Efficiency of Triple Antibiotic Mixture and Propolis as Intracanal Medication in Revascularization Process in Immature Apex: A Clinical Study

Introduction In the last 10 years, numerous published cases and case series described the revascularization or regenerative endodontics. Revascularization is a conservative method for inducing maturogenesis in necrotic immature teeth. The favorable outcomes of regenerative endodontics are largely dependent on the adequate disinfection of the root canal. These canals with compromised fragile underdeveloped dentinal walls represent a contraindication for mechanical instrumentation; thus, chemical debridement remains the main form of disinfection. A mixture of ciprofloxacin, metronidazole, and minocycline, known as the triple antibiotic paste (TAP), has been shown to be very effective in eliminating endodontic pathogens in vitro and in situ. However, TAP has an adverse effect on stem cell survival. Discoloration of the tooth is a problem mostly related to the use of minocycline in TAP. Moreover, TAP can demineralize dentin resulting in reduced microhardness and fracture resistance. Propolis, a flavonoid-rich resinous product of honeybees, is ten times less cytotoxic than calcium hydroxide and has a well-known antibacterial effect. Therefore, creating alternatives to the TAP for disinfecting the root canal of necrotic teeth during the process of pulp revascularization is thought to be of value.

Materials and methods Forty patients with immature, nonvital maxillary incisors were included in this study from the outpatient clinic of the Faculty of Dentistry, Ain Shams University, Cairo, Egypt. A detailed medical and dental history was obtained from each patient's parents or guardians. Only medically free patients were included in this research. The clinical and radiographic exclusion criteria were teeth with vertical fractures, periodontally involved teeth, and nonrestorable teeth. All procedures were performed after obtaining proper institutional review board approval based on the regulations of the Ethical Committee of the Faculty of Dentistry, Ain Shams University. Intraoral periapical radiographs revealed immature apices. The age of the patients ranged between 8 and 18 years. Informed consent was signed for each case by the patient's parents or guardians including the proposed treatment and possible outcomes or complications.

Cases were divided randomly and equally into 4 groups according to the intracanal medicament (10 patients for each group):

TAP group: was treated with Triple Antibiotic Paste CP group: was treated with Ciprofloxacin + Propolis paste CM group: was treated with Ciprofloxacin + Metronidazole paste PM group: was treated with Propolis + Metronidazole paste

1. Triple Antibiotic Paste (TAP):