|Year : 2020 | Volume
| Issue : 3 | Page : 114-118
Comparative evaluation of macro-form and nano-form of bioactive glass and triple antibiotic paste on fracture resistance of root dentin
Sara S Elmallah1, Maram F Obeid2, Mohamed A Elsayed BDS, MSc 3
1 Department of Endodontics, Faculty of Dentistry, Fayoum University, Fayoum, Egypt
2 Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
3 Department of Endodontics, Faculty of Dentistry, Assiut University, Assiut, Egypt
|Date of Submission||27-Jan-2020|
|Date of Acceptance||18-Jul-2020|
|Date of Web Publication||30-Oct-2020|
Mohamed A Elsayed
Department of Endodontic, Faculty of Dentistry, Assiut University, Assiut 71515, Egypt
Source of Support: None, Conflict of Interest: None
The aim of this study was to compare the effect of using nanoparticle and macroparticles of bioactive glass (BAG) and triple antibiotic paste (TAP) as intracanal medicaments on the fracture resistance of root dentin.
Materials and methods
After root canal preparation, one hundred single-rooted premolars were randomly assigned into five groups according to the applied intracanal medicaments (n = 20): BAG, bioactive glass nano-form (BAG-N), TAP, triple antibiotic paste nano-form (TAP-N), and a control group where only irrigation with 5% NaOCl was done. After mounting roots in a universal testing machine, the force required to break each tooth was recorded in Newtons. Data analysis was performed using Kruskal–Wallis test to determine the level of significance among all groups P less than 0.05, and Mann–Whiteny test was used to compare paired independent samples.
Fracture resistance values of BAG either macro or nano-form were significantly higher than those of TAP macro and nano-forms. Roots treated with nano-form medicament either BAG or TAP showed lower fracture resistance values than those treated with macro form but this difference was statistically insignificant. Roots treated with TAP-nano-form showed the lowest fracture resistance values among all groups.
Using nano-form medicaments as intracanal dressing did not enhance fracture resistance of endodontically treated teeth.
Keywords: bioactive glass, endodontically treated teeth, fracture resistance, intracanal medication, nano medication, triple antibiotic paste
|How to cite this article:|
Elmallah SS, Obeid MF, Elsayed MA. Comparative evaluation of macro-form and nano-form of bioactive glass and triple antibiotic paste on fracture resistance of root dentin. Tanta Dent J 2020;17:114-8
|How to cite this URL:|
Elmallah SS, Obeid MF, Elsayed MA. Comparative evaluation of macro-form and nano-form of bioactive glass and triple antibiotic paste on fracture resistance of root dentin. Tanta Dent J [serial online] 2020 [cited 2020 Nov 27];17:114-8. Available from: http://www.tmj.eg.net/text.asp?2020/17/3/114/299629
| Introduction|| |
Complete eradication of bacteria involved in the endodontic infection is one of the major targets in endodontic treatment. Commonly, this issue is accomplished by chemicomechanical procedures with the aid of antimicrobial irrigation solutions with or without intracanal medications between visits. Mechanical preparation can significantly diminish intracanal bacteria but does not entirely eliminate them. Consequently, the adjunct use of an intracanal medicament may help in the elimination of bacteria that remain and provide an environment conducive for periapical tissue repair.
Antibiotics may aid throughout endodontic treatment but its ineffectiveness in the systemic route of administration has commanded local application in the form of intracanal medication to rise its efficacy. In 1996 Hoshinoet al. mentioned the triple antibiotic paste (TAP) for root canal disinfection purpose, which is a combination of ciprofloxacin, metronidazole, and minocycline dissolved in a macrogol/propylene glycol vehicle. Subsequently, several studies described the antimicrobial value of this mixture against the pathogens commonly found inside the root canal system including Enterococcus faecalis,. Unfortunately, the use of TAP led to coronal discoloration when compared to other endodontic medicaments,,, showed a tendency to demineralize the radicular dentin, and created a cytotoxic environment for stem cells.
Bioactive glass (BAG) has been lately introduced as an intracanal medicament with some hopeful recognized outcomes [12–15]. It consists of SiO2, Na2O, CaO2, and P2O5 at different concentrations. The antibacterial mechanism of BAG is attributed to a blend of several factors including high pH; an increase in osmotic effects; and Ca/P precipitation.
With the rapid development in the field of nanotechnology for medical applications, nanoparticles are believed to have a significant future. These are microscopic particles with one or more dimensions in the nanometer range (i.e. between 1 and 100 nm). Their high surface area,, charge density, and a greater degree of interaction with cells, have resulted in higher levels of antibacterial activity. Also, the electrostatic interaction between the positively charged nanoparticles and the negatively charged bacterial cells, together with the accumulation of many nanoparticles on the bacterial cell membrane, lead to an increase in membrane permeability with rapid loss of membrane function.
The application of root canal medicaments directly over radicular dentin affects its physical characteristics and dentin strength which is determined by the link between hydroxyapatite (consist mainly from calcium and phosphorus) and collagenous fibrils subsequently, the dentin fracture resistance is affected,. However, there are limited data about the effect of using nanoparticulate medicaments on fracture resistance of root dentin. Therefore, the present study aimed to evaluate the effect of nanoparticle BAG and TAP intracanal medicaments in comparison to their corresponding macroparticles on the fracture resistance of root dentin.
| Materials and Methods|| |
After approval of the Ethical Committee of Faculty of Dentistry, Ain Shams University, 100 sound single-rooted premolars extracted for periodontal or orthodontic reasons, were collected from 45 to 55-year-old patients attending the outpatient clinic at the Oral Surgery Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt, and stored in purified filtered water. The patients were informed about the use of their teeth for scientific purposes.
Buccolingual and mesiodistal radiographs were obtained to exclude teeth with internal resorption. Teeth were decoronated at the level of the cementoenamel junction to standardize the specimens length at 15 mm using steel discs (Brasseler USA, Savannah, Georgia, USA). Size 15 K-file was inserted into the canal till the tip was just visualized beyond the apical foramen using a surgical operating microscope. Working length was then determined by subtracting one mm from the file length. Radicular preparation was done by series of ProTaper rotary instruments (DentsplyMaillefer, Ballaigues, Switzerland) up to a master apical file F3 using torque and speed-controlled electric motorX Smart (DentsplyMaillefer, Ballaigues, Switzerland). The speed and torque values were set as recommended by the manufacturer. Irrigation was done using 3 ml of 2.6% NaOCl between each file via a 30-G irrigating tip. Root canals were rinsed with saline as a final flush and dried using paper points.
Preparation of TAP
Pre-prepared TAP composed of Metronidazole 500 mg tablets (Flagyl 500 mg; Aventis, Cairo, Egypt), Ciprofloxacin 250 mg tablets (Ciprocin 250 mg; EPICO, Cairo, Egypt) and Doxycycline 100 mg capsules (Vibramycin; Pfizer, Cairo, Egypt) with 1 : 1 : 1 ratio were used. Nano-emulsion was prepared by using tween 80, a surfactant and emulsifying agent (Nanotech, Dreamland, 6th of October, Egypt) [Figure 1]a. 1.5 gm of the paste in 15 ml distilled water was prepared using 3 ml of Tween ethanol, then the ethanol was completely evaporated to get the aqueous solution.
|Figure 1: Transmission Electron microscope scan showing the particle size of TAP-N (a), BAG-N (b). BAG-N, bioactive glass nano-form; TAP-N, triple antibiotic paste nano-form.|
Click here to view
Preparation of BAG
BAG NS0001 was prepared using the alkoxide sol-gel technique. The chemical composition includes 45% SiO2, 25% CaO, 25% Na2O, and 5% P2O5 (Nano-Stream, 6th of October, Egypt). The oxide composition was prepared using silicon and phosphorous alkoxides together with sodium salt as sodium hydroxide and Ca-salt as Calcium hydroxide. Deionized water and ethanol alcohol were used as solvents. The gel prepared at 70°C and pH = 2 was then aged for a week to complete the reaction and then heat treated at a different temperature up to 800°C [Figure 1]b.
The particle size of both materials was analyzed using transmission electron microscopy (LEO 912 AB; Ziess, Munich, Germany) working at 120 kV, and was less than 100 nm [Figure 1].
All the specimens were randomly divided into four experimental and one control groups (n = 20) according to the applied intracanal medicaments: BAG-N and BAG groups: the powder was added to distilled water at the ratio of 1 : 0.6 wt./vol to get a homogenous paste. This paste was introduced into the root canal with the aid of a lentulo-spiral and size 40 plugger. TAP-N and TAP groups: the paste was delivered into the root canal by a sterile plastic syringe then size 40 plugger was used for condensation to remove any air bubbles. (Control group): only canal irrigation was done using 5 ml of 5% NaOCl for 3 min Afterward, all specimens were coronally sealed with composite (3 M ESPE; St. Paul, Munich, Minnesota, USA) placed in microtubes, and incubated at 37°C in 100% humidity for 7 days.
Fracture resistance testing
The apical 8 mm of roots were embedded in acrylic resin blocks of 1.5 cm diameter exposing 7 mm of the coronal end of each root. The acrylic resin was allowed to polymerize for 1 h. A protractor was used to ensure vertical alignment of the long axis of the roots. The blocks with the vertically aligned roots were mounted in a universal testing machine (Model 4502; Instron, Canton, Massachusetts, USA). A cone-shaped 0.5 inch diameter metal rod with 5° taper down to 0.25 inch followed by 45° taper to a blunt tip was mounted on the Instron tester vertically over the canal opening of each root and load was applied slowly with increasing force at a rate of 1.0 mm/min, until the root fractured. This point was recorded by the computer monitoring software and measured in Newtons.
| Results|| |
Mean ± standard deviation values of the force required to fracture the roots in all groups are presented in [Table 1]. The Kruskal–Wallis test showed a statistically significant difference among all groups (P = 0.031). The result is significant at P value less than or equal to 0.05). The data were analyzed by nonparametric tests using Mann–Whiteny test to compare paired independent samples. The mean fracture resistance values of BAG and BAG-N were significantly higher than those of TAP and TAP-N. Samples in groups BAG-N and TAP-N showed lower fracture resistance values than those in other groups but this difference was statistically insignificant. TAP-N showed the lowest fracture resistance values among all groups. The control group showed fracture resistance values lower than that of BAG and BAG-N but this difference was statistically significant only with BAG.
|Table 1: Mean±SD values of the force required to fracture the roots in Newton|
Click here to view
| Discussion|| |
The successful endodontic treatment depends primarily on the effective destruction and elimination of bacterial biofilms. Several studies showed that even after meticulous chemomechanical disinfection, bacterial biofilms can persist in the root canal system justifying the need for inter appointment intracanal medication.
For several decades, calcium hydroxide (CH) has been widely used as an intracanal medicament. Nevertheless, prolonged exposure of dentin to CH resulted in reduction of flexural strength and subsequently fracture resistance. Nerwichet al. concluded that the structure of collagen fibers and hydroxyapatite crystals is disrupted by the exposure to CH and so can alter the physical properties of dentin. As well, the antibacterial activity of CH can be inactivated by exudates from the periapical tissue and dentin buffering effect. Such drawbacks in CH forced to search for alternative intracanal medicaments. TAP is one of these alternatives, this intracanal medicament could eliminate, E. faecalis from the dentinal tubules of the apical half of root canal up to 400 μ depth.
In the present study, the fracture resistance of roots treated with BAG and TAP was recorded. Results have demonstrated that the fracture resistance of roots filled with BAG either macro ornano-form was significantly higher than that of nano or macro TAP. These findings may be related to ions dissolved from BAG such as silica ions which enhance the mineralization of dentin surface [31–33]. As well Hassan and Khallaf found that the silver nanoparticles enhance the mineralization of dentin surface gradually over time and significantly increase the dentine microhardness compared to calcium hydroxide after either 3 days or 1 week.
Findings of our study agree with Marendinget al. they assessed the effect of CH compared to micro and nanoparticulate BAGs and found that CH caused a significant drop in mean flexural strength values compared to the control treatment after 10 days, meanwhile, the BAG caused less drop in flexural strength but this difference did not reach the statistical significance.
In this study, the root fracture resistance of macro and nanoTAP treated groups showed the lowest values. These findings come in agreement with previous studies, who found a significant decrease in root dentin microhardness after one and 3 months of treatment with TAP. This may beattributed to acids that are commonly added to antibiotics to enhance their chemical stability, control tonicity, or to ensure physiological compatibility. Exposure of root dentin to acidic antibiotics for long term negatively affects their mechanical properties. In addition, Minocycline, a component in the TAP, can chelate calcium and demineralize dental hard tissues,,.
Roots in the control group which were treated with 5%NaOCl showed lower fracture resistance values than roots filled with BAG macro form and this difference was statistically significant. This is similar to the findings of Simet al. who reported that the 5.25% NaOCl reduced the elastic modulus and flexural strength of dentin. Likewise, Marendinget al. studied the effect of NaOCl on root dentin and found a concentration dependent effect of NaOCl on mechanical dentine properties resulting from the disintegration of the organic dentine matrix.
| Conclusion|| |
Within the limitations of this study, results have shown that the intracanal medication influenced the vertical root fracture resistance with a varying degree with no significant difference between macro and nano-form. Further studies with different preparation and irrigation protocols are recommended in future investigations.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Xavier F, Nevares G, de Albuquerque DS, Gominho LF, de Alcântara Dellazari RL, Cunha RS, et al.
Analysis of the effect of ultrasonic agitation on the cleaning of root canals using different periods during the final irrigation. Rev Sul Bras Odontol 2014; 11:321–327.
Murvindran V, Raj JD. Antibiotics as an intracanal medicament in endodontics. J Pharm Sci Res 2014; 6:297–12.
Sato I, Ando-Kurihara N, Kota K, Iwaku M, Hoshino E. Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ
. Int Endod J 1996; 29:118–124.
Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, et al
antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J 1996; 29:125–130.
Windley WIII, Teixeira F, Levin L, Sigurdsson A, Trope M. Disinfection of immature teeth with a triple antibiotic paste. J Endod 2005; 31:439–443.
Yassen GH, Chu TMG, Eckert G, Platt JA. Effect of medicaments used in endodontic regeneration technique on the chemical structure of human immature radicular dentin: anin vitro
study. J Endod 2013; 39:269–273.
Lenherr P, Allgayer N, Weiger R, Filippi A, Attin T, Krastl G. Tooth discoloration induced by endodontic materials: a laboratory study. Int Endod J 2012; 45:942–949.
Kim JH, Kim Y, Shin SJ, Park JW, Jung IY. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod 2010; 36:1086–1091.
Kahler B, Rossi-Fedele G. A review of tooth discoloration after regenerative endodontic therapy. J Endod 2016; 42:563–569.
Parhizkar A, Nojehdehian H, Asgary S. Triple antibiotic paste: momentous roles and applications in endodontics: a review. Restor Dent Endod 2018; 43:28–28.
Ruparel NB, Teixeira FB, Ferraz CC, Diogenes A. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod 2012; 38:1372–1375.
Zehnder M, Söderling E, Salonen J, Waltimo T. Preliminary evaluation of bioactive glass S53P4 as an endodontic medication in vitro
. J Endod 2004; 30:220–224.
Zehnder M, Luder H, Schätzle M, Kerosuo E, Waltimo T. A comparative study on the disinfection potentials of bioactive glass S53P4 and calcium hydroxide in contra-lateral human premolars ex vivo
. Int Endod J 2006; 39:952–958.
Goel A, Sinha A, Khandeparker RVS, Mehrotra R, Vashisth P, Garg A. Bioactive glass S53P4 versus chlorhexidine gluconate as intracanal medicament in primary teeth: an in-vivo
study using polymerase chain reaction analysis. J Int Oral Health 2015; 7:65–74.
Chaudhari DV, Shashikiran N, Maurya A, Gugwad S, Gaonkar N, Taur S, et al
. Comparative evaluation of antimicrobial efficacy of sodium hypochlorite, silver diamine fluoride fluoride, chitosan and bioactive glass nanoparticles as root canal irrigants against the bacterial strain of enterococcus faecalis-anin vitro
study. J Clin Diagn Res 2020; 14:15–19.
Kishen A. Advanced therapeutic options for endodontic biofilms. Endo Top 2010; 22:99–123.
Sadek RW, Moussa SM, El Backly RM, Hammouda AF. Evaluation of the efficacy of three antimicrobial agents used for regenerative endodontics: anin vitro
study. Microb Drug Resist 2019; 25:761–771.
Shrestha A, Zhilong S, Gee NK, Kishen A. Nanoparticulates for antibiofilm treatment and effect of aging on its antibacterial activity. J Endod 2010; 36:1030–1035.
Shaik I, Goyal S, Bhowmick S, Shetty SV, Shetty V, Sharma S, et al
. Knowledge and assessment of endodontists in the field of nanotechnology in endodontics: a qualitative research. J Adv Med Dent Sci Res 2020; 8:65–16.
Kishen A, Shi Z, Shrestha A, Neoh KG. An investigation on the antibacterial and antibiofilm efficacy of cationic nanoparticulates for root canal disinfection. J Endod 2008; 34:1515–1520.
Yamamoto O. Influence of particle size on the antibacterial activity of zinc oxide. J Inorg Mater 2001; 3:643–646.
Hadi SA, Al-Mizraqchi AS. Antibacterial activity of zinc oxide nanoparticles on the growth of Enterococcus Feacales, Candida and total root canal microbiota (in vitro
study). Indian J Pub Health Res Dev 2020; 11:17–19.
Cohen M, Garnick JJ, Ringle RD, Hanes PJ, Thompson WO. Calcium and phosphorus content of roots exposed to the oral environment. J Clin Periodontol 1992; 19:268–273.
Zarei M, Afkhami F, Malek Poor Z. Fracture resistance of human root dentin exposed to calcium hydroxide intervisit medication at various time periods: anin vitro
study. Dent Traumatol 2013; 29:156–160.
Yassen G, Vail M, Chu T, Platt J. The effect of medicaments used in endodontic regeneration on root fracture and microhardness of radicular dentine. Int Endod J 2013; 46:688–695.
Fan W, Wu D, Ma T, Fan B. Ag-loaded mesoporous bioactive glasses against Enterococcus faecalis biofilm in root canal of human teeth. Dent Mater J 2015; 34:54–60.
Mohammadi Z, Dummer PMH. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J 2011; 44:697–30.
Nerwich A, Figdor D, Messer HH. pH changes in root dentin over a 4-week period following root canal dressing with calcium hydroxide. J Endod 1993; 19:302–306.
Jafarzadeh H, Mohammadi Z, Kinoshita J-I, Manabe A, Kobayashi M, Shalavi S, et al
. Effects of root canal irrigants and medicaments on dentin and vice versa: a review of literature. J Dent Mater Tech 2020; 9:1–9.
Ghabraei S, Marvi M, Bolhari B, Bagheri P. Minimum intracanal dressing time of triple antibiotic paste to eliminate Enterococcus faecalis (ATCC 29212) and determination of minimum inhibitory concentration and minimum bactericidal concentration: an ex vivo
study. J Dent (Tehran) 2018; 15:1–9.
Forsback AP, Areva S, Salonen J. Mineralization of dentin induced by treatment with bioactive glass S53P4 in vitro
. Acta Odontol Scand 2004; 62:14–20.
Krithikadatta J, Indira R, Dorothykalyani AL. Disinfection of dentinal tubules with 2% chlorhexidine, 2% metronidazole, bioactive glass when compared with calcium hydroxide as intracanal medicaments. J Endod 2007; 33:1473–1476.
Sawant K, Pawar AM. Bioactive glass in dentistry: a systematic review. Saudi J Oral Sci 2020; 7:18–3. [Full text]
Hassan R, Khallaf M. Effect of a silver nanoparticle intracanal-based medicament on the microhardness of human radicular dentine. Endod Pract Today 2018; 12:125–127.
Marending M, Stark WJ, Brunner TJ, Fischer J, Zehnder M. Comparative assessment of time-related bioactive glass and calcium hydroxide effects on mechanical properties of human root dentin. Dent Traumatol 2009; 25:126–129.
Yilmaz S, Dumani A, Yoldas O. The effect of antibiotic pastes on microhardness of dentin. Dent Traumatol 2016; 32:27–31.
Verma P, Ansari A, Tikku AP, Chandra A, Yadav RK, Bharti R, et al
. Effect of intracanal medicaments on radicular dentine: an attenuated total reflection-Fourier-transform infrared spectroscopy analysis. Asian J Oral Health Allied Sci 2020; 10:12–18.
Tanase S, Tsuchiya H, Yao J, Ohmoto S, Takagi N, Yoshida S. Reversed-phase ion-pair chromatographic analysis of tetracycline antibiotics: application to discolored teeth. J Chromatogr B Biomed Sci Appl 1998; 706:279–285.
Sim T, Knowles J, Ng YL, Shelton J, Gulabivala K. Effect of sodium hypochlorite on mechanical properties of dentine and tooth surface strain. Int Endod J 2001; 34:120–132.
Marending M, Luder H, Brunner T, Knecht S, Stark WJ, Zehnder M. Effect of sodium hypochlorite on human root dentine–mechanical, chemical and structural evaluation. Int Endod J 2007; 40:786–793.