X-ray evaluation of pulp calcification in adult permanent teeth after pulpotomy / 北京大学学报(医学版)

OBJECTIVE@#To compare the clinical effects of pulpotomy with two kinds of calcium silicate materials, and to evaluate the formation of dentin bridge and pulp calcification after pulpotomy of adult permanent teeth.@*METHODS@#Patients who visited the General Department of Peking University School and Hospital of Stomatology from November 2017 to September 2019 and planned for pulpotomy on permanent premolars and molars with carious exposed pulp were selected. They were randomly divided into two groups. Bioceramic putty material iRoot BP (iRoot group, n=22) and mineral trioxide aggregate MTA (MTA group, n=21) were used as pulp capping agents, respectively. The patients were recalled after one year and two years. The clinical efficacy, dentin bridge index (DBI) and pulp calcification index (PCI) were recorded. Blinding method was used for the patients and evaluators.@*RESULTS@#There was no significant difference in gender, mean age, dentition and tooth position between the two groups (P>0.05). Seven cases were lost during the first year (4 cases in iRoot group and 3 cases in MTA group). In the iRoot group, 1 case had transient sensitivity at the time of 1-year follow-up. The cure rate of the two groups was 100% at the time of 2-year follow-up. The proportion of dentin bridge formation was 38.9% one year after operation, 55.6% two years after operation. The proportion of partial or even complete disappearance of root canal image was 5.6% before operation, 38.9% and 55.6% one and two years after operation, respectively. The difference was statistically significant by rank sum test (P < 0.05). There was no significant difference in dentin bridge formation and pulp calcification between the two groups (P < 0.05). DBI and PCI after operation was as the same as those before operation (44.4% cases of DBI and 25% cases of PCI) or gradually increased (55.6% cases of DBI and 75% cases of PCI). Spearman's nonparametric correlation analysis showed that age was positively correlated with preoperative pulp calcification index (PCI0, P < 0.05), but not with the dentin bridge index (DBI1, DBI2), pulp calcification index (PCI1, PCI2) and the degree of change (DBI2 vs. DBI1, PCI1 vs. PCI0, PCI2 vs. PCI0) 1-year and 2-year after operation (P>0.05).@*CONCLUSION@#According to this study, good clinical effects were obtained within 2-year after pulpotomy of adult permanent teeth with MTA and iRoot. In some cases, the root canal system had a tendency of calcification aggravation, and there was no statistical difference in the development of this trend between the two groups.

Randomized Clinical Study of the Use of MTA and Biodentine™ for Pulpotomy in Primary Teeth

ABSTRACT Objective: To verify, through clinical and radiographic evaluations, the in vivo response of the dentin-pulpal complex of human primary teeth after pulpotomy with MTA and Biodentine™ in a follow-up period of 3, 6, and 12 months. Material and Methods: Thirty teeth were divided into MTA pulpotomy (n = 15) and Biodentine™ pulpotomy (n = 15) from children between 5 and 9 years of age, a randomized clinical trial with simple random sampling. The materials were inserted into the cavity after opening and removing the coronary pulp tissue. The cavity base consisted of glass ionomer cement and light-cured composite resin restoration. Clinical and radiographic analyses were performed after 3, 6, and 12 months. Statistical analysis by Fisher's exact test for dichotomous data at a 5% significance level was utilized. Results: Both materials caused color change after 12 months. However, MTA showed a higher percentage than Biodentine™ (p<0.0001). Pain was detected only with Biodentine™ at six months and mobility at 12 months (p=0.0013). Radiographically, after 12 months, periapical lesions, interradicular lesions, and internal resorption were evidenced in 13% of the cases for Biodentine™-treated teeth (p<0.0013). MTA induced pulp calcification in 13% of cases, unlike Biodentine™ (p<0.0013). Conclusion: BiodentineTM and MTA are suitable for clinical use in pulpotomy treatment, yet both materials lead to tooth discoloration.

Expression of Matrix Metalloproteinases-8 and Myeloperoxidase in Pulp Tissue after Pulpotomy with Calcium Silicate Cements

ABSTRACT Objective: To evaluate the pulp tissue of rat molars after pulpotomies with mineral trioxide aggregate (MTA), BiodentineTM (BDT) and calcium hydroxide (CH) mixed with sterile saline solution (24 hours, 72 hours, 7 days and 15 days), through correlating MPO activity with active neutrophils and MMP8 activity with tissue remodeling. Material and Methods: Thirty-eight Wistar rats were randomly distributed into groups (control, I (MTA gray), II (BDT), and III (CH)) and subdivided according to the study period of 24 hours, 72 hours, 7 days or 15 days after pulpotomy. MMP8 activity was assessed through fluorescence technique, and MPO activity was determined using the MPO assay. Results: A gradual decrease of MPO and MM8 activity occurred in the group MTA over the experimental periods (p<0.05). Groups BDT and CH exhibited an increase in the activity at 7 and 15 days (p<0.05). Conclusion: MTA demonstrated a decrease in the values of MPO e MMP8. BDT and CH showed high neutrophilic and collagenase activity over the experimental periods.

Induction of root development and apical closure in permanent mandibular molar with irreversible pulpitis through total pulpotomy with application of mineral trioxide aggregate / Inducción del termino de desarrollo radicular y cierre apical en molar mandibular permanente con pulpitis irreversible a través de pulpotomía total con aplicación de agregado de trióxido mineral

Loss of teeth vitality when root formation is incomplete, results in weaker structures leaving them prone to fractures and unfavourable long-term prognosis. Apexogenesis is currently the treatment of choice in immature teeth and is indicated in vital teeth without pulpal pathologies. The treatment aims to eliminate the causal agent of the damage, and provide the necessary conditions to preserve vitality in the tooth and induce apical root closure. A 6-year-old male patient was treated at the Endodontics Clinic, Universidad de La Frontera upon complaining of acute pain in tooth 30. The tooth presented incomplete root development due to dental caries with pulp exposure and a diagnosis of irreversible symptomatic pulpitis. Total pulpotomy was performed with the application of Mineral Trioxide Aggregate and controlled at 1, 4, 6, 7 and 12 months, achieving root development and apical closure in the permanent molar. The result was comparable with studies that support this therapy in teeth with irreversible pulpitis. This work seeks to contribute to the existing evidence on the management of immature permanent teeth with irreversible pulpitis to induce root development and apical closure, and maintain pulp vitality.

La pérdida de vitalidad en dientes con formación radicular incompleta trae como resultado el debilitamiento de estos, dejándolos propensos a fracturas con un desfavorable pronóstico a largo plazo. Las terapéuticas actuales de regeneración pulpar en dientes inmaduros estan principalmente indicadas en cuadros de pulpitis irreversible y buscan eliminar el agente causal de daño y brindarle al diente las condiciones y estímulos necesarios para preservar vitalidad e inducir el cierre apical radicular. Un paciente de 6 años de edad y de sexo masculino, acude a la Clínica de Especialidad de Endodoncia de la Universidad de la Frontera, consultando por un dolor agudo en diente 4.6 el cual presentaba un desarrollo radicular incompleto producto de una caries con exposición pulpar con diagnóstico de Pulpitis Irreversible Sintomática. Se realiza una pulpotomia total con aplicación de Mineral Trioxide Aggregate y se controla a los 1, 4, 6 y 7 meses obteniendo un interesante resultado comparable con estudios que avalan dicha terapeutica en dientes con pulpitis irreversible. Este trabajo busca contribuir a la evidencia existente sobre el manejo de dientes permanentes inmaduros con cuadros de pulpitis irreversible para inducir el desarrollo radicular, cierre apical y mantener vitalidad pulpar.

Comparison between calcium hydroxide mixtures and mineral trioxide aggregate in primary teeth pulpotomy: a randomized controlled trial

Abstract Objectives: To evaluate the effect of calcium hydroxide (CH) associated with two different vehicles as a capping material for pulp tissue in primary molars, compared with mineral trioxide aggregate (MTA). Methodology: Forty-five primary mandibular molars with dental caries were treated by conventional pulpotomy using one of the following materials: MTA only (MTA group), CH with saline (CH+saline group) and CH with polyethylene glycol (CH+PEG group) (15 teeth/group). Clinical and periapical radiographic examinations of the pulpotomized teeth were performed 3, 6, and 12 months after treatment. Data were tested by chi-squared analysis and a multiple comparison post-test. Results: The MTA group showed both clinical and radiographic treatment success in 14/14 teeth (100%), at all follow-up appointments. By clinical evaluation, no teeth in the CH+saline and CH+PEG groups had signs of mobility, fistula, swelling or inflammation of the surrounding gingival tissue. However, in the CH+saline group, radiographic analysis detected internal resorption in up to 9/15 teeth (67%), and inter-radicular bone resorption and furcation radiolucency in up to 5/15 teeth (36%), from 3 to 12 months of follow-up. In the CH+PEG group, 2/11 teeth (18%) had internal resorption and 1/11 teeth (9%) presented bone resorption and furcation radiolucency at all follow-up appointments. Conclusion: CH with PEG performed better than CH with saline as capping material for pulpotomy of primary teeth. However, both combinations yielded clinical and radiographic results inferior to those of MTA alone.

Two-year outcomes of pulpotomy in primary molars using mineral trioxide aggregate: a retrospective study / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the two-year outcomes of primary molars pulpotomy using mineral trioxided aggregate (MTA) and to find out the potential influence factor, with the help of electronic medical record database.@*METHODS@#Children who received primary molars pulpotomy in the Department of Pediatric Dentistry in Peking University School and Hospital of Stomatology from May, 2014 to November, 2015 were searched in the Electronic Medical Record Database of Peking University School and Hospital of Stomatology, via the database for scientific research provided by the corporation of Kaientai. The children who were healthy, no more than 8 years old and followed up over 1.5 years were selected as the subjects of this study. At the same time, those children who didn't have complete medical records and X-rays before and after treatment were removed. Basic information, the relevant medical records and radiographic records of those children were collected. All molars were examined clinically and radiographically, and classified into 1 of 5 outcomes: N, H, P0, PX, PY. Molars classified into P0, PX and PY were regarded as failed. Survival analysis was applied. The survival rate and survival time of the deciduous teeth were calculated.Multivariate analysis was performed by using Cox proportional hazard model.@*RESULTS@#One hundred and fifteen children were finally included,aged from 2.6 to 8.2 years, with the mean age of (4.5±1.1) years. 211 primary molars were included, and the average follow up time was (880±154) days. A good level of agreement between the raters was found for molars with five outcomes(κ=0.913). Intrarater reliability was good for molars with five outcomes (κ=0.916). Forty-nine molars failed by September, 2017. Forty-three molars had abnormal radiographic manifestation. Six molars suffered premature loss. Only fourteen molars had an associated gingival swelling or parulis, or pathologic mobility upon clinical examination. The cumulative survival probability of half a year, one year, one year and a half, two years, two year and a half for the pulpotomy was 100%, 98.5%, 92.9%, 90.5%,73.8% through the Kaplan-Meier method, respectively. Through the analysis of Cox proportional hazard model, the survival probability was significantly higher when the age was younger. When sodium hypochlorite and the saline were used as the irrigation at the same time, the survival probability was not improved for those teeth with more bleeding in the operation compared with that used saline only. The teeth with preformed metal crown (PMC) gained longer median survival time than those restored with resin composite and others, but the difference was not significant, either. What's more, gender, the restoration time of PMC, the restoration of the opposite teeth were not found to be associated with the success of the treatment.@*CONCLUSION@#The cumulative survival probability of two years after the primary pulpotomy was 90.5%, complying the current instructions in our department. The survival probability of the molars after the treatment was significantly affected by the age.

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.

A Biological Approach in Repair of Damaged Dental Pulp and Periapical Tissues using Platelet Rich Fibrin, Mineral Trioxide Aggregate and Laser Biostimulation.

This article describes about a biological approach in the repair of dental pulp and periapical tissues using biomaterials (platelet rich fibrin [PRF] and mineral trioxide aggregate [MTA]) and laser biostimulation. Case 1: Pulpotomy with PRF, MTA, and laser biostimulation. Patient follow-up was done at 1, 3, and 6 months. On 6 months follow-up, the patient was asymptomatic and tooth responded positively to pulp tests. Radiograph revealed normal periodontal ligament space and trabecular bone pattern. Case 2: Apexification procedure using PRF, MTA, and laser biostimulation in 31 and 41. Patient follow-up was done at 1, 3, and 6 months. On 6 months follow-up, radiograph revealed relative root lengthening, thickening of the canal walls in the apical one-third of root, and a healing lesion. Repair and regenerative potential of PRF, an enhanced cellular metabolism with laser biostimulation in combination with the sealing ability of MTA enhances the clinical success outcomes in pulpotomy and apexification procedures.

Ineffectiveness of Antibiotic-Based Pulpotomy for Primary Molars: a Survival Analysis

To investigate the two-year survival rate of primary molars treated with non-instrumentation endodontic treatment with mixed antibiotic paste containing chloramphenicol, tetracycline, zinc oxide and eugenol (CTZ pulpotomy), and compare it to the conventional root canal treatment with calcium hydroxide paste. Material and Methods:Thirty-six children, mean age 6.2 years old (standard deviation, SD=1.5), presenting at least one primary molar with irreversible pulpitis or necrotic pulp, were included in this prospective clinical study. Teeth were assigned to CTZ pulpotomy (Group I) or calcium hydroxide pulpectomy (Group II) and assessed clinically and radiographically for up to 26 months. Data were analyzed using descriptive statistics, Chi-square test, Kaplan-Meier survival analysis and Log-rank test. Results:Fifty-three primary molars were treated in Group I (n=37) or Group II (n=16). Children were followed up for 1 to 26 months (mean=12.0; SD=7.1). Treatment failure rates were 73.0% in Group I and 31.3% in Group II. Overall, mean survival time was 15.2 months (95% confidence interval, CI 12.6û17.9); Group I (mean 13.2; 95% CI 10.2-16.3) had a lower survival rate than Group II (mean 18.9; 95% CI 14.5-23.2) (p=0.02). Necrotic pulp treatments had significantly lower survival rates (p=0.01) than pulpitis treatments. Conclusion:Non-instrumentation endodontic treatment of primary molars with CTZ paste resulted in a low survival rate in a two-year follow-up; its radiographic ineffectiveness discourages its use instead of conventional root canal endodontic treatment...

Inflammatory effect of green propolis on dental pulp in rats

Pulpotomy in deciduous teeth is a controversial issue, especially with regard to alternative materials used for the direct pulp capping of the root canal pulp tissue. The aim of the present study was to perform a histological analysis of the initial reaction of the root canal pulp tissue in rats, following pulpotomy and pulp capping with (1) green propolis extract, (2) iodoform paste, (3) green propolis extract + iodoform and (4) calcium hydroxide paste with saline solution. Analyses were performed after 24 hours, 72 hours and 7 days. The substances containing green propolis extract and iodoform led to the production of an intense inflammatory infiltrate and necrosis in the root canal pulp tissue throughout the analyses. In the calcium hydroxide group, inflammatory infiltrate only prevailed at the 72-hour evaluation. Among the substances tested, calcium hydroxide paste induced the lowest intensity of inflammatory response in the root canal pulp tissue. Longer studies should be carried out to analyze the pulp repair process following pulpotomy and pulp capping with the compounds analyzed.

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...

Comportamiento clínico y radiográfico de agregado trióxido mineral (MTA) vs material de restauración intermedio (IRM) en pulpotomías de dientes temporales / Clinical and radiographic behavior of mineral trioxide aggregate (MTA) vs intermediate restorative material (IRM) en pulpotomies of deciduous teeth

A lo largo del tiempo se han utilizado diversos materiales de obturación para pulpotomías de dientes temporales, con características tales que aseguren el éxito del tratamiento, tal como elOxido de zinc y eugenol, IRM, Ionómero de vidrio y actualmenteelMTA,que ha mostrado excelentes propiedades en comparación con otros materiales.Por tantoel objetivo de esta investigación fue evaluar el comportamiento clínico y radiográficodel trióxido mineral agregado (MTA) encomparación con el material de restauración intermedia (IRM) utilizado en el tratamiento en pulpotomía de molares temporales,en pacientesque acuden a la clínica de especialidaden Odontopediatría de la Facultad de Odontología de la Universidad Autónoma del Estado de México,en el periodo de abril de 2010 a febrero de 2011.Materiales y métodos:Se seleccionaron 10 pacientes de entre 3 y 6 años de edad con caries en molares temporales; a cada uno se les realizaron pulpotomías empleando MTA e IRM formando dos grupos: 1. Grupo control con IRM en 11 molares y 2. Grupo con MTA en 12. Se realizaron evaluaciones clínicas y radiográficas a tres y seis meses.Resultados: De los 10 pacientes incluidos, uno fue excluido del estudio por no asistir a las citas control. La muestra definitiva incluye 6 niños y 3 niñas, con promedio de edad de 4.3años. Los dientes restaurados con mayor frecuencia fueron elprimer molar superior derecho e izquierdo temporal con 6 restauraciones cada uno. En la evaluación clínica no se observaron signos o síntomas de patología, alanálisis radiográficono se observo signos de patología a los tres y seis meses. Conclusiones: Ambos materiales demostraron ser una elección adecuada para la terapéutica de pulpotomías y mantener el órgano dentario con funcionalidad hasta el momento de suexfoliación. Se observó éxito en el tratamiento en el aspecto clínico y radiográfico.

Realização da técnica de pulpotomia no serviço público odontológico / Implementation of the pulpotomy in dental public service

O propósito desta pesquisa foi descrever a técnica de pulpotomia empregada pelos cirurgiões- dentistas nos serviços odontológicos da 9ª Coordenadoria Regional de Saúde do Rio Grande do Sul. O delineamento do estudo é exploratório descritivo, sendo a coleta de dados feita a partir de questionários enviados aos 37 Cirurgiões-dentistas de 12 municípios. Os resultados mostraram que 23 profissionais (62,2%) realizam pulpotomia no serviço. Esses profissionais indicam a pulpotomia para o tratamento de polpas expostas ou inflamadas de dentes com rizogênese completa e incompleta em ambas as dentições em sessão única, utilizando isolamento relativo para remoção da polpa coronária com a ajuda de curetas e soro fisiológico como substância irrigadora. Sobre o remanescente pulpar utilizam hidróxido de cálcio e antibiótico como biomaterial protetor. A técnica de pulpotomia traz resultados satisfatórios segundo os profissionais que a executam, sendo realizada a proservação após a pulpotomia, através de exame clínico e radiográfico.Não foi questionado quanto tempo após a pulpotomia é feita a proservação.

The purpose of this research was to describe the pulpotomia technique employed by dentists in services in dentistry of the 9ª Coordenadoria Regional de Saúde do Rio Grande do Sul. It is a descriptive and explorative, study the data collection from the questionnaires sent to 37 DDS in 12 cities. The results showed that 23 professionals (62.2%) do pulpotomia in service. These professionals indicate the pulpotomia for the treatment of pulps exposed or inflamed with complete and incomplete root formation in both the dentition in one session using relative isolation and curettes with the use of saline as irrigating solution. On the remmant dental pulp using calcium hydroxide paste and antibiotic as protector biomaterial. The technique of pulpotomia has satisfactory results in accordance with the professionals, being preservated after pulpotomia through clinical and radiographic examination.

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.