Evaluation of the Antimicrobial Effect of Pre-Synthesized Novel Antibiotic Electrospun Nanofibers as an Intracanal Delivery Strategy for Regenerative Endodontics: A Randomized Clinical Trial

Sara Gamal Elgamal; Jealan M. El-Shafei; Hassan Mohamed El-Said Azzazy; Reham Ali Dwedar; Sherif Adel El-Khodary

doi:10.3889/oamjms.2022.9750

Authors

Sara Gamal Elgamal Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
Jealan M. El-Shafei Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
Hassan Mohamed El-Said Azzazy Department of Chemistry, American University in Cairo, New Cairo, Egypt
Reham Ali Dwedar Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt
Sherif Adel El-Khodary Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2022.9750

Keywords:

Triple antibiotic paste, Electrospun nanofibers, Immature necrotic teeth, Regenerative endodontics, Intracanal medicament

Abstract

AIM: The aim of this study is to evaluate the antimicrobial effect of pre-synthesized novel antibiotic loaded electrospun nanofibers and compare it with conventional triple antibiotic paste when used in patients with immature necrotic teeth.

METHODS: Antibiotic loaded nanofibers were fabricated by electrospinning. Thirty-four patients with immature necrotic teeth were included in the study. In the first visit, access cavity preparation was performed to obtain the first bacteriological sample (S1). The canals were thoroughly irrigated using sodium hypochlorite 1.5% and a second sampling was performed (S2). Patients were randomly divided into two groups according to the intracanal medicament used: Modified triple antibiotic paste (MTAP) loaded electrospun nanofibers or MTAP paste. At the second appointment, the third samples (S3) were taken. The intracanal bacterial count was determined using the spread plate culture technique. Scanning electron microscopy (SEM) was used to examine the morphology of the fabricated MTAP loaded electrospun nanofibers.

RESULTS: Both MTAP nanofibers and MTAP paste resulted in significant reduction of bacterial count after the irrigation step. MTAP nanofibers resulted in significantly higher percent reduction of bacterial count (p < 0.05).

CONCLUSIONS: It was concluded that electrospinning technology can be used to fabricate antibiotic containing nanofibers which can results in enhanced disinfection in regenerative endodontic procedures.

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References

Lin LM, Kahler B. A review of regenerative endodontics: Current protocols and future directions. J Istanbul Univ Fac Dent. 2017;51(3 Suppl 1):S41-51. https://doi.org/10.17096/jiufd.53911 PMid:29354308 DOI: https://doi.org/10.17096/jiufd.53911

Lopes L, Neves JA, Botelho J, Machado V, Mendes JJ. Regenerative endodontics procedure: An umbrella review. Int J Environ Res Public Health. 2021;18(2):754. https://doi.org/10.3390/ijerph18020754 PMid:33561086 DOI: https://doi.org/10.3390/ijerph18020754

Almutairi W, Yassen GH, Aminoshariae A, Williams KA, Mickel A. Regenerative endodontics: A systematic analysis of the failed cases. J Endod. 2019;45(5):567-77. https://doi.org/10.1016/j.joen.2019.02.004 PMid:30905573 DOI: https://doi.org/10.1016/j.joen.2019.02.004

Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, et al. In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J. 1996;29(2):125-30. https://doi.org/10.1111/j.1365-2591.1996.tb01173.x PMid:9206436 DOI: https://doi.org/10.1111/j.1365-2591.1996.tb01173.x

Bains RB, Verma P, Pandey PT. Systematic review of the antimicrobial efficacy of triple antibiotic paste used as intra-canal medicament in teeth with primary endodontic infection. Asian J Oral Heal Allied Sci. 2021;11(2):1-7. https://doi.org/10.25259/AJOHAS_3_2021 DOI: https://doi.org/10.25259/AJOHAS_3_2021

Do Couto AM, Espaladori MC, Leite AP, Martins CC, de Aguiar MC, Abreu LG. A systematic review of pulp revascularization using a triple antibiotic paste. Pediatr Dent. 2019;41(5):341-53. PMid:31648664

Montero-Miralles P, Martín-González J, Alonso-Ezpeleta O, Jiménez-Sánchez MC, Velasco-Ortega E, Segura-Egea JJ. Effectiveness and clinical implications of the use of topical antibiotics in regenerative endodontic procedures: A review. Int Endod J. 2018;51(9):918-88. https://doi.org/10.1111/iej.12913 PMid:29480932 DOI: https://doi.org/10.1111/iej.12913

Jung HJ, Seo I, Jha BK, Suh SI, Suh MH, Baek WK. Minocycline inhibits angiogenesis in vitro through the translational suppression of HIF-1α. Arch Biochem Biophys. 2014;545:74-82. http://doi.org/10.1016/j.abb.2013.12.023 PMid:24412777 DOI: https://doi.org/10.1016/j.abb.2013.12.023

Dos Santos LG, Chisini LA, Springmann CG, de Souza BD, Pappen FG, Demarco FF, et al. Alternative to avoidtooth discoloration after regenerative endodontic procedure: A systematic review. Braz Dent J. 2018;29(5):409-18. https://doi.org/10.1590/0103-6440201802132 PMid:30517438 DOI: https://doi.org/10.1590/0103-6440201802132

Dubey N, Xu J, Zhang Z, Nör JE, Bottino MC. Comparative evaluation of the cytotoxic and angiogenic effects of minocycline and clindamycin: An in vitro study. J Endod. 2019;45(7):882-9. https://doi.org/10.1016/j.joen.2019.04.007 PMid:31133343 DOI: https://doi.org/10.1016/j.joen.2019.04.007

Karczewski A, Feitosa SA, Hamer EI, Pankajakshan D, Gregory RL, Spolnik KJ, et al. Clindamycin-modified triple antibiotic nanofibers: A stain-free antimicrobial intracanal drug delivery system. J Endod. 2018;44(1):155-62. https://doi.org/10.1016/j.joen.2017.08.024 PMid:29061356 DOI: https://doi.org/10.1016/j.joen.2017.08.024

Sabrah HA, Yassen GH, Liu W, Goebel W, Gregory RP. The effect of diluted triple and double antibiotic pastes on dental pulp stem cells and established Enterococcus faecalis biofilm. Clin Oral Investig. 2015;19(8):2059-66. https://doi.org/10.1007/s00784-015-1423-6 PMid:25689981 DOI: https://doi.org/10.1007/s00784-015-1423-6

Alghilan MA, Windsor LJ, Palasuk J, Yassen GH. Attachment and proliferation of dental pulp stem cells on dentine treated with different regenerative endodontic protocols. Int Endod J. 2017;50(7):667-75. https://doi.org/10.1111/iej.12669 PMid:27272393 DOI: https://doi.org/10.1111/iej.12669

Negm MI, El-Shafei JM, Roshdy NK, Eid GE. Determination of mesenchymal stem cell origin during bleeding-induced regenerative endodontic procedure using 2-step real-time reverse-transcription polymerase chain reaction (qRT-PCR). Acta Sci Dent Sci. 2018;2(6):5-10.

Mallishery S, Shah T. Regenerative endodontics looking inward. J Adv Med Med Res. 2020;32(7):83-98. https://doi.org/10.9734/jammr/2020/v32i730454 DOI: https://doi.org/10.9734/jammr/2020/v32i730454

Seo SJ, Kim HW, Lee JH. Electrospun nanofibers applications in dentistry. J Nanomater. 2016;2016:5931946. https://doi.org/10.1155/2016/5931946 DOI: https://doi.org/10.1155/2016/5931946

Albuquerque MT, Ryan SJ, Münchow EA, Kamocka MM, Gregory RL, Valera MC, et al. Antimicrobial effects of novel triple antibiotic paste-mimic scaffolds on actinomyces naeslundii biofilm. J Endod. 2015;41(8):1337-43. https://doi.org/10.1016/j.joen.2015.03.005 PMid:25917945 DOI: https://doi.org/10.1016/j.joen.2015.03.005

Albuquerque MT, Evans JD, Gregory RL, Valera MC, Bottino MC. Antibacterial TAP-mimic electrospun polymer scaffold: Effects on P. gingivalis-infected dentin biofilm. Clin Oral Investig. 2016;20(2):387-93. https://doi.org/10.1007/s00784-015-1577-2 PMid:26319981 DOI: https://doi.org/10.1007/s00784-015-1577-2

Porter ML, Münchow EA, Albuquerque MT, Spolnik J, Hara AT, Bottino MC. Effects of novel 3D antibiotic-containing electrospun scaffoldson dentin discoloration. J Endod. 2017;42(1):106-12. https://doi.org/10.1016/j.joen.2015.09.013 PMid:26602451 DOI: https://doi.org/10.1016/j.joen.2015.09.013

Pankajakshan D, Albuquerque MT, Evans JD, Kamocka MM, Gregory RL, Bottino MC. Triple antibiotic polymer nanofibers for intracanal drug delivery: Effects on dual species biofilm and cell function. J Endod. 2016;42(10):1490-5. https://doi.org/10.1016/j.joen.2016.07.019 PMid:27663615 DOI: https://doi.org/10.1016/j.joen.2016.07.019

Azabi A. The Antimicrobial Efficacy of Innovative 3D Triple Antibiotic Paste-mimic Tubular Scaffold against Actinomyces Naeslundii. Doctoral Dissertation, Indiana University; 2015. http://dx.doi.org/10.7912/C2/1607

Kumar S. Nanofiber incorporated intracanal medicaments and its antibacterial effect against Enterococcus faecalis biofilm an in vitro study. Sifonoforos. 2019;1(12):1-4. Available from: http://repositorytnmgrmu.ac.in/id/eprint/10830 [Last accessed on 2021 Sep 10].

Vaishali A, Varma KM, Bhupathi PA, Bharath TS, Ramesh MV, Varma PV. In vitro evaluation of antimicrobial efficacy of 2% chlorhexidine loaded electrospun nanofibers. J Pierre Fauchard Acad (India Sect). 2017;31(2-4):105-8. https://doi.org/10.1016/j.jpfa.2017.01.006 DOI: https://doi.org/10.1016/j.jpfa.2017.01.006

Verma P, Chaturvedi T, Gupta V, Srivastava R, Srivastava A. Evaluation of metronidazole nanofibers in patients with chronic periodontitis: A clinical study. Int J Pharm Investig. 2012;2(4):213. Available from: http://www.jpionline.org/text.asp?2012/2/4/213/107007 DOI: https://doi.org/10.4103/2230-973X.107007

de-Jesus-Soares A, Prado MC, Nardello LC, Pereira AC, Cerqueira-Neto AC, Nagata JY, et al. Clinical and molecular microbiological evaluation of regenerative endodontic procedures in immature permanent teeth. J Endod. 2020;46(10):1448-54. https://doi.org/10.1016/j.joen.2020.07.005 PMid:32681848 DOI: https://doi.org/10.1016/j.joen.2020.07.005

Nagata JY, Soares AJ, Souza-Filho FJ, Zaia AA, Ferraz CC, Almeida JF, et al. Microbial evaluation of traumatized teeth treated with triple antibiotic paste or calcium hydroxide with 2% chlorhexidine gel in pulp revascularization. J Endod. 2014;40(6):778-83. https://doi.org/10.1016/j.joen.2014.01.038 PMid:24862703 DOI: https://doi.org/10.1016/j.joen.2014.01.038

Arruda ME, Neves MA, Diogenes A, Mdala I, Guilherme BP, Siqueira JF, et al. Infection control in teeth with apical periodontitis using a triple antibiotic solution or calcium hydroxide with chlorhexidine: A randomized clinical trial. J Endod. 2018;44(10):1474-9. https://doi.org/10.1016/j.joen.2018.07.001 PMid:30144986 DOI: https://doi.org/10.1016/j.joen.2018.07.001

Pereira AC, de Oliveira ML, Cerqueira-Neto AC, Gomes BP, Ferraz CC, de Almeida JF, et al. Treatment outcomes of pulp revascularization in traumatized immature teeth using calcium hydroxide and 2% chlorhexidine gel as intracanal medication. J Appl Oral Sci. 2020;28(55):e20200217. https://doi.org/10.1590/1678-7757-2020-0217 DOI: https://doi.org/10.1590/1678-7757-2020-0217

Teixeira MA, Amorim MT, Felgueiras HP. Poly(vinyl alcohol)-based nanofibrous electrospun scaffolds for tissue engineering applications. Polymers (Basel). 2019;12(1):7. https://doi.org/10.3390/polym12010007 PMid:31861485 DOI: https://doi.org/10.3390/polym12010007

Pillay V, Dott C, Choonara YE, Tyagi C, Tomar L, Kumar P, et al. A review of the effect of processing variables on the fabrication of electrospun nanofibers for drug delivery applications. J Nanomater. 2013;2013:789289. https://doi.org/10.1155/2013/789289 DOI: https://doi.org/10.1155/2013/789289

Vlachou M, Siamidi A, Kyriakou S. Electrospinning and drug delivery. In: Electrospinning and Electrospraying Techniques and Applications. London: Intech Open Books; 2019. p. 1-22. https://doi.org/10.5772/intechopen.86181 DOI: https://doi.org/10.5772/intechopen.86181

Rossi-Fedele G, Kahler B, Venkateshbabu N. Limited evidence suggests benefits of single visit revascularization endodontic procedures a systematic review. Braz Dent J. 2019;30(6):527-35. https://doi.org/10.1590/0103-6440201902670 DOI: https://doi.org/10.1590/0103-6440201902670

American Association of Endodontics. Clinical Considerations for a Regenerative Procedure (New, Revised 6-18-16). Chicago, Illinois: American Association of Endodontics; 2016. p. 1-6. Available from: http://www.aae.org/uploadedfiles/publications_and_research/research/currentregenerativeendodonticconsiderations.pdf [Last accessed on 2016 Oct 21].

Sathorn C, Parashos P, Messer HH. How useful is root canal culturing in predicting treatment outcome? J Endod. 2007;33(3):220-5. https://doi.org/10.1016/j.joen.2006.11.006 PMid:17320700 DOI: https://doi.org/10.1016/j.joen.2006.11.006

Cameron R, Claudia E, Ping W, Erin S, Ruparel NB. Effect of a residual biofilm on release of transforming growth factor β1 from dentin. J Endod. 2019;45(9):1119-25. https://doi.org/10.1016/j.joen.2019.05.004 PMid:31277901 DOI: https://doi.org/10.1016/j.joen.2019.05.004

El-Tayeb MM, Abu-Seida AM, El Ashry SH, El-Hady SA. Evaluation of antibacterial activity of propolis on regenerative potential of necrotic immature permanent teeth in dogs. BMC Oral Health. 2019;19(1):174. https://doi.org/10.1186/s12903-019-0835-0 PMid:31387578 DOI: https://doi.org/10.1186/s12903-019-0835-0

Sarhan WA, Azzazy HM, El-Sherbiny IM. Honey/chitosan nanofiber wound dressing enriched with allium sativum and cleome droserifolia: Enhanced antimicrobial and wound healing activity. ACS Appl Mater Interfaces. 2016;8(10):6379-90. https://doi.org/10.1021/acsami.6b00739 DOI: https://doi.org/10.1021/acsami.6b00739

He P, Li Y, Huang Z, Guo ZZ, Luo B, Zhou CR, et al. A multifunctional coaxial fiber membrane loaded with dual drugs for guided tissue regeneration. J Biomater Appl. 2020;34(8):1041-51. https://doi.org/10.1177%2F0885328219894001 DOI: https://doi.org/10.1177/0885328219894001

Sarhan WA, Azzazy HM. Apitherapeutics and phage-loaded nanofibers as wound dressings with enhanced wound healing and antibacterial activity. Nanomedicine. 2017;12(17):2055-67. https://doi.org/10.2217/nnm-2017-0151 DOI: https://doi.org/10.2217/nnm-2017-0151

Sabharwal S, Bhagat SK, Gami KS, Siddhartha A, Rai K, Ahluwalia Y. An in vivo study to compare anti microbial activity of triantibiotic paste, 2% chlorhexidine gel, and calcium hydroxide on microorganisms in the root canal of immature teeth. J Int Soc Prev Community Dent. 2019;9:263-8. https://doi.org/10.4103/jispcd.JISPCD_400_18 PMid:31198699 DOI: https://doi.org/10.4103/jispcd.JISPCD_400_18