Antimicrobial Efficacy of Contemporary Obturating Materials used in Primary Teeth- An In-vitro Study

Evaluating antimicrobial activity and cytotoxicity of silver nanoparticles incorporated into reinforced zinc oxide eugenol: an in vitro study

PURPOSE

This study aimed to evaluate the antibacterial and cytotoxic effects of reinforced zinc oxide-eugenol (rZOE) incorporated with different concentrations of silver nanoparticles (AgNPs).

METHODS

The pastes of rZOE alone or mixed with AgNPs at concentrations of 1%, 2%, and 5% of weight were prepared. In vitro antimicrobial activity of prepared materials against Streptococcus (S.) mutans and Lactobacillus (L.) acidophilus were evaluated after 2, 4, and 6 h of contact times using direct contact test (DCT) and also following 24 h incubation by well-diffusion test (WDT). The cytotoxicity of the tested materials on human dental pulp stem cells was also determined by MTT assay.

RESULTS

The DCT demonstrated that the time-dependent reductions of the colony numbers of both bacteria by three different concentrations of AgNPs incorporated into rZOE were equal but steeper than the rZOE alone (P < 0.05). The increases in growth inhibition zones of S. mutans and L. acidophilus were associated with the increasing concentration of AgNPs mixed with rZOE in the WDT; however, statistical analysis did not show any significant differences (P = 0.092). The MTT assay revealed a significantly lower percentage of cell viability after 1 day of culture only with the rZOE + AgNP5% in comparison to the rZOE alone (P = 0.011) and the control medium (P = 0.001).

CONCLUSION

Since the antimicrobial activities of three different concentrations of AgNPs incorporated into rZOE were equal and AgNPs had lower toxicity at lower concentrations, using AgNPs at 1% concentration is suggested to be mixed with rZOE.

Efficacy of non-instrumental Endodontic treatment in primary teeth: a systematic review of clinical randomized trials

BACKGROUND

Endodontic therapy in pediatric dentistry is a challenging procedure, especially for special needs, uncooperative, and very young patients. A new conservative approach which is the non-instrumental endodontic treatment (NIET) has been developed to simplify the management of primary teeth requiring pulpectomy. This review aimed to compare the efficiency of NIET and conventional endodontic treatment in primary teeth.

METHODS

Electronic databases including MEDLINE (via PubMed), Cochrane Library (CENTRAL), and Scopus without restrictions on publication year or publication language were searched. Only randomized clinical trials reporting clinical and radiographical outcomes of NIET and conventional pulpectomy on primary teeth were considered eligible. Two reviewers extracted the data according to the PRISMA statement and assessed the bias risk using the revised Cochrane risk-of-bias tool and a meta-analysis was performed.

RESULTS

From 3322 screened articles, seven articles meeting the inclusion criteria were included. The selected studies included 283 primary molars, of 213 children aged between 3 and 9 years, treated by NIET and conventional pulpectomy, and had follow-up periods ranging from 1 month to tooth exfoliation. Two studies reported good success rates for both the NIET technique and endodontic therapy with no statistically significant difference while three studies showed radiographical significant differences with a low success rate for the NIET technique. Only one study reported better outcomes in the pulpectomy group with statistically significant differences. The quantitative grouping of the included studies showed no significant differences between NIET and conventional endodontic therapy regarding clinical and radiographical success (p value > 0.05).

CONCLUSION

No difference between the NIET technique and the conventional endodontic therapy in primary molars requiring pulpectomy could be confirmed. Results of the present review need to be interpreted with caution since the quality of evidence according to the GRADE was considered as moderate to very low. Therefore, additional clinical trials on the NIET technique are recommended.

Evaluation of antibacterial effects of different intracanal medicaments on Enterococcus faecalis in primary teeth: An in vitro study

OBJECTIVES

Successful endodontic therapy is based on the reduction of infecting bacteria by cleaning, shaping, and disinfecting of the root canal system, thus the use of intracanal dressing is necessary for optimal success of root canal treatment. This study was designed to evaluate the effect of chitosan and propolis as intracanal medicaments against Enterococcus faecalis compared to calcium hydroxide in primary root canals.

MATERIAL AND METHODS

Ninety-six extracted primary second molars were collected. Teeth preparation was completed to size 30 K-file. They were randomly divided into four groups; (A): chitosan, (B): propolis, (C): calcium hydroxide, and (D): control group (saline). The tooth specimens were inoculated with E. faecalis. Then, tested materials were applied for all groups in accordance to the groups each tooth belonged to. Following this, the bacterial colonies were counted after 24 h, 72 h, and 1 week of applying dressing materials and incubation. Finally, one-way analysis of variance and Fisher's least significant difference tests were used for statistical comparisons between the groups at a significance level of .05.

RESULTS

No statistically significant difference was found between groups A, B, and C for both 24 h and a week (p ≥ .05). Yet, a statistical difference between groups A, B, C, and D after 72 h and 1 week were seen (p ≤ .05).

CONCLUSIONS

Chitosan and propolis medicaments were as effective as calcium hydroxide against E. faecalis in primary root canal treatment and might be considered as an alternative dressing material between treatment sessions.

Hematological and Biochemical Responses of Newly Formulated Primary Root Canal Obturating Material: An In Vivo Study

Background and objective Any drug or medicinal agent, when implanted into the body, gets biotransformed by various organ systems and the toxic byproducts of this process alter the normal physiological process. In this experimental study, we aimed to quantify the safety of newly formulated primary root canal obturating material by investigating the hematological and biochemical parameters related to liver function. Methodology Forty-eight Wistar rats (weighing 250-350 grams) were classified into three groups (n=16) through random allocation. Preoperative blood samples were collected by puncturing the orbital venous plexus, the values of which were used as control. Zinc oxide eugenol (ZOE), calcium hydroxide iodoform paste (Metapex), and newly formulated triple antibiotic obturating paste (TAOP) were implanted (100 µg) into dorsal connective tissues. Blood samples on the seventh, 15th, and 30th postoperative days were evaluated respectively by analyzing hematological, hepatic, and, renal function tests for acute and chronic inflammatory responses. Results  The intra-group and inter-group comparisons among all the test materials after seven days exhibited high significance in terms of hemoglobin (Hb), mean corpuscular volume (MCV), neutrophils, and serum glutamic-oxaloacetic transaminase (SGOT) (p<0.001), while others showed mixed responses (p<0.05 to p>0.05). After 15 days, the comparisons showed high significance with respect to packed cell volume (PCV), mean cell volume (MCV), and serum creatinine (p<0.001), while others showed significant to nonsignificant differences (p<0.05 to p>0.05). At the end of 30 days, all the parameters showed mixed responses (p<0.001 to p>0.05). Conclusion The newly formulated obturating material TAOP showed lower adverse hematological, hepatic, and renal effects in experimental animals compared to other test materials, with most parameters reverting to normal after 30 days.

Evaluation of the Antibacterial Activity of Triclosan-incorporated Root Canal Filling Materials for Primary Teeth against Enterococcus faecalis

Aim and objective

To compare the antibacterial activity of root canal filling materials namely zinc oxide eugenol and Endoflas FS with or without the incorporation of Triclosan.

Materials and methods

The study consisted of four groups, with 15 samples in each group: group I (zinc oxide eugenol paste), group Ia (zinc oxide eugenol paste + 2.5% Triclosan), group II (Endoflas FS), and group IIa (Endoflas FS + 2.5% Triclosan). A double layer agar well diffusion test was used to evaluate the antibacterial activity against Enterococcus faecalis. The zones of microbial inhibition were measured at the end of 24 hours, 6th day, and 29th day.

Results

On intergroup comparison, the difference in the antibacterial activity was found to be highly significant (p < 0.001). Among the various groups evaluated, group IIa showed the highest antibacterial activity against E. faecalis followed by group II, group Ia, and the least activity being shown by group I throughout the experimental periods. On intragroup comparison at different time intervals, a maximum zone of inhibition was seen at 24 hours with a p value < 0.05 in all the tested groups.

Conclusion

Incorporation of 2.5% triclosan into zinc oxide eugenol and Endoflas FS enhanced the antimicrobial activity of both the root canal filling materials with lasting antimicrobial activity even at the end of the 29th day.

Clinical significance

The antimicrobial efficacy of a root canal filling material is an ideal requirement, which will help in combating the residual microflora present in the root canal system following chemomechanical preparation. The addition of an antimicrobial agent such as triclosan to the root canal filling materials, enhances their antimicrobial efficacy significantly and thus, rendering the pulpectomy-treated tooth with a better prognosis.

How to cite this article

Deepak BM, Prabhakar AR, Karuna YM, et al. Evaluation of the Antibacterial Activity of Triclosan-incorporated Root Canal Filling Materials for Primary Teeth against Enterococcus faecalis. Int J Clin Pediatr Dent 2021;14(3):393–397.

Comparison of Modified Triple Antibiotic Paste in Two Concentrations for Lesion Sterilization and Tissue Repair in Primary Molars: An In Vivo Interventional Randomized Clinical Trial

Introduction

"Lesion sterilization and tissue repair" (LSTR) is a non-instrumentation endodontic treatment modality that has recently gained popularity with promising results in several clinical trials. However, there is a dearth of evidence regarding the concentration of modified triple antibiotic paste (MTAP) to be used for the procedure.

Aim and objective

To compare the clinical and radiographic efficacy of 1 mg/mL and 1 g/mL concentrations of MTAP (ciprofloxacin, metronidazole, and clindamycin) used in LSTR of primary molars.

Materials and methods

Sixty-four infected primary molars in children between 4 years and 10 years of age were randomly allocated to two groups. Lesion sterilization and tissue repair at 1 mg/mL concentration of MTAP (group I) and 1 g/mL concentration of MTAP (group II) was performed. Clinical and radiographic outcomes were evaluated using Coll and Sadrian's criteria at 10 days, 1 month, and 3 months and the results were tabulated.

Statistical analysis

The data obtained were subjected to statistical analysis with IBM. SPSS statistics software 23.0 Version. To test the significance in categorical data, a Chi-square test was used. The probability value of 0.05 was considered significant.

Results

At the end of 3 months review, clinical success rates of group I and group II were 84.4 and 90.6%, respectively, and radiographic evaluation showed group I-78.1% and group II-90.6%.

Conclusion

Both 1 mg/mL and 1 g/mL concentrations of MTAP used in LSTR of primary molars had similar success rates with no statistically significant difference.

Clinical significance

Lesion sterilization and tissue repair when found to be equally effective in less concentration may aid in achieving adequate infection control with the least detrimental effect on the remaining vital pulp and periradicular structures. In addition, this circumvents the systemic administration of potent antibiotics thus combating antibiotic resistance.

How to cite this article

Shankar K, Ramkumar H, Dhakshinamoorthy S, et al. Comparison of Modified Triple Antibiotic Paste in Two Concentrations for Lesion Sterilization and Tissue Repair in Primary Molars: An In Vivo Interventional Randomized Clinical Trial. Int J Clin Pediatr Dent 2021;14(3):388-392.

Local Drug Delivery Systems for Vital Pulp Therapy: A New Hope

Vital pulp therapy (VPT) is deliberated as an ultraconservative/minimally invasive approach for the conservation of vital pulpal tissues, preservation of dental structure, and maintenance of tooth function in the oral cavity. In VPT, following the exposure of the dental pulp, the environment is prepared for the possible healing and probable refunctionalisation of pulpal connective tissue. However, to succeed in VPT, specific biomaterials are used to cover and/or dress the exposed pulp, lower the inflammation, heal the dental pulp, provoke the remaining odontoblastic cells, and induce the formation of a hard tissue, i.e., the dentinal bridge. It can be assumed that if the employed biomaterial is transferred to the target site using a specially designed micro-/nanosized local drug delivery system (LDDS), the biomaterial would be placed in closer proximity to the connective tissue, may be released in a controlled and sustained pattern, could properly conserve the remaining dental pulp and might appropriately enhance hard-tissue formation. Furthermore, the loaded LDDS could help VPT modalities to be more ultraconservative and may minimise the manipulation of the tooth structure as well as pulpal tissue, which could, in turn, result in better VPT outcomes.

Clinical and radiographic evaluation of pulpectomy in primary teeth: a 18-months clinical randomized controlled trial

BACKGROUND

To avoid untoward changes when primary teeth are replaced by permanent teeth, resorption of the material used in primary teeth root canal filling should occur at the same rate as root resorption. The Aim of this study was to compare the success rates of a mixed primary root canal filling (MPRCF, ingredients: zinc oxide-eugenol [ZOE], iodoform, calcium hydroxide) to those of ZOE and Vitapex in pulpectomised primary molars.

METHODS

One hundred and sixty primary molars from 155 children (average age 5.88 ± 1.27 years) underwent two-visit pulpectomy using one of the three materials. The clinical and radiographic findings at 6, 12 and 18 months were assessed.

RESULTS

At 6 and 12 months, the MPRCF and ZOE success rates were 100%. The Vitapex group showed clinical success rate and radiographic success rate of 100 and 94.5% at 6 months, and 80.4 and 60.7% at 12 months. The 18-month clinical success rates of the MPRCF, ZOE and Vitapex were 96.2, 92.2 and 71.4% and radiographic success rates were 92.5, 88.2 and 53.6%, respectively. There was a statistically significant difference in the success rates between MPRCF and Vitapex and no significant differences between MPRCF and ZOE. More MPRCF were resorbed at same rate with roots than ZOE and Vitapex. Early resorption of root filling resulted in more failure.

CONCLUSIONS

The mixture of ZOE, iodoform and calcium hydroxide can be considered an effective root canal filling material in pulp involved primary teeth and had no adverse effect on tooth replacement.

TRIAL REGISTRATION

ChiCTR-TRC-14004938 . Registered 13 July 2014.

Herbal combat against E. faecalis - An in vitro study

BACKGROUND

Herbs have renewed importance in this modern era for their antimicrobial properties and fewer side effects. So a novel idea to use these herbs for pulpectomy; was implemented. There are chances of failure of pulpectomy due to inefficient removal of microbial load. Thus, for a successful endodontic treatment, obturating material with optimum antimicrobial properties is advocated in the present study.

AIM

To compare and evaluate the antibacterial efficacy of zinc oxide eugenol, zinc oxide with tulsi extract and zinc oxide with aloe vera as obturating materials against E. faecalis bacteria.

MATERIALS AND METHODS

Antimicrobial efficacy of zinc oxide eugenol as control, zinc oxide with tulsi extract and zinc oxide with aloe vera as experimental groups were assessed by using agar diffusion method. The statistical analysis was done.

RESULTS

Intergroup comparison revealed significant difference amongst all the groups except between zinc oxide eugenol and zinc oxide with tulsi extract. Zinc oxide eugenol had significantly higher zone of inhibition among all the groups.

CONCLUSION

According to results obtained from the present study can be summarized as follows: Zinc oxide eugenol > Zinc oxide with tulsi extract > Zinc oxide with aloe vera.