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The Journal of Clinical Pediatric... May 2023Due to concerns about formocresol's mutagenic and genotoxic potential, its use as a pulpotomy medication is currently debatable. The current paper aimed to review the... (Review)
Review
Due to concerns about formocresol's mutagenic and genotoxic potential, its use as a pulpotomy medication is currently debatable. The current paper aimed to review the properties of formocresol and concerns regarding its safety as a pulpotomy medicament for primary teeth. With reference to the context of the recently published literature, the alternatives to formocresol are discussed, together with their benefits and drawbacks. A literature search was conducted using multiple databases comprising of MEDLINE ( PubMed), EMBASE, and Web of Science. The terms used for the search were "formocresol", "pulpotomy", and "primary teeth". In total, 364 articles were obtained from the analysis of the databases. Unrelated articles from the available full text of 174 articles were excluded. The main reasons for excluding the articles were: they were usage and precautionary guidelines. A total of 68 studies were finally included in the review. The literature review in this paper supports the notion that formocresol continues to be the most often utilized pulp dressing agent in primary teeth pulpotomies despite offering no advantages over other pulp dressing chemicals that are currently on the market.
Topics: Humans; Tooth, Deciduous; Formocresols; Dental Pulp; Pulpotomy
PubMed: 37143417
DOI: 10.22514/jocpd.2023.020 -
Clinical Oral Investigations Nov 2023This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives... (Review)
Review
OBJECTIVES
This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures.
METHODS
This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures.
RESULTS
Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up.
CONCLUSIONS
Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups. CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.
Topics: Humans; Pulpotomy; Dental Pulp Cavity; Root Canal Therapy; Dental Pulp; Dental Pulp Necrosis
PubMed: 37870593
DOI: 10.1007/s00784-023-05284-9 -
Zhonghua Kou Qiang Yi Xue Za Zhi =... Jan 2022Internal root resorption is a pathologic phenomenon with a characterization of the intraradicular dentin destruction due to the abnormal activities of odontoclasts. With... (Review)
Review
Internal root resorption is a pathologic phenomenon with a characterization of the intraradicular dentin destruction due to the abnormal activities of odontoclasts. With its insidious pathology, internal root resorption can progress to a great extent before its clinical detection. The etiology and natural history of internal root resorption are uncertain and the associated key molecular pathogenesis have not been understood completely. The resorption is usually initiated by a stimulus with the loss of the protective predentin and progressed by the continuous stimuli of pulp infection. Various factors including trauma, chronic inflammation of the pulp, pulpotomy and tooth transplantation have been proposed for the occurrence of internal root resorption. The present paper reviews the etiology and pathogenesis of internal root resorption and provides guidance for the early intervention in the clinical practice.
Topics: Humans; Pulpotomy; Root Resorption
PubMed: 35012250
DOI: 10.3760/cma.j.cn112144-20210929-00449 -
Clinical Oral Investigations Dec 2021There has been increasing evidence indicating rather high success rates of vital pulp therapies. This umbrella review aimed to provide an overview of existing systematic... (Review)
Review
OBJECTIVE
There has been increasing evidence indicating rather high success rates of vital pulp therapies. This umbrella review aimed to provide an overview of existing systematic reviews regarding the outcomes of vital pulp therapy, specifically direct pulp capping, partial pulpotomy and full pulpotomy, in carious pulp-exposed permanent human teeth.
MATERIALS AND METHODS
The specific PICO questions were as follows: Population - permanent human teeth with carious pulp exposure; Intervention - direct pulp capping with pulp capping materials; Comparators - partial pulpotomy and full pulpotomy; Outcomes - success rate and prognostic factors. PubMed, Ovid and Cochrane databases were searched in conjunction with hand searching. Grey literature was searched too. Study selection, data extraction and study appraisal were performed independently by two authors. A consensus was reached through discussion when disagreements arose.
RESULTS
Six articles fulfilled the inclusion criteria. Higher and more predictable success rates of ≥ 2 years were observed for partial pulpotomy and full pulpotomy in carious pulp-exposed permanent human teeth as compared to direct pulp capping. Possible prognostic factors (pre-operative pulp status, pulp capping material and apex closure) yielded conflicting results. Restorative material, periapical status at baseline, final irrigation solution, age and study type did not seem to affect the treatment outcome.
CONCLUSIONS
Vital pulp therapy is a reliable treatment option for permanent teeth with carious pulp exposure. However, more high-quality studies are required to corroborate this finding.
CLINICAL RELEVANCE
Vital pulp therapy could be considered as an alternative for root canal treatment for carious pulp-exposed permanent teeth.
Topics: Dental Caries; Dental Pulp Capping; Dental Pulp Exposure; Dentition, Permanent; Humans; Pulpotomy; Silicates; Treatment Outcome
PubMed: 33970319
DOI: 10.1007/s00784-021-03960-2 -
Evidence-based Dentistry Dec 2022Introduction A systematic review and meta-analysis of the effectiveness of Biodentine compared to formocresol for pulpotomies in the deciduous dentition.Data sources and... (Meta-Analysis)
Meta-Analysis Review
Introduction A systematic review and meta-analysis of the effectiveness of Biodentine compared to formocresol for pulpotomies in the deciduous dentition.Data sources and study selection Four electronic data bases were searched (Medline, Embase, Cochrane Central Register of Controlled Trials and Web of Science). Randomised controlled trials (RCTs) which compared the use of Biodentine with formocresol were included in the screening. Two reviewers screened the titles and abstracts of the RCTs independently for inclusion in the review and a third reviewer was consulted in the case of any disagreements. Thirteen articles were used for full-text reading and nine were included in the review. Two investigators assessed risk of bias (RoB) by allocating a score of either high, low or unclear, in line with the Cochrane handbook for systematic reviews of interventions. Failure to blind practitioners paired with a lack of standardised application protocol results in high RoB.Data extraction and synthesis Data was extracted from the included studies using customised forms, including: sample size, patient ages, treatment and clinical and radiographic follow-up and results. Meta-analysis of the results was completed using ReviewManager version 5.4.0.Results In total, 626 children were assessed in the RCTs. All teeth were restored with a preformed metal crown placed directly after the procedure, except for two studies, which placed them 24 and 48 hours later. The primary outcomes of clinical failure were defined as pain, tenderness to percussion, swelling, abscess, fistula and pathological tooth mobility at 12 months. These showed that Biodentine had significantly lower failure rates (RR 0.16; 95% CI 0.003-0.87; N = 394). Radiographic failure rates defined as either internal or pathological external root resorption, furcation radiolucencies or a widened periodontal ligament showed significantly lower failure rates (RR 0.19; 95% CI 0.08-0.49; N = 393). However, the results showed no significant difference for secondary outcomes which assessed the teeth both clinically and radiographically at intervals up to 48 months. Outcomes were assessed using GRADE; this showed all results to be of low certainty due to the high RoB.Conclusions Biodentine may be the superior material to formocresol for pulpotomy in the deciduous dentition. However, the results for both primary and secondary outcomes have a very low to low GRADE rating due to high RoB; therefore, robust future studies should be completed to further substantiate these findings.
Topics: Child; Humans; Pulpotomy; Formocresols; Tooth, Deciduous; Molar; Systematic Reviews as Topic
PubMed: 36526840
DOI: 10.1038/s41432-022-0840-z -
Journal of Pharmacy & Bioallied Sciences Jul 2023To evaluate the clinical and radiographic outcomes of apexogenesis with mineral trioxide aggregate (MTA) against other pulpotomy agents in carious/traumatized immature... (Review)
Review
OBJECTIVES
To evaluate the clinical and radiographic outcomes of apexogenesis with mineral trioxide aggregate (MTA) against other pulpotomy agents in carious/traumatized immature permanent teeth.
DATA SOURCE
A web-based search for possibly relevant scientific papers in the English language between January 2013 and August 2022 was undertaken in the databases such as PubMed, Scopus, Cochrane Library, and EMBASE. Only randomized clinical trials that compared MTA against other pulpotomy medicaments conducted in vital immature permanent dentition with open apex, having a sample size of not less than 20 with at least 6 months follow-up, reporting clinical or radiographic outcomes were included in the current review. Case studies, case series, animal studies, studies, non-clinical/clinical trials on mature/necrotic permanent or primary dentition, systematic reviews, and letters to the editor were excluded.
STUDY SELECTION
A total of 236 articles were retrieved from the databases during the search procedure. Two independent investigators conducted a full-text review of 83 studies following a screening of titles and abstracts. Eventually, seven studies were considered for the review. The Cochrane bias assessment tool was used to evaluate the quality of included studies. Five of the selected studies were assigned a low evidence level, whereas two were rated a high evidence level.
CONCLUSION
The present review indicated that the diverse pulpotomy agents had comparable clinical outcomes with MTA for apexogenesis in traumatized or carious immature permanent teeth. However, there is a lack of substantial information to draw firm conclusions about the benefits of one material over another.
PubMed: 37654389
DOI: 10.4103/jpbs.jpbs_530_22 -
Clinical Oral Investigations Jan 2023We performed this network meta-analysis to determine the comparative efficacy of formocresol (FC), ferric sulfate (FS), sodium hypochlorite (NaOCl), calcium hydroxide... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
We performed this network meta-analysis to determine the comparative efficacy of formocresol (FC), ferric sulfate (FS), sodium hypochlorite (NaOCl), calcium hydroxide (CH), mineral trioxide aggregate (MTA), biodentine, and laser for pulpotomy of molar teeth.
MATERIALS AND METHODS
An updated search was conducted in PubMed, Embase, and the Cochrane Library to identify relevant randomized controlled trials (RCTs) published before October 30, 2022, after screening previous meta-analyses. The Cochrane risk of bias assessment tool was used to appraise the methodological quality of included studies. Clinical and radiographic success rates were assessed as outcomes. Random network meta-analysis was performed by using STATA software (version 14.0) with "network" command.
RESULTS
A total of 43 RCTs were included. Network meta-analysis indicated that CH was inferior to other medicaments and techniques in all outcomes, and MTA and biodentine was better than FC, FS, and NaOCl in terms of clinical and radiographic success rates. Results of ranking probabilities suggested that MTA ranked first in all outcomes except for clinical success at both 6 months.
CONCLUSIONS
Our results suggested that MTA was associated with significant improvement in both clinical and radiographic success than other pulpotomy medicaments and techniques, with the highest probability of being the optimal option.
CLINICAL RELEVANCE
The current network meta-analysis determined the comparative efficacy and safety of 7 common pulpotomy medicaments in molar pulpotomy, including FC, FS, NaOCl, CH, MTA, biodentine, and laser, and the pooled results revealed comparable efficacy in clinical and radiographic success rates at 6 and 12 months between FC, FS, and NaOCl in primary molars pulpotomies. However, MTA, biodentine and laser may have more advantages than other pulpotomy medicaments for clinical and radiographic success. Therefore, in clinical practice, practitioners should select MTA, biodentine, or laser as pulpotomy medicaments in molar pulpotomy.
Topics: Pulpotomy; Network Meta-Analysis; Oxides; Calcium Compounds; Calcium Hydroxide; Silicates; Molar; Drug Combinations; Tooth, Deciduous; Aluminum Compounds
PubMed: 36580161
DOI: 10.1007/s00784-022-04830-1 -
Dental Clinics of North America Oct 2021This article is intended to familiarize clinicians with several pulp therapy modalities and new materials that are currently available for immature young pulp in the... (Review)
Review
This article is intended to familiarize clinicians with several pulp therapy modalities and new materials that are currently available for immature young pulp in the adolescent population. Objectives and considerations for immature young permanent teeth as well as the healing potential of the young pulp tissue after treatment of the inflammatory process are discussed. The article emphasizes that the future holds great possibilities for the regeneration of dental pulp in adolescent patients.
Topics: Adolescent; Child; Dental Care; Dental Caries; Dental Pulp Capping; Dentition, Permanent; Humans; Pulpotomy; Treatment Outcome
PubMed: 34503666
DOI: 10.1016/j.cden.2021.07.001 -
International Endodontic Journal Oct 2023To assess the clinical and radiographic outcome of partial pulpotomy by comparing MTA Angelus and Total Fill BC, as pulpotomy agents, in mature teeth with deep caries... (Randomized Controlled Trial)
Randomized Controlled Trial
Treatment outcome of partial pulpotomy using two different calcium silicate materials in mature permanent teeth with symptoms of irreversible pulpitis: A randomized clinical trial.
AIM
To assess the clinical and radiographic outcome of partial pulpotomy by comparing MTA Angelus and Total Fill BC, as pulpotomy agents, in mature teeth with deep caries and symptoms indicative of irreversible pulpitis.
METHODOLOGY
The study was designed as a parallel-two arm, double-blind, randomized superiority clinical trial registered at www.
CLINICALTRIALS
gov (NCT04870398). Symptomatic mature permanent teeth with deep caries fulfilling the inclusion criteria were randomly treated using either MTA Angelus or Total Fill BC. A partial pulpotomy was performed and following complete haemostasis, the capping material was placed over the remaining pulp tissue and a postoperative periapical radiograph was taken. Clinical and radiographic follow-up evaluation was performed for a median time of 2 years, whereas levels of pain intensity were evaluated preoperatively and for 7 days after intervention using Visual Analogue Scale. For the primary outcome (failure/success of treatment), the Kaplan-Meier survival curves for the capping materials were plotted and a log-rank test for equality of survivor functions was applied. A multivariable random effects Cox Regression model was also applied. For the secondary outcome (postoperatively reported pain), a multivariable mixed effects ordinal logistic regression was structured.
RESULTS
One hundred and thirty-seven teeth in 123 patients underwent partial pulpotomy using randomly either MTA Angelus (N = 74) or Total Fill BC (n = 63). The percentage failure for MTA Angelus and Total Fill BC was 10.8% (8/74) and 17.5% (11/63), respectively, but the difference was not statistically significant [adjusted HR: 1.83; 95% confidence interval (CI): 0.68, 4.91; p = .23]. Weak evidence was found that secondary caries involvement may impose a 3.54 times greater hazard for treatment failure (adjusted HR: 3.54; 95% CI: 1.00, 12.51; p = .05). For each passing minute of procedural bleeding control, there was also a 57% higher hazard for treatment failure (adjusted HR: 1.57; 95% CI: 0.99, 2.48; p = .05). The odds for higher postoperative pain were 4.73 times greater for the Total Fill BC compared to MTA Angelus (adjusted OR: 4.73; 95% CI: 2.31, 9.66; p < .001).
CONCLUSIONS
Both materials exhibited similar and favourable outcome rates after partial pulpotomy in teeth with deep caries and symptoms of irreversible pulpitis. Total Fill BC was associated with a higher level of postoperative pain intensities.
Topics: Humans; Pulpitis; Pulpotomy; Calcium Compounds; Silicates; Oxides; Treatment Outcome; Drug Combinations; Aluminum Compounds
PubMed: 37452640
DOI: 10.1111/iej.13955 -
International Endodontic Journal Dec 2023This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine.
METHODOLOGY
This two-armed, parallel-group, randomized, superiority trial included vital mature permanent teeth with deep primary or secondary caries diagnosed radiographically as being at least 75% into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were blindly allocated to receive either SCR or Pulpotomy using computer-generated randomized patient codes concealed in opaque envelopes. All teeth were reviewed clinically and radiographically at 6 months and 1 year post-treatment. Using a significance level of p < .05, the log rank test and Cox proportional hazards regression were used to compare the outcome of SCR and Pulpotomy and to identify potential prognostic factors, respectively.
RESULTS
In all, 58 teeth in the SCR group and 55 teeth in the pulpotomy group completed treatment, after excluding 6 teeth because they did not complete the allocated treatment and another due to severe periodontal disease. At one year, 57/58 (98.3%) teeth from the SCR group and 48/55 (87.3%) teeth from the Pulpotomy group were available for analysis. One tooth in the Pulpotomy group (2.1%) and eight teeth in the SCR group (14.0%) required the further intervention of root canal treatment (p < .05). There were no other significant prognostic factors for survival. Overall, 91.4% of teeth treated with either SCR or Pulpotomy survived without requiring further intervention over a period of one year. No other adverse events occurred over the review period.
CONCLUSION
Within the limitations of this study, Pulpotomy fares better than SCR in preserving the remaining pulp and periapical health. As a treatment modality, Pulpotomy carries greater cost outlay to patient and takes a longer time to complete treatment than SCR. Long-term follow-up is needed to study the pulpal and restorative outcomes of Pulpotomy and SCR.
Topics: Humans; Pulpotomy; Dental Caries Susceptibility; Pilot Projects; Calcium Compounds; Treatment Outcome; Pulpitis; Dental Caries; Silicates
PubMed: 37795835
DOI: 10.1111/iej.13978