Conservative Dentistry and Endodontic Journal

Register      Login

VOLUME 5 , ISSUE 1 ( January-June, 2020 ) > List of Articles


Comparative Evaluation of Antibacterial Efficacy of Three Intracanal Medicaments in Primary Endodontic Infections: A Randomized Clinical Trial

Monika Tandan, Suchita Sukul

Citation Information : Tandan M, Sukul S. Comparative Evaluation of Antibacterial Efficacy of Three Intracanal Medicaments in Primary Endodontic Infections: A Randomized Clinical Trial. Cons Dent Endod J 2020; 5 (1):5-10.

DOI: 10.5005/jp-journals-10048-0056

License: CC BY-NC 4.0

Published Online: 30-11-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Aim: To compare and evaluate the antibacterial efficacy of calcium hydroxide (CH) paste, triple antibiotic paste (TAP), and double antibiotic paste (DAP). Materials and methods: Ninety patients with ninety single-rooted teeth were selected. After complete disinfection, access opening was made and sample S1 was collected with paper point after injecting 5 mL of normal saline. After working length determination and biomechanical preparation till #40 K-file, sample S2 was collected in the same manner as S1. The canals were dried and the three intracanal medicaments were mixed with propylene glycol. The patients were randomly divided into three groups (n = 30) and the medicaments (group I—CH, group II—TAP, and group III—DAP) were placed. After 7 days, following medicament removal, sample S3 was collected. Microbiological samples (S1, S2, and S3) were preincubated for 30 minutes and then plated on brain heart infusion agar and colonies were counted after 24 hours using the classic bacterial counting method. Results: There was significant reduction of bacterial count from stages S1 to S2 and S2 to S3 in all the three experimental groups. The maximum reduction of bacterial count (CFU/mL × 105) at S1, S2, and S3 stages and reduction in mean was seen in group III. However, there were no statistically significant difference between group II (TAP) and group III (DAP). Conclusion: The TAP and DAP have similar antimicrobial efficacy though better than CH.

  1. Chuensombat S, Khemaleelakul S, Chattipakorn S, et al. Cytotoxic effects and antibacterial efficacy of a 3-antibiotic combination: An in vitro study. J Endod 2013;39(6):813–819. DOI: 10.1016/j.joen.2012.11.041.
  2. Agrafioti A, Tzimpoulas NE, Kontakiotis EG. Influence of dentin from the root canal walls and the pulp chamber floor on the pH of intracanal medicaments. J Endod 2013;39(5):701–703. DOI: 10.1016/j.joen.2012.12.039.
  3. Dealmeidagomes B, Ferraz C, Garrido F, et al. Microbial susceptibility to calcium hydroxide pastes and their vehicles. J Endod 2002;28(11): 758–7561. DOI: 10.1097/00004770-200211000-00003.
  4. Mozayeni MA, Haeri A, Dianat O, et al. Antimicrobial effects of four intracanal medicaments on Enterococcus faecalis: an in vitro study. Iran Endod J 2014;9(3):195–198.
  5. Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J 2007;52(1 Suppl):S64–S82. DOI: 10.1111/j.1834-7819.2007.tb00527.x.
  6. Siqueira JF Jr, Lopes HP. Mechanisms of antimicrobial activity of calcium hydroxide: a critical review. Int Endod J 1999;32(5):361–369. DOI: 10.1046/j.1365-2591.1999.00275.x.
  7. Sjogren U, Figdor D, Spångberg L, et al. The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing. Int Endod J 1991;24(3):119–125. DOI: 10.1111/j.1365-2591.1991.tb00117.x.
  8. Madhubala MM, Srinivasan N, Ahamed S. Comparative evaluation of propolis and triantibiotic mixture as an intracanal medicament against Enterococcus faecalis. J Endod 2011;37(9):1287–1289. DOI: 10.1016/j.joen.2011.05.028.
  9. Evans M, Davies JK, Sundqvist G, et al. Mechanisms involved in the resistance of Enterococcus faecalis to calcium hydroxide. Int Endod J 2002;35(3):221–228. DOI: 10.1046/j.1365-2591.2002.00504.x.
  10. Mozayeni MA, Hadian A, Bakhshaei P, et al. Comparison of antifungal activity of 2% chlorhexidine, calcium hydroxide, and nanosilver gels against Candida albicans. J Dent (Tehran) 2015;12(2):109–117.
  11. Waltimo TM, Siren EK, Orstavik D, et al. Susceptibility of oral Candida species to calcium hydroxide in vitro. Int Endod J 1999;32(2):94–98. DOI: 10.1046/j.1365-2591.1999.00195.x.
  12. Pai S, Pai ARV, Thomas MS, et al. Effect of calcium hydroxide and triple antibiotic paste as intracanal medicaments on the incidence of inter-appointment flare-up in diabetic patients: an in vivo study. J Conserv Dent 2014;17(3):208–211. DOI: 10.4103/0972-0707. 131776.
  13. Adl A, Hamedi S, Shams MS, et al. The ability of triple antibiotic paste and calcium hydroxide in disinfection of dentinal tubules. Iran Endod J 2014;9(2):123–126.
  14. Parasuraman VR, Muljibhai BS. 3Mix - MP in endodontics–an overview. Indian journal of dental and medical sciences 2012;3(1):36–45. DOI: 10.9790/0853-0313645.
  15. Yassen GH, Chu TM, Eckert G, et al. Effect of medicaments used in endodontic regeneration technique on the chemical structure of human immature radicular dentin: an in vitro study. J Endod 2013;39(2):269–273. DOI: 10.1016/j.joen.2012.09.020.
  16. Algarni AA, Yassen GH, Gregory RL. Inhibitory effect of gels loaded with a low concentration of antibiotics against biofilm formation by Enterococcus faecalis and Porphyromonas gingivalis. J Oral Sci 2015;57(3):213–218. DOI: 10.2334/josnusd.57.213.
  17. Sinha N, Patil S, Dodwad PK, et al. Evaluation of antimicrobial efficacy of calcium hydroxide paste, chlorhexidine gel, and a combination of both as intracanal medicament: an in vivo comparative study. J Conserv Dent 2013;16(1):65–70. DOI: 10.4103/0972-0707.105302.
  18. Chua EG, Parolia A, Ahlawat P, et al. Antifungal effectiveness of various intracanal medicaments against Candida albicans: an ex-vivo study. BMC Oral Health 2014;14(53):1–8. DOI: 10.1186/1472-6831-14-53.
  19. Haapasalo M, Orstavik D. In vitro infection and disinfection of dentinal tubules. J Dent Res 1987;66(8):1375–1379. DOI: 10.1177/00220345870660081801.
  20. Safavi KE, Spangberg L, Langeland K. Root canal dentinal tubule disinfection. J Endod 1990;16(5):207–210. DOI: 10.1016/s0099-2399(06)81670-5.
  21. Orstavik D, Haapasalo M. Disinfection by endodontic irrigants and dressings of experimentally infected dentinal tubules. Endod Dent Traumatol 1990;6(4):142–149. DOI: 10.1111/j.1600-9657.1990.tb00409.x.
  22. Estrela C, Pimenta FC, Ito IY, et al. Antimicrobial evaluation of calcium hydroxide in infected dentinal tubules. J Endod 1999;25(6):416–418. DOI: 10.1016/S0099-2399(99)80269-6.
  23. Shaik J, Garlapati R, Nagesh B, et al. Comparative evaluation of antimicrobial efficacy of triple antibiotic paste and calcium hydroxide using chitosan as carrier against Candida albicans and Enterococcus faecalis: an in vitro study. J Conserv Dent 2014;17(4):335–339. DOI: 10.4103/0972-0707.136444.
  24. Bazvand L, Aminozarbian MG, Farhad A, et al. Antibacterial effect of triantibiotic mixture, chlorhexidine gel, and two natural materials propolis and aloe vera against Enterococcus faecalis: an ex vivo study. Dent Res J (Isfahan) 2014;11(4):469–474.
  25. Adl A, Shojaee NS, Motamedifar M. A comparison between the antimicrobial effects of triple antibiotic paste and calcium hydroxide against Enterococcus faecalis. Iran Endod J 2012;7(3):149–155.
  26. Taneja S, Kumari M, Parkash H. Nonsurgical healing of large periradicular lesions using a triple antibiotic paste: a case series. Contemp Clin Dent 2010;1(1):31–35. DOI: 10.4103/0976-237X.62519.
  27. Kim JH, Kim Y, Shin SJ, et al. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod 2010;36(6):1086–1091. DOI: 10.1016/j.joen.2010.03.031.
  28. Thomas MS. Crown discoloration due to the use of triple antibiotic paste as an endodontic intra-canal medicament. Saudi Endod J 2014;4(1):32–35. DOI: 10.4103/1658-5984.127985.
  29. Sabrah AH, Yassen GH, Liu WC, et al. The effect of diluted triple and double antibiotic pastes on dental pulp stem cells and established enterococcus faecalis biofilm. Clin Oral Investig 2015;19(8):2059–2066. DOI: 10.1007/s00784-015-1423-6.
  30. Maniglia-Ferreira C, de Almeida-Gomes F, Pinto MM, et al. In vitro evaluation of the antimicrobial effects of different intracanal medications in necrotic immature teeth. Eur Arch Paediatr Dent 2016;17(4):251–255. DOI: 10.1007/s40368-016 -0236-x.
  31. Yadlapati M, Souza LC, Dorn S, et al. Deleterious effect of triple antibiotic paste on human periodontal ligament fibroblasts. Int Endod J 2014;47(8):769–775. DOI: 10.1111/iej.12216.
  32. Gupta SP, Bhati M, Jhajharia K, et al. Evaluation of antimicrobial and antifungal efficacy of inter appointment intracanal medicaments against Enterococcus and Candida albicans: an in vitro study. J Int Oral Health 2015;7(6):97–102.
  33. Iqbal A. Antimicrobial irrigants in the endodontic therapy. Int J Health Sci (Qassim) 2012;6(2):186–192. DOI: 10.12816/0005998.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.