The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics

Bacteria have been implicated in the pathogenesis and progression of pulp and periapical diseases. The primary aim of endodontic treatment is to remove as many bacteria as possible from the root canal system and then to create an environment in which any remaining organisms cannot survive. This can only be achieved through the use of a combination of aseptic treatment techniques, chemomechanical preparation of the root canal, antimicrobial irrigating solutions and intracanal medicaments. The choice of which intracanal medicament to use is dependent on having an accurate diagnosis of the condition being treated, as well as a thorough knowledge of the type of organisms likely to be involved and. their mechanisms of growth and survival. Since the disease is likely to have been caused by the presence of bacteria within the root canal, the use of an antimicrobial agent is essential. Many medicaments have been used in an attempt to achieve the above aims, but no single preparation has been found to be completely predictable or effective. Commonly used medicaments include calcium hydroxide, antibiotics; non-phenolic biocides, phenolic biocides and iodine compounds. Each has advantages and disadvantages, and further research is required to determine which is best suited for root canal infections.

In vitro evaluation of antimicrobial activity of sealers and pastes used in endodontics

The antimicrobial activity of four root canal sealers (AH Plus, Sealapex, Ketac Endo, and Fill Canal), two calcium hydroxide pastes (Calen and Calasept), and a zinc oxide paste was evaluated. Seven bacterial strains were used, six of them standard; Micrococcus luteus ATCC 9341, Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27853, Staphylococcus epidermidis ATCC 12228, Escherichia coli ATCC 25922, and Enterococcus faecalis ATCC 10541. There was a wild strain of Streptococcus mutans isolated from saliva obtained in an adult dental clinic. Activity was evaluated using the agar diffusion method with Brain Heart Infusion agar and Müller Hinton medium seeded by pour plate. Calcium hydroxide-based sealers and pastes were either placed directly into 4.0 × 4.0 mm wells or by using absorbent paper points. The plates were kept at room temperature for 2 hr for diffusion. After incubation at 37°C for 24 hr, the medium was optimized with 0.05 g% TTC gel and inhibition haloes were measured. All bacterial strains were inhibited by all materials using the well method. However, when the materials were applied with absorbent paper points, Enterococcus faecalis was not inhibited by zinc oxide, and Pseudomonas aeruginosa was not inhibited by AH Plus, Fill Canal, and the zinc oxide-based paste. We conclude that sealers and pastes presented antimicrobial activity in vitro and culture medium optimization with 0.05 g% TTC gel facilitated observation of the inhibition haloes. Copyright © 2000 by The American Association of Endodontists.

Use of nanoparticulate zinc oxide as intracanal medication in endodontics: pH and antimicrobial activity

The aim of this study was to evaluate the pH and antimicrobial activity of micro or nanoparticulate zinc oxide (ZnO) pastes with or without calcium hydroxide (CH). The following medications were evaluated: microparticulate ZnO + polyethylene glycol (PEG) 400; nanoparticulate ZnO + PEG 400; PEG 400; CH + microparticulate ZnO + PEG 400 and CH + nanoparticulate ZnO + PEG 400. The pH was assessed between 12 hours and 28 days, using a digital pH meter. The antimicrobial activity against Enterococcus faecalis (ATCC-9212), Candida albicans (ATCC-10231), Pseudomonas aeruginosa (ATCC-27853), Staphylococcus aureus (ATCC-6538) and Kocuria rhizophila (ATCC-9341) was determined in triplicate using agar diffusion test. The results were submitted to Kruskal-Wallis/Dunn and ANOVA/Tukey tests with 5% significance. The highest pH values were found for CH+ZnO, with higher values for nanoparticulate ZnO after 12 hours and 21 days (p<0.05). CH+ZnO medication promoted higher growth inhibition against P. aeruginosa and lower against E. faecalis. Calcium hydroxide pastes have higher pH and antimicrobial activity when associated with either micro- or nanoparticulate zinc oxide.

Biomaterials for Clinical Application in Endodontics

Endodontic therapy consists in the management of several tissues such as pulp tissue, periodontal tissue, periapical bone and dentine. These tissues are often contaminated by blood, periapical exudates and biological fluids. An ideal orthograde or retrograde filling material should be non toxic, noncarcinogenic, nongenotoxic, biocompatible with the host tissues, insoluble in tissue fluids, and dimensionally stable. Calcium-silicate MTA based cements own many of these ideal characteristics, but the long setting time, the non-easy handling and the lack of mechanical properties at early times are few drawbacks which may complicate the clinical application. The aim of this study was to investigate the chemical, physical and biological properties of calcium-silicate MTA cements in order to improve the mechanical properties and the handling keeping the biological characteristics unchanged. Chemical and physical properties such as setting time, solubility, water-uptake, ion release, sealing ability were investigated according the ISO and ADA specifications. The bioactivity (ability to produce apatite nano-sferulities) of MTA cements were evaluated using ESEM/EDX, micro-Raman and ATR/FTIR spettroscopy.

[Cone beam computed tomography in endodontics: a review for daily clinical practice]

Since the introduction of cone beam computed tomography (CBCT), this 3-dimensional diagnostic imaging technique has been established in a growing number of fields in dental medicine. It has become an important tool for both diagnosis and treatment planning, and is also able to support endodontic treatments. However, the higher effective dose of ionizing radiation compared to conventional 2-dimensional radiographs is not justifiable in every case. CBCT allows for a more precise diagnosis of periapical lesions, root fractures as well as external and internal resorptions. Concerning the utility of CBCT in treatment planning decisions, the gain of information through 3-dimensional imaging for any of these pathologies has to be evaluated carefully on an individual basis. Moreover, radioopaque materials such as root canal filling and posts often create artefacts, which may compromise diagnosis. The aim of this review is to summarize the possibilities and limits of CBCT imaging in endodontology as well as introduce guidelines for daily clinical practice. Furthermore, the article presents possible therapeutic advantages of preexisting CBCT scans for root canal treatments.

The impact of loupes and microscopes on vision in endodontics.

AIM To report on an intraradicular visual test in a simulated clinical setting under different optical conditions. METHODOLOGY Miniaturized visual tests with E-optotypes (bar distance from 0.01 to 0.05 mm) were fixed inside the root canal system of an extracted maxillary molar at different locations: at the orifice, a depth of 5 mm and the apex. The tooth was mounted in a phantom head for a simulated clinical setting. Unaided vision was compared with Galilean loupes (2.5× magnification) with integrated light source and an operating microscope (6× magnification). The influence of the dentists' age within two groups was evaluated: <40 years (n = 9) and ≥40 years (n = 15). RESULTS Some younger dentists were able to identify the E-optotypes at the orifice, but otherwise, natural vision did not reveal any measurable result. With Galilean loupes, the younger dentists <40 years could see a 0.05 mm structure at the root canal orifice, in contrast to the older group ≥40 years. Only the microscope allowed the observation of structures inside the root canal, independent of age. CONCLUSION Unaided vision and Galilean loupes with an integrated light source could not provide any measurable vision inside the root canal, but younger dentists <40 years could detect with Galilean loupes a canal orifice corresponding to the tip of the smallest endodontic instruments. Dentists over 40 years of age were dependent on the microscope to inspect the root canal system.