A new strategy in root canal therapy: there is a lot going on in endodontic disinfection

Apical periodontitis (AP) is the inflammatory response in the surrounding tissues at the root tip of a tooth to a microbial infection of the root canal system inside the tooth. AP can only resolve after thorough root canal disinfection. However at present, state-of-the-art root canal treatment does not always result in sufficient decontamination. This thesis describes the development of a new strategy which even disinfects the complex structures of the root canal system. The strategy is based on a multiple-hurdle principle and has been tested in various in-vitro models with varying conditions. An application, the modified salt solution, has been developed.In the second part of the thesis, aspects of current root canal disinfection have been investigated. At present, sodium hypochlorite (NaOCl) is the most used root canal disinfectant. It is an unstable molecule and therefore the quality of NaOCl solutions in dental practices has been evaluated. It appeared that frequently the concentration of NaOCl was lower than expected.Sometimes, root canal disinfection takes place in two treatment sessions. Then, calcium hydroxide (CH) is used to temporarily dress the root canals between the sessions, with the aim to further reduce the microbial load. This thesis shows that CH cannot eliminate biofilm bacteria and that side-effects after CH application occur. In the biofilms, CH causes a precipitate. Also, the susceptibility of bacterial species to disinfection may alter. Application of CH then results in a shift in biofilm composition in favour of the most resilient species

The influence of apical periodontitis on the concentration of inflammatory mediators in peripheral blood plasma and the metagenomic profiling of endodontic infections: Study design and protocol

Increased systemic inflammation has been identified in presence of oral disease, specifically endodontic disease. It is important to investigate whether treatment of the oral disease ameliorates systemic inflammation. Furthermore, there is no information about the extent to which different microorganisms may trigger inflammatory response. Objectives: Primarily (i) to compare the plasma concentrations of inflammatory mediators of apical periodontitis (AP) subjects to controls, (ii) to evaluate whether elimination of the endodontic infection reduces systemic inflammation (iii) to investigate the microbiome of root canal infections. Secondarily i) to correlate the inflammatory mediator data with the microbiome data to investigate whether the type of infection influences the type and severity of the inflammatory condition ii) to examine patterns in the inflammatory mediator data before and after tooth extraction in order to establish a biomarker signature of AP/oral disease. This is a multi-centre prospective case-control intervention study. The cohort will consist of 30 healthy human volunteers with one or two teeth with a root-tip inflammation and 30 matched healthy controls. Peripheral blood will be drawn at 6 time points, 3 before and 3 after the extraction of the tooth with apical periodontitis. The teeth will be pulverized, DNA extraction and sequencing will be performed. This study aims to compare the concentration of inflammatory blood plasma proteins in between AP-subjects and controls at different time points before and after the tooth extraction in a systematic and complete way. Additionally the composition of the root canal microbiome in association with the inflammatory response of the host will be assessed

Potential of calcium to scaffold an endodontic biofilm, thus protecting the micro-organisms from disinfection

Biofilms in the root canal of a tooth (endodontic biofilm) can induce and sustain apical periodontitis which is an oral inflammatory disease. Still, little is known about the composition of the endodontic biofilm. Studies on biofilms in root canals focus on the identification of the microbial species, but the majority of the biofilm consists of matrix material. Environmental aspects determine the structure of the biofilm and extracellular matrix. Calcium is involved in biofilm formation and activity at three levels. Firstly in cell-environment; calcium may ‘condition’ the surfaces of support and bacterial cells. Secondly, in cell-cell interaction; calcium plays a role in build up of biofilm structures. Typically, calcium ions act as ‘cation bridges’ between polysaccharides originating from different cells. Thirdly, within cells, calcium is required for certain biochemical reactions in bacteria and some bacterial physiological activities. Because calcium is present in the root canal, it could play a significant role in the organization of the biofilm. Chelators, already used in endodontics to remove the smear layer by disintegration of the structural cohesion calcium bonds, could weaken the biofilm matrix by removing calcium from the extracellular matrix thus disturbing its coherence. Subsequently, this disruption could increase the efficacy of disinfecting agents