Survival rate and associated factors affecting pulpectomy treatment outcome in primary teeth

Does the Modality of Dental Treatment Affect the Treatment Prognosis and the Necessity of Re-Treatments?

BACKGROUND

The utilization of evidence-based approaches is crucial to achieving long-term positive outcomes for treatment performed chairside or under general anesthesia. The study aimed to evaluate if treatment modality (at the chairside or under general anesthesia) affects prognosis and the need for re-treatment.

METHODS

Oral-hygiene, gingival, and plaque indexes were recorded during the control appointment. The success of all treatments was evaluated according to the scoring of particular evaluation criteria.

RESULTS

A total of 1066 dental procedures were performed on 92 children. Plaque index scores were higher for patients treated under general anesthesia. The success rate of restorative procedures was 82.5% under general anesthesia and 80.6% at the chairside. There was no statistically significant difference between the mean number of restorative treatments and the need for re-treatment between general anesthesia or chairside (p = 0.649, p = 0.311). The mean number of unsuccessful endodontic treatments performed under general anesthesia was higher than performed chairside. Only two out of thirty stainless-steel crowns were decemented, all performed under general anesthesia.

CONCLUSIONS

The high volume of restoration failure due to secondary caries has highlighted the need for alternative approaches to caries management, especially given the risks associated with repeat general anesthetic.

Success Rate and Related Factors of Vitapex Pulpectomy in Primary Teeth: A Retrospective Study

OBJECTIVES

 Our aims were to evaluate the Vitapex pulpectomy (PE) success rate, Vitapex resorption rate, and their associated factors in primary teeth.

MATERIAL AND METHODS

 This retrospective study evaluated the clinical records of Vitapex PE-treated patients at the Pediatric Dental Clinic, Faculty of Dentistry, Mahidol University, from 2013 to 2019. The patient's and pulpectomized tooth's characteristics, procedure, materials used, and type of operator were recorded. A dentist evaluated and compared the periapical lesion, root status, obturation quality, and Vitapex resorption on preoperative, immediate, and follow-up digital radiographs. PE failure was defined as radiographic lesion progression.

STATISTICAL ANALYSIS

 The Kaplan-Meier method was used to estimate the Vitapex PE success rate and Vitapex resorption rate. Multivariate Cox regression was used to determine the related factors.

RESULTS

 In total, 647 Vitapex PE teeth from 448 patients (19-121-month-old) were analyzed. The follow-up periods ranged from 6 to 60 months. The success rate was 88.9 and 68.1% at the 12- and 24-month follow-up, respectively, and remained stable at 53.8% at the 36 to 60-month follow-ups. The factors related to Vitapex PE failure were age and a preoperative pathologic lesion. More than 50% of the pulpectomized teeth presented Vitapex resorption faster than physiologic root resorption at the 12-month follow-up. The patients' age at treatment and the obturation quality were significantly related to the Vitapex resorption rate.

CONCLUSIONS

 The success rate of Vitapex PE decreased time dependently and was related to the patient's age at treatment and a preoperative lesion. The Vitapex resorption was faster than root resorption and was associated with the patient's age at treatment and the root filling extravasation.

Lesion sterilization and tissue repair with chloramphenicol, tetracyline, zinc oxide/eugenol paste versus conventional pulpectomy: A 36-month randomized controlled trial

BACKGROUND

Endodontic treatment of primary molars represents one of the challenges in pediatric dentistry. There is a lack of consensus in the literature about the endodontic techniques and filling paste for primary teeth with pulp necrosis.

AIM

To compare the effectiveness of the LSTR technique (lesion sterilization and tissue repair) with CTZ paste (chloramphenicol, tetracycline, zinc oxide and eugenol) and pulpectomy with ZOE paste (zinc oxide and eugenol) in the treatment of primary molars with pulp necrosis.

DESIGN

Eighty-eight primary molars with pulp necrosis from 70 children between the ages of 3 and 8 years were included. The teeth were randomized to the LSTR with CTZ paste group or pulpectomy with ZOE paste group. Clinical and radiographic evaluations were performed at 18, 24, 30 and 36 months.

RESULTS

At 36 months, clinical success was 86.4% in LSTR with CTZ paste and 90.9% in pulpectomy with ZOE paste (p = .45). Radiographic success was 43.2% in both groups (p = 1.00). The overall success was 40.9% in LSTR with CTZ paste and 43.2% in pulpectomy with ZOE paste (p = 1.00).

CONCLUSION

After 36 months of evaluation, the effectiveness of the LSTR technique with CTZ paste and pulpectomy with ZOE paste was similar for the treatment of primary molars with pulp necrosis.

A model selection criterion for clustered survival analysis with informative cluster size

We propose a model selection criterion for correlated survival data when the cluster size is informative to the outcome. This approach, called Resampling Cluster Survival Information Criterion (RCSIC), uses the Cox proportional hazards model that is weighted with the inverse of the cluster size. The RCSIC based on the within-cluster resampling idea takes into account the possible variability of the within-cluster subsampling and the possible informativeness of cluster sizes. The RCSIC allows for easy execution for the within-cluster resampling idea without a large number of resamples of the data. In contrast with the traditional model selection method in survival analysis, the RCSIC has an additional penalization for the within-cluster subsampling variability. Our simulations show the satisfactory results where the RCSIC provides a more robust power for variable selection in terms of clustered survival analysis, regardless of whether informative cluster size exists or not. Applying the RCSIC method to a periodontal disease studies, we identify the tooth loss in patients associated with the risk factors, Age, Filled Tooth, Molar, Crown, Decayed Tooth, and Smoking Status, respectively.

An approach of preserving a mandibular primary second molar by a hemisection procedure: A case report with 36-month follow up

Primary teeth play a crucial role in functional, aesthetic and speech tasks. They are also responsible for maintaining the jaw space for successor permanent teeth. Thus, dentists should understand that extraction might be the easiest decision but not always the correct one, especially, in the case of multiple loss of primary molars. On the other hand, endodontic treatments should be accurately diagnosed - necrotic and irreversibly inflamed teeth - and performed with suitable dental tools and materials. Then it is important to provide a good sealing with a suitable final restoration. This case report discusses an approach for preserving a mandibular primary second molar which had a radiographic lesion in the mesial root and the furcation area with multiple loss of primary molars (before eruption of first permanent molar). This treatment was done by performing a root canal treatment (pulpectomy) just for the distal root and a hemisection procedure by extracting the mesial root, followed by applying SSC crown and space maintainer (band and loop). To conclude, this type of treatment should be temporary until the eruption of the first permanent molar and then changed to be a lingual arch appliance. Moreover, hemisection was a suitable alternative approach to extraction over 36 months of following up.