Antimicrobial effects of a root canal cleanser in treating contaminated implants. Ex vivo study Zachary Rifkin, Erica Lavere, Lynn Mikulski, Sebastiano Andreana School of Dental Medicine, University at Buffalo, Buffalo, NY, USA Insert Picture Here Abstract #4027 ABSTRACT RESULTS CONCLUSIONS INTRODUCTION MATERIALS AND METHODS REFERENCES ACKNOWLEDGEMENTS Objective: The purpose of this study was to assess the effectiveness of a root canal cleanser (HybenX, Epien Medical, Inc) on suppressing bacterial growth in bony defects and on implant surfaces. Method: Fresh porcine ribs were obtained and cut into bone blocks (n=10, then sterilized in a steam autoclave at 121 degrees Celsius. Ten sterile titanium implants (Nobelpharma MKIII) were used and each implant was placed into a block; a 4mm deep circumferential bony defect was created within a 1mm distance to the implant. Each defect was inoculated with a suspension of S. sanguinis and blocks placed into an atmosphere of 5% CO2 at 37 degrees Celsius for 24 hours. Subsequently, five implants were treated with the root canal cleanser. The tip for gel delivery was placed into the defect and removed once the gel encompassed the entire defect. The remaining five-implant/bone blocks were not treated (control group). Each gel-treated defect was rinsed with sterile saline, and irrigated until no gel was visible. Subsequently, the defects were rinsed with 20 uL of tryptic soy broth (TSB) to retrieve any remaining bacteria. The rinse was placed in 200 uL of TSB transport media. The five untreated defects received same process. Implants were removed from the defects and sonicated in the transport media to retrieve any bacteria on the implant surface. Acquired media was then plated on tryptic soy agar and left for 48 hours to grow. The trial was repeated twice. Result: The agar plates containing plated media from the defects treated with the gel had significantly less colony forming unites present (p <0/05) when compared to the plates from untreated defects. Most of the specimens from the gel-treated group showed no growth at all. Conclusion: The root canal cleanser successfully suppressed bacteria growth in ex vivo bony defects and on implant surfaces. Peri-implantitis is an arising problem in the dental field today due to the increase in the amount of implants placed. In a previously conducted study it was determined that the prevalence of peri-implantitis was 21.7%. Because of the increase in the prevalence of this disease it is crucial to treat this condition as aggressively and as least invasive as possible. Using HybenX root canal cleanser to treat this condition is minimally invasive. HybenX was designed to be used routinely as a supplemental rinse and debriding agent for enhanced cleansing of dental plaque and other infectious matter from clinically important surfaces in the oral cavity. It actively detaches pathological material from its substrate during the rinsing application by exerting a superficial denaturing action onto oral surfaces. The FDA approved device HybenX, is made by creating a blend of the two aqueous reaction products that are derived from the aromatic sulfonation of hydroxybenzene and hydroxymethoxybenzene under aromatic sulfonation reaction conditions. The two reaction products are used to create the final product without any further purification or isolation steps. The HybenX mixture contains mono-sulfonated and bis-sulfonated hydroxybenzenesulfonic acid (HBSA) and mono- and bis-sulfonated hydroxymethoxybenzenesulfonic acid (HMBSA) together with free sulfuric acid and water. HYBENX is an active cleanser that effectively pulls infectious materials and biofilm off of the tissues whereas the other types of dental rinses usually just passively carry away only the debris that has already been mechanically detached and is lying loose on the tissue surfaces. The image below illustrates what tissues are effected by peri-implantitis. Image courtesy of AAP.  The use of the root canal cleanser was significantly effective at suppressing the growth of S. sanguinis when samples were compared to the control group.  This technique can serve as a beneficial form of treatment against peri-implantitis and subsequent infected implant defects not only due to its efficacy in halting bacterial growth, but as well as its non-invasive capabilities during application. Basara ML. “HybenX Development Review.” HybenX Advanced Oral Decontaminant Boehm TK, Ciancio SG. J.of the International Academy of Periodontology. 2011, 13(2):58-63 Derks J, Tomasi C. “Peri-implant health and disease. A systematic review of current epidemiology”. J Clin Periodontal Dec 12. Lavere E, Sagor J, Mikulski LM, and Andreana S. Antimicrobial Effects of Diode Laser. Treatment of Peri-implantitis: Pilot Study. J Dent Res 2013; vol 92 spec issue A, Abs I would like to thank the University at Buffalo School of Dental Medicine for funding this experiment, as well as my faculty and peers for their guidance and support through this study. According to the model first described by Lavere et (2013):  Porcine ribs were cut in blocks and sterilized in a steam autoclave. The implants were treated with glow discharge in between each study.  10 sterile implants were placed into the bone blocks (Nobelpharma MKIII). A 4 mm bony defect was 360° around the implant.  Each defect was then inoculated with 10 μL of S.sanguinis. The implant containing bone blocks were left for 24 hours.  The HybenX cleanser was used on 5 of the defects.  The remaining five implants were not treated with the cleanser to serve as a control group.  The tip for gel delivery was placed into the defect and removed once the gel encompassed the entire defect.  Each gel-treated defect was rinsed with sterile saline, and irrigated until no gel was visible. Subsequently, the defects were rinsed with 20 uL of tryptic soy broth (TSB) to retrieve any remaining bacteria.  Implants were removed from the defects and sonicated in the transport media to retrieve any bacteria on the implant surface.  All of the acquired media were plated on tryptic soy agar and left for 48 hours to grow. The colony forming units were then counted.