Elsevier

Journal of Endodontics

Volume 30, Issue 10, October 2004, Pages 689-694
Journal of Endodontics

Clinical Research
An Evidence-Based Analysis of the Antibacterial Effectiveness of Intracanal Medicaments

https://doi.org/10.1097/01.DON.0000129959.20011.EEGet rights and content

The authors reviewed the literature evaluating the antibacterial effectiveness of intracanal medicaments used in the management of apical periodontitis. A PICO (problem, intervention, comparison, outcome) strategy was developed to identify studies dealing with calcium hydroxide, phenolic derivatives, iodine–potassium iodide, chlorhexidine, and formocresol. The final inclusion/exclusion criteria eliminated all papers except five that evaluated calcium hydroxide. The total sample size in the included studies was 164 teeth. Microbiologic sampling was performed before endodontic treatment (S1), after instrumentation and irrigation (S2), and after intracanal medication (S3). At S2, 62% of canals were positive. After medication, 27% still showed detectable growth. Of cultures that were positive at S2, 45% were still positive at S3. Most studies did not address issues of culture reversals or false positive and false negative cultures. The main component of antibacterial action appears to be associated with instrumentation and irrigation, although canals cannot be reliably rendered bacteria free. Calcium hydroxide remains the best medicament available to reduce residual microbial flora further.

Section snippets

MATERIALS AND METHODS

To answer the clinically relevant question, a four-step method of evidence-based analysis was applied: Step 1, a search for the best evidence, conducting a comprehensive search of the endodontic literature in electronic databases; Step 2, appraisal and selection of papers according to study validity and clinical importance; Step 3, collection and analysis of the published evidence; and Step 4, determining the clinical applicability of the results.

A MEDLINE search strategy was developed to

Included and Excluded Studies

The primary search from all sources identified 152 related references. After scanning of the titles and abstracts, the full text of 17 studies was obtained and underwent the data extraction process. These articles covered calcium hydroxide (13 papers), camphorated para-monochlorophenol (3 papers), camphorated phenol (1 paper), iodine–potassium iodide (3 papers), chlorhexidine (1 paper), and formocresol (2 papers). Based on the inclusion and exclusion criteria developed at the start of the

DISCUSSION

The studies evaluated in this analysis reinforce the strong correlation between apical periodontitis and the presence of bacteria in canals (162 of 164 teeth, or 99%). Cleaning, shaping, and irrigation greatly reduce the cultivable numbers of bacteria, typically by 99% to 99.9%. However, these studies have shown that it is impossible to achieve a sterile root canal system in all cases by cleaning and shaping alone (62% remaining positive), in agreement with the findings of Byström and Sundqvist

References (33)

  • SundqvistG

    Bacteriological studies of necrotic dental pulps. Thesis

    (1976)
  • MöllerAJR et al.

    Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys

    Scand J Dent Res

    (1981)
  • ByströmA et al.

    Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis

    Endod Dent Traumatol

    (1987)
  • SjögrenU et al.

    Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis

    Int Endod J

    (1997)
  • ByströmA et al.

    The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy

    Int Endod J

    (1985)
  • ByströmA et al.

    Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy

    Scand J Dent Res

    (1981)
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