Efficacy of a Novel Nanoparticle -Augmented Disinfection Protocol

The primary objective of endodontic therapy is rigorous infection control, achievedthrough the chemo‐mechanical preparation of the root canal system. While mechanicalfiling shapes the canal, it is physically impossible for instruments to reach everyinternal surface.5 Consequently, chemical irrigation is the only method available todisinfect "untouched" anatomical complexities‐such as isthmuses, fins, and large lateralcanals. These hidden areas often harbor tissue debris and resilient biofilms that must bedissolved or neutralized chemically to ensure long‐term clinical success.While traditional irrigants like Sodium Hypochlorite (NaOCl) and EDTA remain the clinicalgold standards, the field is shifting toward natural alternatives. Chitosan and Aloe Verahave recently emerged as effective herbal options, with Chitosan gaining particularattention as a promising final irrigation solution. Derived from natural sources,Chitosan is highly accessible and cost‐effective. It offers a unique combination ofbiological and chemical benefits that address the limitations of traditional syntheticchemicals.Chitosan, and specifically Chitosan Nanoparticles (CNPs), exhibits potent antimicrobialactivity against a wide spectrum of both Gram‐positive and Gram‐negative bacteria.Research indicates that CNPs are highly effective at disrupting biofilms by preventingbacteria from adhering to the canal surfaces, effectively halting the development ofcomplex microbial communities. The primary antibacterial action of Chitosan is derivedfrom its polycationic (positively charged) nature. This charge creates a fatal attractionto the negatively charged surfaces of bacterial cells, leading to two major destructiveeffects.Activation of irrigating solution by techniques as passive ultrasonic irrigation (PUI),enhances its efficacy and dynamic flow, and improves its antibacterial property andclinical outcomes.Diabetes mellitus (DM) is defined as a multisystem complex metabolic disease that affectsaround 9% of the adult population. DM has two types, type 2 DM (T2DM) is caused bydecreased cellular sensitivity of beta cells in islets of Langerhans of the pancreas toinsulin which is referred as "insulin resistance". In general DM has an effect on theimmune system that could be seen as a delay in wound healing with increasedsusceptibility to chronic inflammation and impaired tissue repair10.Considering dental health, DM was reported to be the third most prevalent chronic medicalcondition among dental patients. Patients with DM are more liable to the development ofseveral oral infections including fungal and bacterial infections. This is believed to bedue to the decrease in salivary flow rate which in return leads to the absence of itsantimicrobial effects11. DM patients have reduced beta‐endorphin production whichtranslates to higher pain perception in diabetic patients, this reduction inbeta‐endorphin levels might be responsible for higher pain incidence postoperatively incontrolled patients12.