evaluation of postoperative pain after using 3mix-tatin versus calcium hydroxide iodoform paste in necrotic primary molars treated by lesion sterilization and tissue repair therapy

Conditions: Necrotic Pulp; Postoperative Pain

Summary: the aim of the current study is to compare a newly introduced material which is a combination of triple mix antibiotics paste and anti-hyperlipidemia drug simvastatin, the new material is named 3mix-tatin \& will be compared to triple antibiotic paste for management of necrotic primary molars by using lesion sterilization and tissue repair lstr technique.

3mix-tatin will prepared by mixing three commercially available antibiotics with simvastatin. after removing the coating materials, 3 types of antibiotics are pulverized by porcelain mortars and pestles to achieve fine powders. a total of 100 mg ciprofloxacin, 100 mg metronidazole, and 100 mg cefixime will be mixed in a ratio of 1: 1: 1. two milligrams of simvastatin will be added to the drugs blend to form 3-mix-tatin. preparation of 3mixtatin will be trained and supervised by an expert pharmacist. 3mixtatin will be stored in a tightly capped porcelain container, adding a small amount of silica gel in a bag inside the container to maintain low humidity. this powder will be mixed with normal saline to form a creamy paste of 3mixtatin at the time of application. local anesthesia using mepivicaine hydrochloride 3% (septodont, saint-maurdesfosses, france) will be administered. rubber dam isolation. access cavity will be prepared with a fissure bur in a high-speed handpiece, necrotic pulp tissue will be removed using a sterile sharp spoon excavator. the canal orifices will be enlarged with a round bur (one mm diameter and two mm depth) to create medication receptacles. cotton pellet moistened with 2.5% sodium hypochlorite (naocl) will be placed in the pulp chamber for 1 minute. bleeding, if present, will be controlled by applying sterile cotton pellet moistened with 10% sodium hypochlorite against the pulp stumps and will be maintained for 1 min. the 3-mix-tatin will be mixed with saline to obtain a creamy mix and placed over the canal orifices and the pulpal floor. the access opening will be sealed with a glass ionomer cement , and the tooth will be restored with a stainless steel crown.

Eligibility criteria:
inclusion criteria: * children age range from 5-8 years. * children free from any systemic diseases or medical problems. * primary molar with necrotic pulp, with pain, gingival abscess, fistula openings, or clinical mobility not exceeding grade two. * radiographic evidence of non-perforating internal resorption, external resorption not exceeding 1\\3 of the root, furcation or periapical radiolucency. exclusion criteria: * non-restorable molars or beyond repair, for example: decay reaches to bifurcation, a hard gingival margin cannot be established or infection cannot be eradicated by other mean (balaji, 2007). * patient with known allergy to any type of antibiotics or anti-hyperlipidemia drugs. * patient with facial cellulitis or lymphadenopathy * lack of patient/parent compliance and cooperation. * refusal of participation or failure to obtain an informed consent.