Combined Effect of a Mixture of Silver Nanoparticles and Calcium Hydroxide against Enterococcus faecalis Biofilm

The aim of this study was to evaluate the antibiofilm effectiveness of calcium hydroxide (Ca[OH]₂) mixed with 0.02% silver nanoparticles (AgNPs) in comparison with 1 mg/mL triple antibiotic paste (TAP), Ca(OH)₂, and 0.02% AgNPs against Enterococcus faecalis using confocal laser scanning microscopy.

Ninety dentin disks were prepared, sterilized, and inoculated with E. faecalis to establish a 3-week-old biofilm model. The samples received 1 mg/mL TAP, a mixture of Ca(OH)₂ + 0.02% AgNPs, Ca(OH)₂, or 0.02% AgNPs (n = 20/group). Specimens in each group were equally subdivided into 2 groups and incubated for 2 and 4 weeks. Untreated dentin disks (n = 10) were exposed to sterile saline solution and acted as a positive control. Sterile dentin disks (n = 10) were incubated anaerobically in brain-heart infusion broth and served as a negative control. At the end of each observation period, the specimens were stained with LIVE/DEAD BacLight dye (Molecular Probes, Eugene, OR) and analyzed with confocal laser scanning microscopy to determine the proportion of dead cells in the biofilm. Statistical analysis was performed using the generalized linear model repeated measure and Tukey tests (P < .05).

A significantly greater proportion of dead cells was observed in the samples treated with 1 mg/mL TAP (90.39% and 99.41%) and a mixture of Ca(OH)₂ + AgNPs (90.85% and 98.49%) than those in the samples treated with Ca(OH)₂ (76.14% and 91.71%) and AgNPs (62.83% and 88.07%) at 2 and 4 weeks, respectively. A significant difference in the antibiofilm effectiveness was observed among the groups (P < .05), except for 1 mg/mL TAP and the mixture of Ca(OH)₂ + AgNPs (P > .05). All medicaments showed a significant difference in antibiofilm efficacy at the 2 time points.

The mixture of Ca(OH)₂ + AgNPs showed a high antibiofilm effect and was not significantly different from 1 mg/mL TAP. Furthermore, long-term contact between intracanal medicaments and bacterial cells achieved significant antibiofilm efficacy.