Evaluation of minimal inhibitory concentration of two new materials using tube dilution method: An in vitro study

The Effect of Chitosan Incorporation on Physico-Mechanical and Biological Characteristics of a Calcium Silicate Filling Material

OBJECTIVES

A tricalcium silicate-based cement, Biodentine™, has displayed antibiofilm activity when mixed with chitosan powder. This study aimed to assess the effect of chitosan incorporation on the physico-mechanical and biological properties of Biodentine™.

METHODS

In this study, medium molecular weight chitosan powder was incorporated into Biodentine™ in varying proportions (2.5 wt%, 5 wt%, 10 wt%, and 20 wt%). The setting time was determined using a Vicat apparatus, solubility was assessed by calculating weight variation after water immersion, radiopacity was evaluated and expressed in millimeters of aluminum, the compressive strength was evaluated using an Instron testing machine, and the microhardness was measured with a Vickers microhardness tester. In addition, surface topography of specimens was analyzed using scanning electron microscopy, and the effect of chitosan on the viability of human embryonic kidney (HEK 293) cells was measured by a colorimetric MTT assay.

RESULTS

Incorporation of 2.5 wt% and 5 wt% chitosan powder delivered an advantage by speeding up the setting time of Biodentine material. However, the incorporation of chitosan compromised all other material properties and the crystalline structure in a dose-dependent manner. The chitosan-modified material also showed significant decreases in the proliferation of the HEK 293 cells, signifying decreased biocompatibility.

SIGNIFICANCE

Chitosan incorporation into calcium silicate materials adversely affects the physical and biological properties of the material. Despite the increased antimicrobial activity of the modified material, the diminution in these properties is likely to reduce its clinical value.

Biodentine Inhibits the Initial Microbial Adhesion of Oral Microbiota In Vivo

This study aimed to evaluate the in vivo initial microbial adhesion of oral microorganisms on the biomaterial Biodentine compared to MTA and AH Plus. Cylindrical samples of the materials were prepared, and dentin slabs served as a control. An individual intraoral lower jaw splint served as a carrier for the samples and was worn by six volunteers. The specimens were worn for 120 min. Adherent bacteria were quantified by determining the colony-forming units (CFUs), while the visualization and quantification of total adherent microorganisms were facilitated by using DAPI and live/dead staining combined with fluorescence microscopy. Bovine dentin had a significantly higher number of aerobic CFUs compared to Biodentine (p = 0.017) and MTA (p = 0.013). The lowest amounts of DAPI-stained adherent microorganisms were quantified for Biodentine (15% ± 9%) and the control (18% ± 9%), while MTA showed the highest counts of initially adherent microorganisms (38% ± 10%). Significant differences were found for MTA and Biodentine (p = 0.004) as well as for MTA and the control (p = 0.021) and for AH Plus and the control (p = 0.025). Biodentine inhibited microbial adherence, thereby yielding an antimicrobial effectivity similar to that of MTA.

Antimicrobial Potential of Grape Seed Extract and MTA: A Comparative Experimental Study

AIM: This study aims to evaluate and compare the antibacterial potential of mineral trioxide aggregate (MTA) and grape seed extract (GSE) against Streptococcus mutans, Enterococcus faecalis, Staph aureus, Candida albicans, Lactobacillus spp., and Streptococcus sobrinus. HYPOTHESIS: We hypothesized that GSE could have potent antimicrobial effect against oral pathogens when compared to MTA. MATERIALS AND METHODS: MTA and GSE were utilized to determine the antibacterial effectiveness against S. mutans, E. faecalis, S. aureus, C. albicans, Lactobacillus spp. and S. sobrinus using the agar well diffusion test. The tested materials were used according to the manufacturer’s instructions and put into the prepared wells of agar plates; diluted inocula (105 and 106 CFU/ml) of the tested microorganism strains were also used. For bacteria, all plates were incubated at 37°C in anaerobic conditions, and for C. albicans, at 30°C. The inhibitory zones were determined after 3 days. A digital caliper was used to measure the diameter of bacterial inhibition zones surrounding each well to the nearest size in mm. RESULTS: GSE-created inhibition zones against all tested microorganisms except C. albicans, zones were significantly larger than MTA-created zones (p < 0.05). CONCLUSION: Both MTA and GSE showed antimicrobial effect against all tested microorganisms except C. albicans, which will pave the route to use GSE as a natural herbal substitute of MTA.

Comparison of MTA versus Biodentine in Apexification Procedure for Nonvital Immature First Permanent Molars: A Randomized Clinical Trial

This study aimed to evaluate the radiological and clinical outcomes of Biodentine apical plugs compared to mineral trioxide aggregate (MTA) in treating immature molars with apical lesions in children. Materials and Methods: Thirty immature roots of 24 permanent lower first molars with apical lesions were randomly divided into two groups: group 1 (15 roots) treated with MTA apical plugs and group 2 (15 roots) treated with Biodentine apical plugs. Treatment radiological outcomes were assessed using the periapical index (PAI) scale after 6 and 12 months of treatment. The presence or absence of apical calcified barrier (ACB) was assessed after 12 months of treatment. The visual analog scale (VAS) was used to compare the postoperative pain between the two groups after 1, 3, 7, and 14 days of treatment. PAI scores between the two groups were compared using the Mann–Whitney U test, the presence or absence of the ACB was compared using the chi-square test, and the VAS scores were compared using the t-test. The statistical significance threshold was set at 0.05. Results: There were no statistically significant differences in the PAI between the two groups at 6 and 12 months postoperatively. After 12 months, four cases in the Biodentine group showed ACB formation, whereas ACB was not found in any case treated with MTA. The VAS scores were statistically lower in the MTA group on the first day after treatment. Nevertheless, these scores were not statistically significantly different after 3, 7, and 14 days of treatment between the two groups. Conclusions: Biodentine can be used as an apical plug to treat immature permanent molars with apical lesions in a single visit in children. Biodentine showed favorable outcomes in apical lesions healing, which was comparable to MTA but with a decreased treatment time associated with its use.

Current status on antimicrobial activity of a tricalcium silicate cement

Biodentine (BD) is a bioactive material with many indications in endodontic therapy. The purpose of this study was to compile and review the outcomes of in vitro and in vivo studies of BD in terms of antimicrobial effectiveness. An electronic search was carried out in PubMed, from January 2009-April 2021 using the keywords: (Biodentine or dentine substitute or "Ca₃SiO₅" or tricalcium silicate cement or bioceramic cement) and (antimicrobial activity or antimicrobial effect or antimicrobial effectiveness or antibacterial activity or antibacterial effect or antibacterial effectiveness or antibiofilm activity or antibiofilm effectiveness). Two independent reviewers evaluated the studies for eligibility. All studies that did not include BD or its antimicrobial properties, as well as abstracts not written in English, were excluded. This review identified the need to develop standardized methods to evaluate antimicrobial activity in vitro. Most of the studies were against planktonic bacteria and gave conflicting results. Studies ex vivo and in vivo against biofilm are required to elucidate the antimicrobial activity of BD.

The Optimization of Extraction Process, Antioxidant, Whitening and Antibacterial Effects of Fengdan Peony Flavonoids

Flavonoids have important biological activities, such as anti-inflammatory, antibacterial, antioxidant and whitening, which is a potential functional food raw material. However, the biological activity of Fengdan peony flavonoid is not particularly clear. Therefore, in this study, the peony flavonoid was extracted from Fengdan peony seed meal, and the antioxidant, antibacterial and whitening activities of the peony flavonoid were explored. The optimal extraction conditions were methanol concentration of 90%, solid-to-liquid ratio of 1:35 g:mL, temperature of 55 °C and time of 80 min; under these conditions, the yield of Fengdan peony flavonoid could reach 1.205 ± 0.019% (the ratio of the dry mass of rutin to the dry mass of peony seed meal). The clearance of Fengdan peony total flavonoids to 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical, hydroxyl radical and 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) free radical could reach 75%, 70% and 97%, respectively. Fengdan peony flavonoid could inhibit the growth of the Gram-positive bacteria. The minimal inhibitory concentrations (MICs) of Fengdan peony flavonoid on S. aureus, B. anthracis, B. subtilis and C. perfringens were 0.0293 mg/mL, 0.1172 mg/mL, 0.2344 mg/mL and 7.500 mg/mL, respectively. The inhibition rate of Fengdan peony flavonoid on tyrosinase was 8.53-81.08%. This study intensely illustrated that the antioxidant, whitening and antibacterial activity of Fengdan peony total flavonoids were significant. Fengdan peony total flavonoids have a great possibility of being used as functional food materials.

Comparative evaluation of antimicrobial and antifungal efficacy of bioactive root-end filling materials: An in vitro study

Context:

Microorganisms are the main cause of failure of endodontic treatment. When retreatment fails periapical surgery followed by retrograde filling is done to seal the apex. A root-end filling material should have antimicrobial property as well as bioactive properties necessary for healing, repair, and regeneration of the apex.

Aims:

The aim of this study was to evaluate the antibacterial and antifungal efficacy of three bioactive root-end filling materials: mineral trioxide aggregate (MTA) Plus, Biodentine, Endosequence root repair material (ERRM) against Enterococcus faecalis and Candida albicans.

Subjects and Methods:

E. faecalis and C. albicans standard bacterial strains were used. 100 μl was taken from liquid cultures of E. faecalis and planted in Mueller-Hinton agar and the same amount of C. albicans was planted in Sabouraud dextrose agar by lawn culture. MTA Plus, Biodentine, and ERRM were aseptically filled into the opened pits. Following this, the media were kept in the drying oven at 37°C for 24, 48, and 72 h and the diameters of the inhibition zones were measured.

Statistical Analysis Used:

Statistical analysis was carried out by Kruskal–Wallis, Post hoc (Mann–Whitney), Friedman, and Post hoc (Wilcoxon-sign) test.

Results:

Among the three groups, the antimicrobial activity of Biodentine against E. faecalis was statistically higher than MTA Plus and ERRM (P < 0.05). Antifungal activity of MTA Plus against C. albicans was statistically higher than Biodentine and ERRM (P < 0.05). ERRM showed the smallest inhibition zone against E. faecalis and C. albicans among the three groups (P < 0.05).

Conclusions:

Biodentine exhibited the greatest antimicrobial activity and MTA Plus exhibited the greatest antifungal activity among the three groups. ERRM exhibited the least antibacterial and antifungal activity among the three groups.

Chitosan Enhances the Anti-Biofilm Activity of Biodentine against an Interkingdom Biofilm Model

Endodontic infection is a biofilm disease that is difficult to irradicate with current treatment protocols, and as such, persistent micro-organisms may lead to ongoing or recurrent disease. The potential for the use of enhanced filling materials to modify biofilm regrowth is a promising strategy. This current study aimed to evaluate the anti-biofilm efficacy of calcium silicate cements modified with chitosan. The development of mono-species and multi-species biofilms on ProRoot MTA, Biodentine and bovine dentine discs were explored using quantitative microbiology analysis. The effect on regrowth of biofilms was assessed following the addition of chitosan to each cement. In comparison to a dentine substrate, both materials did not show the ability to inhibit biofilm regrowth. Biodentine incorporated with chitosan displayed a dose-dependent reduction in multi-species biofilm regrowth, unlike MTA. Notably, interkingdom biofilms were shown to enhance bacterial tolerance in the presence of chitosan. This study demonstrates the potential to enhance the antimicrobial properties of Biodentine. The findings highlight the need for appropriate model systems when exploring antimicrobial properties of materials in vitro so that interspecies and interkingdom interactions that modify tolerance are not overlooked while still supporting the development of innovative materials.

Minimal Intervention in Dentistry: A Literature Review on Biodentine as a Bioactive Pulp Capping Material

Root canal treatment has been the treatment of choice for carious pulp exposures. In the perspective of minimally invasive dentistry and preventive endodontics, a direct pulp capping procedure with a reliable bioactive material may be considered an alternative approach provided that the pulp status is favorable. However, the treatment of pulp exposure by pulp capping is still a controversial issue with no clear literature available on this topic, leaving the concerned practitioner more confused than satisfied. Biodentine is a relatively new bioactive material explored for vital pulp therapy procedures. This article discusses its role in direct pulp capping procedures. A thorough literature search of the database was done using PubMed, Google Scholar, and Scopus using the keywords preventive endodontics, calcium silicate cement, direct pulp capping, Biodentine, and vital pulp therapy. Reference mining of the articles that were identified was used to locate other papers and enrich the findings. No limits were imposed on the year of publication, but only articles in English were considered. This paper is aimed at reviewing the current literature on Biodentine as a direct pulp capping material. The review will provide a better understanding of Biodentine's properties and can aid in the decision-making process for maintaining the vitality of exposed dental pulp with minimal intervention.

Antimicrobial action of NeoMTA Plus on mono- and dual-species biofilms of Enterococcus faecalis and Candida albicans: An in vitro study

OBJECTIVE

To evaluate the antimicrobial action of NeoMTA Plus on mono- and dual-species biofilms of Enterococcus faecalis and Candida albicans.

MATERIAL AND METHODS

A total of 171 sterile dentin blocks, measuring 4 mm × 4 mm × 1 mm, were incubated in media containing E. faecalis (3.1 × 10⁸ cells/mL) and/or C. albicans (1 × 10⁷ cells/mL) for 2 d. These blocks were randomly divided into three groups: the control (no treatment with biomaterials), MTA (treated with an MTA sample with width and thickness same as those of the dentin block after the material was set), and NeoMTA Plus (treated with NeoMTA Plus in a fashion similar to the treatment of the MTA group) groups. The biomaterials remained in contact with the biofilms for 24 h. Quantitative analyses of the number of colony-forming units (CFUs) and metabolic activity (XTT), were performed. Furthermore, qualitative analysis of biofilm structure was performed by scanning electron microscopy. Data were statistically analyzed considering a significance level of 5%.

RESULTS

XTT and the number of CFUs were similar among the groups (p > 0.05). The type of biofilm (mono- or dual-species) or the biomaterial used (MTA or NeoMTA Plus) did not affect the results. Biofilm structure exhibited a robust architecture composed of yeast and bacterial cell multilayers and was homogeneous among the groups.

CONCLUSION

NeoMTA Plus was not effective against mono- and dual-species biofilms of E. faecalis and C. albicans. Further research investigating biofilm removal methods including those involving the use of biomaterials with antiseptics and other supporting therapies is warranted.

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.

Effect of Biotitania and Titania Addition on Bioactivity and Antibacterial Properties of Calcium Silicate Cement

Introduction

Nanoparticles are gaining more interest in dentistry for their antimicrobial, physical as well as other properties. This study aimed to evaluate the effect of adding two types of nanoparticles (NPs) on calcium silicate hydraulic cement's (CSHC) unique bioactivity and antibacterial properties.

Methods and Materials

Biotitania/AgCl NPs were synthetized and characterized for its morphology, types of formed functional groups and crystalline AgCl using field emission scanning electron microscope (FE-SEM) equipped with energy-dispersive X-ray spectroscopy (EDS), X-ray diffractometer (XRD), Fourier transformation infrared spectroscopy (FT-IR) and thermo-gravimetric analysis (TGA). The former NPs and commercial titania (TiO2) NPs were added (0.5, 1.5 and 3-weight %) to commercial CSHS powder. A total of 140 disk-shaped specimens (10 mm×1 mm) were prepared (seven material groups per each test in addition to the eighth cell control group) to evaluate cell viability and alkaline phosphatase activity (ALP) after 3 and 12 days, respectively. All were incubated with mesenchymal stem cells. Antibacterial efficacy against Streptococcus mutans (S. mutans) was evaluated through the bacterial growth curve slopes while being in direct contact with the tested material groups for 18 h. One-way analysis of variance (ANOVA) and post hoc Tukey's tests were used to analyze the obtained data.

Results

Addition of all NPs percentages had no significant effect (P 0.05) on cell viability in comparison to positive control CSHC. Commercial TiO2 NPs (0.5 weight %) had statistically significant lower values (P≤0.05) for bacterial growth curve slope. However, addition of all NPs percentages had significantly improved (P≤0.05) the ALP activity of CSHC with the most prominent effect to 3-weight% biotitania/AgCl NPs.

Conclusion

Based on this in vitro study, addition of biotitania/AgCl NPs up to 3-weight% significantly improved the bioactivity of CSHC without having a significant negative impact on its antibacterial efficacy. Interestingly, the addition of commercial TiO2 even in small amounts can significantly improve CSHC antibacterial efficacy.

Antimicrobial Activity of Calcium-Enriched Mixture Cement and Biodentine on Enterococcus faecalis: An in Vitro Study

Introduction

The main cause of endodontic failure is residual bacteria in the root canal system. Enterococcus faecalis (E. faecalis) is the predominant species isolated from infected root canals. This study aims to compare the antibacterial activity of calcium-enriched mixture (CEM) cement and Biodentine as root canal filling materials on E. faecalis.

Methods and Materials

Seventy extracted human single-rooted teeth were prepared and infected with E. faecalis for 24 h. Specimens were randomly divided into control or experimental groups; the later were filled with either CEM cement or Biodentine. Dentinal samples were collected after 7 and 30 days and transferred to test tubes. After incubation, the number of colony forming units (CFUs) were counted and analyzed using the Kruskal-Wallis test, followed by the Mann Whitney U test. The level of significance was set at 0.05.

Results

The reduction in mean CFU level of E. faecalis was significantly more in the presence of CEM cement at both time intervals (P<0.001). Compared to the positive control, Biodentine significantly reduced the mean CFU level only after 30 days (P<0.01).

Conclusion

Although both biomaterials exerted antibacterial activity against E. faecalis, the CEM cement had more antibacterial activity than Biodentine.

Novel 3-Methyl-2-alkylthio Benzothiazolyl-Based Ionic Liquids: Synthesis, Characterization, and Antibiotic Activity

Three series of novel 3-methyl-2-alkylthio benzothiazolyl ionic liquids (ILs) were synthesized for the first time. After structural identification, their melting point, solubility, and thermostability together with antibiotic activity were determined successively. As a result, 3-methyl-2-alkylthio benzothiazolyl p-toluene sulfonate was found to have the highest antibacterial activity among the three series of ILs. Meanwhile, it has a good solubility in water as well. On the basis of comprehensive comparison with similar compounds, the effect of cations and anions of these benzothiazolium ILs on typical physical properties together with antibiotic performance was explored and discussed, which is very beneficial to take the greatest advantage of their structural designability for various purposes. Furthermore, the experiment data preliminarily discovered the relationships of the structure-properties/activities of the above three kinds ILs to a certain extent, which can provide useful references for future research and for the potential application of these new ILs as surfactant antiseptics or agricultural chemicals.

Biodentine™ material characteristics and clinical applications: a 3 year literature review and update

INTRODUCTION

Biodentine™ has frequently been acknowledged in the literature as a promising material and serves as an important representative of tricalcium silicate based cements used in dentistry.

AIM

To provide an update on the physical and biological properties of Biodentine™ and to compare these properties with those of other tricalcium silicate cements namely, different variants of mineral trioxide aggregate (MTA) such as ProRoot MTA, MTA Angelus, Micro Mega MTA (MM-MTA), Retro MTA, Ortho MTA, MTA Plus, GCMTA, MTA HP and calcium enriched mixture (CEM), Endosequence and Bioaggregate™.

STUDY DESIGN

A comprehensive literature search for publications from November 20, 2013 to November 20, 2016 was performed by two independent reviewers on Medline (PubMed), Embase, Web of Science, CENTRAL (Cochrane), SIGLE, SciELO, Scopus, Lilacs and clinicaltrials.gov. Electronic and hand search was carried out to identify randomised control trials (RCTs), case control studies, case series, case reports, as well as in vitro and animal studies published in the English language.

CONCLUSIONS

The enhanced physical and biologic properties of Biodentine™ could be attributed to the presence of finer particle size, use of zirconium oxide as radiopacifier, purity of tricalcium silicate, absence of dicalcium silicate, and the addition of calcium chloride and hydrosoluble polymer. Furthermore, as Biodentine™ overcomes the major drawbacks of MTA it has great potential to revolutionise the different treatment modalities in paediatric dentistry and endodontics especially after traumatic injuries. Nevertheless, high quality long-term clinical studies are required to facilitate definitive conclusions.

MTA versus Biodentine: Review of Literature with a Comparative Analysis

An ideal dental repair material should possess certain exclusive properties such as adequate adhesive ability, insolubility, dimensional stability, biocompatibility, bioactivity etc. New materials claiming better performance are continuously being introduced in the market to optimize the care of dental patients. Biodentine has been recently introduced as the "the first all-in-one, bioactive and biocompatible material for damaged dentin replacement". Manufacturers claim that Biodentine has noticeably shorter setting time in contrast to other silicate cements such as Mineral Trioxide Aggregate (MTA) and also has better mechanical and handling properties. This article is aimed to compare the properties of MTA and Biodentine analyzing the research work done in this field so far by various researchers all across the globe.