Disinfection of the root canal and the periradicular region results in good healing of the periradicular region. The application of antibacterial drugs to endodontic lesions is one of the clinical procedures that can be used to sterilise such lesions. One such technique is LSTR (lesion sterilisation and tissue repair), which employs the use of a mixture of antibacterial drugs for disinfection of oral infectious lesions, including dentinal, pulpal and periapical lesions24. 3Mix-MP (macrogol, propylene, glycol) medicament has been found to be effective as a pulpotomy24 and pulpectomy25 medicament in the treatment of infected primary teeth. In children, excellent clinical outcomes have been observed in the ﬁrst- and second-year area oral health programme26,27.
preparation. The reliance on mechanical instrumentation and aversion to the use of cytotoxic agents has led to the lack of use of an intra-canal dressing by many clinicians. Calcium hydroxide has been found to be more successful as an intra-canal medicament, but it has a few limitations and it is difﬁcult to completely remove it from the root canal walls before obturation, which might adversely affect the quality of the apical seal. Recent reports also suggest that, due to its strong alkalinity, it may de-nature the carboxylate and phosphate groups leading to a collapse in the dentine structure. Therefore it is not recommended for long periods28. Moreover, it did not totally eliminate bacteria from the root canal system5,11. Antibiotics in different combinations have been tried in root canal dressings and found to be effective2. Triple antibiotic paste was successful in the healing of non-surgical, endodontically treated, large cyst-like periradicular lesions29 and dens invaginatus in a mandibular premolar with a large periradicular lesion30. It was found to be effective in the disinfection of immature teeth31 in dogs, and in inhibiting enterococcal growth20,32. Thus, with further research, it could possibly be used as an intra-canal medicament in children.
n Root canal irrigant Although mechanical instrumentation of root canals can reduce the bacterial population, effective elimination of the bacteria cannot be achieved without the use of antimicrobial root canal irrigation and medication. A new root canal irrigant, BioPure MTAD, which is a mixture of a tetracycline isomer (3% doxycycline), an acid (4.25% citric acid) and a detergent (0.5% polysorbate 80), has been introduced, as it is known to remove the smear layer more effectively than sodium hypochlorite and EDTA (ethylenediaminetetraacetic acid). In addition, it has been effective against Enterococcus faecalis and may have substantive antimicrobial action lasting up to 4 weeks. It fulﬁls the requirements of an ideal root canal irrigant as it is able to remove most of the smear layer, and possesses superior bactericidal activity.
ENDO (Lond Engl) 2010;4(1):41–48
n Pulpotomy/pulpectomy medicament
by N ht
t Grossman’s polyantibiotic paste (penicillin, bacitracin, chloremphenicol, streptomycin) was introduced in 1951. It was ineffective against anaerobes and the use of penicillin induced an allergic reaction. t A mixture of neomycin, polymyxin and nystatin was found to be unsuitable against endodontic bacteria. t Clindamycin has been tried as a root canal dressing23. It was unsuccessful, as clindamycinresistant enterococci were recovered from the root canal 10 days after placement of the root canal dressing. Besides, it had no advantage over calcium hydroxide. t Three-mix medicament (ciproﬂoxacin, metronidazole, minocycline): a combination of drugs was preferred due to the complexity of root canal infections. They were also known to reduce the development of resistant bacterial strains24.
n History of topical antibiotics in endodontics3,22
pyrig No Co t fo rP n Root canal medicaments ub lica The use of an intra-canal medicament might be helptio ful in eliminating remaining bacteria that survived t ess c e n en inside root canals after complete chemo-mechanical
process. It is hoped that antibiotics contained within intra-canal/pulpotomy medicaments might be able to diffuse into these areas to reduce the number of viable bacteria present and improve periapical healing3.
Role of antibiotics in paediatric endodontics
Bacteria have been implicated in the pathogenesis and progression of pulpal and periapical diseases.