The antimicrobial effects of root canal irrigation and medication

Comparative evaluation of selected concentrations of sodium hypochlorite on the outcome of endodontic therapy among Ghanaians

BACKGROUND

Endodontic treatment is one of the main dental treatments to manage inflamed or infected root canal systems of teeth. The success of endodontic treatment principally depends on eradicating microorganisms in the root canal by chemo-mechanical debridement with irrigation solutions like sodium hypochlorite (NaOCl). NaOCl has been used in concentrations ranging from 0.5% to 5.25%. This study determined the antimicrobial effectiveness of selected concentrations (0.5%, 1.0%, 2.6%, and 5.2%) of NaOCl in endodontic treatment.

METHODS

The study sites were the University of Ghana Dental School (UGDS) and Noguchi Memorial Institute for Medical Research (NMIMR). Sixty infected single-rooted single-canal teeth were used. Before (S1) and after (S2), root canal samples during the endodontic treatment with the selected concentrations of NaOCl were examined via anaerobic and aerobic cultures. The isolates were identified using Matrix Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry (MALDI-TOF MS).

RESULTS

All S1 samples were positive for cultivable bacteria. Fifty-three (53) different microbial species belonging to 20 different microbial genera were isolated. Streptococcus viridans was the most frequently isolated microbe. There were zero isolates in the root canals irrigated with 2.6% and 5.2% NaOCl. Two teeth had isolates in the groups irrigated with the lower concentrations (0.5% and 1.0%) of NaOCl. The persistent bacteria were one species each of Streptococcus mitis and Streptococcus oralis, respectively.

CONCLUSION

Root canal treatments using chemo-mechanical preparation with the selected concentrations (0.5%, 1.0%, 2.6%, and 5.2%) of NaOCl were effective in significantly reducing the microbial load, and for the 5.2% and 2.6% concentrations, in eliminating all the microorganisms.

An In Vitro Study: Does Adding Iodine Potassium Iodide and Cetrimide to Calcium Hydroxide Paste Enhance Its Antimicrobial Effect Against Oral Biofilms?

Objectives This study aimed to evaluate the antibiofilm effect of calcium hydroxide (CH), 0.5% iodine potassium iodide (IKI), and 0.5% cetrimide (CTR), alone and in combinations on one-week and three-week-old biofilms. Materials and methods Gingival plaque was collected, and biofilms were grown in vitro anaerobically. Biofilms were exposed to each of the three medicaments and their combinations for one day, one week, and two weeks. Proportions of dead and live bacteria in the biofilms were evaluated. Results The killing of bacteria by different medicaments in the three-week-old biofilm was lower than in the one-week-old biofilm (p<0.05). The efficacy of IKI and CTR in killing bacteria was weaker than that of CH, but the highest efficacy in killing was achieved when all three were combined (p<0.05). There was no significant difference in the antibiofilm effect between a day's exposure to the mixture of the three medicaments and one or two weeks of treatment with CH alone (p>0.05). Conclusions Three-week-old biofilms are more resistant to medicaments than one-week-old biofilms. Combining IKI and CTR with CH resulted in a stronger antibiofilm effect than using CH alone. Mixing the three medicaments may enable obtaining the desired clinical effect in a shorter exposure time.

Potential Clinical Applications of Ozone Therapy in Dental Specialties-A Literature Review, Supported by Own Observations

Apart from conventional treatment, dentists are increasingly relying on physical therapy modalities in their clinical practice. The aim of this literature review is to analyze the clinical relevance and potential uses of ozone in modern dentistry. The research question is geared towards detailing the multiple potential applications of ozone therapy in a range of dental specialties. Based on the available literature, accessed via the PubMed, Google Scholar, Scopus, and EBSCO databases, a detailed search of the electronic literature was performed for 2001-2022. Eligible studies were chosen according to inclusion and exclusion criteria, using keywords: ozone, ozone therapy, therapeutic applications, oxidants, dental disinfectants, oral medicine, physical therapy in dentistry. Out of 834 manuscripts, 273 studies were curated. A total of 70 publications were used in the final consideration. After assessing their quality, they were analyzed to determine the relevance and potential use of ozone in the various aspects of modern dentistry. Ozone therapy is used mainly as an adjunct to the primary clinical or pharmacological treatment. In some cases of oral mucosal disease, it has proven effective as a primary therapy. During the literature analysis, it was noted that ozone therapy in dentistry is a subject of ongoing research, and the results are not always consistent. The multitude of studies in the literature on the applications of ozone in dentistry reflects the search for its undiscovered physical therapeutic potential.

A Self-Supplying H2O2 Modified Nanozyme-Loaded Hydrogel for Root Canal Biofilm Eradication

The success of root canal therapy depends mainly on the complete elimination of the root canal bacterial biofilm. The validity and biocompatibility of root canal disinfectant materials are imperative for the success of root canal treatment. However, the insufficiency of the currently available root canal disinfectant materials highlights that more advanced materials are still needed. In this study, a nanozyme-loaded hydrogel (Fe3O4-CaO2-Hydrogel) was modified and analyzed as a root canal disinfectant material. Fe3O4-CaO2-Hydrogel was fabricated and examined for its release profile, biocompatibility, and antibacterial activity against E. faecalis and S. sanguis biofilms in vitro. Furthermore, its efficiency in eliminating the root canal bacterial biofilm removal in SD rat teeth was also evaluated. The results in vitro showed that Fe3O4-CaO2-Hydrogel could release reactive oxygen species (ROS). Moreover, it showed good biocompatibility, disrupting bacterial cell membranes, and inhibiting exopolysaccharide production (p < 0.0001). In addition, in vivo results showed that Fe3O4-CaO2-Hydrogel strongly scavenged on root canal biofilm infection and prevented further inflammation expansion (p < 0.05). Altogether, suggesting that Fe3O4-CaO2-Hydrogel can be used as a new effective biocompatible root canal disinfectant material. Our research provides a broad prospect for clinical root canal disinfection, even extended to other refractory infections in deep sites.

Cytocompatibility and antimicrobial activity of a novel endodontic irrigant combining citric acid and chlorhexidine

OBJECTIVES

This study aimed to evaluate the antibacterial ability and cytocompatibility of a new irrigant solution for endodontic treatment composed of 10% citric acid (CA) and 1% chlorhexidine (CHX).

METHODS

Thirty-five extracted single-canal human teeth were selected and de-crowned. Canal systems (n = 7/group) were infected with Enterococcus faecalis for 4 weeks and subject to irrigation with 1% CHX; 10% CA; irrigating solution 10% CA associated with 1% CHX (CACHX); 2.5% NaOCl or sterile water (control). Microbiological samples were collected immediately and 18 h after irrigation (enriched samples). The canals were filled with culture medium post irrigation to verify the bacterial presence/absence qualitatively and quantitatively through colony counting (log₁₀ CFU/mL). A multiparametric assay was performed after exposure of human periodontal ligament fibroblasts (HPdLF) to the test solutions. The Kruskal-Wallis test with Dunn´s post-test and Fisher's exact test were employed at the 95% confidence level to compare differences among groups.

RESULTS

All tested solutions were cytocompatible with human periodontal ligament fibroblasts. No difference was observed on antibacterial activity between 1% CHX, 10% CA, CACHX and 2.5% NaOCl (p > 0.05). Eighteen hours after irrigation, CACHX samples were the only that did not present E. faecalis in the root canal system.

CONCLUSIONS

The demonstrated good in vitro biocompatibility and elimination of E. faecalis suggest a potential use of 10% CA associated with 1% CHX as a solution for microbiological control during endodontic treatment.

CLINICAL RELEVANCE

Irrigants play an essential role during endodontic therapy. This irrigating solution, based on the association of 10% citric acid with 1% chlorhexidine, seems viable for clinical procedures.

Comparison of Er:YAG laser and ultrasonic in root canal disinfection under minimally invasive access cavity

The disinfection of root canal through minimally invasive access cavity remains questionable. This in vitro study compared the effectiveness of three disinfection measures including conventional irrigation, ultrasonic assisted irrigation, and erbium:yttrium-aluminum-garnet (Er:YAG) laser assisted irrigation through conventionally or minimally invasive access. Sixty-six extracted maxillary first molars were randomly divided into group 1 conventionally invasive access group (CIA) and group 2 computer-guided minimally invasive access group (MIA). Each group was further randomly divided into three subgroups, (A) conventional irrigation (CI), (B) passive ultrasonic agitation (PUI), and (C) Er:YAG laser activated irrigation (LAI). Enterococcus faecalis (E. faecalis) infection model was established inside all root canals after instrumentation was performed up to ProTaper Universal F2. After various disinfection methods, microbial samples were collected from root canals by paper tip method and cultured, and colony forming units (CFU) values of each sample were calculated. Then the root canals were enlarged to the size of F3, after which dentin debris was collected from the F3 file. After dilution and culturing, the CFU value was calculated for each group. Two-way analysis of variance (ANOVA) was performed to test the interaction. The results revealed a significant antagonism (F = 3.394, P = 0.043). The bacterial CFU counts of group B and group C were significantly less than that of group A (P < 0.05), and there was no significant difference between group B and C (P > 0.05). Additionally, group 2A was better than group 1A (P < 0.05); there was no significant difference between group 1B and group 2B, group 1C and group 2C (P > 0.05). Comparison of the bacterial CFU counts in dentin debris after disinfection, the results revealed a significant antagonism (F = 7.224, P = 0.002), and group C had the least. The disinfection effect of Er:YAG laser or ultrasonic assisted computer-guided minimally invasive access is similar to conventionally invasive access, and Er:YAG laser is better than ultrasonic in removing bacteria from dentinal tubules and is easy to operate, which is more suitable for minimally invasive root canal treatment.

Enhanced Eradication of Enterococcus faecalis Biofilms by Quaternized Chitosan-Coated Upconversion Nanoparticles for Photodynamic Therapy in Persistent Endodontic Infections

Due to the persistent presence of Enterococcus faecalis biofilms in apical root canals, persistent endodontic infections (PEIs) have always been an intractable disease to solve. The conventional root canal disinfectants (e.g., calcium hydroxide, chlorhexidine) are arduous to scavenge the stubborn infection. With the progress of nanomedicine in the biomedical field, antimicrobial photodynamic therapy (aPDT) is emerging as a prospective anti-infective therapy for PEIs. Herein, quaternized chitosan (QCh) modified upconversion nanoparticles (UCNP)@SiO₂/methylene blue (MB) are developed with enhanced antibacterial/biofilm performance for aPDT in PEIs. QCh is coated on the UCNP@SiO₂/MB by testing the changes in diameter, chemical functional group, and charge. Interestingly, QCh also increases the conversion efficiency of UCNP to generate more reactive oxygen species (ROS). Furthermore, the prepared UCNP@SiO₂/MB@QCh exhibits highly effective antibacterial activity against free E. faecalis and related biofilm in vitro and extracted teeth. Importantly, the additional QCh with positive charges enhance UCNP@SiO₂/MB@QCh contact with E. faecalis (negative charges) through electrostatic interaction. Then, UCNP@SiO₂/MB@QCh could stick close to the E. faecalis and generate ROS under the irradiation by a 980 nm laser. The in vitro cellular test shows that UCNP@SiO₂/MB@QCh has acceptable cytocompatibility. Thus, UCNP@SiO₂/MB@QCh could offer a novel strategy for the potential aPDT clinical applications in the treatment of PEIs.

Effectiveness of D,L-2-hydroxyisocaproic acid (HICA) and alpha-mangostin against endodontopathogenic microorganisms in a multispecies bacterial-fungal biofilm in an ex vivo tooth model

AIM

To develop a defined multispecies root canal biofilm model ex vivo, and to perform viable compositional analysis following D,L-2-hydroxyisocaproic acid (HICA), alpha-mangostin, Calcicur^® , and Odontopaste^® exposure.

METHODOLOGY

Time-kill assays were conducted in vitro using HICA, alpha-mangostin, Calcicur^® , Odontopaste^® , and saline solution on the planktonic cultures of C. albicans, E. faecalis, L. rhamnosus, and S. gordonii. Human root dentine blocks were prepared (n = 100) ex vivo, and multispecies suspensions containing each of 1.5 × 10⁸  CFU/mL C. albicans, E. faecalis, L. rhamnosus, and S. gordonii in brain heart infusion (BHI) were incubated within the root canals for 21 days. Canals (n = 20/group) were then exposed to medicaments for 7 days. Samples taken from the inner (first 0.1 mm) and deeper (second 0.1 mm) dentine by drilling with Ash Steel Burs No. 5 and No. 6, and residual roots were cultured in broth for 24 h. Cell growth was detected by spectrophotometry and confirmed by culture on agar. The other set of inner dentine, deeper dentine, and residual root samples were sonicated, and then exposed with 50 μM PMA before DNA was extracted using the QIAamp DNA mini kit. Real-time quantitative PCR was performed to determine the biofilm composition as well as the number of live and total cells remaining in the biofilm following each treatment. The OD data were analysed with Kruskal-Wallis and Friedman with Wilcoxon signed-rank test between and within groups, respectively, agar culture and qPCR data with Pearson chi-square with Mann-Whitney and Cochran with McNemar tests, respectively (p < .0001).

RESULTS

Time-kill assays revealed that HICA and Calcicur^® killed all planktonic organisms within 24 h, whilst alpha-mangostin killed the organisms within 72 h. However, Odontopaste^® was a slow-killing agent: 10 cells of planktonic organisms survived after exposure to the agent for 7 days. The ex vivo tooth model demonstrated that HICA and alpha-mangostin significantly inhibited the cell growth in all sampling depths (p < .0001). All species-specific data revealed the effectiveness of each medicament on the biofilm composition.

CONCLUSIONS

D,L-2-hydroxyisocaproic acid and alpha-mangostin had antimicrobial activity against multispecies bacterial-fungal biofilms.

Antimicrobial action, cytotoxicity, calcium ion release, and pH variation of a calcium hydroxide-based paste associated with Myracrodruon urundeuva Allemão extract

The extract of Myracrodruon urundeuva Allemão (aroeira), as a vehicle, associated with calcium hydroxide (CH) paste was evaluated based on cell viability, antimicrobial action, calcium ion release, and pH variation. Calcium hydroxide with propylene glycol was used as control. The pH variation was measured at 3, 24, 72, 168, 140, 360, and 720 h and calcium ion release was measured on days 7, 15, and 30. Cell viability was assessed with NIH/3T3 cells using MTT and crystal violet assays, after 24, 48, and 72 h. Antibacterial activity was determined by the disc diffusion method, while microbial reduction (Enterococcus faecalis) was evaluated using the time-kill test. The CH paste formulated with aroeira showed antibacterial activity against Enterococcus faecalis and further did not interfere with pH, calcium ion release, or cell viability; moreover, the formulation had antimicrobial activity and could serve as a vehicle for CH paste.

Intratubular disinfection with tri-antibiotic and calcium hydroxide pastes

OBJECTIVE

The aim of this study was to compare the in vitro intradentinal antimicrobial ability of the calcium hydroxide and tri-antibiotic pastes.

MATERIALS AND METHODS

Standard bovine dentin tubes were sterilized and then infected with Enterococcus faecalis by a new contamination protocol of great depths of dentin. The specimens were filled with the medications, divided into two test-groups: calcium hydroxide (Group 1) and tri-antibiotic (Group 2) pastes. After 15 days, the teeth were evaluated by microbiological culture and confocal laser scanning microscopy (CLSM) with viability dye assay LIVE/DEAD inside dentinal tubules. In experiment of culture, the bacterial collection of the dentin fragments was done for counting the colony-forming units.

RESULTS

The tri-antibiotic paste had a slightly greater antimicrobial effect; however, there was no statistical difference between the groups.

CONCLUSIONS

It was concluded that the tri-antibiotic paste and the calcium hydroxide paste exercise the same effect on intra-tubular decontamination against E. faecalis. So, due the multiples advantages, the calcium hydroxide paste can be the choice for dentinal decontamination in regenerative procedures.

Bactericidal Effect of Strong Acid Electrolyzed Water against Flow Enterococcus faecalis Biofilms

INTRODUCTION

This study evaluated the bactericidal effect of strong acid electrolyzed water (SAEW) against flow Enterococcus faecalis biofilm and its potential application as a root canal irrigant.

METHODS

Flow E. faecalis biofilms were generated under a constant shear flow in a microfluidic system. For comparison, static E. faecalis biofilms were generated under a static condition on coverslip surfaces. Both the flow and static E. faecalis biofilms were treated with SAEW. Sodium hypochlorite (NaOCl, 5.25%) and normal saline (0.9%) were included as the controls. Bacterial reductions were evaluated using confocal laser scanning microscopy and the cell count method. Morphological changes of bacterial cells were observed using scanning electron microscopy.

RESULTS

The confocal laser scanning microscopic and cell count results showed that SAEW had a bactericidal effect similar to that of 5.25% NaOCl against both the flow and static E. faecalis biofilms. The scanning electron microscopic results showed that smooth, consecutive, and bright bacteria surfaces became rough, shrunken, and even lysed after treated with SAEW, similar to those in the NaOCl group.

CONCLUSIONS

SAEW had an effective bactericidal effect against both the flow and static E. faecalis biofilms, and it might be qualified as a root canal irrigant for effective root canal disinfection.

Antimicrobial effect of three disinfecting agents on Resilon cones and their effect on surface topography: An in vitro study

Aim:

The objective of this study was to evaluate the effectiveness of 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and 2% peracetic acid (PAA) in disinfecting Resilon cones and to evaluate topographical changes microscopically under scanning electron microscope (SEM) after rapid chemical disinfection.

Materials and Methods:

Resilon cones were disinfected in an ultraviolet (UV) light chamber for 20 min and contaminated by immersing in a microbial suspension of Enterococcus faecalis for 30 min. The contaminated cones were then immersed in the 5.25% NaOCl, 2% CHX, and 2% PAA for 1 min, 5 min, and 10 min, separately. The cones were then incubated at 37°C in thioglycollate broth for 7 days and examined for turbidity. The samples showing turbidity were subcultured on blood agar and incubated at 37°C for 48 h. Gram staining was done to confirm that the cultured bacteria were E. faecalis. Surface changes of disinfected Resilon cones were evaluated under SEM.

Statistical Analysis Used:

The data were analyzed statistically using Kruskal-Wallis, analysis of variance (ANOVA), and Mann–Whitney U-test.

Result:

In eliminating E. faecalis, 5.25% NaOCl was most effective followed by 2% PAA and 2% CHX. Topographic examination of tested Resilon cones revealed some surface deposits after disinfection with 5.25% NaOCl and 2% CHX, whereas 2% PAA caused surface erosion.

Conclusion:

In disinfecting Resilon cones, 5.25% NaOCl is most effective followed by 2% PAA and 2% CHX.

Synergistic antibacterial activity of chlorhexidine and hydrogen peroxide against Enterococcus faecalis

The aim of the present study was to compare the in vitro antibacterial activity of common root canal irrigants with a combination technique against intratubular Enterococcus faecalis. Seventy-five human single-rooted teeth were selected and their crowns and root-ends were removed to obtain specimens 5 mm in length. The specimens were contaminated with E. faecalis and divided into five experimental groups (n = 15). These groups were irrigated with 2% chlorhexidine (CHX), 3% hydrogen peroxide (H2O2), 5.25% sodium hypochlorite (NaOCl), CHX/H2O2 and sterile saline (control). Surface and deep dentinal chips were collected for each sample. After incubation, the numbers of colony-forming units (CFUs) were counted. The Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis (α = 0.05). In the surface dentin, CHX, NaOCl, and CHX/H2O2 had significantly higher antibacterial activity than H2O2 (P < 0.05). In the deep dentin, NaOCl and CHX/H2O2 had significantly higher antibacterial activity than CHX and H2O2 (P < 0.05). CHX/H2O2 had similar antibacterial effectiveness to NaOCl in both surface and deep dentinal tubules. This combination can be considered a potentially useful irrigant for root canal treatment.

Incidence of post-obturation pain after single-visit versus multiple-visit non-surgical endodontic treatments

BACKGROUND

Post-obturation pain is frustrating to both patients and dentists. Its incidence may change with the use of contemporary endodontic techniques. This randomised clinical trial aims to compare the incidence of post-obturation pain at one and seven days after single-visit and multiple-visit non-surgical endodontic treatments.

METHODS

Patients who required primary endodontic treatment in the two clinical trial centres in Hong Kong (HK) and in Beijing (PK) were recruited. Three HK dentists and three PK dentists performed endodontic treatments on 567 teeth using the same procedures and materials, either in a single visit or over multiple visits, using either core carrier or cold lateral condensation for obturation.

RESULTS

The attrition rate was 5.1%, and a total of 538 teeth were evaluated. Among these teeth, 232 (43%) were operated in HK, 275 (51%) were treated in a single visit, and 234 (43%) were treated using core carrier obturation. Logistic regression analysis showed that teeth with apical periodontitis (OR = 0.35, 95% CI = 0.21-0.57, p < 0.01) and less pre-operative pain (OR = 1.10, 95% CI = 1.03-1.18, p < 0.01) had lower incidences of post-obturation pain after one day. The incidences of post-obturation pain after one day for single-visit and multiple-visit treatments were 24.7% (68 of 275) and 33.5% (88 of 263), respectively (p = 0.50). The incidences of post-obturation pain after seven days for single-visit and multiple-visit treatments were 4.0% (11 of 275) and 5.3% (14 of 263), respectively (p = 0.47).

CONCLUSIONS

There was no significant difference in the incidences of post-obturation pain after one day and seven days with single-visit or multiple-visit endodontic treatments.

TRIAL REGISTRATION

ChiCTR-IOR-15005989.

Effect of laser therapy on the inflammatory response induced by endodontic medications implanted into the subcutaneous tissue of rats

INTRODUCTION: Endodontic medications contain toxic components that cause varying degrees of inflammation.OBJECTIVE: This study evaluated the effect of laser therapy on the inflammatory response induced by intracanal medications implanted into the subcutaneous tissue of rats using a quantitative analysis of mast cells.MATERIAL AND METHOD: Polyethylene tubes containing the medications were implanted in the dorsum of 60 rats divided into six groups, including HS (P.A. calcium hydroxide paste), HL (P.A. calcium hydroxide paste and laser therapy), HPS (P.A. calcium hydroxide paste with camphorated paramonochlorophenol), HPL (P.A. calcium hydroxide paste with camphorated paramonochlorophenol and laser therapy), IS (iodoform with saline) and IL (iodoform with saline and laser therapy). The animals were euthanized eight or fifteen days after surgery, and samples were removed and embedded in paraffin. Histological sections were stained with 0.2% toluidine blue for the quantification of mast cells. Analysis of variance (ANOVA) and Tukey's post-hoc test were applied to determine significant differences in the number of mast cells between groups (p<0.05).RESULT: There was a decrease in mast cells for the HL, HPL and IL groups when compared with the HS, HPS and IS groups at both time points. There was no statistically significant difference between the HPS and HPL groups at the eight-day time point.CONCLUSION: Laser therapy was effective at modulating the inflammatory response induced by endodontic medications by significantly reducing the number of mast cells.

Clonal diversity in biofilm formation by Enterococcus faecalis in response to environmental stress associated with endodontic irrigants and medicaments

AIM

To determine whether clonal diversity within E. faecalis affects biofilm formation when exposed to antimicrobial compounds found in endodontic medicaments and irrigants.

METHODOLOGY

Five human isolates of E. faecalis were compared; biofilms were grown in microtitre trays in the presence of sodium hypochlorite, calcium hydroxide, chlorhexidine, tetracycline or clindamycin. Biofilms were quantified by staining with crystal violet and optical density determined with a microplate reader. Slime production (an amorphous extracellular matrix comprising polysaccharides, glycoproteins and glycolipids loosely attached to the cell surface) was determined qualitatively by growth on Congo red agar plates. Linear mixed models were used to examine whether medicaments affected biofilm growth of the isolates in the presence of the medicaments or irrigants.

RESULTS

Overall, different endodontic antimicrobials significantly altered biofilm growth in E. faecalis isolates. Two E. faecalis isolates significantly (P < 0.0001) increased biofilm formation in the presence of tetracycline and one in the presence of NaOCl (P = 0.018). Qualitatively, slime production also varied between isolates and correlated with biofilm production.

CONCLUSIONS

When subjected to sub-minimum inhibitory concentration (MIC) levels of antimicrobial compounds found in endodontic medicaments, E. faecalis isolates demonstrated significant clonal variation in their capacity to form biofilms. Interestingly, there was a correlation between slime production and the ability of isolates to form a biofilm in the presence of antimicrobials. The results indicate that isolates of E. faecalis that form biofilms in response to endodontic medicaments may be more likely to survive endodontic treatment.

In vitro efficacy of different irrigating solutions against polymicrobial human root canal bacterial biofilms

The purpose of this in vitro study was to compare the antimicrobial efficacy of five different irrigating solutions against complex polymicrobial bacterial biofilms harvested from root canals to model actual endodontic irrigation as closely as possible, and to test the efficacy of these irrigants in these conditions. Two multi-species in vitro biofilms were generated from bacterial samples taken from patients presenting with acute pulpitis. The microbial composition of these samples was characteristic of the disease. The biofilms were incubated with 1000 p.p.m. Solumium Dental (ClO(2)), 0.2% chlorhexidine (CHX), 5.25% sodium-hypochlorite (NaOCl), 5.25% Neomagnol, 10% iodine and phosphate buffered saline (PBS) as control. After the microbiological preparation of the samples, colony forming units (CFU) were counted. NaOCl, iodine and Neomagnol were the most effective, whilst CHXand Solumium appeared to be less effective against these specific biofilms. The efficacy of the most effective agents differed according to biofilm and application time. All irrigants were efficient to some extent, but NaOCl proved to be the most efficient, while chlorine dioxide (ClO(2)) yielded the poorest results in these circumstances. The efficacy of NaOCl was already well-known, but our results also point out that iodine could have an important role in endodontic irrigation.

Applicability of bacterial cellulose as an alternative to paper points in endodontic treatment

Dental root canal treatment is required when dental caries progress to infection of the dental pulp. A major goal of this treatment is to provide complete decontamination of the dental root canal system. However, the morphology of dental root canal systems is complex, and many human dental roots have inaccessible areas. In addition, dental reinfection is fairly common. In conventional treatment, a cotton pellet and paper point made from plant cellulose is used to dry and sterilize the dental root canal. Such sterilization requires a treatment material with high absorbency to remove any residue, the ability to improve the efficacy of intracanal medication and high biocompatibility. Bacterial cellulose (BC) is produced by certain strains of bacteria. In this study, we developed BC in a pointed form and evaluated its applicability as a novel material for dental canal treatment with regard to solution absorption, expansion, tensile strength, drug release and biocompatibility. We found that BC has excellent material and biological characteristics compared with conventional materials, such as paper points (plant cellulose). BC showed noticeably higher absorption and expansion than paper points, and maintained a high tensile strength even when wet. The cumulative release of a model drug was significantly greater from BC than from paper points, and BC showed greater compatibility than paper points. Taken together, BC has great potential for use in dental root canal treatment.

The influence of smear layer removal on primary tooth pulpectomy outcome: a 24-month, double-blind, randomized, and controlled clinical trial evaluation

BACKGROUND

The effect of smear layer (SL) removal on primary tooth pulpectomy outcome has not been well elucidated.

AIM

To determine the effect of SL removal on primary tooth pulpectomy outcome.

METHODS

This is a double-blind, randomized, and controlled clinical trial. Forty-eight patients were randomly divided into SL removal (G1 = 40 teeth) or smear layer nonremoval (G2 = 42 teeth) groups. Following the chemomechanical preparation with K-files and 2.5% sodium hypochlorite (NaOCl), teeth were irrigated with either 6% citric acid and 0.9% physiologic solution (G1) or only 0.9% physiologic solution (G2). Camphorated paramonochlorophenol was used as intracanal medication. At the second appointment, 1 week after, root canals were filled with zinc oxide-eugenol paste. Clinical and radiographical baseline criteria were stipulated equally for both groups.

RESULTS

The success rate (G1 = 91.2%; G2 = 70.0%) was statistically different (P = 0.04) between the groups. In G2, the outcome was affected significantly by pulpal necrosis (P = 0.02), pre-operatory symptoms (P = 0.02), and periapical/inter-radicular radiolucency (P = 0.04).

CONCLUSION

The pulpectomy outcome was improved by smear layer removal. The outcome for teeth with pulpal necrosis, pre-operatory symptoms, or periapical/inter-radicular radiolucency was significantly improved by removal of the smear layer.

Optimizing future treatment of enterococcal infections: attacking the biofilm?

Enterococcus faecalis and Enterococcus faecium are among the leading causative agents of nosocomial infections and are infamous for their resistance to many antibiotics. They cause difficult-to-treat infections, often originating from biofilm-mediated infections associated with implanted medical devices or endocarditis. Biofilms protect bacteria against antibiotics and phagocytosis, and physical removal of devices or infected tissue is often needed but is frequently not possible. Currently there are no clinically available compounds that disassemble biofilms. In this review we discuss all known structural and regulatory genes involved in enterococcal biofilm formation, the compounds directed against biofilm formation that have been studied, and potentially useful targets for future drugs to treat enterococcal biofilm-associated infections.

Newer root canal irrigants in horizon: a review

Sodium hypochloride is the most commonly used endodontic irrigant, despite limitations. None of the presently available root canal irrigants satisfy the requirements of ideal root canal irrigant. Newer root canal irrigants are studied for potential replacement of sodium hypochloride. This article reviews the potential irrigants with their advantages and limitations with their future in endodontic irrigation.

In vitro analysis of the cytotoxicity and the antimicrobial effect of four endodontic sealers

Introduction

The aim of this study was to investigate in vitro the cytotoxicity and antibacterial properties of four different endodontic sealers using human periodontal ligament fibroblast cell proliferation and visual analysis of growth inhibition.

Methods

A silicone (GuttaFlow), silicate (EndoSequence BC), zinc oxide eugenol (Pulp Canal Sealer EWT) and epoxy resin (AH Plus Jet) based sealer were incubated with PDL fibroblasts (10⁴ cells/ml, n = 6) up to 96 h. Cell proliferation (RFU) was determined by means of the Alamar Blue assay. Cell growth and morphology was visualized by means of fluorescent dyes. Possible antibacterial properties of the different sealers were visualized by means of SEM (Enterococcus faecalis; Parvimonas micra).

Results

Fibroblast proliferation depended on sealer and cultivation time. After 72 and 96 h GuttaFlow and EndoSequence BC showed relatively non-cytotoxic reactions, while Pulp Canal Sealer EWT and AH Plus Jet caused a significant decrease of cell proliferation (p < 0.001). Visualization of cell growth and morphology with various fluorescent dyes supplemented the results. No antibacterial effect of EndoSequence BC to P. micra was found, whereas GuttaFlow showed a weak, Pulp Canal Sealer EWT and AH Plus Jet extensive growth inhibition. Also, no antibacterial effect of GuttaFlow, EndoSequence BC or AH Plus Jet to E. faecalis could be detected.

Conclusions

These in vitro findings reveal that GuttaFlow and EndoSequence BC can be considered as biocompatible sealing materials. However, prior to their clinical employment, studies regarding their sealing properties also need to be considered.

Enterococcus faecalis biofilms eradication by root canal irrigants

The aim of this study was to evaluate the minimal biofilm eradication concentration (MBEC) of sodium hypochlorite (NaOCl), chlorhexidine (CHX), EDTA, and citric and phosphoric acids after 1, 5, and 10 minutes of exposure to biofilms of Enterococcus faecalis. The biofilms grew in the MBEC high-throughput device for 24 hours at 37 degrees C and were exposed to 10 serial two-fold dilutions of each irrigating solution. The viable cell counts were log(10) transformed, and a concentration of an irrigant was considered to eradicate the biofilms when it produced a reduction of > or = 5 logarithmic units. NaOCl was the most effective agent, capable of eradicating the biofilms after 1 minute at a concentration of 0.00625%. CHX eradicated biofilm after 5 minutes at 2%. EDTA and citric and phosphoric acid solutions were not effective against the biofilms at any concentration or time tested.