Is there evidence for the use of lesion sterilization and tissue repair therapy in the endodontic treatment of primary teeth? A systematic review and meta-analyses

Evaluation of the modified 3Mix-Simvastatin combination in non-instrumental endodontic therapy of necrotic primary molars: A two-arm randomized controlled trial

OBJECTIVE

This study aimed to assess the clinical and radiographic outcomes of non-instrumentation endodontic treatment (NIET) using a modified antibiotic mix of cefixime, ciprofloxacin and metronidazole with simvastatin (an anti-inflammatory, bone regeneration drug) on necrotic primary molars compared to conventional pulpectomy to help preservation of necrotic primary teeth until its natural exfoliation.

MATERIALS AND METHODS

Forty mandibular primary second molars with necrotic pulp tissue from 38 healthy patients aged between 4 and 8 years were randomly assigned to two groups with a 1:1 allocation ratio. Group A teeth underwent conventional root canal treatment. The procedure involved a two-visit approach, employing k-files and h-files during the initial visit, followed by the application of calcium hydroxide paste as canal dressing between visits, while Group B teeth were treated with 3Mixtatin. All teeth were clinically evaluated after 1, 3, 6, and 12 months, and radiographically at 3, 6, and 12 months. Two external examiners assessed the results. Data analysis was conducted using a chi-square test at a 0.05 significance level.

RESULTS

At the end of the follow-up interval, 90% of teeth in each group exhibited no clinical signs or symptoms. Additionally, inter-radicular radiolucency healing occurred in 75% of cases in the NIET group and 89.5% in the conventional pulpectomy group. However, no statistically significant difference was found between the two groups.

CONCLUSION

NIET using 3Mixtatin seems to be a good alternative choice to conventional pulpectomy, offering a less complex treatment approach that may help avoid the complications associated with traditional pulpectomy and could be suitable for teeth with shorter roots.

The effect of an antibacterial mixture and non-instrumentation endodontic treatment in primary teeth: A systematic review and meta-analyses

Studies assessing the clinical and radiographic success of LSTR in terms of the presence of pain, mobility, swelling, fistula/sinus tract, interradicular radiolucency, and root resorption have not been performed. We therefore performed a systematic review with the aim of evaluating the effectiveness of lesion sterilization and tissue repair (LSTR), using three antibacterial mixtures (3Mix), in treating primary teeth. Well-defined search strategies developed for four electronic databases, Web of Science, OVID, PubMed, and Scopus, were used in this study. Two independent reviewers selected relevant articles from 3,232 studies by screening titles and abstracts. Based on the inclusion criteria, 25 articles were selected. Eight analyses of clinical and radiographic results were conducted based on 6, 12, 18, and 24-month follow-up intervals. Data extraction and quality appraisal were performed by three independent reviewers. The composition of antibiotic mixtures used for LSTR varied substantially, with inconsistent radiographic and clinical success rates across the included studies. A quantitative grouping of the studies showed no significant differences between 3Mix and the control medicaments regarding radiographical and clinical success (p-value > 0.05). The available evidence on different LSTR using 3Mix is scarce, and the study findings were inconsistent. Therefore, additional clinical trials on 3Mix with different compositions are needed.

Lesion sterilization and tissue repair with chloramphenicol, tetracyline, zinc oxide/eugenol paste versus conventional pulpectomy: A 36-month randomized controlled trial

BACKGROUND

Endodontic treatment of primary molars represents one of the challenges in pediatric dentistry. There is a lack of consensus in the literature about the endodontic techniques and filling paste for primary teeth with pulp necrosis.

AIM

To compare the effectiveness of the LSTR technique (lesion sterilization and tissue repair) with CTZ paste (chloramphenicol, tetracycline, zinc oxide and eugenol) and pulpectomy with ZOE paste (zinc oxide and eugenol) in the treatment of primary molars with pulp necrosis.

DESIGN

Eighty-eight primary molars with pulp necrosis from 70 children between the ages of 3 and 8 years were included. The teeth were randomized to the LSTR with CTZ paste group or pulpectomy with ZOE paste group. Clinical and radiographic evaluations were performed at 18, 24, 30 and 36 months.

RESULTS

At 36 months, clinical success was 86.4% in LSTR with CTZ paste and 90.9% in pulpectomy with ZOE paste (p = .45). Radiographic success was 43.2% in both groups (p = 1.00). The overall success was 40.9% in LSTR with CTZ paste and 43.2% in pulpectomy with ZOE paste (p = 1.00).

CONCLUSION

After 36 months of evaluation, the effectiveness of the LSTR technique with CTZ paste and pulpectomy with ZOE paste was similar for the treatment of primary molars with pulp necrosis.

Lesion sterilization and tissue repair (LSTR) method in irreversible dental pulp changes of primary teeth

Background/Aim: Deep carious lesions on primary teeth usually have been causing infectious dental pulp changes. If indicated, traditional endodontic root canal treatment for these kinds of pulpal infections in primary teeth usually should involve the performing of pulpectomy methods, but often with questionable prognosis. The lesion sterilization and tissue repair (LSTR) approach is one of the good endodontic therapeutic alternatives for affected primary teeth with a poor prognosis, which could otherwise be condemned to premature extraction. Aim was to evaluate the medium-term clinical success in everyday practice of the LSTR method applied in affected primary teeth with irreversible pulpal tissue infections by observation of reduction/absence of their clinical symptoms. Material and methods: The study sample included child patients who had one or more of their affected primary molars with irreversible pulpal tissue changes of poor prognosis treated with the LSTR method. For each patient whose primary molar tooth was endodontically treated with the LSTR method a clinical evaluation of treated tooth was performed at intervals of 1 and 12 months afterwards. Results: Study sample was consisted of 40 child patients aged 4 to 9 years, with 45 primary molars included in total. It was obvious that the symptoms related to affected sample teeth have already been decreased almost immediately after initial action of triple antibiotic paste. Final outcome after 12-months follow-up period was success of applied LSTR method in 43 (95.6%) affected sample teeth in a way that initial clinical symptoms completely decreased and disappeared. Conclusions: LSTR method has been shown as successful pulpotomy technique for noninstrumental endodontic approach in non-vital pulp treatment of primary molar teeth in a 12-months follow-up period.

Effectiveness of iodoform-based filling materials in root canal treatment of deciduous teeth: a systematic review and meta-analysis

Introduction

The objective was to review the effectiveness of iodoform-based compared to noniodoform-based filling materials in the root canal treatment of deciduous teeth.

Methods

This systematic review and meta-analysis used randomized clinical trials with six months or more follow-up. The risk of bias of individual studies and the certainty of the evidence were evaluated (Cochrane risk of bias tool and GRADE, respectively).

Results

The initial search resulted in 5,127 studies after removal of duplicates. After screening by title and abstract, 34 full-text studies were eligible and 21 remained in the qualitative synthesis and 19 in the meta-analysis. Iodoform-based filling materials resulted in fewer clinical failures when compared to noniodoform-based filling materials at the 6 months (OR = 0.43, 95%CI: 0.19–0.97, p = .04) and 9–12 months (OR = 0.46, 95%CI: 0.23–0.93, p = .03), but not at the 18–30 months follow-up (OR = 1.08, 95%CI: 0.58–2.03, p = .81). When considering radiographic failures, there was no statistical difference between iodoform-based and noniodoform-based filling materials at the 6 months (OR = 0.72, 95%CI: 0.39–1.32, p = .29) and 18–30 months follow-ups (OR = 1.06, 95%CI: 0.51–2.21, p = .87), but fewer radiographic failures were detected at the 9–12 months follow-up (OR = 0.49, 95%CI: 0.29–0.80, p = .005).

Conclusion

Iodoform-based filling materials showed better clinical and radiographic performance when compared to non-iodoform-based filling materials in the short term, and similar performance in the long term. However, most of the studies exhibited unclear or high risk of bias and the overall certainty of the evidence ranged from low to very low. Therefore, new randomized clinical trials must be accomplished to corroborate this conclusion.

Vital and Nonvital Pulp Therapy in Primary Dentition: An Umbrella Review

Dental caries is the most common non-communicable disease in children with significant aesthetic, functional, and quality of life deterioration. Depending on the depth, two approaches may be considered in primary dentition: vital pulp therapy (VPT) or non-vital therapy (NPT). This umbrella review aimed to critically assess the available systematic reviews (SRs) on VPT and NPT. An electronic database search was conducted (PubMed, Embase, Scopus, Cochrane, Web of Science, and LILACS) until June 2021. The Risk of Bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). From 272 entries, 33 SRs were included. Regarding the methodological quality, three studies were critically low, nine low, seventeen moderate, and six were rated as high quality. The quality of evidence produced by the available SRs was moderate. Future high standard SRs and well-designed clinical trials are warranted to better elucidate the clinical protocols and outcomes of VPT and NPT.

Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial

This study compared the cost of endodontic treatment in primary teeth involving a technique that does not require root canal instrumentation using antibiotic paste (CTZ) with that of the instrumented technique using iodoform paste (GP). This study is part of a randomized, controlled, parallel arm, noninferiority, 1:1 allocation, blinded (patient) multioperator study of 52 primary incisors of children aged 3 to 6 years with caries lesion and pulp involvement. Each technique was performed according to the creators' descriptions. The cost was assessed by analyzing the costs of capital, dental supplies, and professional labor according to the time taken to perform the procedure and the CHEERS guidelines were used to report the cost assessment. Endodontic treatment with CTZ had a 58.33% lower execution cost than GP (US$6.73 and US$16.15, respectively). The t-test showed significant differences between groups regarding treatment time and total cost (p < 0.0001). The CTZ technique seems to be more economically viable than GP for endodontic treatment of primary teeth, requiring a shorter treatment time and lower costs.

Antibiotic Mixtures in Noninstrumental Endodontic Treatment of Primary Teeth with Necrotic Pulps: A Systematic Review

OBJECTIVE

To compare the effectiveness of topical antibiotic mixtures used in noninstrumental endodontic treatment (NIET) of primary teeth.

METHODS

Electronic databases including MEDLINE, the Cochrane Library, and Scopus database were searched. Randomized clinical trials evaluating the clinical and radiological outcomes of topical antibiotics used in NIET were selected. The revised Cochrane risk-of-bias tool (RoB 2.0) was used to assess the quality of the methodology of the included articles.

RESULTS

Five articles comparing the outcomes of four different drugs combination were included. Three studies conducted to evaluate the success rate of two combinations of antibacterial drugs consisting of ciprofloxacin-minocycline-metronidazole (3 Mix) in one group and ciprofloxacin-minocycline-ornidazole in the other group showed no statistically significant difference between both groups (P > 0.05). The ciprofloxacin-minocycline-ornidazole group showed better results compared with the 3 Mix group. One study conducted to compare the effectiveness of 3 Mix with ciprofloxacin-tinidazole-minocycline reported no significant difference between both groups, and one study that compared 3 Mix and ciprofloxacin-metronidazole-clindamycin mixture concluded that the overall success rates of both groups were 80.96% and 76.20%, respectively, with no statistically significant difference.

CONCLUSION

Based on the overall success rates, the ciprofloxacin-minocycline-ornidazole mixture was considered more effective than the 3 Mix which was more effective than the ciprofloxacin-tinidazole-minocycline and the ciprofloxacin-metronidazole-clindamycin groups. Clinical Relevance. Different antibiotic combinations, showing good clinical and radiographic success in treating necrotic primary teeth, can be used effectively in NIET and this technique can be considered effective for teeth with advanced root resorption and when conventional endodontic treatment is contraindicated.