Direct effect of intracanal medicaments on survival of stem cells of the apical papilla

J Endod. 2012 Oct;38(10):1372-5. doi: 10.1016/j.joen.2012.06.018. Epub 2012 Aug 16.


Introduction: Regenerative endodontic procedures are an alternative treatment for immature teeth with necrotic pulps. Typically, intracanal medicaments such as triple antibiotic paste (TAP) or double antibiotic paste (DAP) and calcium hydroxide (Ca[OH](2)) are used for disinfection. However, their effect on human stem cells of the apical papilla (SCAPs) is unknown. We hypothesized that intracanal medicaments at high concentrations are toxic to SCAPs. To test this hypothesis, a cell culture assay was used.

Methods: Briefly, SCAPs were cultured and subjected to either no drug treatment or various concentrations including TAP, DAP, modified TAP (ciprofloxacin, metronidazole and cefaclor), Augmentin (Champs Pharmacy, San Antonio, TX), or Ca(OH)(2). Viable stem cells counts were obtained using an automated method of detecting trypan blue dye at 3 days after treatment.

Results: All 4 antibiotics significantly reduced SCAP survival in a concentration-dependent fashion. Interestingly, Ca(OH)(2) was conducive with SCAP survival at all concentrations.

Conclusions: Collectively, our data show that high concentrations of antibiotics have a detrimental effect on SCAP survival, whereas lower concentrations as well as Ca(OH)(2) at all tested concentrations are conducive with SCAP survival and proliferation. These studies highlight the clinically important point that intracanal medicaments must be used at concentrations that are bactericidal while having minimal effects on stem cell viability.

MeSH terms

  • Adolescent
  • Amoxicillin-Potassium Clavulanate Combination / administration & dosage
  • Amoxicillin-Potassium Clavulanate Combination / toxicity
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / toxicity*
  • Calcium Hydroxide / administration & dosage
  • Calcium Hydroxide / toxicity
  • Cefaclor / administration & dosage
  • Cefaclor / toxicity
  • Cell Survival / drug effects*
  • Cells, Cultured
  • Ciprofloxacin / administration & dosage
  • Ciprofloxacin / toxicity
  • Dental Papilla / cytology
  • Dental Papilla / drug effects*
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Metronidazole / administration & dosage
  • Metronidazole / toxicity
  • Molar, Third / cytology
  • Root Canal Irrigants / administration & dosage
  • Root Canal Irrigants / toxicity*
  • Statistics, Nonparametric
  • Stem Cells / drug effects*


  • Anti-Bacterial Agents
  • Root Canal Irrigants
  • Metronidazole
  • Ciprofloxacin
  • Cefaclor
  • Amoxicillin-Potassium Clavulanate Combination
  • Calcium Hydroxide