efficacy of 25% propolis extract as intracanal irrigating solution

2. ADITI SINGH
P.G DEPT OF PAEDODONTICS
SDCH ,RISHIKESH

3. Kumar MV, Pandey RK, Khanna R,
Agarwal J.
J Indian Soc Pedod Prev Dent 2014;32:120-4

4. INTRODUCTION
AIM
MATERIALS & METHODOLOGY
TECHNIQUE
RESULTS
DISCUSSION
CONCLUSION

5. Bacteria are the major cause of pulpal and
periapical diseases.
Main objective of endodontic therapy is
clean sterile root canals which can be sealed
of at the apex.
Complexity of the root canal system,
invasion of the dentinal tubules by
microorganisms, formation of smear layer
during instrumentation and presence of
dentin as a tissue are the major obstacles for
complete elimination of bacteria during
cleaning and shaping of root canal systems.
American Association of Endodontists Guidelines for Rootcanal Irrigants & disinfectants;Endodontics Colleagues
for excellence;2011(2011):1-8

6. Intracanal irrigants are solutions that exert
their effects mechanically and chemically.
Mechanical effects of irrigants are generated
by the back and forth flow of the irrigation
solution during cleaning and shaping of the
infected root canals, significantly reducing
the bacterial load.
American Association of Endodontists Guidelines for Rootcanal Irrigants & disinfectants;Endodontics Colleagues
for excellence;2011(2011):1-8

7. To effectively clean and disinfect the root canal
system, an irrigant should be able to disinfect
and penetrate dentin and its tubules, offer long-
term antibacterial effect (substantivity),
It must remove the smear layer
It must be nonantigenic, nontoxic and
noncarcinogenic.
In addition, it should have no adverse effects on
dentin or the sealing ability of filling materials.
It should be relatively inexpensive, convenient
to apply and cause no tooth discoloration.
Other desirable properties for an ideal irrigant
include the ability to dissolve pulp tissue and
inactivate endotoxins.
American Association of Endodontists Guidelines for Rootcanal Irrigants & disinfectants;Endodontics Colleagues
for excellence;2011(2011):1-8

8. Broad antimicrobial spectrum
High efficacy against anaerobic and facultative
microorganisms organized in biofilms
Ability to dissolve necrotic pulp tissue remnants
Ability to inactivate endotoxin
Ability to prevent the formation of a smear layer
during instrumentation or to dissolve the latter
once it has formed.
Systemically nontoxic when they come in contact
with vital tissues, noncaustic to periodontal
tissues, and with little potential to cause an
anaphylactic reaction
Kandaswamy D, Venkateshbabu N; Root canal irrigants; J Conserv Dent. 2010 Oct-Dec; 13(4): 256–264.

9. Kandaswamy D, Venkateshbabu N; Root canal irrigants; J Conserv Dent. 2010 Oct-Dec; 13(4): 256–264.

10. Sodium hypochlorite (household bleach) is the
most commonly used root canal irrigant.
It is an antiseptic and inexpensive lubricant that
has been used in dilutions ranging from 0.5% to
5.25%.
Mechanism of Action : Free chlorine in NaOCl
dissolves vital and necrotic tissue by breaking
down proteins into amino acids.
Decreasing the concentration of the solution
reduces its toxicity, antibacterial effect and
ability to dissolve tissues.
Increasing its volume or warming it increases its
effectiveness as a root canal irrigant.
American Association of Endodontists Guidelines for Rootcanal Irrigants & disinfectants;Endodontics Colleagues
for excellence;2011(2011):1-8

11. advantages disadvantages
1. ability to dissolve organic
substances present in the root
canal system and its affordability
1. cytotoxicity when injected into
periradicular tissues,
2. Foul smell and taste, ability to
bleach clothes and ability to
cause corrosion of metal
objects.
3. it does not kill all bacteria,
4. it does not remove all of the
smear layer.
5. It also alters the properties of
dentin.
6. The results of a recent
in vitro study show that the most
effective irrigation regimen is
5.25% at 40 minutes, whereas
irrigation with 1.3% and 2.5% NaOCl
for this same time interval is
ineffective in removing E. faecalis
from infected dentin cylinders
American Association of Endodontists Guidelines for Rootcanal Irrigants &
disinfectants;Endodontics Colleagues for excellence;2011(2011):1-8

12. It has a broad-spectrum antibacterial action, sustained
action and low toxicity.
Its used as intra canal medicament due to its substantivity
and long-lasting antimicrobial effect, which arises from
binding to hydroxyapatite.
Mechanism of action : It has a cationic molecular
component that attaches to negatively charged cell
membrane areas, causing cell lysis.Its property to bind
with hydoxyapatite crystal
The major advantages of chlorhexidine over NaOCl are its
lower cytotoxicity and lack of foul smell and bad taste.
However, unlike NaOCl, it cannot dissolve organic
substances and necrotic tissues present in the root canal
system.
In addition, like NaOCl, it is unable to kill all bacteria and
cannot remove the smear layer.
American Association of Endodontists Guidelines for Rootcanal Irrigants & disinfectants;Endodontics Colleagues
for excellence;2011(2011):1-8

13. Chelating agents such as ethylene diamine
tetraacetic acid (EDTA), citric acid and tetracycline
create a stable calcium complex with dentin mud,
smear layers, or calcific deposits along the canal
walls. This may help prevent apical blockage and aid
disinfection by improving access of solutions through
removal of the smear layer.
NaOCl is an adjunct solution for removal of the
remaining organic components.
Irrigation with 17% EDTA for one minute followed by a
final rinse with NaOCl is the most commonly
recommended method to remove the smear layer.
Longer exposures can cause excessive removal of
both peritubular and intratubular dentin.
EDTA has little or no antibacterial effect
American Association of Endodontists Guidelines for Rootcanal Irrigants & disinfectants;Endodontics Colleagues
for excellence;2011(2011):1-8

14. Iodine potassium iodide (IKI) is a traditional root
canal disinfectant and is used in concentrations
ranging from 2% to 5%.
Mechanism of Action : IKI kills a wide spectrum
of microorganisms found in root canals but shows
relatively low toxicity in experiments using
tissue cultures.
Iodine acts as an oxidizing agent by reacting with
free sulfhydryl groups of bacterial enzymes,
cleaving disulfide bonds.
E. faecalis often is associated with therapy-
resistant periapical infections, and combinations
of IKI and CHX may be able to kill Ca(OH)2-
resistant bacteria more efficiently.

15. An alternative solution to EDTA for removing the smear
layer is the use of BioPure™ MTAD™ (DENTSPLY Tulsa Dental
Specialties, Tulsa, Okla.), a mixture of a tetracycline
isomer, an acid (citric acid) and a detergent.
MTAD was developed as a final rinse to disinfect the root
canal system and remove the smear layer.
The effectiveness of MTAD to completely remove the
smear layeris enhanced when a low concentration of NaOCl
(1.3%) is used as an intracanal irrigant before placing 1 ml
of MTAD in a canal for 5 minutes and rinsing it with an
additional 4 ml of MTAD as the final rinse.
It appears to be superior to CHX in antimicrobial activity.
In addition, it has sustained antibacterial activity, is
biocompatible and enhances bond strength
American Association of Endodontists Guidelines for Rootcanal Irrigants & disinfectants;Endodontics Colleagues
for excellence;2011(2011):1-8

16. H2O2 kills aneaerobic bacteria
Combined with sodium hypochlorite it
removes the debris due to effervescence
effect of peroxide .
Drawback of this solution : ephysema due to
liberation of oxygen bubbles into the soft
tissue.So it cannot be used under strong
pressure
Conc. Of Hydrogen peroxide to be used
safely is 3% .

17. Non toxic non irritant in small conc.
Used in 1-5% conc. Most frequently 2% for
irrigation
In combination with Hydrogen peroxide it
produces oxygen & chlorine which have
antimicrobial & better dissolving &
depurative effect.
Kovac J,Kovac D; Effect of irrigatin solutions in endodontic therapy ;
Bratisl Lek Listy ;2011;112(7)

19. Cohen S, Hargreaves K ; Cohen’s Pathway of pulp;2011;10 Ed Mosby Elsevier

20. Cohen S, Hargreaves K ; Cohen’s Pathway of pulp;2011;10 Ed Mosby Elsevier

21. Electrochemically activated water (also known
as oxidative potential water)
Hydrogen peroxide traditionally has been used as
an irrigant in conjunction with NaOCl.
0.2% or 0.5% CHX in addition to NaOCl, either as
an irrigant or mixed with Ca(OH)2 as an
interappointment medicament. These
combinations can overcome the inhibiting effect
of dentin dust on conventional medicaments and
can optimize their antimicrobial properties
against certain resistant bacteria and yeasts
NaOCl with a final 17% EDTA rinse with an equal
mixture of 2% NaOCl and 18% etidronic acid
during and after instrumentation and a protocol
involving 1% NaOCl during preparation and 2.25%
peracetic acid after instrumentation.
Cohen S, Hargreaves K ; Cohen’s Pathway of pulp;2011;10 Ed Mosby Elsevier

22. Conventional
• Syringes
• Needles
EndoActivatorr
• It is based on sonic vibration (up to 10,000
cpm) of a plastic tip in the root canal
EndoVac
• the EndoVac system is based on a negative-pressure
approach whereby the irrigant placed in the pulp
chamber is sucked down the root canal and back up
again through a thin needle with a special design

23. Propolis is a natural product that has gained increased interest due to its
antimicrobial activity against a wide range of pathogenic microorganisms.
COMPOSITION :
resin and balsams (50-60%),
pollen (5-10%),
other constituents like amino acids, minerals, vitamins A and B complex,
Highly active biochemical substance known as biofl avonoids (vitamin P),
phenols, and aromatic compounds.
USES IN DENTISTRY
Propolis has been used in dentistry as
As storage media for avulsed teeth,
For prevention of caries,
Dentine hypersensitivity
Pulp capping agent
Mahmoud AS, Almas K, Dahlan AA. The effect of propolis on dentinal hypersensitivity and level of satisfaction
among patients from a university hospital Riyadh, Saudi Arabia. Indian J Dent Res 1999;10:130-7

24. To assess the potential of water-soluble 25%
propolis extract against microorganisms
present in root canals of primary teeth
during endodontic procedures.

25. SAMPLE SIZE : 70 Primary teeth were selected divided in 2 groups based on
the irrigating solution used
Group A consisted of 35 subjects with 0.9% isotonic saline as an irrigating
solution.
Group B : consisted of 35 subjects with 25% water-soluble propolis as an
irrigating solution
INCLUSION CRITERIA :
The patients in the age group of 4-7 years, having good general health,
without history of antibiotic coverage and radiographic evidence of
carious pulp exposure in primary teeth with restorable tooth structure.
Teeth with necrotic pulp.
Atleast 2/3rd of root length of the tooth must be present
EXCLUSION CRITERIA :
The clinical and radiographic evidence of pathosis in periapical or
furcation area and presence of internal/external resorption
Root resorption not more than 1/3rd of root length.
Informed consent was taken from the parent & guardian of patients involved
in the study.

26. Local anesthesia &
rubber dam isolation
high speed hand
piece & sterilized
round bur (number 2)
under constant
irrigation
Pulp extirpation with
sterile barbed broach
of number 15
Sample collected
with sterile paper
point & put in
transport media
Canal preparation
done with sterile H
file
Post irrigation
sample collected

27. Sample mixed for 30s
in vortex mixture
0.01ml sample plated
on blood agar plates
Plates incubated at
37oC for 48-72 hr
Each isolate was
identified using
standard conventional
techniques &
biochemical tests

28. Group A Group B
Pre
irrigation
Post
irrigation
Pre
irrigation
Post
irrigation
Streptococci 24000 17000 22000 6000
Staphylococ
ci
22000 18000 24000 13000
E fecalis 15000 10000 16000 7000
Ecoli 8000 5000 10000 5000
Mean change in bacterial colony counts :
Streptococci : 59.2%
Staphylococci : 68.2%
E fecalis : 52.3%
E coli : 37.4%

29. Sample collection with adsorbent paper point is insufficient to
collect those from lateral accessory canals , apical ramifications
or dentinal tubules & deeper areas etc.
Primary teeth infections are polymicrobial in nature with more
types of pathogens involved , that could not be isolated in this
study.
Method of isolation & identification used was insufficient to
isolate the uncultivable & fastidious microbes.
Only quantitative antibacterial effects of propolis assessed.
Sodium hypochlorite & Chlorhexidine are the irrigants of choice
in permanent as well as primary teeth which were not included in
the study
Water extract of propolis as claimed by the authors doesn’t
affect the biological activity of propolis, indeed was found to
decrease its efficacy though , when compared by its resinous
extract or lipid extract.

30. FAVOUR AGAINST
• Silva et al : propolis is least irritating
solution (less than Saline)
• Ramos etal : less inflammatory than
corticosteroids antibiotic preparation
in periapical region.
• Najafi et al : water extract of propolis
retained most of its flavanoids , so
didn’t affect its biological properties
• Arslan et al : propolis is an effective
intracanal irrigant in eradicating
E. faecalis and C. albicans.
• Madhubala et al : ethanolic extract of
propolis was more effective than tri
antibiotic paste at the end of 2 days
against E.fecalis
• Valera et al : propolis + saline irrigation
erradicated E.coli completely
• Chemical variability of different types
of propolis .
• Difficult to manipulate as naturally it’s
a lipid derivative resin material.
• Procurement of pure 100% propolis is
difficult as it can get easily
contaminated by pollutants & heavy
metals .
• May not be safe for asthamatic patients
, patients having allergic tendencies,
increased immune response.
• Potent anaphylactic reaction possible.

31. Propolis is an excellent natural antibiotic
with multiple health benefits.
However owing to different biochemical
properties depending upon its origin data is
still insufficient about its safety.
Being resin based in nature more
formulations need to be found out & tested ;
that can make it easy to use in a small
working area like a root canal making it a
more tangible option for endodontic therapy.

32. Silva FB, Almeida JM, Sousa SM. Natural medicaments in
endodontics — a comparative study of the anti-
inflammatoryaction. Braz Oral Res 2004;18:174-9.
Ramos IF, Biz MT, Paulino N, Scremin A, Della Bona A, Barletta FB,
et al. Histopathological analysis of corticosteroidantibiotic
preparation and propolis paste formulation as intracanal
medication after pulpectomy: An in vivo study. J Appl Oral Sci
2012;20:50-6.
Arslan S, Ozbilge H, Kaya EG, Er O. In vitro antimicrobial activity
of propolis, BioPure MTAD, sodium hypochlorite, and
chlorhexidine on Enterococcus faecalis and Candida albicans.
Saudi Med J 2011;32:479-83
Ruviére DB, Leonardo MR, da Silva LA, Ito IY, Nelson-Filho P.
Assessment of the microbiota in root canals of human primary
teeth by checkerboard DNA-DNA hybridization. J Dent Child
(Chic) 2007;74:118-23.
Najafi MF, Vahedy F, Seyyedin M, Jomehzadeh HR, Bozary K.
Effect of the water extracts of propolis on stimulation and
inhibition of different cells. Cytotechnology 2007;54:49-56

33. Mahmoud AS, Almas K, Dahlan AA. The effect of propolis on dentinal hypersensitivity
and level of satisfaction among patients from a university hospital Riyadh, Saudi
Arabia. Indian J Dent Res 1999;10:130-7
Kandaswamy D, Venkateshbabu N; Root canal irrigants; J Conserv Dent. 2010 Oct-
Dec; 13(4): 256–264.
American Association of Endodontists Guidelines for Rootcanal Irrigants &
disinfectants;Endodontics Colleagues for excellence;2011(2011):1-8
Madhubala MM, Srinivasan N, Ahamed S. Comparative evaluation of propolis and
triantibiotic mixture as an intracanal medicament against Enterococcus faecalis. J
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