Intracanal Medication Research Articles

Cytocompatibility, Antibacterial, and Anti-Biofilm Efficacy of Grape Seed Extract and Quercetin Hydrogels Against a Mature Endodontic Biofilm Ex Vivo Model

Background/Objectives: To assess the cytocompatibility, antibacterial and anti-biofilm efficacy of grape seed extract (GSE) and quercetin hydrogels versus calcium hydroxide (CH) as intracanal medications (ICMs) against an endodontic ex vivo biofilm model. Methods: Single-rooted teeth (n = 50) were prepared and sterilized before being infected with E. faecalis to develop a mature biofilm. They were divided into five equal groups according to the ICM used: G1: medicated with CH paste, G2: medicated with GSE hydrogel, G3: medicated with quercetin hydrogel, G4: positive control group that was infected and not medicated, and G5: negative control group that was neither infected nor medicated. After 1 week, the ICM was removed, and the root canals were cultured to assess the antibacterial efficacy by counting the colony-forming units and the anti-biofilm efficacy by the crystal violet assay. Dead/live bacterial viability was assessed by CFLSM examination, while the cytocompatibility was assessed using the MTT assay. Results: CH had the best antibacterial efficacy, followed by GSE and quercetin hydrogels (p < 0.001). Regarding the anti-biofilm efficacy, GSE was superior, followed by quercetin and CH (p < 0.001). CFLSM examination showed CH and GSE hydrogel to be highly effective in comparison to the positive control (p < 0.0001), with no statistical difference between them (p > 0.05). CH showed significantly higher cell viability percentages using a 500 μg/mL, while quercetin and GSE started to show cell viability > 70% at concentrations of 125 μg/mL and 62.5 μg/mL. Conclusions: CH fulfilled the ideal requirements of ICM as being both antibacterial and non-cytotoxic compared to the other materials tested.

Antimicrobial and anti-endotoxin activity of N-acetylcysteine, calcium hydroxide and their combination against Enterococcus faecalis, Escherichia coli and lipopolysaccharides.

The management of endodontic infections is a complex challenge, mainly due to the involvement of diverse microorganisms and their by-products. This study aimed to evaluate the efficacy of N-acetylcysteine (NAC), calcium hydroxide (Ca(OH)2), and their combined application as intracanal medications in combating Enterococcus faecalis, Escherichia coli, and lipopolysaccharides (LPS) from E. coli. A total of 60 single-rooted human teeth were carefully selected and divided into six groups. These tooth canals were deliberately exposed to E. faecalis (ATCC 29212) and E. coli (ATCC 25922) to induce biofilm formation. Subsequently, the specimens were treated with NAC, Ca(OH)2, or a combination of both substances. Three samples of the root canals were collected at three moments: the first sample (S1) was to confirm the initial contamination, the second sample (S2) was immediately post-instrumentation, and the third sample (S3) was collected after the use of the intracanal medication. The antimicrobial efficacy of these intracanal medications was assessed by enumerating colony-forming units per milliliter (CFU/mL). In addition to this, the kinetic chromogenic Limulus Amebocyte Lysate (LAL) assay by Lonza was used to quantify LPS from E. coli. Data tested for normality; then, Kruskal-Wallis and Friedman tests were used, and Dunn's for multiple comparisons. The findings of this study showed significant reductions in the microbial load of E. faecalis and E. coli by S3. Notably, there were no statistically significant differences among the treatment groups concerning these microorganisms. However, it was observed that only the combination of NAC and Ca(OH)2 led to a noteworthy decrease in the quantity of E. coli's LPS after 7-days, demonstrating a statistically significant difference from the other treatment groups. NAC + Ca(OH)2 combination, applied for a duration of 7-days, proved to be more suitable in reducing the presence of E. faecalis, E. coli, and LPS from E. coli within the context of endodontic infections.

Mustard Gel versus Chlorhexidine Gel as Root-Canal Medicament Against Enterococcus Faecalis: An in vitro Study.

To evaluate the efficacy of mustard gel versus chlorhexidine (CHX) gel in treating the most resistant Enterococcus faecalis (E. faecalis) bacteria as intra-canal medications. Randomised controlled trial (in vitro study). Place and Duration of the Study: Department of Operative Dentistry, de'Montmorency College of Dentistry, in collaboration with Lahore General Hospital, between March and October 2021. Forty single-rooted teeth, extracted and randomly allocated, were divided into two groups. Group 1 underwent treatment with CHX gel, while Group 2 was treated with Mustard gel. Subsequently, after disinfection, each tooth was horizontally divided into three equal parts. The middle section was standardised and inoculated with a controlled strain of E. faecalis. Intra-canal medicaments were administered for seven days. Bacterial colonies were quantified as colony forming units (CFU/mL) and subjected to analysis using Statistical Package for Social Sciences (SPSS) version 25. The median bacterial count observed was 1,550 (range 775 - 2,500) for Group 1, contrasting with 400 (range 200 - 775) for Group 2, indicating a significant difference in bacterial count between the groups (p <0.001). Mustard gel demonstrated significantly superior efficacy compared to chlorhexidine gel against E. faecalis in root canal procedures. Chlorhexidine, Enterococcus faecalis, Mustard, Root canal medicament, Antimicrobial drug-resistance, Root canal irrigants.

Antibacterial efficacy of carnosic acid as an intracanal medicament against Enterococcus faecalis: Quantitative polymerase chain reaction study

Abstract Aim: The aim of this study was to quantitatively assess the antibacterial effectiveness of carnosic acid, propolis, and calcium hydroxide when used as intracanal medications against Enterococcus faecalis. Methodology: Forty-six human mandibular single-rooted premolar root lengths were standardized to 12 mm after decoronation. Cleaning and shaping were performed. The specimens were placed in Eppendorf Tubes and autoclaved. E. faecalis was inoculated into the canals and incubated for 21 days. The teeth were categorized into four groups: I - carnosic acid, II - propolis, III - calcium hydroxide, and IV - nonmedicated group. The medicaments were applied to the root canals and incubated for 14 days. The DNA extraction of E. faecalis was obtained from dentinal shavings harvested at 400-μm depth and a real-time quantitative polymerase chain reaction was performed. Statistical Analysis: Data were analyzed using the Kruskal–Wallis test and Dunn’s intergroup comparison test in SPSS software. Results: E. faecalis present were 4.14, 6.98, 3.80, and 56.84 mean copies/μl in groups I, III, III, and IV, respectively. A significant difference in antibacterial efficacy was observed between medicated and untreated control groups. However, no statistically significant differences were observed among the groups treated with different medicaments. Conclusion: Carnosic acid has promising antibacterial activity against E. faecalis when used as an intracanal medicament.

Antimicrobial efficacy of nanoparticle calcium hydroxide and silver nanoparticles on Enterococcus faecalis: An in vitro study

Abstract Background: In root canal disinfection, intracanal medicaments play a vital role. Typical intracanal medicament, calcium hydroxide (CH), has the lowest efficacy against the biofilm of Enterococcus faecalis. Nanoparticles and their combinations may increase antimicrobial activity, making them better than conventional CH. Aim: The aim is to determine the efficacy of nanoparticle CH (NPCH) and silver nanoparticles (AgNP) against E. faecalis. Materials and Methods: A total of 60 premolars were chosen. The samples were cleaned and decoronated. Cleaning and shaping were done. The apices were tightly sealed with modeling wax before being injected with 5 μl of E. faecalis (ATCC 29212) bacterial suspension, and then left to incubate. Samples were categorized into CH (G-I), NPCH (G-II), AgNP (G-III), and a combination of NPCH + AgNP (G-IV) according to the intracanal medication used. Eppendorf tubes were used to transfer dentin chips after they had been incubated for 7 days. The process of obtaining bacterial colony-forming units (CFUs) involves inoculating sediments onto blood agar. Results: The findings are statistically significant, number of CFUs seen with the Combination of NPCH + AgNP is lower than the other experimental groups, the group treated with CH had the largest number of CFUs. Conclusions: The highest antibacterial effect was seen in combination of NPCH + AgNP.

Effectiveness of mechanical vs. chemomechanical methods in removing intracanal calcium hydroxide medication: a randomised trial.

To compare the mechanical and chemomechanical methods for removing calcium hydroxide medication from the root canal system. The triple-blind, randomised clinical trial was conducted at the Department of Operative Dentistry and Endodontics, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan, from December 16, 2022, to June 15, 2023, and comprised patients having necrotic teeth and chronic apical pathosis. They were randomised into groups A and B. On the initial visit, after access opening and chemomechanical preparation, calcium hydroxide paste was placed as an intracanal medication in both groups. the patients were recalled after two weeks. In Group A, calcium hydroxide was removed from the canals using a rotary master apical file, while in Group B, an endoactivator was used to sonically agitate the endodontic irrigant. Verification of placement was done by using a periapical radiograph. Data was analysed using SPSS 26. Of the 98 individuals assessed initially, 60(61.22%) were included; 34(57%) females and 26(43%) males with age ranging from 19 to 57 years. There were 27(45%) incisors, 22(36.7%) premolars and 11(18.3%) canines. There were 30(50%) patients in each of the 2 groups. The intergroup difference was not statistically significant (p=0.43). Tooth arch did not significantly correlate with the removal method (p=0.79). Both methods were found to be equally effective in removing water-based calcium hydroxide medication from the endodontic system. NCT05744661.

Efficacy of Glycyrrhizin as an Intracanal Medicament on Bacterial Load Reduction in Primary Infected Root Canals: A Randomized Clinical Trial.

This study was done to clinically investigate the efficacy of glycyrrhizin-based intracanal medication (ICM) compared to calcium hydroxide Ca(OH)2 and Ledermix on the bacterial counts inside the root canals of necrotic teeth with chronic periapical periodontitis. Thirty-six patients having single-rooted and single-canaled necrotic teeth with chronic periapical periodontitis were enrolled in this research. Aseptic control measures were taken before clinical steps. Access cavity preparation was done. First bacteriological samples (S1) were collected immediately after access cavity preparation and before cleaning and shaping inside the root canals. Cleaning and shaping were performed on the root canals. Patients were randomly allocated into 3 groups according to the type of intracanal medicament used [Ca(OH)2, Ledermix, Glycyrrhizin]. Second bacteriological samples (S2) were collected after 1 week from placing the ICMs. S1 and S2 were transferred to the lab of microbiology for culturing on blood agar dishes in anaerobic conditions, and the bacteria on the plates were enumerated as colony-forming units (CFUs) by the manual counting method. The anti-bacterial efficacy of the ICM was estimated by the percentage reduction in the bacterial colonies from S1 to S2. All tested ICM documented a significant reduction in the CFUs from S1 to S2 (p < 0.05). Regarding S1, there was no significant difference between the three tested materials (p > 0.05). Regarding S2, Glycyrrhizin and Ledermix showed significantly lower CFUs than Ca(OH)2. There was no significant difference between Glycyrrhizin and Ledermix. Under the conditions of the present study, Glycyrrhizin and Ledermix showed comparable antimicrobial effects that were better than the commonly used Ca(OH)2 ICM. Glycyrrhizin may be a promising ICM. Herbal medicine can be considered as an alternative antimicrobial material for root canal disinfection because it has many benefits, like low toxicity, absence of microbial resistance, and favorable antimicrobial efficacy. This study highlights the clinical efficacy of Glycyrrhizin as a promising ICM. How to cite this article: Eltantawi AR, Abdel-Razik GM, Elhawary YM, et al. Efficacy of Glycyrrhizin as an Intracanal Medicament on Bacterial Load Reduction in Primary Infected Root Canals: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(6):540-546.

In Vitro Evaluation of Sodium Hypochlorite, Chlorhexidine, Propolis, and Calcium Hydroxide Effect on Lipoteichoic-Acid-Induced Proinflammatory Cytokines Production.

This study aimed to evaluate the effects of sodium hypochlorite (NaOCl), chlorhexidine (CHX), and the glycolic extract of propolis (GEP) as endodontic irrigants and of calcium hydroxide [Ca(OH)2], CHX, or Ca(OH)2 + CHX as intracanal medications on the capacity of the lipoteichoic acid (LTA) of Enterococcus faecalis in macrophages' proinflammatory cytokines production. Freshly extracted 108 human single-rooted teeth were used in this study. The LTA of E. faecalis was standardized in double-distilled pyrogen-free water (250 µg/mL) and inoculated into the specimens subdivided into nine subgroups (n = 12). Cultures of murine macrophages (RAW 264.7) were treated with 30 µL of each sample collected from root canals and incubated (37 °C, 5% CO2) for 24 h. Lastly, anti-TNF-α, anti-IL-6, anti-IP-10, anti-MIP-1α, anti-G-CSF, and anti-IL-1β DuoSet kits were used to perform an ELISA assay. Data were analyzed using one-way ANOVA and Tukey test (p ≥ 0.05). It was found that 1% NaOCl was the most effective irrigant in reducing the capacity of LTA in cytokines production, followed by 12% GEP and 2% CHX, respectively. Ca(OH)2 + CHX presented the best results when associated with NaOCl or GEP. Thus, NaOCl or GEP associated with Ca(OH)2 + CHX were effective in reducing the capacity of LTA in different macrophages pro-inflammatory cytokines production.

Comparative Evaluation of Penetration Depth and Antimicrobial Efficacy of Calcium Hydroxide, MAS Paste, Nitrofurantoin, and Levonadifloxacin against Enterococcus faecalis: A Confocal Laser Scanning Microscopic Study

Abstract Aim: The most prevalent species in persistent and secondary infections linked to endodontic failure is Enterococcus faecalis. The objective of this in vitro investigation was to assess the antibacterial efficacy and penetration depth of calcium hydroxide, nitrofurantoin, levonadifloxacin, and a mixture of antibiotic and steroid paste (MAS paste) against E. faecalis. Materials and Methods: A total of 40 single-rooted tooth samples were decoronated apically and coronally to yield 10 mm root sections. All tooth samples were biomechanically prepared and were inoculated with E. faecalis bacteria for 21 days. The study involved four groups, each containing 10 teeth as follows: group 1—calcium hydroxide, group 2—MAS paste consisting of ciprofloxacin, metronidazole as antibiotics, and dexamethasone as corticosteroid, group 3—nitrofurantoin, and group 4—levonadifloxacin. For 7 days, the corresponding intracanal medications were injected into the canals. On the seventh day, dentinal debris was extracted from the blocked lumen to quantitatively evaluate the antibacterial activity of the experimental medications. The depth of penetration (DOP) of medicaments under study was assessed by viewing 1 mm thick horizontal sections under a confocal laser scanning microscope, one from each of the four subgroups. The sections were stained with florescent stain before being under the microscope. Results: Results showed that on day 7, the mean colony-forming units were lowest for levonadifloxacin, indicating the highest antimicrobial efficacy (P &lt; 0.05). This was followed by nitrofurantoin, MAS paste, and calcium hydroxide. Additionally, levonadifloxacin achieved the greatest DOP, followed by nitrofurantoin, MAS paste, and calcium hydroxide. These results suggest a correlation between DOP and antimicrobial efficacy. Conclusion: Within the confines of this study, it can be concluded that levonadifloxacin exhibited the highest antimicrobial efficacy, even at a low concentration of 8 µg/mL. Therefore, it can serve as a viable intracanal medicament in endodontic therapy.

Antimicrobial Effects of Formulations of Various Nanoparticles and Calcium Hydroxide as Intra-canal Medications Against Enterococcus faecalis: A Systematic Review.

The combination of calcium hydroxide (Ca(OH)₂)and nanoparticles (NPs) offers a promising approach to improving the efficacy of intra-canal treatments. Their synergistic effects can enhance antimicrobial action, improve penetration, and promote better healing outcomes in endodontic therapy. This review article examines the antimicrobial efficacy of various nanoparticles combined with Ca(OH)₂ against Enterococcus faecalis (E. faecalis) compared to Ca(OH)₂ alone as an intra-canal medicament. The analysis is based on in vitro studies involving bacterial inoculation on human-extracted teeth. Publications from 2013 to 2024 were retrieved from databases such as PubMed, Scopus, the Cochrane Library, and EBSCOhost and were screened according to specific inclusion criteria. Ultimately, 11 studies met these criteria for inclusion in the systematic review. A meta-analysis was not conducted due to the heterogeneity of the studies regarding the duration of medicament application, analytical methods, and result interpretations. The results indicate that NPs combined with calcium hydroxide exhibit superior bactericidal effects compared to Ca(OH)₂ alone, suggesting their potential as effective intra-canal medicaments. Thus, a systematic review concluded that nanoparticle-based Ca(OH)₂ intra-canal medicaments exhibit superior antibacterial/antimicrobial capabilities against E. faecalis when compared to Ca(OH)₂individually.

Assessment of Calcium Concentration and pH at the Periapical Environment on Placing Calcium Hydroxide with Different Natural Vehicles – An In vitro Study

Abstract Background: In root canal therapy, the number of microorganisms in canals can be controlled by giving proper intracanal medication dressing. Calcium concentration and changes in pH at the periapical region denote the effect of antibacterial action in the periapical region. Aim: The aim is to determine a suitable natural vehicle for calcium hydroxide (Ca(OH)2) as an intracanal medicament by assessing the calcium concentration and changes in pH at the periapical region. Materials and Methods: A total of 60 extracted single-rooted permanent teeth were equally allotted into four groups – Group I: Ca(OH)2 with distilled water, Group II: Ca(OH)2 with aloe vera, Group III: Ca(OH)2 with coconut water, and Group IV: Ca(OH)2 with neem extract. pH was determined by pH meter and calcium by chromatography. The values were taken on days 1, 2, 3, 7 and 14. Results: All the materials showed alkaline pH and release of calcium ion throughout the study. For day 1, the mean pH value was highest for distilled water (10.06) and lowest for aloe vera extract (9.42). The highest calcium release during day 1 was by coconut water (67.85) and the least calcium release was by aloe vera (42.01). On day 14, the highest calcium release was by distilled water (89.98) followed by coconut water (67.24) and least by neem extract (61.13). pH values and calcium release in four different natural vehicles were significant (P &lt; 0.05). Conclusion: All natural materials used in this study showed good Ca(OH)2 diffusion when used as a vehicle with Ca(OH)2 in root canals.

Recent advances in antimicrobial and biosynthesis properties of bioglass and nanoparticles: A narrative review

Oral hard and soft tissue engineering using bioactive substances that trigger other proteins or the immune system is the main focus of biomaterials research. Long-lasting tissues and tissue components develop due to this natural ground ingredient. Bioactive glass (BAG) is one type of biomaterial that is currently used. BAG is utilized in soft-tissue restoration, orthopedics, air abrasion, pulp capping, root canal therapy, dental implant coating materials, mineralizing agents and dental restorative materials, among other medical specialities, due to its bioactive properties, which make it suitable for use in a range of clinical settings, including dentistry and medicine, where issues with complex tissue regeneration arise.Bioglass is used in dentistry for permanent restoration, intracanal medication or temporary restorative purposes. This article extensively explores the applications of Bioglass in dentistry, explicitly focusing on elucidating its mechanisms of action and biological effects. Emphasizing the uniqueness of Bioglass, this article underscores its role as a transformative tool in modern dental care.

Regressão de lesão periapical após tratamento não cirúrgico – Relato de caso

The present study aims to present the clinical case report regarding non-surgical endodontic treatment performed on tooth 22, with diffuse periapical lesion, suggesting chronic dento-alveolar abscess. The methodology consists of an individual descriptive study of the case report type, which includes radiographic images of a 23-year-old female patient. Clinically, in addition to swelling, it was found that there was mobility, absence of pain in the thermal test (cold) and on palpation. After a complete clinical examination, endodontic treatment, coronary opening, root canal exploration, and root canal preparation were initiated using the modified Oregon crown-apex preparation technique, associated with 2.5% sodium hypochlorite as an irrigating solution. Calcium hydroxide paste was applied as an intracanal medication for a period of 30 days and the coronary access was sealed with glass ionomer. In the following session, after verifying the absence of clinical signs and symptoms, it was decided to fill the root canal using the Tagger's Hybrid technique associated with gutta-percha and AH Plus endodontic cement. After the 24-month preservation period, tissue repair and bone neoformation of the area were observed, as well as the absence of clinical signs.

Comparative evaluation of antibacterial efficacy of nitrofurantoin, chitosan, and calcium hydroxide in combination with propylene glycol as an intracanal medicament against endodontic pathogen - An in vitro study.

The objective is to evaluate and compare the antibacterial efficacy of nitrofurantoin, chitosan, and calcium hydroxide (Ca(OH)2) in combination with propylene glycol (PG) as an intracanal medicament against endodontic pathogens. Fifty-two extracted single-rooted maxillary and mandibular anterior teeth and premolars were selected. The root canals were enlarged using Protaper universal rotary files. Clinical isolates of microorganisms collected from retreatment cases were used. Bacterial isolates obtained from infected root canals were introduced into brain-heart infusion (BHI) broth. Incubation of samples for 14 days was carried out to facilitate the development of mature biofilms. Intracanal medicaments were divided into four groups: Group 1 - Nirofurantoin+20% PG, Group 2 - Chitosan+20% PG, Group 3 - Ca(OH)2 + 20% PG, and Group 4 - 20% PG. The prepared root samples were incubated for 7 days. After collecting dentin samples, they were placed in a phosphate-buffered saline solution. Serial dilutions were then performed, and each dilution was plated on BHI agar. The plates were incubated for 24 h at 37°C. The antibacterial efficacy was assessed by calculating the percentage of remaining colony-forming units. Antibacterial efficacy of chitosan paste was significantly higher followed by nitrofurantoin as compared to other groups when used as an intracanal medicament. In the root-canal biofilm model, the combination of chitosan and PG demonstrated a significant reduction in the viability of endodontic pathogens when employed as intracanal medication for 7 days. This suggests its potential as an effective intracanal medicament for endodontic retreatment.

CONDUTA DO ESPECIALISTA EM ENDODONTIA FRENTE AO RETRATAMENTO ENDODÔNTICO

Failure cases represent a significant percentage within endodontic practice. It is then necessary, in most cases, to carry out endodontic retreatment, which requires the search for a quick, safe and efficient technique. The objective of this study was to analyze the clinical conduct of the Endodontic Specialist in relation to endodontic retreatment through the completion of a questionnaire. To this end, 40 dental surgeons specializing in Endodontics, registered with CRO-PE, were selected. The results demonstrated that 97.5% of those surveyed indicated retreatment in the presence of a periapical lesion with symptoms, 50% in the absence of a periapical lesion with symptoms. Both in root canals treated endodontically and exposed to the oral environment for 30 days (75%) and in canals exposed for 40 days (82.5%) Specialists recommended retreatment in teeth that required a restoration with the presence of an intra-radicular post. 90%. Still in relation to how they use the Association of K, H and Gates-glidden files. The most used solvent was Eucalyptol (62.5%), followed by orange peel oil (55%), Xylol (7. 5%) and chloroform (7.5%). 5% do not use any solvent. 56.4% of those surveyed introduce the solvent up to the middle third in cases of overfilling of the root canal. 62.5% of those surveyed recommend a limit for canal preparation and filling of 1mm below the radiographic vertex. Using foraminal patency in 97.5% of cases. The most used irrigating solution was Chlorinated Soda (60%), followed by labarraque solution (25.0%), Dankin's liquid (17.5%) and saline solution (7.5%). 97.5% stated that they performed retreatment in two sessions and in these cases they used Callen (45.0%) and Callen associated with PMCC (42.5%) as intra-canal medication. The products tricresol formalin, calcium hydroxide P.A and formocresol were mentioned respectively by 15.0%, 12.5% ​​and 5.0%, 80% of those surveyed responded that in cases of flare-up they would not leave the tooth open to the oral environment . And 20% responded that they would leave it. Still in relation to flare-up, the intra-canal medication of choice when not leaving the canal open to the mouth was Callen (37.5%), followed by tricresol formalin (31.1%), callen + PMCC (25% ), calcium hydroxide P.A. (9.4%) and formocresol (3.1%). The drug of choice in cases of acute endodontic treatment was Amoxicillin associated with Clavulanate (92.5%).

REGRESSÃO DE LESÃO RADIOTRANSPARENTE ÓSSEA APÓS TERAPIA ENDODÔNTICA CONSERVADORA

Periapical lesions are found associated with the apex of a tooth without vitality, after contamination of the root canals, characterized radiographically by the presence of a radiolucent image at the apex of the affected element. The objective of this work is to report the regression of a periapical lesion, with a diagnosis of periapical abscess without fistula, after conventional endodontic treatment, confirmed through radiographic examinations and clinical images. A 24-year-old female patient complained of pain in the right anterior region and, days before the initial consultation, reported drainage of purulent secretion through the gums. In the intraoral physical examination, edema was observed at the bottom of the vestibule close to the incisors, pain on horizontal and vertical percussion and on the periapical radiograph the presence of a radiolucent image was observed close to the apex of tooth 36. A cold pulp sensitivity test was performed, obtaining a negative result. . With the purpose of decontaminating the root canals, endodontic treatment was carried out, using a preparation technique associated with the activation of chemical irrigants and intracanal medication between sessions. After a few weeks, the remission of clinical signs of inflammation and infection was observed and, after 3 months, radiographically, the beginning of repair of the lesion with bone formation was evident. The reported case highlights the importance of effective decontamination of the root canal as a determining factor for the regression process of periapical lesions. A longer period of clinical and radiographic follow-up of the case is necessary to verify complete repair.

Lesão endodôntica primária sumulando uma lesão endo-perio

This study aims to present a clinical case of retreatment with the regression of an endodontic lesion, which simulated an endospinal lesion, with monthly changes of calcium hydroxide paste (UltraCal®) and preservation of the lesion repair. A 47-year-old female patient was referred for dental treatment due to the need for retreatment in elements 45 and 46. On clinical examination, the presence of a periodontal pocket fistula of more than 10 millimeters on the mesia and distal surface, respectively, was observed. Cone-beam computed tomography demonstrated the presence of filling material, as well as periapical and lateral bone radiotransparency. The retreatment was performed with rotary instrumentation (Reciproc Blue®), and the preparation of the canal with Reciproc Blue. 2.5% Sodium Hypochlorite was used as an irrigating solution, and the intracanal medication used was calcium hydroxide paste (UltraCal®) and crown sealing was done with glass ionomer cement. After 3 months, a regression of the lesion was observed, at 6 months, treatment success was observed only with endodontic therapy, without the need for periodontal treatment, confirming the diagnosis of primary endodontic lesion with secondary periodontal involvement. It is concluded that endodontic retreatment associated with intracanal medication determined clinical and radiographic success, ruling out the need for periodontal therapy.

Dens invaginatus Type II in an Immature Lateral Incisor With Apical Periodontitis Treated With Regenerative and Strategic Antimicrobial Procedures: A Case Report

Dens invaginatus is a developmental dental anomaly that can predispose the tooth to pulp and periradicular disease. Management of this condition can be challenging because of anatomic and microbiologic issues. This case report describes the regenerative endodontic treatment using a strategic antimicrobial protocol for management of an immature maxillary lateral incisor with type-II dens invaginatus associated with apical periodontitis in a 13-year-old patient. The tooth presented with a complex anatomy and was associated with an active sinus tract. Because the true root canal was not negotiable in its coronal part due to the presence of the dens invaginatus, the closed end of the invagination (pseudocanal) was perforated to permit access to the apical segment of the true root canal for cleaning and disinfection. Both the invagination and the true canal were treated using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation, supplementary disinfection with passive ultrasonic irrigation and interappointment calcium hydroxide medication. After 2 exchanges of calcium hydroxide medication, the sinus tract did not disappear, then the antimicrobial protocol was changed to include an antibiotic solution for irrigation and antibiotic paste for intracanal medication. After signs and symptoms disappeared, regenerative endodontic treatment was performed by inducing blood clot formation within the root canal. The coronal canal segment including the invagination was filled with Biodentine. Follow-up including cone-beam computed tomography examination showed complete healing of the apical periodontitis lesion and mineralized tissue formation at the apical portion of the true root canal.

Importance of intracanal calcium hydroxide medication between sessions in chronic dentoalveolar abscesso (clinical case)

Importance of intracanal calcium hydroxide medication between sessions in chronic dentoalveolar abscesso (clinical case)

Comparative Evaluation of Cytotoxicity of Zinc Oxide Nanoparticles Mixed With Herbal Extract as an Intracanal Medicament: A Zebrafish Model Study.

Objective In this study, zebrafish embryos are used to study the cytotoxic effects of a novel intracanal medication (ICM) based on zinc oxide nanoparticles (ZnO NPs) loaded with polyherbal extracts (Azadirachta indica and Solanum xanthocarpum). Material and methods In the present study, a green and sustainable method was employed for the synthesis of ZnO NPs mixed with bark and seed extracts of Azadirachta indica and Solanum xanthocarpum to be used as a polyherbal ICM. Formulation of ZnO NPs was confirmed with color change in mixture produced upon dissolving zinc acetate dihydrate in distilled water followed by slow addition of sodium hydroxide solution and herbal extracts. The effects of these green synthesized ZnO NPs were evaluated through a zebrafish embryo toxicity test. Embryos were exposed to different concentrations (25, 50, and 100 µg/mL) of synthesized experimental doses of ZnO NP and compared with the control embryos. Toxicological endpoints, such as the zebrafish embryo's survival rate, hatching rate, and heart rate, were noted and described. Results A concentration-dependent increase in mortality rate and hatching delay followed by declined heart rate was observed in green synthesized ZnO NP-treated embryos. The maximum toxicity was observed with an increase in the concentration of 100 µg/mL of the experimental dose, and at a low concentration of 25 µg/mL, it does not effectively show any developmental alteration in zebrafish embryos. Conclusion A novel polyherbal ICM loaded with ZnO NPs exhibited a dose-dependent effect on the heart rate, hatching, and mortality rate of the embryos. At optimal concentrations, the medication demonstrated minimal developmental malformations and cytotoxic effects, indicating its safety for use. However, increasing concentrations of the medication resulted in severe developmental malformations.