(TC01) A Novel Combination of Triple Antibiotics (Penicillin G, Metronidazole, Ciprofloxacin: PMC) as an Intracanal Medicament to Promote Pulpal Regeneration and Apical Healing

Abstract: Traditionally, calcium hydroxide has been used as an intracanal medicament for adjunct chemomechanical disinfection and/or as a component of the Endodontic Regeneration Protocol. In the past two decades, however, triple antibiotic paste (TAP), a combination of minocycline, ciprofloxacin, and metronidazole, has garnered interest in replacing calcium hydroxide due to TAP's greater strength as an antibacterial agent. Nevertheless, studies have shown that the use of TAP can discolor dentin and alter the normal physical/mechanical properties of radicular dentin. The use of TAP, as well as modified forms of TAP, has generated clinical concerns in its use as an intracanal medicament. To address these clinical concerns, an alternate combination of antibiotics has been developed, combining Penicillin G, Metronidazole, and Ciprofloxacin (PMC). A 2023 case report has shown the effectiveness of PMC versus TAP in promoting periapical healing prior to final obturation, allowing regeneration of the periodontal ligament space as well as reducing or eliminating external inflammatory root resorption. Despite the lack of clinical trials, PMC may also be less likely to stain the dentin due to the white color of Penicillin G or alter the mechanical properties of the dentin because of the absence of minocycline. PMC also demonstrates wider microbial coverage than TAP, such as effectiveness against E. faecalis. Therefore, the objective of this table clinic is to review the current literature on PMC and discuss the application of PMC as an alternative to CaOH and TAP as an intracanal medicament.