3Mix-MP
| Combination of | |
|---|---|
| Metronidazole | Nitroimidazole antibiotic |
| Ciprofloxacin | Fluoroquinolone antibiotic |
| Minocycline | Tetracycline antibiotic |
| Clinical data | |
| Other names | 3Mix-MP; 3MIX-MP; 3Mix paste with macrogol–propylene glycol |
| Routes of administration | Intracanal, topical dental |
| 3Mix-MP | |
|---|---|
| Other names | 3Mix-MP paste; Triple antibiotic paste (macrogol/propylene glycol vehicle) |
| Specialty | Endodontics; pediatric dentistry |
3Mix-MP (also written 3Mix-MP paste) is an intracanal medicament used in dentistry, particularly in endodontic procedures. The name refers to a mixture of three antibacterial drugs ("3Mix") combined with a carrier ("MP") made from macrogol (polyethylene glycol) and propylene glycol.[1] It has been studied as part of approaches described as lesion sterilization and tissue repair (LSTR) and non-instrumentation endodontic treatment (NIET), particularly in primary (deciduous) teeth.[2]
Composition
[edit]3Mix‑MP is composed of three antibiotics: metronidazole, ciprofloxacin and minocycline, mixed as a paste and combined with a vehicle comprising macrogol (polyethylene glycol) and propylene glycol.[1] Metronidazole provides activity mainly against obligate anaerobes, ciprofloxacin acts against many gram‑negative and some gram‑positive bacteria, and minocycline (a tetracycline derivative) has a broad spectrum that overlaps both groups.[3]
The macrogol–propylene glycol base gives the preparation an ointment‑like consistency and enhances penetration of the antibiotics into dentinal tubules and the root canal system. In ex vivo models, mixtures of ciprofloxacin, metronidazole and minocycline in this form have been shown to diffuse through dentine and substantially reduce viable bacteria in infected root‑canal dentine.[4][5]
Use in dentistry
[edit]3Mix-MP has been studied as a locally applied antibacterial dressing intended to disinfect infected root canal systems. In one clinical report describing LSTR therapy in primary teeth, the medicament was placed at root canal orifices or on the floor of the pulp chamber and then sealed with restorative materials.[1]
Clinical applications
[edit]Lesion sterilization and tissue repair (LSTR) and NIET
[edit]3Mix‑MP is most closely associated with LSTR therapy and with non‑instrumentation endodontic treatment (NIET) of necrotic primary molars. In these techniques, the medicament is placed in the pulp chamber and at the canal orifices (with or without limited canal instrumentation) and the tooth is sealed and restored in a single visit.[1][5]
In a prospective study of 80 mandibular primary molars with carious pulpal involvement, Trairatvorakul and Detsomboonrat used 3Mix‑MP in NIET and followed the cases for 24-27 months. They reported a clinical success rate of 75 per cent but a radiographic success rate of 36.7 per cent, concluding that 3Mix‑MP NIET showed good short‑term clinical outcomes but could not replace conventional pulpectomy as a long‑term treatment.[6]
A 2021 systematic review of antibiotic mixtures in NIET for primary teeth identified several randomized clinical trials using 3Mix‑based pastes. Overall, mixtures containing ciprofloxacin-metronidazole-minocycline (3Mix) showed acceptable clinical and radiographic success, although some alternative combinations (for example, replacing metronidazole with ornidazole) performed as well or better. The authors concluded that different topical antibiotic mixtures, including 3Mix‑type preparations, can be effective in NIET, but the quality of evidence is limited and longer‑term comparative data are needed.[7]
Direct pulp capping in primary molars
[edit]3Mix‑MP has also been investigated as a direct pulp capping material. In a randomized, double‑blind controlled trial in 44 primary molars with carious pulp exposures, Ali and Raslan compared direct pulp capping with 3Mix‑MP against calcium hydroxide. After 12 months, clinical and radiographic success rates were 54.5 per cent in the 3Mix‑MP group and 77.3 per cent in the calcium hydroxide group; the difference was not statistically significant, and exposure size, location and restoration extent did not significantly affect outcomes.[8]
Regenerative endodontics
[edit]Triple‑antibiotic mixtures identical or similar to 3Mix (with or without the MP vehicle) are widely used as intracanal medicaments in regenerative endodontic procedures (revascularization) for immature permanent teeth with necrotic pulps. Reviews of these protocols describe ciprofloxacin-metronidazole-minocycline pastes as effective in reducing intracanal bacterial loads and creating a suitable environment for tissue ingrowth, although concerns about cytotoxicity at high concentrations and tooth discoloration have led to the investigation of modified formulations with reduced antibiotic doses or substitution of minocycline.[3][9]
Evidence
[edit]A 2025 systematic review and meta-analysis of LSTR in primary teeth (using three-antibacterial-drug combinations, including "3MIX") reported that included studies used varying formulations and follow-up intervals, and found no significant difference in clinical and radiographic success between 3MIX and conventional pulpotomy/pulpectomy at 12 months in its meta-analysis.[10]
Clinical results reported for 3Mix-MP in primary molars have varied by study design and outcome measures. For example:
- In a randomized controlled trial in necrotic primary molars, 3Mix-MP and a modified formulation replacing minocycline with clindamycin (3Mix-MP-R) had broadly similar reported success rates over follow-up in that study.[2]
- A study with approximately 2-year follow-up in mandibular primary molars reported higher clinical success than radiographic success and concluded that 3Mix-MP NIET could not replace conventional root canal treatment agents as a long-term therapy in that setting.[11]
Laboratory research has also evaluated 3Mix-MP against other intracanal medications. In an ex vivo dentin model, 3Mix-MP (and a clindamycin-modified version) showed high antibacterial activity compared with several alternatives; however, the study noted that very high antibiotic concentrations used in some 3Mix-MP preparations were not more effective than modified triple antibiotic paste at a concentration cited as recommended by the American Association of Endodontists in that context.[12]
Adverse effects and limitations
[edit]A case report and associated laboratory work in the Journal of Endodontics found that, among the three antibiotics in a triple antibiotic paste, minocycline was associated with discoloration in that study.[13] A 2016 systematic review of tooth discoloration after regenerative endodontic therapy similarly noted a strong association of discoloration with the use of triple antibiotic paste containing minocycline, and suggested reconsidering minocycline-containing formulations in that context.[14]
Laboratory studies of triple antibiotic pastes also have reported that both antibiotic formulation and vehicle can affect cytotoxicity; for example, one Journal of Endodontics study found pastes prepared with macrogol + propylene glycol (MP) to be less cytotoxic than pastes prepared with water under the conditions tested.[15]
See also
[edit]References
[edit]- ^ a b c d Takushige, T; Cruz EV; Asgor Moral A; Hoshino E (2004). "Endodontic treatment of primary teeth using a combination of antibacterial drugs". International Endodontic Journal. 37 (2): 132–138. doi:10.1111/j.0143-2885.2004.00771.x. PMID 14871180.
- ^ a b Raslan, N; Mansour O; Assfoura L (2017). "Evaluation of antibiotic mix in Non-instrumentation Endodontic Treatment of necrotic primary molars". European Journal of Paediatric Dentistry. 18 (4): 285–290. doi:10.23804/ejpd.2017.18.04.04. PMID 29380613.
- ^ a b Parhizkar, A.; Nojehdehian, H.; Asgary, S. (2018). "Triple antibiotic paste: momentous roles and applications in endodontics: a review". Restorative Dentistry & Endodontics. 43 (3): e28. doi:10.5395/rde.2018.43.e28. PMID 30135847.
- ^ Sato, I.; Ando-Kurihara, N.; Kota, K.; Iwaku, M.; Hoshino, E. (1996). "Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ". International Endodontic Journal. 29 (2): 118–124. doi:10.1111/j.1365-2591.1996.tb01172.x. PMID 9206435.
- ^ a b Singh, K.; Reddy, A.; Arya, A.; Sridhar, V.; Ranjan, M.; Bulbule, N. (2024). "Lesion Sterilization Tissue Repair: A Review". Journal of Pharmacy and Bioallied Sciences. 16 (Suppl 1): S75 – S77. doi:10.4103/jpbs.jpbs_411_23. PMID 38595433.
- ^ Trairatvorakul, C.; Detsomboonrat, P. (2012). "Success rates of a mixture of ciprofloxacin, metronidazole, and minocycline antibiotics used in the non-instrumentation endodontic treatment of mandibular primary molars with carious pulpal involvement". International Journal of Paediatric Dentistry. 22 (3): 217–227. doi:10.1111/j.1365-263X.2011.01181.x. PMID 21951271.
- ^ Chouchene, F.; Masmoudi, F.; Baaziz, A.; Maatouk, F.; Ghedira, H. (2021). "Antibiotic Mixtures in Noninstrumental Endodontic Treatment of Primary Teeth with Necrotic Pulps: A Systematic Review". International Journal of Dentistry. 2021: 5518599. doi:10.1155/2021/5518599. PMC 8175181. PMID 34135965.
{{cite journal}}: CS1 maint: article number as page number (link) - ^ Ali, H.; Raslan, N. (2021). "Direct pulp capping (DPC) in primary molars using (3Mix-MP) and the characteristics of the carious lesion as predictor factors for its success: a randomized controlled trial". European Archives of Paediatric Dentistry. 22 (4): 633–642. doi:10.1007/s40368-020-00600-3. PMID 33543449.
- ^ Schmalz, G.; Ettl, T.; Kühnel, E.; Krastl, G. (2016). "A Review of Tooth Discoloration after Regenerative Endodontic Therapy". Journal of Endodontics. 42 (7): 1009–1017. doi:10.1016/j.joen.2015.12.022. PMID 26852148.
- ^ Baghlaf, Khlood; Alamoudi RA (2025-10-15). "Clinical and radiographic success of lesion sterilization and tissue repair in primary teeth: a systematic review and meta-analysis". Saudi Dental Journal. 37 (7–9): 61. doi:10.1007/s44445-025-00059-2. PMC 12528516. PMID 41091393.
- ^ Trairatvorakul, Chutima; Detsomboonrat Palinee (May 2012). "Success rates of a mixture of ciprofloxacin, metronidazole, and minocycline antibiotics used in the non-instrumentation endodontic treatment of mandibular primary molars with carious pulpal involvement". International Journal of Paediatric Dentistry. 22 (3): 217–227. doi:10.1111/j.1365-263X.2011.01181.x. PMID 21951271.
- ^ da Cunha Neto, Miguel Angelo; de Almeida Coêlho Jéssica; Pinto Karem Paula; Cuellar Maricel Rosário Cardenas; Marcucci Maria Cristina; Leal Silva Emmanuel João Nogueira; de Andrade Flaviana Bombarda; Sassone Luciana Moura (October 2021). "Antibacterial Efficacy of Triple Antibiotic Medication With Macrogol (3Mix-MP), Traditional Triple Antibiotic Paste, Calcium Hydroxide, and Ethanol Extract of Propolis: An Intratubular Dentin Ex Vivo Confocal Laser Scanning Microscopic Study". Journal of Endodontics. 47 (10): 1609–1616. doi:10.1016/j.joen.2021.07.014. hdl:11449/222217. PMID 34310981.
- ^ Kim, Jong-Hyun; Kim Yuran; Shin Su-Jung; Park Jeong-Won; Jung Il-Young (June 2010). "Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report". Journal of Endodontics. 36 (6): 1086–1091. doi:10.1016/j.joen.2010.03.031. PMID 20478471.
- ^ Kahler, Bill; Rossi-Fedele Giampiero (April 2016). "A Review of Tooth Discoloration after Regenerative Endodontic Therapy". Journal of Endodontics. 42 (4): 563–569. doi:10.1016/j.joen.2015.12.022. PMID 26852148.
- ^ Faria, Gisele; Rodrigues Elisandra Márcia; Coaguila-Llerena Hernán; Gomes-Cornélio Ana Lívia; Angéloco Renan Rodrigues Neto; Pereira Maristela Soares Swerts; Tanomaru Filho Mario (December 2018). "Influence of the Vehicle and Antibiotic Formulation on Cytotoxicity of Triple Antibiotic Paste". Journal of Endodontics. 44 (12): 1812–1816. doi:10.1016/j.joen.2018.09.009. PMID 30477667.