Intracanal Medicament Research Articles

Effect of calcium hydroxide on morphology and physicochemical properties of Enterococcus faecalis biofilm

Calcium hydroxide Ca(OH)2 has been used as an intracanal medicament to targets microbial biofilms and avert secondary infection in the root canal system. This study evaluated the effects of this material on the morphology and physicochemical properties of an established in-vitro biofilm of Enterococcus faecalis. A biofilm of E. faecalis was grown in multichannel plates. The chemicals including Ca2+, OH−, and saturated Ca(OH)2 (ie 21.6 mM) were prepared in order to evaluate which component eradicated or amplified biofilm structure. Various biochemical and microscopic methods were used to investigate the properties of the biofilm. Biofilms treated with Ca(OH)2 absorbed more Ca2+ because of the alkaline pH of the environment and the ions affected the physicochemical properties of the E. faecalis biofilm. A denser biofilm with more cavities and a granular surface was observed in the presence of Ca2+ ions. This resulted in a decrease in the surface-to-biofilm ratio with increases in its biomass, thickness, colony size, and volume. Calcium hydroxide did not destroy E. faecalis biofilms but rather contributed to the biofilm structure. This in-vitro study sheds light on a missing link in the formation of E. faecalis biofilm in which the Ca2+ in Ca(OH)2

Efficacy of Chlorhexidine Intracanal Medicament on Periodontal Healing in Concomitant Endodontic-Periodontal Disease with Communication: A Randomized Clinical Trial

Background: Chlorhexidine has been extensively used in various periodontal and endodontic infections. However its use in combined endo perio lesion has not been defined clearly. The aim of this study was to evaluate the efficacy and synergistic effect of chlorhexidine intra canal medicament with combination of comprehensive periodontal therapy in endodontic periodontal lesions. 
 Materials and Methods: The patients were randomly assigned group 1 and group 2. Both the groups were treated by phase 1 and phase 2 periodontal treatments while group 1patients received conventional root canal treatment and group 2 patients were treated by chlorhexidine intracanal medicament for 6 months. The primary outcome measures are probing pocket depth, relative attachment level and bleeding on probing. 
 Results: Both groups showed improvement on primary outcome measures. However, group 2 showed significant more reduction in probing pocket depth (PPD) and bleeding on probing (BOP) and gain in relative attachment level (RAL) after complete 6 months treatment with chlorhexidine. Postoperative measurements from group1 and group 2 showed reductions in mean PPD of 2.63±0.98 and 3.57±1.13 mm, mean BOP reduction of 76.78±31.41and 87.54±22.35 and mean RAL gains of 2.42±1.27 and 3.42±0.94 mm, respectively. 
 Conclusion: 2% CHX gel used as an intracanal medicament along with periodontal treatment demonstrated more favourable treatment response in terms of periodontal healing.

Assessment of Fracture Resistance of Cranberry and Grape Seed Extract Intracanal Medicament

Plant extracts, specifically cranberry and grape seed extract, have recently been shown to have remineralizing potential for enamel and dentine. Hence, the aim of the study is to assess the effect of a newly formulated intracanal medicament using cranberry and grape seed extract on the fracture resistance of root dentine compared to chlorhexidine and saline. The root canals of orthodontically extracted premolars (n = 16) were instrumented and randomly divided into four groups: the cranberry seed extract group, the grape seed extract group, the chlorhexidine (CHX) group, and lastly, the saline group was used as control. Results showed that the chlorhexidine group had slightly less fracture resistance of the root in comparison to the cranberry ICM and grape seed ICM groups. Hence, the study concluded that the addition of cranberry and grape seed extract into the intracanal medicaments improves the fracture resistance property.

Anti-Inflammatory Potential of Intracanal Medicament Containing Oregano Essential Oil

Oregano is widely used as aromatics in food and alcohol. Oregano oil has been used in traditional medicine for decades. Oregano essential oil (OEO) is extracted from leaves from the oregano plant. Oregano is known for its antibacterial and antispasmodic properties due to its polyphenol content, which includes many flavones. The aim of the study was to assess the Anti-Inflammatory Potential of Intracanal Medicament Containing Oregano Essential Oil (OEO). The anti-inflammatory activity of an intracanal medicament containing oregano essential oil at various concentrations was evaluated using the raw 264.7 cell line. The ability of extracts to suppress nitric oxide generation by cells was used to calculate percentage inhibition. Curcumin was used as the standard. The study concluded that anti-inflammatory activity of the formulation showed IC50 value of 94.34%, and hence can be used clinically to treat infected root canals.

Evaluation of Antibacterial and Antifungal Effects of Calcium Hydroxide Mixed with Two Different Essential Oils.

Background: Calcium hydroxide is a routinely used material for root canal disinfection during root canal treatment. Natural products have great potential in terms of their antibacterial effects. This study aimed to establish an effective alternative intracanal medicament using Origanum dubium (O. dubium) and Mentha spicata (M. spicata) essential oils. Materials and Methods: O. dubium and M. spicata, collected from Lefke, Cyprus, were separately subjected to hydrodistillation. The obtained essential oil compositions were analysed simultaneously by gas chromatography (GC) and gas chromatography/mass spectrometry (GC-MS). The compositions were then divided into groups and mixed with calcium hydroxide at a 1:1 concentration; after that, the pastes were tested on Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans), which are the most common resistant pathogenic microorganisms in the root canal. The antibacterial activity of the pastes was measured using a disk diffusion assay. Results: The GC and GC-MS analyses revealed that O. dubium and M. spicata had major compositions of carvacrol (75.8%) and carvone (71.3%), respectively. Antimicrobial activity was found to be significantly higher when study groups with O. dubium essential oil were applied to both E. faecalis and C. albicans. The results also show that M. spicata, together with calcium hydroxide, demonstrated a significant antifungal effect on C. albicans when incubated for 72 h. Conclusions: M. spicata was found to be an effective antimicrobial agent on C. albicans, whereas O. dubium was found to be very effective on both E. faecalis and C. albicans. These data demonstrate that these natural essential oils may be promising candidates for alternative intracanal medicament in future routine clinical applications.

Present status and future directions of intracanal medicaments

Two fundamental goals of endodontic treatment are to prevent or treat apical periodontitis. From a predictive perspective, several variables can affect the outcome of root canal treatment. Some of these variables depend on intraoperative factors, which include irrigation technique, size of the apical preparation, use of intracanal medicaments or the number of appointments necessary to complete the treatment. However, the outcome may also be affected by host and microbial factors. The intensity of periradicular bone loss or tissue damage, the presence of preoperative pain and associated conditions such as mechanical allodynia and central sensitization, the anatomical complexity of the apical portion of the canal, and the virulence and longevity of the bacterial infection can all have a profound influence on the outcome. Furthermore, numerous medical conditions have been reported to decrease the capability of the immune system to heal the periapical tissues. It is the clinician's responsibility to analyse these variables and incorporate them into the disinfection strategy to maximize the chances of healing. This narrative review will focus on the present status of intracanal medicaments, the clinical indications for their use and future directions for research.

Effect of antibacterial intracanal medicaments mixed with different vehicle used in inter-appointment flare-up patients

Background: Post-operative pain is a common finding after endodontic treatment, its incidence ranges from 3% to 58%. It may be due to microbial, mechanical or chemical injury to the periapical tissues. Calcium hydroxide has been recommended for use as an intracanal medicament based on its antibacterial, antiresorptive and tissue dissolving properties. The use of chlorhexidine gluconate as an intracanal medicament has been suggested either in the form of 2% gel or solution placed in a sustained release device or active points. Aim of the study: To evaluate and compare the effect of antibacterial intracanal medicaments mixed with different vehicle and used in inter-appointment flare-up patients. Materials and methods: The present study was conducted in the Department of Conservative Dentistry and Endodontic of the dental institute. This study was conducted on 45 permanent single-rooted mandibular premolars with acute apical periodontitis. Results: It is evident that the preoperative pain in Group 1, 2 and 3 patients was 3.56, 3.88 and 3.41 respectively. The post-operative pain for Group 1, 2 and 3 patients decreased significantly from 6 to 48 hours. However, on comparing the pain intensity for Group 1, 2 and 3, results were non-significant.

Effect of temperature and passive ultrasonic irrigation of EDTA 17% in smear layer removal

Smear layer removal in root canal treatment is required to aid the diffusion of intracanal medicament and help sealer penetrate into dentinal tubules. The need for irrigants is important to facilitate smear layer removal in the root canal. Various methods have been proposed in some articles, but their application in apical third still challenges many clinicians due to the complexity of the root canal. This study aimed to analyze the effect of temperature and passive ultrasonic irrigation (PUI) activation of EDTA 17% solution in smear layer removal. Twenty-four extracted mandibular premolars were decoronated to standard root length of 14 mm. The preparation of root canals was completed with crown-down technique using ProTaper FHU to file F3 (30/.09). The root canal irrigation was done with NaOCl 5.25% and EDTA 17% solution. The samples were divided into four groups, namely 25 ºC of EDTA 17% solution (group 1), 37 ºC of EDTA 17% solution (group 2), 25 ºC of EDTA 17% solution with PUI activation (group 3), and 37 ºC of EDTA17% solution with PUI activation (group 4). Smear layer removal was observed under scanning electron microscopy (SEM) and scored ordinally from 1-5. Non-parametric Friedman test showed significant results in all the groups (p<0.05). Post hoc Wilcoxon Signed Rank test showed significant results between group 2 and group 3 (p = 0.039), and between group 3 and group 4 (p = 0.038). The combination methods of temperature and PUI activation showed a significant result in smear layer removal.

<strong>Effectiveness of ChKM solution compared to triple-antibiotic paste as an intracanal medicament for bacteria that cause a chronic periapical abscess</strong>

Introduction: Chronic periapical abscesses are caused by polymicrobial bacteria, including E. faecalis, S. mutans, S. sanguinis, and P. gingivalis. These bacteria can be eliminated with chlorophenol camphor menthol (ChKM) solution and triple-antibiotic paste (TAP) as an intracanal medicament. This study compared the effectiveness of ChKM solution to triple-antibiotic paste as an intracanal medicament for bacteria that cause a chronic periapical abscess. Methods: An experimental laboratory was conducted in-vitro with the microdilution method and optical density measurement using a spectrophotometer. The cell inhibition percentage was calculated to determine the MIC value. The MBC values were confirmed by cultivating the Mueller Hinton Agar samples, incubating them at 37°C for 24 hours, and observing bacterial growth. Bacteria did not grow in the medium at MBC value. The lower MIC and MBC were sensitive and could be an effective medicament choice. Results: The MIC ChKM solution inhibits E. faecalis ATCC 29212, S. mutans ATCC 25175, S. sanguinis ATCC 10556, and P. gingivalis ATCC 33277 were 4000, 4000, 2000, and 2000 µg/mL consecutively. While MIC of TAP were 6, 0.375, 0.75, and 1.5 µg/mL, respectively. Moreover, MBC of the ChKM solution were 32000, 32000, 8000, 8000 µg/mL and MBC of the TAP were 768, 24, 24, 96 µg/mL. Conclusions: ChKM solution and TAP effectively inhibited and killed E. faecalis, S. mutans, S. sanguinis, and P. gingivalis as an intracanal medicament, as seen from the MIC and MBC values. However, TAP is more effective than the ChKM solution because MIC and MBC values of TAP are much lower than the ChKM solution. This finding indicated that TAP is more effective at the lowest concentration than ChKM solution. It should be highlighted that this was an in-vitro study involving specific microbes; thus, further clinical research is needed.

<strong>The MIC and MBC of calcium hydroxide medicament against bacteria that cause chronic periapical abscess in the vulnerable initial 7-days of endodontic treatment</strong>

Introduction: The primary aetiology of chronic periapical abscesses, including E. faecalis, S. mutans, S. sanguinis, and P. gingivalis, can be eliminated using intracanal medicaments such as calcium hydroxide. The purpose of this study was to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) value of calcium hydroxide paste in the vulnerable initial 7-day of treatment against E. faecalis ATCC 29212, S. mutans ATCC 25175, S. sanguinis ATCC 10556, and P. gingivalis ATCC 33277. Methods: An in-vitro laboratory experiment using a spectrophotometer as a microdilution method was conducted to determine bacteria's MIC and MBC values on calcium hydroxide paste. The sample used in this study was four bacteria using intracanal medicament of calcium hydroxide (Ca(OH)2), incubated for seven days at 37°C, and then bacterial growth was observed. The cell inhibition percentage was calculated using optical density measurements to determine the MIC value. The low MIC and MBC were defined as sensitive bacteria to calcium hydroxide. Results: Calcium hydroxide paste against E. faecalis (ATCC 29212) with MIC values at a concentration of 750 μg/ml and MBC values at a concentration of 96,000 μg ml; S. mutans (ATCC 25175) with MIC value at a concentration of 3,000 ug/ml and MBC value at a concentration of 48,000 ug/ml; S. sanguinis (ATCC 10556) with MIC value at a concentration of 3,000 ug/ml and MBC value at a concentration of 6,000 ug/ml; P. gingivalis (ATCC 33277) with MIC value at a concentration of 6,000 ug/ml and MBC value at a concentration of 48,000 ug ml. Conclusions: Calcium hydroxide can inhibit bacterial growth activity. E. faecalis (ATCC 29212) and S. sanguinis (ATCC 10556) are more sensitive to calcium hydroxide paste than other bacteria, with the lowest MIC and MBC on seven days of incubation since the maximum calcium and hydroxyl ions are released.

Effect of Different Intracanal Medicaments on the Viability and Survival of Dental Pulp Stem Cells

Background: Stem cells play an important role in the success of regenerative endodontic procedures. They are affected by the presence of medicaments that are used before the induction of bleeding or the creation of a scaffold for endodontic regeneration. This study examines the effects of different intracanal medicaments on the viability and survival of dental pulp stem cells at different doses and over different exposure times. Methods: Dental pulp stem cells were cultured from healthy third molar teeth using the long-term explant culture method and characterized using flow cytometry and exposed to different concentrations of calcium hydroxide, doxycycline, potassium iodide, triamcinolone, and glutaraldehyde, each ranging from 0 (control) to 1000 µg/mL. Exposure times were 6, 24, and 48 h. Cell viability was measured using the MTT assay, and apoptosis was measured using the Annexin V-binding assay. Results: All medicaments significantly reduced cell viability at different concentrations over different exposure times. Calcium hydroxide and triamcinolone favored cell viability at higher concentrations during all exposure times compared to other medicaments. The apoptosis assay showed a significant increase in cell death on exposure to doxycycline, potassium iodide, and glutaraldehyde. Conclusion: The intracanal medicaments examined in our study affected the viability of dental pulp stem cells in a time and dose-dependent manner. They also adversely affected the survival of dental pulp stem cells. Further studies are needed to better understand the effect of prolonged exposure to medicaments according to clinical protocols and their effect on the stemness of dental pulp stem cells.

The effect of four different intracanal medicaments on the push-out bond strength of root canal sealers.

This study aimed to compare the effect of 4 different intracanal medicaments on the push-out bond strength of two sealers (AH Plus and MTA Fillapex). 100 single-rooted extracted premolar teeth were divided into 5 groups, with 20 samples in each group, one group being the control group. After cleaning and shaping procedures, the canals were filled with 4 different medicaments: calcium hydroxide, tri-antibiotic paste (TAP), Metapex, or Chlorhexidine (2%) gel for 2 weeks. Following this, the medicaments were rinsed away, and the samples in those sub-groups were obturated with gutta-percha/AH Plus or MTA Fillapex sealers. After 2 weeks of incubation, a 2-mm-thick middle section from each root was evaluated to test push-out strength. The obtained data were tabulated, and appropriate statistical analysis was performed (two-way ANOVA and LSD test). When comparing the average values, the bond strength values of AH Plus were significantly higher than those of MTA Fillapex (p<0.05) in all medicament groups. Based on the findings, we concluded that AH Plus had comparatively higher bond strength than MTA Fillapex. We also observed that AH Plus had higher bond strength in the presence of calcium hydroxide, whereas MTA Fillapex in the presence of Chlorhexidine. A comparison of the push-out bond strength shows that irrespective of the root canal segment or the final irrigant used, AH Plus showed higher values among all groups. The limitation of the current study was that the effect of TAP on the bond strength of endodontic sealers was not negative.

Evaluation of the Antibacterial Activity of Ibuprofen, Triple Antibiotic Paste and Calcium Hydroxide as intracanal medicaments Against Enterococcus faecalis in Single Rooted Teeth. A Comparative Invitro Study

Evaluation of the Antibacterial Activity of Ibuprofen, Triple Antibiotic Paste and Calcium Hydroxide as intracanal medicaments Against Enterococcus faecalis in Single Rooted Teeth. A Comparative Invitro Study

Biocompatibility evaluation of of 3 different intracanal medicaments (A histological study)

Biocompatibility evaluation of of 3 different intracanal medicaments (A histological study)

Investigating the Potential of 2%Chlorhexidine as a Vehicle for Enhancing the Antibacterial Effect of Calcium Hydroxide and Triple Antibiotic Paste Intracanal Medicaments in Primary Teeth

Investigating the Potential of 2%Chlorhexidine as a Vehicle for Enhancing the Antibacterial Effect of Calcium Hydroxide and Triple Antibiotic Paste Intracanal Medicaments in Primary Teeth

Effect of nanoparticle based intra-canal medicaments on root dentin micro-hardness.

Complete eradication of bacterial infection from the root canal with minimum or no effect on the microhardness of the dentin is desirable for the success of endodontic treatment. The effect of nanoparticle based intracanal medicaments on the root dentine microhardness was assessed. The medicaments used were combination of calcium hydroxide - silver nanoparticles, Combination of graphene oxide - silver nanoparticles, Calcium hydroxide and a control group. Vickers hardness value were evaluated and compared at coronal, middle and apical third level. Graphene oxide - silver nanoparticles based intracanal medicament showed least effect on the microhardness of the root dentin compared to calcium hydroxide and calcium hydroxide combined with silver nanoparticle based intracanal medicaments.

Antimicrobial Efficacy of Morinda citrifolia, Nisin, and 2% Chlorhexidine Against Enterococcus faecalis: An In-Vitro Study.

AimThe aim of this study was to evaluate and compare the antimicrobial activity of 2% chlorhexidine gluconate (2% CHX), Morinda citrifolia (M. citrifolia), and nisin (NI) all in gel forms against Enterococcus faecalis (E. faecalis)-infected root canals.MethodologyForty single-rooted mandibular premolars extracted for orthodontic reasons were decoronated and chemomechanical preparation of the root canal was performed. After sterilization, the samples were inoculated with E. faecalis for one week and grouped according to the medicament used namely, saline as the control group (Group-A), 2% CHX (Group-B), M. citrifolia (Group-C), and NI (Group-D). After 7days of incubation, in order to evaluate the effectiveness of the intracanal medicaments on the canal wall and its radicular dentin, the specimens dentin chips were retrieved and inoculated on brain heart infusion (BHI) blood agar plates from each tube and incubated at 37°C for 24 hours to obtain bacterial colony forming unit (CFU) count. The data was statistically analyzed using one-way ANOVA test and multiple comparisons among different groups were complemented by post hoc Tukey test.ResultsThe CFU count indicating the number of viable bacterial colonies was found to be highest in Group-A (saline). Group-B (CHX 2%) showed the least CFUs followed by Group-D (NI) and Group-C (M. citrifolia).ConclusionIn an attempt to overcome the disadvantages and toxic effects of a few commercially available intracanal medicaments and irrigants, the present study was aimed at using herbal extracts to evaluate and compare their antimicrobial efficacy with the commercially available medicaments against E. faecalis. Nisin was an effective antimicrobial agent and its action was found to be comparable with CHX.

In-vitro evaluation of antimicrobial efficacy of triple antibiotic paste, metapex and newly introduced iodine based asphaline temp as intracanal medicament against enterococcus faecalis

Background: Microorganisms and their products are considered as the etiological agents of pulp necrosis and peri-radicular lesions. They may survive during endodontic procedures due to anatomical structural complexities and limitations of access by instrumentation and irrigants. The present study was conducted to assess antimicrobial efficacy of newly introduced iodine based Asphaline Temp, Triple antibiotic paste and Calcium hydroxide based Metapex against Enterococcus faecalis. Materials &amp; Methods: 90 extracted, single-rooted human permanent teeth were instrumented and autoclaved. Samples were inoculated with the pure culture of E. faecalis and incubated. After incubation, colony-forming units (CFUs) were recorded before medication. Each group was further divided into 3 subgroups based on time duration of testing for days – 1 day, 5 days, and 7 days, containing 10 samples each. Group I – Asphaline Temp; Group II – Triple antibiotic paste (TAP); Group III – Metapex. The various time interval bacterial CFUs within the group were compared. Results: Percentage reduction in bacteria count on 1 day, 5 day and 7 day in Group I (Asphaline Temp) was 77.2, 96.5 and 98.3; in Group II (TAP) was 70.5, 90.4 and 93.2 and in Group III (Metapex ) was 25.8, 46.2 and 58.2.

Intracanal calcification following regenerative endodontic treatment: a systematic review and meta-analysis.

Calcification is a common finding in endodontic cases after regenerative endodontic therapy (RET). We aimed to identify the prevalence of intracanal calcification after RET and to compare intracanal calcification outcomes in RET using either calcium hydroxide [Ca(OH)2] or antibiotics. We searched PubMed, Web of Science, ProQuest Dissertations & Theses, and Scopus databases for clinical, cross-sectional, case-control, and cohort RET studies published until May 2020 in the English language and reporting a calcified case after RET. The Cochrane risk-of-bias tool for randomized trials and Risk of Bias In Non-randomized Studies of Interventions were used for bias assessment. Meta-analyses were performed, overall and separately, for intracanal medicaments using a random-effects model with weighted inverse variance methods. Subgroup analysis was performed according to the calcification type. Eight studies were included. The overall prevalence of intracanal calcification after RET was 30.7% (95% confidence interval [CI]: 0.15-0.45,[Formula: see text]=92.6%), 46.5% with Ca(OH)2 vs. 25.8% with antibiotic-based intracanal medicaments. Subgroup analyses for complete calcification outcome showed a higher prevalence of complete calcification in the Ca(OH)2 group (46.5%, 95% CI: 0.17-0.68,[Formula: see text]%) than in the antibiotic group (10%, 95% CI: - 0.04-0.43,[Formula: see text]%). Based on the studies included, available evidence shows a statistically significant association between complete calcification and Ca(OH)2 paste as an intracanal medicament. Other contributing factors, such as blood clot formation and follow-up time, might also play an essential role in forming intracanal calcification. This study highlights the significant association between complete calcification and Ca(OH)2 paste.

Microbial analysis of endodontic infections in teeth with post-treatment apical periodontitis before and after medication.

This study aimed to determine the intraradicular microbiota of previously root canal-treated teeth with apical periodontitis and to investigate the antibacterial effectiveness of different intracanal medicaments. Sixteen patients with post-treatment apical periodontitis were allocated into two groups according to the intracanal medicament used: calcium hydroxide (CH) and 2% chlorhexidine gluconate gel (CHX) group. Total bacterial loads, as well as the amount of Enterococcus faecalis (E. faecalis) were determined before (S1) and after (S2) chemomechanical preparation and finally, after intracanal medication (S3) by means of ddPCR. The unpaired t test was used to compare parametric. S3-total bacteria copy number of the CH group was lower than the CHX group (p<0.05). There was no statistical difference between the CHX- and the CH groups in terms of E.faecalis copy number (p>0.05). But in terms of total bacteria, CH is better than CHX. Consequently, CH can be used to optimise the antibacterial efficiency of chemomechanical preparation in previously root canal-treated teeth with apical periodontitis.