Comparison of Antibacterial Efficacy of Triple Antibiotic-Loaded Hydrogel Versus Modified Triple Antibiotic-Loaded Hydrogel as Intracanal Medicament Against Enterococcus faecalis: An In vitro Study.

OBJECTIVE: Triple antibiotic paste (TAP) is known to have an essential role in the success of endodontic treatment by eliminating pathogens from the root canal system. Unfortunately, it causes discolouration and cytotoxicity at high concentrations. The objective of this research was to assess and compare the antimicrobial effectiveness of various concentrations (1 mg, 5 mg, 10 mg) of TAP, TAP hydrogel (TAPH), M-TAP, and M-TAP hydrogel (MTAPH) against Enterococcus faecalis. METHODS: The agar well diffusion method was used to assess the antibiotic sensitivity of the following intracanal medicaments: TAP (ciprofloxacin, metronidazole, and minocycline) mixed in a ratio of 1: 1: 1; TAPH, M-TAP (ciprofloxacin, metronidazole, and amoxicillin), M-TAPH and plain hydrogel. Each tested medicament was individually evaluated for its antimicrobial activity against Enterococcus faecalis. Structural and topographical characterisation were analysed using a Scanning Electron Microscope (SEM) and interpreted using ImageJ software. A microdilution broth test was performed to examine the minimum inhibitory concentration and minimum bactericidal concentration (MBC) of M-TAP and TAP. RESULTS: Except for the plain hydrogel, M-TAP and hydrogel and TAP and hydrogel showed significantly varied inhibitory zones at different concentrations. M-TAPH showed the highest mean zone of inhibition of 21.6, 33.33 and 38.0 mm at a concentration of 1, 5, and 10 mg/mL when compared to TAPH, which showed a mean zone of inhibition of 3.3 mm,12.3 mm, 21.3 mm at the respective concentrations. The MIC study shows that more than 75% of Enterococcus faecalis growth was inhibited by M-TAP at a concentration of 5 µg/mL, whereas TAP showed inhibition at a concentration of 35 µg/mL. MBC results indicate that almost 99.9% of the bacterial population was killed at a concentration of 100 µg/mL (10-1) for TAP and 10 µg/mL (10-2) for M-TAP. CONCLUSION: The antibacterial efficacy of M-TAP was significantly higher than TAP. Application of M-TAP at lower doses is advised to overcome the disadvantages seen with TAP.

Comparison of Reverse Sandwich Restorations Versus Composite Fillings for the Restoration of External Cervical Resorptions: An In-Vitro Study.

OBJECTIVE: The aim was to compare the 'reverse sandwich restoration' to resin composite restorations re- garding marginal adaptation, fracture resistance, favourable/unfavourable fractures in the management of external cervical resorption. METHODS: Forty-eight extracted maxillary central incisors were selected and endodontically treated. Cervical regions of the labial root surfaces received simulated resorptive defects and were restored as three randomly allocated groups: Reverse Sandwich Restoration (resin composite + resin-modified glass ionomer) (RSR); resin composite restoration (COMP), and no restoration (NR). Each group was further divided into two subgroups (n=8 each): Thermomechanical Aging (TA) (equivalent to one year) and No Aging (NA). Marginal adaptation was scored by scanning electron microscopy. Fracture resistance was tested using a universal testing machine. Favourable versus unfavourable fractures were classified based on fracture extent. RESULTS: TA decreased the marginal adaptation for both RSR and COMP. Mean fracture resistance per groups were: RSR-NA 1522.4+-94.9N, RSR-TA 939.6+-72.9N, COMP-NA 1197.6+-95.7N, COMP-TA 870.4+-86.3N, NR-NA 1057.1+-88.1N, and NR-TA 836.6+-81.9N, respectively. Fracture resistance was the highest for RSR- NA compared to all other groups (p<0.05). TA decreased the fracture resistance in all groups (p<0.05), there was no significant difference between RSR and COMP regarding fracture resistance and favourable/ unfavourable fractures (p>0.05). CONCLUSION: RSR provided comparable results to resin composite fillings to restore artificial cervical defects pertaining to marginal adaptation, fracture resistance, and favourable versus unfavourable fractures. RSR is preferable due to its inherent biocompatibility to the periodontium. (EEJ-2023-04-050).

Comparative Evaluation of Bacterial Reduction by Laser-Activated Irrigation Technique (LAI) With Conventional Needle Irrigation (CNI) in Single-Rooted Teeth With Pulpal Necrosis: A Single-Blinded Randomized Controlled Trial.

Aim  To compare the bacterial reduction in single-rooted teeth with pulpal necrosis after laser-activated irrigation technique (LAI) and conventional needle irrigation (CNI). Methodology In this clinical trial (CTRI/2021/09/047767), 32 patients with pulpal necrosis were enrolled. Under complete aseptic conditions, access cavity preparation was done and the baseline sample S1 was collected from the root canal using paper points. After chemo-mechanical preparation they were allocated into two groups, following block randomization; Group A - CNI with 27 gauge side-vented needle, Group B - LAI with pulsed Er,Cr:YSGG (erbium, chromium:yttrium-scandium-gallium-garnet) (2780 nm) laser. After irrigant activation, canals were dried and a second sample S2 was taken using paper points. Microbial analysis using quantitative polymerase chain reaction (qPCR) was done to quantify the bacterial reduction among the two groups. Inter-group and intra-group analysis was done using the independent student t-test and Bonferroni test, respectively. The data was represented in terms of quantification cycle (Cq) values, which are inversely proportional to the microbial count.  Results There was no significant difference in S1 between the two groups (mean difference=0.0205; p=0.912). There was a significant difference in S2 between the two groups for the organisms (mean difference=0.8042; p=0.000). The mean percentage of bacterial reduction in CNI was 10.82% and in LAI it was 25.92%.  There was a significant difference in S1 through S2 within the two groups for the organisms (p=0.000). The mean difference of Cq value is high for LAI compared to CNI (1.3494).  The fold change was calculated by taking the ΔCq value and ΔΔCq value after the logarithmic transformation of the Cq value. LAI showed lower levels of DNA at S2 similar to CNI. There is no significant difference in mean fold change between CNI and LAI (p=0.564).  Conclusion This clinical trial concluded that both LAI and CNI were effective in bacterial reduction. There was greater bacterial reduction with LAI (25.92%) than with the CNI (10.82%) in single-rooted teeth with pulpal necrosis using qPCR analysis.

The Antimicrobial Effect of Pomegranate Peel Extract versus Chlorhexidine in High Caries Risk Individuals Using Quantitative Real-Time Polymerase Chain Reaction: A Randomized Triple-Blind Controlled Clinical Trial.

The aim of the present study was to compare the antibacterial effectiveness of chlorhexidine and PPE oral rinse on S. mutans, Lactobacilli, and Veillonella, in clinical salivary samples of patients with advanced stages of dental caries at baseline and two and four weeks with PCR technique. This triple-blind randomized clinical trial involved 60 high caries risk adult patients, 19-59 years of age, randomly allocated into two groups of 30 subjects each. The intervention group received pomegranate peel extract mouthwash, whereas the control group received chlorhexidine mouthwash. Unstimulated pooled saliva was collected from the floor of the mouth before and after the intervention. The quantitative real-time polymerase chain reaction was employed to analyze the bacterial copies of each salivary sample at baseline and two and four weeks. The significance level was fixed at 5% (α = 0.05). Overall comparison of antimicrobial effectiveness across both groups revealed insignificant outcomes. The control group evinced a significant reduction in S. mutans between a specific time, i.e., baseline and 4 weeks (p=0.043). PPE oral rinse as a natural product or ecological alternative was effective in disrupting activity across all microorganisms tested in this triple-blind RCT; however, the nutraceutical, when compared to chlorhexidine, was not as effective against S. mutans.

Concentrated Growth Factors as an Ingenious Biomaterial in Regeneration of Bony Defects after Periapical Surgery: A Report of Two Cases.

The overall success of a periapical surgery is assessed in terms of regeneration of functional periradicular tissues. The regenerative potential of platelets has been well documented. This article describes the use of concentrated growth factors (CGF), a new family of autologous platelet concentrates, as a sole material for bone regeneration after periapical surgery. 32- and 35-year-old female patients diagnosed with Ellis Class IV, an open apex in 11 with apical periodontitis in 11 and 12 and previously root canal-treated 31 and 41 with a chronic apical abscess, respectively, were managed with endodontic surgery. Subsequent to apicectomy and retrograde filling, the CGF fibrin block and membrane were used before suturing. There was uneventful healing during the immediate post-op and the subsequent follow-up periods. CGF is produced by a differential centrifugation process that results in the formation of a denser fibrin matrix richer in growth factors than those observed in PRF. Reasonable osseous healing was seen as early as 6-month follow-up, thereby recommending the use of CGF as an alternative to bone grafts and membranes in extensive periapical lesions to enhance bone regeneration and to decrease the healing time.