Protección pulpar directa y posterior apexogénesis: informe de un caso clínico / Direct pulp capping followed by apexogenesis: a clinical case report

Objetivo: Describir el tratamiento de un paciente que pre- sentó un incisivo superior permanente con exposición pulpar y desarrollo radicular incompleto utilizando Biodentine como material para la protección pulpar directa. Caso clínico: Un paciente de 9 años fue derivado para la evaluación y el tratamiento del diente 11. El examen clínico y radiográfico reveló la presencia de una fractura amelodentinaria, con exposición pulpar y desarrollo radicular incompleto. Luego de lavar y desinfectar el área de la fractura, se protegió la pulpa expuesta con Biodentine y se restauró la cavidad. El paciente fue citado para control a los 18 y 25 meses. En los controles se comprobó que el diente se mantuvo asintomático y funcional. Luego de 25 meses, el examen clínico y radiográfico confirmó la presencia de pulpa vital y el completo desarrollo del remanente radicular. Los resultados obtenidos en el presente caso clínico sugieren que el empleo de Biodentine puede ser considerado como una valiosa alternativa para la protección de la pulpa ex- puesta en dientes con desarrollo radicular incompleto (AU)

Aim: To describe the treatment of a patient that presented a permanent maxillary central incisor with pulp exposure and incomplete root formation, using Biodoentine as the material for direct pulp protection. Clinical case A 9-year-old male patient was referred for evaluation and treatment of tooth 11. The clinical and radio-graphic examination revealed the presence of a dentinoe- namel fracture, with pulp exposure and incomplete root for- mation. After cleaning and disinfecting the area, the exposed pulp was protected with Biodentine and the cavity was re- stored. The patient was scheduled for control after 18 and 25 months. In these evaluations, it was confirmed that the tooth remained asymptomatic and functional. After 25 months, the clinical and radiographic examination showed the presence of vital pulp and a completed development of the root. The obtained results of this clinical case suggest that Biodentine can be considered a valuable alternative for pulp capping in teeth with incomplete root formation (AU)

Evaluation of dentinogenesis inducer biomaterials: an in vivo study

Abstract When exposure of the pulp to external environment occurs, reparative dentinogenesis can be induced by direct pulp capping to maintain pulp tissue vitality and function. These clinical situations require the use of materials that induce dentin repair and, subsequently, formation of a mineralized tissue. Objective: This work aims to assess the effect of tricalcium silicate cements and mineral trioxide aggregate cements, including repairing dentin formation and inflammatory reactions over time after pulp exposure in Wistar rats. Methodology: These two biomaterials were compared with positive control groups (open cavity with pulp tissue exposure) and negative control groups (no intervention). The evaluations were performed in three stages; three, seven and twenty-one days, and consisted of an imaging (nuclear medicine) and histological evaluation (H&E staining, immunohistochemistry and Alizarin Red S). Results: The therapeutic effect of these biomaterials was confirmed. Nuclear medicine evaluation demonstrated that the uptake of 99mTc-Hydroxymethylene diphosphonate (HMDP) showed no significant differences between the different experimental groups and the control, revealing the non-occurrence of differences in the phosphocalcium metabolism. The histological study demonstrated that in mineral trioxide aggregate therapies, the presence of moderate inflammatory infiltration was found after three days, decreasing during follow-ups. The formation of mineralized tissue was only verified at 21 days of follow-up. The tricalcium silicate therapies demonstrated the presence of a slight inflammatory infiltration on the third day, increasing throughout the follow-up. The formation of mineralized tissue was observed in the seventh follow-up day, increasing over time. Conclusions: The mineral trioxide aggregate (WhiteProRoot®MTA) and tricalcium silicate (Biodentine™) present slight and reversible inflammatory signs in the pulp tissue, with the formation of mineralized tissue. However, the exacerbated induction of mineralized tissue formation with the tricalcium silicate biomaterial may lead to the formation of pulp calcifications

Efficacy of Lasers Treatment of Exposed Pulps to Stimulate Healing: A Systematic Review and Meta-Analysis

Abstract Objective: The present systematic review and meta-analysis aimed at evaluating the efficacy of laser's treatment of exposed pulps to stimulate healing. Material and Methods: MEDLINE, PubMed, Cochrane Library, Embase, ISI, Google Scholar have been searched as the electronic databases for performing systematic literature between 2005 to 2019. Searches were performed with MESH terms. The quality of the studies included was assessed using the Critical Appraisal Skills Program checklist. For Data extraction, two reviewers blind and independently extracted data from the abstract and full text of the studies included. Moreover, the fixed-effect model's odds ratio for a 95% confidence interval (CI) was calculated. Random effects were used to deal with potential heterogeneity, and I2 showed heterogeneity. The meta-analysis and forest plots have been evaluated using the Comprehensive Meta-Analysis Stata. Results: Five studies (3 RCTs and 2 animal studies) were included in this study. The Odds Ratio was 1.90 (95% CI 1.39-2.42; p=0.00); there was a statistically significant difference between the laser and the control groups (p=0.00). Conclusion: The success rate of laser treatment for exposed pulps is higher than mineral trioxide aggregate, resin, calcium hydroxide and resin-modified glass-ionomer cement. The exact mechanism of this effect has not yet been determined; further research on lasers' impact on exposed pulps treatment is required.

An experimental study of simvastatin-collagen composite sponge as a direct pulp capping material in rat molars / 华西口腔医学杂志

OBJECTIVE@#To assess the feasibility and efficacy of simvastatin-collagen composite sponge as a novel, direct pulp capping material.@*METHODS@#A total of 120 Sprague-Dawley rats were randomly divided into three groups: the simvastatin-collagen composite sponge group (SIM group), the collagen sponge group (CS group), and the Ca(OH)2 group (CH group). An endodontic entry cavity was prepared on the occlusion of the first molar on the left maxillary of each rat. The contralateral teeth were utilized as the normal control group. The rats were experimented after 1, 3, 7, 14, and 28 days. X-ray observations were conducted and the specimens underwent hematoxylin-eosin (HE) and Masson's Thichrome staining. Dentin bridge formations and pulpal biology reactions were evaluated histopathologically.@*RESULTS@#X-ray results: high-density images could be observed on the pulp exposure sites in the CH group on the 28th day. In the SIM group, high-density images could be observed after 14 and 28 days, whereas in the CS group, high-density images were not observable in the exposed area. HE and Masson's Thichrome staining results: different degrees of inflammation under the cavity were detected in the three groups at different time points. The inflammatory reaction of the CS group was the most serious. The degree of the inflammatory reaction varied significantly between the SIM and the CS groups on the 14th and 28th days (P<0.01). The inflammatory reaction in the SIM group was lighter than in the CH group. There was a statistical difference between the SIM and the CH groups on the 14th day (P<0.05). During the observation period, the SIM group induced the best and fastest formation of reparative dentin. As for dentin bridge formation, a significantly higher complete bridge rate was observed in the SIM group than in the CH and in the CS groups on the 14th day (P<0.05) and for the SIM and the CH groups compared with the CS group on the 28th day (P<0.05).@*CONCLUSIONS@#The simvastatin-collagen composite sponge exhibited satisfactory biocompatibility with the pulp tissue and promoted the formation of reparative dentin. The application of simvastatin-collagen composite sponge as a pulp-capping material has satisfactory potential.

Identificación del complejo rojo en la necrosis pulpar abierta y cerrada con técnicas moleculares / Red complex identification in exposed and unexposed necrotic pulp with molecular techniques

Objetivo: identificar el complejo rojo periodontal, formado por Porphyromonas gingivalis, Treponema denticola y Tannerella forsythia, en la infección endodóntica primaria de necrosis pulpar, con cámara abierta y cerrada, utilizando técnicas de reacción en cadena de la polimerasa. Materiales y métodos: se realizó la toma para reacción en cadena de la polimerasa en 27 dientes con necrosis pulpar, 13 con cámara pulpar abierta y 14 con cámara cerrada. Resultados: en las muestras de necrosis abierta se identificaron P. gingivalis en un 92 por ciento, T. denticola en un 76 por ciento, T. forsythia en un 76 por ciento y el complejo rojo en un 61 por ciento. Las tomas de necrosis cerrada mostraron P. gingivalis en un 78 por ciento y T. denticola en un 57 por ciento; no se identificaron T. forsythia ni el complejo rojo. El análisis estadístico evidenció diferencias significativas entre los dos grupos (P<0,05). Conclusión: el sinergismo de las tres bacterias que forman el complejo rojo agravaría la patogénesis de la infección endodóntica y permitiría relacionar la microbiología endodóntica con la microbiología de periodontitis crónica.

Avances en protección pulpar directa con materiales bioactivos / Recent advances in direct pulp capping with bioactive materials

Con el advenimiento de los materiales Bioactivos hoy hay un cambio de paradigma en el tratamiento de la protección pulpar directa. Está ampliamente demostrado en la literatura tanto en los estudios in vitro como in vivo, que estos materiales son más efectivos que el hidróxido de calcio para lograr cambios biológicos y microestructurales en el tejido pulpar y dentinario. Es así que surgen los materiales bioactivos, los cuales son sustancias que al ponerse en contacto con los tejidos vivos, provocan un efecto positivo sobre los mismos formando tejidos calcificados. Inducen una respuesta biológica específica en la interfase material-tejido. Actualmente los que cuentan con mayor aval científico son: MTA, Biodentine y Theracal LC.

Nowadays with the arrival of the Bioactive Materials, there has been an important change in the treatment of direct pulp capping. It is already probed, in studies in vitro and in vivo that these materials are more effective than calcium hydroxide as they obtain biological and microstructural changes in the pulpar and dentinal tissues.That is the reason for the appearance of the BIOACTIVE materials, which cause a specific biological response in the interface material-tissue when they are in contact with the vital tissues. The actual materials with the best scientific acceptance are: MTA, Biodentine and Theracal.

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.

Fracturas coronarias con exposición pulpar: reporte de tres casos clínicos en diferentes edades / Crown fractures with pulp exposure: report of three clinical cases at different ages

Los traumatismos dentarios son la causa más frecuente de daño en los dientes anteriores. Las fracturas coronarias con pulpa expuesta representan entre el 18 al 20 por ciento de las lesiones traumáticas que involucran las piezas dentarias. En esta comunicación clínica, los autores muestran un tratamiento preventivo: técnica de Cvek, que evita que los dientes afectados llegen a un tratamiento endodóntico total

Tenascin and Fibronectin Expression after Pulp Capping with Different Hemostatic Agents: A Preliminary Study

This study investigated the expression of extracellular matrix glycoproteins tenascin (TN) and fibronectin (FN) in pulp repair after capping with calcium hydroxide (CH), following different hemostasis protocols. Class I cavities with a pulp exposure were prepared in 42 human third molars scheduled for extraction. Different hemostatic agents (0.9% saline solution, 5.25% sodium hypochlorite and 2% chlorhexidine digluconate) were used and pulps were capped with CH cement. After 7, 30 or 90 days, teeth were extracted, formalin-fixed, and prepared for immunohistochemical technique. Hemostatic agents did not influence the expression of TN and FN. Both glycoproteins were found in the entire the pulp tissue and around collagen fibers, but were absent in the mineralized tissues. In the predentin, TN showed positive immunostaining and FN had a variable expression. Within 7 days post-treatment, a slightly more pronounced immunostaining on the pulp exposure site was observed. Within 30 days, TN and FN demonstrated a positive expression around the dentin barrier and at 90 days, a thin and linear expression of TN and FN was delimitating the reparative dentin. In conclusion, hemostatic agents did not influence TN and FN expression. Immunostaining for TN and FN was seen in different regions and periods, demonstrating their role in pulp repair.

Este estudo investigou a expressão das glicoproteínas Tenascina (TN) e Fibronectina (FN) da matriz extracelular no reparo pulpar após capeamento com hidróxido de cálcio (HC), seguindo diferentes protocolos de hemostasia. Cavidades de classe I com exposição pulpar foram preparadas em 42 terceiros molares humanos indicados para extração. Diferentes agentes hemostáticos (solução salina a 0,9%, hipoclorito de sódio a 5,25% e clorexidina a 2%) foram usados e as polpas foram capeadas com cimento de HC. Após 7, 30 ou 90 dias, os dentes foram extraídos, fixados em formalina e preparados para análise imunoistoquímica. Os agentes hemostáticos não influenciaram a expressão de TN e FN. Ambas glicoproteínas foram encontradas em todo tecido pulpar, ao redor das fibras colágenas e estiveram ausentes nos tecidos mineralizados. Na pré-dentina, a TN mostrou forte imunoexpressão e a FN teve uma expressão variável. Após 7 dias, foi observada uma expressão levemente mais pronunciada no lugar da exposição pulpar. Aos 30 dias, a TN e a FN demonstraram uma expressão mais forte sob a barreira dentinária e aos 90 dias, uma expressão fina e linear da TN e FN apresentava-se delimitando a dentina reparativa. Em conclusão, os agentes hemostáticos não influenciaram e expressão da TN e da FN. A imunoexpressão da TN e FN foi observada em diferentes regiões e períodos, demonstrando o seu papel no reparo pulpar.

Fraturas coronárias com exposição pulpar: levantamento epidemiológico em um período de 8 anos / Coronal fractures with pulp exposure: epidemiological survey in an 8-year period

O objetivo deste estudo foi avaliar a frequência, a distribuição clínico-demográfica e a resposta ao tratamento das fraturas coronárias com exposição pulpar diagnosticadas em um ambulatório de trauma dentoalveolar em um período de 8 anos. As informações demográficas, clínicas, radiográficas e de tratamento foram obtidas dos prontuários dos pacientes. No período, 996 pacientes foram atendidos no ambulatório e 120 (12%) apresentaram fraturas coronárias com exposição pulpar. No total, 154 dentes foram diagnosticados com fraturas coronárias com exposição pulpar, incluindo principalmente os incisivos centrais superiores (70%). As causas mais comuns do trauma foram as quedas da própria altura (21%) e os acidentes automobilísticos (15,5%). O tratamento realizado mostrou ótimo resultado, reforçando o bom prognóstico dos dentes tratados adequadamente.

The aim of the present study was to evaluate the frequency, clinical and demographic distribution and response to treatment of the coronal fractures with pulp exposure diagnosed in a clinic for treatment of dentoalveolar trauma in an 8-year period. Demographic, clinical, radiological and treatment informatoin were obtained from the patients files. In the period, 996 patients attended the clinic and 120 (12%) presented with coronary fractures with pulp exposure. A total of 154 teeth were diagnosed with coronary fractures with pulp exposure, including mostly upper central incisors (70%). The most common causes for the fractures were falls (21%) and car/motorcycle accidents (15,5%). Treatment driven for the studied cases showed excellent results, reinforcing the overall good prognosis of the properly treated teeth.

Pulpotomías con sulfato férrico y MTA en dientes primarios: serie de casos / Ferric sulfate and MTA pulpotomies in primary teeth: a case series

En 11 pacientes se realizaron 7 pulpotomías con agregado trióxido mineral (MTA) y 6 con Sulfato Férrico (SF). Se incluyeron pacientes que presentaron dientes primarios con exposición accidental de la pulpa durante la remoción de caries en ausencia de signos y síntomas clínicos y/o radiográficos de patología pulpar. Las piezas tratadas fueron restauradas con coronas preformadas de acero inoxidable y controladas clínica y radiográficamente cada 6 meses. El seguimiento promedio fue de 15,6 meses para ambos grupos, con éxito clínico de un 100 por ciento para ambos medicamentos. El éxito radiográfico fue de 85,71 por ciento para el MTA y de 83,33 por ciento para el SF. Si bien ambos medicamentos presentaron un buen desempeño clínico y radiográfico durante el periodo de seguimiento, el SF fue más económico y necesitó un menor tiempo de trabajo, característica deseable en odontopediatría.

In eleven patients 7 pulpotomies were performed with Mineral Trioxide Aggregate (MTA) and 6 with ferric sulphate (FS). We included patients who had primary teeth with accidental exposure of the pulp during caries removal in the absence of clinical signs and symptoms and / or radiographic evidence of pulpal pathology. The treated pieces were restored with preformed stainless steel crowns and controlled clinically and radiographically every 6 months. The average follow-up was 15.6 months for both groups, with clinical success of 100 percent for both treatments. Radiographic success was 85.71 percent for the MTA and 83.33 percent for SF.ÊAlthough both procedures showed good performance during the clinical and radiographic follow-up period, the SF was cheaper and required less working time, a desirable characteristic in pediatric dentistry.

Retrospective study of the prognosis and influence factors of crown-fractured young maxillary incisors with pulp exposure / 华西口腔医学杂志

<p><b>OBJECTIVE</b>The aim of the present study is to investigate the prognosis and influencing factors of crown-fractured young permanent teeth with pulp exposure.</p><p><b>METHODS</b>Case records of crown-fractured young permanent teeth with pulp exposure in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology during 1991 to 2008 with more than 2 years follow-up were collected. These patients were treated with pulpotomy at the first visit at our hospital no matter whether these teeth were treated or untreated with direct pulp capping. The age of patients, interval between trauma and treatment, root development, mobility and tenderness to percussion were recorded. The prognosis was analyzed and Logistic regression was used to analyze the influencing factors.</p><p><b>RESULTS</b>Totally 118 cases satisfied the inclusion criteria, including 136 crown-fractured teeth with pulp exposure. The patients of (8.8 +/- 1.2) years old were periodically monitored for (46.1 +/- 22.0) months. The success rate of pulpotomy after pulp exposure was 85.3%. Pulp necrosis occurred in 20 teeth (25.0 +/- 19.0) months after trauma. The extent of tenderness to percussion showed significant correlation with pulp necrosis, while the age of the patients, interval between injury and treatment, and mobility of the teeth were not related to pulp necrosis.</p><p><b>CONCLUSION</b>The success rate of pulpotomy after pulp exposure is good. Tenderness to percussion is an important signal of pulp necrosis. There are no evidence about the relationship between the patient's age, interval between injury and treatment, mobility of the pulp-exposed teeth and the pulp prognosis.</p>

Tissue response to direct pulp capping with calcium hydroxide preceded by corticosteroid or corticosteroid/antibiotic dressing: a histological study in rats / Resposta do tecido pulpar à aplicação da pasta à base de hidróxido de cálcio precedida do emprego do curativo de corticosteróide ou corticosteróide/antibiótico: estudo histológico em ratos

Purpose: This study histologically evaluated the reaction of tooth pulp to treatment with calcium hydroxide in distilled water preceded by a corticosteroid (Decadron) or corticosteroid/antibiotic (Otosporin) dressing. Methods: Calcium hydroxide solution was applied to exposed tooth pulp for 5 min or for 72 h, using a sample of 120 molars of rats; histological examination was performed 7, 14, 30 and 60 days after treatment. Results: A mild inflammatory reaction was observed at 7 and 14 days whether the dressings were used for 5 min or for 72 h. When the corticosteroid/antibiotic dressing was used for 5 min, the tissue reaction and the mineralized barrier formed at 30 and 60 days were similar to those of animals in the control group. Use of the corticosteroid dressing for 5 min or 72 h or the corticosteroid/antibiotic dressing for 72 h delayed healing of the pulp tissue. Conclusion: Temporary dressings resulted in a milder inflammatory reaction during the early postoperative period. The tissue reaction and the quality of the barrier formed when the Otosporin temporary dressing was applied for 5 min were similar in the experimental and the control groups at longer postoperative periods. Temporary dressings of Decadron applied for 5 min or 72 h or Otosporin applied for 72 h caused a slight retardation of the healing process of the tissue that was apparent 30 days after the intervention.

Objetivo: Avaliar a reação pulpar à pasta de hidróxido de cálcio em água destilada, precedida de curativo de corticosteróide (Decadron) ou corticosteróide/antibiótico (Otosporin) por 5 min ou 72 h. Metodologia: Em 120 polpas de dentes de ratos expostas, a análise histológica foi realizada após 7, 14, 30 e 60 dias de cada tratamento. Resultados: Nos períodos iniciais observou-se leve reação inflamatória quando os curativos foram aplicados por 5 min ou 72 h. A reação tecidual e a barreira formada sob ação do hidróxido de cálcio após o curativo de Otosporin por 5 min foram semelhantes àquelas do grupo controle aos 30 e 60 dias. Os curativos de demora com Decadron por 5 min e 72 h e Otosporin por 72 h promoveram retardo no processo de reparação. Conclusão: Os curativos de demora promoveram reação inflamatória mais suave nos períodos iniciais de análise. A reação tecidual e a qualidade da barreira formada sob a ação do Otosporin por 5 min foram semelhantes àquelas do grupo controle nos períodos pós-operatórios mais longos. Os curativos de demora com Decadron por 5 min e 72 h e Otosporin por 72 h promoveram ligeiro retardo no processo de reparação tecidual a partir de 30 dias.

Posibilidades del compuesto de minerales trióxido (MTA) como material de protección directa de la pulpa dental expuesta: una revisión bibliográfica / Possibilities of mineral trioxidce aggregate (MTA) as a pulp-capping agent: a review

La preservación de la vitalidad pulpar juega un rol preponderante en la conservación de piezas dentarias en la arcada dentaria. El objetivo de este trabajo es analizar las propiedades del compuesto de minerales trióxido (MTA) como material de uso endodóntico, con un enfoque particular en cuanto a la posibilidad de ser aplicado en protecciones directas de la pulpa. En comparación con las preparaciones de hidróxido de calcio tradicionales o los materiales que lo contienen, elMTA ha demostrado reunir las condiciones necesarias para ser utilizado con ese objetivo. El MTApresenta un buen sellado marginal, y estimula la formación de puentes dentinarios calcificados de espesor y calidad significativamente mayores conservando la salud del tejido pulpar remanente. Desde el punto de vista clínico, el material ha demostrado un alto porcentaje de éxito y aparececomo un buen sustituto del hidróxido de calcio en cuanto a su uso en los procedimientos de protección pulpar directa y en pulpotomías. Sin embargo, los estudios clínicos basados en la evidencia realizados hasta el momento son escasos y aún se hacen necesarios nuevos estudios longitudinales en cohortes de pacientes bien controlados, antes de que el MTA pueda ser definitivamente recomendadopara ser utilizado en forma rutinaria como material de protección pulpar directa en la clínica diaria.

Tratamiento de una pieza dentaria permanente fracturada en paciente con parßlisis cerebral / Treatment of fratured permanent dental tooth in patient with cerebral palsy

El presente artículo reporta el caso clínico del traumatismo dentario de un paciente de 14 a±os de edad de sexo masculino con Parßlisis Cerebral Espßstica post-natal, que sufre una caída frontal produciéndose fractura coronaria con exposición pulpar del incisivocentral superior derecho y movilidad de la pieza dentaria por rotura de ligamento periodontal, fue tratado bajo anestesia general en centro quirúrgico realizando tratamiento de endodoncia e instalación de corona completa de acrílico como tratamiento restaurador.

The present article reports the Clinical case of a dental trauma in a 14 year-old male patient, with Post-birth Cerebral Spastic Palsy, who suffered a fall that produces a coronal fracture of an upper central incisor with pulp exposure, and mobility due to breakage of the periodontal ligament. The tooth was treated under general anesthesia in a surgical center; an endodontic treatment and a full acrylic crown were performed.

Clinical and radiographic comparison of primary molars after formocresol and electrosurgical pulpotomy: a randomized clinical trial.

BACKGROUND: Vital pulpotomy is a single-stage procedure defined as the surgical amputation of the coronal portion of exposed vital pulp, usually as a means of preserving the vitality and function of the remaining radicular portion. OBJECTIVES : The aim of this study was to compare the clinical and radiographic success rates for electrosurgical vs formocresol pulpotomy in human primary molar teeth. SETTINGS AND DESIGN: This was a prospective, randomized clinical trial. MATERIALS AND METHODS: In this randomized clinical trial, pulpotomies were performed on 70 primary molars in children aged 5-10 years. The teeth were treated using either a conventional formocresol (35 teeth) or electrosurgical technique (35 teeth). Following the pulpotomy procedure, the teeth were evaluated for clinical and radiographic success for three, six and nine months. The teeth were evaluated for the presence of pain, abscess, fistula, mobility, internal and external resorption, and radiolucency. STATISTICAL ANALYSIS: The data were assessed with Fishers' Exact test. RESULTS: After nine months of follow-up, the clinical and radiographic success rates were 96 and 84% respectively in the electrosurgical group and 100 and 96.8% respectively in the formocresol group. There was no statistically significant difference between the success rates in the two groups ( P > 0.05). CONCLUSIONS: Our results showed the failure rates for electrosurgical pulpotomy to be equal to those for formocresol pulpotomy. Although electrosurgical pulpotomy is a nonpharmacological technique giving favorable results, it is still a preservative technique. Further studies using larger samples and longer evaluation periods are recommended.

Curved canals: ancestral files revisited.

The aim of this article is to provide an insight into different techniques of cleaning and shaping of curved root canals with hand instruments. Although a plethora of root canal instruments like ProFile, ProTaper, LightSpeed etc dominate the current scenario, the inexpensive conventional root canal hand files such as K-files and flexible files can be used to get optimum results when handled meticulously. Special emphasis has been put on the modifications in biomechanical canal preparation in a variety of curved canal cases. This article compiles a series of clinical cases of root canals with curvatures in the middle and apical third and with S-shaped curvatures that were successfully completed by employing only conventional root canal hand instruments.