Clinical and Radiographic Success Rates of Pulpotomies in Primary Molars Treated with Formocresol, BiodentineTM, and Endo Repair: A Randomized Clinical Trial

ABSTRACT Objective: To compare the clinical and radiographic success rates of formocresol, BiodentineTM, and Endo Repair agents in primary molars after 12 months. Material and Methods: This randomized double-blind clinical trial was conducted on healthy children referred to the Department of Pediatric Dentistry, Kerman, Iran, in 2018. One hundred twenty children (human primary molar teeth) aged 3-9 years were selected and randomly divided into three interventions (with pulpotomy medicament agents), including formocresol, BiodentineTM, and Endo Repair. All pulpotomized teeth were restored using stainless steel crowns and evaluated clinically and radiographically during a 12-month follow-up. Fisher exact test was used to determine the association of categorical variables and the data were analysed with SPSS 25. Results: All the available teeth in formocresol and BiodentineTM groups obtained clinical success, whereas 62.5% of the Endo Repair group was successful in this regard. Radiographic success rates of the formocresol, BiodentineTM, and Endo Repair groups were 94.7%, 70%, and 28.1% after a 12-month follow-up, respectively. Moreover, pulp canal obliteration was observed in 26.3%, 25%, and 12.5% of the formocresol, BiodentineTM, and Endo Repair groups. Conclusion: This study reported a high rate of clinical success using both BiodentineTM and formocresol pulpotomy techniques. However, the radiographic success rate of formocresol was higher than that of BiodentineTM, and Endo Repair was not considered a suitable pulpotomy medicament agent.

Eficacia clínica del MTA en Pulpotomías de pacientes pediátricos: Una Revisión Sistemática / Eficácia Clínica da MTA em Pulpotomias Pediátricas de Pacientes: Uma Revisão Sistemática / Clinical Efficacy of MTA in Pediatric Patient Pulpotomies: A Systematic Review

Objetivo: Analizar la eficacia clínica del Agregado Trióxido Mineral (MTA) en pulpotomías a través de estudios comparativos con el formocresol, sulfato férrico e hidróxido de calcio; en pacientes pediátricos con edad de tres a nueve años. Materiales y Métodos: El artículo se basa en una revisión sistemática de la literatura, por ello, se utilizaron como fuentes de información las bases de datos: PubMed, Scielo, y Biblioteca Virtual de Salud. Asimismo, como criterios de inclusión se establecieron publicaciones del año 2008 al 2019, cuya procedencia se derivó de journalsy revistas académicas arbitradas; los cuales permitieron obtener dieciséis ensayos que evaluaban la eficacia clínica a través de los signos y síntomas de las patologías pulpares más comunes: absceso, inflamación gingival, movilidad patológica, dolor a la percusión y dolor espontáneo. Resultados: El MTA obtuvo una eficacia de 97,9% en contraposición al 86,9% del Sulfato Férrico. En relación al Formocresol, el MTA logró el 99% contra un 98,3% de eficacia. Además, en la comparación del MTA con el Hidróxido de Calcio el primero logró un 98,2% y el segundo 74,5%. Conclusiones: El MTA obtuvo una mayor eficacia clínica debido a su biocompatibilidad, pH básico y su elevada facultad al sellar la cámara pulpar. Por lo tanto, puede emplearse como un material seguro para las pulpotomías de pacientes pediátricos.

Objetivo: Analisar a eficácia clínica do Agregado de Trióxido Mineral (MTA) em pulpotomias através de estudos comparativos com formocresol, sulfato férrico e hidróxido de cálcio; em pacientes pediátricos de três a nove anos de idade. Materiais e Métodos: O artigo é baseado em uma revisão sistemática da literatura, portanto, bases de dados foram utilizadas como fontes de informação: PubMed, Scielo, e Biblioteca Virtual. Da mesma forma, como critério de inclusão, foram estabelecidas publicações de 2008 a 2019, cuja origem foi derivada de periódicos e revistas acadêmicas de referência; o que nos permitiu obter dezesseis ensaios que avaliaram a eficácia clínica através dos sinais e sintomas das doenças mais comuns da polpa: abscesso, inflamação gengival, mobilidade patológica, dor na percussão e dor espontânea. Resultados: A MTA obteve uma eficácia de 97,9% contra 86,9% para o sulfato férrico. Em relação ao Formocresol, o MTA alcançou 99% contra 98,3% de eficácia. Além disso, na comparação do MTA com o hidróxido de cálcio, o primeiro atingiu 98,2% e o segundo 74,5%. Conclusões: A MTA obteve uma maior eficácia clínica devido a sua biocompatibilidade, pH básico e sua alta faculdade ao selar a câmara de celulose. Portanto, pode ser usado como material segura para pulpotomias de pacientes pediátricos.

Objective: To analyze the clinical efficacy of the Mineral Trioxide Aggregate (MTA) in pulpotomies through comparative studies with formocresol, ferric sulfate and calcium hydroxide; in pediatric patients aged three to nine years. Materials and Methods: The article is based on a systematic review of the literature, therefore, databases were used as sources of information: PubMed, Scielo, and Virtual Health Library. Likewise, as inclusion criteria, publications from 2008 to 2019 were established, whose origin was derived from journals and refereed academic journals; which allowed us to obtain sixteen trials that evaluated clinical efficacy through the signs and symptoms of the most common pulp diseases: abscess, gingival inflammation, pathological mobility, pain on percussion and spontaneous pain. Results: MTA obtained an efficacy of 97.9% as opposed to 86.9% for ferric sulfate. Concerning to Formocresol, MTA achieved 99% versus 98.3% efficacy. Also, in the comparison of MTA with Calcium Hydroxide, the former achieved 98.2% and the latter 74.5%. Conclusions: MTA obtained a higher clinical efficacy due to its biocompatibility, basic pH and its high faculty when sealing the pulp chamber. Therefore, it can be used as a safe material for pediatric patient pulpotomies.

Pulpotomía con biodentine comparado con formocresol en pacientes con dentición primaria / Biodentine versus formocresol for pulpotomy in primary teeth

RESUMEN: Introducción: En dentición primaria, la pulpotomía con formocresol ha sido convencionalmente utilizada para el tratamiento de caries cercanas a la pulpa. Sin embargo, la seguridad de este material ha sido cuestionada. Por otro lado, el biodentine ha sido propuesto como un biomaterial sustituto bioactivo de la dentina, pero no está clara su efectividad. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y una tabla GRADE para el resumen de los resultados. Resultados y conclusiones: Identificamos tres revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos correspondientes a ensayos aleatorizados. Concluimos que no se puede establecer con claridad si biodentine comparado con formocresol aumenta el éxito clínico y el éxito radiográfico en pulpotomía en pacientes con dentición primaria, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: Pulpotomy with formocresol is the main treatment protocol following carious pulp exposure in primary teeth, but many concerns have been raised regarding its safety. Biodentine has been proposed as a bioactive dentine substitute, but there is still uncertainty regarding its effectiveness. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified three systematic reviews including two studies overall, of which both were randomized trials. We are uncertain whether biodentine compared to formocresol for pulpotomy improves clinical and radiographic success, as the certainty of the evidence has been assessed as very low.

Amniotic Membrane versus Formocresol as Pulpotomy Agents in Human Primary Molars: An in vivo Study

Objective: To determine and compare the efficacy of Amniotic Membrane (AM) as a pulpotomy agent with Formocresol (FC) clinically and radiographically. Material and Methods: 30 deciduous molars warranted for pulpotomy in 24 children (4-9 years) were divided equally into two groups of 15 each. Group1: Amniotic membrane pulpotomy and Group 2: Formocresol pulpotomy, which was followed by placement of glass ionomer cement and stainless steel crown restoration. The patients were recalled after 1, 3, 6 and 9 months for clinical and radiographic evaluation. Fisher's exact test and Mcnemar test were used for statistical analysis. Results: Results indicated both clinically and radiographically amniotic membrane performed at par with formocresol. Conclusion: Amniotic membrane with its regenerative, antibacterial properties and the ability to deliver growth factors has shown promising results comparable to gold standard formocresol when used as a pulpotomy agent and hence can be recommended as an alternative pulpotomy agent.

Efectividad clínica y radiográfica de la pasta antibiótica CTZ en pulpotomías de molares primarios: ensayo clínico aleatorio controlado / Clinical and radiographic effectiveness of antibiotic paste CTZ in primary molars pulpotomy: ramdomized controlled clinical trial

El objetivo de este trabajo fue evaluar clínica y radiográficamente la efectividad de la pasta antibiótica CTZ en pulpotomías de molares primarios. Se realizó un ensayo clínico aleatorio controlado, en 40 molares primarios de 40 preescolares con edades entre 3 y 6 años. Los pacientes fueron seleccionados y asignados aleatoriamente a dos grupos: Formocresol (n=20), CTZ (Cloranfenicol-Tetraciclina-Oxido de Zinc Eugenol, n=20). Los dientes fueron restaurados con ionómero de vidrio y coronas metálicas de acero preformadas. La evaluación clínica y radiográfica fue realizada a los 3 y 6 meses. Se utilizó el programa SPSS v.17 para el análisis de los datos, y la aplicación del Test Exacto de Fisher al 5 %. El comportamiento clínico a los 3 meses mostró 75 % de éxito para los molares tratados con formocresol y 70 % para el CTZ. Radiográficamente se obtuvo 90 % de éxito para el grupo con formocresol y 100 % para la pasta CTZ. A los 6 meses el éxito clínico del formocresol fue de 85 % y del CTZ 80 %. El éxito radiográfico mostrado fue 65 % para los atendidos con formocresol y 80 % para el CTZ (p > 0,05). No se observaron diferencias significativas entre los grupos de tratamiento. La pasta CTZ es una alternativa en el tratamiento de pulpotomías de molares temporales. Ofrece un efecto antimicrobiano, estabilización del proceso de reabsorción radicular, sin ocasionar daños a la formación del diente permanente.

The objective of this study to evaluate the clinical and radiographic effectiveness of antibiotic paste CTZ in pulpotomy of primary molars. A randomized controlled clinical trial was performed, in 40 molars of 40 patients aged 3 to 6 years. Were selected and randomly assigned to two groups: Formocresol (n=20), CTZ (Chloramphenicol-Tetracycline-Zinc Oxide Eugenol, n=20). The teeth were restored with glass ionomer and performed steel metal crowns. Clinical and radiographic evaluation procedure was performed at 3 and 6 months. SPSS v.17 program for data analysis, and application of the Fisher exact test was used 5 %. The clinical behavior at 3 months showed 75 % success rate for molars treated with formocresol and 70 % for the CTZ. Radiographically 90 % success rate for the group with formocresol and 100 % for the CTZ paste was obtained. At 6 months formocresol clinical success was 85 % and 80 % CTZ. Radiographic success was shown 65 % for those treated with formocresol and 80 % for the CTZ (p>0.05). No significant differences in the results shown were observed. CTZ paste is an alternative in the treatment of pulpotomy of molars. It provides an antimicrobial effect, stabilizing the process of root resorption, without causing damage to the permanent tooth formation.

Tratamientos pulpares en dientes primarios / Pulp therapies in primary teeth

El mantenimiento de las piezas dentarias para desempeñar sus funciones en la alimentación, en la expresión oral, en el mantenimiento de espacios en las arcadas dentarias, en el estímulo para el crecimiento y desarrollo de los maxilares, entre otras acciones, ha sido considerado esencial para el logro de un desarrollo armónico. Por otro lado, y a pesar de los avances en la materia, la caries dental es la causa más frecuente de las patologías pulpares en los dientes primarios y constituye el principal motivo de su deterioro y/o su pérdida. Las características histo-patológicas de la pulpa dental, la brevedad de su ciclo vital, el tamaño relativo de las cámaras pulpares, favorecen el rápido compromiso pulpar y propician que el proceso infeccioso progrese rápidamente a la necrosis. Ello ha determinado y determina el desarrollo de numerosas técnicas y tratamientos, diferentes ofertas terapéuticas de las cuales ninguna ha alcanzado el consenso universal. Como establecen las Guías de Odontología Pediátrica sobre tratamientos pulpares en dientes primarios, la literatura dental en esta área ofrece escasa y pobre evidencia para sustentar las diferentes técnicas y constantemente señalan la necesidad de nuevos y rigurosos estudios que la avalen.

Comparative study of efficacy of formocresol and calcium hydroxide pulpotomy in primary molars

Comparative study of formocresol and calcium hydroxide pulpotomy procedure has a particular importance in this part of the subcontinent where low socioeconomic status is debilitating and does not allow many persons to undergo an expensive therapy like Mineral Trioxide Aggregate therapy, laser therapy and electro cauterization modality of pulpotomy. The purpose of this study was to compare the efficacy of two different vital pulp therapy techniques both clinically and radiographically in cariously exposed primary molars, utilizing calcium hydroxide and formocresol as the material for pulpotomy. It was a Quasi-experimental study. The sampling technique was a non-randomized convenience sampling. The study was conducted and completed in one year 28, Military Dental Centre, La-hore. The study was carried out using clinical and radiological criteria of follow up for evaluating the success of the two techniques by selecting 60 subjects, all Pakistanis. The sample comprised of subjects within 4 to 6 years age bracket selected alternatively according to gender. Formocresol and Calcium hydroxide pulpotomy was performed after amputation and proper hemostasis of the coronal pulp chamber and the selected patients were divided into two groups. The patients selected for formocresol pulpotomy were placed in Group F and the patients for calcium hydroxide pulpotomy were placed in Group C. Follow up of the cases were performed at 03 months, 06 months and 01 year period and the results in terms of success and failure were recorded in the stipulated data form and analyzed by SPSS version 17 for Windows. Sixty cariously exposed primary molars required vital pulp therapy. Thirty primary molars [50%] in Group F and thirty primary molars [50%] in Group C. 27 teeth [90%] treated with formocresol and 17 teeth [56.7%] with calcium hydroxide were classed as clinically and radiographically successful at the end of one year. The results showed a significant difference in the efficacy of the two groups [p= 0.004]. It was concluded that there was a significant difference in the efficacy of the two medicaments projecting higher rate of success with formocresol as compared to calcium hydroxide both clinically and radiographically

Existe associação entre manchas de esmalte em pré-molares e tratamento endodôntico nos seus antecessores decíduos? / Is there an association between enamel stains in premolars and endodontic treatment of their primary molar predecessors?

Objetivo: este estudo longitudinal retrospectivo objetivou avaliar se existe relação entre o surgimento de manchas de esmalte em pré-molares, após o tratamento endodôntico dos seus antecessores molares decíduos.Métodos: as crianças submetidas à pesquisa, pacientes do Instituto de Medicina Integral Professor Fernando Figueira (IMIP), desde a mais tenra idade, foram localizados, juntamente com seus prontuários, e agrupados igualmente em três grupos conforme avaliação: (1) pré-molares sucessores de dentes decíduos que foram submetidos ao tratamento endodôntico com sessão única de Formocresol; (2) pré-molares sucessores de dentes decíduos que foram submetidos ao tratamento endodôntico com CTZ; (3) pré-molares cujos molares decíduos antecessores não possuíam lesões de acometimento pulpar. Um único examinador, com o intuito de identificar manchas de esmalte, avaliou 180 pré-molares, sem conhecimento prévio do histórico clínico ao qual foram submetidos seus antecessores decíduos,utilizando inspeção visual conferindo um índice Cohen´s kappa = 0,90. O teste de Qui-quadrado de Person e o exato de Fisher foram utilizados para identificar as diferenças entre os grupos experimentais e entre os grupos experimentais e o controle, respectivamente, em relação ao surgimento de manchas. O nível de significância adotado nesse estudo foi de 5%. Resultados: foi identificado que 8,3% dos pré-molares tratados com Formocresol e 11,7% tratados com o CTZ apresentaram algum tipo de mancha no esmalte (p>0.05), no entanto, não foram detectadas manchas nos dentes do grupo controle (p<0.05). Conclusão: quando os dentes antecessores decíduos foram submetidos à terapia endodôntico com Formocresol ou CTZ, houve surgimento de manchas em pré-molares, não havendo, no entanto, diferença estatisticamente significante...

Objective: The aim of this longitudinal retrospective study was to investigate whether there is association of the presence of enamel stains in premolars after endodontic treatment of their primary molar predecessors. Method: The children of this research have been patients of the Integral Medicine Institute Professor Fernando Figueira (IMIP) since their earliest age. The children were localized, their clinical charts were retrieved, and three groups were formed according to the evaluation: (1) successor premolars of primary molars subjected to single-session endodontic treatment with formocresol; (2) successor premolars of primary molars subjected to endodontic treatment with CTZ paste; and (3) successor premolars of primary molars that had no previous pulp involvement. A single examiner blinded to the clinical history of the primary molar predecessors evaluated 180 premolars for enamel stains by visual inspection, with a Cohen?s index kappa=0.90. Pearson?s square chi and Fisher?s exact tests were used to identify the differences among the experimental groups, and between the control and experimental groups, respectively, as regards the presence of enamel stains. The significance level was set at 5%. Results: 8.3% of the premolars that had the primary molar predecessors treated with formocresol and 11.7% of those treated with CTZ had some kind of enamel stain (p>0.05). There were no enamel stains in the teeth of the control group (p less than 0.05). Conclusion: When the primary molar predecessors were subjected to endodontic treatment with both formocresol and CTZ, enamel stains developed in the premolars, though without statistically significant difference...

Estudo clínico, radiográfico, histológico e imuno-histoquímico na resposta pulpar após o uso de diferentes materiais capeadores em pulpotomias de dentes decíduos humanos / Clinical, radiographic, histological, and immunohistochemistry study on pulpal response after the use of different pulp capping materials in pulpotomies of human primary teeth

O objetivo deste estudo foi avaliar: 1) a resposta pulpar de dentes decíduos humanos após pulpotomia com diferentes materiais capeadores por meio de análise clínica, radiográfica e histológica; e 2) a expressão da Proteína 1 da Matriz Dentinária (DMP-1) na resposta pulpar. Vinte e cinco molares decíduos inferiores de 22 crianças com idade entre 6 e 9 anos foram criteriosamente selecionados. Os dentes foram randomicamente divididos nos grupos Formocresol de Buckley diluído a 1/5 (Grupo I - FC), Hidróxido de Cálcio (Grupo II HC), Agregado Trióxido Mineral (Grupo III MTA), Otosporin® + Hidróxido de Cálcio (Grupo IV OTO+HC) e Cimento Portland (Grupo V PC), e tratados pela técnica convencional de pulpotomia em sessão única. As avaliações clínicas e radiográficas foram realizadas até o período normal de esfoliação. Os dentes foram extraídos e processados para análise histológica e imuno-histoquímica. Os resultados clínicos e radiográficos não mostraram diferença estatisticamente significativa nos grupos estudados (p>0,05). A análise estatística da avaliação histológica revelou diferença estatisticamente significativa para presença de barreira dentinária e camada odontoblástica entre o Grupo I(FC) e os Grupos II(HC), III(MTA), IV(OTO+HC) e V(PC) visto que o Grupo I(FC) não apresentou barreira dentinária e camada odontoblástica em nenhuma das lâminas observadas. Não houve diferença estatisticamente significativa entre os grupos estudados quando da avaliação da calcificação pulpar. Para o item reabsorção interna observou-se diferença estatisticamente significativa entre o Grupo I(FC), II(HC) e os Grupos III(MTA), IV(OTO+HC) e V(PC) onde não se observaram reabsorções internas nas análises histológicas. A análise da expressão da DMP-1 demonstrou para o Grupo I(FC) imunomarcação localizada na região de calcificações pulpares localizadas nas raízes dos dentes avaliados, não havendo camada odontoblástica nem formação de barreira dentinária. Os Grupos II(HC), III...

The aim of this study was to evaluate: 1) the pulpal response of human primary teeth after pulpotomies with different pulp capping materials through clinical, radiographic and histological analysis; and 2) the expression of Dentin Matrix Protein 1 (DMP-1) in the pulpal response. Twenty-five primary molars of 22 children aged 6-9 years-old were criteriously selected. The teeth were randomly divided into the following groups: Buckleys Formocresol (diluted 1:5) (Group I - FC), Calcium Hydroxide - (Group II CH), Mineral Trioxide Aggregate (Group III MTA), Otosporin® + Calcium Hydroxide (Group IV OTO+CH) and Portland cement (Group V PC); and treated by the conventional technique of pulpotomy at a single appointment. The clinical and radiographic evaluations were performed until the teeth underwent normal exfoliation. The teeth were extracted and processed for histological and immunohistochemical analyses. The clinical and radiographic studies did not show statistically significant difference among the groups studied (p>0.05). The statistical analysis of the histological evaluation revealed statistically significant difference relating to the presence of the dentine barrier and odontoblastic layer between Group I(FC) and Groups II(CH), III(MTA), IV(OTO+CH) and V(PC) since the Group I(FC) did not exhibited dentine barrier and odontoblastic layer in any of the cuts observed. There was no statistically significant difference among the groups studied regarding to the evaluation of pulpal calcification. Concerning to internal resorption, there was a statistically significant difference among Group I(FC), II(CH) and Groups III(MTA), IV(OTO+CH) and V(PC) where internal resorption was not seen in the histological analyses. The analysis of the expression DMP-1 demonstrated for Group I(FC) immunostaining located in the area of pulpal calcifications within the roots of the teeth evaluated; however, neither odontoblastic layer nor dentine barrier were seen...

Estudo clínico, radiográfico, histológico e imuno-histoquímico na resposta pulpar após o uso de diferentes materiais capeadores em pulpotomias de dentes decíduos humanos / Clinical, radiographic, histological, and immunohistochemistry study on pulpal response after the use of different pulp capping materials in pulpotomies of human primary teeth

O objetivo deste estudo foi avaliar: 1) a resposta pulpar de dentes decíduos humanos após pulpotomia com diferentes materiais capeadores por meio de análise clínica, radiográfica e histológica; e 2) a expressão da Proteína 1 da Matriz Dentinária (DMP-1) na resposta pulpar. Vinte e cinco molares decíduos inferiores de 22 crianças com idade entre 6 e 9 anos foram criteriosamente selecionados. Os dentes foram randomicamente divididos nos grupos Formocresol de Buckley diluído a 1/5 (Grupo I - FC), Hidróxido de Cálcio (Grupo II HC), Agregado Trióxido Mineral (Grupo III MTA), Otosporin® + Hidróxido de Cálcio (Grupo IV OTO+HC) e Cimento Portland (Grupo V PC), e tratados pela técnica convencional de pulpotomia em sessão única. As avaliações clínicas e radiográficas foram realizadas até o período normal de esfoliação. Os dentes foram extraídos e processados para análise histológica e imuno-histoquímica. Os resultados clínicos e radiográficos não mostraram diferença estatisticamente significativa nos grupos estudados (p>0,05). A análise estatística da avaliação histológica revelou diferença estatisticamente significativa para presença de barreira dentinária e camada odontoblástica entre o Grupo I(FC) e os Grupos II(HC), III(MTA), IV(OTO+HC) e V(PC) visto que o Grupo I(FC) não apresentou barreira dentinária e camada odontoblástica em nenhuma das lâminas observadas. Não houve diferença estatisticamente significativa entre os grupos estudados quando da avaliação da calcificação pulpar. Para o item reabsorção interna observou-se diferença estatisticamente significativa entre o Grupo I(FC), II(HC) e os Grupos III(MTA), IV(OTO+HC) e V(PC) onde não se observaram reabsorções internas nas análises histológicas. A análise da expressão da DMP-1 demonstrou para o Grupo I(FC) imunomarcação localizada na região de calcificações pulpares localizadas nas raízes dos dentes avaliados, não havendo camada odontoblástica nem formação de barreira dentinária. Os Grupos II(HC), III...

The aim of this study was to evaluate: 1) the pulpal response of human primary teeth after pulpotomies with different pulp capping materials through clinical, radiographic and histological analysis; and 2) the expression of Dentin Matrix Protein 1 (DMP-1) in the pulpal response. Twenty-five primary molars of 22 children aged 6-9 years-old were criteriously selected. The teeth were randomly divided into the following groups: Buckleys Formocresol (diluted 1:5) (Group I - FC), Calcium Hydroxide - (Group II CH), Mineral Trioxide Aggregate (Group III MTA), Otosporin® + Calcium Hydroxide (Group IV OTO+CH) and Portland cement (Group V PC); and treated by the conventional technique of pulpotomy at a single appointment. The clinical and radiographic evaluations were performed until the teeth underwent normal exfoliation. The teeth were extracted and processed for histological and immunohistochemical analyses. The clinical and radiographic studies did not show statistically significant difference among the groups studied (p>0.05). The statistical analysis of the histological evaluation revealed statistically significant difference relating to the presence of the dentine barrier and odontoblastic layer between Group I(FC) and Groups II(CH), III(MTA), IV(OTO+CH) and V(PC) since the Group I(FC) did not exhibited dentine barrier and odontoblastic layer in any of the cuts observed. There was no statistically significant difference among the groups studied regarding to the evaluation of pulpal calcification. Concerning to internal resorption, there was a statistically significant difference among Group I(FC), II(CH) and Groups III(MTA), IV(OTO+CH) and V(PC) where internal resorption was not seen in the histological analyses. The analysis of the expression DMP-1 demonstrated for Group I(FC) immunostaining located in the area of pulpal calcifications within the roots of the teeth evaluated; however, neither odontoblastic layer nor dentine barrier were seen...

Estudo clínico randomizado do laser de baixa intensidade em pulpotomias de dentes decíduos humanos / Randomized clinical study of lower intensity laser in human deciduous teeth after pulpotomy

O objetivo deste estudo foi verificar por meio de observações clínicas e radiográficas a resposta in vivo do complexo dentinopulpar de dentes decíduos humanos após pulpotomia com diferentes terapêuticas para manter a vitalidade pulpar. Sessenta molares decíduos inferiores de crianças com idade entre 5 e 9 anos foram criteriosamente selecionados. Os dentes foram randomizadamente divididos nos grupos Formocresol de Buckley diluído a 1/5 (Grupo I), Hidróxido de Cálcio (Grupo II), Laser de Baixa Intensidade (Grupo III) e Hidróxido de Cálcio precedido por Laser de Baixa Intensidade (Grupo IV) e tratados pela técnica convencional de pulpotomia em uma única sessão. As avaliações clínicas e radiográficas foram realizadas nos períodos de 3, 6 e 12 meses do pós-operatório. Nos resultados observou-se que clinicamente não houve diferença estatisticamente significativa nos grupos estudados. Radiograficamente houve associação em relação à presença de reabsorção interna no grupo II (HC) dos 3 meses para os 6 meses e dos 3 meses para os 12 meses de proservação (p= 0,04) e, em relação à presença de calcificação pulpar nos grupos I (FC) com p=0,04 e no grupo III (LBI+OZE) com p=0,01 dos 3 meses para os 12 meses e dos 6 meses para os 12 meses. Na comparação entre os grupos, a análise estatística dos resultados demonstrou que houve associação entre formação de barreira dentinária entre os grupos I (FC) e II (HC), entre os grupos I (FC) e IV (LBI+HC), entre os grupos II (HC) e III (LBI+OZE) e entre os grupos III (LBI+OZE) e IV (LBI+HC) nos três períodos de avaliação (p=0,00). O Formocresol apresentou os maiores índices de sucesso clínico e radiográfico entre os grupos de estudo, entretanto não está associado à formação de barreira dentinária. O Laser de Baixa Intensidade mostrou maiores índices de sucesso clínico e radiográfico com relação à reabsorção interna e calcificação pulpar em comparação com os grupos II (HC) e IV (LBI+HC), entretanto também não está associado...

The aim of this study was to determine through clinical and radiographic observations response in vivo dentinopulpar complex in human deciduous teeth after pulpotomy with different therapies to maintain their pulp vitality. Sixty mandibular primary molars of children aged between 5 and 9 years were carefully selected. The teeth were randomly divided into groups Formocresol Buckley diluted 1/5 (Group I), Calcium Hydroxide (Group II), Low Intensity Laser (Group III) and Calcium Hydroxide preceded by Low Intensity Laser (Group IV) and treated by a conventional pulpotomy technique in a single session. The clinical and radiographic evaluations were performed at 3, 6 and 12 months postoperatively. The results showed that there was no clinically significant difference among groups. Radiographically there was an association for the presence of internal reabsorption in the group I (FC) of 3 months to 6 months and 3 months to 12 months, and an association for the presence of pulp calcification in groups I (FC) with p=0,04 and group III (LBI+ZOE) with p=0,01 of 3 months to 12 months and 6 months to 12 months. In comparison among the groups in each period, the statistical analysis of results showed that there was an association between the formation of dentin barrier for groups I (FC) and II (CH), for groups I (FC) and IV (LBI+CH), for groups II (CH) and III (LBI+ZOE) and for groups III (LBI+ZOE) and IV (LBI+CH) in the three periods evaluation (p = 0.00). The formocresol showed the higher levels of clinical and radiografic success among the study groups, however is not associated with the formation of dentin barrier. The Low Intensity Laser showed higher levels of clinical and radiographic success with respect to internal resorption and pulp calcification compared with groups II (CH) and IV (LBI + CH), but it is also not associated with the formation of dentin barrier. Thus, it is suggested that Low Intensity Laser may be considered an alternative...

Estudo clínico randomizado do laser de baixa intensidade em pulpotomias de dentes decíduos humanos / Randomized clinical study of lower intensity laser in human deciduous teeth after pulpotomy

O objetivo deste estudo foi verificar por meio de observações clínicas e radiográficas a resposta in vivo do complexo dentinopulpar de dentes decíduos humanos após pulpotomia com diferentes terapêuticas para manter a vitalidade pulpar. Sessenta molares decíduos inferiores de crianças com idade entre 5 e 9 anos foram criteriosamente selecionados. Os dentes foram randomizadamente divididos nos grupos Formocresol de Buckley diluído a 1/5 (Grupo I), Hidróxido de Cálcio (Grupo II), Laser de Baixa Intensidade (Grupo III) e Hidróxido de Cálcio precedido por Laser de Baixa Intensidade (Grupo IV) e tratados pela técnica convencional de pulpotomia em uma única sessão. As avaliações clínicas e radiográficas foram realizadas nos períodos de 3, 6 e 12 meses do pós-operatório. Nos resultados observou-se que clinicamente não houve diferença estatisticamente significativa nos grupos estudados. Radiograficamente houve associação em relação à presença de reabsorção interna no grupo II (HC) dos 3 meses para os 6 meses e dos 3 meses para os 12 meses de proservação (p= 0,04) e, em relação à presença de calcificação pulpar nos grupos I (FC) com p=0,04 e no grupo III (LBI+OZE) com p=0,01 dos 3 meses para os 12 meses e dos 6 meses para os 12 meses. Na comparação entre os grupos, a análise estatística dos resultados demonstrou que houve associação entre formação de barreira dentinária entre os grupos I (FC) e II (HC), entre os grupos I (FC) e IV (LBI+HC), entre os grupos II (HC) e III (LBI+OZE) e entre os grupos III (LBI+OZE) e IV (LBI+HC) nos três períodos de avaliação (p=0,00). O Formocresol apresentou os maiores índices de sucesso clínico e radiográfico entre os grupos de estudo, entretanto não está associado à formação de barreira dentinária. O Laser de Baixa Intensidade mostrou maiores índices de sucesso clínico e radiográfico com relação à reabsorção interna e calcificação pulpar em comparação com os grupos II (HC) e IV (LBI+HC), entretanto também não está associado...

The aim of this study was to determine through clinical and radiographic observations response in vivo dentinopulpar complex in human deciduous teeth after pulpotomy with different therapies to maintain their pulp vitality. Sixty mandibular primary molars of children aged between 5 and 9 years were carefully selected. The teeth were randomly divided into groups Formocresol Buckley diluted 1/5 (Group I), Calcium Hydroxide (Group II), Low Intensity Laser (Group III) and Calcium Hydroxide preceded by Low Intensity Laser (Group IV) and treated by a conventional pulpotomy technique in a single session. The clinical and radiographic evaluations were performed at 3, 6 and 12 months postoperatively. The results showed that there was no clinically significant difference among groups. Radiographically there was an association for the presence of internal reabsorption in the group I (FC) of 3 months to 6 months and 3 months to 12 months, and an association for the presence of pulp calcification in groups I (FC) with p=0,04 and group III (LBI+ZOE) with p=0,01 of 3 months to 12 months and 6 months to 12 months. In comparison among the groups in each period, the statistical analysis of results showed that there was an association between the formation of dentin barrier for groups I (FC) and II (CH), for groups I (FC) and IV (LBI+CH), for groups II (CH) and III (LBI+ZOE) and for groups III (LBI+ZOE) and IV (LBI+CH) in the three periods evaluation (p = 0.00). The formocresol showed the higher levels of clinical and radiografic success among the study groups, however is not associated with the formation of dentin barrier. The Low Intensity Laser showed higher levels of clinical and radiographic success with respect to internal resorption and pulp calcification compared with groups II (CH) and IV (LBI + CH), but it is also not associated with the formation of dentin barrier. Thus, it is suggested that Low Intensity Laser may be considered an alternative...

Adipose Stem Cells as Alternatives for Bone Marrow Mesenchymal Stem Cells in Oral Ulcer Healing

BACKGROUND AND OBJECTIVES: Adipose tissue is now recognized as an accessible, abundant, and reliable site for the isolation of adult stem cells suitable for tissue engineering and regenerative medicine applications. METHODS AND RESULTS: Oral ulcers were induced by topical application of formocresol in the oral cavity of dogs. Transplantation of undifferentiated GFP-labeled Autologous Bone Marrow Stem Cell (BMSCs), Adipose Derived Stem Cell (ADSCs) or vehicle (saline) was injected around the ulcer in each group. The healing process of the ulcer was monitored clinically and histopathologically. Gene expression of vascular endothelial growth factor (VEGF) was detected in MSCs by Reverse Transcription-Polymerase Chain Reaction (RT-PCR). Expression of VEGF and collagen genes was detected in biopsies from all ulcers. Results: MSCs expressed mRNA for VEGF MSCs transplantation significantly accelerated oral ulcer healing compared with controls. There was increased expression of both collagen and VEGF genes in MSCs-treated ulcers compared to controls. CONCLUSIONS: MSCs transplantation may help to accelerate oral ulcer healing, possibly through the induction of angiogenesis by VEGF together with increased intracellular matrix formation as detected by increased collagen gene expression. This body of work has provided evidence supporting clinical applications of adipose-derived cells in safety and efficacy trials as an alternative for bone marrow mesenchymal stem cells in oral ulcer healing.

Comparative evaluation of formocresol and mineral trioxide aggregate as pulpotomy agents in deciduous teeth.

Aim: To evaluate and compare mineral trioxide aggregate (MTA) and formocresol as pulpotomy medicaments by clinical and radiographic assessments and to assess the histological features of both pulpotomy medicaments in deciduous teeth. Materials and Methods: This study was performed on 100 mandibular deciduous molar teeth requiring pulpotomy treatment. Children between age four and six years were randomly selected and divided into formocresol or MTA group. The patients were recalled after 3, 6, 9, 12 months respectively and evaluated clinically and radiographically. Histological assessment was done on lower deciduous canine teeth, which were undergoing serial extraction for interceptive orthodontic purpose. Pulpotomy was done on four teeth with formocresol and another four teeth with MTA. The teeth were extracted after six months following pulpotomy procedure and histologically evaluated. Two freshly extracted carious teeth were taken as controls. Results: Clinical and radiographic criteria were laid and Chi analysis revealed significant difference in mobility ( P≤0.05), periodontal ligament widening ( P≤0.01 level) and inter - radicular radiolucency ( P≤0.02 level) between two groups at the end of 12 months. Histologically, in MTA group, a layer of new dentine formation with less dentinal tubules at the pulpotomized site was found. In formocresol group, increased inflammatory cells, a zone of atrophy, were noted in radicular portion of pulp. Conclusion: MTA is superior to formocresol clinically, radiographically. Histological analysis showed better reparative ability with hard tissue barrier formation with MTA compared to formocresol.

Histological evaluation of the pulp of primary teeth after pulpotomy with formocresol and SUAB2

Formocresol is a popular pulpotomy medicament in primary dentition. Because of its systemic and local side effects, it may be essential to use another material instead of formocresol. The purpose of this study was to assess the pulpal response after pulpotomy histologically with two different agents; namely, formocresol and SUAB2. In this randomized clinical trial study, 14 teeth of seven children that should had been extracted because of orthodontic treatment were selected. These teeth were randomly divided into two formocresol and SUAB2 [Shahed University Anti Bleeding 2] groups. Seven teeth were pulpotomized with formocresol and seven teeth with SUAB2. These teeth were extracted after 2 months and the pulpal response was evaluated. Finally, the data were analyzed with exact fisher and Mann-Whitney tests. In the formocresol group, severe inflammation was seen in four teeth, mild inflammation in three teeth, abscess in four teeth, necrosis in two teeth, fibrosis in three teeth and internal resorption in four teeth. In the SUAB2 group, severe inflammation was not seen. Moderate and mild inflammation was seen in four teeth, abscess in two teeth, necrosis in two teeth, fibrosis in three teeth and internal resorption in four teeth. Mann-Whitney test revealed that inflammation is significantly less in the SUAB2 group compared with the formocresol group [p<0/05]. Based on the results of this study, SUAB2 may be used in primary teeth pulpotomy

Comparison of three pulpotomy agents in primary molars: a randomised clinical trial

Pulpotomy is an accepted treatment for the management of cariously exposed pulps in symptom free primary molars. The purpose of this study was to compare the clinical and radiological outcomes of three different single-visit vital pulp therapies including pulpotomy with electrosurgery [ES], formocresol [FC] and ferric sulfate [FS] in cariously exposed primary molar teeth. Seventy-six patients, 5-10 years old, were enrolled in this clinical investigation. One primary molar tooth of each patient was selected for this study. Samples were randomly divided into three groups. Teeth were treated with FC in group 1 [i.e. control group] [n=24], FS in group 2 [n=28], and ES in group 3 [n=24] using standardized pulpotomy procedures. All treated teeth were clinically and radio graphically evaluated after 6 and 9 months. Statistical analysis was performed using Fishers exact test. The overall success rate in groups 1, 2 and 3 was 87.5%, 82.1% and 83.3%, respectively. Favorable clinical and radiological success rates of FS and ES pulpotomy was observed which was comparable to FC. FS and ES can be considered alternative materials for the pulpotomy of primary molars

[Histopatological evaluation of pulpal response of primary teeth following pulpotomy with formocresol, ferric sulfate and Iranian mineral trioxide aggregate]

Formocresol is one of the most common pulpotomy madicaments in the primary teeth. Because of its systemic and local side effects, it may be essential to use another material instead of formocresol. The purpose of this study was to assess the pulpal response after pulpotomy in the primary teeth using 3 different agents: formocresol, ferric sulfate and Iranian MTA. In this randomized clinical trial, 30 teeth of 14 children that were to be extracted because of orthodontic treatment were selected. These teeth were divided randomly into three groups of 10. The teeth in each group were pulpotomized with formocresol, ferric sulfate and MTA, respectively. These teeth were extracted after 2 months and the pulpal responses were evaluated according to the degree of inflammation and extent of pulpal involvement. Dentinal bridge formation was also evaluated. Finally, the data were analyzed with Kruskal-wallis and sign test. In the formocresel group, moderate and severe inflammation was seen in 5 cases, necrosis in 4 cases, and abscess in 1 case. In the ferric sulfate group, moderate and severe inflammation was seen in 5 cases, necrosis in 1, abscess in 1, and internal rsorption in 1 case. In this group, dentinal bridge was formed in 1 case. In the MTA group, severe inflammation was seen in 1 case and dentinal bridge formation in 7 cases. Kruskal-wallis test revealed that inflammation in the MTA group was less than that of formocresol and sulfate ferric, significantly [p < 0.05]. Sign test showed that dentinal bridge formation in the MTA group was more than that in formocresol and ferric sulfate, significantly [p < 0.05]. Based on the results of this study, Iranian MTA can be used in primary teeth pulpotomy

Análise química do formocresol após simulação de uso em clínica / Chemical analysis of formocresol after simulated clinical use

Objetivo: Analisar o teor de formaldeído em diversas marcas de formocresol e verificar se há alteração na fórmula do produto após simulação de uso, bem como das marcas entre si. Método: Neste estudo in vitro foram utilizados quatro diferentes marcas comerciais do medicamento formocresol (Biodinâmica, Iodontec, Inodon e Iodontosul) realizando simulação de seu uso em clínica através da manipulação diária dos produtos por um período de 60 dias. A análise química foi realizada nos laboratórios da Faculdade de Química da PUCRS, com o formaldeído, principal componente com propriedade de evaporação significativa do formocresol, onde foram realizadas três análises químicas pelo método de cromatografia gasosa. Resultados: Houve diminuição no teor de formaldeído durante o período de 60 dias nas quatro marcas comerciais, sugerindo que a eficácia do produto pode ser diminuída ao longo do uso. Constatou-se também que houve diferença na quantidade inicial de formaldeído entre as marcas pesquisadas. Conclusão: A eficácia do produto pode ser diminuída ao longo do uso, porém não há evidências conclusivas, havendo a necessidade de estudos adicionais.

Objective: To analyze the formaldehyde content in different brands of formocresol and to evaluate whether there are alterations in the product formula after simulated use and among the brands. Method: This in vitro study used four commercial brands of formocresol (Biodinâmica®, Iodontec®, Inodon® and Iodontosul®) simulating its clinical use by handling these products daily during 60 days. The chemical analysis was performed at the laboratory of PUCRS's Chemistry School and focused on formaldehyde, which is formocresol's main component with Signify cant evaporation property. The analysis comprised three chemical analyses by the gaseous chromatography method. Results: There was a decrease in the formaldehyde content decreased in the 60-day period for all four brands, suggesting that the product efficiency may decrease with time. It was also observed that the initial formaldehyde content differed among the researched brands. Conclusion: The efficacy of the product may decrease with time, but the results are not conclusive, needing further research.

Estudo clínico e radiográfco do formocresol de Buckley a 1/5 e do cimento Portland utilizados para pulpotomias em dentes decíduos humanos / Clinical and radiographic study on 1/5 dilution of Buckley?s formocresol and Portland cement used for pulpotomies of human primary teeth

O objetivo deste estudo foi comparar a eficácia clínica e radiográfca do formocresol de Buckley diluído a 1/5 e do cimento Portland como agentes capeadores pulpares em dentes decíduos humanos acometidos por cárie extensa, tratados pela técnica convencional de pulpotomia. Sessenta e oito primeiros molares inferiores em 52 crianças com idades entre 5 e 9 anos foram criteriosamente selecionados. De forma randômica, formaram-se dois grupos de 34 molares, cada qual sendo tratado com um dos agentes capeadores a serem comparados. Após a realização das pulpotomias, avaliações clínicas e radiográficas foram realizadas nos períodos de 3, 6 e 12 meses do pós-operatório. Nenhum sinal de falha clínica foi observado, para ambos os grupos, em todos os períodos avaliados. Diferença estatisticamente signifcativa entre os grupos foi observada apenas quando avaliada a coloração da coroa dentária e a obliteração do canal radicular, visto que todos os dentes tratados com o cimento Portland apresentaram discreta coloração acinzentada e estenose radicular. O cimento Portland foi tão efetivo quanto o formocresol como capeador pulpar em pulpotomias de dentes decíduos. Embora os resultados sejam encorajadores, estudos futuros e com acompanhamentos a longo prazo são necessários para se determinar a indicação clínica segura do cimento Portland.

This study aimed at comparing the clinical and radiographic effectiveness of 1:5 dilution of Buckley?s formocresol and Portland cement as pulp dressing agents in carious primary teeth treated by conventional pulpotomy. Sixty eight primary mandibular molars in 52 children between 5 and 9 years old were criteriously selected. Clinical and radiographic evaluations were recorded 3, 6 and 12-months postoperatively. No signs of clinical failure were observed at all follow-up appointments in both groups. Statistically signifcant difference between both groups was only observed when assessing tooth crown discoloration and pulp canal obliteration since all of the teeth treated with Portland cement presented dicrete grayish discoloration and root stenosis. Portland cement was equally effective as formocresol as pulp capping agent in pulpotomies of deciduous teeth. Although our results are very encouraging, further studies and longer follow-up assessments are needed in order to determine the safe clinical indication of Portland cement.

Comparative evaluation of jojoba oil versus formocresol pulpotomy in primary molars - in vitro study [histopathological and immunohistochemical]

This study was conducted to evaluate and compare the histopathological and immunohistochemical responses of dog's dental pulp to formocresol pulpotomy versus jojoba. It was conducted on 32 primary molars of four dogs between the ages of one to two months. One of the dogs was used as control, while the rest of the molars were treated by formocresol and jojoba oil [pulpotomies]. The animals were destroyed after one month. The pulp tissues of all the teeth were submitted to histological and immunohistochemical evaluation. The pulp of the Jojoba oil treated group revealed slight hypervascularization, some blood vessels showed dilatation and areas of pulp calcification were detected. The cellularity of the pulp and its fibrous elements appeared normally with no inflammatory cell infiltration, while the pulp treated with formocresol was highly vascularized with high number of chronic inflammatory cells, areas of calcification with obvious increased collagen fiber density, in addition to numerous vacuoles and necrotic areas. In addition jojoba oil showed moderate immunoreactivity of von Willebrand factor in endothelial cells which may indicate increase in nitric oxide synthase. Histological and immunohistochemical reactions of dental pulp to Jojoba oil were more favorable than formocresol. The greater success rate of jojoba oil rather than FC pulpotomy in this study is attributed to anti inflammatory effect of jojoba oil compared to formocresol