Comparing Amla (Emblica Officinalis) and 3% Sodium Hypochlorite Against Enterococcus Faecalis in Root Canal Treatment: a Randomized Controlled Trial

The primary objective of endodontic therapy is the complete elimination of microorganismsfrom the root canal system. Successful root canal treatment (RCT) depends on effectivecleaning, shaping, and disinfection of the root canal system. During canal preparation,the removal of bacterial toxins and the smear layer is essential to minimize themicrobial load. However, because bacteria and dentinal debris may remain within thecomplex anatomy of the root canal system, mechanical instrumentation alone is ofteninsufficient to achieve complete disinfection. Elimination of the infection beforeobturation is critical for improving treatment success and promoting periapical healing.Enterococcus faecalis is one of the microorganisms most frequently associated withpersistent root canal infections and endodontic treatment failure. It is a facultativeanaerobic, Gram‐positive coccus capable of surviving under harsh environmentalconditions. E. faecalis can persist in nutrient‐deprived environments, exhibitsresistance to several intracanal medicaments, and tolerates alkaline conditions with a pHof up to 11.5, making it particularly difficult to eradicate.To enhance microbial elimination, root canal preparation is routinely supplemented withirrigating solutions. Sodium hypochlorite (NaOCl) is the most widely used endodonticirrigant because of its broad‐spectrum antimicrobial activity and tissue‐dissolvingproperties. It is commonly used in concentrations ranging from 0.5% to 5.25%. AlthoughNaOCl is considered the gold standard irrigant, higher concentrations are associated withincreased cytotoxicity, tissue irritation, and caustic effects. Accidental extrusionbeyond the root apex may result in severe damage to the surrounding periodontal andperiapical tissues.In view of these limitations, there is growing interest in identifying natural irrigantsthat provide effective antimicrobial activity with fewer adverse effects. Emblicaofficinalis (Amla) is a medicinal plant with well‐documented antibacterial,anti‐inflammatory, antioxidant, and analgesic properties. It has been widely used intraditional medicine and is rich in vitamin C and other bioactive compounds. Several invitro studies have demonstrated significant antibacterial activity of Emblica officinalisagainst Enterococcus faecalis. In addition, it is inexpensive, readily available, and hasno reported toxicity when used appropriately.The present randomized controlled trial aims to compare the antibacterial efficacy ofEmblica officinalis with 3% sodium hypochlorite as root canal irrigants duringnon‐surgical root canal treatment of mature single‐rooted anterior teeth with pulpnecrosis and apical periodontitis. Antibacterial efficacy will be assessed by measuringbacterial colony‐forming units (CFU/mL), and clinical outcomes will be evaluated byassessing pain on percussion, tenderness on palpation, and the presence of a sinus tractfollowing treatment.