Clinical and Radiographic Evaluation of Various Herbal Products Used with Zinc Oxide as an Obturating Material in Primary Teeth: An In Vivo Study.

AIM: To compare the clinical and radiographically mixture of zinc oxide with Aloe vera, Curcumin and neem as an obturating material for pulpectomy. MATERIALS AND METHODS: The study comprised of age group 4-8 years children requiring endodontic treatment for at least a single primary molar tooth. Sixty primary molar teeth from 43 children were divided equally and randomly into four study groups. The materials used for obturation were zinc oxide powder (ZnO) and Eugenol (ZOE) (group I), ZnO and Aloe vera Gel (group II), ZnO and Curcumin Powder (group III), ZnO and neem extract (group IV). They were evaluated clinically and radiographically at immediate postoperative and then at 1-, 3-, 6-, and 9-month intervals. RESULTS: At the end of 9 months, the Chi-square test revealed 100% success rate for recovery of pain in group I and III, 66.66% in group II and 93.3% in group IV. The success rates for absence of abscess and for periradicular radiolucency in group I, III, and group IV were 100% and 66.6% for group II. The success rate for periapical radiolucency in group I and group III was 100%, in group II 66.6% and in group IV 93.35%. The success rate for all the groups shows 100% success in terms of pathological root resorption. CONCLUSION: Zinc oxide eugenol has proven to be the best obturating material. ZnO with Aloe vera showed a success rate which is significantly lower than the other medicaments. ZnO with Curcumin and ZnO with neem had shown promising clinical and radiographical results. CLINICAL SIGNIFICANCE: ZnO with Curcumin and ZnO with neem can be used as a root canal filling material in primary teeth with further follow-up studies.

Alternative root canal filling materials to zinc oxide eugenol in primary teeth: a systematic review of the literature.

PURPOSE: The aim of this review was to compare the currently available root canal filling materials for primary teeth to zinc oxide eugenol (ZOE) to find a suitable alternative. The search question was: which root canal filling materials used in pulpectomy for primary teeth give better clinical and radiographic success rates than ZOE? METHODS: A systematic search was conducted using five databases, namely Cochrane central register of controlled trials (CENTRAL), MEDLINE via PubMed, Science Direct, Scopus and EBSCOhost using a selection of "MeSH terms". The "Modified Jadad Scale" was used for the methodology assessment of the included studies. RESULTS: Out of 480 articles identified in the initial search, 8 articles met all the inclusion criteria. The results showed that, compared to ZOE, ZOE with calcium hydroxide and iodoform had better clinical and radiographic success rates, a resorption rate similar to that of the roots, faster resorption of extruded particles and a maximum decrease in the size of pre-operative inter-radicular radiolucencies. CONCLUSION: Numerous materials, proposed and used by clinicians in root canal filling in primary teeth, can be recommended as alternatives to ZOE. However, none of them could be the ideal material in primary teeth. Thus, more high-quality well-designed randomised clinical trials are required to develop more high-performing materials.

Lesion sterilization and tissue repair with chloramphenicol, tetracyline, zinc oxide/eugenol paste versus conventional pulpectomy: A 36-month randomized controlled trial.

BACKGROUND: Endodontic treatment of primary molars represents one of the challenges in pediatric dentistry. There is a lack of consensus in the literature about the endodontic techniques and filling paste for primary teeth with pulp necrosis. AIM: To compare the effectiveness of the LSTR technique (lesion sterilization and tissue repair) with CTZ paste (chloramphenicol, tetracycline, zinc oxide and eugenol) and pulpectomy with ZOE paste (zinc oxide and eugenol) in the treatment of primary molars with pulp necrosis. DESIGN: Eighty-eight primary molars with pulp necrosis from 70 children between the ages of 3 and 8 years were included. The teeth were randomized to the LSTR with CTZ paste group or pulpectomy with ZOE paste group. Clinical and radiographic evaluations were performed at 18, 24, 30 and 36 months. RESULTS: At 36 months, clinical success was 86.4% in LSTR with CTZ paste and 90.9% in pulpectomy with ZOE paste (p = .45). Radiographic success was 43.2% in both groups (p = 1.00). The overall success was 40.9% in LSTR with CTZ paste and 43.2% in pulpectomy with ZOE paste (p = 1.00). CONCLUSION: After 36 months of evaluation, the effectiveness of the LSTR technique with CTZ paste and pulpectomy with ZOE paste was similar for the treatment of primary molars with pulp necrosis.

Comparative volumetric analysis of three different obturating materials in primary molars under cone beam computed tomography: an in-vitro study.

BACKGROUND: To increase the success rate of the endodontic treatment in primary teeth various, obturating materials have been introduced to meet the specific requirements for deciduous dentition and to create a three-dimensional (3D) seal to prevent recurrence of bacterial infection. This study was conducted to compare and evaluate the three-dimensional seal and volumetric filling of primary canals obturated with different medicaments using cone beam computed tomography (CBCT). METHODS: In-vitro cross sectional study was designed with sample size of 108 specimens. Thirty-six extracted primary molars were selected for the study and randomly divided into 3 groups A (Metapex; Meta Biomed, Osong-eup, Korea), B (Endoflas; Sanlor Laboratories, Cali, Colombia) and C (Zinc oxide eugenol; DPI India Ltd., Mumbai, India). After access opening, canals were prepared up to 30 no k- file followed by obturation with Metapex, Endoflas and Zinc oxide eugenol in respective groups. CBCT was done before and after the obturation for volumetric analysis. The data obtained were analyzed to attain POV (percentage of obturated volume) and PVV (percentage volume of voids). RESULTS: The percentage of obturated volume (POV) was highest for Endoflas group (88.87) followed by Metapex (83.58) and ZnO (72.78) and the difference was statistically significant. Whereas the percentage volume of voids (PVV) was more in Zinc oxide eugenol group (27.22) followed by Metapex (16.42) and least voids were seen in Endoflas group (11.14). CONCLUSIONS: Voids were found in all three obturating materials. Endoflas showed superior three-dimensional (3D) sealing capability whereas ZnO eugenol having least sealing capacity.

Influence of treatment setting on success of pulpectomy in primary molars: a retrospective analysis up to 4 years.

OBJECTIVES: The objective of this study was to analyze the success of primary molar pulpectomy with a minimum of 1 year and up to 4 years follow-up with focus on the treatment setting (general anesthesia, sedation, local anesthesia alone). METHOD AND MATERIALS: Data were retrieved from 92 patients' records between 2012 and 2020. The pulpectomy treatment using calcium-hydroxide/iodoform paste was performed under general anesthesia (n = 45), nitrous oxide sedation (n = 21), or local anesthesia alone (n = 39). Bivariate and multivariate analyses were performed. RESULTS: The overall success of pulpectomy was 59.5% 4 years post-treatment. The 4-years clinical success rate was clinically relevantly higher under general anesthesia (78.6% vs 57.1% under nitrous oxide sedation, 43.8% with local anesthesia only) and in the mandibular arch (70.8% vs 38.5% in the maxillary arch). This could be related to the strict case selection under sedation and especially general anesthesia. Despite statistically significant differences in the bivariate analysis for most outcomes and follow-up periods, this was not the case in multivariate regression. CONCLUSION: Pulpectomy performed in primary molars offers a successful long-term treatment option especially with a strict case selection as under general anesthesia.

Comparative Evaluation of Postoperative Pain in Primary Teeth Obturated With Zinc Oxide Eugenol versus Metapex: A Randomized Clinical Trial.

The fundamental objective of pulp treatment is to preserve the integrity and health of oral tissues. Pulp necrosis or irreversible pulpitis is the key indication for performing pulpectomy in primary teeth. It can be performed as a single-visit or multi-visit procedure using suitable obturating material. Various obturating materials can be used like zinc-oxide eugenol or metapex. A controversy reflects in literature and among experts in regard to single-visit or multi-visit endodontics. Hence, the purpose of this randomized clinical trial is to assess the incidence of postoperative pain with zinc oxide eugenol and metapex as an obturating material in single-visit and multiple-visit pulpectomy. The study was conducted at M S Ramaiah Dental College and Hospital, Bangalore in one year duration from 2020 to 2021. Two groups of children, forty in each group, aged between four to eight years, were included in the study. Groups were divided to perform single-visit and multi-visit endodontics with zinc-oxide eugenol and metapex as obturating material. The sample size of 40 were considered and allocated to respective group by concealment allocation. The conventional pulpectomy procedure was carried out. The post operative pain was assessed by using the pain scale through the telephonic conversation with the patient within 24 hours of treatment. Proportions were compared using Chi-square test of significance and the "p" value of less than 0.05 indicates statistical significance. The results showed, no statistically significant difference in teeth obturated with zinc oxide eugenol and metapex in both single-visit and multi-visit pulpectomy. The comparison of zinc oxide eugenol and metapex in single-visit group and multi-visit group had a 'p' value of 0.9233 and 0.4233 respectively. There were no differences between single and multi-visit treatment protocols with respect to the incidence of post operative pain. Single visit pulpectomy can be performed with added advantages with either zinc oxide eugenol or metapex.

Ferric sulfate pulpotomy in primary teeth with different base materials: a 2-year randomized controlled trial.

OBJECTIVE: To evaluate the effects of zinc oxide-eugenol, calcium hydroxide, and mineral trioxide aggregate as base materials on the clinical and radiographic success of ferric sulfate pulpotomies in primary molars. METHOD AND MATERIALS: Following hemostasis with 15.5% ferric sulfate, 105 teeth were randomly allocated to three groups: Group 1, zinc oxide-eugenol; Group 2, calcium hydroxide; and Group 3, mineral trioxide aggregate. All teeth were restored with stainless-steel crowns. Clinical and radiographic examinations were conducted at 6, 12, 18, and 24 months. RESULTS: After 24 months, clinical success rates for Groups 1 to 3 were 97.1% (34/35 teeth), 94.2% (33/35 teeth), and 97.1% (34/35 teeth), respectively (P > .05). Radiographic success rates were 65.7% (23/35 teeth), 65.7% (23/35 teeth), and 77.1% (27/35 teeth), respectively (P > .05). Internal resorption was the most observed radiographic finding (15/105 teeth). CONCLUSIONS: The choice of zinc oxide-eugenol, calcium hydroxide, and mineral trioxide aggregate, as base materials, did not affect the clinical and radiographic success of ferric sulfate pulpotomies in primary teeth.

An in vivo comparative clinical and radiographic evaluation of a mixture of zinc oxide-Ocimum sanctum extract, zinc oxide-ozonated oil, and zinc oxide-eugenol as obturating materials in primary molars.

Background: To overcome some of the disadvantages of the current primary root canal obturating materials, there is a continued interest in search for chemical compounds with broader and more effective antibacterial action and less cytotoxicity. Aim: This study aimed to evaluate and compare in vivo the clinical and radiographic success of mixtures of zinc oxide-Ocimum sanctum extract, zinc oxide-ozonated oil, and zinc oxide-eugenol (ZOE) as obturating materials in pulpectomy of primary molars. Settings and Design: This was an in vivo randomized controlled clinical trial. Materials and Methods: Ninety primary molars selected were randomly divided into three groups. Group A was obturated with zinc oxide-O. sanctum extract, Group B with zinc oxide-ozonated oil, and Group C with ZOE. All the groups were evaluated for success or failure based on clinical and radiographic criteria at the end of 1, 6, and 12 months. Statistical Analysis Used: The intra- and inter-examiner reliability of the first and the second co-investigators was calculated by Cohen's kappa statistic. The data were analyzed using Chi-square test, P ≤ 0.05 (indicates statistical significance). Results: By the end of 12 months, the overall clinical success rate was 88%, 95.7%, and 90.9% in Groups A, B, and C, respectively; whereas the radiographic success rate was found to be 80%, 91.3%, and 86.4% in Groups A, B, and C, respectively. Conclusion: On the basis of the overall success rates of all the three obturating materials, the following order of performance can be concluded: zinc oxide-ozonated oil > ZOE > zinc oxide-O. sanctum extract.

LSTR Antibiotic Paste Versus Zinc Oxide and Eugenol Pulpectomy for the Treatment of Primary Molars with Pulp Necrosis: A Randomized Controlled Trial.

Purpose: The purpose of this study was to compare the effectiveness of lesion sterilization and tissue repair (LSTR) antibiotic paste comprised of chloramphenicol, tetracycline, and zinc oxide and eugenol (CTZ) versus zinc oxide eugenol (ZOE) pulpectomy in the treatment of primary molars with pulp necrosis. Methods: A total of 70 three- to eight-year-old subjects with 88 primary mandibular molars with pulp necrosis were included. The teeth were randomized to the CTZ group or ZOE group. The time taken to perform both techniques was recorded. The parents of the children and the dentist who performed clinical evaluations were blind to the group assignment, although the radiographic evaluator could see the difference in treatments. Clinical and radiographic assessments were performed at three, six, nine, and 12 months. Results: At the 12-month evaluation, the clinical success was 86.4 percent for CTZ and 90.9 percent for ZOE (P=0.50), the radiographic success was 75.0 percent for CTZ and 72.7 percent for ZOE (P=0.81), and the overall success was 70.5 percent for CTZ and 72.7 percent for ZOE (P=0.81). The mean time taken to perform was 61.4 (±20.5 standard deviation) minutes for CTZ and 145.1 (±53.2) minutes for ZOE (P<0.001). Conclusions: At 12 months, both techniques presented no significant difference in success rates for nonvital pulp therapy in primary molars with necrosis. The lesion sterilization and tissue repair procedure time using chloramphenicol, tetracycline, zinc oxide, and eugenol was significantly shorter than for a zinc oxide eugenol pulpectomy.

Clinical and radiographic success of (partial) pulpotomy and pulpectomy in primary teeth: A systematic review.

AIM: The aim of this systematic review was to evaluate the clinical outcome of partial pulpotomy, pulpotomy and pulpectomy for treating primary teeth with normal or infected pulp or with irreversible pulpitis. METHODS: Two reviewers on Pubmed and ISI Web of Science performed a comprehensive literature review of publications from 1966 until July 2019. Pico outline was used to facilitate literature research. Among abstracts, publications were selected according to the following criteria: prospective clinical study, correct indication for the performed treatment, clear definition of clinical and/or radiographic success criteria and at least 6-month follow-up period. The strict selection criteria under the keywords "pulpotomy", "partial pulpotomy" and "pulpectomy" resulted in a limited amount of randomised controlled trials (RCT) or controlled clinical trials (CT). Qualitative assessment of the selected clinical studies and level of evidence was included according to the criteria described by the Oxford Centre for Evidence-Based Medicine (CEBM). CONCLUSION: Prerequisites for a successful pulpotomy are symptom-free teeth, sterile removal of coronal pulp and haemostasis. Both MTA and formocresol perform well for partial pulpotomies after caries exposure. Formocresol had been the most popular amputation material for pulpotomies. Due to the potential side effects, other medicaments, such as ferric sulfate, mineral trioxide aggregate (MTA) or NaOCl are suggested. Grey and white MTA yeld the same results. Lasers are not recommended due to their large diversity. Regarding pulpectomy, the conditions, procedures, and evaluation for the treatment were not well defined in the studies. Nevertheless, there is evidence to use calcium hydroxide, zinc oxide eugenol paste or iodoform based pastes as root filling materials for non-vital molars. Pulpectomies showed better success rates than pulpotomies. Stainless steel crowns are recommended as definite restorations after both endodontic treatments. Longer follow-up periods, further clinical studies with comparable conditions and clear definition of evaluation criteria are needed to further confirm the results of endodontic treatment in primary teeth.

Use of Non-Vital Pulp Therapies in Primary Teeth.

Purpose: To present an evidence-based guideline for non-vital pulp therapies due to deep caries or trauma in primary teeth. Methods: The authors, working with the American Academy of Pediatric Dentistry, conducted a systematic review/meta-analysis for studies on non-vital primary teeth resulting from trauma or caries and used the GRADE approach to assess level of certainty of evidence for clinical recommendations. Results: GRADE was assessed from high to very low. Comparing teeth with/without root resorption, pulpectomy success was better (P<0.001) in those without preoperative root resorption. Zinc oxide plus iodoform plus calcium hydroxide ([ZO/iodoform/CH]; Endoflas TM ) and zinc oxide and eugenol (ZOE) pulpectomy success did not differ from iodoform (iodoform plus calcium hydroxide; VitapexTM, MetapexTM) (P=0.55) after 18-months; however, ZO/iodoform/CH and ZOE success rates remained near 90 percent while iodoform was 71 percent or less. Network analysis ratings showed ZO/iodoform/CH and ZOE better than iodoform. Lesion sterilization tissue repair (LSTR) was better (P<0.001) than pulpectomy in teeth with preoperative root resorption, but pulpectomy results were better (P=0.09) if roots were intact. Rotary instrumentation of root canals was significantly faster (P<0.001) than manual, but the quality of fill did not differ (P=0.09) and both had comparable success. Network analysis ranked ZO/iodoform/CH the best, ZOE second, and iodoform lowest at 18 months. Success rates were not impacted by method of obturation or root length determination, type of tooth, number of visits, irrigants, smear layer removal, or timing/type of final restoration. Conclusions: Pulpectomy 18-month success rates supported ZO/iodoform/CH and ZOE pulpectomy over iodoform. LSTR had limited indication for teeth with resorbed roots and requires close monitoring.

Treatment of severely decayed anterior primary teeth with short-post technique (Mushroom Restorations) under general anesthesia.

AIMS: The aim of this study was to evaluation the treatment success of the short post technique (mushroom restoration) using a composite resin in severely decayed primary anterior teeth after 6, 12, and 18 months after treatment. METHODS: Eighteen children aged 3-5 years with severely decayed primary maxillary anterior teeth (60 anterior maxillary primary teeth in total) were included. Patients were treated under general anesthesia (GA). After pulpectomy, a "mushroom shape" was formed in the root canals for the purpose of retention, and the root canals were filled with zinc oxide-eugenol (ZOE), and the teeth were restored with composite resin. The status of treatment was evaluated clinically and radiographically for periapical radiolucency, pathological root resorption, marginal fracture, and loss of restoration for each treated tooth. All findings were recorded. RESULTS: As a result of the evaluation criteria, the success rates at 6, 12 and 18 months were 86%, 80%, and 71%, respectively. None of the teeth showed apical radiolucency or pathological root resorption at the end of the 18th month period. CONCLUSION: The short-post (mushroom restorations) technique is a clinically acceptable alternative method for restoration of severely decayed primary teeth. This study supports the feasibility of treatment with this technique for pediatric patients treated under GA.

The effect of smear layer on bacterial penetration through roots obturated using zinc oxide eugenol-based sealer.

BACKGROUND: Smear layer removal has been shown to reduce bacterial penetration through root canal obturations when resin-based endodontic sealer is used. The purpose of this in vitro study was to test this effect when a non-resin-based sealer is used. MATERIAL AND METHODS: Thirty root segments were assigned to the following groups: Smear layer removed (n = 8); smear layer retained (n = 8); negative controls (n = 10; 5 with smear layer, 5 without); and positive controls (n = 4; 2 with smear layer, 2 without). After rotary instrumentation, smear layers were removed in the treatment group and half of controls using 17% ethylenediamenetetraacetic acid (EDTA) prior to obturation. Each obturated root was affixed into a dual-chamber leakage model employing Streptococcus mutans. Roots were incubated at 37 °C for 120 d. Days until lower chamber turbidity occurred was recorded for each sample, and data were analyzed using Kaplan-Meier survival curve analysis (p = 0.05). RESULTS: No negative controls leaked, while all positive controls were turbid within 1 day. Mean days to leakage for roots with smear layer intact was 82.75 (+/- 33.29, 95% CI), although three never leaked. Mean days to leakage through roots with smear layer removed was 46.25 (+/- 26.67, 95% CI), and all leaked. Treatment survival curves were significantly different (p = 0.048). CONCLUSIONS: Under the conditions and limitations of this study, retaining the smear layer reduced the rate of bacterial penetration through canals which had been obturated using zinc oxide eugenol (ZOE) -based sealer.

A comparison of calcium hydroxide/iodoform paste and zinc oxide eugenol as root filling materials for pulpectomy in primary teeth: A systematic review and meta-analysis.

Zinc oxide eugenol (ZOE) has traditionally been used as a root filling material in primary teeth pulpectomy. Calcium hydroxide and iodoform (Ca(OH)2/iodoform) may have advantages as a root canal filling material to evaluate treatment success of Ca(OH)2/iodoform pulpectomy in primary teeth compared with ZOE based on clinical and radiographical criteria. All human clinical studies reporting clinical and radiographical outcomes of Ca(OH)2/iodoform compared with ZOE in primary teeth pulpectomy were identified in digital bibliographic databases. Two authors independently selected studies and extracted relevant study characteristics. Success of treatment was based on an accomplishment of specific clinical and radiographical criteria. Meta-analyses were performed to appraise study heterogeneity and aggregated statistics. Out of 5,000 articles identified in initial search, 15 articles met all inclusion criteria, while 10 were included in the meta-analyses. At 6- and 12-month follow-up, there were no statistically significant differences in the clinical and radiographical success rates of Ca(OH)2/iodoform and ZOE. However, ZOE was shown to have statistically significant higher success rates at ≥18-month follow-up. On the basis of the findings of this systematic review, we recommend that Ca(OH)2/iodoform be utilized for pulpectomy in primary teeth nearing exfoliation; conversely, ZOE should be utilized when exfoliation is not expected to occur soon. Future randomized control clinical trials with a long-term follow-up are needed before a reliable conclusion can be drawn as to the best pulpectomy material. The success of pulpectomy in primary teeth depends on selecting the ideal root canal filling material. It is challenging to select the appropriate filling materials for primary teeth. ZOE or ZOE/iodoform combined with Ca(OH)2 appears to be the materials of choice if primary teeth are not nearing exfoliation. More high-quality randomized control clinical trials with a long-term follow-up period are needed before a reliable conclusion can be drawn as to the best pulpectomy material in primary teeth (systematic review registration number: CRD42016037563).

Primary molar pulpotomies with different hemorrhage control agents and base materials: A randomized clinical trial.

OBJECTIVE: To evaluate the clinical and radiographical success of primary molar pulpotomies which used 15.5% ferric sulfate (FS) or 1.25% sodium hypochlorite (NaOCl) for hemostasis and zinc oxide-eugenol (ZOE) and calcium hydroxide (CH) pastes as base materials. METHODS: In 29 healthy children, 80 primary molars were randomly allocated to one of the study groups: Group 1: FS-ZOE, Group 2: FS-CH, Group 3: NaOCl-ZOE, and Group 4: NaOCl-CH. After hemostasis with the respective solutions, pulp stumps and floor of the pulp chambers were covered with either ZOE or CH pastes. All teeth were restored with stainless steel crowns. Follow-up examinations were carried out at 1, 3, 6, and 12 months. RESULTS: One tooth in Group 1 and two teeth in Group 4 were extracted because of pain and periapial pathosis at sixth month. After 12 months, clinical success rates of pulpotomies in Groups 1-4 were 95%, 100%, 100%, and 89.5%, respectively. The differences were not significant (P = 0.548). Radiographic success rates for Groups 1-4 were 80%, 88.9%, 78.9%, and 84.2%, respectively. No statistically significant difference was found (P = 0.968). Pain on percussion was the most observed clinical finding. However, internal root resorption was the most common radiological finding and it was observed significantly more in mandibular primary molars (P < 0.05). CONCLUSION: Both ZOE and CH can be preferred as base materials after hemostasis achieved by the use of 15.5% FS or 1.25% NaOCl in primary tooth pulpotomy.

In Vitro Evaluation of Cell Compatibility of Dental Cements Used with Titanium Implant Components.

PURPOSE: To evaluate the biocompatibility of five dental cement compositions after directly exposing human gingival fibroblast (HGF) and MC3T3-E1 preosteoblast cells to cement alone and cement applied on commercially pure titanium (cpTi) specimens. MATERIALS AND METHODS: Nanostructurally integrated bioceramic (NIB), resin (R), resin-modified glass ionomer (RMGIC), zinc oxide eugenol (ZOE), and zinc phosphate (ZP) compositions were prepared according to the respective manufacturer's instructions. Samples were prepared in cylindrical Teflon molds or applied over the entire surface of polished cpTi discs. All samples were cured for 0.5, 1, 12, or 24 hours post-mixing. Direct contact testing was conducted according to ISO 10993 by seeding 6-well plates at 350,000 cells/well. Plates were incubated at 37°C in a humidified atmosphere with 5% CO2 for 24 hours before individually plating samples and cpTi control discs. Plates were then incubated for an additional 24 hours. Microtetrazolium (MTT) cell viability assays were used to measure sample cytotoxicity. RESULTS: For samples that cured for 24 hours prior to direct contact exposure, only NIB and ZP cements when cemented on cpTi demonstrated cell viability percentages above the minimum biocompatibility requirement (≥70%) for both the investigative cell lines. R, RMGIC, and ZOE cements exhibited moderate to severe cytotoxic effects on both cell lines in direct contact and when cemented on cpTi specimens. For HGF cells, ZOE cemented-cpTi specimens exhibited significantly decreased cytotoxicity, whereas RMGIC cemented-cpTi specimens exhibited significantly increased cytotoxicity. CONCLUSIONS: Despite previous studies that showed enhanced cpTi corrosion activity for fluoride-containing compositions (NIB and ZP), there was no significant difference in cytotoxicity between cement alone and cemented-cpTi. In general, the MC3T3-E1 preosteoblast cells were more sensitive than HGF cells to cement composition. Ultimately, cement composition played a significant role in maintaining host cell compatibility. Results of this work help illustrate the impact of different cement formulations on host cell health and emphasize the need for understanding material properties when selecting certain formulations of dental cements, which can ultimately influence the survival of dental implant systems.

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.

Zinc oxide eugenol and Endoflas pulpectomy in primary molars: 24-month clinical and radiographic evaluation.

CONTEXT: Despite modern advancement in material and technical aspect, management of infected primary molars is of prime concern in pediatric endodontics. An effective root canal material plays the major role in achieving the fluid impervious seal by defending against variant microflora and maintaining the tooth in function for longer duration. AIMS: This study aims to evaluate and compare the success of endoflas as root canal filling material in infected primary molars with zinc oxide eugenol (ZOE). MATERIALS AND METHODS: Primary molars with necrotic pulp in healthy, cooperative children were selected. Ethical clearance and informed consent was obtained. Standardized pulpectomy procedure was done and root canals were filled with either ZOE or endoflas. Further follow-up with clinical and radiographic evaluation was carried at 0, 3, 6, 12, and 24 months. The findings obtained were statistically analyzed using Chi-square test. RESULTS: Endoflas showed acceptable results as root canal filling material in primary molars even at 2-year follow-up, though overfilling of root canals led to low success rate compared to teeth with combined optimal and under fillings. There was no significant difference between the two materials (P > 0.05). CONCLUSIONS: Endoflas could be a potential alternative to ZOE for preserving infected primary molars.

Pulp treatment for extensive decay in primary teeth.

BACKGROUND: In children, dental caries (tooth decay) is among the most prevalent chronic diseases worldwide. Pulp interventions are indicated for extensive tooth decay. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. After treatment, the cavity is filled with a medicament. Materials commonly used include mineral trioxide aggregate (MTA), calcium hydroxide, formocresol or ferric sulphate.This is an update of a Cochrane Review published in 2014 when insufficient evidence was found to clearly identify one superior pulpotomy medicament and technique. OBJECTIVES: To assess the effects of different pulp treatment techniques and associated medicaments for the treatment of extensive decay in primary teeth. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health Group's Trials Register (to 10 August 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2017, Issue 7), MEDLINE Ovid (1946 to 10 August 2017), Embase Ovid (1980 to 10 August 2017) and the Web of Science (1945 to 10 August 2017). OpenGrey was searched for grey literature. The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing interventions that combined a pulp treatment technique with a medicament or device in children with extensive decay in the dental pulp of their primary teeth. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed 'Risk of bias'. We contacted authors of RCTs for additional information when necessary. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. We performed data synthesis with pair-wise meta-analyses using fixed-effect models. We assessed statistical heterogeneity by using I² coefficients. MAIN RESULTS: We included 40 new trials bringing the total to 87 included trials (7140 randomised teeth) for this update. All were small, single-centre trials (median number of randomised teeth = 68). All trials were assessed at unclear or high risk of bias.The 87 trials examined 125 different comparisons: 75 comparisons of different medicaments or techniques for pulpotomy; 25 comparisons of different medicaments for pulpectomy; four comparisons of pulpotomy and pulpectomy; and 21 comparisons of different medicaments for direct pulp capping.The proportion of clinical failures and radiological failures was low in all trials. In many trials, there were either no clinical failures or no radiographic failures in either study arm.For pulpotomy, we assessed three comparisons as providing moderate-quality evidence. Compared with formocresol, MTA reduced both clinical and radiological failures, with a statistically significant difference at 12 months for clinical failure and at six, 12 and 24 months for radiological failure (12 trials, 740 participants). Compared with calcium hydroxide, MTA reduced both clinical and radiological failures, with statistically significant differences for clinical failure at 12 and 24 months. MTA also appeared to reduce radiological failure at six, 12 and 24 months (four trials, 150 participants) (low-quality evidence). When comparing calcium hydroxide with formocresol, there was a statistically significant difference in favour of formocresol for clinical failure at six and 12 months and radiological failure at six, 12 and 24 months (six trials (one with no failures), 332 participants).Regarding pulpectomy, we found moderate-quality evidence for two comparisons. The comparison between Metapex and zinc oxide and eugenol (ZOE) paste was inconclusive, with no clear evidence of a difference between the interventions for failure at 6 or 12 months (two trials, 62 participants). Similarly inconclusive, there was no clear evidence of a difference in failure between Endoflas and ZOE (outcomes measured at 6 months; two trials, 80 participants). There was low-quality evidence of a difference in failure at 12 months that suggested ZOE paste may be better than Vitapex (calcium hydroxide/iodoform) paste (two trials, 161 participants).Regarding direct pulp capping, the small number of studies undertaking the same comparison limits any interpretation. We assessed the quality of the evidence as low or very low for all comparisons. One trial appeared to favour formocresol over calcium hydroxide; however, there are safety concerns about formocresol. AUTHORS' CONCLUSIONS: Pulp treatment for extensive decay in primary teeth is generally successful. Many included trials had no clinical or radiological failures in either trial arm, and the overall proportion of failures was low. Any future trials in this area would require a very large sample size and follow up of a minimum of one year.The evidence suggests MTA may be the most efficacious medicament to heal the root pulp after pulpotomy of a deciduous tooth. As MTA is relatively expensive, future research could be undertaken to confirm if Biodentine, enamel matrix derivative, laser treatment or Ankaferd Blood Stopper are acceptable second choices, and whether, where none of these treatments can be used, application of sodium hypochlorite is the safest option. Formocresol, though effective, has known concerns about toxicity.Regarding pulpectomy, there is no conclusive evidence that one medicament or technique is superior to another, and so the choice of medicament remains at the clinician's discretion. Research could be undertaken to confirm if ZOE paste is more effective than Vitapex and to evaluate other alternatives.Regarding direct pulp capping, the small number of studies and low quality of the evidence limited interpretation. Formocresol may be more successful than calcium hydroxide; however, given its toxicity, any future research should focus on alternatives.

Outcome of Endodontic Surgery: A Meta-analysis of the Literature-Part 3: Comparison of Endodontic Microsurgical Techniques with 2 Different Root-end Filling Materials.

INTRODUCTION: The aim of the present study was to investigate the influence of root-end preparation and filling material on endodontic surgery outcome. A systematic review and meta-analysis was conducted to determine the outcome of resin-based endodontic surgery (RES, the use of high-magnification preparation of a shallow and concave root-end cavity and bonded resin-based root-end filling material) versus endodontic microsurgery (EMS, the use of high-magnification ultrasonic root-end preparation and root-end filling with SuperEBA [Keystone Industries, Gibbstown, NJ], IRM [Dentsply Sirona, York, PA], mineral trioxide aggregate [MTA], or other calcium silicate cements). METHODS: An exhaustive literature search was conducted to identify prognostic studies on the outcome of root-end surgery. Human studies conducted from 1966 to the end of December 2016 in 5 different languages (ie, English, French, German, Italian, and Spanish) were searched in 4 electronic databases (ie, Medline, Embase, PubMed, and Cochrane Library). Relevant review articles on the subject were scrutinized for cross-references. In addition, 5 dental and medical journals (Journal of Endodontics; International Endodontic Journal; Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics; Journal of Oral and Maxillofacial Surgery; and International Journal of Oral and Maxillofacial Surgery) were hand checked dating back to 1975. All abstracts were screened by 3 independent reviewers (H.B., M.K., and F.S.). Strict inclusion-exclusion criteria were defined to identify relevant articles. Raw data were extracted from the full-text review of these selected articles independently by each of the 3 reviewers. In case of disagreement, an agreement was reached by discussion, and qualifying articles were assigned to group RES. For EMS, the same search strategy was performed for the time frame October 2009 to December 2016, whereas up to October 2009 the data were obtained from a previous systematic review with identical criteria and search strategy. Weighted pooled success rates and a relative risk assessment between RES and EMS were calculated. To make a comparison between groups, a random effects model was used. RESULTS: Sixty-eight articles were eligible for full-text review. Of these, per strict inclusion exclusion criteria, 14 studies qualified, 3 for RES (n = 862) and 11 for EMS (n = 915). Weighted pooled success rates for RES were 82.20% (95% confidence interval [CI], 0.7965-0.8476) and 94.42% for EMS (95% CI, 0.9295-0.9590). This difference was statistically significant (P < .0005). CONCLUSIONS: The probability for success for EMS proved to be significantly greater than the probability for success for RES, providing best available evidence on the influence of cavity preparation with ultrasonic tips and/or SuperEBA (Keystone Industries, Gibbstown, NJ), IRM (Dentsply Sirona, York, PA), MTA, or silicate cements as root-end filling material instead of a shallow cavity preparation and placement of a resin-based material. Additional large-scale randomized clinical trials are needed to assess other predictors of outcome.