Elimination of Enterococcus faecalis in the root canals using ayurvedic extracts obtained from Calotropis procera : An in vitro study

The elimination of antimicrobial drugs resistant bacteria from root canals, such as Enterococcus faecalis, poses a challenge. These bacteria are predominantly isolated from failed endodontic cases and asymptomatic persistent periapical lesions. The aim of this study was to evaluate the elimination of E. faecalis from root canals using Ayurvedic extracts obtained from the leaves of Calotropis procera. Three forms of Ayurvedic extracts were prepared from the leaves of C. procera, namely Swarasa, Kwaatha and Hima. Initially, a disc diffusion test was conducted to assess the antimicrobial properties of these extracts against E. faecalis, comparing them with 2 routinely used endodontic irrigants. Seventy-two single-rooted mandibular premolars were instrumented up to the Protaper F2 rotary file and subjected to sterilization. The root canals were then cultured with E. faecalis to form a mature biofilm. All sample teeth were irrigated with the study irrigants and instrumented with the WaveOne GOLD large file (0.40/.08v). The debris collected in these files underwent testing for bacterial load using the colony-forming unit (CFU) test. Statistical analysis of the results was performed using One-way ANOVA and the Kruskal-Wallis test (P<0.0001). Ayurvedic extracts yielded significantly better results compared to control irrigants in the disc diffusion assay. However, all study irrigant groups performed efficiently against E. faecalis with no statistically significant difference observed using the CFU test in root canals. Ayurvedic extracts obtained from the leaves of C. procera were as effective as standard root canal irrigants (NaOCl and CHX) in eliminating E. faecalis from the root canals.