Outcome assessment methods of bioactive and biodegradable materials as pulpotomy agents in primary and permanent teeth: a scoping review.

BACKGROUND: Pulpotomy procedures aiming to preserve and regenerate the dentin-pulp complex have recently increased exponentially due to developments in the field of biomaterials and tissue engineering in primary and permanent teeth. Although the number of studies in this domain has increased, there is still scarcity of evidence in the current literature. OBJECTIVES: (1) Report the methods of outcome assessment of pulpotomy clinical trials in both primary and permanent teeth; (2) Identify the various bioactive agents and biodegradable scaffolds used in pulpotomy clinical trials in both primary and permanent teeth. MATERIALS AND METHODS: A scoping review of the literature was performed, including a search of primary studies on PubMed, Scopus, Web of Science, ProQuest and Clinicaltrials.gov. A search for controlled trials or randomized controlled trials published between 2012 and 2023 involving primary or permanent teeth receiving partial or full pulpotomy procedures using bioactive/regenerative capping materials was performed. RESULTS: 127 studies out of 1038 articles fulfilled all the inclusion criteria and were included in the current scoping review. More than 90% of the studies assessed clinical and radiographic outcomes. Histological, microbiological, or inflammatory outcomes were measured in only 9.4% of all included studies. Majority of the studies (67.7%) involved primary teeth. 119 studies used non-degradable bioactive cements, while biodegradable scaffolds were used by 32 studies, natural derivates and plant extracts studies were used in only 7 studies. Between 2012 (4 studies) and 2023 (11 studies), there was a general increase in the number of articles published. India, Egypt, Turkey, and Iran were found to have the highest total number of articles published (28, 28,16 and 10 respectively). CONCLUSIONS: Pulpotomy studies in both primary and permanent teeth relied mainly on subjective clinical and radiographic outcome assessment methods and seldom analyzed pulpal inflammatory status objectively. The use of biodegradable scaffolds for pulpotomy treatments has been increasing with an apparent global distribution of most of these studies in low- to middle-income countries. However, the development of a set of predictable outcome measures as well as long-term evidence from well conducted clinical trials for novel pulpotomy dressing materials are still required.

Outcome of Partial Pulpotomy in Immature Permanent Teeth with Symptomatic Irreversible Pulpitis: A Prospective Case Series Assessment.

INTRODUCTION: The aim of this prospective case series was to assess the clinical and radiographic outcome of partial pulpotomy in caries-exposed symptomatic, vital, immature, permanent molars. METHODS: Thirty-four immature molars with deep caries and symptoms of irreversible pulpitis were treated by partial pulpotomy and ProRoot MTA as a capping material. After complete caries removal, the inflamed part of the pulp was removed. Complete hemostasis was achieved using a sterile cotton pellet moist initially with sodium hypochlorite 1.5% and then with sterile saline. ProRoot MTA (Dentsply Sirona, Charlotte, NC) was placed as a capping material onto the remaining pulp tissue. The cavity was sealed using a light-curing resin-modified Ca(OH)2 cavity liner, and patients were referred to a pediatric dentist for permanent restoration. Descriptive statistics and cross tabulations were performed including variables examined before, during, and after the procedure. RESULTS: All examined teeth presented a favorable clinical and radiographic outcome with normal periapical tissues, complete apical closure, and formation of a dentinal bridge beneath the capping material. Signs of partial pulp chamber calcification were only detected in 2 cases. Postoperatively, most patients did not report any pain (23/34, 67.7%), whereas the rest reported minor intensity pain (11/34, 32.3) and the use of analgesic or anti-inflammatory drugs only for 1 day (10/34, 29.4%). CONCLUSIONS: Partial pulpotomy seems to provide a universally successful outcome when managing symptomatic vital immature teeth with no signs of complications and completion of apical closure. It could be a viable treatment of choice in cases of caries-exposed vital immature teeth with symptoms of irreversible pulpitis.

Comparison of the radiopacity of selected materials used for vital pulp therapy: An in vitro assessment.

BACKGROUND: An assessment of the therapeutic effects of vital pulp treatment is based on both clinical and radiological evaluation. OBJECTIVES: The aim of the research was a long-term (after 1, 2, 4, 6, and 8 weeks) radiological assessment of X-ray absorption by 8 selected materials used for the vital treatment of dental pulp. MATERIAL AND METHODS: The materials, prepared in accordance with the manufacturers' recommendations, were placed in molds measuring 10 mm in diameter and 2 mm in thickness. The molds with the samples were placed on an occlusal film with an aluminum step wedge, and then X-rayed using an intraoral X-ray unit. After processing, an X-ray image with varying degrees of opacity was obtained. The radiological density of the samples, the step wedge and the background was measured 6 times using a densitometer. The tests were repeated at the following intervals: after 7 days, and after 2, 4, 6, and 8 weeks. The molds with the material samples were stored in an incubator at 37°C and 95% humidity. RESULTS: The obtained results were statistically analyzed. The mineral trioxide aggregate (MTA) materials exhibited the highest degree of contrast, whereas the lowest radiopacity was shown for the non-setting calcium hydroxide preparations (p < 0.0001). Calcium hydroxide cements presented medium radiopacity values. CONCLUSIONS: The radiopacity of all the evaluated materials showed a statistically insignificant increasing tendency with regard to the duration of the experiment. All the tested preparations showed acceptable radiopacity, enabling radiological detection in the course of vital pulp therapy.

Postoperative assessment of diode laser zinc oxide eugenol and mineral trioxide aggregate pulpotomy procedures in children: A comparative clinical study.

AIM: The present study is an attempt to compare and evaluate postoperative assessment of diode laser zinc oxide eugenol (ZOE) pulpotomy and diode laser mineral trioxide aggregate (MTA) pulpotomy procedures in children. MATERIALS AND METHODS: Forty carious primary molars indicated for pulpotomy within the age group of 4-9 years were selected and divided into two groups of 20 each using simple randomization, Group 1: Diode laser MTA and Group 2: Diode laser ZOE pulpotomy. The teeth were evaluated clinically for 1 year at 3, 6, and 12 months interval and radiologically for 6 and 12 months. RESULTS: Clinically and radiographically, 100% teeth treated with diode laser MTA and 94% treated with diode laser ZOE were considered successful after 12-month follow-up interval. No significant difference was seen between two groups. CONCLUSION: Despite the success rate, the cost factor of diode laser and MTA could be the limiting factor in its judicious use in pulpotomy procedure.

Comparison of Visual Analog Scale Scores in Pain Assessment during Pulpotomy using Different Injection Materials in Children Aged 6 to 8 and 8 to 10 Years.

AIM: Proper anesthesia and pain management during treatment are most important concerns in dentistry for people of all ages, especially children. This study compared the success rate of lidocaine block with articaine buccal infiltration during anesthesia of the primary mandibular second molars in children aged 6 to 8 and 8 to 10 years. MATERIALS AND METHODS: The present clinical trial was conducted on 40 children aged 6 to 8 and 8 to 10 years who were referred to the Department of Pediatrics of the Faculty of Dentistry at Shahid Sadoughi University of Medical Sciences in Yazd (Islamic Republic of Iran) and needed to be treated with pulpotomy on both primary mandibular second molars. The patients were randomly divided into two groups. At the first session, a group received articaine buccal infiltration and the other group experienced inferior alveolar nerve (IAN) block. At the next visit, this trend was reversed. Visual analog scale (VAS) was used to evaluate the pain during pulpotomy. RESULTS: Data were analyzed by Statistical Package for the Social Sciences (version 17) software using Mann-Whitney test. According to the results of this test, the pain during pulpotomy was significantly lower in the articaine group (p < 0.001). CONCLUSION: Articaine buccal infiltration can be employed for pulpotomy treatment in primary mandibular second molars. CLINICAL SIGNIFICANCE: This research will eliminate block injection of lidocaine in children and utilize infiltration of articaine for pulpotomy treatment of mandibular teeth, hence preventing lingual nerve damage and prolonging paresthesia of IAN, lip, and cheek bite due to IAN block anesthesia.

Cost Estimates for Bioactive Cement Pulpotomies and Crowns in Primary Molars.

PURPOSE: To explore cost-effective options for pulpotomy, chamber fillings, and crowns in primary molars using bioactive cements. METHODS: Thirty extracted primary molars were divided into five groups, each having two sets of three teeth (one first molar and two second molars). Pulpotomy and restorative options were randomly assigned: Biodentine plus Ketac Molar; NuSmile NeoMTA plus Tempit LC; NeoMTA Plus plus Fuji IX; MTA Angelus plus IRM capsule; MTA Flow plus IRM powder and liquid. After mixing one dose, pulp chambers of the first molar and one second molar were filled with a two-millimeter layer of bioactive cement and filling material (protocol A). The other second molar's chamber was solo filled by a single mixed dose of bioactive cement (protocol B). The cost for each material was calculated independently, regardless of the group to which they belonged. A market assessment for primary molar crowns was performed, and a comparison table was produced. RESULTS: For protocol A, the lowest mean cost per tooth (LMC) was obtained for NeoMTA cements and IRM powder and liquid; for solo bioactive cement pulp chamber filling, protocol (B), LMC was obtained for NeoMTA cements. Zirconia crowns were the costliest. CONCLUSIONS: NeoMTA-type cements were the most cost-effective option for single-tooth pulpotomy. Zirconia crowns had the highest cost per tooth.

MTA Pulpotomies: A Long-Term Case Series Outcomes Assessment of Complicated Crown Fractures.

BACKGROUND: This retrospective case series describes the outcomes of anterior teeth with complicated fractures treated using mineral trioxide aggregate (MTA) in pulpotomy procedures. METHODS: 33 teeth were treated with MTA pulpotomy procedures in an endodontic private practice. All patients had been referred to the practice for diagnosis and treatment of a pulpal exposure due to complicated crown fractures. The teeth were either recalled directly or "indirectly" by the referring dentist. Teeth recalled directly were categorized as healed, healing, non- surgical root canal treatment completed for either aesthetic or restorative reasons, or persistent disease. Teeth recalled indirectly were categorized as successful or failed. RESULTS: 27 teeth were available for recall; 20 teeth directly and 7 teeth indirectly. The mean recall for teeth recalled directly was 3.94 years and the mean recall for teeth recalled indirectly was 5.9 years. The recall range for teeth recalled directly was 0.51 to 10.49 years and for teeth recalled indirectly was 3.58 to 10.66 years. Of the cases available for direct recall, 13 of 20 teeth were healed positive to pulp tests, 4 of 20 teeth were healed negative to pulp tests and 3 of 20 teeth had non-surgical root canal treatment completed. 15 of the 20 teeth recalled directly where discolored. 7 of 7 teeth recalled indirect were successful as determined by the radiographs and a report from the restorative dentist. CONCLUSIONS: MTA is a viable alternative to calcium hydroxide for pulpotomies.

Assessment of Mineral Trioxide Aggregate pulpotomy in mature permanent teeth with carious exposures.

AIM: To assess the outcome of mineral trioxide aggregate (MTA) complete pulpotomy in permanent teeth with carious exposures. METHODOLOGY: Fifty-two permanent molar teeth with fully developed roots and vital pulps in 43 patients aged 11-51 years were included. Preoperative pulpal and periapical diagnosis was established. After informed consent, each tooth was anaesthetized, isolated with dental dam and disinfected with 5% NaOCl before caries excavation; subsequently, a full pulpotomy was performed. Haemostasis was achieved, and Grey MTA (Angelus, Londrina, Brazil) was placed as the pulpotomy agent; a moist cotton pellet was placed, and the tooth was temporized with the intermediate restorative material (IRM). Permanent restorations were placed 1 week later if the tooth was asymptomatic, and a postoperative periapical radiograph was taken. Clinical and radiographic evaluation was completed at 3 months, 6 months, 1 year and 3 years postoperatively. RESULTS: Clinical signs and symptoms suggestive of irreversible pulpitis were established in 44/52 teeth, and periapical rarefaction was present in 14 teeth. Immediate failure occurred in one tooth. The recall rate ranged from 92% at 3 months to 80.3% at 3 years, with an overall 100% clinical and 97.5% radiographic success during the first year, and 92.7% success at 3 years. All cases with periapical rarefaction were associated with improvement in the periapical index (PAI) score. Two cases had new periapical rarefaction associated with dislodgment of the permanent restoration. A hard tissue barrier was detected radiographically in 5 cases and canal narrowing in 7 cases. CONCLUSION: MTA full pulpotomy was a successful treatment option for cariously exposed pulps in mature permanent molar teeth.

Efficiency and Reliability of Thermal and Electrical Tests to Evaluate Pulp Status in Primary Teeth with Assessment of Anxiety Levels in Children.

OBJECTIVE: Assessing the pulp status plays a vital role in diagnosis and treatment planning in dentistry especially in children, who may not be able to verbalize their dental symptoms. Pulp sensibility test is used as a valuable investigation to evaluate the state of pulp. The aim of this study is to assess the efficiency and reliability of thermal and electrical pulp tests in primary teeth and to rule out the anxiety level involved in each tests. STUDY DESIGN: 30 children aged between 6 to 8 years with carious primary molar teeth in need of conservative pulp therapy were included in this study. 3 tests at random were employed on each tooth which includes cold, heat, electrical pulp test. The sensitivity, specificity, positive predictive value and negative predictive value were evaluated based on the clinical visual examination on access opening and the accuracy for each test was calculated. The Facial Image Scale (FIS) was used to assess the state of dental anxiety in children due to these pulp sensibility tests. RESULTS: The highest accuracy rate was calculated for EPT (0.814) followed by cold test (0.777) and heat test (0.759). CONCLUSION: No significant association was found between the accuracy of all the three tests. (P value > 0.05). Cold test is the most reliable test due to its simplicity and ease to perform. (FIS -1.53).

Histologic Assessment of Quick-Set and Mineral Trioxide Aggregate Pulpotomies in a Canine Model.

INTRODUCTION: Quick-Set (Primus Consulting, Bradenton, FL) is a calcium aluminosilicate cement that is a potential alternative to mineral trioxide aggregate (MTA) with greater acid resistance and faster setting. The purpose of this study was to compare the effects of Quick-Set and MTA on pulpal tissues in response to pulpotomy procedures. METHODS: The pulp chambers of 42 maxillary teeth in 7 beagle dogs were accessed, and the coronal pulpal tissue was removed. Pulpotomy procedures were performed, placing the experimental materials directly over the radicular pulp tissues. The dogs were sacrificed at 70 days, and the teeth and surrounding tissues were removed and prepared for histologic analysis. The sections of the pulpotomy areas were scored for inflammation, pulp tissue organization, reactionary dentin formation, and quality of dentinogenesis. RESULTS: The Quick-Set group exhibited significantly more pulpal inflammation (P = .002) and significantly less pulp tissue organization (P = .004). No significant difference was noted for reactionary dentin formation (P = .526) and quality of dentinogenesis (P = .436). CONCLUSIONS: Compared with ProRoot White MTA (Dentsply Tulsa Dental Specialties, Tulsa, OK), Quick-Set exhibited more pulpal inflammation and decreased pulp tissue organization. No significant differences were noted for reactionary dentin formation and quality of dentinogenesis.

Two-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter randomized clinical trial.

OBJECTIVES: Oral healthcare expenses are increasing rapidly as a result of the growth of high-cost health technologies worldwide. In many developing/developed countries, low-cost tooth extraction is the alternative treatment option for a high-cost root canal therapy (RCT) for management of human molars with irreversible pulpitis. Vital pulp therapy with calcium-enriched mixture cement (VPT/CEM) as a new alternative treatment option has demonstrated excellent treatment outcomes up to 1 year; if 2-year radiographic/clinical effectiveness as well as cost-effectiveness of the VPT/CEM is also non-inferior compared with RCT, it can serve as a viable treatment for mature molars with irreversible pulpitis. MATERIALS AND METHODS: In this prospective, multicenter (n = 23), non-inferiority clinical trial, 407 patients were randomized to either one-visit RCT (n = 202) or VPT/CEM (n = 205) for 27 months. In this part of study, the primary outcome measure was the 2-year clinical and radiographic treatment outcomes. Cost-effectiveness was also analyzed. RESULTS: Mean follow-up times were 24.62 ± 0.72 and 24.61 ± 0.69 months in RCT (n = 166) and VPT/CEM (n = 166) arms, respectively. Clinical success rates in the two study arms were equal (98.19%); however, radiographic success rates were 79.5 and 86.7% in RCT and VPT/CEM arms, respectively, with no statistical difference (P = 0.053). The treatment time span mean was approximately three times greater in the RCT than in the VPT/CEM arm (94.07 vs. 31.09 min; P < 0.001). RCT had a cost of 171.5K per molar tooth compared with 44.5K for VPT. CONCLUSIONS: VPT/CEM reduced time and cost spent. When considering clinical as well as cost-effectiveness of VPT/CEM, this treatment option is not only non-inferior but also superior to RCT in mature permanent molar teeth with established irreversible pulpitis. CLINICAL RELEVANCE: Vital pulp therapy with CEM is a cost-effective and reliable biological technique for endodontic treatment of permanent molar teeth with irreversible pulpitis and can be recommended for general clinical practice.

Factors affecting clinical outcome following treatment of early childhood caries under general anaesthesia: a two-year follow-up.

AIM: To investigate factors that might affect the clinical outcome of early childhood caries treatment under dental general anaesthesia (DGA). DESIGN: Retrospective longitudinal study. The medical records of paediatric patients with early childhood caries who underwent full dental rehabilitation under DGA during 2011 in a private medical facility in Jeddah, Saudi Arabia, were investigated. Study parameters were the patient's financial arrangements and compliance with suggested recall plan. Statistical analysis of caries recurrence and the need to repeat the rehabilitation process was also performed. RESULTS: Eighteen percent failed to attend any post-operative visit. Twenty-six percent did not comply with the post-operative preventive plan. The overall relapse rate was high (58.5%), with the highest percentage (68%) among the non-compliant group. The highest frequency of repeat DGA (10%) was in the non-compliant group. CONCLUSIONS: Despite the high rate of post-operative caries recurrence, DGA is still an acceptable treatment option as it minimises the need for future dental treatment. Compliance by caregivers with post-operative care plans is as important as the procedure itself. In Saudi Arabia, targeting the actual caregivers with post-operative dental health education presents challenges that might affect the clinical outcome of DGA.

Effectiveness of MTA pulpotomy in primary molars: a critical assessment of relevant studies.

DATA SOURCES: Medline. STUDY SELECTION: Studies that evaluated the efficacy of MTA as a pulpotomy medicament in primary teeth were included, abstracts, observational studies and case reports were excluded. Only English language studies were considered. DATA EXTRACTION AND SYNTHESIS: Studies were assessed and graded by two reviewers using a weighted criteria based system and a qualitative summary of the evidence provided. RESULTS: Twenty-two studies were included, 17 studies compared MTA with formocresol, four studies compared MTA with calcium hydroxide, ferric sulphate, Portland cement, calcium-enriched mixture cement (CEM) and one study compared white MTA with grey MTA. CONCLUSIONS: Based on the assessment criteria employed, there was no evidence that MTA was better than present materials and techniques as a pulpotomy medicament.

Root canal obturation of primary teeth: disposable injection technique.

The aim of the study was to outline a simple, cost-effective technique for obturation of primary tooth root canals. A total of 75 primary teeth were treated in 52 subjects by the technique discussed, i.e. injecting plastic flowable material into the root canals after desired preparation, using disposable needle and syringe. All the patients were followed up for 3 years and 6 months, with no clinical or radiologic evidence of pathology or need for untimely extraction. In conclusion, the technique described is simple, economical, can be used with almost all filling materials used for the purpose, and is easy to master with minimal chances of failure.

Realização da técnica de pulpotomia no serviço público odontológico / Implementation of the pulpotomy in dental public service

O propósito desta pesquisa foi descrever a técnica de pulpotomia empregada pelos cirurgiões- dentistas nos serviços odontológicos da 9ª Coordenadoria Regional de Saúde do Rio Grande do Sul. O delineamento do estudo é exploratório descritivo, sendo a coleta de dados feita a partir de questionários enviados aos 37 Cirurgiões-dentistas de 12 municípios. Os resultados mostraram que 23 profissionais (62,2%) realizam pulpotomia no serviço. Esses profissionais indicam a pulpotomia para o tratamento de polpas expostas ou inflamadas de dentes com rizogênese completa e incompleta em ambas as dentições em sessão única, utilizando isolamento relativo para remoção da polpa coronária com a ajuda de curetas e soro fisiológico como substância irrigadora. Sobre o remanescente pulpar utilizam hidróxido de cálcio e antibiótico como biomaterial protetor. A técnica de pulpotomia traz resultados satisfatórios segundo os profissionais que a executam, sendo realizada a proservação após a pulpotomia, através de exame clínico e radiográfico.Não foi questionado quanto tempo após a pulpotomia é feita a proservação.

The purpose of this research was to describe the pulpotomia technique employed by dentists in services in dentistry of the 9ª Coordenadoria Regional de Saúde do Rio Grande do Sul. It is a descriptive and explorative, study the data collection from the questionnaires sent to 37 DDS in 12 cities. The results showed that 23 professionals (62.2%) do pulpotomia in service. These professionals indicate the pulpotomia for the treatment of pulps exposed or inflamed with complete and incomplete root formation in both the dentition in one session using relative isolation and curettes with the use of saline as irrigating solution. On the remmant dental pulp using calcium hydroxide paste and antibiotic as protector biomaterial. The technique of pulpotomia has satisfactory results in accordance with the professionals, being preservated after pulpotomia through clinical and radiographic examination.

Understanding mineral trioxide aggregate/Portland-cement: a review of literature and background factors.

AIM: This was to carry out a review of the literature concerning mineral trioxide aggregate (MTA) and Portland cement with regards to clinical, biological and mechanical findings and a possible substitution of MTA through Portland cement for endodontic use. STUDY DESIGN: Electronic literature search of scientific papers from January 1993 to January 2009 was carried out on the MEDLINE and Scopus databases using specific key words. In total, 57 papers were identified that dealt with MTA and Portland cement in a relevant way. RESULTS: The review of 50 papers conforming to the applied criteria showed that MTA and Portland cements have the same clinical, biological and mechanical properties. In animal experiments and technical characterisations both materials seemed to have very similar properties. The only difference is bismuth oxide in MTA added for better radio opacity. It seems likely that MTA materials are based on industrial Portland cements mixed with bismuth oxide. More studies, especially some long-term studies comparing MTA and Portland cement, are necessary. CONCLUSION: The existing literature gives a solid base for clinical studies with Portland cement in order to replace MTA as an endodontic material. Portland cement could be a substitute for most endodontic materials used in primary teeth.

Mineral trioxide aggregate as a pulpotomy medicament: an evidence-based assessment.

AIM: The principles of evidence-based dentistry were used to compare mineral trioxide aggregate (MTA), formocresol (FC), ferric sulphate (FS) and calcium hydroxide (CH) as primary molar pulpotomy medicaments. METHODS: Electronic databases were searched and sieved for relevant papers by examining titles, abstracts and finally full texts. Included were randomized clinical trials (RCTs) and clinical trials (CTs) comparing the clinical and radiographic successes of MTA, FC, FS and CH pulpotomies. Data were extracted and common odds ratios (CORs) were derived by fixed effects meta-analysis (direct or indirect MA). Mean clinical and radiographic success rates from relevant study arms were examined. RESULTS: Eighteen RCTs and 10 CTs (total 1,260 molars) were identified to compare MTA and FC. Direct MAs found MTA was significantly more successful clinically (COR=3.11; 95%CI=1.09-8.85) and radiographically (COR=4.50; CI=1.78-11.42) than FC, and clinical and radiographic data confirmed this. Fourteen RCTs and 4 CTs (total 959 molars) were identified to compare MTA and FS. Indirect MAs found no statistically significant difference in clinical successes, but a statistically significant difference in the radiographic successes of MTA and FS (COR=4.69; CI=1.70-12.95). Clinical and radiographic data showed MTA was significantly more successful than FS. Nine RCTs and 7 CTs (total 531 molars) were identified to compare MTA and CH. Indirect MAs found statistically significant differences in the clinical (COR=6.48; CI=1.75-24.0) and radiographic (COR=10.47; CI=3.35-32.76) successes of MTA and CH. Clinical and radiographic data confirmed MTA was significantly more successful than CH. CONCLUSION: Currently available evidence suggests MTA compared with FC, FS and CH as a pulpotomy medicament resulted in significantly higher clinical and radiographic successes in all time periods up to exfoliation.

Assessment of the anesthetic effectiveness of anterior and middle superior alveolar injection using a computerized device versus traditional technique in children.

UNLABELLED: The study aims to evaluate the anesthetic effectiveness of the Anterior and Middle Superior Alveolar (AMSA) injection administered through a computer-controlled local anesthetic delivery system (CCLAD), and compare it with the traditional buccal and palatal injections used to anesthetize maxillary primary molars. MATERIALS AND METHODS: The sample included 80 primary maxillary molars, divided into 2 equal groups: Pulpotomy and extraction groups. Each group was divided equally into 4 subgroups: A. First molars anesthetized with the traditional technique, B. first molars anesthetized with the CCLAD, C. second molars anesthetized with the traditional technique, and D. second molars anesthetized with the CCLAD. The evaluation was done single blind using SEM scale. RESULTS: The AMSA injection with the CCLAD was found to be effective in anesthetizing maxillary primary molars in pulpotomy and extraction procedures. There was no significant difference between the two anesthetic techniques except in the step of gingival retraction buccally in, which the traditional injections were more effective than the CCLAD during extractions. No significant difference was found between first and second primary molars in the effectiveness of both techniques. CONCLUSION: The AMSA injection using CCLAD was found to be effective in children.

Assessment of a novel alternative to conventional formocresol-zinc oxide eugenol pulpotomy for the treatment of pulpally involved human primary teeth: diode laser-mineral trioxide aggregate pulpotomy.

OBJECTIVE: The purpose of this study was to investigate whether a diode laser pulpotomy with mineral trioxide aggregate (MTA) sealing could be an acceptable alternative to the conventional formocresol pulpotomy and zinc oxide eugenol (ZOE) sealing in human primary teeth. METHODS: A randomized, single-blind, split-mouth study was used with a sample of 16 children aged from 3 to 8 years (mean age=5.10 years). A total of 26 pairs of teeth from these 16 patients were selected based on clinical and radiographic criteria. One tooth from each pair was randomly assigned to either the laser-MTA pulpotomy group or the formocresol-ZOE pulpotomy group. All teeth were followed up clinically and radiographically at 2.3, 5.2, 9.5 and 15.7 months. All extracted failures were sectioned and photographed to assess possible reasons for this. RESULTS: A total of seven laser-MTA-treated teeth were deemed to be radiographic failures (mean time until failure=9.1 months) compared to three formocresol-ZOE treated teeth (mean time until failure=12.5 months). These results were not significant using Fisher's exact test (P>0.05). Six of the laser-MTA failures and all three formocresol-ZOE failures exhibited furcal and/or periapical radiolucencies with or without pathologic root resorption. One of the laser-MTA failures displayed premature root resorption and is being observed for exfoliation. Analysis of photographs of teeth available for extraction revealed errors in clinical technique in addition to expected signs of a disease process such as the presence of granulation tissue and areas of pathologic root resorption. CONCLUSIONS: The laser-MTA pulpotomy showed reduced radiographic success rates compared to the formocresol-ZOE pulpotomy at 15.7 months; however, these results were not statistically significant. Improved success rates among a larger patient sample and a longer follow-up period would be required for the laser-MTA pulpotomy to be considered a routine alternative to the conventional formocresol-ZOE procedure. Meticulous restorative techniques must be followed to ensure the success of laser-MTA pulpotomies.

Evidence-based assessment: evaluation of the formocresol versus ferric sulfate primary molar pulpotomy.

PURPOSE: Formocresol and ferric sulfate were evaluated as pulpotomy medicaments using evidence-based dentistry principles. Formocresol has been challenged as a potential carcinogen and mutagen, leading to consideration of ferric sulfate. METHODS: The PICOT statement was: (P) In human carious primary molars with reversible coronal pulpitis, (I) does a pulpotomy performed with ferric sulfate, (C) compared with formocresol, (O) result in dinical/radiographic success, (T) in time periods up to exfoliation? Relevant papers (N=894) were identified from databases and inclusion criteria were applied; 94 papers remained (randomized clinical trials [RCTs]=7; clinical trials [CTs]=28; case-control studies=14; opinions, cohort, and cross-sectional studies=4; reviews=22; irretrievable papers=19). Three RCTs and 10 CTs (total teeth: formocresol=753; ferric sulfate=90) were meta-analyzed; 1 RCT and 1 CT were tested for homogeneity (odds ratios; 95% confidence intervals); 3 RCTs and 10 CTs were examined by student's t test. RESULTS: Clinical data indicated ferric sulfate was significantly more successful than formocresol (OR=1.95; CI=1.01-3.80). Radiographic data indicated no difference between medicaments (OR=0.90; CI=0.58-1.39). Medicaments did not differ with t-tests of clinical (P>.10) and radiographic (P>.50) data. CONCLUSIONS: This evidence-based assessment concluded that, in human carious primary molars with reversible coronal pulpitis, pulpotomies performed with either formocresol or ferric sulfate are likely to have similar clinical/radiographic success.