Clinical and radiographic efficacy of LSTR with 3Mix-R antibiotic paste in paediatric patients aged 4-9 years at the Dr. René Puig Bentz Clinic, Universidad Nacional Pedro Henríquez Ureña.
Description
In pediatric dentistry, it is common for children to require pulp therapies due to deep cavities that compromise pulp health. The objective of this research was to verify the clinical and radiographic effectiveness of the 3Mix-R paste, in order to increase treatment options and evaluate an alternative material that could replace tetracycline-derived antibiotic pastes, which have been shown to cause staining in the germs of successor teeth. The use of the 3Mix-R antibiotic paste, composed of metronidazole, ciprofloxacin, clindamycin, and distilled water, is proposed. This paste is rarely used due to the lack of research and the replacement of minocycline with clindamycin, which is prohibited by the International Association of Pediatric Dentistry (IAPD). To measure the effectiveness of 3Mix-R paste, it was compared with PTA paste, which has scientific evidence of its effectiveness. The study evaluated 20 cases, dividing the patients into two groups: 50% received 3Mix-R paste, and the other 50% received PTA paste, with clinical and radiographic follow-ups conducted two weeks, one month, and three months after the material's placement. The results of the general linear model (GLM) analysis showed no significant difference in the clinical and radiographic effectiveness pattern between the groups (p> 0.05), indicating equivalent effectiveness between both pastes. Additionally, chi-square analysis showed no significant difference in treatment responses according to the initial pulp diagnosis (p> 0.05). The study results conclude that treatment with 3Mix-R in primary molars demonstrates clinical and radiographic effectiveness over a three-month observation period, suggesting that 3Mix-R paste can be considered a viable alternative like PTA.
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For the present study, which aimed to verify the clinical and radiographic effectiveness of the 3Mix-R paste, two phases were carried out. The first, a cross-sectional phase, involved sample collection and filling out clinical records. This phase was conducted by establishing a rapport with the student and the patient's parent/guardian, during which the child's participation in the study was requested. Only patients who consented and signed the consent form were included, followed by the randomization process. Randomization was done using software to determine the group to which each patient belonged, either group A (3Mix-R) or group B (PTA). The second, prospective phase, consisted of the follow-up of clinical and radiographic controls for the children treated with either 3Mix-R or PTA paste. For the preparation of the 3Mix-R paste, three containers with pulverized components were used. The preparation steps were as follows: 1. Using a spatula, 500 mg of metronidazole was placed on a glass slab. 2. 100 mg of clindamycin was placed on the glass slab in the same amount as the metronidazole. 3. The same was done with 200 mg of ciprofloxacin. 4. The three components were mixed. 5. On another glass slab, a portion of distilled water was taken until a whipped cream-like texture was obtained. 6. Finally, for the standard preparation of the 3Mix-R, one part of distilled water was mixed with seven parts of the 3Mix-R mixture (24). For the preparation of the PTA paste, the following steps were followed: The medications were mixed in a ratio of 1:1:1. 1. 200 mg of ciprofloxacin 2. 500 mg of metronidazole 3. 100 mg of amoxicillin 4. Vehicle (distilled water) (24). For the application of the medication in the tooth, the pastes were mixed separately, either 3Mix-R or PTA, by one of the researchers. The operator was blinded to which paste was being handled. This was done according to the group to which the patient belonged (group A or B). The conventional LSTR technique was performed: chamber opening with a high-speed diamond round bur and an endo-Z bur, followed by removing the pulp chamber with a spoon excavator, controlling bleeding with cotton pellets, irrigating the chamber with saline, and placing cotton with 17% EDTA in the chamber to remove the smear layer. Once the medication was prepared, it was placed in the tooth, sealed with restorative glass ionomer, and a confirmation radiograph was taken. After 7 days, the treatment was evaluated, and the tooth was slightly trimmed to adapt a stainless-steel crown for protection.