Root Canal Infection and Its Impact on the Oral Cavity Microenvironment in the Context of Immune System Disorders in Selected Diseases: A Narrative Review

Chitosan: A Versatile Biomaterial Revolutionizing Endodontic Therapy

Owing to their nanoscale dimensions, nanomaterials have special chemical and physical properties that set them apart from their bulk counterparts. The exterior dimensions of a minimum of half of the particles span several nanometers in their size distribution. Silver nanoparticles (AgNPs) are one type of nanomaterial that has been widely used because of their strong antibacterial properties, which can kill bacteria that are resistant to many drugs. Due to its potential for regulated release, localized retention, and safeguarding the active ingredients against environmental or enzymatic deterioration, nanoparticle technology has also emerged as a promising medication delivery method. The techniques for creating nanoparticles can be easily scaled up and used for a wide variety of medications. Since polymeric nanoparticles are biodegradable, biocompatible, and have more readily available formulation techniques than other nanoparticle drug delivery approaches, their range of applications has been expanding. Chitosan, also known as deacetylated polysaccharide, is a straight-chain cationic polymer that is typically a cationic copolymer. It can be generated naturally or by deacetylating chitin. Consequently, it contains an extensive array of biomedical applications, such as efficient healing of wounds, regeneration of tissues, regeneration of bone, and anti-infection. Because of its functional diversity, accessibility, and being both biodegradable and biocompatible, it has a wide spectrum of uses in dentistry. Recent research on chitosan-based nanoparticles is founded on the field's growing comprehension of the characteristics of chitosan and techniques for chemical or physical modification that are used to optimize the drug loading and release characteristics of the nanoparticles.

Extrusion of Sodium Hypochlorite in Oval-Shaped Canals: A Comparative Study of the Potential of Four Final Agitation Approaches Employing Agarose-Embedded Mandibular First Premolars

Background: The aim of this investigation was to assess the apical extrusion potential of sodium hypochlorite (NaOCl) in agarose-embedded mandibular first premolars employing four final agitation procedures. Methods: Based on CBCT confirmation of single oval-shaped canals, one hundred extracted mandibular first premolars were chosen. Using 5.25% NaOCl, the teeth were prepared using the XP Endo Shaper and divided into experimental and control groups. The following were the experimental groups: Group 1 comprised the XP-Endo Finisher, Group 2 the Ultrasonic Activation, Group 3 the Gentle File Finisher Brush, and Group 4 the 27-gauge side-vented needle. To test extrusion, the teeth were placed in a 0.2% agarose gel that contained the pH-sensitive dye m-cresol purple, allowing pixel quantification via ImageJ software (version 1.54i). Results: The XP Endo Finisher featured the most pixels, depicting higher apical extrusion (p < 0.01), followed by the side-vented needle, Gentle File Finisher Brush, and PUI, while the Control Group endured no extrusion. Conclusions: The effective irrigation method for root canal therapy is critical, especially in situations of open apices, resorption, or perforation. According to in vitro experiments, the XP-Endo Finisher has the maximum sodium hypochlorite extrusion, which is determined by parameters such as apical preparation size and irrigation system.

Green Synthesized Polymeric Iodophors with Thyme as Antimicrobial Agents

Antimicrobial resistance (AMR) is a growing concern for the future of mankind. Common antibiotics fail in the treatment of microbial infections at an alarming rate. Morbidity and mortality rates increase, especially among immune-compromised populations. Medicinal plants and their essential oils, as well as iodine could be potential solutions against resistant pathogens. These natural antimicrobials abate microbial proliferation, especially in synergistic combinations. We performed a simple, one-pot synthesis to prepare our formulation with polyvinylpyrrolidone (PVP)-complexed iodine (I2), Thymus Vulgaris L. (Thyme), and Aloe Barbadensis Miller (AV). SEM/EDS, UV-vis, Raman, FTIR, and XRD analyses verified the purity, composition, and morphology of AV-PVP-Thyme-I2. We investigated the inhibitory action of the bio-formulation AV-PVP-Thyme-I2 against 10 selected reference pathogens on impregnated sterile discs, surgical sutures, cotton gauze bandages, surgical face masks, and KN95 masks. The antimicrobial properties of AV-PVP-Thyme-I2 were studied by disc diffusion methods and compared with those of the antibiotics gentamycin and nystatin. The results confirm AV-PVP-Thyme-I2 as a strong antifungal and antibacterial agent against the majority of the tested microorganisms with excellent results on cotton bandages and face masks. After storing AV-PVP-Thyme-I2 for 18 months, the inhibitory action was augmented compared to the fresh formulation. Consequently, we suggest AV-PVP-Thyme-I2 as an antimicrobial agent against wound infections and a spray-on contact killing agent.

Management of symptomatic irreversible pulpitis using irrigation agitation techniques in anterior teeth

Endodontic pain, a common complication after root canal treatment, affects 2.5% to 60% of patients. Therefore, it is of interest to compare apical negative pressure irrigation (EndoVac) with conventional needle irrigation to assess their impact on postoperative pain in permanent anterior teeth with symptomatic irreversible pulpitis. Fifty patients were randomly assigned to either the EndoVac or needle irrigation group. Pre and post-operative pain levels were assessed using a Visual Analog Scale and the amount of Ibuprofen taken was recorded. At 12-, 24-, and 48-hour intervals, the EndoVac group reported significantly less pain than the needle irrigation group. The needle irrigation group also required more Ibuprofen. The apical negative pressure irrigation system (EndoVac) resulted in significantly less postoperative pain and reduced the need for analgesic medication than the conventional needle irrigation protocol.

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.