Antibacterial Additives in Epoxy Resin-Based Root Canal Sealers: A Focused Review

Abstract

Dental materials used in root canal treatment have undergone substantial improvements over the past decade. However, one area that still remains to be addressed is the ability of root canal fillings to effectively entomb, kill bacteria, and prevent the formation of a biofilm, all of which will prevent reinfection of the root canal system. Thus far, no published review has analysed the literature on antimicrobial additives to root canal sealers and their influence on physicochemical properties. The aim of this paper was to systematically review the current literature on antimicrobial additives in root canal sealers, their anti-fouling effects, and influence on physicochemical properties. A systematic search was performed in two databases (PubMed and Scopus) to identify studies that investigated the effect of antimicrobial additives in epoxy resin-based root canal sealers. The nature of additives, their antimicrobial effects, methods of antimicrobial testing are critically discussed. The effects on sealer properties have also been reviewed. A total of 31 research papers were reviewed in this work. A variety of antimicrobial agents have been evaluated as additives to epoxy resin-based sealers, including quaternary ammonium compounds, chlorhexidine, calcium hydroxide, iodoform, natural extracts, antibiotics, antifungal drugs, and antimicrobial agent-functionalised nanoparticles. Antimicrobial additives generally improved the antimicrobial effect of epoxy resin-based sealers mainly without deteriorating the physicochemical properties, which mostly remained in accordance with ISO and ANSI/ADA specifications.

Treatment outcome following a single-visit coronal indirect restoration by a CAD/CAM technique in endodontically treated teeth with coronal contamination: A pilot retrospective study

“…Compact obturation and adequate depth of root lling block the penetration of oral bacteria into the root canal. Furthermore, in the clinic and in experiments, acceptable antibacterial activity and sealing ability of root canal sealers create an inadequate environment for the viability of bacterial organisms [33][34][35][36]. In the in vitro model of other studies, if even small amounts of bacteria in saliva entered the apical root through coronal sealing, turbid culture medium in which the apical root was immerged was noted [37,38].…”

Iodoform-Blended Portland Cement for Dentistry

“…Iodoform is adequately biocompatible with the various dental tissues and has also seen longstanding service as an antimicrobial radiopaque admixture in calcium hydroxide and resin-based root filling and pulp capping materials [7,8,[13][14][15]17,[20][21][22][23]. Radiographic studies indicate that 20 wt% replacement iodoform in Portland cement formulations is sufficient to comply with the regulatory radiographic standards for root filling materials [7,18,19,22], yet very little work has been carried out on the impact of iodoform on the complex hydration chemistry of the cement matrix [8].…”

“…Of these, CHI 3 (iodoform) is a common constituent of commercial calcium hydroxide-based pulp capping formulations (e.g., Vitapex ® (Neo Dental International Inc., Federal Way, WA, USA) and Metapex (Meta Biomed, Colmar, PA, USA)). Iodoform is also added to epoxy resin endodontic sealers to confer radiopacity and antimicrobial properties [13][14][15].…”

Antimicrobial Efficacy of Nanopropolis Coated Vs Silver-Curcumin Nanoparticles Coated Gutta-Percha Points on Various Microbial Species. A Comparative In Vitro Study

“…Few studies were conducted to investigate the antimicrobial effect of either sealers or gutta-percha, combined with antimicrobial agents in combating residual infection. Among these antibacterial materials are calcium hydroxide, zinc oxide, chlorohexidine, antibiotics and iodoform (7,(10)(11)(12)(13) .…”