Vital pulpotomy of deciduous molars using N2 and other materials

Pulp treatment for extensive decay in primary teeth

BACKGROUND

Dental decay in primary teeth remains a considerable health problem. Where decay extends to involve the dental pulp, pulp treatment techniques are often used to manage both symptomatic and symptom free teeth.

OBJECTIVES

To assess the relative effectiveness of: various pulp treatment techniques in retaining primary molar teeth with decay involving the pulp for at least 12 months; pulp treatment techniques and extractions in avoiding long term sequelae.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register (August 2002); the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to August 2002); EMBASE (1980 to August 2002); Science Citation Index Expanded (1981 to August 2002); Social Science Citation Index (1981 to August 2002); Index to Scientific and Technical Proceedings (1982 to August 2002); System for Information on Grey Literature in Europe (August 2002). Key journals were handsearched. There was no restriction on language of publication.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials (RCTs) comparing different pulp treatment techniques (with each other, with extraction or with no treatment) for extensive decay in primary molar teeth. Primary outcomes were extractions following pulp treatment and long term effects.

DATA COLLECTION AND ANALYSIS

Data extraction and quality assessment were carried out independently and in duplicate. Authors were contacted for additional information where necessary.

MAIN RESULTS

Eighty-two studies were identified but only three were suitable for inclusion. Nine studies meeting the inclusion criteria but with inappropriate study design or analysis are also described. Included trials investigated formocresol pulpotomy, ferric sulphate pulpotomy, electrosurgical pulpotomy or zinc oxide eugenol pulpectomy in symptom free, cariously exposed teeth. Data were unavailable on long term effects. Data on extraction following pulp treatment was available in all three studies and in two studies there was no statistically significant difference between the treatments. The difference seen in the other study, where more teeth treated by ferric sulphate pulpotomy were extracted compared to zinc oxide eugenol pulpectomy, must be viewed with caution.

REVIEWER'S CONCLUSIONS

Based on the available RCTs, there is no reliable evidence supporting the superiority of one type of treatment for pulpally involved primary molars. No conclusions can be made as to the optimum treatment or techniques for pulpally involved primary molar teeth due to the scarcity of reliable scientific research. High quality RCTs, with appropriate unit of randomisation and analysis are needed.

Thermal effects of CO2 laser on the pulpal chamber and enamel of human primary teeth: an in vitro investigation

BACKGROUND AND OBJECTIVE

Thermal effects of direct exposure of the pulp chamber to CO2 laser irradiation were evaluated and potentially safe parameters for its clinical application were determined.

STUDY DESIGN/MATERIALS AND METHODS

Using conventional methods, the pulp chambers of freshly extracted primary cuspids were exposed and then subjected to CO2 laser irradiation at the following parameters: 2, 4, 6, 8, 10, 15, and 20 Watts power settings; 0.76 mm diameter spot size; total energy densities between 4-1,058 J/cm2; exposure time between .01-60 s. Exposures in the continuous wave mode were performed in some specimens. In others, single firings of a .01 s pulse duration and a 1 s pulse interval were conducted. Temperature measurements were conducted using a thermocouple and thermal camera.

RESULTS

Significant statistical differences in maximum temperature rise on enamel were observed in groups that received total energy densities > or = 8 J/cm2 (P < or = 0.01); within the pulp chambers these were observed in groups that used > or = 44 J/cm2 (P < or = 0.01).

CONCLUSION

Parameters appropriate for pulpotomy were observed at energy densities up to 176 J/cm2 in the continuous wave mode and 264 J/cm2 using single pulses, wherein temperature rises below 5.5 degrees C were recorded on tooth surface.

Review of calcium hydroxide

Calcium hydroxide is a material which has been used for a variety of purposes since its introduction into dentistry in the early part of the twentieth century. In its pure form, the substance has a high pH, and its dental use relates chiefly to its ability to stimulate mineralization, and also to its antibacterial properties. A range of products has been formulated with different therapeutic actions, the effects of which are partially dependent upon the tissue to which they are applied. The material is reviewed under the following general headings: biochemical actions; dental formulation; uses.

In vivo fixative effect of formocresol on pulpotomized deciduous teeth of dogs

Formocresol was checked with respect to its in vivo fixative effect after pulpotomy, through observation of tissue resistance to necrosis. The root pulps were freed from their hard-tissue wrapping and processed for 48 hours, followed or not by capping (15 days) with zinc oxide-eugenol or with zinc oxide-eugenol-formocresol. The effect of only capping with zinc oxide-eugenol, with or without formocresol, was also recorded.

Cell-mediated immune response to dog pulp tissue altered by eugenol within the root canal

After pulpal extirpation of twenty teeth in each of four dogs, these animals were primarily immunized intramuscularly with the dog's own pulp (three dogs) and saline solution with pulp (one dog). A fifth dog was used as a control for skin tests. Secondary immunizations were accomplished via the root canal every 7 days over a 28-day period. Cell-mediated skin-test reactions demonstrated less of a response to the eugenol alone than when the dog's pulp was incubated with this material. In vitro analysis of cell-mediated immune response (lymphocyte proliferation) showed a marked response to the pulp altered by eugenol as compared to the saline-treated pulp (p less than 0.004). Therefore, dog's pulp tissue became antigenically altered by eugenol material, recognized by the host, and a specific cell-mediated lymphocyte proliferation resulted.

Antibody formation to dog pulp tissue altered by formocresol uithin the root canal

After pulpal extirpation of twenty teeth in each of five dogs, these animals were primarily immunized intramuscularly by combining formocresol with the dog's own pulp (three dogs), saline solution with pulp (one dog) and injecting sheep erythrocytes (one dog). A sixth dog was used as a control for the Arthus skin test. Secondary immunizations were accomplished via the root canal every 7 days over a 28-day period. Arthus skin-test reactions demonstrated less of a response to the formocresol alone than when the dogs' pulp was conbined with this material. In vitro analysis of hemagglutinating antibody titer showed a tremendous increase when pulp was incubated with formocresol as compared to the saline-treated pulp. Therefore, dogs' pulp tissue became antigenically altered by the formocresol recognized by the host, and a specific humoral response resulted.