Formocresol Pulpotomy Research Articles

Evaluation of the formocresol versus mineral trioxide aggregate primary molar pulpotomy: a meta-analysis

To apply meta-analysis to compare the clinical and radiographic effects of mineral trioxide aggregate (MTA) with formocresol (FC) when used as wound dressing for pulpotomy of primary molars. The study list was obtained by searching MEDLINE, The Cochrane Library, EMBASE, and SCI. Only those papers that met the inclusion criteria were analyzed. Six studies met the inclusion criteria. There was significant difference between the success rates of FC- and MTA-treated pulpotomized primary molars (P < .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, with the RR (Relative Risk) being 0.32 (95% confidence interval [CI] 0.11 to 0.90) and 0.31 (95% CI 0.13 to 0.74), respectively. Internal root resorption happened less in the MTA group with RR 0.29, 95% CI 0.11 to 0.77. MTA induces less undesirable responses and might be FC's suitable replacement.

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.

Is there life after Buckley's Formocresol? Part I – A narrative review of alternative interventions and materials

(1) To present a narrative review of the currently available alternative interventions and materials to formocresol pulpotomy for the management of extensive caries in the primary molar, and (2) to produce a clinical protocol for pulp therapy techniques in the extensively carious primary molar. The International Agency for Research on Cancer has recently classified formaldehyde as carcinogenic to human beings. Since Buckley's Formocresol contains 19% formaldehyde in its full strength and, therefore, 1% in a 20% dilution, a safer alternative should be identified. A narrative review of the published literature for primary molar pulp therapy techniques was undertaken following an extensive and appropriate literature search. A specialist group of paediatric dentists was formed to arrive at a consensus and establish an evidence-based protocol for the management of extensively carious primary molar teeth. Part I of this paper explores the currently available alternative interventions and materials to formocresol in the form of a narrative review. The second part of the paper will present the formation of a specialist group to arrive at a consensus and establish an evidence-based protocol for the management of the extensively carious primary molar. After consideration of a review of extensively searched literature, a protocol and key points document have been developed to assist clinicians in their treatment planning. Further long-term studies with the highest level of evidence (i.e. randomized controlled trials) are required to enable us to identify acceptable alternatives which can replace formocresol.

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

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. 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. 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. 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.

Nd:YAG laser pulpotomy of human primary teeth

Formocresol has been a popular pulpotomy medicament in the primary teeth for the past 60 years. However, its toxic effect has been of concern. Laser therapy is a non-pharmacologic hemostatic technique for pulpotomy procedure. But research on laser therapy for primary tooth pulpotomy is sparse. The purpose of this study was to evaluate the effects of Nd:YAG laser pulpotomy on human primary teeth. Patients with primary tooth that required pulpotomy, because of pulpal exposure to caries, were selected for this study. After removal of coronal pulpal tissue using a sterile sharp spoon excavator, Nd:YAG laser at 2 W, 20 Hz, 100 mJ or 1:5 dilution of formocresol was introduced into the canal orifice for complete hemostasis. Then, intermediate restorative material (IRM) paste was placed over the pulp stump, and the tooth was restored either with composite resin or stainless steel crown. Clinical follow-ups were made every 3 months after treatment. X-ray was taken every 6 months. Sixty-four teeth were treated with Nd:YAG laser and followed for 6–48 months. Sixty-two out of the sixty-four teeth (96.9%) were clinically successful, and 90.6% were radiographically successful. In control group, 51 primary molars were treated with formocresol, 88.2% were clinically successful, 82.3% were radiographically successful, during an average of 20.4 months follow-up period. The successful rate of Nd:YAG laser pulpotomy was higher than formocresol pulpotomy. The permanent successors of the laser treated group erupted without any complications. Therefore, Nd:YAG laser pulpotomy can be considered for use as pulpotomy technique in clinical practice.

Pulp treatment for extensive decay in primary teeth.

Dental decay in primary teeth remains a considerable health problem. Where decay extends to involve the dental pulp, pulp treatment techniques are often used to manage both symptomatic and symptom free teeth. To assess the relative effectiveness of: various pulp treatment techniques in retaining primary molar teeth with decay involving the pulp for at least 12 months; pulp treatment techniques and extractions in avoiding long term sequelae. We searched the Cochrane Oral Health Group's Trials Register (August 2002); the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to August 2002); EMBASE (1980 to August 2002); Science Citation Index Expanded (1981 to August 2002); Social Science Citation Index (1981 to August 2002); Index to Scientific and Technical Proceedings (1982 to August 2002); System for Information on Grey Literature in Europe (August 2002). Key journals were handsearched. There was no restriction on language of publication. Randomised or quasi-randomised controlled trials (RCTs) comparing different pulp treatment techniques (with each other, with extraction or with no treatment) for extensive decay in primary molar teeth. Primary outcomes were extractions following pulp treatment and long term effects. Data extraction and quality assessment were carried out independently and in duplicate. Authors were contacted for additional information where necessary. Eighty-two studies were identified but only three were suitable for inclusion. Nine studies meeting the inclusion criteria but with inappropriate study design or analysis are also described. Included trials investigated formocresol pulpotomy, ferric sulphate pulpotomy, electrosurgical pulpotomy or zinc oxide eugenol pulpectomy in symptom free, cariously exposed teeth. Data were unavailable on long term effects. Data on extraction following pulp treatment was available in all three studies and in two studies there was no statistically significant difference between the treatments. The difference seen in the other study, where more teeth treated by ferric sulphate pulpotomy were extracted compared to zinc oxide eugenol pulpectomy, must be viewed with caution. Based on the available RCTs, there is no reliable evidence supporting the superiority of one type of treatment for pulpally involved primary molars. No conclusions can be made as to the optimum treatment or techniques for pulpally involved primary molar teeth due to the scarcity of reliable scientific research. High quality RCTs, with appropriate unit of randomisation and analysis are needed.

Treatment of vital and non‐vital primary molar teeth by one‐stage formocresol pulpotomy: clinical success and effect upon age at exfoliation

The clinical success and effect upon the age at which teeth exfoliated was prospectively observed in 175 primary molars that had received formoceresol pulpotomies performed by one operator. The success rate among 142 vital teeth was 99.3% and among 33 non-vital teeth 84.8%. There was no significant effect upon age at exfoliation after either type of pulpal treatment.

Formocresol and alternative primary molar pulpotomy medicaments: a review

This paper reviews the history, clinical success and concerns regarding the safety of formocresol as a primary molar pulpotomy medicament. The alternatives to formocresol are discussed and their advantages and disadvantages evaluated.

Periodontal changes following coronal/root perforation and formocresol pulpotomy

A clinical case report is presented which describes the sequelae of an iatrogenic lateral crown/root perforation and a formocresol pulpotomy. The post-operative course of the initial therapy included significant hard and soft tissue destruction and eventual tooth loss. The possible implication of the role of formocresol is discussed.

Electrosurgical pulpotomy—A 6-month study in primates

The primary teeth of five <i>Macaca nemestrina</i> monkeyswere treated using either a conventional formocresol or electrosurgical technique following pulpotomy. One animal was killed at each of the following posttreatment intervals: 1 h, 3 months, 4 months, 5 months, and 6 months. Pulps of the treated teeth were evaluated histologically for the presence of inflammation, fibrosis, necrosis, resorption, and reparative dentin formation. Results indicated that the electrosurgery pulpotomy technique produced a tissue response comparable to that induced with the conventional formocresol pulpotomy technique.

Comparison of calcium hydroxide and formocresol pulpotomies in primary teeth in lambs: Preliminary study

Calcium hydroxide and formocresol pulpotomieswere performed on 28 primary teeth of seven lambs. The prepared specimens were examined under the light microscope at 1-, 7-, 14-, 30-, 60-, 120-, and 180-day intervals. Treatment of 14 teeth with calcium hydroxide and 12 of 14 teeth with formocresol was histologically successful.

Local versus general anesthesia: a study of pulpal response in the treatment of cariously exposed teeth

TJL wo procedures common to operative dentistry when treating a patient’s cari­ ously exposed teeth are calcium hydrox­ ide direct pulp capping, for permanent teeth, and the formocresol pulpotomy, for primary teeth.1,2 Both procedures are done to enhance the pulpal response by promoting physiologic accommodation of pulp exposures on affected teeth in the most conservative way possible, short of complete endodontic therapy. This study discusses whether a correlation exists be­ tween the success of conservative pulp therapy and the use of a conventional, local anesthetic, with a vasoconstrictor. The question of whether patients under­ going operative dentistry procedures under general anesthesia benefit from not having conventional, local anesthetics administered is investigated. The re­ sponse of the dental pulp after surgery done with and without the use of a local anesthetic is investigated in particular.

Calcium hydroxide pulpotomy for primary teeth: a clinical study

Calcium hydroxide pulpotomies were performed in 17 carious primary mandibular molars. Variables in the pulpotomy procedure were recognized and controlled in an attempt to obtain a more favorable result or end product. The effects of two methods of hemorrhage control were also evaluated. The duration of treatment for the study ranged from three to nine months. Treatment was clinically successful for all 17 teeth. The radiographic evaluations were more favorable for the experimental group than for the control group. Treatment was radiographically successful for 15 teeth, questionable for one tooth, and unsuccessful for one other tooth. The results of this study suggest that the aluminum chloride-calcium hydroxide pulpotomy may be a viable alternative to formocresol pulpotomies in the primary dentition. Although these findings encourage continued research, including a long-term follow-up, a histologic study is indicated.

Reactivity of human lymphocytes to pulp antigens

Lymphocyte transformation induced by Formocresol-treated and untreated extracts of homologous pulp tissue was evaluated in groups of children who differed in past experience with Formocresol pulpotomies. Significant transformation responses were observed in studies of 25 of the 40 children. Neither the ability to respond nor the level of lymphocyte response to the pulp extracts was related to a clinical history of Formocresol pulpotomy. Sensitization to pulp-related antigens was a common finding in this study and was moderately well correlated with indexes of past and current dental disease.

Endodontic treatment of primary teeth

Endodontic treatment of primary teeth is undertaken by indirect pulp capping, direct pulp capping, formocresol pulpotomy and pulpectomy. The same treatment principles apply to both primary and permanent teeth with infected or necrotic pulps. The main differences are the use of formocresol for root canal medication and a resorbably zinc-oxide and eugenol paste for root canal obturation.

Comparison of Dycal and formocresol pulpotomies in young permanent teeth in monkeys

Dycal and formocresol pulpotomies were performed on forty immature permanent teeth of three young adult monkeys. Findings indicate that continued root development occurs with both materials and that failure is due to bacterial infection of the pulp.

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.

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.

Formocresol pulpotomy of primary teeth and occurrence of enamel defects on the permanent successors

Fifty-two permanent tooth pairs of 37 children aged 8 to 16 years were evaluated for opacities and hypoplasia of the enamel. Formocresol pulpotomy had been performed in one of the primary teeth proceeding each tooth pair. The study comprised teeth with clinically and radiographically successful and unsuccessful pulpotomies. None of primary control teeth had a history of pulp exposure. 57 permanent teeth with caries-free predecessors were included for further control.In the formocresol treated group the prevalence of opacities according to localization was: occlusal surface 25%, buccal surface 37% and palatal surface 14%. In the control group, the corresponding prevalence was 21%, 35% and 14%. The prevalence of hypoplasia was 2%, 8% and 0% respectively, in the formocresol group and 2%, 14% and 4% in the control group. In the 57 permanent teeth opacities were found in 16% of the occlusal and buccal surfaces and in 18% of the palatal surfaces. The prevalence of hypoplasia was 12%, 5% and 0% respectively.No differences in prevalence of enamel defects on permanent teeth could be demonstrated in relation to child age when formocresol pulpotomy was performed.The conclusion of the study was that no relationship between formocresol pulpotomy of primary teeth and enamel defects on their permanent successors could be demonstrated.

Relationship between formocresol pulpotomies on primary teeth and enamel defects on their permament successors : PRUHS R. J., OLEN G. A. and SHARMA P. S.J. Am. Dent Assoc.94 (1977) 698–700

Relationship between formocresol pulpotomies on primary teeth and enamel defects on their permament successors : PRUHS R. J., OLEN G. A. and SHARMA P. S.J. Am. Dent Assoc.94 (1977) 698–700