Intracanal Medicament Research Articles

Evaluation of Effect of Septilin™ and Calcium Hydroxide Intracanal Medicaments on Interappointment Flare-up and Healing of Apical Periodontitis-Pilot Study

ABSTRACT Background: Endodontic microflora comprises of multispecies, hence no single intracanal medicament can disinfect the root canal completely. Newer herbal medicaments need to be researched which may be more effective. Hence there was a need to evaluate and compare the effect of Septilin and calcium hydroxide intracanal medicaments on interappointment flare up and healing in apical periodontitis. Aim and objective: To evaluate and compare the effect ofcalcium hydroxide and septilin intracanal medicaments in interappointment flare up and periapical healing. Materials and Methods: Thirty patients with periapical lesions in the anterior region of jaw were selected. Intracanal medicaments were inserted as Group I -Calcium hydroxide(n=15) and Group IISeptilinTM (n=15). After 7 days the intracanal medicament was changed and obturation done after 15 days. Patients were evaluated clinically for VRS pain score at 1&2 weeks and 1, 3 and 6 months. Radiographic evaluation using PAI index was done by two trained observers at interval of 1, 3 and 6 months. Results: showed no incidence of flare up. After three months there was significant change in the PAI score. At 6 months, 20% of calcium hydroxide group whereas 13.33% of SeptilinTM group had PAI score of 1. Conclusion: At 3 months the periapical healing in both groups was similar. At 6 months Calcium hydroxide group showed better healing as compared to SeptilinTM group.

Comparative Evaluation of Antibacterial Efficacy, Molecular Docking of Ethanolic Extract of Blackseed, Seaweed and Calcium Hydroxide Intracanal Medicament with Enterococcus Faecalis Antigens

ABSTRACT Aim: To evaluate the inhibitory effect of ethanolic extract blackseed, seaweed, and calcium hydroxide intracanal medicament with Enterococcus faecalis biofilm. To study the binding interaction between the active components of blackseed and seaweed against the enterococcal surface protein of (E. faecalis) by molecular docking. Materials and Methods: The ethanolic extracts of blackseed and seaweed were prepared using the Soxhlet apparatus. They were divided into three groups, namely, |Group I: Calcium hydroxide, Group II: Blackseed, and Group III: Seaweed. The antibacterial activity of the three groups was detected employing various concentrations ranging from 250, 125, and 62.5 μg/ml and based on the zone of inhibition. The inhibitory potential of medicaments to inhibit E. faecalis growth at various stages and kinetics plate were assessed following biofilm architecture evaluation by crystal violet biofilm assay. With the Swissdock suite, the molecular docking procedure was carried out. PyMOL version 4.1.5 was the program used for visualization. Since enterococcal surface protein (Esp) is primarily involved in the formation of biofilms, it was chosen as the target protein of E. faecalis. Based on their chromatographic investigations, Group II Thymoquinone (TQ) and Group III Ledenoxide were chosen as ligands. Results: The percentage of inhibition of E. faecalis biofilm was analyzed as statistically significant observed within groups. On post-hoc analysis, significant differences were present between the groups (P < 0.05). Molecular docking reveals binding energies of thymoquinone (Group II) and ledenoxide (Group III) against the enterococcal surface protein of E. faecalis were −6.90 Kcal/mol and −6.44 Kcal/mol, respectively. Conclusion: Compared to seaweed, black seed extract exhibited higher antibacterial activity against the E. faecalis biofilm in microbial inhibition and molecular interaction.

Comparative Evaluation of Penetration of Various Nano-sized Intra-canal Medicaments: An In Vitro Confocal Laser Scanning Microscopic Study.

To assess and contrast the depth of penetration of conventional calcium hydroxide, nanoparticle calcium hydroxide, silver nanoparticles, and combination of nanoparticle calcium hydroxide and silver nanoparticles into dentinal tubules using confocal laser scanning microscope. Eighty human single-rooted teeth were decoronated and instrumented up to Protaper Universal F3. Teeth were separated into four groups at random (n = 20) following chemomechanical preparation. Group 1: Control Conventional Calcium Hydroxide; Group 2: Nanoparticle Calcium Hydroxide; group 3: Silver Nanoparticles; group 4: Combination of Nanoparticle Calcium Hydroxide and Silver Nanoparticles. With the use of lentulo spirals, medications were injected into the canals, stirred up with ultrasound, and then kept at 37°C for 24 hours. A 1 mm thick slice was obtained at 5 mm from the root apex by sectioning the root perpendicular to the long axis of the tooth and then put on a glass slide to measure the depth of penetration using a confocal laser microscope. To quantify the depth of penetration among the four groups, a one-way ANOVA was used and post hoc-Tukey's test was used to compare between groups. All of the groups were statistically significant, with group 4 showing the greatest depth of penetration, followed by group 2 and group 3. In contrast, all other groups in the intergroup comparison were statistically significant (P value 0.05) aside from the comparison of group 2 to group 3. Silver nanoparticles and nanoparticle calcium hydroxide together demonstrated greater penetration than calcium hydroxide, silver nanoparticles, and nanoparticle calcium hydroxide alone.

Comparative evaluation of the antibacterial efficacy of two experimental calcium silicate-based intracanal medicaments: An in-vitro study.

Success of endodontic treatment relies on minimizing microbial load by chemo-mechanical preparation and intra-canal medication(ICM). Calcium hydroxide based ICMs have known disadvantages. Calcium silicate-based cements(CSC) exhibit antibacterial activity, thus promoting researchers to experiment with their formulations to use them as ICMs. Evaluation and comparison of the antimicrobial efficacy of two experimental CSC (MTA & Biodentine + 2%chlorhexidine) and Bio-C Temp against E.faecalis. Test materials were divided into four groups namely Group1-Bio-C Temp, Group2-UltraCAL XS, Group3-Biodentine+2%CHX and Group4-MTA+2%CHX. Direct contact test was done by placing a standardized suspension of E.faecalis on test materials and bacterial growth was assessed spectrophotometrically using ELISA at one, three and seven days. Data was analysed using one-way ANOVA, Tukey's multiple post hoc test and paired-t test. Results: Intragroup comparison revealed decreased mean optical density(OD) in groups 1, 2, and 4; no significant difference in group 3. Intergroup comparison showed statistical differences in mean OD values between groups (3 and 4); groups (1 and 2) at days one(p-0.018) and three(p-0.035), but no difference individually. Group 4 showed the highest antimicrobial efficacy on day seven. MTA+2%CHX & Biodentine+2%CHX showed better antimicrobial efficacy and hence could be used as potential ICMs.

Non-surgical management of paresthesia induced by calcium hydroxide extrusion – a case report with a 4-year follow-up

The present case report describes the non-surgical treatment of alveolar inferior nerve paresthesia caused by the extrusion of calcium hydroxide as intracanal medicament. A 45-year-old female patient had a chief complaint of numbness and pain in the left lower lip region for 2 months. Radiographic examination revealed calcium hydroxide overflow into the mandibular canal. Irrigation of the root canal system with saline using a 27-gauge needle was done to remove as much calcium hydroxide as possible but proved ineffective in removing material from the outside tissues. Root canal treatment was completed in 1 week, and non-surgical paresthesia treatment with steroids and pregabalin was done for one month. In the 1-year follow-up control, the paresthesia had reduced significantly. In a 4-year follow-up visit, there was a complete resolution of paresthesia, and the radiographic analysis showed that calcium hydroxide was completely resorbed.

Antimicrobial efficacy of Odontopaste in endodontics: a systematic review

AimTo evaluate the efficacy of Odontopaste in reducing the microbial load in endodontics compared to other intracanal medicaments.Materials and methodsThe literature was electronically searched on PubMed, Google Scholar, Scopus, Ovid Medline and Web of Science. In-vitro, ex-vivo and in-vivo studies that evaluated the antimicrobial efficacy of Odontopaste were included. The risk of bias was assessed using the Quality Assessment Tool for In Vitro Studies.ResultsA total of four in-vitro studies were included in the systematic review. One study showed that Odontopaste had significantly more microbial cell growth on roots in all dentine depths compared to other medicaments or test agents. Another study found that Odontopaste significantly decreased colony-forming units compared to propolis and chlorhexidine. Further results showed that Odontopaste did not significantly decrease microbial numbers when used in isolation. Additionally, combining Odontopaste and calcium hydroxide did not enhance the effectiveness of calcium hydroxide. The studies had a medium to high risk of bias.ConclusionThere is insufficient high-quality evidence to assess the antimicrobial efficacy of Odontopaste compared to other intracanal medicaments. Further research is required to determine Odontopaste’s efficacy as an antimicrobial medicament in endodontics.

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

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

Influence of the severity of periodontal disease on the outcome of non-surgical endodontic therapy: A prospective cohort study.

To investigate the influence of severity of periodontal disease on periapical healing after non-surgical endodontic therapy (NSET). In this prospective study, subjects (n = 45) requiring NSET in a mandibular molar tooth with the diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting radiographic periapical index (PAI) score ≥ 3 and concomitant endodontic periodontal lesion (CEPL) without communication were enrolled. After dividing as per the classification of Periodontal and Peri-Implant Diseases and Conditions, subjects were equally allocated into three groups. Group I- only endodontic lesion {control: healthy periodontium (n = 15)}, Group II- CEPL having stage I and II periodontitis (n = 15) and Group III- CEPL having stage III periodontitis (n = 15). Standardized two-visit NSET was performed with 2% chlorhexidine gel as an intracanal medicament. Periodontal therapy was instituted wherever required. Subjects were recalled at 6-and 12-months for clinical and radiographic assessment. Chi-square test was performed to evaluate the difference between the groups. At 12-month follow-up, all teeth in the three study groups were asymptomatic. On radiographic evaluation of the periapical region, healing was observed in 80%, 47% and 50% of teeth in Groups I, Group II and Group III, respectively. However, the difference was not statistically significant between the groups (p = 0.150). The severity of periodontal disease had no influence on periapical healing after NSET in teeth with concomitant endodontic periodontal lesions without communication. Periodontal disease has significant impact on apical periodontitis however severity of the periodontitis does not negatively impact the apical periodontitis.

Examining the Effects of Asiaticoside on Dental Pulp Stem Cell Viability and Proliferation: A Promising Approach to Root Canal Treatment.

This study aims to evaluate the impact of asiaticoside (AC) on the viability and proliferation of dental pulp stem cells (DPSCs), considering the known negative effects of routinely used intracanal medicaments. This evaluation will be compared with the outcomes from using traditional intracanal medicaments, specifically triple antibiotic paste (TAP) and calcium hydroxide [Ca(OH)2]. The DPSCs were obtained from the third molars of an adult donor. The application of flow cytometry was employed to do a phenotypic analysis on DPSCs using CD90, CD73, CD105, CD34, CD14, and CD45 antibodies. The methylthiazol tetrazolium (MTT) assay was employed to assess cellular viability. The cells were treated with different concentrations of TAP and Ca(OH)2 (5, 2.5, 1, 0.5, and 0.25 mg/mL), along with AC (100, 50, 25, 12.5, and 6.25 µM). A cell proliferation rate was performed at 3, 5, and 7 days. The characterization of DPSCs was conducted by flow cytometry analysis, which verified the presence of mesenchymal cell surface antigen molecules (CD105, CD73, and CD90) and demonstrated the absence of hematopoietic markers (CD34, CD45, and CD14). Cells treated with concentrations over 0.5 mg/mL of TAP and Ca(OH)2 showed a notable reduction in cell viability in comparison to the untreated cells (p < 0.05). Additionally, the cells treated with different concentrations of AC 12.5, 6.25, 25, and 50 µM did not differ significantly from the untreated cells (p > 0.05). Nevertheless, cells treated with concentrations of 100 µM showed a significant reduction in viability compared to the untreated cells (p < 0.05). After a period of 7 days, it was noted that cells exposed to three different concentrations of AC (50, 25, and 12.5 µM) had a notable rise in cell density in comparison to TAP and Ca(OH)2 (p < 0.05). Furthermore, cells that were exposed to a concentration of 12.5 µM exhibited the highest cell density. The cellular viability of the AC-treated cells was superior to that of the TAP and Ca(OH)2-treated cells. Moreover, the AC with a concentration of 12.5 µM had the highest degree of proliferation. This study underscores the importance of evaluating alternative root canal medicaments and their effects on DPSCs' growth and vitality. The findings on AC, particularly its influence on the survival and proliferation of DPSCs, offer valuable insights for its probable use as an intracanal medication. This research contributes to the ongoing efforts to identify safer and more effective intracanal treatments, which are crucial for enhancing patient outcomes in endodontic procedures. How to cite this article: Alazemi MJ, Badawi MF, Elbeltagy MG, et al. Examining the Effects of Asiaticoside on Dental Pulp Stem Cell Viability and Proliferation: A Promising Approach to Root Canal Treatment. J Contemp Dent Pract 2024;25(2):118-127.

Fabrication and characterization of mesoporous calcium silicate and silver-incorporated mesoporous calcium silicate nanoparticles with low cytotoxicity and antibacterial properties as a dental biomaterial

AimThis study aimed to fabricate and characterize Mesoporous calcium silicate nanoparticles (MCSNs) and silver-incorporated Mesoporous calcium silicate nanoparticles (Ag-MCSNs) as bioactive nanoparticles either for hybridization with contemporary endodontic materials to improve their bioactivity by using (MCSNs) as a drug delivery system, and to achieve both low cytotoxicity and enhanced antibacterial activity by incorporating Ag which is avery potent antibacterial agent to form (Ag-MCSNs) as new multifunctional materials. MethodsThe MCSNs and Ag-MCSNs nanoparticles were made using the template method. Both nanoparticles' mesoporous structure, specific surface area, pore volume, pore size, and shape were examined and characterized by FTIR, XRD, EDS, DLS, and FE-SEM. The ion release, pH change, cytotoxicity by MTT assay, and antibacterial properties against planktonic Enterococcus faecalis were further investigated by colony forming units (CFUs) counting technique. ResultMCSNs nanoparticles were prepared and successfully incorporated with silver as Ag-MCSNs. MCSNs and Ag-MCSN nanoparticles had the characteristic mesoporous material shape and over time showed sustained ion release (Ca2+,Si4+ and Ag+) ,with an alkaline pH value (8.2–9.0). Both materials showed no obvious cytotoxicity but more cell viability with MCSNs (vitality value is >70%). Both nanoparticles showed antibacterial activity against Enterococcus faecalis (p < 0.05). With MCSNs containing Ag (Ag-MCSNs) showing higher antibacterial effect. ConclusionBoth mesoporous calcium silicate nanoparticles (MCSNs) and mesoporous calcium silicate nanoparticles loaded with silver (Ag-MCSNs) displayed a characteristic mesoporous structure, ion release, alkaline pH, minimal cytotoxicity, and outstanding antibacterial performance with MCSNs containing Ag (Ag-MCSNs) showing higher antibacterial effect. This substance may be improved to provide a better root canal filler material, sealer, or novel intracanal medicament in dentistry.

The Evaluation of Anti-Osteoclastic Activity of the Novel Calcium Hydroxide Biodegradable Nanoparticles as an Intracanal Medicament

IntroductionThe aim of this study was to evaluate the anti-osteoclastic activity of calcium hydroxide–loaded poly(lactic-co-glycolic acid) nanoparticles [Ca(OH)2-loaded PLGA NPs] in comparison to calcium hydroxide nanoparticles [Ca(OH)2 NPs]. MethodsRAW 264.7 cell lines (third–fifth passage) were cultured and incubated with soluble receptor activator of nuclear factor kappa B ligand in triplicate. Subsequently, Ca(OH)2-loaded PLGA NPs and Ca(OH)2 NPs were added for 7 days to evaluate their effects on receptor activator of nuclear factor kappa B ligand–induced osteoclast differentiation of RAW 264.7 cells by tartrate-resistant acid phosphatase activity. Additionally, a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was conducted to confirm the cytotoxicity of treatments to cells. ResultsTartrate-resistant acid phosphatase staining showed a significant reduction in the osteoclast number when treated with Ca(OH)2-loaded PLGA NPs compared with Ca(OH)2 NPs (P < .01). In comparison to the control, the number of osteoclasts significantly reduced upon treatment with Ca(OH)2-loaded PLGA NPs (P < .05), but there was no significant difference in Ca(OH)2 NPs. Furthermore, osteoclast morphology in both treatment groups exhibited smaller sizes than the control group. Neither Ca(OH)2-loaded PLGA NPs nor Ca(OH)2 NPs demonstrated cytotoxic effects on RAW264.7 cells. ConclusionsBoth Ca(OH)2 NPs with and without poly(lactic-co-glycolic acid) have the ability to inhibit osteoclast differentiation. However, Ca(OH)2-loaded PLGA NPs exhibit greater potential than Ca(OH)2 NPs, making them a promising intracanal medicament for cases of root resorption.

Comparative Evaluation of Antimicrobial Efficacy of Triple Antibiotic Paste Herbal Combination and Camphorated Monochlorophenol as Intracanal Medicaments against Enterococcus faecalis in Deciduous Molars: An In Vivo Study.

Compare the efficacy of triple antibiotic paste (TAP), herbal extracts, and camphorated monochlorophenol (CMCP) as intracanal medicaments against Enterococcus faecalis (E. faecalis) in deciduous molars. A total of 60 samples were collected from canals of first and second molars of 4-10-year-old children, with more than two-thirds root length, and fitting the inclusion criteria. Samples were collected at three intervals-S1 was collected just after access opening, S2 was collected after biomechanical preparation (BMP) and irrigation, and just before placement of medicament. Randomization was done to place the medicaments into three groups: group I-CMCP, group II-TAP, and group III-herbal combination. Sample S3 was taken 48 hours after removal of medicament from the canals. The collected samples were transported via Amies media to the laboratory, where they were anaerobically incubated for 24 hours. Growth of E. Faecalis was observed, and manual counting of the colony-forming unit (CFU) was done. The change in CFU in all samples was calculated, and the results were statistically analyzed. The results show that there is a change from S1 (TAP = 118.67 ± 122.48, herbal = 109.07 ± 106.43; CMCP = 110.73 ± 120.53) to S2 (TAP = 34.13 ± 63.47; herbal = 27.67 ± 39.39; CMCP = 16.40 ± 26.32) and S3 (TAP = 12.33 ± 24.82; herbal = 4.73 ± 12.78; CMCP = 3.40 ± 7.12). It is seen that there is a significant difference seen from S1 to S2 in all three groups (p ≤ 0.05) using repeated measure analysis of variance (ANOVA) test. This shows that all three medicaments were effective in reducing bacterial counts of E. Faecalis from sample S1 (pre) to S3 (post) significantly after exposure to root canal bacterial flora for 48 hours (2 days). The pairwise comparison of the change in CFU within each group, S1-S3, also shows significant changes. There is a significant decrease in CFU seen from S1 to S2 and S1 to S3 but not from S2 to S3 for all three groups, which was evaluated using the post hoc Bonferroni test. It was also observed that in between the canals, although there was a change from S1 to S3 in terms of the CFU, there was no significant difference in the decrease in the bacterial count when intercanal comparison was made. There was, however, a change that was seen to be significant when values from each canal were compared from S1 to S3. All three medicaments have successfully shown a decrease in the numbers of E. faecalis, which the study aimed at checking. Although the effect varied intergroups, it was mild, so herbal alternatives could be used instead of antibiotics and CMCP. Also, because the local application is effective in controlling interappointment flare-ups, the medicaments can be successfully given without having to prescribe systemic antibiotics. Tawde MM, Lakade L, Patil S, et al. Comparative Evaluation of Antimicrobial Efficacy of Triple Antibiotic Paste Herbal Combination and Camphorated Monochlorophenol as Intracanal Medicaments against Enterococcus faecalis in Deciduous Molars: An In Vivo Study. Int J Clin Pediatr Dent 2024;17(3):243-254.

A Comparative Evaluation of Herbal Extracts and Triple Antibiotic Paste as Intracanal Medicament against Enterococcus faecalis: A Microbiological Study.

The purpose of the study is to compare and evaluate the efficacy of herbal extracts over modified triple antibiotic paste (MTAP) as intracanal medicaments against Enterococcus faecalis (E. faecalis). Ginger, turmeric, and nutmeg extract were checked for antibacterial activity by agar disk diffusion method at 100, 50, 25, and 12.5% concentration. Combination groups were prepared, and the combination group showing the best zone of inhibition was further evaluated. A total of 103 samples were taken and divided into five groups: group I-MTAP, group II-ginger, group III-turmeric, group IV-nutmeg, and group V-saline. Based on different concentrations, the groups were again subdivided into subgroups at 100, 50, 25, and 12.5%. Combination groups of ginger + nutmeg, ginger + turmeric, and turmeric + nutmeg were made and evaluated. The combination group showing the best zone of inhibition was again divided into 100, 50, 25, and 12.5% and further evaluated. Modified triple antibiotic was effective in the elimination of E. faecalis. Herbal extracts showed a reduction in the number of E. faecalis. Nutmeg showed a reduction in E. faecalis, followed by ginger, followed by turmeric. This study shows that the combination of ginger + nutmeg at 12.5% concentration (35 mm) showed the highest zone of inhibition among all the herbal combinations, which is almost equal to that of MTAP. Golla S, Gambhir N, Gupta N, et al. A Comparative Evaluation of Herbal Extracts and Triple Antibiotic Paste as Intracanal Medicament against Enterococcus faecalis: A Microbiological Study. Int J Clin Pediatr Dent 2024;17(3):285-290.

Time-Dependent Antibacterial Effects of Citrullus Colocynthis Seed Extract Compared to Calcium Hydroxide in Teeth Infected with Enterococcus Faecalis.

Endodontic efforts are focused on eliminating intracanal pathogens. Applying intracanal medicament for infected teeth is beneficial for achieving better antibacterial effects in endodontic treatments. Different intracanal medicaments should be assessed and compared for this purpose. The aim of this study was to assess the antibacterial efficacy of Citrullus colocynthis seed extract comparing to Ca(OH)2 on teeth contaminated with Enterococcus faecalis. In this in vitro study, a novel strain of Enterococcus faecalis (Enterococcus spp. ATCC 19433) yielded from the root canal treated tooth with persistent apical periodontitis. The canals of 78 human single-rooted extracted teeth were contaminated with mentioned strain and treated with Citrullus colocynthis essential oil and Ca(OH)2 for 1, 7, and 14 days. To determine the chemical composition of the oils, gas chromatography-mass spectrometry (GC-MS) was applied. The percentage reduction from baseline c.f.u./mL values was estimated. Oleic acid, benzoic acid, and gallic acid were the major contents of Citrullus colocynthis essential oil. The c.f.u./mL count decreased considerably as contact duration rose for both medicaments. After 7 days, a statistically significant difference was identified between the medicaments. Citrullus colocynthis showed higher antimicrobial efficacy. However, after 14 days, no substantial difference was found. Citrullus colocynthis essential oil, displayed great antimicrobial efficacy against Enterococcus faecalis higher than Ca(OH)2 over the first week contact period.

Evaluation of rise in pH and oxygen release at the site of simulated external root resorption cavities using different oxygen-releasing biomaterials: An in vitro study.

External inflammatory root resorption has rapid onset and progresses aggressively. It leads to cementum loss, which allows communication between the infected pulp and the periodontium through the denuded dentinal tubules. Primary management strategy includes adequate chemomechanical debridement and lesion arrest for which maintaining alkaline pH and aerobic conditions is essential for healing and repair of the resorption defect. The aim of this study is to evaluate rise in pH and oxygen release at the site of simulated external root resorption cavities using different oxygen-releasing biomaterials. In 40 extracted single-rooted teeth access opening and chemomechanical debridement were done. Cavities simulating resorption defect are prepared on the roots. The samples are divided into four groups (n = 10) based on the biomaterial used. After placing the biomaterial, the root apices were sealed. Half of the samples from each group were tested for oxygen release using dissolved oxygen meter and the other half for rise in pH using pH meter at 7, 14, 21, and 28 days. The pH values were analyzed using Friedman 2-way analysis of variance (ANOVA) and Kruskal-Wallis test. Oxygen release was measured using the two-way and repeated-measures ANOVA. Calcium peroxide group showed the highest mean pH and oxygen release than other groups at any given point of time. Incorporating oxygen-releasing biomaterials such as calcium peroxide and perfluorodecalin into intracanal medicaments, such as calcium hydroxide, creates an alkaline and oxygen-enriched milieu in the periapical tissues.

A Comparative Evaluation of Antimicrobial Efficacy of Various Intracanal Medicaments (Curcuma longa, Honey, Nitrofurantoin, and Calcium Hydroxide) on Enterococcus faecalis: An in vitro Study

Background In the modern era of dentistry, natural and herbal alternatives are favored since they are renewable, have fewer adverse effects, and are cost-effective. Purpose To assess the effectiveness of different intracanal medications in eliminating Enterococcus faecalis. Materials and Methods In total, 50 single-rooted extracted teeth were decoronated at the cemento-enamel junction followed by the preparation of the canal. Then, in each of the presterilized samples, inoculum containing the E. faecalis was transferred and incubated at 37°C for 24 hours. Samples were allocated into 5 groups of 10 each: Group A (saline), Group B (calcium hydroxide), Group C ( Curcuma longa), Group D (honey), and Group E (nitrofurantoin group). The medicaments were injected into the canals respectively, the antibacterial assessment was done on the 1st and 7th day. Dentinal shavings are incubated and streaked on Mueller–Hinton agar plates and incubated for 24 hours at 37°C and the colony forming units (CFUs) were assessed. Results Among all the groups, there was a significant change in the number of colonies from Day 1 to Day 7, except in Group A (saline). Comparison between the groups revealed significant differences, with better efficacy by Group D (honey) followed by Group E (nitrofurantoin) and Group C ( C. longa). The least antimicrobial efficacy was observed with calcium hydroxide and no activity with saline. Conclusion Honey has the greatest antimicrobial efficacy among all the tested intra-canal medicament groups.

Assessment of Anti-inflammatory, Antimicrobial and Cytotoxicity of Chitosan-Moringa Composite and Calcium Hydroxide Nanoparticles as an intra-canal medicament in vitro

In this study Chitosan nanoparticles was characterized usingUV spectrophotometry, FT-IR, Transmission electron microscopy, and X-Ray diffraction. The composition of Moringa oleifera of ethanolic extract was analyzed using GC-Mass.The antimicrobial, anti-inflammatory, and cytotoxicity of Chitosan-Moringa composite, H2CaO2 nanoparticles, Ca(OH)2, and Moringa oleifera of ethanol extract as an intra-canal medicament in vitro were also investigated. Results of our research summarized that; The UV of chitosan nanoparticles range from 280 to 300 nm. The FT-IR results confirm the presence of a broad and powerful band at 3442 cm1, 1636 cm1, and 1052 cm1 all band confirm the presence of the native chitosan. The X-Ray diffraction proved three strong characteristic peaks indicating crystallinity of chitosan nanoparticles chains. The TEM of Chitosan nanoparticles size was between 76.61 – 126.91nm and the shape was less spherical with slightly wrinkled surface. The major chemical compounds in Moringa ethanol extract by GC-Mass were detected. Also, the antimicrobial activity of Moringa extracts proved that ethanol extract had the highest zone of inhibition. The antimicrobial activity of Moringa-chitosan composite had the highest antimicrobial activity followed by H2CaO2 nanoparticles against dental pathogens. The anti-inflammatory effects on HRBC hemolysis at concentration 100μg/mL Ca (OH)2 gave the best lower production than the positive control Stander Indo meth followed by H2CaO2 nanoparticles, Moringa ethanol extract, and finally Chitosan-Moringa composite. The MTT assay against OEC have been showed that, Ca (OH)2 is the most cytotoxic with the lowest IC50 followed by Moringa ethanol extract, Chitosan-Moringa composite, and finally H2CaO2 nanoparticles.

Efficacy of a Novel Intracanal Medicament on Total Antioxidant Status in Patients With Apical Periodontitis: A Randomized Controlled Clinical Trial.

Introduction Successfulendodontic treatment relies upon the microbial debridement of the root canal system. This can be achieved to a great extent by using intracanal medicaments, which inhibit the microbes growing in the root canal. Evaluating the capacity of oxidants in the saliva is a crucial parameter for assessing the antioxidant capacity of any individual, which decreases in inflammatory conditions. An effective intracanal medicament can increase the total antioxidant capacity of saliva, which comes down because of inflammatory conditions. Aim To evaluate the effect of two intracanal medicaments on the antioxidant capacity of saliva. Materials and methods In a randomized prospective clinical trial, 42 patients with a mean age of 18-70 years were selected based on exclusion and inclusion criteria, and the baseline value of the total antioxidant capacity of saliva was recorded. The patients were categorized into two groups as per the block randomization method (Group I: calcium hydroxide (Maarc, New Delhi, India) intracanal medicament; Group II: Hekla lava (SBL Pvt. Ltd., Germany) intracanal medicament). Access opening, working length determination, and cleaning and shaping were conducted using hand K-files and ProTaper Gold rotary files. Intracanal medicaments were placed according to the groups assigned, and temporary restoration was placed. The patients were recalled after seven days. If the tooth was asymptomatic, obturation was completed, and a saliva sample was collected to assess thetotal antioxidant capacity. Results The total antioxidant capacity of saliva was increased afterusing intracanal medicaments and endodontic therapy, and there was a statistically significant difference before and after using both the medicaments (p=0.0005; i.e., calcium hydroxide and Hekla lava. When both medicaments were compared, there was no significant difference in the antioxidant capacity of salivaamong medicaments (p=0.384). Conclusion The total antioxidant capacity ofsaliva was increased after using both the intracanal medicaments. Hence, Hekla lava can be potentially used as an alternativeintracanal medicament.

Calcium hydroxide-loaded nanoparticles dispersed in thermosensitive gel as a novel intracanal medicament.

Design, produce and assess the viability of a novel nanotechnological antibacterial thermo-sensible intracanal medicament This involves encapsulating calcium hydroxide (Ca(OH)2) within polylactic-co-glycolic acid (PLGA) nanoparticles (NPs) and dispersing them in a thermosensitive gel (Ca(OH)2-NPs-gel). In addition, perform in vitro and exvivo assessments to evaluate tissue irritation and penetration capacity into dentinal tubules in comparison to free Ca(OH)2. Reproducibility of Ca(OH)₂-NPs was confirmed by obtaining the average size of the NPs, their polydispersity index, zeta potential and entrapment efficiency. Moreover, rheological studies of Ca(OH)2-NPs-gel were carried out with a rheometer, studying the oscillatory stress sweep, the mean viscosity value, frequency and temperature sweeps. Tolerance was assessed using the membrane of an embryonated chicken egg. In vitro Ca(OH)2 release was studied by direct dialysis in an aqueous media monitoring the amount of Ca(OH)2 released. Six extracted human teeth were used to study the depth of penetration of fluorescently labelled Ca(OH)2-NPs-gel into the dentinal tubules and significant differences against free Ca(OH)2 were calculated using one-way anova. Ca(OH)2-NPs-gel demonstrated to be highly reproducible with an average size below 200 nm, a homogeneous NPs population, negative surface charge and high entrapment efficiency. The analysis of the thermosensitive gel allowed us to determine its rheological characteristics, showing that at 10°C gels owned a fluid-like behaviour meanwhile at 37°C they owned an elastic-like behaviour. Ca(OH)2-NPs-gel showed a prolonged drug release and the depth of penetration inside the dentinal tubules increased in the most apical areas. In addition, it was found that this drug did not produce irritation when applied to tissues such as eggs' chorialantoidonic membrane. Calcium hydroxide-loaded PLGA NPs dispersed in a thermosensitive gel may constitute a suitable alternative as an intracanal antibacterial medicament.

Comparative evaluation of antimicrobial efficacy of triple antibiotic paste and amoxicillin clavulanate paste as an intracanal medicament against Enterococcus faecalis: An in vitro study

Background: Triple antibiotic paste (TAP) is the commonly used intracanal medicament against Enterococcus faecalis. Amoxicillin clavulanate paste (ACP) is recommended as a “fall-back” antibiotic when traditional dental antibiotics fail. Literature comparing the antimicrobial efficacy of TAP and ACP in eradicating E. faecalis from the root canal system is sparse; hence, this in vitro study was conducted to evaluate and compare the antimicrobial efficacy of TAP and ACP as an intracanal medicament for endodontic treatment of single-rooted permanent teeth against E. faecalis. Materials and Methods: This in vitro, experimental study evaluated 60 root samples obtained from extracted single-rooted human permanent teeth. The canal diameter was enlarged and subsequently infected with E. faecalis for 21 days. Four groups of the contaminated samples were treated with TAP, ACP, calcium hydroxide (positive control), and saline (negative control), respectively. Dentinal shavings were collected at the end of the 1st, 7th, and 10th day and inoculated in agar plates. The number of colony-forming units was determined, and the data were statistically analyzed using the Kolmogorov–Smirnov and Shapiro–Wilks test. P &lt;0.05 was considered statistically significant. Results: The mean number of E. faecalis colony counts across all 3 test days demonstrated that TAP exhibited the highest inhibition of bacterial growth, followed by ACP which is not statistically significant (P = 1.00). Conclusion: Considering the limitations of this in vitro study, the findings suggest that ACP could be an effective alternative intracanal medicament to TAP for endodontic therapy.