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1.
Br Dent J ; 232(7): 459, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35396428
2.
Br Dent J ; 232(8): 524-530, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35459824

RESUMO

Background According to the Children's Dental Health Survey 2013, around one in ten children in Wales, Northern Ireland and England will have sustained dental trauma to a permanent incisor by the of age 15. Management of an exposed pulp in an immature permanent incisor is often urgent and has an impact on the long-term outcome of the tooth; therefore, it is essential that general dental practitioners feel confident in managing such a scenario to achieve an optimal outcome. This paper discusses the indications, technique, materials and outcomes.Aims This article aims to review the literature, which discusses various treatment modalities and materials for pulpal therapy and root canal treatment in the immature permanent tooth.Method Electronic searches were limited to English language, human studies, published within the past five years and the medical subject heading terms used were: direct pulp capping, apexogenesis, Cvek pulpotomy, full pulpotomy/pulpectomy, partial pulpotomy, apexification, non-vital pulp therapy and mineral trioxide aggregate apexification. Older, seminal articles identified through the references sections have also been included.Conclusion A number of options are available for the management of immature permanent teeth that have suffered an insult such as caries or trauma. This paper reviews the various methods of pulpal treatment, preservation therapy and root canal treatment options depending on the extent of the damage.


Assuntos
Cavidade Pulpar , Odontólogos , Adolescente , Compostos de Cálcio , Criança , Dentição Permanente , Combinação de Medicamentos , Humanos , Óxidos , Papel Profissional , Pulpotomia/métodos , Silicatos/uso terapêutico , Resultado do Tratamento
3.
Braz Oral Res ; 36: e049, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35442378

RESUMO

The purpose of this review was to identify and analyze the main characteristics of the 100 most-cited papers in the field of endodontic therapy in primary teeth. A search for the most-cited articles was conducted in the Clarivate Analytics Web of Science 'Core-Collection' (WoS-CC) database up to December 2020. Papers were ranked in descending order, by number of citations, and each paper was matched with the citation count on Scopus and Google Scholar. Two independent reviewers selected the most-cited papers and analyzed it according to the number and density of citations, year and journal of publication, authors, countries and contributing institutions, study design, topic of the paper, and keywords. Spearman's correlation and Poisson regression were used to determine associations between the number of citations and study characteristics. The citation count varied from 15 to 135 (WoS-CC), 8 to 141 (Scopus), and 14 to 317 (Google Scholar). Of the 306 contributing authors, most paper contributions were from Sakai VT, Oliveira TM, and Machado MAAM (5 each). Most of the papers originated from the USA (n=21) and Brazil (n=18). Randomized trials were the most common study design (n=32), and "pulpotomy" was the most frequently used keyword (n=35). Poisson regression showed that the number of citations decreased by 1.5% each year, and increased by 9.7% for each unit of impact factor. This bibliometric analysis highlighted papers, authors, and institutions that have contributed to endodontic therapy in primary teeth. Common terms of interest in this research area was also identified, representing the first bibliometric analysis on this subject.


Assuntos
Bibliometria , Projetos de Pesquisa , Brasil , Pulpotomia , Dente Decíduo
4.
Lasers Med Sci ; 37(5): 2545-2554, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35230575

RESUMO

This study has aimed to evaluate the clinical and radiographic success rates of calcium hydroxide pulpotomy (CH) with biostimulation (PBMT) and compare them to that of CH, formocresol (FC), mineral trioxide aggregate (MTA) pulpotomies without PBMT in primary molars. A total of 172 pulpotomies were performed on primary first or second mandibular molars in 94 children who were 5-8 years old. The pulpotomy procedure was performed with four different techniques. In the PBMT group, before the CH placement, 820-nm diode laser radiation was applied to each pulp-stump for 12 s (10 mW, 2.5 J/cm2). The clinical (lack of spontaneous pain, abscess or fistula, and pathological mobility) and radiographic success (lack of periapical/furcal lesions and internal/external resorption) were recorded at 6 and 12 months. The data was statistically evaluated. p value < 0.05 was considered as significant. After 12 months, the clinical and radiographic success rate (a tooth with at least one of the findings was considered unsuccessful) was 97%/92% for FC and 97%/95%, 87%/73%, and 71%/45% for MTA, CH + PBMT, and CH, respectively. There was no significant difference between the CH + PBMT and the other groups in clinical success, while a significant difference was found between CH and FC, MTA groups. In radiographic success, there was a significant difference between the CH and the other groups. No significant difference was found between the 6th- and 12th-month results in clinical success for all the groups. A decrease in success over time was seen only in the CH group for radiographic results. CH without PBMT showed the worst clinical and radiographic results among the groups. CH + PBMT showed similar clinical success compared to the MTA and FC groups. In radiographic success, CH + PBMT showed higher success compared to CH, but this success was not high as compared to MTA and FC.


Assuntos
Formocresóis , Pulpotomia , Compostos de Alumínio , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Criança , Pré-Escolar , Combinação de Medicamentos , Seguimentos , Humanos , Óxidos/uso terapêutico , Pemetrexede , Pulpotomia/métodos , Silicatos/uso terapêutico , Dente Decíduo
5.
Rev. Fac. Odont (Córdoba) ; 32(1): 11-19, mar 2022. ^etab
Artigo em Espanhol | BINACIS, BINACIS, UNISALUD | ID: biblio-1359722

RESUMO

Introducción: La terapia con pulpotomía es un tratamiento comúnmente llevado a cabo en pacientes pediátricos para contrarrestar la infección presente, frecuentemente se utilizan agentes químicos como antimicrobianos siendo algo contradictorios en cuanto a sus efectos. Objetivo: Evaluar la acción antimicrobiana del extracto etanólico de propóleo al 10% en terapia pulpar de órganos dentarios primarios. Materiales y Metodos: En este estudio se utilizó el Extracto Etanólico de Propóleo (EEP) al 10% de origen natural para el tratamiento de pulpotomías, su acción antimicrobiana fue evaluada mediantela recolección de muestras microbiológicas antes de la colocación de EEP muestra (S1) y después de su colocación muestra (S2). Se evaluó el grado de desarrollo microbiano en Unidades McFarland y por conteo de UFC en dos tiempos inicial y 24 hrs. Resultados: El propóleo mostró capacidad antimicrobiana ya que los resultados presentan una disminución promedio del crecimiento bacteriano entre las 20 muestras, siendo de 8, 30 a 8,10 en S1 y S2, así como de 9,18 a 8,96 en S1a y S2a. Los resultados muestran un efecto antimicrobiano, obteniendo diferencias entre S1 y S2, resultados que favorecen la capacidad antimicrobiana del propóleo. Conclusiones: El uso de extractos de plantas o derivados naturales como puede ser el propóleo para el tratamiento de terapias pulpares como son las pulpotomías en dientes temporales es prometedor como alternativa del formocresol.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Própole/análogos & derivados , Polpa Dentária , Pulpotomia , Odontopediatria
6.
Int Endod J ; 55(6): 613-629, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35348216

RESUMO

BACKGROUND: Traumatic dental injuries involving the pulp are quite common and there is a need to evaluate the quality of evidence on the success of vital pulp treatment (VPT) interventions in traumatised permanent teeth. OBJECTIVES: The aim of this systematic review was to assess the success of VPT in the management of traumatised human vital permanent teeth diagnosed with complicated crown or crown-root fractures. METHODS: An electronic search of the following databases: Web of Science, Scopus, PubMed, MEDLINE, EMBASE, LILACS, Clinical Trial Registries and the grey literature was performed until 25th /8/2021. Controlled clinical trials, cohort studies, case-control studies, case series with at least five cases and a minimum of 12-months follow-up were included. Non-English language literature was excluded. Two independent assessors performed study selection, data extraction and quality assessment using the National Institutes of Health's quality assessment tool. Disagreements were resolved through consensus/with a third assessor. RESULTS: A total of 14-studies (2-controlled clinical trials, 1-case-control, and 11-case series) published between 1978-2020, with a total of 1081 permanent teeth and an age range between 6-42 years-old were included. Bias analysis ranged considerably from 'good' to 'poor'. Meta-analysis was not performed due to data heterogeneity, unclear reporting, and limited number of controlled clinical studies. Partial pulpotomy was the main reported clinical procedure with an overall success rate between 82.9-100%. Complete pulpotomy and direct pulp capping were associated with lower success rates of 79.4-85.7% and 19.5%, respectively. Calcium hydroxide was the main pulp capping material with favourable clinical and radiographic success (79.4-100%). Biodentine® , mineral trioxide aggregate and IRoot® BP were also associated with a high clinical and radiographic success, 80-91%, 80-100%, and 90-100%, respectively, albeit in fewer studies. DISCUSSION: Although a high success rate has been reported when using VPT in managing pulpally involved traumatised teeth, the results of this systematic review clearly highlighted a paucity and low quality of the available evidence. CONCLUSIONS: Overall high success of VPT in the management of traumatised vital permanent teeth were reported, although based on limited evidence of well-conducted clinical studies. REGISTRATION: PROSPERO database (CRD42020205213).


Assuntos
Cárie Dentária , Silicatos , Adolescente , Adulto , Hidróxido de Cálcio/uso terapêutico , Criança , Coroas , Cárie Dentária/terapia , Capeamento da Polpa Dentária/métodos , Dentição Permanente , Humanos , Pulpotomia/métodos , Silicatos/uso terapêutico , Adulto Jovem
7.
Int Endod J ; 55(5): 416-429, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35152464

RESUMO

AIM: The aim of the study was to compare the outcome of full pulpotomy using 2 calcium silicate-based materials compared with mineral trioxide aggregate (MTA) in symptomatic mature permanent teeth with carious pulp exposure. METHODOLOGY: This study was designed as a parallel, double blind, randomized controlled trial where symptomatic mature permanent teeth with carious pulp exposure meeting the inclusion criteria were randomly treated with full pulpotomy using one of 3 calcium silicate-based materials (ProRoot MTA, Biodentine and TotalFill). Full pulpotomy was performed, and haemostasis was achieved via a cotton pellet moistened with 2.5% NaOCl. A 3-mm layer of the calcium silicate-based material was randomly placed as the pulpotomy agent through a block randomization process followed by a resin-based composite restoration. Postoperative periapical radiograph was taken. Clinical and radiographic evaluation were completed after 6 months and 1 year. The patient and evaluator were blinded to the type of materials used. Pain levels were scored preoperatively and 7 days after treatment. Effect of potential prognosis factors including gender, age, diagnosis, bleeding time and type of caries were also analysed. RESULTS: One hundred and sixty-four teeth in 146 patients received full pulpotomy and were randomly assigned to either the tested or control material through block randomization technique (50 MTA, 50 Biodentine and 64 TotalFill). The age ranged from 10 to 70 years. The diagnosis was irreversible pulpitis in 112 teeth (72%) and reversible pulpitis in 28 teeth (28%). The majority of patients presented with severe pain, during the first week 96.9% reported complete relief of pain or mild pain. Four cases had immediate failure. At 6 months the overall success rate was 92.2%, over 1 year 156/164 teeth attended follow-up with 12 failures (2 restorative failures and 10 endodontic failures), the overall success of pulpotomy at 1 year was 92.3% (144/156); 91.8% in MTA, 93.3% in Biodentine and 91.9% in TotalFill with no significant difference amongst the groups and no side effects observed. No significant association was evident between outcome and the investigated variables. CONCLUSIONS: The 1-year success rate of full pulpotomy did not differ significantly between Biodentine pulpotomy, TotalFill pulpotomy, and MTA pulpotomy. The study was registered with clinical trials; registration number (NCT04345263).


Assuntos
Pulpite , Pulpotomia , Adolescente , Adulto , Idoso , Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Criança , Combinação de Medicamentos , Humanos , Pessoa de Meia-Idade , Dente Molar/diagnóstico por imagem , Dente Molar/cirurgia , Óxidos/uso terapêutico , Dor , Pemetrexede , Pulpite/cirurgia , Pulpotomia/métodos , Silicatos/uso terapêutico , Resultado do Tratamento , Adulto Jovem
8.
Int Endod J ; 55(5): 430-440, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35226769

RESUMO

AIM: The study aimed to compare the outcome of complete pulpotomy (CP) and partial pulpotomy (PP) techniques when utilised for the management of mature permanent teeth with carious pulpal exposure and symptomatic irreversible pulpitis (SIP). METHODOLOGY: The study protocol was registered with ClinicalTrials.gov (NCT04397315). One hundred and six permanent mandibular molars with carious pulpal exposure and clinical diagnosis of SIP with periapical index ≤2, from patients aged between 18 and 40 years were randomly allocated in equal proportion to either CP or PP group. Allocated procedures were performed using standardised protocols. The allocated procedure was abandoned in cases where pulpal bleeding could not be controlled within 6 min using cotton pellets soaked in 3% sodium hypochlorite. MTA was used as a pulpotomy agent and teeth were restored using a base of glass ionomer followed by composite restoration. The pain was recorded by the patient preoperatively before administration of local anaesthesia and postoperatively every 24 h for 1 week using visual analogue scale. Success was analysed at 12 months based on clinical and radiographic examination. Mann-Whitney U test was used to compare age, pain scores and mean analgesic consumption between the groups. Categorical data were analysed using chi-square test. Fisher's exact test was used to assess the clinical and radiographic success and incidence of pain. Kaplan-Meier analysis was used to assess the survival of teeth. A p-value <.05 was considered as statistically significant. RESULTS: One hundred and one patients were analysed at follow up. Higher success was observed in CP (89.8%) in comparison to PP group (80.8%), but the difference was non-significant statistically (p = .202). Although no significant difference was observed in pain incidence between the groups at 24 h (p = .496), a significant difference in pain intensities was observed between groups at all the tested time intervals, with lower values reported in CP group (p < .05). CONCLUSIONS: Both CP and PP resulted in favourable outcomes in the management of cariously exposed permanent teeth with signs indicative of SIP. Given the more conservative nature of PP, it may be attempted first before proceeding to CP in such cases.


Assuntos
Pulpite , Pulpotomia , Adolescente , Adulto , Compostos de Alumínio , Compostos de Cálcio/uso terapêutico , Combinação de Medicamentos , Humanos , Óxidos/uso terapêutico , Dor , Pulpite/cirurgia , Pulpotomia/métodos , Silicatos/uso terapêutico , Resultado do Tratamento , Adulto Jovem
9.
Beijing Da Xue Xue Bao Yi Xue Ban ; 54(1): 113-118, 2022 Feb 18.
Artigo em Chinês | MEDLINE | ID: mdl-35165477

RESUMO

OBJECTIVE: To evaluate the clinical characteristics and effectiveness of pulpotomy in mature permanent teeth with bioceramic putty repairmen iRoot and mineral trioxide aggregate (MTA). METHODS: Pulpotomy was performed on mature permanent premolars and molars with carious exposures at the Department of General Dentistry of Peking University School and Hospital of Stomatology, from November 2017 to September 2019. The patients were randomly divided into 2 groups, Group iRoot (n=22) and Group MTA (n=21). In Group iRoot, bioceramic putty repairmen iRoot was used as pulp capping agent, while in Group MTA, mineral trioxide aggregate was used as pulp capping agent. All the patients had signed informed consent forms. The clinical efficacy was evaluated by clinical examinations (temperature and electrical activity test) and imaging examinations 3, 6, and 12 months after surgery. Blinding was used for the patients and evaluators, but due to the obvious differences in the properties of the two pulp capping agents, the blinding method was not used for the treatment provider (the attending physician). RESULTS: There was no significant difference in gender, average age, dentition and tooth position distribution between the two groups (P>0.05). In the study, 7 cases were lost to follow-up 12 months after operation (4 cases in Group iRoot, and 3 cases in Group MTA). One case in each of the two groups had transient sensitivity at the end of the 3-month follow-up, and the pulp vitality was normal at the end of the 6-month follow-up. One case in Group iRoot showed sensitivity at the end of the 12-month follow-up. The success rates of the two groups at the end of 12-month follow-up were 100%, and the cure rates were 94.4% (Group iRoot) and 100% (Group MTA), respectively, and the difference was not statistically significant (P>0.05). No cases in Group iRoot had obvious crown discoloration, while 3 cases in Group MTA had. CONCLUSION: The clinical characteristics and effectiveness of pulpotomy in mature permanent teeth with bioceramic putty repairmen iRoot were similar with MTA. Bioceramic putty repairmen iRoot is an acceptable material when used in pulpotomy of mature permanent teeth. Because it is not easy to cause tooth discoloration after treatment and is convenient to operate, bioceramic putty repairmen iRoot has a better clinical application prospect.


Assuntos
Pulpotomia , Silicatos , Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Combinação de Medicamentos , Humanos , Óxidos/uso terapêutico , Silicatos/uso terapêutico , Resultado do Tratamento
10.
Int Endod J ; 55 Suppl 3: 497-511, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35080024

RESUMO

Therapeutic strategies focussed on the pulp preservation, are important when managing vital teeth with deep caries and an exposed pulp. These vital pulp treatments (VPTs); however, are not new, with indirect and direct pulp capping procedures being described as a therapy for carious teeth for over a century. As a result of unpredictable outcomes, the traditional indications for VPT particularly when the pulp was exposed were limited to the treatment of immature teeth with incomplete root formation. Over the last 20 years, the advent of regenerative endodontics and the promotion of biologically based therapies aimed at reducing intervention have reinvigorated VPT with new waves of basic science and clinical research indicating a role for VPT not only in mature cariously affected teeth, but also in teeth with signs and symptoms indicative of irreversible pulpitis. Driven by new materials such as hydraulic calcium silicate cements, a better understanding of pulpal immunity and biology as well and improved tissue handling, VPT has been at the forefront of treatment recommendations made by global Cariology and Endodontic organizations. Care must be exercised, however, as key gaps in scientific knowledge remain alongside severe limitations in educational dissemination amongst dentists. Although research has highlighted that carious injury to the dentine-pulp complex stimulates a wide range of responses and that the interaction between infection, inflammation and repair will eventually impact on the outcome of pulpitis, our ability to accurately and objectively diagnose the true inflammatory state of the pulp remains poor. An overreliance on symptoms leaves clinicians with subjective, crude diagnostic tools by which to inform treatment planning and decision-making, which results in large variations in the treatments offered to patients. Not only is there an urgent need to develop preoperative and intraoperative diagnostic tools, but there is also a paucity of the high-quality comparative evidence required to answer the most important questions and justify treatment options. The aim of this review was to consider the current status of VPT and to discuss the principle problems that are hindering clinical acceptance of these techniques. Potential solutions and opportunities are offered to suggest ways that VPT may become a more consistently prescribed evidenced-based treatment in dental practice.


Assuntos
Cárie Dentária , Pulpite , Cárie Dentária/tratamento farmacológico , Capeamento da Polpa Dentária , Humanos , Pulpite/cirurgia , Pulpotomia/métodos , Tratamento do Canal Radicular , Silicatos/uso terapêutico
11.
Int Endod J ; 55(4): 290-311, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35076954

RESUMO

BACKGROUND: Consensus on the treatment of choice for complicated crown fractures of teeth is limited. Recent guidance recommends vital-pulp-therapy; however, the preferred type is not specified. Higher success rates for pulpotomy compared to pulp-capping have been documented, which suggests pulpotomy may be a preferable option for complicated crown-fractures. OBJECTIVES: The purpose of this systematic review was to determine the success rate of pulpotomy (partial and complete) on teeth that suffered complicated crown fractures. PARTICIPANTS: patients who have suffered a complicated crown fracture to an anterior permanent tooth. INTERVENTION: pulpotomy (partial or complete). Comparator: pulp-capping or root canal treatment. OUTCOME: combined clinical and radiographic success at or after 12 months. METHODS: A systematic literature using key search terms was conducted using PubMed, Web of Science and Cochrane-Central-Register-of-Controlled-Trials (CENTRAL) as well as a grey literature search from inception to May 2021 and without language restricted to English. Strict inclusion criteria were applied. A standardized tool with defined criteria to assess the risk of bias in each study was used. For non-randomized comparative trials, the Robins-I tool was used while the Newcastle-Ottawa scale was used for non-comparative non-randomized studies. RESULTS: Seven retrospective clinical studies were included. The studies reported high success rates for pulpotomy with overall success ranges for partial or complete pulpotomy ranging from 75% to 96%. One study compared the success rates of pulpotomy to an alternative treatment option pulp capping (90.9% vs. 67%, respectively). Due to the lack of homogeneity in the included studies, a meta-analysis was not possible. DISCUSSION: This review highlights the limited evidence based for the current guidance on treatment of complicated crown fractures. The findings of the review indicate high success rates for pulpotomy; however, there is a moderate risk of bias and small sample sizes in the included studies with the result that the overall results should be interpreted with caution. CONCLUSION: Within the limitations of this review, the benefits and high success rates reported for partial pulpotomy suggest this procedure, rather than pulp-capping, should be considered as the treatment of choice for both immature and mature teeth that have suffered complicated crown-fractures.


Assuntos
Dentição Permanente , Pulpotomia , Coroas , Capeamento da Polpa Dentária/métodos , Humanos , Pulpotomia/métodos , Estudos Retrospectivos , Resultado do Tratamento
12.
J Endod ; 48(4): 457-478.e4, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35090933

RESUMO

INTRODUCTION: Crown fracture with pulp involvement and concomitant complications is a traumatic injury that may have several clinical considerations for dentists and patients. The aim of the present study was to appraise existing scientific evidence on factors related to pulp survival after complicated crown fracture following vital pulp therapy. METHODS: An electronic search was performed on 8 sources of published and unpublished literature, as of August 18, 2021. Randomized controlled trials and nonrandomized studies were included, involving patients undergoing treatment in teeth (mature or immature), with vital pulp, after complicated crown fracture. Risk of bias of included studies was examined and assessed through RoB 2.0 or the Risk of Bias in Nonrandomized Studies of Interventions tool, conditional on study design. Random effects meta-analyses were conducted, where applicable, and the certainty of evidence was evaluated through the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: Of the 506 initial articles, 24 were eligible for inclusion in the qualitative synthesis, and 7 ultimately contributed to meta-analyses. Based on synthesized evidence, in teeth treated with pulpotomy, there was no difference in successful clinical/radiographic outcome denoting pulp survival, when either bioceramic material versus CaOH2 (2 studies, Risk Ratio [RR] = 1.07; 95% confidence interval [CI], 0.99-1.16; P = .09; I2 = 0.0%), or mineral trioxide aggregate versus CaOH2 (2 studies, RR = 0.94; 95% CI, 0.76-1.16; P = .56; I2 = 0.0%). For different pulp management procedures, in pooled immature and mature teeth samples, there was no evidence that pulpotomy performed better than pulp capping with either CaOH2 or mineral trioxide aggregate (5 studies/6 comparisons, RR = 1.06; 95% CI, 0.71-1.58; P = .77; I2 = 74.8%). Risk of bias for randomized controlled trials ranged from raising some concerns to low, whereas nonrandomized studies were recorded as serious to critical risk of bias. CONCLUSIONS: The quality of the evidence was very low to moderate. The need for more carefully designed clinical trials in the field is profound, to inform high-quality clinical decision making.


Assuntos
Pulpotomia , Fraturas dos Dentes , Coroas , Capeamento da Polpa Dentária/métodos , Exposição da Polpa Dentária/terapia , Humanos , Pulpotomia/métodos , Fraturas dos Dentes/etiologia , Fraturas dos Dentes/terapia
13.
Lasers Med Sci ; 37(4): 2293-2303, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35075598

RESUMO

This study investigated the clinical and radiographic effectiveness of MTA partial pulpotomy with low power or high power diode laser irradiation in primary molars. In this randomized single-blind clinical trial, 63 mandibular second molars were assigned into three groups (n = 21). After pulp amputation and achieving hemostasis, MTA was placed over pulp stumps in group 1 (MTA). The patients in groups 2 (LLLT-MTA) and 3 (DL-MTA) underwent low level (660 nm, 200 mW) and high power (810 nm, 1 W) diode laser radiation prior to MTA placement, respectively. The occurrence of clinical failure (spontaneous pain, tenderness upon percussion, swelling, fistula, mobility) and radiographic failure (periodontal ligament widening, external or internal root resorption, periapical or furcal radiolucency) was recorded up to 18 months after therapy. MTA and LLLT-MTA groups showed clinical success rate of 100% throughout the experiment. The clinical success rate of DL-MTA group was 95.2%, 95.2%, and 87.5% after 6, 9, and 18 months. The radiographic success rates were 90.5%, 90.5%, and 87.5% in the MTA group; 100%, 95.2%, and 88.2% in the LLLT-MTA group, and 85.7%, 76.2%, and 68.7% in the DL-MTA group, at 6-, 9-, and 18-month follow-ups, respectively. No significant differences were found in the frequency of clinical or radiographic failure among the groups at any interval (p > 0.05). MTA partial pulpotomy was a suitable technique for vital pulp therapy in deciduous teeth. The addition of low power or high power diode laser radiation to the procedure did not cause a significant difference in success rate values.


Assuntos
Lasers Semicondutores , Pulpotomia , Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Combinação de Medicamentos , Humanos , Lasers Semicondutores/uso terapêutico , Óxidos/uso terapêutico , Pemetrexede , Pulpotomia/métodos , Silicatos/uso terapêutico , Método Simples-Cego , Dente Decíduo , Resultado do Tratamento
14.
Mymensingh Med J ; 31(1): 223-229, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34999706

RESUMO

Root canal treatment (RCT) is preferred treatment for mature teeth with irreversible pulpitis. But sometimes it is very difficult to perform due to complex pulpal anatomy and the vitality of tooth is completely lost by this procedure. A new hope has been emerged to consider pulpotomy treatment as an effective treatment in mature permanent teeth with irreversible pulpitis as with the new understanding of pulp biology and recent innovation of bioactive material like MTA. The aim of the study was to evaluate the outcome of MTA pulpotomy for mature third molars with symptoms indicative of irreversible pulpitis. This quasi-experimental study was conducted at Department of Conservative Dentistry and Endodontics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from September 2019 to August 2020. Twenty permanent mandibular third molar teeth with fully developed roots and diagnosed as irreversible pulpitis in 20 patients aged 25-50 years were selected for this study. After informed consent, each tooth was anaesthetized, isolated with dental dam and disinfected with 5% NaOCl before caries excavation; caries was removed, and then, a full pulpotomy was performed. Haemostasis was achieved and MTA (Angelus, Brazil) was placed as the pulpotomy agent over the pulp chamber floor covering the canal orifices and rest of the cavity was sealed with glass-ionomer filling over the set MTA. Clinical and radiographic evaluation was completed at 3 months, 6 months, and 1 year postoperatively. Descriptive statistics were used to assess outcomes. The recall rate ranged from 90% at 3 months to 85% at 1 year, with an overall 100% clinical and radiographic success during the 3 month and 6 month, and 95% success at the end of 1 year. MTA pulpotomy sustained a good success rate over the 1 year follow-up in mature third molar teeth clinically diagnosed with irreversible pulpitis.


Assuntos
Pulpite , Pulpotomia , Compostos de Alumínio , Bangladesh , Compostos de Cálcio/uso terapêutico , Combinação de Medicamentos , Humanos , Óxidos , Pulpite/terapia , Silicatos , Resultado do Tratamento
15.
J Endod ; 48(3): 312-319, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34974080

RESUMO

INTRODUCTION: Complete pulpotomy is the removal of the coronal portion of a vital pulp and is a means of preserving the vitality of the remaining root portion. The objective of this study was to evaluate the 12-months success rate of complete pulpotomy with Biodentine on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis. MATERIALS AND METHODS: A total of 68 molars diagnosed with symptomatic irreversible pulpitis in 68 patients aged 20 years and older were included in this study. The exclusion criteria were intraoperative clinical signs of pulp necrosis on the molar to be treated such as no bleeding, or uncontrollable pulp hemorrhage (more than 5 minutes of hemostasis) on at least 1 canal. A complete pulpotomy with Biodentine was performed on molars with symptomatic irreversible pulpitis by the same operator and with the same protocol. A 12-months postoperative follow-up was conducted to evaluate clinical and radiologic success. RESULTS: A total of 66 patients received complete pulpotomy; 52 could be examined 12 months postoperatively. Clinical and radiologic analysis at 12 months postoperatively revealed a success rate of 87% (45 of 52 molars) and a failure rate of 13% (7 of 52 molars). There was a relationship between age, tooth type, and preoperative periapical condition and treatment success with P < .05. CONCLUSION: Compliance with the indications and protocol for complete pulpotomy with Biodentine on mature permanent molars with symptomatic irreversible pulpitis gives positive results at the 12-month follow-up.


Assuntos
Pulpite , Pulpotomia , Adulto , Compostos de Cálcio , Seguimentos , Humanos , Dente Molar/cirurgia , Pulpite/cirurgia , Pulpotomia/métodos , Silicatos , Resultado do Tratamento , Adulto Jovem
16.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 57(1): 16-22, 2022 Jan 09.
Artigo em Chinês | MEDLINE | ID: mdl-35012247

RESUMO

In recent years, great progress has been made in research on the treatment of pulpitis, mainly due to the rapid development of basic and clinical researches in this field, and some achievement from basic research has been applied in clinical practice. Advances in the diagnostic methods for pulpitis can help the clinicians to recognize the true state of pulpitis more accurately and to adopt the corresponding treatment methods including indirect/direct pulp capping, pulpotomy, pulp regeneration and root canal therapy. The new theory of pulpitis diagnosis and the studies on immune defense, repair function of dental pulp and new pulp capping materials have significantly improved the success rate of vital pulp therapy. For diffuse coronary pulpitis or radicular pulpitis, which is difficult to achieve vital pulp therapy successfully, methods of pulp revascularization, cell homing and pulp stem cells-mediated pulp regeneration can also be used as treatment options in addition to root canal therapy. The present article focuses on the research progress on pulpitis treatments and related clinical transformation practices, in order to provide reference on vital pulp therapy and pulp regeneration for clinicians.


Assuntos
Pulpite , Polpa Dentária , Capeamento da Polpa Dentária , Humanos , Pulpite/terapia , Pulpotomia , Regeneração
17.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 57(1): 38-43, 2022 Jan 09.
Artigo em Chinês | MEDLINE | ID: mdl-35012250

RESUMO

Internal root resorption is a pathologic phenomenon with a characterization of the intraradicular dentin destruction due to the abnormal activities of odontoclasts. With its insidious pathology, internal root resorption can progress to a great extent before its clinical detection. The etiology and natural history of internal root resorption are uncertain and the associated key molecular pathogenesis have not been understood completely. The resorption is usually initiated by a stimulus with the loss of the protective predentin and progressed by the continuous stimuli of pulp infection. Various factors including trauma, chronic inflammation of the pulp, pulpotomy and tooth transplantation have been proposed for the occurrence of internal root resorption. The present paper reviews the etiology and pathogenesis of internal root resorption and provides guidance for the early intervention in the clinical practice.


Assuntos
Reabsorção da Raiz , Humanos , Pulpotomia , Reabsorção da Raiz/etiologia
18.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 57(1): 95-100, 2022 Jan 09.
Artigo em Chinês | MEDLINE | ID: mdl-35012258

RESUMO

Vital pulp therapy(VPT)is an important pathway to preserve and maintain pulp tissue in a healthy state. VPT has been improved recently as the new progress achieved in pathobiology, bioactive materials and clinical research. The present review summarizes the clinical outcomes and prognostic factors of VPT, including direct pulp capping, partial pulpotomy and full pulpotomy in mature permanent teeth with carious pulp exposure, and briefly introduces the new progress in this field.


Assuntos
Cárie Dentária , Compostos de Cálcio , Cárie Dentária/terapia , Capeamento da Polpa Dentária , Dentição Permanente , Humanos , Pulpotomia , Silicatos , Resultado do Tratamento
19.
J Dent ; 116: 103890, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34780875

RESUMO

OBJECTIVES: To compare the success rate of vital pulp therapy following complete pulpotomy in immature first permanent molars, during caries treatment, using novel fast-setting calcium silicate cement (Novel CSC) versus MTA. METHODS: Six- to eight- years old children, who received pulpotomy of first immature permanent molar using one layer novel CSC (Protooth) or two layers slow-setting MTA (MTA Angelus) covered with glass ionomer were recalled for radiographic and clinical evaluation after two years. The effects of cement type, age, gender, jaw, anesthesia type, and restoration type were assessed on the clinical success of pulpotomy and continued root formation (apexogenesis) as the treatment outcome. RESULTS: Out of 366 included teeth in the study, 316 teeth were available for statistical analysis. The mean observation time was 28.2 ±â€¯2.7 months. Novel CSC showed significantly higher clinical success rate (93.1%) compared to MTA (84.5%). Restored teeth with stainless steel crowns after pulpotomy and treatments performed under general anesthesia had a statistically significant effect on treatment outcome in contrast to age, gender, and jaw type. CONCLUSION: The observations of this retrospective study suggested that the success rate of vital pulp therapy following complete pulpotomy using one layer fast-setting novel CSC was significantly higher than slow-setting MTA covered with glass ionomer. Treatment under general anesthesia and restoration using stainless steel crowns influenced the treatment outcome. CLINICAL SIGNIFICANCE: Novel fast-setting calcium silicate cement is a promising new biomaterial for vital pulp therapy in immature permanent molars that allows complete root formation overtime with apexogenesis. Clinicians must also be aware of the importance of immediate definitive restoration and proper sealing and isolation in vital pulp therapy.


Assuntos
Pulpotomia , Cimento de Silicato , Compostos de Alumínio/uso terapêutico , Cálcio , Compostos de Cálcio/uso terapêutico , Criança , Suscetibilidade à Cárie Dentária , Combinação de Medicamentos , Humanos , Dente Molar/diagnóstico por imagem , Óxidos/uso terapêutico , Estudos Retrospectivos , Silicatos/uso terapêutico , Resultado do Tratamento
20.
Clin Oral Investig ; 26(3): 3287-3297, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34854987

RESUMO

OBJECTIVE: The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth. MATERIALS AND METHODS: A total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal-Wallis. RESULTS: At 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544). CONCLUSION: In the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results. CLINICAL RELEVANCE: Simple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.


Assuntos
Pulpite , Pulpotomia , Compostos de Alumínio/uso terapêutico , Materiais Biocompatíveis , Compostos de Cálcio/uso terapêutico , Combinação de Medicamentos , Humanos , Dente Molar/cirurgia , Óxidos/uso terapêutico , Pulpite/cirurgia , Pulpotomia/métodos , Tratamento do Canal Radicular/métodos , Silicatos/uso terapêutico
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