196 European Archives of Paediatric Dentistry // 11 (Issue 4). 2010 Key words: Metronidazole, anaerobic bacteria, primary teeth pulpectomy Postal address: Prof. Betül Kargül. Department of Paediatric Dentistry, Marmara University, Dental School, Büyükciftlik Sok. No: 6 Kat: 4 34365 Nisantasi, Istanbul, Turkey. Email: bkargul@marmara.edu.tr B. Kargül, I. Tanboga, B. Altinok Dept. Paediatric Dentistry, Marmara University, Dental School, Department of Paediatric Dentistry, Istanbul,Turkey Conventional endodontic treatment of primary molars using metronidazole as an intra-canal medicament: a pilot study Abstract AIM: This was to evaluate the clinical and radiographic out- comes of an antibacterial drug (Metronidazole, Nidazol, IE Ulagay Ilac A.S) application as an intra-canal medicament combined with pulpectomy in infected primary molar teeth. METHODS: The study material consisted of data collected from children treated at the Dental School Dept. of Paediatric Dentistry in Marmara University between 2000 and 2004. Clinical and radiographic data were collected over 2 years from patients who had received a topical application of met- ronidazole in root canal dressing before a pulpectomy was completed. Clinical success parameters were: no abscess IRUPDWLRQ QR ﾀVWXOD QR SDLQ DQG QR SDWKRORJLF PRELOLW\ at treated teeth with metranidazole dressing. The overall success and failure rates were analysed. Radiographic diag- nosis was standardized between investigators and intra and inter-rater reliability assessed. Both investigators read and evaluated all radiographs, after a comparison of results, a consensus was agreed upon for each result. STATISTICS: All data were entered into an Excel format and SPSS 11.0 P < 0.05 were used for Windows and Chi-square for statisti- cal analyses. RESULTS: There were 64 molars assessed for clinical and radiographic success. Considering the eruption times, success rate was 75% as determined by the last follow up clinically and radiographically according to predetermined success criteria. In the 64 molars, 4 cases demonstrated loss of the alveolar bone, 3 exhibited varying degrees of root resorptions on radiographic examination and 3 showed clinical pathologic mobility. Fistulae were observed in only 1 case and early loss was detected in 5 cases. CONCLUSION: These results suggest that main factors responsible for fail- ure may be associated with uncertain mixing proportions of the metronidazole paste and inadequate maxillary restora- WLRQV %XW VRPH PRGLﾀFDWLRQV LQ SUHSDULQJ WKH SDVWH FRXOG LQFUHDVH LWV HIﾀFDF\ Introduction As primary teeth maintain arch length and preserve masti- catory function, clinicians must be familiar with treatments for pathology of primary teeth. Where the radicular pulp is QRQYLWDO RU LUUHYHUVLEO\ LQﾁDPHG WKH WUHDWPHQW RI FKRLFH LV pulpectomy [Koch, 2001; AAPD, 2009] with an aim a tooth that would otherwise be extracted, and in doing so, to pre- vent space loss and disturbance to the permanent dentition [Llyewelyn, 2000]. Periapical infections with microorganism involvement have been found in animal models and human studies [Möller et al., 1981; Sundqvist, 1992; Tannure et al., 2009]. Elimination of bacteria from infected root canal systems is challenging and various measures have been described to reduce the num- ber of microorganisms in root canals. These measures have included instrumentation techniques, irrigation regimens and intra-canal medicaments [Mohammadi et al., 2009]. Among these measures is local application of antibacterial drugs combined with mechanical dental treatment conducted to give good results for canal disinfection [Palmu et al., 1979; Torabinejad et al., 1995]. Medicaments. Nitroimidazole derivatives are known to have good antibacterial activity against clinically important anaerobes [Kargül and Kadir, 2001]. Metronidazole is a nitroimidazole compound that exhibits a broad spectrum of activity against protozoa and anaerobic bacteria. Known for its effective antibacterial activity against anaerobic cocci as well as Gram-negative and Gram-positive bacilli, it has been used both systemically and topically in the treatment of perio- dontal disease [Piccolomini et al., 1999]. Advantages of using metronidazole are that it provides ready availability as oral and intravenous dosage forms, rapidly bactericidal, good tis- sue penetration, cost-effective, acceptable pharmacokinetics and pharmacodynamics and its undiminished antimicrobial activity [Kargül and Kadir, 2001]. The antibacterial properties of nitroimidazole derivatives against organisms in infected primary root canals have not been fully proven. Nevertheless, extensive in vitro and in situ studies have been conducted showing the combination of DQWLELRWLFV VXFK DV ULIDPSLFLQH PHWURQLGD]ROH FLSURﾁR[DFLQ and minocycline to be effective against oral bacteria, includ- ing those in endodontic lesions of primary teeth. [Hoshino et al., 1996; Takushige et al., 2004]. Data on using metronidizole for primary teeth is limited. Accordingly, the aim of the present study was to evaluate the clinical and radiographic outcomes of an antibacterial drug application as an intra-canal medica- ment combined with pulpectomy in infected primary molar teeth.