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PubMed2002

Current concepts in vital primary pulp therapy.

REVIEW: Recent progress in understanding the molecular and cellular changes during tooth development and how they are mimicked during tissue repair, offers the opportunity to assess the biologic validity of the various vital pulp treatments. Under this light, indirect pulp treatment can be an acceptable procedure for primary teeth with reversible pulp inflammation, provided that this diagnosis is based on a good history, a proper clinical and radiographic examination, and the tooth had been sealed with a leakage-free restoration. Several articles report the success of this technique of direct pulp capping (DPC) and calcium hydroxide has been widely used with high success rates in young permanent teeth, but the results in primary teeth are less satisfactory. Recent studies have reported successful results with direct adhesive capping of exposed pulps, while others showed pulp inflammation and unacceptable results using this technique. Thus, the traditional rationale for the use of calcium hydroxide should be maintained, and this treatment modality reserved for iatrogenic exposures in asymptomatic teeth that are expected to exfoliate within a short period of time. In younger children, iatrogenic or carious exposures should be treated by pulpotomy. Formocresol has been the most popular pulp dressing material for pulpotomized primary molars for many years but, due to its deleterious effect, the use of formocresol is decreasing considerably worldwide. Ferric sulphate has been proposed as a substitute to formocresol, and the success rates were comparable to those of formocresol. More recently, considerably better results have been obtained with MTA (Mineral Trioxide Aggregate), and statistically significant differences were reported when compared with formocresol. Internal root resorption, a finding seen both in ferric sulphate and formocresol, was not observed in the MTA treated teeth. MTA is commercially available, but its cost is very high, and cannot be kept once opened. Thus, ferric sulphate can still be a valid and inexpensive solution for pulpotomies in primary teeth.

Journal Article↗
PubMed2006

Effects of Nd:YAG laser pulpotomy on human primary molars.

The purpose of this study was to compare the effects of Nd:YAG laser pulpotomy to formocresol pulpotomy on human primary teeth. Patients with a primary tooth that required pulpotomy because of pulpal exposure to caries, were selected for this study. After removal of coronal pulpal tissue, Nd:YAG laser at 2 W, 20 Hz, 100 mJ or a 1:5 dilution of formocresol was introduced into the canal orifice for complete hemostasis. IRM paste was then placed over the pulp stump, and the tooth was restored either with composite resin or stainless steel crown. Sixty-eight teeth were treated with Nd:YAG laser and followed up for 6 to 64 months. Clinical success was achieved in 66 out of the 68 teeth (97 %), and 94.1 % were radiographically successful. In the control group, 69 primary molars were treated with formocresol and followed up for 9 to 66 months; 85.5 and 78.3% achieved clinical and radiographic success, respectively. The success rate of Nd:YAG laser pulpotomy was significantly higher than that of formocresol pulpotomy. The permanent successors of the laser-treated teeth erupted without any complications.

Chi-Square Distribution↗
PubMed2005

Effectiveness of 4 pulpotomy techniques--randomized controlled trial.

Pulpotomy is the accepted therapy for the management of cariously exposed pulps in symptom-free primary molars; however, evidence is lacking about the most appropriate technique. The aim of this study was to compare the relative effectiveness of the Er:YAG laser, calcium hydroxide, and ferric sulfate techniques with that of dilute formocresol in retaining such molars symptom-free. Two hundred primary molars in 107 healthy children were included and randomly allocated to one of the techniques. The treated teeth were blindly re-evaluated after 6, 12, 18, and 24 months. Descriptive data analysis and logistic regression analysis, accounting for each patient's effect by a generalized estimating equation (GEE), were used. After 24 months, the following total and clinical success rates were determined (%): formocresol 85 (96), laser 78 (93), calcium hydroxide 53 (87), and ferric sulfate 86 (100). Only calcium hydroxide performed significantly worse than formocresol (p = 0.001, odds ratio = 5.6, 95% confidence interval 2.0-15.5). In conclusion, calcium hydroxide is less appropriate for pulpotomies than is formocresol.

Calcium Hydroxide↗
PubMed1999

Reinforcement mechanism of dentin mechanical properties by intracanal medicaments.

The reinforcement mechanism of dentin mechanical properties by intracanal medicaments was investigated. The dumbbell-shaped specimens were prepared from a collagen sheet, demineralized dentin and organic dissolved dentin. After immersing the specimens in intracanal medicaments (eugenol and formocresol), the tensile test was carried out in 37 degrees C water and the Vickers hardness test was performed. The tensile strengths increased after eugenol and formocresol immersion, especially collagen and organic dissolved dentin after formocresol immersion and demineralized dentin after eugenol immersion. Thus, formocresol immersion might have reinforced the dentin tensile strength by protein coagulation, while eugenol immersion might have reinforced the dentin tensile strength by not only protein coagulation but also chelation with hydroxyapatite. However, the hardness values did not significantly change after intracanal medicament immersion.

Analysis of Variance↗
PubMedDate not supplied

Evaluation of the carbon dioxide laser on vital human primary pulp tissue.

PURPOSE: The purpose of this study was to evaluate the response of the human primary pulp to the carbon dioxide laser and formocresol for vital pulp therapy. METHODS: Fifteen healthy children with intact, caries-and-restoration-free, contralateral primary cuspids with at least two-thirds of the roots remaining who were scheduled for orthodontic extraction were randomly assigned to pulpotomy treatment with a carbon dioxide laser or formocresol. The treated teeth were clinically and radiographically evaluated at 28 and 90 days post-treatment prior to extraction. The extracted teeth were evaluated histologically for pulpal response. RESULTS: All teeth were asymptomatic and clinically normal at both observation periods. Internal root resorption was observed in one formocresol and two laser treated teeth. There was a significant inverse correlation between the laser energy applied to the pulp and the degree of inflammation at 28 days (P = .01) but not at 90 days (P = .27). CONCLUSION: Carbon dioxide laser treatment compared favorably to formocresol for pulpotomy in primary teeth.

Child↗
PubMedDate not supplied

Evaluation of the novel anti-inflammatory agent tetrandrine as a pulpotomy medicament in a canine model.

Tetrandrine, a bisbenzylisoquinoline alkaloid with unique broad-spectrum anti-inflammatory properties, was evaluated as a pulpotomy medicament in a canine model. Histological sections were evaluated after three days (acute inflammation) and six weeks (chronic inflammation) by two criteria: 1) intensity and degree of inflammation, and 2) extent of pulp involvement. The results of the three-day dressings revealed significant neutrophil infiltration in only 30% of teeth treated with tetrandrine, compared with 81%, 84%, and 100% of teeth treated with Ledermix, (Lederle Pharmaceuticals, Wolfrathausen, Germany), formocresol (Creighton Pharmaceuticals, Sydney, Australia) and saline (controls) respectively (P < 0.01). After six weeks, there was significant lymphocyte infiltration in only 30% of teeth treated with tetrandrine, compared with 66%, 90%, and 100% on teeth treated with Ledermix, formocresol, and saline controls respectively. (P < 0.01). In both three-day and six-week specimens in tetrandrine-treated teeth the extent of inflammation was limited to less than one-third of the coronal section of the pulp, whereas teeth treated with Ledermix or formocresol showed cellular infiltration extending to greater than two-thirds of the pulp (P < 0.01). Comparative studies with berbamine, a natural analog of tetrandrine, showed that it was less potent than tetrandrine, but significantly better than Ledermix and formocresol on both acute and chronic pulp inflammation (P < 0.05 and P < 0.01 respectively). These results suggest that tetrandrine may have value as a pulpotomy medicament.

Alkaloids↗
PubMed2002

Clinical studies on ferric sulphate as a pulpotomy medicament in primary teeth.

AIM: The purpose of this paper is to review three prospective and two retrospective studies that have been published on the use of ferric sulphate as a pulpotomy medicament and, also, present the results of a recently completed, 3 year comparative study in pulpotomized primary teeth using ferric sulphate and diluted formocresol. The most important finding from the reviewed studies was that ferric sulphate gives very good clinical and radiographic results with high tooth survival rates and with no statistically significant differences from that of formocresol. Internal resorption is a common radiographic finding in both ferric sulphate and formocresol treatments with no statistically significant differences between them. However, internal resorption differs in size and progression rate among teeth. There were cases reported in which the size of the internal resorption was very small and unchanged over time, and even cases where the area of the resorption was self-repaired with hard tissue. Some of the authors considered only teeth with progressing and/or extensive internal resorption as failures, while small size and unchanged with time internal resorption was not considered as failure. CONCLUSION: Based on the data of the reviewed studies it is suggested that ferric sulphate be used, rather than formocresol, for pulpotomies of primary teeth as the latter has been blamed for systemic and local side effects on the developing successors.

Journal Article↗
PubMed2002

[The clinical evaluation of tinidazole-iodoform-phenocamphor paste as an intra-canal sterilization medication for acute periapical periodontitis].

OBJECTIVE: To compare the clinical effect of tinidazole-iodoform-phenocamphor paste on acute periapical periodontitis with of formocresol. METHODS: 80 permanent teeth of acute periapical periodontitis were selected and divided randomly into tinidazole-iodoform-phenocamphor paste group (T group) and formocresol group (C group). The periapical signs and symptoms were recorded. Radiographs were taken and periapical radiolucent areas were calculated. After root canal preparation,the tinidazole-iodoform-phenocamphor paste was used as an intra-canal dressing medication for 7 days in T group and the formocresol paper point was used in C group. During the course of root canal treatment,the standard paper-point sampling method was used to collect and quantify the periapical exudates and the clinical findings were assessed with clinical periapical index(CPI). All statistical analyses were finished with Sigmastat software. RESULTS: At the first visit, there was no significant difference between two groups of CPI indexes and exudates volumes (P>0.05). The stepwise regression results suggested that exudates volumes had a significant correlation to periapical percussion(P=0.0031). There was a close relationship between radiolucent areas and periapical percussion or swelling degree (P=0.1148, P<0.0001). After the root canal sterilization, there was a statistically significant decrease in exudates volumes and CPI indexes (P<0.01), but the difference of exudates volumes and CPI indexes between two groups was not statistically significant (P>0.05). CONCLUSION: It indicated that tinidazole-iodoform-phenocamphor paste had the same effect on controlling acute periapical periodontitis as that of formocresol.

Clinical Trial↗
PubMed2006

Antimicrobial endodontic compounds do not modulate alkylation-induced genotoxicity and oxidative stress in vitro.

OBJECTIVE: To investigate if formocresol, paramonochlorophenol, or calcium hydroxide modulate the genotoxic effects induced by the oxidatively damaging agent hydrogen peroxide (H2O2) or the alkylating agent methyl methanesulfonate (MMS) in vitro by using single cell gel (comet) assay. STUDY DESIGN: Chinese hamster ovary (CHO) cells in culture were exposed directly to formocresol, paramonochlorophenol, or calcium hydroxide (adjusted to 100 microg/mL) for 1 hour at 37 degrees C. Subsequently the cultures were incubated with increasing concentrations (0-10 micromol/L) of MMS in phosphate-buffered solution (PBS) for 15 minutes at 37 degrees C or of H2O2 at increasing concentrations (0-100 micromol/L) in distilled water for 5 minutes on ice. The negative control cells were treated with PBS for 1 hour at 37 degrees C. The parameter from the comet assay (tail moment) was assessed by the Kruskal-Wallis nonparametric test followed by a post hoc analysis (Dunn test). RESULTS: Clear concentration-related effects were observed for the genotoxin-exposed CHO cells. Increase of MMS-induced DNA damage was not significantly altered by the presence of the compounds tested. Similarly, no significant changes were observed when hydrogen peroxide was used with the endodontic compounds evaluated. CONCLUSION: Formocresol, paramonochlorophenol, and calcium hydroxide are not able to modulate alkylation-induced genotoxicity or oxidative DNA damage as depicted by the single cell gel (comet) assay.

Alkylating Agents↗
PubMed1990

Effect of intracanal medicaments on the sealing ability of TERM.

An in vitro leakage study was performed to determine the effect of intracanal medicaments on the sealing ability of Temporary Endodontic Restorative Material (TERM). Fifty extracted mandibular molars with uniform access preparations were restored with TERM after placement of either a dry cotton pellet (control) or a pellet moistened with eugenol, formocresol, CMCP, or a paste of sodium perborate and superoxol. Multiple quantitative measurements were made on each intact specimen at five time intervals after restoration, and, in some cases, after thermocycling. Statistical analysis revealed no significant leakage in the control group, or in the groups which used eugenol, formocresol, or CMCP when they were compared with the control group. Analysis, however, did show significant leakage for the group containing the bleaching paste. The authors concluded that the sealing ability of TERM is not affected by eugenol, formocresol, or CMCP. However, it should not be used for the temporary restoration of teeth being treated by the walking bleach technique.

Borates↗
PubMed1981

Formaldehyde in dentistry: a review of mutagenic and carcinogenic potential.

For many years there has been controversy over the value of antimicrobial drugs for intracanal dressings in endodontics. Formocresol, a formaldehyde compound, has evolved as the preferred drug for routine endodontic procedures, as well as pediatric endodontics. The increase in the use of formaldehyde has been complicated by the introduction of paraformaldehyde pastes for filling root canals. Neither of these formulas has ever been standardized. The doses are arbitrary, and the common dose of formocresol has been shown to be many times greater than the minimum dose needed for effect. The efficacy of paraformaldehyde pastes is questionable and remains clouded by inconclusive evidence, conflicting research, inadequate terminology, and a lack of convincing statistical evidence. The clinical use and delivery of formocresol and paraformaldehyde pastes remain arbitrary and unscientific. Formaldehyde has a known toxic mutagenic and carcinogenic potential. Many investigations have been conducted to measure the risk of exposure to formaldehyde; it is clear that formaldehyde poses a carcinogenic risk in humans. There is a need to reevaluate the rationale underlying the use of formaldehyde in dentistry particularly in light of its deleterious effects.

Carcinogens↗
PubMed1995

The effects of intracanal medicaments, fillers, and sealers on the attachment of human gingival fibroblasts to an exposed dentin surface free of a smear layer.

To date there has been very little research into the possible effects of endodontic therapy on regeneration of the lost periodontal attachment. The objective of this study was to examine the effects of endodontic medicaments on fibroblast attachment to dentin surfaces free of a smear layer. Pulp chambers of extracted third molars were filled with one of the following medicaments: gutta-percha with Roth's zinc oxide and eugenol-based sealer, warm gutta-percha with sealer, warm gutta-percha without sealer, calcium hydroxide, formocresol, cotton pellet, or left empty. A predetermined dentin surface area was then inoculated with human gingival fibroblasts at a concentration of 2 x 10(4) cells per ml. The cells were allowed to adhere to the dentin surface for either 4 or 24 hours, then cell attachment was quantified using a methyl-tetrazolium assay. The data were analyzed using a Kruskal-Wallis one-way analysis of variance and Dunn's multiple comparison test. It was determined that fibroblast attachment was significantly reduced when exposed to formocresol or warm gutta-percha without sealer at both the 4 and 24 hour interval (P < or = 0.05). This suggests that the use of formocresol or warm gutta-percha without sealer in a root canal may impede periodontal wound healing and regeneration.

Analysis of Variance↗
PubMed2001

[Effects of different disinfectants on levels of endotoxin in canals of chronic periapical periodontitis].

OBJECTIVE: The objective of this study is to compare effects of formocresol, camphorated phenol and Ya Kan (metronedazole) on endotoxin levels in canals of chronic periapical periodontitis. METHODS: A total of 30 patients with chronic periapical periodontitis were selected from outpatients, and 10 cases each were randomly picked out to treat by sealing with formocresol, camphorated phenol and Ya Kan respectively. All patients were both sampled before and after sealing of these disinfectants, and chromogenic substrate method of limulus amebocyte lysate (LAL) test was used to measure levels of endotoxin. RESULTS: The effects of Ya Kan, formocresol and camphorated phenol on levels of endotoxin did not showed significant difference. CONCLUSION: Some anti-anaerobic bacterial drugs can be used to treat chronic periapical periodontitis.

Anti-Infective Agents, Local↗
PubMedDate not supplied

A critical look at glutaraldehyde.

Glutaraldehyde has been proposed as an alternative to formocresol in pulpotomy treatment of primary teeth. Data regarding effects of the two medicaments have been discussed in the literature, but little attention has been given to critical comparisons concerning parameters of toxicity, mutagenicity, and systemic distribution of the two agents. This paper reviews previous data on systemic distribution of glutaraldehyde and formocresol from pulpotomy sites, as well as cytotoxicity and mutagenicity of the agents. Comparisons reveal little difference between the agents on the parameters reviewed. The authors question the rationale for glutaraldehyde as an alternative to formocresol.

Formocresols↗
PubMed1989

[Solvent action of sodium hypochlorite on fresh and formalin fixed tissue: a biochemical approach].

Debridement of the root canal system has long been recognized as the critical phase of success in endodontic therapy. Because of the morphological complexity of most root canals, complete removal of the pulp tissue during the mechanical preparation of these root canals is often impracticable. Sodium hypochlorite is thus currently favored by most endodontists as the routine irrigant on account of its antimicrobial action and its capacity to dissolve fresh tissue together with necrotic tissues. Formocresol is another common medicament for endodontic treatment and is usually used for pulpotomy, pulpectomy and intracanal medication. Nevertheless, it was empirically believed that formocresol may interrupt the action of sodium hypochlorite in the dissolution of residual tissue. Therefore, the present study was undertaken to testify whether formocresol can substantially retard the solvent action of sodium hypochlorite by comparing the effectiveness of 5% sodium hypochlorite on fresh and formalin-fixed tissues. Connective tissue from the abdominal wall of Sprague-Dawley rats was cut into pieces weighing 0.05 g and measuring about 2 x 10 x 10 mm. A total of 20 pieces of tissue were collected and divided into two groups: 10 pieces were used immediately as the fresh-tissue group; the other 10 pieces were fixed in 10% formalin for 7 days as the fixed-tissue group. Each group was then immersed in 5 ml of 5% sodium hypochlorite for 60 seconds, and 1 ml was aspirated from each for assay. Dialysis was performed using 2 liters of double distilled water for a period of 4 hours with the water changed hourly.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2002

Response of the primary pulp to inflammation: a review of the Leeds studies and challenges for the future.

AIM: The purpose of this paper is to consider evidence for the early involvement of the pulp in primary molars following a proximal caries attack and to consider the evolution of ferric sulphate as the possible alternative to formocresol for pulp therapy in primary molars. Concerns have been expressed over the wisdom of using products containing formaldehyde in children and alternatives should be considered, even though there is no substantive data to support the claims of formocresol toxicity. Pulp therapy is still often required in the management of large proximal caries in primary molars. General dental practitioners often comment on the futility of restoring primary teeth with the common perception being that restorations more often than not fail in the primary teeth. One common cause is abscess formation following proximal restorations. The main reason why this occurs is that proximal restorations in primary teeth are often carried out without consideration being paid to the state of the pulp. We have shown in a series of studies in Leeds that pulp inflammation in primary molars precedes its exposure. Most primary molars where caries had involved more than half inter-cuspal distance manifested pulp inflammation involving the entire pulp horn, but rarely the root canal tissue. This would mean that in most primary teeth with proximal caries, which are indicated for a pulpotomy, the removal of the coronal pulp alone would render them free of inflammation. This would then bring into question the use of formocresol on an otherwise uninflammed radicular tissue, which has a viable blood supply. CONCLUSION: Pulp inflammation in primary molars sets in at an early stage of a proximal carious attack. Also, in most cases, a medicament that would achieve haemostasis, such as ferric sulphate, rather than achieve fixation of the tissues is all that would be required for the preservation of the primary tooth until exfoliation.

Journal Article↗
PubMed2004

[Effect of tinidazole-dexamethasone-iodoform paste on controlling endodontic interappointment emergencies].

PURPOSE: To compare the clinical effect of tinidazole-dexamethasone-iodoform paste on intracanal dressing medication for teeth with chronic periapical periodontitis with that of formocresol. METHODS: 520 permanent teeth with chronic periapical periodontitis were selected and divided randomly into tinidazole-dexamethasone-iodoform paste group (A group) and formocresol group (B group). The periapical signs and symptoms were recorded, radiographs were taken. After root canal preparation, the tinidazole-dexamethasone-iodoform paste was used as an intracanal dressing medication for one week in A group and the formocresol paper point was used in B group. During the course of canal treatment, the clinical findings were assessed with clinical periapical index (CPI), the cases were followed up for two years. RESULTS: There was significant difference between A and B group (P<0.01), group A was better than group B. There was no significant difference between two groups of the success rate after following up two years (P>0.05). CONCLUSION: As an intra-canal sterilization medication,tinidazole-dexamethasone-iodoform can reduce the occurrence of endodontic interappointment emergencies in teeth with chronic periapical periodontitis and has a good long-term result.

Adult↗
PubMed1990

PH of endodontic medicaments used in pediatric dentistry: effects of dyadic combinations.

The optimum pH of an endodontic medicament is close as possible to that of body fluids, i.e., around 7.2 as higher and lower pH's are likely to cause cellular necrosis of tissues in direct contact with the medicament. This study investigated the pH of various endodontic medicaments commonly used in pediatric dentistry, both singly and in the various combinations available for clinical use. The results showed that the pH ranged from a low of 2.90 +/- 0.02 for iodoform paste (Kri) to a high of 12.45 +/- 0.02 for calcium hydroxide (Calyxl). Eugenol showed a pH of 4.34 +/- 0.05, formocresol 2.79 +/- 0.02, and a commercially-available antibiotic-corticosteroid paste (Ledermix) 8.13 +/- 0.01. Addition of up to 50 percent (v/v) of Ledermix or 25 percent Kri respectively did not affect the pH of Calyxl significantly. Although the addition of up to 75 percent Kri to Ledermix caused a fall in pH, the changes are probably not significant clinically. Furthermore, the addition of 50 percent eugenol to formocresol increased its pH significantly. The optimum pH of an endodontic medicament is as close as possible to that of body fluids, i.e., around 7.2. Higher and lower pH's are likely to cause cellular necrosis of tissues in direct contact with the medicament. However with the exception of calcium hydroxide there has been very little information available on the pH of endodontic medicaments commonly used in pediatric dentistry. Medicaments such as formocresol, eugenol and iodoform pastes have been extensively used for endodontic therapy yet very little attention has been given to their pH values.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium Hydroxide↗