Non-surgical treatment of pulpitis, including those with history of spontaneous pain, using a combination of antibacterial drugs

This is a retrospective clinical study of 360 teeth diagnosed with pulpitis and treated locally with a combination of three antibacterial drugs (ciprofloxacin, metronidazole and minocycline, “3Mix-MP”) without a pulpectomy procedure. Consecutive patients with a clinical diagnosis of pulpitis had pre-operative factors collected (spontaneous pain, pulp exposure, depth of carious lesion) and were treated by placement of 3Mix-MP onto the pulpal floor of the carious lesion where softened dentin was intentionally left, if any was present. The treated lesions were then sealed by glass-ionomer cement and restored by resin inlays. A good clinical outcome was defined as the lack of any spontaneous pain, no mechanical allodynia to biting and the presence of pulpal responsiveness to cold or electrical stimuli. Using these criteria, a good clinical outcome was found in 342 (95%) of the 360 cases. Six cases progressed to pulpal necrosis and the remaining 12 cases required re-treatment using the same 3Mix-MP, resulting in a subsequent good outcome. Recalcification of softened dentin was evident on postoperative radiographs. These data suggest that 3Mix-MP may be worth evaluating in prospective randomized clinical trials for treatment of pulpitis including cases of so-called “irreversible” pulpitis.