Hearn-Lesion Sterilization and Tissue Repair-Dr. Hearns course video CSPD

Video Transcription

Video Summary

The webinar introduced lesion sterilization and tissue repair (LSTR) as a newer, AAPD-endorsed option for managing primary teeth with suspected irreversible pulpitis or necrosis when traditional pulpotomy or pulpectomy may be less feasible. Dr. Graham Hearn reviewed LSTR’s origins in Japan (1990s) and early studies showing lesion resolution and normal exfoliation/eruption, while noting that evidence quality is often low and success definitions vary.<br /><br />A major theme was diagnostic uncertainty in primary tooth pulp status. The speaker challenged the common assumption that achieving hemostasis reliably indicates reversible pulpitis, citing literature suggesting bleeding control does not necessarily correlate with inflammation level. Because diagnosis is imperfect, LSTR can be useful in “gray-zone” cases.<br /><br />Key evidence comparisons were summarized: pulpectomy tends to outperform LSTR in teeth without root resorption, but LSTR may have better outcomes when roots already show resorption (where pulpectomy success drops). Clinically, LSTR was positioned as a practical tool to avoid extraction, space maintainers, or GA—especially for 4–6-year-olds with primary first molars (Ds) before 6-year molar eruption, retreatment of failing pulps, behavioral limitations, or parent preference.<br /><br />Technique overview: perform caries removal and pulpotomy access; achieve hemostasis (speaker uses ferric sulfate); disinfect/irrigate (often chlorhexidine); place “3Mix” antibiotic paste (metronidazole + ciprofloxacin + minocycline, or an alternate replacing minocycline with clindamycin) into canal orifices; optionally cover with MTA; seal with resin-modified glass ionomer and restore with full coverage. Contraindications included non-restorable teeth, perforations, significant mobility/advanced resorption, relevant medical issues, and antibiotic allergy considerations. The session ended with practical sourcing tips for compounded 3Mix and Q&A on isolation, radiopacity, retreatment, and antibiotics.

Keywords

lesion sterilization and tissue repair (LSTR)

AAPD-endorsed pediatric endodontics

primary teeth irreversible pulpitis

primary tooth necrosis management

3Mix antibiotic paste

metronidazole ciprofloxacin minocycline regimen

clindamycin minocycline alternative

pulpectomy vs LSTR outcomes

diagnostic uncertainty hemostasis pulpotomy

ferric sulfate chlorhexidine MTA RMGI full-coverage restoration