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The Differential Effectiveness of Calcium Hydroxide (Ca(OH)2) Combination with Chlorhexidine Digluconate (CHX) 2% and Clindamycin Hydrochloride 5% Against Enterococcus faecalis (in vitro)

  • Erma Sofiani ,
  • Novita Kartika Sari ,


Background: The main factor causing failure of root canal treatment is re-infection of the bacterium Enterococcus faecalis, so it is necessary to give the right intracanal medicament. Calcium hydroxide (Ca(OH)2) is an intracanal medicament often used in endodontic treatment. To increase the effectiveness of calcium hydroxide, a mixing agent is needed. Mixing agents such as Chlorhexidine digluconate (CHX) 2% (aqueous) and Clindamycin hydrochloride 5% (viscous). The viscous mixing agent can penetrate well into the dentinal tubules, and the antibiotic can fight various root canal endodontic pathogens and dentinal tubules without causing discoloration. This study aims to determine the differential effectiveness of calcium hydroxide combination of chlorhexidine digluconate 2% and Clindamycin hydrochloride 5% as an intracanal medicament against Enterococcus faecalis (in vitro).

Methods: The design was in vitro experimental laboratories that tested the value of turbidity (Optical Density) using a spectrophotometer before and after being treated. Data were analyzed by the Kruskal-Wallis test and then Mann-Whitney U Test.

Results: The positive control group had the largest negative Optical Density (OD) difference, followed by a calcium hydroxide combination of Chlorhexidine digluconate 2%, and the third sequence was a calcium hydroxide combination of Clindamycin hydrochloride 5%. A negative OD difference indicates a decrease in the number of bacterial cells.

Conclusion: There are differences in the effectiveness of the antibacterial of intracanal medicament calcium hydroxide combination of Chlorhexidine digluconate 2% and calcium hydroxide combination of Clindamycin hydrochloride 5%.


  1. Saatchi M, Shokraneh A, Navaei H, Maracy MR, Shojaei H. Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis. J Appl Oral Sci 2014; 22: 356–365. doi: 10.1590/1678-775720140032.
  2. Bhardwaj SB. Role of Enterococci faecalis in failure of Endodontic treatment. Int.J.Curr.Microbiol.App.Sci 2013; 8: 272-277. doi: 10.1016/j.joen.2005.10.049.
  3. Evans M, Davies JK, Sundgvist G. Mechanisms involved in the resistance of Enterococcus faecalis to calcium hydroxide. Int Endod J 2002; 35: 221-228. doi: 10.1046/j.1365-2591.2002.00504.x.
  4. Walton RE, Torabinejad M. Endodontics: principles and practice. Fifth edition. St. Louis, Missouri: Elsevier; 2015. p. 482
  5. Athanassiadis B, Abbott PV, Walsh L. The use of calcium hydroxide, antibiotics and biocides as anti-microbial medicaments in endodontics. Aust Dent J 2007; 52: 864–882. doi: 10.1111/j.1834-7819.2007.tb00527.x.
  6. Mustafa M, Alaajam WH, Azeim AA, Alfayi NA, Alqobty RM, Alghannam S. Diffusion of calcium hydroxide through dentinal tubules of retreated root canals: An in vitro study. Eur J Dent 2018; 12: 386–392. doi: 10.4103/ejd.ejd_77_18
  7. Gomes BPFA, Ferraz CCR, Vianna ME, Rosalen PL, Zaia AA, Teixeira FB, Souza-Filho FJ. In vitro anti-microbial activity of calcium hydroxide pastes and their vehicles against selected microorganisms. Braz. Dent. J 2002; 13: 155-161. doi: 10.1590/s0103-64402002000300002.
  8. Cruz EV, Kota K, Huque J, Iwaku M, Hoshino E. Penetration of propylene glycol into dentine. Int Endod J 2002; 35: 330-336. doi: 10.1046/j.1365-2591.2002.00482.x.
  9. Crespo MP, Pereira K de F, Kuga MC, Porto TS, Armada L. Alkalizing potential and calcium release of residues from intracanal dressing containing calcium hydroxide. Rev. Odontol. UNESP 2018; 47: 383–387. doi: 10.1590/1807-2577.11018
  10. Mohammadi Z, Jafarzadeh H, Shalavi S. Antimicrobial efficacy of chlorhexidine as a root canal irrigant: a literature review. J Oral Sci 2014; 56: 99–103. doi: 10.2334/josnusd.56.99.
  11. Delgado RJR, Gasparoto TH, Sipert CR, Pinheiro CR, Moraes IG, Garcia RB, Bramante CM, Campanelli AP, Bernardineli N. Antimicrobial Effects of Calcium Hydroxide and Chlorhexidine on Enterococcus faecalis. J Endod 2010; 36: 1389–1393. doi: 10.1016/j.joen.2010.04.013.
  12. Cohenca N. Disinfection of Root Canal Systems The Treatment of Apical Periodontitis. 1st ed. Iowa: John Wiley & Sons Inc; 2014.
  13. Patel P, Patel P. Formulation and evaluation of clindamycin HCL in situ gel for vaginal application. Int J Pharm Investig 2015; 5: 50-56. doi: 10.4103/2230-973X.147233
  14. Bharathi Ch, Jayaram P, Sunder RJ, Saravana KM, Bhargavi V, Handa VK, Dandala R, Naidu A. Identification, isolation and characterization of impurities of clindamycin palmitate hydrochloride. J. Pharm. Biomed. Anal. 2008; 48: 1211–1218. doi: 10.1016/j.jpba.2008.08.011.
  15. Zargar N, Abadi MRH, Sabeti M, Yadegari Z, Baghban AA, Dianat O. Antimicrobial efficacy of Clindamycin and triple antibiotic paste as root canal medicaments on tubular infection: An in vitro study. Aust Endod J 2018; 45: 1-6. doi: 10.1111/aej.12288.
  16. Bolla N, Kavuri SR, Tanniru HI, Vemuri S, Shenoy A. Comparative Evaluation Of Antimicrobial Efficacy Of Odontopaste,Chlorhexidine And Propolis As Root Canal Medicaments Against Enterococcus Faecalis And Candida Albicans. J. int. dent 2012; 5: 14–25.
  17. Kritivasan S, Rajan M, Muralidharan NP, Kumar RP. Comparative evaluation of commercially available calcium hydroxide with custom-made calcium hydroxide intercanal medicaments on Enterococcus faecalis. Drug invent. Today 2018; 10: 3446-3449.
  18. Zerella JA, Fouad AF, Spiangberg LSW, Farmington, Conn, Baltimore. Effectiveness of a calcium hydroxide and chlorhexidine digluconate mixture as disinfectant during retreatment of failed endodontic cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100: 756-761. doi: 10.1016/j.tripleo.2005.05.072.
  19. Saber SEM, El-Hady SA. Development of an intracanal mature Enterococcus faecalis biofilm and its susceptibility to some anti-microbial intracanal medications; an in vitro study. Eur J Dent 2012; 6: 43-50.
  20. Surender LR, Bhamini B, Reddy CR, Sainath D, Kumar N, Pallepagu S. Evaluation Of Antibacterial Efficacy Of 2% Chlorhexidine Gel, Calcium Hydroxide And Lincosamide Based Antibiotic Against Enterococcus Faecalis- An In Vitro Study. Open Dent J. 2019; 8: 73-75. doi:10.36106/ijsr
  21. Molander A, Dahlen G. Evaluation of the antibacterial potential of tetracycline or erythromycin mixed with calcium hydroxide as intracanal dressing against E. faecalis in vivo. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96: 744–750. doi: 10.1016/s1079-2104(03)00361-5.
  22. Dewi SRP, Santoso RA, Sujatmiko B, Wibowo IS. Antibacterial activity of various calcium hydroxide solvents against Fusobacterium nucleatum and Enterococcus faecalis. J Phys Conf Ser 2019;1: 1-7. doi:10.4103/SDJ.SDJ_45_20
  23. Kumar A, Tamanna S, Iftekhar H. Intracanal medicaments – Their use in modern endodontics: A narrative review. J Oral Res Rev 2019; 11: 94-99. doi: 10.4103/jorr.jorr_3_19
  24. Deepak BS, Sherin JC, Mallikarjun GK. Removal Of Intracanal Medicaments – A Review. Unique J. Med. Dent. Sci 2015; 3: 14-22.

How to Cite

Erma Sofiani, & Novita Kartika Sari. (2022). The Differential Effectiveness of Calcium Hydroxide (Ca(OH)2) Combination with Chlorhexidine Digluconate (CHX) 2% and Clindamycin Hydrochloride 5% Against Enterococcus faecalis (in vitro). Bali Medical Journal, 11(2), 680–685.




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