Comparison of antibacterial effect of calcium hydroxide combined with chlorhexidine and povidone-iodine against Enterococcus faecalis in dentinal tubules of human incisors: An in vitro comparative study

Abstract

A BSTRACT Background and Objectives: It has been found that the microorganism behind the failure of root-filled teeth is Enterococcus faecalis , which shows resistance to most of the intra-canal medicaments. Therefore, the purpose of this study was to evaluate the antibacterial efficacy of three intra-canal medications—calcium hydroxide with saline, combinations of calcium hydroxide with 2% chlorhexidine (CHX), and calcium hydroxide with 5% povidone-iodine—against E. faecalis in dentinal tubules of human incisors. Materials and Methods: Forty permanent maxillary central incisors were made into standardized segments and infected with E. faecalis . They were treated with a paste made of calcium hydroxide and 2% CHX, calcium hydroxide and 5% povidone-iodine, and calcium hydroxide and saline for 1 week. Dentinal shavings collected from the canal were suspended in thioglycollate broth solution and spread on brain heart infusion agar. Colony-forming units (CFUs) were enumerated and the CFU per milligram of dentin was calculated. The pH of the medicaments used was measured with the help of pH meter. Results: The results showed that the paste made from calcium hydroxide and 2% CHX was significantly more effective than that made from calcium hydroxide and povidone-iodine, and calcium hydroxide and saline. The addition of CHX or povidone-iodine did not affect the alkalinity of calcium hydroxide. Conclusion: This study concludes that Ca(OH) 2 + 2% CHX are effective against E. faecalis . Combinations of calcium hydroxide and 5% povidone-iodine showed better antibacterial effect than calcium hydroxide and saline. Ca(OH) 2 + saline was ineffective against E. faecalis .

How Adding Chlorhexidine or Metallic Nanoparticles Affects the Antimicrobial Performance of Calcium Hydroxide Paste as an Intracanal Medication: An In Vitro Study

“…The dosages of CHX incorporated into the CH paste were selected according to the most commonly used concentrations in similar studies [ 13 , 14 , 15 , 18 , 19 , 20 , 22 , 25 ] for comparison purposes. For the metallic salts, in particular the PMNPs, which are still very little studied as intracanal medications, the antimicrobial susceptibilities of E. faecalis and C. albicans were first verified using a standard MIC/MBC determination method (CLSI M07-A8), and the dosages to be tested were selected based on the MICs (0.5×, 1×, and 2×), as previously described [ 50 , 51 , 52 ].…”

“…Various antimicrobial substances have been tested as adjuvants for CH paste in an attempt to increase its antimicrobial activity [ 12 ]. Chlorhexidine (CHX) is the reference antiseptic molecule in dentistry and displays a broad spectrum of activity against Gram-positive and Gram-negative bacteria as well as fungi [ 13 , 14 , 15 ]. It is biocompatible and adsorbs to dental tissues, allowing for prolonged, gradual release at therapeutic levels [ 13 , 14 , 15 , 16 ].…”

“…Chlorhexidine (CHX) is the reference antiseptic molecule in dentistry and displays a broad spectrum of activity against Gram-positive and Gram-negative bacteria as well as fungi [ 13 , 14 , 15 ]. It is biocompatible and adsorbs to dental tissues, allowing for prolonged, gradual release at therapeutic levels [ 13 , 14 , 15 , 16 ]. The benefit of mixing CH with CHX has been extensively studied [ 13 , 15 , 17 , 18 , 19 ].…”

Efectividad del gel de clorhexidina y pasta de hidróxido de calcio con clorhexidina como medicamento intraconducto en la eliminación del Enterococcus faecalis

“…Figueiredo et al 28 en el año 2006, Ghabraei et al 29 en el 2018 y Punathil et al 30 en el 2020 evaluaron la actividad antimicrobiana del HC combinado con CHX al 2%. Se aplicó los medicamentos en las muestras infectados con E. faecalis.…”

“…En el estudio de Figueiredo et al 28 utilizaron dos métodos: la prueba de difusión en agar y la prueba de contacto directo. El HC + CHX al 2% requirió de 30 segundos a 6 horas para eliminar todos los microorganismos analizados, mientras que en los estudios de Ghabraei et al 29 y Punathil et al 30 no indican el tiempo de efectividad. En el estudio de Figueiredo et al 28 Samiei et al 10 en el año 2018 comparó los efectos antibacterianos de un gel que contienen óxido de zinc y una mezcla de HC y CHX al 0,12% como medicación intracanal, las muestra se infectaron con E. faecalis.…”