Microorganisms In Root Canals Research Articles

The Successful Management of Non-healing Extraoral Draining Sinus of Odontogenic Origin: A Report of Two Cases

Extraoral draining sinus of odontogenic origin usually lacks intraoral symptoms, thus it may be diagnosed as a cutaneous lesion. It is rare and may be confused with a wide variety of diseases for example furuncle, pericoronitis in relation to the mandibular third molars, parotid fistula, preauricular sinuses, periapical and periodontal pathology, and many more. Patients might seek treatment from their physician as they are not aware of its odontogenic origin and these cases usually are misdiagnosed and leading to inappropriate treatment. Objective: To discuss the detailed management of two cases of extraoral draining sinus that were successfully treated. Case Reports: The first case was referred by the Department of Oral and Maxillofacial Surgery, for management of extraoral draining sinus originating from tooth 36. In the second case, the extraoral draining sinus is caused by pulpal necrosis of several mandibular anterior teeth. Intra-radicular microorganisms in infected root canals primarily obligate anaerobes have been the aetiologic cause of apical periodontitis if left untreated may cause these types of symptoms. Conclusion: As it is uncommon and the absence of any dental symptoms, thus, it’s paramount important to diagnose these types of cases to treat the disease and to avoid unnecessary treatments such as prolonged prescription of antibiotics. Therefore, the dental cause should be ruled out for any cutaneous sinus tract so that a correct diagnosis can be ascertained, and proper management can be delivered to the patient.

Degradation of Fusobacterium nucleatum biofilm and quantity of reactive oxygen species due to a combination of photodynamic therapy and 2.5% sodium hypochlorite

Background: The persistence of microorganisms in the root canal system is one of the leading causes of root canal treatment failure. Biofilms of putative pathogens hidden inside dentin tubules and other root canal ramifications may limit current disinfection protocols. Photodynamic therapy (PDT) with a wavelength of 628 nm can be used as an antimicrobial strategy that uses low-power laser energy to activate a non-toxic photosensitizer to produce singlet oxygen with the ability to kill microorganisms in root canals. Fusobacterium nucleatum was used because this bacterium is one of the bacteria involved in root canal infection. Purpose: The aim of this study was to compare the bactericidal efficacy of sodium hypochlorite (NaOCl) 2.5%, PDT, and a combination of PDT and NaOCl 2.5% against Fusobacterium nucleatum. Methods: Mature biofilm Fusobacterium nucleatum was divided into four groups according to the protocol of decontamination: K1 (negative control – biofilm), K2 (NaOCl 2.5%), K3 (PDT), and K4 (NaOCl 2.5% + PDT). Biofilm degradation was observed using optical density (OD) at 570 nm using a microplate reader. A reactive oxygen species quantity check was carried out using a nitroblue tetrazolium test, and OD observation was done with a microplate reader at 540 nm. Results: Group 4 (NaOCl 2.5% + PDT) showed more biofilm bacteria elimination than the other groups. Conclusion: A combination of PDT and NaOCl 2.5% can be considered an effective protocol for the elimination of Fusobacterium nucleatum. There is a potentiation relationship between NaOCl 2.5% and PDT FotoSan. Biofilm degradation occurs because of the effect of antibacterial NaOCl 2.5% and the irradiation effect of the Toluidine blue O photosensitizer.

Antimicrobial efficacy of different herbal extracts against root canal pathogens - An in vitro study.

The antimicrobial activity exhibited by the plant extracts against various pathogens has previously been demonstrated to a limited extent. However, the antibacterial effects of most of them have not yet been clarified in endodontics. This study aimed to determine the antimicrobial activity of some medicinal plants' methanolic extracts against some root canal microorganisms. In this in vitro study, after gathering the five plants (pomegranate peel, clove, Zhumeria majdae, Eucalyptus galbie and green tea), their methanolic extracts were obtained by the maceration method, and the antimicrobial activity was determined using micro- and macro-dilution methods. The microorganisms tested in this study were Enterococcus (E.) faecalis, Porphyromonas (P.) gingivalis and Fusobacterium (F.) nucleatum. Non-ready-to-use calcium hydroxide (CH), ready-to-use Calcipex II CH and methanol were used as control materials. The nonparametric Kruskal-Wallis and Friedman tests were used to analyse and evaluate the data and variables. In all concentrations and time intervals studied, eucalyptus extract showed the highest antimicrobial activity against E. faecalis. All the extracts showed growth-inhibitory effects against P. gingivalis and F. nucleatum. There were no significant differences between the anti-enterococcus effects of eucalyptus extracts and non-ready-to-use CH (P > 0.05). There was a greater efficacy of Eucalyptus galbie extract than other extracts.

Inhibition of RGS10 Aggravates Periapical Periodontitis via Upregulation of the NF-κB Pathway

IntroductionPeriapical periodontitis develops due to the interplay between root canal microorganisms and host defenses. The mechanism underlying the pathogenesis of periapical periodontitis remains unclear. Regulator of G protein signaling protein 10 (RGS10) has been suggested to play a role in regulating inflammation. This study explored the potential regulatory effects of RGS10 on periapical periodontitis and the proinflammatory pathway of nuclear factor (NF)-κB. MethodsDisease models of periapical inflammation in mice were established, and adenovirus-associated virus (AAV) was used to inhibit RGS10 expression. Periapical lesions were detected using micro-computed tomography. Quantitative reverse transcriptase PCR (qRT-PCR), western blotting (WB), enzyme-linked immunosorbent assay (ELISA), enzyme activity staining of tartrate-resistant acid phosphatase, and immunohistochemistry were conducted to assess the role of RGS10 expression on NF-κB proinflammatory signaling, OPG, RANKL, and osteoclasts in the periapical regions of each group. TNFα was used to stimulate L929 cells alone or with small interfering RNA (siRNA). To assess the expression of associated molecules, WB, immunofluorescence, qRT-PCR, and ELISA were performed. ResultsRGS10 inhibition increased alveolar bone destruction in periapical periodontitis lesions and substantially enhanced the NF-κB proinflammatory signaling pathway activation level. Furthermore, RGS10 inhibition upregulated the ratio of OPG/RANKL and the maturation of osteoclasts during alveolar bone resorption. L929 cell TNFα stimulation and siRNA transfection confirmed these in vivo results. ConclusionRGS10 negatively regulates NF-κB proinflammatory signaling in periapical periodontitis and participates in bone remodeling. Therefore, RGS10 is a promising treatment option for long-term chronic periapical inflammation and may be a new target for the artificial regulation of inflammation.

Antibacterial Effect of Longan Extract and Diode Laser Combination on Peptostreptococcus Species in Type 2 Diabetic Patients with Apical Periodontitis - A Pilot Study

Diabetes mellitus is a risk factor for developing periapical infections and increases resistance against pharmacotherapy. Microorganisms are the major cause for periradicular diseases. Peptostreptococcus spp. is the most common bacterial isolate from root canals of primary endodontic infections in diabetic patients. Herbal irrigants are being researched for its efficacy against root canal microorganisms owing to their resistance against commonly used irrigants and medicaments. Longan extract is known for its antimicrobial and antiglycemic action. Diode laser is a newer modality in the disinfection of root canal system. The aim of this study was to assess the antibacterial effect of longan extract (longan fruit extract) and diode laser on Peptostreptococcus species in type 2 diabetic patients with primary endodontic infections using PCR technique. Eleven subjects with type 2 diabetes requiring endodontic treatment were selected for the study based on convenience sampling for a period of 3 months. The preoperative root canal samples were collected after gaining access to the root canal system and initial instrumentation of root canals. Postoperative sample were obtained following a disinfection protocol using 3% NaOCl, 17% EDTA, longan extract as the final irrigant, followed by diode laser irradiation. Both the preoperative and postoperative samples were collected as per Moller’s criteria using sterile paper points. The mean percentage reduction following irrigation of the root canal with longan extract was 71.18% whereas diode laser showed 100% disinfection. In conclusion, the combination of longan extract and diode laser provides an effective mode of root canal disinfection in type 2 diabetic patients with apical periodontitis.

Improving the microbial sampling and analysis of secondary infected root canals by passive ultrasonic irrigation

ObjectiveThe persistence of pathogenic microorganisms in root canals is the most common reason for the failure of root canal treatment and the necessity of a root filling treatment, which results in an uncertain prognosis due to technical complexity and the variety of highly adaptable microorganisms.This study evaluated the effect of passive ultrasonic irrigation (PUI) on the outcome of the microbial analysis of root canal-treated teeth with persistent or recurrent apical inflammation in vivo.Materials and methodsSample collection was performed after root filling removal (sample S1, control group) and after PUI with NaCl (sample S2) using sterile paper points. In total, 19 samples were obtained. Quantification was performed by means of serial dilution of the samples. Subcultivated pure cultures were identified using MALDI-TOF MS complemented by the Vitek-2-System or PCR, followed by sequencing of the 16S rRNA gene. The results of the samples (S1 and S2) were evaluated regarding their bacterial count and composition.ResultsThe total count of bacteria and the number of aerobic/facultative anaerobic microorganisms significantly increased in the S2-samples after application of PUI. The number of obligate anaerobic microorganisms showed an increase after PUI, although it was not significant. We detected 12 different aerobic/facultative anaerobic microorganisms before PUI, and in 21 cases after PUI. Two different obligate anaerobic microorganisms were found in S1 samples compared to nine different species in S2 samples.ConclusionsPUI is a powerful method for detaching bacteria in infected root canals and enables a more precise analysis of the etiology of persistent endodontic infections.Clinical relevanceThis study indicates that PUI exerts a positive cleansing effect and adds to the accessibility of microorganisms during the application of bactericidal rinsing solution in root canal treatments.

Evaluation of the antibacterial effect of apple cider vinegar, black tea and sodium hypochlorite irrigant solutions on infected root canal microorganisms of primary teeth: An invitro study

Evaluation of the antibacterial effect of apple cider vinegar, black tea and sodium hypochlorite irrigant solutions on infected root canal microorganisms of primary teeth: An invitro study

Interrelationship between the Microbial Communities of the Root Canals and Periodontal Pockets in Combined Endodontic-Periodontal Diseases.

Periodontal and Endodontic diseases are biofilm-related diseases. The presence of microorganisms in root canals (RCs) and the complex microbiota of periodontal pockets (PPs) contribute to the development of endodontic-periodontal diseases. This study performed a systemic analysis using state-of-the-art sequence data to assess the microbial composition of infected RCs and PPs to further assess the microbiota and verify the possibility of cross-infection between these sites. The microbiomes of these combined diseases were examined with a focus on the V3-V4 hypervariable region of the 16S rRNA gene. The number of species in PP was higher than in RC, and there was a predominance of obligate anaerobes and gram-negative bacteria. In the RCs, the genera Enterococcus, Parvimonas, Stomatobaculum predominated, in contrast, the PPs revealed a predominance of Enterococcus, Parvimonas, Stomatobaculum, Peptostreptococcus and Mogibacterium. The RC and PP microbiome was not similar with regards to the sharing of OTUs for phyla and genera (8 and 67, respectively). The evaluation of molecular markers revealed a large number of markers for resistance to antibiotics of the carbapenem and beta-lactam type (broad spectrum). Another relevant finding of this study was the markers related to systemic diseases related to cardiac muscle and rheumatology, among others. In conclusion, the RC microbiota was less complex and diverse than PP. Interactions between microbial communities were present. The shared genus can signal communication between the endodontic and periodontal microbiomes.

INVESTIGATION OF ANTIBACTERIAL ACTIVITY OF ND: YAG - LASER AND STANDARD ENDODONTIC TREATMENT

Introduction: The microbial infection is one of the main causes of the dental pulp and periodontal diseases. Previously used methods for its elimination are not fully effective, and often some microorganisms in root canals (RC) remain unaffected after treatment. Another modern method for disinfection of root canal system is laser disinfection. Different types of lasers are used - Nd: YAG, Er: YAG, Diode laser. Purpose: The purpose of our study is to compare the antibacterial activity of ND: YAG laser and conventional endodontic therapy in the treatment of infected root canals. Materials and methods The study involved 36 teeth of patients diagnosed with pulp gangrene or chronic periapical periodontitis, requiring endodontic treatment. They were divided into two groups of 18 teeth each one. The teeth in both groups are prepared by Protaper Universal rotary instruments (Maillefer Instruments SA, Ballaigues, Switzerland). In group 1the root canals disinfection is performed with a Nd: YAG laser (source of Nd: YAG laser (1064 nm) is the AT Fidelis - Fotona d.d., Ljubljana laser system). In group 2 was used the following protocol of root canal disinfection: 2.5% sodium hypochlorite solution and 17% EDTA divided by irrigation with distilled water. Then a sterile paper point is placed in the root canals, and a microbiological sample is taken again. Results: In all compared pairs, there was no significantly different effect regarding the number of microorganisms. Conclusions: The disinfection rinsing method with NaOCl has the strongest antimicrobial effect in clinical studies (90% against all microbial isolates). The use of Nd: YAG laser independently is not always sufficient for root canal disinfection - the effect is about 66%.

Root canal microorganisms and their antibiotic susceptibility in patients with persistent endodontic infections, with and without clinical symptoms.

Secondary/persistent infections are present in teeth with previous root canal treatment, and a great variety of anaerobic microorganisms has been observed in these infections. The antibiotics prescription is occasional; however, in some cases, it is essential, particularly when the general health condition of the patient is compromised. The aims of this study were to identify the associated microorganisms in diagnosis of persistent or secondary apical periodontitis and to evaluate the susceptibility level to the antibiotics most used. Fifteen patients with persistent or secondary apical periodontitis requiring endodontic re-treatment were included. Microbiological samples were taken from the root canals and incubated in thioglycollate under anaerobic conditions. Anaerobic CDC agar (formulated by the Center for Disease Control and Prevention) was employed as a culture medium and the microorganisms were identified using the API system. The microorganisms were subjected to antibiograms with three different antibiotics. Twenty-six microorganisms were identified, the most common genus was Enterococcus (26.8%), Streptococcus (19.22%), Aerococcus (19.1%), and Clostridium (11.4%). 48% of them were susceptible to amoxicillin, with 28% of resistance. For clavulanic acid/amoxicillin, the susceptibility occurred in 32%, with 28% of resistance; and for clindamycin, the susceptibility was present in 40%, with 52% of resistance. The most frequently detected associated microorganism for secondary infections was genus Enterococcus, which exhibited high resistance to the studied antibiotics.

Potential risk of microorganisms in root canals

Potential risk of microorganisms in root canals

Root canal cleaning effectiveness with passive ultrasonic irrigation: A comparative in vitro study between Irrisafe and EndoUltra tip

Background: Root canal irrigation has an important role in removing pulp tissue, dentine debris, and microorganisms in root canals. Passive ultrasonic irrigation (PUI) Irrisafe is a high-frequency wired ultrasonic device, which is usedto obtain cleanliness of root canal from cavitation and acoustic streaming. EndoUltra is a high-frequency wireless ultrasonic device. It has advantages in terms of its ease of application. However, further research is needed to identify the variations in effectiveness between PUI Irrisafe and EndoUltra tip for dentine debris cleanliness. Objective: The aim of this study was to determine the effectiveness between the activation of PUI Irrisafe and EndoUltra tip on the dentine debris cleanliness of the apical third of a root canal. Methods: This experimental study was carried out on 50 mandibular premolar teeth with a single root canal from extracted teeth. The teeth were irrigated with 5% NaOCl with the activation of EndoUltra # 20/02 (15 and 30 s), with 5% NaOCl with the activation of the PUI tip Irrisafe # 20/02 (15 and 30 s), or with conventional irrigation (30 s). The assessment of the dentine debris score was assessed by two observers using a scanning electron microscope (SEM). Analysis of the results used the Kruskal—Wallis and Mann—Whitney U tests. Results: Differences in median cleanliness scores for the apical third of the root canal from the Irrisafe group, the EndoUltra group, and conventional group had a Kruskal—Wallis test value of P = 0.005. The results showed that there were significant differences (P < 0.05) in five groups. Conclusion: PUI activation with the EndoUltra tip had a better effectiveness on the dentine debris cleanliness of the apical third of a root canal than the Irrisafe tip at 15 and 30 s.

Antimicrobial efficacy of aqueous and ethanol extracts of Euclea divinorum Hiern on tooth root canal microorganisms

Antimicrobial efficacy of aqueous and ethanol extracts of Euclea divinorum Hiern on tooth root canal microorganisms

Antibiofilm activity of flavonoid mangosteen pericarp extract against porphyromonas gingivalis bacteria

Background. Necrosis teeth need a procedure called the root canal treatment to eliminate microorganisms in root canal, so the inflammation process did not continue to the periapical.One of the microbes that exist in thenecrosis teethis Porphyromonas gingivalis, that capable of forming biofilm because it has the ability to communicate with bacteria signaling (quorum sensing). It is necessary to discover another antibiofilm agent as an irrigation material in root canal preparation deriving from nature. Flavonoidmangosteen pericarp extract can disrupt acyl-homoserine lactones (AHLs) thus quorum sensing bacteria will be disrupted and causing permanent attachment and the establishment of colonies on the surface of the teeth any barrier. Purpose. The aim of this study found out the antibiofilmactivity of flavonoid mangosteen pericarp extract against Porphyromonas gingivalis bacteria. Method. This studyhasa laboratory experimental with post-test only group design. Porphyromonas gingivalis ATCC 33277 was diluted according to Mc. Farland standard 106CFU/ml in Tryptic Soy Broth (TSB) medium and inserted into microtitterplate flexible U bottom. Porphyromonas gingivalis was incubatedfor 6x24 hour and checked with a simple staining to see the formation of biofilm. Flavonoid mangosteen pericarp extract was added in various concentrations and OD (optical density) readings done with a wavelength of 595 nm. Result. Flavonoid mangosteen pericarp extractshowed a decrease of OD value from control in all concentrations.Conclusion.Flavonoid mangosteen pericarp extract has antibiofilm activity against Porphyromonas gingivalis bacteria.

Association of specific microorganisms with endodontic signs and symptoms. A comparative study

Aim:The study aimed to evaluate the association of root canal microorganisms red complex and E. facealis with endodontic clinical signs and symptoms using polymerase chain reaction.Materials and Methods:Bacterial samples were obtained using sterile paper points from the teeth of 100 subjects divided into two groups; Group I: 50 individuals with primary tooth infections and Group II: 50 individuals with failed endodontic treatment having the secondary infection. DNA extracted from samples was analyzed for endodontic pathogens by using species-specific primers.Results:The pain was noticed in 66%, (33 of 50 subjects) in primary infection and 60% (30 of 50) in a secondary infection. A statistically significant association between pain and E. faecalis bacteria observed both in primary infection and secondary infection (P < 0.05). Tenderness on percussion was associated with 40% cases in Group I and 70% cases in Group II. The red complex accounted for 94% of cases associated with tenderness on percussion in primary infection while 86% of cases associated with secondary infection with a statistically significant association (P < 0.05).Conclusion:Prevalence of red complex bacteria and E. faecalis suggested the association of studied bacteria with symptomatic infected pulp and periradicular diseases.

In Vitro Effect of Er:YAG Laser on Different Single and Mixed Microorganisms Being Associated with Endodontic Infections.

Objective: The purpose of this in vitro study was to evaluate the antimicrobial effect of activated irrigation with different modes of erbium-doped yttrium aluminum garnet (Er:YAG) laser application on microorganisms related to secondary endodontic infection. Background: Er:YAG laser has been recommended as an adjuvant tool for root canal disinfection during endodontic treatment. Materials and methods: Laser-activated irrigation (LAI) with 300 or 600 μm tips were tested with or without intermittent irrigation with 0.9% sodium chloride (NaCl) solution against different microorganisms (five single strains and dual species (Streptococcus gordonii combined with Actinomyces oris or Fusobacterium nucleatum) in root canals after 3 days of incubation. In a 21-day infection model, LAI was used together with intermittent rinsing with sodium hypochlorite (NaOCl) against the dual-species mixtures; here the incidence of microbial regrowth after up to 7 days was monitored. Results: In the 3-day root infection model, LAI protocols did not show any significant reduction of the microbial load when compared with manual irrigation with saline solution. In the 21-day infection, S. gordonii combined with A. oris were not detectable anymore after applying the LAI protocol with a 600 μm tip (30 mJ/10 pps) up to 7 days after treatment. Conclusions: Application of LAI with a 600 μm tip by using an Er:YAG laser might be advantageous in treatment of endodontic infections.

Butyrate Stimulates Histone H3 Acetylation, 8-Isoprostane Production, RANKL Expression, and Regulated Osteoprotegerin Expression/Secretion in MG-63 Osteoblastic Cells.

Butyric acid as a histone deacetylase (HDAC) inhibitor is produced by a number of periodontal and root canal microorganisms (such as Porphyromonas, Fusobacterium, etc.). Butyric acid may affect the biological activities of periodontal/periapical cells such as osteoblasts, periodontal ligament cells, etc., and thus affect periodontal/periapical tissue destruction and healing. The purposes of this study were to study the toxic effects of butyrate on the matrix and mineralization marker expression in MG-63 osteoblasts. Cell viability was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. Cellular apoptosis and necrosis were analyzed by propidium iodide/annexin V flow cytometry. The protein and mRNA expression of osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-B ligand (RANKL) were analyzed by Western blotting and reverse transcriptase-polymerase chain reaction (RT-PCR). OPG, soluble RANKL (sRANKL), 8-isoprostane, pro-collagen I, matrix metalloproteinase-2 (MMP-2), osteonectin (SPARC), osteocalcin and osteopontin (OPN) secretion into culture medium were measured by enzyme-linked immunosorbant assay. Alkaline phosphatase (ALP) activity was checked by ALP staining. Histone H3 acetylation levels were evaluated by immunofluorescent staining (IF) and Western blot. We found that butyrate activated the histone H3 acetylation of MG-63 cells. Exposure of MG-63 cells to butyrate partly decreased cell viability with no marked increase in apoptosis and necrosis. Twenty-four hours of exposure to butyrate stimulated RANKL protein expression, whereas it inhibited OPG protein expression. Butyrate also inhibited the secretion of OPG in MG-63 cells, whereas the sRANKL level was below the detection limit. However, 3 days of exposure to butyrate (1 to 8 mM) or other HDAC inhibitors such as phenylbutyrate, valproic acid and trichostatin stimulated OPG secretion. Butyrate stimulated 8-isoprostane, MMP-2 and OPN secretion, but not procollagen I, or osteocalcin in MG-63 cells. Exposure to butyrate (2–4 mM) for 3 days markedly stimulated osteonectin secretion and ALP activity. In conclusion, higher concentrations of butyric acid generated by periodontal and root canal microorganisms may potentially induce bone destruction and impair bone repair by the alteration of OPG/RANKL expression/secretion, 8-isoprostane, MMP-2 and OPN secretion, and affect cell viability. However, lower concentrations of butyrate (1–4 mM) may stimulate ALP, osteonectin and OPG. These effects are possibly related to increased histone acetylation. These events are important in the pathogenesis and repair of periodontal and periapical destruction.

Evaluation of Antimicrobial Activity of Two Endodontic Sealers: Zinc Oxide with Thyme Oil and Zinc Oxide Eugenol against Root Canal Microorganisms- An in vitro Study.

AimThe present study was aimed to find out and compare the antimicrobial effect of the paste containing zinc oxide cement mixed with thyme oil (ZO + Th oil) with that of the paste containing zinc oxide and eugenol (ZO + E) against Staphylococcus aureus, Escherichia coli, Enterococcus faecalis, and Pseudomonas aeruginosa, common root canal pathogens of deciduous teeth.Materials and methodsAn in vitro antimicrobial effect was carried out by the agar diffusion method. The ZO + Th oil paste was filled in the punched holes of Mueller Hinton agar at two equidistant points. The same was followed for ZO + E paste. For 24 hours, all the plates were incubated at a temperature of 37°C. The inhibition zones in millimeters around the wells were calculated. There were 6 times repetitions of the test for each microorganism. Data were tabulated and analyzed statistically using one-way analysis of variance (ANOVA) and Tukey’s post hoc comparison test. Level of significance for the tests was 5%.ResultsZones of bacterial inhibition were highest for ZO + Th oil paste against the pathogenic microorganisms S. aureus, followed by E. coli, E. faecalis, P. aeruginosa while for ZO + E paste, the decreasing order against pathogenic microorganisms was E. coli, S. aureus, E. faecalis, and P. aeruginosa. Statistically significant difference was found in both the pastes, ZO + Th oil paste and ZO + E paste.ConclusionZO + Th oil paste showed higher levels of antimicrobial effect against the root canal pathogens.How to cite this article: Thosar NR, Chandak M, Bhat M, Basak S. Evaluation of Antimicrobial Activity of Two Endodontic Sealers: Zinc Oxide with Thyme Oil and Zinc Oxide Eugenol against Root Canal Microorganisms—An in vitro Study. Int J Clin Pediatr Dent 2018;11(2):79-82.

Triple antibiotic paste: momentous roles and applications in endodontics: a review.

This study investigated the latest findings and notions regarding ‘triple antibiotic paste’ (TAP) and its applications in dentistry, particularly endodontics. TAP is a combination of 3 antibiotics, ciprofloxacin, metronidazole, and minocycline. Despite the problems and pitfalls research pertaining to this paste has unveiled, it has been vastly used in endodontic treatments. The paste's applications vary, from vital pulp therapy to the recently introduced regeneration and revascularisation protocol. Studies have shown that the paste can eliminate the root canal microorganisms and prepare an appropriate matrix for further treatments. This combination is able to remove diverse groups of obligate and facultative gram-positive and gram-negative bacteria, providing an environment for healing. In regeneration protocol cases, this allows the development, disinfection, and possible sterilization of the root canal system, so that new tissue can infiltrate and grow into the radicular area. Moreover, TAP is capable of creating a discipline in which other wanted and needed treatments can be successfully performed. In conclusion, TAP, as an antibacterial intracanal medication, has diverse uses. Nevertheless, despite its positive effects, the paste has shown drawbacks. Further research concerning the combined paste and other intracanal medications to control microbiota is a must.

In vitro Assessment of Calcium Hydroxide Removal from Endo Blocks by Simple Irrigation with NaOCl and the Passive Ultrasonic Irrigation Technique

Because endodontic pathology is caused due to bacterial contamination of the root canal system, endodontic treatment should focus on eliminating microorganisms in root canals. For more than 70 years Calcium Hydroxide has an important role in antimicrobial endodontic therapy. The use of calcium hydroxide is limited by the incomplete removal thereof, a residue covering 20% to 45% of the ductal wall, even after irrigation with NaOCl or EDTA. This study aims to evaluate the removal of calcium hydroxide in root canals using two different techniques.