Postoperative pain after single-visit root canal treatment or vital pulp therapy: A systematic review and meta-analysis

BACKGROUND

This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain.

STUDIES REVIEWED

The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT.

RESULTS

The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I2 = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I2 = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I2 = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001).

PRACTICAL IMPLICATIONS

PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.

Comparison of Visual Analog Scale Scores in Pain Assessment during Pulpotomy using Different Injection Materials in Children Aged 6 to 8 and 8 to 10 Years

AIM

Proper anesthesia and pain management during treatment are most important concerns in dentistry for people of all ages, especially children. This study compared the success rate of lidocaine block with articaine buccal infiltration during anesthesia of the primary mandibular second molars in children aged 6 to 8 and 8 to 10 years.

MATERIALS AND METHODS

The present clinical trial was conducted on 40 children aged 6 to 8 and 8 to 10 years who were referred to the Department of Pediatrics of the Faculty of Dentistry at Shahid Sadoughi University of Medical Sciences in Yazd (Islamic Republic of Iran) and needed to be treated with pulpotomy on both primary mandibular second molars. The patients were randomly divided into two groups. At the first session, a group received articaine buccal infiltration and the other group experienced inferior alveolar nerve (IAN) block. At the next visit, this trend was reversed. Visual analog scale (VAS) was used to evaluate the pain during pulpotomy.

RESULTS

Data were analyzed by Statistical Package for the Social Sciences (version 17) software using Mann-Whitney test. According to the results of this test, the pain during pulpotomy was significantly lower in the articaine group (p < 0.001).

CONCLUSION

Articaine buccal infiltration can be employed for pulpotomy treatment in primary mandibular second molars.

CLINICAL SIGNIFICANCE

This research will eliminate block injection of lidocaine in children and utilize infiltration of articaine for pulpotomy treatment of mandibular teeth, hence preventing lingual nerve damage and prolonging paresthesia of IAN, lip, and cheek bite due to IAN block anesthesia.

Efficacy of orally administered prednisolone versus partial endodontic treatment on pain reduction in emergency care of acute irreversible pulpitis of mandibular molars: study protocol for a randomized controlled trial

BACKGROUND

Irreversible pulpitis is a highly painful inflammatory condition of the dental pulp which represents a common dental emergency. Recommended care is partial endodontic treatment. The dental literature reports major difficulties in achieving adequate analgesia to perform this emergency treatment, especially in the case of mandibular molars. In current practice, short-course, orally administered corticotherapy is used for the management of oral pain of inflammatory origin. The efficacy of intraosseous local steroid injections for irreversible pulpitis in mandibular molars has already been demonstrated but resulted in local comorbidities. Oral administration of short-course prednisolone is simple and safe but its efficacy to manage pain caused by irreversible pulpitis has not yet been demonstrated. This trial aims to evaluate the noninferiority of short-course, orally administered corticotherapy versus partial endodontic treatment for the emergency care of irreversible pulpitis in mandibular molars.

METHODS/DESIGN

This study is a noninferiority, open-label, randomized controlled clinical trial conducted at the Bordeaux University Hospital. One hundred and twenty subjects will be randomized in two 1:1 parallel arms: the intervention arm will receive one oral dose of prednisolone (1 mg/kg) during the emergency visit, followed by one morning dose each day for 3 days and the reference arm will receive partial endodontic treatment. Both groups will receive planned complete endodontic treatment 72 h after enrollment. The primary outcome is the proportion of patients with pain intensity below 5 on a Numeric Scale 24 h after the emergency visit. Secondary outcomes include comfort during care, the number of injected anesthetic cartridges when performing complete endodontic treatment, the number of antalgic drugs and the number of patients coming back for consultation after 72 h.

DISCUSSION

This randomized trial will assess the ability of short-term corticotherapy to reduce pain in irreversible pulpitis as a simple and rapid alternative to partial endodontic treatment and to enable planning of endodontic treatment in optimal analgesic conditions.

TRIAL REGISTRATION

ClinicalTrials.gov, identifier: NCT02629042 . Registered on 7 December 2015. (Version n°1.1 28 July 2015).

Pulp repair after pulpotomy using different pulp capping agents: a comparative histologic analysis

PURPOSE

This study's purpose was to histologically evaluate the repair of rat tissue after pulpotomy and covering the pulp tissue with Copaifera langsdorffi oil resin, green propolis extract, fibrin sponge and iodoform-based paste.

METHODS

Pulpotomies were performed in the maxillary and mandibular first molars of 21 Wistar rats (84 total teeth). The access cavities were sealed with Coltosol, and histological evaluations were performed at 24 hours, 15 days, and 30 days postoperatively.

RESULTS

For all experimental periods and materials, an inflammatory response constituted predominantly by neutrophils was observed, being of milder intensity for the Copaifera langsdorffii oil-resin group and more severe for the fibrin sponge group, which exhibited periapical microabscesses. Necrosis was observed in all groups, and its extension increased with time, except for teeth protected with Copaifera langsdorffii oil-resin. Formation of a mineralized tissue barrier in the pulp exposure area occurred only in the Copaifera langsdorffii oil-resin group. Other findings, such as vascular congestion, edema, and hemorrhage, were observed in all cases.

CONCLUSIONS

The inflammatory response was less severe, the area of pulp necrosis was smaller, and more frequent formation of a mineralized tissue barrier was noted after pulpotomy was performed with Copaifera langsdorffii oil-resin compared to the other materials tested.

Complications within the first 24 hours after dental rehabilitation under general anesthesia

PURPOSE

The purpose of this survey study was to assess adverse events in young, healthy children treated for dental caries under general anesthesia (GA) in the first 24 hours after discharge from Cincinnati Children's Hospital Medical Center (CCHMC).

METHODS

This study involved a sample of 50 2- to 10-year-old healthy patients who were scheduled for dental rehabilitation under GA at CCHMC. The principal investigator called 24 hours after discharge from the treatment facility and interviewed parents using a 22-item questionnaire, which generally addressed some daily functions of childhood. Analysis of the data involved descriptive statistics, frequency distribution, and cross-tabulation.

RESULTS

There was no significant difference among patients by gender or age group who slept while traveling home. Older children tended to vomit, while younger children had diarrhea. More moderate and severe complaints were reported for restorative work involving stainless steel crowns (SSCs) compared to no restorative work (ie, extractions only) or restorative work without SSCs.

CONCLUSION

Some children may experience temporary disruption of bodily functions. Additionally, restorative procedures involving stainless steel crowns may cause more complaints and a return to preoperative home behaviors may take 6 or more hours.

Repair of furcal perforation treated with mineral trioxide aggregate in a primary molar tooth: 20-month follow-up

Furcal perforations may occur during access opening of the pulp chamber or cavity preparation. The perforation can cause an inflammatory reaction in the periodontal ligament. Management of these iatrogenic accidents can pose a significant clinical challenge, mainly when they occur in primary teeth. Current developments in the techniques and materials utilized for root perforation repair have enhanced this procedure's prognosis. Recently, mineral trioxide aggregate (MTA) has been used for several dental purposes. This biocompatible material promotes bone healing and elimination of clinical symptoms. The purpose of this case report was to describe the treatment of a furcal perforation using mineral trioxide aggregate (MTA) in a primary molar tooth. After 20 months, the tooth was asymptomatic. The radiolucent image had disappeared and bone formation at the furcation area had been observed, suggesting healing of the underlying periodontal tissues. Therefore, MTA may be considered an alternative option for the repair of furcal perforation in primary teeth, prolonging the longevity of these dental elements.

Spontaneous alignment of permanent successors after enucleation of odontogenic cysts associated with primary teeth

Pulpotomy and pulpectomy occasionally lead to cyst formation in the primary dentition. They show specific clinical features of large size, rapid growth, buccal expansion and displacement of permanent teeth. Complete enucleation of the cyst with extraction of the associated primary teeth and preservation of the permanent teeth appeared to be the most suitable treatment option. Normal alignment of the permanent teeth occurred spontaneously even their initial positions were highly unfavourable.

Effect of formaldehyde on rat liver in doses used in pulpotomies

Many studies have questioned the toxic effects of formocresol, one of which is its systemic distribution. This study focused on determining whether there was risk of acute hepatic lesion after the use of intravenous formaldehyde in doses for multple pulpotomies in rats. Histological and biochemical changes were evaluated. Results showed that very high doses of formaldehyde injected into rats, doses that were much higher than those given for multiple pulp treatments in a single session in Pediatric Dentistry, showed no signs of liver toxicity.

Endodontics and infective endocarditis – is antimicrobial chemoprophylaxis required?

The purpose of this review is to evaluate the evidence implicating nonsurgical endodontic procedures in inducing infective endocarditis (IE). The literature is reviewed and findings about dental procedures that elicit bacteraemia [in particular root canal treatment (RCT)], sequelae of bacteraemia, relationship between IE and RCT and variation between antibiotic prophylaxis (AP) guidelines are highlighted. At present, there is still significant debate as to which dental procedures require chemoprophylaxis and what antibiotic regimen should be prescribed. Currently, there are insufficient primary data to know whether AP is effective or ineffective against IE. Practitioners are bound by current guidelines and medico-legal considerations. Thus, the profession requires clear, uniform guidelines that are evidence-based.

Iatrogenic trauma to oral tissues

BACKGROUND

Iatrogenic trauma can be defined as any trauma that has been induced by the dentist's activity, manner, or therapy. The aim of this article is to present traumatic oral tissue lesions of iatrogenic origin.

METHODS

Thirteen cases of chemical (due to ferric sulfate and formocresol), physical (due to orthodontic wires and appliances), and thermal (due to electrosurgery) injuries to the oral tissues are reported.

RESULTS

Chemical, physical, and thermal injuries in the oral, gingival, or palatinal mucosa of iatrogenic origin can exhibit various clinical features. The management of traumatic injuries is dependent on the severity of the involvement in the periodontal tissues. While, in most cases, the elimination of the offending agent and symptomatic therapy were sufficient, in severe cases, or when the injury resulted in permanent defects, periodontal surgery and regenerative therapy may be necessary.

CONCLUSIONS

The skill, experience, and up-to-date knowledge of dentists are the main factors to prevent possible iatrogenic traumas. Although "To err is human," careful practice is very important for the principle "Primum non nocere" ("First do no harm").

Microleakage of restorative techniques for pulpotomized primary molars

PURPOSE

This study's purpose was to assess in vitro microleakage of different restorative materials after pulpotomies in primary molars.

METHODS

Proximo-occlusal cavity preparations were prepared in 60 extracted primary molars. The selected teeth had at least 3 sound walls and one half to two thirds of root length remaining. Carious tissue was removed, pulpotomy was performed, and IRM filled the pulp chamber. The teeth were then randomly divided equally into 5 groups and restored as follows: (1) group 1 with a compomer; (2) group 2 with a reinforced glass ionomer material; (3) group 3 with amalgam; (4) group 4 with a stainless steel crown (SSC); and (5) group 5 with IRM only (control). After thermocycling for 500 cycles, teeth were immersed in dye for 24 hours and progressively ground prior to microleakage evaluation. The worst result for each section was logged and results were statistically analyzed (Kruskal-Wallis and Mann-Whitney).

RESULTS

Group 1 showed the highest percentage of no leakage of all groups. Leakage from occlusal and cervical margins was markedly shown for all specimens of groups 2, 3, and 5.

CONCLUSIONS

(1) Bonding agents and resin based restorations were able to provide the best total margin protection. (2) SSCs cemented with glass ionomer cement were unable to hermetically seal teeth; and (3) Tytin, Ketac Molar, and IRM restorations did not appear to be leakage-resistant materials for pulpotomies of primary molars.

A randomized controlled trial comparing mandibular local anesthesia techniques in children receiving nitrous oxide-oxygen sedation

The aim of this study was to test the hypothesis that dental pain control using infiltration/intrapapillary injection was less effective than inferior alveolar block/long buccal infiltration anesthesia in children. A total of 101 healthy children, aged 5-8 years, who had no contraindication for local anesthetic and who needed a pulpotomy treatment and stainless steel crown placement in a lower primary molar were studied. A 2-group randomized blinded controlled design was employed comparing the 2 local anesthesia techniques using 2% lidocaine, 1:100,000 epinephrine. All children were given 40% nitrous oxide. Children self-reported pain using the Color Analogue Scale. The study was conducted in a private pediatric dental practice in Mount Vernon, Wash. Overall pain levels reported by the children were low, and there were no differences between conditions at any point in the procedure. Pain reports for clamp placement were block/long buccal 2.8 and infiltration/intrapapillary 1.9 (P = .1). Pain reports for drilling were block/long buccal 2.0 and infiltration/intrapapillary 1.8 (P = .7). Nine percent of children required supplementary local anesthetic: 4 of 52 (7.7%) in the block/long buccal group and 5 of 49 (10.2%) in the infiltration/intrapapillary group (P = .07). The hypothesis that block/long buccal would be more effective than infiltration/intrapapillary was not supported. There was no difference in pain control effectiveness between infiltration/intrapapillary injection and inferior alveolar block/long buccal infiltration using 2% lidocaine with 1:100,000 epinephrine when mandibular primary molars received pulpotomy treatment and stainless steel crowns.

Outcomes of vital primary incisor ferric sulfate pulpotomy and root canal therapy

PURPOSE

To compare ferric sulfate (FS) pulpotomy and primary tooth root canal therapy (RCT) in cariously exposed vital pulps of primary incisors.

METHODS

A total of 133 incisors in 50 children were randomly selected to be treated by FS pulpotomy (64) or RCT (69).

RESULTS

Two years after treatment, 77 incisors (41 FS pulpotomy, 36 RCT) were available for clinical and radiographic examination. There was no clinical evidence of pathosis in 78% of FS pulpotomy-treated and 100% of RCT-treated incisors. Two independent pediatric dentists evaluated periapical radiographs of the treated incisors. Incisors were classified into 1 of 4 treatment outcomes: N, normal treated incisor; H, nonpathologic radiographic change present; PO, pathologic change present, but not requiring immediate extraction; PX, pathologic change present, extract immediately. Survival analysis was applied. A moderate level of agreement between raters was found for incisors with outcome PX (K = 0.54). Intra-rater reliability was substantial for incisors with outcome PX (K = 0.61). No difference was demonstrated in the proportion of FS pulpotomy- and RCT-treated incisors rated PX at the 2-year recall (x2 = 0.6). RCT incisors demonstrated a significantly higher survival rate than FS pulpotomy incisors at 2 years (p = 0.04).

CONCLUSIONS

Treatment outcomes for RCT incisors were not significantly different from FS pulpotomy-treated incisors at 2 years; however, at 2 years the survival rate of RCT incisors was statistically greater than that of FS pulpotomy-treated incisors.

Premature exfoliation of primary molars related to the use of formocresol in a multivisit pulpotomy technique: a case report

Since its introduction in 1904, formocresol has become one of the most widely studied dental medicaments. In the United Kingdom, it is the preferred primary tooth pulpotomy medicament of the majority of Specialists in Paediatric Dentistry. Reports of adverse effects resulting from its clinical use are rare. This paper presents a case of premature exfoliation of primary molars that may be related to the use of formocresol in a multivisit pulpotomy technique.

Radiographic features and outcome of root canal treatment carried out in the Łódź region of Poland

AIM

The aim of this study was to assess the radiographic features and factors affecting the long-term results of root canal treatment in the Lódź region of Poland.

METHODOLOGY

Three hundred and fifty-five periapical radiographs of previously endodontically treated teeth (282 root-filled teeth and 73 teeth with pulpotomy) from 236 patients were evaluated in the study. The patients were aged from 15 to 76 years and randomly selected amongst subjects referred to the Institute of Dentistry. Medical University of Lódź and two private dental practices. The radiographs were examined by the authors according to criteria proposed by De Cleen et al. (1993) using an illuminated viewbox in a dark room. The Fisher's exact test was used to compare the frequencies in teeth groups.

RESULTS

Amongst root-filled teeth, 49% were adequately filled within 0-2 mm of the radiographic apex. Periapical radiolucencies were observed in 25% of root-filled teeth. Teeth without periapical pathosis were more often filled within 0-2 mm of the apex (59%) than teeth with pathosis (17%). Teeth were most often adequately filled (64%) in patients attending the Institute of Dentistry. In patients attending the dental outpatients' departments, 71% of teeth were inadequately filled. Amongst the teeth treated with pulpotomy, 67% had a periapical radiolucency.

CONCLUSION

The radiographic technical quality of the root canal treatment was associated with the outcome that root fillings of adequate standard were associated with health more often than inadequate root fillings. Pulpotomy was associated with periapical disease in the majority of cases.

Success rate of formocresol pulpotomy in primary molars restored with stainless steel crown vs amalga

PURPOSE

The purpose of this retrospective study was to compare the success rates of formocresol pulpotomy in primary molars restored with stainless steel crowns (SSC) to those restored with amalgam (AM).

METHODS

Radiographs of pulpotomized primary molars restored with SSC or AM in the principal author's pediatric dentist practice were evaluated and defined as a "failure" when one or more of the following signs were present: internal (IR) or external (ER) root resorption and periapical (PR) or inter-radicular (IRR) radiolucency. Pulp canal obliteration was not regarded as failure. Three hundred and forty-one molars were available for follow-up evaluations ranging from 6 to 103 months.

RESULTS

Forty-seven (14%) teeth were defined as "failure," with a rate of 13% (36/287) for teeth restored with SSC and 20% (11/54) for AM. This difference was not statistically significant (P>0.1). Failure rates of 2 surfaces AM was 23% (7/30), much higher than that of one surface AM (10%, 2/20). Most of the failed teeth presented more than one pathologic finding, with IR being the most frequently observed (36%), followed by ER (31%), IRR (22%) and PR (11%). Pulp canal obliteration was detected in 80% of the teeth, with similar rates in both groups. Failures were observed initially after a mean follow-up of 27 and 29 months in teeth restored with AM and SSC, respectively.

CONCLUSIONS

Pulpotomized primary molars can be successfully restored with one surface amalgam if their natural exfoliation is expected within not more than two years.

Histological evaluation of electrosurgery and formocresol pulpotomy techniques in primary teeth in dogs

The purpose of this study was to compare pulpal and periapical tissue reactions to electrosurgery versus formocresol pulpotomy techniques in the primary teeth of dogs. The study was conducted on 33 primary teeth of three mongrel dogs between the ages of one to three months. Each dog had three teeth treated by Formocresol Pulpotomy with Mechanical Coronal Pulp Removal (FC), three teeth treated by Electrosurgery Pulpotomy with Mechanical Coronal Pulp Removal (ES/MCPR), three teeth treated by Electrosurgery Pulpotomy with Electrosurgical Coronal Pulp Removal (ES/ECPR), and two teeth serving as untreated Controls. Dogs one, two and three were sacrificed performing the pulpotomies at two, four and six weeks, respectively. The pulp, periapical tissue and after surrounding bone were submitted to histological examination and the histological reaction was recorded. The results were fourteen out of 18 unfavorable and zero out of three favorable histological reactions occurred in the FC treated teeth. Six out of 18 unfavorable and one out of three favorable histological reactions occurred in the ES/MCPR treated teeth. Nine out of 18 unfavorable and two out of three favorable histological reactions occurred in the ES/ECPR treated teeth. One out of 18 unfavorable and zero out of three favorable histological reactions occurred in the untreated Control teeth. The conclusion of this study is that of the three experimental groups, the teeth treated by Electrosurgery Pulpotomy with either Mechanical or Electrosurgical Coronal Pulp Removal exhibited less histopathological reaction than the teeth treated by Formocresol Pulpotomy.

Comparison of ferric sulfate, formocresol, and a combination of ferric sulfate/formocresol in primary tooth vital pulpotomies: a retrospective radiographic survey

Studies have suggested that formocresol has toxic and carcinogenic potential. A search for an alternative medicament for primary tooth pulpotomies has led to ferric sulfate as a possible alternative. A retrospective study was done in a multipractitioner IHS (Indian Health Service) clinic. Radiographic success or failure was determined for 202 primary tooth pulpotomies performed with either formocresol, ferric sulfate, or a combination procedure of formocresol and ferric sulfate. The post-operative period for the pulpotomies ranged from one month to thirty-six plus months. There was no statistical difference in radiographic failure rates between formocresol, ferric sulfate, or the combination procedure when results were analyzed regardless of post-op period. However, when post-op periods were considered, formocresol performed better at > 36 months and the combination procedure showed significantly more failures at > 36 months.

Results of crown-height reduction and partial coronal pulpectomy in rhesus monkeys (Macaca mulatta)

BACKGROUND AND PURPOSE

In research facilities using non-human primates, crown-height reduction with partial coronal pulpectomy ("vital pulpotomy") is routinely performed on canine teeth of adult male monkeys to reduce self-trauma and the potential for injury to staff or cage-mates. Success of pulpotomy techniques in humans is reportedly 40 to 60%. Failure leads to chronic inflammation and pulp necrosis, which introduces variability in research animals, and may affect research results. The purpose of the study reported here was to determine failure rate of this procedure by evaluating clinical and radiographic findings at 3, 9, and 24 months after crown amputation and partial coronal pulpectomy of maxillary canines in adult male rhesus monkeys.

METHODS

Forty-seven maxillary canine teeth from 24 adult male rhesus monkeys were treated by use of crown amputation and partial coronal pulpectomy, using standard dental technique. Follow-up clinical and radiographic examination was performed 3, 9, and 24 months after surgery.

RESULTS

At three months after surgery, there was no clinical evidence of failure at any of the teeth. On the basis of radiographic findings, 2 of 47 teeth had failed and one was suspicious for early failure. At nine months, clinical evidence of failure was not apparent; radiographically, 5 of 44 teeth appeared to have failed and 3 others were suspect. Two years post-operatively, failure was clinically evident at two teeth, with radiographic evidence of failure in five teeth, and suspicion of early failure in an additional six of 41 teeth [corrected].

CONCLUSIONS

The failure rate of crown amputation and partial coronal pulpectomy of canine teeth in adult male rhesus monkeys is high, and the chronic inflammation associated with this is cause for concern.

Clinical preconditions and treatment modality: effects on pulp surgery outcome

BACKGROUND

The purpose of this research was to evaluate the factors affecting the outcome of localized laser pulp surgery in the canine model.

STUDY DESIGN/MATERIALS AND METHODS

Pulpal exposures 2 mm and 5 mm in diameter were prepared in eight healthy teeth in each of five dogs. The total of 40 teeth were left open to infection from the oral cavity for 3 hours or 72 hours; 2-3 mm of surface pulpal tissue were then removed using a fresh diamond bur or a CO2 laser emitting@9.3 microns, at 3.5 W average power in the Superpulse mode. Teeth were monitored clinically and radiographically by one blinded, pre-standardized clinician for 3 months.

RESULTS

Chi-square test and Fisher's Exact test (2-tail) results associated laser treatment with significantly better clinical and radiographic outcome (P < 0.001). Using regression analysis, duration of pulpal exposure to contamination by the oral environment was identified as primary determinant for treatment outcome within the laser-treated and control groups (P = 0.0018).

CONCLUSION

Clinical preconditions significantly affect the outcome of pulp surgery treatments.

Ferric sulfate pulpotomy in primary molars: a retrospective study

PURPOSE

This investigation collected clinical and radiographic data from a retrospective chart review of patients receiving ferric sulfate pulpotomies with a sub-base of zinc oxide eugenol in a clinical practice over a five-year period.

METHODS AND MATERIALS

Clinical and radiographic data were available for 242 primary molars in 171 children with follow-up times ranging from 4-57 mos (mean = 19 mos).

RESULTS

The overall radiographic success rate ranged from 74-80%. The frequency of normal appearing pulps decreased over time. The most frequently observed pulpal responses were calcific metamorphosis (6-33%) and internal resorption (7-18%). Overall clinical success was 99%. Only 9 of the 242 teeth were extracted due to radiographic and/or clinical failure. A survival analysis demonstrated that the overall cumulative probability of survival remained high over time with a cumulative survival of over 90% after 3 years.

CONCLUSIONS

The overall success rates in this study are lower than those reported previously in the literature for ferric sulfate pulpotomies, but are comparable with those reported for 1:5 dilution, 5-min formocresol pulpotomies.

Two radicular cysts associated with endodontically treated primary teeth: rationale for long-term follow-up

Although radicular cysts are relatively rare, they do occur. In addition, it appears that these lesions present in association with endodontically treated primary teeth. As shown in this paper and previous reports, cysts can be associated with a variety of pulp therapies. These lesions can lead to bony expansion and resorption. Radicular cysts may also cause displacement and damage to the developing permanent dentition. Given the severity of these sequelae it is prudent to recommend regular radiographic examination of primary teeth that have undergone pulp therapy.

Odontogenic cysts related to pulpotomized deciduous molars: clinical features and treatment outcome

OBJECTIVE

The purpose of this study was to assess the morbidity and outcomes associated with large cysts that developed in conjunction with pulpotomized deciduous molars.

STUDY DESIGN

This retrospective study was based on the files of 18 patients who were referred to 2 oral surgery departments during a 10-year period (1986-1996). The inclusion criteria were large cyst lesions (>1 cm in diameter) and complete documentation. Data regarding symptoms at presentation, histologic and radiologic features, treatment modalities, morbidity, and outcomes were analyzed.

RESULTS

An equal gender distribution of patients was found, as were a later development in males (12+/-2 years in boys, 9+/-2 years in girls) and a 5:1 ratio favoring the mandible over the maxilla. Treatment included enucleation (12 patients) and marsupialization (6 patients). The morbidity was high and included loss of permanent teeth (3 patients), extensive loss of alveolar bone (3 patients), use of flaps (2 patients), and adjuvant orthodontic treatment (9 patients).

CONCLUSION

Failure of early detection and treatment of cysts that develop in conjunction with pulpotomized deciduous molars can cause considerable morbidity. Therefore, periodic clinical and radiologic follow-up until the eruption of succedaneous teeth is recommended.

Mineralized deposits in pulps of incompletely developed permanent monkey incisors after pulpotomy with tungsten carbide fissure burs

The exposed pulp of incompletely developed permanent incisors of nine monkeys were treated with partial pulpotomy with tungsten carbide fissure burs on an air turbine equipment. The pulps were capped with calcium hydroxide (Dycal) followed by insertion of conventional amalgam. The results were studied by conventional light microscopy after 1 and 6 months. Rod-like mineralized pulpal deposits were seen in five of the nine animals, in 9 out of 67 teeth, evenly distributed at the two observation times. Also the lengths of the deposits appeared similar, while the thickness had increased markedly after 6 months. After 1 month the presence of a central vessel lumen was observed in the deposits. The results seemed to indicate that the mechanism of formation was an initial pathologic mineralization of the vessel wall, and a growth of the deposits by the elaboration of fibrous, atubular dentin on to the outside of this wall.

Glutaraldehyde preparations and pulpotomy in primary molars

The study clinically and radiographically evaluated the long-term success rate of pulpotomy treatment in pulp-exposed primary molars. Five clinicians participated in this study and four glutaraldehyde preparations included 2% buffered, 2% unbuffered, 5% buffered, and 5% unbuffered glutaraldehyde solutions were used. There were 201 children, 108 boys and 93 girls, ranging in age from 4 to 7 years with 258 primary molars treated. After 36 months, 150 teeth with complete clinical records and radiographs were available for evaluation. The treatment of 98% of the patients was clinically successful, but when evaluated radiographically the overall success rate was 78.7%. The group treated with 5% buffered glutaraldehyde showed the highest success rate (87.5%) and group treated with the 5% unbuffered solution the lowest (74.1%), but no significant difference was found among the four groups. Canal obliteration was noted in 22 teeth successfully treated. Four of the teeth that were not successfully treated had canal obliteration before other pathoses became evident. The relative high failure rate in this long-term follow-up indicated that clinicians should be cautious before extensively using glutaraldehyde as a pulpotomy agent.

The effect of glutaraldehyde pulpotomy treatment on pulpal enzymes

The enzymes lactate dehydrogenase (LD), succinate dehydrogenase (SD), alkaline phosphatase (AP), and glucose-6-phosphate dehydrogenase (G-6-PD) were evaluated at specific locations in pulp tissue following glutaraldehyde pulpotomies. Pulpotomies were performed on maxillary first molars in 40 rats after sacrifice at times 0, 24 hr, seven days, or one month, and experimental teeth were treated with 6% buffered glutaraldehyde. Teeth were prepared for frozen sectioning and the sections were subjected to incubation media to detect each enzyme. Significant differences were found regarding the location of staining and the time intervals at which stain was present or absent. Staining for LD and AP was the most intense throughout the four observation time periods, though staining for these enzymes as well as for G-6-PD had begun to diminish by day seven in the coronal thirds. Staining was completely absent in the coronal thirds at one month but remained in the middle and apical thirds throughout one month. SD was the only enzyme that was totally absent in the coronal third at seven days and totally absent in the middle third at one month. These findings suggest that LD, AP, and the biochemical mechanisms that they represent remain active longer than SD and G-6-PD following exposure to glutaraldehyde. This information is important in identifying mechanisms that are important for repair, healing, and recovery following pulpal injury.

Periodontal changes following coronal/root perforation and formocresol pulpotomy

A clinical case report is presented which describes the sequelae of an iatrogenic lateral crown/root perforation and a formocresol pulpotomy. The post-operative course of the initial therapy included significant hard and soft tissue destruction and eventual tooth loss. The possible implication of the role of formocresol is discussed.

Endodontic interappointment flare-ups: a prospective study of incidence and related factors

Severe pain and/or swelling following a root canal treatment appointment are serious sequelae. Information varies or is incomplete as to the incidence of these conditions and related factors. In this study, data were collected at root canal treatment appointments on demographics, pulp/periapical diagnoses, presenting symptoms, treatment procedures, and number of appointments. Patients that then experienced a flare-up (a severe problem requiring an unscheduled visit and treatment) had the correlating factors examined. Statistical determinations were by chi-square analysis with significance at 0.05 or less. Nine hundred forty-six visits resulted in an incidence of 3.17% flare-ups. Flare-ups were positively correlated with more severe presenting symptoms, pulp necrosis with painful apical pathosis, and patients on analgesics. Fewer flare-ups occurred in undergraduate patients and following obturation procedures. There was no correlation between patient demographics or systemic conditions, number of appointments, treatment procedures, or taking antibiotics.

Postoperative pain incidence related to the type of emergency treatment of symptomatic pulpitis

Some endodontic emergencies occur as a result of attempts to relieve symptoms of pulpitis. The aim of this study was to identify any predictor of postoperative pain in a patient population treated by dental students. Patients who reported for treatment of symptomatic pulpitis were subjected to three different emergency treatment regimens. Clinical data was collected on those patients who reported in the emergency service with severe postoperative pain within 24 hours of emergency endodontic treatment. Statistical analysis of these data suggested that the type of endodontic emergency procedure carried out was a significant predictor of severe postoperative pain.

A clinical study of ferric sulfate as a pulpotomy agent in primary teeth

Pulpotomies were performed on 83 primary molars in 62 patients. Ferric sulfate or formocresol was placed on the pulpal stumps, and teeth were followed for 3-, 6-, and 12-month periods. After the one-year follow-up, 28 of 29 teeth treated with ferric sulfate (FS group) were considered successful and 21 of 27 teeth treated with formocresol (FC group) were judged to be successful. The FS group demonstrated greater combined clinical and radiographic success than the FC group at the one-year recall (P < 0.05). Although the results of this study are promising, further study with longer observation periods is warranted before this technique can be recommended.

Healing of the guinea pig incisor after partial pulp removal

A histological and microradiographical study was made of eruption and healing of guinea pig lower incisors after endodontic treatment compared with intact incisors. One incisor per animal was cut perpendicularly at the level of the gingiva. One third to one half of the pulp was removed. The experimental periods were 0, 4, 7, 16, 21 and 31 days. Unstained, HE or Brown and Brenn stained sections were studied microscopically. Some teeth were sectioned undecalcified and studied microradiographically. In intact incisors the dentin matrix deposition and mineralization were described. In the dentin, incisally to the pulp proper, narrow canals, the walls of which consisted of mineralized material, were found opening at the occlusal surface. Histologically, in the treated teeth, a beginning of cell-rich fibrodentin deposition at the original dentin wall was present at Day 4. At Day 7 a substantial walling off of the pulp is achieved by cell-rich and some cell-poor fibrodentin. After 16 days large amounts of cell-rich and cell-poor fibrodentin were covered by some tertiary dentin. After 31 days the amount of tertiary dentin was larger than after 16 days and also covered the incisal part of the root canal walls. Further apically some vasodentin and newly formed normal, secondary, dentin was observed. In course of this period the cells of the cell-rich and cell-poor fibrodentin first showed necrobiosis, then necrosis. The cell-rich fibrodentin appeared not fully mineralized. All blood vessels and strands of soft tissue which ran in canals in the fibrodentin came to a dead end. Thus the root canal was fully obturated. Although the teeth appeared (nearly) normal to the naked eye and radiographically after 31 days, histologically they were not. Large amounts of fibrodentin still being present incisally which showed the dual potential of the guinea pig pulp to produce both fibrodentin and orthodentin.

The floor of the pulp chamber following pulpotomy

The purpose of this study was to investigate the incidence of pulpal floor damage caused by operator error in a standard pulpotomy exercise, and to determine if this damage produced significant changes in dentin morphology and thickness at the base of the pulp chamber. One hundred and fourteen primary molar teeth were utilized in this study, 61 having pulpotomies and the remainder untreated. The dentin thickness in the furcation was measured on all the teeth and the pulpal floor morphology was examined using both light and scanning electron microscopy. The difference in thickness of dentin in the furcation of pulpotomized and non-pulpotomized teeth was not statistically significant. Less than fourteen per cent of pulpotomized teeth showed damage to the pulpal floor and this damage was only minimal in all cases. This study therefore suggests that damage to the pulpal floor during preparation is unlikely to be a factor contributing to failure of pulpotomies.

[Histomorphometry of dentigerous cysts in children, associated or not with formocresol]

Literature reports appeared in the last years suggested that some type of dentigerous cyst (DC) in children would initiate by teh action of other factors than developmental and at different stages of dental sac growth. Periodontitis and pulp therapy with formocresol (FC) have been suggested as aeteological factors, both promoting DC in children by irritation of the underlaying dental sacs of premolar. The purpose of this study is to analyse the pathological changes in DC of patients aged 0 to 15 years, and to compare the findings according to the anatomical site of DC and the existence of previous FC therapy. Morphological changes observed in the epithelium and the connective wall did not show clear differences between both groups of DC. The histometric measurements of epithelial changes did not show significant statistical differences of various parameters in the DC walls. These facts would not support the hypotesis of DC initiation from FC effects.

A critical look at glutaraldehyde

Glutaraldehyde has been proposed as an alternative to formocresol in pulpotomy treatment of primary teeth. Data regarding effects of the two medicaments have been discussed in the literature, but little attention has been given to critical comparisons concerning parameters of toxicity, mutagenicity, and systemic distribution of the two agents. This paper reviews previous data on systemic distribution of glutaraldehyde and formocresol from pulpotomy sites, as well as cytotoxicity and mutagenicity of the agents. Comparisons reveal little difference between the agents on the parameters reviewed. The authors question the rationale for glutaraldehyde as an alternative to formocresol.

[Results of treatment of milk teeth pulp by modified formocresol method]

The purpose of the study was evaluation of the results of treatment of molar pulp diseases by the formocresol method from the standpoint of the development of inflammatory complications in periapical tissues, disturbances of physiological resorption of roots, disturbances of mineralization of crowns of homologous permanent teeth. For the treatment milk molars were qualified with the diagnosis of grade II pulpopathy in children aged from 3 to 9 years. The treatment was done using formocresol by a modified method of pulp amputation according to Buckley after previous devitalization with parapaste. The status of 143 teeth was examined again 1 to 4 years after completion of treatment. The proportion of positive results after one year was 94%, after two years it was 90%, after three years 87% and after four years 80%. The cause of premature loss of most teeth was root resorption acceleration by 18-24 months. No harmful action of formocresol on the buds of permanent teeth was noted.

Radiographic evaluation of pulpal therapy for primary anterior teeth

A total of 144 anterior primary incisors with formocresol pulpotomies or pulpectomies comprised the study sample. Although the former had a moderately high success rate, those incisors treated with the latter procedure had a better prognosis. It may be the preferred treatment when the extent of pulpal involvement cannot be determined.

Consequences of endodontic treatment of primary teeth. Part II. A clinical investigation into the influence of formocresol pulpotomy on the permanent successor

In the context of a study of the development of enamel lesions in permanent successors of primary molars treated by formocresol pulpotomy, a comparative clinical study was performed of 278 premolars divided equally between test side and control side. These teeth were assessed by two observers who, when finding enamel lesions, always differentiated between opacities and hypoplasias. The principal conclusions from this study are the following: The degree of agreement between the two observers was 96 percent. There was no significant difference in number of teeth with enamel lesions, between test side and control side. When the observed teeth with enamel lesions were related to the age at which pulpotomy was performed, the difference was still insignificant. Separate comparison of opacities and hypoplasias likewise showed no significant differences, even if related to age at which pulpotomy was performed. A formocresol pulpotomy exerts no influence on the size of enamel lesions found in permanent successors of the teeth on which pulpotomies were performed. The general conclusion from the results of this study is that formocresol pulpotomy is a successful technique for the treatment of primary teeth, not only as regards the life-span of these primary teeth (see Part I of the study) but also in terms of its effect on their permanent successors.

Long term effects of primary molar pulpotomies on succedaneous bicuspids

Forty-three bicuspids which replaced successfully pulpotomized vital or non-vital primary molars, and twenty bicuspids, which erupted following unsuccessful pulpotomies requiring extraction of the preceding teeth, were examined for defects of position and enamel. In comparison with contralateral control teeth, test teeth in both groups showed an increased prevalence of rotation and enamel surface defects.