4. Discussion
inflammation, discoloration of teeth, necrotic, pain
SYMPTOMATIC APICAL PERIODONTITIS, INFLAMMATION, SMEAR LAYER, NECROTIC, CAVITY
This study monitored the effects of different root canal medicaments in necrotic teeth with symptomatic apical periodontitis. Before the placement of the medicaments in the pulp canal, the smear layer was removed using an EDTA rinse to allow maximum penetration of the medicament in the dentinal tubules and the accessory canals. This allowed thorough disinfection of the canal space by effectively eliminating all the niches where bacteria may reside [TAP is a combination of three different antibiotics, ciprofloxacin, metronidazole, and minocycline. Ciprofloxacin is a broad-spectrum antimicrobial agent which has bactericidal action against both Gram-negative and Gram-positive bacteria. Metronidazole is effective primarily against obligate anaerobic bacteria, while minocycline is a broad-spectrum tetracycline that mainly has a bacteriostatic action on bacteria through inhibition of bacterial protein synthesis. The synergistic effect of these three antibiotics in eliminating bacteria and achieving better post-operative pain control is in concurrence with the results of a previous study by Omaia et al. [In the current study, CH has the second lowest pain scores of all the groups. CH is the most widely used intra-canal medicament and has good antimicrobial activity. Due to the alkaline environment created in the apical area, CH also neutralizes periapical inflammation [CHX is a broad-spectrum antimicrobial effective against Gram-positive and Gram-negative bacteria [Presence of minocycline has been reported to cause discoloration of teeth when used as an intra-canal medicament. This may be avoided by using dentine bonding agent in the pulp chamber to prevent minocycline uptake by coronal dentine. Another method may be alternating minocycline with cefaclor to make modified TAP, which has been reported to have good antimicrobial activity [The current study has certain limitations. Firstly, in the present study, cotton pellets were used as endodontic spacers and to wipe off excess medicaments from the access cavity walls. This step might leave residual cotton fibres on the access cavity walls, and can interrupt the seal of the temporary restoration as well as acting as a potential substrate for surviving bacteria [