes were placed into polyethylene tubes and implanted into the subcutaneous tissue. After 7, 14 and 30 days, the samples were processed and histologically evaluated (hematoxylin and eosin). The tissue surface in contact with the material was analyzed, and the quantitative analysis determined the volume density occupied by the inflammatory infiltrate (giant cells, polymorphonuclear cells and mononuclear cells), fibroblasts, collagen fibers and blood vessels. For the antimicrobial analysis, 20 dentin blocks infected with E. faecalis were treated with calcium hydroxide pastes in different vehicles; 0.4% chlorhexidine in PG, PG, extract from Casearia sylvestris Sw in PG and a positive control (infection and without medication) for 7 days. The efficiency of the pastes was evaluated by the live/dead technique and confocal microscopy. The results showed that 0.4% chlorhexidine induced a higher inflammatory response than the other groups. The Casearia sylvestris Sw extract showed satisfactory results in relation to the intensity of the inflammatory response. In the microbiological test, there were no statistical differences between the evaluated intracanal dressings and the percentage of bacterial viability was between 33 and 42%. The control group showed an 86% viability. Antimicrobial components such as chlorhexidine or Casearia sylvestris Sw did not improve the antimicrobial activity against E. faecalis in comparison to the calcium hydroxide+PG treatment. In addition, the incorporation of chlorhexidine in the calcium hydroxide paste promoted the highest inflammatory response.
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Affiliation(s)
- Raquel Zanin Midena
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Roberto Brandão Garcia
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Bruno Cavalini Cavenago
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Marina Angélica Marciano
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Paloma Gagliardi Minotti
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Ronald Ordinola-Zapata
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | | | - Flaviana Bombarda de Andrade
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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Pai S, Vivekananda Pai AR, Thomas MS, Bhat V. Effect of calcium hydroxide and triple antibiotic paste as intracanal medicaments on the incidence of inter-appointment flare-up in diabetic patients: An in vivo study. J Conserv Dent 2014; 17:208-11. [PMID: 24944440 PMCID: PMC4056388 DOI: 10.4103/0972-0707.131776] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 11/22/2022] Open
Abstract
Aim: To evaluate and compare the effect of antibacterial intracanal medicaments on inter-appointment flare-up in diabetic patients. Materials and Methods: Fifty diabetic patients requiring root canal treatment were assigned into groups I, II, and III. In group I, no intracanal medicament was placed. In groups II and III, calcium hydroxide and triple antibiotic pastes were placed as intracanal medicaments, respectively. Patients were instructed to record their pain on days 1, 2, 3, 7, and 14. Inter-appointment flare-up was evaluated using verbal rating scale (VRS). Results: Overall incidence of inter-appointment flare-up among diabetic patients was found to be 16%. In group I, 50% of the patients and in group II, 15% of the patients developed inter-appointment flare-up. However, no patients in group III developed inter-appointment flare-up. The comparison of these results was found to be statistically significant (P = 0.002; χ2 = 12.426). However, with respect to intergroup comparison, only the difference between groups I and III was found to be statistically significant (P = 0.002; χ2 = 12.00). Conclusions: Calcium hydroxide and triple antibiotic paste are effective for managing inter-appointment flare-ups in diabetic patients. Triple antibiotic paste is more effective than calcium hydroxide in preventing the occurrence of flare-up in diabetic patients.
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Affiliation(s)
- Swathi Pai
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Manipal, Karnataka, India
| | - A R Vivekananda Pai
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
| | - Manuel S Thomas
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
| | - Vishal Bhat
- Department of Pharmacology, Melaka Manipal Medical College, Manipal University, Manipal, Karnataka, India
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