Discolouration Blues After Disinfection: A Hard Nut To Crack???

Success of regenerative endodontic treatment depends upon the disinfection of the root canal system. Since almost no instrumentation is carried out, the disinfection protocol relies only on the medications used. Commonly used triple antibiotic paste (TAP) composed of metronidazole, ciprofloxacin, and minocycline has certain drawbacks. Minocycline binds to calcium ions via chelation to form an insoluble complex and results in tooth discolouration. Several antibiotics have been suggested as an alternative to minocycline in the triple antibiotic paste. Recently, antibiotic alternatives to minocycline have been proposed for use in combination with ciprofloxacin and metronidazole, including cefaclor and doxycycline, but discolouration persisted even after the substitution. The aim of this study is to assess the discolouration potential of modified TAP, where minocycline is substituted with amoxyclav and clindamycin. These antibiotics were selected based on two criteria: (1) They don't interfere with the action of ciprofloxacin and metronidazole, and (2) they have a mechanism of action similar to minocycline so that the entire antimicrobial spectrum is covered. Keywords: regenerative, medicament, triple antibiotic paste, disinfection, discolouration, minocycline