05/06/2026
🦷 TRIPLE ANTIBIOTIC PASTE (TAP) IN ENDODONTICS 🦷
Triple Antibiotic Paste (TAP) is a combination of:
✔️ Metronidazole
✔️ Ciprofloxacin
✔️ Minocycline
🔬 Mechanism of Action
Metronidazole & Ciprofloxacin → Bactericidal
(Kill bacteria directly)
Minocycline → Bacteriostatic
(Prevents bacterial growth)
✅ Why is TAP Used?
TAP provides a broad-spectrum antibacterial effect, making it effective against:
Gram-positive bacteria
Gram-negative bacteria
Anaerobic microorganisms
It is especially useful in:
✔️ Persistent root canal infections
✔️ Weeping canals
✔️ Non-vital teeth with periapical lesions
✔️ Cases where canals cannot be dried even after multiple sittings
⚠️ Major Drawback of TAP
Minocycline can cause:
❌ Tooth staining / discoloration
Therefore:
🚫 Avoid TAP in anterior teeth (esthetic zone)
🔄 Alternatives for Anterior Teeth
✅ Modified TAP (MTAP)
Minocycline is replaced with Clindamycin
➡️ Reduces the risk of discoloration
✅ Double Antibiotic Paste (DAP)
Combination of:
Metronidazole
Ciprofloxacin
➡️ No minocycline = less staining
❗However, studies suggest DAP may be less effective than TAP.
✅ Modified DAP
Metronidazole
Ciprofloxacin
2% Chlorhexidine
➡️ Found to be relatively effective and a good alternative in esthetic cases.
🧪 How to Prepare TAP?
1️⃣ Obtain the antibiotics in tablet form
2️⃣ Crush them using an autoclaved mortar & pestle
3️⃣ Add:
Propylene glycol (preferred), OR
Saline / Chlorhexidine
➡️ Mix into a paste consistency
🦷 Placement into Canal
The paste can be placed using:
✔️ Lentulo spiral
✔️ MTA carrier
✔️ Pluggers
🕒 Usually kept intracanal for 2–4 weeks
💡 Freshly mixed TAP is generally considered more effective than commercially available premixed formulations.
📌 Clinical Tip
For better efficacy:
✂️ Remove the tablet coating before crushing.
⚠️ Important Reminder
Neither TAP nor Calcium Hydroxide can replace proper biomechanical preparation.
✅ Adequate irrigation and activation for at least 15 minutes remains the key to successful disinfection.
Intracanal medicaments should be considered only as an adjunct to proper endodontic treatment.
