Aim: This study was done to clinically investigate the efficacy of glycyrrhizin-based intracanal medication (ICM) compared to calcium hydroxide Ca(OH)2 and Ledermix on the bacterial counts inside the root canals of necrotic teeth with chronic periapical periodontitis.
Methodology: Thirty-six patients having single-rooted and single-canaled necrotic teeth with chronic periapical periodontitis were enrolled in this research. Aseptic control measures were taken before clinical steps. Access cavity preparation was done. First bacteriological samples (S1) were collected immediately after access cavity preparation and before cleaning and shaping inside the root canals. Cleaning and shaping were performed on the root canals. Patients were randomly allocated into 3 groups according to the type of intracanal medicament used [Ca(OH)2, Ledermix, Glycyrrhizin]. Second bacteriological samples (S2) were collected after 1 week from placing the ICMs. S1 and S2 were transferred to the lab of microbiology for culturing on blood agar dishes in anaerobic conditions, and the bacteria on the plates were enumerated as colony-forming units (CFUs) by the manual counting method. The anti-bacterial efficacy of the ICM was estimated by the percentage reduction in the bacterial colonies from S1 to S2.
Results: All tested ICM documented a significant reduction in the CFUs from S1 to S2 (p < 0.05). Regarding S1, there was no significant difference between the three tested materials (p > 0.05). Regarding S2, Glycyrrhizin and Ledermix showed significantly lower CFUs than Ca(OH)2. There was no significant difference between Glycyrrhizin and Ledermix.
Conclusion: Under the conditions of the present study, Glycyrrhizin and Ledermix showed comparable antimicrobial effects that were better than the commonly used Ca(OH)2 ICM. Glycyrrhizin may be a promising ICM.
Clinical significance: Herbal medicine can be considered as an alternative antimicrobial material for root canal disinfection because it has many benefits, like low toxicity, absence of microbial resistance, and favorable antimicrobial efficacy. This study highlights the clinical efficacy of Glycyrrhizin as a promising ICM.
Martinho FC, Chiesa WMM, Leite FRM, et al. Antigenicity of primary endodontic infection against macrophages by the levels of PGE2 production. J Endod 2011;37(5):602–607. DOI: 10.1016/j.joen.2010.12.005.
Martinho FC, Chiesa WMM, Leite FRM, et al. Antigenic activity of bacterial endodontic contents from primary root canal infection with periapical lesions against macrophage in the release of interleukin-1β and tumor necrosis factor α. J Endod 2010;36(9):1467–1474. DOI: 10.1016/j.joen.2010.06.012.
Martinho FC, Chiesa WMM, Marinho ACS, et al. Clinical investigation of the efficacy of chemomechanical preparation with rotary nickel-titanium files for removal of endotoxin from primarily infected root canals. J Endod 2010;36(11):1766–1769. DOI: 10.1016/j.joen.2010.08.019.
Gomes BPFA, Pinheiro ET, Gadê-Neto CR, et al. Microbiological examination of infected dental root canals. Oral Microbiol Immunol 2004;19(2):71–76. DOI: 10.1046/j.0902-0055.2003.00116.
Vera J, Siqueira JF, Ricucci D, et al. One- versus two-visit endodontic treatment of teeth with apical periodontitis: A histobacteriologic study. J Endod 2012;38(8):1040–1052. DOI: 10.1016/j.joen.2012. 04.010.
Vianna ME, Horz HP, Conrads G, et al. Effect of root canal procedures on endotoxins and endodontic pathogens. Oral Microbiol Immunol 2007;22(6):411–418. DOI: 10.1111/j.1399-302X.2007.00379.
Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J 2007;52(1 Suppl):S64–82. DOI: 10.1111/j.1834-7819.2007.tb00527.
Tang G, Samaranayake LP, Yip HK. Molecular evaluation of residual endodontic microorganisms after instrumentation, irrigation and medication with either calcium hydroxide or Septomixine. Oral Dis 2004;10(6):389–397. DOI: 10.1111/j.1601-0825.2004.01015.
Weiger R, De Lucena J, Decker HE, et al. Vitality status of microorganisms in infected human root dentine. Int Endod J 2002;35(2):166–171. DOI: 10.1046/j.1365-2591.2002.00465.
Bansal R, Jain A. Overview on the current antibiotic containing agents used in endodontics. North Am J Med Sci 2014;6: 351–358. DOI: 10.4103/1947-2714.139277.
Klotz MD, Gerstein H, Bahn AN. Bacteremia after topical use of prednisolone in infected pulps. J Am Dent Assoc 1965;71(4):871–875. DOI: 10.14219/jada.archive.1965.0079.
Almadi EM, Almohaimede AA. Natural products in endodontics. Vol. 39, Saudi Med J 2018;39:124–130. DOI: 10.15537/smj.2018.2.21038.
Siqueira JF, Guimarães-Pinto T, Rôças IN. Effects of chemomechanical preparation with 2.5% sodium hypochlorite and intracanal medication with calcium hydroxide on cultivable bacteria in infected root canals. J Endod 2007;33(7):800–805. DOI: 10.1016/j.joen.2006.11.023.
Gomaa MA, Elhawary YM, Badr AE. Glycyrrhizin enhances the proliferation of diabetic bone marrow-derived mesenchymal stem cells: A potential therapeutic agent in endodontic surgery. J Contemp Dent Pract 2023;24(7):494–499. DOI: 10.5005/jp-journals-10024-3536.
Wang L, Yang R, Yuan B, et al. The antiviral and antimicrobial activities of licorice, a widely-used Chinese herb. Acta Pharm Sin B. 2015;5:310–315. DOI: 10.1016/j.apsb.2015.05.005.
Tang ZH, Li T, Tong YG, et al. A systematic review of the anticancer properties of compounds isolated from licorice (Gancao). Vol. 81, Planta Med 2015;81:1670–1687. DOI: 10.1055/s-0035-1558227.
Badr AE, Omar N, Badria FA. A laboratory evaluation of the antibacterial and cytotoxic effect of Liquorice when used as root canal medicament. Int Endod J 2011 Jan;44(1):51–58. DOI: 10.1111/j.1365-2591.2010.01794.
Alrashidi MA, Badawi MF, Elbeltagy MG, et al. The effect of glycyrrhizin on the viability and proliferation of dental pulp stem cells compared to intracanal medicaments. J Contemp Dent Pract 2024;25(3):267–275. DOI: 10.5005/jp-journals-10024-3652.
Messier C, Epifano F, Genovese S, et al. Licorice and its potential beneficial effects in common oro-dental diseases. Oral Dis 2012;18: 32–39. DOI: 10.1111/j.1601-0825.2011.01842.x.
Duque TM, Prado M, Herrera DR, et al. Periodontal and endodontic infectious/inflammatory profile in primary periodontal lesions with secondary endodontic involvement after a calcium hydroxide-based intracanal medication. Clin Oral Investig 2019;23(1):53–63. DOI: 10.1007/s00784-018-2401-6.
Xavier ACC, Martinho FC, Chung A, et al. One-visit versus two-visit root canal treatment: Effectiveness in the removal of endotoxins and cultivable bacteria. J Endod 2013;39(8):959–964. DOI: 10.1016/J.JOEN.2013.04.027.
Abi-Rached GPC, Herrera DR, Zaia AA, et al. Efficacy of ethylene-diamine-tetra-acetic acid associated with chlorhexidine on intracanal medication removal: A scanning electron microscopy study. Microsc Res Tech 2014;77(9):735–739. DOI: 10.1002/jemt.22395.
Yoneda M, Kita S, Suzuki N, et al. Application of a chairside anaerobic culture test for endodontic treatment. Int J Dent 2010;2010:1–8. DOI: 10.1155/2010/942130.
Attia DA, Farag AM, Afifi IK, et al. Antimicrobial effect of different intracanal medications on various microorganisms. Tanta Dent J 2015;12(1):41–47. DOI: 10.1016/j.tdj.2014.10.005.
Waltimo T, Trope M, Haapasalo M, et al. Clinical efficacy of treatment procedures in endodontic infection control and one year follow-up of periapical healing. J Endod 2005;31(12):863–866. DOI: 0000164856.27920.85.
Ehrmann EH, Messer HH, Adams GG. The relationship of intracanal medicaments to postoperative pain in endodontics. Int Endod J 2003;36(12):868–875. DOI: 10.1111/j.1365-2591.2003.00735.
Pastorino G, Cornara L, Soares S, et al. Liquorice (Glycyrrhiza glabra): A phytochemical and pharmacological review. Phytotherapy Res. Wiley Onine Library; 2018;32(12):2323–2339. DOI: 10.1002/ptr.6178.
Ng Y ling, Spratt D, Sriskantharajah S, Gulabivala K. Evaluation of protocols for field decontamination before bacterial sampling of root canals for contemporary microbiology techniques. J Endod 2003;29(5):317–320. DOI: 10.1097/00004770-200305000-00001.
Smith CS, Setchell DJ, Harty FJ. Factors influencing the success of conventional root canal therapy—A five-year retrospective study. Int Endod J 1993;26(6):321–333. DOI: 10.1111/j.1365-2591.1993.tb00765.
Akdemir EG, Bakay S, Uzuner S. High pressure processing of licorice drink with respect to quality characteristics, microbial inactivation, and shelf-life extension. J Food Process Preserv 2021;(5):45. DOI: 10.1111/jfpp.15465.
Shinada M, Azuma M, Kawai H, et al. Enhancement of interferon-γ production in glycyrrhizin-treated human peripheral lymphocytes in response to concanavalin A and to surface antigen of hepatitis B virus. Proc Soc Exp Biol Med 1986;181(2):205–210. DOI: 10.3181/00379727-181-42241.
Zhang YH, Yoshida T, Isobe K, et al. Modulation by glycyrrhizin of the cell-surface expression of H-2 class I antigens on murine tumour cell lines and normal cell populations. Immunology 1990;70(3):405–410. PMID: 1696243.
Zhang YH, Isobe K, Nagase F, et al. Glycyrrhizin as a promoter of the late signal transduction for interleukin-2 production by splenic lymphocytes. Immunology 1993;79(4):528–534. PMID: 8406577; PMCID: PMC1421919.
Yasui S, Fujiwara K, Tawada A, et al. Efficacy of intravenous glycyrrhizin in the early stage of acute onset autoimmune hepatitis. Dig Dis Sci 2011;56(12):3638–3647. DOI: 10.1007/s10620-011-1789-5.
Hung CH, Kee KM, Chen CH, et al. A randomized controlled trial of glycyrrhizin plus tenofovir vs. tenofovir in chronic hepatitis B with severe acute exacerbation. Clin Transl Gastroenterol 2017;8(6):e104. DOI: 10.1038/ctg.2017.29.
Mou KH, Han D, Liu WL, et al. Combination therapy of orally administered Glycyrrhizin and UVB improved active-stage generalized vitiligo. Braz J Med Biol Res 2016;49(8). DOI: 10.1590/1414-431X20165354.
Moazeni M, Hedayati MT, Nabili M, et al. Glabridin triggers over-expression of MCA1 and NUC1 genes in Candida glabrata: Is it an apoptosis inducer. J Mycol Med 2017;27(3):369–375. DOI: 10.1016/j.mycmed.2017.05.002.
Peters LB, Van Winkelhoff AJ, Buijs JF, et al. Effects of instrumentation, irrigation and dressing with calcium hydroxide on infection in pulpless teeth with periapical bone lesions. Int Endod J 2002;35(1): 13–21. DOI: 10.1046/j.0143-2885.2001.00447.
Yadav R, Tikku A, Chandra A, et al. A comparative evaluation of the antimicrobial efficacy of calcium hydroxide, chlorhexidine gel, and a curcumin-based formulation against Enterococcus faecalis. Natl J Maxillofac Surg 2018;9(1):52. DOI: 10.4103/njms.njms_47_17.
Van Der Sluis LWM, Versluis M, Wu MK, et al. Passive ultrasonic irrigation of the root canal: A review of the literature. Int Endodont J 2007;40: 415–426. DOI: 10.1111/j.1365-2591.2007.01243.
Paul P, Chandru T, Peedikayil F, et al. Effectiveness of various intracanal medicaments on Candida albicans: An in vitro study. SRM J Res Dent Sci 2020;11(2):82. DOI: 10.4103/srmjrds.srmjrds_20_20.
Nascimento MHM do, de Araújo DR. Exploring the pharmacological potential of glycyrrhizincyrrhizic acid: From therapeutic applications to trends in nanomedicine. Future Pharmacol 2022;2(1):1–15. DOI: 10.3390/futurepharmacol2010001.
Abul N, Karthick K, Mathew S, et al. Herbal extracts in endodontics. J Indian Acad Dent Spec Res 2017;4(1):23. DOI: 10.4103/jiadsr.jiadsr_18_17.
Schmidt K, Melzig Matthias F, Bereswill S, et al. Glycyrrhizincyrrhizic acid decreases gentamicin-resistance in vancomycin-resistant enterococci. Planta Med 2016;82(18):1540–1545. DOI: 10.1055/s-0042-114781.
Tamhankarm K, Dhaded NS, Kore P, et al. Comparative evaluation of efficacy of calcium hydroxide, propolis, and Glycyrrhizincyrrhiza glabra as intracanal medicaments in root canal treatment. J Contemp Dent Pract 2021;22(6):707–712. DOI: 10.5005/jp-journals-10024- 3106.
Abinaya K, Divya R, Asha J, et al. Antimicrobial efficacy of liquorice extracts on most common endodontics pathogens. J Pharm Bioallied Sci 2023;15(5):760–763. DOI: 10.4103/jpbs.jpbs_39_23.
Chittrarasu M, Sathyanarayana SS, Ahamed S, et al. Antimicrobial efficacy of liquorice against Enterococcus faecalis biofilms in various concentrations at time-dependent variables: An in vitro study. J Conserv Dent 2019;22(1):7–11 DOI: 10.4103/JCD.JCD_173_18.
Geeta I, Anjum Husna AS, Sha S, et al. In silico evaluation of the efficacies of two different medicaments against Enterococcus faecalis. Endodontology 2019;31(1):9–12. DOI: 10.4103/endo.endo_88_18.