Monday, April 9, 2018

Effectiveness of 4 pulpotomy techniques – randomized controlled trial

Article Title: Effectiveness of 4 pulpotomy techniques – randomized controlled trial
Author(s):  Huth KC et al
Journal: Journal of Dental Research
Date: 2005; 84: 1144-1148
Major Topic: Pulpotomy medicaments
Type of Article: randomized controlled trial
Main Purpose: This study aimed to determine the relative effectiveness of calcium hydroxide, ferric sulfate, Er:YAG laser in comparison to formocresol.
Key Points:  Er:YAG laser treatment and ferric sulfate were found to be as successful as formocresol pulpotomies but calcium hydroxide was not and may be an inappropriate pulpotomy medicament.
·      Er:YAG lasers have been suggested for pulpotomies because of hemostatis, antimicrobial, and cell-stimulating properties with only slight thermal alteration to pulpal tissue
·      Ferric sulfate has been used due to its hemostatic effects
·      Calcium hydroxide is reported to cause internal resorption
·      Formocresol is seen as the “gold standard” for pulpotomies but there are concerns about cytotoxicity and potential mutagenicity
·      200 primary molars in 107 health children were randomly allocated to one of the 4 treatments (formocresol, calcium hydroxide, ferric sulfate, and Er:YAG laser). The molars were followed for 24 months
·      Success rates after 24 months:
o   85% formocresol
o   78% Er:YAG laser
o   53% calcium hydroxide
o   86% for ferric sulfate
·      Only calcium hydroxide performed significantly worse than formocresol over 24 months.
·      No difference in pulpotomy success rates was seen when comparing those done in clinic versus those done under GA.
·      Sample size was not big enough to determine if there was in fact no difference between Er:YAG laser and formocresol pulpotomies
·      3 teeth in the Er:YAG laser group and 6 teeth in the calcium hydroxide group had to be excluded due to uncontrolled bleeding that occurred during irradiation or calcium hydroxide placement.
·      Formocresol fixes tissue in the coronal 1/3 of the radicular pulp and causes hemostasis by vessel thrombosis and impaired microcirculation.
·      Ferric sulfate precipitates protein plugs, resulting from the reaction of blood with both ferric and sulfate ions that occlude capillary orifices, causing hemostasis
·      Er:YAG lasers causes instant, reversible decrease of blood flow for 3-6 minutes but with no signs of hyperemic reaction that might be caused by heat
·      Calcium hydroxide is thought to create a superficial coagulation necrosis, possibly inhibiting bleeding and fluid loss
·      Pulpal status may more crucial to a successful pulpotomy procedure when calcium hydroxide and the Er:YAG laser are used than when ferric sulfate and formocresol are used.

Remarks:
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Assessment of Article:  Level of Evidence/Comments: II-1

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