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


  • Nermine Hassan Department of Endodontics, Faculty of Dentistry, Cairo University, Giza, Egypt
  • Alaa Diab Department of Endodontics, Faculty of Dentistry, Cairo University, Giza, Egypt image/svg+xml
  • Geraldine Ahmed Department of Endodontics, Faculty of Dentistry, Cairo University, Giza, Egypt



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


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.


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How to Cite

Hassan N, Diab A, Ahmed G. Post-operative Pain and Antibacterial Efficacy of Silver Nanoparticles Formulations Intracanal Medication: A Randomized Controlled Clinical Study. Open Access Maced J Med Sci [Internet]. 2021 Oct. 9 [cited 2023 May 31];9(D):248-56. Available from:



Dental Pathology and Endodontics