CLINICAL AND RADIOGRAPHIC EVALUATION OF

3MIXTATIN AND MTA IN PRIMARY TEETH

PULPOTOMIES: A RANDOMIZED CONTROLLED
INTRODUCTION
 Maintaining the pulp vitality of the decayed or traumatized primary teeth
is utmost important to ensure the integrity and smooth transition from
primary to permanent dentition.
 Pulpotomy technique can be done in primary teeth to preserve the
vitality of pulp based on the extent of pulp involvement.
 A pulpotomy is performed in a primary tooth when caries removal results in a pulp
exposure in a tooth with a normal pulp or reversible pulpitis or after a traumatic pulp
exposure and there is no radiographic sign of infection or pathologic resorption.

 When the coronal tissue is amputated, the remaining radicular tissue must be judged to
be vital without suppuration, purulence, necrosis, or excessive hemorrhage that cannot
be controlled by a cotton pellet after several minutes.
OBJECTIVES
 The radicular pulp should remain asymptomatic without adverse clinical signs or
symptoms such as sensitivity, pain, or swelling.
 There should be no postoperative radiographic evidence of pathologic external
root resorption.
 Internal root resorption may be self-limiting and stable.
 There should be no harm to the succedaneous tooth.
 The coronal pulp is amputated, pulpal hemorrhage is controlled, and the remaining
vital radicular pulp tissue surface is treated with a long-term clinically-successful
medicament.

 After the coronal pulp chamber is filled with a suitable base, the tooth is restored
with a restoration that seals the tooth from microleakage.

 If there is sufficient supporting enamel remaining, GIC or composite resin can

provide a functional alternative when the primary tooth has a life span of two years
or less.

 However, for multisurface lesions, a stainless steel crown is the restoration of

choice.
 Traditionally many medicaments have been tried as a pulpotomy medicament.

 But due to their lack of potentiality or carcinogenic nature lead to a path in search of
newer materials which are effective, biocompatible, bioactive, and bactericidal to act
as a potential pulp medicament.

 In this newer era of regenerative pulpotomy procedures, Mineral Trioxide Aggregate

and Bone Morphogenetic Proteins and many newer agents like nano-
hydroxyapatite crystals and Biodentin are being used.
MTA
 Mineral trioxide aggregate is considered as gold standards in the field of
vital pulp therapies.

 MTA has an enhanced nonresorbable seal over the vital pulp and the
ability to induce hard tissue formation due to the release of cytokine from
bone cells.
COMPOSITION
 Portland cement (75%)
Tricalcium silicate (CaO)3SiO2,
Dicalcium silicate (CaO)2SiO2,
Tricalcium aluminate (CaO)3 Al2O3,
Tetracalcium aluminoferrite (CaO)4Al2O3Fe2O3
 Bismuth Oxide (20%)
 Gypsum (5%)
ADVANTAGES

 Biocompatible with peri-radicular tissues.

 Non cytotoxic.
 Possesses antimicrobial activity.
 Non resorbable.
 Excellent Sealing properties.
 Very basic alkaline (high pH when mixed with water).
 Facilitate regeneration of periodontal ligament.
DISADVANTAGES

 Difficult to manipulate
 Long setting time
 Discolouration of hard tissue
 Expensive
3MIXTATIN
 Statin components are well known for their regenerative capacity.

1. They enhance the activity of osteoblasts and decrease the osteoclastic function
leading to increase the rate of bone formation.
2. They also improve the function of odontoblasts resulting in the ameliorated formation
of dentin and angiogenesis.
3. Statins also exhibit potent anti-inflammatory properties and maintain the levels of pro-
inflammatory cytokines.

 Assuming these properties might have a role in the regeneration of pulp and dentin,
statins are used as a pulpotomy medicament in 3Mixtatin.
 COMPOSITION

 Metronidazole (100mg)
 Ciprofloxacin (100mg)
 Cefixime (100mg)
 Simvastatin (2mg)

3Mixtatin is an acronym for a mix of 3Mix and Simvastatin. This combination aims at decreasing
the bacterial load, eliminating pulp inflammation and results in dental hard tissue formation.
AIM

To comparatively evaluate the medicaments MTA, 3Mixtatin in primary

teeth pulpotomy, after considering their role in pulp repair. MTA belong to
the group of calcium-silicate based materials prepared synthetically and
3Mixtatin being an emerging material in regenerative dentistry.
INCLUSION CRITERIA

 Patients with no relevant medical history

 Absence of radiographic evidence of pulp degeneration such as
Widening of periodontal ligament space (PDL widening),
Internal and external resorption of the root (IRR and ERR),
Furcal radiolucency or inter radicular bone destruction(FR/IBD)

 Presence of at least two-thirds of the root length

 n=70

n=64
Group1 Group 2
n=32 n=32

MTA 3MIXTATIN
CLINICAL PROCEDURE
Group I: MTA

(A)Preoperative photograph; (B) Intraoperative view after removal of coronal pulp tissue;
(C) Intraoperative view showing MTA
Group II: 3Mixtatin

(A)Preoperative photograph; (B) Intraoperative view after removal of

coronal pulp tissue; (C) Intraoperative view showing 3mixtatin;
 At the 24-hour follow-up, the pulpotomized teeth in both groups were
given stainless-steel crowns which were cemented using luting glass
ionomer cement. The treatment of all sixty-four teeth was done by the
same operator in this study.
EVALUATION CRITERIA

 The participants were recalled for clinical and radiographic evaluation.

 The radiographic evaluation was done in comparison with the preoperative

radiograph with the radiographs taken at a time interval of 3, 6, 9, and at 12th
month.
MTA PULPOTOMY

(E) 3rd month radiograph; (F) 6th month radiograph; (G) 9th month radiograph;
(H) 12th month radiograph
MIXTATIN PULPOTOMY

(F) 3rd month radiograph; (G) 6th month radiograph; (H) 9th month radiograph;
(I) 12th month radiograph
Clinical scoring criteria was based on the clinical signs, including
 Spontaneous pain
 Swelling
 Abscess/fistula
 Abnormal mobility
 Tender on percussion
 Soft tissue redness
The radiographic signs that are included for evaluation are
 Periodontal ligament widening
 Internal resorption
 External resorption
 Furcal radiolucency/interradicular bone destruction
 Pulp canal obliteration
 Periapical bone destruction
RESULTS
 In the present study there was no statistically significant difference between
clinical success rates in months 3, 6, 9, and 12 (p < 0.5).
 In both groups, clinical signs of failure in one patient each was seen at 6th
month follow-up period with tender on percussion.
 Spontaneous pain in one patient in MTA group at 9th month follow-up
period and in one patient in 3Mixtatin group at 3rd month follow-up period
was seen.
RADIOGRAPHIC EVALUATION
 In MTA group, pulp canal obliteration in 1 patient each at 6th month follow-up period and at
9th month follow-up period was seen. Pulp canal obliteration, PDL widening, and internal
resorption were seen in single patient each.

 At the end of the 12th month, there were 2 patients with PDL widening, 1 patient with pulp
canal obliteration and 1 patient with internal resorption.

 In 3Mixtatin group radiographical signs of PDL widening, internal resorption, and pulp canal
obliteration were seen in 1 patient each at 6th month follow-up period. At 12th month follow-
up period signs of PDL widening and pulp canal obliteration were seen in 1 patient each and
internal resorption was seen in 2 patients.
DISCUSSION
 A plethora of medicaments, like formocresol, glutaraldehyde, ferric sulfate, calcium hydroxide,
zinc oxide eugenol, paraformaldehyde, has been used over the years for pulpotomy.
 Ideal properties for the pulpotomy medicament include
 Nontoxic
 Non-mutagenicity
 Biocompatibility
 Dimensional stability,
 Antibacterial, and benign to the biological tissues,
 Should promote healing and have no ill effects on the tooth bud.
 All these pulpotomy medicaments have remained unsatisfactory, and thus emphasis of all
researchers has moved from an era of "preservation" toward "regeneration." This resulted in
the research and synthesis of bioactive material, Mineral Trioxide Aggregate (MTA)
 MTA has remained the gold standard material in vital pulp therapy for years, owing to its
bioactive potential, biocompatibility, antibacterial properties with exceptional stability and
high sealing ability.

 MTA also has certain disadvantages to its credit. Hence, there was a need to develop
new material in this category, as efficacious as MTA, but with superior qualities than any
other calcium silicate-based materials.

 A newer medicament has been introduced through research was 3Mixtatin, an acronym
for the new combination of 3Mix antibiotic paste and Simvastatin.
 Statins are well known for their antihyperlipidemic action in
cardiovascular patients and supported by both experimental and clinical
studies for their pleiotropic effects which led the statin components to
be used in the field of regenerative dentistry.
 Statins increase bone formation by improving the function of bone-forming cells while depressing
the function of bone-destroying cells.

 This led the researchers to hypothesize their role in odontogenesis and intricacies of the
pathways through which Simvastatins promoted dentin formation.

 The combination of triple antibiotic powder 3Mix with Simvastatin gives 3Mixtatin, which was
mixed with normal saline for ease of placement.

 The amalgamation of these materials reduces bacterial load, lessens pulpal inflammation, and
also results in dentinogenesis.
 At the end of the pulpotomy treatment, stainless steel crowns (SSCs) are given to
protect the pulpal tissue from microleakage and result in an increased success rate.

 In the present study, based on the evaluated overall clinical score, it was found that
93.8% of the pulpotomized primary molars were successful in all two groups MTA and
3Mixtatin over a 12-months follow-up period.

 Based on radiographical evaluation 75% success rate was seen in the MTA group,
and 78% success rate in 3Mixtatin was seen at the end of 12th-month follow-up.
CROSS REFERENCE
 Objective: This study was conducted to compare the efficacy of 3Mixtatin (a combination of simvastatin
and 3Mix antibiotic) with MTA and Formocresol for the pulpotomy of primary molars.
 Study design: 114 children aged 3-6 years old with 150 primary molars were randomly allocated to three
groups. MTA, Formocresol or 3Mixtatin were used for Pulpotomies. Examinations were conducted at 6, 12
and 24 months after treatment for the presence of pain, tenderness to palpation and percussion, sinus
tract, swelling, presence of internal or external root resorption, inter-radicular radiolucency, and periapical
lesion.
 Results: 122 teeth were available for 24-month follow-up study. The overall success rate was 78.9% for
FC, 90.5% for 3Mixtatin and 88.1% for MTA group. There was no significant difference in overall success
rate among the groups after 24-month follow-up (X2 =2.43, df = 2, P =0.27).
 Conclusion: Our findings demonstrated remarkable results of 3Mixtatin in pulpotomy of primary teeth at
the 24-month follow-up. Therefore, 3Mixtatin may be considered as an effective material in pulpotomy of
primary teeth because of its successful results
 Introduction: The study was performed to evaluate and compare the clinical and radiographic efficacy of
chlorhexidine (CHX) polymer scaffold, 3Mixtatin, and formocresol for vital primary pulp therapy—a
randomized clinical study.
 Materials and methods: A total of 120 primary molars were included from children aged between 6 and 8
years in this randomized clinical study based on inclusion and exclusion criteria and were randomly
allocated into three groups (group I—CHX polymer scaffold, group II—3Mixtatin, and group III—
formocresol. Pulpotomy was performed in a vital cariously exposed primary tooth with healthy
periodontium where their retention is more beneficial than extraction. Subjects were followed up at 1, 3,
and 6 months for clinical and radiographic evaluations.
 Results: At 6 months of follow-up, the overall success rate of pulpotomy in groups I, II, and III was 56.41,
71.05, and 60.52% in each group, respectively. Nonsignificant difference (p > 0.05) was seen during
intergroup comparison.
 Conclusion: However, among the three materials used in this study, 3mixtatin comparatively had better
results.
 Background: The aim of this study was to evaluate clinical and radiographic success rates of 3Mixtatin
and Modified 3Mix‑MP paste and compare it with conventional root canal treatment procedure in primary
molars requiring pulpectomy.
 Materials and Methods: In this in vivo study, 66 primary molars in 52 children aged between 4 and 8
years with primary molars having chronic periapical abscess were treated randomly with 3Mixtatin,
Modified 3Mix‑MP paste, and Metapex.
 Results: By the end of 12‑month follow‑up among the three groups, Group I seemed to be performing
consistently better as compared to the other two groups when evaluated clinically and radiographically.
However, Group III resulted in the greatest number of failures, with success rate being mere 42.9% at
the end of follow‑up period.
 Conclusion: Radiographic and clinical healing occurred in all the three groups; however, based on our
results, Group I seemed to be performing consistently better among the three groups at 12 ‑month
follow‑up. Hence, it can be inferred that 3Mixtatin used as a localized agent is effective and comparable
to both Modified 3Mix‑MP paste and conventional pulpectomy procedure involving calcium hydroxide and
iodoform paste in primary teeth.
 Objective:-This study aimed to examine the efficacy of 3Mixtatin (a combination of simvastatin and
3Mix antibiotic) as a novel pulp capping biomaterial in DPC of human primary molars.

 Methods:- In this randomized clinical trial, 160 primary molars from 83 healthy children aged 3– 6
years were randomly allocated into four groups. Small traumatic non-caries pulpal exposures were
treated by DPC using simvastatin, 3Mix, 3Mixtatin, or MTA.

 Results:- One hundred and twenty-nine teeth were available for follow-up study. By the end of 12
months, the overall success rates were 93.8% in MTA, 91.9% in 3Mixtatin, 62.5% in 3Mix, and 57.1%
in simvastatingroups. No statistically significant difference was found between the outcomes of MTA
and 3Mixtatin groups (P > 0.05). 3Mixtatin had statistically superior results compared to 3Mix and
simvastatin (P < 0.01).

 Conclusion:- Radiographic and clinical outcomes in 3Mixtatin group could suggest it as an acceptable
alternative in DPC of primary molar teeth.
 Objectives:.The aim of this study was to assess the success of the repair of bony defects, caused by pre-treatment
perforations, with a mixture of three antibiotics combined with simvastatin (3Mixtatin) compared to MTA in hopeless
primary molars.
 Study design: In this randomized clinical trial, 80 teeth from 65 healthy children aged 3–6 years with interradicular
or periapical root resorption and/or perforation in primary molars were treated either with 3Mixtatin or MTA before
conventional pulpectomy and restoration. The subjects were followed up clinically and radiographically for 4, 6, 12
and 24 months after pulp treatment to evaluate and compare the healing process. The data were compared using
chi-square test at a significance level of 0.05.
 Results: By the end of 24 months in 3Mixtatin group, 31 (96.8%) teeth revealed no clinical signs or symptoms with
arrested resorption progress in radiographs. In MTA group, clinical signs and symptoms including pain, mobility
and sinus tract were observed in 18 (48.6%) teeth with cessation of root/ interradicular radiolucency in 7 (18.9%)
teeth without bone repair.
 Conclusions: Radiographic and clinical healing occurred more successfully following 3Mixtatin treatment compared
to treatment with MTA, it may lead to a paradigm shift in the pulpal treatment of primary teeth in the future .
CONCLUSION
The study results help to conclude that the prospective likelihood of
3Mixatin can be used as a potential alternative to MTA in pulp therapy in
deciduous teeth with 12 months follow-up period. 3Mixtatin showed better
results than MTA which may need a further follow-up period for a long term
effects of the both the medicaments.
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2. Goel N, Kumar A, Singhal R, Jha S, Namdev R, Rani R. Comparative Evaluation of

Chlorhexidine Polymer Scaffold, 3Mixtatin, and Formocresol for Vital Primary Pulp
Therapy: A Randomized 6-month Clinical Study. Int J Clin Pediatr Dent. 2023;16(3):478–
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Pulpotomy in Primary Molars using MTA and Formocresol Compared to 3Mixtatin: A Novel
Biomaterial. Journal of Clinical Pediatric Dentistry. 2018 Jan 1;42(5):361–6.

4. Aminabadi N, Huang B, Samiei M, Agheli S, Jamali Z, Shirazi S. A Randomized Trial Using

3Mixtatin Compared to MTA in Primary Molars with Inflammatory Root Resorption: A Novel
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3Mixtatin and Modified 3Mix-MP paste using lesion sterilization and tissue repair technique to
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