European Archives of Paediatric Dentistry

, Volume 14, Issue 3, pp 191–194 | Cite as

Histological and CBCT evaluation of a pulpotomised primary molar using calcium enriched mixture cement

  • L. Mehrdad
  • B. MalekafzaliEmail author
  • F. Shekarchi
  • Y. Safi
  • S. Asgary
Case Report



Pulpotomy is one of the most commonly used treatments for retaining pulpally involved primary molar teeth in order to prevent tooth extraction and maintain space within the jaws. A recent randomised clinical trial found that calcium enriched mixture (CEM) cement demonstrated favourable 2-year treatment outcomes for pulpotomy of carious primary molars comparable with mineral trioxide aggregate (MTA). The use of cone beam computer tomography (CBCT) has not previously been used to evaluate pulpotomy and histological outcomes.

Case report

A coronal pulpotomy was performed on a carious maxillary first primary molar in a 7-year-old child with non-contributory medical history. Following haemostasis, the radicular pulp was covered with 2–3 mm of CEM and the tooth restored.


At the 2-year follow-up appointment, clinical/radiographic examinations of the pulpotomised tooth revealed that vital pulp therapy was successful in maintaining the tooth asymptomatic; however, the first maxillary molars had to be extracted for orthodontic reasons. CBCT and histological examinations showed thick/complete calcific bridges with tubular dentine at the amputation sites. The underlying dental pulp had normal structure and was un-inflamed.


Based on these findings, it seems that CEM cement can induce a favourable biological response in dental pulps of primary teeth and CBCT may be useful to evaluate pulpotomy outcomes.


Calcium enriched mixture CEM cement Deciduous Dentinogenesis Histological Imaging, Three-dimensional Pulpotomy 


  1. Asgary S, Eghbal MJ, Parirokh M. Sealing ability of a novel endodontic cement as a root-end filling material. J Biomed Mater Res A. 2008;87:706–9.PubMedGoogle Scholar
  2. Asgary S, Eghbal MJ, Parirokh M, Ghoddusi J. Effect of two storage solutions on surface topography of two root-end fillings. Aust Endod J. 2009;35:147–52.PubMedCrossRefGoogle Scholar
  3. Asgary S, Eghbal MJ, Ehsani S. Periradicular regeneration after endodontic surgery with calcium-enriched mixture cement in dogs. J Endod. 2010;36:837–41.PubMedCrossRefGoogle Scholar
  4. Asgary S, Nosrat A, Homayounfar N. Periapical healing after direct pulp capping with calcium-enriched mixture cement: a case report. Oper Dent. 2012;37:571–5.PubMedCrossRefGoogle Scholar
  5. Asgary S, Eghbal MJ, Ghoddusi J, Yazdani S. One-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter, randomized, non-inferiority clinical trial. Clin Oral Investig. 2013;17:431–9.Google Scholar
  6. Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG. Endodontic applications of cone-beam volumetric tomography. J Endod. 2007;33:1121–32.PubMedCrossRefGoogle Scholar
  7. Fallahinejad Ghajari M, Asgharian Jeddi T, Iri S, Asgary S. Direct pulp-capping with calcium enriched mixture in primary molar teeth: a randomized clinical trial. Iran Endod J. 2010;5:23–6.Google Scholar
  8. Fuks AB. Vital pulp therapy with new materials for primary teeth: new directions and treatment perspectives. J Endod. 2008;34:S18–24.PubMedCrossRefGoogle Scholar
  9. Garcia-Godoy F, Novakovic DP, Carvajal IN. Pulpal response to different application times of formocresol. J Pedod. 1982;6:176–93.PubMedGoogle Scholar
  10. Hill SD, Berry CW, Seale NS, Kaga M. Comparison of antimicrobial and cytotoxic effects of glutaraldehyde and formocresol. Oral Surg Oral Med Oral Pathol. 1991;71:89–95.PubMedCrossRefGoogle Scholar
  11. Kangarlou A, Sofiabadi S, Yadegari Z, Asgary S. Antifungal effect of calcium enriched mixture (CEM) cement against Candida albicans. Iran Endod J. 2009;4:101–5.Google Scholar
  12. Lewis BB, Chestner SB. Formaldehyde in dentistry: a review of mutagenic and carcinogenic potential. J Am Dent Assoc. 1981;103:429–34.PubMedGoogle Scholar
  13. Malekafzali B, Shekarchi F, Asgary S. Treatment outcomes of pulpotomy in primary molars using two endodontic biomaterials. A 2-year randomised clinical trial. Eur J Paediatr Dent. 2011;12:189–93.PubMedGoogle Scholar
  14. Myers DR, Pashley DH, Whitford GM, McKinney RV. Tissue changes induced by the absorption of formocresol from pulpotomy sites in dogs. Pediatr Dent. 1983;5:6–8.PubMedGoogle Scholar
  15. Nosrat A, Asgary S. Apexogenesis treatment with a new endodontic cement: a case report. J Endod. 2010;36:912–4.PubMedCrossRefGoogle Scholar
  16. Nosrat A, Seifi A, Asgary S. Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial. J Endod. 2011;37:562–7.PubMedCrossRefGoogle Scholar
  17. Nosrat A, Seifi A, Asgary S. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial. Int J Paediatr Dent. 2013;23:56–63.PubMedCrossRefGoogle Scholar
  18. Patel S. New dimensions in endodontic imaging: Part 2. Cone beam computed tomography. Int Endod J. 2009;42:463–75.PubMedCrossRefGoogle Scholar
  19. Peng L, Ye L, Tan H, Zhou X. Evaluation of the formocresol versus mineral trioxide aggregate primary molar pulpotomy: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:e40–4.PubMedCrossRefGoogle Scholar
  20. Peng L, Ye L, Guo X, et al. Evaluation of formocresol versus ferric sulphate primary molar pulpotomy: a systematic review and meta-analysis. Int Endod J. 2007;40:751–7.PubMedCrossRefGoogle Scholar
  21. Rahimi S, Mokhtari H, Shahi S et al. Osseous reaction to implantation of two endodontic cements: mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM). Med Oral Patol Oral Cir Bucal. 2012;17(5):e907–11.Google Scholar
  22. Samiee M, Eghbal MJ, Parirokh M, Abbas FM, Asgary S. Repair of furcal perforation using a new endodontic cement. Clin Oral Investig. 2010;14:653–8.PubMedCrossRefGoogle Scholar
  23. Srinivasan V, Patchett CL, Waterhouse PJ. Is there life after Buckley’s Formocresol? Part I—a narrative review of alternative interventions and materials. Int J Paediatr Dent. 2006;16:117–27.PubMedCrossRefGoogle Scholar
  24. Trope M. Regenerative potential of dental pulp. Pediatr Dent. 2008;30:206–10.PubMedGoogle Scholar
  25. Tziafas D, Smith AJ, Lesot H. Designing new treatment strategies in vital pulp therapy. J Dent. 2000;28:77–92.PubMedCrossRefGoogle Scholar
  26. Wu MK, Wang ME, Chang SP. Antibody formation to dog pulp tissue altered by a paste containing paraformaldehyde. Int Endod J. 1989;22:133–7.PubMedCrossRefGoogle Scholar
  27. Zarrabi MH, Javidi M, Jafarian AH, Joushan B. Histologic assessment of human pulp response to capping with mineral trioxide aggregate and a novel endodontic cement. J Endod. 2010;36:1778–81.PubMedCrossRefGoogle Scholar
  28. Zarrabi MH, Javidi M, Jafarian AH, Joushan B. Immunohistochemical expression of fibronectin and tenascin in human tooth pulp capped with mineral trioxide aggregate and a novel endodontic cement. J Endod. 2011;37:1613–8.PubMedCrossRefGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2013

Authors and Affiliations

  • L. Mehrdad
    • 1
  • B. Malekafzali
    • 1
    • 2
    Email author
  • F. Shekarchi
    • 1
  • Y. Safi
    • 3
  • S. Asgary
    • 4
  1. 1.Dental Research CenterResearch Institute of Dental Sciences, Shahid Beheshti University of Medical SciencesTehranIran
  2. 2.Department of Paediatric Dentistry, Dental Research CenterShahid Beheshti University of Medical SciencesTehranIran
  3. 3.Department of Oral and Maxillofacial Radiology, Dental SchoolShahid Beheshti University of Medical SciencesTehranIran
  4. 4.Iranian Center for Endodontic ResearchResearch Institute of Dental Sciences, Shahid Beheshti University of Medical SciencesTehranIran

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