Antimicrobial and cytotoxic effects of phosphoric acid solution compared to other root canal irrigants

Optimization of Growth Conditions of Streptomyces coelicoflavus Strain AUMC B- 535 in Rock Phosphate Beneficiation Process

Phosphorus is an essential mineral for all living things, particularly plants. While phosphorus is a limited and non-renewable resource, global reserves of phosphorus are abundant. There are phosphate mines in more than 40 countries around the world, producing high-grade phosphate rock (27-36% P2O5), but low-grade phosphate rock (less than 27% P2O5) is neglected as phosphate rock waste (PRW). So, microbiological improvement of RPW grades is our main area of interest. Therefore, in Vitro biotreatment of RPW using Streptomyces coelicoflavus strain AUMC B- 535 was the main focus of this study. To improve the microbiological upgrade of RPW, the growth conditions of strain AUMC B- 535, including temperature, initial pH, incubation time, carbon source type, and UV radiation exposure time, were assessed. The strain grew well after 7 days of cultivation in 1.0 kg L-1 of 14.9% P2O5 RPW using D-glucose as the carbon source. The optimal temperature was 35 °C and the pH was 7 ± 0.2. UV rays with a wavelength of 254 nm exposure for 3 h leads to its activity. Biotreated RPW was found to contain six distinct layers under optimal growth conditions, whereas the control had only four layers. Also, the P2O5% rate increased by 14.9% to 15.38%. Technologies that are clean, efficient and affordable are in high demand worldwide. Green mineral beneficiation methods can benefit from the technology based on Streptomyces for treating PRW, as it can enhance the P2O5% grade of PRW by modifying the growth conditions of Streptomyces.

Tissue-friendly dentin treatments as a potential element in revascularization protocol (ex-vivo study)

BACKGROUND

Endodontic treatment aims to eliminate pulp tissue, microorganisms, and toxins while creating an environment conducive to tissue revitalization and regeneration. Sodium hypochlorite, the gold-standard irrigant, is effective but has significant cytotoxic effects, prompting the need for safer alternatives. This study investigates the cytotoxicity, cell proliferation, adhesion to dentin, and osteogenic differentiation of cells exposed to Dual Rinse HEDP, curcumin, and sodium hypochlorite (2.5%) for 1, 5, and 15 min, focusing on their potential application in revitalization and regenerative endodontic protocols.

METHODOLOGY

Samples were assigned to groups based on the irrigant used: control, HEDP, curcumin, or sodium hypochlorite (2.5%) for exposure durations of 1, 5, and 15 min. Cytotoxicity was assessed using the MTT assay, with optical density measured at the specified times. Cell proliferation was evaluated via the Trypan blue exclusion test, with viable cells counted using a hemocytometer. Data were presented as mean and standard deviation (SD) values and statistical significance was set at p < 0.05 for all tests. Cell adherence to dentin discs was analyzed using scanning electron microscopy (SEM) after 5-min irrigant exposure. Osteogenic differentiation was assessed through alizarin red staining for calcium deposition and quantitative PCR analysis of BMP-2, TGF-β1, VEGF, and DSPP gene expression.

RESULTS

Cell cytotoxicity differed significantly across groups (p < 0.05), with HEDP showing the best results at 1 and 5 min. After 15 min, Group II had the highest value, followed by Group I. HEDP also recorded the highest cell proliferation, followed by curcumin. HEDP exhibited substantial calcium deposition and significantly upregulated BMP-2, TGF-β1, VEGF, and DSPP gene expression, surpassing other materials. Curcumin moderately promoted calcified nodule formation. Osteogenic media also induced significant gene upregulation.

CONCLUSIONS

Dual Rinse HEDP and curcumin are tissue-friendly. Dual rinse HEDP efficiently increases stem cell adherence to dentin discs and their osteogenic differentiation. So, this irrigant has the potential to be used in regeneration protocols.

Push-Out Bond Strength of Fiber-Reinforced Post Using Various Post Space Irrigation Treatments

Objective: This study aims to provide the impact of different endodontic irrigation treatments after post space preparation on the push-out bond strength of fiber posts to dentin using self-adhesive cements. Methods and Materials: A total of 180 extracted premolar teeth were selected. The canals were instrumented by and then were filled. After preparing the post space, teeth were divided into 12 groups according to irrigants (normal saline solution; 17% EDTA [ethylenediaminetetraacetic acid] + 5.25% NaOCl [sodium hypochlorite]; 17% EDTA; 5.25% NaOCl; and 1.2% chlorhexidine [CHX]) and irrigation technique (conventional syringe irrigation [CSI] and passive ultrasonic irrigation [PUI]). After cementation, the samples were sectioned to obtain 1-mm disks from coronal and apical parts, a push-out test was performed using a universal testing machine (Z050, Zwick/Roell, Ulm, Germany) at a speed of 1 mm/min. The data were analyzed using one-way analysis of variance (ANOVA) and Mann-Whitney U tests. Results: The push-out bond strength was higher in coronal segment in comparison to apical segment. The highest push-out bond strength value was related to NaOCl + EDTA using PUI (12.39 ± 1.08). There are significant differences when comparing NaOCl + EDTA group with EDTA group using CSI or PUI technique (p  < 0.05) except in coronal region with CSI technique. In both apical and coronal regions, phosphoric acid irrigation was found to be similar to normal saline solution and CHX groups regardless of activation technique. Conclusion: The push-out bond strength values were significantly affected by the irrigation protocol. Using PUI and 17% EDTA + 5.25% NaOCl in apical region could be an effective irrigant for smear layer removal after post space preparation.

[Repair of perirradicular tissues in non-surgical endodontic treatment. A review]

Introduction

Non-surgical endodontic treatment aims to prevent apical periodontitis, achieved with the disinfection of the root canal system. Additionally, there are pathologies where the toxic content of the canal goes to the periradicular tissues, causing osteolysis or lesions of the bone tissue that are radiographically observed as radiolucent images. When the endodontic treatment is successful, the repair of these lesions occurs over time.

Aim

To analyze the periradicular repair process of non-surgical endodontic treatment and the factors that affect it.

Materials and Methods

An electronic search was carried out using the search engines PUBMED, Scopus, Google Academic, and Scielo with the words "Non-Surgical Endodontic Treatment," "Periapical Tissues," "Biological Repair," "Apical Repair." Factors such as incomplete texts, PDF texts, and publication date of the article were considered, including data from the last five (05) years.

Results

The information reviewed comprised 236 articles analyzed with the inclusion and exclusion criteria, and only 42 articles met these criteria.

Conclusion

The success of endodontic treatment lies in the absence of clinical and radiographic signs and symptoms of infection; this is achieved with a good application of clinical protocols and procedures focused on the disinfection of the root canal system, from diagnosis, biomechanical preparation, and disinfection of the root canal system with irrigating substances and filling, including coronal rehabilitation from an aesthetic and/or prosthetic point of view.

Research methods assessing sodium hypochlorite cytotoxicity: A scoping review

Sodium hypochlorite (NaOCl) cytotoxicity has been assessed using different methodologies, which has led to arbitrary interpretations. This scoping review aimed to discuss the different methodological protocols for assessing NaOCl cytotoxicity. A literature review performed in the PubMed and Embase databases up to July 2023 identified manuscripts reporting NaOCl cytotoxicity. The dataset identified 546 publications, further screened by 2 reviewers. Ninety studies were identified and mined methodologically to collect information on cell type, cytotoxicity assay, NaOCl dilution solutions, presence of fetal bovine serum (FBS), and NaOCl exposure time. The culture medium used in cytotoxicity assays contains buffering substances that neutralize the pH of NaOCl, thus reducing its cytotoxicity, an approach that may lead to bias when solutions with different pH are compared. For short exposure periods, as in simulations to evaluate the contact between irrigant and periapical tissue cells during chemo-mechanical preparation, NaOCl dilution should be performed with saline, which does not buffer the irrigant. For long exposure periods, as in simulations of irrigant extrusions, NaOCl should be diluted in the culture medium, to reproduce the expected buffering effect occurring in extrusions. The presence of FBS in culture medium can decrease NaOCl toxicity. There is no standardization of NaOCl cytotoxicity methodologies. This poses the risk of arriving at incorrect results and, therefore, pertinent tests must be refined.

Antimicrobial effects of a borate-based bioactive glass wound matrix on wound-relevant pathogens

OBJECTIVE

The antimicrobial effects of a borate-based bioactive glass matrix (BBBGM) on clinically relevant microorganisms was investigated for up to seven days in vitro.

METHOD

A total of 19 wound-relevant pathogens were studied using the in vitro AATCC 100 test method.

RESULTS

The reduction of viable Gram-negative and Gram-positive bacteria and yeasts at days 4 and 7 post-culture on the BBBGM was significant (> 4log10) in most cases. Mould counts were reduced (<2log10) during the seven-day assessment, indicating that mould viability and reproduction was inhibited. The cell count of each organism was reduced at seven days indicating that the BBBGM not only reduced the viable cell count, but that the cell count did not recover during the seven-day period, indicating a sustained reduction in pathogenic activity.

CONCLUSION

Based on the present results, the use of a BBBGM as a pathogenic barrier should be considered as a tool for combating pathogenic colonisation and infection in acute and hard-to-heal (chronic) wounds.

Disinfectant effectiveness of chlorhexidine gel compared to sodium hypochlorite: a systematic review with meta-analysis

This study aimed to compare the disinfectant ability of chlorhexidine (CHX) gel and sodium hypochlorite (NaOCl). Systematic searches were conducted from inception until December 8th, 2022 (MEDLINE/PubMed, Cochrane Library, Web of Science, Scopus, Embase, and Grey Literature databases). Only randomized clinical trials were included. The revised Cochrane risk of bias tools for randomized trials were used to assess the quality of studies. Meta-analyses were performed. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool. Six studies were included. Five had a low risk of bias and 1 had some concerns. Three studies assessed bacterial reduction. Two were included in the meta-analysis for bacterial reduction (mean difference, 75.03 [confidence interval, CI, -271.15, 421.22], p = 0.67; I2 = 74%); and 3 in the meta-analysis for cultivable bacteria after chemomechanical preparation (odds ratio, 1.03 [CI, 0.20, 5.31], P = 0.98; I2 = 49%). Five studies assessed endotoxin reduction. Three were included in a meta-analysis (mean difference, 20.59 [CI, -36.41, 77.59], p = 0.48; I2 = 74%). There seems to be no difference in the disinfectant ability of CHX gel and NaOCl, but further research is necessary.

Inhibition of Acinetobacter baumannii Biofilm Formation Using Different Treatments of Silica Nanoparticles

There exists a multitude of pathogens that pose a threat to human and public healthcare, collectively referred to as ESKAPE pathogens. These pathogens are capable of producing biofilm, which proves to be quite resistant to elimination. Strains of A. baumannii, identified by the "A" in the acronym ESKAPE, exhibit significant resistance to amoxicillin in vivo due to their ability to form biofilm. This study aims to inhibit bacterial biofilm formation, evaluate novel silica nanoparticles' effectiveness in inhibiting biofilm, and compare their effectiveness. Amoxicillin was utilized as a positive control, with a concentration exceeding twice that when combined with silica NPs. Treatments included pure silica NPs, silica NPs modified with copper oxide (CuO.SiO2), sodium hydroxide (NaOH.SiO2), and phosphoric acid (H3PO4.SiO2). The characterization of NPs was conducted using scanning electron microscopy (SEM), while safety testing against normal fibroblast cells was employed by MTT assay. The microtiter plate biofilm formation assay was utilized to construct biofilm, with evaluations conducted using three broth media types: brain heart infusion (BHI) with 2% glucose and 2% sucrose, Loria broth (LB) with and without glucose and sucrose, and Dulbecco's modified eagle medium/nutrient (DMEN/M). Concentrations ranging from 1.0 mg/mL to 0.06 µg/mL were tested using a microdilution assay. Results from SEM showed that pure silica NPs were mesoporous, but in the amorphous shape of the CuO and NaOH treatments, these pores were disrupted, while H3PO4 was composed of sheets. Silica NPs were able to target Acinetobacter biofilms without harming normal cells, with viability rates ranging from 61-73%. The best biofilm formation was achieved using a BHI medium with sugar supplementation, with an absorbance value of 0.35. Biofilms treated with 5.0 mg/mL of amoxicillin as a positive control alongside 1.0 mg/mL of each of the four silica treatments in isolation, resulting in the inhibition of absorbance values of 0.04, 0.13, 0.07, 0.09, and 0.08, for SiO2, CuO.SiO2, NaOH.SiO2 and H3PO4.SiO2, respectively. When amoxicillin was combined, inhibition increased from 0.3 to 0.04; NaOH with amoxicillin resulted in the lowest minimum biofilm inhibitory concentration (MBIC), 0.25 µg/mL, compared to all treatments and amoxicillin, whereas pure silica and composite had the highest MBIC, even when combined with amoxicillin, compared to all treatments, but performed better than that of the amoxicillin alone which gave the MBIC at 625 µg/mL. The absorbance values of MBIC of each treatment showed no significant differences in relation to amoxicillin absorbance value and relation to each other. Our study showed that smaller amoxicillin doses combined with the novel silica nanoparticles may reduce toxic side effects and inhibit biofilm formation, making them viable alternatives to high-concentration dosages. Further investigation is needed to evaluate in vivo activity.

Dual effectiveness of a novel all-in-one endodontic irrigating solution in antibiofilm activity and smear layer removal

The continuous destruction of dental hard tissues increases the risk of bacterial invasion, which leads to pulp infections. Irrigation is critical for successful root canal treatment in terms of infection control. However, no single irrigant covers all of the functions demanded, including antibiofilm and tissue-dissolving activities. The aim of this study was to investigate the antimicrobial properties of Triton, an all-in-one irrigant, on Enterococcus faecalis and multispecies oral biofilms in dentin canals, as well as its ability to remove the smear layer. Dentin blocks (192 specimens) were prepared from single-root human teeth and then assigned to 48 groups (24 groups for each biofilm type). Serial centrifugation was used for bacterial introduction into dentinal tubules. After 3 weeks, half of the specimens were created a uniform smear layer. The following treatments were applied: short time (separate): Triton, 6% NaOCl, 2% NaOCl, and water (all for 3 min); short time (combined): Triton (3 + 1 min), 6% NaOCl +17% EDTA (3 + 1 or 2 + 1 min), and 2% NaOCl +17% EDTA (3 + 1 min); and long time: Triton (3 + 3 min), 6% NaOCl (5 min), 6% NaOCl +17% EDTA (5 + 1 min), and water (3 + 3 min). Confocal laser scanning microscopy and scanning electron microscopy were employed to examine the antimicrobial activity and smear layer removal, respectively. The results revealed that despite the absence or presence of the smear layer, Triton (3 + 3 min) showed the highest killing for both tested biofilms (61.53%-72.22%) among all groups (p < 0.05). Furthermore, the smear layer was removed by Triton after 3 + 3 min, exposing open dentin canals. These findings demonstrated that Triton can provide dual benefits of antibiofilm and smear layer removal capabilities simultaneously, indicating a simplified and effective strategy for application in root canal treatment.

Irrigants and irrigation activation systems in Endodontics

Root canal infections are typically polymicrobial and involve strong bacterial interactions. The goal of endodontic treatment is to remove infected content from the root canal system to allow the healing of a pre-existing periapical lesion or to prevent infection of the periradicular tissues. Instrumentation alone is not capable of touching all of the root canal walls. Therefore, the irrigation process is an essential step in the endodontic treatment. However, due to the complex anatomy of the root canal system, this cleaning is very challenging. Although syringe and needle irrigation associated with the use of chemical substances is still the most used method, it does not guarantee optimal cleaning of the root canals. As a result, not only alternative irrigating substances but also numerous activation systems - which are technologies that aim to optimize the action of irrigating substances, both chemically and physically - have been developed. This work aimed to review the characteristics of both classic and current alternatives of irrigating substances and irrigation activation systems.

EDTA-functionalized silica nanoparticles as a conditioning agent for dentin bonding using etch-and-rinse technique

OBJECTIVE

This study investigated the possibility of using ethylenediaminetetraacetic acid functionalized silica nanoparticles (EDTA-SiO₂) as a dentin-conditioning agent using etch-and-rinse technique to promote the durability of dentin bonding.

METHODS

The SiO₂-EDTA were synthesized by N- [(3- trimethoxysilyl) propyl] ethylenediamine triacetic acid (EDTA-TMS) and SiO₂ (50 nm), then characterized by Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), X-ray photoelectron spectroscopy (XPS) and transmission electron microscopy (TEM). The capacity of SiO₂-EDTA to chelate calcium ions from dentin was examined by inductively coupled plasma-optic emission spectrometry (ICP-OES). The dentin surfaces conditioned with SiO₂-EDTA were detected by field emission scanning electron microscopy (SEM), TEM and microhardness testing. For dentin bonding, dentin surfaces were adopted wet- or dry-bonding technique and bonded with adhesive (Adper^TM Single Bond2) and applied composite resin (Filtek Z350) on them. The durability of dentin bonding was evaluated by mircotensile bond strength test, in-situ zymography and nanoleakage testing.

RESULTS

FTIR, TGA and XPS results showed that SiO₂-EDTA contained N element and carboxyl groups. SEM, TEM and microhardness results indicated that SiO₂-EDTA group created extrafibrillar demineralization and retained more intrafibrillar minerals within dentin surface. In the dentin bonding experiment, SiO₂-EDTA group achieved acceptable bond strength, and reduced the activity of matrix metalloproteinase and nanoleakage along bonding interface.

CONCLUSION

It was possible to generate a feasible dentin conditioning agent (SiO₂-EDTA), which could create dentin extrafibrillar demineralization and improve dentin bond durability.

CLINICAL SIGNIFICANCE

This study introduces a new dentin conditioning scheme based on SiO₂-EDTA to create extrafibrillar demineralization for dentin bonding. This strategy has the potential to be used in clinic to promote the life of restoration bonding.

Cytocompatibility and antimicrobial activity of a novel endodontic irrigant combining citric acid and chlorhexidine

OBJECTIVES

This study aimed to evaluate the antibacterial ability and cytocompatibility of a new irrigant solution for endodontic treatment composed of 10% citric acid (CA) and 1% chlorhexidine (CHX).

METHODS

Thirty-five extracted single-canal human teeth were selected and de-crowned. Canal systems (n = 7/group) were infected with Enterococcus faecalis for 4 weeks and subject to irrigation with 1% CHX; 10% CA; irrigating solution 10% CA associated with 1% CHX (CACHX); 2.5% NaOCl or sterile water (control). Microbiological samples were collected immediately and 18 h after irrigation (enriched samples). The canals were filled with culture medium post irrigation to verify the bacterial presence/absence qualitatively and quantitatively through colony counting (log₁₀ CFU/mL). A multiparametric assay was performed after exposure of human periodontal ligament fibroblasts (HPdLF) to the test solutions. The Kruskal-Wallis test with Dunn´s post-test and Fisher's exact test were employed at the 95% confidence level to compare differences among groups.

RESULTS

All tested solutions were cytocompatible with human periodontal ligament fibroblasts. No difference was observed on antibacterial activity between 1% CHX, 10% CA, CACHX and 2.5% NaOCl (p > 0.05). Eighteen hours after irrigation, CACHX samples were the only that did not present E. faecalis in the root canal system.

CONCLUSIONS

The demonstrated good in vitro biocompatibility and elimination of E. faecalis suggest a potential use of 10% CA associated with 1% CHX as a solution for microbiological control during endodontic treatment.

CLINICAL RELEVANCE

Irrigants play an essential role during endodontic therapy. This irrigating solution, based on the association of 10% citric acid with 1% chlorhexidine, seems viable for clinical procedures.

Can the Concentration of Citric Acid Affect Its Cytotoxicity and Antimicrobial Activity?

Background: There has been no unanimity concerning the ideal concentration of citric acid for safe use in clinical practice. This study evaluated the cytotoxicity and the antibacterial activity in infected dentinal tubules of 10% and 1% citric acid (CA) solutions. Methods: The cytotoxicity of CA solutions in DMEM (diluted 1/10, 1/100) was assessed in L-929 fibroblasts. A broth macrodilution method (MIC and MBC) was used to assess CA antibacterial concentration. The antimicrobial activity of CA solutions was also evaluated after their final rinse inside root canals in previously Enterococcus faecalis-contaminated dentinal tubules. Ten infected dentine samples were rinsed for 5 min with 5% NaOCl and subsequently with 1% citric acid for 3 min. Another 10 were rinsed with 5% NaOCl and 10% citric acid for 3 min; the remaining four specimens were utilized as positive controls. Two uncontaminated specimens were used as negative controls. After LIVE/DEAD BacLight staining, the samples were assessed using CLSM to analyze the percentage of residual live and dead cells. Results: Both undiluted and diluted CA solutions showed severe toxicity; no changes from normal morphology were displayed when diluted 1/100. The MIC and MBC of CA were 6.25 mg/mL and 12.50 mg/mL, respectively. CA solutions demonstrated significantly low levels of bacterial counts than the positive control group, reporting a value of 9.3% for the 10% solution versus the 1% solution (35.2%). Conclusions: Despite its valuable antimicrobial properties, the cytotoxic effects of citric acid should be considered during endodontic treatment.

Antibacterial efficacy of peracetic acid in comparison with sodium hypochlorite or chlorhexidine against Enterococcus faecalis and Parvimonas micra

Background

The main goal of an endodontic treatment is a complete debridement of the root canal system; however, currently mechanical shaping and chemical cleaning procedures for this purpose have deemed non-satisfactory.

Methods

The efficacy of peracetic acid (PAA; 0.5, 1.0, 2.0%), as a root canal irrigation solution, against Enterococcus faecalis (DSM 20478) and Parvimonas micra (DSM 20468) when compared with the one of sodium hypochlorite (NaOCI; 1.0, 3.0, 5.0%), chlorhexidine digluconate (CHX; 0.12, 0.2, 2.0%) and 0.9% NaCI (as a control solution) was in vitro investigated with the agar diffusion and direct contact methods. The inhibition zone diameters observed with the agar diffusion test were determined. The viable bacterial counts (CFU/ml) were calculated with the direct method.

Results

The agar diffusion test showed that all three root canal irrigation solutions had an efficacy against E. faecalis at all concentrations. The largest inhibition zone diameters against E. faecalis were observed with 5.0% NaOCI. At all three concentrations of PAA, NaOCI, and CHX, the inhibition zone diameter increased with increase in concentration. For P. micra, PAA had a similar inhibition zone diameter despite a concentration increase. In contrast, for NaOCI and CHX, the inhibition zone diameter increased with increasing concentration. 2.0% CHX produced the largest inhibition zone diameter against P. micra. For E. faecalis, only the comparison between 2.0% PAA and 5.0% NaOCI showed statistical significance (p = 0.004). For P. micra the efficacy comparison between the lowest, middle, and highest concentrations of each solution, a statistical significance (p < 0.05) was found for all three solutions. After direct contact with PAA, NaOCI and CHX, no viable bacteria could be determined for either P. micra or E. faecalis.

Conclusions

PAA had a similar antibacterial efficacy as the one of NaOCl and CHX when in direct contact with E. faecalis and P. micra. In the agar diffusion test, PAA showed a similar antibacterial efficacy as the one of CHX and a lower one as the one of NaOCl for E. faecalis.

High Counts and Anthracene Degradation Ability of Streptococcus mutans and Veillonella parvula Isolated From the Oral Cavity of Cigarette Smokers and Non-smokers

The composition and metabolic functions of oral microbiota are affected by many factors including smoking leading to several health problems. Cigarette smoking is associated with changes in oral microbiota composition and function. However, it is not known if the depletion of certain bacterial genera and species is due to specific toxins in cigarette smoke, or indirectly due to competition for colonization with smoking-enriched bacteria. Therefore, the aim of this study was to determine the effect of cigarette smoking on the microbial prevalence and polycyclic aromatic hydrocarbons (PAHs) biodegradation of selected enriched and depleted oral bacteria from oral microbiota of smokers compared to that in non-smokers. Samples of oral rinse from smokers and non-smokers were collected (n = 23, 12 smokers and 11 non-smokers) and screened for oral bacterial strains of Streptococcus mutans, Lactobacillus spp., and Veillonella spp. Comparing counts, S. mutans, V. tobetsuensis, and V. dispar showed higher counts in smokers compared to non-smokers while the Lactobacillus spp. were higher in non-smokers. Lactobacillus fermentum was prevalent in smokers, representing 91.67% of the total Lactobacillus spp. isolates. The biodegradation potential of anthracene; a representative of PAHs of collected isolates, in single and mixed cultures, was assayed with anthracene as the sole source of carbon using 2,6-dichlorophenol indophenol (2,6-DCPIP) as indicator. S. mutans isolates recovered from smokers showed higher degradation of anthracene compared to those recovered from non-smokers. The anaerobic anthracene biodegradation activity of V. parvula isolates from non-smokers was the highest among all isolates of the three recovered genera from the same subject. The anthracene biodegradation potential of Lactobacillus spp. was variable. Combinations of isolated bacteria in co-cultures showed that Lactobacillus spp. interfered with anthracene biodegradation ability along with the viable counts of S. mutans and Veillonella spp. In conclusion, oral dysbiosis due to cigarette smoking was observed not only due to changes in oral bacterial relative abundance but also extended to bacterial functions such as anthracene biodegradation tested in this study. Microbe-microbe interactions changed the anthracene biodegradation potential and growth of the microbial mixture compared to their corresponding single isolates, and these changes differ according to the constituting bacteria.

Disinfectants Used in Stomatology and SARS-CoV-2 Infection

Effective disinfection is a basic procedure in medical facilities, including those conducting dental surgeries, where treatments for tissue discontinuity are also performed, as it is an important element of infection prevention. Disinfectants used in dentistry and dental and maxillofacial surgery include both inorganic (hydrogen peroxide, sodium chlorite-hypochlorite) and organic compounds (ethanol, isopropanol, peracetic acid, chlorhexidine, eugenol). Various mechanisms of action of disinfectants have been reported, which include destruction of the structure of bacterial and fungal cell membranes; damage of nucleic acids; denaturation of proteins, which in turn causes inhibition of enzyme activity; loss of cell membrane integrity; and decomposition of cell components. This article discusses the most important examples of substances used as disinfectants in dentistry and presents the mechanisms of their action with particular focus on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The search was conducted in ScienceDirect, PubMed, and Scopus databases. The interest of scientists in the use of disinfectants in dental practice is constantly growing, which results in the increasing number of publications on disinfection, sterilization, and asepsis. Many disinfectants often possess several of the abovementioned mechanisms of action. In addition, disinfectant preparations used in dental practice either contain one compound or are frequently a mixture of active compounds, which increases their range and effectiveness of antimicrobial action. Currently available information on disinfectants that can be used to prevent SARS-CoV-2 infection in dental practices was summarized.

The effect of selective carious tissue removal and cavity treatments on the residual intratubular bacteria in coronal dentine

Background/purpose

The use of cavity treatments may help in the reduction of bacteria remaining in dentinal tubules after selective carious tissue removal. This study aimed to investigate the effect of selective carious tissue removal and treatment with either 35% phosphoric acid +0.12% chlorhexidine or dentine conditioner on the residual intratubular bacteria in coronal dentine of deep carious lesions.

Materials and methods

Thirty carious human molars were randomly divided into three groups; group 1: untreated carious teeth (positive control), group 2: carious teeth treated with 35% phosphoric acid and chlorhexidine disinfectant after selective carious tissue removal and group 3: carious teeth treated with dentine conditioner after selective carious tissue removal. Another six non-carious teeth was used as negative control. The presence of bacteria and depth of bacteria remaining in dentinal tubules were determined by scanning electron microscopy (SEM). Chi square test and one-way, repeated-measures analysis of variance were used for statistical analysis.

Results

Using SEM, coronal dentine of group 1, 2 and 3 revealed cocci, rod and filamentous bacteria within dentinal tubules. Positive rates of bacteria detection in coronal dentine of group 1 were significant higher than those of group 2 and 3 (P < 0.05). The distance of bacteria remaining in the dentinal tubules in group 1, 2 and 3 were 1149.14 ± 384.44, 707.98 ± 357.19 and 869.25 ± 470.75 μm, respectively.

Conclusion

Both treatment groups had similar ability to reduce the number of intratubular bacteria in coronal dentine of carious teeth, but not complete elimination.

Smear Layer Removal from Root Canal Dentin and Antimicrobial Effect of Citric Acid-modified Chlorhexidine

Objective:

To study the effectiveness of various concentrations of citric acid (CA) added to 2% chlorhexidine (CHX) on smear layer removal from the root canal wall and antimicrobial efficacy against Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans).

Methods:

Fifty-three single-rooted mandibular premolars were decoronate and the root canals underwent mechanical instrumentation using MTwo rotary files to size 40/0.06. The samples were then randomly divided into 5 groups according to the root canal irrigants to be used: 17% ethylenediaminetetraacetic acid (EDTA), 2% CHX, 1%, 6%, and 10% citric acid-modified 2% chlorhexidine (CAmCHX). Three teeth irrigated with phosphate-buffered saline (PBS) were used as a negative control. The smear layer removal effectiveness was evaluated under scanning electron microscopy (SEM). Images were randomly taken at the apical, middle, and coronal third level. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. Disc diffusion and direct exposure tests were performed along with three additional control groups consisting of 1%, 6%, and 10% CA groups to assess and compare the antimicrobial efficacy of irrigants against E. faecalis and C. albicans. Statistical analysis was conducted using one-way ANOVA and Dunnett’s T3 tests.

Results:

Smear layer removal effectiveness in 17% EDTA group and 6% and 10% CAmCHX groups were not significantly different in the coronal and apical third of the root canal (P>0.05), however at the middle third of the root canal, the 10% CAmCHX group had significantly less remaining smear layer than all of the other experimental groups (P<0.05). There was significantly more smear layer remnant in the CHX group (P<0.01). For antimicrobial efficacy, the largest growth inhibition zone against E. faecalis was recorded in the 10% CAmCHX group (P<0.05). For planktonic E. faecalis, 1%, 6%, and 10% CAmCHX demonstrated an insignificant difference in antimicrobial efficacy compared to CHX (P>0.05). CA demonstrated no antifungal effect against C. albicans. Whereas, 6% and 10% CAmCHX resulted in the largest growth inhibition zone. Also, adding CA to CHX resulted in an insignificant difference in antifungal effect against planktonic C. albicans compared to CHX (P>0.05).

Conclusion:

When CA was added into CHX, the mixed irrigant demonstrated smear layer removal ability. Additionally, its antimicrobial effect remained the same.

Effective targeting of breast cancer cells (MCF7) via novel biogenic synthesis of gold nanoparticles using cancer-derived metabolites

Biogenic synthesis of nanoparticles provides many advantages over synthetic nanoparticles including clean and non-toxic approaches. Nanoparticle-based application for the development of diagnostics and therapeutics is a promising field that requires further enrichment and investigation. The use of biological systems for the generation of gold nanoparticles (AuNPs) has been extensively studied. The search for a biocompatibility approach for the development of nanoparticles is of great interest since it can provide more targeting and less toxicity. Here, we reported a bio-reductive approach of gold to AuNPs using metabolites extracted from mammalian cells, which provided a simple and efficient way for the synthesis of nanomaterials. AuNPs were more efficiently synthesized by the metabolites extracted from breast cancer (MCF7) and normal fibroblasts (F180) cells when compared to metabolites extracted from cell-free supernatants. The metabolites involved in biogenic synthesis are mainly alcohols and acids. Spectroscopic characterization using UV-visible spectra, morphological characterization using electron microscopy and structural characterization using X-ray diffraction (XRD) confirmed the AuNPs synthesis from mammalian cells metabolites. AuNPs generated from MCF7 cells metabolites showed significant anticancer activities against MCF7 and low toxicity when compared to those generated from F180 cells metabolites. The results reflected the cytotoxic activities of the parent metabolites extracted from MCF7 versus those extracted from F180. Comparative metabolomics analysis indicated that MCF7-generated AuNPs harbored tetratetracontane, octacosane, and cyclotetradecane while those generated from F180 harbored a high percentage of stearic, palmitic, heptadecanoic acid. We related the variation in cytotoxic activities between cell types to the differences in AuNPs-harboring metabolites. The process used in this study to develop the nanoparticles is novel and should have useful future anticancer applications mainly because of proper specific targeting to cancer cells.

Orthodontic bonding procedures significantly influence biofilm composition

BACKGROUND

Because changes in surface properties affect bacterial adhesion, orthodontic bonding procedures may significantly influence biofilm formation and composition around orthodontic appliances. However, most studies used a mono-species biofilm model under static conditions, which does not simulate the intraoral environment and complex interactions of oral microflora because the oral cavity is a diverse and changeable environment. In this study, a multi-species biofilm model was used under dynamic culture conditions to assess the effects of the orthodontic bonding procedure on biofilm formation and compositional changes in two main oral pathogens, Streptococcus mutans and Porphyromonas gingivalis.

METHODS

Four specimens were prepared with bovine incisors and bonding adhesive: untreated enamel surface (BI), enamel surface etched with 37% phosphoric acid (ET), primed enamel surface after etching (PR), and adhesive surface (AD). Surface roughness (SR), surface wettability (SW), and surface texture were evaluated. A multi-species biofilm was developed on each surface and adhesion amounts of Streptococcus mutans, Porphyromonas gingivalis, and total bacteria were analyzed at day 1 and day 4 using real-time polymerase chain reaction. After determining the differences in biofilm formation, SR, and SW between the four surfaces, relationships between bacteria levels and surface properties were analyzed.

RESULTS

The order of SR was AD < PR < BI < ET, as BI and ET showed more irregular surface texture than PR and AD. For SW, ET had the greatest value followed by PR, BI, and AD. S. mutans and P. gingivalis showed greater adhesion to BI and ET with rougher and more wettable surfaces than to AD with smoother and less wettable surfaces. The adhesion of total bacteria and S. mutans significantly increased over time, but the amount of P. gingivalis decreased. The adhesion amounts of all bacteria were positively correlated with SR and SW, irrespective of incubation time.

CONCLUSIONS

Within the limitations of this study, changes in SR and SW associated with orthodontic bonding had significant effects on biofilm formation and composition of S. mutans and P. gingivalis.

Quaternary ammonium silane, calcium and phosphorus-loaded PLGA submicron particles against Enterococcus faecalis infection of teeth: An in vitro and in vivo study

Refractory root canal infection of human teeth is the primary cause of dental treatment failure. Enterococcus faecalis is the major cause of refractory root canal infection. In the present study, poly(D,L-lactic-co-glycolide) (PLGA) submicron particles were used as carriers to deliver an antimicrobial quaternary ammonium silane (code-named K21) as well as calcium and phosphorus elements. The release profiles, antibacterial ability against E. faecalis, extent of infiltration into dentinal tubules, biocompatibility and in vitro mineralization potential of the particles were investigated. In addition, the antimicrobial effects of the particles against E. faecalis infection were evaluated in vivo in the teeth of beagle dogs. The encapsulated components were released from the PLGA particles in a sustained-release manner. The particles also displayed good biocompatibility, in vitro mineralization ability and antibacterial activity against E. faecalis. The particles could be driven into dentinal tubules of dentin slices by ultrasonic activation and inhibited E. faecalis colonization. In the root canals of beagle dogs, PLGA submicron particles loaded with K21, calcium and phosphorus demonstrated strong preventive effects against E. faecalis infection. The system may be developed into a new intracanal disinfectant for root canal treatment.

Antimicrobial activity of Lactobacillus fermentum TcUESC01 against Streptococcus mutans UA159

Dental caries is a multifactorial chronic-infection disease, which starts with a bacterial biofilm formation caused mainly by Streptococcus mutans. The use of probiotics has shown numerous health benefits, including in the fight against oral diseases. Strains of Lactobacillus fermentum have already shown probiotic potential against S. mutans, but there are still few studies. Thus, the aim of our study was to evaluate the antimicrobial activity of the inoculum and metabolites produced by L. fermentum TcUESC01 against S. mutans UA159. For this, a growth curve of L. fermentum was performed and both the inoculum and the metabolites formed in the fermentation were tested against the growth of S. mutans UA159 in agar diffusion tests, and only its metabolites were tested to determine the minimum inhibitory concentration, minimal bactericidal concentration and inhibition of cell adhesion. Inhibition of biofilm formation, pH drop and proton permeability were also tested with the metabolites. The zone of inhibition began to be formed at 14 h and continued until 16 h. The inoculum containing L. fermentum also showed zone of inhibition. The MIC for the metabolites was 1280 mg/mL and the MBC was obtained with a concentration higher than the MIC equal to 5120 mg/mL. Half of the MIC concentration (640 mg/mL) was required to inhibit S. mutans adhesion to the surface of the microplates. In the biofilm analyzes, the treatment with the metabolites in the tested concentration was not able to reduce biomass, insoluble glucans and alkali soluble compared to the control biofilm (p > 0.05). The metabolites also did not affect acid production and acid tolerance of S. mutans cells in biofilms compared to saline group (p > 0.05). Lactic acid (50.38%) was the most abundant organic acid produced by L. fermentum. This is the first report showing that the metabolites produced by the Lactobacillus fermentum TcUESC01 have a potential to be used as an antimicrobial agent against S. mutans, showing anti-adherence and bactericidal activity against planktonic cells of S. mutans. Thus, further studies should be carried out in order to better understand the antimicrobial activity of metabolites of L. fermentum TCUESC01.

Cytotoxicity of Chelating Agents Used In Endodontics and Their Influence on MMPs of Cell Membranes

Abstract This study evaluated the cytotoxic effect and the ability to inhibit matrix metalloproteinases (MMP-2 and MMP-9) of 0.2% chitosan (CH) and 1% acetic acid (AA) compared with 17% ethylenediaminetetraacetic acid (EDTA). Cell viability assay was performed according to ISO 10993-5 with mouse fibroblasts (L929). The culture was exposed to 0.2% CH, 1% AA, and 17% EDTA. The chelating agents were evaluated immediately after contact with the cells and after 6 h, 12 h, and 24 h of incubation. Cell viability was analyzed using the 3-(4,5-dimethythiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Inhibition of the gelatinolytic activity of MMP-2 and MMP-9 was evaluated by gelatin zymography. Different concentrations of CH were evaluated: 50 mM, 5 mM, 0.5 mM, and 0.05 mM. EDTA (0.5 mM) was used as a positive control. The results demonstrated that CH and AA had an initial cytotoxic effect, which decreased after 6 h, 12 h, and 24 h, being statistically similar to EDTA (P > 0.05). Additionally, CH at concentrations of 50 mM, 5 mM, and 0.5 mM had an inhibitory effect on MMP-2 and MMP-9, similar to that of the control with EDTA. The chelating agents had no cytotoxic effects after 24 h. MMP-2 and MMP-9 were inhibited by the experimental solutions.

Antibacterial Activity and Impact of Different Antiseptics on Biofilm-Contaminated Implant Surfaces

Several antiseptic agents have been proposed for the treatment of peri-implantitis as a complementary therapeutic strategy in addition to mechanical devices. The aim of this study was to compare six different antiseptics, as well as alternative formulations of the same chemical agent, with respect to their decontamination efficacy and impact on chemical properties of the implant surface. Titanium disks with a micro-rough surface, previously contaminated with Porphyromonas gingivalis and Streptococcus mutans biofilms, were treated for 2 min with different antiseptics (liquid sodium hypochlorite 5.25%, gel sodium hypochlorite 5.25%, liquid chlorhexidine 0.2%, gel chlorhexidine 1%, gel citric acid 40%, and gel orthophosphoric acid 37%) or sterile saline solution (control) and their antibacterial activity as well as their ability to remove biofilm were assessed by viable bacterial count and scanning electron microscopy, respectively. Spectroscopic analysis was also performed on non-contaminated disks after exposure to the antiseptics, in order to detect any change in the elemental composition of the titanium surface. All the antimicrobial formulations examined were effective against P. gingivalis and S. mutans biofilms. SEM analysis revealed however that liquid sodium hypochlorite 5.25% was more effective in dissolving biofilm residues. Spectroscopic analysis detected traces of the antiseptics, probably due to insufficient rinsing of the titanium surfaces. In conclusion, since gel formulations of these antiseptic agents possessed a similar antibacterial activity to the liquid formulations, these may be proposed as alternative treatments given their properties to avoid overflows and increase contact time without significant side effects on the bone.

Polymer conjugation optimizes EDTA as a calcium-chelating agent that exclusively removes extrafibrillar minerals from mineralized collagen

During development of mineralized collagenous tissues, intrafibrillar mineralization is achieved by preventing mineralization precursor inhibitors that are larger than 40 kDa from entering the collagen fibrils. Such a property is incorporated in the design of a calcium chelator for dentin bonding in the etch-and-rinse technique that selectively demineralizes extrafibrillar apatite while leaving the intrafibrillar minerals intact. This strategy prevents complete demineralization of collagen fibrils, avoids collapse of collagen that blocks resin infiltration after air-drying, and protects the completely demineralized fibrils from bacteria colonization and degradation by endogenous proteases after resin bonding. In the present study, a water-soluble glycol chitosan-EDTA (GCE) conditioner was synthesized by conjugation of EDTA, an effective calcium chelator, to high molecular weight glycol chitosan, which exhibits weak chelation property. The GCE conjugate was purified, characterized by FTIR, ¹H NMR, isothermal titration calorimetry and ICP-AES, and subjected to size exclusion dialysis to recover molecules that are >40 kDa. The optimal concentration and application time for etching dentin were determined by bond strength testing to ensure that the dentin bonding results were comparable to phosphoric acid etching, and maintained equivalent bond strength after air-drying of the conditioned collagen matrix. Extrafibrillar demineralization was validated with transmission electron microscopy. Inhibition of endogenous dentin proteases was confirmed using in-situ zymography. The water-soluble GCE dentin conditioner was non-cytotoxic and possessed antibacterial activities against planktonic and single-species biofilms, supporting its ongoing development as a dentin conditioner with air-drying, anti-proteolytic and antibacterial properties to enhance the durability of bonds created using the etch-and-rinse bonding technique. STATEMENT OF SIGNIFICANCE: The current state-of-the-art techniques for filling decayed teeth with plastic tooth-colored materials require conditioning the mineralized, biofilm-covered, decayed dentin with acids or acid resin monomers to create a surface layer of completely- or partially-demineralized collagen matrix for the infiltration of adhesive resin monomers. Nevertheless, fillings prepared using these strategies are not as durable as consumers have anticipated. Conjugation of polymeric glycol chitosan with EDTA produces a new conditioner for dentin bonding that demineralizes only extrafibrillar dentin, reduces endogenous protease activities and kills biofilm bacteria. The high molecular weight glycol chitosan-EDTA is non-cytotoxic to the key regenerative players within the dentin-pulp complex. This advance permits dry bonding and the use of hydrophobic resins.

Dry-bonding to dentin using alternative conditioners based on iron-containing solutions or nitric acid

OBJECTIVES

To evaluate the effect of experimental conditioners (10-3 solution - 10-3, 6.8% ferric oxalate - FOX, and 1.4% nitric acid - NI) on dentin elastic modulus, flexural strength, bond strength, failure mode, and adhesive interface morphology of two etch-and-rinse adhesives (XP Bond, Dentsply or One-Step, Bisco) applied on etched dry dentin.

METHODS

Sound human third molars were used for the microtensile bond strength test (n = 8), performed at 24 h and after one year of water storage. Failure modes were evaluated by scanning electron microscopy. Dentin bonding interface was analyzed by confocal laser scanning microscopy (n = 3). Adhesive systems were applied on phosphoric acid-etched, wet (positive control) and dry (negative control) dentin, and on etched and dry dentin previously treated with 10-3 (15s), FOX (60s), or NI (15s). Bovine dentin bars (n = 15) were immersed into the conditioning solutions and subjected to a three-point bending test.

RESULTS

XP Bond + 10-3 or NI resulted in lower bond strength than phosphoric acid. One-Step + 10-3 or NI resulted in bond strengths equivalent to the positive control. Experimental conditioners presented no bond strength reduction after one year, regardless of the bonding agent tested. One-Step resulted in more adhesive failures than XP Bond at 24 h, and mixed failures increased after storage. All experimental conditioners promoted hybridization and resin tags formation, except FOX. Dentin elastic modulus was not affected by the conditioners, whereas flexural strength was significantly reduced by FOX.

CONCLUSIONS

Adequate and stable dentin bonds were achieved when the bonding agents were applied on 10-3 or NI-treated dentin. None of the experimental conditioners reduced dentin elastic modulus, but dentin flexural strength was significantly reduced by FOX-conditioning.

PLGA submicron particles containing chlorhexidine, calcium and phosphorus inhibit Enterococcus faecalis infection and improve the microhardness of dentin

Enterococcus faecalis (E. faecalis), a Gram-positive facultative anaerobe, is reported to take responsibility for a large portion of refractory root canal infections and root canal re-infections of human teeth. Chlorhexidine is a strong bactericide against E. faecalis but cannot infiltrate into dentinal tubules. On the other hand, a common negative effect of root canal medicaments is the decrease of dentin microhardness. In this study, poly(D,L-lactic-co-glycolide) (PLGA) submicron particles were applied as delivery carriers to load and release the chlorhexidine as well as calcium and phosphorus. The release profiles, antibacterial ability against E. faecalis, infiltration ability into dentinal tubules, biocompatibility and effects on dentin microhardness of these particles were investigated. Results revealed that encapsulated chemicals could be released in a sustained manner from the particles. The particles also exhibited excellent biocompatibility on MC3T3-E1 cells and significant antimicrobial property against E. faecalis. On dentin slices, the particles could be driven into dentinal tubules by ultrasonic activiation and inhibit E. faecalis colonization. Besides, dentin slices medicated with the particles displayed an increase in microhardness. In conclusion, PLGA submicron particles carrying chlorhexidine, calcium and phosphorus could be developed into a new intra-canal disinfectant for dental treatments.

In-and-Out Molecular Changes Linked to the Type 2 Diabetes Remission after Bariatric Surgery: An Influence of Gut Microbes on Mitochondria Metabolism

Different kinds of gastrointestinal tract modulations known as “bariatric surgery” are actually the most effective treatment for obesity and associated co-morbidities, such as type 2 diabetes (T2DM). The potential causes of those effects have yet to be explained. In our study, we focused on molecular changes evoked by laparoscopic sleeve gastrectomy leading to T2DM remission. Two complementary metabolomics techniques, namely, liquid chromatography coupled with mass spectrometry (LC-MS) and gas chromatography mass spectrometry (GC-MS), were used to study those effects in a group of 20 obese patients with T2DM selected from a cohort of 372 obese individuals who underwent bariatric surgery and did not receive anti-diabetic treatment afterward. Modified levels of carnitines, lipids, amino acids (including BCAA) and α- and β-hydroxybutyric acids were detected. Presented alterations suggest a major role of mitochondria activity in T2DM remission process. Moreover, some of the observed metabolites suggest that changes in gut microbiota composition may also correlate with the tempo of diabetes recovery. Additional analyses confirmed a relationship between biochemical and clinical parameters and the aforementioned metabolites, thereby, highlighting a role of mitochondria and microbes. Our data suggests that there is a previously undescribed relationship between mitochondria and gut microbiota, which changes after the bariatric surgery. More investigations are needed to confirm and explore the observed findings.

Cytotoxicity of Endodontic Irrigants on Human Periodontal Ligament Cells

Introduction:

Root canal irrigation has an extremely important role in the success of endodontic treatment. During endodontic treatment, the irrigants will be in contact with pulpal and periapical tissues. The purpose of this study was to clarify the potential toxicological implications of NaOCl, EDTA, MTAD, CHX and QMix on periapical and periodontal tissues.

Methods and Materials:

Cytotoxicity of solutions was evaluated on cultured human periodontal ligament (hPDL) that were carefully removed from the middle third of premolar roots. Cytotoxicity of the materials was assessed after 1, 5 and 15 min of exposure using the Mosmann’s Tetrazolium Toxicity (MTT) assay. Optical density of the solution was read at 540-690 nm wavelength. The intensity of color generated correlated with the percentage of viable cells. Data were statistically analyzed using repeated measures ANOVA followed by Bonferroni test.

Results:

The mean percentage of viable cells in all experimental groups was significantly different from sterile saline groups at all time points (P<0.0001). The mean percentage of viable cells significantly decreased over time in MTAD and NaOCl groups. The lowest and highest cytotoxicity belonged to MTAD and EDTA groups, respectively at all the time points (P<0.05).

Conclusion:

MTAD had the lowest cytotoxicity compared to NaOCl, CHX, QMix and EDTA. These impacts have been time dependent. These irrigation fluids may cause unfavorable effects on vital tissues.

Cytotoxicity, genotoxicity and antibacterial activity of poly(vinyl alcohol)-coated silver nanoparticles and farnesol as irrigating solutions

OBJECTIVE

To evaluate the cytotoxicity, genotoxicity and antibacterial activity of poly(vinyl alcohol)-coated silver nanoparticles (AgNPs-PVA) and farnesol (FAR).

DESIGN

The cytotoxicity (% of cell viability) was evaluated by MTT assay and the genotoxicity (% of DNA in the tail) was evaluated by Comet assay. Root canal disinfection with different irrigating protocols was evaluated ex vivo in human teeth contaminated with Enterococcus faecalis for 21days. Three microbiological samples were collected: initial (after contamination); post-irrigation (after irrigation); and final (after 7days). After each sample, the number of log 10 CFU mL^-1 was determined. Statistical analyses was performed using two-way ANOVA and Bonferroni post-hoc tests for MTT assay, Kruskal-Wallis and Dunn post-hoc tests for Cometa and antibacterial assays (α=0.05).

RESULTS

The MTT assay showed that AgNPs and FAR were less cytotoxic that sodium hypochlorite (NaOCl) and showed a lower% of DNA in the tail, in comparison with H₂O₂ (positive control - C+). In the post-irrigation microbiological sample, all the irrigating protocols were more effective than C+ (without irrigation). NaOCl/saline, NaOCl/saline/AgNPs-PVA and NaOCl/saline/FAR led to complete bacterial elimination (p >0.05). In comparison with the initial sample, both the post-irrigation and the final samples showed microbial reduction (p < 0.05).

CONCLUSIONS

AgNPs-PVA and FAR showed low cytotoxicity and genotoxicity, and exhibit potential for use as a final endodontic irrigation protocols.

Unusual Root Canal Irrigation Solutions

Microorganisms and their by-products play a critical role in pulp and periradicular pathosis. Therefore, one of the main purposes of root canal treatment is disinfection of the entire system of the canal. This aim may be obtained using mechanical preparation, chemical irrigation, and temporary medication of the canal. For this purpose, various irrigation solutions have been advocated. Common root canal irrigants, such as sodium hypochlorite, chlorhexidine, and a mixture of tetracycline, acid, and detergent have been extensively reviewed. The aim of this review was to address the less common newer root canal irrigation solutions, such as citric acid, maleic acid, electrochemically activated water, green tea, ozonated water, and SmearClear.

Ozone therapy as an adjuvant for endondontic protocols: microbiological - ex vivo study and citotoxicity analyses

Objectives

This study evaluated the antimicrobial efficacy of ozone therapy in teeth contaminated with Pseudomonas aeruginosa, Enterococcus faecalis, and Staphylococcus aureus using a mono-species biofilm model. Parallel to this, the study aimed to evaluate the cytotoxicity of ozone for human gingival fibroblasts. Material and Methods: One hundred and eighty single-root teeth were contaminated with a mono-species biofilm of Enterococcus faecalis, Pseudomonas aeruginosa, and Staphylococcus aureus. Groups were formed: Group I - control; Group II - standard protocol; Group III - standard protocol + ozone gas at 40 µg/mL; and Group IV - standard protocol + aqueous ozone at 8 µg/mL. In parallel, human gingival fibroblasts were submitted to the MTT test. Cells were plated, then ozone was applied as follows: Group I (control) - broth medium; Group II - aqueous ozone at 2 µg/mL; Group III - aqueous ozone at 5 µg/mL; and Group IV - aqueous ozone at 8 µg/mL. Data were submitted to the Kruskal Wallis test and Bonferroni post hoc analyses to assess microbiology and cytotoxicity, respectively (p<0.05%).

Results

The results revealed antimicrobial efficacy by Group IV with no CFU count. The cytotoxicity assay showed Groups III and IV to be the most aggressive, providing a decrease in cell viability at hour 0 from 100% to 77.3% and 68.6%, respectively. Such a decrease in cell viability was reverted, and after 72 hours Groups III and IV provided the greatest increase in cell viability, being statistically different from Groups I and II.

Conclusion

According to the applied methodology and the limitations of this study, it was possible to conclude that ozone therapy improved the decontamination of the root canal ex vivo. Ozone was toxic to the cells on first contact, but cell viability was recovered. Thus, these findings suggest that ozone might be useful to improve root canal results.

Clinical efficacy of EDTA ultrasonic activation in the reduction of endotoxins and cultivable bacteria

AIM

This clinical study was conducted to investigate the influence of 17% ethylenediaminetetraacetic acid (EDTA) ultrasonic activation after chemomechanical preparation (CMP) on eliminating/reducing oral bacterial lipopolysaccharides (known as endotoxins) and cultivable bacteria in teeth with pulp necrosis and apical periodontitis.

METHODOLOGY

Samples were taken from 24 root canals at several clinical periods: S1 - before CMP; S2 - after CMP; S3 - after EDTA: G1 - with ultrasonic activation (n = 12) and G2 - without ultrasonic activation (n = 12). Root canals were instrumented using Mtwo rotary files. Culture techniques were used to determine the number of colony-forming units (CFU). Limulus amebocyte lysate (LAL) was used to measure endotoxin levels. Friedman's and Wilcoxon signed-rank tests were used to compare the amount of bacteria and endotoxin levels in each period (P < 0.05).

RESULTS

Endotoxins and cultivable bacteria were recovered in 100% of the initial samples (S1). CMP was effective in reducing endotoxins and bacterial load (all with P < 0.05). Higher values of endotoxin reduction were achieved with EDTA ultrasonic activation [G1, 0.02 EU mL^-1 (range 0.01-0.75)] compared with the no activation group [G2, 1.13 EU mL^-1 (range 0.01-8.34)] (P < 0.05). Regarding bacterial reduction, no statistically significant difference was found in S3, regardless of the group (G1, G2, P > 0.05).

CONCLUSIONS

Chemomechanical preparation was effective in reducing bacteria and endotoxins, but could not completely eliminate them. The ultrasonic activation of EDTA was effective in further reducing endotoxin levels in the root canals of teeth with pulp necrosis and apical periodontitis.