Journal of International Dental and Medical Research ISSN 1309-100X Antibacterial Efficacy of Secang Heartwood http://www.jidmr.com Putri Yulandari and et al Volume ∙ 12 ∙ Number ∙ 3 ∙ 2019 Page 863 Antibacterial Efficacy of Secang Heartwood (Caesalpinia sappan L.) Extract Solutions Against Enterococcus faecalis Biofilm Obtained from Clinical Isolates Putri Yulandari 1 , Ratna Meidyawati 2 *, Anggraini Margono 2 , Dewa Ayu Npa 2 , Meita Herisa 1 1. Conservative Dentistry Residency Program, Faculty of Dentistry, University of Indonesia, Jakarta, Indonesia. 2. Department of Conservative Dentistry, Faculty of Dentistry, University of Indonesia, Jakarta, Indonesia. Abstract 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. Experimental article (J Int Dent Med Res 2019; 12(3): 863-869) Keywords: Enterococcus faecalis, Biofilm, Secang heartwood extract, Optical density. Received date: 11 February 2019 Accept date: 19 March 2019 Introduction Enterococcus faecalis is the most common bacterial species found in infected root canals after endodontic treatment, root canals after failed endodontic treatments, and persistent infections in root canals. 1 Athanassiadis et al. (2007) have found that E. faecalis causes 4%– 40% of primary endodontic infections. 2 Kauffman et al. (2005) have shown that E. faecalis is associated with 29%–77% of obturated root canal cases. 3 Meanwhile, other studies have found that E. faecalis accounts for 90% of root canal infections after root canal treatment. 4 The main cause of an unsuccessful root canal is the presence of microorganisms in the apical part of the root. 5 Based on the research of Peters et al. (2001), mechanical preparation with various techniques will leave more than 35% of the surface of the untreated root canal, and as a result, bacteria in the root canal are not completely eliminated. 6 A previous research has reported that mechanical root canal preparation with the additional use of irrigation materials can reduce the number of bacteria up to 40% - 60%. 7 Therefore, antibacterial substances in the form of irrigation and medicaments can be used to eliminate the remaining bacteria in the root canal. There are various types of antibacterial substances that have antibacterial properties *Corresponding author: Ratna Meidyawati Department of Conservative Dentistry, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia. E-mail: adnaliza@usim.edu.my