Comparative evaluation of the auxiliary effect of different herbs to enhance the antibacterial efficacy of calcium hydroxide against Enterococcus faecalis biofilm – An in vitro study

Abstract

Aim: The increase in potential side effects and safety concerns of conventional medicaments has led to the recent popularity of herbal alternative medications. The herbal products are known for their high antimicrobial activity, biocompatibility, anti-inflammatory, and antioxidant properties. The present study was designed to compare the effectiveness of calcium hydroxide (CH) in combination with various herbs as intracanal medicaments against Enterococcus faecalis biofilm. Methods: Forty extracted single-rooted maxillary teeth were decoronated and sectioned into two halves. They were later infected with E. faecalis to form a biofilm for 21 days. Subsequently, the root samples were divided into a control group and three experimental groups – the control group was treated with CH powder mixed with distilled water and the experimental Group 1 was treated with CH powder and aloe vera gel placed over PerioCol-guided tissue regeneration (GTR) membrane; Group 2 was treated with CH powder mixed with coronil, and incorporated with aloe vera gel; and Group 3 was treated with CH powder mixed with Ajmodadi Churna incorporated with aloe vera gel. At the end of 7 and 14 days, the antimicrobial efficacy of medicaments against E. faecalis biofilm was assessed at the depths of 200–400 μm. Kruskal–Wallis test and post hoc analysis – Mann–Whitney test were used for statistical analysis. Results: Ajmodadi Churna was most effective followed by coronil and CH placed over the PerioCol GTR membrane. Conclusion: Ajmodadi Churna exhibited superior results. Coronil displayed good efficacy against E. faecalis in long-term use and thus could be used as an effective intracanal medicament. Among the Ayurvedic preparations, both hold a promising future but to implement their use as sole intracanal medicaments clinically, further in vivo and long-term studies are warranted.