Primary Endodontic Infections Research Articles

Antimicrobial efficacy of commercially available ozonated olive oil and sodium hypochlorite with and without ultrasonic activation in primary endodontic infections: A randomized clinical trial

Aim: This study compared the antimicrobial efficacy of commercially available ozonated olive oil and sodium hypochlorite (NaOCl) with and without ultrasonic activation in primary endodontic infections.Materials and Methods: Fifty-six patients fulfilling the inclusion criteria were selected and randomly assigned to four groups (n = 14) according to the irrigant and irrigation technique employed during biomechanical preparation. Group 1: NaOCl, Group 2: NaOCl with passive ultrasonic irrigation (PUI), Group 3-Ozonated olive oil, and Group 4-Ozonated olive oil with PUI. Bacteriological samples were taken from the canals before (S1) and after (S2) preparation using sterile paper points. Microbiological samples (S1, S2) were incubated and plated on Brain Heart Infusion agar. Colonies were counted after 24 h using the classic bacterial counting method. Collected data were statistically analyzed.Results: Statistically significant reduction (P < 0.05) of bacterial counts was found from S1 to S2 in all four experimental groups. The mean percentage reduction of bacterial counts of Group 1 and Group 3 was found to be lower than that of Group 2 and Group 4. The highest mean percentage bacterial reduction was seen in Group 2 (P < 0.05).Conclusion: PUI significantly enhanced the antimicrobial activity of the experimental groups and ozonated olive oil can be used as an adjunctive irrigant in primary endodontic infections. The antibacterial activity of ozonated olive oil with PUI was found to be comparable with that of NaOCl with PUI.

Comparative Effect of Various Irrigants with Herbal Formulations in Reducing Enterococcus Faecalis Count

Background: Enterococcus faecalis is associated with different forms of periradicular diseases, both primary and persistence endodontic infections. Traditional herbals have high antimicrobial, anti-inflammatory, antioxidant and biocompatible properties that make their use in dentistry more extensive. Judicious use of these herbal formulations has been found to mitigate the E.faecalis count. Aim: To compare the effect of various irrigants with herbal formulations in reducing Enterococcus faecalis count Materials and methods: Different herbal formulated irrigants were procured commercially. The test organism E.faecalis was isolated and maintained in the Nutrient Agar Slope at 4 degree C. Different concentrations of herbal irrigants were mixed with BHI agar and 50μL of the test organisms were added and poured into sterile petri dishes. Lawn culture of the test bacteria was made on the Plates and incubated at 37 degree C for 24 hrs and the colony forming units(CFU) were counted and recorded. Result: In this present study, comparing all 3 samples there is a higher reduction of count in Sample 3 (Cardamom and Tulsi mediated) than Sample 1 and Sample 2. Conclusion: Based on the results presented, it is possible to conclude that the herbal formulations represent a good reduction of Enterococcus faecalis.

The effect of photodynamic therapy on postoperative pain in teeth with primary endodontic infection

Introduction: The objective of this study was to investigate the action of photodynamic therapy on pain control after endodontic treatment in asymptomatic teeth with a primary infection, within a single visit. Methods: Sixty (60) single-rooted teeth with pulp necrosis and periapical lesions were selected and randomly divided into two (2) groups (n = 30), according to the protocol; a control group (CG) and a group using photodynamic therapy (aPDT). The canals were instrumented with Reciproc files # 25 up to 40 along the entire length of the canal, using 2% chlorhexidine gel as the auxiliary chemical substance, followed by irrigation with sterile saline. aPDT consited of 0.005% methylene blue as photosensitizer, using AsGaAl diode laser, 660 nm wavelength, 100 mW of power and 9 J of energy, using optical fibers with 365 μm in diameter. The canals were filled with Endomethasone N cement. Results: Pain intensity was assessed at 8, 12, 24, 48, 72 h and 1 week after endodontic treatment using a visual analogue scale. The level of pain was classified as none (0), mild (1–3), moderate (4–7) or severe (8–10). The data were at a significance level of 5%. There was a statistically significant difference (p<0.05) in the periods of 8, 12, 24, 48 and 72 h between the control group and the aPDT group. After 1 week, there was no statistically significant difference. Conclusions: It is concluded that photodynamic therapy had a significant effect on decreasing post-endodontic treatment pain in teeth with necrotic pulp and asymptomatic periapical lesions.

Prevalence of Fungi in Primary Endodontic Infections of a Greek-living Population Through Real-time Polymerase Chain Reaction and Matrix-assisted Laser Desorption/Ionization Time-of-flight Mass Spectrometry

IntroductionFungi are considered to be opportunistic pathogens that may play a significant role in the pathogenesis of endodontic infections. The main purpose of this study was to assess the prevalence of 2 selected genera of fungi, Candida albicans and Aspergillus spp., using real-time polymerase chain reaction (RT-PCR) and to compare the findings with the respective ones obtained by a culture-dependent approach, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-ToF MS). A secondary aim was to assess the presence of other bacteria growing under aerobic conditions. MethodsMicrobial samples were obtained from the root canals of 60 teeth associated with pulp necrosis and apical periodontitis. DNA was extracted, and RT-PCR was applied for the detection of C. albicans and Aspergillus spp. pathogenic subtypes. In addition, MALDI-ToF MS was performed to identify microorganisms grown under aerobic conditions. ResultsBased on RT-PCR, Aspergillus was detected in 8 cases, whereas C. albicans was detected in 4 cases. Using MALDI-ToF MS, no trace of Aspergillus was detected, whereas C. albicans was identified in 2 cases. Significant differences were revealed in the detection potential for Aspergillus spp. between MALDI-ToF MS and RT-PCR (P = .01); conversely, this was not the case for C. albicans (P = .50). After MALDI-ToF MS, 35 samples showed evidence of bacterial growth. The vast majority was colonized by Achromobacter xylosoxidans followed by Lactobacillus spp., Methylobacterium spp., and Enterococcus faecalis. ConclusionsThe findings confirm the presence of fungi in primarily infected canals with apical periodontitis as well as some rarely inspected aerobic bacterial species. A. xylosoxidans was prevalent; however, the clinical relevance of its presence needs to be investigated further.

Randomized Clinical Trial of Antimicrobial Effi cacy of two Herbal Products as Root Canal Irrigants in Primary Endodontic Infections

AIM: To evaluate &amp; compare antimicrobial efficacy of two herbal products as root canal irrigants in primary endodontic infections. MATERIALS&amp;METHOD: 78 patients were selected, out of which only 66 patients met the inclusion criteria &amp; were furtherrandomly divided into 3 groups (n=22 each), Group-1: 2.5% Sodium Hypochlorite, Group – 2: Chitosan, Group – 3 : Propolis. Access cavity was prepared &amp; working length was determined radiographically. A sterile paper point was inserted into the canal for 60 sec. Three samples were taken for each tooth. Biomechanical preparation was done upto master apical size #40 K-file. Irrigation was done with the respective irrigants. Post instrumentation sample (S2) was collected in the similar manner as S1. Microbiological samples (S1, S2) were preincubated for 30 minutes and plated on Brain heart infusion agar. Colonies were counted after 24 hours using classic bacterial counting method. Normality of data was checked using Shapiro wilk testand intra/intergroup comparison was done using Anova&amp; Post hoc Tukey test RESULTS: The mean bacterial counts of Group- II were found to be lower than that of Group- III &amp; Group- I. However, the difference was not statistically significant when compared to Group- I but the difference was statistically significant with Group- III. CONCLUSION: It can be concluded that herbal products have shown significant antimicrobial activity in comparison to 2.5 % Sodium hypochlorite in primary endodontic infections in patients and can be recommended for use in clinical situations. KEYWORDS: Chitosan, Herbal irrigants, Irrigants, Propolis, Sodium Hypochlorite

RANDOMIZED CLINICAL TRIAL OF ANTIMICROBIAL EFFICACY OF TWO HERBAL PRODUCTS AS ROOT CANAL IRRIGANTS IN PRIMARY ENDODONTIC INFECTIONS.

AIM: To evaluate &amp; compare antimicrobial efficacy of two herbal products as root canal irrigants in primary endodontic infections. MATERIALS&amp;METHOD: 78 patients were selected, out of which only 66 patients met the inclusion criteria &amp; were furtherrandomly divided into 3 groups (n=22 each), Group-1: 2.5% Sodium Hypochlorite, Group – 2: Chitosan, Group – 3 : Propolis. Access cavity was prepared &amp; working length was determined radiographically. A sterile paper point was inserted into the canal for 60 sec. Three samples were taken for each tooth. Biomechanical preparation was done upto master apical size #40 K-file. Irrigation was done with the respective irrigants. Post instrumentation sample (S2) was collected in the similar manner as S1. Microbiological samples (S1, S2) were preincubated for 30 minutes and plated on Brain heart infusion agar. Colonies were counted after 24 hours using classic bacterial counting method. Normality of data was checked using Shapiro wilk testand intra/intergroup comparison was done using Anova&amp; Post hoc Tukey test RESULTS: The mean bacterial counts of Group- II were found to be lower than that of Group- III &amp; Group- I. However, the difference was not statistically significant when compared to Group- I but the difference was statistically significant with Group- III. CONCLUSION: It can be concluded that herbal products have shown significant antimicrobial activity in comparison to 2.5 % Sodium hypochlorite in primary endodontic infections in patients and can be recommended for use in clinical situations. KEYWORDS:Chitosan, Herbal irrigants,Irrigants, Propolis, Sodium Hypochlorite

Fungal species in endodontic infections: A systematic review and meta-analysis.

Fungal infections are common on oral mucosae, but their role in other oral sites is ill defined. Over the last few decades, numerous studies have reported the presence of fungi, particularly Candida species in endodontic infections, albeit in relatively small numbers in comparison to its predominant anaerobic bacteriome. Here, we review the fungal biome of primary and secondary endodontic infections, with particular reference to the prevalence and behavior of Candida species. Meta-analysis of the available data from a total of 39 studies fitting the inclusion criteria, indicate the overall weighted mean prevalence (WMP) of fungal species in endodontic infections to be 9.11% (from a cumulative total of 2003 samples), with 9.0% in primary (n = 1341), and 9.3% in secondary infections (n = 662). Nevertheless, WMP for fungi in primary and secondary infections which were 6.3% and 7.5% for culture-based studies, increased to 12.5% and 16.0% in molecular studies, respectively. The most prevalent fungal species was Candida spp. The high heterogeneity in the reported fungal prevalence suggests the need for standardized sampling, and speciation methods. The advent of the new molecular biological analytical platforms, such as the next generation sequencing (NGS), and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF), that enables identification and quantitation of a broad spectrum of hitherto unknown organisms in endodontic infections should radically alter our understanding of the endodontic mycobiome in the future. Candida spp. appear to be co-pathogens with bacteria in approximately one in ten patients with endodontic infections. Hence, clinicians should comprehend the importance and the role of fungi in endodontic infections and be cognizant of the need to eradicate both bacteria and fungi for successful therapy.

Antimicrobial efficacy of triple antibiotic paste in teeth with primary endodontic infection: A systematic review

Objectives: This systematic review aims to assess the antimicrobial efficacy of triple antibiotic paste (TAP) as an intracanal medicament for root canal treatment of permanent or primary teeth with primary endodontic infection, as compared to other intracanal medicaments. Material and Methods: Three electronic databases, namely PubMed, CENTRAL, and Google Scholar, were searched for articles published in the English language till December 2019. Two hundred eighty-three studies were obtained for screening from an electronic database and one from the reference list of an article. After screening 234 records by title and abstract, 226 were excluded, and eight were selected for full-text eligibility assessment. Finally four studies were included in the systematic review. Results: Due to variations in the methods of outcome measurement and its evaluation at different time points, it was impossible to present the results as a meta-analysis. Thus, a narrative synthesis was performed for TAP compared to comparators used. The overall quality of included studies suggested a moderate risk of bias. Three comparators were reported in the included studies: Calcium hydroxide (CH) with 2% chlorhexidine (CHX), CH alone, and Ocimum sanctum. The antimicrobial efficacy of TAP was significantly better than plain CH and O. sanctum, whereas results did not differ significantly between TAP and CH plus 2% CHX. Conclusion: There is a lack of sufficiently high-quality clinical studies regarding the use of TAP. More clinical trials are recommended comparing the antimicrobial efficacy of TAP and other intracanal medicaments under standard protocols to establish a strong clinical evidence.

Influence of Bacterial Profiles in Cytokine and Clinical Features of Endodontic Disease

IntroductionWe verified the association between selected bacterial profiles and levels of cytokines, chemokines, and the expression of signs and symptoms of primary endodontic infection with apical periodontitis. MethodsSamples were collected from 21 root canals, and macrophages were stimulated for 24 hours. Tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, IL-10, IL-12p70, interferon gamma, and chemokine (C-C motif) ligand 2 (CCL2) were measured using cytometric bead array. We investigated the overlapping networks between cytokines and chemokines with regression analysis. Checkerboard DNA-DNA hybridization was used to assess 40 target bacteria species. Using factor analysis, bacterial species aggregated in 2 factors. The association of bacteria species–based factors on cytokine and chemokine levels and clinical features was estimated with regression analysis. ResultsA negative relationship between IL-10 (anti-inflammatory cytokine) and CCL2, TNF-α, and IFN-γ (proinflammatory cytokines) (all P < .05) was observed. CCL2 was positively correlated with TNF-α (P < .01). Thirty-eight bacteria species were detected in primary endodontic infection with apical periodontitis. The first bacteria species–based factor was associated with the size of the radiolucent area (coefficient = 15.42) and tenderness to percussion/pain on palpation (coefficient = 20.79). The second factor was associated with CCL2 levels (coefficient = 1.28). ConclusionsDifferent bacterial profiles can be differentially related to the expression of inflammatory proteins and the experience of clinical features.

Identification of Fusobacterium nucleatum in primary and secondary endodontic infections and its association with clinical features by using two different methods.

Fusobacterium nucleatum is an important oral pathogen involved in endodontic infections. This study aimed to assess the frequency of Fusobacterium nucleatum in primary and secondary endodontic infections and its associations with the clinical features in a Brazilian population by using both culture and nested PCR methods. A total of 100 microbial samples from patients with primary (n=50) and secondary endodontic infections (n=50) were analyzed by using culture and nested PCR methods. Strict anaerobic techniques were used for culture and identification of F. nucleatum. The DNA extracted from the samples was analyzed for the presence of target species by using species-specific primers. Culture and nested PCR methods detected F. nucleatum, respectively, in 11/100 and 82/100 root canals. F. nucleatum was isolated by culture from 10/50 (20%) root canals with primary infections and from 1/50 (2%) root canal with secondary/persistent infections. Nested PCR detected F. nucleatum in 42/50 (84%) root canals with primary infections and in 40/50 (80%) root canals with secondary/persistent endodontic infections. F. nucleatum was associated with spontaneous pain, tenderness to percussion, pain on palpation, swelling, tooth mobility, wet root canals, hemorrhagic exudate, tooth decay, inadequate restoration, and poor endodontic filling. F. nucleatum was found in more cases of primary endodontic infections than in cases of secondary/persistent ones. A higher prevalence of F. nucleatum was detected by using the nested PCR method than by using culture. The presence of F. nucleatum in the root canals was associated with several clinical features. The high prevalence of F. nucleatum in the root canals detected by molecular methods, and its association with several clinical features reveals the importance of these species in the development of apical pathologies and reinforces the need of an endodontic treatment directed to bacterial elimination.

English

BACKGROUND The key to a successful endodontic treatment is to ensure complete eradication of the infection present and to prevent reinfection. This depends on meticulous disinfection using intracanal irrigants. In dentistry the most commonly used irrigant is sodium hypochlorite which has the disadvantages of cytotoxicity and unpleasant taste. The extracts of neem have been used since ages for their medicinal values and used widely for health care. However, the potential use of such an agent for the success of endodontic procedures has not yet been investigated. Hence, if proved effective, such a natural agent will have a dominant hold against the chemical disinfectants in terms of biocompatibility and tissue response. This study aimed to evaluate the effectiveness of Q-MIX (2 in 1), 10 % neem (Azadirachta indica), and 2 % sodium hypochlorite on the growth and culture of Enterococcus faecalis and Mutant Streptococcus over a period of 4 weeks. METHODS This is a descriptive study conducted among samples collected from 30 healthy patients who were indicated for pulpectomy. The sample size was taken for convenience. Incisors of these individuals were selected on the basis that they had to undergo endodontic treatment due to primary endodontic infection. The zones of inhibition were measured by agar well diffusion method. Statistical analysis was done using independent T test &amp; chi-square test. RESULTS Statistical analysis showed that the mean zones of inhibition in this study were 20.54 mm, 9.65 mm and 4.54 mm for Q-MIX (2 in 1), 10 % neem and 2 % sodium hypochlorite. The significance was greater between Q-MIX (2 in 1) and the other two agents as the P-value was &lt; 0.001. CONCLUSIONS The result indicated Q-MIX (2 in 1) is a more effective root canal irrigant when compared to 10 % neem and 2 % sodium hypochlorite. KEY WORDS Q-MIX (2 in 1), Azadirachta indica, Apical Periodontitis, Enterococcus faecalis

Teeth with Apical Periodontitis Obturated in the Presence or Absence of Cultivable Micro-Organisms: A Two-Year Prospective Study of Treatment Outcomes

Objective: This prospective study aims to evaluate the one-year and two-year outcomes of root canals with apical periodontitis obturated in the presence or absence of cultivable micro-organisms, and define the influence on endodontic treatment outcome from different independent variables. Methods: 87 patients with 45 exposed and 43 unexposed canals who previously participated in a microbiological study of primary endodontic infections were invited back for review in 12 and 24 months after endodontic treatment. The review involves clinical examination, questionnaire interview and radiographic assessment in order to determine the treatment outcomes. The influence of independent variables, such as gender, age, tooth location, etc., on the treatment outcome, has also been analysed. Results: A total of 85 teeth of 84 patients were reviewed one and two years after obturation. Chisquare test for trend showed that the one-year radiographic healing of apical lesions was significantly different between culture-positive and negative canals (P&lt;0.05). However, there is no significant difference in the two-year radiographic healing between the two groups of canals (P&gt;0.05). None of the independent variables was found to be significant in affecting the endodontic treatment outcome on logistic regression analysis. Conclusions: The presence of positive culture prior to obturation seemed to affect the healing of periapical tissues in a one-year review, but the effect appeared to be temporal and not affected the long-term outcome.

Is there bacterial infection in the intact crowns of teeth with pulp necrosis of sickle cell anaemia patients? A case series study nested in a cohort.

To evaluate the presence of bacteria in permanent teeth with intact crowns (without caries, periodontal disease or dental trauma) in patients with sickle cell anaemia (HbSS genotype) by analysing their clinical, imaging and microbiological parameters. This is a case series study nested in a cohort. In the first follow-up of this cohort study (Journal of Endodontics, 2013, 39, 177), 10 HbSS patients with at least one tooth with an intact crown and clinically diagnosed with pulp necrosis by pulse oximetry adapted for dentistry and a cold pulp sensitivity test (n=27 teeth) were selected. Changes in the pulp chamber, root and periodontal ligament were identified in the tomographic analysis. Bacterial culture, staining for live and dead bacteria, and real-time polymerase chain reaction with 16S rRNA primers were used to identify the presence of bacteria. Culture sample collection was performed immediately after access to the pulp chamber. The microbiome was analysed with a MiSeq sequencer (Illumina, San Diego, CA). The diagnosis of pulp necrosis was confirmed clinically in 82% (22/27) of the teeth. The amount of bacterial load identified was less than 100copiesμL-1 in 23% (5/22) of the teeth with intact crowns and pulp necrosis. Thirteen bacterial species were identified that are commonly found in urinary tract infections, septicaemia and infective endocarditis. Only one of these species, Granulicatella adjacens, has also be found in primary endodontic infections. Prospective clinical, imaging and microbiological analyses suggest that pulp necrosis of teeth with intact crowns in HbSS patients is not associated with the presence of bacteria.

New Bacterial Combinations in Secondary Endodontic Infections of Patients with a Recent Systematic Antibiotic Therapy.

To date, the microbiota associated with persistent endodontic infections has only been analyzed in patients who did not receive any antibiotic therapy for at least 3 months before endodontic treatment. In this clinical study, secondary endodontic infections of patients who recently received systematic antibiotic therapy before endodontic treatment were analyzed and compared with the actual data available in the literature. Root canal-filled teeth with periradicular lesions of 20 patients who were under systematic antibiotic therapy which ended 1-21 days before the endodontic treatment were studied. A wide range of antibiotics was administered, including amoxicillin, amoclav, amoxicillin/metronidazole, ampiclox (ampicillin and cloxacillin), doxycycline, tetracycline, ciprofloxacin, and azithromycin. Microorganisms were isolated according to standard protocols and identified using MALDI-TOF-MS. A narrative review of the literature was conducted to compare the results of this study with the data reported so far. The presence and concentrations of bacteria isolated from the infected root canals were comparable with those depicted in the literature, although the total colony-forming units number in saliva was rather low. The number of different bacterial species isolated and identified in each patient as well as the diversity over all patients did not show signs of any influence of the administered antibiotics. Weissella hellenica and Cellulomonas spp. were detected in root canals for the first time. Granulicatella adiacens and Dietzia spp., previously isolated from primary endodontic infections, were detected for the first time in persistent root canal infections in this patient group. The bacterial diversity reported to date in secondary endodontic infections should be extended with the new microbial composition revealed in endodontic patients who had recently received systematic antibiotic therapy.

Detection of Streptococcus mutans in symptomatic and asymptomatic infected root canals.

To investigate the presence of Streptococcus mutans in root canals of symptomatic necrotic teeth (SNT) and their associated acute apical abscesses (AAA) and in the root canals of asymptomatic necrotic teeth (ANT). It also aimed to investigate the presence of the cnm and cbm genes in specimens that harbored S. mutans. DNA was extracted from samples collected from 10 patients presenting pulpal necrosis associated with radiographic evidence of apical periodontitis (ANT) and from 10 patients in need of endodontic therapy due to the presence of pulpal necrosis (SNT) and AAA. The control group consisted of 10 patients with teeth with normal vital pulp and requiring endodontic treatment for prosthetic reasons. The presence of S. mutans was detected by quantitative real-time-PCR (qPCR) using species-specific primers. Samples harboring S. mutans were further evaluated for the presence of CBP genes by qPCR as well. All studied sites showed a high prevalence of S. mutans, except the control group. Specifically, 60% of ANT and 70% of AAA/SNT paired samples were positive for S. mutans. The cnm gene was detected positive for S. mutans only in ANT samples (66.6%). The cbm gene was not detected in any of the investigated sites. S. mutans was found in high prevalence in both asymptomatic and symptomatic endodontic infections, including in abscesses, but it was not detected in the root canals of teeth with normal vital pulp. Interestingly, cnm+ S. mutans was only detected in asymptomatic/chronic primary endodontic infections associated with apical lesion. Therefore, it appears that cnm, and possibly other CBPs, may play an underestimated role in chronic endodontic infections. A high prevalence of Streptococcus mutans cnm+ gene was detected only in asymptomatic primary endodontic infections associated with apical lesion. Therefore, it appears that this collagen-binding protein gene plays an underestimated role in asymptomatic/chronic endodontic infections.

Antibacterial Activity of a New Ready-To-Use Calcium Silicate-Based Sealer.

The aim of this study was to evaluate the antibacterial potential of a calcium silicate-based sealer (Bio-C Sealer, Angelus) against common bacteria in primary and secondary endodontic infections. Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus mutans were exposed to fresh Bio-C Sealer for 24 h by the agar diffusion method (n=5). Additionally, the antibacterial activity was investigated against E. faecalis and S. mutans biofilms (48 h old) grown in discs with 4 mm in diameter and 2 mm in height. (n=3) of set discs of Bio-C Sealer (Angelus), EndoFill (Dentsply-Mallefer), Sealer 26 (Dentsply), AH Plus (Dentsply), Sealapex (Sybron-Endo) and EndoSequence BC Sealer (Brasseler). The antibacterial activity was evaluated by colony forming unity (CFU) counting using ImageJ software. Data were compared by one-way ANOVA followed by Holm-Sidak test (a=5%). Fresh Bio-C Sealer exhibited antimicrobial activity against all bacteria evaluated by agar diffusion method, except for S. mutans. Set discs of all endodontic sealers tested showed similar CFU values for E. faecalis (p>0.05). S. mutans in biofilms showed higher susceptibility to EndoFill compared with the other sealers (p<0.05). In conclusion, the results indicate that fresh Bio-C Sealer does not inhibit S. mutans growth, but exhibits antibacterial activity against E. faecalis, S. aureus, P. aeruginosa and E. coli. After setting, the Bio-C Sealer exhibits an antimicrobial potential comparable to that of the other sealers evaluated in E. faecalis biofilm, but lower than that of EndoFill for S. mutans biofilm.

Clinical influence of calcium hydroxide and N-acetylcysteine on the levels of resolvins E1 and D2 in apical periodontitis.

To investigate the presence of resolvins E1 (RvE1) and D2 (RvD2) in teeth with primary endodontic infections and apical periodontitis, and to assess the influence of calcium hydroxide medication [Ca(OH)2 ], in association with 2% chlorhexidine gel (2% CHX gel), and N-acetylcysteine (NAC) on the levels of RvE1 and RvD2 in periapical tissues. Thirty-six single-rooted teeth with primary endodontic infections and apical periodontitis were selected and randomly divided into three groups according to the medication: [Ca(OH)2 ]+saline solution (SSL) [Ca(OH)2 +SSL group] (n=12), Ca(OH)2 +2% chlorhexidine gel [Ca(OH)2 +2% CHX gel group] (n=12) and NAC [NAC group] (n=12). Samples were collected from the periapical interstitial fluid at two different sampling times: before (S1) and after 14days of intracanal medications (S2). Resolvins were measured using the enzyme-linked immunosorbent assay. Data were analysed using paired t-test, Wilcoxon test and Kruskal-Wallis test, followed by Dunn's post hoc test; all statistical tests were performed at a significance level of 5%. RvE1 and RvD2 were detected in 100% of the samples (36/36) at S1 and S2. Ca(OH)2 medication did not increase the levels of RvE1 or RvD2 (both P>0.05); however, NAC significantly increased the levels of RvE1 and RvD2 after 14days of treatment (P<0.05). RvE1 and RvD2 were detected in periapical tissues from teeth with root canal infections. Moreover, calcium hydroxide medication did not increase the levels of resolvins in apical periodontitis. In contrast, the use of NAC intracanal medication significantly increased the levels of RvE1 and RvD2 after 14days of treatment.

Comparative Evaluation of Antibacterial Efficacy of Three Intracanal Medicaments in Primary Endodontic Infections: A Randomized Clinical Trial

Comparative Evaluation of Antibacterial Efficacy of Three Intracanal Medicaments in Primary Endodontic Infections: A Randomized Clinical Trial

Analysis of Active Bacteria Persisting after Chemomechanical Procedures: An RNA- and DNA-based Molecular Study

IntroductionBecause active cells present higher abundance of ribosomal RNA (rRNA) than rDNA (rRNA genes), data obtained with rDNA-based quantitative polymerase chain reaction (qPCR) and rRNA-based qPCR (RT-qPCR) were correlated to search for active bacteria after chemomechanical procedures (CMP). In addition, the ability of both assays to detect bacteria in endodontic samples was evaluated. MethodsSamples were taken from 40 teeth with primary endodontic infections before (S1) and after CMP (S2). DNA and cDNA (synthetized from RNA) were used as templates for qPCR using universal primers for bacteria and species-specific primers for Bacteroidaceae sp. HOT-272, Cutibacterium acnes, Selenomonas spp., and Enterococcus faecalis. ResultsAfter CMP, there was a drastic reduction in the number of total bacteria, Selenomonas spp., and E. faecalis, whereas no significant difference was observed for the levels of Bacteroidaceae sp. HOT-272 and C. acnes. The concentration of rRNA copies in S2 samples was significantly higher than the corresponding levels of rDNA for assays targeting total bacteria, Bacteroidaceae sp. HOT-272, and C. acnes (P < .05), indicating persistence of active bacteria. The rDNA-based qPCR presented low sensitivity and high specificity when compared with RT-qPCR. For most assays, samples positive for rDNA were also positive for rRNA (positive predictive value = 100%). ConclusionsCMP was effective in reducing levels but not the metabolic activity of total bacteria. Bacteroidaceae sp. HOT-272 and C. acnes were active members of the persistent community. Although less sensitive than RT-qPCR, most rDNA-based qPCR assays had a low risk of providing false-positive results in postinstrumentation samples.

Microbial Association with Genus Actinomyces in Primary and Secondary Endodontic Lesions, Review.

The main reason for root canal treatment failure is the persistence of microorganisms after therapy, or the recontamination of the root canal system due to an inadequate seal. In the mouth, Actinomyces spp. constitute a significant part of the normal flora, which is indicative of their ability to adhere to oral tissue and resist cleansing mechanisms, such as salivary flow. This review, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), aims to clarify the prevalence of microbial genera that are associated with the genus Actinomyces in primary and secondary endodontic infections (primary outcome), and to identify the most prevalent species of the Actinomyces genus in endodontic lesions (secondary outcome). A total of 11 studies were included in the qualitative and quantitative analysis, and a total of 331 samples were analyzed. Bacteria of the genus Actinomyces were found in 58 samples, and 46 bacterial genera were detected in association with bacteria of the genus Actinomyces. Bacteria of the genus Streptococcus and Propionibacterium were those most frequently associated with Actinomyces in the endodontic lesions considered, and Actinomyces israelii was the most frequently involved species.