Hyaluronic acid as a pulpotomy material in primary molars: an up to 30 months retrospective study.

BACKGROUND: The aim of this retrospective study was to determine the long-term clinical and radiographic success of our previous randomized clinical trial and to compare the success of hyaluronic acid, with the widely used formocresol and ferric sulphate agents. METHODS: This retrospective study is the extension of the 1-year survey of our randomized clinical trial that had compared the effectiveness of a hyaluronic acid pulpotomy over formocresol and ferric sulphate pulpotomies and included clinical and radiographic evaluations with a follow-up period of over 24 months for 44 children who applied to our clinic between May 2019 and September 2019. Long-term clinical and radiographic data were obtained from the periodic files of our department, wherein each tooth's file was examined to identify any clinical and radiographic findings. Descriptive statistics and Pearson's chi-square tests were used to evaluate the data. Statistical significance was considered as p < 0.05. RESULTS: The clinical and radiographic success rates of the hyaluronic acid, formocresol, and ferric sulphate groups were not statistically different at > 24 months. None of the teeth in the hyaluronic acid group showed any clinical findings at > 24 months. CONCLUSIONS: Hyaluronic acid pulpotomies exhibited comparable success rates to formocresol and ferric sulphate materials spanning over 24 months examinations. Because of convenient accessibility and applicability of hyaluronic acid, it may be recommended as a promising alternative medicament for pulpotomy treatments of primary molars. However, further long-term follow-up human studies are needed to better understand the effect of hyaluronic acid on the dental pulp of human primary molars.

Efficacy of orthoMTA, retroMTA and ferric sulphate as pulpotomy agents in primary molars: a randomized clinical trial.

Purpose: The purpose of this study is to evaluate the clinical and radiographic success rates of RetroMTA, OrthoMTA, and ferric sulfate as pulpotomy agents in primary molars. Materials and methods: Ninety-six primary second molars from 32 children aged 5 to 9 years were enrolled in this study. The teeth were randomly divided into three groups based on the pulpotomy agent used: O-MTA, R-MTA, and FS. Clinical and radiographic follow-up examinations were conducted at 3, 6, 9, and 18 months postoperatively. Results: At the end of the study period, 84 teeth were evaluated. The clinical success rates were 75% for FS, 96.4% for O-MTA, and 92.8% for R-MTA groups. In the radiographic analysis, the success rates at the 18-month follow-up period were 50% for FS, 85.8% for O-MTA, and 82.2% for R-MTA groups. According to the Chi-square test and Kaplan-Meier survival analysis, there was a statistically significant difference among the success rates and survival probabilities of the groups (p<0.05). Conclusion: OrthoMTA and RetroMTA demonstrated better treatment outcomes for pulpotomy of primary second molars than ferric sulfate at the 18-month follow-up period.

Evaluation of Chitosan and Ferric Sulphate as Pulpotomy Agents in Primary Teeth: A Randomized Controlled Trial.

Introduction: Preservation of healthy pulp tissue is detrimental for the function and vitality of carious primary teeth. Several hemostatic agents used for pulpotomy in primary teeth showed adverse effects on viable surrounding structures. Aims: To assess the clinical and radiographic success of chitosan (CH) pulpotomy in primary molars and to compare it with ferric sulphate (FS). Materials and methods: A total of 40 carious lower primary second molars in 5-9 years children are selected for conventional pulpotomy technique. Over radicular stumps, FS is placed for 15 seconds in the control group, and CH for 4-5 minutes in the study group, followed by intermediate restoration (IRM). Intraoral periapical radiographs were taken immediately after 1 week and after 3rd and 6th months. The clinical and radiographic success rate is assessed and statistically analyzed. Results: Chitosan (CH) showed a 65% radiographical and 100% clinical success rate, and FS showed 55 and 95%, respectively. Conclusion: Chitosan (CH) showed better results than FS as a pulpotomy agent in primary teeth. How to cite this article: Guguloth S, Jamnapalli SR, Patloth T, et al. Evaluation of Chitosan and Ferric Sulphate as Pulpotomy Agents in Primary Teeth: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2023;16(2):223-226.

Wood color modification with iron salts aqueous solutions: effect on wood grain contrast and surface roughness.

Wood is a biosourced material with unique aesthetic features due to its anatomy and chemical composition. White oak wood surface color can be modified with the use of iron salts, which react with wood phenolic extractives, present as free molecules in wood porous structure. The impact of modifying wood surface color with iron salts on the final appearance of wood, including its color, grain contrast and surface roughness, was evaluated in this study. Results showed that following the application of iron (III) sulphate aqueous solutions on white oak wood surface, its roughness increased, which is due to grain raising after wetting of wood surface. The color modification of wood surface with iron (III) sulphate aqueous solutions was compared with a non-reactive water based blue stain. The contrast associated to wood grain that was expressed by the standard deviation of luminance values in wood images, also increased after application of the iron (III) sulphate aqueous solution on white oak wood surface. The comparison of contrast changes showed that wood samples stained with iron (III) sulphate on their curved surface had the highest increase in grain contrast compared to iron-stained wood showing the straight grain and to wood surfaces colored by a non-reactive water-based stain for both curved and straight grains.

COMPARING THE CLINICAL AND RADIOGRAPHIC OUTCOMES OF PULPOTOMIES IN PRIMARY MOLARS USING BIOACTIVE ENDODONTIC MATERIALS AND FERRIC SULFATE - A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS.

OBJECTIVE: To compare the clinical and radiographic outcomes of pulpotomies in primary molars using bioactive endodontic materials and ferric sulfate. DESIGN: The search was conducted in PubMed, Ebscohost, ProQuest, and Scopus databases till June 2021. Children undergoing pulpotomy therapy in primary molars treated with ferric sulfate (FS) and bioactive endodontic materials were evaluated for clinical and radiographic success. Meta-analysis was performed on a random-effects model to assess the success at 6,12,18, and 24 months. The quality of studies was evaluated using the Cochrane risk of bias tool for randomized trials RESULTS: No significant difference was observed between Mineral trioxide aggregate (MTA) and FS at 24 months for both clinical [RR0.98 (95%CI 0.15,6.34), I2 = 0%] and radiographic [RR0.74 (95%CI: 0.23,2.43), I2 = 0%] success. At 6 months [RR1.36 (95%CI: 0.10,19.34), I2 = 33%], no difference was observed in the clinical [RR1.00 (95%CI: 0.95,1.05), I2 = 0%] and radiographic success [RR0.99 (95%CI: 0.88,1.11), I2 = 51%] between Biodentine (BD), FS and radiographic success of calcium enriched cement and FS [RR0.25 (95%CI: 0.03, 2.22), I2 = 0%]. CONCLUSION: Amongst bioactive materials, MTA and FS demonstrated equal success rates in both clinical and radiographic outcomes with follow-up periods of up to 24 months. Future, high-quality trials are required to verify the result of the current review.

A randomized clinical trial of hyaluronic acid gel pulpotomy in primary molars with 1 year follow-up.

OBJECTIVE: This randomized clinical study aimed to evaluate the success of hyaluronic acid (HA) as a pulpotomy medicament of human primary molars and to compare it with formocresol (FC) and ferric sulphate (FS) pulpotomy treatments up to 12 months. MATERIALS AND METHODS: The study was conducted with 130 primary molars of 44 children. The ethical approval and registration to clinical trials (No: NCT04115358) were completed. After the removal of all the coronal pulp tissue, a 0.5% HA gel, or a FC, or a 20% FS solution were applied randomly to the radicular pulp tissues of the primary molars. Then, the pulp chambers were filled with a zinc oxide eugenol cement and restored either with a composite filling material or with a stainless-steel crown. The treatment success rates of the 3 groups were followed and compared clinically and radiographically at 1st-, 3rd-, 6th- and 12th-months. RESULTS: Primary molars treated with FC, FS and HA dressings were clinically successful 77.5%, 86.8% and 87.5% respectively after 12th-month follow-up (p > .05). Radiographic successes of FC, FS and HA groups were lower than clinical successes (57.6%, 68.8%, 57.9% respectively at the 12th-month) but the difference between the groups was not statistically significant (p > .05). Equivalence analysis assuming not more than 10% difference between the materials suggested that HA was not inferior to FC or FS. CONCLUSIONS: Within the limitations of this study, our randomized clinical trial shows that HA is a promising pulpotomy medicament in primary molars. However, further studies are justified to further improve the HA material success.

Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth: A Systematic Review of the Literature.

Background: Pulpotomy of primary teeth provides favorable clinical results over time; however, to date, there is still not a consensus on an ideal pulp dressing material. Therefore, the aim of the present systematic review was to compare pulpotomy agents to establish a preferred material to use. Methods: After raising a PICO question, the PRISMA guideline was adopted to carry out an electronic search through the MEDLINE database to identify comparative studies on several pulp dressing agents, published up to October 2019. Results: The search resulted in 4274 records; after exclusion, a total of 41 papers were included in the present review. Mineral trioxide aggregate (MTA), Biodentine and ferric sulphate yielded good clinical results over time and might be safely used in the pulpotomies of primary molars. Among agents, MTA seemed to be the material of choice. On the contrary, calcium hydroxide showed the worst clinical performance. Although clinically successful, formocreosol should be replaced by other materials, due to its potential cytotoxicity and carcinogenicity. Conclusion: MTA seemed to be the gold standard material in the pulpotomy of primary teeth. Promising results were also provided by calcium silicate-based cements. Further randomized clinical trials (RCTs) with adequate sample sizes and long follow-ups are encouraged to support these outcomes.

Efficacy of ferric sulphate as a pulpotomy medicament in primary molars: an evidence based approach.

AIM: To evaluate the available evidence on the efficacy of ferric sulphate (FS) compared to other pulpotomy medicaments in primary molars. METHODS: A comprehensive literature search was conducted through five databases (PubMed, Ovid®, EBSCOhost, Cochrane Library and ProQuest) and only those papers which met the inclusion criteria were accepted. The quality of the studies used for systematic review was rated by two independent researchers based on Fuks and Papagiannoulis (Eur Arch Paediatr Dent 7:64-71, 2006) criteria and graded as A (38-42), B1 (32-37), B2 (25-31), C (≤ 24). Inter-examiner reliability was measured using Kappa statistics. RESULTS: A total of 1371 studies were available, of which only two studies full-text articles were included for quality assessment with an excellent inter-researcher agreement (k = 0.9). The comprehensive search revealed that, none of the 20 studies obtained grade A. Only three studies were graded as B1, 5 studies received grade B2 and 12 studies attained grade C. Only 4 prospective randomised clinical trials reported high success rate with FS compared to other materials. Remaining 14 studies revealed low success rate with FS compared to other pulpotomy medicaments. CONCLUSION: There is insufficient evidence to support the application of FS as a pulpotomy medicament in primary molars in the existing English literature. Hence, properly planned randomised clinical trials with large sample size and long-term follow up are needed to support FS as an effective pulpotomy medicament compared to other traditional and new medicaments.

The teaching of management of the pulp in primary molars across Europe.

AIM: To determine which methods of primary pulp therapy are currently being taught in European dental schools. METHODS: An online survey tool was employed to send questionnaires to paediatric dentistry departments of 202 European dental schools. Email addresses were obtained from the European Academy of Paediatric Dentistry and questionnaires were sent to one member of each department in December 2014. The survey included questions on treatment choices and clinical scenarios where respondents indicated how they would advise students to proceed, given a particular case. RESULTS: Fifty-one responses from 22 different countries were obtained. Eleven schools reported that they taught only undergraduate students, 4 only postgraduates and 36 taught both. Forty-three schools taught indirect pulp capping, the most popular material being calcium hydroxide; 26 taught direct pulp capping, mostly using mineral trioxide aggregate (MTA). Teaching of pulpotomy was widespread across Europe, with MTA being the most popular material, taught in 37 schools, followed by ferric sulphate, in 29. Formocresol, however, was still being taught in 12 dental schools. Responses to the clinical scenarios were mostly in accordance with previously selected choices. CONCLUSIONS: This study had a representative sample, showing a wide variation in primary pulp therapies taught in Europe. Comparison with previous studies shows new trends in taught therapies, possibly driven by recent research in primary pulp management and the development of new materials.

Dental Material Choices for Pulp Therapy in Paediatric Dentistry.

OBJECTIVE: The purpose of this study was to assess the restorative choices for pulpal therapy by members of the Australian and New Zealand Society of Paediatric Dentistry (ANZSPD). METHODS: Members of the ANZSPD were sent an online survey asking about the procedures that they performed and their choice of dental materials. RESULTS: The respondents were 31 general dentists (GD) and 55 specialist paediatric dentists (PD). Materials used for indirect pulp capping included calcium hydroxide [Ca(OH)2] cement (CHC), glass ionomer cement or resin-modified glass ionomer cement (GIC/RMGIC), Ca(OH)2 paste (CHP) and mineral trioxide aggregate (MTA). Materials for direct pulp capping included MTA, CHP and CHC. Materials and techniques used for pulpotomy included MTA, ferric sulphate, formocresol and diathermy, CHP and CHC. GD and PD were similar in their choice of materials. However, there was no preferred product for pulp therapy. Most GD learnt how to use MTA from CPD lectures, while some PD learnt how to use MTA from their postgraduate training as well as CPD lectures. Many GD and PD did not have hands-on training from their education on how to use MTA (GD: 80%, PD: 43%). Most would like to attend hands-on MTA courses (GD: 86%, PD: 65%). CONCLUSION: There was no clear preferred product for the various types of pulp therapy in paediatric dentistry. Education appears to be the major barrier to the use of MTA rather than the cost of MTA.