The document describes an in vitro study that compared the antibacterial efficacy of 10% metronidazole gel, 2% chlorhexidine gel, and a combination of calcium hydroxide and 2% chlorhexidine gel against Enterococcus faecalis. Forty single-rooted teeth were divided into four groups and treated with the different medications. Group II, which used 2% chlorhexidine gel, showed the most significant reduction in E. faecalis. Group I, with 10% metronidazole gel, was the least effective. The combination treatment in Group III performed moderately. Group IV, the control, showed no reduction. The study concluded that 2% chlorhexidine gel was the most effective treatment

1. AN IN VITRO COMPARATIVE EVALUATION OF
ANTIBACTERIAL EFFIACACY OF
2%CHLORHEXIDENE,10%METRONIDAZOLE AND
COMBINATION OF CALCIUM HYDROXIDE AND
2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS
FAECALIS
PRESENTED BY
MEENAKSHI DIXIT
JR1

2.  INTRODUCTION
 AIM
 OBJECTIVE
 MATERIAL AND METHOD
 CONCLUSION
 RESULT
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND
COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

3.  Pulpal infection due to caries or trauma can result in the microbial
colonization of the root canal system including ramifications,
isthmuses, apical deltas, and dentinal tubules.
 Root canal infections are usually polymicrobial in nature and are
dominated by anaerobic bacteria.
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND
COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

4.  The microbial elimination from the endodontium, is therefore, crucial
in the treatment of the infected root canal.
 Residual bacteria within the root canals grow and multiply, causing
persistent or recurrent periapical disease.
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL
AND COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

5. The objective of this in vitro study is to compare the antibacterial
efficacy of 10% metronidazole gel, 2% chlorhexidine (CHX) gel, and a
combination of calcium hydroxide and 2% CHX gel against
Enterococcus faecalis (E. faecalis) using a culture technique.
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE
GEL AND COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

6. Forty single root extracted for periodontal or other reasons
were selected for the study and stored in physiological saline
Conventional accesses to the root canals were obtained
The working length was determined using the Ingle’s
radiographic method
 AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND
COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS
MATERIAL AND METHOD

7.  Step-back technique with K-files up to size 40 at the apex. With each
change in file size, the canal was irrigated with 1 ml of 2.5% sodium
hypochlorite and Ethylenediaminetetraacetic gel.
 The final irrigation was done for one minute using 17% EDTA
solution to eliminate the smear layer produced during the initial
preparation.
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND COMBINATION OF
CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

8.  All teeth were dried and paper points and weighed.
 Thereafter, the canals were filled with water, and the teeth were
weighed again, to calculate the volume of the canals in microliters.
 The apical foramina of all teeth were sealed with epoxy resin
Teeth were stored in physiological saline
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND
COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

9.  The surfaces were dried with filter paper and with paper
points in the root canal.
 The root canals were filled with a sterile Casein Soya meal
peptone solution and the specimens were placed in test tubes
containing CSL and autoclaved twice for 30 minutes at
121°C.
 Placed in saline, the test tubes were covered with a glass lid
and incubation
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND
COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

10.  Finally, the CSL was removed , and the roots were blotted dry
 The E. faecalis organism was cultured for 24 hours at 37°C in
CSL.
 An inoculum of E. faecalis was injected into the canals.
 The inoculated specimens were placed in test tubes filled with
agar, covered with 200 μl of physiological saline. The test
tubes were covered with a glass lid and incubation
 IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL
AND COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

11. The specimens were then randomly divided into
three experimental groups and one control
group [Table 1], each containing 10 samples.
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND COMBINATION OF
CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

12.  After placement of the intracanal medicaments in the teeth, the
specimens were incubated at 37°C, for seven days.
 Following this, the canals were cleaned using an ultrasonically
activated No.15 K-file, along with water irrigation, for complete
removal of the medicament.
 After the medicament removal, root canal was prepared manually
with a new Hedstrom file, size 40.
 AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND COMBINATION OF
CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

13.  Each file, together with the dentin removed from the canal wall, was
transferred to a test tube containing 10 ml CSL with inactivating
substances.
 The instrument was shaken up in the test tube for 10 seconds with a
vibrator.
 The colony forming units (CFU) per millimeter in the shaken solution
were determined by standard laboratory methods.
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND
COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

14.  Group I with 10% metronidazole gel showed minimal reduction.
results indicate that the Group I samples had 7.72 × 105 CFU/ml of
E. faecalis with 10% Metronidazole gel, in our study. [Figure 3].
However this was not very effective against E. faecalis, as seen in the
results. In our study,
N IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND
COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS


15.  Group II samples with 2% CHX gel, showed significant reduction of
E. faecalis.
Group II samples had excellent efficacy against E. Faecalis, because in
a total of 10 canals incubated with the bacterial strain and treated with
CHX,
only 2.80 × 105 CFU / ml were found [Figure 4].
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND COMBINATION
OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

16.  Samples in Group III, medicated with a combination of calcium
hydroxide and 2% CHX gel,
showed a moderate reduction which demonstrated 5.08 × 105 CFU /ml
of E. Faecalis . This was significantly inferior to the performance of
2% CHX alone .
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND
COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

17.  There was no reduction observed in Group IV (control group)
patients.
Group IV (Control Group) did not show any antibacterial activity as
no intracanal medicament was placed and it had 9.77 × 105 CFU / ml
E. Faecalis .
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND
COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

18. AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND
COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

19. AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND COMBINATION
OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

20. AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND COMBINATION
OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

21. AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND COMBINATION OF
CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

22. RESULTS
 Group I with Ten percent Metronidazole gel in this study has not been
very effective against E. faecalis, as it is active against strict
anaerobes, but is ineffective against facultative anaerobes
 Group II samples with 2% CHX gel, showed significant reduction of
E. faecalis.

23.  Group III samples medicated with a combination of Calcium hydroxide and
2% Chlorhexidene gel demonstrated a significantly inferior performance
than that of 2% Chlorhexidene alone.
 Group IV (Control Group) did not show any antibacterial activity, as
no intracanal medicament was placed
 AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND COMBINATION OF
CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

24.  Within the limitations of this study, 2% CHX gel showed
substantial antimicrobial activity against E. faecalis. The
combination of Calcium hydroxide and 2% CHX gel also
showed good antimicrobial activity, while 10% Metronidazole
gel was least effective.
AN IN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND COMBINATION OF
CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

25.  1. Schafer E, Bossmann K. Antimicrobial efficacy of CHX and two
Calcium hydroxide formulations against Enterococcus faecalis. J
Endod 2005;31:53-6.
 2. Stephen JC, Belanger M. Dentinal tubule disinfection using three
Calcium hydroxide formulations. J Endod 2005;31:50-2
 INAN VITRO COMPARATIVE EVALUATION OF ANTIBACTERIAL EFFICACY OF 10%METRONIDAZOLE GEL ,2%CHLORHEXIDENE GEL AND
COMBINATION OF CALICIUM HYDROXIDE AND 2%CHLORHEXIDENE GEL AGAINST ENTEROCOCCUS FAECALIS

26. THANK YOU