Evaluation of Antimicrobial Efficacy of various Intracanal Medicaments in Primary Teeth: An in vivo Study
Debasmita Das, PV Samir, Rajnish K Verma, Nipa Singh
Citation Information :
Das D, Samir P, Verma RK, Singh N. Evaluation of Antimicrobial Efficacy of various Intracanal Medicaments in Primary Teeth: An in vivo Study. Int J Clin Pediatr Dent 2017; 10 (3):267-271.
Introduction: Bacteria and their products play a primary etiological role in the initiation and perpetuation of pulpoperiapical pathosis. Intracanal medication is important for endodontic success as it eliminates microorganisms that persist after chemomechanical preparation.
Aim: To compare antimicrobial efficacy of calcium hydroxide powder, triple antibiotic paste, calcium hydroxide with 2% chlorhexidine solution, and triple antibiotic paste with 2% chlorhexidine solution.
Materials and methods: A total of 48 nonvital primary teeth were included in this study. After access opening first microbiological sample (s1) was collected by using absorbent paper point introducing into canal. Second microbilogical sample (s2) was taken following chemomechanical preparation and the teeth were divided into four groups: Group I: calcium hydroxide (CH) powder with distilled water; group II: CH with 2% chlorhexidine solution; group III: triple antibiotic powder with distilled water; group IV: triple antibiotic paste with 2% chlorhexidine solution. Then the canals were filled with any one group of the medicament and cavity was temporarily sealed with zinc oxide eugenol. After 1 week, a postmedication sample (s3) was collected. Then the canal was filled with Metapex, restored with glass ionomer cement.
Conclusion: From the experiments carried out in this study, with the limitations, an inference can be drawn that a combination of antimicrobial agent used as intracanal medicament is definitely better than single agent like Ca(OH)2.
Ohara PK, Torabinejad M, Kettering JD. Antibacterial effects of various endodontic irrigants on selected anaerobic bacteria. Endod Dent Traumatol 1993 Jun;9(3):95-100.
Marsh SJ, Largent MD. A bacteriologic study of the pulp canals of infected primary molars. J Dent Child 1967 Nov;34(6): 460-470.
Blome B, Braun A, Sobarzo V, Jepsen S. Molecular identification and quantification of bacteria from endodontic infections using real-time polymerase chain reaction. Oral Microbiol Immunol 2008 Oct;23(5):384-390.
Manzur A, González AM, Pozos A, Silva-Herzog D, Friedman S. Bacterial quantification in teeth with apical periodontitis related to instrumentation and different intracanal medications: a randomized clinical trial. J Endod 2007 Feb;33(2):114-118.
Smpson WJ. An examination of root canal anatomy of primary teeth. J Can Dent Assoc (Tor) 1973 Sep;39(9):637-640.
Valera MC, Salvia AC, Maekawa LE, Camargo SE, Carvalho CA, Camargo CH, Koga-Ito CY. Antimicrobial analysis of chlorhexidine gel and intracanal medicaments against microorganisms inoculated in root canals. Minerva Stomatol 2010 Jul-Aug;59(7-8):415-421.
Byström A, Claesson R, Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endod Dent Traumatol 1985 Oct;1(5):170-175.
Estrela C, Pimenta FC, Ito IY, Bammann L. In vitro determination of direct antimicrobial effect of calcium hydroxide. J Endod 1998 Jan;24(1):15-17.
Sathorn C, Parashos P, Messer H. Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysis. Int Endod J 2007 Jan;40(1):2-10.
Burrus D, Barbean L, Hodgson B. Treatment of abscessed primary molars utilizing lesion sterilisation and tissue repair: literature Review and Reports of three cases. Pediatr Dent 2014 May-Jun;36(3):240-244.
Pravakar AR, Sridevi E, Raju OS, Satish V. Endodontic treatment of primary teeth using combinations of antimicrobial drugs: an in vivo study. J Indian Soc Pedod Prev Dent 2008 Jan;26(Suppl 1):S5-S10.
Triaratvorakul C, Pepstomboonrat P. Success rates of mixture of ciprofloxacin, metronidazole and minocycline antibiotics used in non-instrumentation endodontic treatment of mandibular primary molars with carious pulp involvement. Int J Paediatr Dent 2012 May;22(3):217-227.
Onçag O, Gogulu D, Uzel A. Efficacy of various intracanal medicaments against Enterococcus faecalis in primary teeth: an in vivo study. J Clin Pediatr Dent 2006 Spring;30(3):233-237.
Saleh IM, Ruyter IE, Haapasalo M, Østravik D. Survival of Enterococcus faecalis in infected dentinal tubules after canal filling with different root canal sealers in vitro. Int Endod J 2004 Mar;37(3):193-198.
Grossman LI. Poly antibiotic treatment of pulpless teeth. J Am Dent Assoc 1951 Sep;43(3):265-278.
Almyroudi A, Mackenzie D, McHugh S, Saunders WP. The effectiveness of various disinfectants used as endodontic intracanal medications: an in vitro study. J Endod 2002 Mar;28(3):163-167.
Madhubala MM, Srinivasn N, Ahamed S. Comparative evaluation of propolis and triantibiotic mixture as an intracanal medicament against Enterococcus fecalis. J Endod 2011 Sep;37(9):1287-1289.
Gomes BP, Montagner F, Berber VB, Zaia AA, Ferraz CC, de Almeida JF, Souza-Filho FJ. Antimicrobial action of intracanal medicaments on the external root surface. J Dent 2009 Jan;37(1):76-81.
Heiling I, Steinberg D, Kenig S, Gavrilovich I, Sela MN, Friedman M. Efficacy of a sustained-release device containing chlorhexidine and Ca(OH)2 in preventing secondary infection of dentinal tubules. Int Endod J 1992 Jan;25(1):20-24.
Sinha N, Patil S, Dodwad PK, Patil AC, Singh B. Evaluation of antimicrobial efficacy of calcium hydroxide paste, chlorhexidine gel, and a combination of both as intracanal medicament: an in vivo comparative study. J Conserv Dent 2013 Jan-Feb;16(1):65-70.
Siqueira JF Jr, Rocas IN, Lopes HP, Magalhães FA, de Uzeda M. Elimination of Candida albicans infection of the radicular dentin by intracanal medications. J Endod 2003 Aug;29(8): 501-504.
de Souza-Filho FJ, Soares AJ, Vianna ME, Zaia AA, Ferraz CC, Gomes BP. Antimicrobial effect and pH of chlorhexidine gel and calcium hydroxide alone and associated with other materials. Braz Dent J 2008;19(1):28-33.
Gomes BP, Vianna ME, Sena NT, Zaia AA, Ferraz CC, de Souza Filho FJ. In vitro evaluation of the antimicrobial activity of calcium hydroxide combined with chlorhexidine gel used as intracanal medicament. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006 Oct;102(4):544-550.
Sato I, Ando-Kurihara N, kota K, Iwaku M, Hoshino E. Sterilization of infected root canal dentine by topical application of a mixture of Ciprofloxacin, metronidazole and minocycline in situ. Int Endod J 1996 Mar;29(2):118-124.
Murvindran V, Raj JD. Antibiotics as an intracanal medicament in Endodontics. J Pharm Sci Res 2014 Aug;6(9):297-301.
Saleh IM, Ruyter IE, Haapasalo M, Ostravik D. Survival of Enterococcus faecalis in infected dentinal tubules after canal filling with different root canal sealers in vitro. Int Endod J 2004 Mar;37(3):193-198.
Evensen NA, Braun PC. The effects of tea polyphenols on Candida albicans: inhibition of biofilm formation and proteasome inactivation. Can J Microbiol 2009 Sep;55(9):1033-1039.
Ross ZM, O'Gara EA, Hill DJ, Sleightholme HV, Maslin DJ. Antimicrobial properties of garlic oil against human enteric bacteria: evaluation of methodologies and comparisons with garlic oil sulfides and garlic powder. Appl Environ Microbiol 2001 Jan;67(1):475-480.
Prabhakar AR, Vipin A, Basappa N. Effect of curry leaves, garlic and tea tree oil on Streptococcus mutans and Lactobacilli in children: a clinical and microbiological study. Pesq Bras Odontopediatria Clin Integr 2009 Sep-Dec;9(3):259-263.
Whittaker JM, James RA, Lozada J, Cordova C, GaRey DJ. Histological response and clinical evaluation of heterograft and allograft materials in the elevation of the maxillary sinus for the preparation of endosteal dental implants sites. Simultaneous sinus elevation and root form implantation: An eight-month autopsy report. J Oral Implantol 1989;15(2):141-44.
Linkow LI, Wagner JR. Management of implant-related problems and infections. J Oral Implantol 1993;19(4): 321-35.
Vassos DM, Petrik PK. The sinus lift procedure: An alternative to the maxillary subperiosteal implant. Pract Periodont Aesth Dent 1992;4:14-19.
Judy KWM. Oral implantology case reports. NYS Dent J 1986;52:24-26.
Wagner JR. A 3½-year clinical evaluation of resorbable hydroxylapatite OsteoGen (HA Resorb) used for sinus lift augmentations in conjunction with the insertion of endosseous implants. J Oral Implantol. 1991;17:152-64.
Wagner JR. A clinical and histological case study using resorbable hydroxylapatite for the repair of osseous defects prior to endosseous implant surgery. J Oral Implantol 1989;15: 186-92.
LeGeros RZ. Calcium phosphates in oral biology and medicine. In: Myers HM (Ed). New York: Karger Press 1991;15.
Fang Y, Agrawal DK, Roy DM. Thermal stability of synthetic hydroxylapatite. In: Brown PW, Constantz B (Eds). Hydroxylapatite and Related Materials. CRC Press: Boca Raton, Fla: 1994:269-82.
Brown WE, Eidelman N, Tomazic B. Octacalcium phosphate as a precursor in biomineral formation. Adv Dent Res 1987;1:306-13.
Urist MR, Dowell TA. The newly deposited mineral in cartilage and bone matrix. Clin Orthopaed Rel Res 1967;50:291-308.
Bonar LC, Roufosse AH, Sabine WK, Grynpas MD, Glimcher MJ. X-ray diffraction studies of the crystallinity of bone mineral in newly synthesized and density fractionated bone. Calcif Tissue Int. 1983;35:202-09.
Roberts JE, Bonar LC, Griffin RG, Glimcher MJ. Characterization of very young mineral phases of bone by solid state phosphorus magic angle sample spinning nuclear magnetic resonance and X-ray diffraction. Calcif Tissue Int 1992;50: 42-48.
Lee DD, Landis WJ, Glimcher MJ. The solid, calcium-phosphate mineral phases in embryonic chick bone characterized by highvoltage electron diffraction. J Bone Min Res 1986;1:425-32.
Roberts WE, Turley PK, Brezniak N, Fielder PJ. Bone physiology and metabolism. Calif Dent Assoc J 1987;15:54-61.
Roberts WE. Bone tissue interface. J Dent Educ 1988;52: 804-09.
Brunski JB. Biomechanical factors affecting the bone-dental implant interface. Clin Mat 1992;10:153-201.
Spivak JM, Ricci JL, Blumenthal NC, Alexander H. A new canine model to evaluate the biological response of intramedullary bone to implant materials and surfaces. J Biomed Mat Res 1990;24:1121-49.
Karande V, Levrant S, Hoxsey R, Rinehart J, Gleicher N. Lysis of intrauterine adhesions using gynecoradiologic techniques. Fertil Steril 1997;68:658-62.
Chen FP, Soong YK, Hui YL. Successful treatment of severe uterine synechiae with transcervical resectoscopy combined with laminaria tent. Hum Reprod 1997;12:943-47.
Protopapas A, Shushan A, Magos A. Myometrial scoring: A new technique for the management of severe Asherman's syndrome. Fertil Steril 1998;69:860-64.
Coccia ME, Becattini C, Bracco GL, Pampaloni F, Bargelli G, Scarselli G. Pressure lavage under ultrasound guidance: A new approach for outpatient treatment of intrauterine adhesions. Fertil Steril 2001;75:601-06.
Coccia ME, Becattini C, Bracco GL, Bargelli G, Scarselli G. Intraoperative ultrasound guidance for operative hysteroscopy: A prospective study. J Reprod Med 2000;45:413-18.
Polishuk WZ, Weinstein D. The Soichet intrauterine device in the treatment of intrauterine adhesions. Acta Eur Fertil 1976;7:215-18.
March CM. Intrauterine adhesions. Obstet Gynecol Clin North Am 1995;22:491-505.
Amer MI, El Nadim A, Hassanein K. The role of intrauterine balloon after operative hysteroscopy in the prevention of intrauterine adhesion: A prospective controlled study. MEFS J 2005;10:125-29.
Amer MI, Abd-El-Maeboud KH. Amnion graft following hysteroscopic lysis of intrauterine adhesions. J Obstet Gynaecol Res 2006;32:559-66.
Burns JW, Skinner K, Colt J, Sheidlin A, Bronson R, Yaacobi Y, Goldberg EP. Prevention of tissue injury and postsurgical adhesions by precoating tissues with hyaluronic acid solutions. J Surg Res 1995;59:644-52.
De Iaco PA, Stefanetti M, Pressato D, Piana S, Dona M, Pavesio A, Bovicelli L. A novel hyaluronan-based gel in laparoscopic adhesion prevention: Preclinical evaluation in an animal model. Fertil Steril 1998;69:318-23.
Tsapanos VS, Stathopoulou LP, Papathanassopoulou VS, Tzingounis VA. The role of Seprafilm bioresorbable membrane in the prevention and therapy of endometrial synechiae. J Biomed Mater Res 2002;63:10-14.
Pace S, Stentella P, Catania R, Palazzetti PL, Frega A. Endoscopic treatment of intrauterine adhesions. Clin Exp Obstet Gynecol 2003;30:26-28.
Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V. Reproductive outcome following hysteroscopic adhesiolysis in Asherman's syndrome. Int J Fertil Menopausal Stud 1996;41:462-65.
Everett C. Incidence and outcome of bleeding before the 20th week of pregnancy: Prospective study fromgeneral practice. BMJ 1997;315:32-34.
Kumari AS, Haq A, Jayasundaram R, Abdel-Wareth LO, Al Haija SA, Alvarez M. Metformin monotherapy in lean women with polycystic ovary syndrome. R & Pro D. Biomed Online 2005;10:100-04.
Crave JC, Fimbel S, Lejeune H, Cugnardey N, Dechaud H, Pugeat M. Effects of diet and metformin administration on sex hormone binding globulin, androgens, and insulin in hirsute and obese women. J Clin Endocrinol Metab 1995;80:2057-62.
Pasquali R, Gambineri A, Biscotti D, Vicennati V, Gagliardi L, Colitta D, Fiorini S, Cognigni GE, Filicori M, Morselli-Labate AM. Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome. J Clin Endocrinol Metab 2000;85:2767-74.
Ehrmann DA, Cavaghan MK, Imperial J, Sturis J, Rosenfield RL, Polonsky KS. Effects of metformin on insulin secretion, insulin action, and ovarian steroidogenesis in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1997;82:524-30.
De Leo V, la Marca A, Ditto A, Morgante G, Cianci A. Effects of metformin on gonadotropin-induced ovulation in women with polycystic ovary syndrome. Fertil Steril 1999;72:282-85.
Yarali H, Yildiz B, Demirol A, Zeyneloglu HB, Yigit N, Bukulmez O, Koray Z. Co-administration of metformin during rFSH treatment in patients with clomiphene citrate-resistant polycystic ovarian syndrome: A prospective randomized trial. Hum Reprod 2002;17:289-94.
Palomba S, Falbo A, Orio F (Jr), Manguso F, Russo T, Tolino A, Colao A, Dale B, Zullo F. A randomized controlled trial evaluating metformin pretreatment and coadministration in nonobese insulin-resistant women with polycystic ovary syndrome treated with controlled ovarian hyperstimulation plus timed intercourse or intrauterine insemination. Hum Reprod 2005 Jun 15 (Epub ahead of print).
Stadtmauer LA, Toma SK, Riehl RM, Talbert LM. Metformin treatment of patients with polycystic ovary syndrome undergoing in vitro fertilization improves outcomes and is associated with modulation of the insulin-like growth factors. Fertil Steril 2001;75:505-09.
Stadtmauer LA, Toma SK, Riehl RM, Talbert LM. Impact of metformin therapy on ovarian stimulation and outcome in ‘coasted’ patients with polycystic ovary syndrome undergoing in vitro fertilization. Reprod Biomed Online 2002;5:112-16.
Glueck CJ, Phillips H, Cameron D, Sieve-Smith L, Wang P. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce firsttrimester spontaneous abortion: A pilot study. Fertil Steril 2001;75:46-52.
Kocak M, Caliskan E, Simsir C, Haberal A. Metformin therapy improves ovulatory rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome. Fertil Steril 2002;77:101-06.
Cole PA, Robinson CH. Mechanism and inhibition of cytochrome P-450 aromatase. J Med Chem 1990;33:2933-42.
Akhtar M, Njar VC, Wright JN. Mechanistic studies on aromatase and related C-C bond cleaving P-450 enzymes. J Steroid Biochem Mol Biol 1993;44:375-87.
Palter SF, Tavares AB, Hourvitz A, Veldhuis JD, Adashi EY. Are estrogens of import to primate/human ovarian folliculogenesis? Endocr Rev 2001;22:389-424.
Weil S, Vendola K, Zhou J, Bondy CA. Androgen and follicle stimulating hormone interactions in primate ovarian follicle development. J Clin Endocrinol Metab 1999;84:2951-56.
Vendola KA, Zhou J, Adesanya OO, Weil SJ, Bondy CA. Androgens stimulate early stages of follicular growth in the primate ovary. J Clin Invest 1998;101:2622-29.
Mitwally MF, Casper RF. Aromatase inhibitors for the treatment of infertility. Expert Opin Investig Drugs 2003;12:353-71.
Mitwally MF, Biljan MM, Casper RF. Pregnancy outcome after the use of an aromatase inhibitor for ovarian stimulation. Am J Obstet Gynecol 2005;192:381-86.
Mitwally MFM, Casper RF. The use of aromatase inhibitor for induction of ovulation in cases of clomiphene citrate failure. Curr Opin Obstet Gynecol 2002;14:255-63.
Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 2001;75:305-09.
Sammour A, Bijan MM, Tan SL, Tulandi T. Prospective randomised trial comparing the effects of letrazole (LE) and clomiphene citrate (CC) on follicular development, endometrial thickness and pregnancy rate in patients undergoing superovulation prior to intrauterine insemination (IUI). Fertil Steril 2001;76(Suppl 1):S110.
Mitwally MF, Casper RF. Single-dose administration of an aromatase inhibitor for ovarian stimulation. Fertil Steril 2005;83:229-31.
Fisher SA, Reid RL, Van Vugt DA, Casper RF. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril 2002;78:280-85.
Fatemi HM, Kalibianakis E, Tournaye H, Camus M, Van Steirteghem AC, Devroey P. Clomiphene citrate vs letrozole for ovarian stimulation: A pilot study. Reprod Biomed Online 2003;7:543-46.
Hu Y, Cortvrindt R, Smitz J. Effects of aromatase inhibition on in vitro follicle and oocyte development analyzed by early preantral mouse follicle culture. Mol Reprod Dev 2002;61: 549-59.
Shetty G, Krishnamurthy H, Krishnamurthy HN, Bhatnagar S, Moudgal NR. Effect of estrogen deprivation on the reproductive physiology of male and female primates. J Steroid Biochem Mol Biol 1997;61:157-66.
Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003;18:1588-97.
Mitwally MF, Casper RF. Aromatase inhibition improves ovarian response to follicle-stimulating hormone in poor responders. Fertil Steril 2002;77:776-80.
Goswami SK, Das T, Chattopadhyay R, Sawhney V, Kumar J, Chaudhury K, Chakravarty BN, Kabir SN. A randomized single blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: A preliminary report. Hum Reprod 2004;19:2031-35.
Newkirk KM, Chandler HL, Parent AE, et al. Ultraviolet radiation-induced corneal degeneration in 129 mice. Toxicol Pathol 2007;35:819-26.
Pettenati MJ, Sweatt AJ, Lantz P, et al. The human cornea has a high incidence of acquired chromosome abnormalities. Hum Genet 1997;101:26-29.
Snibson GR. Collagen cross-linking: A new treatment paradigm in corneal disease—a review. Clin Experiment Ophthalmol 2010;38:141-53.
Spoerl E, Raiskup-Wolf F, Kuhlisch E, Pillunat LE. Cigarette smoking is negatively associated with keratoconus. J Refract Surg 2008;24:S737-40.
Rabinowitz YS, Nesburn AB, McDonnell PJ. Videokeratography of the fellow eye in unilateral keratoconus. Ophthalmology 1993;100:181-86.
Goodrich DW, Lee WH. The molecular genetics of retinoblastoma. Cancer Surv 1990;9:529-54.
Moodaley LC, Woodward EG, Liu CS, Buckley RJ. Life expectancy in keratoconus. Br J Ophthalmol 1992;76:590-91.
Honein MA, Dawson AL, Petersen EE, Jones AM, Lee EH, Yazdy MM, Ahmad N, Macdonald J, Evert N, Bingham A, et al. Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy. JAMA 2017 Jan 3;317(1):59-68.
Chervenak FA, Jeanty P, Cantraine F, Chitkara U, Venus I, Berkowitz RL, Hobbins JC. The diagnosis of fetal microcephaly. Am J Obstet Gynecol 1984 Jul 1;149(5):512-517.
Papageorghiou AT, Thilaganathan B, Bilardo CM, Ngu A, Malinger G, Herrera M, Salomon LJ, Riley LE, Copel JA. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Ultrasound Obstet Gynecol 2016 Apr;47(4):530-532.
Chibueze EC, Parsons AJ, Lopes KD, Yo T, Swa T, Nagata C, Horita N, Morisaki N, Balogun OO, Dagvadorj A, et al. Diagnostic accuracy of ultrasound scanning for prenatal microcephaly in the context of Zika virus infection: a systematic review and meta-analysis. Sci Rep 2017 May 23;7(1):2310.
Cordeiro MT. Zika virus: laboratory diagnosis. In: Zika in focus. Springer International Publishing; 2017. pp. 59-62.
Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodušek V, et al. Zika virus associated with microcephaly. N Engl J Med 2016 Mar 10;374(10):951-958.
Zare Mehrjardi M, Keshavarz E, Poretti A, Hazin AN. Neuroimaging findings of Zika virus infection: a review article. Jpn J Radiol 2016 Dec;34(12):765-770.
Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016 Jan;47(1):6-7.
Brasil P, Pereira JP Jr, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, Rabello RS, Valderramos SG, Halai UA, Salles TS, et al. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med 2016 Dec 15;375(24):2321-2334.