Antibacterial efficacy of secang heartwood (Caesalpinia sappan L.) extract solutions against Enterococcus faecalis biofilm obtained from clinical isolates

Enterococcus faecalis is the common bacteria causing persistent root canal infections, and its virulence is 1000 times stronger in biofilms than planktons. Chlorhexidin is a golden standard irrigation material in eliminating E. faecalis in endodontic treatment, however it has cytotoxicity, which can increase the number of free radicals with risk of cell death. Due to some side effect of chemical irrigation solutions used during root canal preparation, it is useful to seek for herbal alternatives with better profile of side effects and equivalent efficacy. Thus, this study aimed to analyze the efficacy of secang heartwood extract in eliminating E. faecalis biofilm. The study sample was the patient with a diagnosis of chronic apical periodontitis and chronic apical abscess. Bacterial growth of E. faecalis clinical isolates bacteria was seen from 4 patients (total 7 patients) and confirmed through bacterial DNA with conventional PCR and electrophoresis tests. Biofilms were exposed to various treatments: secang heartwood in four different concentrations (625, 1,250, 2,500, and 5,000 μg/mL) and 2% CHX (standard irrigation medium). The antibacterial effects were assessed based on the optical density (OD) value obtained using an ELISA reader which reflects the amounts of bacterial cells. The mean OD value from five concentrations: 625, 1,250, 2,500, 5,000 μg/mL and 2% CHX were identified (0,037, 0,084, 0,126, 2,007 and 0,037) p > 0.05. Secang heartwood has an antibacterial property that is effective in eliminating E. faecalis biofilm. Secang heartwood concentration of 625 μg/mL had the same antibacterial efficacy as 2% CHX solution, whereas a concentration of 5,000 μg/mL had the lowest efficacy. The results of this study are expected to add new insight and knowledge in the field of endodontics with the use of natural ingredients that are not toxic but have antibacterial efficacy against E.faecalis biofilms.