Advertisement

European Archives of Paediatric Dentistry

, Volume 16, Issue 4, pp 303–312 | Cite as

Evidence of pulpotomy in primary teeth comparing MTA, calcium hydroxide, ferric sulphate, and electrosurgery with formocresol

  • E. Stringhini Junior
  • M. E. B. Vitcel
  • L. B. OliveiraEmail author
Systematic Review

Abstract

Aim

The aim of this study was to evaluate the scientific evidence of pulpotomy in primary teeth comparing mineral troxide aggregate (MTA), calcium hydroxide, ferric sulphate, and electrosurgery with formocresol.

Methods

A systematic search using key words was conducted using seven databases up to December 10, 2013. Clinical articles in English, Portuguese and Spanish were selected, which were in accordance with the inclusion and exclusion criteria and the research objective of comparing whether pulpotomy performed with formocresol in primary teeth is more effective than other medicaments or techniques.

Results

Out of the 12,515 publication initially identified, 30 clinical articles were included in the systematic review and analysed by four meta-analyses. The success rate of MTA (94.6 %) was higher than that of formocresol (87.4 %), with a statistically significant difference (OR = 0.39; 95 % CI = 0.25–0.62). Formocresol pulpotomy success was not statistically different from ferric sulphate or electrosurgery.

Conclusion

MTA was clinically and radiographically superior to formocresol for pulpotomy of primary teeth. The other alternatives to formocresol such as electrosurgery and ferric sulphate can be used instead of formocresol since they showed success similar to formocresol. In addition, there is no evidence to support calcium hydroxide for pulpotomies in primary teeth.

Keywords

Pulpotomy Primary tooth Systematic review Meta-analysis Endodontic treatment 

References

  1. Aeinehchi M, Dadvand S, Fayazi S, Bayat-Movahed S. Randomized controlled trial of mineral trioxide aggregate and formocresol for pulpotomy in primary molar teeth. Int Endod J. 2007;40:261–7.PubMedCrossRefGoogle Scholar
  2. Agamy HA, Bakry NS, Mounir MM, Avery DR. Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth. Pediatr Dent. 2004;26:302–9.PubMedGoogle Scholar
  3. Agell RS. Clinical and radiographic evaluation of primary molars with necrotic pulp treated with two formocresol concentrations. Acta Odontol Venez. 1989;27:3–9.Google Scholar
  4. Alaçam A, Odabas ME, Tüzüner T, Sillelioglu H, Baygin O. Clinical and radiographic outcomes of calcium hydroxide and formocresol pulpotomies performed by dental students. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:e127–33.PubMedCrossRefGoogle Scholar
  5. American Academy of Pediatric Dentistry (AAPD). Guideline on pulp therapy for primary and immature permanent tooth. Clinical guidelines—reference manual 2012–2013. Pediatr Dent. 2012;34:222–9.Google Scholar
  6. Ansari G, Ranjpour M. Mineral trioxide aggregate and formocresol pulpotomy of primary teeth: a 2-year follow-up. Int Endod J. 2010;43:413–8.PubMedCrossRefGoogle Scholar
  7. Anthonappa RP, King NM, Martens LC. Is there sufficient evidence to support the long-term efficacy of mineral trioxide aggregate (MTA) for endodontic therapy in primary teeth. Int Endod J. 2013;46:198–204.PubMedCrossRefGoogle Scholar
  8. Bahrololoomi Z, Moeintaghavi A, Emtiazi M, Hosseini GA. Clinical and radiographic comparison of primary molars after formocresol and electrosurgical pulpotomy: a randomized clinical trial. Indian J Dent Res. 2008;19:219–23.PubMedCrossRefGoogle Scholar
  9. Bergoli AD, Primosch RE, de Araujo FB, Ardenghi TM, Casagrande L. Pulp therapy in primary teeth—profile of teaching in Brazilian dental schools. J Clin Pediatr Dent. 2010;35:191–5.PubMedCrossRefGoogle Scholar
  10. Bowen JL, Math-Muju K, Nash DA, et al. Pediatric and general dentists’ attitudes toward pulp therapy for primary teeth. Pediatric Dent. 2012;34:210–5.Google Scholar
  11. De Coster P, Rajasekharan S, Martens L. Laser-assisted pulpotomy in primary teeth: a systematic review. Int J Paediatr Dent. 2013;23:389–99.PubMedGoogle Scholar
  12. Dean JA, Mack RB, Fulkerson BT, Sanders BJ. Comparison of electrosurgical and formocresol pulpotomy procedures in children. Int J Paediatr Dent. 2002;12:177–82.PubMedCrossRefGoogle Scholar
  13. Dunston B, Coll JA. A survey of primary tooth pulp therapy as taught in US dental schools and practiced by diplomates of the American Board of Pediatric Dentistry. Pediatr Dent. 2008;30:42–8.PubMedGoogle Scholar
  14. Eidelman E, Holan G, Fuks AB. Mineral trioxide aggregate vs. formocresol in pulpotomized primary molars: a preliminary report. Pediatr Dent. 2001;23:15–8.PubMedGoogle Scholar
  15. Elkhadem A, Nagi P. Effectiveness of MTA pulpotomy in primary molars: a clinical assessment of relevant studies. Evid Based Dent. 2013;14:46.PubMedCrossRefGoogle Scholar
  16. Erdem AP, Guven Y, Balli B, et al. Success rates of mineral trioxide aggregate, ferric sulfate, and formocresol pulpotomies: a 24-month study. Pediatr Dent. 2011;33:165–70.PubMedGoogle Scholar
  17. Fernandez CC, Martinez SS, Jimeno FG, Rodrigues AIL, Mercade M. Clinical and radiographic outcomes of the use of four dressing materials in pulpotomized primary molars: a randomized clinical trial with 2-year follow-up. Int J Paediatr Dent. 2013;23:400–7.PubMedGoogle Scholar
  18. Fornetti APC, Lourenço Neto N, Moretti ABS, et al. Clinical and radiographic study on 1/5 dilution of Buckley’s formocresol and Portland cement used for pulpotomies of human primary teeth. Rev Odontol UNESP. 2009;38:161–8.Google Scholar
  19. Fuks AB, Holan G, Davis JM, Eidelman E. Ferric sulfate versus dilute formocresol in pulpotomized primary molars: long-term follow up. Pediatr Dent. 1997;19:327–30.PubMedGoogle Scholar
  20. Ghajari MF, Kermani NM, Fard MJK, Vantanpour M. Comparison of formocresol and ferric sulfate pulpotomy in primary molars: a systematic review and meta-analysis. J Den (Tehran). 2009;6:29–36.Google Scholar
  21. Godhi B, Sood PB, Sharma A. Effects of mineral trioxide aggregate and formocresol on vital pulp after pulpotomy of primary molars: an in vivo study. Contemp Clin Dent. 2011;2:296–301.PubMedCentralPubMedCrossRefGoogle Scholar
  22. Golpayegani MV, Ansari G, Tadayon N, Shams SH, Mir M. Low-level laser therapy for pulpotomy treatment of primary molars. J Den (Tehran). 2009;6:168–74.Google Scholar
  23. Hincapié S, Fuks A, Mora I, Bautista G, Socarras F. Teaching and practical guidelines in pulp therapy in primary teeth in Colombia–South America. Int J Paediatr Dent. 2014. doi: 10.1111/ipd.12103.PubMedGoogle Scholar
  24. Holan G, Eidelman E, Fuks AB. Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol. Pediatr Dent. 2005;27:129–36.PubMedGoogle Scholar
  25. Hugar SM, Deshpande SD. Comparative investigation of clinical/radiographical signs of mineral trioxide aggregate and formocresol on pulpotomized primary molars. Contemp Clin Dent. 2010;1:146–51.PubMedCentralPubMedCrossRefGoogle Scholar
  26. Huth KC, Al-Khatar NH, Wolf P, et al. Long-term effectiveness of four pulpotomy techniques: 3 year randomized controlled trial. Clin Oral Investig. 2012;16:1243–50.PubMedCrossRefGoogle Scholar
  27. Huth KC, Paschos E, Hajek-Al-Khatar N, et al. Effectiveness of 4 pulpotomy techniques-randomized controlled trial. J Dent Res. 2005;84:1144–8.PubMedCrossRefGoogle Scholar
  28. Ibricevic H, Al-Jame Q. Ferric sulfate as pulpotomy agent in primary teeth: twenty month clinical follow-up. J Clin Pediatr Dent. 2000;24:269–72.PubMedCrossRefGoogle Scholar
  29. Ibricevic H, Al-Jame Q. Ferric sulfate and formocresol in pulpotomy of primary molars: long term follow-up study. Eur J Paediatr Dent. 2003;4:28–32.PubMedGoogle Scholar
  30. Jabbarifar SE, Khademi AA, Ghasemi D. Success rate of formocresol pulpotomy versus mineral trioxide aggregate in human primary molar tooth. J Res Med Sci. 2004;9:304–7.Google Scholar
  31. Khorakian F, Mazhari F, Asgary S, et al. Two-year outcomes of electrosurgery and calcium-enriched mixture pulpotomy in primary teeth: a randomized clinical trial. Eur Arch Paediatr Dent. 2014;15:223–8.PubMedCrossRefGoogle Scholar
  32. Leon RR, Steele PJ, Jeansonne BG. Ferric sulfate hemostasis. Effect on osseous wound healing left in situ for maximum exposure. J Endod. 1993;19:170–3.CrossRefGoogle Scholar
  33. Lin PY, Chen HS, Wang YH, Tu YK. Primary molar pulpotomy: a systematic review and network meta-analysis. J Dent. 2014;42:1060–77.PubMedCrossRefGoogle Scholar
  34. Liu JF. Effects of Nd: YAG laser pulpotomy on human primary molars. J Endod. 2006;32:404–7.PubMedCrossRefGoogle Scholar
  35. Loh A, O’Hoy P, Tran X, et al. Evidence-based assessment: evaluation of the formocresol versus ferric sulfate primary molars pulpotomy. Pediatr Dent. 2004;26:401–9.PubMedGoogle Scholar
  36. Markovic D, Zivojinovic V, Vucetic M. Evaluation of three pulpotomy medicaments in primary teeth. Eur J Paediatr Dent. 2005;6:133–8.PubMedGoogle Scholar
  37. Mickenautsch S, Yengopal JV, Bonecker M, et al. Minimum intervention: a new approach in dentistry. 1st ed. Houghton: Midentistry corp; 2006.Google Scholar
  38. Moretti AB, Sakai VT, Oliveira TM, et al. The effectiveness of mineral trioxide aggregate, calcium hydroxide and formocresol for pulpotomies in primary teeth. Int Endod J. 2008;41:547–55.PubMedCrossRefGoogle Scholar
  39. Naik S, Hegde A. Mineral trioxide aggregate as a pulpotomy agent in primary molars: an in vivo study. J Indian Soc Pedod Prev Dent. 2005;23:13–6.PubMedCrossRefGoogle Scholar
  40. Neamatollahi H, Tajik A. Comparison of clinical and radiographic success rates of pulpotomy in primary molars using formocresol, ferric sulfate and mineral trioxide aggregate (MTA). J Den (Tehran). 2006;3:6–14.Google Scholar
  41. Ng FK, Messer LB. Mineral trioxide aggregate as a pulpotomy medicament: an evidence-based assessment. Eur Arch Paediatr Dent. 2008;9:58–73.PubMedCrossRefGoogle Scholar
  42. Ni Chaollai A, Monteiro J, Duggal MS. The teaching of management of the pulp in primary molars in Europe. A preliminary investigation in Ireland and the UK. Eur Arch Paediatr Dent. 2009;10:98–103.PubMedCrossRefGoogle Scholar
  43. Noorollahian H. Comparison of mineral trioxide aggregate and formocresol as pulp medicaments for pulpotomies in primary molars. Br Dent J. 2008;204:E20.PubMedCrossRefGoogle Scholar
  44. Odabas ME, Bodur H, Baris E, Demir C. Clinical, radiographic, and histopathologic evaluation of Nd: YAG laser pulpotomy on human primary teeth. J Endod. 2007;33:415–21.PubMedCrossRefGoogle Scholar
  45. Papagiannoulis L. Clinical studies on ferric sulphate as a pulpotomy medicament in primary teeth. Eur J Paediatr Dent. 2002;3:126–32.PubMedGoogle Scholar
  46. 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
  47. Peng L, Ye L, Guo X, Tan H, Zhou X, Wang C, Li R. Evaluation of formocresol versus ferric sulphate primary molar pulpotomy: a systematic review and meta-analysis. Int End J. 2007;40:751–7.CrossRefGoogle Scholar
  48. Ranly DM, Garcia-Godoy F. Reviewing pulp treatment for primary teeth. J Am Dent Assoc. 1991;122:83–6.PubMedCrossRefGoogle Scholar
  49. Ranly DM. Pulpotomy therapy in primary teeth: new modalities for old rationales. Pediatr Dent. 1994;16:403–9.PubMedGoogle Scholar
  50. Rivera N, Reyes E, Mazzaoui S, Morón A. Pulpal therapy for primary teeth: formocresol vs electrosurgery: a clinical study. J Dent Child (Chic). 2003;70:71–3.Google Scholar
  51. Sabbarini J, Mohamed A, Wahba N, El-Meligy O, Dean J. Comparison of enamel matrix derivative versus formocresol as pulpotomy agents in the primary dentition. J Endod. 2008;34:284–7.PubMedCrossRefGoogle Scholar
  52. Sano JT, Valdivieso MVM. Estudio comparativo, clínico radiográfico del sulfato férrico (15.5 %) y formocresol (Fórmula de Buckley) en pulpotomías de molares deciduas: resultados a 12 meses. Odont Pediatr. 2002;1:17–22.Google Scholar
  53. Shirvani A, Asgary S. Mineral trioxide aggregate versus formocresol pulpotomy: a systematic review and meta-analysis of randomized clinical trials. Clin Oral Investig. 2014;18:1023–30.PubMedCrossRefGoogle Scholar
  54. Simancas-Pallares MA, Díaz-Caballero AJ, Luna-Ricardo LM. Mineral trioxide aggregate in primary teeth pulpotomy. A systematic literature review. Med Oral Patol Oral Cir Bucal. 2010;15:942–6.CrossRefGoogle Scholar
  55. Smaïl-Faugeron V, Courson F, Durieux P, et al. Pulp treatment for extensive decay in primary teeth. Cochrane Database Syst Rev. 2014;8:CD003220. doi: 10.1002/14651858.CD003220.pub2.PubMedGoogle Scholar
  56. Sonmez D, Sari S, Cetinbas T. A Comparison of four pulpotomy techniques in primary molars: a long-term follow-up. J Endod. 2008;34:950–5.PubMedCrossRefGoogle Scholar
  57. Srinivasan D, Jayanthi M. Comparative evaluation of formocresol and mineral trioxide aggregate as pulpotomy agents in deciduous teeth. Indian J Dent Res. 2011;22:385–90.PubMedCrossRefGoogle Scholar
  58. Subramaniam P, Konde S, Mathew S, Sugnani S. Mineral trioxide aggregate as pulp capping agent for primary teeth pulpotomy: 2 year follow up study. J Clin Pediatr Dent. 2009;33:311–4.PubMedCrossRefGoogle Scholar
  59. Sushynski JM, Zealand CM, Botero TM, Boynton JR, Majewski RF, Shelburne CE, Hu JC. Comparison of gray mineral trioxide aggregate and diluted formocresol in pulpotomized primary molars: a 6- to 24-month observation. Pediatric Dent. 2012;34:120e–128e.Google Scholar
  60. Waterhouse PJ, Nunn JH, Whitworth JM. Formocresol pulpotomy an investigation of the relative efficacy of Buckley’s Formocresol and calcium hydroxide in primary molar vital pulp therapy. Br Dent J. 2000;188:32–6.PubMedGoogle Scholar
  61. Zealand CM, Briskie DM, Botero TM, Boynton JR, Hu JC. Comparing gray mineral trioxide aggregate and diluted formocresol in pulpotomized human primary molars. Pediatr Dent. 2010;32:393-9.Google Scholar
  62. Zurn D, Seale NS. Light-cured calcium hydroxide vs formocresol in human primary molar pulpotomies: a randomized controlled trial. Pediatr Dent. 2008;30:34–41.PubMedGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2015

Authors and Affiliations

  • E. Stringhini Junior
    • 1
  • M. E. B. Vitcel
    • 2
  • L. B. Oliveira
    • 1
    Email author
  1. 1.Department of Pediatric DentistrySão Leopoldo Mandic School of DentistryCampinasBrazil
  2. 2.Department of Pediatric DentistryUnisep School of DentistryFrancisco BeltrãoBrazil

Personalised recommendations