Comparative evaluation of antimicrobial efficacy of triple antibiotic paste and propolis extract using three different vehicles as intracanal medicament: An in vitro study

To the Editor, With great interest I read the article titled ‘Comparative evaluation of antimicrobial efficacy of triple antibiotic paste and propolis extract using three different vehicles as intracanal medicament: An in vitro study” by Veronica G et al., published in the Journal of Dr NTR University of Health Sciences in 2024, investigates the antimicrobial efficacy of triple antibiotic paste (TAP) and propolis extract as intracanal medicaments, using three different vehicles. While the study addresses a relevant topic in endodontics, the methodological limitations and interpretation of results warrant a critical review.[1] The study addresses a pertinent concern in endodontic treatment – the need for effective intracanal medicaments to eliminate remaining bacteria after instrumentation. The comparison of triple antibiotic paste (TAP), a well-established medicament, with propolis extract, a natural alternative, is clinically relevant and explores the potential benefits of natural agents and the research question is clearly defined: to compare the antimicrobial efficacy of TAP and propolis extract in different vehicles against specific microorganisms commonly found in root canals. However, while E. faecalis is a well-established endodontic pathogen; the relevance and prevalence of S. aureus and C. albicans as primary root canal pathogens are questionable.[2] The inclusion of more prevalent and aggressive organisms like Aggregatibacter actinomycetemcomitans or Fusobacterium nucleatum would have strengthened the study. The rationale behind choosing these specific microorganisms should be clearly stated and adequately justified. A crucial limitation is the lack of detailed information regarding the source, geographical origin, and chemical composition of the propolis extract. Propolis composition varies significantly depending on the plant source and geographical location, influencing its biological activity. Without proper standardization and characterization of the propolis extract, it’s difficult to extrapolate the findings and replicate the experiment. Future studies should employ standardized propolis extracts with known compositions, ideally using high-performance liquid chromatography (HPLC) to define the active compounds.[3] The in vitro model used in the study, while practical for initial screening, is a simplified representation of the complex in vivo conditions within a root canal. The study fails to consider factors like dentinal tubules, biofilm formation, the presence of organic debris, and the buffering capacity of dentin, all of which can significantly affect the antimicrobial activity of medicaments. More sophisticated models, such as dentin tube models or biofilm models, would provide a more realistic assessment of the medicaments’ efficacy. Veronica G et al.’s study provides a valuable initial comparison of TAP and propolis extract as intracanal medicaments. However, the limitations in the study design, methodology, and data analysis necessitate a cautious interpretation of the results. While the study suggests that TAP may be more effective in vitro, further research using more robust methodologies and clinically relevant conditions is needed to fully evaluate the potential of propolis extract as a viable alternative intracanal medicament. Addressing the identified weaknesses and incorporating the suggested recommendations will pave the way for more reliable and clinically relevant studies in this area. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.