Evaluation of triple antibiotic paste removal by different irrigation procedures

Julie A. Berkhoff, Paul B. Chen, Fabricio B. Teixeira, Anibal Diogenes

Research output: Contribution to journalArticle

  • 41 Citations

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.

Original languageEnglish (US)
Pages (from-to)1172-1177
Number of pages6
JournalJournal of Endodontics
Volume40
Issue number8
DOIs
StatePublished - 2014

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Ointments
Anti-Bacterial Agents
Dentin
Dental Pulp Cavity
Calcium Hydroxide
Endodontics
Radioactivity
Jordan
Poisons
Syringes
Ultrasonics
Needles
Analysis of Variance
Tooth
Stem Cells

ASJC Scopus subject areas

  • Dentistry(all)

Cite this

Evaluation of triple antibiotic paste removal by different irrigation procedures. / Berkhoff, Julie A.; Chen, Paul B.; Teixeira, Fabricio B.; Diogenes, Anibal.

In: Journal of Endodontics, Vol. 40, No. 8, 2014, p. 1172-1177.

Research output: Contribution to journalArticle

Berkhoff, Julie A.; Chen, Paul B.; Teixeira, Fabricio B.; Diogenes, Anibal / Evaluation of triple antibiotic paste removal by different irrigation procedures.

In: Journal of Endodontics, Vol. 40, No. 8, 2014, p. 1172-1177.

Research output: Contribution to journalArticle

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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.",
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