Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions. Reparative hard tissue formation following calcium hydroxide application after partial pulpotomy in cariously exposed pulps of permanent teeth. Pulpotomy in caries-exposed immature permanent molars using calcium-enriched mixture cement or mineral trioxide aggregate: a randomized clinical trial. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. A clinical and histological evaluation of conservative pulpal therapy in human teeth. Pulp exposure occurrence and outcomes after 1- or 2-visit indirect pulp therapy vs complete caries removal in primary and permanent molars. Treatment outcomes of pulpotomy in primary molars using two endodontic biomaterials. A 2-year randomised clinical trial. A clinical study of direct pulp capping applied to carious-exposed pulps. A randomized controlled study of the use of ProRoot mineral trioxide aggregate and Endocem as direct pulp capping materials. Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth. Partial pulpotomy on caries-free teeth using enamel matrix derivative or calcium hydroxide: a randomized controlled trial. Clinical, radiographic and histologic analysis of the effects of pulp capping materials used in pulpotomies of human primary teeth Effect of mineral trioxide aggregate and formocresol pulpotomy on vital primary teeth: a clinical and radiographic study. Laser Pulpotomy–An Effective Alternative to Conventional Techniques: A 12 Months Clinicoradiographic Study A Randomized Controlled Study of the Use of ProRoot Mineral Trioxide Aggregate and Endocem as Direct Pulp Capping Materials: 3-month versus 1-year Outcomes. Clinical Evaluation of Success of Primary Teeth Pulpotomy Using Mineral Trioxide Aggregate(®), Laser and Biodentine(TM)- an In Vivo Study. Indirect pulp treatment in primary teeth: 4-year results.
PURPOSE This manuscript presents evidence -based guidance on the use of vital pulp therapies for treatment of deep caries lesions in children . A guideline panel convened by the American Academy of Pediatric Dentistry formulated evidence -based recommendations on three vital pulp therapies : indirect pulp treatment ( IPT ; also known as indirect pulp cap ) , direct pulp cap ( DPC ) , and pulpotomy . METHODS The basis of the guideline 's recommendations was evidence from " Primary Tooth Vital Pulp Therapy : A Systematic Review and Meta- Analysis . " ( Pediatr Dent 2017;15;39[1]:16 - 23 . ) A systematic search was conducted in PubMed ® / MEDLINE , Embase ® , Cochrane Central Register of Controlled Trials , and trial data bases to identify r and omized controlled trials and systematic review s addressing peripheral issues of vital pulp therapies such as patient preferences of treatment and impact of cost . Quality of the evidence was assessed through the Grading of Recommendations Assessment , Development , and Evaluation approach ; the evidence -to-decision framework was used to formulate a recommendation . RESULTS The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions . The panel recommends use of  mineral trioxide aggregate ( MTA ) and formocresol in pulpotomy treatments ; these are recommendations based on moderate- quality evidence at 24 months . The panel made weak recommendations regarding choice of medicament in both IPT ( moderate- quality evidence [ 24 months ] , low quality evidence [ 48 months ] ) and DPC ( very-low quality evidence [ 24 months ] ) . Success of both treatments was independent of type of medicament used . The panel also recommends use of ferric sulfate  ( low- quality evidence ) , lasers ( low- quality evidence ) ,  sodium hypochlorite  ( very low- quality evidence ) , and  tricalcium silicate  ( very low- quality evidence ) in pulpotomies ; these are weak recommendations based on low- quality evidence . The panel recommended against the use of calcium hydroxide as pulpotomy medicament in primary teeth with deep caries lesions . Conclusions and practical implication s : The guideline intends to inform the clinical practice s with evidence -based recommendations on vital pulp therapies in primary teeth with deep caries lesions . These recommendations are based upon the best available evidence to- date In a prospect i ve study , partial pulpotomy was performed on six permanent molars with deep carious lesions and pulpal involvement . The bleeding pulp was irrigated with normal tap water until bleeding had stopped and the exposed pulp was covered with calcium hydroxide followed by zinc oxide eugenol , and finally covered with a semipermanent restoration . All teeth showed hard tissue barrier formation , both clinical ly and radiographically , within three months and were free from subjective and objective symptoms through the observation period ( average observation period was 26 months ) . The patients also experienced the therapy positively . These findings and those of others have helped gain more recognition for partial pulpotomy as a strong possible alternative therapy when pulps are exposed by deep carious lesions and a bleeding pulp is exposed during the excavation process . The rationale for this therapy is to remove the infected and /or inflamed pulpal areas beneath the carious lesion and disintegrated tissue . A rapid and simplified procedure would allow the general practitioner to perform this procedure when necessary at dental clinics , without specialist facilities under conditions that avoid unnecessary contamination of the pulp OBJECTIVE To compare clinical and radiographic outcomes of pulpotomy treatment using calcium-enriched mixture ( CEM ) cement and mineral trioxide aggregate ( MTA ) in carious-exposed vital immature permanent first molars . DESIGN Fifty-one immature molars with clinical carious exposure with symptomatic/asymptomatic pulpitis met the inclusion criteria and r and omly assigned to one of the treatment groups ( CEM [ 26 teeth ; 59 roots ] , MTA [ 25 teeth ; 59 roots ] ) . After performing pulpotomy and covering the radicular pulps with the bio material s , all teeth were permanently restored . Blinded clinical and radiographic evaluations were performed at 6 and 12 months after operation for signs of success or failure . Radiographs were evaluated for complete/partial apical closure . The data were analysed using chi-square test and generalized estimating equation ( GEE ) model . RESULTS There was no significant difference at the baseline between the two experimental groups . All available cases ( 49 teeth ) showed pulp survival and signs of continuous root development after 12 months . Overall , complete apical closure ( apexogenesis ) occurred in 76.8 % and 73.8 % of radiographically interpreted roots in CEM cement and MTA groups , respectively . There was no statistical difference in terms of radiographic outcomes between two groups . CONCLUSIONS Calcium-enriched mixture cement and MTA showed similar performance in pulpotomy of immature caries-exposed permanent molars Less invasive excavation methods have been suggested for deep caries lesions . We tested the effects of stepwise vs. direct complete excavation , 1 yr after the procedure had been carried out , in 314 adults ( from six centres ) who had received treatment of a tooth with deep caries . The teeth had caries lesions involving 75 % or more of the dentin and were central ly r and omized to stepwise or direct complete excavation . Stepwise excavation result ed in fewer pulp exposures compared with direct complete excavation [ difference : 11.4 % , 95 % confidence interval ( CI ) ( 1.2 ; 21.3 ) ] . At 1 yr of follow-up , there was a statistically significantly higher success rate with stepwise excavation , with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [ difference : 11.7 % , 95 % CI ( 0.5 ; 22.5 ) ] . In a subsequent nested trial , 58 patients with exposed pulps were r and omized to direct capping or partial pulpotomy . We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [ 31.8 % and 34.5 % ; difference : 2.7 % , 95 % CI ( -22.7 ; 26.6 ) ] . In conclusion , stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation . In view of the poor prognosis of vital pulp treatment , a stepwise excavation approach for managing deep caries lesions is recommended Three intermediary base material s , a zinc oxide-eugenol ( Cavitec ) and two calcium hydroxide liners ( Life and Dycal ) , were selected at r and om for use as a base beneath  amalgam or composite restorations on humans following complete caries removal .  Life and Dycal , selected at r and om , were also used as direct and indirect pulp capping agents as clinical ly indicated . Clinical evaluations of signs and symptoms were made before treatment and at one-week , six-month , and one-year intervals following treatment . Histological evaluations were performed on three complete caries removal teeth and 18 direct pulp capping teeth six months following treatment . No significant differences in clinical symptomatology result ed between the material s in the complete caries removal group or the indirect and direct pulp capping groups PURPOSE The purpose of this study was to examine whether 1- or 2-visit indirect pulp therapy ( IPT ) is more successful and to determine if the operator can successfully decide when to stop removing caries without exposing the pulp . METHODS A total of 154 teeth ( 94 primary second molars and 60 young permanent first molars ) were included in the study from a total of 123 4- to 15-year-old patients . The teeth had deep carious lesions but lacked the preoperative signs and symptoms of irreversible pulpitis . The teeth were r and omly selected and treated either with 1-visit IPT , 2-visit IPT , or direct complete excavation ( DCE ) . Follow-up examinations were conducted on the teeth over 1 year at 3-month intervals . RESULTS The pulp was exposed in 12 teeth ( 22 % ) treated by DCE , whereas 3 teeth ( 6 % ) were treated by 1-visit IPT and 4 teeth ( 8 % ) with 2-visit IPT . A statistically significant difference was found between IPT and DCE groups in terms of pulp exposure ( P<.05 ) . The teeth without pulp exposure showed normal clinical and radiographic conditions during the 1-year follow-up , except for 3 primary teeth . CONCLUSIONS Indirect pulp therapy in both primary and young permanent teeth can be used successfully with a 1- or 2-visit approach AIM To compare the treatment outcomes of calcium-enriched mixture ( CEM ) cement and mineral trioxide aggregate ( MTA ) as pulp dressing bio material s in vital pulpotomy of carious primary molars . STUDY DESIGN split-mouth r and omised clinical trial . MATERIAL S AND METHODS Forty children aged 4 - 8 years with 2 carious teeth requiring pulpotomy were selected and r and omly assigned to MTA ( n = 40 ) or CEM ( n = 40 ) groups . After coronal pulp removal , the remaining radicular pulp was covered with an appropriate bio material ; the teeth were then permanently restored . Clinical /radiographic success/failures were blindly evaluated at 6- , 12- and 24-month follow-ups . STATISTICS the recorded data were analyzed with McNemar test and GEE . RESULTS A total of 36 , 33 and 35 patients were available for 6- , 12- and 24-month follow-ups , respectively . At the 12-month follow-up only one and three teeth in the CEM and MTA groups had pathologic external root resorption , respectively . The resorbed teeth were then missed due to extraction /exfoliation at the 24-month follow-up ; all other treated teeth were sign/symptom-free . Overall , clinical and radiographic outcomes in both MTA/CEM groups were comparable at the three follow-ups without significant differences . Time had no significant effect on the success . CONCLUSION MTA and CEM demonstrated favourable treatment outcomes for pulpotomy of carious primary molars ; CEM may be an effective pulp dressing bio material Direct  pulp capping of carious-exposed pulp was performed on 44 teeth . We evaluated the success rates of these cases , and analyzed the relationships between the success rates and their clinical findings . Furthermore , we examined the length of time necessary for adequate postoperative follow-up . The success rate in this study was 81.8 % . Age of the patients , type of teeth , responses to thermal stimuli and percussion , and the diameter of pulpal exposure had no bearing on the success rate . However , the degree of bleeding on pulpal exposure was related to the success rate ( p = 0.042 ) . The success rates of cases in which postoperative follow-up periods were 3 to 18 months were similar ( 80 to 83 % ) , whereas those with follow-up for 21 months ( 91.7 % ) and 24 months ( 100 % ) showed higher success rates . These results showed that direct pulp capping was applicable to carious-exposed pulp , and the degree of bleeding is indicative of the prognosis of this treatment . The length of time necessary for adequate postoperative follow-up was suggested to be 21 months INTRODUCTION The purpose of the present study was to evaluate and compare the short-term clinical outcomes of direct pulp capping using ProRoot MTA ( Dentsply , Tulsa , OK ) or Endocem ( Maruchi , Wonju , Korea ) as capping material s in a prospect i ve r and omized controlled study . MATERIAL S AND METHODS This study was conducted with subjects who were recruited from the pool of patients from the Department of Conservative Dentistry at the Dental College of Yonsei University , Seoul , Korea , between January and May 2013 . Of the 48 teeth confirmed to be eligible for direct pulp capping , a total of 46 teeth were r and omly assigned to either the ProRoot MTA or the Endocem group ( 23 teeth per group ) . Direct pulp capping was performed using these 2 material s , and clinical and radiographic evaluations were performed at 1 , 2 , 4 , and 12 weeks after the treatments . Teeth with no response to pulp vitality test and those exhibiting clinical or radiographic signs and /or symptoms of irreversible pulpitis or pulp necrosis were considered to be failures . RESULTS Thirty-two patients ( 43 teeth ) were examined at the 3-month follow-up ( patient recall rate = 91.4 % ) ; 22 of these teeth were in the ProRoot MTA group , and 21 were in the Endocem group . The overall success rate was 93 % , and the success rates in the ProRoot MTA and Endocem groups were 95.5 % ( 21/22 teeth ) and 90.5 % ( 19/21 teeth ) , respectively . Statistical analyses of these success rates did not reveal any significant difference between the groups ( P = .522 ) . CONCLUSIONS In this r and omized controlled study , no significant difference in the short-term clinical outcomes of direct pulp capping using ProRoot MTA or Endocem as the capping material was found . Furthermore , the favorable short-term outcome success rate of 93 % indicates that direct pulp capping may be a reliable treatment for pulp exposure in adult teeth The aim was to assess the prevalence of pulp exposure after stepwise versus direct complete excavation of permanent posterior teeth with deep carious lesions . The material , representing 116 patients aged 6 - 16 yrs ( mean = 10.2 yrs ) , consisted of 127 teeth with radiographs revealing carious lesions to such a depth that pulp exposure could be expected if  direct complete excavation  was performed . Teeth with clinical symptoms , other than transient pain shortly before treatment , were not accepted . The teeth were r and omly selected for either treatment procedure . Stepwise excavation implied removal of the bulk of carious tissue and application of calcium hydroxide , followed by sealing of the cavity with zinc-oxide eugenol cement . After a period of 8 - 24 weeks the rest of the carious dentin was removed and the cavity sealed with calcium hydroxide , zinc-oxide-eugenol ( ZOE ) and a restorative material . Direct complete excavation entailed removal of all carious dentin followed by sealing as mentioned above . In case of pulp exposure , pulp treatment was performed . The pulp was exposed in 40 of the teeth treated by direct complete excavation . The corresponding figure for those treated by stepwise excavation was 17.5 % . The difference was statistically significant . The teeth with no pulp exposure after direct or stepwise excavation showed normal clinical and radiographic conditions at the last check-up ( mean = 43 months ) AIM To compare the effect of enamel matrix derivative ( EMD ) and calcium hydroxide [ Ca(OH)(2 ) ] on exposed human pulp . METHODOLOGY Fifteen pairs of human contralateral premolars were intentionally and partially pulpotomized . The exposed pulps were r and omly capped with either EMDgel ( Emdogain ) or a mix of Ca(OH)(2 ) and sterile water . The subjects recorded pain or discomfort during the first 10 days and were also interviewed and examined by a blinded examiner at 1 day , 2 weeks , 3 and 6 months post-operation . Periapical radiographs were taken prior to the operation , and 3 and 6 months post-operation . After 6 months , the teeth were extracted and processed for histological evaluation . The data were described and analysed using McNemar test and Kaplan-Meier survival analysis . RESULTS The EMDgel-treated teeth had significantly less tooth hypersensitivity than the Ca(OH)(2)-treated teeth during the first 2 weeks ( P = 0.031 ) but were not significantly different after 2 weeks ( P = 0.125 ) . No detectable periapical radiographic changes were observed in any teeth and radiographic evidence of dentine bridge formation from both groups were not significantly different during the follow-up periods ( P > 0.05 ) . Histological evaluation demonstrated that the Ca(OH)(2)-treated teeth had less inflammation and more dentine bridge formation than those in the EMDgel-treated teeth . CONCLUSIONS After 6 months , healthy pulps capped with Ca(OH)(2 ) had more favourable results than counterparts capped with EMDgel . However , similar clinical and radiographic results were seen in both groups Aim To compare the clinical , radiographic and histological responses of the pulp to mineral trioxide aggregate ( MTA ) , calcium hydroxide ( CH ) and Portl and cement ( PC ) when used as a pulpotomy agent in human primary teeth . Study design Forty-five m and ibular primary molar teeth were r and omly assigned to CH , MTA or PC groups and treated by pulpotomy technique . Methods The teeth were treated by conventional pulpotomy technique , differing only in the capping material for each group . Clinical and radiographic evaluations were recorded at 6- , 12- and 24-month follow-up . Teeth in the regular exfoliation period were further processed for histologic analysis .Statistics Data were tested using parametric tests at a significance level of 5 % . The histological results were expressed descriptively . Results Clinical ly and radiographically , the MTA and PC groups showed 100 % success rates at 6 , 12 and 24 months . In CH group , several teeth presented clinical and radiographic failures detected throughout the follow-up period , and internal resorption was a frequent radiographic finding . Histologic analysis revealed the presence of dentine-like mineralised material deposition obliterating the root canal in the PC and MTA groups . CH group presented , in most of the sections , necrotic areas in the root canals . Conclusions MTA and PC may serve as effective material s for pulpotomies of primary teeth as compared to CH . Although our results are very encouraging , further studies and longer follow-up assessment s are needed in order to determine the safe clinical indication of Portl and cement BACKGROUND Pulpotomy is the common therapy for cariously exposed pulps in symptom-free primary molar teeth .  Formocresol ( FC ) is considered the gold st and ard dressing agent for pulpotomy , but concerns have been raised over the years about its safety . Other alternative pulpotomy agents have been investigated and suggested . OBJECTIVE The objective was to evaluate and compare the clinical and radiographic response of FC and white mineral trioxide aggregate ( MTA ) as pulpotomy material s on primary molars . MATERIAL S AND METHODS Fifty primary molars , with deep carious lesion that exposed a vital but asymptomatic pulp , in 37 children aged 4 - 7 years were treated with conventional pulpotomy procedure .  The teeth were divided r and omly into two groups . Group I ( FC ) and group II ( MTA ) . The treated teeth were evaluated clinical ly and radiographically and were followed-up for 12 months . RESULTS At the end of the 12 months follow-up , the clinical success rates for FC and MTA were 81 % and 100 % , respectively . There was a statistically significant difference ( P = 0.04 ) between the clinical success rates of FC and MTA . While the radiographic success rates for FC and MTA were 81 % and 96 % , respectively , there was no statistically significant difference between the radiographic success of MTA and FC . CONCLUSION White MTA showed a higher clinical and radiographic success rate when compared to FC as a pulpotomy agent in vital primary molars , and it has a potential to become a replacement for FC in primary molars ABSTRACT Background : Vital pulpotomy is a single-stage procedure of surgical amputation of the coronal portion of exposed vital pulp , usually as a means of preserving the vitality and function of the remaining radicular portion . Aims and objectives : The aim of this study was to compare the clinical and radiographic success rates for ferric sulfate ( FS ) , electrosurgery ( ES ) and laser pulpotomy in human primary molars . Material s and methods : In a r and omized clinical trial , 30 primary molars indicated for pulpotomy in children aged 4 to 10 years were treated using either a FS ( 10 teeth ) , ES technique ( 10 teeth ) and laser ( 10 teeth ) . Following the pulpotomy , the teeth were evaluated for clinical and radiographic success at 3 , 6 , 9 and 12 months on the basis of the presence of pain , sinus , mobility , internal and external resorption , periapical radiolucency , calcification in the canal and bone loss . Statistical analysis : The data were assessed with Chi-square test . Results : After 12 months of follow-up , both clinical and radiographic success rates were 100 % in the laser group but only 80 % in both ES and FS groups . There was statistically significant difference between the success rates of three groups ( p < 0.05 ) . Conclusion : Laser pulpotomy showed better clinical as well as radiographical results than ES and FS pulpotomy . Laser pulpotomy was also found superior in terms of operating time , patient cooperation , ease of use and pain . Although results of the study showed the failure rates for electrosurgical pulpotomy to be equal to those for FS pulpotomy , electrosurgical pulpotomy being a nonpharmacological technique considered more favorable . Further studies using larger sample size and longer evaluation periods are suggested . How to cite this article : Gupta G , Rana V , Srivastava N , Ch and na P. Laser Pulpotomy – An Effective Alternative to Conventional Techniques : A 12 Months Clinicoradiographic Study . Int J Clin Pediatr Dent 2015;8(1):18 - 21 INTRODUCTION The purpose of this study was to assess the long-term clinical outcomes of direct pulp capping ( DPC ) with ProRoot MTA ( Dentsply , Tulsa , OK ) and Endocem ( Maruchi , Wonju , Korea ) as pulp capping material s. To this end , the 1-year cumulative successes of both material s were evaluated and compared with those of the 3-month outcomes in a prospect i ve , r and omized controlled trial . METHODS Patients were recruited from the Department of Conservative Dentistry of the Yonsei University Dental Hospital , Seoul , South Korea , from January to May 2013 . Of the 48 teeth that met the inclusion criteria , 46 teeth were r and omly allocated to either ProRoot MTA or Endocem groups ( n = 23 ) . Direct pulp capping was performed , and clinical and radiographic examinations were conducted over 1 year after the treatment . Survival analyses were conducted to compare the cumulative successes between ProRoot MTA and Endocem and to evaluate other clinical variables . RESULTS Forty-one teeth were recalled 1 year after the treatments ( recall rate = 89.13 % ) . There were no significant differences between the cumulative successes  of ProRoot MTA and Endocem in either log-rank or Cox proportional hazard regression analyses ( P > .05 ) . Among the other clinical variables , cavity type ( class I , II , III vs class V ) was determined to be significant in both the log-rank test ( P = .001 ) and Cox regression analysis ( P = .006 ) . CONCLUSIONS Both ProRoot MTA and Endocem exhibited similar cumulative successes as direct pulp capping material s up to 1 year . The teeth restored with class V cavities exhibited significantly lower cumulative success rates after direct pulp capping compared with the teeth restored with other types of cavities INTRODUCTION Pulpotomy technique basically consists of removing the coronal pulp and fixing the radicular pulp with a medicament . It is the most widely accepted clinical procedure for treating primary teeth with coronal pulp inflammation caused by caries with no involvement of the radicular pulp . AIM To evaluate the success and efficacy of Mineral Trioxide Aggregate ( MTA ) , Lasers and Biodentine as pulpotomy agents both clinical ly and radiographically . MATERIAL S AND METHODS In the present study , 60 primary molars in children whose pulpal status warranted pulpotomy were selected and r and omly assigned into three groups that included MTA , Laser and Biodentine allocating 20 teeth to each group . The pulpotomy procedure was then performed on all selected teeth followed by restoration with stainless steel crowns . Later the patients were recalled for 3 months and 6 months for clinical and radiographic evaluation . RESULTS Statistical analysis was done using Fisher exact test to determine pair wise comparison of three agents with respect to clinical and radiographic criteria . Kruskal-Wallis ANOVA , Mc Nemars test was applied to evaluate the efficacy of each agent between 3 months and 6 months . The results showed that maximum success rate was found in MTA group . However , the comparison between three groups was statistically not significant ( p<0.05 ) . CONCLUSION Pulpotomies performed with either MTA , Laser or Biodentine are equally efficient with similar clinical /radiographic success and hence can be considered as alternatives to Formocresol PURPOSE To evaluate clinical and radiographic outcomes of indirect pulp treatment ( IPT ) in primary molars after long-term function ( up to 60 months ) . METHODS Teeth with deep carious lesions without signs and symptoms of irreversible pulpitis were divided by r and om allocation into two groups , according to the capping material utilized over demineralized dentin : experimental group ( 1 ) : self-etching adhesive system ( Clearfil SE Bond ) ; and control group ( 2 ) : calcium hydroxide liner ( Dycal ) . Both groups were filled with resin composite ( Z250 ) and su bmi tted to a clinical and radiographic monitoring period until exfoliation . RESULTS After the follow-up period ( up to 60 months ) , no statistical difference was found between groups ( P= 0.514 ) . The overall success rate reached 78 % . The failures occurred after the first year period recall
Vital permanent teeth with cariously exposed pulp can be treated successfully with vital pulp therapy .
INTRODUCTION This systematic review aims to illustrate the outcome of vital pulp therapy , namely  direct pulp capping , partial pulpotomy , and full pulpotomy  , in vital permanent teeth with cariously exposed pulp .