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 programme 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 amongst 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 amongst 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 amongst the groups when comparing quantitative S1 or S2 data, there were significantly lower bacterial counts in the Ca(OH)(2) + Ciprofloxacin group (0.49 x 10(2)) than the pure Ca(OH)(2) (1.25 x 10(2)) and Ca(OH)(2) + Ibuprofen groups (0.76 x 10(2)) at S3. The percentage 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.