Influence of Sapindus mukorossi extract in comparison to 17% EDTA as final root canal irrigant on the sealer penetration and microleakage of dentinal tubules.

OBJECTIVE: The study evaluated the effect of Sapindus mukorossi (SM) extract as a final root canal irrigant on sealer penetration (SP) in dentinal tubules and microleakage. MATERIALS AND METHODS: Samples were selected based on inclusion and exclusion criteria. An access opening in all samples was performed and the working length was decided using pro taper for canal finishing along with constant irrigation. Specimens were randomly divided into 3 groups. Group 1 was irrigated with 3 ml of 17% EDTA; group 2 was irrigated with SM irrigant and group 3 samples were irrigated with 0.9% saline. After obturation, samples were vertically placed in 1% methylene blue dye cut in half longitudinally, and viewed under a stereomicroscope. Analysis of SP in the dentinal tubule was assessed using scanning electron microscopy (SEM). For microleakage assessment, mean and standard deviation were reported and One-Way ANOVA was applied. SP was compared using Kruskal-Wallis' test. For inspecting the interaction between SM/EDTA and NaOCl, Fisher's exact test was applied. No statistically significant difference between microleakage in any of the tested groups was observed. The control group showed minimum leakage as compared to EDTA and SM. RESULTS: The results displayed that there was no significant difference, (p=0.67), between dentinal tubule SP at 2 mm. A significant difference between dentinal tubule SP among groups at 5 mm was observed (p<0.05). CONCLUSIONS: SM ethanolic extract showed comparable outcomes of smear layer removal and sealer penetration to 17% EDTA, as a final irrigant in root canal cleaning. Therefore, SM has the potential to be used as an adjuvant final irrigant in conjunction with NaOCl.

Comparative evaluation of Sapindus Mukorossi extract with 17% EDTA on smear layer removal in various parts of the tooth root.

OBJECTIVES: This study aimed to compare the effectiveness of an experimental root canal irrigant and 17% Ethylene-di-amine tetra acetic acid for removal of the smear layer in the coronal, middle and apical portions of the root canal. MATERIALS AND METHODS: Ninety human single rooted maxillary and mandibular teeth were selected for this study. The teeth were randomly divided into two experimental groups and one control group as follows: Group A (Ethanolic extract of Sapindus Mukorossi), Group B (17% EDTA), and Group C (Distilled water). The root canals of all three groups were prepared with stainless steel K-files by means of the standard step-back technique and irrigated with 5.25% sodium hypo chloride. The teeth were decoronated, following the irrigation and divided longitudinally into two-halves and visualized using scanning electron microscope (SEM) for the amount of smear layer present utilizing the three-point score system. The observations were noted both before and after the treatment. Nonparametric tests were applied for the comparison and p-value ⩽ 0.05 was considered as statistically significant. RESULTS: It was evident from that smear layer was completely removed in coronal portion of 27 out of 30 teeth in-group A. For middle and apical areas of group A, 24 and 19 teeth showed complete smear layer removal. In-group B it was found that there were 24, 21, and 3 teeth at coronal, middle and apical, areas respectively where smear layer were completely absent. Intra group comparison showed a significant difference (p = 0.002) in smear layer removal was found for group A at coronal, middle and apical thirds. Similarly, a significant difference (p = 0.001) was also found for group B; however heavy smear layer was found among the three parts of the canal for group C. CONCLUSIONS: Ethanolic extract of Sapindus Mukorossi have higher effectiveness in removing the smear layer from the root canal in comparison to 17% EDTA.

Canal pretreatment using cold atmospheric argon plasma, chitosan and Chlorine p6 activated by photodynamic therapy with EDTA as a final irrigant on the pushout bond strength of fiber post.

AIMS: To evaluate the effect of contemporary root canal irrigants i.e., Cold atmospheric argon plasma (CAAP), Chlorine p6 (Clp6), and chitosan on the push-out bond strength (PBS) of glass fiber post (GFP) and marten hardness (MH) of root canal dentin compared to NaOCl+EDTA. MATERIALS AND METHODS: The anatomic crown of sixty human mandibular premolars was removed by transversal section till cement-enamel junction (CEJ). Root canals were prepared and canals were dried and obturated using gutta-percha points and AH plus sealer. Post space was prepared and specimens were arbitrarily divided into four groups based on the post-space irrigation. (n = 15) Group 1: 5.25% NaOCl + 17% EDTA, Group 2: CAAP + 17% EDTA, Group 3: Chitosan + 17% EDTA and Group 4: Clp6 + 17% EDTA. For MH evaluation five samples from each disinfected group were taken and MH was assessed with the help of an ultra microhardness tester. GFP was cemented using self-etch dual cure cement on the remaining 10 samples from each group. Samples were vertically planted in acrylic resin blocks 1 mm thick slices were subjected to push-out testing and failure mode analysis using a universal testing machine and Stereomicroscope. ANOVA and Tukey multiple comparison tests were used to compare the means of bond integrity attained (p = 0.05). RESULTS: The maximum values of PBS and MH were displayed in group 1 (5.25% NaOCl + 17% EDTA) specimens. However, group 3 exhibited the minimum values of bond strength and MH scores. Intergroup comparison analysis revealed that group 2, group 3, and group 4 displayed comparable outcomes of PBS and MH (p > 0.05). The cervical and middle third of group 1 specimens displayed a cohesive type of failure. However, the apical section of group 1 and other tested groups exhibited the adhesive type of failure. CONCLUSION: Canal irrigation with 5.25% NaOCl and 17% EDTA appears to be better in terms of improving the bond integrity of fiber posts with no compromise in MH of the dentin as compared to the contemporary irrigant used.

Effects of traditional and novel proteolytic agents on tissue dissolution and dentine microhardness.

The study aimed to evaluate the tissue-dissolving ability of papain and bromelain with respect to that of sodium hypochlorite (NaOCl) at the temperatures of 25°C and 60°C. The study also assessed the effects of these proteolytic agents on radicular dentine microhardness. Warming NaOCl, papain and bromelain solutions resulted in significant tissue dissolution at all time intervals (p < 0.001). At 60°C, bromelain showed significantly higher tissue weight loss at every time interval when compared to NaOCl (p < 0.001). All of the three organic tissue dissolvents reduced the microhardness at 1 hr when compared to their respective baseline values. The reduction in microhardness from the baseline reading was statistically significant only in the papain group at 30 min (p = 0.018) and at 60 min (p = 0.03) when compared to the control group. Hence it was concluded that bromelain exerted superior tissue dissolution action, especially when warmed, with minimal effect on dentine microhardness.

Efficacy of disinfection procedures performed prior to regenerative endodontic therapy: An integrative review.

The aim of this integrative review was to identify whether the disinfection procedures performed prior to regenerative endodontic treatment were effective on biofilm removal from the root canals. The research was based on PubMed, Latin American and Caribbean Health Sciences Literature (Lilacs) and Scientific Electronic Library Online (SciELO) databases. Four articles were selected; one of the studies was in vivo and the others ex vivo. Different disinfection procedures were studied, characterised mainly by the use of intracanal medication, highlighting the double antibiotic paste, triple antibiotic paste and calcium hydroxide paste. Disinfection ability was evaluated against Enterococcus faecalis and multispecies biofilms by using the fluorescence technique and colony forming unit counting, for 7 to 21 days. Double antibiotic paste and triple antibiotic paste demonstrated excellent antibiofilm activity, unlike CH paste that showed limited disinfection, even when associated with different antimicrobial agents. Triple antibiotic paste was the most effective medication against biofilm.

Update on citric acid use in endodontic treatment: a systematic review.

This systematic review aims to analyse the available evidence concerning the use of citric acid (CA) in endodontics treatment and to assess its results in terms of different considerations: effect on smear layer removal, influence on sealer bond strength, activation effect by means of sonic or ultrasonic devices, effects on dentine surface, antibacterial activity, and effectiveness boost for regenerative procedures, releasing growth factors from dentin. To evaluate the results of CA as a final irrigant and compare them to other chelating agents. This review followed the PRISMA checklist. An electronic search was conducted in MEDLINE (OVID), Scopus (Elsevier) and the Web of Science (Thomson Reuters) databases. Risk of bias of included studies was evaluated using the modified CONSORT checklist and the PRIRATE checklist 2020 guidelines. 39 studies fulfilled the eligibility criteria to be included in this review: 27 in vitro studies using extracted human teeth, 10 in vitro studies using human dentin disks, and 2 RCT. Citric acid has proven to be effective in smear layer removal, showing better results in coronal and middle root thirds, improving its effect when combined with manual dynamic activation. There is no agreement regarding citric acid effect on sealer adhesion and adaptation to root canal walls due to heterogeneity within studies. Citric acid irrigation can decrease dentine microhardness and cause decalcification and erosion, especially when used before NaOCl. Citric acid has proven to be beneficial in regenerative endodontic procedures due to higher TGF-ß1 release.Trial registration: Prospero database CRD42021267055.

Bromelain-based endodontic irrigant: preparation, properties, and biocompatibility: An in-vitro study.

The aim of the study was to determine the properties, efficacy and biocompatibility of combining bromelain enzyme, chlorohexidine and EDTA (BCE) to create a novel endodontic irrigant. Fourier transform infrared spectrometry was performed to confirm the stability of the BCE and direct contact inhibition test was performed to determine antibacterial action. Baseline pH and surface tension of irrigants was compared with determine stability. Subcutaneous injection to dorsal skin of rabbits was graded for presence of inflammation, oedema, granulation and fibrosis. BCE caused less overall irritation, less oedematous and was earlier to heal than 2.5% NaOCl. The pH stability of BCE was also superior to 2.5% NaOCl. A one-way ANOVA test was performed for the direct contact inhibition and microleakage test. A significant difference was determined (p ≤ 0.05) between BCE and 2.5% NaOCl for antibacterial action. BCE irrigant is effective in preparing dentinal surfaces for root canal without adverse effects and promising longevity.

Potential of Bouea macrophylla kernel extract as an intracanal medicament against mixed-species bacterial-fungal biofilm. An in vitro and ex vivo study.

OBJECTIVE: To investigate the antimicrobial activity of B. macrophylla kernel extract against mixed-species biofilms of E. faecalis, S. gordonii and C. albicans in vitro. To evaluate the efficacy of the extract as an intracanal medicament compared with Ca(OH)2 and chlorhexidine in ex vivo tooth model. METHODS: The antibiofilm effect of B. macrophylla kernel extract was determined by AlamarBlue™ assay and the effect on biofilms was visualized by LIVE/DEAD® BacLight™ viability test. Mixed-species biofilms were incubated into the tooth model (N = 42) for 21 days. The teeth were randomly divided into 4 medicament groups for 7 days: (i) normal saline, (ii) calcium hydroxide (Ca(OH)2), (iii) chlorhexidine gel, (iv) B. macrophylla kernel extract. Dentine samples were collected, qPCR with PMA was used to quantify the viability and species composition of each sample. SEM was used to visualize the effect of medicament on biofilm structure. RESULTS: The MBIC was 6.25 mg/mL and the MBEC was 50 mg/mL. The integrity of microbial cells was progressively compromised as concentration increased, resulting in greater cell death. Ex vivo tooth model revealed that biofilm treated with 50 mg/mL of the B. macrophylla extract demonstrated a significantly higher proportions of dead cells than in Ca(OH)2, chlorhexidine and normal saline groups (p < 0.01). Disruption of biofilm structure and enlargement of dentinal tubules was observed in B. macrophylla group on SEM. CONCLUSION: The extract of B. macrophylla kernel exhibited significant antibiofilm effect against the mixed-species biofilms of E. faecalis, S. gordonii and C. albicans.

Comparative effects of SWEEPS technique and antimicrobial photodynamic therapy by using curcumin and nano-curcumin on Enterococcus faecalis biofilm in root canal treatment.

OBJECTIVES: This study aimed to compare the antimicrobial effects of the shock wave enhanced emission photoacoustic streaming (SWEEPS) technique and Antimicrobial photodynamic therapy (aPDT) with curcumin and nano-curcumin photosensitizers on Enterococcus faecalis (E. faecalis) biofilm in root canals of extracted teeth. MATERIALS AND METHODS: This experimental study was conducted on extracted single-rooted human teeth. The teeth were decoronated at the cementoenamel junction, the root canals were instrumented with BioRace system, and their apices were sealed. Smear layer was removed, and the teeth were autoclave-sterilized. E. faecalis strains were cultured in sterile brain heart infusion (BHI) and a bacterial suspension with 0.5 McFarland standard concentration was prepared. The root canals were inoculated with the bacterial suspension and incubated at 37 °C for 4 weeks. The teeth were then divided into 12 groups (curcumin, nano-curcumin, curcumin + LED, nano-curcumin + LED, curcumin + SWEEPS, nano-curcumin + SWEEPS, curcumin + LED + SWEEPS, nano-curcumin + LED + SWEEPS, SWEEPS, positive control and negative control). The number of colony forming units (CFUs) was counted and analyzed by one-way ANOVA and Tukey's test. RESULTS: A significant difference was noted in colony count among the groups (P<0.001). LED alone had the lowest and nano-curcumin + LED + SWEEPS had the highest root canal cleaning efficacy. SWEEPS along with curcumin, nano-curcumin, and LED significantly decreased the bacterial count compared with other groups (P<0.05). CONCLUSION: Application of the SWEEPS technique with curcumin and nano-curcumin as photosensitizer activated by LED in aPDT improved the reduction of E. faecalis in root canals.

Comparative evaluation of the antibacterial effect of Allium sativum, calcium hydroxide and their combination as intracanal medicaments in infected mature anterior teeth: A randomized clinical trial.

AIM: The purpose of this study was to compare the antibacterial effects of Allium sativum (garlic extract), calcium hydroxide (Ca [OH]2 ) and their combination as intracanal medicaments in infected mature anterior teeth using real-time PCR. METHODOLOGY: This prospective double-blind, controlled, parallel, superiority, randomized clinical trial was carried out on 66 permanent, necrotic incisors associated with asymptomatic apical periodontitis in 66 male patients. Patients were randomly divided into three groups (n = 22) according to the intracanal medications used. After access preparation, four microbiological samples (S) were taken using sterile absorbent paper points as follows: S1: before canal instrumentation and S2: after cleaning and shaping. The third sample (S3) and fourth sample (S4) were taken after the placement of the tested intracanal medications into their corresponding canals for 7 and 14 days, respectively. Total DNA was extracted from microbiological samples and relative quantitative real-time PCRs were done to quantify the relative gene expression fold change (FC) for Enterococcus faecalis and Streptococcus species. At significance level p ≤ .05, the data were statistically analysed in SPSS software using Kruskal-Wallis and Freidman's tests, followed by Dunn-Bonferroni post hoc test for pairwise comparisons. RESULTS: Both bacterial mean FC decreased significantly after mechanical instrumentation (S1 to S2) in all groups. However, no statistically significant differences were found after intracanal medicament placement (from S2 to S3 and from S3 to S4) except in the garlic group. Garlic significantly reduced Enterococcus faecalis FC in S3 and S4 when compared to Ca (OH)2 and Ca (OH)2 + garlic combination. However, garlic and Ca (OH)2 reduced Streptococcus bacteria in S3 similarly. Whilst in S4, garlic showed significantly more reduction than Ca (OH)2 . The combination of Ca (OH)2 with garlic extract showed the least significant bacterial reduction. CONCLUSION: Within the study limitations, garlic intracanal medicament has a comparable anti-Streptococcus efficiency to Ca (OH)2 , whilst it is more effective against Enterococcus faecalis species. When Ca (OH)2 and garlic are combined, their antibacterial effectiveness is reduced. Increasing the time of application for tested intracanal medicaments by more than one week has no additional antibacterial effectiveness.

Biochemical changes and macrophage polarization of a silane-based endodontic irrigant in an animal model.

Silane-based/fully hydrolyzed, endodontic irrigant exhibiting antimicrobial properties, is prepared, and is hypothesized to control macrophage polarization for tissue repair. Albino wistar rats were injected with 0.1 ml root canal irrigant, and bone marrow cells procured. Cellular mitochondria were stained with MitoTracker green along with Transmission Electron Microscopy (TEM) performed for macrophage extracellular vesicle. Bone marrow stromal cells (BMSCs) were induced for M1 and M2 polarization and Raman spectroscopy with scratch assay performed. Cell counting was used to measure cytotoxicity, and fluorescence microscopy performed for CD163. Scanning Electron Microscopy (SEM) was used to investigate interaction of irrigants with Enterococcus faecalis. K21 specimens exhibited reduction in epithelium thickness and more mitochondrial mass. EVs showed differences between all groups with decrease and increase in IL-6 and IL-10 respectively. 0.5%k21 enhanced wound healing with more fibroblastic growth inside scratch analysis along with increased inflammation-related genes (ICAM-1, CXCL10, CXCL11, VCAM-1, CCL2, and CXCL8; tissue remodelling-related genes, collagen 1, EGFR and TIMP-2 in q-PCR analysis. Sharp bands at 1643 cm-1 existed in all with variable intensities. 0.5%k21 had a survival rate of BMSCs comparable to control group. Bacteria treated with 0.5%k21/1%k21, displayed damage. Antimicrobial and reparative efficacy of k21 disinfectant is a proof of concept for enhanced killing of bacteria across root dentin acquiring functional type M2 polarization for ethnopharmacological effects.

Cytotoxicity of root canal irrigating solutions and photodynamic therapy using curcumin photosensitizer.

BACKGROUND: Photodynamic therapy (PDT) has shown satisfactory antibacterial effects. However, little information regarding the cytotoxicity potential of PDT using curcumin as a photosensitizer (PS) on fibroblasts are found. The aim of this in vitro study was to evaluate the cytotoxicity of root canal irrigating solutions and photodynamic therapy with curcumin PS on the L-929 cell line. METHODS: Healthy mouse skin fibroblast cells were distributed into the following 7 experimental groups: G1 - culture medium DMEM (control group); G2 - 0.9% sodium chloride; G3 - 2.5% sodium hypochlorite (NaOCl); G4 - 5% NaOCl; G5 - PDT with curcumin PS at 500 mg/L + blue LED; G6 - PDT with curcumin PS at 750 mg/L + blue LED; and G7 - PDT with curcumin PS at 1000 mg/L + blue LED. All experimental groups which underwent PDT action were submitted to blue LED for 4 min, with a wavelength of 480 nm and energy fluency of 75 J/cm². The cultures were maintained under standard cell culture conditions (37°C, 100% humidity, 5% CO2). Cell viability analysis was performed using the colorimetric method to evaluate the periods of 6, 24, and 48 h. Data were subjected to the Kruskal-Wallis test, followed by the Dunn test to compare groups and Friedman test to compare periods (α = 0.05). RESULTS: When comparing the periods, no significant differences were observed for any of the experimental groups analyzed (p > 0.05), except for the NaOCl2.5 group that exhibited higher cell viability at 6 h compared to the period of 48 h (p = 0.0489). In the comparisons of the experimental groups, there were no statistically significant differences between the control group compared to all disinfection protocols, regardless of the period evaluated (p > 0.05), except for the PDT + C1000 group that showed lower cell viability (P < 0.05). CONCLUSIONS: PDT with curcumin at 1000 mg/L was cytotoxic on L-929 fibroblast cell culture. However, laser-activated curcumin at a concentration of 500 mg/L presented no influence on L-929 fibroblast cell viability in in vitro conditions.

Effect of Citric Acid Versus EDTA on Radiographic Root Development in Regenerative Endodontic Treatment: An Animal Study.

INTRODUCTION: Regenerative endodontic treatment was introduced with the aim of reinforcing the root and enabling further root development. In the process of dentin mineralization, bioactive molecules are entrapped in the dentin matrix, which can be released later by rinsing the dentin with chelating agents. This study aimed to compare the effects of citric acid and EDTA on radiographic root development in regenerative endodontic treatment in an animal model. METHODS: Premolars of 3 beagle dogs were used in this study. The teeth at 1 side of the jaw were irrigated with EDTA according to the regeneration protocol of the American Association of Endodontists. The teeth in the other quadrant were irrigated with citric acid in the second treatment session. Follow-up radiographs were obtained at 6 months, and the primary and final data were analyzed in SPSS Version 23 (IBM Corp, Armonk, NY) using the analysis of covariance. RESULTS: There was no significant difference between the 2 irrigating solutions regarding the increase in root length (P = .668); however, EDTA showed significantly superior efficacy in increasing the root dentin thickness compared with citric acid (P = .022). CONCLUSIONS: Within the limitations of this study, the use of citric acid versus EDTA was not superior on radiographic root development in regenerative endodontic treatment.

A critical analysis of research methods and experimental models to study intracanal medicaments.

In order to ensure predictable decontamination of the root canal system, chemo-mechanical preparation of the root canal space is sometimes supplemented with the use of intracanal medication. As microbial control of the root canal space is fundamental to the resolution of apical periodontitis, root canal disinfection strategies haven been researched intensively. The use of intracanal medication as a supplementary step to the chemo-mechanical preparation of the root canal space is one of them. Because of the costs and limitations of clinical research it is relevant and common practice to first evaluate alternative or new root canal disinfection modalities in laboratory studies. This involves the simulation of a root canal infection in a laboratory model, on which different disinfection strategies can be tested. When modelling the infected root canal, different levels of infection can be discriminated: suspended bacteria, microbial biofilms and infected dentine. This review describes the experimental models associated with these infection levels and critically appraises their value and methodological details. Suggestions for relevant research methods and experimental models are given, as well as some good practices for laboratory-based microbiological studies.

Antimicrobial action of photodynamic therapy on Enterococcus faecalis biofilm using curing light, curcumin and riboflavin.

The aim of this study was to assess the effect of antimicrobial photodynamic therapy (aPDT) with curcumin and riboflavin on three-week Enterococcus faecalis biofilm. At first the 15-mm root canals of 65 single rooted extracted human teeth (including maxillary incisors, mandibular and maxillary canines and mandibular premolars) were separated from the crown and were prepared with ProTaper instruments. After autoclave sterilisation, samples were inoculated with E. faecalis suspension, and incubated for three weeks. After ensuring biofilm formation by scanning electron microscopy (SEM) in two teeth, the remaining 63 teeth were randomly divided into seven groups (n = 9): aPDT + curcumin, aPDT + riboflavin, LED, curcumin, riboflavin, 5.25% NaOCl (positive control) and no intervention (negative control). For light source a LED unit with 390-480 nm wavelength (peak of 460 nm), power density of 1000 ± 100 mW cm-2 and mean energy density of 60 J cm-2 was used. The roots were horizontally sectioned into coronal, middle and apical thirds each with 5 mm thicknesses. Dentin chips with equal weight (1 ± 0.005 g) were collected from the root canal walls with Gates Glidden drills and were transferred into microtubes containing 1 mL of sterile saline and vortexed for 30 s. Next, 10 µL of the contents of each tube was serially diluted and eventually, 10 µL of each solution was cultured on BHI agar. The number of colony-forming units was determined. Data were analysed using the Kruskal-Wallis and Friedman tests. The colony reduction was not significantly different between NaOCl and either riboflavin + LED or Curcumin + LED. The 5.25% NaOCl group showed maximum reduction in colony count, compared with the negative control (P = 0.00). Groups with aPDT with Curcumin + LED (P = 0.005), and with riboflavin + LED (P = 0.011) showed significant reduction in colony count in all three canal thirds (P < 0.05) without any difference with one another. With significant reduction of E. faecalis colony count, aPDT with Curcumin and riboflavin can serve as an adjunct to routine root canal disinfection method.

Efficacy of antimicrobial photodynamic therapy and Er,Cr:YSGG laser-activated irrigation on dentinal tubule penetration of MTA-based root canal sealer: a confocal microscopy study.

BACKGROUND: Antimicrobial photodynamic therapy (aPDT) and laser-activated irrigation (LAI) are adjunctive therapies developed to enhance the effectiveness of root canal disinfection. Sealer penetration into dentinal tubules is significant for preventing re-infection, and the sealer's penetration ability is affected by the chemo-mechanical preparation of the root canal. This study aimed to evaluate the efficacy of aPDT and LAI on dentinal tubule penetration of MTA-based root canal sealer. METHODS: Forty single-rooted mandibular premolars were divided into four groups (n = 10): control, methylene blue 50 mg/L (MB50), curcumin 500 mg/L (C500), and Er,Cr:YSGG and sodium hypochlorite (LAI). The smear removal efficiency of the groups on intraradicular dentin was evaluated with a scanning electron microscope (SEM). Confocal laser scanning microscopy (CLSM) was performed to determine the depth of penetration of MTA Fillapex into dentinal tubules. Data were analyzed statistically. RESULTS: The maximum penetration depth of the C500 group was significantly higher than that of the other groups in all three levels of root sections (p<0.05). Regarding mean penetration depth, the highest values were obtained from the C500 group. However, there was no statistically significant difference between the C500 and MB50 groups in the middle and coronal thirds of the root (p>0.05). The LAI group showed the lowest penetrated area percentage in the middle and coronal third of the root (p<0.05). The C500 and LAI groups were more effective in removing the smear layer than the control and MB50 groups. CONCLUSION: aPDT could enhance the penetration of MTA-based root canal sealer into dentin tubules.

Comparative Evaluation of Efficacy of Calcium Hydroxide, Propolis, and Glycyrrhiza glabra as Intracanal Medicaments in Root Canal Treatment.

AIM: To evaluate and compare the antimicrobial efficacy of Ca(OH)2, 25% propolis, and 25% Glycyrrhiza glabra as intracanal medicaments in root canal treatment. MATERIALS AND METHODS: Total 60 freshly extracted permanent incisors were decoronated and chemomechanical preparation of root canal was performed. Samples were inoculated with a pure culture of Enterococcus faecalis and incubated for 21 days. Colony-forming units (CFUs) were recorded before medication. Incubated samples were randomly categorized into three groups, namely, Ca(OH)2, propolis, and G. glabra, with 20 samples in each group. Antibacterial activity was assessed by evaluating the variance in the CFUs on Day 7. Paired "t" test and Post-hoc Tukey's test were applied to analyze the data. RESULTS: Reduction of CFUs was noticed in all the groups (p <0.001), however the reduction was more predominant in the propolis group. CONCLUSION: Propolis is more effective against E. faecalis, when compared to G. glabra and Ca(OH)2. CLINICAL SIGNIFICANCE: Propolis could be used as an effective medicament in root canal treatment.

In vitro antimicrobial activity and comparison of the herbal extracts and sodium hypochlorite against primary plaque colonizers.

NaClO is not suitable as a root canal irrigant because of its cytotoxicity. Good biocompatibility irrigants are required to have antibacterial activity. Many herbal products like Bee glue, Noni juice and Azadirachta indica have such properties. This study aims to investigate the possible effects of propolis, MCJ and Neem on bacterial infections and cytotoxicity in primary plaque colonizers. Direct contact and agar diffusion tests evaluated the antibacterial activity of herbal products against Fusobacterium, Candida albicans and Prevotella. The CCK 8 test determined the influence of these herbal products on the proliferation of human apical papilla stem cells (hSCAPs) and human periodontal fibroblasts (hPDLFs). A migration assay test was performed in addition to quantitative real-time PCR which measured osteogenic differentiation in hSCAPs. All herbal extracts tested in this study exhibited antibacterial activity comparable to NaClO against bacterial infections, while the strongest bacteriostatic effect was shown in the herbal treated group. These extracts had much weaker effects on the proliferation and migration of hSCAPs and hPDLFs as calculated by the CCK-8 assay against NaClO. Bee glue treatment had the most potent effect on osteogenic differentiation, followed by treatment with Noni juice and Azadirachta indica (Neem), while NaClO showed the lowest effect. For primary plaque colonizers of immature or advanced permanent teeth, Bee glue, Noni juice, and Azadirachta indica can be promising irrigants with good biocompatibility. Direct contact process and agar diffusion studies have tested the antibacterial activity against Fusobacterium, Candida albicans and Prevotella. The CCK 8 test determined the influence of these three plants on the proliferation of human apical papilla stem cells (hSCAPs) and human periodontal fibroblasts (hPDLFs). In order to examine migration ability, migration assay test was performed. Alizarin red staining, alkaline phosphatase (ALP) staining and quantitative real-time PCR measured osteo-/odontogenic differentiation in hSCAPs. All herbal extracts tested in this study exhibited antibacterial activity comparable to NaClO against bacterial infections, while the strongest bacteriostatic effect was shown in the treated group. These extracts had much weaker effects on the proliferation and migration of hSCAPs and hPDLFs as calculated by the CCK-8 assay against NaClO. Bee glue treatment had the most potent effect on osteo-odontogenic differentiation, followed by treatment with Noni juice and Azadirachta indica (Neem), while NaClO showed the lowest effect. For primary plaque colonizers of immature or advanced permanent teeth, Bee glue, Noni juice and Azadirachta indica (Neem) can be promising irrigants.

Can Ethanolic Leaf Extract of Olive or Black Mulberry Substitute Sodium Hypochlorite as a Root Canal Irrigant? An In Vitro Study.

AIM: This study aimed to evaluate Olea europaea (olive) leaves and Morus nigra (black mulberry) leaves as potential natural alternatives to sodium hypochlorite (NaOCl) endodontic irrigant. Their antimicrobial activity against Enterococcus faecalis (E. faecalis) and their effects on both root dentin microhardness and push-out bond strength of resin sealer/root dentin were assessed. METHODOLOGY: Fifty-four extracted teeth were selected. Samples were grouped according to the irrigant used: group I (control): 2.5% NaOCl, group II: 8% ethanolic extract of Olea europaea, and group III: 2% ethanolic extract of Morus nigra. Antibacterial activity (n = 6) was evaluated after each canal was autoclaved, inoculated with E. faecalis, and incubated. Canals were sampled before and after chemicomechanical canal preparation with 2 mL of irrigant. The colony-forming units (CFUs) were counted at 1/10 and 1/100 broth concentrations. Vickers hardness number (VHN) of root dentin (n = 6) was measured before and after root canal preparation and irrigation. Push-out bond strength testing (n = 9) was carried out following preparation, irrigation, obturation, and thermocycling. Results were considered statistically significant at p ≤0.05. RESULTS: Following irrigation, the CFUs of E. faecalis were significantly reduced with no significant difference in the CFU count between all groups at both broth concentrations. A significant reduction in root dentin microhardness resulted in all groups following irrigation, with Morus nigra resulting in the lowest percentage reduction (26.42 ± 1.12). The lowest significant mean push-out bond strength was revealed in the Olea europaea group (3.372 ± 1.513 MPa). CONCLUSION: The use of 2% mulberry (Morus nigra) leaf extract and 8% olive (Olea europaea) leaf extract as alternatives to NaOCl provides promising antimicrobial action against E. faecalis. CLINICAL SIGNIFICANCE: 2% Morus nigra extract may represent a promising natural endodontic irrigant.

Influence of Propolis, Ozone and Photodynamic therapy in root canal disinfection on resin bond strength to radicular dentin.

AIM: The aim of the present study was to assess post space disinfection using different irrigants and their effect on radicular dentin bond to SERC. MATERIALS AND METHODS: Forty single rooted mandibular 2nd premolars were collected and disinfected. All samples were decoronated maintaining root length of 12 mm and embedded vertically in acrylic resin. Shaping of the canal was performed using reciprocating system. Canals were dried using paper points and obturated with gutta percha via lateral condensation. Peso-reamers were used to create post space up to 10 mm. The post space was irrigated with 1% NaOCl before being randomly allocated into four groups (n = 10) according to different methods of canal disinfection. Samples in group 1 were subjected to photoactivated disinfection (PAD), group 2 irrigated with ethanol based propolis group 3 disinfected using ozone and group 4 irrigated with 2.25 % NaOCl with 17 % EDTA and ECL. GFP was fitted using SERC. Each sample was cut into 1 mm from coronal, middle and apical and subjected to pushout bond strength (PBS) via universal testing machine. Fracture analysis were confirmed by stereomicroscope at 40x magnification. For comparison of means, Analysis of variance (ANOVA) and Tukey multiple comparison test was used maintaining the level of significance at p <  0.05. RESULTS: The highest PBS at all three levels were found in group 4, canal disinfected with 2.5 % NaOCl with 17 % EDTA and ECYL. Whereas, the lowest PBS was observed in group 1. Inter group comparison, prosthetic space disinfected with propolis extract showed no significant difference to group 4 canal disinfected with 2.5 % NaOCl with 17 % EDTA and ECYL at all three levels (p > 0.05). Intra group comparison in all experimental groups showed no significant difference was noted in coronal and middle thirds of group 1, group 2 and group 3 respectively (p > 0.05). CONCLUSION: 2.5 % NaOCl with EDTA and ECL treatment (group 4) remains the gold standard when used as a final canal irrigant. Propolis can be used as potential irrigant for canal disinfectant provided if the composition becomes standardized.