-
International Journal of Paediatric... Jul 2023Endodontic treatment of primary molars represents one of the challenges in pediatric dentistry. There is a lack of consensus in the literature about the endodontic... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Endodontic treatment of primary molars represents one of the challenges in pediatric dentistry. There is a lack of consensus in the literature about the endodontic techniques and filling paste for primary teeth with pulp necrosis.
AIM
To compare the effectiveness of the LSTR technique (lesion sterilization and tissue repair) with CTZ paste (chloramphenicol, tetracycline, zinc oxide and eugenol) and pulpectomy with ZOE paste (zinc oxide and eugenol) in the treatment of primary molars with pulp necrosis.
DESIGN
Eighty-eight primary molars with pulp necrosis from 70 children between the ages of 3 and 8 years were included. The teeth were randomized to the LSTR with CTZ paste group or pulpectomy with ZOE paste group. Clinical and radiographic evaluations were performed at 18, 24, 30 and 36 months.
RESULTS
At 36 months, clinical success was 86.4% in LSTR with CTZ paste and 90.9% in pulpectomy with ZOE paste (p = .45). Radiographic success was 43.2% in both groups (p = 1.00). The overall success was 40.9% in LSTR with CTZ paste and 43.2% in pulpectomy with ZOE paste (p = 1.00).
CONCLUSION
After 36 months of evaluation, the effectiveness of the LSTR technique with CTZ paste and pulpectomy with ZOE paste was similar for the treatment of primary molars with pulp necrosis.
Topics: Child; Humans; Child, Preschool; Eugenol; Chloramphenicol; Pulpectomy; Zinc Oxide; Dental Pulp Necrosis; Zinc Oxide-Eugenol Cement; Sterilization; Tooth, Deciduous; Root Canal Filling Materials
PubMed: 36719000
DOI: 10.1111/ipd.13056 -
Journal of Endodontics Sep 2020Postnatal stem cells critically maintain tissue homeostasis and possess immense potential for tissue regeneration. These stem cells in the orofacial system were not...
Postnatal stem cells critically maintain tissue homeostasis and possess immense potential for tissue regeneration. These stem cells in the orofacial system were not identified until early 2000s when they were first found in the dental pulp and termed dental pulp stem cells (DPSCs). Isolated from either permanent or deciduous teeth, DPSCs were characterized to be highly clonogenic with multidifferentiation and neurovascular properties. Subsequent studies suggested that the origin of DPSCs may be associated with neural crest-derived cells and localized adjacent to neurovascular bundles as indicated by specific surface markers. DPSCs serve as key contributors to pulp homeostasis and injury repair. Mechanistic studies have revealed a fine-tuning regulatory network composed of both extrinsic and intrinsic factors that orchestrate fates of DPSCs. These findings have shaped our understanding of their biological nature as niche responsive progenitors. As we explore the potential of DPSCs in pulp regeneration, preclinical studies have developed diverse DPSC transplantation-based strategies, among which preconditioned DPSCs and DPSC aggregates have shown particular promise. Confirmed by recent clinical advances, DPSC transplantation after pulpectomy has successfully rebuilt the physiological pulp structure in situ functionalized with neurovascularization, indicating a novel regenerative approach for treating pulp diseases. Here, we summarized the 20-year golden journey on DPSCs from the unprecedented discovery to current clinical breakthroughs, while also suggesting future directions and challenges regarding expansion of regenerative applications and evaluation of in vivo DPSCs in diseases and therapies. The historical perspective of this field will provide a blueprint for the stem cell research and enlighten principles for de novo organ regeneration.
Topics: Cell Differentiation; Cell Proliferation; Dental Pulp; Regeneration; Stem Cells
PubMed: 32950195
DOI: 10.1016/j.joen.2020.06.027 -
Journal of Conservative Dentistry : JCD 2019Vitapex has been a popular obturating material for several decades. In recent times, lesion sterilization and tissue repair (LSTR) has shown promising results. This... (Review)
Review
BACKGROUND
Vitapex has been a popular obturating material for several decades. In recent times, lesion sterilization and tissue repair (LSTR) has shown promising results. This technique uses a mixture of 3 antibiotics for sterilization of the root canals and healing of periradicular tissues.
OBJECTIVE
The objective of this systematic review was to compile all the literature comparing Vitapex and LSTR for pulpally involved primary teeth and evaluate the success rate in terms of clinical and radiographic outcomes.
MATERIALS AND METHODS
This review is based on PRISMA guidelines. The electronic search on MEDLINE via PubMed database and Google scholar, cross-referencing and hand search of journals was carried out for articles from January 1, 2000 to December 31, 2019. Articles only in the English language were selected. Out of the 17 articles, 3 unique articles were identified for the review, of which 2 were randomized controlled trials and 1 was a retrospective study.
RESULTS
All the three articles were assessed for their quality and all had a low risk of bias. It was found that LSTR and Vitapex had a high clinical success after 12 months. The radiographic success after 6 months was high but decreased after 12 months in both the groups.
CONCLUSION
There is no difference in the success rate of LSTR as compared to Vitapex for the treatment of pulpally involved primary teeth.
PubMed: 33088056
DOI: 10.4103/JCD.JCD_76_20 -
Pediatric Dentistry Nov 2021The purpose of this study was to compare the effectiveness of lesion sterilization and tissue repair (LSTR) antibiotic paste comprised of chloramphenicol, tetracycline,... (Randomized Controlled Trial)
Randomized Controlled Trial
The purpose of this study was to compare the effectiveness of lesion sterilization and tissue repair (LSTR) antibiotic paste comprised of chloramphenicol, tetracycline, and zinc oxide and eugenol (CTZ) versus zinc oxide eugenol (ZOE) pulpectomy in the treatment of primary molars with pulp necrosis. A total of 70 three- to eight-year-old subjects with 88 primary mandibular molars with pulp necrosis were included. The teeth were randomized to the CTZ group or ZOE group. The time taken to perform both techniques was recorded. The parents of the children and the dentist who performed clinical evaluations were blind to the group assignment, although the radiographic evaluator could see the difference in treatments. Clinical and radiographic assessments were performed at three, six, nine, and 12 months. At the 12-month evaluation, the clinical success was 86.4 percent for CTZ and 90.9 percent for ZOE (P=0.50), the radiographic success was 75.0 percent for CTZ and 72.7 percent for ZOE (P=0.81), and the overall success was 70.5 percent for CTZ and 72.7 percent for ZOE (P=0.81). The mean time taken to perform was 61.4 (±20.5 standard deviation) minutes for CTZ and 145.1 (±53.2) minutes for ZOE (P<0.001). At 12 months, both techniques presented no significant difference in success rates for nonvital pulp therapy in primary molars with necrosis. The lesion sterilization and tissue repair procedure time using chloramphenicol, tetracycline, zinc oxide, and eugenol was significantly shorter than for a zinc oxide eugenol pulpectomy.
Topics: Anti-Bacterial Agents; Child; Child, Preschool; Dental Pulp Necrosis; Eugenol; Humans; Molar; Pulpectomy; Root Canal Filling Materials; Sterilization; Tooth, Deciduous; Zinc Oxide; Zinc Oxide-Eugenol Cement
PubMed: 34937613
DOI: No ID Found -
Journal of Dentistry Sep 2019Management of carious teeth with signs and symptoms indicative of irreversible pulpitis is traditionally invasive, but emerging evidence suggests successful treatment...
OBJECTIVES
Management of carious teeth with signs and symptoms indicative of irreversible pulpitis is traditionally invasive, but emerging evidence suggests successful treatment outcomes with less invasive vital pulp treatment such as coronal pulpotomy. The objective of this systematic review is to determine whether coronal pulpotomy is clinically effective in treating carious teeth with signs and symptoms indicative of irreversible pulpitis.
SOURCES
MEDLINE; PubMed; Embase, Web of Science, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform and ClinicalTrials.gov were searched until December 2018.
STUDY SELECTION
Prospective, retrospective and randomised clinical trials investigating coronal pulpotomy or comparing pulpotomy to root canal treatment in permanent mature carious teeth with signs and symptoms indicative of irreversible pulpitis were included. Studies were independently assessed for risk of bias using Cochrane Systematic Reviews of intervention criteria and modified Downs and Black quality assessment checklist.
DATA
Eight articles were selected for analysis. The average success rate for coronal pulpotomy was 97.4% clinical and 95.4% radiographic at 12 month follow-up. This was reduced to 93.97% clinical and 88.39% radiographic success at 36 months follow-up. Results from the only comparative clinical trial showed pulpotomy to have comparable success to root canal treatment at 12, 24 and 60 month follow-up.
CONCLUSIONS
The evidence suggests high success for pulpotomy for teeth with signs and symptoms of irreversible pulpitis, however, results are based on heterogeneous studies with high risk of bias. Well-designed, adequately powered randomised controlled trials are required for evidence to change clinical practice.
CLINICAL SIGNIFICANCE
Management of carious teeth with irreversible pulpitis is traditionally invasive, but emerging evidence suggests potentially successful treatment outcomes with less invasive therapies such as coronal pulpotomy.
Topics: Calcium Compounds; Dental Pulp Capping; Dental Pulp Exposure; Humans; Pulp Capping and Pulpectomy Agents; Pulpitis; Pulpotomy; Root Canal Therapy; Silicates
PubMed: 31229496
DOI: 10.1016/j.jdent.2019.06.005 -
The Journal of Clinical Pediatric... Jul 2021In a tooth with deep dentinal caries; judicious removal of infected dentin and isolating affected dentin from oral fluids with suitable biocompatible material is called... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
In a tooth with deep dentinal caries; judicious removal of infected dentin and isolating affected dentin from oral fluids with suitable biocompatible material is called indirect pulp therapy (IPT). This randomized clinical trial was done to evaluate and compare the efficacy of Biodentine, Theracal LC and. Dycal as an indirect pulp capping agent in young permanent teeth.
STUDY DESIGN
IPT was performed in 60 young permanent molars with caries approaching pulp in 55 healthy children using Biodentine, Theracal and Dycal. A 2-3mm layer of GIC was placed over the intervening material followed by restoration of cavity with composite. Clinical and radiographic examinations were conducted at 3 weeks, 3 months, 6 months,12 months, 18 months and 24 months. The data was compared using chi-square test at a significance level of 0.05.
RESULTS
By end of 24 months ,54 teeth presented for follow up with overall success rate of 100% in Theracal, 94.44% in Biodentine, and 77.78% in Dycal. Overall success of Theracal was statistically significant in comparison to Biodentine and Dycal at 24 months follow up (p= 0.03) Conclusions: Radiographic and clinical outcomes of Theracal and Biodentine suggest their use as an alternative material for IPT in young permanent molars with higher success.
Topics: Calcium Compounds; Child; Dental Pulp Capping; Humans; Oxides; Pulp Capping and Pulpectomy Agents; Silicates
PubMed: 34192759
DOI: 10.17796/1053-4625-45.3.3 -
International Journal of Clinical... 2019The purpose of this systematic review was to compare the efficacy of single-visit pulpectomy (SVP) vs multiple-visit pulpectomy (MVP) in infected primary teeth. (Review)
Review
OBJECTIVE
The purpose of this systematic review was to compare the efficacy of single-visit pulpectomy (SVP) vs multiple-visit pulpectomy (MVP) in infected primary teeth.
MATERIALS AND METHODS
An extensive literature search in the English language was conducted in PICO format using MeSH terms using databases (PubMed, EBSCO, Ovid, and Cochrane) and pre-specified inclusion and exclusion criteria were applied to identify relevant studies comparing pulpectomy in single and multiple visits.
RESULTS
Only 4 studies (3- clinical study; 1- microbial study) sustained the final analysis and were included for critical appraisal. Results of the systematic search revealed that there are only a few studies comparing the efficacy of single-visit pulpectomy vs multiple-visit pulpectomy in infected primary teeth.
CONCLUSION
On the basis of the available studies, evidence favors the SVP protocol over the MVP protocol. Whenever possible the single-visit protocol can be preferred over the multiple-visit protocol. The quality of evidence available is low.
HOW TO CITE THIS ARTICLE
Tirupathi SP, Krishna N, Rajasekhar S, Clinical Efficacy of Single-visit Pulpectomy over Multiple-visit Pulpectomy in Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2019;12(5):453-459.
PubMed: 32440053
DOI: 10.5005/jp-journals-10005-1654 -
Journal of Oral and Maxillofacial... 2023Rickets is a disorder caused by a lack of vitamin D, calcium or phosphate. It leads to softening and weakening of the bones. Dental manifestation of rickets includes...
Rickets is a disorder caused by a lack of vitamin D, calcium or phosphate. It leads to softening and weakening of the bones. Dental manifestation of rickets includes enamel hypoplasia and delayed tooth eruption. The most important oral findings are characterised by spontaneous gingival and dental abscesses occurring without a history of trauma or caries. Radiographic examination revealed large pulp chambers, short roots, poorly defined lamina dura and hypoplastic alveolar ridge. These dental abscesses are common, and therefore, extraction and pulpectomy are the treatment of choice. Oral manifestations of rickets should be diagnosed early by both physicians and dentists to prevent severe dental complications. This article aims to report a case of rickets in a 3-year-old girl, describing the dental findings and the treatment to be performed in these cases.
PubMed: 38304513
DOI: 10.4103/jomfp.jomfp_233_23 -
Community Dentistry and Oral... Feb 2024The aim of this randomized clinical trial was to compare the impact of two management options for primary molars with pulp necrosis (pulpectomy or extraction) on... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The aim of this randomized clinical trial was to compare the impact of two management options for primary molars with pulp necrosis (pulpectomy or extraction) on children's oral health-related quality of life (OHRQoL).
DESIGN
A total of 100 children aged 3-5 years with at least one necrotic primary molar were selected and randomized into the study groups. The Brazilian version of early childhood oral health impact scale (B-ECOHIS) was completed by the parent proxy reports at baseline and after 4, 8 and 12 months. Differences between the trial groups were assessed through bootstrap linear regression for B-ECOHIS scores, logistic regression for dental pain self-reports and anxiety scores (α = 5%).
RESULTS
The mean (SD) B-ECOHIS scores at baseline and after 12 months were 17.7 (6.5) and 3.0 (4.0) in the pulpectomy group and 18.8 (7.7) and 7.9 (7.7) in the extraction group. Both treatments significantly improved OHRQoL, but tooth extraction group showed higher scores in total B-ECOHIS (p < .001) and most domains, indicating lower OHRQoL. Furthermore, higher anxiety levels were reported for dental extraction compared to pulpectomy (OR = 2.52; p = .008).
CONCLUSION
Pulpectomy resulted in an improved OHRQoL scores after 12 months when compared to tooth extraction and should be considered as the treatment of choice for necrotic primary molars.
Topics: Child, Preschool; Humans; Dental Care; Dental Caries; Oral Health; Pulpectomy; Quality of Life; Tooth Extraction
PubMed: 37519111
DOI: 10.1111/cdoe.12895