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 Table of Contents  
Year : 2020  |  Volume : 17  |  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

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 Submission27-Jan-2020
Date of Acceptance18-Jul-2020
Date of Web Publication30-Oct-2020

Correspondence Address:
Mohamed A Elsayed
Department of Endodontic, Faculty of Dentistry, Assiut University, Assiut 71515, Egypt
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tdj.tdj_3_20

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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 Top

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[1]. 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[2].

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[3]. In 1996 Hoshinoet al.[4] 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[5],[6]. Unfortunately, the use of TAP led to coronal discoloration when compared to other endodontic medicaments[7],[8],[9], showed a tendency to demineralize the radicular dentin[6],[10] and created a cytotoxic environment for stem cells[11].

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[16]. 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[17].

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)[16]. Their high surface area[18],[19], charge density[20], and a greater degree of interaction with cells[21], have resulted in higher levels of antibacterial activity[22]. 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[16].

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[23] subsequently, the dentin fracture resistance is affected[24],[25]. 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 Top

Sample selection

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.

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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].

Samples classification

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 Top

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

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  Discussion Top

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[26].

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[27]. Nerwichet al.[28] 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[29]. 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[30].

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[34] 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.[35] 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[25],[36] 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[25]. 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[6],[37],[38].

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.[39] who reported that the 5.25% NaOCl reduced the elastic modulus and flexural strength of dentin. Likewise, Marendinget al.[40] 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 Top

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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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