Thursday, April 27, 2017

Caries Control and Other Variables Associated With Success of Primary Molar Vital Pulp Therapy

Department of Pediatric Dentistry
Lutheran Medical Center
           
Resident’s Name: John Diune                                                                                   Date: 4/26/2017
Article Title: Caries Control and Other Variables Associated With Success of Primary Molar Vital Pulp Therapy
Author(s): Raj Vij BDS DDS, James Coll DMD MS, Preston Shelton DDS MS, Naila Farooq BDS MSc DDPH
Journal: Pediatric Dentistry
Date: 2004
Major Topic: Pulp Therapy
Type of Article: Retrospective chart audit
Main Purpose: Evaluate treatment of teeth with deep carious lesions with GIC CC prior to pulpotomy in some cases, and investigating other factors that could contribute to success/failure of these teeth treated with either Formocresol pulpotomy (FP) or indirect pulp therapy (IPT)
Key Points: (2 lines Max): “IPT, therefore, appears to be better alternative to pulpotomy procedures to treat caries close to the pulp”
 
2 groups of patients with a total of 226 teeth were treated with either caries control 1-3 months prior to IPT or FP, and then restored with either IRM or with SSC, amalgam, GIC, or composite.
-          Breakdown:
o   Group 1: 133 teeth
§  78 à FP
§  55 à IPT
o   Group 2: 93 teeth
§  40à FP
§  53à IPT
o   Caries control: 75 of 226 teeth (1-3 months prior to IPT or FP)
§  ART, no local anesthetic, spoon or low-speed IRM or GIC placed.
§  Done in cases with reversible pulpitis symptoms
o   FP (118) restored with SSC, amalgam, GIC, or composite
§  EXCEPT 13 in Group 1 restored with IRM
o   IPT (108) - 80% GIC liner/base used to cover dentin
§  All restored with SSC, amalgam, GIC, or composite
-          Teeth selected for IPT and FP were identical upon radiographic presentation, with deep caries approaching the pulp
o   For FP complete caries removal resulted in mechanical pulp exposure
o   For IPT deepest layer of decayed dentin left in place to avoid pulp exposure

RESULTS
 
Success over time
 
0-1 year
1-2 years
2-3 years
>3 years
FP success
95%
84%
76%
70%
IPT success
98%
96%
94%
94%
 
Effect on exfoliation
-          IPT (101) and FP(74) assessed for exfoliation
o   2% of IPT and 36% of FP were categorized as early exfoliation
o   These exfoliations were significantly different
 
Caries lesion control
-          GIC CC restorations (50 teeth) had 92% success rate
-          No GIC CC restorations (176 teeth) had 79% success rate
-          Broken down regarding IRM (15 teeth)
o   Had 67% success rate
 
Tooth type (1st vs 2nd primary molars)
-          Combined 1st molars (IPT+FP) à 76% success rate
-          Combined 2nd molars (IPT+FP) à 92% success rate
-          Further broken down:
o   1st molars IPT à 92%
o   1st molar FP à 61%
o   2nd molar IPT à 98%
o   2nd molar FP à 83%
 
Pain consistent with reversible pulpitis
-          1st molars 39 (of 131) had treated for reversible pulpitis
o   20 IPT à 85% success
o   19 FP à 53% success
-          2nd molars 30 (of 95) with history of pain
o   14 IPT à 93% success
o   16 FP à 75% success
 
Type of restoration final
-          198 IPT/FP restored with SSC immediately à 83% success
-          15 IPT/FP restored with amalgam, composite, GI à 87% success
-          13 (FP only) restored with IRM only à 39%
 
Take aways:
-          “IPT, therefore, appears to be better alternative to pulpotomy procedures to treat caries close to the pulp”
-          GIC CC prior to further treatment either with FP or IPT
o   “drying out” of leathery dentin
o   Allows for more accurate case selection (irreversible pulpitis not diagnosed initially can become diagnosed subsequently)
-          2nd primary molars had greater successful treatments than 1st primary molars
o   Controversial
o   Holan et al 2002 in agreement though
-          Poor seal compromises treatment
o   IRM placed in emergency FP’s with low success rate in this study
o   Those restored with conventional restorations were occlusal only (allowing good seal)
-          IPT treated teeth had much greater percentage with normal exfoliation
o   Concurs with other research
o   Possibly due to chronic infection not clinically or radiographically evident in FP-treated teeth
 
Remarks:
 
 
Assessment of Article:  Level of Evidence/Comments:
 

No comments:

Post a Comment