Pulpectomy is the procedure of extirpating the diseased pulp associated with microorganism and debris from the canal and obturating with an antibacterial resorbable filling material and it is indicated when the inflammation of the pulpal tissue involves the radicular pulp or when nonvital tooth is diagnosed. Obturating the canal creates a fluid tight seal along the length of the root from the coronal opening to the apical system and eliminating all portals of entry between the periodontium and the root canal system.

1. OBTURATING MATERIALS FOR PULPECTOMY
IN PEDIATRIC DENTISTRY
DR PREM SHANKAR CHAUHAN

2. INTRODUCTION
• Primary teeth are the best space maintainers and hence should be preserved and retained as long as
possible.
• Pulpectomy is the procedure of extirpating the diseased pulp associated with microorganism and debris
from the canal and obturating with an antibacterial resorbable filling material and it is indicated when
the inflammation of the pulpal tissue involves the radicular pulp or when nonvital tooth is diagnosed.
• Ultimately, pulpectomy is needed to achieve good hermetic seal which depends on various factors such
as good biomechanical preparation, types of obturating material used and achievement of minimum
voids.
• Obturating the canal creates a fluid tight seal along the length of the root from the coronal opening to
the apical system and eliminating all portals of entry between the periodontium and the root canal
system.

3. Goals Of Any Procedure Performed In A
Primary Tooth
• Remove acute and chronic infection from tooth or oral cavity.
• Maintain tooth structure.
• Maintaining arch length.
• Preserve masticatory function.

4. Pulp therapy for primary teeth is a very
challenging situation
• Anatomy( tortuous and ribbon shaped) of the
primary teeth
• Roots get resorbed physiologically
• In order to allow for the development of the
succedaneous tooth, primary molar roots are
usually curved, these curves increase the chance
of perforation of the apical portion of the root or
the coronal one-third of the canal into the
furcation.

5. • Substances with antimicrobial properties are frequently used as root canal filling materials in
deciduous teeth.
• The main objective of endodontic treatment is total elimination of microorgansims from the root
canal and the prevention of subsequent reinfection which is achieved by proper cleaning and
shaping followed by the complete obturation of the canal space.

6. DISCUSSION
• The ultimate goal of endodontic obturation has remained the same for the past 50 years i.e. to
create a fluid-tight seal along the length of the root canal system from the coronal opening to the
apical termination.

7. Goals of obturation
• Fill the entire root canal system & complexities completely as closely as possible with a suitable
obturating materials so that no voids remain.
• Filling the root canal with a material that will resorb and give way for the eruption of the
permanent tooth.
• As there is developmental, anatomical & physiological differences between primary & permanent
teeth, there is difference in obturation techniques and materials from that of permanent teeth.

8. Criteria for an ideal pulpectomy obturant
(Rifkin & Rabinowitch)
1. Non-inflammatory and nonirritating to the
underlying permanent tooth
2. Radio-opacity for visualization on
radiographs
3. Ease of insertion
4. Resorbability
5. Ease of removal
6. Antiseptic property
7. Stable disinfecting power
8. Excess press beyond the apex should be re-
sorbed easily
9. Adhere to walls of the canal and should not
shrink
10. Insoluble in water
11. Should not discolor the tooth
12. Induce vital tissue to seal the canal with
calcified or connective tissue
13. Harmless to the adjacent permanent tooth
germ
14. Not set to a hard mass

9. Various root canal obturating materials for
primary teeth
ZINC OXIDE
EUGENOL
1.ZO+Propolis
2.ZO+Ozonated
oil
3.ZOE+CaOH+NF
4.Iodoformized
ZOE
5.ZO+Calen paste
6.ZO+CaOH
7.ZOE+Aldehydes
8.
IODOFORM BASED
PASTES
Iodoform
Walkhoff paste
KRI Paste
Maisto paste
Endoflas
Endoflas-
chlorophenol
free
Pulpotec
CALCIUM
HYDROXIDE BASED
PASTES
Calcium
hydroxide
Calen paste
CALCIUM
HYDROXIDE+I
ODOFORM
BASED PASTE
Vitapex
Metapex
OTHER
OBTURATING
MATERIALS
smartseal
Guedes pinto
paste
Chitra HAP-Fill
Aloevera
Ozone
Rifocort
CTZ Paste
Colla cote

10. Zinc Oxide Eugenol
• Bonastre (1837) discovered ZOE and it was subsequently used in dentistry by Chisholm
(1876), as one of the most widely used materials for root canal filling of primary teeth.
• It was first described by Sweet in 1930 and until 2008, it was the only material explicitly
recommended in the clinical guidelines developed by the AAPD.
• Usually, a thin mix of ZOE is made which allow the material to flow easily but it may push
the material beyond the apex. But if thick paste is used, it leads to underfilled canals (to
avoid this pressure syringe technique can be used, which was introduced by Camp in
1984).
• ZOE without any catalyst allows a longer working time for filling of canals.

11. • Zinc oxide–eugenol cement contains zinc oxide, rosin, and zinc acetate in the powder.
• The rosin increases fracture resistance and the zinc acetate is effective in accelerating the
reaction rate.
• The liquid is a preparation of eugenol, which reacts with the powder to form an amorphous
chelate of zinc eugenolate.

12. Advantages
1. Excellent antibacterial and analgesic effects (in lower concentrations)
2. Radiopaque for good radiographic visibility
3. Easy to manipulate & fill in the canals
4. Insoluble in tissue fluids
5. Easily available
6. Cost effective
7. No tooth discoloration

13. Disadvantages
1. Slow resorption
2. Irritation to the periapical tissues
3. Necrosis of bone and cementum of primary tooth
4. Harm the permanent tooth bud
5. Forms a fibrous capsule and alters the path of eruption

14. Shows authors and their observations for zinc
oxide eugenol.

16. Barr et al. in 1991, stated that after primary teeth with ZOE pulpectomies were lost, they did not find retained filler
particles associated with molar teeth. They reported that incisor pulpectomies may have retained ZOE initially after
exfoliation, but it was not seen on subsequent radiographs at follow-up.
Sadrian and Coll in 1993, stated that the data findings from their retrospective evaluation indicated that retained ZOE
tended to resorb with time which may reflect osteoclastic activity to reduce or eliminate retained ZOE particles. The filling
material took a mean time of 50.1 months for Zinc oxide eugenol to resorb. In the cases in which ZOE was retained, 80%
showed significant reduction of the retained filler’s size over time. Thus, they advised that it is better to fill canals short of
the apex rather than to the apex or beyond, to avoid retention. None of the retained filler particles caused any observed
pathology. They concluded that retained Zinc oxide eugenol was not related to the pulpectomy success or failure.
Holan and Fuks (1993), reported that, permanent incisors that replace traumatized deciduous incisors treated with Zinc
oxide eugenol pulpectomies have 2-3 times higher incidence of enamel defects when compared to normal teeth. They
Compared pulpectomies of nonvital primary molars using ZOE and KRI paste, it was concluded that KRI paste presented
with a higher success than ZOE in cases of first molars, maxillary molars and overfilling of the canals. Success rates for both
ZOE and KRI were similar in underfilled teeth and slightly higher for KRI paste when fillings were flush to the apex.

17. • To improve the properties and success rate of zinc oxide eugenol combination with different
components were used like formocresol, formaldehyde and paraformaldehyde and cresol but the
addition of these compounds neither elevated the success rate nor made the material more
resorbable as compared to zinc oxide eugenol alone.
• A study was conducted in which iodoformized zinc oxide eugenol was tested for its antibacterial
effect against the aerobic and anaerobic bacteria obtained from the root canals of primary teeth
and was found to be effective for both the aerobic and anaerobic bacteria of the root canals of
primary teeth with maximum sustaining period of 10 days.

18. zinc oxide combinations with other materials

19. Calcium hydroxide
• Calcium hydroxide was introduced by Herman.
• The main drawback of the material is that despite of its antiseptic and
osteoconductive properties, it has the tendency to get depleted from
the canals earlier than the physiologic root resorption.
• Antibacterial effect is primarily due to the liberation of hydroxyl ions
and inactivation of enzymes in the bacterial cytoplasmic membrane.

20. • Calcium hydroxide containing root canal filling materials can trigger inflammatory root resorption when
come in contact with some vital tissue , when used in primary teeth with hyperemic pulp.
• Also, when this paste is used in necrotic pulp , it produces a superficial layer of necrosis causing damage
to dentin which, in turn can lead to exposure of dentin to odontoclasts and cause subsequent damage.
• The alkaline property of the calcium hydroxide was said to counteract the inflammatory process by
activating the alkaline phosphatase activity and acting as a local buffer, which was important for hard
tissue formation.

21. • Chawla HS et al (1998) conducted a pilot study in primary molars where Calcium Hydroxide paste was used as
root canal filling material. Clinical and radiographic follow-up for 6 months was carried out at 2 months
interval, revealed that the treated teeth with Ca(OH)2 as root canal filling material were successful, which
show no pain and tenderness to percussion. Decrease in size of radiolucency was seen.
Showing antibacterial properties of calcium hydroxide reported by various authors.

22. Iodoform pastes
Iodoform
• It is a preparation of iodine obtained by action of chlorinated lime upon an alcoholic solution of potassium
iodide when heated at 1040°F.
• No irritant action. Relieves pain and is a potent disinfectant.
• Better resorbability and disinfectant properties than ZOE.
• Iodoform because of the presence of iodine causes yellowish discoloration of the tooth that may
compromise the esthetics.
Castagnola and Orlay showed that iodoform pastes are bactericidal to microorganisms in the root canal and
lose only 20% of their potency over a period of 10 years.

23. Walkhoff Paste
Composition
1. Iodoform
2. Parachlorophenol (33-37%)
Used as antiseptic agent which dissolve albumin and therefore progressively penetrate into the canaliculi of the
tooth.
3. Camphor (63-67%)
• Treat pain
• Arrest the hemorrhage
4. Menthol (1.40-2.90%.)
• Anodyne
• Antispasmodic
• Antiseptic
• External remedy in facial neuralgia, odontalgia, as an obtunder of sensitive dentin as a local anesthetic.

24. KRI Paste
• KRI paste is basically an iodoform paste, was introduced by Volkoff as a resorbable paste suitable for root
canal filling.
• According to Rifkin, it meets all criteria required from an ideal root canal filling material for primary teeth.
• It was also found to have long-lasting bactericidal potential.
• Overall success rate for KRl paste was 84% versus 65% for ZOE.

25. Kri-1: In 1989, a procedure was published for root canal preparation and filling in necrotic primary molars
with a paste made of Kri-1 and pure calcium hydroxide obtaining a high percentage of success with
remission of all symptoms.
• This was the first publication in which formaldehyde was mentioned as a component of root canal
filling material, thus partly recovering Buckley’s formula, which contained 40% formaldehyde and
glycerine.
KRI-3: This liquid differs from commonly used KRI-1 paste in that, its parachlorophenol, camphor and
menthol concentration are twelve times superior and hence possess greater antimicrobial properties.
Holan G et al (1993) found that the success rates of 84% with KRI paste group verus 65% with ZOE group. Overfills
more successful KRI paste 79% versus ZOE 41%. The excess paste will resorb without causing any adverse side effecs.

26. Maisto Paste
Composition
1. Zinc oxide -14g
2. Iodoform-42 g,
3. thymol-2 g,
4. Chlorophenol camphor-3 cc,
5. lanolin – 0.5 g.
It differs from KRI paste, in that it also contains Zinc oxide, thymol and lanolin. It reduces the resorption rate
of the paste from within the canals of endodontically treated primary teeth.
Pabla T et al (1997) evaluated the antimicrobial efficacy of Zinc Oxide Eugenol, Iodoform paste, KRI paste, Maisto
paste and Vitapex against aerobic and anaerobic bacteria from infected nonvital primary anterior teeth. Order of
antimicrobial activity: Maisto paste > Iodoform paste> Zinc Oxide Eugenol> Vitapex.

27. Vitapex/Metapex
• Vitapex was introduced by Kawakami et al in 1979.
• Metapex (METABIOMED) and Vitapex (Neo Dental Chemical Products Co., Ltd, Tokyo, Japan) are available
in preformed syringes, which is directly placed into the canals and the material is extruded by simple
pressure.
• Addition of polysiloxane oil in Vitapex, enhances fluidity and permeability, which also improves the
collateral benefit of root canal filling.

28. COMPOSITION

29. • The fast resorption of metapex and
vitapex, causes voids in the canal leading
to formation of hollow tube.
Prevention of intra radicular resorption
thereby preventing hollow tube effect
• Mortazavi and Mesbahi who treated
children in two visits, performed
formocresol pulpotomy on the first visit
and then preparation and obturation of
the canals in the second visit. It is
possible that foreign body giant cells may
have been chemically fixed, thus losing
their ability to resorb the vitapex paste in
the root canals.

30. • In 2009, AAPD guidelines cited iodoform based pastes as suitable alternatives to zinc oxide eugenol. The
silicone oil content of metapex neutralizes the alkalinity of the paste to a certain extent, thereby causing lesser
injury to the periapical tissues.
• Calcium hydroxide - iodoform mixture (Metapex) is considered to be an ideal pulpal filling material for primary
teeth, but it resorbs a little faster than the rate of normal physiologic root resorption.
• Clinical success rate of 96.8% and radiographic success rate of 72.5% was reported for metapex. Metapex
easily resorbs from the periapical areas, no foreign-body reaction, and it has a potent germicidal properties
are the needs fulfilled by iodoform pastes that can successfully be used as root canal filling material.
• In a study by Mortazavi and Mesbahi, it was found that in comparison with ZOE and Vitapex, the
comprehensive success rates of Vitapex and ZOE were found to be 100% and 78.5%, respectively.
• The higher number of overfilled canals and presence of voids observed with Metapex is due to the thinner
consistency of the premixed paste which may flow more easily into the narrow and tortuous canals of primary
molars and reach the apex or even beyond.

31. Doneria D et al (2017) in their study evaluated the clinical and radiographic success of zinc oxide-ozonated oil (ZnO-
OO), modified 3Mix antibiotic paste and Vitapex in treatment of primary molars requiring pulpectomy. On the basis
of the over-all success rates of all the three medicaments, following order of performance can be inferred clinical
success and radiographical success:- ZnO-OO(100%)=Vitapex(100%)> modified 3MIX-MP paste.(95.8% and 79.2%).
Advantage
• Non toxic to permanent successor tooth
• Antiseptic action
• Good adherence to the canal walls
• Non- setting to a hard mass
• Resorption faster than root, complete resorption
of the excess paste is expected within 2-8 weeks.
• Applicability of the material is easier
• Radiopaque
Disadvantage
• Rapid elimination of iodoform by the organism
leaves behind empty spaces inside the root canal
• Pushed beyond the apex
• Discoloration of the teeth

32. Showing antibacterial properties of Vitapex and Metapex reported by various authors.

33. Endoflas
Endoflas is a resorbable paste manufactured in South America available in powder liquid
form.
Since the resorption rate of Endoflas is similar to that of the physiological root resorption rate, the resorption is
limited to the obturation material that is extruded beyond the apex extra without the resorption of the material
inside the root canal.

34. Navit S et al (2016) evaluated the antimicrobial efficacy of obturating materials against E. faecalis, amongst all the
groups Endoflas had significantly higher zone of inhibition. Antimicrobial efficacy of various materials according to
this study can be summarized as follows: Endoflas > ZOE >Calcium hydroxide + Chlorhexidine > Calcium hydroxide +
Iodoform +Distilled water ~ Metapex > Saline.
Advantages
1. Hydrophilic and can be used in mildly humid canals.
2. Firmly adheres to the surface of the root canals to
provide a good seal.
3. Disinfect dentinal tubules and difficult to reach
accessory canals that cannot be disinfected or
cleansed mechanically.
4. Only resorbs when extruded extraradicularly, but does
not wash out intra-radicularly
Disadvantage
1. Periapical irritation
2. Tooth discoloration

35. Ramar and Mungra compared the clinical and radiographic evaluation of Metapex, RC fill, and Endoflas for a
duration of 9 months. Results showed that Endoflas gave an overall success rate of 95.1%, Metapex 90.5%, and RC
Fill 84.7%.
Endoflas has a high success rate when compared to that of zinc oxide eugenol. It has a clinically proven success
rate of 93.3%–95.1%. However, the success rate is lower (58%–76%) when extruded beyond the apex.
Praveen et al (2011) cited that the hydrophilic property of endoflas made obturation compatible in even mildly
humid canals. Owing to its broad spectrum of antibacterial activity, it can disinfect dentinal tubules and difficult to
reach accessory canals which cannot be cleansed mechanically.
Rewal et al. indicated that Endoflas with a success rate of 100% is a superior material compared to ZOE.

36. Showing antibacterial properties of Endoflas reported by various authors.

38. Following endodontic treatment of primary teeth radiolucent lesions were may be due to the
filling material that contain phenol. Chlorophenol was eliminated from endoflas as it has
fixation effect which may affect the osteoblast cells.
Endoflas-Chlorophenol-free (CF)

39. • It is a calcium hydroxide-based paste.
• Calen paste exhibits biocompatibility, high antimicrobial activity and
satisfactory clinical, radiographic outcomes and intermediate setting time
values.
• The mean initial pH was 6.1 and it exhibited a progressive increase until
reaching a peak at the five-hour time point with mean ph value of 8.4. It
has high registration levels, which indicate high radiopacity and lower
solubility when compared with the other groups.
Calen paste
Pinto DN et al (2011) compared success rate of ZOE and calen paste thickened with zinc oxide. High success rate
with calen/zo was seen as this material prevented pathologic root resorption and induced new bone formation.
ZnO provides better consistency to the paste.

40. Smartseal
• It is a root canal obturating material which is based on polymer technology.
• It uses a hydrophilic principle which can absorb surrounding moisture and expand which results in filling of
spaces and voids.
• Hydrophilic nature is revealed by ProPoints, which permits infinite water volume existing in the root canal
system that is engrossed by these points.
• This water may hydrogen bond to the existing polar locations, therefore, permitting the enlargement inside
the polymeric chains.
Advantages
• Geometry of point can be accurately made
• Biocompatibility
• Controlled expansion

41. Guedes Pinto Paste
Introduced by Guedes Pinto in 1991.

42. Advantages
• Easy to apply
• Faster resorption than root
• No toxic effects on permanent
successor
• Radiopaque
Disadvantages
• Pulp obliteration due to osteogenic potential
• Induces internal resorption in primary teeth
• Lack of adhesion to the hard tissue, leading to inadequate seal against
microleakage
• Can be depleted from canal
• Resorbs earlier than the physiological resorption of the roots
Study by Praetzel [2008] confirms that GP paste had a favorable antimicrobial action along with an
exceptional diffusion capability against all the microorganisms. Antimicrobial action of GP occurred in
decreasing order against: Bacillus subtilis, Streptococcus oralis, Streptococcus mutans, Staphylococcus
epidermis, Escherichia coli, Staphylococcus aureus and Enterococcus faecalis.

43. Chitra HAP-Fil
It is a hydroxyapatite nanoparticle gel based root filler material which corresponds to the bone and dentin′s
mineral content. It is highly biocompatible. “Chitra HAP-Fil” satisfies all requirements of an ideal pulpectomy
material.
Jeeva PP et al (2014) conducted a study to investigate the microbial and cellular response of Chitra HAP-Fil in
comparison with Zinc oxide eugenol and Metapex. They evaluated the antimicrobial and cytotoxic activity of
three pulpectomy materials. It was found that the Metapex is significantly least cytotoxic than Chitra HAP Fil
which is less cytotoxic than Zinc oxide eugenol.

44. Pulpotec
• It has antibacterial, antiseptic and anti-inflammatory properties. Iodoform is the main
component and because of its antiseptic properties, it acts like an antibiotic paste at
the entry of the empty root canal.
• It can be used in teeth with bone lesion and also help in reducing the infection
clinically.
• Clinical and Radiolographical results show that this procedure could be considered as
an alternative to the conventional endodontic treatment for the treatment of necrotic
primary teeth in paediatric dentistry.
Aboujaoude S et al (2015) in their study evaluated the effectiveness of a Pulpotec modified endodontic approach
on primary molars presenting necrotic pulp and furcation bone loss in a cohort of healthy children. In this study
67.7% of patients showed healing of bone loss, and a significant difference in height and width of the lesion was
observed (respectively 80.6%, 71%).

45. Aloe vera
• It is a herbal material that has been founded naturally and because of its properties,
it can be used widely in dentistry for various therapeutic properties.
• Various phases of wound healing process has been enhanced by Aloe vera such as
macrophage recruitment, collagen synthesis and wound contraction.
• The chemical constituents of it are part of the physiological functions of living flora
and hence, they have better compatibility with the human body.
• It can be used for various preventive purposes owing to its anti-inflammatory,
antifungal, moisturizing, antibacterial, antiviral and pain-relieving properties.
Khairwa A et al (2014) evaluated clinical and radiographic success of zinc oxide combined with aloe vera and
showed good success rate. They reported that this material can be used as an alternative for zinc oxide eugenol.

46. TULSI (OCIMUM SANCTUM)
• Jaidka S et al in 2014 The antimicrobial efficacy of obturating materials used in primary teeth was
evaluated against E. Faecalis. Materials zinc oxide eugenol, zinc oxide with tulsi extract and zinc oxide
with aloe vera as obturating materials.
• Intergroup comparison revealed significant difference amongst all the groups except between zinc
oxide eugenol and zinc oxide with tulsi extract. Zinc oxide eugenol had significantly higher zone of
inhibition among all the groups.
• According to results obtained from the present study can be summarized as follows: Zinc oxide
eugenol > Zinc oxide with tulsi extract > Zinc oxide with aloe vera

47. Ozone
Ozone is energized and gaseous form of oxygen. It is unstable and dissociates readily back into oxygen, thereby
liberating a strong oxidizing agent i.e. Nascent oxygen which is responsible for bactericidal and fungicidal effects.
Chandra SP et al (2014) conducted a study and found good clinical success rate at 12 months follow up, which
was attributed to the antibacterial and excellent healing properties of ozone peroxides. Radiographic success rate
of ZOE was less than that of ozonated oil-ZOE. It was concluded that Ozone can be considered as a good
alternative for ZOE.

48. Rifocort
It is a product formed from a corticosteroid and an antibiotic, presenting a great antimicrobial action and
recommended for the treatment of primary teeth presenting with pulpal infectious processes. The paste also
presented bactericidal action against most organisms except for Enterococcus faecalis and Bacillus subtilis.

49. CTZ Paste
• CTZ is an antibiotic paste Comibation of chloramphenicol 500mg+tetracycline 500mg+zinc oxide 1000mg+
eugenol 1 drop.
• Chloramphenicol is an antimicrobial agent that acts against a large number of aerobic, facultative
anaerobe and spirochetes as well as gram +ve and gram –ve microorganisms.
• Tetracycline is a broad spectrum antibiotic which can be bactericidal at high conc. offering excellent
effectiveness against gram –ve bacteria and all anaerobes.
• ZOE provides analgesic properties and potent antibacterial action against staphylococcus, micrococci,
bacillus and enterobacteria for more than 30 days.

50. Advantages
• Simple and easy application
• Antibacterial property
• Stabilization of bone resorption
• Does not cause tissue sensitivity
• Does not produce damage to the permanent tooth in development
Disadvantages
• Pigmentation of the crown of the treated tooth
Fereira JL et al (2017) evaluate the clinical and radiographic CTZ (Chloramphenicol-Tetracycline-Zinc Eugenol
Oxide) antibiotic paste in pulpotomies of primary molars. 93% and 88.4% clinically; 97.7%and 93% were
radiographic at 6 and 12 months respectively.

51. Mixture of zinc oxide powder calcium
hydroxide in sodium fluoride
• In the study conducted by Chawla a mixture of zinc oxide powder and calcium hydroxide paste in
sodium fluoride displayed moderate inhibitory activity against, Staphylococcus epidermidis,
Streptococcus mutans, Staphylococcus aureus and Bacillus subtilis and other gram positive micro-
organisms.
• It showed weak inhibition against Enterococcus faecalis.
• The improved efficacy of this mixture could be attributed to the addition of fluoride, whose
antimicrobial effect is well established.

52. COLLA COTE
• It is a soft white pliable biocompatible sponge obtained from bovine collagen
• It can be applied to moist or bleeding canals
• Its an absorbable collagen barrier which prevents or diminishes extravasation of root
canal filling material during primary molar pulpectomies.
• Also can be used as a scaffold for bone growth and so can be applied on the wounds.

53. ROLE OF COLLA COTE
• Physiological and pathological resorptive process change the position of the apical
foramen almost continuously.
• Bleeding from periapex makes obturation difficult, colla cote can be used as an apical
stop, or barrier over which obturant can be filled.
• Colla cote is widely used in endodontic therapy. When left inside a periapical defect,
colla cote gradually resorbs providing a scaffold for bone deposition and growth.

54. FRANK’S PASTE
• Combination of calcium hydroxide + champhorated parachlorophenol
• It is well tolerated by adjacent periapical tissue without any inflammation &
with deposition of osteodentin.

55. Lesion sterilization and tissue repair (LSTR)
• In recent years, Cariology Research Unit of Niigata University School of Dentistry has developed the concept of
LSTR.
• The theory behind LSTR is that the repair of damaged tissue might occur if lesions are disinfected.
• This has also been referred to non-instrumentation endodontic treatment (NIET).
• The mix is also called as triple antibiotic paste/polyantibiotic paste, antibiotic mixture.
• It uses a mixture of 3 antibiotics.
1. Metronidazole
2. ciprofloxacin
3. minocycline.
• The walls of access cavity were chemically cleaned with EDTA, a chelating agent, which is used to improve the
chemo mechanical debridement because of its ability to remove smear layer and allowing antibiotics to
penetrate into the dentinal tubules. Pulpal floor is covered with 3 mix-MP. The procedure which is termed as
“medication cavity”.

56. Authors and their observations on LSTR procedure

60. Toxicity and Biocompatibility
• ZOE when combine with formocresol increases its antibacterial efficacy but, formorcresol has been
demonstrated to be toxic to pulp fibroblast and eugenol has been shown to be toxic to human
submandibular gland carcinoma (HSG) cells .
• Huang et al. [2007] reported that root canal filling materials with strong antibacterial additions showed
definitive cytotoxicity to U2OS cells. Contrary to the antibacterial effects, Vitapex and Ca(OH)2 with iodoform
paste showed good biocompatibility i.e. high survival rate of the U2OS cells but had low antibacterial effects.
• It was reported that iodoform based tooth filling pastes caused considerable tissue necrosis and had a higher
cytotoxicity than ZOE. They concluded that, when primary root filling materials have strong antibacterial
properties, the cytotoxicity is strong too.

61. • ZOE though has antibacterial properties better than other materials concerns are raised regarding its delayed
resorption and toxicity which limits its use in current practice.
• To overcome the toxicity, aloe vera and ozonated oil was substituted for eugenol and the authors reported
good clinical and radiographic success rates. Hence, these materials can be used as alternatives to traditional
ZOE.
• Ca(OH)2 combinations were introduced with the idea of matching the resorption rate with that of primary
teeth, but the major disadvantage with these materials was that it resorbed very much earlier than that of
physiologic root resorption.
• To overcome the above material disadvantages endoflas can be used which has the property of resorption of
extruded material with no intracanal resorption.
• With the advent of novel techniques and materials like LSTR and pulpotec, necrotic primary teeth can also be
preserved there by maintaining the arch integrity.
CONCLUSION

62. REFERENCES
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