Post-operative Pain and Antibacterial Efficacy of Silver Nanoparticles Formulations Intracanal Medication: A Randomized Controlled Clinical Study

Nermine Hassan; Alaa Diab; Geraldine Ahmed

doi:10.3889/oamjms.2021.6503

Authors

Nermine Hassan Department of Endodontics, Faculty of Dentistry, Cairo University, Giza, Egypt
Alaa Diab Department of Endodontics, Faculty of Dentistry, Cairo University, Giza, Egypt
Geraldine Ahmed Department of Endodontics, Faculty of Dentistry, Cairo University, Giza, Egypt https://orcid.org/0000-0002-2273-3438

DOI:

https://doi.org/10.3889/oamjms.2021.6503

Keywords:

Silver Nanoparticles, Flare-up, Post-operative pain, Intracanal medication, Calcium hydroxide, Bacterial reduction, Bacterial count, Silver nanoparticles/calcium hydroxide, Necrotic canal

Abstract

AIM: To evaluate the effect of using combined calcium hydroxide/silver nanoparticles or silver nanoparticles (AgNPs) or calcium hydroxide (Ca(OH)₂) individually as intracanal medications in reducing postoperative pain and intracanal bacterial count. MATERIALS AND METHODS: Thirty patients with necrotic mandibular anterior teeth were randomly divided into 3 groups; Ca(OH)₂ + AgNPs or AgNPs gel (Intervention Groups) or Ca(OH)₂ (Control Group). Patients received a standard 2-visit endodontic treatment and recorded their pain levels after 4, 24, 48, 72 and 96 hours following the first and second visit on a modified visual analogue scale (VAS). Intracanal bacterial counts were assessed using culturing before and after instrumentation and intracanal medication. Outcome data were statistically analyzed using Kruskal-Wallis and Fisher’s Exact tests to compare between the groups and Friedman’s test to assess the changes by time. RESULTS: At 24 hours interappointment the incidence of pain was statistically significant (P = .005) as well as at 48 hours (P = .001). There was a statistically significant difference between the mean percentage reduction of anaerobic bacterial counts in the three groups with the highest percentage in the Ca(OH)₂ + AgNPs group at 98.9% followed by AgNPs group 98.5% and Ca(OH)₂ at 85.3% (P <0.001). CONCLUSIONS: Combined calcium hydroxide/silver nanoparticles reduced the intracanal bacterial counts significantly, but adversely affected the interappointment pain. Based on that finding, this combination should be tested in different concentrations with different ratios to reach the most effective combination that reduce pain with high antibacterial efficacy.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Siqueira JF. Microbial causes of endodontic flareups. Int Endod J. 2003;36(7):453-63. https://doi.org/10.1046/j.1365-2591.2003.00671.x PMid:12823700 DOI: https://doi.org/10.1046/j.1365-2591.2003.00671.x

Devakar R, Malarvizhi D, Mitthra S, Prakash V. An update of pain management in endodontic flare-ups: A review. Indian J Public Health Res Dev. 2019;10(11):3011-3. https://doi.org/10.5958/0976-5506.2019.04366.3 DOI: https://doi.org/10.5958/0976-5506.2019.04366.3

Hermann B. Calcium Hydroxide as a Means for Treating and Filling Tooth Root Canals, Dr Thesis; 1920. p. 29.

Kim D, Kim E. Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: A literature review-Part II. In vivo studies. Restor Dent Endod. 2015;40(2):97-103. https://doi.org/10.5395/rde.2015.40.2.97 PMid:25984470 DOI: https://doi.org/10.5395/rde.2015.40.2.97

Anjaneyulu K, Nivedhitha MS. Influence of calcium hydroxide on the post-treatment pain in Endodontics: A systematic review. J Conserv Dent. 2014;17(3):200-7. https://doi.org/10.4103/0972-0707.131775 PMid:24944439 DOI: https://doi.org/10.4103/0972-0707.131775

Ibrahim AM, Zakhary SY, Amin SA. Calcium hydroxide intracanal medication effects on pain and flare-up: A systematic review and meta-analysis. Restor Dent Endod. 2020;45(3):e26. https://doi.org/10.5395/rde.2020.45.e26 PMid:32839707 DOI: https://doi.org/10.5395/rde.2020.45.e26

Fernandez CC, Sokolonski AR, Fonseca MS, Stanisic D, Araújo DB, Azevedo V, et al. Applications of silver nanoparticles in dentistry: Advances and technological innovation. Int J Mol Sci. 2021;22(5):2485. https://doi.org/10.3390/ijms22052485 PMid:33801230 DOI: https://doi.org/10.3390/ijms22052485

Wong J, Zou T, Lee AHC, Zhang C. The potential translational applications of nanoparticles in endodontics. Int J Nanomedicine. 2021;16:2087-106. PMid:33727815 DOI: https://doi.org/10.2147/IJN.S293518

El Abbasy FE, Ibrahim S, Shaker O, Ahmed G. Intra-canal medication containing silver nanoparticle versus calcium hydroxide in reducing postoperative pain: A randomized clinical trial. F1000Research. 2018;7:1949. https://doi.org/10.12688/f1000research.17199.1 DOI: https://doi.org/10.12688/f1000research.17199.1

Afkhami F, Pourhashemi SJ, Sadegh M, Salehi Y, Fard MJ. Antibiofilm efficacy of silver nanoparticles as a vehicle for calcium hydroxide medicament against Enterococcus faecalis. J Dent. 2015;43(12):1573-9. https://doi.org/10.1016/j.jdent.2015.08.012 PMid:26327612 DOI: https://doi.org/10.1016/j.jdent.2015.08.012

Javidi M, Afkhami F, Zarei M, Ghazvini K, Rajabi O. Efficacy of a combined nanoparticulate/calcium hydroxide root canal medication on elimination of Enterococcus faecalis. Aust Endod J. 2014;40(2):61-5. https://doi.org/10.1111/aej.12028 PMid:25244219 DOI: https://doi.org/10.1111/aej.12028

Balto H, Bukhary S, Al-Omran O, BaHammam A, Al-Mutairi B. Combined effect of a mixture of silver nanoparticles and calcium hydroxide against Enterococcus faecalis biofilm. J Endod. 2020;40(10):880-5. https://doi.org/10.1016/j.joen.2020.07.001 PMid:32679241 DOI: https://doi.org/10.1016/j.joen.2020.07.001

Singh RD, Khatter R, Bal RK, Bal CS. Intracanal medications versus placebo in reducing postoperative endodontic pain: A double-blind randomized clinical trial. Braz Dent J. 2013;24(1):25-9. https://doi.org/10.1590/0103-6440201302039 PMid:23657409 DOI: https://doi.org/10.1590/0103-6440201302039

Tak WS, Kim DJ, Ryu SC. Preparation and properties of hydroxyapatite/methylcellulose for bone graft. J Korean Ceram Soc. 2018;55(2):145-52. https://doi.org/10.4191/kcers.2018.55.2.12 DOI: https://doi.org/10.4191/kcers.2018.55.2.12

Xinping L, Shengli L, Miaotao Z, Wenlong Z, Chuanghong L. Evaluations of antibacterial activity and cytotoxicity on ag nanoparticles. Rare Metals Mater Eng. 2011;40(2):209-14. https://doi.org/10.1016/s1875-5372(11)60017-9 DOI: https://doi.org/10.1016/S1875-5372(11)60017-9

Alabdulmohsen Z, Saad A. Antibacterial effect of silver nanoparticles against Enterococcus faecalis. Saudi Endod J. 2017;7(1):29-35. https://doi.org/10.4103/1658-5984.197989 DOI: https://doi.org/10.4103/1658-5984.197989

Siqueira JF, Paiva SS, Rôças IN. Reduction in the cultivable bacterial populations in infected root canals by a chlorhexidinebased antimicrobial protocol. J Endod. 2007;33(5):541-7. https://doi.org/10.1016/j.joen.2007.01.008 PMid:17437868 DOI: https://doi.org/10.1016/j.joen.2007.01.008

Jalalzadeh SM, Mamavi A, Shahriari S, Santos FA, Pochapski MT. Effect of pretreatment prednisolone on postendodontic pain: A double-blind parallel-randomized clinical trial. J Endod. 2010;36(6):978-81. https://doi.org/10.1016/j.joen.2010.03.015 PMid:20478449 DOI: https://doi.org/10.1016/j.joen.2010.03.015

Derry CJ, Derry S, Moore RA, McQuay HJ. Single dose oral ibuprofen for acute postoperative pain in adults. Cochrane Database Syst Rev. 2009;3:CD001548. https://doi.org/10.1002/14651858.cd001548.pub2 PMid:19588326 DOI: https://doi.org/10.1002/14651858.CD001548.pub2

Sadaf D, Ahmad MZ. Factors associated with postoperative pain in endodontic therapy. Int J Biomed Sci. 2014;10(4):243-47. PMid:25598754

Phan N, Blome C, Fritz F, Gerss J, Reich A, Ebata T, et al. Assessment of pruritus intensity: Prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus. Acta Derm Venereol. 2012;92(5):502-7. https://doi.org/10.2340/00015555-1246 PMid:22170091 DOI: https://doi.org/10.2340/00015555-1246

ElMubarak AH, Abu-bakr NH, Ibrahim YE. Postoperative pain in multiple-visit and single-visit root canal treatment. J Endod. 2010;36(1):36-9. https://doi.org/10.1016/j.joen.2009.09.003 PMid:20003932 DOI: https://doi.org/10.1016/j.joen.2009.09.003

Torabinejad M, Shabahang S, Bahjri K. Effect of MTAD on postoperative discomfort: A randomized clinical trial. J Endod. 2005;31(3):171-6. https://doi.org/10.1097/01.don.0000137642.50944.a2 PMid:15735462 DOI: https://doi.org/10.1097/01.don.0000137642.50944.a2

Ali S, Mulay S, Palekar A, Sejpal D, Joshi A, Gufran H. Prevalence of and factors affecting post-obturation pain following single visit root canal treatment in Indian population: A prospective, randomized clinical trial. Contemp Clin Dent. 2012;3(4):459-63. https://doi.org/10.4103/0976-237x.107440 PMid:23633809 DOI: https://doi.org/10.4103/0976-237X.107440

Holdgate A, Asha S, Craig J, Thompson J. Comparison of a verbal numeric rating scale with the visual analogue scale for the measurement of acute pain. Emerg Med (Fremantle). 2003;15(5-6):441-6. https://doi.org/10.1046/j.1442-2026.2003.00499.x PMid:14992058 DOI: https://doi.org/10.1046/j.1442-2026.2003.00499.x

Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: Guidance for protocols of clinical trials. BMJ. 2013;346(15):e7586. https://doi.org/10.1136/bmj.e7586 PMid:23303884 DOI: https://doi.org/10.1136/bmj.e7586

Becker DE, Reed KL. Local anesthetics: Review of pharmacological considerations. Anesth Prog. 2012;59(2):90-101; quiz 102-3. PMid:22822998 DOI: https://doi.org/10.2344/0003-3006-59.2.90

Seltzer S, Naidorf IJ. Flare-ups in endodontics: II. Therapeutic measures. J Endod. 2004;30(7):482-8; discussion 475. https://doi.org/10.1097/00004770-200407000-00006 PMid:15220642 DOI: https://doi.org/10.1097/00004770-200407000-00006

Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: A systematic review. J Endod. 2011;37(4):429-38. https://doi.org/10.1016/j.joen.2010.12.016 PMid:21419285 DOI: https://doi.org/10.1016/j.joen.2010.12.016

Walton R, Fouad A. Endodontic interappointment flareups: A prospective study of incidence and related factors. J Endod. 1992;18(4):172-7. https://doi.org/10.1016/s0099-2399(06)81413-5 PMid:1402571 DOI: https://doi.org/10.1016/S0099-2399(06)81413-5

Pickenpaugh L, Reader A, Beck M, Meyers W, Peterson L. Effect of prophylactic amoxicillin on endodontic flare-up in asymptomatic, necrotic teeth. J Endod. 2001;27(1):53-6. https://doi.org/10.1097/00004770-200101000-00019 PMid:11487166 DOI: https://doi.org/10.1097/00004770-200101000-00019

Alí A, Olivieri JG, Duran-Sindreu F, Abella F, Roig M, García-Font M. Influence of preoperative pain intensity on postoperative pain after root canal treatment: A prospective clinical study. J Dent. 2016;45:39-42. https://doi.org/10.1016/j.jdent.2015.12.002 PMid:26678517 DOI: https://doi.org/10.1016/j.jdent.2015.12.002

Gomes-Filho JE, Silva FO, Watanabe S, Cintra LT, Tendoro KV, Dalto LG, et al. Tissue reaction to silver nanoparticles dispersion as an alternative irrigating solution. J Endod. 2010;36(10):1698-702. https://doi.org/10.1016/j.joen.2010.07.007 PMid:20850681 DOI: https://doi.org/10.1016/j.joen.2010.07.007

Ferreira NS, Martinho FC, Cardoso FG, Nascimento GG, Carvalho CA, Valera MC. Microbiological profile resistant to different intracanal medications in primary endodontic infections. J Endod. 2015;41(6):824-30. https://doi.org/10.1016/j.joen.2015.01.031 PMid:25892513 DOI: https://doi.org/10.1016/j.joen.2015.01.031

Sakamoto M, Siqueira JF, Rôças IN, Benno Y. Bacterial reduction and persistence after endodontic treatment procedures. Oral Microbiol Immunol. 2007;22(1):19-23. https://doi.org/10.1111/j.1399-302x.2007.00315.x PMid:17241166 DOI: https://doi.org/10.1111/j.1399-302X.2007.00315.x

Hargreaves KM, Berman LH, Rotstein I. Microbiology of endodontic infections. In: Cohen’s Pathways of the Pulp. 11th ed. Netherlands: Elsevier; 2015. p. 610-1.

Kim D, Kim E. Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: A literature review-Part I. In vitro studies. Restor Dent Endod. 2014;39(4):241-52. https://doi.org/10.5395/rde.2014.39.4.241 PMid:25383341 DOI: https://doi.org/10.5395/rde.2014.39.4.241

Wu D, Fan W, Kishen A, Gutmann J, Fan B. Evaluation of the antibacterial efficacy of silver nanoparticles against Enterococcus faecalis biofilm. J Endod. 2014;40(2):285-90. https://doi.org/10.1016/j.joen.2013.08.022 PMid:24461420 DOI: https://doi.org/10.1016/j.joen.2013.08.022

Zhang F, Li M, Wei Z, Zhao B. The effect of a combined nanoparticulate/calcium hydroxide medication on the biofilm of Enterococcus faecalis in starvation phase. Shanghai Kou Qiang Yi Xue. 2016;25(1):11-5. PMid:27063301

Siqueira J Jr., Guimaraespinto T, Rocas I. Effects of chemomechanical preparation with 2.5% sodium hypochlorite and intracanal medication with calcium hydroxide on cultivable bacteria in infected root canals. J Endod. 2007;33(7):800-5. https://doi.org/10.1016/j.joen.2006.11.023 PMid:17804315 DOI: https://doi.org/10.1016/j.joen.2006.11.023

Shuping G, Orstavik D, Sigurdsson A, Trope M. Reduction of intracanal bacteria using nickel-titanium rotary instrumentation and various medications. J Endod. 2000;26(12):751-5. https://doi.org/10.1097/00004770-200012000-00022 PMid:11471648 DOI: https://doi.org/10.1097/00004770-200012000-00022

Guzman M, Dille J, Godet S. Synthesis and antibacterial activity of silver nanoparticles against gram-positive and gramnegative bacteria. Nanomedicine. 2012;8(1):37-45. https://doi.org/10.1016/j.nano.2011.05.007 PMid:21703988 DOI: https://doi.org/10.1016/j.nano.2011.05.007

Morones JR, Elechiguerra JL, Camacho A, Holt K, Kouri JB, Ramírez JT, et al. The bactericidal effect of silver nanoparticles. Nanotechnology. 2005;16(10):2346-53. https://doi.org/10.1088/0957-4484/16/10/059 PMid:20818017 DOI: https://doi.org/10.1088/0957-4484/16/10/059

Wang L, Hu C, Shao L. The antimicrobial activity of nanoparticles: Present situation and prospects for the future. Int J Nanomedicine. 2017;12:1227-49. https://doi.org/10.2147/ijn.s121956 PMid:28243086 DOI: https://doi.org/10.2147/IJN.S121956

Rai MK, Deshmukh SD, Ingle AP, Gade AK. Silver nanoparticles: The powerful nanoweapon against multidrug-resistant bacteria. J Appl Microbiol. 2012;112(5):841-52. https://doi.org/10.1111/j.1365-2672.2012.05253.x PMid:22324439 DOI: https://doi.org/10.1111/j.1365-2672.2012.05253.x