Antimicrobial and Antibiofilm Properties of Bioceramic Materials in Endodontics

Antibiofilm efficacy of a calcium silicate-based intracanal medicament against Fusobacterium nucleatum strains

This study evaluated the antibiofilm efficacy of a calcium silicate-based intracanal medicament (Bio-C Temp) against Fusobacterium nucleatum (F. nucleatum). Dentin slices (n = 88) were inoculated with F. nucleatum biofilms and divided into experimental groups (n = 24 each) treated with Bio-C Temp, triple antibiotic paste (TAP), or Ca(OH)2 for 1 or 2 weeks. Untreated dentin slices exposed to saline served as a positive control, while sterile dentin slices incubated anaerobically served as a negative control. Bacterial viability was assessed using confocal laser scanning microscopy after staining with LIVE/DEAD® BacLight™ dye. Samples treated with TAP demonstrated the highest percentage of dead bacteria (95%). The antibiofilm effect of TAP and Bio-C Temp significantly increased from Week 1 to Week 2. At Week 2, samples treated with Bio-C Temp showed a significantly higher percentage of dead bacteria (75.25%) than those treated with Ca(OH)2 (58.65%). TAP showed superior efficacy against F. nucleatum biofilms. After an application time of 2 weeks, the antibiofilm efficacy of Bio-C Temp was superior to that of Ca(OH)2.

Effect of bioceramic-based and resin-based sealers on postoperative discomfort following root canal therapy: a systematic review and meta-analysis

Background

The aim of this systematic review and meta-analysis was to furnish evidence-based recommendations for the utilization of bioceramic-based and resin-based sealers in clinical endodontics, with a focus on reducing postoperative discomfort.

Methods

The investigation's methodology was registered on the International Prospective Database of Systematic Reviews (PROSPERO: CRD42022355506) and executed using the 2020 PRISMA protocol. Articles were selected utilizing the PICO technique and applying specific inclusion and exclusion criteria. Articles published between January 2000 and August 2022, PubMed, MEDLINE, and DOAJ were utilized as primary data sources. After the identification of studies, two autonomous reviewers evaluated the titles and abstracts, and data from qualifying studies were extracted.

Results

Nine published studies were included in this analysis. The findings indicate that there were no significant differences in the Visual Analog Scale (VAS) scores between resin-based and bioceramic root canal sealers at intervals of 6 hours, 12 hours, 24 hours, and 48 hours after treatment.

Conclusion

The findings of this systematic review and meta-analysis suggest that after the utilization of bioceramic sealers during root canal therapy, the pain and discomfort levels were not significantly different from those experienced pain after the use of resin-based sealers.

Pulpotomy in primary teeth: Biodentine™ versus calcium hydroxide. A systematic review and meta-analysis

Introduction

Pulpotomy is the total amputation of coronal pulp tissue and subsequent placement of a pulpotomy agent over the root canal orifices, followed by a coronal seal. The most suitable pulpotomy agent for successful treatment outcomes remains controversial.

Objectives

To evaluate and compare the clinical and radiographic success of calcium hydroxide (CH) and Biodentine (BD) in primary tooth pulpotomy at 6 and 12 months.

Materials and methods

An automatised search of the PubMed-Medline, Web of Science, and SCOPUS electronic databases was performed to identify scientific articles on primary tooth pulpotomies with either calcium hydroxide (CH) or Biodentine (BD) as a pulpotomy agent, published until January 2024. The software used for meta-analysis was R 4.3.1 (R Core Team, 2023).

Results

Of the 594 potentially eligible articles, 14 met the inclusion criteria: seven articles on CH pulpotomy and seven articles on BD pulpotomy with 6- and 12-months of follow-up. The meta-analysis concluded a mean clinical success rate of 91.8 % at 6 months and 79.0 % at 12 months for the CH group, and 99.2 % at 6 months and 98.8 % at 12 months for the BD group. In terms of the mean radiographic success, the CH group achieved 74.2 % at 6 months and 63.7 % at 12 months, whereas the BD group achieved 99.4 % at 6 months and 98.4 % at 12 months. In comparison, the meta-analysis concluded a marginally significant difference in clinical success in favour of the BD group at 6 months (p = 0.091). At 12 months, clinical success was significant in the BD group (p = 0.023). Regarding radiographic success, a significant difference in favour of the BD group was observed at 6 (p = 0.008) and 12 months (p < 0.001).

Conclusion

BD showed significantly higher clinical and radiographic success than CH in pulpotomy.

Endodontic and Surgical Management of Root Perforation Caused by Intermaxillary Fixation (IMF) Screw Placement: A Case Report

The use of fixation screws is a valuable tool in the clinical practice of oral and maxillofacial surgeries. One potential complication of screw placement for fracture fixation is root damage during surgery. In some cases, this damage can further lead to irreversible pulp damage, which requires endodontic and/or surgical intervention. The present report describes a case of iatrogenic root perforation during intermaxillary fixation (IMF) screw placement, leading to pulp necrosis. Despite the complication, the root damage was effectively managed through non-surgical root canal treatment using calcium silicate root filling material, followed by surgical apicectomy and retrograde fill. The patient was asymptomatic at a nine-month follow-up, and radiographic examinations showed signs of initial bone healing at the surgical site. After the successful management of the root perforation, the patient was referred to the prosthodontics department for the placement of the final restoration. It is important to understand the potential damage that may occur with screw-root contact and how it can be avoided or minimized. This report highlights the challenges and considerations in managing such cases and emphasizes the importance of using IMF screws with caution and the need for regular follow-ups in instances where tooth root damage has been confirmed.

The Push-Out Bond Strength, Surface Roughness, and Antimicrobial Properties of Endodontic Bioceramic Sealers Supplemented with Silver Nanoparticles

This study evaluated push-out bond test (POBT), surface roughness, and antimicrobial properties against Enterococcus faecalis of bioceramic sealers supplemented with silver nanoparticles (AgNPs). The sealers tested were CeraSeal®, EndoSequence® BC SealerTM, and Bio-C® Sealer. The POBT was measured with a Universal Testing Machine, and the type of failure was evaluated with a stereomicroscope. The roughness average (Sa) and peak-valley height (Sy) values were evaluated by atomic force microscopy. The bacterial growth inhibition was evaluated using a disk diffusion test, and antimicrobial activity was determined with the plate microdilution method. The POBT showed no significant difference between sealers with and those without NPs in cervical and apical thirds (p > 0.05). In the middle third, the adhesion force was significant for Endosequence BC Sealer® (p < 0.05). The results showed that the Sa and Sy parameters, when AgNPs were added, did not show a statistically significant difference compared to the groups without nanoparticles (p > 0.05). All tested sealers showed bacterial growth inhibition, but no significant difference was found. Their efficacy, in descending order of antibacterial activity when AgNPs were added, is as follows: EndoSequence® BC SealerTM > Bio-C® Sealer > CeraSeal®. The incorporation of AgNPs into bioceramics improves antimicrobial activity without affecting mechanical properties.

Antibiofilm Efficacy of Calcium Silicate-Based Endodontic Sealers

BACKGROUND

Using endodontic sealers with long-term antimicrobial properties can increase the success of endodontic treatment. This study aimed to assess the antimicrobial activity over time of two calcium silicate (CS)-based sealers, AH Plus Bioceramic and BioRoot RCS, and to compare them with an epoxy resin-based sealer, AH Plus Jet, against mature polymicrobial biofilms grown on human radicular dentin.

METHODS

The antimicrobial activity of the sealers was tested using a direct contact test after 1 and 6 weeks of contact with the biofilms. Cell viability was determined by the adenosine triphosphate (ATP) method and flow cytometry (FC). The results of the ATP test were analyzed using an ANOVA with Welch's correction, followed by the Games-Howell test. The number of cells with damaged membranes obtained by FC in each period was compared by means of an ANOVA and Duncan's test. For the comparison between times, a Student's t-test was used.

RESULTS

Globally, after a week of contact, the epoxy resin-based sealer obtained the best results. However, at 6 weeks, the two CSs showed the highest antimicrobial efficacy, with a significant increase in this activity over time.

CONCLUSIONS

Calcium silicate-based sealers exert long-term antimicrobial activity against endodontic biofilms.

Antimicrobial Peptide- and Dentin Matrix-Functionalized Hydrogel for Vital Pulp Therapy via Synergistic Bacteriostasis, Immunomodulation, and Dentinogenesis

The preservation of vital pulps is crucial for maintaining the physiological functions of teeth; however, vital pulp therapy (VPT) of pulpitis teeth remains a substantial challenge due to uncontrolled infection, excessive inflammation, and limited regenerative potential. Current pulp capping agents have restricted effects in the infectious and inflammatory microenvironment. To address this, a multifunctional hydrogel (TGH/DM) with antibacterial, immunomodulatory, and mineralization-promoting effects is designed. The antimicrobial peptide (AMP) and demineralized dentin matrix are incorporated into the hydrogel, achieving sustainable delivery of AMP and a cocktail of growth factors. In vitro results show that TGH/DM could kill endodontic microbiota, ameliorate inflammatory responses of human dental pulp stem cells (hDPSCs), and prompt odontogenic differentiation of inflammatory hDPSCs via activation of peroxisome proliferator-activated receptor gamma. In vivo results suggest that TGH/DM is capable of inducing M2 phenotype transformation of macrophages in mice and fostering the regeneration of the dentin-pulp complex in inflamed pulps of beagle dogs. Overall, this study first proposes the synergistic regulation of AMP and tissue-specific extracellular matrix for the treatment of pulpitis, and the advanced hydrogel provides a facile and effective way for VPT.

Impact of calcium hydroxide and 2-hydroxyisocaproic acid on the microhardness of root dentine: an in vitro study

To evaluate and compare the effect of calcium hydroxide [Ca(OH)2] and 2-hydroxyisocaproic acid (HICA) on the microhardness of root dentine. Fifty-one matured maxillary central incisors with straight root and type I canal configuration were decoronated to a standardized length of 16 mm. The root canals were cleaned and shaped using rotary instruments up to size F5. The tooth samples were then randomly assigned into three groups (n = 17) based on the intracanal medicament placed. Group A: control group with no intracanal medicament, Group B: root canals placed with Ca(OH)2, and Group C: root canals placed with HICA. After 1 week, the intracanal medicaments placed within the root canals were removed and the canals were dried. Subsequently, the specimens were split longitudinally into two halves and subjected to the Vickers microhardness test with indentations made at the coronal, middle, and apical-third root regions. The data were analyzed using one-way ANOVA and Tukey's post hoc tests. The control group showed significantly highest microhardness value (P < 0.001), followed by HICA and finally, Ca(OH)2 at the coronal, middle, and apical-third root regions, respectively. Nonetheless, there were no statistically significant differences in microhardness values across different root regions within each group. HICA was found to have a significantly lesser reduction in root dentine microhardness which could be a potential alternative to Ca(OH)2. Nevertheless, future studies are warranted to verify the present outcomes in the clinical setting.

Biological properties versus solubility of endodontic sealers and cements

Endodontic sealers and cements used in root canal treatment have different compositions and properties. Common to all materials is that their primary goal is to fill gaps and voids, making a permanent seal of the root canal system. Furthermore, aspects such as antibacterial properties, cytotoxicity, setting time, solubility and biocompatibility are also crucial and ought to be considered. Over the years, a shift in the view on the importance of these aspects has ocurred. Whereas the antibacterial properties were considered important when the technical factors in endodontics were less developed, the sealing ability and biocompatibility have later been considered the most critical factors. The introduction of tricalcium silicate cements and sealers has led to a renewed interest in material properties, as these cements seem to have good sealing ability and at the same time combine favourable antimicrobial effects with excellent biocompatibility. This review discusses how the various properties of root canal sealers and cements may conflict with the primary aim of providing a permanent seal of the root canal system.

An in vitro evaluation of endodontic sealers and an antibiotic to assess their antimicrobial effect against Enterococcus faecalis

Objective

This study aimed to compare the antimicrobial effect of three endodontic sealers (AH Plus, Mineral trioxide aggregate [MTA] Fillapex, and BioRoot RCS) with and without amoxicillin against E. faecalis.

Methodology

Amoxicillin, equivalent to 10% of the sealers' total weight, was mixed with the sealers. Another batch was prepared without amoxicillin. The direct contact test (DCT) and the agar diffusion test were used to assess the antibacterial effect. Results were analysed using one-way analysis of variance (ANOVA), the F-test, and the Kruskal-Wallis test.

Results

AH Plus significantly suppressed E. faecalis without the addition of amoxicillin in the DCT (p = 0.011), while in the agar diffusion test, BioRoot RCS had a larger inhibition zone than the control (p < 0.001). When amoxicillin was added to the sealers, AH Plus (p = 0.003) and MTA Fillapex (p = 0.042) reduced E. faecalis growth. In contrast, all three sealers showed larger inhibition zones than the control (p = 0.001), with AH Plus displaying a larger inhibition zone than MTA Fillapex (p = 0.042) and BioRoot RCS (p = 0.032).

Conclusions

It was thus concluded that the addition of amoxicillin to endodontic sealers enhances their antimicrobial activity against E. faecalis.

Bioactive ceramic-based materials: beneficial properties and potential applications in dental repair and regeneration

Bioactive ceramics, primarily consisting of bioactive glasses, glass-ceramics, calcium orthophosphate ceramics, calcium silicate ceramics and calcium carbonate ceramics, have received great attention in the past decades given their biocompatible nature and excellent bioactivity in stimulating cell proliferation, differentiation and tissue regeneration. Recent studies have tried to combine bioactive ceramics with bioactive ions, polymers, bioactive proteins and other chemicals to improve their mechanical and biological properties, thus rendering them more valid in tissue engineering scaffolds. This review presents the beneficial properties and potential applications of bioactive ceramic-based materials in dentistry, particularly in the repair and regeneration of dental hard tissue, pulp-dentin complex, periodontal tissue and bone tissue. Moreover, greater insights into the mechanisms of bioactive ceramics and the development of ceramic-based materials are provided.

Characterization and Assessment of Physical Properties of 3 Single Syringe Hydraulic Cement-based Sealers

INTRODUCTION

A number of sealers with different chemistries are badged as Bioceramic, implying biological activity, but have dissimilar properties, which has implications on the sealer properties and will affect the quality and outcome of root canal treatment. This study aimed to assess the physical and chemical properties of 3 hydraulic cement-based sealers, namely BC Universal sealer compared with Totalfill BC sealer and AH Plus Bioceramic.

METHODS

The microstructure and composition of the sealers were assessed using scanning electron microscopy and energy dispersive spectroscopy after setting. The crystalline phases were assessed by X-ray diffraction analysis and the leachates were tested using inductively coupled plasma. All testing was performed at 0, 7, and 28 days. The physical properties of film thickness, flow, radiopacity, and solubility were evaluated using ISO 6876:2012 standards.

RESULTS

All 3 sealers contained calcium, zirconium, and silicon. Totalfill BC had the highest calcium release at 7 and 28 days followed by AH Plus Bioceramic and BC Universal sealer. All 3 sealers adhered to the ISO standard in terms of flow and radiopacity. BC Universal sealer was slightly over the range (>50 μm) for film thickness. All sealers exceeded the solubility range set by ISO 6876:2012.

CONCLUSION

Although these hydraulic cement sealers had similar components and delivery, the properties varied significantly. The testing of material properties to confirm the suitability for clinical use is necessary.

Bridging the Gap between Endodontic Failure and Success: A Case Report on Intentional Replantation

This case report describes a case of intention replantation in a 15-year-old patient with a mandibular permanent right second molar that had undergone root canal treatment previously. The tooth was tender on percussion. Radiographic evaluation showed the presence of a separated instrument and periapical radiolucency. The surgical procedure was performed under local anesthesia, and the tooth was extracted. After cleaning and disinfecting the root canal system, the tooth was reimplanted, and the socket was filled with a mixture of bone graft material and a growth factor. A stainless steel crown was then placed to protect the tooth. A follow-up examination was performed after 12 months. The clinical and radiographic examinations revealed a well-healing periapical lesion with no signs of infection. The patient was asymptomatic, and the tooth was functional. The results of this case indicate that intentional replantation can lead to a favorable outcome.

A comparative study of biological properties of three root canal sealers

OBJECTIVES

The aim of this study was to evaluate the effects of Hiflow with other two kinds of root canal sealers on the biological behavior of stem cells from the apical papilla (SCAP), the influence on inflammatory cytokines release and its antibacterial effects.

MATERIALS AND METHODS

Material extracts of Hiflow, iRoot SP, and AH Plus were prepared. Then, SCAP was incubated with extracts. The effects were evaluated by CCK-8, wound healing assay, ALP staining, alizarin red staining, and qRT-PCR. Meanwhile, polymorphonuclears (PMNs) and monocytes were isolated and treated with extracts for 4 h and 24 h respectively. Cell viability was analyzed by Annexin-V/PI double staining flow cytometry. The effects on the release of cytokines were observed by ELISA. The antibacterial effects of different sealers were tested against three kinds of bacteria found in chronic apical periodontitis.

RESULTS

A series of results of SCAP showed that Hiflow and iRoot SP could promote cell proliferation, migration, and osteogenesis (p < 0.05). Although Hiflow was associated with greater cell apoptosis and necrosis when incubated with PMNs and monocytes (p < 0.05), it had an approximate release of anti-inflammatory cytokines with iRoot SP, which was higher than AH plus (p < 0.05). The co-culture showed that Hiflow and iRoot SP inhibited the colony formation of F. nucleatum (p < 0.05). However, both sealers had no obvious antibacterial effect on E. faecalis and P. gingivalis (p > 0.05).

CONCLUSIONS

In summary, Hiflow and iRoot SP both had positive biological stimulus on SCAP. Meanwhile, Hiflow showed a better induction on anti-inflammatory cytokines over the others. All the properties mentioned above and its antibacterial effect of F. nucleatum promise Hiflow a bright application prospect in endodontic uses.

CLINICAL RELEVANCE

References for clinical work to use BC Sealer Hiflow as a good biological root canal sealer.

Nanomaterials Modulating the Fate of Dental-Derived Mesenchymal Stem Cells Involved in Oral Tissue Reconstruction: A Systematic Review

The critical challenges in repairing oral soft and hard tissue defects are infection control and the recovery of functions. Compared to conventional tissue regeneration methods, nano-bioactive materials have become the optimal materials with excellent physicochemical properties and biocompatibility. Dental-derived mesenchymal stem cells (DMSCs) are a particular type of mesenchymal stromal cells (MSCs) with great potential in tissue regeneration and differentiation. This paper presents a review of the application of various nano-bioactive materials for the induction of differentiation of DMSCs in oral and maxillofacial restorations in recent years, outlining the characteristics of DMSCs, detailing the biological regulatory effects of various nano-materials on stem cells and summarizing the material-induced differentiation of DMSCs into multiple types of tissue-induced regeneration strategies. Nanomaterials are different and complementary to each other. These studies are helpful for the development of new nanoscientific research technology and the clinical transformation of tissue reconstruction technology and provide a theoretical basis for the application of nanomaterial-modified dental implants. We extensively searched for papers related to tissue engineering bioactive constructs based on MSCs and nanomaterials in the databases of PubMed, Medline, and Google Scholar, using keywords such as "mesenchymal stem cells", "nanotechnology", "biomaterials", "dentistry" and "tissue regeneration". From 2013 to 2023, we selected approximately 150 articles that align with our philosophy.

Antimicrobial Activity of Five Calcium Silicate Based Root Canal Sealers against a Multispecies Engineered Biofilm: An In Vitro Study

AIM

The present study's objective was to compare the impact of CerasealR, total fill BC SealerR, Bio-C SealerR, AH Plus BioceramicR, and K-BiocerR on the elimination of a multispecies' endodontic biofilm at 3, 7 and 14 days.

MATERIALS AND METHODS

A total of 20 freshly extracted, caries-free premolars were prepared for the study to create dentinal disks. For the multispecies biofilm formation, Enterococcus faecalis, Proteus mirabilis, Pseudomonas aeruginosa, and Candida albicans were cultured and used to inoculate hydroxyapatite discs. After incubation, the biofilms were placed on blotting papers in petri dishes with an orthodontic bend. Different root canal sealers, including CeraSeal, total Fill BC Sealer, Bio-C Sealer, AH Plus Bioceramic, K-Biocer, and Sealite, were injected into the bend, facilitating contact with the biofilms. The samples were divided into seven groups, including a negative control. At specific intervals, 3, 7, and 14 days, 3 biofilm samples from each group were collected, diluted, and plated on Agar media for colony counting and analysis.

RESULTS

In all tested groups, the total bacterial count significantly decreased between day 3 and 14 (p < 0.05) with no statistically significant differences among the different sealers' groups at all-time points for the total bacterial count, E. faecalis count, and P. mirabilis count. However, Sealite demonstrated the most consistent effectiveness in reducing bacterial counts across multiple categories. The sealite group was capable of decreasing the C. albicans count significantly between day 3 and day 14 (p < 0.05) in comparison with the bioceramic groups.

CONCLUSION

All sealers had antibacterial activity against the multispecies biofilm between day 3 and day 14. The ascending order of sealers in terms of their effectiveness in killing bacteria, based on the provided results, is as follows: Sealite, Bio-C Sealer, AH Plus, CeraSeal, TotalFill, and K-Biocer. However, there were no statistically significant differences in the bacterial counts among the different sealer groups at any time point.

CLINICAL SIGNIFICANCE

The role of sealers in combating biofilm-associated infections highlights their potential clinical utility in preserving root canal health. Understanding the antimicrobial properties of these sealers is vital for informed decision-making in selecting the most effective materials for improved treatment outcomes and long-term success in endodontic procedures.

A critical review of the material properties guiding the clinician's choice of root canal sealers

OBJECTIVES

The introduction of hydraulic cement sealers has increased the popularity of single cone obturation where the chemistry and properties of hydraulic cement sealers are crucial. This article has investigated the materials present on the market by reviewing the chemistry aiming at understanding whether these materials are optimized or have been tested appropriately.

METHODOLOGY

A market search on materials called bioceramic and hydraulic sealers was undertaken. The safety data sheet and manufacturer details for every material were searched and the components were checked. The literature was searched for information about the properties of these materials based on their composition.

RESULTS

The safety data sheets and manufacturer details were imprecise with some manufacturers providing little detail on composition. From the publications reviewed, it is apparent that the materials used clinically are not optimized, and there is little evidence that the material chemistry and presentation aid the clinical technique in any way.

CONCLUSIONS

There has been a rapid increase in materials identifying as bioceramics on the market. These materials have diverse chemistries, and some of the constituents are not declared. This may affect the clinical performance of these materials.

CLINICAL SIGNIFICANCE

Smart materials developed on the clinical need which are appropriately tested are necessary for a paradigm shift in root canal obturation. It is important to use reputable materials that have been adequately researched in clinical practice.

The Efficacy of Er:YAG Laser-Activated Shock Wave-Enhanced Emission Photoacoustic Streaming Compared to Ultrasonically Activated Irrigation and Needle Irrigation in the Removal of Bioceramic Filling Remnants from Oval Root Canals-An Ex Vivo Study

The removal of filling material is important for successful root canal retreatment. The aim of the study was to compare the efficiency of two activated irrigation techniques, the shock wave-enhanced emission photoacoustic streaming (SWEEPS) mode of the Er:YAG laser and ultrasonically activated irrigation (UAI) and a conventional syringe-needle technique (SNI), in the removal of bioceramic sealer/gutta-percha during conventional retreatment in oval root canals. The study sample consisted of distal root canals of 42 extracted human mandibular molars, which were prepared using a ProTaper Next system up to size 40/0.06 and filled with bioceramic sealer using a single-cone obturation technique. The teeth were then re-treated with a Reciproc Blue RB40 file and 3% sodium hypochlorite solution. The prepared teeth were randomly divided into three groups (n = 14 per group) and subjected to one of the three irrigation methods. Micro-CT scans were performed at different stages to assess the amount of filling material after each retreatment phase. The results of the study showed that all the tested irrigation techniques reduced a statistically significant amount of the remnant filling material at retreatment (p < 0.05), and there were no statistically significant differences in efficacy between the three methods. All tested techniques had similar efficacy in the removal of the remaining filling remnants.

Bioceramics utilization for the repair of internal resorption of the root: A case report

BACKGROUND

The objective of this work is displaying a successful treatment for an internal resorption case under operating microscope using bioceramic material.

CASE SUMMARY

Periapical radiograph showed radiolucent lesion representing large internal resorption of the root. The respective defect was obturated using endoscquence bioceramic material follow up at the month 18 after treatment revealed no abnormal finings clinically and radiographically.

CONCLUSION

New generations bioceramics have many advantages that internal root resorption cases can benefit from. The use of operating microscope helps to apply obturating materials with precision. However, long term study on a large sample is required in future studies.