Lesion Sterilization and Tissue Repair (LSTR) Approach for Delaying Tooth Extraction: A Case Report

Sümeyye Kabak; Tuğçe Nur Şahin; Asu Çakır

doi:10.61139/ijdor.1814623

Lesion Sterilization and Tissue Repair (LSTR) Approach for Delaying Tooth Extraction: A Case Report

Abstract

Primary teeth may present with periradicular lesions too advanced to be managed by conventional endodontic treatment. Recent studies have shown that the Lesion Sterilization and Tissue Repair (LSTR) approach using triple-antibiotic pastes effectively eliminates root canal bacteria. This supports host immune-mediated tissue repair, thereby delaying tooth extraction. A six-year-old uncooperative girl presented with pain in mandibular primary molars 74 and 85, showing cavitated lesions, a buccal abscess, furcation involvement, distal root resorption in 74, and internal resorption in both mesial roots. Diagnosed with pulpal necrosis and chronic periapical periodontitis, LSTR therapy was applied after the family declined extraction under general anesthesia. Pain resolved by one month, lesions decreased with intermittent pain at three months, chronic pain fully resolved by six months, and at one year, sinus tract formation and advanced root resorption were noted, though the patient remained asymptomatic; follow-up continues. LSTR therapy is a practical interim option for retaining primary teeth otherwise indicated for extraction, though further studies are needed to clarify its long-term outcomes.

Keywords

Ethical Statement

A written consent form was obtained from the patient’s parent during the treatment process.

References

Şengüler B, Seyedoskuyi V, Akkuş G, Akdağ B, Doğan E, Aslantaş A, et al. Lesion sterilization and tissue repair in pediatric dentistry. Aydın Dent J. 2022;8(1):27-41.
Çakır İS, Bodrumlu EH. Lesion sterilization and tissue repair in pediatric dentistry. J Ege Univ Sch Dent. 2023;44(3):283-9.
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):446-50.
Bektaş Ö. An alternative approach in primary tooth endodontic treatment: lesion sterilization and tissue repair technique. HRU Int J Dent Oral Res. 2023;3(3):166-72.
Suresh S. Lesion sterilization and tissue repair (LSTR) technique. Academia Letters. 2021;Article 2423.
American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. Chicago, Ill; American Academy of Pediatric Dentistry; 384-392, 2020.
Kashyap N. LSTR - a new technique for treating deciduous teeth with pulpal infections. EC Dent Sci. 2023;22:1-4. He M, Du M, Fan M, Bian Z. In vitro activity of eugenol against Candida albicans biofilms. Mycopathologia. 2007;163(3):137-43.
Thosar N, Basak S, Bahadure RN, Rajurkar M. Antimicrobial efficacy of five essential oils against oral pathogens: an in vitro study. Eur J Dent. 2013;7(5):S71-7.

D’Avila Farias M, Oliveira PS, Dutra FSP, et al. Eugenol derivatives as potential antioxidants: is phenolic hydroxyl necessary to obtain an effect? J Pharm Pharmacol. 2014;66(5):733-46.
Hemalatha R, Nivetha P, Mohanapriya C, et al. Phytochemical composition, GC-MS analysis, in vitro antioxidant and antibacterial potential of clove flower bud (Eugenia caryophyllus) methanolic extract. J Food Sci Technol. 2015;52(11):1-10.
Venkadeswaran K, Thomas PA, Geraldine P. Experimental evaluation of the anti-atherogenic potential of Piper betle and its active constituent eugenol. Biomed Pharmacother. 2016;80:276-88.
Reis B, Barbosa C, Soares L, Brum S, Barbosa O, Marques M. In vitro analysis of antimicrobial activity of CTZ binder used as material plug in deciduous teeth pulp. Rev Pró-Univ. 2016;7(3):39-42.
Crystal YO, Fuks AB. Pulpotomy for primary teeth: techniques and materials. In: Fuks AB, Moskovitz M, Tickotsky N, editors. Contemporary endodontics for children and adolescents. Cham: Springer; 2023. p. 201-22.
Takushige T, Cruz EV, Asgor Moral A, Hoshino E. Endodontic treatment of primary teeth using a combination of antibacterial drugs. Int Endod J. 2004;37(2):132-38.
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(4):280-2.
Arangannal P, Muthiah G, Jeevarathan J, Sankar P. Lesion sterilization and tissue repair in nonvital primary teeth: an in vivo study. Contemp Clin Dent. 2019;10(1):31-5.
Kim JH, Kim Y, Shin SJ, Park JW, Jung IY. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod. 2010;36(6):1086-91.
Coll JA, Dhar V, Vargas K, Chen CY, Crystal YO, AlShamali S, et al. Use of non-vital pulp therapies in primary teeth. Pediatr Dent. 2020;42(5):337-49.
Diep SN. Retrospective analysis of pulpotomy medicaments and lesion sterilization and tissue repair in primary molars: a 24-month follow-up [dissertation]. Houston (TX): University of Texas School of Dentistry at Houston; 2024.
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(Suppl):S5-10.

Details

Primary Language

English

Subjects

Paedodontics

Journal Section

Case Report

Authors

Sümeyye Kabak ^*
0009-0004-3979-0916
Türkiye

Tuğçe Nur Şahin
0000-0002-7617-9719
Türkiye

Asu Çakır
0000-0003-1276-9709
Türkiye

Publication Date

August 31, 2026

Submission Date

November 6, 2025

Acceptance Date

February 26, 2026

Published in Issue

Year 2026 Volume: 6 Number: 2

DOI

https://doi.org/10.61139/ijdor.1814623

IZ

https://izlik.org/JA38SM79TJ

Cite

RIS / Bibtex

APA

Kabak, S., Şahin, T. N., & Çakır, A. (2026). Lesion Sterilization and Tissue Repair (LSTR) Approach for Delaying Tooth Extraction: A Case Report. HRU International Journal of Dentistry and Oral Research, 6(2), 186-193. https://doi.org/10.61139/ijdor.1814623

AMA

1.Kabak S, Şahin TN, Çakır A. Lesion Sterilization and Tissue Repair (LSTR) Approach for Delaying Tooth Extraction: A Case Report. HRU Int J Dent Oral Res. 2026;6(2):186-193. doi:10.61139/ijdor.1814623

Chicago

Kabak, Sümeyye, Tuğçe Nur Şahin, and Asu Çakır. 2026. “Lesion Sterilization and Tissue Repair (LSTR) Approach for Delaying Tooth Extraction: A Case Report”. HRU International Journal of Dentistry and Oral Research 6 (2): 186-93. https://doi.org/10.61139/ijdor.1814623.

EndNote

Kabak S, Şahin TN, Çakır A (August 1, 2026) Lesion Sterilization and Tissue Repair (LSTR) Approach for Delaying Tooth Extraction: A Case Report. HRU International Journal of Dentistry and Oral Research 6 2 186–193.

IEEE

[1]S. Kabak, T. N. Şahin, and A. Çakır, “Lesion Sterilization and Tissue Repair (LSTR) Approach for Delaying Tooth Extraction: A Case Report”, HRU Int J Dent Oral Res, vol. 6, no. 2, pp. 186–193, Aug. 2026, doi: 10.61139/ijdor.1814623.

ISNAD

Kabak, Sümeyye - Şahin, Tuğçe Nur - Çakır, Asu. “Lesion Sterilization and Tissue Repair (LSTR) Approach for Delaying Tooth Extraction: A Case Report”. HRU International Journal of Dentistry and Oral Research 6/2 (August 1, 2026): 186-193. https://doi.org/10.61139/ijdor.1814623.

JAMA

1.Kabak S, Şahin TN, Çakır A. Lesion Sterilization and Tissue Repair (LSTR) Approach for Delaying Tooth Extraction: A Case Report. HRU Int J Dent Oral Res. 2026;6:186–193.

MLA

Kabak, Sümeyye, et al. “Lesion Sterilization and Tissue Repair (LSTR) Approach for Delaying Tooth Extraction: A Case Report”. HRU International Journal of Dentistry and Oral Research, vol. 6, no. 2, Aug. 2026, pp. 186-93, doi:10.61139/ijdor.1814623.

Vancouver

1.Sümeyye Kabak, Tuğçe Nur Şahin, Asu Çakır. Lesion Sterilization and Tissue Repair (LSTR) Approach for Delaying Tooth Extraction: A Case Report. HRU Int J Dent Oral Res. 2026 Aug. 1;6(2):186-93. doi:10.61139/ijdor.1814623