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

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 program 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 among 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 among 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 among 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 of 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.