Discoloration of Roots Caused by Residual Endodontic Intracanal Medicaments

Abstract

Aims. This study examined the extent to which intervisit corticosteroid-based antibiotic pastes (CAP) medicaments contribute to staining of tooth structure after attempted removal by irrigation techniques. Methods. A total of 140 roots were prepared and the canals were filled with Ledermix paste (demeclocycline), Odontopaste (clindamycin), and Doxypaste (doxycycline). The pastes were removed after 2 or 4 weeks of storage in the dark using EDTA and NaOCl with either a 27-gauge-slotted needle or an EndoActivator (Dentsply). The roots were then exposed to an intense light source for 30 minutes each week and photographed after a further 1, 3, or 6 months. Digital images were standardized and data for changes in luminosity were analysed using repeated measures ANOVA and a post hoc test. Results. Removal of the medicament did not prevent later discolouration. There was no significant difference between the paste removal methods. Ledermix paste caused the greatest darkening compared to the untreated controls, for both application periods and both methods of removal. Doxypaste and Odontopaste caused less darkening than Ledermix. Conclusion. Medicaments that stain teeth may continue to discolour teeth despite best attempts to remove them. This study stresses the importance of material selection and minimising contact of Ledermix within the coronal aspects of teeth.

Factors affecting the rate of oxidation and resultant discolouration of tetracyclines contained in endodontic medicaments and irrigants

“…These bound residues can cause the root dentine to darken over time long after the paste has been removed (Chen et al . ).…”

“…As tetracyclines bind readily to tooth structure, use of a tetracycline-containing irrigant (such as MTAD) or a tetracycline-containing medicament paste will lead to the presence of residual tetracycline bound to the root dentine despite subsequent cycles of irrigation. These bound residues can cause the root dentine to darken over time long after the paste has been removed (Chen et al 2014).…”

A critical analysis of research methods and experimental models to study tooth discolouration from endodontic materials

“…For the question ‘Does Ledermix paste cause discolouration of teeth?’, there are no randomized clinical trials on this topic, and hence, no systematic reviews or meta‐analyses have been possible. The level of available evidence is placed relatively low on the pyramid of evidence‐based dentistry, with three case reports (Athanassiadis et al, 2018), and six in vitro studies using human teeth and human roots (Chen et al, 2012, 2014; Kim et al, 2000a, 2000b; Lal et al, 2013; Thomson et al, 2012). Details of these are summarized in Table 1.…”

Can Revascularization Serve as a Treatment Alternative to Apexification for Management of Immature Non-vital Permanent tooth? - A Review

“…9 The use of tetracycline and minocycline as intracanal medicaments leads to extensive tooth discoloration 14 so instead, doxycycline can be considered as an alternative which has found to cause less discoloration. 15 Patient age and time elapsed since tooth become non-vital -Younger the patient and lesser the duration of time since the tooth become non-vital more is the likelihood that regeneration would occur. It is not advisable to carry out regenerative endodontic procedures in children younger than 8 years or older than 16 years unless the tooth has an open apex with thin walls that are at risk from subsequent fracture.…”