1
|
Philip N, Cherian JM, Mathew MG, Thomas AM, Jodhka S, John N, Suneja B, Duggal M. Treatment outcomes of pulpotomy versus pulpectomy in vital primary molars diagnosed with symptomatic irreversible pulpitis: protocol for a non-inferiority randomised controlled trial. BMC Oral Health 2024; 24:626. [PMID: 38807160 PMCID: PMC11134690 DOI: 10.1186/s12903-024-04411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/24/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Pulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. However, despite emerging evidence indicating similarities between primary and permanent tooth pulp response to dental caries, there is limited research on whether pulpotomy can be similarly used as a definitive treatment modality for vital primary teeth with irreversible pulpitis. This randomised controlled trial (RCT) aims to compare the treatment effectiveness of pulpotomy versus pulpectomy in management of vital primary molars diagnosed with symptomatic irreversible pulpitis over a two-year period. METHODS/DESIGN This clinical study is a parallel, two-armed, open label, non-inferiority RCT with a 1:1 allocation ratio between the experimental intervention arm (pulpotomy) and the active comparator arm (pulpectomy). Healthy cooperative children, between 4-9 years of age, who have painful primary molars with clinical symptoms typical of irreversible pulpitis will be recruited after obtaining informed consent from their parents/legal guardians. 50 vital primary molars clinically diagnosed with symptomatic irreversible pulpitis will be randomly distributed between the two treatment arms. The primary outcomes that will be assessed are clinical and radiographic success after six-months, one-year and two-years of the trial interventions. The influence of baseline pre-operative variables (age; gender; tooth type; site of caries; pre-operative furcal radiolucency; pre-operative pain intensity) and intra-operative factors (time taken to achieve haemostasis) on treatment outcomes will also be assessed. The secondary outcome evaluated will be the immediate (24 h and 7 d) post-operative pain relief afforded by the two treatment interventions. DISCUSSION This trial seeks to provide evidence on whether pulpotomy treatment can be no worse than the standard pulpectomy treatment for the management of symptomatic irreversible pulpitis in vital primary molars. TRIAL REGISTRATION ClinicalTrials.gov (NCT06183203). Registered on 30 January 2024.
Collapse
Affiliation(s)
- Nebu Philip
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Joe Mathew Cherian
- Department of Pedodontics and Preventive Dentistry, Christian Dental College, Ludhiana, India
| | - Mebin George Mathew
- Department of Pedodontics and Preventive Dentistry, Christian Dental College, Ludhiana, India
| | - Abi M Thomas
- Department of Pedodontics and Preventive Dentistry, Christian Dental College, Ludhiana, India
| | | | - Nino John
- Primary Health Care Corporation, Doha, Qatar
| | | | - Mandeep Duggal
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| |
Collapse
|
2
|
Lin GSS, Chin YJ, Choong RS, Wafa SWWSST, Dziaruddin N, Baharin F, Ismail AF. Treatment Outcomes of Pulpotomy in Primary Teeth with Irreversible Pulpitis: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:574. [PMID: 38790569 PMCID: PMC11119415 DOI: 10.3390/children11050574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
AIM This systematic review and meta-analysis aimed to evaluate the success rates of pulpotomy treatment for irreversible pulpitis in primary teeth. METHODS This study was registered and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Relevant studies published between January 1980 and April 2023 were identified across eight online databases and two paediatric dentistry textbooks. Study selection, data extraction, and quality assessment were conducted by multiple investigators independently. Data analysis involved single-arm and two-arm meta-analyses, leave-one-out sensitivity analysis, meta-regression, and assessment of publication bias. The risks of bias were evaluated using the Cochrane Collaboration's assessment tools. The levels of evidence were determined using the Oxford Centre for Evidence-Based Medicine (OCEBM) tool. RESULTS Five primary studies were included. The weighted mean overall success rates at 6-month and 12-month follow-ups were 97.2% and 94.4%, respectively. Two-arm meta-analysis revealed no significant difference (p > 0.05) between the use of mineral trioxide aggregate (MTA) and non-MTA bioceramic-based materials as pulpotomy medicaments. The sample size of each study did not affect the degree of data heterogeneity. Egger's test revealed no significant publication bias. CONCLUSIONS Pulpotomy may be regarded as an alternative modality for treating primary teeth with irreversible pulpitis. Nevertheless, future well-designed trials and extended follow-up periods are warranted.
Collapse
Affiliation(s)
- Galvin Sim Siang Lin
- Department of Restorative Dentistry, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan Campus, Kuantan 25200, Pahang, Malaysia
| | - Yu Jie Chin
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (Y.J.C.); (R.S.C.); (N.D.)
| | - Rob Son Choong
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (Y.J.C.); (R.S.C.); (N.D.)
| | | | - Nabihah Dziaruddin
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (Y.J.C.); (R.S.C.); (N.D.)
| | - Fadzlinda Baharin
- Paediatric Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu 16150, Kelantan, Malaysia;
| | - Ahmad Faisal Ismail
- Department of Paediatric Dentistry and Dental Public Health, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan Campus, Kuantan 25200, Pahang, Malaysia;
| |
Collapse
|
3
|
Hu X, Zhao C, Wang L, Zhang Z, Yang F, Zhang H. A retrospective study on iRoot BP Plus full pulpotomy for primary molars with partial irreversible pulpitis. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2024; 42:242-248. [PMID: 38597084 PMCID: PMC11034405 DOI: 10.7518/hxkq.2024.2023308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/22/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES This study aimed to observe the outcomes of iRoot BP Plus full pulpotomy in primary molars with partial irreversible pulpitis retrospectively. METHODS Collect 102 cases of primary molars with partial irreversible pulpitis undergoing iRoot BP Plus full pulpotomy from January 2019 to August 2023, with a follow-up period of 24-47 months. Based on the presence of irreversible pulpitis symptoms before surgery, the included cases will be divided into asymptomatic group (n=53) and symptomatic group (n=49). Observe the clinical and imaging success rates of both groups. RESULTS Clinical success rates were 96.2% and 97.9% in asymptomatic and symptomatic groups, and radiographic success rates were 96.2% and 93.9% respectively. CONCLUSIONS iRoot BP Plus full pulpotomy can be used for the treatment of primary molars with partial irreversible pulpitis under an enhanced pulpotomy protocol.
Collapse
Affiliation(s)
- Xiaoyan Hu
- Dept. of Pediatric Dentistry, Stomatologic Hospital & College, Anhui Medical University, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Chunhui Zhao
- Dept. of Pediatric Dentistry, Stomatologic Hospital & College, Anhui Medical University, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Lu Wang
- Dept. of Endodontics, Stomatologic Hospital & College, Anhui Medical University, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Zheng Zhang
- Dept. of Radiology, Stomatologic Hospital & College, Anhui Medical University, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Fan Yang
- Dept. of Endodontics, Stomatologic Hospital & College, Anhui Medical University, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Hongyan Zhang
- Dept. of Endodontics, Stomatologic Hospital & College, Anhui Medical University, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei 230032, China
| |
Collapse
|
4
|
Sabbagh S, Bahrololoomi Z, Sarraf Shirazi A, Zarebidoki F, Salajegheh S, Fotouhi F, Akbarzadeh Baghban A, Asgary S. Comparative evaluation of cervical pulpotomy and pulpectomy for primary molars with irreversible pulpitis: a multicentre randomised controlled trial. Eur Arch Paediatr Dent 2024; 25:255-265. [PMID: 38488954 DOI: 10.1007/s40368-024-00880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 02/02/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The objective of this multicentre randomised controlled trial was to compare the clinical/radiographic outcomes of cervical pulpotomy using calcium-enriched mixture cement (PCEM) and pulpectomy using Metapex (PM) in primary molars with irreversible pulpitis (IP). METHODS A total of 134 primary molars from 94 children were randomly assigned to two intervention groups: the PCEM group (n = 74) and the PM group (n = 60). Baseline characteristics including age/gender/molar type/tooth type/jaw were recorded. The primary outcome measures were clinical/radiographic success rates assessed at the first and second follow-up appointments. Secondary outcomes included reasons for clinical/radiographic failures. Multiple logistic regression analysis was performed to determine the impact of various factors on the success rates. RESULTS The mean age of the participants in both groups was similar (PCEM group: 5.4 years, PM group: 5.5 years). Gender distribution, molar type, tooth type, jaw, and number of practitioners were comparable between the groups. The clinical success rate at the first follow-up was 98.6% in the PCEM group and 96.4% in the PM group. At the second follow-up, the clinical success rate was 97.1% in the PCEM group and 91.1% in the PM group. The radiographic success rates at the first and second follow-up were 98.6% and 96.4% in the PCEM group and 96.4% and 91.1% in the PM group, respectively. Multiple logistic regression analysis did not reveal any significant association between the success rates and age/gender/molar type/jaw, or treatment groups (P > 0.05). CONCLUSION In primary molars with IP, both simple/conservative cervical pulpotomy using calcium-enriched mixture cement and pulpectomy using Metapex demonstrated high clinical/radiographic success rates. No significant differences were observed between the two treatment modalities. These findings suggest that both techniques can be considered effective treatment options for managing primary molars with IP. TRIAL REGISTRATION NUMBER Trial registration number: IRCT20201226049838N1, retrospectively registered on 12 January 2021.
Collapse
Affiliation(s)
- S Sabbagh
- Department of Pediatric Dentistry & Dental Materials Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Z Bahrololoomi
- Department of Pedodontics & Social Determinants of Oral Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - A Sarraf Shirazi
- Department of Pediatric Dentistry, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - F Zarebidoki
- Department of Pedodontics, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - S Salajegheh
- Department of Pedodontics, Faculty of Dentistry, Hormozgan University of Medical Sciences, Hormozgan, Iran
| | - F Fotouhi
- Pediatric Dentist, Private Practice, Yazd, Iran
| | - A Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
5
|
Haghgoo R, Molaasadolah F, Taghizade F, Ansari G, Asgary S. THREE-YEAR OUTCOME OF DIODE LASER PULPOTOMY OF PRIMARY MOLARS USING THREE PULP CAPPING AGENTS: A SPLIT-MOUTH RANDOMIZED CLINICAL TRIAL. J Evid Based Dent Pract 2023; 23:101920. [PMID: 38035897 DOI: 10.1016/j.jebdp.2023.101920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 11/09/2022] [Accepted: 08/22/2023] [Indexed: 12/02/2023]
Abstract
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.
Collapse
Affiliation(s)
- Roza Haghgoo
- Department of Pediatric Dentistry, School of Dentistry, Shahed University, Tehran, Iran
| | - Fatemeh Molaasadolah
- Department of Pediatric Dentistry, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fateme Taghizade
- Department of Pediatric Dentistry, School of Dentistry, Shahed University, Tehran, Iran
| | - Ghassem Ansari
- Department of Pediatric Dentistry, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Hu X, Liang Z, Wang Q, Liu L. A retrospective study of iRoot BP Plus pulpotomy compared with Vitapex pulpectomy for irreversible pulpitis of primary molars with the presence of coronal pulp tissue. Int J Paediatr Dent 2023; 33:216-226. [PMID: 36453980 DOI: 10.1111/ipd.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Pulpotomy has been successfully performed in immature and mature permanent teeth with irreversible pulpitis but rarely in primary teeth. AIM To evaluate the outcomes of iRoot BP Plus pulpotomy and Vitapex pulpectomy in primary molars with irreversible pulpitis. DESIGN We selected 130 primary molars of 99 patients, aged 3-7 years, diagnosed with irreversible pulpitis with coronal pulp tissue and treated with iRoot BP Plus pulpotomy or Vitapex pulpectomy (median follow-up period: 18 months). They were divided into the pulpotomy (n = 88) and pulpectomy (n = 42) groups according to treatment procedure. The pulpotomy group was further divided into asymptomatic (n = 46) and symptomatic (n = 42) subgroups according to preoperative symptoms. The chi-squared test and Cox regression were performed to analyze the outcomes. RESULTS Clinical and radiographic success rates were significantly higher in the pulpotomy group (98.9% and 95.5%) than in the pulpectomy group (88.1% and 54.8%) and did not differ significantly between asymptomatic and symptomatic pulpotomy subgroups. CONCLUSION Irreversible pulpitis of primary molars with coronal pulp tissue can be successfully treated with iRoot BP Plus pulpotomy. Early intraradicular resorption of materials is the main adverse outcome of Vitapex pulpectomy.
Collapse
Affiliation(s)
- Xiaoyan Hu
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Basic Science of Stomatology, Jiangsu Province Engineering Research Center of Stomatological Translational, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.,Key Laboratory of Oral Diseases Research of Anhui Province, Department of Pediatric Dentistry, College & Hospital of Stomatology, Anhui Medical University, Hefei, China
| | - Zhaojia Liang
- Key Laboratory of Oral Diseases Research of Anhui Province, Department of Pediatric Dentistry, College & Hospital of Stomatology, Anhui Medical University, Hefei, China
| | - Qun Wang
- Key Laboratory of Oral Diseases Research of Anhui Province, Department of Pediatric Dentistry, College & Hospital of Stomatology, Anhui Medical University, Hefei, China
| | - Laikui Liu
- Jiangsu Province Key Laboratory of Oral Diseases, Department of Basic Science of Stomatology, Jiangsu Province Engineering Research Center of Stomatological Translational, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
7
|
Alnassar I, Altinawi M, Rekab MS, Alzoubi H, Abdo A. Evaluation of the efficacy of mineral trioxide aggregate and bioceramic putty in primary molar pulpotomy with symptoms of irreversible pulpitis (a randomized‐controlled trial). Clin Exp Dent Res 2022; 9:276-282. [PMID: 36464977 PMCID: PMC10098274 DOI: 10.1002/cre2.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES Preserving the primary teeth is important, as they play an important role in the integrity of the dental arch, the development of the craniofacial complex, speech, and chewing. This study aimed to evaluate the effectiveness of both Mineral Trioxide Aggregate (MTA) and Bioceramic putty in primary molar pulpotomy with symptoms of irreversible pulpitis. MATERIALS AND METHODS In this study, 40 s primary mandibular molars in 40 healthy children aged 6-8 years were examined and classified into 2 groups according to the material: group A, with 20 primary molars capped by MTA, and group B, with 20 teeth capped by Bioceramic putty. Clinical and radiographic evaluation of the treatment results was carried out after 1 week, 3 months, 6 months, 9 months, and 1 year. RESULTS Clinical and radiological success rates in the MTA group reached 95%, where a case of failure was observed after a year of follow-up. In the Bioceramic group, the success rate reached 100% after a year of follow-up, without any statistically significant differences between groups (p = .311). CONCLUSIONS Pulpotomy using biocompatibility materials (MTA-Bioceramic) in primary molars with symptoms of irreversible pulpitis is considered effective due to the better advantages of the use of Bioceramic over MTA. This clinical trial was approved by Australian New Zealand Clinical Trials (12621001631897).
Collapse
Affiliation(s)
- Ibrahim Alnassar
- Department of Pediatric Dentistry, College of Dentistry Damascus University Damascus Syria
| | - Mohamed Altinawi
- Department of Pediatric Dentistry, College of Dentistry Damascus University Damascus Syria
| | - Mohammad Salem Rekab
- Department of Restorative Dentistry and Endodontics, College of Dentistry Damascus University Damascus Syria
| | - Hasan Alzoubi
- Department of Pediatric Dentistry, College of Dentistry Damascus University Damascus Syria
| | - Anas Abdo
- Department of Restorative Dentistry and Endodontics, College of Dentistry Damascus University Damascus Syria
| |
Collapse
|
8
|
Asgary S, Sarraf Shirazi A, Sabbagh S. Management of primary molars with irreversible pulpitis employing tampon pulpotomy: Report of three cases with 34-month mean follow-up. Clin Case Rep 2021; 9:2289-2294. [PMID: 33936681 PMCID: PMC8077301 DOI: 10.1002/ccr3.4017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 11/24/2022] Open
Abstract
This study suggests that tampon-based coronal pulpotomy using a calcium silicate-based biomaterial can be a reliable approach for the treatment of vital primary molars with irreversible pulpitis.
Collapse
Affiliation(s)
- Saeed Asgary
- Iranian Center for Endodontic ResearchResearch Institute of Dental SciencesShahid Beheshti University of Medical SciencesTehranIran
| | - Alireza Sarraf Shirazi
- Pediatric Dentistry DepartmentSchool of DentistryMashhad University of Medical SciencesMashhadIran
| | - Sedigheh Sabbagh
- Dental Materials Research CenterMashhad University of Medical SciencesMashhadIran
| |
Collapse
|
9
|
Sajadi FS, Jalali F, Khademi M. Ferric Sulfate Versus Calcium-Enriched Mixture Cement in Pulpotomy of Primary Molars: A Randomized Clinical Trial. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
10
|
Parirokh M, Torabinejad M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy. Int Endod J 2017; 51:177-205. [PMID: 28836288 DOI: 10.1111/iej.12841] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/21/2017] [Indexed: 01/09/2023]
Abstract
Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick-Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term 'bioactive endodontic cements (BECs)', which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.
Collapse
Affiliation(s)
- M Parirokh
- Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - M Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| |
Collapse
|
11
|
Sabbagh S, Sarraf Shirazi A, Eghbal MJ. Vital Pulp Therapy of a Symptomatic Immature Permanent Molar with Long-Term Success. IRANIAN ENDODONTIC JOURNAL 2016; 11:347-349. [PMID: 27790270 PMCID: PMC5069917 DOI: 10.22037/iej.2016.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Vital pulp therapy (VPT) is the preferred conservative treatment for preservation of symptomatic pulps in immature permanent teeth. The present case report summarizes VPT of an immature permanent molar with irreversible pulpitis associated with apical periodontitis in a 9-year-old boy. Cervical pulpotomy was performed and radicular pulp stumps were covered with calcium-enriched mixture (CEM) cement; the tooth was then restored with stainless steel crown. After a 50-month follow-up period, the pulpotomized molar was clinically functional and asymptomatic. Moreover, radiographic evaluation revealed evidence of complete root development as well as normal periodontal ligament around the roots. The successful outcome achieved through VPT using CEM biomaterial in the reported case suggests that this method may produce favorable outcome for vital immature permanent teeth with irreversible pulpitis and periapical disease.
Collapse
Affiliation(s)
- Sedigheh Sabbagh
- Student Research Committee, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Sarraf Shirazi
- Dental Material Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Jafar Eghbal
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
12
|
Mohammadi Z, Asgary S, Shalavi S, V. Abbott P. A Clinical Update on the Different Methods to Decrease the Occurrence of Missed Root Canals. IRANIAN ENDODONTIC JOURNAL 2016; 11:208-13. [PMID: 27471533 PMCID: PMC4947846 DOI: 10.7508/iej.2016.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/08/2016] [Accepted: 05/24/2016] [Indexed: 11/30/2022]
Abstract
One of the main causes of endodontic treatment failure is the clinician's inability to localize all the root canals. Due to the complex anatomy of the root canal system, missed canals are not uncommon. There are several strategies to decrease the possibility of missed root canals starting with good pre-operative radiographies. In order to overcome the limitations of conventional radiographies, cone-beam computed tomography (CBCT) can be considered. A correct access cavity preparation is of pivotal importance in localizing the orifices of the root canals. Furthermore, ultrasonics are very important devices to find missed canals. Increasing magnification and illumination enhance the possibility of finding all root canals during root canal treatment. The purpose of the present paper was to review all of the above techniques and devices.
Collapse
Affiliation(s)
- Zahed Mohammadi
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shaheed Beheshti University of Medical Sciences, and Iranian National Elite Foundation, Tehran, Iran;
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
| | | | - Paul V. Abbott
- School of Dentistry, University of Western Australia, Perth, Australia
| |
Collapse
|