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Timponi Goes Cruz A, Antoniw Klemz A, Ribeiro Rosa EA, Soares Grecca F, Mattos B, Piasecki L, Machado R, Ignácio SA, da Silva Neto UX. Cleaning and disinfection of the root canal system provided by four active supplementary irrigation methods. Sci Rep 2024; 14:3795. [PMID: 38361036 PMCID: PMC10869831 DOI: 10.1038/s41598-024-53375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
This in vitro study evaluated the bacterial reduction provided by the EndoActivator (EA), Easy Clean (EC), passive ultrasonic irrigation (PUI), and XP-Endo Finisher. Eight-four mesial roots of mandibular first molars were instrumented, inoculated with Enterococcus faecalis, and divided into four groups (n. 20). Bacterial reduction in the main canals and dentinal tubules were respectively determined by MTT assays and Live/Dead BackLight technique through confocal laser scanning microscopy (CLSM) at 50, 100, and 150 µm in-depth (n. 10 per group). Statistical analyses were conducted following a significance level of 95% (P < 0.05). A significant statistical difference was just identified between XPF and EC in the main canals. In the dentinal tubules from the main root canals, at 100 and 150 µm in-depths, significant statistical differences were only observed between XPF and EC (P = 0.027) for the former and between XPF and EC (P = 0.011) and XPF and PUI (P = 0.021) for the latter. In the dentinal tubules from the isthmus, at 100 µm in-depth, statistically relevant differences did occur between XPF and EC (P = 0.038) and EC and EA (P = 0.029). At 150 µm in-depth, these differences were only significant by comparing XPF and PUI (P = 0.025) and XPF and EC (P = 0.036). Although no irrigation method could thoroughly disinfect the RCS, bacterial reduction indexes were generally better after using XPF.
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Affiliation(s)
- Alessandra Timponi Goes Cruz
- Department of Endodontics, College of Dentistry, Pontifical Catholic University of Paraná-PUC/PR, Curitiba, Paraná, Brazil
| | - Adriane Antoniw Klemz
- Department of Endodontics, College of Dentistry, Pontifical Catholic University of Paraná-PUC/PR, Curitiba, Paraná, Brazil
| | - Edvaldo Antônio Ribeiro Rosa
- Department of Biosciences, College of Dentistry, Pontifical Catholic University of Paraná-PUC/PR, Curitiba, Paraná, Brazil
| | - Fabiana Soares Grecca
- Department of Endodontics, College of Dentistry, Federal University of Rio Grande do Sul-UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bianca Mattos
- Department of Endodontics, College of Dentistry, Pontifical Catholic University of Paraná-PUC/PR, Curitiba, Paraná, Brazil
| | - Lucila Piasecki
- Department of Periodontics & Endodontics, College of Dentistry, University at Buffalo, Buffalo, NY, USA
| | - Ricardo Machado
- Clinical practice limited to Endodontics, Navegantes, Santa Catarina, Brazil.
| | - Sérgio Aparecido Ignácio
- Department of Statistics, College of Dentistry, Pontifical Catholic University of Paraná-PUC/PR, Curitiba, Paraná, Brazil
| | - Ulisses Xavier da Silva Neto
- Department of Endodontics, College of Dentistry, Pontifical Catholic University of Paraná-PUC/PR, Curitiba, Paraná, Brazil
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Kathiria NV, Attur K, Bagda KM, Venkataraghavan KP, Patel K, Mustafa MB, Attur SK. Postendodontic Pain Using Single File System with Different Irrigation Protocols in Single-visit Root Canal Treatment: A Randomized Control Trial. J Contemp Dent Pract 2024; 25:180-185. [PMID: 38514417 DOI: 10.5005/jp-journals-10024-3572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
AIM To evaluate the intensity of postendodontic pain (PEP) using final irrigation with side-vented needle (SV), EndoActivator (EA), and Ultra X (UX) in single-visit endodontics (SVE) with F-One rotary files. MATERIALS AND METHODS A total 150 patients indicated for endodontic treatment were selected. Single-visit endodontics treatment was performed under local anesthesia. For the final irrigation protocol, they were divided into three groups: group I (SV), group II (EA), and group III (UX). The severity of PEP was assessed using visual analogue scale (VAS) score after 6, 12, 24, and 48 hours. Analgesics taken by patients, for pain, were also recorded. Finally, the data were tabulated and statistically analyzed using SPSS 20.0 software at a level of significance being 0.05. RESULTS Postendodontic pain was less in group III (UX) and group II (EA) compared with group I (SV) at 6 and 12 hours, which is statistically significant (p < 0.05). There was no statistically significant difference found after 24 hours and 48 hours. CONCLUSION The intensity of PEP was minimum in patients treated with EndoActivator and ultrasonic along with single rotary file systems. The incidence of analgesic intake was similar in all three groups. How to cite this article: Kathiria NV, Attur K, Bagda KM, et al. Postendodontic Pain Using Single File System with Different Irrigation Protocols in Single-visit Root Canal Treatment: A Randomized Control Trial. J Contemp Dent Pract 2024;25(2):180-185.
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Affiliation(s)
- Nishtha V Kathiria
- Department of Conservative Dentistry and Endodontics, Narsinhbhai Patel Dental College & Hospital, Visnagar, Gujarat, India, Phone: +91 9712994610, e-mail:
| | - Kailash Attur
- Department of Conservative Dentistry and Endodontics, Narsinhbhai Patel Dental College & Hospital, Visnagar, Gujarat, India
| | - Kamal M Bagda
- Department of Conservative Dentistry and Endodontics, Goenka Research Institute of Dental Science, Gandhinagar, Gujarat, India
| | | | - Kiran Patel
- Oral and Maxillofacial Surgery, Shreyas Dental Clinic, Ahmedabad, Gujarat, India
| | - Mohammed B Mustafa
- Department of Conservative Dentistry and Endodontics, Narsinhbhai Patel Dental College & Hospital, Visnagar, Gujarat, India
| | - Shylaja K Attur
- Department of Conservative Dentistry and Endodontics, Narsinhbhai Patel Dental College & Hospital, Visnagar, Gujarat, India
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Zeng C, Hu P, Egan CP, Bergeron BE, Tay F, Ma J. Bacteria debridement efficacy of two sonic root canal irrigant activation systems. J Dent 2024; 140:104770. [PMID: 37923053 DOI: 10.1016/j.jdent.2023.104770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE To evaluate the bacteria debridement efficacy of two generations of sonic root canal irrigant activation systems: EndoActivator (Dentsply Sirona), the first generation, and SmartLite Pro EndoActivator, the second generation. METHODS Instrumented, autoclaved, single-rooted human premolars were inoculated with Enterococcus faecalis (ATCC-29212) for 21 days. The bacteria biofilm-containing teeth were randomly divided into 5 groups (N=8): Group 1: Syringe-side-vented needle (S-N) delivery of saline for 1 min; Group 2: S-N delivery of 2% NaOCl for 1 min; Group 3: S-N delivery of 2% NaOCl for 5 min; Group 4: EndoActivator activation of 2% NaOCl for 1 min; Group 5: SmartLite Pro EndoActivator activation of 2% NaOCl for 1 min. The teeth were evaluated for bacterial reduction using CFU counts, and the percentages of dead bacteria within the dentinal tubules using confocal laser scanning microscopy. RESULTS Activation of NaOCl with EndoActivator or SmartLite Pro EndoActivator significantly reduced the overall intracanal bacterial load, compared with S-N irrigant delivery (P<0.05), with no significant difference between the two agitation devices (P>0.05). Nevertheless, S-N delivery of 2% NaOCl for 5 min produced better bacteria debridement than either sonic agitation system. Different degrees of bacteria kill were identified in the coronal-middle portions and apical portion of the canal space. CONCLUSION Delivery time of NaOCl affects the efficacy of bacteria disinfection. Activation for 1 min with the EndoActivator or SmartLite Pro EndoActivator demonstrated comparable canal wall biofilm and intracanal bacteria reduction efficacy when 2% NaOCl was used as irrigant for disinfecting E. faecalis in single-rooted teeth. CLINICAL SIGNIFICANCE Although the sonic root canal irrigant activation devices investigated do not completely eliminate live bacteria biofilms from the canal space, they help reduce bacteria load during irrigant activation.
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Affiliation(s)
- Chang Zeng
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Pei Hu
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Colin P Egan
- The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian E Bergeron
- The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Franklin Tay
- The Dental College of Georgia, Augusta University, Augusta, GA, USA.
| | - Jingzhi Ma
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Gioster-Ramos ML, Pivoto-João MMB, Pinto JC, Guerreiro-Tanomaru JM, Tanomaru-Filho M. Diamond-coated ultrasonic tip decreases debris and uninstrumented surface after preparation of curved canals with isthmus. Braz Oral Res 2023; 37:e102. [PMID: 38055520 DOI: 10.1590/1807-3107bor-2023.vol37.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/29/2023] [Indexed: 12/08/2023] Open
Abstract
The aim of this study was to evaluate root canal preparation with nickel titanium rotary instruments and complementary preparation with ultrasonic tip in curved canals of mandibular molars with isthmus. Twenty-eight mesial roots of mandibular molars with curvature between 20° and 40° and presence of isthmus throughout the entire extension of the root canals were prepared using ProDesign Logic CM (PDL) up to size 40.05, or HyFlex EDM (HFEDM) up to size 40.04. Complementary preparation was performed in the isthmus region using the ultrasonic insert E18D (Helse, Istmo Diamantada). The root canals were scanned using micro-CT (SkyScan 1176) at 9 µm voxel size before and after each preparation step. Transportation, percentage of increase in volume, debris and uninstrumented surface (UNS) were evaluated. Mann Whitney, Wilcoxon, paired and non-paired t-tests were used for statistical analysis (α = 0.05). The canals prepared with PDL and HFEDM obtained similar results for all the variables assessed before using E18D (p > 0.05). E18D significantly decreased the percentage of debris and UNS values in both Groups (p < 0.05). The complementary preparations with E18D caused a smaller quantity of debris in the isthmus of the canals previously prepared with PDL in comparison with HFEDM (p < 0.05). PDL and HFEDM provided similar root canal preparation. PDL promoted a smaller quantity of Debris in the isthmus than HFEDM after using E18D. E18D significantly improved cleaning, and reduced Debris and UNS.
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Affiliation(s)
- Maria Luiza Gioster-Ramos
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Restorative Dentistry, Araraquara, SP, Brazil
| | | | - Jáder Camilo Pinto
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Restorative Dentistry, Araraquara, SP, Brazil
| | | | - Mário Tanomaru-Filho
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Restorative Dentistry, Araraquara, SP, Brazil
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DUQUE C, SOUZA ACA, AIDA KL, PEREIRA JA, CAIAFFA KS, SANTOS VRD, COSME-SILVA L, PRAKKI A. Synergistic antimicrobial potential of EGCG and fosfomycin against biofilms associated with endodontic infections. J Appl Oral Sci 2023; 31:e20220282. [PMID: 36995882 PMCID: PMC10065763 DOI: 10.1590/1678-7757-2022-0282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the cytotoxicity and synergistic effect of epigallocatechin gallate (EGCG) and fosfomycin (FOSFO) on biofilms of oral bacteria associated with endodontic infections. METHODOLOGY This study determined minimum inhibitory and bactericidal concentration (MIC/MBC) and fractionated inhibitory concentration (FIC) of EGCG and FOSFO against Enterococcus faecalis, Actinomyces israelii, Streptococcus mutans, and Fusobacterium nucleatum. Monospecies and multispecies biofilms with those bacteria formed in polystyrene microplates and in radicular dentin blocks of bovine teeth were treated with the compounds and control chlorhexidine (CHX) and evaluated by bacterial counts and microscopy analysis. Toxicity effect of the compounds was determined on fibroblasts culture by methyl tetrazolium assays. RESULTS The combination of EGCG + FOSFO demonstrated synergism against all bacterial species, with an FIC index ranging from 0.35 to 0.5. At the MIC/FIC concentrations, EGCG, FOSFO, and EGCG+FOSFO were not toxic to fibroblasts. EGCG+FOSFO significantly reduced monospecies biofilms of E. faecalis and A. israelli, whereas S. mutans and F. nucleatum biofilms were eliminated by all compounds. Scanning electron microscopy of multispecies biofilms treated with EGCG, EGCG+FOSFO, and CHX at 100x MIC showed evident biofilm disorganization and substantial reduction of extracellular matrix. Confocal microscopy observed a significant reduction of multispecies biofilms formed in dentin tubules with 84.85%, 78.49%, and 50.6% of dead cells for EGCG+FOSFO, EGCG, and CHX at 100x MIC, respectively. CONCLUSION EGCG and fosfomycin showed a synergistic effect against biofilms of oral pathogens related to root canal infections without causing cytotoxicity.
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Tan L, Liu Q, Chen Y, Zhao YQ, Zhao J, Dusenge MA, Feng Y, Ye Q, Hu J, Ou-Yang ZY, Zhou YH, Guo Y, Feng YZ. Comparison of sealer penetration of sonic activation versus conventional needle irrigation: a systematic review and meta-analysis of randomized controlled trials. BMC Oral Health 2022; 22:566. [PMID: 36463149 PMCID: PMC9719620 DOI: 10.1186/s12903-022-02608-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/21/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Most existing studies comparing the efficiency of sonic irrigation (SI) and conventional needle irrigation (CNI) in increasing the penetration of sealers into dentine tubules are controversial; and this study aimed to determine whether the use of SI can lead to greater sealing ability than CNI, during the root canal treatment. METHODS The EMBASE, PubMed, and Cochrane Library databases were used to find confocal laser scanning microscopy studies evaluating percentage and maximum depth of sealer penetration following the use of SI or CNI in mature permanent teeth until October 2022. The critical estimative checklist of randomized controlled trials of the standardized Joanna Briggs Institute was adopted to independently score the quality of each study. The random-effect model for meta-analysis was used to analyse for each canal segment (apical, middle, coronal). The results are shown in the forest plots as weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). RESULTS Ninety-seven articles were included in the preliminary screening, and nine of them were included in this study. Eight studies were included in the meta-analysis.The meta-analysis exhibited great increases in the coronal (WMD: 8.09, 95% CI 2.78-13.40/WMD: 165.32, 95% CI 128.85-201.80), and middle segments (WMD: 8.81, 95% CI 5.76-11.87/WMD: 132.98, 95% CI 68.71-197.25) for the percentage and maximum depth of sealer penetration, respectively. The percentage of sealer penetration in the apical thirds region was nonsignificant (WMD: 4.73, 95% CI - 2.34-11.80). However, the maximum depth of sealer penetration in the apical thirds region was significant (WMD: 121.46, 95% CI 86.55-156.38). Chi-squared analysis revealed heterogeneity scores of 0.0-70.0% and 44.0-90.0% for the percentage and maximum depth of sealer penetration, respectively. DISCUSSION This review verified that SI significantly improves tubular dentin sealer penetration in most areas of the root canal; thus, SI may lead to better filling efficiency and anti-reinfection effects than CNI during and after the root canal therapy. Nevertheless, a large heterogeneity in the current data comparing the irrigation efficiency of SI versus CNI in the apical third of the root canal was found, implying the necessity to standardize root canal irrigation procedures and obtain more accurate results in this area. TRIAL REGISTRATION INPLASY database (INPLASY202270116).
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Affiliation(s)
- Li Tan
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Qiong Liu
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Yun Chen
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Ya-Qiong Zhao
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Jie Zhao
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Marie Aimee Dusenge
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Yao Feng
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Qin Ye
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Jing Hu
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Ze-Yue Ou-Yang
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Ying-Hui Zhou
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China ,grid.452708.c0000 0004 1803 0208National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China
| | - Yue Guo
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Yun-Zhi Feng
- grid.452708.c0000 0004 1803 0208Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
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Abdelgawad LM, ElShafei NAA, Eissa SA, Ibrahim DY. Efficacy of Photoinduced Photoacoustic Streaming and Diode Laser Irrigation Techniques on Smear Layer Removal, Sealer Penetration and Push-out Bond Strength. J Lasers Med Sci 2022; 13:e12. [DOI: 10.34172/jlms.2022.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022]
Abstract
Introduction: The present study aimed to test the efficiency of photoinduced photoacoustic streaming using 2940 nm Er: YAG laser and 980 nm diode laser agitation on smear layer removal, sealer penetration and push-out bond strength. Methods: Sixty single canaled human permanent teeth were collected for this study. Specimens were grouped into three experimental groups (20 teeth in each group), depending on the activation protocol used for final irrigation: Group I (needle agitation), group II (980nm diode laser agitation) and group III (photon induced photoacoustic streaming (PIPS) using 2940 nm Er: YAG laser. The quantity of irrigant was standardized in all groups to 4 ml. The irrigant was activated for 40 seconds in different groups under continuous flow. Two teeth from each group were used to check the smear layer removal, and then the remaining teeth in each group were randomly divided into three equal experimental subgroups according to methods of evaluation used: subgroup A: Sealing ability evaluated by dye penetration method; subgroup B: SEM for sealer penetration; and subgroup C: Push-out bond strength assessed by the universal test machine. Results: As regards smear layer removal, results showed that the PIPS group had opened dentinal tubules, followed by the diode laser group, while the least cleaning effect was found in the Side-vented needle group. As for Sealing ability and dye penetration, a statistically significant difference was found between all of the three groups, with the Er:YAG laser (PIPS) having the best sealing ability and sealer penetration. Push-out bond strength results showed no statistically significant difference between diode and Er:YAG groups, with a significant difference between each of them and the Side-vented needle group. Conclusion: Using the diode or Er:YAG laser (PIPS) for irrigant activation led to better irrigant penetration and smear layer removal which subsequently led to obvious sealer penetration, better sealing, and strength properties of endodontic treated teeth.
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Affiliation(s)
- Latifa Mohamed Abdelgawad
- Dental Laser Applications Department, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Egypt
| | - Nancy Attia Ahmed ElShafei
- Restorative and Dental Materials department, Oral and Dental Research Division, National Research Centre, Cairo, Egypt
| | - Somaia Abdlatif Eissa
- Meical Microbiology and Immunology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Yahia Ibrahim
- Restorative and Dental Materials department, Oral and Dental Research Division, National Research Centre, Cairo, Egypt
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Wong J, Manoil D, Näsman P, Belibasakis GN, Neelakantan P. Microbiological Aspects of Root Canal Infections and Disinfection Strategies: An Update Review on the Current Knowledge and Challenges. FRONTIERS IN ORAL HEALTH 2022; 2:672887. [PMID: 35048015 PMCID: PMC8757850 DOI: 10.3389/froh.2021.672887] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
The oral cavity is the habitat of several hundreds of microbial taxa that have evolved to coexist in multispecies communities in this unique ecosystem. By contrast, the internal tissue of the tooth, i.e., the dental pulp, is a physiologically sterile connective tissue in which any microbial invasion is a pathological sign. It results in inflammation of the pulp tissue and eventually to pulp death and spread of inflammation/infection to the periradicular tissues. Over the past few decades, substantial emphasis has been placed on understanding the pathobiology of root canal infections, including the microbial composition, biofilm biology and host responses to infections. To develop clinically effective treatment regimens as well as preventive therapies, such extensive understanding is necessary. Rather surprisingly, despite the definitive realization that root canal infections are biofilm mediated, clinical strategies have been focused more on preparing canals to radiographically impeccable levels, while much is left desired on the debridement of these complex root canal systems. Hence, solely focusing on "canal shaping" largely misses the point of endodontic treatment as the current understanding of the microbial aetiopathogenesis of apical periodontitis calls for the emphasis to be placed on "canal cleaning" and chemo-mechanical disinfection. In this review, we dissect in great detail, the current knowledge on the root canal microbiome, both in terms of its composition and functional characteristics. We also describe the challenges in root canal disinfection and the novel strategies that attempt to address this challenge. Finally, we provide some critical pointers for areas of future research, which will serve as an important area for consideration in Frontiers in Oral Health.
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Affiliation(s)
- Jasmine Wong
- Discipline of Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Daniel Manoil
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Peggy Näsman
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Georgios N Belibasakis
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Prasanna Neelakantan
- Discipline of Endodontology, Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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Zeng C, Everett J, Sidow S, Bergeron BE, Tian F, Ma J, Tay FR. In vitro evaluation of efficacy of two endodontic sonic-powered irrigant agitation systems in killing single-species intracanal biofilms. J Dent 2021; 115:103859. [PMID: 34706267 DOI: 10.1016/j.jdent.2021.103859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy of two sonic-powered irrigation systems, EDDY and EndoActivator, in killing intracanal biofilms. METHODS Eighty-three instrumented, autoclaved single-rooted human premolars were inoculated with Enterococcus faecalis (ATCC-29212) for 21 days to generate mature, single-species biofilms. The teeth were devided into four groups: irrigation with saline (N = 11); irrigation with 2% NaOCl without agitation (N = 24); irrigation with 2% NaOCl with agitation by the EndoActivaor (N = 24); irrigation with 2% NaOCl with agitation by the EDDY (N = 24). Colony-forming unit (CFU) counts and XTT assay were used to evaluate bacterial load. Additional teeth were split into root-halves for fluorescence staining to examine the percentages of live/dead bacteria in the dentinal tubules present in different canal locations (coronal, mid-root and apical portions). RESULTS Agitation of 2% NaOCl by EDDY or EndoActivator reduced bacteria load more proficiently than the use of 2%NaOCl without agitation (p < 0.05). No significant difference was detected between the two sonic-powered irrigant agitation systems (p > 0.05). Confocal laser scanning microscopy indicated that both devices had better intratubular bacteria killing efficacy than the use of 2% NaOCl only in all parts of the canal space (p < 0.05), with no significant difference detected between EDDY and EndoActivator (p > 0.05). Elimination of intracanal and intratubular bacteria were less efficient in the apical portion of the canal space for all experimental groups. CONCLUSION The two sonic-powered irrigant activation systems demonstrated comparable intracanal bacteria reduction efficacy when 2% NaOCl was used for disinfecting E. faecalis biofilms in single-rooted teeth. CLINICAL SIGNIFICANCE With the use of 2% NaOCl as irrigant, the EDDY and EndoActivator sonic-powered irrigant agitation systems have improved and equivalent intracanal bacteria reduction efficacy but are incapable of completely killing all bacteria that resided within the dentinal tubules of root canals.
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Affiliation(s)
- Chang Zeng
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Joseph Everett
- The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Stephanie Sidow
- The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian E Bergeron
- The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Fucong Tian
- The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Jingzhi Ma
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Franklin R Tay
- The Dental College of Georgia, Augusta University, Augusta, GA, USA.
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Choi MJ, Kim MA, Choi Y, Neelakantan P, Yu MK, Min KS. A novel three-dimensionally printed model to assess biofilm removal by ultrasonically activated irrigation. Int Endod J 2021; 54:1871-1877. [PMID: 34043827 DOI: 10.1111/iej.13579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 02/05/2023]
Abstract
AIM To apply an innovative three-dimensionally printed tooth model to investigate the efficacy of three ultrasonically activated irrigation (UAI) systems in removing multispecies biofilms from dentine samples. METHODOLOGY Three-dimensionally printed teeth with a curved root canal were fabricated with a standardized slot in the apical third of the root to achieve precision fit of human root dentine specimens. Multispecies biofilms including Enterococcus faecalis, Streptococcus mitis and Campylobacter rectus were developed in the root canal for 21 days. The canals were allocated to be irrigated with 1% sodium hypochlorite (NaOCl) using a syringe and needle or ultrasonically activated NaOCl with a stainless-steel file (Irrisafe), a conventional nickel-titanium (Ni-Ti) file (CK) or a blue heat-treated Ni-Ti file (Endosonic Blue). Infected root canals irrigated with distilled water served as controls. Bacterial reduction was determined by colony-forming unit (CFU) counting (n = 20), whilst biofilms were analysed using confocal laser scanning microscopy (n = 7) and field emission scanning electron microscopy. For CFU counting, the independent two-sample t-test (Welch's t-test) was examined to compare overall bacterial reduction amongst groups. For CLSM analysis, the data were analysed using one-way analysis of variance (ANOVA), followed by the Scheffé post hoc test. The p-values <.05 were considered to indicate statistical significance. RESULTS All groups in which NaOCl was ultrasonically activated had significantly lower CFU values than the syringe-and-needle irrigation and control groups (p < .05). Ultrasonic activation with the stainless-steel file and blue heat-treated Ni-Ti file significantly reduced the biofilm volume compared with other groups (p < .05). Overall, UAI with the blue heat-treated file resulted in the highest antibacterial and biofilm removal efficacy. CONCLUSIONS UAI with different inserts had differential antibiofilm effects. The blue heat-treated Ni-Ti ultrasonic insert resulted in the greatest antibacterial and biofilm removal from dentine in this standardized root canal model.
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Affiliation(s)
- Min-Ji Choi
- Department of Conservative Dentistry, School of Dentistry, Jeonbuk National University, Jeonju, Korea
| | - Mi-Ah Kim
- Department of Conservative Dentistry, School of Dentistry, Jeonbuk National University, Jeonju, Korea
| | - Yoorina Choi
- Department of Conservative Dentistry, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Prasanna Neelakantan
- Discipline of Endodontology, Department of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Mi-Kyung Yu
- Department of Conservative Dentistry, School of Dentistry, Jeonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Kyung-San Min
- Department of Conservative Dentistry, School of Dentistry, Jeonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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