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.

Objective: To evaluate effect of activated charcoal and activated charcoal calcium hydroxide combination mixed with distilled water on dentin microhardness.Materials and methods: 48 extracted human maxillary incisor teeth were decoronated at the cementoenamel junction and prepared using Protaper next up to X 4. Then they were randomly allocated to three treatment groups and one control group (12 samples for each group) according to applied medicament as follows: The control group (no medication was applied), Group I: Ca(OH) 2 ( Cerkamed, Poland) mixed with distilled water, Group II: Activated charcoal (Eucarbon Sedico, Cairo, Egypt) / Ca(OH) 2 combination mixed with distilled water, Group III: Activated charcoal mixed with distilled water. After medicament application, specimens were incubated at 37 °C for 24 h, 3 and 7 days. After each storage period, 4 randomly selected specimens were taken from each group and a middle 2-mm root cylinder was horizontally sectioned from each root for microhardness evaluation using the Vickers microhardness tester. Data were analyzed using Twoway ANOVA test to study the effect of intracanal medication, time, and their interactions on mean micro-hardness values.Results: There was no statistically significant difference between microhardness values of specimens treated with different intracanal medications and control group at different time periods. Conclusion:Activated charcoal alone or combined with calcium hydroxide mixed with distilled water as intracanal medication up to one week didn't affect dentin microhardness.

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Objective: This study aimed to evaluate efficacy of activated charcoal and activated charcoal/ calcium hydroxide combination versus calcium hydroxide as intracanal medication against Enterococcus faecalis Methods: 42 extracted single rooted premolar teeth were prepared, sterilized and inoculated with E. faecalis for 21 days. After incubation, initial bacterial counts were detected. Then, samples were divided randomly into three groups (n = 14) according to the used medication as follows: Group I: Ca (OH) 2 mixed with distilled water, Group II: activated charcoal /Ca (OH) 2 mixed with distilled water, Group III: activated charcoal mixed with distilled water, then samples were incubated for 7 days. The percentage reduction in colony counts (%RCC) after 7 days was used to measure the antibacterial effectiveness of different intracanal medications. The percentage reduction in bacterial counts in the three groups were compared statistically using the One-way ANOVA test.Results: Activated charcoal and calcium Hydroxide/activated charcoal groups showed statistically significantly higher mean percentage of reduction in bacterial counts than Calcium Hydroxide group.. Conclusion:Activated charcoal and Calcium Hydroxide/Activated charcoal were effective against Enterococcus faecalis than calcium hydroxide.