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Journal of Conservative Dentistry and... Apr 2024This clinical trial aimed to compare the clinical success of coronal pulpotomy and indirect pulp capping (IPC) in managing symptomatic deep proximal caries in molars...
AIM
This clinical trial aimed to compare the clinical success of coronal pulpotomy and indirect pulp capping (IPC) in managing symptomatic deep proximal caries in molars with moderate pulpitis over a 12-month period.
MATERIALS AND METHODS
A total of 108 vital mature permanent molars with moderate pulpitis were randomly allocated to the IPC ( = 54) or coronal pulpotomy group ( = 54). Dycal and Biodentine were used as pulp-capping materials, followed by composite restoration. The absence of periapical infection and asymptomatic teeth that positively responded to the cold pulp sensitivity test (only in IPC) was considered posttreatment success at 12 months. Data from the study were analyzed using the Chi-square test and Kaplan-Meier survival analysis.
RESULTS
There was a statistically significant difference between preoperative symptoms and the cold pulp sensibility test response ( = 0.000), indicating an association between symptoms and pulp sensibility. The average remaining dentine thickness (RDT) value was 0.48 ± 0.5 mm, with no statistically significant difference found between the location of caries and RDT ( = 0.084, P > 0.05). Compared to the IPC group, the pulpotomy group had a greater number of patients at 12 months after treatment that required no intervention. The Kaplan-Meier survival analysis revealed that the mean survival duration for pulpotomy was 48 weeks, and for IPC, it was 42.3 ± 2.35 weeks.
CONCLUSION
Coronal pulpotomy with Biodentine proved more effective in reducing symptoms, achieving radiographic success, and ensuring tooth survival compared to IPC with calcium hydroxide.
PubMed: 38779201
DOI: 10.4103/JCDE.JCDE_63_24 -
Scientific Reports Nov 2022This study aimed to investigate the factors affecting the success rate of full pulpotomy in permanent posterior teeth with pulpitis. The study included 105 permanent...
This study aimed to investigate the factors affecting the success rate of full pulpotomy in permanent posterior teeth with pulpitis. The study included 105 permanent posterior teeth clinically diagnosed as reversible or irreversible pulpitis in 92 patients aged 18-82 years. All teeth underwent a full pulpotomy using mineral trioxide aggregate as a capping material and were recalled for clinical and radiographic evaluation at 3, 6, 12, and 24 months postoperatively. The overall success rate after the 12-month review was above 90%, and failed cases mainly occurred during the first 12 months after treatment. In this study, the treatment outcome of pulpotomy was not related to sex, or tooth position and the cause of pulpitis. To analyze the influence of age on the treatment outcome, all the teeth were allocated to three groups: group 1 (18-39 years); group 2 (40-59 years); and group 3 (≥ 60 years). A significant difference in success rate was found between groups 1 and 3 (P = 0.014). These results suggest that pulpotomy can be used as an alternative treatment for permanent mature teeth diagnosed with pulpitis and that aging is one factor affecting the treatment outcome.
Topics: Humans; Pulpitis; Pulpotomy; Dentition, Permanent; Treatment Outcome
PubMed: 36434032
DOI: 10.1038/s41598-022-24815-0 -
Singapore Dental Journal Dec 2013This systematic review assesses the effect of methods commonly used to manage the pulp in cases of deep caries lesions, and the extent the pulp chamber remains... (Review)
Review
BACKGROUND
This systematic review assesses the effect of methods commonly used to manage the pulp in cases of deep caries lesions, and the extent the pulp chamber remains uninfected and does not cause pulpal or periapical inflammatory lesions and associated tooth-ache over time.
STUDY DESIGN
An electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to March 2013. In addition, hand searches were carried out. Two reviewers independently evaluated abstracts and full-text articles. An article was read in full if at least one of the two reviewers considered the abstract potentially relevant. Altogether, 161 articles were read in full text. Of these, 24 studies fulfilled established inclusion criteria. Based on studies of at least moderate quality, the quality of evidence of each procedure was rated in four levels according to GRADE.
RESULTS
No study reached the high quality level. Twelve were of moderate quality. The overall evidence was insufficient to assess which of indirect pulp capping, stepwise excavation, direct excavation and pulp capping/partial pulpotomy, pulpotomy or pulpectomy is the most effective treatment approach for teeth with deep caries.
CONCLUSIONS
Because of the lack of good studies it is not possible to determine whether an injured pulp by deep caries can be maintained or whether it should be removed and replaced with a root canal filling. Both randomized studies and prospective observational studies are needed to investigate whether a pulp exposed to deep caries is best treated by measures intended to preserve it or by pulpectomy and root filling.
Topics: Dental Atraumatic Restorative Treatment; Dental Caries; Dental Pulp; Dental Pulp Capping; Humans; Prospective Studies; Pulp Capping and Pulpectomy Agents; Pulpotomy; Root Caries
PubMed: 24360260
DOI: 10.1016/j.sdj.2013.11.001 -
Medicina Oral, Patologia Oral Y Cirugia... Nov 2010Evidence-based dentistry is a critical evaluation, awareness of the available evidence to improve decision making about the care of individual patients and/or... (Comparative Study)
Comparative Study Review
UNLABELLED
Evidence-based dentistry is a critical evaluation, awareness of the available evidence to improve decision making about the care of individual patients and/or communities.
OBJECTIVE
To systematically analyze the available scientific literature on clinical and radiographic results of two materials used in pulpotomy in primary teeth: formocresol and mineral trioxide aggregate.
MATERIALS AND METHODS
It was identified relevant publications through a search of electronic databases such as MEDLINE (Ovid) and The Cochrane Library. To be included in the review, studies had to define the material used in child patients with pulp exposure by caries or tooth-alveolar trauma.
RESULTS
Of the 21 articles obtained in the initial phase of the review, only 19 were available in full text and of these only met the requirements for inclusion 6 items, which were confronted, analyzed and discussed later.
CONCLUSIONS
The clinical evidence available showed significant differences regarding the use of a material or another. In addition to the findings of clinical follow--radiographic and taking into account the potential toxicity of formocresol suggest the use of mineral trioxide aggregate pulpotomy of primary teeth.
Topics: Aluminum Compounds; Calcium Compounds; Child; Child, Preschool; Drug Combinations; Formocresols; Humans; Oxides; Pulpotomy; Silicates; Tooth, Deciduous
PubMed: 20526246
DOI: 10.4317/medoral.15.e942 -
International Journal of Clinical... 2010(1)Aloe-Barbadensis Mill (Liliaceae) is used in the traditional medicine of Mexico and other countries for anti-inflammatory and cosmetic purposes (Diez-Martinez 1981,... (Review)
Review
(1)Aloe-Barbadensis Mill (Liliaceae) is used in the traditional medicine of Mexico and other countries for anti-inflammatory and cosmetic purposes (Diez-Martinez 1981, Grindlay and Reynolds 1986). Two components are obtained from the fresh leaves of Aloe-Barbadensis, a bitter yellow juice (exudate), which drains from the transversally cut leaves used as a laxative (Ishii et al 1990) and a mucilaginous gel from leaf parenchyma, which has been used as a remedy for a variety of pathological states such as arthritis, gout, acne, dermatitis, burns and peptic ulcers induced by epithelial alterations (Cap-passo and Ganginella 1997, Reynolds and Dweek 1999). The aim of this study is to evaluate efficacy of Aloe-Vera gel as a healing agent in an endodontic procedure called pulpotomy. Fifteen primary molars were treated for pulpotomy using 'Aloe-Vera gel'. Patients were recalled after 1 month to check for any clinical symptoms. None of the patients reported with clinical symptoms of pain, mobility, abscess and histopathological evaluation done following extraction after 2 months showed positive signs of healing.
PubMed: 27507917
DOI: 10.5005/jp-journals-10005-1059 -
Pakistan Journal of Medical Sciences 2017To evaluate the therapeutic effects of pulpotomy and pulpectomy on deciduous molars with deep caries.
OBJECTIVE
To evaluate the therapeutic effects of pulpotomy and pulpectomy on deciduous molars with deep caries.
METHODS
A total of 124 children (192 molars) with deep caries treated from February 2014 to February 2015 were selected. They each had at least one molar with deep caries. MTA pulpotomy (101 molars) and Vitapex pulpectomy (91 molars) as well as prefabricated metal crown repair were conducted. The patients were followed up for 18 months after surgery, and the therapeutic effects were evaluated through clinical and X-ray examinations.
RESULTS
The proportion of molars without lesions was 80.20% in pulpotomy group, which significantly exceeded that of pulpectomy group (72.53%). The pulpotomy group with good clinical manifestations underwent spontaneous pain in four molars during follow-up, and five molars gradually underwent pain and gingival redness and swelling. The pulpectomy group suffered from occlusion discomfort in nine molars and gingival fistula in seven molars during follow-up. The postoperative morbidity of pulpectomy group was significantly higher than that of pulpotomy group (χ=4.50, P=0.04). The 18-month tooth survival rates of pulpotomy and pulpectomy groups were 90% and 79% respectively, which were significantly different (χ=4.645, P=0.031).
CONCLUSION
The postoperative outcomes of pulpotomy are superior to those of pulpectomy.
PubMed: 29492080
DOI: 10.12669/pjms.336.13488 -
Dental Traumatology : Official... Dec 2022Complicated crown fractures are frequently encountered in the paediatric population and pulpotomy procedures (either partial or coronal) are recommended to maintain the...
BACKGROUND/AIM
Complicated crown fractures are frequently encountered in the paediatric population and pulpotomy procedures (either partial or coronal) are recommended to maintain the pulp. The aim of this study was to determine the pulp outcomes of permanent teeth with complicated crown fractures treated with pulpotomy in a hospital-setting and to identify potential factors which may influence the outcomes.
MATERIAL AND METHODS
Data for this retrospective study were extracted from dental records of patients with complicated crown fractures and treated with pulpotomies at a single centre between 1 January 2015 and 30 August 2019. Pulp outcomes were determined, and the associations between the outcome and independent variables were assessed using the Chi-Square test of independence and the Point-Biserial Correlation Test. Predictors of outcome were identified using the binary logistic regression model.
RESULTS
The overall success of pulpotomy in managing traumatised permanent teeth was 61%, which was lower than those previously reported. Pulp healing was seen in 54.1% and 73.7% of teeth treated with partial pulpotomies and coronal pulpotomies, respectively. The presence of a radiographically detectable dentine bridge (p < .01) and longer clinical experience of the clinician (p < .04) was significantly associated with successful outcomes. The history of pain and the stage of root development were identified as significant predictors of the outcome.
CONCLUSION
Pulpotomy is a viable treatment modality for complicated crown fractures in the paediatric population. However, appropriate case selection and further training may be required to ensure improved pulp healing outcomes. A longer follow-up period should be considered to identify late-stage complications.
Topics: Humans; Child; Pulpotomy; Retrospective Studies; Treatment Outcome; Dental Pulp Exposure; Dentition, Permanent; Tooth Fractures
PubMed: 35972842
DOI: 10.1111/edt.12781 -
The Journal of Clinical Pediatric... Mar 2023Selecting an appropriate vital pulp therapy (VPT) for primary teeth with reversible pulpitis can sometimes be confusing for clinicians. Encouragingly, continuous... (Clinical Trial)
Clinical Trial
Selecting an appropriate vital pulp therapy (VPT) for primary teeth with reversible pulpitis can sometimes be confusing for clinicians. Encouragingly, continuous developments in capping materials with bioactive properties help the selection of less-invasive treatments. This non-randomized clinical trial aimed to assess the clinical and radiographic success rates of indirect pulp treatment (IPT), direct pulp capping (DPC), partial pulpotomy (PP) and pulpotomy in primary molars utilizing TheraCal PT over a 12-month period. Different inclusion criteria were assigned for each treatment to assess the eligibility of each treatment type for specific clinical scenarios. Additionally, the association of tooth survival with some variables was assessed. The trial was registered at clinicaltrials.gov (NCT04167943) on 19 November 2019. Primary molars (n = 216) with caries extending into the inner dentin third or quarter were included. Selective caries removal was employed in IPT. Non-selective caries removal was employed in other groups, and treatment was decided according to pulp exposure characteristics, whereby the most conservative treatment was selected for the least clinically detectable pulp inflammation. Cox regression was performed to assess the effects of different variables on tooth survival using ˂ 0.05 for detecting statistical significance. The 12-month combined clinical and radiographic success rates for IPT, DPC, PP and pulpotomy were 93.87%, 80.4%, 42.6% and 96.15%, respectively. Proximal surface involvement, provoked pain and first primary molars were associated with increased odds of treatment failure. According to the specified inclusion criteria, IPT, DPC and pulpotomy using TheraCal PT demonstrated acceptable results, while PP was associated with poor treatment outcomes. The odds of failure increased with proximal surface involvement, provoked pain and first primary molars. These results provide insights into different scenarios when managing deep carious lesions in primary teeth. The effects of clinical predictors on treatment outcomes may guide clinicians in case selection.
Topics: Humans; Dental Pulp Capping; Tooth, Deciduous; Calcium Compounds; Silicates; Pulpotomy; Treatment Outcome; Dental Caries; Molar
PubMed: 36890738
DOI: 10.22514/jocpd.2023.004 -
Laser Therapy Sep 2018The aim of this investigation was to evaluate clinical and radiographic effects of diode laser pulpotomy on young human primary molars.
BACKGROUND AND AIMS
The aim of this investigation was to evaluate clinical and radiographic effects of diode laser pulpotomy on young human primary molars.
MATERIALS AND METHODS
This double-blind, split-mouth randomized clinical trial was conducted on 14 children, aged 3-9 years. In total, 20 pairs of teeth were selected from those with pulpal exposure due to caries. Case selection was conducted based on clinical and radiographic criteria with similar teeth in each patient. One tooth was randomly assigned to diode laser pulpotomy as case and the other tooth was pulp-treated using formocresol as control. Diode laser at a 10-W power was applied on the remaining pulp tissue following coronal pulp amputation in the case group, while a cotton pellet with diluted formocresol was placed over the amputated pulp in the control group. Reinforced zinc oxide-eugenol paste was then placed over the pulp stump and the tooth was restored with stainless steel crown. A 6- and 12-month followed-up was conducted clinically and radiographically in order to assess the success rates. Data were analyzed with Fisher's exact test.
RESULTS
Clinical failure rate was almost zero when the cases were followed and examined clinically (100% success), with 95% and 90% of the cases in the case group (diode laser) being judged as successful in radiographic examination after 6 and 12 months, respectively. Cases in the control group (formocresol) had almost the same clinical success rate (100%) with no failure judged by radiographic evaluation at 6 and 12 months. These results did not show any significant differences when analyzed using Fisher's exact test (P > 0.05).
CONCLUSION
There was no significant difference between diode laser pulpotomy and formocresol pulpotomy of human primary teeth after 6 and 12 months. Only a fraction of cases (5%) had radiographic problems at their follow-up in the laser group.
PubMed: 32158064
DOI: 10.5978/islsm.27_18-OR-17 -
Iranian Endodontic Journal 2015Maintaining deciduous teeth in function until their natural exfoliation is absolutely necessary. Vital pulp therapy (VPT) is a way of saving deciduous teeth. The most... (Review)
Review
Maintaining deciduous teeth in function until their natural exfoliation is absolutely necessary. Vital pulp therapy (VPT) is a way of saving deciduous teeth. The most important factors in success of VPT are the early diagnosis of pulp and periradicular status, preservation of the pulp vitality and proper vascularization of the pulp. Development of new biomaterials with suitable biocompatibility and seal has changed the attitudes towards preserving the reversible pulp in cariously exposed teeth. Before exposure and irreversible involvement of the pulp, indirect pulp capping (IPC) is the treatment of choice, but after the spread of inflammation within the pulp chamber and establishment of irreversible pulpitis, removal of inflamed pulp tissue is recommended. In this review, new concepts in preservation of the healthy pulp tissue in deciduous teeth and induction of the reparative dentin formation with new biomaterials instead of devitalization and the consequent destruction of vital tissues are discussed.
PubMed: 25598803
DOI: No ID Found