Short-Term Antibacterial Efficacy of Three Bioceramic Root Canal Sealers Against Enterococcus Faecalis Biofilms

Ciljevi: Cilj istraživanja bio je ispitati antimikrobnu učinkovitost triju biokeramičkih materijala za punjenje korijenskog kanala na biofilm s bakterijama E. faeaclis. Materijali i metode: Bakterijski biofilm s enterekokima fekalis uzgojen je na papirnatim filtar-diskovima postavljenima na ploče s agarom. Nakon inkubacije diskovi su prekriveni s četirima različitim materijalima za punjenje korijenskih kanala: 1. jednokomponentnim biokeramičkim punilom (TotalFill BC Sealer); 2. dvokomponentnim biokeramičkim punilom (BioRoot RCS); 3. punilom proizvedenim na temelju mineralnog trioksidnog agregata (MTA Fillapex); 4. punilom proizvedenim na temelju epoksidne smole (AH Plus). Nakon kontaktnog 60-minutnog razdoblja materijali su uklonjeni, a diskovi uloženi u epruvete s puferiranom fiziološkom otopinom. Nakon serijskog razrjeđivanja, suspenzija je nasađena na ploče s agarom te su nakon 24 sata izbrojene narasle kolonije i određen njihov ukupan broj prema čimbeniku razrjeđenja. Rezultati: Nije bilo značajne razlike u antimikrobnoj učinkovitosti između TotalFill BC Sealera i AH Plusa (p = 0,386). Oba materijala pokazala su bolju antibakterijsku učinkovitost od BioRoot RCS-a i MTA Fillapexa (p < 0,001). Zaključak: Total Fill BC Sealer i AH Plus bolje antibakterijski djeluju od BioRoot RCS-a i MTA Fillapexa.Objectives: The aim of the study was to evaluate the antimicrobial efficacy of three bioceramic root canal sealers against Enterococcus faecalis (E. faecalis) biofilm. Material and methods: E. faecalis bacterial suspension was grown on filter paper discs on agar plates. After the incubation period, the discs were covered with four different root canal sealers: 1) Premixing bioceramic root canal sealer (TotalFill BC Sealer); 2) Dual component bioceramic sealer (BioRoot RCS); 3) Mineral trioxide agreggate based sealer (MTA Fillapex); 4) Epoxy resin-based selar (AH Plus). After contact time of 60 minutes, the sealers were removed, and the discs were transferred into sterile tubes containing phosphate buffered saline. After serial dilutions, the aliquots of the suspension were cultivated for 24 hours. After the incubation period, the colony forming units (CFUs) were counted. Results: There were no significant differences in antibacterial efficacy between the Total Fill BC Sealer and the AH Plus sealer (p=0.386). Both sealers showed better antibacterial efficacy compared to the BioRoot RCS and the MTA Fillapex (p<0.001). Conclusion: The Total Fill BC Sealer and AH Plus had better antibacterial efficacy than the BioRoot RCS and the MTA Fillapex sealers

Znanje i stajališta doktora dentalne medicine u Hrvatskoj o propisivanju antibiotika u endodonciji: presječno istraživanje

Objectives: To assess dentists’ level of knowledge and practice concerning antibiotic usage in endodontics using the European Society of Endodontology position statement as a reference. Material and Methods: A cross-sectional study was conducted in the form of an electronic questionnaire consisting of 23 questions, including dentists’ demographic and professional characteristics, attitudes as well as experiences regarding antibiotics in endodontics. Data were evaluated by the Mann-Whit-ney test or the Kruskal Wallis 1-way ANOVA, α = 5%. Results: The overall mean self-reported knowl-edge of antibiotics usage in endodontics was 11.7±2.5 points, out of a maximum possible score of 23. The factors associated with a higher knowledge were: age (P≤0.001), clinical experience (P≤0.001), specialist training (P=0.008), and adherence to the guidance on the use of systemic antibiotics in endodontics (P=0.006). Dentists who specialized in endodontics (16.1±2.2) achieved higher levels of knowledge. Conclusion: Knowledge on antibiotic usage in endodontics among dentists in Croatia is insufficient. There is a need for continuing education on the use of antibiotics among general dentists.Ciljevi: Procijeniti razinu znanja i iskustva stomatologa o primjeni antibiotika u endodonciji koristeći se kao referencijom konsenzusom Europskoga endodontološkoga društva. Materijal i metode: Ovo presječno istraživanje provedeno je na temelju elektroničkoga upitnika sastavljenoga od 23 pitanja, uključujući demografske i profesionalne značajke doktora dentalne medicine, njihova stajališta i iskustva u vezi s korištenjem antibiotika u endodonciji. Podatci su analizirani Mann-Whitneyjevim testom ili Kruskal-Wallisovim jednosmjernim ANOVA testom – α = 5 %. Rezultati: Ukupna prosječna vrijednost znanja doktora dentalne medicine iznosila je 11,7 ± 2,5 bodova, od najviše mogućih 23. Čimbenici povezani s višim znanjem bili su dob (P ≤ 0,001), kliničko iskustvo (P ≤ 0,001), specijalističko usavršavanje (P = 0,008) te poštovanje smjernica o primjeni sistemskih antibiotika u endodonciji (P = 0,006). Doktori dentalne medicine koji su specijalizirali endodonciju (16,1 ± 2,2) postigli su višu razinu znanja. Zaključak: Znanje o primjeni antibiotika u endodonciji među doktorima dentalne medicine u Republici Hrvatskoj je nedostatno. Potrebna je stalna edukacija o upotrebi antibiotika među populacijom općih doktora dentalne medicine

Antimicrobial action of bioceramic materials for filling root canals

Cilj: Ciljevi istraživanja bili su usporediti antimikrobnu učinkovitost biokeramičkih materijala za punjenje korijenskih kanala, te ispitati njihovu antibakterijsku učinkovitost na planktonske stanice i mlade biofilmove E. faecalis. Materijali i metode: U prvom dijelu istraživanja pretražene su tri elektroničke baze podataka: MEDLINE preko OvidSP platforme, Embase preko OvidSP platforme i Web of Science. Istraživanja su uključena neovisno o dizajnu istraživanja, vrsti publikacije i jeziku. Dva autora su zasebno ocijenila kvalitetu izvještavanja. U drugom dijelu istraživanja bakterijska suspenzija je postavljena na površinu svježe pripremljenih materijala te materijala koji su stvrdnjavali jedan ili tri dana u vertikalno postavljenim mikrotitarskim pločama. Nakon inkubacije 2, 5, 20 i 60 minuta u svaku jažicu mikrotitarske ploče dodan je triptaza soja bujon. Nakon serijskog razrjeđivanja, izbrojane su kolonije. U trećem dijelu istraživanja bakterijski biofilmovi su uzgojeni na filter papirnatim diskovima postavljenima na ploče s agrom te su, nakon inkubacije, diskovi prekriveni s četiri materijala za punjenje korijenskih kanala. Nakon 60 minuta, materijali za punjenje su uklonjeni i diskovi su prenešeni u epruvete s fosfatom puferiranom fiziološkom otopinom. Nakon serijskog razrjeđivanja, izbrojane su kolonije. Rezultati: Prvi dio istraživanja obuhvatio je 37 istraživanja koja su ispitivala antimikrobu učinkovitost biokeramičkih materijala za punjenje korijenskih kanala. Nije bilo moguće napraviti usporedbu rezultata istraživanja i dati jasan zaključak i usporedbu djelovanja jer su istraživači koristili različite izvore i starosne skupine mikroorganizama, različita vremena stvrdnjavanja materijala i kontakta između mikroorganizama i materijala i različite antimikrobne testove. U drugom dijelu istraživanja su biokeramički materijali pokazali značajno bolju učinkovitost u odnosu na kontrolnu skupinu i materijal temeljen na umjetnoj smoli (p 0.05), a slijedi ih MTA Fillapex (Angelus) (p 0.05), ali bolju od materijala koji su stvrdnjavali jedan dan (p< 0.05). Svi materijali su pokazali najbolju učinkovitost nakon 20 minuta kontakta s bakterijama, neovisno jesu bili svježe pripremljeni ili stvrdnjavali jedan ili tri dana. U trećem dijelu istraživanja nije bilo značajne razlike između TotalFill BC Sealera (Brasseler SAD) i AH Plusa (Dentsply) (p=0.386). Oba materijala su pokazala bolju antibakterijsku učinkovitost od BioRoot RCS-a (Septodont) i MTA Fillapexa (Angelus) (p<0.001). Zaključak: Budući da su istraživanja uključena u sustavni pregledni rad visoko heterogena, nije moguće donijeti zaključak o tome koji materijal ima najbolje djelovanje niti preporuke za kliničku praksu jer su istraživanja provođena na različite načine, što čini metaanalizu neizvedivom. Potrebno je usuglasiti metodološki pristup, jasno definirati podjelu materijala i provesti istraživanja na ljudima kako bi se moglo donijeti preporuke za kliničku praksu. U istraživanju učinka biokeramičkih materijala na planktonske stanice E. faecalis, biokeramički materijali su pokazali bolju učinkovitost u usporedbi s konvencionalno korištenim materijalom temeljenim na umjetnoj smoli. Materijali su pokazali najbolju učinkovitost nakon 20 minuta kontakta s bakterijskom suspenzijom, neovisno o tome da li je materijal bio svježe pripremljen ili je stvrdnjavao jedan ili tri dana. U istraživanju učinka biokeramičkih materijala na mlade biofilmove E. faecalis, TotalFill BC Sealer (Brasseler SAD) i AH Plus (Dentsply) su pokazali bolju kratkoročnu antibakterijsku učinkovitost od BioRoot RCS-a (Septodont) i MTA Fillapexa (Angelus).Aim: The aims of the studies were to compare the antimicrobial efficacy of bioceramic root canal sealers and to examine their antibacterial efficacy on planktonic cells and young biofilms of E. faecalis. Materials and methods: In the first part of the study, three electronic databases were searched: MEDLINE via OvidSP platform, Embase via OvidSP platform and Web of Science. Studies were included irrespective of research design, type of publication, and language. Reporting quality was assessed by two authors independently. In the second part of the study, the bacterial suspension was placed on the surface of freshly mixed sealers and one or three days set sealer in vertically held microtiter plates. After incubation of 2, 5, 20 and 60 minutes, Tripticase Soy Broth was added to each well of the microtiter plate. After serial dilution, colony forming units were counted. In the third part of the study, bacterial biofilms were grown on filter paper discs placed on agar plates and, after incubation, the discs were covered with four root canal sealers. After 60 minutes, the sealers were removed and the discs were transferred to tubes containing phosphate buffered saline. After serial dilution, colony forming units were counted. Results: The first part of the study included 37 studies that examined the antimicrobial efficacy of bioceramic sealers. It is not possible to make a comparison of the results from studies and to give a clear conclusion about their comparative activity because the studies used heterogeneous source and age groups of microorganisms, setting and contact times of sealers and antimicrobial tests. In the second part of the study bioceramic materials showed significantly better efficacy than the control group and resin-based material (p 0.05), followed with MTA Fillapex (Angelus) (p 0.05), but better than sealers set for one day (p <0.05). All sealers exibithed the highest efficacy after 20 minutes of contact, independly sealers were freshly mixed or set for one or three days. In the third part of the study, there was no significant difference between TotalFill BC Sealer (Brasseler USA) and AH Plus (Dentsply) (p = 0.386). Both sealers showed better antibacterial efficacy than BioRoot RCS (Septodont) and MTA Fillapex (Angelus) (p <0.001). Conclusion: Since the studies included in the systematic review are highly heterogeneous, it is not possible to give a conclusion about which sealer has the best performance or recommendations for clinical practice because the studies were conducted in different ways, which makes meta-analysis futile. It is necessary to uniform the methodological approach, clearly define the materials classification and conduct studies on humans in order to be able to make recommendations for clinical practice. In a study of efficacy of bioceramic materials on E. faecalis planktonic cells, bioceramic sealers showed better efficacy compared to commercially used resin-based sealer. All sealers exhibited strongest efficacy at 20 minutes of contact time, independly sealer was freshly mixed or one or three day set. In a study of the efficacy of bioceramic sealers on young E. faecalis biofilms, TotalFill BC Sealer (Brasseler USA) and AH Plus (Dentsply) showed better short-term antibacterial efficacy than BioRoot RCS (Septodont) and MTA Fillapex (Angelus)

Antimicrobial action of bioceramic materials for filling root canals

Cilj: Ciljevi istraživanja bili su usporediti antimikrobnu učinkovitost biokeramičkih materijala za punjenje korijenskih kanala, te ispitati njihovu antibakterijsku učinkovitost na planktonske stanice i mlade biofilmove E. faecalis. Materijali i metode: U prvom dijelu istraživanja pretražene su tri elektroničke baze podataka: MEDLINE preko OvidSP platforme, Embase preko OvidSP platforme i Web of Science. Istraživanja su uključena neovisno o dizajnu istraživanja, vrsti publikacije i jeziku. Dva autora su zasebno ocijenila kvalitetu izvještavanja. U drugom dijelu istraživanja bakterijska suspenzija je postavljena na površinu svježe pripremljenih materijala te materijala koji su stvrdnjavali jedan ili tri dana u vertikalno postavljenim mikrotitarskim pločama. Nakon inkubacije 2, 5, 20 i 60 minuta u svaku jažicu mikrotitarske ploče dodan je triptaza soja bujon. Nakon serijskog razrjeđivanja, izbrojane su kolonije. U trećem dijelu istraživanja bakterijski biofilmovi su uzgojeni na filter papirnatim diskovima postavljenima na ploče s agrom te su, nakon inkubacije, diskovi prekriveni s četiri materijala za punjenje korijenskih kanala. Nakon 60 minuta, materijali za punjenje su uklonjeni i diskovi su prenešeni u epruvete s fosfatom puferiranom fiziološkom otopinom. Nakon serijskog razrjeđivanja, izbrojane su kolonije. Rezultati: Prvi dio istraživanja obuhvatio je 37 istraživanja koja su ispitivala antimikrobu učinkovitost biokeramičkih materijala za punjenje korijenskih kanala. Nije bilo moguće napraviti usporedbu rezultata istraživanja i dati jasan zaključak i usporedbu djelovanja jer su istraživači koristili različite izvore i starosne skupine mikroorganizama, različita vremena stvrdnjavanja materijala i kontakta između mikroorganizama i materijala i različite antimikrobne testove. U drugom dijelu istraživanja su biokeramički materijali pokazali značajno bolju učinkovitost u odnosu na kontrolnu skupinu i materijal temeljen na umjetnoj smoli (p 0.05), a slijedi ih MTA Fillapex (Angelus) (p 0.05), ali bolju od materijala koji su stvrdnjavali jedan dan (p< 0.05). Svi materijali su pokazali najbolju učinkovitost nakon 20 minuta kontakta s bakterijama, neovisno jesu bili svježe pripremljeni ili stvrdnjavali jedan ili tri dana. U trećem dijelu istraživanja nije bilo značajne razlike između TotalFill BC Sealera (Brasseler SAD) i AH Plusa (Dentsply) (p=0.386). Oba materijala su pokazala bolju antibakterijsku učinkovitost od BioRoot RCS-a (Septodont) i MTA Fillapexa (Angelus) (p<0.001). Zaključak: Budući da su istraživanja uključena u sustavni pregledni rad visoko heterogena, nije moguće donijeti zaključak o tome koji materijal ima najbolje djelovanje niti preporuke za kliničku praksu jer su istraživanja provođena na različite načine, što čini metaanalizu neizvedivom. Potrebno je usuglasiti metodološki pristup, jasno definirati podjelu materijala i provesti istraživanja na ljudima kako bi se moglo donijeti preporuke za kliničku praksu. U istraživanju učinka biokeramičkih materijala na planktonske stanice E. faecalis, biokeramički materijali su pokazali bolju učinkovitost u usporedbi s konvencionalno korištenim materijalom temeljenim na umjetnoj smoli. Materijali su pokazali najbolju učinkovitost nakon 20 minuta kontakta s bakterijskom suspenzijom, neovisno o tome da li je materijal bio svježe pripremljen ili je stvrdnjavao jedan ili tri dana. U istraživanju učinka biokeramičkih materijala na mlade biofilmove E. faecalis, TotalFill BC Sealer (Brasseler SAD) i AH Plus (Dentsply) su pokazali bolju kratkoročnu antibakterijsku učinkovitost od BioRoot RCS-a (Septodont) i MTA Fillapexa (Angelus).Aim: The aims of the studies were to compare the antimicrobial efficacy of bioceramic root canal sealers and to examine their antibacterial efficacy on planktonic cells and young biofilms of E. faecalis. Materials and methods: In the first part of the study, three electronic databases were searched: MEDLINE via OvidSP platform, Embase via OvidSP platform and Web of Science. Studies were included irrespective of research design, type of publication, and language. Reporting quality was assessed by two authors independently. In the second part of the study, the bacterial suspension was placed on the surface of freshly mixed sealers and one or three days set sealer in vertically held microtiter plates. After incubation of 2, 5, 20 and 60 minutes, Tripticase Soy Broth was added to each well of the microtiter plate. After serial dilution, colony forming units were counted. In the third part of the study, bacterial biofilms were grown on filter paper discs placed on agar plates and, after incubation, the discs were covered with four root canal sealers. After 60 minutes, the sealers were removed and the discs were transferred to tubes containing phosphate buffered saline. After serial dilution, colony forming units were counted. Results: The first part of the study included 37 studies that examined the antimicrobial efficacy of bioceramic sealers. It is not possible to make a comparison of the results from studies and to give a clear conclusion about their comparative activity because the studies used heterogeneous source and age groups of microorganisms, setting and contact times of sealers and antimicrobial tests. In the second part of the study bioceramic materials showed significantly better efficacy than the control group and resin-based material (p 0.05), followed with MTA Fillapex (Angelus) (p 0.05), but better than sealers set for one day (p <0.05). All sealers exibithed the highest efficacy after 20 minutes of contact, independly sealers were freshly mixed or set for one or three days. In the third part of the study, there was no significant difference between TotalFill BC Sealer (Brasseler USA) and AH Plus (Dentsply) (p = 0.386). Both sealers showed better antibacterial efficacy than BioRoot RCS (Septodont) and MTA Fillapex (Angelus) (p <0.001). Conclusion: Since the studies included in the systematic review are highly heterogeneous, it is not possible to give a conclusion about which sealer has the best performance or recommendations for clinical practice because the studies were conducted in different ways, which makes meta-analysis futile. It is necessary to uniform the methodological approach, clearly define the materials classification and conduct studies on humans in order to be able to make recommendations for clinical practice. In a study of efficacy of bioceramic materials on E. faecalis planktonic cells, bioceramic sealers showed better efficacy compared to commercially used resin-based sealer. All sealers exhibited strongest efficacy at 20 minutes of contact time, independly sealer was freshly mixed or one or three day set. In a study of the efficacy of bioceramic sealers on young E. faecalis biofilms, TotalFill BC Sealer (Brasseler USA) and AH Plus (Dentsply) showed better short-term antibacterial efficacy than BioRoot RCS (Septodont) and MTA Fillapex (Angelus)

Antimicrobial action of bioceramic materials for filling root canals

Cilj: Ciljevi istraživanja bili su usporediti antimikrobnu učinkovitost biokeramičkih materijala za punjenje korijenskih kanala, te ispitati njihovu antibakterijsku učinkovitost na planktonske stanice i mlade biofilmove E. faecalis. Materijali i metode: U prvom dijelu istraživanja pretražene su tri elektroničke baze podataka: MEDLINE preko OvidSP platforme, Embase preko OvidSP platforme i Web of Science. Istraživanja su uključena neovisno o dizajnu istraživanja, vrsti publikacije i jeziku. Dva autora su zasebno ocijenila kvalitetu izvještavanja. U drugom dijelu istraživanja bakterijska suspenzija je postavljena na površinu svježe pripremljenih materijala te materijala koji su stvrdnjavali jedan ili tri dana u vertikalno postavljenim mikrotitarskim pločama. Nakon inkubacije 2, 5, 20 i 60 minuta u svaku jažicu mikrotitarske ploče dodan je triptaza soja bujon. Nakon serijskog razrjeđivanja, izbrojane su kolonije. U trećem dijelu istraživanja bakterijski biofilmovi su uzgojeni na filter papirnatim diskovima postavljenima na ploče s agrom te su, nakon inkubacije, diskovi prekriveni s četiri materijala za punjenje korijenskih kanala. Nakon 60 minuta, materijali za punjenje su uklonjeni i diskovi su prenešeni u epruvete s fosfatom puferiranom fiziološkom otopinom. Nakon serijskog razrjeđivanja, izbrojane su kolonije. Rezultati: Prvi dio istraživanja obuhvatio je 37 istraživanja koja su ispitivala antimikrobu učinkovitost biokeramičkih materijala za punjenje korijenskih kanala. Nije bilo moguće napraviti usporedbu rezultata istraživanja i dati jasan zaključak i usporedbu djelovanja jer su istraživači koristili različite izvore i starosne skupine mikroorganizama, različita vremena stvrdnjavanja materijala i kontakta između mikroorganizama i materijala i različite antimikrobne testove. U drugom dijelu istraživanja su biokeramički materijali pokazali značajno bolju učinkovitost u odnosu na kontrolnu skupinu i materijal temeljen na umjetnoj smoli (p 0.05), a slijedi ih MTA Fillapex (Angelus) (p 0.05), ali bolju od materijala koji su stvrdnjavali jedan dan (p< 0.05). Svi materijali su pokazali najbolju učinkovitost nakon 20 minuta kontakta s bakterijama, neovisno jesu bili svježe pripremljeni ili stvrdnjavali jedan ili tri dana. U trećem dijelu istraživanja nije bilo značajne razlike između TotalFill BC Sealera (Brasseler SAD) i AH Plusa (Dentsply) (p=0.386). Oba materijala su pokazala bolju antibakterijsku učinkovitost od BioRoot RCS-a (Septodont) i MTA Fillapexa (Angelus) (p<0.001). Zaključak: Budući da su istraživanja uključena u sustavni pregledni rad visoko heterogena, nije moguće donijeti zaključak o tome koji materijal ima najbolje djelovanje niti preporuke za kliničku praksu jer su istraživanja provođena na različite načine, što čini metaanalizu neizvedivom. Potrebno je usuglasiti metodološki pristup, jasno definirati podjelu materijala i provesti istraživanja na ljudima kako bi se moglo donijeti preporuke za kliničku praksu. U istraživanju učinka biokeramičkih materijala na planktonske stanice E. faecalis, biokeramički materijali su pokazali bolju učinkovitost u usporedbi s konvencionalno korištenim materijalom temeljenim na umjetnoj smoli. Materijali su pokazali najbolju učinkovitost nakon 20 minuta kontakta s bakterijskom suspenzijom, neovisno o tome da li je materijal bio svježe pripremljen ili je stvrdnjavao jedan ili tri dana. U istraživanju učinka biokeramičkih materijala na mlade biofilmove E. faecalis, TotalFill BC Sealer (Brasseler SAD) i AH Plus (Dentsply) su pokazali bolju kratkoročnu antibakterijsku učinkovitost od BioRoot RCS-a (Septodont) i MTA Fillapexa (Angelus).Aim: The aims of the studies were to compare the antimicrobial efficacy of bioceramic root canal sealers and to examine their antibacterial efficacy on planktonic cells and young biofilms of E. faecalis. Materials and methods: In the first part of the study, three electronic databases were searched: MEDLINE via OvidSP platform, Embase via OvidSP platform and Web of Science. Studies were included irrespective of research design, type of publication, and language. Reporting quality was assessed by two authors independently. In the second part of the study, the bacterial suspension was placed on the surface of freshly mixed sealers and one or three days set sealer in vertically held microtiter plates. After incubation of 2, 5, 20 and 60 minutes, Tripticase Soy Broth was added to each well of the microtiter plate. After serial dilution, colony forming units were counted. In the third part of the study, bacterial biofilms were grown on filter paper discs placed on agar plates and, after incubation, the discs were covered with four root canal sealers. After 60 minutes, the sealers were removed and the discs were transferred to tubes containing phosphate buffered saline. After serial dilution, colony forming units were counted. Results: The first part of the study included 37 studies that examined the antimicrobial efficacy of bioceramic sealers. It is not possible to make a comparison of the results from studies and to give a clear conclusion about their comparative activity because the studies used heterogeneous source and age groups of microorganisms, setting and contact times of sealers and antimicrobial tests. In the second part of the study bioceramic materials showed significantly better efficacy than the control group and resin-based material (p 0.05), followed with MTA Fillapex (Angelus) (p 0.05), but better than sealers set for one day (p <0.05). All sealers exibithed the highest efficacy after 20 minutes of contact, independly sealers were freshly mixed or set for one or three days. In the third part of the study, there was no significant difference between TotalFill BC Sealer (Brasseler USA) and AH Plus (Dentsply) (p = 0.386). Both sealers showed better antibacterial efficacy than BioRoot RCS (Septodont) and MTA Fillapex (Angelus) (p <0.001). Conclusion: Since the studies included in the systematic review are highly heterogeneous, it is not possible to give a conclusion about which sealer has the best performance or recommendations for clinical practice because the studies were conducted in different ways, which makes meta-analysis futile. It is necessary to uniform the methodological approach, clearly define the materials classification and conduct studies on humans in order to be able to make recommendations for clinical practice. In a study of efficacy of bioceramic materials on E. faecalis planktonic cells, bioceramic sealers showed better efficacy compared to commercially used resin-based sealer. All sealers exhibited strongest efficacy at 20 minutes of contact time, independly sealer was freshly mixed or one or three day set. In a study of the efficacy of bioceramic sealers on young E. faecalis biofilms, TotalFill BC Sealer (Brasseler USA) and AH Plus (Dentsply) showed better short-term antibacterial efficacy than BioRoot RCS (Septodont) and MTA Fillapex (Angelus)

Antimicrobial efficacy of commercially available endodontic bioceramic root canal sealers: A systematic review.

BACKGROUND:Recently, a new generation of bioceramic root canal sealers has been introduced onto the market. Many in vitro studies have investigated the antimicrobial properties of these sealers, but their comparative efficacy in antimicrobial activity is still unknown. METHODOLOGY:Three electronic databases were searched: MEDLINE and Embase via the OvidSP platform, and Web of Science, up to June 25, 2019. Studies were included irrespective of study design, type of publication and language. Reporting quality was assessed by two authors independently. Meta-analysis was not performed due to studies being highly heterogeneous. RESULTS:We included 37 studies that analysed the antimicrobial effects of bioceramic sealers. Most of them used a planktonic cell model, with the exception of nine studies which used biofilms. It was not possible to make direct comparison of results from studies and to give a clear conclusion about the comparative antimicrobial activity of these materials because the studies used heterogeneous sources and ages of microorganisms, setting and contact times of sealers, and antimicrobial tests. Furthermore, some materials showed completely different results when tested with different methods. CONCLUSIONS:In conclusion, multiple in vitro studies have shown that bioceramic sealers may have various degrees of antimicrobial activity. However, it is still impossible to make conclusions about their comparative efficacy and to recommend the use of one over another in clinical practice because the studies available were conducted in different ways, which makes meta-analysis futile. A uniform methodological approach, consistent definitions and studies on humans are urgently needed in this field of research so that recommendations for practice can be made