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Alghofaily M, Almana A, Alrayes J, Lambarte R, Weir MD, Alsalleeh F. Chitosan-Gelatin Scaffolds Loaded with Different Antibiotic Formulations for Regenerative Endodontic Procedures Promote Biocompatibility and Antibacterial Activity. J Funct Biomater 2024; 15:186. [PMID: 39057307 PMCID: PMC11278440 DOI: 10.3390/jfb15070186] [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: 05/13/2024] [Revised: 06/17/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND This study investigated the biocompatibility and antibacterial efficacy of chitosan-gelatin (CH-G) scaffolds loaded with slow-releasing antibiotic formulations used in regeneration endodontic procedures (REPs). METHODS Scaffolds were fabricated using freeze drying and loaded with varying concentrations of augmentin or modified triple antibiotic paste (mTAP). High-resolution scanning electron microscopy (SEM) was used to characterize the scaffold, while drug release was monitored via UV-Vis spectrophotometry. Immortalized human mesenchymal stem cells (hMSCs) were cultured on CH-G scaffolds alone (control), either 0.1 mg/mL or 1 mg/mL of augmentin or mTAP, and 10 mg/mL calcium hydroxide (Ca(OH)2). Cell viability and proliferation were assessed using the Alamar Blue assay and SEM, respectively, and live/dead staining further corroborated cell viability. Antibacterial activity against Enterococcus faecalis was evaluated using the MTT assay and confocal laser scanning microscopy (CLSM). RESULTS Augmentin at 0.1 mg/mL appeared to promote better cell growth and attachment within the scaffolds than all other formulations, exhibiting acceptable viability. SEM revealed improved cell attachment in augmentin and mTAP groups compared to the Ca(OH)2 group. Augmentin at 1 mg/mL and mTAP groups significantly reduced viable bacteria compared to controls. Augmentin groups and mTAP at 1 mg/mL were highly effective in eliminating E. faecalis biofilms, with mTAP potentially causing more cell death within the remaining biofilm structures. CONCLUSIONS This study suggests that CH-G scaffolds loaded with augmentin and mTAP, particularly at a concentration of 1 mg/mL, offer promising advantages for REPs due to their biocompatibility, antibacterial efficacy, and ability to promote cell attachment. Further research may explore the long-term effects in clinical settings.
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Affiliation(s)
- Maha Alghofaily
- Restorative Dental Sciences, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia
| | - Aljowhara Almana
- College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia; (A.A.); (J.A.)
| | - Jenan Alrayes
- College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia; (A.A.); (J.A.)
| | - Rhodanne Lambarte
- Molecular and Cell Biology Laboratory, King Saud University Medical City, P.O. Box 60169, Riyadh 11545, Saudi Arabia;
| | - Michael D. Weir
- Department of Biomaterials and Regenerative Dental Medicine, University of Maryland School of Dentistry, Baltimore, MD 21201, USA;
| | - Fahd Alsalleeh
- Restorative Dental Sciences, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia
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Goulart TS, Hawerroth T, da Silveira Teixeira C, Cesca K, Silva RR, de Moraes RR, Minamisako MC, Umeda Takashima MT, Cábia NC, Bortoluzzi EA, Mazzon RR, de Almeida J, da Fonseca Roberti Garcia L. Assessment of multispecies biofilm growth on root canal dentin under different radiation therapy regimens. Clin Oral Investig 2024; 28:324. [PMID: 38761225 DOI: 10.1007/s00784-024-05719-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVES To assess the growth of a multispecies biofilm on root canal dentin under different radiotherapy regimens. MATERIALS AND METHODS Sixty-three human root dentin cylinders were distributed into six groups. In three groups, no biofilm was formed (n = 3): NoRT) non-irradiated dentin; RT55) 55 Gy; and RT70) 70 Gy. In the other three groups (n = 18), a 21-day multispecies biofilm (Enterococcus faecalis, Streptococcus mutans, and Candida albicans) was formed in the canal: NoRT + Bio) non-irradiated + biofilm; RT55 + Bio) 55 Gy + biofilm; and RT70 + Bio) 70 Gy + biofilm. The biofilm was quantified (CFUs/mL). Biofilm microstructure was assessed under SEM. Microbial penetration into dentinal tubules was assessed under CLSM. For the biofilm biomass and dentin microhardness pre- and after biofilm growth assessments, 45 bovine dentin specimens were distributed into three groups (n = 15): NoRT) non-irradiated + biofilm; RT55 + Bio) 55 Gy + biofilm; and RT70 + Bio) 70 Gy + biofilm. RESULTS Irradiated specimens (70 Gy) had higher quantity of microorganisms than non-irradiated (p = .010). There was gradual increase in biofilm biomass from non-irradiated to 55 Gy and 70 Gy (p < .001). Irradiated specimens had greater reduction in microhardness after biofilm growth. Irradiated dentin led to the growth of a more complex and irregular biofilm. There was microbial penetration into the dentinal tubules, regardless of the radiation regimen. CONCLUSION Radiotherapy increased the number of microorganisms and biofilm biomass and reduced dentin microhardness. Microbial penetration into dentinal tubules was noticeable. CLINICAL RELEVANCE Cumulative and potentially irreversible side effects of radiotherapy affect biofilm growth on root dentin. These changes could compromise the success of endodontic treatment in oncological patients undergoing head and neck radiotherapy.
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Affiliation(s)
- Taynara Santos Goulart
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianópolis, CEP: 88040-900, Santa Catarina, Brazil
| | - Tainara Hawerroth
- Department of Endodontics, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Cleonice da Silveira Teixeira
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianópolis, CEP: 88040-900, Santa Catarina, Brazil
| | - Karina Cesca
- Department of Chemical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Rodrigo Rohenkohl Silva
- Department of Restorative Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Rafael Ratto de Moraes
- Department of Restorative Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | | | - Nayara Cardoso Cábia
- Department of Radiotherapy, Oncology Research Center (CEPON), Florianópolis, SC, Brazil
| | - Eduardo Antunes Bortoluzzi
- Department of Diagnosis & Oral Health, Endodontics Division, University of Louisville, Louisville, KY, USA
| | - Ricardo Ruiz Mazzon
- Department of Microbiology, Immunology and Parasitology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Josiane de Almeida
- Department of Endodontics, University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Lucas da Fonseca Roberti Garcia
- Department of Dentistry - Endodontics Division, Health Sciences Center, Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, Florianópolis, CEP: 88040-900, Santa Catarina, Brazil.
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Pedrinha VF, Santos LM, Gonçalves CP, Garcia MT, Lameira OA, Queiroga CL, Marcucci MC, Shahbazi MA, Sharma PK, Junqueira JC, Sipert CR, de Andrade FB. Effects of natural antimicrobial compounds propolis and copaiba on periodontal ligament fibroblasts, molecular docking, and in vivo study in Galleria mellonella. Biomed Pharmacother 2024; 171:116139. [PMID: 38198959 DOI: 10.1016/j.biopha.2024.116139] [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: 10/04/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024] Open
Abstract
Root canal treatment addresses infectious processes that require control. Occasionally, the radicular pulp is vital and inflamed, presenting a superficial infection. To preserve pulpal remnants, conservative procedures have gained favor, employing anti-inflammatory medications. This study investigated the effects of propolis (PRO), and copaiba oil-resin (COR) associated with hydrocortisone (H) and compared their impact to that of Otosporin® concerning cytotoxic and genotoxic activity, cytokine detection, and toxicity in the Galleria mellonella model. Human periodontal ligament fibroblasts (PDLFs) were exposed to drug concentrations and evaluated by the MTT assay. Associations were tested from concentrations that did not compromise cell density. Genotoxicity was evaluated through micronucleus counting, while cytokines IL-6 and TGF-β1 were detected in the cell supernatant using ELISA. Molecular docking simulations were conducted, considering the major compounds identified in PRO, COR, and H. Increasing concentrations of PRO and COR were assessed for acute toxicity in Galleria mellonella model. Cellular assays were analyzed using one-way ANOVA followed by Tukey tests, while larval survivals were evaluated using the Log-rank (Mantel-Cox) test (α = 0.05). PRO and COR promoted PDLFs proliferation, even in conjunction with H. No changes in cell metabolism were observed concerning cytokine levels. The tested materials induce the release of AT1R, proliferating the PDFLs through interactions. PRO and COR had low toxicity in larvae, suggesting safety at tested levels. These findings endorse the potential of PRO and COR in endodontics and present promising applications across medical domains, such as preventive strategies in inflammation, shedding light on their potential development into commercially available drugs.
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Affiliation(s)
- Victor Feliz Pedrinha
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo (FOB - USP), Bauru, São Paulo, Brazil; Department of Biomaterials and Biomedical Technology (BBT), University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands.
| | - Letícia Martins Santos
- Department of Operative Dentistry, School of Dentistry, University of São Paulo (FO-USP), São Paulo, Brazil
| | | | - Maíra Terra Garcia
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
| | | | - Carmen Lucia Queiroga
- State University of Campinas, CPQBA, Division of Phytochemistry, Campinas, São Paulo, Brazil
| | - Maria Cristina Marcucci
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
| | - Mohammad-Ali Shahbazi
- Department of Biomaterials and Biomedical Technology (BBT), University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Prashant Kumar Sharma
- Department of Biomaterials and Biomedical Technology (BBT), University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Juliana Campos Junqueira
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
| | - Carla Renata Sipert
- Department of Operative Dentistry, School of Dentistry, University of São Paulo (FO-USP), São Paulo, Brazil
| | - Flaviana Bombarda de Andrade
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo (FOB - USP), Bauru, São Paulo, Brazil
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Smoczer C, Park YK, Herrington JB, Askar MA, Plecha S, Krukonis E, Paurazas SB. A Potential Intracanal Medicament, 2-Hydroxyisocaproic Acid (HICA): Cytotoxicity, Genotoxicity, and Its Effect on SCAP Differentiation. Dent J (Basel) 2023; 11:270. [PMID: 38132408 PMCID: PMC10743052 DOI: 10.3390/dj11120270] [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: 10/16/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Intracanal medicaments with maximal antimicrobial efficacy and minimal damage to resident stem cells are essential for successful regenerative endodontic procedures. 2-Hydroxyisocaproic acid (HICA) could have the attributes of a potential intracanal medicament. This study evaluates its cytotoxicity, genotoxicity, and effects on the odontogenic and osteogenic differentiation of the stem cells of the apical papilla (SCAP). Cytotoxicity and cell viability assays were performed on cells treated for 24, 48, and 72 h with varying concentrations of HICA and compared to the standard intracanal medicament, calcium hydroxide. The genotoxicity was assessed via immunofluorescence for two markers of DNA double-strand breaks: phosphorylated γH2AX and 53BP1. The SCAP differentiation was evaluated based on the alkaline phosphatase activity, Alizarin Red staining, and expression of odontogenic and osteogenic genes (DSPP1, BSP1, OCN, RUNX2) in the presence of selected HICA concentrations. HICA was not cytotoxic at concentrations up to 10 mg/mL, regardless of the exposure time, although it was cytostatic at all tested concentrations. HICA was not genotoxic at concentrations below 5 mg/mL. No difference in cytotoxicity or genotoxicity was found between HICA and calcium hydroxide at 1 mg/mL. HICA retained about 70% of the osteogenic differentiation potential at 1 mg/mL. Within the limitations of this in vitro study, we show that HICA at 1 mg/mL could be a potential intracanal medicament for REPs.
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Affiliation(s)
- Cristine Smoczer
- Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (C.S.); (S.P.); (E.K.)
| | - Yun K. Park
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
| | - James B. Herrington
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
| | - Mazin A. Askar
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
| | - Sarah Plecha
- Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (C.S.); (S.P.); (E.K.)
| | - Eric Krukonis
- Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA; (C.S.); (S.P.); (E.K.)
| | - Susan B. Paurazas
- Graduate Endodontics, University of Detroit Mercy School of Dentistry, Detroit, MI 48208, USA (M.A.A.)
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Gioster-Ramos ML, Pedrinha VF, Barros MC, Bezerra RM, Andrade FB, Kuga MC, Vaz LG. Antimicrobial effect of Pentaclethra Macroloba plant extract against Enterococcus Faecalis. BRAZ J BIOL 2023; 83:e272095. [PMID: 38055574 DOI: 10.1590/1519-6984.272095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/10/2023] [Indexed: 12/08/2023] Open
Abstract
This study evaluated the antimicrobial efficacy of a new intracanal drug based on Pentaclethra macroloba extract, a plant of Amazonian origin, against Enterococcus faecalis using macrodilution test and intratubular evaluation with Confocal Laser Scanning Microscopy (CLSM). The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) of the pure extract of Pentaclethra macroloba andits association with calcium hydroxide and ultracall were determined. Then, thirty-three dentin cylinders were prepared and inoculated with E. faecalis, to evaluate the antimicrobial effect of the medications on the dentinal tubules with CLSM. The data was analyzed using the Kruskal-Wallis and Dunn tests. The extract in association with calcium hydroxide showed a lower CBM, and in the intratubular test all tested medications were effective against E. faecalis (P >0.05). The new intracanal drug based on P. macroloba extract has an antimicrobial effect against E. faecalis and further studies are needed for its clinical use.
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Affiliation(s)
- M L Gioster-Ramos
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Faculdade de Odontologia, Departamento de Materiais Odontológicos e Prótese, Araraquara, SP, Brasil
| | - V F Pedrinha
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Dentística, Endodontia e Materiais Odontológicos, Bauru, SP, Brasil
| | - M C Barros
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Dentística, Endodontia e Materiais Odontológicos, Bauru, SP, Brasil
| | - R M Bezerra
- Universidade Federal do Amapá - UNIFAP, Laboratório de Bioprospecção e Absorção Atômica, Macapá, AP, Brasil
| | - F B Andrade
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Dentística, Endodontia e Materiais Odontológicos, Bauru, SP, Brasil
| | - M C Kuga
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Faculdade de Odontologia, Departamento de Odontologia Restauradora, Araraquara, SP, Brasil
| | - L G Vaz
- Universidade Estadual Paulista "Júlio de Mesquita Filho" - UNESP, Faculdade de Odontologia, Departamento de Materiais Odontológicos e Prótese, Araraquara, SP, Brasil
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The Vehicles of Calcium Hydroxide Pastes Interfere with Antimicrobial Effect, Biofilm Polysaccharidic Matrix, and Pastes' Physicochemical Properties. Biomedicines 2022; 10:biomedicines10123123. [PMID: 36551879 PMCID: PMC9775961 DOI: 10.3390/biomedicines10123123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 12/09/2022] Open
Abstract
The objective of the present study was to investigate the pH, volumetric alteration, antimicrobial action, and effect on biofilm matrix polysaccharides of calcium hydroxide (CH) pastes with different vehicles available in endodontics: CH + propylene glycol (CHP), UltraCal XS®, Metapaste®, and Metapex®. The pH was analyzed at different time intervals using a pH meter. For volumetric alteration, a microtomographic assay was performed before and after immersion in water. Enterococcus faecalis was chosen for microbiological tests. The bacterial viability and extracellular matrix were quantified with direct contact evaluation (dentin blocks) and at the intratubular level (dentin cylinders) using LIVE/DEAD BacLight and Calcofluor White dyes via confocal laser scanning microscopy (CLSM). Kruskal-Wallis and Dunn's tests were used to analyze pH and direct contact assays, while one-way ANOVA and Tukey tests were used to analyze volumetric alteration and intratubular decontamination (α = 0.05). Higher pH values were obtained during the initial days. Volumetric alterations were similar in all groups. Lower bacterial viability was obtained for dentin blocks and cylinders when CH pastes were used. UltraCal XS and Metapex had lower values for the extracellular matrix. The pH of all CH pastes decreased with time and did not promote medium alkalization for up to 30 days. CH paste can reduce bacterial viability through direct contact and at an intratubular level; however, UltraCal XS and Metapex are involved with lower volumes of extracellular matrices.
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Can the Concentration of Citric Acid Affect Its Cytotoxicity and Antimicrobial Activity? Dent J (Basel) 2022; 10:dj10080148. [PMID: 36005246 PMCID: PMC9406502 DOI: 10.3390/dj10080148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: There has been no unanimity concerning the ideal concentration of citric acid for safe use in clinical practice. This study evaluated the cytotoxicity and the antibacterial activity in infected dentinal tubules of 10% and 1% citric acid (CA) solutions. Methods: The cytotoxicity of CA solutions in DMEM (diluted 1/10, 1/100) was assessed in L-929 fibroblasts. A broth macrodilution method (MIC and MBC) was used to assess CA antibacterial concentration. The antimicrobial activity of CA solutions was also evaluated after their final rinse inside root canals in previously Enterococcus faecalis-contaminated dentinal tubules. Ten infected dentine samples were rinsed for 5 min with 5% NaOCl and subsequently with 1% citric acid for 3 min. Another 10 were rinsed with 5% NaOCl and 10% citric acid for 3 min; the remaining four specimens were utilized as positive controls. Two uncontaminated specimens were used as negative controls. After LIVE/DEAD BacLight staining, the samples were assessed using CLSM to analyze the percentage of residual live and dead cells. Results: Both undiluted and diluted CA solutions showed severe toxicity; no changes from normal morphology were displayed when diluted 1/100. The MIC and MBC of CA were 6.25 mg/mL and 12.50 mg/mL, respectively. CA solutions demonstrated significantly low levels of bacterial counts than the positive control group, reporting a value of 9.3% for the 10% solution versus the 1% solution (35.2%). Conclusions: Despite its valuable antimicrobial properties, the cytotoxic effects of citric acid should be considered during endodontic treatment.
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Efficacy of Ciprofloxacin, Metronidazole and Minocycline in Ordered Mesoporous Silica against Enterococcus faecalis for Dental Pulp Revascularization: An In-Vitro Study. MATERIALS 2022; 15:ma15062266. [PMID: 35329718 PMCID: PMC8953332 DOI: 10.3390/ma15062266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
Pulp revascularization of teeth with necrotic pulp has become an alternative treatment in cases with immature apex. Microbial control is essential to achieve a successful outcome and continued root development. Enterococcus faecalis (E. faecalis) is the most frequently isolated bacterial species in root canals of endodontically failed teeth. Our main goal was to compare the in-vitro antimicrobial efficacy of different antibiotic formulations delivered by ordered mesoporous silica (OMS) against E. faecalis. To determine antibiotic susceptibility, we tested OMS and triple antibiotic paste (TAP; ciprofloxacin:metronidazole:minocycline) with different reagents in different concentrations, using the Kirby−Bauer disk diffusion method. OMS and metronidazole showed no antibacterial activity against E. faecalis. Mixtures of OMS and antibiotics in proportions of 2:2:14 and 4:1:7 (mg/L of ciprofloxacin:metronidazole:minocycline, respectively) showed the lowest antibacterial activity. The antibacterial activity of the combined solutions of ciprofloxacin and metronidazole was significantly higher (p < 0.005). Combinations in different concentrations of minocycline, ciprofloxacin, and metronidazole in OMS have shown activity against E. faecalis, although the combined use of ciprofloxacin and metronidazole has shown the most effective results. This study demonstrates the efficacy of intracanal antibiotic combination paste activity against E. faecalis, avoiding the use of minocycline, whose undesirable effect of teeth staining is a common problem for patients and professionals in dental clinic.
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Vatankhah M, Khosravi K, Zargar N, Shirvani A, Nekoofar MH, Dianat O. Antibacterial efficacy of antibiotic pastes versus calcium hydroxide intracanal dressing: A systematic review and meta-analysis of ex vivo studies. J Conserv Dent 2022; 25:463-480. [PMID: 36506621 PMCID: PMC9733540 DOI: 10.4103/jcd.jcd_183_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Conflicting findings on the potency of antibiotic pastes versus calcium hydroxide (CH) have been evident in the literature. Aims To compare the antibacterial efficacy of single antibiotic paste (SAP), double antibiotic paste (DAP), triple antibiotic paste (TAP), and modified TAP (mTAP) with CH on bacterial biofilms. Methods PubMed, Scopus, and Embase were comprehensively searched until August 23, 2021. The study protocol was registered in the PROSPERO. Ex vivo studies performed on Enterococcus faecalis or polymicrobial biofilms incubated on human/bovine dentin were selected. The quality of the studies was assessed using a customized quality assessment tool. Standardized mean difference (SMD) with a 95% confidence interval (CI) was calculated for the meta-analysis. Meta-regression models were used to identify the sources of heterogeneity and to compare the efficacy of pastes. Results The qualitative and quantitative synthesis included 40 and 23 papers, respectively, out of 1421 search results. TAP (SMD = -3.82; CI, -5.44 to -2.21; P < 0.001) and SAPs (SMD = -2.38; CI, -2.81 to - 1.94; P < 0.001) had significantly higher antibacterial efficacy compared to the CH on E. faecalis biofilm. However, no significant difference was found between the efficacy of DAP (SMD = -2.74; CI, -5.56-0.07; P = 0.06) or mTAP (SMD = -0.28; CI, -0.82-0.26; P = 0.31) and CH. Meta-regression model on E. faecalis showed that SAPs have similar efficacy compared to TAP and significantly better efficacy than DAP. On dual-species (SMD = 0.15; CI, -1.00-1.29; P = 0.80) or multi-species (SMD = 0.23; CI, -0.08-0.55; P = 0.15) biofilms, DAP and CH had similar efficacy. Conclusions Ex vivo evidence showed that antibiotic pastes were either superior or equal to CH. The studied SAPs had considerably higher or similar antibacterial effectiveness compared to DAP, CH, and TAP. Hence, combined antibiotic therapy was not necessarily required for root canal disinfection ex vivo.
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Affiliation(s)
- Mohammadreza Vatankhah
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Khosravi
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Zargar
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Omid Dianat
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland, USA,Address for correspondence: Dr. Omid Dianat, Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, 650 West Baltimore Street, 4th Floor, Baltimore, MD 21201, USA. E-mail:
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