Restor Dent Endod.  2015 Nov;40(4):322-327. 10.5395/rde.2015.40.4.322.

Treatment of non-vital immature teeth with amoxicillin-containing triple antibiotic paste resulting in apexification

• Park HB
• Lee BN
• Hwang YC
• Hwang IN
• Oh WM
• Chang HS

• KMID: 2316953
• DOI: http://doi.org/10.5395/rde.2015.40.4.322

Abstract

A recent treatment option for non-vital immature teeth in young patients is revascularization with triple antibiotic paste (TAP). However, tooth discoloration was reported with the use of conventional minocycline-containing TAP. In this case report, amoxicillin-containing TAP was used for revascularization of non-vital immature teeth to prevent tooth discoloration. At the 1 yr follow up, the teeth were asymptomatic on clinical examination and showed slight discoloration of the crown due to mineral trioxide aggregate (MTA) filling rather than amoxicillin-containing TAP. Radiographic examination revealed complete resolution of the periapical radiolucency, and closed apex with obvious periodontal ligament space. However, the root growth was limited, and the treatment outcome was more like apexification rather than revascularization. These results may be due to unstable blood clot formation which could not resist the condensation force of MTA filling, whether or not a collagen matrix was in place. These cases showed that although revascularization was not successful, apexification could be expected, resulting in the resolution of the periapical radiolucency and the closure of the apex. Therefore, it is worthwhile attempting revascularization of non-vital immature teeth in young patients.

Keyword

Amoxicillin; Apexification; Immature teeth; Revascularization; Triple antibiotic paste

MeSH Terms

Amoxicillin
Apexification*
Collagen
Crowns
Follow-Up Studies
Humans
Periodontal Ligament
Tooth Discoloration
Tooth*
Treatment Outcome
Pemetrexed
Amoxicillin
Collagen

Figure

• 

  Figure 1 Clinical photographs and periapical radiographs of the mandibular right second premolar with an open apex. (a) Preoperative clinical photograph showing fractured dens evaginatus; (b) Preoperative periapical radiograph showing apical radiolucency and open apex; (c) Periapical radiograph after MTA filling showing limited blood clot space; (d) Clinical photograph at the 12 month follow-up showing slight grayish discoloration of the crown; (e) Periapical radiograph at the 12 month follow-up showing resolution of the apical radiolucency and limited root formation.

• 

  Figure 2 Periapical radiographs and clinical photograph of the mandibular right second premolar with an open apex. (a) Preoperative periapical radiograph showing apical radiolucency with underdeveloped root; (b) Periapical radiograph after MTA filling showing limited blood clot space despite using collagen matrix; (c) Periapical radiograph at the 12 month follow-up showing resolution of the apical radiolucency without further root formation; (d) Clinical photograph at the 12 month follow-up showing slight grayish discoloration of the crown due to MTA filling.

Reference

1. Dominguez Reyes A, Muñoz Muñoz L, Aznar Martín T. Study of calcium hydroxide apexification in 26 young permanent incisors. Dent Traumatol. 2005; 21:141–145.

2. Ghose LJ, Baghdady VS, Hikmat YM. Apexification of immature apices of pulpless permanent anterior teeth with calcium hydroxide. J Endod. 1987; 13:285–290.

3. Huang GT. Apexification: the beginning of its end. Int Endod J. 2009; 42:855–866.

4. Rafter M. Apexification: a review. Dent Traumatol. 2005; 21:1–8.

5. Sato I, Ando-Kurihara N, Kota K, Iwaku M, Hoshino E. Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ. Int Endod J. 1996; 29:118–124.

6. Baumgartner JC, Falkler WA Jr. Bacteria in the apical 5 mm of infected root canals. J Endod. 1991; 17:380–383.

7. Windley W 3rd, Teixeira F, Levin L, Sigurdsson A, Trope M. Disinfection of immature teeth with a triple antibiotic paste. J Endod. 2005; 31:439–443.

8. Pinheiro ET, Gomes BP, Drucker DB, Zaia AA, Ferraz CC, Souza-Filho FJ. Antimicrobial susceptibility of Enterococcus faecalis isolated from canals of root filled teeth with periapical lesions. Int Endod J. 2004; 37:756–763.

9. Ding RY, Cheung GS, Chen J, Yin XZ, Wang QQ, Zhang CF. Pulp revascularization of immature teeth with apical periodontitis: a clinical study. J Endod. 2009; 35:745–749.

10. Reynolds K, Johnson JD, Cohenca N. Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report. Int Endod J. 2009; 42:84–92.

11. Kim JH, Kim Y, Shin SJ, Park JW, Jung IY. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod. 2010; 36:1086–1091.

12. Hargreaves KM, Giesler T, Henry M, Wang Y. Regeneration potential of the young permanent tooth: what does the future hold? J Endod. 2008; 34:S51–S56.

13. Thibodeau B, Teixeira F, Yamauchi M, Caplan DJ, Trope M. Pulp revascularization of immature dog teeth with apical periodontitis. J Endod. 2007; 33:680–689.

14. Shah N, Logani A, Bhaskar U, Aggarwal V. Efficacy of revascularization to induce apexification/apexogensis in infected, nonvital, immature teeth: a pilot clinical study. J Endod. 2008; 34:919–925.

15. Thomson A, Kahler B. Regenerative endodonticsbiologically-based treatment for immature permanent teeth: a case report and review of the literature. Aust Dent J. 2010; 55:446–452.

16. Law AS. Considerations for regeneration procedures. J Endod. 2013; 39:S44–S56.

17. Dodd MA, Dole EJ, Troutman WG, Bennahum DA. Minocycline-associated tooth staining. Ann Pharmacother. 1998; 32:887–889.

18. Kim B, Song MJ, Shin SJ, Park JW. Prevention of tooth discoloration associated with triple antibiotics. Restor Dent Endod. 2012; 37:119–122.

19. Akcay M, Arslan H, Yasa B, Kavrik F, Yasa E. Spectrophotometric analysis of crown discoloration induced by various antibiotic pastes used in revascularization. J Endod. 2014; 40:845–848.

20. Cheek CC, Heymann HO. Dental and oral discolorations associated with minocycline and other tetracycline analogs. J Esthet Dent. 1999; 11:43–48.

21. Sabrah AH, Yassen GH, Gregory RL. Effectiveness of antibiotic medicaments against biofilm formation of Enterococcus faecalis and Porphyromonas gingivalis. J Endod. 2013; 39:1385–1389.

22. Sousa EL, Gomes BP, Jacinto RC, Zaia AA, Ferraz CC. Microbiological profile and antimicrobial susceptibility pattern of infected root canals associated with periapical abscesses. Eur J Clin Microbiol Infect Dis. 2013; 32:573–580.

23. American Association of Endodontists. Considerations for Regenerative Procedures. updated 2013 July 31. Available from: www.aae.org/Dental_Professionals/Considerations_for_Regenerative_Procedures.aspx.

24. Galler KM, D'Souza RN, Federlin M, Cavender AC, Hartgerink JD, Hecker S, Schmalz G. Dentin conditioning codetermines cell fate in regenerative endodontics. J Endod. 2011; 37:1536–1541.

25. Wigler R, Kaufman AY, Lin S, Steinbock N, Hazan-Molina H, Torneck CD. Revascularization: a treatment Park HB et al. for permanent teeth with necrotic pulp and incomplete root development. J Endod. 2013; 39:319–326.

26. Jung IY, Lee SJ, Hargreaves KM. Biologically based treatment of immature permanent teeth with pulpal necrosis: a case series. J Endod. 2008; 34:876–887.

27. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004; 30:196–200.