Candida albicans (C. albicans) is the fungus most frequently isolated from endodontic root canal infections. Although recognized by dental pulp and periradicular tissue cells that elicit immune responses, it eludes host defenses and elicits cell death. Then, C. albicans binds tooth dentin, forms biofilms, and invades dentinal tubules to resist intracanal disinfectants and endodontic treatments. Insensitive to most common medicaments, it survives sequestered within biofilms and intratubular dentin. Thus, C. albicans has been associated with cases of persistent or refractory root canal infections. Its treatment strategies may require alternative intracanal irrigants, intracanal medicaments such as chlorhexidine gel or human beta defensin-3 (HBD3), Ca-Si-based obturating materials, and microsurgical procedures.

Heat treatment of nickel-titanium (NiTi) alloy produces a better arrangement of the crystal structure, thereby leading to increased flexibility and improved fatigue resistance or plastic behavior. This study aimed to assess the performance of various heat-treated NiTi rotary instruments in S-shaped resin canals. Forty S-shaped resin canals were instrumented (10/group) with either Twisted Files (R-phase), WaveOne (M-wire), Hyflex CM, or V Taper 2H (CM-wire) with the same apical size and taper (25/0.08). Each S-shaped resin canal was scanned both before and after instrumentation with microcomputed tomography. Changes in canal volume and transportation were evaluated at regular intervals (0.5 mm). Differences between instruments at the apical curve, coronal curve, and straight portion of the canals were analyzed statistically. All tested instruments caused more transportation at the coronal rather than apical curvatures, with the exception of Twisted Files for which apical transportation was the highest for any instrument or location (P < 0.05). The transportation was mostly influenced by the alloy type rather than their cross-sectional characteristics (P < 0.05). The volumetric increase after instrumentation was similar for all tested instruments at the apical curve (P > 0.05), whereas Hyflex CM created the most conservative preparations at the coronal curve (P < 0.05). At the straight portion, volumetric changes were largest for Twisted Files and smallest for V Taper 2H (P < 0.05). Amongst heat-treated NiTi instruments, the CM-wire based instruments created the most favorable preparations in S-shaped resin canals.

Yoo YJ, et al. Restor Dent Endod. 2018 Nov;44:e7. https://doi.org/10.5395/rde.2019.44.e7

Apical periodontitis is caused by biofilm-mediated root canal infection. Early phase oral bacterial biofilms are inhibited by Lactobacillus plantarum lipoteichoic acid (Lp.LTA). However, mature biofilms that develop over 3 weeks are more resistant to traditional endodontic medicaments. Therefore, this study examined the effectiveness of Lp.LTA on disrupting mature Enterococcus faecalis biofilms, and on enhancing the effects of endodontic medicaments. LTA was purified from L. plantarum through butanol extraction followed by hydrophobic and ion-exchange chromatography. E. faecalis biofilms were formed over 3 weeks on glass bottom dishes and in dentin blocks obtained from human single-rooted premolars. These mature biofilms were treated with or without Lp.LTA for 1 h, followed by additional treatment with either chlorhexidine digluconate (CHX), calcium hydroxide (CH), or triple antibiotics for 24 h. Biofilms on glass were live/dead stained and quantified by ZEN through confocal laser microscopy. Bio-films in dentin were fixed, sputter coated and analyzed by ImageJ with scanning electron microscopy. Preformed E. faecalis mature biofilms on the culture dishes were dose-dependently disrupted by Lp.LTA. Lp.LTA potentiated the effects of CHX or CH on the disruption of mature biofilm. Interestingly, CHX-induced disruption of preformed E. faecalis mature biofilms was synergistically enhanced only when pre-treated with Lp.LTA. Furthermore, in the dentin block model, Lp.LTA alone reduced E. faecalis mature biofilm and pre-treatment with Lp.LTA promoted the anti-biofilm activity of CHX. Lp.LTA could be an anti-biofilm or supplementary agent that can be effective for E. faecalis-biofilm-induced diseases.

Park SH, et al. Restor Dent Endod. 2016 Feb;41(1):37-43. https://doi.org/10.5395/rde.2016.41.1.37

Oh S, et al. Restor Dent Endod. 2016 Feb;41(1):12-21. https://doi.org/10.5395/rde.2016.41.1.12