Search Results (3)

Dental infections can disrupt root development in immature permanent teeth, making traditional endodontic treatment challenging. Apexogenesis, a regenerative approach that promotes natural root development, offers a potential solution. However, issues related to disinfection and material biocompatibility still remain. The objective of this study was to evaluate the synergistic antimicrobial and antibiofilm properties of double and triple antibiotic combinations against common oral pathogens, and to incorporate the most effective combination into a thermosensitive hydrogel, to develop an alternative intracanal medication. Antibiotics were tested alone and in combination in planktonic and biofilm conditions of oral bacteria and Candida albicans. The antibiotic combinations with potential antimicrobial synergy were tested on Enterococcus faecalis biofilms in radicular dentin by confocal microscopy. Metronidazole (ME), ciprofloxacin (CI), and fosfomycin (FO) were incorporated into poly(N-vinylcaprolactam) (PNVCL) hydrogels, and their antibiofilm activity was compared to PNVCL hydrogels containing chlorhexidine (CHX) or calcium hydroxide (CH). The cytotoxicity of the hydrogels was assessed on MDPC-23 odontoblast-like cells using metiltetrazolium assays. A statistical analysis was performed using ANOVA followed by Tukey’s test (p < 0.05). The combination of ME + CI + FO showed superior antibiofilm effects in mono- and dual-species biofilms and on biofilms inside dentinal tubules, comparable to CHX. PNVCL hydrogels with ME + CI + FO significantly reduced E. faecalis biofilms in dentinal tubules, exhibiting a higher efficacy than PNVCL + CH. Cytotoxicity tests revealed minimal effects on cell viability for both PNVCL hydrogels with and without antibiotics. In conclusion, ME + CI + FO showed potent antimicrobial synergy and, when loaded in thermosensitive PNVCL hydrogel, demonstrated significant antibiofilm activity and low cytotoxicity. These findings emphasize the potential of this formulation as an effective and biocompatible endodontic medication, especially for the treatment of immature permanent teeth. Full article

The regenerative endodontic procedure (REP) is an alternative solution for endodontic treatment of permanent teeth with incomplete root apex development. It results in angiogenesis, reinnervation, and further root formation. Indications for REP include immature permanent teeth with necrotic pulp and inflammatory lesions of the periapical tissues. The main contraindications comprise significant destruction of the tooth tissues and a lack of patient cooperation. We distinguish the following stages of this procedure: disinfection of the canal, delivery of the REP components, closure of the cavity, and follow-up appointments. For effective canal disinfection, the use of both rinsing agents and intracanal medicaments is suggested. Sodium hypochlorite and triple antibiotic paste are used most commonly. Light-activated disinfection is proposed as an alternative method. The prerequisite for the regeneration process of the pulp is the supply of its essential components: stem cells, growth factors, and scaffolds to the canal lumen. Blood clotting, platelet-rich plasma, and platelet-rich fibrin are used for this purpose. For a proper course of REP, it is also necessary to close the tooth canal tightly. For this purpose, mineral trioxide aggregate (MTA), tricalcium silicate (Biodentine), or types of glass ionomer cement are employed. The patient should attend regularly scheduled follow-up appointments and each time undergo a thorough interview, physical and radiological examination. The most important indicator of a successful REP is the continued growth of the root in length and thickness and the closure of the root apex visible on X-rays. Many different proposals for a management protocol have been published; the following paper proposes the authors’ original scheme. Regenerative endodontics is the future of the endodontic treatment of immature permanent teeth; however, it still requires a lot of research to refine and standardize the treatment protocol. The application of tissue engineering methods seems to be promising, also for mature teeth treatment. Full article

Alpha-adrenergic agonists, such as the Imidazoline derivatives (ImDs) of oxymetazoline and xylometazoline, are highly effective hemostatic agents. ImDs have not been widely used in dentistry but their use in medicine, specifically in ophthalmology and otolaryngology, warrants consideration for pulpal hemostasis. This review presents dental healthcare professionals with an overview of ImDs in medicine. ImD solutions have the potential to be more effective and biocompatible than existing topical hemostatic compounds in pulpal management. Through a comprehensive analysis of the pharmacology of ImDs and the microphysiology of hemostasis regulation in oral tissues, a conceptual model of pulpal management by ImD solutions is presented. Full article