Pulpotomy In Primary Teeth Research Articles

Comparative evaluation of formocresol and electrosurgical pulpotomy in human primary teeth- An in vivo study

Introduction: Vital pulpotomy is defined as the surgical amputation of the coronal portion of exposed pulp followed by the placement of medicament over the remaining radicular pulp thereby maintaining the vitality of the remaining radicular pulp.Aim and Objective: The aim of this study was to compare clinically and radiographically the success rate of formocresol (FC) and electrosurgical pulpotomy in human primary teeth.Materials and Methods: In this study, thirty primary molars between 3 and 8 years of age were taken from the Outpatient Department of Pedodontics and Preventive Dentistry. Teeth were randomly divided into two groups of fifteen teeth each based on type of pulpotomy performed (15 receiving electrosurgical pulpotomy and 15 receiving FC pulpotomy). Under rubber dam isolation, pulpotomy was performed in both the groups and teeth were restored with stainless steel crowns. The patients were recalled at 3, 6, and 9 months for clinical and radiographic follow-up. The data were evaluated using Chi-square test.Results: Statistical analysis showed no significant difference between the two groups (P > 0.05). The overall clinical success of FC was 100%, whereas that of electrocautery was 96% at 3-, 6-, and 9-month follow-up. The overall radiographic success of FC was 100%, 93%, and 93% and that of electrocautery was 97%, 87%, and 77% at 3, 6, and 9 months, respectively. The teeth considered as failures were subjected to further treatment.Conclusion: There was statistically no significant difference in the pre-operative clinical and radiographic features between the two groups with the p>.05 as statistically analysed using chi-square test. Further studies using larger samples and longer evaluation periods are recommended.

Histopathological Evaluation of Dental Pulp of Primary Teeth Pulpotomized with Formocresol with/without a Capping Agent: A Randomized Clinical Trial.

Objectives:This study aimed to assess the reaction of dental pulp of pulpotomized teeth with/without applying a capping agent. This study was performed as randomized clinical trial.Materials and Methods:This split-mouth clinical trial was conducted on eight pairs of primary canine teeth scheduled for extraction as part of orthodontic treatment. The teeth were randomly assigned to the intervention and control groups. In the intervention group, canine teeth were restored with amalgam after pulpotomy with formocresol. In the control group, zinc oxide eugenol paste was applied as the capping agent after pulpotomy with formocresol, and the teeth were then restored with amalgam. After 1 month, the teeth were extracted in both groups and stained with hematoxylin and eosin for histological analysis. Pulp reaction was assessed in terms of pathological parameters. Data were analyzed using the Mann–Whitney U-test and Fisher's exact test. The statistical analysis software was SPSS 16.Results:No significant difference was found between the two groups in terms of inflammation, vitality, internal resorption, bleeding, presence of osteoclasts and dentinoclasts, and internal regeneration. Dentinal bridge did not form in any group.Conclusion:According to the results of this study, formocresol pulpotomy of primary teeth can be completed without the application of a capping agent.

One-year outcomes of MTA and modified Portland cement pulpotomy in primary teeth: a randomized clinical trial

Purpose: To compare the efficacy of Mineral Trioxide Aggregate (MTA) and Modified Portland Cement (MPC) as pulpotomy medicaments in primary molars. Methods: A sample of 54 children 4 to 6 years old of age, who had at least one primary mandibular second molar that needed pulpotomy were randomly placed in MTA (n = 28) or MPC (n = 26) groups. After completing the pulpotomy procedures, the teeth received a stainless-steel crown. Clinical and radiographic successes/failures were blindly evaluated at 6 and 12 months, and Fisher's exact test was used to analyze the differences. Results: At 6- and 12-month follow-ups, MTA and MPC had 100% clinical success rate. Radiographic success rates of MTA were 92.9% at 6 months and 89.3% at 12 months. While the rate for MPC group was 88.5% at both intervals. There was no statistically significant difference between the two groups. Conclusion: The results of this investigation showed that treatment success rate with MPC was comparable to MTA pulpotomy. However, additional clinical research that considers long-term follow-ups is required to test the usefulness of MPC in the pulpotomy treatment of primary teeth.

Pulpotomy of Primary Molar Teeth with Biodentine – A Case Report

A 7-year-old boy was referred to the department of conservative dentistry and endodontics, Bangabandhu Sheikh Mujib Medial University (BSMMU) with pain on his left lower jaw. After clinical and radiological examination, it was diagnosed as a case of reversible pulpitis. Biodentine pulpotomy was performed followed by permanent restoration with glass-ionomer. The presented case was done to evaluate the efficacy of Biodentine as pulpotomy medicament in primary molar teeth, on follow-up it was found to be successful.Birdem Med J 2017; 7(3): 238-241

Clinical and Radiographic Evaluation of Four Different Pulpotomy Agents in Primary Molars: A Longitudinal Study.

Background The medicament formocresol (FC) used for pulpotomy in primary teeth has great concerns regarding its toxicity due to one of its constituent formaldehyde which acts by tissue fixation. Therefore, new medicaments were introduced which claimed preservation and regeneration of pulp.Aim The present study is aimed to compare and evaluate the clinical and radiographic success of FC, pulpotec, mineral trioxide aggregate (MTA), and emdogain (EMD) as pulpotomy medicaments in human primary molars.Design A sample of 21 patients with 84 teeth were selected. All the patients have at least four teeth eligible for pulpotomy according to selection criteria. In each mouth, the teeth selected were randomly allocated into four groups with 21 each.Results After 24 months of follow-up, the clinical success rates were FC (94%), pulpotec (94%), MTA (100%), and EMD (83%) and radiographically FC (88%), pulpotec (83%), MTA (94%), and EMD (72%), which were statistically not significant (p > 0.05).Conclusion The outcome of this study demonstrates MTA has a high success rate compared with FC, pulpotec, and EMD as pulpotomy agent. In addition, MTA, pulpotec, and EMD can be considered as alternatives to FC as pulpotomy agent.How to cite this article Sunitha B, Puppala R, Kethineni B, Mallela MK, Peddi R, Tarasingh P. Clinical and Radiographic Evaluation of Four Different Pulpotomy Agents in Primary Molars: A Longitudinal Study. Int J Clin Pediatr Dent 2017;10(3):240-244.

Acemannan and Formocresol Pulpotomies in Primary Teeth: a Comparative Histopathological Study

AIM: The present study was conducted to compare the histopathological effects of acemannan to that of formocresol as pulp-dressing agents in primary teeth underwent pulpotomy. MATERIALS AND METHODS: Aloe vera gel high molecular weight fractions (AHM) containing native ingredients of polysaccharide (acemannan) and glycoprotein (verectin) were obtained by using the patented hyper dry system after washing out coloured materials with running water from Aloe vera gel slurry. Forty-six primary first teeth from children between 6-9 years, which formerly planned for serial extraction were selected. The children were distributed into two equal groups; twelve teeth for each. Pulpotomy was done in both groups; where group I treated by AHM, acemannan, as a dressing agent while formocresol used as a dressing agent in group II. The teeth from each group were extracted at two, four, and twelve week intervals for histopathological evaluation. RESULTS: In group I (Acemannan), after twelve weeks significantly better results in pulp inflammation, incomplete dentine bridge formation, and soft tissue organization were demonstrated (p<0.05). Most of the acemannan-treated group demonstrated no pulp inflammation with only (3/12, 25%) revealed mild pulp inflammation under the exposure site and only one tooth 1/12 teeth (8.3%) showed partial dentine bridge formation. In contrast, group II (Formocresol) moderate or severe pulp inflammation (10/12, 83%), no dentine bridge formation were observed. In almost all cases (10/12, 83%) the soft tissue of the pulp was not well organized. CONCLUSION: According to these findings, AHM, acemannan may be a suitable agent for pulpotomy in primary teeth. Moreover, the inflammatory response was less severed and no necrosis was noted after pulpotomy with acemannan compared to formocresol.

Evaluation and comparison of mineral trioxide aggregate and biodentine in primary tooth pulpotomy: Clinical and radiographic study.

Pulpotomy is the common therapy for cariously exposed pulps in symptom-free primary molar teeth. For many years, researchers have searched for an ideal material that allows regeneration of the residual pulp. The purpose of this study was to evaluate the efficacy of mineral trioxide aggregate (MTA), Biodentine as a pulpotomy medicament in primary teeth, both clinically and radiographically. A total of 25 children (50 human primary molar teeth) aged between 5 and 9 years were selected in this randomized clinical study. The patients were randomly assigned to receive the pulpotomy medicaments in either [Group 1]: MTA or [Group 2]: Biodentine. All pulpotomized teeth were restored with stainless steel crowns and evaluated clinically and radiologically at 1, 3, 6 and 12 months. Statistical analysis using Mann-Whitney U test and Fisher's exact test, and chi-square test was performed to determine the significant differences between the groups. Clinical and radiological success rates were 96 and 80% in Group 1 and 96 and 60% in Group 2, respectively. There were no significant differences between the groups (P > 0.05). The radiographic success rates decreased in the controls, but there were no significant differences. Biodentine showed similar clinical and radiographic results as MTA in the 12-month evaluation and can be safely used as a pulpotomy medicament.

Plasma Level Formaldehyde in Children Receiving Pulpotomy Treatment under General Anesthesia.

Formocresol has long been used by dentists for pulpotomy of primary teeth. Due to some concerns regarding its possible carcinogenicity, formocresol has been the topic of numerous studies. This study sought to assess the changes in plasma level of formaldehyde of children after receiving pulpotomy under general anesthesia. Twenty-five children between 2-6 years requiring dental treatments under general anesthesia were studied. Blood samples were taken of children before and after the procedure. Plasma level of formaldehyde was measured using high performance liquid chromatography (HPLC). A total of 106 pulpotomy treatments were performed in 25 children using 126 cotton pellets dipped in formocresol. An increase and a decrease in plasma level of formaldehyde were noted in 5 (20%) and 20 (80%) children, respectively post-operatively compared to baseline. The t-test showed no significant difference in plasma level of formaldehyde pre- and postoperatively (P=0.12). the plasma level of formaldehyde in children who had higher levels of formaldehyde prior to the operation was also higher than that of others after the operation and this association was statistically significant (P=0.001, r=0.64). The results showed no significant change in the mean plasma level of formaldehyde in children who received pulpotomy under general anesthesia compared to its baseline value.

Better outcome in pulpotomy on primary molar with Biodentine

Aim: The primary objective of any pulp therapy is to maintain the integrity and health of a tooth and its supporting tissue as well as to maintain arch length and space maintenance. The aim of this case is to a probate and popularizes the technique of vital pulpotomy in primary teeth with biodentin.Update Dent. Coll. j: 2015; 5 (2): 57-62

Zinc Oxide-Eugenol Pulpotomy in Primary Teeth: A 24-Month Follow-up.

The purpose of the present study was to evaluate the clinical and radiographic effectiveness of zinc oxide-eugenol (ZOE) as the only pulp capping agent in pulpotomies carried out on decayed primary molars after a follow-up period of 24 months. In total, 60 pulpotomies were performed on 38 patients aged 3 to 11 years. Pulpotomy treatment consisted of the removal of the coronal pup tissue, subsequent hemostasis, irrigation with saline solution, drying and pressure with sterile cotton pellets, and placement of a thick regular ZOE base with a minimal amount of eugenol directly over the vital radicular pulp. Additionally, a histopathologic study was carried out on some of the molars treated. After a 24-month follow-up, we considered 51 procedures to be successful and 9 failures using clinical and radiographic criteria; most of the failures occurred between the 12th and 18th month. Results suggest that the proposed pulpotomy treatment with ZOE as the only capping agent may be considered as an alternative technique in the pulp treatment of primary molars.

Comparative evaluation of calcium silicate-based dentin substitute (Biodentine®) and calcium hydroxide (pulpdent) in the formation of reactive dentin bridge in regenerative pulpotomy of vital primary teeth: Triple blind, randomized clinical trial.

Background:Considering the biological concerns of calcium hydroxide (CH) as a pulpotomy agent, an alternative silicate based dentin substitute i.e. Biodentine (Ca3SiO5) was evaluated clinically and radiographically.Aims:To evaluate the effectiveness of dentin substitute (Biodentine) in regenerative pulpotomy of vital primary teeth that would giv a biological base to its use in forming reactive dentin bridge and overcoming the drawbacks of calcium hydroxide.Material and Methods:Randomised clinical trial on 40 bilateral carious primary molars in 20 participant children (aged 5-10 years) was carried out by same operator using Ca3SiO5(group-1) and CH (group-2) as vital pulpotomy agents. Blinded clinical and radiographic outcomes were observed at 3, 6 and 12 months interval.Results:Clinical outcomes of both protocols were analysed using Pearson's chi-square test applied at P < 0.05. Descriptive statistics were expressed as mean increase in dentin bridge formation in mms from two reference points in standardized radiographs using paired ‘t’- test at baseline and 12 months and found to be statistically significant (P < 0.05) in group-1 when compared with group-2.Conclusion:Group-1 revealed statistically favourable regenerative potential along with clinical success compared to group 2 thereby sharing both indications and mode of action with CH, but without its drawbacks of physical and clinical properties.

Effect of Aloe Vera in Oral Health-A Review

Aloe vera is a plant that belongs to Liliaceae family. The name Aloe derives from the Arabic word “Alloeh” meaning shining bitter substance while “vera” in Latin means true. There are more than 300 species of the aloeplant, but the Aloe barbadensis species exhibits the best medicinal properties. Aloe vera contains various minerals and vitamins and has got various properties such as immunomodulatory, antiviral and anti inflammatory in nature. The Greek scientists regarded Aloe vera as the universal panacea. It has its uses in various systemic conditions like skin disorders, bowel disorders, diabetes and in hyperlipidemic patients. It has also been used in dentistry for its beneficial properties in various conditions like lichen planus, apthous stomatitis, oral submucous fibrosis, pulpotomy of primary teeth, prevention of dry sockets, obturation of primary teeth, disinfection of irrigation units, bleeding and painful gums, disinfection of gutta percha cones, burning mouth syndrome and in radiated head and neck cancer patients.

Clinical and Radiographic Evaluation of Success of Two commercially Available Pulpotomy Agents in Primary Teeth: An in vivo Study

The aim of this study is to evaluate and compare Biodentine and mineral trioxide aggregate (MTA) as pulpotomy agents by clinical and radiological assessments in primary teeth. In this study, 90 decayed primary molars indicated for pulpotomy were chosen and are divided into two groups. Soft enamel and dentinal caries were removed using spoon excavator. Access opening was done using highspeed cool water handpiece. Normal saline was used to irrigate pulp chamber, later saline moistened cotton pellet was used to obtain hemostasis in both groups. Restorations were placed in respective groups and immediate postoperative radiographs were taken. Follow-ups were done at every 3 months intervals, i.e., 3, 6, 9, and 12 months respectively. Statistical evaluation was carried out by using paired t-test which showed no significant difference between the two groups (p ≥ 0.05) with high success rate of 95.5%. Pulpotomy with MTA and Biodentine is a reliable biological method for pulp treatment of primary teeth. Mineral trioxide aggregate and Biodentine could be considered as a reliable biological method for pulp-otomy of primary teeth.

Clinical Evaluation of Low Level Diode Laser Application For Primary Teeth Pulpotomy.

Inspite of latest advances in the materials and techniques practiced for the treatment of pulpally infected teeth with better reported success rate, still the question arises for safety and effectiveness of these medicaments. The objective of the present study was to compare the effectiveness of the Low Level Laser Therapy to Mineral Trioxide Aggregate (MTA) when used for pulpotomy in vital human primary molars. The sample consisted of 40 primary molars from 29 children aged four to seven years. The teeth were selected based on clinical, radiographic criteria and randomly allocated to two groups. All the 40 primary molars were subjected to standard pulpotomy procedure, where in 20 molars received MTA (Group I) and 20 molars received LLLT (Group II) pulpotomy. Children were recalled at 3, 6 and 12 months intervals and pulpotomised molars were examined clinically and radiographically. Data was analysed using chi-square test. MTA showed 94.7% success rate at all the three intervals, where as LLLT showed a success of 95% at three months, which decreased gradually to 85% at six months and 80% at 12 months. Intergroup comparisons were not significant. Low level laser therapy can be considered for primary teeth pulpotomy and its success is comparable to MTA pulpotomy technique.

Letter to the Editor on "Clinical Evaluation of Success of Primary Teeth Pulpotomy Using Mineral Trioxide Aggregate, Laser and Biodentine - An Invivo Study".

Letter to the Editor on "Clinical Evaluation of Success of Primary Teeth Pulpotomy Using Mineral Trioxide Aggregate, Laser and Biodentine - An Invivo Study".

Pulpotomy Medicaments used in Deciduous Dentition: An Update.

The aim of this paper was to review the history and the scientific literature published on pulpotomy medicaments and to present the findings of these studies. The review showed that pulpotomy of primary teeth has been treated with many different techniques and medicaments, that some of these approaches are controversial and that their results have presented variables of success rates in term of clinical, radiographic and histologic observation. It is important that all clinicians, particularly for pediatric dentists, be up to date with the recent trends in this area of dental treatment for children.

Is pulpotomy obsolete? A clinical study on the success rates of indirect pulp capping and pulpotomy in the treatment of deep dentinal caries in primary second molars

Background and Objectives: Traditionally, there are two treatment modalities for vital primary teeth with deep carious lesion, which include indirect pulp therapy (IPT) and pulpotomy. Enormous research and review in vital pulp therapy gave rise to a question, if primary tooth pulpotomy is obsolete, and should IPT replace pulpotomy? IPT has shown higher long-term success rates than any pulpotomy procedures other than mineral trioxide aggregate (MTA). Hence, the objectives of this study were to evaluate the success rates of IPT using calcium hydroxide and MTA pulpotomy clinically and radiographically. Materials and Methods: Eighty primary second molars were selected and randomly divided into two therapeutic groups of 40 each. Group 1 were treated with IPT using calcium hydroxide paste and Group 2 were treated with conventional pulpotomy using MTA paste followed by stainless steel crown. Follow-up evaluation was done at an interval of 6 weeks, 3 months, and 6 months. Results: The follow-up evaluation revealed 100% clinical success in teeth treated with MTA pulpotomy and one radiographic failure of internal resorption detected at 3 months. There was 100% clinical and radiographic success with teeth treated with IPT. Though there was one radiographic failure with MTA pulpotomy, it was not statistically significant (P > 0.05). Conclusion: Indications being the same for both the procedures why not opt for IPT which offers several advantages over pulpotomy like fewer potential side effects, non-invasive, decreased chair time, child cooperation, and cost-effectiveness.

Bacteriological evaluation of Allium sativum oil as a new medicament for pulpotomy of primary teeth.

Objective:To compare the effects of Allium sativum oil and formocresol on the pulp tissue of the pulpotomized teeth.Materials and Methods:Twenty children were selected for this study. All children had a pair of non-vital primary molars. A sterile paper point was dipped in the root canals prior to the mortal pulpotomy. These paper points were collected in transfer media and immediately transported to the microbiological lab to be investigated microbiologically (for Streptococcus mutans and Lactobacillus acidophilus). Then the procedure of mortal pulpotomy was performed. After 2 weeks, the cotton pellets were removed and sterile paper points were dipped in the root canals for microbiological examination. Then comparison between the count of bacteria before and after treatment was conducted. Statistical analysis was performed using independent t-test and paired t-test at the significance level of α = 0.05.Results:After application of both medicaments, there was a marked decrease in S. mutans and L. acidophilus counts. The difference between the mean of log values of the count before and after the application was highly significant for both medicaments (P < 0.05); however, better results were obtained when A. sativum oil was used.Conclusion:A. sativum oil had more powerful antimicrobial effects than formocresol on the bacteria of the infected root canals.

Assessment of the potential of Allium sativum oil as a new medicament for non-vital pulpotomy of primary teeth.

Objective:The objective of this study was to compare the clinical and radiographic effects of Allium sativum oil and formocresol in nonvital pulpotomy in primary teeth.Materials and Methods:Twenty children ranging in age from 4 to 8 years were included in the study. In every one of those children, pulpotomy was indicated for the primary molars. Pulpotomy procedure was performed and the radicular pulp tissue of one molar was capped with A. sativum oil in a cotton pellet while the other molar was capped with formocresol. The teeth were evaluated clinically and radiographically before and after 6 months using standard clinical and radiographic criteria. Statistically, these results revealed significant difference between the radiographic findings of nonvital pulpotomy in primary molars with the two medicaments. Statistical analysis was performed using independent t-test and paired t-test at the significance level of α = 0.05.Results:A. sativum oil has potent antibacterial properties that enable it to combat intracanal microbes in the infected pulp of primary molars. Better results were obtained when A. sativum oil was used.Conclusion:A. sativum oil had more powerful effects than formocresol on the infected pulp of primary nonvital molars.

Clinical Evaluation of Success of Primary Teeth Pulpotomy Using Mineral Trioxide Aggregate(®), Laser and Biodentine(TM)- an In Vivo Study.

Pulpotomy technique basically consists of removing the coronal pulp and fixing the radicular pulp with a medicament. It is the most widely accepted clinical procedure for treating primary teeth with coronal pulp inflammation caused by caries with no involvement of the radicular pulp. To evaluate the success and efficacy of Mineral Trioxide Aggregate (MTA), Lasers and Biodentine as pulpotomy agents both clinically and radiographically. In the present study, 60 primary molars in children whose pulpal status warranted pulpotomy were selected and randomly assigned into three groups that included MTA, Laser and Biodentine allocating 20 teeth to each group. The pulpotomy procedure was then performed on all selected teeth followed by restoration with stainless steel crowns. Later the patients were recalled for 3 months and 6 months for clinical and radiographic evaluation. Statistical analysis was done using Fisher exact test to determine pair wise comparison of three agents with respect to clinical and radiographic criteria. Kruskal-Wallis ANOVA, Mc Nemars test was applied to evaluate the efficacy of each agent between 3 months and 6 months. The results showed that maximum success rate was found in MTA group. However, the comparison between three groups was statistically not significant (p<0.05). Pulpotomies performed with either MTA, Laser or Biodentine are equally efficient with similar clinical/radiographic success and hence can be considered as alternatives to Formocresol.