Efficacy of the non-instrumentation endodontic treatment with CTZ paste in primary molars: Protocol of a multicenter randomized clinical trial with two years of follow-up

Authors

DOI:

https://doi.org/10.33448/rsd-v11i16.37140

Keywords:

Endodontic Treatment; Primary Teeth; Non-instrumentation technique; CTZ paste; Pulpectomy.

Abstract

Objective: There is a lack of high-quality evidence on the efficacy of the non-instrumentation endodontic treatment (NIET) in primary molars, compared to the conventional endodontic treatment technique. This protocol describes a multicenter randomized clinical trial that aims to evaluate the efficacy of a NIET technique for primary molars using a paste containing antibiotics (chloramphenicol and tetracycline – CTZ group) compared to a control group of conventional technique and root filling with zinc oxide eugenol (ZOE). Methodology: Children aged 3 to 9 years (N=218) will be randomly allocated to one of the groups: CTZ or ZOE. In CTZ, after the location of root canals entrance, irrigation will be performed using 1% sodium hypochlorite and CTZ paste will be placed over the root canal entrances, with no instrumentation of the root canals. In ZOE group, manual instrumentation of root canals with endodontic K-files will be performed, and then, the root canals will be filled with ZOE paste. At the same appointment, teeth will be restored with a double-seal of glass ionomer and a bulk fill resin composite. Children will be followed-up for 6, 12, 18 and 24 months. The primary endpoint will be the success of endodontic treatments evaluated by clinical and radiographic criteria after 24 months. Conclusions: NIET with CTZ paste could be an option to manage primary teeth, once the technique could have non-inferior efficacy to the conventional technique that involves root canal instrumentation. The approach could have good acceptance from children and parents considering the reduced clinical time.

References

Agarwal, S. R., Bendgude, V. D., & Kakodkar, P. (2019). Evaluation of Success Rate of Lesion Sterilization and Tissue Repair Compared to Vitapex in Pulpally Involved Primary Teeth: A Systematic Review. Journal of Conservative Dentistry, 22(6), 510–515. https://doi.org/10.4103/JCD.JCD_76_20

Barbosa, T. de S., Vicentin, M. D. S., & Gavião, M. B. D. (2011). Qualidade de vida e saúde bucal em crianças - Parte I: versão brasileira do Child Perceptions Questionnaire 8-10. Ciência & Saúde Coletiva, 16(10), 4077–4085. https://doi.org/10.1590/S1413-81232011001100013

Buchanan, H., & Niven, N. (2002). Validation of a Facial Image Scale to assess child dental anxiety. International Journal of Paediatric Dentistry, 12(1), 47–52. https://doi.org/10.1046/j.0960-7439.2001.00322.x

Cappiello, J. (1964). Tratamientos pulpares en incisivos primarios. Revista de La Asociación Odontológica Argentina, 52(4), 139–145.

Chan, A. W., Tetzlaff, J. M., Gøtzsche, P. C., Altman, D. G., Mann, H., Berlin, J. A., & Moher, D. (2013). SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ, 346, e7586. https://doi.org/10.1136/BMJ.E7586

Chouchene, F., Masmoudi, F., Baaziz, A., Maatouk, F., & Ghedira, H. (2021). Antibiotic Mixtures in Noninstrumental Endodontic Treatment of Primary Teeth with Necrotic Pulps: A Systematic Review. International Journal of Dentistry. https://doi.org/10.1155/2021/5518599

Coll, J. A., Dhar, V., Vargas, K., Chen, C. Y., Crystal, Y. O., AlShamali, S., & Marghalani, A. A. (2020). Use of Non-Vital Pulp Therapies in Primary Teeth. Pediatric Dentistry, 42(5), 337–349.

Coll, J. A., Vargas, K., Marghalani, A. A., Chen, C. Y., AlShamali, S., Dhar, V., & Crystal, Y. O. (2020). A Systematic Review and Meta-Analysis of Nonvital Pulp Therapy for Primary Teeth. Pediatric Dentistry, 42(4), 256–461.

De Deus Moura, L. de F. A., De Lima, M. de D. M., Lima, C. C. B., Machado, J. I. A. G., De Moura, M. S., & De Carvalho, P. V. (2016). Endodontic Treatment of Primary Molars with Antibiotic Paste: A Report of 38 Cases. The Journal of Clinical Pediatric Dentistry, 40(3), 175–177. https://doi.org/10.17796/1053-4628-40.3.175

de Oliveira, S. C. M., Floriano, I., Tedesco, T. K., Gimenez, T., Imparato, J. C. P., & Calvo, A. F. B. (2021). Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial. Brazilian Oral Research, 35. https://doi.org/10.1590/1807-3107BOR-2021.VOL35.0126

Duarte, M. L., Pires, P. M., Ferreira, D. M., Pintor, A. V. B., Neves, A. de A., Maia, L. C., & Primo, L. G. (2020). 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. Clinical Oral Investigations, 24(9), 2959–2972. https://doi.org/10.1007/S00784-020-03415-0

Frankl, S. N. (1962). Should the parent remain with the child in the dental operatory? Journal of Dentistry for Children, 29(2), 150–162.

Garrocho-Rangel, A., Jalomo-Ávila, C., Rosales-Berber, M. Á., & Pozos-Guillén, A. (2021). Lesion Sterilization Tissue Repair (LSTR) Approach Of Non-Vital Primary Molars With A Chloramphenicol-Tetracycline-ZOE Antibiotic Paste: A Scoping Review. The Journal of Clinical Pediatric Dentistry, 45(6), 369–375. https://doi.org/10.17796/1053-4625-45.6.1

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. International Endodontic Journal, 29(2), 125–130. https://doi.org/10.1111/J.1365-2591.1996.TB01173.X

Lima, C. C. B., Conde Júnior, A. M., Rizzo, M. S., Moura, R. D., Moura, M. S., Lima, M. D. M., & Moura, L. F. A. D. (2015). Biocompatibility of root filling pastes used in primary teeth. International Endodontic Journal, 48(5), 405–416. https://doi.org/10.1111/IEJ.12328

Lokade, A., Thakur, S., Singhal, P., Chauhan, D., & Jayam, C. (2019). Comparative evaluation of clinical and radiographic success of three different lesion sterilization and tissue repair techniques as treatment options in primary molars requiring pulpectomy: An in vivo study. Journal of the Indian Society of Pedodontics and Preventive Dentistry, 37(2), 185. https://doi.org/10.4103/JISPPD.JISPPD_6_19

Luengo-Fereira, J., Ayala-Jiménez, S., Carlos-Medrano, L. E., Toscano-Garciá, I., & Anaya-Álvarez, M. (2019). Clinical and Radiographic Evaluation of Formocresol and Chloramphenicol, Tetracycline and Zinc Oxide-Eugenol Antibiotic Paste in Primary Teeth Pulpotomies: 24 month follow up. The Journal of Clinical Pediatric Dentistry, 43(1), 16–21. https://doi.org/10.17796/1053-4625-43.1.4

Martins-Júnior, P. A., Ramos-Jorge, J., Paiva, S. M., Marques, L. S., & Ramos-Jorge, M. L. (2012). Validations of the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). Cadernos de Saúde Pública, 28(2), 367–374. https://doi.org/10.1590/S0102-311X2012000200015

Moura, J., Lima, M., Nogueira, N., Castro, M., Lima, C., Moura, M., & Moura, L. (2021). LSTR Antibiotic Paste Versus Zinc Oxide and Eugenol Pulpectomy for the Treatment of Primary Molars with Pulp Necrosis: A Randomized Controlled Trial. Pediatric Dentistry, 43(6), 435–442.

Piaggio, G., Elbourne, D. R., Pocock, S. J., Evans, S. J. W., & Altman, D. G. (2012). Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. JAMA, 308(24), 2594–2604. https://doi.org/10.1001/JAMA.2012.87802

Sato, I., Ando-Kurihara, N., Kota, K., Iwaku, M., & Hoshino, E. (1996). Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ. International Endodontic Journal, 29(2), 118–124. https://doi.org/10.1111/J.1365-2591.1996.TB01172.X

Sato, T., Hoshino, E., Uematsu, H., & Noda, T. (1993). In vitro antimicrobial susceptibility to combinations of drugs on bacteria from carious and endodontic lesions of human deciduous teeth. Oral Microbiology and Immunology, 8(3), 172–176. https://doi.org/10.1111/J.1399-302X.1993.TB00661.X

Smaïl-Faugeron, V., Glenny, A. M., Courson, F., Durieux, P., Muller-Bolla, M., & Fron Chabouis, H. (2018). Pulp treatment for extensive decay in primary teeth. The Cochrane Database of Systematic Reviews, 5(5). https://doi.org/10.1002/14651858.CD003220.PUB3

Sousa, H. C. S., de Lima, M. de D. M., Lima, C. C. B., de Moura, M. S., Bandeira, A. V. L., & de Deus Moura, L. de F. A. (2020). Prevalence of Enamel Defects in Premolars Whose Predecessors Were Treated with Extractions or Antibiotic Paste. Oral Health & Preventive Dentistry, 18(1), 793–798. https://doi.org/10.3290/J.OHPD.A45083

Takushige, T., Cruz, E. V., Asgor Moral, A., & Hoshino, E. (2004). Endodontic treatment of primary teeth using a combination of antibacterial drugs. International Endodontic Journal, 37(2), 132–138. https://doi.org/10.1111/J.0143-2885.2004.00771.X

Published

01/12/2022

How to Cite

SANTOS, P. S.; OLIVEIRA, N. M. de; RAMOS, T.; DORNELLAS, A. P. .; ROCHA, A. de O.; VITALI, F. C.; MOCCELINI, B. S.; RIGO, D. C. A. .; MARQUES, R. P. de S.; PONTES, L. R. A.; MATOS, J. de M. .; LOUVAIN, M. C.; SOVIERO, V. L. V. M.; FIDALGO, T. K. da S.; BOLAN, M.; SANTANA, C. M.; CARDOSO, M.; MENDES, F. M. Efficacy of the non-instrumentation endodontic treatment with CTZ paste in primary molars: Protocol of a multicenter randomized clinical trial with two years of follow-up. Research, Society and Development, [S. l.], v. 11, n. 16, p. e111111637140, 2022. DOI: 10.33448/rsd-v11i16.37140. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/37140. Acesso em: 19 apr. 2024.

Issue

Section

Health Sciences