J. Nihon
Univ.
Sch.
Dent.,
Vol.
34, 233-236,
Antibacterial
1992
Efficacy Medicaments
Nimet GENCOGLU,
of Root
Canal
DDS' and Gilven KOLEKCI, DDS2
(Received19 November1991and accepted17 March 1992) Key words:
intracanal medicament, calcium hydroxide, camphorated parachlorophenol, iodine-potassium iodide Abstract
The antibacterial efficacy of four endodontic medicaments was studied in vitro. Calcium hydroxide (CALACEPT), camphorated parachlorophenol (CPCP), Cresophene, and 2% iodine-potassium iodide (IKI) were tested against four anaerobic microorganisms, Streptococcus mutans, Peptostreptococcus anaerobius, Porphyromonus gingivalis and Fusobacterium nucleatum, for 10 or 15 min. IKI was effective only against F. nucleatum and P. gingivalis, and the others were effective against all four microorganisms. Introduction The elimination of microorganisms from the root canal has always been an important part of endodontic therapy. The population of microorganisms in an infected root canal may be reduced significantly by biomechanical instrumentation, irrigation and intracanal medication[1,2]. Selection of these medications has been
based
on effectiveness,
toxicity,
inflammation
potential
and
diffusibility121.
Medicaments currently used in endodontics have been thoroughly reviewed by SPANGBERG[1]. As an intracanal medicament, 2% iodine-potassium iodide (IKI) is an outstanding example of a deposit antiseptic combining excellent antimicrobial activity with low tissue irritation121. Pear considered camphorated parachlorophenol (CPCP) to be the preferred agent because of its antimicrobial activity and low tissue toxicity131.Also the vapor of metacresylacetate (Cresatin) has been found to be effective against staphylococci. Calcium hydroxide was introduced as an antibacterial dressing for endodontic therapy by Herman in 1920. It has been used for apexification and pulp-capping procedures, and is now used as an intracanal medication in endodontic therapy[4,5]. The aim of this study was to evaluate the bactericidal efficacy of the frequently used intracanal medications IKI, CPCP, Cresophene and CALACEPT against four different obligate anaerobes found in the root canal. Materials
and Methods
The antibacterial effectiveness of calcium hydroxide (CALACEPT, Scania Dental AB; Knivsta, Sweden), 2% iodine-potassium iodide, Cresophene and CPCP were tested against the four microorganisms, Streptococcus mutans (ATCC 1 Department of Endodontics, Faculty of Dentistry, Marmara University 2 Department of Microbiology, Faculty of Dentistry, Istanbul Universty To whom all correspondence should be addressed: Dr. Nimet GENCOGL U, Faculty of Dentistry, Anafartalar sok., Fulya ap. 3/ 1, YefilkOy,Istanbul, TURKEY.
234
13419),
Peptostreptococcus
(HG66,
HG91),
and
microorganisms
Sagawa,
cultures
were
paper
submerged
in
4 points placed
the
inoculum
placed
in
tube
effect
of
turbidity
of
the
negative
agar
GasPak h
at
plate
for
37•Ž.
as
min,
then
solution.
The
glycolate
tubes.
described
were
placed in
After above,
of into
and
procedure
of
the results
subcultured
test
were
then and on
positive
paper the 10
were were
the
evidence
bacterial
ml
placed incubated
of
presence
that
had
a
Brucella
placed
into
incubated pour
directly and
Table
I
anaerobic
a
plates,
growth which
in were for
thioglycolate into
thio-
subcultured
recorded.
for the other
a
for
culture
the
the
germicid-
the
of
points
10 were
of
the
into
organism
be
after
growth
those
were
test
points
37•Ž,
conditions,
containing
tubes
the
at
then
containing points
beakers
for
in
the
minimize
including
sterilized
control
was repeated
s to
incubation
to
beaker tubes
sterilized
the
the
medicaments submerged
solution
plates
were
remaining
containing
tube,
agar
4 remaining the
vortexing,
h
test
removal,
10
anaerobic
considered
separate
remaining
72
The
those
medium
for
blood
colonies
the
test
Upon
Each
achieve
was
Two
placed two
The entire
of
staining, tube.
controls
and
presence
Gram
the
min.
extra-coarse
sterile
beakers
and The
points
3 min.
from
20
was
The to
the
thioglycolate
thioglycolate,
System
of
points
vortexed
tube.
confirmation.
one
from
After
each
least
Oral
Japan.
Twenty
at
the
15
of
then
solution.
in
Jar The
by
ml
was
for
response
corresponding
used
test
recorded
of
after 10
tube
each
removed
containing
Anaerobic
confirmed
removed
residual
growth
blood
were
were
Each
was
in
points 10
bacteria.
al
as
the
of
of
Netherlands,
presterilized
for
paper
anaerobic
University,
chemiclave.
inoculum
Three
placed
Dental
a
milliliters
beakers.
the
Twenty-four in
The
Department
Amsterdam,
beakers.
gingivalis
25586).
Steenbergen,
Osaka
the
Porphyromonus
(ATCC
Van
Dentistry,
Ten
20
then
J.
resterilized
controls. of
other
a test
anaerobic
the
as
of
the
sterile
were
each
Ten
and
for
containing
were
solutions.
72
used into
T.
Bacteriology,
to
points
a beaker
were
was
of
transferred
absorbant
from
Centre
Dept.
27337),
nucleatum
obtained
Academic
Hirosuke
(ATCC
Fusobacterium
were
Microbiology,
min,
anaerobius
microorganisms[61.
3
235
Results Table organisms.
1 shows the effectiveness of the medicaments against Streptococcus mutans, Peptostreptococcus anaerobius,
the four microPorphyromonus
gingivalis and F. nucleatum were all destroyed by CALACEPT, CPCP and Cresophene after both 10 and 15 min. However 2% IKI was only effective against P. gingivalis and F. nucleatum. The control paper points which were placed directly into the thioglycolate tubes after contamination in the bacterial cultures all produced positive growth in cultures and subcultures. The uncontaminated control paper points placed directly into the thioglycolate tube did not produce any growth. The results of these control procedures confirmed the adequacy of the anaerobic growth methods and the non-contamination of the paper points. Discussion In recent studies, obligate anaerobic microbes have been found in certain cases of pulpal necrosis and periapical lesionsw. Since microbes are etiologically involved in pulpal-periapical disease, it is important to eliminate them. BYSTROM et al. indicated that, without antibacterial dressing, mechanical cleansing of the root canals and rinsing with sodium hypochlorite solution can only eliminate bacteria from 50% of initially infected root canalsr51. Persistence of microorganisms may even result in complete failure of root canal treatment in the long termm.
CPCP, IKI, Cresatine and Ca(OH)2 have been widely used as interpoint intracanal medications and are considered to be potential antimicrobial agents. Although the effect of intracanal medication on aerobic microorganisms has been widely studied, little research has been done on anaerobic microorganisms. STUARTet al. investigated the effectiveness of Ca(OH)2 and CMCP against S. mutans, A. viscosus, B. gingivalis and B. fragilis and found that Ca(OH)2 showed significantly higher antimicrobial activity than CMCP. No difference was found for A. viscosusr81.BYSTROM et al. investigated the bactericidal efficacy of CALACEPT, CP and CMCP in 65 single rooted teeth with periapical lesions. After treatment with CP or CMCP, bacteria were recovered from 10 of 30 treated root canals, whereas bacteria were recovered from only one of 35 treated root canals after CALACEPT treatmenti51. STEVENANDGROSSMAN reported that Ca(OH)2 was less effective than CMCP in killing E. fecalis in experimentally infected root canals of catsm. GOLDMAN AND PEARSONhave reported that 30% of root canals that were infected at the first appointment
still
contained
bacteria
after
medication
with
CMCP [10].
HAAPSALO ANDORSTAVIK investigated the effect of CMCP and CALACEPT on E. faecalis in in vitro models of dentinal tubules. They found that while CMCP completely disinfected the dentinal tubules, CALACEPT failed to eliminate E. faecalis[11]. SAFAVIet al. investigated the effect of Ca(OH)2 and IKI in vivo. They found that the frequency of culture reversals was significantly lower for Ca(OH)2 than for IKI[12].ELLERBRUCH ANDMURPHYinvestigated the effects of formocresol, NaOCI, IKI,
aqueous
glutaraldehyde,
aqueous
PCP
and
CPCP
against
S.
epidermis,
236
Lactobacillus, activity
of
Streptococcus, formocresol
and was
Enterococcus
greater
than
and that
found of
the
that other
the
antibacterial medications[3].
KOONTONGHAEW et al. indicated that chemomechanical preparation and intracanal dressing with CMCP for 1 and 3 days induced a rapid decrease in the number of bacteria in infected canals[4]. In our investigation, Ca(OH)2 (CALACEPT), CPCP, and Cresatine were found to be effective in eliminating all four anaerobic microorganisms studied. We found that, after biomechanical instrumentation and irrigation, intracanal medicaments can have an effect on living residal microorganisms and influence the prognosis of endodontic therapy. References [1] SPANGBERG, L.: Intracanal Medication. In: Endodontics, INGLEJ. I and TAINTOR J. F., eds., 3rd, Lea Febiger, Philadelphia, 566-576, 1985 [2] WALTON, R. E.: Intracanal medicaments, Dental Clinics of North America, 28, 783-796, 1984 [3] ELLERBRUCH, E. S. and MURPHY, R. A.: Antimicrobial activity of root canal medicament vapors, J. Endodont., 3, 189-193, 1977 [4] KOONTONGKAEW, S., SILAPICHIT, R. and THAWEBOON, B.: Clinical and laboratory assessment of camphorated monochlorophenol in endodontic therapy, Oral Surg., 65, 757-762, 1988 [5] BYSTROM A., CLAESSON, R. C. and SUNDQVIST, G.: The antibacterial effect of camphorated parachlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals, Endodont. Dent. Traumatol., 1, 170-175, 1986 [6] NIKOLAUS, B. E., WAYMAN, B. E. and ENCINAS, E.: The bactericidal effect of citric acid and sodium hypochlorite on anaerobic bacteria, J. Endodont., 14, 31-34, 1988 [7] TRONSTAD, L., BARNETT, F., Riso, K. and SLOTS,J.: Extraradicular endodontic infections, Endodont. Dent. Traumatol., 3, 86-90, 1987 [8] STUART, K. G., MILLER, C. H., BROWN, C. E. and NEWTON, C. V.: The comparative antimicrobial effect of calcium hydroxide, Oral Surg., 72, 101-104, 1991 [9] STEVEN, R. H. and GROSSMAN, L. I.: Evaluation of the antimicrobial potential of calcium hydroxide as an intracanal medicament, J. Endodont., 9, 372-374, 1983 [10] GOLDMAN, M. and PEARSON, A. H.: Postdebridement bacterial flora and antibiotic sensitivity, Oral Surg., 28, 897-905, 1969 [11] HAAPASALO, M. and ORSTAVIK, D.: In vitro infection and disinfection of dentinal tubules, J. Dent. Res., 66, 1375-1379, 1987 [12] SAFAVI, K. E., DOWDEN, W. E., INTROCASO, J. H. and LANGELAND, K.: A comparison of antimicrobial effects of calcium hydroxide and iodine-potassium iodide, J. Endodont., 11, 454-456, 1985