Effectiveness and clinical implications of the use of topical antibiotics in regenerative endodontic procedures: a review

Abstract

Regenerative endodontic procedures (REPs) are biologically based procedures planned to replace damaged tissues, including dentinee and root structures, as well as cells of the pulp-dentine complex. Effective sterilization of the root canal is essential in REPs, and antibiotics have been widely used to disinfect root canals. The aim of this paper was to review the scientific literature on (i) Effectiveness of antibiotics used in REPs against bacteria implicated in endodontic disease; (ii) Scientific evidence supporting the use of topical antibiotics in REPs; (iii) Clinical implications of the use of antibiotics in REPs and the possible side effects; (iv) Effect of antibiotics on dental pulp stem cells; and (v) Ongoing research on the use of antibiotics in REPs. Antibiotics used in REPs are effective against bacteria implicated in endodontic infections. Triple antibiotic pastes with minocycline attain complete disinfection of immature teeth with necrotic pulps, without affecting SCAP. Experimental studies carried out in dogs support the use of antibiotics in REPs. Clinical studies report high success rates of RET using antibiotics as intracanal dressings. However, tooth discolouration is an important side effect of the use of TAP. An antibiotic paste containing only metronidazole and ciprofloxacin could be a good alternative to the use of TAP. The use of antibiotic-containing scaffolds or clindamycin-modified triple antibiotic (metronidazole, ciprofloxacin and clindamycin) polymer could be a biologically safe antimicrobial drug delivery system in REPs.

Evaluation of the Bactericidal Activity of a Hyaluronic Acid-Vehicled Clarithromycin Antibiotic Mixture by Confocal Laser Scanning Microscopy

“…A remarkable number of microorganisms are able to invade the root canal space, forming a biofilm and infiltrating the dentinal walls [35]. Therefore, REPs require a high-level, wide-spectrum disinfection, deep into the dentinal tubules, that does not disrupt the remaining dentin, or negatively affect stem cell viability [12,13,17,24]. The American Association of Endodontists' Regenerative Committee has established a recent protocol which includes the use of either calcium hydroxide or DAP and TAP [11].…”

“…Several in vitro and in vivo studies have described the efficacy of the combination of ciprofloxacin, metronidazole and minocycline (3-MIX), against several endodontic pathogens [12][13][14][15]. However, this topical triple antibiotic paste (TAP) may result in substantial tooth discoloration, primarily due to the chelating effect of the minocycline against the calcium ions [16][17][18]. Additionally, the bonding agents applied in the pulp chamber may be partially ineffective against root and crown staining [19,20].…”

“…Therefore, the recovery of a novel disinfecting solution is current in the emergent pulp regeneration field. Previous studies have reported that clindamycin or cefaclor-modified TAPs have demonstrated favorable outcomes when they were used during regenerative endodontic treatments [17]. However, an alternative antibiotic combination, composed of ciprofloxacin, metronidazole and clarithromycin (3-MIXC), has demonstrated high antimicrobial properties with no discoloration effects in vitro [26].…”

Revitalization Teeth: A Prospective Case Series

“…Therefore, low concentrations between 0.39 mg/mL [28] and 0.1 mg/mL [23] are recommended to date. For triple antibiotic pastes, minocycline has been replaced with cefuroxim to avoid tooth discoloration [30][31][32]. In the described cases, triple antibiotic paste was prepared in a liquid consistency and inserted into the canal by use of a syringe in a controlled manner under an operating microscope.…”

Evaluation of a Novel Endodontic Paste for Primary Teeth with Necrotic Pulp

“…However, as pastes that contains tetracycline or its derivates have the disadvantage of stain tooth structures the use of these substances has been discouraged. 11 Due to this reason, this study questioned whether modifying the original CTZ paste formulation would affect its properties in order do establish a novel paste to be used in dentistry. Therefore, the aim of this study was to evaluate physiochemical properties of a novel paste (CZ Paste) for endodontic treatment of primary teeth with necrotic pulps and compare its antimicrobial activity to CTZ and ZOE pastes.…”