Gingival and localized alveolar bone necrosis related to the use of arsenic trioxide paste--two case reports.

The leakage of arsenic trioxide paste from tooth fillings has been associated with widespread necrosis of the supporting periodontal tissues. This report describes two cases of arsenic trioxide paste-induced gingival and localized alveolar bone necrosis in the mandible, following the use of arsenic trioxide paste as a pulp-devitalized agent. The first case was a 54-year-old female complaining of a painful white patch on the gingival tissue of the left mandibular second molar (tooth #37) after treatment by a private dentist. She underwent completely debridement of all necrotic soft tissue with physical saline irrigation. The gingival tissue was gradually replaced with vascular tissue and completely healed after 7 weeks. The second case was a 30-year-old female complaining of severe pain and continuous gingival bleeding from the right maxillary first bicuspid (tooth #14) following treatment by a private dentist. She finally accepted debridement of the sequestrum and necrotic alveolar bone with decortication to induce active bleeding. A partial thickness gingival flap was made to cover the wound. Four weeks later, the supporting tissues had completely healed. Arsenic trioxide paste is a cytotoxic agent and may cause harmful adverse effects on adjacent periodontium and supporting hard tissue if leakage occurs, or it is used carelessly. There is no indication for the use of arsenic trioxide paste in modern dental practice.

Mandibular bone necrosis caused by use of arsenic paste during endodontic treatment: two case reports.

AIM: To report that arsenical pastes are still employed in endodontics and to highlight the potentially serious consequences of their use. SUMMARY: Chemotherapeutic agents such as arsenic trioxide and paraformaldehyde were once commonly employed as pulp-necrotizing agents. Their cytotoxic effects are well recognized, and leakage from teeth has been associated with widespread necrosis of periodontal tissues and bone. This report describes two cases of severe bone necrosis affecting the mandible following the use of an arsenical paste. KEY LEARNING POINTS: Pulp-necrotizing agents such as arsenic trioxide can cause severe bone necrosis. Arsenical pastes have no place in contemporary dental practice. Dentists should employ appropriate local anaesthetic techniques for pulp extirpation instead of relying on toxic necrotizing agents.

Maxillary bone necrosis following the use of formaldehyde containing paste: management and case series.

Paraformaldehyde is used both as a disinfectant and to devitalise inflamed pulps when local anaesthesia is ineffective. Despite the clinical benefits, paraformaldehyde is not confined to the pulp, but penetrates the dentine and is gradually released as formaldehyde. This case series describes the effects on periodontal and bone tissues of paraformaldehyde used as a devitalising or disinfectant agent.

Is there life after Buckley's Formocresol? Part I -- a narrative review of alternative interventions and materials.

OBJECTIVES: (1) To present a narrative review of the currently available alternative interventions and materials to formocresol pulpotomy for the management of extensive caries in the primary molar, and (2) to produce a clinical protocol for pulp therapy techniques in the extensively carious primary molar. INTRODUCTION: The International Agency for Research on Cancer has recently classified formaldehyde as carcinogenic to human beings. Since Buckley's Formocresol contains 19% formaldehyde in its full strength and, therefore, 1% in a 20% dilution, a safer alternative should be identified. METHODS: A narrative review of the published literature for primary molar pulp therapy techniques was undertaken following an extensive and appropriate literature search. A specialist group of paediatric dentists was formed to arrive at a consensus and establish an evidence-based protocol for the management of extensively carious primary molar teeth. Part I of this paper explores the currently available alternative interventions and materials to formocresol in the form of a narrative review. The second part of the paper will present the formation of a specialist group to arrive at a consensus and establish an evidence-based protocol for the management of the extensively carious primary molar. CONCLUSIONS: After consideration of a review of extensively searched literature, a protocol and key points document have been developed to assist clinicians in their treatment planning. Further long-term studies with the highest level of evidence (i.e. randomized controlled trials) are required to enable us to identify acceptable alternatives which can replace formocresol.

Gingival necrosis following the use of a paraformaldehyde-containing paste: a case report.

AIM: To report on an unusual case of gingival necrosis following the use of a paraformaldehyde-containing paste in root canal treatment. SUMMARY: Paraformaldehyde preparations are toxic to hard and soft tissues. In an era of effective local anaesthesia, toxic devitalizing preparations have few applications. However, in a mobile world population, severe tissue injury may occasionally be encountered after the use of paraformaldehyde or other toxic agents in some parts of the world. Dentists should avoid such preparations and be alert of the features and management of local toxicity if they encounter it in practice. KEY LEARNING POINTS: Paraformaldehyde-containing pastes have no application in contemporary dentistry. Dentists should avoid toxic preparations for pulp devitalization. Dentists should be aware of the features and management of tissue necrosis resulting from the use of toxic dressing materials.

The acute nephrotoxicity of systemically administered formaldehyde in rats.

AIM: The purpose of this study was to assess the acute nephrotoxicity of formaldehyde, as it is believed to be the toxic component of formocresol. METHODS: A sample of 24 Sprague-Dawley rats was used in the study and divided into 3 groups of 8 rats each. The following procedures were performed: group A) formaldehyde equivalent dose to 20 pulpotomies, injected into the main vein of each rat's tail; group B) formaldehyde equivalent dose to 100 pulpotomies injected; group C) control group with a saline solution injected. Blood analyses were performed after 24 and 48 hours to assess urea and creatinine levels. Urine samples were taken after 24 hours to analyse for LDH protein levels. Rats were sacrificed after 48 hours and histology samples of renal tissue were studied for any pathological defects. RESULTS: Evaluation of histological samples of kidney tissue did not show any inflammation or other tissue lesions. No significant differences were found, using an ANOVA test procedure, among the variables of LDH protein or creatinine levels after 24 and 48 hours. Significant differences were found between the levels of urea and creatinine after 48 hours between the control group and the other test groups. CONCLUSION: The use of formaldehyde at the usual clinical doses or with an amount equivalent to 100 pulpotomies did not produce renal tissue damage and the blood and urine factors analysed did not show significant changes after 48 hours in the experimental model used.

Ferric sulphate and formocresol in pulpotomy of primary molars: long term follow-up study.

AIM: The objective of this study was to compare the effects of ferric sulphate (FS) to that of the full strength of formocresol (Buckley's formula) (FC) as pulpotomy agents in primary human molar teeth 42-48 months after treatment. This was to assess the succeeding premolar teeth for decalcification, abnormal morphology or any other defect. METHODS: Seventy children, ranging in age from 3 to 6 years, mean 4.3 years, were treated for pulpotomy of primary molars. Ferric sulphate 15.5% solution (applied for 15 seconds for 84 teeth) and formocresol solution (5 minutes procedure for next the 80 teeth) were used as pulpotomy agents. In both groups, pulp stumps were covered with zinc oxide eugenol paste. Permanent restorations were, in most cases, stainless steel crowns and in some of them amalgams. Follow-up clinical assessments were every 3 months and the radiographic follow-up time was 6, 20 and 42-48 months after treatment. STATISTICS: The differences were statistically analyzed using the Chi square test. RESULTS: These revealed 96.4% clinical success rate in the FS and 97.5% in the FC groups. Radiographic success rate in the FS group was 92.0%, while 94.6% in the FC group. No statistical significant differences were found between the radiographic assessment of the two pulpotomy agents. CONCLUSION: Ferric sulphate showed similar clinical and radiographic success rate as a pulpotomy agent for primary molar teeth after long term evaluation period, compared with formocresol. Ferric sulphate, because of its lower toxicity, may become a replacement for formocresol in primary molar teeth.

Sistema Endox: desvitalización y esterilización electrónica. Estudio clínico / System Endox: Electronic desvitalization and esterilization. A clinical study

Los conocimientos y la tecnología están cambiando rápidamente la práctica de la Odontología para mejorar nuestros conocimientos y el servicio a nuestros pacientes. El sistema endodóntico Endox nos pennite en una primera fase la medición apical y posteriormente en una segunda fase la desvitalización y esterilización, mediante la utilización de la corriente alterna de alta frecuencia, ya que elimina tanto el tejido vascuao-nervioso como los microorganismos presentes en los canales radiculares. Este estudio demuestra que la utilización del Endox mejora los resultados clínicos para satisfacción tanto de los profesionales como de los pacientes (AU)

No disponible

Use of a resin-ionomer in crown-root fracture repair of a canine tooth of a dog.

A resin-ionomer material was used to repair a longitudinal sub-crestal crown-root fracture of a maxillary canine tooth of a young dog. Infinity, the resin-ionomer used in this report, has been shown in human studies to be biocompatible with soft and osseous tissues, making it appropriate for use as a subgingival restorative material. The tooth was treated endodontically to achieve apexification, followed by conventional endodontic treatment, crown-root fracture repair, and preparation for placement of an Inceram crown.

[Application of phytotherapy in odontology: the case of Euphorbia balsamifera. Endodontic clinical trial]. / Application de la phytothérapie à l'odontologie: cas d'Euphorbia balsamifera. Essais d'études cliniques endodontiques.

Phytotherapy is a medicinal and ancestral practice in Africa. It deals with all the fields of human pathology. We wanted to ascertain the efficacy of some plants used in odontology as Euphorbia balsamifera traditionally used as antalgic treatment of acute dental pulpitis. The latex of the plant was caught and treated as to get enough stable paste. We used that paste in the same conditions we use arsenical nerve caustics, a pulpal devitalizer widely used in dental offices. The study carried out on 37 teeth has shown that latex of Euphorbia balsamifera is an effective pulpal devitalizing in contact with the pulp. Its lifetime action was comparable to that of the pulpal nerve caustics. The active principles are not known, however the product seems attractive as a pulpal devitalizing agent.

Pulpotomy therapy in primary teeth: new modalities for old rationales.

Pulpotomy therapy for the primary dentition has developed along three lines: devitalization, preservation, and regeneration. Devitalization, where the intent is to destroy vital tissue, is typified by formocresol and electrocautery. Preservation, the retention of maximum vital tissue with no induction of reparative dentin, is exemplified by glutaraldehyde and ferric sulfate treatment. Regeneration, the stimulation of a dentin bridge, has long been associated with calcium hydroxide. Of the three categories, regeneration is expected to develop the most rapidly in the coming years. Advances in the field of bone morphogenetic protein (BMP) have opened new vistas in pulp therapy. Human BMPs with dentinogenic properties are becoming available through recombinant technology. We are now entering an era of pulpotomy therapy with healing as the guiding principle.