ORIGINAL RESEARCH |
https://doi.org/10.5005/jp-journals-10005-2485 |
To Evaluate the Success of Natural Compound: Curcumin as Obturating Material in Primary Teeth
1–5Department of Pedodontics & Preventive Dentistry, Faculty of Dental Sciences The SGT Dental College, Hospital & Research Institute, Shree Guru Gobind Singh Tricentenary University, Gurugram, Harayana, India
6Department of Pharmaceutics, SGT College of Pharmacy, Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana, India
Corresponding Author: Rashmi Dalal, Department of Pedodontics & Preventive Dentistry, Faculty of Dental Sciences The SGT Dental College, Hospital & Research Institute, Shree Guru Gobind Singh Tricentenary University, Gurugram, Harayana, India, Phone: +91 8398883473, e-mail: rashmidalal8398883473@gmail.com
ABSTRACT
Background: In a quest a search for newer obturating materials, trends have now shifted from more harmful chemical-based compounds to less toxic and more natural Ayurvedic or herbal materials. Curcumin—a natural extract from turmeric rhizomes, possesses anti-inflammatory and antimicrobial properties and thus may be used as a novel obturating material in the primary teeth.
Objective: To evaluate and compare the efficacy of curcumin powder mixed with zinc oxide-eugenol (ZOE) and ZOE as obturating materials in primary molars.
Materials and methods: A total of 30 primary molars indicated for pulpectomy were selected from 4–8-year-old children and divided into two groups. Group 1—ZOE group included 11 teeth, and in group II, 19 teeth were obturated with—curcumin mixed with ZOE mixed (ZOE + C). The efficacy of these obturation materials was evaluated both clinically and radiographically after 3, 6, and 9 months.
Results: At 9 months, there was a significant reduction in preoperative clinical signs and symptoms. Mobility was absent in all the teeth in group I, while 5 teeth presented with mobility in group II after 9 months.
On radiographic assessment, at the end of the 9 months, material resorption was similar to physiological root resorption in 40% of teeth in group I and 22.2% in group II. Interradicular radiolucency increased in 66.7% of teeth in group II when compared to 20% of teeth in group I. Pathological root resorption was seen in 10% of roots in the ZOE group and 55.6% of the roots in the ZOE+C group.
How to cite this article: Dalal R, Gupta A, Srivastava A, et al. To Evaluate the Success of Natural Compound: Curcumin as Obturating Material in Primary Teeth. Int J Clin Pediatr Dent 2023;16(6):793–799.
Conclusion: Despite the well-documented antibacterial and anti-inflammatory properties of curcumin powder in literature, considering the results of the present study we cannot suggest curcumin powder as successful alternative obturation material for treating deciduous teeth.
Source of support: Nil
Conflict of interest: None
Patient consent statement: The author(s) have obtained written informed consent from the patient’s parents/legal guardians for publication of the case report details and related images.
Keywords: Curcumin, Obturation, Primary teeth, Pulpectomy
INTRODUCTION
Dental caries is the most prevalent chronic oral disease affecting primary dentition. Morphologic variations and negligence in oral hygiene maintenance particularly predispose children to the development of carious lesions and early involvement of the pulp. Maintaining the primary dentition healthy and intact till its normal exfoliation is considered one of the most important aims of pediatric dentistry. A pulpectomy is the preferred procedure for preserving a restorable primary tooth with irreversibly inflamed or necrotic pulp, which would otherwise undergo extraction. The success of the pulpectomy procedure depends on the material being used to obturate the root canals of the primary tooth.1–4
The complex morphology of primary root canals with the presence of several fins and isthmus and the polymicrobial nature of the endodontic infection makes it nearly impossible to achieve complete debridement by biomechanical preparation alone, thus posing several challenges for the clinician. Therefore, an obturating material for primary teeth must possess high antimicrobial efficacy along with several other properties of an ideal obturating material. It should resorb at the same rate as the physiological root resorption, should be biocompatible, non-irritating to periapical tissue, and cause no harm to underlying permanent tooth germs.5,6
Several materials are in use as obturating materials for the primary teeth, in which ZOE is considered the oldest and the most widely used material. It is readily available, possesses anti-inflammatory and some antimicrobial properties, and can be easily manipulated, but it possesses several drawbacks like resorbs at a rate slower than that of the physiological root resorption, deflects the path of the permanent tooth germ, causes periapical tissue irritation, cementum, and bone necrosis.
Zinc oxide-eugenol (ZOE) was followed by the introduction of several other obturating materials like calcium hydroxide, endoflas, iodoform based pastes such as metapex and vitapex; one trying to overcome the drawbacks of the other and to achieve all the properties of ideal obturating material.5–7
More recently, trends have shifted from chemical-based materials to more economical and less harmful natural products and their derivatives. Several herbal and Ayurvedic materials have been given trials in the field of pediatric endodontics in recent years. With high therapeutic value, ease of availability, simplicity of use, greater efficacy, lesser side effects, and economical for the general population, they have gained a lot of popularity in the modern era. Aloe vera, propolis, and tulsi have been given trials in pulpectomy as an obturating material. Their natural extracts, in combination with conventional materials like ZOE and Endoflas, have shown significant clinical and radiographic success.5,8,9
Intense research in the field of pediatric endodontics leads to the introduction of several synthetic and natural obturating materials for pulpectomy in primary teeth. However, not a single material can be said to have all the properties of an ideal obturating material.
Curcumin (diferuloylmethane) is an orange-yellow colored polyphenol derived from the rhizomes of the Curcuma longa plant, a member of the Zingiberaceae family, naturally occurring throughout tropical and subtropical regions of the world. It has been an important ingredient in traditional Ayurvedic and Chinese medicine for thousands of years. It is now known to possess a wide spectrum of pharmacological actions, including antimicrobial, anti-inflammatory, analgesic, antioxidant, chemo-sensitizing, and immunomodulatory properties.10–12
Curcumin has got antimicrobial action and inhibits the growth of various bacteria, fungi, and viruses. The inhibitory effects of curcumin on the cariogenic property of Streptococcus mutans are observed at concentrations as low as 0.5–4 mg/mL. It is effective against Enterococcus faecalis (E. faecalis) and thus can serve to be useful as root canal medicament in endodontics. It has been successfully used in photodynamic therapy against oral bacteria, fungi, and strains resistant to conventional drugs.
In dentistry, turmeric extracts have also been used as pit and fissure sealants, in plaque detection systems, as anticariogenic material, in the treatment of recurrent aphthous stomatitis, oral submucous fibrosis, and in various types of mouthwash, and as subgingival irrigant.12,13
It has been used as a pulpotomy agent in vital pulp therapy of primary molars. In spite of its diverse uses in various fields of dentistry, there is a paucity of literature on its use as an obturating material.14
With this never-ending quest for the search of an ideal obturating material, the present study was performed on patients visiting the Department of Pedodontics & Preventive Dentistry in SGT Dental Hospital, Hospital & Research Institute, Gurugram-NCR region of Haryana, India, with the aim to access the efficacy of curcumin extract as an obturating material for the root canals of primary teeth. The clinical and radiographic success rate of curcumin powder mixed with ZOE as an obturating material in pulpectomy procedure in primary molars was evaluated. To the best of our knowledge and as per online search, this was the first study in the Gurugram-NCR region to evaluate the efficacy of curcumin as root canal obturating material in the primary molars.
MATERIALS AND METHODS
This study was conducted in the Department of Pedodontics & Preventive Dentistry at the Faculty of Dental Sciences, SGT University, Gurugram-NCR, Haryana, India, after approval from the Ethical Committee. Informed written consent was taken from the parents of the children involved. Possible benefits and limitations were explained to the parents prior to treatment. The evaluation was done by clinical and radiographic examination. The duration of the study was from August 2020 to May 2021. The study was also registered under the Clinical Trials Registry of India (CTRI) with registration number CTRI/2020/08/026996.
Sample Size
A total of 30 primary molars indicated for pulpectomy in 4–8-year-old children who reported to the Department of Pedodontics & Preventive Dentistry at the Faculty of Dental Sciences, SGT University, Gurugram, were selected. The selected samples were randomly divided into 2 groups:
- Group I: ZOE
- Group II: ZOE + C
Inclusion Criteria
- Children in the age group of 4–8 years were selected.
- Presence of deep caries, with a history of spontaneous pain and carious exposure to pulp.
- Any sign of inflammation if present.
- Presence of any of these—fistula, sinus, abscess, or interradicular (furcation) radiolucency present radiographically.
Exclusion Criteria
- Intake of antibiotics within 2 weeks before the treatment.
- Extensive root resorption.
- Inadequate bone support or hypermobility.
- Nonrestorable tooth.
Methodology
Written consent was obtained from the parents of the children before starting the procedure, and the 30 selected teeth that fulfilled the inclusion criteria were prepared for the pulpectomy procedure under the rubber dam isolation.
The procedure involved the removal of all the carious tooth structures, done using a round bur (no. 6), and straight-line access was achieved. Pulp was extirpated from the root canals using H and K hand files, along with copious irrigation with 2.5% sodium hypochlorite and normal saline to remove the entire pulp tissue.
A diagnostic radiograph was taken to check the exact length of the root canal, with snugly fitting files extending peri-apically to an average length of that particular tooth. After the working length was established, the files were used to extirpate the pulp and clean the canal up to maximum size no.# 30. Root canals were irrigated thoroughly with 2.5% sodium hypochlorite solution, and normal saline was used as the last irrigating solution. Canals were dried completely using paper points before obturation.
Past inject paste carrier was used with a contra-angled handpiece for obturation in both groups. In the control group, ZO powder was mixed on a glass slab with stainless steel spatula in increments with eugenol into a thick mix which was used to obturate the root canals of primary teeth.
In the experimental group,1 part of curcumin powder was mixed with 100 parts of ZO powder (1:100) (curcumin powder to ZO powder) mixed on the glass slab with stainless steel spatula in increments which was further mixed with eugenol, using the folding technique to form a thick paste. In the present study, curcumin powder in group II was procured from Natural Remedies Private Limited, Bengaluru, India for this study. Curcumin powder was mixed with ZO powder in 1:100 and was calculated in accordance with the study conducted by Menni et al.15 in which they used curcumin gel (Curenext oral gel, ABBOTT India limited) mixed with Endoflas powder in a ratio of 1:3 (Fig. 1).
Fig. 1: Paste formed after mixing of ZO and curcumin powder with eugenol
After obturating the root canals of the tooth, it was restored with glass ionomer cement or composite, and the final restoration was done with stainless steel crown. The patient was examined both clinically and radiographically, postoperatively at 3, 6, and 9 months. Two calibrated examiners who did not perform the treatment analyzed and evaluated the changes as per predefined criteria. In total, 11 teeth were present in group I and 19 teeth in group II. There was a loss to follow-up of one tooth in each group at a 9-month interval.
The teeth were evaluated clinically and radiographically, and clinical evaluation included a decrease in pain, tenderness on percussion (TOP), abscess, swelling, fistula, and pathologic mobility, whereas radiographic assessment included evaluation of resorption of obturating material in comparison with the physiological resorption of the roots, change in the radiolucency in the inter-radicular area and change in the inclination of the underlying permanent tooth germ. The evaluation was done preoperatively and postoperatively at 3, 6, and 9 months.
Statistical Analysis
The data collected was entered into Microsoft Excel and then transferred to Statistical Package for the Social Sciences version 20. Descriptive and inferential statistics were done. Descriptive methods were used to describe the demographic and baseline details of study participants. Categorical data were presented in the form of proportion, and the chi-squared test or Fisher exact test was used for the test of significance. Both inter-group and intragroup statistical analysis was done. All the statistical tests were performed at a 5% significance level.
RESULTS
The most common teeth involved in group I was the mandibular second molar, and the most common teeth involved in group II were the maxillary first molar, followed by the mandibular first molar. The preoperative and postoperative clinical signs and symptoms were tabulated. There was a reduction in all the clinical signs and symptoms after the pulpectomy procedure was completed, and this change was statistically significant when assessed for the absence of pain (p = 0.00) and abscess (p = 0.01) in both groups. At the 9-month follow-up, the pain was reported by one patient in each group, TOP was reported by one patient in the ZOE group, and two patients in the ZOE +C group. Abscess and swelling were not reported in any of the patients in the two groups. Mobility was absent in all the teeth in the ZOE group and was reported in five teeth in the ZOE + C group during the 9-month follow-up period (Tables 1 and 2).
| Clinical parameters | Preoperative N = 11 (100%) |
Postoperative N = 11 (100%) |
p-value |
|---|---|---|---|
| Pain (present) | 9 (81.2) | 0 | 0.00 |
| Tender on percussion | 4 (36.4) | 4 (36.4) | 1.00 |
| Abscess | 1 (9.1) | 0 | 0.01 |
| Mobility | 1 (9.1) | 1 (9.1) | 1.00 |
Bold terms are statistically significant as p < 0.05 Chi-squared test/Fischer’s exact test/McNemar’s test
| Clinical parameters | Preoperative N = 19 (100%) |
Postoperative N = 19 (100%) |
p-value |
|---|---|---|---|
| Pain | 15 (78.9) | 0 | 0.00 |
| Tender on percussion | 10 (52.6) | 7 (36.8) | 0.25 |
| Abscess | 6 (31.6) | 0 | 0.01 |
| Mobility | 6 (31.6) | 5 (26.3) | 1.00 |
Bold terms are statistically significant as p < 0.05 Chi-squared test/Fischer’s exact test/McNemar’s test
In the ZOE group, in 60% of teeth, the resorption of obturating material showed an unfavorable outcome (resorption of material was faster than physiological root resorption in 20% of teeth and slower in 40% of teeth), in 40% teeth the material resorbed at the same rate, as that of the physiological root resorption (favorable resorption). This difference was statistically significant (p = 0.03). In the ZOE + C group, the obturating material resorbed at a faster rate in 72.2% of teeth, a slower rate in 5.6% of teeth, and the material resorption was similar to that of root in 22.2% of teeth. The difference was statistically significant (p = 0.00) (Tables 3 and 4).
| Radiographical parameters | Preoperative N = 11 (100%) | After 9 months N = 10 (100%) | p-value |
|---|---|---|---|
| Radiographic assessment of material at 9 months | – | 0.03 | |
| Favourable (Same rate of resorption) | |||
| Unfavourable | 4 (40.0) | ||
| Slower rate of resorption | 4 (40.0) | ||
| Faster rate of resorption | 2 (20.0) | ||
| Interradicular radiolucency present | |||
| Change in 9 months | 7 (70) | 0.06 | |
| Unfavorable (increase in radiolucency) | – | 2 (20.0) | |
| Favourable (Decrease or No change in radiolucency) | 8(80.0) | ||
| Inclination of underlying tooth germ | 0.59 | ||
| Vertical/original | 9 (81.8) | 7 (63.6) | – |
| Mesial | 0 | 2 (18.2) | 1.00 |
| Distal | 2 (18.2) | 1 (9.1) | 0.59 |
| Pathological root resorption | 0 | 2 (10.0) | 0.50 |
Bold terms are statistically significant as p < 0.05 Chi-squared test/Fischer’s exact test/McNemar’s test
| Radiographical parameters | Preoperative N = 19 (100%) |
After 9 months N = 18 (100%) |
p-value |
|---|---|---|---|
| Radiographic assessment of material at 9 months | |||
| Favourable (same rate of resorption) | 4 (22.2) | ||
| Unfavorable | |||
| Slower rate of resorption | 1 (5.6) | ||
| Faster rate of resorption | – | 13 (72.2) | 0.00 |
| Interradicular radiolucency present | 12 (63.2) | 12 (66.7) | 1.00 |
| Change in 9 months | |||
| Unfavorable (increase in radiolucency) | 6 (33.3) | ||
| Favourable (decrease or remain same in radiolucency) | |||
| Inclination of underlying tooth germ | 0.38 | ||
| Vertical/original | 15 (78.9) | 6 (31.6) | – |
| Mesial | 1 (5.3) | 5 (26.3) | 1.00 |
| Distal | 3 (15.8) | 7 (38.9) | 0.19 |
| Pathological root resorption at 9 months | 20 (55.6) | 0.00 | |
Bold terms are statistically significant as p < 0.05
On radiographic assessment, Inter-radicular radiolucency was present in 70% of the teeth in the ZOE group and 63.2% of teeth in the ZOE+C group preoperatively. At 9 months, it increased in 20% of teeth in the ZOE group (unfavorable outcome). In ZOE + C group, inter-radicular radiolucency increased in 66.7% of teeth after a follow-up of 9 months (Tables 3 and 4).
Preoperatively in the ZOE group, the inclination of underlying tooth germ was vertical in 81.8% of teeth and distal in 18.2% of teeth, whereas 63.6% of teeth showed original or vertical inclination after a follow-up of 9 months. In the ZOE + C group, 78.9% of teeth had a vertical inclination of underlying tooth germ preoperatively,5.3% had mesial, and 15.8% had a distal inclination in this group. After 9 months of follow-up, 31.6% had the original inclination, 26.3% had the mesial inclination, and 38.9% had a distal inclination of the underlying tooth bud (Tables 3 and 4).
Pathological root resorption was seen in none of the roots preoperatively, whereas, at 9 months follow-up, it was seen in 10% of roots in the ZOE group and 55.6% of the roots in the ZOE+C group, and this difference was statistically significant (p = 0.00) (Tables 3 and 4).
DISCUSSION
A pulpectomy is considered the most important procedure in maintaining the integrity of a restorable, irreversibly inflamed, or necrotic primary tooth that would otherwise undergo extraction, and the success rate of this procedure depends entirely on the material being used to obturate the root canals of the primary teeth.3,5,7
Several materials are in use as obturating materials for the primary teeth, in which ZOE is considered the oldest and the most widely used material. It was first introduced in dentistry by Chisholm in the year 1876 and by Sweet as obturating material in the year 1930. ZOE is readily available, possesses anti-inflammatory and some antimicrobial properties, and can be easily manipulated, but it possesses several drawbacks, resorbs at a rate slower than that of the physiological root resorption, deflects the path of the permanent tooth germ, causes periapical tissue irritation, cementum, and bone necrosis.5,7
The present study included 30 primary molars in children with a mean age of 5.9 ± 1.3 years, divided into two groups; group I included 11 teeth obturated with ZOE, and group II included 19 teeth that were obturated with ZOE + C as obturating material. The teeth were evaluated for clinical and radiographic success postoperatively, at 3, 6, and 9 months follow-up.
In the present study, in ZOE, clinical signs and symptoms decreased in all the teeth postoperatively, and only one patient reported pain and TOP at 9 months follow-up. Similarly, in the study done by Pandranki et al.,16 no teeth were reported to have pain, mobility, and abscess at 9 months follow-up in the ZOE group. Chen et al.17 reported a 100% clinical success rate after ZOE pulpectomy at 6 and 12 months intervals with 92.2% clinical success at 18 months intervals. Gould18 reported 68.7%, and Fuks et al.19 reported a 65% success rate with ZOE.
On the radiographic assessment of ZOE at 9 months interval in the present study, the same rate of resorption of material was observed in 40% of teeth, and 40% of teeth had a slower rate of ZOE resorption. In the study reported by Menni et al.15 in the ZOE group, 6.6% of teeth had material resorption slower than that of the root, and 93.3% of teeth had a similar rate of material resorption. The slower rate of ZOE resorption is also reported in other studies in the literature. Allen et al.20 reported a difference in the resorption rate of ZOE and the root; the rate of resorption of ZOE was slower than that of the physiological root resorption and resulting in smaller areas of ZOE retention. Coll et al.21 stated that a fibrous capsule is formed around the ZOE material extruded beyond the apex, which causes retention of the material even after tooth exfoliation and may take several months or years to resorb. Similar findings were also reported by Barker and Lockett,22 Spedding et al.,23 and Mortazavi et al.24
In the present study in group II, curcumin was used in combination with ZOE for obturating the root canals of primary molars. Curcumin is a natural extract from the rhizomes of the Curcuma longa plant and is famous for its extensive therapeutic properties. Chainani-Wu et al.25 reported a systematic review proving the safety of curcumin in several human trials and its role as a potent anti-inflammatory agent. Its anti-inflammatory, antioxidant, and anti-carcinogenic properties have been reported by several authors who conducted various in-vitro and in-vivo trials over a period of many years. Priyadarsini et al.,26 Menon et al.,27 and Aggarwal et al.28 have made a significant contribution to this area of research.
Curcumin is a known broad-spectrum antimicrobial agent and has been, thus, used as a root canal irrigant and medicament to achieve disinfection in endodontic procedures. It has also been used as a pulpotomy agent and for obturating the root canals of primary teeth.
Devaraj et al.29 and DJ Sinha et al.30 reported equal efficacy of triple antibiotic paste and photoactivated curcumin against root canal pathogen E. faecalis. Yadav et al.31 compared the antimicrobial efficacy of curcumin gel with calcium hydroxide and chlorhexidine and reported its significant efficacy against E. faecalis. Several other studies confirming the antibacterial efficacy of curcumin against root canal pathogens, mainly E. faecalis, were conducted by Neelakantan et al.,32 Prabhakar et al.,33 and Mandroli et al.34
In pediatric endodontics, Hugar et al.35 compared the success rate of turmeric gel as a pulpotomy agent in the primary molars. Similarly, Purohit et al.14 reported the clinical and radiographic success of turmeric gel as a pulpotomy agent in primary teeth. Prabhakar et al.36 evaluated curcumin as a pulpotomy agent in rat molars and found results comparable to mineral trioxide aggregate pulpotomy.
With diverse uses of curcumin in the field of dentistry, its use as an obturating material is gaining attention now. Radhakrishna et al.,37 for the first time, reported a case series where four primary molars that had undergone pulpectomy procedures were obturated with curcumin gel mixed with endoflas powder (CGE). Menni et al.15 reported the first randomized control trial, evaluating a total of 30 primary molars indicated for pulpectomy in 4–9-year-old children. In this study, teeth were obturated with ZOE and CGE. It was a new material in combination with endoflas, reporting promising results.
In the ZOE + C group in the present study, there was a 100% reduction in pain and abscess postoperatively, and only one patient reported pain in a tooth at 9 months to follow-up. At 9 months, two teeth were reported with TOP, and five teeth were reported with mobility. The results were in accordance with the study reported by Menni et al.,15 where the CGE group showed a 100% clinical success rate at the end of 6 months. Similar results were obtained in the case series reported by Radhakrishna et al.37 all four teeth remained clinically asymptomatic at the end of 3 months.
In radiographic assessment in the ZOE + C group, 77.8% of teeth were reported with unfavorable outcomes, where the material resorption was slower in 5.6% and faster than physiological root resorption in 72.2% of teeth. Only four teeth (22.2%) were reported with a similar rate of resorption of the material and the root. The results were incomparable with the results of the study reported by Menni et al.,15 where in the CGE group, 33.3% of teeth had material resorption faster than the roots. In the case series reported by Radhakrishna et al.,37 one tooth in which material was extruded peri-apically, faster resorption of the material was seen within one week of obturation. One of the possible reasons for the faster resorption of curcumin may be its poor physicochemical stability, and rapid metabolism in the tissues, which is reported in the studies reported by Jager et al.38 and Karthikeyan et al.39 In the present study rate of resorption of curcumin was observed to be faster in teeth where the material extruded peri-apically as compared to teeth which were optimally or underfilled.
In the present study, at 9-month intervals, an increase in interradicular radiolucency was seen in 66.7% of teeth in ZOE + C group. In the study by Menni et al.,15 furcation radiolucency resolved at 6 months follow-up in all the teeth which presented with radiolucency preoperatively (53.3% teeth). In the case series reported by Radhakrishna et al.,37 two teeth presented with a decrease in radiolucency in the interradicular area at 3 months follow-up.40 The results of our study were thus contrary to the results of the previous study.
In the present study, pathological root resorption after a period of 9 months was seen in 55.6% of roots in the ZOE + C group, and 10% of roots presented with pathological root resorption in the ZOE group. In radiographic assessment, the results of the present study were different from the results of the study reported by Menni et al.15 The probable reasons may be explained according to the findings reported by Moskovitz et al. in 2005, who emphasized that the success rate of pulpectomy procedure does not depend entirely on the obturating material being used but also on the severity of pretreatment infection or radiolucency in the furcation area and also on the prevention from microleakage as soon as the pulpectomy procedure was completed.
Teeth that had pretreatment furcation radiolucency were reported to have more failures following the pulpectomy procedure by Coll et al.21 and Sadrian et al. in 1985. It also depends on the individual body’s response and resistance to infection (Fernandes et al., 1996).
One of the possible reasons for the pathological resorption of roots in the present study may be the concentration and formulation of curcumin used for obturation in the present study. In a study by Menni et al.,15 curcumin was used in gel form as compared to powder form in the present study. The use of a very precise concentration of curcumin drug is very important, as reported by Gorabi et al.,40 that curcumin at higher doses causes cell cytotoxicity. It is also supported by the findings of Chan et al. in 2006 studied the dose-dependent effect of curcumin on osteoblast proliferation and stated that curcumin at higher doses causes apoptosis and necrosis of bone remodeling cells. In the present study, pathological root resorption was seen mainly in teeth which were over-obturated than under or optimally obturated teeth in ZOE + C group.
CONCLUSION
Limitations of the present study include a smaller sample size, and along with this, age, gender, and involved tooth were variable factors in both the study groups. Also, the minimal inhibitory concentration and minimal bactericidal concentration of curcumin against root canal pathogens were not calculated prior to the study; the amount of drug used was calculated on the basis of previous studies in literature.
Within the limitations of the present study, it can be concluded that even though curcumin has high antibacterial and anti-inflammatory efficacy, considering the results of the present study, we cannot suggest curcumin in combination with ZOE as a successful obturating material for primary teeth. Considering its faster resorption from the canals, inability to decrease the preoperative furcation radiolucency, and a cause of pathological root resorption in a large number of roots, it cannot be suggested as a suitable alternative for the obturating materials in the primary teeth.
ORCID
Shalini Garg https://orcid.org/0000-0001-5931-0693
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