In vitro evaluation of the antimicrobial activity of calcium hydroxide combined with chlorhexidine gel used as intracanal medicament

Gomes, Brenda Paula Figueiredo de Almeida; Vianna, Morgana Eli; Sena, Neylla Teixeira; Zaia, Alexandre Augusto; Ferraz, Caio Cézar Randi; Filho, Francisco José de Souza

doi:10.1016/j.tripleo.2006.04.010

Cited by 115 publications

(74 citation statements)

References 45 publications

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“…Two percent CHX gel is commonly used as a chemical auxiliary in endodontic therapy, which shows its effectiveness against microorganisms present in infected root canals 16 . The association of CH and 2% CHX has been used as an intracanal dressing because of its enhanced antimicrobial action against endodontic pathogens 8 . It has been found that CHX may induce reactive oxygen species (ROS) production in the alkaline environment with a biphasic response, which are possibly involved in the killing of root canal microorganisms 29 .…”

Section: Discussionmentioning

confidence: 99%

Exopolysaccharide dispelled by calcium hydroxide with volatile vehicles related to bactericidal effect for root canal medication

et al. 2016

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Objective: Enterococcus faecalis is the dominant microbial species responsible for persistent apical periodontitis with ability to deeply penetrate into the dentin. Exopolysaccharides (EPS) contribute to the pathogenicity and antibiotic resistance of E. faecalis. Our aim was to investigate the antimicrobial activity of calcium hydroxide (CH), camphorated parachlorophenol (CMCP), and chlorhexidine (CHX) against E. faecalis in dentinal tubules.Material and Methods:Decoronated single-canal human teeth and semicylindrical dentin blocks were incubated with E. faecalis for 3 weeks. Samples were randomly assigned to six medication groups for 1 week (n=10 per group): CH + 40% glycerin-water solution (1:1, wt/vol); CMCP; 2% CHX; CH + CMCP (1:1, wt/vol); CH + CMCP (2:3, wt/vol); and saline. Bacterial samples were collected and assayed for colony-forming units. After dentin blocks were split longitudinally, confocal laser scanning microscopy was used to assess the proportion of viable bacteria and EPS production in dentin.Results:CMCP exhibited the best antimicrobial activity, while CH was the least sensitive against E. faecalis (p<0.05). CHX showed similar antimicrobial properties to CH + CMCP (1:1, wt/vol) (p>0.05). CH combined with CMCP inhibited EPS synthesis by E. faecalis, which sensitized biofilms to antibacterial substances. Moreover, increasing concentrations of CMCP decreased EPS matrix formation, which effectively sensitized biofilms to disinfection agents.Conclusion:The EPS matrix dispelled by CH paste with CMCP may be related to its bactericidal effect; the visualization and analysis of EPS formation and microbial colonization in dentin may be a useful approach to verify medicaments for antimicrobial therapy.

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Section: Discussionmentioning

confidence: 99%

Exopolysaccharide dispelled by calcium hydroxide with volatile vehicles related to bactericidal effect for root canal medication

et al. 2016

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“…The time needed for CH to optimally disinfect the root canal system is still unknown and might be related to root canal exudate, the microorganism type, microorganism location in the root canal system, the smear layer, and the degree of susceptibility to the medication 28 . Although Shuping, et al 88 (2000) reported that use of CH in the canals for 1 week resulted in a 92.5% reduction, evidence shows that CHX has antibacterial activity against E. faecalis after 1 day 27,34,45 .…”

Section: Discussionmentioning

confidence: 99%

Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis

et al. 2014

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ObjectiveEnterococcus faecalis (E. faecalis) is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine (CHX) is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature.Material and MethodsA comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05.ResultsEighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles). Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa) was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001). Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115).ConclusionsAccording to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary to confirm and correlate the findings of this study with the clinical outcomes.

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“…Basrani et al, Lin et al and Ballal et al found that the CHX gel was more effective than the Ca(OH) 2 paste against E. faecalis and C. albicans 58,59,60. Several other authors reported that the antimicrobial effect of Ca(OH) 2 alone was significantly lower than that of Ca(OH) 2 mixed with CHX 61,62,63,64…”

Section: Reviewmentioning

confidence: 99%

Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part I.In vitrostudies

Kim

2014

Restor Dent Endod

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The goal of endodontic treatment is the prevention and control of pulpal and periradicular infections. Calcium hydroxide (Ca(OH)2) has been widely used in endodontics as an intracanal medicament to eliminate the remaining microorganisms after chemomechanical preparation. The purpose of this article is to review the antimicrobial properties of Ca(OH)2 as an intracanal medicament in root canal treatment. The first part of this review details the characteristics of Ca(OH)2 and summarizes the results of in vitro studies related to its antimicrobial effect. The antimicrobial effect of Ca(OH)2 results from the release of hydroxyl ions when it comes into contact with aqueous fluids. Ca(OH)2 has a wide range of antimicrobial effects against common endodontic pathogens, but is less effective against Enterococcus faecalis and Candida albicans. The addition of vehicles or other agents might contribute to the antimicrobial effect of Ca(OH)2.

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In vitro evaluation of the antimicrobial activity of calcium hydroxide combined with chlorhexidine gel used as intracanal medicament

Cited by 115 publications

References 45 publications

Exopolysaccharide dispelled by calcium hydroxide with volatile vehicles related to bactericidal effect for root canal medication

Exopolysaccharide dispelled by calcium hydroxide with volatile vehicles related to bactericidal effect for root canal medication

Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis

Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part I.In vitrostudies

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