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      A comparative evaluation of Morinda citrifolia, green tea polyphenols, and Triphala with 5% sodium hypochlorite as an endodontic irrigant against Enterococcus faecalis: An in vitro study

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          Abstract

          Background:

          Endodontic infections require effective removal of microorganisms from the root canal system for long-term prognosis. Sodium hypochlorite (NaOCl) is the most effective irrigant currently, but potential complications due to its toxicity warrant search for newer alternatives. In this study, the antimicrobial efficacy of Morinda citrifolia (MC), green tea polyphenols and Triphala was compared with 5% NaOCl against Enterococcus faecalis.

          Materials and Methods:

          In this in vitro study sixty extracted human premolar teeth were infected with E. faecalis, a Group D Streptococci for 48 h. At the end of 48 h, the vital bacterial population was assessed by counting the number of colony-forming units (CFUs) on blood agar plate. Samples were divided into five groups; Group I (distilled water), Group II (NaOCl), Group III (MC), Group IV (Triphala), and Group V (green tea polyphenols). The samples were irrigated with individual test agents and CFUs were recorded. Kruskal–Wallis test was performed as the parametric test to compare different groups. Student's t-test was used to compare mean values between groups before and after treatment with test agents ( P < 0.001).

          Results:

          NaOCl was the most effective irrigant the elimination of E. faecalis reinforcing its role as the best irrigant available currently and a gold standard for comparison of the experimental groups. Its antibacterial effect was comparable to Triphala. Among the experimental groups, MC showed the minimum antibacterial effect.

          Conclusion:

          The use of herbal alternatives as a root canal irrigant might prove to be advantageous considering the several undesirable characteristics of NaOCl.

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          Most cited references33

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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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            Association of Enterococcus faecalis with different forms of periradicular diseases.

            Data from culture studies have revealed that Enterococcus faecalis is occasionally isolated from primary endodontic infections but frequently recovered from treatment failures. This molecular study was undertaken to investigate the prevalence of E. faecalis in endodontic infections and to determine whether this species is associated with particular forms of periradicular diseases. Samples were taken from cases of untreated teeth with asymptomatic chronic periradicular lesions, acute apical periodontitis, or acute periradicular abscesses, and from root-filled teeth associated with asymptomatic chronic periradicular lesions. DNA was extracted from the samples, and a 16S rDNA-based nested polymerase chain reaction assay was used to identify E. faecalis. This species occurred in seven of 21 root canals associated with asymptomatic chronic periradicular lesions, in one of 10 root canals associated with acute apical periodontitis, and in one of 19 pus samples aspirated from acute periradicular abscesses. Statistical analysis showed that E. faecalis was significantly more associated with asymptomatic cases than with symptomatic ones. E. faecalis was detected in 20 of 30 cases of persistent endodontic infections associated with root-filled teeth. When comparing the frequencies of this species in 30 cases of persistent infections with 50 cases of primary infections, statistical analysis demonstrated that E. faecalis was strongly associated with persistent infections. The average odds of detecting E. faecalis in cases of persistent infections associated with treatment failure were 9.1. The results of this study indicated that E. faecalis is significantly more associated with asymptomatic cases of primary endodontic infections than with symptomatic ones. Furthermore, E. faecalis was much more likely to be found in cases of failed endodontic therapy than in primary infections.
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              In vitro infection and disinfection of dentinal tubules.

              An in vitro model for dentinal tubule infection of root canals was developed. Cylindrical dentin specimens, 4 mm high with a diameter of 6 mm and a canal 2.3 mm wide, were prepared from freshly extracted bovine incisors. The cementum was removed from all dentin blocks. The tubules were opened by four-minute treatments with 17% EDTA and 5.25% NaOCl before being infected with Enterococcus faecalis ATCC 29212 in yeast extract-glucose broth. Bacteria rapidly invaded the tubules. After three weeks of incubation, a heavy infection was found 400 micron from the canal lumen, and the front of the infection reached 1000 micron in some blocks. Camphorated paramonochlorophenol (CMCP) and a calcium hydroxide compound, Calasept, were tested for their disinfecting efficacy toward E. faecalis-infected dentin. Liquid CMCP rapidly and completely disinfected the dentinal tubules, whereas CMCP in gaseous form disinfected tubules less rapidly. Calasept failed to eliminate, even superficially, E. faecalis in the tubules. The method used in bacteriological sampling allowed for sequential removal of 100-micron-thick zones of dentin from the central canal toward the periphery. Control specimens were uniformly infected and yielded growth in bur samples up to some 500 microns from the surface. The model proved quite sensitive and seems suitable for in vitro testing of root canal medicaments.
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                Author and article information

                Journal
                Dent Res J (Isfahan)
                Dent Res J (Isfahan)
                DRJ
                Dental Research Journal
                Medknow Publications & Media Pvt Ltd (India )
                1735-3327
                2008-0255
                Mar-Apr 2018
                : 15
                : 2
                : 117-122
                Affiliations
                [1 ]Department of Conservative Dentistry and Endodontics, Government Dental College, Thiruvananthapuram, India
                [2 ]Department of Conservative Dentistry and Endodontics, Government Dental College, Thrissur, Kerala, India
                [3 ]Department of Microbiology, Government Medical College, Thiruvananthapuram, India
                Author notes
                Address for correspondence: Dr. A. R. Divia, Attuvalappil House, P. O. Puranattukara, Thrissur - 680 551, Kerala, India. E-mail: drardivia@ 123456gmail.com
                Article
                DRJ-15-117
                10.4103/1735-3327.226526
                5858070
                29576775
                a02deeaa-c9e9-4c98-be9c-92c5bd846543
                Copyright: © 2018 Dental Research Journal

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 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
                : July 2016
                : August 2017
                Categories
                Original Article

                Dentistry
                enterococcus faecalis,green tea,morinda citrifolia,sodium hypochlorite,triphala
                Dentistry
                enterococcus faecalis, green tea, morinda citrifolia, sodium hypochlorite, triphala

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