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Background and aim: To establish lesion sterilization and tissue repair (LSTR) therapy as an alternate treatment option in managing infected primary molars with poor prognosis that were indicated for extraction, thereby fulfilling the objective of retaining the primary tooth till its normal exfoliation in the dental arch. Materials and methods: A total of 84 children who met the inclusion criteria requiring extraction in 142 teeth involving primary molars were included in the study. The selected patients were allocated to two groups, that is, group I-LSTR therapy with 3Mix-MP paste and group II-pulpectomy with metapex. All the treated teeth were then clinically and radiographically evaluated after 1, 3, 6, 9, and 12 months, respectively, to determine the success between groups I and II. Pearson's Chi-squared test along with the z-test was used to compare the clinical and radiographic success of the two groups (p < 0.05). Results: Pain and tenderness were completely resolved within one month of follow-up in both groups. Abscesses were resolved completely at 1 month in the pulpectomy group and mobility was resolved at 6 months follow-up in both groups. Interradicular and periradicular radiolucency persisted even at 12 months of the follow-up period in both groups. The intergroup comparison revealed no statistical differences between LSTR and pulpectomy procedure and both were equally effective at all time intervals (p > 0.05). Conclusion: Both LSTR therapy with 3Mix-MP and pulpectomy with metapex showed 100% clinical success rates. Radiographically no changes were observed even at the 12-month follow-up period in both groups. LSTR therapy can be an alternative treatment option for pulpally involved primary teeth with poor prognosis and in cases where mechanical instrumentation could not be achieved due to physiologic root resorption. How to cite this article: Sefa I, Garg N, Pathivada L, et al. Success of Lesion Sterilization and Tissue Repair Therapy and Pulpectomy in the Management of Infected Primary Molars with Poor Prognosis. Int J Clin Pediatr Dent 2024;17(1):41-47.

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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.

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Morphological dental anomalies such as supernumerary roots are rare in primary teeth. Their location, frequency, and associated peculiar root canal morphology should be known to a pediatric dentist. It is crucial to carefully examine intraoral radiographs to ensure that such variations do not go undetected. Such variances must be identified to ensure complete cleaning and filling of all root canals. Negligence in treating all canals can result in recurrent infection or treatment failure. Understanding the anatomical variation of the tooth like radix entomolaris (RE), is important for successful dental treatment. This report presents a rare case of bilateral RE of primary mandibular first molars in middle childhood treated with lesion sterilization and tissue repair.

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INTRODUCTION: "Lesion sterilization and tissue repair" (LSTR) is a non-instrumentation endodontic treatment modality that has recently gained popularity with promising results in several clinical trials. However, there is a dearth of evidence regarding the concentration of modified triple antibiotic paste (MTAP) to be used for the procedure. AIM AND OBJECTIVE: To compare the clinical and radiographic efficacy of 1 mg/mL and 1 g/mL concentrations of MTAP (ciprofloxacin, metronidazole, and clindamycin) used in LSTR of primary molars. MATERIALS AND METHODS: Sixty-four infected primary molars in children between 4 years and 10 years of age were randomly allocated to two groups. Lesion sterilization and tissue repair at 1 mg/mL concentration of MTAP (group I) and 1 g/mL concentration of MTAP (group II) was performed. Clinical and radiographic outcomes were evaluated using Coll and Sadrian's criteria at 10 days, 1 month, and 3 months and the results were tabulated. STATISTICAL ANALYSIS: The data obtained were subjected to statistical analysis with IBM. SPSS statistics software 23.0 Version. To test the significance in categorical data, a Chi-square test was used. The probability value of 0.05 was considered significant. RESULTS: At the end of 3 months review, clinical success rates of group I and group II were 84.4 and 90.6%, respectively, and radiographic evaluation showed group I-78.1% and group II-90.6%. CONCLUSION: Both 1 mg/mL and 1 g/mL concentrations of MTAP used in LSTR of primary molars had similar success rates with no statistically significant difference. CLINICAL SIGNIFICANCE: Lesion sterilization and tissue repair when found to be equally effective in less concentration may aid in achieving adequate infection control with the least detrimental effect on the remaining vital pulp and periradicular structures. In addition, this circumvents the systemic administration of potent antibiotics thus combating antibiotic resistance. HOW TO CITE THIS ARTICLE: Shankar K, Ramkumar H, Dhakshinamoorthy S, et al. Comparison of Modified Triple Antibiotic Paste in Two Concentrations for Lesion Sterilization and Tissue Repair in Primary Molars: An In Vivo Interventional Randomized Clinical Trial. Int J Clin Pediatr Dent 2021;14(3):388-392.

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Aim: The rate of healing of periapical lesion after the antibacterial dressing with triple antibiotic paste and calcium hydroxide was assessed. Materials and Methods: Case reports which used triple antibiotic paste and calcium hydroxide as the intracanal dressing was searched in PubMed, Google Scholar and Cochrane Oral Health's Trials Register up to August 2020, without language and period restriction. Two authors independently reviewed all identified titles and abstracts for eligibility. Tables were generated to summarize the included studies. Results: Sixteen (n = 16) articles met the eligibility criteria. Nonsurgical endodontic treatment was carried out in eleven cases with triple antibiotic paste and in nineteen cases calcium hydroxide was used. Results of the study after analyzing the case reports indicate that both triple antibiotic paste and calcium hydroxide are equally effective as intracanal medicament. In cases where calcium hydroxide failed to eliminate symptoms, triple antibiotic paste was found to be effective. Conclusion: As far as the effect on the healing of the periapical lesions is concerned, all the studies showed a high success rate. Available scientific data indicates nonsurgical treatment can be adopted as a routine measure to conservatively treat large periapical lesions of endodontic origin.

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BACKGROUND: In continuation with the ultraconservative minimal intervention approach for carious lesions treatment, lesion sterilization and tissue repair (LSTR) is a novel concept of using antibacterial drugs to disinfect dentinal, pulpal, and periapical lesions. AIMS: The purpose of this study is to evaluate the clinical, radiographic, and microbiologic success rate of indirect pulp treatment (IPT) using a new technique minimal excavation and LSTR with triple antibiotic paste (TAP), for primary molars. SETTINGS AND DESIGN: This was randomized controlled trial design. MATERIALS AND METHODS: Forty-two healthy cooperative children aged 5-10 years having deep carious lesion in primary molars were randomly assigned to receive either traditional IPT with calcium hydroxide or minimal excavation and LSTR with TAP. Follow-up was done at 6 weeks, 3, 6, and 15-18 months intervals, and treatment success or failure was determined by a combination of clinical, microbiological, and radiographic findings. STATISTICAL ANALYSIS USED: Qualitative data were analyzed using Pearson's Chi-square test. Mann-Whitney U nonparametric test was used for statistically significant differences between the bacterial counts (median values and percent reduction) between the two groups and the Wilcoxon sign rank test for the intragroup evaluation of bacterial counts. RESULTS: LSTR with TAP was found to be as effective as traditional indirect pulp treatment (P < 0.05). CONCLUSIONS: Minimal excavation and LSTR with TAP can be an effective treatment methodology for the management of deep carious lesions in primary molars.

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INTRODUCTION: Paediatric endodontics is part of paediatric dental practice. Teeth with infected root canals, particularly those in which the infection has spread around the apical foramen and furcation area, is a common problem in primary dentition for such conditions pulpectomy is the procedure. Pulpectomy procedure proves to be long and complicated and has remained controversial for a number of reasons. Lesion sterilization and tissue repair therapy (LSTR) is a relatively new biologic approach for carious lesions with or without pulpal and periapical involvement using a mixture of antibiotics. OBJECTIVES: The aim of this study was to evaluate clinical and radiographic success of three different LSTR techniques as treatment options in primary molars requiring pulpectomy. METHODS: Sixty-three primary molars of fifty children aged between 4 and 8 years with primary molars requiring pulpectomy were treated with modified 3Mix-MP antibiotic paste without removal of accessible radicular pulp (Group I), modified 3Mix-MP with removal of accessible radicular pulp (Group II) and Chloramphenicol, tetracycline and zinc oxide eugeno (CTZ) paste (Group III). The subjects were followed up clinically at one, six, and twelve months whereas radiographically at six and twelve months, respectively. RESULTS: The results showed that clinical success rates of Group I, Group II and Group III were 90%, 90.5% and 81.8% respectively and radiographical success rates were 75%, 76.2% and 63.6% respectively after twelve months observation. CONCLUSION: On the basis of the overall success rates of all the three LSTR techniques, following order of performance can be inferred clinical success and radiographical success: - 3Mix-MP without removal of radicular pulp = 3Mix-MP with removal of radicular pulp >CTZ paste.

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BACKGROUND: Vitapex has been a popular obturating material for several decades. In recent times, lesion sterilization and tissue repair (LSTR) has shown promising results. This technique uses a mixture of 3 antibiotics for sterilization of the root canals and healing of periradicular tissues. OBJECTIVE: The objective of this systematic review was to compile all the literature comparing Vitapex and LSTR for pulpally involved primary teeth and evaluate the success rate in terms of clinical and radiographic outcomes. MATERIALS AND METHODS: This review is based on PRISMA guidelines. The electronic search on MEDLINE via PubMed database and Google scholar, cross-referencing and hand search of journals was carried out for articles from January 1, 2000 to December 31, 2019. Articles only in the English language were selected. Out of the 17 articles, 3 unique articles were identified for the review, of which 2 were randomized controlled trials and 1 was a retrospective study. RESULTS: All the three articles were assessed for their quality and all had a low risk of bias. It was found that LSTR and Vitapex had a high clinical success after 12 months. The radiographic success after 6 months was high but decreased after 12 months in both the groups. CONCLUSION: There is no difference in the success rate of LSTR as compared to Vitapex for the treatment of pulpally involved primary teeth.

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AIM AND OBJECTIVE: The aim of this study is to evaluate the clinical and radiographic success of endodontic treatment of nonvital primary teeth using lesion sterilization and tissue repair (LSTR) therapy. MATERIALS AND METHODS: A sample size of 40 primary molars from 34 children of 3-10 years of age were selected for the study. Nonvital primary molars were treated using LSTR technique with a combination of antibacterial drugs comprising ciprofloxacin, metronidazole, and doxycycline with propylene glycol as vehicle. The procedure was completed in a single appointment. Only analgesics were prescribed postoperatively. Postoperative evaluation was done after 1, 3, 6, and 12 months. RESULTS: Clinical signs and symptoms got resolved in the 1st-month follow-up itself and continued in the subsequent visits. Radiographic evaluation showed a gradual improvement in success rates through the 12-month follow-up period. CONCLUSION: LSTR technique can be considered as an alternative treatment option for nonvital primary teeth avoiding a course of systemic antibiotics to the children. Doxycycline can be used in the drug combination instead of minocycline which also gives higher clinical and radiographic success.

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OBJECTIVE: To evaluate the clinical and radiographic success rates of 3Mix and Vitapex in the treatment of necrosed primary teeth. MATERIALS AND METHODS: Seventy teeth of healthy children aged 4-9 years with necrotic primary molar (nonvital) were treated with 3Mix (lesion sterilization tissue repair therapy) and Vitapex before restoration with stainless steel crowns. The participants were followed up clinically and radiographically for 3 months and 6 months, respectively. The outcome was compared using Fisher exact test with a significance level of p < 0.05. RESULTS: Clinical success rate of 3Mix group at 3 months and 6 month follow-up was 100% and 97.14% and that of Vitapex group was 100% and 100%, respectively. The radiographic success rate of 3Mix group at 3 months and 6 months was 74.29% and 77.14% and of Vitapex group was 97.14% and 97.14%, respectively. Considering the clinical success, no statistical difference was found between the two groups at the end of 6 month (p = 1.000). But radiographically statistical significant difference was found between the two groups (p = 0.028). CONCLUSION: Non-instrumentation endodontic treatment using 3Mix has shown a good clinical success of 97.14% but the radiographic success rate at 6 months was lower (77.14%). So it can be suggested that the use of 3Mix antibiotic treatment cannot replace conventional root canal treatment over the long term. HOW TO CITE THIS ARTICLE: Rai R, Shashibhusan KK, Babaji P, et al. Clinical and Radiographic Evaluation of 3Mix and Vitapex as Pulpectomy Medicament in Primary Molars: An In Vivo Study. Int J Clin Pediatr Dent 2019;12(6):532-537.

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BACKGROUND: Complete pulpectomy and elimination of wide range of microorganisms from infected primary root canals is not possible through conventional endodontic procedures. Thus, lesion sterilization and tissue repair (LSTR) therapy employing 3Mix tri-antibiotic paste have been used as an alternative endodontic modality for infected primary teeth. AIM: This study aims to evaluate the root resorption rate of endodontically treated mandibular primary molars with conventional endodontic treatment or LSTR therapy and to compare it with their healthy contralateral teeth. MATERIALS AND METHODS: Fifty carious first and second primary mandibular molars from 25 healthy children aged 7-10 years were treated with two different endodontic procedures using LSTR Therapy and conventional endodontic treatment. The resorption rate of these teeth with healthy contralateral teeth was compared clinically and radiographically at 3, 6, 12 and 36 months using Chi-square test. RESULTS: At 12 months, clinically, there was no difference in the outcomes of both groups but radiographically, statistically significant difference (P < 0.001) in root resorption between treated teeth and their controls in both the groups was observed. At 36 months, interradicular bone resorption around the crown of succedaneous teeth and their delayed eruption was noted in LSTR group. CONCLUSIONS: LSTR therapy could be a viable treatment modality for infected/nonvital primary molars with poor prognosis and intended to be maintained for shorter duration in the oral cavity as natural space maintainers.

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A deciduous tooth affected by dental caries involving the pulp tissue with subsequent periradicular pathosis at times makes the conventional endodontic procedures a dilemma for a variety of reasons. In this situation, lesion sterilization and tissue repair (LSTR) stands out as the only option by which dentists could increase the longevity of the deciduous teeth of a young child. This therapy aims to eliminate bacteria from the root canals by sterilizing the lesion and promoting tissue repair and regeneration by the host's natural tissue responses. This article reviews the rationale, indications, contraindications and the procedure in detail. How to cite this article: Sain S, Reshmi J, Anandaraj S, George S, Issac JS, John SA. Lesion Sterilization and Tissue Repair-Current Concepts and Practices, Int J Clin Pediatr Dent. 2018;11(5):446-450.

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OBJECTIVES: The aim of this study was to evaluate the clinical and radiographic success of zinc oxide (ZnO)-ozonated oil, modified 3Mix antibiotic paste, and vitapex in the treatment of primary molars requiring pulpectomy. METHODS: Sixty-four primary molars of forty-three healthy children aged between 4 and 8 years with primary molars requiring root canal procedure were treated with ZnO-ozonated oil, modified 3Mix-MP antibiotic paste, and vitapex. Clinical follow up was done at 1, 6,12 months and 18 months while radiographical follow-up was done at 6,12 and 18 months, respectively. RESULTS: The results showed that the clinical success rates of ZnO-ozonated oil, modified 3Mix-MP paste and vitapex were 95.5%,89.5% and 100% respectively and radiographical success rates were 94.4%,80.95% and 100% respectively after 18 months period of observation. CONCLUSION: The overall success rates of ZnO-ozonated oil, vitapex and modified 3Mix antibiotic paste were comparable.