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

摘要

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?×?10 2 ) than the pure Ca(OH) 2 (1.25?×?10 2 ) and Ca(OH) 2 ?+?Ibuprofen groups (0.76?×?10 2 ) 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.