Assessing the efficacy of Laser pulpotomy versus conventional pulpotomy in primary teeth: A systematic review and meta-analysis of clinical trials.

PURPOSE: This study systematically reviewed the clinical and radiographic outcomes of laser versus conventional pulpotomy in primary teeth. It also compared the success and effectiveness of different lasers to enhance the understanding and use of laser pulpotomy as an alternative treatment. METHODOLOGY: An electronic search was carried out in PubMed and Cochrane from 1st January 1999 to 31st December 2023. The published articles in the English language were searched using MeSH terms and text words. Only randomized controlled trials with a sample size of more than 10 and follow-ups over 6 months were included. Meta-analysis and forest plots were evaluated by utilizing Review Manager 5.4 software. Two reviewers assessed the risk of bias using the RoB 2 tool and discrepancies were resolved by the third reviewer. The success rates were combined using a random effects model to determine clinical and radiographic outcomes. We used risk ratios with 95% confidence intervals (CI) as the primary effect measures and set the significance level at 0.05. RESULTS: Only 18 studies met the inclusion criteria after an electronic search. Among them, 13 studies evaluated the clinical and radiographic outcomes of laser with formocresol pulpotomy, 2 studies compared with ferric sulfate pulpotomy, and the remaining studies with Mineral trioxide aggregate (MTA) pulpotomy. The various studies showed different levels of bias. There was no significant difference in the clinical success rate (p = 0.47; RR: 1.01; 95% CI 0.98-1.04; I2 = 0%; p = 0.70) and radiographic success rate (p = 0.94; RR: 1.00; 95% CI 0.91-1.09; I2 = 64%; p = 0.001) between laser pulpotomy and formocresol. Similarly, there was no significant difference between laser pulpotomy and ferric sulfate or MTA pulpotomy. CONCLUSION: Diode laser and LLLT can be considered as alternative pulpotomy agents to formocresol in primary teeth. However, high-quality trials are needed to confirm the accuracy and reliability of these findings.

Allium Sativum Oil as an Alternative Non-Vital Pulpotomy Medicament in Primary Teeth - A Randomised Controlled Trial.

OBJECTIVE: To use Allium sativum oil as non-vital pulpotomy medicament in primary teeth by evaluating its antibacterial effect (Colony-Forming Units/ml- CFU/ml), against Streptococcus mutans and Lactobacillus acidophilus. STUDY DESIGN: A double-blinded, randomised controlled trial. Place and Duration of the Study: Paediatric Dentistry Department, de' Montmorency College of Dentistry, Lahore in collaboration with the Microbiology Department, Lahore General Hospital, from October 2022 to February 2023. METHODOLOGY: Forty patients aged between 4 to 8 years, each containing at least one non-vital primary molar, were randomly divided into Group A (Formocresol) and Group B (Allium sativum oil) using the lottery method. Non-vital pulpotomy (NVP) was performed by removing the coronal necrotic pulp. Sterile paper points were dipped in the root canals and taken to the laboratory. Cotton pellets soaked in the respective medicaments were placed over the root canal orifices and filled temporarily. Patients were recalled after one week. Samples were again taken, and the tooth was restored. Comparison was made between bacterial count at baseline and after one week of treatment, and it was expressed as CFU/ml. RESULTS: There was a significant reduction in median Streptococcus mutans and Lactobacillus acidophilus bacterial count in each group after one week of treatment (p <0.001). Formocresol showed a higher average reduction (30300 ± 14060) compared to Allium sativum oil (24850 ± 9121). However, statistically, the difference was insignificant (p = 0.314) indicating both the medicaments possessed comparable antibacterial effects. CONCLUSION: Allium sativum oil was found an effective alternative to Formocresol. KEY WORDS: Formocresol, Allium sativum, Non-vital pulpotomy, Primary teeth, Randomised controlled trial.

Clinical and Radiographic Success Rates of Pulpotomies in Primary Molars Treated with Formocresol, BiodentineTM, and Endo Repair: A Randomized Clinical Trial

ABSTRACT Objective: To compare the clinical and radiographic success rates of formocresol, BiodentineTM, and Endo Repair agents in primary molars after 12 months. Material and Methods: This randomized double-blind clinical trial was conducted on healthy children referred to the Department of Pediatric Dentistry, Kerman, Iran, in 2018. One hundred twenty children (human primary molar teeth) aged 3-9 years were selected and randomly divided into three interventions (with pulpotomy medicament agents), including formocresol, BiodentineTM, and Endo Repair. All pulpotomized teeth were restored using stainless steel crowns and evaluated clinically and radiographically during a 12-month follow-up. Fisher exact test was used to determine the association of categorical variables and the data were analysed with SPSS 25. Results: All the available teeth in formocresol and BiodentineTM groups obtained clinical success, whereas 62.5% of the Endo Repair group was successful in this regard. Radiographic success rates of the formocresol, BiodentineTM, and Endo Repair groups were 94.7%, 70%, and 28.1% after a 12-month follow-up, respectively. Moreover, pulp canal obliteration was observed in 26.3%, 25%, and 12.5% of the formocresol, BiodentineTM, and Endo Repair groups. Conclusion: This study reported a high rate of clinical success using both BiodentineTM and formocresol pulpotomy techniques. However, the radiographic success rate of formocresol was higher than that of BiodentineTM, and Endo Repair was not considered a suitable pulpotomy medicament agent.

The comparison of calcium hydroxide + biostimulation, calcium hydroxide, formocresol, and MTA pulpotomies without biostimulation in primary teeth: 12-months clinical and radiographic follow-up.

This study has aimed to evaluate the clinical and radiographic success rates of calcium hydroxide pulpotomy (CH) with biostimulation (PBMT) and compare them to that of CH, formocresol (FC), mineral trioxide aggregate (MTA) pulpotomies without PBMT in primary molars. A total of 172 pulpotomies were performed on primary first or second mandibular molars in 94 children who were 5-8 years old. The pulpotomy procedure was performed with four different techniques. In the PBMT group, before the CH placement, 820-nm diode laser radiation was applied to each pulp-stump for 12 s (10 mW, 2.5 J/cm2). The clinical (lack of spontaneous pain, abscess or fistula, and pathological mobility) and radiographic success (lack of periapical/furcal lesions and internal/external resorption) were recorded at 6 and 12 months. The data was statistically evaluated. p value < 0.05 was considered as significant. After 12 months, the clinical and radiographic success rate (a tooth with at least one of the findings was considered unsuccessful) was 97%/92% for FC and 97%/95%, 87%/73%, and 71%/45% for MTA, CH + PBMT, and CH, respectively. There was no significant difference between the CH + PBMT and the other groups in clinical success, while a significant difference was found between CH and FC, MTA groups. In radiographic success, there was a significant difference between the CH and the other groups. No significant difference was found between the 6th- and 12th-month results in clinical success for all the groups. A decrease in success over time was seen only in the CH group for radiographic results. CH without PBMT showed the worst clinical and radiographic results among the groups. CH + PBMT showed similar clinical success compared to the MTA and FC groups. In radiographic success, CH + PBMT showed higher success compared to CH, but this success was not high as compared to MTA and FC.

Eficacia clínica del MTA en Pulpotomías de pacientes pediátricos: Una Revisión Sistemática / Eficácia Clínica da MTA em Pulpotomias Pediátricas de Pacientes: Uma Revisão Sistemática / Clinical Efficacy of MTA in Pediatric Patient Pulpotomies: A Systematic Review

Objetivo: Analizar la eficacia clínica del Agregado Trióxido Mineral (MTA) en pulpotomías a través de estudios comparativos con el formocresol, sulfato férrico e hidróxido de calcio; en pacientes pediátricos con edad de tres a nueve años. Materiales y Métodos: El artículo se basa en una revisión sistemática de la literatura, por ello, se utilizaron como fuentes de información las bases de datos: PubMed, Scielo, y Biblioteca Virtual de Salud. Asimismo, como criterios de inclusión se establecieron publicaciones del año 2008 al 2019, cuya procedencia se derivó de journalsy revistas académicas arbitradas; los cuales permitieron obtener dieciséis ensayos que evaluaban la eficacia clínica a través de los signos y síntomas de las patologías pulpares más comunes: absceso, inflamación gingival, movilidad patológica, dolor a la percusión y dolor espontáneo. Resultados: El MTA obtuvo una eficacia de 97,9% en contraposición al 86,9% del Sulfato Férrico. En relación al Formocresol, el MTA logró el 99% contra un 98,3% de eficacia. Además, en la comparación del MTA con el Hidróxido de Calcio el primero logró un 98,2% y el segundo 74,5%. Conclusiones: El MTA obtuvo una mayor eficacia clínica debido a su biocompatibilidad, pH básico y su elevada facultad al sellar la cámara pulpar. Por lo tanto, puede emplearse como un material seguro para las pulpotomías de pacientes pediátricos.

Objetivo: Analisar a eficácia clínica do Agregado de Trióxido Mineral (MTA) em pulpotomias através de estudos comparativos com formocresol, sulfato férrico e hidróxido de cálcio; em pacientes pediátricos de três a nove anos de idade. Materiais e Métodos: O artigo é baseado em uma revisão sistemática da literatura, portanto, bases de dados foram utilizadas como fontes de informação: PubMed, Scielo, e Biblioteca Virtual. Da mesma forma, como critério de inclusão, foram estabelecidas publicações de 2008 a 2019, cuja origem foi derivada de periódicos e revistas acadêmicas de referência; o que nos permitiu obter dezesseis ensaios que avaliaram a eficácia clínica através dos sinais e sintomas das doenças mais comuns da polpa: abscesso, inflamação gengival, mobilidade patológica, dor na percussão e dor espontânea. Resultados: A MTA obteve uma eficácia de 97,9% contra 86,9% para o sulfato férrico. Em relação ao Formocresol, o MTA alcançou 99% contra 98,3% de eficácia. Além disso, na comparação do MTA com o hidróxido de cálcio, o primeiro atingiu 98,2% e o segundo 74,5%. Conclusões: A MTA obteve uma maior eficácia clínica devido a sua biocompatibilidade, pH básico e sua alta faculdade ao selar a câmara de celulose. Portanto, pode ser usado como material segura para pulpotomias de pacientes pediátricos.

Objective: To analyze the clinical efficacy of the Mineral Trioxide Aggregate (MTA) in pulpotomies through comparative studies with formocresol, ferric sulfate and calcium hydroxide; in pediatric patients aged three to nine years. Materials and Methods: The article is based on a systematic review of the literature, therefore, databases were used as sources of information: PubMed, Scielo, and Virtual Health Library. Likewise, as inclusion criteria, publications from 2008 to 2019 were established, whose origin was derived from journals and refereed academic journals; which allowed us to obtain sixteen trials that evaluated clinical efficacy through the signs and symptoms of the most common pulp diseases: abscess, gingival inflammation, pathological mobility, pain on percussion and spontaneous pain. Results: MTA obtained an efficacy of 97.9% as opposed to 86.9% for ferric sulfate. Concerning to Formocresol, MTA achieved 99% versus 98.3% efficacy. Also, in the comparison of MTA with Calcium Hydroxide, the former achieved 98.2% and the latter 74.5%. Conclusions: MTA obtained a higher clinical efficacy due to its biocompatibility, basic pH and its high faculty when sealing the pulp chamber. Therefore, it can be used as a safe material for pediatric patient pulpotomies.

Pulpotomía con biodentine comparado con formocresol en pacientes con dentición primaria / Biodentine versus formocresol for pulpotomy in primary teeth

RESUMEN: Introducción: En dentición primaria, la pulpotomía con formocresol ha sido convencionalmente utilizada para el tratamiento de caries cercanas a la pulpa. Sin embargo, la seguridad de este material ha sido cuestionada. Por otro lado, el biodentine ha sido propuesto como un biomaterial sustituto bioactivo de la dentina, pero no está clara su efectividad. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y una tabla GRADE para el resumen de los resultados. Resultados y conclusiones: Identificamos tres revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos correspondientes a ensayos aleatorizados. Concluimos que no se puede establecer con claridad si biodentine comparado con formocresol aumenta el éxito clínico y el éxito radiográfico en pulpotomía en pacientes con dentición primaria, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: Pulpotomy with formocresol is the main treatment protocol following carious pulp exposure in primary teeth, but many concerns have been raised regarding its safety. Biodentine has been proposed as a bioactive dentine substitute, but there is still uncertainty regarding its effectiveness. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified three systematic reviews including two studies overall, of which both were randomized trials. We are uncertain whether biodentine compared to formocresol for pulpotomy improves clinical and radiographic success, as the certainty of the evidence has been assessed as very low.

Qualitative assessment of published studies on pulpotomy medicaments for primary molar teeth.

The aim of the present study was to perform a qualitative assessment of published clinical studies, using the Medline database between 2006 and 2016, on commonly used pulpotomy medicaments. Standardized criteria proposed by Fuks and Papagiannoulis in 2006 was used by three independent examiners who assessed a total of 64 studies and graded the papers as grades A (38-42), B1 (32-37), B2 (25-31), or C (<25) based on the score obtained. Dropout rates were calculated based on the initial sample and the final sample used for analysis. Only three papers were grade A, two of which were parts of the same clinical study with results presented at 24 and 42 months, respectively. Twelve papers were graded B1, 19 were graded B2, and 30 were graded C. The quality of evidence seemed greatest for formocresol (2 grade A, 21 grade B), followed by electro surgery (1 grade A study), calcium hydroxide (11 grade B studies), and ferric sulfate (11 grade B studies). The current qualitative assessment clearly highlights the inadequacies in the published studies, especially the study design and clinical and radiographic criteria, thus provides a basis for formulating specific guidelines for researchers embarking on conducting clinical trials on pulpotomy medicaments.

Evaluation of the genotoxic effects of formocresol application in vital pulp therapy of primary teeth: a clinical study and meta-analysis.

OBJECTIVES: This in vivo research investigated whether pulp treatments using formocresol for 7 days would cause mutagenic changes in children's lymphocytes. MATERIALS AND METHODS: The mutagenicity was tested in lymphocyte cultures established from the peripheral blood of children living in Brazil. The samples consisted of 2000 cells from teeth undergoing formocresol pulpotomies in which the formocresol pellet was sealed in the primary tooth for 7 days. It was removed on the seventh day, the base was placed, and the tooth was restored. Two venous blood samples (6-8 ml) were collected from each child; the first was prior to pulp therapy, and the second was 7 days later. Two thousand metaphases were analyzed. The level of significance adopted for the statistics was P < 0.05, and a random effects meta-analysis was performed combining this and two previous studies. RESULTS: There was no significant difference found in the metaphase analysis between the blood samples taken before and after the pulpotomy treatment (Wilcoxon signed rank test); however, the meta-analysis showed a significant difference between the combined studies. CONCLUSIONS: This study did not reveal any mutagenic effects, but based on the combined meta-analysis, we recommend the careful use of formocresol. CLINICAL RELEVANCE: This research helps to bring scientific evidence of the safe use of formocresol in deciduous pulpotomy treatments.

Formulation of Saudi Propolis into Biodegradable Chitosan Chips for Vital Pulpotomy.

BACKGROUND: Propolis has been widely used to treat oral cavity disorders, such as endodontal and periodontal diseases and microbial infections. OBJECTIVE: The study aimed at the formulation of commercial Saudi propolis into biodegradable chitosan chips and evaluation of its effectiveness as a pulpotomy agent. METHODS: The standardization of 80% ethanolic propolis extract was performed regarding its total phenolic content, total flavonoid content, quantitative estimation of main polyphenolic constituents and antioxidant activity. Chitosan chips containing propolis extract were prepared by the solvent/ casting method. The investigated variables were % of chitosan polymer (2, 2.5 and 3%), % of plasticizer (1, 5 and 10%) and incorporation of different concentrations of hydroxypropyl methylcellulose (5, 10 and 20% of polymer weight). The chips were characterized for weight and thickness uniformity, content uniformity, pH, percentage moisture loss, swelling index, tensile strength and in vitro propolis release. The optimal propolis chip formulation was further investigated in dogs regarding the short term response of primary dental pulp to propolis chips compared with the most commonly used formocresol preparation. RESULTS: The prepared films were flexible and demonstrated satisfactory physicochemical characteristics. The optimal formulation showed an initial release of about 41.7% of the loaded propolis followed by a sustained release extended up to 7 days. The kinetics study demonstrated that propolis release was controlled by Fick´s diffusion. The optimal propolis chip formulation resulted in less pulpal inflammation compared to formocresol, and produced hard tissue formation in all specimens. CONCLUSION: Formulation of commercial Saudi propolis as a biodegradable chitosan chip is an effective alternative to the commercially available chemical agents for the treatment of vital pulpotomy.

Evaluation and Comparison between Formocresol and Sodium Hypochlorite as Pulpotomy Medicament: A Randomized Study.

INTRODUCTION: Pulpotomy is the most common treatment to preserve vitality of cariously exposed molars. Various pulpotomy medicaments used should be antimicrobial, should help in healing without damaging surrounding tissue, and should not affect eruption of permanent teeth. Thus, this study was conducted to evaluate and compare the clinical and radiographic outcomes of formocresol (FC) and sodium hypochlorite (NaOCl) in primary molars. The aim of this randomized study was to compare the clinical and radiographic success rate of FC and 5% NaOCl as a pulpotomy medicament in primary molars. MATERIALS AND METHODS: Forty children aged 4 to 9 years with primary carious molar were selected and randomly assigned into two groups: FC and NaOCl. Pulpotomy procedure was then performed followed by restoration with stainless steel crowns. Clinical and radiographic evaluation was done at an interval of 3 to 6 months. RESULTS: Clinical success rate at 3 and 6 months was 100% for both groups. Radiographic success rate for FC was 95% at 3 months and 90% at 6 months, whereas for NaOCl, it was 90% at 3 months and 85% at 6 months. CONCLUSION: Based on this study, result of 5% NaOCl and FC showed no significant difference in their success rate. Hence, NaOCl can be used as pulpotomy medicament; however, further clinical trials with long follow-up period are required. CLINICAL SIGNIFICANCE: Sodium hypochlorite is a potential clinical substitute of FC for vital pulpotomy treatment in primary teeth because of its exceptional biological compatibility and to evade carcinogenic effect of FC.

Plasma Level Formaldehyde in Children Receiving Pulpotomy Treatment under General Anesthesia.

OBJECTIVES: Formocresol has long been used by dentists for pulpotomy of primary teeth. Due to some concerns regarding its possible carcinogenicity, formocresol has been the topic of numerous studies. This study sought to assess the changes in plasma level of formaldehyde of children after receiving pulpotomy under general anesthesia. STUDY DESIGN: Twenty-five children between 2-6 years requiring dental treatments under general anesthesia were studied. Blood samples were taken of children before and after the procedure. Plasma level of formaldehyde was measured using high performance liquid chromatography (HPLC). RESULTS: A total of 106 pulpotomy treatments were performed in 25 children using 126 cotton pellets dipped in formocresol. An increase and a decrease in plasma level of formaldehyde were noted in 5 (20%) and 20 (80%) children, respectively post-operatively compared to baseline. The t-test showed no significant difference in plasma level of formaldehyde pre- and postoperatively (P=0.12). the plasma level of formaldehyde in children who had higher levels of formaldehyde prior to the operation was also higher than that of others after the operation and this association was statistically significant (P=0.001, r=0.64). CONCLUSIONS: The results showed no significant change in the mean plasma level of formaldehyde in children who received pulpotomy under general anesthesia compared to its baseline value.

Amniotic Membrane versus Formocresol as Pulpotomy Agents in Human Primary Molars: An in vivo Study

Objective: To determine and compare the efficacy of Amniotic Membrane (AM) as a pulpotomy agent with Formocresol (FC) clinically and radiographically. Material and Methods: 30 deciduous molars warranted for pulpotomy in 24 children (4-9 years) were divided equally into two groups of 15 each. Group1: Amniotic membrane pulpotomy and Group 2: Formocresol pulpotomy, which was followed by placement of glass ionomer cement and stainless steel crown restoration. The patients were recalled after 1, 3, 6 and 9 months for clinical and radiographic evaluation. Fisher's exact test and Mcnemar test were used for statistical analysis. Results: Results indicated both clinically and radiographically amniotic membrane performed at par with formocresol. Conclusion: Amniotic membrane with its regenerative, antibacterial properties and the ability to deliver growth factors has shown promising results comparable to gold standard formocresol when used as a pulpotomy agent and hence can be recommended as an alternative pulpotomy agent.

Efectividad clínica y radiográfica de la pasta antibiótica CTZ en pulpotomías de molares primarios: ensayo clínico aleatorio controlado / Clinical and radiographic effectiveness of antibiotic paste CTZ in primary molars pulpotomy: ramdomized controlled clinical trial

El objetivo de este trabajo fue evaluar clínica y radiográficamente la efectividad de la pasta antibiótica CTZ en pulpotomías de molares primarios. Se realizó un ensayo clínico aleatorio controlado, en 40 molares primarios de 40 preescolares con edades entre 3 y 6 años. Los pacientes fueron seleccionados y asignados aleatoriamente a dos grupos: Formocresol (n=20), CTZ (Cloranfenicol-Tetraciclina-Oxido de Zinc Eugenol, n=20). Los dientes fueron restaurados con ionómero de vidrio y coronas metálicas de acero preformadas. La evaluación clínica y radiográfica fue realizada a los 3 y 6 meses. Se utilizó el programa SPSS v.17 para el análisis de los datos, y la aplicación del Test Exacto de Fisher al 5 %. El comportamiento clínico a los 3 meses mostró 75 % de éxito para los molares tratados con formocresol y 70 % para el CTZ. Radiográficamente se obtuvo 90 % de éxito para el grupo con formocresol y 100 % para la pasta CTZ. A los 6 meses el éxito clínico del formocresol fue de 85 % y del CTZ 80 %. El éxito radiográfico mostrado fue 65 % para los atendidos con formocresol y 80 % para el CTZ (p > 0,05). No se observaron diferencias significativas entre los grupos de tratamiento. La pasta CTZ es una alternativa en el tratamiento de pulpotomías de molares temporales. Ofrece un efecto antimicrobiano, estabilización del proceso de reabsorción radicular, sin ocasionar daños a la formación del diente permanente.

The objective of this study to evaluate the clinical and radiographic effectiveness of antibiotic paste CTZ in pulpotomy of primary molars. A randomized controlled clinical trial was performed, in 40 molars of 40 patients aged 3 to 6 years. Were selected and randomly assigned to two groups: Formocresol (n=20), CTZ (Chloramphenicol-Tetracycline-Zinc Oxide Eugenol, n=20). The teeth were restored with glass ionomer and performed steel metal crowns. Clinical and radiographic evaluation procedure was performed at 3 and 6 months. SPSS v.17 program for data analysis, and application of the Fisher exact test was used 5 %. The clinical behavior at 3 months showed 75 % success rate for molars treated with formocresol and 70 % for the CTZ. Radiographically 90 % success rate for the group with formocresol and 100 % for the CTZ paste was obtained. At 6 months formocresol clinical success was 85 % and 80 % CTZ. Radiographic success was shown 65 % for those treated with formocresol and 80 % for the CTZ (p>0.05). No significant differences in the results shown were observed. CTZ paste is an alternative in the treatment of pulpotomy of molars. It provides an antimicrobial effect, stabilizing the process of root resorption, without causing damage to the permanent tooth formation.

Clinical Pulpotomy Trial of Copaifera Langsdorffii Oil Resin Versus Formocresol and White Mineral Trioxide Aggregate in Primary Teeth.

PURPOSE: This study's purpose was to assess clinical and radiographic outcomes of Copaifera langsdorffii oil resin (CLOR) as a pulpotomy medicament compared with one-minute full-strength formocresol (FC) and white mineral trioxide aggregate (WMTA). METHODS: Determined by a power analysis, 152 primary molars of 64 four- to eight-year-olds with at least two asymptomatic molars requiring vital pulpotomies were recruited, randomly assigned to receive CLOR, WMTA, or FC, and restored with prefabricated metal crowns. At the 12-month follow-up, recordings of 59 children with 142 treated teeth were taken for clinical and radiographic symptoms. Clinical evaluation was performed by a blinded calibrated evaluator, whereas four evaluators scored each radiograph for pathologies based upon a modified scale previously proposed. The data were statistically analyzed. RESULTS: At 12 months, 100 percent clinical success was observed with all groups. CLOR had the highest frequency of pathologic radiolucencies at 12 months. The radiographic success at 12 months was 76 percent, 90.91 percent, and 88.23 percent for the CLOR, FC, and WMTA groups, respectively (P=0.10). CONCLUSION: Copaifera langsdorffii oil resin can be suggested as a pulpotomy agent for primary teeth up to one year. However, further clinical studies with long-term follow-ups are needed to test its efficacy as a pulpotomy medicament.

Tratamientos pulpares en dientes primarios / Pulp therapies in primary teeth

El mantenimiento de las piezas dentarias para desempeñar sus funciones en la alimentación, en la expresión oral, en el mantenimiento de espacios en las arcadas dentarias, en el estímulo para el crecimiento y desarrollo de los maxilares, entre otras acciones, ha sido considerado esencial para el logro de un desarrollo armónico. Por otro lado, y a pesar de los avances en la materia, la caries dental es la causa más frecuente de las patologías pulpares en los dientes primarios y constituye el principal motivo de su deterioro y/o su pérdida. Las características histo-patológicas de la pulpa dental, la brevedad de su ciclo vital, el tamaño relativo de las cámaras pulpares, favorecen el rápido compromiso pulpar y propician que el proceso infeccioso progrese rápidamente a la necrosis. Ello ha determinado y determina el desarrollo de numerosas técnicas y tratamientos, diferentes ofertas terapéuticas de las cuales ninguna ha alcanzado el consenso universal. Como establecen las Guías de Odontología Pediátrica sobre tratamientos pulpares en dientes primarios, la literatura dental en esta área ofrece escasa y pobre evidencia para sustentar las diferentes técnicas y constantemente señalan la necesidad de nuevos y rigurosos estudios que la avalen.

Comparative evaluation of pro-inflammatory cytokine levels in pulpotomized primary molars.

The present in vivo study was performed to investigate the levels of the pro-inflammatory cytokines, interleukin (IL)-1α, IL-6, and IL-8, in primary molars for which pulpotomy was clinically indicated, and to evaluate the success rates of three different pulpotomy agents employed for cariously (CExp) or mechanically exposed (MExp) primary molars. Forty-seven primary molars were classified as MExp or CExp according to the type of pulpal exposure. Pulp tissue was harvested and analyzed using enzyme-linked immunosorbent assay (ELISA). Subsequently, three pulpotomy agents-calcium hydroxide (CH), mineral trioxide aggregate (MTA), and formocresol (FC)-were applied randomly, and the outcome was observed radiographically for 18 months. Levels of IL-6 and IL-8 were significantly higher in CExp pulp than in MExp pulp (P < 0.05). In the CH pulpotomy group, MExp teeth showed a higher success rate than CExp teeth. There was no significant difference in success rate between MExp and CExp teeth in both the FC and MTA groups. The levels of IL-6 and IL-8 have the potential to become indicators of pulp status and can be monitored by researchers to make the prognosis of vital pulp therapies less uncertain. As MTA and FC yielded higher rates of success than CH in CExp teeth, the choice of pulpotomy agent appears to be important in this context.

Histological Evaluation of Allium sativum Oil as a New Medicament for Pulp Treatment of Permanent Teeth.

OBJECTIVE: The objective of this study was to evaluate the histo pathology effects of two medicaments Allium sativum oil and formocresol on the remaining pulp tissue of the permanent teething children. MATERIALS AND METHODS: A total of 18 premolars were included in this study. Two sound premolars were extracted and subjected to histological examination to show the normal pulp tissue. Pulpo tomy procedure was performed in the rest of the remaining 16 premolars; half of them using Allium sativum oil and the rest of the tested premolars were medicated using formocresol and all were sealed with suitable restoration. Then, premolars extracted at variable intervals (48 hours, 2 weeks, 1 month, 2 months), stained using hemotoxylin and eosin etain (H&E) and prepared for histopathology examination. RESULTS: Histological evaluation seemed far more promising for Allium sativum oil than formocresol. Histological evaluation revealed that teeth treated with Allium sativa oil showed infammatory changes that had been resolved in the end of the study. On the contrary, the severe chronic infammation of pulp tissue accompanied with formocresol eventually produced pulp necrosis with or without fibrosis. In addition, pulp calcification was evidenced in certain cases. CONCLUSION: Allium sativum oil is a biocompatible material that is compatible with vital human pulp tissue. It offers a good healing potential, leaving the remaining pulp tissue healthy and functioning.

Effect of laser (λ 660 nm) and LED (λ 630 nm) photobiomodulation on formocresol-induced oral ulcers: a clinical and histological study on rodents.

The aim of this study was to evaluate, clinically and histologically, the influence of laser and LED photobiomodulation in the healing of formocresol-induced oral mucosa ulcers of rats. We used 60 Wistar rats in which oral ulcers were induced on the gingiva of the lower incisors. Forty-eight hours after inducing the ulcers, the animals were divided into three groups: laser, LED, and untreated. Animals from the laser group received irradiation with GaAlAs, 660 nm, CW, 40 mW, φ 4 mm(2), 4.8 J/cm(2). Animals from the LED group received irradiation with InGaAIP, 630 nm, 150 mW, 4.8 J/cm(2), 0.8 cm spot. Forty-eight hours after oral ulcer induction, both irradiations were applied in a punctuate manner in the center of the ulcer at 48-h interval until the end of the experimental period. The animals were killed at 3, 5, 7, and 11 days after day 0. The results of the clinical evaluation showed that the laser and LED phototherapies were able to accelerate the healing of formocresol-induced oral ulcers, which occurred first in the laser group (ANOVA, p < 0.05). Histologically, there was a slight variation between LED and laser therapy; therefore, the laser group proved to be effective in accelerating wound healing, especially at 5 days, whereas the LED group was more effective at the end of the experimental period. It was concluded that laser and LED photobiomodulation were effective in accelerating the healing of formocresol-induced oral ulcers in both clinical and histological aspects.

A review of the effects of formaldehyde release from endodontic materials.

Formaldehyde is present in most living cells and the environment. In dentistry, patients may be exposed to formaldehyde through the use of several endodontic materials (e.g. AH 26) and during formocresol pulpotomies. This review outlines how the human body reacts to formaldehyde exposure, how recent data has relooked at the issue of carcinogenicity and leukaemia associated with formaldehyde, and whether it is possible to quantify the amount of formaldehyde produced by endodontic cements. The review analyses the way formaldehyde is produced from epoxy resins and addresses the question of whether the amount of formaldehyde from endodontic cements is large enough to override the body's ability to deal with its own endogenous levels of formaldehyde and should the amount of formaldehyde produced be a concern.