Comparison of antibacterial efficacy of intracanal medicaments

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Se compara la eficacia antibacteriana de medicamentos intraconducto tales como el formocresol, glutaraldehido 2% y yodo yoduro de potasio utilisados en pulpotomias.

Transcript of Comparison of antibacterial efficacy of intracanal medicaments

  • 18 J INDIAN SOC PEDOD PREVENT DENT | Jan - Mar 2010 | Issue 1 | Vol 28 |

    Original article

    Comparison of antibacterial efficacy of intracanal medicaments in multiple visit pulpectomies in primary molars-an in vivo study

    Lele GS, Subba Reddy VV1Professor, Department of Pedodontics and Preventive Dentistry, Sinhagad Dental College and Hospital, Pune - 411 043, 1Professor and Head, College of Dental Sciences, Davangere - 577 004, India

    Correspondence:Dr. Gauri S Lele, Department of Pedodontics and Preventive Dentistry, Sinhagad Dental College and Hospital, Pune- 411041, India. E-mail: gaurislele@yahoo.co.in

    Abstract

    Antibacterial efficacy of formocresol, 2% gluteraldehyde and iodine-potassium iodide was assessed by obtaining cultures at consecutive appointments in multiple visit pulpectomies in primary molars. Formocresol and 2% gluteraldehyde were more effective as intracanal medicaments and caused significant reduction in the counts of aerobic and anaerobic microorganisms, thereby supporting the need for placing intracanal medicaments with antibacterial properties, in multiple visit pulpectomies in primary molars.

    Key words

    Formocresol, intracanal medicaments, iodine-potassium iodide, multiple visit pulpectomies, 2% gluteraldehyde

    DOI: 10.4103/0970-4388.60482 PMID: ***

    Introduction

    In endodontic therapy of primary teeth, due to the tortuous and complex nature of root canals and the change in their morphology with root resorption, biomechanical preparation is restricted merely to debridement of the root canals. When this root canal environment is left empty, it allows for microbial recolonization in the pulp space, making it a privileged sanctuary for microorganisms, their by-products and degradation products of both the micro-organisms and pulpal tissue. [1]

    Thus, for optimal success, it becomes imperative to place intracanal medicaments within the pulp chamber or canals, which exert their antimicrobial effect by direct contact with the organisms or by way of vapour

    action of the volatile components that reaches all the irregularities within the canals. Of these, formocresol, 2% gluteraldehyde and iodine-potassium iodide are reported to have excellent antimicrobial activity and vapor-forming effect with minimal toxicity and tissue irritation[2-4] based on observations made in in vitro studies. Hence the present study was aimed at evaluating and comparing the antibacterial efficacy of these intracanal medicaments in primary teeth multiple visit pulpectomies.

    Materials and Methods

    The study was carried out in the Departments of Pedodontics and Preventive Dentistry and Oral Pathology and Microbiology, in children requiring multiple visit pulpectomy procedures for their primary teeth.

    Selection procedureForty healthy children of both genders were selected from those who reported to the department. Informed consent was obtained from parents showing willingness for their childs participation. The inclusion criteria were:~ Age of the child was between 4 and 11 years.

  • 19J INDIAN SOC PEDOD PREVENT DENT | Jan - Mar 2010 | Issue 1 | Vol 28 |

    Lele and Reddy: Intracanal medicaments in multiple visit pulpectomies in primary molars

    ~ The child had a primary molar with the one of the following diagnosis:(i) chronic pulpitis, (ii) chronic periapical abscess, (iii) acute exacerbation of chronic pulpitis, (iv) acute exacerbation of chronic periapical abscess.

    ~ The primary molar had minimal mobility and restorable crown

    ~ Minimal root resorption or bone resorption, as seen radiographically.

    The subjects selected were divided in four groups of 10 children each, wherein for groups I, II and III the intracanal medicaments placed were formocresol, 2% gluteraldehyde and iodine-potassium iodide, respectively. Group IV children formed the control group that received a placebo (distilled water).

    A standardized protocol, as described below, was followed for the pulpectomy procedure and collection of bacterial cultures.

    Clinical methodFor each tooth in every group at the first visit, local anesthetic was administered and under rubber dam isolation, access cavity preparation was done. The pulp tissue was extirpated from the canals using barbed broaches and K-files,[5-7] canals were irrigated using physiologic saline solution[7-9] and the first sample for culture was obtained using sterile paper points.

    On the basis of their radiographic length, the canals were filed, irrigated and dried with paper points. A small cotton pellet, moistened with the respective medicament was placed in the pulp chamber and covered with another plain cotton pellet as an open dressing at the end of the first visit.

    At the second visit after 5-7 days, again under rubber dam isolation, the treatment pellet was removed, canals were irrigated, dried with sterile paper points and a second sample was obtained. Following copious irrigation and drying of canals, cotton pellet moistened with the respective medicament was placed in the pulp chamber and it was sealed with zinc oxide-eugenol cement.

    At the third visit, after initial drying a third culture of the root canals was taken. The tooth was then irrigated, dried and obturated with zinc oxide-eugenol cement. The same procedure was repeated for all the patients with their respective medicaments.

    Collection of bacterial samplesUsing sterile paper points, bacterial samples were

    collected at the first, second and third visit (i.e. a, b and c) from all canals of each tooth included in the study. These were first placed to remove excess of saline solution from canals and were discarded. To obtain the culture, fresh sterile paper points were again inserted in all canals and kept there for a minute so as to absorb as much of exudate along the canal walls as possible [Figure 1]. During this time, the test tube containing fluid thioglycollate medium prepared in the laboratory and sealed with cotton plug was held in readiness. The absorbent points were removed with tweezers and dropped into the tube [Figure 2] and the plug was replaced.[10] The tube was placed back in the stand, after checking that the paper points had dropped into the medium and that it was correctly labeled [Figure 3]. Similarly, at the second visit, after removal of treatment pellet and at the third visit, after removal of zinc oxide-eugenol cement and treatment pellet, copious irrigation of the canals was done and the second and third cultures were obtained. The labeled test tubes were then transported to Department of Oral Pathology and Microbiology.

    Laboratory methodIodine-potassium iodide medicament, fluid thioglycollate and blood agar media were prepared in the laboratory.

    Laboratory culturing methodUnder strict conditions of asepsis, using a platinum loop, the homogenously dispersed material in the test tubes was streaked on to two petriplates containing blood agar. Of these, the test tube and one petriplate were incubated under aerobic conditions and the other petriplate anaerobically for 48 hours using Gaspak chamber and anaerobic jar.

    Figure 1: Collection of bacterial sample

  • 20 J INDIAN SOC PEDOD PREVENT DENT | Jan - Mar 2010 | Issue 1 | Vol 28 |

    Lele and Reddy: Intracanal medicaments in multiple visit pulpectomies in primary molars

    Assessment of microbial growthAssessment of microbial growth in the test tubes and petriplates was carried out after 48 hours The test tubes were assessed for presence or absence of turbidity and were scored as follows [Figures 4 and 5].- Clear (C), i.e. no growth seen- Slight Turbidity (S)

    - Moderate Turbidity (M)- Dense Turbidity (D)

    The petriplates were assessed under both aerobic and anaerobic conditions for presence or absence of growth; growth if seen was quantified by measuring the number of colony forming units (CFUs) with a magnifying lens [Figures 6 and 7].

    Figure 2: Transfer of bacterial sampleFigure 3: Sample in transport medium

    Figure 4: Test tube scores: Slight and Clear Figure 5: Test tube scores: Dense and Moderate

    Figure 6: Microbial growth assessment on petriplates: No growth Figure 7: Microbial growth assessment on petriplates: Growth present

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    Lele and Reddy: Intracanal medicaments in multiple visit pulpectomies in primary molars

    The data so collected was grouped, tabulated and statistically analyzed.

    Results

    Root canal samples from each tooth were obtained at three consecutive visits, wherein a, b and c represent the 1st, 2nd and 3rd visit, 5-7 days apart.

    Comparison of test tube scores at each visit and at different time intervals for each of the four groups was carried out using the Fischers Exact Probability test. For all four groups, the difference in scores from Moderate/Dense to Clear/Slight between the 1st and 2nd visits (a-b) was not statistically significant. However, the difference in scores between 2nd and 3rd visits (b-c) and 1st and 3rd visits (a-c) were found to be statistically significant for groups I and II [Table 1].

    Comparison of test tube scores between different groups at each visit was carried out using the Fischers Exact Probability test as shown in Table 2 and none of the differences in scores were found to be statistically significant.

    Microbial growth in the aerobic culture at different time intervals a, b and c for each of the four groups was recorded as shown in Table 3 and these values were analyzed using the Wilcoxons Signed Rank test. For group I, the differences in CFUs between the 2nd and 3rd visits (b-c) and 1st and 3rd visits (a-c) were statistically significant with P , 0.01 and 0.05, respectively. For group II value of b-c was statisti