Pulpotomy Technique Research Articles

Evaluation of one- versus two-step technique on the outcome of mineral trioxide aggregate pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis

Abstract Context: This study compares one-step and two-step mineral trioxide aggregate (MTA) pulpotomy techniques in treating symptomatic irreversible pulpitis (SIP) in mature molars over 12 months. Aims: To compare the clinical efficacy of one-step versus two-step MTA pulpotomy in mature permanent teeth with SIP. Setting and Design: This clinical trial involved 30 patients with SIP in mandibular molars, comparing one-step and two-step MTA pulpotomy. Methodology: Thirty patients (aged 15–35) with SIP in mandibular molars were randomly assigned to two groups: one-step MTA pulpotomy (n = 15), with final restoration in the same visit, and two-step MTA pulpotomy (n = 15), with interim restoration followed by final restoration after 24 h. Pain levels were assessed using the Numerical Rating Scale at 24, 48, and 72 h postoperatively. Clinical and radiographic follow-ups were performed at 3, 6, and 12 months to assess pulpal vitality, restoration quality, and treatment success. Statistical Analysis: The results were analyzed statistically using the independent t-test, Fisher’s exact test, and Pearson’s Chi-square test. Results: Both groups showed significant pain reduction (P < 0.05) and 100% success at 12 months. Electric pulp tests were positive in all teeth, with 73.33% responding to cold testing. Restoration quality showed no significant differences between groups. Conclusion: Both one-step and two-step MTA pulpotomy techniques showed high success rates in treating SIP in mature molars, with no significant difference. The one-step method is an effective alternative to the two-step approach.

The outcome of full and deep pulpotomy in teeth with extremely deep carious lesion and symptomatic irreversible pulpitis: A non-inferiority randomized controlled trial.

To compare the outcome of full and deep pulpotomy performed in mature permanent teeth with extremely deep carious lesion and symptomatic irreversible pulpitis. This parallel-group, double-blind, non-inferiority randomized controlled trial was conducted after ethical clearance. Patients with mature permanent teeth with extremely deep carious lesion and diagnosis of symptomatic irreversible pulpitis were recruited. Teeth were randomly allocated to two study groups, i.e. Group I: full pulpotomy (excision of pulp tissue up to the level of root canal orifices) and Group II: deep pulpotomy (excision of radicular pulp tissue 2-3 mm apical to root canal orifices). Haemostasis was achieved using cotton pellet moistened with 2.5% NaOCl for up to 10 min. Mineral trioxide aggregate was used as a pulp capping agent and teeth were restored in the same visit with resin composite. Outcome assessment was performed at 12-month follow-up based on clinical and radiographic evaluation. The success rate was determined by intention-to-treat (ITT) and per-protocol (PP) analysis. Two sample t-tests were used to compare the time taken to achieve haemostasis and determine its association with treatment outcome. A total of sixty teeth received treatment in both study groups. The bleeding time was significantly more in Group I (6.13 ± 1.59 min) compared to group II (5.23 ± 1.22 min) (p < .0171). The recall rate was 86.6% at study end point when fifty-two teeth were analysed at 12-month follow up. The success rate was 88.46% and 92.30% for per protocol analysis and 76.67 and 80% for ITT analysis for Group I and Group II, respectively, without any statistically significant difference (p = .610). The absolute risk difference between each treatment was within the 10% non-inferiority limit. There was no statistically significant association between time taken to achieve haemostasis and treatment outcome in both study groups. There was no significant difference between full and deep pulpotomy techniques, with respect to achievement of haemostasis and treatment outcome for management of teeth with extremely deep caries and irreversible pulpitis.

Evaluation of Electrosurgery and Formocresol Pulpotomy Techniques used on Children Primary Teeth

The purpose of this study was to prospectively compare electrosurgical pulpotomy with formocresol pulpotomy technique used on children’s primary teeth by evaluating clinical and radiographic success. During the research period, 260 patients were included in the study. It ranges in age from 2 to 10 years. Among the studied patients, electro surgery patient was 140 and formocresol pulpotomy patient was 120. Teeth were evaluated clinically and radiologically after 6, 12 and 18 months. After 12 months postoperative observation time, the clinical and radiographic success rates for the electrosurgery was 89.29% and 80.52% respectively when 67.50% and 59.71% were for the formocresol technique. There was a statistically significant difference between the electrosurgery and formocresol pulpotomy techniques for both clinically or radiographically techniques. Journal of Dentistry and Allied Science, Vol. 7 No 1: 25-28

Comparative Long-Term Outcomes of Formocresol, Mineral Trioxide Aggregate, and Laser Pulpotomy Techniques in Primary Teeth

ABSTRACT Background: Pulpotomy is a common dental procedure used to treat extensively decayed primary teeth, aiming to preserve the vitality and function of the remaining pulp tissue. Various pulpotomy techniques and materials have been developed, but their long-term outcomes in terms of success rates and complications remain a subject of ongoing research. Materials and Methods: A total of 180 primary molars from children aged 4–8 years were treated using three different pulpotomy techniques: Formocresol (n = 60), Mineral Trioxide Aggregate (MTA) (n = 60), and Laser Pulpotomy (n = 60). Follow-ups were conducted at 6, 12, and 24 months posttreatment to evaluate clinical and radiographic success. Clinical success was defined by the absence of pain, swelling, and mobility, while radiographic success was indicated by the lack of internal resorption, furcation radiolucency, and periapical pathology. Results: At the 24-month follow-up, the clinical success rates were 80% for Formocresol, 95% for MTA, and 90% for Laser Pulpotomy. Radiographic success rates were 75% for Formocresol, 92% for MTA, and 88% for Laser Pulpotomy. MTA demonstrated the highest overall success rates, with statistically significant differences compared to Formocresol (P &lt; 0.01) but not Laser Pulpotomy (P &gt; 0.05). Conclusion Mineral Trioxide Aggregate (MTA) showed superior long-term outcomes compared to Formocresol and comparable results to Laser Pulpotomy for the treatment of primary teeth.

Clinical and Radiographic Evaluation of Diode and Er,Cr:YSGG Lasers as an Alternative to Formocresol and Sodium Hypochlorite for Pulpotomy Techniques in Primary Molars: A Randomized Controlled Clinical Trial.

Background Pulpotomy treatment is one of the vital pulp therapies that can play a major role in the preservation of primary teeth until their natural exfoliation. The objective of this current clinical trial was to assess the clinical and radiographical success of diode and Er,Cr:YSGG lasers as a viable alternative to formocresol (FC) and sodium hypochlorite in the primary molar pulpotomies. Materials and methods Sixty primary molars were selected and randomly allocated to four groups. All treatment groups followed the same clinical protocol, except for the techniques used for hemostasis of the pulpotomy sites. In group A, hemostasis was achieved by applying a 1:5 dilution of FC solution, whereas in group B, 3% sodium hypochlorite was applied to achieve hemostasis. In group C, exposure to a diode laser of 940 nm was performed, whereas for group D, erbium laser irradiation with Er,Cr:YSGG laser of 2,780 nm was employed to achieve hemostasis. Radicular pulp stamps were covered with a 2 mm layer of mineral trioxide aggregate (MTA) paste. Stainless steel crowns were utilized for the final restorations of the primary teeth. The clinical and radiographic outcomes were evaluated at the six- and 12-month follow-up intervals. The investigation was registered with the ClinicalTrials.gov Protocol and Registration System (ID: NCT06002646). Results The overall clinical and radiographic success rates of pulpotomy were 92.3% for FC, 89% for sodium hypochlorite, 98.3% for a diode laser, and 98.7% for Er,Cr:YSGG lasers. There were no statistically significant differences among the four groups (p > 0.05). Conclusions Both the diode and Er,Cr:YSGG lasers showed outcomes comparable to those of FC and sodium hypochlorite. Therefore, they could be promising alternatives to primary tooth pulpotomies.

Pulpal response to partial pulpotomy versus full pulpotomy procedures in puppies: An experimental study.

A Partial pulpotomy technique is an alternative choice of treatment for immature permanent teeth with exposed vital pulps. This study aimed to compare the histopathological pulpal response of the primary teeth of puppies after partial pulpotomy and full pulpotomy using mineral trioxide aggregate (MTA). 72 primary premolars from experimental puppies aged 6-8 weeks were equally divided into test and control groups, as MTA partial pulpotomy (MTA-PP) and MTA full pulpotomy (MTA-FP). After 60 days, the teeth were extracted and examined histologically. The specimens were assessing the extent and intensity of inflammatory response (acute or chronic), necrosis, fibrosis, calcific bridge (presence or absence), pulp calcification, and pathological root resorption. The Inflammation intensity was lower (2.8%) in MTA-PP than in MTA-FP (16.7%) (P = 0.004). MTA-FP also had a significantly higher percentage of localized (27.8%) and diffuse (11.1%) necrosis (P = 0.014), whereas both groups (P = 0.290) had an equal fibrosis degree. A calcific bridge was observed in 72.2% of cases. Meanwhile, pathological internal root resorption was more evident in MTA-FP (63.9%) than in MTA-PP (19.4%) (P <0.0001). Partial MTA pulpotomy procedure demonstrated promising histological findings that can be applied to vital-pulp therapy in primary teeth.

Comparative Evaluation of Low-level Diode Laser and Electrosurgical Pulpotomy in Primary Molars.

Considering the advantages of the nonpharmacotherapeutic techniques over the disadvantages of the pharmacotherapeutic agents, there is a need to evaluate clinically as well as radiographically various nonpharmacotherapeutic techniques to fortify them as replacements to the traditional pulpotomy. This study was conducted to evaluate and compare the clinical and radiographic outcomes of low-level diode laser (LLDL) and electrosurgical pulpotomy in primary molars. Seventy primary molars were allocated to group I (n = 35) and group II (n = 35), which underwent LLDL pulpotomy and electrosurgical pulpotomy, respectively. Clinical and radiographic analysis of all the teeth in the two groups was performed at 1, 3, 6, 9, and 12 months, respectively. Pearson's Chi-squared test was utilized to evaluate the success of both treatment procedures (p < 0.05). During the 12-month follow-up period, the differences between the groups pertaining to clinical and radiographical evaluation were statistically nonsignificant, although enhanced results were seen in the laser pulpotomy group. There was no significant difference in the success rate observed between the LLDL pulpotomy and electrosurgical pulpotomy group at the end of the 12-month follow-up period. The two pulpotomy techniques were found to be successful enough in strengthening the concept of a potent and safe nonpharmacotherapeutic approach in the management of pulpally involved primary molars. This study further establishes nonpharmacological pulpotomy techniques as a favorable alternative to traditional pulpotomy methods. Roy S, Garg N, Pathivada L, et al. Comparative Evaluation of Low-level Diode Laser and Electrosurgical Pulpotomy in Primary Molars. Int J Clin Pediatr Dent 2023;16(4):612-618.

Comparison of various pulpotomy techniques: coronal, cervical, and full pulpotomy

The preservation of deciduous teeth is crucial in pediatric dentistry to maintain normal speech, development, and self-esteem, while also preventing secondary issues like space loss and tooth impaction. Different materials and approaches have been explored over time, ranging from mummification to maintaining pulp vitality and promoting healing. In today's conservative dentistry, techniques like indirect pulp treatment and partial pulpotomy (PP) have gained popularity. Adults diagnosed with irreversible pulpitis due to deep caries often receive root canal therapy (RCT). However, coronal pulpotomy treatment (CPT) has emerged as an affordable alternative for those unable to afford RCT. CPT removes the coronal pulp, allowing the remaining pulp to remain vital. PP and complete pulpotomy are explored as treatments for teeth with signs of irreversible pulpitis. Success depends on eliminating infected tissue, using aseptic techniques, and achieving a tight restorative seal. Materials like MTA have shown favorable outcomes. Direct pulp therapy and PP can effectively preserve vital pulp in primary and young permanent teeth. The choice of pulpotomy material, such as MTA, plays a significant role in success rates.

Evaluation of Chitosan and Ferric Sulphate as Pulpotomy Agents in Primary Teeth: A Randomized Controlled Trial.

Preservation of healthy pulp tissue is detrimental for the function and vitality of carious primary teeth. Several hemostatic agents used for pulpotomy in primary teeth showed adverse effects on viable surrounding structures. To assess the clinical and radiographic success of chitosan (CH) pulpotomy in primary molars and to compare it with ferric sulphate (FS). A total of 40 carious lower primary second molars in 5-9 years children are selected for conventional pulpotomy technique. Over radicular stumps, FS is placed for 15 seconds in the control group, and CH for 4-5 minutes in the study group, followed by intermediate restoration (IRM). Intraoral periapical radiographs were taken immediately after 1 week and after 3rd and 6th months. The clinical and radiographic success rate is assessed and statistically analyzed. Chitosan (CH) showed a 65% radiographical and 100% clinical success rate, and FS showed 55 and 95%, respectively. Chitosan (CH) showed better results than FS as a pulpotomy agent in primary teeth. Guguloth S, Jamnapalli SR, Patloth T, et al. Evaluation of Chitosan and Ferric Sulphate as Pulpotomy Agents in Primary Teeth: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2023;16(2):223-226.

ASSESSMENT OF BIODENTINE PULPOTOMY AS AN ALTERNATIVE TO CONVENTIONAL ROOT CANAL TREATMENT FOR PERMANENT TEETH IN CHILDREN-AN IN VIVO STUDY

A vital pulp tissue is responsible for supporting the tooth structure through reparative dentin production. Preserving pulp vitality is essential in maintaining vascularization and nutrition to the tooth that eventually will support tooth structure &amp; reduce teeth mortality. Root canal treatment for permanent teeth in children is a complex procedure requiring lengthy appointments and multiple visits and often require a full coverage restoration. on the other hand vital pulpotomy requires shorter appointments and usually accomplished in one visit. Vital pulp therapy can help to retain vital permanent teeth that are able to withstand normal function. Vital pulp therapy (VPT) has been increasingly considered as a minimally invasive approach for the management of teeth with inflamed pulps compared to the conventional approach of root canal treatment. Aim To assess the outcome of Biodentine in complete coronal pulpotomy in permanent teeth with symptomatic reversible pulpitis. Methodology In the present study 30 healthy children of age below 12 years requiring pulpotomy were selected after clinical and radiographic assessment. Pulpotomy technique was carried out after local anaesthesia and rubber dam application. After exposure, pulp was amputated to the level of canal orifices (full pulpotomy) using a sterile spoon excavator and high-speed round bur under water coolant. Hemostasias is achieved by cotton pellet moistened with 3 % NaOCl for 2 minutes and repeat as needed, after haemostasis achieved Biodentine was mixed according to the manufacturer’s instructions and gently placed over the pulp to a thickness of 2-3 mm and after that a permanent restoration was placed. All treated patients were followed up at 3-month,6-month,9-month interval for clinical and radiographic evaluation. Resulting data were tabulated and statistically analyzed. Results. Out of the 30 study samples,2 patient cases revealed abnormal clinical and radiographical changes at the end of 3 months and one more patient reported with pain and tenderness to percussion at the end of 6 months. At the end of 9 months follow up, clinical and radiographical success rate was 90.0% respectively. Conclusion Biodentine as a pulpotomy agent has a high successful rate and fulfilled all requirements of an ideal pulpotomy medicament.

Lesion sterilization and tissue repair (LSTR) method in irreversible dental pulp changes of primary teeth

Background/Aim: Deep carious lesions on primary teeth usually have been causing infectious dental pulp changes. If indicated, traditional endodontic root canal treatment for these kinds of pulpal infections in primary teeth usually should involve the performing of pulpectomy methods, but often with questionable prognosis. The lesion sterilization and tissue repair (LSTR) approach is one of the good endodontic therapeutic alternatives for affected primary teeth with a poor prognosis, which could otherwise be condemned to premature extraction. Aim was to evaluate the medium-term clinical success in everyday practice of the LSTR method applied in affected primary teeth with irreversible pulpal tissue infections by observation of reduction/absence of their clinical symptoms. Material and methods: The study sample included child patients who had one or more of their affected primary molars with irreversible pulpal tissue changes of poor prognosis treated with the LSTR method. For each patient whose primary molar tooth was endodontically treated with the LSTR method a clinical evaluation of treated tooth was performed at intervals of 1 and 12 months afterwards. Results: Study sample was consisted of 40 child patients aged 4 to 9 years, with 45 primary molars included in total. It was obvious that the symptoms related to affected sample teeth have already been decreased almost immediately after initial action of triple antibiotic paste. Final outcome after 12-months follow-up period was success of applied LSTR method in 43 (95.6%) affected sample teeth in a way that initial clinical symptoms completely decreased and disappeared. Conclusions: LSTR method has been shown as successful pulpotomy technique for noninstrumental endodontic approach in non-vital pulp treatment of primary molar teeth in a 12-months follow-up period.

Edpuzzle versus Moodle: Learning Tools in Pediatric Dentistry Practice: A Study Pilot.

Fifty students filled out a questionnaire on knowledge of pulp treatments in primary dentition (Pre-Q). They were divided into two groups: one watched a video on the pulpotomy technique before preclinical practice using Moodle 3.4 (group A) and the other used Edpuzzle (group B). On the day of practice, the students resolved any doubts with the teacher. Next, they performed a pulpotomy on an artificial tooth and answered the questionnaire again (Post-Q) together with a satisfaction survey. In both groups, an increase in the number of correct answers was found in the Post-Q compared to the Pre-Q (p &lt; 0.001), but with no significant differences between groups. The pulpotomy practice ratings were higher in group B, which used Edpuzzle (p &lt; 0.001). In the satisfaction survey, we only found significant differences (p = 0.003) in access to the video, since 100% of the students in group A found it easy to view it through Moodle, unlike in group B. Our results suggest that the use of educational platforms specially designed for FL, such as Edpuzzle, can improve the qualifications of students in paediatric dentistry practices.

Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document

PurposeThe European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth.MethodsThree expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified.ResultsThere is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates.ConclusionThe management of deep carious lesions in primary teeth can be challenging and must consider the patient’s compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option.

Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP): a feasibility study

BackgroundProgression of dental caries can result in irreversible pulpal damage. Partial irreversible pulpitis is the initial stage of this damage, confined to the coronal pulp whilst the radicular pulp shows little or no sign of infection. Preserving the pulp with sustained vitality and developing minimally invasive biologically based therapies are key themes within contemporary clinical practice. However, root canal treatment involving complete removal of the pulp is often the only option (other than extraction) given to patients with irreversible pulpitis, with substantial NHS and patient incurred costs. The European Society of Endodontology’s (ESE 2019) recent consensus statement recommends full pulpotomy, where the inflamed coronal pulp is removed with the goal of keeping the radicular pulp vital, as a more minimally invasive technique, potentially avoiding complex root canal treatment. Although this technique may be provided in secondary care, it has not been routinely implemented or evaluated in UK General Dental Practice.MethodThis feasibility study aims to identify and assess in a primary care setting the training needs of general dental practitioners and clinical fidelity of the full pulpotomy intervention, estimate likely eligible patient pool and develop recruitment materials ahead of the main randomised controlled trial comparing the clinical and cost-effectiveness of full pulpotomy compared to root canal treatment in pre/molar teeth of adults 16 years and older showing signs indicative of irreversible pulpitis. The feasibility study will recruit and train 10 primary care dentists in the full pulpotomy technique. Dentists will recruit and provide full pulpotomy to 40 participants (four per practice) with indications of partial irreversible pulpitis.DiscussionThe Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP) study will address the lack of high-quality evidence in the treatment of irreversible pulpitis, to aid dental practitioners, patients and policymakers in their decision-making. The PIP feasibility study will inform the main study on the practicality of providing both training and provision of the full pulpotomy technique in general dental practice.Trial registrationISRCTN Registry, ISRCTN17973604. Registered on 28 January 2021.Protocol versionProtocol version: 1; date: 03.02.2021

Comparative evaluation of complete and partial pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis: A randomized clinical trial.

The study aimed to compare the outcome of complete pulpotomy (CP) and partial pulpotomy (PP) techniques when utilised for the management of mature permanent teeth with carious pulpal exposure and symptomatic irreversible pulpitis (SIP). The study protocol was registered with ClinicalTrials.gov (NCT04397315). One hundred and six permanent mandibular molars with carious pulpal exposure and clinical diagnosis of SIP with periapical index ≤2, from patients aged between 18 and 40years were randomly allocated in equal proportion to either CP or PP group. Allocated procedures were performed using standardised protocols. The allocated procedure was abandoned in cases where pulpal bleeding could not be controlled within 6min using cotton pellets soaked in 3% sodium hypochlorite. MTA was used as a pulpotomy agent and teeth were restored using a base of glass ionomer followed by composite restoration. The pain was recorded by the patient preoperatively before administration of local anaesthesia and postoperatively every 24h for 1week using visual analogue scale. Success was analysed at 12months based on clinical and radiographic examination. Mann-Whitney U test was used to compare age, pain scores and mean analgesic consumption between the groups. Categorical data were analysed using chi-square test. Fisher's exact test was used to assess the clinical and radiographic success and incidence of pain. Kaplan-Meier analysis was used to assess the survival of teeth. A p-value <.05 was considered as statistically significant. One hundred and one patients were analysed at follow up. Higher success was observed in CP (89.8%) in comparison to PP group (80.8%), but the difference was non-significant statistically (p=.202). Although no significant difference was observed in pain incidence between the groups at 24h (p=.496), a significant difference in pain intensities was observed between groups at all the tested time intervals, with lower values reported in CP group (p<.05). Both CP and PP resulted in favourable outcomes in the management of cariously exposed permanent teeth with signs indicative of SIP. Given the more conservative nature of PP, it may be attempted first before proceeding to CP in such cases.

Evaluation of the bond strengths of restorative materials to primary tooth dentin treated with different pulpotomy techniques.

The aim of this study was to investigate the changes of different pulpotomy techniques on the primary tooth dentin and to evaluate the effects of these pulpotomy methods on the shear bond strength of restorative materials to primary tooth dentin. Two hundred and forty dentin specimens were distributed randomly to the study groups as; control, ferric sulphate, Biodentine® , Nd:YAG laser, photobiomodulation, and atmospheric pressure cold plasma (APCP). After the application of pulpotomy methods, samples were again randomly divided to two restorative materials (glass hybrid and composite resin) (n=20) and shear bond strength (SBS) test was performed. Then, 12 new dentin specimens were prepared for all groups for surface analysis. Surface examination (n=12) and fracture analyses (n=240) were carried out with scanning electron microscope (SEM). Statistical significance range was accepted as α <.05 for all data. A statistically significant difference was obtained among all study groups for glass hybrid material as well as composite material (p <.05). While the highest mean SBS value was obtained with Nd:YAG laser (7.58 ± 0.60 MPa), the lowest value was observed with Biodentine® (6.70 ± 0.91 MPa; p=.001) for glass hybrid material. For composite material, the highest mean SBS value was calculated for Nd:YAG laser (13.79 ± 1.24 MPa), while the lowest value was obtained with ferric sulphate (10.17 ± 1.45 MPa; p=.001). Fracture modes were mainly adhesive and mixed type according to SEM analysis. Moreover, morphological changes were observed with SEM on the dentin surfaces of ferric sulphate, Biodentine® and Nd:YAG laser. Within the limitations of this study, Nd:YAG laser increased the shear bond strength values in groups of composite resin. RESEARCH HIGHLIGHTS: In this article, we report the results of the shear bonding strength test of two restorative materials (glass-hybrid vs. composite resin) to primary tooth dentin following the application of five different pulpotomy techniques (ferric sulfate, Biodentine® , Nd:YAG laser, photobiomodulation, and atmospheric pressure cold plasma) were reported. This article will contribute to the literature that there are considerably limited researches concerning the bond strength of glass hybrid to primary dentin and also atmospheric pressure cold plasma in pulpotomies. The SEM examination was performed in two stages in this study; the morphological changes in both treated dentin surfaces and the surfaces of the samples subjected to the shear bond strength test.

Are different pulp treatment techniques and associated medicaments effective for the treatment of extensive decay in primary teeth?

Data sources Cochrane Oral Health's Trials Register and Central Register of Controlled Trials, Medline Ovid, Embase Ovid, Web of Science, Open Grey, US National Institutes of Health Ongoing Trials Register and World Health Organisation International Clinical Trials Registry Platform. There were no restrictions on language or publication dates.Study selection Two reviewers selected randomised clinical trials (RCTs) comparing different pulp interventions in extensively decayed primary teeth, which combined a pulp treatment technique and a medicament.Data extraction and synthesis Data were extracted independently by two reviewers recording year of publication, country of origin, inclusion/exclusion criteria, description of interventions, sample size, mean age, duration of follow-up and outcome data. Risk of bias was assessed by two reviewers. Meta-analysis was performed on RCTs comparing different medicaments for the same pulp technique or different pulp treatment techniques with each other.Results Eighty-seven RCTs were included in qualitative synthesis, yielding 59 studies for meta-analysis. The 87 RCTs involved 7,140 randomised teeth with 17 split-mouth RCTs and 70 parallel arm design. In total, 125 different comparisons were examined using clinical and radiological failure rates; 75 compared different pulpotomy agents or techniques, 25 compared different pulpectomy agents, four compared pulpotomy and pulpectomy, and 21 compared different agents for direct pulp capping. Where possible, data were compared for 6, 12 and 24 months. For pulpotomy, mineral trioxide aggregate (MTA) appears least likely to fail over those time periods. For pulpectomy, results were inconclusive comparing failure rates between various agents; however, two RCTs found a lower failure rate for zinc oxide-eugenol (ZOE) compared with Vitapex. For direct pulp capping, there was a low number of studies undertaking the same comparisons; calcium silicates (eg MTA and Biodentine) hold future promise.Conclusions Overall, evidence quality ranged from moderate to very low. For pulpotomy, MTA may be the best pulpotomy medicament in primary molars. Formocresol is effective but generally accepted as toxic. Biodentine, enamel matrix derivatives, laser application or Ankaferd Blood Stopper (a plant-based haemostatic agent used to control gastrointestinal bleeds) appear to be second choices. If all of these are unavailable, an application of sodium hypochlorite may be the safest option. For pulpectomy, evidence was inconclusive; however, ZOE paste may be more effective than Vitapex, but no further conclusions could be made. For direct pulp capping, the evidence was of low to very low quality. The best alternative may be a tricalcium silicate, especially MTA. Future RCTs may change these findings.

Regenerative Pulpotomy as a Novel Technique for Treatment of Permanent Mature Molars Diagnosed with Irreversible Pulpitis Using Platelet-Rich Fibrin: A Case Series Study

INTRODUCTION: Management of teeth with clinical signs/symptoms suggestive of irreversible pulpitis was conventionally invasive, but the emerging evidences suggested successful treatment outcome using the less invasive vital pulp procedures such as coronal pulpotomy, leading to preservation of the remaining pulp in a vital and functioning state. OBJECTIVES: Evaluation of the clinical/radiographic success of novel regenerative coronal pulpotomy technique using Platelet-Rich Fibrin(PRF) and Biodentine. METHODOLOGY: Three irreversibly inflamed permanent molars with mature roots in three patients were treated by regenerative pulpotomy technique. Access openings were done, and coronal pulps were removed to the level of root canal orifices. Hemostasis in all teeth were done by the compression with cotton pellets moistened with 2.5 % sodium hypochlorite(NaOCl). PRF membranes were prepared by drawing 10 ml of patients’ own blood, then they were immediately centrifuged using a table top centrifuge at 400 gforce for 12mins. The PRF membranes were placed over the remaining radicular pulps followed by Biodentine preparation and placement over the PRF. The cavities were then immediately restored. Patients were scheduled for clinical/radiographic evaluations after three-, six- and 12-months. RESULTS: Throughout the follow-up periods, the three teeth demonstrated clinical/radiographic success with complete resolution of clinical signs/symptoms. CONCLUSIONS: All presented cases showed a favorable clinical/radiographic outcomes of “Regenerative pulpotomy” procedure in treating irreversibly inflamed permanent molars using PRF and Biodentine combination.

Clinical and Radiographic Assessment of an Innovative Pulpotomy Technique Compared to Conventional in Primary Molars (Randomized Clinical Trial)

Purpose: The purpose of this study was to access post-operative clinical as well as radioghraphic success of Diode Laser / Mineral Trioxide Aggregate (MTA) and Diode Laser /Biodentine (BD) pulpotomy procedures in comparison to conventional technique using Formocresol /Zinc Oxide Eugenol (FC/ZOE) pulpotomy for human primary molars. Materials and Methods: A total of 90 lower primary molars that had deep carious lesion and need pulpotomy treatment from 66 healthy and cooperative patients, aged 4-6 years old were chosen for this study. After removal of the coronal tissue and depending on the type of radicular pulp medicament, the teeth were divided randomly and equally into three groups; Group A (FC/ZOE), Group B (Diode Laser/MTA) and Group C (Diode laser/BD). Treatments in all groups were completed with Glass Ionommer restoration then stainless steel crowns. Results: The cumulative clinical and radiographic success rates after 12 months follow up were 90.3%, 96.3% and 100% for the FC/ZOE, Diode Laser/MTA and Diode Laser/BD pulpotomy groups respectively. Conclusion: Laser assessed pulpotomy in combination with MTA or Biodentine had a more advanced clinical and radiographic success rate correlated to FC/ZOE pulpotomy technique in primary molar. Statistically, no significance difference was found between the three study groups in the overall clinical and radiographic success rate.

Pulp therapy in immature traumatized incisor using tricalcium silicate cement – a case report

Abstract Introduction: Traumatic injuries to immature permanent teeth are one of the most recurrent and urgent emergency treatment cases in pediatric dental practice. In many instances, the protocol for responding to this kind of emergency is not correct, and is not performed in a timely manner. Delays in seeking treatment following a complicated crown fracture in young individuals can result in irreversible pulpitis or pulp necrosis. It can leave a wide-open apex and brittle dentinal walls that are unfavorable to manage with conventional endodontic treatment (apexification). Materials and methods: The present report describes the clinical case of a complicated crown fracture in young permanent central incisor, with 18 months of clinical and radiographic follow-up. The traumatized incisor was successfully treated using a coronal pulpotomy technique and tricalcium silicate cement – BiodentineTM. Results: The presented treatment approach provided elimination of the symptoms, an absence of pain episodes, and positive reactions to pulp sensitivity tests. The follow up radiological assessment revealed evidence of a dentin bridge formation and continuation of root maturation. Conclusions: Coronal pulpotomies using tricalcium silicate cement are quick and easy to perform, and unlike endodontic treatment, preserve the tooth structure for the reattached tooth fragment. The restorative technique, the reattachment of fractured tooth fragment, and tooth restoration with a composite resin, represents an aesthetic, functional approach, and is an excellent and easy restorative option for clinicians and young impatient patients.