Effect of Triple Antibiotic Paste and Calcium Hydroxide on the Rate of Healing of Periapical Lesions: A Systematic Review

Overview

Journal J Conserv Dent

Specialty Dentistry

Date 2022 Mar 14

PMID 35282591

Authors

N Kiran Kumar

Biji Brigit

B S Annapoorna

Savitha B Naik

Seema Merwade

K Rashmi

Affiliations

Soon will be listed here.

Abstract

Aim: The rate of healing of periapical lesion after the antibacterial dressing with triple antibiotic paste and calcium hydroxide was assessed.

Materials And Methods: Case reports which used triple antibiotic paste and calcium hydroxide as the intracanal dressing was searched in PubMed, Google Scholar and Cochrane Oral Health's Trials Register up to August 2020, without language and period restriction. Two authors independently reviewed all identified titles and abstracts for eligibility. Tables were generated to summarize the included studies.

Results: Sixteen ( = 16) articles met the eligibility criteria. Nonsurgical endodontic treatment was carried out in eleven cases with triple antibiotic paste and in nineteen cases calcium hydroxide was used. Results of the study after analyzing the case reports indicate that both triple antibiotic paste and calcium hydroxide are equally effective as intracanal medicament. In cases where calcium hydroxide failed to eliminate symptoms, triple antibiotic paste was found to be effective.

Conclusion: As far as the effect on the healing of the periapical lesions is concerned, all the studies showed a high success rate. Available scientific data indicates nonsurgical treatment can be adopted as a routine measure to conservatively treat large periapical lesions of endodontic origin.

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References

Gnanasekhar J . Healing of large periapical lesions following nonsurgical endodontic therapy: case reports. Quintessence Int. 1994; 25(2):115-9. View

De Moor R, De Witte A . Periapical lesions accidentally filled with calcium hydroxide. Int Endod J. 2002; 35(11):946-58. DOI: 10.1046/j.1365-2591.2002.00597.x. View

Taneja S, Kumari M . Use of triple antibiotic paste in the treatment of large periradicular lesions. J Investig Clin Dent. 2012; 3(1):72-6. DOI: 10.1111/j.2041-1626.2011.00082.x. View

Karunakaran J, Abraham C, Karthik A, Jayaprakash N . Successful Nonsurgical Management of Periapical Lesions of Endodontic Origin: A Conservative Orthograde Approach. J Pharm Bioallied Sci. 2017; 9(Suppl 1):S246-S251. PMC: 5731023. DOI: 10.4103/jpbs.JPBS_100_17. View

Fernandes M, de Ataide I . Nonsurgical management of periapical lesions. J Conserv Dent. 2011; 13(4):240-5. PMC: 3010029. DOI: 10.4103/0972-0707.73384. View

Peciuliene V, Maneliene R, Balcikonyte E, Drukteinis S, Rutkunas V . Microorganisms in root canal infections: a review. Stomatologija. 2008; 10(1):4-9. View

Hosoya N, Takahashi G, Arai T, Nakamura J . Calcium concentration and pH of the periapical environment after applying calcium hydroxide into root canals in vitro. J Endod. 2001; 27(5):343-6. DOI: 10.1097/00004770-200105000-00009. View

Dhillon J, Amita , Saini S, Bedi H, Ratol S, Gill B . Healing of a large periapical lesion using triple antibiotic paste and intracanal aspiration in nonsurgical endodontic retreatment. Indian J Dent. 2015; 5(3):161-5. PMC: 4213876. DOI: 10.4103/0975-962X.140843. View

Saatchi M . Healing of large periapical lesion: a non-surgical endodontic treatment approach. Aust Endod J. 2007; 33(3):136-40. DOI: 10.1111/j.1747-4477.2007.00061.x. View

10.

Al Khasawnah Q, Hassan F, Malhan D, Engelhardt M, Daghma D, Obidat D . Nonsurgical Clinical Management of Periapical Lesions Using Calcium Hydroxide-Iodoform-Silicon-Oil Paste. Biomed Res Int. 2018; 2018:8198795. PMC: 5829310. DOI: 10.1155/2018/8198795. View

11.

Dixit S, Dixit A, Kumar P . Nonsurgical treatment of two periapical lesions with calcium hydroxide using two different vehicles. Case Rep Dent. 2014; 2014:901497. PMC: 4123525. DOI: 10.1155/2014/901497. View

12.

Narayanan L, Vaishnavi C . Endodontic microbiology. J Conserv Dent. 2011; 13(4):233-9. PMC: 3010028. DOI: 10.4103/0972-0707.73386. View

13.

Karamifar K, Tondari A, Saghiri M . Endodontic Periapical Lesion: An Overview on the Etiology, Diagnosis and Current Treatment Modalities. Eur Endod J. 2020; 5(2):54-67. PMC: 7398993. DOI: 10.14744/eej.2020.42714. View

14.

Carvalho C, Freire L, Carvalho A, Siqueira E, Bauer J, Gritti G . The Influence of Dentine on the pH of Calcium Hydroxide, Chlorhexidine Gel, and Experimental Bioactive Glass-Based Root Canal Medicament. ScientificWorldJournal. 2015; 2015:686259. PMC: 4539484. DOI: 10.1155/2015/686259. View

15.

Soares J, Santos S, Silveira F, Nunes E . Nonsurgical treatment of extensive cyst-like periapical lesion of endodontic origin. Int Endod J. 2006; 39(7):566-75. DOI: 10.1111/j.1365-2591.2006.01109.x. View

16.

Orucoglu H, Kont Cobankara F . Effect of unintentionally extruded calcium hydroxide paste including barium sulfate as a radiopaquing agent in treatment of teeth with periapical lesions: report of a case. J Endod. 2008; 34(7):888-91. DOI: 10.1016/j.joen.2008.04.012. View

17.

Kunhappan S, Kunhappan N, Saraf K, Kridutt V . Nonsurgical endodontic treatment of teeth associated with large periapical lesion using triple antibiotic paste and mineral trioxide aggregate apical plug: A case series. J Conserv Dent. 2017; 20(2):141-145. PMC: 5564243. DOI: 10.4103/0972-0707.212232. View

18.

Parhizkar A, Nojehdehian H, Asgary S . Triple antibiotic paste: momentous roles and applications in endodontics: a review. Restor Dent Endod. 2018; 43(3):e28. PMC: 6103545. DOI: 10.5395/rde.2018.43.e28. View

19.

Ghabraei S, Marvi M, Bolhari B, Bagheri P . Minimum Intracanal Dressing Time of Triple Antibiotic Paste to Eliminate Enterococcus Faecalis (ATCC 29212) and Determination of Minimum Inhibitory Concentration and Minimum Bactericidal Concentration: An Ex Vivo Study. J Dent (Tehran). 2018; 15(1):1-9. PMC: 6026102. View

20.

Taneja S, Kumari M, Parkash H . Nonsurgical healing of large periradicular lesions using a triple antibiotic paste: A case series. Contemp Clin Dent. 2011; 1(1):31-5. PMC: 3220065. DOI: 10.4103/0976-237X.62519. View