Department of Pediatric Dentistry, University of Murcia, Spain.
Department of Metallurgical and Materials Engineering, Montana Technological University, Butte, Montana, USA.
Am J Dent. 2022 Aug;35(4):205-211.
To investigate and compare the effects of the two widely used regenerative endodontics medicaments: Triple antibiotic paste (ciprofloxacine-metronidazole-clindamycin) and calcium hydroxide on the microhardness and degradation of human root dentin.
Following ethical approval and subject consent to use teeth in this research study, 60 singled-rooted permanent human teeth were randomly divided into six groups:(1) Tri-antibiotic paste with distilled water, or with (2) propylene glycol, (3) calcium hydroxide with distilled water, (4) calcium hydroxide propylene glycol, (5) untreated extracted teeth as negative controls, or (6) teeth instrumented and filled with calcium hydroxide or tri-antibiotic paste as positive controls. The microhardness tests were conducted after 1 and 2 months of exposure to the medicaments using a Vickers microhardness tester. Raman spectroscopy and energy dispersive x-ray spectroscopy were used to evaluate the chemistry and structure of the root dentin.
There were differences in the dentin microhardness following treatment with the medicaments or controls (P< 0.05). The time of root dentin exposure to the medicaments was similar (P> 0.05). The root dentin microhardness was lower in the teeth treated with the triple antibiotic paste or calcium hydroxide when combined with propylene glycol. The root dentin collagen in these treated teeth were also significantly degraded when viewed with Raman spectroscopy and energy dispersive x-ray spectroscopy, whereas the inorganic phase (dentin) remained unaltered. Samples exposed to the antimicrobial agents with water as a vehicle exhibited stronger microhardness and less degradation.
These ex vivo results suggest that the triple antibiotic paste and calcium hydroxide should be used with propylene glycol if a fast diffusion is desired or with water to avoid degrading the collagen and weakening the microhardness of the teeth. Clinical trials are needed of new formulations of medicaments with propylene glycol to disinfect teeth for regenerative endodontic procedures, to help strengthen the teeth to prevent the loss of children's permanent immature teeth by fracture following caries or trauma.
研究和比较两种广泛应用的再生牙内治疗药物：三抗生素糊剂（环丙沙星-甲硝唑-克林霉素）和氢氧化钙对人根牙本质的微硬度和降解的影响。
经过伦理批准和受试者同意在这项研究中使用牙齿，将 60 颗单根恒牙随机分为 6 组：（1）三抗生素糊剂加蒸馏水，或加（2）丙二醇，（3）氢氧化钙加蒸馏水，（4）氢氧化钙加丙二醇，（5）未处理的提取牙齿作为阴性对照，或（6）用氢氧化钙或三抗生素糊剂器械充填的牙齿作为阳性对照。在暴露于药物 1 个月和 2 个月后，使用维氏显微硬度计进行微硬度测试。拉曼光谱和能量色散 X 射线光谱用于评估牙本质的化学和结构。
药物或对照治疗后牙本质微硬度存在差异（P<0.05）。根牙本质暴露于药物的时间相似（P>0.05）。用三抗生素糊剂或氢氧化钙加丙二醇治疗的牙齿，牙本质微硬度较低。用拉曼光谱和能量色散 X 射线光谱观察，这些治疗过的牙齿的牙本质胶原也明显降解，而无机相（牙本质）保持不变。用载剂为水的抗菌剂处理的样本表现出更强的微硬度和更少的降解。
这些体外结果表明，如果需要快速扩散，三抗生素糊剂和氢氧化钙应与丙二醇一起使用，或者与水一起使用，以避免降解胶原并削弱牙齿的微硬度。需要进行临床试验，研究新的含有丙二醇的药物配方，以消毒牙齿进行再生牙内治疗，帮助增强牙齿，防止龋齿或创伤导致儿童恒牙未成熟牙齿断裂。
