Effectiveness of chitosan-propolis nanoparticle against Enterococcus faecalis biofilms in the root canal

The antibacterial efficiency of Chitosan photodynamically activated Phycocyanin, and Morinda Oleifera against S.mutans and the bonding strength between composite resin and caries-affected dentin

Objective

Evaluation of contemporary disinfection techniques, Moringa Oleifera (M.Oleifera), Phycocyanin activated by photodynamic therapy (PDT), and Chitosan, on S.mutans survival rate and bond integrity of composite to carious-affected dentin (CAD).

Methods

The in vitro study was conducted at King Saud University and concluded within three months. Sixty mandibular teeth with cavities extending to the middle third of the dentin were sterilized. S.mutans was inoculated onto the CAD surface of twenty samples. The samples were randomly divided into four groups (n: 15) based on various disinfection regimes. Group-1 received 2% CHX, Group-2 Phycocyanin activated by photodynamic therapy (PDT), Group-3 Chitosan, and Group-4 M.oleifera. S.mutans survival rate was calculated. Ten CAD samples from each group were restored using composite. The bond integrity of samples was assessed using a Universal testing machine (UTM) and failure mode using a stereomicroscope. Analysis of variance (ANOVA) and Tukey's Post Hoc test were used to calculate statistical significance (p=0.05).

Results

Group-2 samples subjected to Phycocyanin activated using PDT, displayed minimal survival rate (0.24 ± 0.05 CFU/ml) of S.mutans.Group-1 samples treated with CHX exhibited the highest count of S.mutans (0.69 ± 0.12 CFU/ml). The most robust bond was observed in Group-3 (Chitosan) samples (19.33 ± 0.47 MPa). In contrast, SBS values were lowest in Group-1 (CHX) treated study samples (13.17 ± 1.88 MPa).

Conclusion

Chitosan, Phycocyanin activated by PDT, and Moringa Oleifera extract exhibit potential as viable substitutes for chlorhexidine (CHX) in clinical settings, presenting the possibility of better eradication of S.mutans and greater adhesive strength to CAD.

Application of Nanomaterials in Endodontics

Recent advancements in nanotechnology have introduced a myriad of potential applications in dentistry, with nanomaterials playing an increasing role in endodontics. These nanomaterials exhibit distinctive mechanical and chemical properties, rendering them suitable for various dental applications in endodontics, including obturating materials, sealers, retro-filling agents, and root-repair materials. Certain nanomaterials demonstrate versatile functionalities in endodontics, such as antimicrobial properties that bolster the eradication of bacteria within root canals during endodontic procedures. Moreover, they offer promise in drug delivery, facilitating targeted and controlled release of therapeutic agents to enhance tissue regeneration and repair, which can be used for endodontic tissue repair or regeneration. This review outlines the diverse applications of nanomaterials in endodontics, encompassing endodontic medicaments, irrigants, obturating materials, sealers, retro-filling agents, root-repair materials, as well as pulpal repair and regeneration. The integration of nanomaterials into endodontics stands poised to revolutionize treatment methodologies, presenting substantial potential advancements in the field. Our review aims to provide guidance for the effective translation of nanotechnologies into endodontic practice, serving as an invaluable resource for researchers, clinicians, and professionals in the fields of materials science and dentistry.

Nanoparticles and Their Antibacterial Application in Endodontics

Root canal treatment represents a significant challenge as current cleaning and disinfection methodologies fail to remove persistent bacterial biofilms within the intricate anatomical structures. Recently, the field of nanotechnology has emerged as a promising frontier with numerous biomedical applications. Among the most notable contributions of nanotechnology are nanoparticles, which possess antimicrobial, antifungal, and antiviral properties. Nanoparticles cause the destructuring of bacterial walls, increasing the permeability of the cell membrane, stimulating the generation of reactive oxygen species, and interrupting the replication of deoxyribonucleic acid through the controlled release of ions. Thus, they could revolutionize endodontics, obtaining superior results and guaranteeing a promising short- and long-term prognosis. Therefore, chitosan, silver, graphene, poly(lactic) co-glycolic acid, bioactive glass, mesoporous calcium silicate, hydroxyapatite, zirconia, glucose oxidase magnetic, copper, and zinc oxide nanoparticles in endodontic therapy have been investigated in the present review. The diversified antimicrobial mechanisms of action, the numerous applications, and the high degree of clinical safety could encourage the scientific community to adopt nanoparticles as potential drugs for the treatment of endodontic diseases, overcoming the limitations related to antibiotic resistance and eradication of the biofilm.

Antimicrobial effect of Pentaclethra Macroloba plant extract against Enterococcus Faecalis

This study evaluated the antimicrobial efficacy of a new intracanal drug based on Pentaclethra macroloba extract, a plant of Amazonian origin, against Enterococcus faecalis using macrodilution test and intratubular evaluation with Confocal Laser Scanning Microscopy (CLSM). The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) of the pure extract of Pentaclethra macroloba andits association with calcium hydroxide and ultracall were determined. Then, thirty-three dentin cylinders were prepared and inoculated with E. faecalis, to evaluate the antimicrobial effect of the medications on the dentinal tubules with CLSM. The data was analyzed using the Kruskal-Wallis and Dunn tests. The extract in association with calcium hydroxide showed a lower CBM, and in the intratubular test all tested medications were effective against E. faecalis (P >0.05). The new intracanal drug based on P. macroloba extract has an antimicrobial effect against E. faecalis and further studies are needed for its clinical use.

Direct and residual antimicrobial effect of 2% chlorhexidine gel, double antibiotic paste and chitosan- chlorhexidine nanoparticles as intracanal medicaments against Enterococcus faecalis and Candida albicans in primary molars: an in-vitro study

BACKGROUND

Thorough disinfection of root canals in primary molars may be complicated by the complex root canal morphology. This in-vitro study aimed to compare direct and residual antimicrobial effect of 2% chlorhexidine (CHX) gel, 500 mg/ml double antibiotic paste (DAP) and chitosan-chlorhexidine nanoparticles (CS-CHX NPs) as intracanal medicaments against Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans) in primary molars.

METHODS

Mesial roots of 63 mandibular second primary molars were infected with E. faecalis and C. albicans. Teeth were divided into 9 groups: Ia: (CS-CHX NPs), IIa: (CHX), IIIa: (DAP), IVa: chitosan nanoparticles (CSNPs) in which medicaments were placed for 3 days, groups Ib: (CS-CHX NPs), IIb: CHX, IIIb: (DAP), IVb: (CSNPs) in which medicaments were placed for 7 days, and Group V (control): teeth were infected, irrigated with saline, and sampled 3- and 7-days post-infection. Microbiological samples were obtained after infection, 3, and 7 days after medicament placement and 7 days after medicament removal for both time points. One-way ANOVA, Tukey's post hoc test and paired t-test were used at p < 0.05.

RESULTS

CS-CHX NPs had the highest anticandidal effect which was comparable to CHX and significantly higher than other medicaments (p < 0.001) at both time points. CS-CHX NPs had the highest effect against E. faecalis which was comparable to DAP and significantly higher than other medicaments (p < 0.001) at 3 days. All medicaments showed similar effect against E. faecalis after 7 days. The 7-days placement significantly increased the antimicrobial effect against both micro-organisms in all groups, except CS-CHX NPs which showed an insignificant increase. CS-CHX NPs showed the highest residual effect against both micro-organisms that increased with 7-days placement.

CONCLUSION

CSNPs and CHX combination showed a synergistic effect against both micro-organisms. CS-CHX NPs displayed a higher effect at a shorter period compared to other medicaments, yet its residual effect was higher with 7-days placement.

Enhanced in vitro antibacterial effect against Enterococcus faecalis by using both low-dose cetylpyridinium chloride and silver ions

BACKGROUND

Enterococcus faecalis (E. faecalis) is frequently isolated from root canals with failed root canal treatments. Due to the strong ability of E. faecalis to resist many often-used antimicrobials, coping with E. faecalis infections remains a challenge. The aim of this study was to investigate the synergistic antibacterial effect of low-dose cetylpyridinium chloride (CPC) and silver ions (Ag⁺) against E. faecalis in vitro.

METHODS

The minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and the fractional inhibitory concentration index (FICI) were used to confirm the existence of the synergic antibacterial activity between low-dose CPC and Ag⁺. Colony-forming unit (CFU) counting, time-killing curve and dynamic growth curve were used to evaluate the antimicrobial effects of CPC and Ag⁺ combinations against planktonic E. faecalis. Four weeks biofilms were treated with drug-contained gels to determine the antimicrobial effect on biofilm-resident E.faecalis, and the integrity of E.faecalis and its biofilms were observed by FE-SEM. CCK-8 assays was used to test the cytotoxicity of CPC and Ag⁺ combinations on MC3T3-E1 cells.

RESULTS

The results confirmed the synergistic antibacterial effect of low-dose CPC and Ag⁺ against both planktonic and 4-week biofilm E. faecalis. After the addition of CPC, the sensitivity of both planktonic and biofilm-resident E. faecalis to Ag⁺ improved, and the combination showed good biocompatibility on MC3T3-E1 cells.

CONCLUSIONS

Low-dose CPC enhanced the antibacterial ability of Ag⁺ against both planktonic and biofilm E.faecalis with good biocompatibility. It may be developed into a novel and potent antibacterial agent against E.faecalis, with low toxicity for root canal disinfection or other related medical applications.

A clinical perspective of chitosan nanoparticles for infectious disease management

Infectious diseases and their effective management are still a challenge in this modern era of medicine. Diseases, such as the SARS-CoV-2, Ebola virus, and Zika virus, still put human civilization at peril. Existing drug banks, which include antivirals, antibacterial, and small-molecule drugs, are the most advocated method for treatment, although effective but they still flounder in many instances. This calls for finding more effective alternatives for tackling the menace of infectious diseases. Nanoformulations are progressively being implemented for clinical translation and are being considered a new paradigm against infectious diseases. Natural polymers like chitosan are preferred to design nanoparticles owing to their biocompatibility, biodegradation, and long shelf-life. The chitosan nanoparticles (CNPs) being highly adaptive delivers contemporary prevention for infectious diseases. Currently, they are being used as antibacterial, drug, and vaccine delivery vehicles, and wound-dressing materials, for infectious disease treatment. Although the recruitment of CNPs in clinical trials associated with infectious diseases is minimal, this may increase shortly due to the sudden emergence of unknown pathogens like SARS-CoV-2, thus turning them into a panacea for the management of microorganisms. This review particularly focuses on the all-around application of CNPs along with their recent clinical applications in infectious disease management.

Evaluation of antibacterial effects of different intracanal medicaments on Enterococcus faecalis in primary teeth: An in vitro study

OBJECTIVES

Successful endodontic therapy is based on the reduction of infecting bacteria by cleaning, shaping, and disinfecting of the root canal system, thus the use of intracanal dressing is necessary for optimal success of root canal treatment. This study was designed to evaluate the effect of chitosan and propolis as intracanal medicaments against Enterococcus faecalis compared to calcium hydroxide in primary root canals.

MATERIAL AND METHODS

Ninety-six extracted primary second molars were collected. Teeth preparation was completed to size 30 K-file. They were randomly divided into four groups; (A): chitosan, (B): propolis, (C): calcium hydroxide, and (D): control group (saline). The tooth specimens were inoculated with E. faecalis. Then, tested materials were applied for all groups in accordance to the groups each tooth belonged to. Following this, the bacterial colonies were counted after 24 h, 72 h, and 1 week of applying dressing materials and incubation. Finally, one-way analysis of variance and Fisher's least significant difference tests were used for statistical comparisons between the groups at a significance level of .05.

RESULTS

No statistically significant difference was found between groups A, B, and C for both 24 h and a week (p ≥ .05). Yet, a statistical difference between groups A, B, C, and D after 72 h and 1 week were seen (p ≤ .05).

CONCLUSIONS

Chitosan and propolis medicaments were as effective as calcium hydroxide against E. faecalis in primary root canal treatment and might be considered as an alternative dressing material between treatment sessions.

Synergistic antimicrobial potential of EGCG and fosfomycin against biofilms associated with endodontic infections

OBJECTIVE

This study aimed to evaluate the cytotoxicity and synergistic effect of epigallocatechin gallate (EGCG) and fosfomycin (FOSFO) on biofilms of oral bacteria associated with endodontic infections.

METHODOLOGY

This study determined minimum inhibitory and bactericidal concentration (MIC/MBC) and fractionated inhibitory concentration (FIC) of EGCG and FOSFO against Enterococcus faecalis, Actinomyces israelii, Streptococcus mutans, and Fusobacterium nucleatum. Monospecies and multispecies biofilms with those bacteria formed in polystyrene microplates and in radicular dentin blocks of bovine teeth were treated with the compounds and control chlorhexidine (CHX) and evaluated by bacterial counts and microscopy analysis. Toxicity effect of the compounds was determined on fibroblasts culture by methyl tetrazolium assays.

RESULTS

The combination of EGCG + FOSFO demonstrated synergism against all bacterial species, with an FIC index ranging from 0.35 to 0.5. At the MIC/FIC concentrations, EGCG, FOSFO, and EGCG+FOSFO were not toxic to fibroblasts. EGCG+FOSFO significantly reduced monospecies biofilms of E. faecalis and A. israelli, whereas S. mutans and F. nucleatum biofilms were eliminated by all compounds. Scanning electron microscopy of multispecies biofilms treated with EGCG, EGCG+FOSFO, and CHX at 100x MIC showed evident biofilm disorganization and substantial reduction of extracellular matrix. Confocal microscopy observed a significant reduction of multispecies biofilms formed in dentin tubules with 84.85%, 78.49%, and 50.6% of dead cells for EGCG+FOSFO, EGCG, and CHX at 100x MIC, respectively.

CONCLUSION

EGCG and fosfomycin showed a synergistic effect against biofilms of oral pathogens related to root canal infections without causing cytotoxicity.

Efficacy of chitosan paste as intracanal medication against Enterococcus faecalis and Candida albicans biofilm compared with calcium hydroxide in an in vitro root canal infection model

Background

Enterococcus faecalis and Candida albicans are frequently found in persistent endodontic infection and could remain in dentinal tubules despite intracanal medication with calcium hydroxide (Ca(OH)₂), a commonly used medication. Thus, an effective and safe antimicrobial medication against such refractory infection is necessary in endodontic retreatment, so we aimed to test the efficacy of chitosan paste against these microorganisms compared with Ca(OH)₂ in root canals of extracted human teeth.

Methods

Thirty-six sterilized human root samples prepared from extracted premolars and upper maxillary incisors were infected with E. faecalis for 14 days, while 32 were infected with C. albicans for 48 h, for mature biofilm formation. The samples were assigned to 6 groups of intracanal medications: Group 1: no medication (negative control); Group 2: 20% Polyethylene glycol (PEG); Group 3: 20% Propylene glycol (PG); Group 4: Ca(OH)₂; Group 5: Chitosan + PEG; and Group 6: Chitosan + PG. After 7 days, intracanal surface dentin was harvested using Protaper next, resuspended, serially diluted and spread on Brain–Heart-Infusion agar (for E. faecalis) and Yeast Extract-Peptone-Dextrose agar (for C. albicans) for colony count. Antimicrobial efficacy was determined as percentage of remaining colony forming unit (CFUs) relative to negative control and analyzed using One-way ANOVA and post-hoc Games-Howell test. The significance level was set at 0.05.

Results

For E. faecalis, chitosan + PG had significantly higher antibacterial activity than Ca(OH)₂ (P = 0.039). Chitosan + PEG and chitosan + PG medication significantly reduced viable bacteria compared with negative control, PEG and PG (P = 0.001, 0.003, 0.024, respectively for chitosan + PEG; P = 0.002, 0.003, 0.014, respectively for chitosan + PG). For C.albicans, chitosan + PEG and chitosan + PG were not significantly different from Ca(OH)₂. However, Chitosan + PEG and chitosan + PG, but not Ca(OH)₂, showed a significantly lower level of remaining CFUs compared with negative control (P = 0.013 and 0.005, respectively).

Conclusion

Chitosan paste showed better efficacy in reducing viable E. faecalis biofilm when compared to Ca(OH)₂ after 7-day intracanal medication in this in vitro root canal model. It could also significantly reduce viable C. albicans, but was not significantly different from Ca(OH)₂.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02385-x.

Nanoparticles in Endodontics Disinfection: State of the Art

Endodontic-related diseases constitute the fourth most expensive pathologies in industrialized countries. Specifically, endodontics is the part of dentistry focused on treating disorders of the dental pulp and its consequences. In order to treat these problems, especially endodontic infections, dental barriers and complex root canal anatomy should be overcome. This constitutes an unmet medical need since the rate of successful disinfection with the currently marketed drugs is around 85%. Therefore, nanoparticles constitute a suitable alternative in order to deliver active compounds effectively to the target site, increasing their therapeutic efficacy. Therefore, in the present review, an overview of dental anatomy and the barriers that should be overcome for effective disinfection will be summarized. In addition, the versatility of nanoparticles for drug delivery and their specific uses in dentistry are comprehensively discussed. Finally, the latest findings, potential applications and state of the art nanoparticles with special emphasis on biodegradable nanoparticles used for endodontic disinfection are also reviewed.

From propolis to nanopropolis: An exemplary journey and a paradigm shift of a resinous substance produced by bees

Propolis, a natural resinous mixture produced by honey bees is poised with diverse biological activities. Owing to the presence of flavonoids, phenolic acids, terpenes, and sesquiterpenes, propolis has garnered versatile applications in pharmaceutical industry. The biopharmaceutical issues associated with propolis often beset its use as being too hydrophobic in nature; it is not absorbed in the body well. To combat the problem, various nanotechnological approaches for the development of novel drug delivery systems are generally applied to improve its bioavailability. This paradigm shift and transition of conventional propolis to nanopropolis are evident from the literature wherein a multitude of studies are available on nanopropolis with improved bioavailability profile. These approaches include preparation of gold nanoparticles, silver nanoparticles, magnetic nanoparticles, liposomes, liquid crystalline formulations, solid lipid nanoparticles, mesoporous silica nanoparticles, etc. Nanopropolis has further been explored to assess the potential benefits of propolis for the development of futuristic useful products such as sunscreens, creams, mouthwashes, toothpastes, and nutritional supplements with improved solubility, bioavailability, and penetration profiles. However, more high-quality clinical studies assessing the effects of propolis either alone or in combination with synthetic drugs as well as natural products are warranted and its safety needs to be firmly established.

Ciprofloxacin-Loaded Gold Nanoparticles against Antimicrobial Resistance: An In Vivo Assessment

Metallic nanoparticles, such as gold nanoparticles (AuNPs), have been extensively studied as drug delivery systems for various therapeutic applications. However, drug-loaded-AuNPs have been rarely explored in vivo for their effect on bacteria residing inside tissues. Ciprofloxacin (CIP) is a second-generation fluoroquinolone with a broad-spectrum of antibiotic properties devoid of developing bacteria resistance. This research is focused on the synthesis and physical characterization of Ciprofloxacin-loaded gold nanoparticles (CIP-AuNPs) and their effect on the colonization of Enterococcus faecalis in the liver and kidneys of mice. The successfully prepared CIP-AuNPs were stable and exerted enhanced in vitro antibacterial activity against E. faecalis compared with free CIP. The optimized CIP-AuNPs were administered (500 µg/Kg) once a day via tail vein to infected mice for eight days and were found to be effective in eradicating E. faecalis from the host tissues. Moreover, unlike CIP, CIP-AuNPs were non-hemolytic. In summary, this study demonstrated that CIP-AuNPs are promising and biocompatible alternative therapeutics for E.-faecalis-induced infections resistant to conventional drugs (e.g., beta-lactams and vancomycin) and should be further investigated.

Akim A, Chong PP. Approaches for Mitigating Microbial Biofilm-Related Drug Resistance: A Focus on Micro- and Nanotechnologies

Biofilms play an essential role in chronic and healthcare-associated infections and are more resistant to antimicrobials compared to their planktonic counterparts due to their (1) physiological state, (2) cell density, (3) quorum sensing abilities, (4) presence of extracellular matrix, (5) upregulation of drug efflux pumps, (6) point mutation and overexpression of resistance genes, and (7) presence of persister cells. The genes involved and their implications in antimicrobial resistance are well defined for bacterial biofilms but are understudied in fungal biofilms. Potential therapeutics for biofilm mitigation that have been reported include (1) antimicrobial photodynamic therapy, (2) antimicrobial lock therapy, (3) antimicrobial peptides, (4) electrical methods, and (5) antimicrobial coatings. These approaches exhibit promising characteristics for addressing the impending crisis of antimicrobial resistance (AMR). Recently, advances in the micro- and nanotechnology field have propelled the development of novel biomaterials and approaches to combat biofilms either independently, in combination or as antimicrobial delivery systems. In this review, we will summarize the general principles of clinically important microbial biofilm formation with a focus on fungal biofilms. We will delve into the details of some novel micro- and nanotechnology approaches that have been developed to combat biofilms and the possibility of utilizing them in a clinical setting.