Comparative antimicrobial efficacy of triple antibiotic paste, 2% chlorhexidine gel, and bromelain paste against Enterococcus faecalis in mandibular premolars: A randomized clinical trial

Abstract

Abstract Context: Given the need to balance safety and effectiveness issues with synthetic agents, herbal alternatives may offer advantages when employed as intracanal medicaments (ICMs). Aim: This randomized control trial assessed antimicrobial efficacy of triple antibiotic paste (TAP), 2% chlorhexidine (CHX) gel, and Bromelain paste as ICM against Enterococcus faecalis . Settings and Design: This is randomized controlled clinical trial. Subjects and Methods: Twenty-four patients with nonvital teeth and single root canals were selected. Following initial access opening and biomechanical preparation, first microbial samples (S1) were collected using paper points. Patients were divided into three groups ( n = 8). Second microbial samples (S2) were collected 1 week after introducing the ICMs. Group 1 (S2a): TAP, Group 2 (S2b): 2% CHX gel, Group 3 (S2c): Bromelain paste. Bacterial growth was observed in both samples using colony–forming unit (CFU) count (CFU/mL). Statistical Analysis Used: The comparison of difference in CFU count among three groups was performed using the one–way ANOVA test ( P < 0.05) followed by post hoc Tukey test. Results: Reduction in CFU count postmedication S2 (S2a, S2b, and S2c) from S1 in each group was statistically significant. Reduction in CFU count was the highest in Group 3 (S2c) (Bromelain) (3.11 × 10 5 ± 0.26 CFU/mL) followed by Group 1 (S2a) (TAP) (3.47 × 10 5 ± 0.19 CFU/mL) and least in Group 2 (S2b) (2% CHX) (5.55 × 10 5 ± 0.23 CFU/mL). Conclusions: Bromelain showed the greatest reduction in E. faecalis CFU/mL compared to TAP and 2% CHX gel, decreasing counts from 8.64 × 10 5 ± 0.37 to 3.11 × 10 5 ± 0.26 over 7 days. As one of the first direct comparisons, the findings highlight bromelain’s potential as an ICM.

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