Efficacy of an iodoform-based filling material for pulpectomy of primary teeth: A 24-month non-inferiority randomized clinical trial.

AIM: The aim of this non-inferiority randomized clinical trial was to compare the efficacy of an iodoform-based paste (Guedes-Pinto -(GP)) as a filling material in pulpectomies of primary teeth, and a standard material composed by calcium hydroxide and iodoform (CaOH/Iodof paste; Vitapex® ). DESIGN: A total of 104 teeth from 61 children (3-8 years old) were randomly allocated to two groups according to filling materials. Children were followed up for 24 months. The primary endpoint was the treatment success rate evaluated through clinical and radiographic examinations at follow-up, and the secondary outcome was the analysis of the canal filling quality. Differences in the proportion of treatment success was calculated based on 95% confidence intervals (95% CI) and with the Miettinen and Nurminen method in the intention-to-treat population, considering a -20% of the non-inferiority limit. RESULTS: From 104 randomized teeth, 102 were followed up after 24 months (attrition rate of 1.9%). The success rate of teeth treated with the GP paste was 86.8% (95% CI: 69.9-94.9) and 78.4% (95% CI: 61.8-89.1) with the CaOH/Iodof paste. Consequently, a non-inferiority of the GP paste was observed when compared to the CaOH/Iodof paste (P < .001). CONCLUSION: The GP paste has a non-inferior success rate than the CaOH/Iodof paste used as filling material for pulpectomy in primary teeth.

Alvogyl and absorbable gelatin sponge as palatal wound dressings following epithelialized free gingival graft harvest: a randomized clinical trial.

OBJECTIVES: This randomized controlled trial compares for the first time effects of Alvogyl versus absorbable gelatin sponge as palatal wound dressings on postoperative pain, amount of analgesic consumption, post-surgical bleeding, and wound re-epithelization. MATERIALS AND METHODS: Following sample size calculation, 36 systemically healthy patients requiring palatal mucosal graft harvesting were randomized to receive Alvogyl (intervention group, 18 patients) or absorbable gelatin sponge (control group, 18 patients) palatal dressings. Patient-reported VAS pain scores over 2 weeks were defined as primary outcome. Post-surgical bleeding, number of analgesics consumed, and complete re-epithelialization of the palatal wound for up to 5 weeks were defined as secondary outcomes. RESULTS: Although significantly higher VAS pain scores were reported in the control as compared with the intervention group up to 12 days post-surgically (from (median [range]) 8.5 [2-10] to 1 [0-2] and from 6 [0-10] to 0 [0-2] respectively), with higher analgesics consumption (from 2 [1-3] to 1 [0-3] and from 1 [0-3] to 0 [0-2] tablets respectively), a multivariate regression analysis considering age, gender, graft width/length, tissue thickness, analgesics intake, and dressing type demonstrated no statistically significant effect of any factor, including dressing type on VAS pain scores. At 4 weeks, 22.2% of patients in the intervention group versus 11.1% in the control group demonstrated complete re-epithelization of their palatal engraftment site, before complete re-epithelization in both groups at 5 weeks. No post-surgical bleeding was reported with both dressings. CONCLUSIONS: Within the study's limitations, results suggest Alvogyl as a practical palatal surgical dressing, comparable with absorbable gelatin sponge in cost, pain reduction, hemostasis, and re-epithelization properties. TRIAL REGISTRATION: www.ClinicalTrials.gov Identifier: NCT03402321 CLINICAL RELEVANCE: Alvogyl could present a novel palatal wound dressing material, comparable with gelatin sponge.

Evaluation of the genotoxicity and cytotoxicity of filling pastes used for pulp therapy on deciduous teeth using the micronucleus test on bone marrow from mice (Mus musculus).

Pulp therapy is the last resort for preserving deciduous teeth. However, the genotoxic and cytotoxic effects of many products used in this therapy are not well established. The aim of this study was to use the micronucleus test on bone marrow from mice to evaluate the genotoxic and cytotoxic effects of four filling pastes: zinc oxide, calcium hydroxide P.A., mineral trioxide aggregate and an iodoform paste (iodoform + camphorated + paramonochlorophenol + rifamycin + prednisolone). Male Swiss mice were divided into 4 groups of 10 animals, each exposed to one of the pastes, and were subdivided according to the dilutions tested: 1/10, 1/50, 1/500 and 1/1000 administered intraperitoneally (0.1ml/10g of weight). Cyclophosphamide was the positive control. The negative controls were dimethylsulfoxide and buffered saline solution. Five animals were killed 24h and five 48h after the treatment. The material was processed in accordance with Schmid (1976) and micronuclei were counted in 1000 polychromatic erythrocytes (PCE), under an optical microscope in a blinded test. Cytotoxicity was evaluated using the PCE/normochromatic erythrocyte (NCE) ratio in 200 erythrocytes. The micronucleus analysis results were evaluated using the conditional test for comparing proportions in situations of rare events. Analysis of variance and Tukey's test were used to evaluate the PCE/NCE ratio. There was significantly greater occurrence of micronuclei in the animals treated with iodoform paste at all the dilutions tested, at both sacrifice times. Greater occurrence of micronuclei was observed among the animals treated with zinc oxide and sacrificed 48h after the treatment, at the dilutions 1:50; 1:500 and 1:1000. Calcium hydroxide P.A. and mineral trioxide aggregate did not present any genotoxic or cytotoxic effects. The genotoxicity and cytotoxicity of zinc oxide and iodoform paste revealed here constitute an initial step towards their contraindication, but additional studies will be necessary in order to securely establish the risks involved in their use.

Comparison of the effect of low level laser therapy with alvogyl on the management of alveolar osteitis.

BACKGROUND: This study investigated the efficacy of low level laser therapy (LLLT) for managing alveolar osteitis (AO). MATERIAL AND METHODS: Sixty patients with alveolar osteitis of mandibular third molars were randomly divided into three groups. In group 1, socket irrigation was followed by alvogyl placement, and the treatment was repeated 48 hours later. In group 2, socket was irradiated with a low power red laser for 3 consecutive days (200 mW, 30 seconds on each of the buccal and lingual surfaces and 30 seconds at the middle of the socket, 6 J per area). The subjects in group 3 underwent treatment with a low power infrared laser with the same parameters as group 2. A visual analogue scale (VAS) was used to record the degree of pain at the morning (T0, before intervention) and at 6 (T1) and 12 (T2) hours later for 3 days. RESULTS: Pain was significantly lower in the alvogyl group than the other groups at T1 and T2 points on day 1 and at T0 and T1 points on day 2 (p<0.05). At T2 point on day 2 and on day 3, VAS became significantly lower in the red laser group compared to the other groups (p<0.05). The infrared laser was not more efficacious than the other groups at any of the treatment intervals, but it reduced VAS to an acceptable level. CONCLUSIONS: LLLT displayed good results in this study for treatment of alveolar osteitis and should be further investigated as an alternative to alvogyl for AO management.

Clinical efficacy of various root canal obturating methods in primary teeth: a comparative study.

AIM: The purpose of this in vivo study was to evaluate and compare the efficacy of different obturating methods used in primary teeth, when obturated using a combination of zinc oxide and iodoform paste (Endoflas F.S.). MATERIALS AND METHODS: A group of 29 patients aged 3-9 years and a total of 64 teeth were selected. These 64 teeth (32 anterior teeth=32 canals, and 32 posterior teeth=80 canals) were randomly divided into 4 groups. Teeth were obturated with Lentulo spiral, pressure syringe, bi-directional spiral and Pastinject. Post-operative evaluation was done for: quality of canal obturation, (underfilled, optimally filled, overfilled) and presence of voids. RESULTS: Pastinject exhibited the highest number of optimally filled canals, while the highest number of underfilled canals were observed with bi-directional spiral, and the highest number of overfilled canals were observed with pressure syringe. A minimum number of voids was present in canals filled with the Pastinject technique and pressure syringe. CONCLUSION: These results suggest that Pastinject was the most effective technique for obturation of primary teeth.

Commonly used topical oral wound dressing materials in dental and surgical practice--a literature review.

A small number of medicaments are used in oral and maxillofacial surgery to dress wounds, relieve pain, prevent infection and promote healing. While these materials are routinely used, their constituents, uses and effects on oral tissues are rarely discussed. This literature review provides an overview of the constituents, uses and effects of the common materials--oxidised regenerated cellulose, Whitehead's varnish, Carnoy's solution, bismuth iodoform paraffin paste (BIPP), zinc oxide eugenol (ZOE) and Alvogyl.

Role of iodoform in jaw lesions: a systematic review.

Iodoform formulations are used as packing material following the surgical removal of jaw lesions. The purpose of this review was to explore the evidence and efficacy of iodoform-based dressings. We have systematically reviewed published articles according to the PRISMA statement. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library database for articles mentioning the use of iodoform as dressing material for jaw lesions from January 2000 to March 2022. Finally, 92 studies were included. A total of 386 patients whose ages ranged from five months to 86 years (male n = 180, female n = 117). Different formulations of iodoform used were BIPP (n = 67), Whitehead's varnish (n = 17), iodoform (n = 7) and, iodine (n = 1) for its antiseptic properties. An iodoform impregnated gauze pack was changed once a week, most commonly, for a stipulated duration, until complete healing of the cavity. In the present review, iodoform was used, most commonly, in pathological cavities following surgical treatment of ameloblastoma and odontogenic keratocyst. Toxicity was reported in two studies. Based on the current review, iodoform is relatively safe and can be used in the management of extensive jaw lesions in which secondary healing is expected. Prospective and randomised control trials are recommended to assess the efficacy of various formulations and to delineate the timeframe for patient compliance.

Iodoform gauze removes necrotic tissue from pressure ulcer wounds by fibrinolytic activity.

Iodoform gauze is used in clinical practice for treatment of infected wounds. However, effectiveness and action mechanism of iodoform gauze for removal of necrotic tissue are unknown. We therefore employed case control and biochemical studies in order to clarify the pharmacological activity of iodoform gauze. A clinical study demonstrated that treatment with iodoform gauze removed necrotic tissue more effectively than treatment with conventional ointments. More than 60% of iodoform gauze-treated wounds were completely debrided within 2 weeks. Consistent with the clinical observation, biochemical analyses revealed clear differences in wound fluid proteins after treatment with iodoform gauze or conventional gauze. The amount of macroaggregates of type I collagen from wounds were remarkably decreased in iodoform gauze. Moreover, iodoform gauze and iodoform itself released non-aggregative type I collagen from necrotic debris in vitro. Taken together, we conclude that iodoform gauze efficiently removes necrotic tissue by its lytic activity for collagen fibers.

Secondary healing after removal of large keratocystic odontogenic tumor in the mandible: enucleation followed by open packing of iodoform gauze.

PURPOSE: The aim of this retrospective study was to present the findings of an open packing method after enucleation of large keratocystic odontogenic tumors (KCOTs) in the mandible. PATIENTS AND METHODS: We performed a retrospective case series study of 27 patients with KCOTs larger than 5 cm treated at our institution between September 2003 and September 2008. A conservative surgical treatment was applied, which involved enucleation of the primary lesion and open packing of the residual osseous defect with iodoform gauze for secondary healing. Bone regeneration, tumor recurrence, and surgical complications were observed and analyzed. We used the χ(2) test and Pearson correlation coefficient for statistical analysis. RESULTS: The postoperative follow-up time was 52.3 months on average (range, 24 to 84 months). The packing gauze was changed every 2 weeks after enucleation, and the total duration for packing was 10.2 months on average (range, 7-15 months). Bone regeneration and satisfactory secondary healing were observed clinically and radiographically after treatment. Only 1 case had a recurrence 6 months after initial treatment, which was attributed to insufficient bony unroofing during enucleation. The recurrent lesion was re-treated by the same method, and no recurrence occurred in the following 6 years. No serious complications from this method of treatment were observed. No significant variables were found to be related to the recurrence. CONCLUSIONS: Enucleation with subsequent open packing was shown to be a conservative and comfortable treatment for patients and appears to be an effective choice for the management of large KCOTs in the mandible.

Management of large periapical cystic lesion by aspiration and nonsurgical endodontic therapy using calcium hydroxide paste.

AIM: To report a case of conservative nonsurgical management of periapical lesions. BACKGROUND: Small periapical lesions of endodontic origin usually heal by conventional endodontic therapy alone. Larger periapical lesions presumed to be cystic may require additional treatment protocols to aid in regression. Conservative nonsurgical management of such lesions eliminates the possible complications of surgery and has wider patient compliance and acceptance. CASE DESCRIPTION: A periapical cystic lesion associated with maxillary central incisor and lateral incisor was treated conservatively using buccal aspiration decompression followed by conventional endodontic therapy employing calcium hydroxide iodoform paste as intracanal medicament is reported. CLINICAL SIGNIFICANCE: The treatment was successful as evidenced by relief of symptoms and radiographic evaluation. CONCLUSION: Large periapical cyst-like lesions can resolve by nonsurgical endodontic therapy employing calcium hydroxide intracanal interappointment medicament.

Comparison of alvogyl, SaliCept patch, and low-level laser therapy in the management of alveolar osteitis.

PURPOSE: The aim of the present randomized prospective clinical trial was to compare the effects of alvogyl, the SaliCept patch, and low-level laser therapy in the management of alveolar osteitis. PATIENTS AND METHODS: The study population included 104 patients who had been referred to our clinic with a complaint of alveolar osteitis. The patients were randomly assigned to 1 of 4 groups: group 1, curettage and irrigation alone; group 2, curettage and irrigation followed by alvogyl applied directly to the socket; group 3, curettage and irrigation followed by a SaliCept patch applied directly to the socket; and group 4, curettage and irrigation followed by continuous-mode diode laser irradiation (808 nm, 100 mW, 60 seconds, 7.64 J/cm(2)). The treatment procedures were repeated after 3 days. The clinical signs and symptoms for each patient were recorded at diagnosis, at 3 days after the diagnosis, and at 7 days after the diagnosis. In addition, the pain intensity levels for each patient were recorded at diagnosis and daily for 7 days after the initial treatment. RESULTS: No statistically significant differences in the management of alveolar osteitis were observed between groups 2 and 3. However, the management of alveolar osteitis was significantly better in group 4 than in the other 3 groups. CONCLUSION: Within the limitations of the present study, it can be concluded that acemannan in the form of the SaliCept patch is an acceptable alternative to alvogyl as a dressing for the management of alveolar osteitis. However, low-level laser therapy treatment at 7.64 J/cm(2) (0.1 W × 60 seconds = 6 J) performed superiorly to both SaliCept and alvogyl in managing alveolar osteitis in our study population.

Pulp repair after pulpotomy using different pulp capping agents: a comparative histologic analysis.

PURPOSE: This study's purpose was to histologically evaluate the repair of rat tissue after pulpotomy and covering the pulp tissue with Copaifera langsdorffi oil resin, green propolis extract, fibrin sponge and iodoform-based paste. METHODS: Pulpotomies were performed in the maxillary and mandibular first molars of 21 Wistar rats (84 total teeth). The access cavities were sealed with Coltosol, and histological evaluations were performed at 24 hours, 15 days, and 30 days postoperatively. RESULTS: For all experimental periods and materials, an inflammatory response constituted predominantly by neutrophils was observed, being of milder intensity for the Copaifera langsdorffii oil-resin group and more severe for the fibrin sponge group, which exhibited periapical microabscesses. Necrosis was observed in all groups, and its extension increased with time, except for teeth protected with Copaifera langsdorffii oil-resin. Formation of a mineralized tissue barrier in the pulp exposure area occurred only in the Copaifera langsdorffii oil-resin group. Other findings, such as vascular congestion, edema, and hemorrhage, were observed in all cases. CONCLUSIONS: The inflammatory response was less severe, the area of pulp necrosis was smaller, and more frequent formation of a mineralized tissue barrier was noted after pulpotomy was performed with Copaifera langsdorffii oil-resin compared to the other materials tested.

Effectiveness of Calvital(®), a calcium hydroxide formulation, on persistent apical periodontitis caused by over-enlargement of apical foramen.

This study aimed to evaluate the effectiveness of Calvital(®), which is a calcium hydroxide formulation, on persistent apical periodontitis caused by over-enlargement of the apical foramen. The study included patients referred to the Department of General Dentistry at Tokyo Dental College Suidobashi Hospital on a diagnosis of persistent apical periodontitis at an external dental clinic. Of them, 20 showing considerable enlargement of the apical foramina were included in the study. Complete disappearance of symptoms was observed in all patients after intracanal application of Calvital(®). We believe that this was due to effective wound-healing brought about the strong alkaline nature of this formulation. We regard Calvital(®) as a highly effective agent for root canal treatment of teeth with persistent apical periodontitis.

Evolution and prognosis of necrotic primary teeth after pulpectomy.

PURPOSE: To study the evolution of 308 necrotic primary teeth after pulpectomy technique with resorbable paste (Kri-1 + calcium hydroxide + metacresol-formaldehyde) after 30 months. METHODS: 134 children between 2-9 years were included, among which they had 348 pulpectomized teeth. Out of these 348 teeth, 308 had necrotic pulp and were included in the study. The filling material consisted of a paste based on Walkhoff's master formula and consisted of the combination of Kri-1a (80.8% iodoform, 2.025% parachlorophenol, 1.215% menthol, 4.68% camphor and excipient 15 mg), pure calcium hydroxide and metacresol formaldehyde (metacresol 20 mg, formaldehyde 20 mg, eugenol 20 mg, eucalyptus 6 mg and excipient 40 mg). Root canal filling was performed in one session by one operator. RESULTS: Pain, swelling, and fistula resolution was observed in most cases at the first recall. Progressive remission of radiolucent areas was also observed. A relationship between fistula and radiolucency in pre-treated furcation area was observed, and, in some cases, premature eruption of permanent teeth was recorded. Only two cases out of 308 treated teeth required extraction.

Clinical and radiographic evaluation of pulpectomies using three root canal filling materials: an in-vivo study.

Various root canal filling materials are used to preserve a pulpally involved carious primary tooth. But there is no single material so far available to fulfill all the requirements of an ideal root canal filling material for a primary tooth. Hence this study was undertaken to evaluate clinically and radiographically the efficacy of three obturating materials - Calcium hydroxide with Iodoform (METAPEX), Zinc Oxide Eugenol with Iodoform (RC FILL) and Zinc Oxide Eugenol and Calcium hydroxide with Iodoform (ENDOFLAS) for a period of 9 months. Results show ENDOFLAS gave an overall success rate of 95.1%, METAPEX - 90.5% and RC FILL - 84.7%. In our study, we conclude that ENDOFLAS, a mixture of Zinc Oxide Eugenol and Calcium hydroxide with Iodoform fulfills most of the required properties of an ideal root canal filling for primary teeth.

Pulp therapy in primary teeth--profile of teaching in Brazilian dental schools.

This study investigates the profile of teaching primary tooth pulp therapy practiced by Brazilian dental schools. A multiple-choice questionnaire was sent by e-mail to 191 dental schools in Brazil, addressed to the pediatric dentistry Chairperson. The two-part survey consisting of multiple-choice questions regarding specific materials and techniques on pulp therapies, moreover, hypothetical clinical scenarios were presented so that the respondents could guide the treatment approach. The questionnaires were returned by 46.5% of the dental schools. Ninety-five percent of surveyed schools teach IPT for the treatment of deep carious lesions in dentin and indicate the calcium hydroxide as capping material (59.3%). The direct pulp capping is taught by 68.7% of schools and calcium hydroxide (97%) was the capping material most indicated. Pulpotomy is taught in 98.7% of schools and formocresol (1:5 dilution) was the medicament of choice (50%). All schools taught pulpectomy and Iodoform paste was the filling material preferred (55%). The results showed a lack of consensus in certain modalities and techniques for primary tooth pulp therapy taught by Brazilian dental schools.

Iodoform Vs Calcium Hydroxide/Zinc Oxide based pastes: 12-month findings of a Randomized Controlled Trial.

This study evaluated clinical and radiographic twelve-month outcomes of root canal treatments (CT) with smear layer removal, performed in primary teeth, using two different root canal filling materials. Pulpectomy was performed on 27 primary teeth with necrosis or irreversible pulpitis, caused by dental caries or trauma, in 23 children (2-7 years old). A single trained operator performed the CT in a single visit in cases without periapical or interradicular radiolucency (PIR) or in multiple visits in cases with PIR. Participants were selected based on specific inclusion and exclusion criteria, and randomly allocated into two groups: Group 1 (G1) - iodoform paste (iodoform + camphorated parachlorophenol + ointment comprising prednisolone acetate 5.0 mg and rifamycin 1.5 mg); Group 2 (G2) - Calen®/ZO paste. Treated teeth were restored with composite resin immediately after the root canal filling. The outcomes were evaluated clinically and radiographically according to specific criteria. Two blinded and standardized evaluators assessed the radiographic outcomes. We used descriptive analyses due to the small sample size. CTs were performed due to caries lesions in 70.4% of the cases and due to trauma in 29.6%. Only one tooth of G1 was unsuccessful; hence, pulpectomy performance in both groups was not influenced by the filling material, nor by any other analyzed variable. The level of the root canal filling was better in the Calen®/ZO group. The clinical and radiographic twelve-month outcomes indicated successful treatment, independently of the root filling material used.

A survey of primary tooth pulp therapy as taught in US dental schools and practiced by diplomates of the American Board Of Pediatric Dentistry.

PURPOSE: The purpose of this study was to repeat a 1997 survey of current pulp therapy practice. METHODS: The directors of dental school predoctoral pediatric dentistry programs (N=56) and board certified pediatric dentists (N=1200) were surveyed in 2005. RESULTS: More dental schools (83%) taught indirect pulp therapy (IPT) compared to 1997. Significantly more used glass ionomer for IPT with most dental schools and diplomates not re-entering a tooth after IPT. Over 30% of schools and diplomates do direct pulp cops using glass ionomer. For pulpotomy, diluted formocresol usage decreased in dental schools (54%) while ferric sulfate significantly increased (24%) and full strength remained at 22%. Shorter placement of pulpotomy medication was noted and ZOE alone the preferred base. Pulpectomy was advocated by 85% of 2005 schools and diplomates with ZOE filler use decreasing while iodoform/calcium hydroxide filler use increasing. CONCLUSIONS: More pediatric dentists are using glass ionomer for IPT and direct pulp capping, and there was a trend away from the use of 1:5 diluted formocresol with more using ferric sulfate for pulpotomy. For pulpectomy, most use ZOE but iodoform pastes and calcium hydroxide have increased in usage since 1997 Disagreements continue concerning when to use certain pulp therapies and some directors and diplomates did not follow the AAPD guidelines.

Cytotoxicity, histopathological, microbiological and clinical aspects of an endodontic iodoform-based paste used in pediatric dentistry: a review.

This review aims at describing and comparing materials commonly used in root canal therapy, the cytotoxicity, histopathological, microbiological and clinical aspects ofa iodoform-based paste (Guedes-Pinto Paste-GPP) used in endodontic treatment of primary teeth. GPP has shown excellent biocompatibility to pulp fibroblasts and mild inflammatory reactions, having been well-tolerated by the periapical and connective tissues. Moreover, GPP bactericidal and bacteriostatic effects against many oral microorganisms were also demonstrated. Regarding clinical trials, the GPP technique has achieved success rates when considering clinical and radiographic examinations. In the face of all the above mentioned results, this paper would like to propose the use of this endodontic material as a root canal filling for primary teeth.