Prevention of Coronal Discoloration with Novel Topical Endodontic Antimicrobial Agents

Objectives: Tetracyclines are a component of triple antibiotic paste and other antibiotic formulations commonly used in pulp regeneration procedures. However, tetracyclines cause tooth staining. A previous case report suggested that use of a bonding agent lining in the pulp chamber may reduce discoloration. Tigecycline is a newer tetracycline antibiotic that has been proposed for regenerative procedures, but whose discoloration potential relative to other endodontic disinfectants remains unclear. The aim of this study was to evaluate prevention of coronal discoloration from a novel combination of tigecycline and Emdogain® when used with a bonding agent.
Methods: Forty extracted human teeth with single root canals were collected and instrumented. The access cavities were acid-etched/bonded, followed by topical application of Emdogain + 10mg/mL tigecycline, Emdogain + 10mg/mL doxycycline, calcium hydroxide or no medication. All teeth were incubated for four weeks. To assess discoloration effects, color measurements were obtained using a spectrophotometer in a light-controlled chamber at D65 artificial light setting. Baseline color measurements were obtained prior to the procedure. Following application of medicaments, color measurements were obtained for the incisal, middle and cervical thirds of the crown at weeks 1 and 4. Mean color change (ΔE) from baseline were evaluated using analysis of variance with repeated measures.
Results: Teeth in treatment and control groups showed no significant change in color at the cervical, middle or incisal thirds (P>0.05) at weeks 1 and 4 from baseline.
Conclusions: Use of a bonding agent in conjunction with antimicrobial treatment appears to minimize tooth discoloration with these tetracycline medicaments.