Bacterial Colonization and Proliferation in Furcal Perforations Repaired by Different Materials: A Confocal Laser Scanning Microscopy Study

Shlomo Elbahary,Cemre Koç,Sohad Haj Yahya,Igor Tsesis,Hagay Shemesh,Eyal Rosen

doi:10.3390/app11083403

Abstract

Following furcal perforation, bacteria may colonize the defect and cause inflammation and periodontal destruction. This study used confocal laser scanning microscopy (CLSM) to evaluate Enterococcus faecalis colonization and proliferation in furcal perforations repaired with different materials. Furcal perforations created in 55 extracted human mandibular molars were repaired using either MTA-Angelus, Endocem, or Biodentine and coronally subjected to E. faecalis suspension for 21 days. The specimens were then stained using a LIVE/DEAD Viability Kit and visualized by CLSM. The minimum and maximum depths of bacterial penetration into the dentinal tubules were 159 and 1790 μM, respectively, with a mean of 713 μM. There were significantly more live than dead bacteria inside the dentinal tubules (p = 0.0023) in all groups, and all three repair materials exhibited a similarly sized stained area (p = 0.083). However, there were significant differences in the numbers of dead bacteria at the circumference of the perforation defect (p = 0.0041), with a significantly higher ratio of live to dead bacteria in the MTA-Angelus group (p = 0.001). Following perforation repair, bacteria may colonize the interface between the repair material and dentin and may penetrate through the dentinal tubules. The type of repair material has a significant effect on the viability of the colonizing bacteria.

Highlights

Perforation can be defined as an artificial communication between the root canal space and the surrounding tooth tissue, or oral environment [1]
Perforations can be pathological or iatrogenic [1,2]. Various factors, such as time elapsed before perforation repair, location or size of the perforation, the repair material used, and the experience of the operator, may all affect the treatment outcome [1,3,4,5]
Understanding the sealing ability of materials used in the repair of perforations and predicting the amount and direction of bacterial leakage are of paramount importance in addressing the pathologies related to perforations [25,26]

Summary

Introduction

Perforation can be defined as an artificial communication between the root canal space and the surrounding tooth tissue (periodontium), or oral environment [1]. Perforations can be pathological (caused by root resorption or caries) or iatrogenic (as a result of dental procedures during access cavity preparation, canal negotiation, or post space preparation) [1,2]. The main goal of perforation management is to seal the defect in order to prevent bacterial contamination, inflammation, and loss of periodontal attachment and to prepare an optimal environment for tissue repair. In this context, the sealing ability and marginal adaptation of the repair material used are crucial in preventing the leakage of irritants and enhancing the chances of success [6,7,8].

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Discussion

Conclusion