Microbiome Changes during Regenerative Endodontic Treatment Using Different Methods of Disinfection.

INTRODUCTION: The purpose of this study was to characterize qualitatively and quantitatively the changes in the endodontic microbiome, in teeth with necrotic pulp, open apexes, and apical periodontitis, with 3 antimicrobial protocols, undertaken in a multicenter clinical trial. METHODS: Microbiological samples were collected from 116 regenerative endodontic teeth, and 97 qualified for inclusion. The teeth were randomly divided into 3 treatment groups: apexification (APEX), regeneration (REGEN), and revascularization (REVASC), all in 2 appointments. The group variables in the first appointment irrigants, and second appointment irrigants and medicaments were as follows: APEX: 5.25%-6% NaOCl, 5.25%-6% NaOCl + 17% EDTA and calcium hydroxide; REGEN: 1.25% NaOCl, 17% EDTA, and 0.1 mg/mL triple antibiotic paste (TAP); and REVASC 5.25% NaOCl, saline, and 1 g/mL TAP, respectively. Sampling was done upon access (S0), after irrigation in the first appointment (S1), and after using medication and irrigation in the second appointment (S2). RESULTS: Quantitative polymerase chain reaction analysis of the 16S ribosomal RNA gene showed significant reduction in bacterial load from S0 to S2 in all groups; however, the APEX and REVASC groups had significantly less residual DNA than the REGEN group (P = .0045). The relative abundance of Bacteroidetes, Fusobacteria, Spirochaetes, and Synergistetes were reduced with the treatment rendered. However, relative abundance of Firmicutes and Actinobacteria was not changed, and that of Proteobacteria increased. LEfSe analysis showed that reduction in bacterial taxa was more in REVASC than APEX, which in turn was more than in REGEN. CONCLUSION: Enhanced antimicrobial protocols lead to better reduction in quantitative and qualitative parameters of the endodontic microflora.

Antibacterial Efficacy and Discoloration Potential of Endodontic Topical Antibiotics.

INTRODUCTION: The optimal concentration for the use of endodontic topical antibiotics is not known. The aims of this study were to determine the minimum bactericidal concentrations (MBCs) and minimum inhibitory concentrations (MICs) of metronidazole, ciprofloxacin, minocycline, Augmentin (GlaxoSmithKline, Research Triangle Park, NC), and tigecycline against common endodontic pathogens and to evaluate ex vivo the antibacterial efficacy and discoloration effect of triple antibiotic paste (TAP), Augmentin, and tigecycline at different concentrations using a slow-release hydrogel scaffold. METHODS: Using the Epsilometer test method (Etest; bioMérieux USA, St Louis, MO), MICs and MBCs of selected antibiotics were determined against Fusobacterium nucleatum, Porphyromonas gingivalis, Streptococcus intermedius, and Enterococcus faecalis. Biofilms of these bacterial species were then grown in extracted single-rooted teeth anaerobically for 3 weeks. Root canals were filled with TAP, Augmentin, and tigecycline at concentrations of 1 or 0.1 mg/mL in a degradable hydrogel scaffold or pure TAP at 1 g/mL for 7 days. Coronal discoloration was evaluated spectrophotometrically at 1, 2, and 3 weeks after dressing. RESULTS: MIC/MBC data showed significant efficacy of tigecycline, Augmentin, and minocycline compared with the other antibiotics (P < .05). Significant differences were found when comparing the log10 colony-forming units of all experimental groups (P < .05). TAP at 1 g/mL had no bacterial growth but caused the greatest discoloration. Hydrogel mixtures with TAP, Augmentin, or tigecycline at 1 mg/mL significantly reduced bacterial growth and the number of positive samples compared with those at 0.1 mg/mL (P < .05) with minimal discoloration. CONCLUSIONS: TAP, Augmentin, and tigecycline in a hydrogel at 1 mg/mL reduced bacterial growth significantly with minimal color change.

Interfacial characteristics of Biodentine and MTA with dentine in simulated body fluid.

OBJECTIVES: Newer tricalcium silicate cements (TSC) may offer biocompatibility with improved working properties. This study aimed to evaluate: (1) the occurrence of mineral deposition at the interface between dentine and two TSC (ProRoot(®) MTA and Biodentine(®)) in simulated body fluid, and (2) to investigate the nature of interfacial layer. METHODS: Six root dentine segments of 1.5mm thickness were obtained from extracted human teeth and were instrumented with Gates-Glidden drills. The specimens were then randomly filled with either MTA or Biodentine. The specimens were placed in the simulated body fluid containing the same phosphate concentration as blood plasma. After 4 weeks, the specimens were examined with Scanning Electron Microscope (SEM) and Energy Disperse X-ray Spectroscopy (EDX) to measure the thickness of the interfacial layer and Ca/P ratio. Transmission Electron Microscope (TEM) and Selective Area Electron Diffraction (SAED) were conducted to examine the interface ultramicroscopically and to determine the nature of the crystalline structure within interfacial layer. RESULTS: The thickness of interfacial layer was significantly higher in the MTA group (14.5 µm vs 4.8 µm) (p<0.001). However, there was no significant difference between MTA and Biodentine in Ca/P ratio of interfacial layer (4.1 vs 2.7) (p>0.05). From TEM examination, amorphous calcium phosphate (ACP) was observed in the interface along with the surface of dentine. CONCLUSIONS: As an alternative to MTA, Biodentine displayed bioactivity by producing an interfacial layer on the root canal dentine even though its thickness was significantly lower than MTA. ACP was observed in the interfacial layer of both biomaterials. CLINICAL SIGNIFICANCE: Biodentine could be considered as an alternative to MTA due to comparable bioactivity which creates interfacial layer between root canal dentin and Biodentine.