Effects of Chitosan as a Novel Obturation Material for Pulpectomized Teeth on Periapical Inflammation, Periodontal Ligament Widening, and Hard Tissue Resorption: A Preliminary Exploratory Study on Dogs
,
Abstract
Objectives: This preliminary animal study was conducted to assess the effects of chitosan as a novel obturation material for pulpectomized teeth on periapical inflammation, periodontal ligament (PDL) widening, and hard tissue resorption.
Materials and Methods: Forty premolar root canals in two mature dogs were obturated with zinc oxide eugenol (ZOE) and an experimental 3% chitosan paste (n=20 in each group). The teeth were then restored with amalgam. After 28 days, the dogs were sacrificed, and histopathological assessment was performed. The amount of resorbed obturation material, degree of inflammatory response, degree of PDL widening, and the number of bone/cementum/dentin resorption defects were recorded under ×40 and ×200 magnifications. Data were analyzed using the Mann-Whitney U test, one-sample Wilcoxon signed-rank test, and Fisher’s exact test (α=0.05).
Results: Bone, cementum, and dentin resorption were seen in 6, 10, and 1 chitosan-obturated canals and 14, 15, and 0 ZOE-obturated canals, respectively. Only the bone resorption defects were significantly fewer in the chitosan group (P=0.026). Mild, moderate, and severe inflammation were observed in 17, 3, and 0 chitosan-obturated canals, and 7, 9, and 4 ZOE-filled canals, respectively (P=0.004). Mild, moderate, and severe PDL widening were seen around 15, 5, and 0 chitosan-filled canals and 7, 12, and 1 ZOE-filled canals, respectively (P=0.025).
Conclusion: The 3% chitosan was superior to ZOE in terms of causing less inflammation and PDL widening. It also decreased bone resorption and acted similar to ZOE in terms of dentin and cementum resorption.
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2. Imani Z, Imani Z, Basir L, Shayeste M, Abbasi Montazeri E, Rakhshan V. Antibacterial Effects of Chitosan, Formocresol and CMCP as Pulpectomy Medicament on Enterococcusfaecalis, Staphylococcus aureus and Streptococcusmutans. Iran Endod J. 2018 Summer;13(3):342-350.
3. Thomas AM, Chandra S, Chandra S, Pandey RK. Elimination of infection in pulpectomized deciduous teeth: a short-term study using iodoform paste. J Endod. 1994 May;20(5):233-5.
4. Bonow MLM, Guedes Pinto AC, Bammann LL. Antimicrobial activity of drugs used in pulp therapy of deciduous teeth. Braz endod J. 1996;1(1):44-8.
5. Leonardo MR, Silveira FF, Silva LA, Tanomaru Filho M, Utrilla LS. Calcium hydroxide root canal dressing. Histopathological evaluation of periapical repair at different time periods. Braz Dent J. 2002;13(1):17-22.
6. Queiroz AM, Nelson-Filho P, Silva LA, Assed S, Silva RA, Ito IY. Antibacterial activity of root canal filling materials for primary teeth: zinc oxide and eugenol cement, Calen paste thickened with zinc oxide, Sealapex and EndoREZ. Braz Dent J. 2009;20(4):290-6.
7. Gould JM. Root canal therapy for infected primary molar teeth--preliminary report. ASDC J Dent Child. 1972 Jul-Aug;39(4):269-73.
8. Shindova M. Root canal filling materials in primary teeth - review. Folia Med (Plovdiv). 2021 Oct 31;63(5):657-662.
9. Blinder Fuks A, Kapietzki A, M. G. Pulp therapy for the primary dentiton. In: Casamassimo P, Fields H, Mctigue D, A. N, editors. Pediatric dentistry: infancy through adolescen. Maryland Heights, Missouri, USA, : Elsevier; 2013. p. 333-51.
10. Nurko C, Garcia-Godoy F. Evaluation of a calcium hydroxide/iodoform paste (Vitapex) in root canal therapy for primary teeth. J Clin Pediatr Dent. 1999 Summer;23(4):289-94.
11. Wright KJ, Barbosa SV, Araki K, Spångberg LS. In vitro antimicrobial and cytotoxic effects of Kri 1 paste and zinc oxide-eugenol used in primary tooth pulpectomies. Pediatr Dent. 1994 Mar-Apr;16(2):102-6.
12. Fuks AB, Eidelman E, Pauker N. Root fillings with Endoflas in primary teeth: a retrospective study. J Clin Pediatr Dent. 2002 Fall;27(1):41-5.
13. Baumgartner J, Rosenberg P, Hoen M, Lin L. Treatment of endodontic infections, cysts, and flare-ups. Ingle's endodontics. Ontario, Canada: BC Decker; 2009. p. 690-713.
14. Roy PM, Harry P, Cailleux A, Allain P. Dangers of bismuth iodoform paraffin paste. Lancet. 1994 Dec 17;344(8938):1708.
15. Targino AG, Flores MA, dos Santos Junior VE, de Godoy Bené Bezerra F, de Luna Freire H.et al. An innovative approach to treating dental decay in children. A new anti-caries agent. J Mater Sci Mater Med. 2014 Aug;25(8):2041-7.
16. Rabea EI, Badawy ME, Stevens CV, Smagghe G, Steurbaut W. Chitosan as antimicrobial agent: applications and mode of action. Biomacromolecules. 2003 Nov-Dec;4(6):1457-65.
17. Sun L, Du Y, Fan L, Chen X, Yang J. Preparation, characterization and antimicrobial activity of quaternized carboxymethyl chitosan and application as pulp-cap. Polymer. 2006 Mar;47(6):1796-804.
18. Ueno H, Yamada H, Tanaka I, Kaba N, Matsuura M, Okumura M.et al. Accelerating effects of chitosan for healing at early phase of experimental open wound in dogs. Biomaterials. 1999 Aug;20(15):1407-14.
19. Matsunaga T, Yanagiguchi K, Yamada S, Ohara N, Ikeda T, Hayashi Y. Chitosan monomer promotes tissue regeneration on dental pulp wounds. J Biomed Mater Res A. 2006 Mar 15;76(4):711-20.
20. Schlueter N, Klimek J, Ganss C. Effect of a chitosan additive to a Sn2+-containing toothpaste on its anti-erosive/anti-abrasive efficacy--a controlled randomised in situ trial. Clin Oral Investig. 2014 Jan;18(1):107-15.
21. Costa EM, Silva S, Pina C, Tavaria FK, Pintado MM. Evaluation and insights into chitosan antimicrobial activity against anaerobic oral pathogens. Anaerobe. 2012 Jun;18(3):305-9.
22. Peter MG. Applications and environmental aspects of chitin and chitosan. J Macromol Sci, Part A Pure Appl. 1995 Apr;32(4):629-40.
23. Uysal T, Akkurt MD, Amasyali M, Ozcan S, Yagci A, Basak F.et al. Does a chitosan-containing dentifrice prevent demineralization around orthodontic brackets? Angle Orthod. 2011 Mar;81(2):319-25.
24. Hayashi Y, Ohara N, Ganno T, Ishizaki H, Yanagiguchi K. Chitosan-containing gum chewing accelerates antibacterial effect with an increase in salivary secretion. J Dent. 2007 Nov;35(11):871-4.
25. Suzuki S, Masuda Y, Morisaki H, Yamada Y, Kuwata H, Miyazaki T. The study of chitosan-citrate solution as a root canal irrigant: A preliminary report. Oral Hyg Health. 2014;2(142):2332-0702.
26. Jaiswal N, Sinha DJ, Singh UP, Singh K, Jandial UA, Goel S. Evaluation of antibacterial efficacy of Chitosan, Chlorhexidine, Propolis and Sodium hypochlorite on Enterococcus faecalis biofilm : An in vitro study. J Clin Exp Dent. 2017 Sep 1;9(9):e1066-e1074.
27. Camacho-Alonso F, Julián-Belmonte E, Chiva-García F, Martínez-Beneyto Y. Bactericidal Efficacy of Photodynamic Therapy and Chitosan in Root Canals Experimentally Infected with Enterococcus faecalis: An In Vitro Study. Photomed Laser Surg. 2017 Apr;35(4):184-189.
28. Camacho-Alonso F, Julián-Belmonte E, Chiva-García F, Martínez-Beneyto Y. Bactericidal Efficacy of Photodynamic Therapy and Chitosan in Root Canals Experimentally Infected with Enterococcus faecalis: An In Vitro Study. Photomed Laser Surg. 2017 Apr;35(4):184-189.
29. Quest BW. Oral health benefits of a daily dental chew in dogs. J Vet Dent. 2013 Summer;30(2):84-7.
30. Voith VL. Separation anxiety in dogs. The cCompendium on continuing education for the practicing veterinarian (USA). 1985.
31. Riekman GA, el Badrawy HE. Effect of premature loss of primary maxillary incisors on speech. Pediatr Dent. 1985 Jun;7(2):119-22.
32. Silva LA, Leonardo MR, Oliveira DS, Silva RA, Queiroz AM, Hernández PG, Nelson-Filho P. Histopathological evaluation of root canal filling materials for primary teeth. Braz Dent J. 2010 Jan;21(1):38-45.
33. Murata SS, Holland R, Souza Vd, Dezan Junior E, Grossi JA, Percinoto C. Histological analysis of the periapical tissues of dog deciduous teeth after root canal filling with diferent materials. J Appl Oral Sci. 2005 Sep;13(3):318-24.
34. Chen L, Tredget EE, Wu PY, Wu Y. Paracrine factors of mesenchymal stem cells recruit macrophages and endothelial lineage cells and enhance wound healing. PLoS One. 2008 Apr 2;3(4):e1886. doi: 10.1371/journal.pone.0001886. Erratum in: PLoS One. 2024 Apr 15;19(4):e0302417.
35. Ramos IF, Biz MT, Paulino N, Scremin A, Della Bona A, Barletta FB.et al. Histopathological analysis of corticosteroid-antibiotic preparation and propolis paste formulation as intracanal medication after pulpectomy: an in vivo study. J Appl Oral Sci. 2012 Feb;20(1):50-6.
36. Center S. A. In: Small Animal Pediatrics: The First 12 Months of Life. Peterson M.E., Kutzler M.A., editors. Elsevier Saunders; 2011. The liver, biliary tract and exocrine pancreas. pp. 368–390.
37. Matthews NS, Mohn TJ, Yang M, Spofford N, Marsh A, Faunt K.et al. Factors associated with anesthetic-related death in dogs and cats in primary care veterinary hospitals. J Am Vet Med Assoc. 2017 Mar 15;250(6):655-665.
38. Brodbelt DC, Pfeiffer DU, Young LE, Wood JL. Results of the confidential enquiry into perioperative small animal fatalities regarding risk factors for anesthetic-related death in dogs. J Am Vet Med Assoc. 2008 Oct 1;233(7):1096-104.
39. Bednarski RM. Dogs and cats. Veterinary anesthesia and analgesia: the fifth edition of Lumb and Jones. 2015 Apr 29:817-26.
40. Short CR. Drug disposition in neonatal animals. J Am Vet Med Assoc. 1984 May 1;184(9):1161-2.
2. Imani Z, Imani Z, Basir L, Shayeste M, Abbasi Montazeri E, Rakhshan V. Antibacterial Effects of Chitosan, Formocresol and CMCP as Pulpectomy Medicament on Enterococcusfaecalis, Staphylococcus aureus and Streptococcusmutans. Iran Endod J. 2018 Summer;13(3):342-350.
3. Thomas AM, Chandra S, Chandra S, Pandey RK. Elimination of infection in pulpectomized deciduous teeth: a short-term study using iodoform paste. J Endod. 1994 May;20(5):233-5.
4. Bonow MLM, Guedes Pinto AC, Bammann LL. Antimicrobial activity of drugs used in pulp therapy of deciduous teeth. Braz endod J. 1996;1(1):44-8.
5. Leonardo MR, Silveira FF, Silva LA, Tanomaru Filho M, Utrilla LS. Calcium hydroxide root canal dressing. Histopathological evaluation of periapical repair at different time periods. Braz Dent J. 2002;13(1):17-22.
6. Queiroz AM, Nelson-Filho P, Silva LA, Assed S, Silva RA, Ito IY. Antibacterial activity of root canal filling materials for primary teeth: zinc oxide and eugenol cement, Calen paste thickened with zinc oxide, Sealapex and EndoREZ. Braz Dent J. 2009;20(4):290-6.
7. Gould JM. Root canal therapy for infected primary molar teeth--preliminary report. ASDC J Dent Child. 1972 Jul-Aug;39(4):269-73.
8. Shindova M. Root canal filling materials in primary teeth - review. Folia Med (Plovdiv). 2021 Oct 31;63(5):657-662.
9. Blinder Fuks A, Kapietzki A, M. G. Pulp therapy for the primary dentiton. In: Casamassimo P, Fields H, Mctigue D, A. N, editors. Pediatric dentistry: infancy through adolescen. Maryland Heights, Missouri, USA, : Elsevier; 2013. p. 333-51.
10. Nurko C, Garcia-Godoy F. Evaluation of a calcium hydroxide/iodoform paste (Vitapex) in root canal therapy for primary teeth. J Clin Pediatr Dent. 1999 Summer;23(4):289-94.
11. Wright KJ, Barbosa SV, Araki K, Spångberg LS. In vitro antimicrobial and cytotoxic effects of Kri 1 paste and zinc oxide-eugenol used in primary tooth pulpectomies. Pediatr Dent. 1994 Mar-Apr;16(2):102-6.
12. Fuks AB, Eidelman E, Pauker N. Root fillings with Endoflas in primary teeth: a retrospective study. J Clin Pediatr Dent. 2002 Fall;27(1):41-5.
13. Baumgartner J, Rosenberg P, Hoen M, Lin L. Treatment of endodontic infections, cysts, and flare-ups. Ingle's endodontics. Ontario, Canada: BC Decker; 2009. p. 690-713.
14. Roy PM, Harry P, Cailleux A, Allain P. Dangers of bismuth iodoform paraffin paste. Lancet. 1994 Dec 17;344(8938):1708.
15. Targino AG, Flores MA, dos Santos Junior VE, de Godoy Bené Bezerra F, de Luna Freire H.et al. An innovative approach to treating dental decay in children. A new anti-caries agent. J Mater Sci Mater Med. 2014 Aug;25(8):2041-7.
16. Rabea EI, Badawy ME, Stevens CV, Smagghe G, Steurbaut W. Chitosan as antimicrobial agent: applications and mode of action. Biomacromolecules. 2003 Nov-Dec;4(6):1457-65.
17. Sun L, Du Y, Fan L, Chen X, Yang J. Preparation, characterization and antimicrobial activity of quaternized carboxymethyl chitosan and application as pulp-cap. Polymer. 2006 Mar;47(6):1796-804.
18. Ueno H, Yamada H, Tanaka I, Kaba N, Matsuura M, Okumura M.et al. Accelerating effects of chitosan for healing at early phase of experimental open wound in dogs. Biomaterials. 1999 Aug;20(15):1407-14.
19. Matsunaga T, Yanagiguchi K, Yamada S, Ohara N, Ikeda T, Hayashi Y. Chitosan monomer promotes tissue regeneration on dental pulp wounds. J Biomed Mater Res A. 2006 Mar 15;76(4):711-20.
20. Schlueter N, Klimek J, Ganss C. Effect of a chitosan additive to a Sn2+-containing toothpaste on its anti-erosive/anti-abrasive efficacy--a controlled randomised in situ trial. Clin Oral Investig. 2014 Jan;18(1):107-15.
21. Costa EM, Silva S, Pina C, Tavaria FK, Pintado MM. Evaluation and insights into chitosan antimicrobial activity against anaerobic oral pathogens. Anaerobe. 2012 Jun;18(3):305-9.
22. Peter MG. Applications and environmental aspects of chitin and chitosan. J Macromol Sci, Part A Pure Appl. 1995 Apr;32(4):629-40.
23. Uysal T, Akkurt MD, Amasyali M, Ozcan S, Yagci A, Basak F.et al. Does a chitosan-containing dentifrice prevent demineralization around orthodontic brackets? Angle Orthod. 2011 Mar;81(2):319-25.
24. Hayashi Y, Ohara N, Ganno T, Ishizaki H, Yanagiguchi K. Chitosan-containing gum chewing accelerates antibacterial effect with an increase in salivary secretion. J Dent. 2007 Nov;35(11):871-4.
25. Suzuki S, Masuda Y, Morisaki H, Yamada Y, Kuwata H, Miyazaki T. The study of chitosan-citrate solution as a root canal irrigant: A preliminary report. Oral Hyg Health. 2014;2(142):2332-0702.
26. Jaiswal N, Sinha DJ, Singh UP, Singh K, Jandial UA, Goel S. Evaluation of antibacterial efficacy of Chitosan, Chlorhexidine, Propolis and Sodium hypochlorite on Enterococcus faecalis biofilm : An in vitro study. J Clin Exp Dent. 2017 Sep 1;9(9):e1066-e1074.
27. Camacho-Alonso F, Julián-Belmonte E, Chiva-García F, Martínez-Beneyto Y. Bactericidal Efficacy of Photodynamic Therapy and Chitosan in Root Canals Experimentally Infected with Enterococcus faecalis: An In Vitro Study. Photomed Laser Surg. 2017 Apr;35(4):184-189.
28. Camacho-Alonso F, Julián-Belmonte E, Chiva-García F, Martínez-Beneyto Y. Bactericidal Efficacy of Photodynamic Therapy and Chitosan in Root Canals Experimentally Infected with Enterococcus faecalis: An In Vitro Study. Photomed Laser Surg. 2017 Apr;35(4):184-189.
29. Quest BW. Oral health benefits of a daily dental chew in dogs. J Vet Dent. 2013 Summer;30(2):84-7.
30. Voith VL. Separation anxiety in dogs. The cCompendium on continuing education for the practicing veterinarian (USA). 1985.
31. Riekman GA, el Badrawy HE. Effect of premature loss of primary maxillary incisors on speech. Pediatr Dent. 1985 Jun;7(2):119-22.
32. Silva LA, Leonardo MR, Oliveira DS, Silva RA, Queiroz AM, Hernández PG, Nelson-Filho P. Histopathological evaluation of root canal filling materials for primary teeth. Braz Dent J. 2010 Jan;21(1):38-45.
33. Murata SS, Holland R, Souza Vd, Dezan Junior E, Grossi JA, Percinoto C. Histological analysis of the periapical tissues of dog deciduous teeth after root canal filling with diferent materials. J Appl Oral Sci. 2005 Sep;13(3):318-24.
34. Chen L, Tredget EE, Wu PY, Wu Y. Paracrine factors of mesenchymal stem cells recruit macrophages and endothelial lineage cells and enhance wound healing. PLoS One. 2008 Apr 2;3(4):e1886. doi: 10.1371/journal.pone.0001886. Erratum in: PLoS One. 2024 Apr 15;19(4):e0302417.
35. Ramos IF, Biz MT, Paulino N, Scremin A, Della Bona A, Barletta FB.et al. Histopathological analysis of corticosteroid-antibiotic preparation and propolis paste formulation as intracanal medication after pulpectomy: an in vivo study. J Appl Oral Sci. 2012 Feb;20(1):50-6.
36. Center S. A. In: Small Animal Pediatrics: The First 12 Months of Life. Peterson M.E., Kutzler M.A., editors. Elsevier Saunders; 2011. The liver, biliary tract and exocrine pancreas. pp. 368–390.
37. Matthews NS, Mohn TJ, Yang M, Spofford N, Marsh A, Faunt K.et al. Factors associated with anesthetic-related death in dogs and cats in primary care veterinary hospitals. J Am Vet Med Assoc. 2017 Mar 15;250(6):655-665.
38. Brodbelt DC, Pfeiffer DU, Young LE, Wood JL. Results of the confidential enquiry into perioperative small animal fatalities regarding risk factors for anesthetic-related death in dogs. J Am Vet Med Assoc. 2008 Oct 1;233(7):1096-104.
39. Bednarski RM. Dogs and cats. Veterinary anesthesia and analgesia: the fifth edition of Lumb and Jones. 2015 Apr 29:817-26.
40. Short CR. Drug disposition in neonatal animals. J Am Vet Med Assoc. 1984 May 1;184(9):1161-2.
| Issue | Vol 21 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v21i22.16034 | |
| Keywords | ||
| Chitosan Zinc Oxide-Eugenol Cement Pulpectomy Inflammation Periodontal Ligament | ||
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How to Cite
1.
Basir L, Babashahi E, Razavi SM, Manshaei M, Rakhshan V. Effects of Chitosan as a Novel Obturation Material for Pulpectomized Teeth on Periapical Inflammation, Periodontal Ligament Widening, and Hard Tissue Resorption: A Preliminary Exploratory Study on Dogs. Front Dent. 2024;21.
