Article Data

  • Views 2482
  • Dowloads 690

Systematic reviews

Open Access

Lesion Sterilization Tissue Repair (LSTR) Approach Of Non- Vital Primary Molars With A Chloramphenicol-Tetracycline-ZOE Antibiotic Paste: A Scoping Review

  • Arturo Garrocho-Rangel1
  • Carolina Jalomo-Ávila1
  • Miguel Ángel Rosales-Berber1
  • Amaury Pozos-Guillén1

1Pediatric Dentistry Postgraduate Program, Faculty of Dentistry, San Luis Potosí University, San Luis Potosí, SLP, México

DOI: 10.17796/1053-4625-45.6.1 Vol.45,Issue 6,December 2021 pp.369-375

Published: 01 December 2021

*Corresponding Author(s): Arturo Garrocho-Rangel E-mail:


The study aimed to perform a systematic scoping review with the need of exploring the actual clinical applications of the chloramphenicol-tetracycline-ZOE antibiotic paste (CTZ) as a lesion sterilization tissue repair (LSTR) therapy agent. Following a scoping framework suggested by Arksey and O’Malley, relevant articles (randomized controlled trials, literature reviews, observational studies, in vitro studies, and clinical case-series reports) published over the last 15 years (in English, Spanish, or Portuguese languages) were identified and retrieved from five internet databases: PubMed, Embase/Ovid, Cochrane Library, Google Scholar, and EBSCO. By title and abstract screening and after removing duplicates, 11 articles were finally included in the present scoping review: five randomized/non-randomized clinical trials, five in vitro studies, and one case-series report. According to the collected information, there were no differences between CTZ paste and conventional pulpectomy, antibiotic pastes, and intracanal filling materials, considering the clinical, radiographic, antimicrobial activity, and periapical tissue biocompatibility outcomes. CTZ has shown excellent rates of clinical success and good radiographic results, with adequate antimicrobial effects; however, its biocompatibility has been put into doubt. Contemporary pediatric dentists should carefully consider the CTZ paste as an alternative endodontic approach for pulpally involved primary molars, with the advantages of being simple and fast, and taking into account the limitations of instrumental pulpectomy such as the microbiological and morphological complexity of primary root canals.


CTZ Paste; Necrotic Primary Teeth; Pulp Therapy

Cite and Share

Arturo Garrocho-Rangel,Carolina Jalomo-Ávila,Miguel Ángel Rosales-Berber,Amaury Pozos-Guillén. Lesion Sterilization Tissue Repair (LSTR) Approach Of Non- Vital Primary Molars With A Chloramphenicol-Tetracycline-ZOE Antibiotic Paste: A Scoping Review. Journal of Clinical Pediatric Dentistry. 2021. 45(6);369-375.


1. American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. Chicago, Ill; American Academy of Pediatric Dentistry; 384–392, 2020.

2. Luengo-Fereira J, Ayala-Jiménez S, Carlos-Medrano LE, Toscano-García I, Anaya-Álvarez M. Clinical and radiographic evaluation of formocresol and chloramphenicol, tetracycline and zinc oxide-eugenol antibiotic paste in primary teeth pulpotomies: 24 month follow up. J Clin Pediatr Dent; 2019;

43: 16–21.

3. Coll JA, Dhar V, Vargas K, Chen CY, Crystal YO, AlShamali S, Marghalani AA. Use of non-vital pulp therapies in primary teeth. Pediatr Dent. 2020; 42: 337–349.

4. Duarte ML, Pires PM, Masterson-Ferreira D, Braga-Pintor AV, de Almeida- Neves A, Cople-Maia L, Guimarães-Primo L. Is there evidence for the use of lesion sterilization and tissue repair therapy in the endodontic treatment of primary teeth? A systematic review and meta-analysis. Clin Oral Invest; 2020 24: 2959–2972.

5. Piva F, Faraco-Junior IM, Estrela C. Antimicrobial activity of different root canal filling pastes used in deciduous teeth. Material Res; 2008; 11: 171–173.

6. Siegl RMC, Lenzi TL, Politano GT, De Benedetto M, Imparato JCP, Pinheiro SL. Two endodontic techniques analysis in a primary molar with fistula. Rev Gaúch Odontol Porto Alegre. 2015; 63: 187–194.

7. Almeida de Deus-Moura LF, Moura de Lima MD, Branco-Lima CC, Gomes- Machado JIA, Silva de Moura M, Vasconcelos de Carvalho P. Endodontic treatment of primary molars with antibiotic paste: A report of 38 cases. J Clin Pediatr Dent. 2016; 40: 175–177.

8. Luengo-Fereira J, Reyes-Rivas H, Toscano I, García-Flores Y, Anaya-Álvarez M, Del Muro-Casas F. Clinical and radiographic evaluation of CTZ (chloramphenicol-tetracycline-zinc eugenol oxide) antibiotic paste in pulp treatment of primary molars. J Dent Health Oral Dis Ther. 2017; 8: 451–455.

9. Santos-Sousa HC, Moura de Lima MD, Branco-Lima CC, Silva de Moura M, Lopes-Bandeira AV, Almeida de Deus-Moura LF. Prevalence of enamel defects in premolars whose predecessors were treated with extractions or antibiotic paste. Oral Health Prevent Dent 2020; 18: 793–798.

10. Arksey H, O’Malley L, et al. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol. 2005; 8: 19–32.

11. Bragge P, Clavisi O, Turner T, Tavender E, Collie A, Gruen RL. The Global Evidence Mapping Initiative: Scoping research in broad topic areas. BMC Med Res Methodol. 2011; 11: 92.

12. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analysis: The PRISMA statement. Int J Surg. 2010; 8: 336–341,.

13. Pérez-Hernández PE, Curioca-Rocha SA, Retana-Ugalde R. Efectividad terapéutica de la pasta CTZ vs. biomecánica convencional en pulpa necrótica de escolares de 4-8 años. Odont Pediatr Act. 2012; 2: 28–36.

14. Mariz-Sousa P, Cavalcanti-Duarte R, Alves de Sousa S. Acompanhamento clínico e radiográfico de dentes decíduos submetidos à terapia pulpar com a pasta CTZ. Braz Res Pediatr Dent and Integrat Clin. 2014; 14(Supl 3): 56–68.

15. Calixto-Chanca KS, Correa-Olaya EI, Anchelia-Ramírez SH. Efectividad clínica y radiográfica de dos pastas antibióticas empleadas en necrosis pulpar en niños de un hospital nacional del Perú. KIRU. 2014; 11: 115–122.

16. Lokade A, Thakur S, Singhal P, Chauhan D, Jayam C. Comparative evaluation of clinical and radiographic success of three different lesion sterilization and tissue repair techniques as treatment options in primary molars requiring pulpectomy: An in vivo study. J Indian Soc Pedod Prev. 2019; 37: 185–191.

17. Amorim LFG, De Toledo OA, Estrela CRA, Decurcio DA, Estrela C. Antimicrobial analysis of different root canal filling pastes used in pediatric dentistry by two experimental methods. Braz Dent J. 2006; 17: 317–322.

18. Lacativa AM, Loyola AM, Alves-Sousa CJ. Histological evaluation of bone response to pediatric endodontic pastes: An experimental study in Guinea pig. Braz Dent J. 2012; 23: 635–644.

19. Almeida de Deus-Moura LF, Moura de Lima MD, Branco-Lima CC, Lopes-Bandeira AV, Silva de Moura M, Mendes-Conde-Junior A, Dos Santos-Rizzo M. Cellular profile of primary molars with pulp necrosis after treatment with antibiotic paste. Int J Exp Pathol. 2018; 99: 264–268.

20. Conde MC, Chisini LA, Sarkis-Onofre R, Schuch HS, Nor JE, Demarco FF, et al. A scoping review of root canal revascularization: Relevant aspects for clinical success and tissue formation. Int Endod J. 2017; 50: 860–874.

21. Chisini LA, Muniz-Conde MC, Grazioli G, Schmidt-San Martin A, Varella de Carvalho R, et al. Bone, periodontal and dental pulp regeneration in dentistry: A systematic scoping review. Braz Dent J. 2019; 30: 77–95.

22. Tedesco TK, Reis TM, Mello-Moura ACV, Da Silva GS, Scarpini S, Floriano I, et al. Management of Deep caries lesions with or without pulp involvement in primary teeth: A systematic review and network meta-analysis. Braz Oral Res. 2021; 35:e004.

23. Prabhakar R, Sridevi E, Raju O, Satish V. Endodontic treatment of primary teeth using a combination of antibacterial drugs: An in vivo study. J Indian Soc Pedod Prevent Dent. 2008; 26 (Suppl 1): S5–S10.

24. Raslan N, Manisour O, Assfoura L. Evaluation of antibiotic mix in non-instrumentation endodontic treatment of necrotic primary molars. Int J Paediatr Dent. 2018;18: 285–290.

25. Doneria D, Thakur S, Singhal P, Chauhan D, Keshav K, Uppal A. In Search of a novel substitute: Clinical and radiological success of lesion sterilization and tissue repair with modified 3Mix-MP antibiotic paste and conventional pulpectomy for primary molars with pulp involvement with 18 months follow-up. Contemp Clin Dent. 2017; 8: 514–521.

26. Nakornchai S, Banditsing P, Visetratana N. Clinical evaluation of 3Mix and Vitapex® as treatment options for pulpally involved primary molar. Int J Paediatr Dent.2010; 20: 214–221.

27. Agarwal M, Mohan-Das U, Vishwanath D. A comparative evaluation of non-instrumentation endodontic techniques with conventional ZOE pulpectomy in deciduous molars: An in vivo study. World J Dent. 2011; 2: 187–192.

28. Pinky C, Shashibhushan KK, Subbareddy VV. Endodontic treatment of necrosed primary teeth using two different combinations of antibacterial drugs: An in vivo study. J Indian Soc Pedod Prevent Dent. 2011; 2: 121–127.

29. Mortasavi M, Mesbahi M. Comparison of zinc oxide and eugenol, and vitapex for root canal treatment of necrotic primary teeth. Int J Paediatr Dent. 2004; 14: 417–424.

30. Reis B, Barbosa C, Soares L, Brum S, Barbosa O, Marques M. In vitro analysis of antimicrobial activity of CTZ binder used as material plug in deciduous teeth pulp. R Pró-Uni. 2016; 7: 39–42.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Scopus: CiteScore 2.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Submission Turnaround Time