An in vitro Comparison of Endodontic Medicaments Propolis and Calcium Hydroxide alone and in Combination with Ciprofloxacin and Moxifloxacin against Enterococcus Faecalis

Radioimaging in the Evaluation of the Therapeutic Effect of the Vegetable Extract Obtained from Epilobium Parviflorum Schreb

For years, apical microleakage has been considered the main factor in endodontic failure therapy. Sealing abilities and antibacterial properties of root canal sealers and intracanal medicaments between appointments have been recognized as important factors for the success of endodontic treatment. Background: Apical periodontitis (AP) is an inflammatory disease around the apex of a tooth root. The microorganisms reach the pulp by dentinal tubules especially when there is an open cavity after a coronal fracture and the pulp is in contact with the septic oral environment. The aim of the study was to evaluate the dynamics of healing by recording periapical index (PAI), after two appointment endodontic procedure with commercial or experimental intracanal medicament. Methods: A total of 40 patients with primary chronic apical periodontitis requiring root canal treatment were assigned randomly into four groups according to the teeth medicated with dehydrated plant extract, calcium hydroxide, calcium hydroxide mixed with chlorhexidine (CHX) gel 2%, Walkhoff paste and obturated on a second visit, 7 days later. Patients were recalled at intervals of 3, 6, and 12 months to evaluate the treated teeth both clinically and radiographically for periapical healing. A 5-score scale PAI was used to evaluate stages of the periapical healing on a periapical radiography using a Kodak Dental imaging software provided by the radio-imagistic center. Results: Radiological evaluation revealed that the experimental intracanal medicament had a cumulative positive healing capacity by reducing the PAI as well as all resorbable pastes used in endodontic conventional therapy. Conclusions: The results suggest that the vegetable dry extract obtained from Epilobium parviflorum Schreb can be used as an inter-appointment medication among with the root canal filling for the positive effect on apical healing quantified by reducing the PAI.

Comparison of antimicrobial efficacy of Calcipex and Metapex in endodontic treatment of chronic apical periodontitis: a randomised controlled trial study protocol

INTRODUCTION

Various intracanal medicaments have been used in cases of chronic apical periodontitis for appropriate disinfection of the root canal system to eliminate microbes especially from the inaccessible areas. Calcium hydroxide is the most common intracanal medicament available in various forms, but its effectiveness with or without iodoform using microbial culture is unknown. Therefore, our aim is to compare the antimicrobial efficacy of Calcipex and Metapex in endodontic treatment of teeth presenting with chronic apical periodontitis by assessing the bacterial load reduction.

METHOD AND ANALYSIS

60 single rooted teeth of patients with diagnosis of chronic apical periodontitis will be selected and the canals debrided chemomechanically. The patients will be randomised into two groups: Calcipex and Metapex. The first sample (S1) for bacterial culture will be taken before placement of intracanal medicament and the second sample (S2) will be taken after 7 days, before final obturation from the canal and sent to lab for culture. Colony-forming unit will be evaluated. Paired t-test will be used to assess difference between antimicrobial efficacies within the group of medicaments. Independent sample t-test will be used to assess antimicrobial efficacies between groups. Level of significance will be kept at 0.05.

ETHICS AND DISSEMINATION

Approval from Aga Khan University Hospital Ethical review committee is taken. Findings will be reported according to the Standard Protocol Items for Randomised Trials guidelines. Research findings will be disseminated through annual reports, peer-reviewed journals and conferences.

TRIAL REGISTRATION NUMBER

NCT04336709.

Comparison of the Effect of Three Irrigation Techniques and Root Canal Preparation Size on Sodium Hypochlorite Penetration into Root Canal Dentinal Tubules

Objective

This study aims to compare the effects of conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI), and innovative sonic-powered irrigation (EDDY) on the penetration of sodium hypochlorite (NaOCl) solutions into root canal dentinal tubules at different levels of the root canal.

Materials and Methods

One hundred ninety-two extracted first mandibular premolars of 17- to 25-year-old patients were decoronated 13 mm from the root apices and separated into two groups according to apical preparation sizes (APS) 25 and 40. The root canals were dried with a paper point and stained in crystal violet for 72 hours. Each APS group was separated into three groups according to irrigation techniques, as follows: CSI, PUI, and EDDY. Roots were perpendicularly resected to the long axis at three levels (coronal, middle, and apical). Photomicrographs were taken of all three cross-sections of each tooth under a stereomicroscope. The depth of the bleached zone was measured with ImageJ software. The data were analyzed by Welch's analysis of variance and an independent t-test (p = 0.05).

Results

No penetration was found at the apical level in the CSI25, CSI40, and PUI25 groups. The EDDY25 and EDDY40 groups showed the most significant penetration at the middle and apical levels compared to the other groups (p < 0.05).

Conclusions

Within the limitations of this study, irrigation techniques and APS affect the penetration depth of NaOCl into the root canal dentinal tubules. In terms of irrigation techniques, the penetration was deepest when EDDY was used, followed by PUI and CSI. In terms of APS, NaOCl penetrated deeper into APS40 than APS25. The use of the EDDY irrigation technique in APS25 can improve the penetration of NaOCl into root canal dentinal tubules at the apical level.

Effect of calcium hydroxide alone or in combination with ibuprofen and ciprofloxacin on postoperative pain and periapical prostaglandin E2 level: A randomized clinical study

AIM

The aim of the present study was to compare pure Ca(OH)2, Ca(OH)2 + ibuprofen and Ca(OH)2 + ciprofloxacin in terms of postoperative pain and prostaglandin E2 (PGE2) level in previously treated teeth with periapical lesions.

MATERIALS AND METHODS

Sixty-six patients were randomly assigned into 3 groups according to the intracanal medication (Ca(OH)2, Ca(OH)2 + ibuprofen and Ca(OH)2 + ciprofloxacin). After removing gutta-percha from the root canals, the PGE2 sample collection was obtained by introducing three sterile paper points into the root canals through the root apex (2 mm). Selected intracanal medicament was placed into the root canal and the participants were told to record postoperative pain levels at 24, 48, and 72 h and on 1 week after treatment using visual analog scale (VAS). At the second appointment, the medicaments were removed and second sampling was performed using the same method. The PGE2 levels measured by enzyme-linked immunosorbent assay kits, and the data were statistically analyzed.

RESULTS

All the tested Ca(OH)2 pastes were found to be significantly effective in lowering the preoperative PGE2 levels. However, intergroup analyses revealed that the Ca(OH)2 + ciprofloxacin group had the highest effectiveness in lowering PGE2 with a significant difference when compared with the pure Ca(OH)2 group. There was no statistically significant difference among the groups in terms of pre- and post-operative pain levels.

CONCLUSION

The Ca(OH)2 + ciprofloxacin medication is more effective than the pure Ca(OH)2 medication in lowering periapical PGE2 level. However, addition of ibuprofen or ciprofloxacin to the Ca(OH)2 paste does not provide extra benefit in terms of post-operative pain relief.

The use of propolis in dentistry, oral health, and medicine: A review

BACKGROUND

Propolis is a resinous product that is collected from plants by bees to cover holes and crevices in their hives. Propolis has potent antibacterial, antiviral, anti-inflammatory, wound healing, and anticancer properties. Propolis has been used therapeutically by humans for centuries, including the treatment of dental caries and mouth infections.

HIGHLIGHT

This review article attempts to analyze the potential use of propolis in general dentistry and oral health management.

CONCLUSION

Propolis is potentially useful in dentistry and oral health management based on available in vitro, in vivo, and ex vivo studies, as well as human clinical trials.

Quaternary ammonium silane, calcium and phosphorus-loaded PLGA submicron particles against Enterococcus faecalis infection of teeth: An in vitro and in vivo study

Refractory root canal infection of human teeth is the primary cause of dental treatment failure. Enterococcus faecalis is the major cause of refractory root canal infection. In the present study, poly(D,L-lactic-co-glycolide) (PLGA) submicron particles were used as carriers to deliver an antimicrobial quaternary ammonium silane (code-named K21) as well as calcium and phosphorus elements. The release profiles, antibacterial ability against E. faecalis, extent of infiltration into dentinal tubules, biocompatibility and in vitro mineralization potential of the particles were investigated. In addition, the antimicrobial effects of the particles against E. faecalis infection were evaluated in vivo in the teeth of beagle dogs. The encapsulated components were released from the PLGA particles in a sustained-release manner. The particles also displayed good biocompatibility, in vitro mineralization ability and antibacterial activity against E. faecalis. The particles could be driven into dentinal tubules of dentin slices by ultrasonic activation and inhibited E. faecalis colonization. In the root canals of beagle dogs, PLGA submicron particles loaded with K21, calcium and phosphorus demonstrated strong preventive effects against E. faecalis infection. The system may be developed into a new intracanal disinfectant for root canal treatment.

Effect of Chinese Propolis as an Intracanal Medicament on Post-Operative Endodontic Pain: A Double-Blind Randomized Controlled Trial

Propolis is a potent anti-microbial and natural anti-inflammatory by-product obtained from the beehive. Studies have demonstrated the superior biocompatibility and anti-microbial properties of propolis as compared to calcium hydroxide. However, its effect on postoperative endodontic pain is unknown. Therefore, this study aimed to investigate the impact of Chinese propolis paste as an intracanal medicament on postoperative endodontic pain intensities compared with calcium hydroxide (control) at different time intervals in necrotic teeth with periapical radiolucency. Eighty patients with single-rooted necrotic teeth with visible periapical radiolucency were recruited and randomly allocated to either the calcium hydroxide or propolis groups. After chemo-mechanical preparation and intracanal medicament insertion, patients were given the VAS (visual analogue scale) to record pain scores. Inter-group data were compared and analyzed using two-way repeated measure ANOVA (Bonferroni test). A p-value of < 0.025 was considered significant. In total, >78% of the patients experienced no or only mild post-operative pain in both the groups at all time intervals, without any significant difference in pain scores between the two groups (p > 0.025). An overall flare-up rate of 14.8% was found. The results suggest that either of these medicaments can be used as an inter-appointment medication for the prevention of postoperative pain in necrotic cases.

Pefloxacin induced changes in serotonergic innervation and mast cell number in rat salivary glands

Pefloxacin is a second-generation fluoroquinolone antibiotic. Besides its advantageous characteristics, side effects including the hypofunction of salivary glands, decreased saliva production, and peripheral neuropathy were observed during the administration of pefloxacin. The aim of this study was to investigate the changes in the number of serotonergic immunoreactive fibers and mast cells after pefloxacin treatment in the parotid and sublingual glands of rats to detect the possible neurotoxic effect of pefloxacin. The adult female rats were treated with intraperitoneal (i.p.) injection of pefloxacin for three or seven days (at a concentration of 20 mg/100g body weight) and the serotonergic innervation pattern along with the change in mast cell number were evaluated by using histochemistry and immunohistochemistry in the parotid and sublingual glands. We found that a three-day treatment significantly increased the number of immunoreactive serotonergic nerve fibers, but after a seven-day treatment the number of serotonin positive nerve fibers decreased almost to values of the control group. The alteration of mast cell number was parallel with the changes of the serotonin positive fibers during the treatment. These results suggest that pefloxacin treatment can modify the finely controlled communication between the immune- and the peripheral nervous systems, resulting neurogenic inflammatory process. The background of this process is the altered serotonergic innervation and the increased number of activated mast cells releasing different mediators for example histamine, which can finally lead to reduced number of serotonin positive nerve fibers after a seven-day treatment of pefloxacin leading to atrophy and hypofunction of the salivary glands.

Efficacy of Triple Antibiotic Paste, Moxifloxacin, Calcium Hydroxide And 2% Chlorhexidine Gel In Elimination of E. Faecalis: An In vitro Study

INTRODUCTION

Root canal treatment is incomplete without usage of intra canal medicaments. They help in the reduction of bacterial count and its by-products, making canals clean and decreasing postoperative pains.

AIM

The aim of this study was to evaluate and compare the antimicrobial activity of triple antibiotic paste, Moxifloxacin, calcium hydroxide and 2% Chlorhexidine (CHX) gel in elimination of Enterococcous faecalis (E. faecalis).

MATERIALS AND METHODS

Seventy-five root blocks were obtained from extracted single rooted human teeth. The canal diameter was increased using Gates- Glidden drill up to size 3 and then contaminated with E. faecalis for 21 days. The contaminated samples were then divided into following 5 groups. Group 1: Saline (negative group), Group 2: Calcium hydroxide Ca(OH)2, Group 3: 2% CHX gel, Group 4: Triple Antibiotic Paste (TAP) (50 μg - metronidazole of 400 mg, 50 μg - minocycline of 100 mg, 50 μg - ciprofloxacin of 100 mg) and Group 5: Moxifloxacin (50 μg - moxifloxacin of 400 mg). Dentin debris was obtained at the end of first, 7th, and 10th day using Gates Glidden drill sizes 4 and 5. The bacterial load was assessed by counting the number of Colony Forming Units (CFUs). The data were analyzed with the ANOVA and Post-Hoc tests to assess the differences in antibacterial efficacy between groups (p=<0.001).

RESULTS

A 2% CHX gel alone completely inhibited the growth of E. faecalis after one, seven and 10 days. The 2% CHX gel was the most effective medicament against E. faecalis, as it showed significant differences with normal saline, calcium hydroxide, Moxifloxacin or triple antibiotic paste at all time intervals. The triple antibiotic paste group showed a moderate antibacterial effect as its difference with all group was significantly better at all days. Moxifloxacin was more effective than calcium hydroxide on 7th and 10th day.

CONCLUSION

Best antimicrobial efficacy was shown by 2% CHX gel. Moxifloxacin was equally efficient compared to triple antibiotic paste against E. faecalis at longer intervals of time.

Effect of Calcium Hydroxide on the Push-out Bond Strength of Endodontic Biomaterials in Simulated Furcation Perforations

Introduction:

The aim of this in vitro study was to evaluate the effect of calcium hydroxide (CH) on push-out bond strength of white mineral trioxide aggregate (WMTA) and calcium-enriched mixture (CEM) cement in simulated furcation perforations.

Methods and Materials:

Furcation perforations, measuring 1.3 mm in diameter and 2 mm in height, were created in 80 human mandibular first molars. The teeth were then divided into 4 groups (n=20). In groups 1 and 3 CH was placed in the perforation for one week, before placement of WMTA and CEM. In groups 2 and 4 perforations were repaired without placement of CH. In groups 1 and 2 the perforation sites were repaired with WMTA and CEM cement was used in groups 3 and 4. After 7 days, the push-out test was carried out using a universal testing machine. Data were analyzed with two-way ANOVA. The level of significance was set at 0.05.

Results:

The maximum and minimum bond strength values were recorded in the WMTA/CH (13.08±1.8 MPa) and CEM cement groups (8.03±0.98 MPa), respectively. There were significant differences in resistance to dislodgement between the WMTA/CH and other groups (P<0.05).

Conclusion:

Placement of CH before placement of WMTA in furcation perforation improves the push-out bond strength of this material.