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