Abstract
Successful disinfection alongside complete endodontic tissue regeneration and revascularization are the most desired clinical outcomes of regenerative endodontics. Despite reported clinical successes, significant limitations to the current regenerative endodontic procedure (REP) have been elucidated. To improve the current REP, an antibiotics and nitric oxide (NO) releasing biomimetic nanomatrix gel was developed. The study evaluates antibacterial effects of an antibiotics and NO releasing biomimetic nanomatrix gel on multispecies endodontic bacteria. Antibiotics, ciprofloxacin (CF) and metronidazole (MN) were mixed and encapsulated within the NO releasing biomimetic nanomatrix gel. The gel was synthesized and self-assembled from peptide amphiphiles containing various functional groups. Antibacterial effects of the antibiotics and NO releasing biomimetic nanomatrix gel were evaluated using bacterial viability assays involving endodontic microorganisms including clinical samples. Pulp-dentin regeneration was evaluated via animal-model experiments. The antibiotics and NO releasing biomimetic nanomatrix gel demonstrated a concentration dependent antibacterial effect. In addition, NO alone demonstrated a concentration dependent antibacterial effect on endodontic microorganism. An in vivo analysis demonstrated the antibiotics and NO releasing biomimetic nanomatrix gel promoted tooth revascularization with maturation of root canals. An optimal concentration of and NO releasing nanomatrix gel is suggested for its potential as a root treatment material for REP and an appropriate protocol for human trials. Further investigation is required to obtain a larger sample size and decide upon ideal growth factor incorporation.
Highlights
Dental pulp tissue exposed to mechanical trauma or cariogenic processes can result in infection of the root canal system and/or periapical tissues
The purpose of this study is to evaluate a mixture of antibiotics (CF and MN) and the nitric oxide (NO) releasing biomimetic nanomatrix gel by measuring: a) antibiotic and NO release characteristics, b) antibacterial activities, and c) regenerative activities using beagle’s teeth as a model
Antibacterial effect of the NO releasing nanomatrix gel in vitro To evaluate the antibacterial effects of the antibiotics and NO releasing nanomatrix gel, four different concentrations (25, 50, 100, and 200 μg/mL) of peptide amphiphiles (PAs)-YK-NO were tested on a 24-hour culture of E. faecalis
Summary
Dental pulp tissue exposed to mechanical trauma or cariogenic processes can result in infection of the root canal system and/or periapical tissues. Due to the immature root structure of permanent teeth with open apices, treatment has historically occurred via an apexification or apexogenesis procedure using calcium hydroxide (CH) and expecting an adequate apical seal [4,5,6]. Mineral trioxide aggregate (MTA) has begun to supplant CH owing to its improved sealing effect and prognosis [7, 8]. The use of MTA is more predictable and significantly decreases the number of treatment appointments [9, 10]
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