Anuradha, R S (2020) Comparative Evaluation of Efficacy of Nisin and Triple Antibiotic Medicament as Intracanal Medicaments against Enterococcus Faecalis: An In Vitro study. Masters thesis, Vivekanandha Dental College for Women, Tiruchengode.
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Abstract
INTRODUCTION: Bacteria are considered the primary cause of pulp and periapical disease. Infection of the root canal system results in apical periodontitis, an inflammatory response in the periradicular tissue, causing pain and resorption of periradicular structure. Successful treatment depends on elimination of the infective microflora from the necrotic root canal system and favours the healing of the periapex. Enterococcus faecalis, a gram positive anaerobe is a persistent organism that despite making up a small portion of the microflora in untreated canals plays a major role in the aetiology of persistent periradicular lesions after root canal treatment. Enterococcus faecalis commonly found in a high percentage of root canal failures and able to survive as a single organism to a period of starvation up to 12 months in the root canal. Although chemo-mechanical preparation reduces the number of bacteria, an intracanal medicament with antibacterial action is required to maximize the disinfection of the root canal system. The need for intracanal medication increases, especially where the infection is resistant to regular treatment. Nisin, a naturally occurring antimicrobial peptide produced by Lactococcus lactis is a class I bacteriocin, used as food preservative and found to be safe in human beings. Various studies have shown that Nisin is more effective against Enterococcus faecalis as an intracanal medicament. The Triple Antibiotic Medicament containing ciprofloxacin, metronidazole and minocycline acts as an anti-microbial agent against Enterococcus faecalis. But minocycline tends to stain the tooth when used for a long term. Hence minocycline is replaced with clindamycin in this study. AIM AND OBJECTIVES: To evaluate and compare the anti-microbial activity of Nisin and Triple Antibiotic Medicament as intracanal medicaments against Enterococcus faecalis using cell culture and Optical Density method (OD600). MATERIAL AND METHODS: Forty- five extracted human permanent mandibular single-rooted pre-molar teeth was collected and stored in distilled water. The specimens were decoronated 1 to 2mm below the cemento-enamel junction using a safe- sided diamond disk to standardise the root length at 15mm. The samples were divided into 3 groups of 15 roots in each group. Then the instrumentation od the canals with sterile rotary nickel-titanium F2 size Pro-taper (DENTSPLY) on a sequential crown down technique. 2.5% sodium hypochlorite was used as an irrigating solution during instrumentation with a sterile 2ml syringe. Smear layer removal in the root canal was done with 17% Ethylene Diamine Tetra-acetic acid (EDTA) solution agitated for 30 seconds using U-files. The roots were autoclaved at 121oC for 15 minutes. Then three layers of clear nail varnish was applied over all external root surfaces and allowed to dry. Bacterial samples of Enterococcus faecalis of ATCC 29212 strain was used in this study. Each root canal was injected with a bacterial solution up to the canal entrance using sterile syringe. Each canal was closed with a dental wax and all samples were incubated in a closed container at 37°C (98.6°F) for a period of 21 days. The canal was re-inoculated with freshly maintained bacterial samples every 3 days. To verify for cell viability and purity of culture, samples made from each canal with a sterile paper point and inoculated into Muller Hilton agar plate and incubated aerobically for 24 hours at 37°C (98.6°F). After 21 days, the canal content was aspirated and each canal was rinsed with 5 ml distilled water using a 2 ml syringe, and then was dried with sterile paper points. The test medicaments were applied to the corresponding groups. Group I (n=15) - Nisin for each sample, Group II (n=15) - Triple Antibiotic Medicament for each sample, and Group III (n=15) - Distilled water for each sample. Group I and II as experimental group whereas Group III as control group. The roots were maintained for 7 days at 37°C (98.6ºF) after sealing with dental wax. The degree of infection of the radicular dentin were investigated on the 8th day, where the specimen of the dentin chips from the full length of the root canal were harvested using a sterile rotary nickel-titanium F3 size pro- taper (DENTSPLY). The dentine debris were removed from the files by placing into a sterile Eppindorf tube containing 1.5 ml of brain heart infused yeast broth in a vortex mixture for 30 seconds. The files will be removed and inspected for dentinal debris remaining in the flutes. The sample will be incubated for 24 hours at 37oC (98.6ºF). Following incubation, each sample was mixed in a vortex mixer for 15 seconds and 1 ml of solution was pipetted into a cuvette. OD600 of each sample was measured to estimate the concentration of Enterococcus faecalis. Under the limitations of the present study, Triple antibiotic medicament in combination of Metronidazole, ciprofloxacin and Clindamycin has higher efficacy in eradicating Enterococcus faecalis as an intracanal medicament. Distilled water had the least efficacy as compared to the other groups throughout the length of the specimen. CONCLUSION: Hence from the results obtained from this present study, it can be concluded that using triple antibiotic medicament is effect than Nisin as an intracanal medicament but clinical scenarios like drug resistant, contra-indication for the patient etc., should be taken for consideration. So in vivo studies are need to be carried out to support the results of the present study.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 241717551 |
| Uncontrolled Keywords: | Nisin and Triple Antibiotic Medicament, Intracanal Medicaments, Enterococcus Faecalis. |
| Subjects: | DENTAL > Conservative Dentistry and Endodontics |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Feb 2021 17:32 |
| Last Modified: | 23 Feb 2021 00:34 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14427 |
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