PEDIATRIC DENTISTRY

V 35 i NO 5

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Clinical ArticL
Effects of Glass Ionomer Temporary Restorations on Pulpal Diagnosis and Treatment
Outcomes in Primary Molars
JamesACoil, DMD, MS' Alison Campbell, DDS^ Natalia I, Chalmers, DDS,

Abstract: Purpose: To evaluate 1) if glass ionomer interim temporary

improved

restorations

(ITR) placed for 1-3 months prior to vital pulp therapy (VPT)

accuracy of diagnosing the pulp's clinical status and subsequent VPT success, and 2) the effect of the loeation of the earious lesion

on VPT Methods: Primary molars (N=117) reeeiving pulp therapy with or without

iTR were evaluated retrospeetively

tending >50 percent into dentin; caries lesion location was identified (proximal or non-proximal).
caries location, and pulp treatment,
often in first primary

and correlated treatment

outcomes after a mean of 34.7 months to these factors. Results: VPT failed

molars (P<.001) than in second primary

(P=.O13) and first molar VPT success (P=.O2). First primary

All teeth had caries ex-

Two examiners rated pulp status assessment,

molars had more proximal lesions than second molars (P<.001). Failure of VPT was

greater for teeth with proximal lesions (P=.O3). Use of iTR significantly improved VPT in teeth with proximal lesions (P=.OO7) but not
lesions (P=38). Conclusions: ITR placed prior to VPT improved pulpal diagnosis and VPT outcomes.
primary

molars with proximal

Last Revision April 23,2012

KEYWORDS:

lesions, and ITR significantly

more

molars. Using ITR improved diagnosis of the pulp status, clinical success of VPT,

improved

the success.

non-proximal

Vital pulp therapy was less successful in

(Pediatr Dent 2013:35:416-21) Received January

30, 2012 /

/ Accepted May 20, 2012

PULP THERAPY, ENDODONTICS, GLASS IONOMER CEMENTS, PRIMARY MOLARS

The American Academy of Pdiatrie Dentistty (AAPD) Reference

Manual' describes the primary objective of pulp therapy as the
ability to "maintain the integrity and health of the teeth and their
supporting tissues. ' For larger carious lesions near the pulp, indirect pulp treatment (IPT) and pulpotomy are the two vital pulp
therapy (VPT) options recommended by the AAPD.
Buckley^ first introduced the formocresol pulpotomy (FGP)
in 1904; to date, it has remained the standard to which all other
vital pulpotomy therapies are compared. In 1955, Sweet' reported
success rates greater than 90 percent for FGP performed on primary teeth, and since then others have reiterated and investigated
alterations to pulpotomy techniques, medicaments, and bases."*'IPT has also been investigated in prospective and retrospective
studies fot the tteatment of deep caries close to the pulp.''" Galcium hydroxide'^ and glass ionomer'^" have both been used successfully for IPT, with success rates above 90 percent and are
significantly better than FGP.'"*'^
A concern while performing VPT in teeth with deep caries
is correct diagnosis of the pulp's condition. Primary tooth pulpotomy and IPT require a vital radicular pulp.' Sometimes it can be
difficult to diagnose the condition of the pulp in teeth with deep
lesions with no frank clinical pulp exposure and/or radiographie
findings.'^ The pulp could be reversibly inflamed or be developing
irreversible pulpitis or be necrotic, both of which contraindicate
VPT. Methods to determine the pulp's vitality in primary teeth
include radiographs, patient history, and signs and symptoms that
are ofi:en difficult to assess in pediattic patients.'
There is a need for an adjunct tool that could aid the clinician
in assessing the pulp's clinical status and selecting the appropriate

pulp therapy. Interim therapeutic restotations (ITRs) with glass

ionomer can be used for caries control in teeth with open cavitated
lesions and carious lesions that exhibit signs of reversible pulpitis.
The therapeutic restoration can be removed once the pulp's vitality is determined, and, if the pulp is vital, a pulpotomy or indirect
pulp cap can be performed. Glass ionomer cement (GIG) has been
studied as a sedative filling over active caries with and without
antibiotics incorporated into the cement.'^"* Kassa et al. found
significantly more inflammation in deep proximal versus occlusal caries in primary molars, but discovered no difference when
caries was less than 50 percent of the total dentin thickness."
Guelmann et al.^" found lesion location affected failure rate of
pulpotomies. Vij et al.'^asserted ITR placed prior to FGP or IPT
improved their success. No study has yet analyzed the effect of
lesion location ot ITR use on the success of pulpal diagnosis and
subsequent vital pulpal therapy success in primary molars.
Tlie purposes of this study wete to: 1 ) evaluate whethet using
glass ionomer ITR's prior to performing definitive VPT in primary molars with deep carious lesions improved the clinician's
ability to determine the pulp's clinical diagnosis and increased success of VPT; and 2) evaluate if primary first and second molars
needing VPT differed in the location of proximal and non-proximal
(NP) carious lesion and, if so, what effect this difference had on
pretreatment pulpal clinical diagnosis and subsequent VPT success.

Methods

This retrospective study, which collected radiographie and clinical

data from a private pdiatrie dental practice in York, Pa., was
reviewed and approved by the Institutional Review Board of the
University of Maryland, School of Dentistiy, Baltimore, Md.
Patient records chosen for this study wete selected through
a computer search using two sets of ctiteria. Starting in 2000,
--Dr. Coll is a clinical professor. Department of Pdiatrie Dentistry, University of Marypatients in this practice with latge cavitated lesions without obland School of Dentistry. Baltimore. Md.. and in private practice, York. Pa: 'Dr, Campbell
vious irreversible pulpitis were treated with GIG ITR's prior to
is in private practice. Georgetown. Texas: and 'Dr, Chalmers is a elinical research fellow.
National Institute of Health, National Institute of Dental and Craniofacial Research, definitive VPT. The first set of data included all patients treated
initially with ITRs before the final VPT of IPT ot pulpotomy
Bethesda,Md..USA
from January 1, 2000 through December 31, 2004, and that had a
Correspond with Dr, Collt dmdl@comcat,net
416

PULP DIAGNOSIS AND CARIES LOCATION

PEDIATRIC DENTISTRY

Stainless steel crown (SSC) placed the same day as the final treatment. This yielded a ptetreatment ITR group of 42 patients
(N=53 molats). The second set of data identified a group of patients
treated in the same practice prior to 1993, when ITR was not totitinely used prior to VPT of IPT or pulpotomy, and who had IPT
or pulpotomy with a SSC placed the same day. This yielded a
No-ITR group of 48 patients (N=64 molars) (Figure 1).
Inclusion criteria for this study were primary teeth with: 1)
caries extending >50 percent of the dentin depth that received
VPT (IPT or FCP) and SSCs the same day as treatment (N=1 17);
and 2) radiographs diagnostic fot furcation and/or periapical evaluation. Exclusion criteria included teeth with: 1) a pretreatment
ITR that did not remain in place until the time of VPT; 2) less
than one year of clinical and radiographie follow-up; 3) inadequate
pre- or post-treatment radiographs or clinical notes; 4) a crown
that had been recemented since its original placement; 5) an existing restoration; 6) radiographie evidence the tooth was nearing
exfoliation; 7) signs ot symptoms of irreversible pulpitis before
or after pretreatment ITR (ie, external/internal rsorption, futcation tadiolucency, swelling, or sinus tract); or 8) composite or
amalgam restorations placed after ptetreatment ITR and VPT.
The ptocedure for placement of pretreatment ITRs in patients treated after 2000 was as follow. The ITRs were almost all
placed at the child's initial examination in large cavitated lesions
without local anesthesia or rubber dam using one of the two glass
ionomer materials, Ketac Molat (3M ESPE, St. Paul, Minn., USA)
or Voco Ionoftl Molar AC (Voco Gmhh, Cuxhaven, Germany).
Partial caries excavation of superficial, non-painful decay was
performed with a spoon excavator or slow-speed round bur (nos.
4-6), and no attempt was made to create clean margins. For the
patients in the ptetreatment ITR group, the ITR's were removed
at the time of the definitive pulp therapy of IPT ot pulpotomy.

N=117
Primary Moiats
Received Vital
Pulp Therapy
and SSC

65 Had IPT

52 Had FCP

88% Successful

83% Successful

T
N=117

53 Had ITR Initially

64 Had No ITR Initally

ITR Group

^...
No-ITR Group

50/53 Successful Vital

50/64 Successful Vital

Pulp Therapy After ITR

Pulp Therapy No ITR

48/51 IPT Succeeded

10/14 IPT Succeeded

2/2 FCP Succeeded

40/50 FCP Succeeded

Diagnostic Pulpal
Assessment Us ng ITR

Diagnostic Pulpal
Assessment No ITR

94%

78%

Figure 1. Disrribuiion of the sample and treatment groups.

V 35 i NO 5

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IPT and pulpotomies were performed identically fot both the

ptetreatment ITR. and No-ITR groups using the following protocol. The teeth receiving a FCP wete treated using local anesthesia
and rubber dam isolation. Caries were excavated until the pulp
was exposed, at which time the dentist made the clinical diagnosis
the pulp was vital. The coronal pulp tissue was amputated, and
hemostasis was obtained using dry cotton pellets firmly placed at
the canal orifices. Buckley's formoctesol (Sultan Health Care,
Hackensack, N.J., USA) full strength was applied for five minutes, and a teinforced zinc oxide and eugenol intermediate restorative material, IRM (Dentsply Caulk, Milford, Del., USA),
was used to fill the chamber before immediate cementation of a
suitable SSC with GIC. Teeth treated with IPT wete diagnosed as
vital through the absence of clinical and radiographie signs and
symptoms indicating irreversible pulpitis. These teeth wete tteated
in an identical manner as those treated with FCP, using local anesthesia and rubber dam isolation, except the caries excavation
was incomplete to ensure the pulp was not exposed. A resinmodified glass ionomer base or the GIC used to cement the SSC
was used as the IPT base over the remaining caries. A suitable SSC
was cemented immediately, as in the pulpotomy procedure, to
minimize microleakage.
Three experienced pdiatrie dentists treated the childten in
a similar, standardized manner. Two pdiatrie dentists (one of
whom was not involved in the patients' treatment) independently
reviewed and evaluated the patients' records. The two dentists
were calibrated prior to this study by rating a separate group of
patients until 10 consecutive teeth received 100 petcent agreement for success and failures (A'=.8235). Discrepancies in evaluation were discussed until the raters reached a consensus.
Criteria for clinical failure for the VPTs of IPT and FCP
wete: postoperative pain ot sensitivity, abnotmal mobility, ptesence
of a sinus tract, or othet gingival swelling. Criteria for radiographie
failure included internal or external root rsorption, widening of
the periodontal ligament, furcation ot periapical radioluciencies,
or other signs of bony destruction. Vital pulp therapy was considered a success if primary molats showed none of the aforementioned signs or symptoms following an IPT or FCP
Pretreatment pulpal diagnosis was deemed successful when
teeth treated with ot without ITR were diagnosed as vital and
the VPT was judged successful. Failure to diagnose the pretreatment vitality status of the pulp was determined when any tooth
treated with or without ITR that had been diagnosed as vital
and received VPT failed, using the pteviously descrihed criteria.
Information collected from chart reviews included: tooth
number; patient age at time of treatment; type of VPT received;
brand name of material used for pretreatment ITR (when performed); length of time ITR was in place (when performed); if the
ITR was lost prior to final treatment (when placed); rater evaluation of clinical and radiographie success or failure of VPT;
follow-up time; and, if possible, the location of the presenting
carious lesion if it could be determined from the radiographs and
chart notations. An NP lesion was defined as any carious lesion
not involving the mesial or distal surface. A proximal lesion was
defined as any carious lesion that involved the tooth's mesial and
or distal surface and may have had occlusal, facial, ot lingual
involvement, but was primarily interproximal.
Pearson's chi-square and Fisher's exact statistical tests were
used to evaluate the data using Stata 12.0 software (StataCorp LP,
College Station, Texas, USA) and the Vassar Stats Website for
Statistical Computation (www.vassat.edu). A _?-value equal to or
less than .05 was used to indicate statistical significance.

Results
Thete were 117 molars (65 first molats and 52 second molars ) in
90 patients treated with VPT. The patients' ages ranged from
PULP DIAGNOSIS AND CARIES LOCATION

417

PEDIATRIC DENTISTRY

V 35 NO 5

SEP ' OCT 13

27 to 102 months old, (mean age 67,1 months old). The

treated teeth were followed from 12 to 73 months, with a mean
follow-up time of 34.7 months for clinical and radiographie
evaluation.
The final definitive VPT in the 117 treated molars was distributed as follows: IPT was used in 65 (56 percent) molars and FCP
in 52 (44 percent) molars (Figure 1), and there was no significant
difference between the success rates for IPT (88 percent) and FCP
(83 percent) {P=.45; Table 1). There was no significant difference in success rates for first molar IPTs vs FCPs (P=.82) or for
second molar IPTs vs FCP (P=.4O). Since IPT and FCP success
was not significantly different within each tooth type (first molar
or second molar), the two types of VPT were combined for
further evaluation. In the combined group VPT in first molars
demonstrated a significantly lower success rate (75 percent)
(P<.001) compared with second molars (98 percent) (Table 1).
ITR Group Prior to VPT. Of the 117 molars, fifty-three
molars in 42 patients received pretreatment ITR (ITR Group) with
Ketac Molar (N=39) and Voco Ionofil (N=14). There was no difference (Fisher's exact test, P=\.OO) in the two brands of ITR in
the subsequent pulp tberapy evaluations, so their results were
combined for a single ITR group. The ITRs were in place in the
teeth for from one to >three months (mean=3.2 months). There
was no significant difference in VPT outcomes for pretreatment
ITR in place for one, two, or >three months (Fisher's exact test,
P=.5O) There was no significant difference in maxillary vs. mandibular molar pulp therapy success, (P=.31) with 48 percent of
pulp therapy failures observed within 18 months.
Among the 33 molars receiving pretreatment ITRs (Figure
1), three failed (N=3 IPT) and were rated as clinical pretreatment
pulpal diagnostic failures, while the remaining 50 were counted
as pretreatment diagnostic successes. Of the 64 teeth that did not
receive pretreatment ITRs, 14 failed (N=4 IPT and N =10 FCP)
and were rated as clinical pretreatment pulpal diagnostic failures.
The improved success of VPT in teeth with pretreatment ITRs
used in 53 of the 117 molars indicated a significantly improved
ability to make the correct clinical pulpal diagnostic assessment
when ITR was used pretretment (P=.O13; Table 1). An exam-

Category*

Success
N (%)

Failure

All molars treated with IPT

57(88)

All molars treated With FCP

43(83)

8
9

Pearson's
chi-square
/"-value

.45

Molar pulp therapy

Total

pie of a clinical pulpal diagnostic success is shown in Figure 2.

Pretreatment with ITR significantly improved the success rate
{P=.QT) of VPT in first molars (65 percent no ITR vs. 89 percent
with ITR). Pretreatment with ITR had no effect on success rate
of VPT in second molars (96 percent with no ITR vs. 100 percent with ITR) {P=.52; Table 2). There was no significant
difference (P=.59) in the frequency of pretreatment ITRs usage
in the two molars types (28 first molars vs. 25 second molars)
(Table 2).
Lesion Location. Data on the location of the presenting
carious lesion were available in 88 of the primary molars. The remaining 29 teeth demonstrated equally large proximal and NP
lesions or could not be categorized, so they were omitted from
lesion location evaluation. It was discovered that 35 first molars
had 29 proximal lesions and six had NP lesions. There were 53
second molars with 20 proximal lesions and 33 NP lesions. Primary first molars had significantly more proximal lesions (P<.001;

117

First vs second molar pulp therapy

Primary first molars vital
pulp treatment

49 (75)

16

Primary second molars vital

pulp treatment

51 (98)

Total

<.OO1

117

Diagnostic assessment based on clinical pulp therapy success

ITR used prior to treatment

50 (94)

No ITR used prior to treatment

50 (78)

Total

117

3
14
=.013

* IPT=indirect pulp treatment; FCP=formocresol pulpotomy; ITR=glass

ionomer interim temporary fillings.

418

PULP DIAGNOSIS AND CARIES LOCATION

Figure 2, (a) A primary first molar with a large, cavitated, proximal

carious lesion (distal). The 4-year-old patient experienced mild tooth
pain when eating candy; a glass ionomer temporary restoration was
placed, (b) The same tooth, seven weeks after an interim therapeutic
restoration was placed, is no longer sensitive to sweets. The tooth is
assessed as having had reversible pulpitis. An indirect pulp treatment
was performed with a glass ionomer base and stainless steel crown,
(c) A radiograph taken 34 months post-treatment shows no pathology and normal exfoliation. This is an example of a successful pretreatment pulpal assessment and subsequent successful pulp therapy
being rated a success.

PEDIATRIC DENTISTRY

Table 3). There was no significant difference {P=.44) in the frequency of ITRs being used in proximal and NP lesions (Table 3).
Only one tooth with a NP lesion failed (97 percent success) compared to the eight failures in teeth with proximal lesion (84 percent success). Statistically, the vital pulp therapy success of teeth
with NP lesions was significantly better {P=.O3) (Table 3). In
the 29 teeth omitted from lesion location determination, 21 had
successful VPT and eight failed and mimicked proximal lesion
success (Fishers exact P= .23)
The 49 molars with proximal lesions were further evaluated
by comparing the success rate when using pretreatment ITR vs.
when no pretreatment ITR was used. Use of ITRs significantly
improved {P=.QQ7) the pulp therapy success for teeth with proximal lesions (Table 3). There were 39 teeth with NP lesions, and
24 were treated with pretreatment ITRs (all succeeded) and 15
were not (one failed). The tise of ITRs for teeth with NP lesions
did not significantly alter the success rates of VPT (Fisher's exact
test, P=.38).

Discussion
In this pdiatrie dental practice, IPT was used in place of FCP for
the treatment of teeth with deep caries treated between 2000 and
2004, unless there was an inadvertent pulp exposure when using
a slow-speed round bur before the IPT. For teeth treated prior
to 1993, IPT was not used as a routine treatment method for
VPT, and FCP was primarily used for treatment of deep caries.
All 117 primary molars in this study were restored immediately
with SSCs after VPT to eliminate the variability of different restorations' microleakage patterns affecting pulp therapy results.
There was no significant difference between the overall IPT's success rate of 88 percent and the overall FCP's success rate of 83
percent; therefore the results of this investigation support the use
of IPT in place of FCP in treating deep caries in primary molars.
When reviewing prior FCP research, the range of success
rates varies widely. Our overall success rate of 83 percent was
greater than that of Farooq (74 percent). Fei (79 percent), and
Vij (70 percent), and was comparable to Holan (83 percent)
and Fuks (84 percent).''''"''''''' The type of restoration, timing
of the final restoration, and type of material varied among
studies. Holan et al."'attributed pulpotomy failures to three main
factors: (1) incorrect diagnosis; (2) pulpal irritation by eugenol;
and (3) microleakage due to incomplete crown coverage.

COMPARISON OF PULP THERAPY SUCCESS

USING GLASS IONOMER INTERIM TEMPORARY
RESTORATIONS (ITR) VS NOT USING ITR
PRIOR TO VITAL PULP THERAPY* =
First molars*

Success
N (%)

ITR used
No ITR used

25 (89)
24 (65)

3
13

25 (100)
26 (96)

Q
1

Primary first
molars N

Primary second
molars N

Second molarsT

ITR used
ITR not used
All molarst
ITR used
No ITR used

28

37

*Total=65; Pearson's chi-square, P=.O2.

tToEal-52; Fishers exact test (1-taiied), P=.52.
t Total=l 17; Pearson's chi-square, P=.59.

25
27

NO 5

SEP

OCT 13

In our study design, immediate placement of SSCs at the

time of VPT appeared to improve the success rate of FCPs, and
this was probably due to decreased microleakage from the SSCs;
other studies did not always use immediate SSCs as final restorations.'"'''" Randall et al.^' showed the superiority of SSCs over
multisurface amalgams, and Croll and Killian et al.-- demonstrated that SSCs have decreased microleakage.
Our overall success rate for IPT (88 percent) was slightly
lower than similar studies, including Falster et al." (90 percent), Farooq et al.''' (93 percent), and Vij et al.'^ (94 percent).
Holland et al.^^ reported a higher failure rate of pulp therapy
in primary first molars than in primary second molars. In our
study, we also had a significantly lower over all success rate of VPT
in primary first molars: 75 percent vs. 98 percent in primary second molars. It is possible that prior studies had proportionally
more primary second molars than the present study, which
caused our findings to differ.
To the best of our knowledge, there are no known studies
that have examined the link between caries location and VPT
success. Our findings support the hypothesis that primary molars
with proximal lesions have lower VPT success rates compared
with primary molars with NP lesions. The literature has conflicting data on success rates of VPTs between the first and second molars. Some report such differences'"*'"'^' and others do
not,' and lesion location may have contributed to such differences.
The key to VPT success lies in proper pulp diagnosis. The only
way to accurately diagnose the inflammatory status of the pulp is
histologically.^'' A patient may present with signs and symptoms

Table 3.

LESION LOCATION ANALYSIS WITH DIFFERENT

CATEGORIES

Category

Primary
first molars

Primary
second
molars

N (%)

P-value

N (%)

Non-proximal lesions
Proximal lesions
Pearson's chi-square (total)
Temporary restorations

ITR
frequency

No ITR
frequency

N(%)

Vital pulp treatment

Success

Proximal lesions

With ITR
Without ITR
Fisher's exact test (1-tailed)
(total)

<,001

88

24 (62)
34 (69)

Nonproximal lesions
Proximal lesions
Fisher's exact test (1-tailed)
(total)

33 (62)
20 (38)

6(17)
29 (83)

Non proximal lesions

Proximal lesions
Pearson's chi-square (total)

Eailure
=N

V 35

:"

15
15

,44

m
Failure

N(%)

38 (97)
41 (84)

.03

88
Success of vital Failtire of vital
pulp therapy pulp therapy
N(%)

32 (94)

9(60)

.007

49

^ IPT=indirect pulp treatment; FCP=formocresol pulpotomy; ITR=glass ionomer

interim temporary fillings.

PULP DIAGNOSIS AND CARIES LOCATION

419

PEDIATRIC DENTISTRY

V 35 i NO 5

SEP ' OCT 13

indicative of a reversible pulpitis, while histologically the pulp

demonstrates changes equivalent to chronic total pulpitis,^"^ which
is a contraindication for VPT. Our results showing a higher success rate of VPT in primary molars with deep cavitated lesions
treated first with ITR's may allow the practitioner to make a better
clinical pulpal diagnosis, resulting in better VPT success for symptomatic and non-symptomatic teeth. For large proximal lesions,
pretreatment with ITR's may act as a barrier to prevent food impaction and reduce viable bacteria in the infected dentin, thus
allowing reparative dentin formation to protect the pulp.
Our results showed no difference in success rates from the
time the ITR was placed to the time of the subsequent VPT. Four
weeks of pretreatment with ITR was the minimum time studied.
The initial placement of the ITR possibly stabilized the microleakage, so the length of time the ITR was in place, one, two, or
more than three months, made no difference in VPT outcome.
ITR's allow remineralization to occur in the inner carious dentin"
and possibly stimulate the pulp to form reparative dentin
similar to the dentinal bridges observed by Salako et al.^'^ beneath MTA pulpotomies. After one to three or more months of
ITR, if the tooth's pulp vitality is questionable, the ITR allows
time for the pulp to form a fistula or some obvious radiographie
lesion indicating the pulp is irreversibly involved. On the other
hand, if the pulp is vital or reversibly inflamed, the tooth remains
clinically and radiographically normal. The authors believe their
findings indicate ITR enhances the clinicians' ability to formulate the correct pulpal diagnosis.
Our data show more proximal lesions required VPT in primary first molars vs. primary second molars. NP lesions had a
better success rate for VPT compared to proximal lesions. Kassa et
al." demonstrated that primary molars with proximal decay depth
greater than 50 percent have inflammation, which can advance
to chronic total pulpitis and partial necrosis. In NP lesions, even
with decay greater than 30 percent of dentin depth, pulpal infiammation is less, and chronic total pulpitis less likely than in
proximal lesions, because the carious biofilm is further from the
pulp due to the thicker residual dentin in this area. This was reported in the Arnim and Doyle data." The Rayner and Southam"
data also showed if the thickness of sound remaining dentin
was greater than 0.9 mm, the degree of inflammation was minimal. The 49 proximal lesions in the current study demonstrated
significantly less VPT success than NP lesions. The amount of residual dentin thickness may be the most important predictor of
pulpal reactions to therapy, and our data appears to support this
theory.
Limitations of the present study should be taken into consideration. First, this was a retrospective study with the potential
for bias in teeth selected, and treatment was performed by three
pdiatrie dentists. Further studies are needed with a larger sample
size to confirm present study results. A randomized, prospective,
double-blind study would be preferential to this retrospective
study. Some failures may have been due to factors other than diagnosis. Limiting the number of operators to a sole provider could
provide less bias in diagnosis and treatment. Also, some of the
cell numbers were small for procedures, and statistical evaluation
via Fisher's exact tests should be judged with these small numbers
in mind.

Conclusions
Based on this study's results, the following conclusions can be
made:
1. Primary first molars demonstrated more proximal lesions
and more vital pulp therapy failures than primary second molars.

420

PULP DIAGNOSIS AND CARIES LOCATION

2.

3.

4.

Teeth treated with glass ionomer interim therapeutic

restorations for one to > three months were more accurately diagnosed with the correct pulpal clinical diagnosis
than when pretreatment interim therapeutic restorations were not used prior to vital pulp therapy.
Vital pulp therapy success improved when using pretreatment interim therapeutic restorations, especially for
teeth with proximal lesions.
Teeth with proximal lesions had more vital pulp therapy
failures, regardless of tooth type (primary first or
second molars), indicating carious lesion location is an
important factor that affects vital pulp therapy success.

Acknowledgments
The authors wish to acknowledge Dr. Norman Tinanoff for his
assistance with the Institutional Review Board and Dr. Vineet
Dhar for help with manuscript preparation.

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