A novel patient‐specific three‐dimensional drug delivery construct for regenerative endodontics

Abstract

for their invaluable assistance during dog surgery and histology processing, respectively. M.C.B. acknowledges the National Institutes of Health (NIH)/National Institute of Dental and Craniofacial Research (NIDCR) (Grants K08DE023552 and R01DE026578). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Antimicrobial Therapeutics in Regenerative Endodontics: A Scoping Review

“…Indeed, the TAPeluting nanofibers are able to release the antibiotics following a well-controlled scenario, with confirmed antimicrobial properties, as demonstrated by the studies included in this review. On the basis of 5 studies that reported on the use of TAP-eluting nanofibers for the disinfection of biofilm-infected dentin samples, 4 showed similar antimicrobial activity as compared with TAP 17,18,32,34 ; the other study 20 exhibited a slightly lower ability to kill bacteria (97.5%) compared with TAP (100%), although it may still be considered an excellent result. One should consider the concentration of antibiotics used to fabricate the TAP-eluting nanofibers in those studies, which ranged from 25 to 35 mg/mL, as being lower than the amount used to prepare the paste-like TAP (50 mg/mL).…”

“…Although intracanal placement of antibiotic pastes has been well-accepted in regenerative endodontic protocols and is recommended by the American Association of Endodontists (AAE), the use of triple antibiotic paste (TAP) has been associated with undesirable clinical outcomes, because it interferes with the release of dentin growth factors 15 , inhibits vascularization due to the presence of minocycline (MINO) 16 , and high toxicity [13][14][15][17][18][19] . Moreover, TAP usually stains dentin 19,20 , causing crown discoloration; therefore, the AAE's current recommendation is that when using TAP as an intracanal medication, the professional should consider using low concentrations (eg, 1-5 mg/mL) of the antibiotics and/or apply TAP only after sealing the pulp chamber with a dentin bonding agent, thus minimizing the risk of staining 21 .…”

“…One may consider that in light of reducing the risks of reinfection without deleterious effects, alternative approaches have also been explored, which may eventually lead to the establishment of a new therapy for the treatment of permanent teeth with necrotic pulp. The literature has related many alternatives to TAP, including but not limited to antibiotic-releasing nanofibers [17][18][19]22,23 , distinct antibiotic formulations [24][25][26] , and delivery vehicles 27,28 . Last, although not recommended by the AAE, the combination of Ca(OH) 2 with chlorhexidine (CHX) has also been reported in clinical studies as an alternative to providing a better antimicrobial effect to Ca(OH) 2 [28][29][30] .…”

“…All the studies considered a beagle dog model and used immature permanent double-rooted teeth from both the upper and lower premolars that had necrotic pulps/apical periodontitis. Alternative antimicrobial strategies to TAP varied from a 3-dimensional (3D) tubularshaped TAP-eluting nanofibrous construct containing 35 mg/mL of each antibiotic 18 to a 1% propolis paste 37 or Qmix solutions composed of CHX, EDTA, and a surfactant detergent 38 . All the teeth were infected following a direct contamination process, ie, the teeth were incorporated with supragingival plaque scaled from the dogs' teeth or they were left open for a certain number of days.…”

“…All the teeth were infected following a direct contamination process, ie, the teeth were incorporated with supragingival plaque scaled from the dogs' teeth or they were left open for a certain number of days. Two studies 18,37 used a histopathologic analysis to examine the healing outcomes (ie, apical root closure, thickness of the dentin layer, and presence or absence of inflammatory reaction around the apical zone), whereas one study 38 used the CFU analysis to verify the antimicrobial potential of the alternative strategies to reduce bacterial counts as compared with TAP. Overall, the use of both the 3D TAP-eluting construct and propolis paste resulted in similar tooth maturation events when compared with TAP administration and also lower toxicity or potential to provoke inflammatory reactions in the periapical area than TAP.…”