Root Canal Disinfection Research Articles

Effect of microbubble as local drug delivery system in endodontic management - An In-Vitro study

Background and ObjectivesMicrobubbles (MBs) are gas or vapor-filled cavities inside liquids with sizes ranging from 2 to 3 µm. Recently, MBs have shown great promise in nanomedicine owing to their high encapsulation efficiency, targeted drug release, improved biocompatibility, and longer blood circulation. Furthermore, they are more suitable for focusing on particular body regions and are safer and non-invasive. MBs generators are used to create bubbles in fluid dynamics, chemistry, medicine, agriculture, and the environment. Drug delivery using MBs increases penetration without causing systemic toxicity.In this study, we examined whether the use of microbubbles as a local drug-delivery mechanism increases tubular penetration of endodontic medications and irrigant. Materials and MethodsAn Enterococcus faecalis culture was added to 38 dentin cylinders of single-rooted teeth. Samples were divided into the experimental and control groups that received a triple antibiotic paste with and without MB infusion (n = 19 in each group), respectively. After 14 days, the number of live bacteria in the samples was determined using confocal laser scanning microscopy. ResultsAfter 14 days of contact with the medication, the percentages of live and dead bacteria were assessed. Results show that Group 2 (Triple antibiotic infused micro bubble) showed significantly (P < 0.05) higher antibacterial efficacy than Group 1 (TAP). ConclusionIn this study, the antibacterial efficacy was significantly higher in the experimental group than in the control group. Therefore, within the limitations of the study it can be said that MB infusion is a viable technique to improve root canal disinfection. Hence, it can be considered as a novel technique for local drug delivery systems in endodontic management.

Revascularization of immature permanent teeth with peri-apical lesions- A case series

When immature permanent teeth become non-vital, the prognosis of the teeth is compromised. Disinfection and obturation of root canals with open apices can be challenging. Revascularization is a useful tool for the treatment of permanent teeth with necrosed pulp and open apex. Clinically, Revascularization procedures consist of disinfection by intra-canal medicaments followed by inducing blood clot in the root canal or implantation of autologous fibrin matrices like PRP/PRF. Such procedures may improve prognosis of necrosed teeth with open apices. Existing studies indicate that regenerative procedures lead to increase in length and wall thickness of radicular dentin. This article presents a case series of three cases where revascularization procedures were successfully carried out.

Efficiency of different irrigation protocols on Cleanliness and disinfection of root canal (An In-vitro study)

Efficiency of different irrigation protocols on Cleanliness and disinfection of root canal (An In-vitro study)

The ability of different diffusing enhancers to deliver chlorhexidine into dentinal tubules: An in vitro evaluation

Background/purposeRoot canal irrigants are difficult to diffuse deep into the dentinal tubules for root canal disinfection. The purpose of this study was to assess the ability of different diffusing enhancers to deliver chlorhexidine (CHX) into dentinal tubules. Materials and methodsThe diffusing property of five diffusing enhancers (acetone, DMSO, Triton X-100, JFC-E and azone) into dentinal tubules was firstly assessed using the Rhodamine B. The ability of the diffusing enhancers to deliver CHX into dentinal tubules was then evaluated both qualitatively and quantitatively. A deep dentinal tubule Enterococcus faecalis infection model was further established to test the bactericidal effect of CHX delivered by different diffusing enhancers. Finally, the in vitro cytotoxicity of these diffusing enhancers was tested using the CCK-8 method. ResultsAzone, Triton X-100 and JFC-E exhibited the largest maximum diffusing depths at all root canal parts (P < 0.05). Azone group also showed the highest percentage of diffusing depths for all root canal parts, followed by Triton X-100 (P < 0.05). The percentage of dead bacteria in dentinal tubules close to cementum layer was significantly higher in the CHX + azone group than in the other groups (P < 0.05), followed by CHX + Triton X-100 and CHX + JFC-E groups. The concentration of CHX diffusing onto the exterior surface of root was significantly higher in CHX + azone group than in the other groups (P < 0.05). All the diffusing enhancers showed relatively low cytotoxicity. ConclusionAzone showed the highest diffusing ability with low cytotoxicity and might be employed as a carrier agent for either intracanal irrigants or medications to achieve more thorough root canal disinfection.

Leaf Extracts of Moringa oleifera Cultivated in Baghdad: Characterization and Antimicrobial Potential against Endodontic Pathogens.

The use of medicinal plant preparations to clean and disinfect root canal infection is gaining popularity. The aim of this study was to evaluate the bioactive composition of leaf extracts of Moringa oleifera plants cultivated in Iraq (specifically Baghdad) and their antimicrobial activity against selected root canal pathogens for potential application in endodontic treatment. Materials and Methods. Moringa leaf extracts were prepared either through cold maceration or warm digestion techniques to perform an ethanolic or aqueous extraction, respectively. Phytochemical detection was performed before thin layer chromatography (TLC) and high-performance liquid chromatography (HPLC) to measure flavonoids and phenolic compounds within both extracts. Then, their antimicrobial activities were investigated against Streptococcus mutans, Enterococcus faecalis, and Candida albicans through minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), and agar well diffusion assay in comparison to NaOCl and Ca(OH)2. Results. Phytochemical screening showed several active ingredients but with higher expression of flavonoids and phenolic compounds. Also, different types of these compounds were detected through TLC and quantified by HPLC. MIC values for ethanolic extract against Streptococcus mutans, Enterococcus faecalis, and Candida albicans were 60, 65, and 55, respectively, while for aqueous extract, MIC values were 70, 80, and 50, respectively. Aqueous extract showed a higher inhibition zone than ethanolic extract for both Streptococcus mutans and Enterococcus faecalis with a statistically significant difference (p ≤ 0.001) for all tested materials except with NaOCl and Ca(OH)2 in Streptococcus mutans and Enterococcus faecalis, respectively. The ethanolic extract showed a higher inhibition zone against Candida albicans, with a statistically significant difference (p ≤ 0.001) for all tested materials. Conclusion. Ethanolic and aqueous extracts of Moringa oleifera leaves cultivated in Baghdad contain considerable quantities of phytochemicals, especially flavonoid and phenolic compounds, and demonstrated antimicrobial activities against selected endodontic pathogens. Therefore, Moringa leaf extracts could be suggested as an alternative antimicrobial material in endodontic treatment.

The efficacy of 2780 nm Er,Cr;YSGG and 940 nm Diode Laser in root canal disinfection: A randomized clinical trial

ObjectivesEffective disinfection of the root canals is the cornerstone of successful endodontic treatment. Diminishing the microbial load within the root canal system is crucial for healing in endodontically treated teeth. The aim of this study was to evaluate the effect of 2780 nm Er,Cr:YSGG and 940 nm diode lasers on the eradication of microorganisms from single-rooted teeth with asymptomatic apical periodontitis.Materials and MethodsThirty participants conforming to the inclusion criteria were randomly divided into 3 groups according to the disinfection protocol used; Conventional group: 2.5% Sodium Hypochlorite (NaOCl) and 17% EDTA solution NaOCl/EDTA, Dual laser group: 2780 nm Erbium, chromium: yttrium scandium-gallium-garnet (Er,Cr:YSGG) laser and 940 nm diode laser Er,CrYSGG/Diode, and Combined group: 17% EDTA and 940 nm diode laser EDTA/Diode. Bacterial samples were collected before and after intervention. The collected data were statistically analyzed using Friedman’s test and Kruskal–Wallis test (P ≤ 0.05).ResultsThe results of the study showed that both dual laser Er,CrYSGG/Diode and combined laser EDTA/Diode groups showed significantly less mean Log10 CFU/ml of aerobic and anaerobic bacterial counts than the conventional NaOCl/EDTA group.ConclusionsIn this study we evaluated in vivo the bactericidal efficacy of three disinfection protocols for endodontic treatment of single-rooted teeth with apical periodontitis. The results indicated that both dual laser Er,CrYSGG/Diode and combined laser EDTA/Diode groups provide superior bactericidal effect compared to the conventional NaOCl/EDTA group.Clinical relevanceThe integration of lasers into root canal disinfection protocols has demonstrated significant bacterial reduction which might promote healing and long-term success.

In vitro efficacy of Er:YAG laser-activated irrigation versus passive ultrasonic irrigation and sonic-powered irrigation for treating multispecies biofilms in artificial grooves and dentinal tubules: an SEM and CLSM study

BackgroundMultispecies biofilms located in the anatomical intricacies of the root canal system remain the greatest challenge in root canal disinfection. The efficacy of Er:YAG laser-activated irrigation techniques for treating multispecies biofilms in these hard-to-reach areas has not been proved. The objective of this laboratory study was to evaluate the effectiveness of two Er:YAG laser-activated irrigation techniques, namely, photon-induced photoacoustic streaming (PIPS) and shock wave-enhanced emission photoacoustic streaming (SWEEPS), in treating multispecies biofilms within apical artificial grooves and dentinal tubules, in comparison with conventional needle irrigation (CNI), passive ultrasonic irrigation (PUI), and sonic-powered irrigation (EDDY). Two types of multispecies root canal biofilm models were established in combination with two assessment methods using scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) with the aim to obtain more meaningful results.MethodsNinety extracted human single-rooted premolars were chosen for two multispecies biofilm models. Each tooth was longitudinally split into two halves. In the first model, a deep narrow groove was created in the apical segment of the canal wall. After cultivating a mixed bacterial biofilm for 4 weeks, the split halves were reassembled and subjected to five irrigation techniques: CNI, PUI, EDD, PIPS, and SWEEPS. The residual biofilms inside and outside the groove in Model 1 were analyzed using SEM. For Model 2, the specimens were split longitudinally once more to evaluate the percentage of killed bacteria in the dentinal tubules across different canal sections (apical, middle, and coronal thirds) using CLSM. One-way analysis of variance and post hoc multiple comparisons were used to assess the antibiofilm efficacy of the 5 irrigation techniques.ResultsRobust biofilm growth was observed in all negative controls after 4 weeks. In Model 1, within each group, significantly fewer bacteria remained outside the groove than inside the groove (P < 0.05). SWEEPS, PIPS and EDDY had significantly greater biofilm removal efficacy than CNI and PUI, both from the outside and inside the groove (P < 0.05). Although SWEEPS was more effective than both PIPS and EDDY at removing biofilms inside the groove (P < 0.05), there were no significant differences among these methods outside the groove (P > 0.05). In Model 2, SWEEPS and EDDY exhibited superior bacterial killing efficacy within the dentinal tubules, followed by PIPS, PUI, and CNI (P < 0.05).ConclusionEr:YAG laser-activated irrigation techniques, along with EDDY, demonstrated significant antibiofilm efficacy in apical artificial grooves and dentinal tubules, areas that are typically challenging to access.

Enhancing Antimicrobial Efficacy and Synergistic Effects of Nano-Silica-Based Combinations With Doxycycline, Metronidazole, and Ciprofloxacin Against Enterococcus faecalis Biofilms.

Enterococcus faecalisbiofilm formation within root canals poses a challenging problem in endodontics, often leading to treatment failure. To combat this issue, nanotechnology offers a promising avenue for enhancing antimicrobial efficacy. This study explores the potential synergistic effects of combining nanoscale silica particles with conventional antibiotics, including doxycycline, metronidazole, and ciprofloxacin, against E. faecalis biofilms. The unique characteristics of silica nanoparticles, such as their increased reactivity and ability to be functionalized with other compounds, make them ideal candidates for augmenting antibiotic efficacy. This research investigates the antimicrobial properties of these silica-based combinations and their potential to eliminate or inhibit E. faecalis biofilms more effectively than conventional treatments. Methodology: The methods involved the preparation of nanostructured silica particles and their combination with doxycycline, Flagyl, and ciprofloxacin at subinhibitory concentrations. These combinations were then tested against E. faecalis biofilms using the agar well diffusion technique. Preliminary results suggested that the synergistic interactions between silica nanoparticles and antibiotics can significantly enhance antimicrobial efficacy. The combined treatment exhibited superior inhibitory effects on E. faecalis compared to antibiotics or silica nanoparticles alone (P< 0.05). Conclusions: This study sheds light on the potential of nanoscale silica-based combinations to address the challenges posed by E. faecalis biofilms in endodontics. Understanding the mechanisms of synergy between nanoparticles and antibiotics can pave the way for the development of more effective and targeted strategies for root canal disinfection, ultimately improving the success rates of endodontic treatments.

Effectiveness of curcumin as photodynamic therapy for endodontic procedures: a narrative review

Endodontic therapy is performed by biomechanical preparation and intracanal medication; however, residual bacteria can be compromised due to their ability to adhere to the root canal walls. Therefore, photodynamic therapy has gained popularity because of its good ability to prevent and eradicate microbial infections by using a light-activated dye. Objective: Analyze and to update the information on the effect of curcumin in photodynamic therapy in root canal treatment. A literature search was carried out in PubMed/MEDLINE, Scopus, Ebsco, Science Direct, and LILACS databases using the keywords "curcumin", "turmeric", "photodynamic", "photochemotherapy", "photoradiation", "photoactivated disinfection", "root canal disinfection", "root canal therapy", "endodontics" in both Spanish and English, from 2018 to 2023. Information from the last five years was collected with the aim of updating the study topic. 749 articles were examined using inclusion and exclusion criteria, of which only 50 met these criteria and were analyzed. Current studies show the effects of therapy on the contamination of the root canal biofilm with E. faecalis, demonstrating that photoactivated curcumin promotes the disruption of the biofilm and reduction of Colony-Forming Units. Curcumin as a photosensitizer demonstrates a potential antibacterial effect significantly decreasing the viability of microbial cells and the vitality of biofilms.

Investigation of the Potential of Nanoparticles as a New Drug Delivery System for Endodontic Treatment: An In Vitro Study

ABSTRACT Background: Endodontic treatment involves the removal of infected dental pulp and subsequent disinfection of the root canal system. The effectiveness of drug delivery systems in root canal disinfection is critical for successful treatment outcomes. This in vitro study explores the potential of nanoparticles as a novel drug delivery system for endodontic treatment Materials and Methods: Nanoparticles were synthesized using a biocompatible polymer and loaded with an antimicrobial agent. A total of 60 extracted human teeth were prepared to create standardized root canal infections. The teeth were randomly divided into three experimental groups: (1) conventional irrigation, (2) nanoparticle irrigation, and (3) control (no irrigation). The root canals in each group were irrigated with their respective solutions for 5 minutes. After treatment, microbial samples were collected from the root canals and cultured for colony-forming unit (CFU) analysis. The depth of penetration of nanoparticles into dentinal tubules was assessed using scanning electron microscopy (SEM). Results: The conventional irrigation group showed a reduction in microbial load from an average of 7.8 × 10^5 CFU/mL (SD ± 1.2 × 10^5) to 3.4 × 10^4 CFU/mL (SD ± 7.9 × 10^3) (P &lt; 0.001). In contrast, the nanoparticle irrigation group exhibited a more significant reduction, with a decrease in CFU to 1.2 × 10^3 CFU/mL (SD ± 4.2 × 10^2) (P &lt; 0.001). SEM analysis revealed deep penetration of nanoparticles into dentinal tubules, reaching an average depth of 150 μm Conclusion: Nanoparticles loaded with antimicrobial agents demonstrated superior efficacy in reducing microbial load within root canals compared to conventional irrigation. Their ability to penetrate dentinal tubules suggests their potential as an innovative drug delivery system for endodontic treatment. Further research and clinical trials are warranted to validate these promising in vitro results and assess the safety and efficacy of nanoparticles in clinical practice.

Repair of perirradicular tissues in non-surgical endodontic treatment. A review

Non-surgical endodontic treatment aims to prevent apical periodontitis, achieved with the disinfection of the root canal system. Additionally, there are pathologies where the toxic content of the canal goes to the periradicular tissues, causing osteolysis or lesions of the bone tissue that are radiographically observed as radiolucent images. When the endodontic treatment is successful, the repair of these lesions occurs over time. To analyze the periradicular repair process of non-surgical endodontic treatment and the factors that affect it. An electronic search was carried out using the search engines PUBMED, Scopus, Google Academic, and Scielo with the words "Non-Surgical Endodontic Treatment," "Periapical Tissues," "Biological Repair," "Apical Repair." Factors such as incomplete texts, PDF texts, and publication date of the article were considered, including data from the last five (05) years. The information reviewed comprised 236 articles analyzed with the inclusion and exclusion criteria, and only 42 articles met these criteria. The success of endodontic treatment lies in the absence of clinical and radiographic signs and symptoms of infection; this is achieved with a good application of clinical protocols and procedures focused on the disinfection of the root canal system, from diagnosis, biomechanical preparation, and disinfection of the root canal system with irrigating substances and filling, including coronal rehabilitation from an aesthetic and/or prosthetic point of view.

Evaluation of cytotoxicity impacts of combined methylene blue-mediated photodynamic therapy and intracanal antibiotic medicaments on dental stem cells

Root canal therapy is a predominant method for treatment of dental pulp and periapical diseases. Conventional methods such as mechanical instrumentations, chemical irrigation and intracanal medicaments pose a huge limitation to root canal disinfection as they kill bacteria and dental stem cells simultaneously. Therefore, much attention has been focused on finding more efficacious antibacterial methods that has no or negligible cytotoxicity for dental stem cells. Herein, we hypothesized that combining antibacterial medicaments with Antimicrobial photodynamic therapy (aPDT) and methylene blue (MB) as a photosensitizer would be effective in reducing death of dental pulp stem cells (DPSCs). To examine this, DPSCs were isolated from third molar teeth through enzymatic digestion. Isolated cells were cultured in αMEM and when reached adequate confluency, were used for further analysis. Cytotoxicity effect of different groups of MB, DAP, MB, LED and their combination on DPSCs was analyzed using MTT assay. DPSCs membrane integrity as a marker of live cells was assessed through measuring lipid peroxidation and lactate dehydrogenase (LDH) release into extracellular space. Results showed that the combination of LED, MB and TAP or aPDT, MB and DAP was more effective in reducing DPSCs death rate compared to TAP and DAP administration alone. Moreover, Malondialdehyde (MDA) and LDH levels were found to be decreased in cells exposed to combination treatment in comparison with single TAP or DAP therapy. Our study shows the promising perspectives of employing combined aPDT, MB and antibiotic medicaments for reduction of dental stem cell death.

Final Irrigant Temoporfin, Femtosecond Laser, and Chitosan Nanoparticles on Extrusion Bond Strength of Glass Fiber Post, Microhardness, and Modulus of Elasticity of Canal Dentin

Final root canal disinfectants Temoporfin, Femtosecond (FS) laser, and Chitosan nanoparticles (NPs) on marten hardness (MH), modulus of elasticity (EIT), and push-out bond strength (PBS) of glass fiber reinforced post (GFRP) to the root dentin. Sixty caries-free single-rooted human premolars were decoronated and a root canal was performed followed by post space. The specimens were then arbitrarily allocated into groups according to the final disinfectant used. Group 1: 17% EDTA, Group 2: Temoporfin, Group 3: FS laser and Group 4: Chitosan NPs. Evaluation of mechanical properties (MH and EIT) was performed on five samples from each group. Ten samples from each group were bonded with GFRP and sectioned. A universal testing machine and stereomicroscope were used to analyze the PBS and failure mode. Means and standard deviations (SD) of MH, EiT, and PBS were assessed using ANOVA and post hoc Tukey. The highest values of MH and EiT were revealed by 5.25% NaOCl+Chitosan NP samples. The lowest scores of MH and EiT were presented by samples irrigated with 5.25% NaOCl+17% EDTA. The coronal section of samples treated with 5.25% NaOCl+Chitosan NPs showed the highest EBS. Chitosan NPs and FS laser have proved to be valuable alternatives to EDTA as both improved PBS without deteriorating the MH and EiT.

In vitro effects of Er: YAG laser-activated photodynamic therapy on Enterococcus faecalis in root canal treatment

ObjectivePhotodynamic therapy (PDT) plays an important role for root canal disinfection. Nevertheless, the effect of photosensitizers penetrating dentin tubules is limited, which ultimately impedes the disinfection effect of PDT. The study implements an Er: YAG laser to activate methylene blue, the photosensitizer, to determine the bactericidal impact of PDT on Enterococcus faecalis in vitro root canals. MethodsWe obtained 53 single root canal teeth with intact roots, standardized the root to 9 mm. The root canals were prepared using ProTaper rotary files. Subsequently, the teeth were sterilized, and Enterococcus faecalis was cultured for 3 weeks in vitro using brain heart infusion (BHI). The model of Enterococcus faecalis root canal infection of teeth was constructed by observing Enterococcus faecalis through electron microscope scanning. The teeth were randomly allocated to five treatment groups (n = 10): control, NaOCl, NaOCl + Er: YAG, PDT, and PDT + Er: YAG. Following treatment, the number of colony forming units (CFU)/ml was assessed for each group. Statistical analysis was conducted using one-way ANOVA, with post-hoc analysis using Tukey's test for multiple comparisons. ResultsThe colony counts in the remaining groups were significantly lower compared to the control group (P<0.001). Using PDT alone had the least impact on reducing colonies, while using PDT and Er: YAG laser together resulted in a significant reduction in colony counts (P<0.001). There was no significant difference in colony counts reduction between the NaOCl + Er: YAG group and the PDT + Er: YAG group (P = 1.000). ConclusionsThe combination of Er: YAG laser and PDT significantly enhanced the bactericidal efficacy of PDT against Enterococcus faecalis in root canals. It had a similar impact on eliminating Enterococcus faecalis when compared to the effect of using Er: YAG laser and NaOCl.

Periapical bacterial disinfection is critical for dental pulp regenerative cell therapy in apical periodontitis in dogs

BackgroundApplication of pulp regenerative cell therapy for mature teeth with periapical lesions is a critical clinical challenge. The bacterial infection in inaccessible location within the root canal system and in the periapical lesions could cause resistance and impediment, leading to limitations in successful therapy. Thus, the aim of this study was to examine the effect of residual bacteria on the outcome of pulp regeneration in mature teeth with apical periodontitis in dogs.MethodsPeriapical lesions were induced in 32 root canals of 4 dogs in two different models in severities, model A and model B. Model A (moderate infection): the canal exposed to the oral cavity for 2 weeks and then closed for 2 weeks. Model B (severe infection): the canal exposed to the oral cavity for 2 months and then closed for 5 months. All root canals were irrigated with 6% sodium hypochlorite, and 3% EDTA and further with 0.015% levofloxacin-containing nanobubbles, which was also used as an intracanal medicament. The aseptic conditions were examined by bacterial anaerobic culture and/or PCR analyses. The root canal treatment was repeated several times, and allogeneic dental pulp stem cells were transplanted into the root canals. The radiographic evaluation of periapical lesions was performed by cone-beam computed tomography before the first treatment, just after cell transplantation, and after 2 months and 6 months in both model A, model B, respectively. The animals were then sacrificed and the jaw blocks were harvested for histological and histobacteriological evaluations of pulp regeneration and periapical tissue healing. Furthermore, the DiI-labelled DPSCs were transplanted into the root canals after complete disinfection (n = 4) or without root canal treatment (n = 4) in the apical periodontitis model (model A) in one dog, and cell localization was compared 72 h after transplantation.ResultsIn 8 out of 12 canals from model A, and 10 out of 15 canals from model B, pulp regeneration with good vascularization, innervation, and a significant reduction in the radiolucent area of the periapical lesions were observed. However, in the other 4 canals and 5 canals from model A and model B, respectively, no pulp tissue was regenerated, and inflammation in the periapical tissue, and external resorption or healed external resorption were detected. The presence of residual bacteria in the periapical tissues and severe inflammation were significantly associated with inhibition of regenerated pulp tissue in these 9 unsuccessful canals (P < 0.05, each) (OR = 0.075, each) analyzed by multiple logistic regression analysis. For cellular kinetics, transplanted cells remained in the disinfected root canals, while they were not detected in the infected root canals, suggesting their migration through the apical foramen under the influence of inflammation.ConclusionsA true pulp-dentin complex was regenerated in the root canal by the pulp regenerative therapy in mature teeth with apical lesions. The successful pulp regeneration was negatively associated both with residual bacteria and inflammation in the periapical tissue.

Comparative evaluation of antimicrobial efficacy of 3C antibiotic paste with triple antibiotic paste as root canal filling material for primary teeth: An in-vitro study

Root canal infection in primary teeth is polymicrobial in nature. Most resistant micro-organisms, such as E.faecalis survive in chronic infection of the root canal at the periapical area and are difficult to remove by various root canal irrigants. C.albicans has been found in chronic infections of root canals of primary teeth due to its ability to invade dentinal tubules. The multiple bacteria strains which cause endodontic infections, make it difficult to clean root canals with a single effective antibiotic. Hence Triple Antibiotic Paste (TAP) has been previously introduced, consisting of ciprofloxacin, metronidazole, and minocycline. Although this mixture aids in pulp regeneration and has been used to disinfect root canal systems, it is linked to tooth discolouration. The aim of this study is to evaluate and compare the antimicrobial efficacy of a newly formulated 3C antibiotic paste (consisting of Ciprofloxacin, Clindamycin, and Cefaclor) with conventional TAP against E. faecalis and C. albicans. In this in-vitro laboratory study, pure culture of C. albicans and E. faecalis will be grown on Sabouraud’s dextrose agar (SD) agar and Brain heart infusion agar (BHI) agar respectively and will be suspended for 24 hours at 37°C. For comparison of antimicrobial efficacy, the zone of inhibition will be for the 3C antibiotic paste against conventional TAP (control) for E. faecalis and C. albicans, and will be determined using digital calliper in millimetre after every 24 and 72 hours. We hypothesise that the newly formulated 3C paste will have better antimicrobial efficacy when compared with conventional TAP. It is expected that a newly formulated 3C paste will prove to be the successful as root canal filling material for primary teeth.

The Effect of Calcium Hydroxide Pastes on Isolated Vital Nerve Fibers

IntroductionCalcium hydroxide pastes (CHPs), commonly used for disinfecting root canals during endodontic treatment, are generally considered safe. However, accidental extrusions result in minimal injuries and little to no discomfort, except when extruded pastes come into contact with nerve bundles, such as the inferior alveolar nerve. Currently, there is a lack of information about the possible role of specific paste vehicles on the extent of nerve injury. The purpose of this study was to compare the role that paste vehicles, such as water or methylcellulose, may play when nerve fibers are exposed to CHP. MethodsIsolated sciatic nerves of Sprague-Dawley rats were exposed to either water-based or methylcellulose-based CHP for varying durations of time (30, 60, or 90 minutes). Histopathological changes, including axonal edema, myelin alterations, and loss of cellular outlines, were assessed, and the degrees of changes were compared using chi-square intraclass correlation coefficient tests. ResultsBoth groups exposed to the pastes demonstrated varying degrees of histopathologic changes, including axonal edema, myelin changes, and loss of cellular outlines, at different exposure times. The water-based calcium hydroxide paste induced these changes more rapidly than the methylcellulose-based paste. Similar patterns were observed in the scanning electron microscopic findings. Exposure time emerged as an important difference in the effects of the 2 pastes. In each of these tests, all observations of water-based paste exposure were rated as moderate to severe, whereas the observed cellular changes (axonal, myelin, and intact cellular outline) were rated as mild to moderate after exposure to methylcellulose-based paste for the same exposure durations. The chi-square tests indicated a statistically significant association between the material and each of the outcomes (axonal changes: χ²15 = 81.0, P < .001; myelin changes: χ²15 = 81.0, P < .001; intact cellular outline, χ²15 = 81.0, P < .001). The intraclass correlation coefficient value was 0.93. ConclusionsThe study demonstrates that axonal and myelin damage increase with longer exposure times, with water-based CHP causing more damage than methylcellulose-based CHP at each time point.

The Efficacy of Different Antibiotic Compounds in Regenerative Treatment of Immature Necrotic Teeth.

Objectives: Endodontic treatment of immature teeth poses a significant challenge, especially in achieving a proper seal using traditional obturation methods. Revascularization presents itself as an alternative approach to this problem, and the application of triple antibiotic paste (TAP) has been suggested as a means to achieve disinfection during the procedure. This study aims to compare the antibacterial properties of three different antibiotic combinations to assess their effectiveness on root canal disinfection. Materials and Methods: Eighty samples were employed to assess the impact of three antibiotic combinations on Enterococcus faecalis, Escherichia coli, Streptococcus mutans, and a combination thereof. The antibiotics included metronidazole, ciprofloxacin, and cefaclor (CCM), the commonly used TAP, and a double antibiotic paste (DAP) composed of metronidazole and ciprofloxacin. Dentin shavings collected using Gates-Glidden drills were placed in microtubes containing a 2ml standard bacterial suspension. Microtube contents were diluted and cultured on BHI agar plates, with colony counts calculated based on dentine shavings' weight in CFU/mg. Kruskal-Wallis and Dunn's post-hoc tests were used for statistical analysis and P<0.05 was considered significant. Results: A significant difference in mean CFU was observed among all bacterial groups (P<0.05). Dunn's post-hoc analysis showed a significant difference only between the control group (methylcellulose) and the other antibiotic groups. There was no significant difference between the other antibiotic groups in two-by-two comparisons. Conclusion: There was no significant difference in the antimicrobial properties of DAP, TAP and CCM. Therefore, DAP and CCM may be used during regenerative treatment.

Comparison of antimicrobial efficacy of green tea extract and Triphala as root canal irrigants against Fusobacterium nucleatum using real-time polymerase chain reaction – An in vitro study

Aim: Fusobacterium nucleatum has gained attention in the endodontic literature as it is a predominant microorganism in primary, secondary, and persistent root canal infections. Current irrigants have lot of drawbacks and are unlikely to predictably achieve a bacteria-free root canal system, which can lead to these failures. Herbal alternatives are now gaining popularity in the field of endodontics, paving a new way in the disinfection of root canals. The aim of this study is to evaluate the antimicrobial efficacy of green tea extract and Triphala as root canal irrigants against F. nucleatum using real-time Polymerase chain reaction (PCR). Methods: Extracted teeth were taken and inoculated with F. nucleatum, which was grown in a Mueller–Hinton agar plate under anaerobic conditions. The samples were cleaned and shaped and irrigated with green tea extract, Triphala extract, and dimethyl sulfoxide, which were compared to the widely used irrigant, sodium hypochlorite. Cycle threshold value was used to calculate the efficacy of the irrigant against F. nucleatum after which the samples were subjected to reverse transcriptase PCR. The data were analyzed and the data between the group were compared using the one-way ANOVA followed by a post hoc Tukey’s test. Results: Triphala extract demonstrated high antimicrobial activity against F. nucleatum1. It revealed statistically significant differences between Triphala extract and sodium hypochlorite (NaOCL) (P = 0.001). Green tea extract also displayed antimicrobial activity. Both the Triphala and green tea extracts showed a significant difference (P &lt; 0.001). Conclusion: Triphala extract showed better antibacterial efficacy when compared to 3% NaOCl and green tea extract against F. nucleatum.

Endodontic Applications of Propolis in Primary and Permanent Teeth: A Scoping Review of Clinical Studies.

The use of propolis-based materials within endodontics to promote pulp wound healing or disinfect the root canal system has been a recent focus of scientists and clinicians. This is mainly because of the well-documented antimicrobial, anti-inflammatory, immunomodulatory and wound healing properties of propolis. This scoping review critically appraises the literature on the clinical applications of propolis-based compounds during endodontic therapy of primary and permanent teeth. An electronic literature search was performed in Scopus, PubMed, and Web of Science up to and including October 2023 to identify studies assessing the use of propolis during endodontic therapy of primary and permanent teeth. A combination of relevant MeSh terms and keywords was used. Only human clinical studies written in English were included. The identified manuscripts were screened and assessed for inclusion by two independent authors. Eligible manuscripts were then subjected to critical appraisal and data extraction with the information being summarised according to their clinical application. A total of 26 human clinical studies were identified and included in the analysis. Propolis was investigated for use in the primary and permanent dentitions as a direct pulp capping or pulpotomy material as well as in root canal disinfection and root filling of teeth with non-vital pulps. Overall, the studies reported that the use of propolis was associated with promising outcomes in terms of efficacy to control inflammation, enhance tissue repair, and disinfection of the root canal system. However, a critical appraisal of the studies revealed a range of methodological and reporting deficiencies, resulting in unreliable results and conclusions in terms of the clinical outcomes reported. Although the studies on the use of propolis-based materials in endodontics reported promising clinical outcomes, they had a range of methodological and reporting flaws. Further well-designed and properly reported controlled clinical studies are essential to derive sound evidence-based conclusions on propolis-based materials. Furthermore, guidelines for quality assurance and safe use of propolis-based materials are necessary to enhance their production for commercial use in endodontics.