European Society of Endodontology position statement: the use of antibiotics in endodontics. 

By Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH

Date: 02/2019
Journal: Int Endod J


is to provide dentists and other healthcare workers with evidence-based criteria for when to use antibiotics in the treatment of endodontic infections, traumatic injuries of the teeth, revascularization procedures in immature teeth with pulp necrosis, and in prophylaxis for medically compromised patients .

•Most endodontic infections are confined within the tooth and can be successfully managed by established local operative treatment (European Society of Endodontology 2006), drainage or tooth extraction without the need for local or systemic antibiotics. However, when there is evidence of systemic involvement and gross, rapid and diffuse spread of infection, antibiotics may be indicated as an adjunct to local treatment.

Systemic antibiotics in Endodontics  (Table 4)

•From current knowledge (Segura-Egea et al. 2017) and based on the International Association of Dental Traumatology (IADT) guidelines (Andersson et al. 2012), antibiotic administration is not indicated in the treatment of tooth fractures, concussion, subluxation, luxation injuries and extrusion.

Types of antibiotics, recommended dosages and duration

•Beta-lactam antibiotics (penicillin V and amoxicillin) are recommended for the treatment of endodontic infections (Segura-Egea et al. 2017) (Table 1) •Clinical improvement in symptoms must be the guide for the duration of antibiotic treatment. As soon as the symptoms have resolved and there is clinical evidence of healing, the antibiotic therapy should be discontinued .

Topical antibiotics in Endodontics

•There is no scientific evidence to support the use of topical antibiotics in pulp capping procedures or in root canal disinfection.

•The antibiotic mixture composed of ciprofloxacin, metronidazole and minocycline known as triple antibiotic paste (TAP) or ‘3mix’ has been used as intracanal therapy to achieve disinfection and resolution of infection in regenerative endodontic procedures (Diogenes et al. 2013).

•However, the use of TAP containing minocycline may cause dentine discolouration so it was replaced with cefaclor.

•However, the ESE position statement on revitalization procedures advocates the use of calcium hydroxide instead of antibiotics to avoid discolouration (European Society of Endodontology 2016).

•In the absence of strong evidence to support the use of antibiotics in regenerative endodontic procedures, their use should be avoided (Galler 2016).

•After avulsion of immature teeth with open apices, topical application of tetracyclines (minocycline or

•doxycycline, 1 mg per 20 mL of saline for 5 min) onto the root surface before reimplantation increases the chance of root canal revascularization and periodontal healing, reducing the incidence of tooth resorption (Andersson et al. 2012).

Antibiotic prophylaxis in Endodontics

•In all treatment situations (Table 2), particularly in surgical endodontic treatment, an overall medical assessment must be based on the individual case, considering the state and control of the disease, the risk of infection related complications and the risk of an adverse drug reaction. In cases of doubt, patient management should be discussed with a physician prior to endodontic treatment .

•The recommended prophylaxis regimen is presented in Table 3