Volume 15, Issue 2

Lesion Sterilization and Tissue Repair in lower primary E: A Case Report

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Razan Abdul Ghani - Pediatric Dentist
Ministry of Health | AMMAN, JORDAN - razanabdulghani939@gmail.com

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Razan Abdul Ghani. Lesion Sterilization and Tissue Repair in lower primary E: A Case Report. Smile Dental Journal. 2020;15(2):18-9.



Three mix medicament of metronidazole, ciprofloxacin and monocycline in a root canal sealer placed at orifices of root canals in lower primary E and sealed with glass-ionomer cement as base and further reinforced with amalgam filling followed by final restoration of stainless steel crown.


Endodontic, lesion, LSTR, Mix drug.


Teeth with infected root canals are common problem in primary dentition; early loss of primary teeth can cause a number of problems, including space loss for successor permenant teeth. Thus an intact tooth successfully disinfected and restored is superior space maintainer than an appliance.1

Metronidazole was the first choice because it has wide bacterial spectrum against anaerobes which were common in oral sites2 However, some bacteria in lesions were resistant to metronidazole thus two other anti-bacterial drugs e.g cipro floxacin and monocycline should be mixed with metronidazole in an effort to eliminate all bacteria.3-5 Figure 1 shows the three antibiotics (Monocycline, Metronidazole, Ciprofloxacin).


A 6 years old male child was seen in a pediatric clinic for evaluation and treatment, the dental history revealed that the patient has spontanous dull pain increased while sleeping in lower primary second molar E.

- Preoperative radiograph shows no changes in the periapical area, no root resorption. (Fig. 2a,b)

- Clinical examination: Shows carious E with mesial cavity. No sinus or gingival swelling. (Fig. 3)

- Procedure: After giving local anasthesia, carious removal was done, acess opening was performed then the walls of the acess cavity were chemically cleaned using 35% phosphoric acid solution before applying 3 Mix-sealer. The orifice of the root canal was enlarged to create amedication cavity (diameter 1mm and depth 2mm) hemorrhage was stopped using cotton pellets immersed in 10 % Naocl. Then 3mix-sealer was applied after preparing with aratio of 1:3:3 the medication cavity was then half-filled with 3mix- sealer and the cavity was sealed with GI cement and reinforced with amalgam completed in one visit. Another visit was required to restore with final restoration of stainless steel crown.


Resolution of clinical symptoms was checked after treatment within 10 days following the procedure. The tooth was firmly attached in the jaw, in function without pain or infection.


The results demonstrate that primary tooth was conserved by LSTR endodontic therapy with excellent clinical result in a single visit, this therapy apparently depends on the elimination of bacteria from the root canal system but not on mechanical procedures. Therefore the clinical procedure is simple and does not require long chair time or multiple visits, the drug mixture was able to penetrate into the endodontic lesion of primary teeth and killed all the bacteria in the 1st day indicating that the lesions can be sterilized by topical application of 3 mix drug. There were no reported side-effects in LSTR.


LSTR therapy using 3 mix-sealer; a mixture of metronidazole, ciprofloxacin and monocycline with root canal sealer provide an excellent outcome in treatment of infected root canals of primary teeth.


  1. Cvek K, Nord CE, Hollender L. Antimicrobial effect of root canal debridement in teeth with immature roots. A clinical and microbiologic study odontol revy. 1976:27:1-10.
  2. Spang berg L, Ruthberg M, Rydinge E. Biologic effects of endodontic antimicrobial agents. J Endod. 1979:5:166-75.
  3. Nielsen BA, Craig Baumgartner J. Comparison of the Endovac system to needle irrigation of root canals. J Endod. 2007:33:611-615.
  4. Sato T, Hoshino E, Uematsa H, Noda T. In vitro antimicrobial susceptibility to combinations of drugs on bacteria from carious and endodontic lesions of human deciduous teeth. Oral Microbial Immunol. 1993:8:172-6.
  5. Hoshino E, Kurihara-Ando N, Sato I, uematsu H, Sato M, Kota K, Iwaku M. In vitro anti bacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline Int Endod J. 1996:29:125-30.
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