Antibiotic Paste Research Articles

Comparative Efficacy of Intracanal Medicaments in Healing Apical Periodontitis: Insights from a Comprehensive Clinical Study

ABSTRACT Background: Apical periodontitis is a prevalent condition that necessitates effective intracanal medicaments for successful endodontic therapy. Materials and Methods: A randomized controlled clinical trial was conducted on 120 patients diagnosed with apical periodontitis. The patients were randomly assigned to three groups, Group A (calcium hydroxide), Group B (triple antibiotic paste), and Group C (chlorhexidine gel), with 40 patients in each group. Each medicament was placed in the root canal after standard endodontic procedures, and the patients were evaluated at 1, 3, and 6 months using radiographic assessment and clinical examination. The primary outcome measure was the reduction in lesion size, and secondary outcomes included pain relief and healing time. Results: After 6 months, Group B (triple antibiotic paste) showed the highest reduction in lesion size, with an average decrease of 75%, followed by Group C (chlorhexidine gel), with a 60% reduction, and Group A (calcium hydroxide), with a 50% reduction. Pain relief was observed in 85% of patients in Group B, 75% in Group C, and 65% in Group A. The average healing time was the shortest in Group B (4 months), compared to Group C (5 months) and Group A (6 months). Conclusion: Triple antibiotic paste demonstrated superior efficacy in healing apical periodontitis compared to calcium hydroxide and chlorhexidine gel.

Antibiofilm efficacy of a calcium silicate-based intracanal medicament against Fusobacterium nucleatum strains

This study evaluated the antibiofilm efficacy of a calcium silicate-based intracanal medicament (Bio-C Temp) against Fusobacterium nucleatum (F. nucleatum). Dentin slices (n = 88) were inoculated with F. nucleatum biofilms and divided into experimental groups (n = 24 each) treated with Bio-C Temp, triple antibiotic paste (TAP), or Ca(OH)2 for 1 or 2 weeks. Untreated dentin slices exposed to saline served as a positive control, while sterile dentin slices incubated anaerobically served as a negative control. Bacterial viability was assessed using confocal laser scanning microscopy after staining with LIVE/DEAD®BacLight™ dye. Samples treated with TAP demonstrated the highest percentage of dead bacteria (95%). The antibiofilm effect of TAP and Bio-C Temp significantly increased from Week 1 to Week 2. At Week 2, samples treated with Bio-C Temp showed a significantly higher percentage of dead bacteria (75.25%) than those treated with Ca(OH)2 (58.65%). TAP showed superior efficacy against F. nucleatum biofilms. After an application time of 2 weeks, the antibiofilm efficacy of Bio-C Temp was superior to that of Ca(OH)2.

Antibacterial effects of different low-level doses of double antibiotic paste on multispecies biofilms in regenerative endodontics: A confocal laser microscopy study

Antibacterial effects of different low-level doses of double antibiotic paste on multispecies biofilms in regenerative endodontics: A confocal laser microscopy study

A comparative evaluation of the antimicrobial efficacy of triple antibiotic paste, clindamycin, and linezolid as an intracanal medicament against Enterococcus faecalis: An in vitro study

ABSTRACT Aim: The aim of the present study was to evaluate and compare the antimicrobial efficacy of three medicaments, triple antibiotic paste (TAP), clindamycin (CLID), and linezolid (LZ) against Enterococcus faecalis, using spectrophotometry. Methods: Seventy-two single-rooted human premolars were collected and prepared using standard protocol and were decoronated to obtain standardized lengths. A pure culture of E. faecalis (ATCC 29212) was procured, grown on blood agar, obtained using a wired loop, and suspended in brain heart infusion (BHI) broth for 24 h. After contaminating the canals with E. faecalis, the prepared samples were divided into three groups, with 24 teeth each, based on the intracanal medicament used, Group A: TAP (ciplox×500 mg, metrogyl 400 mg, minoz 100 mg) + normal saline (NS), Group B: CLID (capsule clid 150) + NS, Group C: LZ (Lizoforce, dry syrup) + NS. The medicaments were syringed into the roots and which were then incubated. After 24 h, 12 samples per group were thoroughly rinsed for removal of intracanal medicaments (ICMs), and instrumented using #4 GG drill to obtain dentinal shavings, which were allowed to fall into sterile BHI broth. The turbidity of the broth was assessed and the optical density (OD) was recorded using spectrophotometer to estimate the concentration of E. faecalis after 1 day. After a period of 7 days, the remaining 12 samples per group underwent identical processing. Results: At the end of day 1, all three antibiotics presented comparable values of OD indicating comparable antimicrobial efficacy. Group-wise comparison revealed that TAP continued to be superior to the other two antibiotics even at the end of 7 days. However, the difference was significant only between TAP and LZ with no significant difference between TAP and CLID and between CLID and LZ. Conclusion: The present study concludes that the use of single-antibiotic CLID and LZ may serve as an effective alternative to the multidrug combination TAP, as an ICM.

Effectiveness of XP-Endo Finisher, Endoactivator, and PUI agitation in the penetration of intracanal medicaments into dentinal tubules: A confocal laser scanning microscope analysis.

This investigation assessed the impact of irrigation activation systems on the depth of penetration of intracanal medicaments into dentinal tubules. Ninety-six mandibular premolar teeth were prepared using ProTaper Next up to size X3. The teeth were randomly divided into four groups based on the final irrigation activation systems (n=24): group 1: EndoActivator, group 2: XP-Endo Finisher, group 3: Passive ultrasonic irrigation (PUI), and group 4: control. After the final irrigation, all the samples were divided into two subgroups (n=12): subgroup A: calcium hydroxide (Ca(OH)2 ) and subgroup B: modified triple antibiotic paste (mTAP). Statistical analysis involved three-way analysis of variance (ANOVA). EndoActivator, XP-Endo Finisher, and PUI activation methods significantly increased the penetration of intracanal medicaments compared to conventional needle irrigation (P<0.05). The XP-Endo Finisher group exhibited the highest penetration percentage and maximum penetration depth, showing a statistically significant difference from the EndoActivator group (P<0.001). No significant difference was observed between XP-Endo Finisher and PUI, nor between PUI and EndoActivator (P>0.05). mTAP showed a higher percentage of dentinal tubule penetration than Ca(OH)2, although no significant difference was found in maximum penetration depth. The coronal region demonstrated the highest penetration percentage and depth, while the apical region showed the lowest. This study showed the effectiveness of XP-Endo Finisher in improving the penetration of intracanal medicaments into dentinal tubules. The findings emphasize the importance of selecting appropriate irrigation activation systems to improve treatment outcomes in endodontics. By demonstrating the effectiveness of advanced systems like XP-Endo Finisher, this research supports their integration into routine clinical practice for better endodontic success.

Comparative Evaluation of Penetration Depth and Antimicrobial Efficacy of Calcium Hydroxide, MAS Paste, Nitrofurantoin, and Levonadifloxacin against Enterococcus faecalis: A Confocal Laser Scanning Microscopic Study

Abstract Aim: The most prevalent species in persistent and secondary infections linked to endodontic failure is Enterococcus faecalis. The objective of this in vitro investigation was to assess the antibacterial efficacy and penetration depth of calcium hydroxide, nitrofurantoin, levonadifloxacin, and a mixture of antibiotic and steroid paste (MAS paste) against E. faecalis. Materials and Methods: A total of 40 single-rooted tooth samples were decoronated apically and coronally to yield 10 mm root sections. All tooth samples were biomechanically prepared and were inoculated with E. faecalis bacteria for 21 days. The study involved four groups, each containing 10 teeth as follows: group 1—calcium hydroxide, group 2—MAS paste consisting of ciprofloxacin, metronidazole as antibiotics, and dexamethasone as corticosteroid, group 3—nitrofurantoin, and group 4—levonadifloxacin. For 7 days, the corresponding intracanal medications were injected into the canals. On the seventh day, dentinal debris was extracted from the blocked lumen to quantitatively evaluate the antibacterial activity of the experimental medications. The depth of penetration (DOP) of medicaments under study was assessed by viewing 1 mm thick horizontal sections under a confocal laser scanning microscope, one from each of the four subgroups. The sections were stained with florescent stain before being under the microscope. Results: Results showed that on day 7, the mean colony-forming units were lowest for levonadifloxacin, indicating the highest antimicrobial efficacy (P &lt; 0.05). This was followed by nitrofurantoin, MAS paste, and calcium hydroxide. Additionally, levonadifloxacin achieved the greatest DOP, followed by nitrofurantoin, MAS paste, and calcium hydroxide. These results suggest a correlation between DOP and antimicrobial efficacy. Conclusion: Within the confines of this study, it can be concluded that levonadifloxacin exhibited the highest antimicrobial efficacy, even at a low concentration of 8 µg/mL. Therefore, it can serve as a viable intracanal medicament in endodontic therapy.

Healing of periapical lesion by non-surgical endodontic therapy: A case report

Periapical lesions often arise as a consequence of pulpal diseases, and most inflammatory periapical lesions are initially managed with conservative non-surgical methods. The success of root canal treatment hinges on the thorough cleaning, shaping, and obturation of the root canal system. Calcium hydroxide and triple antibiotic paste (TAP) are preferred intracanal medicaments due to their effective antibacterial properties. This case report details the non-surgical management of a periapical lesion associated with the mandibular central incisors in a 18-year-old female who presented with periodic swelling and pus drainage in the labial sulcus, due to traumatic accident in the that area. The case underscores the effectiveness of using calcium hydroxide and TAP as interappointment endodontic dressings, leading to favorable clinical and radiographic outcomes for managing a periapical radiolucency.

Synthesis and Characterization of Nanosilica-Coated Antibiotics, TAP: A Comprehensive Study Utilizing XRD, EDS, FTIR, SEM, and TEM – Invitro Study

Abstract Aim: To synthesize nanosilica and investigate its properties, focusing on its interaction with antibiotics, particularly triple antibiotic paste (TAP). Various analytical techniques, including X-ray diffraction (XRD), energy-dispersive X-ray spectroscopy (EDS), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and transmission electron microscopy (TEM), were employed. Materials and Methods: The synthesis of nanosilica involved the meticulous combination of ammonia, ethanol, water, and tetraethyl orthosilicate in a sterile conical flask, followed by centrifugation and drying. Nanosilica was further explored by being combined with antibiotics, including doxycycline, Flagyl, and ciprofloxacin, to create novel antibiotic-coated variants. These combinations were subjected to various analytical techniques to assess their properties. Results: The FTIR spectra of silica nanoparticles revealed specific peaks associated with silicon-oxygen bonds and siloxane structures. Nanosilica coated with antibiotics exhibited distinctive peaks indicating the presence of organic components and Si-O-Si bonds, offering insights into their potential applications in drug delivery systems. SEM images displayed uniformly dispersed spherical particles, while TEM images and histograms provided valuable data about the size distribution of nanosilica, essential for applications like drug delivery. XRD analysis confirmed the crystalline nature of silica nanoparticles and offered insights into their crystallographic structure. Conclusion: This comprehensive study showed the synthesis and characterization of nanosilica and its antibiotic-coated variants, with a particular focus on TAP. The findings contribute to our understanding of their structural and compositional properties, providing potential avenues for applications in diverse scientific and technological fields, including drug delivery and nanotechnology.

Management Of Large Periapical Lesion With A Noninvasive Approach: A Case Report

Periapical lesions develop as a sequela to pulpal diseases. The majority of inflammatory periapical lesions are initially treated with conservative non-surgical procedures. The success of root canal treatment is based on thorough cleaning, shaping and obturation of the root canal system. Calcium hydroxide and triple antibiotic paste (TAP) are recommended as intracanal medicaments due to its antibacterial properties. This case report describes the non-surgical management of a large cyst-like periapical lesion in relation to the maxillary lateral incisor of a 19-year-old male with the chief complaint of periodic swelling and pus drainage from the palatine region with a history of a traumatic accident in the same area. The present case highlights the use of calcium hydroxide and TAP as an interappointment endodontic dressing for non-surgical management of large periapical radiolucency, which resulted in favourable clinical and radiographic outcomes

The Impact of Silver Nanoparticles’ Size on Biofilm Eradication

IntroductionEfficient intracanal disinfection is required for a successful regenerative endodontic treatment. Thus, this study aimed to identify the silver nanoparticles’ (NPs) size (AgNPs) with the highest antibiofilm efficacy when mixed with calcium hydroxide [Ca(OH)2] to eradicate an in vitro endodontic biofilm. MethodsThe various sizes of AgNPs and mixtures were characterized by scanning electron microscopy, transmission electron microscopy, and ultraviolet-visible spectroscopy. A total of 168 dentin root segments were prepared, sterilized, and inoculated for 3 weeks with Actinomyces naeslundii and Fusobacterium nucleatum. Samples were randomly allocated to 4 experimental groups (n = 28/group): 2 nm AgNPs + 35% Ca(OH)2, 5 nm AgNPs + 35% Ca(OH)2, 10 nm AgNPs + 35% Ca(OH)2, and 35% Ca(OH)2 alone. Samples exposed to saline and triple antibiotic paste (TAP) acted as negative and positive control groups, respectively. After 1 and 2 weeks, samples were stained with LIVE/DEAD BacLight dye and examined under a confocal laser scanning microscope to determine the proportion of dead bacteria. ResultsThe characterization procedure revealed a spherical NP's structure with minor aggregations. Except for Ca(OH)2 group, all groups had significantly higher antibiofilm efficacy at 2 weeks. Both the 10 nm mixture (99.5%) and TAP (99.2%) exhibited the highest antibiofilm efficacy at 2 weeks and were not significantly different from one another (P > .05). No significant difference was noted between the 2 and 5 nm mixtures at 1 week (81% and 84%) and 2 weeks (89% and 91%). ConclusionThe 10 nm AgNPs (0.02%) + 35% Ca(OH)2 mixture exhibited the highest antibiofilm efficacy at 2 weeks compared to all other mixtures at both observation periods. Interestingly, the 10 nm mixture performed similarly to TAP at 2 weeks. Excluding Ca(OH)2 group, longer application significantly improved the antibiofilm efficacy of all tested medicaments. Clinical RelevanceThe 10 nm AgNPs + 35% Ca(OH)2 mixture revealed promising results as an intracanal medicament in the regenerative endodontic treatment protocol.

Analysis of tooth staining by endodontic medication in root canal therapy using spectrophotometry.

The assessment of the discoloration caused by calcium hydroxide, triple antibiotic paste, and chlorhexidine gel when used as intra-canal medicaments in teeth undergoing root canal treatment is of interest. The study measured the discoloration over seven and fourteen days using a spectrophotometer. After obtaining ethical clearance, ninety anterior teeth requiring root canal therapy were selected based on eligibility criteria. Using basic randomization, participants were split up into three groups, each consisting of thirty patients. The colorimeter was used to measure preoperative, one and two weeks following the medication's removal. All groups showed significant discoloration, with 2% chlorhexidine gel (p≤0.03) and triple antibiotic paste (p≤0.02) causing the highest discoloration in the central region of teeth. The discoloration was inversely correlated with the remaining dentin thickness. Thus, intracanal medicaments used for endodontic treatment cause tooth discolouration.

Microbiological effect of different intracanal medicaments

The effect of Triple antibiotic paste (TAP), Modified triple antibiotic paste (MTAP) and its combination with Himalayan pink rock salt (HPRS) against Enterococcus faecalis is of interest to dentists. Intracanal medicaments were placed on specimens infected with EF and incubated. Antibacterial efficacy was evaluated by colony forming unit method on the 1st, 3rd, and 7th day. MTAP + HPRS showed the best results against E. faecalis on days 1 and 3 which were statistically significant. All subgroups showed zero colonies on day 7. HPRS combined with TAP/MTAP showed more antibacterial activity than TAP/MTP used without HPRS as intracanal medicament due to its synergistic effect. Hence, a modified triple antibiotic mixed with Himalayan pink rock salt can be used as a potential intracanal medicament with 2% Chlorhexidine.

Single-visit versus multi-visit endodontic retreatment: A systematic review of outcomes in patients with secondary endodontic infection

Abstract Introduction: Secondary endodontic infections present intricate challenges in dental practice, necessitating effective retreatment strategies. The current systematic review aimed to critically evaluate the outcomes of single-visit versus multi-visit endodontic retreatment in patients with secondary endodontic infections. Materials and Methods: The current systematic review was registered in the Open Science Framework database and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Searches were conducted in PubMed/Medline, Scopus, and Web of Science databases for articles published until April 2023. The inclusion criteria for the current systematic review were clinical trials reporting the comparison of nonsurgical single-visit versus multiple-visit endodontic retreatments with predictive outcome. The Cochrane scale was used to assess the risk of bias. Results: Six studies were included in the systematic review. Four studies reported the incidence of postoperative pain, and two studies reported the periapical lesion healing after single- and multiple-visit endodontic retreatments with an 18- and 24-month follow-up. Three studies showed a low risk of bias, one study showed unclear risk of bias, and two studies showed a high risk of bias. Conclusion: Comparative analyses indicated that single-visit endodontic retreatment yielded comparable postoperative pain levels and healing outcomes as retreatment conducted over multiple visits. Notably, the utilization of intracanal medicaments such as calcium hydroxide and triple antibiotic paste demonstrates promise in mitigating postoperative pain subsequent to retreatment procedures.

The Effect of Intracanal Medicaments on the Healing of Apical Periodontitis.

Apical periodontitis is a prevalent inflammatory condition affecting the tissues surrounding the root apex of a tooth. The selection of appropriate intracanal medicaments for its management remains a topic of ongoing research. This study aimed to investigate the effect of calcium hydroxide and triple antibiotic paste on the healing of apical periodontitis. A total of 304 teeth from 215 patientswith apical periodontitis were included in this observational study. Patients were randomly assigned to three groups: Group A (calcium hydroxide), Group B (triple antibiotic paste), and Group C (control). Baseline characteristics were recorded, and follow-up assessments were conducted at three, six, and 12 months. Parameters such as reduction in apical radiolucency, presence of periapical healing, bleeding on probing (BOP) percentage, clinical attachment level (CAL), and periodontal depth were evaluated. At baseline, the three groups exhibited similar distributions of apical periodontitis parameters. Over the 12-month follow-up, Group A and Group B demonstrated a significant reduction in apical radiolucency compared to Group C (p < 0.05). The presence of periapical healing was more frequent in Group A (85%) and Group B (80%) compared to Group C (60%). Group A showed the lowest mean BOP percentage (15.2 ± 3.5), followed by Group B (18.6 ± 4.2) and Group C (22.1 ± 4.8). Similarly, Group A demonstrated the highest mean CAL (5.8 ± 0.9 mm) and the lowest mean periodontal depth (3.2 ± 0.6 mm). Group B exhibited intermediate values for CAL (5.2 ± 1.1 mm) and periodontal depth (3.6 ± 0.8 mm). In this study, both calcium hydroxide and triple antibiotic paste demonstrated potential therapeutic effects in promoting healing and reducing apical radiolucency compared to the control group. Calcium hydroxide exhibited the most favorable outcomes, with a higher presence of periapical healing, lower BOP percentage, and superior CAL and periodontal depth measurements. These findings contribute to the understanding of intracanal medicaments' effectiveness in apical periodontitis management.

Assessing Cell Viability: Comparative Analysis of Calcium Hydroxide, Triple Antibiotic Paste, and Their Synergistic Impact on human Dental Pulp Stem Cells

Abstract Objective The American Association of Endodontists recommends the use of calcium hydroxide (Ca(OH)2) or triple antibiotic paste (TAP) as preferred medicaments in regenerative endodontic treatment. Although both medicaments showed an excellent antibacterial property, their impact on the viability of human dental pulp stem cells (hDPSCs) when used in combination remains uncertain. Previous studies have indicated that at certain concentrations, both Ca(OH)2 and TAP can be harmful to cells. Therefore, it is aimed to assess the effects of Ca(OH)2, TAP, and their combined application on the viability of hDPSCs in this study. Materials and Methods Primary cultured hDPSCs, reaching 80% confluency and at passages 3rd to 4th, were subjected to 24-hour starvation. Subsequently, they were cultured in media supplemented with Ca(OH)2, TAP at 0.1 and 1 mg/mL concentrations, and a combination of Ca(OH)2 and TAP at equivalent concentrations, with Dulbecco's modified eagle medium serving as the control group. The viability and morphology of hDPSCs were assessed using both the quantitative 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and qualitative 4',6-diamidino-2-phenylindole staining. Statistical Analysis First, the data were analyzed by one-way analysis of variance, followed by Bonferroni post hoc to compare between groups. All the tests were conducted at a significance level of 95% (p &lt; 0.05). Results In this study, a notable variation in hDPSCs viability was observed among all groups, with the lowest viability recorded in the combination of Ca(OH)2 + TAP at 1 mg/mL (p &lt; 0.05). Conclusion Ca(OH)2, TAP, and their combination are not toxic to hDPSCs and the use of their combination was superior in hDPSCs viability on Ca(OH)2 + TAP in the 0.1 mg/mL group.

Dens invaginatus Type II in an Immature Lateral Incisor With Apical Periodontitis Treated With Regenerative and Strategic Antimicrobial Procedures: A Case Report

Dens invaginatus is a developmental dental anomaly that can predispose the tooth to pulp and periradicular disease. Management of this condition can be challenging because of anatomic and microbiologic issues. This case report describes the regenerative endodontic treatment using a strategic antimicrobial protocol for management of an immature maxillary lateral incisor with type-II dens invaginatus associated with apical periodontitis in a 13-year-old patient. The tooth presented with a complex anatomy and was associated with an active sinus tract. Because the true root canal was not negotiable in its coronal part due to the presence of the dens invaginatus, the closed end of the invagination (pseudocanal) was perforated to permit access to the apical segment of the true root canal for cleaning and disinfection. Both the invagination and the true canal were treated using an antimicrobial regimen based on chemomechanical preparation with sodium hypochlorite irrigation, supplementary disinfection with passive ultrasonic irrigation and interappointment calcium hydroxide medication. After 2 exchanges of calcium hydroxide medication, the sinus tract did not disappear, then the antimicrobial protocol was changed to include an antibiotic solution for irrigation and antibiotic paste for intracanal medication. After signs and symptoms disappeared, regenerative endodontic treatment was performed by inducing blood clot formation within the root canal. The coronal canal segment including the invagination was filled with Biodentine. Follow-up including cone-beam computed tomography examination showed complete healing of the apical periodontitis lesion and mineralized tissue formation at the apical portion of the true root canal.

Chitosan-Gelatin Scaffolds Loaded with Different Antibiotic Formulations for Regenerative Endodontic Procedures Promote Biocompatibility and Antibacterial Activity.

This study investigated the biocompatibility and antibacterial efficacy of chitosan-gelatin (CH-G) scaffolds loaded with slow-releasing antibiotic formulations used in regeneration endodontic procedures (REPs). Scaffolds were fabricated using freeze drying and loaded with varying concentrations of augmentin or modified triple antibiotic paste (mTAP). High-resolution scanning electron microscopy (SEM) was used to characterize the scaffold, while drug release was monitored via UV-Vis spectrophotometry. Immortalized human mesenchymal stem cells (hMSCs) were cultured on CH-G scaffolds alone (control), either 0.1 mg/mL or 1 mg/mL of augmentin or mTAP, and 10 mg/mL calcium hydroxide (Ca(OH)2). Cell viability and proliferation were assessed using the Alamar Blue assay and SEM, respectively, and live/dead staining further corroborated cell viability. Antibacterial activity against Enterococcus faecalis was evaluated using the MTT assay and confocal laser scanning microscopy (CLSM). Augmentin at 0.1 mg/mL appeared to promote better cell growth and attachment within the scaffolds than all other formulations, exhibiting acceptable viability. SEM revealed improved cell attachment in augmentin and mTAP groups compared to the Ca(OH)2 group. Augmentin at 1 mg/mL and mTAP groups significantly reduced viable bacteria compared to controls. Augmentin groups and mTAP at 1 mg/mL were highly effective in eliminating E. faecalis biofilms, with mTAP potentially causing more cell death within the remaining biofilm structures. This study suggests that CH-G scaffolds loaded with augmentin and mTAP, particularly at a concentration of 1 mg/mL, offer promising advantages for REPs due to their biocompatibility, antibacterial efficacy, and ability to promote cell attachment. Further research may explore the long-term effects in clinical settings.

Potential Crown Discoloration Induced by the Combination of Various Intracanal Medicaments and Scaffolds Applied in Regenerative Endodontic Therapy.

Regenerative endodontics involves the use of various root canal medicaments and scaffolds, which may cause crown discoloration. This study aimed to investigate the combined crown discoloration of scaffolds [platelet-rich fibrin (PRF) and blood clot] applied after administration of different medicaments [modified triple antibiotic paste including doxycycline (mTAPd), modified double antibiotic paste (mDAP), calcium hydroxide (CH), and propolis]. In total, 100 human mandibular premolar teeth were selected and prepared. The teeth were apically resected to simulate immature teeth. The positive and negative control groups (n = 10) consisted solely of blood-only and serum-only samples. The remaining 80 teeth were used for the experimental groups with four different medicaments. Three weeks later, either blood or PRF was applied as a scaffold after removing the medicaments (n = 10). Color changes were assessed before medication placement and at the end of the first, second, and third weeks, as well as on days 0, 1, 30, 60, and 90 after scaffold application. Analysis was carried out using repeated measures of variance, Friedman, one-way ANOVA, Kruskal-Wallis, the dependent paired t-test, and Wilcoxon test. Statistical significance was determined at P = 0.05. All groups including blood and the group including propolis and PRF combination, resulted in a significant increase in discoloration (P < 0.05) and discoloration exceeding clinically acceptable thresholds. CH and the modified versions of TAP (mTAPd) and DAP (mDAP) demonstrated an acceptable level of discoloration when used with a combination of PRF at day 90.

Comparative evaluation of antimicrobial efficacy of various intracanal medicament in young permanent teeth: An in vivo study.

Bacteria and their byproducts are key contributors to the onset and perpetuation of pulpoperiapical pathosis. Intracanal medication is vital in achieving successful endodontic outcomes as it targets and eradicates remaining microorganisms following biomechanical preparation. The aim of the study was to compare and evaluate the antimicrobial efficacy of calcium hydroxide (CH) paste, triple antibiotic paste (TAP), and probiotics (PBs) as intracanal medicament in 12-17-year-old children undergoing root canal treatment for the management of infected pulpal tissues in young permanent teeth. A total of 30 patients aged 12-17 years indicated for endodontic therapy in maxillary incisors and with no systemic complications were selected. They were randomly divided into three groups, i.e., Group I - CH group, Group II - TAP, and Group III - PB allocating 10 teeth in each group. After access opening, the first sample (S1) was collected by inserting a paper point into the root canal, the second sample (S2) was collected immediately after biomechanical preparation, and the third sample (S3) was collected after 7 days, i.e., postintracanal medication. Samples were sent for microbiological analysis to assess the microbial count, and statistical analysis was done for the obtained data. The three intracanal medicaments were successful in reducing the microbial counts of Enterococcus faecalis in the infected root canals. However, according to the results of the study, the PB group demonstrated greater effectiveness against E. faecalis compared to the CH group and displayed similar antimicrobial efficacy as the TAP group. PB exhibited antimicrobial efficacy comparable to TAP but greater than Ca (OH) 2 paste. Hence, PB can be utilized as an intracanal medicament in young permanent teeth.

Root Canal Dentin Microhardness after Contact with Antibiotic Medications: An In Vitro Study.

Background: Antibiotic pastes used as intracanal medication in cases of revascularization therapy might cause negative effects on tooth properties, such as a reduction in dentin microhardness. This in vitro study investigated dentin microhardness in three different locations distancing from the canal lumen after 20 days of treatment with a tri-antibiotic paste (ciprofloxacin, metronidazole, and minocycline), and with a double-antibiotic paste (ciprofloxacin and metronidazole), with calcium hydroxide [Ca(OH)2] UltracalTM XS-treated dentin as comparison. Material and Methods: Human mandibular premolars (n = 48) had the root canals cleaned and shaped and were used to produce dentin slices. Dentin slices remained immersed in the medications for 20 days. The Knoop microhardness (KHN) test was performed before (baseline/Day-0) and after treatment (Day-20) with the medications. Indentations were made at 25 µm, 50 µm, and 100 µm distances from the root canal lumen. The KHN was compared intra-group using Wilcoxon's test. Independent groups were compared using Mann-Whitney's and Kruskal-Wallis' tests, at α = 5%. Results: The microhardness in all the tested groups was reduced at Day-20 in comparison with Day-0 (p < 0.001) (intra-group comparison/same distances). The Day-0 values were similar, and the Day-20 values were higher for the Ca(OH)2 group (p < 0.05) (comparison between groups/same distances). Conclusions: Calcium hydroxide for 20 days would be preferred rather than antibiotic pastes to minimize the expected reduction in dentin microhardness during regenerative procedures.