Abstract
Endodontic infection is a biofilm disease that is difficult to irradicate with current treatment protocols, and as such, persistent micro-organisms may lead to ongoing or recurrent disease. The potential for the use of enhanced filling materials to modify biofilm regrowth is a promising strategy. This current study aimed to evaluate the anti-biofilm efficacy of calcium silicate cements modified with chitosan. The development of mono-species and multi-species biofilms on ProRoot MTA, Biodentine and bovine dentine discs were explored using quantitative microbiology analysis. The effect on regrowth of biofilms was assessed following the addition of chitosan to each cement. In comparison to a dentine substrate, both materials did not show the ability to inhibit biofilm regrowth. Biodentine incorporated with chitosan displayed a dose-dependent reduction in multi-species biofilm regrowth, unlike MTA. Notably, interkingdom biofilms were shown to enhance bacterial tolerance in the presence of chitosan. This study demonstrates the potential to enhance the antimicrobial properties of Biodentine. The findings highlight the need for appropriate model systems when exploring antimicrobial properties of materials in vitro so that interspecies and interkingdom interactions that modify tolerance are not overlooked while still supporting the development of innovative materials.
Highlights
Endodontic infection, in the form of biofilms, have been visualised colonising necrotic and treated root canals [1,2,3]
For Candida and bacteria formed on controls were approximately 1 × log10 less when compared with colonies formed on the tested materials, this did not reach statistical significance for viable cells
Alent (CFE) for Candida and bacteria formed on controls were approxi14 mately 1 × log10 less when compared with colonies formed on the tested materials,3 of this did not reach statistical significance for viable cells
Summary
Endodontic infection, in the form of biofilms, have been visualised colonising necrotic and treated root canals [1,2,3]. Despite chemo-mechanical disinfection, a significant challenge faced by dental cements used in the filling of the root canal space is the presence of persistent microorganisms [7]. In response to the challenges faced in sealing the root canal space, calcium-silicatebased materials have grown in prominence. A variety of new formulations of purer calcium-silicate-based materials have been developed based on tricalcium silicate chemistry [9]. These are termed bioceramics and are used primarily in endodontics [10]. Amongst this group of materials is Biodentine. These materials are indicated for a variety of endodontic procedures, including perforation repairs, regenerative endodontic procedures, retrograde obturation, vital pulp therapy and management of immature permanent teeth, similar applications to those outlined for MTA [11]
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