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Teulé-Trull M, Demiquels-Punzano E, Pérez RA, Aparicio C, Durán-Sindreu F, Sánchez-López E, González-Sánchez JA, Delgado LM. Revision of ex vivo endodontic biofilm model using computer aided design. J Dent 2024; 149:105270. [PMID: 39084546 DOI: 10.1016/j.jdent.2024.105270] [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: 06/10/2024] [Revised: 07/16/2024] [Accepted: 07/26/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVE Most endodontic diseases are bacterium-mediated inflammatory or necrotic process induced by contaminated dental pulp. Although great advances are being performed to obtain more efficient antibacterial strategies for persistent infections, most studies lack of representative models to test their antibacterial effects and their outcomes cannot be promptly translated to clinical practice. Therefore, this study aimed to refine an ex vivo endodontic biofilm model combining human tooth, computer guided design and 3D printing to obtain a more reproducible and predictable model. METHODS Monoradicular teeth were cut using three different methods: hand-held (HCC), mechanical precision (MPC) and computer aid guided cutting (CGC). Then, blocks were reassembled. The different model preparations were assessed in terms of dimensional tolerance, surface analysis, liquid tightness and Enterococcus faecalis biofilm development for 21 days, which was studied by metabolic assays and confocal microscopy. Then, the proposed model was validated using different commercial disinfecting treatments. RESULTS CGC exhibited significantly lower deviation and surface without defects compared to HHC and MPC, leading to superior liquid tightness. Similarly, mature biofilms with high metabolic activity and vitality were observed in all conditions, CGC showing the lowest variation. Regarding the model validation, all antibacterial treatments resulted in the complete eradication of bacteria in the standard 2D model, whereas commercial treatments exhibited varying levels of efficacy in the proposed ex vivo model, from moderately reduction of metabolic activity to complete elimination of biofilm. CONCLUSIONS The novel guided approach represents a more reliable, standardized, and reproducible model for the evaluation of endodontic disinfecting therapies. CLINICAL SIGNIFICANCE During antibacterial treatment development, challenging 3D models using teeth substrates to test antibacterial treatments novel guided approach represents a more reliable, standardized, and reproducible model for the evaluation of endodontic disinfecting therapies.
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Affiliation(s)
- Miriam Teulé-Trull
- Department of Endodontics, Faculty of Dentistry, Universitat Internacional de Catalunya, 08017, Barcelona, Spain
| | - Elena Demiquels-Punzano
- Bioengineering Institute of Technology (BIT), Universitat Internacional de Catalunya, 08017, Barcelona, Spain; Basic Sciences Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017, Barcelona, Spain
| | - Román A Pérez
- Bioengineering Institute of Technology (BIT), Universitat Internacional de Catalunya, 08017, Barcelona, Spain; Basic Sciences Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017, Barcelona, Spain
| | - Conrado Aparicio
- Basic and Translational Research Division, Faculty of Dentistry, Universitat Internacional de Catalunya, 08017, Barcelona, Spain; Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08028, Barcelona, Spain
| | - Fernando Durán-Sindreu
- Department of Endodontics, Faculty of Dentistry, Universitat Internacional de Catalunya, 08017, Barcelona, Spain
| | - Elena Sánchez-López
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, University of Barcelona, 08028 Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, 08028 Barcelona, Spain
| | | | - Luis M Delgado
- Bioengineering Institute of Technology (BIT), Universitat Internacional de Catalunya, 08017, Barcelona, Spain; Basic Sciences Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017, Barcelona, Spain.
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Diaconu CT, Gheorghiță LM, Diaconu AE, Țuculină MJ, Gliga A, Gaeta C, Grandini S, Marinescu IR, Amărăscu MO, Diaconu OA. Current Endodontic Practices among Romanian Dental Practitioners: A Cross-Sectional Study. Dent J (Basel) 2024; 12:283. [PMID: 39329849 PMCID: PMC11431326 DOI: 10.3390/dj12090283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 07/31/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024] Open
Abstract
Root canal therapy (RCT) is usually performed in Romania by general dentists (GDPs) because they are more readily available and more reasonably priced than endodontists. Concerns have been raised about the quality of RCTs performed by GDPs, possibly due to insufficient equipment or knowledge; therefore, this study aims to investigate current endodontic practices in Romania. Materials and Methods: A cross-sectional study was conducted via a questionnaire distributed to 400 randomly selected Romanian dentists, with 285 fully validated completed responses (71.25% response rate). Respondents were grouped by speciality, and statistical analysis, including cross-tabulation and the χ2 (chi-square) test, was used, with a significance level set at p ≤ 0.05 for all tests. Results: Significant differences were found in the use of magnification, rubber dam, sodium hypochlorite concentration, and bioceramics (p < 0.001). No significant differences were observed in preferences for measuring working length (p = 0.166) or rotary instrument motion (p = 0.289). Approximately 6% of the respondents used laser technology with no significant difference across specialities (p = 0.571). Additionally, 77.9% preferred using sodium hypochlorite, with no significant difference between groups (p = 0.006) regarding concentration. Conclusions: Most participants, including GDPs, use modern equipment and techniques during RCT, indicating their awareness and competence in current endodontic practices.
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Affiliation(s)
- Cezar Tiberiu Diaconu
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Lelia Mihaela Gheorghiță
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca Elena Diaconu
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela Jana Țuculină
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Alexandru Gliga
- Department of Operative Dentistry, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Unit of Endodontics, Department of Medical Biotechnologies, Periodontology, Restorative and Pediatric Dentistry, University of Siena, 53100 Siena, Italy
| | - Carlo Gaeta
- Unit of Endodontics, Department of Medical Biotechnologies, Periodontology, Restorative and Pediatric Dentistry, University of Siena, 53100 Siena, Italy
| | - Simone Grandini
- Unit of Endodontics, Department of Medical Biotechnologies, Periodontology, Restorative and Pediatric Dentistry, University of Siena, 53100 Siena, Italy
| | - Iulia Roxana Marinescu
- Department of Rehabilitation Oro-Dental, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Marina Olimpia Amărăscu
- Department of Rehabilitation Oro-Dental, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Oana Andreea Diaconu
- Department of Endodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Meire M, De Moor RJG. Principle and antimicrobial efficacy of laser-activated irrigation: A narrative review. Int Endod J 2024; 57:841-860. [PMID: 38340037 DOI: 10.1111/iej.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
In the last two decades, the activation of root canal irrigants with pulsed lasers as an adjunct in root canal treatment has become increasingly popular. This narrative review explains the physical basics and the working mechanism of laser-activated irrigation (LAI), explores the parameters influencing LAI efficacy, considers historical evolutions in the field and summarizes laboratory and clinical evidence with emphasis on the antimicrobial action of LAI. Cavitation is the driving force behind LAI, with growing and imploding vapour bubbles around the laser tip causing various secondary phenomena in the irrigant, leading to intense liquid dynamics throughout the underlying root canal. High-speed imaging research has shown that laser wavelength, pulse energy, pulse length and fibre tip geometry are parameters that influence this cavitation process. Nevertheless, this has not resulted in standardized settings for LAI. Consequently, there is significant variability in studies assessing LAI efficacy, complicating the synthesis of results. Laboratory studies in extracted teeth suggest that, with regard to canal disinfection, LAI is superior to conventional irrigation and there is a trend of higher antimicrobial efficacy of LAI compared to ultrasonic activation. Clinical evidence is limited to trials demonstrating similar postoperative pain levels after LAI versus no activation or ultrasonic activation. Clinical evidence concerning the effect of LAI on healing of apical periodontitis as yet is scarce.
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Affiliation(s)
- Maarten Meire
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - Roeland J G De Moor
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
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Doğan Çankaya T, Uğur Aydın Z, Erdönmez D. The effect of the enzymes trypsin and DNase I on the antimicrobial efficiency of root canal irrigation solutions. Odontology 2024; 112:929-937. [PMID: 38280114 DOI: 10.1007/s10266-023-00894-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/19/2023] [Indexed: 01/29/2024]
Abstract
The purpose of this study was to evaluate the antibacterial efficacy of using 2.5% NaOCl, 2% chlorhexidine (CHX), Irritrol, and chitosan-coated silver nanoparticles (AgCNPs) alone or in combination with deoxyribonuclease I (DNase I) and trypsin pre-enzyme applications in dentin samples contaminated with Enterococcus faecalis (E. faecalis) by CLSM. 144 dentin blocks with confirmed E. faecalis biofilm formation were divided randomly according to the irrigation protocol (n = 12): NaOCl, CHX, Irritrol, AgCNPs, trypsin before NaOCl, CHX, Irritrol, AgCNPs, and DNase I before NaOCl, CHX, Irritrol, AgCNPs. Dentin blocks were stained with the Live/Dead BacLight Bacterial Viability Kit and viewed with CLSM after irrigation applications. The percentage of dead and viable bacteria was calculated using ImageJ software on CLSM images. At a significance level of p < 0.05, the obtained data were analyzed using one-way Anova and post-hoc Tukey tests. In comparison with NaOCl, CHX had a higher percentage of dead bacteria, both when no pre-enzyme was applied and when DNase I was applied as a pre-enzyme (p < 0.05). There was no difference in the percentage of dead bacteria between the irrigation solutions when trypsin was applied as a pre-enzyme (p > 0.05). AgCNPs showed a higher percentage of dead bacteria when trypsin was applied as a pre-enzyme compared to other irrigation solutions (p < 0.05), while the pre-enzyme application did not affect the percentage of dead bacteria in NaOCl, CHX, and Irritrol (p > 0.05). No irrigation protocol tested was able to eliminate the E. faecalis biofilm. While the application of trypsin as a pre-enzyme improved the antimicrobial effect of AgCNPs, it did not make any difference over other irrigation solutions.
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Affiliation(s)
- Tülin Doğan Çankaya
- Department of Endodontics, Faculty of Dentistry, Alanya Alaaddin Keykubat University, Antalya, Turkey.
| | - Zeliha Uğur Aydın
- Department of Endodontics, Gülhane Faculty of Dentistry, University of Health Sciences, Ankara, Turkey
| | - Demet Erdönmez
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Düzce University, Düzce, Turkey
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Maezono H, Klanliang K, Shimaoka T, Asahi Y, Takahashi Y, Wang Z, Shen Y, Haapasalo M, Hayashi M. Effects of Sodium Hypochlorite Concentration and Application Time on Bacteria in an Ex Vivo Polymicrobial Biofilm Model. J Endod 2024; 50:814-819. [PMID: 38452867 DOI: 10.1016/j.joen.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION In endodontic treatment, it is important to remove or inactivate biofilms in the root canal system. We investigated the effects of different concentrations and application times of sodium hypochlorite (NaOCl) on the viability of bacteria in ex vivo polymicrobial biofilms of different maturation levels. METHODS Polymicrobial biofilms were prepared from dental plaque samples and grown for 1, 2, and 3 weeks under anaerobic conditions on collagen-coated hydroxyapatite discs as an ex vivo biofilm model. The biofilms were then exposed to NaOCl at concentrations ranging from 0.1% to 2% for 1 or 3 minutes. The control group was exposed to sterile distilled water. Viability staining was performed and examined by confocal laser scanning microscopy to determine the percentage of biofilm bacteria killed by NaOCl. Scanning electron microscopy was also performed to visually examine the biofilms. RESULTS Application of NaOCl at 0.5%-2% for both 1 and 3 min killed significantly more bacteria when compared to the controls (P < .05). Cell viability tended to be lower after the application of NaOCl for 3 minutes than that for 1 minute. CONCLUSIONS Our experiments using an ex vivo model showed that within the range of 0.1%-2% of NaOCl, higher NaOCl concentrations and longer application times were more effective in killing biofilm bacteria, and that mature biofilms were more resistant to NaOCl than younger biofilms.
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Affiliation(s)
- Hazuki Maezono
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan.
| | - Kittipit Klanliang
- Division of Endodontics, Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Tsuyoshi Shimaoka
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Yoko Asahi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Yusuke Takahashi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Zhejun Wang
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Markus Haapasalo
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mikako Hayashi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
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Coenye T. Biofilm antimicrobial susceptibility testing: where are we and where could we be going? Clin Microbiol Rev 2023; 36:e0002423. [PMID: 37812003 PMCID: PMC10732061 DOI: 10.1128/cmr.00024-23] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/27/2023] [Indexed: 10/10/2023] Open
Abstract
Our knowledge about the fundamental aspects of biofilm biology, including the mechanisms behind the reduced antimicrobial susceptibility of biofilms, has increased drastically over the last decades. However, this knowledge has so far not been translated into major changes in clinical practice. While the biofilm concept is increasingly on the radar of clinical microbiologists, physicians, and healthcare professionals in general, the standardized tools to study biofilms in the clinical microbiology laboratory are still lacking; one area in which this is particularly obvious is that of antimicrobial susceptibility testing (AST). It is generally accepted that the biofilm lifestyle has a tremendous impact on antibiotic susceptibility, yet AST is typically still carried out with planktonic cells. On top of that, the microenvironment at the site of infection is an important driver for microbial physiology and hence susceptibility; but this is poorly reflected in current AST methods. The goal of this review is to provide an overview of the state of the art concerning biofilm AST and highlight the knowledge gaps in this area. Subsequently, potential ways to improve biofilm-based AST will be discussed. Finally, bottlenecks currently preventing the use of biofilm AST in clinical practice, as well as the steps needed to get past these bottlenecks, will be discussed.
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Affiliation(s)
- Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Ghent University, Ghent, Belgium
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Barros MC, Pedrinha VF, Graeff MSZ, Bramante CM, Duarte MAH, de Andrade FB. A new model of in vitro dentin intratubular contamination for Fusobacterium nucleatum: Validation by confocal laser scanning microscopy. Heliyon 2023; 9:e18042. [PMID: 37539102 PMCID: PMC10395344 DOI: 10.1016/j.heliyon.2023.e18042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/20/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023] Open
Abstract
Objectives To test and validate a new protocol for in vitro contamination of dentinal tubules using Fusobacterium nucleatum (F. nucleatum) by confocal laser scanning microscopy (CLSM), in addition to evaluating the effectiveness of conventional endodontic irrigants such as sodium hypochlorite (NaOCl) and chlorhexidine (CLX) on this biofilm. Material and methods Thirty lower premolars were contaminated with F. nucleatum (ATCC 51190) for 7 days under anaerobic conditions using the proposed new model. The specimens were divided into a control group and experimental groups, according to the irrigants: NaOCl 2.5% and CLX 2%. Then, the samples were submitted for analysis by CLSM and the LIVE/DEAD technique to quantify bacterial viability. Data normality was verified by the Shapiro-Wilk test. Intragroup and intergroup comparisons were performed using the Kruskal-Wallis test, followed by Dunn's post-test. Results The CLSM images obtained demonstrated the effectiveness of the proposed new contamination protocol, with a high percentage of viable bacteria in relation to the treated groups (p < 0.05). Lower viability values were observed for the 2.5% NaOCl group. Conclusion The new contamination protocol resulted in a high and homogeneous percentage of viable bacteria in the dentinal tubules in all specimens evaluated. Both irrigating solutions proved to be effective in reducing the intratubular microbiota, especially 2.5% NaOCl.
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Affiliation(s)
- Mirela Cesar Barros
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Victor Feliz Pedrinha
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | | | - Clovis Monteiro Bramante
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Flaviana Bombarda de Andrade
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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Advances in the Role of Sodium Hypochlorite Irrigant in Chemical Preparation of Root Canal Treatment. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8858283. [PMID: 36685672 PMCID: PMC9859704 DOI: 10.1155/2023/8858283] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
Irrigation of root canal system is of great significance to the success of endodontic treatment, where sodium hypochlorite (NaOCl) is the most widely used irrigant in chemical preparation. NaOCl functions by eliminating bacterial biofilms and dissolving organic tissue, which may vary according to several factors such as the microbiology of root canal infection and the concentration of the irrigant. It has been proposed that the effectiveness of NaOCl could be enhanced via several methods, including heating the irrigant, applying in conjunction with certain reagents, or activating by agitation techniques. Despite its antibacterial and tissue-dissolving capacities, NaOCl should be used with caution to avoid detrimental effect due to its cytotoxicity and negative effect on dentin properties. In this narrative review, we discussed the factors that affect the properties of NaOCl, the methods to improve its efficacy, and the side effects that might occur in clinical practice.
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Robberecht L, Delattre J, Meire M. Isthmus morphology influences debridement efficacy of activated irrigation: A laboratory study involving biofilm mimicking hydrogel removal and high-speed imaging. Int Endod J 2023; 56:118-127. [PMID: 36148855 PMCID: PMC10092478 DOI: 10.1111/iej.13836] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/13/2022]
Abstract
AIM Little is known about the influence of isthmus morphology on the debridement efficacy of activated irrigation. The aim of this study was to investigate the influence of isthmus morphology on the debridement efficacy of laser-activated irrigation (LAI), EDDY and needle irrigation (NI), and to explain the methods of isthmus cleaning by LAI and EDDY. METHODOLOGY Four root canal models (apical diameter: 0.30 mm, taper: 0.06, curvature: 23°, length: 20 mm) were produced by CAD-CAM with different isthmus morphologies: long-wide (4 mm; 0.4 mm), long-narrow (4 mm; 0.15 mm), short-wide (2 mm; 0.4 mm) and short-narrow (2 mm; 0.15 mm). The isthmuses were filled with a hydrogel containing dentine debris. The canals were filled with irrigant and models were assigned to the following irrigation protocols (n = 240): needle irrigation (NI) with a 30G needle, Eddy, and LAI (2940 nm Er:YAG-laser, 15 Hz, 40 mJ, SWEEPS, tip at the canal entrance). Standardized images of the isthmuses were taken before and after irrigation, and the amount of removed hydrogel was determined using image analysis software and compared across groups using Kruskal-Wallis test followed by Dunn's multiple comparison. Visualization of the isthmus during activation was achieved using a high-speed camera. The pattern and speed of the flow in the isthmus as well as transient and stable cavitation were analysed using imaging software. RESULTS Laser-activated irrigation, EDDY and NI removed more hydrogel in short-wide isthmuses than in narrow isthmuses (p < .001). LAI and EDDY removed more hydrogel than NI in every isthmus configuration (p < .001). EDDY showed eddies and stable cavitation, and LAI showed transient cavitation at each pulse, and pulsed horizontal flow with the highest particle speed in closed short isthmuses. CONCLUSIONS Isthmus morphology influences debridement in all irrigation groups. Short-wide isthmuses were the easiest to clean while narrow isthmuses were the most challenging to clean. Width seems to be a more critical anatomical parameter than length. LAI and EDDY resulted in the greatest biofilm removal and performed better than NI. EDDY produced eddies and stable cavitation in the isthmus, and LAI showed transient cavitation and pulsed horizontal flow.
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Affiliation(s)
- Lieven Robberecht
- Section of Endodontology, Department of Oral Health Sciences, Ghent University, Ghent, Belgium.,Department of Restorative Dentistry and Endodontics, Faculty of Odontology, Univ. Lille, Inserm, CHU Lille, U1008, Lille, France
| | | | - Maarten Meire
- Section of Endodontology, Department of Oral Health Sciences, Ghent University, Ghent, Belgium
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Swimberghe RCD, Tzourmanas R, De Moor RJG, Braeckmans K, Coenye T, Meire MA. Explaining the working mechanism of laser‐activated irrigation and its action on microbial biofilms: a high‐speed imaging study. Int Endod J 2022; 55:1372-1384. [DOI: 10.1111/iej.13824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- R. C. D. Swimberghe
- Department of Oral Health Sciences, Section of Endodontology Ghent University Ghent Belgium
| | - R. Tzourmanas
- Department of Oral Health Sciences, Section of Endodontology Ghent University Ghent Belgium
| | - R. J. G. De Moor
- Department of Oral Health Sciences, Section of Endodontology Ghent University Ghent Belgium
| | - K. Braeckmans
- Department of Pharmaceutics, Bio‐Photonics Research Group, Laboratory of General Biochemistry & Physical Pharmacy Ghent University Ghent Belgium
| | - T. Coenye
- Department of Pharmaceutics, Laboratory of Pharmaceutical Microbiology Ghent University Ghent Belgium
| | - M. A. Meire
- Department of Oral Health Sciences, Section of Endodontology Ghent University Ghent Belgium
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Boutsioukis C, Arias‐Moliz MT, Chávez de Paz LE. A critical analysis of research methods and experimental models to study irrigants and irrigation systems. Int Endod J 2022; 55 Suppl 2:295-329. [PMID: 35171506 PMCID: PMC9314845 DOI: 10.1111/iej.13710] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
Irrigation plays an essential role in root canal treatment. The purpose of this narrative review was to critically appraise the experimental methods and models used to study irrigants and irrigation systems and to provide directions for future research. Studies on the antimicrobial effect of irrigants should use mature multispecies biofilms grown on dentine or inside root canals and should combine at least two complementary evaluation methods. Dissolution of pulp tissue remnants should be examined in the presence of dentine and, preferably, inside human root canals. Micro-computed tomography is currently the method of choice for the assessment of accumulated dentine debris and their removal. A combination of experiments in transparent root canals and numerical modeling is needed to address irrigant penetration. Finally, models to evaluate irrigant extrusion through the apical foramen should simulate the periapical tissues and provide quantitative data on the amount of extruded irrigant. Mimicking the in vivo conditions as close as possible and standardization of the specimens and experimental protocols are universal requirements irrespective of the surrogate endpoint studied. Obsolete and unrealistic models must be abandoned in favour of more appropriate and valid ones that have more direct application and translation to clinical Endodontics.
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Affiliation(s)
- Christos Boutsioukis
- Department of EndodontologyAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Strazzi-Sahyon HB, Cintra LTA, Nakao JM, Takamiya AS, Queiroz ÍODA, Henrique Dos Santos P, de Oliveira SHP, Sivieri-Araujo G. Cytotoxicity of root canal irrigating solutions and photodynamic therapy using curcumin photosensitizer. Photodiagnosis Photodyn Ther 2022; 38:102795. [PMID: 35263668 DOI: 10.1016/j.pdpdt.2022.102795] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/20/2022] [Accepted: 03/02/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) has shown satisfactory antibacterial effects. However, few information regarding the cytotoxicity potential of PDT using curcumin as a photosensitizer (PS) on fibroblasts are found. The aim of this in vitro study was to evaluate the cytotoxicity of root canal irrigating solutions and photodynamic therapy with curcumin PS on the L-929 cell line. METHODS Healthy mouse skin fibroblast cells were distributed into the following 7 experimental groups: G1 - culture medium DMEM (control group); G2 - 0.9% sodium chloride; G3 - 2.5% sodium hypochlorite (NaOCl); G4 - 5% NaOCl; G5 - PDT with curcumin PS at 500 mg/L + blue LED; G6 - PDT with curcumin PS at 750 mg/L + blue LED; and G7 - PDT with curcumin PS at 1000 mg/L + blue LED. All experimental groups which underwent PDT action were submitted to blue LED for 4 minutes, with a wavelength of 480 nm and energy fluency of 75 J/cm². The cultures were maintained under standard cell culture conditions (37°C, 100% humidity, 5% CO2). Cell viability analysis was performed using the colorimetric method to evaluate the periods of 6, 24, and 48 hours. Data were subjected to the Kruskal-Wallis test, followed by the Dunn test to compare groups and Friedman test to compare periods (α = 0.05). RESULTS When comparing the periods, no significant differences were observed for any of the experimental groups analyzed (p > 0.05), except for the NaOCl2.5 group that exhibited higher cell viability at 6 hours compared to the period of 48 hours (p = 0.0489). In the comparisons of the experimental groups, there were no statistically significant differences between the control group compared to all disinfection protocols, regardless of the period evaluated (p > 0.05), except for the PDT + C1000 group that showed lower cell viability (p < 0.05). CONCLUSIONS PDT with curcumin at 1000 mg/L was cytotoxic on L-929 fibroblast cell culture. However, laser-activated curcumin at a concentration of 500 mg/L presented no influence on L-929 fibroblast cell viability in in vitro conditions.
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Affiliation(s)
- Henrico Badaoui Strazzi-Sahyon
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Luciano Tavares Angelo Cintra
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Jaqueline Midori Nakao
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Aline Satie Takamiya
- Department of Surgery and Integrated Clinic, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Índia Olinta de Azevedo Queiroz
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | - Paulo Henrique Dos Santos
- Department of Dental Materials and Prosthodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
| | | | - Gustavo Sivieri-Araujo
- Department of Preventive and Restorative Dentistry, Discipline of Endodontics, Araçatuba School of Dentistry, São Paulo State University - UNESP, Araçatuba, SP, Brazil.
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13
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Ordinola‐Zapata R, Mansour D, Saavedra F, Staley C, Chen R, Fok A. In vitro efficacy of a non‐instrumentation technique to remove intracanal multispecies biofilm. Int Endod J 2022; 55:495-504. [PMID: 35152445 PMCID: PMC9314631 DOI: 10.1111/iej.13706] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/27/2022]
Abstract
Aim The aim of this study was to assess the efficacy of a non‐instrumentation technique to disinfect root canals infected by a human dental plaque‐derived multispecies biofilm. Methodology Twenty‐two mandibular incisors were accessed, autoclaved and inoculated with dental plaque. The Center for Disease Control biofilm reactor was used to promote contamination of the root canal space. In the conventional technique (control), the specimens were instrumented until size 35/04 and irrigated with 6% NaOCl. In the non‐instrumentation technique, a glide path was established using K‐files size 10–20 and specimens were immediately cleaned with the GentleWave System. Samples were obtained for culture and 16S rRNA gene sequencing. Differences in abundances of genera were evaluated using Kruskal–Wallis test, and differences in alpha diversity were compared using anova. Alpha and beta diversity indices were calculated using mothur. The Shannon and Chao1 indices were used to measure alpha diversity. The Bray–Curtis dissimilarity was used to measure beta diversity. Differences in community composition were evaluated using analysis of similarity with Bonferroni correction for multiple comparisons. Results The total numbers of reads in biological samples ranged from 126 to 45 286. Significantly fewer reads were obtained from samples following cleaning by either method (p < .0001), and significantly fewer reads were obtained in post‐cleaning samples following conventional versus non‐instrumentation cleaning regiment (p = .002). Communities in pre‐treatment samples were similar in both groups; however, significantly greater relative abundances of Streptococcus, Veillonella and Campylobacter were observed following cleaning using non‐instrumentation technique (Kruskal–Wallis p = .009, .033, and .001, respectively). Whilst no significant differences were observed in Shannon alpha diversity, the Chao1 index was significantly lower in post‐cleaning samples. Conclusions Significant shifts in composition were observed following cleaning by using both regimens, but the impact of this change was greater following a conventional cleaning technique.
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Affiliation(s)
- R. Ordinola‐Zapata
- Division of Endodontics School of Dentistry University of Minnesota Minneapolis MN USA
| | - D. Mansour
- Division of Endodontics School of Dentistry University of Minnesota Minneapolis MN USA
| | - F. Saavedra
- Department of Diagnostic and Biological Sciences School of Dentistry University of Minnesota Minneapolis MN USA
| | - C. Staley
- Division of Basic & Translational Research Department of Surgery University of Minnesota Minneapolis MN USA
| | - R. Chen
- Department of Diagnostic and Biological Sciences School of Dentistry University of Minnesota Minneapolis MN USA
| | - A.S. Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics (MDRCBB) School of Dentistry University of Minnesota Minneapolis MN USA
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14
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Meire MA, van der Waal SV. A critical analysis of research methods and experimental models to study intracanal medicaments. Int Endod J 2022; 55 Suppl 2:330-345. [PMID: 35100452 DOI: 10.1111/iej.13694] [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: 09/12/2021] [Accepted: 01/26/2022] [Indexed: 12/01/2022]
Abstract
In order to ensure predictable decontamination of the root canal system, chemo-mechanical preparation of the root canal space is sometimes supplemented with the use of intracanal medication. As microbial control of the root canal space is fundamental to the resolution of apical periodontitis, root canal disinfection strategies haven been researched intensively. The use of intracanal medication as a supplementary step to the chemo-mechanical preparation of the root canal space is one of them. Because of the costs and limitations of clinical research it is relevant and common practice to first evaluate alternative or new root canal disinfection modalities in laboratory studies. This involves the simulation of a root canal infection in a laboratory model, on which different disinfection strategies can be tested. When modelling the infected root canal, different levels of infection can be discriminated: suspended bacteria, microbial biofilms and infected dentine. This review describes the experimental models associated with these infection levels and critically appraises their value and methodological details. Suggestions for relevant research methods and experimental models are given, as well as some good practices for laboratory-based microbiological studies.
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Affiliation(s)
- M A Meire
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - S V van der Waal
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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15
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Liu C, Li Q, Yue L, Zou X. Evaluation of sonic, ultrasonic, and laser irrigation activation systems to eliminate bacteria from the dentinal tubules of the root canal system. J Appl Oral Sci 2022; 30:e20220199. [DOI: 10.1590/1678-7757-2022-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Chunhui Liu
- Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, China
| | - Qiang Li
- Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, China
| | - Lin Yue
- Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, China
| | - Xiaoying Zou
- Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, China
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