Is Formocresol Obsolete? A Fresh Look at the Evidence Concerning Safety Issues

Pulpotomy versus pulpectomy in carious vital pulp exposure in primary incisors: a randomized controlled trial

BACKGROUND

Pulpotomy as a minimally invasive pulp therapy technique is the treatment of choice for carious pulp exposures, however many pediatric dentists perform pulpectomies in vital primary incisors. The aim of this split mouth randomized controlled study was to compare formocresol pulpotomy and zinc-oxide and eugenol pulpectomy in the treatment of vital pulp exposure in primary incisors.

METHODS

Contralateral pairs of incisors were randomly assigned to receive pulpotomy or pulpectomy in children aging from 18 to 66 months old and were followed up for 12 months.

RESULTS

39 pairs of incisors were included. Clinical and radiographical success rates showed no statistical significant difference (p = 1, p = 0.8 respectively). Relative risk measures for clinical success rates (RR = 1.03, 95%CI 0.87 to 1.23) and for radiographic success rates (RR = 1.03, 95%CI 0.83 to 1.29) with CIs including number one showing no difference between the two groups. The Survival rate using Kaplan-Meier survival analysis score showed 82% for pulpotomy and 74% for pulpectomy at 12 months (P = 0.2).

CONCLUSIONS

Both pulpotomy and pulpectomy techniques can be used successfully in the treatment of carious vital pulp exposure in primary incisors.

TRIAL REGISTRATION

The trial was retrospectively registered in Clinicaltrials .gov with this identifier NCT05589025 on 21/10/2022.

Comparative Evaluation of Amniotic Membrane Derivative, Chitosan with Mineral Trioxide Aggregate, Diode Laser, and Ferric Sulfate as Pulpotomy Agents in Human Primary Molars: An In Vivo Study

Aim

The aim of the present study was to compare the clinical and radiographic success of amniotic membrane derivative (AMD), chitosan with mineral trioxide aggregate (C-MTA), diode laser (DL), and ferric sulfate (FS) as pulpotomy agents in human primary molars.

Materials and methods

In this present study, pulpotomies were performed on 48 primary molars in 30 children aged between 4 and 8 years (12 teeth in each group). Following the pulpotomy procedure, teeth were evaluated clinically and radiographically at 1st, 3rd, 6th, and 9 monthly intervals.

Results

After 9 months of follow-up, the clinical success was 91.6% for AMD and C-MTA and 83.3% for DL and FS. Radiographic success was 91.6, 91.6, 75, and 83.3% for AMD, C-MTA, DL, and FS groups, respectively. There is no statistically significant difference between the four groups (p > 0.05).

Interpretation and conclusion

Results of our study showed that both AMD and C-MTA were equally successful compared to traditional agents like laser and ferric sulfate as pulpotomy agents.

Clinical significance

Amniotic membrane derivative (AMD) and C-MTA are alternative biomimetic pulpotomy agents that can be used in pediatric primary tooth pulpotomies.

How to cite this article

Lahoti VC, Lahoti P, Gundreddy LM, et al. Comparative Evaluation of Amniotic Membrane Derivative, Chitosan with Mineral Trioxide Aggregate, Diode Laser, and Ferric Sulfate as Pulpotomy Agents in Human Primary Molars: An In Vivo Study. Int J Clin Pediatr Dent 2024;17(2):153-157.

Comparative evaluation of the effect of two pulpal medicaments on pain and bleeding status of mandibular molars with irreversible pulpitis post-failure of inferior alveolar nerve block: a double-blind, randomized, clinical trial

Background

Complete relief of pain due to irreversible pulpitis is challenging to obtain with analgesic medications. The high incidence of an inferior alveolar nerve block (IANB) failure makes it difficult for practitioners to perform endodontic treatment without implementing other anesthetic techniques, especially mandibular molars. The aim of this study was to compare efficacies of two different quantities of paraformaldehyde based pulpal medicaments to relieve the pain and control hyperemic pulp post-failure of IANB and supplementary technique in patients experiencing this symptomatic irreversible pulpitis in the permanent mandibular tooth.

Method

Eighty-two participants with severe pain pre-operatively (Heft Parker Visual Analogue Scale, VAS > 114 mm) were enrolled, and pain responses were recorded at different time intervals using the Heft Parker visual analogue scale. To the patients experiencing pain even after the administration of the standard IANB and supplemental intraligamentary injection, one of the two paraformaldehyde based pulpal medicaments was placed in the pulp chamber and sealed. Participants were recalled after 24-48 h (second visit) to assess pain and bleeding reduction.

Results

Results showed a significant decrease in pain severity and bleeding score post medicament placement (p < .05). Hence judicious use within a recommended period, pulpal medicaments can be considered safe.

Conclusion

Paraformaldehyde based pulpal medicament can be used as an alternative to manage pain in patients having severe irreversible pulpitis and hyperalgesia.

Vital Pulp Therapy in Primary Dentition: Pulpotomy-A 100-Year Challenge

Pulpotomy has long been the most indicated vital pulp procedure in primary molars with extensive caries. The success of a pulpotomy is highly technique sensitive and it depends upon many factors, such as diagnosis accuracy, caries excavation method, pulp dressing material, quality of the final restoration and operator experience. This paper provides an overview of the pulpotomy procedure in primary teeth over a century, with reference to advances in technique, medication and restoration possibilities and challenges and controversies surrounding the subject as well as future directions.

Parental and Dentist Satisfaction with Primary Anterior Zirconia Crowns: A Case Series Analysis

This retrospective cohort study evaluated overall parental satisfaction of zirconia crowns (ZC) placed on primary maxillary anterior teeth with that of two independent, blinded dentists. 131 ZC placed in 37 children, aged 24.8-62.2 months (mean = 42.8), who had at least one recall visit a minimum of 6 months after placement were rated (average = 13.3). Crown colour match, crown contour and crown durability were evaluated by parents and compared to photographic evaluations of two independent raters. Overall parental satisfaction was also evaluated. The overall retention rate was 99.7% and parental satisfaction was 100%. Colour match was rated excellent by 84% of parents and 36% of dental evaluators. Crown contour was rated excellent by 97% of parents and 55% of dental evaluators. The length of follow-up had no effect on colour match or crown contour. ZC comprises an aesthetic and durable option for restoring carious primary maxillary incisors and were well-accepted by parents. Parents were less critical than dental evaluators of crown appearance.

Fate of Pulpotomized Teeth in Pediatric Patients: A 3-year Case Series in a Malaysian Dental Teaching Hospital

Aim

This 3-year retrospective case series evaluated the clinical and radiographic outcome of ferric sulfate and formocresol pulpotomy in primary molar teeth in a dental teaching hospital in Malaysia.

Materials and methods

Clinical and radiographic records of all pediatric patients who had pulpotomy of primary molar teeth between July 2005 and October 2008 were evaluated. A total of 55 pulpotomized primary molars were observed. Clinical assessments were carried out during the second visit to assess the presence of sinus tract, gingival swelling, excessive tooth mobility, tenderness to percussion, and abnormal exfoliation of the treated teeth. Periapical radiographs were reviewed for evidence of pathologic root resorption, radicular and/or periapical radiolucency, and abnormal pulp canal calcification. Treatments were regarded as failure in the presence of one or more of the above clinical and/or radiographic signs and symptoms.

Results

Of 55 pulpotomized teeth, 26 (47.3%) remained free from any clinical signs and symptoms and 48 (87.3%) showed no pathological radiographic findings. The clinical success rates of ferric sulfate and formocresol pulpotomy were 44.4% and 60.0%, respectively, whereas the radiographic success rates of ferric sulfate and formocresol pulpotomy were 86.7% and 90.0%, respectively. Although teeth treated with formocresol had higher both clinical and radiographic success rates compared with those treated with ferric sulfate, it was not statistically significant.

Conclusion

The clinical success rates of pulpotomy were lower compared with radiographic success rates. Ferric sulfate is an alternative to formocresol; however, the use of both agents in the dental undergraduate teaching at Universiti Sains Malaysia can still be recommended.

Clinical significance

Formocresol and ferric sulfate are advocated as pulpotomy agents in primary molar teeth since both agents showed comparable clinical and radiographic success rates.

How to cite this article

Sanusi SY, Jamaludin SA, Al-Batayneh OB, et al. Fate of Pulpotomized Teeth in Pediatric Patients: A 3-year Case Series in a Malaysian Dental Teaching Hospital. Int J Clin Pediatr Dent 2020;13(1):79-84.

A Nonconventional Approach to Formocresol Pulpotomy

A different concept of formocresol pulpotomy procedure has been proposed where the formocresol pulpotomy is done with smaller access to the pulp chamber. In our study formocresol pulpotomy was carried out in 128 primary molar teeth with a limited amount of access opening, saving a bit of more tooth structure, which excludes the requirement of placement of a stainless steel crown (SSC). In 2 years follow-up period, no crown fracture was reported. One hundred fifteen teeth remain vital at the end of 2 years period of observation with the periodic clinical and radiographic review. The result shows 89.4% clinical and radiographic success of this nonconventional pulpotomy procedure that corroborates with several studies of the conventional formocresol pulpotomy procedure.

How to cite this article

Chakraborty A, Dey B, Jana S. A Nonconventional Approach to Formocresol Pulpotomy. Int J Clin Pediatr Dent, 2018;11(6):490-495.

Comparative Evaluation of Three Different Materials: Mineral Trioxide Aggregate, Triple Antibiotic Paste, and Abscess Remedy on Apical Development of Vital Young Permanent Teeth

Aims

The aim of the study is to compare the success rate of mineral trioxide aggregate (MTA), Triple antibiotic paste, and Abscess remedy in apical development of vital young permanent teeth.

Subjects and Methods

A total of 60 children aged 6-14 years were selected and were randomly divided into three groups, each comprising of 20 children. Group I, Group II, and Group III in which MTA (Pro root), triple antibiotic paste (3Mix MP), and Abscess remedy (Product Dentaire, Switzerland) was used pulpotomy medicament. The children were recalled 1, 6, 9, 12, 18, and 24 months for clinical and radiographic evaluation and were designed as single-blinded randomized clinical trial.

Statistical Analysis Used

Chi-square test.

Results

The follow-up evaluations revealed that 56 teeth appeared to be clinically and radiographically successful at 24 months' postoperative evaluation. Four teeth treated with Abscess remedy reported pain and periapical lesion.

Conclusions

Overall success rate for all the material was 93%, MTA and Triple antibiotic paste have shown 100% success rate, and Abscess remedy has shown 80% success rate.

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.

A review of the effects of formaldehyde release from endodontic materials

Formaldehyde is present in most living cells and the environment. In dentistry, patients may be exposed to formaldehyde through the use of several endodontic materials (e.g. AH 26) and during formocresol pulpotomies. This review outlines how the human body reacts to formaldehyde exposure, how recent data has relooked at the issue of carcinogenicity and leukaemia associated with formaldehyde, and whether it is possible to quantify the amount of formaldehyde produced by endodontic cements. The review analyses the way formaldehyde is produced from epoxy resins and addresses the question of whether the amount of formaldehyde from endodontic cements is large enough to override the body's ability to deal with its own endogenous levels of formaldehyde and should the amount of formaldehyde produced be a concern.

Dental pulp response to collagen and pulpotec cement as pulpotomy agents in primary dentition: A histological study

INTRODUCTION

As the search for a better biocompatible medicament is on, aim of the present study was to evaluate the pulpal response to collagen particles impregnated in antibiotics (Biofil-AB™) and new commercially available cement (Pulpotec) that can be used as pulpal medicament.

MATERIALS AND METHODS

Total sample of 40 teeth from 20 children in the age group of 7-10 years which are noncarious having bilateral retained primary teeth were enrolled for the study. Nine teeth each were treated with collagen particles (group I) and Pulpotec cement (group II), and the remaining samples were discarded due to various reasons. Both groups were randomly subdivided into three teeth each that were extracted after 7, 15, and 30 days intervals and examined histologically.

RESULTS

Moderate to severe inflammatory cells with newly formed blood vessels and disorganized odontoblastic cell layer was observed in group I after all three intervals with dentinal bridge formation in two specimens. On contrary, none of the specimens in group II showed any signs of inflammation, but there was a discontinuity in the odontoblastic layer lining along the dentin walls.

CONCLUSION

Both materials were proven to be promising alternatives as pulp medicaments. However, collagen was found to be a better material.

Brain injury due to anaphylactic shock as a result of formocresol used during root canal treatment

AIM

Formocresol is still used in many parts of the world despite concerns over its toxicity. A case of a 45-year-old women who experienced brain injury after an analyphlactic reaction to formocresol is presented.

SUMMARY

During routine root canal treatment, the patient experienced nausea and vomiting after formocresol was used as an antibacterial agent in the pulp chamber. The procedure was discontinued and the symptoms resolved. Four days later, the treatment was continued by a different dentist, and the patient developed anaphylactic shock within 10 min of placement of a formocresol-soaked cotton pellet. She received emergency medical treatment and magnetic resonance imaging (MRI) revealed brain injury characterized by swelling of the gyrus in the cerebral watershed territory of the left parietal-occipital lobe. The patient subsequently made a full recovery after supportive treatment.

KEY LEARNING POINTS

A type-I allergic reaction can be induced by formocresol. The reasons for the brain injury are thought to be cerebral hypoxia, which was induced by the anaphylactic shock and/or cerebral parenchymal oedema. All dentists should be aware of the risks involved in the use of formocresol and avoid using materials containing formocresol and related agents.

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

BACKGROUND

Alternatives to vital pulpotomy treatment in primary teeth are being sought because of the high formaldehyde content of traditional formocresol (FC) pulpotomy medicaments.

AIM

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.

DESIGN

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.

RESULTS

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).

CONCLUSION

NaOCl demonstrated clinical and radiographic success comparable to FC.

The obsolescence of formocresol

Concern has existed for almost ten years regarding the safety and efficacy of formaldehyde-based medicaments like formocresol in dentistry. Formocresol has been shown to be therapeutically outdated for decades. While the use of formocresol around the world continues to drop, it is still utilised in alarmingly high rates, an age-old bias that is unsubstantiated by overall academic research. Formaldehyde remains a genotoxic and carcinogenic problem worldwide. The most recent articles are discussed in the light of the need to abandon formocresol.