Endodontic drug delivery for root surface disinfection: a laboratory feasibility evaluation

Abstract

OBJECTIVES This study aims to assess the potential of a mixture of three antibiotics (TreVitaMix, TVM) as an intracanal dressing to disinfect the outer root surface by applying a new in vitro model. MATERIALS AND METHODS Fifty freshly extracted bovine roots were endodontically treated. Forty samples were then thoroughly scaled, mounted to petri dishes, gas sterilized, and randomly allocated to four groups (n = 10/group) according to their intracanal medication: sterile saline (NaCl; control, A); the TVM carrier material alone, i.e., propylene glycol (PG; B); TVM (C); and calcium hydroxide (D). In an additional group (E), the cementum was not removed and TVM was placed. Petri dishes were filled with Fastidious Anaerobe Agar, inoculated with Fusobacterium nucleatum suspension and then anaerobically incubated during 48-h intervals at 37°C up to 192 h. Inhibition zones around the roots were then measured after each incubation period (mm(2)). RESULTS Only teeth inoculated with the TVM dressing showed inhibition at all time points, whereas the other treatments showed no peri-radicular growing inhibition. Presence of cementum had no negative effect on disinfection (p = 0.9320). CONCLUSION TVM was able to penetrate through the dentine and inhibit the bacterial growth of F. nucleatum up to 192 h. CLINICAL RELEVANCE TVM might have the potential to sustainably disinfect the outer root surface in perio-endo lesions and serve as an adjunctive antimicrobial agent. Declaration of interests:The authors declare they have no conflicts of interest. AbstractObjectives To assess the potential of a mixture of three antibiotics (TreVitaMix, TVM) as an intracanal dressing to disinfect the outer root surface applying a new in vitro model. Materials and MethodsFifty freshly extracted bovine roots were endodontically treated. Forty samples were then thoroughly scaled, mounted to petri dishes, gas sterilized and randomly allocated to four groups (n=10/group) according their intracanal medication: Sterile saline NaCl (control, A), the TVM carrier material alone, i.e. propylene glycol (PG; B), TVM (C) and calcium hydroxide (D). In an additional group (E), the cementum was not removed and TVM was placed. Petri dishes were filled with Fastidiuos Anaerobe Agar, inoculated with F. nucleatum suspension and then anaerobically incubated during 48 h intervals at 37°C up to 192 h. Inhibition zones around the roots were then measured after each incubation period (mm 2 ).Results Only teeth inoculated with the TVM dressing showed inhibition at all time points, whereas the other treatments showed no peri-radicular growing inhibition. Presence of cementum had no negative effect on the disinfection (p = 0.9320).Conclusion TVM was able to penetrate through dentine and inhibit the bacterial growth of F. nucleatum up to 192 h.Clinical relevance TVM might have the potential to sustainably disinfect the outer root surface in perio-endo lesions and serve as an adjunctive antimicrobial agent.

Use of a Cellulase from Trichoderma reesei as an Adjuvant for Enterococcus faecalis Biofilm Disruption in Combination with Antibiotics as an Alternative Treatment in Secondary Endodontic Infection

“…Over the last few years, intra-canal preparations containing antibiotic mixtures at concentrations safe for fibroblasts have been studied. These preparations were used to disinfect the root canal during endodontic regeneration procedures to favor root development and improve the treatment prognosis for necrotic immature teeth [ 37 , 38 , 39 ]. Therefore, an irrigation protocol combining enzymes and an antibiotic mixture has potential as a new canal disinfection treatment.…”

“…It is known that a combination of antibiotics can reduce the probability of developing resistant bacteria. However, it should be noted that the diffusion of antibiotics through the dentin (post-treatment) could lead to non-inhibitory concentrations promoting bacterial resistance, especially when the biofilm is intact and not previously altered or disintegrated [ 39 ].…”