Introduction

The gradual resorption of the primary molar roots by the succedaneous tooth bud or periapical tissues inflammation may alter the root position making the conventional root canal treatment (RCT) difficult for primary molars with necrotic pulp. Lesion sterilization and tissue repair (LSTR) or non‐instrumentation endodontic treatment (NIET) offer novel and less complicated alternatives to pulpectomy for treating necrotic primary molars. Recently, statins have demonstrated regenerative potential in dentistry, hence the integration of statins into the triple antibiotic paste may be a promising strategy for enhancing interradicular lesion healing.

Aim

To compare the clinical and radiographic outcomes of NIET using a modified antibiotic mix of cefixime, ciprofloxacin and metronidazole with simvastatin (an anti‐inflammatory, bone regeneration drug) on necrotic primary molars, as compared to conventional pulpectomy.

Patient Profile

• Children (age: 4-8 years) with necrotic pulp and evidence of pulp vitality loss in primary lower second molars (n=38)

  Methods

  Study Design

• A single-center interventional double‐blinded randomized clinical trial.

  Treatment Strategy

• Forty mandibular primary second molars were randomized 1:1 as follows:
• Group A:Teeth were treated with a conventional RCT with 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.
• Group B teeth: Teeth were treated with 3Mixtatin (100 mg each of metronidazole, cefixime, and ciprofloxacin, and 2 mg simvastatin) during NIET.

Assessments

• A standardized periapical radiograph was obtained for each tooth before treatment and during all follow‐up intervals (at 3, 6, and 12 months).
• All teeth were clinically evaluated after 1, 3, 6, and 12 months of the procedure.

Outcomes

Results

• The mean age of the study participants was 6.2 years.
• The total clinical success at 1 month of treatment was 95% for both the study groups. The overall clinical success rate did not differ significantly between the groups at 3 month-follow-up (100%, and 90%, respectively in group A and B).
• At the end of the follow‐up interval, 90% of teeth in each group had no clinical signs or symptoms.
• The radiographic evaluations did not differ significantly between the groups at 3-, 6-, and the 12-month follow-up (inter‐radicular radiolucency healing: 75% of cases in the NIET group and 89.5% in the conventional pulpectomy group, with no significant difference).

Conclusions

• NIET using 3Mixtatin appears to be a good alternative over conventional pulpectomy for treating necrotic primary molars.
• This treatment offers 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 decision to use LSTR in necrotic primary molars should be made meticulously by a dentist, after considering various factors such as the extent of infection, the condition of the tooth, and the overall oral health of the patient.
• The protocol used in this study is recommended for the LSTR technique.

Clin Exp Dent Res. 2024 Apr;10(2):e860.  doi: 10.1002/cre2.860.