A comparison of calcium hydroxide/iodoform paste and zinc oxide eugenol as root filling materials for pulpectomy in primary teeth: A systematic review and meta‐analysis

Abstract

Zinc oxide eugenol (ZOE) has traditionally been used as a root filling material in primary teeth pulpectomy. Calcium hydroxide and iodoform (Ca(OH)2/iodoform) may have advantages as a root canal filling material to evaluate treatment success of Ca(OH)2/iodoform pulpectomy in primary teeth compared with ZOE based on clinical and radiographical criteria. All human clinical studies reporting clinical and radiographical outcomes of Ca(OH)2/iodoform compared with ZOE in primary teeth pulpectomy were identified in digital bibliographic databases. Two authors independently selected studies and extracted relevant study characteristics. Success of treatment was based on an accomplishment of specific clinical and radiographical criteria. Meta‐analyses were performed to appraise study heterogeneity and aggregated statistics. Out of 5,000 articles identified in initial search, 15 articles met all inclusion criteria, while 10 were included in the meta‐analyses. At 6‐ and 12‐month follow‐up, there were no statistically significant differences in the clinical and radiographical success rates of Ca(OH)2/iodoform and ZOE. However, ZOE was shown to have statistically significant higher success rates at ≥18‐month follow‐up. On the basis of the findings of this systematic review, we recommend that Ca(OH)2/iodoform be utilized for pulpectomy in primary teeth nearing exfoliation; conversely, ZOE should be utilized when exfoliation is not expected to occur soon. Future randomized control clinical trials with a long‐term follow‐up are needed before a reliable conclusion can be drawn as to the best pulpectomy material. The success of pulpectomy in primary teeth depends on selecting the ideal root canal filling material. It is challenging to select the appropriate filling materials for primary teeth. ZOE or ZOE/iodoform combined with Ca(OH)2 appears to be the materials of choice if primary teeth are not nearing exfoliation. More high‐quality randomized control clinical trials with a long‐term follow‐up period are needed before a reliable conclusion can be drawn as to the best pulpectomy material in primary teeth (systematic review registration number: CRD42016037563).

Pulpectomy versus pulpotomy in the treatment primary molars with chronic pulpitis

“…The total success rates in ZOE pulpotomy groups were only 68% after 24 months of observation [7]. But R.Najjar,s (2019) meta-analysis shows that ZOE or ZOE/iodoform is the materials of choice for pulpectomy in primary teeth need long time before exfoliation [8].…”

Evaluation of a Novel Endodontic Paste for Primary Teeth with Necrotic Pulp

“…1,4 Traditional pulpectomy procedure in primary molars with necrotic pulp requires instrumentation of root canals system, disinfection with antimicrobial irrigants solutions and filling with absorbable and antibacterial materials. 1,4,5 ZOE paste is a traditional and largely recommended material for conventional treatments involving root canal instrumentation of the primary teeth. 1,4 Its antibacterial effect is mainly attributed to the action of eugenol that causes protein denaturation.…”

“…1,4 Its antibacterial effect is mainly attributed to the action of eugenol that causes protein denaturation. 5,10,24 It is assumed that in view of the anatomical complexity of primary molars, its action is not sufficient enough to reduce the bacterial contamination and the use of antimicrobial irrigating substances is mandatory when instrumentation is performed. 25…”

“…4 The ideal endodontic material for primary teeth must have biocompatibility with periodical tissues, antimicrobial activity, not cause tooth discoloration or interfere with the eruption of permanent successor teeth. 5 In order to increase the success rates of endodontic treatment in children, broad-spectrum antibiotics have been incorporated into these pastes to reduce and/or eliminate the micro biota and their insertion is limited to the pulp chamber, becoming technically more accessible to general practitioners. [6][7][8][9][10] CTZ paste is a pharmacological dental material developed by Cappiello 6,7 composed by chloramphenicol, tetracycline and zinc oxide.…”

Pleiotropic Effects of Eugenol: The Good, the Bad, and the Unknown

“…This phytochemical has emerged from ancient times as a versatile molecule with a plethora of applications in drug, food and cosmetic industries, and agriculture [ 2 ]. In medicine, eugenol is best known for its original use in dentistry as cavity filling cement with local antiseptic and analgesic effects [ 3 , 4 ]. However, the compound has been systematically investigated for numerous other pharmacological activities, such as anti-infective (antimicrobial, antihelmintic, antiviral, antifungal, antiparasitic, and insecticidal) [ 5 , 6 ], anti-inflammatory, antioxidant [ 7 , 8 ], and anticarcinogenic, when administered alone or in synergistic association with conventional therapies [ 9 – 11 ].…”