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.

Formulation of Saudi Propolis into Biodegradable Chitosan Chips for Vital Pulpotomy.

BACKGROUND: Propolis has been widely used to treat oral cavity disorders, such as endodontal and periodontal diseases and microbial infections. OBJECTIVE: The study aimed at the formulation of commercial Saudi propolis into biodegradable chitosan chips and evaluation of its effectiveness as a pulpotomy agent. METHODS: The standardization of 80% ethanolic propolis extract was performed regarding its total phenolic content, total flavonoid content, quantitative estimation of main polyphenolic constituents and antioxidant activity. Chitosan chips containing propolis extract were prepared by the solvent/ casting method. The investigated variables were % of chitosan polymer (2, 2.5 and 3%), % of plasticizer (1, 5 and 10%) and incorporation of different concentrations of hydroxypropyl methylcellulose (5, 10 and 20% of polymer weight). The chips were characterized for weight and thickness uniformity, content uniformity, pH, percentage moisture loss, swelling index, tensile strength and in vitro propolis release. The optimal propolis chip formulation was further investigated in dogs regarding the short term response of primary dental pulp to propolis chips compared with the most commonly used formocresol preparation. RESULTS: The prepared films were flexible and demonstrated satisfactory physicochemical characteristics. The optimal formulation showed an initial release of about 41.7% of the loaded propolis followed by a sustained release extended up to 7 days. The kinetics study demonstrated that propolis release was controlled by Fick´s diffusion. The optimal propolis chip formulation resulted in less pulpal inflammation compared to formocresol, and produced hard tissue formation in all specimens. CONCLUSION: Formulation of commercial Saudi propolis as a biodegradable chitosan chip is an effective alternative to the commercially available chemical agents for the treatment of vital pulpotomy.

Comparative evaluation of pro-inflammatory cytokine levels in pulpotomized primary molars.

The present in vivo study was performed to investigate the levels of the pro-inflammatory cytokines, interleukin (IL)-1α, IL-6, and IL-8, in primary molars for which pulpotomy was clinically indicated, and to evaluate the success rates of three different pulpotomy agents employed for cariously (CExp) or mechanically exposed (MExp) primary molars. Forty-seven primary molars were classified as MExp or CExp according to the type of pulpal exposure. Pulp tissue was harvested and analyzed using enzyme-linked immunosorbent assay (ELISA). Subsequently, three pulpotomy agents-calcium hydroxide (CH), mineral trioxide aggregate (MTA), and formocresol (FC)-were applied randomly, and the outcome was observed radiographically for 18 months. Levels of IL-6 and IL-8 were significantly higher in CExp pulp than in MExp pulp (P < 0.05). In the CH pulpotomy group, MExp teeth showed a higher success rate than CExp teeth. There was no significant difference in success rate between MExp and CExp teeth in both the FC and MTA groups. The levels of IL-6 and IL-8 have the potential to become indicators of pulp status and can be monitored by researchers to make the prognosis of vital pulp therapies less uncertain. As MTA and FC yielded higher rates of success than CH in CExp teeth, the choice of pulpotomy agent appears to be important in this context.

A review of the effects of formaldehyde release from endodontic materials.

Formaldehyde is present in most living cells and the environment. In dentistry, patients may be exposed to formaldehyde through the use of several endodontic materials (e.g. AH 26) and during formocresol pulpotomies. This review outlines how the human body reacts to formaldehyde exposure, how recent data has relooked at the issue of carcinogenicity and leukaemia associated with formaldehyde, and whether it is possible to quantify the amount of formaldehyde produced by endodontic cements. The review analyses the way formaldehyde is produced from epoxy resins and addresses the question of whether the amount of formaldehyde from endodontic cements is large enough to override the body's ability to deal with its own endogenous levels of formaldehyde and should the amount of formaldehyde produced be a concern.

Surface roughness of polyvinyl siloxane impression materials following chemical disinfection, autoclave and microwave sterilization.

BACKGROUND: Autoclave sterilization and microwave sterilization has been suggested as the effective methods for the disinfection of elastomeric impressions, but subjecting elastomeric impressions to extreme temperature may have adverse effects on critical properties of the elastomers. AIM: To evaluate the effect of chemical disinfection as well as autoclave and microwave sterilization on the surface roughness of elastomeric impression materials. MATERIALS AND METHODS: The surface roughness of five commercially available polyvinyl siloxane impression materials (Coltene President, Affinis Perfect impression, Aquasil, 3M ESPE Express and GC Exafast) were evaluated after subjecting them to chemical disinfection, autoclaving and microwave sterilization using a Talysurf Intra 50 instrument. Twenty specimens from each material were fabricated and divided into four equal groups, three experimental and one control (n=25). The differences in the mean surface roughness between the treatment groups were recorded and statistically analyzed. RESULTS: No statistically significant increase in the surface roughness was observed when the specimens were subjected to chemical disinfection and autoclave sterilization, increase in roughness and discoloration was observed in all the materials when specimens were subjected to microwave sterilization. CONCLUSION: Chemical disinfection did not have a significant effect but, since it is less effective, autoclave sterilization can be considered effective and autoclaving did not show any specimen discoloration as in microwave sterilization. Microwave sterilization may be considered when impressions are used to make diagnostic casts. A significant increase in surface roughness may produce rougher casts, resulting in rougher tissue surfaces for denture and cast restorations. CLINICAL SIGNIFICANCE: Autoclave sterilization of vinyl polysiloxane elastomeric impressions for 5 minutes at 134°C at 20 psi may be considered an effective method over chemical disinfection and microwave sterilization, because chemical disinfection does not eliminate all disease-causing microorganisms and microwave sterilization leads to a rougher impression surface.

Influence of pulpotomy medicaments on the ultrastructure and shear bond strength of a self-etch adhesive to primary tooth dentin.

OBJECTIVE: To compare the effect of the pulpotomy medicaments glutaraldehyde, ferric sulfate, and formocresol on the structure and shear bond strength of a self-etch adhesive to the dentin of primary teeth. METHOD AND MATERIALS: Forty human primary molars were sectioned mesiodistally and divided into four groups: group I (control group), dentin specimens were soaked in distilled water for 48 hours; group II, dentin specimens were soaked in 2% glutaraldehyde; group III, dentin specimens were soaked in formocresol; and group IV, dentin specimens were soaked in 15.5% ferric sulfate. All specimens were rinsed with tap water and dried with air. AdheSE One (a self-etch adhesive) and Valux Plus composite resin were applied to the dentin surfaces. The molecular structure of the adhesive itself and adhesive with composite resin were tested using an FTIR spectrometer. Shear bond strength was tested with a universal testing machine. Failure modes analyses were performed with a scanning electron microscope (SEM). RESULTS: Glutaraldehyde showed little changes in the molecular structure of the adhesive itself and adhesive with composite. However, ferric sulfate and formocresol affected the molecular structure of the adhesive alone and the adhesive with composite. The highest mean value of shear bond strength was for the glutaraldehyde group (11.17 ± 4.87 MPa). Ferric sulfate and formocresol significantly reduced shear bond strength after the application of pulpotomy medicaments (7.45 ± 3.73 and 5.31 ± 3.30 MPa, respectively). SEM analysis revealed that most of the specimens failed in cohesive and mixed modes. CONCLUSION: This study revealed that formocresol and ferric sulfate adversely affect the shear bond strength and molecular structure of the adhesive system to primary dentin.

Análise química do formocresol após simulação de uso em clínica / Chemical analysis of formocresol after simulated clinical use

Objetivo: Analisar o teor de formaldeído em diversas marcas de formocresol e verificar se há alteração na fórmula do produto após simulação de uso, bem como das marcas entre si. Método: Neste estudo in vitro foram utilizados quatro diferentes marcas comerciais do medicamento formocresol (Biodinâmica, Iodontec, Inodon e Iodontosul) realizando simulação de seu uso em clínica através da manipulação diária dos produtos por um período de 60 dias. A análise química foi realizada nos laboratórios da Faculdade de Química da PUCRS, com o formaldeído, principal componente com propriedade de evaporação significativa do formocresol, onde foram realizadas três análises químicas pelo método de cromatografia gasosa. Resultados: Houve diminuição no teor de formaldeído durante o período de 60 dias nas quatro marcas comerciais, sugerindo que a eficácia do produto pode ser diminuída ao longo do uso. Constatou-se também que houve diferença na quantidade inicial de formaldeído entre as marcas pesquisadas. Conclusão: A eficácia do produto pode ser diminuída ao longo do uso, porém não há evidências conclusivas, havendo a necessidade de estudos adicionais.

Objective: To analyze the formaldehyde content in different brands of formocresol and to evaluate whether there are alterations in the product formula after simulated use and among the brands. Method: This in vitro study used four commercial brands of formocresol (Biodinâmica®, Iodontec®, Inodon® and Iodontosul®) simulating its clinical use by handling these products daily during 60 days. The chemical analysis was performed at the laboratory of PUCRS's Chemistry School and focused on formaldehyde, which is formocresol's main component with Signify cant evaporation property. The analysis comprised three chemical analyses by the gaseous chromatography method. Results: There was a decrease in the formaldehyde content decreased in the 60-day period for all four brands, suggesting that the product efficiency may decrease with time. It was also observed that the initial formaldehyde content differed among the researched brands. Conclusion: The efficacy of the product may decrease with time, but the results are not conclusive, needing further research.

Pulpotomías en molares primarios. Evaluación clínico radiográfica de formocresol o trióxido mineral agregado / Pulpotomies in primary molars. A clinical and radiographic evaluation of formocresol or mineral trioxide aggregate

A pesar de los avances registrados en las últimas décadas en Odontología, aún no se ha identificado un agente para el tratamiento pulpar ideal que revelealto grado de éxito en molares primarios hasta su normal exfoliación. El formocresol ha sido el medicamentopara pulpotomías más empleado, si bien se ha demostrado que posee características tóxicas para lostejidos con los que entra en contacto. El objetivo de este trabajo prospectivo fue evaluar el comportamiento clínico y radiográfico de un trióxido mineralagregado de fabricación nacional, disponible en el mercado y con aprobación del ANMAT, comparadocon formocresol, como agente de pulpotomías en molares primarios. Metodología: 30 molares primariosde pacientes sin compromiso sistémico, con indicación de pulpotomía recibieron alternadamente, pulpotomías con formocresol diluido (FC) y con Trióxido mineral agregado (TMA) CPM®, siendoevaluados clínica y radiográficamente en un rango de 180 a 300 días. Se registraron como fracasos: la observación clínica de fístula, dolor espontáneo y movilidad no fisiológica, y la radiográfica de reabsorción interna, externa, ensanchamiento periodontaly radiolucidez interradicular. Resultados: La edad media de los pacientes para FC fue 5,6 + 1,24 años, yTMA 6 + 1,64 años. (p = 0.4). El éxito clínico para ambos grupos fue del 94 por ciento, y el radiográfico de 87 por cientopara FC y 94 por ciento para TMA (p = 0.7). Conclusiones: En este trabajo preliminar el Trióxido mineral agregadoy el formocresol demostraron comportamiento clínico y radiográfico semejante. Estos resultados ameritanfuturos estudios aumentando el número de casos y tiempo de observación.

Effect of medications for root canal treatment on bonding to root canal dentin.

Use of resin-based restorative materials recently has become widely accepted for treatment of endodontically treated teeth. However, some solutions routinely used during endodontic treatment procedures may have an effect on bond strengths of adhesive materials to root canal dentin. The purpose of this in vitro study was to evaluate the effect of various medications on microtensile bond strength to root canal dentin. Fourteen extracted human single-rooted teeth were used. The crowns and the pulp tissues were removed. The root canals were then instrumented and widened to the same size. The teeth were randomly divided into seven groups of two teeth each. The root canal dentin walls of the roots were treated with 5% sodium hypochloride (NaOCI), 3% hydrogen peroxide (H2O2), the combination of H2O2 and NaOCl, or 0.2% chlorhexidine gluconate for 60 s; or calcium hydroxide or formocresol for 24 h. The teeth in control group were irrigated with water. The root canals were obturated using C&B Metabond. After 24 h of storage in distilled water, serial 1-mm-thick cross-sections were cut, and approximately 12 samples were obtained from each group. Microtensile bond strengths to root canal dentin were then measured by using an Instron machine. The data were recorded and expressed as MPa. The results indicated that NaOCI, H2O2, or a combination of NaOCl and H2O2 treatment decreased bond strength to root canal dentin significantly (p < 0.05). The teeth treated with chlorhexidine solution showed the highest bond strength values (p < 0.05). In conclusion, chlorhexidine is an appropriate irrigant solution for root canal treatment before adhesive post core applications.

Synthesis and spectroscopic studies on the new Schiff base derived from the 1:2 condensation of 2,6-diformyl-4-methylphenol with 5-aminouracil (BDF5AU) and its transition metal complexes. Influence on biologically active peptides-regulating aminopeptidases.

The synthesis, spectroscopic (IR, 1H and 13C NMR, UV-Vis-NIR, EPR), magnetic measurements and biological studies of a number of complexes of Co(II), Ni(II), Cu(II), Zn(II), Cd(II), Au(III) and Hg(II) of the Schiff base derived from the 1:2 condensation of 2,6-diformyl-4-methylphenol and 5-aminouracil, ((5-[[(3-[[(2,4-dioxopyrimidin-5(1H,3H)-yl)imino]methyl]-2-hydroxy-5-methylphenyl)methylene]amino]pyrimidine-2,4(1H,3H)-dione, hereafter denoted as BDF5AU) are reported. In all cases, the complexes appear to be monomeric. The deprotonated ligand in the phenolic oxygen atom shows a tridentate coordination mode through the two azomethine nitrogen atoms and the phenolic oxygen atom. The coordination of the neutral ligand takes place through the phenolic oxygen atom and one azomethine nitrogen atom and the carbonylic oxygen atom in fourth position of one uracil ring. The biological properties of some perchlorate complexes on the activity of some neutral, acid, basic and omega aminopeptidases (AP) are assayed, demonstrating a general inhibitory effect. Neutral and basic AP are mainly inhibited by Cu(II), Ni(II) and Cd(II) complexes, although tyrosyl-AP is activated by Zn(II) complex. Glutamyl-AP but not aspartyl-AP is inhibited by all the complexes assayed excepting Zn(II) complex. Finally, omega AP is inhibited by Ni(II) and Cd(II) complexes.

Concentration of formocresol used by pediatric dentists in primary tooth pulpotomy.

Diluted formocresol is the most widely recommended primary tooth pulpotomy medicament, but it is not commercially available. This investigation surveyed practicing pediatric dentists about the concentration of formocresol that they use to perform pulpotomies and, if they use diluted formocresol, where they obtain it. Eight-hundred-and-six surveys were sent to a randomly selected sample of practicing pediatric dentists, and 422 were returned for a 52% response rate. Eighty-four percent of the respondents use formocresol for their primary tooth pulpotomies. Of those, 69% use full strength, 27% use diluted and 4% don't know. Sources of diluted formocresol for those who use the diluted form include: 34% who buy it that way, 58% who dilute it themselves and 8% who have the pharmacy dilute it. The majority of pediatric dentists who use formocresol for primary tooth pulpotomies use a full strength formulation.

Adhesion of glass-ionomer cement sealers to bovine dentin conditioned with intracanal medications.

This in vitro study assessed the adherence of glass-ionomer cement (GIC) root canal sealers to dentin conditioned by three endodontic intracanal medications. Three GIC sealers were used: (i) Ketac-Endo; (ii) KT-308, an experimental GIC sealer; and (iii) ZUT, a combination of KT-308 and a silver-containing zeolite (0.2% by weight). Superficial dentin of 120 bovine incisor crowns was used as a substrate. The dentin was irrigated with 2.6% NaOCI for 30 s and then blotted dry. One of the following conditioning media (n = 30) was maintained in contact with the dentin for 7 days: (i) Ca(OH)2 paste; (ii) chlorhexidine gluconate (CHX) liquid 0.12%; (iii) formocresol (FML) liquid; (iv) distilled water (dH2O) used as control. The GIC sealers were applied to the conditioned dentin, bench set for 90 min, stored in 100% humidity at 37 degrees C for 48 h, then tested to failure for shear bond strength (MPa) in an Instron machine. In the ZUT specimens, the shear bond strength did not differ significantly among those conditioned with Ca(OH)2, CHX, FML, and dH2O. For KT-308, the mean scores were significantly lower (p < 0.05) after conditioning with CHX than with dH2O. For Ketac-Endo, the mean scores were significantly lower after conditioning with Ca(OH)2 and FML than with dH2O (p < 0.05). Furthermore Ketac-Endo demonstrated significantly lower (p < 0.05) shear bond strength than KT-308 or ZUT to the dentin conditioned with Ca(OH)2 or FML. The results suggest that intracanal medications differentially influence the adhesion of various GIC sealers to root canal dentin.

Influence of formaline cresol on bond strength of adhesive luting agents to dentin.

The present study investigates the influence of the pulpotomy agent formaline cresol (FC) on bond strength between dentin and five adhesive systems (Super-Bond C&B, Bistite II, Imperva Dual Set, Panavia 21, and Panavia 21 with AD Gel). After the dentin surfaces of 75 bovine teeth (including 25 control samples) were exposed by grinding, 25 of the samples were soaked in FC for 2 days, and 25 samples were soaked for 7 days. Samples were bonded to acrylic rods using five adhesive systems, and tensile bond strengths were determined after 1-day immersion in water. Data were analysed by analysis of variance and Duncan's new multiple range test, and the fractured surfaces were observed through a scanning electron microscope. The bond strengths were found to be influenced by the type of system, soaking period, and their combination. The bond strength values of three adhesive systems (Super-Bond C&B, Imperva Dual Set Bistite II, and Panavia 21 with AD Gel) decreased after soaking in FC. After 7 days of FC exposure, the highest bond strength (9.8+/-2.9 MPa) was obtained with the Super-Bond C&B system.

Avaliaçäo do potencial carcinogênico do formocresol diluído a 1/5 e do glutaraldeído a 2 por cento no modelo experimental DMBA-induzido / The evaluation of the carcinogenic potential of 1/5 formocresol and 2 per cent glutaraldehyde in DMBA-induced model

O objetivo deste trabalho foi avaliar o potencial carcinogênico do formocresol e do glutaraldeído, nas concentraçöes utilizadas clinicamente, em testes de longa duraçäo, a partir do modelo experimental em hamsters sírius dourados para estudo da carcinogênese química bucal induzida pelo uso do DMBA a 0,5 por cento. A análise comparativa macro e microscópica das alteraçöes provocadas pela aplicaçäo tópica do formocresol diluído a 1/5 e glutaraldeído a 2 por cento sobre a mucosa lingual lateral, precedida ou näo por escarificaçäo, após 7, 13 e 20 semanas, permitiu verificar que o formocresol diluído a 1/5 e o glutaraldeído a 2 por cento induzem alteraçöes morfológicas que caracterizam displasia epitelial; näo houve induçäo à formaçäo de papilomas e carcinomas nos animais, tal como ocorreu com o DMBA a 0,5 por cento

Avaliaçäo do potencial cariogênico do formocresol diluído a 1/5 e do glutaraldeído a 2 por cento no modelo experimental DMBA-induzido / The evaluation of the cariogenic potential of 1/5 formocresol and 2 percent glutaraldehyde in DMBA-induced model

A necessidade de se avaliar o potencial cariogênico do formocresol e glutaraldeído, nas concentraçöes utilizadas clinicamente, em testes de longa duraçäo, motivou a realizaçäo deste trabalho, a partir do modelo experimental em hamsters sírios dourados para o estudo da cariogênese química bucal induzida pelo uso do DMBA a 0,5 por cento. A análise comparativa das evoluçöes macroscópica e microscópicas das alteraçöes provocadas pela aplicaçäo tópica do formocresol diluido a 1/5 e do glutaraldeído a 2 por cento sobre a mucosa lingual lateral, precedida ou näo pelo procedimento de trauma por escarificaçäo, após 7, 13 e 20 semanas, permitiu verificar que: 1) O formocresol diluído a 1/5 e o glutaldeído a 2 por cento induzem alteraçöes epiteliais hiperplásicas nos locais das aplicaçöes, mas sem modificaçöes morfológicas que caracterizam displasia epitelial; 2) Näo houve induçäo à formaçäo de papilomas e carcinomas nos animais em que foram aplicados formocresol diluído 1/5 e glutaraldeído a 2 por cento, na mucosa da borda lateral da língua de hamster, tal como foi feito com o DMBA a 0,5 por cento. Desta forma, podê-se concluir que, o formocresol diluído a 1/5 e o glutaraldeído a 2 por cento, quando comparados ao DMBA a 0,5 por cento no mesmo método de aplicaçäo, näo säo carcinógenos completos