Rahmati Afsaneh, Seyedein Farshad, Dianat Omid, Saedi Sara, Rostami Golriz, Akbarzadeh Baghban Alireza, Sabertahan Shima, Kazem Majid
Endodontic Department, Hamedan University of Medical Sciences Dental School, Hamedan, Iran.
Endodontist, Private Office, Tustin, California, USA.
Int J Dent. 2024 Dec 23;2024:7071459. doi: 10.1155/ijod/7071459. eCollection 2024.
The successful management of necrotic pulps and apical periodontitis poses a tough challenge in endodontic therapy, as it involves addressing compromised tooth vitality and microbial invasion of root canal systems. Failure to effectively treat these conditions can lead to persistent infection and severe patient discomfort. The efficacy of double antibiotic paste (DAP), a mixture of ciprofloxacin and metronidazole, was evaluated and compared to calcium hydroxide (CH) by assessing radiographic and clinical outcomes of nonsurgical endodontic treatment in cases with necrotic pulps and the presence of apical periodontitis. Thirty maxillary anterior teeth with necrotic pulps and apical periodontitis (periapical index [PAI] = 5) were divided randomly into two experimental groups. The first group received CH dressing, while the other group filled with DAP as intracanal medicament. After 3 weeks, medicaments were removed, and teeth were obturated in both groups. Teeth were assessed clinically and radiographically at 6-month and 12-month follow-ups. A chi-square test was performed to compare the outcome between the groups. None of the teeth showed complete healing in a 6-month follow-up. At the 12-month follow-up, six samples in the DAP group showed complete healing of the periapical (PA) lesion, while none of the samples in the CH group were completely healed. The PA healing outcome was as follows: in the DAP group, 40% of cases were healed, 60% healing, and 0% diseased, while in the CH group, 0% healed, 93.3% healing, and 6.7% diseased. The results of the two experimental groups in 12 months differed significantly ( < 0.05). DAP group has shown significantly better outcomes compared to CH as intracanal medicament in the treatment of teeth with PA lesions. This finding suggests that DAP may offer a more effective therapeutic approach in managing necrotic pulps and apical periodontitis, potentially improving patient outcomes and treatment success rates. Clinical Trial Registry identifier: IRCT2015060822615N1.
在牙髓病治疗中，坏死牙髓和根尖周炎的成功管理是一项严峻挑战，因为这涉及解决受损的牙齿活力以及根管系统的微生物入侵问题。未能有效治疗这些病症会导致持续感染和患者严重不适。通过评估坏死牙髓且存在根尖周炎病例的非手术牙髓治疗的影像学和临床结果，对环丙沙星和甲硝唑混合物——双抗生素糊剂（DAP）的疗效进行了评估，并与氢氧化钙（CH）进行了比较。30颗患有坏死牙髓和根尖周炎（根尖指数[PAI]=5）的上颌前牙被随机分为两个实验组。第一组接受CH封药，而另一组用DAP作为根管内药物填充。3周后，去除药物，两组牙齿均进行根管充填。在6个月和12个月的随访中对牙齿进行临床和影像学评估。进行卡方检验以比较两组之间的结果。在6个月的随访中，没有牙齿显示完全愈合。在12个月的随访中，DAP组有6个样本显示根尖（PA）病变完全愈合，而CH组没有样本完全愈合。PA愈合结果如下：在DAP组中，40%的病例愈合，60%好转，0%病变；而在CH组中，0%愈合，93.3%好转，6.7%病变。两个实验组在12个月时的结果差异显著（<0.05）。在治疗患有PA病变的牙齿时，DAP组作为根管内药物显示出明显优于CH组的结果。这一发现表明，DAP在管理坏死牙髓和根尖周炎方面可能提供一种更有效的治疗方法，有可能改善患者的治疗结果和成功率。临床试验注册标识符：IRCT2015060822615N1。
