Non –Surgical endodontic therapy using triple- antibiotic paste – case report

Microorganisms within the root canal system should be eliminated for the successful outcome of root canal treatment. This case report describes a successful non-surgical endodontic management of a periapical lesion with sinus tract resistant to calcium hydroxide intra-canal medicament using a combination of antibiotic drugs. A 19-year-old girl presented at the Department of Conservative dentistry and Endodontics with a chief complain of dull continuous pain with respect to her upper anterior teeth. On examination, the maxillary left central incisor was non-vital and there was a draining labial sinus tract with respect to it. Conventional endodontic treatment using calcium hydroxide as an intra-canal medicament did not resolve the sinus tract. Hence triple-antibiotic (metronidazole/ ciprofloxacin/ minocycline) paste was used as an intra-canal medicament. The patient when recalled after 4 weeks revealed significant healing with the disappearance of the sinus tract. When recalled after 1 year, the patient had no symptoms and radiograph showed complete resolution of the radiolucent lesion. These results indicate that triple-antibiotic paste is effective in managing teeth with persistent symptoms which are resistant to calcium hydroxide therapy.