A Comparative Evaluation of Antimicrobial Activity of Septilin, Calcium Hydroxide and 2 % Chlorhexidine as an Intracanal Medicament - An In Vitro Study

One of the most important objectives of root canal treatment is elimination of microorganisms in the root canals. The use of intra-canal medicament may be helpful in eliminating remaining bacteria that survived inside the root canals after complete chemo-mechanical preparation. This study aims to evaluate and compare the antimicrobial activity of Septilin, chlorhexidine and calcium hydroxide against Enterococcus faecalis and Streptococcus mutans. Intra-canal medicament helps in eliminating remaining bacteria that survived inside root canals after complete chemo-mechanical preparation. MethodsThe well variant of agar diffusion test using brain heart infusion agar was used for evaluating the antimicrobial activity of the intra-canal medicaments. McFarland 0.5 turbidity standard was taken as reference to adjust the turbidity of bacterial suspensions. The wells were prepared and filled with of Septilin, chlorhexidine and calcium hydroxide. This was done for both the test organisms and plates were incubated in an incubator for 24 hrs. at 37 °C. After incubation, antimicrobial effectiveness was determined using digital caliper (mm) by measuring zone of inhibition. ResultsThe mean zone of inhibition for chlorhexidine, calcium hydroxide, and Septilin were 29.50 ± 0.58, 25.00 ± 0.00, 20.00 ± 0.82 for E. faecalis and 28.50 ± 1.00, 24.25 ± 0.96, 19.50 ± 1.29 for S. mutans respectively. ConclusionsSeptilin showed significant inhibition against E. faecalis and S. mutans but its antibacterial activity is less compared to that of calcium hydroxide and chlorhexidine. Moreover, the dark colour of the material might cause tooth discoloration.

Discoloration of teeth due to different intracanal medicaments

OBJECTIVES: The objective of this study was to assess coronal discoloration induced by the following intracanal medicaments: calcium hydroxide (CH), a mixture of CH paste and chlorhexidine gel (CH/CHX), and triple antibiotic paste (3Mix). MATERIALS AND METHODS: Seventy extracted single-canal teeth were selected. Access cavities were prepared and each canal was instrumented with a rotary ProTaper system. The specimens were randomly assigned to CH, CH/CHX, and 3Mix paste experimental groups (n = 20 each) or a control group (n = 10). Each experimental group was randomly divided into 2 subgroups (A and B). In subgroup A, medicaments were only applied to the root canals, while in subgroup B, the root canals were completely filled with medicaments and a cotton pellet dipped in medicament was also placed in the pulp chamber. Spectrophotometric readings were obtained from the mid-buccal surface of the tooth crowns immediately after placing the medicaments (T1) and at 1 week (T2), 1 month (T3), and 3 months (T4) after filling. The ∆E was then calculated. Data were analyzed using 2-way analysis of variance (ANOVA), 3-way ANOVA, and the Scheffé post hoc test. RESULTS: The greatest color change (ΔE) was observed at 3 months (p < 0.0001) and in 3Mix subgroup B (p = 0.0057). No significant color change occurred in the CH (p = 0.7865) or CH/CHX (p = 0.1367) groups over time, but the 3Mix group showed a significant ΔE (p = 0.0164). CONCLUSION: Intracanal medicaments may induce tooth discoloration. Use of 3Mix must be short and it must be carefully applied only to the root canals; the access cavity should be thoroughly cleaned afterwards.

A survey of the knowledge, attitude, and awareness about the principal choice of intracanal medicaments among the general dental practitioners and nonendodontic specialists

Removal of the microbial organisms from the root canal system is a prerequisite for the successful outcome of any root canal treatment. Use of an effective intracanal medicament will assist in the disinfection of the root canal system. Intracanal medicaments have been used to disinfect root canals between appointments and reduce interappointment pain. Materials and Methods: A questionnaire survey was conducted to evaluate the knowledge, attitude, and awareness about the principal choice of intracanal medicaments among general dental practitioners and nonendodontic specialists. The questionnaire consisted of 11 questions related to intracanal medicaments in Endodontics. It was distributed to 75 general dental practitioners and 75 other specialists (nonendodontists). Results: In the present study, the authors observed that the knowledge level among the study participants was moderately satisfying. However, the need for more education of the dentists with regard to the intracanal medicaments was perceived. Discussion: Correct knowledge of intracanal medicaments would help the practitioners to decide the apt material of choice as intracanal medicaments in different clinical situations. Conclusion: The present study highlighted the need for more continuing dental education programs with active participation of general practitioners and nonendodontic specialists to update themselves.

Comparative evaluation of postoperative pain intensity after single-visit and multiple-visit retreatment cases: a prospective randomized clinical trial / Avaliação comparativa da intensidade da dor pos-operatoria após casos de retratamento em sessao unica ou multipla: estudo clínico randomizado prospectivo

Objectives: This study was designed to evaluate postoperative pain after endodontic retreatment. Material and Methods: Asymptomatic, multirooted molar & premolar teeth requiring retreatment with 2­5 mm periapical lesions were included. Seventy-eight teeth were randomly placed in four groups (n=20): single-visit (control, group 1), Ledermix (group 2), metronidazole, ciprofloxacin, minocycline mixture (group 3), calcium hydroxide (group 4). The postoperative pain was recorded using a VAS at 6, 12, 24, and 48 h after retreatment. Statistical evaluation was performed using TwoWay Repeated Measures ANOVA and Tukey test. Results: Mild pain occurred in 67.5%, moderate in 30%, and flare-ups in 2.5%, and there was a significant difference between the groups (p <0.01). Significantly lower postoperative pain was observed in TAP and CaOH2 groups (p <0.05). In the 6, 12, and 24 h intervals, there was a significant difference in the pain levels (p <0.05). Conclusion: TAP and CaOH2 are effective for reducing postoperative pain after retreatment. (AU)

Objetivo: Este estudo foi projetado para avaliar a dor pós-operatória após o retratamento endodôntico. Material e Métodos: Foram incluídos dentes molares e pré-molares multirradiculados e assintomáticos que necessitavam de retratamento com lesões periapicais de 2-5 mm. Setenta e oito dentes foram distribuídos aleatoriamente em quatro grupos (n = 20): sessão única (controle, grupo I), Ledermix (grupo II), metronidazol, ciprofloxacina, mistura de minociclina (grupo III), hidróxido de cálcio (grupo IV). A dor pós-operatória foi registrada usando um VAS às 6, 12, 24 e 48 h após o retratamento. A análise estatística foi realizada utilizando ANOVA de dois fatores para medidas repetidas e teste de Tukey. Resultados: Ocorreu dor leve em 67,5%, moderada em 30% e agudizações 2,5%, e houve diferença significativa entre os grupos (p <0,01). Foi observada dor pós-operatória significativamente menor nos grupos TAP e hidróxido de cálcio (p <0,05). Nos intervalos de 6, 12 e 24 h, houve diferença significativa nos níveis de dor (p <0,05). Conclusão: TAP e hidróxido de cálcio são eficazes para reduzir a dor pós-operatória após o retratamento.(AU)

To comparatively evaluate the antimicrobial efficacy of chlorhexidine, nisin and linezolid as an intracanal medicament on Enterococcus faecalis: An in vitro study.

Aim: The present study evaluated the antimicrobial efficacy of Chlorhexidine, Nisin and Linezolid and a control group (Normal saline ) against Enterococcus faecalis (EF). Methods: Human single rooted premolars with type I canal anatomy were instrumented with ProTaper using NaOCl as an irrigant. Supension of EF was inoculated into each root specimen and incubated. The medicaments were syringed into each root and incubated. After 24 hours, 8 samples per group (among the 4 groups) were retrieved. A hole was drilled on each root, and the dentinal shavings obtained were allowed to fall in brain-heart infusion (BHI) broth. Dilutions from the broth were plated and spread over blood agar. Colony-forming units (CFU) of EF was counted. The procedure was repeated after 72 hrs and 1 week. Results: In group Nisin, the mean CFU was 10.6250 at 24 hrs, 6.6250 at 72 hrs and 6.2500 after 1 week respectively (statistically significant). In group Chlorhexidine, mean CFU was found to be the lowest of 10.5000 at 24 hrs, with further gradual increase to 13.7500 at 72 hrs and further increase to 15.8750 by 1 week. Similarly, in group linezolid , the mean CFU was found to decrease from 49.0000 at 24 hrs to 29.8750 at 72hrs and then increase to 34.8750 in 1 week.

Chlorhexidine in Endodontics

Chemical auxiliary substances (CAS) are essential for a successful disinfection and cleanness of the root canals, being used during the instrumentation and if necessary, as antimicrobial intracanal medicaments. Different CAS have been proposed and used, among which sodium hypochlorite (NaOCl), chlorhexidine (CHX), 17% EDTA, citric acid, MTAD and 37% phosphoric acid solution. CHX has been used in Endodontics as an irrigating substance or intracanal medicament, as it possesses a wide range of antimicrobial activity, substantivity (residual antimicrobial activity), lower cytotoxicity than NaOCl whilst demonstrating efficient clinical performance, lubricating properties, rheological action (present in the gel presentation, keeping the debris in suspension); it inhibits metalloproteinase, is chemically stable, does not stain cloths, it is odorless, water soluble, among other properties. CHX has been recommended as an alternative to NaOCl, especially in cases of open apex, root resorption, foramen enlargement and root perforation, due to its biocompatibility, or in cases of allergy related to bleaching solutions. The aim of this paper is to review CHX's general use in the medical field and in dentistry; its chemical structure, presentation form and storage; mechanism of action; antimicrobial activity including substantivity, effects on biofilms and endotoxins, effects on coronal and apical microbial microleakage; tissue dissolution ability; interaction with endodontic irrigants; effects on dentin bonding, metalloproteinases and collagen fibrils; its use as intracanal medicament and diffusion into the dentinal tubules; its use as disinfectant agent of obturation cones; other uses in the endodontic therapy; and possible adverse effects, cytotoxicity and genotoxicity.

Resumo Substâncias químicas auxiliares (SQA) são essenciais para o processo de limpeza e desinfecção dos canais radiculares, sendo utilizadas durante a instrumentação dos canais radiculares e, se necessário, como medicamentos intracanais. Diferentes SQA têm sido propostas e utilizadas, entre elas: hipoclorito de sódio (NaOCl), clorexidina (CHX), EDTA 17%, ácido cítrico, MTAD e solução de ácido fosfórico a 37%. CHX tem sido usada na endodontia como SQA ou medicação intracanal. CHX possui uma ampla gama de atividade antimicrobiana; substantividade (atividade antimicrobiana residual); menor citotoxicidade que NaOCl, demonstrando desempenho clínico eficiente; propriedades de lubrificação; ação reológica (presente na apresentação gel, mantendo os detritos em suspensão); inibe metaloproteinases; é quimicamente estável; não mancha tecidos; é inodora; solúvel em água; entre outras propriedades. CHX tem sido recomendada como uma alternativa ao NaOCl, especialmente em casos de ápice aberto, reabsorção radicular, perfuração radicular e durante a ampliação foraminal, devido à sua biocompatibilidade, ou em casos de alergia ao NaOCl. O objetivo deste trabalho é fazer uma revisão do uso da clorexidina na medicina e na odontologia; sua estrutura química; forma de apresentação e armazenamento; mecanismo de ação, atividade antimicrobiana, incluindo, substantividade, efeitos sobre biofilmes e endotoxinas; efeito sobre infiltração microbiana coronal e apical; capacidade de dissolução do tecido; interação com os irrigantes; efeitos sobre a união à dentina, metaloproteinases e fibrilas de colágeno; a sua utilização como medicamento intracanal e difusão ...

A model system to study antimicrobial strategies in endodontic biofilms

The purpose of this work was to develop a model system to study antimicrobial strategies in endodontic biofilms. Enterococcus faecalis suspension was colonized in 10 human root canals. Five milliliters of Brain Heart Infusion (BHI) were mixed with 5 mL of the bacterial inoculums (E. faecalis) and inoculated with sufficient volume to fill the root canal during 60 days. This procedure was repeated every 72 h, always using 24-h pure culture prepared and adjusted to No. 1 MacFarland turbidity standard. Biofilm formation was analyzed by scanning electron microscopy (SEM). E. faecalis consistently adhered to collagen structure, colonized dentin surface, progressed towards the dentinal tubules and formed a biofilm. The proposed biofilm model seems to be viable for studies on antimicrobial strategies, and allows for a satisfactory colonization time of selected bacterial species with virulence and adherence properties.

Antibacterial efficacy of intracanal medicaments on bacterial biofilm: a critical review

The purpose of this paper is to discuss critically the antibacterial efficacy of intracanal medicaments on bacterial biofilm. Longitudinal studies were evaluated by a systematic review of English-language articles retrieved from electronic biomedical journal databases (MEDLINE, EMBASE, CENTRAL) and handsearching records, using different matches of keywords for root canal biofilm, between 1966 and August 1st, 2007. The selected articles were identified from titles, abstracts and full-text articles by two independent reviewers, considering the tabulated inclusion and exclusion criteria. Disagreements were resolved by consensus. The search retrieved 91 related articles, of which 8.8 percent referred to in vivo studies demonstrating the lack of efficacy of endodontic therapy on bacterial biofilm. Intracanal medicaments were found to have a limited action against bacterial biofilm.

Residual antibacterial activity of chlorhexidine digluconate and camphorated p-monochlorophenol in calcium hydroxide-based root canal dressings

The purpose of this study was to evaluate the residual antibacterial activity of several calcium hydroxide [Ca(OH)2]-based pastes, placed in root canals of dogs' teeth with induced chronic periapical lesions. Root canals were instrumented with the ProFile rotary system and filled with 4 pastes: G1 (n=16): Ca(OH)2 paste + anesthetic solution; G2 (n=20): Calen® paste + camphorated p-monochlorophenol (CMCP); G3 (n=18): Calen®; and G4 (n=18): Ca(OH)2 paste + 2 percent chlorhexidine digluconate. After 21 days, the pastes were removed with size 60 K-files and placed on Petri plates with agar inoculated with Micrococcus luteus ATCC 9341. Pastes that were not placed into root canals served as control. After pre-diffusion, incubation and optimization, the inhibition zones of bacterial growth were measured and analyzed by Mann-Whitney U test at 5 percent significance level. All pastes showed residual antibacterial activity. The control samples had larger halos (p<0.05). The mean residual antibacterial activity halos in G1, G2, G3 and G4 were 7.6; 10.4; 17.7 and 21.4 mm, respectively. The zones of bacterial growth of G4 were significantly larger than those of G1 and G2 (p<0.05). In conclusion, regardless of the vehicle and antiseptic, all Ca(OH)2-based pastes showed different degrees of measurable residual antibacterial activity. Furthermore, unlike CMCP, chlorhexidine increased significantly the antibacterial activity of Ca(OH)2.

Este estudo objetivou mensurar a atividade anti-bacteriana residual de várias pastas à base de hidróxido de cálcio [Ca(OH)2], após permanecerem em canais radiculares de cães com lesões periapicais crônicas induzidas. Os canais radiculares foram instrumentados com o sistema Profile e preenchidos com quatro diferentes pastas: G1-Ca(OH)2 p.a./solução anestésica (n=16), G2-Calen®/PMCC (n=20), G3-Calen® (n=18) e G4-Ca(OH)2 p.a./solução de digluconato de clorexidina a 2 por cento (n=18). Transcorridos 21 dias, amostras foram recuperadas dos canais radiculares com limas Kerr #60 e colocadas em placas de Petri com ágar semeado com Micrococcus luteus ATCC 9341. Pastas não aplicadas nos canais radiculares serviram como controle. Após pré-difusão, incubação e otimização, as zonas de inibição do crescimento bacteriano foram mensuradas e analisadas pelo teste de Mann-Whitney (a<0.05). Verificou-se que todas as pastas apresentaram ação antibacteriana residual, com maiores halos para as amostras-controles. As médias dos halos de inibição para G1, G2, G3 e G4 foram 7,6; 10,4; 17,7 e 21,4 mm, respectivamente. Os halos de inibição de G4 foram significativamente superiores as de G1 e G2 (p<0.05). Portanto, independentemente do veículo, todas as pastas à base de Ca(OH)2 determinaram, em diferentes magnitudes, atividade anti-bacteriana residual mensurável. Ademais, diferentemente do PMCC, a solução de digluconato de clorexidina a 2 por cento ampliou significativamente, a atividade anti-bacteriana residual do hidróxido de cálcio.