Copper–Calcium Hydroxide and Permanent Electrophoretic Current for Treatment of Apical Periodontitis

Abstract

Endodontic failure has been and continues to be a problem for endodontics-specialists. Complicated anatomy, numerous foramens, and accessory canals are an environment for microorganisms to infect the teeth. The purpose of the present work was to evaluate the regeneration of copper–calcium hydroxide (Cupral)-endodontically treated teeth diagnosed with apical periodontitis using an electrophoresis technique. In total, 132 patients, aging from 19 to 65 years old, underwent endodontic treatment mono- and multi-radicular teeth, with complicated canals from January 2019 to June 2020. The patients were divided into two groups: (i) the control group—which included 54 patients (n = 62 teeth) receiving endodontic paste (Calcipast + 1) and, as final filling, the AH-PlusTM cement—and (ii) the Cupral group, which included 78 patients (n = 80 teeth) receiving Cupral paste plus the electrophoretic current and, as final filling, the Atacamit-alkaline cement. The clinical cases were periodically observed along an 18-month follow-up period via radiography. Data were expressed as focal size of the lesions (mean ± standard error (SEM) of all the radiographic outcomes) observed in each group at each interval point. Statistical analysis was performed using the Student’s t-test that allowed us to compare the control and Cupral groups; the statistical significance was set at p < 0.05 and p < 0.01, where the latter was highly significant. Before treatments, the focal sizes were 4.8 mm and 4.95 mm for control and Cupral-treated groups, respectively. After 6 months, the mean focal sizes were 3.9 mm and 2.14 mm for the control and Cupral groups, respectively. After 12 months, in the control group, the mean focal size was measured at 2.8 mm, while, in Cupral group, the lesion size decreased down to 0.31 mm and a highly dynamic regeneration of the destructive focal-bone occurred. After 18 months, the lesions were further significantly reduced in the control group (mean values of 2.62 mm), while they were barely detectable in the Cupral group (0.2 mm). In conclusion, we provide initial evidence that the Cupral-electrophoresis methodology is effective in treating destructive periodontitis of teeth with problematic canals up to 18 months, thus allowing teeth preservation.

Cleaning and Disinfection Protocols for Clear Orthodontic Aligners: A Systematic Review

“…The study conducted by Meto et al [ 34 ], which was removed from this systematic review due to its case report design, tested the efficacy of Cupral ® , a copper-calcium hydroxide solution, as a disinfectant on a biofilm-contaminated aligner. This is an innovative method; its effectiveness has been demonstrated in periodontal or endodontic infections [ 35 , 36 ], but never in orthodontics, and its mechanisms of action remain unknown. In this study, Cupral ® showed encouraging results in terms of elimination of aerobic and anaerobic bacteria.…”

Application of Copper Nanoparticles in Dentistry

“…Another study used copper-calcium hydroxide nanoparticles for treating apical periodontitis in an endodontically treated tooth, and it recommended using them to treat periodontitis [ 102 ]. Researchers have used several copper nanoparticle formulations for periodontal therapy.…”

Debris Removal by Activation of Endodontic Irrigants in Complex Root Canal Systems: A Standardized In-Vitro-Study

“…Caries, dental trauma and tooth malformations frequently cause an infection of the dental pulp, which results, if untreated, in pulpitis, pulp necrosis and, finally, apical periodontitis. In this case, root canal treatment (RCT) is indicated, as the removal of necrotic pulp tissue and bacteria from the entire canal system enables healing of periapical pathosis [1][2][3]. During RCT, the endodontic canal system has to be explored, and the canals are enlarged and debrided by endodontic files.…”