demeclocycline and Root-Resorption

The prognosis of tooth replantation is usually related to the need of endodontic treatment, which has a direct relationship with the occurrence of root resorptions. Several studies have been undertaken in an attempt to prevent, delay, or treat these complications, which are the main causes of loss of replanted teeth. This literature review examines research evidence on intracanal dressings and root canal filling materials used in cases of tooth replantation. A comprehensive search was performed in the Medline/Pubmed, Bireme and Scielo full-text electronic journal databases to retrieve English-language articles referring to these topics that had been published between 1964 and 2010. Calcium hydroxide (CH) remains the usually recommended choice as an intracanal medicament in replanted teeth; however, there is evidence to support the initial use of a corticosteroid-antibiotic combination such as Ledermix paste to control potential early resorption, prior to the introduction of CH where the beneficial effect in the treatment of progressive root resorption has been well proven. Regarding root filling materials, CH-containing sealers are a good option because of their biological properties. Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth.

Topics: Calcium Hydroxide; Demeclocycline; Drug Combinations; Humans; Root Canal Filling Materials; Root Canal Irrigants; Root Resorption; Tooth Replantation; Triamcinolone Acetonide

Antibiotics are a valuable adjunctive to the armamentarium available to health professionals for the management of bacterial infections. During endodontic treatment and when managing trauma to the teeth, antibiotics may be applied systemically (orally and/or parenterally) or locally (i.e. intra-dentally via irrigants and medicaments). Due to the potential risk of adverse effects following systemic application, and the ineffectiveness of systemic antibiotics in necrotic pulpless teeth and the periradicular tissues, the local application of antibiotics may be a more effective mode for delivery in endodontics. The aim of this article was to review the history, rationale and applications of antibiotic-containing irrigants and medicaments in endodontics and dental traumatology. The search was performed from 1981 to 2008 and was limited to English-language papers. The keywords searched on Medline were 'Antibiotics AND endodontics', 'Antibiotics AND root canal irrigation', 'Antibiotics AND intra-canal medicament', 'Antibiotics AND Dental trauma' and 'Antibiotics AND root resorption'. The reference section of each article was manually searched to find other suitable sources of information. It seems that local routes of antibiotic administration are a more effective mode than systemic applications. Various antibiotics have been tested in numerous studies and each has some advantages. Tetracyclines are a group of bacteriostatic antibiotics with antibacterial substantivity for up to 12 weeks. They are typically used in conjunction with corticosteroids and these combinations have anti-inflammatory, anti-bacterial and anti-resorptive properties, all of which help to reduce the periapical inflammatory reaction including clastic-cell mediated resorption. Tetracyclines have also been used as part of irrigating solutions but the substantivity is only for 4 weeks. Clindamycin and a combination of three antibiotics (metronidazole, ciprofloxacin and minocycline) have also been reported to be effective at reducing bacterial numbers in the root canal systems of infected teeth.

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Inflammatory Agents; Citric Acid; Demeclocycline; Doxycycline; Drug Combinations; Glucocorticoids; Humans; Periapical Periodontitis; Polysorbates; Root Canal Irrigants; Root Canal Therapy; Root Resorption; Tetracyclines; Tooth Injuries; Triamcinolone Acetonide

 Non-setting calcium hydroxide (Ultracal XS(®) ) is recommended by the International Association of Dental Traumatology as the initial medicament following avulsion and replantation for mature teeth. There is experimental evidence to suggest Ledermix(®) , placed as an alternative inter-visit dressing may improve periodontal healing..  This study investigated, using a multi-centre randomized controlled trial, the effect of two root canal medicaments, Ledermix(®) and Ultracal XS(®) , on periodontal healing of avulsed and replanted teeth..  Children were recruited if they fulfilled all inclusion criteria. Treatment followed a standardized protocol. Assessment of periodontal healing or ankylosis was made clinically and radiographically by an experienced, 'blinded', clinician at 12months..  Over 200 patients were assessed for eligibility at five centres. Twenty-nine patients were eligible for inclusion. Final analysis involved 22 patients with 27 teeth. Ankylosis was detected in four of the 12 teeth in the Ledermix(®) group and nine of 15 in the Ultracal XS(®) group. No significant difference between medicaments was found in the proportion of teeth or patients showing periodontal healing..  There was no significant difference in periodontal healing between the two medicaments at either a tooth or patient level. The numbers recruited fell short of an estimated power calculation. For patients meeting the inclusion criteria and completing the trial, periodontal healing was seen in 52% of teeth at the 12-month assessment between both groups. The only factor found to significantly influence the periodontal outcome was dry time.

Topics: Adolescent; Calcium Hydroxide; Child; Demeclocycline; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Periodontal Ligament; Root Canal Irrigants; Root Canal Therapy; Root Resorption; Single-Blind Method; Tooth Ankylosis; Tooth Avulsion; Tooth Replantation; Treatment Outcome; Triamcinolone Acetonide; Wound Healing

In the age group between 6 and 12 years, trauma to the upper incisors happens frequently. In the case of avulsion, a replantation is the state-of-the-art treatment; however, it may lead to several complications, particularly if suitable posttraumatic management is not carried out. External cervical resorptions as well as apical granuloma and cysts due to microbial contamination of the root canal are common complications. In the presented trauma case, a conservative approach was chosen to treat a large cystic lesion combined with cervical and apical resorptions. After initial placement of Ledermix and calcium hydroxide into the root canal, a marsupialization with the temporary insertion of an obturator was performed. The gradual reduction led to a fast recovery of the bony defect and a root canal filling was placed. The 2-year follow-up showed an improved condition. All adjacent teeth remained vital during the course of the treatment.

Topics: Adolescent; Aluminum Compounds; Anti-Inflammatory Agents; Calcium Compounds; Calcium Hydroxide; Demeclocycline; Dental Fistula; Drug Combinations; Female; Follow-Up Studies; Gutta-Percha; Humans; Incisor; Oxides; Radicular Cyst; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Therapy; Root Resorption; Silicates; Tooth Apex; Tooth Avulsion; Tooth Cervix; Triamcinolone Acetonide; Wound Healing

The prognosis of replanted teeth depends on several factors, the most important being the length of extra-oral dry time. Studies show that after 60 min dry time, root resorption is predicted. Immediate intracanal placement of Ledermix, a paste containing triamcinolone (corticosteroid) and demeclocycline (tetracycline) has been shown to inhibit root resorption after extended dry time. However, discoloration is possible from the tetracycline in Ledermix. To evaluate the individual influence of corticosteroid and tetracycline on external root resorption after extended extra-oral dry time. Sixty-nine premolar roots of four beagle dogs were extracted and instrumented with NiTi files. Group 1 (negative control) was immediately replanted after root filling with GP and sealer; Group 2 (positive control) was root filled with GP and sealer and replanted after 60 min dry time; In groups 3-5, the canals were filled with Ledermix, Triamcinolone, and Demeclocycline, respectively, and replanted after 60 min dry time. After 4 months, the dogs were sacrificed and the roots were examined histologically for type of healing (favorable or unfavorable) and remaining root diameter. The groups treated with Ledermix, Triamcinolone and Demeclocycline had statistically significantly more favorable healing (75.8%; 69.8%; 52.4%) and more remaining root structure (5.59; 5.48; 5.09) than the group filled with GP and sealer (positive control) (0; 1.15). Corticosteroids were as effective as Ledermix at inhibiting external root resorption.

Topics: Animals; Anti-Inflammatory Agents; Demeclocycline; Dental Alloys; Desiccation; Disease Models, Animal; Dogs; Drug Combinations; Edetic Acid; Epoxy Resins; Glucocorticoids; Gutta-Percha; Nickel; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Resorption; Sodium Hypochlorite; Time Factors; Titanium; Tooth Avulsion; Tooth Replantation; Triamcinolone Acetonide; Wound Healing

Traumatized teeth present a clinical challenge with regard to their diagnosis, treatment plan and prognosis. The injuries to the permanent dentition include crown and root fractures, subluxations, luxations and tooth avulsion. Common complications are pulp necrosis, periapical pathosis and root resorption. This article will describe new clinical modalities for the treatment of avulsed teeth and discuss the rational for their use.

Topics: Demeclocycline; Dental Enamel Proteins; Dental Pulp Necrosis; Drug Combinations; Glucocorticoids; Humans; Periapical Periodontitis; Root Resorption; Tissue Preservation; Tooth Avulsion; Tooth Replantation; Triamcinolone Acetonide

Progressive root resorption is one of the common sequelae in replanted teeth, which is detrimental to their long-term prognosis. Ledermix paste, with its composition of triamcinolone acetonide and demethylclortetracycline, has been shown to inhibit inflammation and the associated hard tissue resorption. This study evaluated the effect of immediate intracanal Ledermix on root resorption of delayed-replanted monkey teeth. A total of 36 roots were root canal treated. For the experimental group, intracanal Ledermix was placed prior to extraction and replantation after 1-h bench dry. The positive control group was root filled and replanted after 1 h while the negative control group was root filled and replanted immediately. The monkeys were sacrificed after 12 weeks. The H&E histological tissue specimens were prepared and evaluated using a method modified from that of Andreasen's morphometric analysis, as favorable or complete healing and unfavorable healing, comprising inflammatory root resorption and replacement resorption. The results were analyzed using Kruskal-Wallis and Mann-Whitney U-tests as well as Wilcoxon signed ranks test. The negative control group produced highly significant favorable healing and unfavorable healing as compared to the Ledermix group (P = 0.000). The Ledermix group only showed significantly higher occurrence of complete healing (35.46%) compared to the positive control group (16.58%) (P = 0.037) but there were no significant differences in the inflammatory root resorption and replacement resorption. Nevertheless, when the latter two unfavorable healing patterns were combined, there was a significantly lower overall unfavorable healing in the Ledermix group (64.54%) when compared to the positive control group (83.43%) (P = 0.037). This unfavorable healing outcome in the Ledermix group, however, was not significantly different from the favorable healing outcome with the same treatment modality (P = 0.110).

Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Demeclocycline; Dental Pulp Necrosis; Drug Combinations; Macaca fascicularis; Male; Root Canal Filling Materials; Root Canal Obturation; Root Resorption; Statistics, Nonparametric; Time Factors; Tooth Replantation; Triamcinolone Acetonide; Wound Healing

Ledermix Paste is a paste containing triamcinolone and demeclocycline with demonstrated anti-inflammatory activity that may slow down resorptive processes after severe traumatic injuries to the dentition. A total of 29 premolar roots of six mongrel dogs were extracted and instrumented with rotary nickel titanium files. Fifteen of these roots were then filled with a calcium hydroxide (Ca(OH)2) slurry and 14 roots were filled with Ledermix Paste paste. All accesses were sealed with glass ionomer and the roots replanted after an extraoral dry time of 60 min. After 4 months, the dogs were killed and the roots prepared for histological evaluation. Five-micrometer thick cross-sections of the root and surrounding tissue taken every 90 micro m were evaluated for healing. In addition, residual root mass was also measured to determine the extent of root structure loss for each treatment method. The Ledermix Paste-treated roots had statistically significantly more healing and less resorption than the roots treated with Ca(OH)2. Root filling with Ledermix Paste also resulted in significantly less loss in root mass due to resorption compared to those roots filled with Ca(OH)2. Immediate intracanal placement of Ledermix Paste at the emergency visit after an avulsion injury appears to decrease resorption and increase favorable healing.

Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Calcium Hydroxide; Demeclocycline; Desiccation; Dogs; Drug Combinations; Root Canal Filling Materials; Root Canal Obturation; Root Resorption; Time Factors; Tooth Avulsion; Tooth Replantation; Triamcinolone Acetonide; Wound Healing

Intracanal medicaments are recommended for use in replanted teeth to inhibit inflammatory root resorption. This study compared the effect of calcium hydroxide (Pulpdent) and a corticosteroid-antibiotic paste (Ledermix) on periodontal healing and root resorption following replantation. Incisors of eight Macaca fascicularis monkeys were extracted, stored dry for 15 min and replanted. After 11 days, root canals in two adjacent maxillary incisors were treated with one medicament and contralateral incisors with the other medicament, or left as untreated controls. Animals were sacrificed 8 weeks later and the teeth prepared for histomorphometric evaluation of periodontal ligament inflammation and root resorption. Periodontal ligament inflammation and inflammatory root resorption were markedly inhibited by both calcium hydroxide and corticosteroid-antibiotic relative to untreated controls. Replacement resorption was lowest in the corticosteroid-antibiotic group, and significantly (P<0.05) more normal periodontal ligament was present in this group (79.6%) than in calcium hydroxide and control groups (64.6% and 62.7%, respectively). Treatment with the corticosteroid-antibiotic inhibited inflammatory resorption and was slightly more effective than calcium hydroxide in producing a periodontal healing response.

Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Calcium Hydroxide; Demeclocycline; Dental Cementum; Dentin; Drug Combinations; Incisor; Macaca fascicularis; Periodontal Ligament; Periodontitis; Root Canal Irrigants; Root Resorption; Statistics, Nonparametric; Tooth Avulsion; Tooth Replantation; Tooth Root; Triamcinolone Acetonide; Wound Healing

Progressive external inflammatory root resorption, a result of persistent inflammation within the periodontal membrane, will cause eventual destruction of the tooth root if the inflammation is not eradicated. This study examined the effects of an antibiotic/corticosteroid paste on experimental inflammatory resorption induced in monkeys in vivo. Histologic evaluation of results with the use of a morphometric technique revealed that the paste eliminated inflammatory root resorption and had no damaging effects upon the periodontal membrane. It was concluded that this antibiotic/corticosteroid combination is an effective medication for use in the treatment of progressive root resorption in traumatically injured teeth.

Topics: Animals; Demeclocycline; Drug Combinations; Macaca fascicularis; Ointments; Periodontitis; Root Canal Filling Materials; Root Resorption; Triamcinolone Acetonide