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

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.

Smart dental materials for antimicrobial applications

“…In the case of antimicrobial polymers, although they overcome some drawbacks of the leachable chemical therapies such as long-term activity (no leaching or exhaustion of the antimicrobial compound), limited toxicity against mammalian cells, reduced antimicrobial resistance, and increased chemical stability [ 163 ]; significant limitations remain regarding the high selectivity against gram-positive strains and high cost of manufacturing [ 163 ]. Finally, although several clinical trials have successfully evaluated the use of NPs in different dental materials as antimicrobial agents [ [164] , [165] , [166] , [167] , [168] ], the wide use of NPs in clinical practice is limited due to concerns regarding the release of toxic ions that could cause inflammation, immunotoxicity, cytotoxicity, and genotoxicity in healthy cells. For example, titanium NPs released from implants after decontamination via ultrasonic tips and lasers cause a strong systemic immune response [ 169 , 170 ].…”

Silver Nanoparticles and Their Therapeutic Applications in Endodontics: A Narrative Review

“…On the other hand, it decreased the incidence and severity of inter-appointment pain. Resultantly, this combination should be tested in different concentrations with different ratios to find the most effective combination with potential applications in endodontic therapy [ 136 ]. The positive impact of AgNPs and nano-Ca(OH) 2 intracanal medicaments on post-endodontic pain and flare-ups in retreatment cases was recently demonstrated; however, the antibacterial effect of AgNPs was comparable to that of Ca(OH) 2 [ 137 ].…”