Usage of Antibiotics as Intracanal Medicament in Endodontics
Elimination of bacteria from root canal system is a key factor in root canal treatment. However, microorganisms can still be observed in the root canal wall after mechanical instrumentation in combination with disinfecting irrigants, which may lead to endodontic treatment failure. Therefore, the application of medicament has an important role in reducing the number of bacteria in the root canal system. Presently, there are various groups of medications showing different benefits and limitations. Antibiotics are one of the medications used in Endodontics. However, due to bacterial infection in the root canal system is mixed populations; the concept of using antibiotics combination has been developed in order to improve the antimicrobial efficacy. Current studies evaluating the effectiveness of the antibiotic combinations cases have been published. Though, clinicians should take into consideration regarding the value of usage and the side effects of those antibiotic combinations.
1. Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol 1965; 20: 340-349.
2. Chavez de Paz LE. Redefining the persistent infection in root canals: possible role of biofilm communities. J Endod 2007; 33: 652-662.
3. Love RM. Clinical management of infected root canal dentin. Pract Periodontics Aesthet Dent 1996; 8: 581-584.
4. Zehnder M, Lehnert B, Schonenberger K, Waltimo T. Irrigants and intracanal medicaments in endodontics. Schweiz Monatsschr Zahnmed 2003; 113: 756-763.
5. Ricucci D, Siqueira JF, Jr. Biofilms and apical periodontitis: study of prevalence and association with clinical and histopathologic findings. J Endod 2010; 36: 1277-1288.
6. Peciuliene V, Maneliene R, Balcikonyte E, Drukteinis S, Rutkunas V. Microorganisms in root canal infections: a review. Stomatologija 2008; 10: 4-9.
7. Gomes BP, Pinheiro ET, Gade-Neto CR, et al. Microbiological examination of infected dental root canals. Oral Microbiol Immunol 2004; 19: 71-76.
8. Blome B, Braun A, Sobarzo V, Jepsen S. Molecular identification and quantification of bacteria from endodontic infections using real-time polymerase chain reaction. Oral Microbiol and Immunol 2008; 23: 384-390.
9. Stuart CH, Schwartz SA, Beeson TJ, Owatz CB. Enterococcus faecalis: its role in root canal treatment failure and current concepts in retreatment. J Endod 2006; 32: 93-98.
10. Song M, Kim HC, Lee W, Kim E. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod 2011; 37: 1516- 1519.
11. Rocas IN, Siqueira JF, Jr., Santos KR. Association of Enterococcus faecalis with different forms of periradicular diseases. J Endod 2004; 30: 315- 320.
12. Sundqvist G, Figdor D, Persson S, Sjogren U. Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85: 86-93.
13. Mozayeni MA, Haeri A, Dianat O, Jafari AR. Antimicrobial effects of four intracanal medicaments on Enterococcus faecalis: an in vitro study. Iran Endod J 2014; 9: 195-198.
14. Koontongkaew S, Silapichit R, Thaweboon B. Clinical and laboratory assessments of camphorated monochlorophenol in endodontic therapy. Oral Surg Oral Med Oral Pathol 1988; 65: 757-762.
15. Godhi B, Sood PB, Sharma A. Effects of mineral trioxide aggregate and formocresol on vital pulp after pulpotomy of primary molars: An in vivo study. Contemp Clin Dent 2011; 2: 296-301.
16. Pruhs RJ, Olen GA, Sharma PS. Relationship between formocresol pulpotomies on primary teeth and enamel defects on their permanent successors. J Am Dent Assoc 1977; 94: 698-700.
17. Rahimi S, Janani M, Lotfi M, et al. A review of antibacterial agents in endodontic treatment. Iran Endod J 2014; 9: 161-168.
18. Baker NE, Liewehr FR, Buxton TB, Joyce AP. Antibacterial efficacy of calcium hydroxide, iodine potassium iodide, betadine, and betadine scrub with and without surfactant against E. faecalis in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 98: 359-364.
19. Orstavik D, Haapasalo M. Disinfection by endodontic irrigants and dressings of experimentally infected dentinal tubules. Endod Dent Traumatol 1990; 6: 142-149.
20. Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J 2007; 52 : S64-82.
21. Vianna ME, Gomes BP, Berber VB, Zaia AA, Ferraz CC, de Souza-Filho FJ. In vitro evaluation of the antimicrobial activity of chlorhexidine and sodium hypochlorite. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97: 79-84.
22. Basrani B, Ghanem A, Tjäderhane L. Physical and chemical properties of chlorhexidine and calcium hydroxide-containing medications. J Endod 2004; 30: 413-417.
23. Law A, Messer H. An evidence-based analysis of the antibacterial effectiveness of intracanal medicaments. J Endod 2004; 30: 689-694.
24. Byström A, Claesson R, Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Dent Traumatol 1985; 1: 170-175.
25. Nerwich A, Figdor D, Messer HH. pH changes in root dentin over a 4-week period following root canal dressing with calcium hydroxide. J Endod 1993; 19: 302-306.
26. Portenier I, Haapasalo H, Rye A, Waltimo T, Orstavik D, Haapasalo M. Inactivation of root canal medicaments by dentine, hydroxylapatite and bovine serum albumin. Int Endod J 2001; 34: 184-188.
27. Haapasalo HK, Siren EK, Waltimo TM, Orstavik D, Haapasalo MP. Inactivation of local root canal medicaments by dentine: an in vitro study. Int Endod J 2000; 33: 126-131.
28. Mohammadi Z. Antibiotics as intracanal medicaments: a review. J Calif Dent Assoc 2009; 37: 98-108.
29. 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.
30. 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.
31. Ehrmann EH, Messer HH, Adams GG. The relationship of intracanal medicaments to postoperative pain in endodontics. Int Endod J 2003; 36: 868-875.
32. Thong YL, Messer HH, Siar CH, Saw LH. Periodontal response to two intracanal medicaments in replanted monkey incisors. Dent Traumatol 2001; 17: 254-259.
33. Pierce A, Heithersay G, Lindskog S. Evidence for direct inhibition of dentinoclasts by a corticosteroid/antibiotic endodontic paste. Dent Traumatol 1988; 4: 44-45.
34. Wong KS, Sae-Lim V. The effect of intracanal Ledermix on root resorption of delayed-replanted monkey teeth. Dent Traumatol 2002; 18: 309- 315.
35. Day PF, Gregg TA, Ashley P, et al. Periodontal healing following avulsion and replantation of teeth: a multi-centre randomized controlled trial to compare two root canal medicaments. Dent Traumatol 2012; 28: 55-64.
36. Abbott PV, Hume WR, Heithersay GS. Effects of combining Ledermix and calcium hydroxide pastes on the diffusion of corticosteroid and tetracycline through human tooth roots in vitro. Endod Dent Traumatol 1989; 5: 188-192.
37. Hoshino E, Kurihara-Ando N, Sato I, et al. 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.
38. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol. J Endod 2004; 30: 196- 200.
39. 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.
40. Cruz EV, Kota K, Huque J, Iwaku M, Hoshino E. Penetration of propylene glycol into dentine. Int Endod J 2002; 35: 330-336.
41. Tremrangsee K, Khemaleelakul S. Sealing ability of root canal filling in canals medicated with 3Mix-MP. CM Dent J 2010; 31: 95-102.
42. Sato T, Hoshino E, Uematsu H, Noda T. In vitro antimicrobial susceptibility to combinations of drugs on bacteria from carious and endodontic lesions of human deciduous teeth. Oral Microbiol Immunol 1993; 8: 172-176.
43. 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.
44. Diogenes A, Henry MA, Teixeira FB, Hargreaves KM. An update on clinical regenerative endodontics. Endod Topics 2013; 28: 2-23.
45. Sedgley CM, Cherkas P, Chogle SMA, et al. Regenerative Endodontics. ENDODONTICS: Colleagues for Excellence newsletter.Spring 2013 - [cited 2016 Mar 7]. Available from: http:// www.aae.org/uploadedfiles/publications_and_researc... newsletter/ecfespring2013.pdf
46. 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.
47. Akgun OM, Altun C, Guven G. Use of triple antibiotic paste as a disinfectant for a traumatized immature tooth with a periapical lesion: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 62-65.
48. 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.
49. 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.
50. Er K, Çelik 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: 63-66.
51. 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: 446-52.
52. Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol 2001; 17: 185-187.
53. Lenherr P, Allgayer N, Weiger R, Filippi A, Attin T, Krastl G. Tooth discoloration induced by endodontic materials: a laboratory study. Int Endod J 2012; 45: 942-949.
54. Kim JH, Kim Y, Shin SJ, Park JW, Jung IY. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod 2010; 36: 1086-1091.
55. Adefurin A, Sammons H, Jacqz-Aigrain E, Choonara I. Ciprofloxacin safety in paediatrics: a systematic review. Arch Dis Child 2011; 96: 874-880.
56. Granowitz EV, Brown RB. Antibiotic adverse reactions and drug interactions. Crit Care Clin 2008; 24: 421-442.
57. Yassen GH, Chu TM, Eckert G, Platt JA. Effect of medicaments used in endodontic regeneration technique on the chemical structure of human immature radicular dentin: an in vitro study. J Endod 2013; 39: 269-273.
58. Yassen GH, Vail MM, Chu TG, Platt JA. The effect of medicaments used in endodontic regeneration on root fracture and microhardness of radicular dentine. Int Endod J 2013; 46: 688- 695.
59. Kusgoz A, Yildirim T, Er K, Arslan I. Retreatment of a resected tooth associated with a large periradicular lesion by using a triple antibiotic paste and mineral trioxide aggregate: a case report with a thirty-month follow-up. J Endod 2009; 35: 1603-1606.
60. Berkhoff JA, Chen PB, Teixeira FB, Diogenes A. Evaluation of triple antibiotic paste removal by different irrigation procedures. J Endod 2014; 40: 1172-1177.
61. Arslan H, Capar ID, Saygili G, Uysal B, Gok T, Ertas H, et al. Efficacy of various irrigation protocols on the removal of triple antibiotic paste. Int Endod J 2014; 47: 594-599.