Athanassiadis Basil, Abbott Paul V, Walsh Laurence J
Private Practice; Brisbane, Queensland, Australia.
UWA Dental School, The University of Western Australia, Perth, Australia.
Eur Endod J. 2018 Jul 19;3(2):66-72. doi: 10.14744/eej.2018.47966. eCollection 2018.
Tetracyclines are a unique class of antibiotics which also have additional effects including anti-inflammatory, anti-resorptive and substantive within the root canal. There has been a long-held view that tetracycline medicaments discolour teeth and should be avoided. The evidence base around this topic was explored, including a review of the methodology used in laboratory studies. A search of PubMed, Medline and Scopus databases was conducted to identify studies of demeclocycline and doxycycline medicaments used in root canal therapy. An analysis of the methodology used in these studies was performed to determine if these replicate current clinical practice. The related literature on mechanisms of tetracycline stability and the effects of light, oxidation, moisture and chemical interactions was examined. Studies investigating the effects of Ledermix paste on segments of bovine dentine and avulsed or reimplanted teeth as well as combinations with other antibiotics were excluded from this review. Even though demeclocycline medicament pastes were introduced in 1962, the first laboratory studies of discolouration were not done until 2000. All later studies followed a similar approach, which included exposure to sodium hypochlorite for up to 30 minutes and storage in moist conditions with 100% humidity. Staining during dark storage and enhanced staining on exposure to light were reported, indicating multiple pathways of degradation of demeclocycline and its reaction products. Light, moisture and oxidation are the key factors which drive discolouration from demeclocycline. Clinical issues from tooth staining can be prevented by removal of medicament pastes from the access cavity, and placement of a sound interim restoration. Use of a doxycycline paste obviates concerns of staining. Laboratory assessments of the potential for staining should replicate in vivo conditions.
四环素是一类独特的抗生素，在根管内还具有抗炎、抗吸收和实质性等其他作用。长期以来，人们一直认为四环素类药物会使牙齿变色，应避免使用。本文探讨了围绕该主题的证据基础，包括对实验室研究中所用方法的综述。检索了PubMed、Medline和Scopus数据库，以确定用于根管治疗的地美环素和多西环素药物的研究。对这些研究中使用的方法进行了分析，以确定它们是否复制了当前的临床实践。研究了四环素稳定性机制以及光、氧化、湿度和化学相互作用影响的相关文献。本综述排除了研究Ledermix糊剂对牛牙本质片段、脱位或再植牙齿的影响以及与其他抗生素联合使用的研究。尽管地美环素药物糊剂于1962年推出，但直到2000年才进行首次关于变色的实验室研究。所有后续研究都采用了类似的方法，包括暴露于次氯酸钠长达30分钟，并在100%湿度的潮湿条件下储存。报告了黑暗储存期间的染色以及光照下染色增强的情况，表明地美环素及其反应产物存在多种降解途径。光、湿度和氧化是导致地美环素变色的关键因素。通过从进入腔中清除药物糊剂并放置合适的临时修复体，可以预防牙齿染色的临床问题。使用多西环素糊剂可消除对染色的担忧。对染色可能性的实验室评估应复制体内条件。
