Antibiotic cocktails and endodontics

อยากทราบวิธีทำ endo ที่เรียกว่า LSTR ที่ใช้ในฟันน้ำนมและฟันแท้ รวมถึง NIET หลักการมันเป็นอย่างไรคะ ขอบคุณค่ะ หรือสามารถหาอ่านรายละเอียดได้ที่ไหน

Basically, it is an antibiotic cocktail dressed in canal for certain period of time to eliminate bacteria, which is the cause of disease. This concept is not new, it was proposed dating back to the 50’s (Bender et al. 1952), it was, however, depopularized later on because of the concern regarding allergic reactions and its ineffectiveness of antibiotics at the time.

The concept resurfaced because of the push from Dr Hoshino’s group (Sato et al. 1996) and also new development of antibiotics. You are right about the components of this cocktail.

Two case reports demonstrated a successful treatment without mechanical instrumentation of a necrotic immature premolar with periapical involvement (apical radiolucency). The treatment involved intraradicular medication with combination of antibiotics instead of conventional apexification. Follow up showed complete closure of the apex and thickening of the root canal wall indicating revitalization of intraradicular tissue. In addition, normal response to thermal and electric pulp test also returned (Banchs et al. 2004; Iwaya et al. 2001).

One case series (87 cases) utilized the similar concept but apply to primary teeth also reported the excellent outcomes (Takushige et al. 2004).

The concept and findings are undeniably exciting. However, I don’t think adopting this concept to daily clinical practice is warranted, at this stage (in the not-too-distant future, probably does??). It is for the simple reason that the above papers are “reports” and not “studies”. There was no control group in these papers, so the favorable outcomes could well be entirely coincidental. I believe the formal study with a better study design is ongoing and its results should be out soon.

References:

Banchs F, Trope M (2004) Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? Journal of Endodontics 30, 196-200.

Bender IB, Seltzer S (1952) Combination of antibiotics and fungicides used in treatment of the infected pulpless tooth. Journal of the American Dental Association 45, 293-300.

Iwaya SI, Ikawa M, Kubota M (2001) Revascularization of an immature permanent tooth with apical periodontitis and sinus tract Dental Traumatology 17, 185-7.

Sato I, Ando-Kurihara N, Kota K, Iwaku M, Hoshino E (1996) Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ Int Endod J 29, 118-24.

Takushige T, Cruz EV, Asgor Moral A, Hoshino E (2004) Endodontic treatment of primary teeth using a combination of antibacterial drugs International Endodontic Journal 37, 132-8.