Controlled drug delivery system endodontic paste as intracanal medication: a bench-to-chair-side case report
Accepted: 16 May 2022
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Aim: To report a new endodontic paste as intracanal medication in an immature tooth with acute periradicular abscess.
Summary: A 9-year-old male child presented to the School of Dentistry with spontaneous moderate pain and swelling in the left permanent mandibular first molar region. Radiographic and intraoral clinical exams revealed previous endodontic treatment with an extensive radiolucent area and incomplete rhizogenesis. The clinical diagnosis was acute periradicular abscess, leading to retreatment. After desobturation and chemical-mechanical preparation, the paste composed of tricalcium phosphate, calcium tungstate, amoxicillin microspheres, and indomethacin nanocapsules was inserted into the root canal system. After 5 months, there were no patient-related symptoms, and an apical barrier has formed with decreased periradicular radiolucent area was observed. The root canal filling and tooth restoration were conducted. At the 1st follow-up - 6 months later - the patient remained symptoms free, and the bone density was still increasing. At the one-year follow-up, there were no clinical symptoms, and a regression of the radiographic lesion with a zone of a hard tissue-like spicules aspect at the external tooth surface could be observed. The case's positive outcome reported a proof-of-concept of the new endodontic paste at the apexification clinical situation.
Key Learning Points
- The present case report showed promising healing results of an experimental material at a molar apexification.
- The first clinical study that evaluated an endodontic paste with controlled drug delivery systems as an intracanal medicament.
- The controlled drug delivery of amoxicillin microspheres and indomethacin nanocapsules associated with α-TCP favored the healing process and the apical barrier formation.
- Chala S, Abouqal R, Rida S. Apexification of immature teeth with calcium hydroxide or mineral trioxide aggregate: systematic review and meta-analysis. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, and Endod. 2011;112:36–42.
- Kandemir DG, Kaval ME, Güneri P, et al. Treatment of immature teeth with nonvital pulps in adults: a prospective comparative clinical study comparing MTA with Ca(OH)2. Int Endod J. 2020;53:5–18.
- Srinivasan V, Patchett CL, Waterhouse PJ. Is There life after buckley's formocresol? Part I - A narrative review of alternative interventions and materials. Int J of Paed Dent. 2006;16:117–27.
- Anjaneyulu K, Nivedhitha MS. Influence of calcium hydroxide on the post-treatment pain in endodontics: a systematic review. J of Conserv Dent. 2014;17:200–7.
- Staffoli S, Plotino G, Torrijos BGN, et al. Regenerative endodontic procedures using contemporary endodontic materials. Materials 2019;12:1–28.
- Kogan P, Jianing H, Glickman GN et al. The effects of various additives on setting properties of MTA. J Endod. 2006;32:569–72.
- Duarte MAH, Alves de Aguiar K, Zeferino MA et al. Evaluation of the propylene glycol association on some physical and chemical properties of mineral trioxide aggregate. Int Endod J. 2012:45:565–70.
- Koutroulis A, Batchelor H, Kuehne SA et al. Investigation of the effect of the water to powder ratio on hydraulic cement properties. Dent Mat. 2019;35:1146–54.
- Dornelles NB, Collares FM, Genari B et al. influence of the addition of microsphere load amoxicillin in the physical, chemical and biological properties of an experimental endodontic sealer. J Dent. 2018;68:28–33.
- Cuppini M, Zatta KC, Mestieri LB et al. Antimicrobial and anti-inflammatory drug-delivery systems at endodontic reparative material: synthesis and characterization. Dent Mat. 2019;35:457–67.
- Nagendrababu V, Chong BS, McCabe P et al. Guidelines for reporting the quality of clinical case reports in Endodontics: a development protocol. Int Endod J. 2019;52:775–78
- Nagendrababu V, Chong BS, McCabe P et al. PRICE 2020 guidelines for reporting case reports in Endodontics: explanation and elaboration. Int Endod J. 2020;53:922–47.
- Kayaoglu G , Erten H, Bodrumlu E et al. The resistance of collagen-associated, planktonic cells of enterococcus faecalis to calcium hydroxide. J Endod. 2009;35:46–9.
- Montagner F, Jacinto RC, Signoretti FGC et al. Clustering behavior in microbial communities from acute endodontic infections. J Endod. 2012;38:158–62.
- Siqueira JF, Rôças IN. Polymerase chain reaction-based analysis of microorganisms associated with failed endodontic treatment. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, and Endod. 2004;97:85–94.
- Gomes BPFA, Pinheiro ET, Jacinto RC et al. Microbial analysis of canals of root-filled teeth with periapical lesions using polymerase chain reaction. J Endod. 2008;34:537–40.
- Ma J, Tong Z, Ling J et al. The effects of sodium hypochlorite and chlorhexidine irrigants on the antibacterial activities of alkaline media against enterococcus faecalis. Arch Oral Biol. 2015;60:1075–81.
- Bernardi A, Zilberstein AACCV, Jäger E et al. Effects of indomethacin-loaded nanocapsules in experimental models of inflammation in rats. Brit J Pharmacol. 2009;158:1104–11.
- Summ O, Evers S. Mechanism of action of indomethacin in indomethacin-responsive headaches. Cur Pain and Head Rep. 2013;17:1–8.
- Chen MR, Dragoo JL. The effect of nonsteroidal anti-inflammatory drugs on tissue healing. Knee Surg, Sports Traumatol, Arthroscopy. 2013;21:540–49.
- Mahmoudian M, Ganji F. Vancomycin-loaded HPMC microparticles embedded within injectable thermosensitivechitosan hydrogels. Progr Biomat. 2017;6:49–56
- Bezgin T, Sönmez H, Orhan K et al. Comparative evaluation of Ca(OH)2 plus points and Ca(OH)2 paste in apexification. Dent Traumatol. 2012;28:488–95.
- Tanomaru-Filho M, Andrade AS, Rodrigues EM et al. Biocompatibility and mineralized nodule formation of Neo MTA Plus and an experimental tricalcium silicate cement containing tantalum oxide. Int Endod J. 2017;50:31–9.
- Simon S, Rilliard F, Berdal A et al. The use of mineral trioxide aggregate in one-visit apexification treatment: a prospective study. Int Endod J. 2007;40:186–97.
- Songtrakul K, Azarpajouh T, Malek M et al. Modified apexification procedure for immature permanent teeth with a necrotic pulp/apical periodontitis: a case series. J Endod. 2020;46:116–23.
- Contopoulos-Ioannidis DG, Alexiou GA, Gouvias TC et al. Life cycle of translational research. Science 2008;321:1298–99.
- Heft MW, Fox CH, Duncan RP. Assessing the translation of research and innovation into dental practice. JDR Clin Transl Res. 2020;5:262–70.
Supporting AgenciesSupported by grants from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES – Finance code 001.
Copyright (c) 2022 Felipe Barros Matoso, Fabiana Grecca, Lucas Siqueira Pinheiro, Vicente Castelo Branco Leitune, Silvia Guterres, Fabrício Mezzomo Collares, Patrícia Maria Poli Kopper
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