An Alternative Approach in Primary Teeth Endodontic Treatment: Lesion Sterilization and Tissue Repair Technique

Abstract

Primary teeth are necessary for chewing, speaking, aesthetics and maintaining the place for the permanent teeth. The success of endodontic treatment in primary teeth depends on the destruction of microorganisms in the root canal system with effective irrigation and obturation. It is not always possible to perform ideal endodontic treatment in a pediatric patient; in this case, lesion sterilization and tissue repair approach can be considered as an alternative technique. This technique can be applied in primary teeth in the presence of abscess, mobility, fistula and radiolucency in the furcation region. This technique is based on the use of triple antibiotic paste (metronidazole, minocycline, ciprofoxacin) to disinfect the root canal system. The aim of this study is to review the indications, contraindications, materials used in treatment and treatment protocol of lesion sterilization and tissue repair technique applied to primary teeth.

Keywords

• necrotic primary teeth
• pulpectomy
• triple antibiotic paste

Süt Dişi Endodontik Tedavisinde Alternatif Bir Yaklaşım: Lezyon Sterilizasyonu ve Doku Tamiri Tekniği

Abstract

Süt dişleri çiğneme, konuşma, estetik ve daimi dişlerin yerinin korunması için gereklidir. Süt dişlerinde endodontik tedavinin başarısı etkin irrigasyon ve obturasyon ile kök kanal sistemindeki mikroorganizmaların elimine edilmesine bağlıdır. Çocuk hastada her zaman ideal endodontik tedavi yapmak mümkün değildir; bu durumda lezyon sterilizasyonu ve doku tamiri yaklaşımı alternatif bir teknik olarak düşünülebilir. Bu teknik süt dişlerinde apse, mobilite, fistül ve furkasyon bölgesinde radyolüsensi varlığında uygulanabilir. Teknik, kök kanal sistemini dezenfekte etmek için üçlü antibiyotik patın (metronidazol, minosiklin, siprofoksasin) kullanılmasına dayanmaktadır. Bu çalışmanın amacı süt dişlerine uygulanan lezyon sterilizasyonu ve doku tamiri tekniğinin endikasyonlarını, kontrendikasyonlarını, tedavide kullanılan materyalleri ve tedavi protokolünü gözden geçirmektir.

Keywords

• nekrotik süt dişleri
• pulpektomi
• üçlü antibiyotik patı

References

1. 1. Cohen M, Burns RC. Path ways of pulp. St Louis Mosby Inc. 8th ed; 2002.
2. 2. Finn SB. Clinical pedodontics. Philadelphia: W.B. Saunders Company. 4th ed.;1995.
3. 3. Jaya AR, Praveen P, Anantharaj A, Venkataraghavan K, Prathibha RS. In vivo evaluation of lesion sterilization and tissue repair in primary teeth pulp therapy using two antibiotic drug combinations. J Clin Pediatr Dent. 2012;37(2):189-91.
4. 4. Shetty AA, Geethanjali G, Hegde AM. Lesion sterilization and tissue repair in primary teeth. SRM J Res Dent Sci. 2020;11(2):99-105.
5. 5. Takushige T, Cruz EV, Asgor MA, Hoshino E. Endodontic treatment of primary teeth using a combination of antibacterial drugs. Int Endod J. 2004;37(2):132-8.
6. 6. Law CS. Management of premature primary tooth loss in the child patient. J Calif Dent Assoc. 2013;41(8):612-8.
7. 7. AAPD. American Academy on Pediatric Dentistry Clinical Affairs Committee – Pulp Therapy Subcommittee. Pulp therapy for primary and immature permanent teeth. Pediatr Dent. 2019-2020:353–61.
8. 8. Belanger C. Pulp therapy for the primary dentition. Pediatr Dent. 1988;10:257–67.

9. 9. American Academy of Pediatric Dentistry. Guideline on management of developing dentition and occlusion in pediatric dentistry. Pediatr Dent. 2012;34:239–51.
10. 10. Swimberghe RCD, Coenye T, De Moor RJG, Meire MA. Biofilm model systems for root canal disinfection: a literature review. Int Endod J. 2019;52(5):604-28.
11. 11. Bergenholtz G. Assessment of treatment failure in endodontic therapy. J Oral Rehabil. 2016;43(10):753-8.
12. 12. Khubchandani M, Jain S, Dahiya P, Khilji I, Teja MS, Nadeshwari G. LSTR-Lesion Sterilization and Tissue Repair a tool in taming the LEO (Lesions of Endodontic Origin)-a review. Int J Med Dent Res. 2021;1(2):9-15.
13. 13. Sato I, Ando-Kurihara N, Kota K, Iwaku M, Hoshino E. Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ. Int Endod J. 1996;29(2):118-24. 14. Buldur B, Kapdan A. Comparison of the EndoVac system and conventional needle irrigation on removal of the smear layer in primary molar root canals. J Clin Pediatr Dent. 2017;41(4):284-8.
14. 15. Belanger GK. Pulp therapy for the primary dentition. Pediatr Dent. 1988;10:257–67.
15. 16. AAPD. Guideline on management of developing dentition and occlusion in pediatric dentistry. Pediatr Dent. 2012;34:239-51.
16. 17. Vijayaraghavan R, Mathian VM, Sundaram AM, Karunakaran R, Vinodh S. Triple antibiotic paste in root canal therapy. J Pharm Bioallied Sci. 2012;4:230-3.
17. 18. Windley W, Teixeira F, Levin L, Sigurdsson A, Trope M. Disinfection of immature teeth with a triple antibiotic paste. J Endod. 2005;31(6):439-43.
18. 19. Fabricius L, Dahlen G, Ohman AE, Möller AJ. Predominant indigenous oral bacteria isolated from infected root canals after varied times of closure. Scand J Dent Res. 1982;90:134–44.
19. 20. Haapasalo M, Orstavik D. In vitro infection and disinfection of dentinal tubules. J Dent Res. 1987;66(8):1375- 9.
20. 21. Nakornchai S, Banditsing P, Visetratana N. Clinical evaluation of 3Mix and Vitapex® as treatment options for pulpally involved primary molars. Int J Paediatr Dent. 2010;20(3):214–2.
21. 22. Takushige T, Cruz EV, Moral MAA, Hoshino E. Non-surgical treatment of pulpitis, including those with history of spontaneous pain, using a combination of antibacterial drugs. J LSTR Ther. 2008;7:1-5.
22. 23. Takushige T, Hataoka H, Ando M, Hoshino E. Endodontic retreatment using 3Mix-MP without removal of previous root canal obturation. J LSTR Ther. 2009;8:3-7.
23. 24. Goswami S. Lesion sterilization and tissue repair in pediatric dentistry. SRM J Res Dent Sci. 2018;9(2):79-82.
24. 25. Nanda R, Koul M, Srivastava S, Upadhyay V, Dwivedi R. Clinical evaluation of 3 mix and other mix in non-instrumental endodontic treatment of necrosed primary teeth. J oral Biol Craniofacial Res. 2014;4(2):114-9.
25. 26. Pilownic KJ, Carvalho CN, Romano AR, Morgental RD, Shen Y, Haapasalo M, et al. Antibiofilm activity of five different endodontic filling materials used in primary teeth using confocal laser scanning microscopy. Pediatr Dent. 2017;39(2):145-49.
26. 27. Parasuraman VR, Muljibhai BS. 3Mix-MP in endodontics–an overview. J Dent Med Sci. 2012;3(1):36-45.
27. 28. Bystrom A, Sundqvist G. Bacteriologic evaluation of the efficacy of mechanical rootcanal instrumentation in endodontic therapy. Scand J Dent Res. 1981;89:321–8.
28. 29. Kayalvizhi 1, Subramaniyan B, Suganya G. Topical application of antibiotics in primary teeth: an overview. J Dent Child. 2013;80(2):71-9.
29. 30. Ozan U, Er K. Endodontic treatment of a large cystlike periradicular lesion using a combination of antibiotic drugs: a case report. J Endod. 2005;31(12):898-900.
30. 31. Prabhakar AR, Sridevi E, Raju OS, Satish V. Endodontic treatment of primary teeth using combination of antibacterial drugs: An in vivo study. J Indian Soc Pedod Prev Dent. 2008;26(5):5-10.
31. 32. Agarwal M, Das UM, Vishwanath D. A comparative evaluation of noninstrumentation endodontic techniques with conventional ZOE pulpectomy in deciduous molars: an in vivo study. World J Dent. 2011;2(3):187-92.
32. 33. Gupta T, Sadna G, Aggarwal N. Lesion sterilization and tissue repair—a recent novel approach for the treatment of very uncooperative pediatric patients. AMEI’s Curr Trends Diagnosis Treat. 2018;2(1):50-3.
33. 34. Trairatvorakul C, Detsomboonrat P. 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. Int J Paediatr Dent. 2012;22(3):217-27.
34. 35. Hoshino E, Iwaku M, Sato M, Ando N, Kota K. Bactericidal efficacy of metronidazole against bacteria of human carious dentin in vivo. Caries Res. 1989;23(2):78–80.
35. 36. Sato T, Hoshino E, Uematsu H, Kota K, Iwaku M, Noda T. Bactericidal efficacy of a mixture of ciprofloxacin, metronidazole, minocycline and rifampicin against bacteria of carious and endodontic lesions of human deciduous teeth in vitro. Microb Ecol Health Dis. 1992;5(4):171–77.
36. 37. Sato T, Hoshino E, Uematsu H, Noda T. In vitro antimicrobial susceptibility to combinations of drugs of bacteria from carious and endodontic lesions of human deciduos teeth. Oral Microbiol Immunol. 1993;8(3):172–76.
37. 38. Aşık A, Önçağ Ö. Alternative endodontic technique in pediatric dentistry: lesion sterilization and tissue repair. Clin Dent Rev. 2022;6(1):1-6.
38. 39. Triveni MN, Dhaval P RM. Lesion sterilization and tissue repair (LSTR) technique and its clinical application in primary and permanent teeth: a review. Ann Essence Dent. 2019;11(4):1-6.
39. 40. Grieve AR, Friend LA, Plant CG. A clinical trial of three root canal medicaments. Br Dent J. 1973;134(5):188-93.
40. 41. Pinky C, Shashibhushan KK, Subbareddy VV. Endodontic treatment of necrosed primary teeth using two different combinations of antibacterial drugs: an in vivo study. J Indian Soc Pedod Prev Dent. 2011;29(2):121-27.
41. 42. Fouad AF. The microbial challenge to pulp regeneration. Adv Dent Res. 2011;23(3):285-89.
42. 43. Anila B, Murali H, Cheranjeevi J, Kapil RS. Lesion sterilization and tissue repair (LSTR): a review. J Sci Dent. 2014;4(2):49-55.
43. 44. Pintor AV, Dos Santos MR, Ferreira DM, Barcelos R, Primo LG, Maia LC. Does smear layer removal influence root canal therapy outcome? a systematic review. J Clin Pediatr Dent. 2016;40(1):1–7.
44. 45. Barcelos R, Tannure PN, Gleiser R, Luiz RR, Primo LG. The influence of smear layer removal on primary tooth pulpectomy outcome: a 24-month, double-blind, randomized, and controlled clinical trial evaluation. Int J Paediatr Dent. 2012;22(5):369–81.
45. 46. Ali M, Moral AA, Quader SMA. Evaluation of pain and tenderness in endodontic treatment of deciduous teeth using (LSTR) 3-mix MP therapy. UpDCJ. 2017;7(2):9–14.
46. 47. Doneria D, Thakur S, Singhal P, Chauhan D, Keshav K, Uppal A. In search of a novel substitute: clinical and radiological success of lesion sterilization and tissue repair with modified 3mix-mp antibiotic paste and conventional pulpectomy for primary molars with pulp involvement with 18 months follow-up. Contemp Clin Dent. 2017;8(4):514–21.
47. 48. Gillen BM, Looney SW, Gu LS, Loushine BA, Weller RN, Loushine RJ, et al. Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis. J Endod. 2011;37(7):895–902.
48. 49. Duanduan A, Sirimaharaj V, Chompu-inwai P. Retrospective study of pulpectomy with Vitapex® and LSTR with three antibiotics combination (3Mix) for non-vital pulp treatment in primary teeth. CMU J Nat Sci. 2013;12(2):131–39.
49. 50. Qadeer S, Munir B, Yousuf Dar S. Comparison of effectiveness of triple antibiotic paste (3mix) and Vitapex for root canal treatment of pulpally involved primary molars. PODJ. 2016;36(4):