Does aPDT reduce bacterial load in endodontic infected teeth? A systematic review and meta-analysis

This systematic review investigated whether antimicrobial photodynamic therapy (aPDT) after chemomechanical root canal disinfection (CD) yields a greater microbial load reduction than only CD. An electronic literature search was conducted on four databases up to November 2022, with no language or publication date restrictions. Randomized and non-randomized clinical trials were included if participants had a primary endodontic infection in permanent teeth, and if microbial loads before and after using aPDT were compared. Two researchers independently screened titles and abstracts to determine study eligibility. Assessments included risk of bias and methodological quality. This review was registered in PROSPERO (CRD42020181783). Eight studies were included in the qualitative analysis, and six were eligible for meta-analysis. In the random effects model, aPDT significantly improved the results of root canal disinfection when compared with standard protocols for cleaning and shaping (p = 0.04, 95% CI -1.72, -0.05). Subgroup analysis suggested that aPDT has a better effect on reducing the load of anaerobic microorganisms (p = 0.003, 95% CI -3.36, -0.69). The use of aPDT as an adjunct to chemomechanical disinfection promotes additional reduction of the microbial load and, therefore, seems to improve the results of root canal treatments in permanent teeth with a primary endodontic infection. However, certainty of evidence should be improved.

Effect of different disinfection protocols in bacterial viability of an intraradicular biofilm formed in situ

The present study aimed to evaluate bacterial viability after the use of different disinfection protocols in root canals infected with a multispecies biofilm (MB) formed in situ. Palatal roots with a single canal were obtained from extracted maxillary molars and sterilized before being inserted into the mouth. The roots were contaminated with a MB in an intraoral appliance worn by ten volunteers. All volunteers wore six roots simultaneously in two intraoral devices for 21 days. One root from each volunteer was assigned to each group (n=10): PUI - passive ultrasonic irrigation; EC - Easy Clean; XPF - XP-endo Finisher; aPDT - antimicrobial photodynamic therapy; CI - conventional irrigation; and NC - negative control. The samples were evaluated under confocal laser scanning microscopy. The percentage of viable cells (VC) was calculated over the total percentage of MB biovolume. Data were statistically analyzed (α=5%). The cell viability in the entire root canal or for each third was compared between groups (Kruskal-Wallis test, Dunn post-hoc test) and for the same group (Friedman test, Dunn post-hoc test). Disinfection protocols were not significantly different from each other (P>.05). Samples in EC, PUI, and aPDT had lower cell viability than in NC (P<.05). In the coronal third of samples in the EC, XPF, PUI and aPDT, the percentage of VC biovolume was lower than in the NC (P<.05). The percentage of VC in EC samples was lower in the coronal and middle thirds than in the apical third (P<.05). EC, PUI and aPDT had significant effects on cell viability in intraradicular multispecies biofilm formed in situ when compared with untreated samples.

Marginal gaps and internal voids after root-end filling using three calcium silicate-based materials: A Micro-CT analysis

This study evaluated the 3D quality of root-end filling, assessing the presence (volume and percentage) of marginal gaps and internal voids formed after retro-filling with three calcium silicate-based materials: MTA Angelus (Angelus Soluçoes Odontologicas, Londrina, PR, Brazil), Biodentine (Septodont Ltd., Saint Maur-des-Faussés, France) and Neo MTA Plus (Avalon Biomed Inc., Bradenton, Florida, US). Thirty human, extracted, single rooted teeth were used. Orthograde root canal treatment, root resection (3mm shorter than the apex) and retrograde cavity preparation with ultrasonic tips were performed. Teeth were divided into 3 groups (n =10 each) following a stratified randomization according to the initial volume of the root-end cavity. After retrofilling, samples were stored for 7 days. Then, two rounds of micro-CT scans were performed: soon after root-end preparation (with the cavity still empty) and 7 days after root-end filling. Marginal gaps, internal voids volume (mm3 and %), as well as, the overall defects (sum of gaps and voids) were evaluated. Statistics compared the three groups in relation to those defects. There was not statistical difference between groups regarding the marginal gaps (P≥ 0.05), the internal voids (P≥ 0.05), and the overall defects (P≥ 0.05). Median (mm3) and % of overall air-entrapment defects (gaps and/or voids) was: 0.004mm3 and 1.749% for MTA Angelus, 0.018mm3 and 6.660% for Biodentine, and 0.012mm3 and 4.079% for Neo MTA Plus. All materials had gaps and/or voids. No differences were found between MTA Angelus, Biodentine and Neo MTA Plus.

Does MTA provide a more favourable histological response than other materials in the repair of furcal perforations? A systematic review

BACKGROUND

There is no consensus on which furcal perforation repair material induces a more favourable histological response. This systematic review of laboratory studies provides an overview of the studies comparing repair materials in animal models.

OBJECTIVES

To evaluate whether mineral trioxide aggregate (MTA) yields a more favourable histological response than other materials when used to repair furcal perforations in animal experimental models.

METHODS

This review followed the PRISMA checklist. The studies included various materials used to repair furcal perforations and compared the histological responses with MTA. An electronic search was conducted in EMBASE, PubMed, Scopus and Web of Science up to 2 September 2020, with no language or publication date restrictions. Studies whose full text was unavailable were excluded. The ARRIVE and SYRCLE tools were used to assess the methodological quality and risk of bias (RoB) of the studies.

RESULTS

The studies included in the qualitative synthesis were conducted in rat (n = 3) and dog (n = 17) models. They were classified as having a low quality, high methodological heterogeneity and high RoB. MTA and Biodentine, the materials most often compared, reduced the inflammatory reaction to mild over time. In addition, a mineralized tissue was formed in all studies. The response yielded by MTA was better than or equivalent to that of the other tested materials.

DISCUSSION

This review confirmed that MTA is the reference standard material for furcal perforation repair. However, research using animal models has inherent limitations, and the substantial methodological heterogeneity across the studies included should be considered. Therefore, the knowledge generated by this systematic review should be translated into clinical practice cautiously.

CONCLUSIONS

Features described in the report and quality assessment guidelines, such as PRIASE, ARRIVE and SYRCLE, should guide researchers. Despite the high RoB and the low methodological quality of the studies included, findings indicated that MTA yields a more favourable histological response than other materials in the repair of furcal perforations.

REGISTRATION

PROSPERO (CRD42020181297).

Effect of Blood Contamination on The Push-Out Bond Strength of Calcium Silicate Cements

This study investigated the effect of blood-contamination on the push-out bond strength of BiodentineTM (BD) and MTA Angelus® (MTA-A) to root dentin over time. Twenty-five teeth were sectioned horizontally to obtain 120 root slices. The lumens were filled with MTA-A or BD: 60 for each cement (30 uncontaminated and 30 blood contaminated). Push out bond strength to dentin was assessed at 24 h (n=10), 7 days (n=10) and 28 days (n=10). Failure modes were classified as: cohesive, adhesive or mixed failure. Two-way ANOVA was used to investigate the interaction between blood contamination vs. hydration period. Mann Whitney test compared different materials in each period, and it also compared the contaminated versus uncontaminated material for each period. Friedman, followed by Dunn`s test, compared periods of hydration for each material, regardless of blood contamination. Failure modes were reported descriptively. The interaction hydration period vs. blood contamination was highly significant for MTA-A (P=0.001) and it was not significant for BD (P=0.474). There were no differences between bond strength of uncontaminated and contaminated BD in any of the periods. Bond strength of uncontaminated MTA-A increased at each time of hydration; but it remained stable over time for blood-contaminated samples. BD had higher bond strength than MTA-A in all periods of hydration. Cohesive failure predominated. Only for MTA-A, the over time bond strength to dentin was affected by blood contamination.

A new in vitro method to evaluate radio-opacity of endodontic sealers

OBJECTIVES

To evaluate a new method for assessing the radio-opacity of endodontic sealers and to compare radio-opacity values with a well-established standard method.

METHODS

The sealers evaluated in this study were AH Plus(®) (Dentsply DeTrey GmbH, Konstanz, Germany), Endo CPM Sealer (EGEO SRL, Buenos Aires, Argentina) and MTA Fillapex(®) (Angelus Dental Products Industry S/A, Londrina, Parana, Brazil). Two methods were used to evaluate radio-opacity: (D) standard discs and (S) a tissue simulator. For (D), ten standard discs were prepared for each sealer and were radiographed using Digora(®) phosphor storage plates (Soredex; Orion Corporation, Helsinki, Finland), alongside an aluminium stepwedge. For (S), polyethylene tubes filled with sealer (n = 10 for each) were radiographed inside the simulator as described. The digital images were analysed using Adobe Photoshop(®) software v. 10.0 (Adobe Systems, San Jose, CA). To compare the radio-opacity among the sealers, the data were analysed by ANOVA and Tukey's test, and to compare methods, they were analysed by the Mann-Whitney U test. To compare the data obtained from dentin and sealers in method (S), Student's paired t-test was used (=0.05).

RESULTS

In both methods, the sealers showed significant differences, according to the following decreasing order: AH Plus, MTA Fillapex and Endo CPM. In (D), MTA Fillapex and Endo CPM showed less radio-opacity than aluminium. For all of the materials, the radio-opacity was higher in (S) than in (D). Compared with dentin, all of the materials were more radio-opaque.

CONCLUSIONS

The comparison of the two assessment methods for sealer radio-opacity testing validated the use of a tissue simulator block.

The impact of the addition of iodoform on the physicochemical properties of an epoxy-based endodontic sealer

Due to the low radiopacity of Sealer 26, iodoform is frequently empirically added to this sealer. Thus, the interference of this procedure with the physicochemical properties of Sealer 26 must be evaluated.

OBJECTIVE

This study evaluated the influence of the addition of iodoform on setting time, flow, solubility, pH, and calcium release of an epoxy-based sealer.

MATERIAL AND METHODS

The control group was pure Sealer 26, and the experimental groups were Sealer 26 added with 1.1 g, 0.55 g or 0.275 g of iodoform. Setting time evaluation was performed in accordance with the ASTM C266-03 speciflcation. The analysis of flow and solubility was in accordance with the ISO 6876-2001 speciflcation. For the evaluation of pH and calcium ion release, polyethylene tubes were filled with the materials and immersed in flasks with 10 ml of deionized water. After 24 h, 7, 14, 21, 28, and 45 days pH was measured. In 45 days, the calcium released was evaluated with an atomic absorption spectrophotometer.

RESULTS

The addition of iodoform increased setting time in comparison with pure sealer (P<0.05). As for flow, solubility, and calcium release, the mixtures presented results similar to pure sealer (p>0.05). In the 24 h period, the mixture with 1.1 g and 0.55 g of iodoform showed lower pH than pure sealer and than sealer added with 0.275 g of iodoform (P<0.05).

CONCLUSIONS

The iodoform added to Sealer 26 interferes with its setting time and solubility properties. Further studies are needed to address the clinical signiflcance of this interference.

Antibacterial activity of two MTA-based root canal sealers

AIM

To evaluate the pH and antibacterial activity of Endo CPM Sealer and MTA Fillapex by two different methods, using white MTA and Endofill as references for comparison.

METHODOLOGY

Antibacterial activity was evaluated against Enterococcus faecalis (ATCC 29212). The agar diffusion test (ADT) was performed to evaluate the effect before setting. The materials were placed in four equidistant wells made in ten agar plates. After incubation at 37 °C for 48 h, the inhibition zones were measured using a digital paquimeter. The direct contact test (DCT) was performed to assess the antibacterial effect after setting. Suspensions of crushed materials were prepared and mixed with E. faecalis. After different periods of time (1, 6, 15 and 60 min), the survival of bacteria was assessed by using 10-fold serial dilution and cultivated on agar plates in triplicate. Colony-forming units (CFU) mL(-1) were calculated after incubation. pH values were also measured in triplicate. Comparison between sealers in the ADT and DCT was performed by the Kruskal-Wallis test.

RESULTS

In the ADT, inhibition zones were found with MTA Fillapex and Endofill. They were similar to each other and greater than the other sealers (P < 0.05). None of the tested sealers demonstrated antibacterial activity in the DCT, and thus, all sealers had similar bacterial counts compared with the negative control group (P > 0.05). White MTA and Endo CPM Sealer suspensions had pH values >11, whilst MTA Fillapex and Endofill had lower values.

CONCLUSIONS

MTA Fillapex and Endofill had an antibacterial effect against E. faecalis before setting, but none of the sealers maintained antibacterial activity after setting, despite the high pH of the MTA-based materials.

Comparative in vivo analysis of the sealing ability of three endodontic sealers in post-prepared root canals

AIM

To compare the sealing ability of the endodontic sealers AH Plus, Sealer 26 and Endofill in premolar teeth of dogs exposed to the oral cavity after post-preparation.

METHODOLOGY

Forty teeth with two canals each underwent root canal cleaning and shaping. Before filling, the canals were randomly distributed into three groups according to the sealer to be used: Group 1 - AH Plus; Group 2 - Sealer 26; and Group 3 - Endofill (Dentsply, Indústria e Comércio Ltda.). Immediately after filling, the gutta percha and sealer were partially removed from the canals, leaving material only in the apical third of the root. The teeth were temporarily sealed with glass ionomer sealer for 72 h to ensure setting. The coronal seal was then removed and the canals were exposed to the oral cavity for 45 days. The animals were euthanased and their mandibles and maxillae were removed. After abundant irrigation with distilled water, the canals were dried and filled with India ink. The teeth were sealed again for 96 h before extraction. The roots of the extracted premolars were separated and stored in labelled test tubes. The roots were cleared and the extent of dye penetration was measured with a 20x stereoscopic magnifying lens.

RESULTS

Statistical analysis revealed that there were significant differences between the sealers studied (P < 0.001). Means for the extent of dye penetration for AH Plus, Endofill and Sealer 26 were, respectively, 0.13, 2.27 and 3.08 mm.

CONCLUSIONS

After 45 days exposure to the oral cavity, none of the sealers was capable of preventing leakage and coronal dye penetration. There were significant differences between the sealers studied, in terms of mean dye penetration.