Direct pulp capping of permanent teeth in New Zealand general dental practice--a practice based research study.

OBJECTIVES: This study aimed to investigate treatment protocols and opinions towards direct pulp capping (DPC) amongst New Zealand (NZ) general dental practitioners (GDP) through a Practice Based Research Network (PBRN) study. DESIGN: Mixed-methods approach using qualitative thematic and quantitative analysis. METHODS: An on-line survey containing Likert scale items and open-ended questions was distributed to GDPs on the Dental Council of New Zealand (DCNZ) register (2012) to collect information on practitioner demographics, treatment protocols, continuing professional development (CPD) and philosophies towards DPC. RESULTs: Two hundred and ten GDPs from North and South Islands providing care in main centres and rural areas engaged with the PBRN and participated in the study. Almost all performed DPC treatment although it was not a common procedure. DPC was perceived as 'successful' or 'very successful' by 95% of respondents, mostly for cases of reversible pulpitis. Most provided DPC for patients of all ages but younger patients were perceived to have the best clinical outcomes. Calcium hydroxide and MTA were the most commonly used materials for DPC. MTA was believed to have the best outcome but cost and handling properties were barriers to its use. The majority of respondents had participated in CPD related to vital pulp therapy and regarded this treatment as conservative and providing time and financial benefits compared with more invasive treatment. Clinicians' timeframes for assessing healing were variable, and combined clinical and radiographic findings were considered most useful. CONCLUSION: New Zealand dentists perceive DPC as a successful and conservative treatment in selected cases. The findings have provided insights into engagement of NZ dentists in using research to inform everyday clinical practice through a PBRN study.

Minimal intervention dentistry procedures: a ten year retrospective study.

UNLABELLED: Minimal Intervention Dentistry (MID) is an effective treatment approach with increasing acceptance among dental professionals. OBJECTIVE: This study aimed to evaluate the MID impact on Dentistry by analyzing procedures performed on patients treated at a Pediatric Dentistry Graduate Program clinic which implemented MID. STUDY DESIGN: The number of procedures including sealants, modified atraumatic restorative treatment (mART), resin crowns, direct pulp capping, pulpotomy, pulpectomy, and deciduous/ permanent extractions from 333 pediatric patients treated between the years 2001 to 2003 and 2008 to 2010 in Distrito Federal, Brazil were analyzed. Statistical analysis involved chi-square and G Williams tests. RESULTS: 783 procedures were analyzed and demonstrated that there was a significant reduction of sealant placement in the last triennium when compared to the first one (p<0.0001). Moreover, there was a significant increase in the amount of mART (p<0.0001). This increase in mART procedures resulted in a significant reduction in procedures with pulp involvement: direct pulp capping (p=0.0014), pulpotomy (p=0.0014) and pulpectomy (p=0.0002). CONCLUSIONS: Based on the results, MID represented a positive impact on the intervention on caries lesions in patients, mainly reflected by the significant reduction in the number of direct pulp capping, pulpotomy and pulpectomy.

Pulp exposures in adults--choice of treatment among Swedish dentists.

This study comprises a survey of Swedish dentists'treatment preferences in cases of carious exposure of the dental pulp in adults.The survey was conducted as part of a comprehensive report on methods of diagnosis and treatment in endodontics, published in 2010 by the Swedish Council on Health Technology Assessment. A questionnaire was mailed to a random subsample of 2012 dental offices where one dentist at each office was requested to answer all questions. Each questionnaire contained one of three sets of questions about endodontic practice routines.Thus around one-third of the subsample received case-specific questions about treating carious exposure. Only general practitioners aged below 70 years were included.The final study sample comprised 412 participants.The dentists were presented with two case scenarios. In Case 1 a 22-year old patient had a deep carious lesion in tooth 36 and in Case 2 a 50-year old patient had a deep carious lesion in tooth 14.The participants were asked to nominate their treatment of choice: pulp capping, partial pulpotomy or pulpectomy. For Case 1, 17 per cent of the respondents selected pulpectomy; the corresponding rate for Case 2 was 47 per cent. Female gender and age group 25-49 years were predictive of selection of less invasive treatment options. However, according to recent guidelines (2011) from the National Board of Health and Wellfare, Swedish dentists are recommended to elect pulpectomy prior to pulp capping/partial pulpotomy when confronted with a tooth having a cariously exposed pulp in adults.

Retrospective Study of the Survival Rates of Indirect Pulp Therapy Versus Different Pulpotomy Medicaments.

PURPOSE: The purposes of this retrospective chart review were to determine: (1) how primary molars in need of vital pulp therapy (VPT) have been treated over a period of four years at a university-based pediatric dental practice (UBP); and which treatments-indirect pulp therapy (IPT), formocresol pulpotomy (FCP), and ferric sulfate pulpotomy (FSP)-have been successful. METHODS: Electronic patient records (axiUm) that contained the procedure codes D3120 (pulp cap-indirect) or D3220 (therapeutic pulpotomy) were totaled by year. Visit records were queried again to identify treatment failures (i.e., extractions [D7140] or pulpectomy [D3221/D3240]). A total of 2,001 primary molar teeth were included in the study. Success was compared using a Kaplan-Meier analysis. RESULTS: At the three-year follow-up, IPT had a 96.2 percent survival rate, FCP had a 65.8 percent survival rate, and FSP had a 62.9 percent survival rate (P<.0001). CONCLUSIONS: Over a four-year period of time, IPT became the more commonly used vital pulp therapy treatment at a university-based pediatric dental practice and had a significantly better survival rate than FCP or FSP.

Permanent teeth pulpotomy survival analysis: retrospective follow-up.

OBJECTIVES: The aim of the present study is to evaluate risk factors influencing the success rates of pulpotomies both in young and adult populations. METHODS: Pulpotomies (n=273) performed by a single endodontic specialist were analyzed, and data on success rates were collected. Additionally, possible explanatory variables were noted such as: age, gender, clinical findings (teeth, type of restoration after pulpotomy), radiographic findings (dentin bridge formation) and systemic conditions. The follow-up period varied from 1 to 29 years, and the results were analyzed by Kaplan-Meier survival curves and also by Cox regression. RESULTS: Age at the time of pulpotomy ranged from 8 to 79 and had not influenced the success rates (p=0.35). The formation of dentin bridge had a strong protective effect (hazard ratio-HR=0.16, p<0.001). The prosthetic crown restorations following pulpotomy had the smallest failure rate, and amalgam has not increased the risk of failure significantly in relation to prosthesis. Resin composite restorations following pulpotomy increased in 263% the risk of failure (HR=3.63, p<0.001). CONCLUSION: This study allowed inferences that pulpotomy may be a successful treatment at any age, and not only for young permanent teeth. It was also possible to conclude that the use of direct composite restorations following pulpotomies is associated with higher failure rates.

Patterns of endodontic care for a Washington state population.

Endodontic care, provided by 3,402 dental offices, was assessed from claims data maintained by the Washington Dental Service for 1999. Approximately 5.7 million dental procedures were provided to 880,317 patients by 2,796 general practitioners, 105 endodontists, and 494 other specialists. Of all dental services, 63,321 (1%) were endodontic procedures involving 52,911 (6%) patients. General dentists, endodontists, and other specialists performed 64.7%, 33.7%, and 1.6% of endodontic procedures, the majority of which were root canal therapy. The most frequent tooth types treated by root canal therapy were mandibular first molars (17.0%), maxillary first molars (15.2%), mandibular second molars (11.8%), maxillary second bicuspids (10.3%), maxillary second molars (9.1%), maxillary central and lateral incisors (8.8%), and mandibular second bicuspids (8.0%). Direct and indirect pulp caps by generalists and conventional retreatment and surgical therapy by endodontists made up the majority of the remaining endodontic services. Men had a greater procedure rate than women for most endodontic procedures.

Primary tooth pulp therapy as taught in predoctoral pediatric dental programs in the United States.

A survey of all predoctoral pediatric dental programs in the United States was conducted to ascertain the contemporary teaching philosophies and techniques for pulp therapy in primary teeth. All 53 predoctoral programs responded to a two-part survey consisting of multiple choice questions regarding which pulp therapies and specific techniques were taught and which pulp therapies would be employed under certain hypothetical clinical scenarios. The results of the survey confirmed some lack of consensus on the selection and application of certain treatment modalities and techniques taught for primary tooth pulp therapy in predoctoral dental programs in the United States.

The diagnosis, classification and treatment of acute pulpal pain by UK general dental practitioners: results of a survey.

There are several problems related to the diagnosis and treatment of the acute painful tooth associated with a deep carious lesion, including the fact that there is little or no correlation between the clinical signs and symptoms and also that the diagnostic tools are not reliable. It is important to understand the problems experienced by dental practitioners and how they routinely make diagnosis and formulate treatment plans. The way general dental practitioners diagnosed, categorised and treated teeth with acute pain was ascertained by a questionnaire completed by practitioners attending postgraduate courses. The results indicate that dental radiographs and the dental history were most frequently used and that few practitioners had, and fewer used electric pulp testers. The concept of using simple clinical categories which correspond to treatment categories does not seem to be in widespread use, though the generally accepted role of calcium hydroxide as an indirect and direct capping material is widespread. The use of corticosteroid materials is not as widespread in younger practitioners as in their older colleagues and the use of emergency pulpotomy is infrequent.

[Success of direct pulp capping after caries excavations]. / Succes van directe pulpaoverkappingen na excaveren.

Direct pulp capping is not generally accepted as a routine dental procedure. It is claimed to be an unpredictable procedure with a low success rate. However, some clinical studies do show success of direct pulp cappings. The aim of this study was to make an inventory of the success rate of direct pulp cappings performed by dental students, and of the variables which influenced the outcome. The success rate for the first 18 months after treatment was 73.8%. Only the variable 'type of tooth' showed a statistical significant correlation: front teeth showed a higher percentage of success than premolars and molars.

Incomplete caries removal: a systematic review and meta-analysis.

Increasing numbers of clinical trials have demonstrated the benefits of incomplete caries removal, in particular in the treatment of deep caries. This study systematically reviewed randomized controlled trials investigating one- or two-step incomplete compared with complete caries removal. Studies treating primary and permanent teeth with primary caries lesions requiring a restoration were analyzed. The following primary and secondary outcomes were investigated: risk of pulpal exposure, post-operative pulpal symptoms, overall failure, and caries progression. Electronic databases were screened for studies from 1967 to 2012. Cross-referencing was used to identify further articles. Odds ratios (OR) as effect estimates were calculated in a random-effects model. From 364 screened articles, 10 studies representing 1,257 patients were included. Meta-analysis showed risk reduction for both pulpal exposure (OR [95% CI] 0.31 [0.19-0.49]) and pulpal symptoms (OR 0.58 [0.31-1.10]) for teeth treated with one- or two-step incomplete excavation. Risk of failure seemed to be similar for both complete and incomplete excavation, but data for this outcome were of limited quality and inconclusive (OR 0.97 [0.64-1.46]). Based on reviewed studies, incomplete caries removal seems advantageous compared with complete excavation, especially in proximity to the pulp. However, evidence levels are currently insufficient for definitive conclusions because of high risk of bias within studies.

Factors affecting treatment outcomes following complicated crown fractures managed in primary and secondary care.

The aims of this retrospective observational study were to determine the factors which affect treatment provision and the Median Survival Time (MST) for maintenance of tooth vitality following complicated crown fracture. The survey was carried out for patients treated at Newcastle Dental Hospital (NDH) according to departmental guidelines over a 2-year period following the introduction of a new protocol for management of these types of injuries. Seventy-three cases of complicated crown fracture were identified in 69 children with a mean age of 10.3 years (SD = 2.5 years). Seventy-one percent of the fractures occurred in males (M:F ratio was 2.5:1). Fifty-one percent of the complicated crown fractures were in immature teeth. Of the 73 traumatised teeth, 45% presented initially in general dental practice (GDP), 37% at the dental hospital and 8% at local accident and emergency departments with the remaining 10% seen at other or unrecorded locations. Of the 41 fractures, which presented initially at a location other than the dental hospital, 38% were referred to the dental hospital without the provision of an emergency pulp bandage. The overall definitive treatments provided for the 37 open apex teeth included pulp cap (19%), partial pulpotomy (32%), cervical pulpotomy (8%) and pulpectomy (35%), while for the 36 closed apex teeth it was pulp cap (28%), pulpotomy (11%), and pulpectomy (61%). Of the 30 teeth, which underwent vital pulp therapy (18 open and 12 closed apex), the MST for the 15 teeth treated with pulp caps was 1460 days (95% CI: 1067, 1853) while for the 15 teeth treated with pulpotomies it was 1375 days (95% CI: 964, 1786). There was no statistically significant difference in the MST between teeth treated with pulp caps and pulpotomies. In conclusion, the proportion of patients referred to secondary care with complicated crown fractures without provision of a pulp bandage is of some concern. More conservative treatment of closed apex teeth sustaining complicated crown fractures, utilizing vital pulp therapy techniques would appear to be appropriate.

[Clinical and radiographic follow up examination on direct pulp capping in primary teeth].

The purpose of this investigation was to evaluate direct pulp capping in primary teeth with calcium hydroxide agents. All utilized datas were selected from all the charts of the 3,675 patients at Pediatric Dentistry clinic of the School of Dentistry, Hiroshima University. The results obtained were as follows: 1) The number of all primary teeth where direct pulp capping, pulpotomy and pulpectomy were performed, was 2,511, and direct pulp capping was performed on 124 primary teeth (4.9%). Out of the 124 primary teeth, 100 were clinically evaluated. 2) At the time of the final follow up examination for each treated tooth, the ratio of teeth judged as being clinically successful were 94 (94.0%) and 6 (6.0%) as being unsuccessful. In the first year after treatment, the majority of unsuccessful cases were found. 3) We had many unsuccessful cases of anterior teeth on which composite resin and glassinomer cement had been filled after direct pulp capping. 4) Of 6 teeth judged as being clinically unsuccessful, 2 showed spontaneous pain, 1 discoloration of the tooth, 1 gingival swelling and 2 abscess formation. 5) Out of 100 primary teeth in the clinical examination, 66 became available for radiographic evaluation, and the ratio of teeth judged as being successful were 58 (87.9%) and 8 (12.1%) as being unsuccessful. During the two years following the treatment, we found most of unsuccessful cases.

Vital pulp capping: a worthwhile procedure.

Despite the progress made in the field of pulp biology, the technique and philosophy of direct vital pulp capping remains a controversial subject. Clinicians are well aware of the immediate and long-term success rates after root canal therapy, but are less certain of the success of vital pulp capping. Researchers have demonstrated that exposed pulps will heal and form reparative dentin. It is realized now that the variable prognosis of vital pulp capping is predominately a restorative issue. The factors that can produce a successful vital pulp cap are discussed in conjunction with two popular techniques.

Indirect pulp capping: a survey.

This study addresses the acceptance of the clinical practice of indirect pulp capping. State and regional dental boards and postgraduate dental education programs throughout the United States were surveyed. Results indicate that no clear consensus exists for the acceptance of this clinical procedure.

[592 pulp cappings in a dental office--a clinical study (1966-1990)]. / 592 Pulpaüberkappungen in einer zahnärztlichen Praxis--eine klinische Prüfung (1966-1990).

In a dental office 592 direct and indirect pulp cappings were followed up to 24 years. 404 of these pulps remained vital. The success of this treatment seemed to be related to age, type of tooth, and the extent of pulp exposure. In some advanced cases the clinical outcome was better than expected.

The annual frequency of root fillings, tooth extractions and pulp-related procedures in Danish adults during 1977-2003.

AIM: To investigate a hypothesized long-time decrease of endodontic treatment in a population with low caries prevalence. METHODOLOGY: A Danish nationwide database including almost all dental diagnostic, prophylactic and therapeutic procedures performed in Danish adults was available. Data on the annual frequencies of root fillings, extractions, pulpotomies, direct pulp cappings and stepwise excavations between 1977 and 2003 were analysed. Data on pulpal and periapical diagnoses were not available and on patients age and gender only from 1996. RESULTS: Between 1977 and 2003 the annual number of root filled canals increased from 268,223 to 364,867 (36%). The annual number of root filled teeth increased from 160,119 to 191,803 (20%). During the period, the annually registered patients increased by 16%. Calculated per 1000 patients, the number of root fillings showed a statistically significant increase of 17%. In root filled teeth the canal/tooth ratio increased from 1.67 to 1.96. Root fillings were frequently recorded in all age groups with the bulk of treatments performed on patients between 40 and 60 years of age. At a total population level, the rate of root fillings decreased among younger individuals and increased among older. The annual number of tooth extractions was more than halved from 656,624 in 1977 to 346,490 in 2003. Pulpotomies decreased markedly over the period and less than 10 treatments per 1000 patients were noted for pulp capping as well as stepwise excavation procedures. CONCLUSIONS: The present study failed to show a long-time decrease of endodontic treatment in a population with low caries prevalence. On the contrary, an increase of root filled canals was observed between 1977 and 2003, which was probably due to a reduction of the tooth extraction rate and an increased treatment of multi-rooted teeth.