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

BACKGROUND: This systematic review aimed to investigate whether vital pulp therapy and root canal treatment (RCT) promote different postoperative pain. STUDIES REVIEWED: The authors searched PubMed, Cochrane Library, Embase, and Latin American and Caribbean Health Sciences Literature databases for studies published through June 30, 2022. The authors included randomized clinical trials if they reported on the assessment of postoperative pain after direct pulp capping, partial pulpotomy, pulpotomy, or single-visit RCT. The authors assessed the frequency of no, mild, moderate, and severe postoperative pain. They conducted meta-analyses to compare postoperative pain after full pulpotomy (PULP) and RCT. RESULTS: The qualitative synthesis included 57 studies, and the authors conducted meta-analysis of 3. PULP leads to more asymptomatic cases (relative risk [RR], 1.06; 95% CI, 1.01 to 1.11; P < .01; I2 = 67%) and to a lower occurrence of mild (RR, 0.89; 95% CI, 0.79 to 0.99; P < .04; I2 = 37%) and moderate (RR, 0.70; 95% CI, 0.51 to 0.95; P < .02; I2 = 57%) postoperative pain than RCT. The frequency of severe pain was very low for both vital pulp therapy and RCT. Moderate to severe postoperative pain was more common at 48 hours through 72 hours after RCT and up to 36 hours after PULP. Pain intensity after PULP was higher using calcium-enriched material compared with using mineral trioxide aggregate at 12, 18, and 36 hours (P < .001). PRACTICAL IMPLICATIONS: PULP showed a significantly higher incidence of no pain and a lower incidence of mild and moderate pain than single-visit RCT. Clinical decisions for RCT or PULP should not be based on differences in postoperative pain. When analgesia is indicated, it probably should be limited to a short time after PULP.

Coronal discoloration induced by calcium silicate-based cements used in full pulpotomy in mature permanent molars: a randomized clinical trial.

OBJECTIVES: This study aimed to randomly compare in vivo coronal discoloration at 6 and 12 months after full pulpotomy in mature permanent molars using MTA, Biodentine, and TotalFill and to investigate the effect of variables such as remaining buccal wall thickness and time to achieve hemostasis. MATERIALS AND METHODS: One hundred eight teeth that met the inclusion criteria received full pulpotomy and were randomly divided into 3 groups via a block randomization technique according to the calcium silicate cement (CSC): ProRoot WMTA, TotalFill, or Biodentine. Assessment of tooth color was carried out using a spectrophotometric device (VITA Easyshade Compact) after composite placement (T0), at 6- and 12-month follow-up. Buccal wall thickness and time to hemostasis were recorded. The primary outcome measure (color change ΔE) was calculated, and the results were analyzed by three-way ANOVA and crosstabulations in relation to material type and effect of variables. RESULTS: Four cases were excluded after pulpotomy failure; 81 teeth were evaluated at 6 months and 95 teeth at 12 months. All CSCs caused tooth discoloration (defined as ΔE > 3.7); MTA significantly caused the highest color change at 6- and 12-month follow-up (76% (19/25) and 87.5% (28/32), respectively) compared to Biodentine (41% (9/22), 48% (13/27)) and TotalFill (44% (15/34), 53% (19/53)) (p = 0.022, p = 0.002), while no significant difference was found between the Biodentine and TotalFill groups (p = 0.813, p = 0.8). Buccal wall thickness (above or below 2.7 mm) had a significant effect on the degree of discoloration (p = 0.004). CONCLUSIONS: The 3 CSCs caused tooth discoloration based on the threshold of ΔE > 3; the remaining buccal wall thickness was a significant factor. The use of Biodentine and TotalFill instead of MTA is encouraged to minimize discoloration. CLINICAL RELEVANCE: While experimental studies report coronal discoloration after CSCs use, clinical data is lacking. This study assessed discoloration using a spectrophotometric device. The use of materials with lower discoloration potential in pulpotomy is encouraged. TRIAL REGISTRATION: The study was registered with clinical trial registration number: NCT04346849 on 14.4.2020.

Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial.

This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA (n = 188), PCEM (n = 194), or RCT (n = 168) arms. Preoperative "Pain Intensity" (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients' demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (P=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (P=0.939), and the trend/changes in pain relief were parallel (P=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (P=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes (P < 0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (P=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.

Surgical management of atypical mycobacterial cervical lymphadenitis in an outbreak of odontological infection.

INTRODUCTION: We report on our experience with surgical management of nosocomial Mycobacterium abscessus cervical lymphadenitis in the setting of an epidemic linked to a dental practice in the community. METHODS: This is an observational case series of children who required surgical treatment of cervical lymphadenitis as part of multidisciplinary management of nosocomial M. abscessus infections. We describe the criteria for surgical management of cervical lymphadenitis as well as patient characteristics and outcomes. RESULTS: Over 1000 children undergoing pulpectomies and pulpotomies at a local dental practice with a contaminated water source were identified as potentially susceptible to atypical mycobacteria infection, identified as M. abscessus. Between August 2016 and May 2017 108 children underwent inpatient evaluation at our institution by general pediatricians and pediatric infectious disease specialists. 90 children required at least 1 surgical intervention by pediatric otolaryngology and/or oral and maxillofacial surgery (OMFS). Children were evaluated by the Pediatric Otolaryngology service if computer tomography (CT) scan of the neck demonstrated lymph nodes of at least 1.5 cm in shortest dimension or lymph nodes with central hypolucencies suspicious for infection with central necrosis. Pediatric Otolaryngology intervened on 11 patients all of whom required selective cervical lymphadenectomy with or without curettage. These patients ranged in age from 3 to 8 years; 8 were male, 6 had concurrent pulmonary nodules. Two patients underwent curettage in addition to lymphadenectomy. Five patients required at least 2 surgical interventions by Pediatric Otolaryngology. CONCLUSION: We found M. abscessus to be an aggressive infection requiring early cervical lymphadenectomy in select patients.

Initial inflammatory response after the pulpotomy of rat molars with MTA or ferric sulfate.

PURPOSE: To compare, both qualitatively and quantitatively, the inflammatory cells, vascular density and IL-6 immunolabeled cells present in the pulp after pulpotomy with white MTA versus 15.5% ferric sulfate (FS). METHODOLOGY: Forty-eight mandibular first molars from 24 Wistar rats were divided into MTA or FS groups and subdivided according to the period after pulpotomy procedure (24, 48 and 72 hours). Four teeth (sound and untreated) were used as controls. Histological sections were obtained and assessed through the descriptive analysis of morphological aspects of pulp tissue and the quantification of inflammatory cells, vascular density and interleukin-6 (IL-6) expression. Data were statistically analyzed (p<0.05). RESULTS: The number of inflammatory cells was similar in both groups, being predominantly localized at the cervical radicular third. In the MTA group, increased inflammation was observed at 48 hours. Vascular density was similar in both groups and over time, being predominant in the medium radicular third. No correlation was found between the number of inflammatory cells and the vascular density. Pulp tissue was more organized in MTA-treated teeth. In both groups, a weak to moderate IL-6 expression was detected in odontoblasts and inflammatory cells. Comparing both groups, there was a greater IL-6 expression in the cervical radicular third of teeth treated with MTA at 24 hours and in the medium and apical thirds at 72 hours, while in the FS group a greater IL-6 expression was found in the apical third at 24 hours. CONCLUSION: The MTA group presented better histological features and greater IL-6 expression than the FS group. However, no difference was observed between the groups regarding the inflammatory status and vascularization, suggesting the usefulness of FS as a low-cost alternative to MTA.

Initial inflammatory response after the pulpotomy of rat molars with MTA or ferric sulfate

Abstract Purpose To compare, both qualitatively and quantitatively, the inflammatory cells, vascular density and IL-6 immunolabeled cells present in the pulp after pulpotomy with white MTA versus 15.5% ferric sulfate (FS). Methodology Forty-eight mandibular first molars from 24 Wistar rats were divided into MTA or FS groups and subdivided according to the period after pulpotomy procedure (24, 48 and 72 hours). Four teeth (sound and untreated) were used as controls. Histological sections were obtained and assessed through the descriptive analysis of morphological aspects of pulp tissue and the quantification of inflammatory cells, vascular density and interleukin-6 (IL-6) expression. Data were statistically analyzed (p<0.05). Results The number of inflammatory cells was similar in both groups, being predominantly localized at the cervical radicular third. In the MTA group, increased inflammation was observed at 48 hours. Vascular density was similar in both groups and over time, being predominant in the medium radicular third. No correlation was found between the number of inflammatory cells and the vascular density. Pulp tissue was more organized in MTA-treated teeth. In both groups, a weak to moderate IL-6 expression was detected in odontoblasts and inflammatory cells. Comparing both groups, there was a greater IL-6 expression in the cervical radicular third of teeth treated with MTA at 24 hours and in the medium and apical thirds at 72 hours, while in the FS group a greater IL-6 expression was found in the apical third at 24 hours. Conclusion The MTA group presented better histological features and greater IL-6 expression than the FS group. However, no difference was observed between the groups regarding the inflammatory status and vascularization, suggesting the usefulness of FS as a low-cost alternative to MTA.

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

AIM: Proper anesthesia and pain management during treatment are most important concerns in dentistry for people of all ages, especially children. This study compared the success rate of lidocaine block with articaine buccal infiltration during anesthesia of the primary mandibular second molars in children aged 6 to 8 and 8 to 10 years. MATERIALS AND METHODS: The present clinical trial was conducted on 40 children aged 6 to 8 and 8 to 10 years who were referred to the Department of Pediatrics of the Faculty of Dentistry at Shahid Sadoughi University of Medical Sciences in Yazd (Islamic Republic of Iran) and needed to be treated with pulpotomy on both primary mandibular second molars. The patients were randomly divided into two groups. At the first session, a group received articaine buccal infiltration and the other group experienced inferior alveolar nerve (IAN) block. At the next visit, this trend was reversed. Visual analog scale (VAS) was used to evaluate the pain during pulpotomy. RESULTS: Data were analyzed by Statistical Package for the Social Sciences (version 17) software using Mann-Whitney test. According to the results of this test, the pain during pulpotomy was significantly lower in the articaine group (p < 0.001). CONCLUSION: Articaine buccal infiltration can be employed for pulpotomy treatment in primary mandibular second molars. CLINICAL SIGNIFICANCE: This research will eliminate block injection of lidocaine in children and utilize infiltration of articaine for pulpotomy treatment of mandibular teeth, hence preventing lingual nerve damage and prolonging paresthesia of IAN, lip, and cheek bite due to IAN block anesthesia.

Diagnosis and Management of Children With Mycobacterium abscessus Infections in the Head and Neck.

PURPOSE: Controversy exists regarding the most appropriate treatment strategy for children with nontuberculous mycobacterial (NTM) cervical lymphadenitis. Mycobacterium abscessus (MAB) is an uncommon cause of NTM cervical lymphadenitis. The purpose of the present study was to evaluate diagnosis, management, and treatment outcomes in children with MAB-associated cervical lymphadenitis resulting from a pulpotomy. MATERIALS AND METHODS: This was a retrospective chart review of children with NTM lymphadenitis of the head and neck caused by MAB treated at Children's Healthcare of Atlanta hospitals (Atlanta, GA). The predictor variables were patient demographics, dental history, clinical presentation, imaging characteristics, laboratory findings, histopathologic examination, treatment, and complications. The outcome variable was disease resolution or persistence. RESULTS: Twenty-two patients (mean age, 6.5 yr) met the inclusion criteria. All patients had pulpotomy at 1 dental practice. The mean time from dental procedure to symptom onset was 43.1 days (range, 3 to 180 days). Children presented with cervical or submandibular swelling, facial swelling, gingival erythema, and skin erythema. Radiographic findings were submandibular or cervical lymphadenitis, maxillary or mandibular osteolysis, subcutaneous abscess, and pulmonary nodules. All children had confirmed or probable MAB infection diagnosed on the pathologic specimen. There were 2 distinct patient presentations that guided surgical management: isolated noninflammatory cervical lymphadenitis, which was partly or completely excised (n = 11), and adjacent extension or disseminated infection requiring subtotal lymph node excision, bone debridement, and postoperative antibiotics (n = 11). Most children required multiple surgical interventions to remove infected tissues. All achieved clinical resolution. CONCLUSION: In this cohort, treatment of NTM lymphadenitis caused by MAB depended on extent of disease and virulence of bacteria. When complete surgical excision was possible, disease resolution was achieved. However, in cases with adjacent extension or dissemination infection, postoperative antibiotics were necessary.

Immediate Postoperative Pain and Recovery Time after Pulpotomy Performed under General Anaesthesia in Young Children.

BACKGROUND: The aim of this retrospective study was to compare immediate postoperative pain scores and need for rescue analgesia in children who underwent pulpotomies and restorative treatment and those who underwent restorative treatment only, all under general anaesthesia. METHODS: Ninety patients aged between 3 and 7 years who underwent full mouth dental rehabilitation under general anaesthesia were enrolled in the study and reviewed. The experimental group included patients who were treated with at least one pulpotomy, and the control group was treated with dental fillings only. The Wong-Baker FACES scale was used to evaluate self-reported pain and need for rescue analgesia. The data were analysed using the Kruskal-Wallis test, two sample t-tests, chi-square tests, and Pearson's correlation analysis. RESULTS: Ninety percent of the children experienced postoperative pain in varying degrees of severity. Immediate postoperative pain scores in experimental group were found to be significantly higher than in control group (x2 = 24.82, p < 0.01). In the experimental group, 48% of the children needed rescue analgesia, compared with only 13% of the children in the control group (x2 = 13.27, p < 0.05). CONCLUSION: Children who underwent pulpotomy treatment had higher postoperative pain scores and greater need for rescue analgesia than control group who underwent only dental fillings.

Characterization of Dental Pulp Myofibroblasts in Rat Molars after Pulpotomy.

INTRODUCTION: Myofibroblasts express alpha smooth muscle actin (α-SMA) and play a critical role in wound healing. Myofibroblast differentiation is controlled by the joint actions of transforming growth factor beta 1 (TGF-ß1) and the extradomain A fibronectin splice variant (EDA-FN). Currently, the contribution of myofibroblasts to dental pulp healing is unknown. Therefore, we analyzed expressional characteristics of α-SMA-positive cells and investigated TGF-ß1, EDA-FN, and α-SMA expression levels after pulpotomy to better understand dental pulp healing. METHODS: The maxillary first molars of 8-week-old Wistar rats were pulpotomized with mineral trioxide aggregate. After 1 to 14 days, localization and colocalization of α-SMA, rat endothelial cell antigen-1 (as a marker of endothelial cells), neuron-glial antigen 2 (as a marker of perivascular cells), prolyl-4-hydroxylase (P4H, as an additional marker of myofibroblasts), and EDA-FN were analyzed using immunohistochemistry and double immunofluorescence. Time-course changes in the messenger RNA expression levels of TGF-ß1, EDA-FN, and α-SMA were evaluated using quantitative real-time polymerase chain reaction analysis. RESULTS: Spindle-shaped α-SMA-positive cells transiently appeared after pulpotomy. These cells initially emerged in the pulp core on day 3 and then accumulated at the wound site by day 5. These cells were isolated from rat endothelial cell antigen-1 positive cells and did not express neuron-glial antigen 2 but did express P4H. The messenger RNA levels of TGF-ß1, EDA-FN, and α-SMA were significantly up-regulated after pulpotomy. EDA-FN and α-SMA were colocalized at the wound sites on day 5. CONCLUSIONS: In association with up-regulation of TGF-ß1 and EDA-FN expression, α-SMA and P4H double-positive cells accumulated at the wound sites after pulpotomy. This suggests that myofibroblasts participate in dental pulp healing.

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

BACKGROUND: Irreversible pulpitis is a highly painful inflammatory condition of the dental pulp which represents a common dental emergency. Recommended care is partial endodontic treatment. The dental literature reports major difficulties in achieving adequate analgesia to perform this emergency treatment, especially in the case of mandibular molars. In current practice, short-course, orally administered corticotherapy is used for the management of oral pain of inflammatory origin. The efficacy of intraosseous local steroid injections for irreversible pulpitis in mandibular molars has already been demonstrated but resulted in local comorbidities. Oral administration of short-course prednisolone is simple and safe but its efficacy to manage pain caused by irreversible pulpitis has not yet been demonstrated. This trial aims to evaluate the noninferiority of short-course, orally administered corticotherapy versus partial endodontic treatment for the emergency care of irreversible pulpitis in mandibular molars. METHODS/DESIGN: This study is a noninferiority, open-label, randomized controlled clinical trial conducted at the Bordeaux University Hospital. One hundred and twenty subjects will be randomized in two 1:1 parallel arms: the intervention arm will receive one oral dose of prednisolone (1 mg/kg) during the emergency visit, followed by one morning dose each day for 3 days and the reference arm will receive partial endodontic treatment. Both groups will receive planned complete endodontic treatment 72 h after enrollment. The primary outcome is the proportion of patients with pain intensity below 5 on a Numeric Scale 24 h after the emergency visit. Secondary outcomes include comfort during care, the number of injected anesthetic cartridges when performing complete endodontic treatment, the number of antalgic drugs and the number of patients coming back for consultation after 72 h. DISCUSSION: This randomized trial will assess the ability of short-term corticotherapy to reduce pain in irreversible pulpitis as a simple and rapid alternative to partial endodontic treatment and to enable planning of endodontic treatment in optimal analgesic conditions. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02629042 . Registered on 7 December 2015. (Version n°1.1 28 July 2015).

Immediate and mediate furcal perforation treatment in primary molars: 24-month follow-up.

BACKGROUND: Furcal perforation consists of a communication between the pulp cavity and the periodontal tissues that can occur accidentally during cavity preparation or root canal instrumentation. This complication may lead to inflammatory reactions and compromise adjacent tissues irreversibly, resulting in the early loss of primary teeth. Perforation sealing with a biocompatible material is necessary to ensure a favourable prognosis. Among different materials, MTA has been employed due to its excellent healing and physical properties. CASE REPORT: The purpose of these case reports was to describe immediate and mediate cases of furcal perforation treatment using MTA in primary molars. In both the cases, after accidental perforation detection, the pulp chamber was cleaned with saline solution to clear off the debris. The wound surface was continuously irrigated with saline solution and a dry sterile cotton pellet was placed on the radicular pulp stumps and perforation area with slight pressure until the bleeding was controlled. The MTA was applied into the perforation and pulp chamber area with the aid of a sterile amalgam carrier. The teeth were restored with resin-modified glass ionomer cement. FOLLOW-UP: Clinical and radiographic follow-up examinations were carried out at 3, 6, 12, 18, and 24 months after perforation sealing. Both the cases remained asymptomatic, presenting no discomfort, mobility, swelling, or fistula after 24-months follow-up. Radiographically, the radiolucent area disappeared as a result of bone formation in the inter-radicular space, showing adjacent tissue preservation. CONCLUSION: Thus, MTA may be considered as an ideal option for conservative treatment of immediate and mediate furcal perforation in primary teeth, once it promoted repair with tooth maintenance in both the cases.

Comparative Study of Pulpal Responses to Pulpotomy with ProRoot MTA, RetroMTA, and TheraCal in Dogs' Teeth.

INTRODUCTION: This study was conducted to evaluate and compare pulpal responses to ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK), RetroMTA (Meta Biomed Co, Ltd, Seoul, Korea), and TheraCal (Bisco Inc, Schamburg, IL) in dog partial pulpotomy models. METHODS: Partial pulpotomies were performed on 60 beagle teeth. The exposed pulp tissues were randomly capped with either ProRoot MTA (n = 15), RetroMTA (n = 15), TheraCal (n = 15), or interim restorative material as a negative control (n = 15). After 4 weeks, the teeth were extracted and processed for histologic and immunohistochemical examinations using osteocalcin and dentin sialoprotein. Calcific barrier formation, inflammatory reaction, and the odontoblastic layer were evaluated and scored in a blind manner. The areas of newly formed calcific barriers were measured for each group. RESULTS: In most of the ProRoot MTA and RetroMTA specimens, continuous calcific barriers were formed, and the pulps contained palisading patterns in the odontoblastic layer that were free of inflammation. However, the TheraCal specimens had lower quality calcific barrier formation, extensive inflammation, and less favorable odontoblastic layer formation. Overall, areas of newly formed calcific barrier were higher in the ProRoot MTA and RetroMTA specimens than in the TheraCal specimens. Also, immunohistochemistry revealed that osteocalcin and dentin sialoprotein were more clearly visible in the ProRoot MTA and RetroMTA specimens than in the TheraCal specimens. CONCLUSIONS: RetroMTA could provide an alternative to ProRoot MTA. Both materials produced favorable pulpal responses that were similar in nature, whereas TheraCal produced less favorable pulpal responses.

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.

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

PURPOSE: This study's purpose was to histologically evaluate the repair of rat tissue after pulpotomy and covering the pulp tissue with Copaifera langsdorffi oil resin, green propolis extract, fibrin sponge and iodoform-based paste. METHODS: Pulpotomies were performed in the maxillary and mandibular first molars of 21 Wistar rats (84 total teeth). The access cavities were sealed with Coltosol, and histological evaluations were performed at 24 hours, 15 days, and 30 days postoperatively. RESULTS: For all experimental periods and materials, an inflammatory response constituted predominantly by neutrophils was observed, being of milder intensity for the Copaifera langsdorffii oil-resin group and more severe for the fibrin sponge group, which exhibited periapical microabscesses. Necrosis was observed in all groups, and its extension increased with time, except for teeth protected with Copaifera langsdorffii oil-resin. Formation of a mineralized tissue barrier in the pulp exposure area occurred only in the Copaifera langsdorffii oil-resin group. Other findings, such as vascular congestion, edema, and hemorrhage, were observed in all cases. CONCLUSIONS: The inflammatory response was less severe, the area of pulp necrosis was smaller, and more frequent formation of a mineralized tissue barrier was noted after pulpotomy was performed with Copaifera langsdorffii oil-resin compared to the other materials tested.

Clinical and radiographic outcomes of calcium hydroxide and formocresol pulpotomies performed by dental students.

OBJECTIVE: The aim of this study was to compare the clinical and radiographic success rates of 3 pulpotomy techniques: formocresol, calcium hydroxide, and calcium hydroxide/iodoform. STUDY DESIGN: The pulpotomies were performed by fifth-year undergraduate dental students. Members of senior staff at the clinics supervised all of the procedures. Informed consent was obtained from each child's parents. The teeth were randomly assigned to the experimental (calcium hydroxide and calcium hydroxide/iodoform) or control (formocresol) groups. After coronal pulp removal and hemostasis, remaining pulp tissue was covered with calcium hydroxide or calcium hydroxide/iodoform paste in the experimental groups. In the control group, formocresol was placed with a cotton pellet over the pulp tissue for 5 minutes and removed; the pulp tissue was then covered with zinc oxide-eugenol. All teeth were restored with stainless-steel crowns. Clinical and radiographic successes and failures were recorded at 1-, 3-, 6-, and 12-month follow-ups by the authors. Data were statistically analyzed using chi-squared tests. RESULTS: The follow-up evaluations revealed that the clinical success rates were 89.7% for formocresol, 33.3% for calcium hydroxide, and 17.2% for calcium hydroxide/iodoform. The radiographic success rates were 89.7% for formocresol, 33.3% for calcium hydroxide, and 13.8% for calcium hydroxide/iodoform. CONCLUSIONS: Formocresol was superior to calcium hydroxide and calcium hydroxide/iodoform pastes for primary molar pulpotomies. Internal resorption was the most common radiographic failure in all 3 pulpotomy techniques.

In vitro toxicity of MTA compared with other primary teeth pulpotomy agents.

OBJECTIVE: The main goal of this work is to compare the In vitro toxicity of MTA with other primary teeth pulpotomy agents. STUDY DESIGN: The In vitro toxicity of MTA, calcium hydroxide, ferric sulphate solution, diluted formocresol and Buckley's formocresol were tested using MTT and Neutral Red Uptake cell viability assays. The results for MTA were compared to those obtained for the other substances using ANOVA and Tukey statistical tests (p < 0.05). RESULTS: MTA had the lower in vitro toxicity and Buckley's formocresol, the higher, with statically significant difference. CONCLUSION: Among the primary teeth pulpotomy agents tested, MTA showed the lower In vitro toxicity, standing as the most promising substitute to formocresol.

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

PURPOSE: The purpose of this survey study was to assess adverse events in young, healthy children treated for dental caries under general anesthesia (GA) in the first 24 hours after discharge from Cincinnati Children's Hospital Medical Center (CCHMC). METHODS: This study involved a sample of 50 2- to 10-year-old healthy patients who were scheduled for dental rehabilitation under GA at CCHMC. The principal investigator called 24 hours after discharge from the treatment facility and interviewed parents using a 22-item questionnaire, which generally addressed some daily functions of childhood. Analysis of the data involved descriptive statistics, frequency distribution, and cross-tabulation. RESULTS: There was no significant difference among patients by gender or age group who slept while traveling home. Older children tended to vomit, while younger children had diarrhea. More moderate and severe complaints were reported for restorative work involving stainless steel crowns (SSCs) compared to no restorative work (ie, extractions only) or restorative work without SSCs. CONCLUSION: Some children may experience temporary disruption of bodily functions. Additionally, restorative procedures involving stainless steel crowns may cause more complaints and a return to preoperative home behaviors may take 6 or more hours.