Abstract
The purpose of this study was to evaluate the pH, solubility and antimicrobial action of Calcium Hydroxide Paste (CH), Double Antibiotic Paste (metronidazole+ciprofloxacin-DAP), calcium hydroxide added to DAP (CH/DAP) and Triple Antibiotic Paste (metronidazole + ciprofloxacin+minocycline-TAP). pH (n=10) were measured by pHmeter. Root canals of acrylic teeth (n=10) were filled with the above-mentioned intracanal-dressings, immersed in ultrapure water, and solubility was measured by the difference between the initial and final volume (7,15 and 30 days) by using micro-computed tomography. Enterococcus faecalis biofilm was induced on bovine dentin disc surfaces (n=20), and treated with the pastes for 7 days. Percentage bacterial viability was verified by confocal microscope, with LIVE/DEAD dye. CH and CH/DAP presented the highest pH values. Regarding solubility, after 7 days, antibiotic groups presented significant volume loss. CH and CH/DAP showed no statistical difference compared with the Control in antimicrobial action against E. faecalis biofilm. However, TAP and DAP presented a significant percentage reduction in bacterial population. Due to high solubility of the pastes, renewing antibiotic dressings every 7 days, or using the medications for this period in regeneration protocols is recommended. DAP is indicated for killing E. faecalis in biofilm because it has antimicrobial action similar to TAP. Adding Calcium Hydroxide to DAP significantly decreased its antimicrobial action. In spite of its the low solubility and high pH values, the CH paste showed a low level of antimicrobial action against E. faecalis in biofilm.
Highlights
Pulp necrosis of immature permanent teeth is a clinical situation in endodontics associated with traumatic injuries, anatomic anomalies and caries in young patients [1]
Treatments have been proposed for artificial apical closure performed in one visit, with mineral trioxide aggregate (MTA) that induced an artificial barrier, and treatment with calcium hydroxide (CH) in multiple-visits, which stimulated the formation of a hard tissue barrier [4]
An alternative that has hardly been studied is the interaction of the antimicrobial action of Double Antibiotic Paste (DAP) with the biological benefits of calcium hydroxide
Summary
Pulp necrosis of immature permanent teeth is a clinical situation in endodontics associated with traumatic injuries, anatomic anomalies and caries in young patients [1]. Regenerative endodontic protocols (REPs) are intended to promote continued root maturation and apical closure. Because of its broad spectrum of action against oral microorganisms and its ability to disinfect dentin [6,7]., Triple Antibiotic Paste (TAP), a combination of metronidazole, ciprofloxacin and minocycline has been widely used. Minocycline can cause tooth discoloration, but the use of only metronidazole and ciprofloxacin, called Double Antibiotic Paste (DAP), solved this problem [8]. An alternative that has hardly been studied is the interaction of the antimicrobial action of DAP with the biological benefits of calcium hydroxide. Based on the foregoing, the aim of the present study was to evaluate the pH, percentage of volumetric loss, the antimicrobial effect of different intracanal dressings used in regenerative procedures, on mono specie (Enterococcus faecalis) biofilms. The null hypothesis tested was that the pastes would have similar values of pH, volumetric loss and antimicrobial effect
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