JMIR Publications

ABSTRACT

Background:

The persistence of Enterococcus faecalis is a significant issue in endodontic therapy, frequently leading to treatment failures. Its capacity to live under extreme conditions, penetrate dentinal tubules, and create resistant biofilms makes conventional antibacterial methods insufficient. Therefore, enhancing the efficacy of intracanal irrigants through advanced activation methods has become crucial for successful root canal disinfection .Despite the proven antimicrobial activity of metronidazole and chlorhexidine, the resilience of Enterococcus faecalis necessitates integrating activation techniques that improve irrigant penetration and disrupt biofilms. Laser and sonic activation methods show promise in enhancing the antibacterial performance of irrigants. However, limited studies exist comparing their effects on metronidazole, chlorhexidine, and saline. Hence, there is a need to evaluate the antibacterial efficacy of these irrigants when used in conjunction with laser and sonic activation techniques.

Objective:

To compare the antibacterial efficacy of metronidazole, chlorhexidine, and normal saline as intracanal irrigants when activated by laser and sonic techniques against Enterococcus faecalis in extracted human mandibular premolars

Methods:

Ninety freshly extracted single-rooted mandibular premolars will be obtained, decoronated, and biomechanically prepared using the ProTaper Universal rotary system up to F2. Canals will be inoculated with Enterococcus faecalis and incubated for 7 days to allow biofilm formation. The teeth will then be randomly divided into three main groups (metronidazole, chlorhexidine, and saline), each subdivided based on the activation method used (laser or sonic). Irrigation protocols will be standardized, and pre- and post-irrigation bacterial samples will be collected on paper points and cultured on Brain Heart Infusion (BHI) agar. Colony-forming units (CFUs) will be counted to evaluate antibacterial efficacy.

Results:

Combining laser activation with metronidazole and chlorhexidine is anticipated to demonstrate superior antibacterial efficacy against E. faecalis compared to sonic activation and saline. The study is expected to reveal the most effective irrigant-activation combination for enhanced disinfection

Conclusions:

This study aims to provide evidence-based insights into optimizing root canal disinfection protocols by evaluating and comparing the synergistic effects of antimicrobial agents and advanced activation techniques. The findings could contribute significantly to improving endodontic treatment outcomes and reducing the incidence of persistent infections caused by E. faecalis. Clinical Trial: This study does not require registration in the Clinical Trials Registry of India (CTRI) as it is a laboratory-based in vitro experimental study involving extracted human teeth, without any interventions on living human participants or clinical outcomes.