Antibacterial effectiveness of novel polyherbal gel, chlorhexidine gluconate, and calcium hydroxide as intracanal medicaments in infected root canals using real-time PCR: a randomized controlled trial

Abstract

Purpose: This study aimed to evaluate the antibacterial effectiveness of three intracanal medicaments: Achyranthes aspera and Trachyspermum ammi based novel polyherbal gel, chlorhexidine gluconate gel, and calcium hydroxide

paste, against Enterococcus faecalis in infected root canals by means of Real- Time Polymerase Chain Reaction (qPCR) for bacterial quantification.

Methods: A triple-arm, randomized controlled trial was conducted on 45 permanent mandibular and maxillary incisor and canine teeth diagnosed with asymptomatic apical periodontitis. Participants were randomly divided into three equal groups (n = 15), each receiving a different intracanal medicament. Microbiological samples were collected using sterile absorbent paper points at two time points: before instrumentation and after 7-day of intracanal medicament placement. The intracanal medicaments tested were a novel polyherbal gel, 1% (w/w) chlorhexidine gluconate gel, and calcium hydroxide paste. Total DNA of Enterococcus faecalis was extracted from these samples, and qPCR was performed to determine the bacterial quantification at both intervals. The primary outcome was the reduction in Enterococcus faecalis load, indicating the antibacterial efficacy of each medicament. Results: All the groups showed a significant reduction in Enterococcus faecalis counts from baseline to day 7. However, the chlorhexidine gel and calcium hydroxide paste exhibited significantly greater reductions than the polyherbal gel (p < 0.05). Conclusions: All three intracanal medicaments tested were effective in significantly reducing Enterococcus faecalis counts. However, the chlorhexidine gel and calcium hydroxide paste demonstrated significantly greater reductions compared to the polyherbal gel. For routine endodontic practice, chlorhexidine gel and calcium hydroxide remain more reliable choices for intracanal disinfection against Enterococcus faecalis and should be preferred in cases with high microbial load. The polyherbal gel, while antibacterial, may be better suited as an adjunct rather than a primary medicament in endodontic disinfection protocols.