Double Antibiotic Paste Research Articles

Residual antibacterial effects of a mixture of silver nanoparticles/calcium hydroxide and other root canal medicaments against Enterococcus faecalis

Background/purposeIntracanal medicaments with high residual inhibition effects are used to achieve successful endodontic treatment and prevent reinfection. This in vitro study aimed to assess antimicrobial residual effects of different intracanal medicaments against Enterococcus faecalis (E. faecalis) in root dentin one week after drug therapy. Materials and methodsSeventy human teeth were standardized to have 15 mm of length and were prepared by ProTaper rotary system. The teeth were randomly divided into six experimental (n = 10) and two control (n = 5) groups and subjected to drug therapy as follows; group CHX: 2% chlorhexidine gel, group CH: calcium hydroxide paste, group CH/CHX: mixture of calcium hydroxide and 2% CHX, group TAP: triple antibiotic paste, group DAP: double antibiotic paste, group CH/AgNPs: mixture of CH paste and silver nanoparticle suspension. After one week, the medicaments were removed from the root canals and E. faecalis was inoculated into the canals. The teeth were incubated at 37 °C for 24 h. Using a size 40 hedstrom file, dentin chips were collected and number of colony forming units were counted. ResultsThe difference between all experimental groups was statistically significant in this regard (P < 0.05) except for DAP and TAP groups, in which, no bacterial colony was noted after culture. After DAP and TAP, the lowest colony count was noted in CH/AgNPs, CH/CHX and CHX groups. The highest colony count was noted in CH group. ConclusionOur results showed favorable residual antibacterial effects of TAP, DAP and CH/AgNP medicaments after one week of application.

Antifungal Efficacy of Triple Antibiotic Paste, Double Antibiotic Paste with Fungicide and Calcium Hydroxide with Chitosan as a Vehicle against Candida albicans: An In vitro Study

Introduction: The purpose of current research is to assess the in vitro antimicrobial efficacy of different medicaments with two different vehicles against Candida albicans (C. albicans).&#x0D; Materials and Methodology: An agar well diffusion assay was used to determine the experimental medicaments' efficacy against C. albicans. Medicaments were divided into six groups, which includes Triple antibiotic powder (TAP) with saline or chitosan, Double antibiotic powder with fungicide (DAPF) with saline or Chitosan, and calcium hydroxide with saline or Chitosan. The diameters of growth inhibition zones were recorded and compared for each group for three days, i.e., 1,4,7 days. The differences between groups were analyzed by Kruskal-Wallis and Mann-Whitney U tests.&#x0D; Results: The largest inhibition zones were observed for the double antibiotic paste + fungicide with chitosan and the smallest for Ca(OH)2 with saline. Over a week, zones of inhibition were consistent only with group V – double antibiotic paste with fungicide and chitosan as the vehicle.&#x0D; Conclusion: DAPF with chitosan is more efficient against Candida albicans. Since the endodontic infections are polymicrobial in origin, the combined local drug delivery of antimicrobial agents such as ciprofloxacin, metronidazole, doxycycline along with antifungal drugs such as fluconazole with an efficient drug carrier (chitosan) is recommended to combat the microbial load.

Comparative evaluation of the cytotoxic effect of different intracanal medicaments

ABSTRACTIntroduction: intracanal medicaments have an important role in disinfecting ofthe pulp space and in endodontic regenerative procedures. These medications comein close contact with the periradicular tissue, thus their degradation products must bebiocompatible with the periapical tissue. Otherwise, these medicaments will resultin intense inflammatory reaction. Aim of the study: The purpose of this in vitrostudy was to evaluate and compare the cytotoxicity of three intracanal medications;Neem oil, double antibiotic paste (DAP) and calcium hydroxide (Ca(OH)2).Materials and Methods: Immortalized human gingival fibroblast cells were retrievedfrom the cell bank and then cultured. Three different intracanal medications (Neemoil, DAP, Ca(OH)2) were added to the cultured cells. Cell viability was evaluatedusing 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) andApoptosis/necrosis assays. Statistical analysis was performed using One-way ANOVAand post-hoc Tukey test. Results: Ca(OH)2 recorded the highest significant cytotoxicityfollowed by Neem oil, then DAP which recorded the lowest significant cytotoxicity.Cytotoxicity of the three intracanal medicaments used were directly proportional totheir concentrations Conclusion: DAP could be better recommended as intracanalmedicament in regenerative endodontic procedures because of its biocompatibilitycompared to the other tested medications.

Comparison of Apically Extruded Debris Associated with Different Irrigation Techniques after Removal of Intracanal Medicaments

This study aimed to compare the effect of XP-endo Finisher file (XPF), passive ultrasonic irrigation (PUI) and conventional irrigation technique using side-vented needle (SVN) on the amount of apically extruded debris after the removal of calcium hydroxide Ca(OH)2 and double antibiotic paste (DAP). Materials and Methods: Sixty extracted human mandibular premolars were used. After decronation, all canals were prepared up to the ProTaper Next X4 file (Dentsply Maillefer, Ballaigues, Switzerland). After dryness, teeth were randomly assigned into 2 groups (n=30) according to the Type of intracanal medication used; Ca(OH)2 and DAP then incubated at 37 °C and 100% humidity. After one week, Samples in each group were randomly assigned to 3 subgroups (n=10) according to the method used for medicament removal: XPF, PUI and SVN. Debris extruded during the removal procedure were collected into pre-weighed Eppendorf tubes then left to dry in an incubator at 37°C for 15 days. The amount of extruded debris was assessed with an analytical balance and calculated by subtracting the initial weight from the final weight of the tube. Data were statistically analyzed using Kruskal-Wallis and Mann-Whitney U test. Results: there was no statistically significant difference regarding the amount of apically extruded debris after using the three irrigation techniques in removal of both Ca(OH)2 and DAP (P-value = 0.141, Effect size = 0.160) and (P-value = 0.237, Effect size = 0.073) respectively. Conclusions: Neither XPF nor PUI increase the risk of intracanal medicament extrusion beyond the apex.

Antimicrobial and immunomodulatory in vitro profile of double antibiotic paste.

To evaluate the antimicrobial and immunomodulatory activity of double antibiotic paste (DAP) in an in vitro infection model. The minimum inhibitory and bactericidal concentrations (MIC and MBC) and the antibiofilm activities (TTC assay) of DAP and its components (ciprofloxacin and metronidazole) were evaluated against Staphylococcus aureus and Enterococcus faecalis compared with triple antibiotic paste (TAP). The cellular viability of RAW 264.7 macrophages (24 and 72h) and L929 fibroblasts (48 and 72h) was evaluated by MTT. Furthermore, the production of TNF-α, IL-12, IL-6, IL-1α, IL-10 and NO (on RAW 264.7), besides IL-6, TGF-β and NO (on L929), stimulated with DAP in baseline and associated with heat-killed microbial-antigen conditions was measured by ELISA and Griess reaction. Data were analysed using the one-way ANOVA test with Bonferroni's corrections. The MBC of pharmacopoeia DAP was similar to TAP for E.faecalis (0.25μg. mL-1 ) and lower for S.aureus (DAP 1μg.mL-1 and TAP 2μg.mL-1 ; p<.001). Ciprofloxacin was the most effective antibiofilm drug from the pastes (35% of reduction for E.faecalis and S.aureus; p<.0001), and both pastes had a similar antibiofilm eradication against both biofilm species (29% and 35% for S.aureus and 76% and 85% for E.faecalis; p<.0001). DAP was cytotoxic against the tested cells. DAP significantly upregulated IL-1α (p<.001), IL-6 (p<.0001), TNF-α (p<.01) and IL-12 (p<.05; in the absence of antigens) and significantly reduced IL-6 (p<.0001; in the presence of HK-S.aureus) and IL-10 (p<.05; in the presence of both antigens) on macrophages. Furthermore, DAP upregulated IL-6 (p<.001) and NO (p<.05; in the absence of antigens), IL-6 (p<.001; in the presence of HK-S.aureus) and reduced NO (p<.001; in the presence of HK-S.aureus). Double antibiotic paste and TAP had similar antimicrobial activity against S.aureus and E.faecalis. DAP upregulated pro-inflammatory cytokines mainly in the absence of antigens and had pro- and anti-inflammatory activity in RAW 264.7 macrophages and L929 fibroblasts in the presence of antigens involved in pulp infections.

The Effects of Double Antibiotic Paste and Amoxicillin-clavulanate Paste Used in Endodontic Regeneration on Microhardness of Radicular Dentine: An In vitro Study.

Objective:Double antibiotic paste is a root canal medicament used in regenerative endodontics and its long-term exposure to dental hard tissues was shown to reduce its mechanical properties. The amoxicillin-clavulanate paste is a medicament effective against endodontic pathogens and is effective in endodontic regeneration. Its effect on radicular dentine is yet to be investigated. The purpose of this study is to investigate and compare the effects of double antibiotic paste and amoxicillin-clavulanate paste on the microhardness of radicular dentine.Materials and Methods:The root canal of 45 premolars was mechanically prepared and divided into three groups for the placement of intracanal medicament: Group 1 (n = 15) double antibiotic paste, Group 2 (n = 15) amoxicillin-clavulanate paste, and Group 3 control group (n = 15). All the specimens were subject to microhardness testing at 500 and 1000 microns depth for 1 week, 1 month, and 3 months and analyzed.Results:There is no significant reduction in microhardness of radicular dentin at 1 week on all the three groups. At 1 month and 3 month period, the amoxicillin-clavulanate paste is found to have no significant effect on dentin microhardness when compared to double antibiotic paste.Conclusion:The use of amoxicillin-clavulanate paste as an intracanal medicament does not cause significant weakening of dentin even after its long-term use.

Spectrophotometric assessment of Tooth discoloration induced by various Antibiotic pastes

Title: Spectrophotometric assessment of tooth discoloration induced by various Antibiotic pastes. Aim: To evaluate tooth discoloration induced by various Antibiotic pastes using spectrophotometer. Materials and Methods: Sixty extracted upper front tooth were selected for the study. Access opening was done and root canal of each tooth was instrumented with hand files. The tooth were then randomly divided into 3 groups: Group A (Triple antibiotic paste: Ciprofloxacin+ Metronidazole+Minocycline), Group B (Modified Triple antibiotic paste: Ciprofloxacin+ Metronidazole+ Clindamycin) and Group C (Double antibiotic paste: Ciprofloxacin+ Metronidazole). In all the groups, medicaments were only applied inside the root canals of the teeth and access cavity was sealed with cotton pellet and temporary restoration. Spectrophotometric readings were obtained from buccal surface of the teeth immediately after placing the medicaments (Baseline data) and at 1 week and after 2 months. Based on spectrophotometric readings at different time interval, ∆E was then calculated. Data were analyzed using 2-way (ANOVA) tests. Results: The maximum color change (ΔE) was observed at 2 months with Triple antibiotic paste (p &lt; 0.0001) followed by Modified Triple antibiotic paste. No significant color change was noted with Double antibiotic paste. Conclusion: Antibiotic paste should be used judiciously inside the root canals of teeth to eliminate chronic root canal infection due to risk of tooth discoloration. Double antibiotic paste is a more promising option.

In vitro cytotoxic effects of different intracanal medicaments on the co-culture of dental mesenchymal stem cells using the MTT assay

Aim: This in vitro study aimed to assess the cytotoxic effects of different intracanal medicaments on the co-culture of dental mesenchymal stem cells. Materials and Methods: The Periodontal Ligament Stem Cells (PDLSCs) and the stem cells of the apical papilla (SCAPs) were isolated from a human teeth. The cells were passaged and underwent mono-culture and co-culture. The cells were then exposed to different concentrations of calcium hydroxide/chlorhexidine, calcium hydroxide/distilled water, double antibiotic paste/ chlorhexidine, and double antibiotic paste/distilled water. The cytotoxicity and cell viability was evaluated and data were analyzed by independent t-test, ANOVA, and Tukey’s test (alpha=0.05). Results: The viability of PDLSCs in co-culture was higher than that in mono-culture following exposure to different concentrations of medicaments. However, when distilled water was used as the vehicle for intracanal medicaments, the viability of SCAPs in mono-culture was higher than that in co-culture. In use of DAP/CHX, the viability of SCAP in co-culture was higher than that in mono-culture (P=0.000). This difference was not significant in exposure of SCAP to DAP/CHX (P>0.05). Conclusions: Generally, the viability of PDLSCs in co-culture was higher than that in mono-culture, and distilled water was a better vehicle than CHX for intracanal medicaments.

Comparative Antimicrobiotic Efficacy Test of Triple Antibiotic Paste, Double Antibiotic Paste with Fungicide and Calcium Hydroxide with Chitosan as Vehicle against Enterococcus faecalis: An In vitro Study

Introduction: This present research aimed to assess the in vitro antimicrobial efficacy of triple antibiotic paste and calcium hydroxide with two different vehicles against Enterococcus faecalis (E. faecalis).&#x0D; Materials and Methodology: An agar well diffusion assay was used to determine the experimental medicaments' efficacy against E. faecalis. Medicaments were divided into six groups, which includes Triple antibiotic powder (TAP) with saline or chitosan, Double antibiotic powder with fungicide (DAP 1) with saline or Chitosan, and calcium hydroxide with saline or Chitosan. These medicines were tested in an agar well diffusion test for three days, i.e., 1,4,7 days. The diameters of growth inhibition zones were recorded and compared for each group were tested in an agar well diffusion test for three days, i.e., 1,4,7 days. The diameters of growth inhibition zones were recorded and compared for each group. These medicaments were evaluated for three days an agar well diffusion test, i.e., on 1,4,7 days. The inhibition zones diameters for each group were recorded and compared — the differences between groups analyzed by Kruskal-Wallis and Mann-Whitney U tests.&#x0D; Results: The largest inhibition zones were observed for the triple antibiotic powder with chitosan and the smallest for Ca(OH)2 with saline. As days progress, they produced lesser antibacterial effects in all groups.&#x0D; Conclusion: Triple antibiotic paste and Chitosan were more effective in eliminating microorganisms than calcium hydroxide and DAP 1.

Effect of hydrogel-based antibiotic intracanal medicaments on crown discoloration.

ObjectivesThis study evaluated the effects of low and moderate concentrations of triple antibiotic paste (TAP) and double antibiotic paste (DAP) loaded into a hydrogel system on crown discoloration and explored whether application of an adhesive bonding agent prevented crown discoloration.Materials and MethodsIntact human molars (n = 160) were horizontally sectioned 1 mm apical to the cementoenamel junction. The crowns were randomized into 8 experimental groups (calcium hydroxide, Ca[OH]2; 1, 10, and 1,000 mg/mL TAP and DAP; and no medicament. The pulp chambers in half of the samples were coated with an adhesive bonding agent before receiving the intracanal medicament. Color changes (ΔE) were detected by spectrophotometry after 1 day, 1 week, and 4 weeks, and after 5,000 thermal cycles, with ΔE = 3.7 as a perceptible threshold. The 1-sample t-test was used to determine the significance of color changes relative to 3.7. Analysis of variance was used to evaluate the effects of treatment, adhesive, and time on color change, and the level of significance was p < 0.05.ResultsCa(OH)2 and 1 and 10 mg/mL DAP did not cause clinically perceivable tooth discoloration. Adhesive agent use significantly decreased tooth discoloration in the 1,000 mg/mL TAP group up to 4 weeks. However, adhesive use did not significantly improve coronal discoloration after thermocycling when 1,000 mg/mL TAP was used.ConclusionsCa(OH)2 and 1 and 10 mg/mL DAP showed no clinical discoloration. Using an adhesive significantly improved coronal discoloration up to 4 weeks with 1,000 mg/mL TAP.

Cytotoxicity and Genotoxicity of Calcium Hydroxide and Two Antibiotic Pastes on Human Stem Cells of The Apical Papilla.

Objective:This study aimed to assess the cytotoxicity and genotoxicity of triple antibiotic paste, double antibiotic paste and calcium hydroxide medicaments on human stem cells of the apical papilla.Methods:In this experimental study, stem cells were isolated from the apical papilla and cultured. They are treated with different concentrations 0.1, 0.5, 1, 10 and 100 mg/ml of medicaments for 24, 48 and 72 hours. The cytotoxicity and genotoxicity of the medicaments were determined using methyl thiazolyl tetrazolium assay and Comet test, respectively.Results:Results showed all tested concentrations of the calcium hydroxide had no significant effect on stem cells at any time point. Triple antibiotic paste showed cytotoxicity in 10 and 100 mg/mL concentrations at all-time points and in 1, 10 and 100 mg/ml concentrations at 72 hours. In addition, its genotoxicity was significantly higher than that of other groups (P<0.05). Double antibiotic paste showed cytotoxic effects only in 100 mg/ml concentration at 24 hours and 10 and 100 mg/ml concentrations at 48 and 72 hours. And also, its genotoxicity in these concentrations was significantly higher than that of control and calcium hydroxide groups (P<0.05).Conclusion:In contrast to calcium hydroxide, triple antibiotic paste and double antibiotic paste, especially in their higher concentrations, induced cytotoxicity and genotoxicity on human stem cells of the apical papilla.

Do intracanal medications used in regenerative endodontics affect the bond strength of powder-to-liquid and ready-to-use cervical sealing materials?

Aim:This study evaluated the effect of four intracanal medications commonly used in regenerative endodontic procedures on the bond strength of four calcium silicate-based materials, in which two are powder-to-liquid products (MTA and MTA-HP) and the other are ready-to-use materials (EndoSequence Root Repair Material Fast Set Putty [ERRM] and Bioceramic Repair [BIO-C Repair]).Methods:Ten bovine central incisors were selected and 4 slices (1.0 ± 0.1 mm) were prepared from each root. Next, four 0.8-mm wide holes were drilled in each slice and specimens were filled with one of the following intracanal medications: triple antibiotic paste, double antibiotic paste, calcium hydroxide with distilled water, and calcium hydroxide with 2% chlorhexidine gel. After 21 days, holes were filled with one of the materials: MTA, MTA-HP, ERRM, or BIO-C Repair. After storage, push-out test and failure analysis were performed. Data were submitted to analysis of variance in a 4 × 4 factorial scheme. Tukey's test was used for multiple comparisons.Results:The use of different interappointment dressings did not influence the results (P > 0.05). ERRM and BIO-C Repair presented significantly higher values than MTA and MTA-HP (P < 0.0001). Specimens showed a 100% occurrence of adhesive failures.Conclusion:The use of different intracanal medications presented similar impact on bond strength of calcium silicate-based materials. Ready-to-use ERRM and BIO-C Repair materials presented the best push-out values to dentine, whereas powder-to-liquid MTA and MTA-HP cements showed the lowest results.

Removal of double antibiotic paste and calcium hydroxide from simulated models of regenerative endodontic procedures using several protocols of irrigation: in-vitro comparison study

Removal of double antibiotic paste and calcium hydroxide from simulated models of regenerative endodontic procedures using several protocols of irrigation: in-vitro comparison study

Comparative Evaluation of Different Irrigation Techniques with Conventional Irrigation Technique for the Removal of Double Antibiotic Paste from Root Canal-An in vitro study

Complete removal of infection, rendering root canal free of an organism is the prime aim of endodontic treatment. It cannot be achieved alone by biomechanical preparation due to the complexity of root canal treatment. Therefore the use of intracanal medicament is a must. The antibiotic paste is frequently used intracanal medicament, usually in regenerative cases. Hence the aim of the is to compare different irrigation technique for removal of double antibiotic paste from root canal through a stereomicroscope. 36 single-rooted were standardized to root length of 12mm then instrumented by Protaper rotary file up to size F4. Irrigation was done using sodium hypochlorite in between instrument change. The root canal was dried using paper point and filled by DAP and then randomly allocated to 3 groups(n=12) according to irrigation system used: conventional syringe irrigation (CSI), Passive ultrasonic irrigation(PUI), EndoVac (EV). Roots were then longitudinally sectioned using the diamond disk and studied under a stereomicroscope using a scoring scale. Data were evaluated using one way ANOVA and Tukey test. Among all experimental group CSI was least efficient. PUI and EV showed greater efficiency but no significant difference between PUI and EV, but a significant difference between CSI and PUI, EV (p&amp;lt; 0.05). Use of irrigation activation system results in efficient removal of DAP compared to CSI.

Antimicrobial Activity and Biocompatibility of Antibiotic-Loaded Chitosan Hydrogels as a Potential Scaffold in Regenerative Endodontic Treatment

IntroductionThe objective of this study was to determine the effectiveness of several antibiotic-loaded hydrogel scaffolds against Enterococcus faecalis, as well as their ability to stimulate proliferation and mineralization of dental pulp stem cells. MethodsFibrin (Fg) or chitosan-fibrin hydrogels (Ch) were prepared using 12.5 mg/mL fibrinogen and 0.4% (w/v) chitosan. Triple antibiotics, clindamycin-modified triple antibiotic paste, or double antibiotics were loaded in gels (1 mg/mL). Antibacterial effect against E. faecalis biofilm was determined by using colony-forming units (CFUs) and confocal laser scanning microscope (CLSM). Cell viability and morphology were determined by loading cells into different gels at 7 and 14 days using the water-soluble tetrazolium salt-1 cell viability assay and Live & Dead cell analysis. Mineralization was detected by using alkaline phosphatase and alizarin red staining activity. ResultsAntibiotic-loaded Fg gel and Ch gel alone without antibiotics resulted in a significant reduction in CFUs compared with the positive control (P < .05). When antibiotics were loaded in Ch gel, there were no CFUs detected in any groups (P < .05). CLSM images showed dense red areas with mostly dead bacteria on the dentin surface in antibiotic-loaded Ch groups, which showed significantly less live bacteria compared with the other groups (P < .05). Triple antibiotic-loaded Fg and Ch gels resulted in a dramatic decrease in the mineralized nodule formation compared with all other gel groups (P < .05). Ch hydrogels resulted in round cell morphology up to 7 days. Ch alone or with double antibiotic paste showed more cell spreading with spindle-shaped morphology at 14 days and higher alkaline phosphatase activity compared with other antibiotic-loaded Ch groups (P > .05). ConclusionsDouble antibiotic-loaded Ch gel appears to enhance the antibacterial properties while maintaining higher cell viability, cell spreading, and mineralization activity, compared with all the other scaffolds investigated.

Antibacterial efficacy and discolouration potential of antibiotic pastes with macrogol for regenerative endodontic therapy.

This study aimed to evaluate the antibacterial efficacy and discolouration potential of antibiotic pastes containing macrogol. Seventy single-rooted teeth were contaminated with a culture of Enterococcus faecalis for 30days. Double (DAP) and triple antibiotic pastes (TAP) containing propylene glycol or macrogol as vehicles were applied. After 15days, bacterial viability was compared. Change in teeth coronal colour was measured by a spectrophotometer. Statistical analysis was performed using anova and Tukey's test (P<0.05). TAP containing clindamycin and propylene glycol was the only medicament that led to the presence of contamination, while the same combination of antibiotics containing macrogol did not result in bacterial growth (P<0.05). Only the pastes containing minocycline in formulation resulted in coronal discolouration (P<0.05). Both DAPs evaluated and the TAP containing clindamycin and macrogol showed to be the preferable options for regenerative endodontic therapy, as they were effective against E.faecalis biofilm and did not promote tooth discolouration.

Optimal antimicrobial concentration of mixed antibiotic pastes in eliminating Enterococcus faecalis from root dentin.

This study aims to identify the optimal concentrations of triple antibiotic paste (TAP), modified triple antibiotic paste (mTAP) and double antibiotic paste (DAP) that could completely eradicate Enterococcus faecalis in dentinal tubules. One hundred and ninety extracted human premolars inoculated with E.faecalis were medicated with calcium hydroxide and mixed antibiotic pastes (TAP, mTAP and DAP at 0.1, 1.25, 5, 10 and 20mgmL-1 of each drug) for seven days before being frozen, pulverised and cultured. Specimens treated with the lowest concentration of the mixed antibiotics capable of eradicating E.faecalis were examined using scanning electron and confocal laser scanning microscopy to confirm the eradication of the microbial. TAP at 10mgmL-1 of each drug was able to completely eliminate bacteria inside dentinal tubules, whereas mTAP and DAP required 20mgmL-1 of each drug. Calcium hydroxide was not effective in eradicating E.faecalis inside dentinal tubules.

Antimicrobial Therapeutics in Regenerative Endodontics: A Scoping Review

IntroductionThis review aimed to provide a critical appraisal of alternative antimicrobial strategies in lieu of traditional triple antibiotic paste (TAP). MethodsThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature search was performed in 8 databases (PubMed/Medline, Embase, LILACS, Web of Science, Scopus, BVS, SciELO, and the Cochrane Library), selecting clinical, in vitro, in vivo, and in situ studies that evaluated antimicrobial alternatives to TAP in regenerative endodontics. Studies lacking an experimental TAP group were excluded. ResultsA total of 1705 potentially relevant records were initially identified. From the 38 studies retrieved for full-text reading, 16 fulfilled all selection criteria and were included in the qualitative analysis. According to the study design, 11 studies were solely in vitro, 1 study was both in vitro and in vivo (animal model), 2 studies were solely animal experiments, and 2 studies were clinical trials. The alternative antimicrobial agents to TAP consisted of modified TAP formulations (eg, a combination of TAP with chitosan); TAP-eluting nanofibers; propolis; chlorhexidine (CHX) gels/solutions; double antibiotic pastes composed of distinct combinations of antibiotics; Ca(OH)2-based formulations; and sodium hypochlorite. Overall, most of the alternative agents performed similarly to TAP, although some strategies (eg, Ca(OH)2- and CHX-based formulations) seemed to present dubious importance in the control of infection. ConclusionsTAP still remains an excellent option in terms of the complete elimination of microorganisms. This review points to the use of electrospun fibers as a drug delivery system to offer a controlled release of the antimicrobial agent, as well as the use of natural compounds, deserving future investigation.

Effect of Hydrogel-Based Antibiotic Intracanal Medicaments on Push-Out Bond Strength.

Objective This study aimed to evaluate the effects of typical clinical concentration (1,000 mg/mL), low concentration (1 mg/mL) triple antibiotic pastes (TAP), and double antibiotic pastes (DAP) on the bond strength between various root cements and radicular dentin. Materials and Methods Intact single-rooted human teeth ( n = 144) were horizontally decoronated and canals instrumented. The roots were treated for 4 weeks with Ca(OH) 2 , 1,000 mg/mL of TAP or DAP, and 1 mg/mL of TAP or DAP. Untreated roots served as a control. After treatment, the medicaments were irrigated and each group was divided into three subgroups receiving MTA, Biodentine, or Endosequence putty cement. After 2 weeks, coronal and middle root cylinders were obtained from each root. Push-out bond strength test and failure analysis were performed for all root cylinders. Statistical Analysis Three-way ANOVA, pairwise comparisons and logistic regression were used for statistical analyses. A significance level of 5% was used. Results For MTA applied in the coronal part of the roots, 1 mg/mL DAP and TAP and Ca(OH) 2 demonstrated significantly higher bond strength compared with the typical clinical concentration and the control groups. For Biodentine applied coronally in the roots, 1 mg/mL of DAP resulted in significantly higher bond strength than all other groups. For Endosequence putty cement applied coronally in the roots, 1 mg/mL of DAP offered significantly higher bond strength than all groups except for Ca(OH) 2 . Conclusion The use of 1 mg/mL DAP resulted in significantly higher push-out bond strength compared with the typical clinical concentration of TAP and DAP regardless of the type of the root cement used.

Regenerative endodontic treatment options for immature permanent teeth: a case report with 21-month follow-up

The treatment of choice for necrotic teeth with incompletely formed roots is apexification with calcium hydroxide, which induces the formation of a hard tissue barrier at the apex, however, in the long term, this medicament may increase the brittleness of dentin walls because of its hygroscopic and proteolytic properties, in addition to the disadvantage of requiring multiple appointments. A treatment option for young permanent teeth with necrotic pulps is pulp regeneration, whose advantage lies in the stimulation of new tissue formation within the root canal. Pulp revascularization is based on the disinfection of the root canal system, often performed with irrigating solutions and intracanal medicaments, accompanied by induction of periapical bleeding and formation of a blood clot that will fill the root canal. The aim of this study was to present a case of avulsion of teeth 11 and 21, both with open apices, treated with replantation associated with regenerative endodontic therapy, but varying the intracanal medicaments used: calcium hydroxide in tooth 11 and double antibiotic paste in tooth 21. Pulp revascularization proved to be effective with both intracanal medicaments used, promoting symptom resolution and complete root development, including apical closure, even in the absence of a well-defined clinical