Pulpotomy in primary teeth: Review of the literature according to standardized assessment criteria

Article

Abstract

Aim: To assess the relevant literature using a modification of the criteria listed in the introductory paper to this issue [Curzon and Toumba, 2006], and to review several new publications on pulpotomies with different materials and techniques that appeared after previously published reviews. Methods: A search of the relevant literature on pulpotomies was identified through Medline between the years 1966–2005. The search generated a total of 358 citations and sieving of these papers was conducted by examining the paper title and assessing its relevance [Loh et al, 2004]. Only clinical studies (non-specified) and retrospective studies were included for assessment. There were 17 criteria (considered major) weighed 2 points and 8 criteria weighed 1 point. A paper that would score between 38–42 points (90+ %) was assessed as Grade A, a score from 32 to 37 points (75–89%) was Grade B1, and between 25 to 31 points (60–74%) Graded B2. Any other paper that reached 24 points or less (less than 59%) was rated Grade C. Results: Of the 358 papers originally identified 48 clinical trials were evaluated according to the set criteria. There was only one paper grade A, 5 papers graded B1, 3 graded B2 and 39 received a C grade. Formocresol or ferric sulphate medicaments were found to be likely to have similar clinical/radiographic results, and MTA seemed to be a more favourable pulp dressing. Conclusion: No conclusion can be made as to the optimum treatment or technique for pulpally involved primary teeth. More high quality, properly planned prospective studies are necessary to clarify these points.

Key words

Primary teeth pulpotomy dressing materials 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Agamy HA, Bakry NS, Mounir MM, Avery DR. Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. Pediatr Dent 2004; 26:302–309.PubMedGoogle Scholar
  2. Al-Zayer MA, Straffon LH, Feigal RJ, Welch KB. Indirect pulp treatment of primary posterior teeth; a retrospective study. Pediatr Dent 2003; 25:29–36.PubMedGoogle Scholar
  3. Alacam A. Long term effects of primary teeth pulpotomies with formocresol, glutaraldehyde-calcium hydroxide and glutaraldehyde-zinc oxide eugenol on succedaneous teeth. J Pedod 1989; 18:123–132.Google Scholar
  4. Araujo FB, Ely LB, Pergo AM, Pesce HF. A clinical evaluation of 2% buffered glutaraldehyde in pulpotomies of human deciduous teeth: a 24-month study. Braz Dent 1995; 6:41–44.Google Scholar
  5. Auerbach C, Moutschen-Damen M, Moutschen M. Genetic and cytogenetical effects of formaldehyde and related compounds. Mutat Res 1977; 39:317–361.PubMedCrossRefGoogle Scholar
  6. Berger JE. Pulp tissue reaction to formocresol and zinc-oxide eugenol. J Dent Child 1965; 32:13–27.Google Scholar
  7. Bjorndal L, Larsen T, Thylstrup A. A clinical and microbiological study on deep carious lesions during stepwise excavation using long treatment intervals. Caries Research 1997; 31: 411–417.PubMedCrossRefGoogle Scholar
  8. Bjorndal L, Thylstrup A. A practice-based study on stepwise excavation of deep carious lesions in permanent teeth. Community Dentistry and Oral Epidemiology 1998:26; 122–128.PubMedCrossRefGoogle Scholar
  9. Block RM, Lewis RD, Sheats JB, Fauley J. Cell-mediated immune response to dog pulp tissue altered by formocresol within the root canal. J Endod 1977; 3:424–430.PubMedCrossRefGoogle Scholar
  10. Block RM, Lewis RD, Sheats JB, Burke SG. Antibody formation to dog pulp tissue altered by formocresol within the root canal. Oral Surg 1978; 45:282–292.PubMedCrossRefGoogle Scholar
  11. Burnett S, Walker J. Comparison of ferric sulfate, formocresol and a combination of ferric sulfate/formocresol in primary tooth vital pulpotomies: a retrospective radiographic survey. J Dent Child 2002; 69: 44–48.Google Scholar
  12. Casas MJ, Layung MA, Kenny DJ, Johnston DH, Judd PL. Two-year outcomes of primary molar ferric sulfate pulpotomy and root canal therapy.Pediatr Dent 2003; 25: 97–102.PubMedGoogle Scholar
  13. Casas MJ, Kenny DJ, Johnston DH, Judd PL. Long-term outcomes of primary molar ferric sulfate pulpotomy and root canal therapy. Pediatr Dent 2004; 26:44–48.PubMedGoogle Scholar
  14. Casas M J, Kenny DJ, Johnston DH, Judd PL et al. Outcomes of vital primary incisor ferric sulfate pulpotomy and root canal therapy. J Can Dent Assoc 2004; 70: 34–38.PubMedGoogle Scholar
  15. Curzon MEJ, Toumba KJ. Restoration of primary teeth: Criteria for assessment of the literature 2006; Eur Arch Paediatr Dent 7, special issue.Google Scholar
  16. Dean JA, Mack RB, Fulkerson BT, Sanders BJ. Comparison of electrosurgical and formocresol pulpotomy procedures in children. Int J Paediatr Dent 2003; 12:177–182.CrossRefGoogle Scholar
  17. Eidelman E, Holan G, Fuks AB. Mineral trioxide aggregate vs formocresol in pulpotomized primary molars: A preliminary report. Pediatr Dent 2001;23:15–18.PubMedGoogle Scholar
  18. Elliot RD, Roberts MW, Burkes J, Phillips C. Evaluation of carbon dioxide laser on vital human primary pulp tissue. Pediatr Dent 1999; 21:327–331.Google Scholar
  19. Fadavi S, Anderson AW. A comparison of the pulpal response to freeze-dried bone, calcium hydroxide, and zinc oxide-eugenol in primary teeth in two cynomolgus monkeys. Pediatr Dent 1996; 18:52–56.PubMedGoogle Scholar
  20. Falster CA, Araujo FB, Straffon LH, Nor JE. Indirect pulp treatment: in vivo outcomes of am adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex. Pediatr Dent 2002; 24: 241–248.PubMedGoogle Scholar
  21. Farooq NS, Coll JA, Kuwabara A, Shelton P. Success rates of formocresol pulpotomy and indirect pulp treatmentof deep dentinal caries in primary teeth. Pediatr Dent 2000; 22: 278–286.PubMedGoogle Scholar
  22. Farsi N, Alamoudi N, Balto K, Mushayt A. Success of minerals trioxide aggregate in pulpotomized primary molars. J Clin Pediatr Dent 2005; 29:307–311.PubMedGoogle Scholar
  23. Fei AL, Udin RD, Johnson R. A clinical study of ferric sulfate as a pulpotomy agent in primary teeth. Pediatr Dent 1991; 13:327–332.PubMedGoogle Scholar
  24. Fishman SA, Udin RD, Good DL, Rodef F. Success of electrofulguration pulpotomies covered by zinc oxide and eugenol or calcium hydroxide: a clinical study. Pediatr Dent 1996; 18:385–390.PubMedGoogle Scholar
  25. Fuks AB, Bimstein E. Clinical evaluation of diluted formocresol pulpotomy in primary teeth of school children. Pediatr Dent 1981; 3:321–324.PubMedGoogle Scholar
  26. Fuks AB, Bimstein E, Klein H, Guelmann M. Assessment of a 2%buffered glutaraldehyde solution in pulpotomized primary teeth of schoolchildren. J Dent Child 1990; 57:371–375.Google Scholar
  27. Fuks AB, Holan G, Davis JM, Eidelman E. Ferric sulfate versus dilute formocresol in pulpotomized primary molars: long term follow-up. Pediatr Dent 1997; 19:327–330.PubMedGoogle Scholar
  28. Fuks AB. Current concepts in vital primary pulp therapy. Eur J Paediatr Dent 2002; 3:115–120.PubMedGoogle Scholar
  29. Fuks AB: Pulp Therapy For The Primary Dentition, In Pediatric Dentistry, Infancy Through Adolescence. 2005; J R Pinkham. Elsevier, 11830 Westline Industrial Drive, St. Louis, MO—4th Edition, 375–393Google Scholar
  30. Gruythuysen RJ, Weerheijm KL. Calcium hydroxide pulpotomy with a light-cured cavity-sealing material after two years. J Dent Child 1997; 64:251–253.Google Scholar
  31. Guelmann M, Fair J, Turner C, Courts FJ. The success of emergency pulpotomies in primary molars. Pediatr Dent 2002; 24:217–220.PubMedGoogle Scholar
  32. Guelmann M, MIlwain MF, Primosch RE. Radiographic assessment of primary molar pulpotomies restored with resin-based materials. Pediatr Dent 2005; 27:24–27.PubMedGoogle Scholar
  33. Holan G, Fuks AB, Keltz N. Success rate of formocresol pulpotomy in primary molars restored with stainless steel crowns vs amalgam. Pediatr Dent 2002; 24:212–216.PubMedGoogle Scholar
  34. Holan G, Eidelman E, Fuks AB. Lon-term evaluation of pulpotomy in primary molars using mineral Trioxide Aggregate and formocresol. Pediatr Dent 2005Google Scholar
  35. Huth KC, Paschos E, Hajek-Al-Khatar N, Hollweck R, et al. Effectiveness of 4 pulpotomy techniques-randomized controlled trial.J Dent Res 2005; 84:1144–1148.PubMedCrossRefGoogle Scholar
  36. Ibrevic H, Al-Jame Q. Ferric sulfate as pulpotomy agent in primary teeth: twenty month clinical follow-up. J Clin Pediatr Dent 2000; 24:269–272.Google Scholar
  37. International Agency for Research on Cancer. Press release no. 153. 15 June 2004. [WWW document.] URL
  38. Judd PL, Kenny DJ. Formocresol concerns: A review. J Can Dent Assoc 1987; 53:401–404.PubMedGoogle Scholar
  39. Kalaskar RR, Damle SG. Comparative evaluation of lyophilized freeze dried platelet derived preparation with calcium hydroxide as pulpotomy agents in primary molars. J Indian Soc Pedod Prev Dent 2004; 22:24–29.PubMedGoogle Scholar
  40. Koch G, Nyborg H. Correlation between clinical and histological indications for pulpotomy of deciduous teeth. J Int Assoc Dent Child 1970; 1:3–10.PubMedGoogle Scholar
  41. Loh A, O’Hoy P, Tran X, et al. Evidence-based assessment. Evaluation of the formocresol versus ferric sulfate primary molar pulpotomy. Pediatric Dentistry 2004; 26:401–409.PubMedGoogle Scholar
  42. Magnusson BO. Therapeutic pulpotomies in primary molars with the formocresol technique. Acta Odontol Scand 1978; 36:157–165.PubMedCrossRefGoogle Scholar
  43. Markovic D, Zibojinovic V, Bucetic M. Evaluation of three pulpotomy medicaments in primary teeth. Eur J Paediatr Dent 2005; 6:133–138.PubMedGoogle Scholar
  44. Maroto M, Barberia E, Planells P, Garcia Godoy F. Dentin bridge formation after mineral trioxide aggregate (MTA) pulpotomies in primary teeth. Am J Dent 2005; 18:151–154.PubMedGoogle Scholar
  45. Mejare I. Pulpotomy of primary molars with coronal or total pulpitis using formocresol technique. Scand J Dent Res 1979; 87:208–216.PubMedGoogle Scholar
  46. Mertz-Fairhurst EJ, Curtis JW Jr, Ergle JW, Rueggeberg FA, Adair SM. Cariostatic and ultraconservative sealed restorations: nine-year results among children and adults. J Dent Child 1995; 62:97–107.Google Scholar
  47. Mertz-Fairhurst EJ et al. Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc 1998; 129:55–66.PubMedGoogle Scholar
  48. Morawa AP, Straffon LH, Han SS, Corpron RE. Clinical evaluation of pulpotomies using dilute formocresol. J Dent Child 1975; 42:28–31.Google Scholar
  49. Myers DR, Shoaf HK, Dirksen TR, Pashley DH, Whitford GM, Reynolds KE. Distribution of 14c formaldehyde after pulpotomy with formocresol. J Am Dent Assoc 1978; 96:805–813.PubMedGoogle Scholar
  50. Naik S, Hegde AM. Mineral trioxide aggregate as a pulpotomy agent in primary molars: An in vivo study. J Indian Soc Pedod Prev Dent 2005; 23:13–16.PubMedCrossRefGoogle Scholar
  51. Nadine G, Goel BR, Yeung CA, Glenny AM. Pulp treatment for extensive decay in primary teeth. Cochraine Database Syst Rev 2003; (1):CD0033220. Review.Google Scholar
  52. Nakashima M. The induction of reparative dentine in the amputated dental pulp of the dog by bone morphogenetic protein. Arch Oral Biol 1990;35:493–497.PubMedCrossRefGoogle Scholar
  53. Nakashima M. Induction of dentine formation on canine amputated pulp by recombinant human bone morphogenetic proteins (BMP)-2 and 4. J Dent Res 1994;73:1515–1522.PubMedGoogle Scholar
  54. Prakash C, Chandra S, Jaiswal JN. Formocresol and pulpotomies in primary teeth. J Pedod 1989; 13:314–322.PubMedGoogle Scholar
  55. Primosch, RE, Glom TA, Jerrell RG. Primary tooth pulp therapy as taught in predoctoral pediatric dental programs in the United States. Pediatr Dent 1997; 19:118–122.PubMedGoogle Scholar
  56. Pruhs RJ, Olen GA, Sharma PS. Relationship between formocresol pulpotomies on primary teeth and enamel defects on their permanent successors. J Am Dent Assoc 1977; 94:698–700.PubMedGoogle Scholar
  57. Redig DF. A comparison and evaluation of two formocresol pulpotomy technics utilizing “Buckley’s “formocresol. J Dent Child 1968; 35: 22–29.PubMedGoogle Scholar
  58. Rivera N, Reyes E, Mazzaoui S, Moron A. Pulpal therapy for primary teeth: formocresol vs electrosurgery: a clinical study. J Dent child 2003; 70:71–73.Google Scholar
  59. Rutherford RB, Wahle J, Tucker M, Roger D, Charette M. Induction of reparative dentine formation in monkeys by recombinant human osteogenic protein-1. Arch Oral Biol 1993; 38:571–576.PubMedCrossRefGoogle Scholar
  60. Saltzman B, Sigal M, Clokie C, Rukavina J, et al. Assessment of a novel alternative to conventional formocresol-zinc oxide eugenol pulpotomy for the treatment of pulpally involved human primary teeth: diode laser-mineral trioxide aggregate pulpotomy. Int J Paediatr Dent 2005;15: 437–447.PubMedCrossRefGoogle Scholar
  61. Sasaki H, Ogawa T, Koreeda M, Ozaki T, et al. Electrocoagulation extends the indication of calcium hydroxide pulpotomy in the primary dentition. J Clin Pediatr Dent 2002; 26:275–277.PubMedGoogle Scholar
  62. Schroder U. A 2-year follow-up of primary molars, pulpotomized with a gentle technique and capped with calcium hydroxide. Scand J Dent Res 1978; 86:273–278.PubMedGoogle Scholar
  63. Shumayrikh NM, Adenubi JO. Clinical evaluation of glutaraldehyde with calcium hydroxide and glutaraldehyde with zinc oxide eugenol in pulpotomy of primary molars. Endod Dent Traumatol 1999; 15:259–264.PubMedCrossRefGoogle Scholar
  64. Smith NL, Seale NS, Nunn ME. Ferric sulfate pulpotomy in primary molars: a retrospective study. Pediatr Dent 2000; 22:192–199.PubMedGoogle Scholar
  65. Srinivasan V, Patchett CL, Waterhouse JP. Is there life after Buckley’s formocresol? Part I—A narrative review of alternative interventions and materials. Int J Paediatr Dent 2006; 16:117–135.PubMedCrossRefGoogle Scholar
  66. Straffon LH, Loos P. The indirect pulp cap: a review and commentary. J Israel Dent Assoc 2000; 17: 7–14.Google Scholar
  67. Stange DM, Seale NS, Nunn ME, Strange M. Outcome of formocresol/ZOE sub-base pulpotomies utilizing alternative radiographic success criteria. Pediatr Dent 2001; 23:331–336.Google Scholar
  68. Sun HW, Feigal RJ, Messer HH. Cytotoxicity of glutaraldehyde and formaldehyde in relation to time of exposure and concentration. Pediatr Dent 1990; 12:303–307.PubMedGoogle Scholar
  69. Thompson KS, Seale NS, Nunn ME, Huff G. Alternative method of hemorrhage control in full strength formocresol pulpotomy. Pediatr Dent 2001; 23:217–222.PubMedGoogle Scholar
  70. Vargas KG, Packham B. Radiographic success of ferric sulfate and formocresol pulpotomies in relation to early exfoliation. Pediatr Dent 2005; 27:233–237.PubMedGoogle Scholar
  71. Vij R, Coll JA, Shelton P, Farooq NS. Caries control and other variables associated with success of primary molar vital pulp therapy. Pediatr Dent 2004; 26:214–220.PubMedGoogle Scholar
  72. Waterhouse PJ, Nunn JH, Whitworth JM, Soames JV. Primary molar pulp therapy—histological evaluation of failure. Int J Paediatr Dent 2000; 10:313–321.PubMedCrossRefGoogle Scholar
  73. Waterhouse PJ, Nunn JH, Whitworth JM. Prostaglandin E2 and treatment outcome in pulp therapy of primary molars with carious exposures. Int J Paediatr Dent 2002; 12:116–123.PubMedCrossRefGoogle Scholar

References

  1. Duggal, M.S., Nooh, A., High, A. Response of the primary pulp to Inflammation: A review of the Leeds studies and challenges for the future. Eur J Paed Dent 2000; 3:112–117.Google Scholar
  2. Falster CA, Araujo FB, Straffon LH, Nor JE. Indirect pulp capping: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex. Pediatr Dent 2002;24:241–248.PubMedGoogle Scholar
  3. Farooq NS, Coll JA, Kuwabara A, Shelton P. Success rates of formocresol pulpotomy and indirect pulp capping in the treatment of deep dentinal caries in primary teeth. Padiatr Dent 2000;22:278–286.Google Scholar
  4. Hobson P. Pulp treatment of deciduous teeth. I. Clinical investigation. Br Dent J 1970;128, 232–238.PubMedCrossRefGoogle Scholar
  5. Holan G, E.Eidelman E, Fuks A. Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol. Pediatric Dentistry 2005; 27: 129–136.PubMedGoogle Scholar
  6. Nadine G, Goel BR, Yeung CA, Glenny AM. Pulp therapy for extensive decay in primary teeth. Cochrane Database Syt Rev 2003; (1): CD0033220. Review.Google Scholar
  7. Vij R, Coll JA, Shelton P, Farooq NS. Caries control and other variables associated with success of primary molar vital pulp therapy. Pediatr Dent2004;26:214–220.PubMedGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2006

Authors and Affiliations

  1. 1.Dept. of Pediatric DentistryHebrew University, Hadassah School of Dental MedicineJerusalemIsrael
  2. 2.Dept. of Pediatric Dentistry, School of DentistryAthens UniversityAthensGreece
  3. 3.Dept. Paediatric dentistryUniversity of LeedsEngland

Personalised recommendations