Antibacterial activity of different root canal sealers against Enterococcus faecalis

Effects of Larrea nitida nanodispersions on the growth inhibition of phytopathogens

Larrea nitida Cav. (Zygophyllaceae) is a plant endemic to Argentina and Chile, and its extract has been studied over the last years due to the presence of antimicrobial agents that can be used to control the growth of some pathogens in agriculture. However, the extract is highly hydrophobic, which strongly affects its fungicidal activity in aqueous media. In this sense, the solid dispersion technique was used to produce L. nitida extract nanodispersions with polyethylene glycol (PLE) and with polyethylene glycol and zinc acetate (PZLE). In order to further evaluate the activity of the extract in PLE and PZLE, blank nanodispersions containing only polyethylene glycol (PEG) and zinc acetate (PZ) without the addition of the extract were also produced. The fungicidal activity of the water-soluble nanoparticles was evaluated at different concentrations (0.037-0.110 g.mL-1). In general, the nanoparticles were successfully produced on a nanometric size and presented a significant inhibitory activity on the growth of the pathogens Fusarium oxysporum and Fusarium verticillioides in aqueous media. Compared to PLE, PZLE presented increased fungistatic activity, possibly due to their increased solubility in water. Even though their application in agriculture should be further investigated, the nanodispersions present great potential to be applied as a green biotechnological tool.

Biological investigation of resinous endodontic sealers containing calcium hydroxide

The purpose of this study was to evaluate, in vivo, the biocompatibility, biomineralization, collagen maturation and the in vitro antibacterial and cytotoxicity of resinous endodontic sealers containing calcium hydroxide. Forty rats were implanted with polyethylene tubes containing Sealer 26, Sealer Plus, Dia-ProSeal and an empty tube, examined after 7, 15, 30 and 60 days. Antimicrobial activity was evaluated against Enterococcus faecalis by Agar Diffusion Test (ADT) through inhibition zones. For cytotoxicity, undifferentiated pulp cells (OD-21) were cultured and assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, exposed to dilution of serial extracts at 6, 24, 48h. Cytotoxicity was analyzed by two-way ANOVA and Bonferroni correction. Kruskal-Wallis test followed by Dunn test was performed for nonparametric data (p<0.05). MTT assay revealed cell proliferation affected by sealers extract in all periods (p<0.0001), except for Dia-Proseal and Sealer Plus ⅛ dilution. Subcutaneous analysis showed at day 7th moderate inflammatory infiltration. After 30 days, Sealer 26 still showed moderate inflammatory infiltrate compared to mild inflammation from control and Dia-ProSeal (p = 0.006). At day 60th, all groups showed similar mild inflammatory infiltrate (p>0.05). Sealer 26 induced more biomineralization than other sealers in all periods. At 7 and 15 days, all sealers had significant percentage of immature collagen fibers. After 60 days Sealer 26 showed more mature fibers compared to other sealers (p<0.001). All sealers had a smaller zone of inhibition than chlorhexidine, but with no significant difference among any group (p>0.05). All sealers showed satisfactory biological responses with in vitro/in vivo biocompatibility and antimicrobial activity against planktonic bacteria. Sealer 26 induced more biomineralization than Sealer Plus and Dia-ProSeal.

Efficacy of Ciprofloxacin, Metronidazole and Minocycline in Ordered Mesoporous Silica against Enterococcus faecalis for Dental Pulp Revascularization: An In-Vitro Study

Pulp revascularization of teeth with necrotic pulp has become an alternative treatment in cases with immature apex. Microbial control is essential to achieve a successful outcome and continued root development. Enterococcus faecalis (E. faecalis) is the most frequently isolated bacterial species in root canals of endodontically failed teeth. Our main goal was to compare the in-vitro antimicrobial efficacy of different antibiotic formulations delivered by ordered mesoporous silica (OMS) against E. faecalis. To determine antibiotic susceptibility, we tested OMS and triple antibiotic paste (TAP; ciprofloxacin:metronidazole:minocycline) with different reagents in different concentrations, using the Kirby−Bauer disk diffusion method. OMS and metronidazole showed no antibacterial activity against E. faecalis. Mixtures of OMS and antibiotics in proportions of 2:2:14 and 4:1:7 (mg/L of ciprofloxacin:metronidazole:minocycline, respectively) showed the lowest antibacterial activity. The antibacterial activity of the combined solutions of ciprofloxacin and metronidazole was significantly higher (p < 0.005). Combinations in different concentrations of minocycline, ciprofloxacin, and metronidazole in OMS have shown activity against E. faecalis, although the combined use of ciprofloxacin and metronidazole has shown the most effective results. This study demonstrates the efficacy of intracanal antibiotic combination paste activity against E. faecalis, avoiding the use of minocycline, whose undesirable effect of teeth staining is a common problem for patients and professionals in dental clinic.

Effectiveness of Three Agents in Pulpotomy Treatment of Permanent Molars with Incomplete Root Development: A Randomized Controlled Trial

The aim of this study was to investigate and compare, radiographically and clinically, the impacts of calcium-silicate based-cement (CSBC), nano-hydroxyapatite and platelet-rich fibrin (PRF) as pulpotomy agents in permanent immature molars with incomplete root development. Sixty-three participants (63 permanent immature molars) were included in this study. The patients were randomly divided into three equal groups. Fast setting MTA (MM-MTA), nano-hydroxyapatite and platelet-rich fibrin were used as pulpotomy agents. The teeth were evaluated clinically and radiographically after 6 and 12 months by two blinded examiners. Apical closure and pulp canal obliteration percentages were recorded. The in vitro reaction of the tested materials after a 7-day immersion period of the different materials in phosphate-buffered solution was analyzed using scanning electron microscopy to associate the in vitro mineralization with in vivo pulp canal obliteration percentages. Data were analyzed using Chi-square and ANOVA tests (α = 0.05). No significant difference was found between the three tested groups in terms of clinical and radiographic success (p > 0.05). All cases demonstrated evidence of root growth, including complete apical closure or continued apical closure. At 12 months, complete apical closure was found among the MM-MTA group (50%), nano-hydroxyapatite group (55%) and platelet-rich fibrin group (60%) (p > 0.05). After 12 months, pulp canal obliteration was more observed in the MM-MTA and nano-hydroxyapatite groups than in the PRF group (p < 0.05). MM-MTA (auto-mixed), NHA (hand-mixed) and PRF (autologous) could be used as pulpotomy agents since they exhibit comparable high clinical and radiographic success rates. However, the fact that the groups managed with MM-MTA and NHA have a higher tendency to canal obliteration might indicate that PRF should be considered the first choice material as pulpotomy agent, as it would make retreatment considerably easier.

Adding Two Antimicrobial Glasses to an Endodontic Sealer to Prevent Bacterial Root Canal Reinfection: An In Vivo Pilot Study in Dogs

Current endodontic procedures continue to be unsuccessful for completely removing pathogens present inside the root canal system, which can lead to recurrent infections. In this study, we aimed to assess the antimicrobial capacity and tissue response of two inorganic bactericidal additives incorporated into a paste root canal sealer on contaminated root dentin in vivo. An experimental study was performed in 30 teeth of five Beagle dogs. After inducing microbiological contamination, root canal systems were treated by randomly incorporating one of two antimicrobial additives into a commercial epoxy-amine resin sealer (AH Plus), i.e., G3T glass-ceramic (n = 10) and ZnO-enriched glass (n = 10); 10 samples were randomized as a control group. After having sacrificed the animals, microbiological, radiological, and histological analyses were performed, which were complemented with an in vitro bactericidal test and characterization by field emission scanning electron microscopy. The tested groups demonstrated a non-significant microbiological reduction in the postmortem periapical index values between the control group and the bactericidal glass-ceramic group (p = 0.885), and between the control group and the ZnO-enriched glass group (p = 0.169). The histological results showed low values of inflammatory infiltrate, and a healing pattern characterized by fibrosis in 44.4% of the G3T glass-ceramic and 60.0% of ZnO-enriched glass. Bactericidal glassy additives incorporated in this root canal sealer are safe and effective in bacterial reduction.

Physicochemical and Antibacterial Properties of Novel, Premixed Calcium Silicate-Based Sealer Compared to Powder-Liquid Bioceramic Sealer

The aim of this study was to compare the physicochemical properties, filling ability, and antibacterial activity of a premixed calcium silicate-based sealer to those of a powder–liquid bioceramic sealer. Ceraseal (CS) and BioRoot (BR) materials were analyzed using scanning electron microscopy and energy-dispersive X-ray spectroscopy at 7 and 14 d of immersion in distilled water. The filling ability of the two sealers as well as the water contact angle, solubility, flow, roughness, crystalline microstructure, pH, and compressive strength were also evaluated. The antibacterial activity was assessed through an agar diffusion as well as through direct tests. All the results were statistically analyzed using one-way or two-way analysis of variance tests. Statistically significant lower void percentages were observed for CS at 2 and 8 mm from the working length (WL) compared to those for the BR group, whilst no significant difference was observed at 5 mm from the WL. BR sealer showed higher alkaline pH, rougher surface, lower water contact angle values, lower flowability, and higher solubility compared to CS. BR showed globular and needle-like crystalline microstructure, whilst CS had globular and flower-like crystalline microstructure up to 72 h. No statistical difference was found for the compressive strength between the two sealers. BR and CS showed no antibacterial effect against Enterococcus faecalis after 3 h, whilst both sealers showed antibacterial capacity after 24 and 72 h. BR demonstrated higher antibacterial activity after 24 h. In conclusion, the use of bioceramic sealers may play an important role in controlling bacterial growth. Moreover, CS may have superior filling ability and lower solubility than the BioRoot sealer due to its specific chemical composition and mixing method.

An Innovative Drug Delivery System Loaded with a Modified Combination of Triple Antibiotics for Use in Endodontic Applications

The objective of the current study was to introduce "Polylactic co-Glycolic Acid- (PLGA-) Coated Ceramic Microparticles" as an innovative drug delivery system, loaded with a new combination of triple antibiotics (penicillin G, metronidazole, and ciprofloxacin (PMC)) for use in endodontic treatments. Ceramic microparticles were made from β-tricalcium phosphate and hydroxyapatite and examined by "Scanning Electronic Microscope (SEM)." Then, fixed amounts of the selected antibiotics were added to a prepared PLGA solution and stirred thoroughly. Next, the prepared ceramic microparticles were dispersed completely in the drugs solution. The deposited "PMC-loaded PLGA-coated ceramic microspheres (PPCMs)" were dried and incubated in phosphate buffer saline (PBS) for 21 days. The drug release from PPCMs was quantified by a UV spectrophotometer. The antimicrobial activity of PPCMs was investigated using the "Agar Plate Diffusion Test (ADT)," "Minimum Inhibitory Concentration (MIC)," and "Minimum Bactericidal Concentration (MBC)" against Enterococcus faecalis (E. faecalis) and Aggregatibacter actinomycetemcomitans (A.a). The cell viability test (MTT) was conducted for cytotoxicity against human gingival fibroblasts. SEM micrographs of PPCMs showed spherical-like ceramic microparticles with smooth surfaces. Crystal-like antibiotic particles (chunks) were also found on PPCMs. Initial burst of antibiotics (31 µg/mL, 160 µg/mL, and 18 µg/mL for ciprofloxacin, metronidazole, and penicillin G, respectively, in the first 4 days) followed by gradual and sustained release was observed within a period of 21 days. PPCMs demonstrated pH close to normal physiological environment and antibacterial activity against E. faecalis and A.a in the first 2 days. MTT showed cell viability of more than 70% for PPCMs after 24 h and 72 h of exposure. In conclusion, PPCMs demonstrated satisfactory release of antibiotics, antibacterial activity against the selected microorganisms, and biocompatibility. Thus, PPCMs may be used to deliver modified triple antibiotics to the root canal system for use in endodontic applications.

Short-Term Antibacterial Efficacy of Three Bioceramic Root Canal Sealers Against Enterococcus Faecalis Biofilms

Objectives

The aim of the study was to evaluate the antimicrobial efficacy of three bioceramic root canal sealers against Enterococcus faecalis (E. faecalis) biofilm.

Material and methods

E. faecalis bacterial suspension was grown on filter paper discs on agar plates. After the incubation period, the discs were covered with four different root canal sealers: 1) Premixing bioceramic root canal sealer (TotalFill BC Sealer); 2) Dual component bioceramic sealer (BioRoot RCS); 3) Mineral trioxide agreggate based sealer (MTA Fillapex); 4) Epoxy resin-based selar (AH Plus). After contact time of 60 minutes, the sealers were removed, and the discs were transferred into sterile tubes containing phosphate buffered saline. After serial dilutions, the aliquots of the suspension were cultivated for 24 hours. After the incubation period, the colony forming units (CFUs) were counted.

Results

There were no significant differences in antibacterial efficacy between the Total Fill BC Sealer and the AH Plus sealer (p=0.386). Both sealers showed better antibacterial efficacy compared to the BioRoot RCS and the MTA Fillapex (p<0.001).

Conclusion

The Total Fill BC Sealer and AH Plus had better antibacterial efficacy than the BioRoot RCS and the MTA Fillapex sealers.

Physical Properties, Antimicrobial Activity and In Vivo Tissue Response to Apexit Plus

We investigated the physical properties, antimicrobial activity, and tissue reaction to Apexit Plus in comparison to Sealapex. Flow, radiopacity, setting time, and solubility were evaluated in each material. The antimicrobial activity against Enterococcus faecalis was performed. Polyethylene tubes containing Apexit Plus or Sealapex, and without material (control group) were implanted into the subcutaneous tissue of rats. At 7, 15, 30, and 60 days of implantation, the specimens were paraffin-embedded and the number of inflammatory cells (ICs) and the amount of birefringent collagen (BC) were quantified. The von Kossa reaction followed by immunohistochemistry for detection of alkaline phosphatase (ALP) was also performed. Statistical analysis was performed with ANOVA and Tukey test (p ≤ 0.05). The flow value of Apexit Plus was greater than Sealapex, whereas the radiopacity (3.44 mm Al) was lower than Sealapex (6.82 mm Al). Apexit Plus showed lower solubility and shorter initial and final setting (p < 0.0001), whereas the antimicrobial activity was significantly greater than Sealapex. Although the number of ICs was higher in Apexit Plus (p = 0.0009) at 7 days, no significant difference was detected between Apexit Plus and Sealapex at 15, 30, and 60 days. All groups showed higher values for BC in the capsules over time. ALP-immunolabelled cells were observed, mainly around von Kossa-positive structures, either in the capsules of Apexit Plus or Sealapex. Therefore, our results revealed that Apexit Plus exhibited a greater effectiveness against Enterococcus faecalis and better physical properties than Sealapex, except for the radiopacity. In vivo findings indicate that Apexit Plus is biocompatible and presents potential bioactivity in the subcutaneous tissue.

Antimicrobial efficacy of commercially available endodontic bioceramic root canal sealers: A systematic review

Background

Recently, a new generation of bioceramic root canal sealers has been introduced onto the market. Many in vitro studies have investigated the antimicrobial properties of these sealers, but their comparative efficacy in antimicrobial activity is still unknown.

Methodology

Three electronic databases were searched: MEDLINE and Embase via the OvidSP platform, and Web of Science, up to June 25, 2019. Studies were included irrespective of study design, type of publication and language. Reporting quality was assessed by two authors independently. Meta-analysis was not performed due to studies being highly heterogeneous.

Results

We included 37 studies that analysed the antimicrobial effects of bioceramic sealers. Most of them used a planktonic cell model, with the exception of nine studies which used biofilms. It was not possible to make direct comparison of results from studies and to give a clear conclusion about the comparative antimicrobial activity of these materials because the studies used heterogeneous sources and ages of microorganisms, setting and contact times of sealers, and antimicrobial tests. Furthermore, some materials showed completely different results when tested with different methods.

Conclusions

In conclusion, multiple in vitro studies have shown that bioceramic sealers may have various degrees of antimicrobial activity. However, it is still impossible to make conclusions about their comparative efficacy and to recommend the use of one over another in clinical practice because the studies available were conducted in different ways, which makes meta-analysis futile. A uniform methodological approach, consistent definitions and studies on humans are urgently needed in this field of research so that recommendations for practice can be made.

The in vitro antimicrobial activities of four endodontic sealers

Background

The purpose of this study was to investigate the antimicrobial activities of four endodontic sealers (GuttaFlow2, AH Plus, ProRoot MTA and RealSeal) against E. feacalis, E.coli and C.albicans.

Methods

The antimicrobial activities of four endodontic sealers were assessed by both agar diffusion test (ADT) and direct contact test (DCT) in this study. In ADT, the results were reported as the diameter of the growth inhibition zone. Both fresh and 1-day-setting sealers were measured. In DCT, microorganisms in suspension were exposed to the sealers for 10, 30 and 60 min and the survival of microorganisms were determined after exposure at different time points(after mixing, 1 and 7 days). The number of colony-forming unit (CFU) was counted. The results were analyzed with ANOVA and Tukey tests.

Results

Both ADT and DCT results showed that Guttaflow2 presented no effect against any tested microorganisms. In ADT, fresh RealSeal had the largest inhibition zone against all tested microbes, followed by AH Plus and ProRoot MTA. ProRoot MTA demonstrated inhibition zones against all the three test microbes after setting for 1 day, while the other three sealers showed no inhibition activity. In DCT, fresh AH Plus had the strongest antimicrobial effects against all the three tested microorganisms for every contact times, while its antimicrobial activity diminished significantly with time. Fresh RealSeal and ProRoot MTA also showed strong antimicrobial effect and still showed antimicrobial effect after 1-day-setting. The antibacterial effects of RealSeal against E. faecalis and antifungal effect of ProRoot MTA were observed after 7 days of setting.

Conclusions

GuttaFlow2 had no antimicrobial activity. Freshly mixed RealSeal and AH Plus demonstrated strong antimicrobial effects. RealSeal showed antimicrobial effects after setting in DCT. ProRoot MTA showed high antimicrobial activity and exhibited anti-inflammation potentials after setting.

[Efficiency of chronic apical periodontitis treatment with use of Granulotec endodontic sealer]

AIM

Efficiency assessment of Granulotec (PD) endodontic sealer for root canal permanent obturation in patients with apical granuloma basing on clinical and radiological data.

MATERIAL AND METHODS

Endodontic treatment of 35 teeth with apical granuloma was performed in 22 patients with root canal obturation by means of lateral condensation with Granulotec sealer. Bone remodeling in periapical area has been estimated in 1, 3, 6 and 8 months with PAI index.

RESULTS

Endodontic post-operative pain has been observed in 5 (14.3%) cases of 35, pain duration varied 1 to 5 days, NSAIDs use hasn't been required. During observation period 2 teeth have been excluded from the test group (one case of periapical abscess with sinus tract and one case periapical abscess without sinus tract). In the end of observation period complete bone remodeling was observed in 30 cases, the periapical lesion size significant reduction was achieved in 2 cases, periapical lesion stabilization - in 1 case. The overall success rate was 91.4%. The mean PAI value decreased from 4.2±0.2 to 1.4±0.2.

CONCLUSION

The Granulotec (PD) use for one visit chronic apical periodontitis treatment allows achieving positive results with low complications risk.

Evaluation of physical-mechanical properties, antibacterial effect, and cytotoxicity of temporary restorative materials

The objective of this study was to compare selective physical-mechanical properties, antibacterial effects and cytotoxicity of seven temporary restorative materials (TRM): five resin-based materials [Bioplic (B), Fill Magic Tempo (FM), Fermit inlay (F), Luxatemp LC (L) and Revotek LC (R)], and zinc oxide-eugenol cement (IRM) and glass ionomer cement (GIC) as the controls. Material and methods The physical-mechanical properties were evaluated by determining microleakage (ML), ultimate tensile strength (UTS) and Shore D hardness (SDH). In addition, the polymerization rate (Pr-1), depth of cure (DC), water sorption and solubility (WS/SL) were evaluated. The antimicrobial effects of the materials were assessed by biofilm accumulation of Streptococcus mutans (BT) and the direct contact test (DCT) by exposure to Enterococcus faecalis for 1 and 24 h, and cytotoxicity by MTT assay. The data were analyzed by ANOVA or Kruskall-Wallis tests, and a complementary post-hoc method (p<0.05). Results Group B, followed by FM and GIC had significantly lower percentages of microleakage in comparison with the other groups; Groups FM and L showed the highest WS, while Groups R and FM showed the significantly lowest SL values (p<0.05). Group R showed the statistically highest UTS mean and the lowest DC mean among all groups. Group F showed the lowest S. mutans biofilm accumulation (p=0.023). Only the Group L showed continued effect against E. faecalis after 1 h and 24 h in DCT. The L showed statistically lower viability cell when compared to the other groups. Conclusions These findings suggest the antibacterial effect of the temporary materials Fill Magic and Bioplic against S. mutans, while Luxatemp showed in vitro inhibition of S. mutans biofilm accumulation and E. faecalis growth. Regarding the cell viability test, Luxatemp was the most cytotoxic and Fill Magic was shown to be the least cytotoxic.