{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T14:01:19Z","timestamp":1784815279814,"version":"3.55.0"},"reference-count":0,"publisher":"Caleo","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur Endod J"],"abstract":"<jats:p>Objectives: This study aims to evaluate i) the antimicrobial and immunomodulatory effects of calcium hydroxide (Ca(OH)2) when combined with nonsteroidal anti-inflammatory drugs (NSAIDs) against Enterococcus faecalis (E. faecalis), and ii) to assess the inflammatory and cytocompatibility responses of this combination in human peripheral blood mononuclear cells (PBMCs).\r\nMethods: Three-week-old E. faecalis biofilms were developed on human dentine blocks and subsequently treated for 1 week with Ca(OH)2 alone or combined with 20% ketoprofen (Keto), 20% diclofenac sodium, or gentamicin. Biofilm disruption was assessed using scanning electron microscopy (SEM), while gelatinase (GelE) activity served as a marker of bacterial virulence. Culture supernatants were used to stimulate PBMCs in vitro for 24 hours. The immunomodulatory responses of PBMCs were evaluated using fluorescence microscopy, NucleoCounter NC-202\u2122 cell analysis for live\/total cell counts and viability, and ELISA for TNF-\u03b1 and IL-1\u03b2 secretion.\r\nResults: All medicated groups showed significantly reduced GelE activity compared to untreated controls, with the most substantial suppression observed in the Ca(OH)2 + diclofenac group. While Ca(OH)2 + diclofenac and Ca(OH)2 + gentamicin were most effective in reduceding TNF-\u03b1 and IL-1\u03b2 levels, Ca(OH)2 + diclofenac was also associated with the lowest PBMCs viability and highest cell aggregation. Ca(OH)2 + Keto preserved PBMCs viability while maintaining anti-inflammatory and antimicrobial effects.\r\nConclusion: Combining Ca(OH)2 with diclofenac sodium or Keto enhances the antimicrobial and immunomodulatory efficacy of Ca(OH)2 against E. faecalis biofilms. Ca(OH)2 + diclofenac reduced PBMCs viability, suggesting a strong immunosuppressive effect that may be beneficial in dampening excessive inflammation but also raises concerns regarding cytocompatibility and dose optimization. Ca(OH)2 + keto demonstrated a more favourable balance between antimicrobial activity and biocompatibility, supporting its potential as a non-antibiotic adjunct in intracanal medication protocols.<\/jats:p>","DOI":"10.65717\/eej.2026.26022","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T13:13:05Z","timestamp":1784812385000},"source":"Crossref","is-referenced-by-count":0,"title":["Enhanced Antimicrobial and Immunomodulatory Effects of Calcium Hydroxide Combined with NSAIDs Against Enterococcus faecalis: An In Vitro Study"],"prefix":"10.65717","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8394-2225","authenticated-orcid":false,"given":"Hanan","family":"Abdullatef","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2610-1294","authenticated-orcid":false,"given":"Omar","family":"Omar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1276-4979","authenticated-orcid":false,"given":"Jaffar","family":"Aldandan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2612-7002","authenticated-orcid":false,"given":"Hatem","family":"Abuohashish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1862-2938","authenticated-orcid":false,"given":"Neveen","family":"Ayad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2860-6755","authenticated-orcid":false,"given":"Faisal","family":"Al-onizan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2058-474X","authenticated-orcid":false,"given":"Nada","family":"Al-dossary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7235-0101","authenticated-orcid":false,"given":"Attika","family":"Al-sadah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1944-3843","authenticated-orcid":false,"given":"Deem","family":"Al-suhaibani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"55248","published-online":{"date-parts":[[2026,7,22]]},"container-title":["European Endodontic Journal"],"original-title":[],"link":[{"URL":"https:\/\/eurendodj.com\/index.php\/pub\/article\/download\/419\/436","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eurendodj.com\/index.php\/pub\/article\/download\/419\/436","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T13:13:05Z","timestamp":1784812385000},"score":1,"resource":{"primary":{"URL":"https:\/\/eurendodj.com\/index.php\/pub\/article\/view\/419"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":0,"URL":"https:\/\/doi.org\/10.65717\/eej.2026.26022","relation":{},"ISSN":["2548-0839"],"issn-type":[{"value":"2548-0839","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,22]]}}}