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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 16  |  Issue : 1  |  Page : 166-168

Comparative evaluation of antibacterial and antifungal efficacy of mineral trioxide aggregate angelus®, mineral trioxide aggregate plus™, and intermediate restorative material – A microbiological In vitro study


1 Department of Pediatric and Preventive Dentistry, Rural Medical College, Loni, Maharashtra, India
2 Department of Conservative Dentistry and Endodontics, Rural Medical College, Loni, Maharashtra, India
3 Department of Periodontics, Rural Medical College, Loni, Maharashtra, India
4 Department of Microbiology, Rural Medical College, Loni, Maharashtra, India
5 Department of Conservative Dentistry, Rural Medical College, Loni, Maharashtra, India

Date of Submission27-Aug-2020
Date of Decision29-Nov-2020
Date of Acceptance18-Jan-2021
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. Sourabh Ramesh Joshi
Department of Pediatric and Preventive Dentistry, Rural Dental College, Loni - 413 736, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_316_20

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  Abstract 


Objective: The study objective was to evaluate the antibacterial and antifungal properties of Mineral Trioxide Aggregate (MTA) Angelus® (MTA-A), MTA Plus™ (MTA-P), and intermediate restorative material (IRM). Materials and Methods: Pellets of MTA-P, MTA-A, and IRM were prepared to test the influence of these cements on the growth of four oral microbial strains, Enterococcus faecalis and Candida albicans, using agar diffusion method. The agar was removed, and the manipulated material was placed in the wells thus formed. The pellets were lodged in the seeded wells and incubated at 37°C for 24–72 h, after which the growth inhibition was measured. The data were analyzed using Student's t-test to compare the differences among the three cements at different concentrations. Results: The test results indicated that the antimicrobial activity of MTA-P, on both the microorganisms tested, was very strong, showing a mean inhibition zone of 3.1 mm, which extends over time toward all the strains. The diameters of the inhibition zones for E. faecalis were statistically significantly larger than that for Candida (P < 0.05) for MTA-P, IRM, and MTA-A. Conclusion: The materials showed antimicrobial activity against the tested strains. IRM showed no antimicrobial activity on Candida. The largest inhibition zone was observed for E. fecalis group. MTA-P created larger inhibition zones than MTA-A and IRM.

Keywords: Antibacterial activity, antifungal activity, inhibition zone, intermediate restorative material, Mineral Trioxide Aggregate Angelus®, Mineral Trioxide Aggregate Plus™


How to cite this article:
Joshi SR, Palekar AU, Pendyala GS, Mopagar V, Deorukhkar S, Singh M. Comparative evaluation of antibacterial and antifungal efficacy of mineral trioxide aggregate angelus®, mineral trioxide aggregate plus™, and intermediate restorative material – A microbiological In vitro study. J Datta Meghe Inst Med Sci Univ 2021;16:166-8

How to cite this URL:
Joshi SR, Palekar AU, Pendyala GS, Mopagar V, Deorukhkar S, Singh M. Comparative evaluation of antibacterial and antifungal efficacy of mineral trioxide aggregate angelus®, mineral trioxide aggregate plus™, and intermediate restorative material – A microbiological In vitro study. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Sep 16];16:166-8. Available from: http://www.journaldmims.com/text.asp?2021/16/1/166/322627




  Introduction Top


Pulpal and periradicular diseases are greatly influenced by the microorganisms, and they can be the cause for failed root canal treatments.[1] The root canal treatment's success depends on the proper shaping, cleaning, and disinfection of the root canal system and good coronal seal. The common cause of failure of root canal treatment is related to inadequate cleaning of the root canal system and disinfection of canals. Most of the lesions of endodontic origin heal after good nonsurgical endodontic treatment, however if they do not, may require surgical treatment (apicoectomy and retrograde filling). Root end resection (apicoectomy) becomes mandatory if there is persistence of infection in the periradicular region. In addition to good sealing ability, root-end filling material should have good antimicrobial and antifungal effects.[2] One of the well-known root-end filling material is intermediate restorative material (IRM), which has good sealing ability and well tolerated by the periapical tissues. However, the antimicrobial efficacy of IRM is low.[3]

ProRoot® mineral trioxide aggregate (MTA) is marketed as gray- and white-colored preparations. Both of these preparations are composed of 75% Portland cement clinker, 20% bismuth oxide, and 5% gypsum by weight. It is generally used as a root-end filling material after apicoectomy. MTA, however, has delayed setting time of 4 h, is quite expensive, and has poor handling properties.[4] To overcome these disadvantages of ProRoot MTA, MTA Angelus® (MTA-A) and MTA Plus™ (MTA-P) were introduced.

MTA-A has lower bismuth oxide than ProRoot. In addition, it has higher amount of calcium carbonate, calcium silicate, and barium zinc phosphate. The content of aluminum oxide in MTA-A is higher than that in ProRoot. MTA-A has better sealing ability than ProRoot and shows similar antibacterial and antifungal activities as those of ProRoot.[5]

MTA-P has similar ingredients as that of ProRoot and MTA-A. It has finer particle size.[6],[7] The antibacterial and antifungal activities of MTA-P are not much known and the number of studies on its antimicrobial activity is low.

The present study was thus designed to compare the antibacterial and antifungal efficacy of MTA-A, MTA-P, and IRM on Enterococcus faecalis and Candida albicans.


  Materials and Methods Top


The test materials – 50 mg of MTA-A (Angelus, Londrina, PR, Brazil), 50 mg of MTA-P (Prevest-Denpro, Jammu City, India), and 50 mg of IRM (Dentsply, Tulsa Dental, OK, USA) – were manipulated strictly in accordance with the manufacturer's instructions. Agar diffusion method was used against five reference strains to evaluate the antimicrobial efficacy of the endodontic cements: Enterococcus faecalis (ATCC 29212) and C. albicans (ATCC 10231).

Evaluation of each endodontic cement was done according to the concentrations given by the manufacturer. Bacteria were diluted to obtain a suspension of approximately 0.5 McFarland which is equal to 108 colony-forming units/mL, in sterile trypticase soy broth. Sterile cotton swabs were used to inoculate E. faecalis and Candida suspensions onto Mueller–Hinton agar plate. Freshly manipulated test materials were filled into 4 mm × 4 mm deep and wide made in the plates with copper punchers. The test materials were prediffused for 2 h at room temperature. All the plates were incubated at 37°C and evaluated at 24 h. A 0.5-mm precision ruler was used to measure the microbial inhibition zones,[7] and the results were expressed as the mean and standard deviation. The differences among MTA-A, MTA-P, and IRM were analyzed using Student's t-test and Tukey's honest significant difference post hoc test, using Statistical Package for Social Sciences software (Chicago, Illinois, USA).

Ethical clearance

This study was approved by the Institutional Ethics Committee of Pravara Institute of Medical Sciences Deemed University with Ref no : PMT/PIMS/IEC/2017/440 dated : 12/12/2017


  Results Top


The values of mean and standard deviation of growth inhibition against different tested microorganisms are presented in [Table 1]. The mean diameter of the growth inhibition zone of E. fecalis was 3.1 cm, 2.4 cm, and 1.5 cm for MTA-P, MTA-A, and IRM, respectively. The mean diameter of the growth inhibition zone of C. albicans was 2.6 cm, 1.8 cm, and 1.1 cm for MTA-P, MTA-A, and IRM, respectively. The growth of inhibition was larger significantly for E. fecalis than C. albicans. When MTA-P was compared with MTA-A and IRM for E. fecalis and C. albicans, it showed statistically significant results (P < 0.05). Furthermore, when MTA-A was compared with IRM for E. fecalis and C. albicans, it showed statistically significant results (P < 0.05). This means both MTAs had higher antimicrobial activity against both the microorganisms than IRM [Table 2].
Table 1: Mean inhibition zones of three cements (cm)

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Table 2: Comparative evaluation of three cements

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  Discussion Top


In this study, the antimicrobial activity of MTA-A, MTA-P, and IRM was evaluated. E. fecalis and C. albicans are the predominant microorganisms found in the periapical and periradicular pathologies. E. fecalis are the cause for failed root canal therapies, whereas C. albicans are the agents which form a biofilm on the root canal surfaces and can cause re-infection. Agar diffusion method was used in our study. This method makes comparison with previous studies easier as it demonstrates the activity of freshly mixed materials.[8] The formation of inhibition zones around the material to be tested for its antimicrobial capacity varies. This variation is mostly due to different agar media, cellular density, and different diffusion capacity of the inhibitory agent.

In the present study, for all the three cements, the largest inhibition zone was seen around E. fecalis. The results revealed that MTA-P had higher antimicrobial activity than that of MTA-A. The antimicrobial activity of MTA-P and MTA-A was significantly higher than that of IRM. The previous studies conducted by different authors showed controversial results regarding the antimicrobial efficacy of MTA-P and MTA-A. In a study conducted in 2007 by Estrela et al., MTA showed no antimicrobial activity against E. faecalis. However, our study proved the antibacterial activity of MTA-P and MTA-A against E. fecalis. According to Asgary et al.,[9] calcium hydroxide has higher antimicrobial activity than MTA. The calcium hydroxide peak was found to be much more pronounced in MTA-P than other forms of MTA.[10] In our study, MTA-P showed higher antimicrobial efficacy than MTA-A and IRM because of increased calcium hydroxide release from MTA-P.

Both MTA-P and MTA-A showed significant inhibition zones formed around Candida, but the zone formed around IRM was 1.1 cm. Therefore, the results suggested that Candida was resistant to IRM or IRM was not active against Candida, as there was no significant zone of inhibition.

The contents of MTA-P and MTA-A are more less the same. The difference exists in the formation of portlandite in a set MTA-P. This is due to the fine particles and the fine grinding property of MTA-P.[10] Furthermore, MTA-P exhibited high release of calcium hydroxide than MTA-A and IRM due to its fine grinding property.[10]

The advantages of MTA-P over MTA-A are its greater viscosity and its shorter setting time. The initial setting time of MTA-P was 7–9 min, whereas that of MTA-A was 12–15 min. The final setting time of MTA-P was 55–60 min, whereas that of MTA-A was 70–80 min.[11],[12] The setting time of MTA is long and inconvenient for both the patient and the dentist.


  Conclusion Top


  1. With the exception of IRM, all the tested materials showed significant microbial activity
  2. MTA-P showed larger inhibition zones in comparison with MTA-A and IRM
  3. The largest inhibition zones were seen with E. fecalis group.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fouad AF, Zerella J, Barry J, Spångberg LS. Molecular detection of Enterococcus species in root canals of therapy-resistant endodontic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:112-8.  Back to cited text no. 1
    
2.
Eldeniz AU, Hadimli HH, Ataoglu H, Orstavik D. Antibacterial effect of selected root-end filling materials. J Endod 2006;32:345-9.  Back to cited text no. 2
    
3.
Pitt Ford TR, Andreasen JO, Dorn SO, Kariyawasam SP. Effect of IRM root end fillings on healing after replantation. J Endod 1994;20:381-5.  Back to cited text no. 3
    
4.
Asgary S, Kamrani FA. Antibacterial effects of five different root canal sealing materials. J Oral Sci 2008;50:469-74.  Back to cited text no. 4
    
5.
Parirokh M, Askarifard S, Mansouri S, Haghdoost AA, Raoof M, Torabinejad M. Effect of phosphate buffer saline on coronal leakage of mineral trioxide aggregate. J Oral Sci 2009;51:187-92.  Back to cited text no. 5
    
6.
Formosa LM, Mallia B, Bull T, Camilleri J. The microstructure and surface morphology of radiopaque tricalcium silicate cement exposed to different curing conditions. Dent Traumatol 2012;28:584-95.  Back to cited text no. 6
    
7.
Estrela C, Bammann LL, Estrela CR, Silva RS, Pécora JD. Antimicrobial and chemical study of MTA, Portland cement, calcium hydroxide paste, Sealapex and Dycal. Braz Dent J 2000;11:3-9.  Back to cited text no. 7
    
8.
Koruyucu M, Topcuoglu N, Tuna EB, Ozel S, Gencay K, Kulekci G, et al. An assessment of antibacterial activity of three pulp capping materials on Enterococcus faecalis by a direct contact test: An in vitro study. Eur J Dent 2015;9:240-5.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Asgary S, Akbari Kamrani F, Taheri S. Evaluation of antimicrobial effect of MTA, calcium hydroxide, and CEM cement. Iran Endod J 2007;2:105-9.  Back to cited text no. 9
    
10.
Guven Y, Tuna EB, Dincol ME, Aktoren O. X-ray diffraction analysis of MTA-Plus, MTA-Angelus and DiaRoot BioAggregate. Eur J Dent 2014;8:211-5.  Back to cited text no. 10
  [Full text]  
11.
Chng HK, Islam I, Yap AU, Tong YW, Koh ET. Properties of a new root-end filling material. J Endod 2005;31:665-8.  Back to cited text no. 11
    
12.
Islam I, Chng HK, Yap AU. Comparison of the physical and mechanical properties of MTA and Portland cement. J Endod 2006;32:193-7.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2]



 

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