In vivo antimicrobial efficacy of 6% Morinda citrifolia, Azadirachta indica, and 3% sodium hypochlorite as root canal irrigants

Comparative Evaluation of Intracanal Smear Layer Removal by Different Root Canal Irrigants: A Scanning Electron Microscope Study

Aim

The purpose of the study is to compare and evaluate the efficacy of different root canal irrigants-100, 75, 50, and 25% neem extract, 100, 75, 50, and 25% apple cider vinegar (ACV), a combination of 5.25% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), and saline on smear layer removal using a scanning electron microscope (SEM).

Materials and methods

A total of 80 freshly extracted single-rooted teeth were collected and divided into 10 groups-group I: normal saline (negative control), group II: NaOCl with EDTA (positive control), group III: 100% neem extract, group IV: 75% neem extract, group V: 50% neem extract, group VI: 25% neem extract, group VII: 100% ACV, group VIII: 75% ACV, group IX: 50% ACV, and group X: 25% ACV. The samples were irrigated with a specific group of irrigants, then split in a longitudinal axis and processed for analysis in an SEM. Microphotographs were obtained and scored according to Torabinejad et al.

Results

Microphotographs were assessed and showed that 100% neem extract was similar to NaOCl with EDTA, followed by 75% neem extract and 100% ACV.

Conclusion

This study showed that 100% neem extract removed the smear layer, similar to the NaOCl with EDTA.

How to cite this article

Sudhakar S, Gupta N, Ghambir N, et al. Comparative Evaluation of Intracanal Smear Layer Removal by Different Root Canal Irrigants: A Scanning Electron Microscope Study. Int J Clin Pediatr Dent 2023;16(4):633-638.

Effectiveness of Morinda Citrofolia, Sapindus Mukorossi, and Curcumin used in curry spice, to the radicular canal irrigant in improving bond integrity of glass fiber post

AIM

Evaluation of the push-out bond strength (PBS) of glass fiber reinforced post (GFRP) bonded to root dentin after canal disinfection using food-based root canal irrigants i.e., Curcumin photosensitizer (CP), Riboflavin photosensitizer (RFP), Morinda Ctrifolia juice (MCJ) and Sapindus Mukorossi (SM) along with MTAD as a final irrigant.

MATERIAL METHODS

Fifty human single-rooted premolar teeth were decoronated. Endodontic preparation was performed along with 2.25% sodium hypochlorite NaOCl solution followed by EDTA solution. Canals were dried and obturated followed by post-space preparation by removing GP. Specimens were allocated into five groups based on different food-based disinfection regimes (n= 10). Group 1: 2.25% NaOCl + MTAD (Control), Group 2: 6% MCJ + MTAD, Group 3: SM + MTAD, Group 4: CP + MTAD and Group 5: RFP + MTAD. All GFRP were bonded to radicular dentin. Root sectioning was performed followed by PBS and failure analysis using a universal testing machine (UTM) and stereomicroscope respectively. The data were analyzed using a one-way analysis of variance (ANOVA) test and the Post Hoc Tukey HSD test (p=0.05).

RESULTS

Samples disinfected with(MCJ+MTAD) at coronal third demonstrated maximum PBS (9.41±0.51 MPa). However, the apical third of group 5 (RFP + MTAD) exhibited the minimum values (4.06±0.23 MPa). Intergroup comparison analysis unveiled that group 2 (MCJ +MTAD) and group 3 (SM+MTAD) displayed comparable outcomes of PBS at all three-thirds. Similarly, samples in group 1 (2.25% NaOCl+ MTAD), group 4 (CP + MTAD), and group 5 (RFP + MTAD) exhibited comparable PBS.

CONCLUSION

Fruit-based irrigants Morinda Citrifolia and Sapindus Mukorossi have the potential to be used as root canal irrigants with a positive influence on bond strength.

Can natural irrigants replace sodium hypochlorite? A systematic review

CONTEXT

Sodium hypochlorite, a gold standard for irrigation in endodontics, has disadvantages like toxicity and root dentin weakening. Alternatives derived from natural products are being explored.

AIMS

This systematic review was done to understand the clinical benefits of natural irrigants when compared with a standard irrigant, sodium hypochlorite.

SETTINGS AND DESIGN REGISTRATION

This systematic review was registered with PROSPERO (2018 CRD42018112837) METHODS AND MATERIAL: This review was done in conformation to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA 2020) statement. In vivo studies using at least one natural irrigant and sodium hypochlorite (NaOCl) were included. Studies using them as medicaments were excluded. PubMed, Cochrane and SCOPUS were searched. RevMan tool for Risk of Bias 2 (RoB 2) and risk-of-bias tool to assess non-randomized studies of interventions (ROBINS-I) were used. GRADEpro was used to assess certainty of evidence.

RESULTS

Ten articles (6 RCTs and 4 clinical studies) on approximately 442 patients were included. Seven natural irrigants were evaluated clinically. Due to the heterogeneity, meta-analysis could not be conducted. Antimicrobial efficacy was found to be similar for castor oil, neem, garlic-lemon, noni, papaine and NaOCl. Neem, papaine-chloramine, neem-NaOCl and neem-CHX were superior, while propolis, miswak and garlic were inferior to NaOCl. Post-operative pain was less for neem. There was no significant difference between papaine-chloramine, garlic extract and sodium hypochlorite in clinical/radiographic success.

CONCLUSIONS

The studied natural irrigants are not more efficacious than NaOCl. At the moment, they cannot replace NaOCl routinely and may only substitute in select cases.

Comparative evaluation of antimicrobial efficacy of nanosilver solution, Azadirachta indica, sodium hypochlorite, and normal saline as root canal irrigants in primary teeth

Background

Microorganisms are the main cause of pulpal and periapical diseases. Hence, the elimination of such potential microbes is achieved by endodontic treatment. Mechanical preparation is the main mechanism to reduce the bacterial load in canals which is enhanced by intracanal irrigants. Despite these procedures, some bacteria might persist within the canals. It is important to disinfect the pulp space and dentinal tubules thoroughly with an effective endodontic irrigant to prevent reinfection of a treated root canal.

Aim

This study aimed to evaluate and compare the antimicrobial efficacy of nanosilver (NS) Solution, Azadirachta indica, sodium hypochlorite, and normal saline when used as irrigants in infected root canals of primary teeth.

Settings and Design

The study was a prospective randomized control trial which was conducted as per the consort statement.

Materials and Methods

Eighty pulpally involved primary teeth requiring endodontic treatment of children aged 5-12 years were selected for this study. The subjects were randomly allocated to 4 groups (3 irrigant and control groups) consisting of 20 children each where Group I = NS solution, Group II = A. indica, Group III = Sodium hypochlorite (2.5%), and Group IV = Control group. Microbiological samples were collected at the baseline (before irrigation) and postirrigation after biomechanical preparation using the selected irrigant. The samples were subjected to an anaerobic bacterial culture test. Microbial colonies were identified and expressed as colony forming units per milliliter.

Statistical Analysis

Data were analyzed using one-way analysis of variance, Paired t-test, and Post hoc Bonferroni test.

Results

NS solution showed the highest mean of 4.384 × 10³ ± 1.019 followed by Sodium hypochlorite with a mean of 3.500 × 10³ ± 1.193 and A. indica of 2.590 × 10³ ± 0.778.

Conclusion

Based on the results of this study, NS solution can be used as an alternative to other root canal irrigating solutions in primary teeth.

Impact of contracted endodontic cavities on instrumentation efficacy-A systematic review

The aim of the present systematic review was to summarise and evaluate the studies comparing the role of contracted endodontic cavities (CECs) and traditional endodontic cavities (TECs) in terms of instrumentation efficacy. The present systematic review comprised of a search of the online databases of Cochrane, PubMed, Google Scholar and grey literature. The articles which were pertaining to instrumentation efficacy in contracted and traditional endodontic cavities were selected based on the PRISMA checklist. Out of the 660 articles which were obtained, irrelevant articles were excluded and a total of 17 articles were selected for this systematic review which assessed the instrumentation efficacy. Eleven studies compared the volume of dentin removed and canal transportation ability. Four studies compared the pulp debridement, and two studies compared the anti-bacterial efficacy between the two groups. The extrusion of debris between the groups was compared by one study. Out of the 17 studies included, 11 studies proved that contracted endodontic cavities negatively impacted the instrumentation efficacy. Hence, the data suggest that the traditional endodontic access cavities have better results when comparing the instrumentation efficacy.

Effect of Neem (Azadirachta indica) versus 2.5% sodium hypochlorite as root canal irrigants on the intensity of post-operative pain and the amount of endotoxins in mandibular molars with necrotic pulps: a randomized controlled trial

AIM

To assess the effect of Neem versus 2.5% NaOCl as root canal irrigants on the intensity of post-operative pain and amount of endotoxins following root canal treatment of mandibular molars with necrotic pulps.

METHODOLOGY

This parallel, prospective, double-blinded, randomized controlled trial with allocation ratio 1:1 was conducted in the out-patient clinic of the Endodontic Department, Faculty of Dentistry, Cairo University, Egypt. Fifty healthy patients with mandibular molars with necrotic pulps were randomly assigned into two equal groups using computer software. In the intervention group, root canals were irrigated using Neem; whilst 2.5% NaOCl was used in the control group. A standard root canal treatment was performed in two visits using ProTaper Next rotary files, with no intracanal medication. Pain intensity was assessed using a numerical rating scale (NRS) 6, 12, 24 and 48 h following instrumentation and canal filling. Endotoxin samples were collected using three paper points before and after canal instrumentation and a sandwich ELISA method was used to quantify the level of endotoxins. Demographic, baseline, and outcome data were collected and analysed using chi-square tests (for the comparisons of categorical variables), Mann-Whitney tests (for non-normally distributed variables) and Student's t tests (for normally distributed variables), A P-value < 0.05 was considered to be statistically significant.

RESULTS

The mean pain scores within the two groups decreased continually over time. The mean pain scores in the Neem group were lower than those in the 2.5% NaOCl group at 6, 12, 24 and 48 h following instrumentation and canal filling with no significant difference between them except at 24 h following instrumentation (P = 0.012). Both irrigants significantly reduced endotoxin levels compared to the pre-instrumentation samples (P < 0.001) by 8% for the NaOCL group and 18% for the Neem group.

CONCLUSION

Neem and 2.5% NaOCl were not significantly different in terms of reducing the intensity of post-operative pain during all follow-up periods except at 24 h following instrumentation where Neem was associated with lower pain intensity. Both irrigants significantly reduced endotoxin levels but were not effective in eliminating endotoxins completely from root canals of mandibular molars with necrotic pulps.

Evaluation of Morinda citrifolia (noni) fruit extract as a bone regenerative material in the treatment of periodontal intrabony osseous defects: Clinical and cone-beam computed tomography assessment

BACKGROUND

Nature and its products can be utilized for regeneration in periodontal destruction and damage to supporting tissues. We come across the use of various graft materials to reestablish the lost bone and for the long-term survival of teeth. The objective of this study was to evaluate the bone fill efficacy of Morinda citrifolia fruit extract in the periodontal bone defect.

MATERIALS AND METHODS

This randomized study included twenty patients indicated for periodontal regenerative therapy and were equally divided and assigned into the experimental and control group. Open flap debridement alone was performed in the control group, while placement of extract along with open flap debridement was done in the experimental group. Clinical parameters assessed were gingival index, probing pocket depth, and relative attachment level, and the amount of bone fill was assessed using cone-beam computed tomography (CBCT) at baseline and at 6-month interval.

RESULTS

From the values of clinical parameters, there was a mean reduction in probing pocket and gain in attachment level and a 27.7% increase in bone fill in experimental group as compared to the control group from CBCT analysis.

CONCLUSIONS

The use of M. citrifolia fruit extract in the intraosseous defect was found to be efficacious in terms of relative attachment level and the amount of bone fill, and it had shown some anti-inflammatory affect.

Essential Oils as Alternatives for Root-Canal Treatment and Infection Control against Enterococcus faecalis—A Preliminary Study

Since natural alternatives are needed in dentistry for the treatment of root canal, where the standard irrigant is NaOCl with significant toxicity, the aim of the study was to assess the antibacterial properties of non-chemical root-canal irrigants (aqueous extracts of oregano, thyme, lemongrass, melaleuca and clove essential oils) against Enterococcus faecalis. For this, aqueous extracts of each essential oil (AqEO) were prepared. A solution of sodium hypochlorite (NaOCl) was used as a positive standard against which the antimicrobial effects of AqEO could be reported. The root canals of seven teeth were inoculated with 20 µL of Enterococcus faecalis ATCC29212 inoculum and incubated overnight at 37 °C. All the teeth canals were instrumented and were irrigated with the corresponding AqEO, NaOCl and saline solution, then rinsed with saline. Bacteriological samples for each canal post-instrumentation were collected with sterile paper points which were inoculated on culture media. A second processing followed the same methodology but involved only irrigation and no instrumentation. Using instrumentation, thyme and clove completely inhibited Enterococcus faecalis growth. Without instrumentation, clove and oregano AqEOs completely reduced the bacterial load as seen in direct inoculation, but bacterial growth was observed in all the samples after enrichment, except for NaOCl. Nevertheless, the turbidity of the enrichment media was lower for the samples irrigated with AqEOs than for control. In conclusion, AqEOs of thyme, oregano and clove showed a promising antibacterial effect, especially when teeth instrumentation was performed.

Herbal medicaments in endodontics - Current guidelines for in vivo studies in India

Elimination of bacteria from infected root canal systems is a challenging task. Various techniques have been described to reduce the number of bacteria within the root canal system, which include chemomechanical instrumentation, use of various irrigants to remove or dissolve organic and inorganic debris, and to destroy bacteria. The intracanal medicament plays a key role in the success of root canal treatment. With the rise in bacterial resistance to antibiotics, there is considerable interest in the development of other classes of antimicrobials for the control of infection. Natural products are known to play an important role in human life. The use of herbal products as mouthwash has been tried and tested in the literature. However, the use of herbal intracanal medicament has been shown promising results when used under in vitro conditions, but in vivo studies are very scarce. This may be due to the limited supporting literature available to use it as intracanal medicament in patients due to the ethical concern. Hence, the purpose of this review is to highlight the current guidelines (laid by the drugs and cosmetics act as per the Gazette of India) regarding the use of herbal medicaments for the clinical trials in endodontics.

Evaluation of 2% Chlorhexidine and 2% Sodium Fluoride as Endodontic Irrigating Solutions on Root Dentine Microhardness: An In Vitro Study

Objectives  The aim of this study was to evaluate the effects of 2% chlorhexidine gluconate (CHG) and 2% sodium fluoride (NaF) as endodontic irrigants on microhardness of root dentin.

Materials and Methods  In this in vitro study, access cavity and root canal preparations were done on 24 freshly extracted anterior teeth. After sectioning into 24 dentin discs using hard tissue microtome in 2 mm thickness, all samples were immersed in solutions of 17% ethylenediamine tetra-acetic acid (EDTA) (2 minutes) followed by 2.5% of sodium hypochlorite (NaOCl) (10 minutes). Then samples were randomly divided into three groups based on the irrigant used: Group I: saline (control group); Group II: 2% NaF; Group III: 2% CHG for two minutes each. Dentin microhardness was measured before (pretreatment), during (after treatment with 17% EDTA and 2.5% NaOCl), and after the experimental period (after treatment with saline, 2% NaF, and 2% CHG) using a Vickers indenter. Statistical evaluation of the data was done using one-way analysis of variance (ANOVA) and the Student’s t -test, and the values are tabulated.

Results  Specimens rinsed in 2% CHG showed a significant increase in Vickers hardness number (VHN) values ( p < 0.05), as compared with EDTA and NaOCl groups, whereas saline and 2% NaF groups showed no significant difference.

Conclusions  NaF did not show any significant effect on microhardness of the root dentin. CHG as an irrigant was seen to have a strengthening effect on dentin microhardness in comparison to NaOCl and EDTA, which has decreased the strength of root dentin.

The Effectiveness of Three Irrigation Systems in the Enterococcus faecalis Reduction after Instrumentation with a Reciprocating Instrument

OBJECTIVE

 This study aimed to analyze the effectiveness of three irrigation systems: EndoActivator, passive ultrasonic irrigation (PUI), and Easy Clean in the reduction of Enterococcus faecalis, after instrumentation with the reciprocating system, through microbiological collection and culture method.

MATERIALS AND METHODS

 A total of 60 extracted human lower premolars were used and standardized at 16 mm in length. The teeth were accessed, contaminated with E. faecalis, and incubated for 21 days at 37°C. Initial collections (S1) were made with an absorbent paper cone to confirm the contamination; subsequently, instrumentation was performed with WaveOne Primary. The teeth were divided into four groups according to the final irrigation protocol (n = 15): group 1. EndoActivator; group 2, PUI; group 3, Easy Clean; and group 4, control group irrigated with saline solution sterile and without agitation. In the final irrigation, the agitation of the 17% ethylene amine tetra-acetic acid (EDTA) solutions was used, then 2.5% sodium hypochlorite (NaOCl); in both for this, three cycles of 20 seconds each. After the chemical-mechanical preparation and agitation of the irrigating solutions, the final collections (S2) for counting the colony-forming units (CFU/mL) occurred.

RESULTS

 The Kruskal-Wallis test revealed that all the agitation systems reduced by 100% and the control group by 65.7%.

CONCLUSION

 The control group presented a significantly higher amount of CFU/mL after the chemical-mechanical preparation than the other groups, which were similar to each other (p > 0.05).

Hypochlorite solution for root canal irrigation that lacks a chlorinated odor

OBJECTIVES

This is an in vitro study to develop a formulation of a hypochlorite solution for root canal irrigation that lacks a chlorinated odor. The antibacterial effect, tissue dissolution efficacy, and the cytotoxicity of the solution were assessed in cell culture and were compared with those of commercial sodium hypochlorite (NaOCl) solutions.

MATERIALS AND METHODS

Trichloroisocyanuric acid (TCA) was used as the source of hypochlorite ions in solution. All required properties of the NaOCl irrigant were evaluated and compared with those of original 2.5% NaOCl solutions currently in use.

RESULTS

Our results revealed that a TCA 3.5% + 1/6 Buffer-1 solution passed the short-term stability test. Moreover, no odor of chlorine gas was detected by three independent observers. The hypochlorite ion content and pH were stable over an incubation period of 4 weeks. The new solution did not differ from commercial products in terms of the dissolution property on bovine pulpal tissue (P > 0.05). Moreover, the antibacterial effect of this solution on Enterococcus faecalis did not differ from that of the commercial products (P > 0.05). In addition, our biocompatibility analysis demonstrated no difference among the tested solutions (P > 0.05).

CONCLUSIONS

According to the results of all properties tested, TCA 3.5% + 1/6 Buffer-1 could be considered an option for NaOCl irrigation with the benefit of no detectable chlorine odor.

Antimicrobial efficacy of 2.5% sodium hypochlorite, 2% chlorhexidine, and ozonated water as irrigants in mesiobuccal root canals with severe curvature of mandibular molars

Objective

The aim of this study is to evaluate the antimicrobial efficacy of 2.5% sodium hypochlorite, 2% chlorhexidine, and ozonated water on biofilms of Enterococcus faecalis, Streptococcus mutans, and Candida albicans in mesiobuccal root canals with severe curvature of mandibular molars.

Materials and Methods

This was an experimental ex vivo study in microbiologic laboratory. Sixty mesiobuccal root canals with severe curvature of mandibular molars were contaminated with standard strains of E. faecalis, S. mutans, and C. albicans. The specimens were randomly divided into four groups (n = 15) according to irrigating solution: SH: 2.5% sodium hypochlorite; CH: 2% chlorhexidine; O₃: ozonated water; and control: double-distilled water. The mesiobuccal root canals of all groups were instrumented with the WaveOne Gold Primary reciprocating system. Three cycles of instrumentation with three short in-and-out brushing motions were performed: (1) in the coronal third, (2) in the middle third, and (3) in the apical third of the canal. A ProGlider file was used before the first cycle.

Statistical Analysis

Statistical analysis was performed using one-way analysis of variance followed by Tukey's multiple comparison test. Samples were collected for viable bacterial counts before and after instrumentation.

Results

All groups showed significant biofilm reduction after irrigation (P < 0.01). After instrumentation, sodium hypochlorite (98.07%), chlorhexidine (98.31%), and ozonated water (98.02%) produced a significantly reduction in bacterial counts compared with double-distilled water (control, 72.98%) (P < 0.01).

Conclusion

All irrigants tested in this study showed similar antimicrobial activity. Thus, ozonated water may be an option for microbial reduction in the root canal system.