TY - JOUR
T1 - Antibiotic approaches to endodontic regeneration
AU - Riaz, Samiya
AU - Samat, Asmak Binti Abdul
AU - Fareed, Muhammad Amber
AU - Zafar, Muhammad Sohail
N1 - Publisher Copyright:
© 2026 The Author(s). Published by MJS Publishing on behalf of Acta Odontologica Scandinavica Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.
PY - 2026/1
Y1 - 2026/1
N2 - Regenerative endodontics (REs) has redefined the management of immature permanent teeth with necrotic pulps by shifting the objective from simple disinfection to biologically driven root maturation and restoration of the dentine–pulp complex. A critical component of this process is the selection of intracanal medicaments that can effectively eliminate microbial infection while preserving the viability of stem cells required for regeneration. This narrative review evaluates the biological and antimicrobial performance of commonly used medicaments, particularly calcium hydroxide (Ca(OH)2) and triple antibiotic paste (TAP), and discusses their role in RE procedures. A literature search was conducted using PubMed/MEDLINE, Scopus, and Web of Science for articles published between January 2000 and March 2025. Although Ca(OH)2 remains widely used due to its antimicrobial properties and ability to promote hard tissue formation, concerns remain regarding its high alkalinity and potential adverse effects on stem cell survival. TAP, in contrast, appears to provide a more supportive environment for dental pulp stem cell proliferation and attachment but is associated with drawbacks such as tooth discoloration and antibiotic-related limitations. Emerging alternatives, including double antibiotic paste (DAP) and nano-modified calcium hydroxide formulations, aim to improve the balance between antimicrobial efficacy and biocompatibility. Overall, current evidence emphasizes the importance of optimizing medicament concentration and duration of application to enhance the predictability and long-term success of RE therapy.
AB - Regenerative endodontics (REs) has redefined the management of immature permanent teeth with necrotic pulps by shifting the objective from simple disinfection to biologically driven root maturation and restoration of the dentine–pulp complex. A critical component of this process is the selection of intracanal medicaments that can effectively eliminate microbial infection while preserving the viability of stem cells required for regeneration. This narrative review evaluates the biological and antimicrobial performance of commonly used medicaments, particularly calcium hydroxide (Ca(OH)2) and triple antibiotic paste (TAP), and discusses their role in RE procedures. A literature search was conducted using PubMed/MEDLINE, Scopus, and Web of Science for articles published between January 2000 and March 2025. Although Ca(OH)2 remains widely used due to its antimicrobial properties and ability to promote hard tissue formation, concerns remain regarding its high alkalinity and potential adverse effects on stem cell survival. TAP, in contrast, appears to provide a more supportive environment for dental pulp stem cell proliferation and attachment but is associated with drawbacks such as tooth discoloration and antibiotic-related limitations. Emerging alternatives, including double antibiotic paste (DAP) and nano-modified calcium hydroxide formulations, aim to improve the balance between antimicrobial efficacy and biocompatibility. Overall, current evidence emphasizes the importance of optimizing medicament concentration and duration of application to enhance the predictability and long-term success of RE therapy.
KW - Intracanal medicaments
KW - antibiotics
KW - irrigants
KW - regenerative endodontics
KW - stem cells
UR - https://www.scopus.com/pages/publications/105039125423
U2 - 10.2340/BIID.V13.45704
DO - 10.2340/BIID.V13.45704
M3 - Article
AN - SCOPUS:105039125423
SN - 2641-5275
VL - 13
SP - 271
EP - 277
JO - Biomaterial Investigations in Dentistry
JF - Biomaterial Investigations in Dentistry
ER -