Success Rate of MTA Pulpotomy on Vital Pulp of Primary Molars: A 3-Year Observational Study

Pulpal response to partial pulpotomy versus full pulpotomy procedures in puppies: An experimental study

BACKGROUND

A Partial pulpotomy technique is an alternative choice of treatment for immature permanent teeth with exposed vital pulps. This study aimed to compare the histopathological pulpal response of the primary teeth of puppies after partial pulpotomy and full pulpotomy using mineral trioxide aggregate (MTA).

MATERIALS AND METHODS

72 primary premolars from experimental puppies aged 6-8 weeks were equally divided into test and control groups, as MTA partial pulpotomy (MTA-PP) and MTA full pulpotomy (MTA-FP). After 60 days, the teeth were extracted and examined histologically. The specimens were assessing the extent and intensity of inflammatory response (acute or chronic), necrosis, fibrosis, calcific bridge (presence or absence), pulp calcification, and pathological root resorption.

RESULTS

The Inflammation intensity was lower (2.8%) in MTA-PP than in MTA-FP (16.7%) (P = 0.004). MTA-FP also had a significantly higher percentage of localized (27.8%) and diffuse (11.1%) necrosis (P = 0.014), whereas both groups (P = 0.290) had an equal fibrosis degree. A calcific bridge was observed in 72.2% of cases. Meanwhile, pathological internal root resorption was more evident in MTA-FP (63.9%) than in MTA-PP (19.4%) (P <0.0001).

CONCLUSION

Partial MTA pulpotomy procedure demonstrated promising histological findings that can be applied to vital-pulp therapy in primary teeth.

Efficacy of orthoMTA, retroMTA and ferric sulphate as pulpotomy agents in primary molars: a randomized clinical trial

Purpose

The purpose of this study is to evaluate the clinical and radiographic success rates of RetroMTA, OrthoMTA, and ferric sulfate as pulpotomy agents in primary molars.

Materials and methods

Ninety-six primary second molars from 32 children aged 5 to 9 years were enrolled in this study. The teeth were randomly divided into three groups based on the pulpotomy agent used: O-MTA, R-MTA, and FS. Clinical and radiographic follow-up examinations were conducted at 3, 6, 9, and 18 months postoperatively.

Results

At the end of the study period, 84 teeth were evaluated. The clinical success rates were 75% for FS, 96.4% for O-MTA, and 92.8% for R-MTA groups. In the radiographic analysis, the success rates at the 18-month follow-up period were 50% for FS, 85.8% for O-MTA, and 82.2% for R-MTA groups. According to the Chi-square test and Kaplan-Meier survival analysis, there was a statistically significant difference among the success rates and survival probabilities of the groups (p<0.05).

Conclusion

OrthoMTA and RetroMTA demonstrated better treatment outcomes for pulpotomy of primary second molars than ferric sulfate at the 18-month follow-up period.

Long-term evaluation of primary teeth molar pulpotomies with Biodentine and MTA: a CONSORT randomized clinical trial

BACKGROUND

Calcium silicate-based materials have become widely used in recent years due to their positive effect on pulp cells, which stimulate tertiary dentin formation.

AIM

The aim of the present study was to evaluate and compare clinically and radiographically the performance of MTA and Biodentine as pulp-dressing materials following pulpotomy in primary molars at 24-month follow-up.

DESIGN

Molars from patients aged 4-9 years scheduled for pulpotomy were treated with either MTA or Biodentine followed by a stainless-steel crown. These molars were clinically and radiographically followed up at 6, 12, 18, and 24 months. Statistical analysis was performed to detect differences between the two groups.

RESULTS

A total of 84 pulpotomies were performed obtaining a total success rate of 99.4 and 97.2% for Biodentine and MTA, respectively, at 24 months, showing no statistically significant differences between the two groups.

CONCLUSION

24-month follow-up showed that Biodentine and MTA have similar effectiveness.

Effect of LASER therapy Vs conventional techniques on clinical and radiographic outcomes of deciduous molar pulpotomy: A systematic review and meta-analysis

BACKGROUND

To systematically review the effectiveness primary molar pulpotomy based on the clinical and radiographic outcomes using lasers over the conventional therapies.

MATERIAL AND METHODS

This systematic review and meta-analysis included Randomized or Quasi-randomized trials comparing LASER with conventional pulpotomy therapies (formocresol, ferric sulphate, MTA or calcium hydroxide) with atleast 6-month follow-up period was included. Risk of bias of included studies was assessed and metanalysis was done using RevMan software.

RESULTS

Of the 1383 articles that were searched, only 14 studies were included for qualitative synthesis and 10 for meta- analysis. There was no statistically significant difference in clinical success rate [OR 0.99, 95%CI (0.19,5.22)] or radiographic success rate [OR 0.77, 95%CI (0.31,1.87)] of LASER therapy compared to Formocresol in primary molar pulpotomy for 6 months. No statistically significant difference were found in clinical success rate [OR 1.04, 95%CI (0.35,3.07)] and radiographic success rate [OR 0.71, 95%CI (0.37,1.35)] at 12 month follow-up also. Comparison of LASER with Ferric Sulphate also did not show a statistically significant difference.

CONCLUSIONS

Meta-analysis showed no statistically significant difference in clinical and radiographic outcomes of LASER pulpotomy with conventional pulpotomy (formocresol and ferric sulphate) at 6 and 12 months follow-up. However, there was considerable risk of bias in the included studies. Key words:Pulp therapy, Laser, formocresol.

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.

[Vital pulp preservation treatment in mandibular right first molar with vertical root fractures: a case report]

This case presents vertical root fracture with vital pulp in mandibular right first molar. Examinations of the history, clinical tests, laser Doppler flowmetry, and radiographs revealed that the tooth showed positive response to electric pulp testing and was normal compared with the healthy control tooth. This study aimed to use a novel vital preserving surgical technique (microapical surgery and nanometer bioactive materials) to make an effective therapeutic decision for the vital tooth with vertical root fracture.

Clinical and radiographic evaluation of diode laser pulpotomy on human primary teeth

Background and aims

The aim of this investigation was to evaluate clinical and radiographic effects of diode laser pulpotomy on young human primary molars.

Materials and methods

This double-blind, split-mouth randomized clinical trial was conducted on 14 children, aged 3-9 years. In total, 20 pairs of teeth were selected from those with pulpal exposure due to caries. Case selection was conducted based on clinical and radiographic criteria with similar teeth in each patient. One tooth was randomly assigned to diode laser pulpotomy as case and the other tooth was pulp-treated using formocresol as control. Diode laser at a 10-W power was applied on the remaining pulp tissue following coronal pulp amputation in the case group, while a cotton pellet with diluted formocresol was placed over the amputated pulp in the control group. Reinforced zinc oxide-eugenol paste was then placed over the pulp stump and the tooth was restored with stainless steel crown. A 6- and 12-month followed-up was conducted clinically and radiographically in order to assess the success rates. Data were analyzed with Fisher's exact test.

Results

Clinical failure rate was almost zero when the cases were followed and examined clinically (100% success), with 95% and 90% of the cases in the case group (diode laser) being judged as successful in radiographic examination after 6 and 12 months, respectively. Cases in the control group (formocresol) had almost the same clinical success rate (100%) with no failure judged by radiographic evaluation at 6 and 12 months. These results did not show any significant differences when analyzed using Fisher's exact test (P > 0.05).

Conclusion

There was no significant difference between diode laser pulpotomy and formocresol pulpotomy of human primary teeth after 6 and 12 months. Only a fraction of cases (5%) had radiographic problems at their follow-up in the laser group.

Comparison of the Shear Bond Strength of Silorane-Based Composite Resin and Methacrylate Based Composite Resin to MTA

Background. Mineral trioxide aggregate (MTA) is a material that has recently gained popularity in the application of the vital pulp therapy. Along with the increasing use of MTA to this end, the permanent restoration material to be placed on MTA has become a significant issue. The aim of this in vitro study was to investigate the bond strength of the novel low-shrinkage silorane-based composite resin (SBC) to MTA.

Methods. Twenty acrylic blocks filled with MTA were prepared for this study. SBC was the test group and methacrylate-based composite resin (MBC) was used as the control group. Shear bond strength test was performed to determine the bond strength. The surfaces of broken samples were evaluated under a stereomicroscope and grouped as adhesive, cohesive and mixed. Data were examined by statistical analysis.

Results. Statistical analysis revealed that SBC exhibited higher shear bond strength than the control group. It was observed that most of the failures in the test group were of cohesive type within MTA.

Conclusion. Based on the results, SBC showed higher shear bond strength than the control group; however, clinical follow-up is needed to evaluate the clinical success.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy

Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick-Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term 'bioactive endodontic cements (BECs)', which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.

Difference of Success Rates of Mineral Trioxide Aggregate Pulpotomies Performed Both by Undergraduate Dental Students and by an Expert Operator: A Retrospective Study

Aim

The aim of this retrospective study was to evaluate the clinical and radiographic success of pulpotomy on primary molars performed by dental students compared to that performed by an expert operator.

Methods

The study was conducted on 142 second primary molars in 102 children. The patients were randomly selected from the available records. The test group (treated by dental students) included 51 subjects (28 males and 23 females, mean age: 7.2 ± 1) and the control group included 51 children (29 males and 22 females, mean age: 7.4 ± 1.2 years). After pulpotomy, a clinical and radiographic evaluation after 12 months was performed. Chi-square test and odds ratio were calculated and significance level was set at p < 0.05.

Results

The success rate was significantly lower, 81.6% (p < 0.05), in the test group than in the control group (93%). The test group showed less clinical and radiographic success (86% and 80%, resp.) compared to the control group (97.2% for clinical success and 93% for radiographic success).

Conclusions

Pulpotomy with MTA is an effective method that ensures a good percentage of success. The clinical experience of the operator is a contributing factor.