Abstract
Background: This is a systematic review to assess and provide a pooled effect estimate, if possible, for the effects of triple antibiotic paste as an intra-canal medication for root canal treatment of mature permanent non-vital teeth with apical periodontitis. This review will assess post-operative pain, flare-up incidence, and clinical and radiographic healing. Methods: Nine electronic databases (Pubmed, CENTRAL, VHL, Scopus, EBSCOhost, Web of Science, Trip, OpenGrey, Proquest) were searched along with two major clinical trial registries. Conference proceedings, reference lists and citations of the included studies were also searched. A total of 537 records were identified and 392 were obtained after duplicate removal. Six records were identified after screening and three studies were included after full text eligibility assessment. Results: Three comparators were reported in the included studies: calcium hydroxide paste, 2% chlorhexidine gel and ledermix paste. There was no statistically significant difference between triple antibiotic paste and calcium hydroxide regarding postoperative pain, and clinical and radiographic healing of periapical lesions. There was no difference between triple antibiotic paste and chlorhexidine regarding flare-up incidence. However, triple antibiotic paste reduced the level of post-operative pain more than ledermix, which was statistically significant. Conclusions: The evidence is still insufficient surrounding the use of triple antibiotic paste; therefore more clinical investigations with high levels of evidence and rigorous methodologies are needed.
Highlights
Pulpal tissue infection initiates inflammation of periapical tissues and results in apical periodontitis[1]
Calcium hydroxide has been considered the gold standard for optimally disinfecting root canals; it had been reported that Enterococcus faecalis the dominant bacteria in resistant endodontic infections, is resistant to calcium hydroxide[6]
Study selection After screening 392 records by title and abstract; 386 records were irrelevant, Six records were identified for full text eligibility assessment: one study[14] was excluded due to using another combination of antibiotics; two studies were awaiting assessment due to unavailable full text[15] and no separate results for non-vital teeth[16]
Summary
Pulpal tissue infection initiates inflammation of periapical tissues and results in apical periodontitis[1]. An effective intra-canal medication in the root canal is required to kill any remaining bacteria[4], thereby reducing postoperative pain and inducing periapical healing[5]. Out of three included studies, Johns et al did not evaluate the post-operative pain (i.e. the primary outcome), and rest other two studies did not evaluate the secondary outcome This is a systematic review to assess and provide a pooled effect estimate, if possible, for the effects of triple antibiotic paste as an intra-canal medication for root canal treatment of mature permanent non-vital teeth with apical periodontitis. This review will assess post-operative pain, flare-up incidence, and clinical and radiographic healing. There was no statistically significant difference between triple antibiotic paste and calcium hydroxide regarding postoperative pain, and clinical and radiographic healing of periapical lesions. Conclusions: The evidence is still insufficient surrounding the use of triple antibiotic paste; more clinical investigations with high levels of evidence and rigorous methodologies are needed
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