Assessment of the antibacterial activity of calcium hydroxide combined with chlorhexidine paste and other intracanal medications against bacterial pathogens

Cláudia Fernandes de Magalhães Silveira, Rodrigo Sanches Cunha, Carlos Eduardo Fontana, Alexandre Sigrist de Martin, Brenda Paula Figueiredo de Almeida Gomes, Rogério Heládio Lopes Motta, Carlos Eduardo da Silveira Bueno, Cláudia Fernandes de Magalhães Silveira, Rodrigo Sanches Cunha, Carlos Eduardo Fontana, Alexandre Sigrist de Martin, Brenda Paula Figueiredo de Almeida Gomes, Rogério Heládio Lopes Motta, Carlos Eduardo da Silveira Bueno

Abstract

Objectives: The purpose of this study was to assess the in vitro antibacterial activity of four formulations of calcium hydroxide [Ca(OH)(2)] pastes against Enterococcus faecalis, Staphylococcus aureus, Pseudomonas aeruginosa and Streptococcus mutans.

Methods: A broth dilution test was performed, and the lengths of time for different pastes to kill the microbial cells were recorded and statistically analyzed. The following medications were assessed: Group I - Ca(OH)(2) + 2.0% chlorhexidine (CHX) gel; Group II - Ca(OH)(2) + camphorated paramonochlorophenol (CMCP) and propylene glycol; Group III - Ca(OH)(2) + propylene glycol; Group IV - Ca(OH)(2) + saline.

Results: The results showed that E. faecalis was the most resistant microorganism. Groups II and III eliminated all the microbial cells in 15 seconds. Group I took 45 seconds to eliminate E. faecalis.

Conclusions: Under the conditions of this study, it was concluded that all the intracanal medications tested showed antibacterial activity. However, the association of Ca(OH)(2) and PMCC or Ca(OH)(2) and propylene glycol showed a better performance, since Groups II and III took a shorter length of time than the other groups to eliminate S. aureus and E. faecalis.

Keywords: Calcium hydroxide; Chlorhexidine gel; Enterococcus faecalis; Intracanal medications.

Figures

Figure 1.
Figure 1.
Maximum time (in seconds) needed for all the test substances to produce negative cultures of each microorganism.

References

    1. Vahdaty A, Pitt Ford TR, Wilson RF. Efficacy of chlorhexidine in disinfecting dentinal tubules in vitro. Endod Dent Traumatol. 1993;9:243–248.
    1. El Karim I, Kennedy J, Hussey D. The antimicrobial effects of root canal irrigation and medication. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:560–569.
    1. Bystrom A, Sundqvist G. Bacteriologic evaluation of the effect of 0.5 percent sodium hypochlorite in endodontic therapy. Oral Surg Oral Med Oral Pathol. 1983;55:307–312.
    1. Zerella JA, Fouad AF, Spangberg LSW. Effectiveness of a calcium hydroxide and chlorhexidine digluconate mixture as disinfectant during retreatment of failed endodontic cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100:756–761.
    1. Haapasalo M, Qian W, Portenier I, Waltimo T. Effects of dentin on the antimicrobial properties of endodontic medicaments. J Endod. 2007;33:917–925.
    1. Friedman S, Komorowski R, Maillet W, Klimaite R, Nguyen HQ, Torneck CD. In vivo resistance of coronally induced bacterial ingress by an experimental glass ionomer cement root canal sealer. J Endod. 2000;26:1–5.
    1. De Rossi A, Silva LAB, Leonardo MR, Rocha LB, Rossi MA. Effect of rotary or manual instrumentation, with or without a calcium hydroxide/1% chlorhexidine intracanal dressing, on the healing of experimentally induced chronic periapical lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99:628–636.
    1. Chong BS, Pitt Ford TR. The role of intracanal medication in root canal treatment. Int Endod J. 1992;25:97–106.
    1. Basrani B, Tjaderhane L, Santos M, Pascon E, Grad H, Lawrence HP, Friedman S. Efficacy of chlorhexidine and calcium hydroxide–containing medicaments against Enterococcus faecalis in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:618–624.
    1. Kontakiotis EG, Tsatsoulis IN, Papanakou SI, Tzanetakis GN. Effect of 2% chlorhexidine gel mixed with calcium hydroxide as an intracanal medication on sealing ability of permanent root canal filling: a 6-month follow-up. J Endod. 2008;34:866–870.
    1. Sathorn C, Parashos P, Messer H. Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysis. Int Endod J. 2007;40:2–10.
    1. Pacios MG, de la Casa ML, de los Angeles Bulacio M, López ME. Calcium hydroxide's association with different vehicles: In vitro action on some dentinal components. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:96–101.
    1. Ferreira FB, Torres SA, Rosa OP, Ferreira CM, Garcia RB, Marcucci MC, Gomes BP. Antimicrobial effect of propolis and other substances against selected endodontic pathogens. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:709–716.
    1. Frank AL. Therapy for the divergent pulpless tooth by continued apical formation. J Am Dent Assoc. 1966;72:87–93.
    1. Chang YC, Tai KW, Chou LS, Chou MY. Effects of camphorated parachlorophenol on human periodontal ligament cells in vitro. J Endod. 1999;25:779–781.
    1. Gomes BP, Ferraz CC, Vianna ME, Berber VB, Teixeira FB, Souza-Filho FJ. In vitro antimicrobial activity of several concentrations of sodium hypochlorite and chlorhexidine gluconate in the elimination of Enterococcus faecalis. Int Endod J. 2001;34:424–428.
    1. Gomes BP, Sato E, Ferraz CC, Teixeira FB, Zaia AA, Souza-Filho FJ. Evaluation of time required for recontamination of coronally sealed canals medicated with calcium hydroxide and chlorhexidine. Int Endod J. 2003;36:604–609.
    1. Davis JM, Maki J, Bahcall JK. An in vitro comparison of the antimicrobial effects of various endodontic medicaments on Enterococcus faecalis. J Endod. 2007;33:567–569.
    1. Neelakantan P, Sanjeev K, Subbarao CV. Duration-dependent susceptibility of endodontic pathogens to calcium hydroxide and chlorhexidine gel used as intracanal medicament: an in vitro evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:e138–141.
    1. Basrani B, Ghanem A, Tjäderhane L. Physical and chemical properties of chlorhexidine and calcium hydroxide-containing medications. J Endod. 2004;30:413–417.
    1. Ercan E, Dalli M, Dülgergil CT. In vitro assessment of the effectiveness of chlorhexidine gel and calcium hydroxide paste with chlorhexidine against Enterococcus faecalis and Candida albicans. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:e27–31.
    1. Lee Y, Han SH, Hong SH. Antimicrobial efficacy of a polymeric chlorhexidine release device using in vitro model of Enterococcus faecalis dentinal tubule infection. J Endod. 2008;34:855–858.
    1. Zehnder M, Grawehr M, Hasselgren G, Waltimo T. Tissue-dissolution capacity and dentin-disinfecting potential of calcium hydroxide mixed with irrigating solutions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:608–613.
    1. Sirén EK, Haapasalo MP, Waltimo TM, Ørstavik D. In vitro antibacterial effect of calcium hydroxide combined with chlorhexidine or iodine potassium iodide on Enterococcus faecalis. Eur J Oral Sci. 2004;112:326–331.
    1. Siqueira JF, Jr, Paiva SS, Rocas IN. Reduction in the cultivable bacterial populations in infected root canals by a chlorhexidine-based antimicrobial protocol. J Endod. 2007;33:541–547.
    1. Vianna ME, Gomes BP, Berber VB, Zaia AA, Ferraz CC, de Souza-Filho FJ. In vitro evaluation of the antimicrobial activity of chlorhexidine and sodium hypochlorite. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:79–84.
    1. Estrela C, Rodrigues de Araújo Estrela C, Bammann LL, Pecora JD. Two methods to evaluate the antimicrobial action of calcium hydroxide paste. J Endod. 2001;27:720–723.
    1. Gomes BPFA, Vianna ME, Sena NT, Zaia AA, Ferraz, Souza Filho FFS. 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;102:544–550.
    1. Gomes BPFA, Ferraz CCR, Vianna ME, Berber VB, Teixeira FB, Souza-Filho FJ. In vitro antimicrobial activity of several concentrations of sodium hypochlorite and chlorhexidine gluconate in the elimination of Enterococcus faecalis. Int Endod J. 2001;34:424–428.
    1. Vianna ME, Gomes BP, Sena NT, Zaia AA, Ferraz CC, de Souza Filho FJ. In vitro evaluation of the susceptibility of endodontic pathogens to calcium hydroxide combined with different vehicles. Braz Dent J. 2005;16:175–180.
    1. Vianna ME, Gomes BP. Efficacy of sodium hypochlorite combined with chlorhexidine against Enterococcus faecalis in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:585–589.
    1. Gomes BP, Ferraz CC, Vianna ME, Rosalen PL, Zaia AA, Teixeira FB, Souza-Filho FJ. In vitro antimicrobial activity of calcium hydroxide pastes and their vehicles against selected microorganisms. Braz Dent J. 2002;13:155–161.
    1. Weiss EI, Shalhav M, Fuss Z. Assessment of antibacterial activity of endodontic sealers by a direct contact test. Endod Dent Traumatol. 1996;12:179–184.
    1. Estrela C, Estrela CRA, Moura J, Bammann LL. Testing calcium hydroxide antimicrobial potential by different methods. J Dent Res. 2000;79:529.
    1. Yücel AÇ, Aksoy A, Ertas E, Güvenç D. The pH changes of calcium hydroxide mixed with six different vehicles. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:712–717.
    1. Siqueira JF, Jr, de Uzeda M. Intracanal medicaments: evaluation of the antibacterial effects of chlorhexidine, metronidazole, and calcium hydroxide associated with three vehicles. J Endod. 1997;23:167–169.
    1. Penesis VA, Fitzgerald PI, Fayad MI, Wenckus CS, BeGole EA, Johnson BR. Outcome of one-visit and two-visit endodontic treatment of necrotic teeth with apical periodontitis: a randomized controlled trial with one-year evaluation. J Endod. 2008;34:251–257.
    1. Fava LR, Saunders WP. Calcium hydroxide pastes: classification and clinical indications. Int Endod J. 1999;32:257–282.
    1. Simon ST, Bhat KS, Francis R. Effect of four vehicles on the pH of calcium hydroxide and the release of calcium ion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;80:459–464.
    1. Safavi K, Nakayama TA. Influence of mixing vehicle on dissociation of calcium hydroxide in solution. J Endod. 2000;26:649–651.
    1. Basrani B, Santos JM, Tjäderhane L, Grad H, Gorduysus O, Huang J, Lawrence HP, Friedman S. Substantive antimicrobial activity in chlorhexidine-treated human root dentin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:240–245.
    1. Ferguson JW, Hatton JF, Gillespie MJ. Effectiveness of intracanal irrigants and medications against the yeast Candida albicans. J Endod. 2002;28:68–71.
    1. Waltimo TM, Sirén EK, Orstavik D, Haapasalo MP. Susceptibility of oral Candida species to calcium hydroxide in vitro. Int Endod J. 1999;32:94–98.
    1. Turk BT, Sen BH, Ozturk T. In vitro antimicrobial activity of calcium hydroxide mixed with different vehicles against Enterococcus faecalis and Candida albicans. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:297–301.
    1. Gomes BP, Montagner F, Berber VB, Zaia AA, Ferraz CC, de Almeida JF, Souza-Filho FJ. Antimicrobial action of intracanal medicaments on the external root surface. J Dent. 2009;37:76–81.
    1. Evans MD, Baumgartner JC, Khemaleelakul SU, Xia T. Efficacy of calcium hydroxide: chlorhexidine paste as an intracanal medication in bovine dentin. J Endod. 2003;29:338–339.
    1. Sirén EK, Haapasalo MP, Waltimo TM, Ørstavik D. In vitro antibacterial effect of calcium hydroxide combined with chlorhexidine or iodine potassium iodide on Enterococcus faecalis. Eur J Oral Sci. 2004;112:326–331.
    1. Sundqvist G, Figdor D, Persson S, Sjögren U. Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85:86–93.
    1. Evans M, Davies JK, Sundqvist G, Figdor D. Mechanisms involved in the resistance of Enterococcus faecalis to calcium hydroxide. Int Endod J. 2002;35:221–228.
    1. McHugh CP, Zhang P, Michalek S, Eleazer PD. pH required to kill Enterococcus faecalis in vitro. J Endod. 2004;30:218–219.
    1. Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J. 2007;52:S64–82.
    1. Haenni S, Schmidlin PR, Mueller B, Sener B, Zehnder M. Chemical and antimicrobial properties of calcium hydroxide mixed with irrigating solutions. Int Endod J. 2003;36:100–105.
    1. Mohammadi Z, Abbott PV. The properties and applications of chlorhexidine in endodontics. Int Endod J. 2009;42:288–302.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren