Life as an endodontic pathogen. Ecological differences between the untreated and root-filled root canals

Chemical, Antibacterial, and Cytotoxic Properties of Four Different Endodontic Sealer Leachates Over Time

INTRODUCTION

The management of apical periodontitis involves the elimination of bacteria to achieve healing of the periapical tissues. To this end, understanding of the antimicrobial properties and cytotoxicity of root canal sealers over time is important. This study aimed to assess the cytocompatibility and antibacterial activity of leachates obtained from selected endodontic sealers.

METHODS

Four sealers were used in this study; AH Plus, an epoxy resin-based sealer, and three hydraulic calcium silicate-based sealers: AH Plus Bioceramic, BioRoot RCS, and BioRoot Flow. Sealer chemistry was assessed by scanning electron microscopy and energy dispersive spectrum analysis. Leachates of the tested sealers were prepared by immersing sealer discs in Hank's balanced salt solution for 28 and 90 days. Element release was assessed using inductively coupled plasma mass spectroscopy. Enterococcus faecalis and Fusobacterium nucleatum were exposed to the leachates followed by colony-forming unit determination, and the human osteoblast-like cell line Saos-2 was assessed with regard to cell death, caspase expression and activity of alkaline phosphatase (ALP) after stimulation with the leachates.

RESULTS

Calcium leaching was detected in the tricalcium silicate-based sealers, which increased the leachate pH significantly (P < .0001). AH Plus Bioceramic leachate displayed antimicrobial activity at 28 days against E. faecalis (P < .01). ALP levels were reduced in response to AH Plus Bioceramic and BioRoot RCS 1-day leachates (P < .05). High cell viability was observed after exposure to all sealers.

CONCLUSIONS

The leachates of the tested sealers were cytocompatible; however, their antimicrobial activity as well as their potential to induce the bone formation marker ALP was minimal.

Comparative evaluation of antimicrobial efficacy of 0.1% octenidine dihydrochloride, superoxidized solution, ozonated water, 0.1% silver nanoparticle solution, and Q mix™ 2 in 1 in root canals infected with Enterococcus faecalis

Introduction

The objective of this study was to compare and evaluate the antimicrobial efficacy of 0.1% octenidine dihydrochloride, superoxidized solution, ozonated water, 0.1% silver nanoparticles (AgNp) solution, and Q mix™ 2 in 1 in root canals infected with Enterococcus faecalis.

Methodology

One hundred and fifty permanent mandibular premolars were inoculated with E. faecalis (0.5 McFarland standards) were incubated at 37°C for 7 days after which preoperative microbial sampling was done and the number of viable E. faecalis cells was obtained as CFU/mL.The specimens were irrigated with 0.1% octenidine dihydrochloride (group 1), Q mix™ 2 in 1 (group 2), super oxidized solution (group 3), 0.1% AgNp solution (group 4), ozonated water (group 5), and normal saline (group 6) during mechanical instrumentation. The final irrigation was followed by microbial sampling and the number of viable E. faecalis cells was obtained as CFU/mL.

Statistical Analysis

Data were analyzed by paired t-test and ANOVA with Tukey's post hoc test.

Results

Paired t-test showed a statistically significant difference between mean CFU before and after irrigation in groups I, II, III, IV, and V respectively (P < 0.05). Group VI showed no statistically significant difference between CFU before and after irrigation (P = 0.131).

Conclusion

The mean bacterial reduction was statistically significant for all the study groups, proving their good antibacterial activity against E. faecalis in root canals whereas 0.1% octenidine dihydrochloride and ozonated water demonstrated relatively higher antimicrobial potential.

Exploring the impact of oral bacteria remnants on stem cells from the Apical papilla: mineralization potential and inflammatory response

Introduction

Bacterial persistence is considered one of the main causal factors for regenerative endodontic treatment (RET) failure in immature permanent teeth. This interference is claimed to be caused by the interaction of bacteria that reside in the root canal with the stem cells that are one of the essentials for RET. The aim of the study was to investigate whether prolonged exposure of stem cells from the apical papilla (SCAP) to bacterial remnants of Fusobacterium nucleatum, Actinomyces gerensceriae, Slackia exigua, Enterococcus faecalis, Peptostreptococcaceae yurii, commonly found in infected traumatized root canals, and the probiotic bacteria Lactobacillus gasseri and Limosilactobacillus reuteri, can alter SCAP's inflammatory response and mineralization potential.

Methods

To assess the effect of bacterial remnants on SCAP, we used UV-C-inactivated bacteria (as cell wall-associated virulence factors) and bacterial DNA. Histochemical staining using Osteoimage Mineralization Assay and Alizarin Red analysis was performed to study SCAP mineralization, while inflammatory and osteo/odontogenic-related responses of SCAPs were assessed with Multiplex ELISA.

Results

We showed that mineralization promotion was greater with UV C-inactivated bacteria compared to bacterial DNA. Immunofluorescence analysis detected that the early mineralization marker alkaline phosphatase (ALP) was increased by the level of E. coli lipopolysaccharide (LPS) positive control in the case of UV-C-inactivated bacteria; meanwhile, DNA treatment decreased the level of ALP compared to the positive control. SCAP's secretome assessed with Multiplex ELISA showed the upregulation of pro-inflammatory factors IL-6, IL-8, GM-CSF, IL-1b, neurotrophic factor BDNF, and angiogenic factor VEGF, induced by UV-C-killed bacteria.

Discussion

The results suggest that long term stimulation (for 21 days) of SCAP with UV-C-inactivated bacteria stimulate their mineralization and inflammatory response, while DNA influence has no such effect, which opens up new ideas about the nature of RET failure.

Comparison of Antimicrobial Activity of Triple, Double, and Cefixime-Based Antibiotic Pastes Against Enterococcus Faecalis: An In Vitro Study

AIM

This in vitro study aims to compare the antimicrobial efficacy of triple antibiotic paste, double antibiotic paste, and cefixime-based triple antibiotic paste against Enterococcus faecalis. Materials and methods: Fifty single-rooted, caries-free, permanent teeth without any developmental defects were included in this study. The specimens were divided into five groups, with each group consisting of 10 teeth that received a specific medicament. The groups were as follows: Group I: control; Group II: calcium hydroxide; Group III: triple antibiotic paste; Group IV: double antibiotic paste; and Group V: cefixime-based triple antibiotic paste. The antimicrobial activity of the medicaments was assessed against E. faecalis at the end of the seventh and 14th days. The colony-forming units (CFU) were calculated using the Kolmogorov-Smirnov and Wilcoxon tests.

RESULTS

After seven days of the experimental process, it was observed that the CFU count was highest in group I and lowest in group V. In a similar vein, after 14 days, the maximum decrease in CFU count was observed in Group V, while the least reduction in CFU count was observed in Group II. On intergroup comparison, it was found that the maximum decrease in CFU was noted in Group V, followed by Group IV, Group III, and Group II.

CONCLUSION

The study results indicated that the cefixime-enriched antibiotic paste had the greatest antimicrobial effectiveness, while the double and triple antibiotic pastes offered superior antibacterial efficacy against E. faecalis at the end of the seventh and 14th days.

Efficacy of Calcium Hydroxide/Saline versus Calcium Hydroxide/Artemisia persica Essential Oil as Intracanal Medicament to Improve Radiographic Visualization of Periapical Lesions in Necrotic Teeth: A Randomized Clinical Trial

Objectives

This study aimed to compare the efficacy of calcium hydroxide (CH)/saline and CH/Artemisia persica (A. persica) essential oil as an intracanal medicament for radiographic resolution of periapical (PA) lesions in necrotic teeth.

Materials and Methods

This randomized clinical trial was conducted on 22 patients with necrotic teeth and PA lesions presenting to two private endodontic offices. The patients were randomly divided into two groups (n = 11) to receive CH/saline (control group) and CH/A. persica essential oil (10%) (intervention group) as intracanal medicaments between treatment sessions. The size of PA radiolucency was measured on parallel PA radiographs taken before treatment and also at 1 and 3 months after completion of treatment. The mean time of healing of PA lesions was also compared between the two groups. Data were analyzed by the independent t-test, chi-square test, and Fisher's exact test (alpha = 0.05).

Results

No significant difference was found between the two groups regarding the changes in the size of PA lesions, relative healing percentage, and speed of healing, neither at 1 nor at 3 months postoperatively (P > 0.05). Regarding the presence/absence of clinical symptoms in the second treatment session, the intervention group showed greater resolution of symptoms, although the difference did not reach statistical significance (P > 0.05).

Conclusion

According to the present results, it appears that the addition of A. persica essential oil to CH for application as intracanal medicament does not add any particular advantage.

Microbial Evaluation of Root Canals after Biomechanical Preparation with Manual K-files, Manual H-files, and Kedo-SG Blue Rotary Files: An In Vivo Study

Aim

The purpose of the present study was to comparatively evaluate the efficacy of Kedo-SG blue rotary files, manual K-files, and manual H-files in eliminating the root canal microflora of primary molars.

Materials and methods

Forty-five primary molars requiring pulpectomy were included in the study. Based on type of instrumentation, the teeth were randomly assigned to one of the three groups: group A: Kedo-SG blue rotary files, group B: manual H-files, and group C: manual K-files. Sterile absorbent paper points were used for sample collection and stored in sterile Eppendorf tubes containing saline as transport medium. Culturing was done on thioglycolate agar and blood agar media for the cultivation of anaerobic and aerobic microbes, respectively, and recorded as colony-forming units (CFU) using digital colony counter. Wilcoxon signed-rank test and one-way analysis of variance (ANOVA) test were performed for statistical analysis.

Results

Postinstrumentation, 93-96% reduction of aerobic and anaerobic microbial count was recorded in group A. Whereas, it was 87-91% reduction in group B and 90-91% reduction in group C. No statistically significant difference was noted between the three groups.

Conclusion

Kedo-SG blue rotary files showed a better reduction of microbes in root canals when compared to manual instrumentation. However, there was no significant difference between manual and rotary instrumentation in microbial reduction of primary root canals.

How to cite this article

Lakshmanan L, Jeevanandan G. Microbial Evaluation of Root Canals after Biomechanical Preparation with Manual K-files, Manual H-files, and Kedo-SG Blue Rotary Files: An In Vivo Study. Int J Clin Pediatr Dent 2022;15(6):687-690.

Potential of Bouea macrophylla kernel extract as an intracanal medicament against mixed-species bacterial-fungal biofilm. An in vitro and ex vivo study

OBJECTIVE

To investigate the antimicrobial activity of B. macrophylla kernel extract against mixed-species biofilms of E. faecalis, S. gordonii and C. albicans in vitro. To evaluate the efficacy of the extract as an intracanal medicament compared with Ca(OH)₂ and chlorhexidine in ex vivo tooth model.

METHODS

The antibiofilm effect of B. macrophylla kernel extract was determined by AlamarBlue™ assay and the effect on biofilms was visualized by LIVE/DEAD® BacLight™ viability test. Mixed-species biofilms were incubated into the tooth model (N = 42) for 21 days. The teeth were randomly divided into 4 medicament groups for 7 days: (i) normal saline, (ii) calcium hydroxide (Ca(OH)₂), (iii) chlorhexidine gel, (iv) B. macrophylla kernel extract. Dentine samples were collected, qPCR with PMA was used to quantify the viability and species composition of each sample. SEM was used to visualize the effect of medicament on biofilm structure.

RESULTS

The MBIC was 6.25 mg/mL and the MBEC was 50 mg/mL. The integrity of microbial cells was progressively compromised as concentration increased, resulting in greater cell death. Ex vivo tooth model revealed that biofilm treated with 50 mg/mL of the B. macrophylla extract demonstrated a significantly higher proportions of dead cells than in Ca(OH)₂, chlorhexidine and normal saline groups (p < 0.01). Disruption of biofilm structure and enlargement of dentinal tubules was observed in B. macrophylla group on SEM.

CONCLUSION

The extract of B. macrophylla kernel exhibited significant antibiofilm effect against the mixed-species biofilms of E. faecalis, S. gordonii and C. albicans.

A computational modeling method for root canal endoscopy using a specific CBCT filter: A new era in the metaverse of endodontics begins

A contemporary technological revolution has started a new era in the metaverse of Endodontics, a world of virtual operational possibilities that use an exact replica of the natural structures of the maxillofacial complex. This study describes a modeling method for root canal endoscopy using modern cone-beam CT (CBCT) software in a series of clinical cases. The method consists in acquiring thin CBCT slices (0.10mm) in the coronal, sagittal, and axial planes. A specific 3D volume filter, the pulp cavity filter of the e-Vol DX CBCT software, was used to navigate anatomical root canal microstructures, and to scan them using root canal endoscopy. The pulp cavity filter should be set to synchronize CBCT scans from 2D mode - multiplanar reformations (MPR) - to 3D mode - volumetric reconstruction. This filter, when adopting the option of volumetric reconstruction, the developed algorithm leaves the dentin density in transparent mode so that the pulp cavity may be visualized. The algorithm applied performs the suppression (visual) of areas with dentin density. This ensures 3D visualization of the slices and the microanatomy of the root canal, as well as a dynamic navigation throughout the pulp cavity. This computational modeling method adds new resources to Endodontics, which may impact the predictability of root canal treatments positively. The virtual visualization of the internal anatomy of an exact replica of the canal ensures better communications, reliability, and clinical operationalization. Root canal endoscopy using this novel CBCT filter may be used for clinical applications together with innovative digital and virtual-reality resources that will be naturally incorporated into the principles of Endodontics.

Improving the microbial sampling and analysis of secondary infected root canals by passive ultrasonic irrigation

OBJECTIVE

The persistence of pathogenic microorganisms in root canals is the most common reason for the failure of root canal treatment and the necessity of a root filling treatment, which results in an uncertain prognosis due to technical complexity and the variety of highly adaptable microorganisms. This study evaluated the effect of passive ultrasonic irrigation (PUI) on the outcome of the microbial analysis of root canal-treated teeth with persistent or recurrent apical inflammation in vivo.

MATERIALS AND METHODS

Sample collection was performed after root filling removal (sample S1, control group) and after PUI with NaCl (sample S2) using sterile paper points. In total, 19 samples were obtained. Quantification was performed by means of serial dilution of the samples. Subcultivated pure cultures were identified using MALDI-TOF MS complemented by the Vitek-2-System or PCR, followed by sequencing of the 16S rRNA gene. The results of the samples (S1 and S2) were evaluated regarding their bacterial count and composition.

RESULTS

The total count of bacteria and the number of aerobic/facultative anaerobic microorganisms significantly increased in the S2-samples after application of PUI. The number of obligate anaerobic microorganisms showed an increase after PUI, although it was not significant. We detected 12 different aerobic/facultative anaerobic microorganisms before PUI, and in 21 cases after PUI. Two different obligate anaerobic microorganisms were found in S1 samples compared to nine different species in S2 samples.

CONCLUSIONS

PUI is a powerful method for detaching bacteria in infected root canals and enables a more precise analysis of the etiology of persistent endodontic infections.

CLINICAL RELEVANCE

This study indicates that PUI exerts a positive cleansing effect and adds to the accessibility of microorganisms during the application of bactericidal rinsing solution in root canal treatments.

Evaluation of the Antibacterial Activity of Triclosan-incorporated Root Canal Filling Materials for Primary Teeth against Enterococcus faecalis

Aim and objective

To compare the antibacterial activity of root canal filling materials namely zinc oxide eugenol and Endoflas FS with or without the incorporation of Triclosan.

Materials and methods

The study consisted of four groups, with 15 samples in each group: group I (zinc oxide eugenol paste), group Ia (zinc oxide eugenol paste + 2.5% Triclosan), group II (Endoflas FS), and group IIa (Endoflas FS + 2.5% Triclosan). A double layer agar well diffusion test was used to evaluate the antibacterial activity against Enterococcus faecalis. The zones of microbial inhibition were measured at the end of 24 hours, 6th day, and 29th day.

Results

On intergroup comparison, the difference in the antibacterial activity was found to be highly significant (p < 0.001). Among the various groups evaluated, group IIa showed the highest antibacterial activity against E. faecalis followed by group II, group Ia, and the least activity being shown by group I throughout the experimental periods. On intragroup comparison at different time intervals, a maximum zone of inhibition was seen at 24 hours with a p value < 0.05 in all the tested groups.

Conclusion

Incorporation of 2.5% triclosan into zinc oxide eugenol and Endoflas FS enhanced the antimicrobial activity of both the root canal filling materials with lasting antimicrobial activity even at the end of the 29th day.

Clinical significance

The antimicrobial efficacy of a root canal filling material is an ideal requirement, which will help in combating the residual microflora present in the root canal system following chemomechanical preparation. The addition of an antimicrobial agent such as triclosan to the root canal filling materials, enhances their antimicrobial efficacy significantly and thus, rendering the pulpectomy-treated tooth with a better prognosis.

How to cite this article

Deepak BM, Prabhakar AR, Karuna YM, et al. Evaluation of the Antibacterial Activity of Triclosan-incorporated Root Canal Filling Materials for Primary Teeth against Enterococcus faecalis. Int J Clin Pediatr Dent 2021;14(3):393–397.

Engineered Chitosan-based Nanoparticles Modulate Macrophage-Periodontal Ligament Fibroblast Interactions in Biofilm-mediated Inflammation

INTRODUCTION

Crosstalk between immune cells and tissue-resident cells regulates the pathophysiology and posttreatment healing of apical periodontitis. This investigation aimed to understand the influence of residual root canal biofilm on macrophage (MQ)-periodontal ligament fibroblast (PdLF) interaction and evaluate the effect of engineered chitosan-based nanoparticles (CSnp) on MQ-PdLF interactions in residual biofilm-mediated inflammation.

METHODS

Six-week-old Enterococcus faecalis biofilms in root canal models were disinfected conventionally using sodium hypochlorite alone or followed by calcium hydroxide medication or CSnp dispersed in carboxymethylated chitosan (CMCS). The effect of the treated biofilms (n = 25/group) on the inflammatory response of THP-1-differentiated MQ monoculture versus coculture with PdLF was evaluated for cell viability, MQ morphometric characterization, inflammatory mediators (nitric oxide, tumor necrosis factor alpha, interleukin [IL]-1 beta, IL-1RA, IL-6, transforming growth factor beta 1 [TGF-β1], and IL-10), and the expression of transcription factors (pSTAT1/pSTAT6)/cluster of differentiation markers (CD80/206) after 24, 48, and 72 hours of interaction. PdLF transwell migration was evaluated after 8 and 24 hours. Unstimulated cells served as the negative control, whereas untreated biofilm was the positive control.

RESULTS

Biofilm increased nitric oxide and IL-1β but suppressed IL-10, IL-1RA, and PdLF migration with significant cytotoxic effects. CSnp/CMCS reduced nitric oxide and IL-1β (P < .01) while maintaining ≥90% cell survival up to 72 hours with evident M2-like MQ phenotypic changes in coculture. CSnp/CMCS also increased the IL-1RA/IL-1β ratio and enhanced TGF-β1 production over time (P < .05, 72 hours). In coculture, CSnp/CMCS showed the highest IL-10 level at 72 hours (P < .01), reduced the pSTAT1/pSTAT6 ratio, and enhanced PdLF migration (P < .01, 24 hours).

CONCLUSIONS

CSnp/CMCS medication facilitated MQ switch toward M2 (regulatory/anti-inflammatory) phenotype and PdLF migration via paracrine signaling.

Fluorescence characteristics of E. faecalis in dentine following treatment with oxidizing endodontic irrigants

INTRODUCTION

This study aimed to assess changes in the fluorescence characteristics of Enterococcus faecalis in human dentine over a period of 24 h following treatment with endodontic irrigants.

METHOD

Sterilised, non-functional extracted third molars were embedded in acrylic resin and uniformly sectioned into 2 mm thick dentine sections. After the removal of smear layer, the dentine sections were inoculated with E. faecalis and cultured for 7 days. The infected dentine sections were subsequently treated with different concentrations of sodium hypochlorite (NaOCl) and hydrogen peroxide (H₂O₂). Bacterial fluorescence readings were assessed at different time points using a calibrated laser device. All data were assessed for normality (Kolmogorov Smirnoff test) and analysed using ANOVA with Bonferroni post-hoc tests.

RESULTS

Fluorescence readings were quenched when E. faecalis infected human dentine sections were treated with oxidizing irrigants in vitro. Throughout a 24-hour period, fluorescence recovered in part but did not return to baseline level.

CONCLUSION

The fluorescence quenching effect of these oxidizing agents needs to be considered when using laser fluorescence in assessing the quality of root canal debridement or disinfection.

Disruption of Enterococcus Faecalis biofilms using individual and plasma polymer encapsulated D-amino acids

OBJECTIVE

Our aim was to assess the anti-biofilm ability of previously unverified individual D-amino acids (DAAs), to produce plasma polymer encapsulated DAAs (PPEDAAs), to measure the shell thickness and subsequent release of DAAs, and to assess the effects of PPEDAAs on Enterococcus faecalis biofilms.

MATERIALS AND METHODS

Microtitre tray assays were used to evaluate the effect of individual DAAs (D-leucine, D-methionine, D-tryptophan, and D-tyrosine) on E. faecalis biofilms of different maturity. A mixture and individual DAAs were encapsulated with a plasma polymer for 10, 20, 40, and 60 min. The shell thickness of PPEDAAs was analyzed by ultra-high-resolution scanning electron microscopy. The release of DAAs from the PPEDAAs encapsulated for 60 min was measured over 7 days using high-performance liquid chromatography. Static biofilms were used to assess the effect of PPEDAAs on E. faecalis biofilms.

RESULTS

Individual DAAs reduced biofilm formation to various degrees, according to the DAA and the experimental times. The shell thicknesses of the PPEDAAs ranged between 31 and 76 nm and increased with encapsulation time. Diffusion of DAAs from the PPEDAAs occurred over 60 min for encapsulated D-leucine, D-methionine, and D-tyrosine and up to 7 days for D-tryptophan. PPEDAAs disrupted biofilms at every experimental time.

CONCLUSIONS

PPEDAAs of various shell thickness can be produced with the proposed methodology, DAAs are subsequently released, and the anti-biofilm activity remains unaltered.

CLINICAL RELEVANCE

Individual DAAs and PPEDAAs have anti-biofilm ability and can be considered as part of a biological strategy in endodontics.

New Insights into the Microbial Profiles of Infected Root Canals in Traumatized Teeth

Traumatic dental injuries in young individuals are often exposed to the invasion of oral microorganisms that leads to pulp necrosis. Infective necrosis in permanent teeth not-fully-developed causes aberrant root formation. Regeneration endodontic treatments (RETs) have shown promising results by promoting continued root development by stem cells. Critical to the success of RET is the thorough disinfection of the pulpal space. To establish effective antimicrobial protocols for root canal disinfection, the invading microorganisms need to be identified. In the present study, we use a combination of culture-based and high-throughput molecular sequencing techniques to investigate the microbial profiles from traumatized teeth (30 cases) and controls, i.e., teeth with pulp infections not caused by trauma (32 cases). Overall, a high microbial diversity in traumatized necrotic teeth was observed. Eubacterium yurii subsps. yurii and margaretiae, as well as key ‘bridging oral species’ F. nucleatum sp., Polymorphum and Corynebacterium matruchotti, were highly associated with traumatized teeth. The microbial compositions of traumatized teeth differed considerably from those of infected teeth not caused by trauma. Age and tooth position also influence microbial compositions. In conclusion, we show that the root canal microflora of traumatized teeth is highly diverse, and it differs from root canal infections not caused by trauma.

Association between Endodontically Treated Maxillary and Mandibular Molars with Fused Roots and Periapical Lesions: A Cone-beam Computed Tomography Cross-sectional Study

INTRODUCTION

Fused root variations of the root canal system increase the complexity of the inner root canal system anatomy. The aim of the present study was to determine, in in vivo conditions, the proportion of periapical lesions in association with endodontically treated maxillary and mandibular molars with fused roots presenting previous root canal treatment by assessing preexisting data via cone-beam computed tomographic volumes.

METHODS

A total of 1160 CBCT scans with an overall sample of 20,836 teeth were screened. A global count of 3701 maxillary molars and mandibular second molars were included in the study. The Cohen kappa test and interclass correlation coefficient tested the intra- and interrater reliability, respectively. The percentage of periapical lesions associated with molars with or without root fusion was determined. Proportions were expressed with 95% confidence intervals (CIs). The z test for proportions was used to analyze differences between subgroups, and an odds ratio was calculated in order to understand the association between periapical lesions and root configuration.

RESULTS

Fused molars presented a prevalence of periapical lesions in endodontically treated teeth of 74.0% (95% CI, 65.2%-82.8%), whereas nonfused molars had a proportion of periapical lesions in root canal-treated teeth of 69.5% (95% CI, 65.2%-73.8%; P > .05). Endodontically treated molars with fused roots presented with 1.3 higher odds of being associated with periapical lesions than endodontically treated molars with nonfused roots.

CONCLUSIONS

A tendency of a higher proportion of periapical lesions was found in the fused rooted molars with a history of root canal treatment when compared with nonfused teeth; however, no statistically significant difference was noted.

Detection, treatment and prevention of endodontic biofilm infections: what's new in 2020?

Endodontic disease, a biofilm infection of the root canal space, is a significant cause of dental morbidity worldwide. Endodontic treatment, or root canal treatment, as it is commonly known is founded on the ability to eradicate microbial biofilm infection and prevent re-infection of the highly complex root canal space. Despite many "advances" in clinical endodontics we have seen little improvement in outcomes. The aim of this critical review paper is to provide a contemporary view of endodontic microbiology and biofilm polymicrobiality, provide an understanding of the host response, and how together these impact upon clinical treatment. Ultimately, it is intended to provide insight into novel opportunities and strategies for the future diagnostics, treatment, and prevention of endodontic disease.

Antibiofilm and Immune Response of Engineered Bioactive Nanoparticles for Endodontic Disinfection

The biological aim of root canal treatment is to facilitate periapical tissue healing following endodontic therapy. This study aimed to develop an organotypic infected root canal model to understand the interaction of bacterial biofilm with macrophages and study the therapeutic effect of engineered bioactive chitosan nanoparticles (CSnp) on macrophages. Ex-vivo experiments were conducted in two phases; Phase-1: Enterococcus faecalis biofilms (two and six weeks old) developed in organotypic root canal model were used to characterize residual biofilm after conventional chemical treatment alone and combined with CSnp utilizing Confocal Laser Scanning Microscopy, Scanning Electron Microscopy and colony-forming units from pulverized dentin. Phase-2: The interaction of post-treatment biofilm and RAW macrophages was evaluated regarding pro/anti-inflammatory markers, cell viability and spreading at 24, 48 and 72 h. Compared to conventionally disinfected six-week-old biofilm, CSnp resulted in less viable bacteria (p < 0.01). Scanning electron micrographs demonstrated disruption of the biofilm. CSnp exhibited less residual bacterial load in pulverized dentin (p < 0.001). Macrophage interaction with CSnp-treated biofilm reduced proinflammatory markers (nitric oxide, TNF-α, IL-1β, and IL-6), increased anti-inflammatory marker (TGF-β1) and enhanced cell survival and spreading over time (p < 0.01 at 72 h). Engineered chitosan nanoparticles concurrently inactivated biofilm and altered the inflammatory response of macrophages that would promote healing.

Physical and biological properties of a novel root canal sealer modified by polyhexamethylene guanidine

The key of the root canal therapy is to eliminate the micro-organism infection, fill the root canal tightly and reduce the stimulation to the periapical tissues. However, it is quite difficult to meet all the conditions due to the defect of the material. Here we develop a novel root canal sealer (MZOE), in which zinc oxide eugenol (ZOE) were fabricated with polyhexamethylene guanidine (PHMG), and the PHMG's concentration is 0.8, 1.0, 1.2 and 1.4%. Our investigation tested its physical properties, antibacterial effect to E. faecalis, C. albicans, E. coli, S. aureus and cytotoxicity to human periodontal ligament fibroblasts (HPDLFs). The physical properties of the MZOE conformed to the ISO 6876:2001, and its antibacterial effect was stronger than ZOE (p<0.05), the RGR of HPDLFs was tested between 1 to 24%, belonging to moderate cytotoxicity. It was suggested that MZOE had good physical properties, high antibacterial effect, and moderate cytotoxicity.

Oral microbiome diversity in chimpanzees from Gombe National Park

Historic calcified dental plaque (dental calculus) can provide a unique perspective into the health status of past human populations but currently no studies have focused on the oral microbial ecosystem of other primates, including our closest relatives, within the hominids. Here we use ancient DNA extraction methods, shotgun library preparation, and next generation Illumina sequencing to examine oral microbiota from 19 dental calculus samples recovered from wild chimpanzees (Pan troglodytes schweinfurthii) who died in Gombe National Park, Tanzania. The resulting sequences were trimmed for quality, analyzed using MALT, MEGAN, and alignment scripts, and integrated with previously published dental calculus microbiome data. We report significant differences in oral microbiome phyla between chimpanzees and anatomically modern humans (AMH), with chimpanzees possessing a greater abundance of Bacteroidetes and Fusobacteria, and AMH showing higher Firmicutes and Proteobacteria. Our results suggest that by using an enterotype clustering method, results cluster largely based on host species. These clusters are driven by Porphyromonas and Fusobacterium genera in chimpanzees and Haemophilus and Streptococcus in AMH. Additionally, we compare a nearly complete Porphyromonas gingivalis genome to previously published genomes recovered from human gingiva to gain perspective on evolutionary relationships across host species. Finally, using shotgun sequence data we assessed indicators of diet from DNA in calculus and suggest exercising caution when making assertions related to host lifestyle. These results showcase core differences between host species and stress the importance of continued sequencing of nonhuman primate microbiomes in order to fully understand the complexity of their oral ecologies.

Biofilm model systems for root canal disinfection: a literature review

The aim of this review was to present an overview of laboratory root canal biofilm model systems described in the endodontic literature and to critically appraise the various factors that constitute these models. The electronic databases MEDLINE, Web of Science and EMBASE were searched up to and including December 2016 to identify laboratory studies using endodontic biofilm models. The following search terms were used in various combinations: biofilm, root canal, in vitro, endodontic, bacteria, root canal infection model, colony-forming unit. Only English papers from journals with an impact factor were selected. The records were screened by two reviewers, and full-text articles were assessed according to pre-defined criteria. The following data were extracted from the included studies: the microbial composition of the biofilm, the substrate, growth conditions, validation and quantification. Seventy-seven articles met the inclusion criteria. In the majority (86%) of the studies, a monospecies biofilm was cultured. In two studies, a dual-species biofilm was grown; others cultivated a multispecies biofilm, containing at least three species. Enterococcus faecalis was the most frequently used test species (in 79% of all studies, 92% of the monospecies studies). Four studies used an inoculum derived directly from the oral cavity. Human dentine was the most frequently used substratum (88% of the studies). Incubation times differed considerably, ranging from one to seventy days. The most common quantification method (in 87% of the studies) was bacterial culturing, followed by microscopy techniques. The variation in laboratory root canal biofilm model systems is notable. Because of substantial variation in experimental parameters, it is difficult to compare results between studies. This demonstrates the need for a more standardized approach and a validated endodontic biofilm model.

Bacterial leakage and marginal adaptation of various bioceramics as apical plug in open apex model

AIM

The aim of the present study was to investigate bacterial leakage and marginal adaptation of bioceramic apical plugs.

METHODS

Extracted human mandibular premolars were prepared to simulate open apex using No. 4 Peeso reamer in retrograde direction. In total, 150 specimens were divided into 10 groups by obturation with five bioceramics in two thicknesses. Groups 1, 3, 5, 7, and 9 were obturated with ProRootMTA, Biodentine, TotalFill BC RRM paste, TotalFill BC RRM putty, and RetroMTA at 3 mm, and groups 2, 4, 6, 8, and 10 were obturated with the same materials at 4 mm. Ten specimens in each group were evaluated for bacterial leakage of Enterococcus faecalis for 75 days. Five specimens from each group were sectioned to investigate the gap area under scanning electron microscope.

RESULTS

The 3- and 4-mm Biodentine and TotalFill BC RRM putty groups and the 4-mm ProRootMTA group exhibited less bacterial leakage and lower mean percentage of gap area than those of the other groups. TotalFill BC RRM paste showed the highest leakage for both the 3- and 4-mm groups.

CONCLUSION

The 3- and 4-mm Biodentine and TotalFill BC RRM putty groups and the 4-mm ProRootMTA group exhibited the best sealing ability and marginal adaptation of apical plugs.

Inflammatory cell expression of Toll-like receptor-2 (TLR2) within refractory periapical granuloma

Background: Toll-like receptor-2 (TLR2) is highly important within the immune system. Characterization of the expression of TLR2 within inflammatory cells in periapical lesions could help in diagnosis and management of refractory cases. The aim of the study is identification of Toll-like receptor (TLR2) through immunohistochemical and immunofluroscence expression in inflammatory cells within refractory periapical granuloma cases. Methods: Eight cases of refractory periapical granuloma were selected out of 772 cases. Histological examination and immunohistochemical staining with polyclonal rabbit antihuman TLR2, monoclonal mouse antihuman CD38, CD68 and CD83 primary antibodies, as well as immunofluorescence staining with goat anti-rabbit TLR2, donkey anti-mouse CD38, CD68 and CD83 primary antibodies was conducted. Positive controls, negative controls and experimental sections with no primary antibody were included in the study. Qualitative analysis and double immunofluorescence technique was used to characterize the TLR + cells. Results: In periapical granuloma, lymphocytes (CD38 cells) expressed the most amount of TLR reactivity followed by macrophages (CD68 cells), and odontogenic epithelial cells. Neutrophils, red blood cells (RBCs) and collagen ground substance were negative to TLR2.  Conclusion: TLR2 was highly expressed by lymphocytes and plasma cells indicative of their major role in the inflammatory process and antigen recognition in refractory periapical granuloma. Dendritic cells expressing TLR2 were low in number suggesting a minor role in sustaining these lesions.

The acid tolerance response and pH adaptation of Enterococcus faecalis in extract of lime Citrus aurantiifolia from Aceh Indonesia

Background: The objective of the present study was to evaluate the acid tolerance response and pH adaptation when Enterococcusfaecalis interacted with extract of lime ( Citrus aurantiifolia).

Methods: We used E. faecalis ATCC 29212 and lime extract from Aceh, Indonesia. The microbe was analyzed for its pH adaptation, acid tolerance response, and adhesion assay using a light microscope with a magnification of x1000. Further, statistical tests were performed to analyze both correlation and significance of the acid tolerance and pH adaptation as well as the interaction activity.

Results:E. faecalis was able to adapt to a very acidic environment (pH 2.9), which was characterized by an increase in its pH (reaching 4.2) at all concentrations of the lime extract (p < 0.05). E. faecalis was also able to provide acid tolerance response to lime extract based on spectrophotometric data (595 nm) (p < 0.05). Also, the interaction activity of E. faecalis in different concentrations of lime extract was relatively stable within 6 up to 12 hours (p < 0.05), but it became unstable within 24–72 hours (p > 0.05) based on the mass profiles of its interaction activity.

Conclusions:E. faecalis can adapt to acidic environments (pH 2.9–4.2); it is also able to tolerate acid generated by Citrus aurantiifolia extract, revealing a stable interaction in the first 6–12 hours.

Discuss the role of microorganisms in the aetiology and pathogenesis of periapical disease

The literature indicates that microorganisms have a critical role in the aetiology and pathogenesis of apical periodontitis. The advancement in microbiological study methods has allowed for the identification of newer species associated with the disease process. At our current understanding, however, the exact roles of specific microorganisms in apical periodontitis are not fully understood but the poly-microbial aetiology of the disease appears to be supported by the literature. The endodontic microbiota is comprised of a subset of microbiota present in the oral cavity, consisting of predominantly anaerobic bacterial species, some fungal and viral species. The pathogenesis of apical periodontitis is essentially the result of a complex interplay between bacterial and host factors, giving rise to a range of presentations depending on the balance of the interaction. The role of endodontic microbiota in the initiation and persistence of apical periodontitis means that the mainstay of endodontic treatment is the elimination of such bacteria. A challenge to the resolution of apical periodontitis after treatment lies in the inadequacy of treatment protocol in completely eradicating the pathogenic species and the inherent ability of certain species to survive the treatment. This issue should be the focus of future research as we continually search for more predictable treatment methods of achieving the resolution of apical periodontitis.

Association between Extracellular Material and Biofilm Formation in Response to Sodium Hypochlorite by Clinical Isolates of Enterococcus faecalis

INTRODUCTION

Extracellular material (ECM) surrounding Enterococcus faecalis may play a role in increasing resistance to environmental stresses. Our aim was to determine ECM levels in response to subminimal inhibitory concentrations of sodium hypochlorite (sub-MIC/NaOCl) or anaerobic growth and determine the impact on biofilm development.

METHODS

From 37 E. faecalis clinical strains, 19 were selected according to their biofilm-producing ability by using a crystal violet biofilm assay: 10 strong, 4 intermediate, and 5 non-biofilm producers. Biofilm assays were subsequently performed on all strains when subjected to sub-MIC/NaOCl. All strains were evaluated for ECM production under aerobic and anaerobic conditions and with sub-MIC/NaOCl. ECM production was assessed by using scanning electron microscopy. Double-blinded independent assessors were used to score levels of ECM production. The esp gene was detected by using polymerase chain reaction. Gelatinase activity was determined by using Todd-Hewitt and gelatin agar.

RESULTS

In aerobic conditions, ECM was expressed in all strains. In the presence of sub-MIC/NaOCl, of the 10 strong biofilm producers, 5 increased their ECM production, and 4 showed increased biofilm growth. Two strains had less ECM production and showed decreased biofilm growth. One isolate demonstrated no observable changes. Most non-biofilm producers demonstrated no observable differences in ECM production, although 1 strain increased biofilm growth. ECM production in anaerobic conditions was highly variable. The esp gene (n = 15) and gelatinase activity (n = 7) were evident among the isolates.

CONCLUSIONS

Clonal diversity among strains of E. faecalis suggests that some strong biofilm producers can upregulate ECM production and increase biofilm growth in response to sub-MIC/NaOCl.

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.

Actinomyces radicidentis and Actinomyces haliotis, coccoid Actinomyces species isolated from the human oral cavity

There are few reports on the bacterial species Actinomyces radicidentis in the literature. In this study, putative A. radicidentis isolates were collected from 16 root canal samples from 601 examined patients. The isolates were examined by biochemical tests, 16S rRNA gene sequencing, Arbitrarily-primed (AP-) PCR, antibiotic susceptibility testing, and MALDI-TOF analyses. In parallel, two A. radicidentis reference strains and two putative A. radicidentis isolates from United Kingdom were tested. Sixteen of the 18 isolates were confirmed as A. radicidentis. The remaining two isolates, both of which were isolated from root canals (one from Sweden and the other from the UK), but were identified as Actinomyces haliotis by sequencing ∼ 1300 base pairs of the 16S rRNA-gene. This isolates had a divergent, but between them similar, AP-PCR pattern, and a common distribution of sequence signatures in the 16S rRNA gene, but were not identified by MALDI-TOF. A. haliotis is a close relative to A. radicidentis, hitherto only been described from a sea-snail. The identity of A. haliotis was confirmed by a phylogenetic tree based on 16S rRNA gene sequences with species specific sequences included, and by additional biochemical tests. The examined bacteria exhibited similar antibiotic susceptibility patterns when tested for 10 separate antibiotic classes with E-tests (bioMérieux). The MIC₉₀ for β-lactams (benzylpenicillin and cefuroxime) and vancomycin was 0.5 mg/L, for colistin and ciprofloxacin 8 mg/mL and for the other antibiotic classes ≤ 25 mg/mL The isolation of A. haliotis from infected dental root canals cast doubt on the accepted opinion that all Actinomyces infections have an endogenous source.

Common Operative Procedural Errors and Clinical Factors Associated with Root Canal Treatment

Abstract Operative procedural errors must be well analyzed in order to avoid influence negatively the root canal treatment (RCT) prognosis. The successful RCT prevents tooth loss and avoids pain and apical periodontitis. This review aimed to categorize common operative procedure errors and clinical factors associated with RCT. Based on this, will be approached common errors of procedures within the clinical operative sequence: endodontic treatment planning, pulp and periapical disease diagnosis, anaesthesia, access cavity preparation, isolation with rubber dam, root canal preparation, root canal filling and retreatment, restoration of endodontically treated teeth, postoperative pain, follow up of endodontically treated teeth. The professional must remind that in each phase of RCT an operative error may have adverse implication on prognosis, and these errors characterize risk factors to failure. The knowledge of probable operative procedural errors and its consequences are essentials to avoid future problems to the tooth health.

Potential applications of antimicrobial peptides and their mimics in combating caries and pulpal infections

Antimicrobial peptides (AMPs) are short cationic host-defense molecules that provide the early stage of protection against invading microbes. They also have important modulatory roles and act as a bridge between innate and acquired immunity. The types and functions of oral AMPs were reviewed and experimental reports on the use of natural AMPs and their synthetic mimics in caries and pulpal infections were discussed. Natural AMPs in the oral cavity, predominantly defensins, cathelicidins and histatins, possess antimicrobial activities against oral pathogens and biofilms. Incomplete debridement of microorganisms in root canal space may precipitate an exacerbated immune response that results in periradicular bone resorption. Because of their immunomodulatory and wound healing potentials, AMPs stimulate pro-inflammatory cytokine production, recruit host defense cells and regulate immuno-inflammatory responses in the vicinity of the pulp and periapex. Recent rapid advances in the development of synthetic AMP mimics offer exciting opportunities for new therapeutic initiatives in root canal treatment and regenerative endodontics.

STATEMENT OF SIGNIFICANCE

Identification of new therapeutic strategies to combat antibiotic-resistant pathogens and biofilm-associated infections continues to be one of the major challenges in modern medicine. Despite the presence of commercialization hurdles and scientific challenges, interests in using antimicrobial peptides as therapeutic alternatives and adjuvants to combat pathogenic biofilms have never been foreshortened. Not only do these cationic peptides possess rapid killing ability, their multi-modal mechanisms of action render them advantageous in targeting different biofilm sub-populations. These factors, together with adjunctive bioactive functions such as immunomodulation and wound healing enhancement, render AMPs or their synthetic mimics exciting candidates to be considered as adjuncts in the treatment of caries, infected pulps and root canals.

Restoration of the root canal treated tooth

When considering endodontically treated teeth, the quality of the restoration is important from the outset. It sheds light into possible causes of pulp necrosis or failure of endodontic treatment and influences the outcome of future endodontic treatment. A tooth undergoing endodontic treatment requires an effective coronal seal during and following completion of endodontic treatment. This paper discusses, using the available literature, the maintenance of optimal coronal seal and coronal integrity during and after root canal treatment.

Bacteria in the apical root canals of teeth with apical periodontitis

BACKGROUND/PURPOSE

Bacteria in the tooth root canal may cause apical periodontitis. This study examined the bacterial species present in the apical root canal of teeth with apical periodontitis. Antibiotic sensitivity tests were performed to evaluate whether these identified bacterial species were susceptible to specific kinds of antibiotics.

METHODS

Selective media plating and biochemical tests were used first to detect the bacterial species in samples taken from the apical portion of root canals of 62 teeth with apical periodontitis. The isolated bacterial species were further confirmed by matrix-assisted laser desorption ionization-time of flight mass spectrometry.

RESULTS

We found concomitant presence of two (32 teeth) or three species (18 teeth) of bacteria in 50 (80.6%) out of 62 tested teeth. However, only 34 bacterial species were identified. Of a total of 118 bacterial isolates (83 anaerobes and 35 aerobes), Prophyromonas endodontalis was detected in 10; Bacteroides, Dialister invisus or Fusobacterium nucleatum in 9; Treponema denticola or Enterococcus faecalis in 8; Peptostreptococcus or Olsenella uli in 6; and Veillonella in 5 teeth. The other 25 bacterial species were detected in fewer than five teeth. Approximately 80-95% of bacterial isolates of anaerobes were sensitive to ampicillin/sulbactam (Unasyn), amoxicillin/clavulanate (Augmentin), cefoxitin, and clindamycin. For E. faecalis, 85-90% of bacterial isolates were sensitive to gentamicin and linezolid.

CONCLUSION

Root canal infections are usually caused by a mixture of two or three species of bacteria. Specific kinds of antibiotic can be selected to control these bacterial infections after antibiotic sensitivity testing.

A clinical study on single-visit root canal retreatments on consecutive 173 patients: frequency of periapical complications and clinical success rate

OBJECTIVES

This study assessed the outcome measures of single-visit root canal retreatments and frequency of periapical complications considering preoperative, intraoperative and postoperative factors.

MATERIALS AND METHODS

Between November 2011 and December 2012, in 173 patients, a total of 234 endodontically treated teeth were retreated in a single appointment by one experienced endodontist. Five teeth were extracted and 119 teeth were lost to follow-up yielding to 110 teeth (47 %) to be examined by two calibrated examiners for the outcome of healing (periapical index score-PAI ≤2; no signs or symptoms) or non-healing (presence of apical periodontitis-PAI >2; signs or symptoms). Preoperative, intraoperative and postoperative factors were evaluated for their association with the outcome. Data were analysed using Fisher's exact and Fisher-Freeman Halton tests for bivariate analysis to identify potential outcome predictors. Logistic regression models were used for multivariate analysis to determine significant outcome predictors.

RESULTS

Mean observation time was 29 months. Follow-up assessment revealed 100 teeth (90.9 %) as healed and 10 teeth (9.1 %) non-healed. Age, gender, tooth type and preoperative (pain, periodontal defects, root filling density and length), intraoperative (sealer extrusion) and postoperative (type of coronal restorations) factors did not significantly affect the outcome (p > 0.05). Preoperative periradicular lesions with diameters less than 5 mm presented significantly better outcome than larger lesions (p < 0.05; odds ratio (OD) 6; 95 % CI 1.45-24.85). Logistic regression model showed an increased risk of non-healing for the parameter of preoperative periradicular lesions with diameters larger than 5 mm (OD 6.42; 95 % CI 1.51-27.27).

CONCLUSIONS

Single-appointment root canal retreatments presented a favourable success rate. Only preoperative lesion size had a significant effect on the outcome where the lesions smaller than 5 mm performed significantly better healing.

CLINICAL RELEVANCE

Single-appointment root canal retreatments could be considered as a viable treatment option for orthograde retreatment cases with periradicular lesion size smaller than 5 mm.

Establishment and maintenance of asepsis in endodontics - a review of the literature

OBJECTIVES

Successful endodontic treatment depends on effective measures to eliminate and prevent infection of root canals. Initially treatment should start with isolation and disinfection of the operating field. This review makes an inventory of the available knowledge regarding its establishment and maintenance.

MATERIALS AND METHODS

A literature search was conducted in the PubMed database in order to identify clinical trials examining disinfection or unintentional contamination of the endodontic operative field. A list of 115 articles was obtained and screened. Five relevant articles were identified. These articles were read in full text. The reference lists from these articles were checked manually for additional studies and three studies were obtained. A total of eight articles met the inclusion criteria.

RESULTS

There was a great variety in terms of aim, method, and material of the included studies. None could prove a totally reliable aseptic operative field and not one chemical, or combination of chemicals, were found in more than one study.

CONCLUSIONS

No study documented complete asepsis following initial disinfection, and no study could document predictable maintenance of an established bacteria-free surface. Critical appraisal and standardization of the disinfection and aseptic procedures in endodontics are needed.

Assessment of Correlation between Clinical Parameters and Pulp Canal Pathogens in Endodontic Pathologies: A Microbiological Study

INTRODUCTION

Success and failure of root canal therapy is largely dependent on the clinician and the patient. Once the tooth is restored into its functional and esthetic place, the root canal therapy is considered to be complete. It is a well-known fact that root canal space acts as a rich reservoir for microorganisms. Past studies show that root canal harbors an array of different microorganisms. Streptococcus mitis and Enterococcus faecalis have been found to be the most prevalent microorganisms isolated from the infected pulp canal space. Hence, we evaluated the association of endodontic signs and symptoms with root canal pathogens.

MATERIALS AND METHODS

A total of 120 patients were selected for the study and divided broadly into two groups: Group I containing patients with primary infection and group II containing patients in which retreatment was required. Both groups contained 60 patients each. Clinical parameters recorded for the study are pain, tenderness on percussion, swelling, periapical radiolucency on radiographic analysis, caries, sinus formation, and tooth mobility. After assessment, opening, and initial filing, sterile paper points were inserted into the root canal space for collection of microbiological sample, which was further send to laboratory for cultural analysis. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software. Student's t-test and Fisher's exact test were used to evaluate the level of significance.

RESULTS

While comparing the mean age of the patients in the two groups, no significant association was seen. Statistically significant results were obtained while comparing the association between pain and S. mitis. Positive correlation was seen on comparing the association between tenderness on percussion and E. faecalis. Also, a positive association was seen between periapical radiolucency and S. mitis.

CONCLUSION

Strong positive correlation exists between S. mitis and E. faecalis and endodontic signs and symptoms.

CLINICAL SIGNIFICANCE

Sound knowledge regarding the association of microbes of root canal and specific endodontic signs and symptoms could help therapeutic management of root canal infections effectively.

Characterization of successful root canal treatment

Knowing the outcome of root canal treatment (RCT) is determinant to substantiate the clinical decision making process, especially when RCT is weighed against the extraction of natural teeth or replacement by prosthetic elements. The ideal scenario in all clinical situations should combine healing/prevention of disease (apical periodontitis) and the functional retention of the tooth. Understanding the risk factors associated with endodontic failure is a key factor to increase the chances of success. The logical action is to reverse the existing disease, which requires intervention to neutralize the bacterial invasion and disrupt the bacterial biofilm within the complex anatomy. Success is more predictable when the immune host defenses are favorable. However, success has different meanings to the dentist, to the patient and to the tooth itself. The life of an endodontically treated tooth depends on the accuracy of the diagnosis and planning, excellence of disinfection, instrumentation and filling procedures (antimicrobial strategies, root canal shaping and coronal and apical seal) and finally the rehabilitation management. The interpretation of constant or intermittent pain and/or discomfort associated with apical periodontitis (AP) in endodontically treated tooth may be suggestive of endodontic failure. The success features of RCT, namely absence of pain, regression of AP, tight seal of canal and coronal spaces, and recovery of tooth function, must be reevaluated over time. In case of doubt between success and failure, cone beam computed tomography (CBCT) could be indicated for detection and precise localization of AP. The possibility of map reading on CBCT images characterizes the real multidimensional structure, providing accurate information on the presence, absence or regression of AP. The survival of an endodontically treated tooth implies understanding the biological and mechanical outcomes as multifactorial events over the individual's life span. The objective of this review of literature is to discuss relevant factors associated with patient's health, tooth and dentist that could account for a successful RCT.

Prevalence and Characteristics of the Maxillary C-shaped Molar

INTRODUCTION

The anatomy of the maxillary C-shaped molar has been the subject of several case reports although no true prevalence research has ever been conducted. The aim of this observational study was to evaluate and characterize the incidence of these morphologies using cone-beam computed tomographic (CBCT) technology.

METHODS

Patients having presurgical CBCT examination were selected. CBCT analysis was performed at 5 different axial levels, and the teeth were classified as maxillary molar C shapes according to the inclusion criteria for the present investigation. The prevalence of C-shaped anatomy was calculated. The z test for proportions in independent groups was used to analyze the differences between proportions. Intrarater reliability was also tested.

RESULTS

A total of 2227 teeth (928 upper first molars and 1299 upper second molars) from 895 patients were included in this research. Five different types of C-shaped molars were found, which included fusion between mesiobuccal and palatal roots (type A), mesiobuccal and distobuccal roots (type B), distobuccal and palatal roots (type C), 2 possible palatal roots (type D), and mesiobuccal and palatal roots connecting with an independent distobuccal root canal at apical or between distobuccal and palatal roots connecting with an independent mesiobuccal root canal at apical (type E). The global prevalence was 1.1% for first molars and 3.8% for second molars. Differences were observed between sex, teeth, and some types of C shapes at P < .05.

CONCLUSIONS

Maxillary C-shaped molars have low prevalence but high anatomic complexity. An understanding of their anatomic configuration and variations is important in ensuring that they are treated properly. Distinct differences exist between C-shaped configurations of upper and lower molars.

Role of Prophylactic Antibiotics in the Management of Postoperative Endodontic Pain

AIM

To investigate the efficacy of using antibiotics in post endodontic treatment as a method to alleviate post-treatment pain.

MATERIALS AND METHODS

After completion of endodontic treatment 129 patients were randomly divided into two groups: Group A (65 patients) received Ibuprofen 400 mg one tablet before procedure and one tablet every 8 hours for the first day, then one tablet once indicated by pain. Group B (64 patients) received the same regimen as group A in addition to amoxicillin, clavulanic acid tablets (one tablet before the procedure, and then one tablet twice daily for a total of 3 days). Intensity of pain at 8 hours interval using visual analog scale (VAS) and total number of Ibuprofen tablets used was recorded by patients.

RESULTS

Peak postoperative pain occurred at 16 hours post-treatment in both groups, there was a significant difference in the pain scale between the two groups in favor for group B over group A (3.8 vs 2.1 respectively). Pain scale was significantly lower in group B at 24, 32, 40, and 48 hours post-treatment with a p-value of < 0.05. The pain scale at 56, 64 and 72 hours were also less in group B, although could not show up as statistical difference. Patients in group A used statistically significant more Ibuprofen than patients in group B (486 vs 402).

CONCLUSION

Antibiotic prescription to manage post endodontic treatment pain results in less pain with less consumption of Ibuprofens.

CLINICAL SIGNIFICANCE

Pain management in endodontics is a real challenge, nonsteroidal anti-inflammatory drugs (NSAIDS) are used effectively in many patients to alleviate post endodontic pain. Nonsteroidal anti-inflammatory drugs may have adverse reactions or may be contraindicated. Short-term use of antibiotics to alleviate pain can be of clinical benefits in these patients.

Photodynamic therapy: An adjunct to conventional root canal disinfection strategies

Although chemical-based root canal disinfectants are important to reduce microbial loads and remove infected smear layer from root dentin, they have only a limited ability to eliminate biofilm bacteria, especially from root complexities. This paper explores the novel photodynamic therapy (PDT) for antimicrobial disinfection of root canals. The combination of an effective photosensitizer, the appropriate wavelength of light and ambient oxygen is the key factor in PDT. PDT uses a specific wavelength of light to activate a non-toxic dye (photosensitizer), leading to the formation of reactive oxygen species. These reactive oxygen molecules can damage bacterial proteins, membrane lipids and nucleic acids, which promote bacterial cell death. In, addition PDT may enhance cross-linking of collagen fibrils in the dentin matrix and thereby improving dentin stability. The concept of PDT is plausible and could foster new therapy concepts for endodontics. The available knowledge should enable and encourage steps forward into more clinical-oriented research and development. This article discusses PDT as related to root canal disinfection, including its components, mechanism of action, reviews the current endodontic literature and also highlights the shortcomings and advancements in PDT techniques.

Continuous drip flow system to develop biofilm of E. faecalis under anaerobic conditions

PURPOSE

To evaluate a structurally mature E. faecalis biofilm developed under anaerobic/dynamic conditions in an in vitro system.

METHODS

An experimental device was developed using a continuous drip flow system designed to develop biofilm under anaerobic conditions. The inoculum was replaced every 24 hours with a fresh growth medium for up to 10 days to feed the system. Gram staining was done every 24 hours to control the microorganism purity. Biofilms developed under the system were evaluated under the scanning electron microscope (SEM).

RESULTS

SEM micrographs demonstrated mushroom-shaped structures, corresponding to a mature E. faecalis biofilm. In the mature biofilm bacterial cells are totally encased in a polymeric extracellular matrix.

CONCLUSIONS

The proposed in vitro system model provides an additional useful tool to study the biofilm concept in endodontic microbiology, allowing for a better understanding of persistent root canal infections.

Traditional and contemporary techniques for optimizing root canal irrigation

Canal irrigation during root canal treatment is an important component of chemo-mechanical debridement of the root canal system. Traditional syringe irrigation can be enhanced by activating the irrigant to provide superior cleaning properties. This activation can be achieved by simple modifications in current technique or by contemporary automated devices. Novel techniques are also being developed, such as the Self-adjusting File (Re-Dent-Nova, Ra'anana, Israel), Ozone (Healozone, Dental Ozone, London, UK), Photoactivated Disinfection and Ultraviolet Light Disinfection. This paper reviews the techniques available to enhance traditional syringe irrigation, contemporary irrigation devices and novel techniques, citing their evidence base, advantages and disadvantages.

CLINICAL RELEVANCE

Recent advances in irrigation techniques and canal disinfection and debridement are relevant to practitioners carrying out root canal treatment.

Antibacterial Power of Sodium Hypochlorite Combined with Surfactants and Acetic Acid

The aim of this ex vivo study was to compare the antibacterial power of 1% NaOCl with 1% acetic acid, 5.25% NaOCl and two commercially available NaOCl modified with surfactants in bovine root dentin. A total of 120 dentin tubes prepared from intact bovine incisors were infected for 21 days with Enterococcus faecalis and randomly divided into six groups as follows: 5.25%NaOCl; Hypoclean; Chlor-Xtra; 1% NaOCl with 1% acetic acid; infected dentin tubes (positive control); and sterile dentin tubes (negative control). At experimental times of 0, 7, 14, 21 and 28 days, dentin chips were collected using sequential round burs with increasing diameters in separate test tubes containing 3 mL of freshly prepared BHI. Statistical analysis were performed using parametric methods (one-way ANOVA, and Bonferroni's multiple comparisons test, α=0.01). After culturing, the number of colony-forming units (CFU) was counted. All the NaOCl solutions showed small number of CFU over 28 days. ChlorXtra and Hypoclean had the smallest number of CFU at all times with greater antimicrobial efficacy than 5.25% NaOCl and 1% NaOCl solution with 1% acetic acid.

Do general dental practitioners leave teeth on 'open drainage'?

OBJECTIVE

There is a need to ascertain the use of evidence-based dentistry in both primary and secondary care in order to tailor education. This study aims to evaluate the use of 'open drainage' as part of endodontic treatment in primary care in South Yorkshire.

METHODS

A questionnaire was circulated to 141 randomly selected general dental practitioners in the South Yorkshire area between January 2012 and January 2013.

RESULTS

The response rate was 79% (112/141). Five of the returned questionnaires were incomplete and therefore not usable. Seventy-nine percent of respondents were general dental practitioners (GDPs) working in mainly NHS or mixed practices. The year of graduation varied between 1970 and 2011. Forty-one percent (44/107) stated that they had never left a tooth on open drainage. Twenty-nine percent (31/107) stated that they sometimes leave teeth on open drainage. Of those respondents who currently leave teeth on open drainage, most (68%) would leave teeth on open drainage for one to two days or less.

CONCLUSIONS

This survey revealed that the practice of leaving teeth on open drainage is still present in general dental practice. Current guidelines do not comment on the use of this treatment modality. There is a need to ascertain further information about practices throughout the United Kingdom in order to provide clear evidence-based guidelines.