Intracanal Medication Research Articles

Major clinical approaches to endodontic treatment in the treatment scenario of patients with head and neck cancer: a systematic review

Introduction: In the context of endodontic treatments and cancer, head and neck squamous cell carcinoma is the 6th most common form of cancer in the world, with more than 400,000 deaths annually. The great challenge is endodontic treatment after radiotherapy processes. Furthermore, the promising applications of exosomes in targeted therapy and we propose future directions for the use of exosomes in clinical and endodontic treatment. Objective: The present study developed a systematic review to elucidate the main clinical approaches to endodontic treatment in the treatment scenario of patients with head and neck cancer. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to September 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 124 articles were found, 35 articles were evaluated in full and 20 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=89.2%<50%. It was concluded that biomechanical preparation using a reciprocating system and 2.5% NaOCl in irradiated teeth demonstrated efficacy in reducing endodontic contaminants. Moreover, Ca(OH)2 as intracanal medication should be performed in irradiated patients with infected root canals. Also, radiotherapy causes changes in pulp behavior patterns in the short term; however, recovery and return to mean values occur after long periods. The probiotic SsK12 significantly reduced the incidence, onset, and duration of severe oral mucositis with a good safety profile. Artificial intelligence has valuable applications in the field of modern endodontics with promising results, especially in endodontic treatments in patients with head and neck cancer.

Controlling root canal infection in oncological patients with apical periodontitis

This study evaluated the effectiveness of chemomechanical preparation associated with intracanal medication in reducing the total bacterial load of infected root canals in cancer patients undergoing antineoplastic treatment. The prevalence, levels and response to treatment of Streptococcus and Actinobacteria species were also assessed. The root canals of teeth with apical periodontitis from oncological and control patients were treated using rotary instrumentation, 2.5% NaOCl irrigation and 1-week calcium hydroxide medication (n=23/group). Bacteriological root canal samples were taken before (S1) and after chemomechanical preparation (S2), and after intracanal medication (S3). DNA extracted from the samples was subjected to 16S rRNA gene-based quantitative real-time polymerase chain reaction assays for evaluation of the treatment effects on total bacteria, Streptococcus species, and members of the Actinobacteria phylum. All S1 samples were positive for bacteria. S1-to-S2 and S1-to-S3 bacterial reduction values were highly significant (p<0.01). Although bacterial counts were reduced from S2 to S3, the decrease was not statistically significant (p>0.05). Intergroup comparisons showed no significant differences in S1, S2 and S3 counts (p>0.05). In the oncological group, 77% of the cases were positive for bacteria in S2, and 68% in S3. In the control group, corresponding figures were 65% for both S2 and S3. There were no significant differences between groups as for streptococci and actinobacteria prevalence, levels and response to treatment (p>0.05). Root canal treatment using rotary instruments, NaOCl irrigation and calcium hydroxide medication was highly effective in reducing the bacterial populations in infected teeth with apical periodontitis from cancer patients, with no significant differences to controls.

Intracanal antibacterial effects of a bioceramic medication compared with calcium hydroxide pastes in different vehicles

The intracanal antibacterial effectiveness of a bioceramic medication was compared with calcium hydroxide pastes in different vehicles. Extracted mandibular incisors with a single long oval canal were selected and distributed into 5 groups based on anatomically paired micro-computed tomographic analyses. The root canals were prepared up to an instrument size 35/04 and contaminated for 30 days with a mixed bacterial culture from subgingival biofilm added with Enterococcus faecalis. The canals were medicated with Bio-C Temp (Angelus Indústria de Produtos Odontológicos, Londrina, PR, Brazil) or a calcium hydroxide paste in glycerin (CHG), camphorated paramonochlorophenol/ glycerin (CHPG), or 2% chlorhexidine (CHCX). Control specimens were filled with sterile saline. After 7 days, the medication was removed by using rotary instruments and saline irrigation. A supplementary approach was conducted, which consisted of 2.5% NaOCl irrigation and agitation with XP-endo Finisher. Bacteriological samples were taken before application (S1) and after removal (S2) of the intracanal medication, and after the supplementary approach (S3). Bacterial DNA extracted from the samples was quantified using real-time polymerase chain reaction. Bacterial counts were significantly reduced from S1 to S2 in all groups, except for the control group. As for S1-to-S3 changes, all groups (control included) showed significant bacterial reduction. S2-to-S3 changes were only significant in the CHPG and CHCX groups (p<0.05). Intergroup comparisons showed no significant differences in S2 (p>0.05), with all medications significantly better than the control (p<0.05). In S3, only the CHPG and CHCX groups showed further significant bacterial reductions. Categorical data analysis showed no intergroup differences (p>0.05). All tested medications significantly reduced the intracanal bacterial counts, with no significant differences between them. Final NaOCl irrigation and agitation using XP-endo Finisher further enhanced disinfection in the CHCX and CHPG groups.

Evaluation of the physicochemical properties of intracanal medications used in traumatized teeth

Aim: The aim of the present study was to evaluate the solubility, flow and radiopacity of Calen (SS White Artigos Dentários Ltd, Rio de Janeiro, Brazil), Calen with zinc oxide (Calen/ZnO), calcium hydroxide + zinc oxide + 2% chlorhexidine (CH/ZnO/CHX), Calplus and Ultracal XS. Methods: 28 bovine incisor specimens were standardized, instrumented and filled with pastes with the aid of a centrix syringe. To assess solubility, the root canals of acrylic teeth (N = 10) were filled with the previously mentioned pastes and scanned by using micro–computed tomography before (initial) and after 7 days of immersion in ultrapure water. The solubility of each specimen was the difference between the initial and final volume. Flow properties were analysed according to the ISO 6876/2012 standard. Radiopacity was radiographically analysed by using Image J software. Data were submitted to analysis of variance and Tukey’s test (alpha 5%). Results: CH/ZnO/CHX and Calplus presented similar values regarding radiopacity. The group composed of Calen paste showed higher flow values. As for solubility, CH/ZnO/ CHX showed lower volume loss, but there was no statistical difference compared to other medications. Conclusion: The medication composed of calcium hydroxide, zinc oxide and 2% chlorhexidine is a suitable alternative for use in traumatized teeth.

Antibacterial Effects of Silica Nanoparticles Loading Nano-silver and Chlorhexidine in Root Canals Infected by Enterococcus faecalis

IntroductionThe persistence of microbial infection can lead to endodontic failure. Enterococcus faecalis (E. faecalis) is acknowledged to be a closely associated bacterium. This study investigated the antimicrobial effects of mesoporous silica nanoparticles (nMS) carrying nano-silver and chlorhexidine (nMS-nAg-Chx) on E. faecalis. MethodsAnalyses were conducted to assess the antimicrobial efficacy of nMS-nAg-Chx toward planktonic E. faecalis, including the zone of inhibition, minimal inhibitory concentration, and growth curves. The measurement of lactic acid, scanning electron microscopy, live-dead bacteria staining, and quantitative real-time PCR were done to further investigate its anti-biofilm effect. Colony forming unit and scanning electron microscopy were used to assess its efficacy in infected root canals. ResultsThe growth of planktonic E. faecalis was suppressed with a minimal inhibitory concentration value of 25 μg/mL (P＜.05). nMS-nAg-Chx concentration-dependently inhibited biofilm formation of E. faecalis with the reduction of lactic acid (P < .05), sparse biofilm structure, reduced percentage of viable bacteria (P < .05), and suppressed expression of ebpR, gelE, ace, and efa genes (P < .05). The 7-day sealing of nMS-nAg-Chx resulted in a notable reduction in bacterial counts compared to the saline control group in the E. faecalis infected root canals (P < .05). ConclusionsnMS-nAg-Chx effectively inhibits E. faecalis and removes its biofilm from infected human root canals. It may be used for endodontic treatments in the control of E. faecalis bacteria as an intracanal medication.

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.

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. 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. Data were analyzed using the Kruskal-Wallis test and Dunn's intergroup comparison test in SPSS software. 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. 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.

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. The aim is to determine the efficacy of nanoparticle CH (NPCH) and silver nanoparticles (AgNP) against E. faecalis. 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. 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. 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%).