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Zoya Tanvir, Zohra Jabin, Nidhi Agarwal, Ashish Anand, Nandita Waikhom
Department of Pediatric Dentistry, Institute of Dental Studies and Technologies, Ghaziabad, Uttar Pradesh, India
76 © 2023 Journal of Indian Society of Pedodontics and Preventive Dentistry | Published by Wolters Kluwer - Medknow
Tanvir, et al.: Antimicrobial efficacy of nanosilver solution, Azadirachta indica, sodium hypochlorite, and normal saline
treatment success depend largely on the elimination biological, and optical features. Their increased surface
of infectious agents from the root canals before area to volume ratio results in the increased reaction
obturation.[1] between nanoparticles and target molecules in a very
short period.[2]
This is accomplished by the procedure of root
canal treatment which includes the mechanical AgNPs are effective against several microorganisms
instrumentation. It helps to debride infected canal such as E. faecalis. They also have properties such
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walls but it cannot eliminate bacteria from inaccessible as high surface area, positive charge density, and
areas of root canal, resulting in inadequate removal polycationic/polyanionic properties which enhance
of bacteria. As a result of these limitations, irrigating their antibacterial effects.[3,4]
solutions have been developed to improve the
mechanical debridement procedure.[2,3] Hence, for
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A complex mix of obligate anaerobes and facultative It is difficult to simulate the oral environment when
anaerobes is involved in the disease process of conducting trials in vitro conditions and the result
dental abscesses.[6] Some bacteria are known as obtained may not be totally authentic. The literature
periodontopathogens, including Prevotella intermedia, explored was lacking in such trials and documented
Porphyromonas gingivalis, Tannerella forsythia, Eikenella research available was done either in vitro or ex vivo.
corrodens, and Fusobacterium nucleatum, Enterococcus Hence, there is a need of exploring in vivo trial of the
faecalis, Staphylococcus aureus have been closely new emerging nanotechnology using NS solution as
associated with acute symptoms of endodontic root canal irrigant and thus the present study was
infections, including abscesses Few studies that have designed.
investigated the root canal microbiota of primary
teeth have suggested that the most commonly isolated Over the time, as there has been an advancement from
species in endodontic infections of primary teeth are conventional approach to the era of new irrigants for
of Fusobacterium, Prevotella, and Porphyromonas genera. improved treatment prognosis. The present study was
Enterococcus species, Staphylococcus species.[7] aimed at evaluating and comparing the antimicrobial
efficacy of NS Solution, A. indica, sodium hypochlorite
E. faecalis is a facultative anaerobic microorganism and normal saline when used as irrigants in infected
which is a normal inhabitant of the oral flora. It has root canals of primary teeth.
the ability of dentinal tubule penetration and biofilm
formation. It is most often related to the failure of Materials and Methods
the root canal treatment and in several kinds of
periradicular lesions including primary and secondary The present study is a prospective randomized control
endodontic infections as it can survive in harsh trial which was planned and conducted as per the
nutritional conditions.[4] CONSORT statement (2010). The approval for this
study was taken from the ethics committee of the
Nanosilver (NS) or Silver nanoparticles (AgNPs) institution. The selection of study participants was
consist of nanosized structures formed from silver done after screening 300 patients (5–12 years) visiting
atoms and range in diameter from 1 to 100 nm. At the the Outpatient Department of Pediatric and Preventive
nanoscale, particles exhibit different physicochemical, Dentistry, IDST, The study included 80 children in
Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 41 | Issue 1 | January-March 2023 | 77
Tanvir, et al.: Antimicrobial efficacy of nanosilver solution, Azadirachta indica, sodium hypochlorite, and normal saline
The selected samples were divided randomly into four Baseline sample was obtained by placing a sterile
groups of 20 children each: paper point (Metabiomed, India) into the root canal file
• Group I: NS solution group. A special formula 1 mm short of working length into the canal for 30 s.
as prepared by Gonzalez‑Luna et al.[11] containing It was then immediately transported to the Eppendorf
nanosilver particles which were spherical and tube containing 1 ml of nutrient broth (Hi Media
particle size of 25 ± 6 nm was used Laboratories Pvt. Ltd., India). The canals were gently
• Group II: A. indica group. An aqueous solution cleaned and shaped.
of Neem extract was prepared by the method
described by Ambareen et al.[12] The root canal was alternatively irrigated with a total
• Group III: Commercially available Sodium of 0.5 mL of group‑specific irrigant, after every step of
hypochlorite (2.5%) was used instrumentation. A sterile 20 cc syringe with 28 gauge
• Group IV: Control group. Saline was used as a needle (Dispo van) was used to deliver 0.5 mL of irrigant
control. into the canal Postirrigation sample was taken by placing
absorbent paper points into the canal till the apex per canal
The synthesis of AgNPs in an aqueous solution was of a size compatible with the root canal diameter were
carried out through chemical reaction of silver nitrate sequentially placed for 30 s. They were then removed
and gallic acid with sodium bicarbonate as stabilizing
from the canals and transferred directly into Eppendorf
agent.
tube containing 1 mL of nutrient broth with a sterilized
tweezer. The treated tooth was flushed with distilled
Characterization of the silver nanoparticles water to prevent the potential carryover of irrigants.
The size and shape of the synthesized AgNPs were
analyzed using a JEOL JEM‑1230 TEM (Transmission
The collected sample Eppendorf tubes were stored
ElectronMicroscope). TEM images were obtained on
in an ice box chamber (4°C) and sent immediately to
an FEI‑Tecnai G2 F20 at an accelerating voltage of 200
a microbiological laboratory for microbial analysis.
Kv. The analysis revealed that 99% of AgNPs were
spherical with a particle size of 25 ± 6 nm [Figure 1]. Proper aseptic measures were followed at all steps.
78 Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 41 | Issue 1 | January-March 2023 |
Tanvir, et al.: Antimicrobial efficacy of nanosilver solution, Azadirachta indica, sodium hypochlorite, and normal saline
The pre‑and post‑irrigation samples obtained were could damage the underlying periapical tissues.
incubated for 48 h at 37°C in an anaerobic chamber (85% Therefore, they should be used cautiously in the
N2, 10% H2, 5% CO2). primary dentition.[11]
After 48 h, the samples were cautiously taken out and In the present study, the three types of the irrigating
the growth on the plates was observed. solutions (AgNPs, A. indica, and sodium hypochlorite),
showed potent antibacterial effects. There were
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The colonies were identified by gram staining on significant differences observed between the three
the basis of their morphology and visualized using experimental groups. Normal saline was used as a
a stereomicroscope. The microbial colonies were control and it showed the least antimicrobial effect.
counted using digital colony counter. The baseline
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and postirrigation microbial counts were expressed as Silver ions possess long‑term antibacterial activity due
colonyforming units per milliliter. to sustained ion release and good biocompatibility
with human cells. With the advent of nanotechnology,
Statistical analysis AgNPs have been synthesized, and they have shown
Statistical analysis was performed using analysis of wide range of antimicrobial properties against various
variance, Paired t‑test, and Post hoc Bonferroni test. bacteria, viruses, and fungi.[8] Hence, they were
The criteria for statistical significance were defined as selected for the present study. An irrigating solution
P < 0.05. was prepared by incorporation of these nanoparticles
and was used in the study.
Results After attachment to the cell membrane and entrance
into the cell, nanoparticles interact with vital cell
The anaerobic microorganisms were quantified in 80 components such as DNA and RNA and alter the cell
primary teeth. A range of bacteria was identified and membrane permeability, genetic material, ribosomes,
isolated from the chosen primary teeth root canals, and proteins producing reactive oxygen species
including Enterococcus species, Staphylococcus species, which alter the metabolic activity of bacteria. All of
Bacillus species, and Candidal species. these mechanisms result in cell lysis due to protein
denaturation.[4,13,14]
It was seen that the mean bacterial colony counts of
all the isolated bacteria reduced considerably after Previous studies have reported that particle size is
irrigation with all irrigants. A significant difference an important factor in the antimicrobial activity of
was seen in the postirrigation samples [Table 1]. nanoparticles.[2] In the present study, NS solution of
spherical‑shaped particles was used due to their better
Intergroup comparisons were done using the Post hoc antimicrobial effect as stated in a study done by Hong
Bonferroni test, which showed a significant difference et al.[15]
between Groups 1 and 2, Groups 1 and 4, Groups 2 and
3, Groups 2 and 4, and Groups 3 and 4. However, a It was suggested by Morones et al. that AgNps with a size
nonsignificant difference was seen when Group 1 was range of 1–100 nm have a great bactericidal potential
compared to Group 3 [Table 2]. against both Gram‑positive and negative bacteria.[16]
On comparison of all the four groups, Group 1 showed In a study by Razumova et al., they demonstrated that
the highest mean of 4.384 × 103 ± 1.019 followed by small particles of nanosilver of 1–2 nm could penetrate
Group 3 with mean of 3.500 × 103 ± 1.193 and Group 2 the dentinal tubules.[17]
of 2.590 × 103 ± 0.778. The change in the microbial count
before and after irrigation was least in Group 4 with The present study was an in vivo study in contrast
the mean value of 0.825 × 103 ± 0.393 [Table 3]. to studies available in literature which are in vitro
or ex vivo. A particle size of 25.2 ± 6.5 nm of silver
Discussion nanoparticles was used. This size was in accordance
to a study by Chan et al. which is the one of the few
During endodontic procedures in permanent studies available in literature that investigated the
teeth, various root canal irrigating solutions such cytotoxic effects and biocompatibility to primary
as sodium hypochlorite, chlorhexidine gluconate, human periodontal ligament stem cells. The particle
ethylenediaminetetraacetic acid, citric acid, and size used in the present study was safe and large
hydrogen peroxide are recommended to achieve enough not penetrate dentinal tubules or periapical
complete debridement of canals. However, in their area and cause damage.[18]
primary counterpart’s nontoxicity to periapical tissues
is an important requirement of endodontic irrigants. In Keeping in view, the differences between the
primary teeth, overflow of irrigating solution through in vitro (laboratory environment) and in vivo (oral
the apical region because of possible resorption areas cavity) conditions, the present study used 25–30 ppm
Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 41 | Issue 1 | January-March 2023 | 79
Tanvir, et al.: Antimicrobial efficacy of nanosilver solution, Azadirachta indica, sodium hypochlorite, and normal saline
One way ANOVA applied, F=29.421, P=0.0001 (significant difference). SD=Standard deviation; SE=Standard error; A. indica=Azadirachta indica;
ANOVA=Analysis of variance
80 Journal of Indian Society of Pedodontics and Preventive Dentistry | Volume 41 | Issue 1 | January-March 2023 |
Tanvir, et al.: Antimicrobial efficacy of nanosilver solution, Azadirachta indica, sodium hypochlorite, and normal saline
of NS solution that was similar to the formula by as an endodontic irrigation with the same effect
Gonzalez‑Luna et al.[11] occurred by using sodium hypochlorite at 2.25%.[11]
In this study, the action of NS solution against microbes In addition, a study done by Moghadas et al. found
was most effective, and a significant reduction in the no significant difference between NaOCl and the NS
microbial count was seen after its delivery into the root solution in their in vitro study.[3]
canals. Table 4 shows comparisons with the results of
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the some previously published studies alongwith their The findings of Ioannidis et al., Rodrigues et al.
conclusion. are contradictory to the present study results and
they concluded that the AgNP irrigant was not
Moghadas et al., and Nabavizadeh et al. also demonstrated effective compared to other commonly used root
canal irrigants.[26,27] They used the AgNPs solution at
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Podar et al., Ioannidis et al. in their study reported References
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