Conti, Taísa Regina; Sakai, Vivien Thiemy; Fornetti, Ana Paula Camolese; Moretti, Ana Beatriz Silveira; Oliveira, Thais Marchini; Lourenço, Natalino; Machado, Maria Aparecida Andrade Moreira; Abdo, Ruy Cesar Camargo
Two clinical cases in which Portland cement (PC) was applied as a medicament after pulpotomy of mandibular primary molars in children are presented. Pulpotomy using PC was carried out in two mandibular first molars and one mandibular second molar, which were further followed-up. At the 3, 6 and 12-month follow-up appointments, clinical and radiographic examinations of the pulpotomized teeth and their periradicular area revealed that the treatments were successful in maintaining the teeth asymptomatic and preserving pulpal vitality. Additionally, the formation of a dentin bridge immediately below the PC could be observed in the three molars treated. PC may be considered as an effective alternative for primary molar pulpotomies, at least in a short-term period. Randomized clinical trials with human teeth are required in order to determine the suitability of PC before unlimited clinical use can be recommended. PMID:19148409
Simon Elison NM
Full Text Available Abstract Background In Tanzania, oral health services are mostly in the form of dental extractions aimed at alleviating acute dental pain. Conservative methods of alleviating acute dental pain are virtually non-existent. Therefore, it was the aim of this study to determine treatment success of emergency pulpotomy in relieving acute dental pain. Methods Setting: School of Dentistry, Muhimbili National Hospital, Dar es Salaam, Tanzania. Study design: Longitudinal study. Participants: 180 patients who presented with dental pain due to acute irreversible pulpitis during the study period between July and August 2001. Treatment and evaluation: Patients were treated by emergency pulpotomy on permanent posterior teeth and were evaluated for pain after one, three and six week's post-treatment. Pain, if present, was categorised as either mild or acute. Results Of the patients with treated premolars, 25 (13.9% patients did not experience pain at all while 19 (10.6% experienced mild pain. None of the patients with treated premolars experienced acute pain. Among 136 patients with treated molars 56 (31% did not experience any pain, 76 (42.2% experienced mild pain and the other 4 (2.2% suffered acute pain. Conclusion The short term treatment success of emergency pulpotomy was high being 100% for premolars and 97.1% for molars, suggesting that it can be recommended as a measure to alleviate acute dental pain while other conservative treatment options are being considered.
Full Text Available The present case describes the clinical & radiographic outcome of a Portland Cement pulpotomy. The 5 years old girl presenting extensive carious exposure in her mandibular left 2nd deciduous molar and was suffering pain in her left lower jaw only on exposure to cold for last 2 days. She was ultimately diagnosed clinic-radio-graphically as a case of irreversible pulpitis. Coronal pulpotomy procedure was carried out in the responsible tooth and Portland cement (PC was applied as a medicament after pulpotomy. At the 3 & 6-months follow-up appointments, treated tooth was asymptomatic clinically and radiographic examinations revealed no sign of periradicular pathosis in the pulpotomized teeth. Additionally, the formation of a dentin bridge immediately below the PC in the treated tooth was confirmed by RVG and CBCT.
Lourenço Neto, N; Marques, N C T; Fernandes, A P; Hungaro Duarte, M A; Abdo, R C C; Machado, M A A M; Oliveira, T M
This was to evaluate the clinical and radiographic outcomes of Portland cement (PC) added to radiopacifying agents in primary molar pulpotomies. Thirty primary mandibular molars of children aged between 5 and 9 years were randomly assigned to the following groups: PC; PC with iodoform (PC + CHI(3)); PC with zirconium oxide (PC + ZrO(2)) and treated by pulpotomy technique. Clinical and radiographic follow-up assessments were performed at 6, 12 and 24 months. Statistical analysis was performed by Fisher's exact test (P < 0.05). The clinical and radiographic evaluations showed 100 % success rates, and the results showed no statistically significant difference between groups. According to this study, PC added to radiopacifying agents exhibited satisfactory clinical and radiographic results in primary molar pulpotomies.
Devi N. R. Devy
Full Text Available Congenital heart disease is a condition of heart anomaly found since birth. The most common is ventricular septal defect whereby an aperture is found in the partition of heart chamber. It is estimated that 40,000 newborn in Indonesia have this defective condition. Dental treatment for patients with such condition must be undertaken in a very cautious way. Tooth with multiple caries can potentially lead to endocarditis bacteria. As such, dentist must be watchful on dental treatment that may worsen the patient’s condition. To prevent endocarditis bacteria, a prophylaxis antibiotic is required as recommended by the American Heart Association (AHA. In this particular case, a dental treatment was undertaken to a child patient with congenital heart disease. Previously, the patient has undergone dental treatment in the form of multiple extractions under general anesthesia before conducting cardiac surgery. In this case the treatment includes mortal pulpotomy, GIC restoration, and fissure sealant – all conducted in one visit under general anesthesia. A year after the treatment, there are no complaints from the patient and no irregularity on x-ray results.
Nosrat, Ali; Peimani, Ali; Asgary, Saeed
The purpose of the study was to evaluate human dental pulp response to pulpotomy with calcium hydroxide (CH), mineral trioxide aggregate (MTA), and calcium enriched mixture (CEM) cement. A total of nine erupted third molars were randomly assigned to each pulpotomy group. The same clinician performed full pulpotomies and coronal restorations. The patients were followed clinically for six months; the teeth were then extracted and prepared for histological assessments. The samples were blindly assessed by an independent observer for pulp vitality, pulp inflammation, and calcified bridge formation. All patients were free of clinical signs/symptoms of pulpal/periradicular diseases during the follow up period. In CH group, one tooth had necrotic radicular pulp; other two teeth in this group had vital uninflamed pulps with complete dentinal bridge formation. In CEM cement and MTA groups all teeth had vital uninflamed radicular pulps. A complete dentinal bridge was formed beneath CEM cement and MTA in all roots. Odontoblast-like cells were present beneath CEM cement and MTA in all samples. This study revealed that CEM cement and MTA were reliable endodontic biomaterials in full pulpotomy treatment. In contrast, the human dental pulp response to CH might be unpredictable.
Full Text Available In cariously exposed immature permanent teeth, the treatment choice is controversial in pediatric dentistry. Radical root canal treatment usually appears to be the solution for these teeth. Even partial pulpotomy is a vital treatment for traumatically exposed immature permanent teeth; extending the borders of indication towards cariously exposed immature permanent teeth with reversible pulpitis may abolish the necessity of pulpectomy. This article describes the partial pulpotomy of a cariously affected immature permanent teeth and the follow-up for 1 year. A healthy 11-year-old male patient was referred to Gazi University Faculty of Dentistry Department of Pediatric Dentistry. The patient had reversible pulpitis symptoms on teeth numbered 45. At radiographic examination, immature apex and deep caries lesion were observed and partial pulpotomy was performed by using calcium hydroxide to maintain vitality of the pulp and allow continued development of root dentin expecting the root will attain full maturity. Clinical and radiographic follow-up demonstrated a vital pulp besides not only closure of the apex (apexogenesis, but also physiologic root development (maturogenesis after 1 year. Partial pulpotomy is an optional treatment for cariously exposed immature permanent teeth for preserving vitality and physiological root development.
Full Text Available The retention of pulpally involved deciduous tooth in a healthy state until the time of normal exfoliation remains to be one of the challenges for Pedodontists. A scientific noise has been generated about several materials some of which have been popular pulpotomy medicaments. Concerns have been raised about the toxicity and potential carcinogenicity of these materials, and alternatives have been proposed to maintain the partial pulp vitality, however to date no material has been accepted as an ideal pulpotomy agent. Mineral trioxide aggregate (MTA is a biocompatible material which provides a biological seal. MTA has been proposed as a potential medicament for various pulpal procedures like pulp capping with reversible pulpitis, apexification, repair of root perforations, etc. Hence the present study was done to evaluate the efficacy of MTA as a pulpotomy medicament. A clinical and radiographic evaluation was done on children where MTA was used as pulpotomy medicament in primary molars for a period of 6 months and it was found to be a successful material.
Peng, Chufang; Zhao, Yuming; Yang, Yuan; Qin, Man
To evaluate the preliminary clinical effect of mineral trioxide aggragate (MTA) pulpotomy on immature permanent teeth with irreversible pulpitis. Twenty-six immature permanent teeth with irreversible pulpitis were recuited from Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. These teeth were treated with partial or full pulpotomy according to the condition of pulp bleeding. MTA was used as pulp capping material. Patients were recalled periodically after the treatment. Clinical and radiographic effects were evaluated. At one year follow-up, 20 teeth were evaluated as healed or healing, 2 teeth were evaluated as failure and 4 teeth were dropped out. The success rate was considered 91% (20/22). A dentinal bridge was radiographcally observed underneath the pulpotomy site in 13 teeth(65%, 13/20). MTA pulpotomy is an effective method for the treatment of immature permanent teeth with irreversible pulpitis. But further research with longer follow up period is required.
Lin, Po-Yen; Chen, Hsueh-Szu; Wang, Yu-Hsiang; Tu, Yu-Kang
Pulpotomy is a common procedure to treat asymptomatic reversible pulpitis in primary molars. The aim of this study is to undertake a systematic review and a network meta-analysis to compare the clinical and radiographic outcomes of different pulpotomy procedures in primary molars. Three authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion. An electronic literature search was performed within MEDLINE (via PubMed), ScienceDirect, Web of Science, Cochrane, and ClinicalKey databases until December 2012. Medications for pulpotomy including formocresol, ferric sulfate, calcium hydroxide, and mineral trioxide aggregate (MTA), and laser pulpotomy are compared using Bayesian network meta-analyses. The outcome is the odds ratio for clinical and radiographic failure including premature tooth loss at 12 and 24 months after treatments amongst different treatment procedures. 37 studies were included in the systematic review, and 22 of them in the final network meta-analyses. After 18-24 months, in terms of treatment failure, the odds ratio for calcium hydroxide vs. formocresol was 1.94 [95% credible interval (CI): 1.11, 3.25]; 3.38 (95% CI: 1.37, 8.61) for lasers vs. formocresol; 2.16 (95% CI: 1.12, 4.31) for calcium hydroxide vs. ferric sulfate; 3.73 (95% CI: 1.27, 11.67) for lasers vs. ferric sulfate; 0.47 (95% CI: 0.26, 0.83) for MTA vs. calcium hydroxide; 3.76 (95% CI: 1.39, 10.08) for lasers vs. After 18-24 months, formocresol, ferric sulfate, and MTA showed significantly better clinical and radiographic outcomes than calcium hydroxide and laser therapies in primary molar pulpotomies. The network meta-analyses showed that MTA is the first choice for primary molar pulpotomies. However, if treatment cost is an issue, especially when the treated primary molars are going to be replaced by permanent teeth, ferric sulfate may be the choice. Copyright © 2014 Elsevier Ltd. All rights reserved.
S E Jabbarifar
Full Text Available Background: In spite of long time and broad use of formaldehyde derivates (Fixation agent in primary tooth pulp treatment, There is some concerns about these derivates such as variability, inconsistency success rate, mutagenicity, cytotoxicity, alergenicity, and some other potential health hazards of them. Therefore other alternative pulpotomy procedures like Bioactive glass (BAG, Glutaraldehyde (2%, Hydroxyappetite (HA, Bone dried freezed (BDF, ferric sulfate (15%, laser, Electrosurgery (ES, Bone Morphogenic proteins (BMP, recombinant protein-1 (RP1, and Mineral Trioxide Aggregate (MTA have been compared. The purpose of this clinical trial is to assess radiographic and clinical success rate of Formocresol (FC pulpotomy in compare with MTA in human primary molar teeth. Methods: 64 molars were pulpotomized equally and randomly with mineral trioxide Aggregate and Formocresol. Prior to trial, we defined a case as failure, when one or more of the events such as external root resorption, internal root resorption, periapical and furca lucency, pain, swelling, mobility, dental abscess, or early extraction appeared. Every treated tooth was defined as successful, if any noted evident was not shown. Results: Totally, 60 teeth treatment (92.2 percent were successful and 7.8 percent were failed. Failure and success rates for MTA group were 6.3 and 93.7 percent, respectively. Failure and success rates in FC group were 8.4 and 90.2 percent respectively. The difference between MTA and FC treatment methods was not significant (Fisher Exact test. Conclusion: Findings of this study show that mineral trioxide aggregate can be an alternative procedure for FC pulpotomy of primary tooth. Keywords: Mineral trioxide aggregate, formocresol, pulpotomy, success and failure rate.
Full Text Available Two cases of young patients with traumatized permanent teeth having complicated crown fractures are reported. Endodontic management included partial pulpotomy by the Cvek technique; restorative management included resin restoration and reattachment of the teeth fragments. Treatments were considered successful in all cases according to the following criteria: absence of clinical symptoms, absence of X-ray signs of pathology, and presence of pulpal vitality 6 to 25 months after treatment.
Abou Chedid, J C; Mchayleh, N; Khalil, I; Melki, B; Hardan, L S
Pulpotomy is the most performed and controversial therapeutic in pediatric dentistry. Formocresol is known to have a toxic effect on living tissues, a mutagenic and carcinogenic potential with a systemic uptake of formocresol via pulpotomized teeth, other alternative products have been investigated. 40 molars were pulpotomized using Micro Mega Mineral Trioxide Aggregate (MM-MTA), which eliminates the need for the use of formocresol. The effects of this material were evaluated both clinically and radiographically. Post-operative control examinations were performed at 1, 6, 12, and 18 months trying to detect spontaneous or stimulated pain, pathological tooth mobility, abscesses or fistulas, internal or external pathological tooth resorption, periapical bone destruction, or canal obliteration. Pain was absent at 18 months post operatively. Thirty six molar treated with the MM-MTA didn't show any mobility or pain, one molar presented a pathological resorption and one molar presented an abscess without a fistula at 12 month. The observations were compared to others related to formocresol, ferric sulfate, MTA, and laser pulpotomies, using the Chi-square test x2. The abundance of positive result strongly demonstrate that the MM-MTA pulpotomy on carious temporary molars is a promising technique.
Full Text Available Aim: To investigate the effect of Emdogain gel (EMD in pulpotomized primary molars and its clinical and radiographic outcomes. Methods and Materials: In this study, 18 lower second primary molars of nine children were treated by pulpotomy. The teeth were randomly assigned to the EMD (experimental and Formocresol (control groups in each patient (split mouth. Following removal of the coronal pulp and haemostasis, the pulp stumps were covered with Emdogain gel in the experimental group followed by application of resin-modified glass ionomer cement over the gel. In the control group, Formocresol (FC was placed with a cotton pellet over the pulp stumps. Lastly, the teeth in both groups were restored with stainless steel crowns. Results: Nine children referred with clinical failure before/at two months follow up. The radiographic evaluation revealed furcation involvement and extensive radicular radiolucency in molars treated with Emdogain gel. Conclusion: The present study showed the failure of enamel matrix derivative in pulpotomy of primary molars; therefore, we do not recommend using Emdogain as a pulpotomy agent for treatment of cariously exposed primary teeth
Full Text Available Background. The aim of this retrospective study was to compare immediate postoperative pain scores and need for rescue analgesia in children who underwent pulpotomies and restorative treatment and those who underwent restorative treatment only, all under general anaesthesia. Methods. Ninety patients aged between 3 and 7 years who underwent full mouth dental rehabilitation under general anaesthesia were enrolled in the study and reviewed. The experimental group included patients who were treated with at least one pulpotomy, and the control group was treated with dental fillings only. The Wong-Baker FACES scale was used to evaluate self-reported pain and need for rescue analgesia. The data were analysed using the Kruskal-Wallis test, two sample t-tests, chi-square tests, and Pearson’s correlation analysis. Results. Ninety percent of the children experienced postoperative pain in varying degrees of severity. Immediate postoperative pain scores in experimental group were found to be significantly higher than in control group (x2=24.82, p<0.01. In the experimental group, 48% of the children needed rescue analgesia, compared with only 13% of the children in the control group (x2=13.27, p<0.05. Conclusion. Children who underwent pulpotomy treatment had higher postoperative pain scores and greater need for rescue analgesia than control group who underwent only dental fillings.
Taha, Nessrin A; Abdulkhader, Sakhaa Z
This prospective study evaluated the outcome of Biodentine (Septodont, Saint Maur des Fosses, France) pulpotomy in young permanent teeth with carious exposure. Twenty permanent molar teeth in 14 patients with carious pulp exposure were treated with Biodentine pulpotomy. The age of the patients ranged from 9-17 years (12.3 ± 2.7 years). A preoperative pulpal and periapical diagnosis was established. After informed consent, the tooth was anesthetized, isolated via a dental dam, and disinfected with 5% sodium hypochlorite before caries excavation. Full pulpotomy was performed by amputating the exposed pulp to the level of the canal orifices, hemostasis was achieved via a cotton pellet moistened with 2.5% sodium hypochlorite, a 3-mm layer of Biodentine was placed as the pulpotomy agent, a Vitrebond liner (3M ESPE, St Paul, MN) was applied, and the tooth was subsequently restored. Postoperative periapical radiographs were taken after placement of the permanent restoration. Clinical and radiographic evaluation was completed after 6 months and 1 year postoperatively. Pain levels were scored preoperatively and 2 days after treatment. Statistical analysis was performed using the Fisher exact test. Clinical signs and symptoms suggestive of irreversible pulpitis were established in all teeth and symptomatic apical periodontitis in 14 of 20 (70%). Two days after treatment, all patients reported complete relief of pain. All teeth were clinically successful at 6 months and 1 year postoperatively. Radiographically, immature roots showed continued root development; dentin bridge formation was detected in 5 of 20 teeth. Seven of 7 teeth with preoperative periapical rarefaction showed signs of healing; 1 tooth had signs of internal root resorption at 1 year with an overall success rate of 95% (19/20). Young permanent teeth with carious exposure can be treated successfully with full pulpotomy using Biodentine, and clinical signs and symptoms of irreversible pulpitis are
Full Text Available "nBackground and Aims: Formocresol is one of the most common pulpotomy medicaments for primary teeth. Because of its systemic and local side effects, it may be essential to use another material instead of formocresol. The aim of this study was to evaluate the histopothalogy of pulp after pulpotomy teeth with sodium hypochlorite and formocresol. "nMaterials and Methods: In this randomized clinical trial, 22 canine teeth that must be extracted because of orthodontic treatment were selected. The teeth were randomly divided into 2 groups (n=11 and pulpotomized with formocresol or sodium hypochlorite. These teeth were extracted after 2 months and pulpal response was evaluated according to the degree of inflammation and extent of pulpal involvement. Dentinal bridge formation was also evaluated. The data were analyzed by Mann-Whitney test. "nResults: In formocresol group, mild inflammation was seen in 4 and moderate inflammation in 3 and severe inflammation in 4 cases. In sodium hypochlorite group mild inflammation was seen in 6 cases and moderate inflammation in 4 cases and severe inflammation in 1 case. Mann-Whitney test revealed that this difference was not statistically significant (P>0.05. In formocresol group, necrosis was seen in 5 cases, but abscess and internal resorption were not seen in any cases. In sodium hypochlorite group, internal resorption was seen in 3 cases; but necrosis and abscess were not seen in any cases. Mann-Whitney test showed that the difference between two groups was significant in terms of necrosis (P=0.02. In sodium hypochlorite group, dentinal bridge was formed in 3 cases; however, no dentinal bridge formation was seen in formocresol group. Mann-Whitney test showed that this difference was not significant statistically (P>0.05. "nConclusion: Based on the results of this study, sodium hypochlorite can be used as a pulpotomy agent in primary teeth.
Mohammad, Shukry Gamal; Baroudi, Kusai
The objective of this study was to compare the clinical and radiographic effects of Allium sativum oil and formocresol in nonvital pulpotomy in primary teeth. Twenty children ranging in age from 4 to 8 years were included in the study. In every one of those children, pulpotomy was indicated for the primary molars. Pulpotomy procedure was performed and the radicular pulp tissue of one molar was capped with A. sativum oil in a cotton pellet while the other molar was capped with formocresol. The teeth were evaluated clinically and radiographically before and after 6 months using standard clinical and radiographic criteria. Statistically, these results revealed significant difference between the radiographic findings of nonvital pulpotomy in primary molars with the two medicaments. Statistical analysis was performed using independent t-test and paired t-test at the significance level of α = 0.05. A. sativum oil has potent antibacterial properties that enable it to combat intracanal microbes in the infected pulp of primary molars. Better results were obtained when A. sativum oil was used. A. sativum oil had more powerful effects than formocresol on the infected pulp of primary nonvital molars.
Haghgoo, Roza; Taleghani, Ferial
Inferior alveolar nerve block is a common technique for anesthesia of the primary mandibular molars. A number of disadvantages have been shown to be associated with this technique. Periodontal ligament (PDL) injection could be considered as an alternative to inferior alveolar nerve block. The aim of this study was to evaluate the effectiveness of PDL injection in the anesthesia of primary molar pulpotomy with mandibular block. This study was performed using a sequential double-blind randomized trial design. 80 children aged 3-7 years old who required pulpotomy in symmetrical mandibular primary molars were selected. The teeth of these children were anesthetized with periodontal injection on one side of the mandible and block on the other. Pulpotomy was performed on each patient during the same appointment. Signs of discomfort, including hand and body tension and eye movement, the verbal complaint and crying (SEM scale), were evaluated by a dental assistant who was blinded to the treatment allocation of the patients. Finally, the data were analyzed using the exact Fisher test and Pearson Chi-squared exact test. Success rate was 88/75 and 91/25 in the PDL injection and nerve block groups, respectively. There was no statistically significant difference between the two techniques (P = 0.250). Results showed that PDL injection can be used as an alternative to nerve block in pulpotomy of the mandibular primary molars.
Mohammad, Shukry Gamal; Baroudi, Kusai
To compare the effects of Allium sativum oil and formocresol on the pulp tissue of the pulpotomized teeth. Twenty children were selected for this study. All children had a pair of non-vital primary molars. A sterile paper point was dipped in the root canals prior to the mortal pulpotomy. These paper points were collected in transfer media and immediately transported to the microbiological lab to be investigated microbiologically (for Streptococcus mutans and Lactobacillus acidophilus). Then the procedure of mortal pulpotomy was performed. After 2 weeks, the cotton pellets were removed and sterile paper points were dipped in the root canals for microbiological examination. Then comparison between the count of bacteria before and after treatment was conducted. Statistical analysis was performed using independent t-test and paired t-test at the significance level of α = 0.05. After application of both medicaments, there was a marked decrease in S. mutans and L. acidophilus counts. The difference between the mean of log values of the count before and after the application was highly significant for both medicaments (P sativum oil was used. A. sativum oil had more powerful antimicrobial effects than formocresol on the bacteria of the infected root canals.
Mineral trioxide aggregate (MTA) used for pulpotomy procedures in immature permanent teeth can reduce treatment to 1 session as opposed to classic calcium hydroxide therapy, which necessitates multiple appointments. The main disadvantage of MTA use is crown discoloration after treatment. The aim of this study was to characterize 3 materials that are used for pulpotomy procedures in immature permanent teeth and assess their color stability in the presence of sodium hypochlorite solution. Hydrated Neo MTA Plus (Avalon Biomed Inc, Bradenton, FL), MTA Plus (Avalon Biomed Inc), and Biodentine (Septodont, Saint-Maur-des-Fossés, France) were characterized after immersion in Hank's balanced salt solution for 1 day and 28 days using a combination of scanning electron microscopy, energy-dispersive spectroscopy, and X-ray diffraction analysis. The color stability of the 3 materials in contact with water or sodium hypochlorite was evaluated by photography, spectrophotometry, and X-ray diffraction analysis. All the materials hydrated and produced calcium hydroxide as a by-product of hydration at early age. All materials interacted with synthetic tissue fluid, forming a calcium phosphate phase. MTA Plus exhibited discoloration in contact with sodium hypochlorite. All the materials tested are suitable to be used in the treatment of immature teeth because they all produced calcium hydroxide, which is necessary to induce dentin bridge formation and continued root formation. Neo MTA Plus and Biodentine are suitable alternatives to MTA, and they do not exhibit discoloration. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Sakai, Vivien Thiemy; Moretti, A B S; Oliveira, T M; Fornetti, A P C; Santos, C F; Machado, M A A M; Abdo, R C C
This study compared the clinical and radiographic effectiveness of mineral trioxide aggregate (MTA) and Portland cement (PC) as pulp dressing agents in carious primary teeth. Thirty carious primary mandibular molars of children aged 5-9 years old were randomly assigned to MTA or PC groups, and treated by a conventional pulpotomy technique. The teeth were restored with resin modified glass ionomer cement. Clinical and radiographic successes and failures were recorded at 6, 12, 18 and 24-month follow-up. All pulpotomised teeth were clinically and radiographically successful at all follow-up appointments. Six out of 15 teeth in the PC group and five out of 14 teeth in the MTA group exfoliated throughout the follow-up period. No statistically significant difference regarding dentine bridge formation was found between both groups throughout the follow-up period. As far as pulp canal obliteration is concerned, a statistically significant difference was detected at 6-month follow-up (p <0.05), since the beginning of mineralised material deposition could be radiographically detected in 100% and 57.14% of the teeth treated with PC and MTA, respectively. PC may serve as an effective and less expensive MTA substitute in primary molar pulpotomies. Further studies and longer follow-up assessments are needed.
Qudeimat, M A; Alyahya, A; Hasan, A A
To prospectively investigate the clinical and radiographic success rates of pulpotomy in permanent molars with clinical signs and symptoms suggestive of irreversible pulpitis using mineral trioxide aggregate (MTA) as a pulp dressing agent. Sixteen patients with 23 restorable permanent molars exhibiting signs and symptoms indicative of irreversible pulpitis were enrolled. A standardized operative procedure was followed for all participants. All teeth were isolated with a dental dam and caries was removed, and then, pulpotomy performed with a sterile round and/or flame shape diamond burs. Haemostasis was achieved with 5% sodium hypochlorite (NaOCl). A mixture of MTA was placed against the wound, and a moistened cotton pellet was placed over the MTA. Teeth were temporized with a glass-ionomer restoration. Three to ten days later, the interim restoration was removed and setting of MTA was evaluated. Teeth were restored with stainless steel crowns. Follow-up evaluations were scheduled at 3, 6, 12 months and annually thereafter. Descriptive statistics were used to assess outcomes. The age of patients at time of pulpotomy ranged between 7.6 and 13.6 years (mean = 10.7± 1.7 yrs). The majority of teeth (91%) had clinical signs and symptoms consistent with a diagnosis of symptomatic irreversible pulpitis and symptomatic apical periodontitis (78%). The follow-up examination period ranged from 18.9 to 73.6 months. Clinically and radiographically, all pulpotomies were considered successful at the end of the follow-up period. Radiographically, a hard tissue barrier was noticed in 13 (57%) teeth. In children, MTA was associated with high clinical and radiographic success as a pulpotomy agent in permanent teeth with clinical signs and symptoms suggestive of irreversible pulpitis. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.
Full Text Available Background: Preservation of pulp vitality is of utmost importance to the normal physiological functioning of tooth in situ and physiological process of exfoliation in a tooth affected by disease or trauma. Pulpotomy serves such a purpose using various medicaments applied directly on vital pulp. Aim: The aim of this study was to evaluate clinically and radiographically the effects of mineral trioxide aggregate (MTA and formocresol (FC as a pulp dressing after coronal pulp amputation (pulpotomy in primary molars prospectively over a period of 1 year. Materials and Methods: Thirty-three healthy children, aged between 5 and 8 years, requiring pulp therapy were selected after clinical and radiographic assessment. A total of 50 maxillary and mandibular primary molars were treated by the conventional pulpotomy technique. The teeth were divided into two equal groups. In Group A, FC was used as the pulp dressing agent, and in Group B, MTA was used before restoration with stainless steel crowns. The research employed was a prospective study. The teeth treated were assessed postoperatively after 1, 3, 6 and 12 months. The observations were tabulated and statistically analyzed. Results: Clinically, both the groups showed 100% success at 1, 3, 6 and 12 months. At 3 months, the radiographic success rates of FC and MTA were 92% and 96%, respectively, and at 6 and 12 months, the radiographic success rates of FC and MTA were 88% and 96%, respectively. Conclusion: MTA showed a higher success rate than FC and may be a favorable material for pulpotomy in primary molars whose pulps have been compromised by a carious or mechanical pulp exposure
Taha, Nessrin A; Khazali, Mohammad A
This study aimed to assess the outcome of partial pulpotomy using mineral trioxide aggregate (MTA) compared with calcium hydroxide (CH) in mature cariously exposed permanent molars. Fifty permanent molar teeth with carious exposures in 50 patients >20 years old were included. Preoperative pulpal and periapical diagnosis was established based on a history of presenting pain, results of cold testing, and radiographic findings. After informed consent, the tooth was anesthetized, isolated via a dental dam, and disinfected with 5% sodium hypochlorite before caries excavation. Partial pulpotomy was performed by amputating 2 mm of the exposed pulp, hemostasis was achieved, and the tooth was randomly assigned for the placement of either white MTA (White ProRoot; Dentsply, Tulsa, OK) or CH (Dycal; Dentsply Caulk, Milford, DE) as the pulpotomy agent. Postoperative periapical radiographs were taken after placement of the permanent restoration. Clinical and radiographic evaluation was completed after 6 months and 1 and 2 years postoperatively. Statistical analysis was performed using the Fisher exact test. Clinical signs and symptoms suggestive of irreversible pulpitis were established in all teeth. Immediate failure occurred in 4 teeth. At 1 year, MTA showed a higher tendency toward success compared with the CH group, and the difference was statistically significant after 2 years (83% vs 55%, P = .052 at 1 year; 85% vs 43%, P = .006 at 2 years). Sex did not have a statistically significant effect on the outcome. MTA partial pulpotomy sustained a good success rate over the 2-year follow-up in mature permanent teeth clinically diagnosed with irreversible pulpitis. More than half of the CH cases failed within 2 years. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
This experiment is an autoradiographical study of the healing process in pulp wounds following pulpotomy and direct capping with calcium hydroxide. Experimental, young adult, mongrel dogs were divided into the following two groups: A group: Pulpotomy was performed and the following intervals allowed to lapse between amputation and sacrifice. One hour before sacrifice, 1μCi/gbw 3 H-thymidine was injected intravenously (flash labeling). B group: Single pulse labeling was performed either one day (1 spl) or two days (2 spl) after amputation. During the first two days after amputation, pulp stem cells under the cutting surface divided and proliferated, with the proliferative rate reaching a maximum during the second day and decreased gradually from the fourth day after pulpotomy. Cells in the first zone became columnar in shapes and assumed a regular arrangement under the necrotic layer. Though these cells were unlabeled in the A group, they were prominently labeled in the B group. These finding indicate a part of the proliferated undifferentiated mesenchymal cells migrated and regularly arranged beneath the necrotic layer, differentiated into odontoblasts and then produced a dentine bridge. The remaining undifferentiated mesenchymal cells in the second zone reverted to pulp stem cells to accomplish healing. (auth.)
Bhagat, Dipti; Sunder, Ravi Kadur; Devendrappa, Shashikiran Nandihalli; Vanka, Amit; Choudaha, Nidhi
Recently, some studies have compared mineral trioxide aggregate (MTA) with portland cement (PC), concluding that the principle ingredients of PC are similar to those of MTA. The purpose of the present study was to evaluate the biocompatibility of PC as a pulpotomy medicament. Thirty premolars that scheduled for extraction for therapeutic reasons were randomly assigned to two experimental groups: ProRoot MTA (PMTA) and PC. After isolation and pulp exposure, pulpotomy was carried out and pulps were dressed with PMTA and PC. After 6 months, the teeth were extracted and prepared for histological analysis based on Cox et al. criteria. The data were analyzed by Z-test of proportion with 1% of allowed error. No statistically significant difference was found between the two groups with respect to inflammatory response, soft tissue organization, and dentine bridge formation (P > 0.05). PC was associated with similar favorable biological response to pulpotomy treatment as PMTA. The findings of this study support the idea that PC can be considered a cheaper substitute to MTA.
Full Text Available Aim: This study aimed to evaluate and compare the Platelet-rich fibrin (PRF and Mineral trioxide aggregate (MTA as a pulpotomy agent in primary molars. Material and Methods: In this study, 50 primary molars from 50 healthy children aged 5–9 years requiring pulpotomy were randomly allocated into two groups. In PRF group, after coronal pulp removal and hemostasis, remaining pulp tissue was covered with PRF preparation. In the MTA group, the pulp stumps were covered with MTA (Pro Root MTA-Root Canal Repair Material, Dentsply International Inc. paste obtained by mixing MTA powder with sterile water at a 3:1 powder to water ratio. All teeth were restored with reinforced zinc oxide eugenol base and glass – ionomer cement. Stainless steel crowns were given in both groups 24 h after treatment. Clinical evaluation was undertaken at 1, 3, and 6 months intervals whereas radiographic evaluation of the treated teeth was carried out at the interval of 6 months. Results: By the end of 6 months, the overall success rate was 90% in PRF group and 92% in MTA Group. A statistically significant difference was observed between the groups at 6 months of follow-up (P 0.05. Conclusion: Radiographic and clinical outcome in PRF group could suggest it as an acceptable alternative in pulpotomy of primary teeth. PRF holds a promising future in the area of primary tooth vital pulp therapy.
Asgary, Saeed; Nourzadeh, Mahdieh; Eghbal, Mohammad Jafar
Human dental pulp inflammation can progress to periapical lesion formation and conventional root canal treatment (RCT) has been the traditional method for disease management. This observational study presents two cases of vital pulp therapy in mature molars diagnosed with irreversible pulpitis and associated with apical periodontitis. In these two clinical cases, the involved teeth had deep carious lesions with a history of spontaneous/lingering pain and radiographic examinations revealed the presence of apical radiolucencies. A conservative miniature pulpotomy (MP) using calcium-enriched mixture (CEM) was performed and the teeth were permanently restored with amalgam. Clinical evaluations indicated resolution of pain 24 hours after treatment; the teeth showed normal vitality, remained asymptomatic and maintained normal function after recall examinations. Furthermore, the 18-month radiographic evaluation showed healing of the apical lesions. Vital pulp therapy using the MP technique with CEM appeared successful in avoiding RCT intervention. These two reports of case outcome suggest that simple MP using a CEM bioregenerative technique may provide a favorable outcome for permanent teeth diagnosed with irreversible pulpitis and associated with apical periodontitis.
Full Text Available 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.
Kumar, Varun; Juneja, Ruchi; Duhan, Jigyasa; Sangwan, Pankaj; Tewari, Sanjay
Background: Pulpotomy has been proposed as an alternative for the management of irreversible pulpitis in permanent molars with closed apices. Aim: To compare the performances of calcium hydroxide (CH), mineral trioxide aggregate (MTA), and platelet-rich fibrin (PRF) as pulpotomy agents in mature permanent molars with irreversible pulpitis. Materials and Methods: Fifty-four permanent mandibular molars with carious exposure and symptoms of irreversible pulpitis were randomly allocated to three groups, and full pulpotomy was performed using CH, MTA, or PRF as pulpotomy agents. Pain intensity was recorded using numeric rating scale score at baseline, 24 h, 7 days, 6 months, and 1 year. Clinical and radiographic assessments were done at 6 months and 1 year. Statistical Analysis: Kruskal–Wallis test and Friedman test were used for intergroup and intragroup comparison of pain scores, respectively. The radiographic outcomes between the three study arms were compared using Chi-square test. Results: Clinical success rate was 94.4% at 7 days, which dropped to 85.4% at 12 months. All three agents were equally effective in providing pain relief at all the intervals tested, with no significant difference between them (P > 0.05 at all intervals). However, at 6 months and 12 months, 26.2% and 52.4% teeth depicted slight widening of periodontal ligament space. No significant difference was observed between the radiographic success rates observed with the three groups (P = 0.135 at 6 months, 0.717 at 12 months). Conclusion: Pulpotomy exhibited a high clinical success rate in mature molars with irreversible pulpitis and selection of biomaterial did not affect its outcome. PMID:27994420
Asgary, Saeed; Verma, Prashant; Nosrat, Ali
Root canal therapy (RCT) is a common and successful treatment for irreversible pulpitis due to carious pulp exposure in mature permanent teeth. However, it is often an expensive procedure, may require multiple appointments, and requires a high level of training and clinical skill, specifically in molars. Uninsured patients, low-income patients, and patients with limited access to specialist care often elect for extraction of restorable teeth with irreversible pulpitis. There is a need for an alternative affordable treatment option to preserve their teeth and maintain chewing function. A case of pulpotomy using calcium-enriched mixture (CEM) cement in two maxillary molars (#14 and 15) in a healthy 36-year-old patient is presented. Both teeth were diagnosed with symptomatic hyperplastic/irreversible pulpitis. Patient did not have dental insurance, was unable to afford RCT, and refused to extract the teeth. CEM pulpotomy and amalgam build-ups were done as an alternative to extraction. At 2-year recall, both teeth were functional with no signs/symptoms of inflammation/infection. Periapical radiographs and 3D images showed normal PDL around all roots. Pulpotomy with CEM biomaterial might be a viable alternative to tooth extraction for mature permanent teeth with hyperplastic/irreversible pulpitis, and can result in long-term tooth retention and improved oral health. PMID:28512498
Yildirim, Ceren; Basak, Feridun; Akgun, Ozlem Marti; Polat, Gunseli Guven; Altun, Ceyhan
The aim of this study was to evaluate and to compare clinical and radiographic outcomes of 4 materials (formocresol, mineral trioxide aggregate (MTA), Portland cement and enamel matrix derivative) using in primary teeth pulpotomies. Sixty-five patients aged 5-9 years (32 female, 33 male) were included in this study. A total of 140 primary first and second molars with deep caries were treated with pulpotomy. All teeth were then restored with stainless steel crowns. The treated teeth were evaluated clinically and radiographically at 3, 6, 12, 18 and 24 months. At 24 months, the clinical success rates of formocresol, MTA, Portland cement, and enamel matrix derivative were 96.9%, 100%, 93.9%, and 93.3%, respectively. The corresponding radiographic success rates were 84.4%, 93.9%, 86.7% and 78.1%, respectively. Although there were no statistically significant differences in clinical and radiographic success rates among the 4 groups, MTA appears to be superior to formocresol, Portland cement, and enamel matrix derivative as a pulpotomy agent in primary teeth.
Marques, N; Lourenço Neto, N; Fernandes, A P; Rodini, C; Hungaro Duarte, M; Rios, D; Machado, M A; Oliveira, T
The objective of this research was to evaluate the response of Portland cement associated with different radio pacifying agents on pulp treatment of human primary teeth by clinical and radiographic exams and microscopic analysis. Thirty mandibular primary molars were randomly divided into the following groups: Group I - Portland cement; Group II - Portland cement with iodoform (Portland cement + CHI3 ); Group III - Portland cement with zirconium oxide (Portland cement + ZrO2 ); and treated by pulpotomy technique (removal of a portion of the pulp aiming to maintain the vitally of the remaining radicular pulp tissue using a therapeutic dressing). Clinical and radiographic evaluations were recorded at 6, 12 and 24 months follow-up. The teeth at the regular exfoliation period were extracted and processed for histological analysis. Data were tested using statistical analysis with a significance level of 5%. The microscopic findings were descriptively analysed. All treated teeth were clinically and radiographically successful at follow-up appointments. The microscopic analysis revealed positive response to pulp repair with hard tissue barrier formation and pulp calcification in the remaining roots of all available teeth. The findings of this study suggest that primary teeth pulp tissue exhibited satisfactory biological response to Portland cement associated with radio pacifying agents. However, further studies with long-term follow-up are needed to determine the safe clinical indication of this alternative material for pulp therapy of primary teeth. © 2015 The Authors Journal of Microscopy © 2015 Royal Microscopical Society.
Coronal Pulpotomy Technique Analysis as an Alternative to Pulpectomy for Preserving the Tooth Vitality, in the Context of Tissue Regeneration: A Correlated Clinical Study across 4 Adult Permanent Molars
Raji Viola Solomon
Full Text Available Aim. (1 The aim of the clinical study revolves around the accurate diagnosis, proper case selection, and the management of acute irreversible pulpitis in permanent molars with closed apices using conservative and economical treatment modalities like vital pulpotomies with regenerative approaches over conventional root canal procedures. (2 To evaluate the use of autologous substances such as platelet concentrates and calcium silicate based materials in promoting the healing and regeneration of the inflamed pulp. Summary. Vital pulpotomy was performed on 5 carious involved, permanent molars diagnosed with acute irreversible pulpitis in 17- to 22-year-old patients. Taking into consideration the patient’s age and the condition of the underlying pulp tissue, PRF pulpotomy was planned in view of preserving the vitality of the intact radicular pulps. Regenerative procedures with second generation blood matrices were chosen to encourage the recovery of the inflamed pulps. The systematic follow-up examinations performed at 3, 6, 9, 12, 18, 22, and 24 months revealed a successful clinical and radiological outcome. Within the limits of the present clinical study and correlating the success across the treated clinical cases, we safely conclude the potential scope of regenerative pulpotomy approaches in acute irreversible pulpitis in adult permanent teeth.
Flávio Fernando Demarco
Full Text Available The aim of this study was to evaluate the clinical status of pulpotomy treatment with calcium hydroxide and to correlate it with the quality of restoration of the treated teeth. Patients were retrieved from the files of the Operative Dentistry clinics (FOUFPel between 1996 and 2000. Twenty-two patients were recalled, which had 23 teeth treated with pulpotomy due to exposure by caries. Seven anterior and 16 posterior teeth composed the evaluated group, being all restored with composite resin. The age varied from 15-50 years (mean 23.9 and the follow-up mean was 34.52 months. Clinical and radiographic examinations were performed to evaluate the clinical status of treatment. The criteria used, clinically favorable and failure, were based on the following clinical exams: pulp vitality; sensitivity; and periapical alterations. The quality of the restorations was based on the USPHS criteria. Pulpotomy treatment was ranked as clinically favorable in 10 teeth (43.5%, 4 in anterior and 6 in posterior teeth. Failure was verified in 13 teeth (56.5%, 4 anterior and 9 posterior. From the group clinically favorable, 90% of the restorations were ranked as clinically satisfactory, while only 10% were unsatisfactory. In the failure group, 77.8% of the restorations were classified was unsatisfactory and 22.2% were ranked as satisfactory. The statistical analysis (Fisher´s exact test demonstrated that there is a statistically significant association between the clinical status of pulpotomy and restoration quality (pO objetivo deste estudo foi avaliar a condição clínica de dentes submetidos à pulpotomia com hidróxido de cálcio, correlacionando com a qualidade das restaurações dos respectivos dentes. A partir dos prontuários da clínica de Odontologia Restauradora da FOUFPel, foram selecionados 22 pacientes (23 dentes submetidos a pulpotomia entre 1996 e 2000. Ao todo, 23 dentes (7 anteriores e 16 posteriores receberam o tratamento de pulpotomia, indicado
Diana Santana de Albuquerque
Full Text Available The aim of this study was to evaluate histological aspects of the pulp-dentin complex of dogs submitted to pulpotomy and capped with ethyl-cyanoacrylate and calcium hydroxide. Thirty dog teeth were divided into 2 groups of 15 as follows: Group 1 - ethyl-cyanoacrylate; Group 2 - calcium hydroxide. The pulpotomies were carried out following all of the treatment precautions recommended for dogs. After 30 days the specimens were submitted to histological preparation and were then blindly evaluated by a histologist. Data were analyzed statistically by the Fisher exact test, comparing the two groups. After 30 days, the presence of a hard tissue barrier was observed in 83.3% of Group 1, and in 100% of Group 2 (p = 0.478. A continuous hard tissue barrier was observed in 50% of the ethyl-cyanoacrylate group and 75% of the calcium hydroxide group (p = 0.652. It can be concluded that both materials induced hard tissue barrier formation, but Group 2 had a higher percentage than Group 1, with no significant statistical differences; the differences observed between the different barriers (continuous/non-continuous were not significant between groups and there was no pulpal necrosis in either group.O objetivo do presente estudo foi avaliar o aspecto histológico do complexo dentino-pulpar de cachorros quando capeado após a pulpotomia com etil-cianoacrilato e hidróxido de cálcio. Trinta dentes de cães foram divididos em 2 grupos de 15 da seguinte forma: Grupo 1 - Etil-cianoacrilato; Grupo 2 - Hidróxido de cálcio. A pesquisa foi realizada tomando-se todos os cuidados recomendados para o tratamento com os cães. Após 30 dias do procedimento realizado os espécimes foram submetidos ao preparo histológico e logo após foram avaliados de forma cega por um histologista. Os resultados foram analisados estatisticamente através do Teste Exato de Fisher. No grupo 1, 83,3% e no grupo 2, 100% dos dentes apresentaram a barreira de tecido duro (p = 0,478. A barreira
Microscopic analysis of dog dental pulp after pulpotomy and pulp protection with mineral trioxide aggregate and white Portland cement Análise microscópica da polpa dental de cães após pulpotomia e proteção pulpar com agregado de trióxido mineral e cimento Portland branco
Full Text Available Considering previous studies on the similarity between the chemical composition of the mineral trioxide aggregate and the Portland cement, the purpose of this study was to investigate the pulp response of dog's teeth after pulpotomy and direct pulp protection with MTA Angelus and white Portland cement. Thirty eight pulp remnants were protected with these materials. One hundred and twenty days after treatment, the animals were sacrificed and the specimens removed and prepared for histological analysis. Both materials demonstrated the same results when used as pulp capping materials, inducing hard tissue bridge formation and maintaining pulp vitality in all specimens. The MTA Angelus and the white Portland cement showed to be effective as pulp protection materials following pulpotomy.Considerando estudos anteriores sobre a similaridade entre a composição química do agregado de trióxido mineral e o cimento Portland, o objetivo deste estudo foi investigar a resposta pulpar de dentes de cães após pulpotomia e proteção pulpar direta com MTA Angelus e cimento Portland branco. Trinta e oito remanescentes pulpares foram recobertos com esses materiais. Cento e vinte dias após o tratamento, os animais foram sacrificados e os espécimes removidos e preparados para análise histológica. Ambos os materiais demonstraram os mesmos resultados quando utilizados como materiais de capeamento pulpar, induzindo a formação de ponte de tecido mineralizado e mantendo a vitalidade pulpar em todos os espécimes. Ambos matérias se mostraram efetivos como protetores pulpares após pulpotomia em dentes de cães.
Sep 16, 2014 ... ... and Methods: Fifty primary molars, with deep carious lesion that exposed a vital but asymptomatic pulp, .... and/or periapical bone destruction or pulp stones. ... following: A normal periodontal ligament space, no furcation.
Yazdani, Shahram; Jadidfard, Mohammad-Pooyan; Tahani, Bahareh; Kazemian, Ali; Dianat, Omid; Alim Marvasti, Laleh
Introduction: Teeth with irreversible pulpitis usually undergo root canal therapy (RCT). This treatment modality is often considered disadvantageous as it removes vital pulp tissue and weakens the tooth structure. A relatively new concept has risen which suggests vital pulp therapy (VPT) for irreversible pulpitis. VPT with calcium enriched mixture (VPT/CEM) has demonstrated favorable treatment outcomes when treating permanent molars with irreversible pulpitis. This study aims to compare patient related factors, safety and organizational consideration as parts of health technology assessment (HTA) of the new VPT/CEM biotechnology when compared with RCT. Materials and Methods: Patient related factors were assessed by looking at short- and long-term clinical success; safety related factors were evaluated by a specialist committee and discussion board involved in formulating healthcare policies. Organizational evaluation was performed and the social implications were assessed by estimating the costs, availability, accessibility and acceptability. The impact of VPT/CEM biotechnology was assessed by investigating the incidence of irreversible pulpitis and the effect of this treatment on reducing the burden of disease. Results: VPT/CEM biotechnology was deemed feasible and acceptable like RCT; however, it was more successful, accessible, affordable, available and also safer than RCT. Conclusion: When considering socioeconomic implications on oral health status and oral health-related quality of life of VPT/CEM, the novel biotechnology can be more effective and more efficient than RCT in mature permanent molars with irreversible pulpitis. PMID:24396372
Bjørndal, Lars; Reit, Claes; Bruun, Gitte Hoffmann
Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had car...
Asgary, Saeed; Fazlyab, Mahta; Sabbagh, Sedigheh; Eghbal, Mohammad Jafar
In modern endodontics, vital pulp therapy (VPT) has been considered an ultra-conservative treatment modality. Based on the level of pulp preservation, VPT includes stepwise excavation, indirect pulp capping (IDPC), direct pulp capping (DPC), miniature pulpotomy (MP), partial/Cvek pulpotomy and coronal/complete pulpotomy (CP). The present article reviews the treatment outcomes of 94 permanent teeth with irreversible pulpitis treated with either IDPC (n=28), DPC (n=28), MP (n=29) or CP (n=9) us...
Natália Gomes e Silva Leonardo
Conclusions: This study demonstrated that all tested materials induced teeth shade changes after 30 days of simulated pulpotomy. The mean variation of color was similar between groups and CAC caused the higher color change.
Mohammad, Shukry Gamal; Raheel, Syed Ahmed; Baroudi, Kusai
The objective of this study was to compare between the clinical and radiographic effects of Allium sativum oil and those of formocresol in vital pulpotomy in primary teeth. A total of 20 children age ranged from 4 to 8 years were included in the study. In every one of those children, the primary molars indicated for pulpotomy. Pulpotomy procedure was performed, and the radicular pulp tissue of one molar capped with A. sativum oil in a cotton pellet, whereas the other molar capped with formocresol, the teeth evaluated clinically and radiographically before and after 6 months, using standard clinical and radiographical criteria. Statistically, these results revealed no significant difference between the radiographic findings of vital pulpotomy in primary molars with the two medicaments was found. A. sativum oil offers a good healing potential, leaving the remaining pulp tissue healthy and functioning. Vital pulpotomy with allium sativa oil was given raise 90% success rate while that with formocresol was 85%. A. sativum oil is a biocompatible material that is compatible with vital human pulp tissue. It offers a good healing potential, leaving the remaining pulp tissue healthy and functioning.
Bane, Khaly; Charpentier, Emmanuel; Bronnec, François; Descroix, Vianney; Gaye-N'diaye, Fatou; Kane, Abdoul Wahabe; Toledo, Rafael; Machtou, Pierre; Azérad, Jean
The present study reports the results of a randomized clinical trial comparing local intraosseous methylprednisolone injection and emergency pulpotomy in the management of acute pulpitis on efficacy, safety, and efficiency end points. After providing prior informed written consent, 94 patients consulting for acute irreversible pulpitis pain at university-affiliated teaching hospital dental clinics in Dakar, Senegal were randomly assigned to either the methylprednisolone treatment group (n = 47) or the pulpotomy treatment group (n = 47). Patients were followed up at 1 week and assessed 6 months later to evaluate the therapeutic outcome of their treatment. At day 7 the patients in the methylprednisolone group reported less intense spontaneous and percussion pain in the day 0-day 7 period than the patients in the pulpotomy group. Methylprednisolone treatment took approximately 7 minutes (4.6-9.3) less to accomplish than pulpotomy (or about half the time). No difference in the therapeutic outcome was found between the 2 treatment groups at 6 months (all credible intervals span 0). This study establishes that methylprednisolone injection for acute pulpitis is relieved by a minimally invasive pharmacologic approach more effectively than by the reference pulpotomy and conserves scarce dental resources (ie, endodontic equipment and supplies, dental surgeon's time). Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Asgary, Saeed; Fazlyab, Mahta; Sabbagh, Sedigheh; Eghbal, Mohammad Jafar
In modern endodontics, vital pulp therapy (VPT) has been considered an ultra-conservative treatment modality. Based on the level of pulp preservation, VPT includes stepwise excavation, indirect pulp capping (IDPC), direct pulp capping (DPC), miniature pulpotomy (MP), partial/Cvek pulpotomy and coronal/complete pulpotomy (CP). The present article reviews the treatment outcomes of 94 permanent teeth with irreversible pulpitis treated with either IDPC (n=28), DPC (n=28), MP (n=29) or CP (n=9) using calcium-enriched mixture (CEM) cement. After a mean follow-up time of 12.3 months, 93 treated teeth were radiographic/clinically successful; only one radiographic failure was observed in the DPC group.
Jul 24, 2016 ... 2017 Nigerian Journal of Clinical Practice | Published by Wolters Kluwer ‑ ... pulpotomy treatment in primary teeth,[1-6] researches which ... Restorable teeth following completion of procedure. ... pulp tissue was completely removed with low-speed .... radiographic failure was observed in seven teeth from.
Conclusion: Although general anesthesia provides an optimal condition for treating children with high caries risk, high failure rates of composite restorations were noted. Indirect pulp capping and ferric sulfate pulpotomy followed by stainless steel crown restorations are successful techniques and can be used to treat deep carious lesions.
Gani, O; Crosa, M E
We have studied the changes presented by mediate and immediate roentgenographic images of indirect pulp capping and pulpotomies. In the cases of indirect pulp capping it was observed an increase of radiolucidity in the places occupied by Ca(OH)2, and sclerotic dentin was present. In pulpotomies, it was found the dentin bridge, which thickness increases with time. The radiolucidity of pulp chamber occupied by Ca(OH)2 was greater in the long time treatment. The radiopacity of non-vital dentin of walls and floor chamber was increased too. It has suggested that Ca++ ion would have migrated from its place and probably would take part in the synthesis of sclerotic dentin, independently of the vitality of the tissue.
Vijay Prakash Mathur
Full Text Available Traumatic injuries occur commonly in children and adolescents and the prevalence of such injuries has increased over the last decade. Such injuries may result in pulpal exposure, which can endanger tooth vitality. Therefore, the treatment for such injuries should be carefully planned so as to preserve the pulp vitality. Teeth with immature roots pose a great challenge for the clinician and procedures like pulpotomy may prove effective as a treatment strategy. Such procedure may ensure continued root development and apexogenesis. Lasers have varied applications in the dental practice such as oral surgical procedures, cavity preparation, disinfection etc. This article is a case report on the use of diode laser for pulpotomy in a young permanent tooth with traumatically exposed pulp in an 8-year-old male.
Kaufman, A Y; Kaffe, I; Littner, M M
Endodontic treatment of a case of fused immature central incisor with a supernumerary tooth with dens in dente is described. Although a chronic dentoalveolar abscess was diagnosed, vitality test signs were positive. Treatment consisted of pulpotomy with calcium hydroxide paste; after 2 1/2 months a permanent root canal filling was placed in the amputated part. Follow-up 2 years postoperatively indicated that the tooth has maintained its vitality. The periapical area is completely healed, and apical closure is evident.
He, W X; Liu, N N; Wang, X L; He, X Y
Since laser was introduced in the field of medicine in 1970's, its application range has continuously expanded. The application of laser in endodontics also increased due to its safety and effectiveness in dental treatments. The majority of the laser application researches in dentistry focused on dentin hypersensitivity, removal of carious tissues, tooth preparations, pulp capping or pulpotomy, and root canal treatment. In this article, we reviewed literature on the effects of laser in the treatments of dental and pulp diseases.
Menezes, Renato; Bramante, Clóvis Monteiro; Garcia, Roberto Brandão; Letra, Ariadne; Carvalho, Vanessa Graciela Gomes; Carneiro, Everdan; Brunini, Sérgio; Oliveira, Rodrigo Cardoso; Canova, Giovana Calichio; Moraes, Fernanda Gomes de
Considering previous studies on the similarity between the chemical composition of the mineral trioxide aggregate and the Portland cement, the purpose of this study was to investigate the pulp response of dog's teeth after pulpotomy and direct pulp protection with MTA Angelus and white Portland cement. Thirty eight pulp remnants were protected with these materials. One hundred and twenty days after treatment, the animals were sacrificed and the specimens removed and prepared for histological ...
Full Text Available Persistent hemorrhage after complete amputation of coronal pulp is a common clinical finding during pulpotomy procedure in primary teeth. These teeth are best managed with pulpectomy, but they have hyperemic pulp with some remaining vital tissue. Good chemico-biomechanical preparation of primary canals cannot guarantee complete removal of this vital tissue from inaccessible areas. Use of Ca(OH 2 containing root filling pastes in vital pulp tissue can cause accelerated resorption of primary roots. The possible mechanism behind such extensive root resorption is discussed with review of literature. A case report of a child with 30 months follow-up is presented and discussed.
Full Text Available Paraformaldehyde has been used in the past as a pulpotomy agent. However, it has a severe cytotoxic effect and may cause alveolar bone necrosis. Depulpin, a devitalizing agent containing 49% paraformaldehyde, is no longer used frequently due to its severe side effects. In the two cases described in the present study, Depulpin was used as a devitalizing agent during root canal treatment. It caused a gradual loss of sensibility in adjacent teeth, gingival necrosis, and osteomyelitis. This case report demonstrates the serious side effects of using a paraformaldehyde-containing paste as a devitalizing agent for pulp, particularly mandibular bone necrosis.
Dawood, Alaa E; Manton, David J; Parashos, Peter; Wong, Rebecca H K
To investigate the displacement of Biodentine ™ following cementation of stainless steel crowns (SSC) with glass-ionomer cement (GIC) on plastic deciduous teeth prepared for pulpotomy. Twenty plastic teeth with prepared occlusal cavities were divided into four groups and had Biodentine ™ placed as a mock pulpotomy agent. The pulp chamber was filled with freshly mixed Biodentine ™ then a GIC-loaded SSC was seated on the tooth using a standardized seating force for periods of: 1 min (Group 1); 2 min (Group 2), 3 min (Group 3) and 6 min (Group 4) after mixing. After 24 h at 37°C and 90% humidity, the crowns were sectioned mesio-distally and standardized digital photographs taken. Image analysis software was used to determine the ratio of the surface area of displaced Biodentine ™ relative to the surface area of the pulp chamber. The thinnest section of the remaining Biodentine ™ was measured. The lowest values of Biodentine ™ displacement and the highest values of remaining Biodentine ™ thickness were associated with Group 4. There were no significant differences between the results in Group 3 and Group 4. Within the limitations of this in vitro study, a GIC-loaded SSC can be seated on Biodentine ™ placed into a pulp chamber 3 min after mixing. © 2015 Wiley Publishing Asia Pty Ltd.
Késsia Suênia Fidelis Mesquita-Guimarães
Full Text Available Objective. This case report describes the changes in caries risk and activity and dental treatment of a 9-year-old patient who presented with signs and symptoms of Niemann-Pick disease type C (NPC. Treatment. The preventive dental treatment included instructions to caregivers for oral hygiene and diet. A calcium hydroxide pulpotomy and restorative dental treatments were performed in a dental office with desensitization techniques and behavioral management. The patient was attended every 3 months for the control of dental plaque biofilm, for topical fluoride application, and for observing the pulpotomized tooth. Results. The bacterial plaque biofilm was being adequately controlled by the caregiver. After 2 years, the clinical and radiographic examination of the pulpotomized tooth showed the absence of internal root resorption and bone rarefaction, and clinical examination showed tooth sensitivity, dental pain, and gingival swelling. Conclusion. The pulpotomy prevented clinical and radiographic success. Dentists must be aware of and be able to identify systemic and local aspects associated with caries risk of children with NPC disease. Furthermore, dentists must employ stringent preventive measures and provide instructions to caregivers to reduce caries risk.
Full Text Available Aim: The present study was undertaken to evaluate the effect of alternative pulpotomy agents such as glutaraldehyde and ferric sulfate on the shear bond strength of self-etch adhesive systems to dentin of primary teeth. Materials and Methods: Eighty human primary molar teeth were sectioned in a mesiodistal direction and divided into experimental and control groups. Lingual dentin specimens in experimental groups were treated with glutaraldehyde and ferric sulfate. Buccal surfaces soaked in water served as control group. Each group was then divided into two groups based on the adhesive system used: Clearfil SE Bond and Adper Prompt L-Pop. A teflon mold was used to build the composite (Filtek Z-250 cylinders on the dentinal surface of all the specimens. Shear bond strength was tested for all the specimens with an Instron Universal Testing Machine. The failure mode analysis was performed with a Scanning Electron Microscope (SEM. Results: The results revealed that glutaraldehyde and ferric sulfate significantly reduced the shear bond strength of the tested adhesive systems to primary dentin. Clearfil SE Bond showed much higher shear bond strength than Adper Prompt L Pop to primary dentin. SEM analysis revealed a predominant cohesive failure mode for both adhesive systems. Conclusion: This study revealed that the pulpotomy medicaments glutaraldehyde and ferric sulfate adversely affected the bonding of self-etch adhesive systems to primary dentin.
Elbay, Ülkü Şermet; Elbay, Mesut; Kaya, Emine; Yıldırım, Sinem
The purpose of the study was to compare the efficacy, injection pain, duration of soft tissue anesthesia, and postoperative complications of two different anesthetics (2% lidocaine with 1:80,000 epinephrine and 3% plain mepivacaine) in pediatric patients in inferior alveolar nerve block (IANB) administered by a computer-controlled delivery system (CCDS). The study was conducted as a randomized, controlled-crossover, double-blind clinical trial with 60 children requiring bilateral pulpotomy or extraction of primary mandibular molars. A CCDS was used to deliver 3% mepivacaine to 1 primary tooth and 2% lidocaine to the contralateral tooth with an IANB technique. Severity of pain and efficacy of anesthesia were evaluated using the Face, Legs, Activity, Cry, Consolability Scale, and comfort and side effects were assessed using a questionnaire. Data were analyzed using the Mann-Whitney U, Wilcoxon t, and Fisher exact tests. Patients receiving 2% lidocaine experienced significantly less pain during injection than those receiving 3% mepivacaine, and no significant differences were found in the pain scores during treatments or in postoperative complications between the two anesthetics. The mean durations of anesthesia for 3% mepivacaine and 2% lidocaine were 139.68 minutes and 149.10 minutes, respectively. Plain mepivacaine and 2% lidocaine were similarly effective in pulpotomy and the extraction of primary mandibular molars. Although the use of 3% mepivacaine provided a shorter duration of anesthesia than 2% lidocaine, both solutions showed similar results in terms of postoperative complications.
Xuedong, Zhou; Dingming, Huang; Jianguo, Liu; Zhengwei, Huang; Xin, Wei; Deqin, Yang; Jin, Zhao; Liming, Chen; Lin, Zhu; Yanhong, Li; Jiyao, Li
The development of an expert consensus on vital pulp therapy can provide practical guidance for the improvement of pulp damage care in China. Dental pulp disease is a major type of illness that adversely affects human oral health. Pulp capping and pulpotomy are currently the main methods for vital pulp therapy. Along with the development of minimal invasion cosmetic dentistry, using different treatment technologies and materials reasonably, preserving healthy tooth tissue, and extending tooth save time have become urgent problems that call for immediate solution in dental clinics. This paper summarizes the experiences and knowledge of endodontic experts. We develop a clinical path of vital pulp therapy for clinical work by utilizing the nature, approach, and degree of pulp damage as references, defense and self-repairing ability of pulp as guidance, and modern technologies of diagnosis and treatment as means.
Full Text Available This case report describes the multidisciplinary management of subgingival horizontal crown-root fracture of an immature permanent maxillary central incisor in a 10-year-old boy. After removal of the fractured fragment, pulpotomy was performed within 48 h from the injury to promote apexogenesis. The tooth was orthodontically extruded until the fracture line was located above the alveolar bone level. Frenectomy, supracrestal fiberotomy, and crown lengthening were performed after adequate stabilization of the extruded tooth for 5 months. Finally, the tooth was restored with composite resin by using the acid etch technique. This report highlights that a multidisciplinary treatment approach with strict cooperation among specialists to manage a complicated crown-root fracture can save and restore a traumatized immature permanent tooth.
Dawood, Alaa E; Parashos, Peter; Wong, Rebecca H K; Reynolds, Eric C; Manton, David J
Mineral trioxide aggregate (MTA) is a calcium silicate-based cement (CSC) commonly used in endodontic procedures involving pulpal regeneration and hard tissue repair, such as pulp capping, pulpotomy, apexogenesis, apexification, perforation repair, and root-end filling. Despite the superior laboratory and clinical performance of MTA in comparison with previous endodontic repair cements, such as Ca(OH) 2 , MTA has poor handling properties and a long setting time. New CSC have been commercially launched and marketed to overcome the limitations of MTA. The aim of the present review was to explore the available literature on new CSC products, and to give evidence-based recommendations for the clinical use of these materials. Within the limitations of the available data in the literature regarding the properties and performance of the new CSC, the newer products could be promising alternatives to MTA; however, further research is required to support this assumption. © 2015 Wiley Publishing Asia Pty Ltd.
Full Text Available Dens evaginatus is the developmental anomaly of tooth that exhibits protrusion of a tubercle from occlusal surfaces of premolar, and lingual surfaces of maxillary central incisor and lateral incisors. Dens evaginatus is common in Caucasian population. Saudi Arabia is also well evidenced of such cases. These tubercles have an enamel layer covering dentin core containing a thin extension of pulp. These cusp-like protrusions are susceptible to pulp exposure from wear or fracture because of malocclusion. Type II dens evaginatus involves normal pulp with immature root apex. Materials to enhance the pulpal recession or pulpotomy procedures indicated in such cases require long time and efforts to ensure pulpal recession or root maturity, respectively. Also prolonged treatment has risk of fracture of the cusp and reinfection and requires patient commitment for the follow-up procedures. Present case describes the use of mineral trioxide aggregate (MTA in type II dens evaginatus of maxillary central incisor.
Full Text Available Calcium-enriched mixture (CEM has been recently introduced as a hydrophilic tooth-colored cement. The CEM cement powder is composed of calcium oxide, calcium sulfate, phosphorus oxide, and silica as major elements. CEM is alkaline cement (pH~11 that releases calcium hydroxide (CH during and after setting. The physical properties of CEM, such as flow, film thickness, and primary setting time are favorable. This cement is biocompatible and induces formation of cementum, dentin, bone and periodontal tissues. This novel cement has an antibacterial effect comparable to CH and superior to mineral trioxide aggregate (MTA and sealing ability similar to MTA. Its clinical applications include pulp capping, pulpotomy, root-end filling and perforation repair. This review describes the composition, properties and clinical applications of CEM in endodontics.
Rutkauskas, John; Seale, N Sue; Casamassimo, Paul; Rutkauskas, John S
For children to receive needed oral health care, adequate training at both the predoctoral and postdoctoral levels of dental education is required, but previous studies have found inadequacies in predoctoral education that lead to general dentists' unwillingness to treat certain young populations. As another way of assessing predoctoral preparation, the aim of this study was to determine the perspectives of first-year residents and pediatric program directors about residents' preparedness to enter advanced education programs in pediatric dentistry. Surveys were sent to all 74 U.S. program directors and 360 first-year residents. The survey focused on procedures related to prevention, behavior management, restorative procedures, pulp therapy, sedation, and surgery, as well as treating patients funded by Medicaid and with special health care needs. Among the first-year residents, 173 surveys were returned for a 48% response rate; 61 directors returned surveys for an 82% response rate. Only half of the residents (55%) reported feeling adequately prepared for their first year in residency; less than half cited adequate preparation to place stainless steel crowns (SSCs) (42%) and perform pulpotomies (45%). Far fewer felt adequately prepared to provide treatment for children six months to three years of age, including examinations (29%), infant oral exams (27%), and children with severe caries (37%). The program directors were even less positive about the adequacy of residents' preparation. Only 17% deemed them adequately prepared to place SSCs and 13% to perform pulpotomies. Approximately half reported their first-year residents were inadequately prepared to treat very young children and children with severe caries (55% each). This study found that the perceived inadequacy of predoctoral education in pediatric dentistry was consistent at both the learner and educator levels, supporting previous studies identifying inadequacies in this area.
Garcia-Godoy, Franklin; Murray, Peter E
The regeneration of immature permanent teeth following trauma could be beneficial to reduce the risk of fracture and loss of millions of teeth each year. Regenerative endodontic procedures include revascularization, partial pulpotomy, and apexogenesis. Several case reports give these procedures a good prognosis as an alternative to apexification. Care is needed to deliver regenerative endodontic procedures that maintain or restore the vitality of teeth, but which also disinfect and remove necrotic tissues. Regeneration can be accomplished through the activity of the cells from the pulp, periodontium, vascular, and immune system. Most therapies use the host's own pulp or vascular cells for regeneration, but other types of dental stem cell therapies are under development. There are no standardized treatment protocols for endodontic regeneration. The purpose of this article is to review the recent literature and suggest guidelines for using regenerative endodontic procedures for the treatment of permanent immature traumatized teeth. Recommendations for the selection of regenerative and conventional procedures based on the type of tooth injury, fracture type, presence of necrosis or infection, periodontal status, presence of periapical lesions, stage of tooth development, vitality status, patient age, and patient health status will be reviewed. Because of the lack of long-term evidence to support the use of regenerative endodontic procedures in traumatized teeth with open apices, revascularization regeneration procedures should only be attempted if the tooth is not suitable for root canal obturation, and after apexogenesis, apexification, or partial pulpotomy treatments have already been attempted and have a poor prognosis. © 2011 John Wiley & Sons A/S.
Chen, Xu; Liu, Yao; Jin, Shi-fu; Zhang, Qian; Jin, Xuan-yu
To determine the age and sex characteristics of the children and type of dental procedures performed under dental general anesthesia (DGA) and to assess the results after six months to one year's follow-up. A sample of 30 patients treated under dental general anesthesia (DGA) during 2006-2007 in the Department of Pediatric Dentistry of China Medical University was reviewed. All the teeth were treated one time. The dental procedures performed included caries restoration, indirect pulp capping, pulpotomy, root canal therapy (RCT) and dental extraction. Oral prophylaxis and topical fluoride applications were performed on all teeth. Pit and fissure sealing was performed on all healthy premolars and molars. SPSS10.0 software package was used for statistical analysis. Chi-square test was used to analyze the difference of the sex distribution in different age group and the difference of dental procedures performed between the primary teeth and the permanent teeth. The age of the patients ranged from 19 months to 14 years. The mental retardation patients accounted for 10% and mental healthy patients accounted for 90% of the sample studied. Males were more than females with the ratio about 2 to 1 in each age group. The dental procedures performed were caries restoration (18.67%), indirect pulp capping (23.26%), pulpotomy (0.77%), RCT (29.16%), dental extractions (2.05%) and fissure sealants (26.09%). The percentage of RCT was higher than that of caries restoration in the primary teeth, whereas the result was opposite as for the permanent teeth as indicated by Chi-square test (X(2)=11.630, P=0.001). New dental caries was not found except 2 patients who suffered from dysnoesia and were not cooperative to have regular examination. Fillings were lost in 3 cases, with 3 anterior teeth and 2 posterior teeth after RCT. All the children could cooperate except two mental retardation patients during the follow-up visit. Caries restoration and RCT are the most frequently performed
Full Text Available Platelet-reach plasma (PRP is an attractive tool in regenerative medicine due to its ability to stimulate proliferation and differentiation of stem cells. Since dental pulp derived stem cells are recognized as central in apexogenesis, the aim of the study was to evaluate radiologically and histologically effects of PRP on apexogenesis in teeth with immature roots. The study included eight monkeys (Cercopithecus Aethiops divided in two equal groups for evaluation 3 and 12 months after treatment. All participants obtained the same treatment including pulpotomy and after-treatment with: hydroxiapatite (HA-incisor and HA+canine PRP. Radiological evaluation was performed using the long cone paralleling technique for recording of defined parameters and histological evaluation was performed using tissue removed en block for the observation of parameters related to apexogenesis. The results obtained radiologically and histologically have shown increase in bridge formation in HA+PRP (75% group after 3 months comparing to HA group (50%. Contrary to that, after 12 months there were no significant differences between groups. The root delay was not registered in the HA+PRP group contrary to HA group where it was registered in 25% after 12 months. Results of the study suggest that PRP is a powerful tool for intensive and rapid apexogenesis since it offers clear and comprehensive results (mostly in the first three months which are early radiologically visible without any failure in the proposed requests.
Tenorio de Franca Talita
Full Text Available Portland cement (PC is a hydraulic binding material widely used in the building industry. The main interest in its use in dentistry is focused on a possible alternative to mineral trioxide aggregate (MTA because PC is less expensive and is widely available. In dentistry, PC has been used in dental procedures such as pulpotomy, pulp capping, repair of root perforation and root-end filling. The purpose of this article is review the dental literature about the PC, its composition with special attention to arsenic content, properties, and application in dentistry. A bibliographic research was performed in Bireme, PubMed, LILACS and Scopus data bases looking for national and international studies about the PC composition, properties and clinical use. It was observed that PC has favorable biological properties very similar to those of MTA. The PC has shown good cell proliferation induction with formation of a monolayer cell, satisfactory inflammatory response, inhibitory effect of prostaglandin and antimicrobial effect. Studies have shown that PC is not cytotoxic, stimulates the apposition of reparative dentin and permits cellular attachment and growth. Regarding arsenic presence, its levels and release are low. PC has physical, chemical and biological properties similar to MTA. Arsenic levels and release are low, therefore, unable to cause toxic effects.
Sherif S Darwish
Full Text Available The success of pulpotomy of young permanent teeth depends on the proper selection of dressing materials. This study aimed to evaluate the histological and histomorphometric response of dentin–pulp complex to the enamel matrix derivative (Emdogain® gel compared to that of calcium hydroxide when used as a pulp dressing in immature young permanent dogs’ teeth. Dentin-like tissues bridging the full width of the coronal pulp at the interface between the injured and healthy pulp tissues were seen after 1 month in both groups. With time, the dentin bridge increased in thickness for calcium hydroxide but disintegrated and fully disappeared for Emdogain-treated group. Progressive inflammation and total pulp degeneration were only evident with Emdogain-treated group. The root apices of Emdogain-treated teeth became matured and closed by cementum that attached to new alveolar bone by a well-oriented periodontal ligament. In young permanent dentition, Emdogain could be a good candidate for periodontium but not dentino–pulpal complex regeneration.
Srinivasan, V; Patchett, C L; Waterhouse, P J
(1) To present a narrative review of the currently available alternative interventions and materials to formocresol pulpotomy for the management of extensive caries in the primary molar, and (2) to produce a clinical protocol for pulp therapy techniques in the extensively carious primary molar. The International Agency for Research on Cancer has recently classified formaldehyde as carcinogenic to human beings. Since Buckley's Formocresol contains 19% formaldehyde in its full strength and, therefore, 1% in a 20% dilution, a safer alternative should be identified. A narrative review of the published literature for primary molar pulp therapy techniques was undertaken following an extensive and appropriate literature search. A specialist group of paediatric dentists was formed to arrive at a consensus and establish an evidence-based protocol for the management of extensively carious primary molar teeth. Part I of this paper explores the currently available alternative interventions and materials to formocresol in the form of a narrative review. The second part of the paper will present the formation of a specialist group to arrive at a consensus and establish an evidence-based protocol for the management of the extensively carious primary molar. After consideration of a review of extensively searched literature, a protocol and key points document have been developed to assist clinicians in their treatment planning. Further long-term studies with the highest level of evidence (i.e. randomized controlled trials) are required to enable us to identify acceptable alternatives which can replace formocresol.
Petrović, Vanja; Pejčić, Natasa; Rakić, Mia; Leković, V.; Stojić, Ž; Vasić, Una
Platelet-reach plasma (PRP) is an attractive tool in regenerative medicine due to its ability to stimulate proliferation and differentiation of stem cells. Since dental pulp derived stem cells are recognized as central in apexogenesis, the aim of the study was to evaluate radiologically and histologically effects of PRP on apexogenesis in teeth with immature roots. The study included eight monkeys (Cercopithecus Aethiops) divided in two equal groups for evaluation 3 and 12 months after treatment. All participants obtained the same treatment including pulpotomy and after-treatment with: hydroxiapatite (HA)-incisor and HA+canine PRP. Radiological evaluation was performed using the long cone paralleling technique for recording of defined parameters and histological evaluation was performed using tissue removed en block for the observation of parameters related to apexogenesis. The results obtained radiologically and histologically have shown increase in bridge formation in HA+PRP (75%) group after 3 months comparing to HA group (50%). Contrary to that, after 12 months there were no significant differences between groups. The root delay was not registered in the HA+PRP group contrary to HA group where it was registered in 25% after 12 months. Results of the study suggest that PRP is a powerful tool for intensive and rapid apexogenesis since it offers clear and comprehensive results (mostly in the first three months) which are early radiologically visible without any failure in the proposed requests
Petrović, Vanja; Pejčić, Natasa; Rakić, Mia; Leković, V.; Stojić, Ž [University of Belgrade, School of Dentistry (Serbia); Vasić, Una [University of Belgrade, Faculty of Medicine (Serbia)
Platelet-reach plasma (PRP) is an attractive tool in regenerative medicine due to its ability to stimulate proliferation and differentiation of stem cells. Since dental pulp derived stem cells are recognized as central in apexogenesis, the aim of the study was to evaluate radiologically and histologically effects of PRP on apexogenesis in teeth with immature roots. The study included eight monkeys (Cercopithecus Aethiops) divided in two equal groups for evaluation 3 and 12 months after treatment. All participants obtained the same treatment including pulpotomy and after-treatment with: hydroxiapatite (HA)-incisor and HA+canine PRP. Radiological evaluation was performed using the long cone paralleling technique for recording of defined parameters and histological evaluation was performed using tissue removed en block for the observation of parameters related to apexogenesis. The results obtained radiologically and histologically have shown increase in bridge formation in HA+PRP (75%) group after 3 months comparing to HA group (50%). Contrary to that, after 12 months there were no significant differences between groups. The root delay was not registered in the HA+PRP group contrary to HA group where it was registered in 25% after 12 months. Results of the study suggest that PRP is a powerful tool for intensive and rapid apexogenesis since it offers clear and comprehensive results (mostly in the first three months) which are early radiologically visible without any failure in the proposed requests.
Maira Morales de Armas
Full Text Available El formocresol comenzó a usarse en Odontopediatría en 1930 y años más tarde se demostró su efecto citostático sobre la pulpa. Se realizan pulpotomías con formocresol diluido en 25 dientes temporales, de los cuales 14 tenían pulpa vital y 11 no vital; se obtuvo el 92,8 % de resultados positivos en los primeros y el 72,7 % en los segundos, después de 1 año de evolución.Formocresol began to be used in Pedodontics in 1930 and as time went by, its cytostatic effect on pulp was proved. 25 decidous teeth were treated with diluted formocresol pulpotomies, 14 had vital pulp and 11 had non-vital pulp. After one year of evolution good results were obtained in 92.8 % of the first group and in 72.7 % of the second group.
Wong, Michelle; Copp, Peter E; Haas, Daniel A
The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4-6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use. The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R ≥ 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics.
Chopra, Radhika; Marwaha, Mohita; Bansal, Kalpana; Mittal, Meenu
Failure of inferior alveolar nerve block in achieving profound anesthesia of the pulp due to various reasons has led to the introduction of more potent local anesthetic agents like articaine. This study was conducted to compare the efficacy of buccal infiltration with articaine in achieving pulpal anesthesia of primary molars as compared to inferior alveolar nerve block with lignocaine. 30 patients (4-8 years) with indication of pulp therapy in at least two mandibular primary molars were selected. Patients were randomly assigned to receive nerve block with lignocaine or infiltration with articaine on first appointment and the other solution on second appointment. All the pulpotomies and pulpectomies were performed by a pediatric dentist. Two researchers standing at a distance of 1.5 m recorded the Pain Scores and Sound, Eye, Motor (SEM) scores. After the completion of procedure, the patient was asked to record the Facial Image score and Heft-Parker Visual Analogue Score (HP-VAS). Pain Score recorded at the time of injection showed significantly more movements with block as compared to infiltration (pblock than infiltration (pinferior alveolar nerve block for primary mandibular molars.
Tenório de Franca, Talita Ribeiro; da Silva, Raphaela Juvenal; Sedycias de Queiroz, Michellini; Aguiar, Carlos Menezes
Portland cement (PC) is a hydraulic binding material widely used in the building industry. The main interest in its use in dentistry is focused on a possible alternative to mineral trioxide aggregate (MTA) because PC is less expensive and is widely available. In dentistry, PC has been used in dental procedures such as pulpotomy, pulp capping, repair of root perforation and root-end filling. The purpose of this article is review the dental literature about the PC, its composition with special attention to arsenic content, properties, and application in dentistry. A bibliographic research was performed in Bireme, PubMed, LILACS and Scopus data bases looking for national and international studies about the PC composition, properties and clinical use. It was observed that PC has favorable biological properties very similar to those of MTA. The PC has shown good cell proliferation induction with formation of a monolayer cell, satisfactory inflammatory response, inhibitory effect of prostaglandin and antimicrobial effect. Studies have shown that PC is not cytotoxic, stimulates the apposition of reparative dentin and permits cellular attachment and growth. Regarding arsenic presence, its levels and release are low. PC has physical, chemical and biological properties similar to MTA. Arsenic levels and release are low, therefore, unable to cause toxic effects.
Blumer, Sigalit; Costa, Liora; Peretz, Benjamin
To present comparative study aims to assist the practitioner to choose between behavior modification (BM) techniques, pharmacologic sedation (N 2 O-O 2 alone or combined with midazolam 0.5 mg/ kg) or routine general anesthesia (GA) for the most successful approach in enabling pediatric dental care. Dental records of 56 children treated in a university dental clinic between 2006-2016 were reviewed, and data on age, gender, required treatment (amalgam restorations, composite restorations, pulpotomy, and stainless steel crowns [SSC]), treatment approaches and therapeutic success at final follow-up were retrieved. Treatment under GA had the best success rates compared to both BM and pharmacologic sedation. N 2 O-O 2 alone had a 6.1-fold greater risk of failure compared to N 2 O-O 2 +midazolam (p- <0.008). Amalgam restorations had a 2.61-fold greater risk of failure than SSC (p- <0.008). The GA mode yielded significantly greater success than the N 2 O-O 2 mode alone. There were no significant differences in success rates between GA and combined midazolam 0.5 mg/kg+N 2 O-O 2 . When choosing restoration material, it is important to remember the high success rate of SSC compared to amalgam restoration.
Davood Ghasemi Tudeshchoie
Full Text Available Background: The most common technique to anesthetize mandibular primary teeth is inferior alveolar (I.A nerve block injection which induces a relatively sustained anesthesia and in turn may potentially traumatize soft-tissues. Therefore, the need of having an alternative technique of anesthesia with a shorter term but the same efficacy is reasonable. The aim of this study was a comparison of the efficacy of two anesthetic techniques of mandibular primary first molar. Materials and Methods: In this randomized crossover clinical trial, 40 children with ages ranged from 5 years to 8 years whose mandibular primary first molars were eligible for pulpotomy, were selected and divided randomly into two groups. The right and left mandibular first molars of group A were anesthetized with infiltration and I. A nerve block techniques in the first and second sessions respectively. The left and right mandibular first molars of group B were anesthetized with I.A nerve block and infiltration techniques in the first and second sessions respectively. The severity of pain were measured and recorded according to sound-eye-motor scale by a certain person. Data was analyzed using Wilcoxon Signed Rank and Mann-Whitney U tests (P < 0.05. Results: The severity of pain was lower in infiltration technique versus I.A nerve block. There were no significant differences between the severities of pain on pulpal exposure of two techniques. Conclusion: It seems that infiltration technique is more favorable to anesthetize the mandibular primary first molar compared to I.A nerve block.
Split-mouth and parallel-arm trials to compare pain with intraosseous anaesthesia delivered by the computerised Quicksleeper system and conventional infiltration anaesthesia in paediatric oral healthcare: protocol for a randomised controlled trial.
Smaïl-Faugeron, Violaine; Muller-Bolla, Michèle; Sixou, Jean-Louis; Courson, Frédéric
Local anaesthesia is commonly used in paediatric oral healthcare. Infiltration anaesthesia is the most frequently used, but recent developments in anaesthesia techniques have introduced an alternative: intraosseous anaesthesia. We propose to perform a split-mouth and parallel-arm multicentre randomised controlled trial (RCT) comparing the pain caused by the insertion of the needle for the injection of conventional infiltration anaesthesia, and intraosseous anaesthesia by the computerised QuickSleeper system, in children and adolescents. Inclusion criteria are patients 7-15 years old with at least 2 first permanent molars belonging to the same dental arch (for the split-mouth RCT) or with a first permanent molar (for the parallel-arm RCT) requiring conservative or endodontic treatment limited to pulpotomy. The setting of this study is the Department of Paediatric Dentistry at 3 University dental hospitals in France. The primary outcome measure will be pain reported by the patient on a visual analogue scale concerning the insertion of the needle and the injection/infiltration. Secondary outcomes are latency, need for additional anaesthesia during the treatment and pain felt during the treatment. We will use a computer-generated permuted-block randomisation sequence for allocation to anaesthesia groups. The random sequences will be stratified by centre (and by dental arch for the parallel-arm RCT). Only participants will be blinded to group assignment. Data will be analysed by the intent-to-treat principle. In all, 160 patients will be included (30 in the split-mouth RCT, 130 in the parallel-arm RCT). This protocol has been approved by the French ethics committee for the protection of people (Comité de Protection des Personnes, Ile de France I) and will be conducted in full accordance with accepted ethical principles. Findings will be reported in scientific publications and at research conferences, and in project summary papers for participants. Clinical
Edison Gabriel Quintero Ricardo
Full Text Available ResumenEl agregado de trióxido mineral (MTA es un material desarrollado para endodoncia. Las principales indicaciones del MTA, son el tratamiento pulpar en dientes vitales (pulpotomias, recubrimiento pulpar directo, apicoformaciones (barrera apical, cirugía endodóncica, reparación de perforaciones furcales, laterales y las provocadas por las reabsorciones. El MTA favorece la formación de hueso y cemento, y puede facilitar la regeneración del ligamento periodontal sin provocar inflamación; como un coadyuvante del MTA en los procesos de reparación tenemos el hidróxido de calcio que es un potente agente bacteriostático y bactericida que se utiliza para el control de microorganismos cuando es empleado como medicamento intraconducto, igualmente actúa como agente catalizador en la modificación del pH en los tejidos periapicales con el fin de favorecer el proceso de cicatrización, presenta excelentes propiedades higroscópica en cuanto al control del exudado en conductos radiculares de dientes con lesiones periapicales grandes los cuales muchas veces presentan humedad persistente en los canales radiculares asimismo actúa en la prevención o detención de procesos resortivos ejerciendo efectos moduladores en la actividad clástica. Por tales propiedades el artículo tiene como fin mostrar los efectos a corto plazo que ocurren en una reabsorción interna y lesión apical al momento de utilizar mineral trióxido agregado (MTA e hidróxido de calcio como material intracanal. (Duazary 2009-II 141-146AbstractMineral trioxide aggregate (MTA is a new material developed for endodontics. The principal indications of MTA are vital pulp therapy (pulpotomy, direct pulp capping, apexification (apical plug, endodontic surgery, and lateral, furcal and resorption perforations repair. The MTA induce the formation of cementum and bone, and it may facilitate the regeneration of the periodontal ligament without causing any inflammation; as a helping of the
Innes, Nicola P T; Ricketts, David; Chong, Lee Yee; Keightley, Alexander J; Lamont, Thomas; Santamaria, Ruth M
21 January 2015). No restrictions were placed on the language or date of publication when searching the databases. Randomised controlled trials (RCTs) that assessed the effectiveness of crowns compared with fillings, other types of crowns, non-restorative approaches or no treatment in children with untreated tooth decay in one or more primary molar teeth. We would also have included trials comparing different methods of fitting crowns.For trials to be considered for this review, the success or failure of the interventions and other clinical outcomes had to be reported at least six months after intervention (with the exception of 'pain/discomfort during treatment and immediately postoperatively'). Two review authors independently assessed the title and abstracts for each article from the search results. and independently assessed the full text for each potentially relevant study. At least two authors assessed risk of bias and extracted data using a piloted data extraction form. We included five studies that evaluated three comparisons. Four studies compared crowns with fillings; two of them compared conventional PMCs with open sandwich restorations, and two compared PMCs fitted using the Hall Technique with fillings. One of these studies included a third arm, which allowed the comparison of PMCs (fitted using the Hall Technique) versus non-restorative caries treatment. In the two studies using crowns fitted using the conventional method, all teeth had undergone pulpotomy prior to the crown being placed. The final study compared two different types of crowns: PMCs versus aesthetic stainless steel crowns with white veneers. No RCT evidence was found that compared different methods of fitting preformed metal crowns (i.e. Hall Technique versus conventional technique).We considered outcomes reported at the dental appointment or within 24 hours of it, and in the short term (less than 12 months) or long term (12 months or more). Some of our outcomes of interest were not