formocresol and Dental-Caries

Pulpotomy is an effective, vital pulp therapy procedure for caries-affected or traumatized primary teeth. Though its efficacy is widely accepted, the superiority of medicaments and techniques remains debatable.. The aims of this review were to compare the success rates of various pulpotomy medicaments or techniques, assess the methodological quality of reviews, and grade the level of evidence for each comparison.. This review followed the principles of evidence-based medicine and recommendations for the overview of systematic reviews. An a priori protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021244489). A comprehensive literature search was performed by two reviewers, and studies were selected from various databases according to predefined criteria. Two reviewers independently used a self-designed pilot-tested form to extract data from the selected studies. A quality analysis was performed using A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) and the ROBIS tool. Reporting characteristics and overlap of the primary studies were also assessed. We used modified Köhler's criteria for evaluating the quality of evidence for outcomes of included systematic reviews and meta-analyses.. The scrutiny of 62 full-text articles resulted in the inclusion of eight systematic reviews. The quality of four of the reviews was found to be critically low, and the overlap of primary studies in the meta-analyses was found to be high. Pulpotomy medicaments/techniques, except calcium hydroxide, had success rates of more than 80% for all domains and time periods. Most of the comparisons revealed no differences in the clinical, radiographic, or overall success rates. Mineral trioxide aggregate, however, was found to have better radiographic and overall success rates than calcium hydroxide at periods greater than 12 and 18 months. It also had a greater radiographic success rate than full-strength/1:5 diluted and full-strength formocresol at 24 months. Formocresol was found to have better overall success rates than calcium hydroxide at all time periods and better radiographic success rates at 12 months. Only 12 of the 63 comparisons had suggestive or weak evidence, whereas all others had either negligible evidence or insufficient data.. The pulpotomy medicaments/techniques, except calcium hydroxide, showed success rates of more than 80%, whereas most comparisons revealed no differences. Mineral trioxide aggregate, however, was found to be better than calcium hydroxide and formocresol in several respects. This study highlights the lack of evidence regarding the choice of pulpotomy agents for the treatment of caries-affected primary teeth and elucidates the domains that require primary studies in the future.

Topics: Calcium Hydroxide; Dental Caries; Formocresols; Humans; Pulpotomy; Systematic Reviews as Topic; Tooth, Deciduous

In children, dental caries is among the most prevalent chronic diseases worldwide. Pulp interventions are indicated for extensive tooth decay. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. After treatment, the cavity is filled with a medicament.This is an update of a Cochrane review first published in 2003. The previous review found insufficient evidence regarding the relative efficacy of these interventions, combining one pulp treatment technique and one medicament.. To assess the effects of different pulp treatment techniques and associated medicaments for the treatment of extensive decay in primary teeth.. We searched the Cochrane Oral Health Group's Trials Register (to 25 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 25 October 2013), EMBASE via OVID (1980 to 25 October 2013) and the Web of Science (1945 to 25 October 2013). We searched OpenGrey for grey literature and the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases.. Eligible studies were randomised controlled trials comparing different pulp interventions combining a pulp treatment technique and a medicament in children with extensive decay involving dental pulp in primary teeth.. Two review authors independently carried out data extraction and risk of bias assessment in duplicate. We contacted authors of randomised controlled trials for additional information if necessary. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. We performed data synthesis with pairwise meta-analyses using fixed-effect models. We assessed statistical heterogeneity using by I(2) coefficients.. We included 47 trials (3910 randomised teeth) compared to three trials in the previous version of the review published in 2003. All trials were single centre and small sized (median number of randomised teeth 68). Overall, the risk of bias was low in only one trial with all other trials being at unclear or high risk of bias. The overall quality of the evidence was low. The 47 trials examined 53 different comparisons: 25 comparisons between different medicaments/techniques for pulpotomy, 13 comparisons between different medicaments for pulpectomy, 13 comparisons between different medicaments for direct pulp capping and two comparisons between pulpotomy and pulpectomy. Regarding pulpotomy, 14 trials compared mineral trioxide aggregate (MTA) with formocresol (FC). MTA reduced both clinical and radiological failures at six, 12 and 24 months, although the difference was not statistically significant. MTA also showed favourable results for all secondary outcomes measured, although again, differences between MTA and FC were not statistically significant (with the exception of pathological root resorption at 24 months and dentine bridge formation at six months). MTA showed favourable results compared with calcium hydroxide (CH) (two trials) for all outcomes measured, but the differences were not statistically significant (with the exception of radiological failure at 12 months). When comparing MTA with ferric sulphate (FS) (three trials), MTA had statistically significantly fewer clinical, radiological and overall failures at 24 months. This difference was not shown at six or 12 months.FC was compared with CH in seven trials and with FS in seven trials. There was a statistically significant difference in favour of FC for clinical failure at six and 12 months, and radiological failure at six, 12 and 24 months. FC also showed favourable results for all secondary outcomes measured, although differences between FC and CH were not consistently statistically significant across time points. The comparisons between FC and FS showed no statistically significantly difference between the two medicaments for any outcome at any time point.For all other comparisons of medicaments used during pulpotomies, pulpectomies or direct pulp capping, the small numbers of studies and the inconsistency in results limits any interpretation.. We found no evidence to identify one superior pulpotomy medicament and technique clearly. Two medicaments may be preferable: MTA or FS. The cost of MTA may preclude its clinical use and therefore FS could be used in such situations. Regarding other comparisons for pulpectomies or direct pulp capping, the small numbers of studies undertaking the same comparison limits any interpretation.

Topics: Aluminum Compounds; Calcium Compounds; Calcium Hydroxide; Child; Child, Preschool; Controlled Clinical Trials as Topic; Dental Caries; Dental Cements; Dental Materials; Drug Combinations; Electric Stimulation Therapy; Ferric Compounds; Formocresols; Humans; Molar; Oxides; Pulpectomy; Pulpotomy; Randomized Controlled Trials as Topic; Silicates; Tooth, Deciduous; Zinc Oxide-Eugenol Cement

Vital pulp therapy aims to treat reversible pulpal injury and includes 2 therapeutic approaches: (1) indirect pulp treatment for deep dentinal cavities and (2) direct pulp capping or pulpotomy in cases of pulp exposure. Indirect pulp treatment is recommended as the most appropriate procedure for treating primary teeth with deep caries and reversible pulp inflammation, provided that this diagnosis is based on a good history, a proper clinical and radiographic examination, and that the tooth has been sealed with a leakage-free restoration. Formocresol has been a popular pulpotomy medicament in the primary dentition and is still the most universally taught pulp treatment for primary teeth. Concerns have been raised over the use of formocresol in humans, and several alternatives have been proposed. Controlled clinical studies have been critically reviewed, and mineral trioxide aggregate and ferric sulfate have been considered appropriate alternatives to formocresol for pulpotomies in primary teeth with exposed pulps. In most of the studies reviewed, the caries removal method has not been described. The use of a high-speed handpiece or laser might result in an exposure of a "normal" pulp that would otherwise not be exposed.

Topics: Aluminum Compounds; Calcium Compounds; Calcium Hydroxide; Dental Caries; Dental Pulp Capping; Drug Combinations; Ferric Compounds; Formocresols; Humans; Laser Therapy; Oxides; Pulpitis; Pulpotomy; Randomized Controlled Trials as Topic; Root Canal Filling Materials; Silicates; Sodium Hypochlorite; Tooth, Deciduous

Dental decay in primary teeth remains a considerable health problem. Where decay extends to involve the dental pulp, pulp treatment techniques are often used to manage both symptomatic and symptom free teeth.. To assess the relative effectiveness of: various pulp treatment techniques in retaining primary molar teeth with decay involving the pulp for at least 12 months; pulp treatment techniques and extractions in avoiding long term sequelae.. We searched the Cochrane Oral Health Group's Trials Register (August 2002); the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to August 2002); EMBASE (1980 to August 2002); Science Citation Index Expanded (1981 to August 2002); Social Science Citation Index (1981 to August 2002); Index to Scientific and Technical Proceedings (1982 to August 2002); System for Information on Grey Literature in Europe (August 2002). Key journals were handsearched. There was no restriction on language of publication.. Randomised or quasi-randomised controlled trials (RCTs) comparing different pulp treatment techniques (with each other, with extraction or with no treatment) for extensive decay in primary molar teeth. Primary outcomes were extractions following pulp treatment and long term effects.. Data extraction and quality assessment were carried out independently and in duplicate. Authors were contacted for additional information where necessary.. Eighty-two studies were identified but only three were suitable for inclusion. Nine studies meeting the inclusion criteria but with inappropriate study design or analysis are also described. Included trials investigated formocresol pulpotomy, ferric sulphate pulpotomy, electrosurgical pulpotomy or zinc oxide eugenol pulpectomy in symptom free, cariously exposed teeth. Data were unavailable on long term effects. Data on extraction following pulp treatment was available in all three studies and in two studies there was no statistically significant difference between the treatments. The difference seen in the other study, where more teeth treated by ferric sulphate pulpotomy were extracted compared to zinc oxide eugenol pulpectomy, must be viewed with caution.. Based on the available RCTs, there is no reliable evidence supporting the superiority of one type of treatment for pulpally involved primary molars. No conclusions can be made as to the optimum treatment or techniques for pulpally involved primary molar teeth due to the scarcity of reliable scientific research. High quality RCTs, with appropriate unit of randomisation and analysis are needed.

Topics: Controlled Clinical Trials as Topic; Dental Caries; Electric Stimulation Therapy; Ferric Compounds; Formocresols; Humans; Molar; Pulpectomy; Pulpotomy; Randomized Controlled Trials as Topic; Tooth, Deciduous; Zinc Oxide-Eugenol Cement

Topics: Aluminum Compounds; Calcium Compounds; Calcium Hydroxide; Child; Child, Preschool; Dental Caries; Dental Pulp Capping; Drug Combinations; Formocresols; Humans; Molar; Oxides; Pulp Capping and Pulpectomy Agents; Pulpotomy; Silicates; Zinc Oxide-Eugenol Cement

The aim of this randomised clinical trial was to compare the clinical and radiographic success rate of 5% sodium hypochlorite (NaOCl) and 20% Formocresol (FC) as a pulpotomy medicament in carious primary molars.. Twenty-four children aged 4-8 years with at least 2 primary molars indicated for pulpotomy were included in this study. Eighty-two teeth received either 5% NaOCl or 20% FC using split mouth design, followed by restoration with IRM base/stainless steel crown (SSC). Clinical and radiographic evaluations were performed at 3, 6 and 12 months.. NaOCl and FC groups demonstrated 100% clinical success at 3 months. At 6 months, NaOCl showed 95% and 87.5% clinical and radiographic success rate respectively, while FC showed 95% clinical and radiographic success rate. After 12 months, the clinical and radiographic success rates were 94.6% and 86.5% respectively for NaOCl, and 92.1% and 86.8% for FC.. The results of this study showed the success rate for NaOCl pulpotomy to be comparable to those for FC pulpotomy.

Topics: Child; Child, Preschool; Crowns; Dental Alloys; Dental Caries; Dental Pulp; Female; Follow-Up Studies; Formocresols; Humans; Male; Methylmethacrylates; Molar; Periapical Diseases; Prospective Studies; Pulpotomy; Radiography; Root Canal Filling Materials; Root Canal Irrigants; Sodium Hypochlorite; Stainless Steel; Tooth Root; Tooth, Deciduous; Treatment Outcome; Zinc Oxide-Eugenol Cement

The aim of the present study was to clinically and radiographically evaluate Mineral Trioxide Aggregate (MTA) as an agent for pulpotomy in primary teeth and to compare it with that of Formocresol (FC) pulpotomy.. Seventy first and second primary mandibular molars of children were chosen on patients who required minimum two pulpotomies in either arch or same arch. After the standardized technique of Pulpotomy with MTA and Formocresol, all molars were treated with a thick mix of Zinc oxide Eugenol cement into the coronal pulp chamber followed by preformed stainless steel crown. The children were followed up for clinical and radio graphical examination after 6, 12 and 24 month for Pain, Swelling, Sinus/fistula, Periapical changes, Furcation radiolucency and internal resorption.. MTA represents 97% clinical success rate in comparison to Formocresol with 85% success. Radiographically also MTA showed more promising results with 88.6% success in comparison to Formocresol with 54.3%.. Thus, MTA pulpotomy has emerged as an easier line of treatment to save the premature loss of primary teeth due to caries or trauma.

Topics: Aluminum Compounds; Calcium Compounds; Chi-Square Distribution; Child; Crowns; Dental Care for Children; Dental Caries; Drug Combinations; Follow-Up Studies; Formocresols; Humans; Molar; Oxides; Postoperative Complications; Pulp Capping and Pulpectomy Agents; Pulpotomy; Radiography; Root Canal Filling Materials; Root Resorption; Silicates; Tooth, Deciduous; Zinc Oxide-Eugenol Cement

A pulpotomy is the therapy for management of pulp exposures due to caries in symptom-free primary molars. The aim was to longitudinally compare the relative effectiveness of the Er:YAG laser, calcium hydroxide and ferric sulphate techniques with dilute formocresol in retaining symptom-free molars. Two hundred primary molars in 107 healthy children were included and randomly allocated to one technique. The treated teeth were blindly reevaluated after 6, 12, 18, 24 and 36 months. Descriptive data analysis and logistic regression analysis accounting for multiple observations per patient by generalised estimating equation were used. Additionally, various influences including tooth type, upper and lower jaws, type of anaesthesia, operator and the final restoration on treatment success were evaluated (Wald chi-square test). After 36 months, the following total (considering clinical and clinically symptom-free radiographic failures) and clinical success rates were determined (in percent): Formocresol 72 (92), laser 73 (89), calcium hydroxide 46 (75), ferric sulphate 76 (97). No significant differences were detected between formocresol and any other technique after 36 months. However, the odds ratio of failure appeared to be three times higher for calcium hydroxide than for formocresol. No significant differences in total success rates were seen regarding the aforementioned influencing clinical parameters. The correct diagnosis of the pulpal status, bleeding control and the specific technique are highly important for long-term success of pulpotomies in primary molars. According to the presented long-term data, pulpotomies using ferric sulphate revealed the best treatment outcome among the used techniques, while calcium hydroxide resulted in the lowest success rates after 3 years. Therefore, we can recommend ferric sulphate for easy and successful treatment of primary molars with caries-exposed pulps.

Topics: Anesthesia, Dental; Calcium Hydroxide; Child; Child, Preschool; Composite Resins; Crowns; Dental Caries; Dental Cavity Lining; Dental Materials; Dental Pulp Exposure; Dental Restoration Failure; Dental Restoration, Permanent; Ferric Compounds; Follow-Up Studies; Formocresols; Glass Ionomer Cements; Humans; Laser Therapy; Lasers, Solid-State; Longitudinal Studies; Methylmethacrylates; Molar; Pulp Capping and Pulpectomy Agents; Pulpotomy; Single-Blind Method; Tooth, Deciduous; Treatment Outcome; Zinc Oxide-Eugenol Cement

Considering formocresol's toxicity, Ca(OH)(2) partial pulpotomy (PP) was studied as a treatment alternative.. To compare success rates of Ca(OH)(2) PP versus formocresol pulpotomy (FP) treatment of pulpally exposed lower primary molars.. A total of 84 lower primary molars, which met study criteria, from 56 child patients were randomly assigned for each treatment. After treatment, blinded clinical and radiographic evaluation with 96.9% and 90% reliability was performed at 6-month intervals to determine treatment success/failure. Chi-squared test was used to compare success rates between the two treatments.. The success rates from 6 to 36 months for PP ranged from 95.03% to 75%, whereas for FP, it was 92.7-74.2%. The success rates for the two treatments at each 6-month interval were not different (P ≥ 0.05). The most frequent failure was internal resorption, affecting five FP teeth and three PP teeth. The resorption was arrested in five of the teeth and was replaced by a radiopaque calcified tissue in one case.. Considering the favourable clinical and radiographic success rate of PP and the potentially toxic effects of formocresol leads us to recommend the use of PP instead of FP in primary teeth with deep carious lesions.

Topics: Calcium Hydroxide; Child; Child, Preschool; Dental Caries; Dental Pulp Cavity; Dental Restoration, Permanent; Follow-Up Studies; Formocresols; Humans; Mandible; Molar; Pulpotomy; Radiography; Root Canal Filling Materials; Survival Analysis; Tooth, Deciduous; Treatment Outcome

To compare the clinical and radiographic success rates of two vital pulpotomy agents: formocresol (FC) and Ankaferd Blood Stopper(®) (ABS), in primary molars during a 12-month follow-up period.. A randomised, single-blind study design was used in a sample of 30 healthy 6-9 year old children with 60 carious primary molars without clinical or radiographic evidence of pulp degeneration.. The pulpotomy agents were assigned as follows: Group 1 was 1:5 diluted Buckley's formocresol (FC) and Group 2 was ABS. Clinical and radiographic follow-up at 3, 6, and 12 months used the following criteria: pain, swelling, sinus tract, mobility, internal root resorption, and furcation and/or periapical bone destruction.. The data were analysed using Chi-square tests.. The clinical and radiographic evaluation at 3 months revealed total success rates of 100% in the FC and ABS groups. Success rates in FC and ABS groups at 6 months were 96.7% and 93.3% respectively. At the 12-month follow-ups, the total success rates in the FC, and ABS groups were 89.3% and 85.7%, respectively. When the groups were compared according to the time intervals, no significant differences were observed between the 3, 6, and 12 month values. The success rates of the materials decreased over time.. FC and ABS were found successful as pulp dressings in primary molars. ABS appears to be an alternative pulpotomy agent but periodical follow-ups must be considered to evaluate long term success rates.

Topics: Child; Dental Amalgam; Dental Caries; Dental Pulp Exposure; Dental Restoration, Permanent; Female; Follow-Up Studies; Formocresols; Hemostatics; Humans; Male; Molar; Periapical Diseases; Phytotherapy; Plant Extracts; Postoperative Complications; Pulp Capping and Pulpectomy Agents; Pulpotomy; Radiography; Root Resorption; Single-Blind Method; Tooth, Deciduous; Treatment Outcome; Zinc Oxide-Eugenol Cement

To compare the clinical and radiographic response of primary teeth to vital pulpotomy using mineral trioxide aggregate (MTA) or formocresol (FC).. A group of 17 children aged 4-9 were selected from those referred to the Paedodontic Department at Shahid Beheshti University, Dental School. Cases with at least two matching teeth were selected (40 teeth), showing signs of pulp involvement. A pulpotomy procedure was carried out in all cases with FC in control teeth whilst MTA was placed in experimental teeth. Clinical and radiographic evaluations were performed at 1-, 6-, 12- and 24-month recall. Statistical analysis using a Fischer exact test was performed on the data to determine significant differences between the groups.. Overall, 22 second and 18 first primary molars were included. The gender ratio was one male to three female. No significant difference was found between the clinical and radiographic outcomes of the two groups at 6-, 12- and 24-month follow-up (P > 0.05). Internal resorption was seen significantly more often in FC cases after 12 months than MTA cases. Overall radiographic appearance of normal structures at 24th month was seen in more than 95% of the cases in MTA and 90% in the FC-treated group (P > 0.05).. Mineral trioxide aggregate for pulp treatment of primary teeth can be considered a replacement for FC.

Topics: Aluminum Compounds; Calcium Compounds; Case-Control Studies; Child; Child, Preschool; Crowns; Dental Amalgam; Dental Caries; Dental Pulp; Dental Restoration, Permanent; Dental Restoration, Temporary; Drug Combinations; Female; Follow-Up Studies; Formocresols; Humans; Male; Molar; Oxides; Periodontal Ligament; Pulpotomy; Radiography, Bitewing; Silicates; Tooth Resorption; Tooth, Deciduous; Treatment Outcome; Zinc Oxide-Eugenol Cement

Clinical and radiographic evaluation of the premedicated direct pulp capping using formocresol (PDC) versus conventional direct pulp capping using calcium hydroxide (CDC) in human carious primary molars.. A total of 120 vital primary molars with pinpoint exposure during caries removal in 84 patients aged 4-5 years were selected. In the PDC group (n = 60), 20% Buckley's formocresol solution, and in the CDC group (n = 60), calcium hydroxide powder were applied to the exposure sites followed by placement of zinc oxide-eugenol base. Teeth were restored with preformed stainless steel crowns. Clinical and radiographic evaluations of the treatment outcomes were performed at regular intervals of 6 and 12 months, respectively, for two years post-operatively.. The prevalence of spontaneous pain, sensitivity on percussion, and fistula were significantly higher in the CDC group compared to the PDC group (P < 0.05). The number of teeth exhibiting periapical/furcal radiolucency or external/internal root resorption was also higher in the CDC group (P < 0.05). The clinical success rate of the PDC was 90% compared to the 61.7% of the CDC (P < 0.05). The radiographic success rates of the PDC and CDC groups were 85% and 53.3%, respectively (P < 0.05).. It seems formocresol premedicated direct pulp capping could safely be used as a substitute for conventional direct pulp capping.

Topics: Calcium Hydroxide; Child, Preschool; Crowns; Dental Alloys; Dental Caries; Dental Cavity Lining; Dental Materials; Dental Pulp Capping; Dental Pulp Exposure; Follow-Up Studies; Formocresols; Humans; Molar; Oral Fistula; Percussion; Periapical Diseases; Radiography; Root Resorption; Stainless Steel; Tooth, Deciduous; Toothache; Treatment Outcome; Zinc Oxide-Eugenol Cement

The aim of this study was to compare the effect of white mineral trioxide aggregate (MTA) to that of formocresol (FC) as pulp dressing agents in pulpotomised primary molars.. In this clinical trial study, 60 lower second primary molars of 46 children were treated by a conventional pulpotomy technique. The teeth were randomly assigned to the MTA (experimental) and FC (control) groups by random numbered table. Following removal of the coronal pulp and haemostasis, the pulp stumps were covered with an MTA paste in the experimental group. In the control group, FC was placed with a cotton pellet over the pulp stumps. The teeth of both groups were restored with stainless steel crowns. Children arrived for clinical and radiographic follow-up evaluation after 6, 12 and 24 months.. The treated teeth in FC group (n = 18) were clinically and radiographically successful after 24 months. The radiographic follow-up evaluation revealed one failure (furcation involvement) in 18 molars treated with MTA after 24 months. The treated teeth in MTA group were clinically successful 24 months postoperatively. Pulp canal obliteration was observed in one of the teeth treated with MTA and four of the teeth treated with FC.. MTA could be used as a safe medicament for pulpotomy in cariously exposed primary molars and could be a substitute for FC.

Topics: Aluminum Compounds; Calcium Compounds; Child; Child, Preschool; Dental Caries; Dental Pulp Capping; Dental Pulp Exposure; Drug Combinations; Female; Follow-Up Studies; Formocresols; Humans; Male; Mandible; Molar; Oxides; Pulpotomy; Radiography; Root Canal Filling Materials; Root Canal Irrigants; Silicates; Tooth, Deciduous; Treatment Outcome

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.

Topics: Aluminum Compounds; Calcium Compounds; Child; Dental Caries; Dental Pulp Capping; Drug Combinations; Follow-Up Studies; Formocresols; Humans; Molar; Oxides; Pulp Capping and Pulpectomy Agents; Pulpotomy; Root Canal Irrigants; Silicates; Tooth, Deciduous; Treatment Outcome

To compare the clinical and radiological outcomes following two different, single visit vital pulp therapy techniques, in cariously exposed primary molar teeth.. A paediatric dental clinic within the Dental Hospital, Newcastle upon Tyne, UK.. Fifty two child patients were sequentially enrolled in the clinical investigation, 26 males and 26 females with an age range of 3.3-12.5 years. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). The total number of teeth treated was 84.. Recruitment was on the basis of strict inclusion criteria. Coronal pulp amputation was prescribed only in teeth with vital, cariously exposed pulp tissue. Treatment was undertaken between October 1994 and December 1996. All cases were reviewed using predefined clinical and radiological criteria. The statistical tests used were logistic regression of a triple nested data structure, chi-squared analysis of equality of treatment and probability of success with relation to subject age.. Eighty-four cariously exposed primary molars required vital pulp therapy. Forty six (55%) teeth were included in the F group and 38 (45%) allocated to the C group. Five teeth were lost to follow-up, leaving 79 teeth: forty four (56%) in group F and 35 (44%) in group C. Eighty four percent (37/44) of teeth treated with formocresol and 77 percent (27/35) treated with calcium hydroxide were classed as clinically and radiographically successful at the cut-off date, December 1997, after a mean clinical review of 22.5 months (range 6.1-38.5 months) and a mean radiographic review of 18.9 months (range 1.3-36.9 months).. This investigation confirms the clinical efficacy of a one-fifth dilution of Buckley's Formocresol as an agent in pulp treatment of cariously exposed, vital primary molar teeth. However, calcium hydroxide in its pure, powder form is a clinically acceptable alternative when combined with strict selection criteria for this method of restorative care. There was a statistically insignificant difference in successful clinical and radiological outcome between the two treatment groups. Success was unrelated to the duration of time taken to achieve haemostasis and the presence or absence of bleeding after placement of the medicament.

Topics: Calcium Hydroxide; Child; Child, Preschool; Dental Caries; Dental Pulp Capping; Female; Formocresols; Humans; Male; Molar; Patient Selection; Pulpotomy; Radiography; Root Canal Irrigants; Treatment Outcome

Qualitative comparison of the clinical, radiographic and histological outcomes in a small sample of cariously exposed primary molars, extracted after unsuccessful pulp treatment by two vital pulpotomy methods.. The primary molars were extracted, because of treatment failure, during a longitudinal clinical investigation of the relative efficacy of 20% Buckley's Formocresol versus calcium hydroxide powder as pulp dressings in vital pulp therapy (in press). Fifty-two child patients were sequentially enrolled in the longitudinal clinical investigation, 26 boys and 26 girls. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). Coronal pulp amputation was prescribed only in teeth with vital, cariously-exposed pulp tissue. All cases were reviewed using predefined clinical and radiological criteria. Seventy-nine cariously-exposed primary molars required vital pulp therapy. Forty-four teeth were included in group F and 35 in group C. Five per cent (n = 2) of teeth in group F and 11 per cent of teeth (n = 4) in group C were terminated from the trial due to clinical and/or radiographic failure. Of the six teeth extracted, five were sufficiently intact to be retained for histological evaluation.. Post-extraction radiographs taken before specimen preparation showed reactionary dentine barrier (bridge) formation in teeth treated with calcium hydroxide. However, the narrowing of root canals, indicative of appositional reactionary dentine deposition, was seen in both groups (F and C). Histological examination confirmed these findings and revealed that pus cells were evident in all specimens examined. There was also histological evidence of resorption of reactionary dentine within the root canal and that forming the calcified barrier (dentine bridge).. The clinical and radiographic outcomes for the five teeth correlate well with the reported findings from decalcified histological section. Although numbers are small, the histological findings may indicate possible reasons for treatment failure. There are few reports of this sort in the literature of this under-researched treatment modality.

Topics: Calcium Hydroxide; Child; Child, Preschool; Dental Caries; Dental Pulp Calcification; Dental Pulp Capping; Dental Pulp Exposure; Dentin, Secondary; Female; Formocresols; Humans; Longitudinal Studies; Male; Molar; Pulpotomy; Radiography; Root Canal Irrigants; Suppuration; Tooth, Deciduous; Treatment Failure; Zinc Oxide-Eugenol Cement

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.

Topics: Aluminum Compounds; Calcium Compounds; Child; Child, Preschool; Crowns; Dental Caries; Dental Enamel Proteins; Dental Pulp Exposure; Drug Combinations; Female; Follow-Up Studies; Formocresols; Glass Ionomer Cements; Humans; Male; Molar; Oxides; Periapical Tissue; Pulp Capping and Pulpectomy Agents; Pulpotomy; Radiography; Silicates; Stainless Steel; Tooth, Deciduous; Treatment Outcome; Zinc Oxide-Eugenol Cement

The purposes of this retrospective chart review were to determine: (1) how primary molars in need of vital pulp therapy (VPT) have been treated over a period of four years at a university-based pediatric dental practice (UBP); and which treatments-indirect pulp therapy (IPT), formocresol pulpotomy (FCP), and ferric sulfate pulpotomy (FSP)-have been successful.. Electronic patient records (axiUm) that contained the procedure codes D3120 (pulp cap-indirect) or D3220 (therapeutic pulpotomy) were totaled by year. Visit records were queried again to identify treatment failures (i.e., extractions [D7140] or pulpectomy [D3221/D3240]). A total of 2,001 primary molar teeth were included in the study. Success was compared using a Kaplan-Meier analysis.. At the three-year follow-up, IPT had a 96.2 percent survival rate, FCP had a 65.8 percent survival rate, and FSP had a 62.9 percent survival rate (P<.0001).. Over a four-year period of time, IPT became the more commonly used vital pulp therapy treatment at a university-based pediatric dental practice and had a significantly better survival rate than FCP or FSP.

Topics: Child; Child, Preschool; Dental Caries; Dental Pulp Capping; Dental Records; Female; Ferric Compounds; Formocresols; Humans; Kaplan-Meier Estimate; Male; Molar; Pediatric Dentistry; Pulpectomy; Pulpotomy; Retrospective Studies; Tooth, Deciduous; Treatment Failure

Topics: Dental Caries; Dental Pulp Capping; Formocresols; Humans; Pulpotomy; Tooth, Deciduous

This study investigates the profile of teaching primary tooth pulp therapy practiced by Brazilian dental schools. A multiple-choice questionnaire was sent by e-mail to 191 dental schools in Brazil, addressed to the pediatric dentistry Chairperson. The two-part survey consisting of multiple-choice questions regarding specific materials and techniques on pulp therapies, moreover, hypothetical clinical scenarios were presented so that the respondents could guide the treatment approach. The questionnaires were returned by 46.5% of the dental schools. Ninety-five percent of surveyed schools teach IPT for the treatment of deep carious lesions in dentin and indicate the calcium hydroxide as capping material (59.3%). The direct pulp capping is taught by 68.7% of schools and calcium hydroxide (97%) was the capping material most indicated. Pulpotomy is taught in 98.7% of schools and formocresol (1:5 dilution) was the medicament of choice (50%). All schools taught pulpectomy and Iodoform paste was the filling material preferred (55%). The results showed a lack of consensus in certain modalities and techniques for primary tooth pulp therapy taught by Brazilian dental schools.

Topics: Anti-Infective Agents, Local; Brazil; Calcium Hydroxide; Curriculum; Dental Caries; Dental Pulp Capping; Dentin; Education, Dental; Endodontics; Formocresols; Humans; Hydrocarbons, Iodinated; Pediatric Dentistry; Pulp Capping and Pulpectomy Agents; Pulpectomy; Pulpotomy; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Therapy; Surveys and Questionnaires; Tooth, Deciduous

The purpose of this study was to determine the level of agreement between pediatric dentists and endodontists at a pulp therapy symposium conjointly sponsored by the American Association of Endodontists (AAE) and the American Academy of Pediatric Dentistry (AAPD) on November 2-3, 2007. Presymposium and postsymposium tests were administered, and respondent answers were compared between pediatric dentists and endodontists. Opinions on 3 areas were sought: pulp therapy for cariously involved primary teeth; indirect pulp treatment (IPT) for cariously involved immature permanent teeth; and innovative treatment options including pulpal revascularization and regeneration. Results were analyzed with chi2 tests. Comparisons of presymposium and postsymposium responses and between the 2 groups of attendees indicated that the pediatric dentistry and endodontic communities agree that formocresol will be replaced as a primary tooth pulpotomy agent, that mineral trioxide is the first choice to take its place, that IPT in primary teeth holds hope as a replacement for pulpotomy, and that IPT is an acceptable pulp therapy technique for cariously involved young permanent teeth. Both groups believe that pulp revascularization and regeneration will be viable treatment modalities in the future. The AAE and the AAPD are positioned to begin preparation of best practice guidelines that share common language and treatment recommendations for pulp therapies performed by both specialties.

Topics: Aluminum Compounds; Attitude of Health Personnel; Calcium Compounds; Dental Caries; Dental Cavity Preparation; Dental Pulp; Dental Pulp Capping; Dental Pulp Diseases; Drug Combinations; Endodontics; Formocresols; Humans; Neovascularization, Physiologic; Oxides; Pediatric Dentistry; Pulpotomy; Regeneration; Root Canal Filling Materials; Silicates; Surveys and Questionnaires

The purpose of this study was to compare clinical, radiographic, and histopathologic effects of Nd:YAG laser pulpotomy to formocresol pulpotomy on human primary teeth. Patients with at least two vital primary molar teeth that required pulpotomy, because of pulpal exposure to caries, were selected for this study. After hemorrhage control, complete hemostasis into the canal orifice was achieved by exposure to Nd:YAG laser (1064 nm) and an He-Ne laser (the aiming beam of the Nd:YAG laser) in noncontact mode at 2 W, 20 Hz, 100 mJ, or was achieved by applying 1:5 dilution of formocresol. Forty-two teeth in two groups were to be followed up clinically and radiographic at 1, 3, 6, 9, and 12 months. Eighteen teeth planned for serial extractions were selected for histopathologic study. The teeth were extracted at 7 and 60 days. The teeth in the laser group had a clinical success rate of 85.71% and a radiographic success rate 71.42% at 12 months. The teeth in the formocresol group had a clinical and radiographic success rate of 90.47% at 12 months. There were no statistically significant differences between laser and formocresol group with regard to both clinical and radiographic success rates. There was a statistically significant difference between 7- and 60-day laser groups with regard to inflammatory cell response criteria. Dentin bridge was absent in all samples. No stained bacteria were observed in any of these samples. In conclusion, Nd:YAG laser may be considered as an alternative to formocresol for pulpotomies in primary teeth.

Topics: Aluminum Silicates; Bacteria; Child; Dental Caries; Dental Pulp Exposure; Dentin, Secondary; Female; Follow-Up Studies; Formocresols; Hemostatic Techniques; Humans; Laser Therapy; Male; Molar; Neodymium; Periapical Diseases; Pulpotomy; Radiography; Root Resorption; Tooth, Deciduous; Treatment Outcome; Yttrium

Pulp therapy in the primary dentition remains a technique generating a tremendous amount of study. Formocresol has been and continues to be the most commonly used intrapulpal medicament despite its known ability to escape the microcirculation of the pulp. Ferric sulfate has gained significant favor as a result of formocresol's disadvantages, though at the cost of requiring a much more acute awareness of the potential for remaining disease and its ability to mask that process. Mineral trioxide aggregate perhaps offers the best immediate alternative to either of the above though at this time it is still cost-prohibitive in a practice that actively treats many children. And, as MTA has no fixative properties of its own, accurately analyzing the extent of the pulpal disease becomes even more critical to the overall success of the procedure. As with other techniques in dentistry, the debate is sure to continue for severl years to come.

Topics: Aluminum Compounds; Calcium Compounds; Child; Child, Preschool; Crowns; Dental Caries; Dental Materials; Dental Pulp Capping; Dental Restoration, Permanent; Drug Combinations; Ferric Compounds; Formocresols; Humans; Oxides; Pulpectomy; Pulpitis; Pulpotomy; Silicates; Stainless Steel; Tooth, Deciduous; Tooth, Nonvital; Zinc Oxide-Eugenol Cement

To produce a working 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. As such, a medicament that can be used to replace formocresol in clinical practice should be identified.. Part I of this paper explored the currently available alternative interventions and materials to formocresol in the form of a narrative review following an extensive literature search. Part II now presents the formation of a specialist group to establish an evidence-based protocol, for the management of the extensively carious primary molar.. A protocol and key points document have been developed to assist clinicians in their treatment planning. Areas for further postgraduate training are identified.

Topics: Algorithms; Carcinogens; Clinical Protocols; Contraindications; Critical Pathways; Decision Trees; Dental Caries; Dental Pulp Capping; Dental Restoration, Permanent; Dental Restoration, Temporary; Formocresols; Humans; Molar; Patient Care Planning; Pulpectomy; Pulpotomy; Tooth Extraction; Tooth, Deciduous; Tooth, Nonvital

To investigate whether formocresol, in Buckley's original formulation, is mutagenic in vivo to lymphocyte cultures obtained from the peripheral blood of children aged from 5 to 10 years old. These children were recruited from those attending the dental clinics of Recife City Council and the University of Pernambuco School of Dentistry, Brazil.. The sample comprised 20 children who had primary teeth with cariously exposed vital pulps. Two venous blood samples were collected (6-8 ml) from each child, the first prior to vital pulpotomy (control group) and the second 24 h after pulpotomy (treated group). This research is a case-control study. The peripheral lymphocytes were grown in a complete culture medium consisting of 78% RPMI 1640 medium (a), supplemented with streptomycin (0.01 mg/ml), penicillin (0.005 ml(-1)), 20% fetal bovine serum (b) and 2% phytohemagglutinin (c). The lymphocytes were assessed for chromosomal aberrations via a previously published method which was modified. The cytogenetic analysis was performed in a blind test, where the slides were codified by an annotator and the scorers did not know which group they were analyzing. For each sample, this envolved the analysis of 200 metaphases. The level of significance adopted in the statistical test was 5.0% (p<0.05).. There was no statistically significant difference in clinical doses between the control and treated groups, using Wilcoxon's Signed Ranks test, for the chromosomal aberrations (P=0.251) and for the total chromosomal breaks (P=0.149). Although there were no statistically significant differences between the control and treated groups, Buckley's formocresol was mutagenic for one patient, raising doubt about the desirability of its use for pulpotomies in children.. The results revealed that, from a statistical standpoint, formocresol is not mutagenic. However, further investigations are required, preferably with a larger sample, in patients needing more than one pulpotomy in order to observe whether an increase in the quantity of the drug would increase the quantity of chromosome aberrations and also to verify individual susceptibility to chromosome alterations with the use of formocresol.

Topics: Case-Control Studies; Cell Culture Techniques; Child; Child, Preschool; Chromatids; Chromosome Aberrations; Cytogenetics; Dental Caries; Dental Pulp Exposure; Female; Formocresols; Humans; Lymphocytes; Male; Mutagens; Pulpotomy; Single-Blind Method; Statistics, Nonparametric; Tooth, Deciduous

Topics: Child; Dental Caries; Formocresols; Humans; Molar; Pulpotomy; Radiography; Retrospective Studies; Root Canal Irrigants; Root Resorption; Tooth, Deciduous; Treatment Outcome

Topics: Adolescent; Child; Dental Caries; Formocresols; Humans; Pulpotomy; Radiography; Retrospective Studies; Root Canal Therapy; Tooth; Tooth Root

Topics: Child; Cresols; Dental Caries; Dental Pulp; Dental Pulp Exposure; Formaldehyde; Formocresols; Humans; Pathology; Pulpotomy; Radiography, Dental; Tooth, Deciduous