The Effects of Azithromycin Modified Triple Antibiotic Paste in Resolving Periapical Inflammation

Area of Science:

• Endodontics
• Microbiology
• Pharmacology

Background:

• Periapical inflammation (AP) presents a significant clinical challenge.
• Triple antibiotic paste (TAP) is used to manage AP but can cause tooth discoloration.
• Understanding the root canal microbiome is crucial for effective AP treatment.

Purpose of the Study:

• To evaluate the anti-inflammatory and antibacterial efficacy of traditional TAP and a modified version (mTAP).
• To assess the impact of TAP and mTAP on tooth discoloration.
• To analyze changes in the root canal microbial community using 16S rDNA sequencing.

Main Methods:

• Periapical inflammation was induced in rabbits and treated with TAP and mTAP.
• Micro-computed tomography (Micro-CT) and Hematoxylin and Eosin (HE) staining were used to assess periapical lesions and bone destruction.
• Inflammatory factors and microbial samples were analyzed; 16S rDNA sequencing characterized the microbial community.

Main Results:

• Both TAP and mTAP significantly reduced apical lesions, inflammatory cytokine expression, and bone destruction compared to the control.
• mTAP demonstrated comparable antibacterial efficacy against common AP pathogens without causing tooth discoloration.
• 16S rDNA analysis revealed distinct periapical bacterial compositions post-treatment, with reduced pathogen levels in TAP and mTAP groups.

Conclusions:

• Modified triple antibiotic paste (mTAP) is a promising alternative to traditional TAP, offering similar efficacy without tooth discoloration.
• Azithromycin shows potential as a substitute for minocycline in endodontic applications.
• 16S rDNA sequencing provides valuable insights into the complex root canal microbiome and its relationship with inflammation.