Double Antibiotic Paste Research Articles

Antibacterial effects of different low-level doses of double antibiotic paste on multispecies biofilms in regenerative endodontics: A confocal laser microscopy study

Antibacterial effects of different low-level doses of double antibiotic paste on multispecies biofilms in regenerative endodontics: A confocal laser microscopy study

Potential Crown Discoloration Induced by the Combination of Various Intracanal Medicaments and Scaffolds Applied in Regenerative Endodontic Therapy.

Regenerative endodontics involves the use of various root canal medicaments and scaffolds, which may cause crown discoloration. This study aimed to investigate the combined crown discoloration of scaffolds [platelet-rich fibrin (PRF) and blood clot] applied after administration of different medicaments [modified triple antibiotic paste including doxycycline (mTAPd), modified double antibiotic paste (mDAP), calcium hydroxide (CH), and propolis]. In total, 100 human mandibular premolar teeth were selected and prepared. The teeth were apically resected to simulate immature teeth. The positive and negative control groups (n = 10) consisted solely of blood-only and serum-only samples. The remaining 80 teeth were used for the experimental groups with four different medicaments. Three weeks later, either blood or PRF was applied as a scaffold after removing the medicaments (n = 10). Color changes were assessed before medication placement and at the end of the first, second, and third weeks, as well as on days 0, 1, 30, 60, and 90 after scaffold application. Analysis was carried out using repeated measures of variance, Friedman, one-way ANOVA, Kruskal-Wallis, the dependent paired t-test, and Wilcoxon test. Statistical significance was determined at P = 0.05. All groups including blood and the group including propolis and PRF combination, resulted in a significant increase in discoloration (P < 0.05) and discoloration exceeding clinically acceptable thresholds. CH and the modified versions of TAP (mTAPd) and DAP (mDAP) demonstrated an acceptable level of discoloration when used with a combination of PRF at day 90.

Root Canal Dentin Microhardness after Contact with Antibiotic Medications: An In Vitro Study.

Background: Antibiotic pastes used as intracanal medication in cases of revascularization therapy might cause negative effects on tooth properties, such as a reduction in dentin microhardness. This in vitro study investigated dentin microhardness in three different locations distancing from the canal lumen after 20 days of treatment with a tri-antibiotic paste (ciprofloxacin, metronidazole, and minocycline), and with a double-antibiotic paste (ciprofloxacin and metronidazole), with calcium hydroxide [Ca(OH)2] UltracalTM XS-treated dentin as comparison. Material and Methods: Human mandibular premolars (n = 48) had the root canals cleaned and shaped and were used to produce dentin slices. Dentin slices remained immersed in the medications for 20 days. The Knoop microhardness (KHN) test was performed before (baseline/Day-0) and after treatment (Day-20) with the medications. Indentations were made at 25 µm, 50 µm, and 100 µm distances from the root canal lumen. The KHN was compared intra-group using Wilcoxon's test. Independent groups were compared using Mann-Whitney's and Kruskal-Wallis' tests, at α = 5%. Results: The microhardness in all the tested groups was reduced at Day-20 in comparison with Day-0 (p < 0.001) (intra-group comparison/same distances). The Day-0 values were similar, and the Day-20 values were higher for the Ca(OH)2 group (p < 0.05) (comparison between groups/same distances). Conclusions: Calcium hydroxide for 20 days would be preferred rather than antibiotic pastes to minimize the expected reduction in dentin microhardness during regenerative procedures.

Effect of Vehicles and Irrigation Solutions and Methods on Removal of Double Antibiotic Paste from Root Canals: Insights from High-performance Liquid Chromatography Analysis

IntroductionIn regenerative endodontics, eradicating antibiotic residues from root canals is imperative, given their detrimental effects on human apical papilla stem cells. Previous antibiotic removal studies lacked precision in identifying types and quantities of residual antibiotics. High-performance liquid chromatography (HPLC) enhances sensitivity and specificity, enabling accurate detection and quantification of residual drugs. Using HPLC analysis, this study explored the influence of vehicles and irrigation solutions and methods on double antibiotic paste (DAP) removal from root canals. MethodsTwo DAP formulations, each containing 5 mg/mL ciprofloxacin and metronidazole, were created using distinct vehicles: macrogol and propylene glycol (MP) or hydroxypropyl methylcellulose (HPMC). Subsequently, 5 μL of DAP was applied to 200 simulated immature teeth with open apices (n = 100 per formulation) and cultured for 28 days at 37°C. Samples were then divided into 11 groups (n = 20 per group), and canals were irrigated with 17% ethylenediaminetetraacetic acid or 10% citric acid, employing a positive pressure syringe or passive ultrasonic irrigation. The irrigation solution and dentin sample from each tooth were evaluated via HPLC for ciprofloxacin and metronidazole quantification. ResultsCitric acid exhibited significantly superior efficacy in antibiotic removal from root canals, with no observable effect of irrigation methods on drug removal. The HPMC-based DAP formulation significantly enhanced ciprofloxacin removal compared with MP-based DAP. ConclusionsFor antibiotic paste removal from root canals, citric acid is effective, and HPMC is a preferable vehicle over MP. Overall, HPLC is a valuable method for detecting, removing, and quantifying residual antibiotics in root canals.

Intracanal medicaments and coronal sealing materials influence on root fracture resistance and coronal discoloration: An in vitro study

Abstract Introduction: Immature teeth are more susceptible to fracture, and intracanal medicaments and coronal filling materials used in regenerative endodontics affect their optic and mechanical properties. This study aimed to evaluate the fracture resistance and coronal discoloration of simulated immature teeth following the placement of several intracanal medicaments and coronal sealing materials. Materials and Methods: Eighty-eight premolars simulating immature teeth were divided into 11 groups (n = 8 each) according to the type of intracanal medicament (triple antibiotic paste [TAP]; double antibiotic pastes [DAP]; calcium hydroxide [Ca(OH)2]) and used coronal barrier materials (mineral trioxide aggregate [MTA] and calcium-enriched mixture [CEM]). A bonding agent was applied in half of the samples in the groups where antibiotic pastes were used (n = 8). After incubating for 3 weeks, the sample’s fracture resistance and color change were evaluated. Data analysis was conducted using multivariate and one-way analysis of variance, Tukey’s honestly significant difference post hoc, and the Kruskal–Wallis tests (α =0.05). Results: The color change after placing the medicaments was comparable among the groups. However, after 3 months, the color change in the TAP-CEM-No-Bonding group was higher than the control, Ca(OH)2-MTA, and DAP-MTA-No-Bonding groups (P &lt; 0.05). The fracture resistance of the TAP-MTA-Bonding, DAP-CEM-Bonding, Ca(OH)2-MTA, and Ca(OH)2-CEM was lower than the control group (P &lt; 0.05). Conclusion: Simultaneous use of DAP-MTA without a dentin bonding agent led to comparable color change and fracture resistance to the control group.

Assessment of Long-Term Success and Survival Rates of Different Types of Intracanal Medicaments.

Antimicrobial endodontic intracanal medicaments play a vital role along with biomechanical preparation in the elimination of bacteria present in the pulp area to achieve success in endodontic therapy. The present research was conducted with the objective of evaluating and comparing intracanal medicaments regarding antibacterial properties against Enterococcus faecalis. One hundred and twenty healthy human premolars of the mandible were used. All premolar crowns were removed, keeping the standardized length of the root as 15 mm. Category 1 received triple antibiotic paste (TAP) (n = 30), Category 2 received double antibiotic paste (DAP) (n = 30), Category 3 received augmentin (n = 30), and Category 4 received calcium hydroxide (n = 30). Hygienic paper points were placed in each root canal, then they were moved to a tube containing 1 mL of brain-heart infusion medium and left there for bacteriological testing. Colony-forming units (CFUs) of E. faecalis were then observed and counted after the plates had been incubated overnight at a temperature of 37°C. During intracategory comparisons, there was a significant reduction in colonies of E. feacilis in each category (P ≤ 0.001). When there were intercategory comparisons, there was a maximum reduction in CFU in specimens of Category 1 (TAP) followed by Category 3 (Augmentin) and Category 2 (DAP). Intracanal medicaments like TAP, DAP, and augmentin are effective against root canal E. faecalis.

Discoloration after revascularization using calcium phosphosilicate-based bioceramic versus mineral trioxide aggregate in necrotic immature permanent anterior teeth: A Randomized clinical trial.

The aim of the current study is to evaluate the effect of calcium phophosilicate-based bioceramic "Totalfill bioceramic putty" and white mineral trioxide aggregate (WMTA) as the coronal plug on discoloration after revascularization of necrotic immature permanent anterior teeth. This study was conducted on (48) necrotic young permanent central incisors in children ranging from 8 to 14 years old, that were randomly allocated to either Totalfill bioceramic (Group I = 24) or WMTA (Group II = 24) as the coronal plug. Two visits revascularization protocol was adopted in this study using 1.5% sodium hypochlorite, followed by 17% ethylenediaminetetraacetic acid, and ending with a saline flush as irrigation solution. The double antibiotic paste was used as intracanal medication. The blood clot was used as scaffold followed by the application of collagen membrane followed by coronal plud malterial. Finally, the access was sealed using resin composite restoration and composite restoration. Clinical assessment was conducted at 1, 3, 6, 9, and 12 months, while radiographic assessment was conducted at 6 and 12 months. Data were statistically analyzed using the Chi-squared test for intergroup comparisons and Cochran's Q test for intragroup comparison. Clinically, Group I exhibited a success rate of 100%, whereas Group II exhibited a success rate of 85.7%. Radiographically, both materials showed a 90.5% success rate. There was no statistically significant difference between both materials for all assessed clinical and radiographic parameters at different follow-up periods. Both Totalfill bioceramic putty and WMTA can be used successfully as coronal plug in esthetic areas.

Comparison of the removal of intracanal medicaments used in regenerative endodontics from root canal system using needle, ultrasonic, sonic, and laser-activated irrigation systems

This study aimed to compare the syringe-needle irrigation (SNI), passive ultrasonic irrigation (PUI), EDDY, and shock wave–enhanced emission photoacoustic streaming (SWEEPS) techniques regarding calcium hydroxide and double antibiotic paste removal from the root canal in regenerative endodontic treatments. Eighty single-rooted human teeth were decoronated and enlarged up to #100 to stimulate the immature tooth model. Root canals were irrigated with 1.5% sodium hypochlorite followed by saline solution according to the regenerative endodontic treatment protocol. Dressed teeth were divided into 2 main groups regarding the used intracanal medicaments. Calcium hydroxide and double antibiotic paste were introduced to the canals, and teeth were stored for 3 weeks. Each medicament group was divided into 4 subgroups according to the activation techniques. Medicaments were removed using a 17% EDTA solution. Teeth were split longitudinally into two parts. The remaining medicaments were evaluated under a stereo microscope with a scoring system. Data were analyzed with the Kruskal-Wallis and Mann-Whitney U tests. Regardless of the used irrigation activation systems, there was no statistically significant difference between the removal of the CH and DAP from the root canal (P>0.05). While SWEEPS had the highest ability regarding the removal of intracanal medicaments, syringe-needle irrigation had the lowest (P<0.05). There was no statistically significant difference between PUI and EDDY (P>0.05). Complete removal of intracanal medicaments could not be achieved with any techniques. SWEEPS technology was more effective in removing intracanal medicaments in regenerative endodontic treatments compared to the sonic and ultrasonic irrigation activation systems.

The efficacy of various irrigation techniques on the removal of double antibiotic paste from simulated immature roots and the amount of apically extruded debris

ObjectiveThis study evaluated the effect of the XP-Endo Finisher (XPF), passive ultrasonic irrigation (PUI) and conventional irrigation using side-vented needle (SVN) on the amount of apically extruded debris and canal cleanliness following the removal of double antibiotic paste (DAP) from immature root canal models.Material and methodsForty-eight extracted mandibular premolars were drilled using peeso drills to simulate immature apices. The canals were filled with DAP and were randomly assigned into 3 groups according to the DAP removal method: XPF, PUI, and SVN (n = 16). The amount of extruded debris was assessed with an analytical balance then roots were split longitudinally and imaged using stereomicroscope to evaluate the residual medicament. Data were statistically analyzed using Kruskal-Wallis and Dunn’s test. Spearman’s correlation coefficient was used to determine significant correlation between extruded debris and the residual DAP scores.ResultsThere was no significant difference between debris extrusion values for all groups (P value 0.237). For canal cleanliness, the amount of remaining DAP was significantly lower in the XPF and PUI compared to SVN (P value < 0.001). A non-significant positive (direct) correlation was found between the amounts of apically extruded debris and residual DAP scores (P value 0.087).ConclusionXPF and PUI were associated with better canal cleanliness during removal of DAP, no difference could be found between the three irrigation techniques regarding the debris extrusion.

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.

Antimicrobial Efficacy of Simvastatin and Double Antibiotic Paste as Intracanal Medicaments: A Randomised Clinical Study

Abstract Introduction: Root canal debridement, irrigation and a microorganism-free environment are key factors in the success of root canal treatment. Intracanal medicaments are used to enhance root canal disinfection. Simvastatin is derived from lovastatin and is a semisynthetic medication. This study compares and evaluates the effect of simvastatin and double antibiotic paste (DAP) as an intracanal medicament in single-rooted teeth with apical periodontitis using colony-forming units (CFUs)/ml. Materials and Methods: Twenty-eight patients with single-rooted teeth diagnosed with apical periodontitis were selected. Under aseptic conditions, patency was gained, sterile saline solution was deposited in the canal and the first sample (S1) was collected. Cleaning and shaping were then carried out following an appropriate technique depending on the configuration of the canal. After irrigation and biomechanical preparation, teeth were randomly assigned to two different groups, and the test intracanal medicament was applied to the root canals. Coronal openings were sealed with temporary restorative cement. The second sample (S2) was collected after 7 days. The samples obtained were checked for a reduction in the bacterial load. They were incubated aerobically for 48 h, and the CFUs were calculated. The Mann–Whitney U and Wilcoxon’s signed-rank tests were used to analyse the results statistically. Results: A significant reduction in bacterial count was present after administration of the intracanal medicament. On intergroup comparison, there was no statistically significant difference in bacterial decrease between the two groups. Comparatively, the mean reduction in the bacterial count was higher in the DAP group. Conclusion: It can be concluded that DAP and simvastatin were effective in the reduction of the bacterial count in single-rooted teeth diagnosed with apical periodontitis. However, DAP demonstrated a better performance in the reduction of bacterial counts.

The effect of calcium hydroxide and double antibiotic paste on radiographic outcomes and periapical MMP-8 levels in regenerative endodontic procedures: a randomized clinical trial.

The primary goal is to evaluate the effects of two different intracanal medicaments, calcium hydroxide [Ca(OH)2] and double antibiotic paste (DAP), on radiographic outcomes during regenerative endodontic procedures (REP) of immature permanent mandibular first molars with symptomatic irreversible pulpitis and symptomatic apical periodontitis (SIP/SAP). Additionally, the secondary goal was to evaluate MMP-8 levels during REP using two different intracanal medicaments. The study included 20 patients with immature mandibular first molars exhibiting SIP/SAP. Participants were randomly assigned into two groups based on the applied intracanal medicament. Ca(OH)2 (n=10) was prepared by mixing it with sterile distilled water, while the same amount of powdered metronidazole and ciprofloxacin were mixed and combined with sterile distilled water for DAP (n=10). MMP-8 in periapical samples were measured at baseline and on the 14th day using immunofluorometric assay. Image-J software with TurboReg plug-in was utilized to determine changes in root length, root width, radiographic root area (RRA) during the 12-month follow-up period. Data were analyzed by SPSS 25.0 (p<.05). Significant increase in MMP-8 on the 14th day compared to baseline in both groups (p<0.001). There was no significant difference between the two groups in terms of the increase in MMP-8 (p>0.05). Root length significantly increased in both groups (p=0.001), with Ca(OH)2 showing a greater increase (p=0.046). Root width and RRA increased similarly in both groups at 12th month. Both Ca(OH)2 and DAP applications resulted in a significant increase in periapical MMP-8 levels. Increase in radiographic root width and root area was similar between two groups, but Ca(OH)2 led to a significantly greater increase in root length. Further studies with larger sample sizes are necessary to validate our findings during REP of vital immature permanent mandibular molars. Clinical Trials database: NCT05581706.

Can a dentin bonding agent prevent color change in regenerative endodontic procedures? An in vitro evaluation.

This in vitro study aimed to determine the efficacy of dentin bonding agents in preventing color changes following Regenerative Endodontic Procedures. One hundred twenty bovine incisors were endodontically prepared and randomly assigned to a two main factors design: application of a dentin bonding agent (Scotchbond Adper, 3M ESPE, St Paul, MN, USA) in the pulp chamber (Group 1, n=60) versus no bonding intervention (Group 2, n=60), and five levels of intracanal medication (n=12/subgroup): Triple antibiotic paste (TAP), double antibiotic paste (DAB), calcium hydroxide (CH), modified triple antibiotic paste (TAPM), and Control (CTL). Color changes were measured over 28 days at multiple time points (1, 3, 7, 14, 21, and 28 days) using the CIEDE2000 formula to calculate the color difference (ΔE00) from baseline (T0). The ΔE00 quantifies the perceptible color difference between the initial and final tooth color, with lower values indicating less discoloration. The results were analyzed using repeated measures ANOVA-2 and post-hoc Holm-Sidak tests. The TAP subgroups, both with and without the bonding agent, exhibited the highest color variation. However, a pulp chamber seal with a bonding agent showed a protective effect against discoloration compared to no seal, even though complete prevention was not achieved. All groups demonstrated ΔE00 values beyond acceptable interpretation thresholds for clinical application, primarily driven by a reduction in lightness (L*) and a decrease in redness (a* value, shifting towards green). In conclusion, while the pulp chamber seal with a bonding agent mitigated TAP-induced discoloration, it did not eliminate it.

Effect of T ect of Triple Antibiotic P riple Antibiotic Paste, Double Antibiotic P aste, Double Antibiotic Paste, and aste, and Calcium Hy Calcium Hydroxide on Antibiotic Resistance of T xide on Antibiotic Resistance of Tet Repr et Repressor Proteins, T oteins, Tetracycline Resistance Gene W cline Resistance Gene W, and T , and Tetracycline Resistance Gene Q: A Randomized

Objective: To investigate the effect of the use of Calcium Hydroxide (Ca(OH)2 ), Triple Antibiotic Paste (TAP), and Double Antibiotic Paste (DAP) as intra-canal medicaments on the development of antibiotic resistance by evaluating tetracycline genes. Methods: Forty five patients were randomly assigned into 3 groups according to the intracanal medication using a web program (www.randomizer.org), (Ca(OH)2 , TAP and DAP). Root canal bacteriological samples were collected before root canal treatment (S1) and after chemo-mechanical procedures (S2). Following root canal shaping procedures, intra-canal medication of the root canals was performed with selected intra-canal medicament. A second appointment was planned for the patients 15 days later. At the second appointment, the medication was removed mechanically and after irrigation of the root canals, the post medication samples (S3) were collected. Bacteriological samples were then investigated for bacterial counts and antibioticresistant genes [Tet Repressor proteins (TetR), Tetracycline resistance gene W (TetW) and Tetracycline resistance gene Q (TetQ)] using polymerase chain reaction (PCR), and the data were statistically analyzed. The Friedman, Kruskall-Wallis and chi-square tests were used. These genes were selected as the difference between TAP and DAP is that TAP contains tetracycline and tetracycline resistance is governed by tet genes. Results: There was no statistically significant difference among the samples (S1, S2, and S3) in terms of the number of root canals positive for antibiotic resistance genes in both the Ca(OH)2 and DAP groups. However, the number of root canals positive for TetR gene increased significantly (6 [40%] to 12 [86%]) following intra-canal medication with TAP. Conclusion: It can be concluded that 15 of days intra-canal medication with TAP causes tetracycline resistance. In contrast, DAP does not cause tetracycline resistance and it has similar antibacterial effectiveness to TAP. The DAP would be the choice of medicament rather than TAP in clinical practice.

Combination of metformin and double antibiotic paste for the regeneration of non-vital immature teeth: a preliminary randomized clinical study

BackgroundThe present study aimed to investigate whether incorporating metformin in double antibiotic paste (DAP) can promote the regeneration process of non-vital immature teeth.MethodsOut of 32 pediatric patients undergoing regenerative endodontic procedures (REPs), 6 cases with a follow-up period of less than 12 months or lack of documentation were excluded then the remaining 26 were analyzed. 15 cases received DAP, and 11 cases received a DAP + metformin as the intra-canal medicament, kept for an average of 23 days. During 18 months of follow-up, clinical and radiographic examinations were performed to evaluate the treatment outcomes based on the resolution of apical periodontitis, root development, and the occurrence of intracanal calcification. The chi-square test was used for the statistical analysis (P < 0.05).ResultsAll patients demonstrated resolution of apical periodontitis; however, complete apical closure was only seen in 50% of the patients. The rate of apical closure and root length was significantly higher in the DAP + metformin group (P = 0.047), although the two groups were not significantly different in terms of root width (P = 0.184). Canal obliteration was seen in 15% of cases, all of which were in the DAP group.ConclusionsAccording to the present findings, metformin could promote root development in the regeneration process when incorporated in DAP.Trial registrationThis clinical trial was registered on the Iranian Registry of Clinical Trials (IRCT20200120046197N1) on 26.2.2021.

Comparison of Antimicrobial Activity of Triple, Double, and Cefixime-Based Antibiotic Pastes Against Enterococcus Faecalis: An In Vitro Study.

This in vitro study aims to compare the antimicrobial efficacy of triple antibiotic paste, double antibiotic paste, and cefixime-based triple antibiotic paste againstEnterococcus faecalis. Materials and methods: Fifty single-rooted, caries-free, permanent teeth without any developmental defects were included in this study. The specimens were divided into five groups, with each group consisting of 10 teeth that received a specific medicament. The groups were as follows: Group I: control; Group II: calcium hydroxide;Group III: triple antibiotic paste; Group IV: double antibiotic paste; and Group V: cefixime-based triple antibiotic paste. The antimicrobial activity of the medicaments was assessed againstE. faecalisat the end of the seventhand 14th days. The colony-forming units (CFU) werecalculated using the Kolmogorov-Smirnov and Wilcoxon tests. After seven days of the experimental process, it was observed that the CFU count was highest in group I and lowest in group V. In a similar vein, after 14 days, the maximum decrease in CFU count was observed inGroup V, while the least reduction in CFU count was observed in Group II. On intergroup comparison, it was found that the maximum decrease in CFU was noted inGroup V, followed by Group IV, Group III, and Group II. The study results indicated that the cefixime-enriched antibiotic paste had the greatestantimicrobial effectiveness, while the double and triple antibiotic pastes offered superior antibacterial efficacy againstE. faecalis at the end of the seventhand 14thdays.

Comparative Evaluation of Antimicrobial Efficacy of Various Antibiotic Pastes and Calcium Hydroxide Using Chitosan as a Carrier Against Enterococcus faecalis: An In Vitro Study.

The use of intracanal medicaments between appointments can serve as an important aid in the sterilization of the root canal system. Calcium hydroxide is commonly used, but it is not completely effective against Enterococcus faecalis. A triple antibiotic paste (TAP) is used but has the problem of tooth discoloration. Double antibiotic paste (DAP) or modified TAP (MTAP) has been suggested to solve this. Chitosan has been used as a vehicle in pharmacology, and it has inherent antibacterial properties too. This study compares the efficacy of DAP and MTAP using chitosan as a vehicle with calcium hydroxide. Sixty single-rooted teeth were taken and decoronated with a length of 13 mm. Biomechanical preparation (BMP) was done with #3 Gates-Glidden (GG) drills, 17% ethylenediaminetetraacetic acid (EDTA), and 5.25% sodium hypochlorite (NaOCl) used for irrigation. These were kept in microcentrifuge tubes with 1 ml brain heart infusion (BHI)broth. Contamination was done with E. faecalis strain for 21 days. DAP and MTAP pastes were prepared and added to the chitosan solution. Groups were divided into 10 each, each medicament with saline or chitosan as the vehicle. The microbial load was measured at the end of two and seven days. The level of significance was kept at p = 0.05. Statistical analysis was done with the Kruskal-Wallis test and analysis of variance (ANOVA). DAP and MTAP groups with chitosan showed a significant reduction in the microbial load when compared to calcium hydroxide with chitosan. DAP and MTAP with chitosan can be effective intracanal medicaments against E. faecalis in refractory endodontic cases.

Direct and residual antimicrobial effect of 2% chlorhexidine gel, double antibiotic paste and chitosan- chlorhexidine nanoparticles as intracanal medicaments against Enterococcus faecalis and Candida albicans in primary molars: an in-vitro study

BackgroundThorough disinfection of root canals in primary molars may be complicated by the complex root canal morphology. This in-vitro study aimed to compare direct and residual antimicrobial effect of 2% chlorhexidine (CHX) gel, 500 mg/ml double antibiotic paste (DAP) and chitosan-chlorhexidine nanoparticles (CS-CHX NPs) as intracanal medicaments against Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans) in primary molars.MethodsMesial roots of 63 mandibular second primary molars were infected with E. faecalis and C. albicans. Teeth were divided into 9 groups: Ia: (CS-CHX NPs), IIa: (CHX), IIIa: (DAP), IVa: chitosan nanoparticles (CSNPs) in which medicaments were placed for 3 days, groups Ib: (CS-CHX NPs), IIb: CHX, IIIb: (DAP), IVb: (CSNPs) in which medicaments were placed for 7 days, and Group V (control): teeth were infected, irrigated with saline, and sampled 3- and 7-days post-infection. Microbiological samples were obtained after infection, 3, and 7 days after medicament placement and 7 days after medicament removal for both time points. One-way ANOVA, Tukey’s post hoc test and paired t-test were used at p < 0.05.ResultsCS-CHX NPs had the highest anticandidal effect which was comparable to CHX and significantly higher than other medicaments (p < 0.001) at both time points. CS-CHX NPs had the highest effect against E. faecalis which was comparable to DAP and significantly higher than other medicaments (p < 0.001) at 3 days. All medicaments showed similar effect against E. faecalis after 7 days. The 7-days placement significantly increased the antimicrobial effect against both micro-organisms in all groups, except CS-CHX NPs which showed an insignificant increase. CS-CHX NPs showed the highest residual effect against both micro-organisms that increased with 7-days placement.ConclusionCSNPs and CHX combination showed a synergistic effect against both micro-organisms. CS-CHX NPs displayed a higher effect at a shorter period compared to other medicaments, yet its residual effect was higher with 7-days placement.

Next generation antibacterial strategies for regenerative endodontic procedures: A scoping review.

The clinical results following regenerative endodontic procedures (REPs) vary according to numerous parameters, including the presence of bacteria. This limitation reduces the indications for REPs and calls for the development of next generation antibacterial strategies (NGAS) providing alternatives to current antibacterial strategies (CAS) such as double or triple antibiotic paste (DAP/TAP) and (Ca(OH)2). The present scoping review aims to describe the current trends regarding the use of such strategies and highlight future perspectives. Four databases (PUBMed, Cochrane, ClinicalTrials and Science Direct) were searched until 1st May 2023. A total of 918 records were identified, 133 were screened and assessed for eligibility, and 87 articles were included. The findings show that (1) clinical studies are only available for CAS, (2) although next generation strategies are the most studied approach since 2017, they are all at the pre-clinical stage, (3) most of the next generation strategies use galenic forms which offer cell support and colonization and which simultaneously contain antibacterial molecules as alternatives to CAS and to antibiotics in general, (4) standardization is required for future research, specifically regarding the bacterial strains studied, the use of biofilm studies and the cellular behaviour assessments. Although NGAS are promising strategies to improve REPs in the context of infection, the current evidence is mostly limited to pre-clinical studies. Further methodological improvement is required to allow relevant comparisons between studies and to reduce the time from bench to bedside.

The antimicrobial efficacy of nanographene oxide and double antibiotic paste per se and in combination: part II

BackgroundFinding strategies to overcome the rising trends of antimicrobial resistance against currently available antimicrobial agents has become increasingly relevant. Graphene oxide has recently emerged as a promising material due to its outstanding physicochemical and biological properties. This study aimed to validate previous data on the antibacterial activity of nanographene oxide (nGO), double antibiotic paste (DAP), and their combination (nGO-DAP).MethodsThe antibacterial evaluation was performed against a wide range of microbial pathogens. Synthesis of nGO was achieved using a modified Hummers' method, and loading it with ciprofloxacin and metronidazole resulted in nGO-DAP. The microdilution method was utilized to assess the antimicrobial efficacy of nGO, DAP, and nGO-DAP against two gram-positive bacteria (S. aureus and E. faecalis), two gram-negative bacteria (E. coli, and S. typhi), and an opportunistic pathogenic yeast (C. albicans). Statistical analysis was conducted using one-sample t-test and one-way ANOVA (α = 0.05). ResultsAll three antimicrobial agents significantly increased the killing percent of microbial pathogens compared to the control group (P < 0.05). Furthermore, the synthesized nGO-DAP exhibited higher antimicrobial activity than nGO and DAP per se.ConclusionThe novel synthesized nGO-DAP can be used as an effective antimicrobial nanomaterial for use in dental, biomedical, and pharmaceutical fields against a range of microbial pathogens, including gram-negative and gram-positive bacteria, as well as yeasts.