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Randomized Controlled Trial
. 2020 Jun;53(6):742-753.
doi: 10.1111/iej.13277. Epub 2020 Mar 2.

Antibacterial effectiveness of calcium hydroxide alone or in combination with Ibuprofen and Ciprofloxacin in teeth with asymptomatic apical periodontitis: a randomized controlled clinical study

E Karataş  1 , M Ö Baltacı  2 , E Uluköylü  1 , A Adıgüzel  2
Affiliations
Randomized Controlled Trial

Antibacterial effectiveness of calcium hydroxide alone or in combination with Ibuprofen and Ciprofloxacin in teeth with asymptomatic apical periodontitis: a randomized controlled clinical study

E Karataş et al. Int Endod J. 2020 Jun.

Abstract

Aim: To evaluate the antimicrobial effectiveness of Ca(OH)2 paste combined with Ibuprofen or Ciprofloxacin in infected root canals of teeth with asymptomatic apical periodontitis.

Methodology: Forty-five patients were randomly divided into three groups using a web programme according to the medication selected: Ca(OH)2 : 1 g Ca(OH)2 powder with 1 mL propylene glycol, Ca(OH)2 + Ibuprofen: 50 mg of Ibuprofen was added into 950 mg Ca(OH)2 powder and mixed with 1 mL propylene glycol, Ca(OH)2 + Ciprofloxacin: 50 mg of Ciprofloxacin was added into 950 mg Ca(OH)2 powder and mixed with 1 mL propylene glycol. Root canal bacteriological samples were collected before root canal treatment (S1) and after chemo-mechanical procedures (S2). After root canal preparation, the intracanal medicaments were placed into the root canals to a level approximately 1 mm short of the working length using K-files and access cavities were filled temporarily. The participants were scheduled for a second visit 7 days later when the medication was removed mechanically, and after irrigation of the root canals, the final samples (S3) were collected. Samples were subjected to quantitative real-time polymerase chain reaction to evaluate the numbers of total bacteria, Enterococcus faecalis and Streptococcus species. For intragroup analysis, a Friedman test was used to compare reduction of counts of total bacteria, Streptococci and E. faecalis amongst the three samples (S1, S2 and S3). The chi-square test was used to compare the number of root canals positive for bacteria in S1, S2 and S3 amongst the groups.

Results: Intragroup analysis revealed a significant reduction in the number of intracanal bacterial cells from S1 to S2 and from S2 to S3 in all medication groups (P < 0.01). Although there was no significant difference amongst the groups when comparing quantitative S1 or S2 data, there were significantly lower bacterial counts in the Ca(OH)2 + Ciprofloxacin group (0.49 × 102 ) than the pure Ca(OH)2 (1.25 × 102 ) and Ca(OH)2 + Ibuprofen groups (0.76 × 102 ) at S3. The percentage reduction from S1 to S3 and from S2 to S3 was significantly greater in the Ca(OH)2 + Ciprofloxacin than the pure Ca(OH)2 and Ca(OH)2 + Ibuprofen groups (P < 0.05). In the Ca(OH)2 + Ciprofloxacin group, there were significantly fewer positive cases (8/15) than the pure Ca(OH)2 (13/15) and Ca(OH)2 + Ibuprofen (13/15) groups (P < 0.05).

Conclusion: The addition of Ciprofloxacin to Ca(OH)2 provided further antibacterial effectiveness when used as an intracanal medicament in vivo during root canal treatment.

Keywords: Ca(OH)₂; Ciprofloxacin; Endodontics; Ibuprofen.

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References

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