Local applications of tetracyclines in endodontics and dental trauma: a review.

Local application of antibiotics within the root canal system may be a more effective mode for delivering the drug. Tetracyclines have been used to remove the smear layer from instrumented root canal walls, for irrigation of retrograde cavities during periapical surgical procedures, and as an intracanal medicament. Substantivity of tetracyclines has been shown for up to at least 12 weeks. BioPure MTAD is effective in removing the smear layer. However, the antimicrobial efficacy against E faecalis of 1.3% NAOCl/MTAD compared with that of the combined alternate use of 5.25% NAOCl and 15% EDTA is still controversial. Substantivity of MTAD has been shown for up to 4 weeks. Furthermore, application of MTAD to 1.3% NAOCl-irrigated dentin may reduce its substantivity. Tetraclean is a mixture of an antibiotic (doxycycline), an acid, and a detergent (like MTAD), with a very low surface tension and high degree efficacy against bacterial biofilms. Ledermix, a glucocorticosteroid-antibiotic compound, due to anti-inflammatory and antiresorptive properties, reduces the inflammatory reaction including clastic-cell mediated resorption, significantly lowers the incidence of replacement resorption, and thus prompts more favorable healing in replanted teeth. A 50:50 mixture of Ledermix paste and Ca(OH)2 has been advocated as an intracanal dressing in cases of infected root canals, pulp necrosis and infection with incomplete root formation (apexification), perforations, inflammatory root resorption, inflammatory periapical bone resorption, and for the treatment of large periapical radiolucent lesions.