Abstract
Purpose: This study compared the antimicrobial efficacy of calcium silicate sealers (BioRoot RCS and Total Fill BC) and conventional sealers (AH Plus and Tubli-seal) against planktonic bacteria and a nutrient-stressed multispecies biofilm. Methods: Antimicrobial properties of freshly mixed sealers were investigated using the direct contact test (DCT) and a nutrient-stressed multispecies biofilm comprised of five endodontic strains. Antimicrobial activity was determined using quantitative viable counts and confocal laser scanning microscopy (CLSM) analysis with live/dead staining. The pH of the sealers was analysed over a period of 28 days in Hanks Balanced Salt Solution (HBSS). Analysis of variance (ANOVA) with Tukey tests and the Kruskal–Wallis test were used for data analysis with a significance of 5%. Results: All endodontic sealers exhibited significant antimicrobial activity against planktonic bacteria (p < 0.05). BioRoot RCS caused a significant reduction in viable counts of the biofilms compared to AH Plus and the control (p < 0.05), while no significant difference could be observed compared to TotalFill BC and Tubli-seal (p > 0.05). CLSM analysis showed that BioRoot RCS and TotalFill BC exhibited significant biofilm inhibition compared to Tubli-seal, AH Plus and the control (p < 0.05). BioRoot RCS presented with the highest microbial killing, followed by TotalFill BC and Tubli-seal. Alkalizing activity was seen from the onset by BioRoot RCS, TotalFill BC and AH Plus. After 28 days, BioRoot RCS demonstrated the highest pH in HBSS (pH > 12). Conclusions: Calcium silicate sealers exhibited effective antimicrobial properties. This was demonstrated by superior biofilm inhibition capacity and microbial killing, with strong alkalizing activity compared to epoxy-based and zinc oxide-eugenol-based sealers.
Highlights
The primary aetiology of endodontic disease is the microbial infection of the root canal system [1,2]
Multispecies bacterial colonies exist within the infected root canal in the form of biofilms [3], making them resistant to antimicrobial agents [4]
Residual microbes remaining at the obturation stage can have a significant effect on the outcome of endodontic treatment, leading to persisting infections [6]
Summary
The primary aetiology of endodontic disease is the microbial infection of the root canal system [1,2]. Calcium silicate sealers have been commercially available for over a decade and are mainly based on tricalcium silicate, dicalcium silicate and tricalcium phosphate They have been shown to have superior bioactive and physiochemical in comparison to zinc oxide-eugenol and epoxy resin-based sealers [11,12,13].The antimicrobial efficacy of hydraulic calcium silicate sealers has been investigated using in vitro tests, including the direct contact test (DCT) [11,14] and mono-species biofilm models, reporting promising antimicrobial activity of calcium silicate sealers [15,16,17,18]. Nutrient-stressed multispecies endodontic biofilm model has been developed and used in previous studies [20,21] This biofilm model simulates the in vivo environment of endodontic infections by being mature and polymicrobial and including nutritionally stressed microorganisms relevant to the endodontic microbiome
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