Failure Of Root Canal Treatment Research Articles

Endodontic Management of Failed Root Canal Treatment in Teeth With Previously Missed Canals: A Report of Two Cases With Rare Root Canal Morphology

Endodontic Management of Failed Root Canal Treatment in Teeth With Previously Missed Canals: A Report of Two Cases With Rare Root Canal Morphology

Combination of Intracanal Medicines with Zinc Oxide Nanoparticles for Effective Eradication of Enterococcus faecalis

Background: Intracanal-resistant infections are the most important reason for root canal treatment failure. Therefore, cleaning the root canals is crucial. The efficiency of nanomedicines in eliminating intracanal contaminations and preventing bacterial attachment to surfaces are new strategies in this field. This study aimed to evaluate the effect of intracanal medicines, including calcium hydroxide (CH), zinc oxide nanoparticles (nZnO), pantoprazole (PP), and chlorhexidine (CHX) on Enterococcus faecalis (E. faecalis) in the individual and combinatorial form in an in vitro design in order to introduce an effective medicine for the eradication of E. faecalis. Sterilized water and sodium hypochlorite (NaOCl) 5.25% were used as the negative and positive control of antimicrobial activity, respectively. Methods: E. faecalis (ATCC 29212) was used for bacterial assays. The powder and the gel forms of the tested compounds were used in the analysis. The antibacterial and antibiofilm activities of the medicines were evaluated by the Minimum Inhibitory Concentration (MIC) determination using the broth microdilution method. The anti-biofilm effect of the tested compounds was assessed by Minimum Biofilm Inhibitory Concentration (MBIC). The antibacterial and antibiofilm effects of antimicrobial agent combinations were detected using the checkerboard assay and determination of the Fractional Inhibitory Concentration Index (FICI). Time-kill kinetics were conducted at zero, 2, 4, 6, 8, 10, 12, and 24 h. Results: Except for the MIC of the NaOCl, which was significantly lower than CH, there was no statistically significant difference between groups in MIC and MBIC. Only the mixture of CHX and nZnO and the mixture of PP and nZnO had a synergic effect against the planktonic and biofilm form of E. faecalis. Except for CHX and ZnO nanoparticles in gel form, other medicines did not show significant anti-biofilm effects against E. faecalis. Furthermore, the gel for CHX and nZnO showed stronger anti-biofilm effects. Conclusion: Combination therapy of common intracanal medicines with zinc oxide nanoparticles would lead to higher antibacterial and anti-biofilm effects against E. faecalis compared to conventional intracanal medicaments.

Impact of different activation procedures on sodium hypochlorite penetration into dentinal tubules after endodontic retreatment via confocal laser scanning microscopy

BackgroundInfected dentinal tubules are a possible source of bacteria that are responsible for the failure of root canal treatment. Therefore, disinfection of dentinal tubules by increasing the penetration of the irrigation solution is important for success in retreatment cases. This study utilized confocal laser scanning microscopy (CLSM) to assess and compare the impact of XPR, ultrasonic irrigation (UI) and sonic activation (SA) on NaOCl penetration into dentinal tubules following endodontic retreatment.MethodsA total of forty mandibular premolars were enrolled in this investigation. Following root canal preparation up to ProTaper X3 file (30/0.07), root canals were obturated with gutta-percha and bioceramic root canal sealer with single cone technique. The root canal filling materials were removed using ProTaper nickel-titanium rotary retreatment files until the working length was reached. The retreatment procedure was finalized using the ProTaper Next X4 (40/0.06). The teeth were divided into four groups based on the irrigation activation technique: control (conventional needle irrigation), SA, UI and XPR. During the final irrigation procedure, Rhodamine B dye was introduced to 5% NaOCl for visualization via CLSM. Subsequent to image acquisition, the maximum penetration, penetration percentage, and penetration area were calculated. Data were statistically analyzed using the Kruskal-Wallis, Friedman, and Bonferroni Dunn multiple comparison tests through R software (p < 0.05).ResultsIn the middle third, UI yielded a significantly higher penetration percentage than the control group (p < 0.05). The UI and XPR groups showed increased penetration percentages in the coronal and middle thirds compared with the apical third (P < 0.05). Maximum penetration was notably reduced in the apical third than in comparison with the coronal and middle thirds in all groups (p < 0.05). In the control, SA and XP groups, the penetration area was ranked in descending order as coronal, middle and apical (p < 0.05). Conversely, in the ultrasonic group, the penetration area was significantly lower in the apical third than in the middle and coronal thirds (p < 0.05).ConclusionsUI enhanced the penetration percentage in the middle third of the root compared with that in the control group. XPR and SA showed no significant effect on NaOCl penetration following retreatment.

ANTIBACTERIAL ACTIVITY OF PAPUYU FISH SCALE CHITOSAN (Anabas testudineus) AGAINST Staphylococcus aureus

Backgrounds: Pulp disease due to caries can be treated through endodontic treatment, which aims to eliminate bacteria in the root canal so microorganisms cannot multiply. Staphylococcus aureus is a resistant microorganism causing root canal treatment failure. Chlorhexidine as a gold standard cannot remove biofilm and other organic debris. Utilization of nature, chitosan of papuyu fish scales (Anabas testudineus) has antibacterial properties that can be an alternative root canal irrigation material. Purpose: Analyze the antibacterial activity of chitosan of papuyu fish scales against Staphylococcus aureus based on the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC). Methods: This research is a true experimental design with posttest only with control group design. The research groups were chitosan of Papuyu fish scales with concentrations of 25%, 50%, 75%, 100%, chlorhexidine gluconate 2% (positive control), and aquadest (negative control) with 6 repetitions. Results: The MIC value in the One-Way ANOVA test showed a significant difference (p&lt;0.05). Data analysis followed by Post Hoc Games-Howell test showed all treatment groups had significant differences between each other (p&lt;0.05). The MBC value in the Kruskal Wallis test shows that there is a significant difference (p&lt;0.05). Data analysis followed by MannWhitney test showed significant differences between each other (p&lt;0.05) except for the group of papuyu fish scale chitosan 25% concentration against papuyu fish scale chitosan 50% concentration, papuyu fish scale chitosan 100% concentration against chlorhexidine gluconate 2% (p&gt;0.05). Conclusion: There is a difference in the antibacterial activity of chitosan of Papuyu fish scales concentrations of 25%, 50%, 75%, 100%, chlorhexidine gluconate 2% (positive control) and aquadest (negative control) against Staphylococcus aureus bacteria.

Evaluation of root and root canal morphology in maxillary premolar teeth: A cone-beam computed tomography study using two classification systems in a Japanese population

Background/purposeInadequate knowledge increases the risk of overlooking root canals and causing procedural errors that can lead to root canal treatment failure. This study aimed to analyze the root and root canal morphology in maxillary premolar teeth using two classification systems assessed by cone-beam computed tomography (CBCT) in a large Japanese population. Materials and methodsThis study evaluated 1443 maxillary teeth including 726 first and 717 s premolars, from 642 Japanese individuals aged 16–84 years. CBCT images were analyzed according to the Vertucci and Ahmed classification systems, focusing on the root and root canal morphology. Variations were analyzed based on gender and age using the chi-square test (P < 0.05). ResultsMaxillary first premolars were predominantly single-rooted (64.9%) and had two root canals (86.2%). Females exhibited a higher prevalence of single-rooted (71.0%) compared to males (49.8%) (P < 0.05). Additionally, single root canals occurred significantly more frequently in females (14.0%) than in males (7.5%) (P < 0.05). Maxillary second premolars mostly had a single root (97.8%) with a single root canal (72.1%). The frequency of second premolars with two root canals significantly increased with age (P < 0.001). The three-rooted configuration occurred in 1.2% and 0.3% of the first and second premolars, respectively. ConclusionMaxillary premolars in a Japanese population showed significant anatomical variations, highlighting the importance of understanding anatomical characteristics specific to age and gender. Ahmed's system provides a more comprehensive description of the morphological variations.

Effectiveness of LED-curing light photodynamic therapy with curcumin (cur-aPDT) as a disinfection method in root canal

Background: Root canal treatment (RCT) is an endodontic treatment that reduces microbial growth and provides a suitable environment to induce periradicular healing. The prevalence of root canal treatment failure caused by Enterococcus faecalis bacteria reaches 90% because the bacteria form biofilms to defend themselves against antibacterial agents. Although the conventional use of NaOCl as a disinfectant has been well-known for a long time, improved disinfection methods are needed to optimize root canal treatment. One of the treatments that can provide better results through reducing the number of microbes is photodynamic therapy (aPDT) mediated with curcumin compound (Cur- aPDT) as a photosensitizer. Curcumin is a compound that can be used as a root canal disinfecting agent which can increase dentin bond strength through its antimicrobial and antioxidant activities with its natural pigment as a photosensitizer. Materials and Methods: The literature review was carried out on PUBMED, MDPI, and Sciencedirect databases with a limit of 2019-2024 to identify published research on the antimicrobial effectiveness of Cur-aPDT as a root canal disinfection method. Conclusion: This review shows that Cur-aPDT is an effective method to disinfect root canals.

A protocol for a comparative evaluation of the fracture resistance of endodontically treated teeth reinforced with Cention N, resin-modified glass ionomer cement (RMGIC) and short fiber reinforced flowable composite as an intraorifice barrier.

Endodontic treatment is the most common method for resolving pulpal and periapical pathology. However, various studies have reported that almost 11%-13% of all teeth that undergo extraction after endodontic treatment show the presence of cracks, craze lines, and vertical root fractures. Teeth with inadequate post endodontic restoration are more prone to fracture and coronal leakage, resulting in the diffusion of oral fluids, bacteria, bacterial products, and possibly root canal treatment failure. Furthermore, studies have advocated the use of endodontically treated teeth with restorative materials that have a similar or higher elastic modulus than the tooth for providing stiffness against forces that cause root fracture. Intraorifice barriers made of restorative materials that can bond to radicular dentin could thus be used to reinforce the radicular dentin while also preventing coronal microleakage. Although the sealing ability of intraorifice barriers has been widely compared in the literature, there have been few studies on the strengthening effect of the materials used in the study as intraorifice barriers when placed into the root canal. As a result, the current in vitro study aims to assess the effect of various materials as intraorifice barriers (Cention N, Resin modified glass ionomer cement, and short fiber reinforced flowable composite) on the force required fracture teeth after root canal treatment. This in vitro study will be done on extracted human mandibular premolars with single root canal where after doing root canal treatment 2-3 mm obturating material would be replaced by intra orifice barriers (Cention N, resin modified glass ionomer cement [RMGIC], and short fiber reinforced flowable composite). The force required to fracture teeth will be calculated using universal testing machine.

Effect of Saga Leaf Extract (Abrus precatorius Linn) in Inhibiting Enterococcus faecalis Bacteria Growth as an Alternative Root Canal Irrigation Material

Abstract Objective This study aims to examine the antibacterial effect of saga leaf extract on Enterococcus faecalis bacteria, which causes root canal treatment failure. Materials and Methods This research was conducted using a laboratory experimental method with saga leaf extract at 3.125, 6.25, 12.5, 25, 50, and 100% concentrations. Two percent chlorhexidine acts as the positive control, and 100% dimethyl sulfoxide as the negative control. The diameter of the inhibition zones was measured using the well diffusion test method. Statistical Analysis Data from the measurement of inhibition zone diameter were obtained and tested statistically using the normality test (Shapiro–Wilk), homogeneity test (Levene), parametric test (one-way analysis of variance), and further test (post hoc test). Results The largest inhibition zone diameter observed in this study was 9.46 mm at 100% concentration; however, it was not bigger than the positive control, which was measured at 16.55 mm. The research data were analyzed based on the classification of Davis and Stout inhibition zones. Conclusion This study concludes that saga leaf extract has an antibacterial effect on the growth of E. faecalis bacteria.

Successful Root Canal Re-treatment of the Second Mandibular Premolar with type III of Vertucci Classification

Knowledge of the root canal system plays a significant role in avoiding the failure of root canal treatment. Premolar teeth may have several anatomical variations in their root canal system. A dentist must understand these root canal systems and their variation to conduct the appropriate treatment. The mandibular second premolar usually consists of a single root with a single root canal. The incidence of lower premolars with two or more root canals varied between 1.2% and 34%. This study aims to evaluate the success of root canal re-treatment of mandibular second premolars with type III Vertucci’s Classification. Case report: A 28-year-old woman visited our dental hospital with a pain sensation in her lower left premolar tooth. The subjective examination revealed that she had experienced pulp capping and root canal treatment last year. However, she felt pain and uncomfortable feeling on that treated tooth. A radiograph examination showed a radiopaque area from the crown edge to half of the root. The radiolucent area from the half tooth to the apical region showed root canal branching. The diagnosis for this tooth was previously treated teeth, asymptomatic apical periodontitis with type III of Vertucci’s Classification. Root Canal Treatment was done using crown down preparation technique and obturation with warm vertical condensation followed by class II composite resin composite as a temporary filling. Results showed that after three months of evaluation, the retreated-tooth condition kept showing good condition without any complaints, pain, or clinical abnormalities, suggesting it could function properly.

Predicting early endodontic treatment failure following primary root canal treatment

BackgroundUnderstanding when and why endodontic treatments fail could help clinicians make prognoses and thus improve treatment outcomes. This study was aimed to assess potential predictors of early endodontic treatment failure. We explored factors contributing to the failure of initial root canal treatment were explored, with a specific emphasis on evaluating the influence of the time elapsed since the initial treatment.MethodsThis retrospective cohort study enrolled 1262 patients who sought endodontic treatment at our department and 175 patients were included for analysis. Potential causes of endodontic treatment failure were investigated, such as inadequate obturation quality, inadequate coronal status, the presence of additional untreated canals, anatomical complexity, instrument separation, iatrogenic perforation, cracks, and endodontic-periodontal lesions. The patients were divided into “short-term” and “long-term” groups depending on the time that had passed since the initial treatment (i.e., < 5 and > 10 years, respectively). The causes of failure in the short-term and long-term group were analyzed and compared using logistic regression analyses. Subgroup analysis was performed according to the number of years since the initial treatment in the short-term group to further investigate the association between the time and cause of failure (i.e., < 1, 2, 3, and 4 years, respectively).ResultsUntreated additional canals were present in 21.7% of all cases, and in 36.9 and 6.4% of cases in the short-term and long-term groups, respectively. Multivariable analysis showed that the presence of untreated additional canals was significantly associated with short-term compared to long-term failure. Untreated additional canals were also associated with endodontic failure within 1, 2, 3, and 4 years.ConclusionsThe presence of untreated additional canals was a predictor of endodontic failure within 5 years following initial root canal treatment. To optimize long-term prognosis, it is important to detect and treat all root canals during the initial treatment.

The assessment of the endodontic foundation

The diagnosis of an endodontic disease requires thorough research, collecting both clinical and radiographic information. The clinical examination includes history taking, visual inspection of the tooth and surrounding tissues, palpation of the soft and hard tissues, periodontal examination and percussion. The radiographic examination provides valuable information, but can never stand alone in arriving at a diagnosis. It is important to link the findings of the radiographic examination to other information. Sometimes, invasive examination is necessary, during which the coronal restoration is removed to allow better assessment of the tooth. This can provide additional information about the presence of caries, fractures, leakage of the restoration or other reasons for failure of the initial root canal treatment. A good diagnosis is essential for planning successful follow-up treatment.

Antibacterial Activity of Robusta Coffee (Coffea Canephora) Husk Extract Against Enterococcus Faecalis and Phorphyromonas Gingivalis: In Vitro Study

Enterococcus faecalis is one of the bacteria that is commonly found in infected root canals, necrotic pulp and failure of root canal treatment, while Phorphyromonas gingivalis play a role in inducing periodontitis. Both bacteria can enter the blood circulation and lead to risk factors for systemic disease such as atherosclerosis. ChKM is the most widely used root canal sterilization, and also 0.2 % chlorhexidine mouthwash for long-term usage. It can destroy a potent cell and is allergenic. Developing an alternative material for root canal sterilization and mouthwash for plaque control is necessary. One of the alternative natural products that is predicted to have antibacterial effect is robusta coffee husk peels. This research aimed to investigate the antibacterial activity of robusta coffee (Coffea canephora) husk extract on E. faecalis and P. gingivalis. The robusta coffee husk was extracted using the maceration process with 96 % ethanol as the solvent. This research is an experimental laboratory, was tested by disk diffusion methods (Kirby-Baurer) using Gram-positive E. faecalis ATCC 29212 and Gram-negative P. gingivalis ATCC 33277 consisted of 6 groups: Aquadest as a negative control group, ChKM (for E.facecalis) and 0.2 % chlorhexidine (for P. gingivalis) as positive control, 4 treatment groups of coffee robusta husk extract with different concentrations there were 250, 250, 500, 750 and 1,000 mg/mL. The antibacterial effect was examined by measuring the clear zone around the disk paper. The results of this study proved the presence of antibacterial activity of coffee robusta husk extract against E. faecalis and P. gingivalis. The higher concentrations followed with a greater antibacterial effect. HIGHLIGHTS Robusta coffee husk extract (Coffea canephora) has an antibacterial property against Gram-positive and Gram-negative bacteria Robusta coffee husk was extracted using the maceration process, and disk diffusion methods (Kirby-Baurer) for antibacterial test Robusta coffee husk extract with a concentration of 1,000 mg/mL showed the greatest inhibition zone. The higher the concentration, the bigger inhibition zone appeared GRAPHICAL ABSTRACT

A protocol for a comparative evaluation of the fracture resistance of endodontically treated teeth reinforced with Cention N, resin-modified glass ionomer cement (RMGIC) and short fiber reinforced flowable composite as an intraorifice barrier

Background: Endodontic treatment is the most common method for resolving pulpal and periapical pathology. However, various studies have reported that almost 11%–13% of all teeth that undergo extraction after endodontic treatment show the presence of cracks, craze lines, and vertical root fractures. Teeth with inadequate post endodontic restoration are more prone to fracture and coronal leakage, resulting in the diffusion of oral fluids, bacteria, bacterial products, and possibly root canal treatment failure. Furthermore, studies have advocated the use of endodontically treated teeth with restorative materials that have a similar or higher elastic modulus than the tooth for providing stiffness against forces that cause root fracture. Intraorifice barriers made of restorative materials that can bond to radicular dentin could thus be used to reinforce the radicular dentin while also preventing coronal microleakage. Although the sealing ability of intraorifice barriers has been widely compared in the literature, there have been few studies on the strengthening effect of the materials used in the study as intraorifice barriers when placed into the root canal. As a result, the current in vitro study aims to assess the effect of various materials as intraorifice barriers (Cention N, Resin modified glass ionomer cement, and short fiber reinforced flowable composite) on the force required fracture teeth after root canal treatment. Methods: This in vitro study will be done on extracted human mandibular premolars with single root canal where after doing root canal treatment 2-3 mm obturating material would be replaced by intra orifice barriers (Cention N, resin modified glass ionomer cement [RMGIC], and short fiber reinforced flowable composite). The force required to fracture teeth will be calculated using universal testing machine.

THE KEYS TO A SUCCESSFUL ROOT CANAL TREATMENT

Failure of root canal treatment (RCT) occurs when endodontic treatment falls short of standard clinical guidelines. An improper mechanical debridement (shaping and cleaning), persistence of bacteria inside the canals and apex, poor obturation quality, coronal leakage, and experience of dentists all probably influence the RCT success or failure. Although there is substantial success of RCT, failures take place in many cases, which usually could be related to the previously mentioned factors. So, it’s considerably imperative to stop the foremost potential factors that cause RCT failure. This paper reviews how to increase the success rate of the RCT.

Comparison of the Antibacterial Effectiveness of Moringa Leaf Extract (Moringa oleifera) on the Growth of Enterococcus faecalis and Streptococcus mutans Bacteria in Vitro

Streptococcus mutans and Enterococcus faecalis are bacterial pathogens of dental caries and root canal treatment failure. The growth of bacteria that cause dental and oral disease can be inhibited by using antibacterials derived from plants that have antibacterial properties. The aim of the research was to compare the antibacterial effectiveness of Moringa oleifera leaf extract against the growth of Enterococcus faecalis and Streptococcus mutans bacteria in vitro. This type of research is a laboratory experiment with a post test only control group design. The research samples were pure cultures of Streptococcus mutans and Enterococcus faecalis. There were seven treatment groups, namely Moringa leaf extract concentrations of 50%, 25%, 12.5%, 6.25%, 3.125%, positive control chlorhexidine and negative control DMSO with four repetitions each. Testing the antibacterial effectiveness of Moringa leaf extract used the diffusion and dilution method, then the data was analyzed using one way ANOVA and post hoc LSD statistical tests. Based on the research results, it was stated that there was effective inhibitory and killing power of Moringa oleifera leaf extract on the growth of Enterococcus faecalis and Streptococcus mutans bacteria. From the research results, it can be concluded that Moringa oleifera leaf extract is more effective as an antibacterial against Streptoccus mutans compared to Enterococcus faecalis

An in-vitro comparison of bond strength of three different root end filling materials with Universal testing machine

Bacterial infection is widely known cause of apical periodontitis. Failure of conventional root canal treatment indicates the periapical surgery, this procedure requires root end resection. For the long term success of periapical surgery, root end filling materials are used. To compare the push-out bond strength of Portland cement, ProRoot MTA and Biodentine used as root-end filling materials using Universal Testing Machine. From the middle part of each root, three dentinal slices were made to produce 93 slices which were divided into 3 groups. In Group A: ProRoot MTA, In Group B: Biodentine and In group C: Portland cement were used and were further divided in subgroups based on soaking time in PBS solution i.e. 24hrs and 7 days before assessing the push out bond strength using Universal Testing Machine. The mode of bond failure of material to root dentin was analyzed using microscope. Data was analyzed using ANOVA and post-hoc tukey’s test. After 24hrs, there was statistically non-significant difference but After 7 days, ProRoot MTA showed significantly higher bond strength as compared to other tested groups. While analyzing the mode of bond failure, ProRoot MTA had adhesive failure, Biodentine had cohesive failure and Portland cement had mixed type of bond failure. All the tested materials showed comparable bond strength but ProRoot MTA had highest bond strength to root dentin among the other tested materials.

Antibacterial Potency of Various Concentrations of Pineapple Peel Extract (Ananas comosus) against Enterococcus faecalis

Introduction: Enterococcus faecalis is a Gram-positive bacterium commonly found in cases of failed root canal treatment. Irrigation material with antibacterial effects are important in supporting the success of root canal treatment. Pineapple peel as a natural ingredient is reported to contain compounds such as flavonoids, saponins, tannins, and bromelain enzymes that have been proven antibacterial effects. Purpose: To determine antibacterial potency of pineapple peel extract (Ananas comosus) with concentrations of 1.56%, 3.125%, 6.25% and 12.5% against E. faecalis. Methods: In vitro quasi-laboratory experimental study with a post-test only control group design consisting of pineapple peel extract with concentrations of 1.56%, 3.125%, 6.25%, 12.5%, and aquadest as negative control with repetition 6 times. The inhibition test was determined using the disc diffusion method on Mueller-Hinton Agar media. The MIC value can be determined using the broth dilution method and the MBC value can be determined using the solid dilution method. The inhibition zone diameter data were analyzed using One Way ANOVA test and Post Hoc Tukey test. Results: Pineapple peel extract with concentrations 12,5% had the largest mean inhibition zone, which is was 3.13 mm. The MIC and MBC values of pineapple peel extract were determined at a concentration of 6.25%. Conclusion: Pineapple peel extract (Ananas comosus) has antibacterial potency against Enterococcus faecalis.

Endodontic Retreatment Failure of Mandibular First Molar and Its Periapical Surgical Management with MTA and Bone Graft—A Case Report

This report discusses the case of a failed root canal treatment in the right mandibular first molar, which exhibited a chronic periapical pathology in its distal and mesial roots. The tooth was managed surgically by periapical curettage and apicoectomy. This approach is indicated in teeth having periapical pathosis which does not resolve by routine endodontic treatment. The aim of periapical curettage is to make the apical periodontium and root canals of the treated tooth free of bacteria and their products. With the advancements in magnification, armamentaria, and materials, the ease of operation and success rate of apicoectomy have underwent a significant improvement. The treated case showed a complete resolution of clinical symptoms and the periapical pathology, thus substantiating the effectiveness of this treatment approach.

Tannin derived from Uncaria gambir Roxb. as potential Enterococcus faecalis UDP-N-Acetylenolpyruvoyl-Glucosamine Reductase (Mur Benzyme) inhibitor: In-silico antibacterial study

The high prevalence of pulp and periapical disease is an important problem for dental and oral health in dentistry. Treatment of pulp and periapical disease is generally carried out utilizing root canal treatment, but the results of the treatment are often not as expected. Enterococcus faecalis is a bacterium that plays a role in the failure of root canal treatment. E. faecalis are Gram-positive bacteria that use the Muramidase B (MurB) enzyme in the biosynthesis of peptidoglycan, which will build bacteria cell walls and play an important role in protecting bacteria. Gambir (Uncaria gambir Roxb.) is an herbal plant that is used in the field of medicine and contains tannin compounds that have antibacterial activity. The purpose of this study was to predict the antibacterial activity of Gambir extracts against the MurB enzyme compared with chlorhexidine through in silico approach. The Mur B enzyme was obtained from the Protein Data Bank (PDB), and the structure of the compound (tannins and chlorhexidine) was obtained from Pubchem. Using Auto dock tools from Pyrx software for docking between the two compounds (tannin and chlorhexidine) with the MurB enzyme, and visualize using Pymol and 3D analysis using Biovia. The results showed that tannins had a binding affinity of more than -7.4 kcal.mol-1 to the MurB enzyme and chlorhexidine had a higher binding affinity than tannins. Both tannins and chlorhexidine have hydrogen bonds with the same three amino acids, that is ARG 159, GLY 123, and ASN 233. The results showed that tannins interacted with the MurB enzyme and could inhibit the action of the MurB enzyme.

Evaluation of Microhardness and Microleakage of CEM Cement after Adding Water to Semi Setting Cement

Introduction: Microleakage is one of the most important factors in the failure of root canal treatment. Microhardness is one of the physical properties of bioceramics that can be affected by various environmental factors such as enviromental humidity. The aim of this study was to evaluation the effect of adding water to semi-setting cement on the microhardness and microleakage of CEM cement.&#x0D; Methods: 50 single-rooted teeth were selected. Teeth were cut from the CEJ region and the apical 3 mm of the root were trimmed and dentinal blocks with 5 mm height were prepared Peeso reamer size 2 was used to prepare the canal. The teeth were divided into two groups of 23 cases and two groups of 2 positive and negative controls. In the first group, CEM-cement prepared according to the manufacturer's instructions was placed in the canal. In the second group, after adding water to the semi-setting CEM cement mixture, the canal was filled with this cement. The samples were placed in 1% methylene blue for 3 days and then cut. Microleakage was recorded under a stereomicroscope. The microhardness of the samples was measured with Vickers device after mounting in acrylic resin. Statistical analysis was performed using SPSS19 software and Mann-Whitney Kruskal-Wallis and one-way ANOVA tests.&#x0D; Results: There was a statistically significant difference between the two groups in microleakage (P-Value &lt;0.008) and microhardness (P-Value &lt;0.001).&#x0D; Conclusion: According to the results of the present study, adding water to the semi-setting CEM cement not only does have a very bad clinical effect, but also may even increase sealling ability.