Keywords: amoxicillin, bone decontamination, chlorhexidine, clindamycin, low-speed drilling
Purpose: The objective of this study was to determine the effect of two antibiotics (amoxicillin and clindamycin) and one antiseptic (chlorhexidine digluconate [CHX]) on the growth and differentiation capacity of primary human osteoblasts.
Materials and methods: Osteoblast proliferation was determined by the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) technique after a 1-minute treatment with 400 μg/mL amoxicillin or 150 μg/mL clindamycin or CHX (0.12% or 0.2%). Flow cytometry was used for apoptosis/necrosis analysis. The study of cell differentiation was performed using a mineralization medium and staining of the nodules formed using red alizarin at 15 and 22 days of treatment with 400 μg/mL amoxicillin or 150 μg/mL clindamycin. Spectrophotometry was used to determine alkaline phosphatase (ALP) activity after 1 minute of treatment.
Results: Treatment of osteoblasts with 0.12% and 0.2% CHX for 1 minute induced a strong dose-dependent reduction in cell proliferation (P < .001) with a significant increase in the percentage of apoptotic cells (P = .004 and < .001, respectively). However, cell proliferation significantly increased (P < .05) after treatment with 150 μg/mL clindamycin. Treatment of the osteoblasts with 150 μg/mL clindamycin for 1 minute significantly increased the expression of ALP (P = .002). Calcium deposition was significantly higher (P < .001) in the 150 μg/mL clindamycin group.
Conclusion: These data support the use of low doses of clindamycin and amoxicillin for intraoral bone graft decontamination and raise questions about the use of CHX. Osteoblast growth and differentiation may be favored by low doses of clindamycin, and it may be the decontaminant of choice for intraoral bone grafts, while CHX is shown as a less bone-friendly agent.