Antimicrobial Therapeutics in Regenerative Endodontics: A Scoping Review

Juliana S Ribeiro; Eliseu A Münchow; Ester A Ferreira Bordini; Wellington Luiz de Oliveira da Rosa; Marco C Bottino

doi:10.1016/j.joen.2020.06.032

Antimicrobial Therapeutics in Regenerative Endodontics: A Scoping Review

J Endod. 2020 Sep;46(9S):S115-S127. doi: 10.1016/j.joen.2020.06.032.

Authors

Juliana S Ribeiro¹, Eliseu A Münchow², Ester A Ferreira Bordini³, Wellington Luiz de Oliveira da Rosa⁴, Marco C Bottino⁵

Affiliations

¹ Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan; Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
² Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
³ Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan; Department of Dental Materials and Prosthodontics, Araraquara School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil.
⁴ Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
⁵ Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan. Electronic address: mbottino@umich.edu.

Abstract

Introduction: This review aimed to provide a critical appraisal of alternative antimicrobial strategies in lieu of traditional triple antibiotic paste (TAP).

Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature search was performed in 8 databases (PubMed/Medline, Embase, LILACS, Web of Science, Scopus, BVS, SciELO, and the Cochrane Library), selecting clinical, in vitro, in vivo, and in situ studies that evaluated antimicrobial alternatives to TAP in regenerative endodontics. Studies lacking an experimental TAP group were excluded.

Results: A total of 1705 potentially relevant records were initially identified. From the 38 studies retrieved for full-text reading, 16 fulfilled all selection criteria and were included in the qualitative analysis. According to the study design, 11 studies were solely in vitro, 1 study was both in vitro and in vivo (animal model), 2 studies were solely animal experiments, and 2 studies were clinical trials. The alternative antimicrobial agents to TAP consisted of modified TAP formulations (eg, a combination of TAP with chitosan); TAP-eluting nanofibers; propolis; chlorhexidine (CHX) gels/solutions; double antibiotic pastes composed of distinct combinations of antibiotics; Ca(OH)₂-based formulations; and sodium hypochlorite. Overall, most of the alternative agents performed similarly to TAP, although some strategies (eg, Ca(OH)₂- and CHX-based formulations) seemed to present dubious importance in the control of infection.

Conclusions: TAP still remains an excellent option in terms of the complete elimination of microorganisms. This review points to the use of electrospun fibers as a drug delivery system to offer a controlled release of the antimicrobial agent, as well as the use of natural compounds, deserving future investigation.

Keywords: Antimicrobial agents; natural compounds; regenerative endodontics; scoping review.

Publication types

Review

MeSH terms

Animals
Anti-Bacterial Agents
Anti-Infective Agents*
Chlorhexidine
Regenerative Endodontics*
Sodium Hypochlorite

Substances

Anti-Bacterial Agents
Anti-Infective Agents
Sodium Hypochlorite
Chlorhexidine

Grants and funding

R01 DE026578/DE/NIDCR NIH HHS/United States