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

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

Primary pulpotomies - what should we be using?

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

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

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

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

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

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

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

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

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

Eficacia clínica del MTA en Pulpotomías de pacientes pediátricos: Una Revisión Sistemática / Eficácia Clínica da MTA em Pulpotomias Pediátricas de Pacientes: Uma Revisão Sistemática / Clinical Efficacy of MTA in Pediatric Patient Pulpotomies: A Systematic Review

Objetivo: Analizar la eficacia clínica del Agregado Trióxido Mineral (MTA) en pulpotomías a través de estudios comparativos con el formocresol, sulfato férrico e hidróxido de calcio; en pacientes pediátricos con edad de tres a nueve años. Materiales y Métodos: El artículo se basa en una revisión sistemática de la literatura, por ello, se utilizaron como fuentes de información las bases de datos: PubMed, Scielo, y Biblioteca Virtual de Salud. Asimismo, como criterios de inclusión se establecieron publicaciones del año 2008 al 2019, cuya procedencia se derivó de journalsy revistas académicas arbitradas; los cuales permitieron obtener dieciséis ensayos que evaluaban la eficacia clínica a través de los signos y síntomas de las patologías pulpares más comunes: absceso, inflamación gingival, movilidad patológica, dolor a la percusión y dolor espontáneo. Resultados: El MTA obtuvo una eficacia de 97,9% en contraposición al 86,9% del Sulfato Férrico. En relación al Formocresol, el MTA logró el 99% contra un 98,3% de eficacia. Además, en la comparación del MTA con el Hidróxido de Calcio el primero logró un 98,2% y el segundo 74,5%. Conclusiones: El MTA obtuvo una mayor eficacia clínica debido a su biocompatibilidad, pH básico y su elevada facultad al sellar la cámara pulpar. Por lo tanto, puede emplearse como un material seguro para las pulpotomías de pacientes pediátricos.

Objetivo: Analisar a eficácia clínica do Agregado de Trióxido Mineral (MTA) em pulpotomias através de estudos comparativos com formocresol, sulfato férrico e hidróxido de cálcio; em pacientes pediátricos de três a nove anos de idade. Materiais e Métodos: O artigo é baseado em uma revisão sistemática da literatura, portanto, bases de dados foram utilizadas como fontes de informação: PubMed, Scielo, e Biblioteca Virtual. Da mesma forma, como critério de inclusão, foram estabelecidas publicações de 2008 a 2019, cuja origem foi derivada de periódicos e revistas acadêmicas de referência; o que nos permitiu obter dezesseis ensaios que avaliaram a eficácia clínica através dos sinais e sintomas das doenças mais comuns da polpa: abscesso, inflamação gengival, mobilidade patológica, dor na percussão e dor espontânea. Resultados: A MTA obteve uma eficácia de 97,9% contra 86,9% para o sulfato férrico. Em relação ao Formocresol, o MTA alcançou 99% contra 98,3% de eficácia. Além disso, na comparação do MTA com o hidróxido de cálcio, o primeiro atingiu 98,2% e o segundo 74,5%. Conclusões: A MTA obteve uma maior eficácia clínica devido a sua biocompatibilidade, pH básico e sua alta faculdade ao selar a câmara de celulose. Portanto, pode ser usado como material segura para pulpotomias de pacientes pediátricos.

Objective: To analyze the clinical efficacy of the Mineral Trioxide Aggregate (MTA) in pulpotomies through comparative studies with formocresol, ferric sulfate and calcium hydroxide; in pediatric patients aged three to nine years. Materials and Methods: The article is based on a systematic review of the literature, therefore, databases were used as sources of information: PubMed, Scielo, and Virtual Health Library. Likewise, as inclusion criteria, publications from 2008 to 2019 were established, whose origin was derived from journals and refereed academic journals; which allowed us to obtain sixteen trials that evaluated clinical efficacy through the signs and symptoms of the most common pulp diseases: abscess, gingival inflammation, pathological mobility, pain on percussion and spontaneous pain. Results: MTA obtained an efficacy of 97.9% as opposed to 86.9% for ferric sulfate. Concerning to Formocresol, MTA achieved 99% versus 98.3% efficacy. Also, in the comparison of MTA with Calcium Hydroxide, the former achieved 98.2% and the latter 74.5%. Conclusions: MTA obtained a higher clinical efficacy due to its biocompatibility, basic pH and its high faculty when sealing the pulp chamber. Therefore, it can be used as a safe material for pediatric patient pulpotomies.

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

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

The Clinical Effectiveness of Calcium Hydroxide in Root Canal Disinfection of Primary Teeth: A Meta-Analysis.

BACKGROUND The aim of this research was to systematically analyze the effectiveness of calcium hydroxide compared to formocresol (FC) and camphor phenol (CP) in root canal disinfection of primary teeth. MATERIAL AND METHODS The meta-analysis was based on the participants, interventions, control, outcome (PICO) study design principle and 16 randomized-controlled clinical trials published from January 2000 to August 2018. The data heterogeneity of each study was assessed by the Q-test. The odds ratio and 95% confidence interval (CI) were calculated based on the heterogeneity results by Revman software. RESULTS Sixteen randomized-controlled clinical trials of 3047 primary teeth were included in this meta-analysis. There were significant differences of clinical effectiveness between calcium hydroxide and FC in root canal disinfection of primary teeth (OR=3.37; 95% CI range: 2.54-4.48, P<0.01) and endodontic inter-appointment emergencies (EIAE) after disinfection for 7 days (OR=0.26; 95% CI range: 0.16-0.42, P<0.01). However, there was no statistical difference of EIAE, after disinfection of primary teeth for 48 hours, between calcium hydroxide and FC (OR=0.62; 95% CI range: 0.34-1.11, P=0.11). There were significant differences of clinical effectiveness between the calcium hydroxide and CP in root canal disinfection of primary teeth (OR=5.50; 95% CI range: 3.36-8.98, P<0.01). CONCLUSIONS This meta-analysis indicated that the effectiveness of calcium hydroxide as root canal disinfectant in primary teeth was more effective than that of FC and CP.

BiodentineTM versus formocresol pulpotomy technique in primary molars: a 12-month randomized controlled clinical trial.

BACKGROUND: The objective of this clinical study was to prospectively compare the clinical and radiographic success rates of BiodentineTM pulpotomies versus formocresol pulpotomies in children vital primary molars. METHODS: A randomized, split-mouth study design was used with a sample of 37 healthy children aged 4- to 8-year-old. A total of 56 pairs (112 teeth) of carious primary teeth, 1 pair per child, were selected for treatment. One tooth from each pair was randomly assigned to either the BiodentineTM pulpotomy group or the formocresol pulpotomy group. Children were followed-up at 3, 6 and 12 months for clinical evaluation and at 6 and 12 months for radiographic evaluation. Data were collected, tabulated and analyzed using Fisher exact and McNemar tests. The level of significance was set at P < 0.05. RESULTS: At 12 months, the clinical success rates of both BiodentineTM and formocresol groups were 100%, while the radiographic success rates for BiodentineTM and formocresol groups were 100% and 98.1%, respectively. There was no statistically significant difference between both groups (P=1). The only observed radiographic failure was furcal radiolucency in the formocresol group at 12-month interval. Pulp canal obliteration was radiographically observed in 10/56 (17.9%) and 7/56 (12.5%) cases in the BiodentineTM and formocresol groups, respectively. CONCLUSIONS: Both BiodentineTM and formocresol pulpotomy techniques demonstrated favorable clinical and radiographic outcomes over a 12-month period without any significant difference. TRIAL REGISTRATION: Registered on NCT03779698 . Date of Registration: 18 December 2018.

Clinical and Radiographic Evaluation of Formocresol and Chloramphenicol, Tetracycline and Zinc Oxide-Eugenol Antibiotic Paste in Primary Teeth Pulpotomies: 24 month follow up.

OBJECTIVE: The purpose of the present study was to evaluate clinically and radiographically the effectiveness of formocresol and the antibiotic paste CTZ (chloramphenicol, tetracycline and zinc oxide-eugenol) in primary teeth pulpotomies, during a 6, 12 and 24 month period. STUDY DESIGN: A total of 80 pulpotomies were performed in 58 patients between three and six years of age. The patients were selected and assigned to two groups: Group I Formocresol (FC, n=40), Group II chloramphenicol-tetracycline-zinc oxide eugenol (CTZ, n=40). The teeth were restored with glass ionomer and pre-formed stainless steel crowns. The treated teeth were evaluated clinically and radiographically at 6, 12 and 24 months. RESULTS: After 24 months of follow up a 100% and 94.3% clinical success was obtained, in the CTZ and formocresol groups respectively (x2= 0.450, p>0.05). The radiographic success was of 97.4% and 94.3% respectively (x2= 0.920, p>0.05). CONCLUSION: The performance of the antibiotic paste CTZ was superior to formocresol. No statistically significant differences were observed between the treatment groups either clinically or radiographically. More randomized clinical trials should be performed before it can be indicated safely.

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.

Evaluation and Comparison between Formocresol and Sodium Hypochlorite as Pulpotomy Medicament: A Randomized Study.

INTRODUCTION: Pulpotomy is the most common treatment to preserve vitality of cariously exposed molars. Various pulpotomy medicaments used should be antimicrobial, should help in healing without damaging surrounding tissue, and should not affect eruption of permanent teeth. Thus, this study was conducted to evaluate and compare the clinical and radiographic outcomes of formocresol (FC) and sodium hypochlorite (NaOCl) in primary molars. The aim of this randomized study was to compare the clinical and radiographic success rate of FC and 5% NaOCl as a pulpotomy medicament in primary molars. MATERIALS AND METHODS: Forty children aged 4 to 9 years with primary carious molar were selected and randomly assigned into two groups: FC and NaOCl. Pulpotomy procedure was then performed followed by restoration with stainless steel crowns. Clinical and radiographic evaluation was done at an interval of 3 to 6 months. RESULTS: Clinical success rate at 3 and 6 months was 100% for both groups. Radiographic success rate for FC was 95% at 3 months and 90% at 6 months, whereas for NaOCl, it was 90% at 3 months and 85% at 6 months. CONCLUSION: Based on this study, result of 5% NaOCl and FC showed no significant difference in their success rate. Hence, NaOCl can be used as pulpotomy medicament; however, further clinical trials with long follow-up period are required. CLINICAL SIGNIFICANCE: Sodium hypochlorite is a potential clinical substitute of FC for vital pulpotomy treatment in primary teeth because of its exceptional biological compatibility and to evade carcinogenic effect of FC.

Use of vital pulp therapies in primary teeth with deep caries lesions

PURPOSE: This manuscript presents evidence-based guidance on the use of vital pulp therapies for treatment of deep caries lesions in children. A guideline panel convened by the American Academy of Pediatric Dentistry formulated evidence-based recommendations on three vital pulp therapies: indirect pulp treatment (IPT; also known as indirect pulp cap), direct pulp cap (DPC), and pulpotomy. METHODS: The basis of the guideline's recommendations was evidence from "Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-Analysis." (Pediatr Dent 2017;15;39[1]:16-23.) A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and trial databases to identify randomized controlled trials and systematic reviews addressing peripheral issues of vital pulp therapies such as patient preferences of treatment and impact of cost. Quality of the evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation approach; the evidence-to-decision framework was used to formulate a recommendation. RESULTS: The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions. The panel recommends use of mineral trioxide aggregate (MTA) and formocresol in pulpotomy treatments; these are recommendations based on moderate-quality evidence at 24 months. The panel made weak recommendations regarding choice of medicament in both IPT (moderate-quality evidence [24 months], low quality evidence [48 months]) and DPC (very-low quality evidence [24 months]). Success of both treatments was independent of type of medicament used. The panel also recommends use of ferric sulfate (low-quality evidence), lasers (low-quality evidence), sodium hypochlorite (very low-quality evidence), and tricalcium silicate (very low-quality evidence) in pulpotomies; these are weak recommendations based on low-quality evidence. The panel recommended against the use of calcium hydroxide as pulpotomy medicament in primary teeth with deep caries lesions. Conclusions and practical implications: The guideline intends to inform the clinical practices with evidence-based recommendations on vital pulp therapies in primary teeth with deep caries lesions. These recommendations are based upon the best available evidence to-date.(AU)

Clinical and radiographic comparison of biodentine, mineral trioxide aggregate and formocresol as pulpotomy agents in primary molars.

AIM: To compare the clinical and radiographic success rates of three different pulpotomy agents in primary molars after 18 months. METHODS: The study was carried out with 51 primary molars of children aged 5-9 years old. The teeth were randomly assigned to the experimental or control groups. After coronal pulp removal and haemostasis, the remaining pulp tissue was covered with Biodentine® or mineral trioxide aggregate in the experimental groups. In the control group, formocresol was placed with a cotton pellet over the pulp tissue for 5 min and after removal the pulp tissue was covered with zinc oxide-eugenol (ZOE) paste. All teeth were immediately restored with reinforced ZOE base and resin modified glass-ionomer cement, and later with pre-formed metal crowns. Follow-up assessments were carried out after 3, 6, 12 and 18 months. RESULTS: Forty-five teeth were available for follow up at the end of 18 months. All of the available teeth for mineral trioxide aggregate and Biodentine® were clinically successful, as were 73.3% of the FC group. Radiographic success rate for the formocresol group at 18 months follow up was 73.3, 100% for mineral trioxide aggregate and 86.6% for Biodentine® group. CONCLUSION: Mineral Trioxide aggregate and Biodentine® showed more favourable results than formocresol.

Comparative evaluation of ankaferd blood stopper, ferric sulfate, and formocresol as pulpotomy agent in primary teeth: A clinical study.

AIM: The aim of the study was to provide a comparative evaluation of the clinical and radiographic success of Ankaferd blood stopper (ABS), formocresol (FC), and ferric sulfate (FS) as pulpotomy agent in primary teeth. SETTINGS AND DESIGN: This is a clinical study. MATERIALS AND METHODS: A total of 45 primary mandibular molar teeth in 26 children aged 6-9 were selected for the study. Teeth were randomly divided into three groups according to the pulpotomy agents (ABS, FC, FS). Following treatment, for 24 months, teeth were clinically and radiographically evaluated once every 3 and 6 months respectively. STATISTICAL ANALYSIS USED: SPSS version 15 software was used in data analysis. Kaplan- Meier, Log Rank and Fisher's exact tests were used to analysis. RESULTS: After follow-up periods ranging from 6 to 24 months (average 20.8±0.56), the clinical success rates for ABS, FC, and FS were 87%, 87%, and 100% respectively. The overall radiographic success was 87%, 80%, and 87%. When success rates of the ABS were compared with other agents, there were no significant differences between groups (P > 0.05). CONCLUSION: Similar success was achieved in the pulpotomy treatment of primary teeth that using ABS, FC, and FS. ABS would be considered a suitable agent for pulpotomy treatment and can be used as an alternative to other agents.

Evaluation and comparison of mineral trioxide aggregate and biodentine in primary tooth pulpotomy: Clinical and radiographic study.

OBJECTIVES: Pulpotomy is the common therapy for cariously exposed pulps in symptom-free primary molar teeth. For many years, researchers have searched for an ideal material that allows regeneration of the residual pulp. The purpose of this study was to evaluate the efficacy of mineral trioxide aggregate (MTA), Biodentine as a pulpotomy medicament in primary teeth, both clinically and radiographically. MATERIALS AND METHODS: A total of 25 children (50 human primary molar teeth) aged between 5 and 9 years were selected in this randomized clinical study. The patients were randomly assigned to receive the pulpotomy medicaments in either [Group 1]: MTA or [Group 2]: Biodentine. All pulpotomized teeth were restored with stainless steel crowns and evaluated clinically and radiologically at 1, 3, 6 and 12 months. Statistical analysis using Mann-Whitney U test and Fisher's exact test, and chi-square test was performed to determine the significant differences between the groups. RESULTS: Clinical and radiological success rates were 96 and 80% in Group 1 and 96 and 60% in Group 2, respectively. There were no significant differences between the groups (P > 0.05). The radiographic success rates decreased in the controls, but there were no significant differences. CONCLUSION: Biodentine showed similar clinical and radiographic results as MTA in the 12-month evaluation and can be safely used as a pulpotomy medicament.

Comparison between biodentine and formocresol for pulpotomy of primary teeth: A randomized clinical trial.

OBJECTIVE: To assess and compare the clinical and radiographic success rates of biodentine and formocresol for pulpotomy in human primary teeth. METHOD AND MATERIALS: A randomized, split-mouth, double-blind, controlled clinical trial was carried out in 37 healthy 4- to 8-year-old children with 56 pairs (112 teeth) of contralateral primary molars indicated for pulpotomy. Matched teeth in each pair were randomized to undergo either biodentine (n = 56 teeth) or formocresol (n = 56 teeth) pulpotomy. In both groups, the teeth were restored with stainless steel crowns. The teeth were evaluated clinically and radiographically at 3 and 6 months by two blinded, standardized, and calibrated examiners. The data were analyzed using chi-square and McNemar tests with a P value of < .05 considered significant. RESULTS: At both the 3- and 6-month follow-ups, all the 37 children with 112 treated teeth were evaluated. Clinical and radiographic success was similar for biodentine (100%) and formocresol (100%), without any statistically significant difference (P = 1). Pulp canal obliteration was radiographically observed in 10/56 (17.9%) and 7/56 (12.5%) cases in the biodentine and formocresol groups, respectively. CONCLUSION: Both pulpotomy techniques showed favorable clinical and radiographic outcomes at 3 and 6 months posttreatment without any significant difference. Hence, biodentine has the potential to become a substitute for formocresol in primary molar pulpotomies.

Clinical Pulpotomy Trial of Copaifera Langsdorffii Oil Resin Versus Formocresol and White Mineral Trioxide Aggregate in Primary Teeth.

PURPOSE: This study's purpose was to assess clinical and radiographic outcomes of Copaifera langsdorffii oil resin (CLOR) as a pulpotomy medicament compared with one-minute full-strength formocresol (FC) and white mineral trioxide aggregate (WMTA). METHODS: Determined by a power analysis, 152 primary molars of 64 four- to eight-year-olds with at least two asymptomatic molars requiring vital pulpotomies were recruited, randomly assigned to receive CLOR, WMTA, or FC, and restored with prefabricated metal crowns. At the 12-month follow-up, recordings of 59 children with 142 treated teeth were taken for clinical and radiographic symptoms. Clinical evaluation was performed by a blinded calibrated evaluator, whereas four evaluators scored each radiograph for pathologies based upon a modified scale previously proposed. The data were statistically analyzed. RESULTS: At 12 months, 100 percent clinical success was observed with all groups. CLOR had the highest frequency of pathologic radiolucencies at 12 months. The radiographic success at 12 months was 76 percent, 90.91 percent, and 88.23 percent for the CLOR, FC, and WMTA groups, respectively (P=0.10). CONCLUSION: Copaifera langsdorffii oil resin can be suggested as a pulpotomy agent for primary teeth up to one year. However, further clinical studies with long-term follow-ups are needed to test its efficacy as a pulpotomy medicament.

A retrospective study of root canal therapy in non-vital primary molars.

AIM: This study was performed to assess the clinical and radiographic success rates of a formocresol and zinc oxide eugenol (ZOE) primary molar root canal therapy (RCT) technique. The effects of this treatment on the permanent successors and on exfoliation times were also investigated. MATERIALS AND METHODS: Study design: the retrospective study included 161 patients with 211 primary molars treated by RCT by a single operator in a private paediatric dental office in the Toronto area. Data were coded and entered into a Microsoft Excel database and analysis undertaken using SPSS software. Predominantly non-parametric tests were used to evaluate statistical differences (p < 0.05). RESULTS: A clinical success rate of 90% (190/211) and a radiographic success rate of 77.3% (136/176) were obtained. Following RCT in a primary molar, enamel defects were found in 6.8% (7/103) of premolars, all of which occurred in first premolars, and in patients treated at a mean age of 54.1 months (p < 0.005). Treated molars exfoliated on average 7.6 months sooner than contralateral teeth (p < 0.005). CONCLUSION: This formocresol and ZOE RCT is a viable treatment for necrotic primary molars and yielded very high clinical and acceptable radiographic success rates.