Importance of disinfection time and procedure with different alginate impression products to reduce dimensional instability.

AIMS: The aim of this study was to determine the best approach to reduce the unfavorable change in the three different dimensions of impressions using disinfection durations of 15 and 30 min; three different disinfection procedures; and alginate impression products as research factors. MATERIALS AND METHODS: CA37, impressional, and cream alginate impressions were used; distortion in the AB, AC, and BC dimensions of impressions using disinfection durations of 15 and 30 min was studied; and no disinfection (ND), conventional disinfection (CD), and sonicator-activated disinfection (SAD) procedures were measured. RESULTS: Regarding AB dimension, the impressional has best performance when CD was applied for both 15 and 30 min. When SAD was applied for 15 min, impressional and cream alginates provide best performance. When CD was applied for 15 min, CA37 and impressional alginates provide best performance. Although ND-applied CA37 alginate after 30 min provides best performance, because of many outlier values, its implication may not be considered as meaningful. Regarding AC dimension, cream alginate has best performance when CD was applied for 15 min. The AC distances in all the alginates are considerably different from the base model after 30 min. Regarding BC dimension, only the CA37 alginate has the best performance when ND was applied for 15 min. All the alginates are considerably different from that of the base model after 30 min. CONCLUSION: Preference of 15-min disinfection can provide favorable results to obtain all impressions with minimally distorted dimensions. CD is an adequate procedure. The studied SAD needs to be developed further. All alginates are comparably successful to obtain impressions with desired distortion degrees.

Effectiveness of chemical disinfection on biofilms of relined dentures: A randomized clinical trial.

PURPOSE: To evaluate the effect of disinfection with sodium perborate or chlorhexidine (when combined with brushing) on the removal of biofilm in relined dentures. METHODS: Swabs were collected 48 hours after the relining procedure and at the follow-up time intervals of 7, 15, 30, 90, and 180 days. The dentures' surface roughness was measured at the same times. 45 subjects were randomly divided into three groups of 15 subjects each. The control group brushed with coconut soap and a soft toothbrush. The sodium perborate group followed the same procedure and also disinfected with sodium perborate solution for 5 minutes per day. The chlorhexidine group followed the control group procedure and disinfected with 2% chlorhexidine digluconate solution for 5 minutes per day. The number of colony forming units and the surface roughness were evaluated statistically by 2-way repeated-measure ANOVA (α = 0.05). RESULTS: The control group dentures exhibited similar levels of microbial cells throughout the experiment. However, after 15 days, no microbial growth was observed on the dentures for which either disinfection agent was used. There were no statistically significant differences in superficial roughness between the groups (P = 0.298). The disinfection agents used, combined with brushing, were able to remove the relined dentures' biofilm after 15 days of disinfection. Roughness was not a predominant factor in CFU reduction.

The effect of the local use of chlorhexidine in surgical treatment of experimental peri-implantitis in dogs.

AIM: To evaluate the effect of surgical treatment of experimental peri-implantitis at implants with different surface characteristics using different anti-infective procedures. MATERIAL AND METHODS: Four implants with different surface characteristics (A: TiOblast, B: OsseoSpeed, C: AT-I, D: TiUnite) were installed in a randomized order in each side of the mandible in 6 labrador dogs 3 months after tooth extraction. Experimental peri-implantitis was induced 3 months later. Surgical treatment of peri-implantitis was performed. The implants were cleaned with gauze soaked in either saline (control) or chlorhexidine (test). Clinical and radiographical examinations were performed and microbiological samples were taken during a 6-month period after surgery. Biopsies were obtained and prepared for histological analysis. RESULTS: Clinical signs of soft tissue inflammation were reduced after surgical therapy in most test and control sites. While the analysis of bone level alterations in radiographs together with histological and microbiological assessments of resolution of peri-implantitis lesions failed to demonstrate statistically significant differences between test and control procedures, the evaluations disclosed significant differences between implant D and implants A, B and C on treatment outcome. CONCLUSION: It is suggested that (i) the local use of chlorhexidine has minor influence on treatment outcome, (ii) resolution of peri-implantitis following surgical treatment without the adjunctive use of local and systemic antimicrobial agents is possible and (iii) the results are influenced by implant surface characteristics.

Establishment of an optimized ex vivo system for artificial root canal infection evaluated by use of sodium hypochlorite and the photodynamic therapy.

AIM: To establish a refined model of artificially infected root canals and confirm its suitability as a sensitive ex vivo method to assess the efficacy of disinfecting agents. Disinfection was evaluated using sodium hypochlorite (NaOCl), either blocked or unblocked by sodium thiosulphate, and a recently promoted method of disinfection, the antibacterial photodynamic therapy (PDT). METHODOLOGY: The roots of bovine incisors were sectioned into three parts, the canals of coronal and middle regions were filled with a suspension of Enterococcus faecalis and the apical region with culture medium. After 7 days, coronal sections were disinfected using NaOCl (0.5%, 1.0% and 3.0% for 30, 60 and 600 s) or a system for photoactivated chemotherapy (PACT; Cumdente, Tübingen, Germany) for antibacterial PDT. Apical sections served as sterile controls and middle sections as bacterial growth controls. In half of the NaOCl-treated specimens, disinfection was arrested. Dentine chips from biopsies at different depths from the central canal towards the periphery were plated and assessed for colony-forming units (CFU). Disinfection was considered biologically relevant if the reduction of CFU was at least three log10 orders of magnitude. RESULTS: Colony-forming units of 10³ - 104 in growth controls indicated effective artificial infection. A biologically relevant reduction of CFU was accomplished with unblocked NaOCl, but not after blocking with NaOCl nor with PDT. CONCLUSIONS: The system reliably detected disinfection of the root canal and dentinal tubules and proved suitable for ex vivo testing of root canal disinfection. The effect of NaOCl depended on the duration of impact. Under the present experimental conditions, the antibacterial PDT system did not achieve sufficient disinfection.

Ex vivo killing of Enterococcus faecalis and mixed plaque bacteria in planktonic and biofilm culture by modified photoactivated disinfection.

AIM: To compare the efficacy of conventional and modified photoactivated disinfection (PAD) against Enterococcus faecalis and mixed plaque bacteria in suspension and biofilms. METHODOLOGY: Enterococcus faecalis (four strains) and mixed plaque bacteria from three adult volunteers were suspended in water, added to methylene blue (MB, 15 µmol L⁻¹), MB mixed with 0.5% hydrogen peroxide and 0.05% chlorhexidine (CHX), MB mixed with 0.5% hydrogen peroxide and 0.05% EDTA or MB mixed with 0.05% EDTA and 0.05% CHX and exposed to laser irradiation from 10 s to 5 min. After exposure, samples were taken, serially diluted and grown aerobically and anaerobically on Tryptic Soy Agar plates or on blood agar plates for 24 and 72 h, respectively. For biofilm experiments, E. faecalis and mixed plaque biofilms were grown on sterile hydroxyapatite (HA) discs coated overnight with bovine dermal collagen type I for 3 weeks. After exposure to MB or MB and low concentration of EDTA with either hydrogen peroxide or CHX, the percentage of killed bacteria by PAD was evaluated using viability staining and confocal laser scanning microscope. For statistical analysis, one-way analysis of variance was performed. RESULTS: Conventional PAD killed from 90.76% to 100% E. faecalis for 3 min, but failed to kill all plaque bacteria even after 5 min of laser irradiation. In modified PAD, up to 100% of suspended E. faecalis and mixed plaque bacteria were killed after 1 min and 30 s of irradiation. Up to twenty times more biofilm bacteria were killed by modified PAD than by conventional PAD with 15 µmol L⁻¹ MB (P < 0.001) and up to eight times more than 2% CHX (P < 0.001) and 1% sodium hypochlorite (P < 0.001). CONCLUSION: Modified PAD was superior to conventional PAD against planktonic and biofilm bacteria.

Wound healing of dehiscence defects following different root conditioning modalities: an experimental study in dogs.

OBJECTIVE: The purpose of this study was to investigate the periodontal healing pattern of dehiscence-type defects following different chemical root conditioning modalities. MATERIALS AND METHODS: Buccal osseous dehiscence defects were created on six teeth of seven dogs. After dental plaque accumulation, defects were treated with sterile saline solution (control group) or one chemical conditioning modality: citric acid (CA group), ethylenediaminetetraacetic acid (EDTA group), tetracycline (TTC group), citric acid + tetracycline (CA + TTC group), or tetracycline + citric acid (TTC + CA group). After 3 months of healing, clinical parameters were evaluated, and the animals were killed. Histological sections were processed, and a computer-assisted histometric analysis was used to evaluate the formation of new cementum, new bone, and epithelial apical migration. RESULTS: All treatments yielded significant improvements in terms of probing depth decrease and clinical attachment level gain compared to baseline values; however, without significant differences among the groups (p > 0.05; one-way ANOVA). The highest amount of new cementum was noted in the EDTA group (3.72 ± 0.83 mm, 77.6 %), while the lowest amount of new bone was observed in the TTC group (0.7 ± 0.94 mm, 14.3 %). However, no statistically significant differences could be observed among the groups regarding epithelial apical migration, new cementum, and alveolar bone formation (p > 0.05). CONCLUSION: Chemical root surface conditioning did not promote any significant improvement in periodontal healing pattern of dehiscence-type defects in dogs. CLINICAL RELEVANCE: Chemical root surface conditioning after surgical debridement did not promote positive or negative effects on periodontal healing pattern of dehiscence-type defects.

Evaluation of an automated dental unit water system's contamination control protocol.

BACKGROUND: This study addresses the efficacy of an automated decontamination protocol using the germicide 'tetra acetyl ethylene diamine (TAED) perborate' (Farmec SpA, Italy). The germicide TAED perborate protocol is used in the Castellini Dental Units fitted with an Autosteril unit (an automated device that can cycle 0.26% TAED perborate solution and sterile water for cleaning the water system between patients and overnight). Prior to testing the Autosteril and the 0.26% TAED perborate protocol on the Logos Jr Dental Unit (Castellini SpA, Italy), TAED perborate was used on a dental unit water system simulation device. METHODS: A dental unit water system simulation device equipped with four dental unit water systems and with naturally grown and mature biofilm contamination was used in this study (three treatment units and one control). One treatment group used a simulated 5 minutes contact with TAED perborate and sterile water for irrigation; the second used a simulated 5 minutes contact with TAED perborate and 2 ppm ClO2 for irrigation; the third used a simulated 5 minutes contact with TAED perborate and municipal water for irrigation. The control group used municipal water for irrigation with no cleaning/disinfection protocols. This protocol was repeated for 30 cycles. Laser scanning confocal microscopy (LSCM) was used to study the effects on natural and mature biofilms, and R2A agar used to quantify heterotrophic plate counts in the effluent irrigant. Antimicrobial efficacy was evaluated by challenging TAED perborate with microbes and spores (M. smegmatis and B. subtilis). Deleterious effects of the germicide were evaluated on metal and nonmetal parts of dental unit water systems. Heterotrophic plate counts using R2A agar and LSCM of the lines were conducted to assess biofilm and microbial control. RESULTS: Baseline water samples showed mean contamination >5.6 log10 cfu/ml. After initial cleaning, all three groups maintained mean contamination levels of less than 1.1 (SD <0.3) log10 cfu/ml. LSCM of baseline samples was positive for live biofilm in all groups. At the end of the study, viable biofilm was only present in the control. In the microbial challenge test, all vegetative organisms were killed within 30 seconds of contact, while spores were killed within 5 minutes. Corrosion was seen in metals used in US-manufactured dental unit materials, while not observed in those used in the Castellini Logos Jr dental unit. CONCLUSION: In this study, the TAED perborate protocol was effective in biofilm control and control of dental treatment water contamination. Use of sterile water or 2 ppm ClO2 along with TAED treatment also controlled planktonic contamination effectively. CLINICAL SIGNIFICANCE: Environmental biofilms contaminate dental unit water systems over time and affect the quality of dental treatment water. Contaminants include environmental biofilms, microbes, including gram-negative rods and endotoxins in high doses that are not of acceptable quality for treating patients. There are many germicidal protocols for treating this contamination and one such is the prescribed use of TAED perborate used in conjunction with sterile water for irrigation in the autosteril device, an integral component of the Castellini dental units for between patient decontamination of dental unit water systems. This study was conducted on an automated simulation dental unit water system to test the TAED perborate protocol's efficacy on naturally grown, mature environmental biofilms, it's efficacy on microbes and spores and it's effects on materials used in dental unit water systems. This translational research addresses both microbial control and material effects of TAED perborate in studying efficacy and possible deleterious effects and simulated use in dentistry. Currently, this antimicrobial use protocol is followed worldwide in the Castellini dental units that are used in day-to-day dental patient care.

Sodium hypochlorite, chlorhexidine gluconate, and commercial denture cleansers as disinfecting agents against Candida albicans: An in vitro comparison study.

When treating patients who have candidiasis, removable dental appliances in active use should be treated as well. The authors aimed to determine, in vitro, the lowest concentration of sodium hypochlorite that would eliminate Candida albicans biofilm, as well as the effectiveness of additional products against C. albicans. Strains of C. albicans formed biofilms on microtiter plates. Sodium hypochlorite was added in dilutions (1:1 to 1:512) and Peridex was added in concentrations of 25%, 50%, and 100%. The plates were incubated for 30 minutes. One tablet each of Efferdent, Polident for Partials, and Polident for Dentures was dissolved in 200 mL of sterile water and added to additional groups of plates. One group was incubated for 30 minutes; the other was incubated for 18 hours. An XTT spectrophotometric reduction assay measured biofilm metabolic activity. Biofilm activity decreased 100% for all strains exposed to sodium hypochlorite for 30 minutes in concentrations of 1:32 or stronger. Biofilm activity decreased 100% for most strains when treated with 50% or 100% Peridex for 30 minutes and Polident for Dentures for 18 hours. From these results, it appears appropriate for providers to recommend a solution of two teaspoons of sodium hypochlorite in one cup of water (1:25) for 30 minutes to treat dentures contaminated with C. albicans.

Evaluation of two methods in controlling dental treatment water contamination.

UNLABELLED: Dental unit water systems are contaminated with biofilms that amplify bacterial counts in dental treatment water in excess of a million colony forming units per milliliter (cfu/ml). The Centers for Disease Control and Prevention and the American Dental Association have agreed that the maximum allowable contamination of dental treatment water not exceed 500 cfu/ml. This study was conducted to evaluate two protocols in controlling contamination of dental unit water systems and dental treatment water. Both methods used an antimicrobial self-dissolving chlorine dioxide (ClO2) tablet at a high concentration (50 ppm) to shock the dental unit water system biofilms initially followed by periodic exposure. To treat dental treatment source water for patient care, 3 parts per million (ppm) ClO2 in municipal/tap water was compared to use of a citrus botanical extract dissolved in municipal water. Heterotrophic microbial counts of effluent water and laser scanning confocal microscopy were performed to evaluate effects of the two treatments. Results from this study indicated that both treatments were effective in controlling biofilm contamination and reducing heterotrophic plate counts <500 cfu/ml. A comprehensive study addressing compatibility of 50 ppm ClO2 on the metals and nonmetal components of the dental water system and effects of low-grade chemicals used on composite bonding to dentin and enamel is warranted before translation from efficacy studies to common clinical use. CLINICAL SIGNIFICANCE: This study provides evidence-based information of using two methods of controlling dental treatment water contamination. The study was conducted in a clinical practice setting in an active dental clinic and the results are meaningful to a clinician who is interested in providing safe dental treatment water for patient care. KEYWORDS: Dental waterline biofilms, Dental treatment water contamination control, Chlorine dioxide, Emulsifiers, Heterotrophic plate counts, Laser scanning confocal microscopy. How to cite this article: Bansal R, Puttaiah R, Harris R, Reddy A. Evaluation of Two Methods in Controlling Dental Treatment Water Contamination. J Contemp Dent Pract 2011;12(2):73-83. Source of support: Nil Conflict of interest: None declared.

Accuracy of a new ring-opening metathesis elastomeric dental impression material with spray and immersion disinfection.

STATEMENT OF PROBLEM: A new elastomeric impression material has been formulated with a ring-opening metathesis chemistry. In addition to other properties of clinical significance, the impression accuracy must be confirmed. PURPOSE: The purpose of this study was to compare the accuracy of the new elastomeric impression material with vinyl polysiloxane and polyether following both spray and immersion disinfection. MATERIAL AND METHODS: Impressions of a modified dentoform with a stainless steel crown preparation in the lower right quadrant were made, and type IV gypsum working casts and dies were formed. Anteroposterior (AP), cross-arch (CA), buccolingual (BL), mesiodistal (MD), occlusogingivobuccal (OGB), and occlusogingivolingual (OGL) dimensions were measured using a microscope. Working cast and die dimensions were compared to those of the master model. The impression materials were a newly formulated, ring-opening metathesis-polymerization impression material (ROMP Cartridge Tray and ROMP Volume Wash), vinyl polysiloxane (VPS, Aquasil Ultra Monophase/LV), and a polyether (PE, Impregum Penta Soft/Permadyne Garant L). Fifteen impressions with each material were made, of which 5 were disinfected by spray for 10 minutes (CaviCide), 5 were disinfected by immersion for 90 minutes (ProCide D), and 5 were not disinfected. There were significant cross-product interactions with a 2-way ANOVA, so a 1-way ANOVA and Dunnett's T3 multiple comparison test were used to compare the dimensional changes of the 3 impression materials, by disinfection status and for each location (alpha=.05). RESULTS: For ROMP, there were no significant differences from the master, for any dimension, when comparing the control and 2 disinfectant conditions. No significant differences were detected among the 3 impression materials for CA, BL, and MD. The working die dimensions of OGB and OGL for VPS with immersion disinfection were significantly shorter than with PE and ROMP (P<.05). Overall, the AP dimension was more accurate than CA, and the BL of working dies was 0.040 mm greater in diameter than MD. CONCLUSIONS: The accuracy of gypsum working casts and working dies from the new and 2 existing types of impression material were similar, for both spray and immersion disinfection. Judicious application of a die spacer can compensate for the small differences observed. VPS may require additional laboratory accommodation to compensate for a shorter working die.

Decontamination of Gutta-percha Cones employed in Endodontics.

The gutta-percha cones used in endodontic treatment are produced in aseptic conditions and their composition includes zinc oxide, which is responsible for antibacterial activity. However, there is the possibility of microbial contamination by manipulation, aerosol or during storage. Although several chemical agents have been tested for their decontamination, there is no consensus on the best disinfection protocol to be used. The aim of this study was to evaluate the decontamination of gutta-percha cones contaminated with the bacteria Enterococcus faecalis, by using chlorhexidine digluconate (CHX) and sodium hypochlorite (NaClO) at different concentrations for short exposure times. For this purpose, gutta-percha cones (size 40) were selected at random from a sealed box and immersed for 1 min in a microbial suspension. Then they were immersed in specific Petri dishes for different groups containing: CHX 2%, NaClO 1% or NaClO 2.5% for 30 s or 1 min, and subsequently placed in tubes containing BHI broth. After incubating the tubes for 48 h, it was observed that 1% and 2.5% NaClO and 2% CHX were effective for decontaminating the cones at those exposure time intervals. Microbial growth was detected in one of the replicates of the group with CHX applied for 30 s. To prevent the possibility of failures at this stage, the exposure time of gutta-percha cones to the decontaminating agent should not be reduced.

Os cones de guta-percha utilizados no tratamento endodôntico são produzidos em condições assépticas e possuem óxido de zinco em sua composição, responsável pela atividade antibac-teriana. No entanto, existe a possibilidade de contaminação microbiana por manipulação, aerossol ou seu armazenamento. Embora vários agentes químicos já tenham sido testados para sua descontaminação, não há consenso sobre o melhor protocolo de desinfecção a ser usado. Nosso objetivo foi avaliar a descontaminação de cones de guta-percha contaminados com a bactéria Enterococcus faecalis, utilizando digluconato de clorexidina (CHX) e hipoclorito de sódio (NaClO) em diferentes concentrações e tempos de exposição curtos. Para esse fim, 40 cones de guta-percha foram selecionados aleatoriamente, de uma caixa selada e imersos por 1 min em uma suspensão microbiana. Em seguida, foram imersos em placas de Petri específicas para diferentes grupos contendo: CHX 2%, NaClO 1% ou 2,5%, nos tempos de exposição de 30s e 1min e subseqüentemente imersos em tubos contendo caldo BHI. Após incubação dos tubos por 48 h, observou-se que NaClO 1% e 2,5% e CHX 2% foram eficazes para a descontaminação dos cones nesses intervalos de tempo de exposição. Em uma das réplicas do grupo com CHX aplicado por 30s foi detectado crescimento microbiano. O tempo de exposição dos cones de guta-percha ao agente de descontaminação não deve ser reduzido para evitar a possibilidade de falhas nesse estágio.

A novel approach to controlling bacterial contamination on toothbrushes: chlorhexidine coating.

PURPOSE: This project was conducted to determine the effectiveness of chlorhexidine-coated toothbrush filaments in reducing quantities of bacteria. MATERIALS AND METHODS: An Institutional Review Board (IRB)-approved, two-group, double-blind, randomized, post-test only study was conducted. Sixty-four individuals utilized control and experimental toothbrushes, for 30 days. At the end of the study toothbrushes were returned and transported to the laboratory for analysis. Microorganisms were detached from the filaments by sonification and vortexing then plated on Mitis Salivarius (MS) (selective) and trypticase soy agar (TSA) 5% Sheep Blood (non-selective) media. Inoculated plates were incubated aerobically for 24 h at 37 degrees C. After incubation, bacterial colony-forming units (CFU) were determined. Data were analysed using Wilcoxon and Kruskal-Wallis tests. RESULTS: Fifty-nine toothbrushes were returned for analysis; experimental (n = 31) and control (n = 28). Data from TSA media revealed a mean CFU for the control group of 5.41 x 10(5) compared with 6.28 x 10(5) for the experimental group. Data from MS agar resulted in a mean CFU for the control group of 4.32 x 10(5) compared with 4.20 x 10(5) for the experimental group. CONCLUSION: Results revealed no statistically significant difference in the quantity of bacteria surviving on toothbrush filaments between control and experimental groups, on both selective and non-selective media, after 30 days.

Ultrasonic Irrigant Activation during Root Canal Treatment: A Systematic Review.

INTRODUCTION: The aim of this study was to systematically review the evidence on the cleaning and disinfection of root canals and the healing of apical periodontitis when ultrasonic irrigant activation is applied during primary root canal treatment of mature permanent teeth compared with syringe irrigation. METHODS: An electronic search was conducted of the Cochrane Library, Embase, LILACS, PubMed, SciELO, and Scopus databases using both free-text key words and controlled vocabulary. Additional studies were sought through hand searching of endodontic journals and textbooks. The retrieved studies were screened by 2 reviewers according to predefined criteria. The included studies were critically appraised, and the extracted data were arranged in tables. RESULTS: The electronic and hand search retrieved 1966 titles. Three clinical studies and 45 in vitro studies were included in this review. Ultrasonic activation did not improve the healing rate of apical periodontitis compared with syringe irrigation after primary root canal treatment of teeth with a single root canal. Conflicting results were reported by the in vitro microbiological studies. Ultrasonic activation was more effective than syringe irrigation in the removal of pulp tissue remnants and hard tissue debris based on both clinical and in vitro studies. Ultrasonic activation groups were possibly favored in 13 studies, whereas syringe irrigation groups may have been favored in 3 studies. CONCLUSIONS: The level of the available evidence was low, so no strong clinical recommendations could be formulated. Future studies should focus on the antimicrobial effect and healing of apical periodontitis in teeth with multiple root canals.

Internal decontamination of dental implants: an in vivo randomized microbiologic 6-month trial on the effects of a chlorhexidine gel.

BACKGROUND: Microbial penetration inside an implant's internal cavity results in a bacterial reservoir that has been associated with an area of inflamed connective tissue facing the fixture-abutment junction. The aim of the present clinical trial was to evaluate the effectiveness of a 1% chlorhexidine gel on the internal bacterial contamination of implants with screw-retained abutments. METHODS: Thirty subjects (age range: 27.3 to 54.2 years) underwent single implant restoration. Three months after prosthodontic restoration, the modified sulcus bleeding index, modified plaque index, full-mouth plaque score, and full-mouth bleeding score were recorded. Microbiologic samples were also collected from the internal part of each fixture. Subjects were then divided into two equal groups: control and test groups (CG and TG, respectively). The CG had the abutment screwed and the crown cemented without any further intervention. Conversely, the TG had the internal part of the fixture filled with a 1% chlorhexidine gel before the abutment placement and screw tightening. Six months later, microbiologic and clinical procedures were repeated in both groups. Total bacterial count and multiplex polymerase chain analysis were performed to detect specific pathogens. RESULTS: Clinical parameters remained stable throughout the study. From baseline to the 6-month examination, the total bacterial counts underwent a significant reduction in the TG (P<0.05). Detection of the single pathogen species did not show any significant differences. However, periopathogens were detected more frequently in the CG. CONCLUSION: The application of a 1% chlorhexidine gel seemed to be an effective method to reduce bacterial colonization of the implant cavity over a 6-month period.

Infection Control in Teeth with Apical Periodontitis Using a Triple Antibiotic Solution or Calcium Hydroxide with Chlorhexidine: A Randomized Clinical Trial.

INTRODUCTION: This randomized clinical study compared the antibacterial effectiveness of treatment protocols using either a triple antibiotic solution (1 mg/mL) or calcium hydroxide/chlorhexidine paste as interappointment medication in infected canals of teeth with primary apical periodontitis. METHODS: The root canals of single-rooted teeth with apical periodontitis were prepared by using a reciprocating single-instrument technique with 2.5% sodium hypochlorite irrigation and then medicated for 1 week with either a triple antibiotic solution (minocycline, metronidazole, and ciprofloxacin) at 1 mg/mL (n = 24) or a calcium hydroxide paste in 2% chlorhexidine gluconate (n = 23). Samples were taken from the canal at the baseline (S1), after chemomechanical preparation (S2), and after intracanal medication (S3). DNA extracts from clinical samples were evaluated for total bacterial reduction using a 16S ribosomal RNA gene-based quantitative polymerase chain reaction assay. RESULTS: All S1 samples were positive for the presence of bacteria, and counts were substantially reduced after treatment procedures (P < .01). Bacterial levels in S2 and S3 samples did not significantly differ between groups (P > .05). S2 to S3 reduction was 97% in the antibiotic group and 39% in the calcium hydroxide/chlorhexidine group; only the former reached statistical significance (P < .01). There were significantly more quantitative polymerase chain reaction-negative S3 samples in the antibiotic group than in the calcium hydroxide group (P < .05). CONCLUSIONS: Interappointment medication with a triple antibiotic solution at the concentration of 1 mg/mL significantly improved root canal disinfection, and its effects were at least comparable with the calcium hydroxide/chlorhexidine paste. Effectiveness and easy delivery of the antibiotic solution make it an appropriate medicament as part of a disinfecting protocol for conventional nonsurgical endodontic treatment and possibly regenerative endodontic procedures.

Effects of disinfection of combined agar/alginate impressions on the dimensional accuracy of stone casts.

This study investigated the effects of disinfection of combined agar/alginate impressions on the dimensional accuracy of resultant stone casts. Impressions of a master cast designed to simulate an abutment tooth were prepared by combining each of two brands of cartridge-form agar impression materials with an alginate impression material. The impressions were immersed in 1% sodium hypochlorite for 10 minutes or 2% glutaraldehyde for 30 minutes. The remaining impressions were sprayed with these two disinfectants and then stored in sealed bags for 10, 30, 60, and 120 minutes. Stone casts obtained from the non-disinfected impressions were also prepared as control. Changes in diameter of the stone casts were then measured. Results indicated that storage for 10 minutes after spraying with 1% sodium hypochlorite was an appropriate disinfection method for combined agar/alginate impressions, as well as immersion in 1% sodium hypochlorite for 10 minutes.

Efficacy and Safety Evaluation of a Chlorine Dioxide Solution.

In this study, a chlorine dioxide solution (UC-1) composed of chlorine dioxide was produced using an electrolytic method and subsequently purified using a membrane. UC-1 was determined to contain 2000 ppm of gaseous chlorine dioxide in water. The efficacy and safety of UC-1 were evaluated. The antimicrobial activity was more than 98.2% reduction when UC-1 concentrations were 5 and 20 ppm for bacteria and fungi, respectively. The half maximal inhibitory concentrations (IC50) of H1N1, influenza virus B/TW/71718/04, and EV71 were 84.65 ± 0.64, 95.91 ± 11.61, and 46.39 ± 1.97 ppm, respectively. A 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test revealed that the cell viability of mouse lung fibroblast L929 cells was 93.7% at a 200 ppm UC-1 concentration that is over that anticipated in routine use. Moreover, 50 ppm UC-1 showed no significant symptoms in a rabbit ocular irritation test. In an inhalation toxicity test, treatment with 20 ppm UC-1 for 24 h showed no abnormality and no mortality in clinical symptoms and normal functioning of the lung and other organs. A ClO2 concentration of up to 40 ppm in drinking water did not show any toxicity in a subchronic oral toxicity test. Herein, UC-1 showed favorable disinfection activity and a higher safety profile tendency than in previous reports.

The effect of formalin storage on the apical microleakage of obturated canals.

Infection control guidelines recommend disinfection of extracted teeth in 10% formalin for 2 weeks before use. Although extracted teeth are routinely used for in vitro endodontic research, the potential influence of formalin has not been evaluated. The purpose of this study was to investigate the effect of formalin storage on the apical seal integrity of obturated canals. There were 100 single-rooted human teeth decoronated, accessed, and randomly divided into four groups. Group 1 was composed of specimens that were instrumented and obturated after extraction without storage in formalin. Groups 2, 3, and 4 were stored in formalin for 2, 4, and 8 weeks, respectively, before treatment. Canals were instrumented to a master apical file size #7 ProFile .04 Taper Series 29 and obturated with Obtura II thermoplasticized gutta-percha and Roth 801 sealer. The teeth were immersed in India ink, cleared, and the greatest extent of linear dye leakage was measured. Microleakage testing displayed significantly less microleakage after 2 and 4 weeks of formalin storage. Leakage measurements after 4 weeks of storage were 62.3% lower than nonfixed specimens. The 8-week storage group demonstrated lower dye penetration compared with the nonfixed group; however, the difference was not statistically significant. Within the scope of this study, storage of extracted teeth in formalin for 2 and 4 weeks resulted in a significant decrease in apical microleakage compared with nonfixed specimens.

Effects of a small electric current on sterilization of a dental unit water line.

In the present study, water was circulated in a simulated dental unit water line with electrifying a small current. The morphology of the biofilm developed on inner surface of the water line and the number of heterotrophic bacteria were investigated to elucidate the effect of a low level electric current on the biofilms formation associated with bacteria reproduction. Destruction and malconformation of biofilms by electrification was observed using SEM, in addition to deformation and hypertrophy of the bacteria. By naked eye observation, small pieces, which were possibly exfoliated biofilms, were detected in electrified water. While an adherent, yellow gel was demonstrated on the inner surface of the water line without electrification. With electrification, the number of bacteria decreased during the first week, however the bacteria increased gradually after that. The number of bacteria without electrification was consistently greater than that with electrification and the difference was statistically significant (P<0.05). The predominant bacteria were identified as Sphingomonas paucimobilis. The excess chlorine levels decreased to a minimum value within one week. The small current appeared to have effects on biofilm formation of heterotrophic bacteria that resulted in enhanced chlorine sterilization of dental unit water. Thus, electrification has considerable potential for the extermination of bacterial biofilms in dental unit water lines.