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Assessment of a novel alternative to conventional formocresol-zinc oxide eugenol pulpotomy for the treatment of pulpally involved human primary teeth: diode laser-mineral trioxide aggregate pulpotomy.

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.

Aluminum Compounds↗

A five-year comparative study of calcium hydroxide-glutaraldehyde pulpotomies versus calcium hydroxide pulpotomies in young permanent molars.

Twenty children with twenty cariously exposed first permanent molars treated with either calcium hydroxide-glutaraldehyde or calcium hydroxide pulpotomies, were followed up clinically and radiographically for a period of five years. Overall success rates obtained at the end of the follow up period were higher with calcium hydroxide-glutaraldehyde pulpotomies (100%) than with calcium hydroxide pulpotomies (80%).

Calcium Hydroxide↗

Formocresol and ferric sulfate have similar success rates in primary molar pulpotomy. In carious primary molars does a pulpotomy performed with ferric sulphate, compared with formocresol, result in greater clinical/radiographic success?

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.

Comment↗

Outcomes of vital primary incisor ferric sulfate pulpotomy and root canal therapy.

PURPOSE: To compare ferric sulfate (FS) pulpotomy and primary tooth root canal therapy (RCT) in cariously exposed vital pulps of primary incisors. METHODS: A total of 133 incisors in 50 children were randomly selected to be treated by FS pulpotomy (64) or RCT (69). RESULTS: Two years after treatment, 77 incisors (41 FS pulpotomy, 36 RCT) were available for clinical and radiographic examination. There was no clinical evidence of pathosis in 78% of FS pulpotomy-treated and 100% of RCT-treated incisors. Two independent pediatric dentists evaluated periapical radiographs of the treated incisors. Incisors were classified into 1 of 4 treatment outcomes: N, normal treated incisor; H, nonpathologic radiographic change present; PO, pathologic change present, but not requiring immediate extraction; PX, pathologic change present, extract immediately. Survival analysis was applied. A moderate level of agreement between raters was found for incisors with outcome PX (K = 0.54). Intra-rater reliability was substantial for incisors with outcome PX (K = 0.61). No difference was demonstrated in the proportion of FS pulpotomy- and RCT-treated incisors rated PX at the 2-year recall (x2 = 0.6). RCT incisors demonstrated a significantly higher survival rate than FS pulpotomy incisors at 2 years (p = 0.04). CONCLUSIONS: Treatment outcomes for RCT incisors were not significantly different from FS pulpotomy-treated incisors at 2 years; however, at 2 years the survival rate of RCT incisors was statistically greater than that of FS pulpotomy-treated incisors.

Child, Preschool↗

Histological evaluation of electrosurgery and formocresol pulpotomy techniques in primary teeth in dogs.

The purpose of this study was to compare pulpal and periapical tissue reactions to electrosurgery versus formocresol pulpotomy techniques in the primary teeth of dogs. The study was conducted on 33 primary teeth of three mongrel dogs between the ages of one to three months. Each dog had three teeth treated by Formocresol Pulpotomy with Mechanical Coronal Pulp Removal (FC), three teeth treated by Electrosurgery Pulpotomy with Mechanical Coronal Pulp Removal (ES/MCPR), three teeth treated by Electrosurgery Pulpotomy with Electrosurgical Coronal Pulp Removal (ES/ECPR), and two teeth serving as untreated Controls. Dogs one, two and three were sacrificed performing the pulpotomies at two, four and six weeks, respectively. The pulp, periapical tissue and after surrounding bone were submitted to histological examination and the histological reaction was recorded. The results were fourteen out of 18 unfavorable and zero out of three favorable histological reactions occurred in the FC treated teeth. Six out of 18 unfavorable and one out of three favorable histological reactions occurred in the ES/MCPR treated teeth. Nine out of 18 unfavorable and two out of three favorable histological reactions occurred in the ES/ECPR treated teeth. One out of 18 unfavorable and zero out of three favorable histological reactions occurred in the untreated Control teeth. The conclusion of this study is that of the three experimental groups, the teeth treated by Electrosurgery Pulpotomy with either Mechanical or Electrosurgical Coronal Pulp Removal exhibited less histopathological reaction than the teeth treated by Formocresol Pulpotomy.

Animals↗

Evaluation of three pulpotomy medicaments in primary teeth.

AIM: To examine the success of the one-appointment pulpotomy technique with three different medicaments on primary molar teeth. METHODS: The study was conducted on 104 primary molars in 104 children with an indication for pulpotomy treatment on at least one primary molar. Primary teeth were treated with either formocresol (FC) (34 teeth), calcium hydroxide (CA) (33 teeth) or ferric sulphate (FS) (37 teeth) using standardised criteria for the pulpotomy procedures. Teeth were clinically and radiographically evaluated during the examination period of 18 months. RESULTS: The clinical success rate at 18 months for the FC and FS groups was 90.9% and 89.2%, respectively. The CA showed an overall clinical success rate of 82.3%, with no statistical difference compared with either the FC or FS groups. The overall radiographic success for each technique was: FC 84.8%, CA 76.5%, and FS 81.1%. The presence of a dentine bridge above the pulp amputation site was observed radiographically for CA (47%), and FS (40.5%) pulpotomies without any statistical difference. Radiographic examination did not reveal the presence of a dentine bridge for any of the teeth treated with FC pulpotomy. CONCLUSION: Favourable clinical and radiographic success rates of ferric sulphate pulpotomy, comparable to formocresol were obtained. Therefore, ferric sulphate can be recommended as a pulpotomy medicament.

Calcium Hydroxide↗

Comparison of electrosurgical and formocresol pulpotomy procedures in children.

OBJECTIVES: Although previous studies have examined the electrosurgical pulpotomy technique for primary teeth, no well-controlled, clinical human trials have been published. The purpose of this study was to prospectively compare electrosurgical pulpotomies vs. formocresol pulpotomies in human vital primary molar teeth. DESIGN: Fifty children were randomly divided into two groups, 25 receiving an electrosurgical pulpotomy and 25 receiving a formocresol pulpotomy. RESULTS: After at least 5 months postoperative observation time, the clinical and radiographic success rates for the electrosurgical groups were 96 and 84%, respectively; and for the formocresol group, 100 and 92%, respectively. CONCLUSION: There were no statistically significant differences between the success rates for the two groups at the P < 0.05 level as tested by Fisher's exact test. This study failed to demonstrate a difference in the success rate between the electrosurgical and formocresol pulpotomy techniques.

Child↗

Mineral trioxide aggregate pulpotomies: a case series outcomes assessment.

BACKGROUND: The greatest threats to developing teeth are dental caries and traumatic injury. A primary goal of all restorative treatment is to maintain pulp vitality so that normal root development or apexogenesis can occur. If pulpal exposure occurs, then a pulpotomy procedure aims to preserve pulp vitality to allow for normal root development. Historically, calcium hydroxide has been the material of choice for pulpotomy procedures. Recently, an alternative material called mineral trioxide aggregate (MTA) has demonstrated the ability to induce hard-tissue formation in pulpal tissue. The authors describe the clinical and radiographic outcome of a series of cases involving the use of MTA in pulpotomy procedures. METHODS: Twenty-three cases in 18 patients were treated with MTA pulpotomy procedures in an endodontic private practice. All of the patients had been referred to the practice for diagnosis and treatment of a symptomatic tooth. All of the authors provided treatment. Pulpal exposures were either due to caries or complicated enamel dentin fractures. RESULTS: Nineteen teeth in 14 patients were available for recall. The mean time of recall was 19.7 months. Of the 19 cases, 15 involved healed teeth, and three involved teeth that were healing. One of 19 cases involved a tooth with persistent disease. CONCLUSIONS: MTA may be useful as a substitute for calcium hydroxide in pulpotomy procedures. Further research, however, is required to clarify this conclusion. CLINICAL IMPLICATIONS: MTA conceivably could replace calcium hydroxide as the material of choice for pulpotomy procedures, if future research continues to show promising results.

Adolescent↗

Pulpotomy medicaments for vital primary teeth. Surveys to determine use and attitudes in pediatric dental practice and in dental schools throughout the world.

Surveys were sent to all Canadian pediatric dental specialists and to Heads of Departments of Pediatric Dentistry of selected dental schools throughout the world, in order to determine the use of and attitudes toward pulpal techniques on vital primary teeth. The preferred pulpotomy medicament of Canadian pediatric dental specialists was the 1:5 formocresol dilution, which was used by 50 percent of the respondents. The second most prevalent medicament was full-strength formocresol, used by 42.2 percent of respondents. The most prevalent medicament utilized in pediatric dental departments of dental schools was full-strength formocresol (40.8 percent) followed in popularity by the 1:5 formocresol dilution (36 percent). Scandinavia was the only geographic region to deviate from formocresol as the preferred pulpotomy medicament. Seventy percent (70 percent) of the pediatric dental departments in Scandinavia preferred calcium hydroxide for pulpotomies. Although 50 percent of the pediatric dental specialists and 55.2 percent of pediatric dental departments expressed concern about harmful effects of the preferred pulpotomy medicament, only 21.2 percent of the dentists and 29.6 percent of the schools were contemplating a change to another material. Because of its long history and lasting popularity, formocresol has been the most widely studied of the many pulpotomy medicaments. Although other techniques have been proposed and studied, the vast majority of pediatric dental practitioners in Canada (92.4 percent) and dental schools worldwide (76.8 percent) utilize either the full-strength or the 1:5 dilution of formocresol as the preferred pulpotomy medicament for vital primary teeth.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

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↗

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↗

Clinical evaluation of glutaraldehyde with calcium hydroxide and glutaraldehyde with zinc oxide eugenol in pulpotomy of primary molars.

The objectives of this study were to clinically evaluate the effectiveness of 2% buffered glutaraldehyde in pulpotomies of human primary molars and to compare the success rate of glutaraldehyde with calcium hydroxide and glutaraldehyde with zinc oxide eugenol as dressing material on the radicular pulp. Pulpotomies were completed on 61 primary molars in 19 children. The teeth were divided into two groups by random allocation. One group had a dressing of zinc oxide-eugenol base (IRM) incorporated with one drop of 2% buffered glutaraldehyde while the other group had a dressing of calcium hydroxide base incorporated with one drop of 2% buffered glutaraldehyde after the initial placement of 2% buffered glutaraldehyde on cotton pellet for 3 min. All teeth had light-curing compomer (Dyract) placed over the dressing material followed by a stainless steel crown restoration within 1 or 2 weeks after the pulpotomy. Blind clinical and radiographic evaluations of 57 teeth available after 12 months showed a success rate of 92.9% and 73.6% respectively. The clinical and radiographic success rates for glutaraldehyde/zinc oxide eugenol pulpotomies were 96.5% and 75.8% respectively while those for glutaraldehyde-calcium hydroxide were 89.2% and 71.4%. There was no statistically significant difference between the two groups either clinically or radiographically. The overall clinical success rate suggested that 2% buffered glutaraldehyde was an effective agent in the pulpotomy of human primary molars.

Calcium Hydroxide↗

Ferric sulphate and formocresol in pulpotomy of primary molars: long term follow-up study.

AIM: The objective of this study was to compare the effects of ferric sulphate (FS) to that of the full strength of formocresol (Buckley's formula) (FC) as pulpotomy agents in primary human molar teeth 42-48 months after treatment. This was to assess the succeeding premolar teeth for decalcification, abnormal morphology or any other defect. METHODS: Seventy children, ranging in age from 3 to 6 years, mean 4.3 years, were treated for pulpotomy of primary molars. Ferric sulphate 15.5% solution (applied for 15 seconds for 84 teeth) and formocresol solution (5 minutes procedure for next the 80 teeth) were used as pulpotomy agents. In both groups, pulp stumps were covered with zinc oxide eugenol paste. Permanent restorations were, in most cases, stainless steel crowns and in some of them amalgams. Follow-up clinical assessments were every 3 months and the radiographic follow-up time was 6, 20 and 42-48 months after treatment. STATISTICS: The differences were statistically analyzed using the Chi square test. RESULTS: These revealed 96.4% clinical success rate in the FS and 97.5% in the FC groups. Radiographic success rate in the FS group was 92.0%, while 94.6% in the FC group. No statistical significant differences were found between the radiographic assessment of the two pulpotomy agents. CONCLUSION: Ferric sulphate showed similar clinical and radiographic success rate as a pulpotomy agent for primary molar teeth after long term evaluation period, compared with formocresol. Ferric sulphate, because of its lower toxicity, may become a replacement for formocresol in primary molar teeth.

Child↗

Permanent versus temporary restorations after emergency pulpotomies in primary molars.

PURPOSE: The purpose of this retrospective study was to determine if immediate placement of a stainless steel crown (SSC) after emergency pulpotomies in primary molars would result in a better outcome when compared to different temporary restorations. METHODS: Records of 94 emergency pulpotomies in primary molars performed at a university pediatric graduate dental clinic between July 2001 and June 2004 were analyzed. Inclusion criteria included: (1) teeth with a positive history of spontaneous or elicited pain; (2) deep caries with close approximation to the pulp; (3) absence of clinical and radiographic signs of pulpal degeneration; (4) abnormal mobility; or (5) swelling. Pulpotomized teeth were temporarily restored with a zinc oxide eugenol-based temporary restoration (IRM) covered with Ketac Molar or with a permanent restoration (SSC). The time interval between emergency and definitive treatment or recall, age, gender, tooth type, and arch were the variables analyzed in the study. Success was determined by record (progress notes and radiographs) verification of SSC placement in case of a temporary restoration and by confirmation of crown presence during recall exam. Data from emergency pulpotomies restored only with IRM was added to the study and included in the statistical analysis. RESULTS: Superior clinical success was obtained when emergency pulpotomies were restored with SSC (86%) when compared to IRM only (61%) or IRM and Ketac Molar combined (77%). Statistical significance was obtained in favor of SSC when survival analysis was performed (P<.001). No statistically significant difference was found for any of the other variables (P>.05). CONCLUSIONS: Immediate placement of an SSC tended to improve the chances for success when emergency pulpotomies are performed.

Child↗