Biofilm in Endodontics: In Vitro Cultivation Possibilities, Sonic-, Ultrasonic- and Laser-Assisted Removal Techniques and Evaluation of the Cleaning Efficacy

Abstract

Incomplete and inadequate removal of endodontic biofilm during root canal treatment often leads to the clinical failure. Over the past decade, biofilm eradication techniques, such as sonication of irrigant solutions, ultrasonic and laser devices have been investigated in laboratory settings. This review aimed to give an overview of endodontic biofilm cultivation methods described in papers which investigated sonic-, ultrasonic- and Er:Yag laser-assisted biofilm removal techniques. Furthermore, the effectiveness of these removal techniques was discussed, as well as methods used for the evaluation of the cleaning efficacy. In general, laser assisted agitation, as well as ultrasonic and sonic activation of the irrigants provide a more efficient biofilm removal compared to conventional irrigation conducted by syringe/needle. The choice of irrigant is an important factor for reducing the bacterial contamination inside the root canal, with water and saline being the least effective. Due to heterogeneity in methods among the reviewed studies, it is difficult to compare sonic-, ultrasonic- and Er:Yag laser-assisted techniques among each other and give recommendations for the most efficient method in biofilm removal. Future studies should standardize the methodology regarding biofilm cultivation and cleaning methods, root canals with complex morphology should be introduced in research, with the aim of simulating the clinical scenario more closely.

Benefits and Challenges of the Use of Two Novel vB_Efa29212_2e and vB_Efa29212_3e Bacteriophages in Biocontrol of the Root Canal Enterococcus faecalis Infections

“…Endodontic procedures reduce most of the root canal biofilm, but some resistant bacteria survive and lead to treatment failure [ 6 , 37 ]. A standard protocol for cleaning and shaping of the canal system includes instrumentation with files and the use of irrigation agents (dissolving the rest of the pulp, removal of the smear layer) with ultrasonic activation (increase in temperature) and intracanal dressings (rise in pH).…”

The Effect of Antioxidants on Dentin Bond Strength after Application of Common Endodontic Irrigants: A Systematic Review

“…All the functions required from an irrigant are not adequately recovered by a single irrigant solution. Optimal irrigation is based on the combination in a specific sequence of several irrigant solutions to obtain, in a predictable way, the goals of safe and effective irrigation [ 2 , 3 ].…”

“…NaOCl has a disinfecting action as well as the ability to dissolve the pulpal remnants and organic components of dentine and predentine in non-instrumented surfaces [ 1 ]. NaOCl used in combination with other disinfectants such as Ethylenediaminetetraacetic acid (EDTA), citric acid, chlorhexidine (CHX), or alone represents the most used endodontic irrigant [ 3 ].…”

Novel Dental Restorative Solutions for Natural Teeth and Implants

“…A biofilm is defined as an aggregate of bacteria in which cells adhere to each other and to a surface [ 28 ]. Biofilms are structured microbial communities embedded in a matrix and designed to survive at a solid/fluid interface [ 29 ]. It is a complex ecosystem in which bacteria are in equilibrium with the host under health conditions.…”

“…Additionally, the hydrolysable tannins were reported by Kharouf to benefit dental practice [ 8 ]. A successful dental root canal treatment depends on a proper cleaning and filling of the root canal system [ 29 , 78 , 79 ]. The use of a solution containing 25% ( w / v ) of tannic acid as the final irrigation, following hydrogen peroxide and sodium hypochlorite, revealed a smoother and cleaner pulp chamber surface compared to hydrogen peroxide and hypochlorite treatment alone [ 80 ].…”