Official Journals By StatPerson Publication
Table of Content-Volume 6 Issue 1 - April 2018
Comparative evaluation of antimicrobial efficacy of two intracanal medicaments and irrigants in conjunction to each other: An in vivo study
Sachin A Gunda1, Priyanka A Jare2*, Ankita Hingmire3, Anil Patil4, Sandhyarani Hudar5, Sridevi Tamagond6
Department of Pedodontics, Bharati Vidyapeeth Deemed University and Dental College, Sangli, Maharashtra, INDIA. Email: priyanka.jare.9@gmail.com
Abstract Background: Due to the complex anatomy of the root canal, mechanical instrumentation leaves significant portions of the root canal walls untouched and there is no evidence that instrumentation alone can completely eliminate microorganisms from the root canal. Therefore additional irrigants and medicaments are required to disinfect the root canal system to reduce the bacterial load to promote healing. Aim: This study aims to evaluate and compare the antimicrobial efficacy of calcium hydroxide and triple antibiotic paste(metronidazole, ciprofloxacin and cefaclor) as intra-canal medicaments in presence of different irrigants as, chlorhexidine and sodium hypochloride, by microbial quantification. Materials and Methods: The present study is randomized controlled trial which aims to assess the antimicrobial efficacy of calcium hydroxide and triple antibiotic paste(metronidazole, ciprofloxacin and cefaclor) as intra-canal medicaments in presence of different irrigants as, chlorhexidine and sodium hypochloride. In the present study all the subjects visiting to the department of Pedodontics will be included after obtaining voluntary informed consent from the subjects’ parents/guardians. Results: All the groups in the study, i.e: group IA, IB, IIA, and IIB showed reduction in the pre- and post-operative microbial count present in the root canals. Whereas among all the groups, the group IIA tend to show the most reduced microbial count, followed by IIB, IA and IB respectively. Conclusion: Adequate amount of irrigation and an appropriate intra-canal medicament can help in achieving this goal. Use of irrigants and intra-canal medications in conjunction with each other will give a synergistic effect in the disinfection protocol. Key Words: antimicrobial efficacy.
INTRODUCTION Dental caries is the most common and infectious disease occurring in children (primary dentition). Caries involving enamel, dentin and pulp in primary dentition, is a common entity due to less thickness of enamel/dentine and large pulp chambers. As a result, teeth with infected root canals with interradicular infections is a common problem in primary dentition. Early exfoliation of primary teeth due to pulpal involvements, can cause many problems to the child including, space loss, ectopic eruptions, impactions of permanent successors, development of aberrant habits as tongue thrusting, speech problems, and impairment of function. Therefore, to avoid the complications and to maintain the arch integrity, it is necessary to preserve the intact tooth in the oral cavity until its correct time of exfoliation. Acarious pulpally infected tooth, successfully disinfected and the clinical crown restored to its full function shall provide with all the functions of intact natural tooth. Endodontic infections in deciduous root canals are associated with wide diversity of microoraganisms. Endodontic treatment are procedures to debride and disrupt and remove the microbial ecosystem associated with the disease process. (Rana et al). Anaerobic and aerobic microorganisms, black pigmented bacilli, streptococci, mutans streptococcus and gram negative aerobic rods were found in necrotic pulp and periapical lesions (Silva et al, 2006). Both aerobic and anaerobic microorganisms as well as facultative microorganisms can be found in the deciduous root canals. The complexity of the root canal system, presence of numerous dentinal tubules, invasion of the dentinal tubules by microorganisms, formation of smear layer during instrumentation are common problems encountered during routine endodontic procedure. To overcome these obstacles, irrigants are a necessity in endodontic treatment of primary teeth. Intracanal irrigants exert their effects mechanically and chemically. Mechanical effects are generated by back and forth flow of the irrigation solution during cleaning and shaping of the infected root canals, significantly, reducing the bacterial load. Irrigants used in primary endodontic treatment are Sodium hypochloride, Chlorhexidine, MTAD, Ethylenediaminetetraacetic Acid and Citric Acid, Carisolv, Ozonated water and Herbal irrigants. Sodium hypochloride is the most commonly used irrigating solution. It gives rise to sodium and hypochlorite ions when combined with water thereby establishing an equilibrium with hypoclorous acid which is responsible for the antibacterial activity of NaOCl. Chlorhexidine is used at 2% concentration as an irrigating solution, it reacts with negatively charged groups on the cell surface, thereby showing greater reduction of intracanal bacteria when compared to sterile saline solution. As the pulpally involved teeth frequently involve the radicular areas of the tooth, reduction of microbial count and sterilization of the infected canals is a mandatory issue. The lesions are repaired or regenerated by the host’s natural tissue recovery process, if the canals are well sterilized. Recalcification of the infected dentin takes place. Therefore, disinfection and sterilization of infected canals is an important step in pulp therapies. Commonly used intracanal medicaments in endodontics are Calcium hydroxide, Chlorhexidine gel, Triple antibiotic paste, etc. Pediatric Endodontic treatment should include the removal of necrotic content, instrumentation and intracanal dressings as essential steps. MATERIALS AND METHDOLOGY
Inclusion Criteria
Exclusion Criteria
D) Distribution of subjects: All the Children were randomly distributed into 4 groups of 15 children each. E: Materials required
PROCEDURE
MICROBIOLOGICAL EXAMINATION
Statystical Analysis
RESULT Table 1:
Table 2:
All the groups in the study, i.e,: group IA, IB, IIA, and IIB showed reduction in the pre and postoperative microbial count present in the root canals. Whereas among all the groups, the group IIA tend to show the most reduced microbial count, followed by IIB, IA and IB respectively.
DISCUSSION The differences in the preoperative and postoperative colony forming units of microbial count in our present study showed significant amount decrease in microbial count in all the groups of combinations of irrigants and intracanal medicaments. The clinical studies in infected primary teeth suggest 3Mix to be an effective root canal treatment material. minocycline may cause tooth discoloration because of photoactivation. Minocycline binds to calcium ions via chelation to form an insoluble complex. It should be limited to the root canal because of the potential risk of tooth discoloration. Calcium hydroxide plays an important role in endodontics, through its ability to indulge hard tissue formation, its moderate antibacterial action and its tissue dissolving capability (Nerwich et al. 1993). Ca(OH)2 dressing may both prevent root canal reinfection and interrupt the nutrient supply to remaining bacteria (Siqueiraand Lopes1999). Its high pH (around 12.5) has a destructive effect on cell membranes and protein structure(Spangberg1994). To be effective against bacteria located inside the dentinal tubules, the hydroxyl ions from Ca(OH)2 should diffuse into dentine at sufficient concentrations and should exceed the dentine buffering ability, reaching pH levels sufficient to destroy bacteria (Siqueiraand Lopes 1999). Use of chlorhexidine inendodonticshas been proposed both as irrigant and intracanal medicament (Delanyetal.1982, Vahdatyetal. 1998, Jeansonne and White 1994, Siqueiraand Uzeda 1997, Ferrazetal.2001). Chlorhexidinehasinhibitory effects onbacteriacommonly found in endodontic infections (Cervone et al. 1990), acting against grampositive and gramnegative migroorganisms (Waler1990). One of the mechanismsthat explains its efficacyisbased on the interaction between the positive charge of themoleculeandnegatively charged phosphate groups on the bacterial cell wall, which allows the chorhexidinemoleculetopenetrate into the bacteria with toxic effects (Lindskog et al. 1998, Hugo and Longworth1964).
CONCLUSION Owing to the unique and complicated anatomy of deciduous teeth and its importance of retention in the jaw, proper disinfection and retention of the pulpally involved primary teeth for appropriate amount of duration is of utmost importance. Adequate amount of irrigation and an appropriate intracanal medicament can help in achieving this goal. Use of irrigants and intracanal medications in conjunction with each other will give a synergistic effect in the disinfection protocol.
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