Assessment of Antimicrobial Efficacy of Nano Chitosan, Chlorhexidine, Chlorhexidine/Nano Chitosan Combination versus Sodium Hypochlorite Irrigation in Patients with Necrotic Mandibular Premolars: A Randomized Clinical Trial

Abstract

AIM: The study was done to assess the antimicrobial effectiveness of Chitosan Nanoparticles (CNPs), Chlorhexidine (CHX), and their combination (CHX/CNPs) versus that of Sodium hypochlorite (NaOCl) in patients with mandibular necrotic premolars and to evaluate their effects on post-operative pain after single-visit endodontic treatment. MATERIALS AND METHODS: Sixty patients with necrotic mandibular premolars were divided randomly to four groups (n = 15) according to the used irrigating solution. Instrumentation was done using rotary ProTaper files. During instrumentation, irrigation was done using 2.5% NaOCl; afterward, canals were flushed with sterile saline. A final flush with the study irrigants was done as follows: 3% CNPs for Group A, 2% CHX for Group B, CHX/CNPs for Group C, and 5.25% NaOCl for Group D. Samples were collected from root canals before and after canal preparation then cultured to assess the number of colony-forming units/ml. All patients were instructed to record their pre- and post-operative pain levels on a numerical rating scale. RESULTS: CNPs and CHX/CNPs were significantly more effective than either CHX or NaOCl; however, there was no significant difference between them against anaerobic bacteria. All tested irrigants were similarly effective against aerobic bacteria. CNPs and CHX/CNPs were associated with significantly lower post-operative pain levels in the first 24 h after treatment. CONCLUSIONS: CNPs and its combination with CHX are significantly more effective than both CHX and NaOCl against anaerobic bacteria isolated from necrotic mandibular premolars. Post-operative pain intensity was significantly lower with CNPs and CNPs/CHX combination than with either NaOCl or CHX.

Effect of Propolis nanoparticles versus sodium hypochlorite as root canal irrigant on postoperative pain and bacterial reduction in mandibular premolars with necrotic pulps: a randomized clinical trial

“…Furthermore, nanoscale systems have been utilized to enhance the biological and physical properties of antimicrobial agents used in endodontics thereby improving their effectiveness in root canal debridement 3 . In this context, previous nano-herbal irrigants showed promising results regarding antibacterial and anti-biofilm activity in vitro [19][20][21][22][23] . Therefore, this study assessed the effect of 20mg/ml propolis nanoparticles extract solution versus 2.5% NaOCl as root canal irrigant on the intensity of postoperative pain, the amount of bacterial reduction, and analgesic intake following single visit root canal treatment of asymptomatic mandibular premolars with necrotic pulps in a prospective, randomized, double-blinded, parallel clinical trial.…”