A comparison and evaluation of two formocresol pulpotomy technics utilizing "Buckley's" formocresol.
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An in vitro study with various vehicles of diffusion of formocresol and its components.
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.
Agar↗
Biochemical effects of formocresol on bovine pulp tissue.
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.
Animals↗
Distribution of 14C-formaldehyde after pulpotomy with formocresol.
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.
Absorption↗
Antibody formation to dog pulp tissue altered by formocresol uithin the root canal.
After pulpal extirpation of twenty teeth in each of five dogs, these animals were primarily immunized intramuscularly by combining formocresol with the dog's own pulp (three dogs), saline solution with pulp (one dog) and injecting sheep erythrocytes (one dog). A sixth dog was used as a control for the Arthus skin test. Secondary immunizations were accomplished via the root canal every 7 days over a 28-day period. Arthus skin-test reactions demonstrated less of a response to the formocresol alone than when the dogs' pulp was conbined with this material. In vitro analysis of hemagglutinating antibody titer showed a tremendous increase when pulp was incubated with formocresol as compared to the saline-treated pulp. Therefore, dogs' pulp tissue became antigenically altered by the formocresol recognized by the host, and a specific humoral response resulted.
Animals↗
Comparison of antimicrobial and cytotoxic effects of glutaraldehyde and formocresol.
The in vitro antimicrobial and cytotoxic concentrations of glutaraldehyde and formocresol were determined. Minimal antimicrobial concentrations of these two agents against selected microbial flora reported in carious primary teeth were 3.125% for glutaraldehyde and 0.75% for formocresol. At a doubling of these concentrations, most organisms, except Candida albicans, Staphylococcus epidermidis, and Streptococcus mutans, were killed by both substances in 30 seconds. Cytotoxicity was evaluated on tissue cultures of pulp fibroblasts and HeLa cells at minimal cidal concentrations and at 10- and 100-fold dilutions. Exposure of pulp fibroblasts and HeLa cells to formocresol and indirect exposure to vapors caused the cells to become atrophic and to form a less dense tissue pattern. Cells directly exposed to glutaraldehyde retained their normal cell shape and tissue pattern, whereas cells indirectly exposed to vapors continued to proliferate. These data showed effective antimicrobial activity at concentrations of 3.125% glutaraldehyde and 0.75% formocresol and suggested that glutaraldehyde may exert a less cytotoxic effect on the immediate and surrounding tissues when used as a pulpotomy agent.
Bacteria↗
Formocresol toxicity: is there a suitable alternative for pulpotomy of primary molars?
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.
Animals↗
[Clinical and radiographic evaluation of deciduous molars with necrotic pulp treated with two concentrations of formocresol].
The purpose of this investigation was to evaluate clinically and radiographically primary molars with necrotic pulps treated with two different formocresol concentrations (full-strength formocresol and 20% dilution of formocresol). A total of 50 cases were evaluated at 3, 6 and 12 months after the treatment. There were not significant statistical differences in the results obtained between both concentrations; therefore it can be conclude that the 20% dilution of formocresol represent a satisfactory treatment for primary molars with necrotic pulps. Due to this findings is possible to assure that this procedure in easy, reliable and cheap; and also is possible to apply to all ages and socioeconomic label.
Child↗
Morphologic and enzyme histochemical observations on the pulp of human primary molars 3 to 5 years after formocresol treatment.
The state of the pulp of twenty-seven primary teeth treated by formocresol pulpotomy (clinically and radiographically successful) was assessed 3 to 5 years after treatment. A wide variation was found in the pulpal condition, from normal pulp tissue to total necrosis. Resorption and apposition of hard tissue were common findings. Five teeth were freeze-sectioned and incubated for histochemical demonstration of oxidative enzymes. The pulps of two teeth were vital; two teeth had necrotic areas subjacent to the amputation paste; and one pulp was totally necrotic. Six teeth were extracted 5 minutes after formocresol pulpotomy and incubated for demonstration of oxidative enzymes. An unstained zone, 1 to 2 mm. deep, was seen in all incubated sections. In conclusion, it seems that the formocresol method should be regarded only as a means to keep primary teeth with pulp exposures functioning for a relativley short period of time.
Dental Pulp↗
Comparison of Dycal and formocresol pulpotomies in young permanent teeth in monkeys.
This study compared Dycal and formocresol pulpotomies on young healthy permanent teeth with respect to continued dentinogenesis and root end development. Pulpotomy was performed on a total of forty permanent teeth with incompletely developed roots in three young stump-tailed monkeys (Macaca speciosa). Twenty teeth were treated with Dycal and twenty with formocresol. At the end of the experimental periods the animals were killed and the specimens were prepared and sectioned en bloc for histologic examination. The interval between treatment and death ranged between 7 and 797 days. Before each experimental procedure a Procion vital dye was administered as a marking agent for continued root development. Twelve of twenty teeth treated with Dycal and seventeen of twenty teeth treated with formocresol were judged to be successful as evidenced by continued root development, absence of periapical pathoses, and the presence of noninflamed or only mildly inflamed pulps. Brown and Brenn staining showed bacteria within the pulps of the teeth that failed. All but one of the teeth in this study showed evidence of continued root development as confirmed by Procion labeling.
Animals↗
Embryotoxicity and teratogenicity of formocresol on developing chick embryos.
White Leghorn chick embryos were used to investigate the embryotoxicity and teratogenicity of 25 and 50% Buckley's formocresol. Embryos were injected at 48 h and sacrificed on the ninth day of incubation. The percentage of mortality of sham and vehicle controls was 4.8 and 17.7%, respectively, whereas eggs injected with 25 and 50% formocresol displayed a 40 and 100% mortality rate. Gross morphological abnormalities, weights, and crown-rump lengths were determined, demonstrating that Buckley's formocresol is embryotoxic and teratogenic in chick embryos. Gross morphological changes were noted to include cranial hematomas, facial abnormalities, eye and beak deformities as well as alterations in feather germ appearance. Histological changes included alterations in the organization of the eyes, and formation of the beak, palate, vasculature, musculature, cartilage, and bone. Moreover, experimental embryos displayed a retardation of development in that they lagged behind their controls by approximately 24 to 36 h.
Abnormalities, Drug-Induced↗
Pulp condition of successfully formocresol-treated primary molars.
The aim of the study was to assess the state of the pulp of primary teeth successfully treated by formocresol pulpotomy. Nineteen teeth, all of them with clinically and radiographically successful treatments, were extracted 3-24 months after treatment. The pulpal condition had changed in all the teeth. Inflammatory reaction or necrosis was observed in all teeth. Dentinal resorption followed by apposition of hard tissue were common findings. In the teeth with vital tissue only in the apical area, the tissue had minor or no signs of inflammation. Microorganisms could be demonstrated in the necrotic tissue in one tooth. The wide range of pulpal conditions observed indicated that there was no typical tissue reaction to formocresol even though treatment was clinically successful. The present study confirms that the formocresol method should be regarded only as a means to keep primary teeth with pulp exposures functioning for a limited period of time.
Child↗
Pulpotomy of primary molars with coronal or total pulpitis using formocresol technique.
The aim of this study was to evaluate whether formocresol can be used successfully in teeth with carious exposure and a vital pulp with clinical symptoms of chronic pulpitis. Further, the study concerned the influence on the success rate of the vehicle for formocresol. Pulpotomies were performed on 81 primary molars. Radiographic and other clinical symptoms were used to divide the material into a coronal chronic and a total chronic pulpitis group. Chosen by lot, zinc oxide-eugenol or Pharmatec (a plaster-like non-eugenol cement) was used as the vehicle for formocresol. After an observation period of 2.5 years the success rate for the whole material was 55%. No statistically significant difference in the rate of success could be demonstrated either between the two diagnostic groups or between the two vehicle groups.
Bandages↗
[A study concerning radiographic diagnosis in dental caries of primary teeth. 1. The investigation on the indications for pulpotomy with formocresol].
The prognosis in the pulpotomy procedure with Formocresol during primary teeth has an excellent clinical results. On the other hand, some reports of a poor prognosis in radiographic findings were found. To obtain valuable information about the indications for pulpotomy procedures is quite difficult in the case of children concerning. In 1972, Kurihara reported radiographic findings the indications for the pulpotomy procedure in primary molars with a stable stage having no root absorption. The authors investigated the clinical and radiographic changes 6 months after the pulpotomy procedure with Formocresol. 26 primary lower molars having four criteria obtained from 3 to 7 year old patients were treated, and 4 primary lower molars were used as controls without the criteria. We found that the dental lamina dura were an especially important finding to judge the indications for pulpotomy with Formocresol in primary molars.
Child↗
[Results of treatment of milk teeth pulp by modified formocresol method].
The purpose of the study was evaluation of the results of treatment of molar pulp diseases by the formocresol method from the standpoint of the development of inflammatory complications in periapical tissues, disturbances of physiological resorption of roots, disturbances of mineralization of crowns of homologous permanent teeth. For the treatment milk molars were qualified with the diagnosis of grade II pulpopathy in children aged from 3 to 9 years. The treatment was done using formocresol by a modified method of pulp amputation according to Buckley after previous devitalization with parapaste. The status of 143 teeth was examined again 1 to 4 years after completion of treatment. The proportion of positive results after one year was 94%, after two years it was 90%, after three years 87% and after four years 80%. The cause of premature loss of most teeth was root resorption acceleration by 18-24 months. No harmful action of formocresol on the buds of permanent teeth was noted.
Child↗
Formocresol and glutaraldehyde pulpotomies in primary teeth.
The purpose of the present study was to compare clinically and radiologically the effects of formocresol and glutaraldehyde as a medicament in pulpotomized carious exposed vital human primary molars. In formocresol group 90% clinical and radiological success rate and in glutaraldehyde group 100% clinical and radiological success rate was observed. Thus it was concluded that glutaraldehyde is better fixative and less toxic agent than formocresol.
Aldehydes↗
Consequences of endodontic treatment in primary teeth. Part I: A clinical and radiographic study of the influence of formocresol pulpotomy on the life-span of primary molars.
In the context of a study of the life-spans of primary teeth subjected to formocresol pulpotomy, 152 such teeth were compared with the corresponding teeth on the contralateral sides. The life-span of each tooth was determined by registration of the time of exfoliation or extraction. In addition, data were collected concerning factors which may influence the life-spans of teeth. The principal conclusions are: There was no significant difference in life-spans between primary teeth with or without pulpotomy. Premature loss due to extraction exerted virtually no influence on the mean life-span of primary teeth, regardless of whether a pulpotomy had been performed. There was no significant difference in the number of extractions of primary teeth with or without a formocresol pulpotomy. There was no significant difference in the mean life-span between primary teeth with vital and those with nonvital pulp at the time of formocresol pulpotomy.
Child↗
Consequences of endodontic treatment of primary teeth. Part II. A clinical investigation into the influence of formocresol pulpotomy on the permanent successor.
In the context of a study of the development of enamel lesions in permanent successors of primary molars treated by formocresol pulpotomy, a comparative clinical study was performed of 278 premolars divided equally between test side and control side. These teeth were assessed by two observers who, when finding enamel lesions, always differentiated between opacities and hypoplasias. The principal conclusions from this study are the following: The degree of agreement between the two observers was 96 percent. There was no significant difference in number of teeth with enamel lesions, between test side and control side. When the observed teeth with enamel lesions were related to the age at which pulpotomy was performed, the difference was still insignificant. Separate comparison of opacities and hypoplasias likewise showed no significant differences, even if related to age at which pulpotomy was performed. A formocresol pulpotomy exerts no influence on the size of enamel lesions found in permanent successors of the teeth on which pulpotomies were performed. The general conclusion from the results of this study is that formocresol pulpotomy is a successful technique for the treatment of primary teeth, not only as regards the life-span of these primary teeth (see Part I of the study) but also in terms of its effect on their permanent successors.
Age Factors↗