Natália Matsuda de Oliveira

Background: Chloramphenicol, tetracycline, zinc oxide (CTZ) paste has been widely used, particularly in Latin America, in Lesion Sterilization and Tissue Repair (LSTR) procedures in primary molars. However, reports on its long-term efficacy are scarce. Aim: This multicentre non-inferiority randomised trial compared the efficacy of LSTR using CTZ paste with conventional zinc oxide-eugenol (ZOE) pulpectomy in primary molars. Design: 199 primary molars from children aged 3–9 years were randomised to the CTZ or ZOE groups. The primary outcome was clinical and radiographic success at 24 months. Clinical time, children’s behaviour, immediate discomfort and postoperative pain were also evaluated. The main analysis followed the intention-to-treat (ITT) principle, comparing success proportions with the Miettinen–Nurminen method, considering a prespecified non-inferiority margin of 15% (p < 0.05). Results: Overall success rates in the ITT population were 64.3% for CTZ and 58.7% for ZOE, with a difference of 5.6% (95% CI: −9.3 to 20.4; p p 0.05). Conclusion: LSTR with CTZ paste was non-inferior to conventional ZOE pulpectomy after 24 months of follow-up.

Background: Although reciprocating instrumentation has been extensively studied for permanent teeth, stronger evidence for its use in primary teeth is lacking.Aim: The aim of this randomized clinical trial was to compare the efficacy of endodontic treatment in primary molars using reciprocating (RECIP) and manual (MAN) instrumentation techniques after 24 months.Design: Primary molars with indication of endodontic treatment were randomly divided into two groups: MAN and RECIP. Treatments were performed, and root canals were filled with calcium hydroxide and iodoform paste. Teeth were later restored with bulk‐fill composite resin and re‐evaluated after 6, 12, 18, and 24 months. The primary outcome was the success of the endodontic treatment evaluated by Cox regression analysis adjusted by cluster and success rate after 24 months in the intention‐to‐treat (ITT) population. Instrumentation time, discomfort, postoperative pain, and quality of root canal filling were also evaluated as secondary endpoints.Results: A total of 151 primary win 107 children were included, and 137 were followed up for 24 months. Success rate of teeth allocated to the MAN group was 57.3% and 55.3% for RECIP (p = .792); MAN instrumentation, however, was more time‐consuming (p = .005).Conclusion: The efficacy of endodontic treatment in primary molars using reciprocating and manual instrumentation is similar after 24 months.

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.

In this study, we evaluated the physicochemical properties (PCP; radiopacity, flow, pH, and solubility) and the quality of root canal filling provided by an experimental industrialized paste (EP), with the same active ingredients as those of the Guedes Pinto paste, compared with the Vitapex® paste. PCP were analyzed according to the ANSI/ADA laboratory testing methods for endodontic filling and sealing materials. To analyze filling capacity, 120 artificial primary teeth (60 maxillary incisors [MIs] and 60 mandibulary molars [MMs]) were endodontically treated. The teeth were divided into eight groups based on the dental group (MIs or MMs), filling material (Vitapex® or EP), and insertion method (syringe or lentulo). The Image J® software was used to analyze the initial an final digital radiographies of each tooth, measuring and comparing root canal and void areas. The percentage of filling failure areas was obtained. Data were submitted to ANOVA and Tukey test of mean comparison. Regarding PCP, both pastes presented results according the ANSI/ADA standards. Flow capacity: Vitapex: 19.6 mm, EP: 25 mm (p < 0.01); radiopacity: Vitapex: 4.47 mmAl, EP: 6.06 mmAl (p < 0.01); pH after 28 days: Vitapex: 7.79, EP: 8.19 (p = 0.12); and solubility after 28 days: Vitapex: 2.68%, EP: 2.89% (p > 0.05). Regarding filling capacity analysis, EP demonstrated 12.5% of failure against 31.5% of Vitapex (p < 0.01). Compared to Vitapex, EP presented statistically significantly better results in flow, radiopacity, pH, and filling capacity. Molars presented more filling failures than incisors. The insertion method using a syringe and a thin tip was significantly better than that using Lentulo spiral carriers.