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Forty-three bicuspids which replaced successfully pulpotomized vital or non-vital primary molars, and twenty bicuspids, which erupted following unsuccessful pulpotomies requiring extraction of the preceding teeth, were examined for defects of position and enamel. In comparison with contralateral control teeth, test teeth in both groups showed an increased prevalence of rotation and enamel surface defects.
The results of therapeutic pulpotomies in primary molars with formocresol technique were studied by systematic follow-up. Of 84 primary lower molars in the clinical study, 56 became available for histological examination. The radiographic follow-up revealed periradicular osteitis in 10 per cent of the teeth treated. Internal root resorption was seen in 37 per cent of the teeth, or one-fifth of the roots treated. The histological examination revealed a very capricious diffusion of the medicament throughout the pulp tissue. Vital pulp remnants in the apical part of the treated roots showed no signs of healing. All pulps presented a varying number of inflammatory cells in the border zone adjacent to the formocresol-fixed region. In 80 per cent of the roots the histological sections revealed signs signs of internal resorption with or without incomplete repair tissue formation.
The vital formocresol pulpotomy is a useful technique to regain satisfactory oral health. Proper evaluation and diagnosis is crucial in order for the dentist to select the pulpal therapy that offers the best chance of long-term success with the fewest complications.
PURPOSE: This study was performed to retrospectively evaluate treatment of deep caries in primary molars with formocresol pulpotomy (FP) and indirect pulp therapy (IPT). METHODS: 133 primary molars with deep caries approaching the pulp were treated with FP (N = 78) or IPT (N = 55) and followed 2-7 years. All IPTs received immediate stainless steel crowns (SSCs); 61 FPs got an immediate SSC, 13 an intermediate restorative material (IRM), and 4 amalgam. Thirteen IPTs and 25 FPs had pre-operative pain compatible with a diagnosis of reversible pulpitis. Treatment notes and radiographs were independently assessed. RESULTS: Overall IPT success was 93% (51/55) versus 74% (58/78) for FP. Molars with pain compatible with a diagnosis of reversible pulpitis were successfully treated by IPT 85% (11/13) versus 76% (19/25) for FP. FP-treated molars exhibited earlier exfoliation 38% (30/78), while all IPT molars exhibited normal exfoliation. FPs receiving immediate SSCs had 50/61 (82%) succeed; FPs restored with an IRM temporary succeeded 5/13 (39%), amalgam 3/4 (75%). CONCLUSIONS: IPT success was significantly higher than FP (P = 0.01) in the treatment of deep caries. Both IPT and FP were successful in treating teeth with pain compatible with the diagnosis of reversible pulpitis. FP significantly hastened the exfoliation of pulpotomized primary molars (P = 0.001). IPT in primary teeth can be successfully used in a one step procedure. SSCs placed immediately after FP significantly increased FP success vs. FP followed by IRM temporary (P = 0.01).
PURPOSE: The purpose of this retrospective study was to compare the success rates of formocresol pulpotomy in primary molars restored with stainless steel crowns (SSC) to those restored with amalgam (AM). METHODS: Radiographs of pulpotomized primary molars restored with SSC or AM in the principal author's pediatric dentist practice were evaluated and defined as a "failure" when one or more of the following signs were present: internal (IR) or external (ER) root resorption and periapical (PR) or inter-radicular (IRR) radiolucency. Pulp canal obliteration was not regarded as failure. Three hundred and forty-one molars were available for follow-up evaluations ranging from 6 to 103 months. RESULTS: Forty-seven (14%) teeth were defined as "failure," with a rate of 13% (36/287) for teeth restored with SSC and 20% (11/54) for AM. This difference was not statistically significant (P>0.1). Failure rates of 2 surfaces AM was 23% (7/30), much higher than that of one surface AM (10%, 2/20). Most of the failed teeth presented more than one pathologic finding, with IR being the most frequently observed (36%), followed by ER (31%), IRR (22%) and PR (11%). Pulp canal obliteration was detected in 80% of the teeth, with similar rates in both groups. Failures were observed initially after a mean follow-up of 27 and 29 months in teeth restored with AM and SSC, respectively. CONCLUSIONS: Pulpotomized primary molars can be successfully restored with one surface amalgam if their natural exfoliation is expected within not more than two years.
PURPOSE: The objective of this outcome study was to compare ferric sulfate pulpotomy (FS) and primary tooth root canal therapy (RCT) on cariously exposed vital pulps of primary molars. METHODS: A total of 291 molars were treated in 130 children--182 molars received FS and 109 received RCT by random selection. RESULTS: At 2-year reassessment, 116 molars (73 FS, 43 RCT) were available for clinical and radiographic examination. There was no clinical evidence of pathosis in 96% of FS and 98% of RCT molars. Two independent pediatric dentists evaluated periapical radiographs of the treated molars. Molars were classified into 1 of 4 outcomes: (1) N--normal treated molar, (2) H--nonpathologic radiographic change present, (3) P(O)--pathologic change present, follow-up in 6 months, and (4) P(X)--pathologic change present, extract immediately. Survival analysis was applied. A good level of agreement between raters was found for molars with outcome P(X) (kappa=0.745). Intrarater reliability was good for molars with outcome P(X) (kappa=0.710). Significantly greater numbers of FS than RCT molars were rated P(X) at the 2-year recall (chi2=5.8; P=.02). No significant difference in survival between the 2 types of vital pulp treatments was detected in log rank tests (P=.22). CONCLUSIONS: Outcomes for FS were poorer than RCT outcomes at 2 years; however, at 2 years, the survival rates were not statistically different.
PURPOSE: The purpose of this study was to compare long-term outcomes of ferric sulfate pulpotomy (FS) and primary tooth root canal therapy (RCT) in vital pulps of deciduous molars exposed to caries lesions. METHODS: A total of 291 molars were treated in 130 children. One hundred and eighty-two molars received FS and 109 received RCT by random selection. RESULTS: At 3-year re-assessment, 29 molars (15 FS, 14 RCT) were available for clinical and radiographic examination. Two independent pediatric dentists evaluated periapical radiographs of the treated molars. Molars were classified 1 of 4 outcomes: (1) N = normal treated molar; (2) H = nonpathologic radiographic change present; (3) P(o) = pathologic change present, follow-up in 6 months; (4) P(x) = pathologic change present extract immediately. Survival analysis was applied. A good level of agreement between raters was found for molars with outcome P(x) (K = 0.79). No difference in radiographic outcomes was demonstrated 3 years after treatment (chi2 = 1.4). Survival analysis demonstrated a 3-year survival probability of 0.62 for FS-treated molars and 0.92 for RCT molars. Survival of RCT molars was significantly greater than for FS molars (Wilcoxon: P = .01; log-rank: P = .02). CONCLUSIONS: RCT-treated molars demonstrated significantly greater survival than FS-treated molars 3 years after treatment.
Rather easy to perform, pulpotomy of the deciduous teeth is the most frequent endodontic treatment performed on children, but also the most controversial. Based on the amputation of the pulp chamber and the conservation of the inflammation-free root canals, the clinical results can be good, depending on the materials used. In this, calcium hydroxide (Ca(OH)2) as well as zinc-oxide-eugenol (ZOE) have been proven very inflammatory whereas Formocresol (FC) remains the reference even if its clinical toxicity is still reported in literature on a very controversial way. Nevertheless, this was sufficient to trigger and stimulate a search for alternatives, and led to the proposition to use ferric sulfate and even more recently MTA as new bases for the treatment of the pulp stumps after pulp chamber amputation.
PURPOSE: The aims of this study were to: (1) retrospectively assess the overall performance of formocresol pulpotomies in primary molars when definitively restored with a resin-based material; and (2) compare the results to previously published studies using more traditional restorative techniques (stainless steel crown, amalgam). METHODS: Records of a 2-operator pediatric dental office using this novel restorative technique were reviewed. Pre- and postoperative radiographs of pulpotomized primary molars restored with Z-100 and with a minimum of 6 months of follow-up were compared to the contralateral nonpulpotomized tooth. Radiographic success was determined by the absence of furcation/periapical osseous radiolucency and internal/external pathologic root resorption. Patient's age, gender, tooth type and arch, follow-up time, ZOE base type used (IRM only or IRM with glass ionomer overlay), and number of surfaces involved were the variables analyzed in the study. Statistical analysis was performed using chi-square analysis. RESULTS: Fifty-nine teeth in 52 patients met the selection criteria. Patient's age at treatment ranged between 44 and 118 months, with an average follow-up time of 21 months (range = 7 to 43). Significant failure rate was found in the mandibular arch (P = .035). When only the occlusal surface was restored, 100% success was obtained. With proximal restorations, 83% (15/18) success was obtained when the base was IRM followed by glass ionomer and 69% (22/32) success for IRM only (P = .259). CONCLUSIONS: Overall, restoration of pulpotomized primary molars with resin-based material was inferior to reported success rates using stainless steel crowns. When proximal surfaces were restored, the failure rate (26%) was comparable to amalgam (23%). Prospective studies with larger sample size are necessary for definitive conclusions.
Some concern has been expressed in recent years about the use of formocresol for vital pulpotomy treatment of primary molars. This paper reviews the literature concerning the toxicity of formocresol and considers the evidence for the use of calcium hydroxide and glutaraldehyde. It is concluded that more work is required in this field before an alternative to formocresol can be recommended and that, in the meantime, a 1:5 dilution of the standard formocresol solution should be used but not included in the zinc oxide-eugenol sublining.
Pulpotomies were performed on 83 primary molars in 62 patients. Ferric sulfate or formocresol was placed on the pulpal stumps, and teeth were followed for 3-, 6-, and 12-month periods. After the one-year follow-up, 28 of 29 teeth treated with ferric sulfate (FS group) were considered successful and 21 of 27 teeth treated with formocresol (FC group) were judged to be successful. The FS group demonstrated greater combined clinical and radiographic success than the FC group at the one-year recall (P < 0.05). Although the results of this study are promising, further study with longer observation periods is warranted before this technique can be recommended.
Pulpal tissue changes following pulpotomies with formocresol, glutaraldehyde-calcium hydroxide and glutaraldehyde-zinc oxide eugenol pastes in primary teeth were investigated for a period of 12 months. Compared with the other groups, clinical, radiographic and histologic examinations revealed glutaraldehyde-zinc oxide eugenol combination had a higher success rate.
The relationship between formocresol, glutaraldehyde-calcium hydroxide and glutaraldehyde-zinc oxide eugenol pulpotomies on primary teeth and enamel defects on the permanent successor were evaluated. There were no significant differences between the test and control groups.
Fifty pulpotomies were carried out on the deciduous teeth of 39 children. Three years later the children were examined clinically and radiologically. Treatment appeared to be successful in 78% of the cases. Success of treatment seemed to be related to meticulousness of the treatment and number of appointments.
This article reviews the currently used medicaments in vital pulpotomy with particular emphasis on therapy for the primary dentition. Their possible mode of action, their effects on the remaining pulpal tissues, surrounding structures and any possible harmful effects are discussed.
The Author reports the results obtained over a period of time with pulpotomy performed on deciduous teeth with the use of a nontamponed 2% solution of glutaraldehyde. Clinical and radiographic follow-up showed a success rate of 97.5% at 6 months and 96% at 12 months. The Author considers that the use of endodontic glutaraldehyde therapy is a valid alternative particularly with regard to formocresol.
The active constituents of formocresol, formaldehyde and cresol, are known toxic agents. The authors administered increments of formaldehyde until systemic morbidity was demonstrated so that tissue damage could be equated with the number of concurrent pulpotomies required to achieve a toxic body load.
This report, the first of a two-part study, was undertaken to quantitate the systemic distribution of formaldehyde from a pulpotomy site, and to compare this level to doses that elicit overt systemic pathology. Maxillary first molars of rats were pulpotomized and treated with 14C-labeled formaldehyde, for 5 minutes. Additionally, four groups of rats were infused with 10, 20, 30, or 50 percent of the first quantity applied to the site. The data show that approximately 30 percent of the 14C-formaldehyde placed in the pulp chamber was distributed systemically; 50 percent to 59 percent was expired as CO2; and 2 percent was excreted.