Theaflavin-3,3'-digallate effectively attenuates biofilm formation by Enterococcus faecalis via the targeting of specific quorum sensing pathways.

Enterococcus faecalis, an opportunistic pathogen responsible for nosocomial infections, exhibits increased pathogenicity via biofilm formation. Theaflavin-3,3'-digallate (TF3), a theaflavin extracted from black tea, exhibits potent antibacterial effects. In the present study, we investigated the inhibitory effect of TF3 on E. faecalis. Our results indicated that TF3 significantly inhibited E. faecalis ATCC 29212 biofilm formation. This observation was further confirmed via crystal violet staining, confocal laser scanning microscopy, and field emission-scanning electron microscopy. To disclose the underlying mechanisms, RNA-seq was applied. TF3 treatment significantly altered the transcriptomic profile of E. faecalis, as evidenced by identification of 248 differentially expressed genes (DEGs). Through functional annotation of these DEGs, several quorum-sensing pathways were found to be suppressed in TF3-treated cultures. Further, gene expression verification via real-time PCR confirmed the downregulation of gelE, sprE, and secY by TF3. These findings highlighted the ability of TF3 to impede E. faecalis biofilm formation, suggesting a novel preventive strategy against E. faecalis infections.

Alterations and correlations in dental plaque microbial communities and metabolome characteristics in patients with caries, periodontitis, and comorbid diseases.

BACKGROUNDS: The pathogenic microorganisms and clinical manifestations of caries and periodontitis are different, caries and periodontitis are usually discussed separately, and the relationship between them is ignored. Clinically, patients prone to dental caries generally have a healthier periodontal status, whereas patients with periodontitis generally have a lower incidence of dental caries. The relationship between dental caries and periodontitis remains unclear. OBJECTIVES: This study aimed to explain the clinical phenomenon of antagonism between dental caries and periodontitis by exploring the ecological chain and bacterial interactions in dental caries, periodontitis, and other comorbid diseases. METHODS: The dental plaque microbiomes of 30 patients with oral diseases (10 each with caries, periodontitis, and comorbid diseases) were sequenced and analysed using 16 S rRNA gene sequencing. The Kyoto Encyclopaedia of Genes and Genomes (KEGG) database was used for a differential functional analysis of dental plaque microbial communities in caries, periodontitis, and comorbid diseases. RESULTS: The coinfection group had the greatest bacterial richness in dental plaque. The principal coordinate analysis showed that caries and periodontitis were separate from each other, and comorbid diseases were located at the overlap of caries and periodontitis, with most of them being periodontitis. Simultaneously, we compared the microbiomes with significant differences among the three groups and the correlations between the microbiome samples. In addition, KEGG pathway analysis revealed significant differences in functional changes among the three groups. CONCLUSIONS: This study revealed the composition of the dental plaque microbial communities in caries, periodontitis, and comorbidities and the differences among the three. Additionally, we identified a possible antagonism between periodontitis and caries. We identified a new treatment strategy for the prediction and diagnosis of caries and periodontitis.

Preparation and Photocatalytic Degradation Performance of Amine-Rich Carbon Nitride with Structural Modulation of the Precursor.

The photocatalytic performance of graphitic phase carbon nitride (g-C3N4) is strongly influenced by its own microstructure as well as the precursor structure that causes the microstructure changes. In this paper, a composite precursor of sodium chloride and cyanamide (NaCl/CA-2) was obtained by freeze-drying, which possess an aggregated state different from that of the non-freeze-drying method. This new aggregation state with the introduction of sodium ions into the cyanamide lattice results in a higher activation energy of NaCl/CA-2 in the thermal polycondensation process of the molten salt-assisted preparation of g-C3N4, which prevented the condensation of two cyanamides to one dicyandiamide, ultimately obtaining FD-CN with an amino-rich structure. The nitrogen atoms on the amino group can provide the photocatalyst with more unpaired electrons that can participate in the photoexcitation process, further improving its electron-hole separation ability and charge transfer efficiency, thus effectively enhancing its photocatalytic activity. Compared to the original g-C3N4, the photocatalytic activity of FD-CN for the degradation of methylene blue increased 2.19 times.

Prevalence and characteristics of accessory mandibular canals in an eastern Chinese population by cone beam computed tomography.

PURPOSE: This retrospective study aimed to determine the prevalence and morphological characteristics of accessory mandibular canals (AMCs) in an eastern Chinese population to provide clinical guidance for reducing intraoperative and postoperative complications. METHODS: Cone beam computed tomography (CBCT) scans of 300 Chinese patients were used to identify AMCs according to a modification of Naitoh's classification. The length of the branch (L0) and the upper and lower angles between the branch and mandibular canal were measured on sagittal images. Additionally, the branches were divided into narrow or wide types by calculating the ratio of the branch diameter to the main canal diameter. The location of the bifurcation point was characterized by measuring its distance to the buccal wall of the mandible (L1), lingual wall of the mandible (L2) and alveolar ridge (L3). RESULTS: The prevalence rate of AMCs was 40.7% (95% CI: 35.1-46.3), and the most common type was the retromolar canal, followed by the forward canal, dental canal, trifid mandibular canals (TMCs) or others, inferior canal and buccolingual canal. Twenty-one cases of multiple branches with unusual patterns were observed in the study. The average values of L0, L1, L2 and L3 were 15.05 ± 0.63 mm, 5.79 ± 0.14 mm, 4.40 ± 0.18 mm and 14.61 ± 0.31 mm, respectively. The mean upper angle and lower angle were 141.59° ± 2.44° and 50.64° ± 2.57°, respectively. Approximately 20.8% of the branches were defined as wide type, and no statistical significance was found between different types. CONCLUSION: AMCs are not rare anatomic variations of the mandibular canal in the eastern Chinese population; thus, CBCT examination is highly recommended for precise evaluation before surgeries involving the mandibles.

Application of WeChat-based flipped classroom on root canal filling teaching in a preclinical endodontic course.

BACKGROUND: This study was aimed to evaluate the application of WeChat-based flipped classroom in root canal filling teaching in a preclinical endodontic course. METHODS: A two-group comparative study was designed. The pre-class test, on-site quiz, and root canal filling on extracted premolars were performed by students from a lecture-based classroom group (LG, n = 30) and a WeChat-based flipped classroom group (WFG, n = 30). Results of the Pre-class test and on-site quiz were analyzed by independent samples t-test. Post-filling radiographs were taken and evaluated by a specialist in oral radiology who was blinded to grouping. Results of root canal fillings were analyzed by the Pearson chi-square test. Student responses in questionnaires were analyzed by Fisher's exact test. RESULTS: The students in WFG could get significantly higher scores in the on-site test and make better performances in root canal filling than those in LG. In terms of questionnaires, students from WFG were perceived to be more motivated to learn, better to understand the knowledge, better to improve communication and clinical skills, easier to perform root canal filling but spending more time. CONCLUSION: The WeChat-based flipped classroom teaching can have a better effect than lecture-based teaching on root canal filling learning for students with limited endodontic experiences.

Captopril inhibits matrix metalloproteinase activity and improves dentin bonding durability.

OBJECTIVES: We investigated the inhibitory effects of captopril on matrix metalloproteinases (MMPs) and its effect as a primer on dentin bonding durability. MATERIALS AND METHODS: One hundred fifty human third molars were selected. Flat surfaces of the middle dentin were exposed, etched 15 s, and followed by pretreatment with a primer for 60 s, including distilled water (control, the negative control primer), 2% chlorhexidine digluconate (CHD, the positive control primer), and captopril solution. Inhibitory effects of primers on MMPs were evaluated by hydroxyproline and gelatinase activity tests. All primers were applied on dentin followed by bonding. Some of the samples were sliced into slabs, placed in a fluorescent solution containing gelatin, and incubated for in situ zymography. Some were cut into sticks, and after aging for 1 day, 12 months, or 24 months, microtensile bonding strength was tested. Some were cut into slabs, aged for 1 day, 12 months, or 24 months, and taken out for nanoleakage tests to reveal interface defects. RESULTS: Hydroxyproline and gelatinase activity analyses showed that captopril exerted better inhibitory effects on MMPs, relative to 2% CHD (p < 0.05). A 0.2% captopril aqueous solution (0.2% CapW) was chosen to apply to the dentin. In situ zymography showed that inhibitory effects of captopril on gelatinase were significantly higher compared to 2% CHD (p < 0.01). Microtensile strength revealed that the bonding effects of the 0.2% CapW group lasted longer, compared to the control and 2% CHD groups (p < 0.05). Interface defects, detected by nanoleakage, were significantly reduced in the 0.2% CapW group, compared to the control and 2% CHD groups (p < 0.05). CONCLUSIONS: Captopril inhibits dentin MMP activities and effectively improves dentin bonding durability. CLINICAL RELEVANCE: Captopril is a promising dentin bonding primer for improving bonding durability.

Influence of needle working length and root canal curvature on irrigation: a computational fluid dynamics analysis based on a real tooth.

BACKGROUNDS: To compare the irrigation efficiency with different needle working length and different root canal curvature based on a real unshaped root canal using computational fluid dynamics (CFD) method. METHODS: Images of the root canal of the maxillary first molar after being prepared to .04/15 were scanned using micro-CT, and then imported into the software for three-dimensional reconstruction. A palatal root canal with a curvature of 23.4° was selected as the experiment canal. The needle working length of the 30-G flat needle was 4.75 mm, 5 mm, 5.25 mm and 5.5 mm short of apical foramen respectively, the flow pattern, irrigation velocity, shear stress were compared. The modified curved canals with a curvature of 0°, 5°, 10°, 20° and 30°were reconstructed via software. The flat needle was replaced at the optical inserted depth, and key parameters of irrigation efficiency were analyzed. RESULTS: Decreased needle working length had a positive impact on irrigation efficiency. With the optimal needle working length, the replacement of the apical irrigation fluid, the effective velocity, and wall shear stress were significantly improved in more severely curved root canals. With the same needle working depth and analogous canal curvature, irrigation efficiency is higher in real canal than that of modified canal. CONCLUSIONS: Short needle working depth, large curvature and the anomalous inner wall of canals help to improve irrigation efficiency.

Adhesive Ability of Different Oral Pathogens to Various Dental Materials: An In Vitro Study.

Introduction: In dental treatments, the reason for secondary caries and the failure of root canal treatment is the microbial infection, which concerns most dentists. The challenge of how to reduce the number of bacteria at the filling materials and the number of residual bacteria in the root canal has become a research hotspot. In this study, the bacterial adhesion properties of several common dental materials were compared to provide a theoretical basis for the selection of antibacterial properties of dental materials. Methodology. Three commonly used dental restorative materials and five sealers in root canal treatment were selected. Each material block was immersed in the corresponding supragingival (Streptococcus mutans and Actinomyces viscosus) or subgingival (Porphyromonas gingivalis and Enterococcus faecalis) bacterial solution and cultured under anaerobic conditions at 37°C for 2, 4, 6, 8, 12, 16, 20, and 24 h. The adhesion of bacteria was observed, and the number of different bacteria adhering to various material model disks was calculated at different time intervals under a scanning electron microscope. The adherent CFU load of the materials was determined by colony counting. Results: Streptococcus mutans and Actinomyces viscosus exhibited the strongest adhesion ability to the resin material blocks. Porphyromonas gingivalis and Enterococcus faecalis exhibited the highest adhesion ability to the AH-Plus sealer block. Conclusions: In dental treatments, dental materials should be selected based on the chemical, physical, and biological properties of materials. In addition, it is necessary to develop new antibacterial dental materials.

[Dynamic Microbial Shifts and Functional Analysis of Saliva Microbial Communities with Caries Children].

Objective: To observe the dynamic changes in the salivary microbiota of children with dental caries and those who were caries-free and to analyze the functional differences in the oral microecology of the two groups during the course of sugar metabolism and the synthesis and transport of multiple amino acids. Methods: Ten children with dental caries and 10 caries-free children were enrolled. We employed Illumina metagenomics technology to analyze the composition and function of salivary microbiome in children with and without caries. Six months later, PacBio single-molecule long-read sequencing technology was used to analyze the changes over time in the oral microbial communities of the two groups. We studied the patterns of change in the oral microbial communities under diseased or healthy conditions and attempted to offer a comprehensive interpretation of children's oral microbiota in terms of its composition and functions. Results: The composition of the oral microbiota of children with or without dental caries changed significantly over time. At the phylum level, changing trends in the salivary microbial communities of children with dental caries were in line with those in caries-free children. In these microbial communities, increased proportions of Firmicutes and decreased proportions of Actinobacteria and Bacteroidetes were found in the two groups. At the genus level, however, the two groups showed significantly different changes of the salivary microbial communities. Upward trends in the abundance of Lactobacillus, Methylobacterium, and Megasphaera were found in the caries group, while the abundance of these genera in the caries-free group showed downward trends. At the species level, L. fermentum, L. gasseri, L. oris, S. downei, and some other species belonging to the genus Lactobacillus showed upward trends in the saliva of children with caries, while they consistently stayed at a relative low level of abundance in caries-free children. The abundance of S. gordonii and S. mutans decreased to a certain extent in children with dental caries, but the abundance of S. gordonii and S. mutans in caries-free children were always at a low level. Species such as S. mutans and C. gracilis were positively correlated to the sum of decayed, missing and filled teeth (dmft), while N. flavescens was negatively correlated to dmft. gltA, icd, and mqo, the key genes related to tricarboxylic acid (TCA) cycle, gudB, a glutamate synthesis-related gene, and argAB/C/J, arginine synthesis-related genes, were significantly increased in caries-free children. In addition, the abundance of the NADH dehydrogenase-related gene nuoB/C/D/E/H/I/J/K/L/M in the electron transport chain increased significantly in caries-free children. Conclusion: Dynamic changes were found in the oral microbiota of children with or without caries. The trends of microbial shifts over time were associated with the oral health status. Oxidative phosphorylation and the synthesis and transport of amino acids such as glutamate and arginine in the oral microecology were more active in caries-free children.

Salivary microbial community alterations due to probiotic yogurt in preschool children with healthy deciduous teeth.

Probiotics are considered valuable to human health since they improve intestinal microbial balance. Probiotics are orally taken and affect the oral microbiota, which is one of the most important parts of the human microbial community. However, there is little information on the effects of probiotics on the oral microbiota. Caries-free preschool children (N = 6) with complete deciduous dentition were enrolled and given 100 g probiotic yogurt daily for 1 year. Salivary samples were collected every 6 months and then sequenced by Illumina MiSeq system based on 16S rDNA V3-V4 hypervariable regions. The data were analyzed to obtain the changes in microbiota profiles before and after the probiotic yogurt consumption. The α diversity analysis showed that salivary microbial diversity and richness were similar between the groups. The ß diversity analysis showed that salivary microbial community structure changed with the consumption of probiotic yogurt. The variation of the microbial community composition was mainly due to 9 genera; for 7 genera (Campylobacter, Haemophilus, Lautropia, Bacillus, Catonella, Lactococcus, and Solibacillus) increased, while 2 genera (Gemella, and Streptococcus) decreased. The variation of salivary microbiota structure and composition with the consumption of probiotic yogurt was revealed. This expands overall insights on the effects of probiotic products on oral microecology. It further provides a basis for predicting possible relations between probiotic interventions and oral health in preschool children.

Retrospective study on the effectiveness of a prevention strategy in a dental hospital during the COVID-19 pandemic.

OBJECTIVES: To evaluate the effectiveness of a prevention strategy against the spread of SARS-CoV-2 infection among dental hospital staff over a 3-month period. MATERIALS AND METHODS: The effectiveness of the prevention strategy, which adopted healthcare staff protective measures, including patient triage and correct usage of personal preventive equipment, was evaluated by SARS-CoV-2 detection and serological testing. Patients who visited the Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China, between January 31 and March 1 (lockdown period) and March 2 and April 27 (reopening period) in 2020 and in the same period in 2019 were included in the study. Patients' diagnosis, age, gender, and several undergoing aerosol-generating procedures during the study period were collected from the hospital's database. Corresponding data were compared year-on-year (2020-on-2019). A total of 757 hospital staff underwent SARS-CoV-2 detection and serological testing on April 28-29, 2020. RESULTS: During the lockdown and reopening period in 2020, the number of hospital visits was dramatically decreased to about 6% and 58%, respectively, compared with the same period in 2019. However, emergency visits were increased 16- and 6.4-fold. A total of at least 6654 patients (13.58%) underwent aerosol-generating procedures during the study period in the year 2020. All hospital staff were negative according to SARS-CoV-2 detection and serological testing (IgG, IgM) data. CONCLUSION: During the study period in 2020, the total number of hospital visits dramatically reduced but emergency visits significantly increased. The prevention strategy implemented successfully prevented SARS-CoV-2 infection spread among healthcare workers in a dental hospital. CLINICAL RELEVANCE: The prevention strategy indicated patient triage and how to adopt preventive measures for controlling SARS-CoV-2 spread among healthcare workers. These data can be used as a reference for other sectors suffering from the COVID-19 pandemic.

In vivo Microbial Diversity Analysis on Different Surfaces of Dental Restorative Materials via 16S rDNA Sequencing.

BACKGROUND This study aimed to provide precise material selection guidance for proper clinical restoration and treatment of plaque-related oral diseases, such as dental caries and periodontal diseases. MATERIAL AND METHODS Four groups (n=24) of restorative material sheets (n=24) were prepared using 3M Z350 composite resin (ZR), zinc phosphate cement (ZPC), glass-ionomer (GI), and ICON permeable resin (IPR). Six volunteers wore a plaque-collection device equipped with the 4 restorative material sheets for 48 hours. Plaque samples were collected, and Miseq sequencing was applied to obtain template DNA fragments for microbial diversity analysis. The data were analyzed with nonparametric tests. RESULTS The microbial diversity on the ZPC surface was significantly lower than that on GI and IPR surfaces. The abundance of Firmicutes and Streptococcus on the ZPC surface was significantly higher than on the surfaces of GI and IPR. In contrast, the abundance of Porphyromonas on the surface of ZPC was significantly lower than that on GI and IPR surfaces. (P<0.05). CONCLUSIONS The results of the present study might serve as a basis for material selection under different oral microbial conditions to provide more accurate treatments and restorative procedures in the oral cavity.

Improved High-Throughput Sequencing of the Human Oral Microbiome: From Illumina to PacBio.

BACKGROUND: A comprehensive understanding of the commensal microflora and its relation to health is essential for preventing and combating diseases. The aim of this study was to examine the structure of the oral microbiome by using different sequencing technologies. Material and Methods. Five preschool children with no symptoms of oral and systemic diseases were recruited. Samples of saliva were collected. A 468 bp insert size library was constructed on the MiSeq platform and then subjected to 300 bp paired-end sequencing. Libraries with longer insert sizes, including a full-length 16S rDNA gene, were sequenced on the PacBio RS II platform. RESULTS: A total of 122.6 Mb of raw data, including 244,967 high-quality sequences, were generated by the MiSeq platform, while 134.6 Mb of raw data, including 70,030 high-quality reads, were generated by the PacBio RS II platform. Clustering of the unique sequences into OTUs at 3% dissimilarity resulted in an average of 225 OTUs on the MiSeq platform; however, the number of OTUs generated on the PacBio RS II platform was 449, far greater than the number of OTUs generated on the MiSeq platform. A total of 437 species belonging to 10 phyla and 60 genera were detected by the PacBio RS II platform, while 163 species belonging to 12 phyla and 72 genera were detected by the MiSeq platform. CONCLUSIONS: The oral microflora of healthy Chinese children were analyzed. Compared with traditional 16S rRNA sequencing technology, the PacBio system, despite providing a lower amount of clean data, surpassed the resolution of the MiSeq platform by improving the read length and annotating the nucleotide sequences at the species or strain level. This trial is registered with NCT02341352.

Klf10 regulates odontoblast differentiation and mineralization via promoting expression of dentin matrix protein 1 and dentin sialophosphoprotein genes.

Klf10, a member of the Krüppel-like family of transcription factors, is critical for osteoblast differentiation, bone formation and mineralization. However, whether Klf10 is involved in odontoblastic differentiation and tooth development has not been determined. In this study, we investigate the expression patterns of Klf10 during murine tooth development in vivo and its role in odontoblastic differentiation in vitro. Klf10 protein was expressed in the enamel organ and the underlying mesenchyme, ameloblasts and odontoblasts at early and later stages of murine molar formation. Furthermore, the expression of Klf10, Dmp1, Dspp and Runx2 was significantly elevated during the process of mouse dental papilla mesenchymal differentiation and mineralization. The overexpression of Klf10 induced dental papilla mesenchymal cell differentiation and mineralization as detected by alkaline phosphatase staining and alizarin red S assay. Klf10 additionally up-regulated the expression of odontoblastic differentiation marker genes Dmp1, Dspp and Runx2 in mouse dental papilla mesenchymal cells. The molecular mechanism of Klf10 in controlling Dmp1 and Dspp expression is thus to activate their regulatory regions in a dosage-dependent manner. Our results suggest that Klf10 is involved in tooth development and promotes odontoblastic differentiation via the up-regulation of Dmp1 and Dspp transcription.

Candida species in periodontitis: A new villain or a new target?

OBJECTIVES: Recent research indicated that fungi might have a role in periodontitis alongside traditional periodontal pathogens. This state-of-the-art narrative review explores current concepts on the involvement of Candida species in periodontitis, and suggests the potential for ecological management of this disease. DATA, SOURCES AND STUDY SELECTION: A literature search was conducted for a narrative review on Web of Science, PubMed, Medline and Scopus about periodontitis associated with Candida species. Published articles, including case reports, case series, observational and interventional clinical trials, and critical appraisals of the literature were retrieved and reviewed. CONCLUSIONS: Several factors predispose individuals to periodontitis associated with Candida species. These include systemic diseases that lead to immunosuppression and oral environment changes such as cigarette smoking. While a consistent significant increase in the detection rate of Candida species in patients with periodontitis has not been universally observed, there is evidence linking Candida species to the severity of periodontitis and their potential to worsen the condition. Candida species may participate in the development of periodontitis in various ways, including cross-kingdom interactions with periodontal pathogens, changes in the local or systemic environment favoring the virulence of Candida species, and interactions between Candida-bacteria and host immunity. CLINICAL SIGNIFICANCE: Mechanical plaque control is the most common treatment for periodontitis, but its effectiveness may be limited, particularly when dealing with systemic risk factors. Understanding the specific role of Candida in periodontitis illuminates innovative approaches for managing the ecological balance in periodontal health.

Expert consensus on irrigation and intracanal medication in root canal therapy.

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment. However, irrigant selection or irrigation procedures are far from clear. The vapor lock effect in the apical region has yet to be solved, impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes. Additionally, ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified. Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes. Indeed, clinicians have been aware of these concerns for years. Based on the current evidence of studies, this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions. The evolution of different kinetic irrigation methods, their effects, limitations, the paradigm shift, current indications, and effective operational procedures regarding intracanal medication are also discussed. This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication, thus facilitating a better understanding of infection control, standardizing clinical practice, and ultimately improving the success of endodontic therapy.

Expert consensus on difficulty assessment of endodontic therapy.

Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy (RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system's anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Dual effectiveness of a novel all-in-one endodontic irrigating solution in antibiofilm activity and smear layer removal.

The continuous destruction of dental hard tissues increases the risk of bacterial invasion, which leads to pulp infections. Irrigation is critical for successful root canal treatment in terms of infection control. However, no single irrigant covers all of the functions demanded, including antibiofilm and tissue-dissolving activities. The aim of this study was to investigate the antimicrobial properties of Triton, an all-in-one irrigant, on Enterococcus faecalis and multispecies oral biofilms in dentin canals, as well as its ability to remove the smear layer. Dentin blocks (192 specimens) were prepared from single-root human teeth and then assigned to 48 groups (24 groups for each biofilm type). Serial centrifugation was used for bacterial introduction into dentinal tubules. After 3 weeks, half of the specimens were created a uniform smear layer. The following treatments were applied: short time (separate): Triton, 6% NaOCl, 2% NaOCl, and water (all for 3 min); short time (combined): Triton (3 + 1 min), 6% NaOCl +17% EDTA (3 + 1 or 2 + 1 min), and 2% NaOCl +17% EDTA (3 + 1 min); and long time: Triton (3 + 3 min), 6% NaOCl (5 min), 6% NaOCl +17% EDTA (5 + 1 min), and water (3 + 3 min). Confocal laser scanning microscopy and scanning electron microscopy were employed to examine the antimicrobial activity and smear layer removal, respectively. The results revealed that despite the absence or presence of the smear layer, Triton (3 + 3 min) showed the highest killing for both tested biofilms (61.53%-72.22%) among all groups (p < 0.05). Furthermore, the smear layer was removed by Triton after 3 + 3 min, exposing open dentin canals. These findings demonstrated that Triton can provide dual benefits of antibiofilm and smear layer removal capabilities simultaneously, indicating a simplified and effective strategy for application in root canal treatment.

Outcome of root canal treatment using warm vertical compaction with bioceramic and resin-based sealers: A randomised clinical trial.

This study aimed to compare the effect of a bioceramic sealer (iRoot SP) and a resin-based sealer (AH Plus) on the outcome of root canal treatment in a 2-year follow-up. Seventy-six teeth with irreversibly or necrotic pulp were recruited. After instrumentation and disinfection, the root canals were obturated using warm vertical compaction with iRoot SP (n = 43) or AH Plus (n = 33). Patients were followed up by clinical and radiographic examination at 6 12 and 24 months with recall rates of 84.2%, 65.8% and 48.7%, respectively. During each recall session, the success rates were 80%, 85.2% and 85% in the iRoot SP group and 82.8%, 91.3% and 88.2% in the AH Plus group. The success rates of the two groups did not differ significantly (p > 0.05). The bioceramic sealer resulted in a similar clinical performance and success rate to the resin-based sealer in endodontic treatment during a 2-year follow-up.

Combatting resistance: Understanding multi-drug resistant pathogens in intensive care units.

The escalating misuse and excessive utilization of antibiotics have led to the widespread dissemination of drug-resistant bacteria, posing a significant global healthcare crisis. Of particular concern is the increasing prevalence of multi-drug resistant (MDR) opportunistic pathogens in Intensive Care Units (ICUs), which presents a severe threat to public health and contributes to substantial morbidity and mortality. Among them, MDR ESKAPE pathogens account for the vast majority of these opportunistic pathogens. This comprehensive review provides a meticulous analysis of the current prevalence landscape of MDR opportunistic pathogens in ICUs, especially in ESKAPE pathogens, illuminating their resistance mechanisms against commonly employed first-line antibiotics, including polymyxins, carbapenems, and tigecycline. Furthermore, this review explores innovative strategies aimed at preventing and controlling the emergence and spread of resistance. By emphasizing the urgent need for robust measures to combat nosocomial infections caused by MDR opportunistic pathogens in ICUs, this study serves as an invaluable reference for future investigations in the field of antibiotic resistance.