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

Nikita B. Ruparel, Fabricio B. Teixeira, Caio C.R. Ferraz, Anibal R Diogenes

Research output: Contribution to journalArticlepeer-review

320 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1372-1375
Number of pages4
JournalJournal of endodontics
Issue number10
StatePublished - Oct 2012


  • Apical papilla
  • biocompatible
  • calcium hydroxide
  • dental stem cells
  • double antibiotic
  • human stem cells of the apical papilla
  • regenerative
  • triple antibiotic

ASJC Scopus subject areas

  • Dentistry(all)


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