The treatment of pulpal diseases in primary teeth represents a significant challenge in public health, particularly in emergency dental care settings, where factors such as limited clinical time, low child cooperation, and structural constraints directly impact treatment effectiveness. In these contexts, conventional pulpectomy using zinc oxide-eugenol (ZOE), although effective, may present operational limitations that restrict its large-scale applicability in public health systems.
In this scenario, non-instrumental endodontic treatment (NIET), based on the concept of Lesion Sterilization and Tissue Repair (LSTR), has emerged as a simplified alternative. Among the available options, CTZ paste shows potential for single-visit application, reducing clinical time and technical complexity.
This study aims to evaluate the clinical and radiographic non-inferiority of CTZ paste compared to conventional pulpectomy with ZOE in primary molars with pulp necrosis, with or without abscess or fistula, treated in emergency dental care settings.
This is a randomized, pragmatic, controlled, non-inferiority clinical trial conducted at a single center, with clinical and radiographic follow-up at 3, 6, and 12 months. Participants will be allocated into two groups: (1) NIET with CTZ paste and (2) conventional pulpectomy with ZOE.
Primary outcomes include pain resolution and absence of clinical signs of infection. Secondary outcomes include radiographic success, clinical time, child behavior (Frankl Scale), need for retreatment, and oral health-related quality of life.
The findings are expected to provide robust evidence regarding the effectiveness of CTZ paste under real-world clinical conditions, contributing to the development of more accessible and effective protocols within public health systems, with the potential to expand access to conservative treatment and reduce early tooth extractions in pediatric dentistry.
Irreversible pulpitis in primary molars;
Pulp necrosis, with or without abscess, in primary molars.
Primary molars with sufficient remaining tooth structure to allow endodontic treatment.
Permanent successor in developmental stages prior to Nolla Stage 8;
Reversible pulpitis;
Indication for endodontic treatment in permanent teeth.
History of allergy or hypersensitivity to any components of the obturation materials (e.g., CTZ paste or zinc oxide-eugenol).
Clinical conditions that prevent adequate management in an outpatient setting.
Parallel
CTZ Paste
DrugCTZ paste is an antimicrobial intracanal medication used in non-instrumental endodontic treatment. The paste is placed into the pulp chamber without mechanical instrumentation, aiming to disinfect the root canal system based on the principles of lesion sterilization and tissue repair (LSTR).
ZOE Pulpectomy
Procedure/SurgeryConventional pulpectomy involving mechanical instrumentation of root canals, irrigation, and obturation with zinc oxide-eugenol paste.
Pain Resolution and Clinical Infection Control
Resolution of dental pain and absence of clinical signs of infection following emergency endodontic treatment in primary molars. Pain will be assessed using the Wong-Baker Faces Pain Rating Scale, a validated scale for measuring pain intensity in children. Scores range from 0 to 10, where 0 indicates "no pain" and 10 indicates "worst possible pain." Higher scores indicate greater pain intensity (worse outcome). Infection control will be determined by the absence of clinical signs such as swelling, fistula, abscess, or pathological mobility. The outcome will also consider the need for unplanned additional interventions as an indicator of treatment failure.
Child Behaviour and Oral Health-Realated Quality of Life
The child's behavior and acceptance of the dental procedure during treatment will be assessed. Child behavior will be evaluated using the Frankl Behavior Rating Scale, a validated four-point scale for assessing cooperation, where 1 indicates definitely negative behavior, 2 indicates negative behavior, 3 indicates positive behavior, and 4 indicates definitely positive behavior. Higher scores indicate more positive behavior (better outcome). In addition, clinical observation of cooperation, the need for behavioral management strategies, and overall acceptability of the procedure will be recorded. The impact of treatment on the child's and caregiver's quality of life will be assessed using validated oral health-related quality of life questionnaires, such as the Early Childhood Oral Health Impact Scale (ECOHIS). ECOHIS total scores range from 0 to 52, where higher scores indicate a greater negative impact on oral health-related quality of life (worse outcome). Subscores for Child Impact
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