Skip to main content
Top
Published in: BMC Oral Health 1/2023

Open Access 01-12-2023 | Candida Albicans | Research

Direct and residual antimicrobial effect of 2% chlorhexidine gel, double antibiotic paste and chitosan- chlorhexidine nanoparticles as intracanal medicaments against Enterococcus faecalis and Candida albicans in primary molars: an in-vitro study

Authors: Mariem Wassel, Mohamed Radwan, Reham Elghazawy

Published in: BMC Oral Health | Issue 1/2023

Login to get access

Abstract

Background

Thorough disinfection of root canals in primary molars may be complicated by the complex root canal morphology. This in-vitro study aimed to compare direct and residual antimicrobial effect of 2% chlorhexidine (CHX) gel, 500 mg/ml double antibiotic paste (DAP) and chitosan-chlorhexidine nanoparticles (CS-CHX NPs) as intracanal medicaments against Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans) in primary molars.

Methods

Mesial roots of 63 mandibular second primary molars were infected with E. faecalis and C. albicans. Teeth were divided into 9 groups: Ia: (CS-CHX NPs), IIa: (CHX), IIIa: (DAP), IVa: chitosan nanoparticles (CSNPs) in which medicaments were placed for 3 days, groups Ib: (CS-CHX NPs), IIb: CHX, IIIb: (DAP), IVb: (CSNPs) in which medicaments were placed for 7 days, and Group V (control): teeth were infected, irrigated with saline, and sampled 3- and 7-days post-infection. Microbiological samples were obtained after infection, 3, and 7 days after medicament placement and 7 days after medicament removal for both time points. One-way ANOVA, Tukey’s post hoc test and paired t-test were used at p < 0.05.

Results

CS-CHX NPs had the highest anticandidal effect which was comparable to CHX and significantly higher than other medicaments (p < 0.001) at both time points. CS-CHX NPs had the highest effect against E. faecalis which was comparable to DAP and significantly higher than other medicaments (p < 0.001) at 3 days. All medicaments showed similar effect against E. faecalis after 7 days. The 7-days placement significantly increased the antimicrobial effect against both micro-organisms in all groups, except CS-CHX NPs which showed an insignificant increase. CS-CHX NPs showed the highest residual effect against both micro-organisms that increased with 7-days placement.

Conclusion

CSNPs and CHX combination showed a synergistic effect against both micro-organisms. CS-CHX NPs displayed a higher effect at a shorter period compared to other medicaments, yet its residual effect was higher with 7-days placement.
Literature
1.
go back to reference Coll JA, Dhar V, Vargas K, Chen CY, Crystal YO, AlShamali S, Marghalani AA. Use of Non-Vital Pulp Therapies in primary teeth. Pediatr Dent. 2020 Sep;15(5):337–49. Coll JA, Dhar V, Vargas K, Chen CY, Crystal YO, AlShamali S, Marghalani AA. Use of Non-Vital Pulp Therapies in primary teeth. Pediatr Dent. 2020 Sep;15(5):337–49.
3.
go back to reference Ferreira NS, Martinho FC, Cardoso FG, Nascimento GG, Carvalho CA, Valera MC. Microbiological profile resistant to different intracanal medications in primary endodontic infections. J Endod. 2015 Jun;41(6):824–30. Epub 2015 Apr 17. Ferreira NS, Martinho FC, Cardoso FG, Nascimento GG, Carvalho CA, Valera MC. Microbiological profile resistant to different intracanal medications in primary endodontic infections. J Endod. 2015 Jun;41(6):824–30. Epub 2015 Apr 17.
8.
11.
go back to reference Paikkatt JV, Aslam S, Sreedharan S, Philomina B, Kannan VP, Madhu S. Efficacy of various intracanal medicaments against aerobic and facultative anaerobic microorganism found in human primary teeth with necrotic pulp: a randomized clinical trial. J Indian Soc Pedod Prev Dent. 2018 Jul-Sep;36(3):268–72. https://doi.org/10.4103/JISPPD.JISPPD_152_17 Paikkatt JV, Aslam S, Sreedharan S, Philomina B, Kannan VP, Madhu S. Efficacy of various intracanal medicaments against aerobic and facultative anaerobic microorganism found in human primary teeth with necrotic pulp: a randomized clinical trial. J Indian Soc Pedod Prev Dent. 2018 Jul-Sep;36(3):268–72. https://​doi.​org/​10.​4103/​JISPPD.​JISPPD_​152_​17
14.
go back to reference Sabrah AH, Yassen GH, Liu WC, Goebel WS, Gregory RL, Platt JA. The effect of diluted triple and double antibiotic pastes on dental pulp stem cells and established Enterococcus faecalis biofilm. Clin Oral Investig. 2015 Nov;19(8):2059–66. https://doi.org/10.1007/s00784-015-1423-6 Sabrah AH, Yassen GH, Liu WC, Goebel WS, Gregory RL, Platt JA. The effect of diluted triple and double antibiotic pastes on dental pulp stem cells and established Enterococcus faecalis biofilm. Clin Oral Investig. 2015 Nov;19(8):2059–66. https://​doi.​org/​10.​1007/​s00784-015-1423-6
16.
go back to reference Shaik J, Garlapati R, Nagesh B, Sujana V, Jayaprakash T, Naidu S. 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 Jul;17(4):335–9. https://doi.org/10.4103/0972-0707.136444 Shaik J, Garlapati R, Nagesh B, Sujana V, Jayaprakash T, Naidu S. 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 Jul;17(4):335–9. https://​doi.​org/​10.​4103/​0972-0707.​136444
19.
go back to reference Thienngern P, Panichuttra A, Ratisoontorn C, Aumnate C, Matangkasombut O. Efficacy of chitosan paste as intracanal medication against Enterococcus faecalis and Candida albicans biofilm compared with calcium hydroxide in an in vitro root canal infection model. BMC Oral Health. 2022 Aug 16;22(1):354. https://doi.org/10.1186/s12903-022-02385-x Thienngern P, Panichuttra A, Ratisoontorn C, Aumnate C, Matangkasombut O. Efficacy of chitosan paste as intracanal medication against Enterococcus faecalis and Candida albicans biofilm compared with calcium hydroxide in an in vitro root canal infection model. BMC Oral Health. 2022 Aug 16;22(1):354. https://​doi.​org/​10.​1186/​s12903-022-02385-x
20.
go back to reference Srimaneepong V, Thanamee T, Wattanasirmkit K, Muangsawat S, Matangkasombut O. Efficacy of low-molecular weight chitosan against Candida albicans biofilm on polymethyl methacrylate resin. Aust Dent J. 2021 Sep;66(3):262–269. https://doi.org/10.1111/adj.12826 Srimaneepong V, Thanamee T, Wattanasirmkit K, Muangsawat S, Matangkasombut O. Efficacy of low-molecular weight chitosan against Candida albicans biofilm on polymethyl methacrylate resin. Aust Dent J. 2021 Sep;66(3):262–269. https://​doi.​org/​10.​1111/​adj.​12826
21.
22.
go back to reference Savitha A, SriRekha A, Vijay R, Ashwija, Champa C, Jaykumar T. An in vivo comparative evaluation of antimicrobial efficacy of chitosan, chlorhexidine gluconate gel and their combination as an intracanal medicament against Enterococcus faecalis in failed endodontic cases using real time polymerase chain reaction (qPCR). Saudi Dent J. 2019 Jul;31(3):360–366. https://doi.org/10.1016/j.sdentj.2019.03.003 Savitha A, SriRekha A, Vijay R, Ashwija, Champa C, Jaykumar T. An in vivo comparative evaluation of antimicrobial efficacy of chitosan, chlorhexidine gluconate gel and their combination as an intracanal medicament against Enterococcus faecalis in failed endodontic cases using real time polymerase chain reaction (qPCR). Saudi Dent J. 2019 Jul;31(3):360–366. https://​doi.​org/​10.​1016/​j.​sdentj.​2019.​03.​003
24.
25.
go back to reference Prabhakar A, Taur S, Hadakar S, Sugandhan S. Comparison of Antibacterial Efficacy of Calcium Hydroxide Paste, 2% chlorhexidine gel and Turmeric Extract as an Intracanal Medicament and their Effect on Microhardness of Root dentin: an in vitro study. Int J Clin Pediatr Dent. 2013 Sep;6(3):171–7. https://doi.org/10.5005/jp-journals-10005-1213. Epub 2013 Oct 14. Prabhakar A, Taur S, Hadakar S, Sugandhan S. Comparison of Antibacterial Efficacy of Calcium Hydroxide Paste, 2% chlorhexidine gel and Turmeric Extract as an Intracanal Medicament and their Effect on Microhardness of Root dentin: an in vitro study. Int J Clin Pediatr Dent. 2013 Sep;6(3):171–7. https://​doi.​org/​10.​5005/​jp-journals-10005-1213. Epub 2013 Oct 14.
26.
go back to reference Kim KW, Yassen GH, Ehrlich Y, Spolnik K, Platt JA, Windsor LJ. The effects of radicular dentine treated with double antibiotic paste and ethylenediaminetetraacetic acid on the attachment and proliferation of dental pulp stem cells. Dent Traumatol. 2015 Oct;31(5):374–9. https://doi.org/10.1111/edt.12181 Kim KW, Yassen GH, Ehrlich Y, Spolnik K, Platt JA, Windsor LJ. The effects of radicular dentine treated with double antibiotic paste and ethylenediaminetetraacetic acid on the attachment and proliferation of dental pulp stem cells. Dent Traumatol. 2015 Oct;31(5):374–9. https://​doi.​org/​10.​1111/​edt.​12181
30.
go back to reference Valera MC, Silva KC, Maekawa LE, Carvalho CA, Koga-Ito CY, Camargo CH, Lima RS. Antimicrobial activity of sodium hypochlorite associated with intracanal medication for Candida albicans and Enterococcus faecalis inoculated in root canals. J Appl Oral Sci. 2009 Nov-Dec;17(6):555–9. https://doi.org/10.1590/s1678-77572009000600003 Valera MC, Silva KC, Maekawa LE, Carvalho CA, Koga-Ito CY, Camargo CH, Lima RS. Antimicrobial activity of sodium hypochlorite associated with intracanal medication for Candida albicans and Enterococcus faecalis inoculated in root canals. J Appl Oral Sci. 2009 Nov-Dec;17(6):555–9. https://​doi.​org/​10.​1590/​s1678-7757200900060000​3
31.
go back to reference Ringelstein D, Seow WK. The prevalence of furcation foramina in primary molars. Pediatr Dent. 1989 Sep;11(3):198–202. Ringelstein D, Seow WK. The prevalence of furcation foramina in primary molars. Pediatr Dent. 1989 Sep;11(3):198–202.
34.
35.
go back to reference Zancan RF, Calefi PHS, Borges MMB, Lopes MRM, de Andrade FB, Vivan RR, Duarte MAH. Antimicrobial activity of intracanal medications against both Enterococcus faecalis and Candida albicans biofilm. Microsc Res Tech. 2019 May;82(5):494–500. https://doi.org/10.1002/jemt.23192 Zancan RF, Calefi PHS, Borges MMB, Lopes MRM, de Andrade FB, Vivan RR, Duarte MAH. Antimicrobial activity of intracanal medications against both Enterococcus faecalis and Candida albicans biofilm. Microsc Res Tech. 2019 May;82(5):494–500. https://​doi.​org/​10.​1002/​jemt.​23192
37.
go back to reference Sinha N, Patil S, Dodwad PK, Patil AC, Singh B. 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 Jan;16(1):65–70. https://doi.org/10.4103/0972-0707.105302 Sinha N, Patil S, Dodwad PK, Patil AC, Singh B. 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 Jan;16(1):65–70. https://​doi.​org/​10.​4103/​0972-0707.​105302
38.
go back to reference Onçag O, Cogulu D, Uzel A. Efficacy of various intracanal medicaments against Enterococcus faecalis in primary teeth: an in vivo study. J Clin Pediatr Dent. 2006 Spring;30(3):233-7. Erratum in: J Clin Pediatr Dent. 2007 Fall;32(1):26. Gogulu, Dislah [corrected to Cogulu, Dilsah]. PMID: 16683672. Onçag O, Cogulu D, Uzel A. Efficacy of various intracanal medicaments against Enterococcus faecalis in primary teeth: an in vivo study. J Clin Pediatr Dent. 2006 Spring;30(3):233-7. Erratum in: J Clin Pediatr Dent. 2007 Fall;32(1):26. Gogulu, Dislah [corrected to Cogulu, Dilsah]. PMID: 16683672.
39.
go back to reference Ruksakiet K, Hanák L, Farkas N, Hegyi P, Sadaeng W, Czumbel LM, Sang-Ngoen T, Garami A, Mikó A, Varga G, Lohinai Z. Antimicrobial Efficacy of Chlorhexidine and Sodium Hypochlorite in Root Canal Disinfection: a systematic review and Meta-analysis of Randomized controlled trials. J Endod. 2020 Aug;46(8):1032–1041e7. https://doi.org/10.1016/j.joen.2020.05.002 Ruksakiet K, Hanák L, Farkas N, Hegyi P, Sadaeng W, Czumbel LM, Sang-Ngoen T, Garami A, Mikó A, Varga G, Lohinai Z. Antimicrobial Efficacy of Chlorhexidine and Sodium Hypochlorite in Root Canal Disinfection: a systematic review and Meta-analysis of Randomized controlled trials. J Endod. 2020 Aug;46(8):1032–1041e7. https://​doi.​org/​10.​1016/​j.​joen.​2020.​05.​002
45.
go back to reference Del Carpio-Perochena A, Kishen A, Felitti R, Bhagirath AY, Medapati MR, Lai C, Cunha RS. Antibacterial Properties of Chitosan Nanoparticles and Propolis Associated with Calcium Hydroxide against single- and Multispecies Biofilms: an in Vitro and in situ study. J Endod. 2017 Aug;43(8):1332–6. https://doi.org/10.1016/j.joen.2017.03.017 Del Carpio-Perochena A, Kishen A, Felitti R, Bhagirath AY, Medapati MR, Lai C, Cunha RS. Antibacterial Properties of Chitosan Nanoparticles and Propolis Associated with Calcium Hydroxide against single- and Multispecies Biofilms: an in Vitro and in situ study. J Endod. 2017 Aug;43(8):1332–6. https://​doi.​org/​10.​1016/​j.​joen.​2017.​03.​017
47.
go back to reference Gomes BP, Vianna ME, Sena NT, Zaia AA, Ferraz CC, de Souza Filho FJ. In vitro evaluation of the antimicrobial activity of calcium hydroxide combined with chlorhexidine gel used as intracanal medicament. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Oct;102(4):544–50. https://doi.org/10.1016/j.tripleo.2006.04.010 Gomes BP, Vianna ME, Sena NT, Zaia AA, Ferraz CC, de Souza Filho FJ. In vitro evaluation of the antimicrobial activity of calcium hydroxide combined with chlorhexidine gel used as intracanal medicament. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Oct;102(4):544–50. https://​doi.​org/​10.​1016/​j.​tripleo.​2006.​04.​010
49.
go back to reference Ong TH, Chitra E, Ramamurthy S, Siddalingam RP, Yuen KH, Ambu SP, Davamani F. Chitosan-propolis nanoparticle formulation demonstrates anti-bacterial activity against Enterococcus faecalis biofilms. PLoS One. 2017 Mar 31;12(3):e0174888. https://doi.org/10.1371/journal.pone.0174888. Erratum in: PLoS One. 2017 Apr 20;12 (4):e0176629. Ong TH, Chitra E, Ramamurthy S, Siddalingam RP, Yuen KH, Ambu SP, Davamani F. Chitosan-propolis nanoparticle formulation demonstrates anti-bacterial activity against Enterococcus faecalis biofilms. PLoS One. 2017 Mar 31;12(3):e0174888. https://​doi.​org/​10.​1371/​journal.​pone.​0174888. Erratum in: PLoS One. 2017 Apr 20;12 (4):e0176629.
53.
54.
Metadata
Title
Direct and residual antimicrobial effect of 2% chlorhexidine gel, double antibiotic paste and chitosan- chlorhexidine nanoparticles as intracanal medicaments against Enterococcus faecalis and Candida albicans in primary molars: an in-vitro study
Authors
Mariem Wassel
Mohamed Radwan
Reham Elghazawy
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-023-02862-x

Other articles of this Issue 1/2023

BMC Oral Health 1/2023 Go to the issue