Comparison of the antibacterial property of Calcium hydroxide, Curcumin and Aloe vera on 6-week-old Enterococcus faecalis biofilm as an intracanal medicament, an in vitro study

Abstract

Background for Treatment: The main purpose of root canal therapy is to eliminate microorganisms and their products from the root canal system to prevent reinfection. Enterococcus faecalis is the most isolated bacteria in resistant or failed endodontic cases. Considering the ineffectiveness, potential side effects and safety concerns of synthetic drugs, the herbal alternatives for endodontic usage might be advantageous. The aim of this study was to compare the antibacterial properties between calcium hydroxide and herbal medicines including Curcumin and Aloe vera as an intracanal medicament in removal of six-week-old mature biofilm of Enterococcus faecalis by the use of colony counting assay.

Materials & Methods: In this study, 82 single root canals with no abnormalities and caries used, after the crown is cut, the root canal cleansed and shaped. Then, the solution containing Enterococcus faecalis was inserted into the canals and replaced daily with new culture medium to produce biofilm within 6 weeks. Then 5 random samples were examined for confirmation of biofilm formation under electron microscopy. The samples divided into 4 groups and the antibacterial agent used as an intra-canal drug for one week, in the first group of calcium hydroxide, in the second group of Curcumin, in the third group of Aloe vera and in the fourth group, which is as control group, it only be washed with normal saline and no material placed in the canal. Then each of the debris collected was dissolved in a certain volume of normal sterile saline and cultured in a plate containing solid culture medium for bacterial count (CFU) and finally, the Colony Count machine determined the number of bacteria in each sample. At the end of the study data was analyzed using SPSS17 software and kruskal-wallis analysis.

Results: The mean CFU in the groups of calcium hydroxide, curcumin and Aloe vera were 749.4444, 630.5556 and 1529.1667, respectively. Compared with the control group; curcumin, calcium hydroxide and Aloe vera showed 99.5%, 99.41% and 98.79% antimicrobial effects, respectively. All 3 groups were significantly different from the control group but were not significantly different from each other (P> 0.05).

Conclusion: Considering the limitations of this study, none of the studied groups achieved 100% growth inhibitory effect. However, all 3 groups showed significant antibacterial activity compared to the control group, so that curcumin had the greatest effect, followed by calcium hydroxide and aloe vera. Therefore, considering the obtained results and easier access, lower cost and the various other properties mentioned for the studied plant materials, these herbal materials can be considered as good alternatives to synthetic medicaments.