Clinical the dentinal tubules in the pulp chamber with

Clinical implications
of the use of antibiotics in REPs

The use of antibiotics as intracanal dressing in
REPs may cause some side effects. A problem that often accompanies the
intracoronal use of TAP containing minocycline is dentin discoloration 24,25,30,i,ii. Reynolds et al. iii have suggested that the discoloring
effect of the minocycline can be minimized by coating the dentinal tubules in
the pulp chamber with a bonding agent. Thibodeau & Trope iv
reported substituting minocycline for cefaclor in the tri-antibiotic formula to
avoid dentin discoloration, and Miller et
al. 38 has confirmed that the incorporation of cefaclor
in the TAP, instead of minocycline, avoids discoloration. The review carried
out by Kahler & Rossi-Fedele v have
analyzed the tooth discoloration in 80 studies of REPs, including 379 treated
teeth. Results demonstrate a strong association of discoloration with the use
of TAP containing minocycline. Authors suggest that either calcium hydroxide or
the double antibiotic paste of metronidazole and ciprofloxacin should
substitute the use of TAP with minocycline in REPs. Sealing the pulp chamber
walls before insertion of TAP decreased coronal discoloration following REP but
did not prevent it vi.
Dental bleaching was able to recover, at least partially, the tooth crown’s
color vii. The
ESE position statement on the use of antibiotics in endodontics concludes that,
taking into account the absence of strong evidence to support the use of antibiotics
in REPs, their use should be avoided 36.

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Other concern associated with intracanal use of
antibiotics is the possibility of promoting antibiotic resistance in some root
canal bacteria viii,ix. The results of Sedgley et al. x, who
analyzed the horizontal exchange of antibiotic resistance between different
bacterial species in root canals, suggest that antibiotic resistance could be already
developing in bacteria recovered from endodontic infections.

The third concern in the use of antibiotics as
intracanal dressing in REPs is the risk of precipitating an allergic reaction
in a sensitive patient or inducing sensitivity in a patient who has never been
sensitive 39, 45. The need for a thorough and complete medical
and dental history of the patient before REP must be highlighted, regardless of
the method of administering the antibiotic during the course of treatment 45.