The effect of triple antibiotic paste as an intracanal medication with an anti-inflammatory drug on post-operative pain of asymptomatic uniradicular necrotic teeth: a double blind randomized clinical trial

Abstract

<ns4:p><ns4:bold>Background:</ns4:bold> Flare-ups may occur after root canal treatment which consist of acute exacerbation of asymptomatic pulpal and/or periradicular pathologic condition. The causative factors of interappointment pain include mechanical, chemical or microbial irritation to the pulp or periradicular tissues. The potential role of microorganisms in interappointment pain is why the success of endodontic treatment depends on complete eradication of microorganisms capable of causing an intraradicular or extraradicular infection. This can be achieved by mechanical cleaning and shaping, in conjunction with irrigation and antibacterial agents. The aim of this study was to assess the ability of triple antibiotic paste with the anti-inflammatory drug diclofenac potassium versus calcium hydroxide used as an intra-canal medication in reducing post-operative pain.</ns4:p><ns4:p> <ns4:bold>Methods:</ns4:bold> 84 patients with asymptomatic uniradicular necrotic teeth were randomly assigned into two groups according to the intra-canal medication used: calcium hydroxide group (CH) and triple antibiotic paste with diclofenac potassium group (TAPC). In the first treatment session, intracoronal cavity preparation was performed after rubber dam isolation followed by chemo-mechanical preparation using rotary Protaper Universal files with saline irrigation followed by intra-canal medication placement then postoperative pain was assessed at 24, 48 and 72 hours postoperatively using Visual Analogue Scale (VAS). In the second treatment session, intracanal medications were removed by irrigation using saline followed by obturation.</ns4:p><ns4:p> <ns4:bold>Results: </ns4:bold>Both intracanal medicaments resulted in a statistically significant decrease in mean pain value from 24 to 48 and 72 hours postoperatively. While when comparing both groups, TAPC intracanal medication showed less post-operative pain compared to that of the CH group at 24, 48 and 72 hours with a statistically significant difference at 48 hours only.</ns4:p><ns4:p> <ns4:bold>Conclusion:</ns4:bold> Both intracanal medicaments were efficient in reducing post-operative pain in asymptomatic uniradicular necrotic teeth.</ns4:p><ns4:p> <ns4:bold>Trial registration: </ns4:bold>Clinicaltrial.gov <ns4:ext-link xmlns:ns3="http://www.w3.org/1999/xlink" ext-link-type="uri" ns3:href="https://clinicaltrials.gov/show/NCT02907489">NCT02907489</ns4:ext-link>, 20/09/2016.</ns4:p>

The Effect of Calcium Hydroxide, Triple Antibiotic Paste and Chlorhexidine on Pain in Teeth with Symptomatic Apical Periodontitis: A Randomised Controlled Trial

“…Metronidazole is effective primarily against obligate anaerobic bacteria, while minocycline is a broad-spectrum tetracycline that mainly has a bacteriostatic action on bacteria through inhibition of bacterial protein synthesis. The synergistic effect of these three antibiotics in eliminating bacteria and achieving better post-operative pain control is in concurrence with the results of a previous study by Omaia et al [ 17 ]. However, in that study, the TAP combination also had an anti-inflammatory drug in it, which might have helped in achieving good pain control due to its anti-inflammatory effect.…”

Comparative evaluation of the antibacterial effect ofAllium sativum, calcium hydroxide and their combination as intracanal medicaments in infected mature anterior teeth: A randomized clinical trial

“…That might be attributed to the use of saline in irrigation, instead of sodium hypochlorite or chlorohexidine, which were used in their study. According to previous studies (Ghahramani et al, 2020; Martins et al, 2013; Mittal et al, 2020; Omaia et al, 2021; Paudel et al, 2011; Sinha et al, 2013; Tang et al, 2004), saline was used to accurately evaluate the antibacterial efficiency of the tested intracanal medications without confusing results from sodium hypochlorite or chlorohexidine antimicrobial effect. Sodium hypochlorite and EDTA were used only after the last sampling to ensure adequate disinfection of the canals before obturation (Basrani & Haapasalo, 2012; Haapasalo et al, 2005; Siqueira & Rôcas, 2008).…”

Evaluation of the Cytotoxicity and apoptotic effect of Nano triple antibiotic paste with Nano anti-inflammatory drug as an intracanal medicament

“…Diclofenac potassium anti-inflammatory drug was proved to be efficient in reducing post-operative pain when it was added to triple antibiotic paste as intracanal medication, its antinflamatory effect was comparable to that of calcium hydroxide when used in asymptomatic teeth with necrotic pulps ( 20 ).…”