Search Results (38)

Cannabinoids have been shown to have effective antibacterial applications. With the limitations of current intracanal endodontic medicaments and the rise of bacterial resistance, it is important to investigate novel treatment strategies for endodontic infections. The aim of this study was to test the antibacterial efficacy of cannabinoids on bacteria in persistent endodontic infections: Enterococcus faecalis, Streptococcus mutans, and Fusobacterium nucleatum. Planktonic bacteria were exposed to a negative control (no exposure), a positive control (3% NaOCl), and the experimental groups Cannabidiol (CBD), Cannabinol (CBN), and Tetrahydrocannabinol (THC). The Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) were also investigated. Biofilms were cultured and treated with cannabinoids. A crystal violet assay (CVA) and live/dead analysis assessed the biofilm degradation and inhibition, respectively. A statistical analysis was performed using an ANOVA. CBD, CBN, and THC reached a MIC for both E. faecalis and S. mutans in planktonic forms. The MBC was found for the tested cannabinoids on planktonic E. faecalis. No MBC was found for S. mutans. The live/dead analysis of E. faecalis and S. mutans biofilms showed a decrease in the viability of the biofilm with an increased cannabinoid concentration. The CVA revealed that cannabinoids only degrade the E. faecalis biofilm. Planktonic F. nucleatum had no MIC for tested cannabinoids. Cannabinoids have inhibitory effects on E. faecalis and S. mutans in the planktonic and biofilm states. No inhibitory effects of F. nucleatum were found at tested concentrations of all three cannabinoids. The findings suggest that cannabinoids have distinct antibacterial effects on certain pathogens associated with persistent endodontic infections. Full article

This study aimed to assess the biocompatibility and bioactivity of three different silver nanoparticles (AgNPs) and calcium hydroxide [Ca(OH)₂] mixtures against human dental pulp stem cells (hDPSCs). hDPSCs were treated with one of the following medicaments: 2 nm mixture, 5 nm mixture, 10 nm mixture, Ca(OH)₂ alone, and triple antibiotic paste (TAP). Cell viability was evaluated using the Cell Counting Kit-8 and LIVE/DEAD Viability/Cytotoxicity Kit. Reactive oxygen species (ROS) were quantified using the 2′,7′-dichlorofluorescein diacetate redox probe. Transforming growth factor (TGF)-β1, interleukin (IL)-1β, tumor necrosis factor (TNF)-α>, and alkaline phosphatase (ALP) were quantified using enzyme-linked immunosorbent assays. Mineralization was assessed using Alizarin Red S staining. Data were compared across groups using the Kruskal–Wallis test and within groups using the Wilcoxon signed-rank test (p < 0.05). Ca(OH)₂ alone and the 10 nm mixture demonstrated the highest cell viability and lowest ROS release (p < 0.05), while the 2 nm and 5 nm mixtures resulted in decreased viability and significant morphological distortion of the cells. Ca(OH)₂ alone and the 10 nm mixture comparably demonstrated the highest production of anti-inflammatory cytokine TGF-β1 (p < 0.05), the lowest production of proinflammatory cytokines IL-1β and TNF-α (p < 0.05), and the highest ALP release and mineralization (p < 0.05). Within the limitations of this in vitro study, Ca(OH)₂ alone and the 10 nm mixture improved hDPSCs’ viability, proliferation, differentiation, and mineralization. Both illustrated a significantly higher anti-inflammatory response by the residing stem cell population. Full article

Background/Objectives: Tooth discoloration is a common concern associated with the use of intra-canal medicaments, particularly those containing antibiotics. This study aims to evaluate the tooth discoloration potential of an experimental antibiotic paste modified with Nano Chitosan (APNC) and compare it with two antibiotic pastes and two calcium hydroxide-based pastes over different time intervals. Methods: Fifty bovine incisors were standardized and prepared up to size 60. The teeth were randomly assigned into five groups based on the medicament applied: Metapaste, Metapex, modified Triple Antibiotic Paste (mTAP), Double Antibiotic Paste (DAP), and APNC. A digital spectrophotometer was used to measure the color parameters (L*, a*, and b*) at two zones, above and below the cemento-enamel junction (CEJ), across four-time points: before application (T0- baseline), immediately after application (T1), after two weeks (T2), and after one month (T3). The color changes (ΔE) were calculated and statistically analyzed using repeated-measure ANOVA. Results: Statistically significant differences in discoloration were observed between the tested medicaments after one month (p < 0.05). mTAP caused the highest ΔE values both above and below the CEJ at all time points, particularly after one month (p < 0.05). Conversely, APNC, Metapaste, and DAP demonstrated the least discoloration, with no significant differences among them. The degree of discoloration was time-dependent and more pronounced below the CEJ in all groups. Conclusions: After one month, the experimental APNC paste induced tooth discoloration comparable to that of Metapaste, indicating minimal esthetic compromise. APNC may be a promising alternative to traditional antibiotic pastes with minimal discoloration effects. Full article

Intracanal reinfections continue to pose a major challenge in endodontic treatment. Photodynamic therapy has emerged as a promising antimicrobial strategy. Regarding this, curcumin (CUR), a natural photosensitizer, shows potential in this context, but its application is hampered by poor solubility and rapid degradation. This study aimed to develop and characterize a CUR-loaded nanoparticle-enriched hydrogel to enhance its stability, sustain its release, and evaluate its antimicrobial efficacy upon photoactivation (PhAc). Curcumin-loaded nanoparticles were synthesized and incorporated into a hydrogel matrix, followed by characterization using scanning electron microscopy, Fourier-transform infrared spectroscopy, in vitro CUR release studies, and rheological analysis. Antibiofilm activity against Enterococcus faecalis was assessed under both photoactivated and non-photoactivated conditions. Cytocompatibility was analyzed through fibroblast viability assays and fluorescence staining. The CUR-containing hydrogel demonstrated a sustained release profile extending beyond 72 h. Rheological studies confirmed its shear-thinning behavior, ensuring injectability even after post-photoactivation. Antibiofilm assays revealed a significant reduction in E. faecalis biofilms, with PhAc formulations exhibiting markedly enhanced antibacterial efficacy compared to their non-PhAc counterparts. Cytocompatibility assays confirmed that all formulations, including those subjected to PDT, preserved fibroblast viability, indicating biocompatibility suitable for clinical use. In sum, the CUR-containing hydrogel exhibits properties that support its potential as an effective intracanal therapeutic, combining antimicrobial and photodynamic effects to help prevent reinfections in endodontic treatments. Full article

Background/Objectives: Bacterial biofilms on root surfaces outside the apical foramen are linked to refractory apical periodontitis, as microorganisms can survive in extraradicular areas and cause persistent infections. This study aimed to precisely evaluate the relationship between extraradicular biofilm and persistent periapical periodontitis through an overview of case reports. Methods: A systematic search of PubMed, Web of Science, Scopus, Embase and ScienceDirect databases was conducted up to June 2023. Keywords included “extraradicular infection”, “wet canal”, “wet canals”, “extraradicular mineralized biofilms”, and “calculus-like deposit”. Only case reports meeting the inclusion criteria were analyzed. Results: Fifteen cases of extraradicular infection were identified, involving eight women and six men aged between 18 and 60 years. These cases included nine failed treatments confirmed through complementary methods such as histobacteriologic analysis, scanning electron microscopy (SEM), or polymerase chain reaction (PCR). Among these, four patients (six teeth) exhibited calculus-like deposits. Conclusions: Extraradicular biofilm is strongly associated with failed endodontic treatments, leading to persistent infections. A structured decision-making approach is essential. Before considering apical surgery, clinicians should prioritize intraradicular infection control through thorough irrigation, antimicrobial medicaments, and adjunctive disinfection techniques. When extraradicular biofilms or mineralized calculus are present, and symptoms persist after optimal intracanal disinfection, apical surgery should be performed. Full article

Background/Objectives: Pain after root canal treatment is a common concern that can greatly affect a patient’s quality of life. Identifying the factors contributing to this pain and focusing on those supported by high-quality research can lead to more effective pain management. This narrative review aims to analyze all available systematic reviews on this topic to determine what has been proven to help decrease pain following the root canal procedure. Methods: A comprehensive literature search was conducted across Scopus and Google Scholar from January 2000 to January 2024, using defined MeSH terms. This yielded 51 systematic reviews, of which 45 specifically investigated factors reducing postoperative pain related to root canal treatment. Results: Eleven factors were identified in the literature, with only eight factors supported by low- to moderate-quality evidence to reduce postoperative pain related to root canal treatment. These eight factors include (1) laser therapy, (2) nonsteroidal anti-inflammatory drugs (especially when combined with acetaminophen) and corticosteroids, (3) ultrasonic irrigation and low concentrations of sodium hypochlorite, (4) cryotherapy, (5) specific combinations of intracanal medicaments (notably calcium hydroxide with chlorhexidine), (6) bioceramic sealers, (7) rotary instrumentation, and (8) apical patency. Conclusions: The insights gained from this narrative review highlight several important factors that reduce postoperative pain related to root canal treatment. Nevertheless, the observed variability in the quality of the evidence calls attention to the necessity for further high-quality research. Full article

Intracanal medicaments are an important adjunct to the effective disinfection of the root canal system. However, conventional intracanal medicaments do not provide adequate protection against Enterococcus faecalis, which is the organism of interest in many cases of root canal failures. This study aimed to evaluate the influence of biosynthesized calcium oxide nanoparticles (CaO NPs) on the antibacterial activity, pH, microleakage and cytotoxicity of intracanal medicaments. CaO NPs were biosynthesized by the direct thermal decomposition of eggshells (EGS) and the reduction of calcium nitrate with papaya leaf extract (PLE). These nanoparticles were mixed with a proprietary calcium hydroxide powder in 10% and 25% (w/w) concentrations and blended in analytical-grade coconut oil to formulate the experimental medicaments. These were then evaluated for antibacterial activity, pH, microleakage and cytotoxicity at 1 day, 7 days and 15 days. A proprietary calcium hydroxide paste formulation (MX) was used as the control. Means and standard deviations were calculated and analyzed using repeated-measures ANOVA for pH and three-way ANOVA for the antibacterial effect, microleakage and cytotoxicity, followed by LSD post hoc analysis. Significant antibacterial activity was noted against Enterococcus faecalis at all times, with zones of inhibition (ZOI) up to 19.60 ± 2.30 mm. pH levels up to 13.13 ± 0.35 were observed for the experimental groups. Microleakage remained comparable to the control, while cytotoxicity was not observed in any of the groups at any time. Intracanal medicaments formulated with 10% and 25% (w/w) of biosynthesized CaO NPs could be promising candidates for the disinfection of the root canal system compared to conventional counterparts. Full article

Calcium hydroxide represents the most commonly used intracanal dressing between sessions; however, it may not be effective against all types of microorganisms. Several compounds of plant origin have attracted increasing attention from researchers in recent years. The objective of this study was to evaluate the cytocompatibility and antimicrobial activity of calcium hydroxide associated with the essential oil of Cyperus articulatus and the new bioceramic intracanal medicament Bio-C Temp^®. Five experimental groups were designed: group Ca–C. articulatus essential oil; group CHPG-calcium hydroxide associated with propylene glycol; group CHCa-essential oil of C. articulatus associated with calcium hydroxide; and group U-UltraCal^® XS; group BCT-Bio-C Temp^®. The control group was a culture medium. Cytocompatibility was assessed by the methyltetrazolium (MTT) assay after exposure of the Saos-2 human osteoblast-like cell line to dilutions of commercial products/associations for 24 h and 72 h. The antimicrobial activity against mature Enterococcus faecalis biofilm was evaluated by the crystal violet assay. All commercial products/associations showed a cell viability similar to or even higher than the control group (p > 0.05) for both periods evaluated. C. articulatus essential oil associated or not with calcium hydroxide showed better antibiofilm capacity. C. articulatus associated or not with calcium hydroxide showed superior cytocompatibility and antimicrobial capacity, representing a promissory intracanal medicament. Full article

Background: This study investigated the biocompatibility and antibacterial efficacy of chitosan–gelatin (CH-G) scaffolds loaded with slow-releasing antibiotic formulations used in regeneration endodontic procedures (REPs). Methods: Scaffolds were fabricated using freeze drying and loaded with varying concentrations of augmentin or modified triple antibiotic paste (mTAP). High-resolution scanning electron microscopy (SEM) was used to characterize the scaffold, while drug release was monitored via UV-Vis spectrophotometry. Immortalized human mesenchymal stem cells (hMSCs) were cultured on CH-G scaffolds alone (control), either 0.1 mg/mL or 1 mg/mL of augmentin or mTAP, and 10 mg/mL calcium hydroxide (Ca(OH)₂). Cell viability and proliferation were assessed using the Alamar Blue assay and SEM, respectively, and live/dead staining further corroborated cell viability. Antibacterial activity against Enterococcus faecalis was evaluated using the MTT assay and confocal laser scanning microscopy (CLSM). Results: Augmentin at 0.1 mg/mL appeared to promote better cell growth and attachment within the scaffolds than all other formulations, exhibiting acceptable viability. SEM revealed improved cell attachment in augmentin and mTAP groups compared to the Ca(OH)₂ group. Augmentin at 1 mg/mL and mTAP groups significantly reduced viable bacteria compared to controls. Augmentin groups and mTAP at 1 mg/mL were highly effective in eliminating E. faecalis biofilms, with mTAP potentially causing more cell death within the remaining biofilm structures. Conclusions: This study suggests that CH-G scaffolds loaded with augmentin and mTAP, particularly at a concentration of 1 mg/mL, offer promising advantages for REPs due to their biocompatibility, antibacterial efficacy, and ability to promote cell attachment. Further research may explore the long-term effects in clinical settings. Full article

Regenerative endodontics (REP) is a new clinical modality aiming to regenerate damaged soft and hard dental tissues, allowing for root completion in young adults’ teeth. Effective disinfection is crucial for REP success, but commonly used antimicrobials often harm the niche dental pulp stem cells (DPSCs). To our knowledge, this is the first study to explore the biocompatibility and antimicrobial potential of pectin as a potential natural intracanal medicament for REPs. Low methoxyl commercial citrus pectin (LM) (pectin CU701, Herbstreith&Fox.de) was used in all experiments. The pectin’s antibacterial activity against single species biofilms (E. faecalis and F. nucleatum) was assessed using growth curves. The pectin’s antimicrobial effect against mature dual-species biofilm was also evaluated using confocal laser scanning microscopy (CLSM) after 30 min and 7 days of treatment. The DPSC biocompatibility with 2% and 4% w/v of the pectin coatings was evaluated using live/dead staining, LDH, and WST-1 assays. Pectin showed a concentration-dependent inhibitory effect against single-species biofilms (E. faecalis and F. nucleatum) but failed to disrupt dual-species biofilm. Pectin at 2% w/v concentration proved to be biocompatible with the HDPSCs. However, 4% w/v pectin reduced both the viability and proliferation of the DPSCs. Low concentration (2% w/v) pectin was biocompatible with the DPSCs and showed an antimicrobial effect against single-species biofilms. This suggests the potential for using pectin as an injectable hydrogel for clinical applications in regenerative endodontics. Full article

Endodontic infections arise from the interactive activities of microbial communities colonizing in the intricate root canal system. The present study aims to update the latest knowledge of nanomaterials, their antimicrobial mechanisms, and their applications in endodontics. A detailed literature review of the current knowledge of nanomaterials used in endodontic applications was performed using the PubMed database. Antimicrobial nanomaterials with a small size, large specific surface area, and high chemical activity are introduced to act as irrigants, photosensitizer delivery systems, and medicaments, or to modify sealers. The application of nanomaterials in the endodontic field could enhance antimicrobial efficiency, increase dentin tubule penetration, and improve treatment outcomes. This study supports the potential of nanomaterials as a promising strategy in treating endodontic infections. Full article

Effective root canal disinfection and the subsequent release of natural growth factors from dentin are crucial to the success of regenerative endodontic procedures. This study evaluated the effect of newly introduced calcium silicate-based temporary intracanal medicament Bio-C Temp and calcium hydroxide-based material UltraCal XS on the release of transforming growth factor β1 (TGF-β1) from root canal dentin. Twenty-two intact and fully developed human premolars from patients aged 15–18 were shaped and irrigated according to the current clinical recommendations. The teeth were then gently split in half, and the root canal dentin of paired samples was covered with Bio-C Temp or UltraCal XS. After 3 weeks of incubation, the specimens were conditioned with 17% EDTA and the collected solution was subjected to the quantification of the released TGF-β1 by performing an ELISA. One-way analysis of variance (ANOVA), followed by Tukey’s test, was selected to determine the statistically significant differences between the groups at the 0.95 confidence level. The highest mean value of released TGF-β1 (1993.1 pg/mL) was detected in the control group, where the root canal dentin was conditioned with 17% EDTA alone. Regarding the experimental groups, Bio-C Temp released a statistically significantly higher amount of TGF-β1 (282.14 pg/mL) compared to UltraCal XS (114.28 pg/mL; p = 0.0158). Bio-C Temp affected the release of growth factors from root canal dentin less than UltraCal XS and may therefore serve as an intracanal medicament for regenerative endodontic procedures. Full article

Intracanal medicaments with maximal antimicrobial efficacy and minimal damage to resident stem cells are essential for successful regenerative endodontic procedures. 2-Hydroxyisocaproic acid (HICA) could have the attributes of a potential intracanal medicament. This study evaluates its cytotoxicity, genotoxicity, and effects on the odontogenic and osteogenic differentiation of the stem cells of the apical papilla (SCAP). Cytotoxicity and cell viability assays were performed on cells treated for 24, 48, and 72 h with varying concentrations of HICA and compared to the standard intracanal medicament, calcium hydroxide. The genotoxicity was assessed via immunofluorescence for two markers of DNA double-strand breaks: phosphorylated γH₂AX and 53BP1. The SCAP differentiation was evaluated based on the alkaline phosphatase activity, Alizarin Red staining, and expression of odontogenic and osteogenic genes (DSPP1, BSP1, OCN, RUNX2) in the presence of selected HICA concentrations. HICA was not cytotoxic at concentrations up to 10 mg/mL, regardless of the exposure time, although it was cytostatic at all tested concentrations. HICA was not genotoxic at concentrations below 5 mg/mL. No difference in cytotoxicity or genotoxicity was found between HICA and calcium hydroxide at 1 mg/mL. HICA retained about 70% of the osteogenic differentiation potential at 1 mg/mL. Within the limitations of this in vitro study, we show that HICA at 1 mg/mL could be a potential intracanal medicament for REPs. Full article

The aim of this study is to assess and analyze the intratubular penetration of the intracanal medications nitrofurantoin (Nit), triple antibiotic paste (TAP), and calcium hydroxide (CH). Sixty freshly extracted single-rooted teeth were acquired and decoronated to a standard length of 15 mm. To prepare specimens up to size F3, rotary ProTaper instrumentation was employed. The prepared teeth were divided into three groups, each of which received one of the tested intracanal medicaments: Group I (calcium hydroxide), Group II (triple antibiotic paste), and Group III (nitrofurantoin). Using a size #30 Lentulo spiral, a freshly prepared therapeutic paste was placed into the canals, and the intracanal medicaments were allowed to set in the incubator at 100% humidity. The samples were subsequently sliced perpendicularly to their long axis using a precision saw and assessed under a scanning electron microscope to assess the depth of penetration of intracanal medicaments at the coronal, middle, and apical portions of the root canal dentin. The data were analyzed using one-way ANOVA and Tukey’s post hoc test. The statistical analysis revealed a significant difference between the experimental groups in the quantity and depth of sealer penetration (p < 0.05). In particular, as compared to the Nit group, both the CH and TAP groups had significantly smaller penetration areas (p < 0.05). In conclusion, this ongoing investigation indicates that nitrofurantoin penetrated dentinal tubules better than calcium hydroxide or triple antibiotic paste. Full article

Calcium salt precipitation induced by intracanal medicaments contributes to the formation of apical hard tissue during apexification. This study compared the calcium salt-forming ability of a new calcium silicate-based intracanal medicament (Bio-C Temp) with that of two commercial calcium hydroxide pastes (Calcipex Plane II and Vitapex) in a rat subcutaneous implantation model. Polytetrafluoroethylene tubes containing each of the three materials were subcutaneously implanted in 4-week-old male Wistar rats. After 28 days, the composition and amount of calcium salts formed at the material–tissue interface were assessed using micro-Raman spectroscopy, X-ray diffraction, and elemental mapping. The tested materials produced white precipitates that had Raman spectra with peaks corresponding to hydroxyapatite and calcite. X-ray diffraction detected hydroxyapatite formation on Calcipex Plane II and Vitapex implants, as well as calcite formation on all three materials. Elemental mapping revealed that Bio-C Temp generated significantly smaller calcium- and phosphorus-rich calcified regions within the subcutaneous connective tissue than Vitapex. These results indicate that Bio-C Temp produced less calcium salt in rat subcutaneous tissue than Vitapex, although all materials formed hydroxyapatite and calcite in rat subcutaneous tissue. Bio-C Temp could be less effective than Vitapex in promoting apical hard tissue formation during apexification. Full article