Herbal products are renewable resources having advantages of easy availability, cost effectiveness, increased shelf life, low toxicity and lack of reported microbial resistance. While in vivo observations of herbal products appear promising, clinical trials are needed to evaluate the biocompatibility and safety factor before they can conclusively be recommended as intracanal medicaments and irrigants. Products made from Azadirachta indica have been used in India since two millennia. As a root canal irrigant, Azadirachta indica extract has exhibited better antimicrobial properties than Sodium hypochlorite.

Objective: To clinically evaluate pain on using Azadirachta indica as an intracanal medicament in comparison with standard intracanal medicaments

Materials and methods:

Fifteen patients with chief complaint of pain were evaluated prior to endodontic treatment using the Heft–Parker visual analogue scale. The patients were divided randomly into three different groups as follows: Group A– 5 patients receiving Calcium hydroxide and Chlorhexidine as intracanal medicament, Group B– 5 patients receiving Calcium hydroxide and saline and Group C– 5 patients receiving Azadirachta indica (Neem) powder and saline. This was followed by access cavity preparation, working length determination and intracanal medicament placement. At the third evaluation, after one week, obturation was undertaken if the patient was asymptomatic.

Results: Calcium hydroxide with Chlorhexidine reduced pain significantly better than Azadirachta indica extract.

Clinical significance: As an intracanal medicament, Azadirachta indica extract is less efficacious than Calcium hydroxide combinations in reducing interappointment pain. This study does not negate the beneficial effects of Azadirachta indica, but Neem when used in a dried leaf powder form with saline does not have a strong analgesic property