Pulp Dressing Agents Used in Primary Teeth: A Review of the Literature

Abstract

Background: Pulpotomy is a technique of vital pulp therapy which can be performed in a primary tooth with pulp exposure due to caries or trauma when there is no clinical or radiographic sign of irreversible pulpitis or necrosis. Since today many different medicaments and techniques have been researched as pulpotomy agents and studies have shown the effectiveness but also the limitations of them. 
 Aim: The aim of this literature review is to overview the medicaments which were used in the past for pulpotomy in primary teeth, but also to evaluate the techniques and medicaments from the present and the future. 
 Results: Formocresol was the first-choice material for many decades, but its use has been limited due to potential mutogenetic and carcinogenetic effects in humans. In addition, glutaraldehyde is no longer used as a material for pulpotomy due to its toxicity. Mineral trioxide aggregate (MTA) seems to have better or comparable success rates as the old gold standard – formocresol, while other materials have high effectiveness. Calcium hydroxide was related to lower success rate and due to adverse effects as the internal root resorption is no longer recommended. Electrosurgery and laser are alternative techniques, while collagen and enamel matrix derivative (EMD) have been researched the last years and also studies about the bone morphogenetic proteins (BMPs) presented promising results. Also, other medicaments, which have been evaluated as pulp dressing materials, are included in this review and they seem to lead to acceptable results.
 Conclusions: MTA seems to be the new gold-standard for pulpotomy, while also other medicaments as ferric sulfate, sodium hypochloride, Portland cement, Biodentine can lead to comparable results. Electrosurgery and laser pulpotomy are alternative and non-pharmacological techniques with good success rates, while also other alternative materials seem to have promising results, but further research is needed.