Antimicrobial and Antibiofilm Properties of Bioceramic Materials in Endodontics

Microbes are prevalent in the root canals of necrotic teeth, and they are the cause of primary and post-treatment apical periodontitis. Bacteria can dwell within the infected root canal system as surface-adherent biofilm structures, which exhibit high resistance to antimicrobial agents. Bioceramic materials, with their biocompatible nature and excellent physico-chemical properties, have been widely used in dental applications, including endodontics. This review focuses on the application of bioceramic technology in endodontic disinfection and the antibiofilm effects of endodontic bioceramic materials. Different bioceramic materials have shown different levels of antibiofilm effects. New supplements have emerged to potentially enhance the antibiofilm properties of bioceramics aiming to achieve the goal of microbial elimination in the root canal system.

Cymbopogon citratus essential oil: an active principle of nanoemulsion against Enterococcus faecalis root canal biofilm

Aim: The objective was to formulate and characterize the nanoemulsion based on Cymbopogon citratus oil, intended for use in teeth infected root canal therapy. The investigation of the antioxidant and antibiofilm potential toward Enterococcus faecalis was aimed as well. Materials & methods: Characterization of oil (by GC/MS analysis) and nanoemulsion (by dynamic light scattering instrument), and determination of antibacterial (by microdilution assay), antibiofilm (by crystal violet assay) and antioxidant properties (by 2,2-diphenyl-1-picryl-hydrazyl-hydrate and thiobarbituric acid assay methods) were provided. Antibiofilm efficacy of irrigation procedure including nanoemulsion was screened on extracted teeth (by CFU counting assay). Results: Notable antibacterial and antibiofilm activity, both against forming and preformed biofilms of oil, was observed. Irrigation involved nanoemulsion showed remarkable antibiofilm potential. Both substances induced some antioxidant activity. Conclusion: Results encourage further research with the aim of application of the nanoemulsion in dental practice.

Inhibition of the CXCL9-CXCR3 axis suppresses the progression of experimental apical periodontitis by blocking macrophage migration and activation

Apical periodontitis (AP) is an acute or chronic inflammatory disease caused by complex interactions between infected root canal and host immune system. It results in the induction of inflammatory mediators such as chemokines and cytokines leading to periapical tissue destruction. To understand the molecular pathogenesis of AP, we have investigated inflammatory-related genes that regulate AP development. We found here that macrophage-derived CXCL9, which acts through CXCR3, is recruited by progressed AP. The inhibition of CXCL9 by a CXCR3 antagonist reduced the lesion size in a mouse AP model with decreasing IL-1β, IL-6 and TNFα expression. The treatment of peritoneal macrophages with CXCL9 and LPS induced the transmigration and upregulation of osteoclastogenic cytokines such as IL-1β, IL-6 and matrix metalloprotease 2, a marker of activated macrophages. This suggests that the CXCL9-CXCR3 axis plays a crucial role in the development of AP, mediated by the migration and activation of macrophages for periapical tissue destruction. Our data thus show that CXCL9 regulates the functions of macrophages which contribute to AP pathogenesis, and that blocking CXCL9 suppresses AP progression. Knowledge of the principal factors involved in the progression of AP, and the identification of related inflammatory markers, may help to establish new therapeutic strategies.

Prevalence, virulence and antifungal activity of C. albicans isolated from infected root canals

Background There is limited data on the prevalence of Candida species in infected root canal systems of human teeth. We attempted to investigate the prevalence, genotype, virulence and the antifungal susceptibility of Candida albicans isolated from infected root canals of patients with primary and post-treatment infections in a UAE population. Methods Microbiological samples from 71 subjects with infected root canals were aseptically collected, and cultured on Sabouraud dextrose agar, and C. albicans was identified using multiplex polymerase chain reaction, and the isolates were further subtyped using ABC genotyping system. Their relative virulence was compared using further four archival samples of endodontic origin from another geographical region, and four more salivary isolates, as controls. The virulence attributes compared were biofilm formation, and production of phospholipase and haemolysin, and the susceptibility to nystatin, amphotericin B, ketoconazole, and fluoconazole was also tested. Results 4 out of 71 samples (5.6%) yielded Candida species. On analysis of variance among the groups, the intracanal isolates, mainly Genotype A, possessed a high degree of phospholipase and haemolysin activity (p < 0.05). The UAE and Finland isolates were stronger biofilm formers and had superior phospholipase production capacity compared with the salivary isolates. All isolates were sensitive to the antifungal chemicals used. The salivary isolates were more sensitive to fluoconazole compared to other groups (p < 0.05). Conclusion The prevalence of C. albicans in infected root canals of patients attending a dental hospital in UAE is low. The strains isolated were good biofilm formers, possessed strong phospholipase and haemolysin activity and were mostly of the genotype A. The fact that the root canal isolates possessed significant hydrolase activity, imply that they are equipped with virulence attributes necessary for survival within a harsh intracanal ecosystem.

Effect of Bioactive Glass-Based Root Canal Sealer on the Incidence of Postoperative Pain after Root Canal Obturation

The purpose of this study is to evaluate the effect of a bioactive glass-based root canal sealer, Nishika Canal Sealer BG (CS-BG), on the incidence of postoperative pain (PP) after root canal obturation (RCO). Eleven dentists performed pulpectomy or infected root canal treatments for 555 teeth. During RCO, CS-BG was used. After RCO, the rate of PP and the factors affecting PP (pain during RCO and pain immediately after RCO) were analyzed. PP was observed in eight teeth (1.5%), and within 7 days after RCO, there were no teeth with pain. In these teeth with PP, there was a significant difference in the occurrence of pain during RCO, but not in the occurrence of pain immediately after RCO, when compared with pulpectomy and infected root canal treatment. These clinical results show that CS-BG has an excellent biocompatibility, and can suppress the distress of patients during RCO.

Fracture of endodontic instruments - Part 1: Literature review on factors that influence instrument breakage

Instrument fracture is a serious complication during endodontic treatment of teeth, having an adverse effect on the outcome of the nickel titanium (NiTi) treatment, especially if the fracture prevents apical access to the infected root canal. Despite the advent of NiTi files, the risk of fracture during the endodontic preparation of root canals, especially in severely curved canals, remains a serious concern. The fracture of NiTi files during preparation may result in a compromised prognosis for the tooth. In the presence of periapical lesions, instrument fracture may reduce the chances of successful healing.

Endodontic Biofilm - An Enigma to the dentist : A review article

Biofilm can be defined as a sessile multi-cellular microbial community characterized by cells that are firmly attached to a surface and enmeshed in a self produced matrix of extracellular polymeric substances.1,2 These are very prevalent in the apical root canals of teeth with primary and post-treatment apical periodontitis.3 It can be categorised as intracanal biofilms, extra radicular biofilms, periapical biofilms and biomaterial centered infections.4 The infected root canal harbors a polymicrobial population of aerobic, anaerobic, Gram-positive, and Gram-negative bacteria in a biofilm mode of growth. Bacterias involved are E. faecalis, Coagulase–negative Staphylococcus, S. aureus, Streptococci, P.aeruginosa, fungi, F. nucleatum, P. gingivalis, T. forsythensis, Actinomyces species and P. Propionicum. These are commonly isolated by culture, microscopy, immunological methods and molecular biology methods.3 The microbial communities grown in biofilm are remarkably difficult to eradicate with antimicrobial agents. Therefore, different antimicrobials ranging from antimicrobial irrigants to advanced antimicrobial methods such as lasers, photoactivated disinfection, and nanoparticles are employed in the management of infected root canal systems.4

Light-Activated Zirconium(IV) Phthalocyanine Derivatives Linked to Graphite Oxide Flakes and Discussion on Their Antibacterial Activity

In search of an effective antibacterial agent that is useful in photodynamic therapy, new derivatives of zirconium(IV) phthalocyanine (ZrPc) complexes were obtained and linked to graphite oxide flakes. In the syntheses of ZrPc derivatives, two bis-axially substituted ligands with terminal amino group and different lengths of linear carbon chain (C4 in 4-aminobutyric acid or C11 in 11-aminoundecanoic acid) were used. The optical properties (absorption and photoluminescence spectra) of ZrPcs and the composites were examined. Broadband red–near-infrared lamp was tested as an external stimulus to activate ZrPcs and the composites. Optical techniques were used to show generation of singlet oxygen during irradiation. Considering the application of graphite oxide-based materials as bacteriostatic photosensitive additives for endodontic treatment of periapical tissue inflammation, the antibacterial activity was determined on one Escherichia coli strain isolated directly from an infected root canal of a human tooth and one strain with silver and antibiotic resistance. Looking at the obtained results, modified levels of activity toward different bacterial strains are discussed.