title: Effect of the addition of chlorhexidine and miswak extract on the clinical performance and antibacterial properties of conventional glass ionomer: an in vivo study.
abstract: BACKGROUND
  Antibacterial restorations can increase the success rate of minimum invasive dentistry especially in young permanent molars with deep carious lesions as an attempt to preserve maximum dental structure and avoid pulp exposure. Further research is warranted to evaluate different antibacterial agents.
  
  
  OBJECTIVE
  This study aimed to evaluate the efficacy of adding chlorhexidine gluconate (CHX) or aqueous miswak (Salvadora persica) extract on the clinical performance and in vivo antibacterial activity of conventional anhydrous glass ionomer cement (GIC).
  
  
  METHODS
  The study was a randomized clinical trial. Sixty young permanent molars, with deep carious lesions in 6- to 9-year-old children were included. After randomization, atraumatic restorative treatment (ART) or stepwise excavation was performed followed by bacterial sampling from the center of the remaining carious dentine in the floor of the pulp. GIC powder was mixed with 0.5% chlorhexidine gluconate liquid in group I; with 100% aqueous miswak in group II; and with deionized water in group III (control). Clinical performance for all groups was assessed at 3, 6, and 9 months. After 9 months, restorations were removed and a second bacterial sample was collected for Streptococcus mutans (S. mutans) quantification and analysis by real-time polymerase chain reaction (PCR) test.
  
  
  RESULTS
  Results showed no statistically significant difference in the success rate of the three groups at the 3-month interval. At 6 and 9 months, however, restoration success was 75% then 60% in group I, 100% then 90% in group II, and 95% then 85% in control group. Group II and the control group showed statistically significant higher survival rates than group I. All groups showed reduction in S. mutans counts in underlying dentine, but the percent reduction was significantly higher in group I. (P < 0.001).
  
  
  CONCLUSIONS
  The addition of CHX and miswak to GIC showed superior antibacterial properties than conventional GIC, without seriously affecting the clinical performance of the restoration until the 6-month follow-up, but failure significantly increased in terms of marginal defects at 9 months with CHX (group 1).
authors.affiliation: Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
authors.forename: Noha Samir
authors.initials: NS
authors.lastname: Kabil
authors.affiliation: Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
authors.forename: Amira Saad
authors.initials: AS
authors.lastname: Badran
authors.affiliation: Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.
authors.forename: Mariem Osama
authors.initials: MO
authors.lastname: Wassel
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects; D002648:Child; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000494:pharmacology*; D004269:DNA, Bacterial / Q000032:analysis; D057087:Dental Atraumatic Restorative Treatment; D003731:Dental Caries / Q000188:drug therapy / Q000382:microbiology; D003804:Dentin / Q000187:drug effects / Q000382:microbiology; D005260:Female; D005899:Glass Ionomer Cements / Q000737:chemistry*; D006801:Humans; D008297:Male; D010936:Plant Extracts / Q000494:pharmacology*; D060888:Real-Time Polymerase Chain Reaction; D032121:Salvadoraceae / Q000737:chemistry*; D013295:Streptococcus mutans / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D005899:Glass Ionomer Cements; D010936:Plant Extracts; C010882:chlorhexidine gluconate; D002710:Chlorhexidine