Minimum Intracanal Dressing Time of Triple Antibiotic Paste to Eliminate Enterococcus Faecalis (ATCC 29212) and Determination of Minimum Inhibitory Concentration and Minimum Bactericidal Concentration: An Ex Vivo Study

Enterococcus faecalis (E. faecalis) is the most commonly isolated microorganism from teeth with postoperative infection. Triple antibiotic paste (TAP) has the ability to eradicate microorganisms from the root canal system when used as an intracanal medicament. The aim of this study was to determine the minimum duration of application of TAP required for elimination of E. faecalis from the root canal system and its minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) in an ex-vivo model.
Root canals of 34 extracted human single canal teeth were inoculated with E. Faecalis after instrumentation, and then 4 g of TAP (ciprofloxacin, metronidazole and doxycycline) was mixed with 4.5 mL of saline and applied as intracanal medicament. The teeth were sectioned longitudinally and dentin chips were collected and evaluated to determine the count of bacterial colonies. Micro-dilution broth test was used to assess the MIC and MBC of TAP. Data were analyzed using SPSS version 22 via the Wilcoxon signed rank test.
After seven days of application of TAP as intracanal medicament, E. faecalis was eliminated from the dentinal tubules of the apical half of root canal up to 400 µ depth. The MIC and MBC of TAP in its original concentration were both found to be 16 µg/mL.
The original concentration of TAP was found to be 5×104 times its MIC. Considering the risk of coronal discoloration of teeth following the use of TAP, application of its lower concentrations is recommended.