Comparison of the Effects of Different Natural and Synthetic Intracanal Medicaments on the Healing of Periapical Lesion in Retreatment Cases (A Randomized Clinical Trial)
Phase: PHASE2
Conditions: Periapical Disease
Sponsor: Ain Shams University

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Comparison of the Effects of Different Natural and Synthetic 
Intracanal Medicaments on the Healing of Periapical Lesion in 
Retreatment Cases (A Randomized Clinical Trial) 
 
A Protocol Submitted to 
Faculty of Dentistry, Ain Shams University 
in Partial  
Fulfillment of Requirements for Doctorate degree in Endodontics 
 
Presented by  
Rawda Mohammad Abd El-Rahman Baghdady 
Assistant lecturer of endodontics- Faculty of dentistry Assiut university 
B.D.S 2009, M.Sc 2017 (Cairo University) 
 
 
Supervisors 
Prof. Dr. Karim Mostafa El Batouty 
Professor of Endodontics  
Vice Dean for Education and Student Affairs 
Faculty of Dentistry Ain Shams University 
 
Dr. Sarah Hossam Fahmy  
Lecturer of Endodontics 
Faculty of Dentistry Ain Shams University 
 
2020

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Introduction/ Background 
Apical periodontitis is an inflammatory disease mostly of microbial etiology. 
There are many factors that may contribute to a persistent periapical radiolucency 
after treatment, intraradicular infection; extraradicular infection; foreign body 
reaction; cysts, and fibrous scar tissue healing following conventional treatment. 
Bacterial injury is probably the major and the most common cause of endodontic 
failure. This occurs when endodontic treatment is carried out inadequately. While 
in most cases, procedural errors (broken instruments, perforations, overfilling, 
underfilling, ledges and so on) do not jeopardize the outcome of endodontic 
treatment unless a concomitant infection is present.   
Root canal infections have a polymicrobial nature; hence, anaerobic and 
facultative anaerobic microorganisms are usually found together in endodontic 
flare-ups and cases with post-treatment disease. Enterococcus faecalis (E. faecalis) 
and Candida albicans (C. albicans) are most commonly found in secondary apical 
periodontitis.  E. faecalis can withstand the ecologically amenable conditions 
within the root canal makes it challenging to eliminate. As this pathogen can grow 
and survive in a hypotonic, hypertonic medium, at a pH ranging from 2 to 10, in 
acid and alkaline environments and those lacking nutrients(1).  
Although biomechanical preparation and shaping of root canal effectively 
decrease the number of microorganisms in the root canal system. However, these 
procedures are unable to completely remove bacteria from lateral canals, isthmuses 
and apical deltas.  Therefore, in order to achieve more decrease in the number of 
intracanal 
bacteria, 
intracanal 
medicaments 
between 
appointments 
is 
recommended. The most important properties of intracanal medicaments are their 
biocompatibility, stability and bactericidal effects. 
Calcium hydroxide is the most commonly used intracanal medication. As it 
has high pH (12.5-12.8), it disturbs outer wall of bacteria, destructs potent toxins of 
bacteria, a lipopolysaccharide and it induces hard tissue formation. But calcium 
hydroxide as a root canal medicament has limitations as it does not eliminate the 
whole spectrum of microorganisms. The antimicrobial ability of calcium hydroxide 
was dependent upon direct contact with bacteria. So, it is not very effective in 
eliminating bacteria from the dentinal tubules.  E. faecalis is small enough to 

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proficiently invade and live within dentinal tubules So, calcium hydroxide needs 
long time to provide its antimicrobial effect Therefore, different intracanal 
medicaments have been used inside the root canal to overcome disadvantages of 
calcium hydroxide. 
Systemic antibiotic therapy may be useful in dental surgical and non-
surgical procedures, but it has many limitations such as allergic reactions or 
toxicities and the development of resistant strains of microbes. Moreover, it needs 
absorption of systemic drugs by the gastrointestinal system, transportation via the 
blood stream to the infected area which require a proper blood supply which is no 
longer available in an infected root-filled tooth. As a result, topical application of 
antibiotics within the canal may be a more effective method for the drug delivering 
Ciprofloxacin is a second-generation fluoroquinolone antibiotic with few 
side effects. Its range of effect includes most strains of bacterial pathogens as 
Enterococcus 
faecalis, 
and 
Streptococcus 
pyogenes. 
Ciprofloxacin 
has 
antimicrobial activity with wide broad spectrum of activities, excellent tissue 
penetration and excellent pharmacokinetic properties. So, it was used as intracanal 
medication either with calcium hydroxide or other locally delivered antibiotics(2).  
Nonsteroidal anti-inflammatory drugs e.g. brufen as a component of inter-
appointment dressing possess potential beneficial effects due to anti-inflammatory 
action as it decrease inflammatory mediators and local analgesia consequently it is 
effective in the relief of posttreatment pain and possible anti-bacterial action (E. 
faecalis). Especially, placing the drug directly at the site of tissue injury may be 
more effective in controlling pain and inflammation than waiting for absorption 
through the gastrointestinal tract. Antibiotics (ciprofloxacin) in conjunction with 
NSAIDs (ibuprofen) may be used as intracanal medication to prevent secondary 
infection.  
To remove drawbacks of the current intracanal medications, extracts of 
herbal plant can be used. Recent trends in endodontics prefers natural plant 
medication due to it has more properties antimicrobials, less expensive, better 
patient tolerance and renewable in nature 
Curcuma longa (turmeric) belongs to the Zingiberaceae family. It is a native 
of south-east Asia and is cultivated mainly in India. It is a natural polyphenolic 

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flavonoid. The main yellow bioactive component of C. longa is curcumin 
(diferuloylmethane). It possesses a wide spectrum of action, including 
anti‑inflammatory, antioxidant, antibacterial, antifungal, antiprotozoal, antiviral, 
antispasmodic and anticancer activities and many other properties which may be a 
gift to dentistry and to be used as intracanal medication. But its clinical 
applications are still restricted due to the poor aqueous solubility, rapid degradation 
and low oral bioavailability(3). 
Endodontics main goal is long lasting sterilization of the root canal. So, 
antibacterial effect of various intracanal medications is of high concern. Since 
nanotechnology has been infiltrating the field of medicine with its high 
antibacterial potential, its use in endodontics is highly prompted.  
The solubility of curcumin can be increased by reducing it to nanoform 
which increases bioavailability, specificity and pharmacological activity. In 
addition to large surface area, controlled particle size, site specific targeting, 
stability, biodegradable and controlled release of drugs   
Data from clinical trials showed that curcumin nano formulations can 
enhance curcumin bioavailability and are systemically safe. On the other hand, 
testing of these nano formulations as therapeutic modalities is highly desirable and 
is vital for upcoming clinical trials and for human use(4). Therefore, the aim of the 
present study is to compare curcumin in its regular and nanoforms versus 
ibuprofen and ciprofloxacin intracanal medicaments 
 
 
 
 
 
 
 
 

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Review of literature 
Fava(5) studied 60 necrotic upper central incisors from 48 patients with acute 
apical periodontitis & evaluated the incidence of post-operative pain after 
biomechanical preparation and dressing with a calcium-hydroxide paste (group 1) 
and a corticosteroid - antibiotic solution (group 2) on the first visit. All patients 
asked to report post-operative pain in 48 h after treatment and then teeth 
reevaluated clinically after 7 days. He concluded that no difference was observed 
in the incidence of post-operative pain between the two groups. 
 
Sundqvist et al.(6) evaluated  which types of organisms in teeth after failure 
of endodontic treatment was present . 54 root-filled teeth with persisting periapical 
lesions were selected for retreatment. After removal of the root filling, initial 
bacteriologic sample was taken from the root canal after instrumentation, second 
samples was taken at second visit after 7 days before placement of intracanal 
medicament and finally  post medication samples after removal of intracanal 
medicament at a third appointment 7 to 14 days later. They found the microbial 
flora was mainly gram-positive organisms, bacteria of the species Enterococcus 
faecalis. They concluded that after endodontic treatment failure, the canals ' 
microbial flora were markedly different from that of primary endodontic treatment. 
Also, three of four endodontic failures were successfully managed by retreatment. 
 
Filho et al.(7) evaluated effects of irrigating solution and CH  intracanal 
medicament on healing of periapical tissue of necrotic teeth with apical lesion in 
dogs. 72 root canals from four mongrel dogs were prepared, using 5.25% NaOCL 
or 2% CHX irrigating solutions. Either obturation was done immediately or an 
application of intracanal medication for 15 days before obturation. Two hundred 
and ten days later, animals were anesthetized, killed, and sections were taken for 
histological examination of periapical healing. They concluded that even with the 
use of concentrated sodium hypochlorite and chlorhexidine as bactericidal 
irrigation, the use of a root canal dressing was important in the root canal treatment 
of dog teeth with chronic apical diseases. 
 
Shuping et al.(8)evaluated the extent of bacterial reduction with nickel-
titanium rotary instrumentation and 1.25% NaOCl irrigation. Also, the additional 
antibacterial effect of calcium hydroxide for >1 week was tested in 42 patients with 

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chronic apical periodontitis. The canals were sampled before treatment, during and 
after instrumentation, and after treatment with calcium hydroxide and the samples 
incubated for 7 days. They found that the initial sample confirmed infection of the 
canals. There was a significantly greater reduction of bacteria after instrumentation 
and irrigation with NaOCl (61.9%) than sterile saline. Also, CH dressing for seven 
days led to sterilization of 92.5% of the canals. They concluded that rotary 
instrumentation in conjunction with sodium hypochlorite irrigation is necessary for 
disinfection of canal, but not completely. Therefore, Ca (OH)2 intracanal 
medication must be added. 
 
Ehrmann et al. (9) investigated the relationship of postoperative pain to three 
different medicaments placed in the root canal of 223 teeth in 221 patients with 
non-vital pulp and acute apical periodontitis presenting for emergency relieve of 
pain. Canals were medicated Group 1: ledermix paste, Group 2: CH paste and 
Group 3: no medicament. Pain was recorded 4 h after root canal therapy and daily 
for 4 days. They found that preoperative pain mean was 44.4% for all groups and 
declined by 22.1% after 24h. After four days the pain score for CH group was ten, 
for no dressing group was seven and for ledermix group was four. They concluded 
that ledermix paste led to more effective decrease of pain level than with Ca (OH)2 
or no dressing at all. 
 
Yoldas et al. (10) determined single or double visit endodontic  treatment 
effect on the post endodontic pain in 218 failed endodontic treatment cases.  Cases 
divided according to presence of pre endodontic pain or not. Nearly half of each 
group was treated in single visit and those in double appointment group were used 
calcium hydroxide- chlorhexidine combination as intracanal medication. They 
found that after seven days, eight cases from the single appointment group and two 
cases from the double visit group had flare-ups. They concluded that double visit 
with intracanal medication remove pain completely than single visit in teeth with 
preoperative pain, decreased flare-ups in all failed endodontic cases. 
 
Rôças et al.(11) studied the association of different periradicular diseases 
with presence of Enterococcus faecalis. Bacterial samples from studied cases were 
taken. PCR was used to identify E. faecalis.  They found that E. faecalis present in 
1/19 pus samples aspirated from acute periradicular abscesses, in 1/10 root canals 
with acute apical periodontitis and in 7/ 21 root canals with asymptomatic chronic 

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periradicular lesions. Moreover, it was found in 20/ 30 cases of persistent 
endodontic infections associated with endodontically treated teeth. They concluded 
that E. faecalis was markedly present, in asymptomatic primary endodontic cases 
than symptomatic ones and in failed endodontic treated teeth than in primary ones. 
 
Zerella et al.(12)evaluated the efficacy of CH mixed with 2% CHX solution 
versus CH on pulp space sterilization of 40 single rooted failed endodontically 
treated teeth with periradicular lesions during nonsurgical endodontic retreatment. 
Determination at the initial visit for presence of enterococci in the root canals was 
done. Application of either medication in root canals over 3 treatment visits (with 
7-10-day intervals) was done. Root canal cultures collection and bacterial growth 
assessment were done daily for 1 week, then weekly for another 3 weeks. They 
found that bacteria present in twelve/40 (30%) before obturation. Aqueous CH 
disinfected 12/20 (60%) teeth and CH mixed in aqueous 2% CHX disinfected 
16/20 (80%) teeth. They concluded that experimental medicament was slightly 
more effective on the disinfection of failed endodontically treated teeth than 
control one.  
 
Ercan et al.(13)assessed the effect of CH and 1% CHX mixture as intracanal 
medicaments in failed endodontically treated cases with apical lesions. 70 patients 
were included. [59 had received root canal treatment and 11 had been subjected to 
previous apical surgery]. Mechanical preparation, 2% CHX irrigation, CH powder 
mixed with 1% CHX solution as intracanal medication was applied for 6-week, 
medicament was periodically changed till teeth became asymptomatic. 
Radiographic and clinical examination was done after 3-months. They found that 
complete healing of retreatment cases 64%, incomplete healing 14% and failure 
22%. They concluded that CH with 1% CHX intracanal medication more 
effectively disinfect teeth with periapical lesions in endodontic retreatment  
 
Gama et al.(14)assessed post-endodontic pain incidence in 138 asymptomatic 
teeth after application of intracanal medicaments (0.12% CHX gel or CH / CPMC 
/glycerin pastes). Incidence of interappointment pain was recorded. They found 
that eighty four percent of cases showed absence of any level of pain regardless the 
type of medicament. There were no significant differences in treatment/retreatment 
cases with/without apical lesions between the two medicaments. They concluded 
that both medications were effective as regards antimicrobial, postoperative pain 

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Therefore, it was advised to used either one or both medications in routine 
treatment/retreatment. 
 
Rocas and Siqueira (15) assessed antimicrobial effect of chemo-mechanical 
preparation supplemented by intracanal medication during treatment of teeth with 
apical periodontitis by molecular microbiologic techniques and samples from 
twenty four nonvital canals were taken at the baseline (S1), after mechanical 
preparation with irrigation by  2.5% sodium hypochlorite (S2), and after intracanal  
medication for  one week with (CHG) or (CHPG) (S3). Identification of bacteria 
by PCR was done. They found that all S1 samples were positive for bacteria. 
Treatment procedures were highly effective in reducing the bacterial levels. 
Overall, S2 and S3 samples were bacteria free by 46%, 62.5% respectively. 
Specifically, in the CHG group: S2 and S3 samples were bacterial free in 50% and 
58% of the canals and in the CHPG group: 42% and 67%. But several bacteria 
were still present in S2 and S3 samples. They concluded that bacterial levels were 
decreased after preparation and medication. Moreover, another antimicrobial 
strategies and materials must be used to overcome all types of microbes which may 
deteriorate the outcome. 
 
Paredes-Vieyra and Enriquez(16) evaluated one and double visits 
endodontic treatment effects on success rate  of  300 maxillary and mandibular 
nonvital teeth with apical periodontitis for  2 years follow up postoperatively. 
Radiographically, all teeth showed small and irregular periapical radiolucencies 
before treatment. In one visit group: master apical file for anterior and premolars 
were #60 and for molars were #45 to #55. Irrigation of canals using EndoVac 
system then obturation.  For the 2visit group, dryness and application of CH for 7 
days then temporary restoration. At the second appointment (7 days after first 
visit), removal of CH with (hand instruments, irrigation with 5.25% NaOCL - 2.5 
mL 17% EDTA – finally; 5.0 mL 5.25% sodium hypochlorite using the EndoVac). 
Canals were dried with sterile paper points, and obturated. They concluded that no 
significant difference in periapical healing between single and double visit 
endodontic treatments radiographically. This may be due to the ability to obtain 
infection control.  
 
Singh et al.(17)compared between 3 different intracanal medications and the 
placebo, evaluated the postoperative pain level after endodontic treatment. Sixty-

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four lower necrotic molars with acute apical periodontitis were included. 1st 
group(n=16): CH paste+2% CHX gel, 2nd group(n=16): 2% CHX gel, 3rd group 
(n=16): CH paste and 4th group(n=16): no dressing. Pain level was recorded 4, 24, 
48, 72 and 96 h after treatment. They found that the post-operative pain level was 
significantly decreased at each time period for 1st and 2nd groups than 3rd and 4th 
groups. They concluded the efficacy of CHX alone or CH - CHX mixture on 
reducing the postoperative pain level for non-vital teeth with acute apical 
periodontitis than Ca (OH)2 dressing alone or no dressing at all. 
 
Gondim et al.(18)evaluated the success of root canal  treatment in deciduous 
necrotic teeth which has or not furcal or periapical lesion detected 
radiographically. This evaluation was done clinically and radiographically, after 
using medication with (CH) pastes prepared with polyethylene glycol (PEG) and 
chlorhexidine (CHX) intracanal dressing. It was included 32 necrotic primary teeth 
(twelve without and twenty with lesion). Preparation and medication of the canals 
with (Ca (OH)2/ polyethylene glycol) or gel 2% chlorhexidine gel with CH. Teeth 
in each group equal sixteen. Teeth filled with final restoration after 1 month. 
Examination of teeth in twelve months for determination of the endodontic therapy 
success (clinically and radiographically). They found that no significant difference 
in the success rate in the studied groups (with and without lesion). They concluded 
that there no difference between both medications clinically and radiographically 
on the success rate.  
 
Pai et al.(19) evaluated and compared antibacterial intracanal medication 
effect on pain between visits in diabetic patients. 50 diabetic cases were divided 
into three groups. 1st group (no dressing), 2nd group (CH) and 3rd group (TAP). 
Recording Pain between visits by verbal rating scale at 1, 2, 3 days, one week and 
after 2 weeks. They found that overall incidence of pain between visits was 16%. 
50% in 1st group, 15% in 2nd group had pain between visits while no one in 3rd 
group. They concluded that between visits TAP prevented pain than CH in diabetic 
patients. 
 
Marickar et al.(20) compared antibacterial effect of propolis, curcumin, 2% 
(CHX), 2% metronidazole gel and 2% of both on E. faecalis. CH as (Control 
group). Agar diffusion and tube dilution tests evaluated MIC effects of 
medications. Time-kill assay analyzed bactericidal activity. They concluded that 

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curcumin and 2% CHX had highest antibacterial effect against E. faecalis, 2% 
(MZ), propolis, 2% (CHX- MZ) and finally CH. Therefore, they reported curcumin 
may considered as an alternative to most commonly available intracanal 
medications. 
 
Raslan et al.(21) compared clinical and radiographic success rates of an 
antibiotic mix consisting of metronidazole, minocycline and ciprofloxacin (3Mix-
MP) and another mix where minocycline was replaced with clindamycin (3Mix-
MP-R) in deciduous necrotic molars without mechanical preparation and 
determined the effect of root resorption on the success of the treatment. 42 necrotic 
mandibular primary molars from 22 healthy children were randomly assigned to 
either mixture. Clinical evaluation was conducted after 1, 3, 6 and 12 months and 
radiographic evaluation was conducted at 6 and 12 months follow ups. They found 
overall success rates of 3Mix-MP and 3Mix- MP-R were 80.96% and 76.20% 
respectively. They concluded that the primary teeth with necrotic pulp can be 
treated with 3Mix-MP or 3Mix-MP-R irrespective of the degree of root resorption.  
 
de Freitas et al.(22) studied the antibiofilm activity and pH of (CH) when 
mixed with NSAIDs and antibiotics. The studied groups included; 1st group (CH) 
paste+ propylene glycol, 2nd group (CH) paste + propylene glycol + 5% diclofenac 
sodium, 3rd group, (CH) paste + propylene glycol + 5% ibuprofen, 4th group (CH) 
paste + propylene glycol +5% ciprofloxacin and finally, positive control group (no 
dressing). For pH analysis, pH was measured at 3h,1,3,7 days with a calibrated pH 
meter for each paste.  For microbial analysis, each paste was placed for 7 days on 
the 30 bovine dentin blocks induced with biofilm for three weeks. Then medication 
washed by sterile water and analyzing specimens. They concluded that the 
combination of NSAIDs or antibiotic did not interfere with the pH of calcium 
hydroxide paste and increased the antimicrobial action of calcium hydroxide paste 
against Enterococcus faecalis biofilm formation. 
 
Ferreira et al.(23)determined antimicrobial effect of different intracanal 
medications in primary root canal infections. Selection of 20 infected canals were 
done then instrumented and divided randomly according to the intracanal dressing 
into two groups: CH or CH/ CHX. Before and after endodontic treatment, samples 
were collected, analyzed by culture, total bacterial load and checkerboard DNA-
DNA hybridization technique. They found no differences in the reduction of 

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cultivable bacteria between (CH)group and CH/ CHX group [ (99.98%), (99.76%) 
respectively]. In initial samples, bacteria present were F. nucleatum ssp. vincentii 
(70%) and Capnocytophaga ochracea (70%). Enterococcus faecalis after 
instrumentation was (60%). F. nucleatum ssp. vincentii (90%) and E. faecalis 
(40%), after either intracanal medications. Significant reduction of bacterial 
number by both medications than the initial sample. But, CH/CHX group had 
highest bacterial number reduction than CH. They concluded that CH /CHX had 
greater antibacterial effect on gram positive and gram-negative species. But its 
antibacterial effect on enterococcus species need further studies. 
 
Marinho et al.(24)studied teeth with apical periodontitis for  the presence of 
bacterial species and their endotoxins level. Also, determination of inflammatory 
mediator levels (IL-1β and TNF-α) after root canal treatment with different 
irrigation. 30 infected root canals were divided randomly into: group I (n =10); 
2.5% NaOCL, group II (n =10); 2% CHX and group III (n =10; saline (control). 5 
Samples were taken by sterile paper points from root canal: S1; at baseline, S2; 
after mechanical preparation, S3; after irrigation by 17% EDTA, S4; after 
medication (CH mixed with saline) for 1 month and S5; before obturation. 
Bacterial detection (PCR) and endotoxin detection (limulus amebocyte lysate 
assay). IL-1β /TNF-α measured by (ELIZA) after macrophages stimulation by 
contents of root canals. They found that S1; bacterial endotoxins=100% + 
reasonable amounts IL-1β and TNF-α), S2; (bacterial endotoxin levels were 
significantly decreased in all groups, with greatest reduction in group I). Reduction 
of bacterial endotoxins levels at S3, S4 and S5with no difference between groups. 
Also, release of IL-1β and TNF-α were reduced directly proportional to residual 
endotoxin levels. They concluded that the greatest reduction after instrumentation 
of bacterial endotoxin levels irrespect of the type of irrigant used. Moreover, 
application of intracanal dressing enhances reduction of endotoxins which lead to 
marked inhibition of macrophages. 
Das et al.(25) compared antimicrobial effect of different intracanal 
medications. Forty-eight necrotic deciduous teeth were included. Samples were 
taken by sterile paper point as follow; S1: after access opening, S2: after canals 
instrumentation. Studied teeth were classified into; 1st group; CH+ distilled water, 
2nd group; CH + 2% CHX, 3rd group: TAP mixed with distilled water, 4th group: 
TAP + 2% CHX. S3: 7 days post medication. Finally, GIC was used for cavity 

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restoration. They found that in S3 of all studied groups: significant decrease in 
Enterococcus faecalis count compared with S2. TAP + 2% CHX intracanal 
dressing showed a maximum bacterial reduction compared to minimum reduction 
in CH group. They concluded that antimicrobial efficacy markedly increased by 
mixing different medications with each other than single one.  
Arruda et al.(26) demonstrated antibacterial effect in infected canals of teeth 
with primary apical periodontitis when using different intracanal dressing. Forty-
eight patients (23 females and 25 males) with single rooted teeth were included.  
After mechanical instrumentation by a reciprocating technique, irrigation with 
2.5% NaOCL.  Medication with either TAP (minocycline, metronidazole, and 
ciprofloxacin) at 1 mg/mL or CH +2% CHX. Samples were collected from the 
canal as follow: S1; at baseline, S2; after chemo-mechanical preparation and S3 
after dressing. Microbiological analysis was made by quantitative polymerase 
chain reaction assay. They found that in S1 bacteria was present. In comparing S2 
with S3, in TAP group: reduction was 97% and in CH/ CHX: 39%. In S3 
quantitative PCR showed negative results in TAP group than in CH group. They 
concluded that TAP (1mg/ml) provide better disinfection of canal than CH/CHX 
paste. Easy application and better antibacterial effect of TAP allowing use of it as 
routine intracanal dressing for conventional nonsurgical root canal treatment and 
possibly regenerative endodontics. 
 
Chockattu et al.(27) compared anti-bacterial efficiency of ibuprofen, 
diclofenac, and calcium hydroxide against Enterococcus faecalis in an endodontic 
model. 76 single-rooted mandibular premolar teeth were instrumented to F4-
ProTaper rotary. All teeth subjected to protocol to make them completely sterilized 
and microbially free then contaminated with E. faecalis for 14 days. Samples were 
taken before and after intracanal medication by paper point for microbiological 
analysis by colony-forming unit counts. The 76 teeth were randomly allocated into 
4 groups (n = 19), depending on medicament used: Group I; Ibuprofen + distilled 
water, Group II; Diclofenac sodium salt+ distilled water Group III; Ca(OH)2 
powder + distilled water  and all in (1:1 w/v) ratio control group; no medicament. 
They concluded the anti-inflammatory nonantibiotics (ibuprofen, diclofenac) had 
antibacterial effect against E. faecalis. Since nonsteroidal anti-inflammatory drugs 
had an anti-bacterial effect, it is possible to replace Ca (OH)2 with NSAIDs, or 

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even combine them to form a cocktail of local disinfectants to optimize canal 
disinfection. 
 
Ahirwar et al.(28) evaluated the antimicrobial efficacy  (both aerobic and 
anaerobic) of Ocimum Sanctum essential oil and compared it with that of TAP for 
deciduous molars. 40 children were selected and assigned randomly into: TAP 
group(n=20) and O. sanctum group (basil) (n=20). Two intracanal samples from 
each patient were collected (after access opening, irrigation and three days after 
medicament placement). The samples were cultured (in aerobic and anaerobic 
media) and CFUs were used for counting. They found that saline + TAP had 
significant antibacterial reduction (with more effect on anaerobic) than saline + O. 
sanctum essential oil. They concluded that to overcome the antibiotic resistance 
due to its abuse, O. sanctum can be used as an alternative intracanal medicament in 
deciduous teeth in long‑ lasting infection as it has antimicrobial and 
anti‑inflammatory efficacy. 
 
Riaz et al.(29) compared the healing of apical lesion by radiograph after 
using two types of intracanal medicament(CH and CH /2% CHX) for 2 weeks. 60 
patients with maxillary and mandibular teeth till first molar and lesion size was 2–4 
mm. Studied groups were randomly assigned into 1st group (CH, n=30) and 2nd 
group (CH / 2% CHX gel, n=30). After 2 weeks the teeth were obturated and final 
restoration were placed. At the end of 3 months of obturation, final outcome was 
assessed radiographically. They found that at end of twelve weeks in 1st group 
apical lesion size reduced (91.03%) while for 2nd group (97.26%). So, CH/2% 
CHX more preferrable than CH alone as intracanal dressing on healing. They 
concluded that CH/2% CHX leads to better apical healing (percentage)   
 
Samir Abouelenien et al.(30)evaluated the effect of DAP and CH 
medications in infected root canals on postoperative pain. Thirty-six single rooted 
nonvital premolars with apical periodontitis were divided randomly: 1st group (CH) 
and 2nd group (DAP). NRS was used for recording preoperative pain. After 
endodontic treatment steps and placement of intra-canal dressings. NRS was used 
for recording postoperative pain at 6, 12 hours, 1 day and 2 days. They concluded 
that in non-vital teeth with apical periodontitis using any type of intracanal 
dressings were effective in decreasing post-operative pain  

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Barbosa-Ribeiro et al.(31) investigated antibacterial effect of CH intracanal 
dressing, its effects on pro-inflammatory cytokines and matrix metalloproteinases 
effects(in canals & periradicular tissues) of failed endodontically treated teeth with 
apical periodontitis. 20 single-rooted teeth with infected canals were divided 
randomly into: 1st group; 2% CHX gel and 2nd group; 6% NaOCL. S1: samples 
before chemo-mechanical preparation and S2: after 1 month of CH based 
intracanal dressing. CFU count for calculation of bacterial reduction, ELISA for 
measuring of PICs and MMPs. They concluded that there was a significant 
decrease in PICs and MMPs levels and consequently bacterial level reduction by 
CH intracanal dressing. Also, on using 2% CHX or 6% NaOCl, there no difference 
between the two types of irrigant on CH intracanal dressing. Using CH intracanal 
dressing for 1 month in failed endodontically treated teeth with apical periodontitis 
(with high levels of bacteria, PIC and MMP) showed excellent prognosis 
 
Özdemir et al.(32) evaluated in periapical lesions the effect of CH and 
(CHX) gel on matrix metalloproteinase-9 (MMP-9) and vasoactive intestinal 
peptide (VIP) secretion. Sixty cases were assigned randomly into: 1st group; (CH, 
n=30) and 2nd group; (CHX gel, n=30). Sterile paper points were used for taking 
pre-and post-treatment samples from the interstitial fluid of periapical lesions. 
ELISA used for determination of VIP and MMP-9 levels. They found that in the 
1st group, VIP level was significantly increase in the post-treatment than in the 
pre-treatment one. In 2nd group, MMP-9 level was significantly increase in the 
post-treatment than the pre-treatment one. They concluded that the amount of 
periapical VIP andMMP-9 secretion affected by the type of intracanal dressing. 
VIP (a neuropeptide that promotes new bone formation), its secretion increased by 
CH dressing. Therefore, using CH dressing may enhance the process of bone tissue 
repair. 
 
da Silva et al.(33) evaluated the effect of association of non-steroidal anti-
inflammatory and antibiotic agents with calcium hydroxide pastes on their 
biocompatibility and cytotoxicity. In 30 rats was used CH pastes with drugs tubes 
and empty tubes by implanting it in subcutaneous tissue. Removing these tubes 
after 1 week and 1 month and analyzed histologically. Pre-osteoblast-like cells 
were cultivated, the cytotoxicity of the paste was determined by MTT test after 1, 
2, 3 days and 1 week. They concluded that tubes contained CH pastes with drugs 
were biocompatible and not cytotoxic. So, pastes of CH with anti-inflammatory or 

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antibiotic may be clinically used as replacement for conventional intracanal 
dressing to decrease microorganism resistance in root canal system. 
 
Karataş et al.(34)  evaluated antimicrobial effectiveness of CH paste with 
ibuprofen or ciprofloxacin in teeth with infected root canal and asymptomatic 
apical periodontitis. 45 patients (23 males and 22 females) were randomly assigned 
into: 1st group; 1 g CH powder + 1 mL propylene glycol, 2nd group ; 950 mg CH 
powder + 50 mg of ibuprofen +1 mL propylene glycol, 3rd group; 950 mg CH 
powder + 50 mg of Ciprofloxacin + 1 mL propylene glycol. Then taken three 
samples from canals; first sample (S1) at baseline, second one (S2) after intracanal 
preparation and final sample (S3); after removal of intracanal medication (7 days 
from their placement). Samples were subjected to microbiological analysis. They 
concluded that calcium hydroxide and ciprofloxacin intracanal medication 
combination produced more antibacterial effectiveness in vivo during endodontic 
treatment of necrotic teeth. 
Neelakantan et al.(35)evaluated different irrigant (curcumin, NaOCl and 
CHX)  antimicrobial effect on E. faecalis biofilm formed on tooth substrate in 
vitro. 96 instrumented extracted human teeth which E. faecalis biofilms were 
formed on it. In 48 hours, 2weeks and 2months biofilms, CFUs was calculated 
after thirty-minute application of test solutions or saline on studied specimens. 
They found that complete removal of bacteria at all time periods only by sodium 
hypochlorite. Also, curcumin and sodium hypochlorite caused significantly 
complete reduction in CFU than chlorhexidine and saline groups in 48 hours and 2 
weeks. But sodium hypochlorite significantly lower CFU/ml in 2 months biofilms 
than curcumin treated samples which showed significantly lower CFU/ml than 
chlorhexidine and saline control group. They concluded that NaOCL (3%) had 
greatest antibacterial effect on biofilms of Enterococcus faecalis formed on the 
tooth substrate, then curcumin and chlorhexidine. Due to sodium hypochlorite side 
effects, curcumin herbal alternative might be promoted to be used in endodontic 
treatment.  
Kumar(36)compared  the effects of different intracanal dressing[(10%, 20%) 
C. longa,  (10%, 20%) Tachyspermum ammi; (1%)chlorhexidine gel; and (10%) 
calcium hydroxide] on  E. faecalis cultures. it was cultivated at 37°C on BHI broth, 
inoculated at 37°C for 72 h.  Microbial zone of inhibition was calculated by well 

End 20 – 05 P 
15 
 
diffusion method. He found that C. longa (20%) and CHX gluconate gel (1%) had 
highest degree of microbial zones inhibition than C. longa (10%) that were highly 
significant when compared to T. ammi (10%, 20%) and calcium hydroxide. He 
concluded that in failed endodontically treated teeth C. longa can be used as 
intracanal dressing. 
Taur et al.(37)compared and evaluated the effect of curcumin and another 
different intracanal dressings on Enterococcus faecalis and its effect on the 
microhardness of root dentin. seventy extracted human single-rooted teeth were 
used for Preparation of 140 dentin blocks. One hundred-twenty blocks were 
infected with E. faecalis (for 21 days) for antibacterial analysis. Then it was treated 
according to type of dressing as: 1st group (CH), 2nd group (CHX gel; 2%), 3rd 
group (curcumin), 4th group (saline) and 5th group (negative control). At depth of 
400 μm, dentin powder was obtained, cultivated in broth media and CFUs counted 
at 1, 3 days and 1 week. Four dentin blocks were used for microhardness analysis 
by preparation of 8 samples each 2 mm thickness. At 400μm from canal lumen 
microhardness test (by Vickers hardness indentation machine) was performed after 
dressings application and this test was done at 1, 3 days and 1 week. They found 
that chlorhexidine group showed total eradication of Enterococcus faecalis, CH 
group (64%) and curcumin group (54%). Chlorhexidine group showed greatest 
effect on microhardness of root dentin, CH group, finally no effect on 
microhardness in curcumin group. They concluded that curcumin has proper 
antibacterial effect with no microhardness effect on root dentine. So, it was 
promoted for its use as intracanal dressing alternative if its antibacterial effect 
accelerated.  
Chamele and Bhat(38)evaluated in vitro the antimicrobial effect of curcumin 
(intracanal dressing) on E. faecalis in primary teeth. 60 single canalled deciduous 
teeth infected with E. faecalis were included. They were treated with a paste made 
of either turmeric extract, calcium hydroxide and saline for one week. Dentinal 
shavings were collected from within the canal. Digital colony counter was used for 
counting CFU. The pH of the medicaments used was measured with the help of pH 
meter. They showed that untreated Group III was significantly different from 
Group I &   Group II, indicating that Group I and Group II were effective against 
the species E. faecalis. They concluded that turmeric extract (curcumin) is 
effective against E. faecalis. Calcium hydroxide and Curcumin showed better 

End 20 – 05 P 
16 
 
antibacterial effect. There is 50% reduction in colony count was observed when 
treated with curcumin. Curcumin is effective against Enterococcus faecalis. Hence 
use of CH which can be substituted with curcumin as an intracanal dressing. 
Dhariwal et al.(39)evaluated clinically the effect of different irrigation 
(NaOCL, C. longa  and green tea) on anaerobic bacteria from canals of infected 
deciduous teeth. 30 children were included. After preoperative radiographs, 
isolation and determination of W.L., collection of 30 samples from canals by 
sterile paper points and placing it in thioglycolate transport medium tubes. 
Microbiological analysis was done by bacterial isolation and antibiotic sensitivity 
testing using 3 irrigating solutions. They reported that the most commonly bacteria 
isolated; (Porphyromonas sp., Bacteroides fragilis, Peptostreptococcus, and S. 
aureus). Also, the antibacterial effectiveness of 3 studied irrigating solutions was 
statistically significant (the highest NaOCL and C. longa and the lowest was green 
tea). They concluded that there was almost a polymicrobial infection in infected 
deciduous teeth. Eradication of predominant infection by endodontic preparation 
(instrumentation and irrigation) considered an important step for disinfection of 
infected deciduous teeth. Also, new herbal extract (C. longa) considered as natural 
alternative for NaOCL due to its adverse effects. 
Vasudeva et al.(40)evaluated the effect of different intracanal dressings(2% 
CHX gel, Honey, Aloe vera gel, C. longa, Propolis gel and CH) on E. faecalis 
present in D.T. 210 lower 1st  premolars were infected with E. faecalis for 21days. 
Studied samples were: 1st group ( Saline; negative control), 2nd group(2%CHX gel) 
, 3rd group ( honey), 4th group(Aloe vera gel), 5th group (20% C. longa gel), 6th 
group (Propolis gel) and 7th group(CH). Microbiological analysis for studied 
intracanal dressings on E. faecalis at 200 mm and 400 mm depth was done at 24, 
72 hours and 5 days.  They found the greatest antimicrobial efficacy was by 2% 
CHX gel then Propolis and C. longa. They concluded that (2% CHX gel) was the 
best antimicrobial intracanal dressing. While herbal extracts (Propolis and C. 
longa) considered the future natural alternative intracanal dressings but they need 
further long-term investigation in vivo  
Xiao et al.(41)investigated the anti-inflammatory effects of curcumin in rat 
gingival fibroblasts both in vitro and in vivo by (the lipopolysaccharide induced 
inflammatory response and ligation-induced experimental periodontitis). In the 

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17 
 
absence or presence of LPS, incubation of gingival fibroblasts by curcumin (by 
oral gavage every 48 hours) at different concentrations. ELISA was used for 
determination of (IL-1β, TNF-α, OPG and soluble RANKL) in culture supernatants 
of rat gingival fibroblasts. After extraction of nuclear fraction of gingival 
fibroblasts, determination of NF-κB activation. Histological analysis was done by 
taking sections from between the first and second molars and observation for 
gingival inflammation. Micro-CT analysis assessed alveolar bone loss at the same 
area. They reported that curcumin decreased production of (IL-1β and TNF-α, 
OPG/sRANKL ratio and NF-κB activation) in rat gingival fibroblasts. They 
concluded that in vivo (gingival inflammation, modulated collagen fiber and 
alveolar bone loss) was reduced significantly by curcumin. Also, inflammatory 
activity in rat periodontitis improved by curcumin through its inhibitory effects of 
NF-κB activation and lowering the OPG/sRANKL ratio induced by 
lipopolysaccharides. 
Lone et al.(42) studied C. Longa healing benefits and its therapeutic effect. 
One hundred seventy-eight cases with dry socket were diagnosed clinically   and 
divided into group I [Turmeric dressing (C. Longa) with mustard oil] and group II 
(ZOE dressing). They found that both studied dressings significantly reduced pain, 
inflammation and discomfort. But faster wound healing with group I than group II. 
Also, C. Longa has no side effect. They concluded that local application of C. 
Longa accentuates wound healing at injury site. Therefore, different forms of the 
turmeric (C. Longa) is effective in treatment of different diseases e.g. surgical 
wounds. 
Meizarini et al.(43)determined the healing effect of  wound by ZO + C. 
Longa dressing as an anti-inflammatory through the expression of macrophages by 
means of immunohistochemistry examination, MAC387 and COX-2.  40 studied 
experimental wistar rats [4 control and 4 treatment groups (n=5)]. From all rat 
excision of part of skin (6 mm × 6 mm) at 24 hours was done. Then dressing 
wound of treatment groups was done by a mixture of ZO + turmeric extract (C. 
Longa), but the control groups (undressed). Sequential scarification of 
experimental rats and excision of subepithelial samples were taken on 72 hours, 
five days, 1 week and 2 weeks was done. Evaluation of the healing of the wound in 
the samples through anti-inflammatory action of dressing. They reported that in the 
treatment groups: MAC387 was showed the highest expression on the fifth day 

End 20 – 05 P 
18 
 
then reduce slowly on 1 week and 2 weeks. While in the undressed groups:  it 
reached the peak after 2 weeks. As regard to COX-2 expression; it started high on 
3rd day, then decreased gradually on 5th and seven days, finally reached to 
minimum at the end of two weeks and this in treatment groups. While in undressed 
groups; it showed higher expression at third day, elevated at fifth day, started to 
reduce after 1 week and finally reduced after 2 weeks. They concluded that the 
wound dressing consisting of (ZO + C. Longa mixture) had an anti-inflammatory 
effect for excised wounds healing. 
Neelakantan et al.(44) tested different irrigants (NaOCL and light or 
ultrasonic activated curcumin) effect in vitro on E. faecalis biofilms. One hundred 
and seventy-five root canals infected with E. faecalis and divided into: 1st group; 
(saline; n= 25), 2nd group; (3% NaOCL; n= 25), 3rd group; (3% ultrasonically 
activated NaOCL; n= 25), 4th group; (3% NaOCL irradiated with blue light; n=25), 
5th group; [curcumin (2.5mg/mL); n=25], 6th group; [ultrasonically activated 
curcumin (2.5mg/mL); n=25], 7th group; [curcumin (2.5mg/mL) irradiated with 
blue light; n=25]. SEM examination of ultrastructure of biofilms was done. 
Confocal microscopy was measured bacterial viability. They found that the dead 
bacteria percentage were significantly lower in control group (saline) than in all 
treatment groups. Light activated curcumin had significantly higher percentage of 
dead bacteria, moreover, no growth of bacteria at depths (200 and 400 microns). 
They concluded that significantly higher antibacterial effect produced by light 
activation than ultrasonic one, the maximum elimination of bacterial biofilms 
(within the root canal lumen and D.T.) caused by light activated curcumin. 
Gera et al.(45)evaluated the anti-microbial effect of nanocurcumin coated 
surgical bandages in-vitro on (E. coli, S. aureus and S. pyogenes). Tetracycline was 
added to surgical bandages. Then comparing between nanocurcumin coated 
surgical bandages native curcumin coated one. It was found that nanocurcumin 
coated bandages showed antimicrobial activity more than 99%, remarkable wound 
healing and controlled drug delivery in comparison to native curcumin coated 
bandages. They concluded that the preparation of nano particles of curcumin and 
nanocurcumin coated bandages are the novel method. The developed 
nanocurcumin coated bandages exhibited superior antimicrobial properties 
compared to other bandages. Curcumin nanoparticles were more effective at both 
accelerating wound closure and clearing infection with microbes as compared to 

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19 
 
curcumin in its bulk size. They considered as promising method to combine normal 
bandages with nano product of natural compound curcumin and antimicrobial 
drug. Moreover, it will not contain any synthetic nano material which can lead to 
toxicity. This will provide a way to use this type of bandages in future also for 
controlled release of drugs at the target site of injury especially with respect to 
cancer treatment.  
Devaraj et al.(46) demonstrated the effect of different intracanal medications 
(photoactivated curcumin, TAP ,DAP, 2% CHX and CH) and untreated teeth as 
control) on E. faecalis biofilms. Microbiological analysis for biofilm mass and 
percentage of live/dead bacteria within the root canal as well as dentinal tubules 
was made by confocal microscopy. Also, colony forming units count was made for 
dentinal shavings obtained from the root canal walls (at 200 and 400 microns 
depth). They concluded that light activated curcumin had maximum activity on 
bacteria and biofilms of E. faecalis followed by TAP. However, 2% CHX more 
effective than CH on killing E. faecalis cells at 200 microns depth in dentinal 
tubules, but both dressings had no effect on its biofilm structure. So, Curcumin, 
TAP and DAP were significantly reduced the Colony forming units at 200 and 
400microns depths when compared to other dressings and untreated group.  
Gopal et al.(47)evaluated bactericidal efficacy of macro-, micro- and 
nanocurcumin on four predominant pathogenic bacteria including E. coli, S. 
enteritidis, S. aureus and S. mutans. They demonstrated a five-fold enhancement in 
bactericidal activity by nanocurcumin. They concluded that the higher penetration 
as shown by the confocal laser scanning microscope imaging and the enhanced 
solubility of the nanocurcumin are speculated to be reasons for the observed 
superior bactericidal property of nanocurcumin 
Gomes-Filho et al.(48)evaluated the effects of different irrigating solutions 
(light activated curcumin, 5% NaOCl and saline) on viability of cell and 
production of cytokine (IL-1β and IL-6) of mouse fibroblasts. 500mg/L curcumin 
pre-irradiated for 60 seconds with Led wavelength (λ) (480 nm) & for 300 seconds 
for photodynamic therapy with 72 Jcm2. Mouse fibroblasts L-929 were cultured in 
24-well cell culture plates containing studied diluted solutions plus culture 
medium. While, control group was culture medium only. After 6, 24 and 48 hours, 
the cell viability was calculated by (MTT) assay, while, ELISA used for evaluation 

End 20 – 05 P 
20 
 
of cytokines from supernatant. They found that cytotoxic effect of PDT curcumin 
and saline was low as control group. But cytotoxic effect of 5% sodium 
hypochlorite in all time intervals was significantly higher than PDT curcumin. IL-
1β and IL-6 were expressed likely by all studied irrigating solutions regardless to 
time intervals. They concluded that light activated curcumin neither has no effect 
on viability of L-929 fibroblasts and not cytotoxic nor inhibit release of cytokines 
IL-1β and IL-6. 
Sivieri-Araujo et al.(49)evaluated antimicrobial effect, biocompatibility and 
production of cytokine by light activated curcumin in rats. In Wistar rats' dorsal 
connective tissue were implanted polyethylene tubes which containing (5% 
NaOCl, 500 mg /L curcumin photosensitizer and saline as control). Scarification of 
rats were done at 1week, 2 weeks, 1, 2 and 3 months of implantation, tubes and 
surrounding tissues were removed,  divided into two part, one; for histological 
analysis, the other for estimation of production of IL-1β and IL-6 by ELISA. They 
reported that severe tissue reactions at 1 week in all studied specimens but reduced 
significantly by time. On the other hand, antimicrobial photoactivated curcumin 
enhanced production of IL-1β at all time intervals. Moreover, the maximum level 
of IL-6 at the end of three months was reached. They concluded that 
biocompatibility was the same in control and experimental groups. While, the 
production of cytokines (IL-1β and IL-6) by rat cells were enhanced by PDT 
curcumin  
Adahoun et al.(50)evaluated the nanocurcumin effects as anti-cancer (PC3, 
HEK and human erythrocytes)and antimicrobial against (Micrococcus luteus, S. 
aureus, E. coli, P. aeruginosa). The anticancer and antibacterial effects of 
nanocurcumin were assessed by cell viability curve, half maximal inhibitory 
concentration and the minimum bactericidal concentration. They found that 
curcumin nanoparticles had significant anticancer effect on (PC3) in comparison of 
parent one and low cytotoxic effect on normal cells (HEK). Hemolytic effect of 
curcumin nanoparticles and its native were very low with no significant difference. 
Also, all different bacterial strains killed by lowest concentration of curcumin 
nanoparticles (MBC) when compared with parent one. Moreover, antimicrobial 
effect of both curcumin nanoparticles and parent one was higher in gram +ve than 
gram -ve bacterial strains. They concluded that curcumin nanoparticles are safe 
compound and has potent antimicrobial and anticancer efficacy, so, it preferred to 

End 20 – 05 P 
21 
 
be use in treatment of prostatic cancer cells. Moreover, curcumin nanoparticles 
have remarkable antimicrobial activity than parent one. Also, low hemolytic and 
cytotoxic activities against eukaryotic cells were showed.  
Zambrano et al.(51) assessed the biological activity of topically applicated 
nanocurcumin on experimental periodontal disease. 16 rats classified into: 
[experimental group (n=8), local microinjections of 3 μL of a 10 mg/mL LPS 
solution from E. coli strain for induction of experimental periodontal disease] and 
[vehicle control group (n=8); PBS]and both these materials were injected 
bilaterally directly into the gingival tissues adjacent to the palatal surface of both 
maxillary first molars 3times / 7 days for 1 month. Each group was injected by 
either nanocurcumin or nano vehicle of the same volume at same sites 2 times per 
7 days. They reported that total inhibition of inflammatory bone resorption by 
topically applicated nanocurcumin (μCT analysis). Also, osteoclast counts, 
inflammatory infiltrate and p38 MAPK and NF-kB activation were reduced 
significantly. They concluded that topical application of nanocurcumin causes 
marked inhibition of number of osteoclastic cells so, inhibit bone resorption and 
inflammation associated with experimental periodontal disease.  
Hashemzadeh et al.(52) evaluated the effect of recently, nanomicelle 
curcumin “nanocurcumin” on the symptoms relief of knee osteoarthritis patients. 
Studied cases were divided into thirty-six patients as experimental that treated with 
capsules (40 mg nanocurcumin) every twelve hours for six weeks and thirty-five 
patients as control treated with placebo (similar components of nanomicelle 
curcumin capsules yet without curcumin). The pain level was recorded by patients 
before treatment at 1st visit and after treatment at the end of 6 weeks. They found 
that pain relieved significantly with nanocurcumin group than with the placebo 
group. They concluded that osteoarthritis symptoms were significantly improved 
by nanocurcumin and can be used as alternative for NSAIDs which were usually 
used for the treatment of the osteoarthritis but with complications such as 
gastrointestinal bleeding 
 
Ghorbanzadeh et al.(53) evaluated effect of the traditional endodontic 
irrigants (sodium hypochlorite) and new ones [rGOCur, rGOCur LED, rGOCur 
PDI ]compared to control group (only bacterial suspension )on disinfection of root 
canal and their effect on virulence factors of Enterococcus faecalis(ex vivo 

End 20 – 05 P 
22 
 
biofilms). Also, on production of intracellular ROS. They found that enterococcus 
faecalis growth inhibition by reduced graphene oxide-curcumin (250μg/ml) 
evaluated by MBIC. However, its anti-biofilm activity was insignificant even after 
application of LED for long periods (300 sec). Also, rGO-Cur LED, rGO-Cur-PDI, 
and NaOCl treatment cause remarkable reduction on expression levels of virulence 
factors in biofilms of Enterococcus faecalis in comparison to control. However, 
there was no significant change in virulence genes expression by LED. They 
concluded that rGO-Cur-PDI can be used clinically to control endodontic 
infections, due to it had double inhibitory effects on virulence activity of E. 
faecalis and biofilm formation ability  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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23 
 
Aim and objectives of the study 
The aim of the present study is to compare curcumin in its regular and nano forms 
versus ibuprofen and ciprofloxacin mixture as intracanal medicaments in 
retreatment cases with periapical lesion regarding: 
(1) Inter-appointment pain 
(2) Antibacterial effect  
(3) Clinical and radiographic signs of healing  
Social & scientific values: 
Currently there are no clinical studies comparing the natural and synthetic 
intracanal medications in patients suffering from symptomatic root canal treatment 
failure.  Thus, we are conducting this study to compare the efficacy of different 
intracanal medicaments [nanocurcumin, curcumin (natural herbs), ciprofloxacin 
and ibuprofen mixtures, calcium hydroxide as control] in  case of posttreatment 
disease  aiming  to  solve  the problem of the inter appointment pain felt by these 
patients after nonsurgical endodontic retreatment. Given that the most common 
cause of pain is microbial infection, so comparing their antibacterial effects and 
effects of these different types of intracanal dressing on periapical lesion healing. 
 
If natural intracanal medications in their bulk or their nanoform will become 
successful and evolution in future endodontics for patients and dentists would be 
achieved. For patients, the best treatment with natural extracts which is more 
applicable and more affordable without side effects would be provided. Despite of 
the fact that the nanoform is more expensive options for sponsorships would be 
available. Regarding dentists an opportunity to provide the best quality service 
with least expenses would be provided, which in turn would save time, effort and 
money. Finally, it will represent a turning point for researchers. 
Study Design: 
 
Randomized clinical trial (medications) 
 
 

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24 
 
Materials and methods 
 Materials used: 
• Nanocurcumin gel# 
• Curcumin powder$ + propylene glycol paste  
• Ciprofloxacin@ + brufen^ + propylene glycol paste 
• Calcium hydroxide paste (Metapaste)* 
Methods: 
This study is designed to be a prospective clinical study. The research proposal 
will be approved by the ethical committee, Faculty of Dentistry Ain shams 
University, Cairo, Egypt. 
Sample size determination: 
A power analysis was designed to have adequate power to apply a two–sided 
statistical test of the research hypothesis (null hypothesis) that there was no 
difference between the antibacterial effect of different tested intracanal medication, 
According to the results of Karataş et al.(34) using 0.05 α error , power of 0.8 and 
effect size  0.48 (difference proportion of positive culture) for four  studied groups. 
The predicted sample size (n) is a total 80 teeth with ratio 1:1:1:1 (study group1: 
study group2: study group3: control) i.e. 20 teeth per group. Sample size 
calculation was performed using G power software version 3.1.9.4 (© 1992-2019) 
Subjects of research: 
 Recruitment: 
 Patients are recruited for present clinical trial from out-patient of the clinic of    
 endodontics at the faculty of dentistry, Ain shams University, Egypt to meet the   
 target sample size. 
 
# Nano Tech Egypt for Photo- Electronics, City of 6 October, Egypt. 
$ Aldoha company, 10th of Ramadan city, Cairo, Egypt  
@ European Egyptian Pharm. Ind., Cairo, Egypt 
^ kahira pharmaceuticals & chemical industries Company, Cairo, Egypt 
*META BIOMED CO., LTD, Korea 

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25 
 
Selection of patients: 
Patients having maxillary or mandibular single rooted anterior or premolar teeth 
with signs &/ or symptoms of post treatment disease and referred for non-surgical 
root canal retreatment will be participated in this study  
Participants Eligibility criteria: 
  Inclusion criteria: 
• Medically free patients. 
• Sex includes both male and female. 
• Patient’s age between 20-60 years. 
• Patients must agree positively to share in the study.    
• Patients able to sign informed consent. 
• On clinical and radiographic examination, the included teeth [Maxillary or 
mandibular single rooted (anterior/premolar) teeth] must be suffering from 
failed endodontic treatment with periapical lesion. 
Exclusion criteria: 
• Badly broken down teeth indicated for extraction or with difficult isolation 
• Teeth with former procedural errors as perforation & instrument separation, 
ledge, etc. 
• Medically compromised patients 
• Patients with history of receiving antibiotics within a month,  
• Periodontally affected teeth by pocket depth > 4mm  
Diagnosis: 
The diagnostic data will be collected in a case report form   
Diagnostic criteria:  
Root canal filled single rooted teeth with post treatment disease manifest by one or 
more of the following criteria: 

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26 
 
- History of recurrent acute &/ or chronic apical lesion &/ or 
- Pain on percussion and /or tenderness on palpation at least after one 
month of primary root canal treatment, &/ or  
- Radiographic evidence of bone loss (apical radiolucency)  
Patient classification: 
According to intracanal medicament that will be used between visits, the 
participants will be categorized into: 
Group I: (n=20) Root canals will be medicated by nanocurcumin gel  
Group II: (n=20) Root canals will be medicated by curcumin powder + propylene 
glycol paste 
Group III: (n=20) Root canals will be medicated by 50mg ibuprofen and 50mg 
ciprofloxacin mixture + propylene glycol paste 
Group IV: (n=20) (positive control) Root canals will be medicated by calcium 
hydroxide in barium sulphate base (metapaste) 
Procedures: 
  First visit: 
Treatment plan will be discussed with patients and their acceptance to share 
in the study will be obtained. Patient will be anesthetized by using inferior alveolar 
nerve block local anesthesia for mandibular premolar teeth or labial/buccal 
infiltration local anesthesia for mandibular or maxillary anterior or maxillary 
premolar teeth. Removal of any caries and previous coronal restoration will be 
done. Teeth will be isolated with rubber dam. Access cavity will be completely 
disinfected before entering the root canals using sodium hypochlorite 2.5%, then 
its effect will be inhibited using sodium thiosulphate 5%.  
Old gutta percha will be removed with protaper rotary retreatment files in the 
following manner D1, (with cutting tip) will be used for first penetration into old 
gutta percha in the coronal third of the canal. D2, (with non-cutting tip) will be 
used for removal of old gutta percha from middle third of the canal. Finally, D3, 
(with non-cutting tip) will be used to remove old gutta percha from apical third of 
the canal. This system will be used without gutta percha solvent. Patency of the 

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27 
 
filled canals will be obtained using manual k files #10, #15. Sterile saline will be 
used as an irrigant. Working length determination will be done by J Morita apex 
locator followed by intraoral periapical radiograph to confirm the length to be 0.5-
1 mm shorter than radiographic apex. 
Sterile paper point equivalent to the size of largest file reaching the working 
length will be placed for one minute in the canal and this is the first sample for 
bacteriological assessment (S1). Then complete cleaning and shaping of the canal 
will be made using 15 ml of 2.5% sodium hypochlorite as an irrigant with a side 
vented needle of 27 gauge placed one millimeter from working length between 
every subsequent instruments and M3-Pro Gold rotary endodontic files, in an 
endodontic motor according to the manufacturer instructions and MD-Chelcream 
will be used as lubricant during mechanical preparation 
After complete cleaning and shaping, inhibition of action of sodium 
hypochlorite using 10 ml of 5% sodium thiosulphate then it will be flushed from 
the canal using sterile saline. Then sterile paper point equivalent to size of master 
apical file will be placed for 1 minute in the canal 1 mm from working length and 
this second sample for bacteriological assessment (S2). Then these cases will be 
divided into four group according to intracanal dressing which will be used: 
- Group I:(n=20) canal will be completely dried and nanocurcumin gel 
will be used as intracanal medicament for 7 days 
- Group II: (n=20) canal will be completely dried and curcumin powder 
1gm + 1ml propylene glycol paste will be used as intracanal medicament 
for 7 days  
- Group III: (n=20) canal will be completely dried and ibuprofen + 
ciprofloxacin mixture (1 g) powder + 1ml propylene glycol paste will be 
used as intracanal medicament for 7 days 
- Group IV: (n=20) (positive control) canal will be completely dried and 
metapaste will be used as intracanal medicament for 7 days. 
Finally, a cotton pellet & temporary filling (MD-Temp) will be applied 
under complete a septic condition. Patient will be given numerical rating scale 
(NRS) and will be asked to rate inter-appointment pain level at 6, 12, 24 & 48 
hours and at 3, 6 day. 
 
 

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28 
 
Second visit: 
After one week (7 days later), placement of rubber dam , removal of the 
temporary fillings will be done and M pro file #20, 0.04 taper will be placed in 
each canal to loosen medicament and to create a space for subsequent irrigating 
solution, then root canal will be washed with 10 mL of sterile saline until saline 
will be got out clear from the canal. Sterile paper point will be placed in the canal 
1mm from the working length to take the last sample (S3). Dryness of the canals 
by paper points and master cone adjustment will be made. Obturation with cold 
lateral compaction technique with gutta percha #35 or #40 with 0.04 taper 
according to canal size and resin sealer will be done. Final restoration with 
composite resin will be done for all teeth. 
The sterile paper points with three samples (S1, S2, S3) will be placed each in 
a sterile tube labelled according to the type of medication and the order of the 
sample and each tube contain broth media then all tubes will be transferred to 
microbiological lab within 2-3 hours from sampling procedure in an ice box with 
refrigerated ice bag in contact with it.  Patient will be recalled at 1, 3, 6 months for 
follow up clinically and radiographically. 
Methods of evaluation: 
1- Inter- appointment pain evaluation:  
Incidence of inter- appointment pain will be collected by the operator 
through NRS which is an 11-point scale consisting of numbers from 0 
through 10:  
0 reading represents “no pain”, 1- 3 readings represent “mild pain”, 4- 6 
readings represent “moderate pain”, 7- 10 readings represent “severe pain” 
   
2- Microbiological evaluation: 
Counting the bacteria by colony forming unit/ml 
3- Clinical and radiographical evaluation of healing: 
The clinical and radiographic data will be collected at the initial examination 
and at 1, 3, 6 months postoperative follow up and will be used as a base to 
determine success or failure of the endodontic retreatment after four studied 
intracanal medications. The following criteria will be used to determine the 

End 20 – 05 P 
29 
 
success or failure of the endodontic retreatment after four studied intracanal 
medications: 
a) Complete repair (success) 
       • on clinical examination: no signs and symptoms of acute or 
       chronic apical periodontitis and 
       • on radiographic examination: no pathological apical root resorption, 
normal PDL space width and complete resolution of lesion present 
preoperatively. 
b) Incomplete repair (success) 
      • on clinical examination: no signs and symptoms of acute or chronic 
apical periodontitis and 
      • on radiographic examination: no pathological apical root resorption and 
size of periapical lesion decreased. 
c) Absence of repair (failure) 
       • on clinical examination: signs and symptoms of acute or chronic apical     
         periodontitis still present and/or 
       • on radiographic examination: presence of pathological apical root 
resorption, no change in the size or increase of pre-existing periapical lesion 
during the follow-up period. 
Statistical analysis: 
Data management and statistical analysis will be performed using the 
Statistical Package for Social Sciences (SPSS) version 21. Data will be presented 
as mean and standard deviation (SD) values, analysis of variance (ANOVA) will 
be used for comparison between groups and the changes by time in each group 
evaluated by T test. 
  
Z test will be used for comparison of proportions with a significance level of 
5% from clinical and radiographic data collected preoperatively and at 1,3,6 
months postoperatively as regard to intracanal dressing type and its relation to the 
visible periapical lesion in radiograph(complete remission or not). 
 
Risks to study participants: 
No adverse effects were reported by previous studies from nanocurcumin 
(Gomes-Filho et al.(48), Sivieri-Araujo et al.(49), Adahoun et al.(50), Zambrano et 
al.(51), Hashemzadeh et al.(52). Moreover , these studies reported its 

End 20 – 05 P 
30 
 
biocompatibility and Hashemzadeh et al.(52)used nanocurcumin in capsules given 
to patients and swallowed them. They provided the patients with analgesic and 
anti-inflammatory effects. However, if any harm is seen in the participants in any 
of studied groups they will be recorded and reported at the end of the trial.  
Benefits to study participants/ community: 
Participants and community will receive the best treatment without side 
effects as these materials are biocompatible. 
Privacy, Record keeping & confidentiality: 
Personal information about participants will be acquired during the process 
of trial recruitment, eligibility screening, and data collection. Much of this 
information consists of private details. All study-related information will be stored 
securely at the study site. All participant information will be stored in locked file 
cabinets in areas with limited access. All records that contain names or other 
personal identifiers will be stored separately from study records identified by the 
patient's serial number. Participants’ study information will not be released outside 
of the study without the written permission of the participant. 
Informed consent materials: 
Patient informed consent: 
The research operator will introduce the trial to the patient and operator will 
obtain signed consent from patients willing to participate in the trial. However, the 
subject could quit at any time without penalty or loss of any benefits. 
Ethics Committee will revise and modify according to their guidelines. 
 
 
 
 
 
 
 

End 20 – 05 P 
31 
 
References:  
1.  
Atila-Pektaş B, Yurdakul P, Gülmez D, Görduysus Ö. Antimicrobial effects 
of root canal medicaments against Enterococcus faecalis and Streptococcus 
mutans. Int Endod J. 2013;46(5):413–8.  
2.  
Mohammadi Z, Jafarzadeh H, Shalavi S, Yaripour S, Sharifi F, Kinoshita JI. 
A review on triple antibiotic paste as a suitable material used in regenerative 
endodontics. Iran Endod J. 2018;13(1):1–6.  
3.  
Neelakantan P, Jagannathan N, Nazar N. Ethnopharmacological approach in 
Endodontic Treatment : A Focused Review. Int J Drug Dev Res. 
2011;3(4):68–77.  
4.  
Mandal M, Jaiswal P, Mishra A. Role of curcumin and its nanoformulations 
in neurotherapeutics : A comprehensive review. J Biochem Mol Toxicol. 
2020;1–17.  
5.  
Fava LRG. Acute apical periodontitis: Incidence of post-operative pain using 
two different root canal dressings. Int Endod J. 1998;31(5):343–7.  
6.  
Sundqvist G, Figdor D, Persson S, Sjögren 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. 
1998;85(1):86–93.  
7.  
Filho MT, Leonardo MR, Da Silva LAB. Effect of irrigating solution and 
calcium hydroxide root canal dressing on the repair of apical and periapical 
tissues of teeth with periapical lesion. J Endod. 2002;28(4):295–9.  
8.  
Shuping GB, 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.  
9.  
Ehrmann EH, Messer HH, Adams GG. The relationship of intracanal 
medicaments to postoperative pain in endodontics. Int Endod J. 
2003;36(12):868–75.  
10.  Yoldas O, Topuz A, Isçi AS, Oztunc H. Postoperative pain after endodontic 
retreatment: Single- versus two-visit treatment. Oral Surgery, Oral Med Oral 
Pathol Oral Radiol Endodontology. 2004;98(4):483–7.  
11.  Rôças IN, Siqueira JF, Santos KRN. Association of Enterococcus faecalis 
with different forms of periradicular diseases. J Endod. 2004;30(5):315–20.  

End 20 – 05 P 
32 
 
12.  Zerella JA, Fouad AF, Spångberg LSW. Effectiveness of a calcium 
hydroxide and chlorhexidine digluconate mixture as disinfectant during 
retreatment of failed endodontic cases. Oral Surgery, Oral Med Oral Pathol 
Oral Radiol Endodontology. 2005;100(6):756–61.  
13.  Ercan E, Dalli M, Duülgergil CT, Yaman F. Effect of intracanal medication 
with calcium hydroxide and 1% chlorhexidine in endodontic retreatment 
cases with periapical lesions: an in vivo study. J Formos Med Assoc. 
2007;106(3):217–24.  
14.  Gama TGV, Machado de Oliveira JC, Abad EC, Rôças IN, Siqueira JF. 
Postoperative pain following the use of two different intracanal medications. 
Clin Oral Investig. 2008;12(4):325–30.  
15.  Rocas IN, Siqueira JF. In vivo antimicrobial effects of endodontic treatment 
procedures as assessed by molecular microbiologic techniques. J Endod. 
2011;37(3):304–10.  
16.  Paredes-Vieyra J, Enriquez FJJ. Success rate of single-versus two-visit root 
canal treatment of teeth with apical periodontitis: A randomized controlled 
trial. J Endod. 2012;38(9):1164–9. 
17.  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.  
18.  Gondim JO, Moreira Neto JJS, Gomes DAS, Azevedo ER, Jeremias F, Giro 
EMA. 
In 
Vivo 
study 
of 
an 
intracanal 
dressing 
of 
calcium 
hydroxide/chlorhexidine in necrotic primary teeth. Brazilian J Oral Sci. 
2014;13(1):70–5.  
19.  Pai S, Vivekananda Pai AR, Thomas MS, Bhat V. Effect of calcium 
hydroxide and triple antibiotic paste as intracanal medicaments on the 
incidence of inter-appointment flare-up in diabetic patients: An in vivo study. 
J Conserv Dent. 2014;17(3):208–11.  
20.  Marickar R, Geetha R, Neelakantan P.  Efficacy of Contemporary and Novel 
Intracanal Medicaments against Enterococcus Faecalis . J Clin Pediatr Dent. 
2015;39(1):47–50.  
21.  Raslan N, Mansour O, Assfoura L. Evaluation of antibiotic mix in non-
instrumentation endodontic treatment of necrotic primary molars. Eur J 
Paediatr Dent. 2017;18(4):285–90.  

End 20 – 05 P 
33 
 
22.  de Freitas RP, Greatti VR, Alcalde MP, Cavenago BC, Vivan RR, Duarte 
MAH, et al. Effect of the Association of Nonsteroidal Anti-inflammatory and 
Antibiotic Drugs on Antibiofilm Activity and pH of Calcium Hydroxide 
Pastes. J Endod. 2017;43(1):131–4.  
23.  Ferreira NS, Martinho FC, Cardoso FGR, Nascimento GG, Carvalho CAT, 
Valera MC. Microbiological profile resistant to different intracanal 
medications in primary endodontic infections. J Endod. 2015;41(6):824–30.  
24.  Marinho ACS, Martinho FC, Leite FRM, Nascimento GG, Gomes BPFA. 
Proinflammatory activity of primarily infected endodontic content against 
macrophages after different phases of the root canal therapy. J Endod. 
2015;41(6):817–23.  
25.  Das D, Samir P, Verma RK, Singh N.  Evaluation of Antimicrobial Efficacy 
of various Intracanal Medicaments in Primary Teeth: An in vivo Study . Int J 
Clin Pediatr Dent. 2017;10(3):267–71.  
26.  Arruda MEF, Neves MAS, Diogenes A, Mdala I, Guilherme BPS, Siqueira 
JF, et al. Infection Control in Teeth with Apical Periodontitis Using a Triple 
Antibiotic Solution or Calcium Hydroxide with Chlorhexidine: A 
Randomized Clinical Trial. J Endod. 2018;44(10):1474–9.  
27.  Chockattu SJ, Deepak BS, Goud KM. Comparison of anti-bacterial 
efficiency of ibuprofen, diclofenac, and calcium hydroxide against 
Enterococcus faecalis in an endodontic model: An in vitro study. J Conserv 
Dent. 2018;21(1):80–4.  
28.  Ahirwar P, ND S, RK S, S S, RA T, A MS. A clinical trial comparing 
antimicrobial efficacy of “essential oil of Ocimum sanctum” with triple 
antibiotic paste as an intracanal medicament in primary molars. J Indian Soc 
Pedod Prev Dent. 2018;36:191–7.  
29.  Riaz A, Maxood A, Abdullah S, Saba K, Din SU, Zahid S. Comparison Of 
Two Intracanal Medicaments In Resolution Of Apical Radiolucency. J Ayub 
Med Coll Abbottabad. 2018;30(3):320–4.  
30.  Samir Abouelenien S, Mohamed Ibrahim S, Gameel Shaker O, Mohamed 
Ahmed G. Evaluation of postoperative pain in infected root canals after using 
double antibiotic paste versus calcium hydroxide as intra-canal medication: A 
randomized 
controlled 
trial 
[version 
1; 
referees: 
2 
approved]. 
F1000Research. 2018;7:1–9.  

End 20 – 05 P 
34 
 
31.  Barbosa-Ribeiro M, Arruda-Vasconcelos R, de-Jesus-Soares A, Zaia AA, 
Ferraz CCR, de Almeida JFA, et al. Effectiveness of calcium hydroxide-
based intracanal medication on infectious/inflammatory contents in teeth 
with 
post-treatment 
apical 
periodontitis. 
Clin 
Oral 
Investig. 
2019;23(6):2759–66.  
32.  Özdemir MB, Karataş E, Albayrak M, Bayır Y. Effect of intracanal 
medicaments on matrix metalloproteinase-9 and vasoactive intestinal peptide 
secretion in periapical lesions of re-treated canals: a randomized controlled 
clinical study. Clin Oral Investig. 2019;23(2):921–8.  
33.  da Silva GF, Cesário F, Garcia AMR, Weckwerth PH, Duarte MAH, de 
Oliveira RC, et al. Effect of association of non-steroidal anti-inflammatory 
and antibiotic agents with calcium hydroxide pastes on their cytotoxicity and 
biocompatibility. Clin Oral Investig. 2020;24(2):757–63.  
34.  Karataş E, Baltacı M, Uluköylü E, Adıgüzel A. Antibacterial effectiveness of 
calcium hydroxide alone or in combination with ibuprofen and ciprofloxacin 
in teeth with asymptomatic apical periodontitis: a randomized controlled 
clinical study. Int Endod J. 2020;0–2.  
35.  Neelakantan P, Subbarao C, Sharma S, Subbarao CV, Garcia-Godoy F, 
Gutmann JL. Effectiveness of curcumin against enterococcus faecalis 
biofilm. Acta Odontol Scand. 2013;71(6):1453–7.  
36.  Kumar H. An in vitro evaluation of the antimicrobial efficacy of Curcuma 
longa, Tachyspermum ammi, chlorhexidine gluconate, and calcium 
hydroxide on Enterococcus faecalis. J Conserv Dent. 2013 Mar;16(2):144–7.  
37.  Taur S, Sugandhan S, Prabhakar A, Hadakar S. Comparison of Antibacterial 
Efficacy of Calcium Hydroxide Paste, 2% Chlorhexidine Gel and Turmeric 
Extract as an Intracanal Medicament and their Effect on Microhardness of 
Root Dentin: An in vitro Study. Int J Clin Pediatr Dent. 2013;6(3):171–7.  
38.  Chamele J, Bhat C. Efficacy of turmeric extract as an intracanal medicament 
in deciduous teeth against Enterococcus faecalis: An in vitro study. 
IntJCurrMicrobiolAppSci. 2014;3(9):17–25.  
39.  Dhariwal NS, Hugar SM, Harakuni S, Sogi S, Assudani HG, Mistry LN. A 
comparative evaluation of antibacterial effectiveness of sodium hypochlorite, 
Curcuma longa, and Camellia sinensis as irrigating solutions on isolated 
anaerobic bacteria from infected primary teeth. J Indian Soc Pedod Prev 
Dent. 2016;34(2):165–71.  

End 20 – 05 P 
35 
 
40.  Vasudeva A, Sinha DJ, Tyagi SP, Singh NN, Garg P, Upadhyay D. 
Disinfection of dentinal tubules with 2% Chlorhexidine gel, Calcium 
hydroxide and herbal intracanal medicaments against Enterococcus faecalis: 
An in-vitro study. Singapore Dent J. 2017;38:39–44.  
41.  Xiao CJ, Yu XJ, Xie JL, Liu S, Li S. Protective effect and related 
mechanisms of curcumin in rat experimental periodontitis. Head Face Med. 
2018;14(1):1–8.  
42.  Lone PA, Ahmed S wakeel, Prasad V, Ahmed B. Role of turmeric in 
management of alveolar osteitis (dry socket): A randomised clinical study. J 
Oral Biol Craniofacial Res. 2018;8(1):44–7.  
43.  Meizarini A, Aryati, Riawan W, Puteri A. Anti-inflammatory properties of a 
wound dressing combination of zinc oxide and turmeric extract. Vet World. 
2018;11(1):25–9.  
44.  Neelakantan P, Cheng CQ, Ravichandran V, Mao T, Sriraman P, Sridharan 
S, et al. Photoactivation of curcumin and sodium hypochlorite to enhance 
antibiofilm efficacy in root canal dentin. Photodiagnosis Photodyn Ther. 
2015;12(1):108–14.  
45.  Gera M, Kumar R, Jain VK, Suman . Preparation of a Novel Nanocurcumin 
Loaded Drug Releasing Medicated Patch with Enhanced Bioactivity Against 
Microbes. Adv Sci Eng Med. 2015;7(6):485–91.  
46.  Devaraj S, Jagannathan N, Neelakantan P. Antibiofilm efficacy of 
photoactivated curcumin, triple and double antibiotic paste, 2% chlorhexidine 
and calcium hydroxide against Enterococcus fecalis in vitro. Sci Rep. 
2016;6:6–11.  
47.  Gopal J, Muthu M, Chun S. Bactericidal Property of Macro-, Micro- and 
Nanocurcumin: An Assessment. Arab J Sci Eng. 2016;41(6):2087–93.  
48.  Gomes-Filho JE, Sivieri-Araujo G, Sipert CR, da Silva Santos LM, de 
Azevedo Queiroz ÍO, Men Martins C, et al. Evaluation of photodynamic 
therapy on fibroblast viability and cytokine production. Photodiagnosis 
Photodyn Ther. 2016;13:97–100.  
49.  Sivieri-Araujo G, Queiroz ÍO de A, Fabbro RD, Esteves F, Cintra LTA, 
Duarte PCT, et al. Rat tissue reaction and cytokine production induced by 
antimicrobial photodynamic therapy. Photodiagnosis Photodyn Ther. 
2017;18:315–8.  

End 20 – 05 P 
36 
 
50.  Adahoun MA, Al-Akhras MAH, Jaafar MS, Bououdina M. Enhanced anti-
cancer and antimicrobial activities of curcumin nanoparticles. Artif Cells, 
Nanomedicine Biotechnol. 2017;45(1):98–107.  
51.  Zambrano LMG, Brandao DA, Rocha FRG, Marsiglio RP, Longo IB, Primo 
FL, et al. Local administration of curcumin-loaded nanoparticles effectively 
inhibits inflammation and bone resorption associated with experimental 
periodontal disease. Sci Rep. 2018;8(1):1–11.  
52.  Hashemzadeh K, Davoudian N, Jaafari MR, Mirfeizi Z. The Effect of 
Nanocurcumin on the Improvement Symptoms of Knee Osteoarthritis: A 
Randomized Clinical Trial. Curr Rheumatol Rev. 2019  
53. Ghorbanzadeh R, Assadian H, Chiniforush N, Parker S, Pourakbari B, Ehsani          
B, et al. Modulation of virulence in Enterococcus faecalis cells surviving 
antimicrobial photodynamic inactivation with reduced graphene oxide-
curcumin: An ex vivo biofilm model. Photodiagnosis Photodyn Ther. 2020 
 
 
 

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۱ 
 
   الملخص العرب 
:  اﻟﻤﻘﺪﻣﺔ 
 يوجد عوامل عديدة يرجع لها فشل عالج اللب 
 اهمها
المسببات الميكروبية 
 التي تنقسم الي ميكروبات هوائية
 والهوائية مثل التي تتحمل اقسي الظروف المحيطة بها وتتالئم مع اقل مصادر للغذاء والنمو 
ولذالك مع التحضيرالقناه ب
استخدام 
 األدوات
اللبية وتعقيمها ب المواد المضادة للميكروبات تظل انواع من
 البكتريا المقاومه في االماكن الضيقة في القناه اللبية مثل القنوات الفرعية 
 لهذا السبب يستخدم ادوية موضعية داخل القناه اللبية بين الجلسات ولكن االنواع التقليدية مثل هيدروكسيد
 الكالسيوم التؤثر جيدا علي البكتريا المقاومة 
 ولذالك استخدام انواع اخري يكون لها تاثير جيد علي انواع البكتريا المختلفة الموجودة في القناه اللبية التي
 فشل عالجها باالدوية التقليدية هذة االنواع مثل خليط المضاد البكتيري مع مضاد االلتهاب وقد استخدم ت من
 قبل ولكن كل دواء بمفرده ووجد لها تاثير جيد 
 كما ان االتجاه الجديد نحو االدويه الطبيعية مثل الكركم وقد وجد لها تاثير ممتاز علي البكتريا المقاومه
 الموجودة في القنوات اللبية التي فشل عالجها من قبل 
   
 
 ولكن وجد ان الكركم العادي له بعض العيوب مثل قلة الذوبان واالنتشار وسرعة التحلل والتكسير لذالك
االتجاه نحو استخدام الكركم النانو اصبح له اهمية كبيره النه اليوجد به هذة العيوب.  
 
اﻟﻐﺮض ﻣﻦ اﻟﺪراﺳﺔ :
 
 مقارنة كفاءه الكركم العادي والكركم النانو بخليط المضاد الحيوي ومضاد االلتهابات 
 كادوية موضعية
 داخل القناه اللبية ف ي حاالت فشل عالج اللب وتقييم تاثير هم كمضادات للبكير يا وعلي تقليل االلم
 وايضاعلي شفاء االتهاب تحت
جذر السن .
 
 :اﻟطﺮيﻘه 
 سوف يتم تقسيم۸۰
 
 سنه ذات قناة واحدةالي ارب ع مجموعات  :
 
 مجموعه۱
 : بعد تنظيف القناه اللبية وتنشيفها يتم وضع الكركم النانو لمدة اسبوع 
مجموعه
٢ : بعد تنظيف القناه اللبية 
 وتنشيفها يتم وضع الكركم العادي لمدة اسبوع 
مجموعه ٣ : 
 بعد تنظيف القناه اللبية وتنشيفها يتم وضع خليط المضاد الحيوي(سيير وفلوكساسير  ) مع
 )  مضاد االلتهابات (بروفير لمدة اسبوع 
مجموعه
٤ :)(مجموعة ضابطه
بعد تنظيف القناه اللبية وتنشيفها يتم وضع 
 هيدروكسيد الكالسيوم
 (ميتابيست)لمدة اسبوع 
 يتم وضع هذة االدوية الموضعية بعد ازاله حشو اللب القديم  بير  الجلسات ثم ازالتها بعد اسبوع من
 وضعها وبعد ذالك يتم حشو اللب من جديد ويتم تقييم تاثير كل دواء موضعي من الناحية
 الميكروبيولوجية وتاثير ه علي تقليل االلم بير  الجلسات ومتابعه االسنان لمدة
٦ 
 اشهر رسيريا واشعاعيا 
لمقارنه 
 ايضا  
 تاثير  
 كل دواء موضعي علي شفاء االتهاب تحت
جذر السن .  
 
 

End 20 – 05 P 
 
 مقارنة تاثير االدوية الطبيعية والصناعية المختلفة المستخدمه كادوية داخل قناه اللب عل  عالج
(   حاالت فشل عالج اللب
التهاب تحت جذر السن ف  تجربة إكلينيكية  
 باالنتقاء العشواب)
 
  
,ﻣشﺮوع رﺳاﻟﺔ ﻣﻘﺪم اﻟي كليﺔ طب االﺳنان جاﻣعﺔ عيﻦ شﻤس 
 ،
 ًتﻤهيﺪا ﻟلحصول علي 
 درجﺔ اﻟﺪكتوراه في عالج اﻟجذور 
 ﻣﻘﺪﻣﺔ ﻣﻦ 
 روضﺔ ﻣحﻤﺪ عبﺪ اﻟﺮحﻤﻦ بﻐﺪادي 
 ﻣﺪرس ﻣساعﺪ بكليﺔ طب اﺳنان جاﻣعه اﺳيوط 
بكاﻟوريوس طب ا ﺳنان جاﻣعﺔ اﻟﻘاهﺮة
٢۰۰۹
 
  
 ﻣاجستيﺮ عالج اﻟجذور جاﻣعﺔ اﻟﻘاهﺮة
٢۰۱۷
  
 
 اﻟﻤشﺮفون 
 
ا.د/كﺮيم ﻣصطفي 
 اﻟبطوطي 
اﺳتاذ بﻘسم عالج اﻟجذور 
ووكيل اﻟكليﺔ ﻟشئون اﻟتعليم واﻟطالب 
كليﺔ طب اﺳنان-جاﻣعﺔ عيﻦ شﻤس 
 
د./ ﺳارة حسام فهﻤي  
 ﻣﺪرس بﻘسم عالج اﻟجذور 
 كليﺔ طب
اﺳنان-جاﻣعﺔ عيﻦ شﻤس 
  
 
۰٢۰٢