Clinical and Radiographic Success Rates of Pulpotomies in Primary Molars Treated with Formocresol, BiodentineTM, and Endo Repair: A Randomized Clinical Trial

Elham Farokh Gisour; Farzaneh Jalali; Fatemeh Jahanimoghadam; Tania Dehesh

Authors

Elham Farokh Gisour
Farzaneh Jalali
Fatemeh Jahanimoghadam
Tania Dehesh

Keywords:

Regenerative Endodontics, Formocresols, Tooth, Deciduous, Pulpotomy

Abstract

Objective: To compare the clinical and radiographic success rates of formocresol, Biodentine^TM, and Endo Repair agents in primary molars after 12 months. Material and Methods: This randomized double-blind clinical trial was conducted on healthy children referred to the Department of Pediatric Dentistry, Kerman, Iran, in 2018. One hundred twenty children (human primary molar teeth) aged 3-9 years were selected and randomly divided into three interventions (with pulpotomy medicament agents), including formocresol, Biodentine^TM, and Endo Repair. All pulpotomized teeth were restored using stainless steel crowns and evaluated clinically and radiographically during a 12-month follow-up. Fisher exact test was used to determine the association of categorical variables and the data were analysed with SPSS 25. Results: All the available teeth in formocresol and Biodentine^TM groups obtained clinical success, whereas 62.5% of the Endo Repair group was successful in this regard. Radiographic success rates of the formocresol, Biodentine^TM, and Endo Repair groups were 94.7%, 70%, and 28.1% after a 12-month follow-up, respectively. Moreover, pulp canal obliteration was observed in 26.3%, 25%, and 12.5% of the formocresol, Biodentine^TM, and Endo Repair groups. Conclusion: This study reported a high rate of clinical success using both Biodentine^TM and formocresol pulpotomy techniques. However, the radiographic success rate of formocresol was higher than that of Biodentine^TM, and Endo Repair was not considered a suitable pulpotomy medicament agent.

References

Kemoli A. Global disparity in childhood dental caries: Is there a remedy? East Afr Med J 2013; 90(4):130-6.

Erdem AP, Guven Y, Balli B, Ilhan B, Sepet E, Ulukapi I, et al. Success rates of mineral trioxide aggregate, ferric sulfate, and Formocresol pulpotomies: a 24-month study. Pediatr Dent 2011; 33(2):165-70.

Fuks AB. Vital pulp therapy with new materials for primary teeth: new directions and treatment perspectives. Pediatr Dent 2008; 30(3):211-9. https://doi.org/10.1016/j.joen.2008.02.031

Mythraiye R, Rao V, Babu MM, Satyam M. Evaluation of the clinical and radiological outcomes of pulpotomized primary molars treated with three different materials: mineral trioxide aggregate, biodentine, and pulpotec. An in-vivo study. Cureus 2019; 11(6):e4803. https://doi.org/10.7759/cureus.4803

El Meligy OA, Allazzam S, Alamoudi NM. Comparison between biodentine and formocresol for pulpotomy of primary teeth: A randomized clinical trial. Quintessence Int 2016; 47(7):571-80. https://doi.org/10.3290/j.qi.a36095

Juneja P, Kulkarni S. Clinical and radiographic comparison of biodentine, mineral trioxide aggregate and formocresol as pulpotomy agents in primary molars. Eur Arch Paediatr Dent 2017; 18(4):271-8. https://doi.org/10.1007/s40368-017-0299-3

B, Rakesh K, Richa K. Clinical and radiographical evaluation of mineral trioxide aggregate, biodentine and propolis as pulpotomy medicaments in primary teeth. Restor Dent Endod 2015; 40(4):276-85. https://doi.org/10.5395/rde.2015.40.4.276

Sushynski JM, Zealand CM, Botero TM, Boynton JR, Majewski RF, Shelburne CE, et al. Comparison of gray mineral trioxide aggregate and diluted Formocresol in pulpotomized primary molars: a 6-to 24-month observation. Pediatr Dent 2012; 34(5):120-8.

Srinivasan V, Patchett C, Waterhouse P. Is there life after Buckley's Formocresol? Part I-a narrative review of alternative interventions and materials. Int J Paediatr Dent 2006; 16(2):117-27. https://doi.org/10.1111/j.1365-263X.2006.00688.x

Goldstein BD. Hematological and toxicological evaluation of formaldehyde as a potential cause of human leukemia. Hum Exp Toxicol 2011; 30(7):725-35. https://doi.org/10.1177/0960327110381682

Lewis BB, Chestner SB. Formaldehyde in dentistry: a review of mutagenic and carcinogenic potential. J Am Dent Assoc 1981; 103(3):429-34. https://doi.org/10.14219/jada.archive.1981.0341

Nishimura H, Higo Y, Ohno M, Tsutsui TW, Tsutsui T. Ability of root canal antiseptics used in dental practice to induce chromosome aberrations in human dental pulp cells. Mutat Res 2008; 649(1-2):45-53. https://doi.org/10.1016/j.mrgentox.2007.07.007

Zarzar P, Rosenblatt A, Takahashi C, Takeuchi P, Júnior LC. Formocresol mutagenicity following primary tooth pulp therapy: an in vivo study. J Dent 2003; 31(7):479-85. https://doi.org/10.1016/S0300-5712(03)00087-3

Zhang L, Steinmaus C, Eastmond DA, Xin XK, Smith MT. Formaldehyde exposure and leukemia: a new meta-analysis and potential mechanisms. Mutat Res 2009; 681(2-3):150-68. https://doi.org/10.1016/j.mrrev.2008.07.002

Han L, Okiji T. Bioactivity evaluation of three calcium silicate‐based endodontic materials. Int Endod J 2013; 46(9):808-14. https://doi.org/10.1111/iej.12062

Nowicka A, Lipski M, Parafiniuk M, Sporniak-Tutak K, Lichota D, Kosierkiewicz A, et al. Response of human dental pulp capped with biodentine and mineral trioxide aggregate. J Endod 2013; 39(6):743-7. https://doi.org/10.1016/j.joen.2013.01.005

Bani M, Aktaş N, Çınar Ç, Odabaş ME. The clinical and radiographic success of primary molar pulpotomy using Biodentine™ and mineral trioxide aggregate: a 24-month randomized clinical trial. Pediatr Dent 2017; 39(4):284-8.

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

Cuadros-Fernández C, Rodríguez AL, Sáez-Martínez S, García-Binimelis J, Mercadé M. Short-term treatment outcome of pulpotomies in primary molars using mineral trioxide aggregate and Biodentine: a randomized clinical trial. Clin Oral Investig 2016; 20(7):1639-45. https://doi.org/10.1007/s00784-015-1656-4

Bani M, Sungurtekin-Ekçi E, Odabaş ME. Efficacy of Biodentine as an apical plug in nonvital permanent teeth with open apices: an in vitro study. Biomed Res Int 2015; 2015:359275. https://doi.org/10.1155/2015/359275

Yoldaş SE, Bani M, Atabek D, Bodur H. Comparison of the potential discoloration effect of bioaggregate, biodentine, and white mineral trioxide aggregate on bovine teeth: in vitro research. J Endod 2016; 42(12):1815-8. https://doi.org/10.1016/j.joen.2016.08.020

Bhavya B, Sadique M, Simon EP, Ravi S, Lal S. Spectrophotometric analysis of coronal discoloration induced by white mineral trioxide aggregate and Biodentine: An in vitro study. J Conserv Dent 2017; 20(4):237. https://doi.org/10.4103/0972-0707.219203

Yoshimine Y, Maeda K. Histologic evaluation of tetracalcium phosphate-based cement as a direct pulp-capping agent. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 79(3):351-8. https://doi.org/10.1016/S1079-2104(05)80229-X

Sena M, Yamashita Y, Nakano Y, Ohgaki M, Nakamura S, Yamashita K, et al. Octacalcium phosphate-based cement as a pulp-capping agent in rats. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97(6):749-55. https://doi.org/10.1016/j.tripleo.2003.10.029

El Meligy OAES, Alamoudi NM, Allazzam SM, El-Housseiny AAM. BiodentineTM versus formocresol pulpotomy technique in primary molars: a 12-month randomized controlled clinical trial. BMC Oral Health 2019; 19(1):1-8. https://doi.org/10.1186/s12903-018-0702-4

Smaïl-Faugeron V, Porot A, Muller-Bolla M, Courson F. Indirect pulp capping versus pulpotomy for treating deep carious lesions approaching the pulp in primary teeth: a systematic review. Eur J Paediatr Dent 2016; 17(2):107-12.

Winters J, Cameron AC, Widmer RP. Pulp therapy for primary and immature permanent teeth. Handbook of Pediatric Dentistry: Elsevier; 2013. p. 103-22. https://doi.org/10.1016/B978-0-7234-3695-9.00007-9

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

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(4):302-9.

Farsi N, Alamoudi N, Balto K, Mushayt A. Success of mineral trioxide aggregate in pulpotomized primary molars. Int J Clin Pediatr Dent 2005; 29(4):307-11. https://doi.org/10.17796/jcpd.29.4.n80t77w625118k73

Zanini M, Sautier JM, Berdal A, Simon S. Biodentine induces immortalized murine pulp cell differentiation into odontoblast-like cells and stimulates biomineralization. J Endod 2012; 38(9):1220-6. https://doi.org/10.1016/j.joen.2012.04.018

Rubanenko M, Moskovitz M, Petel R, Fuks A, editors. Effectiveness of Biodentine versus formocresol as dressing agents in pulpotomized primary molars: preliminary results. Sopot, Poland: 12th congress of EAPD; 2014.

Rajasekharan S, Martens L, Vandenbulcke J, Jacquet W, Bottenberg P, Cauwels R. Efficacy of three different pulpotomy agents in primary molars: a randomized control trial. International J Endod 2017; 50(3):215-28. https://doi.org/10.1111/iej.12619

Coll JA, Seale NS, Vargas K, Marghalani AA, Al Shamali S, Graham L. Primary tooth vital pulp therapy: a systematic review and meta-analysis. Pediatr Dent 2017; 39(1):16-123.

Sonmez D, Sari S, Çetinbaş T. A comparison of four pulpotomy techniques in primary molars: a long-term follow-up. J Endod 2008; 34(8):950-5. https://doi.org/10.1016/j.joen.2008.05.009

Awawdeh L, Al-Qudah A, Hamouri H, Chakra RJ. Outcomes of vital pulp therapy using mineral trioxide aggregate or biodentine: a prospective randomized clinical trial. J Endod 2018; 44(11):1603-9. https://doi.org/10.1016/j.joen.2018.08.004

Holan G, Eidelman E, Fuks AB. Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol. Pediatr Dent 2005; 27(2):129-36.

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(6):55-8.

Carti O, Oznurhan F. Evaluation and comparison of mineral trioxide aggregate and biodentine in primary tooth pulpotomy: Clinical and radiographic study. Niger J Clin Pract. 2017; 20(12):1604-9. https://doi.org/10.4103/1119-3077.196074

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(4):261-7. https://doi.org/10.1111/j.1365-2591.2007.01209.x

Gandolfi M, Spagnuolo G, Siboni F, Procino A, Rivieccio V, Pelliccioni G, et al. Calcium silicate/calcium phosphate biphasic cements for vital pulp therapy: chemical-physical properties and human pulp cells response. Clin Oral Investig 2015; 19(8):2075-89. https://doi.org/10.1007/s00784-015-1443-2

Adlakha VK, Chandna P, Joshi J, Thomas A, Singh N. A comparative evaluation of hydroxyapatite crystals and glutaraldehyde as agents for pulpotomy in deciduous molars. Int J Clin Pediatr Dent 2009; 2(1):13. https://doi.org/10.5005/jp-journals-10005-1035

Shayegan A, Atash R, Petein M, Abbeele AV. Nanohydroxyapatite used as a pulpotomy and direct pulp capping agent in primary pig teeth. J Dent Child 2010; 77(2):77-83.

Jose B, Ratnakumari N, Mohanty M, Varma H, Komath M. Calcium phosphate cement as an alternative for formocresol in primary teeth pulpotomies. Indian J Dent Res 2013; 24(4):522. https://doi.org/10.4103/0970-9290.118370