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Pulpotomy with calcium hydroxide resulted in the presence of reactive dentine barrier and discrete chronic inflammatory infiltrate. Necrotic areas in root canal were observed. a H&E; original magnification 9100. b H&E; original magnification 950
Source publication
Aim:
To compare the clinical, radiographic and histological responses of the pulp to mineral trioxide aggregate (MTA), calcium hydroxide (CH) and Portland cement (PC) when used as a pulpotomy agent in human primary teeth.
Study design:
Forty-five mandibular primary molar teeth were randomly assigned to CH, MTA or PC groups and treated by pulpoto...
Context in source publication
Context 1
... and some dentine barrier formation in the PC and MTA Fig. 1 Flow chart of pulpotomised teeth up to 24 months Eur Arch Paediatr Dent (2013) 14:65-71groups. The CH group showed necrotic areas in the root canals for most of the sections. Other sections revealed the presence of reactive dentine barrier and discrete chronic inflammatory infiltrate (Figs. 5, 6, ...
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Aim. (1) The aim of the clinical study revolves around the accurate diagnosis, proper case selection, and the management of acute irreversible pulpitis in permanent molars with closed apices using conservative and economical treatment modalities like vital pulpotomies with regenerative approaches over conventional root canal procedures. (2) To eval...
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Citations
... Although this review clearly shows that numerous wellconducted clinical studies have evaluated pulpotomy outcomes with bioactive agents both in primary and permanent teeth, more than 90% of the screened trials [18, 21-101, 103-115, 125-127, 131-139, 150-153, 155, 156, 167, 168] assessed the pulpotomy treatment outcome via subjective clinical and radiographic parameters.However, recent data has shown that the initial inflammatory status of the pulp is perhaps the only true determining factor that affects the outcome of treatment. Around only 10% of the studies mapped in this review performed histological analysis or attempted to measure inflammatory biomarkers [18,28,56,87,102,109,133,134,137,152,154,157]. While histological analysis is of course not possible and, in fact, unwarranted in most clinical trials, it remains the only measure of the actual condition of the pulp [169]. ...
Background
Pulpotomy procedures aiming to preserve and regenerate the dentin-pulp complex have recently increased exponentially due to developments in the field of biomaterials and tissue engineering in primary and permanent teeth. Although the number of studies in this domain has increased, there is still scarcity of evidence in the current literature.
Objectives
(1) Report the methods of outcome assessment of pulpotomy clinical trials in both primary and permanent teeth; (2) Identify the various bioactive agents and biodegradable scaffolds used in pulpotomy clinical trials in both primary and permanent teeth.
Materials and methods
A scoping review of the literature was performed, including a search of primary studies on PubMed, Scopus, Web of Science, ProQuest and Clinicaltrials.gov. A search for controlled trials or randomized controlled trials published between 2012 and 2023 involving primary or permanent teeth receiving partial or full pulpotomy procedures using bioactive/regenerative capping materials was performed.
Results
127 studies out of 1038 articles fulfilled all the inclusion criteria and were included in the current scoping review. More than 90% of the studies assessed clinical and radiographic outcomes. Histological, microbiological, or inflammatory outcomes were measured in only 9.4% of all included studies. Majority of the studies (67.7%) involved primary teeth. 119 studies used non-degradable bioactive cements, while biodegradable scaffolds were used by 32 studies, natural derivates and plant extracts studies were used in only 7 studies. Between 2012 (4 studies) and 2023 (11 studies), there was a general increase in the number of articles published. India, Egypt, Turkey, and Iran were found to have the highest total number of articles published (28, 28,16 and 10 respectively).
Conclusions
Pulpotomy studies in both primary and permanent teeth relied mainly on subjective clinical and radiographic outcome assessment methods and seldom analyzed pulpal inflammatory status objectively. The use of biodegradable scaffolds for pulpotomy treatments has been increasing with an apparent global distribution of most of these studies in low- to middle-income countries. However, the development of a set of predictable outcome measures as well as long-term evidence from well conducted clinical trials for novel pulpotomy dressing materials are still required.
... 26 The type of material utilized for primary tooth pulpotomies has been found to significantly affect the prognosis of treatment. [27][28][29] Therefore, the present study evaluated the success of the newly introduced premixed bioceramic (NeoPUTTY ® ) in primary molar pulpotomies in comparison to MTA. ...
... 30 Additionally, the success of NeoMTA ® 2 was in accordance with previous studies that showed high success for MTA pulpotomies, ranging from 90 to 100 percent at the 12-month follow-up. 12,[27][28][29][31][32][33] The failure to find a significant difference between Neo-PUTTY ® and NeoMTA ® 2 in this study is not surprising given its compositional similarity to NeoMTA ® 2, as both are composed of the same tri-and dicalcium silicate powders and contain tantalum oxide as the radiopacifying agent. Also, the small sample size used in this study may have influenced this result. ...
Purpose:
The purpose of this randomized clinical trial was to evaluate the clinical and radiographic success of the premixed bioceramic (NeoPUTTY®) as pulpotomy medicament in primary molars in comparison to NeoMTA® 2.
Methods:
Seventy primary molars indicated for pulpotomy in 42 children were randomly allocated into two groups: (1) a mineral trioxide aggregate (MTA) group (NeoMTA® 2); and (2) a premixed bioceramic group (NeoPUTTY®). Clinical and radiographic examinations of the molars following pulpotomy were conducted by two independent evaluators at six and 12 months. The data were analyzed using Fishe`s exact tests.
Results:
At 12 months, the clinical and radiographic success for the MTA group were 100 percent (34 out of 34) and 94.1 percent (32 out of 34), respectively. For the NeoPUTTY® group, the clinical and radiographic success were 97.1 percent (34 out of 35) and 92.8 percent (32 out of 35), respectively. No significant differences were found between the two materials.
Conclusions:
NeoPUTTY® showed a comparable success to mineral trioxide aggregate in primary molar pulpotomies over 12 months. Further clinical trials with larger sample sizes and longer follow-up periods are recommended.
... The application of biocompatible materials on the root pulp tissue can preserve vitality and stimulate the neoformation of mineralized tissue [2,3]. In the present study, we chose to compare MTA and BD since we can observe in the literature that they have similar clinical successes in approximately 100% of the cases [27,[30][31][32][33][34][35]. Recent studies demonstrate the clinical and radiographic success of teeth that underwent pulpotomy with MTA or BD [36,37]. ...
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.
Keywords:
Pulpotomy; Tooth, Deciduous; Pediatric Dentistry; Dental Pulp Cavity
... Ten studies [36, 37, 41, 43, 44, 46-48, 58, 64] were labeled with "high" risk in incomplete data. Moreover, eight studies [10,36,48,56,63,65,70,71] were labeled with "high" risk in other sources of risk due to extremely insufficient sample size (< 20 in each group). Overall, 28 studies [3, 36, 38-40, 42, 45, 49-51, 53-55, 57-62, 64, 66-69, 72-75] were rated as "moderate" level, and 15 studies [2, 10, 37, 41, 43, 44, 46-48, 52, 56, 63, 65, 70, 71] were rated as "low" level in the overall methodological quality. ...
... Forty-one studies [2, 3, 10, 36-54, 56-61, [63][64][65][66][67][68][69][70][71][72][73][74][75] reported clinical success rate at 6 months after pulpotomy treatment, and network meta-analysis suggested that CH was significantly inferior to FC, FS, NaOCl, MTA, biodentine, and laser, but there was no statistical difference for remaining comparisons (Fig. 4A) (Fig. 5B). ...
Objectives
We performed this network meta-analysis to determine the comparative efficacy of formocresol (FC), ferric sulfate (FS), sodium hypochlorite (NaOCl), calcium hydroxide (CH), mineral trioxide aggregate (MTA), biodentine, and laser for pulpotomy of molar teeth.
Materials and methods
An updated search was conducted in PubMed, Embase, and the Cochrane Library to identify relevant randomized controlled trials (RCTs) published before October 30, 2022, after screening previous meta-analyses. The Cochrane risk of bias assessment tool was used to appraise the methodological quality of included studies. Clinical and radiographic success rates were assessed as outcomes. Random network meta-analysis was performed by using STATA software (version 14.0) with “network” command.
Results
A total of 43 RCTs were included. Network meta-analysis indicated that CH was inferior to other medicaments and techniques in all outcomes, and MTA and biodentine was better than FC, FS, and NaOCl in terms of clinical and radiographic success rates. Results of ranking probabilities suggested that MTA ranked first in all outcomes except for clinical success at both 6 months.
Conclusions
Our results suggested that MTA was associated with significant improvement in both clinical and radiographic success than other pulpotomy medicaments and techniques, with the highest probability of being the optimal option.
Clinical relevance
The current network meta-analysis determined the comparative efficacy and safety of 7 common pulpotomy medicaments in molar pulpotomy, including FC, FS, NaOCl, CH, MTA, biodentine, and laser, and the pooled results revealed comparable efficacy in clinical and radiographic success rates at 6 and 12 months between FC, FS, and NaOCl in primary molars pulpotomies. However, MTA, biodentine and laser may have more advantages than other pulpotomy medicaments for clinical and radiographic success. Therefore, in clinical practice, practitioners should select MTA, biodentine, or laser as pulpotomy medicaments in molar pulpotomy.
... 18,19 Although differences in the agar medium, capacity of diffusion of the materials, bacterial strains, and cell density may interfere in the formation of inhibition zones around the materials studied, the agar plate diffusion test was selected in this study to be the method of antimicrobial activity widely used. 20,21,18 The present study revealed that the diameter of the 33,36 In addition, MTA presents other ideal properties as its high sealing ability, biocompatibility, capacity to stimulate dentin neoformation and regeneration of periodontal tissue. 33,34 According to the results of the present study, MTA presented antimicrobial activity notably against S. mutans and E.Faecalis than antioxidant mix. ...
... 20,21,18 The present study revealed that the diameter of the 33,36 In addition, MTA presents other ideal properties as its high sealing ability, biocompatibility, capacity to stimulate dentin neoformation and regeneration of periodontal tissue. 33,34 According to the results of the present study, MTA presented antimicrobial activity notably against S. mutans and E.Faecalis than antioxidant mix. ...
Introduction: Pulpotomy technique is most widely accepted clinical procedure for treating primary teeth with coronal pulp inflammation caused by caries with no involvement of the radicular pulp.
Aim and Objective: Evaluation andComparision of antimicrobial activity of MTA to Antioxidant Mix used as a pulpotomy agent- In vitro study
Materials and Methods: The test materials i.e MTA and antioxidant mix were manipulated strictly in accordance with the manufacturer's instructions. The antimicrobial activity of this material is evaluated by the agar diffusion method against two reference strains: E. faecalis (ATCC 29212), S. mutans (ATCC25175). Each material is evaluated at concentrations suggested by the
manufacturer. Bacteria is diluted to obtain a suspension of approximately 5 × 108 colony forming units/ml, in sterile Trypticase Soy Broth (TSB). Microbial strains were confirmed by colony forming units and growth characteristics. E. faecalis is inoculated with sterile cotton swabs onto Meuller-Hinton agar plates and S. mutans is inoculated onto blood agar media. Wells 4 mm in diameter and 4 mm deep are prepared on plates with a copper puncher, and immediately filled with freshly manipulated test materials. After prediffusion of the test materials for 2 h at room temperature, all the plates are incubated at 37°C and evaluated at 24 h. Microbial inhibition zones are measured with a 0.5 mm precision ruler and the results are expressed as the mean and standard deviation. To compare the differences among MTA and antioxidant mix data are
Corresponding Author: Dr. Heena Kagdi, ijdsir Volume-2 Issue-1, Page No. 45 - 53
analyzed statistically by one-way analysis of variance (ANOVA) and Tukey's honest significant difference (HSD) post-hoc test, using Statistical Package for Social Sciences (SPSS) software version 21 (SPSS Inc, Chicago, IL, USA).
Conclusion: MTA has better antimicrobial efficacy whereas Antioxidant mix as a new pulpotomy agent though biocompatible and cost effective than any other commercially available medicament does not show any antibacterical activity.
... That reveals a prolonged in ammatory phase that delays the proliferative and regenerative phases. uncontrolled mineralization and intra-pulpal calci cation after using MTA as a DPC material [9], [10]. ...
Aim: Find a reasonable substitution for current DPC materials.
Methods: The hTDM properties were evaluated by assessing its alkalinity, antibacterial activity, and potentiality to induce cell migration compared to MTA. The acute inflammatory response was evaluated 3 days after iatrogenic pulp exposure by histological examination. However, both chronic inflammatory response and dentin-pulp complex regeneration were evaluated after 3 months.
Results: The results of in vitro assessment revealed high alkalinity of MTA while hTDM exhibited optimum alkalinity. Moreover, the higher antibacterial activity and potentiality of inducing cell migration than MTA. The in vivo assessment ensured the ability of hTDM in optimizing the inflammatory response and dentin-pulp complex regeneration. However, MTA prolonged the inflammatory response and induced the formation of a thick calcific bridge toward the pulp tissue.
Conclusion: hTDM semi-rigid scaffold is a promising novel DPC material.
... It can produce effective dentinal bridging in a short time period with less pulpal necrosis and inflammation [12,13]. MTA presents high clinical, radiographic and histological success [6,10,14] but it has a considerable cost. In addition, MTA has a long setting time, difficult handling, and discoloration. ...
Introduction:
Among the new therapeutic materials, MTA and Biodentine are recommended for pulpotomy and sealing the pulp. Considering the similar characteristics of these two materials and considering that their effects on the treatment of primary second molars with irreversible pulpitis have not been compared properly, this study aimed to compare clinical and radiographic success between MTA and Biodentine in pulpotomy of primary mandibular second molars with irreversible pulpitis.
Materials and methods:
This study was conducted as a randomized double-blind clinical trial. Participants were selected according to inclusion criteria and 52 samples were randomly selected using random numbers table in group A. Then, patients in the next group B were matched with the first group in terms of age range and sex. In group A, the remaining pulp was covered with 2 mm MTA+ and in group B with 3 mm Biodentine. Participants were called for clinical evaluation every three months for 12 months (long-term follow-up). Radiographic evaluations were in the sixth and twelfth months.
Results:
Fischer's exact test showed that there was no significant difference between MTA and Biodentine in terms of clinical and radiographic success rates (P value = 1). According to the results of the Kaplan-Meier test, the survival rate in both pulp treatment methods was similar in symptomatic teeth.
Conclusions:
The results of this study showed that Biodentine properties are similar to MTA, and both materials show high clinical and radiographic success rates in long-term follow-up.
... Pulpotomy, which is frequently applied and highly accepted in primary dentition, is a vital pulp treatment performed in case of caries or mechanical exposure of the coronal pulp, while the radicular pulp is still healthy. There are various techniques and capping materials used for pulpotomy in the literature, but the ideal method is still controversial today [1,2]. ...
... In the second application (PBMT), the purpose is to influence various biological processes. Its effective actions on dental pulp include hastened wound healing, preserved vitality, and reduced inflammation of the pulp tissue [2,10,[26][27][28]. Although the number of studies comparing laser-pulpotomy with other techniques is relatively high, the number of studies evaluating the effectiveness of PBMT is limited. ...
... This high success of FC values is associated with the high germicide and fixative properties of the material. In addition to its local toxicity by easily diffusing into the surrounding tissues through root canals and perforations, causing necrosis of periodontium, the formocresol material raises concerns about its systemic spread and mutagenicity [1][2][3]28]. Currently, FS is the material receiving most attention as a pulpotomy medicament after FC [7]. ...
This study has aimed to evaluate the clinical and radiographic success rates of calcium hydroxide pulpotomy (CH) with biostimulation (PBMT) and compare them to that of CH, formocresol (FC), mineral trioxide aggregate (MTA) pulpotomies without PBMT in primary molars. A total of 172 pulpotomies were performed on primary first or second mandibular molars in 94 children who were 5–8 years old. The pulpotomy procedure was performed with four different techniques. In the PBMT group, before the CH placement, 820-nm diode laser radiation was applied to each pulp-stump for 12 s (10 mW, 2.5 J/cm²). The clinical (lack of spontaneous pain, abscess or fistula, and pathological mobility) and radiographic success (lack of periapical/furcal lesions and internal/external resorption) were recorded at 6 and 12 months. The data was statistically evaluated. p value < 0.05 was considered as significant. After 12 months, the clinical and radiographic success rate (a tooth with at least one of the findings was considered unsuccessful) was 97%/92% for FC and 97%/95%, 87%/73%, and 71%/45% for MTA, CH + PBMT, and CH, respectively. There was no significant difference between the CH + PBMT and the other groups in clinical success, while a significant difference was found between CH and FC, MTA groups. In radiographic success, there was a significant difference between the CH and the other groups. No significant difference was found between the 6th- and 12th-month results in clinical success for all the groups. A decrease in success over time was seen only in the CH group for radiographic results. CH without PBMT showed the worst clinical and radiographic results among the groups. CH + PBMT showed similar clinical success compared to the MTA and FC groups. In radiographic success, CH + PBMT showed higher success compared to CH, but this success was not high as compared to MTA and FC.
... Moreover, it was formed towards the pulp tissue obliterating the pulp chamber. These results are in agreement with the studies of Liu et al. and Oliveira et al. that detected uncontrolled mineralization and intra-pulpal calci cation after using MTA as a DPC material [9], [10]. ...
Aim
Find a reasonable substitution for current DPC materials.
Methods
The hTDM properties were evaluated by assessing its alkalinity, antibacterial activity, and potentiality to induce cell migration compared to MTA. The acute inflammatory response was evaluated 3 days after iatrogenic pulp exposure by histological examination. However, both chronic inflammatory response and dentin-pulp complex regeneration were evaluated after 3 months.
Results
The results of in vitro assessment revealed high alkalinity of MTA while hTDM exhibited optimum alkalinity. Moreover, the higher antibacterial activity and potentiality of inducing cell migration than MTA. The in vivo assessment ensured the ability of hTDM in optimizing the inflammatory response and dentin-pulp complex regeneration. However, MTA prolonged the inflammatory response and induced the formation of a thick calcific bridge toward the pulp tissue.
Conclusion
hTDM semi-rigid scaffold is a promising novel DPC material.
... Internal root resorption was not regarded as a failure unless the inflammatory process resulted in significant destructive changes in the tissues surrounding the root. 5,25 Statistical analysis Data analyses were performed by using SPSS 11.5 software for Windows (IBM). The difference between the groups regarding radiographic and clinical success was compared using log-rank test with Kaplan-Meier survival analysis, and cumulative survival rates were calculated. ...
... The studies with MTA have yielded superior clinical success rates, but also satisfactory radiographic outcomes. 10,18,25,32 In the study by Doyle et al 21 applying MTA to FS-treated pulp resulted in better outcomes than FS pulpotomy with a ZOE base. However, the difference in radiographic outcomes between the two groups was not statistically significant. ...
Objective:
To evaluate the effects of zinc oxide-eugenol, calcium hydroxide, and mineral trioxide aggregate as base materials on the clinical and radiographic success of ferric sulfate pulpotomies in primary molars.
Method and materials:
Following hemostasis with 15.5% ferric sulfate, 105 teeth were randomly allocated to three groups: Group 1, zinc oxide-eugenol; Group 2, calcium hydroxide; and Group 3, mineral trioxide aggregate. All teeth were restored with stainless-steel crowns. Clinical and radiographic examinations were conducted at 6, 12, 18, and 24 months.
Results:
After 24 months, clinical success rates for Groups 1 to 3 were 97.1% (34/35 teeth), 94.2% (33/35 teeth), and 97.1% (34/35 teeth), respectively (P > .05). Radiographic success rates were 65.7% (23/35 teeth), 65.7% (23/35 teeth), and 77.1% (27/35 teeth), respectively (P > .05). Internal resorption was the most observed radiographic finding (15/105 teeth).
Conclusions:
The choice of zinc oxide-eugenol, calcium hydroxide, and mineral trioxide aggregate, as base materials, did not affect the clinical and radiographic success of ferric sulfate pulpotomies in primary teeth.
