Elsevier

Archives of Oral Biology

Volume 60, Issue 10, October 2015, Pages 1497-1502
Archives of Oral Biology

An in vitro evaluation of the antibacterial properties of three mineral trioxide aggregate (MTA) against five oral bacteria

https://doi.org/10.1016/j.archoralbio.2015.07.014Get rights and content

Highlights

  • We evaluated antibacterial activity of 3 MTA cements against 5 oral bacteria.

  • The most resistant bacteria was E. faecalis.

  • Disc diffusion test showed only Endocem MTA had an inhibitory effect against E. faecalis.

Abstract

Objective

The purpose of this study was to evaluate the antibacterial ability of three MTA (MTA-Angelus, Endocem MTA, and ProRoot MTA) against five typical oral bacteria (Streptococcus mutans, Enterococcus faecalis, Lactobacillus rhamnosus, Lactobacillus paracasei, and Porphyromonas gingivalis).

Design

For disc diffusion test, each test material was placed into agar plates after inoculation of each bacterial strain. The zones of inhibition of bacterial growth were then measured. Antibacterial broth test was performed by adding the test material into the media. Colony-forming units were counted after incubation with bacteria. The data were analyzed using ANOVA and the Tukey’s test.

Results

Disc diffusion test showed that the antibacterial activity against S. mutans, L. rhamnosus, L. paracasei, and P. gingivalis ranked in decreasing order of MTA-Angelus > ProRoot MTA > Endocem MTA (p < 0.05). An inhibitory effect against E. faecalis was only observed in Endocem MTA. Antibacterial broth test showed that the antibacterial activity against all bacteria was Endocem MTA > MTA-Angelus > ProRoot MTA (p < 0.05).

Conclusion

Discrepant results were obtained from the disc diffusion and antibacterial broth test, with MTA-Angelus and Endocem MTA being most effective, respectively. Both tests revealed that the most resistant bacteria was E. faecalis, which was not susceptible at all, except to Endocem MTA in disc diffusion test.

Introduction

Mineral trioxide aggregate (MTA) has become the material of choice in various endodontic procedures such as pulp capping, pulpotomy, apexogenesis/apexification, repair of root resorption and lateral or furcal perforations, and retrograde filling, because of its superior properties including sealability (Torabinejad, Rastegar, Kettering, & Pitt Ford, 1995), biocompatibility (Torabinejad, Hong, Pitt Ford, & Kettering, 1995a), and bioactivity (Enkel et al., 2008). However, the main drawbacks of MTA are difficulty in handling, long setting time, and discoloration potential (Parirokh & Torabinejad, 2010). The main ingredients are tricalcium silicate, dicalcium silicate, and bismuth oxide, with small quantities of iron and aluminum (Ferris & Baumgartner, 2004). Since the introduction of ProRoot MTA (Dentsply, Tulsa, OK, USA) in 1998, novel commercially available MTA-based products including MTA-Angelus (Angelus, Londrina, PR, Brazil) and Endocem MTA (Maruchi, Wonju, Korea) have been developed in an attempt to improve these shortcomings by modifying the composition and/or concentration of each ingredient. Endocem is an MTA-derived pozzolan cement with a lesser setting time (4 min ± 30 s) and similar biocompatibility and osteogenicity compared to conventional MTA (Choi et al., 2013). As the characteristics of a material may change along with composition modification, numerous studies have evaluated the biological and physical properties of these MTA products.

Considering the indispensable role of microorganisms in the development and progress of pulpal and periapical disease as well as the failure of endodontic treatment, the eradication of microorganisms from the root canal system in endodontic treatment and prevention of bacterial ingress to the root canal system during restorative treatment are the key factors in successful clinical outcome (Baumgartner & Falkler, 1991; Fabricius, Dahlen, Ohman, & Moller, 1982; Fouad, Zerella, Barry, & Spangberg, 2005; Kakehashi, Stanley, & Fitzgerald, 1965; Moller, Fabricius, Dahlen, Ohman, & Heyden, 1981; Siqueira, Rocas, Souto, de Uzeda, & Colombo, 2000; Sundqvist, 1992). Therefore, an ideal dental material should also possess antibacterial property, but not at the expense of its other biological and physical properties.

There is to date limited information, however, on the comparative antibacterial activity of MTA-based products against some of the predominant clinically relevant bacteria including Enterococcus faecalis in endodontic disease, Porphyromonas gingivalis in periodontal disease, Streptococcus mutans in the initiation of dental caries, Lactobacillus rhamnosus, and Lactobacillus paracasei in the progression of dental caries.

This study was conducted to compare the antibacterial effects of three MTA products (MTA-Angelus, Endocem MTA, and ProRoot MTA) against these five typical oral bacteria, and thereby to develop a clinical recommendation for their specific use based on their antibacterial activity.

Section snippets

Compositions of tested cements

The chemical composition of the tested materials (MTA-Angelus, Endocem MTA, and ProRoot MTA) were analyzed by X-ray fluorescence spectrometer (ZSX100e, Rigaku, Akishima, Japan). The powders of each material were pressed into rigid pellets, which were then evaluated twice qualitatively and quantitatively using the fundamental parameter method.

Disc diffusion test

The antibacterial activity was evaluated using five standard bacterial strains: S. mutans (ATCC 25175), E. faecalis (ATCC 4082), and P. gingivalis (ATCC

Compositions of the cements

The chemical compositions of the cements by X-ray fluorescence spectrometer are shown in Table 1. Main chemical compounds were calcium oxide (lime; CaO), silicon dioxide (silica; SiO2), and bismuth oxide (Bi2O3), accounting for approximately 95% of the total mass of MTA-Angelus and ProRoot MTA, and 83% of Endocem MTA. When compared with MTA-Angelus and ProRoot MTA, the amount of CaO was relatively lower, while aluminum oxide (Al2O3), magnesium oxide (MgO), ferric oxide (Fe2O3), and potassium

Discussion

The methods used in the present study for evaluation of antibacterial activity of MTA materials were disc diffusion test and antibacterial broth test. The results of the two tests were not consistent due to the difference in the application of MTA materials. For antibacterial broth test, fresh powder of each MTA material was added to the broth before incubation with bacteria. The growth of bacteria is inhibited if the compositions of the test materials have antibacterial properties, when in

Conflict of interest

There are no conflicts of interest to declare.

Acknowledgment

This study was supported by research grant No. O1500051 from Korea University Medical Center Guro Hospital, Seoul, Korea.

References (50)

  • J.H. Jang et al.

    Tooth discoloration after the use of new pozzolan cement (Endocem) and mineral trioxide aggregate and the effects of internal bleaching

    Journal of Endodontics

    (2013)
  • S. Kakehashi et al.

    The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats

    Oral Surgery, Oral Medicine, Oral Pathology

    (1965)
  • M. Kim et al.

    Comparison of the biological properties of ProRoot MTA, OrthoMTA, and Endocem MTA cements

    Journal of Endodontics

    (2014)
  • C.P. McHugh et al.

    pH required to kill Enterococcus faecalis in vitro

    Journal of Endodontics

    (2004)
  • J. Mente et al.

    Treatment outcome of mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results

    Journal of Endodontics

    (2014)
  • A.K. Mickel et al.

    Effectiveness of stannous fluoride and calcium hydroxide against Enterococcus faecalis

    Journal of Endodontics

    (2003)
  • T. Oviir et al.

    Effects of gray and white mineral trioxide aggregate on the proliferation of oral keratinocytes and cementoblasts

    Journal of Endodontics

    (2006)
  • M. Parirokh et al.

    Mineral trioxide aggregate: a comprehensive literature review—part III. Clinical applications, drawbacks, and mechanism of action

    Journal of Endodontics

    (2010)
  • A.D. Santos et al.

    Setting time and thermal expansion of two endodontic cements

    Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics

    (2008)
  • N.K. Sarkar et al.

    Physicochemical basis of the biologic properties of mineral trioxide aggregate

    Journal of Endodontics

    (2005)
  • J.F. Siqueira et al.

    Checkerboard hybridization analysis of endodontic infections

    Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics

    (2000)
  • T.J. Stowe et al.

    The effects of chlorhexidine gluconate (0.12%) on the antimicrobial properties of tooth-colored ProRoot mineral trioxide aggregate

    Journal of Endodontics

    (2004)
  • C.H. Stuart et al.

    Enterococcus faecalis: its role in root canal treatment failure and current concepts in retreatment

    Journal of Endodontics

    (2006)
  • G. Sundqvist

    Ecology of the root canal flora

    Journal of Endodontics

    (1992)
  • G. Sundqvist et al.

    Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment

    Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics

    (1998)
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