Molecular evaluation of residual endodontic microorganisms after instrumentation, irrigation and medication with either calcium hydroxide or Septomixine

Antibacterial Efficacy of Graphene Nanoparticles against Enterococcus faecalis: In Vitro Study

OBJECTIVE(S)

 This study compared the antimicrobial efficacy of nanographene (NG) particles with chlorhexidine (CHX) and calcium hydroxide (Ca(OH)2) against Enterococcus faecalis.

MATERIALS AND METHODS

 Forty extracted human mandibular premolar teeth were cleaned using a scaler, and the middle-third of the root (6 mm) was decoronated using a rotary diamond disk. The inner diameter of the teeth was made consistent using Gates Glidden Drills #3, treated with ethylene diamine tetra-acetic acid and sodium hypochlorite before sterilization. The samples were then contaminated with E. faecalis grown in Tryptic soy broth for 21 days. Tooth samples were then randomly divided into four groups: Group I (Control), untreated saline; Group II, Ca(OH)2; Group III, CHX; and Group IV, NG. The assessment of bacterial growth was carried out by harvesting dentin chips at the end of 1, 3, and 7 days. The colonies were physically counted and tabulated after 24 hours from seeding. Statistical analysis of the collected data was performed with analysis of variance and Tukey's post hoc test using SPSS Version 20.0.

RESULTS

 The contaminated dentine blocks irrigated with NG (0.5 µg) and CHX (0 ± 0; p < 0.001) had no growth of E. faecalis colonies compared to blocks of Ca(OH)2 (10 ± 21) and saline (927 ± 455). All concentrations of NG (0.5 and 1.0 µg) showed effectiveness higher (p < 0.001) than 2% CHX when measured by the zone of inhibition against E. faecalis. CONCLUSION:  It may be concluded that NG is effective against growth of E. faecalis and may be used as a promising antimicrobial agent during root canal treatment. However, further studies should be done to investigate the effect of NG against other dental pathogens.

Efficacy of Glycyrrhizin as an Intracanal Medicament on Bacterial Load Reduction in Primary Infected Root Canals: A Randomized Clinical Trial

AIM

This study was done to clinically investigate the efficacy of glycyrrhizin-based intracanal medication (ICM) compared to calcium hydroxide Ca(OH)2 and Ledermix on the bacterial counts inside the root canals of necrotic teeth with chronic periapical periodontitis.

METHODOLOGY

Thirty-six patients having single-rooted and single-canaled necrotic teeth with chronic periapical periodontitis were enrolled in this research. Aseptic control measures were taken before clinical steps. Access cavity preparation was done. First bacteriological samples (S1) were collected immediately after access cavity preparation and before cleaning and shaping inside the root canals. Cleaning and shaping were performed on the root canals. Patients were randomly allocated into 3 groups according to the type of intracanal medicament used [Ca(OH)2, Ledermix, Glycyrrhizin]. Second bacteriological samples (S2) were collected after 1 week from placing the ICMs. S1 and S2 were transferred to the lab of microbiology for culturing on blood agar dishes in anaerobic conditions, and the bacteria on the plates were enumerated as colony-forming units (CFUs) by the manual counting method. The anti-bacterial efficacy of the ICM was estimated by the percentage reduction in the bacterial colonies from S1 to S2.

RESULTS

All tested ICM documented a significant reduction in the CFUs from S1 to S2 (p < 0.05). Regarding S1, there was no significant difference between the three tested materials (p > 0.05). Regarding S2, Glycyrrhizin and Ledermix showed significantly lower CFUs than Ca(OH)2. There was no significant difference between Glycyrrhizin and Ledermix.

CONCLUSION

Under the conditions of the present study, Glycyrrhizin and Ledermix showed comparable antimicrobial effects that were better than the commonly used Ca(OH)2 ICM. Glycyrrhizin may be a promising ICM.

CLINICAL SIGNIFICANCE

Herbal medicine can be considered as an alternative antimicrobial material for root canal disinfection because it has many benefits, like low toxicity, absence of microbial resistance, and favorable antimicrobial efficacy. This study highlights the clinical efficacy of Glycyrrhizin as a promising ICM. How to cite this article: Eltantawi AR, Abdel-Razik GM, Elhawary YM, et al. Efficacy of Glycyrrhizin as an Intracanal Medicament on Bacterial Load Reduction in Primary Infected Root Canals: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(6):540-546.

Comparing Antibiotic Pastes with Electrospun Nanofibers as Modern Drug Delivery Systems for Regenerative Endodontics

Nanomaterials have various features that make these types of materials able to be applied in different biomedical applications like, diagnosis, treatment, and drug delivery. Using such materials in endodontic filed both to face the challenges that occur during treatment processes and to make these materials have an antibacterial effect without showing any harm on the host cells. The approach of nanofibers loaded with various antibacterial drugs offers a potential treatment method to enhance the elimination procedure of intracanal biofilms. Clinically, many models of bacterial biofilms have been prepared under in vitro conditions for different aims. The process of drug delivery from polymeric nanofibers is based on the principle that the releasing ratio of drug molecules increases due to the increase in the surface area of the hosted structure. In our review, we discuss diverse approaches of loading/releasing drugs on/from nanofibers and we summarized many studies about electrospun nanofibers loaded various drugs applied in the endodontic field. Moreover, we argued both the advantages and the limitations of these modern endodontic treatment materials comparing them with the traditional ones.

Antibacterial Activity of Sodium Hypochlorite Gel versus Different Types of Root Canal Medicaments Using Agar Diffusion Test: An In Vitro Comparative Study

Aim

This study aimed to evaluate the antibacterial effect of sodium hypochlorite gel and four types of intracanal medicaments.

Materials and Methods

The agar diffusion method was used to evaluate the antibacterial effect of five medicaments (sodium hypochlorite gel (NaOCl), chlorhexidine gel (CHX), calcium hydroxide paste (CH), Ledermix, and Diapex plus) against Enterococcus faecalis (E. faecalis), Staphylococcus aureus (S. aureus), and Escherichia coli (E. coli). The zone of inhibition around each medicament was measured in millimeters, after 48 hours of incubation at 37°C. The antibacterial effects of medicaments against each microbial strain and the sensitivity of microorganisms towards each medicament were compared using the one-way ANOVA and Games–Howell post hoc tests. The level of significance was set to p < 0.05.

Results

All medicaments showed variable inhibition zones for all bacterial strains except Diapex Plus which showed no antibacterial activity. NaOCl gel exhibited the most significant inhibition zones for all bacterial strains followed by CHX gel, Ledermix, and CH. However, the effect of CHX and CH paste against S. aureus was statistically similar, while the effect of CH against E. faecalis was significantly higher than the Ledermix.

Conclusion

Sodium hypochlorite gel displayed the highest antibacterial activity among tested medicaments and can be recommended as a potent intracanal medicament. Chlorhexidine gel showed a significantly higher antibacterial effect when compared with Ledermix and calcium hydroxide. Calcium hydroxide demonstrated stronger antibacterial activity against E. faecalis than Ledermix. Diapex Plus exhibited no antibacterial effect.

Comparative evaluation of antimicrobial efficacy of triple antibiotic paste, calcium hydroxide, and a proton pump inhibitor against resistant root canal pathogens

Objective:

The objective of this study is to compare the antimicrobial efficacy of triple antibiotic paste (TAP) and a proton pump inhibitor (PPI) (omeprazole) in combination with calcium hydroxide (CH) against Enterococcus faecalis and Candida albicans.

Materials and Methods:

E. faecalis and C. albicans were subcultured and inoculated at 37° overnight and were treated with different dilutions of TAP, 25 μg/ml (Group 1), CH (Group 2, control), CH 16 mg/ml + omeprazole 2 mg/ml (Group 3a) (CH 16 mg/ml + omeprazole 4 mg)/ml (Group 3b) for 24, 48, and 72 h in sterile uncoated 96-well microtiter plates. Minimum concentration at which the medicaments produced least optical density was determined using ELISA reader (ELx 808 BioTek Inc., USA) device set at optical density of 630 nm. Results were analyzed statistically by one-way analysis of variance followed by Tukey's multiple comparison tests. The significance level was set at 0.05.

Results:

Mean concentration (irrespective of time) for TAP at which mean minimum optical density was recorded at 1.25 μg/ml (1:20 dilution) and 25 μg/ml (0 dilution) against E. faecalis and C. albicans, respectively. Least optical density for CH plus PPI group was obtained 1.6 μg/ml (1:10 dilution) and 16 μg/ml (0 dilution) for E. faecalis and C. albicans, respectively. However, CH alone showed a weaker antimicrobial action against either of the strains even at full concentration.

Conclusions:

PPI enhanced the antibacterial efficacy of CH against E. faecalis and C. albicans. However, TAP showed the best antibacterial property followed by CH plus PPIs against both the selected strains.

Antimicrobial Efficacy of Triple Antibiotic-eluting Polymer Nanofibers against Multispecies Biofilm

The elimination of microbial flora in cases of immature permanent teeth with necrotic pulp is both key and a challenging goal for the long-term success of regenerative therapy. Recent research has focused on the development of cell-friendly intracanal drug delivery systems. This in vitro study aimed to investigate the antimicrobial action of 3-dimensional (3D) tubular-shaped triple antibiotic-eluting nanofibrous constructs against a multispecies biofilm on human dentin. Polydioxanone polymer solutions, antibiotic-free or incorporated with metronidazole, ciprofloxacin, and minocycline, were electrospun into 3D tubular-shaped constructs. A multispecies biofilm consisting of Actinomyces naeslundii, Streptococcus sanguinis, and Enterococcus faecalis was forced inside the dentinal tubules via centrifugation in a dentin slice in vitro model. The infected specimens were exposed to 2 experimental groups (ie, 3D tubular-shaped triple antibiotic-eluting constructs and triple antibiotic paste [TAP]) and 2 control groups (7-day biofilm untreated and antibiotic-free 3D tubular-shaped constructs). Biofilm elimination was quantitatively analyzed with confocal laser scanning microscopy. Confocal laser scanning microscopic (CLSM) analysis showed a dense population of viable (green) bacteria adhered to dentin and penetrated into the dentinal tubules. Upon 3D tubular-shaped triple antibiotic-eluting nanofibrous construct exposure, nearly complete elimination of viable bacteria on the dentin surface and inside the dentinal tubules was shown in the CLSM images, which was similar (P < .05) to the bacterial death promoted by the TAP group but significantly greater when compared with both the antibiotic-free 3D tubular-shaped constructs and the control (saline). The proposed 3D tubular-shaped antibiotic-eluting construct showed pronounced antimicrobial effects against the multispecies biofilm tested and therefore holds significant clinical potential as a disinfection strategy before regenerative endodontics.

2016 ASE undergraduate essay competition candidate information

The aim of this review is to discuss the role of medicaments and materials used in teeth undergoing root canal treatment and how they affect the overall prognosis of root canal treated teeth. Irrigants, medicaments and materials play a vital role in RCT. They reduce the overall microbial load within the root canal system, help reduce inter-appointment pain, and induce apexification during RCT of permanent teeth with immature apices. In addition, they also help create a hermetic coronal and periradicular seal to entomb any residual microorganisms within the canals and prevent future ingress of contaminants into the root canal system and subsequent reinfection. Whilst the role of various materials in RCT has been thoroughly investigated, the available literature and longitudinal clinical studies evaluating the affect of such materials on the prognosis of RCT is scarce, and requires further investigation.

Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part II. in vivo studies

The first part of this study reviewed the characteristics of calcium hydroxide (Ca(OH)₂) and summarized the results of in vitro studies related to its antimicrobial effects. The second part of this review covers in vivo studies including human clinical studies and animal studies. The use of Ca(OH)₂ as an intracanal medicament represented better histological results in animal studies. However, human clinical studies showed limited antimicrobial effects that microorganisms were reduced but not eliminated through the treatment, and that some species had resistance to Ca(OH)₂. Most of clinical outcome studies supported that there is no improvement in healing of periapical lesions when Ca(OH)₂ was applied between appointments. Further studies are required for the antimicrobial effects of Ca(OH)₂, and search for the ideal material and technique to completely clean infected root canals should be continued.

The effect of retreatment procedure on the pH changes at the surface of root dentin using two different calcium hydroxide pastes

Aim:

To compare pH changes at the cervical, middle and apical surfaces of root dentin in retreated and non- retreated teeth, after canal obturation with two different calcium hydroxide pastes.

Materials and Methods:

After instrumentation of 55 extracted teeth, three cavities with 0.75 mm depth and 1.5 mm in diameter were drilled at buccal root surface. The teeth were randomly divided into five groups. Canals in the first two groups were filled with either mixture of calcium hydroxide and saline solution and calcium hydroxide and 2% chlorhexidine (CHX). In the third and fourth groups canals were first obturated with gutta-percha and AH26 sealer, and then materials were removed. After 2 days canals were filled with two different calcium hydroxide pastes similar to the first and the second groups. The pH was measured in the prepared cavities at 1, 3, 7 and 14 days.

Results:

In the non-retreated groups, pH at the surface of the roots was significantly higher in comparison to the retreated ones (P value < 0.001). pH values were significantly higher in the non-retreated teeth filling with calcium hydroxide and saline solution (P value < 0.001).

Conclusion:

Regarding to the little pH changes at the surface of dentin in retreated teeth, the hydroxyl ions cannot penetrate into the dentinal tubules. Thus, to achieve higher pH at the root surface in retreated teeth, it is clinically advisable to remove more dentin from the inner walls and to use normal saline as a vehicle for calcium hydroxide rather than acidic pH materials.

Endodontic 'solutions' part 1: a literature review on the use of endodontic lubricants, irrigants and medicaments

Endodontic lubricants, irrigants and medicaments help prepare and disinfect root canal systems (RCS) but primary and secondary cases involve different microbes and therefore it is unlikely that one protocol will be effective for both case types. Each individual 'solution' or sequence of'solutions' could play a significant role in each case type, but there are no detailed published guidelines in existence. To help inform clinical practice it was decided to undertake a literature review followed by a UK and Republic of Ireland wide audit on current endodontic'solution' usage within dental schools. The literature review was undertaken under the following headings: pre-op oral rinse; file lubricants; root canal irrigants and intracanal medicaments and provides an evidence base for protocol development for both primary and retreatment cases.The audit project and the protocols developed from the findings of both the literature review and audit will be presented in Part 2.

Microbial culture and checkerboard DNA-DNA hybridization assessment of bacteria in root canals of primary teeth pre- and post-endodontic therapy with a calcium hydroxide/chlorhexidine paste

AIM

To investigate the root canal microbiota of primary teeth with apical periodontitis and the in vivo antimicrobial effects of a calcium hydroxide/chlorhexidine paste used as root canal dressing.

DESIGN

Baseline samples were collected from 30 root canals of primary teeth with apical periodontitis. Then, the root canals were filled with a calcium hydroxide paste containing 1% chlorhexidine for 14 days and the second bacteriologic samples were taken prior to root canal filling. Samples were submitted to microbiologic culture procedure to detect root canal bacteria and processed for checkerboard DNA-DNA hybridization.

RESULTS

Baseline microbial culture revealed high prevalence and cfu number of anaerobic, black-pigmented bacteroides, Streptococcus, and aerobic microorganisms. Following root canal dressing, the overall number of cfu was dramatically diminished compared to initial contamination (P <0.05), although prevalence did not change (P > 0.05). Of 35 probes used for checkerboard DNA-DNA hybridization, 31 (88.57%) were present at baseline, and following root canal dressing, the number of positive probes reduced to 13 (37.14%). Similarly, the number of bacterial cells diminished folowing application of calcium hydroxide/chlorhexidine root canal dressing (P = 0.006).

CONCLUSION

Apical periodontitis is caused by a polymicrobial infection, and a calcium hydroxide/chlorhexidine paste is effective in reducing the number of bacteria inside root canals when applied as a root canal dressing.

Effectiveness of the proton pump inhibitor omeprazole associated with calcium hydroxide as intracanal medication: an in vivo study

INTRODUCTION

The objective of this study was to evaluate the efficacy of the association of a proton pump inhibitor (omeprazole) with Ca(OH)(2) as intracanal medication in a rat model of periapical lesions.

METHODS

Periapical lesions were induced on the first right mandibular molar tooth of 36 male Wistar rats (6 per group). After 28 days, the distal canal of each tooth was prepared, filled with the respective dressing (negative control group, PEG 400; positive control group, Ca(OH)(2) + PEG400; test group, Ca(OH)(2) + omeprazole + PEG 400), and sealed with amalgam for 15 or 28 days. Microbiological samples were taken in 3 periods: S1, after 28 days of lesion induction; S2, after the biomechanical preparation; and S3, after the medication (15 and 28 days).

RESULTS

The radiographic and histologic analysis revealed that either Ca(OH)(2) or Ca(OH)(2) plus omeprazole dressings produced a reduction of periapical lesions at 28 days, when compared with the negative control group. The reduction of periapical lesions and inflammatory cell infiltration was visibly improved by associating omeprazole with Ca(OH)(2), with an increase of reparative bone areas. The microbiological assessment showed a significant decrease of colony-forming units count from S1 to S2 or S3 collecting times, but no differences were observed between the S2 and the S3 time-periods or among the experimental groups within the S3 period. Further bacterial characterization showed a possible selective activity of the medications.

CONCLUSIONS

Our data showed that association of omeprazole with Ca(OH)(2) favored a superior repair of rat periapical lesions and seemed to display different selective activity over endodontic microbiota, in comparison with the conventional Ca(OH)(2) dressing.

Calcium hydroxide inactivates lipoteichoic acid from Enterococcus faecalis

Calcium hydroxide is a widely used endodontic medicament for eliminating viable bacteria and inactivating virulence factors. Enterococcus faecalis, a pathogenic gram-positive bacterium, has been associated with refractory apical periodontitis. Because lipoteichoic acid (LTA) is a major virulence factor of gram-positive bacteria, we examined whether calcium hydroxide could detoxify LTA from E. faecalis. An enzyme-linked immunosorbent assay showed that calcium hydroxide-killed E. faecalis was less potent than heat-killed bacteria in stimulating the release of tumor necrosis factor-alpha by a murine macrophage line, RAW 264.7 (P < 0.05). Pretreatment of LTA with calcium hydroxide remarkably abrogated the ability of LTA to induce the release of tumor necrosis factor-alpha (P < 0.05). Furthermore, calcium hydroxide-treated LTA was not able to stimulate Toll-like receptor 2, which recognizes functionally intact LTA. These results suggest that calcium hydroxide could detoxify LTA, resulting in attenuation of the inflammatory responses to E. faecalis and its LTA.

The antimicrobial effects of root canal irrigation and medication

The role of microorganisms in the development and maintenance of pulpal and periapical inflammation have been well documented. The success of root canal treatment largely depends on the elimination of microbial contamination from the root canal system. Although mechanical instrumentation of root canals can reduce bacterial population, effective elimination of bacteria cannot be achieved without the use of antimicrobial root canal irrigation and medication. This review will discuss the antimicrobial effects of the known root canal irrigants and medicaments and explore future developments in the field.

In vitro activity of amoxicillin, clindamycin, doxycycline, metronidazole, and moxifloxacin against oral Actinomyces

Actinomyces spp have been increasingly associated with endodontic infections. However, the antimicrobial susceptibility of this genus has not been studied extensively. The objective of this study was to determine the susceptibility of oral isolates of Actinomyces naeslundii, Actinomyces gerencseriae, Actinomyces israelii, Actinomyces viscosus, and Actinomyces odontolyticus to amoxicillin, clindamycin, doxycycline, metronidazole, and moxifloxacin using in vitro assays. The minimum inhibitory concentration (MIC) of each bacterial isolate was determined by using E-test strips (AB Biodisk, Solna, Sweden). The MIC(90) was 0.19 microg/mL for amoxicillin, 0.25 microg/mL for doxycycline, 0.50 microg/mL for moxifloxacin, and 1.00 microg/mL for clindamycin. However, metronidazole was not active against any of the Actinomyces spp tested (MIC(90)>256 microg/mL).

The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics

Bacteria have been implicated in the pathogenesis and progression of pulp and periapical diseases. The primary aim of endodontic treatment is to remove as many bacteria as possible from the root canal system and then to create an environment in which any remaining organisms cannot survive. This can only be achieved through the use of a combination of aseptic treatment techniques, chemomechanical preparation of the root canal, antimicrobial irrigating solutions and intracanal medicaments. The choice of which intracanal medicament to use is dependent on having an accurate diagnosis of the condition being treated, as well as a thorough knowledge of the type of organisms likely to be involved and their mechanisms of growth and survival. Since the disease is likely to have been caused by the presence of bacteria within the root canal, the use of an antimicrobial agent is essential. Many medicaments have been used in an attempt to achieve the above aims but no single preparation has been found to be completely predictable or effective. Commonly used medicaments include calcium hydroxide, antibiotics, non-phenolic biocides, phenolic biocides and iodine compounds. Each has advantages and disadvantages, and further research is required to determine which is best suited for root canal infections.

Root canal irrigation--which method?

DATA SOURCES

Medline and reference lists of relevant articles were consulted.

STUDY SELECTION

Papers were quality assessed by two reviewers: only those addressing passive ultrasonic irrigation (PUI) were included in the review.

DATA EXTRACTION AND SYNTHESIS

A qualitative synthesis describing the mechanism and effects of PUI is described.

RESULTS

Fifty-four papers were included in the review and a qualitative summary of the findings presented.

CONCLUSIONS

PUI appears to be a possible adjunctive treatment for cleaning the root canal system and may be more effective than syringe irrigation. More research is needed to clarify the underlying physical mechanisms through which PUI works.