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- Review Article Triple antibiotic paste: momentous roles and applications in endodontics: a review
-
Ardavan Parhizkar1
, Hanieh Nojehdehian1, Saeed Asgary2 -
Restor Dent Endod 2018;43(3):e28.
DOI: https://doi.org/10.5395/rde.2018.43.e28
Published online: June 20, 2018
1Department of Dental Biomaterials, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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- Correspondence to Hanieh Nojehdehian, PhD. Associate Professor, Department of Dental Biomaterials, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran 198396-3113, Iran. hanieh.nojehdehyan@gmail.com
• Received: February 26, 2018 • Accepted: April 10, 2018
Copyright © 2018. The Korean Academy of Conservative Dentistry
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
- This study investigated the latest findings and notions regarding ‘triple antibiotic paste’ (TAP) and its applications in dentistry, particularly endodontics. TAP is a combination of 3 antibiotics, ciprofloxacin, metronidazole, and minocycline. Despite the problems and pitfalls research pertaining to this paste has unveiled, it has been vastly used in endodontic treatments. The paste's applications vary, from vital pulp therapy to the recently introduced regeneration and revascularisation protocol. Studies have shown that the paste can eliminate the root canal microorganisms and prepare an appropriate matrix for further treatments. This combination is able to remove diverse groups of obligate and facultative gram-positive and gram-negative bacteria, providing an environment for healing. In regeneration protocol cases, this allows the development, disinfection, and possible sterilization of the root canal system, so that new tissue can infiltrate and grow into the radicular area. Moreover, TAP is capable of creating a discipline in which other wanted and needed treatments can be successfully performed. In conclusion, TAP, as an antibacterial intracanal medication, has diverse uses. Nevertheless, despite its positive effects, the paste has shown drawbacks. Further research concerning the combined paste and other intracanal medications to control microbiota is a must.
INTRODUCTION
Endodontic treatments are one of the most important and premiere therapies in the world of dentistry; they permit proper tooth function and maintain the dental structure in the oral cavity [1]. Different methods and strategies have been advocated, from the traditional step-back preparation technique to new contemporary approaches, all of which have shown various degrees of success and failure in teeth with a variety of pulp-periapical conditions [2]. Gradually, and as an adjunct to clinical approaches, root canal medicaments, particularly antibiotics, started to reveal their indispensable significance and pivotal rule in achieving successful outcomes [3].
Antibiotic therapy has become an inseparable part of diverse medical and medical-related treatments, and acts as the one of the main fronts against microorganisms [4]. Various antibiotics with divergent formulas are used, for prevention and prophylaxis, to cure active and acute infections and diseases [5,6]. There are different routes in classifying antibiotics; for example, these drugs can be divided into several subclasses; cillins, mycins and porines are instances of such divisions. In other schools of thought, they are categorized according to the types of bacteria they are effective against; like antibiotics that affect gram positive and gram-negative microorganisms or the ones which target strict and facultative aerobes and anaerobes [7,8]. Also, different sets of drugs, like penicillin and its derivatives, consist of diverse formula which represents their characteristics, features, and properties; e.g., amoxicillin differs from ampicillin and penicillin V, both in the range of bacteria it affects and in the way the drug is prescribed. Also, clindamycin, in spite of belonging to the same class of antibiotics, is different from erythromycin as far as microorganisms are concerned [8]. Cillins generally strike gram-positive bacteria whilst an antibiotic like metronidazole is useful for combating gram-negative ones [9]. Thus, in many cases when groups of numerous bacteria are involved, a combination of antibiotics is used; dentistry is not an exception to this rule [10].
Odontogenic infections originate from the dental structure, and like any other infections in our body they engage a huge number of different microbes and microorganisms [2]. Therefore, to confront an odontogenic derived infection, combinations of drugs particularly antibiotics are needed to combat the microbiota responsible for creating the lesion. That is why many antibiotics have been investigated, studied, and used to control and defeat dental infections [11]. The very first use of an antibiotic in endodontics dates back to 1951, when Grossman used a poly-antibiotic formula known as PBSC, a paste in a silicone vehicle and a combination of penicillin, bacitracin, streptomycin, and caprylate sodium [12]. PBSC contained penicillin to affect gram-positive organisms, bacitracin to target penicillin-resistant strains, streptomycin for gram-negative organisms, and sodium caprylate for yeasts. The clinical assessment of PBSC showed therapeutic effects; nevertheless, the formula was not very effective against anaerobic microorganisms that play a pivotal role in endodontic diseases. As a consequence, and in addition to the risk of sensitization and allergy to penicillin, the USA Food and Drug Administration banned PBSC for endodontic use in 1975 [13]. In 2006, the American Association of Endodontists introduced an article regarding several antibiotics for endodontic infections to control root canal microbiota which appear to have a key role in the pathogenesis and progression of the pulp and periapical pathosis [14].
REVIEW
The very first aim of endodontic treatments is to eliminate as many bacteria as possible from the root canal system and create an environment in which no remaining microorganisms can survive [15]. Ideally, this can only be obtained through the use of a combination of aseptic treatment techniques, chemo-mechanical preparation of the root canal, antimicrobial irrigation, and intracanal medicaments [15,16]. Approximately 50 percent of root canal peripherals and ramifications may remain uninstrumented during preparation of the root canal [17]. In this condition, the remaining necrotic tissues may act as a nutrition source for the surviving bacteria [18,19]. Thorough and systemic mechanical instrumentation, irrigation, and use of inter-appointment medication can perhaps reduce this phenomenon. Medicaments can play an important role in the preparation of the root canal for further therapies [17], for example in necrotic pulps and active exudation [20]. Calcium hydroxide has long been used as an inseparable part of root canal treatment in necrotic cases, resulting in less signs and symptoms. Traditionally, calcium hydroxide has been used in open-apex teeth with necrotic pulp tissues for inducing a bridge and preparing the root canal space for forthcoming therapies. Without the use of inter-appointment intracanal medications, such successful results are far-fetched [20,21].
The type of intracanal medication depends upon the precise diagnosis of the tooth condition, a thorough knowledge of the type of microorganisms involved, and finally, their mechanisms of growth and survival. The presence of bacteria within the root canal is the main factor of endodontic disease, and therefore the use of an antimicrobial agent is essential. Many forms of intracanal medicaments, apart from antibiotics and calcium hydroxide have been used in an attempt to accomplish the above aim [22]. These mainly include chlorhexidine and ethylenediaminetetraacetic acid [23].
Currently, the common antibiotic-containing commercial pastes are Ledermix (Lederle Pharmaceuticals, Wolfratshausen, Germany) and Septomixine Forte (Septodont, Saint-Maur, France) [24,25]. Both preparations have corticosteroids as anti-inflammatory agents. However, neither of these pastes can be considered suitable for use against endodontic microbiota owing to their inappropriate spectrum of activity [17,23]. Several studies have investigated different root canal antibiotic agents [26].
Recently, another combination of antibiotics, called ‘triple antibiotic paste’ (TAP) was introduced especially for the regeneration and revascularization protocol and the treatment of open apex teeth with necrotic pulp. This material has also shown other applications in endodontics [25]. Initially, TAP was largely developed by Hoshino and colleagues [24], who investigated the effectiveness of the paste on the removal of microorganisms from the root canals [27]. Researchers have also used TAP in vitro to disinfect Escherichia coli-infected dentine [27]. Later, particular attention was given to the antibiotic paste and its effect against microorganisms present in carious dentine and infected pulp. The outcome showed excellent results in the eradication of the bacteria from the radicular system [28].
TAP is a combination of ciprofloxacin, metronidazole and minocycline [29]. Metronidazole, as a nitroimidazole compound, is particularly toxic to anaerobes and is considered an antimicrobial agent against protozoa and anaerobic bacteria. Minocycline is bacteriostatic and shows activity against gram-positive and gram-negative bacteria. It also causes an increase in the amount of interleukin-10, which is an inflammatory cytokine. Moreover, ciprofloxacin — as a synthetic fluoroquinolone — possesses fast bactericidal action and exhibits high antimicrobial activity against gram-negative bacteria, whilst limited activity against gram-positive ones. Many anaerobic bacteria are resistant to ciprofloxacin. Hence, it is often used with metronidazole in treating mixed infections to compensate for its limited scope [30]. Therefore, TAP can affect gram-negative, gram-positive, and anaerobic bacteria, and this combination can be effective against odontogenic microorganisms [31].
If the TAP is to be used, ciprofloxacin, metronidazole, and minocycline should be mixed equally (1:1:1) [2,25,32] to a final concentration of 0.1–1.0 mg/mL [33,34].
The applications of TAP in endodontics can be considered as follows:
In the regeneration and revascularization protocol of the pulp
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As an intracanal medicament for the treatment of
As an intracanal agent to control flare-ups
As a medicated sealer (to prevent possible re-infection)
As an additive to gutta-percha points in root canal obturation (known as medicated gutta-percha points)
As an intracanal medicament loaded on a scaffold
1. In the regeneration and revascularization protocol of the pulp
Recently, Regenerative Medicine, especially at the molecular and cellular level, has been given great attention. Clinically, medical professionals are inclining towards ‘regeneration’ instead of ‘replacement’ approaches [35]; resulting in state-of-the-art definitions such as ‘vital pulp therapy’ and ‘regenerative endodontics’ [35,36]. In such treatments, clean environment is believed to be a necessity for further success. TAP, which was originally introduced by Banchs and Trope [25], is widely used to achieve a relatively aseptic environment in the radicular space so that the tissue repair and healing can occur [37]. Promising results have attracted numerous endodontists and enthusiastic general dental practitioners to endodontic regenerative procedures (ERPs) [38] which is considered as a form of a revolution in root canal therapy [38,39,40,41]. ERP has now been taken into account as an alternative method to calcium hydroxide-induced apexification, in which the TAP is used as a dressing material instead of the traditional calcium hydroxide [42,43,44,45]. Pulp revascularization, the second component of the regeneration protocol, is desired in the treatment of immature permanent teeth with necrotic pulp and apical periodontitis [44]. And it has managed to exhibit thickening of radicular walls, closure of apical foramen [45], continued root development, and recovery of a relatively positive response to electric pulp testing [37,46]. Clinically, to regenerate and vascularize the pulp, an over-instrumentation is carried out to provide bleeding and consequently stimulation of stem cells into the radicular space. The placement of intracanal medicaments are necessary for this process [47,48].
TAP should be used in the safest possible concentration (1 mg/mL) [44] since higher dosages could have undesired results on the stem cells [49]. Even at low concentrations, TAP has unwanted effects on the proliferative capacity and mineralized matrix formation of dental pulp cells and apical papilla cells [50]. According to several studies, a concentration of 0.125 mg/mL of TAP has no cytotoxic effect on the stem cells; thus, it is expected that a concentration of the antibiotic combination with the lowest possible side effects and adequate ability for removing microorganisms, particularly Enterococcus faecalis (E. faecalis) must be used during endodontic treatments [50,51]. The proper and careful combination of the 3 antibiotics has shown to create an appropriate environment for the cell attachment to occur, and to have enough dislocation resistance [52] for mineral trioxide aggregate (MTA) or calcium enriched mixture (CEM) cement as the bio-regenerative dressing.
Since ERP has presented itself as a promising alternative for the treatment of immature teeth with necrotic pulps, it has been compared with other methods and strategies of such therapies (MTA apical plug), to evaluate the closure of open apices [53]. It was revealed that both treatments succeeded in the closing of the foramen. However, in cases of TAP, an increase in root length in combination with thickening of dentinal walls were also observed [44,54]. Another research has indicated that root maturation after regenerative endodontics is different case by case; depending upon various factors such as time and duration of the treatment, angulations of intra-oral film, method of radiography, anatomic landmarks, and so forth [55]. TAP has also shown a significant antibacterial effect in the radicular dentine compared with the untreated dentine, which helps to disinfect and eradicate endodontic pathogens; a pivotal factor in regeneration and revascularization procedures [56].
Recently, an innovative approach based on the regeneration and revascularization protocol, named ‘SealBio,’ has been introduced to deal with pulp and periapical problems [57,58]. SealBio is claimed to be a simple, non-obturation, easy-to-do, and cost-effective technique with excellent outcomes [59]. Similar to the ERP, thorough disinfection and optimal removal of the bacteria in the root canal system is necessary for success. TAP [60] and modified triple antibiotic paste (MTAP), a combination of metrogyl (metronidazole), ciprofloxacin, and tetracycline [57], have been considered as they are effective on the deeper layers of dentine [60] in the SealBio treatment regime.
Tooth discoloration is said to be a repercussion of minocycline as a component of the intracanal medicament [61,62] and cited as a drawback of the paste. Despite the removal of minocycline from the antibiotic combination and replacement with Cefaclor (a member of the second generation cephalosporins), the defacement of clindamycin and amoxicillin will appear sometimes immediately after treatment and in some cases after a delay [20,37,62]. In several papers, discoloration is blamed on MTA [63]; although further research is needed for better understanding of the cause of such discrepancy [64]. Reynolds et al. [65] believed that if dentinal tubules in the pulp chamber are coated with a bonding agent, discoloration can be minimized.
In vitro observations have also indicated that in cases where TAP is used in regenerative endodontics, higher dentine demineralization and a reduction in dentine micro-hardness due to changes in the chemical structure of the superficial dentine can be seen when compared with calcium hydroxide [66,67].
Another negative side effect to the conditioning of the radicular dentine by TAP seems to be the indirect adverse effect on the stem cells of apical papilla (SCAP) and their survival. It has been shown that dentine conditioning with TAP at commonly used clinical concentration (approximately 1,000 mg/mL) prevents SCAP from survival, but if the concentration is altered and modified to 1 mg/mL, this detrimental effect can be avoided. Lower concentrations (0.1 and 0.01 mg/mL) have also shown no detectable effect on SCAP and therefore it seems that a concentration higher than 1 mg/mL can be lethal to the said stem cells [68]. This contrasts the use of dentine conditioning by calcium hydroxide which promotes SCAP survival and proliferation [49].
2. As an intracanal medicament
TAP is said to serve as an antiseptic agent which can be applied onto the walls of the radicular system to remove microorganisms before or after cleaning, shaping, and irrigating the root canal area [17]. Such an action will result in the reduction or elimination of microorganisms, prevention of post-treatment pain, and enhancement of anesthesia [41]. In a study, Murvindran and James [17] demonstrated the ability of TAP in removing microbiota and preparing a suitable environment for further endodontic treatments, whilst Kim and Kim [69] reported that TAP showed a larger inhibition zones against E. faecalis than calcium hydroxide.
1) For the treatment of periapical lesions
Periradicular lesions associated with non-vital teeth can be generally grouped as periapical abscess, granuloma or cyst. Zain et al. [70] reported that the presence of a large size periapical radiolucency is more likely to be a peri-radicular cyst. Various treatment approaches to manage a large periapical lesion can be classified as either surgical or non-surgical endodontic therapies [71]. Since surgical endodontics has its own problems, it is advisable to initially treat periradicular lesions in a conservative manner by a non-surgical endodontic therapy, usually with the use of an antimicrobial intracanal medicament [71,72]. Özan and Er [73] found that the combination of antibiotic drugs in TAP as an antibacterial dressing, is successful in healing large cyst-like lesions. TAP in other endodontic treatments is considered prior to any sort of surgery. It has been suggested that the TAP can be considered and used with intracanal aspiration in order to successfully cope with a large periapical and cyst-like lesion [74]. TAP has also been used for the treatment of cystic lesions as a multidisciplinary approach including root canal therapy and endodontic surgery [30]. Apparently, other most commonly used medicaments have not succeeded eliminating the signs and symptoms, and disease from its location [75].
2) For the treatment of external inflammatory root resorption
Several studies have shown the importance of TAP in the treatment of external inflammatory root resorption (EIRR). Treatment of such clinical challenges often require the regeneration and revascularization protocol; which in itself consists of disinfecting the root canal system with TAP [24], filling the radicular area with blood clot, and sealing the root canal(s) with MTA and bonded resin restoration [25]. TAP is the most common medication recently used in EIRR although some other medications were also prescribed [76]. It has been shown that this combination of drugs is able to enter dentinal tubules [77] and can kill any bacteria in the carious lesions, necrotic pulp, infected root dentine, and peri-apical lesions [77,78], and thus, stop the resorption process [79].
3) For the treatment of root fracture
Several clinical studies and case reports on teeth with horizontal root fracture and their corresponding treatment with TAP as the intracanal medicament, and MTA as the coronal obturator have radiographically demonstrated repair of the fractured root with the disappearance of the tooth symptoms after a period of 12 months [80]. It is believed that such nonsurgical endodontic management owes its success to the disinfection and the microorganism removal by the TAP resulting satisfactory healing between the broken fragments [24,80,81].
4) For the treatment of primary teeth
Previous research in pediatric dentistry has illustrated that TAP can be used in a very effective way with good clinical success in primary teeth [82]. However, intracanal medication should not replace the instrumentation phase since the antibiotic agents alone cannot eradicate canal infection in long term [64]. In these studies, non-instrumentation endodontic treatment ‘Lesion Sterilization and Tissue Repair’ and the triple antibiotic the paste were used [82,83].
3. As an intracanal agent to control flare-ups
Several studies have shown the effect of TAP in controlling endodontic flare-ups [84] in diabetic patients between treatment appointments. Interestingly, TAP has shown to be more effective than calcium hydroxide in these patients [85]. The combination of the 3 existing antibiotics seems to be able to defeat bacterial resistance and subsequently result in increased antimicrobial action [86]. The anti-inflammatory ability of minocycline can synergistically assist in treating the disease [87,88].
4. As a medicated sealer (to prevent possible re-infection)
TAP has been claimed to be effective against E. faecalis, the microorganism which is said to be the most dominant in persistent endodontic infections [89]. TAP has been added to zinc oxide eugenol-based root canal sealers in order to prevent re-infection and to provide extended antimicrobial property to the sealer [90]. Hoelscher et al. [91] found that amoxicillin, penicillin, clindamycin, and doxycycline relatively enriched the antimicrobial efficacy of Pulp Canal Sealer EWT (Kerr Corporation, Romulus, MI, USA) against E. faecalis. It has been shown that if amoxicillin, doxycycline, and metronidazole are added to Kerr Pulp Canal Sealer, the antibacterial property and apical sealing ability of the material can improve in addition to the increased working time [91,92]. Sharma et al. [93] showed that AH26 (Dentsply, Tulsa Dental, Tulsa, OK, USA) with amoxicillin and doxycycline is effective in removing E. faecalis from dentinal tubules [91,93,94]. Kangarlou et al. [95] showed that TAP improves the antibacterial properties of AH26 and AH plus endodontic sealers. However, Bansal and Jain [13] argued that though TAP can be combined with some root canal sealers, the mixture of TAP with sealers is currently not recommended and that further investigations are needed.
5. As an additive to gutta-percha points in root canal obturation (known as medicated gutta-percha points)
If root canal obturation material includes antibacterials, it can help eliminate microorganisms which are left behind in the anatomical complexities of the radicular area; such as secondary canals, dentinal tubules and isthmus, or areas that biomechanical preparation of root canal system is missed [96]. Gutta-percha points which include metronidazole for disinfecting the root canal system have been studied, and might be regarded an effective ingredient to the obturation material [97]. Indeed, such application needs further in vivo studies to investigate the toxicity, antibacterial, and antifungal effects [97,98] as well as long term effects on antibacterial resistance in individuals especially with dangerous diseases such as tuberculosis.
6. As an intracanal medicament loaded on a scaffold
A growing body of evidence has shown the importance of TAP on a scaffold system, due to the potential to remove and eradicate microorganisms and their biofilm (e.g., Actinomyces naeslundii); a crucial step in endodontic regeneration [99].
Using low concentration of antibiotics on a scaffold in the radicular area has recently attracted attention. TAP, in an effective concentration has no significant sign of being cytotoxic to the stem cells and has demonstrated an ability to stay in the area without further dilution [50]. Also, bioresorbable antibiotic-loaded scaffolds and fibers have been further investigated in endodontic regeneration protocol [100]. In one particular study, an incorporation between double antibiotic paste (DAP) and a nano-fibrous scaffold showed promising potential as a drug delivery system [101].
1. TAP and radicular dentine
A number of studies have revealed that the TAP and the concentration used for regeneration and revascularization protocol may cause significant loss of dentine and a substantial increase in its roughness [102,103]. Such an increase can result in lower dentine wettability, and an enormous amount of reduction in the inorganic phase of the treated dentine in addition to the considerable increase in the organic phase. TAP with its acidic capability (pH = 2.9) [100] can demineralize the dentine surface [104]. Also, research and attenuated total reflection-fourier transform infrared spectroscopy measurements indicated that 1 g/mL TAP showed severe reduction in micro-hardness of the root and demineralization of the dentine. However, if 1 mg/mL methylcellulose-based TAP is used (in comparison with 1 g/mL TAP), this detrimental effect can be reduced. Other literature has suggested that using lower concentrations will again minimize this problem and therefore optimize radicular canal erosion and surface roughness [67,105]. TAP seems to be responsible for adversely affecting the fracture resistance of root canal dentine, particularly when the TAP is compared with chlorhexidine as an intracanal medicament [106].
Several research cases have also demonstrated a greater increase in the root length in teeth treated with TAP when compared with MTA, calcium hydroxide, and formocresol [102]. It seems that the TAP is capable of preparing a matrix for thickening the dentinal walls of the root [42] in comparison with calcium hydroxide and formocresol [107]; an effect which could play a significant role in shaping of the root canal [2,31].
2. Discoloration of the tooth structure
Teeth treated by the TAP have shown a degree of crown discoloration [20,37,108,109], likely that related to the existence of minocycline in the paste. In view of this, great care and caution should be taken in aesthetic zones [25,37,72,107,110]. A number of medicinal replacements, such as amoxicillin [111], Arestin (OraPharma, Inc., Warminster, PA, USA) [112], and Cefaclor (a member of the second generation cephalosporins) have been used to prevent the problem [37,113,114,115]. Recently, the Minocycline-removed paste or DAP have found its place [33,72]. ‘European Society of Endodontology’ advocates the use of calcium hydroxide so as to avoid discoloration [116].
In addition to such modifications in the formula of the paste, several strategies to make up for the discoloration have been investigated. The most commonly recommended is internal bleaching to remove cervical discoloration from the TAP [117]. Another approach is the application of dentine bonding agents or the use of composite resins as dentinal walls sealants [36]. Nonetheless, further evaluation and assessment of the results is necessary [55,108].
3. Removal of the paste
Another pitfall to consider during application of TAP in root canal space is the challenging removal of the paste. Existing irrigation techniques are not able to effectively remove TAP since it penetrates and binds into the dentinal structure [118,119]. Ultrasonic activation of 5.25% sodium hypochlorite seems to be the most effective method in removing the paste [61,120], contrary to chlorhexidine which seems to be the least effective intracanal irrigation solutions [121]. However, Arslan et al. [119] showed that ‘photon-induced photo-acoustic streaming’ (PIPS), which is a contemporary technique for removing materials from root canal walls, was more effective than needle irrigation in the removal of TAP from root canal system [119]. In a similar study, it was found that irrigation activation regiments of ultrasonic irrigation extremely improved the removal of modified TAP from the root canals compared with conventional syringe irrigation [122]. In a recent investigation, Turkaydin et al. [123] used an XP-Endo Finisher to show that it can even remove more TAP than ultrasonic and syringe irrigation methods.
Moreover, the time and number of sessions needed to apply TAP, and the necessity of the removal are the other disadvantages in comparison with one-visit MTA apical barrier technique [36].
4. TAP and operative dentistry
The use of TAP as an antibiotic paste is not limited to endodontics. Investigations have revealed that glass ionomer cement (GIC) containing TAP is quite effective on Streptococcus mutans and Lactobacillus casei. Yesilyurt et al. [124] demonstrated that if the concentration of 1.5% TAP is added to GIC, the physical and bonding properties, the compressive strength, and the bonding strength to dentine are not modified and stay optimal.
CONCLUSIONS
If endodontics is to succeed, root canal microbiota should be properly reduced. Endodontic treatments rely mainly upon the elimination and possible eradication of the involved microbiota and their various virulent features from the root canal system. Biomechanical instrumentation, though an essential step, does not always provide such an environment in the root canal system. Non-instrumentation methods such as tooth repair and strategies towards maintaining a situation for regeneration and revascularization of the pulp should be considered, in which local use of drugs, particularly antibiotics, has shown their significance.
Amongst the combination of antibiotics, TAP, owing to its effectiveness on different microorganisms and its diverse applications and triumphs, is of particular interest in endodontics. However, development of resistant bacterial strains and tooth discoloration are some of its pitfalls. Nonetheless, TAP seems to be a successful combination of drugs in root canal disinfection/sterilization and pulp regeneration and revascularization protocol. All currently available antimicrobial materials for radicular irrigation and medication have their own benefits and limitations; the search for creating the ideal irrigant and inter-appointment medicament continues.
ACKNOWLEDGEMENT
The first author of this paper would like to express his deepest thanks and gratitude to Professor Saeed Asgary for his thorough and kind guidance in addition to his contribution in writing this manuscript. Also, the first author would like to send his appreciation to Professor Hanieh Nojehdehian for her kind contribution and regards concerning this article.
Moreover, the authors of this paper would like to thank Dr. Laleh Marvasti for her kind and undivided attention regarding writing assistance and proofreading the article.
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Conflict of Interest: The authors declare that there is no conflict of interest regarding the publication of this paper. Also, the authors do not have any financial interest in the companies whose materials are included in this article.
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Author Contributions:
Conceptualization: Parhizkar A, Nojehdehian H, Asgary S.
Formal analysis: Parhizkar A, Asgary S.
Investigation: Parhizkar A, Nojehdehian H, Asgary S.
Methodology: Parhizkar A, Nojehdehian H, Asgary S.
Project administration: Parhizkar A, Nojehdehian H.
Supervision: Parhizkar A, Nojehdehian H, Asgary S.
Writing - original draft: Parhizkar A.
Writing - review & editing: Parhizkar A, Nojehdehian H, Asgary S.
- 1. Bhanderi S. The importance of endodontics - continuing education at the FGDP (UK). Prim Dent J 2014;3:14.ArticlePubMedPDF
- 2. Hargreaves KM, Cohen S. Cohen's pathways of the pulp. 10th ed. St. Louis (MO): Mosby; 2011.
- 3. Mohammadi Z. Antibiotics as intracanal medicaments: a review. J Calif Dent Assoc 2009;37:98-108.ArticlePubMed
- 4. Mouton Y. The antibiotics. Role of antibiotics in the prevention of infectious diseases. Lille Med 1975;20:914-915.PubMed
- 5. Enzler MJ, Berbari E, Osmon DR. Antimicrobial prophylaxis in adults. Mayo Clin Proc 2011;86:686-701.ArticlePubMedPMC
- 6. Grossman LI. The use of disinfectants and antibiotics in endodontic practice. J Am Dent Assoc 1956;53:411-415.ArticlePubMed
- 7. Busse HJ, Denner EB, Lubitz W. Classification and identification of bacteria: current approaches to an old problem. Overview of methods used in bacterial systematics. J Biotechnol 1996;47:3-38.ArticlePubMed
- 8. The Johns Hopkins Hospital. Antibiotic guidelines 2015??016. Baltimore (MD): The Johns Hopkins Hospital; 2015.
- 9. Blinov NO, Fedkina NG, Oparysheva EF, Khokhlov AS. Method for the classification of antibiotics in early stages of their study. Izv Akad Nauk SSSR Biol 1964;4:533-545.PubMed
- 10. Monteverde J. The use of combination of antibiotics and anti-inflammatory drugs in clinical dentistry and oral surgery. Trib Odontol (B Aires) 1971;55:99-102.PubMed
- 11. Wynn RL, Bergman SA, Meiller TF, Crossley HL. Antibiotics in treating oral-facial infections of odontogenic origin: an update. Gen Dent 2001;49:238-244.PubMed
- 12. Grossman LI. Polyantibiotic treatment of pulpless teeth. J Am Dent Assoc 1951;43:265-278.ArticlePubMed
- 13. Bansal R, Jain A. Overview on the current antibiotic containing agents used in endodontics. N Am J Med Sci 2014;6:351-358.ArticlePubMedPMC
- 14. American Association of Endodontists. Antibiotics and the treatment of endodontic infections. Chicago (IL): American Association of Endodontists; 2006.
- 15. Mohammadi Z, Abbott PV. On the local applications of antibiotics and antibiotic-based agents in endodontics and dental traumatology. Int Endod J 2009;42:555-567.ArticlePubMed
- 16. Madhavan S, Muralidharan . Comparing the antibacterial efficacy of intracanal medicaments in combination with clove oil against Enterococcus faecalis . Asian J Pharm Clin Res 2015;8:136-138.
- 17. Murvindran V, James DR. Antibiotics as an intracanal medicament in endodontics. J Pharm Sci Res 2014;6:297-301.
- 18. Love RM. Enterococcus faecalis--a mechanism for its role in endodontic failure. Int Endod J 2001;34:399-405.ArticlePubMedPDF
- 19. Peters OA. Current challenges and concepts in the preparation of root canal systems: a review. J Endod 2004;30:559-567.ArticlePubMed
- 20. Park HB, Lee BN, Hwang YC, Hwang IN, Oh WM, Chang HS. Treatment of non-vital immature teeth with amoxicillin-containing triple antibiotic paste resulting in apexification. Restor Dent Endod 2015;40:322-327.ArticlePubMedPMC
- 21. Huang GT. Apexification: the beginning of its end. Int Endod J 2009;42:855-866.ArticlePubMed
- 22. Longman LP, Preston AJ, Martin MV, Wilson NH. Endodontics in the adult patient: the role of antibiotics. J Dent 2000;28:539-548.ArticlePubMed
- 23. Chu FC, Leung WK, Tsang PC, Chow TW, Samaranayake LP. Identification of cultivable microorganisms from root canals with apical periodontitis following two-visit endodontic treatment with antibiotics/steroid or calcium hydroxide dressings. J Endod 2006;32:17-23.ArticlePubMed
- 24. Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, Iwaku M. In vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J 1996;29:125-130.ArticlePubMed
- 25. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod 2004;30:196-200.ArticlePubMed
- 26. Asgary S, Kamrani FA. Antibacterial effects of five different root canal sealing materials. J Oral Sci 2008;50:469-474.ArticlePubMed
- 27. Sato I, Ando-Kurihara N, Kota K, Iwaku M, Hoshino E. Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ . Int Endod J 1996;29:118-124.ArticlePubMed
- 28. Thibodeau B, Teixeira F, Yamauchi M, Caplan DJ, Trope M. Pulp revascularization of immature dog teeth with apical periodontitis. J Endod 2007;33:680-689.ArticlePubMed
- 29. Hargreaves KM, Giesler T, Henry M, Wang Y. Regeneration potential of the young permanent tooth: what does the future hold? J Endod 2008;34(Supplement):S51-S56.ArticlePubMed
- 30. Diwan A, Bhagavaldas MC, Bagga V, Shetty A. Multidisciplinary approach in management of a large cystic lesion in anterior maxilla - a case report. J Clin Diagn Res 2015;9:ZD41-ZD43.ArticlePubMedPMC
- 31. Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod 2009;35:1343-1349.ArticlePubMed
- 32. Yassen GH, Chu TM, Gallant MA, Allen MR, Vail MM, Murray PE, Platt JA. A novel approach to evaluate the effect of medicaments used in endodontic regeneration on root canal surface indentation. Clin Oral Investig 2014;18:1569-1575.ArticlePubMedPDF
- 33. American Association of Endodontists. AAE clinical considerations for a regenerative procedure. Revised 6-8-16. Chicago (IL): American Association of Endodontists; 2016.
- 34. Parasuraman VR, Muljibhai BS. 3Mix- MP in Endodontics – An overview. IOSR J Dent Med Sci 2012;3:36-45.
- 35. Asgary S, Ahmadyar M. Vital pulp therapy using calcium-enriched mixture: an evidence-based review. J Conserv Dent 2013;16:92-98.ArticlePubMedPMC
- 36. Thakur L, Goel M, Sachdeva GS, Kushal Katoch K. Regenerative endodontics: a comprehensive review. EC Dent Sci 2016;3:556-567.
- 37. Wigler R, Kaufman AY, Lin S, Steinbock N, Hazan-Molina H, Torneck CD. Revascularization: a treatment for permanent teeth with necrotic pulp and incomplete root development. J Endod 2013;39:319-326.ArticlePubMed
- 38. Keller L, Offner D, Schwinté P, Morand D, Wagner Q, Gros C, Bornert F, Bahi S, Musset AM, Benkirane-Jessel N, Fioretti F. Active nanomaterials to meet the challenge of dental pulp regeneration. Materials (Basel) 2015;8:7461-7471.ArticlePubMedPMC
- 39. Ritter AL, Ritter AV, Murrah V, Sigurdsson A, Trope M. Pulp revascularization of replanted immature dog teeth after treatment with minocycline and doxycycline assessed by laser Doppler flowmetry, radiography, and histology. Dent Traumatol 2004;20:75-84.ArticlePubMed
- 40. Nagata JY, Gomes BP, Rocha Lima TF, Murakami LS, de Faria DE, Campos GR, de Souza-Filho FJ, Soares Ade J. Traumatized immature teeth treated with 2 protocols of pulp revascularization. J Endod 2014;40:606-612.ArticlePubMed
- 41. Vijayaraghavan R, Mathian VM, Sundaram AM, Karunakaran R, Vinodh S. Triple antibiotic paste in root canal therapy. J Pharm Bioallied Sci 2012;4(Supplement 2):S230-S233.ArticlePubMedPMC
- 42. Gomes-Filho JE, Duarte PC, de Oliveira CB, Watanabe S, Lodi CS, Cintra LT, Bernabé PF. Tissue reaction to a triantibiotic paste used for endodontic tissue self-regeneration of nonvital immature permanent teeth. J Endod 2012;38:91-94.ArticlePubMed
- 43. McTigue DJ, Subramanian K, Kumar A. Case series: management of immature permanent teeth with pulpal necrosis: a case series. Pediatr Dent 2013;35:55-60.PubMed
- 44. Namour M, Theys S. Pulp revascularization of immature permanent teeth: a review of the literature and a proposal of a new clinical protocol. Sci World J 2014;2014:737503.ArticlePubMedPMCPDF
- 45. Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol 2001;17:185-187.ArticlePubMedPDF
- 46. Wang Y, Zhu X, Zhang C. Pulp revascularization on permanent teeth with open apices in a middle-aged patient. J Endod 2015;41:1571-1575.ArticlePubMed
- 47. American Association of Endodontists. Guide to clinical endodontics. 6th ed. Chicago (IL): American Association of Endodontists; 2013.
- 48. Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative endodontics: a review of current status and a call for action. J Endod 2007;33:377-390.ArticlePubMed
- 49. Ruparel NB, Teixeira FB, Ferraz CC, Diogenes A. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod 2012;38:1372-1375.ArticlePubMed
- 50. Sabrah AH, Yassen GH, Liu WC, Goebel WS, Gregory RL, Platt JA. The effect of diluted triple and double antibiotic pastes on dental pulp stem cells and established Enterococcus faecalis biofilm. Clin Oral Investig 2015;19:2059-2066.ArticlePubMedPDF
- 51. Alghilan MA, Windsor L, Palasuk J, Yassen GH. Attachment and proliferation of dental pulp stem cells on dentine treated with different regenerative endodontic protocols. Int Endod J 2016;50:667-675.ArticlePubMedPDF
- 52. Turk T, Ozisik B, Aydin B. Time-dependent effectiveness of the intracanal medicaments used for pulp revascularization on the dislocation resistance of MTA. BMC Oral Health 2015;15:130.ArticlePubMedPMCPDF
- 53. Asgary S, Fazlyab M, Nosrat A. Regenerative endodontic treatment versus apical plug in immature teeth: three-year follow-up. J Clin Pediatr Dent 2016;40:356-360.ArticlePubMedPDF
- 54. Nagy MM, Tawfik HE, Hashem AA, Abu-Seida AM. Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols. J Endod 2014;40:192-198.ArticlePubMed
- 55. Kahler B, Mistry S, Moule A, Ringsmuth AK, Case P, Thomson A, Holcombe T. Revascularization outcomes: a prospective analysis of 16 consecutive cases. J Endod 2014;40:333-338.ArticlePubMed
- 56. Sabrah AH, Yassen GH, Spolnik KJ, Hara AT, Platt JA, Gregory RL. Evaluation of residual antibacterial effect of human radicular dentin treated with triple and double antibiotic pastes. J Endod 2015;41:1081-1084.ArticlePubMed
- 57. Shah N, Logani A. SealBio: a novel, non-obturation endodontic treatment based on concept of regeneration. J Conserv Dent 2012;15:328-332.ArticlePubMedPMC
- 58. Shah N, Jadhav GR, Mittal P, Logani A. Conservative management of dens evaginatus and attached supernumerary tooth/odontome in mandibular premolar with dual radiolucencies. Contemp Clin Dent 2015;6(Supplement 1):S269-S273.ArticlePubMedPMC
- 59. Shah N. A regeneration-based, nonobturation root-canal treatment for fully-mature teeth: six years' experience with “SealBio”. Contemp Clin Dent 2016;7:296-301.ArticlePubMedPMC
- 60. Asgary S, Fazlyab M. A successful endodontic outcome with non-obturated canals. Iran Endod J 2015;10:208-210.PubMedPMC
- 61. Nosrat A, Seifi A, Asgary S. Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial. J Endod 2011;37:562-567.ArticlePubMed
- 62. Rosen T, Hoffmann TJ. Minocycline-induced discoloration of the permanent teeth. J Am Acad Dermatol 1989;21:569.ArticlePubMed
- 63. Naghavi N, Ghoddusi J, Sadeghnia HR, Asadpour E, Asgary S. Genotoxicity and cytotoxicity of mineral trioxide aggregate and calcium enriched mixture cements on L929 mouse fibroblast cells. Dent Mater J 2014;33:64-69.ArticlePubMed
- 64. Trairatvorakul C, Detsomboonrat P. Success rates of a mixture of ciprofloxacin, metronidazole, and minocycline antibiotics used in the non-instrumentation endodontic treatment of mandibular primary molars with carious pulpal involvement. Int J Paediatr Dent 2012;22:217-227.ArticlePubMed
- 65. Reynolds K, Johnson JD, Cohenca N. Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report. Int Endod J 2009;42:84-92.ArticlePubMed
- 66. Yassen GH, Eckert GJ, Platt JA. Effect of intracanal medicaments used in endodontic regeneration procedures on microhardness and chemical structure of dentin. Restor Dent Endod 2015;40:104-112.ArticlePubMed
- 67. Prather BT, Ehrlich Y, Spolnik K, Platt JA, Yassen GH. Effects of two combinations of triple antibiotic paste used in endodontic regeneration on root microhardness and chemical structure of radicular dentine. J Oral Sci 2014;56:245-251.ArticlePubMed
- 68. Althumairy RI, Teixeira FB, Diogenes A. Effect of dentin conditioning with intracanal medicaments on survival of stem cells of apical papilla. J Endod 2014;40:521-525.ArticlePubMed
- 69. Kim D, Kim E. Antimicrobial effect of calcium hydroxide as an intracanal medicament in root canal treatment: a literature review - Part I. In vitro studies. Restor Dent Endod 2014;39:241-252.ArticlePubMedPMC
- 70. Zain RB, Roswati N, Ismail K. Radiographic evaluation of lesion sizes of histologically diagnosed periapical cysts and granulomas. Ann Dent 1989;48:3-5.PubMed
- 71. Dhillon JS, Amita , Saini SK, Bedi HS, Ratol SS, Gill B. Healing of a large periapical lesion using triple antibiotic paste and intracanal aspiration in nonsurgical endodontic retreatment. Indian J Dent 2014;5:161-165.ArticlePubMedPMC
- 72. Thomas MS. Crown discoloration due to the use of triple antibiotic paste as an endodontic intra-canal medicament. Saudi Endod J 2014;4:32-35.Article
- 73. Özan U, Er K. Endodontic treatment of a large cyst-like periradicular lesion using a combination of antibiotic drugs: a case report. J Endod 2005;31:898-900.ArticlePubMed
- 74. Sumanthini MV, Vanitha US, Rupali D, Rahul K. Successful nonsurgical retreatment of resected teeth associated with persistent periapical lesion by placing triple antibiotic paste and mineral trioxide aggregate apical plug - a case report. Endodontology 2013;25:81-88.Article
- 75. Taneja S, Kumari M, Parkash H. Nonsurgical healing of large periradicular lesions using a triple antibiotic paste: a case series. Contemp Clin Dent 2010;1:31-35.ArticlePubMedPMC
- 76. Ordinola-Zapata R, Bramante CM, Minotti PG, Cavenago BC, Garcia RB, Bernardineli N, Jaramillo DE, Hungaro Duarte MA. Antimicrobial activity of triantibiotic paste, 2% chlorhexidine gel, and calcium hydroxide on an intraoral-infected dentin biofilm model. J Endod 2013;39:115-118.ArticlePubMed
- 77. Santiago CN, Pinto SS, Sassone LM, Hirata R Jr, Fidel SR. Revascularization technique for the treatment of external inflammatory root resorption: a report of 3 cases. J Endod 2015;41:1560-1564.ArticlePubMed
- 78. Fernandes M, de Ataide I. Nonsurgical management of a large periapical lesion associated with an immature tooth displaying external inflammatory resorption. J Conserv Dent 2015;18:349-353.ArticlePubMedPMC
- 79. Trope M. Endodontic considerations in dental trauma. In: Ingle JI, Bakland LK, Baumgartner JC, editors. Ingle's endodontics. Hamilton (ON): BC Decker; 2008. p. 1330-1357.
- 80. Er K, Celik D, Taşdemir T, Yildirim T. Treatment of horizontal root fractures using a triple antibiotic paste and mineral trioxide aggregate: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:e63-e66.Article
- 81. Cobankara FK, Ungör M. Spontaneously healed horizontal root fracture in maxillary first premolar: report of a case. Dent Traumatol 2007;23:120-122.ArticlePubMed
- 82. Takushige T, Cruz EV, Asgor Moral A, Hoshino E. Endodontic treatment of primary teeth using a combination of antibacterial drugs. Int Endod J 2004;37:132-138.ArticlePubMed
- 83. Hoshino E, Kota K, Iwaku M. Sterilization of carious lesions by antibacterial drugs new attempt to conserve pulp (part 1). The basic approach. Dent Outlook 1990;75:1379-1386.
- 84. Trope M. Relationship of intracanal medicaments to endodontic flare-ups. Endod Dent Traumatol 1990;6:226-229.ArticlePubMed
- 85. Pai S, Vivekananda Pai AR, Thomas MS, Bhat V. Effect of calcium hydroxide and triple antibiotic paste as intracanal medicaments on the incidence of inter-appointment flare-up in diabetic patients: an in vivo study. J Conserv Dent 2014;17:208-211.ArticlePubMedPMC
- 86. Alam T, Nakazawa F, Nakajo K, Uematsu H, Hoshino E. Susceptibility of Enterococcus faecalis to a combination of antibacterial drugs (3 mix) in vitro . J Oral Biosci 2005;47:315-320.Article
- 87. Seltzer S, Naidorf IJ. Flare-ups in endodontics: II. therapeutic measures. J Endod 1985;11:559-567.ArticlePubMed
- 88. Dunston CR, Griffiths HR, Lambert PA, Staddon S, Vernallis AB. Proteomic analysis of the anti-inflammatory action of minocycline. Proteomics 2011;11:42-51.ArticlePubMedPDF
- 89. Hancock HH 3rd, Sigurdsson A, Trope M, Moiseiwitsch J. Bacteria isolated after unsuccessful endodontic treatment in a North American population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:579-586.ArticlePubMed
- 90. Kaplan AE, Picca M, Gonzalez MI, Macchi RL, Molgatini SL. Antimicrobial effect of six endodontic sealers: an in vitro evaluation. Endod Dent Traumatol 1999;15:42-45.ArticlePubMed
- 91. Hoelscher AA, Bahcall JK, Maki JS. In vitro evaluation of the antimicrobial effects of a root canal sealer-antibiotic combination against Enterococcus faecalis . J Endod 2006;32:145-147.ArticlePubMed
- 92. Shrestha S, Mala K. Evaluation of sealing ability of a root canal sealer with various antibiotic additives: an in vitro study. J Interdiscip Dent 2013;3:21-24.Article
- 93. Sharma D, Grover R, Pinnameneni PS, Dey S, Raju PR. Evaluation of efficacy of combinations of five endodontic sealers with five antibiotics against Enterococcus daecalis: an in vitro study. J Int Oral Health 2014;6:90-95.
- 94. Razmi H, Ashofteh Yazdi K, Jabalameli F, Parvizi S. Antimicrobial effects of AH26 sealer/antibiotic combinations against Enterococcus faecalis . Iran Endod J 2008;3:103-108.PubMedPMC
- 95. Kangarlou A, Neshandar R, Matini N, Dianat O. Antibacterial efficacy of AH Plus and AH26 sealers mixed with amoxicillin, triple antibiotic paste and nanosilver. J Dent Res Dent Clin Dent Prospect 2016;10:220-225.ArticlePubMedPMC
- 96. Susin L, Liu Y, Yoon JC, Parente JM, Loushine RJ, Ricucci D, Bryan T, Weller RN, Pashley DH, Tay FR. Canal and isthmus debridement efficacies of two irrigant agitation techniques in a closed system. Int Endod J 2010;43:1077-1090.ArticlePubMedPMC
- 97. Wang D, Wang Z, Gao J. The development and in vitro release rate determination of controlled-release delivery gutta-percha point containing metronidazole compound. Hua Xi Kou Qiang Yi Xue Za Zhi 2003;21:361-363.PubMed
- 98. Gao J, Wang ZP, Li XG, Wang D, Zhang L. The preparation and in vitro release test of sustained release delivery gutta-percha point containing metronidazole. Shanghai Kou Qiang Yi Xue 2004;13:557-560.PubMed
- 99. Albuquerque MT, Ryan SJ, Münchow EA, Kamocka MM, Gregory RL, Valera MC, Bottino MC. Antimicrobial effects of novel triple antibiotic paste-mimic scaffolds on Actinomyces naeslundii biofilm. J Endod 2015;41:1337-1343.ArticlePubMedPMC
- 100. Bottino MC, Yassen GH, Platt JA, Labban N, Windsor LJ, Spolnik KJ, Bressiani AH. A novel three-dimensional scaffold for regenerative endodontics: materials and biological characterizations. J Tissue Eng Regen Med 2015;9:E116-E123.ArticlePubMed
- 101. Palasuk J, Kamocki K, Hippenmeyer L, Platt JA, Spolnik KJ, Gregory RL, Bottino MC. Bimix antimicrobial scaffolds for regenerative endodontics. J Endod 2014;40:1879-1884.ArticlePubMedPMC
- 102. Yassen GH, Sabrah AH, Eckert GJ, Platt JA. Effect of different endodontic regeneration protocols on wettability, roughness, and chemical composition of surface dentin. J Endod 2015;41:956-960.ArticlePubMed
- 103. Farge P, Alderete L, Ramos SM. Dentin wetting by three adhesive systems: influence of etching time, temperature and relative humidity. J Dent 2010;38:698-706.ArticlePubMed
- 104. Eliades G. Clinical relevance of the formulation and testing of dentine bonding systems. J Dent 1994;22:73-81.ArticlePubMed
- 105. Nerness AZ, Ehrlich Y, Spolnik K, Platt JA, Yassen GH. Effect of triple antibiotic paste with or without ethylenediaminetetraacetic acid on surface loss and surface roughness of radicular dentine. Odontology 2016;104:170-175.ArticlePubMedPDF
- 106. Elgendy AA, Nagy MM. The effect of different intracanal medications on fracture resistance of root canal dentin. Tanta Dent J 2015;12:163-167.Article
- 107. Nabeel A, Prasanna N. Antiseptics and antibiotics used in regenerative endodontics. Int J Pharm Clin Res 2013;5:141-144.
- 108. Kirchhoff AL, Raldi DP, Salles AC, Cunha RS, Mello I. Tooth discolouration and internal bleaching after the use of triple antibiotic paste. Int Endod J 2015;48:1181-1187.ArticlePubMed
- 109. Asgary S, Fazlyab M. Surgical treatment of an immature short-rooted traumatized incisor with an extensive apical lesion using CEM cement. Iran Endod J 2015;10:148-151.PubMedPMC
- 110. Chueh LH, Ho YC, Kuo TC, Lai WH, Chen YH, Chiang CP. Regenerative endodontic treatment for necrotic immature permanent teeth. J Endod 2009;35:160-164.ArticlePubMed
- 111. Thomson A, Kahler B. Regenerative endodontics--biologically-based treatment for immature permanent teeth: a case report and review of the literature. Aust Dent J 2010;55:446-452.ArticlePubMed
- 112. Trope M. Treatment of the immature tooth with a non-vital pulp and apical periodontitis. Dent Clin North Am 2010;54:313-324.ArticlePubMed
- 113. Kim B, Song MJ, Shin SJ, Park JW. Prevention of tooth discoloration associated with triple antibiotics. Restor Dent Endod 2012;37:119-122.Article
- 114. Lee BN, Moon JW, Chang HS, Hwang IN, Oh WM, Hwang YC. A review of the regenerative endodontic treatment procedure. Restor Dent Endod 2015;40:179-187.ArticlePubMedPMC
- 115. Thibodeau B, Trope M. Pulp revascularization of a necrotic infected immature permanent tooth: case report and review of the literature. Pediatr Dent 2007;29:47-50.PubMed
- 116. Galler KM, Krastl G, Simon S, Van Gorp G, Meschi N, Vahedi B, Lambrechts P. European Society of Endodontology position statement: revitalization procedures. Int Endod J 2016;49:717-723.ArticlePubMed
- 117. Miller EK, Lee JY, Tawil PZ, Teixeira FB, Vann WF Jr. Emerging therapies for the management of traumatized immature permanent incisors. Pediatr Dent 2012;34:66-69.PubMed
- 118. Berkhoff JA, Chen PB, Teixeira FB, Diogenes A. Evaluation of triple antibiotic paste removal by different irrigation procedures. J Endod 2014;40:1172-1177.ArticlePubMed
- 119. Arslan H, Akcay M, Capar ID, Ertas H, Ok E, Uysal B. Efficacy of needle irrigation, EndoActivator, and photon-initiated photoacoustic streaming technique on removal of double and triple antibiotic pastes. J Endod 2014;40:1439-1442.ArticlePubMed
- 120. Ding RY, Cheung GS, Chen J, Yin XZ, Wang QQ, Zhang CF. Pulp revascularization of immature teeth with apical periodontitis: a clinical study. J Endod 2009;35:745-749.ArticlePubMed
- 121. Ok E, Altunsoy M, Nur BG, Kalkan A; Wiley Online Library. Effectiveness of different irrigation solutions on triple antibiotic paste removal from simulated immature root canal. Scanning 2015;37:409-413.ArticlePubMedPDF
- 122. Akman M, Akbulut MB, Aydınbelge HA, Belli S. Comparison of different irrigation activation regimens and conventional irrigation techniques for the removal of modified triple antibiotic paste from root canals. J Endod 2015;41:720-724.ArticlePubMed
- 123. Turkaydin D, Demir E, Basturk FB, Sazak Övecoglu H. Efficacy of XP-endo finisher in the removal of triple antibiotic paste from immature root canals. J Endod 2017;43:1528-1531.ArticlePubMed
- 124. Yesilyurt C, Er K, Tasdemir T, Buruk K, Celik D. Antibacterial activity and physical properties of glass-ionomer cements containing antibiotics. Oper Dent 2009;34:18-23.ArticlePubMedPDF
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The Saudi Dental Journal.2025;[Epub] CrossRef - Antibacterial Effect of Cannabinoids on Bacteria Associated with Persistent Endodontic Infections
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International Journal of Molecular Sciences.2025; 26(24): 11936. CrossRef - A Comparative Evaluation of Herbal Extracts and Triple Antibiotic Paste as Intracanal Medicament against Enterococcus faecalis: A Microbiological Study
Divya Singh, Rashi Singh, Nidhi Gupta, Natasha Gambhir, Saritha Golla
International Journal of Clinical Pediatric Dentistry.2024; 17(3): 285. CrossRef - Comparative Evaluation of Push-Out Bond Strength of Conventional Mineral Trioxide Aggregate, Biodentine, a Modified Mineral Trioxide Aggregate, and Two Novel Antibacterial-Enhanced Mineral Trioxide Aggregates
Arokia Rajkumar Shancy Merlin, Vignesh Ravindran, Ganesh Jeevanandan, Rajalakshmanan Eswaramoorthy, Abirami Arthanari
Cureus.2024;[Epub] CrossRef - In Vitro Evaluation of the Effect of Oleanolic Acid as a Potential Root Canal Medicament on Viability and Proliferation of Dental Pulp Stem Cells
Khalifah A. Alhaila, Manal Farouk Badawi, Mohamed G. Elbeltagy, Amany E. Badr
European Journal of General Dentistry.2024; 13(01): 051. CrossRef - Regenerative Endodontic Treatment in Dentinogenesis Imperfecta‐Induced Apical Periodontitis
Ying Liao, Ting Pan, Xianghui Xing, Sivakumar Nuvvula
Case Reports in Dentistry.2024;[Epub] CrossRef - Efecto antimicrobiano como medicación intraconducto de la pasta triantibiótica.
Paúl Sebastián Ulloa Amores, Diana Álvarez Álvarez, María Elizabeth Moscoso Abad, Magda Zulay Bastidas Calva
Revista de la Asociación Dental Mexicana.2024; 81(4): 211. CrossRef - Synthesis and Characterization of Nanosilica-Coated Antibiotics, TAP: A Comprehensive Study Utilizing XRD, EDS, FTIR, SEM, and TEM – Invitro Study
Mahaboob S. Hameed, S. Delphine P. Antony, Rajeshkumar Shanmugam, Sandhya Raghu
Journal of International Oral Health.2024; 16(5): 386. CrossRef - Association between host defence peptide IDR‐1002 and ciprofloxacin: Effects on human dental pulp cells
Danilo César Mota Martins, Maurício Gonçalves da Costa Sousa, Poliana Amanda Oliveira Silva, Lana Ribeiro Aguiar, Rosângela Vieira de Andrade, Amandda Évellin Silva‐Carvalho, Felipe Saldanha‐Araújo, Octávio Luiz Franco, Taia Maria Berto Rezende
Australian Endodontic Journal.2024; 50(3): 547. CrossRef - Comparative evaluation of antimicrobial efficacy of triple antibiotic paste and amoxicillin clavulanate paste as an intracanal medicament against Enterococcus faecalis: An in vitro study
Dhandayuthapani Sasikala, Parisa Norouzi Baghkomeh, Jamaluddin Mohammed Farzan
Dental Research Journal.2024;[Epub] CrossRef - Triple Antibiotic Paste: A Game Changer in Endodontics
Kalagi G. Panchal, Karima Virani, Vraj Patel, Aquib Ali Khan, Anam Pettiwala, Srikala S. Puranik, Srushti Joshi
Journal of Pharmacy and Bioallied Sciences.2024; 16(Suppl 3): S1913. CrossRef - Non-surgical Management of a Large Periapical Lesion: A Case Study of the Successful Application of a Modified Triple Antibacterial Paste
Srushti Awghad, Joyeeta Mahapatra, Amit Reche, Ankita Burse, Aradhana Kibe
Cureus.2024;[Epub] CrossRef - Enhancing Antimicrobial Efficacy and Synergistic Effects of Nano-Silica-Based Combinations With Doxycycline, Metronidazole, and Ciprofloxacin Against Enterococcus faecalis Biofilms
Shahul Hameed, Delphine P Antony, Rajeshkumar Shanmugam, Sandhya Raghu, Hima Sandeep Adimulapu
Cureus.2024;[Epub] CrossRef - Healing of periapical lesion by non-surgical endodontic therapy: A case series
Athira Ramesh, Rajesh Pillai, Afzal A, Anakha Santhosh, Arunima G.S, Sandeep K. V
IP Indian Journal of Conservative and Endodontics.2024; 9(2): 99. CrossRef - Effect of Calcium Hydroxide Versus Double Antibiotic Paste on Endodontic Treatment Outcomes in Teeth With Large Periapical Lesions: A Triple‐Blind Randomized Clinical Trial
Afsaneh Rahmati, Farshad Seyedein, Omid Dianat, Sara Saedi, Golriz Rostami, Alireza Akbarzadeh Baghban, Shima Sabertahan, Majid Kazem, Kee Y. Kum
International Journal of Dentistry.2024;[Epub] CrossRef - Can antimicrobial photodynamic therapy serve as an effective adjunct protocol for disinfecting the necrotic root canal system? A randomized controlled study
Remy Barazy, Hisham Alafif, Hassan Achour, Ahmad Al-Aloul, Yasser Alsayed Tolibah
BDJ Open.2024;[Epub] CrossRef - Drain and Treat: A Rubber Dam Technique for Acute Periapical Abscess
S. Grover, K. Mala, J. D’Souza
Acta Medica Bulgarica.2024; 51(s2): 143. CrossRef - Microbial Dynamics in Endodontic Pathology—From Bacterial Infection to Therapeutic Interventions—A Narrative Review
Klara Wieczorkiewicz, Anna Jarząbek, Estera Bakinowska, Kajetan Kiełbowski, Andrzej Pawlik
Pathogens.2024; 14(1): 12. CrossRef - An in vitro comparative evaluation of the effect of three intracanal medicaments – chlorhexidine gel, triple antibiotic paste, and calcium hydroxide paste on the push-out bond strength of MTA Plus, Biodentine, and calcium-enriched mixture
Gouthami Datta, Ramya Raghu, Ashish Shetty, Gautham P Manjunath, Dishant Patel, Subhashini Rajasekhara
Endodontology.2023; 35(1): 60. CrossRef - The cytotoxic effect of cysteamine and its combinations with various endodontic intracanal medications on fibroblast cells: in vitro study
Esraa Adel Mohamed Abd Elhameed ElGammal, Abeer Hashem Mahran, Salma Hassan El Ashry, Sara Hossam Fahmy
Bulletin of the National Research Centre.2023;[Epub] CrossRef - Healing of large endodontic lesions using a new combination of triple antibiotics: A case report
Saeed Asgary, Ardavan Parhizkar
Clinical Case Reports.2023;[Epub] CrossRef - Effects of Intracanal Medicaments on the Measurement Accuracy of Four Apex Locators: An In Vitro Study
Hamza Cudal, Tuğrul Aslan, Bertan Kesim
Meandros Medical and Dental Journal.2023; 24(3): 215. CrossRef - Comparative evaluation of the antibacterial efficacy of herbal agents as intracanal medicaments individually or in combination with chitosan: An in vitro RTPCR study
Gaurav Patri, Kotni Sheetal, PrasantiKumar Pradhan, Pratik Agrawal, S Lata
Journal of International Oral Health.2023; 15(1): 89. CrossRef - Recent progress in carbon dots for anti-pathogen applications in oral cavity
Yuying Jiang, Chuqiang Yin, Jianning Mo, Xiaoyu Wang, Ting Wang, Guotai Li, Qihui Zhou
Frontiers in Cellular and Infection Microbiology.2023;[Epub] CrossRef - A Comprehensive Review of Lesion Sterilization and Tissue Repair: An Alternative for Pulpectomy in Deciduous Teeth
Aparna Achanta, Amit Reche, Rishika Dakhale, Rudra R Bharate
Cureus.2023;[Epub] CrossRef - Healing of Large Endodontic Lesions Using Long‐Term Application of a New Combination of Triple Antibiotics: A Series of Cases
Saeed Asgary, Ardavan Parhizkar, Maria Beatriz Duarte Gavião
Case Reports in Dentistry.2023;[Epub] CrossRef - Non-cytotoxic Root Canal Dressing with Improved Antimicrobial Efficacy
Farzad Koosha, Jerome Cymerman, Thomas Manders, Marcia Simon, Stephen Walker, Miriam Rafailovich
Journal of Endodontics.2023; 49(2): 205. CrossRef - Triple antibiotics: A synergistic approach to combating infection
Hemant Sawhney, Anukriti Kumari, Ritik Kashwani, Geetanjali Gupta, SJ Das
IP Indian Journal of Conservative and Endodontics.2023; 8(4): 189. CrossRef - A 1-year Clinical and Radiographic Assessment of Regenerative Endodontic Therapy for Necrotic Primary Molars: A Randomized controlled Trial
Dina D Abdelmoneim, Amr M Abdelaziz, Gehan G Allam, Amira S Badran
International Journal of Clinical Pediatric Dentistry.2023; 16(2): 295. CrossRef - “BIODENTINE” THE DENTINE IN A CAPSULE AS AN APICAL BARRIER IN TRAUMATIZED MAXILLARY CENTRAL INCISOR WITH TWO YEARS FOLLOW UP.
Savita Thakur, Udai Bhanu, Gurkirat Singh Grewal
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2022; : 64. CrossRef - Long-term treatment of dentine with triple antibiotic paste promotes stem cell viability and attachment
Samiya Riaz, Ahmad Azlina, Zuliani Mahmood, Aung T. Htun
Journal of Taibah University Medical Sciences.2022; 17(4): 630. CrossRef - Non surgical management of trauma induced root resorption and large periapical
lesion using bioactive material- A case report
Tejasvini Prajapati, Sonali Kapoor, Purnil Shah, Ankit Arora, Hardik Rana
Clinical Dentistry.2022;[Epub] CrossRef - Antibacterial efficacy of antibiotic pastes versus calcium hydroxide intracanal dressing: A systematic review and meta-analysis of ex vivo studies
Mohammadreza Vatankhah, Kamyar Khosravi, Nazanin Zargar, Armin Shirvani, MohammadHossein Nekoofar, Omid Dianat
Journal of Conservative Dentistry.2022; 25(5): 463. CrossRef - Triple Antibiotic Paste: A Suitable Medicament for Intracanal Disinfection
Krutika Malu, Monika Khubchandani
Cureus.2022;[Epub] CrossRef - Present status and future directions of intracanal medicaments
Ronald Ordinola‐Zapata, W. Craig Noblett, Alejandro Perez‐Ron, Zhou Ye, Jorge Vera
International Endodontic Journal.2022; 55(S3): 613. CrossRef - The effect of four different intracanal medicaments on the push-out bond strength of root canal sealers
Shalu Maan, Vijaya Dhar Bhatt, Rohit Singh, Sayak Gupta, Syed Alay Noorain, Aashna Gill, Pradeep Kumar, Sushil Yadav, Preeti Sharma
Journal of Medicine and Life.2022; 15(4): 448. CrossRef - A Comparative Evaluation of Microhardness and Chemical Structure of Radicular Dentin with Two Combinations of TAP and MTAP: An In Vitro Study
P Niharika, Saigeeta Kondamadugu, Nagireddy Venugopal Reddy, Muthumula Daneswari, Annie P Chris, Nikhila V Reddy
International Journal of Clinical Pediatric Dentistry.2022; 15(S2): S151. CrossRef - Comparative Evaluation of Two Antibiotic Pastes for Root Canal Disinfection
Sadhna Sharma, Urvashi Bhushan, Mridula Goswami, CP Baveja
International Journal of Clinical Pediatric Dentistry.2022; 15(S1): S12. CrossRef - Management of External Inflammatory Root Resorption following Tooth Autotransplantation Using a Modified Combination of Triple Antibiotics
Saeed Asgary, Ardavan Parhizkar, Paulo J. Palma
Case Reports in Dentistry.2022;[Epub] CrossRef - Effect of triple antibiotic paste on the bond strength of epoxy and methacrylate resin-based sealers to root canal dentin
Fereshte Sobhnamayan, Alireza Adl, Mahdi Sedigh-Shams, Hossein Mirkhaghani
Journal of Conservative Dentistry.2022; 25(4): 426. CrossRef - Progress of Research on the Application of Triple Antibiotic Paste and Hydrogel Scaffold Materials in Endodontic Revascularization: A Systematic Review
Jia Zhao, Tian Jiao Wang
Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef - The effect of different intracanal medicaments on the dislodgement resistance of mineral trioxide aggregate
Farzaneh Afkhami, Shahrzad Razavi, Sholeh Ghabraei
BMC Oral Health.2022;[Epub] CrossRef - Efficacy of Ciprofloxacin, Metronidazole and Minocycline in Ordered Mesoporous Silica against Enterococcus faecalis for Dental Pulp Revascularization: An In-Vitro Study
Cintia Micaela Chamorro-Petronacci, Beatriz Santos Torres, Rocío Guerrero-Nieves, Mario Pérez-Sayáns, Marcia Carvalho-de Abreu Fantini, Luis Carlos Cides-da-Silva, Beatriz Magariños, Berta Rivas-Mundiña
Materials.2022; 15(6): 2266. CrossRef - Antibiotic Mixtures in Noninstrumental Endodontic Treatment of Primary Teeth with Necrotic Pulps: A Systematic Review
Farah Chouchene, Fatma Masmoudi, Ahlem Baaziz, Fethi Maatouk, Hichem Ghedira, Sivakumar Nuvvula
International Journal of Dentistry.2021; 2021: 1. CrossRef - Potential apply of hydrogel-carried chlorhexidine and metronidazole in root canal disinfection
Yanhong YAN, Peng ZHOU, Haibing LU, Yun GUAN, Ming MA, Juan WANG, Guangwei SHANG, Beizhan JIANG
Dental Materials Journal.2021; 40(4): 986. CrossRef - Evaluation of the Effect of Nitrofurantoin Paste as an Intracanal Medicament on the Chemical Structure of Radicular Dentine
Mewan Abdulrahman, Bestoon Faraj, Kawa Dizaye
Sulaimani Dental Journal.2021; 8(2): 8. CrossRef - Local Drug Delivery Systems for Vital Pulp Therapy: A New Hope
Ardavan Parhizkar, Saeed Asgary, Carlo Galli
International Journal of Biomaterials.2021; 2021: 1. CrossRef - Antibiofilm and cytotoxic effect of 3,3′-dihydroxycurcumin (DHC) as photosensitizer agent in antimicrobial photodynamic therapy for endodontic purposes
Jesse Augusto Pereira, Carlos Roberto Polaquini, VanessaRodrigues dos Santos, Karina Sampaio Caiaffa, Rafaela Laruzo Rabelo, Reinaldo dos Santos Theodoro, Letícia Helena Theodoro, Luis Octavio Regasini, Cristiane Duque
Photodiagnosis and Photodynamic Therapy.2021; 36: 102534. CrossRef - An in-vitro Comparative Evaluation of Quantitative Release of Transforming Growth Factor β-1 from Dentin upon the Action of Endodontic Irrigants, Medicaments, Ultrasonic Activation, and Low-Level Laser Irradiation
Anilkumar Akhila, V. P. Prabath Singh, Kerala R. Varma, Senthil V. Vasudevan, V. Sukhithasri, Salu Sasikumar
Amrita Journal of Medicine.2021; 17(2): 34. CrossRef - Effect of triple antibiotic paste and calcium hydroxide on the rate of healing of periapical lesions: A systematic review
NKiran Kumar, Biji Brigit, BS Annapoorna, SavithaB Naik, Seema Merwade, K Rashmi
Journal of Conservative Dentistry.2021; 24(4): 307. CrossRef - Comparison of the efficacy of CanalBrush, EndoActivator, and Passive Ultrasonic Irrigation on the removal of triple antibiotic paste from root canal walls: An in vitro study
Santosh Kumar, Kavisha Desai, Aparna Palekar, Baswaraj Biradar, Ananjan Chatterjee, Khushboo Kumari
Journal of International Society of Preventive and Community Dentistry.2020; 10(4): 424. CrossRef - Apexification with Calcium Hydroxide vs. Revascularization
H. Boufdil, M. Mtalsi, S. El Arabi, B. Bousfiha, Jose López-López
Case Reports in Dentistry.2020;[Epub] CrossRef - Effect of Intracanal Medicaments and Irrigants on the Release of Transforming Growth Factor Beta 1 and Vascular Endothelial Growth Factor from Cervical Root Dentin
Lívia Nazareth Ferreira, Regina Maria Puppin-Rontani, Fernanda Miori Pascon
Journal of Endodontics.2020; 46(11): 1616. CrossRef - Incorporation of amoxicillin-loaded microspheres in mineral trioxide aggregate cement: an in vitro study
Fábio Rocha Bohns, Vicente Castelo Branco Leitune, Isadora Martini Garcia, Bruna Genari, Nélio Bairros Dornelles, Silvia Stanisçuaski Guterres, Fabrício Aulo Ogliari, Mary Anne Sampaio de Melo, Fabrício Mezzomo Collares
Restorative Dentistry & Endodontics.2020;[Epub] CrossRef - Assessment of Nitrofurantoin as an Experimental Intracanal Medicament in Endodontics
Mewan Salahalddin A. Alrahman, Bestoon Muhammed Faraj, Kawa F. Dizaye, Abdelwahab Omri
BioMed Research International.2020;[Epub] CrossRef - An in vitro assessment of effect on microhardness of dentin using vicker's hardness method
Manoj Chandak, Richa Modi, Rakesh Gogiya, Rakhi Chandak, Anuja Ikhar, Nikhil Mankar
Journal of Datta Meghe Institute of Medical Sciences University.2020; 15(2): 251. CrossRef - Inspection of the Microbiota in Endodontic Lesions
Mario Dioguardi, Giovanni Di Gioia, Gaetano Illuzzi, Claudia Arena, Vito Carlo Alberto Caponio, Giorgia Apollonia Caloro, Khrystyna Zhurakivska, Iolanda Adipietro, Giuseppe Troiano, Lorenzo Lo Muzio
Dentistry Journal.2019; 7(2): 47. CrossRef - Materials for pulpotomy in immature permanent teeth: a systematic review and meta-analysis
Yuan Chen, Xinlei Chen, Yali Zhang, Fangjie Zhou, Jiaxin Deng, Jing Zou, Yan Wang
BMC Oral Health.2019;[Epub] CrossRef - Adjunctive antimicrobial photodynamic therapy to conventional chemo-mechanical debridement of infected root canal systems: A systematic review and meta-analysis
Maryam Pourhajibagher, Abbas bahador
Photodiagnosis and Photodynamic Therapy.2019; 26: 19. CrossRef - Comparison of Antibacterial Effects of Photodynamic Therapy, Modified Triple Antibiotic Paste and Calcium Hydroxide on Root Canals Infected With Enterococcus faecalis: An In Vitro Study
Mohammad Asnaashari, Mohammad Jafar Eghbal, Amirali Sahba Yaghmayi, Mehdi Shokri, Saranaz Azari-Marhabi
Journal of Lasers in Medical Sciences.2019; 10(5): S23. CrossRef
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XML DownloadTriple antibiotic paste: momentous roles and applications in endodontics: a review
Triple antibiotic paste: momentous roles and applications in endodontics: a review
