A Comparison of four pulpotomy techniques in primary molars: a long-term follow-up

Hyaluronic acid as a pulpotomy material in primary molars: an up to 30 months retrospective study

BACKGROUND

The aim of this retrospective study was to determine the long-term clinical and radiographic success of our previous randomized clinical trial and to compare the success of hyaluronic acid, with the widely used formocresol and ferric sulphate agents.

METHODS

This retrospective study is the extension of the 1-year survey of our randomized clinical trial that had compared the effectiveness of a hyaluronic acid pulpotomy over formocresol and ferric sulphate pulpotomies and included clinical and radiographic evaluations with a follow-up period of over 24 months for 44 children who applied to our clinic between May 2019 and September 2019. Long-term clinical and radiographic data were obtained from the periodic files of our department, wherein each tooth's file was examined to identify any clinical and radiographic findings. Descriptive statistics and Pearson's chi-square tests were used to evaluate the data. Statistical significance was considered as p < 0.05.

RESULTS

The clinical and radiographic success rates of the hyaluronic acid, formocresol, and ferric sulphate groups were not statistically different at > 24 months. None of the teeth in the hyaluronic acid group showed any clinical findings at > 24 months.

CONCLUSIONS

Hyaluronic acid pulpotomies exhibited comparable success rates to formocresol and ferric sulphate materials spanning over 24 months examinations. Because of convenient accessibility and applicability of hyaluronic acid, it may be recommended as a promising alternative medicament for pulpotomy treatments of primary molars. However, further long-term follow-up human studies are needed to better understand the effect of hyaluronic acid on the dental pulp of human primary molars.

THREE-YEAR OUTCOME OF DIODE LASER PULPOTOMY OF PRIMARY MOLARS USING THREE PULP CAPPING AGENTS: A SPLIT-MOUTH RANDOMIZED CLINICAL TRIAL

OBJECTIVES

Pulpotomy is the most commonly performed treatment for asymptomatic primary molars with exposed dental pulp. This study aimed to assess the clinical /radiographic success of diode laser pulpotomy with mineral trioxide aggregate (MTA), calcium hydroxide (CH), and calcium-enriched mixture (CEM) cement as pulp capping agents.

METHODS

This split-mouth randomized clinical trial was conducted initially on 34 children aged 3-8 years but 4 patients left the study before the first follow-up visit and the study was accomplished and analyzed with 30 cases. The patients had at least 3 first/second molars with deep caries that in radiographic evaluation revealed that they required pulpotomy. Following pulpotomy, the pulp stump was irradiated with diode laser (noncontact mode, 632 nm, 30 mW power) as photobiomodulation mode. Pulp tissue was then capped with MTA, CH, or CEM cement (n = 30 in each group). Reinforced zinc oxide eugenol was applied over the capping agent, and the teeth were restored with stainless steel crowns. Teeth were clinically/radiographically assessed at 6, 12, 18, and 36 months, after treatment. Data were analyzed by Cochran and McNemar tests.

RESULTS

All 30 patients showed up for clinical/radiographic follow-ups for up to 36 months. Regarding clinical outcomes, the 6-, 12-, 18-, and 36-month success rates of all experimental groups were nearly similar with no significant difference (p > .05). Regarding radiographic outcomes, the 6-month success rates were similar among the groups (p > .05); however, the 12-, 18-, and 36-month outcomes of CEM and MTA groups were similar but significantly superior to that of CH group (p < .05).

CONCLUSION

Diode laser irradiation and subsequent capping of pulp tissue with MTA or CEM cement can be employed for pulpotomy of primary molars.

Evaluation of the reasons for failure in teeth with vital amputation treatment

AIM

This study aims to evaluate the primary teeth undergoing amputation due to dental caries or trauma clinically and radiologically.

MATERIAL AND METHODS

The amputation treatment of 90 primary teeth of 58 patients (Female: 20, Male: 38) aged 4-11 years was evaluated clinically and radiologically. Calcium Hydroxide was used for amputation in this study. Composite or amalgam was preferred as filling material in the same session of the patients. Clinical/radiological (Periapical/Panoramic X-ray) examination was performed on the teeth that were unsuccessful in treatment, on the day of the patient's complaint, and at the end of 1 year in the others.

RESULTS

According to the clinical and radiological findings of the patients, 14.4% of the boys and 12.3% of the girls were unsuccessful. Amputation in male was a need in the 6-7 age group with a rate of 44.6% at most. Amputation in females was a need in the 8-9 age group with a rate of 52% at most.

CONCLUSION

Success in amputation treatment depends on the tooth, the dentist, and the dental material applied.

Antimicrobial and cytotoxic properties of calcium-enriched mixture cement, Iranian propolis, and propolis with herbal extracts in primary dental pulp stem cells

Objectives

In this study, natural substances were introduced as primary dental pulp caps for use in pulp therapy, and the antimicrobial and cytotoxic properties of these substances were investigated.

Materials and Methods

In this in vitro study, the antimicrobial properties of calcium-enriched mixture (CEM) cement, propolis, and propolis individually combined with the extracts of several medicinal plants were investigated against Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus. Then, the cytotoxicity of each substance or mixture against pulp stem cells extracted from 30 primary healthy teeth was evaluated at 4 concentrations. Data were gathered via observation, and optical density values were obtained using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) test and recorded. SPSS software version 23 was used to analyze the data. Data were evaluated using 2-way analysis of variance and the Tukey test.

Results

Regarding antimicrobial properties, thyme alone and thyme + propolis had the lowest minimum inhibitory concentrations (MICs) against the growth of S. aureus, E. coli, and P. aeruginosa bacteria. For E. faecalis, thyme + propolis had the lowest MIC, followed by thyme alone. At 24 and 72 hours, thyme + propolis, CEM cement, and propolis had the greatest bioviability in the primary dental pulp stem cells, and lavender + propolis had the lowest bioviability.

Conclusions

Of the studied materials, thyme + propolis showed the best results in the measures of practical performance as a dental pulp cap.

Comparative efficacy of medicaments or techniques for pulpotomy of primary molars: a network meta-analysis

OBJECTIVES

We performed this network meta-analysis to determine the comparative efficacy of formocresol (FC), ferric sulfate (FS), sodium hypochlorite (NaOCl), calcium hydroxide (CH), mineral trioxide aggregate (MTA), biodentine, and laser for pulpotomy of molar teeth.

MATERIALS AND METHODS

An updated search was conducted in PubMed, Embase, and the Cochrane Library to identify relevant randomized controlled trials (RCTs) published before October 30, 2022, after screening previous meta-analyses. The Cochrane risk of bias assessment tool was used to appraise the methodological quality of included studies. Clinical and radiographic success rates were assessed as outcomes. Random network meta-analysis was performed by using STATA software (version 14.0) with "network" command.

RESULTS

A total of 43 RCTs were included. Network meta-analysis indicated that CH was inferior to other medicaments and techniques in all outcomes, and MTA and biodentine was better than FC, FS, and NaOCl in terms of clinical and radiographic success rates. Results of ranking probabilities suggested that MTA ranked first in all outcomes except for clinical success at both 6 months.

CONCLUSIONS

Our results suggested that MTA was associated with significant improvement in both clinical and radiographic success than other pulpotomy medicaments and techniques, with the highest probability of being the optimal option.

CLINICAL RELEVANCE

The current network meta-analysis determined the comparative efficacy and safety of 7 common pulpotomy medicaments in molar pulpotomy, including FC, FS, NaOCl, CH, MTA, biodentine, and laser, and the pooled results revealed comparable efficacy in clinical and radiographic success rates at 6 and 12 months between FC, FS, and NaOCl in primary molars pulpotomies. However, MTA, biodentine and laser may have more advantages than other pulpotomy medicaments for clinical and radiographic success. Therefore, in clinical practice, practitioners should select MTA, biodentine, or laser as pulpotomy medicaments in molar pulpotomy.

COMPARING THE CLINICAL AND RADIOGRAPHIC OUTCOMES OF PULPOTOMIES IN PRIMARY MOLARS USING BIOACTIVE ENDODONTIC MATERIALS AND FERRIC SULFATE - A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

OBJECTIVE

To compare the clinical and radiographic outcomes of pulpotomies in primary molars using bioactive endodontic materials and ferric sulfate.

DESIGN

The search was conducted in PubMed, Ebscohost, ProQuest, and Scopus databases till June 2021. Children undergoing pulpotomy therapy in primary molars treated with ferric sulfate (FS) and bioactive endodontic materials were evaluated for clinical and radiographic success. Meta-analysis was performed on a random-effects model to assess the success at 6,12,18, and 24 months. The quality of studies was evaluated using the Cochrane risk of bias tool for randomized trials RESULTS: No significant difference was observed between Mineral trioxide aggregate (MTA) and FS at 24 months for both clinical [RR0.98 (95%CI 0.15,6.34), I² = 0%] and radiographic [RR0.74 (95%CI: 0.23,2.43), I² = 0%] success. At 6 months [RR1.36 (95%CI: 0.10,19.34), I² = 33%], no difference was observed in the clinical [RR1.00 (95%CI: 0.95,1.05), I² = 0%] and radiographic success [RR0.99 (95%CI: 0.88,1.11), I² = 51%] between Biodentine (BD), FS and radiographic success of calcium enriched cement and FS [RR0.25 (95%CI: 0.03, 2.22), I² = 0%].

CONCLUSION

Amongst bioactive materials, MTA and FS demonstrated equal success rates in both clinical and radiographic outcomes with follow-up periods of up to 24 months. Future, high-quality trials are required to verify the result of the current review.

Comparison of Clinical and Radiographic Success between MTA and Biodentine in Pulpotomy of Primary Mandibular Second Molars with Irreversible Pulpitis: A Randomized Double-Blind Clinical Trial

Introduction

Among the new therapeutic materials, MTA and Biodentine are recommended for pulpotomy and sealing the pulp. Considering the similar characteristics of these two materials and considering that their effects on the treatment of primary second molars with irreversible pulpitis have not been compared properly, this study aimed to compare clinical and radiographic success between MTA and Biodentine in pulpotomy of primary mandibular second molars with irreversible pulpitis.

Materials and Methods

This study was conducted as a randomized double-blind clinical trial. Participants were selected according to inclusion criteria and 52 samples were randomly selected using random numbers table in group A. Then, patients in the next group B were matched with the first group in terms of age range and sex. In group A, the remaining pulp was covered with 2 mm MTA+ and in group B with 3 mm Biodentine. Participants were called for clinical evaluation every three months for 12 months (long-term follow-up). Radiographic evaluations were in the sixth and twelfth months.

Results

Fischer's exact test showed that there was no significant difference between MTA and Biodentine in terms of clinical and radiographic success rates (P value = 1). According to the results of the Kaplan-Meier test, the survival rate in both pulp treatment methods was similar in symptomatic teeth.

Conclusions

The results of this study showed that Biodentine properties are similar to MTA, and both materials show high clinical and radiographic success rates in long-term follow-up.

A randomized clinical trial of hyaluronic acid gel pulpotomy in primary molars with 1 year follow-up

OBJECTIVE

This randomized clinical study aimed to evaluate the success of hyaluronic acid (HA) as a pulpotomy medicament of human primary molars and to compare it with formocresol (FC) and ferric sulphate (FS) pulpotomy treatments up to 12 months.

MATERIALS AND METHODS

The study was conducted with 130 primary molars of 44 children. The ethical approval and registration to clinical trials (No: NCT04115358) were completed. After the removal of all the coronal pulp tissue, a 0.5% HA gel, or a FC, or a 20% FS solution were applied randomly to the radicular pulp tissues of the primary molars. Then, the pulp chambers were filled with a zinc oxide eugenol cement and restored either with a composite filling material or with a stainless-steel crown. The treatment success rates of the 3 groups were followed and compared clinically and radiographically at 1st-, 3rd-, 6th- and 12th-months.

RESULTS

Primary molars treated with FC, FS and HA dressings were clinically successful 77.5%, 86.8% and 87.5% respectively after 12th-month follow-up (p > .05). Radiographic successes of FC, FS and HA groups were lower than clinical successes (57.6%, 68.8%, 57.9% respectively at the 12th-month) but the difference between the groups was not statistically significant (p > .05). Equivalence analysis assuming not more than 10% difference between the materials suggested that HA was not inferior to FC or FS.

CONCLUSIONS

Within the limitations of this study, our randomized clinical trial shows that HA is a promising pulpotomy medicament in primary molars. However, further studies are justified to further improve the HA material success.

Comparison of Three Treatment Techniques for Deep Carious Lesions in Primary Teeth: An In Vivo Study

Aims

To evaluate and compare three different treatment modalities in the management of deep carious lesions in primary molars.

Material and methods

A total of 60 primary molars from patients aged 4-9 years were randomly divided into three groups with 20 samples each. Sample in Group I received indirect pulp therapy with Mineral Trioxide Aggregate [MTA] as lining material, Group II received the modified Hall technique, and Group III MTA pulpotomy. The patients were evaluated at 1, 3, 6, and 9 months as per evaluation criteria for success or failure of the same. A Chi-square test was used for proportions and for comparison between groups.

Results

Clinically, the success rate for the modified Hall technique and MTA pulpotomy was higher than indirect pulp therapy. Radiographically, the modified Hall technique had the highest success rate of 100 percent among the indirect pulp therapy and MTA pulpotomy. This success rate was however not statistically significant.

Conclusion

All three techniques had promising results clinically and radiographically. Since the results were not statistically significant, conservative treatment like Modified Hall's technique can be preferred over the surgical approach [MTA Pulpotomy].

Clinical significance

This study compares newer techniques called Hall's technique with traditional techniques like indirect pulp capping and MTA pulpotomy. Hall's technique is a quick and noninvasive procedure, which involves fitting the crown and seating it over the tooth without any caries removal/ tooth preparation and no local anesthesia is being practiced. In the present study Hall's technique showed higher rates of success compared to the other two procedures.

How to cite this article

Poludasu M, Kumar Mallela GM, Puppala R, et al. Comparison of Three Treatment Techniques for Deep Carious Lesions in Primary Teeth: An In Vivo Study. Int J Clin Pediatr Dent 2022;15(S-2):S201-S206.

Clinical and Radiographic Assessments of Potassium Nitrate in Polycarboxylate Versus Mineral Trioxide Aggregate as Pulpotomy Biomaterials in Immature Mandibular First Permanent Molars: A Randomized Clinical Trial

INTRODUCTION

The purpose of this study was to compare clinically and radiographically the effects of potassium nitrate in polycarboxylate cement and mineral trioxide aggregate (MTA) as pulpotomy agents in vital immature mandibular first molars.

METHODS

The trial design was a parallel randomized, 1:1 allocation ratio, with both the participants and the data assessor blinded. A total of 50 molars of 48 eligible children aged 6-9 years were studied. The children had mandibular immature first molars with extensive caries that revealed pulp exposure during caries excavation. Patients were randomly allocated equally into 2 groups in which potassium nitrate in polycarboxylate cement (the intervention group) and MTA (the control group) were used as pulpotomy biomaterials. The treated teeth were restored permanently. The primary outcome was clinical/radiographic assessment after 1 week, 6 months, and 12 months. The secondary outcomes were radiometric analysis at 6 and 12 months to determine dimensional changes during maturogenesis. The digital radiographs were imported to image processing software to perform radiometric measurements. Data were tabulated and statistically analyzed with significance set at P ≤ .05.

RESULTS

Only a single tooth failed at the 6-month recall, and another one was lost during recall in each group. Thus, the overall success rate for cases/group who finally attended the 12-month follow-up time point was 92% (23/25) with no statistically significant difference between the 2 groups. At the 12-month recall, successful cases showed root development with an increase in root length and a decrease in apical foramen width. Complete apical closure was observed in 65.2% of the roots in the intervention group and 52.1% in the control group.

CONCLUSIONS

The clinical and radiographic success reported in the present study reveals that potassium nitrate in polycarboxylate cement could be used as a biological and economic alternative to MTA as a pulpotomy agent in vital immature mandibular first molars. Further follow-up for longer periods is recommended.

The role of NMT induction on odontogenic proliferation and differentiation of dental pulp stem cells

This study was conducted to investigate the odontogenic proliferation and differentiation of dental pulp stem cells (DPSCs) after induction by nanoparticle mineral trioxide (NMT). DPSCs were isolated from permanent teeth and placed in tubes containing Dulbecco's modified Eagle's medium, followed by immunocytochemistry analysis. The viability of DPSCs exposed to NMT was measured using MTT assay with trypan blue dye exclusion. Alkaline phosphatase (ALP) activity was evaluated using ALP colorimetric reactions by reacting NMT supernatants with fluorescent-specific ALP substrates. The concentration of osteocalcin was determined using an instant human osteocalcin enzyme-linked immunosorbent assay (ELISA) kit. A human dentin sialophosphoprotein (DSPP) ELISA kit coated with anti-human DSPP antibody was employed to measure DSPP levels. There was a significant difference between ALP activity after exposing the cells to NMT and trioxide mineral aggregate on days 3, 7, and 21. Osteocalcin activity showed a significant difference on days 3, 7, 14, and 21. There was a significant difference in DSPP levels on days 7 and 21. DPSCs exposed to NMT and to trioxide mineral aggregate showed extracellular matrix formation on day 7 and 14, respectively. Furthermore, NMT may effectively increase the proliferation and differentiation of DPSCs as well as their maturation toward odontoblasts.

Clinical and Radiographic Evaluation of the Efficacy of Formocresol, Allium sativum Oil, and Aloe barbadensis Gel as Pulpotomy Medicaments in Primary Molars: A Randomized Controlled Trial

AIM

The aim of the study was to clinically and radiographically evaluate the efficacy of formocresol, Allium sativum oil, and Aloe barbadensis gel as pulpotomy medicaments in primary molars.

MATERIALS AND METHODS

Eighty-two primary molars indicated for pulpotomy were included in the study. The molars included were divided into three groups by simple random sampling, and treatment was done with formocresol as control, comparing it with Aloe barbadensis gel and Allium sativum oil.

RESULTS

The teeth were then followed up for 6 and 12 months clinically and radiographically. Chi-square test was used to compare the clinical and radiographic results between the groups. McNemar test was used to compare the clinical and radiographic results at 6 and 12 months. The results revealed that there was no significant difference between the groups when comparing the experimental groups to the control.

CONCLUSION

The study shows that Aloe barbadensis gel and Allium sativum oil may be used as an alternative to formocresol as pulpotomy medicaments.

HOW TO CITE THIS ARTICLE

Abirami K, Ramkumar H, Senthil D. Clinical and Radiographic Evaluation of the Efficacy of Formocresol, Allium sativum Oil, and Aloe barbadensis Gel as Pulpotomy Medicaments in Primary Molars: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2020;13(5):518-522.

Cytotoxicity, inflammation, biomineralization, and immunoexpression of IL-1β and TNF-α promoted by a new bioceramic cement

Aim To evaluate the cytotoxicity, biocompatibility and mineralization capacity of BIO-C PULPO, and MTA. Methodology L929 fibroblasts were cultured and MTT assay was used to determine the material cytotoxicity on 6, 24, and 48 h. A total of 30 male rats (Wistar) aged between 4 and 6 months, weighing between 250 and 300 g were used. Polyethylene tubes containing BIO-C PULPO, MTA, and empty tubes were implanted into dorsal connective tissue. After the experimental periods (7, 15, 30, 60, and 90 days) the tubes were histologically analyzed using hematoxylin-eosin (H&E), immunolabeling of IL-1β and TNF-α, and von Kossa staining, or without staining for polarized light analysis. The average number of inflammatory cells was quantified; the mineralization assessment was determined by the area marked in μm2 and semiquantitative immunolabeling analyses of IL-1β and TNF-α were performed. Then, data underwent statistical analysis with a 5% significance level. Results It was observed that BIO-C PULPO and MTA presented cytocompatibility at 6, 24, and 48 similar or higher than control for all evaluated period. On periods 7 and 15 days, BIO-C PULPO was the material with the highest number of inflammatory cells (p<0.05). On periods 30, 60, and 90 days, BIO-C PULPO and MTA presented similar inflammatory reactions (p>0.05). No statistical differences were found between Control, BIO-C PULPO, and MTA for immunolabeling of IL-1β and TNF-α in the different periods of analysis (p<0.05). Positive von Kossa staining and birefringent structures under polarized light were observed in all analyzed periods in contact with both materials, but larger mineralization area was found with BIO-C PULPO on day 90 (p<0.05). Conclusion BIO-C PULPO was biocompatible and induced mineralization similar to MTA.

Comparative Evaluation of Success of Biodentine and Mineral Trioxide Aggregate with Formocresol as Pulpotomy Medicaments in Primary Molars: An In Vivo Study

Aim

The study was designed to evaluate and compare the success of Biodentine and mineral trioxide aggregate (MTA) in comparison to formocresol as pulpotomy medicaments over 9 months of the follow-up period.

Materials and methods

The sample of 60 deciduous molars of patients aged 4–7 years were incorporated in the study. The molars were randomly allocated to the experimental and control groups. Following coronal pulp removal and achieving hemostasis, the radicular pulp was covered with either Biodentine or MTA (experimental groups). In the control group, a cotton pellet soaked with diluted formocresol (one-fifth dilution of Buckley's formocresol) was placed over the radicular pulp for 1 minute. All pulpotomized molars were later restored with stainless steel crowns (SSCs).

Results

The achieved clinical success over 9 months of the follow-up period was 100, 95, and 70% with Biodentine, MTA, and formocresol, respectively. The achieved radiographic success over 9 months of the follow-up period was 95, 60, and 25% with Biodentine, MTA, and formocresol, respectively.

Conclusion

Favorable biological, physical, mechanical, and good manipulation properties of Biodentine show that this material can be used efficiently as a pulpotomy medicament in the clinical practice.

How to cite this article

Ahuja S, Surabhi K, Gandhi K, et al. Comparative Evaluation of Success of Biodentine and Mineral Trioxide Aggregate with Formocresol as Pulpotomy Medicaments in Primary Molars: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(2):167–173.

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.

Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth: A Systematic Review of the Literature

Background: Pulpotomy of primary teeth provides favorable clinical results over time; however, to date, there is still not a consensus on an ideal pulp dressing material. Therefore, the aim of the present systematic review was to compare pulpotomy agents to establish a preferred material to use. Methods: After raising a PICO question, the PRISMA guideline was adopted to carry out an electronic search through the MEDLINE database to identify comparative studies on several pulp dressing agents, published up to October 2019. Results: The search resulted in 4274 records; after exclusion, a total of 41 papers were included in the present review. Mineral trioxide aggregate (MTA), Biodentine and ferric sulphate yielded good clinical results over time and might be safely used in the pulpotomies of primary molars. Among agents, MTA seemed to be the material of choice. On the contrary, calcium hydroxide showed the worst clinical performance. Although clinically successful, formocreosol should be replaced by other materials, due to its potential cytotoxicity and carcinogenicity. Conclusion: MTA seemed to be the gold standard material in the pulpotomy of primary teeth. Promising results were also provided by calcium silicate-based cements. Further randomized clinical trials (RCTs) with adequate sample sizes and long follow-ups are encouraged to support these outcomes.

Initial inflammatory response after the pulpotomy of rat molars with MTA or ferric sulfate

PURPOSE

To compare, both qualitatively and quantitatively, the inflammatory cells, vascular density and IL-6 immunolabeled cells present in the pulp after pulpotomy with white MTA versus 15.5% ferric sulfate (FS).

METHODOLOGY

Forty-eight mandibular first molars from 24 Wistar rats were divided into MTA or FS groups and subdivided according to the period after pulpotomy procedure (24, 48 and 72 hours). Four teeth (sound and untreated) were used as controls. Histological sections were obtained and assessed through the descriptive analysis of morphological aspects of pulp tissue and the quantification of inflammatory cells, vascular density and interleukin-6 (IL-6) expression. Data were statistically analyzed (p<0.05).

RESULTS

The number of inflammatory cells was similar in both groups, being predominantly localized at the cervical radicular third. In the MTA group, increased inflammation was observed at 48 hours. Vascular density was similar in both groups and over time, being predominant in the medium radicular third. No correlation was found between the number of inflammatory cells and the vascular density. Pulp tissue was more organized in MTA-treated teeth. In both groups, a weak to moderate IL-6 expression was detected in odontoblasts and inflammatory cells. Comparing both groups, there was a greater IL-6 expression in the cervical radicular third of teeth treated with MTA at 24 hours and in the medium and apical thirds at 72 hours, while in the FS group a greater IL-6 expression was found in the apical third at 24 hours.

CONCLUSION

The MTA group presented better histological features and greater IL-6 expression than the FS group. However, no difference was observed between the groups regarding the inflammatory status and vascularization, suggesting the usefulness of FS as a low-cost alternative to MTA.

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.

Direct pulp capping versus pulpotomy with MTA for carious primary molars: a randomised clinical trial

AIM

Aim of this randomised clinical trial was to compare the outcome of direct pulp capping (DPC) versus pulpotomy, both with MTA, for carious primary molars.

METHODS

Healthy, cooperative children aged 3-9 years with at least one deep carious primary molar requiring vital pulp therapy were included. Data on the primary outcome (all-cause failure) and secondary outcomes (clinical or radiographic failure) were collected blindly semi-annually for a minimum of 1 year up to 3 years and analysed with survival analysis and generalised linear regression at alpha = 5%.

RESULTS

A total of 74 children were randomly allocated on 1:1 basis to DPC (35 children; 40 teeth) or pulpotomy (39 children; 57 teeth). Survival from all-cause failure was 79.7% [95% confidence interval (CI) 69.3-86.9%] at 12 months and 66.0% (95% CI 53.4-76.0%) at 24 months which remained stable up to 36 months, with no differences between groups (P > 0.05). No significant difference was found in the survival rate of the two groups for all-cause [hazard ratio (HR) = 0.95; 95% CI 0.45-2.01; P = 0.88], clinical (HR = 0.74; 95% CI 0.0.19-2.92; P = 0.66), or radiographic failure (HR = 0.80; 95% CI 0.0.36-1.82; P = 0.60) throughout the 3-year follow-up. Regression analysis indicated that needing a second attempt for haemorrhage control was associated with higher clinical failure rate. All-case failure was significantly different for class II versus occlusal cavities and in the latter cavities pulpotomy performed better (P < 0.001).

CONCLUSION

The results of the current trial indicate that both DPC and pulpotomy can be reliable options for the treatment of deep carious primary molars in cooperative children, in carefully selected cases.

BiodentineTM versus formocresol pulpotomy technique in primary molars: a 12-month randomized controlled clinical trial

BACKGROUND

The objective of this clinical study was to prospectively compare the clinical and radiographic success rates of BiodentineTM pulpotomies versus formocresol pulpotomies in children vital primary molars.

METHODS

A randomized, split-mouth study design was used with a sample of 37 healthy children aged 4- to 8-year-old. A total of 56 pairs (112 teeth) of carious primary teeth, 1 pair per child, were selected for treatment. One tooth from each pair was randomly assigned to either the BiodentineTM pulpotomy group or the formocresol pulpotomy group. Children were followed-up at 3, 6 and 12 months for clinical evaluation and at 6 and 12 months for radiographic evaluation. Data were collected, tabulated and analyzed using Fisher exact and McNemar tests. The level of significance was set at P < 0.05.

RESULTS

At 12 months, the clinical success rates of both BiodentineTM and formocresol groups were 100%, while the radiographic success rates for BiodentineTM and formocresol groups were 100% and 98.1%, respectively. There was no statistically significant difference between both groups (P=1). The only observed radiographic failure was furcal radiolucency in the formocresol group at 12-month interval. Pulp canal obliteration was radiographically observed in 10/56 (17.9%) and 7/56 (12.5%) cases in the BiodentineTM and formocresol groups, respectively.

CONCLUSIONS

Both BiodentineTM and formocresol pulpotomy techniques demonstrated favorable clinical and radiographic outcomes over a 12-month period without any significant difference.

TRIAL REGISTRATION

Registered on NCT03779698 . Date of Registration: 18 December 2018.

Clinical, Radiographic and Histological Evaluation of Primary Teeth Pulpotomy Using MTA And Ferric Sulfate

The aim of this study was to evaluate the clinical, radiographic and histological outcomes of the dentin-pulp complex from primary molars after pulpotomy with mineral trioxide aggregate (MTA) and 15.5% ferric sulfate (FS). Thirty-one primary molars were randomly allocated into MTA or FS groups. Clinical and radiographic evaluations were recorded at 3-, 6-, 12- and 18-month follow-up. Teeth at the regular exfoliation period were extracted and processed for histological analysis. Clinical and radiographic data were tested by statistical analysis (p≤0.01). Histological outcomes were analyzed descriptively. All of the treated teeth presented clinical success over the experimental periods. Both groups exhibited 100% of radiographic success at 3, 6 and 12 months. At the 18-month follow-up, one tooth from FS group presented inter-radicular radiolucency (p>0.01). Histologically, the treated teeth presented pulp vitality and absence of inflammatory infiltrate into the connective tissue. Only MTA group showed hard tissue barrier surrounded by odontoblasts over the pulp stumps. Both MTA and 15.5% FS are effective for pulpotomies of primary teeth. Although MTA is considered the first-choice material, FS may be a suitable alternative when treatment cost is an issue.

Efficacy of ferric sulphate as a pulpotomy medicament in primary molars: an evidence based approach

AIM

To evaluate the available evidence on the efficacy of ferric sulphate (FS) compared to other pulpotomy medicaments in primary molars.

METHODS

A comprehensive literature search was conducted through five databases (PubMed, Ovid^®, EBSCOhost, Cochrane Library and ProQuest) and only those papers which met the inclusion criteria were accepted. The quality of the studies used for systematic review was rated by two independent researchers based on Fuks and Papagiannoulis (Eur Arch Paediatr Dent 7:64-71, 2006) criteria and graded as A (38-42), B1 (32-37), B2 (25-31), C (≤ 24). Inter-examiner reliability was measured using Kappa statistics.

RESULTS

A total of 1371 studies were available, of which only two studies full-text articles were included for quality assessment with an excellent inter-researcher agreement (k = 0.9). The comprehensive search revealed that, none of the 20 studies obtained grade A. Only three studies were graded as B1, 5 studies received grade B2 and 12 studies attained grade C. Only 4 prospective randomised clinical trials reported high success rate with FS compared to other materials. Remaining 14 studies revealed low success rate with FS compared to other pulpotomy medicaments.

CONCLUSION

There is insufficient evidence to support the application of FS as a pulpotomy medicament in primary molars in the existing English literature. Hence, properly planned randomised clinical trials with large sample size and long-term follow up are needed to support FS as an effective pulpotomy medicament compared to other traditional and new medicaments.

[Application of minimally invasive cosmetic dentistry in the clinics of pediatric dentistry]

With the minimally invasive treatment attracting considerable attention in the field of dentistry, a series of oral minimally invasive treatment technologies, including minimally invasive cosmetic dentistry (MICD) technology, is emerging. Children, as a special group of patients, are in the critical stage of the initial formation of psychological structure. Therefore, children's dental treatment should not be limited to restoring function and relieving pain. The development, aesthetics, and physical and mental health should also be given attention. Therefore, in recent years, MICD technology has been widely used in diagnosis and treatment of pediatric dentistry. This review provides a detailed introduction regarding a series of techniques in pediatric dentistry.

Pulp treatment for extensive decay in primary teeth

BACKGROUND

In children, dental caries (tooth decay) is among the most prevalent chronic diseases worldwide. Pulp interventions are indicated for extensive tooth decay. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. After treatment, the cavity is filled with a medicament. Materials commonly used include mineral trioxide aggregate (MTA), calcium hydroxide, formocresol or ferric sulphate.This is an update of a Cochrane Review published in 2014 when insufficient evidence was found to clearly identify one superior pulpotomy medicament and technique.

OBJECTIVES

To assess the effects of different pulp treatment techniques and associated medicaments for the treatment of extensive decay in primary teeth.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health Group's Trials Register (to 10 August 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2017, Issue 7), MEDLINE Ovid (1946 to 10 August 2017), Embase Ovid (1980 to 10 August 2017) and the Web of Science (1945 to 10 August 2017). OpenGrey was searched for grey literature. The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing interventions that combined a pulp treatment technique with a medicament or device in children with extensive decay in the dental pulp of their primary teeth.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed 'Risk of bias'. We contacted authors of RCTs for additional information when necessary. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. We performed data synthesis with pair-wise meta-analyses using fixed-effect models. We assessed statistical heterogeneity by using I² coefficients.

MAIN RESULTS

We included 40 new trials bringing the total to 87 included trials (7140 randomised teeth) for this update. All were small, single-centre trials (median number of randomised teeth = 68). All trials were assessed at unclear or high risk of bias.The 87 trials examined 125 different comparisons: 75 comparisons of different medicaments or techniques for pulpotomy; 25 comparisons of different medicaments for pulpectomy; four comparisons of pulpotomy and pulpectomy; and 21 comparisons of different medicaments for direct pulp capping.The proportion of clinical failures and radiological failures was low in all trials. In many trials, there were either no clinical failures or no radiographic failures in either study arm.For pulpotomy, we assessed three comparisons as providing moderate-quality evidence. Compared with formocresol, MTA reduced both clinical and radiological failures, with a statistically significant difference at 12 months for clinical failure and at six, 12 and 24 months for radiological failure (12 trials, 740 participants). Compared with calcium hydroxide, MTA reduced both clinical and radiological failures, with statistically significant differences for clinical failure at 12 and 24 months. MTA also appeared to reduce radiological failure at six, 12 and 24 months (four trials, 150 participants) (low-quality evidence). When comparing calcium hydroxide with formocresol, there was a statistically significant difference in favour of formocresol for clinical failure at six and 12 months and radiological failure at six, 12 and 24 months (six trials (one with no failures), 332 participants).Regarding pulpectomy, we found moderate-quality evidence for two comparisons. The comparison between Metapex and zinc oxide and eugenol (ZOE) paste was inconclusive, with no clear evidence of a difference between the interventions for failure at 6 or 12 months (two trials, 62 participants). Similarly inconclusive, there was no clear evidence of a difference in failure between Endoflas and ZOE (outcomes measured at 6 months; two trials, 80 participants). There was low-quality evidence of a difference in failure at 12 months that suggested ZOE paste may be better than Vitapex (calcium hydroxide/iodoform) paste (two trials, 161 participants).Regarding direct pulp capping, the small number of studies undertaking the same comparison limits any interpretation. We assessed the quality of the evidence as low or very low for all comparisons. One trial appeared to favour formocresol over calcium hydroxide; however, there are safety concerns about formocresol.

AUTHORS' CONCLUSIONS

Pulp treatment for extensive decay in primary teeth is generally successful. Many included trials had no clinical or radiological failures in either trial arm, and the overall proportion of failures was low. Any future trials in this area would require a very large sample size and follow up of a minimum of one year.The evidence suggests MTA may be the most efficacious medicament to heal the root pulp after pulpotomy of a deciduous tooth. As MTA is relatively expensive, future research could be undertaken to confirm if Biodentine, enamel matrix derivative, laser treatment or Ankaferd Blood Stopper are acceptable second choices, and whether, where none of these treatments can be used, application of sodium hypochlorite is the safest option. Formocresol, though effective, has known concerns about toxicity.Regarding pulpectomy, there is no conclusive evidence that one medicament or technique is superior to another, and so the choice of medicament remains at the clinician's discretion. Research could be undertaken to confirm if ZOE paste is more effective than Vitapex and to evaluate other alternatives.Regarding direct pulp capping, the small number of studies and low quality of the evidence limited interpretation. Formocresol may be more successful than calcium hydroxide; however, given its toxicity, any future research should focus on alternatives.

The evaluation of MTA and Biodentine as a pulpotomy materials for carious exposures in primary teeth

OBJECTIVE

This study examined the effects of MTA and Biodentine on the clinical and radiographic success rates of pulpotomies performed on primary teeth with carious pulp exposures.

MATERIALS AND METHODS

This study was conducted with 44 mandibular primary molars requiring vital pulpotomy. Carious dentin surrounding the exposure site was used as the inclusion criteria for all teeth, which were randomly divided into two groups according to pulpotomy material [MTA group (n = 24), Biodentine group (n = 20)]. Treatment was followed up clinically and radiologically for 24 months. Pulp canal obliteration was not regarded as a failure.

RESULTS

Clinical and radiographic success rates at the end of 24 months were 100% for the MTA group and 89.4% for the Biodentine group. Success rates did not vary significantly between the groups (p = 0.646). Pulp canal obliteration was observed in two teeth (8.3%) in the MTA group at 6 months, but the teeth were found to be stabilized by 24 months.

CONCLUSION

The long-term clinical and radiographic success rates obtained in this study indicate that both MTA and Biodentine are appropriate options for pulpotomy treatment of primary teeth with carious exposure in patients whose teeth should be retained for long periods of time.

CLINICAL RELEVANCE

The etiology of exposure determines pulpal response, making it crucial to distinguish between mechanical and carious exposures. The carious exposure is presumed to be accompanied by severe inflammation, which makes the prognosis of treatment unpredictable. Biomaterials can be used especially in cases with carious pulp exposures.

Success Rates of Pulpotomies in Primary Molars Using Calcium Silicate-Based Materials: A Randomized Control Trial

Objective

The aim of this study was to evaluate and compare, both clinically and radiographically, the effects of calcium silicate-based materials (i.e., ProRoot MTA [PR-MTA], MTA-Plus [MTA-P], and Biodentine [BD]) and ferric sulfate [FS] in pulpotomy of primary molars.

Materials and Methods

In this randomized clinical trial, 29 healthy 5- to 7-year-old children with at least four carious primary molars with no clinical or radiographic evidence of pulp degeneration were enrolled. The pulpotomy agents were assigned as follows: Group 1: BD; Group 2: MTA-P; Group 3: PR-MTA; and Group 4: FS. Clinical and radiographic evaluations were performed at 6, 12, and 24 months. Data were analyzed using chi-square tests.

Results

Total success rates at 24 months were 82.75%, 86.2%, 93.1%, and 75.86%, respectively. No statistically significant differences in total success rates were observed among the groups at 6-, 12-, and 24-month follow-ups. When the groups were compared according to follow-up times, the success rates in each group did not vary significantly among the 6–12-month, 6–24-month, or 12–24-month periods (p > 0.05).

Conclusion

Although the success rates of BD, MTA-P, MTA-PR, and FS did not differ significantly, calcium silicate-based materials appeared to be more appropriate than FS in clinical practice.

Comparison of Clinical and Radiographic Success Rates of Pulpotomy in Primary Molars using Ferric Sulfate and Bioactive Tricalcium Silicate Cement: An in vivo Study

Introduction

Formocresol has been a popular pulpotomy medicament for many years. It is considered the “gold standard“ in pediatric dentistry. However, concerns have been raised over its use in children. It has been reported that formocresol has toxic and mutagenic effects in cell culture, dental crypts, and precancerous epithelial cells. Therefore, additional biocompatible treatment alternatives are required to replace formocresol pulpotomy.

Aims

This study compared the clinical and radiographic success rates of ferric sulfate (FS) and bioactive tricalcium silicate cement (Biodentine, Septodont) as pulpotomy agents in primary molar teeth over a period of 9 months.

Materials and methods

Fifty primary molar teeth, symptom free, requiring pulpotomy in children aged 4 to 8 years were treated with conventional pulpotomy procedures. Ferric sulfate 15.5% solution (applied for 15 second for 25 teeth) and Biodentine (for 25 teeth) were used as pulpotomy agents. Permanent restorations were stainless steel crowns in most cases, in both groups. Patients were recalled for follow-up at 1, 3, 6, and 9 months intervals. The data were statistically analysed using chi-square test.

Results

At 9 months, 96% clinical success rate was observed in the FS and 100% in the Biodentine group. Radiographic success rate in the FS group was 84%, whereas 92% in the Biodentine group at 9 months. No statistically significant difference was found between the two groups.

Conclusion

Biodentine can be used as a pulpotomy agent but further long-term studies are required.

How to cite this article

Sirohi K, Marwaha M, Gupta A, Bansal K, Srivastava A. Comparison of Clinical and Radiographic Success Rates of Pulpotomy in Primary Molars using Ferric Sulfate and Bioactive Tricalcium Silicate Cement: An in vivo Study. Int J Clin Pediatr Dent 2017;10(2):147-151.

Comparative Evaluation of Fresh Aloe barbadensis Plant Extract and Mineral Trioxide Aggregate as Pulpotomy Agents in Primary Molars: A 12-month Follow-up Study

Background:

The purpose of this study was to compare the clinical and radiographic outcomes of fresh Aloe vera barbadensis plant extract and mineral trioxide aggregate (MTA) as pulpotomy agents in primary molar teeth.

Materials and Methods:

Pulpotomy procedure was performed in sixty primary molar teeth which were randomly allocated to two groups, i.e., Aloe vera pulpotomy (Group A) and MTA pulpotomy (Group B). All the pulpotomized teeth were evaluated clinically and radiographically at 1, 3, 6, 9, and 12 months of time interval using predetermined criteria.

Results:

The success rates between Groups A and B at the end of the 1^st month were 24.1% and 96.4%, at the end of 3^rd month were 57.1% and 100%, at the end of 6^th month were 75% and 100%, at the end of 9^th month were 66.6% and 100%, and at the end of 12 months were 100% and 100% respectively. The overall success rates at the end of 12-month follow-up period were 6.9% and 71.4%, respectively, after taking dropout patients into consideration, and the difference was statistically significant (P < 0.001).

Conclusions:

MTA pulpotomy was found to be superior when compared to fresh A. barbadensis plant extract pulpotomy in primary molars.

Carious Exposure versus Mechanical Exposure for MTA Pulpotomy in Primary Teeth

Introduction. The etiology of exposure determines pulpal response, making it crucial to distinguish between mechanical and carious exposure. This study clinically and radiographically evaluated the success of MTA pulpotomies conducted to treat carious and mechanical pulp exposure. Materials and Methods. This study was conducted with 50 mandibular primary molar teeth. Teeth were divided into 2 groups according to status of the exposure site, with teeth surrounded by carious dentin placed in a carious exposure group and those surrounded by sound dentin in a mechanical exposure group. MTA pulpotomies were performed for both groups. Treatment was followed up clinically and radiographically for 18 months. Results. Clinical and radiographic success rates at 18 months were 100% for both groups. Success rates did not vary significantly between the groups (p = 1.000). Pulp canal obliteration was only seen in the carious exposure group, observed in 2 teeth (8.3%). Conclusion. The long term success rates achieved in this study indicate that MTA can be used as a vital pulpotomy material for the long term success in primary teeth with either mechanical or carious exposure. The findings of the present study highlight the fact that treatment prognosis is dependent upon diagnosis and selection of the appropriate materials for treatment.

Influence of powder composition and morphology on penetration of Gray and White ProRoot mineral trioxide aggregate and calcium hydroxide into dentin tubules

This study examined the influence of powder composition and morphology on the penetration of Gray and White ProRoot mineral trioxide aggregate (GMTA, WMTA) and calcium hydroxide (CH) into open dentin tubules. GMTA, WMTA, and CH particle dimensions were analyzed by flow particle image analysis (FPIA). Penetration of open dentin tubules into dentin discs was studied by scanning electron microscopy. Five samples of each material were randomly selected and prepared for this study. The GMTA averages for length (μm), width (μm), perimeter (μm), and aspect ratio were 1.94 ± 1.65, 1.43 ± 1.19, 5.61 ± 4.27, and 0.76 ± 0.14, respectively. Corresponding averages for WMTA were 2.04 ± 1.87, 1.49 ± 1.33, 5.88 ± 4.81, and 0.76 ± 0.14, and for CH were 2.26 ± 1.99, 1.62 ± 1.46, 6.70 ± 5.60, and 0.74 ± 0.15, respectively. The rank order of the averages for particle length, width and perimeter from the largest to the smallest material was CH > WMTA > GMTA. The rank order of the averaged aspect ratios was GMTA > WMTA > CH. SEM showed that all three materials, when deposited and agitated on dentin discs, penetrated the open dentin tubules. Tubule occlusion occurred as particle surface concentrations increased. Significant differences in particle length, width, perimeter, and aspect ratio were observed for GMTA, WMTA, and CH (P < 0.0001 in all cases). All particle types penetrated into open tubules when agitated on dentin discs; all tubules were eventually occluded as particle concentrations grew. (J Oral Sci 56, 287-293, 2014).

Success Rate of MTA Pulpotomy on Vital Pulp of Primary Molars: A 3-Year Observational Study

Introduction

Vital pulp therapy is a major contributor in the preservation of primary dentition after caries affliction. Introduction of mineral trioxide aggregate (MTA) has revolutionized such treatment.

Aim

The aim of our study was to evaluate and correlate the effects of MTA clinically and radiographically on pulpotomized primary molars till their exfoliation or extraction followed by histological evaluation.

Study design

This is an observational study.

Materials and methods

A total of 25 teeth were selected from 5- to 8-year-old children requiring pulp therapy on the basis of inclusion and exclusion criterion. The teeth were treated by conventional pulpotomy technique under aseptic conditions using MTA and were immediately restored with stainless steel crown. The teeth were assessed postoperatively till 36 months. The exfoliated or extracted teeth were examined histologically.

Results

The pulpotomized teeth were vital with no adverse clinical findings during the observation period. After 3 months, one tooth showed internal resorption, but the same was not observed after 12 months. Pulp canal obliteration was seen in three cases. At the end of the study, five teeth were exfoliated and one tooth was extracted for maintaining arch symmetry. The histological examination of extracted tooth revealed the presence of healthy pulp and the area of true calcification. Remaining exfoliated teeth presented dentin bridge formation.

Statistics

Frequencies and percentages were used for descriptive statistics. Fisher’s exact tests were used to see the difference between clinical and radiological findings. The probability value was fixed at 5% level of significance.

Conclusion

The response of pulp in primary teeth to MTA was favorable in all cases from clinical and radiographic perspective, and histological evaluation confirmed the observation.

How to cite this article

Godhi B, Tyagi R. Success Rate of MTA Pulpotomy on Vital Pulp of Primary Molars: A 3-Year Observational Study. Int J Clin Pediatr Dent 2016;9(3):222-227.

Clinical and radiographical evaluation of mineral trioxide aggregate, biodentine and propolis as pulpotomy medicaments in primary teeth

Objectives

The purpose of this study was to evaluate the efficacy of mineral trioxide aggregate (MTA), Biodentine and Propolis as pulpotomy medicaments in primary dentition, both clinically and radiographically.

Materials and Methods

A total of 75 healthy 3 to 10 yr old children each having at least one carious primary molar tooth were selected. Random assignment of the pulpotomy medicaments was done as follows: Group I, MTA; Group II, Biodentine; Group III, Propolis. All the pulpotomized teeth were evaluated at 3, 6, and 9 mon clinically and radiographically, based on the scoring criteria system.

Results

The clinical success rates were found to be similar among the three groups at 3 and 6 mon where as a significant decrease in success rate was observed in Group III (84%) compared to both Group I (100%) and Group II (100%) at 9 mon. Radiographic success rates over a period of 9 mon in Groups I, II, and III were 92, 80, and 72%, respectively.

Conclusions

Teeth treated with MTA and Biodentine showed more favorable clinical and radiographic success as compared to Propolis at 9 mon follow-up.

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.

Laser Pulpotomy-An Effective Alternative to Conventional Techniques: A 12 Months Clinicoradiographic Study

BACKGROUND

Vital pulpotomy is a single-stage procedure of surgical amputation of the coronal portion of exposed vital pulp, usually as a means of preserving the vitality and function of the remaining radicular portion.

AIMS AND OBJECTIVES

The aim of this study was to compare the clinical and radiographic success rates for ferric sulfate (FS), electrosurgery (ES) and laser pulpotomy in human primary molars.

MATERIALS AND METHODS

In a randomized clinical trial, 30 primary molars indicated for pulpotomy in children aged 4 to 10 years were treated using either a FS (10 teeth), ES technique (10 teeth) and laser (10 teeth). Following the pulpotomy, the teeth were evaluated for clinical and radiographic success at 3, 6, 9 and 12 months on the basis of the presence of pain, sinus, mobility, internal and external resorption, periapical radiolucency, calcification in the canal and bone loss.

STATISTICAL ANALYSIS

The data were assessed with Chi-square test.

RESULTS

After 12 months of follow-up, both clinical and radiographic success rates were 100% in the laser group but only 80% in both ES and FS groups. There was statistically significant difference between the success rates of three groups (p < 0.05).

CONCLUSION

Laser pulpotomy showed better clinical as well as radiographical results than ES and FS pulpotomy. Laser pulpotomy was also found superior in terms of operating time, patient cooperation, ease of use and pain. Although results of the study showed the failure rates for electrosurgical pulpotomy to be equal to those for FS pulpotomy, electrosurgical pulpotomy being a nonpharmacological technique considered more favorable. Further studies using larger sample size and longer evaluation periods are suggested. How to cite this article: Gupta G, Rana V, Srivastava N, Chandna P. Laser Pulpotomy-An Effective Alternative to Conventional Techniques: A 12 Months Clinicoradiographic Study. Int J Clin Pediatr Dent 2015;8(1):18-21.

In vitro toxicity of propolis in comparison with other primary teeth pulpotomy agents on human fibroblasts

AIM

The aim of this study was to assess and compare the in vitro toxicity of propolis with other primary teeth pulpotomy medicaments.

METHODS

Human periodontal ligament (PDL) cells were subjected to different concentrations of propolis, formocresol, ferric sulfate, and gray mineral trioxide aggregate (MTA) (0.05, 0.5, 5, 50, and 100 μg/mL) for 24 h at 37°C. Cells that were not exposed to the tested materials served as the negative control. In vitro toxicity was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Statistical analysis of the data was accomplished using anova and Tukey statistical tests (P < 0.05).

RESULTS

Only propolis and gray MTA had comparable cell viability to the negative control group. Almost all remaining concentrations of tested materials were significantly inferior to the negative control after 24 h of exposure (P < 0.05).

CONCLUSION

Propolis and MTA are more biocompatible than formocresol and ferric sulfate since they were both able to preserve PDL fibroblasts for up to 24 h.

Root Resorption a 6-Year Follow-up Case Report

This paper describes the clinical course of a pediatric patient developing cervical external root resorption (CERR). An 11-year old male patient had sustained dental trauma and was diagnosed with crown fracture affecting the incisal and middle thirds of the maxillary right permanent central incisor and the maxillary right permanent lateral incisor with pulp exposure and CERR after 24 months. Diagnosis and treatment of CERR are a challenge for dental practitioners. In this case, preservation of natural dentition is shown as a successful treatment in a 6-year follow-up.

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

INTRODUCTION

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.

AIM

To evaluate the success and efficacy of Mineral Trioxide Aggregate (MTA), Lasers and Biodentine as pulpotomy agents both clinically and radiographically.

MATERIALS AND METHODS

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.

RESULTS

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).

CONCLUSION

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.

Clinical and radiographic outcomes of the use of Low-Level Laser Therapy in vital pulp of primary teeth

AIM

This study aimed to compare the clinical and radiographic effectiveness of Low Level Laser Therapy in vital pulp of human primary teeth.

METHODS

Sixty mandibular primary molars of children aged between 5-9 years were assigned into four groups: Diluted Formocresol (FC), Calcium Hydroxide (CH), Low Level Laser Therapy (LLLT) and Calcium Hydroxide preceded by Low Level Laser Therapy (LLLT + CH). The clinical and radiographic evaluations were performed at 6, 12 and 18 post-operative months.

RESULTS

All the groups studied were successful in the clinical evaluation over the follow-up period. At 6 months, the radiographic success rate for FC group was 100%, 60% for CH group, 80% for LLLT group and 85.7% for LLLT + CH group. After 12 months, the radiographic success rate was 100% for FC group, 50% for CH group, 80% for LLLT group and 78.6% for LLLT + CH group. At the 18 months follow-up, 100% of the FC group, 66.7% of CH group, 73.3% of the LLLT group and 75% of the LLLT + CH group.

CONCLUSION

These findings suggest that Low Level Laser Therapy may be considered as an adjuvant alternative for vital pulp therapy on human primary teeth. Low Level Laser Therapy preceding the use of calcium hydroxide showed satisfactory results.

Immunolocalization of dentin matrix protein-1 in human primary teeth treated with different pulp capping materials

The aim of this study was to evaluate the immunolocalization of dentin matrix protein (DMP)-1 in human primary teeth treated with different pulp capping materials. Twenty-five primary molars were divided into the following groups: formocresol (FC), calcium hydroxide (CH), mineral trioxide aggregate (MTA), corticosteroid/antibiotic solution + CH (O + CH), and Portland cement (PC), and all received conventional pulpotomy treatment. The teeth at the regular exfoliation period were extracted for histological analysis and immunolocalization of DMP-1. Statistical analysis was performed using the χ(2) test (p < 0.05). Histological analysis revealed statistically significant differences in the comparison among the groups through the use of a score system regarding the presence of hard tissue barrier, odontoblastic layer, and internal resorption, but not regarding pulp calcification. Immunohistochemical analysis showed immunostaining for DMP-1 in groups CH, MTA, O + CH, and PC. Internal resorption was observed in the groups FC and CH. MTA and PC showed pulp repair without inflammation and with the presence of hard tissue barrier. DMP-1 immunostaining was higher for MTA and PC, confirming the reparative and bioinductive capacity of these materials.

Comparison of particle morphology between commercial- and research-grade calcium hydroxide in endodontics

Ca(OH)2 aqueous slurry is widely used as an inter-appointment antimicrobial dressing in root canal treatment. The aim of this study was to quantify the particle size and shape of commercial-grade UltraCal XS (UC) and to compare it with that of research-grade Ca(OH)2 (RG) using a flow particle image analyzer (FPIA). The morphology and penetration inside the dentin tubules of the UC and RG particles were examined using a scanning electron microscope (SEM). UC and RG (10 mg) were mixed with 15 mL of alcohol, and were sonicated. Five milliliters of the dispersion was subjected to FPIA, and particle length, width, perimeter and aspect ratio were analyzed. In addition, UC paste and RG aqueous slurry were agitated on dentin discs and were prepared for SEM examination. There were significant differences between UC and RG with regard to the frequency of different length groups (P < 0.0001). UC contained smaller particles than RG (P < 0.0001). Under SEM, the agitated UC and RG particles occluded the opening of dentin tubules and penetrated inside the dentin tubules. The size of UC particles is smaller than those of RG. Both UC and RG particles were able to penetrate into open dentin tubules.