Use Of Triple Antibiotic Paste Research Articles

Triple Antibiotic Paste: A Game Changer in Endodontics

ABSTRACT 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.

Resolution of a large periapical lesion in an immature maxillary lateral incisor with the aid of triple antibiotic paste

Apexification procedures are frequently performed on immature permanent teeth with incomplete root formation, open apices and necrotic pulp status with or without periapical lesions in order to induce a calcific barrier prior to root canal therapy. The elimination and control of infection in the root canal space is critical to the success of these procedures. A healthy 21-year old male presented with pulpal necrosis, a large periapical lesion, incomplete root formation and an open apex on a maxillary right lateral incisor. Triple antibiotic paste was used to achieve antimicrobial control after traditional calcium hydroxide paste medicament failed to resolve the symptoms. Obturation was achieved using MTA and the conventional apexification technique. Excellent healing of the large periapical lesion was achieved without surgical intervention and the 4-year follow-up CBCT demonstrated complete bone fill of the lesion. Clinicians should be aware that alternative antimicrobial medicaments, such as triple antibiotic paste, may be beneficial in situations where conventional medicaments prove unsuccessful. The use of triple antibiotic paste may result in sufficient healing of the periapical lesion to justify placement of an MTA apical barrier without the need for surgical intervention

Determination of crown discoloration and fluorescence induced by different medications used in regenerative endodontic procedures: An ex vivo study.

BackgroundCrown discoloration is an undesirable side effect of the use of triple antibiotic paste (TAP) in regenerative endodontic procedures (REPs). The aim of this ex vivo study was to assess the potential for tooth discoloration and induction of fluorescence associated with the use of TAP containing either doxycycline (DOX) or clindamycin (CLIN), and of calcium hydroxide (Ca(OH)2), by spectrophotometric analysis and confocal laser scanning microscopy (CLSM). Material and MethodsA total of forty single-rooted human teeth extracted by therapeutic indication were used. The root canals were enlarged using the step-back technique up to a K #80 file and were randomly divided into four experimental groups (10 specimens each): i)Ca(OH)2 group, ii)TAP with DOX group, iii) TAP with CLIN group, iv) Control group (no treatment). To quantify the change of color of the different groups of teeth included, the Vita Easyshade advance 4.0 spectrophotometer was used. CLSM was used to determine fluorescence. ResultsAfter 28 days of action inside the root canal, no extreme discoloration was visible, to the naked eye, in any of the teeth included in the study. Under the conditions of this ex vivo study, TAP with DOX induced the highest crown discoloration among the medicaments tested. In contrast, Ca(OH)2 and TAP with CLIN did not induce crown discoloration after 28 days. The TAP with DOX group presented the highest fluorescence measurements. ConclusionsConsidering the discoloration potential and fluorescence changes in TAP with DOX or other tetracyclines, and the cytotoxic effect of TAPs, we recommend the use of Ca(OH)2 for REPs. Key words:Discoloration, doxycycline, clinadamycin, calcium hydroxide, endodontics.

Regenerative Endodontics: A Paradigm Shift in Clinical Endodontics.

ABSTRACTPreserving the natural dentition in its normal form and function is one of the major goals of endodontic treatment. Re-establishing the lost vitality and development of root maturation in immature permanent teeth with pulp necrosis/apical periodontitis is quiet challenging clinically. The very basis of regenerative endodontics relies on the concept of tissue engineering using stem cells, biomimetic scaffold, and bioactive growth factors to regenerate the pulp tissue damaged by microbial infection, injury, or developmental defects. In clinical endodontics, this approach is referred to as a “paradigm shift.” Even though repair instead of true regeneration is achieved with current protocols, it is hoped that further research in the area of stem-cell-based tissue engineering will allow for true regeneration and improved treatment outcomes. The aim of this review is to discuss about the various aspects of regenerative endodontics, current clinical protocols, and the future of pulp regeneration techniques.

The Use of Triple Antibiotic Paste and Mineral Trioxide Aggregate for Management of Inflammatory Root Resorption in Dental Avulsion: A Case Report

Tooth avulsion is described as complete displacement of a tooth from its socket due to trauma impact. Severe damage to the pulp and periodontal tissues could lead to severe root resorption and tooth loss. This case report will describe the use of triple antibiotic paste and mineral trioxide aggregate for management of inflammatory root resorption in two avulsed maxillary central incisors.

Effectiveness of triple antibiotic paste as an intra-canal medication for the root canal treatment of non-vital teeth with apical periodontitis: A systematic review

Background: This is a systematic review to assess and provide a pooled effect estimate, if possible, for the effects of triple antibiotic paste as an intra-canal medication for root canal treatment of mature permanent non-vital teeth with apical periodontitis. This review will assess post-operative pain, flare-up incidence, and clinical and radiographic healing. Methods: Nine electronic databases (Pubmed, CENTRAL, VHL, Scopus, EBSCOhost, Web of Science, Trip, OpenGrey, Proquest) were searched along with two major clinical trial registries. Conference proceedings, reference lists and citations of the included studies were also searched. A total of 537 records were identified and 392 were obtained after duplicate removal. Six records were identified after screening and three studies were included after full text eligibility assessment. Results: Three comparators were reported in the included studies: calcium hydroxide paste, 2% chlorhexidine gel and ledermix paste. There was no statistically significant difference between triple antibiotic paste and calcium hydroxide regarding postoperative pain, and clinical and radiographic healing of periapical lesions. There was no difference between triple antibiotic paste and chlorhexidine regarding flare-up incidence. However, triple antibiotic paste reduced the level of post-operative pain more than ledermix, which was statistically significant. Conclusions: The evidence is still insufficient surrounding the use of triple antibiotic paste; therefore more clinical investigations with high levels of evidence and rigorous methodologies are needed.

Tooth Discoloration and Internal Bleaching after the use of Triple Antibiotic Paste for Regenerative Endodontic Treatment of an Immature Necrotic Permanent Tooth: A Case Report

Recently, regeneration of immature necrotic pulp has become an alternative conservative treatment option for young permanent teeth and is a subject of great interest in the field of endodontics. The primary goal of these procedures is to activate the potential of the pulp for dentine deposition and produce a stronger mature root that withstands the forces better. However, the current protocol has potential clinical and biological complications. Amongst them, crown discoloration caused by triple antibiotic paste is deemed to be very frustrating for the dentist and the patient. In the case presented, there was a successful reversal of the crown discoloration by an internal bleaching procedure with superoxol at follow up periods of 3, 6 and 12 months. However, further long-term clinical trials and histological studies are needed to evaluate the long-term outcomes of walking bleach with superoxol in regenerative endodontic procedures.

A Review of Tooth Discoloration after Regenerative Endodontic Therapy

IntroductionThe American Association of Endodontists clinical considerations for regenerative therapy (April 2015) advise of the risk of the possible adverse effect of staining of teeth. It is widely acknowledged that before these guidelines were developed there was no standardized protocol for regenerative therapy, and different approaches using different materials have been reported. The purpose of this review was to undertake a systematic review of published cases to determine the incidence of reported discoloration and examine whether there was any particular association with any material. MethodsA PubMed search was performed using key words for regenerative endodontic therapy consistent with prior published systematic reviews. ResultsThere were 80 studies identified with 379 teeth treated. Many of the studies did not report on the presence or absence of discoloration. It was noted that there was a strong association of discoloration with the use of triple antibiotic paste containing minocycline; however, discoloration was also noted when other materials were used. Unfortunately, bleaching of stained teeth was not predictably achieved in some studies. ConclusionsThe use of triple antibiotic paste with minocycline as the intracanal medicament should be reconsidered. Either calcium hydroxide or the double antibiotic paste of metronidazole and ciprofloxacin may limit discoloration. Mineral trioxide aggregate was also associated with discoloration. However, there is little evidence of an alternative superior material as a coronal barrier. Because discoloration is a patient-orientated outcome, further research should document and identify the incidence of discoloration in regenerative endodontic treatment.

Effect of triple antibiotic paste and calcium hydroxide as intracanal medicaments on bond strength of composite to dentin

Objective: Considering the use of triple antibiotic paste (TAP) for root canal treatment of open apex teeth, this study aimed to assess the effect of TAP and calcium hydroxide (CH) on bond strength of composite to dentin. Methods: This in-vitro study was conducted on 32 extracted human premolar teeth. After disinfection with 2% thymol solution, the enamel on the buccal surface of specimens was removed to expose a smooth dentin surface parallel to the long axis of the teeth with approximately 19mm2 surface areas. Specimens were divided into three groups of 11, 10 and 11 specimens. In group one, TAP, in group two CH and in group three, saline solution were applied to dentin surfaces for 14 days. After removal of medicaments, composite cylinders were bonded to the dentin surfaces using a bonding agent. Shear bond strength was measured in an Instron machine at a crosshead speed of 1mm/min. Data were analyzed using one-way ANOVA. Results: The highest mean bond strength belonged to the control group (14.4760 MPa) and the lowest belonged to the TAP group (11.5808 MPa). The mean bond strength in CH group was less than that of the control and higher than that of the TAP group (11.7834 MPa). However, the difference among the three groups was not statistically significant (p=0.327). Conclusion: Use of medicaments such as CH and TAP has no effect on bond strength of composite to dentin.

Tooth discolouration and internal bleaching after the use of triple antibiotic paste.

To assess the discolouration of teeth with closed and open apices after placement of triple antibiotic paste (TAP, ciprofloxacin, metronidazole and minocycline) in the pulp chamber and whether discolouration could be reversed by internal bleaching procedures. Twenty extracted human mandibular premolars were divided into 2 groups (n = 10): teeth with closed apices (CA) and teeth with open apices (OA). After conventional access, the TAP was sealed in the pulp chamber for 3 weeks. The paste was removed by a rinse with sodium hypochlorite (NaOCl) and a mixture of sodium perborate and distilled water was sealed in the pulp chamber for 1, 2 and 3 weeks. The shade was measured by a spectrophotometer at six time periods: baseline (T0), after 3 weeks of placement of TAP (T1), after removal of TAP with a NaOCl rinse (T2) and after 1 (T3), 2 (T4) and 3 (T5) weeks of internal bleaching with sodium perborate paste. Data were collected based on the CIELAB-CIE1976 (L*a*b*) system and analysed using t-tests and anova. A significant decrease in the mean values of L* (lightness) was observed after treatment with TAP (T1, P < 0.05). Considerable increases in these values after bleaching with sodium perborate (T3 < T4 < T5) were found in both groups. The only significant difference in the intergroup analysis was between T1 and T2, in which ΔE values in the OA group were higher (P = 0.04). TAP discoloured the tooth structure, but discolouration could be reversed with sodium perborate paste. In general, teeth with closed and open apices had the same rates of discolouration and bleaching.

Crown discoloration due to the use of triple antibiotic paste as an endodontic intra-canal medicament

The use of triple antibiotic paste (TAP) (mixture of ciprofloxacin, metronidazole and minocycline) as an intra-canal medicament have shown very encouraging results particularly in non-vital immature teeth associated with periradicular lesions. Hence, before opting for a surgical approach, a non-surgical approach can be thought of with extended use of TAP as intra-canal medicament, especially in patients who are phobic to invasive procedures. On the flip side, the use of TAP has few side-effects, of which one is the discoloration it can cause due to the presence of minocycline in the mix. The purpose of this article is to presents a case of coronal discoloration due to the use of TAP as an endodontic intra-canal medicament.

Foreign Object Lodgment in the Root Canal and Its Management: A Case Report and an Overview

ABSTRACTSelf-introduced foreign object by an adult into the root canal of a lower incisor is seldom reported in the endodontic literature. This case report describes a self-introduced unusual foreign body and its retrieval from the root canal of lower left lateral incisor. A persistent sinus tract resistant to calcium hydroxide intracanal medicament was then successfully treated with the use of triple antibiotic paste. Postendodontically, nonvital bleaching and composite resin restoration was used to restore the form, function and esthetics of the tooth in a conservative manner.How to cite this articleGrover C, Thomas MS, Pai ARV. Foreign Object Lodgment in the Root Canal and Its Management: A Case Report and an Overview. J Contemp Dent 2012;2(2):47-52.

Use of triple antibiotic paste in the treatment of large periradicular lesions

Microorganisms are the possible source of endodontic lesions. The polymicrobial infection makes the sterilization of the root canal difficult. The following case report describes the non-surgical endodontic treatment of teeth with a large periradicular lesion. First, an intracanal dressing of calcium hydroxide was given. Since the symptoms did not subside, the treatment protocol was changed. A triple antibiotic paste was used instead for 3 months. On follow up, teeth were clinically asymptomatic and radiographically showed healing of the periradicular lesion. The result of the case show that when most commonly-used medicaments fail in eliminating the symptoms, then a triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) can be used clinically in the treatment of teeth with large periradicular lesions.

Use of triple antibiotic paste as a disinfectant for a traumatized immature tooth with a periapical lesion: A case report

Elimination of microbial contamination from the root canal system is a precondition for successful root canal treatment. In this regard, mechanical instrumentation, irrigation, and intracanal medication are all important. This case report assesses the efficacy of a triple antibiotic paste consisting of metronidazole, ciprofloxacin, and minocycline in the disinfection of immature teeth with apical periodontitis. An 8-year-old girl presented at the Department of Pediatric Dentistry for the evaluation of right and left maxillary central incisors with crown fractures and luxation. The right central incisor had a large periapical lesion, which was treated by filling the canal with a ciprofloxacin/metronidazole/minocycline paste. After 4 months, the patient had no symptoms, and a radiograph showed the radiolucency had completely resolved. At the 1-year follow-up, a periapical radiograph showed complete root development and apical closure. These results indicate that triple antibiotic paste is effective in disinfecting immature teeth with periapical lesions.