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PubMed1997

Electron microscopic study on nerve terminals during dentin bridge formation after pulpotomy in dog teeth.

This study was designed to examine the relation between pulpal nerves and the differentiation of pulpal cells into preodontoblasts and odontoblasts during the healing process after pulpotomy. A total of 36 upper and lower teeth obtained from six adult dogs were used. The pulp chamber was opened with a sterile diamond bur, the coronal pulp was exposed, and the whole surface of the amputated pulp was capped with calcium hydroxide. The interval between pulpotomy and extraction was 5, 7, 10, 15, 20, 30, 40, 50, and 60 days, and then specimens were examined ultrastructurally. Close contact between fibroblast-like cells/osteoblast-like cells and nerve terminals at the calcification front was observed in the early healing process after pulpotomy, suggesting a close relation between nerve fibers and pulpal cell differentiation.

Animals↗
PubMed1989

Emergency pulpotomy: pain relieving effect with and without the use of sedative dressings.

Seventy-three teeth with acute irreversible pulpitis were subjected to emergency pulpotomies. After removal of the coronal portion of the pulp, a sterile cotton pellet or zinc oxide-eugenol cement was placed against the remaining pulp tissue. The cotton pellet was either dry or moistened with camphorated phenol, cresatin, eugenol, or isotonic saline. This gave six different groups of treatment following the pulpotomy. All teeth were sealed with zinc oxide-eugenol cement. By means of questionnaires, symptoms were recorded after the anesthetic effect was gone and also at 1, 7, and 30 days after treatment. A total of 70 patients (96%) reported pain relief. Three patients did not experience relief and returned for pulpectomy. After the first postoperative day, no pain was reported by any of the patients. The frequency of discomfort decreased from 11% 1 day postoperatively to 1% 30 days after the emergency treatment. There was no difference in recorded symptoms among the six treatment groups. Thus, removal of caries, pulpotomy, and sealing of the cavity apparently was a reliable means to relieve pain. The use of the various dressings did not contribute to the relief of pain.

Analgesics↗
PubMed2000

Ferric sulfate as pulpotomy agent in primary teeth: twenty month clinical follow-up.

Seventy primary molar teeth, carious exposed, symptom free, without any sign of root resorption in children aged from 3 to 6 years (main age 4.3 yr) were treated with conventional pulpotomy procedures. Ferric sulfate 15.5% solution (applied for 15 second for 35 teeth) and formocresol solution (five minute procedure of Buckley's formula for next 35 teeth) have been used as pulpotomy agents. In both groups, pulp stumps were covered with zinc-oxide eugenol paste. Permanent restorations were stainless steel crowns. Clinical check up was every three-months and radiographic follow-up time was six and twenty months after treatment. Our results within this period revealed 100% clinical success rate in both groups. Radiographic success rate was in both groups 97.2%, while in 2.8% cases has shown internal root resorption. On the basis of these results, we can recommend ferric sulfate as a pulpotomy agent in primary teeth in substitution for formocresol at the moment.

Child↗
PubMedDate not supplied

Ferric sulfate pulpotomy in primary molars: a retrospective study.

PURPOSE: This investigation collected clinical and radiographic data from a retrospective chart review of patients receiving ferric sulfate pulpotomies with a sub-base of zinc oxide eugenol in a clinical practice over a five-year period. METHODS AND MATERIALS: Clinical and radiographic data were available for 242 primary molars in 171 children with follow-up times ranging from 4-57 mos (mean = 19 mos). RESULTS: The overall radiographic success rate ranged from 74-80%. The frequency of normal appearing pulps decreased over time. The most frequently observed pulpal responses were calcific metamorphosis (6-33%) and internal resorption (7-18%). Overall clinical success was 99%. Only 9 of the 242 teeth were extracted due to radiographic and/or clinical failure. A survival analysis demonstrated that the overall cumulative probability of survival remained high over time with a cumulative survival of over 90% after 3 years. CONCLUSIONS: The overall success rates in this study are lower than those reported previously in the literature for ferric sulfate pulpotomies, but are comparable with those reported for 1:5 dilution, 5-min formocresol pulpotomies.

Child↗
PubMed2000

Pulpotomy reconsidered: application of an adhesive system to pulpotomized permanent primate pulps.

OBJECTIVE: This study was undertaken to compare the healing response of permanent primate pulps to pulpotomy procedures following hemorrhage control and adhesive hybridization to their response after conventional treatments. METHOD AND MATERIALS: Forty-two cavities were placed throughout the dentitions of 4 adult monkeys. In 24 teeth, following mechanical bur exposure and pulpotomy, hemorrhage was controlled with application of 3% sodium hypochlorite. The cavity was rinsed and the enamel-dentin-pulp surface was restored with an adhesive system for 6 and 7 months. Calcium hydroxide, formocresol, and resin-modified glass-ionomer cement were placed as conventional treatments in 18 teeth for 70 days and cavities were sealed with resin-modified glass-ionomer cement. Following perfusion fixation, tissues were demineralized, sectioned, stained, and histologically graded using defined criteria. RESULTS: Of 24 adhesive system pulps, 10 showed no or minimal pulpal response, 1 showed an acute response, 6 showed a chronic response, 2 showed a severe response, and 5 showed compartmentalized zones of localized necrosis. Only 8 adhesive system pulps showed stained bacteria associated with inflamed tissues. Thirteen adhesive system pulps showed dentin bridging directly at the adhesive system interface. Calcium hydroxide-treated specimens showed healing and dentin formation, while resin-modified glass-ionomer cement and formocresol treatments failed to result in any bridging. Apical tissues in all adhesive-treated specimens showed normal pulps and primary odontoblasts along their entire walls. CONCLUSION: Permanent pulps without periapical radiolucencies may survive pulpotomy, provided that hemorrhage is properly controlled and the pulp-restoration interface is hybridized to exclude all microleakage.

Animals↗
PubMed2001

Healing process of dog dental pulp after pulpotomy and pulp covering with mineral trioxide aggregate or Portland cement.

Considering several reports about the similarity between the chemical compositions of the mineral trioxide aggregate (MTA) and Portland cement (PC), the subject of this investigation was to analyze the behavior of dog dental pulp after pulpotomy and direct pulp protection with these materials. After pulpotomy, the pulp stumps of 26 roots of dog teeth were protected with MTA or PC. Sixty days after treatment, the animal was sacrificed and the specimens removed and prepared for histomorphological analysis. There was a complete tubular hard tissue bridge in almost all specimens. In conclusion, MTA and PC show similar comparative results when used in direct pulp protection after pulpotomy.

Aluminum Compounds↗
PubMedDate not supplied

Alternative method of hemorrhage control in full strength formocresol pulpotomy.

PURPOSE: This investigation evaluated the success of a formocresol pulpotomy technique in which hemostasis was obtained with the same formocresol dampened cotton pellet used to medicate the root pulp stumps and to compare the findings of this investigation with data of published formocresol pulpotomy studies in which hemorrhage was controlled by traditional means. METHODS: Clinical and radiographic data were available for 194 primary molars in 112 patients with follow up times ranging from 5 to 109 months (mean = 38 months). RESULTS: Overall radiographic success was 87%. The most frequently observed pulpal responses were calcific metamorphosis (34%) and internal resorption (10%). Overall clinical success was 98%. Only 7 of 194 molars were extracted due to radiographic and/or clinical failure. Overall cumulative probability of survival remained high over time with a cumulative survival rate of over 94% over 4 years. CONCLUSIONS: The success rates for this variation of the formocresol technique are comparable to those success rates in the literature where hemostasis was obtained in a separate step using a nonmedicated cotton pellet. The results of this study suggest that using the same cotton pellet dampened with full strength formocresol to obtain hemorrhage control and medicate the root pulp is an acceptable variation of the traditional formocresol pulpotomy technique.

Child↗
PubMedDate not supplied

Partial pulpotomy for immature permanent teeth, its present and future.

Traumatic or carious exposure of a vital pulp in an immature permanent tooth presents a significant clinical challenge to maintain proper vitality. Currently available procedures include direct pulp capping, complete pulpotomy and partial pulpotomy. This paper reviews the application of partial pulpotomy in immature permanent teeth and provides prognostic and technique guidance.

Animals↗
PubMed2002

Electrocoagulation extends the indication of calcium hydroxide pulpotomy in the primary dentition.

The primary molars received calcium hydroxide pulpotomy with or without the electrocoagulation procedure. Teeth were evaluated clinically and radiographically at 6, 12, and 24 months after treatment. There was no statistically significant difference in success rate between calcium hydroxide pulpotomies, with and without the electrocoagulation procedure, either clinically or radiographically. These results indicate that a pulpotomy with calcium hydroxide is an effective treatment for cariously exposed pulp in primary molars and electrocoagulation can extend its indication.

Calcium Hydroxide↗
PubMedDate not supplied

Cvek pulpotomy: report of a case with five-year follow-up.

Partial pulpotomy (Cvek pulpotomy) is the treatment of choice for injured permanent incisor teeth with exposed vital pulp tissue and immature apices. This treatment preserves pulpal function, thus allowing continued root development. The present report describes the case of a permanent incisor with incomplete root end closure that underwent a Cvek pulpotomy, with subsequent apical closure. Five years post pulp therapy, the tooth remained symptom free.

Calcium Hydroxide↗
PubMedDate not supplied

Comparison of ferric sulfate, formocresol, and a combination of ferric sulfate/formocresol in primary tooth vital pulpotomies: a retrospective radiographic survey.

Studies have suggested that formocresol has toxic and carcinogenic potential. A search for an alternative medicament for primary tooth pulpotomies has led to ferric sulfate as a possible alternative. A retrospective study was done in a multipractitioner IHS (Indian Health Service) clinic. Radiographic success or failure was determined for 202 primary tooth pulpotomies performed with either formocresol, ferric sulfate, or a combination procedure of formocresol and ferric sulfate. The post-operative period for the pulpotomies ranged from one month to thirty-six plus months. There was no statistical difference in radiographic failure rates between formocresol, ferric sulfate, or the combination procedure when results were analyzed regardless of post-op period. However, when post-op periods were considered, formocresol performed better at > 36 months and the combination procedure showed significantly more failures at > 36 months.

Arizona↗
PubMed1992

Vascularization after pulpotomy.

The vascular changes of the pulpal vessels in experimentally induced pulpotomy in dog tooth were investigated using microcorrosive resin casts technique and scanning electron microscopic examination. The pulpal tissues of the permanent mandibular molars were amputated and then dressed with calcium hydrate. At one to eight weeks after pulpotomy, the experimental teeth were prepared for resin casts of pulpal vessels with hard tissues. One week after pulpotomy, a concave region, which was supposed to be due to the compression by the calcium hydrate, was found in the newly formed pulpal vascular network. Around the concave region was a flat, dense capillary network. In eight weeks, the thick dentin bridge was formed in close proximity to the amputated pulpal surface. The vascular network just beneath the dentin bridge changed into similar features in the three layers of the normal pulpal vascular architecture, which are (i) terminal capillary network (TCN), (ii) capillary network (CN), and (iii) venular network (VN) and which distributed in the superficial layer of the pulpal vessels.

Animals↗
PubMedDate not supplied

Partial pulpotomy and tooth reconstruction of a crown-fractured permanent incisor: a case report.

Pulp exposure due to traumatic injuries in the anterior permanent teeth of adolescents is a common occurrence. A vital permanent maxillary incisor with complex crown fracture and pulp exposure was treated by partial pulpotomy and assessed clinically through pulpal sensitivity tests and radiographically for periapical healing. Partial pulpotomy consisted of pulp tissue removal to a depth of only 1 to 2 mm, then capping the pulpal wound with calcium hydroxide, lining with resin-modified glass-ionomer cement, and restoration with resin composite. At each recall (7, 15, 21, 50, 90, 150, and 250 days), no spontaneous pain was observed; the pulp showed signs of vitality and absence of periapical radiolucency after 90 days. For long-term success, partial pulpotomy is recommended as an option for cases of traumatic pulp exposure in permanent incisors with crown fractures.

Adolescent↗
PubMed1992

Zinc oxide-eugenol pulpotomy and stainless steel crown restoration of a primary molar.

The most durable and reliable method of retaining a primary molar in the mouth after a pulpotomy procedure is complete-coverage restoration with a preformed stainless steel crown. This paper describes a method for performing pulpotomy and stainless steel crown restoration of a primary molar. Neither formocresol, glutaraldehyde, nor calcium hydroxide is used during the pulpotomy phase of the treatment.

Child↗
PubMedDate not supplied

Evidence-based assessment: evaluation of the formocresol versus ferric sulfate primary molar pulpotomy.

PURPOSE: Formocresol and ferric sulfate were evaluated as pulpotomy medicaments using evidence-based dentistry principles. Formocresol has been challenged as a potential carcinogen and mutagen, leading to consideration of ferric sulfate. METHODS: The PICOT statement was: (P) In human carious primary molars with reversible coronal pulpitis, (I) does a pulpotomy performed with ferric sulfate, (C) compared with formocresol, (O) result in dinical/radiographic success, (T) in time periods up to exfoliation? Relevant papers (N=894) were identified from databases and inclusion criteria were applied; 94 papers remained (randomized clinical trials [RCTs]=7; clinical trials [CTs]=28; case-control studies=14; opinions, cohort, and cross-sectional studies=4; reviews=22; irretrievable papers=19). Three RCTs and 10 CTs (total teeth: formocresol=753; ferric sulfate=90) were meta-analyzed; 1 RCT and 1 CT were tested for homogeneity (odds ratios; 95% confidence intervals); 3 RCTs and 10 CTs were examined by student's t test. RESULTS: Clinical data indicated ferric sulfate was significantly more successful than formocresol (OR=1.95; CI=1.01-3.80). Radiographic data indicated no difference between medicaments (OR=0.90; CI=0.58-1.39). Medicaments did not differ with t-tests of clinical (P>.10) and radiographic (P>.50) data. CONCLUSIONS: This evidence-based assessment concluded that, in human carious primary molars with reversible coronal pulpitis, pulpotomies performed with either formocresol or ferric sulfate are likely to have similar clinical/radiographic success.

Child, Preschool↗
PubMed2005

Current concepts in vital pulpotomies in primary teeth.

Vital pulpotomies in primary teeth are performed to maintain the vitality of the pulp and to hold the tooth until it can be normally exfoliated. There exists much controversy surrounding the issue of pulpotomy agents, and the ideal pulp dressing material has not yet been identified. Therefore, it seems that formocresol will still be the first choice for pulpotomies in primary teeth until such agent is identified.

Aluminum Compounds↗
PubMedDate not supplied

Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol.

PURPOSE: The objective of this study was to assess the effect of mineral trioxide aggregate (MTA) as pulp dressing material following pulpotomy in primary molars with carious pulp exposure and compare them to those of formocresol (FC). METHODS: Of 33 children, primary molars treated via a conventional pulpotomy technique were randomly assigned to the MTA group (33 teeth) or FC group (29 teeth). Clinical and radiographic follow-up ranged between 4 and 74 months. The mean follow-up time was 38 months, with no difference between the groups. Twenty-nine teeth were followed until uneventful shedding (mean=33 months). Failures were detected after a mean period of 16 months (range=4 to 30). RESULTS: The success rate of pulpotomy was 97% for MTA (1 failure) and 83% for FC (5 failures). Eight teeth presented internal resorption. In 4 of them (2 of each group), progress of the resorption process stopped and the pulp tissue was replaced by a radioopaque calcified tissue. Pulp canal obliteration was observed in 58% of the MTA group and in 52% of the FC group (total=55%). CONCLUSIONS: MTA showed a higher (though not statistically significant) long-term clinical and radiographic success rate than formocresol, and can be recommended as its replacement as, unlike FC, MTA does not induce undesirable responses.

Aluminum Compounds↗
PubMedDate not supplied

Radiographic success of ferric sulfate and formocresol pulpotomies in relation to early exfoliation.

PURPOSE: The purpose of this retrospective study was to evaluate the radiographic findings with formocresol and ferric sulfate pulpotomies in relation to early tooth loss. METHODS: Vital pulpotomies with either ferric sulfate or formocresol, performed by faculty members between 1992 and 2002 at The University of Iowa, were evaluated retrospectively. Radiographic criteria were established to assess success or failure of the treated tooth. This was then correlated with time of tooth loss and space management. RESULTS: Eighty-five molars, followed between 6 to 61 months, met the inclusion criteria. Of these, 15 (43%) teeth treated with ferric sulfate, 23 (56%) treated with formocresol, and 5 (55%) treated with a combination of ferric sulfate and formocresol remained free of any radiographic pathology. Overall, 13% of the pulpotomized teeth were prematurely lost due to abscess formation and in need of space management. Regardless of the treatment type, internal root resorption was the most common cause of premature exfoliation. CONCLUSIONS: Both ferric sulfate and formocresol pulpotomies can lead to premature exfoliation of primary teeth, with the subsequent need for orthodontic space maintenance. Therefore, radiographic criteria should be taken into consideration when evaluating pulpotomized teeth at recall visits.

Alveolar Bone Loss↗