Intracanal Medication Research Articles

Biocompatibility and Antibacterial Action of Salvadora persica Extract as Intracanal Medication (In Vitro and Ex Vivo Experiment).

This study aimed to test the biocompatibility and antibacterial properties of Salvadora persica (S. persica) extract, a natural product, as an intracanal medication in comparison with calcium hydroxide (Metapaste, META BIOMED, Cheongju, Korea). The pH values of both materials were tested. The biocompatibility of S. persica extract and Metapaste was determined using light microscopy and MTT assays. The antibacterial action was tested using the zone of bacterial inhibition on four common bacterial species. In addition, intracanal medication was administered using 68 extracted single-rooted teeth contaminated with Enterococcus faecalis (E. faecalis), and the percentage reduction in colony count (% RCC) at 1, 3, and 7 days was measured. The extension of activity for both materials was assessed using histological sections and scanning electron microscopy. S. persica was found to be acidic in nature. Both materials showed significantly lower cell viability than the positive control cells on days 1 and 3 but not on day 7. S. persica showed better antibacterial effects against E. faecalis and S. mutans. S. persica extract showed 97.6%, 98.9%, and 99.3% RCC values at 1, 3, and 7 days, respectively, which are comparable to those of Metapaste. S. persica herbal extract is a promising material that can be utilized as an intracanal medication, but its use requires further research.

Deciduous Tooth Pulp Autotransplantation for the Regenerative Endodontic Treatment of Permanent Teeth With Pulp Necrosis: A Case Series

IntroductionIn young individuals, deciduous tooth pulp might be used as a natural, biologic scaffold for the regenerative endodontic treatment (RET) of young permanent teeth with necrotic pulps and apical periodontitis. The present case series demonstrates the clinical and radiographic outcomes of a novel RET using deciduous pulp autotransplantation in traumatized, necrotic young permanent incisors. MethodsFive previously traumatized maxillary incisors of four 8- to 11.5-year-old patients were treated with a RET protocol that used 2.5% NaOCl irrigation and placement of calcium hydroxide dressing in the first visit. After 4 weeks, the intracanal medication was removed, and the whole pulp tissue harvested from the neighboring maxillary deciduous canine was transplanted into the disinfected root canal without induced apical bleeding. Following placement of a mineral trioxide aggregate coronal barrier, the access cavities were restored with acid-etch resin composite. The root canals of donor primary canines were filled with calcium hydroxide-iodoform paste and were restored as with the permanent incisors. ResultsThree patients were followed-up for 24 months, and 1 patient for 12 months. All teeth demonstrated radiographic evidence of complete periapical healing, slight increase in dentinal wall thickness, and continued apical closure in the absence of clinical symptoms. A positive response to cold test was obtained in 1 incisor at 12 months and 2 at 24 months. ConclusionsBased on 12- and 24-month clinical and radiographic findings, the present cases demonstrate a favorable outcome of a RET protocol using deciduous pulp autotransplantation in young permanent incisors with pulp necrosis.

Isolation of Endogenous TGF-β1 from Root Canals for Pulp Tissue Engineering: A Translational Study.

Simple SummaryTissue engineering of the dental pulp has been a goal of dental research for years. In this translational study, a chairside protocol is designed using endogenous dentin matrix proteins as signaling molecules for pulp regeneration. These bioactive molecules can be isolated from root canals by ultrasonic-activated irrigation, further processed chairside, and mixed with a hydrogel. The scaffold material is to be injected into the root canal and effect cell homing, i.e., allowing stem cells from the periapical space to migrate into the root canal. The aim of this innovative approach is the formation of an innervated and vascularized connective tissue that resembles the pulp in form and function.Cell homing for dental pulp tissue engineering has been advocated as a feasible approach to regenerate dental pulp in a clinical setting. In order to develop a translational protocol for clinical application, we wanted to determine the effects of disinfectants on the availability of growth factors from the root canal, the amount that can be obtained in this context, and whether they can be processed for use in tissue engineering procedures. The extraction of growth factors should also be confirmed in a clinical setting. Root canals were prepared in 36 extracted mature teeth, and the amount of TGF-β1 in solution was quantified after different irrigation protocols (sodium hypochlorite, chlorhexidine) and after intracanal medication (calcium hydroxide). Centrifugal filters with a cut-off of 10,000 Da and 3000 Da were used for efficient concentration, and volumes and amounts of retained TGF-β1 were measured at different time points. During conventional endodontic treatment, ethylenediaminotetraacetic acid (EDTA) solution was collected after ultrasonic activation from the root canals of mature teeth of 38 patients, and growth factor content was quantified via enzyme-linked immunosorbent assay (ELISA). Irrigation with sodium hypochlorite reduced TGF-β1 release into EDTA. This effect was partially reversed by canal enlargement after the use of sodium hypochlorite and by subsequent use of calcium hydroxide. A few minutes of centrifugation with a cut-off of 10,000 Da reduced the initial volume of the irrigant by 90% and led to a continuous increase in concentration to the same extent. Furthermore, TGF-β1 was obtained from root canals of mature teeth during endodontic treatment in quantities that have been shown to elicit desirable cellular responses in a subsequent clinical application. A mixture with a suitable scaffold material and injection into the root canal has the potential to promote dental pulp regeneration.

Evaluation of the efficacy of different intracanal medicaments against Candida albicans and Enterococcus faecalis - An In-Vitro study.

This study aims to evaluate the antimicrobial efficacy of certain intracanal medicaments against Candida albicans and Enterococcus faecalis. Freshly extracted 120 single rooted mandibular premolars were selected for the study. Teeth were decoronated and cleaning and shaping was done up to F3 universal protaper system and were divided mainly into two groups: Candida albicans (C. albicans) (n = 60) and Enterococcus faecalis (E. faecalis) (n = 60). The medicaments include: G1: chlorhexidine + calcium hydroxide, G2: sodium hypochlorite + calcium hydroxide, G3: 2% chlorhexidine gel, G4: octenisept, G5: 0.1% octenisept solution + calcium hydroxide, and G6: physiologic saline (n = 5). Teeth were contaminated with Enterococcus faecalis and Candida albicans which were cultured, respectively, in brain heart infusion and Sabouraud's dextrose agar for 21 days followed by intracanal medication and colony forming units were counted on the second and seventh day. Statistical analysis was done using Analysis of Variance (ANOVA) and Tukey's post hoc test. Against C. albicans, CHX + CH, 2% CHX gel, 0.1% octenidine (OCT) gel and OCT + CH showed statistically significant differences on the 2nd and 7th day. But against Enterococcus faecalis, only 0.1% OCT gel and 2% CHX gel showed statistically significant differences on the 2nd and 7th day. Among all the groups, 0.1% OCT gel and 2% CHX gel showed predominant antimicrobial efficacy. From the limitations of the current study, all the medicaments showed antimicrobial effect against Candida albicans and Enterococcus faecalis on the 2nd and 7th day with higher microbial inhibition on the 7th day.

Outcomes of the GentleWave system on root canal treatment: a narrative review.

This study aimed to describe the outcomes of the GentleWave system (GW) (Sonendo) on root canal treatment. Published articles were collected from scientific databases (MEDLINE/PubMed platform, Web of Science, Scopus, Science Direct and Embase). A total of 24 studies were collected from August/2014 to July/2021, 20 in vitro and 4 clinical. GW System was not associated with extrusion of the irrigant, promoted faster organic dissolution than conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI) continuous ultrasonic irrigation (CUI) and EndoVac, reduced more bacterial DNA and biofilm than PUI and CUI, promoted higher penetration of sodium hypochlorite into dentinal tubules than PUI and CUI in vitro, and removed more intracanal medication than CSI and PUI. GW was able to remove pulp tissue and calcifications. Moreover, its ability to remove hard-tissue debris and smear layer was better than that of CSI, and its ability to remove root canal obturation residues was lower or similar to that of PUI, and similar to that of CSI and EndoVac. Regarding root canal obturation of minimally instrumented molar canals, GW was associated with high-quality obturation. Clinically, the success rate of endodontic treatment using GW was 97.3%, and the short-term postoperative pain in the GW group was not different from CSI. Further research, mainly clinical, is needed to establish whether GW has any advantages over other available irrigation methods.

Evaluation and comparison of the antimicrobial activity of herbal extracts with the standard irrigant against Enterococcus faecalis

Background: Numerous actions to diminish the number of microorganisms in the root canal system comprise the usage of a variety of functional techniques, irrigation methods, and intracanal medications. Irrigation goes hand in hand with resources to help remove pulp tissue and/or microorganisms. Purpose: The intent of this trial was to assess as well as compare the antimicrobial activity of herbal irrigant with normal irrigant (2.5% sodium hypochlorite [NaOCl]) against Enterococcus faecalis to test its effectiveness as root irrigation water. Materials and Methods: The culture was elevated overnight at 37°C in brain heart infusion (BHI) broth followed by testing microbial growth for changes in turbidity for 24 h. BHI broth comprising E. faecalis is vaccinated on a BHI agar plate using a grass planting method utilizing a sterile glass dispenser. Five test herbal discs (Curcuma longa [CT]-turmeric, Azadirachta indica [AI], MI, Propolis [P], and Triphala [T]); in addition to two control discs (ethanol as well as NaOCl) positioned on a custom plate. Results: The average blocking area with a drop-down program for each drug was observed to be: NaOCl (24.0 ± 1.74) >P (14.6 ± 1.84) > AI (09.5 ± 1.72) > T (06.4 ± 0.83) > CT (04.3 ± 04.1± ±0.83).) > Morinda citrifolia (03.2 ± 0.30) > ethanol (00.1 ± 0.01). Conclusions: P and AI have shown assuring outcomes in the completion of E. faecalis. Nevertheless, their work has been observed to be under NaOCl.

Management of internal root resorption with mineral trioxide aggregate: A case report

The most significant cause of Internal root resorption is trauma which eventually can lead to destruction of crown or root portion of the tooth. Internal resorption is most commonly seen in the anterior teeth and initiates mainly from the root canal. It may also occur in posterior teeth due to caries involving the pulp cavity. Management of internal resorption requires diagnosis at an early stage using radiographic examination and diagnostic aids like cone beam computed tomography following which successful management of resorbed tooth can be accomplished. This case report demonstrates management of internal resorption in maxillary anterior tooth using calcium hydroxide as intracanal medication and favourable sealing of root canal with Mineral Trioxide Aggregate (MTA) promoting periradicular healing.

Tratamento Endodôntico de Dente com Calcificação Radicular Pós-Trauma: Relato de Caso Clínico

The calcification of the root canal is a process that may occur after a dental trauma or slowly develop due to physiological dental aging. It is characterized by hard tissue deposition on both the pulp chamber and the root canal. Periapical radiography and computed tomography can be used to diagnose this condition. In some cases, it may be associated with pulp necrosis and the presence of periapical injury, and the treatment may be considered to be quite complex. This case report addresses the endodontic treatment of the upper left central incisor, symptomatic, with root canal obliteration and pulp necrosis as a sequela of dental trauma. After all the tests, chronic apical periodontitis was diagnosed, and conventional endodontic treatment was proposed. The most significant difficulty faced was when locating the root canal's entrance. Numerous radiographs were carried out to avoid deviations. The opening of the root canal could only be found at the end of the middle third, só treatment could proceed by using the crown-down technique and intracanal medication based on calcium hydroxide during the sessions. When the patient was asymptomatic, the root canal has been filled. The accomplishment of the technique was successful, and after finishing the case, there was remission of symptoms. After a six-month follow-up period and three years, the healing of the periapical tissues was observed.

Incidence and Factors Related to Endodontic Flare Up - A 1-year Retrospective Study

Background: Endodontic flare up is a common complication of endodontic treatment that results from acute exacerbation of pulpal and peri-radicular pathosis; leading to unscheduled emergency visits that is disturbing for both clinicians and patients. Flare up causes are multifactorial that includes microbial, host, chemical and mechanical factors. Objective: The aim of this retrospective study was to evaluate the incidence and identify risk factors of flare up in a multispecialty dental and maxillofacial center over a period of one year from February 2019 to February 2020. Methods: Data was collected from 323 teeth belonging to 272 patients that completed their root canal treatment on multiple sessions during the evaluation period. The samples were classified based on inclusion criteria and variables according to teeth type; age; sex; pulpal and periapical pathosis; presence of intracanal medication between visits; and absence of coronal seal. Results: The incidence of flare up was 122(38%), the evaluated variables did not show statistical significance in any of the evaluated parameters. Conclusion: The incidence of flare up is widely diverse and may be due to a variety of reasons; and therefore, the management of flare up in each dental facility is different and varies according to their setup; number of clinicians and specialists available. Continuous training and skills improvement for clinician in charge of managing emergency patients with flare up is highly recommended. Keywords: Dental Emergencies; Flare up; Infection; Inflammation; Risk factors; Root canal treatment

Present status and future directions: Endodontic management of traumatic injuries to permanent teeth.

The prognosis of traumatized teeth depends largely on the fate of the pulp and its treatment. This review aims to update the present status on the endodontic management of traumatic injuries to permanent teeth and to identify relevant research areas that could contribute to an improvement in diagnosis and treatment of traumatized permanent teeth. Future research should pay greater attention to (1) diagnostic methods to assess the perfusion of the pulp and enhance detection of tooth cracks and initial signs of root resorption; (2) improved materials for vital pulp treatment; (3) studies focusing on type and duration of splinting after root fractures; (4) antiresorptive intracanal medication in case of posttraumatic pulp necrosis and infection-related resorption and (5) long-term data on the apical barrier technique compared to revitalization.

Efficacy of 6% Sodium Hypochlorite on Infectious Content of Teeth with Symptomatic Irreversible Pulpitis

IntroductionThe objective of this study was to monitor the effects of chemomechanical preparation (CMP) performed with 6% sodium hypochlorite and calcium hydroxide–based intracanal medication (ICM) on the levels and diversity of bacteria, endotoxins (lipopolysaccharides [LPS]), and lipoteichoic acid (LTA) in root canals of teeth with symptomatic irreversible pulpitis. MethodsSamples were collected from 10 teeth with symptomatic irreversible pulpitis before CMP (S1), after CMP (S2), and after ICM (S3). The levels of bacteria, LPS, and LTA were assessed by using checkerboard DNA-DNA hybridization, LAL Pyrogent 5000, and enzyme-linked immunosorbent assay, respectively. Wilcoxon test, repeated-measures analysis of variance, and Tukey post hoc test were used for statistical analysis at a significance level of 5%. ResultsForty species were detected at S1. Two species were eliminated after CMP and 5 after ICM. Resistant and pain-related species were detected in the root canals. Higher levels of culturable bacteria were detected at S1. However, CMP and ICM effectively reduced the microbial load in the root canals. Higher levels of LPS and LTA were detected at S1. CMP was effective in reducing both LPS and LTA (P < .05). ICM produced additional reduction in the levels of LPS (P > .05) and LTA (P < .05). ConclusionsChemomechanical preparation using 6% sodium hypochlorite and calcium hydroxide–based intracanal medication were effective in reducing the levels of bacteria, LPS, and LTA in teeth with vital pulp and irreversibly inflamed pulp.

How Adding Chlorhexidine or Metallic Nanoparticles Affects the Antimicrobial Performance of Calcium Hydroxide Paste as an Intracanal Medication: An In Vitro Study.

The aim of our study was to explore the potential value of metallic (Ag, Cu, and Zn) salts, polymer/metallic nanoparticles, and chlorhexidine (CHX) for improving the antimicrobial activity of calcium hydroxide (CH) against E. faecalis and C. albicans, associated with persistent endodontic infections. A first screening was performed by determining minimum inhibitory/bactericidal concentrations (MIC/MBC). Antimicrobial activity of the CH paste mixed with metallic salts, chitosan or cyclodextrin polymer metallic nanoparticles was compared to the antimicrobial activity of CH paste alone and CH + CHX using a time-kill kinetics assay. The effect of the antimicrobials on the rheological and the key mechanical properties were also examined. Copper and zinc were discarded because of their MIC/MBC values and silver because of its kill time curve profile. Except for a slower setting time after 24 h and a higher weight loss after 1 week of incubation, the mechanical behavior of the CH paste was unaffected by the addition of CHX. Polymeric/metallic nanoparticles failed to potentiate the antimicrobial effect of CH. By contrast, CHX increased this effect and thus could help eradicate E. faecalis associated with persistent root canal infections without altering the desired key physical properties of the CH paste.

Enhanced antibacterial effect against Enterococcus faecalis by silver ions plus Triton X-100 with low concentrations and cytotoxicity.

Enterococcus faecalis (E. faecalis) is commonly considered to be one of chief culprits of secondary and persistent root canal infections. As antibiotic resistance has become a global issue, in order to reduce the use of antibiotics, metal ions have recently been widely used as an alternative. Silver ions (Ag+) have been proved to be a strong bactericide but with high cytotoxicity and discoloration property. Triton X-100 (TX-100) and Ag+ were co-used for the first time as a clinical intracanal medication to obtain both enhanced antibacterial effect and low cytotoxicity. The synergistic antibacterial effect of TX-100 + Ag+ was tested on both planktonic and biofilm-resident E. faecalis on dentine. And the cytotoxicity was tested on MC3T3-E1 cells. Results confirmed the antibacterial activity against both planktonic and biofilm-resident E. faecalis was dramatically improved after TX-100 incorporation. TX-100 and Ag+ mixture demonstrated a similar inhibitory effect as the 2% chlorhexidine (CHX), while the cytotoxicity was much lower than 2% CHX (p < 0.05). In conclusion, TX-100 + Ag+ mixture might be developed into a new effective intracanal medication as the 2% CHX.

The antibacterial effect and the incidence of post-operative pain after the application of nano-based intracanal medications during endodontic retreatment: a randomized controlled clinical trial.

This clinical trial aimed to evaluate the effect of nano-silver and nano-calcium hydroxide intracanal medicaments (ICM) during retreatment regarding their antibacterial effect and their effect on post-operative pain and flare-ups. Sixty-nine patients scheduled for endodontic retreatment were included in this randomized clinical trial and randomly allocated to 3 equal groups (n = 23) according to the type of ICM used. The first microbial sampling (S1) representing the original microbiota was obtained after the removal of the old canal filling. After chemo-mechanical debridement, another sample (S2) was obtained representing the microbial state before ICM application. Patients were randomly allocated to receive either nano-silver (nano-Ag), nano-calcium hydroxide (nano-CH), or calcium hydroxide (CH) as ICM. Patients rated their pain pre-operatively and then after 6, 12, 24, 48, and 72h. During the second visit (7days later), the last microbial sample (S3) was obtained after removal of the ICM. Reduction of total bacterial and total E. faecalis counts and the biofilm-forming capability of the existing microbiota were determined. Results showed reduction in total bacterial count, total E. faecalis count and the biofilm-forming,capability of the existing microbiota after chemo-mechanical debridement (S1-S2) and after the application of ICM (S3-S2). However, the reduction after cleaning and shaping was significantly more pronounced (p < 0.001) compared to the effect of ICM application, with no difference between the 3 ICM (p > 0.05). Post-operative pain was significantly reduced at the 48- and 72-h intervals after the application of nano-Ag and nano-CH only (p < 0.001), with no significant difference between these two ICM (p > 0.05). The incidence of flare-ups in all groups was similar (p > 0.05). The antibacterial effect of the nano-Ag and nano-CH was equivalent to that of CH, but they contributed to better pain control. Nanoparticles may have a positive impact on post-endodontic pain.

Post-operative Pain and Antibacterial Efficacy of Silver Nanoparticles Formulations Intracanal Medication: A Randomized Controlled Clinical Study

AIM: To evaluate the effect of using combined calcium hydroxide/silver nanoparticles or silver nanoparticles (AgNPs) or calcium hydroxide (Ca(OH)2) individually as intracanal medications in reducing postoperative pain and intracanal bacterial count. MATERIALS AND METHODS: Thirty patients with necrotic mandibular anterior teeth were randomly divided into 3 groups; Ca(OH)2 + AgNPs or AgNPs gel (Intervention Groups) or Ca(OH)2 (Control Group). Patients received a standard 2-visit endodontic treatment and recorded their pain levels after 4, 24, 48, 72 and 96 hours following the first and second visit on a modified visual analogue scale (VAS). Intracanal bacterial counts were assessed using culturing before and after instrumentation and intracanal medication. Outcome data were statistically analyzed using Kruskal-Wallis and Fisher’s Exact tests to compare between the groups and Friedman’s test to assess the changes by time. RESULTS: At 24 hours interappointment the incidence of pain was statistically significant (P = .005) as well as at 48 hours (P = .001). There was a statistically significant difference between the mean percentage reduction of anaerobic bacterial counts in the three groups with the highest percentage in the Ca(OH)2 + AgNPs group at 98.9% followed by AgNPs group 98.5% and Ca(OH)2 at 85.3% (P &lt;0.001). CONCLUSIONS: Combined calcium hydroxide/silver nanoparticles reduced the intracanal bacterial counts significantly, but adversely affected the interappointment pain. Based on that finding, this combination should be tested in different concentrations with different ratios to reach the most effective combination that reduce pain with high antibacterial efficacy.

Influence of photodynamic therapy and intracanal medication on Martens hardness, elastic modulus and bond strength of glass-fiber posts to endodontically treated root dentin

BackgroundThe purpose of this in vitro study was to evaluate the influence of photodynamic therapy (PDT) with methylene blue photosensitizer (PS) and calcium hydroxide intracanal medication on Martens hardness (MH), elastic modulus (Eit) and adhesive bond strength of glass-fiber posts in different thirds of intraradicular dentin. MethodsNinety-six bovine teeth were distributed into the following 6 experimental groups: a negative control irrigated with deionized water; a positive control irrigated with deionized water and filled with calcium hydroxide intracanal medication (Ca[OH]2); Ca[OH]2 + methylene blue 50 mg/L without activation; Ca[OH]2 + methylene blue 100 mg/L without activation; Ca[OH]2 + methylene blue 50 mg/L activated by red laser; and Ca[OH]2 + methylene blue 100 mg/L activated by red laser (n = 16). MH and Eit were measured using an ultramicrodurometer under load action of 3 mN (n = 8). Adhesive bond strength was measured using the push-out test in a universal testing machine (n = 8), and representative samples underwent scanning electron microscopy. Data on MH, Eit, and bond strength were subjected to normality tests and analyzed by ANOVA and Tukey's test (α = 0.05). ResultsMethylene blue PS, activated or not by red laser, associated with calcium hydroxide medication did not promote significant difference as compared to the control groups irrigated with deionized water, associated or not with the use of intracanal medication, regarding mechanical properties and bond strength (p > 0.05). Experimental groups showed no difference between the thirds regarding root canal depth (p > 0.05), except for the positive control group, in which the apical third showed higher Eit values than the middle third (p = 0.0324). There was a predominance of mixed failure in all experimental groups, excepted the red laser-activated group treated with the highest concentration of methylene blue, which showed predominance of adhesive failure. ConclusionsPDT with methylene blue PS at 50 mg/L, associated with intracanal calcium hydroxide medication is a satisfactory alternative for endodontic treatment as there is no interference in the mechanical properties and bond strength among glass-fiber posts to intraradicular dentin at any depth of the root canal.

Assessment The Propolis Effect Versus Calcium Hydroxide Effect as Intracanal Medications on Post-Operative Pain in Necrotic Teeth

Assessment The Propolis Effect Versus Calcium Hydroxide Effect as Intracanal Medications on Post-Operative Pain in Necrotic Teeth

Mesoporous Calcium-Silicate Nanoparticles Loaded with Low-Dose Triton-100+Ag+ to Achieve Both Enhanced Antibacterial Properties and Low Cytotoxicity for Dentin Disinfection of Human Teeth.

Mesoporous calcium-silicate nanoparticles (MCSNs) are excellent biomaterials for controlled drug delivery and mineralization induction. In this study, MCSNs were loaded with low-dose silver ion (Ag+) and Triton X-100 (TX-100) as the M-AgTX to achieve both enhanced antibacterial properties and low cytotoxicity for dentin disinfection. The physicochemical property, biocompatibility, infiltration ability into dentinal tubules, anti-bacterial ability against both planktonic Enterococcus faecalis (E. faecalis) and its biofilm on dentin, effects on dentin microhardness and in vitro mineralization property were systematically investigated. Results confirmed that the MCSNs and M-AgTX nanoparticles showed typical morphology of mesoporous materials and exhibited sustained release of chemicals with an alkaline pH value over time. M-AgTX also exhibited excellent biocompatibility on MC3T3-E1 cells and could eliminate 100% planktonic E. faecalis after 48-h treatment. On dentin slices, it could enter dentinal tubules by ultrasonic activation and inhibit the growth of E. faecalis on dentin. M-AgTX could completely inactive 28-day E. faecalis biofilm. TEM confirmed the destruction of cell membrane integrity and Ag+ infiltration into bacteria by M-AgTX. Besides, dentin slices medicated with M-AgTX nanoparticles displayed an increased microhardness. After being immersed in SBF for 7 days, apatite crystals could be observed on the surface of the material tablets. M-AgTX could be developed into a new multifunctional intra-canal medication or bone defect filling material for infected bone defects due to its sustained release profile, low cytotoxicity, infiltration ability, enhanced anti-bacterial and mineralization features.

Late endodontic treatment of a tooth with extrusive dislocation and invasive cervical resorption: a clinical case report

This study aims to report the clinical case of a 16 years-old male patient, who attended a private office reporting that at an accident suffered at the age of 10 years-old, which caused extrusive dislocation in both teeth 11 and 21. At that time, the teeth were repositioned, without an adequate follow-up. Upon physical and radiographic examination, the following features were observed: presence of recurrent sinus tract on the vestibular surface, area of ​​external cervical resorption, and a periapical lesion on tooth 21. Endodontic treatments (necropulpectomy) were performed on teeth 11 and 21, with the placement of a root canal dressing of calcium hydroxide and subsequent root canal filling. In addition, soft tissue flap folding was performed to treat the resorption area and to seal it with glass ionomer cement. A 7 months follow-up radiograph shows stabilization in the process of the tooth resorption and remission of the periapical lesion. In conclusion, the endodontic treatment with intracanal medication, and the sealing of the resorption area were successful to preserve the traumatized tooth. In addition, it is noteworthy that following up with the patient after the trauma episode is essential to monitor the pulp vitality of the tooth involved.

Comparative evaluation of the cytotoxic effect of different intracanal medicaments

ABSTRACTIntroduction: intracanal medicaments have an important role in disinfecting ofthe pulp space and in endodontic regenerative procedures. These medications comein close contact with the periradicular tissue, thus their degradation products must bebiocompatible with the periapical tissue. Otherwise, these medicaments will resultin intense inflammatory reaction. Aim of the study: The purpose of this in vitrostudy was to evaluate and compare the cytotoxicity of three intracanal medications;Neem oil, double antibiotic paste (DAP) and calcium hydroxide (Ca(OH)2).Materials and Methods: Immortalized human gingival fibroblast cells were retrievedfrom the cell bank and then cultured. Three different intracanal medications (Neemoil, DAP, Ca(OH)2) were added to the cultured cells. Cell viability was evaluatedusing 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) andApoptosis/necrosis assays. Statistical analysis was performed using One-way ANOVAand post-hoc Tukey test. Results: Ca(OH)2 recorded the highest significant cytotoxicityfollowed by Neem oil, then DAP which recorded the lowest significant cytotoxicity.Cytotoxicity of the three intracanal medicaments used were directly proportional totheir concentrations Conclusion: DAP could be better recommended as intracanalmedicament in regenerative endodontic procedures because of its biocompatibilitycompared to the other tested medications.