Antimicrobial efficacy of triple antibiotic paste in teeth with primary endodontic infection: A systematic review

Abstract

Objectives: This systematic review aims to assess the antimicrobial efficacy of triple antibiotic paste (TAP) as an intracanal medicament for root canal treatment of permanent or primary teeth with primary endodontic infection, as compared to other intracanal medicaments. Material and Methods: Three electronic databases, namely PubMed, CENTRAL, and Google Scholar, were searched for articles published in the English language till December 2019. Two hundred eighty-three studies were obtained for screening from an electronic database and one from the reference list of an article. After screening 234 records by title and abstract, 226 were excluded, and eight were selected for full-text eligibility assessment. Finally four studies were included in the systematic review. Results: Due to variations in the methods of outcome measurement and its evaluation at different time points, it was impossible to present the results as a meta-analysis. Thus, a narrative synthesis was performed for TAP compared to comparators used. The overall quality of included studies suggested a moderate risk of bias. Three comparators were reported in the included studies: Calcium hydroxide (CH) with 2% chlorhexidine (CHX), CH alone, and Ocimum sanctum. The antimicrobial efficacy of TAP was significantly better than plain CH and O. sanctum, whereas results did not differ significantly between TAP and CH plus 2% CHX. Conclusion: There is a lack of sufficiently high-quality clinical studies regarding the use of TAP. More clinical trials are recommended comparing the antimicrobial efficacy of TAP and other intracanal medicaments under standard protocols to establish a strong clinical evidence.