Comparative Evaluation of Minimally Invasive and Conventional Access on The Biofilm Elimination of Enterococcus Faecalis From the Root Canal System
Keywords:
Bacterial reduction, biofilm elimination, minimally invasive access, conventional access, TruNatomyAbstract
Background: The access cavity is a fundamental step in endodontic treatment. Traditionally, it is performed by completely removing the pulp chamber and all its contents. Recently, the introduction of technologies such as the operating microscope, ultrasound, and Ni-Ti instrumentation systems has allowed this phase to be performed conservatively through minimal invasive access. However, further evidence is needed to determine whether these techniques allow complete elimination of microorganisms within the root canal system.
Objectives: The aim of this study was to evaluate the effects of minimally invasive access (MIA) compared with conventional access (CA) on the disinfection and elimination of biofilm Enterococcus faecalis in root canal therapy.
Methods: Forty-four first molars were selected and randomly divided in groups: MIA and CA (n= 15 each), positive control (n= 8), negative control (n= 6). After access cavity, the root canals were contaminated with E. faecalis for 30 days. Bacterial sampling was performed with sterile paper points before (S1) and after (S2) instrumentation with the TruNatomy system to quantify the bacterial load. Colony-forming units per milliliter (CFU/mL) and scanning electron microscopy (SEM) were used for bacterial reduction assessment and elimination of biofilm. Statistical comparisons were conducted using Student’s t-test or Mann–Whitney U test, with significance set at 5%.
Results: Significant reductions in E. faecalis were observed in all groups, regardless of cavity design. However, the lowest bacterial reduction was found in the MIA group, while the CA group achieved the highest reduction.
Conclusions: Conventional access resulted in significantly better disinfection compared with minimally invasive access. These findings suggest that the design of the access cavity influences bacterial load reduction and biofilm elimination within root canals.
References
Silva EJNL, De-Deus G, Souza EM, Belladonna FG, Cavalcante DM, Simões-Carvalho M, Versiani MA. Present status and future directions - Minimal endodontic access cavities. Int Endod J. 2022 May;55 Suppl 3:531-587. doi: 10.1111/iej.13696.
Smith R, McColl E, Bryce G. Top tips for endodontic access. Br Dent J. 2024; 236, 364–368. doi:10.1038/s41415-024-7199-9.
Neelakantan P, Khan K, Hei Ng GP, Yip CY, Zhang C, Pan Cheung GS. Does the Orifice-directed Dentin Conservation Access Design Debride Pulp Chamber and Mesial Root Canal Systems of Mandibular Molars Similar to a Traditional Access Design? J Endod. 2018 Feb;44(2):274-279. doi: 10.1016/j.joen.2017.10.010.
Bóveda C, Kishen A. Contracted endodontic cavities: the foundation for less invasive alternatives in the management of apical periodontitis. Endodontic Topics. 2015 Nov;33(1):169-86.
Vorster M, van der Vyver PJ, Markou G. Traditional and Conservative Molar Endodontic Access Cavity Designs: A Classification and Overview. South African Dental Journal. 2022 Aug;77(7):407-12. doi:10.17159/2519-0105/2022/v77no7a4.
Clark D, Khademi J. Modern molar endodontic access and directed dentin conservation. Dent Clin North Am. 2010 Apr;54(2):249-73. doi: 10.1016/j.cden.2010.01.001.
Clark D, Khademi JA. Case studies in modern molar endodontic access and directed dentin conservation. Dent Clin North Am. 2010 Apr;54(2):275-89. doi: 10.1016/j.cden.2010.01.003.
Mandil OA, Ghoulah KT, Hazzam BM, Alhijji HS, Al Abbas AH, Rehan AK, Doumani M, Mandil AA. Modern versus Traditional Endodontic Access Cavity Designs. J Pharm Bioallied Sci. 2022 Jul;14(Suppl 1): S24-S27. doi: 10.4103/jpbs.jpbs_668_21.
Shabbir J, Zehra T, Najmi N, Hasan A, Naz M, Piasecki L, Azim AA. Access Cavity Preparations: Classification and Literature Review of Traditional and Minimally Invasive Endodontic Access Cavity Designs. J Endod. 2021 Aug;47(8):1229-1244. doi: 10.1016/j.joen.2021.05.007.
Silva EJNL, De-Deus G, Souza EM, Belladonna FG, Cavalcante DM, Simões-Carvalho M, Versiani MA. Present status and future directions - Minimal endodontic access cavities. Int Endod J. 2022 May;55 Suppl 3:531-587. doi: 10.1111/iej.13696.
Vieira GCS, Pérez AR, Alves FRF, Provenzano JC, Mdala I, Siqueira JF Jr, Rôças IN. Impact of Contracted Endodontic Cavities on Root Canal Disinfection and Shaping. J Endod. 2020 May;46(5):655-661. doi: 10.1016/j.joen.2020.02.002.
Maqbool M, Noorani TY, Asif JA, Makandar SD, Jamayet NB. Controversies in endodontic access cavity design: A literature review. Dental Update. 2020 Oct 2;47(9):747-54. doi: 10.12968/denu.2020.47.9.747.
Silva EJNL, Pinto KP, Ferreira CM, Belladonna FG, De-Deus G, Dummer PMH, Versiani MA. Current status on minimal access cavity preparations: a critical analysis and a proposal for a universal nomenclature. Int Endod J. 2020 Dec;53(12):1618-1635. doi: 10.1111/iej.13391.
Ballester B, Giraud T, Ahmed HMA, Nabhan MS, Bukiet F, Guivarc'h M. Current strategies for conservative endodontic access cavity preparation techniques-systematic review, meta-analysis, and decision-making protocol. Clin Oral Investig. 2021 Nov;25(11):6027-6044. doi: 10.1007/s00784-021-04080-7.
Al-Helou N, Zaki AA, Al Agha M, Moawad E, Jarad F. Which endodontic access cavity is best? A literature review. Br Dent J. 2023 Mar;234(5):335-339. doi: 10.1038/s41415-023-5581-7.
Usta SN, Solana C, Ruiz-Linares M, Baca P, Ferrer-Luque CM, Cabeo M, Arias-Moliz MT. Effectiveness of conservative instrumentation in root canal disinfection. Clin Oral Investig. 2023 Jun;27(6):3181-3188. doi: 10.1007/s00784-023-04929-z.
Shaheen NA, Elhelbawy NGE. Shaping Ability and Buckling Resistance of TruNatomy, WaveOne gold, and XP-Endo Shaper Single-File Systems. Contemp Clin Dent. 2022 Jul-Sep;13(3):261-266. doi: 10.4103/ccd.ccd_1048_20.
Schneider SW. A comparison of canal preparations in straight and curved root canals. Oral Surg Oral Med Oral Pathol 1971; 32:271–5.
Moore B, Verdelis K, Kishen A, Dao T, Friedman S. Impacts of Contracted Endodontic Cavities on Instrumentation Efficacy and Biomechanical Responses in Maxillary Molars. J Endod. 2016 Dec;42(12):1779-1783. doi: 10.1016/j.joen.2016.08.028.
Haapasalo, M.; Orstavik, D. In vitro infection and disinfection of dentinal tubules. J. Dent. Res. 1987, 66, 1375–1379.
Barbosa AFA, Silva EJNL, Coelho BP, Ferreira CMA, Lima CO, Sassone LM. The influence of endodontic access cavity design on the efficacy of canal instrumentation, microbial reduction, root canal filling and fracture resistance in mandibular molars. Int Endod J. 2020 Dec;53(12):1666-1679. doi: 10.1111/iej.13383.
Alovisi M, Pasqualini D, Musso E, Bobbio E, Giuliano C, Mancino D, Scotti N, Berutti E. Influence of Contracted Endodontic Access on Root Canal Geometry: An In Vitro Study. J Endod. 2018 Apr;44(4):614-620. doi: 10.1016/j.joen.2017.11.010.
Rover G, de Lima CO, Belladonna FG, Garcia LFR, Bortoluzzi EA, Silva EJNL, Teixeira CS. Influence of minimally invasive endodontic access cavities on root canal shaping and filling ability, pulp chamber cleaning and fracture resistance of extracted human mandibular incisors. Int Endod J. 2020 Nov;53(11):1530-1539. doi: 10.1111/iej.13378.
Tüfenkçi P, Yılmaz K. The Effects of Different Endodontic Access Cavity Design and Using XP-endo Finisher on the Reduction of Enterococcus faecalis in the Root Canal System. J Endod. 2020 Mar;46(3):419-424. doi: 10.1016/j.joen.2019.11.011.
Vieira GCS, Pérez AR, Alves FRF, Provenzano JC, Mdala I, Siqueira JF Jr, Rôças IN. Impact of Contracted Endodontic Cavities on Root Canal Disinfection and Shaping. J Endod. 2020 May;46(5):655-661. doi: 10.1016/j.joen.2020.02.002.
Marvaniya J, Agarwal K, Mehta DN, Parmar N, Shyamal R, Patel J. Minimal Invasive Endodontics: A Comprehensive Narrative Review. Cureus. 2022 Jun 16;14(6):e25984. doi: 10.7759/cureus.25984.
Siqueira JF Jr, Rôças IN. Present status and future directions: Microbiology of endodontic infections. Int Endod J. 2022 May;55 Suppl 3:512-530. doi: 10.1111/iej.13677.
Babeer A, Bukhari S, Alrehaili R, Karabucak B, Koo H. Microrobotics in endodontics: A perspective. Int Endod J. 2024 Jul;57(7):861-871. doi: 10.1111/iej.14082.
Siqueira JF Jr, Alves FR, Versiani MA, Rôças IN, Almeida BM, Neves MA, Sousa-Neto MD. Correlative bacteriologic and micro-computed tomographic analysis of mandibular molar mesial canals prepared by self-adjusting file, reciproc, and twisted file systems. J Endod. 2013 Aug;39(8):1044-50. doi: 10.1016/j.joen.2013.04.034.
Relucenti M, Familiari G, Donfrancesco O, Taurino M, Li X, Chen R, Artini M, Papa R, Selan L. Microscopy Methods for Biofilm Imaging: Focus on SEM and VP-SEM Pros and Cons. Biology (Basel). 2021 Jan 12;10(1):51. doi: 10.3390/biology10010051.
Tonini R, Salvadori M, Audino E, Sauro S, Garo ML, Salgarello S. Irrigating Solutions and Activation Methods Used in Clinical Endodontics: A Systematic Review. Front Oral Health. 2022 Jan 31;3:838043. doi: 10.3389/froh.2022.838043. Erratum in: Front Oral Health. 2022 Mar 24;3:876265. doi: 10.3389/froh.2022.876265.
Bordea IR, Hanna R, Chiniforush N, Grădinaru E, Câmpian RS, Sîrbu A, Amaroli A, Benedicenti S. Evaluation of the outcome of various laser therapy applications in root canal disinfection: A systematic review. Photodiagnosis Photodyn Ther. 2020 Mar;29:101611. doi: 10.1016/j.pdpdt.2019.101611.
Liu B, Zhou X, Yue L, Hou B, Yu Q, Fan B, Wei X, Qiu L, Huang Z, Xia W, Sun Z, Wang H, Meng L, Peng B, Zhang C, Deng S, Lu Z, Yang D, Hou T, Jiang Q, Xie X, Liu X, Li J, Wang Z, Lyu H, Xue M, Ge J, Du Y, Zhao J, Liang J. Experts consensus on the procedure of dental operative microscope in endodontics and operative dentistry. Int J Oral Sci. 2023 Sep 18;15(1):43. doi: 10.1038/s41368-023-00247-y.
Hou BX. Role of the operating microscope in diagnosis and treatment of endodontic diseases. Zhonghua Kou Qiang Yi Xue Za Zhi. 2018 Jun 9;53(6):386-391. Chinese. doi: 10.3760/cma.j.issn.1002-0098.2018.06.005
