Amniotic Membrane versus Formocresol as Pulpotomy Agents in Human Primary Molars: An in vivo Study

Madu Ghanashyam Prasad, PVA Aditya, Duvvi Naveen Babu, Ambati Naga RadhaKrishna


Objective: To determine and compare the efficacy of Amniotic Membrane (AM) as a pulpotomy agent with Formocresol (FC) clinically and radiographically. Material and Methods: 30 deciduous molars warranted for pulpotomy in 24 children (4-9 years) were divided equally into two groups of 15 each. Group1: Amniotic membrane pulpotomy and Group 2: Formocresol pulpotomy, which was followed by placement of glass ionomer cement and stainless steel crown restoration. The patients were recalled after 1, 3, 6 and 9 months for clinical and radiographic evaluation. Fisher's exact test and Mcnemar test were used for statistical analysis. Results: Results indicated both clinically and radiographically amniotic membrane performed at par with formocresol. Conclusion: Amniotic membrane with its regenerative, antibacterial properties and the ability to deliver growth factors has shown promising results comparable to gold standard formocresol when used as a pulpotomy agent and hence can be recommended as an alternative pulpotomy agent.


Amnion; Formocresols; Tooth, Deciduous; Pulpotomy.

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Niranjani K, Prasad MG, Vasa AA, Divya G, Thakur MS, Saujanya K. Clinical evaluation of success of primary teeth pulpotomy using mineral trioxide aggregate, laser and biodentine (TM): An in vivo study. J Clin Diagn Res 2015; 9(4):ZC35-7. doi: 10.7860/JCDR/2015/13153.5823.

Golpayegani MV, Ansari G, Tadayon N. Clinical and radiographic success of low level laser therapy (LLLT) on primary molars pulpotomy. Res J Biol Sci 2010; 5(1):51-5. doi: 10.3923/rjbsci.2010.51.55.

Patchett CL, Srinivasan V, Waterhouse PJ. Is there life after Buckley's formocresol? Part II - Development of a protocol for the management of extensive caries in the primary molar. Int J Paediatr Dent 2006; 16(3):199-206.

Cortés O, Fernández J, Boj JR, Canalda C. Effect of formaldehyde on rat liver in doses used in pulpotomies. J Clin Pediatr Dent 2007; 31(3):179-82.

Diño BR, Eufemio G, De Villa M, Reysio-Cruz M, Jurado RA. The use of fetal membrane homografts in the local management of burns. J Philipp Med Assoc 1965; 41(12): Suppl:890-8.

Bhushan KS, Singh G, Chauhan G, Prakash S. Amniotic membrane & its structure, features and uses in dentistry – a brief review. Int J Adv Res 2015; 3(11):354-60.

Chopra A, Thomas BS. Amniotic membrane: A novel material for regeneration and repair. J Biomim Biomater Tissue Eng 2013; 18:2-8. doi: 10.4172/1662-100X.1000106.

Fuks AB, Papagiannoulis L. Pulpotomy in primary teeth: review of the literature according to standardized criteria. Eur Arch Paediatr Dent 2006; 1(2):64-72. doi: 10.1007/BF03320817.

Daher A, Alves K, Rodrigues C, Rezende L. Ineffectiveness of antibiotic-based pulpotomy for primary molars: A survival analysis. Braz Res Pediat Dent Integr Clin 2015; 15(1): 205-15. doi: 10.4034/PBOCI.2015.151.22.

Gisoure EF. Comparison of three pulpotomy agents in primary molars: a randomised clinical trial. Iran Endod J 2011; 6(1):11-4.

Fetterolf DE, Snyder RJ. Scientific and clinical support for the use of dehydrated amniotic membrane in wound management. Wounds 2012; 24(10):299-307.

Alshehadat SA, Aung Thu H, Hamid SSA, Nurul AA, Rani SA, Ahmad A. Scaffolds for dental pulp tissue regeneration: A review. Int Dent Med J Adv Res 2016; 2:1-12. doi: 10.15713/ins.idmjar.36.

Rosen PS. Case report on combination therapy using a composite allograft containing mesenchymal cells with an amnion–chorion barrier to treat a mandibular class III furcation. Clin Adv Periodontics 2013; 3(2):64-9. doi: 10.1902/cap.2012.120059.

Liu PF, Guo L, Zhao DW, Zhang ZJ, Kang K, Zhu RP, Yuan XL. Study of human acellular amniotic membrane loading bone marrow mesenchymal stem cells in repair of articular cartilage defect in rabbits. Genet Mol Res 2014; 13(3):7992-8001. doi: 10.4238/2014.September.29.12.

Niknejad H, Peirovi H, Jorjani M, Ahmadiani A, Ghanavi J, Seifalian AM. Properties of the amniotic membrane for potential use in tissue engineering. Eur Cell Mater 2008; 15:88-99. doi: 10.22203/eCM.v015a07.

Hugar SM, Reddy R, Deshpande SD, Shigli A, Gokhale NS, Hugar SS. In vivo comparative evaluation of mineral trioxide aggregate and formocresol pulpotomy in primary molars: A 60-month follow-up study. Contemp Clin Dent 2017; 8(1):122-7. doi: 10.4103/ccd.ccd_849_16.

Yildiz E, Tosun G. Evaluation of formocresol, calcium hydroxide, ferric sulfate, and MTA primary molar pulpotomies. Eur J Dent 2014; 8(2):234-40. doi: 10.4103/1305-7456.130616.

Sönmez D, Durutürk L. Ca(OH)2 pulpotomy in primary teeth. Part I: internal resorption as a complication following pulpotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106(2):e94-8. doi: 10.1016/j.tripleo.2008.04.008.

Moretti AB, Sakai VT, Oliveira TM, Fornetti AP, Santos CF, Machado MA, Abdo RC. The effectiveness of mineral trioxide aggregate, calcium hydroxide and formocresol for pulpotomies in primary teeth. Int Endod J 2008; 41(7):547-55. doi: 10.1111/j.1365-2591.2008.01377.x.

Waterhouse PJ, Nunn JH, Whitworth JM, Soames JV. Primary molar pulp therapy - histological evaluation of failure. Int J Paediatr Dent 2000; 10(4):313-21. doi: 10.1046/j.1365-263x.2000.00211.x.

Chandrashekhar S, Shashidhar J. Formocresol, still a controversial material for pulpotomy: A critical literature review. J Res Dent 2014; 2(3):114-24. doi: 10.4103/2321-4619.143594.

Kumar V, Juneja R, Duhan J, Sangwan P, Tewari S. Comparative evaluation of platelet-rich fibrin, mineral trioxide aggregate, and calcium hydroxide as pulpotomy agents in permanent molars with irreversible pulpitis: A randomized controlled trial. Contemp Clin Dent 2016; 7(4):512-8. doi: 10.4103/0976-237X.194107.

Massee M, Chinn K, Lei J, Lim JJ, Young CS, Koob TJ. Dehydrated human amnion/chorion membrane regulates stem cell activity in vitro. J Biomed Mater Res B Appl Biomater 2016; 104(7):1495-503. doi: 10.1002/jbm.b.33478.

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(4):296-301.

Tziafas D, Papadimitriou S. Role of exogenous TGF‐β in induction of reparative dentinogenesis in vivo. Eur J Oral Sci 1998; 106(S1):192-6.

Kothari CR, Goudar G, Hallur N, Sikkerimath B, Gudi S, Kothari MC. Use of amnion as a graft material in vestibuloplasty: A clinical study. Br J Oral Maxillofac Surg 2012; 50(6):545-9. doi: 10.1016/j.bjoms.2011.09.022.

Mishra S, Singh S. Human amniotic membrane: Can it be a ray of hope in periodontal regeneration? Indian J Res 2014; 3(9):118-21.

Koob TJ, Lim JJ, Massee M, Zabek N, Denozière G. Properties of dehydrated human amnion/chorion composite grafts: Implications for wound repair and soft tissue regeneration. J Biomed Mater Res B Appl Biomater 2014; 102(6):1353-62. doi: 10.1002/jbm.b.33141.

Shetty SS, Chatterjee A, Bose S. Bilateral multiple recession coverage with platelet-rich fibrin in comparison with amniotic membrane. J Indian Soc Periodontol 2014; 18(1):102-6. doi: 10.4103/0972-124X.128261.

Gupta A, Kedige SD, Jain K. Amnion and chorion membranes: potential stem cell reservoir with wide applications in periodontics. Int J Biomater 2015; 2015:274082. doi: 10.1155/2015/274082.