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      How efficacious are Neem, Tulsi, Guduchi extracts and chlorhexidine as intracanal disinfectants? A comparative ex vivo study

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          Abstract

          Introduction:

          In endodontics, despite careful instrumentation and antimicrobial irrigation, root canals still harbor cultivable microorganisms. Such cases require intra canal medicament that eliminates the microbial inhabitants from the canals. Recent trend advocates the use of herbal extracts due to easy availability, cost-effectiveness, low toxicity, and lack of microbial resistance. Hence, in the present study, Neem, Tulsi, and Guduchi extracts were used as intracanal medicaments.

          Aim:

          This study aimed to evaluate and compare the antibacterial efficacy of Neem, Tulsi, Guduchi extracts, and chlorhexidine against Enterococcus faecalis, when used as intracanal medicaments.

          Materials and Methods:

          One hundred and twenty-five extracted human teeth, inoculated with E. faecalis, were divided into four experimental groups and a control group ( n = 25 in each group). The experimental groups were treated with chlorhexidine, Neem, Tulsi, and Guduchi extracts and their antibacterial property was evaluated by estimating microbial counting (CFU/ml).

          Results:

          The reduction in bacterial count for chlorhexidine, Neem, Tulsi, and Guduchi groups was 60.76%, 51.98%, 37.73%, and 34.93%, respectively. Statistically significant difference in reduction of bacterial count was observed in all the groups, when compared with the control group.

          Conclusion:

          Among all the herbal extracts, Neem was found to be the most potent medicament followed by Tulsi and Guduchi. However, chlorhexidine was found to be at epic.

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          Most cited references30

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          Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis.

          This study investigated the role of infection on the prognosis of endodontic therapy by following-up teeth that had had their canals cleaned and obturated during a single appointment. The root canals of 55 single-rooted teeth with apical periodontitis were thoroughly instrumented and irrigated with sodium hypochlorite solution. Using advanced anaerobic bacteriological techniques, post-instrumentation samples were taken and the teeth were then root-filled during the same appointment. All teeth were initially infected; after instrumentation low numbers of bacteria were detected in 22 of 55 root canals. Periapical healing was followed-up for 5 years. Complete periapical healing occurred in 94% of cases that yielded a negative culture. Where the samples were positive prior to root filling, the success rate of treatment was just 68%--a statistically significant difference. Further investigation of three failures revealed the presence of Actinomyces species in each case; no other specific bacteria were implicated in failure cases. These findings emphasize the importance of completely eliminating bacteria from the root canal system before obturation. This objective cannot be reliably achieved in a one-visit treatment because it is not possible to eradicate all infection from the root canal without the support of an inter-appointment antimicrobial dressing.
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            Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment.

            The purposes of this study were to determine what microbial flora were present in teeth after failed root canal therapy and to establish the outcome of conservative re-treatment. Fifty-four root-filled teeth with persisting periapical lesions were selected for re-treatment. After removal of the root filling, canals were sampled by means of advanced microbiologic techniques. The teeth were then re-treated and followed for up to 5 years. The microbial flora was mainly single species of predominantly gram-positive organisms. The isolates most commonly recovered were bacteria of the species Enterococcus faecalis. The overall success rate of re-treatment was 74%. The microbial flora in canals after failed endodontic therapy differed markedly from the flora in untreated teeth. Infection at the time of root filling and size of the periapical lesion were factors that had a negative influence on the prognosis. Three of four endodontic failures were successfully managed by re-treatment.
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              In vitro antimicrobial activity of several concentrations of sodium hypochlorite and chlorhexidine gluconate in the elimination of Enterococcus faecalis.

              The aim of this study was to assess, in vitro, the effectiveness of several concentrations of NaOCl (0.5%, 1%, 2.5%, 4% and 5.25%) and two forms of chlorhexidine gluconate (gel and liquid) in three concentrations (0.2%, 1% and 2%) in the elimination of E. faecalis. A broth dilution test using 24-well cell culture plates was performed and the time taken for the irrigants to kill bacterial cells was recorded. Isolated 24 h colonies of pure cultures of E. faecalis grown on 10% sheep blood plus Brain Heart Infusion (BHI) agar plates were suspended in sterile 0.85% NaCI solution. The cell suspension was adjusted spectrophotometrically to match the turbidity of a McFarland 0.5 scale. One mL of each tested substance was placed on the bottom of wells of 24-well cell culture plates (Corning, NY), including the control group (sterile saline). Six wells were used for each time period and irrigant concentration. Two mL of the bacterial suspension were ultrasonically mixed for 10 s with the irrigants and placed in contact with them for 10, 30, and 45 s; 1, 3, 5, 10, 20, and 30 min; and 1 and 2 h. After each period of time, 1 mL from each well was transferred to tubes containing 2 mL of freshly prepared BHI + neutralizers in order to prevent a residual action of the irrigants. All tubes were incubated at 37 degrees C for 7 days. The tubes considered to have positive growth were those which presented medium turbidity during the incubation period. Data were analysed statistically by the Kruskal-Wallis test. with the level of significance set at P < 0.05. All irrigants were effective in killing E. faecalis. but at different times. Chlorhexidine in the liquid form at all concentrations tested (0.2%, 1% and 2%) and NaOCI (5.25%) were the most effective irrigants. However, the time required by 0.2% chlorhexidine liquid and 2% chlorhexidine gel to promote negative cultures was only 30 s and 1 min, respectively. Even though all tested irrigants possessed antibacterial activity, the time required to eliminate E. faecalis depended on the concentration and type of irrigant used.
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                Author and article information

                Journal
                Ayu
                Ayu
                AYU
                Ayu
                Medknow Publications & Media Pvt Ltd (India )
                0974-8520
                0976-9382
                Jan-Jun 2017
                : 38
                : 1-2
                : 70-75
                Affiliations
                [1]Department of Paedodontics and Preventive Dentistry, Subharti Dental College, Meerut, Uttar Pradesh, India
                [1 ]Department of Microbiology, Subharti Medical College, Meerut, Uttar Pradesh, India
                Author notes
                Address for correspondence: Dr. Ashutosh Bhardwaj, Kripayanam Hospital, Gandhi Road, Kankhal, Haridwar - 249 408, Uttarakhand, India. E-mail: drashutoshpedo@ 123456gmail.com
                Article
                AYU-38-70
                10.4103/ayu.AYU_72_16
                5954265
                4cdbe5d0-8254-4356-a421-e3a242580491
                Copyright: © 2018 AYU (An International Quarterly Journal of Research in Ayurveda)

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Pharmacological Study

                Complementary & Alternative medicine
                antibacterial,chlorhexidine,enterococcus faecalis,guduchi,intracanal medicaments,neem,tulsi

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