J Conserv Dent. 2012 Jul-Sep; 15(3): 293–297.

doi: 10.4103/0972-0707.97964
PMCID: PMC3410345
PMID: 22876022

Comparative evaluation of the antimicrobial activity of natural

extracts of Morinda citrifolia, papain and aloe vera (all in gel
formulation), 2% chlorhexidine gel and calcium hydroxide,
against Enterococcus faecalis: An in vitro study
Anuj Bhardwaj, Suma Ballal,1 and Natanasabapathy Velmurugan1

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This article has been cited by other articles in PMC.

Abstract
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INTRODUCTION
Complete debridement and effective disinfection of the root canal space is an important
prerequisite for achieving long-term success of nonsurgical endodontics.[1] It is known that
elimination of microorganisms is critical for management of pulpal disease. Chemomechanical
instrumentation reduces majority of infecting bacteria, together with their principal substrate of
necrotic pulp debris[2] but retention of microorganisms within the dentinal tubules is thought to
be a source of persistent endodontic infection.[3] The use of an intracanal medicament helps in
the elimination of bacteria that remain even after cleaning and shaping, thereby making the
environment conducive for periapical tissue repair.[4]
E. faecalis is commonly found in cases of failed endodontic infections.[5] Its resistance is known
to increase 1000- to 10,000-fold in the starvation phase.[6] It is probable that the physiologic
state of the cells, particularly in retreatment cases, is closest to the starvation phase. Recent
studies have also shown that E. faecalis is highly resistant to commonly used intracanal
medicaments, such as calcium hydroxide.[7] Even 2% chlorhexidine gluconate has been used as
an irrigant and intracanal medicament in endodontics. Chlorhexidine has a broad spectrum
antimicrobial activity targeting both gram-positive and gram-negative microbes.[8] Hence, the
combination of chlorhexidine and calcium hydroxide as an intracanal medicament has also been
tried to achieve the properties of both medicaments but the antimicrobial action of chlorhexidine
was found to be reduced.[9]
Morinda citrifolia, commercially known as noni, is famous as an important folk medicine and as
a health drink. The juice of M. citrifolia has a broad range of therapeutic effects, including
antibacterial, antifungal, antiviral, antitumor, antihelminthic, analgesic, hypotensive, anti-
inflammatory, and immune-enhancing effects.[10] The effectiveness of M. citrifolia with sodium
hypochlorite and chlorhexidine gluconate to remove the smear layer from the canal walls of
endodontically instrumented teeth was compared by Murray et al. and it was concluded that
6% M. citrifolia can be used as an endodontic irrigant[10] (as per article after usage of irrigant
regime it was concluded).
A gel based on papain, a proteolytic cysteine enzyme, exhibits significant antibacterial and anti-
inflammatory properties.[11] Papain acts as a debris-removing agent. It acts only on affected
tissues, which lack the α1-antitrypsine plasmatic antiprotease that inhibits proteolysis in healthy
tissues. In addition to papain, the chloramines present have the potential of dissolving carious
dentin by means of chlorination of the partially degraded collagen. This mechanism affects the
collagen structure, dissolving hydrogen bonds thus facilitating tissue removal.[12]
Aloe vera (synonym: Aloe barbadensis Miller) belongs to the Liliaceae family. Cosmetic and
some medicinal products are made from the mucilaginous tissue in the center of the aloe vera
leaf and is called as aloe vera gel. Total leaf extracts contain anthraquinones, which have
antibacterial properties.[13]
Till date there is no study to comparatively evaluate the antimicrobial activity of natural extracts
of M. citrifolia, papain, and aloe vera (all in gel formulation), 2% chlorhexidine gel and calcium
hydroxide, against Enterococcus faecalis. Hence, this study was undertaken to evaluate the
disinfection of dentinal tubules when contaminated with E. faecalis using M. citrifolia gel,
papain gel, and aloe vera when compared with calcium hydroxide and chlorhexidine gel.
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MATERIALS AND METHODS

Preparation of blocks
The model proposed by Haapasalo and Ørstavik[14] was modified. One hundred and eighty
freshly extracted single rooted teeth were used for this study. A rotary diamond disk was used to
decoronate the teeth 5 mm below cementoenamel junction and the apical part of the root to
obtain 6 mm of the middle third of the root. Cementum was removed from the root surface.
Gates Glidden drills no. 3 (Mani Inc, Tachigi-ken, Japan) in a slow speed handpiece was used to
standardize the internal diameter of the root canals. The blocks were treated in an ultrasonic bath
of 17% ethylene diamine tetra acetic acid for 5 min followed by 3% NaOCl for 5 min to remove
the organic and inorganic debris. The traces of chemicals used were removed by immersing the
blocks in an ultrasonic bath containing distilled water for 5 min. All the blocks were sterilized in
an autoclave for 2 cycles. The first cycle was at 121°C and the second was with the blocks
immersed in 1 mL of tryptone soya (TS) broth in individual microcentrifuge tubes. This allows
better penetration of the broth into the dentinal tubules. All the blocks were coated externally
with paraffin wax.

Contamination of the blocks

The test organism used for this study was E. faecalis, which is a gram-positive facultative
anaerobic bacterium. E. faecalis (ATCC 29212) was grown in TS agar for 24 h. The culture was
suspended in 5 mL of TS broth and incubated for 4 h at 37°C and its turbidity was adjusted to 0.5
McFarland standard. Each dentin block was placed in presterilized microcentrifuge tubes
containing 1 mL of the TS broth. Fifty microliters of the inoculum containing the E. faecalis was
transferred into each of the microcentrifuge tubes. At the end of 24 h the dentin blocks were
transferred into fresh broth containing E. faecalis. All procedures were carried out under laminar
flow. Purity of the culture was checked by subculturing 5 μL of the broth from the incubated
dentin blocks in TS broth on TS agar plates. Contamination of the dentin blocks were carried out
for a period of 21 days.

Antimicrobial assessment
At the end of 21 days the blocks were irrigated with 5 mL of sterile saline to remove the
incubation broth. The blocks were assigned into 6 groups (n = 30 dentin blocks).
Group 1: Saline (negative control)
Group 2: Calcium hydroxide
Group 3: Papain gel
Group 4: M. citrifolia gel
Group 5: Aloe vera gel
Group 6: 2% Chlorhexidine gel
Calcium hydroxide (Sigma–Aldrich, Mumbai, India) was mixed with sterile saline in a ratio of
1.5:1 (wt/vol) to obtain a paste-like consistency.[15] Hydroxy ethyl cellulose (Encore Natural
Polymers Pvt. Ltd,Gujarat, India.) was used as a thickening agent in the ratio of 2:1 (vol/wt) for
Group 3 (papain raw extract taken from fruit), Group 4 (M. citrifolia raw extract taken from
fruit), Group 5 (aloe vera raw extract taken from leaf), and Group 6 (chlorhexidine).
Hydroxyethyl cellulose is a nonionic, highly inert, and water-soluble agent[16] and has been
used in various studies for gel formation.[17]
The medicaments were placed inside the canals and sealed at both the ends with paraffin wax.
They were incubated in an anaerobic environment for 37°C. At the end of 1, 3, and 5 days
antimicrobial assessment was carried out with 10 blocks each time. Harvesting of the dentin was
carried out at 2 depths (200 and 400 μm) with Gates Glidden drills no. 4 and 5, respectively. The
collected dentin shavings were transferred into 1 mL of sterile TS broth and incubated in an
anaerobic environment at 37°C for 24 h. After 24 h, the contents of each tube was serially
diluted, 100 μL of the broth in 100 μL of sterile saline for 5 times. Fifty microliters of the
dilution was then plated on TS agar plates and incubated for 24 h. Colonies were counted and
readings were tabulated as shown in Table 1.
Table 1
Mean colony counts for different intracanal medicaments at 200 and 400 μm depths at different
time intervals
Statistical analysis
The data were statistically analyzed with one-way analysis of variance followed by Tukey
multiple comparison means to check the difference in bacterial inhibition between the groups
(P < 0.05). The paired t test was used to check for differences in growth at different time
intervals within groups and for differences at the 2 depths (P < 0.05).
Go to:

RESULTS
The current study showed that all the 5 medicaments studied exerted antibacterial activity.
Contamination of the dentin blocks was confirmed when debris samples harvested from the
saline group (negative control) yielded positive growth. Table 1 shows the antibacterial activity,
measured at 2 depths (200 and 400 μm) and at 3 time intervals (1, 3, and 5 days). The inhibition
of growth in all the groups was statistically significant in comparison to the control group
(saline). Group 6 (2% chlorhexidine gel) was the most effective against E. faecalis to the depth
of 400 μm on all days of incubation.
Intergroup comparison of inhibition between groups 4 and 5 (M. citrifolia gel and aloe vera gel)
showed no statistical difference on day 1, but on days 3 and 5 there was a statistically significant
difference. Inhibition in Group 4 (M. citrifolia gel) was also statistically significant compared
with groups 3 and 2 (papain gel and calcium hydroxide, respectively) on all days (1, 3, and 5).
Inhibition in Group 3 (papain gel) was statistically better than Group 2 (calcium hydroxide) on
day 3, whereas on days 1 and 5 they had similar efficacy. The inhibition of growth of E.
faecalis at 200 and 400 μm was uniform with no statistically significant difference for all the
groups.
The inhibition of growth of E. faecalis at the end of days 1, 3, and 5 was varied with different
medicaments.
 Group 2 (calcium hydroxide) showed sufficient antibacterial activity on day 1, which
decreased on day 3 and again increased by day 5.
 Group 3 (papain gel) showed a decrease in antibacterial activity at the end of day 5.
 Group 4 (M. citrifolia gel) showed constant antimicrobial efficacy on all the days (1, 3,
and 5 days).
  Group 5 (aloe vera gel) showed comparable antibacterial activity to M. citrifolia gel on
first day, but there was a gradual decrease in the efficacy by the end of day 5.
To summarize the results, the overall percentage inhibition at 2 depths and different time
intervals was, 100% with chlorhexidine gel ,86.02% with M. citrifolia gel, 78.9% with aloe vera
gel, followed by 67.3% papain gel and 64.3% with calcium hydroxide [Figure 1].

Figure 1
Percentage reduction in bacterial growth at 200 and 400 μm for different medicaments. (Abbreviations:
MC, Morinda citrifolia; CHX, chlorhexidine gel; Ca(OH)2; calcium hydroxide)

Go to:

DISCUSSION
Currently, the use of natural extracts in dentistry has gained importance both to patients and
endodontic professionals as the shift is toward natural health remedies.[18] Hence the use of an
intracanal medicament made of natural extracts is of great significance.
The use of a biocompatible intracanal medicament possessing antimicrobial properties between
appointments may reduce or eliminate bacteria in the root canal system and significantly increase
the success of root canal treatment.[19]
The in vitro model developed by Haapasalo and Ørstavik[14] has been used to assess the
efficacy of endodontic medicaments in the disinfection of dentinal tubules. Lynne et al.[20]
modified this model to include quantitative analysis of bacteria in the dentin tubules to define a
percentage of reduction in colony forming units in infected dentin before and after the
application of intracanal medication preparations.
E. faecalis was chosen as the test organism because it has long been implicated in persistent root
canal infections and more recently has been identified as the species most commonly recovered
from root canals of teeth with post-treatment disease.[21]
This study reveals the effect of newer organic intracanal medicaments (when used as raw
extracts) against E. faecalis. On an average, chlorhexidine gel showed maximum inhibition of E.
faecalis at depths of 200 and 400 μm followed by M. citrifolia gel (86.02%), and aloe vera gel
(78.9%). Levels of inhibition of papain (67.3%) and calcium hydroxide (64.3%) were somewhat
comparable.
In the present study, chlorhexidine gel showed 100% inhibition at depths of 200 and 400 μm
from day 1 to 5. The reason could be due to the bactericidal dosage of 2% and increased
diffusion of the medicament into the dentinal tubules.[15] Basrani et al.[22] showed that 2%
chlorhexidine gel produced a better antimicrobial action as compared to 0.2% chlorhexidine gel
or calcium hydroxide mixed with 0.2% chlorhexidine.
M. citrifolia gel showed 86.02% inhibition at depths of 200 and 400 μm from day 1 to 5.
Murray et al.[10] claim that the presence of l-asperuloside and alizarin may be responsible for
the antibacterial and antimicrobial property of M. citrifolia. The efficacy of M. citrifolia gel
remained the same over the 5-day period. This improved performance could be attributed to the
increased contact time and physical contact of the gel. These results are in accordance with
another study conducted by Wang et al.,[23] wherein 2% chlorhexidine solution when converted
into gel form performed better than the solution alone.
Further studies are needed to determine the optimum concentration of M. citrifolia required when
used in gel form as an intracanal medicament against E. faecalis.
Aloe vera showed 78.72% and 80% inhibition at depths of 200 and 400 μm from day 1 to 5. First
day results of aloe vera gel were comparable to that of M. citrifolia gel, but the values declined
over day 3 and 5. The possible reason for antimicrobial action of aloe vera could be the presence
of 75 potentially active constituents: vitamins, enzymes, minerals, sugars, lignin, saponins,
salicylic acids, and amino acids.[24] The pharmacologic actions of aloe vera, as studied in vitro
or in animals (in most cases the total leaf extract was used) include anti-inflammatory,
antibacterial, and hypoglycemic effects.[12]
Gel based on papain showed 68.05% and 67.28% inhibition at depths of 200 and 400 μm from
day 1 to 5. This was probably due to proteolytic cysteine enzyme present in papain, which
exhibits antibacterial and anti-inflammatory properties.[11]
Calcium hydroxide showed 63.82% and 66.22% inhibition at depths of 200 and 400 μm from
day 1 to 5. Calcium hydroxide has been advocated as an intracanal medicament due to its
bactericidal properties.[25] Gomes et al.[26] reported that E. faecalis present in the dentinal
tubules were resistant to calcium hydroxide intracanal dressing over 10 days. Calcium hydroxide
had decreased efficacy on day 3, but had an increased antimicrobial efficacy at day 5. Similar
results have been reported by Krithikadatta et al.[15]
Go to:
CONCLUSION
Chlorhexidine gel showed the maximum antimicrobial activity against E. faecalis, whereas
calcium hydroxide showed the least. Among the natural intracanal medicaments, M. citrifolia gel
consistently exhibited good inhibition up to the day 5 followed by aloe vera gel and papain gel.
Go to:

Footnotes
Source of Support: Nil

Conflict of Interest: The authors have no conflicts of interest related to this study.

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REFERENCES
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TRANSLATE

J Conserv Dent . 2012 Jul-Sep; 15 (3): 293–297.

doi : 10.4103 / 0972-0707.97964
PMCID: PMC3410345
PMID: 22876022

Evaluasi komparatif aktivitas antimikroba dari ekstrak

alami Morinda citrifolia , papain dan lidah buaya (semua dalam
formulasi gel), gelklorheksidin 2% dan kalsium hidroksida,
terhadap Enterococcus faecalis : An in vitro belajar
Anuj Bhardwaj , Suma Ballal , 1
dan Natanasabapathy Velmurugan 1

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Artikel ini telah dikutip oleh artikel lain di PMC.

Abstrak
Pergi ke:

PENGANTAR
Debridemen lengkap dan disinfeksi ruang saluran akar yang efektif merupakan prasyarat penting
untuk mencapai keberhasilan jangka panjang dari endodontik non- bedah . [ 1 ] Diketahui bahwa
eliminasi mikroorganisme sangat penting untuk pengelolaan penyakit
pulpa. Instrumentasi kemomekanis mengurangi sebagian besar bakteri yang menginfeksi,
bersama dengan substrat utama mereka dari puing-puing pulpa nekrotik [ 2 ] tetapi retensi
mikroorganisme dalam tubulus dentin dianggap sebagai sumber infeksi endodontik persisten.
[ 3 ] Penggunaan obat intrakanal membantu dalam penghapusan bakteri yang tetap ada bahkan
setelah dibersihkan dan dibentuk, sehingga membuat lingkungan kondusif untuk perbaikan
jaringan periapikal . [ 4 ]
E. faecalis umumnya ditemukan pada kasus infeksi endodontik yang gagal. [ 5 ] Ketahanannya
diketahui meningkat 1000 hingga 10.000 kali lipat pada fase kelaparan. [ 6 ] Kemungkinan
keadaan fisiologis sel, terutama dalam kasus perawatan ulang, adalah paling dekat dengan fase
kelaparan. Studi terbaru juga menunjukkan hal itu E. faecalis sangat tahan terhadap obat-
obatan intracanal yang umum digunakan , seperti kalsium hidroksida . [ 7 ] Bahkan
2% klorheksidin glukonat telah digunakan sebagai obat
yang irrigant dan intrakanalis dalam endodontik . Chlorhexidine memiliki aktivitas antimikroba
spektrum luas yang menargetkan mikroba gram positif dan gram negatif. [ 8 ] Oleh karena itu,
kombinasi klorheksidin dan kalsium hidroksida sebagai obat intrakanalis juga telah dicoba untuk
mencapai sifat-sifat kedua obat tetapi tindakan antimikroba dari klorheksidin ditemukan
berkurang. [ 9 ]
Morinda citrifolia , yang secara komersial dikenal sebagai noni, terkenal sebagai obat rakyat
yang penting dan sebagai minuman kesehatan. Jus dari M. citrifolia memiliki berbagai efek
terapi, termasuk antibakteri, antijamur, antivirus, antitumor, antihelminthic , analgesik, hipotensi,
antiinflamasi, dan efek penambah kekebalan. [ 10 ] Keefektifan M. citrifolia dengan
natrium hipoklorit dan klorheksidinglukonat untuk menghilangkan lapisan smear dari dinding
saluran gigi instrumen endodontik dibandingkan dengan Murray et al . dan disimpulkan bahwa
6% M. citrifolia dapat digunakan sebagai irigasiendodontik [ 10 ] (sesuai artikel setelah
penggunaan rezim irigasi disimpulkan).
Gel yang didasarkan pada papain, enzim sistein proteolitik , menunjukkan sifat antibakteri dan
anti-inflamasi yang signifikan . [ 11 ] Papain bertindak sebagai agen penghapus puing. Kerjanya
hanya pada jaringan yang terkena, yang tidak memiliki antiprotease plasmatic α1-
antitrypsine yang menghambat proteolisis dalam jaringan sehat. Selain papain, hadir kloram
memiliki potensi melarutkan karies dentin dengan cara klorinasi gen colla terdegradasi
sebagian . Mekanisme ini mempengaruhi struktur kolagen, melarutkan ikatan hidrogen sehingga
memudahkan pengangkatan jaringan . [ 12 ]
Lidah buaya (sinonim: Aloe barbadensis Miller) milik keluarga Liliaceae . Produk kosmetik
dan beberapa obat yang dibuat dari jaringan mucilaginous di
tengah daun lidah buaya dan disebut sebagai gellidah buaya. Total ekstrak daun
mengandung antrakuinon , yang memiliki sifat antibakteri . [ 13 ]
Hingga saat ini belum ada penelitian yang secara komparatif mengevaluasi aktivitas antimikroba
dari ekstrak alami M. citrifolia , papain, dan lidah buaya (semua dalam formulasi
gel), gel klorheksidin 2%dan kalsium hidroksida, terhadap Enterococcus faecalis . Oleh karena
itu, penelitian ini dilakukan untuk mengevaluasi desinfeksi tubulus dentin ketika
terkontaminasi E. faecalis menggunakan M.citrifolia gel, gel papain, dan lidah buaya bila
dibandingkan dengan kalsium hidroksida dan gel klorheksidin .
Pergi ke:

MATERIAL DAN METODE

Persiapan blok
Model yang diusulkan oleh Haapasalo dan Ørstavik [ 14 ] telah dimodifikasi. Seratus delapan
puluh gigi akar tunggal yang baru diekstraksi digunakan untuk penelitian ini. Disk berlian putar
digunakan untukmenghias gigi 5 mm di bawah persimpangan cementoenamel dan bagian apikal
akar untuk mendapatkan 6 mm sepertiga tengah akar. Cementum dikeluarkan dari permukaan
akar. Gates Glidden latihan tidak.3 (Mani Inc , Tachigi -ken, Jepang)
dalam handpiece kecepatan lambat digunakan untuk menstandarisasi diameter internal saluran
akar. Blok diperlakukan dalam rendaman ultrasonik dari 17% etilen diaminatetra asam asetat
selama 5 menit diikuti oleh 3% NaOCl selama 5 menit untuk menghilangkan puing organik dan
anorganik. Jejak bahan kimia yang digunakan dihilangkan dengan merendam blok dalam
rendaman ultrasonik yang mengandung air suling selama 5 menit. Semua blok disterilkan dalam
autoklaf selama 2 siklus. Siklus pertama adalah pada 121 ° C dan yang kedua adalah dengan
blok direndam dalam 1 mL kaldu kedelai tryptone (TS)
dalam tabung microcentrifuge individu . Ini memungkinkan penetrasi kaldu yang lebih baik ke
tubulus dentin. Semua blok dilapisi secara eksternal dengan lilin parafin.

Kontaminasi blok
Organisme uji yang digunakan untuk penelitian ini adalah E. faecalis , yang merupakan bakteri
anaerob fakultatif gram positif. E. faecalis (ATCC 29212) ditanam di TS agar selama 24
jam. Kultur ditangguhkan dalam 5 mL kaldu TS dan diinkubasi selama 4 jam pada suhu 37 ° C
dan kekeruhannya disesuaikan dengan standar 0,5 McFarland . Setiap blok dentin ditempatkan
di presterilisasi tabungmicrocentrifuge yang mengandung 1 mL kaldu TS. Lima puluh mikroliter
inokulum yang mengandung E. faecalis dipindahkan ke masing-
masing tabung microcentrifuge . Pada akhir 24 jam, blok dentin dipindahkan ke dalam kaldu
segar yang mengandung E. faecalis . Semua prosedur dilakukan di bawah aliran
laminar. Kemurnian kultur diperiksa dengan mensubkultur 5 μL kaldu dari blok dentin yang
diinkubasi dalam kaldu TS pada pelat agar-agar TS. Kontaminasi blok dentin dilakukan selama
21 hari.

Penilaian antimikroba
Pada akhir 21 hari, blok diirigasi dengan 5 mL saline steril untuk menghilangkan kaldu
inkubasi. Blok ditugaskan ke 6 kelompok ( n = 30 blok dentin).
Grup 1: Saline (kontrol negatif)
Kelompok 2: Kalsium hidroksida
Kelompok 3: Gel papain
Grup 4: M. citrifolia gel
Kelompok 5: Gel lidah buaya
Kelompok 6: Gel Chlorhexidine 2%
Kalsium hidroksida (Sigma-Aldrich, Mumbai, India) dicampur dengan salin steril dalam
perbandingan 1,5: 1 ( wt / vol ) untuk mendapatkan konsistensi seperti pasta. [ 15 ] Hidroksi etil
selulosa (Encore Natural Polymers Pvt. Ltd, Gujarat , India.) Digunakan sebagai bahan pengental
dengan perbandingan 2: 1 ( vol / wt ) untuk Grup 3 (ekstrak mentah papain diambil dari buah),
Grup 4 ( M. citrifolia ekstrak mentah diambil dari buah), Kelompok 5
( ekstrak lidah buaya diambil dari daun), dan Kelompok 6 ( chlorhexidine ).
Hydroxyethyl cellulose adalah agen nonionik, sangat inert, dan larut dalam air [ 16 ] dan telah
digunakan dalam berbagai penelitian untuk pembentukan gel. [ 17 ]
Obat-obatan ditempatkan di dalam kanal dan disegel di kedua ujungnya dengan lilin
parafin. Mereka diinkubasi dalam lingkungan anaerob selama 37 ° C. Pada akhir 1, 3, dan 5 hari
penilaian antimikroba dilakukan dengan 10 blok setiap kali. Pemanenan dentin dilakukan pada 2
kedalaman (200 dan 400 μm ) dengan latihan Gates Glidden no. 4 dan 5, masing-
masing. Serutan dentin yang dikumpulkan dipindahkan ke 1 mL kaldu TS steril dan diinkubasi
dalam lingkungan anaerob pada suhu 37 ° C selama 24 jam. Setelah 24 jam, isi setiap tabung
diencerkan secara seri, 100 μL kaldu dalam 100 μL saline steril selama 5 kali. Lima puluh
mikroliter pengenceran kemudian disepuh pada pelat agar-agar TS dan diinkubasi selama 24
jam. Koloni dihitung dan bacaan ditabulasi seperti ditunjukkan pada Tabel 1 .

Tabel 1
Rata-rata koloni dihitung untuk berbagai medikasi intracanal pada kedalaman 200 dan
400 μm pada interval waktu yang berbeda

Analisis statistik
Data dianalisis secara statistik dengan analisis satu arah varian diikuti
oleh Tukey beberapa perbandingan berarti untuk memeriksa perbedaan dalam penghambatan
bakteri antara kelompok ( P <0,05).Dipasangkan t Tes digunakan untuk memeriksa
perbedaan pertumbuhan pada interval waktu yang berbeda dalam kelompok dan untuk perbedaan
pada 2 kedalaman ( P <0,05).
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HASIL
Studi saat ini menunjukkan bahwa semua 5 obat-obatan dipelajari aktivitas antibakteri yang
diberikan. Kontaminasi blok dentin dikonfirmasi ketika sampel puing yang dipanen dari
kelompok saline (kontrol negatif) menghasilkan pertumbuhan positif. Tabel 1 menunjukkan
aktivitas antibakteri, diukur pada 2 kedalaman (200 dan 400 μm ) dan pada 3 interval waktu (1,
3, dan 5 hari). Penghambatan pertumbuhan pada semua kelompok secara statistik signifikan
dibandingkan dengan kelompok kontrol (saline). Kelompok 6 ( gel klorheksidin 2% ) adalah
yang paling efektif melawan E. faecalis hingga kedalaman 400μm pada semua hari inkubasi.
Perbandingan antar kelompok dari penghambatan antara kelompok 4 dan 5 ( M. citrifolia gel
dan gel lidah buaya ) tidak menunjukkan perbedaan statistik pada hari 1, tetapi pada hari 3 dan 5
ada perbedaan yang signifikan secara statistik. Penghambatan di Grup 4 ( M. citrifolia gel) juga
signifikan secara statistik dibandingkan dengan kelompok 3 dan 2 (gel papain dan kalsium
hidroksida, masing-masing) pada semua hari (1, 3, dan 5). Penghambatan pada Kelompok 3
(papain gel) secara statistik lebih baik daripada Kelompok 2 (kalsium hidroksida) pada hari 3,
sedangkan pada hari 1 dan 5 mereka memiliki kemanjuran yang serupa. Hambatan
pertumbuhan E. faecalis pada 200 dan 400 μm adalah seragam tanpa perbedaan yang
signifikan secara statistik untuk semua kelompok.
Hambatan pertumbuhan E. faecalis pada akhir hari 1, 3, dan 5 bervariasi dengan obat-obatan
yang berbeda.
 Kelompok 2 (kalsium hidroksida) menunjukkan aktivitas antibakteri yang cukup pada
hari 1, yang menurun pada hari 3 dan kembali meningkat pada hari ke 5.
 Kelompok 3 (papain gel) menunjukkan penurunan aktivitas antibakteri pada akhir hari ke
5.
 Kelompok 4 ( M. citrifolia gel) menunjukkan kemanjuran antimikroba yang konstan
pada semua hari (1, 3, dan 5 hari).
 Kelompok 5 ( gel lidah buaya ) menunjukkan aktivitas antibakteri sebanding
dengan M. citrifolia gel pada hari pertama, tetapi ada penurunan bertahap dalam
kemanjuran pada akhir hari 5.
Untuk meringkas hasil, persentase penghambatan keseluruhan pada 2 kedalaman dan interval
waktu yang berbeda adalah, 100% dengan klorheksidin gel, 86,02% dengan M. citrifolia gel,
78,9% dengan gellidah buaya , diikuti oleh 67,3% papain gel dan 64,3% dengan kalsium
hidroksida [ Gambar 1 ].
Gambar 1

Persentase pengurangan pertumbuhan bakteri pada 200 dan 400 μm untuk berbagai obat. (Singkatan:
MC, Morinda citrifolia ; CHX, gel chlorhexidine ; Ca ( OH) ; kalsium hidroksida)
2

Pergi ke:

DISKUSI
Saat ini, penggunaan ekstrak alami dalam kedokteran gigi telah menjadi penting baik bagi pasien
dan profesional endodontik karena pergeserannya ke arah pengobatan kesehatan alami . [ 18 ]
Oleh karena itu penggunaan obat intrakanalis yang terbuat dari ekstrak alami sangat penting.
Penggunaan obat intrakanal biokompatibel memiliki sifat antimikroba antara janji dapat
mengurangi atau menghilangkan bakteri di dalam sistem saluran akar dan secara signifikan
meningkatkan keberhasilan perawatan saluran akar. [ 19 ]

Itu in vitro model yang dikembangkan oleh Haapasalo dan Ørstavik [ 14 ] telah digunakan
untuk menilai kemanjuran obat endodontik dalam desinfeksi tubulus dentin. Lynne et al . [ 20 ]
memodifikasi model ini untuk memasukkan analisis kuantitatif bakteri dalam tubulus dentin
untuk menentukan persentase pengurangan unit pembentuk koloni pada dentin yang terinfeksi
sebelum dan setelah penerapanpersiapan obat intrakanal .

E. faecalis dipilih sebagai organisme uji karena telah lama terlibat dalam infeksi saluran akar
persisten dan lebih baru-baru ini telah diidentifikasi sebagai spesies yang paling umum pulih dari
saluran akar gigi dengan penyakit pasca perawatan . [ 21 ]
Studi ini mengungkapkan pengaruh obat-obatan intracanal organik yang lebih baru (bila
digunakan sebagai ekstrak mentah) terhadap E. faecalis . Rata-
rata, gel klorheksidin menunjukkan penghambatan maksimum E. faecalis pada kedalaman
200 dan 400 μm diikuti oleh M. citrifolia gel (86,02%), dan gel lidah buaya (78,9%). Tingkat
penghambatan papain (67,3%) dan kalsium hidroksida (64,3%) agak sebanding.
Dalam penelitian ini, gel klorheksidin menunjukkan penghambatan 100% pada kedalaman 200
dan 400 μm dari hari 1 hingga 5. Alasannya bisa karena dosis bakterisida 2% dan peningkatan
difusi obat ke dalam tubulus dentin. [ 15 ] Basrani et al . [ 22 ] menunjukkan
bahwa gel klorheksidin 2% menghasilkan aksi antimikroba yang lebih baik dibandingkan
dengan gel klorheksidin 0,2% atau kalsium hidroksida yang dicampur
dengan klorheksidin 0,2% .
M. citrifolia gel menunjukkan penghambatan 86,02% pada kedalaman 200 dan 400 μm dari
hari 1 sampai 5. Murray et al . [ 10 ] mengklaim bahwa keberadaan l- asperuloside dan alizarin
mungkin bertanggung jawab untuk properti antibakteri dan antimikroba
dari M. citrifolia . Kemanjuran M. citrifolia gel tetap sama selama periode 5
hari. Peningkatan kinerja ini dapat dikaitkan dengan peningkatan waktu kontak dan kontak fisik
gel. Hasil ini sesuai dengan penelitian lain yang dilakukan oleh Wang et al . , [ 23 ] di
mana larutan klorheksidin 2% bila diubah menjadi bentuk gel dilakukan lebih baik daripada
larutan itu sendiri.
Diperlukan studi lebih lanjut untuk menentukan konsentrasi optimum M. citrifolia diperlukan
saat digunakan dalam bentuk gel sebagai obat intracanal E. faecalis .
Lidah buaya menunjukkan penghambatan 78,72% dan 80% pada kedalaman 200 dan
400 μm dari hari 1 hingga 5. Hasil hari pertama gel lidah buaya sebanding
dengan M. citrifolia gel, tetapi nilainya menurun pada hari ke 3 dan 5. Alasan yang mungkin
untuk tindakan antimikroba dari lidah buaya bisa karena keberadaan 75 konstituen yang
berpotensi aktif: vitamin, enzim, mineral, gula, lignin, saponin , asam salisilat, dan asam amino.
[ 24 ] Tindakan farmakologis lidah buaya , seperti yang dipelajari secara in vitro atau pada
hewan (dalam kebanyakan kasus ekstrak daun total digunakan) termasuk efek anti-inflamasi,
antibakteri, dan hipoglikemik. [ 12 ]
Gel berdasarkan papain menunjukkan penghambatan 68,05% dan 67,28% pada kedalaman 200
dan 400 μm dari hari 1 hingga 5. Hal ini mungkin disebabkan oleh enzim sistein proteolitik
yang terdapat dalam papain, yang menunjukkan sifat antibakteri dan anti-inflamasi . [ 11 ]
Kalsium hidroksida menunjukkan penghambatan 63,82% dan 66,22% pada kedalaman 200 dan
400 μm dari hari 1 hingga 5. Kalsium hidroksida telah dianjurkan sebagai obat intrakanal karena
sifat bakterisidalnya . [ 25 ] Gomes et al . [ 26 ] melaporkan hal itu E. faecalis hadir dalam
tubulus dentin yang resisten terhadap dressing intrakanal kalsium hidroksida selama 10
hari. Kalsium hidroksida mengalami penurunan kemanjuran pada hari ke-3, tetapi memiliki
kemanjuran antimikroba yang meningkat pada hari ke-5. Hasil serupa telah dilaporkan
oleh Krithikadatta et al . [ 15 ]
 Pergi ke:

KESIMPULAN
Gel klorheksidin menunjukkan aktivitas antimikroba maksimum terhadap E. faecalis ,
sedangkan kalsium hidroksida menunjukkan paling sedikit. Di antara obat-
obatan intracanal alami , M. citrifolia gel secara konsisten menunjukkan penghambatan yang
baik hingga hari ke 5 diikuti oleh gel lidah buaya dan papain.
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Catatan kaki
Sumber Dukungan: Nol

Konflik kepentingan: Para penulis tidak memiliki konflik kepentingan terkait dengan penelitian ini.

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REFERENSI