Comparative evaluation of bromelain, double antibiotic paste, and calcium hydroxide as intracanal medicaments against Enterococcus faecalis: an in-vitro study

Aim: The aim of this in vitro study was to compare the antimicrobial effect of double antibiotic paste with that of bromelain and calcium hydroxide in eradication of E. faecalis. Hypothesis: we hypothesized that Bromelain may act as an intracanal medicament. Materials and methods: For this study, 40 extracted human teeth were used. After their decapitation, they were initially instrumented to reach 20 K-file, later they were separated into one control and three experimental groups (n=10) according to the medicament used; Group 1: Bromelain paste, Group 2: Control group, canals were left without any medicament, Group 3: Calcium hydroxide (CH)and Group 4: Double antibiotic paste (DAP). Preparation of all samples was done using Step- back technique to reach #50 file, irrigation using sodium hypochlorite solution of 2.6% concentration and EDTA, then intracanal medicaments were applied. First sample (S1) was collected after inoculation of bacteria into root canals. Second sample (S2) was collected after undergoing instrumentation and irrigation. Third sample (S3) was taken following application of medicament. Sterile cotton pellet and temporary restoration were then applied for seven days. Broth Heart Infusion (BHI) agar was used for culturing of samples then went under incubation to count Colony Forming Unit (CFU's). Results: Regarding S1 samples (after inoculation of bacteria) and S2 (after undergoing instrumentation and irrigation). In all groups, there was no statistically significant difference between them. While S 3 samples showed statistically significant difference in all groups. S3 Samples in Bromelain group showed the least statistically significant bacterial count followed by double antibiotic paste then calcium hydroxide group while S3 samples in negative control group showed the highest statistically significant bacterial count. Conclusion: Bromelain was found as an effective herbal intracanal medicament as it gives superior antimicrobial property compared to other intracanal medicaments. Clinical significance: Intracanal medicament from herbal sources like Bromelain is recommended for root canal disinfection as it has a promising effect with less side effect compared with other intracanal medicaments.