An in Vivo Comparison of Antimicrobial Efficacy of Sodium Hypochlorite and Biopure MTADTM against Enterococcus Faecalis in Primary Teeth: A qPCR Study

Objectives: Biopure MTAD™, a new root canal irrigant has shown promising results against the most common resistant microorganism, E. faecalis, in permanent teeth. However, there is lack of studies comparing its antimicrobial effectiveness with NaOCl in primary teeth. The purpose of this study was to compare the in vivo antimicrobial efficacy of NaOCl 2.5% and Biopure MTAD™ against E. faecalis in primary teeth. Study design: Forty non vital single rooted primary maxillary anterior teeth of children aged 4-8 years, were irrigated either with NaOCl 2.5% (n=15), Biopure MTAD™ (n=15) and 0.9% Saline (n=10, control group). Paper point samples were collected at baseline (S₁) and after chemomechanical preparation (S₂) during the pulpectomy procedure. The presence of E. faecalis in S₁ & S₂ was evaluated using Real time Polymerase Chain Reaction. Results: Statistical significant difference was found in the antimicrobial efficacy of NaOCl 2.5 % and BioPure MTAD™ when compared to saline (p>0.05). However, no statistical significant difference was found between the efficacies of both the irrigants. Conclusions: NaOCl 2.5% and BioPure MTAD™, both irrigants are equally efficient against E. faecalis in necrotic primary anterior teeth. MTAD is a promising irrigant, however clinical studies are required to establish it as ideal root canal irrigant in clinical practice.

Sodium hypochlorite, Biopure MTAD, Irrigant, Endodontic treatment, Primary teeth, Pulpectomy

1. Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol 18:340-348, 1965.

2. Moller AJR. Microbial examination of root canals and periapical tissues of human teeth. Odontologisk Tidskrift 74(suppl):1-380,1966.

3. Moller AJR, Fabricius L, Dahle´n G, O¨ hman AE, Heyden G. Influence on periapical tissues of indigenous oral bacteria and necrotic pulp tissue in monkeys. Scand J Dent Res 89:475-484, 1981.

4. Gomes BPFA, Pinheiro ET, Gade-Neto CR, Sousa ELR, Ferraz CCR, Zaia AA, Teixeira FB, Souza-Filho FJ. Microbiological examination of infected dental root canals. Oral Microbiol Immunol 19:71–76, 2004.

5. Sundqvist G, Figdor D, Persson S, Sjogren U. Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85:86-93, 1998.

6. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 58:589–599, 1984.

7. Ehrich GD, Brian D, Walker WA. Sodium hypochlorite accident: inadver-tent injection into the maxillary sinus. J Endod 19:180-182, 1993.

8. Turkun M, Gokay N, Ozdemir N. Comparative investigation of the toxic and necrotic tissue dissolving effects of different endodontic irrigants. J Dent Facul Istanbul Univ 32:87-94, 1998.

9. Hulsmann M, Hahn W. Complications during root canal irrigation: litera-ture review and case reports. Int Endod J 33:186-193, 2000.

10. Nara A, Dhanu, Chandra P, Anandakrishna L, Dhananjaya. Comparative Evaluation of antimicrobial efficacy of MTAD, 3% NaOCl and Propolis against E. faecalis. Int J Clin Ped Dent 3:21-25, 2010.

11. Torabinejad M, Johnson WB, inventors. Irrigation solution and methods for use. US Patent 20030235804. December 25,2003.

12. Singla MG, Garg A, Gupta S. MTAD in endodontics: an update review. Oral Surg Oral Med Oral Pathol Oral Radio Endod 112:e70-76, 2011.

13. Shabahang S, Torabinejad M. Effect of MTAD on Enterococcus faecalis – Contaminated root canals of extracted human teeth. J Endod 9:576-579, 2003.

14. Torabinejad M, Shabahang S, Bahjri K. Effect of MTAD on postoperative discomfort: a randomized clinical trial. J Endod 31:171-176, 2005.

15. Zhang W, Torabinejad M, Li Y. Evaluation of cytotoxicity of MTAD using the MTT-tetrazolium method. J Endod 29:654-657,2003.

16. Rôças IN, Siqueira JF, Santos KRN. Association of Enterococcus faecalis with different forms of periradicular diseases. J Endod 30:315–320,2004.

17. Shabahang S, Pouresmail M, Torabinejad M. in vitro antimicrobial efficacy of MTAD and sodium hypochlorite. J Endod 29:450-452,2003.

18. SriKumar G.P.V, K Ravi Varma, K. H.K Shetty, Vidya. Comparison of the antibacterial efficiency of MTAD, 2.5% sodium hypochlorite and 2%chlorhexidine against enterococcus faecalis - An ex vivo study. J Endodontology 21(1)39-45, 2009.

19. Onçag O, Cogulu D, Uzel A. Efficacy of various intracanal medicaments against Enterococcus faecalis in primary teeth: An in vivo study. J Clin Pediatr Dent 30(3):233–238, 2006.

20. Cogulu D, Uzel A, Oncag O, Aksoy SC, Eronat C. Detection of Enterococcus faecalis in Necrotic Teeth Root Canals by Culture and Polymerase Chain Reaction Methods. Eur J Dent 1:216-221, 2007.

21. Hegde A M, Pallavi L K. Prevalence of selected microorganisms in the pulp space of human deciduous teeth with irreversible pulpitis. Endodontology 25(1):107-111, 2013.

22. Raoult D, Fournier PE, Drancourt M. What does the future hold for clinical microbiology? Nat Rev Microbiol 2:151-159, 2004.

23. Siqueira JF Jr, Rocas IN, Favieri A, Lima KC. Chemo-mechanical reduction of the bacterial population in the root canal after instrumentation and irrigation with 1%, 2.5%, and 5.25% sodium hypochlorite. J Endod 26(6):331– 334, 2000.

24. Torabinejad M, Shabahang S, Aprecio R, Kettering JD. The antimicrobial effect of MTAD: an in vitro investigation. J Endodon 29:400-403, 2003.

25. Tay FR, Hiraishi N, Schuster GS, Pashley DH, Loushine RJ, Ounsi HF, Grandini S, Yau JYY, Mazzoni A, Donnelly A. Reduction in antimicrobial substantivity of MTAD after initial sodium hypochlorite irrigation. J Endod 32:970-975, 2006.

26. Tay FR, Mazzoni A, Pashley DH, et al. Potential iatrogenic tetracycline staining of endodontically treated teeth via NaOCl/MTAD irrigation: a preliminary report. J Endod 32:354–358, 2006.

27. Kho P, Baumgartner JC. A Comparison of the antimicrobial efficacy of NaOCl/Biopure MTAD versus NaOCl/EDTA against Enterococcus faecalis. J Endod 32:652-655, 2006.

28. Ahangari Z, Samiee M, Yolmeh M, Eslami G. Antimicrobial activity of three root canal irrigants on Enterococcus Faecalis: An in vitro study. Iran Endod J 3:33-37, 2008.

29. Baumgartner JC, Johal S, Marshall JG. Comparison of the antimicrobial efficacy of 1.3% NaOCl/Biopure MTAD to 5.25% NaOCl/15% EDTA for root canal irrigation. J Endod 33:48-51, 2007.

30. Singh S, Krishna S, Acharya RS, Rao P, Ballal V. Comparison of antimicrobial efficacy of Biopure MTAD and 2.5% sodium hypochlorite irrigation in infected root canals following single visit endodontics - An in vivo study. J Endodontology 21(1):27-33, 2009.