Harnessing antimicrobial peptides in endodontics.

Endodontic therapy includes various procedures such as vital pulp therapy, root canal treatment and retreatment, surgical endodontic treatment and regenerative endodontic procedures. Disinfection and tissue repair are crucial for the success of these therapies, necessitating the development of therapeutics that can effectively target microbiota, eliminate biofilms, modulate inflammation and promote tissue repair. However, no current endodontic agents can achieve these goals. Antimicrobial peptides (AMPs), which are sequences of amino acids, have gained attention due to their unique advantages, including reduced susceptibility to drug resistance, broad-spectrum antibacterial properties and the ability to modulate the immune response of the organism effectively. This review systematically discusses the structure, mechanisms of action, novel designs and limitations of AMPs. Additionally, it highlights the efforts made by researchers to overcome peptide shortcomings and emphasizes the potential applications of AMPs in endodontic treatments.

Present status and future directions: Minimally invasive root canal preparation and periradicular surgery.

Inspired by several other surgical disciplines, the quest for treating diseases through minimally invasive procedures has permeated endodontics, but not without controversy. Indeed, pulp amputation/excision and root-end resection are akin to surgical procedures elsewhere in the body and therefore, an increasing number of studies have addressed the "potential" to adopt such minimally invasive procedures in root canal treatment, with the larger goal of conserving tooth tissue for long-term survival of treated teeth. Yet, it is undeniable that this "trend" has been met with immense resistance with unclear evidence to strongly support or refute this philosophy. One may view root canal treatment as having two important procedural parts: (i) gaining access to the root canal and (ii) achieving clean root canals to remove the necrotic/infected or irreversibly inflamed tissues and then fill the space that was occupied by the pulp tissue and subsequently enlarged during cleaning and shaping, which should result in two key long-term outcomes: (i) healing of periradicular periodontitis and (ii) survival/retention of the tooth. Whilst a lot of interest has been directed towards gaining access through minimally invasive cavity designs, it is surprising that little effort has been expended on studying minimally invasive root canal preparation or surgical intervention. The aim of this review is not to promote or denigrate these philosophies, but to provide a balanced overview of the concepts, currently available evidence and future perspectives on minimally invasive endodontics from the context of root canal preparation and surgical endodontics. Specific attention is given to the role of modern irrigation strategies in potentially improving canal cleanliness even when canals are minimally prepared and the areas of research that are currently lacking in this topic.

Tissue Stabilization, Bacterial Adhesion, and Stem Cell Viability in Trans-cinnamaldehyde-conditioned Dentin.

INTRODUCTION: This laboratory study aimed to evaluate the effect of trans-cinnamaldehyde (TC) conditioning on dentin tissue stabilization, bacterial adhesion, and stem cell toxicity. METHODS: Dentin beams (n = 204) from extracted human molars were demineralized in phosphoric acid and treated with TC (2.5, 5, and 7.5%), 50% ethanol-water mixture (vehicle control) or 2.5% glutaraldehyde (GA) (positive control) for 30 minutes. Demineralized but untreated specimens served as the negative control. After treatment, collagen crosslinking was characterized by measuring the elastic modulus (Er) and hardness (n = 5). Biodegradation resistance was examined by determining the loss of dry mass (n = 8), hydroxyproline release (n = 4) and scanning electron microscopy (n = 2), after exposure to bacterial collagenase. Inhibition of bacterial adhesion was investigated by colony counting assay (n = 12) and scanning electron microscopy (n = 2). Viability of stem cells of the apical papilla on TC-conditioned dentin was determined using the Cell Counting Kit-8 assay (n = 8). Data were statistically analyzed using one-way analysis of variance (ANOVA) test followed by Dunnett's multiple comparisons at a significance level of 5%. RESULTS: TC-conditioned dentin showed a concentration-dependent increase in Er and hardness. The Er and hardness of 5% and 7.5% TC-conditioned dentin were significantly greater than that of the negative control and vehicle control groups (P < .05). There was no significant difference in the biodegradation resistance between GA and 5% TC-conditioned dentin (P > .05). TC-conditioned dentin showed a well-preserved collagen fibril network with clear cross-banding, comparable to GA-conditioned dentin. All concentrations of TC inhibited bacterial adhesion on dentin, significantly greater than the negative control (P < .05). There was no reduction in viability of stem cells of the apical papilla viability on TC-conditioned dentin compared to the negative control (P > .05). CONCLUSIONS: TC conditioning stabilized the dentin and protected it from enzymatic degradation. TC prevented bacterial adhesion on the dentin but maintained stem cell viability.

Gutta-percha in endodontics - A comprehensive review of material science.

The complete and three-dimensional fluid tight seal of the root canal system is the final component of the endodontic triad. The long-standing and closest material which has fulfilled this criterion is gutta-percha (GP). Several materials have been tried and tested as an endodontic filling material, of which GP has been most extensively used for years and has established itself as a gold standard. In addition, it has proved itself successful with different techniques of obturation while maintaining its basic requisites. This article deals briefly with the history and evolution of GP, source, chemical composition, manufacturing, disinfection, cross-reactivity, and advancements in the material.