Publications by authors named "H Aksel"

32 Publications

Antibacterial Effect and Bioactivity of Innovative and Currently Used Intracanal Medicaments in Regenerative Endodontics.

J Endod 2021 Aug 23;47(8):1294-1300. Epub 2021 May 23.

Department of Periodontics and Endodontics, University at Buffalo, Buffalo, New York. Electronic address:

Introduction: The purpose of this study was to determine the antibacterial effect and bioactivity of triple antibiotic paste (TAP), calcium hydroxide (Ca[OH]), and calcium hypochlorite (Ca[OCl]).

Methods: Root canals were infected with 3-week-old Enterococcus faecalis biofilm and then medicated for 7 days with TAP, Ca(OH), or Ca(OCl) (n = 10/group). Untreated and uninfected canals were used as positive and negative controls. The antibacterial effect was determined using colony-forming units and a Live/Dead bacterial viability kit. Dental pulp stem cells were seeded on medicated dentin surfaces for 7 days. Sodium thiosulfate and various concentrations of ascorbic acid (1%, 5%, and 10%) were also used to neutralize the samples treated with Ca(OCl) before cell seeding (n = 3 in triplicate). Cell viability and morphology were evaluated using a viability assay and Live/Dead cell analysis. Alkaline phosphatase (ALP) activity was also measured to determine the cells' mineralization activity.

Results: All medicaments decreased the initial bacterial load (P < .05). The highest bacterial reduction in the main canal and dentinal tubules was observed in the Ca(OCl) group (P < .05). TAP- or Ca(OH)-treated dentin surface improved cell viability and ALP activity compared with the untreated dentin surface (P < .05), whereas Ca(OCl) decreased cell viability and ALP activity (P < .05). Ten percent ascorbic acid neutralized the effect of Ca(OCl) on the treated dentin surface, showing higher cell viability (P < .05) and similar ALP activity with the untreated dentin surface and the other groups (P > .05).

Conclusions: Ca(OCl) medication improved root canal disinfection against E. faecalis biofilm compared with TAP and Ca(OH). The adverse effects caused by Ca(OCl) on cell viability and mineralization activity can be neutralized with 10% ascorbic acid.
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http://dx.doi.org/10.1016/j.joen.2021.05.005DOI Listing
August 2021

Effect of heat application on the physical properties and chemical structure of calcium silicate-based sealers.

Clin Oral Investig 2021 May 25;25(5):2717-2725. Epub 2020 Sep 25.

Division of Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA.

Objective: To determine the effect of heat application on the setting and chemical properties of HiFlow BC Sealer and compare to other calcium silicate (CSBS) and epoxy resin-based root canal sealers.

Materials And Methods: AH Plus, BioRoot RCS (BioRoot), Endosequence BC (Endosequence), and HiFlow BC (HiFlow) sealers were placed at 37 °C or subjected to heat at 200 °C for 10 or 30 s, followed by incubation at 37 °C in a humidified incubator during experiments. Setting time, viscosity, and flow were assessed, and changes in chemical structure were evaluated using the Fourier-transform infrared spectroscopy (FTIR). Thermogravimetric analysis was also used to evaluate the weight change (%) of the sealers upon heating from room temperature to 37 °C or 200 °C at a rate of 20 °C/min. Data were analyzed using a two-way ANOVA with a Bonferroni post-hoc test (p = 0.05).

Results: Application of heat extended the setting time for Endosequence and HiFlow but resulted in a faster setting of AH Plus and BioRoot. The highest flow and lower viscosity were observed in HiFlow at high temperature (p < 0.05), whereas the lowest flow with the highest viscosity and greatest weight loss were observed in BioRoot after heat application (p < 0.05). FTIR spectra demonstrated no changes to functional groups after heat application, except for the strong H-O-H absorption peak corresponding to water in BioRoot.

Conclusions: Endosequence and HiFlow showed similar chemical properties with a higher flow and lower viscosity in HiFlow after heat application. Heat application resulted in reduced flow, increased viscosity, and weight loss for BioRoot. The setting of AH Plus was fastened with heat, while its weight loss, viscosity, and flow characteristics were stable.

Clinical Relevance: HiFlow, Endosequence, and AH Plus can be all used with WVC obturation techniques. Heat application resulted in minor changes in their physical properties including setting time, flow, weight loss, and chemical properties, while BioRoot showed a significant amount of weight loss, increase in viscosity, and reduced flowability after heat application.
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http://dx.doi.org/10.1007/s00784-020-03586-wDOI Listing
May 2021

Antimicrobial Activity and Biocompatibility of Antibiotic-Loaded Chitosan Hydrogels as a Potential Scaffold in Regenerative Endodontic Treatment.

J Endod 2020 Dec 15;46(12):1867-1875. Epub 2020 Sep 15.

Division of Endodontics, University at Buffalo, Buffalo, New York. Electronic address:

Introduction: The objective of this study was to determine the effectiveness of several antibiotic-loaded hydrogel scaffolds against Enterococcus faecalis, as well as their ability to stimulate proliferation and mineralization of dental pulp stem cells.

Methods: Fibrin (Fg) or chitosan-fibrin hydrogels (Ch) were prepared using 12.5 mg/mL fibrinogen and 0.4% (w/v) chitosan. Triple antibiotics, clindamycin-modified triple antibiotic paste, or double antibiotics were loaded in gels (1 mg/mL). Antibacterial effect against E. faecalis biofilm was determined by using colony-forming units (CFUs) and confocal laser scanning microscope (CLSM). Cell viability and morphology were determined by loading cells into different gels at 7 and 14 days using the water-soluble tetrazolium salt-1 cell viability assay and Live & Dead cell analysis. Mineralization was detected by using alkaline phosphatase and alizarin red staining activity.

Results: Antibiotic-loaded Fg gel and Ch gel alone without antibiotics resulted in a significant reduction in CFUs compared with the positive control (P < .05). When antibiotics were loaded in Ch gel, there were no CFUs detected in any groups (P < .05). CLSM images showed dense red areas with mostly dead bacteria on the dentin surface in antibiotic-loaded Ch groups, which showed significantly less live bacteria compared with the other groups (P < .05). Triple antibiotic-loaded Fg and Ch gels resulted in a dramatic decrease in the mineralized nodule formation compared with all other gel groups (P < .05). Ch hydrogels resulted in round cell morphology up to 7 days. Ch alone or with double antibiotic paste showed more cell spreading with spindle-shaped morphology at 14 days and higher alkaline phosphatase activity compared with other antibiotic-loaded Ch groups (P > .05).

Conclusions: Double antibiotic-loaded Ch gel appears to enhance the antibacterial properties while maintaining higher cell viability, cell spreading, and mineralization activity, compared with all the other scaffolds investigated.
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http://dx.doi.org/10.1016/j.joen.2020.09.007DOI Listing
December 2020

Soft and Hard Tissue Remodeling after Endodontic Microsurgery: A Cohort Study.

J Endod 2020 Dec 9;46(12):1824-1831. Epub 2020 Sep 9.

Division of Endodontics, University at Buffalo, Buffalo, New York. Electronic address:

Introduction: The aim of this study was to investigate the impact of the incision type, with or without a coronally repositioning flap (CRF), on soft tissue healing and crestal bone remodeling after endodontic microsurgery (EMS).

Methods: Clinical pictures and cone-beam computed tomography images from 47 patients (120 teeth) taken before surgery and at the follow-up appointment were included in this study. Clinical pictures were qualitatively evaluated by 2 endodontists for the gingival marginal level (GML) (recession, same position, or coronal root coverage), papillary height (same position/receded), and for presence/absence of scars for each tooth. Cone-beam computed tomography images were used to calculate the changes in the distance between the cementoenamel junction and the crestal bone level (CBL) between the preoperative and follow-up scans. Statistical analyses were performed to determine a correlation between patient-related factors (age, sex, tooth type, position, and presence/absence of a crown), incision techniques, and changes within the CBL.

Results: Gingival recession was more prevalent in mandibular teeth, molar teeth, and teeth that received intrasulcular or papilla-based incisions (P < .05). Scar formation was affected by the flap design (P < .05). CRF was the only technique resulting in coronal root coverage (P < .05). There were no changes observed in the papillary height between the various flap designs. There was also no statistically significant difference in the crestal bone height between the preoperative and follow-up scan measurements (P > .05).

Conclusions: Soft tissue changes are evident after EMS and can be affected by the flap design selected, as well as the site being treated. Application of CRF can improve the position of GML after EMS. There are insignificant changes within the CBL at the facial aspect of the root after EMS.
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http://dx.doi.org/10.1016/j.joen.2020.08.024DOI Listing
December 2020

The prescribing of antibiotics for endodontic infections by dentists in Turkey: a comprehensive survey.

Int Endod J 2020 Dec 18;53(12):1715-1727. Epub 2020 Sep 18.

Private Practice, Fort Lauderdale, Florida, USA.

Aim: To investigate the antibiotic prescribing patterns for endodontic infections based on the reports of Turkish dentists.

Methodology: A survey consisting of 20 questions on general information and 13 questions on antibiotic prescribing patterns for endodontic cases was delivered to the e-mail addresses of general dentists and specialists via the database of the Turkish Dental Association. Collected data were analysed using Mc-Nemar-Bowker Test and multivariate ordinal logistic regression tests at the significance level of 0.05.

Results: A total of 1007 responses were obtained from 17 827 dentists. The majority of the participants were general dental practitioners (GDP, 80%) whilst 8% were Endodontists. Gender, clinical experience, affiliations and speciality were significant risk factors for antibiotic prescription (P < 0.05). GDPs prescribed antibiotics twice as much as all specialists and members of public hospitals prescribed antibiotics three times more than specialists and clinical academics (P < 0.05). Amoxicillin with clavulanic acid was the most prescribed antibiotic (90%), followed by Ornidazole (25%). Clindamycin was the drug of choice for the patients with penicillin allergy (59%). Infection and fever control (76%), prophylaxis (44%) and avoiding swelling and trismus during endodontic treatment (26%) were the most common reasons for antibiotic prescriptions. Completing a course of prescribed antibiotics was recommended by most (75%). Infective endocarditis, immunosuppression, artificial heart valve and mitral valve prolapse were the main causes of prophylaxis in descending order. Uncontrolled and extensive use of antibiotics by patients (62%) was mentioned as the most effective reason for antibiotic resistance. Up to 10% of participants prescribed antibiotics for symptomatic irreversible pulpitis, asymptomatic apical periodontitis with or without endodontic treatment (8, 12 and 11%, respectively). Up to 20% of dentists prescribed antibiotics for symptomatic apical periodontitis when the pulp was vital or necrotic (13 and 23%, respectively). Almost one third of the participants prescribed antibiotics for symptomatic apical periodontitis of previously treated teeth with or without radiographic lesions whilst 34% prescribed antibiotics for acute apical abscess with localized swelling without systemic involvement.

Conclusions: The majority of dentists reported they prescribed antibiotics inappropriately. It is necessary to improve the knowledge of dentists about antibiotics and their indications in endodontics.
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http://dx.doi.org/10.1111/iej.13390DOI Listing
December 2020
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