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Moon CY, Nam OH, Kim M, Lee HS, Kaushik SN, Cruz Walma DA, Jun HW, Cheon K, Choi SC. Effects of the nitric oxide releasing biomimetic nanomatrix gel on pulp-dentin regeneration: Pilot study. PLoS One 2018; 13:e0205534. [PMID: 30308037 PMCID: PMC6181396 DOI: 10.1371/journal.pone.0205534] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
Successful disinfection alongside complete endodontic tissue regeneration and revascularization are the most desired clinical outcomes of regenerative endodontics. Despite reported clinical successes, significant limitations to the current regenerative endodontic procedure (REP) have been elucidated. To improve the current REP, an antibiotics and nitric oxide (NO) releasing biomimetic nanomatrix gel was developed. The study evaluates antibacterial effects of an antibiotics and NO releasing biomimetic nanomatrix gel on multispecies endodontic bacteria. Antibiotics, ciprofloxacin (CF) and metronidazole (MN) were mixed and encapsulated within the NO releasing biomimetic nanomatrix gel. The gel was synthesized and self-assembled from peptide amphiphiles containing various functional groups. Antibacterial effects of the antibiotics and NO releasing biomimetic nanomatrix gel were evaluated using bacterial viability assays involving endodontic microorganisms including clinical samples. Pulp-dentin regeneration was evaluated via animal-model experiments. The antibiotics and NO releasing biomimetic nanomatrix gel demonstrated a concentration dependent antibacterial effect. In addition, NO alone demonstrated a concentration dependent antibacterial effect on endodontic microorganism. An in vivo analysis demonstrated the antibiotics and NO releasing biomimetic nanomatrix gel promoted tooth revascularization with maturation of root canals. An optimal concentration of and NO releasing nanomatrix gel is suggested for its potential as a root treatment material for REP and an appropriate protocol for human trials. Further investigation is required to obtain a larger sample size and decide upon ideal growth factor incorporation.
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Affiliation(s)
- Chan-Yang Moon
- Department of Pediatric Dentistry, Kyung Hee University, Seoul, Korea
| | - Ok Hyung Nam
- Department of Pediatric Dentistry, Kyung Hee University, Seoul, Korea
| | - Misun Kim
- Department of Pediatric Dentistry, Kyung Hee University, Seoul, Korea
| | - Hyo-Seol Lee
- Department of Pediatric Dentistry, Kyung Hee University, Seoul, Korea
| | - Sagar N. Kaushik
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - David A. Cruz Walma
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ho-Wook Jun
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kyounga Cheon
- Department of Pediatric Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail: (SCC); (KC)
| | - Sung Chul Choi
- Department of Pediatric Dentistry, Kyung Hee University, Seoul, Korea
- * E-mail: (SCC); (KC)
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Kaushik SN, Kim B, Walma AMC, Choi SC, Wu H, Mao JJ, Jun HW, Cheon K. Biomimetic microenvironments for regenerative endodontics. Biomater Res 2016; 20:14. [PMID: 27257508 PMCID: PMC4890532 DOI: 10.1186/s40824-016-0061-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/24/2016] [Indexed: 12/16/2022] Open
Abstract
Regenerative endodontics has been proposed to replace damaged and underdeveloped tooth structures with normal pulp-dentin tissue by providing a natural extracellular matrix (ECM) mimicking environment; stem cells, signaling molecules, and scaffolds. In addition, clinical success of the regenerative endodontic treatments can be evidenced by absence of signs and symptoms; no bony pathology, a disinfected pulp, and the maturation of root dentin in length and thickness. In spite of the various approaches of regenerative endodontics, there are several major challenges that remain to be improved: a) the endodontic root canal is a strong harbor of the endodontic bacterial biofilm and the fundamental etiologic factors of recurrent endodontic diseases, (b) tooth discolorations are caused by antibiotics and filling materials, (c) cervical root fractures are caused by endodontic medicaments, (d) pulp tissue is not vascularized nor innervated, and (e) the dentin matrix is not developed with adequate root thickness and length. Generally, current clinical protocols and recent studies have shown a limited success of the pulp-dentin tissue regeneration. Throughout the various approaches, the construction of biomimetic microenvironments of pulp-dentin tissue is a key concept of the tissue engineering based regenerative endodontics. The biomimetic microenvironments are composed of a synthetic nano-scaled polymeric fiber structure that mimics native pulp ECM and functions as a scaffold of the pulp-dentin tissue complex. They will provide a framework of the pulp ECM, can deliver selective bioactive molecules, and may recruit pluripotent stem cells from the vicinity of the pulp apex. The polymeric nanofibers are produced by methods of self-assembly, electrospinning, and phase separation. In order to be applied to biomedical use, the polymeric nanofibers require biocompatibility, stability, and biodegradability. Therefore, this review focuses on the development and application of the biomimetic microenvironments of pulp-dentin tissue among the current regenerative endodontics.
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Affiliation(s)
- Sagar N Kaushik
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, USA
| | - Bogeun Kim
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, USA
| | - Alexander M Cruz Walma
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, USA
| | - Sung Chul Choi
- Department of Pediatric Dentistry, Kyung Hee University, Seoul, South Korea
| | - Hui Wu
- Department of Pediatric Dentistry, University of Alabama at Birmingham, SDB 311, 1720 2nd Ave South, Birmingham, AL 35294-0007 USA
| | - Jeremy J Mao
- Center for Craniofacial Regeneration at Columbia University, New York City, NY USA
| | - Ho-Wook Jun
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, USA
| | - Kyounga Cheon
- Department of Pediatric Dentistry, University of Alabama at Birmingham, SDB 311, 1720 2nd Ave South, Birmingham, AL 35294-0007 USA
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Kaushik SN, Scoffield J, Andukuri A, Alexander GC, Walker T, Kim S, Choi SC, Brott BC, Eleazer PD, Lee JY, Wu H, Childers NK, Jun HW, Park JH, Cheon K. Evaluation of ciprofloxacin and metronidazole encapsulated biomimetic nanomatrix gel on Enterococcus faecalis and Treponema denticola. Biomater Res 2015; 19:9. [PMID: 26257918 PMCID: PMC4527351 DOI: 10.1186/s40824-015-0032-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/02/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A triple antibiotic mixture (ciprofloxacin; CF, metronidazole; MN, and minocycline; MC) has been used for dental root canal medicaments in pulp regeneration therapy. However, tooth discolorations, cervical root fractures, and inadequate pulp-dentin formation have been reported due to the triple antibiotic regimen. Therefore, an antibiotic encapsulated biomimetic nanomatrix gel was developed to minimize the clinical limitations and maximize a natural healing process in root canal infections. In this study, minimal bacterial concentrations (MBC) of the selected antibiotics (CF and MN) were tested in 14 representative endodontic bacterial species. Then MBC of each CF and MN were separately encapsulated within the injectable self-assembled biomimetic nanomatrix gel to evaluate antibacterial level on Enterococcus faecalis and Treponema denticola. RESULTS Antibiotic concentrations lower than 0.2 µg/mL of CF and MN demonstrated antibacterial activity on the 14 endodontic species. Furthermore, 6 different concentrations of CF and MN separately encapsulated with the injectable self-assembled biomimetic nanomatrix gel demonstrated antibacterial activity on Enterococcus faecalis and Treponema denticola at the lowest tested concentration of 0.0625 µg/mL. CONCLUSIONS These results suggest that each CF and MN encapsulated within the injectable self-assembled biomimetic nanomatrix gel demonstrated antibacterial effects, which could be effective for the root canal disinfection while eliminating MC. In the long term, the antibiotic encapsulated injectable self-assembled biomimetic nanomatrix gel can provide a multifunctional antibiotic delivery method with potential root regeneration. Further studies are currently underway to evaluate the effects of combined CF and MN encapsulated within the injectable self-assembled biomimetic nanomatrix gel on clinical samples.
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Affiliation(s)
- Sagar N Kaushik
- />Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL USA
| | - Jessica Scoffield
- />Department of Pediatric Dentistry, University of Alabama at Birmingham, SDB 304B, 1720 2nd Ave S, Birmingham, AL 35294-0007 USA
| | - Adinarayana Andukuri
- />Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL USA
| | - Grant C Alexander
- />Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL USA
| | - Taneidra Walker
- />Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL USA
| | - Seokgon Kim
- />Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Sung Chul Choi
- />Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Brigitta C Brott
- />Cardiovascular Division, School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Paul D Eleazer
- />Department of Endodontics, University of Alabama at Birmingham, Birmingham, AL USA
| | - Jin-Yong Lee
- />Department of Maxillofacial Biomedical Engineering, Kyung Hee University, Seoul, Korea
| | - Hui Wu
- />Department of Pediatric Dentistry, University of Alabama at Birmingham, SDB 304B, 1720 2nd Ave S, Birmingham, AL 35294-0007 USA
| | - Noel K Childers
- />Department of Pediatric Dentistry, University of Alabama at Birmingham, SDB 304B, 1720 2nd Ave S, Birmingham, AL 35294-0007 USA
| | - Ho-Wook Jun
- />Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL USA
| | - Jae-Hong Park
- />Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL USA
- />Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Kyounga Cheon
- />Department of Pediatric Dentistry, University of Alabama at Birmingham, SDB 304B, 1720 2nd Ave S, Birmingham, AL 35294-0007 USA
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