Comparative evaluation of antimicrobial efficacy of 2% Chlorhexidine gel, Triphala and A.indica as an intracanal medicament against E.faecalis: An in vivo study

Complete debridement and effective disinfection of the root canal space is an important step for achieving long term success of nonsurgical endodontics and this is achieved by effective chemomechanical preparation.Proper chemomechanical preparation reduces a large number of microorganisms in the canals. However, the microorganisms can still remain viable after root canal preparation and gets multiplied between the treatment because of presence of anatomical complexities like dentinal tubules, ramifications, isthmuses and apical deltas and the limitation in accessing the canal system by instrumentation and irrigation. So, use of an intracanal medicament helps in the elimination of microorganisms that remains even after cleaning and shaping.Chlorhexidine (CHX) is a bis-biguanide that has a broad-spectrum antimicrobial activity and is active against both gram positive and gram-negative microbes. 2% CHX has been used as an intracanal medicament and had shown potent results in the past against common endodontic pathogens especially E.faecalis.But in this modern era of dentistry more attention is towards the safer option of herbal alternatives like A.indica (Neem) and Triphala which have been used since many years in the field of ayurvedic medicine due to their anti-microbial, anti-inflammatory, anti-oxidant, anti-tumour, and many other properties.Triphala is a traditional ayurvedic herbal formulation consisting of the dried fruits of three medicinal plants Terminalia chebula (Haritaki), Terminalia bellerica (Bibhitaki) and Phyllanthus emblica (Amla). Triphala means ’three’ [tri] ’fruits’ [phala]. It has a potential of anti-bacterial and anti-inflammatory activity.Neem is known to have medicinal property by each part of the tree. It has anti viral, anti fungal, anti bacterial and anti carcinogenic activity. Nimbidin is a major active component isolated from seed of A.indica which is responsible for its biological activities. The antimicrobial effects of Neem have been reported against S. mutans, E. faecalis and C. albicans.Yet very few studies have been conducted in patients using herbal products as an intracanal medicament. So, there is a need of constant research required to find safer herbal alternative as an intra-canal medicament.