PerioFilm Preparation in the Complicated Endodontic Retreatment of a Tooth with Apical Resorption During Orthodontic Therapy

CliniCal Cases

Katarzyna Banaszek

_{, Monika Łysakowska}

_{, Jerzy sokołowski}

PerioFilm Preparation in the Complicated

Endodontic Retreatment of a Tooth with Apical

Resorption During Orthodontic Therapy

Ocena zastosowania preparatu PerioFilm

w powikłanym leczeniu endodontycznym w trakcie leczenia ortodontycznego

zęba z zaawansowaną resorpcją wierzchołkową

1 _{Department of General Dentistry, Chair of Restorative Dentistry, Medical University of lodz, lodz, Poland} 2 _{Department of Medical and sanitary Microbiology, Medical University of lodz, lodz, Poland}

A – research concept and design; B – collection and/or assembly of data; C – data analysis and interpretation; D – writing the article; E – critical revision of the article; F – final approval of article

Abstract

The article presents the use of the PerioFilm adhesive dressing containing antibiotic piperacillin in the compli-cated endodontic retreatment of tooth 11 with severe apical resorption and alveolar bone loss in a young patient. Ongoing orthodontic therapy could lead to the loss of the tooth. Due to a suspicion of Enterococcus faecalis infec-tion of the root canal system of tooth 11, addiinfec-tional microbiological examinainfec-tions of Enterococcus faecalis strains sensitivity to piperacillin were performed. The piperacillin contained in the preparation was compared in vitro to other antibiotics and chemotherapeutics used in the treatment of Enterococcus faecalis infections. The results of the piperacillin action suggest that this antibiotic inhibits the growth of Enterococcus faecalis strains including those which are resistant to the other antibiotics and chemotherapeutics studied. The treatment caused inhibition of the inflammatory process and partial regeneration of the periapical bone tissues. Thus, it seems to be a valuable alternative and effective agent in the treatment of post-endodontic complications caused by Enterococcus faecalis infections (Dent. Med. Probl. 2014, 51, 3, 402–409).

Key words: endo-perio syndrome, antibiotic, PerioFilm, endodontic retreatment, Enterococcus faecalis.

Streszczenie

W pracy przedstawiono przypadek zastosowania preparatu PerioFilm w powikłanym powtarzanym wcześniej leczeniu endodontycznym w trakcie leczenia ortodontycznego zęba 11 z zaawansowaną resorpcją wierzchołkową. substancją czynną w tym preparacie jest piperacylina, a nośnikiem mieszanka biodegradowalnych żywic. Uzyskano wstępnie dobre wyniki powtórnego leczenia endodontycznego tym preparatem. Ze względu na podejrzenie zaka-żenia o etiologii Enterococcus faecalis dotyczącego systemu kanałowego zęba 11 zdecydowano się przeprowadzić dodatkowe badania mikrobiologiczne wrażliwości szczepów ziarenkowca Enterococcus faecalis na pieperacylinę i inne chemioterapeutyki. Porównano in vitro działanie piperacyliny wchodzącej w skład preparatu do innych anty-biotyków i chemioterapeutyków stosowanych w terapii zakażeń Enterococcus faecalis. Wyniki działania piperacyli-ny sugerują, że ma działanie hamujące wzrost szczepów Enterococcus faecalis, w tym tych, które są oporne na wiele badanych antybiotyków i chemioterapeutyków, zatem stanowi cenną alternatywę w leczeniu zakażeń w obrębie jamy ustnej powodowanych przez te drobnoustroje. Preparat PerioFilm wydaje się skuteczny w leczeniu powikłań powstałych w leczeniu zespołu endo-perio (Dent. Med. Probl. 2014, 51, 3, 402–409).

Słowa kluczowe: zespół endo-perio, PerioFilm, antybiotyk, leczenie endodontyczne, Enterococcus faecalis.

Dent. Med. Probl. 2014, 51, 3, 402–409

PerioFilm Preparation in the Complicated endodontic Retreatment of a Tooth

403

Root resorption is a frequent complication caused by mechanical trauma during orthodon-tic treatment. it often progresses from the root apex and involves the entire apex with periapical tissues [1]. Root resorption is more frequently de-tected in maxillary than mandibular teeth and is associated with impairment of the tooth support-ing apparatus. advanced periapical and margin-al periodontitis result in margin-alveolar bone loss and weaker support of the tooth root [1, 2].

Orthodontic treatment may be accompanied by the development of chronic gingivitis and peri-odontitis, frequently induced by lack of hygiene while wearing braces, which leads to destruction of the gingival connective tissue, periodontal liga-ment and alveolar bone, creating the pathway for bacteria between the oral cavity and the periapi-cal region [3].

Chemomechanical preparation, attempts of eradication and root canal filling do not always completely eliminate bacterial flora. When voids and gaps are left in the filled canals and bacteria are additionally nourished by the inflammatory exudates from pathological pockets, secondary in-fection of the root canal system can occur [4, 5].

examinations of the bacterial flora in the un-successfully treated canals have frequently shown the presence of Enterococcus faecalis [6–9]. a high-er prevalence of infections caused by Enthigh-erococcus spp. strains is often associated with diagnostic and treatment procedures, improper application of an-tibiotics and increase in the number of immuno-compromised patients. These microorganisms are naturally resistant to antibiotics and chemothera-peutics [10], thus the appearance of resistance to penicillin, aminoglycosides and fluoroquinolones poses a therapeutic challenge for clinicians.

The aim of the study was to evaluate the Perio-Film® _{preparation containing piperacillin in the}

complicated endodontic retreatment of a tooth with apical resorption during orthodontic thera-py and to determine piperacillin efficiency against probable E. faecalis infection in vivo. PerioFilm, ac-cording to the manufacturer’s information, has not been so far used in endodontic treatment. More-over, piperacillin activity was compared in vitro to other antibiotics and chemotherapeutics applied in the treatment of E. faecalis infections.

Case Report

The product called PerioFilm is an adhe-sive dressing in the form of film used in dentist-ry (italmed, italy, Firenze; and laboratorios ini-bisa, s.a. spain, Barcelona). The powder (100 mg) contains piperacillin sodium salt (100%) which is

an active substance. The fluid (1 ml) is a solvent containing copolymers of aminoalkylmethacry-late, ammonium methacryaminoalkylmethacry-late, and 95% ethanol and water.

an 18-year old female patient with braces on the maxilla reported a problem with tooth 11. During the eight-year orthodontic treatment (first with a removable orthodontic appliance and later with braces), she had developed some treatment-related complications such as periapical abscesses around tooth 11. Due to them, tooth 11 had been endodontically treated a few times.

On the first clinical examination, the follow-ing symptoms were detected: grade 3 tooth mobil-ity, pathological pockets 9 mm deep on the mesi-al and 7 mm deep on the distmesi-al surface with pus, purulent exudate from the pockets, chronic puru-lent apical periodontitis and an active fistula at the bottom of the pathological pocket (Fig. 1). Tooth 11 remained in the maxilla owing to the braces. Oral hygiene was poor. The braces were left on the upper teeth during the endodontic and periodon-tal treatment described in this article.

Radiographs (Fig. 2a and b) showed transpar-ency around the root apex of tooth 11, indicating a 2.5 mm wide bone destruction; inflammatory le-sions involved bilaterally the entire root reaching the tooth crown. shortening of 1/3 of the original root length (grade 4 root resorption according to levander et al.[2, 11, 12]) with the loss of alveo-lar lamina dura up to 2/3 of the root length on the mesial side of tooth 11 and 21 and semicircularly rounded root apices of these teeth were identified. Due to the generalized inflammation of the marginal periodontium, periodontal treatment was performed as follows: supra- and

subgingi-Fig. 1. The lingual view of tooth 11. The arrow

indi-cates the fistula orifice with purulent exudate on the mesial side of the tooth

Ryc. 1. Widok zęba 11 od strony językowej. strzałka

wskazuje ujście przetoki z ropnym wysiękiem od stro-ny mezjalnej zęba

val scaling of all maxillary and mandibular teeth, curettage with hand instruments followed by the ultrasonic procedure, and pocket irrigation with 0.2% chlorhexidine solution.

although the canal of tooth 11 on the radio-graph seemed (Fig. 2a) to be properly filled, it was decided to retreat it.

The presented case should be regarded as an endo-perio lesion because the infection around tooth 11 involved deep pathological pockets reach-ing the root apex. The management of an endo-perio lesion includes endodontic and endo- periodon-tal treatment. During the endodontic retreatment, the patient was treated in aseptic conditions with the rubber dam isolation. The gutta-percha cone was removed with hand and rotary instruments ProTaper (Dentsply Maillefer). The color of the cone tip (1–2 mm) was changed from orange-pink to gray and green. a profuse purulent yellowish and green discharge was found in the canal. The initial working length was established electroni-cally (apex locator iPeX, nsK, Japan). The canal instrumentation was performed with the “step- -back” technique using Kerr files (Dentsply Maille-fer); size # 40 initial iaF, size # 55 MaF and size # 80 FF. For irrigation, the following agents were

applied: 5.25% naOCl solution (10 ml) with pas-sive ultrasonic irrigation (a size 20 file), 15% eDTa (5 ml to remove smear layer), and 0.9% naCl so-lution.

Considering the therapeutic difficulties, en-do-perio character of a lesion around tooth 11 and possibility of long-lasting infection induced by an-aerobic Enterococcus species [3, 9], the authors de-cided to use PerioFilm containing piperacillin an-tibiotic as a local pharmacotherapy. The patient gave informed consent to the proposed treatment and the study was approved by the Bioethics Com-mission of the Medical University of lodz, Poland: # Rnn/92/13/Ke.

PerioFilm was prepared according to the man-ufacturer’s recommendations and applied to the paper-point dried canal with a 2.5 ml syringe and a blunt-ended thin needle from the kit. PerioFilm was inserted into the root canal up to the region of the resorbed apex. One or two PerioFilm drops were applied to the canal surface and gently blown with air-spray. The product hardened on contact with air. One minute after material hardening, ac-cess to the canal was tightly obturated with glass-ionomer cement. PerioFilm was applied 4 times in 7–10-day intervals.

Fig. 2a–b. The radiographs of maxillary teeth (11 and 21). Transparency at the root apex of tooth 21, indicating

inflammatory lesion of 2.5 mm wide, which involve bilaterally the entire root reaching the tooth crown. Mesial side of tooth 21 with the vertical bone loss. shortening of 1/3 of the original root length of tooth 11 and 21 as compared to roots of tooth 12 and 22; root apices of tooth 11 and 21 rounded semicircularly. Partial loss of the alveolar process in the maxillary bone. The patient is wearing braces on these teeth: a) before retreatment; b) after removal of the root canal filling

Ryc. 2a–b. Radiogramy zębów szczęki (11 i 21). Przy wierzchołku korzenia jest widoczne przejaśnienie odpowiadające

odczynowi zapalnemu o szerokości do 2,5 mm, zmiany zapalne obejmują obustronnie cały korzeń, sięgając do korony zęba. Od strony mezjalnej zęba 21 pionowy zanik kostny. skrócenie długości korzeni zębów 11 i 21 o ponad 1/3 dłu-gości w odniesieniu do korzeni zębów 12, 22; wierzchołki korzeni zębów 11, 21 półkoliście zaokrąglone. Widoczny jest częściowy zanik wyrostka zębodołowego kości szczękowej. na zęby jest założony stały aparat ortodontyczny: a) przed ponownym leczeniem, b) po usunięciu wypełnienia z kanału korzeniowego

PerioFilm Preparation in the Complicated endodontic Retreatment of a Tooth

405

at the same time, PerioFilm (1–2 drops) was also applied to the bottom of the dried patholog-ical pockets at the mesial, distal and lingual sur-faces of tooth 11. after one minute, the material hardened.

Following the last PerioFilm application (40 days from the beginning of the treatment), the canal was filled with a non-setting calcium hy-droxide paste (Biopulp, Chema-elektromet, Rz-eszow, Poland) using a lentulo spiral and the material was condensed in the canal orifice with a sterile cotton pellet. The access to the pulp cavity was obturated with a glass-ionomer cement.

Considering the previous reoccurrence of the difficulties in the treatment of tooth 11, it was de-cided to check whether PerioFilm with piperacil-lin would also be efficient in eradicating E. faecalis strains, often very resistant to antibiotics.

Until the completion of orthodontic treat-ment, the root canal of tooth 11 was filled with calcium hydroxide material and tightly obturated. Calcium hydroxide was used after the 4th

applica-tion of PerioFilm to efficiently inhibit the process of resorption. High calcium hydroxide pH neu-tralizes lactic acid induced by osteoclasts, which in turn prevents dissolution of the bony structure. Moreover, an alkaline environment inhibits colla-genase and acid phosphatase activity and activates alkaline phosphatase, which plays an important role in tissue repair.

after the completion of the orthodontic treat-ment and stabilization of the treated tooth, the apical part of the root canal was filled with MTa material and lateral condensation of gutta-percha with sealer was used in the remaining portion of the canal; the crown was restored with a compos-ite material.

Laboratory Examinations

of Enterococcus faecalis

Strains

The strains used in this in vitro study derived from different materials: urine (n = 4), wound smears (n = 2), throat smears (n = 1), environ-mental smears (n = 2), and central venous cath-eter smear (n = 1). Clinical and reference strains (E. faecalis aTCC 29212, E. faecalis aTCC 51299) were stored at –70°C for further study.

The affiliation of microorganisms to a particu-lar species was determined with aPi 20 strep tests (bioMerieux) according to the manufacturer’s in-structions and confirmed by the PCR reaction for D-alanine-D-alanile ligase (ddl) genes [13]. Bacte-rial Dna was isolated by a Bacteria aX kit (a&a

Biotechnology, Poland). PCR reactions were con-ducted in a volume of 50 μ in a Biometra thermo-cycler. The reaction mixture contained 0.7 U

Su-pertherm polymerase (JMR), 60nM of primers [13]

(iBB), 4.5mM MgCl2 (Qiagen), 5 μl of PCR buffer

and 400μM dnTP (Qiagen). The obtained prod-ucts were separated on 1.5% agarose gel (Prona) in Tae buffer and stained with ethidium bromide (sigma).

examination of E. faecalis strain susceptibili-ty to PerioFilm was performed on 10 clinical and 2 reference strains with the dilution method on liquid medium Mueller-Hinton (bioMerieux) ac-cording to the Clinical and laboratory standards institute (Clsi) recommendations [14]. The dilu-tions of antibiotics were examined in the range from 1024 mg/l to 2 mg/l.

evaluation of bacterial sensitivity to antibiot-ics was performed with the diffusion disk meth-od. The following antibiotics and chemotherapeu-tics (Becton Dickinson) were analyzed: ampicillin (10 µg), penicillin (10 U), chloramphenicol (30 µg), ciprofloxacin (10 µg), erythromycin (15 µg), gen-tamicin (120 µg), streptomycin (300 µg), linezolid (30 µg), tetracycline (30 µg), teicoplanin (30 µg), and vancomycin (30 µg). examination of the sen-sitivity to drugs was conducted on medium Muel-ler-Hinton ii (bioMerieux). The media were in-cubated in 37°C for 16–18 h, and 24 h for van-comycin. The obtained results were interpreted according to the recommendations of the nation-al Reference Centre for Drug sensitivity of Micro-organisms [15] and Clsi[14].

Clinical Management

Forty days after the commencement of the study, the clinical examination revealed tooth sta-bilization, a decrease in grade 3 mobility to grade 2, lack of marginal periodontitis, reduction in path-ological pocket depth from 9 mm to 5 mm on the mesial side of the tooth and from 7 mm to 2 mm on the distal side. The fistula closed after the first application of PerioFilm. a radiograph showed the healing of the periapical tissues (Fig. 3).

Drug Sensitivity

of the Strains Studied

a strain resistant to penicillin and ampicillin (59p) was the only strain moderately sensitive to piperacillin. This strain was also resistant to cip-rofloxacin, erythromycin, and gentamicin, with a moderate level of resistance to chlorampheni-col, streptomycin and tetracycline. The

remain-ing strains, despite the resistance to different anti-biotics (mainly tetracycline (n = 9), ciprofloxacin (n = 7), erythromycin (n = 5), penicillin (n = 4), ampicillin (n = 4), and streptomycin (n = 3), ap-peared to be sensitive to piperacillin. The detailed results are presented in Table 1 and Table 2.

Discussion

Due to the acute course of the disease, the composition of the bacterial flora in the root ca-nal system and in the pathological pockets was not tested at the time of the patient’s first visit.

Fig. 3. The radiograph of teeth 11 and 21. Partial

heal-ing of periapical tissue of tooth 11. The state after the removal of the root canal material

Ryc. 3. Radiogram zębów 11 i 21. Częściowe

zmniej-szenie odczynu zapalnego wokół korzenia zęba 11. stan po usunięciu materiału wypełniającego kanał korzeniowy

Table 1. Drug sensitivity of the studied E. faecalis strains to piperacillin (PerioFilm)

Tabela 1. lekowrażliwość badanych szczepów E. faecalis na piperacylinę (PerioFilm)

items strain no. Minimal inhibito-ry concentration (MiC) value (μg/l) 1. 44p 8 2. 59p 32 3. 38p 2 4. 51p 2 5. 53p 2 6. 92p 2 7. 103p 2 8. 1p 16 9. 61p 16 10. 70p 16 11. aTCC 29212 sensitive to vancomycin 16 12. aTCC 51299 Resistant to vancomycin 4

MiC range for strains resistant to piperacillin: ≥ 128. MiC range for strains moderately resistant to piperacil-lin: ≥ 32 g/l ≤ 64 g/l.

MiC range for strains sensitive to piperacillin: ≤ 16 ug/l.

Table 2. Drug sensitivity of the examined E. faecalis strains Tabela 2. lekowrażliwość badanych szczepów E. faecalis

items strain no. aMP C CiP e GM iMP lnZ P s Te TeC Va

1. 44p s s R s R s s R s R s s 2. 59p R i R R R s s R i i s s 3. 38p s R R R R s s s R R s s 4. 51p s s i s s s s s s R s s 5. 53p s s i i s s s s s R s s 6. 92p R s R R R s s s R R s s 7. 103p s i i R R s s s R R s s 8. 1p s s R s R s s s s R s s 9. 61p R s R i s s s R s R s s 10. 70p R i R R R s s R s R s s

Description of abbreviations used: aMP – ampicillin (10 µg), CiP – ciprofloxacin (5 µg), C – chloramphenicol (30 µg), e – erythromycin (15 µg), GM – gentamicin (120 µg), lnZ – linezolid (30 µg), P – penicillin 10U, s – streptomycin (300 µg), Te – tetracycline (30 µg), TeC – teicoplanin (30 µg), Va – vancomycin (30 µg); s – sensitive strain; i – mod-erately sensitive strain; R – resistant strain.

PerioFilm Preparation in the Complicated endodontic Retreatment of a Tooth

407

PerioFilm was used due to its wide spectrum of activity. The concentration of piperacillin released from the preparation maintained at the dose of 8.5 mg/l for 8–10 days and inhibited 90% of an-aerobic bacteria in the in vitro study [16]. in our previous in vitro study on extracted human teeth, PerioFilm quickly hardened on contact with air as a result of evaporation of an organic component, i.e. ethanol, leaving a thin film that remained on the root surface in high humidity conditions, and gradually underwent biodegradation, releasing the antibiotic[17].

Enterococcus faecalis species have

frequent-ly been isolated and associated with persistent periapical periodontitis [6, 7]. The pathogenicity of E. faecalis may be related to their capability to survive in difficult conditions for a longer time, even with lack of nutritional substances [18]. The virulence of E. faecalis strains can result from its ability to invade dentinal tubules and to adhere to collagen fibers in the presence of serous exu-date [6].

Due to the suspicion of Enterococcus faecalis infection concerning the root canal of tooth 11, additional microbiological examinations of strain sensitivity to piperacillin were performed. Multi-drug resistant strains were chosen to compare their sensitivity to that of piperacillin.

The study showed that strains of 9 clinical iso-lates of E. faecalis and 2 reference strains, E.

fae-calis aTCC 51299 resistant to vancomycin and E. faecalis aTCC 29212 sensitive to vancomycin,

did not indicate resistance to PerioFilm piperacil-lin. Only one strain revealed a moderate level of sensitivity to piperacillin. at the same time it was also resistant to ampicillin, ciprofloxacin, eryth-romycin, gentamicin, penicillin, and moderately sensitive to chloramphenicol, streptomycin, and tetracycline.

antibiotic therapy favors selection and spread-ing of resistant strains, an example of which is the frequent occurrence of resistance to tetracy-cline [19], which is in compliance with the results of this study. lack of sensitivity to gentamicin (HlaR, High level aminoglycoside Resistance) was noticed in 7 strains of E. faecalis, whereas to streptomycin in three. The occurrence of resis-tance to gentamicin differs among countries, e.g. in sweden it was only 1.9% [19] and in the Usa 50% of the strains examined showed resistance [20]. in our study, seven E. faecalis strains were resis-tant to ciprofloxacin. This confirms a growing in-crease in resistance to this drug due to its frequent use [21]. The percentage of resistance to erythro-mycin was low among enterococci isolated in swe-den (8.5%) [19], but a much higher level of resis-tance (25%) was reported in the Usa [20].

as shown in the literature, enterococci isolat-ed from root canals often do not react to antibiot-ic therapy [22]. Therefore, effective agents whantibiot-ich might be applied in the treatment of oral cavi-ty infections induced by these bacteria should be searched for. PerioFilm with piperacillin appears to be such a preparation.

The occurrence of resistance to piperacillin was previously found among 71.8% of E. faecalis strains isolated from bile tracts. Those strains were also highly resistant to ampicillin (76.7%) [23]. accord-ing to the literature, the percentage of strains resis-tant to piperacillin isolated from different clinical materials amounted to 53.4% [24], but the swed-ish data showed a much lower percentage [25, 26]. However, up to 98% of E. faecalis strains which were sensitive to ampicillin remained sensitive to piperacillin with the inhibitor, and 96% of strains to imipenem [27]. in our study, only one of four

E. faecalis strains resistant to ampicillin was

mod-erately resistant to piperacillin (PerioFilm). More-over, all of the investigated strains were sensitive to linezolid, which is in accordance with literature reports [28, 29].

The results of this study confirm that Perio-Film is a valuable agent with high activity against

E. faecalis strains that often cause infections

with-in root canals [6–8]. Thus, it seems that this agent can be successfully used to eradicate microorgan-isms in infections induced after root canal treat-ment.

However, sometimes despite adequate root ca-nal treatment, some microorganisms can survive in the parts of the root canal system which are un-available to instruments and irrigants [30, 31].

The pathogenic factor from the infected canal contributes to resorption of the alveolar bone and the apical cementum without the presence a me-chanical injury. in the presented case, the mechan-ical injury of the tooth induced by wearing braces additionally resulted in formation of the advanced resorption of the root apex and the alveolar bone, favoring the development of endo-perio lesion.

Conclusions

The clinical study revealed efficiency of the piperacillin contained in the PerioFilm prepara-tion which was used in the complicated endodon-tic retreatment of a tooth with apical resorption during orthodontic therapy. Piperacillin inhibited the growth of Enterococcus faecalis strains, includ-ing those which were resistant to the other antibi-otics and chemotherapeutics studied, thus making it a valuable option in the treatment of oral cavity infections induced by these microorganisms.

References

[1] Tronstad l.: Root resorption – etiology, terminology and clinical manifestations. endod. Dent. Traumatol. 1988, 4, 241–252.

[2] levander e., Malmgren O., stenback K.: apical root resorption during orthodontic treatment of patients with multipla aplasia: a study of maxillary incisors. eur. J. Orthod. 1998, 20, 427–434.

[3] Zehnder M., Guggenheim B.: The mysterious appearance of enterococci in filled root canals. int. endod. J. 2009, 42, 277–287.

[4] siqueira J.e. Jr.: aetiology of root canal treatment failure: why well-treated teeth can fail. int. endod. J. 2001, 34, 1–10.

[5] Wu M.K., Dummer P.M., Wesselink P.R.: Consequences of and strategies to deal with residual post-treatment root canal infection. int. endod. J. 2006, 39, 343–356.

[6] Pinheiro e.T., Gomes B.P., Ferraz C.C., sousa e.l., Teixeira F.B., souza-Filho F.J.: Microorganisms from ca-nals of root-filled teeth with periapical lesions. int. endod. J. 2003, 36, 1–11.

[7] Molander a., Reit C., Dahlén G., Kvist T.: Microbiological status of root-filled teeth with apical periodontitis. int. endod. J. 1998, 31, 1–7.

[8] Gomes B., Pinheiro e.T., Gadê-neto C.R., sousa e.l., Ferraz C.C., Zaia a.a., Teixeira F.B., souza-Filho F.J.: Microbiological examination of infected dental root canals. Oral. Microbiol. immunol. 2004, 19, 71–76.

[9] Zoletti G.O., Pereira e.M., schuenck R.P., Teixeira l.M., siqueira J.F. Jr, dos santos K.R.: Characteriza-tion of virulence factors and clonal diversity of Enterococcus faecalis isolates from treated dental root canals. Res. Microbiol. 2011, 162, 151–158.

[10] Cetinkaya Y., Falk P.s., Mayhall C.G.: Vancomycin-resistant enterococci. Clin. Microbiol. Rev. 2000, 13, 687–707. [11] levander e., Bajka R., Malmgren O.: early radiographic diagnosis of apical root resoption during orthodontic

treatment: a study of maxillary incisors. eur. J. Orthod. 1998, 20, 57–63.

[12] levander e., Malmgren O.: long-term follow-up of maxillary incisors with severe apical root resorption. eur. J. Orthod. 2000, 22, 85–92.

[13] Kariyama R., Mitsuhata R., Chow J.W., Clewell D.B., Kumon H.: simple and reliable multiplex PCR assay for surveillance isolates of vancomycin-resistant enterococci. J. Clin. Microbiol. 2000, 38, 3092–3095.

[14] Clinical and laboratory standards institute.Performance standards for antimicrobial susceptibility Testing; six-teenth informational supplement.Clsi document M100-s16 [isBn 1-56238-588-7]. Clinical and laboratory stan-dards institute, Pennsylvania 19087–1898 Usa, 2006.

[15] Hryniewicz W., sulikowska a., szczypa K., Gniadkowski M., skoczynska a.: Recommendations for suscep-tibility testing to antimicrobial agents of selected bacterial species. Post. Mikrobiol. 2005, 44, 175–192 [in Polish]. [16] Visconti P.C., Capuano a., Parrini s.: local antibiotic therapy with sodium piperacillin (a slow-release

prepa-ration). Dent. Cadmos. 2003, 4, 73–82.

[17] Banaszek K., Klimek l.: initial evaluation of PerioFilm biodegradation – a seM study. Twój Prz. stomatol. 2011, 1–2, 54–57 [in Polish].

[18] neely a.n., Maley M.P.: survival of enterococci and staphylococci on hospital fabrics and plastic. J. Clin. Micro-biol. 2000, 38, 724–726.

[19] sun J., song X., Kristiansen B.e., Kjaereng a., Willems R.J., eriksen H.M., sundsfjord a., sollid J.e.: Oc-currence, population structure, and antimicrobial resistance of enterococci in marginal and apical periodontitis. J. Clin. Microbiol. 2009, 47, 2218–2225.

[20] Rams T.e., Feik D., Young V., Hammond B.F., slots J.: Enterococci in human periodontitis. Oral. Microbiol. im-munol. 1992, 7, 249–252.

[21] Piekarska K., Kochman M., lawrynowicz-Paciorek M.: Characteristic of clinical fluoroquinolone resistant isolates of E. faecalis. Med. Dosw. Mikrobiol. 2005, 57, 345–453 [in Polish].

[22] Hancock H.H. 3rd_{, sigurdsson a., Trope M., Moiseiwitsch J.: Bacteria isolated after unsuccessful endodontic}

treat-ment in a north american population. Oral surg. Oral Med. Oral Pathol. Oral Radiol. endod. 2001, 91, 579–586. [23] Weber a., Huber W., Kamereck K., Winkle P., Voland P., Weidenbach H., schmid R.M., Prinz C.: In vitro

activity of moxifloxacin and piperacillin/sulbactam against pathogens of acute cholangitis. World J. Gastroenterol. 2008, 14, 174–178.

[24] Zhanel G.G., DeCorby M., laing n., Weshnoweski B., Vashisht R., Tailor F., nichol K.a., Wierzbowski a., Baudry P.J., Karlowsky J.a., lagacé-Wiens P., Walkty a., McCracken M., Mulvey M.R., Johnson J.: Ca-nadian antimicrobial Resistance alliance (CaRa), Hoban D.J.: antimicrobial-resistant pathogens in intensive care units in Canada: results of the Canadian national intensive Care Unit (Can-iCU) study, 2005–2006. anti-microb. agents Chemother. 2008, 52, 1430–1437.

[25] Claesson C., Hällgren a., nilsson M., svensson e., Hanberger H., nilsson l.e., scope study Group.: sus-ceptibility of staphylococci and enterococci to antimicrobial agents at different ward levels in four northern euro-pean countries. scand. J. infect. Dis. 2007, 39, 1002–1012.

[26] Hanberger H., erlandsson M., Burman l.G., Cars O., Gill H., lindgren s., nilsson l.e., Olsson-liljeq-uist B., Walther s. and the iCU-strama study Group: High antibiotic susceptibility among bacterial patho-gens in swedish iCUs. Report from a nation-wide surveillance program using Ta90 as a novel index of suscepti-bility. scand. J. infect. Dis. 2004, 36, 24–30.

[27] Claesson C., nilsson l.e., Kronvall G., Walder M., sörberg M.: antimicrobial activity of tigecycline and comparative agents against clinical isolates of staphylococci and enterococci from iCUs and general hospital wards at three swedish university hospitals. scand. J. infect. Dis. 2009, 41, 171–181.

PerioFilm Preparation in the Complicated endodontic Retreatment of a Tooth

409

[28] Milatovic D., schmitz F.J., Verhoef J., Fluit a.C.: activities of the glycylcycline tigecycline (GaR-936) against 1,924 recent european clinical bacterial isolates. antimicrob. agents Chemother. 2003, 47, 400–404.

[29] Biedenbach D.J., Bell J.M., sader H.s., Fritsche T.R., Jones R.n.,Turnidge J.D.: antimicrobial susceptibility of Gram-positive bacterial isolates from the asia-Pacific region and in vitro evaluation of the bactericidal activity of daptomycin, vancomycin, and teicoplanin: a senTRY program report (2003–2004). int. J. antimicrob. agents. 2007, 30, 143–149.

[30] Friedman s.: Considerations and concepts of case selection in the management of post-treatment endodontic dis-ease (treatment failure). endod. Topics. 2002, 1, 54–78.

[31] Wada M., Takase T., nakanuma K., arisue K., nagahama F., Yamazaki M.: Clinical study of refractory api-cal periodontitis treated by apicectomy. Part 1. Root canal morphology of resected apex. int. endod. J. 1998, 31, 53–56.

Address for correspondence:

Katarzyna Banaszek

Department of General Dentistry Chair of Restorative Dentistry Medical University of lodz Pomorska 251

92-231 lodz Poland

e-mail: katarzyna.banaszek@umed.lodz.pl Conflict of interest: none declared Received: 22.03.2014

Revised: 19.04.2014 accepted: 22.05.2014

Praca wpłynęła do Redakcji: 22.03.2014 r. Po recenzji: 19.04.2014 r.