Clinical and Radiographic Findings Outcomes of Cases Managed with Lesion Sterilization and Tissue Repair (LSTR) in Pediatric Patients with Periapical Abscesses of Primary Teeth

Abstract

Background: Periapical abscesses of primary teeth are a common reason for emergency pediatric dental visits and a clinically challenging entity in children whose cooperation, anatomy, and developing permanent successors all constrain treatment choices. Lesion Sterilization and Tissue Repair (LSTR), a non-instrumental endodontic approach using a triple antibiotic combination, has been proposed as a minimally invasive alternative to conventional pulpectomy in such cases. Aim: To describe the clinical and radiographic findings of pediatric patients aged 2–11 years presenting with periapical abscesses of primary teeth, and to report the outcomes of the subset of cases managed with LSTR. Materials and methods: A retrospective chart review of 79 children aged 2–11 years (mean 6.25 ± 1.87) with a clinical and/or radiographic diagnosis of periapical abscess of a primary tooth was conducted. Demographic data, chief complaint, symptom duration, jaw and tooth distribution, parental/caregiver oral-hygiene practice, radiographic appearance, treatment modality (including LSTR), follow-up, and post-treatment relapse were recorded. Categorical associations with age (≤5 years vs. ≥6 years) and gender were tested using Fisher's exact test, with significance set at P < 0.05. Results: The sample comprised 33 males (41.77%) and 46 females (58.23%); 35 children (44.30%) were ≤5 years and 44 (55.70%) were 6 years or older. Mandibular teeth (56.96%) and primary first/second molars accounted for the majority of affected teeth. The chief complaint distribution was significantly associated with age (P = 0.047), as were caregiver oral-hygiene practice (P < 0.001) and the pattern of radiographic findings (P < 0.001). LSTR was performed in 12 of the 79 cases (15.19%), with no significant association between use of LSTR and either age (P = 0.666) or gender (P = 0.530). Post-treatment relapse following restoration was uncommon (5.06% with mild and 7.59% with moderate findings) and showed a significant gender association (P = 0.046). Conclusion: In this pediatric cohort, periapical abscesses of primary teeth predominantly affected mandibular molars, were strongly associated with poor caregiver-supported oral-hygiene practice, and were accompanied by readily identifiable radiographic changes. LSTR was used selectively and was followed by an acceptably low rate of clinical relapse, supporting its role as a conservative option in carefully chosen cases. Larger prospective studies with standardized success criteria are needed.