Terminalia Chebula for Root Canals: Does it Help?

observational-study PMID: 37001714

Quick Summary: Research suggests that a plant extract called Terminalia chebula might help strengthen the bond between a tooth filling and the tooth after a root canal, though it wasn't as good at killing bacteria as a standard treatment.

What The Research Found

Scientists tested Terminalia chebula, a plant extract, to see if it could help with root canals. They found that using it as a final rinse after cleaning the tooth helped the filling stick better to the tooth. However, it wasn't as effective at killing bacteria as the usual cleaning solution.

Study Details

Who was studied: The study used 60 extracted human teeth.

How long: The study looked at the immediate effects of the treatments.

What they took: The teeth were treated with different cleaning solutions:

Standard cleaning solution (sodium hypochlorite and EDTA)
Sodium hypochlorite with Terminalia chebula
Sodium hypochlorite with other substances (Malachite green and Indocyanine green)

What This Means For You

If you need a root canal, this research suggests that Terminalia chebula might help make the filling stronger. This could potentially make the filling last longer. However, it's important to remember that the study was done in a lab, not in people's mouths. More research is needed to confirm these findings.

Study Limitations

The study was done in a lab, not on real people.

The study only looked at the immediate effects, not how long the fillings lasted.

The exact amount of Terminalia chebula used wasn't specified.

The study didn't compare Terminalia chebula to other treatments directly.

Key Findings

This 2023 in vitro study found that 5.25% NaOCl + Terminalia chebula (Group 4) significantly improved push-out bond strength (PBS) of glass fiber posts (GFP) to root dentin compared to other disinfectants, particularly in the coronal third (8.71 ± 0.25 MPa). However, its antimicrobial efficacy against E. faecalis was lower than the conventional NaOCl+EDTA protocol (Control Group 1: 0.11 ± 0.01 CFU/mL), with T. chebula reducing survival rates by ~0.18 ± 0.03 CFU/mL. Malachite green (Group 3) and indocyanine green (Group 2) showed inferior bond strength and higher E. faecalis survival rates (0.44 ± 0.08 and 0.52 ± 0.10 CFU/mL, respectively).

Study Design

Type: Observational in vitro study.
Sample Size: 60 human single-rooted premolars.
Groups: 4 groups (n=10 each):
Control: 5.25% NaOCl + 17% EDTA
5.25% NaOCl + ICG
5.25% NaOCl + MG
5.25% NaOCl + T. chebula
Duration: E. faecalis cultures incubated overnight (37°C); bond strength evaluated immediately post-preparation.
Methods: Microbial survival rates quantified via CFU/mL counts. PBS tested using universal testing machine; failure modes analyzed with stereomicroscopy. Statistical analysis: One-way ANOVA and Tukey tests (p=0.05).

Dosage & Administration

T. chebula: 5.25% NaOCl combined with unspecified concentration of T. chebula extract, used as a final post-space irrigant.
Comparator Agents:
17% EDTA (Control)
Indocyanine green (ICG)
Malachite green (MG)
Administration: Irrigation protocols applied after root canal preparation with ProTaper universal system and obturation with Gutta-percha/AH Plus sealer.

Results & Efficacy

Antimicrobial Efficacy:
Control (NaOCl+EDTA) most effective (0.11 ± 0.01 CFU/mL).
T. chebula reduced E. faecalis survival to 0.18 ± 0.03 CFU/mL, outperforming ICG (0.52 ± 0.10) and MG (0.44 ± 0.08) (p<0.05).
Bond Strength:
T. chebula (Group 4) showed highest PBS in coronal third (8.71 ± 0.25 MPa).
ICG (Group 2) had lowest PBS in apical third (1.21 ± 0.71 MPa).
NaOCl+EDTA (Control) showed moderate PBS (6.12 ± 0.44 MPa coronal; 2.31 ± 0.56 MPa apical).
Failure Mode: Mixed/adhesive failures observed in all groups.

Limitations

In vitro model: Does not replicate clinical conditions (e.g., salivary flow, immune responses).
Small microbial sample size: Only n=5 per group for E. faecalis analysis.
Short exposure time: Disinfectant contact duration unspecified; prolonged application may alter outcomes.
Lack of T. chebula standardization: Concentration and active constituents (e.g., tannins, gallic acid) not detailed.
No long-term data: Bond strength and microbial effects beyond immediate post-treatment unknown.

Clinical Relevance

While T. chebula did not match EDTA’s antimicrobial potency, its ability to enhance GFP bond strength in the coronal root suggests potential as an adjunct disinfectant in post-space preparation. Practitioners should note that conventional NaOCl+EDTA remains superior for eliminating E. faecalis. However, T. chebula may offer benefits in improving bond integrity where EDTA’s demineralizing effects are a concern. Further clinical trials are needed to validate these findings in vivo and optimize dosing protocols.

Note: This analysis is limited to the specified study; broader conclusions about T. chebula’s systemic or oral health benefits require additional research.