Long-term effectiveness of four pulpotomy techniques: 3-year randomised controlled trial

Abstract

A pulpotomy is the therapy for management of pulp exposures due to caries in symptom-free primary molars. The aim was to longitudinally compare the relative effectiveness of the Er:YAG laser, calcium hydroxide and ferric sulphate techniques with dilute formocresol in retaining symptom-free molars. Two hundred primary molars in 107 healthy children were included and randomly allocated to one technique. The treated teeth were blindly reevaluated after 6, 12, 18, 24 and 36 months. Descriptive data analysis and logistic regression analysis accounting for multiple observations per patient by generalised estimating equation were used. Additionally, various influences including tooth type, upper and lower jaws, type of anaesthesia, operator and the final restoration on treatment success were evaluated (Wald chi-square test). After 36 months, the following total (considering clinical and clinically symptom-free radiographic failures) and clinical success rates were determined (in percent): Formocresol 72 (92), laser 73 (89), calcium hydroxide 46 (75), ferric sulphate 76 (97). No significant differences were detected between formocresol and any other technique after 36 months. However, the odds ratio of failure appeared to be three times higher for calcium hydroxide than for formocresol. No significant differences in total success rates were seen regarding the aforementioned influencing clinical parameters. The correct diagnosis of the pulpal status, bleeding control and the specific technique are highly important for long-term success of pulpotomies in primary molars. According to the presented long-term data, pulpotomies using ferric sulphate revealed the best treatment outcome among the used techniques, while calcium hydroxide resulted in the lowest success rates after 3 years. Therefore, we can recommend ferric sulphate for easy and successful treatment of primary molars with caries-exposed pulps.

Ineffectiveness of Antibiotic-Based Pulpotomy for Primary Molars: a Survival Analysis

“…However, our results agree with other investigation [7] that showed low success rates in the radiographic assessment of the outcomes using the LSTR pulpotomy conception, confirming that unsuccessful treatments are commonly associated with symptom-free teeth as observed in other studies of the effectiveness of different pulp therapies for primary teeth [20]. Accordingly with the American Academy of Paediatric Dentistry's guideline on pulp therapy [21], radiographic infectious process of pulpectomized teeth should resolve in 6 months, which is evidenced by bone deposition in the pretreatment radiolucent areas.…”

Pulpotomies with Low-Level Laser Therapy in Human Primary Teeth: A Report of Two Cases

“…The evidence demonstrated by researches 9,10,12,15 and in this clinical case report support the use of LLLT as a complement in pulpotomy therapy in primary teeth. Our cases revealed that the LLLT may be considered as an effective alternative for primary molars pulpotomies, since the treated teeth were retained asymptomatic in the oral cavity, according to the results obtained by Golpayegani (2010) 9 and Golpayegani (2009).…”

“…[6][7][8] Recently, the use of low-level laser therapy (LLLT) has shown great promise in the treatment of the oral cavity tissues. [9][10][11][12][13][14] This technology is getting space on dentistry either complementing or replacing traditional methods with…”

Efeitos do Laser de Baixa Intensidade em pulpotomias de dentes decíduos humanos

“…A manutenção da dentição decídua, sem perdas prematuras, preserva a integridade dos arcos e as funções do sistema estomatognático, previne hábitos deletérios e assegura o desenvolvimento do crescimento facial normal (CAICEDO et al, 2006;FUKS, 2008;SUBRAMANIAM et al, 2009;BLANCHARD;HUGAR;DESHPANDE, 2010;COLL, 2010;GODHI;SOOD;SHARMA, 2011;HUTH et al, 2012).…”

“…LUNA- RICARDO, 2010;LIMA et al, 2011;CARDOSO-SILVA et al, 2011;HAGHGOO;ABBASI, 2012), entretanto, ainda não existem evidências suficientes que suportem a superioridade e determine qual o material mais apropriado (NADIN et al, 2003;CASTRO, 2005;PENG et al, 2006;DEERY, 2007;CANNON et al, 2008;FUKS, 2008;ALAÇAM et al, 2009;BERGOLI et al, 2010;ERDEM et al, 2010;LIMA et al, 2011;TATE, 2011;HUTH et al, 2012;YAMAN et al, 2012;ANTHONAPPA;KING;MARTENS, 2013;LOURENÇO NETO et al, 2013;DE COSTER;RAJASEKHARAN;MARTENS, in press). O objetivo da Odontologia baseada em evidências é propor um protocolo fundamentado em dados científicos que direcionem a decisão clínica para o melhor tratamento (FUKS, 2008;NG;MESSER, 2008;TATE, 2011;LEE, 2012; ANTHONAPPA; KING; MARTENS, 2013).…”