Pulp therapy in the primary dentition.
Curr Opin Dent. 1991 Oct;1(5):556-63.
Fuks AB, Eidelman E.
Several treatment options for pulp therapy in primary teeth are reviewed. Conservative
treatments are recommended for primary teeth whose pulps have the potential to recover
once the irritation has been removed. The role of dentin permeability and microleakage
is emphasized when protective basis and indirect pulp treatment are discussed.
Alternative dressings for formocresol pulpotomies such as 6.25% glutaraldehyde
solution, antigen-extracted allogeneic dentin matrix, and crude bone morphogenetic
protein are reported with promising results. Pulpectomy is recommended for teeth
with evidence of chronic inflammation involving radicular pulp or pulp necrosis with
and without periapical involvement. The main disadvantage of zinc oxide-eugenol paste,
widely used for primary root fillings in the United States, is its slow resorption
rate, frequently much slower than that of the root. Other root canal pastes
containing iodoform, or a modification of this with the addition
of calcium hydroxide, are being utilized in South America, Japan, and Europe.
Electronic determination of root canal length in primary teeth with and without root resorption.
Int Endod J. 2002 May;35(5):447-52.
Mente J, Seidel J, Buchalla W, Koch MJ.
AIM: To test an electrical device for determining root canal length in primary teeth
in vitro, and to compare it with the radiographic length measurement. METHODOLOGY: Two
examiners determined the root canal length of 24 extracted maxillary primary incisors
(12 with visible root resorption and 12 without) using an electrical root canal meter
(Tri Auto ZX, Morita, Dietzenbach, Germany). The instrument was left in the root canal
after the second examination and a radiograph was taken. The whole tooth was cleared by
immersion in methylsalicylate and subsequently photographed. Both radiographs and
photographs of cleared teeth were measured and compared with the electronic measurements.
RESULTS: The evaluation of the radiographs showed a mean distance between the instrument
tips and apices of 0.60 (+/- 0.41) mm; evaluation of the cleared teeth showed an
equivalent distance of 0.62 (+/- 0.40) mm. The mean distance between instrument
tip and acceptable working length (determined with the clearing method) was
0.26 (+/- 0.24) mm in teeth without resorption and 0.29 (+/- 0.30) mm in
teeth with resorption. CONCLUSION: The presence of resorption in primary
teeth did not affect the accuracy of electrical measurement of root canal
length in vitro. The application of this method in primary teeth should be evaluated further.
Treatment of crown fractures with pulp exposure in primary incisors.
Pediatr Dent. 2003 May-Jun;25(3):241-7.
Kupietzky A, Holan G.
The treatment options of enamel dentin crown fractures with pulpal exposure in the
primary dentition traditionally consist of direct pulp capping, pulpotomy, pulpectomy,
or extraction. Many clinicians disagree on the most appropriate treatment, and individual
preferences exist within dentistry. Partial pulpotomy, also known as the Cvek pulpotomy,
is a mode of treatment which is widely used in the permanent dentition but less so in
primary teeth. This conservative technique is described and its advantages over the
others are presented. In addition, a report of a case with a 2-year follow-up is also
included. The purposes of this article are: (1) to present the indications and
contraindications of the various treatment modalities for primary incisors with
complicated crown fractures; and (2) to suggest partial pulpotomy as a conservative
and more appropriate approach
for primary incisors with complicated crown fracture.
Endodontic treatment of primary teeth using a combination of antibacterial drugs.
Int Endod J. 2004 Feb;37(2):132-8.
Takushige T, Cruz EV, Asgor Moral A, Hoshino E.
AIM: To evaluate the clinical outcome of 'Lesion Sterilization and Tissue Repair' (LSTR)
therapy for endodontic treatment of primary teeth. METHODOLOGY: A mixture of metronidazole,
ciprofloxacin, and minocycline (3Mix) in ointment (macrogol mixed with propylene glycol: MP)
or in a root canal sealer was used to disinfect infected root canals of 56 patients aged
4-18 years. Out of a total of 87 primary teeth, 81 cases had physiologic root resorption.
A total of 54 radiolucent periradicular lesions were present. The root canals were not
prepared before or after disinfection. 3Mix medicament (3Mix-MP/3Mix-sealer) was placed
at orifices of root canals or on the bottom of pulp chambers, and then sealed with
glass-ionomer cement and further reinforced by a composite resin inlay prepared using
a direct method and cemented with resin. RESULTS: In all cases, clinical symptoms
such as gingival swelling (52 cases), sinus tracts (22 cases), induced dull pain
(3 cases), spontaneous dull pain (26 cases), and pain on biting (46 cases) disappeared
after treatment, although in four cases clinical signs and symptoms were finally
resolved only after retreatment using the same procedures. Thus, gingival abscesses
and fistulae, if present, disappeared after a few days. Successor permanent teeth
erupted without any disorders, or were found radiographically to be normal and in
the process of eruption. All the cases were evaluated as successful. The mean
function time of the primary teeth was 680 days (range: 68-2390 days), except
for one case in which the successor permanent tooth was congenitally missing.
CONCLUSION: Primary teeth with periradicular lesions with or without physiologic
root resorption were treated successfully by the LSTR endodontic therapy.
Evaluation of the carbon dioxide laser on vital human primary pulp tissue.
Pediatr Dent. 1999 Sep-Oct;21(6):327-31.
Elliott RD, Roberts MW, Burkes J, Phillips C.
PURPOSE: The purpose of this study was to evaluate the response of the human primary pulp
to the carbon dioxide laser and formocresol for vital pulp therapy. METHODS: Fifteen healthy
children with intact, caries-and-restoration-free, contralateral primary cuspids with at
least two-thirds of the roots remaining who were scheduled for orthodontic extraction were
randomly assigned to pulpotomy treatment with a carbon dioxide laser or formocresol. The
treated teeth were clinically and radiographically evaluated at 28 and 90 days
post-treatment prior to extraction. The extracted teeth were evaluated histologically
for pulpal response. RESULTS: All teeth were asymptomatic and clinically normal at both
observation periods. Internal root resorption was observed in one formocresol and two
laser treated teeth. There was a significant inverse correlation between the laser
energy applied to the pulp and the degree of inflammation at 28 days (P = .01) but
not at 90 days (P = .27). CONCLUSION: Carbon dioxide laser treatment
compared favorably to formocresol for pulpotomy in primary teeth.
An investigation of the relative efficacy of Buckley's Formocresol and calcium hydroxide in primary molar vital pulp therapy.
Br Dent J. 2000 Jan 8;188(1):32-6.
Waterhouse PJ, Nunn JH, Whitworth JM.
OBJECTIVE: To compare the clinical and radiological outcomes following two different,
single visit vital pulp therapy techniques, in cariously exposed primary molar teeth.
SETTING: A paediatric dental clinic within the Dental Hospital, Newcastle upon Tyne, UK.
SUBJECTS: 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. DESIGN: 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. RESULTS: 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). CONCLUSION: 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.
Mineral trioxide aggregate vs. formocresol in pulpotomized primary molars: a preliminary report.
Pediatr Dent. 2001 Jan-Feb;23(1):15-8.
Eidelman E, Holan G, Fuks AB.
PURPOSE: The aim of this study was to compare the effect of mineral trioxide aggregate
(MTA) to that of formocresol (FC) as pulp dressing agents in pulpotomized primary molars
with carious pulp exposure. METHODS: Forty-five primary molars of 26 children were treated
by a conventional pulpotomy technique. The teeth were randomly assigned to the MTA
(experimental) or FC (control) group by a toss of a coin. Following removal of the
coronal pulp and hemostasis 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 for 5 minutes and removed; the pulp stumps were then covered by zinc
oxide-eugenol (ZOE) paste. The teeth of both groups were restored with stainless
steel crowns. Eighteen children with 32 teeth arrived for clinical and radiographic
follow-up evaluation ranging from 6 to 30 months. RESULTS: The follow-up evaluations
revealed only one failure (internal resorption detected at a 17 months postoperative
evaluation) in a molar treated with formocresol. None of the MTA-treated teeth showed
any clinical or radiographic pathology. Pulp canal obliteration was observed in 9
of 32 (28%) evaluated molars. This finding was detected in 2 out of the 15 teeth
treated with FC (13%) and in 7 out of the 17 treated with MTA (41%).
CONCLUSION: MTA showed clinical and radiographic success as a dressing
material following pulpotomy in primary teeth and seems to
be a suitable replacement for formocresol in primary teeth.
Ferric sulfate as pulpotomy agent in primary teeth: twenty month clinical follow-up.
J Clin Pediatr Dent. 2000 Summer;24(4):269-72.
Ibricevic H, al-Jame Q.
Seventy primary molar teeth, carious exposed, symptom free, without any sign of root
resorption in children aged from 3 to 6 years (main age 4.3 yr) were treated with conventional
pulpotomy procedures. Ferric sulfate 15.5% solution (applied for 15 second for 35 teeth)
and formocresol solution (five minute procedure of Buckley's formula for next 35 teeth)
have been used as pulpotomy agents. In both groups, pulp stumps were covered with
zinc-oxide eugenol paste. Permanent restorations were stainless steel crowns. Clinical
check up was every three-months and radiographic follow-up time was six and twenty
months after treatment. Our results within this period revealed 100% clinical success
rate in both groups. Radiographic success rate was in both groups 97.2%, while in 2.8%
cases has shown internal root resorption. On the basis of these results, we can recommend
ferric sulfate as a pulpotomy agent
in primary teeth in substitution for formocresol at the moment.
Caries control and other variables associated with success of primary molar vital pulp therapy.
Pediatr Dent. 2004 May-Jun;26(3):214-20.
Vij R, Coll JA, Shelton P, Farooq NS.
PURPOSE: This research evaluated initial treatment of deep dental caries with caries control
(CC) procedure and the effect of other factors on the success of indirect pulp therapy (IPT)
and formocresol pulpotomy (FP). METHODS: Retrospective chart audits were performed on 226
primary molars with deep caries approaching the pulp that were treated using IPT and FP.
Mean follow-up was 3.4 years. CC with glass ionomer cement (GIC) was performed on 50 of
the 226 teeth 1 to 3 months before pulp therapy. RESULTS: IPT therapy was successful
94% of the time, whereas FP was successful 70% of the time. The initial use of CC
increased the IPT/FP success rate to 92% vs a 79% success rate in teeth without CC.
Primary molar FP success on primary first molars was 61% vs 83% in second molars.
IPT therapy was successful 92% of the time for first molars vs 98% of the time for
second molars. Thirty-six percent of the FP-treated teeth exfoliated early vs 2% of
the IPT-treated teeth. Primary first molars with reversible pulpitis had a higher
success with IPT (85%) vs FP (53%). The type of final restoration did not affect
IPT or FP success, except that FPs restored with an immediate IRM
(Dentsply/Caulk, Milford, Del) restoration decreased success to 39%.
CONCLUSIONS: IPT for the treatment of deep dental caries lesions produced greater
long-term success than FP. FP success in primary first molars was lower compared to
IPT success, especially in teeth with reversible pulpitis. Also FP-treated teeth
showed significantly earlier exfoliation patterns. The prior treatment of deep dental
caries lesions with CC procedures improved the subsequent IPT or FP success.
Clinical decision-making for caries management in primary teeth. (Free Full Text)
J Dent Educ. 2001 Oct;65(10):1133-42.
Tinanoff N, Douglass JM.
The aim of this review of clinical decision-making for caries management in
primary teeth is to integrate current knowledge in the field of cariology into
clinically usable concepts and procedures to aid in the diagnosis and therapy
of dental caries in primary teeth. The evidence for this paper is derived from
other manuscripts of this conference, computer and hand searches of scientific
articles; and policy statements of councils or commissions of various health
organizations. Current evidence regarding the carious process and caries risk
assessment allows the practitioner to transcend traditional surgical management
of dental caries in primary teeth. Therapy can focus on patient-specific approaches
that include disease monitoring and preventive therapies supplemented by restorative
therapies. The type and intensity of these therapies should be determined utilizing
data from clinical and radiograph examinations as well as information regarding caries
risk status; evidence of therapy outcomes; assessment and reassessment of disease
activity; natural history of caries progression in primary teeth; and preferences
and expectations of guardians and practitioners. Changes in the management of
dental caries will require health organizations and dental schools to educate
students, practitioners, and patients in evidence- and risk-based care.