Evaluation of minimum inhibitory concentration and minimum bactericidal concentration of royal jelly against Enterococcus faecalis, Staphylococcus aureus, and Candida albicans.

Objective: The objective of this study was to ascertain the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of royal jelly (RJ) against three microorganisms frequently linked with endodontic infections: Staphylococcus aureus, Enterococcus faecalis, and Candida albicans. Materials and Methods: Freshly harvested RJ was prepared at different concentrations (20%, 10%, 5%, 2.5%, and 1.25%) in distilled water. The microbial cultures of the target organisms were prepared. MIC was determined using a broth dilution technique, monitoring microbial growth. MBC was determined by inoculating agar plates with samples from tubes showing no apparent growth and evaluating the presence of bacterial or fungal growth following the incubation period. Results: For S. aureus, the MIC and MBC were 5 mg/ml of RJ. For E. faecalis, the MIC and MBC were 10 mg/ml of RJ. For C. albicans, both MIC and MBC were 10 mg/ml of RJ. The findings demonstrated RJ's potential to inhibit and eliminate these pathogenic microorganisms, making it a potential candidate for endodontic infection control. Conclusion: The antimicrobial properties of RJ against S. aureus, E. faecalis, and C. albicans present a promising avenue for enhancing infection control in endodontics. Additional investigations are needed to refine its use in clinical settings, especially in cases with mixed microbial infections.

Thermosensitive hydrogel with programmed dual-octenidine release combating biofilm for the treatment of apical periodontitis.

The utilization of intracanal medicaments is an indispensable procedure in root-canal treatment. However, the conventional intracanal medicaments still need improvement regarding antimicrobial efficacy and ease of clinical operation. To address the above issues, OCT/PECT@OCT + ALK composite hydrogel characterized by programming sequential release of dual antimicrobial agents has been proposed. Thanks to the self-assemble ability of amphiphilic copolymer poly(ε-caprolactone-co-1,4,8-trioxa [4.6]spiro-9-undecanone)-poly(ethylene glycol)-poly(ε-caprolactone-co-1,4,8-trioxa[4.6]spiro-9-undecanone) (PECT), dual hydrophilic and hydrophobic antimicrobial agents could be easily encapsulated in the hydrogel system and tailored for sequential drug release for a better antibiofilm effect. The hydrophilic octenidine (Octenidine dihydrochloride, OCT-HCl) is encapsulated in the hydrophilic part of hydrogel for instantaneous elevating the drug concentration through bursting release, and the hydrophobic octenidine (Octenidine, OCT) is further loaded into the PECT nanoparticles to achieve a slower and sustained-release profile. Additionally, calcium hydroxide (Ca(OH)2) was incorporated into the system and evenly dispersed among PECT nanoparticles to create an alkaline (ALK) environment, synergistically enhancing the antibiofilm effect with higher efficiency and prolonged duration. The antibiofilm effect has been demonstrated in root-canal models and apical periodontitis rats, exhibiting superior performance compared to clinically used Ca(OH)2 paste. This study demonstrates that OCT/PECT@OCT + ALK composite thermosensitive hydrogel is a potential intracanal medicament with excellent antibiofilm effect and clinical operability.

Evaluation of rise in pH and oxygen release at the site of simulated external root resorption cavities using different oxygen-releasing biomaterials: An in vitro study.

Context: External inflammatory root resorption has rapid onset and progresses aggressively. It leads to cementum loss, which allows communication between the infected pulp and the periodontium through the denuded dentinal tubules. Primary management strategy includes adequate chemomechanical debridement and lesion arrest for which maintaining alkaline pH and aerobic conditions is essential for healing and repair of the resorption defect. Aims: The aim of this study is to evaluate rise in pH and oxygen release at the site of simulated external root resorption cavities using different oxygen-releasing biomaterials. Materials and Methods: In 40 extracted single-rooted teeth access opening and chemomechanical debridement were done. Cavities simulating resorption defect are prepared on the roots. The samples are divided into four groups (n = 10) based on the biomaterial used. After placing the biomaterial, the root apices were sealed. Half of the samples from each group were tested for oxygen release using dissolved oxygen meter and the other half for rise in pH using pH meter at 7, 14, 21, and 28 days. Statistical Analysis: The pH values were analyzed using Friedman 2-way analysis of variance (ANOVA) and Kruskal-Wallis test. Oxygen release was measured using the two-way and repeated-measures ANOVA. Results: Calcium peroxide group showed the highest mean pH and oxygen release than other groups at any given point of time. Conclusions: Incorporating oxygen-releasing biomaterials such as calcium peroxide and perfluorodecalin into intracanal medicaments, such as calcium hydroxide, creates an alkaline and oxygen-enriched milieu in the periapical tissues.

Time-Dependent Antibacterial Effects of Citrullus Colocynthis Seed Extract Compared to Calcium Hydroxide in Teeth Infected with Enterococcus Faecalis.

Statement of the Problem: Endodontic efforts are focused on eliminating intracanal pathogens. Applying intracanal medicament for infected teeth is beneficial for achieving better antibacterial effects in endodontic treatments. Different intracanal medicaments should be assessed and compared for this purpose. Purpose: The aim of this study was to assess the antibacterial efficacy of Citrullus colocynthis seed extract comparing to Ca(OH)2 on teeth contaminated with Enterococcus faecalis. Materials and Method: In this in vitro study, a novel strain of Enterococcus faecalis (Enterococcus spp. ATCC 19433) yielded from the root canal treated tooth with persistent apical periodontitis. The canals of 78 human single-rooted extracted teeth were contaminated with mentioned strain and treated with Citrullus colocynthis essential oil and Ca(OH)2 for 1, 7, and 14 days. To determine the chemical composition of the oils, gas chromatography-mass spectrometry (GC-MS) was applied. The percentage reduction from baseline c.f.u./mL values was estimated. Results: Oleic acid, benzoic acid, and gallic acid were the major contents of Citrullus colocynthis essential oil. The c.f.u./mL count decreased considerably as contact duration rose for both medicaments. After 7 days, a statistically significant difference was identified between the medicaments. Citrullus colocynthis showed higher antimicrobial efficacy. However, after 14 days, no substantial difference was found. Conclusion: Citrullus colocynthis essential oil, displayed great antimicrobial efficacy against Enterococcus faecalis higher than Ca(OH)2 over the first week contact period.

The Evaluation of Anti-Osteoclastic Activity of the Novel Calcium Hydroxide Biodegradable Nanoparticles as an Intracanal Medicament.

INTRODUCTION: The aim of this study was to evaluate the anti-osteoclastic activity of calcium hydroxide-loaded poly(lactic-co-glycolic acid) nanoparticles [Ca(OH)2-loaded PLGA NPs] in comparison to calcium hydroxide nanoparticles [Ca(OH)2 NPs]. METHODS: RAW 264.7 cell lines (third-fifth passage) were cultured and incubated with soluble receptor activator of nuclear factor kappa B ligand in triplicate. Subsequently, Ca(OH)2-loaded PLGA NPs and Ca(OH)2 NPs were added for 7 days to evaluate their effects on receptor activator of nuclear factor kappa B ligand-induced osteoclast differentiation of RAW 264.7 cells by tartrate-resistant acid phosphatase activity. Additionally, a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was conducted to confirm the cytotoxicity of treatments to cells. RESULTS: Tartrate-resistant acid phosphatase staining showed a significant reduction in the osteoclast number when treated with Ca(OH)2-loaded PLGA NPs compared with Ca(OH)2 NPs (P < .01). In comparison to the control, the number of osteoclasts significantly reduced upon treatment with Ca(OH)2-loaded PLGA NPs (P < .05), but there was no significant difference in Ca(OH)2 NPs. Furthermore, osteoclast morphology in both treatment groups exhibited smaller sizes than the control group. Neither Ca(OH)2-loaded PLGA NPs nor Ca(OH)2 NPs demonstrated cytotoxic effects on RAW264.7 cells. CONCLUSIONS: Both Ca(OH)2 NPs with and without poly(lactic-co-glycolic acid) have the ability to inhibit osteoclast differentiation. However, Ca(OH)2-loaded PLGA NPs exhibit greater potential than Ca(OH)2 NPs, making them a promising intracanal medicament for cases of root resorption.

Efficacy of a Novel Intracanal Medicament on Total Antioxidant Status in Patients With Apical Periodontitis: A Randomized Controlled Clinical Trial.

Introduction Successful endodontic treatment relies upon the microbial debridement of the root canal system. This can be achieved to a great extent by using intracanal medicaments, which inhibit the microbes growing in the root canal. Evaluating the capacity of oxidants in the saliva is a crucial parameter for assessing the antioxidant capacity of any individual, which decreases in inflammatory conditions. An effective intracanal medicament can increase the total antioxidant capacity of saliva, which comes down because of inflammatory conditions. Aim To evaluate the effect of two intracanal medicaments on the antioxidant capacity of saliva. Materials and methods In a randomized prospective clinical trial, 42 patients with a mean age of 18-70 years were selected based on exclusion and inclusion criteria, and the baseline value of the total antioxidant capacity of saliva was recorded. The patients were categorized into two groups as per the block randomization method (Group I: calcium hydroxide (Maarc, New Delhi, India) intracanal medicament; Group II: Hekla lava (SBL Pvt. Ltd., Germany) intracanal medicament). Access opening, working length determination, and cleaning and shaping were conducted using hand K-files and ProTaper Gold rotary files. Intracanal medicaments were placed according to the groups assigned, and temporary restoration was placed. The patients were recalled after seven days. If the tooth was asymptomatic, obturation was completed, and a saliva sample was collected to assess the total antioxidant capacity. Results The total antioxidant capacity of saliva was increased after using intracanal medicaments and endodontic therapy, and there was a statistically significant difference before and after using both the medicaments (p=0.0005; i.e., calcium hydroxide and Hekla lava. When both medicaments were compared, there was no significant difference in the antioxidant capacity of saliva among medicaments (p=0.384). Conclusion The total antioxidant capacity of saliva was increased after using both the intracanal medicaments. Hence, Hekla lava can be potentially used as an alternative intracanal medicament.

Examining the Effects of Asiaticoside on Dental Pulp Stem Cell Viability and Proliferation: A Promising Approach to Root Canal Treatment.

AIM: This study aims to evaluate the impact of asiaticoside (AC) on the viability and proliferation of dental pulp stem cells (DPSCs), considering the known negative effects of routinely used intracanal medicaments. This evaluation will be compared with the outcomes from using traditional intracanal medicaments, specifically triple antibiotic paste (TAP) and calcium hydroxide [Ca(OH)2]. MATERIALS AND METHODS: The DPSCs were obtained from the third molars of an adult donor. The application of flow cytometry was employed to do a phenotypic analysis on DPSCs using CD90, CD73, CD105, CD34, CD14, and CD45 antibodies. The methylthiazol tetrazolium (MTT) assay was employed to assess cellular viability. The cells were treated with different concentrations of TAP and Ca(OH)2 (5, 2.5, 1, 0.5, and 0.25 mg/mL), along with AC (100, 50, 25, 12.5, and 6.25 µM). A cell proliferation rate was performed at 3, 5, and 7 days. RESULTS: The characterization of DPSCs was conducted by flow cytometry analysis, which verified the presence of mesenchymal cell surface antigen molecules (CD105, CD73, and CD90) and demonstrated the absence of hematopoietic markers (CD34, CD45, and CD14). Cells treated with concentrations over 0.5 mg/mL of TAP and Ca(OH)2 showed a notable reduction in cell viability in comparison to the untreated cells (p < 0.05). Additionally, the cells treated with different concentrations of AC 12.5, 6.25, 25, and 50 µM did not differ significantly from the untreated cells (p > 0.05). Nevertheless, cells treated with concentrations of 100 µM showed a significant reduction in viability compared to the untreated cells (p < 0.05). After a period of 7 days, it was noted that cells exposed to three different concentrations of AC (50, 25, and 12.5 µM) had a notable rise in cell density in comparison to TAP and Ca(OH)2 (p < 0.05). Furthermore, cells that were exposed to a concentration of 12.5 µM exhibited the highest cell density. CONCLUSION: The cellular viability of the AC-treated cells was superior to that of the TAP and Ca(OH)2-treated cells. Moreover, the AC with a concentration of 12.5 µM had the highest degree of proliferation. CLINICAL SIGNIFICANCE: This study underscores the importance of evaluating alternative root canal medicaments and their effects on DPSCs' growth and vitality. The findings on AC, particularly its influence on the survival and proliferation of DPSCs, offer valuable insights for its probable use as an intracanal medication. This research contributes to the ongoing efforts to identify safer and more effective intracanal treatments, which are crucial for enhancing patient outcomes in endodontic procedures. How to cite this article: Alazemi MJ, Badawi MF, Elbeltagy MG, et al. Examining the Effects of Asiaticoside on Dental Pulp Stem Cell Viability and Proliferation: A Promising Approach to Root Canal Treatment. J Contemp Dent Pract 2024;25(2):118-127.

Comparative assessment of nanosized intracanal medicaments on penetration and fracture resistance of root dentin - An in vitro study.

Context: The antimicrobial potential of conventional medicaments is reduced due to their limited permeability. The use of calcium hydroxide (CH) is known to reduce the root strength. Nano intracanal medicaments have the following advantages over conventional such as higher surface area and chemical reactivity, and due to its nanosize, have better penetrability, supporting its possible use as an intracanal medicament. Nano versions of CH, chitosan (CS), CS + CH, curcumin (T), and its conventional forms are used in our study. Aim: The aim of this study was to evaluate and compare the depth of penetration of nanosized intracanal medicaments and their effect on fracture resistance of root dentin. Materials and Methods: Eighty extracted single-rooted teeth were used after decoronation. Canals were enlarged up to size 30 (0.04° taper) using Neoendo instruments (Orikam, India). Teeth were randomly assigned to two broad groups based on the type of intracanal medicament used; Group A: control (conventional) (n = 40) and Group B: nanosized intracanal medicaments (n = 40). Each group was subdivided into four experimental groups (n = 10), Group A1: CH, Group A2: CS, Group A3: curcumin (T), Group A4: CS + CH, Group B1: nano calcium hydroxide (NCH), Group B2: nano CS (NCS), Group B3: nano curcumin (NT), and Group B4: NCS + nano calcium hydroxide (NCS + NCH). All the specimens were stored in a humidor at 37°C for 4 weeks. Out of 10 specimens from each group, five specimens were used for evaluating the depth of penetration using a confocal laser scanning electron microscope, and the remaining five specimens were used for evaluating fracture resistance in a universal testing machine at the end of 4 weeks. Data were analyzed using one-way ANOVA and intergroup comparison using Tukey's post hoc multiple comparison test. Results: The highest fracture resistance was seen with NCS and the maximum depth of penetration with nano calcium hydroxide (NCH). Conclusion: The fracture resistance and depth of penetration at a 4-week interval were higher in nano forms compared to their micro-sized counterparts with all groups. The coronal section presented the highest depth of penetration of intracanal medicaments followed by the middle and least in the apical section of root dentin with all groups.

The effectiveness of single antibiotic paste nitrofurantoin V/S double antibiotic paste in alleviation of post-operative pain of patients suffering from symptomatic irreversible pulpitis-A randomized controlled trial.

Objective: The present research evaluated and compared effectiveness between nitrofurantoin and double antibiotic paste in alleviating post-operative pain in patients suffering from symptomatic irreversible pulpitis. Methods: There were 60 subjects enrolled who were allotted among three groups: Group 1 - Nitrofurantoin, Group 2 - double antibiotic paste, and Group 3 - Control. Succeeding access opening and chemo mechanical preparation, intracanal medicament was placed in the root canals. Using a numerical pain scale, pain scores were measured at the following time intervals: preoperative, 12, 24, 48, and 72 h. One-way ANOVA and post hoc statistical analysis were conducted, with a p-value of ⩽ considered as statistically significant. Results: Preoperatively, most patients experienced moderate to severe pain. The patients in groups 1 and 2 reported considerable reduction in their pain scores (p ⩽ 0.001) on each time interval. However, patients in group 3 experienced a higher level of pain even at 72 h. No considerable distinction was found among participant's pain scores of groups 1 and 2 (p = 0.193). Conclusion: For effective pain-relieving, both nitrofurantoin and double antibiotic paste can be successfully used in patients suffering from symptomatic irreversible pulpitis. However, when calcium hydroxide was used, patients experience high levels of pain.

Impact of calcium hydroxide and 2-hydroxyisocaproic acid on the microhardness of root dentine: an in vitro study.

To evaluate and compare the effect of calcium hydroxide [Ca(OH)2] and 2-hydroxyisocaproic acid (HICA) on the microhardness of root dentine. Fifty-one matured maxillary central incisors with straight root and type I canal configuration were decoronated to a standardized length of 16 mm. The root canals were cleaned and shaped using rotary instruments up to size F5. The tooth samples were then randomly assigned into three groups (n = 17) based on the intracanal medicament placed. Group A: control group with no intracanal medicament, Group B: root canals placed with Ca(OH)2, and Group C: root canals placed with HICA. After 1 week, the intracanal medicaments placed within the root canals were removed and the canals were dried. Subsequently, the specimens were split longitudinally into two halves and subjected to the Vickers microhardness test with indentations made at the coronal, middle, and apical-third root regions. The data were analyzed using one-way ANOVA and Tukey's post hoc tests. The control group showed significantly highest microhardness value (P < 0.001), followed by HICA and finally, Ca(OH)2 at the coronal, middle, and apical-third root regions, respectively. Nonetheless, there were no statistically significant differences in microhardness values across different root regions within each group. HICA was found to have a significantly lesser reduction in root dentine microhardness which could be a potential alternative to Ca(OH)2. Nevertheless, future studies are warranted to verify the present outcomes in the clinical setting.

Efficacy of Triple Antibiotic Paste and Bromelain Paste As Intracanal Medicament Against Enterococcus faecalis: An In-Vivo Study.

Introduction Microorganisms are pivotal contributors to pulp and periapical pathology, often culminating in endodontic treatment failures. The successful outcome of such treatment hinges on the effective eradication of microbial flora through various interventions, including intracanal medicaments (ICMs). However, Enterococcus faecalis (E. faecalis), a highly adaptive Gram-positive bacterium, exhibits remarkable resilience and can persist even after rigorous disinfection efforts. This study explores the efficacy of two ICMs, calcium hydroxide-based triple antibiotic paste (TAP) and a novel alternative containing bromelain, derived from pineapples, in combating E. faecalis infections in vivo. Methodology This in-vivo study was conducted at Sharad Pawar Dental College and Hospital, Wardha, India, and ethical approval was obtained from the institutional ethical committee. The sample size was calculated using the OpenEpi program (version 3.04.04, Open Source Epidemiologic Statistics for Public Health, www.OpenEpi.com), resulting in 15 participants per group. Inclusion criteria encompassed mandibular premolars with carious involvement but no prior restorations, diagnosed with necrotic or infected pulp, and no significant medical history. Exclusion criteria included systemic conditions, pregnancy, retreatment cases, recent antibiotic therapy, calcified canals, and other contraindications. After proper patient consent, access opening and chemomechanical preparation were performed, and root canals (RCs) were randomly divided into two groups: TAP and bromelain paste (BP). TAP was prepared using ciprofloxacin, metronidazole, and minocycline, while BP comprised bromelain powder mixed with saline. Both groups received intracanal medicaments, followed by temporary sealing. Microbiological samples were collected before and after treatment for analysis. Results E. faecalis count (CFU/mL) before instrumentation for the TAP group was (1.94 x 105 [Formula: see text] 7.45 x 103) and for BP group was (1.97 x 105 [Formula: see text] 7.70 x 103) with p-value 0.26 [Formula: see text] p=0.05, so no significant difference was found between them. E. faecalis count (CFU/mL) after instrumentation for the TAP group was (7.70 x 103 [Formula: see text] 9.11 x 102) and for the BP group was (7.26 x 103 [Formula: see text] 8.43 x 102) with p-value 0.18 [Formula: see text] p=0.05, so no significant difference was found between them. However, the E. faecalis count obtained after seven days of intracanal medicament for the TAP group was (3.63 x 101 [Formula: see text] 5.60) and for the BP group was (3.13 x 101 [Formula: see text] 4.55) with p-value 0.012 < p=0.05, so a significant difference was found between them. This means that when compared with the TAP group, there was a greater amount of reduction in E. faecalis count (CFU/mL) for the BP group seven days after the placement of intracanal medicament, and this reduction was statistically significant. Conclusion This in-vivo study highlights the potential of BP as a more effective intracanal medicament against E. faecalis when compared to the conventional TAP. Bromelain's selectivity for Gram-positive bacteria and its diverse therapeutic properties make it a promising natural alternative for endodontic treatment. Further research is warranted to optimize bromelain's clinical application and assess its potential to enhance endodontic outcomes, potentially revolutionizing the field of endodontics.

Management of a Radicular Cyst in Anterior Maxilla With Endosurgical Intervention Along With Use of Mineral Trioxide Aggregate (MTA) and Bone Graft: A Case Report.

Radicular cysts are the most common cystic lesions that affect the jaws, which, though mostly asymptomatic, can be seen radiographically as an oval or pear-shaped unilocular radiolucency in the periapical region. Nonsurgical root canal procedures and periapical surgery followed by placement of bone substitute and bioceramic root-end filling material is generally the treatment of choice. This case report highlights the endosurgical management of long-standing trauma that led to a radicular cyst with respect to three maxillary anterior teeth in a young adult. The clinical and radiographic examination led to a provisional diagnosis of a radicular cyst, which was confirmed by biopsy. Non-surgical root canal treatment was performed with Mineral Trioxide Aggregate (MTA) as the apical barrier and surgical enucleation of the cyst was performed followed by placement of hydroxyapatite bone graft. Follow-ups till two years were done, which revealed the successful management of the case.

Evaluation of antimicrobial efficacy of ethanolic extract of Cuminium Cyminium as intracanal medicament on common bacteria of endodontic infections: An in vitro study.

Context: Antimicrobial intracanal medicaments play a vital role in successful outcome of any endodontic procedure. One such plant extract Cuminium cyminium, as intracanal medicaments needs to be researched. Aims: The purpose of this study was in vitro assessment of the antibacterial activity of ethanol extract of C. Cyminium in comparison to Calcium hydroxide (Ca[OH]2) as intracanal medicament against the pathogens of endodontic infection, at an interval 1 h, 24 h, 48 h, and 72 h. Settings and Design: The study was conducted in the central research laboratory of our institute. Freshly prepared C. cyminium extract was procured from AYUSH approved laboratory and direct contact test (DCT) was utilized, which is based on turbidometric determination of microbial growth in a 96-well microplate, carrying 6 times for each bacteria. Methodology: Three groups were assigned for each material in a 96 microwell plate for DCT. Bacterial growth kinetics was monitored at intervals of 1 h, 24 h, 48 h, and 72 h using spectrophotometer at 595 nm. The optical density of T2 (Test group), P2 (Positive control), and N2 (Negative control) was considered. Statistical Analysis Used: After compiling the data, based on the normality of data, further statistical analysis was conducted using Kolmogorov-Smirnov test, Paired t-test, and pairwise comparisons by Turkey's multiple post hoc procedures. The level of statistical significance was set at P = 0.05. Results: The comparison of mean optical density values of C. cyminium in comparison with Ca(OH)2 against the microorganisms of endodontic origin showed a statically significant decrease in bacterial viability at the end of 24 h, 48 h, and 72 h. Conclusion: Based on the results of the study, it can be concluded that C. cyminium has significant antibacterial action against endodontic origin, at interval of 24 h, 48 h, and 72 h.

Comparative Evaluation of Antimicrobial Efficacy of Various Antibiotic Pastes and Calcium Hydroxide Using Chitosan as a Carrier Against Enterococcus faecalis: An In Vitro Study.

INTRODUCTION: The use of intracanal medicaments between appointments can serve as an important aid in the sterilization of the root canal system. Calcium hydroxide is commonly used, but it is not completely effective against Enterococcus faecalis. A triple antibiotic paste (TAP) is used but has the problem of tooth discoloration. Double antibiotic paste (DAP) or modified TAP (MTAP) has been suggested to solve this. Chitosan has been used as a vehicle in pharmacology, and it has inherent antibacterial properties too. OBJECTIVE: This study compares the efficacy of DAP and MTAP using chitosan as a vehicle with calcium hydroxide. MATERIALS AND METHODS: Sixty single-rooted teeth were taken and decoronated with a length of 13 mm. Biomechanical preparation (BMP) was done with #3 Gates-Glidden (GG) drills, 17% ethylenediaminetetraacetic acid (EDTA), and 5.25% sodium hypochlorite (NaOCl) used for irrigation. These were kept in microcentrifuge tubes with 1 ml brain heart infusion (BHI) broth. Contamination was done with E. faecalis strain for 21 days. DAP and MTAP pastes were prepared and added to the chitosan solution. Groups were divided into 10 each, each medicament with saline or chitosan as the vehicle. The microbial load was measured at the end of two and seven days. RESULTS: The level of significance was kept at p = 0.05. Statistical analysis was done with the Kruskal-Wallis test and analysis of variance (ANOVA). DAP and MTAP groups with chitosan showed a significant reduction in the microbial load when compared to calcium hydroxide with chitosan. CONCLUSION: DAP and MTAP with chitosan can be effective intracanal medicaments against E. faecalis in refractory endodontic cases.

Stevia vs. triple antibiotic paste: An intracanal battle?

BACKGROUND: Intracanal medicaments are vital in treating the infections of the deciduous dentition due to the large percentage of accessory canals that hasten the microbial spread to the periradicular region. Though countless medicaments have been produced to reduce the microbial load and aid symptomatic relief, they still do not fulfill every function of an ideal medicament. OBJECTIVES: The aim of the present study was to evaluate and compare the antimicrobial efficacy of Stevia rebaudiana (S. rebaudiana) and triple antibiotic paste (TAP) against Enterococcus faecalis (E. faecalis). MATERIAL AND METHODS: The present in vitro, parallel, double-blinded study had an equal allocation ratio. The specimens were prepared, randomly divided into 4 groups and inoculated with E. faecalis (ATCC35550). Following incubation, the first 3 groups were treated with S. rebaudiana, triple antibiotic therapy or carbopol gel, respectively, with the 4th negative control group left untreated. The microbial samples were collected before and after treatment, and the counts of colony-forming units (CFUs) were compared. The results were analyzed using the Kruskal-Wallis, Dunn's post-hoc and Wilcoxon's signed rank tests. RESULTS: The first 2 groups displayed a significant decrease in CFUs after drug application, while the carbopol and control groups showed an exponential increase. There was no statistically significant difference between the stevia and TAP groups (p = 0.630). CONCLUSIONS: Stevia gel was comparable to TAP in terms of antimicrobial efficacy, and can therefore be considered a new alternative in intracanal treatment.

Anti-bacterial efficacy of Aloe vera against E. Faecalis in comparison to other intracanal medicaments: A systematic review and meta-analysis.

Introduction: This review article aims to evaluate the antibacterial efficacy of Aloe vera against Enterococcus faecalis (E. faecalis) in comparison to other intracanal medicaments by assessing experimental in-vitro studies associated with the objective, many of which performed bacterial inoculation on extracted human teeth or directly on laboratory petri dishes. Materials & Methods: Publications from 2012 to 2022 were retrieved from databases, including PubMed, Scopus, and Cochrane Library, and they were screened against our inclusion criteria, leading to the incorporation of 18 studies into the systematic review and nine into the meta-analysis. Colony-forming units (CFUs) in the Aloe vera group were compared with saline, sodium hypochlorite (NaOCl), chlorhexidine (CHX), and calcium hydroxide (CaOH) using a meta-analysis (Stata software version 16.0), and forest plots were computed to record the sample size, mean and standard deviation value of the outcome CFU, and 95% confidence intervals. Results: This systematic review indicates that Aloe vera demonstrates bactericidal properties that are higher than or similar to those of saline and CaOH, but CHX, NaOCl, and propolis exhibited higher antibacterial properties against E. faecalis than Aloe vera. In a meta-analysis, Aloe vera showed a non-significantly lower CFU count than CaOH and saline (p > 0.05), while Aloe vera had a higher CFU count than CHX and NaOCl (p > 0.05). Conclusion: In summary, Aloe vera exhibits antibacterial capabilities against E. faecalis that are superior or equal to those of saline and CaOH, respectively, while CHX and NaOCl showed greater antibacterial efficacy against E. faecalis than Aloe vera (PROSPERO registration no. CRD42022314790).

Comparative Evaluation of Antimicrobial Efficacy of Calcium Hydroxide, Chlorhexidine, and Triple Antibiotic Paste in Different Combination Forms as Intracanal Medicaments against Enterococcus faecalis in Primary Teeth: An In Vivo Randomized Clinical Trial.

Aim: To compare and evaluate the antimicrobial efficacy against Enterococcus faecalis (E. faecalis) between a mix of calcium hydroxide [Ca(OH)2] powder and normal saline, a mix of Ca(OH)2 powder and 2% chlorhexidine (CHX) gluconate solution, a mix of triple antibiotic powder (TAP) and normal saline, and mix of TAP and 2% CHX gluconate solution. Materials and methods: A total of 60 teeth were included in the study. The first sample (S1) was collected after access opening from the widest canal of the tooth by inserting sterile absorbable paper point no 20 up to the full length of the canal for 1 minute. The second sample (S2) was collected after the chemomechanical preparation and irrigation. After that, subjects were randomly divided into four groups-group I-a mix of Ca(OH)2 and normal saline; group II-a mix of Ca(OH)2 and 2% CHX; group III-a mix of TAP and normal saline; and group IV-a mix of TAP and 2% CHX. Assigned intracanal medicaments were placed in the canals, and the teeth were temporarily sealed with a temporary restorative material. On the 7th day, canals were reopened and irrigated, and a third bacteriological sample (S3) was taken out. Later, canals were filled with suitable obturating material, followed by the placement of the permanent restoration. Results: There was a very highly significant (p < 0.005) difference in E. faecalis count in all the groups on day 7 after placement of intracanal medicament, being highest in group IV followed by group II, group III, and group I. Conclusion: Triple antibiotic powder (TAP) mixed with 2% CHX gluconate solution has superior antimicrobial efficacy against E. faecalis in primary teeth. How to cite this article: Qamar S, Jayanna R, Ahuja VR. Comparative Evaluation of Antimicrobial Efficacy of Calcium Hydroxide, Chlorhexidine, and Triple Antibiotic Paste in Different Combination Forms as Intracanal Medicaments against Enterococcus faecalis in Primary Teeth: An In Vivo Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(3):448-452.

Influence of Simulated Wound Exudate on the Antimicrobial Efficacy of Various Intracanal Medicaments Against Enterococcus faecalis: An In Vitro Study.

Aim The aim of this study is to compare and evaluate the antimicrobial efficacy of chlorhexidine, calcium hydroxide, and cetylpyridinium chloride against Enterococcus faecalis in the presence and absence of contamination with simulated periapical exudate at different time intervals. Methods Simulated wound exudate and cetylpyridinium chloride gel were prepared prior to testing. The test groups were divided into groups A and B based on the presence and absence of simulated wound exudate. They were further divided into four subgroups as follows: subgroup 1: calcium hydroxide; subgroup 2: 2% chlorhexidine gel; subgroup 3: 0.5% cetylpyridinium chloride gel; subgroup 4: 0.9% saline as control. E. faecalis was inoculated, and the test groups were evaluated at different time periods of six, 12, and 24 hours. Aliquots were then obtained and subjected to 10-fold serial dilutions. A total of 10 µl of individual samples was spread onto the nutrient agar medium using L-rod. The plates were then assessed for colony-forming units (CFU), and the values obtained were subjected to statistical analysis. Kolmogorov-Smirnov and Shapiro-Wilk normality tests were used to check whether the variables follow a normal distribution. For within-group comparison, the Friedman test and the Kruskal-Wallis test were used. For between-group comparison, the Mann-Whitney U test was used. Results Saline had the highest CFU values, while cetylpyridinium chloride had the lowest CFU values in both contaminated and non-contaminated groups. In all the conditions, the CFU values of cetylpyridinium chloride were significantly lowest compared to the other three groups. CFU values of the calcium hydroxide group were significantly high, followed by the chlorhexidine group when compared to cetylpyridinium chloride in both contaminated and non-contaminated groups. Conclusion Within the limitations of the current study, it can be concluded that cetylpyridinium chloride was the most effective intracanal medicament against E. faecalis than calcium hydroxide and chlorhexidine at varying time intervals, even in the presence of a periapical exudate. Thus, cetylpyridinium chloride can be considered an effective intracanal medicament for root canal disinfection.

In Vivo Assessment of the Calcium Salt-Forming Ability of a New Calcium Silicate-Based Intracanal Medicament: Bio-C Temp.

Calcium salt precipitation induced by intracanal medicaments contributes to the formation of apical hard tissue during apexification. This study compared the calcium salt-forming ability of a new calcium silicate-based intracanal medicament (Bio-C Temp) with that of two commercial calcium hydroxide pastes (Calcipex Plane II and Vitapex) in a rat subcutaneous implantation model. Polytetrafluoroethylene tubes containing each of the three materials were subcutaneously implanted in 4-week-old male Wistar rats. After 28 days, the composition and amount of calcium salts formed at the material-tissue interface were assessed using micro-Raman spectroscopy, X-ray diffraction, and elemental mapping. The tested materials produced white precipitates that had Raman spectra with peaks corresponding to hydroxyapatite and calcite. X-ray diffraction detected hydroxyapatite formation on Calcipex Plane II and Vitapex implants, as well as calcite formation on all three materials. Elemental mapping revealed that Bio-C Temp generated significantly smaller calcium- and phosphorus-rich calcified regions within the subcutaneous connective tissue than Vitapex. These results indicate that Bio-C Temp produced less calcium salt in rat subcutaneous tissue than Vitapex, although all materials formed hydroxyapatite and calcite in rat subcutaneous tissue. Bio-C Temp could be less effective than Vitapex in promoting apical hard tissue formation during apexification.

Periapical Lesion: A Single-Sitting Root Canal Treatment.

The aim of root canal treatment is to disinfect the root canal completely and prevent the progression of any periapical infection. Surgical treatment of periapical lesions is associated with many complications and challenges. This article describes the management of a periapical lesion of the right lower premolar in a single-visit root canal procedure using Metapex. The patient was observed for one week for any incidences of flare-ups.