Cold Plasma Therapy of a Tooth Root Canal Infected with Enterococcus faecalis Biofilms In Vitro

Abstract

IntroductionComplete sterilization of an infected root canal is an important challenge in endodontic treatment. Traditional methods often cannot achieve high-efficiency sterilization because of the complexity of the root canal system. The objective of the study was to investigate in vitro the feasibility of using a cold plasma treatment of a root canal infected with Enterococcus faecalis biofilms. MethodsSeventy single-root teeth infected with E. faecalis biofilms were divided into 7 groups. Group 1 served as the negative control group (no treatment), and group 7 was the positive control group with teeth treated with calcium hydroxide intracanal medication for 7 days. Groups 2 to 6 included teeth treated by cold plasma for 2, 4, 6, 8, and 10 minutes, respectively. The disinfection of the E. faecalis biofilm was evaluated by colony-forming unit (CFU) counting. Scanning electron microscopy was used to evaluate the structural changes of the E. faecalis biofilm before and after plasma treatment. Confocal scanning laser microscopy was used to investigate the vitality of the microorganisms in the biofilm before and after plasma treatment. ResultsA significant decrease in the number of CFUs was observed after prolonged cold plasma treatment (based on the statistical analysis of the teeth in groups 2–6). Compared with the positive control group, cold plasma treatment of 8 or 10 minutes (groups 5 and 6) had a significantly higher antimicrobial efficacy (P < .05). The scanning electron microscopic analysis showed that the bacteria membrane was ruptured, and the structure of the biofilm was fully destroyed by the plasma. Confocal scanning laser microscopic studies indicated that the plasma treatment induced E. faecalis death and destruction of the biofilm. ConclusionsThe cold plasma had a high efficiency in disinfecting the E. faecalis biofilms in in vitro dental root canal treatment.