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PURPOSE: The purpose of this study was to compare the in-vitro effects of a European-based formocresol formulation that incorporates eugenol with formocresol alone on the adhesion of macrophages to plastic surfaces. METHODS: Macrophages were obtained from Wistar rats. The adherence capacity of macrophages to a plastic surface was determined. Assays were carried out in Eppendorf tubes incubated for 15 min at 37 degrees C in a humidified atmosphere of 5% CO2. The adherence index was calculated. RESULTS: Results showed that both formocresol/eugenol and formocresol alone significantly decreased the adherence index of macrophages. The formocresol formulation that incorporated eugenol was more potent in inhibiting macrophage adhesion than formocresol alone. CONCLUSIONS: Taking into account that adherence to a substrate is the first step in the phagocytic process of macrophages and in antigen presentation, both formocresol formulations could inhibit macrophage function and modulate immune and inflammatory responses in dental pulp and periapical tissues.
DATA SOURCES: Medline Ovid Library, the Cochrane Library, PubMed, Embase, Science Citation Index (SCI) and System for Information on Grey Literature in Europe (SIGLE). STUDY SELECTION: Reviews, full reports, or research abstracts of prospective, retrospective, comparative, and/or radiographic studies were included, while case reports and letters were excluded. DATA EXTRACTION AND SYNTHESIS: A total of 13 studies (three randomized clinical trials and 10 clinical trials) contributed to the meta-analysis, one randomized clinical trial and one clinical trial were analyzed by the direct technique, and all 13 trials were analyzed by the indirect technique. Data from trials were divided into clinical and radiographic data, and separate statistical analyses were conducted using the direct technique. Odds ratios (ORs) were used to compare the relative success of ferric sulphate and formocresol. Data homogeneity was tested using the chi(2)-test of consistency on the ORs for each trial. RESULTS: Clinical data indicated that ferric sulphate 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>0.10) and radiographic (P>0.50) data. CONCLUSIONS: In human carious primary molars with reversible coronal pulpitis, pulpotomies performed with either formocresol or ferric sulphate are likely to have similar clinical/radiographic success.
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Pulpotomy in primary teeth using the formocresol method results in varying degrees of devitalization of the root pulp. The extent of this devitalization depends on, among other things, the ability of the components of formocresol to leave the dressing. The purpose of this study was to evaluate the rate and duration of diffusion of the components of formocresol when incorporated in different vehicles. The antimicrobial effect of the drugs was used to assess the diffusion of the components of formocresol in blood agar, with a sensitive microorganism as an indicator. Evaluation of the MICs assessed in broth medium for formalin, formocresol and cresol, respectively, and the zone size of growth inhibition on blood agar from these components when incorporated in ZnO or ZnO-eugenol cement, suggested that the initial zone of inhibition from formocresol was due mainly to the diffusion of formaldehyde. Cresol diffused more slowly from the dressing. The presence of eugenol in the dressing, as in ZnO-eugenol cement, gave smaller initial release of formaldehyde, formocresol and cresol compared with the release from ZnO, but more prolonged diffusion. A higher initial release of formaldehyde was obtained when the formocresol was incorporated in ZnO alone compared with ZnO-eugenol cement or Pharmatec.
Calf pulp was treated with full-strength formocresol, diluted formocresol, or saline for 4 hours. After washing and homogenization, the water extractable supernates were analyzed for total amino acid, carbohydrate, and hydroxyproline content. Additional samples were tested against trypsin, pepsin, collagenase, and hyaluronidase. Other tissue samples treated with 1/5, 1/10, and 1/25 dilutions of formocresol were subjected to trypsin and collagenase. The control tissue gave 50 per cent more extractable material, which contained over 300 per cent more total amino acids and hydroxyproline but only slightly more carbohydrate than the treated tissue. Formocresol treatment produced an 80 to 90 per cent reduction in reactivity to trypsin, pepsin, and collagenase but little change from hyaluronidase action. The increase in reactivity of the tissue to enzyme hydrolysis paralleled the increase in dilution of formocresol. These results indicate a profound effect on the protein fraction of pulp exposed to full-strength formocresol.
OBJECTIVE: The purpose of this study was to investigate whether a diode laser pulpotomy with mineral trioxide aggregate (MTA) sealing could be an acceptable alternative to the conventional formocresol pulpotomy and zinc oxide eugenol (ZOE) sealing in human primary teeth. METHODS: A randomized, single-blind, split-mouth study was used with a sample of 16 children aged from 3 to 8 years (mean age=5.10 years). A total of 26 pairs of teeth from these 16 patients were selected based on clinical and radiographic criteria. One tooth from each pair was randomly assigned to either the laser-MTA pulpotomy group or the formocresol-ZOE pulpotomy group. All teeth were followed up clinically and radiographically at 2.3, 5.2, 9.5 and 15.7 months. All extracted failures were sectioned and photographed to assess possible reasons for this. RESULTS: A total of seven laser-MTA-treated teeth were deemed to be radiographic failures (mean time until failure=9.1 months) compared to three formocresol-ZOE treated teeth (mean time until failure=12.5 months). These results were not significant using Fisher's exact test (P>0.05). Six of the laser-MTA failures and all three formocresol-ZOE failures exhibited furcal and/or periapical radiolucencies with or without pathologic root resorption. One of the laser-MTA failures displayed premature root resorption and is being observed for exfoliation. Analysis of photographs of teeth available for extraction revealed errors in clinical technique in addition to expected signs of a disease process such as the presence of granulation tissue and areas of pathologic root resorption. CONCLUSIONS: The laser-MTA pulpotomy showed reduced radiographic success rates compared to the formocresol-ZOE pulpotomy at 15.7 months; however, these results were not statistically significant. Improved success rates among a larger patient sample and a longer follow-up period would be required for the laser-MTA pulpotomy to be considered a routine alternative to the conventional formocresol-ZOE procedure. Meticulous restorative techniques must be followed to ensure the success of laser-MTA pulpotomies.
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.
Diluted formocresol is the most widely recommended primary tooth pulpotomy medicament, but it is not commercially available. This investigation surveyed practicing pediatric dentists about the concentration of formocresol that they use to perform pulpotomies and, if they use diluted formocresol, where they obtain it. Eight-hundred-and-six surveys were sent to a randomly selected sample of practicing pediatric dentists, and 422 were returned for a 52% response rate. Eighty-four percent of the respondents use formocresol for their primary tooth pulpotomies. Of those, 69% use full strength, 27% use diluted and 4% don't know. Sources of diluted formocresol for those who use the diluted form include: 34% who buy it that way, 58% who dilute it themselves and 8% who have the pharmacy dilute it. The majority of pediatric dentists who use formocresol for primary tooth pulpotomies use a full strength formulation.
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.
Bacteriologic studies indicate that 50 percent formocresol in propylene glycol is an efficient bactericide. The tissue-irritation potential of this concentration was evaluated in rats. Assessment of the subcutaneous connective tissue reactions to 50 percent formocresol, 100 percent formocresol, and normal saline solution (as a control) indicates that formocresol, when diluted with propylene glycol, is significantly less irritating to the subcutaneous connective tissue of rats. The atraumatic implantation technique also seems to influence significantly the intensity of tissue reaction. Dilute formocresol deserves further study to evaluate its use in clinical endodontics.
A study was carried out to investigate the effect of formocresol (formalin-creosote) on the periapical tissue after pulpectomy in rats. A pulpectomy was performed on the mesial root of the right mandibular first molar, and, in group A, a paper point containing saline was inserted into the root canal. In group B, a paper point containing formocresol was inserted, and in group C, a drop of formocresol was applied and a paper point containing formocresol was inserted into the root canal. The periapical tissue was examined histologically and histometrically at 3, 7, 14, and 28 days after insertion, and the inflammatory cells and fibroblasts in the apical granulation tissue were also counted. Histologically, in group A, the inflammation observed was slight at 14 and 28 days, while in groups B and C, a moderate inflammation remained. Histometrically, the area of the apical periodontal ligament in groups B and C was increased significantly compared with that in group A at 14 and 28 days. The inflammatory cell count in groups B and C increased significantly compared with that in group A at 7, 14, and 28 days, whereas the fibroblast count in Groups B and C decreased compared with that in Group A at 7, 14, and 28 days. These results demonstrate that formocresol delayed the healing of periapical tissue after pulpectomy.
Pulpotomies were performed on rhesus monkeys with use of formocresol to determine if there was uptake of 14C-formaldehyde into the systemic circulation after formocresol pulpotomies. Five-minute exposure of pulpal tissue to the 14C-formocresol resulted in the systemic absorption of approximately 1% of the dose. Two hours of exposure of pulp tissue to the 14C-formocresol did not increase the systemic absorption. Multiple sequential pulpotomies resulted in proportionately higher systemic absorption of 14C-formaldehyde. Application of 131I to pulpotomy sites indicated that formocresol compromises the microcirculation of the dental pulp. Autoradiography disclosed extensive concentrations of 14C-formaldehyde in the pulp, dentin, periodontal ligament, and bone.
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.
PURPOSE: The aim of this study was to use clinical, radiographic, and histologic examinations to compare the relative success of gray mineral trioxide aggregate (MTA), white MTA, and formocresol as pulp dressings in pulpotomized primary teeth. METHODS: Twenty-four children, each with at least 3 primary molars requiring pulpotomy, were selected for this study's clinical and radiographic portion. An additional 15 carious primary teeth planned for serial extraction were selected for this study's histologic portion. All selected teeth were evenly divided into 3 test groups and treated with pulpotomies. Gray MTA was used as the pulp dressing for one third of the teeth, white MTA was the dressing for one third, and the remaining one third were treated with formocresol. The treated teeth selected for the clinical and radiographic evaluations were monitored periodically for 12 months. The treated teeth selected for histologic study were monitored periodically and extracted 6 months postoperatively. RESULTS: Four children with 12 pulpotomized teeth failed to return for any follow-up evaluations in the clinical and radiographic study. Of the remaining 60 teeth in 20 patients, 1 tooth (gray MTA) exfoliated normally and 6 teeth (4 white MTA and 2 formocresol) failed due to abscesses. The remaining 53 teeth appeared to be clinically and radiographically successful 12 months postoperatively. Pulp canal obliteration was a radiographic finding in 11 teeth treated with gray MTA and 1 tooth treated with white MTA. In the histologic study, both types of MTA successfully induced thick dentin bridge formation at the amputation sites, while formocresol induced thin, poorly calcified dentin. Teeth treated with gray MTA demonstrated pulp architecture nearest to normal pulp by preserving the odontoblastic layer and delicate fibrocellular matrix, yet few inflammatory cells or isolated calcified bodies were seen. Teeth treated with white MTA showed a denser fibrotic pattern, with more isolated calcifications in the pulp tissue along with secondary dentin formation. CONCLUSIONS: Gray MTA appears to be superior to white MTA and formocresol as a pulp dressing for pulpotomized primary teeth.
OBJECTIVE: To evaluate the short period clinical responses after sealed garlicin and formocresol small cotton ball in the root canal entrance to treat chronic periapical periodontitis. METHODS: Treatment records of 185 teeth with chronic periapical periodontitis were compared. Of them, 94 teeth were treated by sealed small garlicin cotton ball in the root canal entrance, 78 were treated by sealed small formocresol cotton ball in the root canal entrance, and the other 13 were treated by sealed small normal saline cotton ball. The curative effects were evaluated through clinical observation. RESULTS: The ratios of acute reaction in 3 days following sealed garlicin, formocresol and normal saline small cotton ball were 5.1%, 10.7%, and 50% in the anterior teeth, and 5.5%, 8.0%, and 60%, in the posterior teeth, respectively. CONCLUSION: The clinical curative effects were similar between garlicin and formocresol in the short period. Formocresol can be substituted by garlicin.
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.