Antifungal Efficacy of Triple Antibiotic Paste, Double Antibiotic Paste with Fungicide and Calcium Hydroxide with Chitosan as a Vehicle against Candida albicans: An In vitro Study

Introduction: The purpose of current research is to assess the in vitro antimicrobial efficacy of different medicaments with two different vehicles against Candida albicans (C. albicans). Materials and Methodology: An agar well diffusion assay was used to determine the experimental medicaments' efficacy against C. albicans. Medicaments were divided into six groups, which includes Triple antibiotic powder (TAP) with saline or chitosan, Double antibiotic powder with fungicide (DAPF) with saline or Chitosan, and calcium hydroxide with saline or Chitosan. The diameters of growth inhibition zones were recorded and compared for each group for three days, i.e., 1,4,7 days. The differences between groups were analyzed by Kruskal-Wallis and Mann-Whitney U tests. Results: The largest inhibition zones were observed for the double antibiotic paste + fungicide with chitosan and the smallest for Ca(OH)2 with saline. Over a week, zones of inhibition were consistent only with group V – double antibiotic paste with fungicide and chitosan as the vehicle. Conclusion: DAPF with chitosan is more efficient against Candida albicans. Since the endodontic infections are polymicrobial in origin, the combined local drug delivery of antimicrobial agents such as ciprofloxacin, metronidazole, doxycycline along with antifungal drugs such as fluconazole with an efficient drug carrier (chitosan) is recommended to combat the microbial load.

Comparison of Apically Extruded Debris Associated with Different Irrigation Techniques after Removal of Intracanal Medicaments

This study aimed to compare the effect of XP-endo Finisher file (XPF), passive ultrasonic irrigation (PUI) and conventional irrigation technique using side-vented needle (SVN) on the amount of apically extruded debris after the removal of calcium hydroxide Ca(OH)2 and double antibiotic paste (DAP). Materials and Methods: Sixty extracted human mandibular premolars were used. After decronation, all canals were prepared up to the ProTaper Next X4 file (Dentsply Maillefer, Ballaigues, Switzerland). After dryness, teeth were randomly assigned into 2 groups (n=30) according to the Type of intracanal medication used; Ca(OH)2 and DAP then incubated at 37 °C and 100% humidity. After one week, Samples in each group were randomly assigned to 3 subgroups (n=10) according to the method used for medicament removal: XPF, PUI and SVN. Debris extruded during the removal procedure were collected into pre-weighed Eppendorf tubes then left to dry in an incubator at 37°C for 15 days. The amount of extruded debris was assessed with an analytical balance and calculated by subtracting the initial weight from the final weight of the tube. Data were statistically analyzed using Kruskal-Wallis and Mann-Whitney U test. Results: there was no statistically significant difference regarding the amount of apically extruded debris after using the three irrigation techniques in removal of both Ca(OH)2 and DAP (P-value = 0.141, Effect size = 0.160) and (P-value = 0.237, Effect size = 0.073) respectively. Conclusions: Neither XPF nor PUI increase the risk of intracanal medicament extrusion beyond the apex.

Comparative Evaluation of Different Irrigation Techniques with Conventional Irrigation Technique for the Removal of Double Antibiotic Paste from Root Canal-An in vitro study

Complete removal of infection, rendering root canal free of an organism is the prime aim of endodontic treatment. It cannot be achieved alone by biomechanical preparation due to the complexity of root canal treatment. Therefore the use of intracanal medicament is a must. The antibiotic paste is frequently used intracanal medicament, usually in regenerative cases. Hence the aim of the is to compare different irrigation technique for removal of double antibiotic paste from root canal through a stereomicroscope. 36 single-rooted were standardized to root length of 12mm then instrumented by Protaper rotary file up to size F4. Irrigation was done using sodium hypochlorite in between instrument change. The root canal was dried using paper point and filled by DAP and then randomly allocated to 3 groups(n=12) according to irrigation system used: conventional syringe irrigation (CSI), Passive ultrasonic irrigation(PUI), EndoVac (EV). Roots were then longitudinally sectioned using the diamond disk and studied under a stereomicroscope using a scoring scale. Data were evaluated using one way ANOVA and Tukey test. Among all experimental group CSI was least efficient. PUI and EV showed greater efficiency but no significant difference between PUI and EV, but a significant difference between CSI and PUI, EV (p< 0.05). Use of irrigation activation system results in efficient removal of DAP compared to CSI.

Antimicrobial Activity and Physicochemical Properties of Antibiotic Pastes Used In Regenerative Endodontics

The purpose of this study was to evaluate the pH, solubility and antimicrobial action of Calcium Hydroxide Paste (CH), Double Antibiotic Paste (metronidazole+ciprofloxacin-DAP), calcium hydroxide added to DAP (CH/DAP) and Triple Antibiotic Paste (metronidazole + ciprofloxacin+minocycline-TAP). pH (n=10) were measured by pHmeter. Root canals of acrylic teeth (n=10) were filled with the above-mentioned intracanal-dressings, immersed in ultrapure water, and solubility was measured by the difference between the initial and final volume (7,15 and 30 days) by using micro-computed tomography. Enterococcus faecalis biofilm was induced on bovine dentin disc surfaces (n=20), and treated with the pastes for 7 days. Percentage bacterial viability was verified by confocal microscope, with LIVE/DEAD dye. CH and CH/DAP presented the highest pH values. Regarding solubility, after 7 days, antibiotic groups presented significant volume loss. CH and CH/DAP showed no statistical difference compared with the Control in antimicrobial action against E. faecalis biofilm. However, TAP and DAP presented a significant percentage reduction in bacterial population. Due to high solubility of the pastes, renewing antibiotic dressings every 7 days, or using the medications for this period in regeneration protocols is recommended. DAP is indicated for killing E. faecalis in biofilm because it has antimicrobial action similar to TAP. Adding Calcium Hydroxide to DAP significantly decreased its antimicrobial action. In spite of its the low solubility and high pH values, the CH paste showed a low level of antimicrobial action against E. faecalis in biofilm.