Histologic characterization of regenerated tissues after pulp revascularization of immature dog teeth with apical periodontitis using tri-antibiotic paste and platelet-rich plasma

Arch Oral Biol. 2016 Nov;71:122-128. doi: 10.1016/j.archoralbio.2016.07.007. Epub 2016 Jul 26.


Introduction: This study evaluates histologically the efficacy of 4 revascularization protocols in necrotic-infected immature dog teeth with apical periodontitis (AP).

Methods: Forty double-rooted immature premolar teeth from 4 female Beagle dogs aged 5 months were used. Four teeth were left untouched as negative controls; the other 36 teeth were infected to develop pulp necrosis and AP. Four teeth were left untreated and assigned to the positive control group. The last 28 teeth were randomly assigned into four experimental groups of 8 teeth, each one treated with a different treatment protocol: A1, sodium hypochlorite (SH)+blood clot (BC); A2, SH+platelet-rich plasma (PRP); B1, SH+modified tri-antibiotic paste (mTAP)+BC; B2, SH+mTAP+PRP. The animals were sacrificed, histologic sections were prepared and three parameters were assessed: (1) presence or absence of new hard tissue on the internal root dentinal walls, (2) presence or absence of continued apical closure, and (3) presence or absence of vital tissue within the canal space.

Results: Significant differences (p<0.05) between the four experimental groups were evident in the percentage of teeth showing histological apical closure (34.5%) and vital tissue within the canal space (68.8%). Group B2 showed the maximal improvement in the three variables assessed (p<0.05). Group A1 showed the minimum percentages in the three parameters assessed (p<0.05).

Conclusions: These results suggest that an intracanal dressing of mTAP, and the use of PRP as scaffold, improves the success rate of the revascularization procedure.

Keywords: Apical negative pressure irrigation; Immature tooth; Mineral trioxide aggregate; Platelet-rich plasma; Pulp regeneration; Pulp revascularization; Scaffold; Tri-antibiotic paste.

MeSH terms

  • Aluminum Compounds / pharmacology
  • Animals
  • Bicuspid
  • Calcium Compounds / pharmacology
  • Cefixime / pharmacology
  • Ciprofloxacin / pharmacology
  • Combined Modality Therapy
  • Dental Pulp / blood supply*
  • Dental Pulp Necrosis / diagnostic imaging
  • Dental Pulp Necrosis / therapy*
  • Dogs
  • Drug Combinations
  • Female
  • Metronidazole / pharmacology
  • Oxides / pharmacology
  • Periapical Periodontitis / diagnostic imaging
  • Periapical Periodontitis / therapy*
  • Platelet-Rich Plasma*
  • Random Allocation
  • Root Canal Irrigants / pharmacology
  • Root Canal Therapy / methods*
  • Silicates / pharmacology
  • Sodium Hypochlorite / pharmacology


  • Aluminum Compounds
  • Calcium Compounds
  • Drug Combinations
  • Oxides
  • Root Canal Irrigants
  • Silicates
  • mineral trioxide aggregate
  • Metronidazole
  • Ciprofloxacin
  • Cefixime
  • Sodium Hypochlorite