Eighteen-month clinical and radiographic evaluation of two root canal-filling materials in primary teeth with pulp necrosis secondary to trauma.

AIM: This study compared clinically and radiographically the use of zinc oxide and eugenol cement (ZOE) and a commercial calcium hydroxide and polyethylene glycol-based paste (Calen(®) ) thickened with zinc oxide as root canal-filling materials for primary teeth with pulp necrosis secondary to trauma within 18months of follow up. MATERIAL AND METHODS: Eligible patients of both genders aged 2years and 6months to 5years and 10months who had been referred for dental treatment at a pediatric dental trauma service and presented at least one anterior primary tooth (central and/or lateral incisor) with pulp necrosis secondary to traumatic injury were selected. Twenty-six children (n=31 teeth) with mean age of 3.4years met the inclusion criteria and were enrolled after parental written consent. The root canals were instrumented and filled with either ZOE (group I; n=15 teeth) or Calen(®) paste [composition: 2.5g calcium hydroxide, 0.5g zinc oxide, 0.05g colophony, and 1.75ml polyethylene glycol 400 (vehicle)] thickened with zinc oxide (Calen(®) /ZO; group II; n=16 teeth). ZO was added to the Calen(®) paste for slowing paste resorption, which should ideally occur simultaneously with the physiologic resorption of primary tooth roots. Clinical success after 18months of follow up was considered as absence of pain, tooth mobility or fistula, and radiographic success as the partial or total remission of apical periodontitis, absence of pathological root resorption or presence of new bone formation. RESULTS: Eighteen months after treatment, the teeth obturated with ZOE and Calen(®) /ZO presented statistically similar (Fisher's exact test; P >0.05) success rates of 93.3% and 87.5%, respectively. CONCLUSION: Our results showed the clinical and radiographic outcomes for Calen(®) /ZO to be equal to those for ZOE after 18months, suggesting that both materials can be indicated for obturating primary teeth with pulp necrosis after trauma.

Antibacterial effects of chemomechanical instrumentation and calcium hydroxide in primary teeth with pulp necrosis.

PURPOSE: This study's purposes were to: evaluate the antibacterial effect of chemomechanical instrumentation and a calcium hydroxide-based dressing in primary teeth with pulp necrosis secondary to trauma; and detect the presence of Fusobacterium nucleatum and black-pigmented rods in the canals of these teeth. METHODS: Microbiological sample collections (MSCs) were obtained: after coronal access to the canals of primary incisors (in 18 teeth; MSC 1); after chemomechanical instrumentation (in 10 teeth; MSC 2); and 72 hours after removal of intracanal medication (in 18 teeth; MSC 3). These samples were sent for microbiological processing. The results were analyzed statistically via chi-square, analysis of variance, and Games-Howell tests (P<.05). RESULTS: Micro-organisms were isolated in approximately 94%, 10%, and 83% of canals, respectively, in MSCs 1, 2, and 3. There was a statistically significant difference only between MSCs 1 and 2 (P<.03). F nucleatum and black-pigmented rods were detected in approximately 56% and 11% of canals in MSC 1, respectively. CONCLUSION: Chemomechanical instrumentation and calcium hydroxide-based dressing have an anti-bacterial effect by significantly reducing the number of micro-organisms in the main root canal. They showed a limited efficacy, however, and did not prevent bacterial regrowth after endodontic therapy in primary teeth with pulp necrosis secondary to trauma.