Efficacy of disinfection procedures performed prior to regenerative endodontic therapy: An integrative review

The aim of this integrative review was to identify whether the disinfection procedures performed prior to regenerative endodontic treatment were effective on biofilm removal from the root canals. The research was based on PubMed, Latin American and Caribbean Health Sciences Literature (Lilacs) and Scientific Electronic Library Online (SciELO) databases. Four articles were selected; one of the studies was in vivo and the others ex vivo. Different disinfection procedures were studied, characterised mainly by the use of intracanal medication, highlighting the double antibiotic paste, triple antibiotic paste and calcium hydroxide paste. Disinfection ability was evaluated against Enterococcus faecalis and multispecies biofilms by using the fluorescence technique and colony forming unit counting, for 7 to 21 days. Double antibiotic paste and triple antibiotic paste demonstrated excellent antibiofilm activity, unlike CH paste that showed limited disinfection, even when associated with different antimicrobial agents. Triple antibiotic paste was the most effective medication against biofilm.

In vitro evaluation of membranes for regenerative procedures against oral bacteria

The current literature on guided bone regeneration (GBR) and guided tissue regeneration (GTR) membrane contamination reports that the physicochemical characteristics of these biomaterials might influence affinity to bacteria, which appears to be a major drawback for the clinical outcome of the regenerative procedures. Thus, this study aimed to evaluate, in vitro, a multispecies biofilm adherence and passage of bacteria through different types of commercially available membranes for GTR/GBR. Four types of membranes were tested (n=12): LC) Lumina Coat®; JS) Jason®; BG) Biogide®; and LP) Lumina PTFE®. Aluminum foil (AL) simulated an impermeable barrier and was used as the control. The membranes were adapted to specific apparatus and challenged with a mixed bacterial culture composed of A. actinomycetemcomitans b, S. mutans, S. mitis, and A. israelii. After 2 h or 7 days, bacterial adhesion and passage of bacteria were evaluated through CFU counting, which was analyzed by two-way ANOVA e post hoc Tukey, at a 5% significance level. Representative areas of two membranes of each group were analyzed through scanning electron microscopy (SEM) to assess the morphology and organization of the biofilm over the membrane fibers. LC and LP presented similar values of adhered bacterial cells (p > 0.05), significantly inferior when compared to the other groups, in both time points (p < 0.05). All the tested groups were permeable to bacterial cells, with no significant difference between the trial period of 2 h and 7 days (p > 0.05). SEM analyses demonstrated that adhered bacteria number increased throughout the time points (2 h < 7 days). Commercially available biological membranes demonstrated intense bacterial adherence and passage of bacteria, which increased throughout the trial period.

Do alternative scaffolds used in regenerative endodontics promote better root development than that achieved with blood clots?

The aim of this integrative review was to identify whether alternative scaffolds used in regenerative endodontics contribute to better root development, in relation to the increase in root length and thickness of dentin walls, compared with blood clot (BC) scaffolds. The literature search was conducted in PubMed, SciELO and Lilacs databases, using descriptors related to the topic. After applying the eligibility criteria, 11 articles were selected and analyzed according to the proposed aim. Five clinical and six in vivo studies, conducted in animals, compared different types of alternative scaffolds with BCs, with emphasis on platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). All scaffolds, alternative or BC, promoted an increase in root length and dentin wall thickness, with varying percentages of increase between studies. In general, there was a significant increase in root length and dentin thickness promoted by PRF and PRP scaffolds, compared with BC. It was concluded that the majority of the scaffolds tested contributed to the increase in root length and thickness of dentin walls, with emphasis on PRF and PRP.