Secondary Root Canal Research Articles

Antibacterial Activity of Ethanol Extract of Aceh Patchouli Leaves (Pogostemon cablin Benth.) against Enterococcus faecalis: A Potential Alternative for Root Canal Infections

The persistence of bacterial infections and antibiotic resistance in secondary root canal infections necessitate effective antimicrobial approaches utilizing natural compounds. This study aimed to evaluate the extraction efficiency, phytochemical composition, and antibacterial activity of the ethanol extract of Aceh patchouli leaves (Pogostemon cablin Benth.) against Enterococcus faecalis. The maceration method was employed for extraction and phytochemical analysis was conducted using gas chromatography-mass spectrometry (GC-MS). Antibacterial activity was assessed using the Kirby-Bauer method, and the minimum inhibitory concentration (MIC) was determined using UV-vis spectrophotometry. The results indicated a total extract yield of 17.25 % and significant antibacterial activity against E. faecalis. The active compounds in the extract were primarily sesquiterpenes and fatty acids, with patchouli alcohol as the most prominent. The MIC value was 12.5 %, suggesting the potential of Aceh patchouli extract as an alternative or adjunctive treatment for root canal infections. This study has the potential to make Aceh's indigenous Pogostemon cablin Benth. plant as an alternative or adjunctive treatment for root canal infections leading to safe and effective treatments that minimize the risk of antibiotic resistance. HIGHLIGHTS The ethanol extract of Aceh patchouli leaves (Pogostemon cablin Benth.) was obtained using the maceration method, yielding a total extract value of 17.25 %. The active compounds of the extract were primarily sesquiterpenes and fatty acids, with patchouli alcohol being the most prominent. The ethanol extract exhibited significant antibacterial activity against Enterococcus faecalis, a common bacterium responsible for secondary root canal infections. The MIC of the extract was 12.5 %, indicating its potential effectiveness as an antimicrobial agent. This study suggests that the Aceh patchouli leaves could serve as an alternative or adjunctive treatment for root canal infections, addressing the challenges of bacterial persistence and antibiotic resistance. GRAPHICAL ABSTRACT

Navigating endodontic outcomes through cone-beam computed tomography: A narrative review

Abstract Periapical radiographs (PRs) have been the most reliable modality for assessing periapical health. Later, the evolution of cone-beam computed tomography (CBCT) revolutionized three-dimensional maxillofacial skeletal imaging. CBCT imaging has emerged as a superior diagnostic tool compared to PR. The aim of this narrative review was to provide a comprehensive overview of the outcomes related to the use of CBCT in evaluating various endodontic treatments, including primary root canal treatments, secondary treatments, endodontic microsurgeries, and vital pulp therapies and the associated prognostic factors. The research selection process involved systematically searching PubMed, Scopus, and Web of Science for literature on CBCT and endodontics. Criteria included English-language; peer-reviewed articles published from January 2010 to December 2023, reporting 1-year outcomes of various endodontic treatments using CBCT. Two independent reviewers screened titles, abstracts, and full texts. A total of 18 outcome study articles utilizing CBCT to evaluate primary root canal treatment were selected, as well as 7 for secondary root canal retreatment, 3 for vital pulp therapy, and 11 articles pertaining to endodontic microsurgery. The outcomes revealed varying success rates and prognostic factors. Consistent with outcome research employing PRs, studies that utilized CBCT also exhibited substantial variability in factors affecting initial and secondary treatment outcomes. The rate of favorable outcomes was significantly lower when assessed with CBCT compared to PR. The results from utilizing CBCT for primary and secondary root canal treatments, endodontic microsurgeries, and vital pulp therapies demonstrate diverse success rates and prognostic factors in comparison to outcomes based solely on PRs.

Characteristics of Enterococcus Faecalis in Periodontitis and Secondary Root Canal Infections in Northern Jordanians-A Pilot Study

Background: Enterococcus faecalis has been found to be related to periodontitis and secondary endodontic infections. In this study, we aimed to study samples of E. faecalis to determine their incidence and virulence in Jordanian patients. Methods: A total of 167 samples were collected from patients with periodontitis and secondary endodontic infections. The Kirby-Bauer method was used to determine the antimicrobial susceptibility. Biofilm formation was studied using the microtiter plate assay and congo red agar assay. Polymerase chain reaction (PCR) was used to detect the presence of E. faecalis virulence genes, namely; asa1, gelE, cylA, esp, hyl, efaA, and ace. Gelatinase and cytolysin activity were also tested using phenotypic methods. Results: Twenty-three (13.8%) samples were positive for E. faecalis. The highest resistance rates were observed against ampicillin (87%), followed by penicillin (82.6%), and erythromycin (60.9%). The highest susceptibility was for levofloxacin (100%), followed by gentamycin and chloramphenicol, each with 95.7%. Most isolates were able to produce biofilm (78.3%). Gelatinase and cytolysin activity were detected in 21.7% and 56.5% of isolates, respectively. efaA was significantly associated with asa1 and gelE (P < 0.05), and esp was significantly associated with cylA, gelE, ace, efaA and asa1 ( P < 0.05). In addition, the gelE. gene was significantly associated with gelatinase production (P < 0.01). Conclusion: In conclusion, we have shown that E. faecalis is involved with periodontal disease and secondary root canal infection with several virulence genes detected. Clinical Relevance: Around 13% of the periodontitis and secondary root canal infection patients were positive for E. faecalis and isolates were resistant to commonly used antibiotics.

Factors associated with the outcome of root canal treatment-A cohort study conducted in a private practice.

To investigate the association of various pre-, intra- and post-operative factors on root canal treatment outcome. In this cohort study, primary or secondary root canal treatment of mature permanent teeth was performed by a single endodontist in a private practice over 13 years, and followed 1-4 years after treatment. Treatment details and clinical and radiographic data were collected. The proportion of successfully treated teeth and roots based on strict radiographic (periapical index (PAI) ≤2) and clinical criteria (absence of pain, swelling or sinus tract) was estimated. To evaluate joint associations of prognostic factors and treatment success probability, 44 pre, intra- and post-operative factors were investigated using bivariate associations, and a multiple logistic regression model was fitted using Generalized Estimating Equations. 1259 teeth (2445 roots, 3149 canals) were assessed with a recall rate of 91%. The proportion of successfully treated teeth was 79.9% [95% confidence interval 77.7-82.1]. Eleven prognostic factors were identified that significantly reduced the odds ratio (OR) for treatment success at tooth level. Six were preoperative: injury history (OR = 0.05[0.01-0.24]), root PAI (OR = 0.29[0.20-0.42], 0.21[0.13-0.34] and 0.22[0.12-0.42] for PAI = 3, 4 and 5, respectively, against PAI = 1), lesion diameter (OR = 0.30[0.21-0.43] and 0.24[0.16-0.37] for diameters of 1-5 mm and ≥6 mm, respectively, against no lesion), tooth type (OR = 0.51[0.27-0.97] and OR = 0.45[0.24-0.83] for premolars and molars, respectively, against incisors or canines), tenderness to periapical palpation (OR = 0.64[0.43-0.94]) and two canals per root (OR = 0.67[0.54-0.83]). Four factors were intraoperative: root filling of unsatisfactory quality (OR = 0.18[0.08-0.40]) or extending beyond or shorter than 2 mm from the apex (OR = 0.44[0.26-0.75] and 0.62[0.40-0.97] respectively), resin sealer (OR = 0.58[0.39-0.87] against bioceramic sealer) and single visit treatment (OR = 0.40[0.21-0.75] against multiple visits). One factor was post-operative: defective coronal restoration (OR = 0.35[0.21-0.56]). The following factors were associated with unsuccessful root canal treatment: (i) history of injury, apical periodontitis with increased severity (larger lesion, higher PAI, tenderness to periapical palpation), or complicated anatomic conditions (premolar or molar, two canals in a single root); (ii) technically suboptimal root filling (of unsatisfactory quality or not ending within 2 mm of radiographic apex) performed in a single-visit, or use of resin sealer instead of novel bioceramic sealer; (iii) suboptimal quality coronal restoration.

Comparison of antimicrobial efficacy of green tea extract and Triphala as root canal irrigants against Fusobacterium nucleatum using real-time polymerase chain reaction – An in vitro study

Aim: Fusobacterium nucleatum has gained attention in the endodontic literature as it is a predominant microorganism in primary, secondary, and persistent root canal infections. Current irrigants have lot of drawbacks and are unlikely to predictably achieve a bacteria-free root canal system, which can lead to these failures. Herbal alternatives are now gaining popularity in the field of endodontics, paving a new way in the disinfection of root canals. The aim of this study is to evaluate the antimicrobial efficacy of green tea extract and Triphala as root canal irrigants against F. nucleatum using real-time Polymerase chain reaction (PCR). Methods: Extracted teeth were taken and inoculated with F. nucleatum, which was grown in a Mueller–Hinton agar plate under anaerobic conditions. The samples were cleaned and shaped and irrigated with green tea extract, Triphala extract, and dimethyl sulfoxide, which were compared to the widely used irrigant, sodium hypochlorite. Cycle threshold value was used to calculate the efficacy of the irrigant against F. nucleatum after which the samples were subjected to reverse transcriptase PCR. The data were analyzed and the data between the group were compared using the one-way ANOVA followed by a post hoc Tukey’s test. Results: Triphala extract demonstrated high antimicrobial activity against F. nucleatum1. It revealed statistically significant differences between Triphala extract and sodium hypochlorite (NaOCL) (P = 0.001). Green tea extract also displayed antimicrobial activity. Both the Triphala and green tea extracts showed a significant difference (P < 0.001). Conclusion: Triphala extract showed better antibacterial efficacy when compared to 3% NaOCl and green tea extract against F. nucleatum.

133 - The use of Reciproc Blue for secondary root canal treatment: detection and analysis of remnants using X-rays, CBCT and the relationship with ESEM-EDX

133 - The use of Reciproc Blue for secondary root canal treatment: detection and analysis of remnants using X-rays, CBCT and the relationship with ESEM-EDX

Inhibiton of green okra fruit (Abelmochus esculentus) extract against Staphylococus aureus ATCC 6538 root canals of teeth

Staphylococcus aureus is bacteria identified in the root canal of infected teeth by 20%, resistant and isolated from secondary root canal treatment. NaOCl 2.5%has toxic properties and causes irritation when pushed into periapical tissue. Green okra fruit (GOF) extract has antibacterial secondary metabolite compound i.e.flavonoids, alkaloids, saponins, tannins and terpenoids. This research was carried out to determine inhibition of GOF extract against S.aureus. Inhibition test useddisc diffution method which consisted of 5 research groups, i.e. GOF with concentration of 1.563%, 3.125%, 6.25%, and 12.5%, and 2.5% NaOCl; the ave-rage diameter of the inhibition zone of the concentration of GOF extract were 0 mm, 0 mm, 14.51 mm, 17.95 mm, and 24.56 mm, respectively. It was concluded that GOF extract has inhibition against of S.aureus starting from concentration of 6.25%. Green okra fruit extract has inhibition close to NaOCl 2.5% against S.aureus at concentration of 12.5%.

Taxonomic abundance in primary and secondary root canal infections.

To evaluate the root canal microbiome composition in cases of primary and secondary apical periodontitis. Thirty-nine samples from patients with primary root canal infections obtained before root canal treatment, and 40 samples obtained during root-end resection procedures from previously filled cases with apical periodontitis were evaluated using 16S rRNA next-generation sequencing analysis (NGS). Demographic and clinical factors included age, sex, infection type, percussion sensitivity, and presence of pain. Differences in abundances of genera were evaluated using Kruskal-Wallis test. Alpha and beta diversity indices were calculated using mothur. The Shannon and Chao1 indices were used to measure alpha diversity. The Bray-Curtis dissimilarity was used to measure beta diversity. Differences in community composition were evaluated using analysis of similarity (ANOSIM) with Bonferroni correction for multiple comparisons. Significantly fewer operational taxonomic units values were observed from samples from secondary infections (p < .0001). While no significant differences were observed in the Chao 1 index between primary and secondary infections, the Shannon alpha diversity was significantly lower in secondary relative to primary infections (p=.008). Among samples, sex, age (adult vs. older adult), percussion sensitivity, and presence of pain all showed no significant effects on community composition via an analysis of similarity (ANOSIM). However, community composition was significantly different depending on whether the sample was from a primary or secondary infection (R=.051, p=.03). Nine microbial genera comprised the predominant taxa observed among samples (>3.3%) and included Parvimonas, Fusobacterium, Campylobacter, Arachnia, Eubacterium, Prevotella, Peptostreptococcus, Fretibacterirum, and Pseudoramibacter. Significantly greater relative abundances of Prevotella, Peptostreptococcus, Veillonella, Lactucaseibacillus, and Dialister were observed in primary infections. Primary endodontic infections are more diverse than secondary infections. The microbial composition is not associated with the clinical manifestations of apical periodontitis.

Reciprocating System for Secondary Root Canal Treatment of Oval Canals: CBCT, X-rays for Remnant Detection and Their Identification with ESEM and EDX

Aim of the study: to evaluate root filling remnants after secondary root canal treatments (SRCTs) of oval-shaped canals with X-rays and cone beam computed tomography (CBCT). The SRCTs were performed using reciprocating NiTi instruments. Methods: Single-rooted teeth (N = 64) were randomly treated with Reciproc Blue (RB) and filled with AH Plus/single cone (SC group) or AH Plus/Guttafusion (GF group). After seven days of storage in HBSS (Hanks balanced salt solution), Gates Glidden burs #2/3 and RB #25 and #40 were used for the SRCTs. The time to complete the procedure was measured. X-rays and CBCT were used to calculate, respectively, the area and the volume occupied by the remnants in the coronal, middle, and apical thirds of each canal. Environmental scanning electron microscopy (ESEM) and energy dispersive X-ray spectroscopy (EDX) were used for qualitative evaluation and morphology composition of the remnants in sectioned roots. A statistical analysis was performed using Sigma Plot (version 13, IBM, Armonk, NY, USA). The study was designed according to PRILE guidelines. Results: After the SRCTs, the middle thirds of the root canals showed the presence of remnants in both groups, as demonstrated by X-rays and CBCT. The GF group showed a statistically significant higher volume of remnants than the SC Group only in the middle third. The ESEM supported by the EDX revealed the remnant composition by the detection of trace elements of sealer and gutta-percha in all root canals. Conclusion: The study demonstrated that the middle third of root canals is a critical region where remnants were packed and spread in the buccal-lingual sides of canals. ESEM-EDX detected a fine layer of filling remnants in all root thirds, suggesting a larger canal contamination than the X-rays and CBCT examinations revealed.

In Vitro Evaluation of Five Newly Isolated Bacteriophages against E. faecalis Biofilm for Their Potential Use against Post-Treatment Apical Periodontitis.

State-of-the-art treatment of root canal infection includes the use of mechanical debridement and chemical agents. This disinfection method is limited, and microorganisms can remain in the canal system. Enterococcus faecalis appears with a high prevalence in secondary and persistent root canal infections and can be linked to endodontic treatment failure due to its various resistance mechanisms. Here, we evaluated the activity of newly isolated bacteriophages against clinical isolates of E. faecalis (including one vancomycin- and gentamicin-resistant strain) as a single treatment or in combination with gentamicin and vancomycin. For the resistant strain, daptomycin and fosfomycin were tested. Sixteen E. faecalis strains were used to screen for the presence of bacteriophages in sewage. Five different bacteriophages were characterized in terms of virion morphology, host range and killing-kinetics against each E. faecalis host strain. To investigate the antibiofilm effect of antibiotic and phages, E. faecalis biofilm was grown on porous glass beads and treated with different antibiotic concentrations and with isolated bacteriophages alone or in staggered combinations. A strong biofilm reduction was observed when phages were combined with antibiotic, where combinations with gentamicin showed a better outcome compared to vancomycin. Regarding the resistant strain, daptomycin had a superior antibiofilm effect than fosfomycin.

Residual Bacteriome after Chemomechanical Preparation of Root Canals in Primary and Secondary Infections

IntroductionSecondary infections may be linked to the presence of residual microorganisms within dental root canals. The purpose of this study was to investigate the bacterial composition of primary and secondary root canal infections before and after chemomechanical treatment. MethodsSamples were collected before chemomechanical preparation (S1) and before obturation (S2) from 19 subjects (10 primary and 9 secondary infections). DNA was extracted, and the V3/V4 region of the 16S ribosomal RNA gene was amplified using the 347 F/803R primers and paired-end sequenced using the MiSeq (Illumina, San Diego, CA) instrument. ResultsSequencing analysis yielded partial 16S ribosomal RNA gene sequences that were taxonomically classified into 10 phyla and 143 genera. The most prevalent phyla in the S1 and S2 samples were Firmicutes and Bacteroides; however, when comparing between sample groups, Proteobacteria seem to have been enriched in secondary infections. The dominant genera in the primary S1 samples were Bacillus, Streptococcus, and Prevotella, whereas Bacillus, Streptococcus, and Selenomonas dominated the secondary infection S1 samples. Bacillus and Marinilactibacillus were the most dominant genera in the primary and secondary S2 samples. The mean number of operational taxonomic units per sample was 32,656 (±12,124 SD) and 37,113 (±16,994 SD) in the S1 and S2 samples, respectively. Alpha and beta diversities presented the same pattern within samples from both groups. ConclusionsGreat interindividual variations in the bacterial composition of the root canal biofilms were observed. There was no difference in the bacterial composition before and after treatment, although some genera survived and seem to be part of a residual microbiome. Our findings revealed a high diversity of the bacterial communities present in root canal infections after chemomechanical treatment, although the majority of the taxa detected were in low abundance.

Influence of Periapical Lesion on Healing in Sinus after Endodontics

Abstract Objective The goal of primary and secondary endodontic treatment is to eliminate the cause of inflammation inside the tooth and in the surrounding tissues. When the inflammation from the root canal system of the tooth spreads beyond the apex of the root, periapical changes in the bone tissue and, in the case of upper premolars and molars, inflammatory changes in the Schneider membrane may occur. Materials and Methods In a retrospective documentation analysis of root canal treatments, three-dimensional (3D) computed tomography images before and after endodontic treatment were assessed to measure the thickness of the Schneider membrane. Forty-five endodontically treated patients aged 21 to 62 years were enrolled in the study. Inflammation of the maxillary sinus was considered when the Schneider membrane was thicker than 2 mm. Statistical analyses were performed with Statistica 12 by StatSoft and StatXact by Cytel using the Shapiro–Wilk test, Student's t-test, and the Mann–Whitney test. Results Out of 12 comparisons between variables, only 3 comparisons were significant. There was a relationship between the treatment effect (reduction in maxillary sinus inflammation 3 months after treatment) and the maximum height of the Schneider membrane (p = 0.004). There was a relationship between the presence of a periapical lesion and the minimum height of the Schneider diaphragm (p = 0.02), and there was a relationship between the presence of a periapical lesion and the maximum height of the Schneider diaphragm (p = 0.04). Conclusion Primary and secondary root canal treatments of maxillary premolars and molars reduce the inflammation of the maxillary sinus 3 months after treatment.

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 Trends of Endodontic and Prosthodontic Treatment by Postgraduate Students in University of Malaya

This study is aimed to provide an insight into the types of treatment carried out by postgraduate students in the past 10 years. A retrospective study was carried out between November 2019 and February 2020 by deriving data from postgraduate students’ clinical logbooks of three different cohorts of Master of Clinical Dentistry (Restorative Dentistry in Conservative Dentistry) in 2010, 2013 and 2016. This retrospective data was systematically extracted from the records and tabulated categorically using an Excel spreadsheet (Microsoft Office Excel 2019). A descriptive analysis was carried out to further evaluate the results. Overall, the types of treatment carried out in the field of endodontics and fixed prosthodontics has changed in the past 10 years. An increasing trend is seen in the placement of all ceramic crowns and primary root canal treatment procedures, while a decreasing pattern is evident for secondary root canal procedures and placement of dental bridges.

Bacteria and virulence factors in periapical lesions associated with teeth following primary and secondary root canal treatment.

This cross-sectional study aimed to investigate the microbial profile and to quantify the levels of endotoxins (LPS) and lipoteichoic acid (LTA) present in periapical lesions associated with root filled teeth and those that had received root canal retreatment. It also aimed to investigate the association between microorganisms and their virulence factors with clinical and radiographic features. Patients with periapical lesions in teeth with post-treatment endodontic disease following primary root canal treatment (n=19) and unsuccessful root canal retreatment (n=13) were treatment planned for endodontic microsurgery, where the periapical lesions were collected. Clinical and radiographic data were also collected. For microbiological analysis, nested polymerase chain reaction was used to detect 17 bacterial species. Levels of LPS and LTA were determined using limulus amebocyte lysate and enzyme-linked immunosorbent assays, respectively. The Student t-test or Wilcoxon-Mann-Whitney tests were applied to compare the data on LPS and LTA with clinical and radiographic features. The associations between the clinical and radiographic features and the bacterial species were analysed using the Fisher's exact test. A significance level of 5% was adopted. Bacterial DNA, LPS and LTA were detected in all samples. Parvimonas micra was the most commonly detected species in all groups, followed by Enterococcus faecalis, Fusobacterium nucleatum and Porphyromonas endodontalis. The type of endodontic treatment, whether a primary root canal treatment or retreatment, was not associated with the presence of any bacterial species in periapical lesions. The levels of LPS and LTA in periapical lesions of root filled teeth were not significantly different from those that had been retreated. Associations between the levels of LPS and LTA with clinical signs and symptoms were found. No association was found between specific bacteria and clinical features. Periapical lesions associated with teeth after primary root canal treatment and retreatment had similar polymicrobial composition. The levels of LPS and LTA in periapical lesions associated with teeth after primary root canal treatment and retreatment were similar, and both were associated with the same symptomatology.

Uji Daya Hambat Ekstrak Kulit Langsat (Lansium parasiticum) Terhadap Pertumbuhan Bakteri Enterococcus faecalis Secara In Vitro

Enterococcus faecalis is a bacteria that commonly found in secondary root canal infections. Enterococcus faecalis is a gram-positive, facultative anaerobic bacteria. Langsat (Lansium parasiticum) is a natural ingredient that contains secondary metabolites and has antibacterial ativity. The aim of this study was to examine the inhibition effect of langsat fruit peel extract (Lansium parasiticum) to the growth of Enterococcus faecalis. This was a laboratory experimental study with post-only control group design. Langsat fruit peel extract with 25%, 50%, 75%, and 100% concentration was using disc diffusion method on Mueller-Hinton Agar (MHA) and the inhibition zone was measured with a sliding caliper. The data were analyzed with Kruskal-Wallis test and Mann-Whithney test. The result of this study was langsat fruit peel extract with 25%, 50%, 75% concentration showed a inhibition zone, while at 100% showed no inhibition zone. The Kruskal-Wallis test showed that there are significant differences (p &lt;0.05) between all groups. The conclusion was langsat fruit peel extract (Lansium parasiticum) have weak inhibition effect of the growth of Enterococcus faecalis bacteria. The inhibition zone of concentrations 25% : 2,20 mm; 50%: 0,94 mm; 75%: 0,36 mm and 100% : 0,00 mm.

Uji Daya Hambat Ekstrak Kulit Langsat (Lansium parasiticum) Terhadap Pertumbuhan Bakteri Enterococcus faecalis Secara In Vitro

Enterococcus faecalis is a bacteria that commonly found in secondary root canal infections. Enterococcus faecalis is a gram-positive, facultative anaerobic bacteria. Langsat (Lansium parasiticum) is a natural ingredient that contains secondary metabolites and has antibacterial ativity. The aim of this study was to examine the inhibition effect of langsat fruit peel extract (Lansium parasiticum) to the growth of Enterococcus faecalis. This was a laboratory experimental study with post-only control group design. Langsat fruit peel extract with 25%, 50%, 75%, and 100% concentration was using disc diffusion method on Mueller-Hinton Agar (MHA) and the inhibition zone was measured with a sliding caliper. The data were analyzed with Kruskal-Wallis test and Mann-Whithney test. The result of this study was langsat fruit peel extract with 25%, 50%, 75% concentration showed a inhibition zone, while at 100% showed no inhibition zone. The Kruskal-Wallis test showed that there are significant differences (p &lt;0.05) between all groups. The conclusion was langsat fruit peel extract (Lansium parasiticum) have weak inhibition effect of the growth of Enterococcus faecalis bacteria. The inhibition zone of concentrations 25% : 2,20 mm; 50%: 0,94 mm; 75%: 0,36 mm and 100% : 0,00 mm.

A 12-month follow-up of primary and secondary root canal treatment in teeth obturated with a hydraulic sealer

ObjectivesThis randomized, controlled, pilot study assessed the outcome of non-surgical primary/secondary root canal treatments either with a novel bioactive sealer and the single-cone technique or with gutta-percha, zinc oxide-eugenol sealer (ZOE), and warm vertical compaction.Materials and methodsSixty-nine patients were randomly divided into two groups that were treated using the single-cone technique with BioRootTM RCS (Septodont) (BIO group) or warm vertical compaction with gutta-percha and ZOE sealer (PCS group). Two subsamples (BIOAP and PCSAP) comprised the cases with apical periodontitis. Treatment was undertaken by four residents using a standardized instrumentation and disinfection protocol. The periapical index (PAI) was recorded, and clinical and radiographic follow-up performed at 1, 3, 6, and 12 months. Treatment success was assessed according to “periapical healing” and “tooth survival”. The test for the equality of proportions, t tests for the equality of means, and non-parametric K-sample tests for the equality of medians were applied when appropriate.ResultsThe survival rate was similar in the BIO and PCS (p = 0.4074) and the BIOAP and PCSAP groups (p = 0.9114). The success rate was higher in the BIO groups, but not statistically significant (p = 0.0735). In both BIOAP and PCSAP groups, a progressive decrease in the PAI was observed.ConclusionAt 12 months, both techniques showed reliable results. Further studies and longer follow-ups are needed.Clinical relevanceThis study documents the feasibility of using a bioactive sealer in conjunction with the single-cone technique to obturate the root canal and obtaining a predictable outcome.Trial registrationClinicalTrials.gov Identifie: NCT04249206

Secondary Root Canal Treatment with Reciproc Blue and K-File: Radiographic and ESEM-EDX Analysis of Dentin and Root Canal Filling Remnants.

Secondary root canal treatment requires the complete removal of filling materials with different chemical-physical properties. A newly developed single-use NiTi instrument (Reciproc Blue, RB) may be more effective in root canal retreatment. The aim of the present study was to evaluate morphology and composition of remnants after retreatment with RB compared to traditional K-File technique, in canals obturated with Thermafil/AH Plus. Twenty-four single-rooted human teeth were shaped with NiTi obturated with AH-Plus/Thermafil and retreated using RB NiTi instruments or manual K-Files. Radiographs were taken to evaluate endodontic space and radiopacity of residual filling-material before/after procedures. After retreatment, samples were longitudinally split and observed by environmental scanning electron microscopy connected to energy dispersive X-Ray spectroscopy (ESEM-EDX) to analyze the debris/remnant position, microchemistry, and dentinal surface morphology. Time for retreatments was recorded and compared using one-way ANOVA (p-value = 0.05). Radiopaque filling residuals were found in both groups. RB system resulted statistically faster than manual K-File in retreatment procedure (p < 0.001). Root canal space radiographic appearance obtained after retreatment with RB was wider than K-File (p < 0.05). ESEM-EDX revealed 4 different morphological dentin area. Area-1: debris-free with typical Ca, P, and N composition of dentin and detected in 70% of the surface. Area-2: presence of deproteinized smear layer free from N and debris in 15% of the surface. Area-3: a thick packed smear layer N-free and with fine debris consisting of trace elements from sealer in 10% of the surface. Area-4: packed with debris and trace elements. No difference was observed between both instruments regarding root canal space appearance and ESEM-EDX analysis. Both systems were able to remove filling material but created a dentine morphology composed of packed debris and filling materials embedded into the smear layer. Dentin surface composition resulted in collagen depleted by irrigation procedures. The reciprocating system required less time to complete retreatment.

Healing of Apical Periodontitis in Patients with Inflammatory Bowel Diseases and under Anti–tumor Necrosis Factor Alpha Therapy

IntroductionWe evaluated healing after nonsurgical primary/secondary endodontic treatment of apical periodontitis (AP) in patients with inflammatory bowel diseases (IBDs) treated with anti–tumor necrosis factor alpha biologic medications (BMs). MethodsNineteen patients with 22 teeth affected by AP from the gastroenterology unit of the hospital with IBDs under treatment with BMs formed the study group (the IBD group). Fourteen patients with 22 teeth with AP, matched by age and sex, without systemic diseases and not taking medications formed the control group. Teeth underwent primary or secondary root canal treatments and clinical and radiographic follow-up every 3 months for 24 months. The periapical index score was recorded, and 2 trained and calibrated endodontists evaluated and compared radiographs (weighted kappa values, κ = 0.8). The Mann-Whitney, t, chi-square, Fisher, and Bruner-Langer tests and analysis of variance–type statistics were used as appropriate. ResultsThe recall rate was 100%. All teeth in the IBD patients and 81% in the control patients healed (P = .108). Initial healing was appreciable at 3 months in the IBD group and 6 months in the control group (P = .174). Overall healing was reached at 6 and 10.5 months in the IBD and control groups, respectively (P = .106). At any time of the experiment, teeth in the IBD patients showed a higher probability of healing (P < .05). Both groups exhibited a similar decrement of the periapical index (P = .291), more significant for the IBD at the 3-month follow-up (P < .05). The 2 BMs used showed a similar trend of healing (P = .628). ConclusionsThe treatment of AP in patients taking BMs had no complications; furthermore, it was associated with faster healing than the controls. These results support the possible therapeutic aid of BMs in treating AP.