Evaluation of Triple Antibiotic Paste Removal by Different Irrigation Procedures

doi:10.1016/j.joen.2013.12.027

Journal of Endodontics

Volume 40, Issue 8, August 2014, Pages 1172-1177

https://doi.org/10.1016/j.joen.2013.12.027 Get rights and content

Abstract

Introduction

Regenerative endodontics aims to re-establish a functional pulp-dentin complex. First, the root canal system is disinfected primarily by irrigants and medicaments. Triple antibiotic paste (TAP), a commonly used intracanal medicament, has been shown to be directly toxic to stem cells at concentrations greater than 0.1 g/mL. Thus, its complete removal is a crucial step in regenerative endodontic procedures. We hypothesized that currently used irrigation techniques do not completely remove TAP from root canal system.

Methods

TAP was radiolabeled by the incorporation of I¹²⁵, and calcium hydroxide (Ultracal; Ultradent, South Jordan, UT) was radiolabeled with Ca⁴⁵. The intracanal medicaments were placed into standardized human root segments and incubated for 28 days at 37°C. Then, canals were irrigated with EndoActivator (Dentsply, Tulsa, OK), passive ultrasonic irrigation, EndoVac (SybronEndo, Coppell, TX), or a syringe/Max-i-Probe needle (Dentsply Rinn, Elgin, IL) using a standardized irrigation protocol in a closed system. Radioactivity levels (counts per minute values) were measured for each tooth before and after the irrigation protocols. Furthermore, the canals were sequentially enlarged and dentin samples collected and evaluated for radioactivity. Data were analyzed with analysis of variance and Bonferroni post hoc testing (P < .05).

Results

Approximately 88% of the TAP was retained in the root canal system regardless of the irrigation technique used (no difference among groups). Furthermore, approximately 50% of the radiolabeled TAP was present circumferentially up to 350 μm within the dentin. Conversely, up to 98% of the radiolabeled intracanal calcium hydroxide was removed, and most residual medicament was found present in the initial 50 μm of dentin.

Conclusions

Current irrigation techniques do not effectively remove TAP from root canal systems, possibly because of its penetration and binding into dentin. However, calcium hydroxide is effectively removed with significant less residual presence.

Section snippets

Tooth Collection and Preparation

This study was approved by the Institutional Review Board of the University of Texas Health Science Center at San Antonio, San Antonio, TX. Extracted teeth were collected from the clinics of the University of Texas Health Science Center at San Antonio School of Dentistry and placed in 15 mmol/L sodium azide for 24 hours at 4°C followed by copious irrigation with sterile saline and used for preparation of the simulated immature roots with open apices.

A total of 36 roots from freshly extracted

Results

Radiolabeled TAP was difficult to remove from the root canal system, and there was no statistical difference for removing labeled TAP among the 4 irrigation groups (Fig. 2). Indeed, the mean percentage removal of radiolabeled TAP was quite similar for the positive-pressure (20.9% ± 9.9%), EA (14.4% ± 5.8%), EV (15.3% ± 5.5%), and PUI (22% ± 13.2%) groups.

In contrast, the radiolabeled Ca(OH)₂ was removed about 4-fold more effectively than labeled TAP from the treated root canal systems (Fig. 3).

Discussion

TAP is a well-established antimicrobial agent shown to be highly effective against endodontic pathogens 8, 9. It has been used in the majority of regenerative endodontic procedures (2). However, it has been shown to have detrimental effects on the stem cells necessary for regenerative treatment success (13). A recent study showed that this medicament when used at currently used concentrations has an adverse effect on stem cell survival even after attempts to remove them from the root canal

Acknowledgments

Supported by the Department of Endodontics at the University of Texas Health Science Center at San Antonio.

The authors deny any conflicts of interest related to this study.

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Basic ResearchEvaluation of Triple Antibiotic Paste Removal by Different Irrigation Procedures

Abstract

Introduction

Methods

Results

Conclusions

Section snippets

Tooth Collection and Preparation

Results

Discussion

Acknowledgments

J Endod

J Endod

J Endod

J Endod

J Am Dent Assoc

J Endod

J Endod

J Endod

Oral Surg Oral Med Oral Pathol

J Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Endod

J Endod

J Endod

J Endod

J Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Endod

J Endod

Basic Research
Evaluation of Triple Antibiotic Paste Removal by Different Irrigation Procedures