Documente Academic
Documente Profesional
Documente Cultură
Neeti
CONTENTS:
1. Introduction 2. History 3. Pulp Capping Agents- Calcium Hydroxide Isobutyl Cyanoacrylate Corticosteroids and antibiotics Collagen fibers 4-Meta adhesive Direct bonding Denatured albumin Mineral trioxide aggregate(MTA) Laser 2 BMP
INTRODUCTION
Primary objective of Pulp treatment of an affected tooth is to maintain the integrity & health of oral tissue.
AAPD 1991, it is possible to stabilize pulp autolysis or eliminate the pulp entirely without significantly compromising the function of the tooth. Aim to treat reversible pulpal injures in both primary & permanent teeth, maintaining pulp vitality & function.
HISTORY
19th century human pulp had very little healing power. 1874 Nitzel : Tricresol- formalin tanning agent
7
1886 Adolph Wilzel Metal (Gold) Foil 1885 Leptowski Formalin 1898 Gysi Paraformaldehyde
Triopaste
1904 Buckley Formocresol or Tricresol Formalin 1908 Solid Formaldehyde
8
medicament over a thin layer of remaining carious dentin, after deep excavation, with no exposure of the pulp. The treatment objective is to avoid pulp
11
This
results
in
the
arrest
of
caries
progression and preservation of the vitality of non exposed pulp. Next sitting involves re-entry after a 6 to 8week interval to remove any remaining carious dentin and place the final restoration.
12
A) Medicament is placed against remaining caries. B) Lasting temporary restoration. Following repair, both materials are removed along with softened caries, and final restorations are placed.
13
A) Capping material covers pulp exposure and the floor of the cavity. B) Protective base C) Restoration.
15
Teuscher
and
Zander
introduced
calcium
When calcium hydroxide is applied directly to pulp tissue reparative dentin bridge formation
17
Three main calcium hydroxide products are: Pulpdent Paste contains 52.5% calcium
hydroxide in an aqueous methyl cellulose solution.
18
3. Isobutyl Cyanoacrylate- Introduced by Berkman in 1971. It has been reported to be an excellent pulp capping agent because of its hemostatic and bacteriostatic properties.
It
cannot
be
regarded
as
an
adequate
therapeutic alternative to calcium hydroxide since it does not produce a continuous barrier of
4. Corticosteroids and antibiotics- Introduced by Brosch JW in 1966. These agents include neomycin and hydrocortisone, ledermix (calcium hydroxide and
7. Direct Bonding- A polygenic film can be layered over an exposed site without displacing pulp tissue and onto surrounding dentin where it penetrates the tubules. The
10. Mineral Trioxide Aggregate (MTA)- Torabinejad described the physical and chemical properties of MTA in 1995. It is ash colored powder made up of fine
Properties:
1. Biocompatible and sealing ability better than that of
4. Compressive strength is 70 MPA, which is comparable with that of IRM. 5. Presents minimal inflammation if extended beyond
the apex.
Mechanism of action: 1. Forms CH that releases calcium ions for cell attachment and proliferation. 2. Creates an antibacterial environment by its alkaline
pH.
3. Encourages differentiation and migration of hard tissue-producing cells
23
24
PULPOTOMY
25
Pulpotomy is defined as amputation of vital pulp from the coronal chamber followed by placement of a medicament over the radicular pulp stumps to stimulate repair, fixation or mummification of the remaining vital radicular pulp. (Braham & Morris 1985)
Removal of the coronal portion of the pulp & the treatment of the remaining radicular pulp in an attempt to maintain the tooth & its supporting structure in a state of health. (Heillig 1984) Procedures involving removal of vital, partially inflamed coronal pulp tissue & placing a dressing over the amputed pulp stumps & placing the final restoration. (Kennedy 1986)
26
Procedure in which the entire coronal pulp is removed, with the aim of removing all the infected pulp tissue, the radicular pulp is then treated in different ways, according to technique employed. (Andlaw & Rock 1993) Complete removal of the coronal portion of dental pulp, followed by placement of a suitable dressing or medicament that will promote healing & preserve the vitality of the tooth. (Finn)
27
MEDICAMENTS
28
Formocresol Glutaraldehyde Calcium hydroxide ZnO eugenol Ferric Sulphate Bone Morphogenic proteins & Osteogenic proteins Devitalizing paraformaldehyde paste Beechwood creosote Antibiotic paste Enriched collagen solution Collagen calcium phosphate gel Tetrandrine Freeze Dried bone Tricalcium phosphate Chondroitin sulphate Denatured albumin Sodium hyaluronate
29
FORMOCRESOL
Introduced by Buckleys 1904
Action of Formocresol on pulp tissue: Formaldehyde undoubtedly fixes the pulp tissue Alters blood flow by inducing thrombus formation ischemia causes coagulation necrosis of tissue deprived of its normal nutrition. Enzymatic hydrolysis of necrotic tissues replacement of it by granulation tissue. Slight resorption of dentinal walls in zone of replacement & deposition of osteodentin as a repair tissue.
30
31
Buckleys Formocresol
Formalin (37%) : 19% Tricresol : 35% Glycerin : 15% Water Achieve 1:5 concentration of original Buckleys formocresol Dilute 3 parts glycerine with 1 part of distilled sterile water. Add 1 part formocresol to 4 part diluent 90ml glycerine 30ml water Loos et al 30ml formocresol
32
Emmerson : determined significant formocresol action within 1st five minutes. Braham & Morris : Linear calcification may have adverse influence on resorption process.
Histological Observation: Massler M & Mansukhani N : surface of pulp immediately under formocresol became fibrous & acidophilic within few minutes after application of formocresol.
33
3 distinct Zones: Acidophilic zone of fixation Zone of atrophy Zone of inflammatory cells
No reparative dentin formation.
1. 2.
3 weeks postoperative:
1. 2.
Middle 3rd:
Stain of tissue decreased Cellular details less distinct
1. 2.
Apical 3rd:
Absence of cellular details Blood vessels containing decomposed erythrocytes which appeared to lose structural integrity
Connective tissue undergoing castration due to decreased number of mature fibroblasts & increase of fibrous intracellular elements. Coagulation necrosis in middle 3rd, delineated apically by a zone of necrotic tissue
Braham & Morris - these zones are obvious in1 month & established in 3months although pulpal fixation did not extend to the apex
36
Toxicity
Post operative systemic transport Possible effects on the enamel of succedaneous teeth Reversible fixation leading to autoantibody formation Mutagenicity & Carcinogenicity Destruction of cellular integrity due to cresol factor
37
Local Toxicity
Pruhs All permanent teeth showed enamel defects because: Formocresol which damages the permanent tooth germs Inflammation which was in the primary tooth which causes the defects in the permanent tooth germs.
38
Human studies not done. Kettley & Mejare in animals Formaldehyde labeled with radioactive carbon which was apparently distributed among the muscles, liver, kidney, heart, spleen & lungs. 1% of total administered dose was absorbed.
Myers et al & Pashley et al concluded that 5-10% formaldehyde is absorbed systemically from pulpotomy sites.
39
40
Advantages
Commonly available medicament Stable at room temperature Long shelf life
Disadvantages:
Reaction reversible Very caustic medication High dose toxic Systemic absorption & distribution throughout the body Has mutagenic & cariogenic potential
41
Internal resorption of the root adjacent to the area where the formocresol was applied. Radiolucency may develop in the bifurcation or trifurcation area. Furcal lesions may contain granulomatous tissue having the potential for cyst formation.
GLUTERALDEHYDE
Known for its high degree of cross linking & limited diffusability. By S Gravenmade Denkert minimum diffusion through apices. Martin J. Davis, Myers & M.D.Switkes- more active in fixing surface tissue & more rapidly limited depth of penetration through tissues.
43
Martin J. Davis et al : Glutaraldehyde & Formocresol - does not perfuse through the apex & shows no systemic distribution & other extra dental phenomena. Franklin Gracia Godoy et al : ZnO as vehicle for Glutaraldehyde 2% glutaraldehyde incorporated in ZnO not effective as when applied for 5min. Hue- Wen- Jeng et al : compared cytotoxicity & found human pulp fibroblast formaldehyde is more toxic & 2.5% glutaraldehyde is 15-20times less toxic Hermandez Pereyra et al : 2% glutaraldehyde & Formocresol R/G success of 80% & 90% with glutaraldehyde after 6months & 2yrs.
44
Prakash C. et al : formocresol showed 90% success whereas Glutaraldehyde 100% success. Glutaraldehyde better fixative & less toxic.
45
Histology
Martin J. Davis, Myers & Switkase - 5% buffered glutaraldehyde, pH= 8.5
After 1week: Coronal third: radicular tissue fixed & found to be non vital. Cells compressed & darkly stained Middle 1/3rd: radicular tissue vital with good cellular details & moderate inflammation
After 8weeks: Coronal 3rd no change Middle 3rd: dystrophic calcification apparent Apical 3rd: vital & demonstrated good cellular details with scattered inflammatory cells. Appearance of multinucleated giant cells & fibroblasts. Indicative of replacement repair Deep red cellular zone adjacent to amputation surface & few lymphocytes & plasma cells. Blood vessels dilated. Remaining pulp free of inflammatory cells & root canal lined with layer of reparative dentin. After 3months: Coronal region: stained red Pulp tissue: no layering or signs of inflammation. Macrophages visible in & adjacent to red zone. No pathosis noted.
47
Kopel concluded:
2% glutaraldehyde accepted as dressing medicament for maintaining vitality of remaining pulp. Histologically, pulp tissue in root does not resemble pulp tissue subjected to formocresol Initial zone of fixation adjacent to dressing does not proceed apically. The tissue which adjoins fixed zone has cellular details & is vital. Fixed zone replaced through macrophagic action with dense collagenous tissue. Established biochemical properties & effect on vital pulp use of 2% glutaraldehyde as pulpotomy agent.
Anna B. Fuks - contraindicate use of Glutaraldehyde Kopel & Gracia Godoy recommend use of 2% Gluteraldehyde for 1 or 3min
48
Advantages:
Reaction with pulp irrevisible Molecules do not diffuse out of apical foramen Fixes tissue instantly Not known to be cytotoxic, mutagenic & cariogenic No systemic toxic effect.
Disadvantages:
Short shelf life Freshly prepared Buffered solution to be refrigerated.
49
Glutaraldehyde Vs Formocresol
Advantages of Glutaraldehyde over Formocresol:
Is better bactericidal Not diffuse apically or laterally from the canals Not known to be cariogenic Not induce toxic effect Less systemic distribution immediately after application Fixes tissue instantly Not known to be caustic Better fixation at lower conc.
50
FERRIC SULFATE
15.5% solution Fei et al 1991 Used: coagulative & haemostatic retraction agent for crown & bridge impression & slightly acidic MOA- agglutination of blood proteins results from reaction of blood with both ferric & sulfate ions. Schroeder controlling hemorrhage might minimize chance of inflammation & internal resorption clot formation. Ranly metal protein clot may act as barrier to irritative components of sub-base & function in passive manner. Landaw & Johnson - 1st to study pulpal response from ferric sulfate in monkey teeth.
51
Duration
Fei et al 1991 Fuks et al 1997 Aktoren & Gencay 2000 Papagiannoulis 2002 Ibrevic & Al Jame 2003 Huth et al 2005 Morkovic et al 2005
53
Composition
Various formulations & uses of ZOE restorative material: Type 1: temporary cementation Type 2: permanent cementation of restoration Type 3: temporary filling material, thermal insulating base Type 4: cavity liners Composition:
Powder Zinc oxide: 69% White resin: 29.3% Zinc sterate : 1% Zinc acetate: 0.7% Liquid Eugenol: 85% Olive oil: 15%
54
Histology
James E. Berger : active inflammatory reactions which varied from simple chronic to acute suppurative pulpitis.
Boller RJ : calcific deposition associated with dentinal debris & bridge formation.
R.L. Glass & H.A. Zander : inflammation, abscess formation & liquefaction necrosis. 24hrs after: underlying tissue contain mass of red blood cells & PMN leukocytes Hemorrhage mass demarcated by Zone of fibrin & inflammatory cells 2weeks after: Degeneration of pulp & chronic inflammation extends into apical portion of pulp lymphocytes, plasma cells & PMNs leukocytes Failed to stimulate osteogenesis.
55
6 months: 1 tooth showed acute inflammation involving entire pulp 12 months: microscopic appearance of acute inflammation 18months: all teeth showed chronically inflamed pulp & absence of fibrous tissue. Doyle et al 92% histologic success, 92% R/G & 100% clinical Success. Ranly : low clinical success rate (80 to 82%)
56
57
CALCIUM HYDROXIDE
Foreman & Barnes
Hermann & Zander - introduced for Pulpotomy & found success rate of 70%
Granath : Apexification following trauma Kaiser & Frank : use for apexification Pure form- high pH & dental use ability to stimulate mineralization & antibacterial properties.
58
MECHANISM OF ACTION:
Antimicrobial activity of calcium hydroxide is related to the release of hydroxyl ions in aqueous environment. Hydroxyl ions are highly oxidant, free radicals that show extreme reactivity. Their lethal effects on the bacterial cells are probably due to the following mechanisms:
59
60
Protein denaturation:
The alkalinization provided by calcium hydroxide breakdown of the ionic bonds that maintain the tertiary structures of proteins. Loss of biological activity of the enzyme and disruption of the cellular metabolism. Structure may also be damaged by hydroxyl ions.
61
62
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Ca hydroxide powder + distilled water creamy paste with high alkalinity 3 main products: Pulpdent- 52.5% calcium hydroxide suspended in aqueous methyl cellulose solution Dycal by L.D. Caulk. Available in 2 pastes- Base & Catalyst Base: Titanium dioxide in glycol salicylate Catalyst: Calcium hydroxide & ZnO in ethyl toluene sulfonamide. Hydrex: 2 paste; non essential oil contain calcium hydroxide, barium sulphate, titanium dioxide & selected resin.
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Hydrex- hydrophobic paraffin oil methacrylate. 1. Relatively insoluble (Prosser ) 2. Poor antibacterial properties (Fisher & Mc Cabe ; Fisher & Shortal ) Hydroxyline resistant to acid etching (Milosevic) Linn & Mc Cabe reaction between calcium & Zn ions & a salicylate chelating agent is accelerated by presence of water.
3. 4.
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Histology
Teuscher & Zander Superficial layer necrotized, accompanied by acute inflammatory changes. Demarcated by new, deeply staining zone comprising basophilic elements of Ca Hydroxide dressing Proteinate zone present New area of fibrous tissue linked to primitive type of bone.
After 4weeks: Acute inflammation subsides new odontoblastic layer bridge of dentin Pulp tissue beneath calcific bridge vital & free of inflammatory cells.
Calcium hydroxide appears to stimulate resorption.
66
Andersen External root resorption of avulsed teeth when repositioned with cal hydroxide Law 49% success in 1yr Doyle et al histological success of 50% & R/G 64% & clinical success 71% Schroder 67% clinical success after 1yr; 38-59% after 2yr in 33 pulpotomized primary teeth. Hellig et al rapid decrease in hemorrhage & better R/G.
Internal Resorption:
Occurs near junction of coronal & radicular pulp (Hannah & Rowe ) Inflammation- inflammatory cells attract osteoclastic cells & initiate internal resorption Vascularity of apical region increased Osteoclastic activity predispose to External Resorption when an irritant (CaOH)2 is placed on the pulp.
67
Via 69% failure (internal resorption) Law 54% failure Magunsson 80% failure
Author
Duration
Waterhouse et al Huth et al
22mths 24mths
Markovic et al
18mths
68
69
Function It is a metalloprotease that acts on procollagen I,II,III. Involved in cartilage development Acts as a disulfide linked homodimer & induce bone & cartilage formation. Plays role in osteoblast differentiation.
BMP 3
BMP 4 BMP 5 BMP 6 BMP 7 BMP 8a BMP 8b BMP 10 BMP 12 BMP 15
COLLAGEN
Bimstein E, Shoshan S. Enriched Collagen Solution. Anna B. Fuks, Y. Michaeli et al 80% teeth vital pulp & 73% of teeth dentin bridge present & cells proliferating through incomplete dentin bridge. Nevins et al used Collagen Calcium Phosphate gel paste.
72
TETRANDRINE
Noval Anti Inflammatory Agent. Composition: 98% buffered saline dissolved in Phosphate & 20% 0.1N HCl with pH 7.2 Tetrandrine pulpotomies Showed significantly less inflammatory changes as compared to formocresol.
73
FERACRYLUM
Incomplete iron salt of Polyacrylic acid 0.05-0.5% iron MOA: binds with plasma proteins & form clot Properties: Bacteriocidal property Devoid of Systemic toxicity Used for various medical surgeries Neetu T. Prabhu & A.K. Munshi : clinical success 100% Histological Examination after 1month: 4 zones Eosinophillic zone Zone of Ghost cells Inflammatory zone Normal radicular pulpal tissue
74
75
Used : Root end filling, DPC, perforation repairs in root, furcation & apexification. Ideal to use against bone. Allow for overgrowth of cementum & formation of bone & facilitate regeneration of PDL.
77
Hydration: MTA forms Colloidal gel solidifies to hard tissue 3-4hrs. Initial pH 10.2 which rises to 12.5 three hrs after mixing. Compressive Strength: increase in presence of moisture for upto 21days. Microhardness & hydration behavior adversely affected Upto 2002 : GREY colored powder MTA.(GMTA) WHITE MTA (WMTA) : Pro Root MTA (Dentsply Endo. Tulsa)
Mineralization:
Induce hard tissue formation in pulpal tissue Histologic evaluation: stimulate Reparative dentin formation with thick dentinal bridging, minimal inflammation & normal hypermia.
79
WMTA found to have 54.9% less Al2O3, 56.5% less MgO & 90.8% less FeO.
80
Cuisia et al : 93% clinical &77% radiographic success with formocresol & 97% Clinical & 93% radiographic success with MTA
Jabbarifar et al : 94% success with MTA Agamy : GMTA>WMTA=Formocresol- 12mths Farsi N : non failure with WMTA whereas 13% radiographic failure & 2% clinical failure with formocresol- 24mths Holan et al : 83% success- formocresol & 97% with MTA- 74mths
81
Nark & Hegde : 100% success with MTA in 6mths Maroto M: GMTA 100% clinical success & 50% radiographic success WMTA radiographically 69% pulp canal signs of stenosis 11.5% - dentin bridge & 1 canal exhibited early signs of internal resorption No statistical significance in rate of stenosis, but GMTA showed significant more dentine bridge. Pinto LM : 2 failure with MTA & 6 failure with Calcium hydroxide in 12mths. Barreshi Nusairk : after 24mths 79% - +ve results. 64% had hard tissue bridge formation while 7 teeth displayed R/G signs of continued root development. Chacko V : WMTA induced more homogenous & continued dentin bridge with less pulpal inflammation than Calcium hydroxide.
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83
The material should resorb as the primary tooth root resorbs. Not irritate the periapical tissues nor coagulate any organic remnants in the canal. Have a stable disinfecting power. Any surplus material passed beyond the apex should be resorbed easily. Inserted easily into the root canal and also removed easily if necessary. Not be soluble in water. Not discolor the tooth. Radio opaque. Harmless to the adjacent tooth germ. Adhere to the walls of the canal & should not shrink Not set as a hard mass, which could deflect erupting successor
(Catagnola 1952, Rifkin 1980, Woods 1984)
84
85
Properties
Extended working time- but set faster in mouth due to increased temperature & humidity. Good sealing potential because of small volumetric changes on setting Eg Tubliseal, Wachs Cement, Nogenol
86
Gould
First proposed single visit pulpectomy 39 molars were filled with ZOE after a follow up of 16 months 35 out of 39 were successful.
87
88
Coll
Retained ZOE after loss of pulpectomized tooth 27.3% after a mean of 40.2 months after loss of treated tooth Retained Short filled ( 1mm or more short of apex) retained ZOE less often than beyond fills Size of particles of most retained ZOE filler decreased over time
89
Antibacterial Activity
ZOE could not inhibit Echerichia coli, S. aureus, Streptococcus viridans Inhibited- S.aureus & S.viridans Inclusion of zinc acetate allowed to inhibit all three
Cox et al
90
91
KRI
Walkhoff 1928 Parachlorophenol, Camphor, Menthol Iodoform Paste 2.025%- Parachlorophenol 4.86%- Camphor 1.215%- Menthol 80.8%- Iodoform Rifkin - It meets all criteria required from an ideal root canal filling material
92
Advantages
Disinfectant to treat osteitis after extractions Remains in paste form and never sets to a hard mass. Smooth, viscous material, can be spun in with lentulo-spiral or injected with pressure syringe Resorbable so if inadvertantly expressed into periapical granulomatous tissue is rapidly removed and replaced by healthy connective tissue ( Castagnola , Woods ) Resorbs in synchrony with roots. Easily inserted and removed Resorbs from apical tissues in one or two weeks.
93
Holan Anna Fuks Compared the ZOE and KRI Success rate of both was similar if underfilled Slightly higher when KRI flushed to the apex
94
Maistos Paste
Maisto 1967 Zinc oxide- 14g Iodoform 42g Thymol- 2g Chlorphenol camphor-3cc Lanolin- 0.50g
95
Eliyahu Mass
Maisto was successful in treating infected molars. Iodoform containing pastes are easily resorbed from the periradicular region. These cause no foreign body reaction like Zinc Oxide Eugenol Over filling and resorption of iodoform containing had no effect on success of treatment rather had positive healing effect.
96
Endoflas
Resorbable paste produced in South America Similar to Vitapex contains Zinc oxide and eugenol PasteTri-iodomethane , Iodine dibutilorthocresol- 40.6% Zinc oxide- 56.5% Calcium Hydroxide1.07% Barium sulfate 1.63% LiquidEugenol Paramonochlorophenol
98
Hydrophilic material- can be used in humid canals Firmly adheres to the surface to provide good seal Disinfects dentinal tubules & hard to reach accessory canals Broad spectrum antibacterial effect
99
It resorbs when extruded extra-radicularly but does not wash out intra-radicularly. ( Fuks) Eugenol causes periapical irritation ( Erausquin)
100
Calcium Hydroxide
Antiseptic Osteoinductive properties(Hendry , Stevens 1983, Sjogren ). Gets depleted from the canals earlier than the physiological resorption.( Pitts ) Lentulo spiral has been reported to be the most effective in carrying calcium hydroxide paste to working length- highest quality filling.
101
Resorbs within 1-2 weeks when extruded(Ranly) Causes no damage to permanent tooth (Reyes) Can be removed easily Eg. Sealapex.- 92.3% success (Sari )
102
Rehman
Determined the amount of duration of diffusion of calcium ion from both calcium hydroxide containing root canal sealer and an intracanal medicament Calcium ion diffusion was more in non setting group.
103
Nadkarni, Damle SG
Compared ZOE and Calcium hydroxide on 70 molars for nine months 94.28% success with Calcium Hydroxide.
104
Chawla HS et al
Mixture of Zinc oxide powder 15 gms, Calcium hydroxide paste ( 1cm) , and distilled water as root canal filling material for 12 months The material remained upto the apex till the beginning of physiologic root resorption Material resorbed at the same rate as the teeth in one case.
105
106
Bone regeneration clinically & Histologically (Dominguez , Block ) Do not set hard so retrieval is easy Harmless to permanent tooth germs It is radiopaque (Garcia Godoy ) Bacteriostatic Rate of resorption faster than phsiological resorption of tooth Resorbs without ill effects (Garcia Godoy).
107
Allergic reactions to iodine in some individuals( Castognala) Discoloration of teeth (Rotstein) Iodoform irritating to the periapical tissue can cause cemental necrosis( Erausquin)
108
Kawakami T
Used Vitapex to find the fate of calcium hydroxide component in root canal filling paste. Water based pastes caused necrosis because of high alkalinity of calcium hydroxide while silicone based paste (VITAPEX) shows no necrotizing effect.
109
Comparison of zinc oxide and eugenol, and Vitapex for root canal treatment of necrotic primary teeth.
Mortazavi M, Mesbahi M Both ZOE and Vitapex gave encouraging results. overall success rates of Vitapex and ZOE were 100% and 78.5%, respectively
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Evaluation of various root canal filling materials in primary molar pulpectomies: an in vivo study.
Ozalp N, Sarolu I, Snmez H. In the ZOE group, all pulpectomies were successful. In the Sealapex group, two pulpectomies Calcicur group, four pulpectomies showed complete resorption of the material in the root canal. Vitapex group, although six pulpectomies showed resorption of the filling material within the canals, this had no effect on the clinical and radiographical success of the treatment.
111
29 26 33 29 55 53 62
Success of pulpectomy with zinc oxideeugenol vs calcium hydroxide/iodoform paste in primary molars.
Trairatvorakul C, Chunlasikaiwan S. At 6 and 12 months, the ZOE success rates were 48% and 85%, respectively, and the Vitapex success rates were 78% and 89% Vitapex appeared to resolve furcation pathology at a faster rate than zinc oxide-eugenol at 6 months, while at 12 months, both materials yielded similar results.
113
Conclusion
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REFERENCES
Don M. Ranly; Pulpotomy therapy in primary teeth: new modalities for old rationales; Pediatric dentistry; 16: 1994; 403-9
D.R. Llewelyn; The pulp treatment of the primary dentition; International Journal of Pediatric Dentistry; 2000; 10: 248-252
Cheng D.Fong, Martin J.Davis; Partial pulpotomy for immature permanent teeth, its present & future; Pediatric Dentistry 24: 29-32, 2002 Scott A. Fishman, Richard D. Udin, David L.Good, Fairborz Rodef; Success of electrofulguration pulpotomies covered by zinc oxide & eugenol or calcium hydroxide: a clinical study; Pediatric Dentistry; 18: 385-90; 1996 Waterhouse PJ; Formocresol & alternative primary molar pulpotomy medicaments: a review; Endod Dent Traumatol 1995; 11: 157-162
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V. Srinivasan, C. L. Patchett, P. J. Waterhouse; Is there life after Buckleys Formocresol? Part I A narrative review of alternative interventions & materials; International Journal of Pediatric Dentistry; 2006; 16: 117-127 V. Srinivasan, C. L. Patchett, P. J. Waterhouse; Is there life after Buckleys Formocresol? Part II Development of a protocol for the management of extensive caries in the primary molar; International Journal of Pediatric Dentistry; 2006; 16: 199-206 Peter L. Judd, David J. Kenny; Formocresol Concern; J. Canad Dent Assn, 1987; no.5; 401-4 Bradley Lewis; Formaldehyde in dentistry: a review for the millennium; The Journal of Clinical Pediatric Dentistry; Vol. 22; No. 2/1998 Sharon D. Hill, N. Sue Seale, E. Matthew Quintero, BS Ingrid Y. Guo; The effect of glutaraldehyde pulpotomy treatment on pulpal enzymes; Pediatric Dentistry: Sep./Oct. 1993; vol. 15, no. 5; 337-42
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Robert J. Feigal, harold H. Messer; A critical look at gluteraldehyde; Pediatric dentistry: April/ May, 1990; Vol. 12, No. 2; 69-71 D.M. Ranly, Franklin Garcia Gogoy, Diane Horn; Time, concentration & pH parameters for the use of gluteralhehyde as a pulpotomy agent: an in vitro study; Pediatric dentistry: sep. 1987/ vol. 9. No.3; 199-203 Ay- Luen Fei, Richard d. Udin, Ronald Johnson; A clinical study of ferric sulfate as a pulpotomy agent in primary teeth; Pediatric dentistry; Nov./Dec. 1991; Vol.13; No.6; 327-32. Nikki L Smith, N. Sue Seale, Martha E. Nunn; ferric sulfate pulpotomy in primary molars: A retrospective study; Pediatric Dentistry 2000; 22: 192199. David M.Strange, N. Sue Seale, Martha E. Nunn, Malcolm Strange; Outcome of formocresol/ ZOE sub-base pulpotomies utilizing alternative radiographic success criteria; Pediatric Dentistry 2001; 23: 331-336
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Derek Zurn, N. sue Seale; Light cured Calcium hydroxide Vs Formocresol in human primary molar pulpotomies: A randomized Controlled trial; Pediatric dentistry 2008; 30: 34-31 A.B.S. Moretti et al, The effectiveness of MTA, calcium hydroxide & formocresol for pulpotomies in primary teeth; International Endodontic Journal, 2008, 41, 547-555 Howard W. Robert, Jeffery M. Toth, David W. Berzins, David G. Charlton; MTA material use in endodontic treatment: A review of the literature; Dental Materials; 24 (2008); 149-164 D. Tuna & A. Olmez; Clinical long term evaluation of MTA as a direct pulp capping material in primary teeth; International Endodontic Journal; 41; 2008; 273-278 Eliezer Eidelman, Dr. Odont, Gideon Holan, Anna B. Fuks; MTA Vs Formocresol in pulpotomized primary molars: a preliminary 118 report; Pediatric Dentistry-2001, 23:15-18
Richard S. Schwartz et al; MTA: a new material for Endodontics; JADA 1999; Vol.130, 967-975 Neeta T. Prabhu, A.K. Munshi; Clinical, radiographic & histological observation of the radicular pulp following Feracrylum pulpotomy; J. Clin Pediatr Dent; 1997, 21(2): 151-156 K. Iohara et al; Dentin regeneration by dental pulp stem cell therapy with recombinant Human Bone morphogenetic Protein2; Journal of Dental Research; 2004; 83(8): 590-595 Yoshito Yoshimine, Katsumasa Maeda, Fukuoka; Histologic evaluation of tetracalcium phosphate based cement as a direct pulp capping agent; OOOE; 1995; 79: 351-8 Manoj Komath, varma H.K.; Fully injectable calcium phosphate cement- a promise to dentistry; Ind J Dent Res; 2004; 15(3): 89-95 Anna B. Fuks; Vital pulp therapy with new materials for primary teeth: New direction & Treatment perspectives; Pediatr Dent 2008; 30: 211-9
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Fuks AB; Pulp therapy for primary dentition. In Pediatric Dentistry: infancy through adolescence; Pediatric Dentistry 2005 Fuks AB, Papaginnoulis L; Pulpotomy in primary teeth: review of literature; Eur Arch Pediatr Dent 2006;7; 64-71 David E. Witherspoon; Vital pulp tissue with new material: New direction & treatment perspectives- Permanent teeth; Pediatr dent 2008; 30; 220-4 Alan R. Milnes; Is Formocresol Obsolete? A fresh look at the evidence concerning safety Issues; Pediatr dent 2008; 30; 237-46 Paula Jane Waterhouse; New Age pulp therapy: Personal thoughts on a hot debate; Pediatr dent 2008; 30; 247-52
D. B. Kennedy; Pulp therapy; Kennedys Pediatric Operative Dentistry; Chapter 18,19; 4th edt.; 157-168
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Mc Donald; Treatment of deep caries, Vital pulp exposure & pulpless teeth; Dentistry for Child & Adolescent; chapter18; 8th edt.; 397-399
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THANK U
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