Comparative Evaluation of Dental Pulp Tissue Dissolution Ability of Sapindus mukorossi and Sodium Hypochlorite

Background The Sapindus mukorossi (SM) extract has been reported to possess antibacterial, antifungal, anti-inflammatory, and antioxidant characteristics. However, there is limited research demonstrating the effectiveness of SM in dissolving dental pulp tissue. Methods In an in vitro investigation, pulp tissue samples were extracted from human teeth, collectively weighing 144 mg. These samples were divided equally and activated by manual digital agitation (MDA) or ultrasonic (US) irrigation for three 30-second cycles with a resting period of 45 seconds between each activation. The samples in each group were sub-categorized into a set of three groups based on the treatment received as normal saline (NS), 5.25% sodium hypochlorite (Hypo), or Sapindus mukorossi (SM). Statistical tests, including the student t-test and one-way analysis of variance (ANOVA), were employed to compare the mean weight differences among the groups, with a significance level set at p ≤ 0.05 for all comparisons. Results The one-way analysis of variance (ANOVA) and independent t-test revealed significant intergroup differences (p<0.05). Turkey's post hoc analysis indicated significant distinctions, particularly when comparing Hypo with the other two irrigants, namely Hypo-NS (p<0.05) and Hypo-SM (p<0.05) when the MDA method was employed. Considering only the method adopted, the US technique was significantly superior (p=0.04) to the MDA. Conclusion Sapindus mukorossi (SM) demonstrated efficacy in dissolving pulp tissue but was not as effective as sodium hypochlorite (Hypo) which is the standard agent for root canal irrigation. SM to be used as an alternative to Hypo on clinical grounds needs further validation from research.

Bromelain-based endodontic irrigant: preparation, properties, and biocompatibility: An in-vitro study

The aim of the study was to determine the properties, efficacy and biocompatibility of combining bromelain enzyme, chlorohexidine and EDTA (BCE) to create a novel endodontic irrigant. Fourier transform infrared spectrometry was performed to confirm the stability of the BCE and direct contact inhibition test was performed to determine antibacterial action. Baseline pH and surface tension of irrigants was compared with determine stability. Subcutaneous injection to dorsal skin of rabbits was graded for presence of inflammation, oedema, granulation and fibrosis. BCE caused less overall irritation, less oedematous and was earlier to heal than 2.5% NaOCl. The pH stability of BCE was also superior to 2.5% NaOCl. A one-way ANOVA test was performed for the direct contact inhibition and microleakage test. A significant difference was determined (p ≤ 0.05) between BCE and 2.5% NaOCl for antibacterial action. BCE irrigant is effective in preparing dentinal surfaces for root canal without adverse effects and promising longevity.

Effect of Various Irrigant Activation Methods and Its Penetration in the Apical Third of Root Canal-In Vitro Study

OBJECTIVE

 The objective of this study was to evaluate the irrigant penetration using iohexol dye with four irrigation techniques.

METHODOLOGY

 Single-rooted premolars were recently extracted and preserved in physiological saline solution. All the samples were standardized to 16 mm. Standard endodontic access was prepared using endoaccess bur (Dentsply Maillefer, Switzerland). The initial patency was established using #10 k file (Mani, Utsunomiya, Tochigi, Japan) to the working length. The cleaning and shaping were performed using the file system ProFit S3 in the following sequence: P0 (orifice enlarger), PF1 (yellow), PF2 (red) #25, and PF3 (blue) #30. The samples were randomly allocated in concealed opaque envelopes into four groups. This was performed by a trained dentist. Fifteen samples were allocated to one group. The groups were divided as follows: Group A-conventional needle (CN), Group B-side-vented needle (SVN), Group C-manual dynamic agitation (MDA), and Group D-EndoActivator (EA). The radiopaque dye irrigant agitation/activation was performed by one operator to prevent operator bias. Following irrigation using the different techniques, digital radiographs were taken, and the measurement was taken from the apical foramen to the point where the dye had penetrated apically for each tooth and the data were entered into an Excel sheet for all the four groups.

RESULTS

 Comparing the four groups, there was a statistically significant difference among the four groups (p < 0.05), thus, favoring the alternate hypothesis. EA had resulted in better penetration of the irrigant compared with the other three groups (p < 0.05).

CONCLUSION

 It was evident that irrigant penetration was best achieved with the use of an EA followed by MDA, SVNs, and then the CN when the preparation was done till size 30 (PF3 #30) using ProFit S3 rotary file system.

Quercetin as an Auxiliary Endodontic Irrigant for Root Canal Treatment: Anti-Biofilm and Dentin Collagen-Stabilizing Effects In Vitro

Bacterial reinfection and root fracture are the main culprits related to root canal treatment failure. This study aimed to assess the utility of quercetin solution as an adjunctive endodontic irrigant that does not weaken root canal dentin with commitment anti-biofilm activity and bio-safety. Based on a noninvasive dentin infection model, dentin tubules infected with Enterococcus faecalis (E. faecalis) were irrigated with sterile water (control group), and 0, 1, 2, 4 wt% quercetin-containing ethanol solutions. Live and dead bacteria percentages in E. faecalis biofilms were analyzed by confocal laser scanning microscopy (CLSM). Elastic modulus, hydroxyproline release and X-ray photoelectron spectroscopy (XPS) characterization were tested to evaluate the irrigants’ collagen-stabilizing effect. The cytotoxicity was tested by CCK-8 assay. Quercetin increased the proportion of dead bacteria volumes within E. faecalis and improved the flexural strength of dentin compared to control group (p < 0.05). Quercetin-treated dentin matrix had less elasticity loss and hydroxyproline release after collagenase degradation (p < 0.05). Moreover, quercetin solutions revealed an increase in the C-O peak area under both C1s and O1s narrow-scan spectra of XPS characterization, and no cytotoxicity (p > 0.05). Quercetin exhibited anti-biofilm activity, a collagen-stabilizing effect with cytocompatibility, supporting quercetin as a potential candidate for endodontic irrigant.

Evaluation of Cytotoxicity and Antibacterial Activity of a New Class of Silver Citrate-Based Compounds as Endodontic Irrigants

In the present study, the cytotoxicity and the antimicrobial activity of two silver citrate-based irrigant solutions were investigated. Cytotoxicity of various concentrations (0.25%, 0.5%, 1%, 2.5%, 5%) of both solutions (BioAKT and BioAKT Endo) was assessed on L-929 mouse fibroblasts using the MTT assay. For the quantitative analysis of components, an infrared (I.R.) spectroscopy was performed. The minimum inhibitory and minimal bactericidal concentrations (M.I.C. and M.B.C., respectively) were ascertained on Enterococcus faecalis strain ATCC 4083. For biofilm susceptibility after treatment with the irrigating agent, a minimum biofilm eradication concentration (M.B.E.C.) and confocal laser scanning microscope (C.L.S.M.) assays were performed. Quantification of E. faecalis cell biomass and percentage of live and dead cells in the biomass was appraised. Normality of data was analyzed using the D’Agostino & Pearson’s test and the Shapiro–Wilk test. Statistical analysis was performed using one-way analysis of variance (ANOVA) and Tukey’s test. Both silver citrate solutions showed mouse fibroblasts viability >70% when diluted to 0.25% and 0.5%. Conversely, at higher concentrations, they were extremely cytotoxic. F.T.-IR spectroscopy measurements of both liquids showed the same spectra, indicating similar chemical characteristics. No substantial contrast in antimicrobial activity was observed among the two silver citrate solutions by using broth microdilution methods, biofilm susceptibility (MBEC-HTP device), and biomass screening using confocal laser scanning microscopy (C.L.S.M.) technique. Both solutions, used as root canal irrigants, exhibited significant antimicrobial activity and low cytocompatibility at dilutions greater than 0.5%.

Comparison of antibacterial efficacy of cinnamon extract, neem extract as irrigant and sodium hypochlorite against Enterococcus fecalis: An in vitro study

Aim

The aim of the study is to compare the antibacterial effectiveness between cinnamon extract as irrigant with neem extract irrigant and sodium hypochlorite against E. fecalis.

Materials and Methods

The present study is a randomized controlled in vitro study conducted on 60 extracted permanent single rooted teeth. The teeth were divided into three groups- Group 1 was irrigated with cinnamon extract, Group 2 was irrigated with neem extract irrigant and Group 3 with 3% sodium hypochlorite. The colonies in the reduction of E. feacalis was noted as CFU values per ml. Wilcoxon signed ranked test was used to compare in between the three groups. Mann- Whitney's test was used for inter group comparison between the three groups.

Results

Cinnamon extract had the maximum reduction in the CFU colonies followed by sodium hypochlorite. Neem extract irrigant had the least reduction in the colonies of E. feacalis. (P < 0.05).

Conclusion

Cinnamon extract irrigant show better reduction in E. fecalis as compared to 3% sodium hypochlorite and neem extract irrigant.

The antibiofilm and collagen-stabilizing effects of proanthocyanidin as an auxiliary endodontic irrigant

AIM

To evaluate the antibiofilm effect of proanthocyanidin (PA) solution as an irrigant against Enterococcus faecalis (E. faecalis) and its influence on the mechanical properties and biodegradation resistance of demineralized root dentine.

METHODOLOGY

Enterococcus faecalis were introduced into human root dentine tubules by a serial centrifugation method and grown for 1 week. Dentine blocks infected with 1-week-old E. faecalis biofilms were treated with the following irrigants: sterile water (control), 2% chlorhexidine (CHX), 2% PA, 5% PA and 10% PA. After treatment, the live and dead bacteria proportions within E. faecalis biofilms were analysed using confocal laser scanning microscopy. To evaluate the biostability of fully demineralized dentine treated by the aforementioned irrigants, the elastic modulus and hydroxyproline release of human dentine incubated in collagenase solution were tested at baseline, after irrigant treatment and after biodegradation, respectively. Furthermore, the surface chemical bond of demineralized dentine collagen treated by various irrigants was characterized by X-ray photoelectron spectroscopy (XPS). Statistical analysis was performed using one-way anova and Tukey's post hoc multiple comparisons with the significance level at 5%.

RESULTS

The proportion of dead E. faecalis volume was significantly higher in the PA and CHX groups than that in the control group (P < 0.05). PA irrigation significantly increased the mechanical properties of demineralized dentine (P < 0.05), and the effect was enhanced with increasing PA concentration. CHX and PA groups had significantly less elasticity loss and hydroxyproline release (P < 0.05). The biomodification of dentine collagen by PA was verified by increased C-O/C-N peak percentage under C1s and C-O peak percentage under O1s narrow-scan XPS spectra.

CONCLUSIONS

Proanthocyanidin killed E. faecalis within biofilms and enhanced the biostability of the collagen matrix of demineralized root dentine. It might be used as an auxiliary endodontic irrigant with antibiofilm and collagen-stabilizing effects.

Exploring the role of Morinda citrifolia and Triphala juice in root canal irrigation: An ex vivo study

Background:

The present ex vivo study explores the role of Indian medicaments in endodontic irrigation in an attempt to search for a safe alternative to sodium hypochlorite (NaOCL).

Aim:

To evaluate the efficacy of commercial preparations of Morinda citrifolia juice (MCJ) and Triphala juice against Enterococcus faecalis and Candida albicans.

Materials and Methods:

The study was conducted on 84 permanent extracted human teeth. After decoronation and biomechanical preparation, inoculated (with E. faecalis and C. albicans) root sections were divided randomly into four experimental (MCJ, Triphala juice, 1% NaOCl, and 2% chlorhexidine [CHX]) and two control groups (preservative control and distilled water). Colony-forming units (CFUs) obtained for each group were counted at baseline (S₀) and after irrigation at 1 and 3 days (S₁and S₂, respectively). Mean of Log CFU at S₀, S₁, and S₂was compared for each irrigant using Friedman's two-way ANOVA.

Results:

There was a significant decrease in microbial counts of both microbes in all groups at S₁, but only CHX could demonstrate further decrease in the microbial counts of both microorganisms at S₂.

Conclusion:

The overall antimicrobial effects of different irrigants were maximum for CHX, whereas MCJ and Triphala juice also showed significant reductions. The herbal irrigants hold the promise of becoming efficient irrigants and warrant further research.

High-purity Nisin Alone or in Combination with Sodium Hypochlorite Is Effective against Planktonic and Biofilm Populations of Enterococcus faecalis

INTRODUCTION

Nisin, a broad-spectrum bacteriocin, has recently been highlighted for its biomedical applications. To date, no studies have examined the antimicrobial and antibiofilm properties of high-purity (>95%) nisin (nisin ZP) on Enterococcus faecalis and biofilms formed by this species. We hypothesize that nisin can inhibit E. faecalis and reduce biofilm biomass, and combinations of nisin and sodium hypochlorite (NaOCl) will enhance the antibiofilm properties against E. faecalis biofilms.

METHODS

Using broth cultures, disc diffusion assays, and biofilm assays, we examined the effects of nisin on various E. faecalis growth parameters and biofilm properties (biovolume, thickness, and roughness). Confocal microscopy was used in conjunction with Imaris and Comstat2 software (Kongens Lyngby, Copenhagen, Denmark) to measure and analyze the biofilm properties.

RESULTS

Nisin significantly decreased the growth of planktonic E. faecalis dose dependently. The minimum inhibitory concentrations against E. faecalis strains OG-1 and ATCC 29212 were 15 and 50 μg/mL, and the minimum bactericidal concentrations were 150 and 200 μg/mL, respectively. A reduction in biofilm biovolume and thickness was observed for biofilms treated with nisin at ≥10 μg/mL for 10 minutes. In addition, the combination of nisin with low doses of NaOCl enhanced the antibiofilm properties of both antimicrobial agents.

CONCLUSIONS

Nisin alone or in combination with low concentrations of NaOCl reduces the planktonic growth of E. faecalis and disrupts E. faecalis biofilm structure. Our results suggest that nisin has potential as an adjunctive endodontic therapeutic agent and as an alternative to conventional NaOCl irrigation.

Effect of various endodontic solutions on punch out strength of Resilon under cyclic loading

Background:

Before obturation, various endodontic solutions are used as a final rinse. These solutions might affect the bond strength of Resilon-Epiphany system. The aim of this study was to evaluate the effect of NaOCl (5.25%), chlorhexidine CHX (2%), EDTA solution (17%), and BioPure MTAD on push out bond strength of Resilon-Epiphany system.

Materials and Methods:

Seventy-five human premolar roots were prepared and divided on the basis of final endodontic solution rinse. The canals were obturated with Resilon-Epiphany system. All samples were restored using a fiber post system and indirect composite crown. The samples received 150 000 cycles of mechanical loading. Push out bond strength was performed in the apical third of root having Resilon obturation.

Results and Conclusions:

Different endodontic solutions tested, did not affected the push out bond strength of Resilon-Epiphany obturation system.

Effect of manual dynamic activation on smear layer removal efficacy of ethylenediaminetetraacetic acid and SmearClear: an in vitro scanning electron microscopic study

The purpose of the present study was to evaluate the effect of manual dynamic activation (MDA) with a master gutta-percha point on the smear layer removal efficacy of 17% ethylenediaminetetraacetic acid (EDTA) and SmearClear. Fifty freshly extracted human single-rooted teeth were prepared using ProTaper rotary system up to F3 size. The prepared teeth were divided into five groups on the basis of final irrigation received. Group A: 3% NaOCl solution (negative control group). Group B: 5 mL of 17% EDTA. Group C: 1 mL of 17% EDTA + MDA for 2 min + 4 mL of 17% EDTA rinse. Group D: 5 mL of SmearClear. Group E: 1 mL of SmearClear + MDA for 2 min + 4 mL of SmearClear rinse. Prepared samples were decoronated and then longitudinally split into two halves and evaluated under scanning electron microscope. Representative images at coronal, middle and apical third level were taken and scored for the amount of smear layer present, using a three-score system. The data were analysed through Kruskal-Wallis and Mann-Whitney U-test. The root canal surfaces of samples of group C and group E (where MDA was done) were significantly cleaner in apical third regions than those of group B and group D (P < 0.05).