Formocresol Pulpotomy Research Articles

Editorial: Is there a place for the formocresol pulpotomy? Indirect pulp capping, the real alterative

Welcome to Volume 24 of the International Journal of Paediatric Dentistry. In 2013, the Journal has received 578 manuscripts from 57 countries. We have an impressive turnround of an average of 17 days from first submission to authors’ receiving a decision. I think you will agree the quality of the papers published improves year on year, and the Journal at present has an acceptance rate of 10%. If accepted, a paper appears in ‘Early View’ and then in print approximately 6 months later. One trend I have noticed is the increase in papers examining oral health-related quality of life, an area of research I fully support. I understand the need to validate these methodologies; however, it would be good to see these tools applied and reported in a way that provides information that would increase our understanding of the needs of children and the best treatment modalities. An issue I think the community of Paediatric Dentistry should address is pulpotomies: what agent should we be using and should we be doing them at all? Here in the UK, formocresol has not been taught as an acceptable pulpotomy agent since 2004 and I know this is the case elsewhere. There are effective alternative materials so should we still be using a material which has the potential to harm our patients and, perhaps more importantly due to the repeated exposures, the dental team. There now is substantial evidence that if caries is isolated from the biofilm on the surface, the lesion will arrest. Therefore, should we not just stop worrying about which material we use and instead seal the caries with an effective indirect pulp cap? I would like to thank all the reviewers who have supported the Journal in the past year and it is my pleasure to announce that Dr Ghanim Aghareed from the University of Melbourne is the Reviewer of the Year. Two members of the Editorial Board are retiring, Magne Raadal and Satu Alaluusua. I would like to thank them for their support of the Journal over the years. I am pleased to say that joining the Board are Ghassem Ansari, Shahid Behedhti Medical University, Iran and David Manton, Melbourne University, Australia. I will take this opportunity to thank the two Associate Editors, Professor Milton Houpt and Dr Paul Ashley, for all their help and advice, together with the team at Wiley, Jenifer Jimenez (Editorial Assistant) and Cheryl Chong (Production Editor) for their support and hard work. Thomas Trier-Mork (Journal Publishing Manager) has moved on to other roles in Wiley. Thomas has been very helpful and supportive of the Journal over many years and I wish him well. I welcome his successor Aske Munk-Jorgensen. My final thanks go to all the authors and readers of the Journal. I wish you all a successful 2014.

English

BACKGROUND: Various Pulpotomy medicaments like Formocresol, Glutaraldehyde, Ferric sulfate, Calcium-hydroxide, MTA, Bone Morphogenic proteins, Collagen, Bioactive glass and Laser have been advocated for use in treatment of pulpally involved primary teeth but the Formocresol pulpotomy technique is the universally taught & preferred pulp therapy for primary teeth. Despite years of apparent successful use as a pulpotomy agent, Formocresol has come under the attack for research & documentation in the literature which have shown it to be toxic, mutagenic & carcinogenic. This debate over the use of Formocresol solution & other formaldehyde containing preparations in children's dentistry continues. The determination of the actual effective dose and concentration for clinical application for pulpotomy in primary teeth is an important area of further research & a thorough clinical, radiographic & histologic investigation in human subjects is very much needed with various dilutions of Formocresol. AIM: To inquire about the use of Formocresol for primary as well as permanent tooth pulpotomy and to know the awareness about the diluted formulations of Formocresol among Indian Pediatric dentists. MATERIALS & METHODS: The questionnaire to know the use of Formocresol by the Pedodontists across India was e-mailed to 165 pediatric dentists out of whom only 120 replied/responded. Thirty eight respondents were academicians and faculty in the field of pediatric dentistry and the remaining 82 were the post graduates students. RESULTS: The results showed that 95% of the respondents use Formocresol for routine pulpotomy procedure in primary teeth. Of those, 42% use full strength Formocresol, 40% use dilute Formocresol & 18% do not know what concentration they are using. CONCLUSION: The study concludes that Formocresol remains the most popular medicament in use for primary tooth pulpotomy followed by calcium hydroxide and MTA, glutaraldehyde and ferric sulphate in the field of Pediatric Dentistry across the country. There is a need for the diluted Formocresol to be made commercially available.

Determining Treatibility of Primary Teeth with Pulpal Exposure

To determine rates of pulpal exposure during caries removal with an excavator or a bur, to assess success rates of vital pulp therapies in both cases, to analyze pulpal bleeding as an indicator of primary teeth treatability. Of the 352 primary mandibular molars with deep carious lesions, 141 with pulp exposed during the removal of caries were grouped according to type of instrument causing pulpal exposure and existence of bleeding at the exposure site. Teeth suitable for direct pulp capping or formocresol pulpotomy were treated and followed up for two years. The difference between the rates of pulpal exposure with an excavator (52.5%) or a bur (47.5%) was insignificant. The treatment success rate of teeth with pulp exposed by an excavator (15.8%) was significantly lower than teeth with pulp exposed by a bur (48.8%), regardless of whether bleeding existed at the exposure site or not; however when bleeding existed, this difference was insignificant (15.8% and 40.6%, respectively). Pulpal exposure possibility during caries removal caused by an excavator and a bur was similar the treatment success rate was lower when the exposure was caused by an excavator the existence of pulpal bleeding resulted in mistakes in diagnoses.

Comparative Evaluation of Formocresol and Mineral Trioxide Aggregate in Pulpotomized Primary Molars - 2 Year Follow Up

The aim of the present study was to clinically and radiographically evaluate Mineral Trioxide Aggregate (MTA) as an agent for pulpotomy in primary teeth and to compare it with that of Formocresol (FC) pulpotomy. Seventy first and second primary mandibular molars of children were chosen on patients who required minimum two pulpotomies in either arch or same arch. After the standardized technique of Pulpotomy with MTA and Formocresol, all molars were treated with a thick mix of Zinc oxide Eugenol cement into the coronal pulp chamber followed by preformed stainless steel crown. The children were followed up for clinical and radio graphical examination after 6, 12 and 24 month for Pain, Swelling, Sinus/fistula, Periapical changes, Furcation radiolucency and internal resorption. MTA represents 97% clinical success rate in comparison to Formocresol with 85% success. Radiographically also MTA showed more promising results with 88.6% success in comparison to Formocresol with 54.3%. Thus, MTA pulpotomy has emerged as an easier line of treatment to save the premature loss of primary teeth due to caries or trauma.

A randomized study of sodium hypochlorite versus formocresol pulpotomy in primary molar teeth

Alternatives to vital pulpotomy treatment in primary teeth are being sought because of the high formaldehyde content of traditional formocresol (FC) pulpotomy medicaments. The aim was to compare the clinical and radiographic success of vital pulpotomy treatment in primary molars using 3% sodium hypochlorite (NaOCl) versus a 1:5 dilution of Buckley's FC. Pulpotomies were performed in primary molars of healthy children between 3 and 10 years old. Sixty-five primary teeth were randomized into two groups that were evaluated for treatment outcomes. Following treatment, the pulp chamber was filled with zinc oxide eugenol (ZnOE) and restored with a stainless steel crown cemented with glass ionomer cement. Clinical and radiographic outcomes were recorded at 6 and 12 months. The control (FC) and experimental (NaOCl) groups demonstrated 100% clinical success at 6 and 12 months. The NaOCl group had 86% (19/22) radiographic success at 6 months and 80% (12/15) at 12 months. The FC group had 84% (21/25) radiographic success at 6 months and 90% (9/10) at 12 months. No significant differences were found in the radiographic outcomes between the two groups at 6 and 12 months (Fisher's exact test; P=0.574 and P=0.468, respectively). NaOCl demonstrated clinical and radiographic success comparable to FC.

Calcium hydroxide partial pulpotomy is an alternative to formocresol pulpotomy based on a 3‐year randomized trial

Considering formocresol's toxicity, Ca(OH)(2) partial pulpotomy (PP) was studied as a treatment alternative. To compare success rates of Ca(OH)(2) PP versus formocresol pulpotomy (FP) treatment of pulpally exposed lower primary molars. A total of 84 lower primary molars, which met study criteria, from 56 child patients were randomly assigned for each treatment. After treatment, blinded clinical and radiographic evaluation with 96.9% and 90% reliability was performed at 6-month intervals to determine treatment success/failure. Chi-squared test was used to compare success rates between the two treatments. The success rates from 6 to 36 months for PP ranged from 95.03% to 75%, whereas for FP, it was 92.7-74.2%. The success rates for the two treatments at each 6-month interval were not different (P ≥ 0.05). The most frequent failure was internal resorption, affecting five FP teeth and three PP teeth. The resorption was arrested in five of the teeth and was replaced by a radiopaque calcified tissue in one case. Considering the favourable clinical and radiographic success rate of PP and the potentially toxic effects of formocresol leads us to recommend the use of PP instead of FP in primary teeth with deep carious lesions.

The formaldehyde inspiration by the child patient, dentist, and dental assistant during formocresol pulpotomy

Although using Buckley's Solution of formocresol (FC) in pulpotomy procedures is becoming less common in pediatric dentistry. This study measured concentrations of formaldehyde (FA) evaporated during fixing and investigated safe procedures for FC pulpotomy. Methods: Ten measurements were taken for each of the conditions described below. Locations measured for each condition were 1) at a position equivalent to the patient, 2) at a position equivalent to the dentist, and 3) at a position equivalent to the assistant dentist. Condition 1 used no peripheral equipment. Condition 2 used an intraoral air evacuator, Condition 3 used extraoral air evacuators, Condition 4 used both extraoral and intraoral air evacuators. At the patient's FA levels were 0.414 ppm during Condition 1, 0.158 ppm during Condition 2, 0.252 ppm during Condition 3, and 0.091 ppm during Condition 4. FA levels at the dentist were 0.115 ppm during Condition 1, 0.042 ppm during Condition 2, 0.081 ppm during Condition 3, and 0.028 ppm during Condition 4. FA levels at the dental assistant were 0.067 ppm during Condition 1, 0.038 during Condition 2, 0.059 ppm during Condition 3, and 0.025 ppm during Condition 4. Exposure concentrations of FA during FC pulpotomy might have using of an extraoral, intraoral air evacuator during FC pulpotomy reduces formaldehyde exposure to patient, dentist, and dental assistant.

The formaldehyde inspiration by the child patient, dentist, and dental assistant during formocresol pulpotomy

The formaldehyde inspiration by the child patient, dentist, and dental assistant during formocresol pulpotomy

Mineral trioxide aggregate and formocresol pulpotomy of primary teeth: a 2‐year follow‐up

To compare the clinical and radiographic response of primary teeth to vital pulpotomy using mineral trioxide aggregate (MTA) or formocresol (FC). A group of 17 children aged 4-9 were selected from those referred to the Paedodontic Department at Shahid Beheshti University, Dental School. Cases with at least two matching teeth were selected (40 teeth), showing signs of pulp involvement. A pulpotomy procedure was carried out in all cases with FC in control teeth whilst MTA was placed in experimental teeth. Clinical and radiographic evaluations were performed at 1-, 6-, 12- and 24-month recall. Statistical analysis using a Fischer exact test was performed on the data to determine significant differences between the groups. Overall, 22 second and 18 first primary molars were included. The gender ratio was one male to three female. No significant difference was found between the clinical and radiographic outcomes of the two groups at 6-, 12- and 24-month follow-up (P > 0.05). Internal resorption was seen significantly more often in FC cases after 12 months than MTA cases. Overall radiographic appearance of normal structures at 24th month was seen in more than 95% of the cases in MTA and 90% in the FC-treated group (P > 0.05). Mineral trioxide aggregate for pulp treatment of primary teeth can be considered a replacement for FC.

Comparative investigation of clinical/radiographical signs of mineral trioxide aggregate and formocresol on pulpotomized primary molars

The objectives of this study were (1) to evaluate clinically and radiographically the effects of mineral trioxide aggregate (MTA) as a pulp dressing after coronal pulp amputation (pulpotomy) in primary molars, (2) to compare the effects of MTA and formocresol in pulpotomized primary teeth. Sixty primary mandibular molars of thirty healthy children aged between 5-8 years were treated by conventional pulpotomy technique. The teeth on the right side are assigned to MTA (Group A) and the left side for the Formocresol (Group B). The children were examined clinically and radiographically every 6 months over a period of 36 months. Results of present study revealed that both MTA and Formocresol has the same effect on the first as well as second primary molars, with chi-square value being 1.1483 (P ≥ 0.05). None of the teeth in either group showed any clinical pathology, showing 100% success rate but radiographically formocresol group showed one case of internal resorption that was regarded as failure in the present study. MTA seems to be more promising predictable with positive response in vital pulp therapy in future than formocresol pulpotomy except for the cost factor.

Evaluation of mandibular infiltration versus mandibular block anaesthesia in treating primary canines in children

The objectives of this study were to determine the effectiveness of mandibular infiltration compared with mandibular block in treating primary canines in children and to relate the effectiveness to the type of treatment performed. A total of 89 children, 6-9 years old, requiring identical treatment on contralateral mandibular canines were selected. The split mouth study design was used. The anaesthetic used in both techniques was 2% lidocaine solution with 1 : 80,000 epinephrine. Dental procedures included class III, IV, and V restorations, formocresol pulpotomies, and extractions. Child's pain reaction and behaviour for each anaesthesia technique and the type of treatment were rated at certain intervals of treatment using sounds, motor, and ocular changes indicating pain and the Frankl Behaviour Rating Scale. Evaluations were made upon injection, probing, rubber dam placement, and during tooth preparation and extraction. No statistically significant difference was found between the two anaesthetic techniques for either pain or behaviour at all evaluation intervals (P > 0.05), during the performance of restorations, pulpotomies, or during extractions. Mandibular infiltration anaesthesia is as effective as mandibular block for restoration, pulpotomy, and extraction in primary canines. The mandibular infiltration anaesthesia was not significantly less painful than the mandibular block.

Clinical and radiographic outcomes of calcium hydroxide and formocresol pulpotomies performed by dental students

The aim of this study was to compare the clinical and radiographic success rates of 3 pulpotomy techniques: formocresol, calcium hydroxide, and calcium hydroxide/iodoform. The pulpotomies were performed by fifth-year undergraduate dental students. Members of senior staff at the clinics supervised all of the procedures. Informed consent was obtained from each child's parents. The teeth were randomly assigned to the experimental (calcium hydroxide and calcium hydroxide/iodoform) or control (formocresol) groups. After coronal pulp removal and hemostasis, remaining pulp tissue was covered with calcium hydroxide or calcium hydroxide/iodoform paste in the experimental groups. In the control group, formocresol was placed with a cotton pellet over the pulp tissue for 5 minutes and removed; the pulp tissue was then covered with zinc oxide-eugenol. All teeth were restored with stainless-steel crowns. Clinical and radiographic successes and failures were recorded at 1-, 3-, 6-, and 12-month follow-ups by the authors. Data were statistically analyzed using chi-squared tests. The follow-up evaluations revealed that the clinical success rates were 89.7% for formocresol, 33.3% for calcium hydroxide, and 17.2% for calcium hydroxide/iodoform. The radiographic success rates were 89.7% for formocresol, 33.3% for calcium hydroxide, and 13.8% for calcium hydroxide/iodoform. Formocresol was superior to calcium hydroxide and calcium hydroxide/iodoform pastes for primary molar pulpotomies. Internal resorption was the most common radiographic failure in all 3 pulpotomy techniques.

Mineral Trioxide Aggregate as Pulp Capping Agent for Primary Teeth Pulpotomy: 2 Year Follow Up Study

The aim of the present study was to clinically and radiographically evaluate Mineral Trioxide Aggregate (MTA) as an agent for pulpotomy in primary teeth and to compare it with that of formocresol (FC) pulpotomy. Nineteen children between the ages of 6 to 8 years with 40 carious primary molars were treated with pulpotomy using either FC or MTA. All the molars were evaluated clinically and radiographically at regular intervals over a twenty four month period. The observations were tabulated and statistically analyzed. Eighty five percent success was observed with FC pulpotomy whereas MTA showed 95% success. MTA showed a higher clinical and radiographic success rate than FC. MTA may be a favorable material for pulpotomy in primary teeth whose pulps have been compromised by a carious or mechanical pulp exposure.

PERAWATAN PULPOTOMI MORTAL SATU KALI KUNJUNGAN PADA MOLAR SULUNG NON VITAL (Laporan Kasus)

Non-vital teeth are supposed to be treated with root canal treatment and root canal filling. However, the problem on root canal treatment on deciduous molars, especially with children who is noncooperative because the difficulty to get access to the root canal on children and root canals on deciduous molars are very complex. Mortal pulpotomy is the way to eliminate necrotic pulp tissue in pulp chamber and replace it with material filling. The material is a combination between formocresol and zinc oxide eugenol. The result on formocresol pulpotomy on deciduous teeth can be seen in clinical, radiographic and histological examination of the teeth, abutment tissue and the growth permanent teeth germ. On this patient the mortal pulpotomy treatment had been done with formocresol on one visit. After a month, on the clinical evaluation there are no subjective complaints and no signs of gingival inflammation.

Treatment of the Primary Tooth: An Online Study Guide

The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. The topics presented in this section are formocresol pulpotomy, electrosurgical pulpotomy, and pulpectomy in primary teeth.

A Clinical Study of Formocresol Pulpotomy versus Root Canal Therapy of Vital Primary Incisors

Pulpotomy of primary incisors is a serious challenge due to the lack of a distinct boundary between the coronal and the radicular pulp and the inaccuracy of the clinical indication criteria. The aim of the present study is the clinical and radiographic evaluation of pulpotomy versus root canal therapy (RCT) of vital primary incisors. A total of 100 incisors in 50 patients (female: 27, male: 23) aged 3-4 years were allocated to formocresol pulpotomy (45 teeth) and RCT (46 teeth) using zinc oxide-eugenol. The radiographic and clinical evaluation of treatment outcomes was performed at 12 and 24 months post-operatively. A history of spontaneous pain, missing restorations, recurrent caries, mobility and percussion sensitivity, parulis or fistula, erythema, and swelling were recorded. Data analysis was performed based on two sample proportional test. The clinical success rate was 86.9% for pulpotomy and 95.6% for RCT (P > 0.05). The radiographic assessment exhibited no pathologic signs in 76.08% of pulpotomy group and 91.3% of RCT group and the difference was statistically significant (P < 0.05). The most common pathologic finding was periodontal widening followed by external/internal root resorption. Periapical radiolucency and fistula in pulpotomized teeth was significantly higher than in RCT-treated teeth (P < 0.05) It may be concluded that the root canal therapy of vital primary incisors may be efficiently substituted for the pulpotomy of these teeth.

Comparison of Enamel Matrix Derivative Versus Formocresol as Pulpotomy Agents in the Primary Dentition

The purpose of this study was to compare the clinical and radiographic success rates of two different pulpotomy agents: one novel agent, the biologically active odontogenic protein enamel matrix derivative (EMD) versus formocresol (FC). A randomized, single-blind, split-mouth study was used with a sample of 15 children aged 4 to 7 years (mean age, 5 ± 0.73 years). A total of 15 pairs of teeth, 1 pair per child, were selected for treatment. One tooth from each pair was randomly assigned to either the EMD pulpotomy group or the FC pulpotomy group. All teeth were followed up clinically and radiographically at 2, 4, and 6 months. After 6 months, the clinical success rates for the FC and EMD groups were 67% and 93%, respectively. Although most likely clinically relevant, the clinical success rate difference after 6 months was not statistically significant. After 6 months, the radiographic success rates for the FC and EMD groups were 13% and 60 %, respectively. There was a statistically significant difference at p ≤ 0.05. The clinical and radiographic assessment of EMD pulpotomized teeth in this study offers preliminary evidence that EMD is a promising material which may be as successful, or more so, than other pulpotomy agents.

Clinical and radiographic comparison of primary molars after formocresol and electrosurgical pulpotomy: A randomized clinical trial

Vital pulpotomy is a single-stage procedure defined as the surgical amputation of the coronal portion of exposed vital pulp, usually as a means of preserving the vitality and function of the remaining radicular portion. The aim of this study was to compare the clinical and radiographic success rates for electrosurgical vs formocresol pulpotomy in human primary molar teeth. This was a prospective, randomized clinical trial. In this randomized clinical trial, pulpotomies were performed on 70 primary molars in children aged 5-10 years. The teeth were treated using either a conventional formocresol (35 teeth) or electrosurgical technique (35 teeth). Following the pulpotomy procedure, the teeth were evaluated for clinical and radiographic success for three, six and nine months. The teeth were evaluated for the presence of pain, abscess, fistula, mobility, internal and external resorption, and radiolucency. The data were assessed with Fishers' Exact test. After nine months of follow-up, the clinical and radiographic success rates were 96 and 84% respectively in the electrosurgical group and 100 and 96.8% respectively in the formocresol group. There was no statistically significant difference between the success rates in the two groups ( P > 0.05). Our results showed the failure rates for electrosurgical pulpotomy to be equal to those for formocresol pulpotomy. Although electrosurgical pulpotomy is a nonpharmacological technique giving favorable results, it is still a preservative technique. Further studies using larger samples and longer evaluation periods are recommended.

Clinical, Radiographic, and Histopathologic Evaluation of Nd:YAG Laser Pulpotomy on Human Primary Teeth

The purpose of this study was to compare clinical, radiographic, and histopathologic effects of Nd:YAG laser pulpotomy to formocresol pulpotomy on human primary teeth. Patients with at least two vital primary molar teeth that required pulpotomy, because of pulpal exposure to caries, were selected for this study. After hemorrhage control, complete hemostasis into the canal orifice was achieved by exposure to Nd:YAG laser (1064 nm) and an He-Ne laser (the aiming beam of the Nd:YAG laser) in noncontact mode at 2 W, 20 Hz, 100 mJ, or was achieved by applying 1:5 dilution of formocresol. Forty-two teeth in two groups were to be followed up clinically and radiographic at 1, 3, 6, 9, and 12 months. Eighteen teeth planned for serial extractions were selected for histopathologic study. The teeth were extracted at 7 and 60 days. The teeth in the laser group had a clinical success rate of 85.71% and a radiographic success rate 71.42% at 12 months. The teeth in the formocresol group had a clinical and radiographic success rate of 90.47% at 12 months. There were no statistically significant differences between laser and formocresol group with regard to both clinical and radiographic success rates. There was a statistically significant difference between 7- and 60-day laser groups with regard to inflammatory cell response criteria. Dentin bridge was absent in all samples. No stained bacteria were observed in any of these samples. In conclusion, Nd:YAG laser may be considered as an alternative to formocresol for pulpotomies in primary teeth.

Better outcomes in pulpotomies on primary molars with MTA

Medline, Cochrane Library, Embase, Science Citation Index and the China National Knowledge Infrastructure were used to source articles. In addition, identified papers' reference lists and their authors' other published literature were also scanned. Studies of interest were randomised controlled trials of primary molar teeth where there was exposure of vital pulp caused by caries or trauma, with at least 6 months follow-up. It was required that selected teeth had no internal root resorption, inter-radicular and periapical bone destruction, no periodontal involvement, swelling, or sinus tract; they should be restorable with stainless steel crowns; and that outcomes were evaluated by clinical symptoms and radiographic evidence where the comparison followed a standard definition of success or failure, as shown by the number of teeth. Data were extracted from each study independently and entered into a database. Differences were resolved by discussion. Studies were scored for validity criteria according to the Jadad scale. Meta-analysis was performed using the software RevMan (version 4.2.8; Copenhagen; The Nordic Cochrane Centre, The Cochrane Collaboration, 2003). Heterogeneity between studies was assessed using a standard chi-square test. If there was homogeneity among the studies, the fixed-effect model (Peto method) was applied to aggregate the data. If homogeneity was rejected then sensitivity analyses were performed using a random-effects model. Six studies met the inclusion criteria (giving a total of 381 teeth). There was a significant difference between the success rates of formocresol (FC)- and mineral trioxide aggregate (MTA)-treated pulpotomised primary molars (P<0.05) Clinical assessments and radiographic findings of the MTA versus FC pulpotomy suggested that MTA was superior to FC in pulpotomy, resulting in a lower failure rate [relative risk, 0.32 (95% confidence interval, 0.11-0.90) and 0.31 (95% confidence interval, 0.13-0.74) respectively]. The results demonstrate that in primary molar teeth with vital pulp exposure caused by caries or trauma, a pulpotomy performed with MTA results in better clinically and radiographically observed outcomes. Fewer undesirable responses were recorded for MTA than when FC was used. Therefore, the study supports the use of MTA instead of FC as wound dressing when performing pulpotomies on primary molars.