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.

Primary tooth vital pulp therapy techniques taught in dental schools in Saudi Arabia: a cross-sectional study.

Worldwide, dental schools employ varying approaches to teaching vital pulp therapy (VPT) for primary teeth. However, little is known about the VPT techniques taught in dental schools in Saudi Arabia. Therefore, this study aimed to describe the approaches of VPT for primary teeth taught in undergraduate dental schools in Saudi Arabia. A nationwide cross-sectional study was conducted between January and June 2022, using an online questionnaire distributed to pediatric dentistry faculty members at all dental schools in Saudi Arabia. The questionnaire collected information on socio-demographic characteristics, educational background, work setting, and VPT teaching approaches. Descriptive statistics and logistic regression models assessed the association between participants' characteristics and the VPT techniques taught. Seventy-seven faculty members from 17 out of 27 dental colleges in Saudi Arabia participated in the study. Most respondents reported teaching indirect pulp capping (95%), with glass ionomer cement and calcium hydroxide being the most popular materials. Only 11 participants (14%) taught direct pulp capping, with mineral trioxide aggregate and calcium hydroxide being the most commonly used materials. Pulpotomy procedures were taught in all dental schools, with formocresol being the most commonly used medicament (84%). No significant associations were found between faculty member characteristics and the likelihood of teaching indirect pulp capping. However, older age categories had a significantly higher chance of teaching direct pulp capping (trend odds ratio: 2.27, p = 0.02). In conclusion, most faculty members (95%) reported teaching indirect pulp capping using glass ionomer cement and calcium hydroxide for primary teeth. Only 14% of the respondents taught direct pulp capping, and the use of mineral trioxide aggregate for direct pulp capping appears to be increasing. Formocresol was the most commonly used pulpotomy medicament. Further research is needed to investigate factors that influence the teaching of VPT for primary teeth in Saudi Arabia.

Histologic comparison of formocresol, platelet-rich fibrin, and hesperidin in pulpotomy: A randomized trial in dogs.

Aims: To histologically assess and compare formocresol (FC), platelet-rich fibrin (PRF), and hesperidin (HPN) as pulpotomy agents in dogs. Materials and Methods: Pulpotomy was attempted from the buccal surface (class V) of 48 teeth in three mongrel dogs (Canis Lupus). Cavities were randomly allocated for three groups (n = 16) according to the pulpotomy agent used; (group I: FC (control), group II: PRF, and group III: HPN). All cavities were then sealed with zinc oxide eugenol followed by resin-modified glass ionomer restoration. Two months later, dogs were euthanized; the specimens were obtained and prepared for histological assessment followed by statistical analysis. Results: HPN specimens showed the best dentin bridge formation and the least inflammatory signs and pulp disorganization. Followed without statistically significant difference by PRF (P ≥ 0.05). Both of HPN and PRF, however, showed a significant difference statistically (P ≤ 0.05) to FC that showed no dentin bridging with more pronounced inflammation, necrosis, and pulp disorganization. Conclusions: For pulpotomy, HPN and PRF seemed histologically to be good substitutes for FC in the dog model.

Exploring the properties of formocresol in dentistry-a comprehensive review.

Due to concerns about formocresol's mutagenic and genotoxic potential, its use as a pulpotomy medication is currently debatable. The current paper aimed to review the properties of formocresol and concerns regarding its safety as a pulpotomy medicament for primary teeth. With reference to the context of the recently published literature, the alternatives to formocresol are discussed, together with their benefits and drawbacks. A literature search was conducted using multiple databases comprising of MEDLINE (via PubMed), EMBASE, and Web of Science. The terms used for the search were "formocresol", "pulpotomy", and "primary teeth". In total, 364 articles were obtained from the analysis of the databases. Unrelated articles from the available full text of 174 articles were excluded. The main reasons for excluding the articles were: they were usage and precautionary guidelines. A total of 68 studies were finally included in the review. The literature review in this paper supports the notion that formocresol continues to be the most often utilized pulp dressing agent in primary teeth pulpotomies despite offering no advantages over other pulp dressing chemicals that are currently on the market.

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.

Primary pulpotomies - what should we be using?

Introduction A systematic review and meta-analysis of the effectiveness of Biodentine compared to formocresol for pulpotomies in the deciduous dentition.Data sources and study selection Four electronic data bases were searched (Medline, Embase, Cochrane Central Register of Controlled Trials and Web of Science). Randomised controlled trials (RCTs) which compared the use of Biodentine with formocresol were included in the screening. Two reviewers screened the titles and abstracts of the RCTs independently for inclusion in the review and a third reviewer was consulted in the case of any disagreements. Thirteen articles were used for full-text reading and nine were included in the review. Two investigators assessed risk of bias (RoB) by allocating a score of either high, low or unclear, in line with the Cochrane handbook for systematic reviews of interventions. Failure to blind practitioners paired with a lack of standardised application protocol results in high RoB.Data extraction and synthesis Data was extracted from the included studies using customised forms, including: sample size, patient ages, treatment and clinical and radiographic follow-up and results. Meta-analysis of the results was completed using ReviewManager version 5.4.0.Results In total, 626 children were assessed in the RCTs. All teeth were restored with a preformed metal crown placed directly after the procedure, except for two studies, which placed them 24 and 48 hours later. The primary outcomes of clinical failure were defined as pain, tenderness to percussion, swelling, abscess, fistula and pathological tooth mobility at 12 months. These showed that Biodentine had significantly lower failure rates (RR 0.16; 95% CI 0.003-0.87; N = 394). Radiographic failure rates defined as either internal or pathological external root resorption, furcation radiolucencies or a widened periodontal ligament showed significantly lower failure rates (RR 0.19; 95% CI 0.08-0.49; N = 393). However, the results showed no significant difference for secondary outcomes which assessed the teeth both clinically and radiographically at intervals up to 48 months. Outcomes were assessed using GRADE; this showed all results to be of low certainty due to the high RoB.Conclusions Biodentine may be the superior material to formocresol for pulpotomy in the deciduous dentition. However, the results for both primary and secondary outcomes have a very low to low GRADE rating due to high RoB; therefore, robust future studies should be completed to further substantiate these findings.

Clinical observation and histopathological evaluation of pulp after pulpotomy of primary teeth with formocresol and biodentine.

Pulpotomy is the typical treatment for keeping deciduous teeth until exfoliation. Formocresol is one of the most common materials used in dental pulpotomy. Due to the side effects of this drug, its replacement with other substances seems necessary. Therefore, this study compared clinical and histopathological evaluations of primary pulpotomy molars with formocresol and biodentine. In this clinical trial, 66 second-mandibular deciduous molars of children aged 6 to 9 years who met the criteria for pulpotomy were selected. Pulpotomy of the teeth was performed using formocresol and biodentine. For each patient, one tooth was randomly placed in the pulpotomy group with formocresol. The other tooth was placed in the pulpotomy group with biodentine. Then the crowns of the teeth were restored with stainless steel veneer. We recorded clinical and radiographic results of these teeth over six months and one year. The teeth were then extracted after 12 months, and hematoxylin-eosin staining was performed for histopathological evaluations. The obtained data were analyzed by Fisher test and SPSS software version 22. The results showed that clinical success of 6 and 12 months of pulpotomy in both groups was 100%. The 6-month radiographic evaluation of the formocresol group was 84.8%, and the biodentine group was 93.9% (p = 0.21). The success of 12-month radiographs of the formocresol group and the biodentine group were 81.8 and 93.9, respectively (p = 0.13). Also, the histopathological evaluation showed that in the biodentine group, there was mild inflammation in two teeth, two teeth showed moderate inflammation, and two teeth showed severe inflammation. In the formocresol group, severe inflammation was seen in two cases. Mild inflammation was not seen in any of the teeth. Moderate inflammation was seen in one tooth. It was found that there was no significant difference between the two groups in terms of inflammation (P >0.05). No necrosis was seen in any of the biodentine group teeth, and there was necrosis in four teeth of the formocresol group. There was a significant difference between the two groups regarding necrosis (P = 0.032). There was no significant difference between the two groups regarding abscess (P> 0.05). According to the obtained results, biodentine could be a suitable alternative for mandibular second molar pulpotomy.

Efficacy of Biodentine versus formocresol in pulpotomy of primary teeth: a systematic review and meta-analysis.

OBJECTIVE: To systematically evaluate and meta-analyze the short-and long-term clinical and radiologic failure rates of Biodentine versus formocresol as pulpotomy medicaments in primary teeth. DATA SOURCES: Relevant medical databases were searched until May 2021 for randomized controlled trials that used Biodentine and formocresol as pulpotomy medicaments in primary teeth with deep caries. Primary outcomes included clinical and radiologic failure rates at 12 months. Secondary outcomes were clinical and radiologic failure rates at 3, 6, 9, 13 to 24, and 25 to 48 months. RESULTS: Nine randomized controlled trials (N = 626) with low risk of bias were included. Pooled analysis showed that compared to formocresol, Biodentine had significantly lower clinical failure rates (relative risk [RR] 0.16; 95% confidence interval (CI) 0.03 to 0.87; six randomized controlled trials; N = 394; GRADE, low) and radiologic failure rates (RR 0.19; 95% CI 0.08 to 0.49; six randomized controlled trials; N = 393; GRADE, low) at 12 months. Radiologic failure rates at 6 and 9 months were significantly lower in the Biodentine group compared to the formocresol group. CONCLUSION: Compared to formocresol, Biodentine may be a superior medicament when used for pulpotomy in primary teeth. Adequately powered randomized controlled trials are needed to substantiate this evidence.

Clinical and radiographic comparison of Biodentine and Formocresol: an updated meta-analysis with trial sequential analysis.

PURPOSE: This meta-analysis aimed to compare the clinical and radiographic success rate of Biodentine as an alternative to Formocresol to provide a critical appraisal of the available literature and evidence-based conclusion as well as update the previous systematic review. METHODS: MEDLINE, CENTRAL, Web of Science, Scopus, and Google Scholar databases were searched up to 20 October 2021 to identify RCTs evaluating pulpotomy with Biodentine/Formocresol in carious primary molars among children ≤ 10 years old. The risk of bias was assessed using the Cochrane RoB-2 tool. RRs and corresponding 95% CIs were calculated to pool results that RR Ëƒ 1 indicated a higher success rate in the Biodentine group and RR < 1 indicated a higher success rate in the Formocresol group. Heterogeneity was calculated using the I2 and τ2 statistics. In addition, trial sequential analysis was performed to adjust results for type I and type II errors and evaluate power of the meta-analysis. RESULTS: Nine RCTs were identified and eight RCTs were included in the meta-analysis and trial sequential analysis. The obtained evidence showed no significant difference between Biodentine and Formocresol in terms of clinical efficacy. However, considering the radiographic success rate the results of the meta-analysis and trial sequential analysis significantly favoured Biodentine. CONCLUSION: Within the limitations of the present review and based on the retrieved findings it has been clearly shown that Biodentine is superior compared to Formocresol in terms of radiographic success rate with firm evidence in this regard. Although the performed meta-analysis showed no significant clinical difference between Biodentine and Formocresol, however, trial sequential analysis revealed a lack of firm evidence in this regard.

Success of medicaments and techniques for pulpotomy of primary teeth: An overview of systematic reviews.

BACKGROUND: Pulpotomy is an effective, vital pulp therapy procedure for caries-affected or traumatized primary teeth. Though its efficacy is widely accepted, the superiority of medicaments and techniques remains debatable. AIM: The aims of this review were to compare the success rates of various pulpotomy medicaments or techniques, assess the methodological quality of reviews, and grade the level of evidence for each comparison. DESIGN: This review followed the principles of evidence-based medicine and recommendations for the overview of systematic reviews. An a priori protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021244489). A comprehensive literature search was performed by two reviewers, and studies were selected from various databases according to predefined criteria. Two reviewers independently used a self-designed pilot-tested form to extract data from the selected studies. A quality analysis was performed using A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) and the ROBIS tool. Reporting characteristics and overlap of the primary studies were also assessed. We used modified Köhler's criteria for evaluating the quality of evidence for outcomes of included systematic reviews and meta-analyses. RESULTS: The scrutiny of 62 full-text articles resulted in the inclusion of eight systematic reviews. The quality of four of the reviews was found to be critically low, and the overlap of primary studies in the meta-analyses was found to be high. Pulpotomy medicaments/techniques, except calcium hydroxide, had success rates of more than 80% for all domains and time periods. Most of the comparisons revealed no differences in the clinical, radiographic, or overall success rates. Mineral trioxide aggregate, however, was found to have better radiographic and overall success rates than calcium hydroxide at periods greater than 12 and 18 months. It also had a greater radiographic success rate than full-strength/1:5 diluted and full-strength formocresol at 24 months. Formocresol was found to have better overall success rates than calcium hydroxide at all time periods and better radiographic success rates at 12 months. Only 12 of the 63 comparisons had suggestive or weak evidence, whereas all others had either negligible evidence or insufficient data. CONCLUSIONS: The pulpotomy medicaments/techniques, except calcium hydroxide, showed success rates of more than 80%, whereas most comparisons revealed no differences. Mineral trioxide aggregate, however, was found to be better than calcium hydroxide and formocresol in several respects. This study highlights the lack of evidence regarding the choice of pulpotomy agents for the treatment of caries-affected primary teeth and elucidates the domains that require primary studies in the future.

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.

Calcium Hydroxide Paste, Mineral Trioxide Aggregate, and Formocresol as Direct Pulp Capping Agents in Primary Molars: A Randomized Controlled Clinical Trial.

Purpose: The purpose of this study was to evaluate the clinical and radiographic outcomes of direct pulp capping (DPC) using calcium hydroxide (CH), mineral trioxide aggregate (MTA), and premedicated DPC with formocresol (FC) in primary teeth. Methods: Sixty primary mandibular second molars with pulp exposures in children aged four to eight years old were treated using DPC. The molars were randomly divided into three groups (n equals 20 per group). Pulp exposures in the CH and MTA groups were capped directly using CH and MTA pastes, respectively, while those in the FC group were premedicated with FC and then capped with zinc oxide eugenol (ZOE) cement. All teeth were finally restored with stainless steel crowns, and clinical and radiographic evaluations were carried out at baseline and three, six, and 12 months after restoration. Fisher's exact test was performed to define the significance between the groups and follow-up periods. Results: The clinical and radiographic findings showed no significant difference between the three groups. The overall success in the CH, MTA, and FC groups were 88.2 percent, 100 percent, and 73.3 percent, respectively. However, these differences were not statistically significant (P>0.05). Conclusion: All three materials examined in this study exhibited clinical and radiographical efficacy when used as direct pulp capping materials.

Assessment of Clinical and Radiographic Success Rate of Formocresol-based Pulpotomy versus Collagen-based Pulpotomy: An In Vivo Study.

AIM: The aim of the study is (a) To use collagen as a pulpotomy material in comparison with the gold standard formocresol-based pulpotomy, (b) to assess the clinical and radiographic success rate of formocresol pulpotomy and collagen-based pulpotomy, and (c) to compare the success rate of formocresol-based pulpotomy and collagen-based pulpotomy over a definitive interval of time. MATERIALS AND METHODS: Totally 30 primary first or second molars indicated for pulpotomy after confirming with the operative diagnosis were taken as samples for this study. This split-mouth technique consists of two groups: Group 1-formocresol pulpotomy (n = 15), and group 2-collagen-based pulpotomy (n = 15). Both the procedures were done in the same patient on regular appointments. Pre- and postoperative radiographs were taken. The children were recalled for clinical and radiographic follow-up at 2, 4, and 6 months. The success of the procedure was assessed based on clinical signs (pain, tenderness to percussion, abscess, swelling, fistula, and pathologic mobility) and radiographic findings (radicular radiolucency, internal and external root resorption, periodontal ligament (PDL) space widening, and furcation radiolucency). The Chi-square test was used to compare the differences between the groups. RESULT: The overall success rate for formocresol pulpotomy (n = 15) was 14, 13, and 10 for the second-, fourth-, and sixth-month review period, respectively. For collagen pulpotomy group (n = 15), the overall success rate was 14, 14, and 14 for the second-, fourth-, and sixth-month review period, respectively. The obtained data from the overall success rate were subjected to statistical analysis, and chi-square test was used. The p-value less than 0.1 was considered a statistically significant result. The chi-square value for the fourth- and sixth-month review was 0.37 and 3.33, respectively. CONCLUSION: Statistically significant value was obtained from the sixth-month review period (p <0.1), which describes that the overall success rate was better for the collagen pulpotomy group when compared with the formocresol pulpotomy group. CLINICAL SIGNIFICANCE: Collagen had proven to be a very good alternative for formocresol, its biocompatibility, and regenerative efficiency and is a benchmark for a better clinical success rate in dentistry. However, its implication in pulpotomy should be subjected to further comparative research study on mineral trioxide aggregate (MTA), Biodentine, etc. Keywords: Collagen-based pulpotomy, Formocresol-based pulpotomy.

A randomised controlled clinical trial comparing pure Portland cement and formocresol pulpotomies followed from 2 to 4 years.

PURPOSE: The purpose of the present prospective randomised clinical control trial was to evaluate the long-term clinical and radiographic success rate of pulpotomies in primary molars using pure Portland cement versus formocresol. Pure Portland cement has shown a high rate of success in pulpotomy treatments, with no side effects. METHODS: Healthy 3- to 11-year-old children were treated with pulpotomies on primary molars as part of their scheduled dental treatment. Pulp dressing alternated randomly between pure Portland cement and formocresol. Data were analysed at follow-up periods up to 48 months. RESULTS: 68 (50%) teeth with pure Portland cement and 68 (50%) teeth with formocresol in 136 healthy children (59 boys and 77 girls) were followed. The overall success rate of the pulpotomies in this study was 95.6%. Pure Portland cement was successful in 100% of the cases (68 out of 68), and formocresol in 91.1% (62 out of 68). No association was found between success and type of tooth or time range from treatment to last follow-up. CONCLUSION: Based on this study's results, it can be concluded that there is no superiority of one material over the other and pure Portland cement can be used in primary molar pulpotomies.

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.

Clinical and Radiographic Success of Low-Level Laser Therapy Compared with Formocresol Pulpotomy Treatment in Primary Molars.

Purpose: The purpose of this study was to assess and compare the clinical and radiographic success rates of low-level laser therapy (LLLT) and formocresol (FC) for pulpotomy in primary teeth. Methods: Utilizing a split-mouth technique, 106 primary molars of 36 five- to eight-year-olds were included. The teeth were selected according to specific clinical and radiographic inclusion criteria and randomly assigned to the LLLT group and FC group. A pulpotomy was performed on each molar; 53 teeth were treated with LLLT, and 53 teeth were treated using FC. Children were followed at six and 12 months for clinical and radiographic evaluation. Results: At six months, the clinical success rate was 98 percent for each group. Radiographic success was 100 percent for the LLLT group and 98 percent for the FC group. At 12 months, both groups showed a clinical success of 96.1 percent. Radiographic success at 12 months was 100 percent and 98 percent for LLLT and FC, respectively. Conclusions: Both low-level laser therapy and formocresol pulpotomy techniques showed favorable clinical and radiographic outcomes in human primary molar teeth over 12 months. Further longitudinal studies with longer follow-up periods and larger sample sizes are encouraged.

Effectiveness of formocresol and ferric sulfate as pulpotomy material in primary molars: a systematic review and meta-analysis with trial sequential analysis of randomized clinical trials.

OBJECTIVES: This study aims to evaluate the success rate of formocresol and ferric sulfate through meta-analysis with trial sequential analysis (TSA). METHOD AND MATERIALS: The protocol of the review was registered in the PROSPERO database (CRD 42018090044). Two independent reviewers used PubMed, Scopus and EBSCOhost databases to identify randomized clinical trials published from inception to June 2019. Patients undergoing pulpotomy therapy in vital primary molars with pulp exposure due to caries treated with formocresol and ferric sulfate were evaluated for clinical and radiographic success. Meta-analysis was conducted to evaluate the success at 6, 12, 18, and 24 months and TSA was performed for success at 24 months. Quality of evidence was determined by Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) analysis. RESULTS: Eight clinical trials were included in meta-analysis. No difference was observed in the clinical and radiographic success rate between formocresol and ferric sulfate at 6, 12, 18, and 24 months. TSA identified required information size of 687 teeth for clinical success and 568 teeth for radiographic success. In addition, it demonstrated evidence for radiographic success rate at an anticipated intervention effect of 10% for formocresol over ferric sulfate. CONCLUSION: Formocresol and ferric sulfate show comparable clinical and radiographic success rates as pulpotomy material in primary molars at 24 months based on the studies with low to moderate quality of evidence.

A Randomized Controlled Clinical Trial Comparing Tricalcium Silicate and Formocresol Pulpotomies Followed for Two to Four Years.

Purpose: Tricalcium silicate (Biodentine), a new synthetic inorganic restorative cement, has shown a high rate of success in pulpotomy treatments, with few side effects. The purpose of the present randomized clinical control trial was to evaluate the long-term success of pulpotomies in human primary molars using tricalcium silicate versus formocresol. Methods: Healthy two- to 10-year-olds were treated with pulpotomies on primary molars as part of their scheduled regular dental treatment. Pulp dressing alternated randomly between tricalcium silicate and formocresol. Data were analyzed at follow-up periods up to 48 months. Results: Thirty-seven (51.4 percent) teeth with tricalcium silicate and 35 (48.6 percent) teeth with formocresol in 58 healthy children (31 boys and 27 girls) were studied. The overall success rate of the pulpotomies in this study was 94.4 percent. Tricalcium silicate was successful in 97.3 percent (36 out of 37) of the cases, and formocresol in 91.4 percent (32 out of 35). No association was found between success and type of tooth or time range from treatment to last follow-up. Conclusion: Tricalcium silicate shows a higher (though not statistically significant) success rate than formocresol in human primary molars pulpotomies followed for two to four years.