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Virdee SS, Albaaj FS, Grant MM, Walmsley D, Camilleri J, Cooper PR, Tomson PL. Antimicrobial Efficacy of Different Irrigant Solutions Using a Novel Biofilm Model: An In Vitro Confocal Laser Scanning Microscopy Experiment. Eur J Prosthodont Restor Dent 2023; 31:50-58. [PMID: 35857530 DOI: 10.1922/ejprd_2419virdee09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/15/2022] [Indexed: 03/03/2023]
Abstract
AIM To determine the ability of different irrigation solutions to biomechanically remove Enterococcus faecalis biofilm from a novel artificial root canal model during chemomechanical preparation. METHODS High resolution micro-computer-tomography scans of a mandibular molar's mesial root were used to produce 50 identical 3D-printed resin root canal models. These were cultured with E.faecalis over seven days to generate biofilm and subjected to chemomechanical preparation using: saline; 17% ethylenediaminetetraacetic acid (EDTA) or 2% sodium hypochlorite (NaOCl) alongside positive/negative controls (n = 10). Canals were prepared to 40/.06 taper, with 1 mL irrigation between instruments, followed by 5 mL penultimate rinse, 30 s ultrasonic activation and 5 mL final rinse. Residual biofilm volume (pixels) was determined following immunofluorescent staining and confocal-laser-scanning-microscopy imaging. Statistical comparisons were made using Kruskal-Wallis with post-hoc Dunn's tests (α ⟨0.05). RESULTS In all canal thirds, the greatest biofilm removal was observed with NaOCl, followed by EDTA and saline. The latter had significantly higher E.faecalis counts than NaOCl and EDTA (P ⟨0.01). However, no statistical differences were found between EDTA and NaOCl or saline and positive controls (P ⟩0.05). CONCLUSIONS Within limitations of this model, 17% EDTA was found to be as effective as 2% NaOCl at eradicating E.faecalis biofilm following chemomechanical preparation. Further investigations with multi-species biofilms are encouraged.
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Affiliation(s)
- S S Virdee
- Department of Restorative Dentistry, School of Dentistry, Birmingham, UK
| | - F S Albaaj
- Department of Conservative Dentistry, College of Dentistry, Mustansiriyah University, Baghdad, Iraq
| | - M M Grant
- Department of Restorative Dentistry, School of Dentistry, Birmingham, UK
| | - D Walmsley
- Department of Restorative Dentistry, School of Dentistry, Birmingham, UK
| | - J Camilleri
- Department of Restorative Dentistry, School of Dentistry, Birmingham, UK
| | - P R Cooper
- Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - P L Tomson
- Department of Restorative Dentistry, School of Dentistry, Birmingham, UK
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Zancan RF, Di Maio A, Tomson PL, Duarte MAH, Camilleri J. The presence of smear layer affects the antimicrobial action of root canal sealers. Int Endod J 2021; 54:1369-1382. [PMID: 33763882 DOI: 10.1111/iej.13522] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
AIM To assess the chemical and microstructural characteristics of dentine after the use of two irrigation protocols and correlate this with the antimicrobial properties of hydraulic calcium silicate cement (HCSC) sealers and changes to the dentine structure/chemistry after sealer placement. METHODOLOGY Two irrigation protocols - Protocol A using 2% NaOCl used 5 mL/5 min and Protocol B with 2% NaOCl (5 mL/5 min) followed by 17% EDTA (5 mL/3 min) - were used to prepare dentine. The chemical and microstructural changes following irrigation were assessed by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and Fourier transform infrared (FT-IR) spectroscopy (n = 5) on dentine obtained from the mid-root and coronal parts of extracted human teeth. Four sealers (AH Plus, BioRoot, MTA Fillapex, TotalFill) were characterized by SEM/EDS (n = 3). The ability of the sealers to eradicate intratubular Enterococcus faecalis biofilms was assessed by live/dead dye and confocal laser scanning microscopy to measure the percentage of living cells. The effect of combined irrigation and root filling on dentine was assessed by SEM and EDS analysis (n = 5). Statistical analysis was undertaken using one-way anova and a number of post hoc tests to detect intergroup differences. The F-test was used for comparison of variances in the microbiology testing. RESULTS The use of NaOCl alone left the smear layer intact, with traces of chlorine remaining on dentine. The use of BioRoot sealer restored the calcium levels of dentine which had been depleted by the irrigation with EDTA. BioRoot exhibited antimicrobial properties against intratubular bacteria even in the presence of smear layer (Protocol A). Smear layer removal improved the bactericidal effect of all sealers and Ca2+ leaching. The use of a chelating agent was important for the intratubular sealer penetration for AH Plus but not the other sealers. CONCLUSION The removal of smear layer was necessary for penetration of AH Plus into the dentinal tubules. BioRoot was a more effective sealer in reducing the bacterial load in the dentinal tubules than the other materials tested and the presence of smear layer did not affect its activity.
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Affiliation(s)
- R F Zancan
- Department of Restorative Dentistry, Dental Materials and Endodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - A Di Maio
- School of Biosciences, University of Birmingham, Birmingham, UK
| | - P L Tomson
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M A H Duarte
- Department of Restorative Dentistry, Dental Materials and Endodontics, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - J Camilleri
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Shah PK, Duncan HF, Abdullah D, Tomson PL, Murray G, Friend TM, Thomas S, Butcher S, Chong BS. Comparison of two case difficulty assessment methods on cohorts of undergraduate dental students – a multi‐centre study. Int Endod J 2020; 53:1569-1580. [DOI: 10.1111/iej.13377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- P. K. Shah
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
| | - H. F. Duncan
- School of Dental Science Trinity College Dublin The University of Dublin Dublin Ireland
| | - D. Abdullah
- Faculty of Dentistry Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia
| | - P. L. Tomson
- School of Dentistry University of Birmingham Birmingham UK
| | | | - T. M. Friend
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
| | | | - S. Butcher
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
| | - B. S. Chong
- Institute of Dentistry Barts & The London School of Medicine & Dentistry Queen Mary University of London London UK
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Arruda-Vasconcelos R, Louzada LM, Feres M, Tomson PL, Cooper PR, Gomes BPFA. Investigation of microbial profile, levels of endotoxin and lipoteichoic acid in teeth with symptomatic irreversible pulpitis: a clinical study. Int Endod J 2020; 54:46-60. [PMID: 32892394 DOI: 10.1111/iej.13402] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/31/2020] [Indexed: 12/28/2022]
Abstract
AIM To investigate the microbial profile, and levels of endotoxin (LPS) and lipoteichoic acid (LTA), in infected dentine (ID) and root canals (RC) at different phases of root canal treatment in teeth with symptomatic irreversible pulpitis. METHODOLOGY Ten volunteers were included, and samples were collected from infected dentine (ID) and the root canal lumen (RC) using sterile excavators and paper points, respectively. RC samples were taken before (S1) and after (S2) chemo-mechanical canal preparation (CMP), and after intracanal medication (ICM; S3). Checkerboard DNA-DNA hybridization was used for microbial analysis. The levels of LPS and LTA were evaluated using the limulus amebocyte lysate assay and ELISA, respectively. Shapiro-Wilk's test was used to verify data normality. Friedman's test was used to evaluate statistical differences using checkerboard DNA-DNA hybridization in the ID and RC at the different phases of the RC treatment. Post hoc Dunn's multiple comparison test was used to verify significant differences recorded at the different time-points. The levels of LPS and LTA were analysed statistically by using repeated measures anova and Tukey's post hoc test to evaluate differences in both sites. The significance level was set at 5% (P < 0.05). RESULTS A total of 40 DNA probes were used for microbial investigation of ID and RC samples using checkerboard DNA-DNA hybridization. The levels and complexity of bacteria were similar in the ID and initial RC samples. The levels of LPS and LTA in ID were significantly higher than the initial RC samples (S1; P < 0.05). Canal preparation was effective in significantly decreasing the levels of bacteria, LPS and LTA (P < 0.05). ICM did not provide additional reduction in the levels of bacteria and LPS (P > 0.05). However, a significant reduction in the levels of LTA was observed after ICM (P < 0.05). CONCLUSION The microbial profile of infected dentine and root canals of teeth with irreversible pulpitis was complex, harbouring different species including Gram-positive and Gram-negative, cocci and bacilli, and facultative and strict anaerobes. Root canal preparation was effective in reducing the levels of bacteria, LPS and LTA from the root canals of teeth with pulpitis.
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Affiliation(s)
- R Arruda-Vasconcelos
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, Brazil.,Department of Oral Biology, Institute of Clinical Sciences, The University of Birmingham School of Dentistry, Birmingham, UK
| | - L M Louzada
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, Brazil
| | - M Feres
- Dental Research Division, Department of Periodontology, Guarulhos University, Guarulhos, Brazil
| | - P L Tomson
- Department of Oral Biology, Institute of Clinical Sciences, The University of Birmingham School of Dentistry, Birmingham, UK
| | - P R Cooper
- Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - B P F A Gomes
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas - UNICAMP, Piracicaba, Brazil
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Virdee SS, Farnell DJJ, Silva MA, Camilleri J, Cooper PR, Tomson PL. The influence of irrigant activation, concentration and contact time on sodium hypochlorite penetration into root dentine: an
ex vivo
experiment. Int Endod J 2020; 53:986-997. [DOI: 10.1111/iej.13290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/09/2020] [Indexed: 12/29/2022]
Affiliation(s)
- S. S. Virdee
- Department of Restorative Dentistry School of Dentistry & Birmingham Dental Hospital University of Birmingham Birmingham UK
| | | | - M. A. Silva
- Histology School of Dentistry Federal University of Campina Grande Patos Brazil
| | - J. Camilleri
- Department of Restorative Dentistry School of Dentistry & Birmingham Dental Hospital University of Birmingham Birmingham UK
| | - P. R. Cooper
- Department of Oral Sciences Faculty of Dentistry University of Otago Otago New Zealand
| | - P. L. Tomson
- Department of Restorative Dentistry School of Dentistry & Birmingham Dental Hospital University of Birmingham Birmingham UK
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Duncan HF, Galler KM, Tomson PL, Simon S, El‐Karim I, Kundzina R, Krastl G, Dammaschke T, Fransson H, Markvart M, Zehnder M, Bjørndal L. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. Int Endod J 2019; 52:923-934. [DOI: 10.1111/iej.13080] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - H. F. Duncan
- Division of Restorative Dentistry Dublin Dental University Hospital Trinity College Dublin Dublin Ireland
| | - K. M. Galler
- Department of Conservative Dentistry and Periodontology University Hospital Regensburg Regensburg Germany
| | - P. L. Tomson
- School of Dentistry Institute of Clinical Sciences University of Birmingham Birmingham UK
| | - S. Simon
- Paris Diderot University, Paris 7 Paris France
| | - I. El‐Karim
- School of Medicine Dentistry and Biomedical Sciences Queen's University Belfast Belfast UK
| | - R. Kundzina
- Faculty of Health Sciences Institute of Clinical Odontology UiT the Arctic University of Norway Tromsø Norway
| | - G. Krastl
- Department of Conservative Dentistry and Periodontology University Hospital of Würzburg Würzburg Germany
| | - T. Dammaschke
- Department of Periodontology and Operative Dentistry Westphalian Wilhelms‐University Münster Germany
| | - H. Fransson
- Faculty of Odontology Department of Endodontics Malmö University Malmö Sweden
| | - M. Markvart
- Cariology and Endodontics Faculty of Health and Medical Sciences Department of Odontology University of Copenhagen Copenhagen Denmark
| | - M. Zehnder
- Department of Preventive Dentistry, Periodontology and Cariology University of Zurich Zurich Switzerland
| | - L. Bjørndal
- Cariology and Endodontics Faculty of Health and Medical Sciences Department of Odontology University of Copenhagen Copenhagen Denmark
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Abstract
Caries prevalence remains high throughout the world, with the burden of disease increasingly affecting older and socially disadvantaged groups in Western cultures. If left untreated, caries will advance through dentine stimulating pulpitis and eventually pulp infection and necrosis; however, if conservatively managed, pulpal recovery occurs even in deep carious lesions. Traditionally, deep caries management was destructive with nonselective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has been advocated for selective (partial) caries removal and a reduced risk of pulp exposure. Selective caries removal strategies can be one-visit as indirect pulp treatment or two-visit using a stepwise approach. Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy and the re-emergence of vital pulp treatment (VPT) techniques such as partial and complete pulpotomy. These changes stem from an improved understanding of the pulp-dentine complex's defensive and reparative response to irritation, with harnessing the release of bioactive dentine matrix components and careful handling of the damaged tissue considered critical. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. Unfortunately, the changes in management are only supported by relatively weak evidence with case series, cohort studies and preliminary studies containing low patient numbers forming the bulk of the evidence. As a result, critical questions related to the superiority of one caries removal technique over another, the best pulp capping biomaterial or whether pulp exposure is a negative prognostic factor remain unanswered. There is an urgent need to promote minimally invasive treatment strategies in Operative Dentistry and Endodontology; however, the development of accurate diagnostic tools, evidence-based management strategies and education in management of the exposed pulp are critical in the future.
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Affiliation(s)
- L Bjørndal
- Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Simon
- Paris Diderot University, Paris, France.,Hôpital de Rouen Normandie, Rouen, France.,Laboratoire IN SERM UMR 1138, Paris, France
| | - P L Tomson
- School of Dentistry, Institute of Clinical Sciences, Birmingham, UK
| | - H F Duncan
- Division of Restorative Dentistry & Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
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8
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Virdee SS, Butt K, Grant M, Camilleri J, Cooper PR, Tomson PL. A systematic review of methods used to sample and analyse periradicular tissue fluid during root canal treatment. Int Endod J 2019; 52:1108-1127. [DOI: 10.1111/iej.13104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/22/2019] [Indexed: 01/01/2023]
Affiliation(s)
- S. S. Virdee
- Department of Restorative Dentistry Institute of Clinical Sciences The University of Birmingham School of Dentistry Birmingham UK
| | - K. Butt
- Department of Restorative Dentistry Institute of Clinical Sciences The University of Birmingham School of Dentistry Birmingham UK
| | - M. Grant
- Department of Restorative Dentistry Institute of Clinical Sciences The University of Birmingham School of Dentistry Birmingham UK
| | - J. Camilleri
- Department of Restorative Dentistry Institute of Clinical Sciences The University of Birmingham School of Dentistry Birmingham UK
| | - P. R. Cooper
- Department of Restorative Dentistry Institute of Clinical Sciences The University of Birmingham School of Dentistry Birmingham UK
| | - P. L. Tomson
- Department of Restorative Dentistry Institute of Clinical Sciences The University of Birmingham School of Dentistry Birmingham UK
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9
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Wolters WJ, Duncan HF, Tomson PL, Karim IE, McKenna G, Dorri M, Stangvaltaite L, van der Sluis LWM. Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs. Int Endod J 2017; 50:825-829. [DOI: 10.1111/iej.12793] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- W. J. Wolters
- Center of Dentistry and Oral Hygiene; University Medical Center Groningen; Groningen The Netherlands
| | - H. F. Duncan
- Division of Restorative Dentistry & Periodontology; Dublin Dental University Hospital; Trinity College Dublin; Dublin Ireland
| | - P. L. Tomson
- College of Medical & Dental Sciences; The University of Birmingham School of Dentistry; Birmingham UK
| | - I. E. Karim
- Centre for Dentistry; School of Medicine; Dentistry and Biomedical Sciences; Queen's University Belfast; Belfast UK
| | - G. McKenna
- Centre for Public Health; Queens University Belfast; Belfast UK
| | - M. Dorri
- School of Oral and Dental Sciences; Bristol Dental School; Bristol UK
| | - L. Stangvaltaite
- Department of Clinical Dentistry; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
| | - L. W. M. van der Sluis
- Center of Dentistry and Oral Hygiene; University Medical Center Groningen; Groningen The Netherlands
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Tomson PL, Lumley PJ, Smith AJ, Cooper PR. Growth factor release from dentine matrix by pulp-capping agents promotes pulp tissue repair-associated events. Int Endod J 2016; 50:281-292. [DOI: 10.1111/iej.12624] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/18/2016] [Indexed: 12/17/2022]
Affiliation(s)
- P. L. Tomson
- Oral Biology; The University of Birmingham College of Medical and Dental Sciences; School of Dentistry; Birmingham UK
| | - P. J. Lumley
- Oral Biology; The University of Birmingham College of Medical and Dental Sciences; School of Dentistry; Birmingham UK
| | - A. J. Smith
- Oral Biology; The University of Birmingham College of Medical and Dental Sciences; School of Dentistry; Birmingham UK
| | - P. R. Cooper
- Oral Biology; The University of Birmingham College of Medical and Dental Sciences; School of Dentistry; Birmingham UK
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11
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Kelly RD, Palin WM, Tomson PL, Addison O. The impact of endodontic access on the biaxial flexure strength of dentine-bonded crown substrates - anin vitrostudy. Int Endod J 2016; 50:184-193. [DOI: 10.1111/iej.12608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/27/2015] [Indexed: 11/30/2022]
Affiliation(s)
- R. D. Kelly
- Biomaterials Unit; College of Medical and Dental Sciences; University of Birmingham School of Dentistry; Birmingham UK
| | - W. M. Palin
- Biomaterials Unit; College of Medical and Dental Sciences; University of Birmingham School of Dentistry; Birmingham UK
| | - P. L. Tomson
- Biomaterials Unit; College of Medical and Dental Sciences; University of Birmingham School of Dentistry; Birmingham UK
| | - O. Addison
- Biomaterials Unit; College of Medical and Dental Sciences; University of Birmingham School of Dentistry; Birmingham UK
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13
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Smith AJ, Lumley PJ, Tomson PL, Cooper PR. Dental regeneration and materials—a partnership. Clin Oral Investig 2008; 12:103-8. [DOI: 10.1007/s00784-008-0189-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 01/24/2008] [Indexed: 11/28/2022]
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Lynch CD, Shortall AC, Stewardson D, Tomson PL, Burke FJT. Teaching posterior composite resin restorations in the United Kingdom and Ireland: consensus views of teachers. Br Dent J 2007; 203:183-7. [DOI: 10.1038/bdj.2007.726] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2007] [Indexed: 11/09/2022]
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