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

Evaluation of the Efficacy of Buccal Midazolam in Comparison With Intranasal Midazolam Sedation in Uncooperative Children During Dental Treatment

Aim: Behavioral management techniques are not always sufficient, and then it is necessary to use pharmacological management methods. The aim of this study is to compare the effectiveness of buccal midazolam sedation with intranasal midazolam in non-cooperative children during dental treatment. Materials and Methods: A randomized single blinded comparative clinical study consisted of 40 children aged 3-6 years who were divided randomly into two groups: Group A intranasal midazolam and Group B buccal midazolam. The onset time of action and recovery time from sedation were compared between the two groups, and the efficacy of sedation was evaluated by Houpt behavior scale. The independent student's T test, Mann-Whitney U test, the Wilcoxon test and the Chi-square test were used. Results: There were no statistically significant differences in the onset time of action (p=0.458) and recovery time from sedation (p=0.148). There were no statically significant differences between the two groups in sleeping, crying, and movement categories (p=0.747), (p=0.183), (p=0.732), respectively, or in the overall Houpt scale (p=0.393), there were statistically significant differences in the sleep variable between the two studied phases in the intranasal group (p=0.014) and in the movement variable in the buccal group (p=0.039). Conclusion: Both buccal midazolam and intranasal sedation were effective in the management of uncooperative children during dental treatment at 85% and 80%, respectively. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12624000945527.

A Prospective Randomised Clinical Trial Evaluating Pulpotomy in Primary Molars With Three Bioceramic Calcium Silicate Cements: 24 Month Follow-Up

BACKGROUND

In recent times, bioceramic calcium silicates have gained attention due to high success rates with pulpotomy in primary teeth.

AIMS

To evaluate and compare the clinical and radiographic outcomes of three different bioceramic calcium silicate cements in vital deciduous teeth treated with pulpotomies over a period of 24 months.

DESIGN

Children aged 4-9 years, with deep dentinal caries (ICDAS 4-6) in primary molars, having no history of spontaneous pain or signs of non-vitality were included in the study. Following clinical and radiographic evaluation 117 primary molars diagnosed as having reversible pulpitis received pulpotomy treatment, after randomly being assigned into three groups based on the bioceramic calcium silicate medicament used: a pre-mixed syringe-loaded MTA putty (NeoPUTTY); a traditional powder-liquid hand mix MTA material (NeoMTA Plus), and a precapsulated, trituration mixed material (Biodentine). Clinical and radiographic evaluation was done at 6, 12, 18 and 24 months.

RESULTS

The cumulative clinical and radiographic success for NeoPUTTY was 92%, NeoMTA Plus 97% and for Biodentine 95% and 89%, respectively, after 24 months follow-up.

CONCLUSION

The clinical and radiographic success rates of all three bioceramic calcium silicate cements were found to be high, with no significant differences over a period of 24 months.

TRIAL REGISTRATION

Clinical trial registration number: CTRI/2021/03/031655.

Pulpotomy in primary teeth: Biodentine™ versus calcium hydroxide. A systematic review and meta-analysis

Introduction

Pulpotomy is the total amputation of coronal pulp tissue and subsequent placement of a pulpotomy agent over the root canal orifices, followed by a coronal seal. The most suitable pulpotomy agent for successful treatment outcomes remains controversial.

Objectives

To evaluate and compare the clinical and radiographic success of calcium hydroxide (CH) and Biodentine (BD) in primary tooth pulpotomy at 6 and 12 months.

Materials and methods

An automatised search of the PubMed-Medline, Web of Science, and SCOPUS electronic databases was performed to identify scientific articles on primary tooth pulpotomies with either calcium hydroxide (CH) or Biodentine (BD) as a pulpotomy agent, published until January 2024. The software used for meta-analysis was R 4.3.1 (R Core Team, 2023).

Results

Of the 594 potentially eligible articles, 14 met the inclusion criteria: seven articles on CH pulpotomy and seven articles on BD pulpotomy with 6- and 12-months of follow-up. The meta-analysis concluded a mean clinical success rate of 91.8 % at 6 months and 79.0 % at 12 months for the CH group, and 99.2 % at 6 months and 98.8 % at 12 months for the BD group. In terms of the mean radiographic success, the CH group achieved 74.2 % at 6 months and 63.7 % at 12 months, whereas the BD group achieved 99.4 % at 6 months and 98.4 % at 12 months. In comparison, the meta-analysis concluded a marginally significant difference in clinical success in favour of the BD group at 6 months (p = 0.091). At 12 months, clinical success was significant in the BD group (p = 0.023). Regarding radiographic success, a significant difference in favour of the BD group was observed at 6 (p = 0.008) and 12 months (p < 0.001).

Conclusion

BD showed significantly higher clinical and radiographic success than CH in pulpotomy.

Clinical and Radiographic Efficacy of Low-level Laser Therapy and Formocresol as Pulpotomy Agents in Primary Molars: A Systematic Review and Meta-analysis

Research question

To evaluate the effectiveness of low-level laser therapy (LLLT) as a pulpotomy agent in primary molars.

Research protocol

This systematic review followed the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline 2020.

Literature search

An electronic search of the databases was performed to find the effectiveness of LLLT over formocresol as a pulpotomy agent in primary molars in children aged between 3 and 10 years.

Data extraction

Authors independently extracted the data from the 14 included studies based on the inclusion criteria. The inclusion criteria comprised studies that compared the clinical and radiographical effectiveness of LLLT pulpotomy with formocresol pulpotomy in primary molars using randomized clinical trials (RCTs).

Quality appraisal

The risk of bias was assessed using a tool developed by the Cochrane Collaboration for RCT studies.

Data analysis

The meta-analyses were performed using the fixed-effects model. Heterogeneity was assessed by a Q test and quantified with I2 statistics. Radiological and clinical success among the teeth treated with either formocresol or LLLT was considered the main outcome.

Results and interpretation of results

The search resulted in 390 published studies. After the removal of duplicate studies and analysis of full-text articles, 14 studies were selected for systematic review. Overall, the results demonstrated a high risk of selection and performance bias. No statistically significant difference was found between LLLT and formocresol as pulpotomy agents when compared clinically and radiographically at 6-9 and 12-month follow-up periods. LLLT is a good alternative method to be used as a pulpotomy agent in cases of reversible pulpitis.

Key message

Low-level laser therapy is an emerging and trending branch in dentistry because of its beneficial effects in various treatment approaches. It can be effectively used in the pulpotomy procedure due to its properties to reduce pulp inflammation, improve healing, and preserve dental pulp vitality.

How to cite this article

Doiphode AR, Kalaskar R, Kalaskar A, et al. Clinical and Radiographic Efficacy of Low-level Laser Therapy and Formocresol as Pulpotomy Agents in Primary Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2024;17(9):1075-1085.

Clinical and radiographic success of TheraCal versus Formocresol in primary teeth pulpotomy: A systematic review and meta-analysis

Background

Various dressing materials have been evaluated for pulpotomy of primary teeth. However, an ideal pulp dressing material has not been identified yet. This systematic review investigated the effectiveness of TheraCal compared to Formocresol in pulpotomy of primary teeth.

Materials and methods

This research was conducted in the form of a secondary study, with a systematic search of texts until 2023 in Scopus, Web of Science, PubMed and Google Scholar databases. The articles were selected based on the inclusion and exclusion criteria and, finally the search results were reported in the PRISMA chart. The quality of the studies was evaluated based on the NIH checklist. The extracted information was entered into Stata17 software. Heterogeneity was evaluated using Cochran's chi-square test and I2 statistics. Egger's tests were used to detect publication bias.

Results

After removing duplicate articles and articles that did not meet the inclusion criteria, 4 studies were selected for qualitative analysis. The odds' ratio of success rate between Formocresol and TheraCal pulpotomy for absence of the pain, abscess, Mobility, internal root resorption and bone radiolucency was obtained 1.12 (95 % CI: 0.32, 3.85, P = 0.86), 0.47 (95 % CI: 0.1, 2.14, P = 0.33), 0.82 (95 % CI: 0.21, 3.21, P = 0.78), 0.89 (95 % CI: 0.3, 2.67, P = 0.84), and 1.96 (95 % CI: 0.68, 5.62, P = 0.21) respectively.

Conclusion

The study results revealed that there was no significant difference in clinical and radiographic success between pulpotomy with TheraCal and Formocresol.

Treatment Outcomes of Pulpotomy in Primary Teeth with Irreversible Pulpitis: A Systematic Review and Meta-Analysis

AIM

This systematic review and meta-analysis aimed to evaluate the success rates of pulpotomy treatment for irreversible pulpitis in primary teeth.

METHODS

This study was registered and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Relevant studies published between January 1980 and April 2023 were identified across eight online databases and two paediatric dentistry textbooks. Study selection, data extraction, and quality assessment were conducted by multiple investigators independently. Data analysis involved single-arm and two-arm meta-analyses, leave-one-out sensitivity analysis, meta-regression, and assessment of publication bias. The risks of bias were evaluated using the Cochrane Collaboration's assessment tools. The levels of evidence were determined using the Oxford Centre for Evidence-Based Medicine (OCEBM) tool.

RESULTS

Five primary studies were included. The weighted mean overall success rates at 6-month and 12-month follow-ups were 97.2% and 94.4%, respectively. Two-arm meta-analysis revealed no significant difference (p > 0.05) between the use of mineral trioxide aggregate (MTA) and non-MTA bioceramic-based materials as pulpotomy medicaments. The sample size of each study did not affect the degree of data heterogeneity. Egger's test revealed no significant publication bias.

CONCLUSIONS

Pulpotomy may be regarded as an alternative modality for treating primary teeth with irreversible pulpitis. Nevertheless, future well-designed trials and extended follow-up periods are warranted.

Outcome assessment methods of bioactive and biodegradable materials as pulpotomy agents in primary and permanent teeth: a scoping review

BACKGROUND

Pulpotomy procedures aiming to preserve and regenerate the dentin-pulp complex have recently increased exponentially due to developments in the field of biomaterials and tissue engineering in primary and permanent teeth. Although the number of studies in this domain has increased, there is still scarcity of evidence in the current literature.

OBJECTIVES

(1) Report the methods of outcome assessment of pulpotomy clinical trials in both primary and permanent teeth; (2) Identify the various bioactive agents and biodegradable scaffolds used in pulpotomy clinical trials in both primary and permanent teeth.

MATERIALS AND METHODS

A scoping review of the literature was performed, including a search of primary studies on PubMed, Scopus, Web of Science, ProQuest and Clinicaltrials.gov. A search for controlled trials or randomized controlled trials published between 2012 and 2023 involving primary or permanent teeth receiving partial or full pulpotomy procedures using bioactive/regenerative capping materials was performed.

RESULTS

127 studies out of 1038 articles fulfilled all the inclusion criteria and were included in the current scoping review. More than 90% of the studies assessed clinical and radiographic outcomes. Histological, microbiological, or inflammatory outcomes were measured in only 9.4% of all included studies. Majority of the studies (67.7%) involved primary teeth. 119 studies used non-degradable bioactive cements, while biodegradable scaffolds were used by 32 studies, natural derivates and plant extracts studies were used in only 7 studies. Between 2012 (4 studies) and 2023 (11 studies), there was a general increase in the number of articles published. India, Egypt, Turkey, and Iran were found to have the highest total number of articles published (28, 28,16 and 10 respectively).

CONCLUSIONS

Pulpotomy studies in both primary and permanent teeth relied mainly on subjective clinical and radiographic outcome assessment methods and seldom analyzed pulpal inflammatory status objectively. The use of biodegradable scaffolds for pulpotomy treatments has been increasing with an apparent global distribution of most of these studies in low- to middle-income countries. However, the development of a set of predictable outcome measures as well as long-term evidence from well conducted clinical trials for novel pulpotomy dressing materials are still required.

Pulpotomy of mature teeth: A systematic analysis of the failed cases

Pulp therapy aims to maintain the health and integrity of teeth and their supporting tissue and preserve the vitality of the tooth pulp affected by dentinal caries or severe traumatic injury. Thus, the best clinical practice provides pulpal health or pathosis diagnosis and various therapeutic interventions evidenced in both the deciduous and permanent dentition for endodontic treatment. The pulp health status determines the type of pulpal therapy used. Vital pulp therapies for primary teeth include protective liners, pulp capping, and pulpotomy for reversible pulpitis; for permanent teeth, pulpotomy can be considered for irreversible pulpitis. For reversible or irreversible pulpitis, invasive management of decayed teeth has traditionally been performed. However, at present, coronal pulpotomy-like vital pulp therapy has led to successful treatment outcomes that are less invasive. Compared to root canal treatments, coronal pulpotomy is cost-effective, less time-consuming, and less technically demanding. The success of a pulpotomy depends on the clinician's experience, appropriate clinical techniques, and materials used. This narrative review provides insights into the systematic analysis of pulpotomy failure, causes and signs of failure, and alternative endodontic interventions.

Comparative Evaluation of Success of NeoPutty Mineral Trioxide Aggregate ® with Formocresol as Pulpotomy Medicaments in Primary Molars: A Clinical Study

OBJECTIVE

This clinical study was aimed to investigate the clinical and radiographic outcomes of NeoPutty MTA ® (Nusmile), a novel mineral trioxide aggregate (MTA) pulpotomy material, in primary teeth of children aged 4-6 years.

METHODS

An in vivo study was done in children aged 4-6 years old. A total of 50 primary second molar teeth were included in the study, with 25 of them undergoing treatment with formocresol (FC) and 25 receiving treatment with NeoPutty MTA ® . The subjects were divided into two groups for treatment: the first group received a treatment involving a 1:5 dilution of Buckley's FC. The second group, however, underwent treatment with NeoPutty MTA ® . This study employs a meticulous approach to evaluate the impact of different treatments on a significant number of molar teeth, using FC and NeoPutty MTA ® as the respective treatment methods. The demographics of the subject pool are well-documented, comprising a balance of male and female participants. The technique employed for pulp removal and the subsequent management of bleeding are outlined, underscoring the thoroughness of the process.

RESULTS

At 12 months, the NeoPutty MTA ® pulpotomy group showed a significantly higher success rate clinically (96%) compared to the FC group (72%) ( P < 0.05), but radiographically although NeoPutty MTA ® was better (92%) than FC (82%), it was not statistically significant. NeoPutty ® -treated teeth exhibited no signs of pain or discomfort and demonstrated better pulp vitality compared to the FC group.

CONCLUSION

NeoPutty MTA ® demonstrated superior clinical success rates and better radiographic outcomes compared to traditional FC pulpotomy.

Advanced Applications in Pediatric Dentistry: A Worldwide Perspective of the Last 13 Years

The enhancement of the clinical management of growing patients has always been a great challenge for orthodontists and pediatric dentists [...].

Histologic comparison of formocresol, platelet-rich fibrin, and hesperidin in pulpotomy: A randomized trial in dogs

Aims

To histologically assess and compare formocresol (FC), platelet-rich fibrin (PRF), and hesperidin (HPN) as pulpotomy agents in dogs.

Materials and Methods

Pulpotomy was attempted from the buccal surface (class V) of 48 teeth in three mongrel dogs (Canis Lupus). Cavities were randomly allocated for three groups (n = 16) according to the pulpotomy agent used; (group I: FC (control), group II: PRF, and group III: HPN). All cavities were then sealed with zinc oxide eugenol followed by resin-modified glass ionomer restoration. Two months later, dogs were euthanized; the specimens were obtained and prepared for histological assessment followed by statistical analysis.

Results

HPN specimens showed the best dentin bridge formation and the least inflammatory signs and pulp disorganization. Followed without statistically significant difference by PRF (P ≥ 0.05). Both of HPN and PRF, however, showed a significant difference statistically (P ≤ 0.05) to FC that showed no dentin bridging with more pronounced inflammation, necrosis, and pulp disorganization.

Conclusions

For pulpotomy, HPN and PRF seemed histologically to be good substitutes for FC in the dog model.

Comparative Evaluation of Chlorhexidine Polymer Scaffold, 3Mixtatin, and Formocresol for Vital Primary Pulp Therapy: A Randomized 6-month Clinical Study

Introduction

The study was performed to evaluate and compare the clinical and radiographic efficacy of chlorhexidine (CHX) polymer scaffold, 3Mixtatin, and formocresol for vital primary pulp therapy-a randomized clinical study.

Materials and methods

A total of 120 primary molars were included from children aged between 6 and 8 years in this randomized clinical study based on inclusion and exclusion criteria and were randomly allocated into three groups (group I-CHX polymer scaffold, group II-3Mixtatin, and group III-formocresol. Pulpotomy was performed in a vital cariously exposed primary tooth with healthy periodontium where their retention is more beneficial than extraction. Subjects were followed up at 1, 3, and 6 months for clinical and radiographic evaluations.

Results

At 6 months of follow-up, the overall success rate of pulpotomy in groups I, II, and III was 56.41, 71.05, and 60.52% in each group, respectively. Nonsignificant difference (p > 0.05) was seen during intergroup comparison.

Conclusion

However, among the three materials used in this study, 3mixtatin comparatively had better results.

How to cite this article

Goel N. Comparative Evaluation of Chlorhexidine Polymer Scaffold, 3Mixtatin, and Formocresol for Vital Primary Pulp Therapy: A Randomized 6-month Clinical Study. Int J Clin Pediatr Dent 2023;16(3):478-482.

Histopathological Biocompatibility Evaluation of TheraCal PT, NeoMTA, and MTA Angelus in a Murine Model

The aim of this study was to evaluate the biocompatibility of the regeneration of the dentin-pulp complex in a murine model with different treatments with MTA Angelus, NeoMTA, and TheraCal PT. An in vivo controlled experimental study of 15 male Wistar rats forming three study groups, the upper and lower central incisors were selected where pulpotomies were conducted, leaving a central incisor as control at 15, 30, and 45 days. For data analysis, these were expressed as mean ± standard deviation and were examined by Kruskal-Wallis test. Three factors were analyzed as follows: "inflammatory infiltrate; disorganization of pulp tissue, and the formation of reparative dentin". No statistical significance was found between the different groups (p > 0.05). Treatment with these three biomaterials (MTA, TheraCal PT, and Neo MTA) presented an inflammatory infiltrate and slight disorganization of the odontoblast layer in the pulp tissue of a murine model, with normal coronary pulp tissue and the formation of reparative dentin in the three experimental groups. Thus, we are able to conclude that all three are biocompatible materials.

Pulp Therapy of Primary Dentition; its Relevance despite Insufficient Histological Evidence: A Review

Pulp treatment in primary dentition is generally divided into vital and non-vital pulp therapies and assists in the preservation of pulpally involved primary teeth in the dental arch until the affected tooth naturally exfoliates. The success of pulp therapies depends on several factors; e.g. proper case selection, accurate diagnosis and good coronal seal. To date, studies on the success and failure rates of pulp treatments are based on clinical signs and symptoms, radiographic findings and histological analysis. However, the clinical and radiographic evidence may not completely portray the true status of the dental pulp. Histological evidence remains the gold standard in the assessment of pulp condition, whether it is in a healthy or adverse state. The aims of the current research were to summarise the treatment outcomes of pulp therapy in primary dentition based on clinical, radiographic and histological criteria, and to support its relevance in the presence of limited histological evidence to measure authentic treatment success. An electronic database search of dental literature from 1990 to 2022 was carried out using the MEDLINE, i.e. PubMed, database. Current dental literature showed that the success rates of primary tooth pulp therapy are high. The obtained results were based largely on clinical and radiographic studies with narrow histological investigations to assess the treatment outcome(s) of pulp therapy in primary dentition. Despite the scarcity of histological evidence, pulp therapies in primary teeth are still practical due to their statistically empirical success compared to their failure. Consequently, pulp therapy of primary dentition is still relevant, and should continue to be indicated as an important treatment option.

Comparative efficacy of medicaments or techniques for pulpotomy of primary molars: a network meta-analysis

OBJECTIVES

We performed this network meta-analysis to determine the comparative efficacy of formocresol (FC), ferric sulfate (FS), sodium hypochlorite (NaOCl), calcium hydroxide (CH), mineral trioxide aggregate (MTA), biodentine, and laser for pulpotomy of molar teeth.

MATERIALS AND METHODS

An updated search was conducted in PubMed, Embase, and the Cochrane Library to identify relevant randomized controlled trials (RCTs) published before October 30, 2022, after screening previous meta-analyses. The Cochrane risk of bias assessment tool was used to appraise the methodological quality of included studies. Clinical and radiographic success rates were assessed as outcomes. Random network meta-analysis was performed by using STATA software (version 14.0) with "network" command.

RESULTS

A total of 43 RCTs were included. Network meta-analysis indicated that CH was inferior to other medicaments and techniques in all outcomes, and MTA and biodentine was better than FC, FS, and NaOCl in terms of clinical and radiographic success rates. Results of ranking probabilities suggested that MTA ranked first in all outcomes except for clinical success at both 6 months.

CONCLUSIONS

Our results suggested that MTA was associated with significant improvement in both clinical and radiographic success than other pulpotomy medicaments and techniques, with the highest probability of being the optimal option.

CLINICAL RELEVANCE

The current network meta-analysis determined the comparative efficacy and safety of 7 common pulpotomy medicaments in molar pulpotomy, including FC, FS, NaOCl, CH, MTA, biodentine, and laser, and the pooled results revealed comparable efficacy in clinical and radiographic success rates at 6 and 12 months between FC, FS, and NaOCl in primary molars pulpotomies. However, MTA, biodentine and laser may have more advantages than other pulpotomy medicaments for clinical and radiographic success. Therefore, in clinical practice, practitioners should select MTA, biodentine, or laser as pulpotomy medicaments in molar pulpotomy.

A comparative evaluation of four regenerative materials for pulpotomy in primary molars: An in vivo study

Background

Preservation of pulpal vitality is of paramount importance as the vital functioning pulp is capable of initiating a unique reparative capacity. The present study aimed to evaluate and compare four regenerative materials for pulpotomy in primary molars.

Materials and Methods

This in vivo study included a total of 120 primary molars from 30 healthy children aged 3-9 years for regenerative pulpotomy procedure. The teeth were then divided by the lottery method (chits with names of materials on it) into four groups so that each child received all four of the regenerative materials; Group 1: Biodentine (BD)™, Group II: Mineral Trioxide Aggregate Plus (MTA Plus™), Group III: Retro MTA (Retro MTA^®), and Group IV: Calcium Enriched Mixture (CEM) cement. All the primary molars (1^st/2^nd molars) were evaluated clinically and radiographically at 6, 12, 18, and 24 months. Data were subjected to the statistical analysis using the Chi-square test. The level of significance was considered as P < 0.05.

Results

Clinical evaluation showed 100% success with BD™ and CEM cement; whereas 96.2% success was seen with MTA Plus™ and Retro MTA^®. On radiographic evaluation, MTA Plus™ and CEM cement showed 96.2% success, whereas BD™ and Retro MTA^® showed 92.59% success rate.

Conclusion

All four regenerative materials showed high success in the pulpotomy of primary molars.

Clinical and radiographic comparison of Biodentine and Formocresol: an updated meta-analysis with trial sequential analysis

PURPOSE

This meta-analysis aimed to compare the clinical and radiographic success rate of Biodentine as an alternative to Formocresol to provide a critical appraisal of the available literature and evidence-based conclusion as well as update the previous systematic review.

METHODS

MEDLINE, CENTRAL, Web of Science, Scopus, and Google Scholar databases were searched up to 20 October 2021 to identify RCTs evaluating pulpotomy with Biodentine/Formocresol in carious primary molars among children ≤ 10 years old. The risk of bias was assessed using the Cochrane RoB-2 tool. RRs and corresponding 95% CIs were calculated to pool results that RR ˃ 1 indicated a higher success rate in the Biodentine group and RR < 1 indicated a higher success rate in the Formocresol group. Heterogeneity was calculated using the I² and τ² statistics. In addition, trial sequential analysis was performed to adjust results for type I and type II errors and evaluate power of the meta-analysis.

RESULTS

Nine RCTs were identified and eight RCTs were included in the meta-analysis and trial sequential analysis. The obtained evidence showed no significant difference between Biodentine and Formocresol in terms of clinical efficacy. However, considering the radiographic success rate the results of the meta-analysis and trial sequential analysis significantly favoured Biodentine.

CONCLUSION

Within the limitations of the present review and based on the retrieved findings it has been clearly shown that Biodentine is superior compared to Formocresol in terms of radiographic success rate with firm evidence in this regard. Although the performed meta-analysis showed no significant clinical difference between Biodentine and Formocresol, however, trial sequential analysis revealed a lack of firm evidence in this regard.

Biodentine™ Pulpotomy in Stage I primary Molars: A 12-month Follow-up

Aim

This study aims to evaluate, over 12 months of clinical and radiographic follow-ups, the performance and outcomes of Biodentine™ pulpotomy in stage I primary molars.

Materials and methods

A total number of 20 stage I primary molars requiring pulpotomy were selected from eight healthy patients aged between 34 and 45 months. Patients presenting a negative attitude toward dental treatment on the dental chair were scheduled for dental treatments under general anesthesia.Pulpotomy with Biodentine™ as a pulp-dressing material was performed on all selected molars. The patients were called back at 1 and 3 months for clinical follow-ups, then at 6 and 12 months for clinical and radiographic follow-ups. Data were tabulated according to follow-up intervals and occurrence of any changes in root maturation, pulp canal obliteration (PCO), periodontal ligament space (PLS), and bone or root lesion.

Results

No statistically significant differences were recorded at 1, 3, 6, and 12 months. There was a statistically significant increase in number of roots with closed apices from six roots at 6 months to 50 roots at 12 months (p < 0.0005) and the PCO was present in all 50 roots at 12 months, after it was present in 36 roots only at 6 months (p = 0.0001).

Conclusion

This is the first randomized clinical trial that evaluates the performance of Biodentine™ as a pulp-dressing agent in stage I primary molar pulpotomy over 12 months of follow-up. Contrary to previous studies, the present work highlights the continued root formation and apical closure (AC) in pulpotomized immature primary molars.

How to cite this article

Nasrallah H, Noueiri BE. Biodentine™ Pulpotomy in Stage I primary Molars: A 12-month Follow-up. Int J Clin Pediatr Dent 2022;15(6):660-666.

A randomized clinical trial of hyaluronic acid gel pulpotomy in primary molars with 1 year follow-up

OBJECTIVE

This randomized clinical study aimed to evaluate the success of hyaluronic acid (HA) as a pulpotomy medicament of human primary molars and to compare it with formocresol (FC) and ferric sulphate (FS) pulpotomy treatments up to 12 months.

MATERIALS AND METHODS

The study was conducted with 130 primary molars of 44 children. The ethical approval and registration to clinical trials (No: NCT04115358) were completed. After the removal of all the coronal pulp tissue, a 0.5% HA gel, or a FC, or a 20% FS solution were applied randomly to the radicular pulp tissues of the primary molars. Then, the pulp chambers were filled with a zinc oxide eugenol cement and restored either with a composite filling material or with a stainless-steel crown. The treatment success rates of the 3 groups were followed and compared clinically and radiographically at 1st-, 3rd-, 6th- and 12th-months.

RESULTS

Primary molars treated with FC, FS and HA dressings were clinically successful 77.5%, 86.8% and 87.5% respectively after 12th-month follow-up (p > .05). Radiographic successes of FC, FS and HA groups were lower than clinical successes (57.6%, 68.8%, 57.9% respectively at the 12th-month) but the difference between the groups was not statistically significant (p > .05). Equivalence analysis assuming not more than 10% difference between the materials suggested that HA was not inferior to FC or FS.

CONCLUSIONS

Within the limitations of this study, our randomized clinical trial shows that HA is a promising pulpotomy medicament in primary molars. However, further studies are justified to further improve the HA material success.

Success rate of three capping materials used in pulpotomy of primary molars: A randomized clinical trial

Background

Carious primary molars, symptomless, or with reversible pulpitis are most frequently treated with pulpotomy to maintain arch integrity, otherwise they would be extracted. The present study was conducted to assess clinically and radiographically the success rate of three capping materials: Nanohydroxyapatite (NHA), Mineral Trioxide Aggregate (MTA), and Formocresol (FC) in pulpotomy of primary molars.

Methods

A clinical trial was carried out on healthy, four to eight years old children, with 72- second primary molars indicated for pulpotomy. Molars were divided into 3 equal groups (24 teeth each) designated to NHA (group 1), MTA (group 2), and FC (group 3) as pulp medicaments. Treated teeth were finally restored with stainless steel crowns. Subjects were monitored clinically and radiographically after three, six, and twelve months. Statistical analysis was presented as intended to treat analysis. Categorical data were analyzed using Fisher’s exact test. The significance level was set at p ≤ 0.05. Statistical analysis was performed using SPSS, version 26.

Results

By the end of the twelve months, the number and percentages of successfully treated molars for Group (1), Group (2) and Group (3) were 10 (41.7%), 19 (79.2%) and 18 (75.0%) respectively; with (NHA) group showing a significantly lower rate of success, (p = 0.019).

Conclusions

MTA is still the material of choice for pulpotomy in primary molars.

Trial Registration

This trial was registered on Clincal.Trial.gov (https://clinicaltrials.gov), on February 8, 2019 (Retrospectively registered). The protocol ID is 181053. The Identifier is NCT03833557.

Stability Evaluation of Lyotropic Liquid Crystalline Precursor for the Co-delivery of Chlorhexidine and Silver Nanoparticles

Sealing the therapeutic agents in the root canal is considered to be an essential step in root canal therapy. The lyotropic liquid crystalline precursor (LLCP) incorporated with chlorhexidine (CHX) and silver nanoparticles (Ag-NPs) has been confirmed as a promising candidate for root canal therapy in the previous study. Importantly, the stability of the LLCP system was a significant determinant for its therapeutic effect and further application. The objective of this study was to comprehensively investigate the stability of the LLCP incorporated with CHX and Ag-NPs. The oil-water partition coefficient of CHX and Ag-NPs was measured. The water absorption and the physical stability of drug-loaded LLCP solution were studied. Stability under high temperature, high humidity, and strong light irradiation was also investigated. The results demonstrated that CHX and Ag-NPs could be entrapped in the water channel of LLCP, indicating the low tendency of drugs leakage. The drug-loaded LLCP was a pseudoplastic fluid and it showed an excellent physical stability with a sedimentation rate of 0.981 and a settling time of 26~28 h. The payload of LLCP was confirmed to weaken the water absorption behavior, which facilitated its transformation to cubic liquid crystal. The stress testing under high temperature, high humidity, and strong light irradiation also manifested that the LLCP was stable when stored under moisture-proof condition. In conclusion, the developed LLCP incorporated with CHX and Ag-NPs was highly stable during storage and qualified for further application.

An Update on Newer Pulpotomy Agents in Primary Teeth: A Literature Review

Primary molars with asymptomatic reversible pulpitis are commonly treated by pulpotomy procedure. Different pulpotomy materials used so far for pulpotomy that have been mentioned in the literature have been included in this article. This literature review includes all medicaments including natural alternatives. Many significant medicaments with their success rates have been mentioned in this paper. To increase the therapeutic success of pulpotomy procedure, it is necessary to identify a novel effective and preferably natural pulpotomy medicament.

Pulp repair response after the use of a dentin-pulp biostimulation membrane (BBio) in primary teeth: study protocol for a randomized clinical trial

Background

Vital pulp therapy aims at maintaining the pulp tissue injured but vital. Thus, the use of capping materials that induce tissue regeneration is a great current trend. This study aims to evaluate clinically and radiographically the pulp repair after the use of dentin-pulp biostimulation membrane in primary teeth.

Methods

Four hundred and sixty-eight teeth from children aged between 5 and 9 years old, both genders, with deep caries lesion with pulp involvement, but no furcal impairment and any sign of necrosis will be selected. The vital pulp therapy will be performed with mineral trioxide aggregate (control group) and dentin-pulp biostimulation chitosan membrane (BBio group). The clinical and radiographic outcomes will be assessed at 12 and 24 months after treatment. The thickness of the dentin barrier will be verified through Image J2 software. The Wilcoxon signed rank test and Mann-Whitney test will respectively compare the intra- and intergroup clinical and radiographic outcomes. Paired t test and independent t test will respectively compare the intra- and intergroup radiographic measurements. The logistic regression will be applied, and the degrees of this association will be measured using odds ratio (OR) and 95% confidence interval (95% CI).

Discussion

Therefore, this study protocol aims at new perspectives of vital pulp therapy of primary teeth by employing new easy-handling, low-cost material to keep viable the pulp tissue capable of regenerating and maintain the physiological process of deciduous tooth exfoliation.

Trial registration

Brazilian Registry of Clinical Trials RBR-6vr58b. Registered on 17 February 2019.

Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth: A Systematic Review of the Literature

Background: Pulpotomy of primary teeth provides favorable clinical results over time; however, to date, there is still not a consensus on an ideal pulp dressing material. Therefore, the aim of the present systematic review was to compare pulpotomy agents to establish a preferred material to use. Methods: After raising a PICO question, the PRISMA guideline was adopted to carry out an electronic search through the MEDLINE database to identify comparative studies on several pulp dressing agents, published up to October 2019. Results: The search resulted in 4274 records; after exclusion, a total of 41 papers were included in the present review. Mineral trioxide aggregate (MTA), Biodentine and ferric sulphate yielded good clinical results over time and might be safely used in the pulpotomies of primary molars. Among agents, MTA seemed to be the material of choice. On the contrary, calcium hydroxide showed the worst clinical performance. Although clinically successful, formocreosol should be replaced by other materials, due to its potential cytotoxicity and carcinogenicity. Conclusion: MTA seemed to be the gold standard material in the pulpotomy of primary teeth. Promising results were also provided by calcium silicate-based cements. Further randomized clinical trials (RCTs) with adequate sample sizes and long follow-ups are encouraged to support these outcomes.