Microbial identification from traumatized immature permanent teeth with periapical lesions using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.

BACKGROUND: This study aims at identifying the microbiota in traumatized immature permanent teeth with periapical lesions using Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). METHODS: The study included 16 immature maxillary central incisors with periapical lesions in 13 patients. Field decontamination and negative control samples were performed before and after access cavity preparation. Root canal samples were taken using sterile stainless-steel hand files following field decontamination. In-office inoculation and pure sub-cultures were performed. Bacterial isolates were prepared for MALDI-TOF MS (Bruker, Billerica, MA USA) analysis using the formic acid extraction method. A comparison of the prevalence of isolated microorganisms was done using a one-sample chi-square test. Comparisons between identified microbial species with the, cone beam computed tomography periapical index (CBCT PAI) scores and lesion volume were also conducted. The Chi-square test was applied to investigate the association between the categorical variables . RESULTS: Out of the forty isolates recovered from the 16 traumatized teeth included in the present study with the mean patients' age of 10.93 ± 1.77, 37 isolates were reliably identified by MALDI-TOF MS. Twelve teeth (62.5%) were polymicrobial. The recovered bacteria belonged to five phyla, 15 genera and 25 species. Firmicutes were the predominant phylum (P < 0.001) over Bacteroidetes, Proteobacteria, Actinobacteria and Fusobacteria. Gram positive bacteria were significantly more prevalent than Gram negative (p = 0.03). Facultative anaerobes were the most prevalent (P < 0.001) compared to the obligate anaerobes and the obligate aerobes. The latter were the least prevalent. Statistically, significant differences existed in the comparison between CBCT PAI scores according to bacterial gram staining. CONCLUSION: Traumatized immature permanent teeth with periapical lesions showed a significant predominance of Gram-positive facultative anaerobes. MALDI-TOF MS provided accurate identification of numerous viable endodontic microbes.

Investigation of the structure and compressive strength of a bioceramic root canal sealer reinforced with nanomaterials.

OBJECTIVES: A root canal sealer that can increase the resistance of endodontically treated teeth to compressive strength would be of great advantage. The purpose of this study is to use three different nanoparticles: multi-walled carbon nanotubes (MWCNTs), Titanium carbides (TC), and Boron nitrides (BN) into a bioceramic adhesive root canal sealer; BioRoot™ RCS, in an attempt to improve its structural and compressive strength properties. METHODS: Three composites of two weight fractions (1- and 2-wt.%) were produced by mixing each nanomaterial separately with a pre-weighed mass of Bioroot powder. The microstructural properties and compressive strength of the different hardened composites obtained were investigated. The composites have been characterized by X-ray Diffraction, Fourier transform infrared spectroscopy, and scanning electron microscopy. Compression testing was performed. RESULTS: The 1-wt.% composites, Bioroot/MWCNTs, and Bioroot/TC, except for the one reinforced with BN, displayed a significant improvement in the compressive strength compared to pristine BioRoot™ RCS. The 2-wt.% composites showed no significant improvement in the compressive strength. CONCLUSION: The addition of 1-wt.% MWCNTs and TC nanomaterials can be considered in the future for enhancing the microstructure and compressive strength properties of pristine BioRoot™ RCS.

Effect of sintering temperature on the physiochemical properties, microstructure, and compressive strength of a bioceramic root canal sealer reinforced with multi-walled carbon nanotubes and titanium carbide.

AIM: Bioceramic root canal sealers like BioRoot RCS have received significant attention for use in endodontics. The addition of a nanophase material like multi-walled carbon nanotubes (MWCNTs) and titanium carbide (TC) to its matrix combined with pressureless sintering might have the potential for improved physiochemical, microstructure, and compressive strength properties. METHOD: ology: MWCNTs and TC nanomaterials were added at a percentage of 1 wt% to a definite weight of pristine BioRoot RCS. Two composites were prepared by ball milling followed by pressureless sintering in static nitrogen at temperatures 600 °C and 800 °C. The setting time, solubility, pH, compressive strength, and density were determined and compared to pristine BioRoot RCS. The microstructural properties of the composites were investigated by XRD, FTIR, Raman spectroscopy, and SEM. RESULTS: The final setting time before and after sintering at 600 °C of the composites was accelerated compared to Bioroot RCS (p = 0.016). The solubility of Bioroot/TC sintered at 600 °C was the lowest (p = 0.07) and its compressive strength was the highest among the sintered samples (p = 0.01). The incorporation of MWCNTs and TC had a significant increase in the compressive strength of Bioroot RCS (p < 0.05). CONCLUSION: The obtained results support the addition of nanomaterials to Bioroot RCS and the use of pressureless sintering.

Effect of phytic acid and ethylenediaminetetraacetic acid on penetration depth of bioceramic and resin sealers.

This study assessed influence of 1% phytic acid and 17% ethylenediaminetetraacetic acid (EDTA) on the dentinal tubules penetration of EndoSequence BC bioceramic-based and AH Plus resin-based sealers using confocal laser scanning microscopy (CLSM). Forty single-rooted mandibular premolars were divided randomly into four groups (n = 10). Group 1 received final irrigation with 1% phytic acid solution and canals sealed by AH Plus sealer, Group 2: 1% phytic acid solution and EndoSequence BC sealer, Group 3: 17% EDTA solution and AH Plus sealer and Group 4: 17% EDTA solution and EndoSequence BC sealer. Specimens were horizontally sectioned 2, 4 and 6 mm from the apex. Average maximum depth of sealer penetration was examined using CLSM. Group three showed the deepest sealer penetration at all three levels which was significantly higher than all other groups (P ˂ 0.05). Deep sealer penetration is achievable with AH Plus and EDTA. Phytic acid groups have moderate tubular penetration ability.

Effect of different irrigation protocols for applications in regenerative endodontics on mechanical properties of root dentin.

The objective of this study was to evaluate the effect of different concentrations of NaOCl with and without passive ultrasonic irrigation (PUI) on mechanical properties of human dentin for applications in regenerative endodontics (RE). Sixty single-rooted teeth were sectioned into 2 halves (n = 120). Dentin bars were produced from one half for flexural strength and the other half was used for microhardness. Specimens were randomly assigned into 10 groups: G1 and G2 (control): distilled water for 30 and 60 min, respectively; G3: 1.5%NaOCl for 30 min; G4:1.5%NaOCl for 60 min; G5: 1.5%NaOCl + PUI for 30 min; G6: 1.5%NaOCl + PUI for 60 min; G7: 5.25%NaOCl for 30 min; G8: 5.25%NaOCl for 60 min; G9: 5.25%NaOCl + PUI for 30 min; G10: 5.25%NaOCl + PUI for 60 min. An increase in NaOCl concentration showed highly significant reduction in mechanical properties. There was no significant difference between 1.5% NaOCl and control group except for specimens treated with PUI for 60 min. NaOCl in concentrations recommended for RE did not have a significant effect on mechanical properties of dentin. However, PUI with increased irrigation time might have an effect even with low NaOCl concentration.

Physiochemical properties of a bioceramic-based root canal sealer reinforced with multi-walled carbon nanotubes, titanium carbide and boron nitride biomaterials.

AIM: Bioceramic-containing root canal sealers are the most recently introduced sealers in endodontics. The present work reported experiments on a bioceramic-based root canal sealer with the objective of improving its physiochemical properties via reinforcement with each one of the three different nanomaterials: multi-walled carbon nanotubes (MWCNTS), titanium carbide (TC) or boron nitride (BN) in two weight percentages (1 wt% and 2 wt%). METHODOLOGY: Each nanomaterial was added to a definite weight of BioRoot root canal sealer (BioRoot™ RCS, Septodont, Saint-Maur-des-Fossés, France). Three composite groups of each weight percentage were prepared for evaluation: BioRoot/MWCNTS, BioRoot/TC and BioRoot/BN. The initial and final setting times, solubility, elution and pH values of the freshly-mixed and set samples were evaluated and compared to pristine BioRoot™ RCS. Setting times were evaluated using Gilmore needles. Solubility and elution were determined after immersion in water for 24 h. Scanning electron microscopy was used to examine the microstructure of the composite materials. RESULTS: The 1-wt. % composites possessed significantly shorter initial and final setting times compared with the pristine BioRoot™ RCS (p < 0.05). The 2-wt.% composites exhibited longer initial setting times but significantly shorter final setting times than BioRoot RCS (p < 0.05). Most of the composites had relatively lower solubility and elution profiles, with BioRoot/1-wt.% TC and BioRoot/1-wt.% BN being the lowest (p < 0.05). BioRoot™ RCS and all composites exhibited an alkaline pH profile over a period of 4 weeks and a significantly higher alkaline pH (p < 0.05) was recorded for BioRoot/1-wt.% and Bioroot/2-wt.% TC. CONCLUSIONS: A bioceramic-containing root canal sealer (BioRootTM RCS) with a shorter setting time, an alkaline pH profile, and a relatively lower solubility may be developed by incorporation of nanomaterials.

Histological observations of pulpal replacement tissue in immature dog teeth after revascularization of infected pulps.

BACKGROUND AND AIM: Many studies have examined the nature of tissue formed in the canals of immature necrotic teeth, following revascularization in animals and humans. While speculations have been made that regeneration of the pulp tissue might take place in the canal, the tissue has been found to be cementum-like, bone-like, and periodontal ligament-like. The purpose of this study was to histologically examine the tissue in the root canals in immature dog teeth that had been artificially infected and then revascularized. METHODS: Two 4- to 5-month-old mongrel dogs with immature teeth were used in the study. In one dog, four maxillary and four mandibular anterior teeth, and in another dog, four maxillary and five mandibular anterior teeth were used in the experiment. Pulp infection was artificially induced in the immature teeth. Revascularization was performed on all teeth by disinfecting the root canals with sodium hypochlorite irrigation and triple antibiotic intracanal dressing, completed with induction of intracanal bleeding, and sealed with an MTA plug. The access cavity was restored with silver amalgam. The animals were sacrificed 3 months after revascularization procedures. The revascularized teeth and surrounding periodontal tissues were removed and prepared for histological examination. RESULTS: Besides cementum-like, bone-like, and periodontal ligament-like tissues formed in the canals, residual remaining pulp tissue was observed in two revascularized teeth. In four teeth, ingrowth of alveolar bone into the canals was seen; presence of bone in the root canals has the potential for ankylosis. CONCLUSIONS: Within the limitation of this study, it can be concluded that residual pulp tissue can remain in the canals after revascularization procedures of immature teeth with artificially induced pulp infection. This can lead to the misinterpretation that true pulpal regeneration has occurred. Ingrowth of apical bone into the root canals undergoing revascularization can interfere with normal tooth eruption if ankylosis occurs.

Clinical and radiographic outcomes of traumatized immature permanent necrotic teeth after revascularization/revitalization therapy.

INTRODUCTION: Revascularization treatment is rapidly becoming an accepted treatment alternative for the management of endodontic pathology in immature permanent teeth with necrotic dental pulps. However, the success and timing of clinical resolution of symptoms, and radiographic outcomes of interest, such as continued hard tissue deposition within the root, are largely unknown. METHODS: In this prospective cohort study, 20 teeth were treated with a standardized revascularization treatment protocol and monitored for clinical and radiographic changes for 1 year. Standardized radiographs were collected at regular intervals, and radiographic changes were quantified. RESULTS: All 20 treated teeth survived during the 12-month follow-up period, and all 20 also met the clinical criteria for success at 12 months. As a group, the treated teeth showed a statistically significant increase in radiographic root width and length and a decrease in apical diameter, although the changes in many cases were quite small (such that the clinical significance is unclear). The within-case percent change in apical diameter after 3 months was 16% and had increased to 79% by 12 months, with 55% (11/20) showing complete apical closure. The within-case percent change in root length averaged less than 1% at 3 months and increased to 5% at 12 months. The within-case percent change in root thickness averaged 3% at 3 months and 21% at 12 months. CONCLUSIONS: Although clinical success was highly predictable with this procedure, clinically meaningful radiographic root thickening and lengthening are less predictable after 1-year of follow-up. Apical closure is the most consistent radiographic finding.