Comparison of anti-bacterial efficiency of ibuprofen, diclofenac, and calcium hydroxide against Enterococcus faecalis in an endodontic model: An in vitro study

Context One of the important goals of root canal therapy is disinfection aided by irrigation and intracanal medicaments. Commonly used nonsteroidal anti-inflammatory agents have shown anti-bacterial activity, thus, when used as intracanal medicaments, nonantibiotic agents have the potential to provide anti-inflammatory, local analgesic, and anti-bacterial activity. Aim The aim of this study is to evaluate and compare the anti-bacterial efficiency of anti-inflammatory nonantibiotics ibuprofen and diclofenac, and routinely used intracanal dressing calcium hydroxide (Ca[OH]2), against Enterococcus faecalis, in an endodontic model. Materials and Methods A total of 76 single-rooted mandibular premolar teeth were decoronated and instrumented up to F4-ProTaper rotary. Apical foramen was sealed with composite resin, and all external surfaces made impermeable with nail varnish, except for coronal access. Roots were autoclaved (121°C for 20 min), placed in Eppendorf tubes, and contaminated with E. faecalis for 14 days. Colony-forming unit (CFU) counts were taken before (CFU-1), and after intracanal medication (CFU-2) by paper point sampling. Test medicaments (Group-1: ibuprofen, Group-2: diclofenac, Group-3: Ca[OH]2) were mixed with distilled water (1:1 w/v), placed into root canals, temporarily sealed, and incubated (37°C; 7 days). Group-4 received no medicament (control). Kruskal-Wallis ANOVA was used to compare the four groups and Mann-Whitney U-test for pair-wise comparisons. Results Within the limitations of the study, anti-inflammatory nonantibiotics (ibuprofen; diclofenac) were shown to have anti-bacterial effect against E. faecalis. Conclusion Since nonsteroidal anti-inflammatory drugs (NSAIDs) have an anti-bacterial effect, it is possible to replace Ca(OH)2 with NSAIDs, or even combine them to form a cocktail of local disinfectants to optimize canal disinfection.