Antimicrobial Efficacy of a Novel Antibiotic-Eluting Injectable Platelet-Rich Fibrin Scaffold against a Dual-Species Biofilm in an Infected Immature Root Canal Model

Abstract

Background and Aims. This study was aimed at evaluating the antibacterial property of an injectable platelet-rich fibrin (I-PRF) scaffold containing triple antibiotic mixture against an Actinomyces naeslundii (A. naeslundii) and Enterococcus faecalis (E. faecalis) biofilm in an infected immature root canal model. Methods. A dual-species biofilm was inoculated inside the root canals via a series of centrifugal cycles. The samples were allocated to three experimental groups (i.e., G1: triple antibiotic mixture, G2: I-PRF containing triple antibiotic mixture, and G3: antibiotic-free I-PRF scaffold) and two control groups (G4: seven-day biofilm untreated and G5: bacteria-free untreated). Results. Bacterial gene quantification change and the overall reduction of live bacteria were evaluated. The highest antibacterial activity against A. naeslundii belonged to G2. However, G1 and G2 had similar antibacterial property against E. faecalis ( p value = 0.814). In general, experimental groups revealed higher levels of antibacterial activity against E. faecalis than against A. naeslundii ( p value < 0.001). Notably, G2 could dramatically decrease the number of live bacteria up to near 92%. Conclusions. The current study provides insight into the antibacterial property of an antibiotic-eluting I-PRF scaffold against a dual-species biofilm colonized inside the root canal. The fabricated scaffold contains not only the antibiotics but also the growth factors, which favor the regeneration.

Regenerative Endodontics and Minimally Invasive Dentistry: Intertwining Paths Crossing Over Into Clinical Translation

“…Possible scenarios for implementation of a MIREP concept as well as a suggested clinical protocol are provided in Figures 1 , 2 according to the clinical need of each respective case; for example whether the infection is a long-standing one or not and whether a single visit or multiple visits regimen is recommended, there can be several proposed regenerative strategies. The nature/source of the scaffold to be placed could have immunomodulatory function ( Khung et al, 2015 ; Shen et al, 2020 ), antibacterial action with controlled antibiotic release ( Moon et al, 2018 ) or a biologically inspired scaffold with dual action ( Hussey et al, 2019 ; Rafiee et al, 2020 ). One suggested single visit-MIREP protocol for a traumatized permanent maxillary necrotic tooth ( Figure 2 ) proposes a contracted endodontic cavity design followed by minimally tapered canal preparation and a disinfection regimen including combined NBW with 1.5% NaOCl followed by the placement of ECM-based hydrogel with/without cell-specific exosomes.…”

“…An antibiotic-releasing injectable Platelet-Rich-Fibrin (I-PRF) scaffold was tested against a dual-species biofilm colonized inside the root canal, showing significant reduction in the bacterial count. The engineered biocompatible autologous scaffold that contained both antibiotics and growth factors, could favor regeneration rather than repair ( Rafiee et al, 2020 ). Moreover, THP-1 macrophages were seeded on a concentrated growth factors (CGF) scaffold, revealing the immunoregulatory role of CGF in macrophage functional activities.…”

Ten years of injectable platelet‐rich fibrin

“…29 Finally, an additional four studies found that i-PRF demonstrated antimicrobial efficacy against both periodontal and cariogenic pathogens. [30][31][32][33]…”

“…It was found that delivering a triple antibiotic mixture using i-PRF was most efficient at reducing bacterial loads when compared to other delivery methods. 31 Although these studies remain limited…”

Efficacy of i-PRF in regenerative endodontics therapy for mature permanent teeth with pulp necrosis: study protocol for a multicentre randomised controlled trial

“…This liquid blood derivative is enriched with high concentrations of platelets, leukocytes, and growth factors [ 31 – 33 ]. Recent studies have reported that i-PRF provides a three-dimensional fibrin-dynamic gel embedded with platelets, leukocytes, type-I collagen, osteocalcin, and growth factors [ 31 ] with the potential to modulate inflammatory processes [ 34 ], exert anti-bacterium and anti-biofilm activities [ 35 , 36 ], and promote osteogenesis [ 37 – 39 ]. Compared to PRF, i-PRF results in better bone regeneration [ 39 ], treatment of gingival recession defects [ 40 ], and elimination of endodontic infection [ 36 ].…”