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New Ways to Disinfect and Fill Dental Hard Tissues

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: closed (29 February 2020) | Viewed by 55305

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Prof. Dr. Matthias Zehnder

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Division of Endodontology, Clinic of Conservative and Preventive Dentistry, Plattenstrasse 11, CH-8032 Zürich, Switzerland
Interests: endodontics; hard tissue disinfection; molecular diagnostics; biomaterials

Special Issue Information

Dear Colleagues,

We live in exciting times. New concepts deriving from basic science are about to enter the dental clinics. However, whether these new approaches will improve our treatment outcomes is debatable Moreover, currently obtaining market certificates for medical devices is a challenging situation, which may create legal impasses for novel concepts. It may thus be wise to also explore alternative ways to use existing materials, or challenge current clinical concepts with new approaches within the legal framework. Scientists, clinicians, and industry representatives need to get together to identify what is not only new but actually useful.

The main goal of the dentist remains to prevent micro-organisms from establishing biofilms in the wrong niches. If that has already happened, treatments aim to alter or remove these microbial communities, thus, arresting or healing the concurrent hard and soft tissue lesions. This Special Issue will gather studies, thoughts, and knowledge by experts in the field on new ways to disinfect and/or fill dental hard tissues. Contributions may be original scientific studies as well as critical narrative or systematic reviews.

Prof. Dr. Matthias Zehnder
Guest Editor

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Keywords

dental caries
biomaterials
tissue engineering
vital pulp therapy
dental filling
root canal filling
disinfection
chemomechanical cleaning
revascularization
periodontology

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Published Papers (12 papers)

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Editorial

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3 pages, 175 KiB

Open AccessEditorial

New Ways to Disinfect and Fill Dental Hard Tissues

by Matthias Zehnder

J. Clin. Med. 2020, 9(5), 1524; https://doi.org/10.3390/jcm9051524 - 18 May 2020

Viewed by 1516

Abstract

The main biological goal in clinical dentistry remains to prevent micro-organisms from exerting pathogenic effects by establishing non-commensal biofilms or entering the wrong niches [...] Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

Research

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15 pages, 3535 KiB

Open AccessArticle

A New Customized Bioactive Glass Filler to Functionalize Resin Composites: Acid-Neutralizing Capability, Degree of Conversion, and Apatite Precipitation

by Matej Par, Thomas Attin, Zrinka Tarle and Tobias T. Tauböck

J. Clin. Med. 2020, 9(4), 1173; https://doi.org/10.3390/jcm9041173 - 19 Apr 2020

Cited by 30 | Viewed by 3590

Abstract

This study introduced an experimental bioactive glass (BG) with a lower Na₂O content than conventional BG 45S5 (10.5 wt% vs. 24.5 wt%), additionally containing CaF₂ (12 wt%) and a network connectivity similar to that of BG 45S5. A series of experimental composites functionalized with 5–40 wt% of the novel BG was prepared and compared to a corresponding series of experimental composites functionalized with 5–40 wt% of BG 45S5. Commercial acid-neutralizing materials (alkasite, giomer, and glass ionomer) were used as references. The capabilities of the materials to neutralize hydrochloric acid (pH = 2.6) and lactic acid (pH = 4.5) were evaluated by real-time pH measurements over 1 h. The degree of conversion and precipitation of calcium phosphate were also investigated. Data were analyzed using one-way and Welch ANOVA at an overall level of significance of 0.05. The acid-neutralizing potential of the experimental BG incorporated into resin composites was generally comparable to that of BG 45S5, and better than that of a giomer and glass ionomer. Fluorine was identified in the precipitate that developed on the composites functionalized with the experimental BG, suggesting a capability of forming fluorapatite. Unlike the 45S5 composition, the experimental BG did not impair the degree of conversion of resin composites. The novel BG filler is therefore an interesting candidate for future investigations of caries-preventive resin composites, and their potential clinical applicability for restorative, preventive, and orthodontic purposes. Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

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15 pages, 2112 KiB

Open AccessArticle

Combined DNase and Proteinase Treatment Interferes with Composition and Structural Integrity of Multispecies Oral Biofilms

by Lamprini Karygianni, Thomas Attin and Thomas Thurnheer

J. Clin. Med. 2020, 9(4), 983; https://doi.org/10.3390/jcm9040983 - 1 Apr 2020

Cited by 36 | Viewed by 4014

Abstract

Modification of oral biofilms adhering to dental hard tissues could lead to new treatment approaches in cariology and periodontology. In this study the impact of DNase I and/or proteinase K on the formation of a simulated supragingival biofilm was investigated in vitro. Six-species biofilms were grown anaerobically in the presence of DNase I and proteinase K. After 64 h biofilms were either harvested and quantified by culture analysis or proceeded to staining followed by confocal laser scanning microscopy. Microbial cells were stained using DNA-dyes or fluorescent in situ hybridization. Exopolysaccharides, eDNA and exoproteins were stained with Calcofluor, anti-DNA-antibody, and Sypro^TM Ruby, respectively. Overall, results showed that neither DNase I nor proteinase K had an impact on total colony-forming units (CFUs) compared to the control without enzymes. However, DNase I significantly suppressed the growth of Actinomyces oris, Fusobacterium nucleatum, Streptococcus mutans, Streptococcus oralis and Candida albicans. Proteinase K treatment induced significant increase in S. mutans and S. oralis CFUs (p < 0.001), whereas C. albicans and V. dispar showed lower CFUs compared to the control. Interestingly, confocal images visualized the biofilm degradation caused by DNase I and proteinase K. Thus, enzymatic treatment should be combined with conventional antimicrobial agents aiming at both bactericidal effectiveness and biofilm dispersal. Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

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12 pages, 1095 KiB

Open AccessArticle

Effects of Contemporary Irrigant Activation Schemes and Subsequent Placement of an Interim Dressing on Bacterial Presence and Activity in Root Canals Associated with Asymptomatic Apical Periodontitis

by Alexandre P. L. Carvalho, Laura C. L. Nardello, Fernanda S. Fernandes, Fernanda P. Bruno, Luiza R. Paz, Elaine F. Iglecias, Heitor M. Honório, Márcia P. A. Mayer, Giulio Gavini and Ericka T. Pinheiro

J. Clin. Med. 2020, 9(3), 854; https://doi.org/10.3390/jcm9030854 - 20 Mar 2020

Cited by 16 | Viewed by 3297

Abstract

New tools for activating endodontic irrigants have evolved, yet their impact on root canal disinfection, in comparison to the passive placing of an inter-visit medication, have not yet been fully elucidated. The use of DNA- and rRNA-based methods may cast some new light on this issue, as they allow a comparison to be made between microbial presence and activity. Therefore, the aim of this single-arm intervention trial is to evaluate the antibacterial effect of endodontic procedures using both molecular methods. Root canal samples were obtained from 20 patients with asymptomatic apical periodontitis after each treatment step: access cavity, chemo-mechanical preparation, adjunctive procedures (XP-endo Finisher file and passive ultrasonic irrigation), calcium hydroxide medication, and 2nd-visit root canal preparation. DNA and cDNA from the samples were subjected to quantitative polymerase chain reaction with universal primers for the bacterial 16S rRNA gene. Chemo-mechanical preparation promoted a drastic reduction in bacterial levels and activity, whereas the adjunctive procedures did not make a significant contribution to further disinfection. At the 2nd visit, bacteria were active after the use of calcium hydroxide medication; however, they were significantly reduced after a 2nd-visit preparation. Consequently, the lowest bacterial levels were found at the end of the treatment. This clinical trial, which used an rRNA and rDNA combined approach, confirmed previous studies showing that root canal preparation represents the main strategy for root canal disinfection. Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

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9 pages, 1074 KiB

Open AccessArticle

Outcome of Root Canal Treatments Using a New Calcium Silicate Root Canal Sealer: A Non-Randomized Clinical Trial

by Angelo Zavattini, Alan Knight, Federico Foschi and Francesco Mannocci

J. Clin. Med. 2020, 9(3), 782; https://doi.org/10.3390/jcm9030782 - 13 Mar 2020

Cited by 62 | Viewed by 7075

Abstract

Background: The aim of this study was to compare the success rate of root canal treatments undertaken using a calcium silicate root canal sealer in combination with a single cone with non-calcium silicate cement and warm vertical condensation. Methods: 150 necrotic or pulpitic teeth were treated. (REC: 08/H0804/79). Following standardized root canal chemo-debridement. The canals were obturated using warm vertical condensation of gutta-percha and epoxy-based sealer (AH plus) or a calcium silicate sealer (BioRoot^TM RCS) with a single cone technique. Follow-up assessment was conducted at 12 months using Cone Beam Computed Tomography (CBCT). Results: At 1-year recall, 104 teeth were assessed (51 AH plus, 53 BioRoot^TM RCS). The success rate using loose criteria for the CBCT images and PA radiographs was respectively 80% and 89% in the AH plus/warm vertical condensation group, 84% and 90% in the BioRoot^TM RCS/single cone group. There was no statistically significant difference between the two groups (Fisher exact test p value 0.6099 for the CBCT images). Conclusion: Within the limitations of this non-randomized trial, a calcium silicate cement in combination with single cone resulted in a similar proportion of successful cases compared to warm vertical condensation and epoxy-based sealer. Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

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13 pages, 3271 KiB

Open AccessArticle

Bioactivity and Physico-Chemical Properties of Dental Composites Functionalized with Nano- vs. Micro-Sized Bioactive Glass

by Reto Odermatt, Matej Par, Dirk Mohn, Daniel B. Wiedemeier, Thomas Attin and Tobias T. Tauböck

J. Clin. Med. 2020, 9(3), 772; https://doi.org/10.3390/jcm9030772 - 12 Mar 2020

Cited by 45 | Viewed by 4216

Abstract

Bioactive resin composites can contribute to the prevention of secondary caries, which is one of the main reasons for failure of contemporary dental restorations. This study investigated the effect of particle size of bioactive glass 45S5 on chemical and physical composite properties. Four experimental composites were prepared by admixing the following fillers into a commercial flowable composite: (1) 15 wt% of micro-sized bioactive glass, (2) 15 wt% of nano-sized bioactive glass, (3) a combination of micro- (7.5 wt%) and nano-sized (7.5 wt%) bioactive glass, and (4) 15 wt% of micro-sized inert barium glass. Hydroxyapatite precipitation and pH rise in phosphate-buffered saline were evaluated during 28 days. Degree of conversion and Knoop microhardness were measured 24 h after specimen preparation and after 28 days of phosphate-buffered saline immersion. Data were analyzed using non-parametric statistics (Kruskal–Wallis and Wilcoxon tests) at an overall level of significance of 5%. Downsizing the bioactive glass particles from micro- to nano-size considerably improved their capability to increase pH. The effect of nano-sized bioactive glass on degree of conversion and Knoop microhardness was similar to that of micro-sized bioactive glass. Composites containing nano-sized bioactive glass formed a more uniform hydroxyapatite layer after phosphate-buffered saline immersion than composites containing exclusively micro-sized particles. Partial replacement of nano- by micro-sized bioactive glass in the hybrid composite did not impair its reactivity, degree of conversion (p > 0.05), and Knoop microhardness (p > 0.05). It is concluded that downsizing bioactive glass particles to nano-size improves the alkalizing potential of experimental composites with no negative effects on their fundamental properties. Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

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15 pages, 4056 KiB

Open AccessArticle

Antibiofilm and Immune Response of Engineered Bioactive Nanoparticles for Endodontic Disinfection

by Hebatullah Hussein and Anil Kishen

J. Clin. Med. 2020, 9(3), 730; https://doi.org/10.3390/jcm9030730 - 9 Mar 2020

Cited by 12 | Viewed by 4146

Abstract

The biological aim of root canal treatment is to facilitate periapical tissue healing following endodontic therapy. This study aimed to develop an organotypic infected root canal model to understand the interaction of bacterial biofilm with macrophages and study the therapeutic effect of engineered bioactive chitosan nanoparticles (CSnp) on macrophages. Ex-vivo experiments were conducted in two phases; Phase-1: Enterococcus faecalis biofilms (two and six weeks old) developed in organotypic root canal model were used to characterize residual biofilm after conventional chemical treatment alone and combined with CSnp utilizing Confocal Laser Scanning Microscopy, Scanning Electron Microscopy and colony-forming units from pulverized dentin. Phase-2: The interaction of post-treatment biofilm and RAW macrophages was evaluated regarding pro/anti-inflammatory markers, cell viability and spreading at 24, 48 and 72 h. Compared to conventionally disinfected six-week-old biofilm, CSnp resulted in less viable bacteria (p < 0.01). Scanning electron micrographs demonstrated disruption of the biofilm. CSnp exhibited less residual bacterial load in pulverized dentin (p < 0.001). Macrophage interaction with CSnp-treated biofilm reduced proinflammatory markers (nitric oxide, TNF-α, IL-1β, and IL-6), increased anti-inflammatory marker (TGF-β1) and enhanced cell survival and spreading over time (p < 0.01 at 72 h). Engineered chitosan nanoparticles concurrently inactivated biofilm and altered the inflammatory response of macrophages that would promote healing. Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

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15 pages, 2447 KiB

Open AccessArticle

Time-Dependent Response of Human Deciduous Tooth-Derived Dental Pulp Cells Treated with TheraCal LC: Functional Analysis of Gene Interactions Compared to MTA

by Ok Hyung Nam, Jae-Hwan Kim, Sung Chul Choi and Young Kim

J. Clin. Med. 2020, 9(2), 531; https://doi.org/10.3390/jcm9020531 - 15 Feb 2020

Cited by 10 | Viewed by 3708

Abstract

Pulp capping material should facilitate hard tissue regeneration on the injured pulp tissue. TheraCal LC (TC) was recently developed. Although TC has shown reliable clinical outcomes after direct pulp capping, there are still remaining concerns regarding its detrimental effect on pulp cells. Therefore, this study aimed to identify the gene expression of human deciduous tooth-derived dental pulp cells exposed to TC compared to mineral trioxide aggregate (MTA). The cells were cultured and exposed to TC and MTA for 24 and 72 h. Next, total RNA was isolated. QuantSeq 3′ mRNA-sequencing was used to examine differentially expressed genes (DEGs) in exposed to TC and MTA. Functional analysis of DEGs was performed using bioinformatics analysis. In gene ontology (GO) functional enrichment analysis, cells in TC for 24 h presented significantly enriched immune response (p < 0.001) and inflammatory response (p < 0.01) compared to MTA. TC showed enriched positive regulation of cell migration at 72 h (p < 0.001). In Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, neuroactive ligand–receptor interaction (p = 1.19 × 10⁻⁷) and calcium signaling pathway (p = 2.96 × 10⁻⁵) were confirmed in the shared DEGs in TC. In conclusion, DEGs in TC may be involved in pathways associated with osteoclastogenesis and osteoclastic differentiation. Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

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12 pages, 3001 KiB

Open AccessArticle

Pulp-Derived Exosomes in a Fibrin-Based Regenerative Root Filling Material

by Anja Ivica, Chafik Ghayor, Matthias Zehnder, Silvio Valdec and Franz E. Weber

J. Clin. Med. 2020, 9(2), 491; https://doi.org/10.3390/jcm9020491 - 11 Feb 2020

Cited by 37 | Viewed by 4182

Abstract

Regenerative endodontics has been described as a paradigm shift in dentistry, despite its current limitation to immature teeth and reparative rather than regenerative outcomes. Cell-free treatments are favored because of regulatory issues. However, the recruitment of host-derived stem cells to the desired site remains challenging. We investigated whether dental pulp-derived exosomes, which are extracellular vesicles that contain proteins, lipids, RNA, and DNA and thus mirror their parental cells, may be used for this purpose. The use of exosomes may present appreciable advantages over the direct use of transplanted stem cells due to a higher safety profile, easier isolation, preservation, and handling. Here we harvested exosomes from a cultured third-molar pulp cell and assessed them by transmission electron microscopy and Western blotting. Human mesenchymal stem cells (MSCs) were exposed to these exosomes to assess exosome uptake, cell migration, and proliferation. In addition, a fibrin gel (i.e., a diluted fibrin sealant), was assessed as a delivery system for the exosomes. Our results show that exosomes attracted MSCs, and the fibrin gel enhanced their effect. Moreover, exosomes improved the proliferation of MSCs. Therefore, we propose that pulp-derived exosomes in combination with a fibrin gel could be a powerful combination for clinical translation towards improved cell-free regenerative endodontics and thus represent a new way to fill dental hard tissues. Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

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10 pages, 3584 KiB

Open AccessArticle

Electrochemical Disinfection of Experimentally Infected Teeth by Boron-Doped Diamond Electrode Treatment

by Anna-Lena Böhm, Maximilian Koch, Stefan Rosiwal, Andreas Burkovski, Matthias Karl and Tanja Grobecker-Karl

J. Clin. Med. 2019, 8(12), 2037; https://doi.org/10.3390/jcm8122037 - 21 Nov 2019

Cited by 15 | Viewed by 4139

Abstract

Disinfection and prevention of re-infection are the decisive treatment steps in endodontic therapy. In this study, boron-doped diamond (BDD) electrodes have been fabricated and used for disinfecting the root canals of extracted human teeth, which had been covered with bacterial biofilms formed by Bacillus subtilis and Staphylococcus epidermidis. The growth of B. subtilis could be successfully impaired, achieving a complete disinfection after 8.5 min treatment time with the success of disinfection depending on the insertion depth of the electrode in the root canal. S. epidermidis could completely be removed after 3.5 min treatment time. A clinically applicable electrode array led to complete disinfection after treatment times of 10 min for S. epidermidis and 25 min for B. subtilis. BDD electrode application allowed for the improved disinfection of root canals and dentin tubules based on a continuous production of reactive oxygen species and their enhanced penetration of dentin tubules most likely due the formation of a continuous stream of small gas bubbles. The treatment times that are required here will be shortened in clinical application, as mechanical shaping of the canal system would precede the disinfection process. Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

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Review

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12 pages, 821 KiB

Open AccessReview

Wound Lavage in Studies on Vital Pulp Therapy of Permanent Teeth with Carious Exposures: A Qualitative Systematic Review

by Amina Munir, Matthias Zehnder and Dan-Krister Rechenberg

J. Clin. Med. 2020, 9(4), 984; https://doi.org/10.3390/jcm9040984 - 1 Apr 2020

Cited by 25 | Viewed by 4137

Abstract

The aim of this study was to systematically review pulp wound lavage in vital pulp therapy (VPT). A search was conducted in six life science databases to identify clinical trials carried out on permanent teeth with a carious pulp exposure and a recall interval of at least six months. Twenty-seven trials of low to moderate risk of bias (RoB-2 and ROBINS-I) were included. Data was extracted and analyzed regarding study characteristics and methods used for pulp wound lavage. The agent used for pulp wound lavage was specified in all included trials. Most of the identified trials (23/27) randomized the pulp capping material. Many (14/27) reported the use of sodium hypochlorite (NaOCl); ten used only saline or water. One trial was identified that compared pulp wound lavage with 2.5% (NaOCl) to saline, another compared 5% glutaraldehyde to water, both in immature molar pulpotomies. Both studies were underpowered. Neither showed a significant difference between treatments. The use of NaOCl was positively correlated to recent year of publication and use of hydraulic calcium silicate cements for pulp capping (p < 0.05). In conclusion, despite a lack of well-designed trials on pulp wound lavage in VPT, a trend towards using NaOCl for this purpose was observed. Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

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23 pages, 831 KiB

Open AccessReview

Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth: A Systematic Review of the Literature

by Maurizio Bossù, Flavia Iaculli, Gianni Di Giorgio, Alessandro Salucci, Antonella Polimeni and Stefano Di Carlo

J. Clin. Med. 2020, 9(3), 838; https://doi.org/10.3390/jcm9030838 - 19 Mar 2020

Cited by 55 | Viewed by 10602

Abstract

Background: Pulpotomy of primary teeth provides favorable clinical results over time; however, to date, there is still not a consensus on an ideal pulp dressing material. Therefore, the aim of the present systematic review was to compare pulpotomy agents to establish a preferred material to use. Methods: After raising a PICO question, the PRISMA guideline was adopted to carry out an electronic search through the MEDLINE database to identify comparative studies on several pulp dressing agents, published up to October 2019. Results: The search resulted in 4274 records; after exclusion, a total of 41 papers were included in the present review. Mineral trioxide aggregate (MTA), Biodentine and ferric sulphate yielded good clinical results over time and might be safely used in the pulpotomies of primary molars. Among agents, MTA seemed to be the material of choice. On the contrary, calcium hydroxide showed the worst clinical performance. Although clinically successful, formocreosol should be replaced by other materials, due to its potential cytotoxicity and carcinogenicity. Conclusion: MTA seemed to be the gold standard material in the pulpotomy of primary teeth. Promising results were also provided by calcium silicate-based cements. Further randomized clinical trials (RCTs) with adequate sample sizes and long follow-ups are encouraged to support these outcomes. Full article

(This article belongs to the Special Issue New Ways to Disinfect and Fill Dental Hard Tissues)

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