Triple Antibiotic Paste Research Articles

Can a dentin bonding agent prevent color change in regenerative endodontic procedures? An in vitro evaluation.

This in vitro study aimed to determine the efficacy of dentin bonding agents in preventing color changes following Regenerative Endodontic Procedures. One hundred twenty bovine incisors were endodontically prepared and randomly assigned to a two main factors design: application of a dentin bonding agent (Scotchbond Adper, 3M ESPE, St Paul, MN, USA) in the pulp chamber (Group 1, n=60) versus no bonding intervention (Group 2, n=60), and five levels of intracanal medication (n=12/subgroup): Triple antibiotic paste (TAP), double antibiotic paste (DAB), calcium hydroxide (CH), modified triple antibiotic paste (TAPM), and Control (CTL). Color changes were measured over 28 days at multiple time points (1, 3, 7, 14, 21, and 28 days) using the CIEDE2000 formula to calculate the color difference (ΔE00) from baseline (T0). The ΔE00 quantifies the perceptible color difference between the initial and final tooth color, with lower values indicating less discoloration. The results were analyzed using repeated measures ANOVA-2 and post-hoc Holm-Sidak tests. The TAP subgroups, both with and without the bonding agent, exhibited the highest color variation. However, a pulp chamber seal with a bonding agent showed a protective effect against discoloration compared to no seal, even though complete prevention was not achieved. All groups demonstrated ΔE00 values beyond acceptable interpretation thresholds for clinical application, primarily driven by a reduction in lightness (L*) and a decrease in redness (a* value, shifting towards green). In conclusion, while the pulp chamber seal with a bonding agent mitigated TAP-induced discoloration, it did not eliminate it.

Evaluation of the antibacterial efficacy of nanomodified triple antibiotic paste with nano anti-inflammatory drug and nano calcium hydroxide as intracanal medicament using confocal laser scanning microscope

Aim: To evaluate and compare the antibacterial efficacy of Nano amoxicillin modified Triple antibiotic paste (mTAP) with nano Ibuprofen and nano calcium hydroxide (Ca(OH)2) as a root canal medicament on Enterococcus faecalis infected root canal dentin.. Methods: Sixty eight semi-cylindrical root samples were infected for 3 weeks with E. faecalis ATCC 29212 and randomly assigned into 4 Groups based on the medication used, Ca(OH)2; Nano Ca(OH)2; Amoxicillin mTAP +I (Ibuprofen); Nano Amoxicillin mTAP + Nano Ibuprofen and was incubated for 7 days. The proportions of dead and live bacteria was quantitatively analyzed by Confocal laser scanning microscopy. One-way ANOVA was used to compare the four groups and intergroup comparison with Tukey’s post hoc tests. Results: Nano Amoxicillin mTAP with Nano Ibuprofen was shown to have a higher antibacterial effect against E. faecalis compared to the unmodified medicaments. Conclusion: Nanomodified ICMs of APIs showed better antimicrobial activity due to their increased stability and deeper penetration into dentinal tubules when compared to conventional forms of ICMs.

Laser Applications in Regenerative Endodontics: A Review.

Introduction: Developing regenerative endodontic treatment (RET) is an exciting approach to managing immature permanent teeth with pulp necrosis. RET is usually performed in two clinical steps: disinfection (first step) and tissue engineering (second step). Recently, laser therapy has entered the field of RET. This study aimed to provide an overview of the literature that employed laser therapy for root regeneration. Methods: A comprehensive search was performed on four databases, including PubMed, Web of Science, Scopus, and Google Scholar. The searched keywords were laser, regenerative endodontics, immature permanent teeth, and dental pulp necrosis, and related English-published articles were included up to October 2023. Results: Thirteen studies utilized a laser for RET. In the first step of RET, both high-power and low-level lasers (through photodynamic therapy [PDT]) may be applied for canal disinfection. In contrast, regenerative procedures in the second step of RET are just accelerated by low-power lasers (biostimulation). The literature does not support the benefit of laser-assisted irrigation in improving the clinical success of RET. There is some evidence that laser-assisted disinfection with a diode laser may provide comparable results to triple antibiotic paste in reducing bacterial counts in root canals while providing slightly better clinical and radiographic outcomes. PDT may be an effective and suitable adjunct to conventional disinfection methods in immature, necrotic teeth. Conclusion: Low-power lasers may be beneficial tools for improving the results of regenerative endodontics through chemical disinfection in the first step (PDT) or by biostimulation in the second step of RET.

Comparative Evaluation of Anti-bacterial, Anti-inflammatory Efficacy and Cytotoxicity of Triple Antibiotic Paste Modified Soft Liners with Conventional Soft Liners: An In-vitro Study

Comparative Evaluation of Anti-bacterial, Anti-inflammatory Efficacy and Cytotoxicity of Triple Antibiotic Paste Modified Soft Liners with Conventional Soft Liners: An In-vitro Study

Effect of T ect of Triple Antibiotic P riple Antibiotic Paste, Double Antibiotic P aste, Double Antibiotic Paste, and aste, and Calcium Hy Calcium Hydroxide on Antibiotic Resistance of T xide on Antibiotic Resistance of Tet Repr et Repressor Proteins, T oteins, Tetracycline Resistance Gene W cline Resistance Gene W, and T , and Tetracycline Resistance Gene Q: A Randomized

Objective: To investigate the effect of the use of Calcium Hydroxide (Ca(OH)2 ), Triple Antibiotic Paste (TAP), and Double Antibiotic Paste (DAP) as intra-canal medicaments on the development of antibiotic resistance by evaluating tetracycline genes. Methods: Forty five patients were randomly assigned into 3 groups according to the intracanal medication using a web program (www.randomizer.org), (Ca(OH)2 , TAP and DAP). Root canal bacteriological samples were collected before root canal treatment (S1) and after chemo-mechanical procedures (S2). Following root canal shaping procedures, intra-canal medication of the root canals was performed with selected intra-canal medicament. A second appointment was planned for the patients 15 days later. At the second appointment, the medication was removed mechanically and after irrigation of the root canals, the post medication samples (S3) were collected. Bacteriological samples were then investigated for bacterial counts and antibioticresistant genes [Tet Repressor proteins (TetR), Tetracycline resistance gene W (TetW) and Tetracycline resistance gene Q (TetQ)] using polymerase chain reaction (PCR), and the data were statistically analyzed. The Friedman, Kruskall-Wallis and chi-square tests were used. These genes were selected as the difference between TAP and DAP is that TAP contains tetracycline and tetracycline resistance is governed by tet genes. Results: There was no statistically significant difference among the samples (S1, S2, and S3) in terms of the number of root canals positive for antibiotic resistance genes in both the Ca(OH)2 and DAP groups. However, the number of root canals positive for TetR gene increased significantly (6 [40%] to 12 [86%]) following intra-canal medication with TAP. Conclusion: It can be concluded that 15 of days intra-canal medication with TAP causes tetracycline resistance. In contrast, DAP does not cause tetracycline resistance and it has similar antibacterial effectiveness to TAP. The DAP would be the choice of medicament rather than TAP in clinical practice.

Case series on two-stage disinfection in regenerative endodontics on permanent mandibular molar with blunderbuss canal

Background: Revascularization is a promising approach as it promotes root end closure forming healthy, thick root dentin at the apex which provides clinical and radiographic success due to the elimination of bacteria and disinfection of the canal which gives a 100% sterile environment to receive SCAP. Aim: To examine the effect of a regenerative endodontic procedure on immature necrotic teeth with apical periodontitis Method: An 8-year-old medically fit boy was referred to the department with a lingering type of pain in the immature permanent mandibular first right molar. Bleeding was induced in the root canals at the third appointment. The blood clots (scaffolds) were covered with MTA, and the tooth was restored with a composite filling. Recall sessions were scheduled after one month and 3 months, when the tooth appeared asymptomatic clinically and radiographically, with considerable periapical healing. Conclusion: An immature multirooted tooth with necrotic pulps and periapical radiolucency was managed with evident clinical and radiographic success, wherein non-setting calcium hydroxide paste and triple antibiotic paste were used sequentially to guarantee complete canal disinfection.

Components and outcome of triple antibiotic paste and its application in endodontic infections

In the field of endodontic therapies, the use of antibiotics, especially in the form of root canal medications, plays a pivotal role in ensuring successful treatment outcomes. This review examines the role of triple antibiotic paste (TAP) in such therapies, delving into its composition, application, and effects on endodontic infections. TAP, a combination of metronidazole, ciprofloxacin, and minocycline, targets the diverse microbial flora in odontogenic infections. Its local application within the root canal space proves more effective than systemic administration, significantly reducing microbial count and aiding in tissue regeneration and disinfection. However, the use of TAP is not without challenges, as it can cause tooth discoloration, particularly due to minocycline, and raise concerns about antibiotic resistance and long-term biocompatibility. This study, conducted through a comprehensive literature search, evaluates the efficacy of TAP, its impact on tooth structure, and its role in maintaining the vitality of diseased pulp. The findings highlight TAP’s significant role in endodontic treatments, emphasizing its benefits in achieving therapeutic goals while acknowledging the need for careful consideration of its drawbacks.

Triple antibiotics: A synergistic approach to combating infection

The utilization of Triple Antibiotic Paste (TAP) in dentistry has emerged as a significant development in endodontic and odontogenic infection management. With increasing cases of odontogenic infections, particularly in the context of the complex root canal anatomy, the selection of appropriate medicaments and disinfectants has become imperative. (1) In situations where conventional manual preparation and irrigation prove inadequate, TAP stands out as an intracanal disinfectant comprising a combination of three antibiotics, exhibiting a synergistic antimicrobial effect against a wide spectrum of microorganisms. This review outlines the multifaceted applications of TAP in dentistry, from its composition and clinical utility to its potential in preserving the vitality of diseased pulp. It also acknowledges the limitations and drawbacks associated with TAP's application, emphasizing the need for precise administration. Furthermore, it discusses TAP's role in primary teeth, expanding its scope beyond conventional endodontics. This research investigation explores the latest insights and considerations surrounding the "triple antibiotic paste" (TAP) and its applications in the field of dentistry, with a particular focus on endodontics.

Triple Antibiotic Paste: Boon to Dentistry

Microorganisms must be removed from the root canal (RC) and periapical region for endodontic success. A sterile state cannot be achieved with only endodontic instrumentation. Local administration of antibiotics has been studied in light of the development of non-instrumentation endodontic treatment, tissue healing and lesion sterilization. Triple antibiotic paste (TAP) with metronidazole, ciprofloxacin, and minocycline works well for non-vital young permanent teeth and the RC pathogen. Present review of literature aims to discuss role of TAP in endodontic treatment.

Lesion Sterilization Tissue Repair and Recent Advances: A Review

Lesion sterilization tissue repair (LSTR) is an emerging approach in dentistry, aimed at eliminating infectious microorganisms from the root canals and promoting tissue repair. This review provides a comprehensive overview of the principles, techniques, and recent advances in LSTR. The traditional root canal treatment focuses on complete debridement and disinfection of the root canal system. However, LSTR offers an alternative approach by employing a triple antibiotic paste (TAP) consisting of metronidazole, ciprofloxacin, and minocycline. This antibiotic combination has shown promising results in eliminating the root canal microbiota, particularly in cases of immature teeth with open apices and necrotic pulps.

Efficacy of Triple Antibiotic Paste and Bromelain Paste As Intracanal Medicament Against Enterococcus faecalis: An In-Vivo Study.

Introduction Microorganisms are pivotal contributors to pulp and periapical pathology, often culminating in endodontic treatment failures. The successful outcome of such treatment hinges on the effective eradication of microbial flora through various interventions, including intracanal medicaments (ICMs). However, Enterococcus faecalis (E. faecalis), a highly adaptive Gram-positive bacterium, exhibits remarkable resilience and can persist even after rigorous disinfection efforts. This study explores the efficacy of two ICMs, calcium hydroxide-based triple antibiotic paste (TAP) and a novel alternative containing bromelain, derived from pineapples, in combating E. faecalis infections in vivo. Methodology This in-vivo study was conducted at Sharad Pawar Dental College and Hospital, Wardha, India, and ethical approval was obtained from the institutional ethical committee. The sample size was calculated using the OpenEpi program (version 3.04.04, Open Source Epidemiologic Statistics for Public Health, www.OpenEpi.com), resulting in 15 participants per group. Inclusion criteria encompassed mandibular premolars with carious involvement but no prior restorations, diagnosed with necrotic or infected pulp, and no significant medical history. Exclusion criteria included systemic conditions, pregnancy, retreatment cases, recent antibiotic therapy, calcified canals, and other contraindications. After proper patient consent, access opening and chemomechanical preparation were performed, and root canals (RCs) were randomly divided into two groups: TAP and bromelain paste (BP). TAP was prepared using ciprofloxacin, metronidazole, and minocycline, while BP comprised bromelain powder mixed with saline. Both groups received intracanal medicaments, followed by temporary sealing. Microbiological samples were collected before and after treatment for analysis. Results E. faecalis count (CFU/mL) before instrumentation for the TAP group was (1.94 x 105[Formula: see text] 7.45 x 103) and for BP group was(1.97 x 105[Formula: see text] 7.70 x 103) with p-value 0.26[Formula: see text] p=0.05, so no significant difference was found between them.E. faecalis count (CFU/mL) after instrumentation for the TAP group was (7.70 x 103 [Formula: see text] 9.11 x 102) and for the BP group was(7.26 x 103 [Formula: see text] 8.43 x 102) with p-value 0.18 [Formula: see text] p=0.05, so no significant difference was found between them. However, the E. faecalis count obtained after seven days of intracanal medicament for the TAP group was (3.63 x 101 [Formula: see text] 5.60) and for the BP group was(3.13 x 101 [Formula: see text] 4.55) with p-value 0.012 < p=0.05, so a significant difference was found between them. This means that when compared with the TAP group, there was a greater amount of reduction in E. faecalis count (CFU/mL) for the BP group seven days after the placement of intracanal medicament, and this reduction was statistically significant. Conclusion This in-vivo study highlights the potential of BP as a more effective intracanal medicament against E. faecalis when compared to the conventional TAP. Bromelain's selectivity for Gram-positive bacteria and its diverse therapeutic properties make it a promising natural alternative for endodontic treatment. Further research is warranted to optimize bromelain's clinical application and assess its potential to enhance endodontic outcomes, potentially revolutionizing the field of endodontics.

Scanning Electron Microscopy Analysis of the Intratubular Radicular Dentin Penetration of Calcium Hydroxide, Triple Antibiotic Paste, and Nitrofurantoin.

The aim of this study is to assess and analyze the intratubular penetration of the intracanal medications nitrofurantoin (Nit), triple antibiotic paste (TAP), and calcium hydroxide (CH). Sixty freshly extracted single-rooted teeth were acquired and decoronated to a standard length of 15 mm. To prepare specimens up to size F3, rotary ProTaper instrumentation was employed. The prepared teeth were divided into three groups, each of which received one of the tested intracanal medicaments: Group I (calcium hydroxide), Group II (triple antibiotic paste), and Group III (nitrofurantoin). Using a size #30 Lentulo spiral, a freshly prepared therapeutic paste was placed into the canals, and the intracanal medicaments were allowed to set in the incubator at 100% humidity. The samples were subsequently sliced perpendicularly to their long axis using a precision saw and assessed under a scanning electron microscope to assess the depth of penetration of intracanal medicaments at the coronal, middle, and apical portions of the root canal dentin. The data were analyzed using one-way ANOVA and Tukey's post hoc test. The statistical analysis revealed a significant difference between the experimental groups in the quantity and depth of sealer penetration (p < 0.05). In particular, as compared to the Nit group, both the CH and TAP groups had significantly smaller penetration areas (p < 0.05). In conclusion, this ongoing investigation indicates that nitrofurantoin penetrated dentinal tubules better than calcium hydroxide or triple antibiotic paste.

The Effect of Rosmarinus Officinalis as a Potential Root Canal Medication on the Viability of Dental Pulp Stem Cells.

The objective of the current study was to assess and compare the impact of triple antibiotic paste (TAP) and calcium hydroxide (Ca(OH)2) with rosmarinic acid (RA) on the viability of dental pulp stem cells (DPSCs). Dental pulp stem cells were isolated and characterized using flow cytometry. The cells were treated with (0.25, 0.5, 1, 2.5, and 5 mg/mL) concentrations for TAP and Ca(OH)2 and (6.25, 12.5, 25, 50, and 100 µM) concentrations for RA. Cell viability was evaluated after 3 days, with cell proliferation further analyzed over 3, 5, and 7 days utilizing the MTT assay. The optical density (OD) was quantified at 570 nm, subsequently enabling the determination of corrected OD and cell viability. ANOVA followed by the post hoc Tuckey test evaluated the statistical significance at p < 0.05. Following the cell viability test, 0.25 and 0.5 mg/mL of TAP and Ca(OH)2 showed no significant difference for DPSCs compared to the control group. While dosages of 1 mg/mL, 2.5 mg/mL, and 5 mg/mL significantly reduced cell viability (p < 0.05). However, 6.25 µM and 12.5 µM concentrations of RA showed a significant increase in cell viability compared to untreated cells, 25 µM and 50 µM concentrations showed no significant difference compared to untreated cells while 100 µM concentration showed a decrease in cell viability (p < 0.05). Moreover, RA at a concentration of 12.5 µM exhibited a significant enhancement in cell proliferation rates after 5 and 7 days. Rosmarinic acid showed a significant increase in cell viability when used at 6.25 and 12.5 µM concentrations compared to TAP and CA(OH)2. The assessment of cytotoxicity associated with bioactive compounds like RA, which processes antimicrobial and anti-inflammatory properties, holds importance. This evaluation could pave the way for novel intracanal medicaments that enhance the regenerative potential of DPSCs.

Comparison of Antibacterial Effect of Novel Triple Antibiotic Paste, Conventional Triple Antibiotic Paste and Diode Laser Beam on Root Canals Infected with Enterococcus Faecalis

Comparison of Antibacterial Effect of Novel Triple Antibiotic Paste, Conventional Triple Antibiotic Paste and Diode Laser Beam on Root Canals Infected with Enterococcus Faecalis

Comparative Evaluation of the Effect of Six Different Low-Surface-Tension Vehicles on the Penetration of Modified Triple Antibiotic Paste in Dentinal Tubules: An In Vitro Study.

Background Modified triple antibiotic paste (MTAP) helps in the elimination of microorganisms which is imperative for the success of endodontic therapy. The intracanal medicament powders must be mixed with vehicles for better handling and penetration in the root canals. The purpose of this study is to comparethe effect of six low-surface-tension vehicles on the penetration of MTAP in dentinal tubules. Methodology The root apices of 60 single-rooted human mandibular premolars were resected to obtain 12mm length. After biomechanical preparation,intracanal medicaments were prepared by mixing with the six vehicles (Group 1-Bupivacaine,Group 2- Sodium ether lauryl sulfate,Group 3- Neosporin H,Group 4- Chlorhexidine gluconate,Group 5- Chitosan, and Group 6- Polyethylene glycol) with MTAP and Rhodamine B dye. Middle and apical transverse sections were scanned under a confocal laser scanning microscope. The data were statistically analyzed using the one-way ANOVA test and the level of significance was p<0.05. Results The maximum depth of penetration was seen in Group 2 (MTAP with sodium ether lauryl sulfate) followed by Group 5 (MTAP with chitosan),Group 4 (MTAP with chlorhexidine gluconate),Group 1 (MTAP with bupivacaine),and Group 6 (MTAP with polyethylene glycol),and the least penetration by Group 3(MTAP with Neosporin H). The depth of penetration in the middle level was in the order of Group 2 followed by Group 4,Group 5, Group 3,Group 6, and Group 1. The depth of penetration in the apical level was in the order of Group 2 followed by Group 5,Group 1,Group 4,Group 6,and Group 3. The overall depth of penetration was significantly higher at the middle level than at the apical level. Conclusion Group sodium ether lauryl sulfate showed the maximum depth of penetration in both the middle and apical areas. The least depth of penetration in the middle area was seen in group bupivacaine andthe apical area by group Neosporin H.

Effectiveness of Laser-activated and Ultrasonic Irrigation Techniques in Removal of Calcium Hydroxide and Modified Triple Antibiotic Paste from the Root Canals: An In Vitro Evaluation.

To evaluate the effectiveness of laser-activated irrigation (LAI) and ultrasonic irrigation (UI) in the removal of calcium hydroxide [Ca(OH)2] and modified triple antibiotic paste (MTAP) from the root canals. Root canals of freshly extracted human permanent maxillary incisors (n = 80) were prepared. The root canals of half sample (n = 40) were filled with Ca(OH)2 and the other half (n = 40) with MTAP, in which propylene glycol was used as a vehicle. After 14 days, roots were randomly assigned to four groups (n = 20) according to the irrigation technique used-group I [Ca(OH)2 with UI], group II (MTAP with UI), group III [Ca(OH)2 with LAI], group IV (MTAP with LAI). The roots were sectioned, and the intracanal medicament residues were evaluated at 25× magnification under stereomicroscope using 4-grade scoring system. One-way analysis of variance (ANOVA) and post hoc Tukey tests were performed. Laser-activated irrigation (LAI) was found to be superior compared to UI. Ca(OH)2 was better removed compared to MTAP with either of the irrigation techniques. A statistically significant difference was found between the Ca(OH)2 with LAI and MTAP with UI groups in all the regions, that is, coronal, middle, and apical thirds. Laser-activated irrigation (LAI) was superior to UI in removing Ca(OH)2 and MTAP. Ca(OH)2 was better removed than MTAP, irrespective of the technique used. However, none of the irrigation techniques could completely remove the intracanal medicament from the root canals. Swathi P, Uloopi KS, Vinay C, et al. Effectiveness of Laser-activated and Ultrasonic Irrigation Techniques in Removal of Calcium Hydroxide and Modified Triple Antibiotic Paste from the Root Canals: An In Vitro Evaluation. Int J Clin Pediatr Dent 2023;16(S-1):S1-S5.

Comparison of Antimicrobial Activity of Triple, Double, and Cefixime-Based Antibiotic Pastes Against Enterococcus Faecalis: An In Vitro Study.

This in vitro study aims to compare the antimicrobial efficacy of triple antibiotic paste, double antibiotic paste, and cefixime-based triple antibiotic paste againstEnterococcus faecalis. Materials and methods: Fifty single-rooted, caries-free, permanent teeth without any developmental defects were included in this study. The specimens were divided into five groups, with each group consisting of 10 teeth that received a specific medicament. The groups were as follows: Group I: control; Group II: calcium hydroxide;Group III: triple antibiotic paste; Group IV: double antibiotic paste; and Group V: cefixime-based triple antibiotic paste. The antimicrobial activity of the medicaments was assessed againstE. faecalisat the end of the seventhand 14th days. The colony-forming units (CFU) werecalculated using the Kolmogorov-Smirnov and Wilcoxon tests. After seven days of the experimental process, it was observed that the CFU count was highest in group I and lowest in group V. In a similar vein, after 14 days, the maximum decrease in CFU count was observed inGroup V, while the least reduction in CFU count was observed in Group II. On intergroup comparison, it was found that the maximum decrease in CFU was noted inGroup V, followed by Group IV, Group III, and Group II. The study results indicated that the cefixime-enriched antibiotic paste had the greatestantimicrobial effectiveness, while the double and triple antibiotic pastes offered superior antibacterial efficacy againstE. faecalis at the end of the seventhand 14thdays.

Comparison of the Photon-initiated Photoacoustic Streaming Technique and a Combination of Different Irrigation Activation Regimens on the Removal of Modified Triple Antibiotic Paste

Amaç: Bu çalışmanın amacı, kök kanallarından modifiye üçlü antibiyotik patının (mTAP) çıkarılmasında foton kaynaklı fotoakustik dalgalanma (PIPS) tekniği ile farklı irrigasyon aktivasyon rejimlerinin kombinasyonunun etkinliğini karşılaştırmaktır.&#x0D; Gereç ve Yöntemler: Yüz beş adet çekilmiş insan mandibular-premolar dişler ProTaper döner eğe kullanarak prepare edildi. Kök kanalları mTAP medikamenti ile dolduruldu ve 4 hafta sonra kökler kullanılan irrigasyon rejimlerine göre rastgele 7 gruba (n=15) ayrıldı: Self-Adjusting File (SAF), Pasif-Ultrasonik-İrrigasyon (PUI) , EndoAktivatör (EA), SAF+EA, SAF+PUI, PUI+EA, PIPS. 3 dişte mTAP kaldırılmadı (pozitif kontrol) ve diğer 3 diş mTAP ile doldurulmadı (negatif kontrol). Kökler uzunlamasına ikiye ayrıldı ve kalan mTAP miktarı, 4 dereceli bir skorlama sistemi kullanılarak 20x büyütme ile değerlendirildi. Veriler Kruskal-Wallis ve Mann-Whitney U testleri kullanılarak değerlendirildi.&#x0D; Bulgular: Tüm deney grupları arasında istatistiksel olarak anlamlı farklılık tespit edildi. PIPS, SAF, SAF+EA ve SAF+PUI, mTAP'yi kök kanalından çıkarmada PUI ve PUI+EA'dan önemli ölçüde daha iyi performans gösterdi (P=0.000). EA orta etkinlik gösterdi. Apikal ve orta üçte birlik kısımda PUI ve PUI+EA ve koronal üçte birlik kısımda PUI önemli ölçüde daha kötü performans gösterdi (P

Comparative Evaluation of Antimicrobial Efficacy of Various Antibiotic Pastes and Calcium Hydroxide Using Chitosan as a Carrier Against Enterococcus faecalis: An In Vitro Study.

The use of intracanal medicaments between appointments can serve as an important aid in the sterilization of the root canal system. Calcium hydroxide is commonly used, but it is not completely effective against Enterococcus faecalis. A triple antibiotic paste (TAP) is used but has the problem of tooth discoloration. Double antibiotic paste (DAP) or modified TAP (MTAP) has been suggested to solve this. Chitosan has been used as a vehicle in pharmacology, and it has inherent antibacterial properties too. This study compares the efficacy of DAP and MTAP using chitosan as a vehicle with calcium hydroxide. Sixty single-rooted teeth were taken and decoronated with a length of 13 mm. Biomechanical preparation (BMP) was done with #3 Gates-Glidden (GG) drills, 17% ethylenediaminetetraacetic acid (EDTA), and 5.25% sodium hypochlorite (NaOCl) used for irrigation. These were kept in microcentrifuge tubes with 1 ml brain heart infusion (BHI)broth. Contamination was done with E. faecalis strain for 21 days. DAP and MTAP pastes were prepared and added to the chitosan solution. Groups were divided into 10 each, each medicament with saline or chitosan as the vehicle. The microbial load was measured at the end of two and seven days. The level of significance was kept at p = 0.05. Statistical analysis was done with the Kruskal-Wallis test and analysis of variance (ANOVA). DAP and MTAP groups with chitosan showed a significant reduction in the microbial load when compared to calcium hydroxide with chitosan. DAP and MTAP with chitosan can be effective intracanal medicaments against E. faecalis in refractory endodontic cases.

Next generation antibacterial strategies for regenerative endodontic procedures: A scoping review.

The clinical results following regenerative endodontic procedures (REPs) vary according to numerous parameters, including the presence of bacteria. This limitation reduces the indications for REPs and calls for the development of next generation antibacterial strategies (NGAS) providing alternatives to current antibacterial strategies (CAS) such as double or triple antibiotic paste (DAP/TAP) and (Ca(OH)2). The present scoping review aims to describe the current trends regarding the use of such strategies and highlight future perspectives. Four databases (PUBMed, Cochrane, ClinicalTrials and Science Direct) were searched until 1st May 2023. A total of 918 records were identified, 133 were screened and assessed for eligibility, and 87 articles were included. The findings show that (1) clinical studies are only available for CAS, (2) although next generation strategies are the most studied approach since 2017, they are all at the pre-clinical stage, (3) most of the next generation strategies use galenic forms which offer cell support and colonization and which simultaneously contain antibacterial molecules as alternatives to CAS and to antibiotics in general, (4) standardization is required for future research, specifically regarding the bacterial strains studied, the use of biofilm studies and the cellular behaviour assessments. Although NGAS are promising strategies to improve REPs in the context of infection, the current evidence is mostly limited to pre-clinical studies. Further methodological improvement is required to allow relevant comparisons between studies and to reduce the time from bench to bedside.