ORIGINAL RESEARCH |
https://doi.org/10.5005/jp-journals-10015-2359 |
Antimicrobial Efficacy of a Novel Obturating Material with and without Iodoform: A Microbiological In Vitro Study
1,2Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) (Deemed to be University), Chennai, Tamil Nadu, India
3,4Department of Preventive Dental Sciences, Division of Pediatric Dentistry, College of Dentistry, Jazan University, Jazan, Saudi Arabia
Corresponding Author: Lavanya Govindaraju, Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) (Deemed to be University), Chennai, Tamil Nadu, India, e-mail: glaavuu@gmail.com; Satish Vishwanathaiah, Department of Preventive Dental Sciences, Division of Pediatric Dentistry, College of Dentistry, Jazan University, Jazan, Saudi Arabia, e-mail: drvsatish77@gmail.com
Received: 02 December 2023; Accepted: 05 January 2024; Published on: 20 February 2024
ABSTRACT
Aim: To compare and evaluate the antimicrobial efficacy of the novel obturating material with the augmentation of iodoform.
Materials and methods: The novel obturating material with and without iodoform was loaded at 100 µL in Mueller–Hilton agar (MHA) plates against Streptococcus mutans (S. mutans) and Escherichia faecalis (E. faecalis) and was left undisturbed for 24 hours. After 24 hours, the inhibition zone was measured in millimeters using a vernier caliper.
Results: The obturating material with iodoform produced a mean inhibition zone of 16.40 mm against S. mutans and 10.60 mm against E. faecalis, whereas the obturating material without iodoform produced a mean inhibition zone of 17.80 mm against S. mutans and 11.00 mm against E. faecalis. It was observed that there was no statistically significant difference found in the zone of inhibition when iodoform was added to the novel obturating material against both S. mutans and E. faecalis.
Conclusion: Due to the undesirable effects of iodoform on primary teeth, a novel obturating material should be developed without the addition of this component and, at the same time, provide maximum antimicrobial effect.
Clinical significance: Selecting the proper obturating material with the right choice of composition is crucial for maximizing the benefits for pediatric patients. An obturating material without iodoform but with the incorporation of other antimicrobial components can enhance the quality of obturation and the success rate of pulpectomy in children.
How to cite this article: Govindaraju L, Jeevanandan G, Maganur PC, et al. Antimicrobial Efficacy of a Novel Obturating Material with and without Iodoform: A Microbiological In Vitro Study. World J Dent 2024;15(1):68–71.
Source of support: Nil
Conflict of interest: None
Keywords: Antimicrobial efficacy, Iodoform, Obturation, Primary teeth
INTRODUCTION
Well-analyzed research pointed toward retaining the primary teeth in asymptomatic status until their physiological exfoliation is successful and radical innovations in the field of pediatric endodontics seasoned in vigor. However, handpicking the ideal obturating material that retained superlative antimicrobial properties prevailed as the least unexplored territory. Despite unanimous views supporting the disadvantages of using zinc oxide eugenol and calcium hydroxide-iodoform paste, these components are still the best options as obturating materials for primary teeth, given the fact that they thrive as pioneers in this field.1–3 An obturating material endowed with superior antimicrobial properties cages any microorganism that frees from the clutches of vigorous chemomechanical preparation, thereby elevating the success rate of the endodontically-treated teeth multifold times.4,5 The core components are zinc oxide, calcium hydroxide, and metronidazole and the present study emerged with a novel obturating material for use. In tune with the antimicrobial efficacy and resorption rate of the core components, variations were induced in the concentration of zinc oxide and calcium hydroxide.6–8 Thus, the novel obturating material was developed by adding 2% metronidazole powder to a concentration of 60:40 calcium hydroxide and zinc oxide powder.6
There is a lot of documentation highlighting the potent antimicrobial properties of iodoform, exhibiting tremendous clinical and radiographic success rates.9 On the downside, its disadvantages include acceleration of the resorption of primary teeth and their yellowish discoloration.10 Considering all these, it is highly recommended that we compare and evaluate the antimicrobial efficacy of the novel obturating material with the augmentation of iodoform before arriving at any significant decision. Hence, the present study was conducted with the primary aim of comparing and evaluating the antimicrobial efficacy of the novel obturating material in the presence and absence of iodoform against Streptococcus mutans (S. mutans) and Escherichia faecalis (E. faecalis).
MATERIALS AND METHODS
Designed as an in vitro study, the present microbiological study secured complete clearance from the institutional review board (IHEC/SDC/PEDO-2125/21/537) before its commencement.
Preparation of the Obturating Material
Making use of a digital weighing machine, 600 mg of calcium hydroxide powder and 400 mg of zinc oxide powder were carefully measured and mixed manually. The mixture was retained in a magnetic stirrer for an hour until the formation of the 60–40 concentration of the mixture. With the efficient use of a motor and pestle, 400 mg of metronidazole tablet was crushed and made into a fine powder. A 2% concentration of calcium hydroxide–zinc oxide–metronidazole powder was prepared by mixing 4mg of metronidazole powder with 196 mg of the calcium hydroxide–zinc oxide mixture. A digital weighing machine was used to measure the exact quantities of the powder.
Preparation of the Test Samples
Soon after dispensing 2 mg of the obturating material and 1 mg of iodoform powder using a digital weighing machine, the novel obturating material with iodoform was prepared by mixing these ingredients and the same was tested against 2 mg of the plain obturating material. The samples were mixed with 2 mL of distilled water, measured with a micropipette, and placed in the vortex for 15 minutes. Following this, they were placed in a mixer for 24 hours.
Preparation of the Culture Medium
The study keenly evaluated the antimicrobial activity of the novel obturating material in the presence and absence of iodoform against S. mutans and E. faecalis by implementing the agar well diffusion method. Soon after Mueller–Hilton agar (MHA) was prepared and sterilized at 121°C for about 15 minutes, the media was poured into 30 sterilized plates (15 for S. mutans and 15 for E. faecalis) and allowed for solidification. The test organisms were swabbed by cutting two wells in each plate using the well cutter. The novel obturating material was loaded at 100 µL in the presence and absence of iodoform and was left undisturbed for 24 hours. Soon after this period, the inhibition zone was measured using a vernier caliper in millimeters (Figs 1 and 2).
Fig. 1: Zone of inhibition of the novel obturating material with and without iodoform against S. mutans (A and B, respectively)
Fig. 2: Zone of inhibition of the novel obturating material with and without iodoform against E. faecalis (A and B, respectively)
Statistical Analysis
The data obtained from the study was keyed into a Microsoft Excel spreadsheet and analyzed thoroughly using Statistical Package for the Social Sciences (SPSS) software (IBM SPSS Statistics, version 20.0, Armonk, New York, United States of America: IBM Corp.). For summarizing and presenting this data, the team made use of descriptive statistics that provided better clarity and conveyed the desired information.
RESULTS
The mean zone of inhibition against S. mutans was found to be greater in the novel obturation material that did not include iodoform. However, no statistically significant difference (p = 0.676) was noted between the obturating materials with and without Iodoform (Table 1). Similarly, the mean zone of inhibition against E. faecalis was also greater in the novel obturation material that did not include iodoform, but no statistical significance was noted (Table 2). Considering the indifference to the antimicrobial efficacy of the addition of iodoform, the novel obturating material can be developed without the addition of iodoform.
| Groups | Mean ± standard deviation (SD) | p-value |
|---|---|---|
| Novel obturating material with Iodoform | 16.4000 ± 1.140 | 0.676 |
| Novel obturating material without Iodoform | 17.8000 ± 1.303 |
| Groups | Mean ± SD | p-value |
|---|---|---|
| Novel obturating material with iodoform | 10.6000 ± 1.140 | 0.812 |
| Novel obturating material without Iodoform | 11.0000 ± 1.000 |
DISCUSSION
The need of the hour is an optimal obturating material for primary teeth, and this is mainly due to the changes brought about in pediatric dental practice. The optimal obturating substance possesses antibacterial properties, resorbs at the same pace as the primary root’s physiological resorption, and can be extruded beyond the apex and resorb faster without harming the developing succedaneous teeth. Besides these, the material must be easy to fill, must adhere to the walls of the primary root canals, be radio-opaque, and refrain from causing any discoloration to the tooth.10 Zinc oxide eugenol is the conventional root canal filling material used for pulpectomy in primary teeth since 1930. Another commonly used obturating material is the combined calcium hydroxide and iodoform paste, which has been reported to show a success rate of 84–100%. All the systematic reviews published to date have been inconclusive in determining the ideal obturating material for primary teeth.11–14 The predominant factor of any obturating material that determines the success of pulpectomy in primary teeth is its antibacterial activity. Keeping this in mind, a novel obturating material encompassing various components with utmost priority given to eminent antimicrobial properties is being developed, and iodoform is one of those components that’s well-acclaimed for its antimicrobial effects.
Iodoform stands class apart from other obturating materials in primary teeth owing to its excellent antimicrobial properties and resorption capabilities.10,15 There are a number of iodoform-based filling materials on the market, including metapex, vitapex, and maisto-capurro paste, which combine calcium hydroxide and iodoform; endoflas, which combine zinc oxide, eugenol and calcium hydroxide with iodoform; RC Fill, which combine zinc oxide, eugenol with iodoform; ZiCal, which combine zinc oxide eugenol, bismuth subcarbonate with iodoform. Calcium hydroxide/iodoform paste is the best filling material for pulpectomy in primary teeth nearing exfoliation, according to a systematic review and meta-analysis that compared the calcium hydroxide/iodoform paste to zinc oxide eugenol as obturating materials for pulpectomy in primary teeth. Zinc oxide eugenol or zinc oxide combined with calcium hydroxide, on the other hand, is the material of choice for primary teeth that must be maintained for an extended period of time before exfoliation.14 The likelihood of intracranial resorption using calcium hydroxide/iodoform paste is the probable cause of the aforementioned confirmation.1 However, this systematic review found no statistically significant difference in the clinical and radiographic success rates of calcium hydroxide/iodoform paste vs zinc oxide eugenol. In fact, in high-quality studies, they discovered that obturation of the primary root canals with zinc oxide eugenol was associated with higher success rates than calcium hydroxide/iodoform.
One recent systemic review and meta-analysis compared the action of iodoform-based filling materials against noniodoform-based filling materials for root canal treatment in primary teeth and came to a singular conclusion that iodoform-based filling materials displayed superior clinical and radiographic performance. Nevertheless, the authors openly stated that the existing studies portrayed a high risk of bias but contained minimal grade of evidence. The authors also stated that a study comparing the same filling material with and without iodoform would be the optimal setting for analyzing the effect of iodoform in obturating materials for primary teeth.16 Furthermore, iodoform bears the disadvantage of accelerating the resorption of the root and compromising the esthetics by causing brown-yellowish discoloration of the tooth.10 Considering all these factors, the present microbiological study focused essentially on comparing the antimicrobial efficacy of the novel obturating material in the presence and absence of iodoform and also bore the weight of deciding whether or not iodoform can be incorporated in the developing obturating material.
The microbiota of the endodontic infections in primary teeth is polymicrobial in nature. Molecular analysis of the microbiota in the root canals of primary teeth diagnosed with pulpal necrosis shows a higher prevalence of S. mutans and E. faecalis.17 The antimicrobial efficacy of the novel obturating material with and without iodoform was determined using the agar well diffusion method. Due to its higher level of dependability, its ease of performance, and its capacity to directly evaluate the efficacy of various obturating materials against the test microorganisms, the approach that has been explained has become the most popular option. As a result, it is able to determine the most effective concentration in an instant.
The most commonly isolated organism from the root canal infections of the primary teeth is none other than S. mutans.18 The novel obturating material without iodoform showed a greater inhibition zone against S. mutans than the novel obturating material with iodoform. The developing obturation material should indisputably display effectiveness against E. faecalis, an opportunistic pathogen that’s highly capable of acquiring resistance against antimicrobials during chemomechanical treatment. Its ability to develop biofilm and its capability to operate the proton pump in order to lower the pH of the intracytoplasmic space are the primary reasons for this potential occurrence. All these prove without doubt the paramount need to evaluate the effectiveness of the obturating material in the presence and absence of iodoform against E. faecalis.
Also, E. faecalis has been reported to contribute to recurrent periradicular lesions post-endodontic treatment in primary teeth.19 In the present microbiological evaluation of the test obturating materials against E. faecalis, it is seen that the novel obturating material without iodoform formed a greater inhibition zone against E. faecalis when compared to the novel obturating material with iodoform. Despite results being in favor of the novel obturating material without iodoform, there was no statistical difference noted against both S. mutans and E. faecalis. The apparent limitation of the present microbiological study is the absence of in vivo influencing factors, which could alter the efficacy of the obturating material. On that account, in vivo trials should be conducted to ascertain the antimicrobial efficacy of the novel obturating material without iodoform for obturation in primary teeth. Alongside that, the biocompatibility and safety of the novel obturating material in the absence of iodoform must be evaluated.
CONCLUSION
No difference was noted in the antimicrobial efficacy of the novel obturating material with and without Iodoform against S. mutans and E. faecalis. Considering the undesirable effects of iodoform and the indifference in the antimicrobial efficacy when added, the novel obturating material can be developed without the addition of iodoform. The Novel Obturating material without iodoform but with the incorporation of other antimicrobial components can enhance the quality of obturation and the success rate of pulpectomy in children.
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