International Journal of Clinical Pediatric Dentistry

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VOLUME 14 , ISSUE 3 ( May-June, 2021 ) > List of Articles

RESEARCH ARTICLE

Comparison of Modified Triple Antibiotic Paste in Two Concentrations for Lesion Sterilization and Tissue Repair in Primary Molars: An In Vivo Interventional Randomized Clinical Trial

Senthil Dhakshinamoorthy, Trophimus G Jayakaran, Charishma S Bommareddy

Keywords : Antibiotic resistance, Ciprofloxacin, Clindamycin, Concentration, Irreversible pulpitis, Lesion sterilization and tissue repair, Metronidazole, Primary teeth, Randomized clinical trial

Citation Information : Dhakshinamoorthy S, Jayakaran TG, Bommareddy CS. Comparison of Modified Triple Antibiotic Paste in Two Concentrations for Lesion Sterilization and Tissue Repair in Primary Molars: An In Vivo Interventional Randomized Clinical Trial. Int J Clin Pediatr Dent 2021; 14 (3):388-392.

DOI: 10.5005/jp-journals-10005-1951

License: CC BY-NC 4.0

Published Online: 29-09-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Introduction: “Lesion sterilization and tissue repair” (LSTR) is a non-instrumentation endodontic treatment modality that has recently gained popularity with promising results in several clinical trials. However, there is a dearth of evidence regarding the concentration of modified triple antibiotic paste (MTAP) to be used for the procedure. Aim and objective: To compare the clinical and radiographic efficacy of 1 mg/mL and 1 g/mL concentrations of MTAP (ciprofloxacin, metronidazole, and clindamycin) used in LSTR of primary molars. Materials and methods: Sixty-four infected primary molars in children between 4 years and 10 years of age were randomly allocated to two groups. Lesion sterilization and tissue repair at 1 mg/mL concentration of MTAP (group I) and 1 g/mL concentration of MTAP (group II) was performed. Clinical and radiographic outcomes were evaluated using Coll and Sadrian's criteria at 10 days, 1 month, and 3 months and the results were tabulated. Statistical analysis: The data obtained were subjected to statistical analysis with IBM.SPSS statistics software 23.0 Version. To test the significance in categorical data, a Chi-square test was used. The probability value of 0.05 was considered significant. Results: At the end of 3 months review, clinical success rates of group I and group II were 84.4 and 90.6%, respectively, and radiographic evaluation showed group I–78.1% and group II–90.6%. Conclusion: Both 1 mg/mL and 1 g/mL concentrations of MTAP used in LSTR of primary molars had similar success rates with no statistically significant difference. Clinical significance: Lesion sterilization and tissue repair when found to be equally effective in less concentration may aid in achieving adequate infection control with the least detrimental effect on the remaining vital pulp and periradicular structures. In addition, this circumvents the systemic administration of potent antibiotics thus combating antibiotic resistance.


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  1. De Menezes Oliveira MA, Torres CP, Gomes-Silva JM, et al. Microstructure and mineral composition of dental enamel of permanent and deciduous teeth. Micros Res and Tech 2010;73(5):572–577. DOI: 10.1002/jemt.20796.
  2. Alazmah A. Early childhood caries: a review. J Contemp Dent Pr 2017;18(8):1–6. DOI: 10.5005/jp-journals-10024-2116.
  3. Takushige T, Cruz EV, Asgor Moral A, et al. Endodontic treatment of primary teeth using a combination of antibacterial drugs. Int Endod J 2004;37(2):132–138. DOI: 10.1111/j.0143-2885.2004.00771.x.
  4. 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(2):125–130. DOI: 10.1111/j.1365-2591.1996.tb01173.x.
  5. Prather BT, Ehrlich Y, Spolnik K, et al. 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(4):245–251. DOI: 10.2334/josnusd.56.245.
  6. Navit S, Jaiswal N, Khan SA, et al. Antimicrobial efficacy of contemporary obturating materials used in primary teeth-an in-vitro study. J Clin Diagnostic Res 2016;10(9):ZC09. DOI: 10.7860/JCDR/2016/21883.8426.
  7. Coll JA, Sadrian R. Predicting pulpectomy success and its relationship to exfoliation and succedaneous dentition. Pediatr Dent 1996;18(1):57–63.
  8. Ruparel NB, Teixeira FB, Ferraz CCR, et al. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod 2012;38(10):1372–1375. DOI: 10.1016/j.joen.2012.06.018.
  9. Grossman LI. Polyantibiotic treatment of pulpless teeth. J Am Dent Assoc 1951;43(3):265–278. DOI: 10.14219/jada.archive.1951.0213.
  10. Sato T, Hoshino E, Uematsu H, et al. Bactericidal efficacy of a mixture of ciprofloxacin, metronidazole, minocycline and rifampicin against bacteria of carious and endodontic lesions of human deciduous teeth in vitro. Microb Ecol Health Dis 1992;5(4):171–177. DOI: 10.3109/08910609209141583.
  11. Alam T, Nakazawa F, Nakajo K, et al. Susceptibility of Enterococcus faecalis to a combination of antibacterial drugs (3Mix) in vitro. J Oral Biosci 2005;47(4):315–320. DOI: 10.1016/S1349-0079(05)80014-3.
  12. Mohammadi Z, Abbott PV. On the local applications of antibiotics and antibiotic-based agents in endodontics and dental traumatology. Int Endod Journ 2009;42(7):555–567. DOI: 10.1111/j.1365-2591.2009.01564.x.
  13. Karczewski A, Feitosa SA, Hamer EI, et al. Clindamycin-modified triple antibiotic nanofibers: a stain-free antimicrobial intracanal drug delivery system. J Endod 2018;44(1):155–162. DOI: 10.1016/j.joen.2017.08.024.
  14. Algarni AA, Yassen GH, Gregory RL. Inhibitory effect of gels loaded with a low concentration of antibiotics against biofilm formation by Enterococcus faecalis and Porphyromonas gingivalis. J Oral Sci 2015;57(3):213–218. DOI: 10.2334/josnusd.57.213.
  15. Prabhakar AR, Sridevi E, Raju OS, et al. Endodontic treatment of primary teeth using combination of antibacterial drugs: an in vivo study. J Indian Soc Pedod Prev Dent 2008;26(5):5.
  16. Nakornchai S, Banditsing P, Visetratana N. Clinical evaluation of 3Mix and Vitapex?? as treatment options for pulpally involved primary molars. Int J Paediatr Dent 2010;20(3):214–221. DOI: 10.1111/j.1365-263X.2010.01044.x.
  17. Pinky C, Subbareddy V, Shashibhushan K. Endodontic treatment of necrosed primary teeth using two different combinations of antibacterial drugs: an in vivo study. J Indian Soc Pedod Prev Dent 2011;29(2):121. DOI: 10.4103/0970-4388.84684.
  18. Jaya AR, Praveen P, Anantharaj A, et al. In vivo evaluation of lesion sterilization and tissue repair in primary teeth pulp therapy using two antibiotic drug combinations. J Clin Pediatr Dent 2012;37(2):189–191. DOI: 10.17796/jcpd.37.2.e5131jp6m1w33v66.
  19. Duanduan A, Sirimaharaj V, Chompu-inwai P. Retrospective study of pulpectomy with vitapex® and LSTR with three antibiotics combination (3Mix) for non-vital pulp treatment in primary teeth. Chiang Mai Univ J Nat Sci 2013;12(2):131–139. DOI: 10.12982/CMUJNS.2013.0012.
  20. Nanda R, Koul M, Srivastava S, et al. Clinical evaluation of 3 Mix and other Mix in non-instrumental endodontic treatment of necrosed primary teeth. J Oral Biol Craniofacial Res 2014;4(2):114–119. DOI: 10.1016/j.jobcr.2014.08.003.
  21. Dasari V, Maroli S, Chowdary L, et al. An in vivo study evaluating lesion sterilization and tissue repair 3 MIX-MP noninstrumentation endodontic treatment as an alternative to conventional endodontic retreatment. J Heal Res 2016;3(4):284.
  22. Shojaee NS, Motamedifar M. A comparison between the antimicrobial effects of triple antibiotic paste and calcium hydroxide against entrococcus faecalis. Iran Endod 2012;7(3):149–155.
  23. Ali M, Moral AA, Quader SA. Evaluation of pain and tenderness in endodontic treatment of deciduous teeth using (LSTR) 3-Mix MP therapy. Update Dent Coll J 2017;7(2):9–14.
  24. 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(3):217–227. DOI: 10.1111/j.1365-263X.2011.01181.x.
  25. Daher A, Viana KA, Leles CR, et al. Ineffectiveness of antibiotic-based pulpotomy for primary molars: a survival analysis. Pesqui Bras Odonto Pediatria Clin Integr 2015;15(1):205–215. DOI: 10.4034/PBOCI.2015.151.22.
  26. Doneria D, Thakur S, Singhal P, et al. In search of a novel substitute: clinical and radiological success of lesion sterilization and tissue repair with modified 3Mix-MP antibiotic paste and conventional pulpectomy for primary molars with pulp involvement with 18 months follow-up. Contemp Clin Dent 2017;8(4):514–521. DOI: 10.4103/ccd.ccd_47_17.
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