Evaluation of antimicrobial effect of Malaysian geopropolis with Aloe vera against Enterococcus faecalis to be used as an intracanal medicament in endodontics

Abstract

Introduction: Enterococcus faecalis can be found in failed endodontic treatment (FET) even after performing primary endodontic treatment (PET). Calcium hydroxide (Ca(OH) 2 ) cannot fully eliminate this microorganism during PET. Brazilian green propolis (bee glue) was found to be more effective against E. faecalis when compared to Ca(OH) 2 . A much less studied Malaysian geopropolis (MP) as well as Aloe vera (AV) is antibacterial but is unknown against E. faecalis . Objective: The objective of this study is to determine the antimicrobial effects of MP, AV, and MP + AV in comparison with Ca(OH) 2 against E. faecalis , as an intracanal medicament. Materials and Methods: Antimicrobial activity of MP, AV, MP + AV, Ca(OH) 2 , and dimethyl sulfoxide was tested against E. faecalis using antimicrobial sensitivity testing, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC). The results were analyzed by Kruskal–Wallis test with Mann–Whitney post hoc test and repeated measures analysis of variance with Bonferroni post hoc test ( P < 0.05). Results: For agar well-diffusion method, MP + AV gave maximum inhibition zone diameter (mean: 8.11 ± 0.015 mm), MP (mean: 6.21 ± 0.046 mm, Ca(OH) 2 (mean: 5.5 ± 0.006), and AV (mean: 5.05 ± 0.012) with P < 0.05. MIC for MP + AV was 2 mg/ml, MP at 8 mg/ml, Ca(OH) 2 at 8 mg/ml, and AV at 16 mg/ml. The MBC for MP + AV is at 4 mg/ml, MP at 16 mg/ml, Ca(OH) 2 at 16 mg/ml, and AV at 32 mg/ml. Conclusion: The combination of MP and AV consistently showed better antimicrobial activity compared to MP and AV alone against E. faecalis . The findings suggest that MP and AV used in combination may be an ideal intracanal medicament in FET and PET.

The antimicrobial efficacy of graphene oxide, double antibiotic paste, and their combination against Enterococcus faecalis in the root canal treatment

“…Three-week-old preformed biofilms of E. faecalis , facultative anaerobic gram-positive cocci, were chosen for the present study as they are the dominant pathogen in failed endodontic therapy [ 44 ]. Their unique features make them a highly resistant endopathogen that complicates endodontic therapy and necessitates the development of more efficient alternative irrigants and medicaments [ 45 – 47 ].…”

Anti-bacterial efficacy of Aloe vera against E. Faecalis in comparison to other intracanal medicaments: A systematic review and meta-analysis

“…Further, while Sahebi et al (2014) used saline for comparison in their studies, they did not mention the use of saline as a control, but a few studies employed a variety of materials as controls, including distilled water, CaOH, NaOCl, dimethyl sulfoxide, ethanol, etc. ( Ehsani et al, 2013 , Ismail et al, 2020 , Karkare et al, 2015 , Noushad et al, 2017 , Vinothkumar et al, 2013 ).…”

“…In total, 12 full-text articles were read thoroughly according to the inclusion criteria from the other method reference folder, and the remaining 18 studies that met the eligibility criteria adequately were from the main databases; no study from the “other method reference” folder was included. The final 18 studies were included in the qualitative analysis ( Abbaszadegan et al, 2016 , Athiban et al, 2012 , Babaji et al, 2016 , Bazvand et al, 2014 , Bhardwaj et al, 2012 , Ehsani et al, 2013 , Eskandarinezhad et al, 2022 , Ghasemi et al, 2020 , Goud et al, 2018 , Ismail et al, 2020 , Karkare et al, 2015 , Noushad et al, 2017 , Ramamurthy et al, 2017 , Sahebi et al, 2014 , Sailaja et al, 2020 , Valera et al, 2013 , Vasudeva et al, 2017 , Vinothkumar et al, 2013 ), and nine studies were included in the meta -analysis ( Bazvand et al, 2014 , Bhardwaj et al, 2012 , Eskandarinezhad et al, 2022 , Ghasemi et al, 2020 , Goud et al, 2018 , Sahebi et al, 2014 , Sailaja et al, 2020 , Valera et al, 2013 , Vasudeva et al, 2017 ). The agreement between reviewers was evaluated with the support of statistics ( Landis and Koch, 1977 ), which showed a high agreement (0.75) among them.…”

“…Meanwhile, the test medicaments included Aloe vera contrasted with other intracanal medicaments, e.g., Propolis, CHX, CaOH, Curcuma longa , NaOCl, tri-antibiotic paste, honey gel, glycolic ginger extracts, CaOH plus metronidazole, etc. Half of the studies used the bacterial count in CFUs as an outcome measure ( Abbaszadegan et al, 2016 , Bazvand et al, 2014 , Bhardwaj et al, 2012 , Eskandarinezhad et al, 2022 , Ghasemi et al, 2020 , Goud et al, 2018 , Sahebi et al, 2014 , Sailaja et al, 2020 , Valera et al, 2013 , Vasudeva et al, 2017 ), while the other half was assessed according to bacterial ZOIs ( Athiban et al, 2012 , Babaji et al, 2016 , Karkare et al, 2015 , Noushad et al, 2017 ) and underwent antimicrobial sensitivity testing according to the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC)( Ehsani et al, 2013 , Ismail et al, 2020 ), quantitative polymerase chain reaction (qPCR)( Vinothkumar et al, 2013 ), and confocal laser scanning microscopy after fluorescent staining ( Ramamurthy et al, 2017 ). The included studies used saline as a positive or negative control group ( Abbaszadegan et al, 2016 , Athiban et al, 2012 , Bazvand et al, 2014 , Bhardwaj et al, 2012 , Eskandarinezhad et al, 2022 , Ghasemi et al, 2020 , Goud et al, 2018 , Ramamurthy et al, 2017 , Vasudeva et al, 2017 , Vinothkumar et al, 2013 ).…”

Efficacy of Locally Delivered Aloe Vera Hydrogel in Patients With Chronic Periodontitis: A Prospective Clinical Study

“…In vitro and in vivo studies have demonstrated the anti-inflammatory, antibacterial, antioxidant, immune-boosting, and hypoglycemic properties of aloe vera gel [ 9 ]. Aloe vera has been used in dentistry for a number of purposes, including the treatment of periodontal disease [ 10 ], the sterilization of gutta-percha [ 11 ], intracanal medicament [ 12 ], the treatment of Candida albicans [ 13 ], and the treatment of aphthous stomatitis [ 14 ]. The current study was done to assess the effectiveness of aloe vera hydrogel in generalised chronic periodontitis patients as an adjuvant to scaling and root planing (SRP).…”