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ENDODONTIC BIOFILMS:
CONTEMPORARY AND
FUTURE TREATMENT
OPTIONS
CONTENTS
• Journal Details
• Introduction
• Endodontic biofilms
• Mechanism of antimicrobial resistance
• Current and future therapeutic strategies
against endodontic biofilm
• Conclusion
• Critical analysis
• Cross references
JOURNAL DETAILS
Journal name : Restorative Dentistry and Endodontics
Article Type : Review Article
Volume : 44
Issue : 1
Date of Publication : February 2019
Indexing : PubMed, Pubmed Central, Google Scholar, KoreaMed, Synapse,
KoMCI, Crossref, DOAJ, Publons .
INTRODUCTION
• Biofilm-
protects the bacteria from host defenses.
increase their resistance to intracanal disinfecting protocols.
• Biofilm-mediated infection - Apical Periodontitis.
• Knowledge about the virulence of endodontic microbiota
within biofilm is essential for the development of novel
therapeutic procedures for intracanal disinfection.
ENDODONTIC BIOFILMS
• Definition-Biofilm can be defined as a sessile multicellular
microbial community charecterized by cells that are firmly attached
to a surface and enmeshed in a self-produced matrix of extracellular
polymeric substance(EPS),usually a Polysaccharide.
-Costerton et al., in
1987
Cohen’s Pathway Of Pulp-11th Edition
• Surfaces- root canal walls
-provide a niche for bacteria
• Biofilm formation depends on conditioning layer.
• Bacterial structures important for adherence -
Polysaccharide-
Pili specific
Adhesins/Ligands
Flagella EPS
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• Biofilms – Bacterial cells – microcolonies - “towers” or
“mushrooms” embedded in EPS matrix - seperated by water
channels.
• Dental biofilm thickness= 300 or more cell layers
• Biofilm matrix – Composed of
Polysaccharides Proteins
Nucleic acids
Cohen’s Pathway Of Pulp-11th Edition
Ingle’s Endodontics-6th Edition
10
Ingle’s Endodontics-6th Edition
Ingle’s Endodontics-6th Edition
In endodontics, there are 4 types of
biofilms,
Extra
Intra canal
radicular
Biomaterial-
Periapical
centered
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Extra radicular Biofilm
Intra canal Biofilm
Biomaterial centered Biofilm
Periapical Biofilm Ingle’s Endodontics-6th Edition
MECHANISMS
OF ANTIMICROBIAL RESISTANCE
• Biofilm - polysaccharide matrix
-retards diffusion of antibiotics
-Inactivates extracellular enzymes- β-lactamase
• Quorum Sensing
Ingle’s Endodontics-6th Edition
Bacterial cells in biofilms
Slow growth
Less metabolism
Nutrient depletion or waste product
accumulation---Altered PH & O2 level
Protection from antimicrobial agents
CURRENT AND FUTURE
THERAPEUTIC STRATEGIES
AGAINSTENDODONTIC BIOFILMS
Irrigants for biofilm eradication
• Sodium hypochlorate
• Chlorhexidine
• EDTA
Intracanal medicament for
biofilm eradication
• Calcium hydroxide
• Chlorhexidine
• Human beta defensins
• Triple antibiotic paste
• Intracanal Medicaments Containing Antibiotics
• Phenolic compounds
Ingle’s Endodontics-6th Edition
• Halogens
• Steroids
• Formaldehyde
• Bioactive glass
Cohen’s Pathway Of Pulp-11th Edition
Calcium Hydroxide
• Broad antimicrobial activity
• Release of aqueous hydroxyl ions
• E.fecalis – resistant to CH
• LTA
• Inactivate lipopolysaccharide (LPS) in gram-negative bacteria.
Chlorhexidine
• Positively charged
• Superior antifungal activity - 400 μm depth dentinal tubules.
• Alter cell walls and nucleoprotein coagulation in C. albicans
• Dual-species biofilms
Human beta defensins
• Cationic antimicrobial peptides
• Critical host defense
• LPS and LTA structure variations
• HBD-1 , HBD-2 , HBD-3 , HBD-4
• HBD3-C15 - C. albicans
Triple antibiotic paste
• Mixture of metronidazole, ciprofloxacin, and minocycline
• Used in regenerative endodontic procedure (REP).
• Effective on infected dentin, intracanal biofilms, and the majority
of endodontic pathogens.
Intracanal Medicaments Containing
Antibiotics
• Bacteriostatic and bactericidal antibiotics
• Mixing erythromycin with Ca(OH)2-improved effectiveness
against E. faecalis.
Ingle’s Endodontics-6th Edition
Phenolic Compounds
Locally used root canal disinfecting agents –
• Phenol
• Formocreosol
• Cresatin
• Parachlorophenol (monoparachlorophenol)
• Camphorated phenol
• Camphorated parachlorophenol.
Ingle’s Endodontics-6th Edition
Halogens
• Intracanal - chloramine-T, an N-chloro-tosylamide sodium salt.
• Iodine – KI -effective antiseptic solution
-low tissue toxicity.
Steroids
• Ledermix paste - nonsetting, water-soluble paste material
• Inhibition of the ribosomal protein synthesis in the bacteria
Cohen’s Pathway Of Pulp-11th Edition
Formaldehyde
• Used as formocresol
• Highly toxic
• Mutagenic
• Carcinogenic
• Volatile
Bioactive Glass
Newer obturating materials: Resilon contain bioactive glass
Cohen’s Pathway Of Pulp-11th Edition
Laser-assisted eradication of biofilms
• Low power laser & Photosensitizing agent-S.intermedius
biofilms
• Er:YAG laser-biofilms of A. naeslundii, E. faecalis,
Lactobacillus casei , Propionibacterium acnes, F. nucleatum,
Porphyromonas gingivalis, or Prevotella nigrescens
Effect of Lactobacillus plantarum-LTA
• Probiotic
• Anti-inflammatory and
• Anti-biofilm effect.
• Inhibit - S. mutans, E. faecalis, and S. aureus biofilms.
Effect of nanoparticles, photodynamic
therapy, ozone, and enzymes
• Nanoparticles - Powders of silver, copper oxide, and zinc oxide
- antimicrobial.
• Reactive oxygen species (ROS)
• Photodynamic therapy - Photosensitiser.
- E. faecalis.
• Ozone
• Enzymes - Dispersin B and proteinase K
CONCLUSION
• Biofilm concept application in endodontic microbiology helps
in understanding the pathogenic potential of the root canal
microbiota and formation of basis of new approaches in root
canal disinfection.
• Recent developments in biocompatible intracanal
medicaments open up new avenues as an ideal therapeutic
agent to eradicate endodontic biofilm.
CRITICAL ANALYSIS
• This article have’nt included any figures or diagrams to explain
the topics.
• This article only gives a brief introduction about certain topics
making it difficult to understand the concept.
CROSS REFERENCES
Aim : To specifically investigate the effect of endodontic irrigants at
their clinical concentration on matrix polysaccharides of cultured
biofilms.
To evaluate the antibiofilm activity of 2.5% sodium hypochlorite
(NaOCl), 2% chlorhexidine(CHX), 2% alexidine (ALX) and 0.2%
cetrimide (CTR)alone and in combination on mature
polymicrobial root canal biofilms on human dentine using
confocal laser scanning microscopy (CLSM).
The aim of the present study was to compare the antibacterial effect of
calcium hydroxide (CH), triantibiotic mixture (TAM), and CH in
combination with chlorhexidine (CHX), sodium hypochlorite (NaOCl)
or colchicine (COL) against Enterococcus faecalis (E.faecalis) in
surface and deep dentinal tubules.
The aim of this study was to assess the effect of the source of
biofilm bacteria, the level of biofilm maturation, and the type of
disinfecting agent on the susceptibility of biofilm bacteria to
antibacterial agents.
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