Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objective

To assess whether lesion sterilization and tissue repair (LSTR) technique resulted in similar clinical and radiographic success outcomes as compared with pulpectomy in primary teeth.

Materials and methods

Randomized clinical trials comparing LSTR with pulpectomy by means of clinical and radiographic parameters were included. Risk of bias was assessed using Cochrane methodology and the certainty of evidence was determined by GRADE.

Results

Six articles were included. Conventional pulpectomy was favored with respect to radiographic success frequency in the systematic review. Four studies were included in meta-analyses. Based on the clinical results at 6 months (RR = 0.99, 95% CI, 0.94–1.04, p = 0.67; I2 = 0%), 12 months (RR = 0.97, 95% CI, 0.90–1.04, p = 0.34; I2 = 0%), and 18 months (RR = 0.89, 95% CI, 0.77–1.04, p = 0.14; I2 = 0%) and radiographic findings at 6 months (RR = 0.91, 95% CI, 0.78–1.06, p = 0.23; I2 = 9%), 12 months (RR = 0.87, 95% CI, 0.65–1.18, p = 0.38; I2 = 64%), and 18 months (RR = 0.84, 95% CI, 0.69–1.02, p = 0.08; I2 = 0%), there was no difference observed regarding success between the two treatments. The quality of evidence ranged from moderate to very low.

Conclusions

No difference between the LSTR and pulpectomy approaches could be confirmed by meta-analyses. The quality of evidence according to the GRADE scheme ranged from moderate to very low.

Clinical relevance

The present meta-analyses could not demonstrate the superiority of one treatment over the other.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ahmed HM (2014) Pulpectomy procedures in primary molar teeth. Eur J Gen Dent 3:3–10

    Article  Google Scholar 

  2. AAPD. American Academy on Pediatric Dentistry Clinical Affairs Committee – Pulp Therapy Subcommittee (2019-2020) Pulp therapy for primary and immature permanent teeth. Pediatr Dent:353–361

  3. Poornima P, Subba Reddy VV (2008) Comparison of digital radiography, decalcification, and histologic sectioning in the detection of accessory canals in furcation areas of human primary molars. J Indian Soc Pedod Prev Dent Jun 26(2):49–52

    Article  Google Scholar 

  4. Takushige T, Cruz EV, Asgor Moral A, Hoshino E (2004) Endodontic treatment of primary teeth using a combination of antibacterial drugs. Int Endod J Feb 37(2):132–138

    Article  Google Scholar 

  5. Hoshino E, Iwaku M, Sato M, Ando N, Kota K (1989) Bactericidal efficacy of metronidazole against bacteria of human carious dentin in vivo. Caries Res 23(2):78–80

    Article  Google Scholar 

  6. Sato T, Hoshino E, Uematsu H, Noda T (1993) In vitro antimicrobial susceptibility to combinations of drugs of bacteria from carious and endodontic lesions of human deciduos teeth. Oral Microbiol Immunol Jun 8(3):172–176

    Article  Google Scholar 

  7. Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, Iwaku M (1996) In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J Mar 29(2):125–130

    Article  Google Scholar 

  8. Ali M, Moral AA, Quader SMA (2017) Evaluation of pain and tenderness in endodontic treatment of deciduous teeth using (LSTR) 3-mix MP therapy. UpDCJ Oct 7(2):09–14

    Google Scholar 

  9. Nakornchai S, Banditsing P, Visetratana N (2010) Clinical evaluation of 3Mix and Vitapex® as treatment options for pulpally involved primary molars. Int J Paediatr Dent May 20(3):214–221

    Article  Google Scholar 

  10. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med Jul 21;6(7):e1000097

  11. Ryan R, Hill S (2019) How to GRADE the quality of the evidence. Cochrane Consumers and Communication Group http://cccrgcochraneorg/author-resources Version 30 March 2019. Accessed 26 July 2019

  12. Agarwal M, Mohan UD, Vishwanath D (2011) A comparative evaluation of noninstrumentation endodontic techniques with conventional ZOE pulpectomy in deciduous molars: an in vivo study. WJD Jul-Sep 2(3):187–192

  13. Daher A, Viana KA, Lees CR, Costa LR (2015) Ineffectiveness of antibiotic-based pulpotomy for primary molars: a survival analysis. Pesqui Bras Odontopediatria Clín Integr 15(1):205–215

  14. Divya DV, Prasad MG, Radhakrishna AN, Sandeep RV, Reddy SP, Santosh Kumar KV (2019) Triple antibiotic paste versus propolis: a clinical quest for the reliable treatment of periapical lesions in primary molars. Saudi Endod J 9:34–39

    Google Scholar 

  15. Doneria D, Thakur S, Singhal P, Chauhan D, Keshav K, Uppal A (2017) 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 Oct-Dec 8(4):514–521

  16. Zacharczuk GA, Toscano MA, López GE, Ortolani AM (2019) Evaluation of 3Mix-MP and pulpectomies in non-vital primary molars. Acta Odontol Latinoam 32(1):22–28

    PubMed  Google Scholar 

  17. Grewal N, Sharma N, Chawla S (2018) Comparison of resorption rate of primary teeth treated with alternative lesion sterilization and tissue repair and conventional endodontic treatment: an in vivo randomized clinical trial. J Indian Soc Pedod Prev Dent 36:262–267

    Article  Google Scholar 

  18. Rewal N, Thakur AS, Sachdev V, Mahajan N (2014) Comparison of endoflas and zinc oxide eugenol as root canal filling materials in primary dentition. J Indian Soc Pedod Prev Dent 32:317–321

    Article  Google Scholar 

  19. Prabhakar AR, Sridevi E, Raju OS, Satish V (2008) Endodontic treatment of primary teeth using combination of antibacterial drugs: an in vivo study. J Indian Soc Pedod Prev Dent Jan;26 Suppl 1:S5-10

  20. Najjar RS, Alamoudi NM, El-Housseiny AA, Al Tuwirqi AA, Sabbagh HJ (2019) A comparison of calcium hydroxide/iodoform paste and zinc oxide eugenol as root filling materials for pulpectomy in primary teeth: a systematic review and meta-analysis. Clin Exp Dent Res Mar 4;5(3):294-310

  21. Smaïl-Faugeron V, Glenny AM, Courson F, Durieux P, Muller-Bolla M, Fron Chabouis H (2018) Pulp treatment for extensive decay in primary teeth. Cochrane Database Syst Rev May 31;5:CD003220

  22. Rodd HD, Waterhouse PJ, Fuks AB, Fayle SA, Moffat MA (2006) British Society of Paediatric Dentistry. Pulp therapy for primary molars. Int J Paediatr Dent Sep;16 Suppl 1:15-23

  23. Sato T, Hoshino E, Uematsu H, Kota K, Iwaku M, Noda T (1992) 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 5(4):171–177

  24. Reddy GA, Sridevi E, Sai Sankar AJ, Pranitha K, Pratap Gowd MJS, Vinay C (2017) Endodontic treatment of chronically infected primary teeth using triple antibiotic paste: an in vivo study. J Conserv Dent Nov-Dec 20(6):405–410

    Article  Google Scholar 

  25. Pintor AV, Dos Santos MR, Ferreira DM, Barcelos R, Primo LG, Maia LC (2016) Does smear layer removal influence root canal therapy outcome? A systematic review. J Clin Pediatr Dent Winter 40(1):1–7

    Article  Google Scholar 

  26. Barcelos R, Tannure PN, Gleiser R, Luiz RR, Primo LG (2012) 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 Sep 22(5):369–381

    Article  Google Scholar 

  27. Gillen BM, Looney SW, Gu LS, Loushine BA, Weller RN, Loushine RJ, Pashley DH, Tay FR (2011) 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 37(7):895–902

    Article  Google Scholar 

  28. Duanduan A, Sirimaharaj V, Chompu-inwai P (2013) 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 12(2):131–139

    Google Scholar 

  29. Moskovitz M, Sammara E, Holan G (2005) Success rate of root canal treatment in primary molars. J Dent 33(1):41–47

    Article  Google Scholar 

  30. Qadeer S, Munir B, Yousuf Dar S (2016) Comparison of effectiveness of triple antibiotic paste (3mix) and Vitapex for root canal treatment of pulpally involved primary molars. Pakistan Oral & Dental Journal Oct-Dec 36(4):654–657

    Google Scholar 

  31. Tannure PN, Azevedo CP, Barcelos R, Gleiser R, Primo LG (2011) Long-term outcomes of primary tooth pulpectomy with and without smear layer removal: a randomized split-mouth clinical trial. Pediatr Dent Jul-Aug 33(4):316–320

    Google Scholar 

Download references

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES) (finance code 001) and Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) – APQ1 2010.352/2019 and E-26/202-399/2017.

Author information

Authors and Affiliations

  1. Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Av. Prof. Rodolpho Paulo Rocco, 325 – Cidade Universitária, Rio de Janeiro, RJ, CEP: 21941-913, Brazil

    Maysa Lannes Duarte, Paula Maciel Pires, Andréa Vaz Braga Pintor, Aline de Almeida Neves, Lucianne Cople Maia & Laura Guimarães Primo

  2. Central Library of the Health Science Center, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Daniele Masterson Ferreira

  3. Centre for Oral Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK

    Aline de Almeida Neves

Authors
  1. Maysa Lannes Duarte
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paula Maciel Pires
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniele Masterson Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andréa Vaz Braga Pintor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aline de Almeida Neves
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lucianne Cople Maia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laura Guimarães Primo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laura Guimarães Primo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duarte, M.L., Pires, P.M., Ferreira, D.M. et al. 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. Clin Oral Invest 24, 2959–2972 (2020). https://doi.org/10.1007/s00784-020-03415-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-020-03415-0

Keywords

Search

Navigation