Antibiotic Paste Research Articles

Effect of Curcuma longa (Turmeric), as an intra-canal medicament, on inter-appointment endodontic pain in patients with symptomatic irreversible pulpitis: A randomized controlled clinical trial

Inter-appointment pain (IAP) is a subtype of postoperative pain which occurs between endodontic appointments. It may begin within a few hours after the first appointment and may continue for several days. Apart from mechanical instrumentation and thorough irrigation, intracanal medicaments play a central role in the disinfection of root canals and thus decreasing IAP. The aim of this study was to evaluate the effect of Curcuma Longa as an intracanal medicament on IAP in patients with symptomatic irreversible pulpitis (SIP). One hundred healthy adult patients having SIP in one of their single-rooted maxillary or mandibular teeth participated in this randomized, parallel, single-blinded clinical trial. After thorough biomechanical preparation, the root canals were randomly medicated with one of the following medicaments, Control (no medicament), Calcium Hydroxide, triple antibiotic paste (TAP), and Curcuma Longa. The pain was recorded using Visual analog scale at 4 h, 24 h, and every day until the seventh day. Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-rank tests. No statistical difference in pain scores was observed between Calcium Hydroxide, TAP or Curcuma Longa groups. It can be concluded that Curcuma Longa, Calcium hydroxide, and TAP are equally effective in controlling IAP.

Web-Based Survey on Regenerative Endodontic Practices among Members of the American Association of Endodontists

IntroductionThe American Association of Endodontics (AAE) Regenerative Endodontics Committee reports here the web-based survey data of regenerative endodontic procedures performed by the AAE members from 2008 to 2019. MethodsThe web-based survey consisted of 2 questionnaires, a revascularization and a follow-up, including clinical and radiographic data at 3, 6, 12 or >12 months after treatment. Data from demographics, etiology, clinical protocols, radiographic, and clinical outcome as perceived by the clinicians were recorded. From 927 entries, 184 full cases were submitted and 126 were suitable for radiographic analysis. The data were divided into cases with 6–12 months and cases with >12 months recall time. Descriptive statistics and univariate analyses were performed. ResultsPredominantly patients were male (63%), average 10 years-old with anterior teeth (77.2%) due to trauma (69.6%). A wide variation in regenerative endodontic procedures protocols was reported by the AAE members. The most common clinical protocols used minimal instrumentation (75.5%), 2.5% or higher concentrations of sodium hypochlorite (83.7%), and antibiotic paste as intracanal medication (58.7%). The majority reported blood clot formation (56%) and most common coronal capping material was white mineral trioxide aggregates (50.5%). Increases in radiographic root length, and radiographic root area were proportional to the time lapsed after treatment. Overall, case outcomes were categorized by clinicians as successful (54.3%), uncertain (23.9%), and unsuccessful (3.8%). ConclusionsThis web-based survey provides a valuable perspective on case selection, clinical protocols, and perceived outcomes for regenerative endodontic procedures and supports the need for future higher level evidence studies.

Comparative Analysis of the Cytotoxic Effects of Modified Triple Antibiotic Hydrogel: Insights From Experimental Models.

The effectiveness of intracanal medicaments (ICMs) in root canal therapy is critical for successful dental treatments, yet their cytotoxic effects pose significant challenges. This research uses zebrafish embryos and dental pulp stem cells (DPSCs) to identify the optimal concentration that balances antibacterial efficacy with minimal toxicity. This study aims to address the need for effective ICMs in dentistry by formulating and assessing the embryotoxicity and cytocompatibility of a novel carrageenan-based modified triple antibiotic paste (MTAP) hydrogel at different concentrations (1, 5, and 10 mg/mL) using a zebrafish model and cell culture assay. The hydrogel was formulated by combining antibiotic solutions (ciprofloxacin, metronidazole, and amoxicillin) with carrageenan and xanthan gum. Zebrafish embryos were exposed to varying concentrations of MTAP hydrogel, chlorhexidine (CHX), calcium hydroxide (CaOH2), and plain carrageenan to assess developmental toxicity, survival rate, heart rate, hatching rate, and macrophage migration. The cytotoxicity against DPSCswas examined within a timeframe of 6, 24, and 72 hours with the use of the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium bromide (MTT) assay. The analysis revealed developmental toxicity with malformations observed at higher concentrations of MTAP hydrogel, CaOH2, and CHXmedicaments, indicating potential toxicity. Significant impacts on survival, heart rate, and hatching rate were noted in the CaOH2 and CHX groups, as well as at higher MTAP hydrogel concentrations, emphasizing the importance of dosage considerations. The neutral red assay confirmed toxicity, with macrophage migration observed in CaOH2, CHX, and higher MTAP hydrogel concentrations. Lower concentrations, particularly at 1 mg/mL, showed no adverse effects on zebrafish embryos and larvae. These findings align with cell viability investigations, which demonstrated that higher antibiotic concentrations resulted in decreased cell proliferation and viability over time. Conversely, at a lower concentration of 1 mg/mL, cell proliferation notably increased after 72 hours.Plain MTAP and CHX exhibited the highest toxicity levels in the MTTassay. The study concludes that while higher concentrations of MTAP hydrogel exhibit toxic effects, the hydrogel at 1 mg/mL demonstrates no adverse impact on zebrafish embryos, larvae, and DPSCs. These findings underscore the necessity of optimizing ICM concentrations to balance antibacterial efficacy and minimal cytotoxicity.

Effect of Vehicles and Irrigation Solutions and Methods on Removal of Double Antibiotic Paste from Root Canals: Insights from High-performance Liquid Chromatography Analysis

IntroductionIn regenerative endodontics, eradicating antibiotic residues from root canals is imperative, given their detrimental effects on human apical papilla stem cells. Previous antibiotic removal studies lacked precision in identifying types and quantities of residual antibiotics. High-performance liquid chromatography (HPLC) enhances sensitivity and specificity, enabling accurate detection and quantification of residual drugs. Using HPLC analysis, this study explored the influence of vehicles and irrigation solutions and methods on double antibiotic paste (DAP) removal from root canals. MethodsTwo DAP formulations, each containing 5 mg/mL ciprofloxacin and metronidazole, were created using distinct vehicles: macrogol and propylene glycol (MP) or hydroxypropyl methylcellulose (HPMC). Subsequently, 5 μL of DAP was applied to 200 simulated immature teeth with open apices (n = 100 per formulation) and cultured for 28 days at 37°C. Samples were then divided into 11 groups (n = 20 per group), and canals were irrigated with 17% ethylenediaminetetraacetic acid or 10% citric acid, employing a positive pressure syringe or passive ultrasonic irrigation. The irrigation solution and dentin sample from each tooth were evaluated via HPLC for ciprofloxacin and metronidazole quantification. ResultsCitric acid exhibited significantly superior efficacy in antibiotic removal from root canals, with no observable effect of irrigation methods on drug removal. The HPMC-based DAP formulation significantly enhanced ciprofloxacin removal compared with MP-based DAP. ConclusionsFor antibiotic paste removal from root canals, citric acid is effective, and HPMC is a preferable vehicle over MP. Overall, HPLC is a valuable method for detecting, removing, and quantifying residual antibiotics in root canals.

Intracanal medicaments and coronal sealing materials influence on root fracture resistance and coronal discoloration: An in vitro study

Abstract Introduction: Immature teeth are more susceptible to fracture, and intracanal medicaments and coronal filling materials used in regenerative endodontics affect their optic and mechanical properties. This study aimed to evaluate the fracture resistance and coronal discoloration of simulated immature teeth following the placement of several intracanal medicaments and coronal sealing materials. Materials and Methods: Eighty-eight premolars simulating immature teeth were divided into 11 groups (n = 8 each) according to the type of intracanal medicament (triple antibiotic paste [TAP]; double antibiotic pastes [DAP]; calcium hydroxide [Ca(OH)2]) and used coronal barrier materials (mineral trioxide aggregate [MTA] and calcium-enriched mixture [CEM]). A bonding agent was applied in half of the samples in the groups where antibiotic pastes were used (n = 8). After incubating for 3 weeks, the sample’s fracture resistance and color change were evaluated. Data analysis was conducted using multivariate and one-way analysis of variance, Tukey’s honestly significant difference post hoc, and the Kruskal–Wallis tests (α =0.05). Results: The color change after placing the medicaments was comparable among the groups. However, after 3 months, the color change in the TAP-CEM-No-Bonding group was higher than the control, Ca(OH)2-MTA, and DAP-MTA-No-Bonding groups (P < 0.05). The fracture resistance of the TAP-MTA-Bonding, DAP-CEM-Bonding, Ca(OH)2-MTA, and Ca(OH)2-CEM was lower than the control group (P < 0.05). Conclusion: Simultaneous use of DAP-MTA without a dentin bonding agent led to comparable color change and fracture resistance to the control group.

Comparative study of the pure AH Plus sealer and its combination with triple antibiotic paste at different concentrations on Enterococcus faecalis bacteria

Comparative study of the pure AH Plus sealer and its combination with triple antibiotic paste at different concentrations on Enterococcus faecalis bacteria

Effect of different root canal irrigants on surface roughness and microhardness of Biodentine combined with triple antibiotic paste: An in vitro study

Background: Biodentine is widely used for endodontic applications; recently, it has been incorporated with triple antibiotic paste (TAP). The effect of endodontic irrigants on the physical characteristics of this new combination needs to be studied. Aims: The aim of the study was to evaluate the surface roughness and microhardness of Biodentine incorporated with TAP subjected to various endodontic irrigants. Materials and Methods: Hundred cylindrical discs (6 mm × 3 mm) were prepared by mixing the Biodentine with TAP (3:1). The specimens were subjected to different irrigating solutions for 5 min in 5 groups (n = 20): Group 1: distilled water (control), Group 2: 2.5% sodium hypochlorite, Group 3: 17% ethylenediaminetetraacetic acid, Group 4: 2% chlorhexidine (CHX), and Group 5: 2% chitosan nanoparticles (CSNs). Half of the specimens in each group were subjected to surface roughness (n = 10) and another half to microhardness (n = 10). Surface roughness was measured using a surface roughness tester, and digital Vickers microhardness testing was performed on each specimen. Statistical Analysis: One-way ANOVA and post hoc Tukey’s tests (P ≤ 0.05) were used. Results: The highest microhardness was found with 2% CSN, whereas 2% CSN and 2% CHX had a minimal effect on the surface roughness of Biodentine incorporated with TAP (P ≤ 0.05). Conclusion: The root canal irrigant 2% CSN exhibited the highest microhardness and least surface roughness of modified Biodentine with TAP.

Effect of different intracanal medicaments combined with chitosan nanoparticles on microhardness and fracture resistance of root dentin – An in vitro study

Abstract Introduction: Chitosan nanoparticles (CSN) are widely used for endodontic disinfection; however, their combination with other intracanal medicaments is least studied; therefore, this study aims to evaluate the effect of various intracanal medicaments incorporated with 0.2% CSN on root dentin microhardness and fracture resistance. Materials and Methods: Fifty extracted human single-rooted premolars were cleaned, decoronated, and standardized to 13 mm root length. After access opening and working length determination, specimens were instrumented with ProTaper rotary files till apical size F3 and alternatively irrigated with 5 ml of 2.5% sodium hypochlorite and normal saline (NS). Final irrigation was done with 5 ml of 1% phytic acid. The specimens were allocated randomly into five groups (n = 10), followed by placement of intracanal medicament for 1 week as follows. Group 1 – 0.2% CSN, Group 2 – Calcium hydroxide (Ca[OH] 2) + 0.2% CSN, Group 3 – Triple antibiotic paste (TAP) + 0.2% CSN, Group 4 – Propolis + 0.2% CSN, and Group 5 – Chlorhexidine gluconate (CHX) + 0.2% CSN. The specimens were then rinsed with NS and 3 mm coronal portion of each specimen was horizontally sectioned to create dentin blocks that were further split vertically and tested for Vickers microhardness (n = 10). The remaining root segment of each specimen was then vertically embedded in an acrylic block and evaluated for fracture resistance (n = 10) under a universal testing machine. The data acquired were statistically assessed using one-way ANOVA and posthoc Tukey tests (P < 0.05). Results: Propolis incorporated with 0.2% CSN showed the highest microhardness and fracture resistance values followed by CHX + 0.2% CSN, TAP + 0.2% CSN, Ca(OH)2 + 0.2% CSN, and least in 0.2% CSN alone. Conclusion: Intracanal medicaments incorporated with 0.2% CSN exhibited a synergetic effect on microhardness and fracture resistance of endodontically treated teeth; however, propolis with 0.2% CSN exhibited higher microhardness and fracture resistance of root dentin.

Comparison of Antifungal Activity of Thymus Vulgaris Essential Oil and Triple Antibiotic Paste Against Candida Albicans Isolated from Root Canal (In Vitro Study)

Background The main objective of chemomechanical endodontic therapy is to reduce or eliminate microorganisms from the root canal system, and intracanal medications are used to accelerate the disinfection process. The aim of this study this study was to assess the antifungal activity of thymus vulgaris essential oil against C. albicans compared to that of triple antibiotic paste. Materials and methods C. albicans was isolated from patients who required endodontic treatment. Using the agar well diffusion method, the efficacy of Thymus vulgaris essential oil against C. albicans was determined at 25 mg/ml, 10 mg/ml, 8 mg/ml, 6 mg/ml, 4 mg/ml, and 2 mg/ml and compared to the triple antibiotic paste. The minimum inhibitory and fungicidal concentrations against Candida albicans were determined using the microbroth dilution method. The constituents were identified using a gas chromatography–mass spectrometer. Results Thymus vulgaris essential oil demonstrated antifungal activity against C. albicans, which appeared to increase as the extract concentration increased, and the difference between all concentrations and triple antibiotic paste was significant (p ≤ 0.01). The MIC and MFC for Thymus vulgaris essential oil were 0.015 mg/ml and 0.031 mg/ml, respectively. 53 compounds were identified by (GC-MS) analysis, which represented more than 95% of the oil composition. The main component was thymol (35.48%). Conclusion Thymus vulgaris essential oil is effective against C. albicans, suggesting that it has the potential to be applied as an intracanal medication.

Assessment of Long-Term Success and Survival Rates of Different Types of Intracanal Medicaments.

Antimicrobial endodontic intracanal medicaments play a vital role along with biomechanical preparation in the elimination of bacteria present in the pulp area to achieve success in endodontic therapy. The present research was conducted with the objective of evaluating and comparing intracanal medicaments regarding antibacterial properties against Enterococcus faecalis. One hundred and twenty healthy human premolars of the mandible were used. All premolar crowns were removed, keeping the standardized length of the root as 15 mm. Category 1 received triple antibiotic paste (TAP) (n = 30), Category 2 received double antibiotic paste (DAP) (n = 30), Category 3 received augmentin (n = 30), and Category 4 received calcium hydroxide (n = 30). Hygienic paper points were placed in each root canal, then they were moved to a tube containing 1 mL of brain-heart infusion medium and left there for bacteriological testing. Colony-forming units (CFUs) of E. faecalis were then observed and counted after the plates had been incubated overnight at a temperature of 37°C. During intracategory comparisons, there was a significant reduction in colonies of E. feacilis in each category (P ≤ 0.001). When there were intercategory comparisons, there was a maximum reduction in CFU in specimens of Category 1 (TAP) followed by Category 3 (Augmentin) and Category 2 (DAP). Intracanal medicaments like TAP, DAP, and augmentin are effective against root canal E. faecalis.

The Effect of Glycyrrhizin on the Viability and Proliferation of Dental Pulp Stem Cells Compared to Intracanal Medicaments.

To study the effect of glycyrrhizin (GA) on the viability and proliferation of dental pulp stem cells (DPSCs) compared with intracanal medicaments. Third molars of an adult donor were used to obtain the DPSCs. Flow cytometry was utilized to conduct phenotypic analysis for DPSCs. The methyl-thiazol tetrazolium (MTT) test was used to detect the cell viability. Cell proliferation assay was conducted at distinct time intervals: 3, 5, and 7 days. The flow cytometry analysis verified the positive expression of mesenchymal cell surface antigen molecules (CD73, CD90, and CD105) and the absence of hematological markers (CD14, CD34, and CD45) in the DPSCs. The cells that treated with concentrations more than 0.5 mg/mL of Ca(OH2) and triple antibiotic paste (TAP) gave significant decrease in viability in comparison to the untreated cells (p < 0.05). Also, the cells treated with concentrations 50 and 25 µM of GA showed no significant difference compared with the untreated cells (p > 0.05), while concentrations 12.5 and 6.25 µM expressed a significant increase in viability compared with the untreated cells (p < 0.05). At 7 days, cells treated with the three different concentrations of GA (12.5, 25, and 50 µM) demonstrated a significant increase in cell density compared with Ca(OH)2 and TAP-treated cells (p < 0.05). Based upon the potential of GA on DPSCs proliferation compared with Ca(OH)2 and TAP, It is conceivable to acknowledge that GA could be used as an intracanal medicaments for revascularization process of necrotic immature teeth. This study emphasizes the significance of assessing alternative root canal medicaments and their impact on the proliferation and viability of DPSCs. The results regarding GA, specifically its impact on the viability and growth of DPSCs, provide essential understanding for its potential application as an intracanal medicine. This study adds to the continuous endeavors in identifying safer and more efficient intracanal therapies, which are essential for improving patient outcomes in endodontic operations. How to cite this article: Alrashidi MA, Badawi MF, Elbeltagy MG, et al. The Effect of Glycyrrhizin on the Viability and Proliferation of Dental Pulp Stem Cells Compared to Intracanal Medicaments. J Contemp Dent Pract 2024;25(3):267-275.

Effect of canal medicaments triple antibiotic paste, Bio-C Temp, and Nano-silver gel activated by visible blue light on canal dentin microhardness and extrusion bond strength of AH plus sealer: A SEM and EDX analysis

AimAssessment of contemporary canal medicaments (Triple antibiotic paste (TAP), Bio-C Temp, and Nano silver gel activated by visible blue light on the dentin microhardness (MH) and push-out bond strength (PBS) of AH plus endodontic sealer. MethodSixty extracted premolars were obtained and decontaminated. Canal cleaning and shaping were performed. The samples were randomly allocated into four groups based on the intracanal medicaments. Group 1= CH paste, Group 2= TAP, Group 3= Bio-C Temp, and Group 4= Nano-silver gel activated by visible blue light. MH assessment was performed using a Vickers Microhardness tester. Forty specimens, ten from each group underwent root canal obturation. PBS and failure mode evaluation were performed. ANOVA and Post Hoc Tukey test were utilized to conduct intra and inter-group comparisons. ResultsThe maximum outcome of surface hardness was presented by Group-3 (Bio-C Temp®) specimens. However, minimum scores of MH were displayed by Group 1 (CH) treated teeth. The highest outcomes of EBS were exhibited by the cervical third of Group 3 (Bio-C Temp®) samples. The apical section of Group 4 Teeth with Nano Silver gel activated by visible blue light revealed the lowest scores of bond integrity. ConclusionBio-C Temp and TAP proved to be better intracanal medicament than other tested groups in terms of the push-out bond strength of the sealer. TAP displayed lower microhardness as compared to the Bio-C Temp.

Comparative evaluation of effect of modified triple antibiotic paste and calcium hydroxide as intracanal medicament on microhardness of root dentin: An in vitro study

ABSTRACT Aim: To assess and compare the impact of modified triple antibiotic paste (MTAP) and calcium hydroxide (CH) as intracanal medicament on microhardness (MH) of root dentin. Materials and Methods: Twenty single-rooted, noncarious, single-canaled permanent teeth were selected. They were decoronated and vertically sectioned into two equal parts to acquire 40 samples. These samples were submerged in acrylic blocks with their pulpal surfaces exposed. These samples were enclosed within acrylic blocks, with their pulp surfaces visible. They were then randomly allocated into four groups (n = 10). MH was measured at three steps: initial measurement of MH before irrigation with 3% sodium hypochlorite (NaOCl); after irrigation with 3% NaOCl; and after interaction with medications (MTAP or CH pastes at an interval of 7 days or 30 days). The degree of reduction in MH percentage was computed. The collected data underwent statistical examination at a significance threshold of P &lt; 0.05. Results: All procedures led to a noteworthy decline in MH values when compared to both prior and initial measurement. The highest reduction in MH was seen after irrigation with 3% NaOCl (P &lt; 0.05). CH showed a greater reduction in MH as compared to MTAP (P &lt; 0.05). More reduction in MH was seen after 30 days as compared to that after 7 days for both CH and MTAP (P &lt; 0.05). Conclusion: Use of intracanal irrigants and medicaments reduces the MH of root dentin. Lesser reduction in MH was observed when utilization of MTAP as compared to CH.

Revascularization Revisited with Modified Triple Antibiotic Paste and NeoPutty MTA®

ABSTRACT Introduction and Aim: Performing endodontic treatment in an immature permanent tooth that has experienced trauma or carious exposure can pose challenges. The root canals in these teeth are typically open and fragile, making instrumentation and obturation difficult. Traditional apexification, which involves placing calcium hydroxide paste in the root canal for a specified period to induce the formation of a calcified barrier, has been a long-standing approach. While it is a widely used method, leaving the paste in the root for extended periods can weaken it due to the paste’s hygroscopic properties and the proteolytic activities of calcium hydroxide. As a result, researchers have been exploring alternative treatments that allow for the full development of immature teeth. Revascularization has emerged as one such alternative, with a variety of treatment protocols documented in scientific literature. Description of the Case: This case report, for the first time, describes the use of NeoPutty MTA® and triple antibiotics paste for revascularization in a young female child on a carious, exposed lateral incisor with opex apex with success. Conclusion: The revascularization process attempted on the infected tooth met with success and closure of apex was noticed in a short period of time.

Effect of microbubble as local drug delivery system in endodontic management - An In-Vitro study

Background and ObjectivesMicrobubbles (MBs) are gas or vapor-filled cavities inside liquids with sizes ranging from 2 to 3 µm. Recently, MBs have shown great promise in nanomedicine owing to their high encapsulation efficiency, targeted drug release, improved biocompatibility, and longer blood circulation. Furthermore, they are more suitable for focusing on particular body regions and are safer and non-invasive. MBs generators are used to create bubbles in fluid dynamics, chemistry, medicine, agriculture, and the environment. Drug delivery using MBs increases penetration without causing systemic toxicity.In this study, we examined whether the use of microbubbles as a local drug-delivery mechanism increases tubular penetration of endodontic medications and irrigant. Materials and MethodsAn Enterococcus faecalis culture was added to 38 dentin cylinders of single-rooted teeth. Samples were divided into the experimental and control groups that received a triple antibiotic paste with and without MB infusion (n = 19 in each group), respectively. After 14 days, the number of live bacteria in the samples was determined using confocal laser scanning microscopy. ResultsAfter 14 days of contact with the medication, the percentages of live and dead bacteria were assessed. Results show that Group 2 (Triple antibiotic infused micro bubble) showed significantly (P < 0.05) higher antibacterial efficacy than Group 1 (TAP). ConclusionIn this study, the antibacterial efficacy was significantly higher in the experimental group than in the control group. Therefore, within the limitations of the study it can be said that MB infusion is a viable technique to improve root canal disinfection. Hence, it can be considered as a novel technique for local drug delivery systems in endodontic management.

Examining the Effects of Asiaticoside on Dental Pulp Stem Cell Viability and Proliferation: A Promising Approach to Root Canal Treatment.

This study aims to evaluate the impact of asiaticoside (AC) on the viability and proliferation of dental pulp stem cells (DPSCs), considering the known negative effects of routinely used intracanal medicaments. This evaluation will be compared with the outcomes from using traditional intracanal medicaments, specifically triple antibiotic paste (TAP) and calcium hydroxide [Ca(OH)2]. The DPSCs were obtained from the third molars of an adult donor. The application of flow cytometry was employed to do a phenotypic analysis on DPSCs using CD90, CD73, CD105, CD34, CD14, and CD45 antibodies. The methylthiazol tetrazolium (MTT) assay was employed to assess cellular viability. The cells were treated with different concentrations of TAP and Ca(OH)2 (5, 2.5, 1, 0.5, and 0.25 mg/mL), along with AC (100, 50, 25, 12.5, and 6.25 µM). A cell proliferation rate was performed at 3, 5, and 7 days. The characterization of DPSCs was conducted by flow cytometry analysis, which verified the presence of mesenchymal cell surface antigen molecules (CD105, CD73, and CD90) and demonstrated the absence of hematopoietic markers (CD34, CD45, and CD14). Cells treated with concentrations over 0.5 mg/mL of TAP and Ca(OH)2 showed a notable reduction in cell viability in comparison to the untreated cells (p < 0.05). Additionally, the cells treated with different concentrations of AC 12.5, 6.25, 25, and 50 µM did not differ significantly from the untreated cells (p > 0.05). Nevertheless, cells treated with concentrations of 100 µM showed a significant reduction in viability compared to the untreated cells (p < 0.05). After a period of 7 days, it was noted that cells exposed to three different concentrations of AC (50, 25, and 12.5 µM) had a notable rise in cell density in comparison to TAP and Ca(OH)2 (p < 0.05). Furthermore, cells that were exposed to a concentration of 12.5 µM exhibited the highest cell density. The cellular viability of the AC-treated cells was superior to that of the TAP and Ca(OH)2-treated cells. Moreover, the AC with a concentration of 12.5 µM had the highest degree of proliferation. This study underscores the importance of evaluating alternative root canal medicaments and their effects on DPSCs' growth and vitality. The findings on AC, particularly its influence on the survival and proliferation of DPSCs, offer valuable insights for its probable use as an intracanal medication. This research contributes to the ongoing efforts to identify safer and more effective intracanal treatments, which are crucial for enhancing patient outcomes in endodontic procedures. How to cite this article: Alazemi MJ, Badawi MF, Elbeltagy MG, et al. Examining the Effects of Asiaticoside on Dental Pulp Stem Cell Viability and Proliferation: A Promising Approach to Root Canal Treatment. J Contemp Dent Pract 2024;25(2):118-127.

Triple Antibiotic Paste: A Game Changer in Endodontics.

Triple antibiotic paste has emerged as a game changer in the field of endodontics, offering a novel approach to the management of refractory endodontic infections and regenerative endodontics. This review article provides an overview of the composition, mechanism of action, clinical applications, advantages, and potential limitations of triple antibiotic paste in endodontic therapy. Additionally, recent advancements and future directions for the use of triple antibiotic paste in endodontics are also discussed.

Comparative Evaluation of Antimicrobial Efficacy of Triple Antibiotic Paste Herbal Combination and Camphorated Monochlorophenol as Intracanal Medicaments against Enterococcus faecalis in Deciduous Molars: An In Vivo Study.

Compare the efficacy of triple antibiotic paste (TAP), herbal extracts, and camphorated monochlorophenol (CMCP) as intracanal medicaments against Enterococcus faecalis (E. faecalis) in deciduous molars. A total of 60 samples were collected from canals of first and second molars of 4-10-year-old children, with more than two-thirds root length, and fitting the inclusion criteria. Samples were collected at three intervals-S1 was collected just after access opening, S2 was collected after biomechanical preparation (BMP) and irrigation, and just before placement of medicament. Randomization was done to place the medicaments into three groups: group I-CMCP, group II-TAP, and group III-herbal combination. Sample S3 was taken 48 hours after removal of medicament from the canals. The collected samples were transported via Amies media to the laboratory, where they were anaerobically incubated for 24 hours. Growth of E. Faecalis was observed, and manual counting of the colony-forming unit (CFU) was done. The change in CFU in all samples was calculated, and the results were statistically analyzed. The results show that there is a change from S1 (TAP = 118.67 ± 122.48, herbal = 109.07 ± 106.43; CMCP = 110.73 ± 120.53) to S2 (TAP = 34.13 ± 63.47; herbal = 27.67 ± 39.39; CMCP = 16.40 ± 26.32) and S3 (TAP = 12.33 ± 24.82; herbal = 4.73 ± 12.78; CMCP = 3.40 ± 7.12). It is seen that there is a significant difference seen from S1 to S2 in all three groups (p ≤ 0.05) using repeated measure analysis of variance (ANOVA) test. This shows that all three medicaments were effective in reducing bacterial counts of E. Faecalis from sample S1 (pre) to S3 (post) significantly after exposure to root canal bacterial flora for 48 hours (2 days). The pairwise comparison of the change in CFU within each group, S1-S3, also shows significant changes. There is a significant decrease in CFU seen from S1 to S2 and S1 to S3 but not from S2 to S3 for all three groups, which was evaluated using the post hoc Bonferroni test. It was also observed that in between the canals, although there was a change from S1 to S3 in terms of the CFU, there was no significant difference in the decrease in the bacterial count when intercanal comparison was made. There was, however, a change that was seen to be significant when values from each canal were compared from S1 to S3. All three medicaments have successfully shown a decrease in the numbers of E. faecalis, which the study aimed at checking. Although the effect varied intergroups, it was mild, so herbal alternatives could be used instead of antibiotics and CMCP. Also, because the local application is effective in controlling interappointment flare-ups, the medicaments can be successfully given without having to prescribe systemic antibiotics. Tawde MM, Lakade L, Patil S, et al. Comparative Evaluation of Antimicrobial Efficacy of Triple Antibiotic Paste Herbal Combination and Camphorated Monochlorophenol as Intracanal Medicaments against Enterococcus faecalis in Deciduous Molars: An In Vivo Study. Int J Clin Pediatr Dent 2024;17(3):243-254.

Discoloration after revascularization using calcium phosphosilicate-based bioceramic versus mineral trioxide aggregate in necrotic immature permanent anterior teeth: A Randomized clinical trial.

The aim of the current study is to evaluate the effect of calcium phophosilicate-based bioceramic "Totalfill bioceramic putty" and white mineral trioxide aggregate (WMTA) as the coronal plug on discoloration after revascularization of necrotic immature permanent anterior teeth. This study was conducted on (48) necrotic young permanent central incisors in children ranging from 8 to 14 years old, that were randomly allocated to either Totalfill bioceramic (Group I = 24) or WMTA (Group II = 24) as the coronal plug. Two visits revascularization protocol was adopted in this study using 1.5% sodium hypochlorite, followed by 17% ethylenediaminetetraacetic acid, and ending with a saline flush as irrigation solution. The double antibiotic paste was used as intracanal medication. The blood clot was used as scaffold followed by the application of collagen membrane followed by coronal plud malterial. Finally, the access was sealed using resin composite restoration and composite restoration. Clinical assessment was conducted at 1, 3, 6, 9, and 12 months, while radiographic assessment was conducted at 6 and 12 months. Data were statistically analyzed using the Chi-squared test for intergroup comparisons and Cochran's Q test for intragroup comparison. Clinically, Group I exhibited a success rate of 100%, whereas Group II exhibited a success rate of 85.7%. Radiographically, both materials showed a 90.5% success rate. There was no statistically significant difference between both materials for all assessed clinical and radiographic parameters at different follow-up periods. Both Totalfill bioceramic putty and WMTA can be used successfully as coronal plug in esthetic areas.

A Comparative Evaluation of Herbal Extracts and Triple Antibiotic Paste as Intracanal Medicament against Enterococcus faecalis: A Microbiological Study.

The purpose of the study is to compare and evaluate the efficacy of herbal extracts over modified triple antibiotic paste (MTAP) as intracanal medicaments against Enterococcus faecalis (E. faecalis). Ginger, turmeric, and nutmeg extract were checked for antibacterial activity by agar disk diffusion method at 100, 50, 25, and 12.5% concentration. Combination groups were prepared, and the combination group showing the best zone of inhibition was further evaluated. A total of 103 samples were taken and divided into five groups: group I-MTAP, group II-ginger, group III-turmeric, group IV-nutmeg, and group V-saline. Based on different concentrations, the groups were again subdivided into subgroups at 100, 50, 25, and 12.5%. Combination groups of ginger + nutmeg, ginger + turmeric, and turmeric + nutmeg were made and evaluated. The combination group showing the best zone of inhibition was again divided into 100, 50, 25, and 12.5% and further evaluated. Modified triple antibiotic was effective in the elimination of E. faecalis. Herbal extracts showed a reduction in the number of E. faecalis. Nutmeg showed a reduction in E. faecalis, followed by ginger, followed by turmeric. This study shows that the combination of ginger + nutmeg at 12.5% concentration (35 mm) showed the highest zone of inhibition among all the herbal combinations, which is almost equal to that of MTAP. Golla S, Gambhir N, Gupta N, et al. A Comparative Evaluation of Herbal Extracts and Triple Antibiotic Paste as Intracanal Medicament against Enterococcus faecalis: A Microbiological Study. Int J Clin Pediatr Dent 2024;17(3):285-290.